Case Studies

Each student will be assigned two of the case studies below. Your post should be approximately 250 words in length and contain substantive information that contributes to an understanding of the disorder under discussion. You may post graphics from online sources, but please do NOT simply cut and paste entire entries from the internet. You are expected to provide references for all the information cited.

Discussion Questions

1. Relate history to the diagnosis. What risk factors are present, and how does each predispose to disease?

2. Explain the cause of the disease in this patient.

3. How could this disease have been prevented in this patient?

4. Discuss the complications that might develop in this patient.

5. Discuss the treatments available to the patient.

6. What is the probable prognosis for this patient?

Case Study#6:  Johnny, a six-year-old child, is brought to the emergency room by his parents.  They report that about two weeks ago he had a severe sore throat and has never fully recovered. He complains of abdominal discomfort, and he is always tired. They have noticed that he has gained noticeable weight in the last few days, his abdomen and genitalia are swollen, and his urine is brownish. Blood pressure is 180/105, and blood tests show strep antibodies, hypoalbuminemia,  and uremia. Urine tests reveal moderate proteinuria, hematuria and red cell casts.  He is diagnosed with acute poststreptococcal glomerulonephritis.

250 words citation and references

Describe how epidemiological data influences changes in health practices. Provide an example and explain what data would be necessary to make a change in practice.

As more and more computational resources are being moved to the ‘cloud’, the separation between ‘data’, ‘knowledge’ and ‘engines’ becomes more critical. This assignment shows, from the inside, the workings of a distributed knowledge-driven architecture. You will download and execute a ‘predictive model’ engine, deploy a knowledge artifact in your running engine, and feed data to the model to get predictions in response. Prerequisites: Download and install the REST client ‘Insomnia’ for your platform from https://insomnia.rest (Links to an external site.) You may find this Insomnia tutorial (Links to an external site.) useful, especially Step 3 for the steps marked as “GET”, and Step 5/6 for the steps marked as “PUT/POST” Ensure you have Java installed on your personal computer See this tutorial (Links to an external site.) on how to install Java 11 Download ‘OpenScoring.jar’ from Canvas and launch it From Windows Explorer: Right Click on the downloaded openscoring.jar file “Open with…” choose “Java ™ Platform” At this point, Openscoring will be active on your machine, and you will be able to use Insomnia to interact with it. Openscoring is an ‘engine’ that can run predictive models, usually the product of data mining/machine learning algorithms, which are expressed using the PMML language (Links to an external site.) for interoperability. PMML is a standard that is gaining adoption even in major EHR sytems, and allows to use “AI” models in combination with more traditional decision support tools, such as CDS rules or scorecards/calculators. We will interact with the engine through a WEB service, even if it runs on your computer: instead of connecting to some ‘www’ site, we will connect to ‘localhost:8080’, which is how your computer sees itself on the network. Insomnia, like our browsers, will allow us to “GET” information from the server, or “PUT/POST” (send) it. Step 1: Configuring the Engine Check OpenScoring is running by successfully submitting the following request through Insomnia GET localhost:8080/openscoring You should get a { “message” : “Not Found” }. Despite the ‘Not Found’, it means the server is running and is ready to accept requests See what happens when a request cannot be satisfied, e.g. using GET localhost:8080/nonexistingserver. You will get a “404 Error” Step 2: Acquiring and deploying the Model Get a PMML predictive model from a repository on the web (A Decision Tree for the IRIS dataset) {5pts} You can download it through Insomnia, or just through your browser GET http://dmg.org/pmml/pmml_examples/KNIME_PMML_4.1_Examples/single_iris_dectree.xml Save it as a file on your computer Open the XML file with a browser, or with an advanced editor such as Wordpad (not Notepad!), and Deploy the file from your local folder into Openscoring {10pts} PUT http://localhost:8080/openscoring/model/Iris Add a ‘binary file’ data, and choose the model file you just saved Set the header ‘Content-type’ to ‘text/xml’ Make sure the model is properly loaded Get the list of deployed models : GET http://localhost:8080/openscoring/model Get the Iris model : GET http://localhost:8080/openscoring/model/Iris Get back the PMML : GET http://localhost:8080/openscoring/model/Iris/pmml Step 3: Evaluate the model Evaluate the model on some data {10pts} Download the input file input.csv from Canvas Submit the data for evaluation : POST http://localhost:8080/openscoring/model/Iris/csv Add the input.csv file as body Set the ‘Content-type’ header to ‘text/plain’ You should get ‘Iris-versicolor’ as a prediction outcome Try changing the values in input.csv Can you see the actual classification criteria in the PMML file? Step 4: Submission Export the Insomnia workspace

Respond

 

Change within the healthcare setting is inevitable and as a nurse leader understanding how change occurs and strategically determining the change process or model needed to best suit the needs of the change is a valuable skill to possess.  In this situation a change is needed surrounding the current organizational structure at a facility.  This situation indicates that there is an in-proportionate number of leaders to staff creating a “top heavy” environment where multiple people are in charge of a single unit(s).  This type of a change consists of organizational restructuring and can create threats to decision-making strategies, including information flow, relationships, and priority setting (Spiers, Lo, Hofmeyer, & Cummings, 2016).  Restructuring the organizational structure will create a feelings of uncertainty among staff and this type of change should be mapped out and well communicated to ensure a smooth transition.  With a top heavy scenario the goal of the organizational restructuring is to ultimately create a more streamlined and direct line of authority, eliminate any duplicate leaders and flatten out the line to reduce the expense.

The three change models discussed could theoretically all be used in this scenario however the one I opted to implement is the PDSA model of change.  This scenario requires a rapid change in organizational structure and Kotter and Roger’s are by design a more slow measured change process.  This organizational restructure requires a plan of action which is restructuring the leadership or reducing the number of leaders within each unit/department.  The plan is then implemented by restructuring leadership or by eliminating excessive leadership in order to create a more direct line of authority and lessen the redundancy of leaders.  If a alteration of the plan is needed upon further eval then the cycle continues.  Flattening out the leadership or reducing the number of leaders is difficult but must be done in a precise manner, enacted upon evaluated and then adjusted if needed.  Kotter and Rogers change models could be applied here but in my opinion the PDSA model and the quick four cycle process works best to implement a rapid change in leadership that is needed in this scenario.

Ask  question

nstruction
For this course, you have presented one final academic research paper to highlight the wealth of information you learned at Grantham. You researched, analyzed, synthesized, and evaluated information from both primary and secondary sources to develop a research project that examined a question, problem, or phenomenon across two or more disciplines. For this week, you will prepare your research reflection. Write 2-3-page reflection to answer the following prompts: · Please describe your study and why it was important to you; why did you decide to investigate this question(s)? What recommendations do you have for practitioners in these disciplines? · What lessons did you learn during this research experience? · What were your personal strengths in the research process; how did you leverage these strengths in the research process? Be specific. Give examples. · What were your opportunities for growth in the research process; what strategies did you use to overcome the challenges? Be specific. Give examples. · How will this research experience help with your career choice or future school? Be specific. Give examples. · How has this work been transformative for you personally and professionally? Your completed assignment should use APA style formatting.

Assignment 2: Discussion—Globalization as an Important Phenomenon

Globalization has been impacting business in a material way for the past 40 to 50 years. In recent years, this impact has been strengthening. Appreciating the impact of this trend and the driving forces is useful for today’s business professionals.

Research the topic using your textbook, Argosy University online library resources, and the Internet. Respond to the following:

• How important would you characterize globalization for developing business professionals? Take a position and provide evidence.
• What do you believe is the single most important force driving globalization in business? Present an argument for your position as to the most important aspect and include a discussion of forces which you believe to be less important.

By Week 1, Day 2, submit your assignment to the appropriate Discussion Area. Through Week 1, Day 4, review and comment on at least two of your peers’ responses.

