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Analyze quality assessment including quality management, data quality, risk exposure, safety initiatives, and identification of best practices for health information.  You are an HIM Supervisor at  hospital and you have been asked to create a new staff training on data compliance rules.  Assume that the new staff has a wide variety of background, with some new staff knowing nothing about data compliance at all.  The training should be basic and introductory.

Background Scenario You are working in neurodegenerative diseases research and found a gene linked to a specific neurodegenerative disease, you would like to find out more information about this gene, the protein it codes, the subcellular location of the gene, and etc. You are also interested to find whether there are other genes in humans similar to the one you found, if yes, what is the function? You would then like to find whether there are similar genes in other animals, so you can potentially use those animals as a model to study the gene you found. Instructions Please perform a search of a specific neurodegenerative disease in human (Alzheimer’s disease (AD), Parkinson’s disease (PD), Prion disease, Motor neurone diseases (MND), Huntington’s disease (HD), Spinocerebellar ataxia (SCA), Spinal muscular atrophy (SMA)) at OMIM, then find a gene of your interest. Please record the name and chromosome location of the gene you select, as well as Phenotype MIM number of your search. CONDUCT A SEARCH OF YOUR CHOSEN GENE AT NCBI DATABASE, AND FIND THE ACCESSION NUMBER OF THE GENOMIC DNA, MRNA AND PROTEIN RELATED TO THE GENE. By using uniprot, please find the subcellular location, expression and the number of isoforms for the protein coded by that gene. Please conduct a BLASTN search of your chosen gene, and restrict database to humans, can you find any paralogs of the gene? If yes, how many? Please conduct a BLASTN search of your chosen gene, and restrict database to Saccharomyces cerevisiae, Drosophila melanogaster or Rattus norvegicus. Can you find orthologs in these species? If yes, which one of the species have the highest similarity to humans? Please conduct a BLASTP search of your chosen protein, and restrict database to humans, can you find any paralogs of the protein? If yes, how many? Please conduct a BLASTP search of your chosen gene, and restrict database to Saccharomyces cerevisiae, Drosophila melanogaster or Rattus norvegicus. Can you find orthologs in these species? If yes, which one of the species have the highest similarity to humans?

Week 7 Discussion Select one of the following case studies and corresponding Differentials Table to complete. In the subject line of your post, please identify which case study you are responding to. Select one of the following case studies. Complete the corresponding “Differentials Table” to align your clinical reasoning – include 5 differentials (excluding the example provided). In SOAP format, discuss what questions you would ask the patient (Review of Systems), what physical exam elements you would include, what further testing you would want to have performed (if any), differential and working diagnosis, treatment plan, including the addition of complementary and OTC therapy, referrals and other team members needed to complete patient care. Upload your Differentials Table and SOAP note to the Discussion Board Note: Document at least one scholarly source to connect your response to national guidelines and evidence-based research in support of your ideas. In your peer replies, please reply to at least one peer who chose a different case study. ***Important Considerations - As you dive deeper into your clinical practice, challenge yourself to formulate well-thought-out differentials prior to arriving at your final diagnosis. Diseases, despite their common features, can become unique and dynamic. This means that symptomatology can easily be affected by different modifying factors such as age, co-morbid conditions, environmental factors, and the like. Case Studies Mildred is a 45-year-old married female with three children. She presents to the clinic with complaints of fatigue and difficulty sleeping. She states she wants to get a good night’s sleep and is requesting a prescription to help her sleep. Mildred tells you she is awake off and on during the night, frequently thinking about her husband’s recent layoff from construction work and the effect this is having on the family. She lies down often during the day and has been so fatigued that she took some time off from work during the last two weeks. She is tearful at times during the visit and looks sad and anxious. On further discussion, she says she feels overwhelmed, helpless, and anxious. She tells you about an episode where she felt her heart beating rapidly, had difficulty catching her breath, felt she was going to have a heart attack, and became frightened until her husband was able to help calm her down. She is not eating as much as usual, and when she reads the newspaper, she does not remember what she has read. Kylie, a 24-year-old female patient, comes to your office for a refill of her allergy medication. Before going into the room, you note that her Patient Health Questionnaire – Depression (PHQ-9) score is 20, and that she is not currently on any medication for depression. When you enter the room, you notice that Kylie is easily startled, and she is sitting in the corner of the room very close to the wall. Dale, a 40-year-old construction worker, lost his 4-year-old daughter in a car accident six months ago, in which his sister was driving and he was a passenger. He is at this visit for a follow-up of a shoulder injury sustained last month. You notice that he has lost about eight pounds since his last visit, and he is somewhat disheveled in his appearance. Dale has not been back to work, and has not been able to get into a car since the accident. Before going into the room, your nurse pulled you aside to let you know that the patient was very rude to the front office staff, and was also rude to her while he was being processed for his visit. This is not Dale’s usual behavior. If you chose case study 1, 2, or 3 complete the below Differentials Table Differential Signs/Symptoms Gold Standard Diagnostics Gold Standard Treatment Ex: PTSD Flashbacks, nightmares, intrusive thoughts, avoidance of reminders of trauma, agoraphobia, sleep disturbance and hypervigilance, feelings of detachment. Clinician-Administered PTSD Scale (CAPS-5) First-line treatment with a trauma-focused psychotherapy such as eye movement desensitization and reprocessing (EMDR). In individuals with comorbid disorders (ex., depression, psychosis) that affect the person’s ability to work in trauma-focused therapy (ex., concentration, motivation), treat with pharmacologic management; SSRI first line such as sertraline or paroxetine. 1. 2. 3. 4. 5.

