Pinochets Medical Report Essays - RTT, Augusto Pinochet

Pinochets 'Medical Report' Essays - RTT, Augusto Pinochet Pinochets 'Medical Report' pinochets 'medical report' Senator Pinochet has a complex medical history, but the main active medical problems at present are diabetic peripheral neuropathy and recently progressive cerebrovascular brain damage. The diabetic neuropathology is contributing to difficulties in walking and to the observed tendency to postural hypertension. The diabetes will also have predisposed to arterial disease as will a past history of smoking The cerebrovascular disease has manifested partly as minor strokes and transient asthmatic attacks but also causes progressive damage without acute symptoms. There is clinical evidence of extensive damage to the brain. This includes bilateral damage to pyramidal tracts to cause spasticity symptoms and to the basal ganglia producing features of parkinsonism. The presence of primitive reflexes indicates damage to the frontal lobes and the memory defecit is comparable with bilateral damage to temporal lobe structures. Difficulties in comprehension are secondary to the memory deficit. While much of the damage is attributable to areas of the brain served by the basilar artery (shown to be calcified, in the CT scans) the frontal lobe impairment indicates more generalised arterial disease. Fitness for trial Physically: Senator Pinochet would at present be able to attend a trial but as features of cerebrovascular damage have progressed despite optimal treatment (with good control of diabetes and blood pressure and antiplaseler agents) further deterioration in both physical and mental condition is likely. Mentally: It is our view that Senator Pinochet would not at the present be mentally capable of meaningful participation in a trial. We base this opinion on: 1. Memory defecit for both recent and remote events. 2. Limited ability to understand complex sentences and questions owing to memory impairment and consequent inability to process verbal information appropriately. 3. Impaired ability to express himself audibly, succinctly and relevantly. 4. Easy fatiguability With these impediments he would be unable to follow the progress of a trial sufficiently to instruct counsel. He would have difficulty in understanding the content and implications of questions put to him and would have inadequate insight into his difficulty. His memory of remote events is impaired. He would have difficulty making himself heard and understood in replying to questions. We are satisfied that the impediments we have identified are due to brain damage, as they are coherent in nature and consistent in manifestation and formal neuropsychological testing showed none of the features of deliberate exaggeration of impairment. In particular those neuropsychological tests indicative of original intelligence and educational levels (such as the vocabulary scale of the WAIS)show superior performance. At present, Senator Pinochet shows no evidence of clinical depression. Situational stress, as likely to be occasioned by trial, produces physiological responses that could accelerate the progression of vascular disease. We were told, however, that Senator Pinochet has in the past shown notable personal abilities in managing stress. We therefore do not feel able to express any useful opinion on the possible effects on his health of undergoing trial. The major episodes of damage seem to have occurred in a cluster of thromboembolic events during September and October 1999. There has been sufficient time for the great majority of any expected spontaneous recovery from these events to have taken place. Although some day to day fluctuation in functional abilities is characteristic of brain damage due to cerebrovascular disease we consider further sustained functional improvement of a significant degree unlikely. Background - the rest of the report: Professor Sir John Grimley Evans, Dr M J Denham, and Professor Andrew Lees undertook a clinical consultation with Senator Pinochet at Norwick Park Hospital on January 25th 2000. The consultation was undertaken in Spanish. Also present: Dr Henry Olivi (Observer) Prof. D J Thomas (Observer) Nurse Shelley Cape, Manuel Cerda (Senator Pinochet's valet) Recent Medical History: Following surgical decompression of lumber spine in 1998 Senator Pinochet was troubled for some weeks by severe headache across the brow. This resolved spontaneously. For the last 8 to 9 months he has noted difficulty in walking and now can only cover 200 yards before his legs become too weak to continue. He now walks with a stick. Numbness of the soles of his feet has also progressed over that time. Over the last ten months he has noticed a gradual