Write your initial response in 300–500 words. Your response should be thorough and address all components of the discussion question in detail, include citations of all sources, where needed, according to the APA Style, and demonstrate accurate spelling, grammar, and punctuation

Do the following when responding to your peers:

• Read your peers’ answers.
• Provide substantive comments by
  • contributing new, relevant information from course readings, Web sites, or other sources;
  • building on the remarks or questions of others; or
  • sharing practical examples of key concepts from your professional or personal experiences
• Respond to feedback on your posting and provide feedback to other students on their ideas.
• Make sure your writing
  • is clear, concise, and organized;
  • demonstrates ethical scholarship in accurate representation and attribution of sources; and
  • displays accurate spelling, grammar, and punctuation.

****** VERY IMPORTANT!!!! Please provide 2 questions with answers relating/pertaining to the discussion/assignment.  Please make sure this is submitted with the assignment requested. ***

Paradoxical directives are used when a therapist thinks that the family may resist a direct intervention. The therapist convinces the clients to keep their symptoms and slowly introduces directions that help to institute change (Goldenberg, Stanton, & Goldenberg, 2016). These directives commonly take on two forms prescriptive which is when the therapists ask the client to do something or descriptive which is when the therapists relabel a behavior that is already being done in a positive manner (Goldenberg et al., 2016). Using these directives asks clients to hold off on changing and intended to provoke defiance (Goldenberg et al., 2016). The purpose of directives is to get the family or the client to decide what they will not do after being told what to do to help the family abandon dysfunctional behavior (Goldenberg et al., 2016). When designing a paradox, a counselor should consider three steps. Redefining is the first step that is used to change the family’s understanding of the problematic symptom (Goldenberg et al., 2016). Prescription is the second step a counselor would need to consider, which is a directive that is concise, brief, and encourages the family to recoil the instruction (Goldenberg et al., 2016). The third step is restraining, are strategies that help the client understand that change will happen, but it is best to do it slowly (Goldenberg et al., 2016).

Reflexive questioning which are used for families to reflect on actions, beliefs, perceptions all the while constructing new ways of thinking and behaving (Goldenberg et al., 2016). These questions help the counselor to understand more in depth from what the client means, their concerns, but also gives them the chance to read their body language which helps them understand what they are not saying (Goldenberg et al., 2016). With this intervention strategy the counselor must consider what type of question to ask as there are many different types of reflective questions a counselor can ask in order to help the families reflect on their concerns and how they may change them. These questions in particular help families more past their current fixed beliefs or ideas and achieve new meaning as they readjust their behaviors (Goldenberg et al., 2016).

Reference

Goldenberg, I., Stanton, M., & Goldenberg, H. (2016). Family therapy: An overview (9th ed.). Boston, MA: Cengage.

The Vargas family arrives to their 5th session together and on time. As a follow-up to the last session’s focus on the family structure, you decide to consider a strategic approach this week. To check in, you invite them to share any feedback from last week’s session. Bob reports that he apologized to Elizabeth for “mishandling the suspension thing” then complains that Elizabeth is still “holding a grudge.” He admits that he often does not understand why she gets so upset and that he wants her to be happy. Elizabeth acknowledges that the apology “is a start” and suggests that the reason Bob doesn’t understand is that he “doesn’t ever listen” to her. Bob tells Elizabeth that he listens, but gets frustrated because he doesn’t know how to “fix it.”

You notice Frank and Heidi sitting together, quietly looking at a book while their parents talk. You inquire about any noticeable changes made during the week. Both parents claim to have made an effort to avoid raising his/her voice and report being pleased with their conduct. When asked about the children, Elizabeth reports noticing improvement. Bob, however, expresses frustration with Frank’s constant need of redirection and numerous reminders to complete his chores. Bob also noted an increase in Heidi’s demands for attention. 

In Voltaire’s tale, Candide travels across the known world witnessing the horrific brutalities that humans commit against one another in the name of religion, power, or simple greed. Having witnessed and experienced this violence, which puts into doubt Candide’s belief that life has a purpose and is primarily good, Candide comes to the conclusion that he and his friends must devote themselves to cultivating their garden. What does Voltaire mean by the phrase “cultivate our garden?” How effective of response is it to the incredible violence and despair present throughout the rest of the book?

In this assignment I need a peer response for the main discussion, that show below.

The peer’s responses

Discussion Grading Criteria: Agreeing and disagreeing do not mean just voicing one’s opinion. The focus of the discussions should remain on the ideas posed in the readings. Agreeing and disagreeing mean making scholarly arguments from the literature that may support your own ideas. Faculty expects you to support your ideas from the readings or similar scholarly writing about the topic in nursing literature. Always cite your source(s) and reference in APA format.

Remember the post and responses should include scholarly writing about the topic in nursing literature.

Note por the professor:

Hello class,

Please refer to your APA format in your postings. The journal name and volume is italicized font. Ex.

…The American Nursing Journal,7(9),,,,

Please update your APA to reflect doi

Amely Perez Cicili

Advanced Family Practicum III

The application of national health reform with millions of people receiving health insurance service is increasing the current challenges facing primary care. A major issue focuses on how to rise capacity while improving superiority and cost efficacy. Policy makers and researchers are suggesting innovative approaches to guarantee the system is ready as more people are gaining access (Barnes & Novosel, 2018). While some strategies seek to increase the number of primary care providers (PCPs), others seek to encourage efficient use of existing providers. As providers, Nurse Practitioners have faced some challenges in their scope of practice. Three of these challenges are the autonomy in practice, the teamwork with physicians, and limited prescriptive authority.

State and organizational policies generate misunderstanding around NP roles. In some states, regulations require NPs to collaborate or be supervised by physicians, whereas in other states, these regulatory requirements have been removed by policy makers. Similarly, some organizations restrict NP practice or fail to provide necessary support so NPs can maximally contribute their advanced skills to teams. On the other hand, teamwork between NPs and physicians in primary care has received care due to their overlapping scopes of practice and the fact that lack of agreement exists between them about their respective roles. On the contrary, when patient care suffers, fragmented teamwork and poor collaboration and communication between team members are often found to be contributing factors (Poghosyan, Shang, Liu, et al.,2015).

Limited right for prescription and referral challenged the development of APN scope of practice. Some people believe that only a physician should be allowed to diagnose, refer, or treat any medical condition. Independent prescribing by a NP does not require collaboration with a physician and is a key element of scope of practice for NPs, as well as being part of the APRN Consensus Model, which seeks to achieve uniformity of state regulation of APRN practice. However, regardless of the existence of the consensus model, there are extensive disparities among the states with respect to prescriptive authority. In some states, prescriptive authority is granted at the time of APRN licensure; in others, the APRN must apply separately for these privileges. (Gardner, Chang, & Duffield, 2012).

References:

Barnes, H., Novosel, L. M. (2018). A scoping review of nurse practitioner workforce data: Part Two of a four-part series on critical topics identified by the 2015 Research Agenda Roundtable. Journal of the American Association of Nurse Practitioners. Advance online publication. doi:10.1097/JXX.0000000000000069.

Gardner, A., Chang, C., & Duffield, A. D. (2012). Delineating the practice profile of advanced practice nursing: a cross-sectional survey using the modified strong model of advanced practice. J Adv Nurs, 69 (9), pp. 1931-1942. Google Scholar

Poghosyan, L., Shang, J., Liu, J., Liu, N., et al. (2015). Nurse practitioners as primary care providers: creating favorable practice environments in New York State and Massachusetts. Health Care Manag Rev;40(1):46–55. doi: 10.1097/HMR.0000000000000010. [PubMed] [CrossRef] [Google Scholar]

The spread of Buddhism in China brought changes in religious ideas and practices, changes in literature and art, and changes in the values and daily lives of families and individuals.  Give THREE examples of such changes, including at least ONE contextualized direct quotation from a primary source assigned for the class.  (You may substitute an image for one of the quotations if you wish.  Please include the image in your paper if you do.) These include:

·      Relevant selections from Ebrey, Chinese Civilization: A Sourcebook (87-108, 132-138, 199-201)

·       The Platform Sutra, the Heart Sutra, Mulian Rescues His Mother, Princess Miaoshan, Tang Poetry (all on iLearn). 

