Angina

 

Case Studies Angina

The patient was a 48-year-old man admitted to the coronary care unit complaining of substernal chest pain. During the 4 months preceding admission, he noted chest pain radiating to his neck and jaw during exercise or emotional upsets. The pain dissipated when he discontinued the activity or relaxed. The results of his physical examination were essentially normal except for a systolic murmur heard best at the apex of the precordium and radiating into the left axilla.

Studies

Results

Routine laboratory work

Within normal limits (WNL)

Cardiac enzyme studies

Creatine phosphokinase (CPK), p. 167

235 units/L (normal: 55–170 units/L)

CPK-MB, p. 171

12 ng/mL (normal: 0–3 ng/mL)

Lactic dehydrogenase (LDH), p. 293

120 units/L (normal: 90–200 units/L)

Serum aspartate aminotransferase (AST), p. 107

24 International units/L (normal: 5–40 International units/L)

Troponins, p. 451

18 ng/mL

Echocardiography, p. 820

Hypokinetic portion of the lateral left ventricle

Electrocardiography (EKG), p. 485

Evidence of left ventricular hypertrophy

Chest x-ray study, p. 956

WNL

Exercise stress test, p. 481

Positive: pain reproduced; ST segment depression noted on EKG (normal: negative)

Echocardiography, p. 820

Normal ventricular wall motion

Transesophageal echocardiography (TEE), p. 840

Mitral regurgitation, dilated left atrium

Lipoproteins, p. 304

HDL

29 mg/dL (normal: >45 mg/dL)

LDL

189 mg/dL (normal: 60–180 mg/dL)

VLDL

12 mg/dL (normal: 7–32 mg/dL)

Homocysteine, p. 269

16 mol/L

C-reactive protein (CRP), p. 165

22 mg/dL

Cardiac catheterization, p. 950

All WNL except:

Pressures

Left ventricular systolic pressure

140 mm Hg (normal: 90–140 mm Hg)

Aortic systolic pressure

130 mm Hg (normal: 90–140 mm Hg)

Ventricular-aortic pressure gradient

5 mm Hg (normal: 0)

Left ventricular function

Cardiac output

3.5 L/min (normal: 3–6 L/min)

End diastolic volume (EDV)

60 mL/m2 (normal: 50–90 mL/m2)

End systolic volume (ESV)

22 mL/m2 (normal: 25 mL/m2)

Stroke volume (SV)

38 mL/m2 (SV = EDV − ESV)

Ejection fraction

0.63 (normal: 0.67 ± 0.07)

Cineventriculography

Mitral regurgitation present, normal muscle function (normal: normal ventricle)

Analysis of O2 gas content, p. 98

No shunting (normal: no shunting)

Coronary angiography (coronary cineangiography), p. 950

90% narrowing of left coronary artery (normal: no narrowing)

Cardiac radio-nuclear scanning, p. 733

Scans normal showed localized area of decreased perfusion and poor muscle function in the myocardium during exercise

Cholesterol, p. 138

502 mg/dL (normal: <200 mg/dL)

Triglycerides, p. 447

198 mg/dL (normal: 40–150 mg/dL)

Diagnostic Analysis

Cardiac radio-nuclear scanning, EKG, and studies ruled out the possibility of MI. Troponins and serial cardiac enzyme indicated cardiac ischemia. Stress testing and a nucleotide scan indicated that the patient was having exercise-related myocardial ischemia (angina). Echocardiography indicated that the heart muscle at the site of ischemia was functioning poorly. Transesophageal echocardiography indicated that the patient had mitral regurgitation. Cardiac catheterization with cineventriculography demonstrated near-normal ventricular function, and coronary angiography indicated significant narrowing of the left coronary artery. Mitral regurgitation was also seen. The patient’s angina was then thought to be caused by the coronary artery disease. Open heart surgery was performed. The patient’s mitral valve was replaced with a prosthesis, and an aortocoronary artery bypass graft was performed. Postoperatively, he had a large pericardial effusion. This diminished his heart function. He underwent pericardiocentesis, and his function improved. Because his serum lipids study showed type IIa hyperlipidemia, a low-cholesterol diet and cholesterol-lowering agents were prescribed. The other cardiac risk factors did indicate increased risk for coronary heart disease. Six months later he was asymptomatic and jogging 3 miles per day.

