Issues on Training Employees Essay Example | Topics and Well Written Essays - 1500 words

Issues on Training Employees - Essay Example Businesses from around the world run global business this way. If an American business obeys a Saudi law by sending a man, Saudis must obey American Homeland Security laws by giving proper identification and taking off shoes when going through airport security. Global businesses can be profitable, if local laws and cultures are respected. This can only be accomplished through proper employee training. After World War II a global market opened up for business around the world. Business started expanding beyond their borders. IBM is an example of a global business. Early on IBM recognized the need for cultural diversity. Formal statements relating to diversity at IBM can be found as far back as 1953 by the then CEO Thomas J Watson Jr, who said: ‘it is the policy of IBM to hire people who have the personality, talent and background necessary to fill a given job, regardless of race, colour or creed.’ (Nicholson 2009) IBM recognized better business practices would be to incorporate the most qualified individual for each job. This task required cultural diversity, not only worldwide, but in their home country of the United States. The statement above was very progressive for the 1950’s. IBM started this policy and continued to this day by following: This type of policy was brought about through laws like the American Disability Act, Affirmative Action, and other labor laws. The work/life balance is important to every country’s cultures. Different cultures expect different work days, work weeks, and vacation practices. The advancement of women can be achieved in the majority of countries that IBM operates in. However, in several Middle Eastern and other Islamic countries this is not legal or even possible. In Saudi Arabia, Malaysia, Iran, and other Islamic countries women do not experience the same freedoms as they do in the West. An example would be in Saudi Arabia

Philosophical issus Essay Example | Topics and Well Written Essays - 250 words - 1

Philosophical issus - Essay Example s is mainly because one belongs in, a family may have high standards of behavior code where the members are trained to act and behave in a certain manner which may be very different from others. Additionally, community based behavioral system where they have established rules and regulation on behavior, for example, in some African communities it is wrong foe a young person to salute the elders with their hands instead the young person beds and the elder touched the forehead of the young person as a sign of respect (James and Stuart 100-187). Kantian ethics auger well with the conception of morality ethical this is because it mainly deals with moral realism, which claims that moral propositions refer to objective facts, which are independent of human opinion. Moreover, ethical subject reflects a close relationship between morality and people’s feelings and opinions of some issues creates disagreement of people on correct direct issues that real dispute is not about objective truth but about their own preference(Richard, pp 56-89). According to the social contract theory, in the absence of rules, law, and political order human life would be solitary, poor, short and nasty the element. Personal moral however guides a person on doing what is wrong without being followed by anybody around and prevent them from engaging in immoral activities. (James and Stuart

Distinguishing Fear From Anxiety

Distinguishing Fear From Anxiety Introduction Anxiety disorders constitute the largest group of mental diseases in European countries {Andlin-Sobocki et al., 2005, Eur J Neurol, 12 Suppl 1, 1-27}. Human anxiety disorders can be categorized into generalized anxiety disorders, panic attacks, Posttraumatic stress disorders (PTSD), Obsessive-compulsive disorder (OCD) and special phobias, are amongst the most prevalent with a 28% lifetime prevalence and an incidence of 18% {Kessler et al., 2005, Arch Gen Psychiatry, 62, 617-27}. Pathological expression of both fear and anxiety are thought to represent certain aspects of anxiety disorders. Specific phobias are considered, as fear disorders, whereas generalized anxiety is viewed as an example of anxiety disorders.   PTSD patients do not only suffer from conditioned fear symptoms to discrete cues that act as a reminder of a previous trauma, but they also exhibit persistent symptoms of sustained anxiety. The regulation of fear and anxiety is the heart of many psychopathological di sorders also reflected in the extremely high comorbidity rate with other mood disorders, such as depression. Up to 90% of individuals expressing an anxiety disorder also develop depression, which could increase suicide rates (Gorman, 1997) and constitutes a significant problem for the community in general. Currently available pharmacotherapies such as selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs), have emerged as effective alternatives to the benzodiazepines and have been paralleled by a similar growth in effective and available psychological treatments, particularly cognitive and cognitive-behavioural therapy. A considerable portion of patients, however, requires long-term treatment throughout the whole life or does not respond at all. For coping with these limitations, focusing on a better understanding of these diseases and improved