Ethical Justification: Involving Human Volunteers in Trials

Ethical Justification: Involving Human Volunteers in Trials Ethical Justification of Involving Human Volunteers in Phase 1 Trials Zoheb Rafique INTRODUCTION Tremendous development in recent medical science and the consequent discoveries resulting in successful prevention and also cure of different diseases are shared by clinical research involving the human volunteers. Preceding the trials in the human subjects, and to ensure safety, the proposed drug and other interventions are either tested in animals (vivo) or in laboratory (vitro) to evaluate initial safe starting dose for the human beings and to key out the benchmarks for the clinical monitoring for the potential unfavorable effects. These pre human trials might not necessarily protect against the untoward effects in the human beings as happened in the case of thalidomide tragedy, which caused disability and killed thousands of babies born to the mothers, those who took this medicine. Use of healthy human volunteers in the preliminary experiments or phase I clinical trials either reduces or excludes risks of subsequent undesirable effects in the future trails (1). Phase-1 trials are conducted in order to test the safety, reactions and immunogenicity of vaccines in volunteers. Novel treatments for the cancer are first tested in phase 1 trials enrolling the patients with advanced disease, who have exhausted the standard treatment options. Phase-1 oncology trials are the pivot point in the translation of new cancer therapies from bench to bedside. Nevertheless, these trials remain ethically controversial. The controversy stems from the fact that, classically, phase-1 oncology clinical trials involve first-in-human testing of experimental treatment candidates in patients with a terminal diagnosis, who typically have exhausted standard treatment options. Commentators on the ethics of phase-1 clinical trials make diametrically opposed claims about the prospect of direct medical benefit from participation in these trials-benefits that can be attributed to receiving the experimental treatment intervention. One camp of benefit skeptics, inhabited mainly by bioethicists , characterizes this form of research as lacking any reasonable prospect of direct medical benefit. They see an ethical cloud hovering over phase-1 trials, because the vast majority of patients volunteer for phase-1 trials out of a motivation to receive medical benefit. In the view of these skeptics, such patients therefore harbor a ‘therapeutic misconception’ about research participation. This misconception calls into question the validity of informed consent and thereby undercuts the ethical basis of these trials (2). In this paper, I will discuss the ethical justification of the participation of human volunteers in phase-1 trials. DISCUSSION It is now widely accepted that medical research designed for the benefit of populations in developed countries should not be conducted with subjects recruited from populations in economically underdeveloped countries. Indeed, it is ethically objectionable to recruit from populations in resource-poor settings, even in developed countries, unless those populations are particularly susceptible to the condition the research is designed to relieve. In one study, there was proposal to conduct a phase-1 vaccine study recruiting subjects from the United States when the purpose is to assist the population of Mali, in Sub-Saharan Africa, to overcome the pervasive local consequences of Malaria. The ethical principle of justice, which requires a fair allocation of the risks and benefits of medical research, provides that the risk of research should not be planned to affect subjects from one population when benefits of the research are primarily directed to another population. It may accordingly appear, at first assessment, that the Malian government’s requirement that all phase-1 testing of the antimalarial vaccine be conducted in the United States is as unethical as it would be for the United States government to require that all phase-1 testing of a vaccine or other product intended primarily to benefit the population of the United States be conducted in Mali. Yet codes of ethical conduct are less consistent on this point than commentators usually require being. The World Medical Association’s much-cited Declaration of Helsinki: Ethical principles for Medical Research Involving Human subjects provides that â€Å"Medical research is only justified if there is a reasonable likelihood that the population in which the research is carried out stand to benefit from the results of the research.† By this criterion, conduct of the phase-1 study in the United States appears unethical. In the context of HIV/AIDS, however, the WHO’S Global program on AIDS (1989) provided that, â€Å"in general, initial phase-1 trials should be conducted in the country of origin of the vaccine†. By this criterion, phase-1 testing in the United States is appropriate, if a vaccine would originate and initially be governmentally approved in the United States. The situation would be otherwise, of course, if the NIH was funding the study for production of the vaccine in Mali. The ethical remains of where the initial phase-1 vaccine trials can be conducted most equitably, with least risk of exploitation and most protection of the interests of study subjects (3). Most clinical research trials today require the informed consent. Concern however is raised that subjects of phase 1 trial studies might not provide valid consent. In particular, few commentators worry