Questions:

1.         Based on the ratio of cholesterol to HDL, what is the patient’s risk for coronary heart disease?

2.         If these blood tests were drawn 1 year ago, what treatment would have been indicated?

3.         Could surgery have been avoided?

Assignment 2: Tax Cuts and Jobs Act

 

Assignment 2: Tax Cuts and Jobs Act

Due Week 8 and worth 250 points

The Tax Cuts and Jobs Act was signed on December 22, 2017 and produced some of the most significant impacts in tax law in over 30 years. In this assignment, you will use the Internet or the Strayer University Online Library (https://research.strayer.edu) to research the tax reform changes brought about by the Tax Cuts and Job Act, analyze the impact these changes have on individual tax payers, and identify related tax planning strategies.

Write a three to five (3-5) page paper in which you:

  1. Summarize the purpose of the Tax Cuts and Jobs Act and explain the main objective(s) for its implementation.
  2. Examine three significant changes brought forth by the Tax Cuts and Jobs Act and discuss at least two advantages and/or disadvantages of each.
  3. Analyze the impact that each of the three significant changes has on the taxpayer as an individual and a family.
  4. Recommend tax planning strategies to maximize tax savings based on the three significant changes identified. Provide a rationale.
  5. Use at least three quality academic resources in this assignment. Note: Wikipedia and similar websites do not qualify as academic resources. Internet websites that include a .gov or .org extension qualify as quality academic resources. It is suggested that you use Strayer University Online library, located at https://research.strayer.edu/

Your assignment must follow these formatting requirements:

Be typed, double spaced, using Times New Roman font (size 12), with one-inch margins on all sides; citations and references must follow school-specific format. Check with your professor for any additional instructions. Include a cover page containing the title of the assignment, the student’s name, the professor’s name, the course title, and the date. The cover page and the reference page are not included in the required assignment page length.

The specific course learning outcome associated with this assignment is:

  • Analyze the impact of the Tax Cuts and Jobs Act on personal tax revenues, liabilities, deductions, and exemptions.

Grading for this assignment will be based on answer quality, logic/organization of the paper, and language and writing skills, using the following rubric.

1. Review the following request from a customer: We have a need to reed it to. The current system has a whole bunch of reports, but no way for the user to update them by themselves without getting IT involved.

  

1. Review the following request from a customer:

We have a need to replace the aging Signage Application. This application is housed in District 4 and serves the district as well as two other districts. We would like a new application that can be used statewide to track all information related to road signs. The current system is old and doesn’t do most of what we need it to. The current system has a whole bunch of reports, but no way for the user to update them by themselves without getting IT involved. We also can’t create our own reports, on-demand, when we need to. Currently, data is entered into the application manually by Administrative Staff, but in the future, we would like to be able to take a picture of the road sign using a phone app, and have it automagically populate the database with geospatial location and other information. We thought about having a Smart Watch interface, but we don’t need that. Also, the current method does not have any way to manage the quality of the data that is entered, so there is a lot of garbage information there. There is no way to centrally manage security access, with the existing application. We want to get real time alerts when a sign gets knocked over in an accident and have a dashboard that shows where signs have been knocked over across the state. This is kind of important, but not super-critical. We need to store location information, types of signs, when a new sign is installed, who installed it, etc. We plan to provide the phone app to drivers in each district who will drive around, take pictures of the signs, and upload them to the database at the end of each day, or in realtime, if a data connection is available. Back in Central Office, reviewers will review the sign information and validate it. A report will be printed every month with the results and a map. There are probably other things, but we can’t think of anything else right now.

2. List the main goal(s) of this request

3. Write all the user stories you see (include value statements and acceptance criteria, if possible)

4. Prioritize the user stories as

a. Critical

b. Important 

c. Useful

d. Out of Scope

5. Are the user stories sufficiently detailed? If not, what steps would you take to split them/further define them?

6. What are the known Data Entities?

7. Is there an implied business process? Draw an activity diagram or a flow chart of it

8. Who are the actors/roles?

9. What questions would you ask of the stakeholders to get more information?

10. What technology should be used to implement the solution?

11. What would you do next as the assigned Business Analyst working on an Agile team?

Mexican Mail Order Brides

 

Narducci also saw loads of middle- and higher-center-class men, in  https://mailorderbridesadvisor.com/latin-brides/   addition to wealthy males, who looked for a bride overseas. Agencies that set up American males with overseas girls cost for translation companies, emails, contacts and naturally excursions to fulfill the women at socials. We’d like to say a word about mail order brides and explain the distinction between mail order brides and the Russian brides and others on a web-based relationship web site like RoseBrides.com. Whether you’re new to international online dating or a veteran, when you’re looking for a mail order bride you’ve come to the proper place – and we’re pleased to have you ever as a member.