CAPITAL BUDGET DECISION MAKING FOR AN ORGANIZATION—PART 2 As a reminder, you will continue to play the role of a consultant who has been hired by a mid-sized company that recently went public to provide some recommendations related to their short-term and long-term financial needs. Your first project is to analyze the short- and long-term capital budget needs of the company. You will prepare and submit a 3- to 5-page report, including an executive summary in which you synthesize your recommendations for the following fiscal year, along with the provided Excel spreadsheet with your calculations. Explain your findings and your recommendations. For each of the items in your report, you will complete the calculations in the Module 3 Assignment Part 1 Template and will then use that financial information to develop your report to the owner using the Module 3 Assignment Part 2 Template. In your report, be sure to include relevant citations from the Learning Resources, the Walden Library, and/or other appropriate academic sources to support your work. RESOURCES Be sure to review the Learning Resources before completing this activity. Click the weekly resources link to access the resources.  WEEKLY RESOURCES To prepare for this Assignment: Return to the Module 3 Assignment Part 1 Template to continue completing the calculations. Return to your Module 3 Assignment Part 2 Template to complete Part 2 of your report. Note: Be sure to keep a copy of your completed Assignment this week, as you will be adding to the same file for your Week 8 Assignment. BY DAY 7 Submit your synthesis of financial data related to long-term financing needs for an organization, to include the following: PART 2: LONG-TERM WORKING CAPITAL CONSIDERATIONS: TIME VALUE OF MONEY AND BONDS (1–2 PAGES, PLUS CALCULATIONS IN EXCEL) Future Value: If the company deposits $2 million in a bank account that pays 6% interest annually, how much will be in the account after 5 years? Present Value: What is the present value of a security that will pay $29,000 in 20 years if securities of equal risk pay 5% annually? Required Interest Rates: The company owner has said she will retire in 19 years. She currently has $350,000 saved and thinks she will need $800,000 at retirement. What annual interest rate must she earn to reach that goal, assuming she does not save any additional funds? Future Value of an Annuity: Find the future values of these ordinary annuities. Compounding occurs once a year. $500 per year for 8 years at 14% $250 per year for 4 years at 7% $700 per year for 4 years at 0% Present Value of an Annuity: Find the present values of these ordinary annuities. Discounting occurs once a year. $600 per year for 12 years at 8% $300 per year for 6 years at 4% $500 per year for 6 years at 0% Bond Valuation: The company has two bonds in their investment portfolio, Bond C and Bond Z. Each bond matures in 4 years, has a face value of $1,000, and has a yield to maturity of 8.2%. Bond C pays an 11.5% annual coupon, while Bond Z is a zero-coupon bond. Assuming that the yield to maturity of each bond remains at 8.2% over the next 4 years, calculate the price of the bonds at each of the following years to maturity. Explain any observed differences from the pricing calculations of the two bonds. Years to MaturityPrice of Bond CPrice of Bond Z4  3  2  1  0   Yield to Maturity and Yield to Call: The owner is interested in investing some retained earnings in corporate bonds. She is considering the following: Bond A has a 7% annual coupon, matures in 12 years, and has a $1,000 face value. Bond B has a 9% annual coupon, matures in 12 years, and has a $1,000 face value. Bond C has an 11% annual coupon, matures in 12 years, and has a $1,000 face value. Each bond has a yield to maturity of 9%. a. Before calculating the prices of the bonds, identify whether each bond is trading at a premium, at a discount, or at par. b. Calculate the price of each of the three bonds. c. Calculate the current yield for each of the three bonds.

1st peer: Week 7 Discussion Part I Table 1: Amenorrhea  Complete the Table   Distinguish between primary and secondary amenorrhea o   Primary amenorrhea: no menstrual period by age 15 or within 3 years of breast development o   Secondary amenorrhea: no menstrual period for 3 cycles or absence of periods for at least 6 months in those who previously have had their periods Clinical presentation o   SMR IV o   Physical signs of eating disorder: anorexia, low pulse, temperature, and blood pressure. Dry skin. o   Androgen excess: acne, excess hair on body, male pattern baldness o   Hyperinsulinemia: central adiposity, acanthosis nigricans, striae List 3 differentials o   Pregnancy o   Thyroid disease o   Polycystic ovarian syndrome Labs ordered o   Pregnancy test o   FSH o   Estradiol o   TSH o   T4 o   Prolactin o   Estradiol o   LH o   Total and free testosterone o   DHEA-S and androstenedione o   17-OH o   Pelvic ultrasound o   Chromosomal analysis o   Pituitary MRI Causes o   Pregnancy o   Hypogonadotropic conditions: decreased FSH and LH production, low estrogen o   Ovarian dysfunction o   Structural causes o   Hypothalamic or pituitary gland dysfunction o   Functional: chronic illnesses, stress, athletics, eating disorders Treatment/Management Based on individual needs. Close monitoring of the patient and her menstrual periods – which should return to a normal frequency of at least every 45 days. Complications Vasomotor symptoms, osteoporotic fractures, endometrial hyperplasia, metabolic and cardiovascular disease, infertility, galactorrhea, hyperandrogenism, psychological effects Table 2: Dermatologic Conditions (Maaks et al., 2020). Common Skin Lesions Description Common Location Treatment/Plan Mongolian Spots Blue or slate gray, irregular, variably sized macules. Presacral or lumbosacral area, upper back, shoulders, extremities. Often covers large area. Transient and will resolve as the child gets older and the skin darkens. Erythema Toxicum