A Book Review of All Quiet on the Western Front

While All Quiet on the Western Front may help us understand the effects of the Great War on Germany, it is as an account of trench warfare and a simple story of human endurance. It is understandably one of the most famous of war novel.â€Å"All quiet on the western front†Ã‚  Ã‚   talks about the vehemence of war, friendship, bewilderment and mishap. It gives a description of German soldiers’ experiences. It is a clear, simple narration. Quite terrible are those dreamlike pictures in its ditches.The same for the severe feeling of being alone for the friend on leave only to return to the forefront .Remarque is the intensely interesting story of war experience of Paul Baumer who is a member of German army in world war one.He is positioned on the western front having a role of fighting against the French and English soldiers. He however hated the war believing that it was needless and that the war has decimated the generation he belongs .This fight of the adolescent Germans was seen by Paul as useless which they have been forced to do.This was a time that Germany was trying to gain influence in the world .Paul and 7 others eventually die   in the book as depicted in the last chapter. Paul gives a picture of dying men around him in many of the battles. The pattern of Remarque’s presentation in the book is awesome. All pages with the exception of the short paragraph in the last chapter are described in first person.The portrayal of the characters makes the reader feels as if at the scene of the battle. Two passages I really found interesting in the book the first being   where Paul expresses his longing to survive: â€Å"I think no more of the dead man   : â€Å"I think no more of the dead man. He is of no consequence to me now. With one bound the lust to live flares up again and everything that has filled my thoughts goes down before it† (138-139).Here  Ã‚   the objectives of all the armies is   illustrated and it is that they all want to live and arrive home safely and they are desperate to achieve this by all means whether good or bad. The book also teaches that to escape the fear of war the best thing is to face it. In another passage, Paul talks about how his teacher previously advised about the battle to the German youths:   â€Å"Kantorek would say that we stood on the threshold of life. And so it would seem. We had as yet taken no root.The war swept us away† (16).In this place, the book depicts how young men, unprepared for war but preparing for their future are forced to give their dreams and aspirations in other to face a gruesome and deadly battle. What a mature strong men may not survive is being faced by this young people i.e. famine, poverty, thirst, terrors and demise of friends or even they themselves. Will they survive?Even after the war, if they survive they are old and what can they do with their lives again? No jobs, no families, and no homes again. Unfortunately various life e vents appear purposeless after fighting in the trenches.â€Å"All quiet on the western front† relates the events of one man who suddenly found himself in the war he knew little or nothing about. Paul Braumer was laboring in trenches while for the purpose of the uplifting of the Germany he volunteered himself for war having been persuaded by his teacher.He and his friends served as members of the infantry. Paul wondered not only the possibility of escaping without himself being killed  Ã‚   as he watched his friends dying one after the other but also the likelihood of surviving a world without war. He observed the trenches of western government were soaked in human blood from the death and massacre of the people.Remarque in his book allows for a period of relief amidst hell of battle. His approach is simplistic, clear and direct without losing the essential purpose and value. There are also periods of lyrics and thoughtful ruminations. Patriotism and countryman spirit are co nfronted by entity of the pompous schoolmaster who persuaded the writer and his fellows to join together.Disconnection from the civilian way of life is seen following the narrator’s leave having previously left the school for trenches with no assurance of establishing ties. It allows for a pensive thought on the generalized effects of war most marked by hindsight. Horrors are slimly depicted. With progression of the novel in terms of its character transformation, character reinforcement, the breaking and twisting in the battle front, we are being gradually challenged by the Aristocrats and the disastrous genre of the book.The Genre of the book is tragedy. In one scene of the book, Paul and his friends were together in the open space over the boxes being used as latrines: â€Å"And it will be 2 hours before we get up again† (page 7). Paul rails: â€Å"There he lies now but why? The entire world should have passed.† The book depicts the combination of joy, happine ss sorrow and the outbreak of violence.All quiet on the western front is laudable as it will compete to emerge as one of the best if not ever best book written on war. I enjoy reading the book and the lesson I learn is that war can be terrible. I give the book distinction and I can recommend it anytime, anyday.   

Management and Work Culture Essay

Instrumental to conduct SWOT analysis, and 3. Plan and build strategy based on the work culture How to develop strategic and operational plans by knowing work culture It is integral part of any individual, and organization. It describes shared value of an organization. It helps anyone to understand how things are done. Here is my cultural preferences: well resourced, ethical, and teamwork centered. Knowing my ideal work culture, I can do better planning and formulate the strategies for an organization. My cultural preferences Necessary resources to do high standard work. Using advantages of available resources, one can do better job of delivering projects with high quality standards. Active promotion of equal rights and justice for all. It will create a culture to grow with the company attitude. Fairness among the employees and employer makes everyone trust each other and the employer. Emphasis on social and environmental responsibility. In this culture, work and life balance here. Social and environmental responsibility culture will help employees more committed to the employer. Because organization is not just focusing on profit itself but also understand human values and help communities around them. Interdependence. Culture of interdependence makes everyone connected, and emphasis the important of collaboration between them. It results toward high level of performance, innovation, and productivity. Friendly and supportive colleagues. Friendliness and supports among colleagues is highly important for employees to challenge themselves, confront each other, and share the knowledge between them. Essential Competencies to Conducting (SWOT) analysis Strategizing competency is one of the most essential to do SWOT analysis. Steps to conduct SWOT analysis: 1. Identify mission statement and goals, 2. Review of internal strength and weaknesses, and 3. To find external opportunities and threats that affect the business or an organization. How my competencies relate to the essential competencies for conducting a SWOT analysis Based on competencies and career interests profiler, my strength are 1.

Psychology and Psychiatrist Sigmund Freud Essay

The study of personality is one of the biggest topics of interest within psychology. There are numerous personality theories that exist making the most major ones fall right into at least one of our four major perspectives. These perspectives on personality attempt to describe the different patterns in personality, including how the patterns form and how people differ on individual levels. In my essay I will go into more in depth detail about these major perspectives and afterwards explain to you how changeable or unchangeable I think my personality is. To start off, there are four different perspectives. The first is Psychoanalytic Perspective. This perspective emphasizes the importance of early childhood experiences and the unconscious mind. This particular perspective was created by psychiatrist Sigmund Freud who strongly believed that things that are hidden in the unconscious could be revealed in numerous different ways. However the Neo-Freudian theorists only agreed in the importance of the unconscious, but disagreed with other aspects of Freud’s theories. The second perspective is called The Humanistic Perspective. This focuses on psychological growth, free will, and my favorite, personal awareness. This perspective is my favorite because it takes a more positive outlook on human nature and is centered on how each person can achieve their individual potential. The third perspective is called The Trait Perspective. This one is centered on identifying, describing, and measuring certain traits that make up a human’s personality. By knowing and understanding this, researchers have come to believe that they can now better comprehend the differences between individuals. The last perspective is The Social Cognitive Perspective. This one emphasizes the major importance of observational learning, self-efficiency, situational influences and cognitive processes. Now as far as explaining how changeable or unchangeable I think my own personality is, my personality really depends on who you are, what day it is, what went on that day, and in a lot of cases what kind of mood I’m in.

Charles darwin Essay Example | Topics and Well Written Essays - 1250 words - 2

Charles darwin - Essay Example This governmental body has set safety standards which are to be followed by all the companies and the safety and health professionals have to ensure that these standards are being followed and obeyed by every company. The article â€Å"Importance of safety consideration in site layout and organization† is written by Anumba and Bishop. The article was published in the Canadian Journal of Civil Engineering in the year 1997. The article discusses the facts that generally at the time of laying out the site plan are ignored and it has been mentioned that these facts are very important to be considered in the practical implementation. It has been discussed that in general no company focusses much on safety methods that must be adopted. Here it has been mentioned that occupational safety and health professionals must keep a proper check on such companies and proper action must be taken against such companies (Anumba & Bishop, 1997). Safety and health professionals are responsible for planning out and formulating the rules and standards that are to be set for the employees. They have to first plan out a team of highly professional and experienced professionals which would work together as a team to formulate the points and rules and finalize them, then a team must be developed which would ensure that the rules and standards set by the agency are being implemented or not. While planning and formulating the rules it must be made sure that the rules that are being designed must be practically applicable and can be applied to all organizations and firms (Bailey, 2008). Each and every aspect regarding health care issues must be kept under consideration and all sorts of companies and firms must be kept in view while designing the rules and points of the act. It is the responsibility and duty of the health and safety professionals to design such rules and set such standards that each and every employee feels safe and secure while working in the workplace environment. Safety

Business project Essay Example | Topics and Well Written Essays - 2500 words

Business project - Essay Example The objective of my research is to investigate, and highlight recruitment and retention problems for canvassing staff that the company is currently experiencing. A  literature review  is a critical and in depth evaluation of previous research in a particular area. It allows anyone reading the paper to establish why you are pursuing this particular research program. The role of a literature review is to discover answers to a research problem. Machi & Mc Evoy (2008) explain an advance literature review as the foundation for identifying a problem that demands original research, and is the basis for the study of a research problem. Both authors even explain further that a literature review critically proposes further research which guides the problem into identifying research objective that then leads to findings and conclusion from the whole research. Therefore the literature review covers areas such as Job satisfaction and turnover Intention, organisational culture and behaviour towards work life balance. Researchers have developed a variety of conceptual frameworks to model the turnover process. As noted by Lambert et al. (2001), scholars speculate that employee turnover can be predicted using comprehensive measures of job satisfaction; otherwise stated, high job satisfaction is associated with low employee turnover. Moreover, research shows that the relationship between job satisfaction and actual employee turnover is moderated by intentions. Schwepker (2001) noted that positive and statistically significant relationships have been reported in dozens of studies exploring leaving intentions and actual leaving behavior. In other words, intention to leave a job is an immediate precursor to actually leaving. For this reason, positive relationship between professionalism in the workplace and job satisfaction. In his research, Schwepker (2001) also noted that statistically significant,

