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By: J. Narkam, MD

Program Director, New York University Long Island School of Medicine

Eduardo is a 36-year-old Latino man who has been dating Janice cholesterol levels 60 year old buy cheap simvastatin on line, a 33-year-old Caucasian woman cholesterol fluidity discount 20 mg simvastatin amex, for several years cholesterol in eggs hdl or ldl purchase 10mg simvastatin with mastercard. He feels that he cannot commit to marriage because he feels unsure if Janice is the "right one" for him. Janice wants to marry Eduardo and reports feeling frustrated that he has so many doubts. Eduardo further reports that he is unsure if he could stay faithful to one person for the rest of his life. It seems to me that it made sense when the average life span was only 30 years or so. How can someone make a decision like this during their 20s or 30s and have it be a good decision for 50 must maintain a rapport-building posture- for example, by maintaining eye contact and facing the patient with an open posture without a physical barrier such as a large desk impeding communication. Third, the psychologist actively and carefully listens to the patient, allowing him or her to answer questions without constant interruption. Fourth, the psychologist is nonjudgmental and noncritical when interacting with the patient, especially in regard to personal disclosures. The professional also strives toward genuine respect, empathy, sincerity, and acceptance, without acting as a friend or a know-it-all. He or she tries to create a supportive, professional, and respectful environment that will help the patient feel as comfortable and as well understood as possible during the interview. Effective Listening Skills In addition to the development of rapport, an effective interviewer must be a good listener. While this may appear obvious, good listening skills are important to develop and generally do not come naturally for most people. People often find it challenging to fully listen to another without being distracted by their thoughts and concerns. Many are too focused on what they are thinking or want to say rather than on listening to someone else. This includes the content of what is being said as well as the feelings behind what is being said. Listening also involves paying attention to not only what is being said but how it is presented. For example, someone may deny that he or she is angry yet have their arms crossed and teeth clenched, thus suggesting otherwise. Thus, listening involves a great deal of attention and skill including the ability to read between the lines. In our increasingly multicultural society, it is important for interviewers to be attentive to the influence of culture on communication and interviewing styles. Sue and Sue (2003) outline a number of important subtle differences in communication style associated with various ethnic groups. For example, their review of the literature suggests that Caucasians tend to speak loud and fast using head nods, eye contact, and quick responses, objective, and task-oriented communication. However, African Americans tend to speak with affect, use eye contact more when speaking than when listening, and use more affective and interpersonal communication styles. Asian Americans and Latino/a populations tend to speak more softly, avoid eye contact when listening as well as speaking to a high status person, and use low-key and indirect communication styles. They suggest that psychologists must be sensitive to different communication styles and learn more about how race, culture, and gender impact these styles. Janice is really nice and I like being with her but who knows what the future will hold for us. The professional must use language appropriate to the patient, whether a young child, an adolescent, or a highly educated adult. The interviewer generally avoids the use of professional jargon, or psychobabble, and speaks in terms that are easily understood. The interviewer tries to fully understand what the patient is trying to communicate and asks for clarification when he or she is unsure. On the basis of the information given, the depression does not appear severe enough to require hospitalization or other dramatic interventions. Observation of Behavior the interviewer pays attention not only to what is being said during a clinical interview, but also to how it is being said.

