Alcohol Abuse or Dependence?

Discussion Question: Alcohol Abuse or Dependence?

Consider a woman who gets intoxicated on alcohol three or four times a year and each time fights with someone and destroys property, either hers or somebody else’s. Provide a 500 word or more response on the following:

Would you diagnose her with a substance use disorder? Why or why not?
Would you think differently regarding your diagnosis if she were 16 years old vs. 28 years old or 58 years old?
What else would you need to know to make an accurate diagnosis?
What assessment methods should be used to make an accurate diagnosis? Support your viewpoint by using at least two examples.
As appropriate, cite the online course, the textbook, and other credible, scholarly sources to substantiate the points you are making.

psychology 15

In your opinion considering all that you have learned about adolescence what do you think are the most difficult hurdles an adolescent may struggle to overcome? Explain and give details.
support your posting with empirical (peer-reviewed) research and provide the appropriate APA citation
Minimum word requirement is 250 words
will reflect proper grammar spelling organization length citations content of the knowledge reasoning and APA citation and referencing
references can not be older than 4 years.

Family Health Assesment

Select a family to complete a family health assessment. (The family cannot be your own.)

Before interviewing the family, develop three open-ended, family-focused questions for each of the following health patterns:

Values, Health Perception
Nutrition
Sleep/Rest
Elimination
Activity/Exercise
Cognitive
Sensory-Perception
Self-Perception
Role Relationship
Sexuality
Coping
NOTE: Your list of questions must be submitted with your assignment as an attachment.

After interviewing the family, compile the data and analyze the responses.

In 1,000-1,250 words, summarize the findings for each functional health pattern for the family you have selected.

Identify two wellness problems based on your family assessment.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

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

You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.

Supply of health services

Note: The Instructor will post the document for this Assignment by Day 1 of Week 4.
To deliver health care services, an ACO needs to create a competent workforce that can provide health care to the patients that are in the ACO. Some integrated ACO entities already have employed physicians and mid-level providers that receive salaries from the organization, whereas other non-integrated ACO entities need to invest in external relationships with independent physicians and other providers.

Since ACOs do not have managerial control over non-employed providers, additional controls and incentives may be necessary to ensure that efficiency is maximized.
ACOs also need to consider the number and mix of specialists (e.g., family practice vs internal medicine) and mid-level providers (e.g., physician assistants and nurse practitioners) in delivering primary care services that can promote value. Maximizing value requires appropriate workforce decisions on supply and incentives to encourage providers to minimize costs. For this Assignment, examine the Week 4 Assignment document and consider the efficiency in the supply of health services.

To prepare for this Assignment:
Review the scenario and Week 4 Assignment document provided to you by the Instructor. Based on the financial data, conduct a financial projection (revenues, expenses, and profit) that analyzes the efficiency of the supply of health services.
Note: This Assignment will be graded using this rubric: Document: Week 4 Assignment Rubric (Word document)
The Assignment:

reimbursement method: salary or fee-for-service; 3) recommendations for financial incentives to address the challenges of supplier-induced demand and how to ensure efficiency. Interpret the net profit from the ACO contract based on your recommendations. Explain the rationale behind your recommendations, including the impact made by your financial calculations.
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Breast Cancer

The required elements: Your paper should contain the following elements in the order listed below.

Abstract – this section must contain the following:

Topic Sentence: Your abstract must contain one sentence that clearly and concisely introduces the topic of the paper

Content Sentences: Your abstract must mention the following five main topics of the paper: introduction, statistics/epidemiology, financial costs, anatomy & physiology/etiology, diagnosis/treatment/prognosis

Conclusion Sentence: Abstract contains one sentence that mentions key conclusions and/or findings, future directions/research

Main Body – this section must contain the following five main topics (the subtopics are recommendations to use if appropriate to your disease/condition):

Introduction:

Thoroughly define the disease/condition

History of the disease/condition

Statistics/Epidemiology:

Statistical prevalence (e.g. overall, gender, age)

Types of distributions (e.g. frequencies, patterns)

Types of determinants (e.g. causes, risk factors)

Financial Costs:

Costs to the individual/family

Possible costs to society

Loss of productivity

Anatomy & Physiology/Etiology:

The normal and abnormal structure & function behind the disease/condition

Cause(s) of the disease/condition

Diagnosis/Treatments/Prognosis:

How this disease/condition is diagnosed (e.g. history, exam, diagnostic imaging, labs)

How the condition/disease is treated (e.g. traditional medical treatments, alternative methods of treatment)

The prediction of this disease/condition’s outcome

Conclusion – this section must contain four to six sentences that sum up the main topics of the paper.