treatment is urgently needed. Distinguishing fear from anxiety Fear Vs Anxiety Fear- Behavioural manifestation associated with clearly identified imminent threat. Anxiety- Generalized fear without object, an apprehensive anticipation of future potential threats The main function of fear and anxiety is to act as a signal of danger, threat, or motivational conflict, and to trigger appropriate adaptive responses. For some authors, fear and anxiety are indistinguishable, whereas others believe that they are distinct phenomena. In particular fear is a generalized adaptive state of apprehension to an imminent threat (Michael Davis, 2010). It begins rapidly and dissipates rapidly once a threat is removed. Fear is provoked by imminent and real danger, Animals may learn to fear situations in which they have previously been exposed to pain or stress, and subsequently show avoidance behavior when they re-encounter that situation. Young animals may show an innate fear reaction to sudden noise or disturbances in the environment, but rapidly become habituated to them. When they are used to a familiar environment, then a fear of novelty may develop. Ethologists have also made the important observation that fear is often mixed up with other aspects of moti vation. Thus, conflict between fear and approach behavior may results in displacement activities (e.g., self-grooming in rats and mice). Such displacement activities may be the behavioral expression of an anxious state. In contrast anxiety is often elicited by less specific and less predicable threats (Michael Davis, 2010). Anxiety is a generalized response to an unknown threat or internal conflict, whereas fear is focused on known external danger. It has been suggested, anxiety can only be understood by taking into account some of its cognitive aspects, particularly because a basic aspect of anxiety appears to be uncertain. Originally, anxiety is associated with arousal and vigilance, as a result it can be defined as longer lasting state of apprehension that can become pathological if its become extreme.    Defense and coping strategies Fear or anxiety, result in the expression of a range of adaptive or defensive behaviors, which are aimed to escape from the source of danger or motivational conflict. These behaviors depend on the context and the repertoire of the species. Fight or flight, was coined exactly 75 years ago, in 1929, Walter Cannon originally formulated this term for the human response to threat, Fear and anxiety. The phrase fight or flight has influenced the understanding and expectations of both clinicians and patients. However, both the order and the completeness of Cannons famous phrase are suspect. Fight or flight mischaracterizes the ordered sequence of responses that mammals exhibit as a threat escalates or approaches. In recent years, ethologists working with nonhuman primates have clearly established distinct fear responses that proceed sequentially in response to increasing threat. The order of these responses may have important implications for understanding and treating acute stress in humans . The sequence, originally described by Jeffrey A. Gray, begins with what ethologists call the freeze response or freezing, terms corresponding to what clinicians typically refer to as hypervigilance (being on guard, watchful, or hyper-alert). This initial freeze response is the stop, look, and listen response associated with fear. The survival advantage of this response is obvious. Specifically, ethological research has demonstrated that prey that remains frozen during a threat are more likely to avoid detection because the visual cortex and the retina of mammalian carnivores primarily detect moving objects rather than color. Immobilization or freezing, are usually elicited when the threat is inescapable, and is characterized by autonomic inhibition (hypotension, bradycardia), and a more pronounced increase in the neuroendocrine response activation of the hypothalamopituitary-adrenal axis and increased glucocorticoid secretion. This type of passive response was originally described by Engel Schmale as a conservation-withdrawal strategy. The concept of alternative (active/passive) strategies itself owes much to the work of Henry and coworkers. Specific brain circuits appear to mediate distinct coping reactions to different types of stressors. Psychopathological fear/anxiety Although fear acts as a physiological signal of danger, threat, or motivational conflict, it can become pathological and interfere with the ability to survive. Development of specific anxiety disorders, i.e., social phobia, obsessive-compulsive and panic disorders or specific phobias are consequences of pathological fear expression. Anxiety disorders are marked by excessive future fear, often in response to specific objects or situations and in the absence of a true danger. Anxiety disorders are extremely common in the general population. According to a recent epidemiological study, the lifetime prevalence of any anxiety disorder is 28.8% (Kessler et al, 2005). Increased anxiety in animal models, as a trait, can be attributed to at least two sets of factors: (i) a genetic predisposition, essentially linked to the expression of genes that are involved in the various neurochemical mechanisms underlying fear and anxiety; and (ii) the influence of environmental factors. These environmental factors can interact with the expression of the relevant