Psychosocial Treatments For Premature Ejaculation Health And Social Care Essay

Premature interjection ( PE ) is a really common sexual disfunction among patients and changing prevalence estimations runing from 20 % down to 3 % . Premature interjection is characterized by interjection [ that ] ever or about ever occurs anterior to or within about 1 min of vaginal incursion ; inability to detain interjection on all or about all vaginal incursions ; and negative personal effects, such as hurt, bother, defeat and/or the turning away of sexual familiarity. Although psychological issues are present in most of the patients with premature PE, as a cause or as a effect, research on the effects of psychological attacks for PE has in general non been controlled or randomised and is missing in long-run followup.Aims ATo measure the efficaciousness of psychosocial intercessions for PE. To look into any differences in efficaciousness between different types of psychosocial interventions for PE. To compare psychosocial intercessions with pharmacological intervention and pharmacological intervention in association with psychosocial intervention for PE.Search methods ATests were searched in computerized general and specialised databases, such as: Medline by Pubmed ( 1966 to 2010 ) ; PsycINFO ( 1974 to 2010 ) ; EMBASE ( 1980 to 2010 ) ; LILACS ( 1982 to 2010 ) ; Cochrane Central Register of Controlled Trials ( Cochrane Library, 2010 ) ; and by look intoing bibliographies, and reaching makers and research workers.Choice standards ATests were eligible if they were Rrandomised or quasi-randomised controlled tests measuring psychosocial intercessions for PE. Surveies compared ingwith different psychosocial intercessions, pharmacological intercessions, waiting list, or no intervention for PE.Data aggregation and analysis AInformation on patients, intercessions, and results was extracted by at least two independent referees utilizing a standard signifier. The primary result step for comparing the effects of psychosocial intercessions to waiting list and standard medicines was betterment in IELT ( i.e. , clip from vaginal incursion to interjection ) . The secondary result was alteration in validated PE questionnaires.Consequences AOne survey ( De Carufel 2006 ) showed important betterments in continuance of intercourse ( MD:407.90 ; CI:302.42, 513.38 ) twosomes ‘ sexual satisfaction ( MD: -26.10 ; CI: -50.48, -1.72 ) and sexual map in favor of behavioural therapy ( BT ) compared with waiting list. This survey besides showed that a new Functional-sexological intervention ( FS ) was significantly better than waiting list for continuance of intercourse ( MD:412.00 ; CI:305.88- 518.12 ) , alteration over clip in subjective perceptual experience of continuance of intercourse ( Womans: MD:2.88 ; CI: 2.06, 3.70 ; Work force: MD:2.52 ; CI:1.65, 3.39 ) and twosomes ‘ sexual satisfaction ( MD -25.10 CI [ -47.95, -2.25 ) . One survey ( Li 2006 ) showed that the combination of Thorazine and BT was superior than chlorpromazine entirely related to the IELT ( MD:1.11 ; CI:0.82, 1.40 ) , SAS ( MD: -8.72 ; CI: -11.09, -6.35 ) and to some CIPE inquiries ( anxiousness in sexual activity, spouse sexual satisfaction, patient sexual satisfaction, control ejaculatory physiological reaction and ejaculatory latency ) . One survey ( Yuan 2008 ) showed that the direct comparing between BT and citalopram showed important difference in betterment of IELT ( Risk Ratio:0.52 ; CI:0.34, 0.78 ) and in the figure of twosomes satisfied with sex life after the intervention ( Risk Ratio: 0.60 ; CI:0.39, 0.93 ) in favor to drug therapy.Writers ‘ decisions AOverall, weak grounds shows that psychological intercessions are effectual in the intervention of PE. RandomisedA , controlled surveies of psychotherapeutics for PE are few, and the bulk has a little sample size. The early success studies ( 97,8 % ) of Masters and Johnson could non be replicated. One survey found a important betterment from baseline in the continuance of intercourse, sexual satisfaction and sexual map with new functional-sexological intervention and behaviour therapy compared to waiting list. One survey showed that the combination of Thorazine and BT was superior than Thorazine entirely. Randomised tests with larger group samples tests a re still needed to further research the current available grounds for psychological intercessions for handling PE.Plain linguistic communication sum-up APsychosocial intercessions for premature interjectionAPremature interjection ( PE ) is a really common ailment among work forces. Is characterized by interjection which ever or about ever occurs anterior to or within about one minute of vaginal incursion ; and inability to detain interjection on all or about all vaginal incursions ; and negative personal effects, such as hurt, bother, defeat and/or the turning away of sexual familiarity. Although psychological issues are present in most of the patients with PE, as a cause or as a effect, research on the effects of psychological attacks for PE is non clear. The early success studies ( 97.8 % ) of Masters and Johnson could non be replicated.This reappraisal assessed the efficaciousness of psychosocial intercessions for PE and found four tests that affecting 253 PE patients. Weak groun ds shows that psychological intercessions alone/or in combination with medicine are effectual in the intervention of PE.ABackground ADescription of the status APremature interjection is a really common sexual disfunction among patients and changing prevalence estimations runing from 20 % down to 3 % ( Simons 2001 ; Porst 2007 ; Jannini 2005 ; Althof 2010 ) . The prevalence rate depend on what definition were considered ( Althof 2010 ) . PE A is a ego defined status and there is no established diagnostic trial for this status, but at that place have A been many different definitions of PE ( Melnik 2009a ) . These definitions have been imprecise, subjective and missing an grounds base doing confusion as to what truly constitutes PE Intravaginal ejaculatory latency clip ( IELT ) is an nonsubjective ( timed ) step of the Until clip from vaginal incursion until interjection. It is one of the standard primary result steps in clinical tests of PE. Standards have been published that define any interjection happening in 1 min, 2 min, 3 min or even 7 min from incursion, or 8-15 penile pushs, as premature.A Alternatively, the European Association of Urology upsets of interjection guidelines, published in 2004, defined PE as the inability to command interjection for a â€Å" sufficient † length of clip before vaginal incursion ( McMahon 2008a ) . A population-based multicenter survey with 500 twosomes from five states: the Netherlands, United Kingdom, Spain, Turkey, and the United States utilizing a stop-watch during intercourse showed a average IELT of 5.4 proceedingss ( 0.55-44.1 proceedingss ) . This multicenter survey was conducted on a â€Å" normal † general male population, with no complains of PE ( Waldinger 2009 ) . Recently, the International Society for Sexual Medicine has proposed the following evidence-based definition: â€Å" Premature interjection is a male sexual disfunction characterized by interjection [ that ] ever or about ever occurs anterior to or within about 1 min of vaginal incursion ; inability to detain interjection on all or about all vaginal incursions ; and negative personal effects, such as hurt, bother, defeat and/or the turning away of sexual familiarity † ( McMahon 2008a ) . Subtypes of PE are defined harmonizing to their features and include womb-to-tomb versus acquired PE, planetary ( it occurs in all sexual brushs ) versus situational PE ( it happens in some state of affairss, with some spouses ) , and subtypes based on the accompaniment of other sexual jobs, peculiarly erectile disfunction ( Waldinger 2006a ; Waldinger 2006b ; APA 2000 ) . Time to blurt out is of import, but PE entirely based on IELT does non accurately qualify the status. PE is a multidimensional status and IELT entirely is non sufficient to qualify it. Other of import facets to include in the diagnosing include the patient ‘s subjective feeling of deficiency of control and the negative psychosocial effects of the status ( hurt ) A ( Jannini 2005 ; Porst 2007 ) , PE has a important consequence on the wellbeing of persons and on their sexual relationships ( McCabe 1970 ; Dunn 1999 ) . Work force with PE have reported reduced sexual assurance, trouble in set uping relationships and hurt at non fulfilling their spouses because of PE ( McMahon 2004, McMahon 2008b ; McMahon 2008c ; Symonds 2003 ; Rowland 2007 ; Patrick 2005 ) .Description of the intercession ACurrent schemes for PE therapy arise from both pharmacologic and psychological positions, reflecting restrictions in comprehension of the etiology of PE ( Melnik 2009a ) . The determiners of PE are doubtless complex, with differences between work forces with A A womb-to-tomb PE from work forces with acquired PE. Biogenic theories of PE have been multivariate at best, runing from psychosomatic manifestations of anxiousness or forming from early sexual experience to biologic accounts such as a hyperexcitable ejaculatory physiological reaction or disfunction of 5-hydroxytryptamine ( 5-HT ) receptor Waldinger 2008. Indeed, SSRIs, which modulate 5-HT signaling, have demonstrated efficaciousness in this scene and may be prescribed off-label to work forces with PE. Whether pharmacological agents such as dapoxetine or off-label clomipramine ( a TCA ) , paroxetine, Zoloft, and Prozac, or with day-to-day dosing of off-label paroxetine, clomipramine, Zoloft, Prozac, or citalopram should be encouraged as a first line intervention intercession ( Althof 2010 ) these medicines are a simple and, if non used for a life-time, cost effectual intervention for PE, there are some restrictions to their widespread usage. First, supplying a systemic drug for PE may be unneeded, given reasonably good results from psychosocial intercessions. Second, the serotonergic drugs have been associated with lessened desire, and in some instances, diminished rousing. Therefore, these drugs would non be recommended for patients who besides have low sexual desire or erectile disfunction. Third, they would non be recommended for patients with an undiagnosed bipolar upset, as they may significantly increase the likeliness of oncoming of a frenzied episode. Finally, are besides m inor side effects that accompany any drug usage, and these should be examined in footings of patient tolerance. Although psychological issues are present in most of the patients with PE, as a cause or as a effect, research on the effects of psychological attacks for PE is non clear The first publications on psychotherapeutics result surveies emphasized the psychological facets in the etiology of PE ( Althof 2007 ; Althof 2006 ; Kaplan 1974 ; Kaplan 1989 ) . The most normally proposed theories on the causality of PE, attribute it to a †conditioned physiological reaction † by which a form of speedy interjection is thought to go habituated. When onanism or sexual intercourse is repeatedly hurried, because of fright of find, anxiousness or guilt, †a rapid response may follow † . Based on this belief, in 1956, the urologist James Semans published behavioural intercessions for the direction of PE the â€Å" stop-start † technique ( Semans 1956 ) . Semans reported that 100 % of his patients utilizing the â€Å" stop-and-start † technique succeeded in commanding the minute of interjection. This method involves the spouse exciting the adult male ‘s phallus until he has the esthesis of about climaxing, at which clip stimulation is ceased until this feeling abates. The sequence may be repeated until the interjection can be controlled voluntarily ( Semans 1956 ) . With the grounds presently available, there are no informations back uping and retroflexing the old consequences reached by Semans, or even consensus account why this government may work. In the 1970ss, Masters and Johnson ( Masters 1970 ) , reported that after traveling through a two-week plan, 97.8 % of their clients presented remittal of PE. The â€Å" squeezing technique † proposed by them involves single and twosomes therapy, and requires the female spouse to squash the frenulum of the phallus for a few seconds one time the male has achieved â€Å" full hard-on † and begins to feel the impulse to blurt out. After the squeezing is released, a twosome must wait for approximately 30 seconds. This direction is followed until the male has delayed blurt outing for a period of 1520A proceedingss. Once the male learns to detain interjection, insertion ( and finally intercourse ) can be attempted utilizing the female superior place and she is instructed non to travel. The eventual end is for the male to develop sufficient control over his interjection to protract vaginal intercourse. The reported failure rates of 2.2 % instantly after intervention and 2.7 % at the five twelvemonth followup. Other research workers have been unable to retroflex Masters and Johnson ‘s success rates. Numerous