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Complete Program Capstone and Project Management Intellipath for Unit 4 for BOTH CLASSES and 2 REPLIES IN EACH UNIT 4 DISCUSSION FORUM

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Complete Program Capstone and Project Management Intellipath for Unit 4 for BOTH CLASSES and 2 REPLIES IN EACH UNIT 4 DISCUSSION FORUM. I’m working on a Business exercise and need support.

You will log into both courses for the same student and complete the UNIT 4 INTELLIPATH FOR EACH COURSE
THIS IS VERY EASY WORK….You will click on each mini task in the intellipath unit and answer the questions…I need at least a B on both…It is easy because you can skip all the readings and go straight to the questions, and redo the questions as many times as you want to get a better score
I also need you to reply to 2 STUDENTS in each Unit 4 Discussion forum

Complete Program Capstone and Project Management Intellipath for Unit 4 for BOTH CLASSES and 2 REPLIES IN EACH UNIT 4 DISCUSSION FORUM

CSU Role of Carbohydrases in Minimizing Use of Harmful Substances Presentation.

UNIT VI POWERPOINT PRESENTATIONWeight: 9% of course gradeGrading RubricInstructionsThis unit has assessed engineering principles applicable to industrial and hazardous waste management. Steps were evaluated for an adsorption system design using engineering principles and presenting engineering calculations for waste treatment.The steps in the lesson were accomplished by the required reading of an article describing laboratory adsorption tests for lead and zinc removal. The lesson used the article’s data combined with engineering principles to design a prototype lead treatment system, and a required article presented a novel method for reducing leather tanning waste.For this assignment, prepare a PowerPoint presentation that assesses engineering principles applicable to industrial and hazardous waste management by evaluating steps for an adsorption system design using engineering principles and presenting engineering calculations for waste treatment.Specifically address the following items in your PowerPoint presentation.Provide a title and introduction.Summarize the Durga, Ramesh, Rose, and Muralidharan Required Unit Resources article.List the steps required for design of a prototype adsorption system.From Required Unit Resources, use the Yusuff and Olateju article’s equation (7) for the Radke-Prausnitz isotherm to evaluate qe for a Ce lead concentration of 10 mg/L. Show your calculation.Explain how your value of qe determined from the equation compares to the value in Yusuff and Olateju’s article exhibit 10a. Do you think there is an error in the equation? Explain.In the unit lesson, if the prototype’s wastewater flow is 500 gpd instead of 100 gpd and the influent lead concentration is still 10 mg/L, what would be the lead inflow rate in units of grams per day? Show your calculation.Provide a summary of your PowerPoint information.Your PowerPoint presentation must be at least 15 slides in length with a title slide and reference slide (title and reference slides do not count toward the minimum slide count). You should utilize at least the two Required Unit Resources: the Durga et al. and the Yusuff and Olateju articles. Ensure you refer to the unit lesson as you are creating your PowerPoint presentation.Please adhere to APA Style when creating citations and references for this assignment. Do not include slide notes in your presentation. Be sure to use fonts that are large enough to view from a distance. This includes any fonts within images that you use. Be sure to cite and reference all information and images.
CSU Role of Carbohydrases in Minimizing Use of Harmful Substances Presentation

UMBC Income Budget Transaction Activity Volumes & Charge per Patient Excel Worksheet.

Using Excel to calculate the following exercise. Call Information:
Charge Amounts (These are what you would send to the insurer)

Call Type
Commercial
Medicare

BLS Emergency
550.00
550.00

BLS Non-Emergency
300.00
300.00

ALS Emergency
800.00
800.00

Payment Amounts (This is the amount you would collect on each patient.)

Call Type
Commercial
Medicare

BLS Emergency
475.50
340.69

BLS Non-Emergency
275.00
212.93

ALS Emergency
700.00
404.57

Based on the data above, build an income budget on what you will think you will make in the month of June. You board wants to know: The amount you charged all patients. The contractual allowances for the month of June. (The amount your charged minus the amount you owe.) The expected amount of revenue you will make. They want to see the following data in an excel sheet, because your treasurer is an accountant and likes excel. Your call volume for the month of June Call Volume Commercial Medicare BLS Emergency Your birth month (January 1, February 2, etc.) 65 BLS Non-Emergency 30 Your day of birth (1, 2, ….31) etc. ALS Emergency Last 2 digits of your phone Number 10
UMBC Income Budget Transaction Activity Volumes & Charge per Patient Excel Worksheet

