A 60-year-old man comes to your office because of a persistent cough that has been bothering him for the past 3 months. His cough is dry and is more frequent during the evenings. He also notes frequent nasal congestion, especially when he is exposed to dust and cold weather. He reports no hemoptysis, weight loss, wheezing, fever, or changes in his appetite. What additional questions would you ask to learn more about his cough?

• How would you classify his cough based on the duration to help with the diagnosis?
• What diagnostic tests do you want to include to help you with your diagnosis?

Create a differential diagnosis flow sheet for this patient for this patient and include the diagnostics as well as the pharmacological management and rationale related to the differentials. Support your discussion with evidence-based research.

Respond to at least two colleagues who identified strategies different from your own by proposing alternative strategies.

Response to Hilda

Transference and countertransference are common when working with children because the therapist can envision himself or herself as the savior. They are attempting to save the child from harm or from a bad parent/parents. If the harmer is identified as the parent/parents, the therapist can create a competitive countertransference. According to Malawista (2004) “This form of countertransference, where the therapist has an unconscious competition with the parents may be particularly powerful when it coincides with a child’s own rescue fantasy that the therapist would be a better parent to the child” (p.377). If the therapist self-identifies competitive countertransference to be an issue they should never act on it.

A strategy for transference and countertransference is to prevent rescue fantasies. This prevention can be achieved by not objectifying the parents as bad or as the villain. “When the focus of treatment with children is based on the therapist as the ‘real and good’ object and parents as ‘real and bad’ objects, a therapist/patient countertransference/ transference configuration can emerge in the form of rescue fantasies within the therapeutic dyad” (Malawista, 2004, p. 384). The social worker should not take over the role as the child’s parent/parents. They should provide the parent with tools and resources and give the parents time to develop using those tools. The parent/parents should also be involved in any decisions regarding his/her child. The social worker should never decide the child’s treatment without parental consent.

Another strategy I would use is self-care. The therapist often becomes overworked and too busy to practice self-care. Working with children can lead to exhaustion, burnout, orcompassion fatigue. Consistent daily or weekly self-care is needed. I would use yoga, fishing, and exercise as self-care tools. I would manage my self-care daily to maintain longevity in my profession.

Reference

Malawista, K. L. (2004). Rescue fantasies in child therapy: Countertransference/ transference enactments. Child and Adolescent Social Work Journal. 21(4), 373–386.

Read each question and give me your opinion if you agree or disagree with it

charbel

1.

The two articles are interrelated but written in a different literature style. Both discusses the effect of a prior existing traumatic event on children that witnessed the September 11 attacks. However, each article targets different kind of audience The article from “Archives of Pediatrics and Adolescent Medicine” is a scientific research based on a retrospective cohort study. It targets students studying social sciences, professionals working with children and variety of interested researchers. Therefore, this research is considered a scholarly article. It can be used as a reliable resource for building a perspective on the impact of conjoined exposure to the WTC attacks and to other traumatic events on the behavioral problems of preschool children. This research presented information using proper outline starting with an abstract and finishing with discussions. The authors included figures and tables to further represent data in a clear and accurate manner. Table 1 shows that exposure to high intensity WTC events took place independent of other trauma exposure (Chemtob, Nomura and Abramovitz, 2008). The second article written by Carey is a news paper report published by New York Times that targets readers interested in having a general idea about the latest studies concerning the risk associated with prior trauma exposed on children that witnessed the September 11 attacks. This report focuses on the findings of “The Archives of Pediatrics and Adolescent Medicine” that shows the negative impact of 9/11 on children that experienced a prior traumatic event (Carey, 2008). This article is less reliable for observing the progress of the research implementation and theory establishment. However, this popular media article gives an overview of the research and insights on the surrounding opinion relating to it. Moreover, Carey expressed her own point of view regarding the research and supported it with additional researches regarding the functioning of the amygdala part of the brain during exposure to a traumatic event.

Pavel Redko

2.