Supply chain management in web technology Essay

Supply chain management in web technology - Essay Example In this research work, the theoretical aspects of the Supply Chain and how technology, specifically, the internet has helped in augmenting this system and in what way has the companies gained out of it. In order to execute this, measures are defined for targets by establishing key performance indexes which would be measured at the beginning of a technological implementation and measured again at the end of the technological implementation. This helped in establishing the gain out of technology. Technology helps in augmenting efficiency of supply chain management, particularly on the Global scale. However, SCM is not all technology but also an art. Careful work execution is as much important as technology for a successful SCM. 1. Study of the existing systems and the theory behind Supply Chain Management. This would involve going through the available literature in order to identify the various factors that make up the Supply Chain. Impact of every one of the factors is ascertained and the technology solution for every one of the factors is also identified, if available. Once these are identified, then the work in the case progresses with more clarity added to the nature of factors that influence the technology changes. Available literature is exhaustively collected for this purpose and the same is documented and referenced. 2. 2. Once the literature review is done, appropriate analysis is done to ascertain the impact of technology on supply chain. This would help in understanding the success of the technological innovations in this field. In addition to that, the effectiveness of such technological innovations and the extent to which they are trustable is also identified from the analysis. The analysis of the literature will also throw up other issues that have come up because of technological application on the supply chain. The advantages will also be discussed in short and the disadvantages along with issues that need to be countered or remain unsolved are also listed down. 3. An industry visit is done to identify the type of usage that exists in the industry in terms of supply chain. The practical issues that come up during the course of normal work and the methodology adopted by the industry's managers to counter these issues are also identified and taken in for consideration. One or two managers of the company are requested for an interview and then a set of qualitative questions are posed to them on the success of Supply chain management tools. The extent of success is then ascertained and points are allocated on a Likert Scale from 1 to 8. Based on this, another set of analysis is done and its closeness to the theoretical study is identified, if available. Secondly, during the course of the work, other targets listed are also met. 4. A final conclusion is drawn based on the literary review, the short survey that was taken from the company and its managers. Finally, the objective of the work, whether the technological application favours the supply chain and whether it has optimised work is done and identified. Literature Review Approach The methodology adopted for this literature review will be as follows: 1. Different products in the industry for Supply chain mana

Work place emotions and attitudes Essay Example | Topics and Well Written Essays - 2500 words

Work place emotions and attitudes - Essay Example Emotions are an attempt to express outwardly, to express what we believe. How a person feel is a reflection of how he thinks. Negative thoughts produce negative emotions and positive thoughts produce positive emotions. Laws exist about emotions just like there are laws about physics. Every emotion is a result of some thought that preceded that emotion. If a person has a healthy body then how he thinks causes how he feels. How he feels affects how he behaves. And, how he behaves produces results (Pennington and Haslam, N.D.). Attitudes are inclination or propensities, or tendencies, to react in a favorable or unfavorable way toward an object or any situation. Attitudes reflect a person’s likes and dislikes toward other persons, objects, events, and activities in their environment. Attitudes can have a significant effect on the behavior of a person at work. In the world of work we are concerned with attitudes toward supervision, pay, benefits, promotion or anything that might trigger positive or negative reactions. Employee satisfaction and attitudes represent one of the key areas of measuring organizational effectiveness. Attitudes toward supervision, pay, benefits, promotion, or anything that might trigger positive or negative reactions. Employee satisfaction and attitudes represent one of the key areas for measuring organizational effectiveness. Because of the importance of the links of task, contextual, and ethical performance with important measures of organizational effectiveness, one of the key goals of managers should be to create linkages between employee performance and their satisfaction. However, it is not always easy to change a person’s attitudes about their work. The reason is that, attitudes toward work may be only one important aspect of the person’s structure of attitudes. They might be linked strongly to other important ones, making them deeply embedded, and thereby limiting how much managers can succeed in altering the way