that subjects of phase 1 oncology trials have an exaggerated idea of any chance of the therapeutic benefit. The Empirical studies tells that phase 1 trial participants are highly optimistic an d hopeful about their chance of personal benefit and also are motivated by hope for the clinical improvement. Altruism, on other hand is much less often identified as driving the decision to enroll, when quoted as motivating factor; and it typically is not the prime reason for the participation. In one research study, sixty one (61 %) of phase 1 oncology participants were doubtful about altruism would motivate the advanced cancer patients to enroll in the non beneficial research and several phase 1 volunteers in another study showed â€Å"Surprise† at idea of research participation based exclusively on altruism. Some studies find, however that the individuals in some other types of research trials often participate in the hope of helping others. As an example, schaeffer and colleagues describe that â€Å"hope others benefit† is one of the two most common motivational factors for the healthy volunteers (4). The research participants should be fully informed about the di fference between research and therapy and also risk-benefit ratio. The researcher should offer patients substitutes other than participation in the trials and also vulnerable population should not be included in the trials at any cost and especially in the phase-1 trials. CIOMS guideline 7 talks about inducement of participation in research. According to the guideline the research subjects can be reimbursed for their needs such as transport and other expenses, and also lost earnings, that is associated with participation in the research. Those persons who receive no any direct benefit from research may also get a small amount of money for their inconvenience due to the participation in research. All volunteers may get the medical services unrelated to research and could have tests and procedures performed free of cost. Payments in terms of money or in kind to the research subjects may not be so huge as to carry them to take unwarranted risks or volunteer against the better judgment. Incompetent persons are vulnerable to the exploitation for financial gain by the guardians. A subject who withdraws himself/herself from the research for various reasons related to research study, such as unacceptable side-effects of a study drug, or who is withdrawn on health grounds, should be paid or recompensed as if full participation had taken place. For all biomedical research involving human subjects, the investigator must ensure that potential benefits and risks are reasonably balanced and risks are minimized. The Declaration of Helsinki deals with the wellbeing of research subjects and the avoidance of risk. Thus, considerations related to the well-being of the human subject should take precedence over the interests of science and society, clinical testing must be preceded by adequate laboratory or animal experimentation to demonstrate a reasonable probability of success without undue risk, every project should be preceded by careful judgment of predictable burden and ris ks in comparison with the foreseeable benefits to research subjects or to others; physician-researchers must be confident that the risks involved have been adequately assessed and can be satisfactorily managed; and the risks and burdens to the subject must be minimized, and reasonable in relation to the importance of the objective or the knowledge to be gained (5). CONCLUSION The first basic principle of the Declaration of Helsinki requires biomedical research involving human subjects to be based on â€Å"adequately performed laboratory and animal experimentation and on a thorough knowledge of the scientific literature.† This implies that human subjects should not be used unless and until successful experiments in animals, as well as in vitro, have been completed. The Declaration, like most consensus documents formulated by representatives of different nations and medical traditions, is often vague and difficult to interpret in specific cases. It might allow proceeding to clinical trials if adequate animal studies demonstrated the inapplicability irrelevance, or absence of a useful animal model. If animals died immediately after receiving a vaccine, this would undoubtedly prohibit using the vaccine in human subjects (6). I will conclude this paper by saying that research is the only way of getting rid of various diseases through proper treatment an d also benefiting future patients from those diseases which have no cure at present or any medical treatment available, so research should not be stopped. In my opinion, human volunteers can be involved in phase-1 trials but following all international guidelines and all other aspects of biomedical ethics. REFERENCES Inayat Ullah Memon. JUSTIFICATION OF PARTICIPATION OF HUMAN SUBJECTS IN PHASE 1 CLINICAL TRIALS: AN ETHICAL ANALYSIS. Bangladesh Journal of Bioethics 2011; 2(2):26-29 Franklin G Miller and Steven Joffe. Benefit in phase 1 oncology trials: therapeutic misconception or reasonable treatment option? Clinical Trials. 2008; 5: 617-623. Bernard Dickens. Reverse Exploitation in the Baltimore Malaria Vaccine Study. Emily Abdoler, Holly Taylor, and David Wendler. The Ethics of Phase 0 Oncology Trials. Clin cancer Res. 2008; 14(12): 3692-3697. International Ethical Guidelines for Biomedical Research Involving Human Subjects. CIOMS 2002; 1-113. Wendy K. Mariner. Why Clinical Trials of AIDS Vaccines Are Premature. Public Health and the Law. AJPH. 1989; Vol. 79, No. 1: 86-91.