The manner and format through which data is presented can completely change what the audience takes away from any type of news or informational media. Writers and editors have the power to infuse their opinions into their interpretation of scholarly data sets, compiling fact with opinion in a way that can sensationalize a topic or ‘dumbs it down’ in a way that makes it more interesting to consumers of the media. Examples of this can be found in any contemporary news broadcast, and constantly fills our social media feeds regardless our network of choice. The Word is a powerful tool, and content creators, editors and aggregators need to understand the responsibility that they have to their audience to produce content that is factual, unbiased and true to the spirit of the original source of the data set.

Benedict Carey provides an example of a writer that chose to refrain from sensationalizing a study related to a very sensitive subject, and instead provides an informed summation of a very detailed experiment. His article ‘Study finds prior trauma raised children’s 9/11 risk’ is a great read, although the title of the article still contained elements of the tabloid flair that is now quite common with the New York Times and other major newspapers. The target reader for this particular article is one that can be considered educated, but someone with an academic interest in the topic. The narrative refrains from being overbearing, and the reader doesn’t come away feeling burdened by facts and statistics. My one concern with his interpretation of the results of the study is that he glosses over the fact that traumatic events had an affect on children, regardless whether they had experienced traumatic events in the past. While both Carey’s article and the original study clearly indicate that prior events resulted in a higher likelihood of chronic stress-related symptoms, Carey’s interpretation doesn’t state clearly enough that children without prior trauma were still very effected by 9/11. According to an article detailing another study detailed in the New England Journal of Medicine, thirty-five percent of parents surveyed throughout the course of the study reported that their children had at least one of five stress syndromes following exposure to the terrorist attacks of September 11th. (Schuster et al., 2001) A scholarly paper covering the same study takes a different approach. Rather than relying on their abilities to craft a narrative, the authors of the article chose to present a very wide sampling of data sets relating to the effect that 9/11 had on children that were privy to the event. The reader is provided much of the raw information, but is also provided room to deduce their own interpretation of the data. The group’s summation of the study was very informative, going above and beyond in collecting a sampling of demographic information to include factors that didn’t even have a clear correlation to support the hypothesis of the study. The intended audience for the Chemtob, Nomura and Abramovitz article is a psychology professional or an individual interested in an in-depth analysis of the topic. All three of the contributing authors are veritable experts in the field of psychology, with added expertise in child psychology and stress response in children and infants Both articles describe the same experiment but the intention and perspective of each is very different. It is clear that each of the articles was written with a different target audience in mind, and there is nothing wrong with this. Not every reader of Carey’s article is going to want to know the detailed elements of the experimentation, and very few readers of the Chemtob, Nomura and Abramovitz article would prefer a narrative summation to ‘the real thing’. I am happy to see that a writer from a mainstream news source has the necessary restraint to properly present information on what many still consider to be a sensitive topic in this country, and look forward to taking a closer look at other articles written by Carey on other topics that can command my attention.

3.

christopher

For this experiment I chose case study 2. Based on the information, my hypothesis is that during weeks 1 and 3 Jacob will take less time to finish his homework due to the implementation of an incentive, that is early completion of work results in longer play time. On weeks 2 and 4, there will be a longer time to completion because the incentive for work completion is already given. In this experiment, the independent variable is Jacob’s homework, the dependent variable would be the amount of play time awarded to Jacob. When conducting this experiment, the two extraneous variables that would play a factor is the amount of homework Jacob is assigned and Jacob’s mastery of the material. Part II There is a study that I simulated in Stats that helped me lay the foundation for the actual study. The topic of the study is “The Perception of Manhood in Minority Communities and its Effects on the Family Dynamic”�. The mood regarding minorities and manhood is often misunderstood and misrepresented by those who live that reality. I believe that a positive trend in the perception of manhood in minority communities will provide a significant boost in male confidence level (where confidence level is equal to a numerical value) and in some way challenge the legacy definition of manhood. The independent variables are the race and gender of the participants whereas the dependent variables are the individual’s sociocultural definition of manhood and the post interview adjusted confidence level. There are several extraneous variables that could also be dependent variables in this study such as: engagement in an interracial vice intra-racial relationship (assuming that those in interracial relationships definitions would be different from those in intra-racial relationships), educational level (since those with higher educational levels would have a more modern definition of manhood) and positive paternal involvement (assuming negative paternal involvement would affect the definitions of those with positive paternal involvement).