genes during early development and determine the functional properties of the neural and biochemical systems involved in coping with stressful events. They can also modulate the learning processes that occur at a later stage, when the individual is confronted with various life events, and determine the capacity to cope successfully with aversive or threatening situations in adulthood. These predisposing factors, either innate or acquired, determine individual affective styles or coping strategies, which are thought to play an important role in vulnerability to psychopathology. Brain structures and functional circuitry involved in fear/anxiety Limbic System: Emotional brain Limbic areas include the hippocampus (HPC), amygdala, cortex, thalamus, hypothalamus and the bed nucleus of striaterminalis (BNST). Hippocampus and amygdala are considered as a main area involves in emotion, but I will mainly focus on the amygdala. Hippocampus The hippocampus is a part of the forebrain, located in the medial temporal lobe. The hippocampus consists of the dentate gyrus, the Cornu Ammonis fields (CA1-CA3), and the subiculum. The main information input to the hippocampus is via the entorhinal cortex and the main information output from the hippocampus is via the subiculum. Between entorhinal cortex and subiculum, three major pathways of the hippocampus are described. The perforant pathway from entorhinal cortex forms excitatory connections with the granule cells of the dentate gyrus (Bliss and Lomo, 1973). The mossy fiber pathway, formed by the axons of the granule cells of the dentate gyrus, connects the granule cells with the pyramidal cells in the area CA3 of the hippocampus (Lu et al., 1997). The Schaffer collateral pathway connects the pyramidal cells of the CA3 region with the pyramidal cells in the CA1 region of the hippocampus (Collingridge et al., 1983). Amygdala The amygdala is a limbic system structure and is a key target area implicated in emotional processing. It is composed of several interconnected nuclei located in the medial temporal lobes in mammals and is reciprocally linked to sensory cortices, thalamus, and autonomic control centers (Sah et al., 2003). Its internal and external connections permit the amygdala to evaluate environmental stimuli, attach salience to them, then generate appropriate autonomic, endocrine, and behavioral responses (Adolphs, 1999; Rogan LeDoux, 1996; Walker Davis, 2002). In addition, the amygdala is involved in detecting and evaluating emotional expression (Adolphs, 1999). The lateral nucleus of the amygdala (LA) has been implicated as the critical area where sensory stimuli achieve emotional salience. Consequently, the amygdala is needed for proper emotional processing, as in fear and anxiety, memory, and attention (Davis, 1997; Keele, Hughes, Blakeley, Herman, 2008; LeDoux, Cicchetti, Xagoraris, Roma nski, 1990). Plasticity in neurotransmission is important in maintaining the emotional significance of stimuli we encounter (Ehrlich, 2009). However, if those synapses and circuits become super-sensitized, what was once adaptive emotional behaviors can become psychopathologies, such as anxiety disorders and depression (Keele, 2005; Rosen Shulkin, 1998). Amygdala structure The amygdaloid complex is comprised of 13 nuclei, which are further divided into 3 groups: the basolateral complex, the cortical nuclei, and the centromedial nuclei. The basolateral complex is composed primarily of the basolateral (BLA) and lateral (LA) amygdala nuclei (Keele et al., 2008; Sah et al., 2003). Neuroanatomical studies reveal that there are extensive internuclear and reciprocal intranuclear connections (Pitkanen, Savander, LeDoux, 1997). Physiological studies further suggest that the amygdala nuclei are primarily individual functional units with the flow of information through the amygdala being highly organized, as seen in fear conditioning studies (LeDoux, 2000). Sensory afferents (context + tone) terminate in the LA (Romanski, Clugent, Bordi, LeDoux, 1993). The information proceeds in a predominantly unidirectional flow from the lateral to medial at which point the LA sends glutamatergic projections to the central nucleus of the amygdala (CeA), as well the BLA and o ther nuclei (Sah et al., 2003; Pitkanen et al., 1997; Smith Par eacute;, 1994). The CeA, where much of the amygdala nuclei projections converge and insubstantial intra-amygdaloid fibers exit, constitutes the output of the amygdala (Sah et al., 2003; Pitkanen et al., 1997). Two main cell types have been described morphologically and physiologically in the BLA (Rainnie, Asprodini, Shinnick-Gallagher, 1993; Sah et al., 2003). The first type is glutamatergic projection neurons that give off collaterals within the nucleus. They account for 70% of the neuronal population (McDonald, 1982). Their secondary and tertiary dendrites appear spiny, distinguishing them from the other neuronal type (Sah et al., 2003). In the LA, pyramidal neurons account for about 95% of the population. Pyramidal neurons show broad action potentials and spike frequency accommodation of varying degrees, and express N-methyl-D-aspartic acid (NMDA), a-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA), and k ainate receptors. Main input to these neurons is cortical and thalamic, but they are highly modulated by interneurons and monoaminergic afferents from brain stem nuclei (Marowsky, Yanagawa, Obata, Vogt., 2005; Rainnie, 