Generalist Intervention

Abstract This paper explores the topic of the disenfranchised population of the African American Culture, how the Generalist Intervention Model will be effective in my intervention, how African Americans were impacted by past situations, oppression and discrimination, resources available to this group, problems with this group, and social justice and social welfare. Introduction This paper examines the African American culture and how the social worker as a Generalist can intervene on their behalf. African Americans were used for slavery and denied any civil rights for many years of human history.African Americans experienced racism and discrimination but it did not impact their determination to seek freedom. Many people in US History fought for Civil Rights and failed many times. It was not until the revolution war that changes were attempted. Historical Background The struggles of the African American culture have existed for almost all human history. During the 17th century, Europ ean settlers in North America turned to slaves as a cheaper labor source. The first slaves arrived in Virginia around 1619 and slavery existed in America for the next 250 years.Many African Americans were captured during African wars and raids, and then sold to white traders (Williams, 2005). African Americans were treated poorly and striped from many rights. It was not until the revolutionary war that the cease of slavery was attempted. Some blacks were freed but were still mistreated in several ways. Blacks were not allowed in most public places and attended their own schools. The fight to end slavery was difficult, but abolitionists finally won. Slavery ended in the United States in 1865, but the people who were once slaves didn't get treated fairly after slavery ended.Therefore the Civil Rights Movement continued (Williams, 2005). African Americans have been the victims of both institutional and individual racism in ways that have left almost indelible imprints on every man, wom en, and child (Kirst-Ashman ; Hull, pg. 457). Problems for African Americans African Americans experience discrimination in employment, housing, health care, and education (Kirst-Ashman ; Hull, pg. 456). Job opportunities offered to African Americans are usually the lowest paying ones. This problem tends to lead to a higher poverty rate in the African American culture.Almost 24 percent of African American families live in poverty, according to the U. S. Census Bureau (2006) (Kirst-Ashman ; Hull, p 456). In 2003 the U. S. Census Bureau reported that African Americans have been said to have the highest rates of disability. Also, African-Americans tend to have a higher percentage in mental disorders. African Americans are often incorrectly diagnosed with having a mental disorder because they are often prone to use the emergency room for medical attention (Kirst-Ashman ; Hull, p 456).Some other problems seen in the African American culture are communications patterns and family experien ces. Many times the African American language is misunderstood for a lack of education. In all cultures grammar and speech are different but can be translated as the same meaning. As a social worker we must understand the different cultures and their way of communication. Another issue that a social worker should be educated in is family experiences. African American churches have played a big role in the history of the civil rights movement (Kirst-Ashman ; Hull, p 457).A major part of the social worker knows the background of the client’s religious views. Religion has a major impact on the history, decisions, and values of the client. Knowing the problems, experiences and historical background of any client can help the intervention process. The African American culture has had many obstacles and setbacks as they tried to gain Civil Rights. In today’s society African Americans have the same rights as other cultures in the United States. However, bitterness from past a ctions against African Americans is still an issue in today’s society.The purpose to analyze social policies such as Civil Rights are to specify the rights of specific groups such as women, men, persons of color, persons of every national origin, persons with mental and physical challenges, older persons, children and youth, persons of all faiths, and persons with specific sexual orientations (Jansson, 2009, p 7). Violation of the Civil Rights can be declared as unethical from an outcomes perspective (Jansson, 2009, p. 41). When people are denied the rights enjoyed by others, they are less likely to be an asset to society (Jansson, 2009).African Americans were stripped from having the same rights as others. First-ethnical principle views include honesty, due process, fairness, and not killing (Jansson, 2009). Many African Americans were killed from hatred acts and unfairness. The relativist approach views of what constitutes unacceptable violations of civil rights