Case Study On Susan Cushing Syndrome- myassignmenthelp.com

Question: Discuss about theCase Study On Susan Cushing Syndrome. Answer: Introduction Cushing syndrome is the clinical depiction as a result of increased levels of plasma glucocorticoids. This condition is rare but most frequently occurs in adults aged 25-50. It may be Adrenocorticotropic hormone (ACTH) reliant or in other instances autonomous. ACTH dependent causes include adrenal tumors that secrete glucocorticoids, diffuse ACTH secreting tumors, micro nodular hyperplasia of the adrenal gland (90% being unilateral) and prolonged exposure to exogenous steroids in the management of autoimmune diseases including Systemic Lupus Erythematosus and rheumatic arthritis. ACTH independent often involve receptor signaling and expression by adrenocortical cells a case seen in Beta adrenergic agonists, ADH, gonadotrophin releasing hormone (GnRH)and in ACTH producing anterior pituitary adenomas (70% of cases). It is also commonly associated with obesity and Diabetes Mellitus Type II and hypertension (National Endocrine and Metabolic Diseases Information Service (NEMDIS), July 200 8). Presentation Individuals with Cushing syndrome present with truncal obesity, fatty buffalo shoulder, facial obesity hence the moon face appearance, poor muscle development, unproportioned arms and legs. Visible purple striae may be seen on the abdomen, arms, thighs and breasts. Women may report of infertility, irregular periods and susceptibility to fractures especially if premenopausal. In some cases, depression and anxiety disorders, hyperglycemia, fatigue and in about 85% hypertension may occur. The female-male sex based incidence ratio of Cushing syndrome due to adrenal or pituitary tumors is about 5:1. Pathophysiology Of Cushing Syndrome Extended exposure of body tissues to elevated levels of cortisol(glucocorticoid) causes Cushing syndrome. ACTH-dependent causes are mainly endogenous and include Cushings disease (60-70%), CRH-producing hypothalamic tumors and macro nodular hyperplasia. In ACTH-independent cases foundations include ectopic cortisol production by ovarian carcinomas, small cell lung carcinomas and neuroendocrine tumors resulting in high ACTH levels. Overproduction of endogenous glucocorticoids independent of ACTH is on most occasions due to adrenocortical neoplasms(adenomas). In a homeostatic body system, the hypothalamus secretes Corticotrophin releasing hormone(CRH) to the anterior pituitary which releases Adrenocorticotrophic Hormone that act on the Zona fasciculata producing cortisol from the progenitor cholesterol. The plasma reference levels are 140-700nmol/L in the morning and 80-350nmol/L at midnight (Biochemistry Reference Ranges Goodhope,2012). Cortisol functions to stimulate gluconeogenesis in fasting state, downregulates the production of interleukin-12and Tumor Necrosis Factor Alpha by antigen presenting cells upregulating the production of IL-4, IL-10 and IL-13 by the T helper cells resulting in prevention of an overactive immune response. Furthermore, cortisol antagonizes the functioning of insulin. This results insulin resistance and decreased energy dependent translocation of glucose by the GLUT-4 transporter this in the case of Cushing syndrome the hyperactivity of cortisol results in the manifestation of diabetes mellitus type II. In calcium homeostasis in bone, cortisol results in increased resorption, there is also increased potassium efflux and reduced intestinal calcium absorption. Excess of cortisol causes osteoporosis and hyperkalemia in this case (The Journal of Clinical Endocrinology and Metabolism. 15 (2): 17681). Cortisol also functions to increase the level of free amino acids through protein catabolism. It also inhibits immunoglobulins IgA and IgM, in hypercortisolism, there is evident hyperlipidemia and decreased peripheral glucose utilization as a result of liberated amino acids. There is also evident muscular atrophy, thin skin and subcutaneous tissues, scraggy thin hair and uneven fat distribution. Significant diuretic effects of cortisol occur in high cortisol levels in serum, the potassium ions are excreted and sodium retained. The salt and water retention results in the round moon face appearance seen in Cushing Syndrome The role cortisol in the CNS cannot be overlooked. In cognition it is involved the hippocampal formation on short term memory. The control of the circadian rhythm (McDonalds veterinary endocrinology and reproduction (5th ed) via control of the suprarchiasmatic nucleus. In Cushing syndrome sleep and mood disorders are common. Depression may also occur and psychologic stress exaggerated. In obese individuals there is elevated cortisol courtesy of cortisol regeneration from cortisone by hydroxysteroid 11-beta dehydrogenase 1. Susans respiratory rate was 30 breaths per minute which is higher than the normal range of 12-20 breaths per minute, she is also hypertensive with a recorded blood pressure of 160/90 mmHg (normal range of 90/60- 120/80 mmHg). Her body temperature was at 35.0C, this is below the normal reference range of 36.5C-37.3C. There is also a reported increase in the pulse, the recorded value is 128bpm, the value is elevated off the normal range of 60-100bpm. There is subclinical pain with a score of 0/10. The urinary output is reduced to 5mls per hour (normal 30-80ml/per hour). The respiratory recovery after anesthesia is slow and there is a reflex apnea due to the compensatory mechanisms of the surgically induced hypoxia. The recovery from the respiratory depression takes elimination of carbon dioxide and reduction in the ventilation to perfusion ratios in the lungs. The post-op hypertensive state was triggered by the reflex reaction to glucocorticoid suppression. There is also marked reduction of the production of aldosterone. This mechanisms involve a secondary adrenal insufficiency resulting from the suppression of the Hypothalamic-pituitary adrenal axis (HPA). Suppression of the renin angiotensin system and reduction of the diuretic mechanism of action of cortisol produce a resultant increase in the cardiac output thus an elevated blood pressure. Additionally, the basal body temperature is reduced, this is as a result of the suppression of the pontine temperature control centers and the recovery phase from the surgical anesthesia. Susan is also in a steroid crisis and the physiological mechanisms are sabotaged by the sudden withdrawal of he obviously high levels of cortisol. The reduction is the metabolism by these two individual triggers result in the transient hypothermia. Coupled with the hypothermic