1999; Sah et al., 2003; Sullivan, Coplan, Kent, Gorman, 1999). The second type of neurons is interneurons, also called stellate cells (Sah et al., 2003). They account for 5-10% of the neurons in the BLA and are local circuit gamma-aminobutyric acid (GABA) releasing cells with short duration action potentials and no spike frequency accommodation. AMPA receptors are expressed but NMDA receptors are reportedly absent (Sah et al., 2003). Like the projection neurons, input is cortical and thalamic with modulatory input from brainstem nuclei (Lang and Par eacute;, 1998). Afferent and Efferent Connectivity Amygdala innervation consists of sensory input from the thalamus and cerebral cortex and autonomic input from the hypothalamus and brain stem (Keele et al., 2008; Sah et al., 2003). All sensory modalities glutamatergically project to the amygdala via the thalamus, sensory cortices, association cortices, and other polymodal cortical areas (McDonald, 1998; Romanski LeDoux, 1993; Sah et al., 2003). Brain stem projections provide monoaminergic modulation of the amygdala. There is extensive serotonergic innervation from the dorsal raphe nucleus (DRN), dopaminergic innervation from the ventral tegmental area, and noradrenergic innervation from the locus coeruleus (Clayton Williams, 2000;Marowsky et al., 2005; McIntyre, Power, Roozendaal, McGaugh, 2003; Rainnie, 1999). Main output of the amygdala is projected from the CeA. Lesion and stimulation studies have shown cortical, hypothalamic, and brain stem regions to be target areas, directly and indirectly through projections to the bed nuc leus of the stria terminalis (Iwata, Chida, LeDoux, 1987; LeDoux, Iwata, Cicchetti, Reis, 1988; LeDoux, 2000; Sah et al., 2003; Turner, Mishkin, Knapp, 1980; Walker Davis, 2002). CeA efferents modulate specific behavioral and autonomic responses to fear, anxiety, and stress (Davis, 1997; Rosen Schulken, 1998; Sah et al., 2003). The CeAs connection to the hypothalamus allows activation of the sympathetic nervous system, such as an increase in heartbeat, galvanic skin response, and pupil dilation in response to fear. For inducing behavioral responses to fear, there are projections from the CeA to brainstem nuclei. For instance, connections with the periaqueductal gray induce freezing behavior and with the nucleus reticularis pontis caudalis (PnC) increase acoustic startle response (Davis, 1992). The brainstem innervation is so extensive that the amygdala contacts almost every brainstem region involved in autonomic functioning (Keele et al., 2008; LeDoux, 1992; Price, 2003). Behavioral Function The amygdalas contribution to emotion has long been documented. Initially, monkey bilateral temporal lobectomy studies performed by Klà ¼ver and Bucy (1937 1939), resulted in agnosia, hyperorality, hypersexuality, social withdrawl, difficulty recognizing emotionality of objects, and placidity. This became known as Klà ¼ver-Bucy syndrome. In following amygdalectomy studies a loss of fear, aggression, and normal social interactions with an increase in exploration was found (Goddard, 1964; Aggleton Young, 2000). Rodent lesion studies further demonstrated decreased active fear avoidance (Poremba Gabriel, 1999) and decreased passive conditioned fear response (Roozendaal, Koolhaas, Bohus, 1993), for instance, amygdala lesioned rats fail to show freezing behavior in the presence of danger, such as a cat (Blanchard Blanchard, 972). Specific lesioning of the lateral nucleus of the amygdala blocked conditioned fear (LeDoux et al., 1990). Amygdalectomized humans also show impairments in fear conditioning (LaBar, LeDoux, Spencer, Phelps, 1995). Additionally, human subjects do not recognize fear from facial expressions, voices, (Adolphs, Tranel, Damasio, Damasio, 1995), or music (Gosselin et al., 2005), and judge deceitful looking individuals as trustworthy (Adolphs, Tranel, Damasio, 1998). Stimulation and activation studies further corroborate amygdala lesion evidence. Human amygdala stimulation often produces observable fear responses as well as subjective feelings of fear (for review see Davis, 1992). Functional magnetic resonance imaging (fMRI) further shows activation of the amygdala during viewing of fearful faces (Rosen Donley, 2006) and following fear conditioning when the conditioned stimulus is presented (LaBar, Gatenby, Gore, LeDoux, Phelps, 1998). In animals, amygdala stimulation shows an increase in behaviors, such as, vigilance, attention, and arousal (Rosen Schulkin, 1998) and an increase in autonomic responding; such as, respiration, heart rate, and blood pressure (for review see Davis, 1992). Additional emotions reported in humans have been anger and rage (Joseph, 2000). One female subject displayed enraged facial expressions, lips retracted and grimacing, then progressed to aggressive behavior and attack (Mark, Ervin, Sweet, 1972). These are emotional behavior autonomic responses that are often a component of the fear response. Fear Conditioning and Long-Term Potentiation One commonly used technique for studying amygdala function in both animals and humans is conditioned fear learning (Bà ¼chel, Morris, Dolan, Friston, 1998; Walker Davis 2002). To accomplish this type of learning a neutral sensory stimulus (conditioned stimulus or CS, often a light or tone) is paired with a noxious stimulus (unconditioned stimulus or US) such as a mild electric shock. Upon repeated US-CS pairing the learned