are powerfu lly shaped by culture and politics (Jansson, 2009, p 42). African Americans were denied the right to vote. The Civil Rights Acts have allowed the vulnerable population of African Americans to enjoy the rights that they were once stripped of. InterventionWhat is Generalist practice? Generalist practice knows a wide array of skills, working with individuals, families, groups, organizations, and communities, and the work in based on a body of knowledge, practice skills, and professional values (Kirst-Ashman ; Hull, p 3). The social worker links people with programs or services through a process of careful assessment. The advocate presents and argues for services for a single client who otherwise would be rejected, as well as fights to modify rules, regulations, or laws on behalf of a class or group of clients who usually might be discriminated against.The evaluator carefully collects and evaluates data to assess client or community need to formulate a plan of intervention. The outreach worker actively reaches into the community to identify people who need services and to help them meet their needs (Gibbs, Locke, Lohmann, 1990). When practicing the generalist approach the Generalist Intervention Model is the foundation. The GMI is a practice model that provides step-by-step directions concerning how to undertake the planned change process, which is general, directed at addressing problems (Kirst-Ashman ; Hull, p 32).There are three major features of the GMI, 1) eclectic knowledge base, 2) core seven-stepped planned process, 3) generalist approach. Eclectic knowledge base is when a wide range of skills to target any size system, and professional values are used. A social worker should be aware of the different cultures and values of individuals. When assessing a client the seven-step planned process should be used. These processes consist of engagement, assessment, planning, implementation, evaluation, termination and follow up. Using the planned process can help t he success in a client’s outcome.Using the generalist approach means that any problem can be looked at and evaluated from many levels of intervention. (Kirst-Ashman ; Hull) Another aspect to be considered when using the generalist approach is the level in which you will practice on. There are three levels that can be used in social work practice, macro, mezzo, and macro interventions. The practice of macro social work is the effort to help clients by intervening in large systems. Examples include lobbying to change a health care law, organizing a state-wide activist group or advocating for large-scale social policy change.Macro practice is one of the key distinctions between social work and other helping professions, such as psychiatric therapy. Macro social work generally addresses issues experienced in mezzo or micro social work practice, as well as social work research. Macro practice empowers clients by involving them in systemic change (Jansson, 2009). Mezzo social work practice deals with small-to-medium-sized groups, such as neighborhoods, school, or other local organizations. Examples of mezzo social work include community organizing, management of a social work organization or focus on institutional or cultural change rather than individual clients.Social workers engaged in mezzo practice are often also engaged in micro and/or macro social work. This ensures the needs and challenges of individual clients are understood and addressed in tandem with larger social issues (Jannson, 2009). Micro practice is the most common kind of social work, and is how most people imagine social workers providing services. In micro social work, the social worker engages with individuals or families to solve problems. Common examples include helping individuals to find appropriate housing, health care and social services.Family Therapy and individual counseling would also fall under the auspices of micro practice. Many social workers engage in micro and mezzo pract ice simultaneously. Even the most ambitious macro-level interventions have their roots in the conversations between a single social worker and a single client. Conclusion In conclusion the African American Culture had many struggles with obtaining their civil rights. Generalist social work can be a major benefit in helping the African American culture. The generalist practice engages in all walks of life.The generalist approach can help individuals gain needed resources and gain an equal opportunity in today’s society. References Gibbs, P. , Locke, B. L. , ; Lohmann, R. (1990). Paradigm for the Generalist Continuum. Journal of Social Work Education, 232-243. Jansson, B. (2009). The reluctant Welfare State: Engaging History to Advance Social Work in Contempory Society. Belmont: Brooks/Cole. Kirst-Ashman, K. , ; Hull, G. H. (2012). Understanding Generalist Practice. Belmont: Brooks/Cole. Williams, G. (2005). History of the Negro race in Maerica. New York: Putman's Sons.