·      The iLearn PowerPoint of Buddhist art

·      Monkey

Please note that Ebrey, The Cambridge Illustrated History of China is NOT a primary source, and that you should NOT quote from it directly.  You should, however, read it carefully and use whatever you’ve learned from it in your own words in your paper. Likewise, my lecture notes are a SECONDARY source, so you shouldn’t quote me directly or footnote me, but you’re welcome to put anything you learned from me in class in your own words and use it in your paper. DO NOT USE SOURCES OTHER THAN THOSE ASSIGNED FOR THE CLASS.

Your paper should have the normal features of an essay: a meaningful title, a point of view expressed in an introduction and conclusion, clearly defined paragraphs that systematically provides evidence to support your point of view.  Citations should be in parentheses, with author’s name (NOT the editor of the anthology, if you’re using it), title of the selection, and page number.  Proofread carefully, revise accordingly.  

Essay #1 Rhetorical Analysis

Assignment: Write a paper formatted in MLA style of four to five pages in length (use Times New Roman 12) that addresses the topic below.

You must include a Works Cited page.

Following the examples and instructions in Chapter Eight of Writing Arguments, write a rhetorical analysis of another writer’s argument. You may (in fact, you are encouraged to) develop your essay beyond the outline given in chapter eight. Part of your critique may include a discussion of potential arguments and counter-arguments that the author could have made and an analysis of the ways that including those counter-arguments (and the rebuttals) might have strengthened the author’s argument.

Fleming’s “Youthful Indiscretions” (438) 

Link to Article on Flemings “Youthful Indiscretions”   http://files.eric.ed.gov/fulltext/EJ794241.pdf  in which paper needs to be written on

Step 1

Locate the thesis of the argument you are analyzing. The author or presenter will often state it in one succinct sentence close to the beginning of the article, essay or presentation.

Step 2

List each argument and piece of evidence in support of the thesis and leave space for notations.

Step 3

Analyze the logic, facts and any data that the argument presents. Look out for emotional arguments, hasty generalizations, and red herrings, which a sound argument must omit. Also look for erroneous facts, omissions of facts that you know should be there, and data that is dated or taken out of context. Make notes as you work.

Step 4

Look at studies that the author quotes if they seem suspect. Sometimes researchers do only short studies or studies that do not include a large enough sample. Sometimes they don’t ask the right questions or the methodology is weak. Also, the references should come from credible sources; credible sources are those written by research scholars in the field or practicing experts. Make notes as you work.

Step 5

Open your analysis with a paragraph that ends with your own thesis, either agreeing or disagreeing with the other person’s thesis.

Step 6

Address the argument point by point. Do so in the same order in which the author or speaker presented his points. Alternatively, you can group related points together. Concede valid points, but point out flaws in others. Save your strongest, most important point for last.

Step 7

Weave in concrete support for your analysis. Cite reliable, current references.

Step 8

Conclude the analysis with the discussion of your strongest point or with a short discussion of the subject matter as it pertains to your thesis

Read the Electronic Signature, Attestation, and Authorship practice brief.Preview the document
Using APA format, respond to the following prompt in 1 1/2 to 2 double-spaced pages:In your own words, respond to the following:
In your own words, recommend a minimum of five potential issues to consider when developing a policy on electronic signatures.
Advocate in your policy and procedure (P&P) how you will use audit logs to support and monitor the E-Signature process.
Research the laws and regulations specific to the State you reside in, verifying if laws have been updated since the Practice Brief was published and ensure the most recent laws are accurately referenced in your P&P.
Per APA formatting, in-text citations are expected, as are a reference list page and a cover page. These pages are extra and in addition to the 1 1/2 to 2 double-spaced pages noted above.
You are welcome to cite and use sources in addition to the brief; just be sure to cite them appropriately in the APA format and include them in your reference list.

Individuals with avoidant and anxious attachment styles, also known as narcissists and co-dependents, often find each other and form unstable relationships. In this forum, define the notions of narcissism and codependency. Then explain why the two types get attracted to each other and why their relationship tends not to last. You may use the readings or the internet. But rephrase everything using your own words.

 

 

 

Please I need help with this Genetic Pre-lab, its due in 2 days, if it can be done sooner, even better. Attached to this is the pre-lab( data sheet) please DRAW ALL PUNNETT SQUARES necessary for questions. Do all questions, no plagiarism. The data has been entered in RED

 

Literature Evaluation Table

In nursing practice, accurate identification and application of research is essential to achieving successful outcomes. The ability to articulate research data and summarize relevant content supports the student’s ability to further develop and synthesize the assignments that constitute the components of the capstone project.

The assignment will be used to develop a written implementation plan.

For this assignment, provide a synopsis of the review of the research literature. Using the “Literature Evaluation Table,” determine the level and strength of the evidence for each of the eight research articles you have selected. The articles should be current (within the last 5 years) and closely relate to the PICOT question developed earlier in this course. The articles may include quantitative research, descriptive analyses, longitudinal studies, or meta-analysis articles. A systematic review may be used to provide background information for the purpose or problem identified in the proposed capstone project.

While APA style is not required for the body of this assignment, solid academic writing is expected, and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are not required to submit this assignment to LopesWrite.

AttachmentsNRS-493-RS4-LiteratureEvaluationTable.docx

PAPER 2

 

Capstone Change Project Outcomes

After working with your preceptor to assess organizational policies, create a list of measurable outcomes for your capstone project intervention. Write a list of three to five outcomes for your proposed intervention. Below each outcome, provide a one or two sentence rationale.

The assignment will be used to develop a written implementation plan.

APA style is not required, but solid academic writing is expected.

You are not required to submit this assignment to LopesWrite.

PAPER 3

 

Professional Capstone and Practicum Reflective Journal

Students are required to submit weekly reflective narratives throughout the course that will culminate in a final, course-long reflective journal due in Topic 10. The narratives help students integrate leadership and inquiry into current practice.

This reflection journal also allows students to outline what they have discovered about their professional practice, personal strengths and weaknesses, and additional resources that could be introduced in a given situation to influence optimal outcomes. Each week students should also explain how they met a course competency or course objective(s).

In each week’s entry, students should reflect on the personal knowledge and skills gained throughout the course. Journal entries should address one or more of the areas stated below.  In the Topic 10 graded submission, each of the areas below should be addressed as part of the summary submission.

1. New practice approaches
2. Interprofessional collaboration
3. Health care delivery and clinical systems
4. Ethical considerations in health care
5. Practices of culturally sensitive care
6. Ensuring the integrity of human dignity in the care of all patients
7. Population health concerns
8. The role of technology in improving health care outcomes
9. Health policy
10. Leadership and economic models
11. Health disparities

While APA style is not required for the body of this assignment, solid academic writing is expected, and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are not required to submit this assignment to LopesWrite

NURS 6640: Psychotherapy with Individuals Week 10-

Response 1

Thank you for your post regarding counseling older adults. The number of older adults in the United States is expected to nearly double from 40.3 to 72.1 million from 2010 to 2030(Wheeler, 2014). Although mental illness is not a normal part of aging, at least 20% of older adults have one or more mental health conditions (Wheeler, 2014). The client in your post appears to be dealing with trauma or posttraumatic stress disorder (PTSD). This changing demographic will likely mean an increased need for mental health resources and services, especially as they relate to trauma exposure in this age group (Cook & Simiola, 2017). Many older adults may have experienced trauma but do not recognize the potential detrimental health effects or disclose these experiences to health care providers (Cook & Similoa, 2017). As future psychiatric-mental health nurse practitioners (PMHNP) it is important to offer an environment of trust so that these individuals are able to disclose their true thoughts and experiences. Being aware of what the client has gone through will allow the provider to best create a treatment plan that benefits the client.

References

Cook, J. M., & Simiola, V. (2017). Trauma and PTSD in older adults: Prevalence, course,concomitants and clinical considerations. ​Current Opinion in Psychology​, ​14​, 1–4.https://doi-org.ezp.waldenulibrary.org/10.1016/j.copsyc.2016.08.003Wheeler, K. (Ed.). (2014). ​Psychotherapy for the advanced practice psychiatric nurse: A how-toguide for evidence-based practice​ (2nd ed.). New York, NY: Springer Publishing Company.

