Category: Essays

Instruction:
Discussion Topic: Read the case study on p. 299 of your textbook. Based on the information provided and your own research, which procedure would you recommend to me should I develop a blockage of the carotid artery? Make a persuasive case for your choice. [And, yes, you can ask me questions about my medical history in the discussion topic. But please read the Medical Q & A post to see if your question has already been answered.] Here is the instruction Q&A.
Do you or any family members have a history of stroke, heart disease, heart attack, seizures?
Yes. My father has angina, many cardio stents, and history of a double bypass. My mother has a-fib. Both grandmothers died of strokes. One grandfather had a ruptured aortic aneurysm.
Have you ever been diagnosed with any blood-thinning issues?
No
Any allergies to contrast dye that you are aware of?
Not that I’m aware of.
Do you know if the buildup in your carotid artery has narrowing of more 70%? Narrowing of 50-70%?
The narrowing is 65%.
History of irregular heart rhythm?
No . . . except when grading papers. [I’m kidding!]
Any bleeding in the brain in the past two months?
Gosh, I hope not!
History of kidney disease?
No
Any known allergies to medications?
I am allergic to most substances known to mankind, including 99.9% of all painkillers. I am not exaggerating. It is a very real problem. I have to carry a flash drive with all my allergies on my person at all times.
Do you exercise regularly?
I swim three times a week. I also torment the law school basketball league every chance I get.
Do you have risk factors of stroke such as hypertension or smoking?
I have never smoked. I do not have hypertension, but I have had high cholesterol in the past.
How old are you?
Proudly, I turned 50 years in May!
How much do you feel this condition currently interferes with your daily activities?
My condition is noticeable.
How do you feel about needing to take blood thinner medications daily?
I’m concerned about blood thinners because I bruise very easily without them. Plus I’m a natural-born klutz. I’m hobbling around on a broken leg right now.
If your lifestyle needed to change after the surgery, would it be easy for you to do?
It would be much easier for me than most people since I survived a near-fatal car crash and had to learn to walk and function all over again at the age of 25. Hence, why I am not playing in the WNBA.
Height and weight
I am 5′ 6″ and weigh ~140 lbs.
One thing no one asked but I will offer unsolicited: I am terrified of being incapacitated by a stroke (after watching what my grandmothers went through).
Also, I prefer sedation or general anesthesia to local anesthesia. If I can hear or see anything, I would probably have a panic attack.
Is your cholesterol being treated with medication or just diet and exercise?
I do take atorvastatin for high cholesterol, but it’s still well controlled by diet and exercise. The drug is merely a safeguard given my strong family history. [Even on medication and a strict diet, my father’s cholesterol level is well over 400.]
Do you have a pacemaker or anything of the sort that a magnet will pick up in a test, (i.e., MRI)?
My entire body is held together by metal and mesh.
Are you diabetic or pre-diabetic?
I was pre-diabetic a year ago. But I was able to control it with diet. Now my counts are normal. However, both my parents and my maternal aunts and uncle are diabetic.
Have you ever had neck surgery?
No, that’s one surgery I have not had to endure.
Do you ever experience slight to severe chest pain at all?
No
What is your medical procedure preference? Why?
Nice try, but this is your assignment, I have given you all the information to offer your recommendation to me. This is about the only question I won’t answer. I mean, come on, I gave you my age and weight!!! What more do you want? LOL

Now here is the student answer that need to respond back to them.
Student1:

