please read the attached file cearfully before telling me you can do.docxChereCheek752
please read the attached file cearfully before telling me you can do it.
I need a complete
power
point presentation (that incloud outlines and pictures) that pointing
3 main points
on the
topic
that is mentioned in the attached file + the speech for the slides that must be 5-7 min lon.
.
please read my post carefully.then place handshakei have the wor.docxChereCheek752
please read my post carefully.then place handshake
i have the work already but i want u do
introduction, background, and conclusion
for it.
and some changes on the paper that already written.
you just need to
add three pages on my paper
.
deadline 20-24 hours.
i attached my paper,
.
Please read the attachment.Please write a pure Essay Paper. Plea.docxChereCheek752
Please read the attachment.
Please write a pure Essay Paper. Please read the instructions. Then follow the grade sheet. Please fully understand both attachments. Also, the essay will be scanned before student upload it for a final grade. Please make sure error is free. And references are given with cited.
.
Please read first because this Assignment is for correction.Plea.docxChereCheek752
Please read first because this Assignment is for correction.
Please, read through the corrections before sending me messages. Because, if you don’t I will not response to your messages. Also, I will attached two more articles for whoever I choose to help me with this assignment. In addition, please, remove the introduction, and also attach a sample of a “Needs Assessment”
Topic Needs Assessment
Title: HIV among Young Men Who Have Sex with Men
Section 1: Background Information
All of this is opinion and needs to come out.
Sex is seemingly as old as the world is. However, sex among men, and especially young men having sex with men has not always been in the books of history. This is arguably one of the latest practices, although some sources have claims of sex among men after the antediluvian period. While sex has positive effects such as procreation, there are some negative effects which include contraction of deadly sexually transmitted diseases.
One such disease is HIV/AIDS.
HIV/AIDS is an acronym for
Human ImmunoDefiency Virus/ Acquired Immune Deficiency Syndrome
not capitalized
. Da
ta
from the Centers for Disease Control and Prevention (2015) sho
ws
that
while
over one million people aged above 13 years of age were living with the disease in the US by the year 2014
,
with
an average of 40,000 new infections are recorded each year (Centers for Disease Control and Prevention [CDC], 2015)
when you use the word while...it indicates as opposite statement coming..and that is not what this sentence did
. The high number of people who are ignorant about their HIV status
and
those who purposely choose to ignore it
has
continued to increase the risk levels for other uninfected people in the world, among them being young men who have sex with men
isn’t it possible that they are one of the above?
.
In this areas and/or introduction...you should be discussing morbidity, mortality,....you need to highlight incidence is higher in this group than in others
Introduction
The issue of young men having sex with other men has continued to be a thorny issue for a number of years, dividing the society between those who support this practice and those who oppose it. Supporters of young men having sex with other men argue that people have a right to decide their sexual orientation and preferences without undue pressure from external forces. However, those who oppose this practice argue that it emanated from social decay and as such should not be supported. One common point of agreement between these two camps is that the practice of young men having sex with men is risk and has the capability to cause grave danger to these men.
opinion
Although sex even among heterosexual could turn out to be risk and a cause of contraction of dangerous sexually transmitted diseases and infections, the risk of contraction of such health complications is doubly higher among young men who have sex with other men.
There are several reasons that c.
Please read below, and write esaay.I need 3 pages.Overvi.docxChereCheek752
Please read below, and write esaay.
I need 3 pages.
Overview
Many people are unaware of just how much they use media. It is important for us to have an awareness of the various types of media that inundate our culture and the degree to which we use those media. This is a component of media literacy.
Instructions
For this assignment, you will keep 3 days of media logs and then write a reflective essay. Please keep a daily journal that records your media use for three days. Track you use of all of the following (even if you don't use something, please make a note of that). Keep track of the time periods when you use it and what you are using it for.
Computer—online
Computer--offline
TV
Newspapers/Magazines
Radio
Stereo/CD
Books
Telephone
Other
For each day, keep a detailed record of how much time you spend using each different medium, and the purpose of the media use (e.g., talking to parents, playing music while studying, recreational TV, etc.) Keep daily logs; you may turn in your "Media Logs" as a list, a table, in columns or in whatever format you choose.
In addition to the 3 days of logs, please write a reflective essay (about 2-4 pages, double spaced) that comments on what you learned about your media use by doing this assignment. For the essay, you may want to think about: what did you learn? did anything surprise you? did you notice any patterns in your media use? has your media use changed? why do you use some forms of media more or less? what role do you think media plays in most people's lives?...)
By Sunday at 11:59 pm PST, please submit:
the 3 days of media logs, AND
your essay
.
Please Read Before RespondingI need assistance with a .docxChereCheek752
***Please Read Before Responding***
I need assistance with a well thought out, well written AWP essay the Essay must use evidence (concrete details from the story) to support your answer. Five paragraphs.
http://www.ciaranhinds.eu/pdf/crucible3.pdf
.
Please provide response to the below post. Topic #1) You are an .docxChereCheek752
Please provide response to the below post.
Topic #1) You are an administrator for the Contoso Corporation and you are responsible for multiple Hyper-V hosts. Often, the developers need to create virtual machines so that they can test their applications. Describe the steps you should take so that developers can create and manage their own machines yet not have direct access to the Hyper-V hosts.
Topic #2) You are an administrator for the Contoso Corporation, which has approximately 400 servers running Windows Server 2012 R2, 50 servers running Windows Server 2012, and 200 servers running Windows Server 2008 R2. You also have several virtual machines running Windows 7 and Windows 8/8.1 and you have approximately 15 domain controllers. From time to time, you field requests in which you need to specify when a user has logged in and when a user has accessed confidential documents. Describe how to handle such requests.
.
Please provide an annotation for the two articles attached AND ide.docxChereCheek752
Please provide an annotation for the two articles attached AND identify three common themes in both articles.
Note the purpose of the article, the participants/subject of the study, the conclusions drawn by the author(s), and the validity of the conclusions. Evaluate the article: is it a credible source? Describe the credibility of the author – are there any biases? How well did the author support his or her assertions? Did they provide an adequate literature review? Were there any limitations?
Due tomorrow, 02/07/2017 at noon.
Note the purpose of the article, the participants/subject of the study, the conclusions drawn by the author(s), and the validity of the conclusions. Evaluate the article: is it a credible source? Describe the credibility of the author – are there any biases? How well did the author support his or her assertions? Did they provide an adequate literature review? Were there any limitations?
.
please read the attached file cearfully before telling me you can do.docxChereCheek752
please read the attached file cearfully before telling me you can do it.
I need a complete
power
point presentation (that incloud outlines and pictures) that pointing
3 main points
on the
topic
that is mentioned in the attached file + the speech for the slides that must be 5-7 min lon.
.
please read my post carefully.then place handshakei have the wor.docxChereCheek752
please read my post carefully.then place handshake
i have the work already but i want u do
introduction, background, and conclusion
for it.
and some changes on the paper that already written.
you just need to
add three pages on my paper
.
deadline 20-24 hours.
i attached my paper,
.
Please read the attachment.Please write a pure Essay Paper. Plea.docxChereCheek752
Please read the attachment.
Please write a pure Essay Paper. Please read the instructions. Then follow the grade sheet. Please fully understand both attachments. Also, the essay will be scanned before student upload it for a final grade. Please make sure error is free. And references are given with cited.
.
Please read first because this Assignment is for correction.Plea.docxChereCheek752
Please read first because this Assignment is for correction.
Please, read through the corrections before sending me messages. Because, if you don’t I will not response to your messages. Also, I will attached two more articles for whoever I choose to help me with this assignment. In addition, please, remove the introduction, and also attach a sample of a “Needs Assessment”
Topic Needs Assessment
Title: HIV among Young Men Who Have Sex with Men
Section 1: Background Information
All of this is opinion and needs to come out.
Sex is seemingly as old as the world is. However, sex among men, and especially young men having sex with men has not always been in the books of history. This is arguably one of the latest practices, although some sources have claims of sex among men after the antediluvian period. While sex has positive effects such as procreation, there are some negative effects which include contraction of deadly sexually transmitted diseases.
One such disease is HIV/AIDS.
HIV/AIDS is an acronym for
Human ImmunoDefiency Virus/ Acquired Immune Deficiency Syndrome
not capitalized
. Da
ta
from the Centers for Disease Control and Prevention (2015) sho
ws
that
while
over one million people aged above 13 years of age were living with the disease in the US by the year 2014
,
with
an average of 40,000 new infections are recorded each year (Centers for Disease Control and Prevention [CDC], 2015)
when you use the word while...it indicates as opposite statement coming..and that is not what this sentence did
. The high number of people who are ignorant about their HIV status
and
those who purposely choose to ignore it
has
continued to increase the risk levels for other uninfected people in the world, among them being young men who have sex with men
isn’t it possible that they are one of the above?
.