Qualitative Research Project Essay Example for Free

Qualitative Research Project Essay

Abraham Lincoln :: essays research papers

Abraham Lincoln Abraham Lincoln was the sixteenth President of the United States. He served from 1861- 1865. People referred to him as " Honest Abe." During the Civil War Lincoln helped with the North, in doing this the North selected him for a second time in 1864. In all of his time he never wavered from his primary goal- to save the Union and also he saw the nation through it's most dreadful experience, war between Americans. In the beginning- Abraham was born on February 12, 1809. Him ad his family moved a couple of times from place to place. With helping on the farm and managing to get in some schooling at a local school. He learned how to read and write. His full size grew to be 6'4. The middle years- In 1832, as a captain of the Militia Company, he went off to the Black Hawk War. Soon after the War he ran for the Illinois legislature and lost. Afterward with a partner, he opened his own general store but went broke. In 1834, as a Whig, he was elected to the legislature and served four terms. But in the meantime, he read enough law to finally become a lawyer and in 1837 he moved to Springfield. Here he attended legislative sessions, practiced law, and met his future wife. Family life- Abraham's wife was Mary Todd; she was a Kentucky born girl. They were soon married on November 4, 1842. They had together four kids, Robert, Edward, William, and Thomas. But Edward died shortly before his fourth birthday, William died in the White House of typhoid at only age eleven, and also son Thomas died in 1871 at age eighteen right before adulthood. Being the President- In 1846, Lincoln won election to the U.S. House of Representatives. He served up until 1849, then returned to Springfield. In the 1850's he returned to politics. He spoke out against slavery extension. In 1856 he became a Republican. Two years later he ran for U.S. Senate, but lost however. He won the President nomination on the third ballot and won. He was elected President on November 6, 1861. In November 1863, Lincoln dedicated the Gettysburg battlefield, in a short speech known as the Gettysburg Address. It summed up the Civil War and it's meaning to the Americans.