EXECUTIVE SUMMARY The report is about a 12-week critical evaluation about my experience of the Mega Simulation Game that I was to execute with other four group members. The exercise requires identifying the primary reflective theories that will be used for reflective learning. In my case, I used Lawrence-Wilkes ‘REFLECT’ and Gibb’s Reflective Model. I used these two models to enumerate on two incidences in the group work experience, which were related to interpersonal dynamics, and personal performance in-group work. The interpersonal dynamics such as personality clashes, different cultural values, and personal interests acted as a hindrance to communication and collaboration. However, the commitment of the team was very high and this kept the team going. The second incidence was on personal performance where the group leveraged on individual strengths and delegated tasks. The delegation of tasks was fruitful but the end product was not due to personal interests overriding the group interests. I learnt the need for effective communication, the power of leadership and the need to accommodate varied opinions. Introduction Reflection has numerous meaning that includes self-review, self-awareness, self-criticism, self-appraisal, self-assessment, personal cognizance and other terms that are related to these terms. Boyd and Fales (1983) defined reflection learning as “the process of externally examining and exploring an issue of concern, triggered by an experience, which creates and clarifies meaning in terms of self and which results in a changed conceptual perceptive.” The definition brings out key important issues in reflective learning: there needs to be an issue that is examined, meaning of the issue must be derived and lastly the meaning should improve the perspective of the individual in a similar situation in the future. In this reflection paper, I will pursue two types of reflection: interpersonal dynamics and performance of the members of the groups. Teamwork is used everywhere from class settings to organizations and even communities to accomplish tasks that require collaboration, brainstorming and synergy. The primary objective of a team is delegation of responsibility and development of a proper plan for the completion of a goal (Hughes and Jones, 2011). The interpersonal dynamics is about how people use nonverbal cues such as facial expressions and body language to complement verbal communication in on-on-one interactions. The reason I decided to discuss interpersonal dynamics is because I saw the group as a cross-functional one rather than a functional one. The reasons I think the group was cross-functional was that all the members in the group were specializing on different careers and also we had never worked together as a team. The simulation game was a onetime project where the group would be dissolved after its completion. Parker (2015) noted that cross functional teams were more susceptible to interpersonal barriers such as cultural biases, work styles, turf wars, conflicts, lack of trust, and differing priorities. Some of these things played out during our game simulation task. The second area that I am going to explore is performance of members in the group. I felt this is an area worthy of exploitation as the different members had a different level of performance towards contributing to the success of the group. It is impossible to separate team performance from individual performance because the former depends on the latter. Individual standards comprise of the performance expectations that each team member expresses as personal pressure to achieve (Larson and LaFasto, 1999). I specifically noted that I put a lot of effort together with another member in the teamwork, which stimulated others to perform better, but sometimes it was not sufficient enough to reach our desired goals. I will employ the Gibbs Reflective Cycle (1988) and Lawrence-Wilkes ‘REFLECT’ model (2014) to critically reflect on the two MSG experiences. I used Gibb’s reflective model because it is a simple model to use and provides questions that I have to answer in a particular order. Just like the Gibbs model, Lawrence-Wilkes ‘REFLECT’ model uses a simple concept of reflection making it easy for the user to apply it. The model uses a bacronym (an acronym devised in reverse to fit a word) on the word REFLECT. I will not be using the Honey and Munford’s learning style as it is too simplistic in its steps to allow me to critically reflect on my experiences. Gibb’s reflective model is a useful tool in reflection as it provides critical phases of an experience from what one experienced to how they would make changes and respond better in subsequent events. The different phases include description, feelings, evaluation, analysis, conclusion, and action plan. Below is the Gibb’s reflective cycle with the relevant questions that need to be answered for each phase Figure 1 (Gibbs, 1988) Gibb’s reflective model directly fits to the happenings of the group. In my reflection, I was first wondering why there was no sense of cohesion in the group when we started. The opinions were so diverse and the commitments were so dissimilar. I was feeling that personal priorities and interest were coming in the way of cooperative approach. Most of the group members, including I felt distraught and disillusioned by the progress of the group in the initial weeks due to the lack of organization and poor ranking. We did not have a leader who would inspire us through the disillusionment. In the Tuckman’s stages, the group dwelled so much in the forming stage where the group members were getting to know each other and there was general socializing (Martin, 2006). Lawrence-Wilkes -‘REFLECT’ model (2014) comprises of steps that are almost similar to that of Gibb’s reflective cycle but it goes to a deeper level to analyze elements such as strengths and weaknesses, reference to external checks, looking at the responsibilities and asking the ‘what if’ question. The model examines more details that not only assist in reviewing past experiences but also learning from them and integrating new ideas to enable change. The model requires reviewing of experiences from both objective and subjective angles. Below is the REFLECT barconym used in the model. Table 1 (Lawrence-Wilkes and Ashmore, 2014) Lawrence-Wilkes ‘REFLECT’ model of Reflective Practice R 1. Reflect Look back, review and ensure intense experiences are reviewed ‘cold’ (subjective and objective). E 2. Evaluate What happened? What was important? (Subjective and objective) F 3. Focus Who, what, where, etc. Roles, responsibilities, etc. (Mostly objective) L 4. Learn Question: why, reasons, perspectives, feelings? Refer to external checks. (Subjective and objective) E 5. Evaluate Causes, outcomes, strengths, weaknesses, feelings – use metacognition. (Subjective and objective) C 6. Consider Assess options, need/possibilities for change? Development needs? ‘What if?’ scenarios? Refer to external checks. (Mostly objective) T 7. Trial Integrate new ideas, experiment, take action, and make change. (Repeat cycle: Recall…) Incident 1: My group was comprised of five members that are evidently from different cultural backgrounds and also hold diverse