association between the two stimuli elicits a behavioral response (conditioned response or CR) that can last indefinitely with o nly a few pairings (Maren, 2005). The convergence of the cortical sensory input and thalamic relays from the spinothalamic tract in the amygdala as well as the abolishment of learned fear response after amygdala lesions implicate it as the site for conditioned fear learning (LeDoux et al., 1990; Ledoux, 2000). The learned association as well as the fear behavioral response is seen across many species and has been extensively studied in rats, cats, primates, and humans. The neural mechanisms have also been conserved across these animal species and probably humans as well (LeDoux, 1996; Price, 2003). Long-term potentiation (LTP) functions as a mechanism for increasing synaptic strength between two neurons. Experimentally it can be induced by tetanic stimulation of afferent fibers; however, naturally occurring similar mechanisms are induced in the LA during conditioned fear learning (McKernan Shinnick-Gallagher, 1997; Rogan LeDoux, 1996; LeDoux, 2000). Support comes from the observat ion that before conditioning, neurons in the LA respond to CS and US input. After conditioning, the postsynaptic neurons response to the CS is greatly enhanced. This suggests that fear conditioning provides a suitable means for examining amygdala synaptic plasticity and fear circuitry. The proposed LTP molecular mechanism initiating fear conditioning is that the CS induces a release of glutamate, which activates the glutamatergic receptors on postsynaptic LA neurons. The US further depolarizes the neurons causing the release of the Mg2+ block in the NMDA receptors (NMDARs) allowing an influx of Ca2+. The additional Ca2+ initiates second messenger cascades that are responsible for the increased neuronal response to the CS. Blocking NMDARs with the antagonist DL-2-amino-5- phosphonovalerate (APV) prevents the acquisition of fear conditioning. If APV is delivered after training it does not affect the consolidation of the fear memory further supporting the necessary involvement of NMDAR s in the LTP mechanism. Ca2+ influx due to L-type voltage-gated calcium channels (L-VGCCs) is also required for the association to occur. The L-VGCCs may be opening in response to the strong depolarization from the US, especially when postsynaptic spiking and back-propagating action potentials occur. How learned fear memories are acquired and the mechanisms involved is essential to understanding normal amygdala functioning. Fear conditioning provides a means for studying dysfunction of fear circuitry and the resulting abnormal fear behaviors. Fear circuitry receives intense inhibitory modulation. When the inhibition is removed the fear conditioning mechanisms, such as LTP, are unmodulated and the circuitry enters a hyperexcited state. This could potentially lead to abnormally enhanced fear associations resulting in heightened fear responses. Manipulating the fear circuitry by altering inhibitory modulators and then assessing the fear behavior responses could elucidate the mechanisms leading to fear and anxiety disorders. Neuropeptide Y (NPY) system: Involvement in fear and anxiety NPY: Overview Neuropeptide Y(NPY) was isolated from porcine brain more than two decades ago (Tatemoto et al., 1982). This 36-amino-acid residue is one of the most abundant peptides found in the central nervous system (CNS) of all mammals, including humans {Chan-Palay et al., 1985; Chan-Palay et al., 1986}. It is one of the most conserved peptides in evolution (Larhammar, 1996; Larhamar and Salaneck, 2004), suggesting an important role in the regulation of basic physiological functions (Larhammar et al., 1993). At present, five NPY receptor subtypes have been cloned and designated-Y1, Y2, Y4, Y5, and y6 (Dumont et al., 1993; Gehlert, 1994; Michel et al., 1998)-all of which couple to Gi/o proteins and inhibit the production of cyclic AMP (Palmiter et al., 1998). NPY has important modulatory functions in the immune and cardiovascular systems (Song et al., 1996; Michalkiewicz et al., 2001), circadian rhythms (Antonijevic et al., 2000; Yannielli and Harrington, 2001), food intake (Jolicoeur et al., 199 5), and seizure (Husum et al., 1998; Colmers and El Bahh, 2003) and the response to pain (Munglani et al., 1996). NPY is involved in anxiety related behaviors (Thorsell and Heilig, 2002), and there is increasing support for the role of NPY in mood disorders such as depression (Redrobe et al., 2002a). It is constantly reported that NPY producing anxiolytic-like effect and can be observed different battery of behavioral tests like elevated plus maze, light dark, open field, and stressed induced hyperthermia. Consistent findings across different rodent modes have been proving the true anxiolytic effect of NPY. The presence of different NPY receptors and the plethora of NPY-induced behavioral effect raise the question as to whether NPY and its receptors have an effect on fear, and extinction of conditioned fear. The NPY Y1 receptors can be found in number of brain regions but prominent in cerebral cortex, amygdala, and hippocampus (Kask et al., 2002). The majority of studies have been proved the involvement of NPY Y1 receptor in the regulation of anxiety. In the present study I am focusing on fear reducing properties of NPY following the hypothesis that anxiolytic-like effect of NPY mediated my Y1 receptors.