The Effect of Rural Population Density on Socio-economic Dissertation

The Effect of Rural Population Density on Socio-economic Characteristics of Rural Communities - Dissertation Example From the research it can be comprehended that rural population or settlement density is a very important factor or variable in identifying, delineating, analysing and categorising the rural communities. Modern day rural communities are typically formed out of a symbiosis between a central urban centre and a rural matrix within which it is embedded, in terms of the labour market, service provided, social interaction and other activities. The concept of the rural population and the nature of these settlement densities are essential variables as one tries to comprehend the important factor in understanding the socio-economic, the population density and the settlement matrix of the sparsely populated rural areas, where the thin and decreasing population densities presents both theoretical and practical problems for those involved in rural planning. Rural population density has a strong influence over the socio-economic and demographic characteristics of the various non-urban communities, especially in the developed world, and forms to be a fundamental variable within the realms of planning and public policy framing. Thus, we find that study of rural population density is an essential subject in order to develop these spresely-populated areas better. However, a closer look at this subject of rural population shows us that not much work has been done in this line owing to the complex nature of the population density. It is not easy to distinguish between cause and effect, while explaining the various planes of human density, and the type and depth of their relationships with different social aspects. The complex nature of population density also implicates the involvement of the socio-economic, environmental, and historical factors that help to create a specific density spectrum and kind, like, linear, clustered, or randomly distributed, in respect to any type of rural community (Argent, Smailes, & Grif?n, 2005). The perceived density or the qualitative dimensions of population density are yet to be explored in details. only a few researchers have worked in this regards, as for example, Irving and Davidson (1973) defined social density (interpersonal relationships between members of a rural community), and Tuan (1977) in his papers emphasized that the feelings of crowding or loneliness were created owing to an individual’

Female Bisexuality Research Paper Example | Topics and Well Written Essays - 1250 words

Female Bisexuality - Research Paper Example An article in the New York Times discussed the concept of attraction as it relates to women. According to the article women were not as stimulated by the sight of men without clothes as women. Sensuality is more relevant to sexual arousal than is gender. What women find erotic is not based on the male nude form but the sensuality of the subject matter. Scientists have discussed the nature of attraction for women and have connected it to bisexuality in women. Researcher Meredith Chivers states that for women who are heterosexual â€Å"looking at a naked man walking on the beach is about as exciting as looking at landscapes.† Proving this point, she showed participants in her study landscapes of the Himalayas and naked men doing yoga or tossing stones in the ocean. Both sets of footage had the same response, but women doing calisthenics in the nude increased blood flow at a significant rate. The discussion in the article sought to explain how bisexual behavior has become a more common experience in female interactions. Newman (2008) writes that â€Å"Dr. Chivers’ work adds to a growing body of scientific evidence that places female sexuality along a continuum between heterosexuality and homosexuality, rather than as an either-or phenomenon†. Josephine Decker who directed a documentary called â€Å"Bi the Way† about the frequency of bisexual behavior in women states that women are more fluid in their sexuality. In contrast, when men who were identifying themselves as bisexual were given the same type of test by Dr. Chivers it was determined that they were more attracted to naked men than women. This suggests that there is a distinct difference between the way in which women and men are aroused from a visual perspective and that the concept of bisexual activity is likely founded through different perspectives on arousal. Even though female bisexual be havior is a trend in

Should we have the Good Faith Exception extended to searches and Research Paper

Should we have the Good Faith Exception extended to searches and seizures - Research Paper Example ditions. The Fourth Amendment is limited to governmental searches and seizures made by the federal government and also state governments through the Due Process Clause, Justice Felix Frankfurter said in the case â€Å"The security of one's privacy against arbitrary intrusion by the police is basic to a free society† (Wolf v. Colorado [1941])). But in order to understand what an unreasonable search and seizure is, we must fist understand the concept or definition of â€Å"search†. In the landmark case of Katz v. ... Any evidence that are taken in violation of the Fourth Amendment is inadmissible as evidence in any criminal prosecution in a court. The Fourth Amendment protects man from unreasonable government interference in his daily life, although several Supreme Court cases have provided certain exceptions to this general rule. One of this exceptions established by the Supreme Court was made in the landmark case of United States v. Leon (1984) is the â€Å"good faith rule†. The fact of the case was based on a drug case that was under surveillance by the police authority in Burbank, California. Based on the information given by the officer taking the said surveillance, a certain Officer Rombach filed for an application of a search warrant for three residences upon the review and approval of the District Attorney. A state court judge after reviewing the request, issued a search warrant. Hence, a search ensued and the suspects were indicted for federal drug offenses. Upon trial, respondent suspects moved that the evidence taken in the search be inadmissible as evidence stating that the affidavit lacked sufficient proof of probable cause. Officer Rombach replied in his defense that his reliance on the search warrant was based on good faith, believing that the officer that gave the information was based on his personal knowledge that would in effect lead to a proper probable cause. The Courts accepted the defense and thereafter established good faith reliance on a defective search warrant by the court, as an exception to the exclusionary rule in violating the Fourth Amendment. As Justice Brennan and Justice Marshall dissented in the case, I also agree that the good faith exception is a dangerous decision that can violate the civil liberties protected by the

Project Management Risk Management Case Study (Space Shuttle) Essay

Project Management Risk Management Case Study (Space Shuttle) - Essay Example Could it have been averted? In this essay today, we will look at the mishap from the perspective of Risk Management and try to critically analyze the causes, and lessons learnt from the tragedy. Launching a Space Shuttle has always been a tricky business. With so many complexities to handle and parameters to fulfill simultaneously, it involves a high level of risk. On 1st February 2003, the Flight Control Team at Columbia did not report any issues or problems related to the planned de-orbit and re-entry. The team had indicated no concerns about the debris impact to the left wing during ascent, and it seemed like any other re-entry since all the systems were normal and the weather observations and forecasts were within guidelines. However, as Columbia descended from space into the atmosphere, the heat produced by air molecules colliding with the Orbiter typically caused wing leading-edge temperatures to rise steadily. In the events that followed, a broken message was recorded from the mission commander: â€Å"Roger, uh, bu†¦Ã¢â‚¬  This was the last message from the crew. Soon after that, the space shuttle started disintegrating causing a loud boom and debris being sca ttered in the clear skies of Dallas. In case of any space program, the margin of error has to be next to nil since it not only entails billions of dollars of public money but also many precious lives. With Columbia, too, although the risk probability was extremely high, the consequences were still acceptable. So what went wrong? According to the Columbia Accident Investigation Board (CAIB), politics, budgets, schedule pressure and managerial complacency all contributed in causing the Columbia disaster. The CAIB report also delved deeply into the underlying organizational and cultural issues that led to the accident. However, the most apparent cause seems to be inaccurate risk assessment. In a risk-management scenario similar to the Challenger disaster of 1986, NASA management failed

Topic Exploration Paper Essay Example | Topics and Well Written Essays - 750 words

Topic Exploration Paper - Essay Example In most western countries like America, fatherhood has undergone a revolution. This revolution has been brought about a change in the traditional gender roles where women were involved in reproductive while men carried out the productive roles to sharing of parenthood responsibilities as the women go into productive roles as well. Women were purely the care givers and men the breadwinners. This therefore distanced them from any direct involvement in their children’s lives other than providing the meals for them while the mother did all the other things for them. As society evolved and women began advocating for their own equality and equity rights, the men started getting more involved in childhood responsibilities other than just fathering and provision of food. The 20th Century has seen fatherhood rise to the status of fathers raising their own children without the presence of a mother or wife. It has also seen gay men becoming fathers and bringing up their own kids without the presence of the traditional family setup of mother, father and child and these children still grow up like other children (Ozgun, Erden and Ciftci, 2011). Fathers have started getting more interested in the other aspects of their children’s lives other than just grooming them towards being the heirs to their property. They care about their other previously trivial aspects of their lives like their health both psychological wellbeing as well as physical wellbeing, their education and their social life as well. Fathers of this era are seen taking their children to sports, to hospitals for checkups, and to recreational facilities for bonding which was non-existent and still in in other cultures. When it comes to African societies, there is a division between those who have become urbanized and hence taken up similar fatherhood roles with the western societies as explained earlier and those who

Individuals Relationship to the Community Essay Example | Topics and Well Written Essays - 750 words

Individuals Relationship to the Community - Essay Example Sartre's existentialism and Human Emotions talk about how an individual can get the essence of his individuality through his existence. According to him, humans are thrown in this world without essence and with the span of time that he spends in the world, he has the chance to make decisions for there are choices available no matter what kind of situation circumstance he will be. He also added that since the people are born in the environment where there is no external value, it is already his chance to achieve the internal value that he desires. This optimistic view of existence can be related to how people base their decisions, most of which depend on what will people say and how people will judge. The individual and the community can never be separated although that is the aim and the goal of each one, still to depart from what is real and existing as a factor of survival is absolutely impossible. That is because of the reality that man cannot live and interact with himself alone. The interaction with other people that is needed for the nourishment of his physical, mental and emotional aspects is quite significant to be disregarded. This is the same reason why the community, the place for interaction is indispensable for his survival. The disadvantage comes in when free will and personal decisions get replaced by what we call "rules," rules which Freud said to be a kind of mutual relationship which replaces the individual's freedom by the rules of the society. This means that one is restricted to do things of his desire to give way to order and justice. Individual instincts for happiness are also controlled so as to reach the level of civilization which is thought to be progr ess. And since we talked about progress as another goal of every society, we can't remove the fact that progress deals with new technology which just like what Said mentioned in his book Representations of the Intellectual can somehow alter the real meaning of freedom. This is due to social conformity that needs to be accomplished to get the work done riding along with technology. The improvements and progress being the aim of every community and society, or group of individuals which usually follow a rule will always violate the so-called "norm of freedom" which Said partly talked about in the said book. The point being raised here is that even if there is a choice for man to be totally free at a given time or place, there is always a big possibility for him to be submissive to the rules which to him will bring forth bigger advantages. The violation then comes in when the expectations of the man who went struggling to deprive himself from personal satisfaction for a bigger cause gets corrupted by a bigger longing not from an individual but from the society, which supposedly is the on that would protect and or work for his desires to be achieved. A violation can also be done to personal freedom of choice and decision is when at a moment, the basis for a particular action or agendum is already the reaction of the community which cumulatively formed the rules in the society. What went wrong between the individual and the community was the interlocking of desires both from the individual and the community. No matter how mutual the so-called rules can be, there is always a greater desire that may pass over the well-made rules of the