NURS 6640: Psychotherapy with Individuals

Week 10- Response 2

Thank you for your post regarding counseling older adults. As this population is expected to increase over the next decade, it is important to understand the implications of working with this age group. New research has shown that understanding potential in relation to aging will allow the older population to access latent skills and talents later in life (Wheeler, 2014).Psychiatric-mental health nurse practitioners (PMHNPs) who work with older adults should be proficient at assessing the status of their client’s cognitive, affective, functional, physical, and behavioral function, as well as their family dynamics (Wheeler, 2014). Dialectical behavior therapy (DBT) can be used for the older adult. DBT was originally developed as a treatment for individuals meeting criteria for borderline personality disorder (BPD) and those experiencing chronic suicidal ideation (Stein, Hearon, Beard, Hsu, & Bjoergvinsson, 2016). More recently, adapted forms of DBT have been used effectively as both primary and adjunctive treatments fora range of psychiatric disorders, including bipolar disorder, treatment-resistant depression, and eating disorders (Stein et al., 2016). In practice, this writer has seen that older adults seem to put their mental health on the back burner. They often do not put much effort into treatment because they are more concerned with their physical health. Due to this reality, DBT is a good therapy to implement with the older population, so that they will understand the impact of their mental health on their overall wellbeing.

References

Stein, A. T., Hearon, B. A., Beard, C., Hsu, K. J., & Bjoergvinsson, T. (2016). Properties of theDialectical Behavior Therapy Ways of Coping Checklist in a Diagnostically Diverse PartialHospital Sample. ​JOURNAL OF CLINICAL PSYCHOLOGY​, ​72​(1), 49–57.https://doi-org.ezp.waldenulibrary.org/10.1002/jclp.22226Wheeler, K. (Ed.). (2014). ​Psychotherapy for the advanced practice psychiatric nurse: A how-toguide for evidence-based practice​ (2nd ed.). New York, NY: Springer Publishing Company

1) The culture you have selected and some general information about that culture (traditions, beliefs, practices, etc.). Note: This is general info and you are not discussing yourself and your practices here.

2) How you and those close to you within your culture (friends, family, etc.) practice the traditions & beliefs, what the values mean to you, etc. Note: This is when you can discuss in more detail how you practice the culture you have selected.

3) Discussion of the food item that you brought in and how it represents your culture. What meaning does that food have for your culture? For example, in the Chinese culture, dumplings represent luck (a student’s words, not mine). Note: You may also discuss your own practices (example: your family makes this food on holidays).

NR 222 RUA HEALTHY PEOPLE 2020

Preparing the assignment

Follow these guidelines when completing this assignment. Speak with your faculty member if you have questions.

1. 1)  Identify a health problem or need for health promotion for a particular stage in the life span of a population
   from a specific culture in your area.
2. 2)  Choose one of the Leading Health Indicators (LHI) priorities from Healthy People 2020:
   https://www.healthypeople.gov/2020/Leading-Health-Indicators
3. 3)  Research a topic related to health and wellness associated with one of the Healthy People 2020 topic areas.
4. 4)  Submit your topic to the instructor for approval at least 2 weeks prior to the final assignment due date, but
   earlier if desired. All topics must be approved.
5. 5)  You will develop an educational health promotion project addressing the population/culture in your area.
6. 6)  Use TurnItIn in time to make any edits that might be necessary based on the Similarity Index prior to submitting
   your paper to your faculty. Consult with your faculty about the acceptable Similarity Index for this paper.
7. 7)  For writing assistance (APA, formatting, or grammar) visit the Citation and Writing Assistance: Writing Papers at
   CU page in the online library.
8. 8)  Include the following sections (detailed criteria listed below and in the Grading Rubric).
9. Introduction and Conclusion- 15 points/15%
   • Introduction establishes the purpose of the paper and describes why topic is important to health promotion
     in the target population in your area.
   • Introduction stimulates the reader’s interest.
   • Conclusion includes the main ideas from the body of the paper.
   • Conclusion includes the major support points from the body of the paper.
10. Relate Topic to Target Population- 25 points/25%
    • Describes the topic and target cultural population.
    • Includes statistics to support significance of the topic.
    • Explains how the project relates to the selected Healthy People 2020 topic area.
    • Applies health promotion concepts.
11. Summary of Articles- 25 points/25%
    • A minimum of three (3) scholarly articles, from the last 5 years, are used as sources.
    • Articles meet criteria of being from scholarly journals and include health promotion and wellness content.
    • At least one article is related to the chosen cultural group.
    • Summaries all key points and findings from the articles.
    • Includes statistics to support significance of the topic.

Write a brief Introduction why you chose these decisions .

 

Decision 1

The PMHNP will administer 10 mg of zyprexa orally at bed time and initiate 230mg of invega sustenna through intramuscular, in addition to 156 mg via the same route on day four. A similar dose will be administered within one months’ time. In addition the PMHNP will administer 10mg of Abfility orally at bed time. Expected outcome for this decision is a 25% decrease in the PANSS score (Stahl, 2013). This decision is also expected to alleviate the patient’s psychotic symptoms and achieve normalcy within one month. A slight weight gain is also expected as the drugs are known to increase weight in patients. Because I don’t select the other decisions, the patient is expected to have faster and noticeable changes in psychotic behavior within two weeks of treatment commencement.

Decision 2

At this point the PMHNP will decide to continue with use of medications selected in decision 1 (Stahl, 2013). However the PMHNP will instruct the administering nurse to begin intramuscular injections of 300mg of Abfility and continue with 10 mg of the same drug in the morning. At this point, PANSS is expected to decrease by 50 % although the patient will also have noticeable weight gain due to use of invega sustenna (Stahl 2014). Because I don’t select other decisions, the patient is expected to have less cardiovascular drug toxicities and experience reduced risks for adverse drug reactions between Invega sustenna and Haldol Deaconoate.

Decision 3

The decision at this point is to have the patient continue with Invega Sustenna and provide psychological counseling on the effects of the drugs associated with weight gain. It will be essential to explain to the patient that the weight gain from this drug is minimal in comparison with other drugs (Stahl, 2013). The PMHNP will set an appointment follow up date with the patient after one month duration and refer to the nutritionist and physical activity instructor. The difference between expected outcome in decision 3 and results of the decision is Abfility may not be efficacious for more than a period of 6 months given that it does not bind to D 2 receptors in a similar manner as Invega Sustenna. This will necessitate the PMHNP to change to Abfility Maintena because it is easily tolerated by patients on Abfility.

Because I don’t select the other decisions, the patent will be able to utilize the same drug for the longest possible duration and optimize on their efficacy prior to switching to other types of medication (Stahl, 2013). Since the patient may not have the mental capacity to participate in the decision making process or make autonomous mental health decisions, it is essential to discuss treatment options with the spouse and explain the importance of adherence to treatment (Stein & Giordano, 2015). In addition, the mental health nurse is required to make those decisions which will benefit the patient and also outweigh the risk for adverse health outcomes.

References

Like earthquake and volcano eruptions, major hurricanes and tornadoes have occurred long before there were humans on Earth. Choose one hurricane or tornado that significantly impacted humans and report on it. Be sure to cover how it affected the Earth, damages and death tolls, economic impact and any permanent consequences.

Your paper should meet the following requirements:

• 3-4 pages in length (does not include title and reference page)
• 1-2 outside sources

This “Assignment 3” writing assignment is a comparative essay focused on topics encountered in our HUM 111 class. The project will be based on research but will reflect your views and interpretation of the topic. This project is designed to help you stretch your mind and your abilities as an organized, innovative, and critical thinker. If approached properly, it should also be fun!

Choose one (1) of the topics from the list of topic choices below. Read the topic carefully. Write a three to four (3-4) page paper (750-1,000 words) that follows instructions and covers each part of the topic. (The title page and References list do not get included in this word count).

For the topic you choose:

1.     Establish a clear thesis about your topic as part of the introductory paragraph (often the thesis is the last thing one determines after doing the basic research and outline; however it will be placed in the first paragraph of your paper).

2.     This is a comparative essay. Comparison approached properly will require some critical thinking on your part. Use a point-by-point approach for the essay. That means, if comparing subject A with subject B, don’t do the first half of the essay on subject A and then the second half on subject B–that will seem like two (2) separate essays and comparisons will tend to get lost. Instead, you should be mentioning both subjects in most of your paragraphs as you compare them throughout the essay. Comparisons will identify similarities as well as contrasts.