state is the increased pulse rate. This is produced as a result of tachycardia and increased nervous stimulation after the surgical pressure. The body registers a shock which culminates in the increase in the heart rate. Reduction in aldosterone and altered feedback to the HPA axis causes a reduced production of urine. There is recorded retention of sodium of potassium ions thus a hypovolemic shock. A conglomeration of all these pathological cases result in Susans post-operative presentation. Considering the presentation, Susans management involve the monitoring of all her vital signs. The values are measured and recorded two hourly. Any notable change is reported for further intervention. Electrolyte values are also taken on a frequent schedule especially in the first 48 hours after the surgery. Administer intravenous fluids and account for the fluid intake and output at regular intervals. Pain is also monitored and analgesics administered accordingly to alleviate pain. To avert any episode of hypovolemic shock or Addisonian crisis, Cortisol is administered to replace the inadequate hormonal levels. Care for the laparoscopic site, the wound is drained and cleaned using a sterile technique to reduce the risk of an infection. The indwelling urinary catheter is removed on the first day post-op and a clear liquid diet is started on the first day. Dietary progression is made on a need-basis. Psychosocial support is given to relieve anxiety. On discharge, the Susan and any appropriate family members will get an explanation and schedule on the take home medication and prescription. General health messages on the effect of the surgical procedure and physiological response to the resultant procedure. The messages include dietary management of sugar, side effects of glucocorticoid therapy and the importance of physical exercise of the overall outcome of the recovery process. Details of the next checkup are also provided for .Susan also has to report any alarming signs in the process. Interdisciplinary Heathcare Team Susans condition requires an entire team approach to effectively manage her condition. Apart from her the primary medical and nursing team the social worker, nutritionist and the health educator are involved. The integration of the entire team is required to produce an outcome sufficient to make Susans life more productive and fruitful. The medical condition will become more lucid. The social worker provides is the backbone of the familial responsibility at hand. The care of all her three children verses her income from the casual employment. She does require an extensive monetary plan and linking up to more agencies to provide financial support and education to children. On the returns from her wages, the social worker provides liaises with monetary organizations that provide saving plans and insurance policies suitable to the financial muscle Susan has. The nutritionist evaluates and provides the nutritional needs of Susan. They assist in providing a treatment plan which may include special diets, foods that help ease swallowing, dietary changes as a result of the condition and also patient and family education on nutrition topics related to Susans condition. The health educator will also be of much importance in educating Susan and his family on topics related Cushings syndrome and other general health concerns. This include causes, prevention and even treatment. Topics concerning usage of over the counter drugs can also be handled by the health educator. Others include personal hygiene and general cleanliness. Conclusion Susan is obese and presents with a typical case of Cushing syndrome, determination of her differential diagnosis is based on her presenting case of primary depression and alcoholism. The diagnostic approach to the cause of the hypercortisolism involves a 24-hr urine sample collection and assay of cortisol levels. In elevated cortisol levels, a low dose of dexamethasone (2mg/day for 2 days) is administered and on the subsequent urine collection if the cortisol is suppressed by more than 50% then it is definitive case (European Journal of Endocrinology, vol. 176, no. 5, pp. 613624, 2017). When suppression is non-evident a repeat test is done with a higher dose of 8mg /day for 2 days and as in the case there would be no suppression because the cause of ACTH suppression secondary to an adrenal tumor. The adrenal tumor is visualized via a CT Scan and as indicated a surgical plan of a right adrenalectomy is done. The procedure is done and she has due rehabilitation and integration to her s tate. References Barrett, K. E., Barman, S. M., Boitano, S., Brooks, H. (2016). Ganongs review of medical physiology. 26th edition page 364.NY: McGraw-Hill Medic Boscaro, M., Barzon, L., Fallo, F., Sonino, N. (2013). Cushing's syndrome.The Lancet,357(9258), 783-791. Chyun, Y. S., Kream, B. E., Raisz, L. G. (2015). Cortisol decreases bone formation by inhibiting periosteal cell proliferation.Endocrinology,114(2), 477-480. Lindholm, J., Juul, S., Jrgensen, J. O. L., Astrup, J., Bjerre, P., Feldt-Rasmussen, U., ... Laurberg, P. (2014). Incidence and late prognosis of Cushings syndrome: a population-based study.The Journal of Clinical Endocrinology Metabolism,86(1), 117-123. MARIEB, N. J., SPANGLER, S., KASHGARIAN, M., HEIMANN, A., SCHWARTZ, M. L., SCHWARTZ, P. E. (2012). Cushings syndrome secondary to ectopic cortisol production by an ovarian carcinoma.The Journal of Clinical Endocrinology Metabolism,57(4), 737-740. Newell-Price, J., Bertagna, X., Grossman, A. B., Nieman, L. K. (2016). Cushing's syndrome.The Lancet,367(9522), 1605-1617. Palmore, W. P., Anderson, R., Mulrow, P. J. (2013). Role of the pituitary in controlling aldosterone production .Endocrinology,86(4), 728-734. Lodish M, Stratakis CA. A genetic and molecular update on adrenocortical causes of Cushing syndrome. Nature Reviews Endocrinology. 2016 May;12(5):255. MARIEB, N. J., SPANGLER, S., KASHGARIAN, M., HEIMANN, A., SCHWARTZ, M. L., SCHWARTZ, P. E. (2012). Cushings syndrome secondary to ectopic cortisol production by an ovarian carcinoma.The Journal of Clinical Endocrinology Metabolism,57(4), 737-740. Stimson, R. H., Andersson, J., Andrew, R., Redhead, D. N., Karpe, F., Hayes, P. C., ... Walker, B. R. (2015). Cortisol release from adipose tissue by 11-hydroxysteroid dehydrogenase type 1 in humans.Diabetes,58(1), 46-53. Ushiyama, T., Suzuki, K., Kageyama, S., Fujita, K., Oki, Y., Yoshimi, T. (2014). A case of Cushing's syndrome due to adrenocortical carcinoma with recurrence 19 months after laparoscopic adrenalectomy.The Journal of urology,157(6), 2239.