For the purpose of the Agreements between the City and the Homeowner "sold" shall mean the property is sold cholesterol levels for dummies purchase 20 mg simvastatin overnight delivery, title transferred average cholesterol during pregnancy discount simvastatin 40mg online, Agreement of Deed executed cholesterol levels in quinoa purchase 10mg simvastatin amex, or the owner no longer resides at the property as their principal residence. Recipient Selection Criteria: Clients are accepted for the Minor Home Repair Program on a first-qualified, first-served basis. Owners of properties must be the primary residents, owned the property for at least one year, and properties assisted must be located in the city limits. Property must be free of code enforcement liens or any other assessment unless owner has made arrangements to pay off or such violation will be addressed in the work write-up. Generally, such needs may include: purchase of emergency supplies for eligible households to weatherproof damaged homes; interim repairs to avoid further damage; tree and debris removal required to make individual housing units habitable; and post disaster assistance with non-insured repairs. This strategy shall be implemented only in the event of a federal or state declared disaster declaration using any funds that have not been encumbered. Income Categories to be served: Very- low and low- income households as defined by the U. All assistance will be given in the form of a 10 year, 0% interest rate loan forgivable at a rate of 10% per year. No payments will be due until the property is sold or there is a transfer of title. If the owner of the property dies during the lien period an income-qualified heir of the property may live out the term of the lien period in accordance with the established Housing Policy. All properties are subject to recapture of funds, through a recorded lien placed on the property. Recipient Selection Criteria: An eligible recipient shall be assisted on a first-qualified, firstserved basis. Summary of the Strategy: the City shall provide funds to demolish and replace single-family homes when upon inspection, the estimated cost to rehabilitate the home exceeds 75 percent of the cost of demolition and new construction and the condition of the home compromises the life, health, and/or safety of the household. Terms, Recapture, and Default: Funding for this program will be provided in the form of a 0% interest, 20 year deferred payment loan, forgivable at 5 percent per year secured by a recorded mortgage and note. The mortgage and note shall provide for prorated repayment, which shall be due if the home is sold, title is transferred or conveyed, or the home ceases to be the primary residence for the owner during the affordability period. Only subordination requests which increase the affordability of the housing unit or assist a household with medical expenses will be considered. However, if the need for a sponsor should arise, the City of Cocoa will use a Request for Proposals process in accordance with Chapter 67-37. Incentives include a provision that will allow for review and approval of expedited permitting on a priority basis for all housing activities needing any type of city permits which are expected to result in the creation or preservation of affordable housing in the City (see Attachment "I"). Ongoing Review Process the City of Cocoa utilizes a development review process that reviews all proposed changes to ordinances, resolutions, regulations procedures or policies to determine the impact on housing cost prior to the adoption by City Council. Such action shall require the affirmative vote of at least four (4) members of City Council. Allowance of Flexibility in Densities for Affordable Housing the Council has the right to enter into development agreements pursuant to the Florida Municipal Home Rule Powers Act. The City will continue to encourage the creation of new affordable housing within the city through the creation of a Housing Bonus Program. The Allowance of Affordable Accessory Residential Units in Residential Zoning Districts the Planning & Zoning (P&Z) Division will review the City code definition of accessory structures in relation to compatibility of the comprehensive plan and provide for accessory dwelling units in residential zoning districts as applicable. The Reduction of Parking and Setback Requirements for Affordable Housing Requests for a reduction of parking and/or setback requirements for affordable housing will be reviewed by the City staff and the appropriate board (Planning & Zoning, Board of Adjustment) and/or City Council. Any reductions will be allowed on a case by case basis if appropriate through development agreements. Since 2007, the City has entered into three (3) affordable housing development agreements for setback reductions, two (2) with Habitat for Humanity of Brevard County, Inc. Allowance of Flexible Lot Configurations, Including Zero-Lot-Line Configurations for Affordable Housing Requests for flexible lot configurations will be reviewed by the City staff and the appropriate board (Planning & Zoning, Board of Adjustment) and/or City Council. Flexible lot configurations will be allowed on a case by case basis if appropriate through development agreements. Request for modification of street requirements will be reviewed by the City staff and the appropriate board (Planning & Zoning, Board of Adjustment) and/or City Council. The Preparation of a Printed Inventory of Locally Owned Public Land Suitable for Affordable Housing the Housing & Neighborhood Division will ensure that the Finance Department continues to monitor and update locally owned public land suitable for affordable housing.