Bailey, Hoyt and Yoshihasi (2012) state the two fundamental principles of evidence based medicine (EBM) include an ordinal ranking of evidence and evidence without patient preferences, values and circumstantial information is not sufficient when making a medical decision. Clinical practice guidelines (CPG) along with EMB help to standardize medical care. “Such standardization implies that clinical practice should be consistent with the best available evidence that would apply to the majority of the patients (Bailey et al, 2012).” In regards to your health question; based upon CPG, EBM and your Q&A, I would recommend an endarterectomy if you ever develop a carotid artery.
Based upon evidence found in a random controlled trial (RCT) to determine the best surgical procedure for a carotid artery; the EBM and CPG relied on patient preferences and values as a contributing factor in making the best medical determination. The study conducted by Murad, Shahrour, Montori, Sha, and Ricotta (2011) highlighted that when compared to endarterectomy, stenting had a relative risk (RR) factor of 1.45 with a confidence interval (CI) of 1.06-1.99 which demonstrated an increase in risk of stroke and a RR of 0.43 and CI of 0.26-0.71 resulting in a decrease in the amount of heart attacks. The RR for stenting was > 1 which means the chances of having a stroke are increased. The RR for heart attacks was <1 which means the risk of heart attacks decrease. To break it down in layman’s terms, out of total of 7,848 patients for every 1,000 patients opting for stents nineteen more patients would have strokes ; while ten less patients would have heart attacks (Murad et al, 2011). The 95% CI means the numbers are pretty accurate. You do not present any current cardiovascular concerns besides your family history. You are petrified of strokes and stenting will increase the chances of a stroke over time. My recommendation is centered on expert recommendations; the relevancy of the recommendations to your specific case; and the appraisal and validity of the CPG overall. I took into consideration your family history of cardiovascular diseases, your current medical state, and unsolicited information regarding strokes in making my recommendation. I would like to know your past medical exposure to radiation so I can discuss the amount of radiation involved in the procedure. I would presume your fatal car crash recovery required many x-rays. Having an endarterectomy and stents both have their pros and cons, but considering all of my research I am a proponent of my final recommendation. Please let me know if you have any further questions or concerns. References Hoyt, R. E., Bailey, N., and Yoshihasi, A. (Eds.). (2012). Health Informatics: A Practical Guide for Healthcare and Information Technology Professionals. (5th ed.). Murad MH1, Montori VM, Ricotta JJ. Shah ND, Shahrour A, (2011). A systematic review and meta-analysis of randomized trials of carotid endarterectomy vs stenting. JVasc Surg. 2011 Sep;54(3): 832-6. Student 2: From my review of your medical Q&A, I observe that you have a high probability of developing heart disease, attributable to your family history, and carotid artery disease or the narrowing of the carotid artery. Should you develop a blockage of the carotid artery, I would recommend the surgical endarterectomy procedure for the following reasons: 1. According to the evidence of the case study, stenting was associated with an increased risk of stroke and decreased risk of myocardial infarction; the evidence proves that the surgery is better in reducing incidences of stroke. 2. According to Hoyt, et al (2012) “the second principle of evidence-based medicine (EBM) states that patients’ values and preferences are essential in the process of decision making” (p.290). In the Q&A, you mentioned that you are terrified of being incapacitated by a stroke another reason I recommend the surgical option is because of your aversion to stroke (not that anyone would want it anyway). 3. Again, Hoyt, et al (2012) stated that “patients vary in their surgical risk e.g. those with a history of heart disease may prefer less invasive procedure to avoid prolonged anesthesia (p.299).” On the flipside, you noted your preference to sedation or general anesthesia to local anesthesia in order to avoid a panic attack. This is also why I believe in surgery as your best option. Evidence-Based medicine from my perspective is a pathway to achieve the highest level of quality in healthcare through unbiased and substantial medical evidence. Sackett, et al. (1996) defines EBM as “the integration of best research evidence with clinical expertise and patient values”. According to Hoyt, et al. (2012) “clinical practice guidelines (CPGs) obtain the best of evidence-based medical information and create a treatment strategy to treat a specific disease or ailment.” These strategies are meant to reduce costs and also improve the health of the patient. From experience, medical performance is based on quality and quality is based on evidence; to achieve quality care, Clinicians must have access to the best available medical care hence the need for Evidence-Based Medicine. Realistically, today, a lot of challenges arise from EBM practice such as situations where results may not be applicable to every patient population. I believe that in spite of these limitations, its benefits outweigh those limitations. REFERENCES Sackett D. L, Rosenberg W. M C, Gray J A M, Haynes R. B, Richardson W. S (1996). Evidence based medicine: what it is and what it isn't. BMJ 312:71 Hoyt, R. E., Bailey, N., and Yoshihasi, A. (Eds.). (2012). Health Informatics: A Practical Guide for Healthcare and Information Technology Professionals. (5th ed.). Raleigh, NC: lulu.ISBN: 978-1105437557 Health Informatics, Chapter 15: Evidence-Based Medicine and Clinical-Practice Guidelines