In this areas and/or introduction...you should be discussing morbidity, mortality,....you need to highlight incidence is higher in this group than in others
Introduction
The issue of young men having sex with other men has continued to be a thorny issue for a number of years, dividing the society between those who support this practice and those who oppose it. Supporters of young men having sex with other men argue that people have a right to decide their sexual orientation and preferences without undue pressure from external forces. However, those who oppose this practice argue that it emanated from social decay and as such should not be supported. One common point of agreement between these two camps is that the practice of young men having sex with men is risk and has the capability to cause grave danger to these men.
opinion
Although sex even among heterosexual could turn out to be risk and a cause of contraction of dangerous sexually transmitted diseases and infections, the risk of contraction of such health complications is doubly higher among young men who have sex with other men.
There are several reasons that c.
Please read below, and write esaay.I need 3 pages.Overvi.docxChereCheek752
Please read below, and write esaay.
I need 3 pages.
Overview
Many people are unaware of just how much they use media. It is important for us to have an awareness of the various types of media that inundate our culture and the degree to which we use those media. This is a component of media literacy.
Instructions
For this assignment, you will keep 3 days of media logs and then write a reflective essay. Please keep a daily journal that records your media use for three days. Track you use of all of the following (even if you don't use something, please make a note of that). Keep track of the time periods when you use it and what you are using it for.
Computer—online
Computer--offline
TV
Newspapers/Magazines
Radio
Stereo/CD
Books
Telephone
Other
For each day, keep a detailed record of how much time you spend using each different medium, and the purpose of the media use (e.g., talking to parents, playing music while studying, recreational TV, etc.) Keep daily logs; you may turn in your "Media Logs" as a list, a table, in columns or in whatever format you choose.
In addition to the 3 days of logs, please write a reflective essay (about 2-4 pages, double spaced) that comments on what you learned about your media use by doing this assignment. For the essay, you may want to think about: what did you learn? did anything surprise you? did you notice any patterns in your media use? has your media use changed? why do you use some forms of media more or less? what role do you think media plays in most people's lives?...)
By Sunday at 11:59 pm PST, please submit:
the 3 days of media logs, AND
your essay
.
Please Read Before RespondingI need assistance with a .docxChereCheek752
***Please Read Before Responding***
I need assistance with a well thought out, well written AWP essay the Essay must use evidence (concrete details from the story) to support your answer. Five paragraphs.
http://www.ciaranhinds.eu/pdf/crucible3.pdf
.
Please provide response to the below post. Topic #1) You are an .docxChereCheek752
Please provide response to the below post.
Topic #1) You are an administrator for the Contoso Corporation and you are responsible for multiple Hyper-V hosts. Often, the developers need to create virtual machines so that they can test their applications. Describe the steps you should take so that developers can create and manage their own machines yet not have direct access to the Hyper-V hosts.
Topic #2) You are an administrator for the Contoso Corporation, which has approximately 400 servers running Windows Server 2012 R2, 50 servers running Windows Server 2012, and 200 servers running Windows Server 2008 R2. You also have several virtual machines running Windows 7 and Windows 8/8.1 and you have approximately 15 domain controllers. From time to time, you field requests in which you need to specify when a user has logged in and when a user has accessed confidential documents. Describe how to handle such requests.
.
Please provide an annotation for the two articles attached AND ide.docxChereCheek752
Please provide an annotation for the two articles attached AND identify three common themes in both articles.
Note the purpose of the article, the participants/subject of the study, the conclusions drawn by the author(s), and the validity of the conclusions. Evaluate the article: is it a credible source? Describe the credibility of the author – are there any biases? How well did the author support his or her assertions? Did they provide an adequate literature review? Were there any limitations?
Due tomorrow, 02/07/2017 at noon.
Note the purpose of the article, the participants/subject of the study, the conclusions drawn by the author(s), and the validity of the conclusions. Evaluate the article: is it a credible source? Describe the credibility of the author – are there any biases? How well did the author support his or her assertions? Did they provide an adequate literature review? Were there any limitations?
.
Please provide a statement that addresses your reasons for transferr.docxChereCheek752
Please provide a statement that addresses your reasons for transferring and the objectives you hope to achieve. You can type directly into the box, or you can paste text from another source. (250-650 words). I'm a Bachelor Student, who wants to transfer to another university, so they need this essay.
.
Please provide a brief response to the following questions1) How .docxChereCheek752
Dr. Herskovits' discoveries about African cultural practices supported Dr. Woodson's beliefs that Eurocentric thinking distorted understanding of African history and culture. Dr. Cheikh Anta Diop believed that African people were responsible for Egyptian culture and civilization, which he supported through evidence but was a controversial Afrocentric perspective.
PLEASE NOTE OF SOURCESMATERIALS ALSO INCLUDED---USE THEMT.docxChereCheek752
PLEASE NOTE OF SOURCES/MATERIALS ALSO INCLUDED---USE THEM
TWO ASSIGNMENTS
TWO ASSIGNMENTS
TWO ASSIGNMENTS
TWO ASSIGNMENTS
TWO ASSIGNMENTS
TWO ASSIGNMENTS
.
Please note that the following vignettes represent samples of the ty.docxChereCheek752
Please note that the following vignettes represent samples of the types of questions you will be asked to respond to on the comprehensive exam. You will NOT receive these questions on the comprehensive exam; they are for study purposes only. Vignette Please compose a well-written and organized essay in response to each of the following questions. When writing your essays, please 1.Use APA (6th edition) Style, with 1-inch margins, double-spaced, 12 font, with a reference list at the end. 2.Write clearly and concisely. 3.Cite appropriate, and especially current, literature (empirical and/or theoretical). 4.Avoid all sexist idioms and allusions. 5.Remember to demonstrate your multicultural competence where appropriate. Vignette: Utilize this scenario for all of your responses A 42-year-old African American woman was brought to the emergency room by police officers for evaluation prior to going to jail to await disposition. She reported that she had been shopping when "something happened." She said that she had no recollection of events between the time she entered the store and an hour later, when she was arrested for shoplifting in a nearby department store with a considerable amount of stolen property on her person. She protested her innocence and became so agitated, belligerent, and profane that the arresting officers took her to the hospital for evaluation. At the hospital she reported that two years previously she had been arrested for shoplifting and had had amnesia for the act. The charges against her were then dropped because she explained that both the shoplifting and the amnesia resulted from her forgetting to eat after taking her insulin. Of note, her blood-sugar level on testing in the emergency room was elevated. The patient calmed down appearing asymptomatic after the evaluation and was transferred to jail pending a preliminary hearing. When she learned that her release was planned for the next day and that the charges against her would not be dropped, she became extremely agitated, angry, and abusive to the officers. Shortly thereafter, she complained of a headache and said she had no recollection of her abusive behavior. Later that evening she accosted an officer angrily. When the officer responded and addressed the patient by name, "Naomi," the patient said that her name was "Oprah" and that she would not allow herself to be called "Naomi," whom she described as a "wimp and a loser." "Oprah’s" voice and movement were somewhat different from those of "Naomi." She claimed that she had done the shoplifting and stepped back so that "Naomi" could be caught and humiliated, and that if she had wanted to, she could have evaded detection easily. She was returned to the ER and subsequently admitted to the inpatient psychiatric unit for observation. For the next two days, the patient had many apparent switches of personality, accompanied by conspicuous changes in dress, makeup, and demeanor. On several occasions "Oprah" was disrupti.
Please no plagiarism. I have attached an example to go by. The popul.docxChereCheek752
Please no plagiarism. I have attached an example to go by. The population I chose and currently work with are incarcerated juveniles, so at-risk youth.
Boundary Issues
It may not be possible or reasonable for counselors to always avoid dual relationships with clients. For example, counselors who live and work in small rural communities may attend the same religious institutions as their clients, or use the same libraries, doctors, or other services. In these multiple-relationship situations, counselors would not be in violation of ethical standards if they took reasonable steps to protect their objectivity and efficacy, and to avoid possibilities of exploitation or harm.
Counselors and supervisors usually consider dual relationships on a continuum of risk. As you work through the notion of dual relationships, you should consider the relationship with your client and the context of the situation. It is also important to consider the impact of dual roles on the power dynamics of the therapeutic relationship. For example, clients, students, and supervisees have less experience, knowledge, and power compared with licensed counselors and supervisors. Consequently, they are less likely to recognize inappropriate boundary crossings or to express their concerns about these crossings. It is your responsibility as an ethical practitioner to monitor and ensure appropriate boundaries across all related counseling situations.
For this Discussion, review the
Clinical Mental Health Counseling: Boundary Issues
media and consider the population that you are interested in working with as a professional counselor. Then, review the Learning Resources for this week and explore potential boundary issues you may encounter while working with this population. Reflect on potential benefit or harm related to boundary crossing. Finally, consider potential consultants who might be able to address any boundary issues.
Post by Day 3
a brief description of the population you selected. Then, explain any potential boundary issues you anticipate may be challenging in working with this population and explain why. Explain the potential benefit or harm associated with boundary crossing with this population. Finally, explain who you might consult with to address this boundary issue and why.
Be sure to use the Learning Resources and the current literature to support your response.