3.     Do not try to do everything on your two (2) subjects. You should end up narrowing your focus to a few insights and issues about the subjects being compared. And, from those fairly specific points of comparison, you will develop a thesis and glean some lessons.

4.     Follow closely the instructions below for your specific topic.

5.     Include a concluding paragraph at the end. This paragraph will, in some way, refer back to the thesis established in your first paragraph, since now you have demonstrated and supported it. It may be here that you also include your observations relating your study to the modern workplace or society (see your topic). Try to finish with flair!

6.     Use at least four (4) good quality academic sources, with one (1) source being the class text. Note: Wikipedia and other similar Websites do not qualify as academic resources.

 

Topic Choices – Choose just one (1) of the topics below:

• Qualities of the Hero: Comparing Gilgamesh and Odysseus. Write an essay comparing these two (2) heroic figures from ancient epics of different cultures, especially focusing your analysis on the sources about their encounters with monsters: Gilgamesh encounters the monster guarding the forest, Humbaba, in Tablets 3-5 of the Epic of Gilgamesh (seehttp://www.ancienttexts.org/library/mesopotamian/gilgamesh/; scroll down to the Tablet links; think of “Tablet” numbers like chapter numbers).” Odysseus encounters Polyphemus the Cyclops in Book 9 of The Odyssey (see http://www.theoi.com/Text/HomerOdyssey9.html; from line 105 to the end). Your paper should:

a) Compare Gilgamesh and Odysseus as to their heroic qualities, noting similarities and differences, using specific examples from the epics.

b) Summarize what this indicates about differences between ancient Mesopotamian and Greek cultures in their ideals and expectations.

c) From this comparison, suggest ways that current cultural ideals and expectations shape modern notions about role models and heroes.

 

• Confucius and Aristotle on Virtue. Write an essay comparing these two (2) ancient thinkers on the concept of virtue or good ethical character and conduct. Stay focused on the issue; keep any biographical or other information short or limited. As much as possible, analyze their writings (in translation, of course), using Confucius’ Analects (athttp://classics.mit.edu/Confucius/analects.html ) and Aristotle’s Nicomachean Ethics (at http://classics.mit.edu/Aristotle/nicomachaen.html ). Your paper should:

a) Compare the teachings of Confucius and Aristotle on what constitutes virtue or good ethical character and conduct, noting similarities and differences in specific ideas or emphasis.

b) Consider what your findings suggest about differences between ancient Chinese and ancient Greek culture.

c) From this comparison, suggest ideas of virtue that can apply to ethics in a modern setting, such as a diverse workplace.

 

• Comparing Sculptures of Ancient India and Greece. Write an essay comparing the way gods and humans were depicted in sculpture in ancient India and Greece, and identify the cultural values and ideals that these art works reflect in each case. Your paper should:

a) Using specific examples, compare the way gods and people were depicted in the sculptures of ancient India and Greece, noting similarities and differences.

b) Identify the cultural values and ideals that these art works reflect for each society.

c) From this comparison, suggest a modern situation of artistic expression and the ways it reflects or counters prevailing cultural values.

 

• Comparing Ancient Skeptics. Write an essay comparing Lucretius and Wang Chong (=Wang Ch’ung), skeptical philosophers of ancient Rome and China. They were skeptical about popular religious and spiritual beliefs and widely-held superstitions. Lucretius was an Epicurean philosopher of Roman culture (Chapter 6). Wang Ch’ung was a thinker in ancient Chinese culture (Chapter 7). Focus your comparison on their writings as found at http://www.humanistictexts.org/lucretius.htm and http://www.humanistictexts.org/wangchung.htm#On Not Flying to Heaven. Your paper should:

a) Using examples from their writings, compare these two (2) thinkers on their views about specific subjects and on their approach in explaining and expressing their skepticism.

b) From this comparison, identify popular beliefs in each culture that seem similar and those that seem different.

c) From this comparison, suggest any modern situation in which materialist skeptics confront spiritual and religious beliefs, and comment on the considerations of free expression and cultural respect.

 

• Comparing Ancient Male Rulers. Take any two (2) of these rulers and write an essay comparing them: Ramses II, Shihuangdi, Constantine, Ashoka, Pericles, or Charlemagne. Select rulers from different cultures. You may also propose (for approval or not) a ruler not listed. Avoid lengthy quoting or lengthy close paraphrasing from biographical sources. Make it YOUR comparative analysis. Your paper should:

a) Compare the two (2) rulers in terms of their situation and methods of rule and their apparent ideals and practices, noting similarities and differences. Use specific examples.

b) Consider what your study suggests about the cultures over which they ruled, identifying any similarities and differences between the cultures.

c) From this comparison, suggest lessons about different types of effective leadership in the world of modern business and / or modern politics.

 

• Comparing Ancient Female Rulers. Compare the Tang Empress Wu Zetian (also known as Empress Wu or as Wu Zhao; ruled China around 690-705 AD) with either the Pharaoh Cleopatra (ruled Egypt around 51-31 BC) or the Pharaoh Hatshepsut (ruled Egypt around 1478-1458 BC). You may also propose (for approval or not) a female ruler not listed. Avoid lengthy quoting or lengthy close paraphrasing from biographical sources. Make it YOUR comparative analysis. Your paper should:

a) Compare the two (2) rulers in terms of their situation and ascent to power, their methods of rule, and their achievements and resourcefulness, noting similarities and differences. Use specific examples.

b) Consider what your study suggests about the cultures over which they ruled, identifying any similarities and differences between the cultures.

c) From this comparison, suggest lessons about different types of effective leadership by a female in the world of modern business and / or modern politics.

The Project Paper will be graded on:

1.     The level to which the instructions were followed for the paper generally and for the specific topic.

2.     The establishment of a clear thesis about your topic.

3.     The adequacy and relevance of information, examples, and details which support the general thesis.

4.     Covering each part of the topic as instructed, including the comparisons, the consideration of ancient cultural differences, and the reflection on lessons for modern society or the modern workplace.

5.     The quality of your research and your persuasiveness using critical reasoning.

6.     The use and acknowledgement of a minimum of four (4) required references (the class textbook plus at least two (2) other quality academic sources) documented using the APA style –including both the use of a proper References list and the use of proper in-text citations.

7.     Adherence to standard rules of grammar, punctuation, paragraphing, and mechanics, and general clarity of presentation.

 

Your assignment must follow these formatting requirements:

• Be typed, double spaced, using Times New Roman font (size 12), with one-inch margins on all sides. Both in-text citations and a References list are required. Citations and references must follow APA style format. Check with your professor for any additional instructions specific to the selected topic. (Note: Students can find APA style materials located in the course shell for guidance).
• Include a cover page containing the title of the assignment, the student’s name, the professor’s name, the course title, and the date. The cover page and the reference page are not included in the required page length. For our purposes, you may omit any abstract page.

The specific course learning outcomes associated with this assignment are:

• Explain how key social, cultural, and artistic contributions contribute to historical changes.
• Explain the importance of situating a society’s cultural and artistic expressions within a historical context.
• Examine the influences of intellectual, religious, political, and socio-economic forces on social, cultural, and artistic expressions.
• Identify major historical developments in world cultures during the eras of antiquity to the Renaissance.
• Use technology and information resources to research issues in the study of world cultures.
• Write clearly and concisely about world cultures using proper writing mechanics.

I need only 4 simple pages without any out resources USE JUST THE FILE ATTACHED AND THE LINK AT THE BOTTOM. **With the verb (I). I will attach the Pamela Hays’ Addressing Model and the first part that I did it about my self.

The name of this class is Culture and Gender in Counseling and Psychotherapy

The paper has to due in two parts. The first part I did it in the first of the semester, and the second part it due now. 

It is a self- assessment. The first part was about my self identity. And the second part is:

 The second section is due Week 11 and should be 4-6 pages APA Style. This section is to include a self-assessment using Pamela Hays’ Addressing Model discussed in class along with reflections of changes or new awareness that has emerged as a result of the course. In other words, reflect back on Part 1. You are to turn in the graded copy of Part 1 along with Part 2.