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this paper discuss the gibbs reflective cycle and it should include 6 parts which are describe,explain,evaluate,analysis,conclude and action plan. i will send exemplar but with different issue in this work i would write about medication error, please use 4-5 reference journal article with 5 years old.

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The links of three articles:
http://writing.colostate.edu/files/classes/6500/file_ec147617-ade5-3d9c-c89ff0384aeca15b.pdf

http://thevalueofsparrows.com/2013/07/06/saturday-reading-entering-into-the-serpent-by-gloria-anzaldua/

http://sydbrown.net/wp-content/uploads/2008/06/John-Edgar-Wideman-Our-Time.pdf

In “Arts of the Contact Zone,” Mary talks about the “autoethnographic” text, “a text in which people undertake to describe themselves in ways that engage with representations others have made of them”, and about “transculturation,” the “processes whereby members of subordinated or marginal groups select and invent from materials transmitted by a dominant or metropolitan culture”.

First, summarize and analyze Pratt’s argument. What are the contact zones and what type of representations come out of them? Explain and consider her use of the terms “ethnographic texts,””autoethnographic texts,” “autochthonous texts,” and “transculturation.” Why are these types of writings important? What do they signify?What qualifies a text as autoethnographic, and what cultural work do those texts perform?

Then, reread “Entering into the serpent” and “our time” with Pratt’s discussion in mind. In your essay present a reading of Anzaldua and Wideman as examples of autoethnographic texts. In what ways do these texts fit Pratt’s description? Are there any ways in which they do not fit the qualifications for an autoethnographic text? Why is it important to consider these texts in this way? What does it add to our understanding of them?

Remember that beyond merely summarizing Pratt’s argument, you need to discuss the importance of these issues and apply her terms to specific moments you see in Anzaldua and Wideman. You must use strong textual evidence from all three texts and consider in your conclusion the significance of autoethnographic projects and your readings of these texts.

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The subject area is more of a political linguistics or political discourse analysis.
Number of sources/references : as many as possible
(The internet references : the least, the better)

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NUTH 1004
Dying with Dignity

Reflection Paper

Write a paper based on your own personal feelings or reflections and relate it to course material.
Consider:

� Your own beliefs, values, fears, experiences and cultural background surrounding death and dying.
� The meanings and messages found in �Tuesdays with Morrie – an old man, a young man, and life�s greatest lesson.� ISBN: 978-07679-0592-3
� What have you learned about yourself from this class?
� How will these teachings influence the care you will provide to others?
� What do you think and feel about the concepts found in the reading?
� All papers are expected to be typed using 12 font and double spaced.
� 1-2 pages long with use of APA format

� All papers for this course will be graded on the following criteria:
Clarity of writing (20pts)
Creativity of writing style (20pts)
Relevancy of topic to class (20pts)
Good use of spelling and grammar (20 pts)
Use of APA format ( 20pts).
There is no one right or wrong answer here. This paper will be your own reactions to a topic or self-reflection.

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compare the works of J.S. Bach from the early 1700�s and Franz Liszt from the 1800�s. They both were accomplished keyboardists. However, their styles were very different. Despite the vast differences, there are some overlapping similarities between these two musicians. Explain in a short 1 to 2 page essay how the two composers were similar and how they were different. What cultural similarities did they share? How was society different, thus creating distinctive musical styles. This is to be kept brief. Make sure this is not simply a biography of the composers. Try using their most famous compositions. Focus the essay on their music.

