Discussion 2: The Baroque Age

1.Why did the Baroque style develop differently in northern and southern Europe? 

2.What are the key characteristics of the baroque style in each region?

3.Choose a piece of artwork or a musical composition that was not discussed in the chapter  that you feel exemplifies each region’s particular baroque style (northern and southern).  Be sure to explain why this piece fits into the stylistic characteristics you described.  (Please provide the images or links to the music you select in your post).

All discussions must be written in essay MLA format and should be at least 3-4 well-developed paragraphs in length total.

This is not a research assignment. Students need to use their own critical thinking skills.  Any information referenced must be cited in MLA format. Referencing outside research, however, is STRONGLY discouraged.

Please answer questions with opinions, and please separate questions and answers.

Required Text: Adventures in the Human Spirit
Author of Text: Philip E. Bishop
Edition:  7th (older editions accepted)
ISBN No.:13: 978-0-205-88147-5

WRIT 2 – COURSEWORK RESIT (50%)

1. Describe and critically evaluate a human resources management activity used by an organization of your choice. Based on your analysis, suggests ways of improving the way the organization manages this activity. You will also need to review the organizations strategic plans and evaluate if the HR Activity under review is aligned with the strategic plans of the organization. (50 marks)
2. In the constantly changing world, there are certain future directions that are anticipated for the field of human resources management as a profession. Conclude your answer by briefly mentioning which of these challenges may be the most challenging in the Greek context, specifically where high levels of labor unrest is commonplace. (50 marks)

(Total length of paper: 3,000 words)

Please use at least six (8) academic resources following the Harvard style. Your work will be tested for plagiarism via TurnitIn.

Learning Outcomes

Following successful completion of this module, the student should be able to:

• Evaluate key management theories, including Taylorism/ Scientific Management and the Human Relations approach.

• Identify key perspectives and concepts within organisational behaviour, including perception, motivation, communication, personality and group dynamics.

• Discuss the key areas within the HRM function, with reference to the CIPD Profession Map and its implications for personal and professional development.
• Explain the relationship between employees, managers, leaders, HRM professionals (and other stakeholders) and organisational change.
• Analyse the key components of career development and their contribution to individual and organisational performance.

Marking Criteria

For marking your work I shall take into account the following five main criteria: organisation and structure, research, analysis, subject knowledge, and presentation.

Organisation and Structure: The essay should be well organised and focused. It should have a clear structure (introduction, main body, and conclusion) and be coherent. It must demonstrate a logical development of the main ideas. You should make clear at the beginning what you are going to discuss and why, and adhere to this plan. (20 points)

Research: As essay should be engaging and should draw upon an appropriate number of textbooks, scholarly articles and resources recommended to you by your tutor. Your essay must show a strong understanding of IPE theories. (20 points)

Analysis: Your essay should demonstrate insightfulness, persuasiveness, and strong critical thinking, rather than simply describing some facts or recording information. You must use appropriate examples, case studies, etc., in support of your position. Evidence of originality of thought is needed to secure a high mark. (25 points)

Subject Knowledge: Your essay should reveal firm engagement and a high degree of familiarity with the subject. You must address all of the questions posed with convincing evidence. Everything written must be relevant to the topic and you should include your own points of view on the issue. (25 points)

Presentation: Your essay should be carefully written, with the fullest attention paid to clarity, accuracy of expression, layout, referencing, and proper use of paragraphs and punctuation. It should be free of spelling and grammatical errors. It must include a bibliography at the end, presented in alphabetical order. It is important that you print the word count at the top right of the title page. The word count should be the total number of words in the essay, including the title, but excluding the bibliography. (10 points)

UNDERGRADUATE/HIGHER NATIONAL PROGRAMMES – GENERIC CRITERIA

%

90  –  100  A quite exceptional and outstanding answer, providing insights which would not be available publicly, and would, with some editing, be publishable.  In addition to the features of the next section, this range is distinguished by superior organisation, economic use of language and totally comprehensive, given the conditions of the exercise.

80  –  89    An answer which demonstrates an excellent understanding of the question and of the complexity of the issues involved.  There is a sound basis of relevant factual knowledge and/or the theoretical issues involved.  Most of the important issues are dealt with in a detailed, specific and systematic way.  There is either some measure of original thinking in the answer or an accurate and comprehensive account is given in a way which demonstrates understanding, for example by structuring the material such that it could not have been based just on reproduction of lecture notes and programme material.  Evidence of creativity, critical approach, and wide reading beyond the core subject matter.