views and values. I noticed due to the diversity in the group, there was no effective communication and there were issues when it came to sense of responsibility. The first incident was our group’s inability to operate cohesively due to differences in personality and cultural values. My previous encounter with the topic of diversity is that it (diversity) can lead to team effectiveness and innovation (West, 2012). But on the contrary, the initial weeks of our groups was faced with communication challenges as we worked together. Initially, I thought that the reason for the incongruity was that the exercise was new to everyone and no one had substantive information on how to go about the exercise. Everyone in the group was in constant search of what is expected of the exercise. The disappointment was evident in week 3 due to the poor ranking, which left everyone demotivated. Waller, Gupta and Giambatista (2004) noted that lack of effective communication leads to deviation from attaining team goals. We got confused on what were our desired goals. Despite the miscommunication, the group was able to function as there were elements that were consistent with structuration theory on how groups use rules and resources to form its structure (Frey, Gouran and Poole, 1999). Our group was held together by the weekly meeting that were mandatory and I believe were it not for the rules, the team functioning would have been impaired. I must applaud my group because irrespective of the communication barriers, the group was able to hold on and try to overcome these barriers. The attendance of the meetings was satisfactory as there was minimal absenteeism, which was accompanied by apologies and genuine reasons such as illness or class time. In my assessment, the general theme of the group according to Myers Briggs Type Indicator (MBTI) was feelers instead if thinkers. Feelers judge situations based on feelings or emotions while thinkers judge situations based on logical analysis (Quenk, 2013). Most of the choices that were made such as marketing for image cars were based on personal emotions, which lead to disregard of facts and information. I must admit despite the personality clash in the group; all the group members were committed to accomplishing the task successfully. The commitment even inspired us on meeting twice a week to try and better our ranking and get a better grip of the whole game simulation concept. Personally, I was not thinking about how to bridge the miscommunication gap or clashing personalities but on the task at hand and this was also the general trend in the group. Even up to the end of the exercise in the 12th week, we communicated but we never did so effectively. The ranking of the group improved over time even though it did not reach the desired goal. Upon critical review at the end of the exercise, I could only make sense of the group performance through the self-organization theory. The theory postulates that order can arise from a disordered system due to interactions of distinct parts of the system. The incidence on interpersonal dynamics, especially the personality clashes and miscommunication between the group members, helped me to develop transferable skills to do with closing ranks when it comes to personality and cultural differences. The group would have attained a better rank if we resolved the disillusionment in the early stages of teaming as this would have gone a long way in working harmoniously (Searle and Swartz, 2015). I also saw the fruits of commitment as the members were able to perform regardless of the cohesion problems. Incident 2 The second incident was related to the individual performances and their contribution to the overall group performance. Personally, I believe am a natural leader who takes the mantle of leadership in any situation. I believe that one does not need to be appointed formally to take the leadership role but can take the steering wheel from any position. I subscribe to the relationship-oriented leadership model where the leader is more focused on the human resources than the task at hand. I would motivate the members of the group by telling them how the assignment was important and how we should all be committed towards improving our ranking. The group needed a small dose of external motivation to keep them going and energized (Beagle, 2012). When I was motivating and inspiring the team, I found the motivator in me, which was essential in keeping myself going and also the group. I noticed that a team produced synergy and a better output than an individual but it is the latter that contributes to the results of the former. Despite the shaky start, we realized that we need to use our individual strengths for team success (Graham et al., 2012). At different points of the assignment, we had to assign and delegate duties and cover ground on the different actions that needed to be taken. We tried to leverage on the strengths of the individual members as much as possible. The use of individual strengths to delegate tasks did not work effectively as I expected as the third phase of Fisher’s Theory of Decision Emergence was not adhered to. The third phase is the emergence phase where an individual needs to soften on their stance and let the interest of the team prevail over personal interests (Littlejohn, Foss and Oetzel, 2016). In some situations, we had to go with individual opinions instead of consensus, which did not work well for the team. In the future, I would advocate for more compromise and consensus instead of personal opinions as the latter risks being biased and non-inclusive. I learnt that anyone can be a situational leader if they wanted to make a difference amidst uncertainty and anyone can lead from any position (Alizor, 2013). I saw the importance of delegating duties as it covered more ground but it needs better coordination to achieve a common goal. I believe my strength and individual contribution was leadership and motivation. Conclusion I appreciate the experience as it was an eye-opener especially on different aspects of group tasks. I understood how group dynamics can work against the success of a team and they need to be identified and dealt with at the early stages of an assignment. For instance, team members need to understand each other’s values and culture, and accommodate them. Understanding each other is the first step of breaking the communication barrier. I appreciated the importance of effective communication, which our group lacked, eventually leading to poor coordination and cooperation. I must admit that the strength of our group lied in commitment more than anything else. After communication, personal interest was the other weakness. I learnt the need to let other team members speak their mind, brainstorming and softening individual stance for the good of the team. I was a culprit myself of holding strong stances, sometimes unconsciously, on some of the issues. Looking back at the exercise, I acknowledge that for better interpersonal reactions, the parties need self-awareness. Lastly, I appreciated the power of leadership in motivating and inspiring team members towards tasks accomplishment. References Alizor, J. (2013). Leadership: Understanding Theory, Style,