Diary Of Internship Essay

My first day at work, on practice, to be more accurate, was mainly about getting familiar with the staff I will be working with. When I first got contacted from the UniCredit bank, I was told to go to business office of this bank that was located in street Zelenih beretki 24, and to talk with the person that was in charge of this business office, Mrs. Suzana Krajina Jusupović. I spoke with her, and she immediately introduced me to the staff, first with the people that have been working in section Payment operations, and then with other staff. People from the Payment operations section were my co-workers for that week. I taught were highly of these people, because I could see how much business are they doing. Monday was usually a day when a lot of business was done, since people accumulated their bills and obligations on weekends. I used this day to see how are the things done, since they gave me no responsibilities. Tuesday was the day in which I was introduced to the business of Payment operations and I have immediately begun to clarify the credit transfers, bills and to make stamps, because they couldn’t give me more authorities and power. I was in some way disappointed with this, because I wanted to prove that I can do more and help them in more ways than this. The thing I liked is that I had a contact with the people that were coming in the bank, and I could see how does it look to be on the other side. Day after that, I continued doing the same thing, and I was getting pretty good at communicating with people that were coming. My co-workers also explained me the division between the bills that we were getting. We were dividing them into the inner ones- the ones that had the sender account and the receiver account from UniCredit, the ones that were going from UniCredit bank to other banks, and the ones that had a connection with income. My job was to divide the accounts into these three categories, and then to give them to the next office, where these accounts were sent to further arrangement. Thursday was the day that I changed my workplace. They have sent me to the next office where I could see the next part of the process of the Payment operations. This was the part in which we were to scan all the accounts and then send them, in groups that are called batches, to Mostar, because the main UniCredit bank is located there. Then the people from Mostar would send us via mail the announcement if any of these batches had a mistake in it or were bad in any way. Batches were sent through very complex but yet easy to use application, that has been made by the IT support in Split. Batches were also divided in the same manner as accounts. In Friday, they have allowed me to work with scanner and I have pretty much enjoyed in this area, because all business was done with the computer, and I like this, because the possibility of error is minimal, and doing business is easier and faster. This was a very interesting job, although I had a feeling that I would be annoyed doing the same thing all over again. That is the thing I didn’t like in this job. I spend only a week in this section, and I could immediately know almost everything there is to know, and the job was the same from day to day, with a little possibility that something different will happen. Second week 19.-23. March When I came to a job on 19th March, I was immediately informed that I will be working on cashier that week. This branch of UniCredit bank was consisted of four cashiers, and one of them was in some way special, since it was a cashier for legal persons. Other three were regular cashiers. This special cashier had a special office, and the person working here, Sanjin, was separated from other cashiers and he was in contact with legal persons only. He was in contact with other cashiers though, since they were all connected in a case of, for example, lack of money. I was sent in this office, and since it was separate, I could do some things and make mistakes without of risk of being seen by other staff or by the clients. All the employees were working with the same software, and they called it Core. Basically, the persons with the bigger knowledge and skills had access to more applications in this program. Sanjin gave me a big responsibility from day one. My first assignment for that day was to input and register the transactions of one big client that was operating with the bank on daily basis. I couldn’t make a mistake, since I had a supervisor, and I wasn’t in a direct contact with the client, everything was done electronically. At the end of the day, we had to check if our balance of payments was zero, and to check if we have as much money in our cashier, as we have in our computer database. Tuesday was also very exciting day. I had a lot of job, and I was getting to know more about the cashier and the business related to it. Then, one big client came, and we had to give him a lot of money that we didn’t have in the cashier. I wasn’t aware of the fact that the money was sent to the vault that was in the building. I was given that privilege to go there, and I was very pleased with this, since they have told me that I was a first student that has been given this chance. I was impressed by the amount of money there- I thought that I have to go to a movie theatre to see that. The vault had about eight men employed there, and they were counting the money. The whole sight was impressive. After all this, I came back to office and continued with regular activities. The next day, nothing excited happened really, I was just given some more responsibilities since I was allowed to do transactions with clients that came in (this also had to be done electronically). I could also count the money on those awesome machines, and I was pretty satisfied because I always had a desire to do that . Thursday was the day I found out that Sanjin was in charge of cash dispenser machines, and he was ought to keep them full of money. He would send an e-mail to persons that could check the status of these machines with the computer, and they would say if there is a need for a refill. I was very pleased when I found out that we have to go and place the money in those machines, because I was interested to see how it works. We first put the money in boxes that were made to be placed in the machines. We went to those machines, locked the door so nobody could come in, and replaced those boxes full of money with the empty ones. It wasn’t complex machine at all, inside of it there was a keyboard similar to the one that you can see on the computer, and with the keyboard we could insert the amount of money that we have put there in the computer memory. Friday was the day when I continued doing business with regular clients, and I felt so natural in doing this, I could almost see myself doing this for the rest of my life. This job was very unpredictable and full of action, and that is what attracted me. Third week 26.