Neonatorum Firm, yellow-white papules or pustules with erythematous flare, 1 to 2mm in size. Cheeks, nose, forehead Clears in 2 weeks, completely gone in 4 months Milia, Miliaria, “Prickly Heat” Firm, pearly, white papules Cheeks, nose, forehead Will spontaneously resolve Seborrheic Dermatitis “Cradle Cap” Erythematous, flaky to thick crusts of yellow, greasy scales Scalp, face, behind the ears, neck, trunk, and diaper area Infants: resolves within the 1st year of life, mineral oil may be used. Adolescents: antifungal, anti-inflammatory, keratolytic Café au Lait Spots Tan to light brown macules, oval or irregular in shape, increases in number with age. Anywhere on the skin Monitor, usually no treatment indicated Faun Tail Nevus Posterior midline cutaneous lesion. Excessive hair growth. Represents underlying spinal abnormality Lumbosacral. Posterior midline. Intense pulse light Port Wine Stain (Nevus Flammeus) Purple-red macules, tend to be large. Face, occiput, neck, possibly extremities Pulsed dye lasers, photodynamic therapy Hemangioma (Strawberry Hemangioma) Overgrowth of blood vessels that are either flat, raised, or cavernous. Can be a pale macule, telangiectatic lesion, or bright red nodular papule. Superficial: upper dermis of skin. Deep cavernous: subcutaneous and hypodermal layers. Propranolol. Intralesional and oral steroids. Table 3: Differential Diagnosis Common Childhood Rashes (Maaks et al., 2020). CC: Rash Condition Appearance/Location Treatment Hand Foot mouth disease Vesicular eruptions in the oropharynx, maculopapular rash in the hands and feet. Rash evolves to vesicles especially on the dorsa of hands and soles of feet. Supportive care – rest, hydration, antipyretics Impetigo Nonbullous: 1-2mm erythematous pustules that become vesicles or bullae – leaving moist, honey-colored crusty lesions. Bullous: large, flaccid, thin-wall, superficial, annular or oval pustular blisters – leaving thin varnish-like coating or scale. Common on face, hands, neck, extremities, perineum. Antibiotics: amoxicillin-clavulanate, cephalexin, dicloxacillin, cloxacillin, or clindamycin. Topical antibiotic for milder cases. Measles Enanthem (Koplik spots) on the oral mucosa, opposite the lower molars. Small, irregular, bluish white granules on an erythematous base. Supportive care – rest, hydration, antipyretics Varicella Centripetal rash beginning on scalp, face, or trunk. Leads to teardrop vesicles. Can occur on all mucosal tissues, mouth, pharynx, larynx, trachea, vagina, anus. Supportive care – rest, hydration, antipyretics. Antihistamines or oatmeal baths for itching. Anti-staphylococcal penicillin or cephalosporins for bacterial superinfections. Scarlet Fever Petechiae in mouth. Tongue with papillae. Scarlatina rash exanthema is red, blanches to pressure, papular – leading to coarse skin with sandpaper sensation. Begins on the neck, spreads to trunk and extremities. 10-day course of antibiotics – either penicillin or amoxicillin. Erythromycin for those with PCN allergy. Pediculosis capitis or head lice Lice visualized. Nits are small white oval cases attached to hair shaft and are laid within 4mm of the scalp. Common in the back of the head, nape, behind ears. Pediculicides Molluscum contagiosum Small, firm, pink to flesh-colored discrete papules 1-6mm in size. Papules become umbilicated with cheesy core. Common in face, axillae, antecubital area, trunk, popliteal fossae, crural area, extremities. Curettage, salicylic acid, KOH, Imiquimod, cantharidin, lemon myrtle oil Scabies Curving burrows, especially in webs of fingers, sides of hands, folds of wrist, armpits, elbows, belt line, buttocks, half of foot and heel, palms, soles, scalp, face, posterior auricle, axilla. Permethrin 5% repeated in 1 week. Antihistamine, hydrocortisone, NSAIDs for itching. Clean environment, linens, clothing. Roseola Diffuse, nonpruritic, discrete, rose-colored maculopapular rash, about 2-3mm in diameter. Supportive care – rest, hydration, antipyretics Table 4: Physical Activity and Sports Participation (Maaks et al., 2020). Physical activity recommendations include children and adolescents participating in at least ____ minutes of moderate to vigorous physical activity daily. o   60 minutes What medical conditions would exclude a child from sports participation?  o   Asthma o   Cardiac conditions o   Cardiac murmurs o   Diabetes mellitus o   Hypertension o   Seizures o   Sickle cell trait o   Acute infectious conditions o   Infectious mononucleosis o   Communicable skin infections o   Tinea corporis o   Tinea capitis o   HSV o   Molluscum contagiosum o   Furuncles, carbuncles, folliculitis, impetigo, cellulitis, S. aureus o   Scabies o   HIV and other blood-borne viral pathogens o   Exercise-induced dyspnea What are the three entities of the female athlete triad? o   Low energy availability with or without a disordered eating pattern o   Menstrual dysfunction o   Low bone mineral density (osteopenia or osteoporosis) Table 5: Sexually Transmitted Diseases (Maaks et al., 2020). Complete the table. Infection Common Signs & Symptoms Diagnostic Tests Treatment/Follow-up Chlamydia Majority is asymptomatic. Males: dysuria, urethritis, proctitis, pharyngitis. Females: dysuria, vaginal discharge, vaginitis, cervicitis, post-coital bleeding, breakthrough bleeding, dyspareunia, pelvic pain NAAT by urine, vaginal, endocervical, rectal or oropharyngeal swab. Azithromycin 1g PO x 1 dose or Doxycycline 100mg PO bid x 7 days. Retest at 3 months. Gonorrhea Majority is asymptomatic. Males: dysuria, urethritis, proctitis, pharyngitis. Females: dysuria, vaginal discharge, vaginitis, cervicitis, post-coital bleeding, breakthrough bleeding, dyspareunia, pelvic pain. NAAT by urine, vaginal, endocervical, rectal or oropharyngeal swab. Ceftriaxone 250mg IM x 1 dose and azithromycin 1g PO x 1 dose. Retest at 3 months. Trichomoniasis Majority with minimal or no symptoms. Males: urethritis, epididymitis, prostatitis. Females: diffuse, malodorous, or