An Online Essay Sample is a Great Idea

An Online Essay Sample is a Great IdeaA lot of people are looking for an Osu Essay Sample when trying to get a college degree online. They are looking for a quality essay that will help them get accepted into a school that they are interested in.It's important that you take your time when taking a University course online because there is so much more going on than just sitting in a classroom and sitting at your desk. The things that will happen while you are learning how to play the game competitively are things that you need to be aware of, but in a short amount of time.It's great to find an essay that is designed specifically for a college online course. There are many of these online, but if you're looking for a free one, the most common one that is found is a word document. You can just right click on it and choose 'Save As' to save it to your computer.Another common Osu Essay Sample that you may find is a free trial version. These are usually found by searching on Google or Yah oo, although some places offer it for free. This is a good option for someone who doesn't have time to check their email for anything else.You can get your essays through several different places. If you have trouble with a particular site or can't find one on the first page of results, go to Google and type in the site and hit enter.The advantage of using an essay sample for an Osu game is that it is already formatted so you only have to write what you need. For example, if you want to write about an opponent who is playing a certain character, all you have to do is add it to your text file.When it comes to using an essay for college online, it's a really good idea to use one that is ready for you to use. It will save you a lot of time and energy for you to have to look for a free one, especially if you don't have the time to write essays.

My Counseling Theory Paper free essay sample

Running head: Finding Meaning Finding Meaning in Life Sandy Patty Made Up University Abstract What is to be said about life and circumstances? There are many different theories and perspectives about it, but my concern is when someone feels they have to be subject to their circumstance. Further in this paper I will discuss my personal counseling theory and how I believe that not one person has to be ruled by a certain circumstance and that they are not by any means validated by one person because they have the opportunity to discover meaning in their life for themselves and discover an array of opportunities in life.Finding Meaning in Life Introduction My story is not something new or one that has never been told before, but it is unique to me and bears significant value due to the way that it shaped and formed me into the person I am today and the reason for me pursuing a career in counseling. We will write a custom essay sample on My Counseling Theory Paper or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page I come from a mixed, biracial, and very religious family. The women in my family all seem to have gone through significant and grave hardships and/or traumatic experiences. My grandmother was sold as a sex slave when she was 3 years old because her Mother was dirt poor and needed money to sustain her drug/alcohol addiction.At an early age my grandmother was forced into prostitution as a way of life and a means to sustain herself. She then later met my grandfather who was a minister in a local religious church and they married. My mother was born into a very religious environment, strict dress codes, no jewelry, makeup, pants, they were forcefully instructed that they were the lesser of men, and they were to always obey their husband regardless of the issue or circumstance. During my Mother’s adolescent years she was a victim of child molest and the perpetrator was an important figure in the church. When my Mother attempted to tell my grandmother what had happened, she was severely physically punished and accused of lying. Since then, she never once told a soul as it continued to occur. She had become a pin-cushion for a â€Å"religious leader† within the church. Later on in life, my Mother met my father who was a young youth pastor in town and they married. My father was also a very religious man and held strongly to his beliefs. My parents struggled financially and experienced many hardships due to church and family.I believe my parents were somewhat forced in marriage at such an early age due to their religious setting and they were not prepared at all for what faced them ahead. My mother had children by age 19 and her life changed dramatically. My one and only older sibling was born and he became the closest thing to a mentor that I had. I too, grew up in a very religious and strict home environment. We were taught that there was only one way to live and it was according to the Bible and the rules taught in Church, anything else was unacceptable and reprimanded.My father was always a very hard worker and was hardly home due to working so many jobs in order to provide for the family. When he was home, I remember him and my mother arguing constantly due to issues with his family interfering with their marriage and finances. From an early age, I remember my mother crying and coming to me to talk about what was bothering her or issues with my father. I would just listen and offer advice as best as an 8 yr. old could and I remember thinking to myself, â€Å"Is this normal, am I supposed to be doing this? It felt strange and hard to not be biased in a situation involving my family, but I learned at a very young age things a child should not know or experience. I definitely had to grow up quick and learned to figure things out on my own. My older brother pretty much raised me and was the only person I could confide in or talk to. My family was not very affectionate, but rather very cold and distant and always brought everything back to a religious setting.I have always been told I was very mature for my age and I attribute this to my childhood or lack thereof and being forced to play an adult role due to circumstance. I do not write this story for pity, but rather because I believe it played a significant role in me pursuing counseling as a career path. It feels so natural for me when I’m talking to people because it was something I can always remember doing. From such an early age, I have always been engaged with older people and hearing about issues from failed relationships to traumatic/crisis situations.I strongly believe that this is one of the reasons I am not a very judgmental person because I feel I have experienced so much that I know what it is like to go through many different situations and not so pleasant circumstances. Core Theoretical Principles My counseling theory is that even though human beings have the need for approval or longing of someone else to bring substantial meaning in their life, they are not by any means validated by any one person or situation because you focus on the present and future and make the most of your circumstance.I experienced that in my childhood every time I saw my mother and father arguing and later I would hear from her what exactly happened between them. I remember thinking to myself that why would someone stay in an abusive situation or at least not stand up for themselves. I concluded that she needed to be validated by the relationship and for her to leave the relationship or stand up for herself would mean to defy her husband, church, and God. The Existential theory really brought insight into my life because it helped me understand what I always knew and from what I had experienced at an early age. In essence Existentialism states that we are not victims of circumstance because, to a large extent, we are what we choose to be (Corey, 2009, pg. 133). It is about recognizing