Risk assessment and environmental impact assessment

SECTION 1 1.1 INTRODUCTION This report is on the use of risk assessment (RA) in Environmental impact assessment (EIA). Over the last three decades, there has been a remarkable growth of environmental issues in sustainability and the better management of development in harmony with the environment (Glasson at al 2004). The most popular and widely used environmental management techniques are EIA and RA. EIA is a process to identify and predict the impact on the environment and on man’s health and well being of legislative proposals, policies programmes, projects and operational procedures, and to interpret and communicate information about the impacts (Munn 1979). The EIA process includes screening, scoping, impact prediction and evaluation, impact mitigation, decision making (EIA follow up) with public participation and consideration of alternatives potentially incorporated in all the stages of the process (Woods 1995, Canter 1996, Lee and George 2000). The US National Research council (NRC) defines RA as the characterization of the potential adverse effect of human exposure on environmental hazards. A special assessment procedure that aims at tackling certain consequences of human activities is called Risk Assessment (Demidova and Cherp). The stages in risk assessment are as follows: hazard identification, exposure assessment, risk estimation, risk evaluation and risk management (Eduljee 1999). Environmental risk assessment is a generic term for the series of tools and environmental risks and the formation of judgement about them. (DOE 1995, DETR2000) Risk assessment emerged in the mid to late 1970s as an administrative requirement in the form of both statues and executive orders requiring not only more extensive documentation to justify proposed risk regulation, but also the balancing of risk against economic costs and benefits. (Atkisson et al 1985). Environmental Health risk assessment has been defined as the systematic scientific characterization of potential adverse health effect resulting from human exposure to hazardous agents or situations (Faustman and Omenn 2001). In concept, EIA and RA have evolved as parallel and sometimes overlapping procedures for rational reform to policy making (Andrews 1995). The purpose of both concepts is to provide an acceptable basis for making public decisions, not necessarily to generate new scientific knowledge (Andrews 1995). Table 1 below summarizes the similarities and differences of EIA and RA. 1.2 SIMILARITIES AND DIFFERENCES IN RA AND EIA The most important similarity is comparing the stages of RA with those of the EIA process. Thus, hazard identification in RA is equivalent to screening and scoping in EIA, risk estimation is equivalent to impact prediction in EIA, risk evaluation is equivalent to impact prediction in EIA (determining the significance of the impact) while mitigation in EIA can be equated to risk management (specifically risk reduction and control). (Eduljee 1999). SECTION 2 2.1 BRIEF DESCRIPTION OF THE TWO CASE STUDIES Two EIA case studies will be compared from two different industrial sectors and they are the Berkeley nuclear power station where a new building for radioactive waste is to be constructed and the A350 Westbury bypass. The aim of this report is to examine how environmental/health risk has been used in each of these EIA’s and the advantage or potential for improving the use of environmental /health risk assessment in these EIA’s. 2.11 A350 WESTBURY BYPASS- CASE A The construction scheme will comprise approximately 5.8 kilometres of new single carriage way around the eastern and northern sides of Westbury and it aims to provide traffic relief for Westbury, allowing road space in the town to be reallocated to other modes, improve journey time reliability of the A350 route and improve access to employment areas, particularly the West Wilts Trading Estate, and between the west Wiltshire towns. The construction phase will last between 18 months to 2 years and would involve site preparation, earthworks main road construction and construction of final surfaces. Impacts identified resulting from construction is as follows Generation of noise and dust with earthworks and vehicular movement Pollution risk associated with working in close proximity to surface and groundwater resources. Possible disturbance of ecological and heritage resources Generation and disposal of waste Change of land use pattern Post construction impacts were identified as road traffic and emissions from traffic. (Wiltshire county council, 2007) 2.12 BERKELEY NUCLEAR POWER STATION-CASE B Magnox electrical Limited has proposed to construct an intermediate level radioactive waste (ILW) storage building on Berkeley nuclear licensed site. This building will store packaged ILW wastes that have arisen over time and will store these wastes until an offsite disposal facility is available. The ILW waste will house packaged radioactive waste in one above ground location, rather than storing waste below ground as it currently occurs at the Berkeley nuclear power station. The project will be carried out in three stages, Construction of the building Operation/filling of the building with packages of ILW. Long term storage of ILW during care and maintenance period until a disposal route becomes available. The technical assessment areas covered by the environmental impact statement are as follows- Air quality and dust Archaeology and cultural heritage Ecology Geology, hydrology and soils Noise and vibration Surface waters Traffic and transport. (Gloucestershire country 2007) SECTION 3 3.1 THE USE OF RISK ASSESSMENT IN EACH EIA 3.2 METHODOLOGY USED FOR ASSESSMENT IN EIS The methodology of analysis of impact should be taken into consideration when comparing the two EIS used for this study bearing in mind that the case studies are from different industrial sectors. Berkeley nuclear power plant is a high risk and high profile project and it deals with radioactive waste (although the radioactive waste is solid and there is no emission to air). Westbury bypass on the other hand is low risk low profile project with significant impact on air quality (rise in dust particulate matter and oxides of nitrogen) during the construction phase and emissions from vehicles after construction. Method of analysis of impacts- Case A The following methods were used in the analysis of local effects Qualitative and quantitative assessment used to analyze air quality. Dispersion model selection(air quality strategy) Meteorology Sensitive receptors Short term mean concentrations Method of analysis for case-B Simple qualitative to complex quantitative method was used to analyze air quality The use of scientific criteria Comparison of predicted changes with established national and international air quality standards, objectives and thresholds. Interpretation of planning and other environmental policies for example, the assessment of whether the predicted change will conflict the objectives of an air quality management area. Review of comparable proposals on environment. The NSCA flow chart -Event tree analysis Generic assessment methodology. Though the methodology used for risk assessment is similar, the event tree analysis which was used in case study B was absent in case study A. SECTION 4 4.1 POTENTIAL FOR IMPROVING OR EXTENDING EIA EIA have emphasized possible impact on natural ecosystems and, to some extent, human communities but have paid no attention to health effect of other risks (Beanlands 1984a, Clark 1984a and Giroult 1984a). More precisely, even for impacts whose ultimate significance might involve health, such as air pollution, EIA studies typically predict only the environmental fate of contaminants, rather than the effect on health itself and RA have emphasized human health effects, especially potential mortality due to cancer or technological catastrophes. (Andrews 1995) The stages of RA were incorporated into both case studies, but RA was not carried out extensively especially in the Berkeley nuclear power station case. It is recommended that a separate section concerned with health risk assessment be prepared within the EIS for high risk and high profile projects but it was absent in this case. There was failure to conduct probability assessment (uncertainty analysis) in case of the unforeseen accidents like explosions or unplanned discharge of radioactive solid waste into the environment. Risk =probability (likelihood or chance that harm will occur) Ã- consequence (nature of the harm that can occur). There was also no mitigation plans in case of an accident, if there was, then it was not included in the EIS. Risk communication was also absent in both case studies. Also the dose response or exposure assessment which measures the intensity, frequency and duration of human exposure to an agent was present for case A, (Extrapolation dose response methodology) but the effects of the dose for air quality pollutants in case B was not analyzed properly. Hazard index calculation for non carcinogens was absent. HAZOP analysis carried out in case A but absent in case B. Source-pathway-receptor identified in case A, but only source and receptor identified in case B. Risk-benefit analysis also absent. Including the omitted RA analyses above would have improved the use of RA in these EIA’s SECTION 5 5.1 CONCLUSION/ RECOMMENDATIONS Many actions need both EIA and RA assessment. In these instances, a more useful analysis would be obtained from combining the two. (Andrews 1995) The aim of this report has been to evaluate how environmental/health RA were used in different stages of the two reviewed EIS’s, and point out how possible ways that RA might have played a greater role. Systematic application of RA in accordance to best practice was not observed. For a better Incorporation of RA into EIA, there should be emphasis on emergency response measures in the event of accidents and associated environmental perturbations. Canter (1993). REFERENCES Wiltshire County Council, (2007) A350 Westbury bypass Environmental Impact Statement 2007. Trowbridge, Wiltshire County Council. Gloucestershire County council (2007) Berkeley ILW Store. Environmental Impact Statement Issue 1 Gloucester. Gloucestershire County Council. Andrews,R.N.C (1995) Environmental Impact Assessment and Risk Assessment: Learning from each other, In P Wathern (Ed)Environmental impact Assessment: Theory and Practice (Routledge/London) Brookes, A. (2001) Environmental Risk Assessment and Risk management, in P. Morris and R Therivel (Eds) Methods of Environmental Impact Assessment, 2nd Edition(Spon Press/London) Eduljee, G (1999), Risk Assessment in Petts, J. (Ed), Handbook of Environmental Impact Assessment, Volume 1, Process, Methods and Potential, Blackwell Science, London Demidova, O and A Cherp (2005), “Risk assessment for improved treatment of health considerations in EIA” Environmental Impact Assessment Review 2(4), page 411-429. Canter, L. W (1993) “Pragmatic Suggestions of Incorporating Risk Assessment Principles in EIA studies”. Environmental Professional, 15(1), Page 125-138.