yellow-green discharge with or without vulvar irritation. NAAT testing of vaginal/urethral secretions. Metronidazole 2g PO x 1 dose. Retest at 3 months. Syphilis Primary: painless ulcer or chancre Secondary: skin rash, lymphadenopathy Latent: lacking clinical manifestations Serologic nontreponemal and treponemal tests. Penicillin G Genital Herpes Primary: flu-like illness, multiple and painful vesicles on genital area. Dysuria, tingling, burning or itching sensation. PCR test of herpetic lesion. Initial: Acyclovir 400mg PO tid x 7-10 days or Valacyclovir 1g PO bid x 7-10 days. Recurrent: Acyclovir 800mg bid x 5 days or Valacyclovir 1g PO daily x 5 days. Suppressive: Acyclovir 400mg PO bid or Valacyclovir 1g PO daily. HIV Starts as brief, acute viral syndrome and transitions into chronic illnesses and immunodeficiency. Serologic testing for HIV-1 and HIV-2. Rapid tests available. Antiretrovirals. PrEP for partners. Routine follow-up. Case Scenario - Part 2 Case Scenario 1: Talla is a 16-year-old who has come into the clinic because she has not had a menstrual period in 5 months. She reports she started menstruating at 13 years old. She denies being sexually active. 1) What more should you know about Talla? Last menstrual period Frequency, duration, flow amounts, and regularity of menstrual cycle Medical history: any existing conditions History of extreme weight loss, loss of smell, galactorrhea, headaches, or visual changes Lifestyle: restrictive diets, exercise habits, life stressors Current medications: use of antipsychotics, antidepressants, anticonvulsants, or opiates (associated with hyperprolactinemia) Exposure to chemotherapy or radiation Presence of any eating disorders or high intensity athletic training Family history Sexual history Presence of cyclic pelvic pain History of endometrial or cervical procedures Presence of hyperandrogenemia: male pattern hair growth or loss, excessive acne Presence of autoimmune conditions or other chronic illnesses Uncontrolled diabetes (Nawaz et al., 2024). 2) What diagnostic tests should you order and why? Urine pregnancy test – rule out pregnancy To rule out hypothalamic or pituitary dysfunction: FSH, LH, estradiol To rule our hyperandrogenism: Total testosterone Fasting morning serum 17-hydroxyprogesterone DHEA-S Prolactin – rule out hyperprolactinemia TSH – rule out thyroid causes Pelvic ultrasound CMP, ESR, CRP, CBC – rule out chronic disease such as liver conditions or inflammatory bowel disease (Nawaz et al., 2024). 3) How should you manage this condition? Treatment for amenorrhea depends on the underlying cause or etiology: Gonad disorders: hormone therapy – hormonal contraceptives Outflow tract abnormalities, such as imperforate hymen or cervical stenosis: surgical correction Functional hypothalamic amenorrhea: encourage reversal of contributing factors, such as weight gain, stress reduction, lifestyle changes, dietary changes. Nutrition counseling programs are beneficial as well. Hyperprolactinemia or prolactin-secreting tumor: dopamine agonist cabergoline 2nd peer: Table 1: Amenorrhea Category Primary Amenorrhea Secondary Amenorrhea Definition Absence of menstruation by age 15 in girls with normal secondary sexual characteristics or by age 13 in girls without secondary sexual characteristics. Absence of menstruation for three cycles or six months in women who previously had regular menstrual cycles. Clinical Presentation No menarche, delayed puberty. Absence of menstruation, possibly with other symptoms like weight gain, hair loss, or galactorrhea. Differentials Turner syndrome, Müllerian agenesis, Androgen insensitivity syndrome. Polycystic ovary syndrome (PCOS), Hyperprolactinemia, Thyroid disorders. Labs Ordered Pregnancy test (?-hCG), FSH, LH, Estradiol, Prolactin, Thyroid function tests (TSH, Free T4), Androgen levels (testosterone, DHEA-S). Pregnancy test (?-hCG), FSH, LH, Estradiol, Prolactin, Thyroid function tests (TSH, Free T4), Androgen levels (testosterone, DHEA-S). Causes Genetic/chromosomal abnormalities, Anatomical defects, Endocrine disorders. Pregnancy, PCOS, Hyperprolactinemia, Hypothyroidism, Stress or excessive exercise, Low body weight. Treatment/Management Hormone replacement therapy, Surgery for anatomical issues, Psychological support. Treat underlying cause (e.g., thyroid medication, dopamine agonists for prolactinoma, lifestyle modifications), Hormonal therapy, Weight management. Complications Infertility, Osteoporosis (due to low estrogen levels), Psychological impact (e.g., stress, anxiety). Infertility, Osteoporosis (due to low estrogen levels), Psychological impact (e.g., stress, anxiety). Table 2: Dermatologic Conditions Common Skin Lesions Description Common Location Treatment/Plan Mongolian Spots Bluish-gray patches Lower back, buttocks None, usually fade by age 3-5 Erythema Toxicum Neonatorum Red papules, pustules on an erythematous base Trunk, face, extremities None, self-limiting Milia, Miliaria, “Prickly Heat” Small white or clear papules Face (milia), skin folds (miliaria) None, keep skin cool and dry Seborrheic Dermatitis “Cradle Cap” Greasy, yellowish scales Scalp, face Gentle washing, emollients, mild corticosteroids Café au Lait Spots Light brown macules Anywhere on the body None, monitor for neurofibromatosis Faun Tail Nevus Tuft of hair overlying the spine Lower back None, MRI if spinal dysraphism is suspected Port Wine Stain (Nevus Flammeus) Dark red to purple macules/patches Face, neck, limbs Laser therapy, cosmetic cover-ups Hemangioma (Strawberry Hemangioma) Bright red, raised lesions Anywhere on the body Observation, beta-blockers, laser treatment Table 3: Differential Diagnosis Common Childhood Rashes Condition Appearance/Location Treatment Hand Foot Mouth Disease Vesicles on hands, feet, and oral mucosa Supportive care, hydration, pain relief Impetigo Honey-colored crusted lesions on face and extremities Topical/oral antibiotics (e.g., mupirocin) Measles Koplik spots, maculopapular rash starting on face