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The earliest behavioural theories suggested that the impairment of food intake in anorexia nervosa can be viewed as a speci c learned behavior, perpetuated by environmental reinforcements (Blinder, Freeman & Stunkard, 1970, p. 1093). The individual engages in excessive dieting. The resultant weight loss may be positively reinforced (at least initially) by the reactions of peer groups and negatively reinforced by the absence of being overweight (which can be met with disapproval and even peer rejection). This over-simplistic model leaves many questions unanswered. Some suggest that general societal pressure are too remote to act as an immediate reinforcer for dietary restriction; other positive reinforcers that have been suggested are attention (Allyon, Haughton & Osmond, 1964), stimuli in the environment (Bachrach, Erwin & Mohr, 1965), an empty stomach (Gilbert, 1986) or an endogeneously produced substance (Szmukler & Tantam, 1984). Avoiding anxiety associated with eating and weight gain has also been suggested to negatively reinforce dietary restriction (Leitenberg, Agras & Thomson, 1968).

) In sum, Kant prizes individual responsibility and believes that people ought to be treated as equals, since we all share the uniquely human ability to reason morally This fact transcends our material differences What is perhaps less useful to health workers is his idea that individual responsibility and freedom to make the best moral judgements stops when universalisable rules are discovered In the fraught world of health care there are cases in which the human interest is best served by suspending moral laws Finally, the most signi cant inadequacy of Kant s theory an inadequacy health workers ignore at their peril is its underemphasis on consequences In the real world it is no defence, either morally or legally, to say that what was done was done out of a pure motive to be moral.

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Considerations of logic, probability of outcome and actual outcome must enter the picture when the degree of morality is assessed A more complete view of morality comes into play when the consequences are considered The ethical realm incorporates much more than pure motive just like in law where conspiracy to murder (intent to murder) and actual murder (where the consequence is that life is lost) are different crimes with different punishments And beyond the legal sphere, wanting to be kind to another person is not the same as actually being kind to her Actually being kind to a person surely shows a higher degree of morality than meaning to, but never getting around to it..

predict either a benign or malignant etiology. A thorough history and physical examination may provide clues to assist in distinguishing benign and malignant adnexal masses. In patients with early EOC, physical exam ndings may differ from patients with advanced EOC. Patients may describe pain, bloating, early satiety, intermittent nausea and/or vomiting, (and if the mass is large), pelvic pain and/or pressure, or dif culty with defecation, particularly if the mass is xed in the posterior cul-de-sac. Patients may describe low-grade fevers or malaise. Often, patients may not experience any symptoms at all. The presence of a xed, solid, irregular pelvic mass palpated on physical examination may be suspicious of an ovarian malignant neoplasm. However, patients with leiomyomas, tubo-ovarian abscesses, or severe endometriosis may have symptomatic xed lesions palpated on examination that are completely benign. A malignancy can also be present in the absence of a pelvic mass especially if a patient has abdominal ascites or a palpable upper abdominal mass. There are limitations to the physical examination, especially among women who are obese. Adnexal masses larger

The media may focus on how online missteps can hurt your career, but they rarely mention how a digital you can help you succeed. What you do online can show your value to potential employers and clients, make you more visible in your field, and give you experience you need to create the career you want. Yes, it s true that you might harm your career (or at least change it radically and suddenly) with your online activities. Posting drunken pictures of yourself on MySpace might prevent you from getting that first job out of college. Sharing outrageous views could make potential clients look in other places. Writing about your employer in negative terms or any terms at all on your blog could get you dooced.

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