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History
Assignment #3: Book Analysis: The growth of technology (American Genesis) by Thomas Hughes.
Worth 100 points

In Assignment #3, you will critically analyze a book related to US involvement in either
(a) the wider world (Overthrow or A People’s History of American Empire) or (b) the
growth of technology (American Genesis) or (c) sports and how sports history has
intertwined with politics and culture (People’s History of Sports).
To clarify, if you chose Overthrow or People’s History of Am. Empire, you will ONLY address the
topic of the US in the wider world in this analysis; you do not need to address the topic of the
growth of technology or sports. If you chose American Genesis, you only need to address the
growth of technology in the US; you don’t need to cover the US in the wider world or sports. If you chose People’s History of Sports, you only need to address sports history and how it interweaves
with politics and culture; you don’t need to cover the US in the wider world or technology.

The Assignment Guidelines and Objectives:

Part 1:Summary – ½ to 2/3 of a page, double-spaced (approximately)

Here you will write a brief, clear summary of the book. In the summary, be sure to
include:

• basic introductory information about the book (author, title, date of
publication)
• the author’s central argument (or thesis statement) and main points
• the basic narrative of the book (What is the overall “story” that the author is
trying to tell? Explain briefly.)
• mention a few specific examples (you don’t have to delve too deeply into the
examples, but you should mention them here)

Part 2: Analysis – 3/4 to 1.5 pages, double-spaced (approximately)
Here you will analyze the author’s interpretation of US involvement in either (a) the
wider world or (b) the growth of technology or (c) sports history & accompanying
political, social, and cultural changes. In this section, include analysis of the following,
focusing on:

• who and what the author included in his/her interpretation of US involvement
in either (a) the wider world or (b) technology or (c) sports, including a few
examples that they chose to include (and your analysis of how these choices
– of what to include – shaped the author’s narrative)
• who and what the authors chose not to include in their interpretation of US
involvement in (a) the wider world or (b) technology or (c) sports (and your
analysis of how these choices – of what not to include – shaped the author’s
narrative)
• the style and tone of the writing (and your analysis of how this shaped the
narrative)
• any biases or specific perspectives that the author demonstrates in the writing
(and your analysis of how this shaped the narrative)
• If mentioned by the author, discuss any evidence that the authors use to
support their interpretations (and how this evidence shaped the narrative).

Part 3: Your Interpretation of US involvement in the wider world or technology or
sports, as informed by the reading – ¾ to 1 page, double-spaced approximately

In this section, you will briefly explain what you believe to be the most important and
enriching information about the history of US involvement in the wider world or the US
history of technology or sports history & accompanying political, social, and cultural
changes. In other words, you will now briefly explain your own interpretation of this
history, after reading this book. Include:

• what you believe are the most important and enriching issues related to the
topic of US involvement in the wider world or the US history of technology or
US sports history (and an explanation of why these are important and
enriching issues)

• your opinion as to what is most valuable and least valuable from the book
(even if you think everything is valuable or nothing is valuable, you need to
address what you think is of most value and what is of least value)

• your opinion of this book. Do you like it? Does it affect your understanding of
the past and/or the present? Would you recommend it? To whom… and
why?

Format & Instructions for Submitting through the Dropbox:

1. This assignment should be about three or four pages total, double-spaced with reasonable
margins and fonts.

2. Please label the different sections: Part 1, Part 2, and Part 3.

3. Be as clear as possible in your writing and use standard academic language.

4. Use your own words. Don’t rely on quotes from the book or a book review you can
find online. When discussing another author’s ideas, you must either paraphrase (put it in
your own words) or quote the author. If you quote the author, you must cite the source,
including the page number.

5. Cite your sources at the end of the paper, using the Chicago format. You must cite your
sources, even if the only source you used was the book you are reviewing. A link to a quick
guide to Chicago style is: http://www.chicagomanualofstyle.org/tools_citationguide.html

6. Please save this document in a simple “word” format, simple text or rich text file, or in a “pdf”
format. Attach the file to the folder “Assignment #3” in the Dropbox.