Respond by Day 5
and expand on your colleague’s posting by providing an alternate perspective on how you would work with your colleague’s selected population. Provide potential boundary crossing challenges that your colleague did not discuss and offer potential solutions for addressing these challenges.
Required Resources
Note:
To access this week's required library resources, please click on the link to the Course Readings List, found in the
Course Materials
section of your Syllabus.
Readings
Herlihy, B., & Corey, G. (2015).
ACA ethical standards casebook
(7th ed.). Alexandria, VA: American Cou.
PLEASE NO PLAGIARIZE!! Have 10 hours to fullfil this work. 1page or .docxChereCheek752
Women have long faced inequality compared to men, but the women's rights movement in the mid-late 20th century improved women's status by opening positions traditionally held by men. While some feel women have achieved equality in the 21st century, others disagree. The document asks how one would describe current gender equality in Western culture and whether there are still major areas of large-scale discrimination against women, requesting two examples if so or a rationale if not.
Please Paraphrase the following into a more scholarly toneI f.docxChereCheek752
Please Paraphrase the following into a more scholarly tone:"
"I feel like after reading these excerpts I feel like the first answer clarified what exactly Gus Casely-Hayford was really trying to figure out about Ethiopian history. It was clear that he was trying to figure out its history, however, it was difficult to put the pieces together and pinpoint things that could lead to it's past. I don't think it was a specific sentence it was really just how they answered it that helped me put it together.
A sentence in another paragraph that clarified what the answer was at number two when it said "After this, Ethiopia switched to Christianity, which has a direct link with the history of the kingdom. The Patriarch claims that the Ark of the Covenant was brought to Ethiopia". It clarifies what the patriarch really meant when he said that they had accepted the old testament.
These excerpts can help when I am doing homework because they can be used as a structure when answering questions for my future homework. In my next homework, I will aim to have more references and actually pinpoint what the answer is because I feel like I do not fully answer the question I only answer it partially. So I can turn in something rather than nothing. It is sometimes difficult to understand the main idea or interpret what some people are saying in the documentaries. The readings, however, are easier to understand.
.
Please only respond if you are familiar with raspberry piIam loo.docxChereCheek752
Please only respond if you are familiar with raspberry pi
Iam looking to send Binary data over the GPIO pins. I need to use one of the input and output pin to send binary data on the output.
If you are very familiar with Raspberry pi please message me.
THank you
.
Please note this is 2 ASSIGNMENTS ......Please only orginial work on.docxChereCheek752
Please note this is 2 ASSIGNMENTS ......Please only orginial work only and please follow the instruction provided
Assignment 1: Week 3 COURSE PROJECT
Week 3: Create the Database
Create the database and associated tables in your database environment.
Assignment 2: Week 3 ILAB
iLab 3: Database Creation and Table Manipulation
.
PLEASE NEED TWO RESPONSES TWO HUNDRED WORDS EACHDistinguish b.docxChereCheek752
PLEASE NEED TWO RESPONSES TWO HUNDRED WORDS EACH:
Distinguish between various factions/denominations within Christianity (Catholic/Protestant/Orthodox/etc) and their impact on mainstream (dominant) expression of how Christianity is viewed by those on the "outside."
Consider the viewpoints we saw represented in
Once I Was a Beehive.
How does it differ or compare to popular or mainstream faith as you know it? Of course, it is one interpretation of faith in Jesus and how it impacts daily life (and during troubling times, as seen in the film).
For example, if I walked into one church, I might find folks picking up and handling snakes, singing rather loudly and outwardly in their expressions of worship. If I went to the congregation next door the following Sunday, I might find a church that barely whispered, used no music at all, and perhaps simply followed a monotone lecture/sermon style delivered over the course of an hour, or two, or three! Both representing the same organism/religion...
Please respond with no less than 200 words, and respond to at least one of your classmate's post.
.
Please no plagiarism and make sure you are able to access all resour.docxChereCheek752
Please no plagiarism and make sure you are able to access all resource on your own before you bid. I need this completed by 10/21/17 at 12pm.
Application:
Applying Theoretical Interventions for Clients Experiencing Life Transition and Developmental Issues, Part II
Marriage, couple, and family counselors have varying caseloads. What they all have in common is that their group of clients—whether large or small—represents the variety of human experience. Even those counselors with a specific clinical focus see variety in the ways in which specific issues manifest in different relationships. Part of the goal of your counseling program is to expose you to varying scenarios so that when you are faced with differing client situations, you will have the evidence-based research knowledge, flexibility, analytical skills, and theory-integration practice to know the best course of action to take with a particular couple or family.
To prepare for this Application Assignment, select and view one movie from the list provided in this week’s Learning Resources. Begin to conceptualize the couple's or family’s problem through your theoretical orientation and identify interventions that you might use. Finally, begin to locate articles in the Walden Library that could be used to justify the interventions you selected.
The assignment (2–3 pages)
Identify the movie you selected and the life transition/developmental issue present in the couple/family.
Conceptualize the couple's/family's problem through your chosen theoretical orientation.
Describe two interventions you would use to address these couple/family issues and how you would use them. (
Note
: The interventions may not emerge from your chosen theoretical orientation.)
Justify the intervention you selected with two evidence-based research articles.
Support your Application Assignment with specific references to all resources used in its preparation. You are asked to provide a reference list for all resources, including those in the Learning Resources for this course.
Submit your assignment by
Day 7
.
Learning Resources
Required Resources
Media
Please select, obtain, and view one of the following movies to use with this week’s Application Assignment:
Please note:
These films are
not
available through Walden Library. Contact your instructor if you are unable to obtain a copy independently.
Movie: Rydell, M. (Director). (1981).
On golden pond
[Motion picture]. [With K. Hepburn, H. Fonda, & J. Fonda]. United States: IPC Films.
Movie: Demme, J. (Director). (2008).
Rachel getting married
[Motion picture]. [With A. Hathaway, R. DeWitt, & D. Winger]. United States: Sony Pictures Classics.
Movie: Redford, R. (Director). (1980).
Ordinary people
[Motion picture]. [With A. Sutherland, M. Tyler Moore, & J. Hirsch]. United States: Paramount Pictures.
Readings
Article: Haggan, P. S. (1998). Counseling adult children of aging parents.
Educational Gerontology
,
24
(4), 333. Ret.
Please need two posts of 200 words each. Discuss the ways in whi.docxChereCheek752
Please need two posts of 200 words each.
Discuss the ways in which Confucianism can or may weave into our everyday lives, given what you've read and watched/reviewed. Consider the ways you saw Confucianism as a religion and/or as a philosophy displayed in the film
Confucius
, focusing on the themes of bravery, self-sacrifice, respect, and loyalty. As you've been reading through the text, you'll find multiple arguments suggesting that Confucianism is less religion, more philosophy. What are your thoughts? Use examples from the film and text to support your conclusions.
.
Please look for the following errors in this document.ErrorsKeyb.docxChereCheek752
Please look for the following errors in this document.
Errors
Keyboarding Errors
Capitlalization Errors
Abbreviation errors
Number Expression Errors
Scholarship Search
Subject Verb Agreement
Pronoun Problems
Sentence Construction
Comma Errors
Other punctuation errors
Format Errors: Letters and Memos
Format Errors: Report and job search documents
Editing for content, clarity and conciseness
.
Please make sure that your writers are properly writing the final re.docxChereCheek752
Please make sure that your writers are properly writing the final references of the journals correctly. The last paper the writer did not write the journal reference in the right format. Example, what he/she did was
Markinsin, J. The effects of health on others. Retrieved from
http://journal
of health management.
THIS IS INCORRECT FORMAT!!!!!!!!!!!!!!!!!!!!!!!!!!
All journals should be written as such:
Markinson, J. (2014). The effects of health on others.
The Journal of Health Management, 6
(3), p. 101-120.
The writers should know this. Please let me know if anything else is needed. This upcoming assignment is straightforward paper. Let the writers know that at least
TWO
scholarly nursing journals should be used.
ASSIGNMENT DETAILS:
As of 2014 health care expenditures in the United States are near 17% of our gross domestic product (GDP), with a major portion of Medicare funding goes towards chronic illness and care at the last 6 months of life. The Patient Protection and Affordable Care Act has made some initial legislative changes in our health system, but not sufficient to address our growing expenditures and caring for our large aging population. In this assignment, learners will synthesize issues in aging with health policy solutions by writing a paper on one health issue for older individuals addressed in the topic and offering a policy solution. Example of issue: In 2014, over 50% of the costs of institutional long-term care for older persons are paid for with public funds from Medicaid.
Directions:
Write a 12000-1500 word paper that addresses a health issue for older individuals. Include the following:
1.Evaluate what the literature suggests as a resolution to your chosen issue.
2.Discuss any attempts to incorporate the solution into public policy.
3.Determine the barriers to implementation of the solution.
4.Analyze the options being discussed for public and/or private funding.
5.Propose your own recommendation.
.