-30. March Since there was obviously my goal to find out more about this job, because I can really see myself doing some of this work, Suzana wanted me to go to the retailing sector for two remaining weeks. As I knew from before, banks have a problem of tangibility of their business, since all the services have that problem. Banks decided to represent some of their services as products, so the people could see these tangible parts, such are credit cards or cash machines. They also represent their credit loans as products, and I was sent to the retailing sector to see how are credit loans actually sold. These credits can be divided into mortgage credit, cash/money credit, bilateral credit etc. During my work in UniCredit I have only been introduced to cash credits. This branch, its retailing sector to be more precise, was segmented into two parts: in one part family bankers were employed, and in other part these bankers were called personal bankers. The difference was not actually in the number of the people who were operating with bankers, but in the income of the people. If someone had an income of 2000 KM or more, he would be assigned to the personal banker. If not, they would be assigned to family banker. There are four family bankers, and two personal bankers employed in that branch currently. I was given the freedom of choice to go where ever I want, and to watch who ever I want while doing business. Monday was the day when I was introduced with the meaning of the credits and with the way in which these bankers were communicating with people. I immediately saw that this part of work is a lot harder that all the others I have seen so far, since these people had enormous amount of work. They had to prepare the credits, to form a map and a plan of credit, to validate it, to send it to approval, and in the same time, they had to communicate and encourage other people to „buyâ€Å" credits. I didn’t have much to do, since I was asked just to watch and listen them doing work. Next day was a little bit more interesting. I had an opportunity to see software designed for credits. This application was pretty complex, but just like everything based on computer, it had a possibility of correcting any possible mistakes. The thing is that this application had numerous steps and fields you need to fill in order to make a credit map. This map is a foundation of credit, and the map is sent to the Board of Credit Risks, when finished, and this Board then makes the decision whether to approve this credit or not, based on information from the map. In Wednesday I was getting some more information about credit. For the first time, I’ve watched credit development from the start. When client came, he wanted to know if he can get a cash credit in 10,000 KM amount. First thing that had to be done was that the banker had to check if he had any other credits and debits in other banks. Banker could automatically see whether or not the client has some credits and debits in UniCredit bank from the database. Only way in which the banker could find out about the full list of obligations of the client was to send an e-mail to Central bank register, and to get this information from the people employed in Central bank. Then, when given this information, the employee could see if the client is in a possibility to get a loan. After this step, the banker needs some additional information, such as if the person needs a guarantor or not, his ID number, his credit card status etc. After this, the banker is making credit map. I also learned how to scan all the files necessary for the credit, how to separate them, and how to index those files. I was asked the same day when I have learned this to track this new scanning program, and to inform the IT support if I had any problems. Thursday was very interesting because I could speak to the clients now, since I already had some knowledge about credits. I was, of course, constantly mentored by other bankers, and I have tried to prove myself as much as possible. I have soon realized that it is not easy communicating with people on a daily basis, since they sometimes don’t have patience and understanding of delays and possible mistakes. I have continued scanning all the credits, and then sending them to further editing. These credits were then sent to a segment that is called Credit administration, and then to Board of Credit Risks. Next day I have been granted with more opportunities of proving myself since they let me input client information and data in the computer. I was a little bit scared, since I knew how big responsibility this was and how one wrong click can slow things down, but I did just fine. It was the end of the month, and all of the credits were ought to be send in order to be approved, so everybody was pretty nervous. I had a lot of obligations and tasks, since they all needed help to catch up and to finish their business. I continued with scanning the files, and with sending them to Credit administration. Deadline and its influence could be seen on these employees, and I felt a need to help them as much as I could. Fourth week 2.-6. April My final week of the practice started at the same place as the third one. First day of this week was regular one, since I continued doing my job with the credits. I was spending more time with personal bankers, who were doing the business with the clients who had income of 2000 KM or more. They, of course, had a smaller number of clients, but these clients were very rich and they were bringing more money to the bank, so the bankers that are in contact with these clients need to have a good communication skills. Tuesday was the day when I was assigned with the most boring job I’ve done there. I had to go to the archive and find some old credits and database. This wasn’t the thing I was hoping to do, but I realized that this is also the way in which I can contribute. I’ve looked through these old files, and I had opportunity to compare old and new way of making credit maps. Next day, when I came, I was told that I have already done on every job they have planned me to work on, so I had a full freedom of doing whatever I want. I have decided to stay in the retail sector that day, since it was the place in which I had the best connection and communication with the people, and it was the most dynamic place. I have also been asked to help with the cash dispenser machines, and I did that again. I have given my report to the IT sector regarding the scanning software, and they were pretty satisfied with my results. In Thursday I have decided to go back to the cashier, since I have enjoyed there very much. I counted the money again, and got the opportunity to see all the foreign currencies, like Canadian dollar, Australian dollars, and others, which was great. I’ve met a lot of interesting people that day, and since we finished with all legal persons, we could invite and do transactions for other people as well. My last day at work was 6th April. I was disappointed by this, since I had really liked spending time here and learning new things. I spend the whole day in retail sector, and I was once again looking at credits and loans. At the end of the day, I’ve gave my evaluation sheets to Suzana and asked her to fill it. I finished with all the best marks, and she told me I left a strong impression on her. She also wished me to be her co-worker one day. I was very happy about this, since I had a desire to satisfy all the expectations and to do my practice in a fine manner. Before leaving, I’ve said goodbyes to everyone and thanked them for their faith in me.