Counselor Ethical Boundaries and Practices Essay

Part of being a counselor requires an understanding of dual relationships and the boundaries that are in place between a client and their counselor. Being a good counselor requires an understanding of the role that ethics plays in the professional relationship. Ethics are not simply a way of protecting the client but offer protection to the counselor as well. Counselor Decision-Making and Counseling Examples In the counseling profession dual relationships also known as multiple relationships can be defined as a situation in which multiples roles exists between the counselor and the client. Callanan et al discuss the fact that when a counselor and a client â€Å"blend their professional relationship with a non-professional relationship, then ethical concerns must be considered (2014).† The boundaries that are set in place between a counselor and a client are done so to protect both parties. A counselor is in a position of power in the life of their client and if the boundaries are not in place, the counselor could take advantage of their client and cause difficulties for them. To determine if a boundary crossing or a dual relationship is ethical and appropriate with a client that I am treating I would look first to the ACA code of ethics to determine what is viewed as unethical dual relationships. The ACA code of ethics goes into some detail in regards to what is considered to be a n unethical dual relationship. ACA Code A.5.a states that a â€Å"sexual and/or romantic counselor– client interactions or relationships with current clients, their romantic partners, or their family members are prohibited (2014).† The code of ethics also explains that counselors are prohibited from providing counseling services to someone that they have previously had a sexual/romantic relationship with. If the  situation that I am involved in is not covered within the ethical guidelines, then I would seek the advise of my supervisor or trusted colleague to determine what their thoughts are in regards to the situation that I have found myself in. In making my decision, I would look to determine that the decisions being made would not adversely affect my client or myself. I would also look to determine if the change in relationship would be therapeutic to my client. If I was dealing with a situation where I was sexually attracted to my client or my client was sexually attracted to me; I would look to the ACA code of ethics and determine that a sexual relationship with a client is considered unethical. Geyer believes â€Å"there seems to be considerable agreement within both secular and Christian circles that romantic or sexual relationships are always unethical concurrent with or during counseling and virtually always unethical afterwards (Dual Role Relationships and Christian Counseling, 1994).† If during a counseling session with a client, they felt that I was not hearing them, it might be appropriate to do some self-disclosure. This is a boundary crossing but as long as the self-disclosure does not cause the client to feel negative effects then it is acceptable as a way to make sure the client understands the counseling is listening and understands what the client is feeling. If I was working in a small town that did not have other counseling options, then I might be placed in a position to have a dual relationship with a client. A friend could come to me needing assistance in dealing with an issue and due to the area that we live in, there might not be another counselor that they could go and see. In this situation, I believe a dual relationship would be allowed as long as the boundaries between friendship and counseling are fully laid out before beginning. The friend would have to come into the sessions not as a friend but as a client, someone that I am there to assist without passing judgment. If I had been treating a client who had been involved in car crash where their actions caused the death of the passenger in the car, would it be ethical for me to cross the boundary of leaving the office and going to the site of the accident. I believe in this case that it would be acceptable for me to cross that boundary and go with my client as a support system as they are trying to come to terms with their actions that caused the death of another. By going with them to the site of the accident, they are able to have a sense of being protected as they process what  transpired and led them to that point in their life. Ethical Issues and Dimensions The ACA Code of Ethics defines an appropriate amount of time of 5 years following the termination of therapy to be acceptable for a counselor to pursue a sexual/romantic relationship with a past client. I believe that in some instances 5 years would be a good amount of time to pass before looking for that type of relationship but in some cases longer might be better. I will have been in a very powerful position with my client and therefore depending on what they were receiving counseling for, it might not have been enough time for that power dynamic to have equaled out. If I were seeing a client and they invited me to their birthday party, this would be considered unethical because I would be seeing them outside of the counseling sessions. If services have been terminated and we are the five years out of the counseling relationship, I would be able to attend the party without fear of my actions being unethical. How the relationship with the client ended also plays a part in being able to interact with them after termination of therapy. Lebaw (2014) states that there are different types of termination of counseling services; the termination of services can be carefully planned or be totally unplanned and based on cases that were either successful or unsuccessful. If the termination of services was a negative experience for the client, it might be more ethical to not interact with them after the ending of the counseling sessions. Professional Collaboration Counseling It is important for counselors and other stakeholders to work together in regards to the care of a client. There are different situations in which multiple areas of help will be needed for the clients’ safety and well-being and it is important that each member of the team is able to communicate effectively with one another. Multidisciplinary Team It is important for a counselor in certain situations to be able to work with  other professionals to ensure the best care is being given to a client. If I have not been trained in handling addictions and have a client that is dealing with severe depression but is also an alcoholic then it would be beneficial for me to work in conjunction with their addiction counselor. Then as I am treating the client for their depression, the addiction counselor is working with them in regards to their alcohol addiction. In this case the addictions counselor and I would need to be able to communicate back and forth with one another to ensure that our client was receiving the best possible care for their co-occurring disorders. Also, with having another person involved in the care of the client it helps to keep the firm boundaries in place that maintains the safety of the client and myself. The addictions counselor and I would meet regularly to discuss our plans to achieve a detailed care plan tha t gives our client the best possible outcome. Staton and Gilligan (2003) define the objective of collaboration as â€Å"developing mutual agreement on ways to work together to provide the most effective services.