Please identify the one sculpture from each of the following artist .docxChereCheek752
Please identify the one sculpture from each of the following artist and describe what you are seeing. What is your reaction to each sculpture? What are they made out of? The artists are:
Dale Chihuly
and
Tom Otterness
.
I need one page assıgnment about these questıons
I need thıs assıgnment ın 10 hours. Time is really ımportant
.
Please I would like you to write a discussion with 200 words by answ.docxChereCheek752
Please I would like you to write a discussion with 200 words by answering the following questions.
Please I want good works and no plagiarism.
Egypt's president Abdel Fatah al-Sissi recently met with President Trump. The conversation included discussion of the fight against terrorism, the Middle East’s multiple wars, the refugee crisis and Egypt’s anemic economy. The two leaders, however, were criticized for not discussing human rights. Should human rights concerns take a back seat to national security cooperation? Why or why not? Which do you view as being more important? Why.
If you are not familiar with this issue, please do some research before posting.
.
Please identify the leadership traits, skills, and behaviors that yo.docxChereCheek752
Please identify the leadership traits, skills, and behaviors that you consider the most important in leading and motivating subordinates. Examine specifically why you selected the traits, skills and behaviors in relation to employee motivation
Bierman, L., Ferrell, O. C., & Ferrell, L. (2016).
Management: Principles and applications, custom edition
[Electronic version]. Solon, OH: Academic Media
Solution
s.
.
Please i need a research paper about Langauge and Culture.( 1500 wor.docxChereCheek752
Please i need a research paper about Langauge and Culture.( 1500 word )
with an
1 - Introduction ( with hook sentence at the
beginning)
2- first paragraph about ( is it important to merge between langauge and culture )
3 - second paragraph about ( if you visit a foreign country, do you like to know their culture)
4 - third paragraph ( what is the right way to learn other country's culture ) by { watching their culture movies or searching to the internet)
5 conclusion.
.
Please help me with this program1 – Hello WorldCreate a proj.docxChereCheek752
Please help me with this program
1 – Hello World
Create a project using buttons, a single display label, and event procedures to display “Hello World” in 6 languages (default English + 5 more, your choice). Watch basic coding and naming standards; include comments/remarks.
.
PLEASE HELP REVISE & STRUCTURENEED INTRODUCTIONANALYSISCO.docxChereCheek752
PLEASE HELP REVISE & STRUCTURE:
NEED INTRODUCTION
ANALYSIS
CONCLUSION
Policies decisions are guided by complexed specialized knowledge not always understood by the public. Often, an economist is solicited by the government to offer judgement based upon his or her expertise. The recommendations should not conflict with values that emphasize serving the interests of others. The argument can be made that market failure is a reflection of government failure to correct the market. According to Weimer and Vining (2011)
This piece belong to you since you’re expert in this area,
Dealing with foster care for youth how they are able to leave the system before they are 21. This policy was written because of the high number of young people who left care early were in need of services. These services range from housing to employment assistance. We were eager to address the concerns of the former foster youth, but we had to ensure that the policy we drafted had to include stipulations on what services youth would receive. Because if we allowed them to receive all of the resource given to kids who are still in care, local departments would not be able to accommodate the youth adequately.
Reference
Weimer, D. L., & Vining, A. R. (2011). Policy analysis: Concepts and practice (5th ed.). Upper Saddle River, NJ: Pearson. ISBN: 9780205781300
.
Please provide a statement that addresses your reasons for transferr.docxChereCheek752
Please provide a statement that addresses your reasons for transferring and the objectives you hope to achieve. You can type directly into the box, or you can paste text from another source. (250-650 words). I'm a Bachelor Student, who wants to transfer to another university, so they need this essay.
.
Please provide a brief response to the following questions1) How .docxChereCheek752
Dr. Herskovits' discoveries about African cultural practices supported Dr. Woodson's beliefs that Eurocentric thinking distorted understanding of African history and culture. Dr. Cheikh Anta Diop believed that African people were responsible for Egyptian culture and civilization, which he supported through evidence but was a controversial Afrocentric perspective.
PLEASE NOTE OF SOURCESMATERIALS ALSO INCLUDED---USE THEMT.docxChereCheek752
PLEASE NOTE OF SOURCES/MATERIALS ALSO INCLUDED---USE THEM
TWO ASSIGNMENTS
TWO ASSIGNMENTS
TWO ASSIGNMENTS
TWO ASSIGNMENTS
TWO ASSIGNMENTS
TWO ASSIGNMENTS
.
Please note that the following vignettes represent samples of the ty.docxChereCheek752
Please note that the following vignettes represent samples of the types of questions you will be asked to respond to on the comprehensive exam. You will NOT receive these questions on the comprehensive exam; they are for study purposes only. Vignette Please compose a well-written and organized essay in response to each of the following questions. When writing your essays, please 1.Use APA (6th edition) Style, with 1-inch margins, double-spaced, 12 font, with a reference list at the end. 2.Write clearly and concisely. 3.Cite appropriate, and especially current, literature (empirical and/or theoretical). 4.Avoid all sexist idioms and allusions. 5.Remember to demonstrate your multicultural competence where appropriate. Vignette: Utilize this scenario for all of your responses A 42-year-old African American woman was brought to the emergency room by police officers for evaluation prior to going to jail to await disposition. She reported that she had been shopping when "something happened." She said that she had no recollection of events between the time she entered the store and an hour later, when she was arrested for shoplifting in a nearby department store with a considerable amount of stolen property on her person. She protested her innocence and became so agitated, belligerent, and profane that the arresting officers took her to the hospital for evaluation. At the hospital she reported that two years previously she had been arrested for shoplifting and had had amnesia for the act. The charges against her were then dropped because she explained that both the shoplifting and the amnesia resulted from her forgetting to eat after taking her insulin. Of note, her blood-sugar level on testing in the emergency room was elevated. The patient calmed down appearing asymptomatic after the evaluation and was transferred to jail pending a preliminary hearing. When she learned that her release was planned for the next day and that the charges against her would not be dropped, she became extremely agitated, angry, and abusive to the officers. Shortly thereafter, she complained of a headache and said she had no recollection of her abusive behavior. Later that evening she accosted an officer angrily. When the officer responded and addressed the patient by name, "Naomi," the patient said that her name was "Oprah" and that she would not allow herself to be called "Naomi," whom she described as a "wimp and a loser." "Oprah’s" voice and movement were somewhat different from those of "Naomi." She claimed that she had done the shoplifting and stepped back so that "Naomi" could be caught and humiliated, and that if she had wanted to, she could have evaded detection easily. She was returned to the ER and subsequently admitted to the inpatient psychiatric unit for observation. For the next two days, the patient had many apparent switches of personality, accompanied by conspicuous changes in dress, makeup, and demeanor. On several occasions "Oprah" was disrupti.
Please no plagiarism. I have attached an example to go by. The popul.docxChereCheek752
Please no plagiarism. I have attached an example to go by. The population I chose and currently work with are incarcerated juveniles, so at-risk youth.
Boundary Issues
It may not be possible or reasonable for counselors to always avoid dual relationships with clients. For example, counselors who live and work in small rural communities may attend the same religious institutions as their clients, or use the same libraries, doctors, or other services. In these multiple-relationship situations, counselors would not be in violation of ethical standards if they took reasonable steps to protect their objectivity and efficacy, and to avoid possibilities of exploitation or harm.
Counselors and supervisors usually consider dual relationships on a continuum of risk. As you work through the notion of dual relationships, you should consider the relationship with your client and the context of the situation. It is also important to consider the impact of dual roles on the power dynamics of the therapeutic relationship. For example, clients, students, and supervisees have less experience, knowledge, and power compared with licensed counselors and supervisors. Consequently, they are less likely to recognize inappropriate boundary crossings or to express their concerns about these crossings. It is your responsibility as an ethical practitioner to monitor and ensure appropriate boundaries across all related counseling situations.
For this Discussion, review the
Clinical Mental Health Counseling: Boundary Issues
media and consider the population that you are interested in working with as a professional counselor. Then, review the Learning Resources for this week and explore potential boundary issues you may encounter while working with this population. Reflect on potential benefit or harm related to boundary crossing. Finally, consider potential consultants who might be able to address any boundary issues.
Post by Day 3
a brief description of the population you selected. Then, explain any potential boundary issues you anticipate may be challenging in working with this population and explain why. Explain the potential benefit or harm associated with boundary crossing with this population. Finally, explain who you might consult with to address this boundary issue and why.
Be sure to use the Learning Resources and the current literature to support your response.
Respond by Day 5
and expand on your colleague’s posting by providing an alternate perspective on how you would work with your colleague’s selected population. Provide potential boundary crossing challenges that your colleague did not discuss and offer potential solutions for addressing these challenges.
Required Resources
Note:
To access this week's required library resources, please click on the link to the Course Readings List, found in the
Course Materials
section of your Syllabus.
Readings
Herlihy, B., & Corey, G. (2015).
ACA ethical standards casebook
(7th ed.). Alexandria, VA: American Cou.