certain tragedies experienced in life, but also embracing and understanding the positive opportunities that lie ahead, and to also comprehend the fact that we are human and what it means to be just that.It is a difficult concept to grasp at first because society teaches us that it is about building relationships and finding someone to validate who you are as a person, but existentialism is about understanding and facing the fact that we are essentially alone and facing that anxiety. It is in this theory that we tend to discover just who we are as a person and are able to discover more about ourselves and make sense of our existence. According to Carl Rog ers, his experience taught him that if one is able to get to the core of an individual, one finds a trustworthy, positive center. He believed that people are trustworthy, resourceful, capable of self-understanding and self-direction, able to make constructive changes, and able to live effective and productive lives. In this theory, I believe that despite circumstance, a person is able to â€Å"bounce back† and still be able to live a healthy and high functioning life. I would incorporate what Car Rogers expressed as the three main attributes needed to foster change, Congruence, Unconditional Positive Regard, and Accurate Empathic Understanding.For me, it has always been very important for me to deal with someone on a personal level, never forgetting that we are all humans and not above anyone else. I honestly believe that when you treat someone with respect regardless of age, gender, race, etc. then trust and respect is created and that is the number one element in any counseling relationship. Gestalt is another form of holistic psychology theory and one that I would strongly employ because I am a firm b eliever in perception and the meaning-making process. Gestalt therapy suggests that the objective is to enable the client to become more fully and creatively alive and to become free from the blocks and unfinished business that may diminish satisfaction, fulfillment, and growth, and to experiment with new ways of being (Corey, 2009, pg. 204). It looks at the bigger picture as a whole not just one part of the whole because I believe in order to truly understand someone you need to perhaps dissect pieces, but only in order to understand the whole.Anticipated Settings I currently am employed at a Child Family Advocacy Center that helps victims of domestic violence, sexual assault, child abuse, and elder abuse. I have always been interested in the helping profession and because of my childhood and the many different experiences and circumstances I encountered, I have always known I wanted to work in this specific area in order to attempt to make a change and help people who fall victims of such a terrible circumstance.As a future counselor I would like to remain relatively in the same field of helping victims of a crime, which include sexual assault, child molest, and domestic violence. I have seen and experienced all of this personally whether with family or friends and I have a passion and urge to help make a difference. I believe that life is definitely not fair, people are played the cards they are dealt, but also that a person is not validated by their past circumstances or anyone and it is up to them to find meaning in their life and discover who they are and want to become.Techniques I believe that it is necessary to provide adequate education and training to all the community because there are many people who unaware of the laws that can protect them from crimes and they are also unaware of the many various options they have to change their situation. I would employ an ongoing community education program offering free training to local offices, schools, day cares, etc. , just to spread the word of the different community resources available to help the people.In working closely with and advocacy center, I would incorporate a domestic violence group that is not biased and one that actually helpful to people and does not enable them. Unfortunately, services in this area are limited to the same s ervice providers and people are left with limited options. Too many times, clients have approached me with disappointment in therapist they have encountered and they are turned off by the idea of counseling because of several negative experiences. I am very passionate about this type of work specifically because of my past and I would like to genuinely be able to help people in these types of situations and therefore, would in the future, like to offer counseling services specifically to victims of domestic violence, sexual assault, and/or child abuse. I would not be biased, and because of my past I understand what it is like to live in that type of situation and I also understand leaving is not always the easiest decision a person can make because there are many factors to consider.People in these types of situations are very unique in the fact that they have learned to survive on their own and know what they need to do or to say the right thing in order to survive. This is not a situation where one counseling theory covers all clients, so I would tailor each to the specific person because I understand their situation is unique and requires a technique to match. Also, I believe that it is vital to establish a healthy relation ship with the client in order for them to trust you and open up to you. I would incorporate many of the Rogerian techniques regarding the genuine relationship with the client, trusting environment.Victims of any of these types of crime have been through some of the most horrendous situations and they have learned to adapt to the perpetrators needs and threats. If a counselor walks into a session with an â€Å"all knowing† authoritative attitude it will discourage the victim from speaking the truth and the counselor will have lost, which may have been the only opportunity, to help the victim possible change their circumstance. I would enter into the counselor/client relationship giving respect and trust on my part and genuinely attempting to get to know the client and their unique situation.I would also involve the client every step of the way because it is this same client that returns to their situation at home and not me so I would always need to have their best interest and safety in mind. The clients would not just be another file on my desk, but rather a person who’s life can be altered by perhaps just one meeting in counseling so what better change to reach out and try and help someone. It is with this that I would definitely incorporate many of the existential techniques in helping clients find meaning in their life b y exploring their different life situations.Limitations A very common limitation that I experience already in the line of work I do now is the fact that even though I am passionate about this field, the actuality of it is that I cannot change a person, they have to decide for themselves when that change is appropriate. Many times I have seen counselors burnout in this field because they feel they are not making any significant change due to many victims returning to the same abusive relationship or circumstance. So in theory, all of these techniques and theories are wonderful, but in reality they are dependent on the client.Summary Life is simple, it’s just not easy. People have to play the cards they are dealt. Life is not fair by any means and we could use this as an excuse to wallow in pity or use it to motivate us to overcome and conquer our situation. We are not validated by any one circumstance or person, we can choose to discover for ourselves who we are and who we wish to become. My personal counseling theory is just that, very personal because it was unknowingly developed over time due mostly through what I have experienced in life.