European Cars Are Better Than Japanese Essay Example for Free

European Cars Are Better Than Japanese Essay The design is specialized to cater to the specific needs of a consumer. Every country in the world manufactures its own cars, whether it is Japan, America or Europe. European cars are vastly superior to Japanese cars when examining performance, design and safety. The key feature that makes European cars better than all other cars is performance. Performance of a care is judge by how well the, brakes, suspension, traction, transmission and engine work. When European car manufacturers talks about performance they are referring to power generated by the car. European cars manufacturers combine all the aspects of performance to create an extraordinarily spectacular engine, which has maximum horse power and torque. Some European cars engines are hand-built, which helps delivers performance at a perfect level. Power from the engine has to be delivered to the wheels; transmission plays a vital role in delivering the power and speed from the engine to wheels. Car manufacturers in Europe develop a transmission system which is particularly adept at applying output so that it can be delivered quickly, smoothly and efficiently when called upon. European car manufacturers are especially renowned for their designs, because their designs allow precision in handling, efficiency in engine performance and good brakes. An efficient power output of the engine leads to an increased maximum speed limit that the car can reach. To maximize the speed that a car can reach the external shape of the body of a car is designed with special care as well. When European car manufacturers talk about speed, they keep in mind the aerodynamics of the car. Designers ensure that the car has a streamlined body shape, which reduces air resistance experienced by a car while it is in motion. In addition, aerodynamics designing provides for the external appearance of the car to look elegant, fashionable, artistic and sensational. European cars are made out of high-strength steel body panels make the safer when an impact takes place. They are manufactured with 7 different air bags inside the care to avoid the impact and causing the driver and passenger to be much safer. If a car can reach high speeds in a short span of time then it needs good brakes. European engineers ensure safety and handling does not become an issue for the driver and the passenger by providing an anti-lock braking system. This system prevents the car from skidding and allows the driver with greater control over the car because due to the anti-braking system the wheels of the car are only gradually reduced in speed. Rather than bringing the wheels of the car to an abrupt halt, the brakes of the car provide with better independent suspension for each wheel, which can help withstand shocks and bumps. European cars are superior in performance design and safety. Japanese cars lack behind in performance when compared to European cars. They have weaker and lighter engines, which only reduce the manufacturing cost, but result in giving a poor performance. Japanese car engines are manufactured on low budget. The lack in use of technology during the production makes the cars less reliable, because the finished engine does not produce much power. Less power means less torque and horsepower. Production companies in Japan manufacture engines using heavy equipment and machinery. This allows them to produce cars in a greater quantity, but there is no guarantee for quality . Japanese engineers focus on building lighter engines which gives more gas millage. Japanese cars are designed using weaker body structures making the car lighter. They use to steel alloy to manufacture the exterior of the less expensive material. Exterior of the car is brittle enough to not to withstand an impact, hence making less safe. Japanese cars are not safest car in the world. To avoid the cost to manufacture the car, they use disk brakes which have a higher risk of worning out faster than anti-lock brakes. They use one suspension for two pair of wheel, which causes to feel the smallest shock and bump while ridding the car. Japanese car don’t use that much technology to make their car safe enough. European cars are superior to Japanese cars. They are better in performance, design and safety. European cars are comfortable, luxurious and high end cars. Japanese cars are ordinary and standard cars. Japanese cars are cheaper that European, but buying an expensive car gives you a lot of option to enjoy the ride of the car. , and produce products with a superior passenger cabin but employ lower standards outside of the cabin. Disk brakes, Alloy Wheels, and Brake Override Systems have been standard on most mid-size domestic cars for years, yet are still optional or non-existent on many major Japanese mid-size cars being sold today. Anti-lock braking system (ABS) is an automobile safety system that allows the wheels on a motor vehicle to maintain tractive contact with the road surface according to driver inputs while braking preventing the wheels from locking up (ceasing rotation) and avoiding uncontrolled skidding. It is an automated system that uses the principles of threshold braking and cadence braking which were practised by skilful drivers with previous generation braking systems. It does this at a much faster rate and with better control than a driver could manage. With 72% of its body panels made from high-strength steel, theody structure is even more rigid than its renowned predecessors. The advanced front crumple zone has been refined with approximately 17,000 computer-simulated collisions and 150 crash tests. An innovative front bulkhead and deformation zones that act on four independent levels to help divert the energy of a frontal impact under, over and around the passenger cabin.