70  –  79    As above but a slightly less consistently excellent level.  Alternatively, this range of mark may be given for an answer which, while not having original insights, gives comprehensive and accurate coverage of the issues at a high level throughout the answer, without significant omissions or errors.

60  – 69     An answer which demonstrates a clear understanding of the question and grasp of the complexity of the issues involved.  There is a sound basis of relevant factual knowledge and/or of theoretical issues involved, with few significant errors.  The issues involved are dealt with in a systematic way.  Some of the issues may be limited in critical approach, but organised to display a comprehensive understanding and factual information essentially complete.

50  –  59    An answer which demonstrates an understanding of the major or basic issues in the question.  There is a basis of factual knowledge and/or of relevant theoretical issues.  Although some errors may be present, the overall framework of the answer is sensible and accurate.  Most of all the issues may be dealt with at the level of obviously available programme material given to the student.  The answer shows planning in its construction, with a clear train of thought or development of argument present.  Average competent performance, well presented, demonstrating understanding of most of the essential issues.

40  –  49    An answer which demonstrates a limited understanding of the major or basic issues in the question.  There is some relevant factual knowledge and/or awareness of theoretical issues, but it is patchy.  A few significant errors may be present.  The answer is not well planned, with little development of argument, and often much irrelevant material is present.  Lacks clarity of expression.

The lower range (40-45) would include an answer where relevant factual knowledge and/or awareness of theoretical issues is poor and confused, but not absent.  Many significant errors may be present.  The answer is poorly planned, with little clear train of thought or development of argument, and much of the answer may be irrelevant.

38  –  39    An answer which fails to demonstrate any appreciable understanding of the major issues or basic issues of the question.  Relevant factual knowledge and/or awareness of theoretical issues, if present at all, is very poor and confused and very limited.  Many significant errors may be present.  Much or all of the answer may be irrelevant.  Poorly organised and very limited in scope.

30  –  37    Attempts an answer, but relevant factual knowledge and/or awareness of theoretical issues is very poor and confused, and very limited with many significant errors.

10  –  29    Not clear that an answer is properly attempted.  Only a few minor points made at all relevant to the answer and these may be superficial.  Most material is irrelevant or incorrect.

1 –  9        An answer that is so short or irrelevant that only a few marks are justified.  For example, one or two points may be made which show some peripheral awareness of certain possibly relevant issues.

ASSIGNMENT 3

• Policy Analysis

In this assignment, students will examine the selected bill from Assignment 2, and critically analyze, and evaluate the context in which the area of concern or issue relates to the policymaking process.

SELECT BILL FROM ASSINGMENT 2

Bill

Patient Protection and Affordable Care Act: President Obama signed the Patient Protection and Affordable Care Act (Obamacare) on March 23, 2010

 Federal bill

H.R. 3590 (111^th United State Congress)

Sponsor: Dean of the House, John Dingell of Michigan

Purpose: to make health insurance more affordable for those with little or no coverage.

Pass United State Congress: The bill was introduced on October 29, 2009, and passed on November 7, during the 1st Session of the 111th Congress.

Assignment Criteria:

Develop a scholarly paper that addresses the following criteria:

1. State the selected bill including the bill number and title.
2. Identity the area of concern or issue clarifying the underlying and related concerns.
3. Describe the background of the area of concern or issue – assess economic, legal, and regulatory processes that prompted the writing of the bill
4. Identify all direct and/or indirect stakeholders and stakeholder position on the area of concern.
5. Identify the strengths, weaknesses, opportunities, and threats (SWOT) to the bill.
6. Evaluate how issues in the bill will affect stakeholders at an institutional, local, state, and/or federal level.
7. Using the Essentials of Master’s Education, propose two ways the master’s prepared nurse leader can act as a change agent, contribute to the policy-making process, and advocate for quality, cost-effective care.
8. The scholarly paper should be in narrative format, 5 to 6 pages excluding the title and reference page.
9. Include an introductory paragraph, purpose statement, and a conclusion.
10. Include level 1 and 2 headings to organize the paper.
11. Write the paper in third person, not first person (meaning do not use ‘we’ or ‘I’) and in a scholarly manner. To clarify: I, we, you, me, our may not be used. In addition, describing yourself as the researcher or the author should not be used.
12. Include a minimum of five (5) professional peer-reviewed scholarly journal references to support the paper (review in Ulrich’s Periodical Directory) and be less than five (5) years old. Instructor can revise these guidelines to include websites.

