Many if not most of the topics that you studied in the eText and tackled in the discussions and labs are, or will be directly or indirectly impacted by the myriad effects of climate change. At this point in the course, you should be able to assess the various predictions from the climate models and mesh them with what you have already learned to fashion a credible assessment of our planet’s future.
Instructions
Prepare yourself for this discussion by studying the relevant material presented in the two websites linked below. Most of the living scientists who have received the Nobel Prize are members of the first organization in the list. The second two federal agencies are two of the most respected in this country and world. Amazing that our country will listen with rapt attention to everything that NASA has to say about outer space, but ignore what they say about climate change.
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Write a 1000-1500 word essay addressing each of the following points/questions. Be sure to completely answer all the questions for each bullet point. There should be two main sections, one for each bullet below. Separate each section in your paper with a clear heading that allows your professor to know which bullet you are addressing in that section of your paper. Support your ideas with (2) sources (1 outside source and the textbook) using citations in your essay. Make sure to cite using the APA writing style for the essay. The cover page and reference page in correct APA do not count towards the minimum word amount. Review the rubric criteria for this assignment.
Part 1:
Describe the eight steps to integrating evidence-based practice into the clinical environment. What barriers might you face in implementing a new practice to address your research topic (as identified in Module 1)? Describe strategies that could be used to increase success including overcoming barriers.
Part 2:
Describe six sources of internal evidence that could be used in providing data to demonstrate improvement in outcomes.
Assignment Expectations:
Length: 1000 – 1500 words Structure: Include a title page and reference page in APA format. These do not count towards the minimum word count for this assignment. Your essay must include an introduction and a conclusion.References: Use appropriate APA style in-text citations and references for all resources utilized to answer the questions. A minimum of one (1) scholarly source and the textbook are required for this assignment.Rubric: This assignment uses a rubric for scoring. Please review it as part of your assignment preparation and again prior to submission to ensure you have addressed its criteria at the highest level.Format: Save your assignment as a Microsoft Word document (.doc or .docx) or a PDF document (.pdf)File name: Name your saved file according to your first initial, last name, and the assignment number (for example RHall Assignment 1.docx)
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Define patient-centeredness in the context of evidence-based practice. Describe barriers to the implementation of patient-centered evidence-based care in your practice environment and share actions that might be taken to alleviate these barriers.
Your initial posting should be at least 400 words in length and utilize at least one scholarly source other than the textbook. Please reply to at least two classmates. Replies to classmates should be at least 200 words in length.
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Summarize the Applebaum article. Based on ethical theories we have considered this semester, state whether there is factual evidence in the author(s)’ claims about mental health treatment or not.
Articulate one thing you learned about the history of institutionalization you were not aware of before this week’s lesson. Why is that important ethically?
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Summarize the Applebaum article. Based on ethical theories we have considered this semester, state whether there is factual evidence in the author(s)’ claims about mental health treatment or not.
Articulate one thing you learned about the history of institutionalization you were not aware of before this week’s lesson. Why is that important ethically?
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PSYCHIATRIC SERVICES ♦http://ps.psychiatryonline.org ♦July 2004 Vol. 55 No. 7 7 75 51 1 A dvance directives have been one of the more promising innova- tions in recent years to give patients a greater voice in their psychiatric treatment (1). Completed when pa- tients are competent, advance direc- tives allow patients to appoint proxy decision makers and to make choices about particular treatments, all to take effect should patients later be- come incompetent to make decisions for themselves. Advance directives have been hailed as a way of encour- aging patients and treaters to discuss future contingencies and to negotiate mutually acceptable approaches to care (2,3). All states have statutes that govern the use of advance directives, which can be applied to general med- ical and psychiatric care, and many states now have special provisions for advance directives for psychiatric care per se.