minor changes to these two BASICs techniques have been suggested over the old ages by other sex research workers. Reccently the International Society for Sexual Medicine ( ISSM ) defines four chief psychotherapeutic intervention groups. These include: behavior therapy, particularly modified Masters and Johnson and Semans techniques, psycho instruction, psychodynamic therapy and cognitive behavioral therapy ( CBT ) ( Althof 2010 ) . The more normally examined psychotherapeuticss are derived from cognitive behavioral schools. These therapies are developed from cognitive therapy, which focuses on dysfunctional beliefs, and so incorporates constituents of behavioural psychotherapeutics, and its purpose is to rectify the negative deformed knowledges and dysfunctional underlying beliefs that maintain sexual disfunction. They include cognitive therapies, behavioral therapies, job work outing therapies and curative reading stuffs ( bibliotherapy ) . Numerous descriptive surveies hav e examined the proficient issues in accommodating these therapies to the clinical diverseness. Some of the more of import versions include stressing A behavioral techniques, peculiarly earlier in therapy and frequently reiterating information, utilizing different centripetal modes.How the intercession might work ASexually outcomes surveies must entree the complex interplay between the biological, emotional, psychological and relational constituents of persons and twosomes lives. Besides PE has been associated with anxiousness, depression, and hurt in work forces and their female spouses. Phamarcological intercession entrees portion of this complex â€Å" scenario † . Psychotherapy intercessions aims to alter dysfunctional feelings and attitudes and aid persons to develop to healthier, more effectual forms of behaviour. Harmonizing Althof 2002 A one of the lessons learned from the †Viagra revolution was that no affair how efficacious and safe the medical intercession, me dicines entirely could non ever overcome the psychosocial obstructions that maintained the disfunction and interfered with sexual life â€Å" . The premise behind psychosocial intercessions is that when patients learn about PE they begin to develop new sexual direction schemes to cover with restrictive sexual forms ; turning away of sexual activity ; and an involuntariness to discourse sex with a spouse ( Metz 1997 ) . The proposal is to: supply an empathic, supportive clinician-patient relationship, cut down or extinguish public presentation anxiousness, and assist him derive or recover sexual assurance ; alteration opposition to medical therapy, every bit good as to supervise topics ‘ clinical position and intervention response ; and modify his maladaptive sexual â€Å" books † ( Some signifiers of cognitive deformations ( e.g. generalisation of the sexual trouble, self observation during the sexual activity ) may interfere with sexual map. These issues need to be addressed during the psychotherapeutics procedure ( Althof 2006 ; Colpi 2004 ) . Some signifiers of cognitive deformation may interfere with sexual map that why is of import to supply didactic information and cut down the stigma associated with the premature interjection ( Althof 2006 ; Althof 2007 ) .Why it is of import to make this reappraisal AWork force with PE A study decreased sexual assurance, trouble in set uping relationships, and a negative impact on their quality of life. The consequence of PE on the person and the sexual relationship is important. On the other manus, the drug intervention offers benefits, but besides of import inauspicious effects which can impact its prescription A usage. So, a systematic reappraisal measuring the effects of psychological intercessions for PE seems seasonably.Aims ATo measure the efficaciousness of psychosocial interventions are effectual in the intervention of premature interjection. To look into if there are differences in efficaciousness between the different types of psychosocial intervention in PE. To compare psychosocial intercessions with pharmacological intervention and pharmacological intervention in association with psychosocial intervention on bettering on PE. To execute a meta-analytic synthesis of surveies, when possible.Methods AStandards for sing surveies for this reappraisal ATypes of surveies AAll published or unpublished randomised and quasi-randomised controlled tests measuring psychosocial intercessions for PE. Studies comparing psychosocial intercessions versus either pharmacological intercession or waiting list or no intercession or with another psychosocial intercession were eligible for this reappraisal.Types of participants APatients were included in this reappraisal if diagnosed with premature interjection, either defined by trialists harmonizing to DSM III ; IV ; IV-R, ICD or International Consensus standards. When tests failed to use diagnostic standards, the badness of PE was described by the usage of standardised evaluation graduated tables.Types of intercessions AExperimental intercessionsAny psychosocial intercessions that was A validated or described by the survey ‘s writer as being for premature interjection in tervention, as for illustration behaviour therapy, particularly modified Masters and Johnson and Semans techniques and psycho-education. Combined psychosocial intercessions were besides included in this reappraisal. In order to be eligible, a survey should include at least one group where merely some psychosocial intercession was given.Control InterventionsOther psychosocial intervention, placebo, non-intervention, pharmacological intervention and pharmacological intervention in association with psychosocial intervention.Types of result steps APrimary results AImprovement in IELT ( i.e. , clip from vaginal incursion to interjection, interjection latent clip ) ( McMahon 2008a ) Patient studies of betterment in control over interjection ( McMahon 2008a ) Patient ( and/or spouse ) studies of betterment in satisfaction with sexual intercourse ( McMahon 2008a )Secondary results AWhere informations were available, secondary results included: Chinese Index Premature Ejaculation ( CIPE ) – ego administered ( Yuan 2004 ) ; Change over clip in sexual satisfaction ( work forces and spouse are individually evaluated ) ; Sexual Interaction Inventory ( SII ) ( Hudson 1982 ) ; Satisfaction with Treatment Althof 2010 ; Self-rating Anxiety Scale ( SAS ) ( Zung 1971 ) ; Change over Time in Subjective Perception of Duration of Intercourse ( Scale 1 to 9 ) ; Change over Time in Objective Measure of Duration of Intercourse from Penetration to Ejaculation ( in Seconds ) .Search methods for designation of surveies A( ( â€Å" Ejaculation † [ Mesh ] ) or ( premature interjection ) or ( rapid interjection ) or ( ejaculatory upsets general pattern ) ( psychotherap* ) OR ( psychosocial intercession ) OR ( psychoeducation ) OR ( get bying accomplishments ) OR ( brief motivational guidance ) OR ( sexual therapy ) OR ( anxiety direction preparation ) OR ( matrimonial therapy ) OR ( group therapy ) OR ( cognitive therapy ) OR ( behavio* therapy ) OR ( focal therapy* ) OR ( general guidance ) OR ( psychodynamic therapy ) OR ( supportive therapy ) OR ( psychoanalyses ) OR ( interpersonal therapy ) OR ( cognitive therapy ) OR ( single therapy ) OR ( twosomes therapy ) OR ( waiting list ) ) ( â€Å" Counseling † [ Mesh ] ) or ( reding ) or ( Counselors ) or ( Counselor ) # 2 OR # 3 ( ( randomised controlled test [ platinum ] ) or ( controlled clinical test [ platinum ] ) or ( randomised [ tiab ] ) or ( placebo [ tiab ] ) or ( drug therapy [ sh ] ) or ( randomly [ tiab ] ) or ( test [ tiab ] ) or ( groups [ tiab ] ) ) non ( animate beings [ mh ] non ( worlds [ mh ] and animate beings [ mh ] ) ) # 1 AND # 4 AND # 5Electronic hunts A We searched the undermentioned databases: MEDLINE by Pubmed ( 1966 to 2009 ) ; PsycINFO ( 1974 to 2010 ) ; EMBASE ( 1980 to 2010 ) ; LILACS ( 1982 to 2010 ) ; Cochrane Central Register of Controlled Trials ( Cochrane Library, 2010 ) .Electronic hunts AWe searched the undermentioned databases: MEDLINE by Pubmed ( 1966 to 2009 ) ; PsycINFO ( 1974 to 2010 ) ; EMBASE ( 1980 to 2010 ) ; LILACS ( 1982 to 2010 ) ; Cochrane Central Register of Controlled Trials ( Cochrane Library, 2010 ) .Searching other resources ADesignation of all surveies via experts in the field, conference proceeding and personal communications. Handseaching of mentions notes of included surveies and relevant reappraisals. Unpublished studies, abstract and studies were considered for inclusion on the same footing as published studies. There were no limitations based on linguistic communication or day of the month. Handseaching the first publications of Archivess of Sexual Behavior, Journal of Sex & A ; Marital Therapy, and Journal of Sexual MedicineData aggregation and analysis AChoice of surveies ATwo referees ( TM and RR ) independently assessed ( blind to the determination made by each other ) the relevancy of each abstract produced by the hunt scheme. These were categorized into Relevant, Not relevant and Unsure. Articles of all relevant and diffident commendations were retrieved. Citations were read by each reappraisal writer ( blind to the determination made by each other ) utilizing pre-set standards and a entering sheet to place those included in the reappraisal. In instances of dissension, unfastened treatment took topographic point between all reappraisal writers and a determination was reached by consensus. Reasons for inclusion and exclusion were recorded.Data extraction and direction ADatas were being extracted from tests that met the inclusion standards. Data A included: inclusio n/exclusion standards ; method of randomization ; allotment privacy ; judge ‘s sightlessness ; sample size ; intention-to-treat Numberss ; figure and grounds for drop-outs ; age ; wellness position ; enlisting beginning ; initial tonss and standard divergence of all evaluation graduated tables applied ( including QoL ) ; diagnosing standards used ; length of test ; follow-up period ; length and frequence of Sessionss ; puting of therapy ; therapy type and theoretical account used ( i.e group or single therapy ) . For primary and secondary results, end point tonss and standard divergences from all evaluation graduated tables were extracted. In tests utilizing pharmacotherapy, the name of medicine, dose, frequence, side effects, and conformity were recorded. When informations were ill-defined or losing, matching writer was contacted.Appraisal of hazard of prejudice in included surveies AQuality appraisalThe methodological quality of the included tests in conformity to the Cochra ne Handbook for Systematic Reviews of Interventions ( Higgins 2008 ) . The ratings were compared and any incompatibilities between the reappraisal writers in the reading of inclusion standards and their significance to the selected tests were discussed and resolved. The undermentioned spheres were assessed as ‘Yes ‘ ( i.e. low hazard of prejudice ) , ‘Unclear ‘ ( unsure hazard of prejudice ) or ‘No ‘ ( i.e. high hazard of prejudice ) . The survey writer ( s ) were contacted to seek elucidation in instance of uncertainness over informations: Was the sequence coevals adequate? Was allotment adequately concealed? Was cognition of the allocated intercessions adequately prevented during the survey? Were uncomplete result informations adequately addressed? Are studies of the survey free of suggestion of selective result coverage? Was the survey seemingly free of other jobs that could set it at a high hazard of prejudice? These appraisals were reported for each person survey in the ‘Risk of prejudice in included surveies ‘ tabular array under the ‘Characteristics of included surveies ‘ , and jointly here: ‘Figure 30 ‘ , ‘Figure 31 ‘ .Measures of intervention consequence AFor uninterrupted informations, such as CIPE ( Chinese Index of Premature Ejaculation ) , the chief results of involvement was the alteration in mark from baseline to concluding appraisal. We used average difference ( MD ) with 95 % assurance interval ( CI ) . For dichotomous results, such as patient studies of betterment in control over interjection, the end point is of involvement, and the hazard ratio ( RR ) with 95 % CI were used to mensurate intervention consequence.Unit of measurement of analysis issues AFor tests comparing more than two intercession groups, the relevant intercession group was assessed. Couple, spouse and the patients themselves were besides considered.Covering with losing informations AFor dichotomous results, all exclusions/dropouts were identified. If no information available ( either from the study or the writers ) , it was assumed that dropout was due to intervention failure in conformity with ITT rules. The sensitiveness of the consequences to this premise were tested. For surveies utilizing uninterrupted results in which standard divergence ( SD ) was non reported, and no information was available from the survey writers, an SD was impute through obtaining the mean SD across surveies for intervention and control groups.Appraisal of heterogeneousness AStatistical heterogeneousness in the consequences of the tests was assessed diagrammatically and by the I2 statistic. An I2 of a†°? 