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Complex Adaptive Systems in Healthcare

Share this: Facebook Twitter Reddit LinkedIn WhatsApp Kathryn Moultrie Clinical Microsystem According to Freshman, 2010, et al p. 19-20, complex high delivery healthcare delivery systems are the intricate framework of “relationships” (groups), within an organization that provides health care in our complex society and environment. These relationships should represent the multiple interactions with roles of each member. The line between those within the system, and those outside systems should remain clear; every system has ways of including and excluding elements. The coalitions (partnerships) formed are a necessity, the boundaries must remain open as to not isolate any member. Communication between members is the rules that keep the group stable, as well as information exchange with positive feedback, which in turn makes the outcomes of the groups as a whole effective. A clinical microsystem is the combination of a small group of people who work together in a definite setting on a regular base or need to provide care and the individuals who receive that care, are recognized as a member of the group to (Freshman, 2010, et al p. 19-20, 21-23 and Complex Adaptive Systems in Healthcare, Video (n. d.). The system (at work), that I would like to better understand are the aspects of the “system”, of our Patient Aligned Care Team (PACT) which consist of 5-6 individuals including a Travel Nurse coordinator (TVC). Systems in general, according to Freshman 2010, et al p. 20-23, are made up of groups of individuals (“well-oiled machines”); however in healthcare some systems (like ours) are often excluding, isolating, lack of knowledge and obscure to their users who are the Veteran/patients, physician nurses, and staff, essential elements of a microsystem. Our organizations constructed clinical microsystems, involves the Veteran/Patient, Aligned Care Team (PACT), the PCP, Nurse, and Travel Nurse Coordinator (TVC). This system designed for providing clinical care (while the Veteran is traveling) that is based on theories of patients’ knowledge organizational development, leadership and quality improvement in the paradigm of continuum of care (Freshman 2010, et al p. 20-23 and Mack 2017 Nu 414 Interprofessional Teams Discussion Board posts p. 1). Part 2 Sociogram A sociogram is a graphic representation which serves to reveal and analyses the relationships within the group and the environment of health and education services, however I found it difficult to draw a sociogram, for mapping the emotional/ functional dynamics of this group/unit, instead I have instead discussed the aspect of the system to understand better. The “system”, of our Patient Aligned Care Team (PACT), (related to care of the Veterans while traveling), which includes patient/family, PCP, TVC (RN), nurse (PACT), social worker (PACT), or others. The primary objective, as a group is the ability of these individual to communicate and collaborate effectively and to ensure that no elements are excluded so that the line between those within the system and outside of the system is clear to all. The open boundaries include closed boundaries’ isolate. Information exchange increases knowledge, and would have a positive outcome of the group as a whole (Freshman 2010, et al p. 20-23 and Mack 2017 Nu 414 Interprofessional Teams Discussion Board posts p. 1). Part 3: The Complexity of the Work of the Registered Nurse in Practice. The complexity of the work of the Registered Nurse (RN), in practice, is the freedom to make clinical judgement choices and actions relevant to their clinical practice. This often also involves, other work activities related to the daily functioning of the nurses individual unit as well as other parts of the unit or hospital or even interdisciplinary team. The registered nurse must be skillful in a given moment to evaluate the situation; this is referred to “trade-off decisions”. Making a “trade-off” decisions, involves the critical evaluation of a given situation, the interpretation of patient’s information, and to then to make critical decisions about the needed actions (Ebright, P., 2010 and Cook, R.,
Strategic Plan Presentation Essay. Paper Details:I HAVE ATTACHED ALL ASSIGNMENTS FROM PREVIOUS WEEKS FOR THIS, AS WELL AS THE GRADING RUBRIC Now that you have completed your review of the Stevens District Hospital Strategic Planning Scenario, you have been asked to provide a presentation to the governing board of the hospital. This board is comprised of the president of the hospital, four business leaders from the community, and three leaders of the medical staff. Create a 10- to 12-slide (title and reference slides do not count) Microsoft® PowerPoint® presentation that summarizes your analysis and goals created. Your presentation should: Provide an overview of the market. State the mission and vision for Stevens District Hospital. Provide the SWOT analysis. Summarize the goals created for Stevens District Hospital. Explain the rationale for goals created. Describe itemized resources that may be needed. Explain how the strategic plan provides focus and direction for Stevens District Hospital. Format your assignment according to APA guidelines. Include a title page, detailed speaker notes, and a reference page. If you use resources outside of the information provided in the assignment, be sure to cite your references using correct APA formatting. Submit your assignment in a Microsoft PowerPoint presentation. The grading criteria requires an introduction and a conclusion. Can you please add itStrategic Plan Presentation Essay