However, mental health profes- sionals have always been concerned that advance directives could also be used in a less collaborative way. One of the earliest proponents of advance directives, Thomas Szasz—a fierce critic of psychiatric diagnosis and treatment—suggested that people with mental disorders use advance di- rectives to preclude future treatment, especially treatment with medica- tions (4). As Szasz saw it, if advance directives represented the unalter- able choices of competent patients, there would be no way to override the preferences embodied in the direc- tives. This suggestion raised theprospect of a class of patients who would be permanently untreatable, even if they later became psychotic and were hospitalized involuntarily.
Now, in the wake of a decision by the U.S. Court of Appeals for the Second Circuit, that prospect seems closer to materializing.
The case, Hargrave v. Vermont, grew out of a complaint filed in 1999 on behalf of Nancy Hargrave, a woman with a history of paranoid schizophrenia and multiple admis- sions to the Vermont State Hospital (5). Hargrave had completed an ad- vance directive—known in Vermont as a “durable power of attorney for health care,” or DPOA—in which she designated a substitute decision mak- er in case she lost competence and in which she refused “any and all anti- psychotic, neuroleptic, psychotropic, or psychoactive medications.” The major national law firm that repre- sented Hargrave immediately filed suit to block the state of Vermont from overriding her advance directive should she ever again be involuntarily committed and obtained certification to represent the entire class of pa- tients in similar situations.
Hargrave’s target was Act 114, a 1998 Vermont statute that attempted to address the dilemma inherent in psychiatric advance directives. Al- though advance directives were in- tended to facilitate patients’ partici- pation in treatment decisions, they have, as noted, the potential to pre- vent all treatment, even of patients who are ill enough to qualify for civil commitment under the prevailing dangerousness standards. To mitigate this prospect, the Vermont legislature allowed hospital (or prison) staff to petition a court for permission to treat an incompetent involuntarily committed patient, notwithstanding an advance directive to the contrary.
Before the court could authorize non- consensual administration of medica- tion, it had to allow the terms of the patient’s advance directive to be im- plemented for 45 days. So a patient like Hargrave, who had declined all medications, would be permitted to go unmedicated for a 45-day period, after which the court could supercede the patient’s refusal of treatment.
The core of Hargrave’s challenge to the statute was based on Title II of the Americans With Disabilities Act (ADA), which requires that “no qual- ified individual with a disability shall, by reason of such disability, be ex- cluded from participation in or be de- nied the benefits of the services, pro- grams, or activities of a public entity, or be subjected to discrimination by any such entity” (6). Hargrave claimed that she and other members of her class were being discriminated against on the basis of mental disor- der, given that only committed per- sons with mental illness could have their advance directives overridden under Act 114. And the public “serv- ices, programs, or activities” from which she was being excluded was the state’s durable power of attorney for health care itself.
In response, the state of Vermont offered three arguments. First, be- cause Hargrave had been involuntari- ly committed, Vermont claimed that she qualified under an exclusion to the ADA for persons who pose a “di- rect threat.” Next, the state contend- ed that the plaintiff was not being dis- criminated against on the basis of dis- ability, because anyone who complet- ed an advance directive was suscepti- ble to having his or her choices su- perceded (the state has an alterna- tive override mechanism that in- volves judicial appointment of a Psychiatric Advance Directives and the Treatment of Committed Patients P Pa au ul l S S.
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Dr. Appelbaum, who is editor of this col- umn, is A. F. Zeleznik distinguished pro- fessor and chair in the department of psy- chiatry at the University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, Massachusetts 01655 (e-mail, appelbap@ummhc.org).
L La aw w & & P Ps sy yc ch hi ia at tr ry y guardian), and in any event, it was the status of being civilly committed, not being mentally ill, that was the point of distinction here. Finally, Vermont looked to a federal regula- tory provision that allows a public entity to continue existing practices, despite an ADA challenge, if the change being called for would “fun- damentally alter the nature of the service, program, or activity” (7).
The Second Circuit, like the U.S.