International Accounting

 The Travels of a T-Shirt in the Global Economy

Objectives of this Assignment –

The overarching goal of this activity is to assist you in recognizing the structure, dynamics, and distribution channels encountered in the global marketplace as seen through the eyes of the textile and apparel industries. These are presented from both a current and historical perspective.

This assignment involves an evaluation of the cultural, economic, and political factors impacting sourcing decisions, in addition to the implications of various global alliances on trade policies and regulations. Upon completion of this activity, you should recognize various factors that impact compliance with labor laws, standards of social responsibility, and the treatment of workers in textile and apparel production. The assignment should challenge your critical thinking skills and support further development of your written and verbal communication abilities.

Upon completion of the assignment, you should recognize the differences in viewpoints among those who advocate globalization and free trade versus those who support more protectionist perspectives.

Evaluation Criteria –

You will be evaluated on four major criteria, including:

• Completeness of responses: Was the entire question answered thoroughly? Did you use examples to substantiate your responses?
• Justification of argument: Were your answers sound and based on appropriate and educated reasoning? Was a rigorous approach taken in defending opinions and viewpoints?
• Overall professionalism: (correct grammar, spelling, etc., in written responses).
• Participation in the class discussion.

Assignment Specifications –

Please prepare a written response to the following question and then select six (6) additional questions from those which follow and prepare your response to each of them. Please limit your question selections to one question selected per chapter.

Question 1 – As you read Travels of a Tee Shirt, what insights or surprises did you encounter?

Additional Questions (Select six questions from the following list limiting your choices to one per chapter)

Chapter 1

How does the author answer the following question, which is the title of this chapter: “Are subsidies the reason America has dominated the global cotton industry for 200 years?”

Chapter 2

• Use specific examples to support the thesis that the American cotton market has dominated the world market by “ducking the labor markets.”

Chapter 3

• “Lubbock is the center of the ‘Silicon Valley’ of cotton production.” Cite specific examples from the chapter to support this claim.
• Explain the impact of genetically modified cotton on production. What corporation has been a leader in this technological advance? What has been the response from Lubbock cotton growers?

Chapter 4

• How has the Citizens‐Shallowater Co‐op Gin affected Lubbock cotton farmers?
• How have cotton growers been able to get value from cotton production beyond the white lint that becomes cotton fiber used in textiles? (Cite specific examples to support your answer.)
• What has been the primary mission of the Plains Cotton Cooperative Association (PCCA)? What has contributed to the success of the PCCA?
• “According to at least some observers, the definitive source of U.S. cotton farmers’ comparative advantage is their ability to get help from friends in high places.” Explain and support this statement.
• In May 2008, Congress overrode President Bush’s veto of the 2008 Farm Bill, a piece of legislation that would have resulted in considerable reductions in many of the subsidies paid to wealthy, large‐commodity farmers. Senator Charles Grassley said the trick to getting this override was “to smear lipstick on a pig.” What is the meaning of his statement?
• The author contends that the answer to the question “How have cotton farmers maintained their comparative advantage since 1792?” is “not in the data; it is embedded in the story.” How does she defend this position?
• Explain the plight of West African cotton farmers. (Use citations from the text to support your explanation.)
• According to the author, what has been the impact of genetically modified seed such as Bt cotton on growers in developing nations?

Chapter 5

• Explain the significance of the following quotes relative to the information the author was able to gather while in China: “China has a centuries‐old tradition of hospitality, even for Nobodies…” and “Chinese culture also has a deep respect for education…”
• Describe the author’s impression of Number 36 Cotton Yarn Factory.
• Of what did Shanghai Brightness Number 3 Garment Factory remind the author?
• Explain what information “Figure 5.2: U.S. Apparel Prices v. Import Share” reveals.

Chapter 6

• Explain the following quote: “The floods of cheap cotton clothing that flow today from China to the United States are almost a symmetric reversal of the trade flows of a century ago.”