HIV-infected Patients Malignancies in Abdominal Operations

essay help online HIV-infected Patients Malignancies in Abdominal Operations. Association of preoperative immunological parameters with tumor stage and postoperative sepsis in HIV-infected patients with malignancies undergoing abdominal operations Abstract Purpose Until recently, reports on malignancies in HIV-infected patients undergoing abdominal operations are scarce. Our study was to analyze association of preoperative immunological parameters with tumor stage and postoperative sepsis in HIV-infected patients with malignancies undergoing abdominal operations from a single institution. Methods Data were analyzed for 32 HIV-infected patients with malignancies who underwent abdominal surgery between 2009 and 2013 in a surgical department. Results A total of 32 patients with an average age of 50.6 years (range, 26-74 years) were included, in whom 78% (25/32) presented with non-AIDS defining malignancies (NADMs) that 64% (16/25)) were advanced (III/IV), 47% (15/32) had postoperative sepsis and 3(9.4%) died postoperatively. There are significant differences in preoperative CD4 percent, CD8 count, CD4/CD8 ratio and postoperative sepsis morbidity (p0.05) for patients with CD4 count more than 200 cells/μL in comparison with those with CD4 count less than 200cells/μL.Moreover, CD4 count, CD4 percent and CD4/CD8 ratio have no statistical differences between NADM patients (n=25) with stage I-II and III-IV cancers (P>0.05), but have significant differences between patients (n=32) with and without postoperative sepsis (p<0.05). Conclusions Our study suggests that preoperative immunological parameters including CD4 count, CD4 percent and CD4/CD8 ratio correlate with postoperative sepsis morbidity, but are not associated with TNM stage of NADMs for HIV-infected patients with malignancies undergoing abdominal operations Key words HIV/AIDS; Sepsis; CD4 count; CD4 percent; CD4/CD8 ratio. Introduction Human immunodeficiency virus (HIV) infection and acquired immune deficiency syndrome (AIDS) is a worldwide pandemic. In recent years, the number of HIV-infected patients is progressively increasing. With the introduction of highly active antiretroviral therapy (HAART) in 1996, survival for people infected with HIV and those diagnosed with AIDS has dramatically improved [1-3]. HIV-infected patients with weak immune systems are known to be at increased risk for certain cancers classified as AIDS-defining malignancies (ADMs) including Kaposi’s sarcoma, non-Hodgkin’s lymphoma and invasive cervical cancer. As treatments for HIV/AIDS improve and patients are living longer, the distribution of cancers in this population has undergone a dramatic shift in China. Despite the fact that cases of those AIDS-defining malignancies associated with AIDS progression have decreased, the number of non-AIDS-defining malignancies (NADMs) is on the rise [4-6]. As a result, the demand for surgical treatment in HIV-infected patients with malignant tumor is on the rise. Until recently, several studies have shown that abdominal operations for HIV-infected patients have higher postoperative septic complications and mortality rate[7-10]. However, to our knowledge, no detailed reports focusing on HIV-infected patients with malignancies undergoing abdominal operations have been published. Thus, a better understanding of clinical characteristics of malignant tumors in HIV-infected patients undergoing abdominal operations is needed. The primary objective of this study was to summarize the clinicopathologic factors of patients with malignancies who underwent abdominal operations and to compare the results from shanghai public health clinical center, a designated tertiary care university hospital. Methods This study is a retrospective review of a maintained database from shanghai public health clinical center, a designated tertiary care university hospital for treatment of HIV-infected patients. All malignancy patients with a preoperative diagnosis of HIV infection or acquired immunodeficiency syndrome (AIDS) and without preoperative sepsis undergoing abdominal operations from September 2009 to September 2013 were retrieved and analyzed using the computerized patient record system. Demographic data collected included age, sex, diagnosis, tumor stage, laboratory variables, length of hospital stay, postoperative sepsis morbidity and mortality. All patients took routine laboratory examinations before surgery and underwent a detailed evaluation including age, peripheral blood cells including preoperative white blood cell count, hemoglobin and platelet count, albumin levels, preoperative immunological parameters including CD4 count, CD4 percent, CD8 count, CD4/CD8 ratio, TNM stage of NADMs and length of hospital stay. Patients whose preoperative CD4 counts<350cells/μl started highly active anti-retrovirus therapy (HAART) and for those patients whose preoperative CD4 counts≤200cells/μl, the antibiotic and antifungal medications were started preoperatively to prophylaxis against pneumocystis carinii pneumonia (PCP) and fungal infection[11]. Postoperative sepsis was diagnosed as systemic inflammatory response syndrome (SIRS) plus infection according to 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definition[12]. Statistical analysis All the data were analyzed by SPSS 16.0 statistical software (SPSS Inc., Chicago, IL). Results of all continuous data with normal distribution were presented as mean and standard deviation (SD) while continuous variables not normally distributed were presented as median and interquartile range (IQR). The Shapiro–Wilk test was used to test the normality of the data distribution. The Mann–Whitney U test or Student t test when appropriate were used to analyze differences in continuous variables. Fisher’s exact test was used to compare categorical variables. A receiver operating characteristics (ROC) curve was also generated and the area under the curve (AUC) was calculated to evaluate the discriminatory ability of preoperative immunological parameters. All tests were 2-sided. P<0.05 indicates statistical significance. Results A total of 32 HIV-infected patients with malignancies confirmed by pathology and without preoperative sepsis undergoing abdominal operations were enrolled in this study. None of the patients with malignancies diagnosed during the study period reported previous histories of malignant tumors. The average age was 50.6 years (range 26–74 years), with a male predominance (male:female ratio,29:3). There were seven AIDS-defining malignancies (22%, 7/32) including 2 hepatic lymphoma, 1 hepatosplenic lymphoma, 1 gastric lymphoma and 3 peritoneal burkitt lymphoma, and 25 patients with non-AIDS defining malignancies (78%, 25/32) including 9 colorectal carcinoma, 3 hepatic carcinoma, 8 gastric carcinoma, 1 esophageal carcinoma, 1 cholangiocarcinoma, 1 primary retroperitoneal tumor, 1 renal carcinoma and 1 gallbladder cancer. Most non-AIDS-defining-malignancy (NADM) (64%, 16/25) patients had stage III-IV cancers before surgery, and less manifested with stage I-II malignancies(36%,9/25). TNM stage classification is according to the latest American Joint Committee on Cancer (AJCC) staging manual. Post-operative sepsis occurred in 47% (15/32) of patients who underwent abdominal surgical procedures along with three deaths (9.4%,3/32)(one following resection of an esophageal cancer, another after total colectomy and right nephrotomy and ureterectomy in a patient with colon cancer and ureteral carcinoma, and a third after local resection of a late hepatic lymphoma). Sepsis was caused by polymicrobial infections (e.g. E.coli, Enterococcus, streptococcus pneumoniae, anaerobic bacteria and Candida albicans).The median length of hospital stay was 21 days. (Table 1). Compared with patients with preoperative CD4 count less than 200cells/μL, there are significant differences in preoperative variables including CD4 percent, CD8 count, CD4/CD8 ratio and postoperative sepsis morbidity for patients with preoperative CD4 count more than 200 cells/μL (p0.05) (Table 2). Furthermore, there were no significant differences in the age, preoperative immunological variables including CD4 count, CD4 percent,CD8 count and CD4/CD8 ratio, other parameters including white blood cells, hemoglobin, platelet, albumin and length of hospital stay between NADM patients (n=25) with stage I-II and III-IV cancers.