Table of Contents Introduction The Legacy of Fela Kuti Afrobeat and Its Influences Conclusion Works Cited Introduction Fela Kuti is a Nigerian musician, composer, and multi-instrumentalist also known as the pioneer of the Afrobeat genre back in the 1950s-1980s. Kuti’s contribution to African music is often compared to Bob Marley’s contribution to reggae: they were both spiritual leaders, visionaries, and prophets of their genre. Kuti created the Afrobeat sound that has not only made it to the 21st century but also helped to develop all contemporary forms of Black music, from funk to electronic. Not only was he prolific with a discography of more than 60 albums but also an ardent political activist who was fighting against political corruption. For his political and social activism, Fela Kuti even received the informal title of “Black president” in his home country. “Fela Kuti: Music is the Weapon” is an essential documentary for anyone who would like to understand the musician’s life, vision, and legacy. Shot in Lagos, Nigeria, at the peak of Kuti’s career, the film contains a series of heartfelt, sincere, and courageous interviews with the pioneer of the Afrobeat genre. This paper reviews the documentary and explains Fela Kuti’s contribution in the context of diverse traditional African music. The Legacy of Fela Kuti Since the 1980s, Fela Kuti has served as an inspiration for several films and even a Broadway play. However, nothing provides an experience as raw, arresting, and intimate as music Is the Weapon shot by two French directors Jean-Jacques Flori and Stéphane Tchalgadjieff in 1982. Not only did they have a chance to be with the musician instead of exploring his life retrospectively: they accompanied him during one of the most essential and formative experiences of his life. In the late 1960s, Kuti visited Los Angeles, where he found congenial activists and became radicalized by the American Black Power movement (Ogbar 87). That was when his political views crystallized: he believed in the importance of fighting European imperialism and reviving African artistic and religious traditions (Ajayi 46). Shortly after his return to Lagos, Kuti founded a commune and a political party with a promise to become the next Nigerian president (Drewett 196). The musician never made good on that pledge; in actuality, he spent years persecuted and having confrontations with the authorities. The question arises as to what in Kuti’s upbringing and background compelled him to express himself through music and political work. The musician was born into an influential family where both of his parents were politically and socially opinionated. His father was a school headmaster and Protestant minister, and his mother was at the forefront of the fight for women’s rights in Africa (Collins 100). Initially, Kuti was sent to London to study medicine like his brother, but his love for music prevailed. Soon the musician enrolled in the Trinity College of Music, where the trumpet was his preferred instrument (Collins 152). In the years to follow, Kuti returned to West Africa, lived in Ghana and Nigeria, and invented a new musical direction that he called afrobeat. Music Is the Weapon showcases the contrasts that are integral to the city of Lagos. The documentary pays a lot of attention to the urban spaces and shows the dangers of the country’s largest city. It is unsafe, brutal, and violent; it also never sleeps and never lets one let down their guards. The Shrine, a music club where Kuti was performing, is an oasis among this chaos. It is a safe place where people can connect and bond over music. Afrobeat gives them much-needed relief from the daily hassle. What music Is the Weapon succeeds in demonstrating is that Kuti’s political and music identities were not separate: they were connected and interlocked. In the documentary, he ponders the role of the musician in the world: “See because when the higher forces give you the gift of music, musicianship, it must be well used for the good of humanity (“‘Music Is the Weapon’: The Must-See Fela Kuti Documentary from 1982”).” Kuti sees his talent as something that needs to be handled with care and used not only to make a profit: “If you use it for your own self by deceiving people… you will die young, you see (Onyebadi 129).” Music Is the Weapon is an attempt to show his influence and send a message of human dignity and potential. Afrobeat and Its Influences Today, it is believed that afrobeat has stylistic origins in fuji music and highlife with American funk and jazz influences. Some of its defining characteristics include the focus on chanted vocals, complex intersecting rhythms, and percussion (Agawu 98). One may wonder what exactly made afrobeat so beloved by