4.

Vanessa

“Karl wants to determine whether adding a gas treatment to his full gas tank really does help increase the number of miles to the gallon his car gets. He suspects it does help but wants to test it to be sure he is getting his money’s worth for the treatment. He decides that for one month, he will track his gas mileage without the treatment. He records his gas mileage for the month. The next month, he adds the treatment each time he fills his tank. He records his gas mileage for the month and compares the mileage of the two months.” In example A, the hypothesis would be the outcome that Karl is attempting to predict in regards to his gas mileage. Since the example tells us Karl suspects adding the gas treatment to his gas tank does benefit his gas mileage, in this case, we could formulate Karl’s hypothesis would look something like this: “Adding a gas treatment to a full tank of gas will increase the number of miles to the gallon the car gets to a clinically or statistically significant degree.” The independent variable, which is the factor that Karl is manipulating in order to test his hypothesis, would be adding the gas treatment to his car’s full gas tank. The dependent variable, the factor that is being tested for dependency on the independent variable, would be the car’s gas mileage, or how many miles it gets to the gallon. A possible extraneous variable would be the temperature outside while driving, as temperature is an extraneous factor that affects gas mileage that also would generally be outside of Karl’s control and independent of the gas treatment’s effects I’ve always been interested in the natural ecological environments that exist around us. However, as we know, recent climate change has affected that plant life rate. An experiment I would like to conduct would be one concerning the rate of plant growth in relation to recent significant climactic change events on planet Earth. My hypothesis would be that places with a more industrialized, more highly concentrated population will see a greater negative effect on plant growth rate in those geographical locations due to higher amounts of greenhouse gas emissions. The independent variable would be concentration of greenhouse gases, and the dependent variable would be plant growth. Extraneous variables would of course be any factor that could possibly affect the plant growth independently of the greenhouse gases, such as fertilizer, soil, light, water, and pest population.

Instructions: Use what you have learned in this class about business writing (audience awareness, concision, precision, directness, simplicity, etc.) and craft a bad news email (see scenarios below). Make sure that this email follows the content and structure guidelines in the “Email Writing” Powerpoint that we went over in class.

Format: Please format this assignment like an email, including a “To:” line, a “From:” line and – importantly – a “Subject:” line. Also, please end with an appropriate closing. You will lose points if you fail to format this properly. Example:

To: Mary Smith

From: John Doe

Subject: Informative, attention-grabbing subject line that you write

Dear Mary,

Your message in here.

All the best/Sincerely/some appropriate closing,

John Doe

________________

Scenarios (select ONE of the following scenarios to use):

All scenarios were adapted from Guffey, Rhodes and Rogin, Business Communication: Process and Product, South-Western College Pub (2011).

1. Request Refusal: Carnival Rejects Under-21 Crowd

The world’s largest cruise line finds itself in a difficult position. Carnival climbed to the number one spot by promoting fun at sea and pitching its appeal to younger customers who were drawn to onboard discos, swim-up bars, and hassle-free partying. But apparently the partying of high school and college students went too far. Roving bands of teens had virtually taken over some cruises in recent years. Travel agents complained of “drunken, loud behavior,” as reported by Mike Driscall, editor of Cruise Week.

To crack down, Carnival raised the drinking age from 18 to 21 and required more chaperoning of school groups. But young individual travelers were still unruly and disruptive. Thus, Carnival instituted a new policy, effective immediately. No one under 21 may travel unless accompanied by an adult over 25. Says Vicki Freed, Carnival’s vice president for marketing, “We will turn them back at the docks, and they will not get refunds.”