Supportive care, vitamin A, isolation Varicella Vesicular rash in different stages, starting on trunk Antihistamines, antivirals (if severe), supportive care Scarlet Fever Sandpaper-like rash, strawberry tongue Antibiotics (penicillin or amoxicillin) Pediculosis capitis (Head lice) Itchy scalp, nits on hair shafts Topical pediculicides, combing out nits Molluscum Contagiosum Flesh-colored, umbilicated papules Observation, cryotherapy, topical treatments Scabies Intense itching, burrows in web spaces of fingers Topical permethrin, oral ivermectin Roseola High fever followed by rash on trunk Supportive care, antipyretics Table 4: Physical Activity and Sports Participation Category Details Physical activity recommendations Children and adolescents should participate in at least 60 minutes of moderate to vigorous physical activity daily. Medical Conditions That May Exclude a Child from Sports Participation Medical Conditions Severe asthma or uncontrolled asthma Hypertrophic cardiomyopathy Severe hypertension Active infections (e.g., myocarditis, pericarditis) Recent concussion with ongoing symptoms Severe anemia Certain orthopedic conditions or injuries Three Entities of the Female Athlete Triad Entities Low energy availability (with or without disordered eating) Menstrual dysfunction (e.g., amenorrhea) Low bone mineral density (e.g., osteoporosis) Table 5: Sexually Transmitted Diseases Infection Common Signs & Symptoms Diagnostic Tests Treatment/Follow-up Chlamydia Often asymptomatic, dysuria, pelvic pain, discharge NAAT (nucleic acid amplification test) Azithromycin or doxycycline; retest in 3 months Gonorrhea Purulent discharge, dysuria, pelvic pain NAAT Ceftriaxone plus azithromycin; retest in 3 months Trichomoniasis Frothy green-yellow discharge, itching, burning Wet mount microscopy, NAAT Metronidazole or tinidazole; retest in 3 months Syphilis Primary: chancre; Secondary: rash, mucous patches; Tertiary: gummas, neurologic symptoms RPR or VDRL followed by confirmatory FTA-ABS Penicillin G; follow up with RPR or VDRL titers Genital Herpes Painful vesicles, ulcers, prodromal symptoms (tingling, itching) PCR or viral culture, serologic testing Acyclovir, valacyclovir, or famciclovir; suppressive therapy for recurrent outbreaks HIV Flu-like symptoms, lymphadenopathy, opportunistic infections HIV antibody/antigen test (ELISA) and confirmatory Western blot or PCR Antiretroviral therapy (ART); regular follow-up with CD4 count and viral load monitoring Case Scenario 1: Talla is a 16-year-old who has come into the clinic because she has not had a menstrual period in 5 months. She reports she started menstruating at 13 years old. She denies being sexually active. What more should you know about Talla? What diagnostic tests should you order and why? How should you manage this condition? What More Should You Know About Talla? To better understand Talla's condition, it is essential to gather more information through a detailed history and physical examination. Key areas to explore include her menstrual history, such as previous menstrual cycle patterns, including regularity, duration, and flow, as well as any changes in the pattern before cessation. Additionally, her medical history should be reviewed for any recent illnesses or chronic conditions, significant weight loss or gain, eating habits, and any history of eating disorders. Exercise patterns, particularly excessive physical activity, should also be considered. Family history of menstrual irregularities or endocrine disorders is important, along with psychosocial factors such as stress levels related to school, family, or social pressures. It is also critical to inquire about symptoms of potential underlying causes, including signs of hyperandrogenism (acne, hirsutism), thyroid dysfunction (weight changes, fatigue, temperature intolerance), and hyperprolactinemia (galactorrhea, headaches, vision changes). What Diagnostic Tests Should You Order and Why? Based on Talla's clinical history and physical examination, several diagnostic tests should be considered. A pregnancy test is essential to rule out pregnancy, a common cause of secondary amenorrhea. Blood tests, including a complete blood count (CBC) to check for anemia or other systemic issues, thyroid function tests (TSH, Free T4) to rule out thyroid dysfunction, and a prolactin level to check for hyperprolactinemia, should be conducted. Additionally, measuring follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels can assess ovarian function, while estradiol levels evaluate estrogen status. Testing androgen levels (testosterone, DHEAS) can help check for hyperandrogenism, and fasting glucose and insulin tests can assess for insulin resistance if polycystic ovary syndrome (PCOS) is suspected. Imaging, such as a pelvic ultrasound, can evaluate the ovaries and uterus for structural abnormalities or PCOS. How Should You Manage This Condition? The management of Talla's condition will depend on the underlying cause identified through history, examination, and diagnostic testing. Possible management strategies include lifestyle modifications, such as counseling on a healthy diet and exercise if weight-related issues are identified, and advising on reducing the intensity and frequency of exercise if it is excessive. Medical management may include treating thyroid dysfunction according to the specific disorder diagnosed, using dopamine agonists like bromocriptine or cabergoline for hyperprolactinemia, and managing PCOS with lifestyle changes, hormonal contraceptives to regularize menstruation, and possibly insulin-sensitizing agents like metformin. Providing psychosocial support is also crucial if stress or psychological factors are significant, potentially involving a referral to a counselor or psychologist. Regular follow-up is necessary to monitor response to treatment and any changes in symptoms. Given Talla’s age and the potential for various underlying causes, a sensitive and supportive approach is vital.