Black communities all over the world and turned Kuti into the prophet of African music. Afrobeat was indeed a novel genre back in the 1960s; however, it had deep roots in centuries-old African music traditions. One of the instruments that impacted the formation of the new musical direction is the mbira. Get your 100% original paper on any topic done in as little as 3 hours Learn More The standard English name for the instrument is the thumb piano because it is played with thumbs and one finger. Mbira takes origin in Zimbabwe, a small South African country with a culturally diverse population (Chikowero 65). From a technical standpoint, the mbira is similar to a Western music box, as the musician produces sound by plucking flat metal strips of various lengths (Miller and Shahriari 354). However, the Zimbabwean instrument is not a literal equivalent of a music box – on the contrary, it has its own technical peculiarities. For instance, the performers often attach small seashells, pieces of metal, or even plastic bottle caps to the resonator of their instrument (Miller and Shahriari 355). This modification allows them to produce a characteristic buzzing timbre that signifies Zimbabwean mbira and sets it apart. As a result, the sounds of mbira are unique and captivating: they are bell-like, repetitive, rattling, buzzing, and mesmerizing. Because of its effect and importance, the mbira is widely used for worship and traditional rituals. The full name of the instrument is mbira dzavadzimu, which stands for “mbira of the ancestors.” Another instrument that has great importance for modern African music is kinda, a large, heavy log xylophone with between 17 to 22 bars. The wooden bars are rested on banana tree trunks that are orthogonal to the ground for stability during performances. Akadinda is a large instrument: with its length up to seven meters, it can allow four people to play it at once. Sometimes ensembles composed of several akadindas are used: each of them has its own pitch, and together they make a harmonic sound. While many cultures of sub-Saharan Africa use xylophones of similar design, Ugandan akadindas are different from those, because they often have hollow dips in the centers of their bars (Millar and Shahriari 359). As with mbira, this peculiar construction serves to provide a specific timbre: when a performer strikes the center of a bar, the sound becomes a hollower (Miller and Shahriari 359). Another similarity to mbira is that akadinda is used in religious rituals, and playing it is seen as a way to reconnect with long-gone ancestors. These two examples suffice to demonstrate that Fela Kuti’s musical career did not happen in a vacuum, but developed in a rich and multi-faceted musical culture of his home continent. Apart from having a multitude of African instruments and musical traditions to draw inspiration from, Fela Kuti’s approach to music is also profoundly African in a philosophical sense. The philosophy of afrobeat praises and appreciates indigenous African traditions, which, for instance, manifest in the beliefs about mbira and akadinda. This connection makes Fela Kuti not an isolated figure, but a true successor of the long history of African music and spiritual traditions that surround it. Conclusion Africa has a thousand-year-long musical tradition that started becoming political in the mid-20th century. At the forefront of the new African music and political activism was Fela Kuti, the younger son of a Protestant minister and a feminist. For Fela Kuti, music and political activism were inseparable: he saw his musical gift as a weapon that he could use when fighting for the good of the pan-African nation. Kuti was strongly pro-Black and saw European colonialism as the enemy to be defeated for the prosperity of the continent. His musical legacy lives to this day due to its versatility, novelty, and at the same time, loyalty to African traditions. Works Cited Agawu, Kofi. The African Imagination in Music. Oxford University Press, 2016. Ajayi, Temitope Michael. “’Identity and Ideological Representation in Selected Fela Anikulapo-Kuti’s Songs’’.” Journal of West African Languages, vol. 44, 2017, pp. 44-54. Chikowero, Mhoze. African Music, Power, and Being in Colonial Zimbabwe. Indiana University Press, 2015. We will write a custom Essay on Fela Kuti: Music Is the Weapon specifically for you! Get your first paper with 15% OFF Learn More Collins, John. Fela: kalakuta notes. Wesleyan University Press, 2015. Drewett, Michael. “REVIEW| Fela: Kalakuta Notes.” [email protected] Journal, vol. 6, no. 2, 2016, pp. 196-197. Fela Kuti: Music Is the Weapon. Directed by Jean Jacques Flori and Stéphane Tchalgadjieff, 1982. Miller, Terry E., and Andrew Shahriari. World Music: A Global Journey. 4th ed. Routledge, 2016. ‘Music Is the Weapon’: The Must-See Fela Kuti Documentary from 1982. 2015, Web. Ogbar, Jeffrey OG. Black Power: Radical Politics and African American Identity. Johns Hopkins University Press, 2019. Onyebadi, Uche. “Political Messages in African Music: Assessing Fela Anikulapo-Kuti, Lucky Dube and Alpha Blondy.” Humanities, vol. 7, no. 4, 2018, p. 129.
Strayer University W7 Rights of Citizens & Security Guard Summary.