parsons dance company :: essays research papers

  Ã‚  Ã‚  Ã‚  Ã‚  I went to see the Parsons Dance Company on Tuesday April 9th. It was a very interesting show. There were actually many different techniques that I observed in this performance. This company uses many different forms of dance all into one technique, which makes them a unique company.   Ã‚  Ã‚  Ã‚  Ã‚  One characteristic of technique that I noticed in most of the pieces performed was fast paced movement. Every piece was very upbeat and synchronized with the music. All their movements were done to the accents in the music. In â€Å"Too Many Cooks† all the movements were in sync with the sounds in the music. In â€Å"Mood Indigo,† there were three duets and they all showed different colors of indigo by how they dancers expressed their movements. The first duet was the color purple and they showed a couple in love and the movement was very quick. The second duet was the color light purple and the movement was very slow, this was the only piece where the movement was pretty slow. Since it was a lighter color they made the movement slower which fit the whole idea. In many of the other pieces they movement was fast as well.   Ã‚  Ã‚  Ã‚  Ã‚  In the piece, â€Å"Caught,† the technique here dealt with strobe lights. David Parson’s choreographed this piece and it was very well done. They had the dancer jumping in the air while they strobed her to give it a suspended in time look to the movement. This is not really a dance technique, but more for perspective. It’s not very often you see someone in the air for a split second suspended in the air. This is a very unique technique and many other companies should try it. David Parson’s is a genius for designing this piece.

All The President’s Men

Alan Pakula's All The President's Men is set in 1972, around the events of the Watergate scandal. The Democratic Party headquarters has been burglarized, and famous reporters Woodward and Bernstein are on the case for the Washington post. They have to wade through waters of government secrecies, to reach their investigation all the way to the White House. Robert Redford plays Woodward well off of Dustin Hoffman's portrayal of Bernstein.Redford effectively uses minimalist expressions to convey the sense of an honest reporter observing the facts, while Hoffman seems comfortable in the skin of a charming, energized journalist, that is true to the integrity of his calling, despite his tendency to ruffle feathers—as in one of the opening sequences, where he plucks Redford's copy up without permission, to give it some polished touches.Redford reacts defensively, and Hoffman presses with his side of the disagreement—but ultimately, both convey amiable personalities that are on the overall balanced and fair examples of honest, stubborn and incorruptible journalists from America's past. Redford and Hoffman unravel the facts that result in Nixon's resignation, in a tense, constant train of dialog and drama, that draws the audience forward, quickly and steadily, toward inevitable events of political disgrace.Beside being a gripping and well-paced piece of dramatic cinema, however, President's Men also reinforces its authenticity as a representation of the workings of journalism, through its own correct correlations to the facts of one of the greatest scandals in American politics. Even though the movie acts as a sensational thriller of investigative reporting, it also stands as a unique copy of trustworthy investigation itself, staying so close to the facts. As John Berkowitz notes in his article All The President's Men: This scandal is widely renown and remembered by historians and people who lived through it.What’s so captivating, though, is Pakula revealing a behind-the-scenes look at how the story broke, as one clue after another was uncovered. From the first anomaly, and traveling further down the rabbit hole, we are so engaged that we can’t look away. So, indeed, the film is a work of art, and not just a act-by-act mirror of real-life events, but also, it can be seen that, just as the narrative unfolds like an onion, and rolls out ever faster as the plot progresses—also, the through-lines go in circles, as the reporters chase several leads at once, and the true story details are chronicled in a faithfulness to repetitive investigation..In his 1976 review, Roger Ebert notes: For all of its technical skill, the movie essentially shows us the same journalistic process several times as it leads closer and closer to an end we already know. The film is long, and would be dull if it weren't for the wizardry of Pakula, his actors, and technicians. What saves it isn't the power of narrative, but the success of techniq ue. Still, considering the compromises that could have been made, considering the phony â€Å"newspaper movie† this could have been, maybe that's almost enough.