……………………………………………………………………………………………………..

Here what is the professor said:

C) Self-Assessment.  This paper has two parts. The first section will be a follow-up to in-class activities presented in Weeks 1 and 2.  For this assignment you will reflect on your cultural identity.  Honesty is expected and will not be penalized, however a respectful tone is required.  The first section should be 2-3 pages APA Style and is an honest assessment of your cultural identity, how you see yourself at the start of this class. We will do a few in-class exercises during the first two weeks to support this process. The second section is due Week 11 and should be 4-6 pages APA Style. This section is to include a self-assessment using Pamela Hays’ Addressing Model discussed in class along with reflections of changes or new awareness that has emerged as a result of the course. In other words, reflect back on Part 1. 

The following are questions to consider in the completion of this assignment:

a) Which one of these identities (from the ADDRESSING model) do you find to be most salient? Why? Which is least salient? Why?

b) What does it mean to you (and to American Society as a whole) to be part of this group? 

c) What are some of your recollections about interactions and experiences that have significantly impacted your cultural identity development as part of this group?  Have your feelings changed or stayed the same about being part of this group?

d) Have you contributed to discrimination/oppression as part of this group?  Have you been a victim of discrimination/oppression as part of this group? 

e) What messages have you received (directly or indirectly) about people who share your identity, and people who do not share your identity?

f) What are some skills you have learned in this class that you can use when working with individuals from diverse groups?

g) Have your views changed since taking this class?  If so, how?  What are some areas you still need to work on? 

The link for Pamela Hay’s 

https://ltc.highline.edu/cce/Addressing%20Complexities%20in%20Counseling%20(ADRESSING%20model)-%20Hays.pdf

EN360 Technical Communication

Directions: Be sure to save an electronic copy of your answer before submitting it to Ashworth College for grading. Unless otherwise stated, answer in complete sentences, and be sure to use correct English, spelling and grammar. Sources must be cited in APA format. Your response should be four (4) double-spaced pages; refer to the “Assignment Format” page located on the Course Home page for specific format requirements.

Part A: Written and Oral Communication Skills

Locate a website for an organization that hires graduates in your major. Besides technical skills, what writing and communication skills does this organization seek in a job candidate? Write a one-page essay on what they say directly on this subject. Include reasons why each skill is important, and any additional written/spoken skills that you believe would give a candidate a competitive advantage.

Part B: Effective Writing Teams

a. What types of projects require collaboration?

b. What are four primary attributes of an effective writing team? Provide an example for each.

Part C: Internet Source Distortion/Misrepresentation

From media, personal experience, or the Internet, identify an example of each of the following sources of distortion (faulty causal and/or statistical inference) for the following:

a. A study with questionable sponsorship or motives

b. Reliance on insufficient evidence/hasty generalization

c. Unbalanced or biased presentation

d. Unexamined assumptions

e. Faulty causal reasoning

Part D: Checklist for Style – Local Newspaper

Using the “Checklist for Style” on the following page (also found in Chapter 11 of your textbook), rewrite the following letter to a local newspaper.

In the absence of definitive studies regarding the optimum length of the school day, I can only state my personal opinion based upon observations based by me and upon teacher observations that have been conveyed to me. Considering the length of the present school day, it is my opinion that the day is excessive length-wise for most elementary pupils, certainly for almost all of the primary children.

To find my answer to the problem requires consideration of two ways in which the problem may be viewed. One way focuses upon the needs of the children, while the other focuses upon logistics, transportation, scheduling, and other limits imposed by the educational system. If it is necessary to prioritize these two ideas, it would seem reasonable to give the first consideration to the primary reason for the very existence of the system, i.e., to meet the educational needs of the children the system is trying to serve.

Grading Rubric

Please refer to the rubric on the next page for the grading criteria for this assignment.

This is the end of Assignment 4.

CATEGORYExemplarySatisfactoryUnsatisfactoryUnacceptable

20 points15 points10 points5 points

The student describes 4 or

more well-written, currently

marketable skills with

reasons why each skill is

important.

The student describes 4 or

more well-written, currently

marketable skills with fewer

than 4 reasons why the skills

are important.

The student describes 4

currently marketable skills,

but does not provide

support for his or her

choices.

The student describes

fewer than 4 currently

marketable skills, and does

not provide support for his

or her choices.

20 points15 points10 points5 points

The student describes 4 or

more types of projects that

require collaboration + 4

attributes of an effective

writing team with examples

of each.

The student describes 2 to 3

types of projects that

require collaboration + 4

attributes of an effective

writing team with only

partial examples.

The student describes only

1 type of project that

requires collaboration + 4 or

fewer attributes of an

effective writing team with

only partial examples.

The student fails to

describe any projects that

require collaboration +

provides inappropriate

supporting attributes of an

effective writing team.

20 points15 points10 points5 points

The student provides 5 well-

written/evaluated examples –

one for each of the 5 sources

of distortion.

The student provides 5

adequately

written/evaluated examples

– one for each of the 5

sources of distortion.

The student provides

passably written/evaluated

examples that may or may

not cover each of the 5

sources of distortion.

The student provides

poorly written/evaluated

examples that may or may

not cover each of the 5

sources of distortion.

15 points 12 points 8 points 5 points

The student’s new iteration

is less than half the length of

the original and is free of all

the errors outlined in the

“Checklist for Style”.

The student’s new iteration

is less than half the length of

the original and includes no

more than 3 of the errors

outlined in the “Checklist for

Style”.

The student’s new iteration

is less than or equal to half

the length of the original

and includes no more than 5

of the errors outlined in the

“Checklist for Style”.

The student’s new

iteration is more than than

half the length of the

original and includes more

than 5 of the errors

outlined in the “Checklist

for Style”.

10 points 8 points 5 points 2 points

Student makes no errors in

grammar or spelling that

distract the reader from the

content.

Student makes 1-2 errors in

grammar or spelling that

distract the reader from the

content.

Student makes 3-4 errors in

grammar or spelling that

distract the reader from the

content.

Student makes more than

4 errors in grammar or

spelling that distract the

reader from the content.

15 points 12 points 8 points 5 points

The paper is written in

proper format. All sources

used for quotes and facts are

credible and cited correctly.

Excellent organization,

including a variety of

thoughtful transitions.

The paper is written in

proper format with only 1-2

errors. All sources used for

quotes and facts are credible

and most are cited correctly.

Adequate organization

includes a variety of

appropriate transitions.

The paper is written in

proper format with only 3-5

errors. Most sources used

for quotes and facts are

credible and cited correctly.

Essay is poorly organized,

but may include a few

effective transitions.

The paper is not written in

proper format. Many

sources used for quotes

and facts are less than

credible (suspect) and/or

are not cited correctly.

Essay is disorganized and

does not include effective

transitions.

Format – APA

Format, Citations,

Organization,

Transitions (15

Points)

Mechanics –

Grammar,

Punctuation,

Spelling (10 Points)

Part A: Written and

Oral Communication

Skills (20 points)

Part C: Internet

Source

Distortion/Misrepre

sentation (20 points)

Part D: Checklist for

Style – Local

Newspaper (15

points)

Part B: Effective

Writing Teams (20

points)

Clinical Case Exam

Eve is a thirty-two-year-old woman who comes to the therapist for treatment of depression. Her current symptoms include the following: depressed mood, apathy, anhedonia, hypersomnia, significant daytime fatigue, suicidal ideations, and low frustration tolerance. She has experienced five prior episodes of depression. The symptom picture was much the same during each episode, though in this most recent episode she reports that her suicidal thoughts have increased. She also is increasingly pessimistic about psychiatric treatment being helpful for her. 

Eve’s first episode occurred at the age of twenty-one and the second at age twenty-five. During these first two episodes of depression, each of which lasted approximately eight to nine months, she was functional but seriously depressed. She did not seek treatment; apparently in both cases she eventually experienced spontaneous remissions. In the next episode (her third, at age 27), she did see a psychotherapist and reports that it was somewhat helpful, but the treatment (psychotherapy alone) did not resolve her depression. Again she eventually recovered after twelve months. Again, it was likely a spontaneous remission. 