Reference Section – this section must contain the following:

This is not just a separate section; rather, referencing should occur throughout the paper via parenthetical citations anytime you paraphrase or make direct quotes. Please be sure to cite any language in the paper that should be cited. Your paper should also have a final reference page listing 5-10 credible sources researched for your paper.

Do not include your critique/summary from Assignment 2: Annotated Bibliography; simply list the references utilized in your paper in APA format on the reference page.

Please make note of the following tips and tricks:

There is no minimum word count for this paper; however, your paper should be thorough and include all the required components listed in the instructions and rubric.

Please note that less than 10% of your paper should contain direct quotes.

Avoid bulleted lists within the body of your paper.

Do not write in first or second person.

One last reminder: be sure to properly cite your work, both internal to the paper as well as within the reference page.

Plato’s Republc

Topic: Plato’s Republc
Order Description
Write a four page paper on the following questions and their answers. Be specific in your references to the text.
1. What are the arguments that Thrasymachus and Glaucon make for the superiority of living immorally?
2. What are the arguments that Socrates makes for the superiority of living morally?
3. What is training that the ?Guardians? of a just society must go through? Which things are they to avoid and which they are supposed to indulge in?
4. Why is the ?Philosopher King? considered the best option for leadership of a just society? What are the positive characteristics of the ?Philosopher King??

Nursing Informatics and the Foundation of Knowledge.

Review the information in Figure 6–2 in Nursing Informatics and the Foundation of Knowledge.
Develop a clinical question related to your area of practice that you would like to explore.
Consider what you currently know about this topic. What additional information would you need to answer the question?
Using the continuum of data, information, knowledge, and wisdom, determine how you would go about researching your question.
Explore the available databases in the Walden Library. Identify which of these databases you would use to find the information or data you need.
Once you have identified useful databases, how would you go about finding the most relevant articles and information?
Consider how you would extract the relevant information from the articles.
How would you take the information and organize it in a way that was useful? How could you take the step from simply having useful knowledge to gaining wisdom?
By Day 7 of Week 4
Write a 3- to 4-page paper that addresses the following:

Summarize the question you developed, and then relate how you would work through the four steps of the data, information, knowledge, wisdom continuum. Be specific.
Identify the databases and search words you would use.
Relate how you would take the information gleaned and turn it into useable knowledge.
Can informatics be used to gain wisdom? Describe how you would progress from simply having useful knowledge to the wisdom to make decisions about the information you have found during your database search.

Nurse Change Project

Change project: In South Florida patients with type 2 diabetes, does lifestyle modification such as diet and physical activity help lower HBA1C compared to

those who do not make life style changes.

Write a literature review of your change project topic using peer-reviewed articles, books, and evidence-based guidelines. Identify and cite all sources of data according to APA guidelines. The goal is to review and critique the most current research to support your change project; this research will help drive the focus of your research.Summarize the key findings and provide a transition to the methods, intervention, or clinical protocol section of your final paper. Describe any gaps in knowledge that you found and the effects this may have on nursing practice as it relates to your change project topic. The literature review should be a synthesis of how each article relates to your change project. Also, when writing your literature review, remember to include subtopics to your main topic and gather data on these areas as well. For example, if you are doing a project on cancer, then subtopics for cancer treatments should be included.

A minimum of 10 Peer-reviewed articles

Literature is supported by scientific evidence that is credible and timely. Subtopics

are used to support the main topic.

Presents a thorough and insightful analysis of significant findings related to the change project topic. Ideas are synthesized and professionally sound and creative. Insightful and comprehensive conclusions and solutions are present

Your integrative literature review should be at least 6 pages

According to The Institute for Health Care Improvement (2006), “

According to The Institute for Health Care Improvement (2006), “Continuing Education (CE) is a vehicle for spreading best practices and how to improve patient outcomes.” In short, continuing education assists with keeping health care teams well-informed of current research, laws, regulations, and practices in the fields in which they practice.

Massoud M. R., Nielsen, G. A., Nolan K., Schall, M. W., Sevin. C. (2006). A Framework for Spread: From Local Improvements to System-Wide Change. Retrieved from http://www.ihi.org/resources/Pages/IHIWhitePapers/AFrameworkforSpreadWhitePaper.aspx

Review the following literature:

Belliolio, M. F. & Stead, L. G. (2009). Continuing Education Meetings and Workshops: Effects on Professional Practice and Health Care Outcomes. Annals of Emergency Medicine. 53(5). 685-687.