50 % was considered considerable heterogeneousness, and we used the random-effects theoretical account. If I2 is & lt ; 50 % , we used a fixed-effect theoretical account. Possible grounds for clinical heterogeneousness were: 1.A A A the type of intercession offered ( single, twosome or group mode ) ; 2.A A A the badness of symptoms at baseline ( harmonizing with ego administered PE questionnaires ) ; 3.A A A the figure of psychological therapy Sessionss offered ; 4.A A A the proportion of participants being on medicine. Possible beginnings of heterogeneousness were assessed by sensitiveness and subgroup analyses as described above ( Higgins 2008 ) . Clinical heterogeneousness was explored by looking at separate subgroups of tests.Appraisal of describing prejudices AWe attempted to cut down publication and related prejudice ( PRB ) through the usage of alternate, robust hunt schemes, including handsearching Archivess of Sexual Behavior, Journal of Sex & A ; Marital Therapy, and Journal of Sexual Medicine. We were besides make usage of Internet hunt engines, conduct a comprehensive hunt of the gray literature, alternate beginnings of informations or synthesized grounds, A and contact experts in sexology research. Possible beginnings of coverage prejudices, which could be as publication prejudice, linguistic communication prejudice, commendation prejudice, hapless methodological quality, and heterogeneousness, and were analysed harmonizing to the surveies in inquiry.Data synthesis ADue to the intercessions and results heterogeneousness, it was non possible to pool the informations and to execute a meta-analysis.Dichotomous and uninterrupted informationsDichotomous results were pooled utilizing comparative hazards. For uninterrupted results, two methods will be used for pooling informations. Where all tests measured an result utilizing the same graduated tables and where the mean, standard divergence and sample size in each group were known, average differences ( MD ) were calculated. Where some of the tests measured results on different graduated tables and it will non see appropriate to straight unite informations from these steps, the standardized mean difference ( SMD ) was calculated. Both dichotomous and uninterrupted results were presented with 95 % assurance intervals.Subgroup analysis and probe of heterogeneousness AInitially was planned to execute subgroup analysis for subsets of participants ( such as individual versus holding a relationship ; immature versus aged ) , badness of PE ( mild, moderate, terrible ) , different psychotherapeutics technique ( single, twosome or group mode ) , figure of psychological therapy Sessionss offered, or drop-outs to research clinical heterogeneousness in the meta-analysis. Due to the little figure of included surveies and deficiency of available information sing these variables, merely different psychotherapeutics technique was considered for subgroup analysis.Sensitivity analysis ADue to the intercessions and results heterogeneousness, it was non possible to pool the informations and to execute sensitiveness analyses.Consequences ADescription of surveies ASee ‘Characteristics of included surveies ‘ , ‘Chara cteristics of excluded surveies ‘ .Consequences of the hunt AThe electronic and manual hunts resulted in 504 mentions, of which 487 were clearly non relevant to this reappraisal. Of the staying 17 mentions, 13 were excluded after reading the full documents.Included surveies AFour surveies affecting 253 PE patients met the inclusion standards and three of them were non-English surveies. There was full understanding on the inclusion of the five surveies for the reappraisal. Duration of included tests covered two hebdomads to twelve hebdomads. These tests included 253 male participants and 36 twosomes. Three tests compared psychotherapeutics techniques for PE versus pharmacological intercession and one compared the psychotherapeutics either with waiting list or functional-sexological intervention. These surveies were used to turn to the three aims outlined in the debut to this reappraisal.PutingAll surveies were conducted on an outpatient footing and were carried out in Canada ( n = 1 ) , China ( n = 2 ) and Egypt ( n = 1 ) .ParticipantsThe participants were consistent with the DSM-IV or DSM-III R diagnosing of PE and by the International Society of Sexual Medicine PE Criteria ( McMahon 2008 ) .InterventionsThe first aim was to find whether psychosocial interventions are effectual in handling PE and for this proposal merely one test was included. De Carufel 2006 evaluated the effects of a new functional-sexological ( FS ) intervention for PE. The intervention is intended to better control over the minute of interjection ; work forces larn how to command their rousing without holding to disrupt sexual activity. This intervention is based on the transition of sexual exhilaration through simple techniques: work forces are instructed to concentrate on the temporal, spacial and energetic dimensions of their motions, to utilize their musculuss in different ways ( for illustration, to loosen up the natess ) , to change theA velocity of sexual activity before and during intercourse, to take a breath from the stop, and to utilize places that require less muscular tenseness ( De Carufel 2006 ) . Treatment besides includes instruction on sensualness and information about the sexual responses of work forces and adult females. Study participants met the undermentioned choice standards: the adult male ‘s IELT was A less than two proc eedingss ; the twosome ‘s relationship was ongoing for at least one twelvemonth ; participants agreed to either take portion in hebdomadal meetings as a twosome or undergo a 12-week waiting list followed by a matrimonial intercession for the intervention of PE ; and participants presented with no major mental or physiological wellness jobs. Thirty-six A twosomes received one of three curative options: the new functional-sexological ( FS ) intervention ; a behavioural intervention ( BT ) including the squeezing and stop-start techniques ; or a 12-week waiting list ( WL ) . Participants provided an nonsubjective step of the continuance of intercourse from incursion to interjection. IELT was assessed prior to intervention, A during intervention and at follow-up. The consequences indicated that the FS intervention was really effectual and led to important betterments in the continuance of intercourse ( Figure 1 ) , sexual satisfaction ( Figure 18, Figure 19, Figure 21, Figure 24, Figure 27 ) and sexual map compared with the WL group. This comparing showed no difference sing the other results ( Figure 6, Figure 16, Figure 17, Figure 20, Figure 21, Figure 25, Figure 27, Figure 26 ) . The behavioural intervention obtained similar consequences compared with the FS therapy sing all results assessed ( Figure 8, Figure 9, Figure 10, Figure 7, Figure 12 ) . The comparing between BT versus WL showed better consequences in favor to BT group sing the undermentioned results: a ) continuance of intercourse from incursion to interjection ( Figure 1 ) ; B ) alteration over clip in subjective perceptual experience of continuance of intercourse ( Figure 14, Figure 15 ) ; c ) frequence of satisfaction for adult females ( Figure 23, analysis 5.7.1 ) ; vitamin D ) perceived pleasance for adult females ( Figure 23, analysis 5.7.4 ) ; vitamin E ) twosome ‘s sexual satisfaction ( Figure 24 ) .There was no difference between these intercessions sing sexual Interaction Invento ry Over Time – Work force ( Analysis 5.1 ) . The 2nd aim was to look into if efficacy differs between the different types of psychosocial intervention for PE. For this proposal, the merely included survey was the De Carrufel test which was described supra. This survey compared BT versus functional-sexological intervention. The 3rd aim was to compare the psychotherapeutics with the pharmacotherapy in patients with PE and three surveies fulfilled this demand: : Yuan 2008 indiscriminately allocated 96 patients with PE to one of three groups: behavioural therapy merely ( n = 32 ) ; citalopram ( a selective 5-hydroxytryptamine reuptake inhibitor ) merely ( n = 32 ) ; and a combination of citalopram and behavioural therapy ( n = 32 ) . The result steps were self reported IELT and both spouses satisfaction with their sexual life ( Yuan 2008 ) . After intercession, all three groups showed a important addition in the clip oversight before interjection. The direct comparing between citalopram-only versus BT-only favoured the citalopram group for the IELT ( Figure 5 ) and spouses sexual satisfaction ( Figure 28 ) .The comparing between combined attack versus citalopram-only favoured the combination group for both results ( .Figure 11, Figure 29 ) . The combined-approach group reported the highest sexual satisfaction, followed by the citalopram-only and behavioral-therapy-only groups. The writers concluded that the combined attack was an effectual in tervention for PE. In this survey, for statistical analysis, the conditions â€Å" satisfied † and â€Å" fundamentally satisfied † were classified as a alone group, therefore were non individually evaluated sing the result sexual satisfaction with sex life ( both spouses together ) . Fifty-one 2006 indiscriminately allocated 90 patients with PE to one of two groups: psychological intercession plus Thorazine ( n = 45 ) ; and chlorpromazine merely ( control group ; n = 45 ) . Chlorpromazine ( tri-cyclic antidepressant ) intervention comprised unwritten tablets ( 25 milligram ) taken twice daily for a sum of 6 hebdomads ; the intercession group besides received comprehensive behavioural psychotherapeutics. Each session of psychological intervention lasted at least 30 min, and Sessionss were given twice per hebdomad during this period. The result steps were tonss on the Chinese Index of Sexual Function for PE ( CIPE ) and IELT. CIPE scores for control of ejaculatory physiological reaction, sexual satisfaction of the patients and their spouses and anxiousness or depression about sexual activity were significantly better in the combined-intervention group than in the control group ( Figure 3 ) . The results IELT and SAS graduated table besides favoured the combined att ack ( Figure 2, Figure 4 ) . At follow-up, one month after intervention, the efficaciousness rates ( as IELT ) of the two groups were 82.9 % and 30 % , severally ( P & lt ; 0.01 ) ( Figure 13 ) . The writers concluded that a behavioural psychotherapeutics intercession enhanced the clinical efficaciousness of drug intervention for PE ( Melnik 2009 ) . Abdel-Hamid 2001 conducted a prospective, double-blind, randomised, crossing over survey of 31 patients with primary PE. Patients received one of four drugs administered on an as-needed footing 35 hours before awaited sexual intercourse ( clomipramine, Zoloft, paroxetine, Viagra ) or were instructed to utilize the pause-squeeze technique. The survey consisted of five 4-week periods of intervention, separated by 2-week washout periods. Anxiety mark and interjection latency clip were measured before intervention, after each intervention and during washout periods. Sexual satisfaction tonss were measured after each intervention. The three antidepressants ( clomipramine, Zoloft and paroxetine ) were tantamount in footings of efficaciousness and safety ( Abdel-Hamid 2001 ) . The pause-squeeze technique was associated with the lowest success rate ( 54.8 % ) compared with other modes. In add-on, the technique was associated with lower sexual satisfaction tonss and lower ejaculatory latency times in comparing with those achieved with Viagra and paroxetine, but the values were comparable to those achieved with clomipramine and Zoloft. For these patients with PE, Viagra showed the best consequences in footings of ejaculatory latency and satisfaction. This survey demonstrates besides that paroxetine is superior to the pause-squeeze technique in footings of ejaculatory latency and sexual satisfaction. It was non possible to pull out informations of this survey since the mean and standard divergence were non presented, merely the median. Besides that, the first writer declared that these informations were non available any longer. The 4th aim was determine whether psychosocial interventions were effectual for PE compared with drug therapy and for this, there were two surveies: Yuan 2008 and Abdel-Hamid 2001, which were described above.ResultsRating graduated tables included in this reappraisal: The Chinese Index of Premature Ejaculation ( CIPE ) is frequently used as a diagnostic tool.A It has five points that assess interjection clip from insertion, control of over IELT times, sexual satisfaction, spouse satisfaction and anxiousness and depression related to sex. Improvement in Ejaculation Latency Time ( IELT ) Patient studies of betterment in control over interjection ( McMahon 2008a ) Patient ( and/or spouse ) studies of betterment in satisfaction