PLEASE NO PLAGIARIZE!! Have 10 hours to fullfil this work. 1page or .docxChereCheek752
Women have long faced inequality compared to men, but the women's rights movement in the mid-late 20th century improved women's status by opening positions traditionally held by men. While some feel women have achieved equality in the 21st century, others disagree. The document asks how one would describe current gender equality in Western culture and whether there are still major areas of large-scale discrimination against women, requesting two examples if so or a rationale if not.
Please Paraphrase the following into a more scholarly toneI f.docxChereCheek752
Please Paraphrase the following into a more scholarly tone:"
"I feel like after reading these excerpts I feel like the first answer clarified what exactly Gus Casely-Hayford was really trying to figure out about Ethiopian history. It was clear that he was trying to figure out its history, however, it was difficult to put the pieces together and pinpoint things that could lead to it's past. I don't think it was a specific sentence it was really just how they answered it that helped me put it together.
A sentence in another paragraph that clarified what the answer was at number two when it said "After this, Ethiopia switched to Christianity, which has a direct link with the history of the kingdom. The Patriarch claims that the Ark of the Covenant was brought to Ethiopia". It clarifies what the patriarch really meant when he said that they had accepted the old testament.
These excerpts can help when I am doing homework because they can be used as a structure when answering questions for my future homework. In my next homework, I will aim to have more references and actually pinpoint what the answer is because I feel like I do not fully answer the question I only answer it partially. So I can turn in something rather than nothing. It is sometimes difficult to understand the main idea or interpret what some people are saying in the documentaries. The readings, however, are easier to understand.
.
Please only respond if you are familiar with raspberry piIam loo.docxChereCheek752
Please only respond if you are familiar with raspberry pi
Iam looking to send Binary data over the GPIO pins. I need to use one of the input and output pin to send binary data on the output.
If you are very familiar with Raspberry pi please message me.
THank you
.
Please note this is 2 ASSIGNMENTS ......Please only orginial work on.docxChereCheek752
Please note this is 2 ASSIGNMENTS ......Please only orginial work only and please follow the instruction provided
Assignment 1: Week 3 COURSE PROJECT
Week 3: Create the Database
Create the database and associated tables in your database environment.
Assignment 2: Week 3 ILAB
iLab 3: Database Creation and Table Manipulation
.
PLEASE NEED TWO RESPONSES TWO HUNDRED WORDS EACHDistinguish b.docxChereCheek752
PLEASE NEED TWO RESPONSES TWO HUNDRED WORDS EACH:
Distinguish between various factions/denominations within Christianity (Catholic/Protestant/Orthodox/etc) and their impact on mainstream (dominant) expression of how Christianity is viewed by those on the "outside."
Consider the viewpoints we saw represented in
Once I Was a Beehive.
How does it differ or compare to popular or mainstream faith as you know it? Of course, it is one interpretation of faith in Jesus and how it impacts daily life (and during troubling times, as seen in the film).
For example, if I walked into one church, I might find folks picking up and handling snakes, singing rather loudly and outwardly in their expressions of worship. If I went to the congregation next door the following Sunday, I might find a church that barely whispered, used no music at all, and perhaps simply followed a monotone lecture/sermon style delivered over the course of an hour, or two, or three! Both representing the same organism/religion...
Please respond with no less than 200 words, and respond to at least one of your classmate's post.
.
Please no plagiarism and make sure you are able to access all resour.docxChereCheek752
Please no plagiarism and make sure you are able to access all resource on your own before you bid. I need this completed by 10/21/17 at 12pm.
Application:
Applying Theoretical Interventions for Clients Experiencing Life Transition and Developmental Issues, Part II
Marriage, couple, and family counselors have varying caseloads. What they all have in common is that their group of clients—whether large or small—represents the variety of human experience. Even those counselors with a specific clinical focus see variety in the ways in which specific issues manifest in different relationships. Part of the goal of your counseling program is to expose you to varying scenarios so that when you are faced with differing client situations, you will have the evidence-based research knowledge, flexibility, analytical skills, and theory-integration practice to know the best course of action to take with a particular couple or family.
To prepare for this Application Assignment, select and view one movie from the list provided in this week’s Learning Resources. Begin to conceptualize the couple's or family’s problem through your theoretical orientation and identify interventions that you might use. Finally, begin to locate articles in the Walden Library that could be used to justify the interventions you selected.
The assignment (2–3 pages)
Identify the movie you selected and the life transition/developmental issue present in the couple/family.
Conceptualize the couple's/family's problem through your chosen theoretical orientation.
Describe two interventions you would use to address these couple/family issues and how you would use them. (
Note
: The interventions may not emerge from your chosen theoretical orientation.)
Justify the intervention you selected with two evidence-based research articles.
Support your Application Assignment with specific references to all resources used in its preparation. You are asked to provide a reference list for all resources, including those in the Learning Resources for this course.
Submit your assignment by
Day 7
.
Learning Resources
Required Resources
Media
Please select, obtain, and view one of the following movies to use with this week’s Application Assignment:
Please note:
These films are
not
available through Walden Library. Contact your instructor if you are unable to obtain a copy independently.
Movie: Rydell, M. (Director). (1981).
On golden pond
[Motion picture]. [With K. Hepburn, H. Fonda, & J. Fonda]. United States: IPC Films.
Movie: Demme, J. (Director). (2008).
Rachel getting married
[Motion picture]. [With A. Hathaway, R. DeWitt, & D. Winger]. United States: Sony Pictures Classics.
Movie: Redford, R. (Director). (1980).
Ordinary people
[Motion picture]. [With A. Sutherland, M. Tyler Moore, & J. Hirsch]. United States: Paramount Pictures.
Readings
Article: Haggan, P. S. (1998). Counseling adult children of aging parents.
Educational Gerontology
,
24
(4), 333. Ret.
Please need two posts of 200 words each. Discuss the ways in whi.docxChereCheek752
Please need two posts of 200 words each.
Discuss the ways in which Confucianism can or may weave into our everyday lives, given what you've read and watched/reviewed. Consider the ways you saw Confucianism as a religion and/or as a philosophy displayed in the film
Confucius
, focusing on the themes of bravery, self-sacrifice, respect, and loyalty. As you've been reading through the text, you'll find multiple arguments suggesting that Confucianism is less religion, more philosophy. What are your thoughts? Use examples from the film and text to support your conclusions.
.
Please look for the following errors in this document.ErrorsKeyb.docxChereCheek752
Please look for the following errors in this document.
Errors
Keyboarding Errors
Capitlalization Errors
Abbreviation errors
Number Expression Errors
Scholarship Search
Subject Verb Agreement
Pronoun Problems
Sentence Construction
Comma Errors
Other punctuation errors
Format Errors: Letters and Memos
Format Errors: Report and job search documents
Editing for content, clarity and conciseness
.
Please make sure that your writers are properly writing the final re.docxChereCheek752
Please make sure that your writers are properly writing the final references of the journals correctly. The last paper the writer did not write the journal reference in the right format. Example, what he/she did was
Markinsin, J. The effects of health on others. Retrieved from
http://journal
of health management.
THIS IS INCORRECT FORMAT!!!!!!!!!!!!!!!!!!!!!!!!!!
All journals should be written as such:
Markinson, J. (2014). The effects of health on others.
The Journal of Health Management, 6
(3), p. 101-120.
The writers should know this. Please let me know if anything else is needed. This upcoming assignment is straightforward paper. Let the writers know that at least
TWO
scholarly nursing journals should be used.
ASSIGNMENT DETAILS:
As of 2014 health care expenditures in the United States are near 17% of our gross domestic product (GDP), with a major portion of Medicare funding goes towards chronic illness and care at the last 6 months of life. The Patient Protection and Affordable Care Act has made some initial legislative changes in our health system, but not sufficient to address our growing expenditures and caring for our large aging population. In this assignment, learners will synthesize issues in aging with health policy solutions by writing a paper on one health issue for older individuals addressed in the topic and offering a policy solution. Example of issue: In 2014, over 50% of the costs of institutional long-term care for older persons are paid for with public funds from Medicaid.
Directions:
Write a 12000-1500 word paper that addresses a health issue for older individuals. Include the following:
1.Evaluate what the literature suggests as a resolution to your chosen issue.
2.Discuss any attempts to incorporate the solution into public policy.
3.Determine the barriers to implementation of the solution.
4.Analyze the options being discussed for public and/or private funding.
5.Propose your own recommendation.
.
Please identify the one sculpture from each of the following artist .docxChereCheek752
Please identify the one sculpture from each of the following artist and describe what you are seeing. What is your reaction to each sculpture? What are they made out of? The artists are:
Dale Chihuly
and
Tom Otterness
.
I need one page assıgnment about these questıons
I need thıs assıgnment ın 10 hours. Time is really ımportant
.
Please I would like you to write a discussion with 200 words by answ.docxChereCheek752
Please I would like you to write a discussion with 200 words by answering the following questions.
Please I want good works and no plagiarism.