Filipe, H. P., Sliva, E. D., Stulting, A. A., Golnik, K. C. (2014). Continuing Professional Development: Best Practices. Middle East African Journal of Ophthalmology. 21(2), 134-141. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4005177/

Based on your research of professional literature and the literature above, in a 3 page scholarly evaluation essay:

Chemical Analysis

Chemical Analysis
INSTRUCTIONS TO CANDIDATES
1. There are NINE questions on this paper worth a total of 180 marks.
2. You should complete ALL questions.
Question 1: X-Rays (5 + 5 + 5 + 5 + 3 + 2 = 25 marks)
a) Explain the chemical principles behind the medical imaging method known as a CT scan. Your answer should include a description of the radiation source and how that radiation interacts in order to produce a medically useful diagnostic image. What applications can this be used for, and what are the advantages and limitations?
b) Similar spectroscopic methods utilising X-rays include XRF and XRD techniques. What do XRF and XRD stand for? Explain the difference between these two methods.
c) Suppose you have three different formulations of paracetamol tablets, where each formulation utilises a different polymorph of paracetamol in the solid state (a polymorph is a different crystal structure of the same material). You are given the task of analysing the different formulations to work out which polymorphic state of paracetamol is used in each of the formulations. You have also been asked to analyse for metal content in these tablets. Suppose also that the only instruments you currently have available to you are XRD and XRF. Explain which technique would you use to analyse for:
i) the polymorphic state, and
ii) the metal content.
d) How would you prepare the tablets for the analyses above?
e) Superman is rumoured to have X-Ray vision. Apparently he can see through brick walls using this amazing superpower. But is this realistic? If I set up an X-Ray source and detector, will I really be able to see through a brick wall? Briefly explain your answer.
f) Is Ironman better than Superman?
Question 2: Drug tests (10 + 5 + 5 = 20 marks)
a) There are a wide range of drug-test strips available for many different applications. Such tests have been recently introduced by Victoria Police to test to see if drivers have been taking drugs and driving. Equally, there are a lot of simple assays using strips to test for compounds like glucose and cholesterol. Choose a test for a particular drug or biomarker (there are test strips for amphetamine, marijuana, cocaine, cholesterol etc), and explain how the strip works. Your answer should include:
i) Are other ancillary devices required to analyse the strip? Explain.
ii) Are these methods of analysis quantitative? Explain your answer.
iii) Describe one major limitation of the method?
b) Because blood glucose monitoring is extremely important for diabetes patients, and the instances of diabetes is increasing dramatically, a lot of research has been undertaken to develop new sensing technology that is non-invasive and does not require a blood sample form the patient. One such technology is based on the electromagnetic emissions in the near-infrared part of the spectrum. All objects emit IR radiation, and both the intensity of the radiation and spectral characteristics of the object are determined by its absolute temperature as well as by the properties and states of the object. Researchers believe that, by placing a sensor close to the skin, these IR emissions can be used to estimate the amount of glucose in blood. Recent research has shown that glucose sensors based on this technology are at least as effective as the current electrochemical sensors requiring patients to place a blood sample on a test-strip.
i) How is it possible that you could use the total IR emission spectrum from the human body to specifically measure glucose concentrations?
ii) Would such an IR-glucose device require calibration? How might this be done?
c) The use of cannabis for medicinal purpose has become a hot topic in recent times. Both leaves and seed contain a range of compounds that can potentially be very useful from a therapeutic perspective. However, many of these compounds are also problematic and potentially dangerous to long term health.
A recent article published in the journal of Nutrition stated the following:
‘The distribution of heavy metals content in cannabis leaf and seed were investigated. The heavy metals determined in samples were arsenic, cadmium, chromium, iron, nickel, lead mercury and manganese. The results obtained revealed that metal levels in cannabis leaf exceeded those of cannabis seed except in manganese, which had the highest metal content among all the metals determined. The results further showed that the As, Cd, Cr, Fe, Ni, and Hg levels in cannabis leaf exceeded those of the cannabis seed.’