(P >0.05) (Table 3). In addition, comparison of clinical data between patients with and without postoperative sepsis was shown in Table 4. When assessing malignancy patients with postoperative sepsis vs those without postoperative sepsis, there were no significant differences in age, the preoperative CD8 count, white blood cell count, hemoglobin, platelet count, albumin levels and length of hospital stay(P>0.05). However, the preoperative CD4 count, CD4 percent and CD4/CD8 ratio were dramatically lower in the patients with postoperative sepsis (P<0.05) (Table 4). Finally, the relationship between the specificity and the sensitivity of preoperative CD4 count, CD4 percent and CD4/CD8 ratio measurement for the detection of postoperative sepsis is represented by a receiver operating characteristic (ROC) curve (Figure 7D). The area under the ROC curve (AUC) was 0.777 for CD4 count, 0.746 for CD4 percent and 0.721 for CD4/CD8 ratio.(Figure 1 and Table 5). Discussion To the best of our knowledge, reports on malignancies in HIV-infected patients undergoing abdominal operations are scarce. The incidence of NADMs has increased, while the relative frequency of ADMs has decreased due to introduction of highly antiretroviral therapy in 1996[4-6]. In this study, non-AIDS-defining malignancies made up 78% of all cancers diagnosed, in which the colorectal, gastric and hepatic cancers are the most common, however, the cancer incidence cannot be determined from our study. In previously published reports of HIV-infected patients with colon cancer, hepatic cancer or lung cancer, median ages are relatively low, malignancies are more aggressive, stage of tumor at presentation is late and thus survival is short[13-19]. Data from our study also suggest that a younger patient age (mean age, 50.6 years) at the time of malignant tumor diagnosis can be expected in patients with HIV infection. Moreover, most malignancies were detected at an advanced stage III-IV. Hence, it is important for regular cancer screening to take place and perhaps screening for malignant tumor should begin in a relatively younger population with HIV infection in order to detect cancer in its earliest stages, increase the curative resection rate of tumor and improve prognosis. Clinically, HIV-infected patients with CD4 count less than 200cells/μL were generally diagnosed as AIDS and have been shown that have increased complications undergoing surgery[7-10]. Considering our limited patients included, we therefore tried to compare clinical data according to the preoperative CD4 count with a breakpoint value of 200cells/μL. By comparison, statistically significant differences in the preoperative CD4 percent, CD8 count and CD4/CD8 ratio were observed, which is easily explained by the fact that there are positive correlations among all the above immunological markers used to monitor the progression of HIV infection demonstrated by the earlier study [20-22]. Previous studies have demonstrated that the degree of immune suppression is correlated directly with the risk of the ADMs including Kaposi sarcoma and non-Hodgkin lymphoma, where the risk increases with declining CD4 cell count [23-25]. However, relationship between the degree of immune deficiency and the risk of the NADMs is controversial [23,26-29]. To date, it seems that there are currently no data available to shed light on the effect of immune status on the development and progression of NADMs in HIV-positive patients. It is well-known that the CD4 count, CD4 percent, CD8 count or CD4/CD8 ratio is a key measure of the health of the immune system for HIV-infected patients. The lower the number, the greater damage HIV has done[20]. Surprisingly, by comparison, we do not find difference in HIV-infected patients with TNM stage I-II and III-IV of NADMs according to preoperative CD4 count stratification. Furthermore, there are also no significant differences in preoperative immunological variables including CD4 count, CD4 percent, CD8 percent and CD4/CD8 ratio between patients with stage I-II and III-IV NADMs, suggesting that immunological parameters are not associated with tumor stage Although immune deficiency would impair the ability of the host to limit expansion of tumoral cells, immunosuppression did not appear to correlate with tumor grade and stage demonstrated by a former published report on HIV–associated adenocarcinoma of the colon[15]. Based on these results, we believe that the host immune status is possibly not major factors to impact on tumor development and progression in HIV-patients with NADMs, which deserves to be further studied in the future. In agreement with previous clinical studies, this study has shown that overall postoperative sepsis morbidity was 47% (15/32) and mortality 9.4% (3/32)[7-10]. We also demonstrated that lower preoperative CD4 counts <200cells/μL is associated with an increased risk of sepsis morbidity, which is consistent with prior literature suggesting an association between severity of immune status and risk of septic complications after abdominal surgery[7-10]. However, advantage of this study is that our object used for comparison has a better consistency in that all our patients with malignancy are under semi-elective open abdominal surgery and type of procedure is similar. Of note, in addition, the statistical analysis in this study demonstrated that the preoperative CD4 percent and CD4/CD8 ratio were also dramatically lower in the patients with postoperative sepsis besides CD4 count, suggesting they may also correlate with postoperative sepsis. Moreover, the AUC analysis has shown that the preoperative CD4 count was slightly superior to CD4 percent and CD4/CD8 ratio in terms of predictive accuracy. To our knowledge, this study may be the first to show CD4 percent is associated with postoperative sepsis morbidity. On the other hand, our data also suggest that preoperative CD4 count is slightly superior to CD4 percent, and CD4 percent is a little better than CD4/CD8 ratio for the prediction of postoperative sepsis in malignancy patients with HIV infection or AIDS. Our study does have several limitations. First, this study is a retrospective, single-centre study. Second, HIV viral load also as a marker of immune status for HIV-infected patients was not routinely taken preoperatively because of the limited hospital expenses. Third, we cannot obtain the exact duration of HIV infection and survival time of every patient in our study. Finally, only 32 HIV-infected patients with malignancies were studied, which is possibly not enough to draw a definite conclusion. Therefore, further large studies are needed to validate our findings. CONCLUSIONS Our results suggest that preoperative immunological parameters including CD4 count, CD4 percent and CD4/CD8 ratio correlate with postoperative sepsis morbidity, but are not associated with TNM stage of NADMs for HIV-infected patients with malignancies undergoing abdominal operations HIV-infected Patients Malignancies in Abdominal Operations