I’m working on a international law report and need an explanation to help me study.

Week 7 Assignment 2 – The Rights of CitizensOverviewIt is important to understand your responsibilities as a criminal justice professional when engaging with citizens. This assignment is broken into three parts and you must complete each part of the assignment.Each part includes a text or video scenario to which you will respond by writing a 1–2 page paper for each scenario that examines specific information regarding the events using your knowledge of the United States Constitution.InstructionsPart 1: Law Enforcement Officer Arrives at the Scene ScenarioAn 18-year-old high school student walks to class carrying a backpack. He is stopped by the school security guard and his backpack is searched. A loaded handgun is discovered. The school security guard takes the student to the principal’s office. The principal calls the local police. In the state where the school is located, it is illegal to carry a concealed weapon without a permit and all weapons are prohibited on campus.Officer Smith arrives at the school approximately 10 minutes later. Officer Smith takes a statement from the school security guard and searches the student’s backpack. He seizes the gun and places the student under arrest. Officer Smith then asks the student if he would like to make a statement to explain why he was carrying a concealed weapon on campus.The student replies, “What weapon? That’s not my backpack and I never saw that gun before.”The student is then transported to the local jail. However, on the way to the local jail, Officer Smith asks the student again why he brought a loaded gun on campus. The student admits that it was his gun and stated that he needed it for protection. Upon arrival at the local jail, the student is booked. Six hours later, the student is interviewed by a Detective Columbo. The detective reads the student his Miranda warning and asks the student if he would like to make a statement.The student replies, “No, I want a lawyer.”Write a 1–2 page paper in which you:Examine the constitutional amendment or amendments that would relate to this situation.Outline the appropriate procedures you would need to follow to comply with the associated amendments to ensure admissibility of evidence.Evaluate the officer’s actions and determine whether his search, the student’s confession, and the weapon discovery were lawful and/or admissible. Provide a rationale for your opinion.Use at least two sources to support your writing. Choose sources that are credible, relevant, and appropriate. Cite each source listed on your source page at least one time within your assignment. For help with research, writing, and citation, access the library or review library guides.Consider using Cornell Law’s LII U.S. Constitution Web page. Note: Wikipedia and similar websites do not qualify as academic resources.Part 2: Arrest and Trial ScenarioTyler, a well-known escort service provider in his community, is suspected of the murder of an escort who worked for him. The local police meet Tyler at the airport when he arrives from a trip to Cancun. He is arrested for his suspected connection to the murder of the escort. The police do not inform Tyler of his right to remain silent or his right to counsel. They immediately begin to interrogate him. They continue to question him until he admits that he knew the prostitute and that she worked for him. He also admits that he was with her the night of the alleged murder. Tyler is transported to the local jail and booked. The prosecutor files charges of first degree murder against Tyler. Tyler does not waive his rights to a speedy trial. He asks that an attorney be appointed and demands a trial by jury.Write a 1–2 page paper in which you:Examine the constitutional amendment or amendments that would relate to this situation.Identify and discuss four elements of arrest.Describe the appropriate procedures to comply with Tyler’s rights to due process.Examine any consequences that might occur if his right to due process is violated.Use at least two sources to support your writing. Choose sources that are credible, relevant, and appropriate. Cite each source listed on your source page at least one time within your assignment. For help with research, writing, and citation, access the library or review library guides.Part 3: Correctional Officers and Rights of InmatesHudson v. McMillian is a U.S. Supreme court case involving the excessive force resulting in a claim of cruel and unusual punishment under the Eighth Amendment. The court’s decision resulted in the five-pronged Hudson test, also known as PANAM:(P)erceived threat by correctional officers;(A)ny and all efforts to de-escalate;(N)eed for the application of force;(A)mount of force that was used and;(M)edical issues, and extent of any injuries, that are used to evaluate cases involving any use of force before trial and after conviction.The test helps the courts determine whether correctional officers’ actions were reasonable, necessary, and conducted in good faith.Watch the video scenario and take notes as you watch: CJ in Practice Constitutional Issue: Deprivation of Inmates’ RightsWrite a 1–2 page paper in which you:Summarize the events of this scenario and the persons involved.Examine the constitutional amendments related to this situation and whether the rights of the inmates in this scenario were violated. Support your opinion.Determine whether the incidents pass the five-pronged Hudson test discussed above.Recommend how the sergeant should respond to the officer’s behavior. Support your response.Use at least two sources to support your writing. Choose sources that are credible, relevant, and appropriate. Cite each source listed on your source page at least one time within your assignment. For help with research, writing, and citation, access the library or review library guides.This course requires the use of Strayer Writing Standards. For assistance and information, please refer to the Strayer Writing Standards link in the left-hand menu of your course. Check with your professor for any additional instructions.The specific course learning outcome associated with this assignment is:Make sound ethical decisions with consideration for legal precedence, supreme court decisions, statutory laws, and constitutional amendments.
Strayer University W7 Rights of Citizens & Security Guard Summary

MGT 560 SEU W9 Walmart and Global Expansion Case Study

MGT 560 SEU W9 Walmart and Global Expansion Case Study.

For this assignment, you will read Walmart’s Global Strategies case study (p. 279) and then respond to the following questions and make decisions based on those questions. What was Walmart’s early global expansion strategy? Was this a good strategy for Walmart? Why or why not?What cultural problems did Walmart face in some of the international markets it entered?Now, assume the role as the Director of Walmart’s global strategic
planning team. You have been tasked to explore the benefits and
challenges of expansion into one of the following regions. Choose one of
the following regions and describe the opportunities and challenges in
that region. Summarize the cultural environment, choose an entry
strategy from the text, and describe how you would implement this entry
strategy. Make sure you are very detailed in your explanation. Regions:Latin AmericaEuropean UnionSoutheast AsiaRussiaMiddle EastYour well-written paper should meet the following requirements: Be 5-6 pages in length, which does not include the title page,
abstract, or required reference page, which are never a part of the
content minimum requirements.Use Saudi Electronic University academic writing standards and APA style guidelines.Support your submission with course material concepts, principles and theories from the textbook and at least two scholarly, peer-reviewed journal articles.Review the grading rubric to see how you will be graded for this assignment.References:“In-Depth Integrative Case Study 2.2: Walmart’s Global Strategies” (p. 279) in International Management: Culture, Strategy, and Behavior Ahsan, M., & van Wyk, J. (2018). Going past entry mode: Examining foreign operation mode changes at the strategic business unit level. Journal of Managerial Issues, 30(1), 28.Jiang, F., Ananthram, S., & Li, J. (2018). Global mindset and entry mode decisions: Moderating roles of managers’ decision-making style and managerial experience. Management International Review, 58(3), 413-447.Luthans, F., & Doh, J. P. (2018) International management: Culture, strategy, and behavior(10th ed.) McGraw-Hill Education, New York, NY ISBN 13: 978-1259705076 ( my textbook )
MGT 560 SEU W9 Walmart and Global Expansion Case Study