Chapter 7

• What is the story behind this chapter’s subtitle: “Docility on a Leash”?
• What steps have been taken over the centuries to keep workers, usually women and minorities, from moving from toiling in the fields to low‐skill factory work?
• What did sociologist Ching Kwan Lee discover was a primary motivation behind young women leaving rural areas to work in factory towns?
• What transformation has occurred in the former textile centers of Manchester, England; Charlotte, North Carolina; the state of Alabama; and Osaka, Japan?
• How has Hong Kong’s apparel industry changed?
• What does the author mean by the phrase “the long race to the bottom?”

Chapter 8

• How does the author explain the following: “Global capitalism and labor activities are not enemies but are instead cooperators, however unwitting?”
• Explain what Nike is doing to provide “corporate social responsibility” activities?
• What were the findings of the Cambridge University case study on the environmental impact of a cotton T‐shirt?
• What is the long‐term impact of the phthalates found in plastics such as the parrot found on the front of the author’s cotton T‐shirt?
• Explain the environmental Kuznets curve.
• According to empirical evidence, which countries have more promising environmental profiles—nations that embrace free trade or those that promote protectionism? Why?
• What did Alexandra Harvey reveal in her work The China Price: The True Cost of Chinese Competitive Advantage?
• Explain the author’s story about a photo of Shanghai before the 1949 Communist Revolution from one of her coffee‐table books compared to what a photo of modern‐day Shanghai might show.

Chapter 9

• Explain the relationship between Auggie Tantillo and Julie Hughes.
• Explain the implications of Figures 9.1 and 9.2.
• Explain the rules for cotton T‐shirts associated with “preferential treatment status” in free‐trade agreements.

Chapter 10

• What is the author’s answer to the following: “How did the United States—as the self‐anointed free trade champion of the universe—end up with such a dauntingly complex and downright silly mass of barriers to the import of T‐shirts?”

Chapter 11

• What have been some of the unintended consequences of protecting manufacturing jobs in U.S./Western textile and apparel industries?
• What evidence does the author cite to support Joseph Schumpeter’s theory of creative destruction?
• How did quota allocations help a nation like the Philippines? Since 2004, why have nations that once supported such quota allocations begun to have second thoughts?

This exercise will increase your familiarity with some of the tools available from the

NCBI web site.  Follow the instructions below and answer the questions in a separate text

document.  Upload this document to the Assignment folder Homework 6.

In this exercise, you will use the tools at NCBI to learn more about globins, which are

frequently referenced in the textbook.

Change the pull-down menu near the

top of the page from “All Databases” to “protein” and search for “beta globin”.

1)

How many records are retrieved with this search?

We would like to start by finding the human beta globin protein.  One way to do this is to

restrict the search to only human sequences.  Add the words “AND Homo sapiens

[ORGN]” after the words beta globin in the search field and press Go.  This searches for

entries with the words “beta globin” and the words “Homo sapiens” in the organism field.

2)

How many entries did this search retrieve?

Click on the first entry and look at the information contained in the file.

3)

What is the accession number of this beta globin entry?

Click the FASTA link at the top of the page.  This redisplays the sequence in FASTA

format, a common format used in bioinformatics.  The essential elements of this format

are a line beginning with the “>” sign followed by a description of the sequence, and the

nucleotide or amino acid sequence starting on the next line.

4)

Copy and paste the FASTA formatted amino acid sequence (starting with the >

symbol) as your answer to question 4.

On the right side of the page, click on the “Run BLAST” link. We are going to search for

proteins similar to the Beta globin protein using BLAST. Copy and paste the FASTA

format beta globin protein sequence into the Query sequence field.  Change the database

to “refseq”. Press the “blast” button at the bottom of the page.  You will be redirected to a

temporary page that displays the estimated wait time for the search.  This could take

several minutes, but is usually quick.

The results page will display the “hits” in graphical format at the top of the page.  Scroll

down to see the alignments of your query protein with hits from the database.  Scroll

back above the graphical output and find click the link “taxonomy reports”.  This will

display a list of all of the organisms contain sequences similar to your query.  Keep in

mind that the default settings of the blast program restrict your results to the top 100 hits,

there are many more good hits that are not displayed.

Immediately to the right of the species names are the scores of the blast matches.  Since

the sequence you searched with is also in the database, the best hit will be to your query

sequence from humans.