Episode number four (age 29): Eve was treated by her primary care physician with Zoloft. She started this medication at a dose of 50 mg qd and she did tolerate it. After one month on this dose the dose was increased at first to 100 mg and then to 150 mg. After 3 months during which she did not show any improvement she was switched to Wellbutrin. Again she started with a low dose and was eventually increased to a dose of 300 mg qd. On both the Zoloft and the Wellbutrin, there was no significant improvement, but she remembers that she did experience increased irritability. Since the medication was not effective, she simply stopped taking it (four months into treatment). Eve continued to be depressed but somehow tolerated it and never talked to her doctor about it again. By twelve months her depression lifted. 

Episode number five (age 30): This time Eve saw a psychiatrist and was tried on a number of different drugs: Effexor (up to 300 mg); Wellbutrin added to Effexor (doses in the therapeutic range). On Wellbutrin and Effexor she showed a 10% reduction in symptoms on the Hamilton Depression Rating Scale, but her slight improvement was accompanied by increased irritability, and that was the reason she stopped this medication combination after six weeks. The next medication she was prescribed was Remeron (which she stopped after five days due to excessive daytime sedation). Next she was tried on Effexor and lithium (she discontinued the lithium after three weeks due to sedation and nausea). Before stopping she had attained a blood level of 0.6 and no noticeable improvement. Finally, she was prescribed Cymbalta; again, not successful. Her psychiatrist diagnosed her as having treatment-resistant major depression without psychotic symptoms. 

She now seeks treatment for her sixth episode of depression, which began three months ago and has gotten increasingly more severe. 

Eve denies any history of psychotic symptoms, mania or hypomania, suicide attempts, or significant abuse of alcohol or other recreational drugs. She does drink four cups of coffee a day, attempting to stay alert and combat her constant fatigue. She takes a low dose of Inderal to treat a “mild case of hypertension.” She was started on this medication about three months prior to her current episode of depression. She says that she has no other medical problems. 

In her first episode, the break-up of a romantic relationship seems to have triggered the depressive episode. This was the case again in her second episode. However, in all later episodes there were no noticeable psychosocial stressors occurring prior to the depression. The depressions seemed to “come out of the blue.” She is currently married, in a stable and supportive relationship with her husband, and works as a university librarian. 

Family history is significant. Her maternal grandmother (someone she never met) had had a number of psychiatric hospitalizations and she killed herself when she was twenty-nine years old. One cousin has had a “nervous breakdown. Eve does not know any details about this. A great aunt was a severe alcoholic, and mother suffers from moderately severe chronic depression. 

Eve says that now she feels desperate and is plagued by recurring and intense suicidal impulses. Coming to the current therapist, she sees this as her “last resort.” 

Questions

Make a diagnosis (and mention possible diagnoses/diagnoses to rule out), and explain the rationale for the diagnosis. Main candidates: recurrent major, unipolar depression; bipolar II; possible unreported substance abuse, axis II and axis III co-morbidity 

What are the points in favor of a bipolar II diagnosis? 

What might account for the failure to respond to any of the prior treatments? 

Given the diagnosis you have made, describe your medication treatment strategies. Discuss not only initial choices of medications but also your next-step strategy and why you’ve chosen it. (In doing so, be sure to provide a rationale for your choices.) What questions should be addressed about the class of medications that is chosen (e.g., mood stabilizers)? 

Compare and contrast the biological, genetic, neurological, and physiological aspects of mental illness and pharmacology

Integrate current evidence based research in psychopharmacology

Consider ethical and multicultural factors in psychopharmacology

Lab details
Locate a dripping water faucet (or set a faucet to drip). Collect the water that drips from the faucet over a selected period of time (in a container sufficient to hold the water). Calculate the amount of water (in gallons) lost per unit time. Calculate how much water would be lost in one year from this drip. 

1. Determine the cost of water per thousand gallons of water (from local water board or a water bill). Calculate the cost of the drip per year from the information you have. 
2. Determine the amount and cost of the water you use in taking your shower regularly. You will need to set the shower faucet as you normally do. Record the time in minutes it takes you to shower, determine the amount of water used (by catching it and measuring it somehow) in one minute, and then calculate the gallons used, the cost per shower, and the cost year using the procedure outlined above for the dripping faucet. 
3. Next, you are to compare the amount of water used by taking your regular shower vs. the amount of water consumed in taking a “military shower” (alternately turn the water off and on to save as much water as you can). 
4. Calculate the savings of water and cost for one year to take your regular shower vs. a military shower. 
5. Calculate the flow rate of your kitchen sink per minute. Estimate how many minutes the faucet might be on over the course of one day. How much water would you estimate goes straight from tap to drain?
6. How many toilets are in your home? Are any of them low-flow toilets? Suggest a way to make a low-flow toilet out of a regular-flow toilet.
7. Identify at least three ways in which you can decrease water use anywhere in the home.
8. Assuming a use of 10,000 gallons per month per household, estimate how much water must be available to support your local town population?
9. What is the source(s) of your local water supply?
10. Are there any pollution issues with this water source?

Deliverables:
You will submit a properly formatted paper for this lab. Please submit a discussion of your experience with this activity including a description of the data that you gathered, all of the calculations that you performed and answers to the questions. Please include a data log or table of all of the data that you collected and include all calculations.

Your paper should meet the following requirements:

• 3-4 pages in length
• 1-2 outside sources

Create a 15-slide presentation that highlights the standards, policies, and technical requirements of an Electronic Medical Record System (EMR) implemented within a 400-bed hospital in compliance with Meaningful Use. Provide examples, technical details, and supporting evidence when available.

Adaptive radiation is the process by which one species gives rise to multiple species that exploit different features of the environment, such as food resources or habitats (see Section 5.9, Figure 5.22). Different features of the environment exert the selective pressures that push populations in various directions (phenotypic divergence); reproductive isolation, the necessary condition for speciation to occur, is often a by-product of the changes in morphology, behavior, or habitat preferences that are the actual objects of selection. Likewise, variations among local populations in biotic interactions can result in phenotypic divergence and therefore have the potential to function as mechanisms of adaptive radiation. Resource competition is often inferred as a primary factor driving phenotypic divergence. For example, species of the globeflower fly Chiastocheta present a unique case of adaptive radiation as a result of resource competition. At least six sister species of the genus Chiastocheta lay their eggs (oviposition) on the fruits of the globeflower, Trollius europaeus (Figure 12.14); however, the different species of globeflower flies differ in the timing of their egg laying. One species lays its eggs in 1-day-old flowers, whereas all the other species sequentially deposit their eggs throughout the flower life span. In a series of field experiments, Laurence Despres and Mehdi Cherif of Université Joseph Fourier (Grenoble, France) found evidence that supports the hypothesis that the evolutionary divergence of species of Chiastocheta was a result of disruptive selection on the timing of egg laying (reproduction). The researchers established that intense intraspecific competition occurs within each of the species, but differences in the timing of egg laying and larval development functions to minimize competition among species (the concept of resource partitioning will be examined in Chapter 13).

Although numerous studies have illustrated the role of competitive interactions in adaptive radiation, the importance of other interactions, such as mutualism or predation, remain largely unexplored. The research of Patrik Nosil and Bernard Crespi of Simon Fraser University (British Columbia, Canada), however, has shown that adaptive radiation can result from divergent adaptations to avoid predators. Nosil and Crespi’s research focused on two ecotypes (populations of the same species adapted to their local environments) of the stick insect Timema cristinae (see Section 5.8 and Chapter 5, Field Studies: Hopi Hoekstra for discussion of ecotypes). Timema walking sticks are wingless insects inhabiting southwestern North America. Individuals feed and mate on the host plants on which they reside. The two distinct ecotypes of Timema are adapted to feeding on different host plants, Ceanothus and Adenostoma. The two host plants differ strikingly in foliage form, with Ceanothus plants being relatively large and tree-like with broad leaves and Adenostoma plants being small and shrub-like with thin, needle-like leaves (Figure 12.15).