District Court that had originally heard the case, failed to find any of these contentions persuasive. With regard to the claim that Hargrave and other involuntarily committed pa- tients constitute a direct threat, the three-judge panel noted that not all committed patients would be a threat to others, as required under the ADA, because many were hospital- ized for danger to self. Even persons who were found to be dangerous to others at the time of commitment, the court held, could not be pre- sumed still to be dangerous when override of their advance directives was sought. The court was similarly unpersuaded that some condition other than mental illness was the ba- sis for the differential treatment, giv- en that Act 114 applied only to per- sons with mental illness. And allow- ing advance directives to stand as written, the court decided, even when patients were committed, does not fundamentally alter the advance directive statute (although it might affect the provision of psychiatric treatment to involuntary patients), which the court held was the proper point of reference. Hence the court concluded that Act 114 violated the ADA and enjoined its enforcement.
Hargrave,then, stands for the proposition that the state, having es- tablished a statutory basis for medical advance directives, cannot exclude in- voluntarily committed psychiatric pa- tients from its coverage. Although the Second Circuit’s opinion applies di- rectly only to Vermont and New York, it is an influential court, and its opin- ion may well be echoed in other cir- cuits around the country. Advance di- rectives may now constitute an iron- clad bulwark against future involun- tary treatment with medication—ex- cept in emergencies—even for in-competent, committed patients and even when the alternative is long- term institutional care.
In many respects, Hargraverepre- sents a continuation of the battle over the right of psychiatric patients to re- fuse treatment that began in the 1970s.
Indeed, the list of amici who filed briefs in support of Hargravereflected the coalitions that were formed to push for a right to refuse treatment 30 years ago. But that battle ended ambiguous- ly. Although some states were com- pelled by the courts to permit even committed patients to refuse medica- tion unless they were found incompe- tent by a judge, other states still allow the treating physician—sometimes af- ter a second opinion has been ob- tained—or a panel of clinicians to over- ride refusal on clinical grounds (8).
Even in states that require findings of incompetence and substituted judg- ment as to whether the patient, if com- petent, would have accepted the treat- ment, the vast majority (typically more than 90 percent) of cases that are adju- dicated end with the court authorizing involuntary treatment with medication.
The sense of many experienced ob- servers is that when patients are psy- chotic and treatment seems clearly in- dicated, the courts find a way to justify administration of medication, some- times despite the legal criteria (8).
If adopted more widely, however, Hargravewould appear to provide a tool whereby patients who are deter- mined to avoid treatment with med- ications would be able (except in emergencies) to completely preclude such treatment. A reviewing court would be bound to honor the terms of the now-incompetent patient’s ad- vance directive and order that treat- ment be withheld. Judges or quasi-ju- dicial decision makers would no longer have the discretion to apply “common-sense” criteria—for exam- ple, that patients with flagrant psy- chosis should be treated if possible— to mandate medication. Today, few severely ill committed patients avoid treatment with medications, regard- less of the legal standard in their ju- risdiction. Hargravecould change that. If large numbers of patients were to complete advance directives such as Nancy Hargrave’s, declining all medication, hospitals might wellbegin to fill with patients whom they could neither treat nor discharge.
Are there legal mechanisms that could avoid this outcome without run- ning afoul of the ADA? In the Har- gravecase, the court itself noted that nothing in this decision precludes statutory revisions that do not single out persons who are disabled because of mental illness—for example, revi- sions that increase the competency threshold for executing a DPOA or that allow the override of the DPOA of any incompetent person whenever compliance with the DPOA would substantially burden the interests of the state. However, it is doubtful that raising the competence threshold would have much impact, and the court’s suggestion regarding “interests of the state” that might warrant over- riding any person’s advance directive is, frankly, enigmatic.
But perhaps a clever legislator can find an opening here to blunt the im- pact of the decision. And there is no guarantee that other circuits, or even ultimately the U.S. Supreme Court, would necessarily agree with the Sec- ond Circuit’s analysis. Of course, were the level of concern sufficient, it would always be possible for Con- gress to amend the ADA to exclude the class of persons at issue. Con- gress, though, is typically reluctant to tinker with major legislation, and the disability rights community would likely oppose firmly any amendment of the ADA.