5)

What is the score of the hit to human sequences?  What other organisms contain

sequences that match with the same score? (click on the scientific name on the

taxonomy reports page to see the taxonomy entry for that organism.  You can find

the common name listed there if one exists).

All of the organisms with similar sequences found in this search are primates.  Lets see if

we can find if more distantly related organisms have proteins similar to beta globin.

Return to the protein blast page and paste the beta globin sequence in the query window

again.  This time type “Mammals” in the “Organism” field and check the “exclude” box.

This will restrict the blast search to non-mammal sequences.  Press Blast again and wait

for the results.

Again, you will have 100 or so hits.  Scroll down to the alignment of the top hit.  There is

a lot of information here, use it to answer the following questions.

6)

What is the score and expect value of the top hit?  How many “identities” or

identical amino acids are shared between these two sequences?  What percentage

of the sequences is identical?

7)

The result also lists a category called positives, what do you think positives are?

(look at the alignment for clues).

8)

From which species is the top hit?  Can find the common name for this organism?

Find the hit to a “hemoglobin, subunit beta” protein from the chicken,

Gallus

gallus

(use

a text search).  Click on the link “Sequence ID: NP_990820.1”. The link takes you to the

gene page for hemoglobin beta subunit from chicken.  This provides much information

about the organism, gene and protein.

On the right side, find “More about the HBBA gene” and click on “HBBA gene”

Scroll down to “Genomic Context”.

9)

On which chicken chromosome is this gene located? What other globin genes are

located in this region?  Mouse over the arrows representing genes in the figure in

the “Genomic context section”.

10)

Click on OR51M1 that is downstream of the hemoglobin genes.  What type of

protein does this gene encode

Read “Metagenomic insights into the human gut resistome and the forces that shape it” by Forslund et al. and answer the following questions in a text file and deposit it into the assignment folder for Homework 5.

1) What is a resistome?  Why is it useful to think about antibiotic resistance in this context rather then focusing on individual organisms?

2) What is the authors’ explanation for the presence of antibiotic resistance genes in organisms living in diverse and remote environments in the wild?

3) Describe the “farm-to-fork” model for the selection and spread of antibiotic resistant microbes.

4) Compare and contrast the strengths and limitations of traditional phenotypic tests  with metagenomics for understanding antibiotic resistance in bacteria.  How does “functional metagenomics” attempt to overcome the weaknesses of these approaches?

5) Describe the role of gene transfer in the spread of antibiotic resistance.  Based on what you read, which method(s) of gene transfer are likely involved in spreading resistance determinants in bacteria?

6) Why were the resistance genes described by Sommer et al. (page 321) mostly different from previously known resistance genes?

7) Based on what you have read, why do you think the resistance potential of human gut microbes is significantly greater in Spain and China and significantly lower in Japan and the United States?  Support your argument with specific examples form the paper.

8) The paper suggests there are three major mechanisms for antibiotic resistance.  Can you think of three different ways a bacterium might avoid being affected by antibiotics?

Homework – 2A

• Download the file R.RDataand load it into R using load(“5.R.RData”). Consider the linear regression model of y on X1 and X2. What is the standard error for β1? (Also attached screenshot from RStudio to display the code has been executed)

• Next, plot the data using matplot(Xy,type=”l”). Which of the following do you think is most likely given what you see?

A)

1. b)
2. c)

3)

4)

5)

6)

As depression struck the new nation in the mid-1780s, new questions arose about the nature of American democracy. Many conservatives believed that the answer lay in a stronger national government. Most radicals believed it was up to the states to relieve the financial burden of the people. These sentiments fostered a movement for a new constitution. Political differences soon stimulated the creation of political parties.

Compare and contrast the Articles of Confederation with the new Constitution of 1787. What were the strengths and weaknesses of the Articles vis-à-vis the Constitution? Give specific instances that demonstrate the weakness of the Articles (such as the Western problem).

Then analyze the drafting of the Constitution, using specific details to show how the various states (slave vs. free, east vs. west) compromised in order to effectively draft a constitution. Pay particular attention to Roger Sherman’s plan, the Great Compromise, which broke a stalemate that could have been fatal to the development of the new Constitution.