Appendicitis and Antibiotics: An Argument Against Appendectomies

write my term paper Share this: Facebook Twitter Reddit LinkedIn WhatsApp Abstract: Appendicitis represents one of the most common causes of abdominal pain with roughly 300,000 cases reported annually totaling 1 million patient days of admission. Since McBurney first successfully completed an appendectomy in 1889 it has been the main stay of treatment for acute appendicitis worldwide. Upon presentation of abdominal symptoms medical providers categorize appendicitis’ as an inflamed intact appendix (uncomplicated), perforated or abscessed (complicated) via assistance from CT and US. Due to the advances in surgical outcomes and techniques, appendectomies continue to be the mainstay of treatment for uncomplicated acute appendicitis and well-formed abscesses despite not requiring urgent surgical care. Non-operative alternatives such as antibiotic therapy for uncomplicated acute appendicitis have been considered by many physicians for years without a systematic conclusion. While recurrence with non-operative alternatives remains an issue, complication rates, hospital stay and overall cost all decrease with use of antibiotic in uncomplicated acute appendicitis. Outline Introduction Definition The appendix is a tube-like pouch coming off of the cecum in the right lower abdomen where the small and large intestines join. The average length of the appendix is approximately 9-10 cm, but the length can vary as much as 2-20 cm. The appendicular artery supplies blood flow to the entire length of the pouch. 1 Historically the appendix was thought to have no function but recently research has shown the role in intestinal immunity. Through the unique shape and position in the abdomen it houses specific microbiota that may serve protective factors against many inflammatory diseases.2 Pathophysiology Appendicitis’ are caused by luminal obstruction of the pouch with etiologies ranging from benign or malignant tumors (1%), foreign bodies (4%), hardened feces (fecalith) (35%), and hyperplasia of lymphoid cells (60%). There is additional evidence to support that genetic, environmental and infectious properties all playing a role in the various etiologies.1 Environmentally, appendicitis’ are more likely to occur during the summer months due to higher levels of air pollution. Further, anatomically, risk factors include appendiceal length of 4-10 cm. The pathophysiology of appendicitis begins with blockage of the lumen which precipitates inflammation and mucus production in the pouch. This inflammation causes an increase in pressure. Further pressure is added as infection develops and bacteria grow and pus forms. Circulation of blood flow is compromised leading to ischemia of the pouch which may progress to necrosis. Necrosis may precipitate perforation and peritonitis.1 Uncomplicated acute appendicitis is defined as acute inflammation of the appendix in the absence of an abscess, phlegmon, free perforation or peritonitis. 3 Epidemiology Acute appendicitis has a life-time risk of 8.6% in men and 6.7% in women and the risk for emergency appendectomy is 12% in men and 23% in women.4 Caucasians are at increased risk in comparison to other ethnicities. Peak in incidence of appendicitis in the 2nd decade of life.5 The rate of diagnosis of appendicitis in females has increased with time possibly due to increased use of CT scans in the last 15 years. Abdominal pain from gynecology etiologies is ruled out via CT scans and females are receiving appropriate diagnosis.6 Appendicitis’ are more common in urban and industrialized areas and less common in more rural areas. This may be in explained by the type of diet in these areas with agrarian rural communities consuming diets rich in high fiber in comparison to low-fiber urban diets.6 Patient Presentation Classic Presentation Pain is the first symptom and is often gradual and poorly localizes to either the epigastric or periumbilical area. Initially the pain is vague, but it may be intense enough to awaken patients from slumber. Pain will migrate to the lower right quadrant while increasing in intensity. 7 As pain migrates, frequently associated symptoms include: nausea, anorexia and unstained vomiting. 7 Patients often feel constipated even after passing a bowel movement.7 Other signs/ symptoms: Guarding: involuntary contraction of abdominal muscles in anticipation of pain elicited by palpation Rebound Tenderness: pain following cessation of prolonged deep palpation to tender area Positive Rovsing’s sign: pain in right lower quadrant when left lower quadrant is deeply palpated Positive psoas sign: pain in right lower quadrant with flexion of the thigh against counterpressure above the knee. Positive obturator sign: pain in right lower quadrant with passive flexion of the right hip and knee with external rotation. Moderate leukocytosis, low-grade fever, malaise, constipation or diarrhea. Patients under the age of 15 are more likely to present with vomiting as their initial symptom, complain of GI/GU symptoms, high-grade fever and URI symptoms. Due to the atypical presentation, these patients are more likely to be misdiagnosed and experience perforation. 7 Elderly typically do not present with the classic presenting symptoms. However, appendicitis accounts for 14% of all acute abdominal complaints amongst the elderly.7 Diagnosis 70% of appendicitis are considered “typical” and can be diagnosed on history, physical exam and evaluation of blood chemistry tests alone. However, in 30% of appendicitis cases the clinical presentation mimics other abdominal or pelvic diseases and are defined as “atypical.” In these atypical cases, imaging modalities are especially important.8 US Ultrasound is historically first line examination for someone presenting with appendicitis symptoms, however, it only has an accuracy between 75% and 95% (sensitivity around 85% and specificity around 90%). With atypical anatomical variations such as pelvic or retrocaval positioning the US is unable to even identify the appendix.8 Diagnosis via ultrasound is made via appendiceal changes or periappendiceal changes. Appendiceal changes include “the identification of the inflamed appendix, which appears as a tubular and a peristaltic structure with a diameter > 6 mm (sensitivity and specificity values of 98% have been reported), a concentric wall stratification and target aspect.” 