with sexual intercourse Change over Time in Subjective Perception of Duration of Intercourse Change over Time in Sexual Satisfaction Sexual Interaction Inventory over Time Satisfaction with Treatment Change over Time in Subjective Perception of Duration of Intercourse ( Scale of 1 to 9 ) Change over Time in Objective Measure of Duration of Intercourse from Penetration to Ejaculation ( in seconds )Excluded surveies ATwelve clinical tests were excluded ( despite being about intercessions for people with PE ) because they did non incorporate a control group. The surveies and the grounds for exclusions are presented in the ‘Characteristics of excluded surveies ‘ . Expecting appraisal There are no surveies expecting appraisal. Ongoing surveies We know of no on-going surveies.Hazard of prejudice in included surveies ADe Carufel 2006 and Abdel-Hamid 2001 were categorized as low hazard of prejudice. Fifty-one 2006 and Yuan 2008 were categorized as moderate hazard of prejudice. Of the four surveies included, all specified the method of randomization ( De Carufel 2006 ; Abdel-Hamid 2001 ; Yuan 2008 ; Li 2006 ) ( ‘Figure 31 ‘ ) .Allocation AAllotment was adequately concealed in two included tests ( Abdel-Hamid 2001 ; De Carufel 2006 ) and ill-defined in the other two ( Fifty-one 2006 ; Yuan 2008 ) ( ‘Figure 30 ‘ ) .Blinding APatient ‘s blinding was non considered applicable for psychosocial intercessions surveies. Consequently, the writers considered merely the judges blinding. Evaluator ‘s blinding was mentioned in merely two included tests ( Abdel-Hamid 2001 ; De Carufel 2006 ) ( ‘Figure 30 ‘ ) .Incomplete result informations AMerely one survey did no reference result information s ( Abdel-Hamid 2001 ) ( ‘Figure 30 ‘ ) .Selective coverage AMerely Li 2006 survey was considered free of selective coverage ( ‘Figure 30 ‘ ) .Other possible beginnings of prejudice AMerely Abdel-Hamid 2001 survey was considered free of other prejudice ( ‘Figure 30 ‘ ) .Effectss of intercessions AEffectss of intercessions are described in the Heading â€Å" Included Studies † , under the subheading ‘Interventions ‘ ( ‘Included surveies ‘ ) .Discussion ASummary of chief consequences AOne survey ( De Carufel 2006 ) showed important betterment in continuance of intercourse, twosomes ‘ sexual satisfaction and sexual map in favor of BT and a new Functional-sexological intervention ; compared with waiting list. One survey ( Li 2006 ) showed that the combination of Thorazine and BT was superior than chlorpromazine entirely related to the IELT, SAS and to CIPE. On survey ( Yuan 2008 ) showed that the direct comparing between BT and citalopram showed important difference in betterment of IELT in favor to drug therapy. The consequences of reviewed tests yield inconsistent and hapless decisions sing the effectivity of psychotherapeutics.Overall completeness and pertinence of grounds AIndeed, this was the first systematic reappraisals about psychosocial intercessions for PE. Besides, through this reappraisal, the writers performed a broad hunt including a manual hunt in the chief gender diaries, mentions of mentions and contact with the experts on the subject. Randomized, controlled surveies of psychotherapeutics for PE are few, and the bulk have a little sample size. One-half of the included surveies was considered as low hazard of prejudice and the other half, moderate hazard. The aims of this reappraisal were: ( a ) determine whether psychosocial interventions were effectual for PE against placebo ( waiting list ) , ( B ) to measure if there was a different consequence between the types of psychosocial intervention and ( degree Celsius ) to measure the function of psychological intercession in concurrence with pharmacological intervention for bettering PE and ( vitamin D ) determine whether psychosocial interventions were effectual for PE compared with drug therapy. The new functional-sexological intervention ( including the squeezing and stop-start techniques ) and the traditional BT led to important betterments in the continuance of intercourse, sexual satisfaction, and sexual map compared with baseline and with the control group ( waiting list ) , but no difference between them were found. Traditional BT is established technique in the literature for PE and the functional-sexological intervention did non add any betterment in the results. While a general consensus exists that psychotherapeutics confers extra benefits on patients who use pharmacological therapy for PE ( Althof 2006 ) few comparative, controlled surveies have investigated the benefits of psychotherapeutics in combination with medicine in the intervention of this upset ( Melnik 2009a ) . By contrast, recent articles support the efficaciousness of combined intervention over pharmacotherapy or psychotherapy entirely for the intervention of PE. Furthermore, these surveies besides indicate that combination therapy consequences in a decreased rate of intervention discontinuance and improved satisfaction with intervention one of the most of import results in gender research. Restrictions of surveies of combination therapy include deficiency of description of healer features ( for illustration, professional preparation ) and of psychological techniques used. Fifty-one 2006 test showed that the combination of clomipramine and BT was superior than clomipramine en tirely related to the IELT, SAS and to the undermentioned inquiries of the CIPE questionnaire: ejaculatory latency ( inquiry 4 ) , control of ejaculatory physiological reaction ( inquiry 5 ) , patient sexual satisfaction ( inquiry 6 ) , spouse ‘s sexual satisfaction ( inquiry 7 ) and patient ‘s anxiousness in sexual activity ( inquiry 10 ) . After 1-month follow-up the IELT was statistically higher in combined group. Yuan 2008 test showed that the combined attack ( citalopram plus BT ) was non statistically different from citalopram entirely related with the betterment of IELT neither with the couple satisfaction with sexual life. The direct comparing between BT and citalopram showed important difference in betterment of IELT in favour A of drug therapy. However, this test was classified as moderate prejudice hazard and was non clear if the BT was applied by a psychologist or by a doctor ( Yuan 2008 ) . The pause-squeeze technique was associated with lower success rate ( sexual satisfaction tonss and IELT ) compared with Viagra and paroxetine, but the values were comparable to those achieved with clomipramine and Zoloft ( Abdel-Hamid 2001 ) . Restrictions of the surveies include deficiency of randomised controlled tests, consequence sizes that are non clearly clinically important, validated outcome assessment instruments as survey end points, deficiency of obliging follow-up informations bespeaking care of intervention consequences, and deficiency of intervention manuals that allow reproduction.Quality of the grounds AOne-half of the included surveies were considered a low hazard of prejudice and the other half, moderate hazard.Potential prejudices in the reappraisal procedure AFor both Chinese tests, the first writers were contact for extra informations, but with no answer. In the Yuan 2008 and Li 2006 tests informations about the allotment privacy was non adequately described.Agreements and dissensions with other surveies or reappraisals AThere is merely old published systematic reappraisal ( Melnik 2009 ) . However this reappraisal was carried out in 2008, besides included quasi-randomised surveies and did non present quantitative information analysis.Writers ‘ decisions ADeductions for pattern AFor people- with PE: There is A weak grounds of the benefitsA of psychosocial intercessions in combination with pharmacologic therapyA for PE and psychosocial therapy entirely. For clinicians- Overall, small grounds ( most surveies that demonstrate efficaciousness are non controlled or randomised and have limited followup ) shows that psychological intercessions are effectual in the intervention of PE. Randomized, controlled surveies of psychotherapeutics for PE are few, and the bulk employ a little sample sizes. One survey found a important betterment from baseline in the continuance of intercourse, sexual satisfaction and sexual map with new functional-sexological intervention and behaviour therapy compared to waiting list. One survey showed that the combination of Thorazine and BT was superior than Thorazine entirely. For policy shapers: -There is a demand for farther research to analyze psychosocial intercessions for PE. For laminitiss: – Funders with an involvement in psychosocial intercessions for PE should back up further adequately powered, and designed surveies. In order to be able to believe about the cost deductions of PE wellness services research is needed into the long term results and quality of life impactDeductions for research AGiven the heterogeneousness of patients with PE, research is needed to better understand peculiarly for patients with womb-to-tomb PE and no antiphonal patients. An option would be planing intercessions that address these different clinical features instead than merely look intoing chief effects of psychosexual interventions, research should turn to specific interactions between patient features and intervention modes. Tests should to boot mensurate several other of import results, including phases of motive and preparedness to alter, including increased sexual assurance, sexual satisfaction, increased familiarity, patient and spouse satisfaction, operation, and health-related quality of life ( Althof 2006 ) . The current usage of validated questionnaires may surely lend to a better cognition of certain psychological issues, such as the sum of self-pride, anxiousness, and depressive feelings ( Melnik 2009 ) . Some issues remain undiscovered ( Waldinger 2008 ) . For illustration, which psychological fundamental law makes work forces more vulnerable to endure psychologically from short IELTs and what are the psychological features of work forces who perceive themselves as enduring from PE while holding objectively long IELTs? Randomized tests with larger group samples tests are still needed to further research the current available grounds for psychological intercessions for handling PE. The tests should be conducted over a longer follow-up period to farther look into delayed effects of psychological intercessions. Furthermore, the elucidation of the optimum dosage and continuance of any psychosocial intervention besides still needs farther probe ( Althof 2010 ) . The techniques used for randomization, sightlessness ( judges blind ) and allocation privacy should be described clearly in presentation of a survey. In add-on, all results should be presented in figures every bit clear as possible in a manner that readers can analyze the informations and draw decisions themselves ( Melnik 2009 ) .AAs psychosocial intercessions are used for people with PE, big, simple, well-designed and reported tests are justified to set up whether they are effectual. Randomized tests with larger group samples tests are still needed to further research the current available grounds for psychological intercessions for handling PE. The tests should be conducted over a longer follow-up period to farther look into delayed effects of psychological intercessions. Research workers may wish to look into further the intercessions included in this reappraisal in the ways suggested or to research other psychosocial intercessions for PE. Further surveies of psychosocial intercessions for PE should include clinically meaningful results such as: A important alterations in satisfaction with sexual/ affectional relationship, mental province, backsliding, A battle with services, quality of life, go forthing the survey early, satisfaction with attention, societal operation, inauspicious effects, and economic results ( cost-effectiveness and cost-benefit ) . Finally, ongoing researches to extricate what are the most effectual constituents in psychosexual therapy. Should output information that will help in the defining and ordination of future intervention programmes in sexual researchA in a mode that will enable the delivering of the most cost effectual intervention to as much of the population as possible.A A A ARecognitions ATo the Prostatic and Urological Cancer Diseases for back uping and redacting this reappraisal.Contributions of writers ATamara Melnik – chief referee, protocol and reappraisal development, appraisal of surveies, hazard prejudice appraisal, updating. Rachel Riera – protocol and reappraisal development, appraisal of surveies, hazard prejudice appraisal. Maria Eduarda Santos Puga – hunt schemes Sidney Glina – protocol and reappraisal development Alvaro Nagib Atallah – critical assessment of concluding version Stanley E. Althof – critical assessment of concluding versionDeclarations of involvement ANone declaredDifferences between protocol and reappraisal ADue to the intercessions and results heterogeneousness, it was non possible to pool the informations and to execute meta-analysis as antecedently planned at protocol phase.