Finally, compare and contrast the debate over ratification between the Federalists and the Anti-Federalists. Make sure you cite specific examples from the Federalist Papers to support the Federalist position and contrast it with leading proponents of the opposition (such as John Hancock). Analyze how the debate over a bill of rights illustrates the differences between the two parties. Evaluate the relative success of the Bill of Rights in achieving an effective balance between national and states’ interests.

This paper must be four to five double-spaced pages in length (not including the References page) and utilize no less than four academic quality sources. Margins should be no more than one inch (right and left) and the essay should be composed in an appropriate font and size. Sources must be documented and cited using APA format.

HECTOR, JASMINE, and JESSICA

DESCRIPTION at INTAKE

Hector Vega, a seven-year-old boy of Puerto Rican and Dominican descent, was brought to the outpatient clinic by his foster parents, Mr. and Mrs. Armstrong, because of their concerns about Hector’s difficulty functioning at home and in his special education school.  In a recent incident, Hector was suspended from school for trying to stab a classmate with a pencil after the classmate accidentally knocked into him while passing by.

Hector and his two sisters, Jasmine (11) and Jessica (5), have lived with the Armstrongs since being removed from their biological mother’s care four years ago.  A preschool teacher had called child protective services after she noticed bruises on Hector’s buttocks when she was helping him get dressed after using the bathroom.  After child protective service workers interviewed the children and visited the home, they determined that Hector and Jasmine had been repeatedly physically abused by Ms. Vega and her boyfriend.  When the two older children misbehaved, they were beaten with an extension cord, had hot sauce put on their genitals, or were made to kneel on uncooked rice.  Jasmine told the Armstrongs that she didn’t remember when their mother had started hitting her when she was “bad,” but that Hector’s abuse had started when he was about eighteen months old.  All three children had witnessed many violent episodes between their mother and her boyfriend.  Jasmine said that the two often hit, kicked, and threw things at each other when they were angry, and that she had seen blood all over their faces and clothes after some of their fights.  Jasmine said she would take her younger siblings into the bedroom closet during these incidents.

The Armstrongs know little about the siblings’ early developmental history, but they reported that all three children were underweight, quiet, and fearful when they were first placed with them.  Hector was still in diapers and using a pacifier.  His language seemed significantly delayed, and he wasn’t yet speaking in full sentences.  As Hector got older, his behavior became increasingly difficult to manage.  His foster parents reported that he often becomes angry and aggressive with very little provocation.  He seems to crave danger, and once climbed out the window to walk on the railings of their fourth-story fire escape.  He also has difficulty falling asleep, and sometimes gets no more than one or two hours of sleep a night.  When he does fall asleep, he often has nightmares about monsters and vampires.  His foster mother also reported that he has always hidden food in his room.  On several occasions, she has found week-old sandwiches and glasses of milk under his bed.

The Armstrongs have concerns about Hector’s sisters, too.  When Jasmine was placed with the Armstrongs she was seven years old.  Mrs. Armstrong said that Jasmine acted just like her siblings’ mother, and insisted on feeding and diapering Hector and Jessica.  They don’t have confirmation of this, but they assumed that much of the responsibility for taking care of her brother and sister was left to her.  The Armstrongs also reported that Jasmine has always seemed sad and anxious, and is very hard on herself when she doesn’t do well in school or when she makes even a small mistake.  Mrs. Armstrong reported that Jasmine recently dropped a glass of milk on the floor.  Mrs. Armstrong said that she didn’t have the heart to yell at her because Jasmine called herself stupid and hit herself in the head with her fists three or four times.

Mr. and Mrs. Armstrong report that they worry about five-year-old Jessica’s activity level and difficulty concentrating.  They described Jessica has always being on the go and not being able to stay with any one activity for very long.  She also has a very strong startle response and jumps and gets upset when she hears loud voices.

QUESTIONS FOR DISCUSSION

1. What kinds of trauma have Hector and his sisters been exposed to?
2. If you didn’t know the children’s trauma history, what diagnoses might you consider for them?
3. How does knowing about the siblings’ trauma history impact the diagnoses they might receive?
4. What are your hypotheses about how the siblings’ traumatic experiences have impacted their functioning?
5. Assess the degree of emotional regulation for Hector using Saxe’s framework.
6. Assess the stability of the social environment, using Saxe’s framework.
7. What does your assessment suggest for treatment plans?
8. How would you prioritize treatment plans?