Size Matters

Size Matters â€Å"Size† Matters â€Å"Size† Matters By Mark Nichol How do you treat the word size (or is it sized?) when it’s used in combination with other words as an adjective? Here’s a rundown of the options, with judgments about the best bets. The combination of mid with size is treated in various combinations: as midsize, mid-size, midsized, and mid-sized. The most prevalent form, logically following the tendency to omit hyphens after prefixes and because omitting the second d is simpler than retaining it is midsize. Medium-sized, however, prevails over medium-size; the hyphen is to be expected, because medium is an entire word, not just a prefix, like mid, but the retention of the final d is puzzling. Midsize is the adjective of choice for vehicles, while medium-sized is much more likely to apply not only to entities such as businesses and organizations but also to most other products and objects. And how should references to comparatively small or large phenomena be styled? Some people would follow the pattern by writing small-size or small-sized, or large-size or large-sized, but -size or -sized is redundant because small and large provide a frame of reference to the quality being discussed, whereas medium is vague enough to require the contextual clue of -sized, even when small and/or large are also employed in the passage. (A range should be rendered as follows: â€Å"Small to midsize cars were tested† or â€Å"The survey applied to small to medium-sized businesses.†) Words for bed sizes are expressed as, for example, king-size or king-sized. Merriam-Webster’s Collegiate Dictionary, probably the most widely consulted dictionary in the publishing industry, notes that king-size is prevalent, which is consistent with its entries for similarly constructed words, include bite-size, legal-size, life-size, man-size, plus-size, pocket-size, in which the -sized form is regarded as a variant. Similar terms, such as those in the sentences as â€Å"We watched a car-size boulder tumbling down the slope† or â€Å"A house-size depression appeared in the field,† can be created as needed. However, writers should take care in producing such constructions with less common references. â€Å"He approached the brick-size object as it hovered in front of him† is reasonable, because although bricks vary in size, most readers will probably think of the typical red clay building material. But â€Å"a dog-size creature† is vague because of the disparity of size among dog breeds, and â€Å"a cell phone–size device† may seem awkwardly constructed. (Try â€Å"a device the size of a cell phone† instead.) Want to improve your English in five minutes a day? Get a subscription and start receiving our writing tips and exercises daily! Keep learning! Browse the Spelling category, check our popular posts, or choose a related post below:7 Examples of Passive Voice (And How To Fix Them)8 Proofreading Tips And TechniquesHyphenation in Compound Nouns

Topic 4-1 Essay Example | Topics and Well Written Essays - 250 words

Topic 4-1 - Essay Example The student may interest in a given career such as teaching but depicting behaviors that are not appropriate for the teaching career. For example, the student may introvert and has low motivation to research. The student may also like doing things in isolation than group (Brown & Lent, 2013). When attending to such a student, a counselor applying the Social Cognitive Theory may train the student to develop extrovert behavior to enable open interaction with others. The counselor may also encourage and admit the student in tasks that require group participation so that the latter can develop skills and behaviors that support open socialization and corporation. The counselor may also urge the student to identify the best teacher and note the characters that make them perform to attract admiration. The counselor should then train and encourage the student to emulate and practice the behaviors of the role-model teacher (Brown & Lent, 2013). The choice of the Social Cognitive Theory relates to it ease to assist in effective counseling of career related problems. Focus on social interactions and environmental influences on human behavior provide immediate elements to check when attending a client. It is easier to analyze and influence behaviors of a client by studying the social and environmental forces that influence

Compare the parliamentary and presidential forms of government. What Essay

Compare the parliamentary and presidential forms of government. What are the strengths and weakness of each - Essay Example The Prime Minister (who is the chief executive) may be elected to the legislature in the same way that all other members are elected" (Governing Systems and Executive-Legislative Relations n.d.). Power in Parliamentary systems is concentrated in the Parliamentary leaders. It follows that pressure groups, to promote their interests, must influence the leaders, and this they can do effectively only by putting pressure on them directly or by acting through agencies that can, above all the parties and civil servants. Parliament, of course, also has some influence with its leaders, hence it is not entirely useless for British pressure groups to try to influence Prime Ministers (Mettenhiem 27). But compared to the pressures exerted through parties and civil servants their parliamentary activities are secondary. For instance, the need to focus pressure on the bureaucrats is reinforced by the activities of British government. First, the vast scope and technical character of decision-making r equired by welfare-state policies has led to the devolution of more and more decision-making authority to the bureaucracy, so that there is in Britain a vast amount of executive legislation (Ben-Zion Kaminsky 221). Equally important, the decision-making powers delegated to the Departments are likely to be of special concern to interest groups (Lijphart 129). General policy, of course, is still predominantly made by the Government, but technical details, especially the sort needing fairly frequent revisions (e.g., how much money is to be paid to doctors; what prices to guarantee to the farmers; on what basis to grant or withhold licenses to build, import, issue securities or acquire raw materials), are taken care of by the Departments, and such details are likely to be of as great concern to interest groups as policy in its broad sense (Mettenhiem 29). In contrast to Parliamentary systems, where the P.M is a party leader, the President is chosen by a separate election. "The President then appoints his or her cabinet of ministers (or "secretaries" in US parlance). Ministers/Secretaries usually are not simultaneously members of the legislature, although their appointment may require the advice and consent of the legislative branch" (Governing Systems and Executive-Legislative Relations n.d.). In this view, the constitutional separation of the executive and the legislature is the main culprit in the now excessive fractionizing of governmental power. Following Lijphart (1992): "the notion of the supremacy of parliament as a whole over its parts is a distinctive characteristic of parliamentary systems" (37). The main differences between the Parliamentary and Presidential forms of government are found in separation of power (Lijphart 16). In general, the Presidential form stipulates separation of power between different branches while the Parliamentary form means a fusion of power. In both forms, corporatism is characterized by high concentrations of government power as well as private power (Ben-Zion Kaminsky 221). Pluralism, on the other hand, is based on low concentrations of government and private power. A state-directed system is characterized by high concentration of government power, and low concentration of private power. And, finally, high concentratio