Led Zeppelin: Musicians, Folklorists, Poets

Led Zeppelin is generally considered to have been one of the most influential rock bands to have existed.   The band came into existence in the late 1960s from Britain, following the lead of several other musical acts which led to the coining of the term â€Å"British Invasion.†Ã‚   But unlike many other bands, Zeppelin was not only interested in making music, but in offering their own takes on classical stories, such as the Trojan war. Their songs all employed a variety of poetic elements, such as rhyme scheme, metaphors, and allusions, and have connections to a number of true poems..   This can be seen when Led Zeppelin's songs â€Å"Stairway to Heaven† and â€Å"Achilles' Last Stand† are compared to W.H. Auden's â€Å"The Shield of Achilles† and Lord Alfred Tennyson's â€Å"The Lady of Shallot.† Led Zeppelin's â€Å"Stairway to Heaven† has long been considered one of the band's most famous contributions to the musical community.   The song has a main storyline about a woman who has spent her life concerned with material matters and never giving thought to the idea that perhaps the treasures she accumulated in life would never truly grant her a place in Heaven. There is an allusion to the buying of alms.   The practice of buying alms was a common and popular practice in the early days of the Catholic church and involved people paying a certain amount of money to priests to have their sins forgiven, thus leading to the song's notion that by accumulating wealth, salvation might be attained. â€Å"Stairway to Heaven† also has a definite rhythm.   The song alternates from having lines that are 6 – 12 syllables long.   The stanzas begin with lines that are either 10 to 12 syllables long and each consecutive line gradually decreases the amount of syllables that are present: And it's whispered that soon if we all call the tune  Ã‚   (12 syllables) Then the piper will lead us to reason.   (10 syllables) And a new day will dawn for those who stand long   (11 syllables) And the forests will echo with laughter.   (10 syllables) Immediately, a pattern in the rhythm can be seen.   The first line is 12 syllables and the following line is reduced by two syllables.   The third line is then one syllable less than the first line and the final line is the same as the second.   Such use of rhythm allows for the song to be more organized when set to music and for the poem to be more melodic when recited, to have a more flowing and surreal tone to it. The song also involves the use of repetition.   The first stanza incorporates the repetition of the same phrase in lines two and five of the song, â€Å"And she's buying the stairway to heaven/ [†¦] ooh, ooh, and she's buying the stairway to heaven.†Ã‚   That repetition is seen in the last couplet of the second verse with the phrase â€Å"Ooh, it makes me wonder† and is repeated again in the last line of fourth stanza. The poem also incorporates a sense of Arthurian legend, such as with the idea of â€Å"The Lady of Shallot† by Lord Alfred Tennyson.   Tennyson states that, â€Å"Willows whiten, aspens quiver,/ Little breezes dusk and shiver/ thro' the wave that runs for ever† (10-12).   Led Zeppelin changes the image slightly and states that â€Å"If there's a bustle in your hedgerow, don't be afraid./ It's just a spring clean for the May queen./ [†¦] Dear Lady, can you hear the wind blow, and did you know/ your stairway lies on the whispering wind.†Ã‚   There is an allusion to everything being alive in both examples.   Both incorporate an environment that is still except for the wind and largely pastoral. Even more similar is the idea of an idealistic young woman dressed in white.   Led Zeppelin refers to: There walks a lady we all know Who shines white light and wants to show How everything still turns to gold. And if you listen very hard  the tune will come to you at last. The image is nearly identical to the Lady of Shallot described by Tennyson: Lying, robed in snowy white that loosely flew to left and right — that leaves upon her falling light — thro' the noises of the night [†¦] They heard her singing her last song. Both women have a sense of idealism about them that eventually leads to their greater disappointment.   The woman in â€Å"Stairway to Heaven† is soon to be disappointed by the fact that her wealth will not bring her into eternal salvation.   The Lady of Shallot is only just beginning to come to terms with the fact that Lancelot does not love her and she has thrown away her life loving someone who will never have the same affection for her.   Both women are approached as being virginal creatures: they wear white, there is a sense of innocence in their believing that everything is as beautiful as gold. Even more stirring is the idea that the final stanza of â€Å"Stairway to Heaven† refers to listeners finally being able to hear her song, while â€Å"Our Lady of Shallot† is referred to as singing one final song.   Both end with a sense of finality and tragedy.   The women are lost because of their innocence and their false hope in the world and it is the final notes of their individual songs that their existences in the world are finally realized. Led Zeppelin's â€Å"Achilles' Last Stand† immortalizes one of the most famous figures of the Trojan war.   In the song, Achilles speaks of leaving for the war as a means of finding greater glory in his life as a warrior and achieving the last dreams he has within him, whether or not he lives or dies.   W. H. Auden's poem â€Å"The Shield of Achilles† personifies Achilles' shield and makes her seem to be a maternal figure who knows that Achilles will soon suffer an untimely death at the hands of his enemies but is wholly unable to prevent the death from occurring. Auden's poem has a definite rhythmic structure.   The main verses are seven lines each, while the more choral stanzas are eight lines, making the text more melodic when read.   Through the use of repetition, the idea of a song being present in the poem is obvious. Both â€Å"The Shield of Achilles† and â€Å"Achilles' Last Stand† mention a number of mythical references.   â€Å"The Shield of Achilles† alludes to the gods Hephaestus and Thetis while â€Å"Achilles' Last Stand† refers to Atlas and Albion.   The poems also refer to the same foreboding figure, a decrepit old man symbolizing Achilles' death.   â€Å"The Shield of Achilles† refers to the man as being â€Å"a ragged urchin, aimless and alone† while â€Å"Achilles' Last Stand† refers to the man as â€Å"to seek the man whose pointed hand/the giant step unfolds.† But the tone of the two poems differ greatly.   â€Å"Achilles' Last Stand† is one of glory in battle and despite the fact that the persona is aware that certain death may await him, he is willing to face his fate, regardless of the outcome: When they told us we should go As I turn to you You smiled at me How could we say no? With all the fun to have to live the dreams we always had Woa the song to sing When we at last return again (1-8). The persona wants to be immortalized for his duty in battle, wants to fulfill his goal of being a legendary warrior and spoken of for years after his death.   The use of such positive ideas, such as â€Å"when we at last return† refer to a disregard for death.   Even the end of the poem, when the persona finally dies, is positive, â€Å"The mighty arms of Atlas/hold the heavens from the earth/ I know the way, know the way, know the way.†Ã‚   There is never any submission.   The persona faces death gracefully, with the mentality of a warrior. Auden's poem is much different in its tone.   There is an idea of the shield lamenting, beginning a premature mourning of her beloved warrior.   The poem even incorporates a scene from the Holocaust's concentration camps to make the tone of the poem that much more somber, â€Å"Barbed wire enclosed an arbitrary spot/ Where bored officials lounged (one cracked a joke)/ And sentries sweated for the day was hot.†Ã‚   The entire poem is built around the premise of death and dying, and the shield is witness to all that suffering, even though she mourns Achilles the most. Even the depiction of immortal duties are different.   When â€Å"The Final Stand of Achilles† refers to â€Å"the mighty arms of Atlas, hold the heaven from the earth†, there is a sense of masculine pride, of a true warrior succeeding in his duties even though he suffers slightly.   â€Å"The Shield of Achilles† offers a more human take on such a task.   Atlas's duty is suddenly doled out to a number of individuals, all of whom are too weak to take on such a responsibility, â€Å"The mass and majesty of this world, all/ That carries weight and always weighs the same / Lay in the hands of others; they were small.† Through the use of repetition, rhythmic patterns, and thematic continuity, Led Zeppelin's songs are shown to be just as poetic as musical, especially when compared to a number of poems similar in content and structure, and prove that songs are merely poems set to music. Works Cited Auden, W.H. â€Å"The Shield of Achilles.† Led Zeppelin.   â€Å"Stairway to Heaven†. Led Zeppelin.   â€Å"Achilles' Last Stand.† Tennyson, Lord Alfred.   â€Å"The Lady of Shallot.†      