INTAKE SESSION WITH FOSTER PARENTS

During their intake appointment at the clinic, the Armstrongs reported that the children seem to have both good and bad days.  They describe Hector as being a loving and sensitive child who can nevertheless suddenly become enraged if he perceives another child as becoming threatening or if he’s criticized by a teacher.  The stabbing incident that brought Hector to the clinic is only the last in a long line of instances of aggressive behavior at school.  When asked, Hector said that the kids in his class are mean to him and hit him all of the time.  He said that he has no choice but to defend himself and hit them back.  In the last year, Hector had two previous suspensions for hitting and kicking one of his male teachers.  When asked about this teacher, Hector said that the teacher yells at him a lot and always blames everything that goes wrong in the class on him.

Although Hector attends a special school for emotionally disturbed children, he learns very little because he is rarely able to sit through a full class period.  Hector appears to be extremely hyperactive and is unable to sit for more than a few minutes at a time.  He has great difficulty attending to his classwork and has very poor frustration tolerance.  He often appears angry and sullen, but he can quickly become expansive and almost hysterical.  Hector was initially put on a trial of Ritalin.  While on the medication, Hector was better able to attend to his work and stay in his seat for longer periods of time.  The medication, however, did not help Hector’s poor frustration tolerance, his aggressive behavior, or his emotional lability.

The Armstrongs report that Jasmine tends to hurt herself when she becomes disappointed in herself for making mistakes of any kind and not doing well in school.  She often hits herself in the head and on several occasions has cut her forearm with the edge of a paper clip.  Five-year-old Jessica seems to have the most difficulty when she’s required to sit quietly in school.  She tells them that she “sees bad things” at those times and she “feels better” when she’s running around.  She also has an extremely strong startle response and jumps whenever she hears loud voices in the street, in other classrooms, or from other apartments in her building.

The Armstrongs report that all the children seem anxious before and after the scheduled monthly visits with their biological mother, Ms. Vega, but that Hector’s behavior at school becomes particularly problematic.  Two of his suspensions from school have closely followed visits with Ms. Vega.  The Armstrongs report that Ms. Vega is inconsistent with her visits, and that she comes to the foster agency for only about half of her scheduled visits with her children.  When she does come for her visits, she seems to feel that the children don’t show her enough affection.  She either cries or becomes angry and yells at the children.  The Armstrongs have spoken to the children’s case manager many times about how upset the children become around the times of the visits, but she says that she can’t do anything to change the schedule because the judge has ordered the visits.

QUESTIONS FOR DISCUSSION

1. Use the concept of survival circuits (Saxe et.al.)  to describe the presentation by the Armstrongs of Hector having “good and bad days”.

1. What factors secondary to the siblings’ exposure to chronic trauma may be influencing their functioning?

1. What are some explanations for Ms. Vega’s (biological mother) inconsistent and inappropriate behavior at the scheduled visits with her children?

1. What are the major symptoms Hector is having?  List potential reasons why a 7 year old might have these symptoms

1. Discuss how Hector’s developmental level and age influence his symptoms.

1. Are these symptoms likely to be transient or chronic?

1. List the symptoms of Hector’s sisters, and how they differ from his. Discuss why there might be these differences.

1. What do you want to do next?

INTERVIEW

Upon interviewing the Armstrongs, the intake therapist learned that the Armstrongs received special training so that their home could be certified as a therapeutic foster home.  The Armstrongs appear to be highly skilled, patient, and loving.  In addition, they report having close relationships with their two biological children, who are both employed and have families of their own.

The Armstrongs both grew up in Jamaica and report that an authoritarian style of parenting and using physical punishment is the norm there.  They report that their parents used harsh methods of punishment and they were both “flogged” with switches as children.  The Armstrongs said that they used less harsh methods with their own children, but they describe themselves as being strict and reported that they sometimes spanked their children when they were young.  They’ve found, though, that the same methods of discipline are less effective with their foster children.  Their experience has been that Jasmine becomes overly fearful and Hector and Jessica become disturbingly agitated when they raise their voices.  They reported that, although the training they received from the foster agency was extremely helpful, they would welcome some education about how to parent children like Hector, Jasmine, and Jessica.