Concept Of Maximising Shareholder Wealth And Competing Theories Finance Essay

Concept Of Maximising Shareholder Wealth And Competing Theories Finance Essay Maximizing share holder wealth is a concept in which optimally increasing the long-term value of the firm is emphasized. Milton Friedman recipient of the Nobel Memorial Prize in Economic Sciences is often quoted as saying The business of business is business He actually did say there is one and only one social responsibility of business-to use it resources and engage in activities designed to increase its profits so long as it stays within the rules of the game, which is to say, engages in open and free competition without deception or fraud. Friedman used the term profits, rather than shareholder wealth but the two are often seen as interchangeable. Not only is this not true, there is an increasing body of opinion that views the prime motive of maximizing shareholder wealth as deeply flawed. In the history accounting and finance, it is assumed that the objective of the business is to maximize the value of a company. Put simply, this means that the managers of a business should create as much wealth as possible for the shareholders. Given this objective, any financing or investment decision that is expected to improve the value of the shareholders stake in the business is acceptable. In short, the objective for managers running a business should be profit maximization both in the short and long-term. Shareholders are deemed as the owners of the business. Their main aim is to increase their wealth, finance managers are employed to achieve this aim. In order to maximise shareholder wealth it would mean Maximising the flow of dividends to shareholders through time there is a long term prospective (Arnold, 2005) Shareholder wealth is a short-term gain, and can be artificially increased without adding any tangible assets or products to the companys rooster. You can, for example, simply lay off an entire short-term unessential department; say Research and Development rather than the shop floor, and the next quarters profits will be increased. But what about the social responsibility of the workers made redundant in order to make share price healthy? That is the fallacy with an unthinking mantra of maximizing. Almost any executive decision, no matter how socially irresponsible or unethical can be justified as intended to increase the stock price. Managers on short term leash might stay at the same point on the demand curve but economize more on resource if they must maximize shareholder wealth. Economizing inputs tend to offset the maximisers reducing output. In an economy with widespread monopoly some firms encouraged to maximize shareholder wealth would primarily encourage while others shoul d slash production and reduce allocative efficiency one cannot predict which effect would dominate. Traditional theory suggests that the key aim of any business is to generate the greatest possible value for the company, leading to the maximum possible return for shareholders. As Ian Davies argues, this so-called Shareholder Theory is based on the idea that the ultimate aim of a company is to generate profit and pass this profit, along with any associated value, on to the shareholders who took the risk of purchasing those shares in the first place (Davies, 2007); furthermore, any approach that minimises the companys outgoings will, in theory, contribute to the growth of the asset-value of the company and therefore to the ultimate return to shareholders. Within the concept of Shareholder Theory, there is technically no limit to the methods that might be used in order to maximise shareholder wealth. One of the most commonly used methods, according to Jill H. Ellsworth and Matthew V. Ellsworth, is strategies for the reduction of tax liabilities, in other words reducing the amount of tax paid in order to increase the amount of money that can be paid out as dividends to shareholders (Ellsworth Ellsworth, 2007 ed., p. 58). However, arguably, this theory is overly simplistic: for example, while one strategy might generate greater short-term wealth for shareholders, a less obvious strategy might, in the longer-term, generate far greater wealth. For example, while a company could use surplus profits in order to increase the dividend, it could also use them to invest in projects that could yield far greater gains in the future. This, in turn, could increase the overall share price. This approach highlights an important problem: not all share holders are the same, and while some are willing to wait for the longer-term results, others are after short term gain. There is no guarantee that both can be satisfied by the same approach. COMPETING THEORIES Other theories for example Stakeholder theory asserts that managers should make decisions that take into account the interests of all stakeholders of the firm. Such stakeholders include not only financial claimholders but also employees, managers, customers, suppliers, local communities, government, and others. Thus, stakeholder theory involves trying to maximize multiple objectives. Maximization of shareholder wealth focuses on owners and is a single-valued objective. This does not mean that corporate managers should disregard stakeholders other than owners. On the contrary, they need to be aware of the needs, wants, and interests of these other constituencies, but the owners come first. Although Shareholder Theory has been the dominant approach for many years, the new Stakeholder Theory is gaining ground. This theory suggests that Shareholder Theory is merely one part of the overall strategy that should be employed, with the others including such relatively unfixed concepts as earnings per share, employee satisfaction and environmental protection. Andy Coulson-Thomas argues that Stakeholder Theory is based on the idea that a business is an organic creature that will produce better results for everyone if holistically managed and, overall, led towards a situation in which every aspect of the company is performing well (Worthington et al., 2008, p. 147). This is clearly not a short-term theory, and one again illustrates the dramatic divide between the aims of different shareholders. However, Stakeholder Theory does have one major advantage, which is that it allows a more organic, cross-company angle to be applied, one which allows for stable long-term growth at the ex pense, perhaps, of short-term profit and wealth maximisation. Its also important to consider the size of the company and its location. Size