Egypt's president Abdel Fatah al-Sissi recently met with President Trump. The conversation included discussion of the fight against terrorism, the Middle East’s multiple wars, the refugee crisis and Egypt’s anemic economy. The two leaders, however, were criticized for not discussing human rights. Should human rights concerns take a back seat to national security cooperation? Why or why not? Which do you view as being more important? Why.
If you are not familiar with this issue, please do some research before posting.
.
Please identify the leadership traits, skills, and behaviors that yo.docxChereCheek752
Please identify the leadership traits, skills, and behaviors that you consider the most important in leading and motivating subordinates. Examine specifically why you selected the traits, skills and behaviors in relation to employee motivation
Bierman, L., Ferrell, O. C., & Ferrell, L. (2016).
Management: Principles and applications, custom edition
[Electronic version]. Solon, OH: Academic Media
Solution
s.
.
Please i need a research paper about Langauge and Culture.( 1500 wor.docxChereCheek752
Please i need a research paper about Langauge and Culture.( 1500 word )
with an
1 - Introduction ( with hook sentence at the
beginning)
2- first paragraph about ( is it important to merge between langauge and culture )
3 - second paragraph about ( if you visit a foreign country, do you like to know their culture)
4 - third paragraph ( what is the right way to learn other country's culture ) by { watching their culture movies or searching to the internet)
5 conclusion.
.
Please help me with this program1 – Hello WorldCreate a proj.docxChereCheek752
Please help me with this program
1 – Hello World
Create a project using buttons, a single display label, and event procedures to display “Hello World” in 6 languages (default English + 5 more, your choice). Watch basic coding and naming standards; include comments/remarks.
.
PLEASE HELP REVISE & STRUCTURENEED INTRODUCTIONANALYSISCO.docxChereCheek752
PLEASE HELP REVISE & STRUCTURE:
NEED INTRODUCTION
ANALYSIS
CONCLUSION
Policies decisions are guided by complexed specialized knowledge not always understood by the public. Often, an economist is solicited by the government to offer judgement based upon his or her expertise. The recommendations should not conflict with values that emphasize serving the interests of others. The argument can be made that market failure is a reflection of government failure to correct the market. According to Weimer and Vining (2011)
This piece belong to you since you’re expert in this area,
Dealing with foster care for youth how they are able to leave the system before they are 21. This policy was written because of the high number of young people who left care early were in need of services. These services range from housing to employment assistance. We were eager to address the concerns of the former foster youth, but we had to ensure that the policy we drafted had to include stipulations on what services youth would receive. Because if we allowed them to receive all of the resource given to kids who are still in care, local departments would not be able to accommodate the youth adequately.
Reference
Weimer, D. L., & Vining, A. R. (2011). Policy analysis: Concepts and practice (5th ed.). Upper Saddle River, NJ: Pearson. ISBN: 9780205781300
.
PLEASE HELP REVISE & STRUCTURENEED INTRODUCTIONANALYSISCO.docx
Family Medicine 20 28-year-old female with lowerabdominal p
1. Family Medicine 20: 28-year-old female with lower
abdominal pain
User: Daniela Fernandez
Email: [email protected]
Date: February 24, 2021 11:32PM
Learning Objectives
The student should be able to:
Conduct a culturally sensitive, empathic history.
Appreciate the ways in which victims of violence may manifest
symptoms and be alert to clues a patient may give that he/she
has been a victim of intimate partner violence.
Discuss ways to assist the patient in developing a safety plan.
Discuss reporting requirements for intimate partner violence.
Appreciate a survivor’s perspective in an abusive relationship
and the barriers to his/her seeking help.
Apply knowledge of the differential diagnosis of lower
abdominal and pelvic pain in evaluating the patient.
Knowledge
Significance of the Location of Lower Abdominal Pain
The location of the abdominal pain is important, as it can help
narrow your differential diagnosis. For example, diffuse
abdominal
pain may represent gastroenteritis, whereas localized right
lower quadrant pain is classic for but not limited to
appendicitis. Think
about what is in the various quadrants of the abdomen when
2. considering the differential diagnosis of abdominal pain.
Red Flags of Life-Threatening Condition in Patient with Lower
Abdominal/Pelvic Pain
There are many signs and symptoms of a life-threatening
condition in a patient with abdominal or pelvic pain. Examples
include:
Abrupt onset of severe pain
Shock with hypotension and tachycardia
Distension
Peritoneal irritation signs
Rigid abdomen
Pulsatile abdominal mass
Absent bowel sounds
Fever
Vomiting
Diarrhea
Weight loss
Menstrual changes
Trauma, prior surgeries, or operative scars
History/presence of blood in emesis
History/presence of blood in stool
Severity of the pain
Ecchymoses/bruising
Rebound tenderness
Mass or ascites
Obstetrical History
G Gravida or number of pregnancies
T Number of Term pregnancies
P Number of Preterm infants
4. Constipation: Patients may give a history of having small, hard
pellets for stools, decreased frequency of stooling, harder stools
than usual, or occasionally having loose stools, which may
actually signify an impaction, where the patient has soft stool
leaking
around an impacted hard stool. This type of stooling pattern is
more often associated with irritable bowel syndrome.
Irritable bowel syndrome (IBS): Many patients will describe
abdominal pains of varying location, associated with either soft,
frequent, loose stools, or constipation, or an alternating stool
pattern. They may also describe abdominal bloating, increased
flatulence, and mucus in the stool. The symptoms of IBS are
frequently worse when the patient is under stress, anxious, or
depressed. Symptoms of IBS can be brought on initially by a
case of gastroenteritis and can be aggravated by stress, diet, and
change in activity—and the symptoms are often unpredictable.
Caffeine and dairy products can make symptoms worse. The
diagnosis is based on clinical history, physical exam, and
absence of alarming symptoms suggesting other pathology.
The Rome IV criteria is often used to aid diagnosis of adult
IBS:
Recurrent abdominal pain, on average ≥ 1 day per week in past
3 months with two or more of following features:
1. Related to defecation
2. Associated with change in stool frequency
3. Associated with change in stool form (appearance)
Endometriosis: Patients with endometriosis may begin to notice
increasingly more painful and heavier menstrual cycles as early
as late adolescence. A patient with endometriosis might indeed
have lower abdominal discomfort, often starting after ovulation
during most cycles and continuing through their menstrual
cycle. There may also be low back pain or painful stooling. It is
not
5. uncommon for a patient with endometriosis to experience pain
with intercourse. Ultrasounds or MRIs may be needed in order
to
help diagnose the problem. Laparoscopy may be needed to
definitively diagnose, treat, or alleviate symptoms. Hormonal
contraception often stops the pain and the process, thus
preserving the patient’s ability to become pregnant later.
Genetic factors
are often involved.
Inflammatory bowel disease (IBD): Patients with IBD usually
have some combination of abdominal pain, bloody diarrhea, and
frequent stooling. The onset of symptoms frequently occurs in
the late 20s or early 30s. The patient may ultimately be
diagnosed
with either ulcerative colitis or Crohn Disease. Diagnosis is
made through specific radiological findings on barium enema,
small
bowel follow-through, and by colonoscopy.
Muscular pain or musculoskeletal pain is generally
reproducible. On exam, there is usually point tenderness to
palpation of
the affected muscles. The pain may recur during certain
activities or when the offending position is (re)assumed.
Psychosomatic pain: Symptoms from this type of pain are
variable and can be associated with or aggravated by other
etiologies
such as IBS or gastritis. The pains can occur anywhere
throughout the abdomen. They usually present as an atypical
pain pattern,
occur in a depressed or otherwise mentally ill patient, and may
point toward a psychogenic cause. This is a diagnosis of
exclusion.
Stress: The patient's symptoms and pains tend to be increased
when the patient is under increased stress or is involved in other
negative interactions. The patient may present with a whole
constellation of other stress-related symptoms, such as
7. Screening recommendations:
The American College of Obstetrics and Gynecology suggests
screening all patients who come to them (family planning
patients,
all ob-gyn patients, and all prenatal patients) at first visit, at
each trimester, and at the postpartum visit. It may help to
preface
asking such questions with a statement such as: "Because
intimate partner violence (IPV) is so common, I ask all of my
patients
about this..."
The U.S. Preventive Services Task Force (USPSTF)
recommends that clinicians screen women of childbearing age
for IPV, such as
domestic violence, and provide or refer women who screen
positive to intervention services. (Level of Evidence: B)
This is routinely done at annual exams or when red flags are
present.
Here is a good resource regarding screening for intimate partner
violence.
Prevalence:
It is important to be aware of IPV when addressing our patients,
as approximately 25% of women in the U.S. report being
victimized by an intimate partner at some point in their lifetime.
While the majority of IPV victims are women, they can be any
gender, occur in both heterosexual and same-sex relationships,
and across all socioeconomic, age, and ethnic divides.
Complications:
In addition to the trauma incurred, the rates of chronic
disease—including heart disease, diabetes, depression, and
suicide—are
significantly higher in victims as well as in adults who were
8. victimized as children as a result of direct abuse and exposure
to IPV.