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Counsel for plaintiffs and defendants frequently engage in extensive research and consultation with pertinent medical experts to cholesterol chart numbers purchase simvastatin on line understand the medical issues in a case cholesterol medication weight gain buy simvastatin. A trial court would have none of these advantages available to cholesterol test results ranges discount simvastatin 10mg on-line it before reviewing extensive medical records and could deprive a defendant of critical information necessary to defend a claim simply because the court simply did not understand why particular records might be relevant to a particular case. Presumably, most plaintiffs are not concerned with disclosure of treatment of routine illnesses. Defense counsel have no interest in treatment for such conditions as that treatment did not advance any theory of defense counsel might wish to assert. Counsel for plaintiffs are in a unique position, however, to locate and redact information about which his or her client may be particularly sensitive. For example, if a plaintiff has suffered a severe injury to his knee and wishes to keep private the fact that he is impotent, the attorney representing him can explain that he should not assert claims of diminished sex life or mental anguish or depression as a result of the knee injury to avoid disclosure. The attorney can then be proactive in taking steps to redact any reference to the impotence before disclosure to defense counsel. Moreover, counsel for plaintiff will have the best motivation to ensure that all references to impotence are redacted from the records. The only threat of re-disclosure to the "public" would occur at trial or in pleadings filed with the court. In such instances, counsel for plaintiff and counsel for defendant can agree to appropriate steps to prevent third party disclosure just as they do in cases involving trade secrets and proprietary business information. The question is whether the purpose of protecting patientphysician communications will be adversely affected by allowing defense counsel full access to medical records to determine what portions of the records arguably relate to the damages and proximate cause issues asserted in the case. More importantly, both counsel for plaintiff and counsel for defendant have a direct financial and professional motivation to scour thousands of pages of records to find the "smoking gun" in a medical malpractice case where the "piиcederйsistance" will establish or destroy a particular claim for damages. Never file an appeal out of pique or spite or to "teach a lesson" to the judge or the other lawyer. Evaluate your position calmly and dispassionately and then make a clear and carefully reasoned recommendation to the client and/or its insurance carrier. Do not argue with the claims representative and never go over his or her head unless invited to do so. Not So Fast the usual reaction by a trial lawyer who suffers an unexpectedly bad result before a judge or a jury is to fall back on the notion that the appellate court will correct it. An appeal can do more harm than good and should be filed only after careful deliberation and certainly with the approval of the client. I will submit an example from a long-ago case that involved a point of law that seemed to have been clearly established. The company representative, who had not finished law school, considered himself a student of the law and wanted to "know what the law is"; in other words, whether the accepted point of law was actually the law. Try as I might, I could not convince him that an appeal of this small verdict could result in replacing a very dubious trial court ruling with an appellate decision that would greatly damage the insurance industry. In the end, the appellate court upheld the principle, but only after a considerable portion of my hair had turned gray. This nightmare provided me with a valuable example, which I have used many times over the years. It may be best to file a motion for judgment notwithstanding the verdict or a motion for a new trial. That gives the trial judge an opportunity to see the error of his or her ways and gives you a chance to reflect on the situation. In the case of an insurance carrier, be certain that its claim representative has sufficient facts to make an informed decision and then abide by that decision. And above all, do not gloat or second guess the claims representative after the appeal is concluded. Keep these points in mind: (1) move quickly, (2) do not hurry, (3) stay calm, and (4) do not overlook the possibility that your initial reaction might have been wrong. Instead, the parents could be held liable based on their alleged negligence in performing a voluntary undertaking to prevent the consumption of alcohol by guests under the age of 21. As a reminder for future submissions, the following are the Amicus Committee members: CommitteeChairman Michael L. According to the panel, however, the parents were not liable as social hosts because the parents did not supply the alcohol, store it, or affirmatively permit its consumption. He concentrates his practice in the areas of appeals, insurance coverage and toxic, environmental and mass torts.

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I would have gone down the hall between two nurses cholesterol medication impotence purchase generic simvastatin canada, past DeeDee and Loubelle and Mrs cholesterol synthesis definition quality 10mg simvastatin. It was a new nurse-they were always changing-with a lean cholesterol medication niacin purchase simvastatin 10 mg with amex, sand-colored face and sandy hair, and large freckles polka-dotting her bony nose. For some reason the sight of this nurse made me sick at heart, and it was only as she strode across the room to snap up the green blind that I realized part of her strangeness came from being empty-handed. Somebody in Belsize must be having shock treatments, unknown to me, and the nurse had, quite understandably, confused me with her. I waited until the nurse had made her little circuit of my room, patting, straightening, arranging, and taken the next tray in to Loubelle one door farther down the hall. Then I shoved my feet into my slippers, dragging my blanket with me, for the morning was bright, but very cold, and crossed quickly to the 514 Unit 6 / Adjustment and Breakdown and they would bear me, howling and hitting, past "Do you want to sit down? Doctor Nolan pointed at a Doctor Nolan put her arm around me and wooden bench, but my legs hugged me like a mother. The walls were bright, white lavatory tile with Miss Huey began to talk in a low, soothing bald bulbs set at intervals in the black ceiling. Finally, we stopped at a green Analyzing the Reading door with Electrotherapy printed on it in black letters. Under what and me were a pallid man in a circumstances would such treatment be administered? Unit 6 / Adjustment and Breakdown 515 Contents Chapter 18 Chapter 19 Chapter 20 Chapter 21 Individual Interaction Group Interaction Attitudes and Social Influence Psychology: Present and Future the Japanese stock exchange H ow and why do we interact with others the way we do? Then we study how we are influenced by the presence of and interactions with one another. Psychology Journal Why do people choose to interact with certain people and not with others? In your journal, keep a log for several days of the people you communicate with and how you communicate with them. For example, do you use only verbal communication, or do your friends and family realize what you are feeling by the look on your face or other signs? He bought a small island in the Bahamas, built a splendid estate, and surrounded himself with armed guards and attack dogs. Were there enough guards to protect him in case his wealth attracted criminals to loot the island? In addition, the gilded cage soon became boring; so he fled back to the anonymity of a big city. Vocabulary social psychology social cognition physical proximity stimulation value utility value ego-support value complementarity · · · · · · · Objectives · Discuss why we need friends. This topic is the concern of social psychology-the study of how our thoughts, feelings, perceptions, and behaviors are influenced by our interactions with others. Social cognition, a subfield of social psychology, is the study of how we perceive, store, and retrieve information about these social interactions. Every day we are making judgments about others based on our perceptions of who they are. Then, when we interact with these people, we must adjust our judgments to explain their behavior and ours. In this relationship we learn to associate close personal contact with the satisfaction of basic needs. Later in life we seek personal contact for the same reason, even though we can now care for ourselves. Being around other human beings-interacting with others-has become a habit that would be difficult to break. Moreover, we have developed needs for praise, respect, love and affection, the sense of achievement, and other rewarding experiences. These needs, acquired through social learning, can only be satisfied by other human beings (Bandura & Walters, 1963). Anxiety and Companionship Social psychologists are interested in discovering what circumstances intensify our desire for human contact.