8 Periappendiceal changes include: thickening of periappendiceal fat tissue because of a marked mesenteric hypertrophy, the presence of periappendiceal fluid collections and peritoneal fluid material, mesenteric lymphadenopathies, phlegmons, abscesses and inflammatory thickening of cecal or ileal walls. 8 The main limitations of US are “represented by the difficulty to recognize normal appendix, the poor experience of operator, obesity, bowel gas, atypical appendicitis and perforation and finally by the pain caused by compression during examination.”8 CT Abdominal CT is the best noninvasive diagnostic tool available due to high levels of both sensitivity and specificity.4 The diagnostic accuracy of CT scans in between 94-100% in determining the site and course of the inflamed appendix. The sensitivity is 82-94% and specificity 91-100%. 8 Alvarado Score to Perform CT While CT is considered the gold standard for diagnosis of appendicitis, concerns for radiation in pediatric populations can be reduced by utilizing the Alvarado score prior to performing CT. 9 Recommendations for CT imaging and patient disposition based on the Alvarado score included: conservative use of CT for scores of 3 or less, surgical consultation prior to CT for scores of 7 or greater, and consideration of CT for equivocal scores of 4 through 6.9 Scoring Features with a total of 10 Migration of pain 1 point Anorexia  1 point Nausea 1 point Tenderness in right lower quadrant 2 points Rebound pain  1 point Elevated temperature 1 point Leukocytosis  2 points Shift of white blood cell count to the left  1 point Appendicitis Inflammatory Response The score is constructed using eight variables: right-lower-quadrant pain, rebound tenderness, muscular defense, WBC count, proportion neutrophils, CRP, body temperature, and vomiting. 10 The Appendicitis Inflammatory Response score improved upon the Alvarado score by including objective measures rather than the subjective synthesis of information from variables with ill-defined diagnostic valve. Further, the Alvarado score was developed using a retrospective study rather than confirming suspicion of the appendicitis which coincides with the utility of the test. 10 In one study, the scoring system was able to successfully identify 73% of the non-appendicitis patients to the low probability group and 67% of the patients with advanced appendicitis to the high-probability group with high accuracy. Only 37% of the patients remained in the indeterminate group. The Appendicitis Inflammatory Response performed more favorably than the Alvarado score.10 Treatment Emergency Department Care Patients suspected of appendicitis should be NPO in preparation of emergent surgery. Historically, patients with acute undifferentiated abdominal pain were not given analgesics due to concern that analgesics would mask the patient’s symptoms and prevent physical exam findings from being as reliable. However, this has not been proven to delay diagnosis or accuracy in diagnosis. Analgesia should be given to patients with clinical judgement.11 Appendectomies Preoperative Antibiotics: A single dose of a second-generation cephalosporin has been shown to reduce the rate of superficial surgical site infections in nonperforated, gangrenous, and perforated appendicitis.12 The timing of administration of antibiotics preoperative has not shown to make a difference in reduction of surgical site infections.12 Postoperative Antibiotics: Perforated appendicitis’ are treated with postoperative antibiotics as a supplement to surgical source control. The length of time of antibiotics given is variable and produces inconsistent results in reduction of superficial surgical site infections. However, due to the operative would class IV status, antibiotics for a minimal length of time are indicated.13 Antibiotic therapy postoperative and preoperative for non-perforated appendicitis did not reduce the rate of surgical site infections, while also increasing the cost of care.13 Laparoscopic Guidelines form the Society of American Gastrointestinal and Endoscopic Surgeons list the indications for laparoscopic appendectomy identical to those for open appendectomy. However, it is contraindicated in patients with significant intra-abdominal adhesions, radiation or immunosuppressive therapy, severe portal hypertension, coagulopathies, and first trimester pregnancy.14 Disadvantages include increased time in OR, operations typically last 20 minutes longer than open surgeries and increased cost.15 Advantages include cosmetic satisfaction, shortened hospital stay and decreased post-op wound infections.15 Complications Risk factors for complications following appendectomies include: increasing age, female sex, rural residence, perforation status, daytime surgery and open surgical technique and surgical time greater than 77 minutes. 16,17 Complications following appendectomy occur in 7% of children.5 Abscess: Intraabdominal abscess is the most common complication of appendectomies. 18 There is no difference in laparoscopic vs open appendectomies in incidence of occurrence.19 Small bowel obstruction: In one retrospective study of 3,000 patients, small bowel obstruction was seen in 1.24% and was surgically treated in 0.68% of all appendectomies. 