Write a response to the following prompt: Historians sometimes distinguish between “history from the top down” and “history from the bottom up.” History from the top down focuses on leaders and elites: presidents, politicians, military officers, and the like. History from the bottom up discusses the experiences of common people: average citizens, racial minorities, immigrants, workers, and families. Which approach offers a better path for understanding the history of the United States since 1945? Who exerted a greater influence on U.S. foreign and domestic affairs – elites or common people? Do you believe that political and military elites charted a course that the nation followed? Or have broad-based social movements made up of average people exerted more influence since 1945? If you were teaching a course on U.S. history since 1945, which approach would you be more likely to emphasize? In formulating your answer, choose three different individuals/groups that we have discussed in the third section of this course (modules 11-14). How do the experiences of each individual/group reflect the top down/bottom up divide? What sort of historical agency – that is, influence – were your individuals/groups able to exert? Be as specific as possible and be sure to use the assigned readings to defend your answer. Your answer must quote and cite at least three different primary documents from the required reading for Modules 11 through 14. Instructions: Be as specific as possible, and be sure to use the assigned readings to defend your answer. Answers that are too short or too long (more than 50 words in either direction) will lose points. Your answer must quote and cite at least three different documents from the required reading for Modules 1 through 4. Your answer will be checked for plagiarism using Turn-It-In. Your answer should be based on material covered in class lectures and in the assigned reading for this course. DO NOT CONSULT OTHER SOURCES. I do not want to know what Google tells you about this topic. All the information you need to answer this question can be found in the assigned reading and in your class notes. Some tips on formatting and length: 750 words is not much! It’s about three double spaced pages (1” margins, 12 point font). Be brief, especially in your introductory paragraph. Get right to your argument, don’t waste words describing everything we’ve covered in the course. There’s no need to make sweeping statements like “Since the beginning of U.S. history....” The prompt asks several different (but closely related) questions. You do not need to answer each and every one of them, but you should try to address most of them (at least in passing) in your essay. Suggested format:  75 words: Introductory paragraph that ends with a clear thesis statement (that is, your argument and your answer to the question asked in the prompt). body paragraph 1, which should contain your first example and a quotation from your first document. body paragraph 2, which should contain your second example and a quotation from your second document. A transition paragraph between paragraphs should address the similarities/differences between your first and second example. 200 words: body paragraph 3, which should contain your third example and a quotation from your third document. A transition paragraph between paragraphs should address the similarities/differences between this example and your first two examples. 75 words: a concluding paragraph that compares your three examples and reiterates (not word-for-word!) your thesis from the introduction. You MUST introduce and contextualize your quotes. We’ve read dozens of documents this term. You must tell your reader what document you’re quoting.  GOOD: Southern African Americans had their own definition of freedom. “We claim freedom as our natural right,” black residents of Nashville stated in a petition, “and ask that in harmony and co-operation with the nation at large, you should cut up the roots the system of slavery.” As these petitioners noted, the work of freedom remained incomplete, even after emancipation. BAD: Southern African Americans had their own definition of freedom. “We claim freedom as our natural right, and ask that in harmony and co-operation with the nation at large, you should cut up the roots the system of slavery.” The second example is extraordinarily confusing for your reader. Who are you quoting? Are these your words? Introduce your quotes, and then explain them in your own words. You should also try to avoid extended quotations. In almost all circumstances, you shouldn’t be quoting more than one or two sentences at a time. When you’re trying to quote a longer passage, intersperse your own words as necessary. When I see paragraph-length citations I start to worry that you’re just trying to fill up space… Historians use Chicago Manual of Style, Humanities format. Use footnotes, not parenthetical/in-text citations. Cite the documents from Eric Foner’s Voices of Freedom as follows: Elizabeth Cady Stanton, “Home Life,” in Eric Foner, ed. Voices of Freedom, Vol. 2, 6th Edition (New York: W.W. Norton, 2020), 14-17. You do not need to cite my video lectures. Consider these to be common knowledge shared by the class. Submit your document as a Microsoft Word file – or a similar word processing file. Do not convert the file to a PDF. Late papers will lose 1/3 of a letter grade per 24 hours (i.e. A- becomes B+, C+ becomes C). Please include a word count on your paper. Download a copy of this prompt and instructions.Download Download a copy of this prompt and instructions. Download or preview the Rubric for Analytical Essay.Download Download or preview the Rubric for Analytical Essay. PreviousNext

READ THE FOLLOWING CASE STUDIES AND SEARCH FOR THE GUIDELINES THAT ANSWERS THE SPECIFIC QUESTIONS? CASE 1 A 54-year-old woman with chronic pain due to inflammatory arthritis presents to your clinic stating that she is having a “flare” of her arthritis but is out of her Oxycontin® and immediate-release oxycodone. She is aware that it is too early to fill her prescriptions, but she insists that she will be traveling out of state and “really needs” her medications. Question: How do you Approach This Patient in the community setting? What is the implications of prescribing this medication? Please provide evidence. CASE 2 A 27-year-old woman on buprenorphine-naloxone (Suboxone®) for treatment of opioid dependence is admitted to the hospital with severe abdominal pain due to a perforated gastric ulcer. She received hydromorphone in the ED, and is urgently taken to the operating room. Postoperatively, she is on a patient-controlled analgesic (PCA) pump containing fentanyl. Her last dose of buprenorphine-naloxone was 20 h prior to the surgery; her daily dose is 16 mg. Question: How can Pain be Managed in Patients who are Taking Buprenorphine-Naloxone? What Adjustments to her Medication Regimen can be Recommended? CASE 3 A 20-year-old man is brought to the emergency department (ED) by his family for evaluation. His family reports that he failed out of school in his second year at a local community college. He admits to escalating struggles with prescription pain pills (prescription opioids), and then heroin use. He appears to be in opioid withdrawal; he describes anorexia and diarrhea, and is yawning and sweating on exam. He has a Clinical Opioid Withdrawal Scale (COWS) score of 15, indicating moderate withdrawal. His provider orders clonidine, ondansetron, and 2/0.5 mg sublingual buprenorphine/naloxone, with a plan to observe him in the ED. The provider subsequently receives a concerned call from the hospital pharmacist. Question: The Pharmacist States That the Provider is Unable to Administer Buprenorphine in the ED Without an X-Waivered DEA Number. Is This Accurate? CASE 4 A 23-year-old woman attends an outpatient treatment program and office-based buprenorphine clinic. She has been doing well while maintained on 16 mg/day of buprenorphine. Recently though, she has missed group sessions and provided a urine for drug screening that tested positive for clonazepam and amphetamine. One of the other members in her group reported that they saw a “urine bottle fall out of her purse” as it spilled next to her chair in a group session; her counselor was unaware of this event. QUESTION: WHAT ARE THE POLICIES REGARDING THE USE OF ILLICIT SUBSTANCES OR URINE ADULTERATION OR SUBSTITUTION DURING SUBSTANCE ABUSE TREATMENT?