Constructing Flyovers At Sri Lankan Traffic Jammed Areas Construction Essay

Constructing Flyovers At Sri Lankan Traffic Jammed Areas Construction Essay An efficient transport network is the backbone of a healthy economy. As SriLankans most of our productivity is lost due to the inefficient and congested road network. One of the recent additions for traffic management and to alleviate congestion in colombo city and its suburbs has been the introduction of flyovers at important intersections of the main road corridors. The main function of a flyover is the separation of conflicting traffic movements thereby minimizing conflicts by using the vertical space. Therefore, it is assumed to cause less impact to the adjacent properties and the existing infrastructure. However, this depends on the type of flyover and the traffic pattern at the junction. 2. The efficiency of the recently introduced flyovers in the suburbs of the city of colombo can be tested by comparing before and after conditions of important traffic engineering parameters. It is also important to analyze the congestion level at the intersection and its significance compared to the entire road system. Basically the speed and the system capacity can be compared as main considerations to test this at a particular location. Moreover, the benefits and cost of a flyover against other reasonable and alternatives to obtain a similar result should be taken in to consideration and evaluated. In this research has attempted to compare the economic benefits of introducing flyovers against other short term and long term alternatives. The possible solutions available both from traffic and transport aspects are also widely discussed in my research. 3. The first of the series of large scale flyovers introduced to Sri Lanka recently are located across main railway lines in and around colombo. The first of these was a concrete cantilever type flyover in Ragama. This was constructed in 1996 in order to avoid the delay caused by the railway gate closures at the main line. A second flyover was completed along the baseline Road area. Dematagoda which was also across the main railway line in year 2000 to prevent the stagnation of vehicles on the Base line road. This was a 6 lane viaduct (culvert) type concrete structure. The 3rd flyover, which is a steel structure, was constructed in 2008 at Kelaniya within a record period of just 66 days; this was also to avoid the delay from the main railway line across the colombo-Kandy Road. The main purpose for the construction of all these flyovers was to reduce delays caused to vehicle traffic due to the closures of rail gates and reduction of accidents. 4. The latest flyover was constructed at Nugegoda junction in 2009. This is the first flyover at a road intersection, constructed in order to reduce intersection delays in Nugegoda. This too is a steel structure. 5. From the above details we could basically divide flyovers in SriLanka in to two main categories, a. Those across railway lines (railway overpasses) and b. those across road intersections resulting in grade separations. 6. The comparisons of key performance factors such as speed, safety, and economic cost with or without the flyover can be analyzed for both categories. Also, the economic viability of each category could be tested by comparing the cost and the benefits of the design life of each flyover. Selection of the type of flyover and its design are also of interest. In this respect, the comparison between cost, life time, possibility of land use, space utilization as well as the visual and function impacts on the area would be considered as being relevant decision making parameters for the selection of the type of flyover. CHAPTER TWO METHODOLOGY AIM The aim of this research is to identify and analyze the issues related the construction of flyovers at the traffic jammed areas in colombo district, How to improve finds the achievements and drawbacks being available in the flyovers. STATEMENT OF PROBLEM 2. The growth of population, economy and as a result of the prevailing economic policy, the number of motor transport is increasing daily but the road network has not developed in such a manner to cater for the increasing requirement creating a great impact on the growth of our economy. Similarly the inefficiency of public passenger transportation combines together with this, as it is the mode of travel used by the general public for day to day activities. 3. Moreover Improvements to Public Transportation can reduce traffic congestion by attracting car and other motorized users to bus and train transportation hence can contribute to the economy in long term by reduce fuel consumption, efficient use of road and vehicle fleet, reduced accidents, etc. Increasing of private motorized vehicles by widening and improving more capacity to it will create further problems to the traffic environment in future. Hence, the concern of more tax and quota system to reduce vehicle ownership will help to reduce the vehicle growth rate. But at the same time government should improve public transportation to satisfactorily for the convenience of all users. 4. On the other hand very expensive infrastructure will negatively impact to the economy of a country as they lose the power for expenditure to other important needs at the same time hence the inflation rate would be unbearable if they are already have economic crisis. Therefore, injection of local funding to huge infrastructure which will produce marginal benefits is a waste for a nation. However, the flyovers also can be constructed using reinforced concrete structures too at lower cost than steel structure presented at placed in Colombo these days. THE RESEARCH HYPOTHESIS 5. It is hypothesized that construction of flyovers at the traffic jammed areas as this is the best remedy for the issue, in this context there is no such requirement for add more kilometers to our road network. SCOPE OF THE RESEARCH 6. This research paper examines the lapses in the road network, one of the most recent traffic management methods, Improvements to Public Transportation can reduce traffic congestion and public passenger transportation at present, on its maintenance and existence, and how it affects the economy of our country and the ways available to overcome the problem effectively. METHOD OF DATA COLLECTION 7. The data for the research is collected both from primary and secondary sources. Primary data The Primary data has been collected from 40 samples in colombo district. Secondary data The data required for the research collected from the secondary sources with relevant Books, RDA/UDA Specialized personals and the Internet utilized. LIMITATION OF THE RESEARCH 8. My Limitation is Primary data was collected mainly from questionnaires, it is assumed in the information is 100% correct. Forty consumer of flyover were selected for the study. This also is a limitation in the generalization of the result. GLOBAL EXPERIENCES WITH FLYOVERS 1. Flyovers have been assumed to be an ultimate solution for traffic congestion in the congested cities of developing countries. Large number of flyovers has been constructed in our country in last few years. However, the actual performance of such flyovers is debatable when considering the overall impact to other transport functions such as pedestrian facilities, visual aesthetics and business developments in the locality. There is a strong public perception that flyovers have solved or will solve traffic problems in metropolitan areas.   Therefore, there is no apparent resistance from the public, media, politicians and administrators when flyovers are constructed.   The only resistance comes from the few that are adversely affected, for example, owners/tenants of business establishments, residents and civil institutions.   In response they are often criticized for not being socially conscientious and for being anti-development  since they usually cannot justify their own re asons from a professional point of view and there is no support for them even if hundreds of thousands may even suffer from the adverse effects of such developments.   The position that the interests and convenience of society at large over the inconvenience or losses to a few are often ignored in many countries.   There appears to be no counter to such arguments since there is indeed some logic and truth to it. 2. It has in fact been shown that the convenience of a flyover mainly occurs only during the non-peak hours of traffic flow.   For example, during non-peak hours well-designed at-grade intersections like those in all present flyovers are doing fine as it is only in peak hours that flyovers have a slight advantage. The convenience is also felt only in 2 directions of traffic flow out of a possible 12 directions at an intersection.   These misconceptions have had a great influence on the publics mind that flyovers indeed solve all traffic problems at intersections.   Only in-depth analysis and engineering computations can counter this influence.  For example, our country and in developing countries are examining possibilities of introducing toll systems to recover the huge cost of these flyovers. However there are difficulties in implementing such methods due to the lack of space for toll booths and also the difficulty of imposing this to the users who only have marginal benefits from a single facility within the overall road infrastructure. 3. The experience of our country and in developing countries is that flyovers have not given the anticipated benefits for developing cities. Moreover this has been considered as a threat to the urban architecture as well as the accessibility within the city. Common complaints regarding flyovers are the negligence of public transport, transit facilities, and pedestrian facilities. STUDY AREA 4. In the colombo suburban area there are four flyovers of recent origin. The three (04) railway flyovers namely at Dematagoda, Ragama, Dehiwala and the recently constructed at Pattiya Junction in Kiribathgoda are included in this study Figure 01. The Nugegoda flyover is at a road intersection. This too is included to be discussed separately. The data required for the research collected from the secondary sources with relevant Books, RDA/UDA Specialized personnel and the Internet utilized. ANALYSIS 6. The analysis is carried out under two categories namely flyover performance at road intersection and flyover across the railway lines. FLYOVERS AT ROAD INTERSECTION 7. The travel time data of all the turnings including the through traffic on the flyover at Nugegoda intersection were used to calculate the average (daily average) speed and delay at each approach of road links (Figure 02). Figure 02: Travel Time Survey at Nugegoda Intersection with Flyover 8. The average two way traffic flow speed on each 100 meters segment of all four road approaches (up to 2km) of the Nugegoda flyover. The average speed of road links other than on the flyover includes the signal delay too. 9. It was observed from the above analysis that flyovers at railway crossings give higher benefits when compared to that of road intersections. The comparison of basic values indicates that concrete flyovers are better than that of steel structures. This is evident when the life time and the maintenance of the two types of flyovers are compared. Even though the economic analysis was done for 20 years, the concrete structures can last for more than 50 years without many repairs on it. Therefore the benefits of concrete structures are much more than those indicated in this analysis. 10. The flyover at Nugegoda intersection designed for 20 years. According to the travel time survey data, this flyover indicates the lowest savings. It also has the highest per lane km cost. However, the signalization with improvements to approach links of the intersection as an alternative to the flyover indicates very well. 11. It was observed that the flyover or signalization alone does not solve the traffic congestion at an intersection but that it also needs capacity improvements of approach links for an improvement at that intersection. It can be observed that most of the intersection approaches are often blocked by parked vehicles and other activities such as uncontrolled pedestrian movements and temporary businesses on the walkways. Therefore it is often seen that the existing road infrastructures in urban areas are not properly utilized. The capacity of road links and the intersection can be improved by enhanced traffic management strategies. NEW FLYOVERS PLANNED BUT LACK PROPER PEDESTRIAN WALKWAYS 12. It has come into the notice of the Srilanka that in order to improve the transport system the Srilanka government has planned plenty of routines. Integrated multimodal transport system, will play a prominent part in offering an effective public transport service and hopefully will reduce private vehicles. 13. All in all, the main focus is on the development of more roads and more effective mass transportation. Though, there is no emphasis on the common man- the pedestrian- and his requirement for safe problem free movement space. 14. There is no doubt in my mind that with steady increase in the numbers of cars and footpaths, pedestrian space in the colombo city has become increasingly marginalized. In other word, the footpath was meant to be a place for the common man to walk upon and did not belong to the owner of plots adjoining the access road. 15. Theoretically speaking, roads have been widened in Srilanka and flyovers have been built in all the major cities of the country without offering safe and convenient facilities for pedestrian to cross over. The requirement for adequate pedestrian space is an absolute must especially in places where large number of people gets together such as in neighborhood markets and shopping centers specially Dehiwala. 16. Unfortunately, here also, the focus seems to be on providing for the movement of vehicles and the parking of cars. Shoppers dodge their way around moving cars, three-wheelers, motorcycles and accidents are frequent and common. Despite this traders have continued to resist the pedestrianisation of shopping streets fearing loss of business. TRANSPORTABLE ROADWORK TRAFFIC SIGNAL SYSTEM TRAFFIC-RELATED Low-cost traffic signal system for one-way alternating traffic. Easy to control, clearly organized at a glance. Universal in use with power cable, Telephone cable and others. All signal heads uniformity and simple. MODES OF OPERATION: Automatic fixed time mode Automatic green time extension Automatic green on demand All-red in cable and radio mode Manual operation from every signal head possible in cable and radio mode FLYOVER CONSTRUCTION 17. Recent traffic counts have shown that there are in excess of 30,000 vehicles using the roundabout daily at colombo area. The straight-through movement between the east and west sides off the South Ring Road was the highest recorded traffic movement at the roundabout and represents approximately 40% of the total traffic using the roundabout. There was an urgent need for grade separation. 