20 Superficial surgical site infection: Risk factors for superficial surgical site infection include diabetes, incisional length >7 cm, fecal contamination and operative time >75 minutes.21 Mortality: In one retrospective study in Sweden examining case fatality rates in 9 years showed 2.44 deaths per 1,000 appendectomies. The study had an excess rate of death for patients with nonperforated appendicitis and nonsurgical abdominal pain suggesting that the deaths may partly be caused by the surgical trauma.22 Negative Appendectomies: Currently 15-25% of all presumed appendicitis result in negative appendectomies. These unnecessary surgeries result in the same complications listed above and coincide with non-perforated complications of appendectomies.8 Further, there is evidence that there is a greater risk of abdominal adhesions in patients with healthy appendices compared to that of acute appendicitis. 8 Antibiotic Alternatives Despite appendectomies being the mainstay of treatment since the introduction of the surgical procedure in the 1880’s, in 1959 Coldrey studied nearly 500 patients treated with just antibiotics for appendicitis and proved low morbidity and mortality rates.23 Recurrence Rates: Readmission Rates: Cost Savings Short duration of therapy: Minimal sick leave: Health Care Dollar Savings: Special Patient Populations: Resource limited areas Contraindications to surgery Conclusions/ Recommendations Increased use of CT scan for confirmation of diagnosis. Antibiotic use for uncomplicated appendicitis Patient should be involved in the decision-making process of treatment Operation: potential complications, cost, time off work Antibiotics: fear of impending recurrence, antibiotic side effects References Schreiber ML. Acute Appendicitis: Classic Considerations with Cautions. MEDSURG Nursing. 2018;27(6):394-396. Girard-Madoux MJH, Gomez de Agüero M, Ganal-Vonarburg SC, et al. The immunological functions of the Appendix: An example of redundancy? Seminars in Immunology. 2018;36:31-44. doi:10.1016/j.smim.2018.02.005. Rocha LL, Rossi FMB, Pessoa CMS, Campos FND, Pires CEF, Steinman M. Antibiotics alone versus appendectomy to treat uncomplicated acute appendicitis in adults: What do meta-analyses say? World J Emerg Surg. 2015;10(1):1-7. doi:10.1186/s13017-015-0046-1 Paajanen H, Grönroos JM, Rautio T, et al. A prospective randomized controlled multicenter trial comparing antibiotic therapy with appendectomy in the treatment of uncomplicated acute appendicitis ( APPAC trial ). 2013. doi:10.1186/1471-2482-13-3 Georgiou R, Eaton S, Stanton MP, Pierro A, Hall NJ. Efficacy and Safety of Nonoperative Treatment for Acute Appendicitis: A Meta-analysis. Pediatrics. 2017. doi:10.1542/peds.2016-3003 Buckius MT, McGrath B, Monk J, Grim R, Bell T, Ahuja V. Changing epidemiology of acute appendicitis in the United States: Study period 1993-2008. J Surg Res. 2012;175(2):185-190. doi:10.1016/j.jss.2011.07.017 Pisarra VH. Recognizing the various presentations of appendicitis. Dimensions of Critical Care Nursing. 2001;20(3):24-27 Ryan WL. Appendicitis : Symptoms, Diagnosis, and Treatments. New York: Nova Science Publishers, Inc; 2010. Ohle R, O’Reilly F, O’Brien KK, Fahey T, Dimitrov BD. The Alvarado score for predicting acute appendicitis: a systematic review. BMC Med. 2011;9:139. Published 2011 Dec 28. doi:10.1186/1741-7015-9-139 Andersson M, Andersson RE. The appendicitis inflammatory response score: A tool for the diagnosis of acute appendicitis that outperforms the Alvarado score. WORLD JOURNAL OF SURGERY. 32(8):1843-1849. doi:10.1007/s00268-008-9649-y. Singer DD, Thode JHC, Singer AJ. Effects of pain severity and CT imaging on analgesia prescription in acute appendicitis. American Journal of Emergency Medicine. 2016;34(1):36-39. doi:10.1016/j.ajem.2015.09.015. Wu W-T, Tai F-C, Wang P-C, Tsai M-L. Surgical site infection and timing of prophylactic antibiotics for appendectomy. Surgical Infections. 2014;15(6):781-785. doi:10.1089/sur.2013.167. Le D, Rusin W, Hill B, Langell J. Post-operative antibiotic use in nonperforated appendicitis. Am J Surg. 2009;198(6):748-752. doi:10.1016/j.amjsurg.2009.05.028 [Guideline] Korndorffer JR Jr, Fellinger E, Reed W. SAGES guideline for laparoscopic appendectomy. Surg Endosc. 2010 Apr. 24(4):757-61 Kouhia ST, Heiskanen JT, Huttunen R, Ahtola HI, Kiviniemi VV, Hakala T. Long-term follow-up of a randomized clinical trial of open versus laparoscopic appendicectomy. Br J Surg. 2010 Sep. 97(9):1395-400. Patel SV, Nanji S, Brogly SB, Lajkosz K, Groome PA, Merchant S. High complication rate among patients undergoing appendectomy in Ontario: a population-based retrospective cohort study. Canadian Journal Of Surgery Journal Canadien De Chirurgie. 2018;61(6):412-417. doi:10.1503/cjs.011517. Moreira LF, Garbin HI, Da-Natividade GR, Silveira BV, Xavier TV. Predicting factors of postoperative complications in appendectomies. Revista Do Colegio Brasileiro De Cirurgioes. 2018;45(5):e19. doi:10.1590/0100-6991e-20181920. Alharbi FM, Almutairi TS, Algayed HK, et al. Predictors of Length of Stay, Complications and Patient’s Satisfaction after Appendectomy. Egyptian Journal of Hospital Medicine. 2017;69(8):3050-3053. doi:10.12816/0042854. Asarias, J.R., Schlussel, A.T., Cafasso, D.E. et al. Surg Endosc (2011) 25: 2678. Tingstedt B, Johansson J, Nehez L, Andersson R. Late abdominal complaints after appendectomy—readmissions during long‐term follow‐up. Dig Surg 2004; 21: 23–27 Noorit P, Siribumrungwong B, Thakkinstian A. Clinical prediction score for superficial surgical site infection after appendectomy in adults with complicated appendicitis. WORLD JOURNAL OF EMERGENCY SURGERY. 13. doi:10.1186/s13017-018-0186-1. Blomqvist PG, Andersson RE, Granath F, Lambe MP, Ekbom AR. Mortality after appendectomy in Sweden, 1987–1996. Ann Surg 2001; 233: 455–460. Coldrey E. Five years of conservative treatment of acute appendicitis. J Int Coll Surg 1959; 32: 255–261. Share this: Facebook Twitter Reddit LinkedIn WhatsApp