The two Timema ecotypes differ in 11 quantitative traits (see Figure 12.15), comprising aspects of color, color pattern, body size, and body shape. These differences between the two ecotypes appears to be a result of divergent selection. The different traits exhibited by each of the ecotypes appear to provide crypsis (avoidance of observation) from avian predators on the respective host-plant species. Field experiments were conducted to determine how differences in phenotypic traits influenced the survival rates of the two ecotypes on the two plant species. Each of the two Timema ecotypes was placed on each of the two host-plant species. The results of the experiment clearly indicated that the direction and magnitude of divergence in traits represent adaptations that function to reduce rates of predation on Timema on their respective host-plant species. The ecotypes of T. cristinae, like the example of the limnetic and benthic ecotypes of sticklebacks examined in Chapter 5, can be considered to represent an early stage of adaptive radiation because studies indicate that reproductive isolation is not complete (see Section 5.6, Figure 5.15).

Ecological Issues & Application Urbanization Has Negatively Impacted Most Species while Favoring a Few

As we will see in the chapters that follow, species interactions are ubiquitous in nature and play a fundamental role in the structuring of ecological communities. Perhaps no other interaction, however, has as great an impact on the diverse array of plants and animals that inhabit our planet as their interaction with the human species.

As we first presented in Chapter 9 (Ecological Issues & Applications), the primary cause of population declines and recent species extinctions is habitat loss as a result of human activities—namely, changing land-use patterns. There are two major land-use changes that are responsible for habitat loss in terrestrial environments: expanding agriculture and urbanization.

According to the Food and Agricultural Organization (FAO) United Nations’ statistics, at present some 11 percent (1.5 billion hectares) of the globe’s land surface (13.4 billion ha) is used in crop production (arable land and land under permanent crops), and even more land (3.2 to 3.6 billion ha) is used to raise livestock. Together, agricultural lands account for almost 40 percent of Earth’s land surface. The negative impacts of the expansion of agriculture to meet the needs of the growing human population have been central to the discussion of the decline of biological diversity on our planet, a topic we will examine in more detail in Chapter 26. The increasing urbanization of the human population over the past century (Figure 12.16), however, has led to the emergence of a new field of ecology—urban ecology—to study the ecology of organisms in the context of the urban environment.

Ecology has historically focused on “pristine” natural environments; however, by as early as the 1970s, many ecologists began turning their attention toward ecological interactions taking place in urban environments. What has emerged is a picture of species interactions dominated by humans, which negatively impacts most species and benefits only a few.

Estimates of urban land area vary widely from 0.5 to slightly more than 2.0 percent of the world’s land, depending on the criteria used to define urban development. Historically, cities have been compact areas with high population densities that grew slowly in their physical extent. Today, however, urban areas are expanding twice as fast as their populations. According to the United States Census Bureau, about 30 percent of the U.S. population currently lives in cities, whereas another 50 percent lives in the suburbs. More than 5 percent of the total surface area of the United States is covered by urban and other developed areas; this is more than the land covered by the combined totals of national and state parks.

The expansion of urbanization produces some of the greatest local extinction rates and frequently eliminates the large majority of native species. Eyal Shochat of Arizona State University’s Global Institute of Sustainability and colleagues used data from Phoenix, Arizona, and Baltimore, Maryland, to contrast the distribution of species in these two urban areas as compared to the surrounding natural ecosystems. Their findings show a general pattern of decline in the number of species in urban environments as compared to both surrounding agricultural and natural ecosystems (Figure 12.17).

Species vary in their ability to adapt to the often drastic physical changes along the gradient from rural to urban habitat. Moving from the rural landscape of natural ecosystems and cultivated lands into the suburban landscape, one moves through a heterogeneous mixture of residential areas, commercial centers, and the managed vegetation of parks and cemeteries. The main cause for the loss of species in these suburban environments is habitat alteration. Yet in contrast to the decline in the number of species, both suburban areas and urban centers are usually characterized by higher population densities of resident species as compared to adjacent natural lands. For example, in a study of population of northern cardinals (Cardinalis cardinalis) in the metropolitan area of Columbus, Ohio, and surrounding forested landscape of central Ohio, Lionel Leston and Amanda Rodewald of Ohio State University found that birds were four times more abundant in urban than rural forests. Their research showed that food abundance was as much as four times greater in the urban habitat as compared to the forests of the surrounding region because exotic vegetation, refuse, and bird feeders may all provide food sources for birds in these urban environments.

Some mammals, such as raccoons (Procyon lotor), skunks (Mephitis mephitis), and rabbits (Sylvilagus spp.) have also benefited from the spread of the suburban landscape, finding shelter beneath sheds and porches, and an abundance of food—for raccoons, garbage; for skunks, insects and larvae on lawns and in gardens; and for rabbits, an abundance of high quality food plants in gardens and flowerbeds. Larger species, rapidly adapting to human presence, are moving into the suburban landscape and dramatically increasing in number. White-tailed deer (Odocoileus virginiaus), carriers of Lyme disease, find an abundance of forage on grass, shrubs, and gardens. Resident Canada geese (Branta canadensis), attracted to large open areas of grass—including golf courses and parks—create both a nuisance and health problems. In recent years, coyotes (Canis latrans), attracted by garbage and small prey including rodents and pets (cats and small dogs), are becoming more common in suburban areas. Even black bears (Ursus americanus) are attracted to backyard bird feeders and dumpsters in suburban areas adjacent to forested, rural landscapes.

In addition to increased abundance and predictability of food resources, recent research indicates that a reduction in predator populations in urban environments favors resident species. Evidence has been gathered that supports the idea that urban environments are safer for some species than are rural habitats. Both birds and squirrels in urban environments benefit from reduced nest predation and are able to spend a greater proportion of their time foraging compared with individuals in the surrounding natural ecosystems, indicating that the urban habitat is less risky than the surrounding rural habitats.

Species adapted to habitats along the suburban gradient drop out as they come to urban centers where habitat changes sharply. Vegetation is limited to scattered parks, some tree-lined streets, and vacant lots. Species that benefit from the habitat provided by these core urban centers are often referred to as “urban exploiters.” Among plants, urban exploiters tend to be ruderal species (see discussion of plant life history classification in Section 10.13) that can tolerate high levels of disturbance. Examples include wind-dispersed weeds (grasses and annuals) that colonize abandoned lots and properties, and plants that can grow in and around pavement.

Bird species that thrive in urban habitats are often adapted to nesting in environments that are similar to the cityscape. For example, species that use cliff-like rocky areas, such as the rock dove (pigeons, Columba livia) and peregrine falcon (Falco peregrinus), are “pre-adapted” to using the barren concrete edifices of urban buildings, whereas cavity-nesting species, such as the house sparrow (Passer domesticus), house finch (Haemorhous mexicanus), and European starling (Sturnus vulgaris) are able to inhabit human dwellings.

Mammalian urban exploiters consist of species that are able to find shelter in human dwellings and exploit the rich food source provided by refuse, such as the house mouse (Mus musculus), the black rat (Rattus rattus), and brown rat (Norway rat: Rattus norvegicus).

Urban environments typically have more in common with other cities than with adjacent natural ecosystems, so species that flourish in urban habitats are often not native to the region. Rather, these species tend to disperse from city to city, typically with assistance—either intentionally or unintentionally—from humans (see Chapter 8, Ecological Issues & Applications). Species such as rock doves, starlings, house sparrows, Norway rats, and the house mouse are found in all cities in Europe and North America. As a result, many studies have found that the number (and proportion) of non-native species tends to increase as you move from rural habitats toward urban centers. In general, the proportion of species that is non-native goes from less than a few percent in rural areas to more than 50 percent at the urban core.

This combination of negative interactions with the majority of native species—while enhancing a small subset of often non-native species, which we have manipulated to serve our needs, facilitated through dispersal, or created urban environments in which their populations flourish—is resulting in what urban and conservation ecologists refer to as biotic homogenization, which is the gradual replacement of regionally distinct ecological communities with cosmopolitan communities that reflect the increasing global activity of humans.

Reflecting the views of Machiavelli, analyze the movie The Firm (1993), looking into the plot and characters in the movie and explain the validity of Machiavelli’s ideas in the society reflected by the film. Essay should be no less than 1000 words following MLA format.