18. Effective traffic management throughout the duration of the project was vital as the same volume of vehicles used the roundabout during construction as they did before construction. From public opinion, traffic management was put in place effectively and major delays were rare. CHAPTER FOUR IDENTIFY MAJOR ISSUES AND DIFFICULTIES UPLIFTING EXISTING ROAD NETWORK AND IDENTIFY EFFECTS SUPPLY AND DEMAND WIDENING WORKS UNDERWAY ON THE WAY TO INCREASE THE NUMBER OF LANES. 1. Congestion can be reduced by either increasing road capacity (supply), or by reducing traffic (demand). Capacity can be increased in a number of ways, but needs to take account of hidden demands otherwise it may be used more strongly than anticipated. Critics of the approach of adding capacity have compared it to inducing demand that did not exist before. Reducing road capacity has in turn been attacked as removing free choice as well as increasing travel costs and times. INCREASED SUPPLY CAN INCLUDE: Adding more capacity at bottlenecks (such as by adding more lanes at the expense of parking/harden type shoulders or safety zones, or by removing local obstacles like bridge supports and widening tunnels) Adding more capacity over the whole of a route (generally by adding more lanes) Creating new routes Traffic management improvements REDUCTION OF DEMAND CAN INCLUDE: Vehicle parking or non parking restrictions. Vehicle park or no parking (Ride) facilities allowing parking at a distance and allowing continuation by private and commercial transport or selected lane. Reduction of road capacity to force traffic onto other ways and modes. Road entering fees (Southern highway) charging money for access onto a road/specific area at certain times, congestion levels or for certain road users. Road reserve area, where regulatory restrictions prevent certain types of vehicles from driving under certain circumstances or in certain areas. Rule/Policy approaches, which usually attempt to provide either strategic alternatives or which encourage greater usage of existing alternatives through promotion, subsidies or restrictions. TRAFFIC MANAGEMENT 2. Global positioning system (GPS) devices are used to determine global locations points, which are measured and recorded as Longitude (E), Latitude (S), and Elevation/Altitude (meters above sea level). Anyway before commencement of a GPS survey must be required checklist. Traffic monitoring, via radio, GPS or possibly mobile type phones, to advise road users. Fluctuate type message installed along the roadway, to advise road users. Navigation or clear identifying system possibly linked up to automatic traffic reporting. Traffic monitoring / analyzing permanently installed, to provide real-time traffic counts. Road traffic monitoring/Analysis, to provide information on highway. Computerized highway system, a future idea which could reduce the safe interval between cars (required for braking in emergencies) and increase highway capacity by as much as 100% while increasing travel speeds. Parking area and guidance with information systems providing dynamic advice to motorists about free parking. Active vehicle controlling (Critical situation) system hard area (Parking, bus halt) as an extra traffic lane, it uses CCTV and monitor the traffics use of the extra lane. OTHER ASSOCIATED 3. Other associated are, School time (Start/End) arranged to avoid busy time traffic. Driving behavior promotion and enforcement moreover driving practices, frequent lane such as security or school hrs etc changes can reduce a roads capacity and exacerbate jams. Visual/Sound barriers such as horn CGR gate bell ringing etc; to prevent drivers from slowing down out of curiosity. Condition of speed reductions, showing speed limit, humps etc with lower speeds allowing cars to drive closer together, this increases the capacity of a road. 4. Moreover where space-efficient vehicles, usually motor bike, three-wheels and cars ride or drive in the allocated space between cars, buses, and trucks specially peek hrs. This is however illegal in many countries as it is perceived as a safety risk. ADVANTAGES AND DISADVANTAGES DURING THE FLYOVER Acceptable and accepted only rail borne modes can in practice get people out of cars. Smooth no violent movements vertically, laterally, or backwards/forwards. Comfortable Re-assuring tram lines (New proposal year 2009 but not succeeded) give confidence that service operates. Safe many times safer than vehicle travel. Speedy short journey times can be achieve. Compatible with pedestrians in pedestrianised areas. Clean and green enhances the environment no emissions at street level. Avoids traffic congestion through segregation and priority. 5. Roads including highways with grade separation generally allow traffic to move freely, with fewer interruptions, and at higher overall speeds; this is why speed limits are typically higher for grade-separated roads. In addition, less conflict between traffic movements reduces the capacity for accidents. Motorways, though having higher average speeds, usually have much lower accident rates per distance traveled than roads which are not grade separated. 6. However, grade-separated junctions are very space-intensive, complicated, and costly, due to the need for large physical structures such as tunnels, ramps, and bridges. Their height can be obtrusive, and this, combined with the large traffic volumes that grade-separated roads attract, tends to make them unpopular to nearby landowners and residents. New grade-separated road plans can receive significant opposition from local groups for these reasons. 7. Rail-over-rail grade separations take up less space than road grade separations, because shoulders are not needed, there are generally fewer branches and side road connections to accommodate (because a partial grade separation will accomplish more improvement than for a road), and because at-grade railway connections often take up significant space on their own. However, they require significant engineering effort, and are very expensive and time-consuming to construct. 8. Rail-over-road grade separations require very little additional space because no connections need be built, but require significant engineering effort and are expensive and time-consuming to construct above. 9. Many closures from 1990 to 2010 happened, and many people thought that it was the beginning of the Colombo, Galle, Kandy vehicles, but the situation changed after 1990. Large number of automobiles started creating pollution and smog. High rising of petrol diesel in international market also thought people that petrol running automobile is far worse than electricity driven street rail. ROAD INFRASTRUCTURE 10. Under this topic road infrastructure can be improve under this conditions, Grade or type separation, using bridges (or, less often, tunnels) freeing movements from having to stop for other crossing movements. congested motorway-type roadway. Reducing junctions (1) Providing through lanes that bypass junction on-ramp and off-ramp zones (Except highway access) (2) A grade access road, roads that limit the type and amounts of way along their lengths. REVERSIBLE TYPE LANES 11. Considering the day today, certain sections of highway operate in the opposite direction on different times of the day or days of the week. SEPARATE LANES 12. Separate lanes for specific user groups, Public bus ways, Pedestrians (High occupancy vehicle lane) URBAN PLANNING AND DESIGN 13. Urban planning and city planning (UDA/NHDA planning) practices can have a huge impact on levels of future traffic congestion, though they are of limited relevance for short-term change. Grid type plan (Interconnect system) including road network geometry, rather than tree-like system which reduce local traffic, but increase total distances driven and discourage walking by reducing connectivity. Zoning laws that encourage development under mixed type, which reduces distances between residential, commercial, and recreational destinations (and encourage cycling and walking) The development is residential and commercial areas designed to maximize access to public transport. THOUGHTS ON URBAN PLANNING AND DESIGN 14. A well-developed transportation system plays a great role for any country of the world to develop and it remains so for our country also. The country has developed up to a certain extent throughout the time but the transportation has not, to cater for the increasing demand. On our journey for development this has to be the primary area to be considered. It is not only a responsibility of the government but also depends on the attitude of the people. The government also has the responsibility to put a genuine effort for this other than going only for political achievements and thereby should give priority for the development of this area. 15. When I made the interview RDA and UDA expertise they are said that we have done researches and given most economical and the feasible methods to develop this area but we dont know how it is going to be done due to non availability of funds and facilities 16. The above economic analysis is carried out considering only the volume of transport savings based on a travel time survey at each flyover location. A comprehensive study could have been carried out to test the situation more accurately if the respective data sources had been available. 17. However, this is a good strategy for eliminating the delay at railway crossings as a long term consideration. Also the concrete flyovers across railways are more economical than the steel bridges constructed in a very short period. CHAPTER FIVE ANALYSIS 1. My Analysis was done in the area of Nugegoda, one of the closest towns to the Colombo city. Questionnaire was prepared and distributed among all age groups. The sample size is 40 personnel and all responded with their identity. Figure 01 2. My 2nd observation was made to find out how many people (from 40 personnel sample) are using flyovers and how often they use it. According to Figure 02 it has been observed that more than 65% persons are using flyovers daily and they feel the difference between the previous and the current situation of the time saving. Figure 02 3. My 3rd observation was made to find out who are the majority using this flyovers. It has been observed that there is more than 60% personnel are the users of public transports. Following details in Figure 03 were taken according to the observations made. Figure 03 4. My next observation shows in figure 04 and Figure 5, Average serving time per a journey Vs person. According to chart it says that the actual time period is very less comparing before situation. According to research 90% time saved. As a result air pollution, Diesel/petrol consumption, Police man power, Vehicle wastage etc minimize proportionally. Figure 04 Figure 5 Finally, during the research, my hypothesis was proved, because the majority stated that construction of flyovers where the traffic jammed areas are the best remedy for the issue. CHAPTER SIX CONCLUSIONS AND RECOMMENDATIONS TO OVERCOME THE CRISIS 1. In order to minimize the city traffic congestion, the authorities have only handful of options. The highly effective solutions practice in other countries as follows.. a. Controlling traffic using methodical light system, b. Directing traffic through one direction of the full carriageway. c. Controlling traffic with the aid of authorized personnel (police men) d. Construction of flyovers. In Sri Lanka the respective authorities has constructed six flyovers at highly congested areas in Colombo suburbs. These locations were selected according the statistical surveys carried out by the experts in this field. However, it is inevitable that this effort has not succeeded in few locations as anticipated. Hence, during this research, I developed an argument to justify that the construction of flyovers are the best remedy for this issue by obtaining the opinion from the general public as my target group. This is the target group for early surveys carried out by the RDA in conjunction with University of Moratuwa to justify the construction of flyovers in Colombo suburbs as well. 2. A well developed transportation system plays a great role for any country of the world. The country has developed up to a certain extent throughout the time but the transportation has not sufficient to cater for the increasing demand of Road network. The construction of many flyovers in our most needed area, responsibility of the government but also depends on the attitude of the people especially all drivers and pedestrians. The also should give their fullest support to the current rules and regulations. 3. During the research, my hypothesis was proved, because the majority stated that construction of flyovers where the traffic jammed areas are the best remedy for the issue. 4. After carrying out a survey and analyzing the data, the following are the details of identified benefits and summarized as follows. Avoids traffic congestion through segregation and priority Speedy shortens journey times Smooth no violent movements vertically, laterally, or backwards/forwards Comfortable Compatible with pedestrians in giving pedestrianised areas Reduces the capacity for accidents 5. Moreover in this survey and analyzing the data, the few limitation and barriers identified as follows; Complicated, and costly, due to the need for large physical structures and for maintenance Their height can be obtrusive. c. Require a significant engineering and time-consuming to construct. 6. It has come into the notice of the urban planers that in order to improve the transport system a multi modal approach should be made. All in all, the main focus is on the development of more roads and more effective mass transportation. Priority should be given to the commuter and his requirement for a safe problem free movement space. 7. Finally, according to collected primary/secondary data. Following actions can be taken to minimizing traffic jammed. Without any delay some facts are presently available and not to standard. Banning of All On-Street Parking for Vehicles in City Limits Traffic Signal Lights Introduction of Substitute Roads to Main Roads Widening of roads Restriction of Slow Moving Traffic and Heavy Vehicles During Rush Hours Separating Pedestrians from Active Traffic Flow Proper maintenance of roads- specially culvert and rainy period road situation required quickly repairing system Creating driving discipline presently available new driving licence card entering system Implementation of New Highways Connecting Main Cities of The Country Electronic Traffic Monitoring Systems for Main Cities specially actual road jammed persons rules violated persons capturing part Discouraging Individual Vehicles Entering Cities (Peak hours container, tractor etc) Bus Stands (Required up lift and move to main road) Construction Work (Required combined worked force (RDA/UDA/CEB/NWSDB) 8. During the last decades the country has developed immensely; therefore the alternative methods to control traffic congestion are highly essential because of the increasing of the vehicles. The government also has the responsibility to put a genuine effort for this other than going onl