Symptoms and Conditions Experienced More Frequently by
Victims of IPV Red Flags for Intimate
Partner Violence
Individuals who were victimized by their intimate partner are
more likely to experience:
Migraines, frequent headaches
Chronic pain syndrome
Heart and blood pressure problems
Arthritis
Stomach ulcers, frequent indigestion, diarrhea, constipation,
irritable bowel syndrome, spastic colon
Pain during sex (dyspareunia), dysmenorrhea, vaginitis, pelvic
inflammatory disease, chronic pelvic pain syndrome, and
other gynecological diagnoses
Invasive cervical cancer and preinvasive cervical neoplasia
Depression, anxiety, and post-traumatic stress
Unexplained or poorly explained findings on physical exam
Red flags for intimate partner violence include:
Delay in seeking medical care
Non-compliance with treatment plan
Partner insisting on staying close and answering questions
directed to patient
Hesitancy or not answering questions or inconsistent or
incorrect answers given to questions
Shyness or reticence in answering questions
Explanation of problem or incident does not match severity of
findings
Facilitating Discussion About Intimate Partner Violence
9. There are several nonjudgmental ways to ask about intimate
partner violence. Examples include:
"Do you feel safe at home?"
"Because violence is so common, and there are so many forms
of violence, I am asking all my patients about it. Is anyone
now or has anyone in the past hurt you emotionally, physically,
or sexually. Is anyone threatening you?"
"All couples disagree at sometime. What happens when you
disagree/fight/argue?"
"Does your partner ever force you to do things you do not want
to do or keep you from doing things you want to do?"
"How do you handle money issues in your relationship?"
"I often see the type of symptoms that you have in people who
are being hurt at home or in a relationship. Do you think that
this might be happening to you?"
There are lots of things you can do to facilitate discussion about
IPV.
Ask screening
questions
Many clinics will ask a screening question of all patients during
the triage process. Asking the patient, "Do you
feel safe at home?" follows the vital signs and questions about
whether or not the patient is having any pain.
This open-ended question allows the patient to share
information they might have about feeling unsafe at
home, in their neighborhood, or where they live, work, or shop,
or feeling threatened or actually being abused
by someone. This question is appropriate for any age, gender, or
socioeconomic class. It may take several
visits for the patient to feel comfortable enough with the
provider to discuss such a sensitive issue.
11. Ensure
confidentiality
Update and review HIPAA forms and make sure that all staff
are aware of how to use them. Be sure to tell the
patient that anything discussed in the room will not be shared
with anyone not directly involved with their
care, including their partner and family members.
Direct
assessment
Interviewing can begin with indirect questions such as, "Tell me
about your relationship," but should include a
direct assessment of safety, including questions regarding
weapons in the house and danger or possible harm
to the children or pets.
Know your local
laws
All states require reporting of child abuse and some require
reporting of intimate partner violence. Be open
with your patient about your legal constraints.
Facilitate
impartiality
Consider using a telephone service for interpretation if an
appropriate professional interpreter is not present in
the office. Do not use a friend or relative.
Listen
nonjudgmentally Validate the patient's concerns and the fact
that abuse is not the fault of the victim.
12. Handling Children During a Sensitive History and Exam
It is generally preferred to have children outside the room
during a pelvic or genital exam of the parent. Depending on the
age of
the child, some parents may prefer to have the child sit in the
room in a corner and face away from the exam table, or keep a
sleeping child in a stroller in the room with them. The clinician
may have sensitive questions to ask; the parent-patient may not
want the child to see them undressed and undergoing this exam.
There is frequently someone on staff who will watch or
entertain the child or children during this portion of the exam.
Or the
parent may have come to the clinic with a friend or relative with
whom the child can stay in the waiting room during that portion
of the visit.
It is also important to have a chaperone in the room for the
exam for legal reasons and for protection of the clinical staff.
This
person should be named in the chart note.
Symptoms of Exposure to Domestic Violence in Children and
Adolescents
Obvious physical signs of physical or sexual abuse
Behavioral or emotional problems, such as increased
aggression, increased fear or anxiety, difficulty sleeping or
eating, or
other signs of emotional distress
Chronic somatic concerns
30% to 60% of perpetrators of intimate partner violence also
abuse children in the household.
Intimate Partner Violence Safety Assessment
14. affectionate. Unfortunately, in most cases, the cycle begins
again and often the violence is increasingly severe.
Documenting a Case of Suspected Intimate Partner Violence
When documenting a history of abusive behavior, use the
patient's own words in quotes and fill in names after pronouns
are used.
Example: "then he (John Smith)…". Use neutral language.
Example: "patient states", not "patient alleges," which may give
a false
impression of disbelief.
Give a detailed description of the patient's appearance,
behavioral indicators, injuries and stages of healing, and health
conditions. If the patient consents, use photos to document
injuries; one with a face included in the photo, and then close-
ups of
the injury. If photos are not possible, draw and describe injuries
on a body map in blue ink as this is difficult to alter/reproduce.
Document recommendations for support and follow-up as well
as materials given to the patient.
Document abuse history as reported by patient in the subjective.
The subjective section is meant to document the patient's
experience and verification is not applicable. Include any
laboratory and radiology tests ordered with results to maintain a
complete record for the patient. Document results of health and
safety assessments and plans for follow-up as well as referrals
and materials given to the patient. Document recommendations
for support. If the patient was referred for a post-rape exam,
document the referral site. Maintain strict confidentiality and
safeguard the chart rather than limit the contents for best care
practices.
Clinical Skills
Adequately Addressing Your Patient's Needs Within Time
15. Constraints
It is a common scenario to see a patient that is scheduled for an
acute visit, but the situation requires more time to be adequately
addressed. Prioritize the most acute or high risk issues raised
during this visit and focus on these, and then emphasize the
importance of follow-up and schedule a follow-up visit as soon
as possible.
Management
The Role of the Health Care Provider in the Care of a Victim of
Intimate Partner Violence
Acknowledge
the abuse
and health
implications
It is important to acknowledge the abuse, recognize the health
implications, and share this with your patient.
Support your
patient's
decisions
While you may not always agree with the decisions your patient
makes to stay or escape, it is important that you
support their decisions. They have a greater understanding of
the complexity of the problem, and have more
information on which to base their actions.
Address
safety issues
Address the level of risk and safety issues for your patient.
16. Provide information for them to go to a safe haven if
needed. As lack of a telephone or computer (or monitoring of
their use) often make it unsafe or impossible for
victims to contact IPV resources from home, it is important not
only to give contact information to the patient, but
also to offer a means for them to contact services while in your
office. One should be aware that the person inflicting
the violence might check the patient's/victim's phone and
computer for recent phone calls, website visits, and
emails.
Practice
cultural
sensitivity
Cultural differences can give the appearance of abuse, be
accepting of practices some might consider abusive, and
can inhibit the ability to interview or support a victim.
Practicing sensitivity in caring for patients from different
backgrounds is key to a supportive patient-clinician
relationship.
Consider
impact of
abuse on
children and
other
vulnerable
When children or other vulnerable persons who are less able to
make decisions on their own behalf are in the home,
consideration must be given to the impact of the abuse on them
physically and mentally as well as their safety.
Even in states where reporting abuse towards a domestic partner
is not mandated, the impact or abuse on a child or
other vulnerable person may be and will supersede the desires
18. report this abuse to
child protection services. Mandated reporters would also report
any high-risk situation of IPV in which children are at risk.
However, state laws are less clear about whether exposure to
IPV in the absence of injury or serious risk of injury to the
child
would require a report to children's protective services.
In some states, stringent rules/laws require mandated reporters
to notify child protection services whenever a child is in the
home
and has been exposed to a parent's abuse, whether or not the
child has been directly abused. Proponents of this definition
point to
the ample documentation of the overlap between adult IPV and
child abuse and the adverse psychological effects on children
who
witness IPV. Opponents of this policy believe it penalizes
women for abuse that they have no control over and may
discourage
women from seeking help. It also could elevate the level of risk
for the victim.
In other states, a child's exposure to IPV does not automatically
require a mandatory child protection report. The provider has
wider discretion to assess whether a child has been directly
involved and what other factors may exist to put the child at
risk. In
these states, a provider would take into account the existence of
direct injury to a child, the potential danger of the situation, and
the capacity of the mother to keep her children safe in deciding
whether to notify Child Protective Services (CPS).
The rules for victims who are adults and are not disabled vary
dramatically from state to state, from mandatory reporting for
evidence of abuse to reporting only if the victim asks the
clinician to do so. Contact your local Domestic Violence
helpline and ask
what the rules are for the community in which you work. You
19. can find out about your local resources by calling the National
DV
Hotline at (800) 799-SAFE, TTY (800) 787-3224.
Studies
Recommended Studies for Evaluation of Lower Abdominal Pai n
Pap test—
thin prep Recommended in the setting of previous abnormal
results.
KOH/saline
wet prep
This is a quick test which should be done as it could indicate
inflammation (white blood cells) or diagnose
trichomonas, bacterial vaginosis, or yeast vaginitis.