Social Work homework help

Social Work homework help. Ensure to follow ALL directions, no plagiarsm, and complete by the 25th at noon EST. There are two midterms. They are as follows:HIS 321 Midterm:Taking examinations is a skill that requires careful attention. There are generally three elements in developing a good essay answer: understanding the question, planning the answer, and then developing a thorough response. In planning the answer, you should prepare an outline or a list of points for discussion in a logical fashion. Be sure that the points are sufficient to answer the question. The essay should begin with a topic sentence that restates the question in declarative form. You should provide supportive information with specific detail to illustrate your points. References to readings and notes are always helpful. The essay should end by drawing appropriate conclusions. Please be sure to reread and recheck your essay for clarity, construction, errors, and to be sure that the answer makes a clear statement. You should properly cite all your sources, including textbooks and any other sources you use to develop your answer.You are required to answer all four (4) questions. Your answers should be about 500 words in length.What set the Puritans (who arrived in America in 1630) apart from other early English colonists? During the first century of settlement they faced many challenges. Discuss these challenges and the Puritans? responses to them.In 17th century North America the French, Spanish, Dutch, and English all jockeyed to obtain a share in the New World while the Native Americans fought to hang to what had once been theirs alone. The Africans became unwilling participants in this international contest. What were some of the long-term effects of the cross-cultural exchanges among these groups? Discuss both specific benefits and negative aspects in detail, illustrating your answer with examples from your reading.If you were a well-to-do 17th century European or Englishman looking to make a financial investment in the American colonies, would you choose to put your money in the New England area or the Chesapeake? How did the two areas differ in terms of family structure, work, class, religion, and state building? What impact would these things have on your decision to invest and why?In 1719 Daniel Defoe published his novel Robinson Crusoe. Set in 1651, the hero explains his circumstances:Being the third son of the family and not bred to any trade, my head began to be filled very early with rambling thoughts. My father, who was very ancient, had given me a competent share of learning, as far as house-education and a country free school generally go, and designed me for the law; but I would be satisfied with nothing but going to sea?.My father, a wise and grave man, gave me serious and excellent counsel against what he foresaw was my design. He called me one morning into his chamber, where he was confined by the gout, and expostulated very warmly with me upon this subject. He asked me what reasons, more than a mere wandering inclination, I had for leaving father?s house and my native country?. He told me it was men of desperate fortunes on one hand, or of aspiring, superior fortunes on the other, who went abroad upon adventures, to rise by enterprise, and make themselves famous in undertakings?.Life and Adventures of Robinson Crusoe by Daniel Defoe Philadelphia: Porter & Coates, 1870. Digital E Book on Goggle BooksIf colonial America differed from England because it offered greater opportunities to both those of ?desperate fortunes? or ?superior fortunes?, the degree to which one could take advantage of these opportunities depended upon gender, race, ethnicity, and religion. Consider the ways in which three of these factors enabled some people to enjoy the promise of Colonial America more fully than others.HIS 322 midterm:Identify and explain the provocative events, laws, and actions that resulted in rebellion, revolution, and war.Describe the military strategies, forces, and support networks that allowed the United States to defeat the British.Explain the concepts of diversity and inclusion in the context of a global society.You must answer all fiveÿ(5) questions below.Compare the social and political climate in England in the 1760s with the colonies. How did immigrants from outside England affect theÿsociopoliticalÿconditions of the colonies? Were there significant differences in the colonies between the coastal cities and theÿbackcountry?Summarize and explain the decisions made in the British House of Commons regarding their debts following the French and Indian War and why these decisions were challenged by the colonists. How could Britain have avoided these economic problems? How could Britain have better managed the political fallout in North America? Why was the response so different in Canada?Explain the actions of the colonists in the 1760s and 1770s and the responses by the British government that led to the political break and the Declaration of Independence. How did the colonists protest these actions? Were the grievances of the colonists legitimate?Analyze the Declaration of Independence. What were the main arguments for independence? How did the United States live up to these ideals in 1776 and how did it fall short? Did the Declaration of Independence mark a completely new philosophy in government in North America, or was it more of a fulfillment of ideas of the English constitution?How did American troops fight the Revolutionary War? How did the tactics differ from the British? How was the American army ultimately able to fend off the more numerous, better-trained British army and its adjuncts?When responding to the essay questions, keep in mind that they are essays and not short-answer questions. Essays should be detailed and have resources to support factually based comments. Your answer must state your hypothesis and be supported with detailed information, including dates, specific examples, and material from the readings. The conclusion should follow logically from the information you have presented.Any quotations, specific information, and ideas drawn from your reading (including the textbook) must be cited and referenced inÿAPAÿ(or Chicago/Turabian) format.Each essay should be a minimum ofÿtwo pages (500 words) in length, not including references. Be sure to check your writing for spelling and grammar.Social Work homework help