Because the ultimate scope and im- pact of Hargravemay not be known until a decade from now, it is worth- while to consider the possible effect of the decision on the use of advance directives for psychiatric treatment.
Current research suggests that most patients who complete advance direc- tives do not use these directives to de- cline all treatment with medication but rather to indicate preferences among alternative treatments or to in- form future treaters of particular con- cerns—for example, the care of their pets while they are hospitalized. Al- though Hargravemay stoke some en- thusiasm for advance directives among patients who are opposed to receiving any medication, it remains PSYCHIATRIC SERVICES ♦http://ps.psychiatryonline.org ♦July 2004 Vol. 55 No. 7 7 75 52 2 Continues on page 763 PSYCHIATRIC SERVICES ♦http://ps.psychiatryonline.org ♦July 2004 Vol. 55 No. 7 7 76 63 3 LAW & PSYCHIATRY Continued from page 752 to be seen how common the phenom- enon will become. Studies now under way will tell us more about the utility of advance directives in psychiatry— for example, whether, given the cur- rent state of the mental health sys- tem, advance directives actually have an impact on subsequent care (9). At a minimum, however, it seems likely that Hargrave,as it becomes more widely known, will chill enthusiasm for psychiatric advance directives among many clinicians. Because clini- cians’ suggestions that patients con- sider completing advance directives probably play an important role in en- couraging the completion of such di- rectives (10), Hargrave’s legacy may be to inhibit the use of this once- promising tool. ♦ References 1. Appelbaum PS: Advance directives for psy- chiatric treatment. Hospital and Communi- ty Psychiatry 42:983–984, 1991 2. Srebnik DS, LaFond J: Advance directives for mental health treatment. Psychiatric Services 50:919–925, 1999 3. Swanson JW, Tepper MC, Backlar P, et al:
Psychiatric advance directives: an alterna- tive to coercive treatment? Psychiatry 63:160–177, 2000 4. Szasz T: The psychiatric will: a new mecha- nism for protecting persons against “psy- chosis” and psychiatry. American Psycholo- gist 37:762–770, 1982 5. Hargrave v Vermont, 340 F. 3d 27 (2nd Cir 2003) 6. Americans With Disabilities Act, United States Code, Title 42, Section 12132 7. Code of Federal Regulations, Title 28, Sec- tion 35.130 (b)(7) 8. Appelbaum PS: Almost a Revolution: Men- tal Health Law and the Limits of Change.
New York, Oxford University Press, 1994 9. Papageorgiou A, King M, Janmohamed A, et al: Advance directives for patients com- pulsorily admitted to hospital with serious mental illness: randomised controlled trial.
British Journal of Psychiatry 181:513–519, 2002 10. Srebnik DS, Russo J, Sage J, et al: Interest in psychiatric advance directives among high users of crisis services and hospitaliza- tion. Psychiatric Services 54:981–986, 2003
AT3 Template (2000 words) You should insert tables, charts, and graphs into this document via cut and paste, snipping tool etc. All appendices should be included after the text. Everything is based on Narrative Writing. (Narrative Unit attached. Construct: The construct that I will be teaching is Narrative writing. Curriculum link: Age group/class of target students: Year 5 Short description (100 words) of context: Part One – Identifies evidence-based strategies for use in your teaching (1250 words) Criteria 1. Describes the evidence base for strategy/ies Criteria 2. Discusses the credibility of the evidence base Criteria 3. Explains the suitability of the strategy/ies to cater for the range of Zone of Proximal Development groups Criteria 4. Discusses the influence of context on the selection of evidence-based strategies Part Two – Evaluates the impact of your teaching (1250 words) Criteria 5. Interprets student growth data to inform evaluation Criteria 6. Interprets other sources of evidence (e.g., student attitude, teacher workload, school resourcing) Criteria 7. Makes inferences by combining evidence of student growth with other sources of evidence Criteria 8. Discusses the impact of your teaching Appendix A: Construct including curriculum link and source (i.e., set of rubrics, progression)
Write level descriptions for the construct. These can be based on one or more of the following: research literature, a Guttman analysis, a pairwise comparison, an adapted taxonomy, work samples. If you have taught the construct many times, you may also use experience to describe the construct levels.