Longitudinally Extensive Transverse Myelitis Patients

Longitudinally Extensive Transverse Myelitis Patients Characteristics of Longitudinally Extensive Transverse Myelitis patients: a retrospective analysis of 40 consecutive cases at a tertiary care hospital from North-West India Abstract Longitudinally extensive transverse myelitis (LETM), characterised by spinal cord inflammation extending three or more vertebral segments may be caused by multiple disorders most common being neuromyelitis optica(NMO). Such is the frequent association between these two entities that there is a growing concern to regard them as being practically synonymous with each other. However, all potential etiologies should be considered in the assessment of LETM. We conducted retrospective analysis (2010-2014) of 40 patients of LETM for demographic features, clinical presentation, laboratory investigations and neuro-imaging. Result: Majority of the patients presented acutely with bladder dysfunction and paraparesis. Ten out of 40(25%) were classified as NMO among which only 4 were serum NMO antibody positive. Among the rest, there were 6 patients of MS, 3 patients of tubercular, 2 patients each of ADEM, spinal AVM and postinfectious etiology, one patient each of SACD and SLE. A group of 13 pati ents remained in whom no causative factor could be identified from the available investigations. Conclusion: LETM even with optic neuritis does not universally represent a diagnosis of NMO and one needs to be cautious while making a diagnosis of NMO without consideration of other etiologies as the treatment and prognosis differs among different etiologies. Abbreviations: MS (multiple sclerosis); AVM (arteriovenous malformation); SACD (subacute combined degeneration); ADEM (acute disseminated encephalomyelitis); TM (transverse myelitis). Key words: Longitudinally extensive transverse myelitis; Neuromyelitis optica Introduction Longitudinally extensive transverse myelitis (LETM) is a relatively recent term designating a transverse myelitis(TM) that extends three or more vertebral segments vertically. These lesions, which may occasionally span the entire length of the spinal cord, are much rarer and in general associated with greater morbidity than the typical lesions of idiopathic TM or multiple sclerosis (MS) associated TM(1). The key discriminating feature of LETM lesions is their length. The most frequent cause of LETM is neuromyelitis optica (NMO). In recent times the association between these two conditions has been so heavily emphasized that when LETM is encountered, an erroneous diagnosis of NMO may be made prior to careful consideration of other potential etiologies of LETM(1). Thus, early recognition and establishment of the aetiology of LETM from appropriate workup is essential for optimizing outcome and in some cases commencing appropriate treatment to prevent future attacks of central nervous system (CNS) inflammation. Studies comparing clinical, laboratory and radiological profiles of the LETM patients are scarce, especially from the developing countries. Thus, this study was conducted to review the characteristics of presentation and etiological classification of LETM at SMS Medical College and Hospital, Jaipur, a tertiary care centre of North India. Patients and Methods The study is a retrospective analysis (2010-2014) of 40 patients classified as having LETM on the basis of clinical manifestations of myelitis and spinal MRI finding of lesions typically extending three or more vertebral segments in length, admitted in SMS Medical College and Hospital, Jaipur with the following objectives:- To study the clinical, radiological and CSF profile of patients with LETM. To determine the aetiology of the myelitis. Patient demographics, presenting symptoms, clinical manifestations and investigations were recorded on data entry forms. The investigations included routine blood profile along with markers of connective tissue disorders (ESR, CRP, ANA, Anti dS DNA), MRI (of involved spinal cord segments in T2-weighted images of spinal MRI and MRI Brain), CSF analysis (including oligoclonal bands) and serum NMO antibody (NMO Ab) which was done by indirect immunofluorescence method. Results 40 patients were found to fulfil the LETM criteria. 22 among the 40 patients were less than 30 years age (55%). Overall Mean age was 28 years with male: female ratio of 1.8:1, suggestive of male preponderance. Apart from it no specific trend was observed among the study group in terms of their demographics. The majority of patients presented with bladder dysfunction, paraparesis and quadriparesis. Most of the patients had an acute presentation. Collectively, thoracic spinal cord segment was most commonly involved. 12 patients had clinically significant vision impairment at the time of presentation of which 10 were classified as NMO according to Wingerchuck et al criteria, one case was classified as MS and another was a case of SACD (Table 1). Table 1: Presenting Clinical features Table 2: Radiological Findings Cerebrospinal fluid (CSF) pleocytosis was seen in 55 %( 22 out of 40 patients) ranging from 10 to 250 cells/cumm. Among 10 NMO patients, 5 showed CSF pleocytosis of which 2 had neutrophilic predominance. The maximum cell count among NMO patients was 35 cells with lymphocytic predominance. Apart from it, 3 patients of tubercular, 2 patients each of postinfectious etiology and ADEM , one patient of MS and 4 patients of undetermined etiology also showed CSF pleocytosis. The maximum CSF cell count was 250 cells in one of the tubercular patient with lymphocytic predominance. CSF proteins were elevated in 15 out of 40(37.5%) patients of which 3 patients were each of MS and tubercular etiology, 2 patients each of NMO and postinfectious etiology and 5 patients were of undetermined category. Out of 40 patients, 18 had extensive lesions involving >6 spinal cord segments .Among 38 patients in whom MRI brain was done, 10 showed abnormalities, of which 5 patients were of MS, two were each of ADEM and tubercular etiology and another one was NMO (NMO Ab positive) (Table 2).Among the MS patients, abnormalities were seen involving deep white matter of bilateral cerebral hemispheres, corpus callosum, brainstem and basal ganglia. Based upon the above-mentioned clinical presentation and investigations, patients were classified according to their etiologies (Table 3). Table 3: Etiology of LETM patients 10 patients were of NMO fulfilling revised diagnostic criteria for neuromyelitis optica by Wingerchuk et al (7). In 8 out of 10 patients NMO antibody was sent, 2 patients refused for it. 4 out of them were NMO Ab positive and remaining 4 were negative. Among 10 NMO patients only one patient had lesions in MRI brain typical of NMO (Figure 12)). Four of ten patients in whom serum NMO Ab was done showed positivity and one of the NMO Ab positive patient had brain MRI abnormality involving brainstem, posterior part of corpus callosum, left parietal periventricular white matter. Six patients were of MS fulfilling the revised McDonald criteria for diagnosis of MS. Three patients were of tubercular myelitis ,two patients each were of ADEM , postinfectious etiology, and spinal AVM. One was having nutritional cause in form of vitamin B12 deficiency and one patient had SLE (ANA dsDNA positive). Rest of the patients could not be categorised to a definite etiology from the available investigations. Discussion In our series, common presenting symptoms were bladder dysfunction, paraparesis, quadriparesis, and visual impairment. Majority of the patients studied suffered from bladder dysfunction and paraparesis. It is a difficult task to determine the underlying etiology of LETM and it is worth exploring each case for subtle clues that may point toward the correct underlying diagnosis as the prognosis and long-term treatment decision differs in each category. Till now there are no studies describing association of clinical features and demographic features with the etiology of the myelitis (2). In our series the maximum CSF cell count (250) was in tubercular patient. Maximum CSF cell count in NMO and MS patients was 35 and 30 respectively. It is now well established that LETM does not universally represent a diagnosis of NMO, even in the setting of optic neuritis. However, in our series demyelinating disorders were found to be the most common cause of LETM and NMO was the most common etiology among demyelinating disorders. All NMO patients fulfilled the criteria laid down by Wingerchuk et al (3). Among ten NMO patients, four were NMO antibody positive. Three main laboratory techniques are utilized in identifying the antibodies. In our patients it was done by the indirect immunofluorescence method which has the reported sensitivity and specificity of 86% and 91% respectively (4). At present, it is unclear whether there is truly a subset of patients with clinical NMO that are NMO antibody negative, or if this is a result of inadequate sensitivity of existing immunoassays to detect the antibody, or inadequately sensitive and specific diagnostic criteria, or a combination of all of these factors. Although a regular follow up was not available in all NMO patients, a telephonic survey revealed that four NMO patients, of which two were seronegative and in two NMO antibody was not done, had no relapse and are doing well. Apart from this, one patient died from subsequent relapse and one could not be assessed in follow up. Among the four NMO antibody positive patients, who were under regular follow up, two (50%) presented with relapsing- remitting form of illness. One was 25 years old male who initially had 4 episodes of paraparesis with near complete recovery each time and developed vision impairment in the fifth episode and another was a 12 year old girl who had four relapses with simultaneous occurrence of vision impairment and paraparesis in the first episode. Thus, 4 patients had a monophasic disease course in 1 year follow up. However, a diagnosis of monophasic NMO should be considered with caution, because more than 90% of patients with NMO ultimately develop a relapsing cou rse. One prospective Class I study found that the presence of aquaporin-4–specific autoantibodies (AQP4) predicts recurrence of TM or conversion to NMO(5). So was our observation in the form that out of the 3 patients who had relapse, 2 were NMO antibody positive. Therefore, we speculate that AQP4 antibody status, particularly seropositivity, has some predictive value. Median age of onset of NMO is in the fourth decade. In our series all NMO patients were below 40 years of age except one who was a 52 years old female (figure 3).Interestingly this patient apart from late onset, also presented with slowly progressive paraparesis of one year duration which has not been described earlier in the literature. In spinal NMO lesions, the central part of the cord is commonly affected, including both grey and white matter with peripheral sparing (figure 3). These imaging features may therefore help to differentiate MS from NMO in patients who present with LETM(6). Among the NMO antibody positive patients, one had typical brain lesions of NMO (Figure 1). In patients with clinical and radiological features otherwise typical for NMO, 60–85% of cases have been shown to have abnormal brain lesions. Lesions involving the diencephalon and brainstem distinctly atypical for MS have been commonly reported in NMO patients. These distinctive lesions predominately involve the hypothalamus and can extend to brain tissue surrounding the third and fourth ventricle and aqueduct of Sylvius and seem to be characteristic brain lesions of NMO(7). There were 13 patients in whom a definite etiological diagnosis could not be made from the feasible investigations. This group is usually described in the literature as ‘idiopathic’. However, the idiopathic nature is a diagnosis of exclusion. In our series whether these patients were belonging to the category of postinfectious or some other form of demyelinating etiology was not clear from the investigations that were done in these patients as these patients were also later lost to follow up. Among 3 patients who were classified as tubercular on the basis of reactive CSF and positive TB PCR, one had intramedullary spinal tuberculomas (Figure 4). Intramedullary tuberculomas (IMT) are seen in only 2 out of 100,000 cases of tuberculosis and 2 out of 1,000 cases of central nervous system tuberculosis, are even rare as a cause of LETM(8).Out of these three, one had complete recovery with ATT and remaining 2 had poor outcome with bedridden status. Among 40 LETM patients, we were able to categorise only two patients as ADEM on clinical and radiological grounds (Figure 5).Both patients were of paediatric age (14 and 16 years) group, had complete and rapid recovery with no recurrence on 6 month follow up, which made the diagnosis even more certain, and correlated with the fact that monophasic course is the hallmark of ADEM. MRI features of ADEM that are unusual in MS are symmetric bilateral disease, relative sparing of the periventricular white matter and deep grey matter involvement (9). However, 22% of ADEM patients had a periventricular lesion pattern indistinguishable from that seen in MS (10).Similar radiological features were observed by us in both patients (Figure 5 and 6). The radiological features of spinal cord involvement in ADEM in adults have not been well studied. In a small Dutch series, one-third of patients had lesions extending more than two vertebral segments on spinal MRI at presentation (11). Approximately 75 % patients with ADEM have a preceding infection, and by definition there will be evidence of demyelination within the brain, as well as in the spinal cord, as seen in our patients (Figure 6). These features may help to differentiate ADEM from NMO spectrum disorders. Among the metabolic causes, subacute combined degeneration (SACD) of the cord due to vitamin B12 deficiency can produce longitudinally extensive hyperintense signal on MRI imaging as seen in one of our patient (Figure 7). Generally T2 weighted scans demonstrate focal high signal abnormalities in the white matter of the dorsal and posterior columns in SACD (12). In conclusion, the differential diagnosis of LETM is broad. Although characteristically associated with NMO, this diagnosis accounts for less than half of cases of isolated LETM in adults, and may be even less common in children. Patients presenting with LETM require a thorough work-up to exclude other treatable causes particularly infectious and inflammatory. The management of LETM is dependent on distinguishing inflammatory from non-inflammatory aetiologies and in identifying patients who are at high risk of further attacks. Figure Legends Figure 1: MRI brain showing hyperintensities (arrowheads) involving brainstem, left parietal periventricular white matter, posterior part of corpus callosum in seropositive patient of NMO (12 year old girl) Figure 2: MRI cervical spine T2 weighted sagittal and axial images of same patient showing predominant involvement of central grey matter (arrowheads). Figure 3: MRI cervical spine T2 weighted sagittal and axial images of 52 years old NMO antibody positive female showing predominant involvement of central grey matter. Figure 4:T2 weighted sagittal and axial images showing hyperintensity (arrowheads) in cervical cord with contrast enhancement suggestive of tuberculoma. Figure 5: MRI cervicodorsal spine, T2 weighted sagittal and axial images of a 16 year old girl with ADEM.MRI brain of the same patient showed lesions (arrowheads) in basal ganglia, brainstem and cortex typical of ADEM. Figure 6: MRI brain and spine of a 14 years old male with ADEM showing hyperintensities in brain involving bilateral periventricular white matter and long segment hyperintensity in the cord extending upto conus. Figure 7: Hyperintense signal in posterior aspect (arrow) of cervicodorsal cord in T2 weighted axial and sagittal images of SACD patient. References Eckstein C., Syc S. and Saidha S., â€Å"Differential diagnosis of longitudinall extensive transverse myelitis in adults† ENJ 2011; 3 🙠 1). July 2011. Scott T., Frohman E., De Seze J. et al., Evidence-based guideline: Clinical evaluation and treatment of transverse myelitis. Neurology; December, 2011 Wingerchuk et al. Revised diagnostic criteria for NMO. Neurology 2006;66:1485-9 Waters P, Vincent A. Detection of anti-aquaporin-4 antibodies in neuromyelitis optica: Current status of the assays. Int MS J 2008; 15:99-105. Weinshenker B, Wingerchuk D, Vukusic S, et al. Neuromyelitis Optica IgG predicts relapse following longitudinally extensive transverse myelitis. Ann Neurol 2006; 59:566–569 Wingerchuk, DM. Neuromyelitis Optica Spectrum Disorders. Continuum Lifelong Learning Neurol 2010; 16(5): 105-121 Brain Abnormalities in Neuromyelitis Optica Spectrum Disorder K. Woojun, K. Su-Hyun, H. So-Young and K. Ho Jin Multiple Sclerosis International Volume 2012. Imaging Diagnosis of Spinal Intramedullary Tuberculoma: Case Reports and Literature Review Lu Ming J Spinal Cord Med. Apr 2010;33(2):159 162 Kesselring J, Miller DH, Robb SA, et al. Acute disseminated encephalomyelitis. MRI findings and the distinction from multiple sclerosis. Brain 1990;113(Pt 2):291–302 Dale RC, de Sousa C, Chong WK, Cox TC, Harding B, Neville BG. Acute disseminated encephalomyelitis, multiphasic disseminated encephalomyelitis and multiple sclerosis in children. Brain 2000; 123(Pt 12):2407–2422 Ketelslegers I, Visser I, Neuteboom R, Boon M, Catsman-Berrevoets C and Hintzen R. Disease course and outcome of acute disseminated encephalomyelitis is more severe in adults than in children. Mult Scler 2011; 17(4): 441–448 Larner A, Zeman A, Allen C. MRI appearances in subacute combined degeneration of the spinal cord due to vitamin B12 deficiency. JNNP 1997;62:99-101.