A Comparison of the Bandar and Cowboy Star Restaurant Butcher Restauant

A Comparison of the Bandar and Cowboy Star Restaurant & Butcher Restauant The Bandar and Cowboy star restaurant butcher restaurants compare by both restaurants serving cuisine that is natural and conventional based rather than fast foods. In regard to this, both serve fresh livestock meat and seafood. Also, both restaurants have incorporated wine in their menu which is optional for customers and a separate room exclusive for alcoholic drinks for interested customers (Bandar Persian Prime Restaurant, 2018). On the other hand, they differ by offering more specified and diversified meals; Bandar incorporates vegetables in their meals while Cowboy focuses more on meat products for their customers (Cowboy Star Restaurant and Butcher Shop, 2018). What positively influences both restaurants towards attracting and retaining their customers is the quality of their products. Considering they offer natural foods is a great motivation especially towards the customers who prefer organic foods. Additionally, there is the incorporation of vegetables upon request which caters well for the vegetarians since not all customers prefer meals based on meat products. Similarly, both restaurants offer meat products which can be considered as a negative influencer to the customers who totally disregard meat products and its association. Owing to this, there are customers who can entirely avoid the restaurants on the basis of animal product association. Additionally, seafood presents a mixture of reactions among customers; it is the most favorite to some while others disregard it but are comfortable with other livestock products. Furthermore, the involvement of alcoholic drinks in the form of wine or beer is not perceived positively by all customers despite being optional and may discourage potential clients of different faith/religion. Depending on the nature of customer, this may, therefore, act as a drawback.

Persian Empire Research Paper Example | Topics and Well Written Essays - 750 words

Persian Empire - Research Paper Example The formation of the Persian Empire began in 550 B.C., when King Stages of Media, who subjugated much of Iran and eastern Anatolia (Turkey), was crushed by his southern neighbor Cyrus II ("the Great"), king of Persia (559–530B.C.). This upset the stability of power in the Near East. The Lydians of western Anatolia under King Croesus took advantage of the fall of Media to push east, and clashed with Persian forces. The Lydian army withdrew for the winter but the Persians marched on to the Lydian capital at Sardis, which fell after a two-week siege. The Lydians had been allied with the Babylonians and Egyptians, and Cyrus now had to meet these major powers head-on. The Babylonian empire controlled Mesopotamia and the eastern Mediterranean. In 539 B.C., Persian forces defeated the Babylonian army at the site of Opis, east of the Tigris. King Cyrus entered Babylon and presented himself as a customary Mesopotamian monarch, restoring temples and releasing political prisoners. The on e western power that remained unconquered in Cyrus' brilliant campaigns was Egypt. It was left to his son Cambyses to beat the Egyptian forces in the eastern Nile Delta in 525B.C. After a ten-day siege, Egypt's ancient capital Memphis fell to the Persians.2 A crisis at the court forced Cambyses to go back to Persia but he died on the way and Darius I emerged as king. During his reign and the reign of his successors, the empire was stabilized, roads for communication were built, a system of satraps (governors) was established, major building projects, such as royal buildings at Susa and a new dynastic center of Persepolis, were begun, more lands were gained.3 And for the next two and a half centuries, the Persians enjoyed a fairly peaceful period of history, disturbed only by the occasional revolts of the Aegeans. The Organization and Governance of the Empire Though built upon the Assyrian structure, the Persian administrative system was far more competent and civilized. The empire w as divided into twenty provinces, or satrapies, each ruled by a governor called a satrap. To check the satraps, a secretary and military officials on behalf of the "Great King, King of Kings" were installed in every province. Also, special inspectors, "the Eyes and Ears of the King,"4 traveled all over the realm. Imperial post roads connected the important cities. Along the Royal Road between Sardis and Susa there was a post station every fourteen miles, where king's couriers could obtain rested horses, enabling them to cover the 1600-mile route in a week. "Nothing mortal travels so fast as these Persian messengers," wrote Herodotus. "These men will not be hindered..., either by snow, or rain, or heat, or by the darkness of night." 5   The Persian Empire was the first to endeavor to govern many different ethnic groups on the principle of equal responsibilities and rights for all peoples. So long as subjects paid their taxes and kept the peace, the king did not interfere with local religion, customs, or trade. Darius I revolutionized the world economy by placing it on a silver and gold coinage system also introducing a controlled and sustainable  tax  system that was accurately designed for each satrapy, based on their hypothetical productivity and their economic potential. Due to the vast geographical size, ethnic and cultural diversity of the subjected peoples, constant struggle for power on a regional scale, such as revolts led by the Greeks and the Egyptians, the creation of a large,

Alexander the Great Essay Example | Topics and Well Written Essays - 1250 words

Alexander the Great - Essay Example Alexander the great became King of the Macedon after the death of a father, Philip II at the age of 20. Alexander engaged in a journey of the conquest of around 11 years and fought more than 70 battles. Alexander the great had able to conquer the half of the world from India to Egypt in 32 years. Alexander created an empire which was so vast that it covered two million square miles and it stretched across the three continents. The integration of dream and great achievement distinguished Alexander as one of the greatest leaders of all-time. During the 12 years of the campaign, Alexander had defeated armies that were five times of own army, leading own armies of Macedonians in freezing weather and across deserts. Alexander faced tremendous hardships to unite and bring together the known world under a one single common unified vision. The main success of Alexander the great as a leader was the ability and passion for inspiring and encouraging all the men to think great things to think big and later achieve them with great commitment, passion, and enthusiasm. Alexander’s main motive and the dream was to unite Asia and Europe. Alexander called unity of Europe and Asia as â€Å"The Brotherhood of Man†. According to Alexander, brotherhood would help to unite and bring together the different culture of different societies into one unit which would be governed by the spread of Hellenism. Alexander’s dream of brotherhood was attained at different aspects (Fox 82). Even after the empire of Alexander the great Greek was a common language. ... Alexander called unite of Europe and Asia as â€Å"The Brotherhood of Man†. According to Alexander, brotherhood would help to unite and bring together different culture of different societies in to one unit which would be governed by spread of Hellenism. Alexander’s dream of brotherhood was attained at different aspects (Fox 82). Even after the empire of Alexander the great Greek was a common language. Due to the fact gospels were written in Greek it helped to reach large audience as it helped them to understand. The Alexander the great and the visionary leadership style is the classic combination of leaderships which is taught nowadays in military and business schools. Research done on the visionary leadership style of Alexander and it clearly shows that leadership style used by Alexander helps to communicate extensively with the people and resonate with their feelings and hearts. The strong case on business for the visionary style of leadership can be done by noticing at the pride in organization, retention of employees and shared sense of purpose and goals. Ronald Reagan’s speech of â€Å"Berlin Wall† and Martin Luther King’s speech on â€Å"I Have a Dream† are various examples of visionary leadership style which is same as Alexander the great. Visionary leaders used to have a clear picture on their minds and are able to go inside into the dreams and hopes of the people and would help to create destination. Creating destination among the people not only helps people to inspire but also would help them to challenge to be better (Martin and Blackwell 186). The effective visionary leadership strategy used by Alexander would help to stretch people’s gullibility just at the right moment of time. Felling the

Capstone Course Essay Example | Topics and Well Written Essays - 1000 words

Capstone Course - Essay Example Looking back, much of my time as a student was spent deciphering theories and philosophies with little or no effort in comprehending the practicality and application of these concepts, perspectives, and beliefs. Like many others, I too questioned the relevance of my learning with what I aimed to do in my professional life. Thus, the senior capstone course has acted as a bridge between theory and application, which is an outcome that I value the most. While an integration of subject-specific and cross-disciplinary knowledge and the assimilation of theory and application are the outcomes of my course experience that I greatly value. The learning outcome that I believe will be most helpful in my professional career is that of an enhanced level of self-efficacy, which is one of the characteristics internalized in a student during capstone courses (Dunlap 65). The systematic design of the course included class participation, interdisciplinary project, e-portfolio, research presentation an d a course reflective essay. The effort undertaken for the completion of these tasks allowed me to assume a larger share of the responsibility for my education and also played an integral role in acting as a means of socialization with my classmates and course instructor (Collier 285-299). The fact that the capstone project was planned as an independent endeavor meant that each student had to embark upon the task of using his/her individual learning, distinct perspectives on a range of topics and issues and cross-disciplinary knowledge to produce an independent study. My course project on insurance fraud was reflective of a range of understandings and comprehensions on the subject matter. The most critical factor which shaped the course of my independent study on insurance fraud was being on the ground. I also noted in my reflective essay on insurance fraud, how my interactions with the victims of this menace helped in the establishment of a relationship of trust.