Chlamydia /
gonorrhea
DNA probe
Chlamydia and gonorrhea can present with a yellow discharge,
abdominal pain, and dyspareunia. This is the
preferred method for diagnosis of chlamydia and gonorrhea
because both can be performed using the same
sample, and the sample can be endocervical, urethral, vaginal,
oral, or urine.
Urine
dipstick Helpful to rule out a urinary tract infection (UTI).
Urine
pregnancy
test
21. this is still the preferred method for sexual assault tests, for
tests of cure, and for oral and rectal specimen.
HCG beta sub This is generally not indicated because of the
sensitivity of the urine pregnancy test. If the results of the
urinepregnancy test were inconclusive, a blood test such as
HCG Beta Sub would be needed.
Clinical Reasoning
Severe / Life-Threatening Causes of Abdominal Pain
Appendicitis
Patients with appendicitis often start with visceral pain that is
dull and in the periumbilical region; within a short
time the pain classically localizes; presentation is usually of
fairly acute onset with moderate to severe right
lower quadrant pain. There is often a history of nausea and/or
vomiting. There are usually some changes in the
patient's bowel movements.
Ectopic
pregnancy
Ectopic pregnancy is a medical emergency. Early medical
treatment reduces the need for surgery, but if the
fallopian tube is in danger of rupture, surgical intervention may
be necessary. Patients present with divergent
symptoms ranging from no pain and normal menses to intense
pain and irregular or absent menses. A good
history, the physical exam and lab testing (always get a
pregnancy test if the patient has a uterus) are crucial for
this diagnosis. Imaging is also usually needed. You need the
date of the patient's last menstrual period (LMP), her
menstrual history, most recent intercourse dates, the types of
contraception used currently and used in the past
22. /ever used, history of any vaginal or pelvic infections, and
history of previous ectopic or normal pregnancies.
Endometriosis
While endometriosis is not typically life-threatening, it can be
severe. The majority of patients are of reproductive
age and present with cyclical pelvic pain, following the
menstrual cycle in patients with regular menses. The
location and pattern of the pain can vary widely, depending
upon which organs have been affected. For example,
those with bladder involvement may present with urinary
frequency, urgency or dysuria. Endometriosis may also
present as infertility in an otherwise asymptomatic patient or as
an incidental finding during surgery.
Ovarian
pathology
Patients with ovarian problems generally have lower abdominal
or pelvic pain. Pain from ovarian torsion or
ruptured cyst or ectopic pregnancy may be very severe and
usually has a sudden onset. Patients often present to
the emergency department due to the pain, and this is
appropriate since imaging is usually necessary to
determine the exact cause of the pain. In several cases, the pain
from ovarian problems may persist for several
weeks. It is often aggravated by intercourse or strenuous
activity.
Pelvic
inflammatory
disease
Patients with pelvic inflammatory disease (PID) might have
abdominal or pelvic pain, which is worse with sexual
23. intercourse or with activities such as running or jumping, which
cause jarring of the pelvic organs. This diagnosis
has significant morbidity, which increases with the severity of
the disease and with the length of time to
diagnosis. Studies show that approximately one in four patients
who had a single episode of PID later
experienced tubal infertility, chronic pelvic pain, or an ectopic
pregnancy, as a result of scarring and adhesions.
Tubal adhesions leading to infertility have been reported to
occur in 33% of patients after their first episode of
PID, and up to 50% after the second pelvic infection.
Normal
pregnancy
Patients who have normal pregnancies may experience some
lower abdominal discomfort or pain as the uterus
undergoes normal growth. This is more a diagnosis of
exclusion, but you would not want to miss a pregnancy.
Certain medications should not be given to patients who are
pregnant. Fetuses should not be exposed to
radiation.
Trauma
A careful history is important in regard to trauma. Be aware of
the patient's body language and response to
touch. Consider the consistency of the history with the exam.
Have the patient undress and examine the patient
thoroughly in a gown so that all areas can be visualized.
Consider taking a photograph of any injuries and bruises
if there is a way to appropriately attach them to the patient's
medical record, and if the patient gives consent.
References
American College of Obstetricians and Gynecologists (ACOG).
25. Family Violence Prevention Fund. Compendium of State
Statutes and Policies on Domestic Violence and Health Care.
Produced 2010.
Accessed June 9, 2020.
Futures Without Violence (formerly The Family Violence
Prevention Fund). First Printing: September, 2002. Updated:
2020. Accessed
February 8, 2020.
Futures Without Violence. The Facts on Domestic, Dating and
Sexual Violence. Released 2009. Accessed February 8, 2020.
Futures Without Violence. The Facts on Women, Children and
Gun Violence. Released 2013. Accessed February 8, 2020.
Futures Without Violence. The Health Care Costs of Domestic
and Sexual Violence. Updated March 2010. Accessed February
8, 2020.
Hatcher RA et al. Contraceptive Technology 19th edition,
Ardent Media, 2007.
http://www.contraceptivetechnology.org/table.html.
Accessed February 8, 2020.
Institute for Clinical Systems Improvement (ICSI). Initial
management of abnormal cervical cytology (Pap smear) and
HPV testing.
Algorithm. Bloomington (MN): Institute for Clinical Systems
Improvement (ICSI); Oct 2008;32:63. Accessed February 8,
2020.
Katz VL et al, Infections of the Upper Genital Tract:
Endometritis, Acute and Chronic Salpingitis In: Comprehensive
Gynecology, 5th
edition. Philadelphia, PA: Mosby; 2007.
26. Marsicano E, Vuong GM, Prather CM. Gastrointestinal causes
of abdominal pain. Obstet Gynecol Clin North Am.
2014;41(3):465-89.
National Consensus Guidelines on Identifying and Responding
to Domestic Violence Victimization in Health Care Settings.
Produced by
The Family Violence Prevention Fund, 383 Rhode Island Street,
Suite 304, San Francisco, CA 94103-5133. (415) 252-8900.
TTY (800)
595-4889. First Printing: September, 2002. Updated: February,
2004.
Planned Parenthood Interactive website. Birth Control Methods
and Options | Types of Birth Control. Accessed February 8,
2020.
Shian B, Larson ST. Abdominal Wall Pain: Clinical Evaluation,
Differential Diagnosis, and Treatment. Am Fam Physician.
2018;98(7):429-36.
Silverman JG, Decker MR, Reed E, Raj A. Intimate partner
violence victimization prior to and during pregnancy among
women residing
in 26 U.S. states: associations with maternal and neonatal
health. Am J Obstet Gynecol. 2006;195(1):140‐ 8.
Trigg BG, Kerndt PR, Aynalem G. Sexually transmitted
infections and pelvic inflammatory disease in women. Med Clin
North Am.
2008;92(5):1083‐ 113.
Wet Mount. Military Obstetricts & Gynecology.
http://www.brooksidepress.org/Products/Military_OBGYN/Text
book/Discharge/WetMount.htm Accessed June 9, 2020.
28. Pain HistorySome Common Causes of Lower Abdominal Pain
Presenting in Primary CareIntimate Partner Violence: Screening
Recommendations, Prevalence, and ComplicationsSymptoms
and Conditions Experienced More Frequently by Victims of IPV
Red Flags for Intimate Partner ViolenceFacilitating Discussion
About Intimate Partner ViolenceHandling Children During a
Sensitive History and ExamSymptoms of Exposure to Domestic
Violence in Children and AdolescentsIntimate Partner Violence
Safety AssessmentIncreasing Severity of Intimate Partner
ViolenceEscalating Cycle of Intimate Partner
ViolenceDocumenting a Case of Suspected Intimate Partner
ViolenceClinical SkillsAdequately Addressing Your Patient's
Needs Within Time ConstraintsManagementThe Role of the
Health Care Provider in the Care of a Victim of Intimate Partner
ViolenceStudiesRecommended Studies for Evaluation of Lower
Abdominal PainClinical ReasoningSevere / Life-Threatening
Causes of Abdominal PainReferences
Assignment requirements
Read “Case 6: Fixer Upper: Expanding the Magnolia Brand” in
your Connect textbook.
Evaluate Magnolia Brands’ sustainable competitive advantage
by analyzing the case study and answering the following
questions in 350 to 525 words:
· How will the components of the external environment impact
Magnolia Brands’ ability to realize their vision?
· Who are Magnolia Brands’ major competitors?
· What other factors are affecting the growth of Magnolia
Brands?
· What internal factors must be considered for Magnolia Brands
to achieve its vision and mission?
· What are some of Magnolia Brands’ strengths and
weaknesses?
· How does the new show represent an opportunity in the home
29. remodeling industry?
· What challenges or threats might Magnolia Brand face?
· What measurements can be used to determine if the new show
is successful?
· What is the feasibility of the ability of Magnolia Brands to
continue to be successful? Why?
Read Case 8.3: Speaking Out about Malt, located on page 311 in
your textbook. Determine whether Mary acted irresponsibly or
disloyally in your opinion. Describe the actions that you think
Mary should take next. Explain what you would do if you were
in Mary’s position.