You are a fairly new assistant director of marketing at Carnival, and your boss has told you to answer an email inquiry from Sheryl Kiklas of All-World Travel, a travel agency that features special spring-and summer-break packages for college and high school students. Sheryl is trying to book a cruise for the entire cheerleading, dance squad, and football teams from Large Urban University, the recent winners of the American Athletic Conference football title. Sheryl is talking about nearly 200 student athletes, several dozen more students who support the team as managers and trainers, and about two dozen coaches – essentially, a party cruise for college football players and cheerleaders. All-World Travel has been one of Carnival’s best customers. However, Carnival no longer wants to encourage unaccompanied young people. You must refuse the request of Ms. Kiklas to help set up student tour packages. Carnival discourages even chaperoned tours. Its target market is now families. You must write to All-World Travel and break the bad news. Try to promote fun-filled, carefree cruises destined for sunny, exotic ports of call that remove guests from the stresses of everyday life. By the way, Carnival attracts more passengers than any other cruise line – more than 1 million people a year from all over the world. More than 98 percent of Carnival’s guests say that they were well satisfied.

Your Task: Write an email to Sheryl Kiklas, All-World Travel Agency, skiklas@allworldtravel.com, politely declining the booking of Large Urban University’s athletic teams and informing her of Carnival’s shift in focus from young pleasure seekers to families; also let her know that you would like to continue Carnival’s business relationship with All-World.

2. Damage Control for Disappointed Customers: J. Crew Goofs on Cashmere Turtleneck

Who wouldn’t want a cashmere zip turtleneck sweater for $18? At the J. Crew website, many delighted shoppers scrambled to order the bargain cashmere. Unfortunately, the price should have been $218! Before J. Crew officials could correct the mistake, several hundred shoppers had bagged the bargain sweater for their digital carts.

When the mistake was discovered, J. Crew immediately sent an e-mail to the soon-to-be disappointed shoppers. The subject line shouted “Big Mistake!” Emily Woods, chair of J. Crew, began her message with this statement: “I wish we could sell such an amazing sweater for only $18. Our price mistake on your new cashmere zip turtleneck probably went right by you, but rather than charge you such a large difference, I’m writing to alert you that this item has been removed from your recent order.”

As an assistant in the communication department at J. Crew, you saw the e-mail message that was sent to customers, and you tactfully suggested that the bad news might have been broken differently. Your boss says, “OK, hot stuff. Give it your best shot.”

Your Task: Although you have only a portion of the message, analyze the customer bad-news message sent by J. Crew Chair Emily Woods and write an improved version. In the end, J. Crew decided to allow customers who ordered the sweater at $18 to reorder it for $118.80 to $130.80 (depending on size), and you can use this information in your message. (Customers were given a special order code at checkout to claim one of the discounted sweaters.) Remember that J. Crew customers are youthful and hip. Keep your message upbeat.

3. Bad News to Employees: No Go for Tuition Reimbursement

Ashley Arnett, a hardworking bank teller, has sent a request asking that the company create a program to reimburse the tuition and book expenses for employees taking college courses. Although some companies have such a program, your organization – Fox Federal Credit Union – has not felt that it could indulge in such an expensive employee perk. Moreover, the CEO is not convinced that companies see any direct benefit from such a program. Employees improve their educational credentials and skills, but what is to keep them from moving that education and skill set to another employer? Your company has over 200 employees. If even a fraction of them started classes, the company could see a huge bill for the cost of tuition and books. Because the organization is facing stiff competition and its profits are sinking, the expense of such a program is out of the question. In addition, it would involve administration – applications, monitoring, and record keeping. It is just too much of a hassle. When employees were hard to hire and retain, companies had to offer employment perks. But with a soft economy, such inducements are unnecessary.

Your Task: As director of human resources, send an individual response to Ashley Arnett. The answer is a definite no, but you want to soften the blow and retain the loyalty of the conscientious employee.