i) How might you prepare the cannabis leaves for analysis? What instrument would you use?
ii) Would you change anything in the sample preparation for the analysis of the seeds compared to the leaves?
Question 3: pH, sodium chloride and cheese (5 + 10 + 5 + 5 + 5 + 5 + 5 + 5 = 45 marks)
a) If I measure the pH of a particular phosphate buffer, the meter reads 7.2. If I add NaCl to this solution, the pH changes. Why does this happen? Is it that the NaCl is acidic or basic?
b) Suppose the ionic strength of the pH 7.2 phosphate buffer mentioned above is 30 mM. Estimate the pH of this buffer solution if I add enough NaCl to give an ionic strength equivalent to that of blood (assume blood has an ionic strength equivalent to 0.9% w/v NaCl). Hint: OK, even though this is an open book exam, you might need to realise that this is a question about calculating and applying activity coefficients! (MW NaCl = 58.5 g mol-1)
c) If I now try to measure the pH of blood plasma I find after a few measurements that the response of the electrode becomes very slow. Suggest a possible cause (I don’t want a list of every possible thing you may have written in your book, I want the most likely problems for this situation!).
In a determination of sodium chloride in a cheese sample, the Volhard method was used.
d) After sample preparation, 50.00 mL of 0.1040 M AgNO3 was added. The titration of excess silver required 21.05 mL of 0.067 M KSCN with. If 10.0 g of cheese was used for the analysis, estimate the %w/w of NaCl in the cheese sample.
e) The endpoint of the Volhard titration requires Fe3+ to be present in solution. Suppose the solubility product for Fe(OH)3(s) is 1.0 x 10-28 (the fact that I have given you this information is a hint in this question). Is the pH of the solution to be titrated likely to be an issue in the Volhard method? Should a low or high pH be used? Explain.
f) Refering to part e) above, red ferric thoicyanate complex becomes visible when the concentration of Fe is around 1 x 10-7 M. Estimate the maximum pH of a solution containing both Fe and SCN- so that the red FeSCN complex still forms.
g) The general method for the Volhard method requires removal of the AgCl precipitate prior to titration with SCN-. Why?
h) For titrations of Br and I- via the Volhard method, no filtration step is required. Why might we have to remove ACl, but not AgBr or AgI?
Question 4: A really big chromatography question (8 + 3 + 2 + 5 + 10 + 5 + 5 + 5 + 2 + 5 = 50 marks)
Barbiturates are drugs that act as central nervous system depressants, and can therefore produce a wide spectrum of effects, from mild sedation to total anaesthesia. They are also effective as anxiolytics, hypnotics, and anticonvulsants. Barbiturates also have analgesic effects; however, these effects are somewhat weak, preventing barbiturates from being used in surgery in the absence of other analgesics. They have addiction potential, both physical and psychological. Barbiturates have now largely been replaced by benzodiazepines in routine medical practice – for example, in the treatment of anxiety and insomnia – mainly because benzodiazepines are significantly less dangerous in overdose. However, barbiturates are still used in general anaesthesia, for epilepsy, and occasionally for the treatment of recurrent migraines and cluster headaches (under stringent protocols with mandatory physician monitoring for addiction and abuse). Barbiturates can also be obtained illegally, and clandestine laboratories around the world produce ‘cocktails’ of barbiturates to supply the illegal drug market.
Suppose you work in the ‘CSI’ laboratory, and you have been asked to quantify and identify a powder obtained from an illegal laboratory. It contains a mix of barbiturate compounds. In order to complete the quantification step you decide to use a HPLC method using a C8 reverse-phase column with an 60:40 acetonitrile:water mobile phase buffered at pH 3. A series of standards of five different barbiturates was run and the chromatogram below was produced. Detection by UV at 228 nm. The compounds corresponding to each of the peaks are given in Table 1.
Table 1: Peak identification of the barbiturates (with their concentrations) in standard solution. Numbers correspond to the peak in the chromatogram.
1. Barbital (0.4 mg mL-1)
2. Phenobarbital (0.1 mg mL-1)
3. Talbutal (0.4 mg mL-1)
4. Amobarbital (0.4 mg mL-1)
5. Mephobarbital (0.1 mg mL-1)
The structures of the barbiturate compounds used in the standard are below (in no particular order).
a) Using the relative retention times in the chromatogram, and the information in Table 1, assign a name (barbital, phenobarbital, talbutal, amobarbital, mephobarbital) to the structures above (redraw the structures in your exam book).