High-fi Cy-fi Essay -- Argumentative Persuasive Literature Papers

High-fi Cy-fi The world of Cyberpunk can be compared to a creature of fantasy. This fantasy creature unfolds wings of enchantment and uncoils a sinewy body of treachery and suspicion that is adept at drawing the attention of anyone who has an interest in science fiction or adventure. Cyberpunk is a form of science-fiction that is described by Garyn Roberts as "characterized by tough characters in tough worlds (Intro 1006)." The toughness of cyberpunk heroes can be related to the detective fiction stories of the 1920’s and 1930’s. This particular genre is also characterized by themes of technology, particularly virtual reality. In this form of science-fiction literature, it is very easy to discern the involvement of Rock ‘n’ Roll and punk themes. In this essay, I plan to prove that cyberpunk is a very creative form of literature and not the irrelevant, or unimportant, literature it was once perceived to be (Intro 1006). To do this I will provide an in-depth description of what is referred to as the Matrix, access to the matrix, descriptions of the extent to which technology is integrated into the life of those inhabiting a cyberpunk reality, and electronics capable of creating artificial creatures. The Matrix. In the cyberpunk world it can be linked to everything or it can represent everything such as in the movie The Matrix. When spoken of in terms of being a physical entity the matrix is simply nothing. The matrix is a name given to the theoretical space that exists in the digital world. "Trying to remind myself that this place and the gulfs beyond are only representations, we aren’t "in" Chromes computer, but interfaced with it, while the matrix simulator in Bobby’s apartment generates this illusion†¦ (Gibson 1011)." In ... ...rpunk is a form of writing that is sure to grow in popularity. Bibliography Bear, Greg(ory Dale). "Blood Music." The Prentice Hall Anthology of Science Fiction and Fantasy. Ed. Leah Jewell. Upper Saddle River: Prentice Hall, 2001. 1019-1035 Cameron, James. "Terminator, The." Published by: Pacific Western, Hemdale Film Funding, Euro Film Funding, and Cinema 84: 1984. James Cameron and Gale Anne Hurd Gibson, William (Ford). "Burning Chrome." The Prentice Hall Anthology of Science Fiction and Fantasy. Ed. Leah Jewell. Upper Saddle River: Prentice Hall, 2001. 1006-1019 "Matrix." Infoplease Dictionary. 2001 Learning Network. 7 Dec, 2001 http://www.infoplease.com/ipd/AO531187.html. Roberts, Garyn G. "Introduction to ‘Burning Chrome’." The Prentice Hall Anthology of Science Fiction and Fantasy. Ed. Leah Jewell. Upper Saddle River: Prentice Hall, 2001. 1006

What is Special Education? Essay -- Education Educating Teaching Essay

Before covering the main idea behind how technology can enhance learning of special students, it is important to discuss what qualifies a student as ?special?. Special Education is identified as, ?the education of children who deviate socially, mentally, or physically from the average to such an extent that they require major modifications of usual school practices,? (Encyclopedia Britannica Online, 2005, p.1). According to the Individuals with Disabilities Education Act Amendments of 1997, ?students with disabilities include those with mental retardation, hearing impairments, speech or language impairments, visual impairments, serious emotional disturbance, orthopedic impairments, autism, other health impairments, or specific learning disabilities,? (Warger, 1999, p.1). Since there are so many different types of disabilities, each student needs to be assessed to determine the best type of learning environment for them (Ralabate, 2002, p. 13-14). This is a very important part of help ing special education students from the very beginning of their education. With the right leadership from teachers, and knowing what works best with teaching each unique student, they can reach their full potential in learning. Inclusion ?Children who learn together, learn to live together? (Renaissance Group, 1999, p.1). Resurfacing the issue of different teaching methods in Special Education, many schools educate students in an Inclusive environment. Inclusion refers to the placement and participation of students with special needs into a general education environment such as classrooms and extra curricular programs (Lewis & Doorlag, 1999, p.5). Many find the use of inclusion in schools very beneficial to both special and general education ... ....gov/ERICWebPortal/Home.portal?_nfpb=true&_pageLabel=Thesaurus&_nfls=false This an online ERIC thesaurus defining assistive technology. ?Special education.? Encyclopà ¦dia Britannica Online. 2005. This is an online encyclopedia definition of special education. Internet Resources Internet for Education. (2005). Retrieved on April 27, 2005 from http://www.vts.rdn.ac.uk/tutorial/education?sid=4740639&op=preview&manifestid=82&itemid=7126 This site contains information on the ways the internet can enhance education. Renaissance Group. (1999, October, 14). Inclusive Education. Retrieved April 20, 2005 from http://www.uni.edu/coe/inclusion/ . This site contains a lot of current information concerning the importance, philosophy, and future of education in an inclusive environment.