Map the ZPD of your students to the levels in the construct (this could be on a Guttman chart). Appendix B: Explanatory documents related to the teaching plan (summary of teaching plan
Document your teaching plan (this can be summarized in one page).
Implement your teaching plan (ideally eight weeks of teaching but can be less). At the completion of your teaching,
use formal and/or informal assessment methods to collect evidence of student proficiency on the construct. Appendix C: Evidence of student growth (template from Week 6, Activity 6.2) Appendix D: Summary of other evidence (in a table)
Appendix E: Reference list detailing literature/videos etc. cited
This is how Guttman chart is made… I need 2 Guttman man chart that shows post teaching and pre teaching… showing the students growth… the 3-color box is that student’s area of need. That where they are at. Make a Guttman Chart for narrative writing for Criteria Appendix A (Example attached) 1.1.1 Easy criteria and at the end are the hardest criteria.
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It may be that attorneys hire you to consult with them regarding digital evidence and its relationship with what their client has been charged with or is under investigation for.
Discuss the steps you would take, as an examiner, to perform an attorney-client privilege (ACP) investigation.
If you know an attorney, ask them what the most difficult thing is when it comes to digital evidence.
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Each review will be 400-600 words in length, demonstrate critical thinking, and show evidence of the application of course content and terminology. The review will focus on and describe the student’s informed opinion in four areas:
1. Performers (This should be one of the shortest parts of the review) 2. Context (This should also be a short part of the review) 3. Music Description / Planes of Listening (This should be the largest part of the review) 4. Writers Opinion, including the reviewer’s personal reaction to the concert experience (This should be a substantial part of the review)
Concert reviews will utilize complete sentences, proper organization, correct grammar, and accurate spelling. Each concert review is worth 100 points (10 percent of your final grade), so be sure to submit quality work.
Please review the content in the Concert Reviews Module for more information about Concert Reviews.
Link to video: https://www.youtube.com/watch?v=rOjHhS5MtvA
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Reply to the following discussion with one reference. Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion. Cite resources in your responses to other classmates.
Discussion
Discuss the contraceptive methods using the latest evidence-based guidelines that Karen would be medically eligible for.
Evidence-based guidelines from the American College of Obstetricians and Gynecologists (ACOG) (2019) indicate that women with pre-existing medical conditions should avoid the use of hormonal contraceptives. Nevertheless, https://perfectwriterblog.com/humanities/im-working-on-a-humanities-question-and-need-an-explanation-to-help-me-learn-1/ there are various contraceptive methods, apart from condoms, which Karen is medically eligible for. The first option is using a non-hormonal intrauterine device (IUD), also known as the coil. Secondly is using a diaphragm; this is a cup-like device inserted into the vaginal canal to prevent sperm from passing through the cervix to the womb. A third option is the calendar method, whereby the patient calculates their safe days and avoids sex during ovulation (ACOG, 2019).
Identify one method that you feel would be most beneficial to Karen and discuss why you selected it.
Out of all the contraception methods discussed herein, the most beneficial for Karen is the IUD. Firstly, the American Cancer Society (2020) asserts that IUD reduces the risk of cervical cancer; this is important for Karen because she has a family history of the condition. Secondly, the IUD is non-hormonal; this is beneficial for Karen, with DVT https://www.keenessays.xyz/computer-science-homework-help/take-the-assignment-from-the-previous-week-add-at-least-twice-as-much-data-to-t/ and cardiac disease history. Thirdly, according to the case “Karen does not desire pregnancy soon,”; IUDs are effective for as long as 5-10 years.
Are there any methods that you would not recommend for Karen? Why?