(Ebert) So, while the action mounts in ever-rising tension and even greater consequences of revelation, the story also takes time to recount the details of what really happened in a way that also pushes the piece past being just a virtuoso of cinematic excellence, into the realm of being a half-documentary, where we are left with a serious look back on a significant period in the politics of America, where justice would rain down, and powerful people would fall.It is true, for instance, of course, that one of the central pivot points of the film, the Watergate break-in, really happened, but that fact also lends to the plot a certain augmentation, whereby the craft of the story must abide by the facts, yet still deliver the cinematic recipe of entertainment, toward the end of audience enlightenment. It is also true, in fact, as another main gate of the film's framework to reality, that Nixon was re-elected that same year—but despite the credibility of fidelity to the truth, again, there comes with that design a certain sharpening of the tools of audience engagement.Ebert suggests that the film suffers from its sticking to the true story too much, but regardless of the aesthetic interpretation of the way the movie was made, it must at least be conceded that the melding of history and storytelling creates a unique fusion, where in some senses the best of both worlds can be explored—while some restraints of narrative execution might be acknowledged.Most of the details in the film vacillate between uncovering the truth, and chasing down false leads, all toward the inevitable denouement of the Watergate scandal—creating a great tension in the audience. Indeed, almost all of the highlights of interest, including the illegal intelligence gathering, and the in-depth expose of politica l corruption—were all true elements of this period in history–for little poetic license was required to embellish the work.The facts as they happened, embedded in the cinematic experience, seem a natural fit for informative entertainment. The true force and character of the work stems from its journalistic feel, which in turn, I feel, arises from it being mired in the medium of the very subject matter to which it referred. In other words, the film often acts as more of a documentary than a movie at times, while at other moments you feel as if you are caught up in the resolution of a climax or suspenseful scenario that only true cinematic excellence can deliver.In this sense then, I would disagree with Ebert's assessment that the film suffers from its faithfulness to the standards of journalism, but rather it benefits from this homogeneity, and in turn allows the viewer to be drawn even further into the events—being more trusting in their verisimilitude–an d therefore more committed to the outcome of the story. The audience's investment in the piece is heightened by the way the film breaks down the plot at times, to allow for dead-end leads and frustrating sources to be explored.The way that Redford and Hoffman seem to be going in circles in some scenes, or to be standing too still in one of the political storms of the century, lends to the believability of the drama–and therefore our attention to how it all plays out. References Berkowitz, John. (2008). All The President's Men. [online]. Available:http://thecelebritycafe. com/movies/full_review/12666. html Ebert, Roger. (1976). All The President's Men. [online]. Available:http://rogerebert. suntimes. com/apps/pbcs. dll/article? AID=/19760101/REVIEWS/601010301/1023

Electronic medical records systems

INTRODUCTIONScientific and social changes of the 21st century have brought a radical change in the Health care delivery system with excellent technological innovations. One such innovation is the Electronic Medical Record System. An electronic medical record (EMR) is a medical record in digital format.The health care sector is accountable today with an alarming rise in medical litigations.This legal accountability of the health care system has given rise to a number of documents that have to be recorded ,preserved and made available to the patients on demand.The documentation includes, 1.Diagnosis and Treatment Report which very Health Care delivery center today provides to the patient on the details of the diagnosis of the disease with follow up instructions, the Medicine information and the allergy reactions that could follow; dietary restrictions, dos and don’ts, restrictions and exercises prescribed. They take an acknowledgement either from the patient or an authorized per son after receiving the report.This documentation serves a key purpose in medical practice.2.The Health Record which is the proper documentation of records of all treatments and medications, as well as a record of a patient’s reactions and behavior. The health record is the written and legal evidence of treatment. This reflects only facts and not the judgment of the doctor. Careful and accurate documentation is vital for patient welfare and that of the doctor.Documentation includes, medication administered, treatments done with date & time, factual, objective and complete data, with no blank spaces left in charting, on flow sheets or on check lists, calls made to health care team, client’s response, signature of the nurse in every entry and consent for treatment. A private hospital inMilan, Italy, has been asked to handover for police verification of the medical records of at least twenty one cases who had heart valve surgery, following complaints that the surgeon repl aced heart valves even in patients who did not need them replaced.3. Informed Consent, which is a document, recorded before any terminally ill person receives his chemotherapy or an invasive procedure. The patient or his/her health attorney should give a well-documented informed consent before such procedures.Informed consent means that tests, treatments and medications have been explained to the person, as well as outcomes, possible complications and alternative procedures. Any medical hospital can be pushed into a center of a litigation storm after allegations without informed consent.4.Medical Billing and Insurance, which are part of the health care system in USA.Electronic medical record keeping facilitates access of patient data by physicians at any given location ,accurate   claims processing by insurance companies , building automated checks for drug and allergy interactions,clinical notes and laboratory reports.The term electronic medical record can be expanded to include systems which keep track of other relevant medical information.THE TECHNOLOGYFive levels of an Electronic HealthCare Record (EHCR) keeping can be classified as follows;1.The Automated Medical Record ,which is a paper-based record with some computer-generated documents. 