Examine the three theoretical models of opportunity recognition Essay

Examine the three theoretical models of opportunity recognition - Essay Example In our second section, we de-construct the factors that impact opportunity recognition. Here, we explain the various ways in which cognition impacts opportunity recognition. In our third section, we study the influence of human and social capital on the opportunity recognition process. In our fourth and last section, we summarize the arguments and provide concluding remarks. I. Opportunity Recognition: theoretical constructs The capacity to identify and spot a successful business opportunity is the hallmark of a preliminary stage in any new entrepreneurial venture creation (Ardichvili, Cardozo & Ray 2003). Once an opportunity is recognized, the individual then proceeds to analyze it through different angles. What distinguishes an individual’s capability to identify the right opportunity? This forms the basis of the discussion for our paper. When we extend the unit of analysis from an individual to a firm, then we can also infer that opportunity recognition follows from a caref ul, analytical process (Denrell, Fang & Winter 2003). Possibly, we could conclude that an individual may not possess all the resources that are at the disposal of a firm, yet an individual develops his or her own methods to evaluate a business opportunity. ... These form the broad backbone of the opportunity recognition process. Shane (2003 p.60) also lists out three factors that influence the possibility of gaining information access: 1) prior life and work experience, 2) the social network structure and 3) information search. Previous experiences in a particular field helps people gain awareness and confidence about the domain. Sometimes, this translates into a deeper capacity for identifying unexplored business possibilities within the chosen business realm (Bishop 2011). Again, if the individuals belong to a family that has predominantly focused on their own businesses, this could influence them to spot business opportunities more easily. In essence, family occupation could influence individuals’ attitude and thought processes about business. Certain functional domains could also guide individuals towards entrepreneurial domains. For examples, people with more exposure to sales and marketing tend to have a good grasp of the mark et. They understand consumer behavior to some extent and can appreciate the process flow of business. This could be one factor that gives them an entrepreneurial spirit. Membership of a network also assists in the opportunity recognition process. Ozgen & Baron (2007) suggest that individuals may gain information about new business ventures from their mentors, business networks and professional associations. For individuals who have been entrepreneurs before, this would help them identify new business ideas more easily (Ucbasaran, Westhead & Wright 2009). Networks could be formal ones such as that of colleagues sharing the same work function at the employer’s premises. Another possibility is a group that meets informally after

MOVE Philadelphia Bombing Research Paper Example | Topics and Well Written Essays - 1750 words

MOVE Philadelphia Bombing - Research Paper Example As such the news media plays a fundamental role in helping an individual understand each of these complex interpersonal and societal dynamics. Due to the history of race and class oppression in the United States, an overwhelming racial tension and undercurrent of class struggle exists at almost every level of American society. When groups that have suffered from the media’s bias, such as African Americans, have taken up cause and struggled against their portrayal in the media, they have been met with an even more aggressive media bias. Because of this, negative racial perceptions of African-Americans and black activism have been far more prevalent than those that exist within white activist individuals or communities. The MOVE bombing in Philadelphia shows the disparity in treatment and representation of black activists, both for their tactics and their presentation. In the aftermath of the MOVE bombing, those responsible downplayed the racial undertones of the decision to bom b the activist. However in a culture where racism is accepted in action but denounced in public, political projects such as the bombing of MOVE, â€Å"Overtly claim to hold colorblind views, (but they) covertly manipulate racial fears in order to achieve political gains†. (Omni & Winant 58). ... t even though the civil rights era had begun a full 30 years previously, United States officials and the society at large, was still very much afraid of the perceived threat of black nationalism, black activism, black terrorism, and any other activism carried out by African-Americans (King & Smith 79). As such, the response to almost any form of black activism, crime, drug usage, or any other illegal, or conceivably illegal, activity was extreme to say the least. For years, pundits and political analysts have pointed to the unjust treatment of African-Americans under the criminal justice system of the United States. The violent reaction to the Philadelphia MOVE community was one that can only be understood as a response motivated primarily by racial fear, suspicion, and a great deal of prejudice and preconceived notions with respect to the way in which this particular group was expected to behave. Ultimately, the events that took place in 1985, with regards to the Philadelphia MOVE g roup, helps to illustrate the disparity between the way in which black separatism and white separatism was treated. For instance, an individual who might have espoused a radical ideology that promoted rabid antigovernment views and promoted a degree of racial discord and white supremacy would not likely have been engaged in the same manner that the individuals of the Philadelphia MOVE group were treated. Interestingly, a complete and thorough analysis of the incident up to and including the bombing of this group denotes the fact that even though a high percentage of the group’s members were in fact African-American, a unique level of black separatism, racism, and other racial motivations existed in the media portrayal of this incident. However, the lack of evidence for this media

Business Continuity Planning Research Paper Example | Topics and Well Written Essays - 1000 words

Business Continuity Planning - Research Paper Example In 2007, Hewlett Packard conducted a study on the uptake of business continuity planning in some selected organizations. The results indicated that about â€Å"31% of small business† had no business continuity planning in place (Guy & Lownes-Jackson, 2011, p.55). This paper will explore how business can develop a business continuity plan to certify that they are prepared to face disruptive events that natural or manmade factors can trigger within the business environment. In this research paper, I will explore the steps that business can take to develop an efficient business continuity planning that will boost the preparedness to face disaster. In particular, the paper will delve on the steps that organizations must follow to arrive at a concrete and useful business continuity planning. First, the paper will explore first step called the initiation step where senior management of an organization meets and carry out a comprehensive review of the shortcomings in preparedness alo ng with evaluating available resources. Second, the paper will address the second stage—business impact analysis. The paper will reveal the value of business impact analysis and its execution. ... Lastly, the fifth section of the paper will detail how organizations carry out maintenance and testing of business continuity planning they have developed. Such a paper should provide significant insights on the process of business continuity planning and embed it as a core strategy that businesses can adopt to remain competitive in a world for myriads of factors can cause business to stop their operations. Business continuity planning Business operations are often at risk of disruption by threats from natural forces or human factors. For instance, terrorists attack on World Trade Centre and the Tsunami in Japan left many businesses with the lack of capacity to do any business operations (Adkins, Thornton & Blake, 2009). It is such threats that create a need for business continuity planning because this process allows business to resume their operations and sustain critical operations when an outage occurs (Wei. 2009). In order for an organization to have a business continuity plan i n place, it has to follow the five steps necessary in creating a Business continuity plan. a) Initiation the Plan This is often the first state of business continuity planning where the senior management of the organization meet, strategize, and evaluate the feasibility of the project. This meeting plays an integral role in allowing the managers to own the business continuity-planning project and dedicate various resources for its completion. In this meeting, the management will review the goals and objective of the project and align them with the business objectives of the organization (Rinehardt, 2010). In addition, the management must also identity

Branch and Palm Trees Essay Example for Free

Branch and Palm Trees Essay It was raining, I didn’t like rain. In fact, I didn’t like any kind of weather. That was why I only left my house when I had to. I was just heading to my bed so I could relax and finish the book that I was currently reading, it was about†¦Ã¢â‚¬ ¦wait, I forgot the name†¦..it was something about a girl who volunteered for her little sister to fight to the death†¦Ã¢â‚¬ ¦.wait! It was called The Hunger Games! Then It was all a blackout and I was sound asleep. I woke up to the sound of crashing waves and the taste of salt and sand grains in my mouth. I opened my eyes, and at first I thought I was dreaming. Somehow, after a while, I could tell it wasn’t a dream. It was real. All I could see was blue salt water crashing on the sand shore in front of me. I stood up and touched the water, it felt fairly warm so I could tell I was somewhere besides California (where I lived at the time). I look over the horizon to see only blue skies. This worries me. I am still in my pajamas that are yellow with green palm trees. I turn around and see a fairly sized island with mostly all palm trees packed together into groups. I start walking to the palm trees, my feelings to what has just happened were kind of jumbled and I was confused. I’m halfway to the closest palm tree when I hear the bushes on my left side rustling. It could be my imagination or it could be the ocean breeze. I didn’t know which. To my surprise, it was neither. I push aside the bush only to see a huge lizard lumber out. I shook that off and continued walking towards the palm trees again. I reach the edge and start walking in. The farther I went in the darker it would get because of the dense vegetation. I had nothing else to do, so I continued walking farther and farther in. I tried carving lines into every tree trunk I passed so I could possibly find my way back. Eventually I gave up on that (It was to much work). The sun was going down and now all I was thinking about was where I was going to sleep. I came up with the idea to make a cushion of some kind and then put it up in a stable tree branch. I took the most comfortable looking leaves, stacked them on top of each other and hoped for the best. I woke up in the morning dazed and I could feel the sun rays beaming across the side of my face and my shoulders. The sun is out, but it’s still freezing. I started looking around for food because my stomach was growling, and to my surprise there was a pile of mangos piled neatly at the foot of a tree trunk. At the moment, I wasn’t thinking about how they got there like that, I was thinking about how delicious they looked. I reach over, grab the best looking one I can find, and shove almost half of it in my mouth and I dropped the second half. There was a haggard looking man walking toward me with a knife pointed toward me. At first he was yelling at me saying things, like it took him 3 days to get the mangos. Then he was questioning me, asking, How did you get here? Where are you from? and what do you want? I told him that I didn’t know how I got here, I was from California, and all I wanted was to go home. He told me that if I was hungry he could provide me with some, but very little food. I thought it was better than nothing so I followed him. He stopped in front of a fairly sized hut made out of palm tree branches and bamboo sticks. It sure did look a lot better then the leaf ‘†bed† I made. He pushes aside the seaweed curtain and proceeded to lead me in. There is no kind of furniture, but I am not surprised. I sit down around the fire he had going. He walks back to the fire with a dead, skinned monkey on a stick. Doesn’t look very appetizing but it’s better than nothing. He holds over the fire and slowly turns it until it is done cooking. He rips off a leg and hands it to me. I reach for it reluctantly. Right away he bites down into the monkey. He must have been very hungry, but so am I. I bite down into the thigh and it tastes a lot better than I thought it would. I am alarmed by the sounds of a helicopter. I rush out to see that helicopter landing on the open beach. Once it had landed I ran toward the window and started banging on it. All I wanted to do was return home. After a while of speaking to the men from the helicopter they told me they actually weren’t looking for me but for the haggard man I was with. He had been on that Island for 4 years! Then they tell me that they will only have room for him. They say that they will have to come back for me later. But how much later? Great.