Remember that no late work will be accepted, so be careful of this deadline.

Grading:
Part 1 – Summary: worth 20 points
Part 2 – Analysis: worth 40 points
Part 3 – Your Interpretation of the Subject: worth 30 points
Quality of writing: worth 10 points
Total: 100 points
Grading Criteria: When evaluating this assignment, I will be grading on the following criteria: (a) clarity,
(b) relevance and thoughtfulness, and (c) thoroughness of covering the themes specified in the bullet
points of the assignment guidelines.

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Tina grew up in Campbell River and started her studies at VIU this fall. To help save money she decided to live at home. Discuss the opportunity costs of her decision on choice of residence.

Draw the marginal benefit curve for the consumption of candy and explain the shape that you chose to represent.

For each of the following state the effect each scenario would likely have on demand or quantity of lumber demanded.

The American housing market is starting to rebound and the number of new homes being built skyrockets.

The cost of logging permits falls leading to a lower price for lumber.

The cost of steel and concrete skyrockets.

The show Canada’s Handyman Challenge has inspired many Canadians to pick up wood working as a hobby.

The wages of loggers is increased leading to a higher price for lumber.

The Nanaimo Swim Center is pondering raising the price of admission from $6 to $6.60 to increase revenues. The managers survey the community and estimate that the number of paid admissions would fall by 20 percent. Calculate the price elasticity of demand using the point formula and state whether this fee increase would increase or decrease revenues.

The following equations describe demand supply and supply for kayaks in Nanaimo:

Supply = 3P-300

Demand = 3700-2P

Using this information draw the supply and demand curves and calculate the equilibrium quantity and price for kayaks in Nanaimo.

Discuss and show graphically how the supply and quantity of tomatoes would change due to the following events:

Farm workers organize a union and bargain for a $2/hr wage increase.

New innovations in hydroponics and greenhouses make it cheaper and easier to produce tomatoes year-round.

Tomatoes become much more popular and everyday usage expands greatly.

The late summer and early fall is marked by frequent rains and extremely cold nights.

The cost of fertilizer falls sharply.

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Memo
To: Marcus Peters, Exploration Analyst.
From: James Wright, VP Exploration.
Subject: Irish Sea Option
Priority: HIGH.
This Memo contains market sensitive information and is to be treated as CONFIDENTIAL.

In line with the company’s strategic intent to diversify our current operations beyond N. America, The Netherlands, Nigeria and Angola the Board has requested a briefing on Offshore Ireland. In particular there is interest in a Farm-In option to a License held there.
Just to give you some background, we have had sight of some encouraging 3D seismic intimating significant hydrocarbon resource (confirmed by a separate competent persons report). The existing license holder and their partners have supplied us with an Investment Appraisal Document. However, the Board has requested that we prepare our own Appraisal Documents and run the data through our own Capital Approval Process.
Whilst I have not as yet been able to meet with the Chairman to confirm the exact documentation required we can at this stage assume that we will, at the very least, need to start with a a briefing document that provides Historical Exploration and Production Data for Ireland.

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To what degree is Diego Velazquez�s Las Meninas typical or representative of the northern Baroque period? Which of the arguments of art critics, Joel Synder and Svetlana Alpers, (or any other arguments put forth in the handout) seems most reasonable to you and why? What does it suggest to you that the princess seems to be dividing her attention between what is in front of her and the window? Finally, why, do you imagine, has this painting become so famous? In other words, what is it about, besides being a portrait of Philip IV�s family? Or in other words, what in your opinion is special or mysterious about the painting?
Note: This is not a research assignment. To do an outstanding job, you only need to consult your book, along with the class handouts, to orient you regarding the cultural context of the artifact. What�s most important is that you answer the question with critical observation and analysis of the artifact and the materials given in class. If you decide you would like to do research (which is fine), be sure to document your sources properly.
� Be sure to properly document your sources using MLA format.

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