Importance of Initial Consultation and Ethical Issues Facing the Therapist

Introduction This paper discusses why the initial consultation is so important and what factors an ethical therapist will cover in this aspect of the therapy process. It also tackles the ethical issues besetting a therapist in the conduct of his profession dealing with psychotherapeutic counseling and hypnotherapy and counseling skills. The role of a therapist in the behaviour alteration of his or her client is so vital that it is necessary to observe some ethical considerations in the practice of his profession. Importance of initial consultation An initial consultation is the first of the stages of psychotherapy and generally includes a discussion of the reasons as to why the client is seeking psychotherapy help and what he is hoping to obtain from the experience. Why it is important is because it provides an opportunity to find out whether the needs, interests, and goals of the client fit with the skills of the therapist. This stage also provides the initial clarification about the limits of confidentiality, therapeutic approach, and other terms of professional services. Moreover, the initial consultation helps both the client and the therapist to gauge whether each is likely to be able to work with the other successfully (Plante, 2011). The importance of initial consultation is also found in making a formal determination of the client’s fit for a psychotherapeutic relationship and potential for meaningful change (Klonoff, 2010). Whilst informed consent is shown as important in the therapy process, with a clear descr iption of the limits of confidentiality, full informed consent to treatment has been mandated by ethical guidelines. If for example, a client approaches a therapist for initial consultation, informed consent to treatment may involve information on behavioural therapies demonstrating effectiveness and rapid changes in the treatment of the behavioral problem that the client is complaining about (e.g. panic) (Weiner and Hess, 2006). Further, initial consultation is important because it is where a range of decisions are in terms of whether to schedule a second session. For example, the client may evaluate whether it is adequate to have his or her needs be met by working with the therapist, as well as whether the practical terms of the therapy are acceptable to the client. In addition, considering the information thus provided during the consultation session, the therapist may ascertain whether he or she possesses the needed expertise to work effectively and successfully with the client (Klonoff, 2010). Another importance of initial consultation is that it allows initiating a collaborative relationship between the client and the therapist and evaluating initial consultation efforts. If the therapist happens to assess a need for consultation services, then the entry stage would then initiate a consulting relationship. The value of initial consultation is seen in the establishment of a voluntary and collaborative consulting relationship between the counselor and the client. Different role expectations can lead to resistance on the part of the client, which thus necessitates a vital importance of agreement relating to role expectations to reduce such potential resistance. An initial step in evaluating a client’s condition is establishing an accurate diagnosis, which is done during the initial consultation (Boylan et al., 2011). Much as the above are important for conducting an initial consultation, it is also because such consultation may potentially lead the client not to continue further services. The client may come to a decision that the therapist, for some reason, cannot adequately meet his or her needs. For example, he or she may find the therapist as being too direct, aloof, expensive, inexperienced, young, old, etc., and thus may conclude that the therapist’s qualities are not fit to his or her needs. The client may also feel better after the initial consultation and may no longer feel compelled to continue further sessions. Similarly, the therapist may decline from providing continued services for a variety of reasons, such as the client’s revelation of an alcohol problem, about which the therapist might decide to refer him or her instead to a specialist in the treatment of problems relating to substance abuse (Plante, 2011). Alternatively, there are times that patients are referred by their physician right after discharge from an inpatient rehabilitation setting. Of note, the one seeking therapy for the patient is in fact not the patient himself but the patient’s family. Perceptive health care professionals are the ones who usually recognise a need for psychotherapy by the patient, with an emphasis on coping, psychoeducation, and deficit adjustment. Therefore, it must not always be assumed that it is the client who is motivated to seek psychotherapy (Klonoff, 2010). In cases of patients being considered for psychotherapy, a physician’s referral is needed, in which relevant medical records must be acquired to determine whether the patient is appropriate for therapy as well as whether he or she anticipates potential psychotherapeutic needs and challenges. It is during the initial consultation in which records are presented after being obtained and reviewed in advance in order for the therapis t to thoroughly understand what the client has gone through or is going through (Klonoff, 2010). Therefore, without the initial consultation, psychotherapeutic intervention might not be sufficient and effective enough. Ethical issues faced by therapists The psychotherapist is guided by ethical standards and codes that provide professional standards aimed at guiding their ethical conduct (Kohlenberg and Tsai, 2007). One ethical issue faced by a therapist in terms of initial consultation is whether to provide the consultation free of charge to the client, as some clients who have taken up this offer tended to decide to continue in counseling because of being obliged to do so. This would prompt a concern whether the therapist has violated any portion of the code of ethics (Welfel, 2013). There are some who do not charge for initial consultations, and it is important that the client is informed whether the therapist does or does not charge for the first session (Wheeler, 2014). A potential problem may ensue with the use of a free initial consultation. This is because clients may feel committed after the initial consultation and may have difficulty declining further treatment because the initial consultation was free of charge. Some mig ht even regard this practice as taking advantage of clients and may perhaps be seen as undue influence mentioned in the code of ethics (Welfel, 2013). Another ethical issue that may ensue during initial consultation is sexual attraction between the client and the therapist, which is identified as a boundary ethical issue (Houser et al., 2006). The client may have emotional or sex-related problems that he/she initially presents to the therapist, which the therapist must approach objectively. Albeit discussion of these feelings can foster therapeutic progress, it is still unethical and counter-therapeutic to act on them. Even when it may seem sound to become sexual with a client with sexual problems as an intervention, engaging in such unethical activity is definitely against established ethical standards and codes. Rather, the best intervention that the therapist may adopt for his/her client with sexual problems is sex therapy with the client and a significant other.The several malpractice suits filed against therapists relating to sexual relationships with their client only confirm the unethical and counter-therapeutic stance of se xual relationship between the therapist and client (Kohlenberg and Tsai, 2007). Even at the onset of the initial consultation, sexual attraction may already spark, which the therapist, being the more responsible person, must put a wall against. Emotional tyranny is also a common ethical issue that may occur even during an initial consultation. It is a term describing abuse of power by psychotherapists to the disadvantage of their clients, caused by the power imbalance between them. For example, during the initial consultation, the therapist’s power is seen in how he establishes the therapy session, how long the session should last, how often he and the client should meet, how much the session costs, and what the permissible and impermissible behaviour must be within the session (Kohlenberg and Tsai, 2007). The realm of ethical decision-making involves the aspects of ethical dilemma, the client and the therapist’s values, race, gender, personal history, etc.; local and national laws; professional knowledge; and codes of ethics (Houser et al., 2006). The therapist may also face violations relating to dual relationships. Such relationships are nonsexual that may involve counseling a friend, relative, or neighbour, as well as receiving referrals from people who know the client and the counseling process. An ethical dilemma of dual relationships may potentially occur when the therapist has several roles with a client; in that apart from being a client, the person is also a friend, a neighbor, a relative, etc. to the therapist. It has been suggested that accepting referrals from existing clients may constitute a boundary violation (Houser et al., 2006). Indeed, even at the initial consultation, the therapist is already face-to-face with the issue of whether to continue with the professional relationship, or terminate it right away upon seeing his or her friend across the table as a client seeking therapy. Self-disclosure is another ethical issue besetting the therapist. Even during the initial consultation, the issue of self-disclosure may occur. Relating to this issue, it is important to determine the extent of information a therapist should share with the client and the types of self-disclosure to be made as well. Another example of ethical issue involving boundary is socialising with a client outside the counseling session and negotiating for fees (Houser et al., 2006). One possible ethical dilemma facing the therapist during is confidentiality, which deals with maintaining privacy and non-disclosure of information to others outside the counseling relationship, unless the client expresses consent to do so (Jenkins, 2007; Houser et al., 2006). Whenever the client enters the counseling room for the first time, he or she already expects that anything being discussed with the therapist would be kept confidential. It has been found that violations of confidentiality were a common complaint made against therapists and counselors. The client, even in the initial consultation, already begins disclosing some personal matters to the therapist, which the therapist is expected to keep confidential as his legal duty. Of important note however is the fact that confidentiality is not absolute and that there are times in which the therapist may divulge certain information a necessary (Corey, 2013; Houser et al., 2006). Examples of these are those surrounding harm that may involve the client who is contemplating about suicide or is expressing thoughts about inflicting harm to others; court-involved clients; child abuse reports; and clients with medical conditions who express engaging in precarious acts relating to their condition (e.g. HIV) (Houser et al., 2006). Further, it was found that successful outcomes ensue when clients change their personal values and take a close resemblance of that of the therapist/counselor. A relevant ethical dilemma with regard to this is in order for the counseling to be successful, how similar the client’s values must be to the counselor. Moreover, another dilemma is whether fostering such similarity is ethical and helpful enough to the client. A question for the profession is whether therapists utilise moral and ethical frameworks reflecting society’s norms as the only basis of their ethical decision-making, or whether therapists come to an ethical decision whilst taking into account the values, morality, and ethical stances of their diverse client population (O’Donohue and Fisher, 2009; Houser et al., 2006). These issues are being dealt with even upon an initial consultation. Conclusion This paper dealt with the importance of initial consultation and the ethical issues facing the therapist in the performance of his profession. An initial consultation is important because it forms the basis of the client’s diagnosis. It generally covers finding out the reasons as to why the client seeks help and what he or she aims to obtain as a result of the psychotherapy experience. The ethical issues faced by the therapist in the conduct of his profession during the initial consultation are those involving a decision to charge the client for a specific fee or not for the initial consultation; potential sexual attraction between them; the issue of confidentiality and client consent; emotional tyranny; violations relating to dual relationships; and self-disclosure. Having laid down these ethical factors besetting a therapist, the conclusion being arrived at is that the therapist is bound by set standards and ethical codes through which the expected functions of his performance must be based, and that he/she should conduct the initial consultation and further sessions objectively. References Boylan, J. C., Malley, P. B/, and Reilly, E. P. (2011) Practicum Internship: Textbook and Resource Guide for Counseling and Psychotherapy. Third Edition. NY: Brunner-Routledge. Corey, G. (2013) Theory and Practice of Counseling and Psychotherapy. Ninth Edition. Mason, OH: Cengage Learning. Houser, R., Wilczenski, F. L., and Ham, M. (2006) Culturally Relevant Ethical Decision-Making in Counseling. London: Sage Publications, Inc. Jenkins, P. (2007) Counseling, Psychotherapy and the Law. London: Sage Publications, Inc. Klonoff, P. S. (2010) Psychotherapy After Brain Injury: Principles and Techniques. NY: The Guilford Press. Kohlenberg, R. J. and Tsai, M. (2007) Functional Analytic Psychotherapy: Creating Intense and Curative Therapeutic Relationships. NY: Springer. O’Donohue, W. T. and Fisher, J. E. (2009) General Principles and Empirically Supported Techniques of Cognitive Behavior Therapy. NJ: John Wiley & Sons. Plante, T. G. (2011) Contemporary Clinical Psychology. NJ: John Wiley & Sons. Weiner, I. B. and Hess, A. K. (2006) The Handbook of Forensic Psychology. NJ: John Wiley & Sons. Welfel, E. (2013) Ethics in Counseling and Psychotherapy. Mason, OH: Cengage Learning. Wheeler, K. (2014) Psychotherapy for the Advanced Practice Psychiatric Nurse: A How-to Guide for Evidence-Based Practice. NY: Springer Publishing Company, LLC. Bibliography Boylan, J. C., Malley, P. B/, and Reilly, E. P. (2011) Practicum Internship: Textbook and Resource Guide for Counseling and Psychotherapy. Third Edition. NY: Brunner-Routledge. Clarkson, P. (2005) Transactional Analysis Psychotherapy: An Integrated Approach. NY: Routledge. Cooper, J. and Alfille, H. (2011) A Guide to Assessment for Psychoanalytic Psychotherapists. London: Karnac Books Ltd. Corey, G. (2013) Theory and Practice of Counseling and Psychotherapy. Ninth Edition. Mason, OH: Cengage Learning. Forrest, G. G. (2010) Self-disclosure in Psychotherapy and Recovery. Plymouth: Jason Aronson. Houser, R., Wilczenski, F. L., and Ham, M. (2006) Culturally Relevant Ethical Decision-Making in Counseling. London: Sage Publications, Inc. Jenkins, P. (2007) Counseling, Psychotherapy and the Law. London: Sage Publications, Inc. Klonoff, P. S. (2010) Psychotherapy After Brain Injury: Principles and Techniques. NY: The Guilford Press. Kohlenberg, R. J. and Tsai, M. (2007) Functional Analytic Psychotherapy: Creating Intense and Curative Therapeutic Relationships. NY: Springer. O’Donohue, W. T. and Fisher, J. E. (2009) General Principles and Empirically Supported Techniques of Cognitive Behavior Therapy. NJ: John Wiley & Sons. Plante, T. G. (2011) Contemporary Clinical Psychology. NJ: John Wiley & Sons. Weiner, I. B. and Hess, A. K. (2006) The Handbook of Forensic Psychology. NJ: John Wiley & Sons. Welfel, E. (2013) Ethics in Counseling and Psychotherapy. Mason, OH: Cengage Learning. Wheeler, K. (2014) Psychotherapy for the Advanced Practice Psychiatric Nurse: A How-to Guide for Evidence-Based Practice. NY: Springer Publishing Company, LLC.