Customer Retention Tools Used By Public And Private Banks Marketing Essay

Customer Retention Tools Used By Public And Private Banks Marketing Essay Customer retention is the activity that a selling organization undertakes in order to reduce customer defections. Successful customer retention starts with the first contact an organization has with a customer and continues throughout the entire lifetime of a relationship. A companys ability to attract and retain new customers, is not only related to its product or services, but strongly related to the way it services its existing customers and the reputation it creates within and across the marketplace. Customer retention is more than giving the customer what they expect; its about exceeding their expectations so that they become loyal advocates for your brand. Creating customer loyalty puts customer value rather than maximizing profits and shareholder value at the centre of business strategy. The key differentiator in a competitive environment is more often than not the delivery of a consistently high standard of customer service. Private and Public Banks Banks have been broadly divided into private and public. A private bank is that in which there are but few partners, and these attend personally to its management. A public bank is that in which there are numerous partners or shareholders, and they elect from their own body a certain number, who are entrusted with its management. he business of banking consists chiefly in receiving deposits of money, upon which interest may or may not be allowed; in making advances of money, principally in the way of discounting bills; and in affecting the transmission of money from one place to another. Banks in metropolitan cities are usually the agents of the banks in smaller communities and charge a commission on their transactions. The profits of a bank are that portion of its total receipts including discount, interest, dividends, and commission which exceeds the amount of the expenses. List of Private Banks in India Bank of Punjab Bank of Rajasthan ICICI HDFC Centurion bank IndusInd bank Federal bank UTI bank Jammu Kashmir bank South India bank Karnataka bank List of Public Banks in India Allahabad bank State bank of India Punjab National bank Punjab Sind bank Bank of Maharashtra Bank of India Canara bank UCO bank Central bank of India IDBI CUSTOMER RETENTION TOOLS USED BY PRIVATE BANKS Social media major customer retention tool in private banks: To retain more and more customers private banks use social media. In this in case of responding to customers social media is a powerful retention tool. In this before contacting to customer service department, customers can go online and can get information regarding anything. Bank world relationship -personal banker To retain the customers private banks started bank word relationship in this they will do: they will assign special persons to a group of clients in which clients can mail to these persons for personal help and financial advice. Keep customers informed In this to retain their customers they have started their customers informing about latest schemes and offers and necessary information. For informing the customers banks send letters, e-mails, make phone calls and send messages on their mobile phones. Contest for customers For existing customers to retain them they have started to reward customer loyalty by running a customer -only competition or contest. In this the entry is free and automatic for existing customers and publicises the results in newsletter and website Offers related or complementary products Banks are providing complementary products or services to their customers because this helps them in retaining their customers. Anniversary offer In this banks are providing special anniversary offers one year exactly after the customer first came to banks. Employee motivation Employee morale and motivation plays an important role in customer retention. A demoralized employee tends not to listen to customer and in turn can turn away a good customer off. Empowerment of people, investment in soft skill/product and other relevant trainings and right technology to monitor the results need to be employed. Incentive schemes along with right compensation across the spectrum of staff from front office to marketing leading to documented evidence of improvement in customer retention and satisfaction leads to long term profitability and loyalty. This will also require management buy-in and commitment. In the long term loyal and motivated employees lead to more business and satisfied customer. Banks need to strive to make each employee a brand ambassador for the Bank. Managing customer complaints Customer complaints are identified by a number of ways in private banks: such as customer complaint box, written form, verbal form.. Customers usually make complaint about their problems telling the relevant person in the bank. Complaints are managed by taking quick actions. This helps in the retention of customers. Relationship Managers (RMs) The concept of Relationship Manager (RM) is used in the banks. The job of RM is generally performed by the branch officers. The interviews revealed that the main job of Relationship Managers to reach out to the customers both corporate and personal, to make sure that the job is done in a systematic manner within the clients time frame. The relationship managers for corporate banking are very much important because during the relationship the bank attempts to solve the problems of client organization and satisfy its needs through a series of transactions. It helps in the customer retention. INTERNET BANKING Private Banks have their own website. Internet Banking has already been started. Following are the common features of Internet Banking: View account balances and transaction history Verify deposits Check loan balances Check loan payment information View interest information Various information regarding their products In this customers can get every information through internet. It is an important tool to retain customers. SPATIAL CONVENIENCE Spatial convenience is provided by branch location and technology driven delivery services such as ATM. To create spatial convenience branches and ATM booths should be established near the target customers.. ATM is used to provide convenience by placing them in locations like shopping mall, in some central place of areas. SEGEMENTATION To retain the customers in banks they started segmentation. The factors that banks emphasize to identify the needs and requirements are as follows: For corporate customer: Financial Strength and credit worthiness Market Positioning Reputation Integrity Industries Listed Companies For personal banking: Occupation Income and Propensity to save Attitude towards banking Market demand Geographic concentration BUILDING MANAGING CUSTOMER RELATIONSHIP Relationship marketing encompasses activities of attracting, maintaining, and enhancing customer relationships. It is an organizational philosophy that impacts on operations and processes, employees, customer service and quality and customer retention. Win-win rewards It provides benefits for both the customer and the private banks Successful marketing of these initiatives means customers are encouraged to use cost-saving electronic banking services that enable maximum efficiency and profitability. For example, consumers may be required to receive statements online, use their debit card a certain amount of times each month, use online banking or bill pay and/or enrol in direct deposit. This lowers personal service costs and statement costs (for printing and mailing) and gives bankers the time and resources they need to focus on building relationships with key customers. Technology Telephone banking is another option for customer retention as this service is for convenience of customer. And for this purpose following technology is used: Interactive voice response (IVR) IVR systems are used very commonly by various service organizations for order placements, purchasing airline tickets, telephone banking, caller routing and identification, obtaining balance inquiries, paying bills, completing surveys and polls and looking up selective information, to name a few. IVR systems are also used at call centres to help identify customers needs and prepare the live customer service representative by obtaining information from the caller ahead of time, such as account numbers, name, social security number, address information, etc. IVR for short is a software application that allows telephone caller to select options from various menus. IVR systems are available 24 hours a day, seven days a week, so callers can access them anywhere, anytime. Callers may enter requested information into telephone keypad or by simply speaking commands. Commands generally consists of numbers or simply Yes or No answers. IVR systems also have voice options for help, speak with a customer care specialist or other various straight forward options. CUSTOMER RETENTION TOOLS USED BY PUBLIC BANKS Relationship based pricing Existing customers feel that they are being ignored by banks when it comes to pricing as competitive rates are being offered to new customers only. This forces public banks to have a pricing strategy. Customers who have multiple products with Banks across different lines of business (LOBs) expect transparency in product pricing. They tend to stay loyal and this loyalty needs to be taken care of. Relationship based pricing (RBP) is a new mantra which institutions are now trying to get into. RBP helps in evaluating the total income earned from the customer across all the LOBs and work out mutually profitable pricing. RBP helps banks to treat each customer differently, based on the overall relationship value, with innovative pricing strategies across enterprise. Banks can ensure that the benefits and rewards are provided based on total value the customer provides thereby enriching the customer loyalty. This helps a lot in customer retention. Employee motivation Employee morale and motivation plays an important role in customer retention. A demoralized employee tends not to listen to customer and in turn can turn away a good customer off. Empowerment of people, investment in soft skill/product and other relevant trainings and right technology to monitor the results need to be employed. Incentive schemes along with right compensation across the spectrum of staff from front office to marketing leading to documented evidence of improvement in customer retention and satisfaction leads to long term profitability and loyalty. This will also require management buy-in and commitment. In the long term loyal and motivated employees lead to more business and satisfied customer. Banks need to strive to make each employee a brand ambassador for the Bank. Keep customers informed Same way like private banks they also retain their customers, they also have started their customers informing about latest schemes and offers and necessary information. For informing the customers banks send letters, e-mails, make phone calls and send messages on their mobile phones. Rewards management Customers expect banks to be flexible and willing to change while offering rewards. Listening to them will go a long way in knowing what is wanted and what is not. Outdated products/service as a reward will not go down well with customers and addition of newer loyalty partners with innovative ideas will be welcome. Innovative ways of redeeming rewards like online redemption, redemption against purchases etc are the ones which will be liked. Proper segmentation of customers is required so that the right product/reward is targeted. Loyalty programs need to be constantly evolving based on the market conditions and technology needs to be used extensively in this regard. Profitable and cost effective Customer Relationship Management has become a key strategic area with an increased focus on this issue by top management of Banks. The opportunity for banks has never been greater to assume a more customer centric responsibility. Continuous use of customer feedback, tuning loyalty programs, improving employee morale along with the relevant Enterprise wide technology platform to monitor all these will ensure in improving customer relationships with the active participation of management across the organizational functions. Management buy-in and participation across the different level in the hierarchy is important in improving customer relationships, helping to deepen brand loyalty and increase customer lifetime value. In the end loyalty equals increasing profits and a strong competitive edge which is the order of the day. Ultimately, best strategies in customer loyalty management reflect in higher customer satisfaction indices and improved bottom line f or the Bank. Education for the customer on products and services offerings:Â   Customers need to have adequate information about banks products, services, delivery channels and the costs associated with each. However, bank does not have unlimited resources to provide personalized education at the branch level. Integrated banking platforms support Push-To-Talk and similar applications which can deliver personal interaction remotely. Customer Empowerment with necessary information and tools to encourage independent decision making:Â   Customer can use calculators, simulators and modellers to compare different products understand the steps to be taken to achieve their financial goals and seek guidance in broader financial matters such as wealth creation and retirement planning. Humble ATMs Public banks have just introduced humble ATMs to retain its customers. In these ATMs if a person can interact with bank staff if the nearest branches are closed. Social Media To retain more and more customers public banks use social media. In this in case of responding to customers social media is a powerful retention tool. In this before contacting to customer service department, customers can go online and can get information regarding anything. CONCLUSION There is a great competition between public and private banks. Customer retention is their major motive. To retain their customers banks adopted many tools and techniques. Private sector banks focus more on customer retention as compared to Public sector banks. Private sector bank follows the 80/20 rule which means that the top 20 customers generate the 80% of organization revenue. It is easy and cost effective to retain the existing customers, than to gain new. This is the strategy which both Public and Private sector banks follow.