Mr. and Mrs. Armstrong are committed to caring for the three children.  They make sure to spend some individual time with each child engaging in an activity that each child loves. For example, Hector is a very good athlete and loves to play soccer.  He and Mr. Armstrong go to a nearby park to play soccer at least once a week.  Hector has formed a very good relationship with his foster parents and calls them Mommy and Daddy.  He appears to especially admire and respect his foster father.

QUESTIONS FOR DISCUSSION

1. Why do you think the Armstrong’s decided to become therapeutic foster parents?
2. What cultural factors may be influencing the Armstrongs’ parenting practices?
3. What are Hector’s strengths?  What are the protective factors in Hector’s environment?
4. What do you need to look up?  What do you want to do next?

ASSESSMENT

Hector’s new therapist completed a full assessment and determined that her first task was help Hector achieve a sense of psychological safety.  Hector called his incidents of affective dysregulation “going crazy,” and said that they scared him sometimes.  The therapist decided to work on improving Hector’s ability to manage his emotions.  Hector had severe difficulties in the following areas:

1. Range and intensity of emotions. Hector was expressing his emotions so intensely and inappropriately that they were interfering with his social and academic functioning.
2. Ability to label emotions or use feelings language. Hector was not able to talk about or accurately label his feelings.   He could say only that he “goes crazy” a lot.
3. Ability to connect emotions to trigger events. Hector was not aware of the connection between his emotional reactions and the situations or thoughts and beliefs that caused them.  When his therapist walked him through a “moment by moment” assessment of the stabbing incident that led to his last suspension from school, Hector said that all of a sudden and for no reason a kid in his class pushed him hard.  Hector said that he wasn’t thinking of anything and that his mind was blank when he “went crazy” and stabbed the kid who pushed him with a pencil.
4. Use of coping strategies. Hector had few strategies for coping with overwhelming emotions, and most of these were maladaptive. While the therapist was observing him play a frustrating game, she noticed that Hector didn’t use coping self-statements before approaching a difficult task or ask for help. And when she asked him about his biological mother, he seemed overwhelmed and began to take objects off her desk and throw them in the garbage.

QUESTIONS FOR DISCUSSION

1. What neurobiological consequences of trauma do you see in Hector?
2. How might these symptoms relate to his trauma history?
3. How might you intervene with these neurobiological consequences?
4. What do you think “psychological safety” means? Why do you think the therapist decided to start with helping Hector achieve a sense of psychological safety?
5. How does your body react when you are feeling anxious (sad, angry, excited)
6. What coping skills do you regularly use when you experience strong emotions?
7. What strategies might you use with Hector to help him cope better?
8. What do you want to do next?

TREATMENT

Hector’s therapist initially began working on helping Hector become aware of and label his feelings.  She worked on this in two ways.  First, she made sure to label any feelings that came up in the course of pretend play.  Hector particularly liked to play with superhero figures, so the therapist labeled the feelings of the figures during play.  For example, when two superheroes were engaged in a battle, the therapist labeled the figures as being angry, frightened, ashamed, or sad, as dictated by the play situation, and connected the situation to the feeling it evoked.  She also helped Hector understand that emotions often have physical manifestations.  When she worked with Hector, they often played frustrating games such as Operation or Sorry because Hector has particular difficulty managing frustration and disappointment.  The therapist helped Hector discover that his stomach hurts and that he clenches his fists and jaw when he feels frustrated.

Next, the therapist worked on helping Hector identify the thoughts and situations that trigger difficult behavior……

If left unrecognized and untreated, exertional heat illness can be catastrophic. Unfortunately, each year we see several high school, collegiate, and even professional athletes succumb to this condition. As you’ll read in the articles associated with this post, catastrophic EHI (i.e. heat stroke) is a preventable condition. You will also read how it is imperative that health care professionals and coaches recognize the signs and symptoms of the condition immediately so that appropriate interventions can be activated. For this week’s discussion topic, I am asking you to read several articles and answer the below questions. Please note that all articles for this week are in the folder labeled “journal articles”.

Please thoroughly answer each of the below questions.

1) What are the best ways for the treatment of Exertional Heat Stroke?

2) Knowing the best practices, how would you feel if someone did not administer these practices, because they were uncomfortable doing so?

3) What are ways we could educate the public on the appropriate care steps?

4) What further information and concerns need to be brought forth on this topic?