There are contraception methods that are not recommended for Karen. These include combined-injectables like depo provera, hormonal implants, and combined patch/vaginal rings containing hormones like estrogen (ACOG, 2019). This is because the use of such contraceptives in women with a history of DVT and cardiac illness may increase their risk of thrombus formation or venous thrombus.
References
American Cancer Society (ACS) (2020, January 3). Risk factors for cervical cancer. American
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Why do you think many healthcare practitioners are often unwilling to change practice patterns, based on research findings? Some practitioners criticize evidence-based practice as “cookbook care.” Considering these perceptions, how would you utilize your education and experiences in planning the implementation of a major change?
2l1
Consider the question: “Why do physicians and nurses kill more people than airline pilots?” Apply your critical thinking skills to this argument and critique the statement. First, do you think it’s true? If it is, what do you think about their rationale? How would you address it if the question were posed to you in a forum?
2dq1
What kinds of extraneous variables (not cited in the studies) do you think could have affected the relationships between the independent variables and the dependent variables in both the Messina et al. and Coyne et al. studies?
2dq2
How effectively do you think the Coyne et al. study and the Messina et al. study both used their review of literature to help the reader understand why the research question was asked? How could they have done it more effectively?
3/1
Given that there is a documented advantage to the use of an experimental and control group design, discuss why other designs are frequently used, and the situations that may prompt the use of one.
3/2
Discuss your understanding of the concept of internal validity in a research study, and the impacts of several errors or biases that can reduce the study’s validity.
4/1
Why do you think so many people have problems with using, interpreting, or applying statistics in making business decisions?
4/2
As you have learned to evaluate different research studies, what elements seem the most important to you for evaluation of the research’s quality? Why?
5/1
Discuss the concept of the normal distribution, why it is important, and what you think it means.
5/2
When students talk about “grading on the curve,” how does that apply to the normal distribution?
6/1
Discuss the differences between the concepts of correlation and causality, and why it is critically important to make sure that the differences are understood?
6/2
What are the indicators for using a t-test? Create a research scenario in which it would be correct to use a t-test, including the research question, sample size, and dependent and independent variables.
7/1
What are the indicators for using an ANOVA? Create a research scenario in which it would be correct to use an ANOVA, including the research question, sample size, and dependent and independent variables.
7/2
What are the indicators for using a regression analysis? Create a research scenario in which it would be correct to use a regression analysis, including the research question, sample size, and dependent and independent variables?
8/1
Re-visit the roadmap that you began at the start of your program of study. Complete information regarding this course. In the discussion, reflect on how this course meets your career goals. What have you gleaned from the course that will help you in your career path? Respond to at least two other classmates.
8/2
Discuss your thoughts about the ethics of using informed consent vs. blinding the subjects to the expected outcomes of the intervention. Should they be told? How much should they be told cookbook care? How would the placebo effect be impacted if subjects are told which intervention is being applied to them?
Healthcare practitioners are often unwilling to change patterns based on research findings because it affects the way the carry out their duties. Some healthcare practitioners have developed a pattern and routine of performing their duties of which they feel changes will inconvenience them. As a result, they prefer performing their duties as they have always been doing, thus criticizing evidence-based changes. In addition, the healthcare practitioners have the perception that the evidence-based research is the personal opinion because the researchers cooks the data and make the conclusion that favor their working style. In order to utilize knowledge gained through education and experience in planning to implement changes, it is necessary to involve healthcare practitioners in the research process so that they get the opportunity to understand the outcome of the research, hence taking part in the implementation process.
Question 2/1
This statement is true because pilots’ working environment is not similar with that of nurses and physicians. First, if the pilot commits serious error, he/she will die with the passengers, unlike the nurses and physicians who let the patients to die alone. As a result, the pilots would be more careful than the nurses and physicians. The second reason is that pilots follow specific protocol and guideline in their working environment. For instance, they double check that everything is working properly before commence the journey because they have enough time. Journal of American Medical………………………………………………………………………………………………………………………………………………………………………………………………………………………………….