affects such matters as taxation liability and economy of scale, and there are dramatically different rules when it comes to larger corporate entities. Although generalisations are dangerous, its true to say that smaller companies face less legislation in terms of moves to prevent tax avoidance etc., although to compensate for these larger companies often employ legal teams to address such issues. Davies argues that this balances out leading to virtual parity in terms of how companies of different sizes deal with taxation (and) they end up paying virtually the same rates, albeit from very different starting points (Davies, 2007, p. 37). Its also possible to relocate the companys base to a state with little or no corporate income tax, or where potential lawsuits are far more likely to be resolved in the companys favour. This may generate subsequent problems for shareholders, however, since their profits will be considered to be coming from abroad and may therefore be subject to additional taxation. This is an example of what McLaney calls blind strategy (Davies, 2007, p. 6), whereby something that initially seems to be good (for the company) is ultimately bad for the shareholders. In light of the factors above, CEOs of major companies are being urged, to look to other theories of corporate purpose. In this theory, the customer comes first. Perhaps the most notable change of purpose, as advocated by Richard Ellsworth and Ian Davies, is to change corporate focus from the shareholder to the customer. For example, in his book Leading with purpose Ellsworth offers statistics, drawn from a study of 23 companies that show those businesses that were mostly customer-focused exceeded their industries median performance by 36 per cent. But what does focusing on the customer mean? Isnt it something that successful businesses have always done? Yes and no. In his book, The New Business Road Test John W. Mullins defines customer focus as a corporations ability to resolve customers pain. Mullins then goes on to highlight the case of Nike who impacted on the sports shoe market by designing shoes that met the specific speed and endurance needs of distance runners. In 1972, eight years after Nike (then known as Blue Ribbon Sports) was formed, four of the top seben finishers in the Olympic marathon wore Nike shoes. Two decades later, afte r many years of strong growth, Nike targeted women, for whom its products seemed to hold limited appeal. Nikes researchers found that for active women, clothes had to perform a double-duty, handle an intense workout and look good on the street. Nike turned their research iinto new product lines and in 2005 their combined womens business grew by almost 20% outpacing even the companies overall growth. But away from Mullins, Naomi Kliens book, No Logo, shows there is more to Nikes corporate purpose than target markets. Klien points out that Nike is also probably the most famous case of western companies using sweatshop labour a scandal that was bought to national USA attention in 1995-96 and has dogged the company ever since. The question is this: how do we interpret Nikes repeated attempts to change unethical working practices at its various sites around the world? What do we say about the introduction of schools, donations and increased wages it has given out to workers it previously exploited? Can they be seen as cynical attempts by a panicked business to maintain shareholder value, or genuine efforts to resolve their customers moral pain? Nikes efforts at ethical working practices brings me to CSR Corporate Social Responsibility CSR has become the basis on what organisations do well. There are several studies as to what CSR is, several researchers (Friedman, Rudolf, Davis etc.) have given their own definitions, the World Business Council has defined it as the continuing commitment by business to behave ethically and to contribute to economic development while improving the quality of life of the workforce and their families, as well as of the local community and society at large. (Source: Xrefer, definition of Corporate Social Responsibility) Companies usually implement CSR into their policies and practices so the effects of their activities have a positive social, environmental, legal and economic impact on the communities in which they operate and on their stakeholders. Some organisations behave more socially responsibility because it is an obligation by the managerial board, but also because of fear of backlash from environmentalist and consumer pressure groups and the media, and negative corporate image. It has been argued that behaving in a more socially responsibility manner can be beneficial to an organisation in the long run. A good example of an ethical organisation is the Body Shop. The Body Shop was founded by Anita Roddick in 1976, and has achieved worldwide status for being profitable and socially responsible, which proved that an organisation can be ethical and successful and reward shareholders and satisfy stakeholders at the same time. It has achieved worldwide popularity due its ethical practices, famously recognised for being against animal testing and promoting cosmetic products that have not been tested on animals, . They had a business case to provide body care products that have not been tested on animals and their business case just provides further support that an organisation can be profitable whilst being ethical. SHAREHOLDER WEALTH CRITICISM Another difficulty with Shareholder Theory is that aspects of wealth growth, most notably those related to tax, are increasingly complex and require a variety of forensic-level approaches that are often impossible for a large corporation to undertake. For example, some shareholders might benefit from a corporation-based tax reduction strategy, while others might be better off utilising their own such systems. Its impossible to tell which system will suit which shareholder, and its also impossible to mix the two systems. There is therefore a fundamental need to balance competing needs and, often, to find a balance that generates the best average result for shareholders. To compensate for such problems, companies can help their shareholders to form their own corporation designed to either own stock or to act as consultants (mainly for smaller companies). A. McNeil notes that such tactics are likely to appeal only to shareholders who are more proactive in their involvement in the company, whereas research shows that over three quarters of shareholders prefer a far more passive involvement (McNeil, 2007, p. 85). Furthermore, a number of commentators have argued that such tactics usually offer fewer benefits than they promise on paper, since there must be consideration given to the costs of incorporation and the operation of such a company. Turner and Johnson, for example, argue that the hidden costs in such an operation almost always outweigh the possible benefits (Turner Johnson, 2003, p. 238). Ultimately, the concept of maximising shareholder wealth represents a return to the principle of using a business in order to increase the wealth of individuals. As Andy Coulson-Thomas has suggested, this approach has often been lost in