University Of Texas Rio Grande Valley Qualified Nurse Practitioners Discussion

University Of Texas Rio Grande Valley Qualified Nurse Practitioners Discussion.

I’m working on a nursing discussion question and need a reference to help me learn.

main discussion same rulesWhat are the various practice options available to the NPs in your state?Discuss your practice preference and reasons for choosing it.reponse one. richardWhat are the various practice options available to the NPs in your state? There are multiple practice settings for nurse practitioners in Texas. You can have your own proprietorship, work in a hospital, work in a nursing home, work in a hospital, working in ER, work in urgent care, retail health, teach at a university, teach at a community college, work for the government, work as a private entrepreneur.There are four options a business structure in practice. Sole proprietorship, partnership, limited liability company (LLC), and corporation (Buppert, 2018).Discuss your practice preference and reasons for choosing it. I prefer to have a private practice but have to continue with a cooperation while building my practice. My success and your success are closely related to factors that can be researched prior to opening a business. You must find a need for the services in the community, interest in the services to be provided, size of the potential patient pool in the community, willingness of the community to use the services of an NP and of third-party payers to reimburse NPs for services. If there are issues consider a cash business (Buppert, 2018). As you plan your future practice, ask yourself:What do you services will I offer?How will you market the services?Who will purchase the services?Where will the business be located?How big will the practice be?How will the practice’s activities, policies, and procedures be organized?How will expenses be covered?What are the potential problems with the business?How will those problems be dealt with?What start-up money is needed, if any?What form will start-up funds take: equity or debt?How will start-up costs be repaid?Often used to convince investors to invest or lenders to lend money to get the business started, a business plan is also an exercise that forces someone who is considering starting a business to research its feasibility and organize a plan for carrying out the business goals.After all of this consideration you will want to write a business plan. This is a 25-to-40-page plan and is used to add a small startup loan or find investors. Consultants who help medically minded NPs can cost thousands of dollars. Some NPs who have started practices have enlisted students in graduate business programs to create business plans for them as part of a class project.Nurse Practitioners are ideally positioned to be transformational leaders. As we work our way around to present health care systems in the united states we need to step up and guide others through inspiration, strength of vision, and motivating groups of people to work toward common goals (McCafferty & Reinoso, 2017)Buppert, C. (2018). Nurse practitioner’s business practice and legal guide. Jones & Bartlett Learning.McCafferty , R., & Reinoso, H. (2017). Transformational leadership: A model for advanced practice holistic nurses. https://journals.sagepub.com/doi/full/10.1177/0898010116685242. https://pubmed.ncbi.nlm.nih.gov/30208775/.reponse two. 1. What are the various practice options available to the NPs in your state? -Fortunately, for Nurse Practitioners there are many practice settings and options available. Settings such as outpatient clinics,hospitals,schools, telehealth, community centers, retail clinics as well as self employment are all options. More and more NP’s are going into their own practice/business and this can come with its own pros and cons. The types of practice depends on speciality, but can include: primary care, pediatrics, travel medicine, cosmetic/medspa,home health visits and nursing homes to name a few. There are barriers that can occur depending on what state you live in. For example, living in Texas you would need to have a colloborating physician onboard and this can be costly as well as difficult to find. Also, getting on certain commercial insurance plans can be a roadblock too as taking insurance is critical to improve accesibility to patients. There are also many overhead costs that are required when you have your own business and those costs need to be accounted before making this decision. Althogh, there are many options as far as praticing in Texas goes for NP’s each one should be carefully thought out as it is a longterm decision. 2. Discuss your practice preference and reasons for choosing it- My practice preference would be to not be in business by myself. I know there are many advantages to this, but with so many practice options in various settings I don’t think taking on the burden is necessary. Ideally, I would like to practice as a PMHNP in the telehealth space and or outpatient practice. A statistic that I came across regarding telepsychiatry was astonishing. The field of global Telepsychiatry Market accounted for $5.82 billion in 2019 and is expected to reach $30.34 billion by 2027. This is a large number and keeps growing. The pandemic has also played a factor in this and I believe this is where the future for psychiatry is. Down the road, I would not mind being in a leadership role or having some kind of investment in an innovative telepsych company. That is my preference and am hoping with telepsychiaty I will be able to reach so many more patients than I could in a traditional setting. Buppert, C. (2018). Nurse practitioner’s business practice and legal guide. Jones & Bartlett Learning.Research and Markets. (2020). Global Telepsychiatry. https://www.globenewswire.com/news-release/2020/10/23/2113443/0/en/Global-30-34-Billion-Telepsychiatry-Market-Outlook-to-2027.html#:~:text=Global%20Telepsychiatry%20Market%20accounted%20for,22.9%
University Of Texas Rio Grande Valley Qualified Nurse Practitioners Discussion

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