TIME VALUE OF MONEY AND CAPITAL BUDGETING If you were to think about your personal life in the way a financial manager would think about their professional decisions, how do you think you would you approach some long-term financing decisions? For example, if you were gifted $30,000, would you consider how to get the best return over a 5-, 10-, or 20-year period? How might these concepts apply when trying to decide between buying a new car, fixing a current car, leasing a car, and buying a used vehicle? In the Week 6 Discussion, you focused on an organization with which you are familiar and identified some of the organization’s short-term financing needs. In this week’s Discussion, you will turn your focus to long-term financing needs for the organization. RESOURCES Be sure to review the Learning Resources before completing this activity. Click the weekly resources link to access the resources.  WEEKLY RESOURCES To prepare for this Discussion: Thinking back to the organization you examined in the Week 6 Discussion, pinpoint at least one capital investment for which the organization will need to secure financing in the coming fiscal year (e.g., perhaps the company wants to invest in a warehouse in China, leading to an increase of 8% in profits). Note: This could be based on an actual situation, or you may use your creativity to create a possible project for the organization. Be prepared to provide some details about the project (i.e., purchase of equipment, acquisition of another company or property to expand operations, how much money will be required and for what purposes, etc.). Also, if you were a manager involved in decision making about this capital budgeting need, consider what questions you would have about the company’s financial position before engaging in this type of investment. Review the time value of money (TVM) concepts and consider the potential risks and benefits to the organization of engaging in such a project.  BY DAY 3 Post a summary of the value of a capital investment project for your selected organization using time value of money concepts. In your summary, do the following: Identify at least one capital investment for which the organization will need to secure financing in the coming fiscal year and provide a brief description of the project (type of project, estimated costs and allocation of funds, etc.). Note: This could be based on an actual situation, or you may use your creativity to create a possible project for the organization. Identify what questions you would have, as a manager, about the company’s financial position before engaging in this type of investment. Using the concept of time value of money as the basis for your explanation, propose why the capital investment would or would not be of value to the organization at this time.

Instructions Congratulations, you have assembled your leadership team, and they are excited to participate in this meeting with you. Because your leadership team represents various roles—including the chief nursing officer (CNO), who is responsible for the clinical aspect of patient care delivery; the CFO, who is responsible for leveraging funds to keep abreast of trends in healthcare expenditures; and the chief technology officer (CTO), who is in charge of the protection of patient personal health information—this activity represents a simulated interprofessional meeting. Working in a sector as complicated and complex as healthcare requires a type of leadership known as relational leadership, where individuals with professional roles and expertise can be maximized when their work is coordinated with other professionals in an atmosphere of trust, where communication is collaborative, and where there is an appreciation for each other's roles and responsibilities. Interprofessional teams function best when each member views their role from the leader's perspective, which fosters high-level strategic decision-making and action-taking, consensus building, and accountability sharing (Nelson, Tassone, & Hodges, (2014). References: Nelson, S., Tassone, M., & Hodges, B. D. (2014). Structuring for success. In Creating the health care team of the future: The Toronto model for interprofessional education and practice (pp. 38-41). Ithaca, NY: IRL Press.   Key individuals on your leadership team have been identified to address the issues facing your organization. You, as the CEO will facilitate a simulated strategy meeting with the CFO, CNO, and the CTO. In your simulated interprofessional meeting, you will review the Issue Brief Working Template from Week 3, which you also included in your simulated memorandum to your team in this week's first assignment. For this simulated meeting, you will look at the issues from multiple perspectives including the financial implications on the organization from the CFO's perspective, the delivery of safe and quality clinical healthcare from the CNO's perspective, the safeguards needed to protect patient health information from the perspective of the CTO, and the overall perspective that you have as the CEO. Your assignment is to describe how you would conduct your meeting to engage these senior leaders in an iterative process to narrow down to the top 10 issues to the final three issues on which you and your team will now focus. You will also report on what challenges and conflicts which may occur during the consensus-building dialogue. The Medicare reimbursement issue is already affecting your hospital's financial situation and has surfaced to be of grave concern. Since this issue has the most potential to disrupt hospital operations and the delivery of quality healthcare, you have made the decision and must inform your leadership team that the Medicare reimbursement issue must be one of the three issues addressed. As the outcome of this simulated meeting and for this assignment, you will a) create the meeting minutes (sample shown below) reflecting the discussion during the simulated meeting, and b) revise your Issue Brief Working Template to reflect only the three issues that your team has chosen. Your team concurs with your projection about the need to address the reimbursement issue and has made this their top priority. Your revised Issue Brief Working Template will have this issue as the number one priority. Sample meeting minutes are shown here. Table 4. Sample meeting minutes Hospital X Leadership Team Meeting Agenda/Minutes Attendees: Item #1: Review of the top 10 issues and trends affecting our organization Discussion: Item #2: Strategies to address the prioritized issues Discussion: Action: Item #3: Next steps Discussion: Action: Respectfully submitted, Length: This assignment will have a title page, the minutes from your simulated team meeting, your revised Issues Brief Working Template from Week 3, which now reflects the top three issues—with the U.S. reimbursement mechanisms as the top issue, and a reference page.