2.The Computerized Medical Record (CMR), which makes the documents of level 1 electronically available. 3.The Electronic Medical Record (EMR) which restructures and optimizes the documents of the previous levels ensuring inter-operability of all documentation systems.4.The Electronic Patient Record (EPR) which is a patient-centered record with information from multiple institutions.5.The Electronic Health Record (EHR) adds general health-related information to the EPR that is not necessarily related to a disease. The development of standards for EMR interoperability is vital because of the fact that without interoperable EMRs, practicing physicians, pharmacies and health care institutions cannot share patient informat ion, which is necessary for timely patient-centered care.There are many standards relating to specific operation of   EMRs in the USA and across the globe. These include â€Å"ASTM International continuity of care record † in which patient health summary is based upon XML; â€Å"ANS1 X12†,which is a set of protocols used for transmitting any data including billing information; â€Å"CEN†,which is the European Standard for EMR; â€Å"DICOM†,A popular standard in radiology record keeping and â€Å"HL7† which is commonly used in clinical document architecture applications.There are many software programs specially developed for electronic record keeping. This includes ‘Doctors partner’, an advanced Electronic Medical Records (EMR) System with Integrated Appointment Scheduling Billing, Prescription Writer, Transcription Module, Document Management and Workflow Management built to meet HIPAA standards. ‘Practice Partner Patient Reco rds’ is an award winning electronic medical records (EMR) system, allowing practices to store and retrieve patient charts electronically. There are innumerable such branded medical record softwares available today (Ringold et.al.,2000)The American Medical Association and 13 other medical groups representing 500,000 physicians have signaled their intention to go electronic with the AMA formed Physicians’ â€Å"Electronic Health Record Coalition† to recommend affordable, standards-based technology to their constituents. President Bush has also promoted a nationwide computerized medical records system in a recent visit to a children's hospital at Vanderbilt University.THE COSTThe National Academy of Sciences report states that the health care industry spent between $10 and $15 billion on information technology in 1996. RED medic Inc., a California based firm have introduced a cheap online medical record service with an annual membership of about $35.The company Web site will collect, store and access everything ever wanted by health-care professionals to know about a patient’s medications, allergies, immunizations, conditions, doctors, emergency contacts and insurance providers. The system will store and transmit more complex information such as advance directives, EKGs and other essential medical documents and diagnostic imaging techniques. This health information service is capable of delivering information to any doctor or hospital, anytime, within the United States.RISK ASSESSMENTAlthough the issue of the privacy of patient records has received due attention in the last two years with arguments that Electronic medical records presents new threats to the privacy of patient-identifiable medical records, The Health Insurance Portability and Accountability Act of 1996 paved ways to protect the privacy of medical records Thus, any violation on these lines will be violation of the basic law.Under data protection legislation and the law i n USA, the responsibilty for patient records in any form including films and tracings from diagnostic imaging procedures such as x-ray, CT, PET, MRI, ultrasound, etc.   lies always on the creator and custodian of the record, who is usually a health care practice or facility and   the patient owns the information within the record and has a right to view the originals, and to obtain copies under law. Thus, electronic medical record system is a technologically viable cost effective system that has to be utilized by the health care sector governed by legal and ethical principles.CONCLUSIONEMRs can serve a great purpose by making the patient data available to any authorized physician   or   patient anywhere and anytime towards more transparent health care   when monitored effectively.REFERENCEHallvard Là ¦rum, MD, Tom H. Karlsen, MD, and Arild Faxvaag, MD, PhD. â€Å"Effects of scanning and eliminating paper based medical records on hospital physician’s clinical workà ‚  Ã‚   practice†.. Journal of the American Medical Informatics Association 10: 588-595. 2003.Medical Board of California: Medical Records – Frequently Asked Questions.Ringold, JP Santell, and PJ Schneider. â€Å"ASHP national survey of pharmacy practice in acute care   settings: dispensing and administration–1999†. American Journal of Health-System   Pharmacy 57 (19): 1759-75. 2000.US Code of Federal Regulations, â€Å"of Individually Identifiable Health Information†   Title 45, Volume 1,October 1, 2005.