The focus of consultee-centered case consultation is on challenges experienced by the consultee rather than on problems concerning an individual case or client how much cholesterol in shrimp cocktail order cheap simvastatin. Inexperience cholesterol not bad buy cheap simvastatin 10 mg on line, lack of information high cholesterol levels nz buy simvastatin 20mg lowest price, and mistakes made by the consultee are often the topic of discussion. For instance, a graduate student in psychology may seek consultation from an experienced supervisor about discomfort and anxiety experienced when conducting psychotherapy with patients who are older than the student. Finally, consultee-centered administrative consultation generally involves working on administrative and personnel issues within an agency. For example, an outpatient clinic board of directors may wish to consult with a psychologist about problems in the leadership performance of their executive director. Organizational Consultation: Clinical psychologists also frequently provide consultation to an enormous range of nonmental health agencies and organizations. Businesses, nonprofit agencies, and government organizations all employ people who must work cooperatively to achieve a common purpose and keep the organization running effectively and 368 Roles and Responsibilities business and industry executives (Auerbach, 2001; Hays & Brown, 2004; P. In fact, executive coaching is now a $630 million per year industry with 10,000 coaches located worldwide (Auerbach, 2001). Clinical psychologists, as well as other professionals from a variety of disciplines such as social work, marriage and family therapy, human resources, and so forth, have developed services for leading executives as an executive coach. They generally focus on ways to help executives become better leaders and managers as well as develop strategies to improve interpersonal relationships, productivity, and efficiency in companies. Executive coaches may consult with business leaders about stress management, goal setting, and a host of other topics and services related to human behavior and business. Executive coaching has become a potentially new and lucrative area of work for many clinical psychologists looking to expand their range of professional activities and services (Hays & Brown, 2004). As experts in human behavior, psychologists can offer useful advice on dealing with the interpersonal and organizational problems and conflicts that inevitably arise in organizational life. Organizational consultation generally uses systems theory to understand and intervene in organizations (Hanna, 1988; Kurpius, 1985). As discussed earlier in this book, systems theory proposes that all aspects of a system (whether a family or a professional organization) interact and react to changes and behavior in each element of the system. Each element or subsystem within the large organizational structure is dependent on other elements or subsystems, therefore changes that occur at one level will usually influence changes at other levels (Fuqua & Kurpius, 1993). For example, suppose that one division of a company is losing a great deal of money, has experienced several major failures, and has a leader perceived by most employees as incompetent. The division is unable to maintain employee loyalty and morale, and most of the employees are looking for work elsewhere. Systems theory would predict that the problems within this division are likely to impact the entire company. Losses by the division may need to be compensated for by other more productive and successful divisions within the company. The successful divisions are likely to feel resentful for having to bail out a failing division. Consultants to organizations must use systems theory to diagnose organizational problems and provide interventions. They know that tinkering with one aspect of an organization will probably have ripple effects on other parts of the organization, and must be mindful of the entire system when intervening. Stages of Consultation Many of the stages that have been used to describe the psychotherapy process apply to consultation as well. Executive Coaching: In recent years, executive coaching has become extremely popular as a way to bring principles of psychology to Understanding the Question: First the consultant must evaluate the situation in order to understand the nature of the referral question and the goals of the consultation. The consultant must determine whether he or she has the training, experience, and expertise to provide a competent and professional consultation. Frequently, the initial question posed by the person(s) seeking consultation changes during the course of the consultation. For example, a personnel director of a company may ask a psychologist to consult Consultative, Teaching, and Administrative Roles on stress management techniques for employees of her company. She tells the psychologist that downsizing and layoffs have resulted in a high degree of stress. She wants the psychologist to offer stress management workshops for small groups of employees as well as individual sessions for those interested in specialized one-on-one help. However, during the initial consultation it becomes clear to the psychologist (and the personnel director) that the management of the company has been ineffective and must be altered to reduce employee stress. The personnel director then decides that dealing with management issues should occur prior to offering the stress management workshops initially requested.

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