Read the article below and write an article review discussing your thoughts about EPM technology and the implications in respiratory clinical practice.  Click the hyperlinks below to access the article.  Use the submission rubric in the dropbox to guide your response. Note: This is an extensive article.  Please read the sections: "Introduction"-"Extubation Readiness." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10201... CriteriaLevel 4 4 points Level 3 3 points Level 2 2 points Level 1 1 point Criterion Score RESPONSIVENESS Responds to assigned or selected topic and connects to related topics Goes beyond what is required in some meaningful way (e.g., ideas contribute a new dimension to what we know about the topic, unearths something unanticipated); Is substantive and evidence-based; Demonstrates that the student has read, viewed, and considered the Learning Resources in the course and that the assignment answer/paper topic connects in a meaningful way to the course content; and Is submitted by the due date. Responds to the assigned or selected topic; Is substantive and evidence-based; Demonstrates that the student has read, viewed, and considered the Learning Resources in the course and that the assignment answer/paper topic connects in a meaningful way to the course content; and Is submitted by the due date. Somewhat misses the point of the assigned or selected topic; and/or Lacks in substance, relying more on anecdotal than evidence; and/or Contains little evidence that the student has read, viewed, and considered the Learning Resources in the course and that the assignment answer/paper topic connects in a meaningful way to the course content; and/or Is submitted by the due date. Misses the point of the assigned or selected topic; and/or Relies primarily on anecdotal evidence; and/or Contains little evidence that the student has read, viewed, and considered the Learning Resources in the course and that the assignment answer paper topic connects in a meaningful way to the course content; and/or Is submitted past the late deadline.  Score of RESPONSIVENESS, / 4 CONTENT KNOWLEDGE In-depth understanding and application of concepts and issues presented in the course (e.g., insightful interpretations or analyses; accurate and perceptive parallels, ideas, opinions, and conclusions), showing that the student has absorbed the general principles and ideas presented and makes inferences about the concepts/issues or connects to them to other ideas; Rich and relevant examples; Thought-provoking ideas and interpretations, original thinking, new perspectives; Original and critical thinking; and Mastery and thoughtful/accurate application of knowledge and skills or strategies presented in the course. Understanding and application of the concepts and issues presented in the course, demonstrating that the student has absorbed the general principles and ideas presented; Relevant examples; Thought-provoking ideas and interpretations, some original thinking; Critical thinking; and Mastery and application of knowledge and skills or strategies presented in the course. Minimal understanding of concepts and issues presented in the course, and, while generally accurate, displays some omissions and/or errors; and/or Few and/or irrelevant examples; and/or Few if any thought-provoking ideas, little original thinking; and/or “Regurgitated” knowledge rather than critical thinking; and/or Little mastery of skills and/or numerous errors when using the knowledge, skills, or strategies presented in the course. A lack of understanding of the concepts and issues presented in the course and/or application is inaccurate and contains many omissions and/or errors; and/or No examples or irrelevant examples; and/or No thought-provoking ideas or original thinking; and/or No critical thinking; and/or Many critical errors when applying knowledge, skills, or strategies presented in the course. Score of CONTENT KNOWLEDGE, / 4 QUALITY OF WRITING Uses language that is clear, concise, and appropriate; Has few if any errors in spelling, grammar, and syntax; Is extremely well organized, logical, and clear and never confuses the reader; Uses a preponderance of original language and uses direct quotes only when necessary and/or appropriate; and Provides information about a source when citing or paraphrasing it. Uses language that is clear; Has a few errors in spelling, grammar, and syntax; Is well organized, logical, and clear; Uses original language and uses direct quotes when necessary and/or appropriate; and Provides information about a source when citing or paraphrasing it. Uses language that is unclear and/or inappropriate; and/or Has more than occasional errors in spelling, grammar, and syntax; and/or Is poorly organized, is at times unclear and confusing, and has some problems with logical flow; and/or Reflects an underuse of original language and an overuse of direct quotes and paraphrases; and/or Sometimes lacks information about a source when citing or paraphrasing it.  Uses unclear and inappropriate language; and/or Has many errors in spelling, grammar, and syntax; and/or Lacks organization in a way that creates confusion for the reader; and/or Contains many direct quotes from original source materials and/or consistently and poorly paraphrases rather than using original language; and/or Lacks information about a source when citing or paraphrasing it.