† Fiddler et al (2010) said that â€Å"meaningful engagement and decisions should be made in collaboration with the patient about his/her treatment and future management.† The client should be a part of the process of the care plan and not just being told what is going to be taking place, it allows the client to have a voice in their treatment. If my client did not wish for me to collaborate with their addictions counselor, wanting to keep the two areas separate then I would need to treat the client solely within the scope of the depression. I would not be able to provide my client with any advice as to why they are drinking or even why they find it difficult to stop drinking. As an individual counselor working alone with the client, I need to be sure that I do nothing unethical with the client. By knowing what I have been trained in and informing my client that because I do not have the experience or training to treat them in regards to their addiction, I am not only taking car e of myself ethically but the client as well. Part of the job of a supervisor-counselor relationship is for them to not only train the student in what it is to be a counselor, but to be a support system for the student. This puts the supervisor in a position of extreme importance to the student. Not only is the supervisor putting forth a grade on the students’ performance, but they are also being confided in by the student with the  struggles the student is having. The supervisor could use this position to influence the student in an unethical way if they are not careful. It would be simple for the supervisor to manipulate the student’s feelings towards them. These are very similar to the things that a counselor could do to a client if they did not monitor themselves. AS a counselor, you have the trust of your client that everything you are doing is being done to help them and not harm them. A criteria that could be used to determine if something a fellow counselor is being done is ethical or not is by knowing and being familiar with the ACA code of ethics as well as the laws of the state that I am practicing in. If I found a fellow counselor acting in an unethical way it would be my duty to report them to the licensing board. The board is the only one who has the right to pass judgment and sentence on a counselor who has behaved unethically. Development of Ethics Ponton stated â€Å"In whatever specialty counselors practice, they are asked to provide expertise to the problem of balancing an individual’s needs, strengths, and identity with the group or society within which that individual functions (2009).† Since taking this course I have become more familiar with the roles that ethics needs to play in the relationship between not only counselor and client; but counselor and counselor, and counselor and supervisor. That each of these relationships forms a chain that needs to be strong and well defined. The role that ethics plays in the life of a counselor is something that is very important. Ethics are not just there to protect the client, they protect the counselor as well. From this course I have learned that there will be times when the lines between ethical and unethical are not going to be clearly defined; yet there is a support system available to me. I learned that there is nothing wrong with going to my community of counselors for support or direction when I am unsure of a step. This is a profession where not only do we help clients but we help each other. Conclusion Someone who is beginning in the counseling profession needs to be fully aware of the ethical guidelines set in place by not only the ACA but the state in which they are practicing. The code of ethics are not in place simply to  protect the client; but to also provide protection to the counselor. The role of ethics and boundaries is important and something that a counselor will need to continuously watch and learn about as the work with clients. Though boundaries can fluctuate they should never be crossed in a way that could harm a client. As a counselor, I need to know what cases that I can treat and those that I can’t and be willing to work with others to give my clients the best possible care. There are ethical guidelines for not only the interaction with clients but for the interactions with other counseling professionals. Without ethics to guide a counselor in their practice, they are in a position to do major harm to their clients. This course has shown me that ethics a re an integral part of the counseling profession and need to be respected. Refeences American Counseling Association (2014). 2014 ACA Code of Ethics. Alexandria, VA: Author Callanan, P., Corey, C., Corey, G., & Corey, M. (2014). Issues and Ethics in the Helping Professions. Stamford:CT Fiddler, M., Borglin, G., Galloway, A., Jackson, C., McGowan, L., & Lovell, K. (2010). Once-a-week psychiatric ward round or daily inpatient team meeting? A multidisciplinary mental health team’s experience of new ways of working. International Journal Of Mental Health Nursing, 19(2), 119-127. doi:10.1111/j.1447-0349.2009.00652.x Geyer, M. C. (1994). Dual Role Relationships and Christian Counseling. Journal Of Psychology & Theology, 22(3), 187-195. Lebow, J. (2014). Stages of therapy: Engagement, assessment, and termination. In , Couple and family therapy: An integrative map of the territory (pp. 151-170). Washington, DC, US: American Psychological Association. doi:10.1037/14255-007 Ponton, R. F., & Duba, J. D. (2009). The â€Å"ACA Code of Ethics†: Articulating Counselin g’s Professional Covenant. Journal Of Counseling & Development, 87(1), 117-121. Staton, A. R., & Gilligan, T. D. (2003). Teaching School Counselors and School Psychologists to Work Collaboratively. Counselor Education & Supervision, 42(3), 162.

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