COMM 120 Cuymaca Communication Climates Interpersonal Relationship Discussion

COMM 120 Cuymaca Communication Climates Interpersonal Relationship Discussion.

I’m working on a communications writing question and need support to help me understand better.

Activity 9: Analyzing Communication Climates88 unread replies.88 replies.Chapter 10 discusses the concept of “communication climates”. Basically, it is a term used to describe the emotional tone of a relationship. Weather metaphors are a helpful way of describing the emotional tone of our relationships and give us an idea of the quality of a relationship without having to do an in-depth analysis. Examples of a communication climate could be something like: “Sunny” for a happy relationship, “Cloudy” for a relationship that is difficult or depressing, “Stormy” if there is a lot of conflict”, etc. Just imagine the weather outside on a given day and how it makes you feel and that is the similar comparison you would make in a relationship.That being said, below is an activity designed to get you to think about some of the “communication climates” in your own relationships”. Read the questions below and respond with a few sentences answering each of the questions. You will have until Sunday at 11:59pm to complete the activity.1. Identify the communication climate of an important interpersonal relationship using weather metaphors like “sunny, gloomy, rainy, calm, etc.2. List the communication that created and now maintains that “climate”. List both verbal and non-verbal messages like “complimenting one another”, “listening to each other”, “arguing a lot”, etc.3. Describe what you can do to either maintain the climate (if it is positive) or to improve the climate (if it is negative). Again, think about verbal and nonverbal messages like “asking more questions”, “making more eye contact”, “less interrupting”, “more smiling”, etc.
COMM 120 Cuymaca Communication Climates Interpersonal Relationship Discussion

Why Read Literature?” discussion,

Why Read Literature?” discussion,.

Prepare: Prior to writing your initial post, read Chapters 1 through 3 of Journey into Literature. Reflect: As we explored in the “Why Read Literature?” discussion, literature can provide us with a multitude of perspectives, ideas, and experiences. Additionally, there is a long tradition of critical reading and writing about literature (i.e., analyzing literature to seek a deeper understanding about various interests and concerns). Chapter 2 focuses on these ideas. Consider why people write and how that writing may benefit us. Write: Your initial post should be at least 200 words in length. The minimum word count does not include references. In your post, answer the following questions:Why might a writer feel compelled to write about literature? How does it benefit us personally and/or professionally?What kind of writing and thinking skills do you hope that you will develop in this course based on the description of writing about literature in Sections 1.1, 2.1, and 2.3 of the text?Incorporate readings found in Chapters 1 through 3 to help illustrate the points you make
Why Read Literature?” discussion,

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