b) You will note from Table 1 that the standard solution contained phenobarbital and mephobarbital at a concentration of 0.1 mg mL-1, whilst all of the other compounds are present at the higher 0.4 mg mL-1 concentration. Despite the different concentrations used, the peak areas are approximately the same, explain why this might be the case.
c) The pKa of all these barbiturates is about 4.5. Are they acidic or basic compounds? What is the functional group responsible for this behaviour?
d) The pH of the mobile phase was set to 3. Why would this be the case? What would happen to the chromatography if the pH was set to 6?
e) If the molar mass of barbital is 184 g mol-1, and the pKa is 4.5, calculate the percent of the compound that would be ionised in a standard solution where the concentration is 0.4 mg mL-1.
f) Would the proportion ionised change from that you calculated above if the barbital is dissolved in the 60:40 acetonitrile:water mobile phase instead of pure water? Explain your answer.
g) If instead of using a C8 column you switched to a cation exchange column where the mobile phase was set to pH 2, what would happen to the chromatography? You should comment on peak shape and retention time.
h) OK, so now you switch to an anion exchange column where the pH is buffered to 8. What would you expect to happen to the chromatogram? Again comment on peak shape and retention time.
i) Do you think you could use a GC method for this analysis? Explain your answer.
j) If you look at the structure of these 5 molecules, would you be able to distinguish between them using i) IR spectroscopy and ii) HNMR spectroscopy. Comment on what differences you might observe in the spectra in order to differentiate the molecules.
Question 5: Multiple choice (1 mark each = 10)
Find the correct answer to each of the following.
i) How many signals would you expect to see in the 1H NMR spectrum of the following compound?
A) 6
B) 3
C) 5
D) 4
E) 2
ii) If a chemical shift of an NMR signal is 7.2 ppm measured on a 60 MHz NMR spectrometer, how many Hz would this signal be from the TMS signal?
A) 8.3 Hz
B) 432 Hz
C) 0.12 Hz
D) 72 Hz
E) 60 Hz
iii) Using a 60 MHz spectrometer, the protons in dichloromethane appear at 5.30 ppm. When the same sample is placed in a 100 MHz instrument, where does the signal appear?
A) 8.33 ppm
B) 3.18 ppm
C) 5.30 ppm
D) cannot be determined from information given
iv) Which of the methyl groups in the compounds below will exhibit the most downfield (highest) chemical shift in 1H NMR spectroscopy?
A) methyl amine
B) methanol
C) propanone
D) propane
E) toluene
v) What is the ratio of the protons in the following compound?
A) 3:3:3:2
B) 6:3:2
C) 9:2
D) 3:2
E) 6:2
v) What splitting pattern is observed in the proton NMR spectrum for the CH3 hydrogens in the compound below?
A) singlet
B) doublet
C) triplet
D) quartet
E) septet
vi) What splitting pattern is observed in the proton NMR spectrum for the CH2 hydrogens in the compound below?
A) singlet
B) doublet
C) triplet
D) quartet
E) septet
vii) How many signals will be observable in the DEPT 13C NMR spectrum of naphthalene (structure below)?
A) 0
B) 1
C) 2
D) 3
E) 10
viii) Which of the following statements best explains the information we can gain from infrared spectroscopy?
A) It allows us to determine the number of protons in a compound.
B) It allows us to determine the kinds of functional groups in a compound.
C) It allows us to determine the molecular weight and the mass of some fragments of a compound.
D) It allows us to determine the presence and nature of a carbocation in the compound.
E) It allows us to determine the presence and nature of a free radical in the compound.
ix) Which of the compounds below would be expected to show intense IR absorption at 1715 cm-1?
A) CH3CH2CO2H
B) 1-hexene
C) 2-methylhexane
D) CH3CH2CH2NH2
x) Which of the technique(s) listed below can readily distinguish between these two compounds?
A) 1HNMR
B) IR
C) 13CNMR
D) A and B
E) A and C
Question 6: Some short answer ones (5 + 5 + 5 = 15 marks)
a) Deduce the identity of the following compound from the spectral data given. C9H10O2: 13C NMR, d 18.06 (quartet), 45.40 (doublet), 127.32 (doublet), 127.55 (doublet), 128.61 (doublet), 139.70 (singlet), 180.98 (singlet); IR, broad 3500-2800, 1708 cm-1
b) Deduce the identity of the following compound from the 1H NMR data given.
C8H10O: d 3.4 (3H, singlet), 4.5 (2H, singlet), 7.2 (5H, singlet)
c) Spectra A and B below are infrared spectra of 2-methyl-1-butanol and tert-butyl methyl ether. Assign each compound its correct spectrum. Explain your reasoning.
Spectra A
Spectra B
Question 7: Putting it together (15 marks)
Use the spectral data below to identify the major structural features evident in the following spectra, and hence identify the compound (C8H10O2). You should explain your reasoning and cross-reference between the IR, 1H, and 13CNMR, for justifying the proposed structure.