The Effect Of Nutritionist On Health Treatment Of Bn

The nutritionist’s role in treatment of BN is to help develop a reasonableplan of controlled eating while assessing the patient’stolerance for structure.Immediate goals must beinterruption of the binge-and-purge cycle, restoration of normaleating behavior, and stabilization of body weight, even if already overweight. Attemptsat dietary exacerbatebinge-purge behavior.Metabolic state must be considered when prescribing thebaseline diet.Assessment ofclinical signs of ahypometabolic state, like a low T3 level and cold intolerance, is useful in determining the caloric prescription. If a low metabolismis suspected, a caloric prescription of 1600 to 1800calories daily is a reasonable startbut this prescriptionshould be titrated upwards, in 100 to 200 calorie increments,to stimulate the metabolic rate. Ultimately, a weightmaintenance diet of 2200 to 2400 kcal/day is attainable and welltolerated (Halmi, 2005). Body weight should be monitored with a goal of stabilization;however, BN patients need a great deal of encouragement to followweight maintenance versus weight loss diets. They must bereminded that attempts to restrict caloric intake may only increasethe risk of binge eating.A balanced macronutrient intake is essential for the provisionof a regular meal pattern. This should include sufficientcarbohydrates to prevent craving and adequate protein and fatto promote satiety. In general, a balanced diet providing 50% to55% of the calories from carbohydrate, 15% to 20% fromShow MoreRelatedBulimia Nervos Eating Disorder1271 Words   |  6 Pagesthey believe are seemingly â€Å"low in calories†. Often, an individual may feel out of control during eating binges and even ashamed afterwards. Clinicians often refer individuals to Cognitive Behavioral Therapy, a specifically adapted version called CBT-BN, as well as primary and secondary care. There are two types of Bulimia, the purging type and the non-purging type. The non-purging type will tend to over exercise or fast after they have consumed such a large amount of food. As stated before, theRead MoreSymptoms Of Mental Health Issues Essay2046 Words   |  9 PagesI was an RA when I was in college, so I am no stranger to the signs and symptoms of mental health issues. In my eighty-person dorm I ‘talked a girl off a ledge,’ dealt with alcoholism and drug abuse, and was there for countless nights of tears brought on by homesickness and hazing. However, in all my time as an undergraduate, the one issue that plagued my friend group and the young women on my campus the most was something I had never encountered until I stepped foot on my college campus. It wasRead MoreThe Walt Disney Company and Disney Management25371 Words   |  102 Pagesproï ¬ t. 2005—Bankruptcy Pending In early 2005, Disneyland Paris was on the verge of bankruptcy. The newest park attraction at Disneyland Paris, Walt Disney Studies, featured Hollywood-themed attractions such as a ride called â€Å"Armageddon—Special Effects† based on a movie starring Bruce Willis, ï ¬â€šopped. Guests said it lacked attractions to justify the entrance price, and others complained it focused too much on American, rather than European, ï ¬ lmmaking. Disney blames other factors: the post-9/11 tourism