recent years as individuals (instead) work for the greater good of the company, which is often valued more highly than the wealth of the shareholders (Worthington et al., 2008, p. 58). Its clear that attempts to focus on the maximisation of shareholder wealth often involve increased complexity and, as a result, present a number of potential points at which profit can be lost. There are a number of conflicting theories in terms of which approach might be best when it comes to maximising shareholder wealth, but its clear that the most fundamental problem is that shareholders often have different, and in many cases competing, aims the key difference is in terms of how quickly they want to see a profit, and the needs of short-term profit-seekers are like ly to contradict the needs of those seeking a longer-term profit generation system. There is even the problem with the stock price itself as illustrated in my third paragraph above. It simply isnt always in management control. Again, as we have seen recently, share value largely depends on the confidence the market has in a corporation or the sector that the corporation operates in. as confidence in the banking sector has recently plummeted, even organizations with a healthy balance sheet have seen their share prices tumble. Consider the monopolist in a nation that denigrates shareholder wealth maximization and has rules and norms that discourage lay-offs. Employees cannot easily be laid off. Their jobs cannot be radically reconfigured without their consent. As such, the monopolist might not cut production and raise prices further, despite the shareholder-wealth-maximization basis for doing so, because it must pay the employees anyway if labor markets are rigid and if it cannot costlessly redeploy its workforce. In such circumstances, not only are the employees with jobs protected, but national wealth is increased (or at least not decreased) by slack agency controls on managers. A weak shareholder primacy norm facilitates greater production. I would say there is the problem of the shareholders themselves. These are not necessarily long-term investors with the interests of the company at heart, but transient individuals, some of whom, as we have seen lately, may actually look to make money out of a business by betting on the share price going down .i.e. taking the fall of shareholders like Conrad Black and Bernard Madoff. As per tutor2u,  Managers of a business should create as much wealth as possible for the shareholders. Given this objective, any financing or investment decision that is expected to improve the value of the shareholders stake in the business is acceptable. This is based on the assumption that managers operate in the best interests of stockholders, not themselves, and do not attempt to expropriate wealth from lenders to benefit stockholders. Another assumption is that managers act in a socially responsible manner and do not create unreasonable costs to society in pursuit of stockholder wealth maximization.  Ã‚  (Blackwell publishing, 2009) Wealth maximization is achieved by maximization of the cash flows of the organization.  Ã‚  Cash flow is a better yardstick than the profits. There are several objections against the profit maximization: One it is vague; there are multiple meanings of Profit.  Ã‚  For example profit after tax, retained earnings. Thus profits cannot be the ultimate goal. Two it is uncertain; as per Freemba, Profit cannot be ascertained well in advance to express the probability of return as future is uncertain. It is not at possible to maximize what cannot be known. Hence the timing of the profit cant be estimated. Three it ignores time value of money; Profits ignore the time value of money which is not in the case of cash flows. One can exactly find the timing of cash flows. Hence cash flow is a better measure. CONCLUSION Despite its advantages of greatly simplifying directors decision making we should discard the fictional undiversified shareholder concept for two reasons. First, it is highly unrealistic, more so than the other alternatives here considered. Second, it is indeterminate as to the degree of risk-aversion that should be ascribed to this fictional shareholder, and this degree of freedom completely undercuts ability of the shareholder wealth maximization norm to constrain director conduct. The  goal of Maximization of profits I think to be a narrow outlook. Evidently when profit maximization becomes the basis of financial decisions of the concern, it ignores the interests of the community on the one hand and that of the government, workers and other concerned persons in the enterprise on the other hand. Hence profit maximization is not considered as the ultimate financial objective. Wealth maximization is considered to be the most important financial objective Organization should also consider non financial objectives too to satisfy the other stakeholders of the organization. Stakeholder can be a person, group, organization, or system who affects or can be affected by an organizations actions. This means satisfying the objectives of customers, suppliers, government agencies, families of employees, special interest groups.  This will help in achieving the success in long term too. Ultimately, the concept of maximising shareholder wealth represents a return to the principle of using a business in order to increase the wealth of individuals.This approach has often been lost in recent years as individuals work for the greater good of the company, which is often valued more highly than the wealth of the shareholders Its clear that attempts to focus on the maximisation of shareholder wealth often involve increased complexity and, as a result, present a number of potential points at which profit can be lost. There are a number of conflicting theories in terms of which approach might be best when it comes to maximising shareholder wealth, but its clear that the most fundamental problem is that shareholders often have different, and in many cases competing, aims the key difference is in terms of how quickly they want to see a profit, and the needs of short-term profit-seekers are likely to contradict the needs of those seeking a longer term profit generation system I also conclude that from above highlights it shows just how complex and interlinked all the financial and psychological aspects of business are. It is no longer enough (if it ever was) for businesses to concentrate soley on their shareholders. In the current climate of a credit crunch fuelled by a potent mix of incompetence and greed, with business ethics under scrutiny like never before, the customer is all of us. And the pain we need resolving is not just economic, but social and environmental as well if corporation investment decisions are best pursued through the use of a fictional shareholder concept, rather than through attempts by directors to ascertain and satisfy to the extent possible the conflicting preferences of their corporations actual shareholders and perhaps other stakeholders as well then the fictional diversified shareholder concept, despite its significant implementation difficulties, is the preferred alternative among those here considered. .