She also presents the tales of “The Hopeful Bride and the Farmer,” “The Homesteader and the Sheep Rancher” and several other others. One only needs that there have been more of those matchmaking tales she might tell. Well, as one trendy observer noted, “Better to meet by mail than in jail,” but he was speaking about e-mail.

Women from Vietnam, the Philippines, Russia and Ukraine constitute the majority of the brides in these providers. These girls often come to those international matchmaking agencies because they’re making an attempt to escape the poor economic realities of their residence nations, similar to being in danger of sexual and financial exploitation. This article will highlight the  <!–td {border: 1px solid #ccc;}br {mso-data-placement:same-cell;}–>https://mailorderbridesadvisor.com/latin-brides/  fact of Vietnamese mail-order brides specifically.

The Australian public additional embraced its government’s new insurance policies following the media circus of the Jana Klintoukh case. According to an earlier Grant Thornton International Business Report for 2012, Russia had a good larger proportion of girls in senior management at forty six%, nonetheless highest on the earth. Economic and social conditions for girls in Russia and other Post-Soviet states are a motivational factor to find international preparations. 52 % of Russia’s workforce is made up of women, yet based on some sources they typically hold low positions of prominence in their house country and work jobs with less respect and decrease wages ; and women earn forty three % of what men do. Join our community and become a member to find assist and hook up with different girls dwelling with HIV.

These components cause the bride to stick with her husband, regardless if there is abuse. This is one of the most open types of trafficking women into developed nations and virtually three,000 marriage businesses have been identified in driving the business. There was, however, a curious disconnect between what women wished to advertise and what they believed that men needed concerning social expertise, especially for the mail order brides. In 2006, I publishedtwo studies of the mating preferences of mail order brides from Colombia, Russia, and the Philippines with certainly one of my college students, Bibiana Paez . Although the motives of ladies looking for Western husbands are often pushed by economic issues, this is not always the case. Bibiana conducted in-depth interviews with several “brides,” husbands of mail order brides, and the proprietor of a mail order bride company in Colombia.

A notary is required, however as a result of the laws are open to interpretation, the requirements can range from notary to notary. According to immigration statistics from the United States Department of Homeland Security, Colombia has ranked in the high 10 of countries since 1999 from which fiancées have emigrated for the United States. As well, the number of Colombians being admitted to the United States between 1999 and 2008 using fiancé visas has increased 321 %. There have been reported cases in which foreign spouses have deserted their Canadian sponsors upon arrival in Canada or quickly thereafter, usually collecting welfare, which the sponsor is obligated to repay.

Second, some marriage brokers and businesses within the business are extra involved with profit than they are about the nicely-being of the women they declare to help discover love and new life. Lastly, people do not maintain IMBs responsible for the safety of the mail-order brides they introduce their purchasers to, leaving many mail-order brides in danger of violence and exploitation from their spouses. Agencies should also obtain the potential bride’s written consent to launch her private contact info to the client. After receiving this information, the bride has the choice to just accept or refuse communication with the consumer. This law is an try to protect mail-order brides from turning into battered wives, and lawmakers are hopeful that these modifications will serve to empower the ladies to know more about the males with whom they’re linking their futures. The mail-order brides business actually paints a very ambiguous picture.

In June 2013, The Philippine embassy in Seoul reported that it had obtained many complaints from Filipinas who’ve married Korean men through mail-order, regularly becoming “victims of grave abuses”. The girls were marketed in online and offline “catalogs” to South Korean males. In many circumstances however, victims had been fed false details about the background of their future spouse and household, and suffered abuse from the South Korean males, which led to “abandonment of the marital house, separation and divorce”, Villasanta stated. A mail-order bride is a lady who lists herself in catalogs and is chosen by a man for marriage. In the 20th century, the trend was primarily towards women dwelling in growing international locations in search of men in additional developed nations. In the twenty-first century, the pattern is now based totally on internet-primarily based assembly places which don’t per se qualify as mail-order bride providers.

He or she may help you discover a reliable worldwide marriage broker and help make sure that your “mail-order” matrimony is for retains. In November 2004, a federal jury in Baltimore awarded $433,500 to Nataliya Fox in a suit towards worldwide marriage dealer Encounters International. The company’s owner, Natasha Spivak, arranged Fox’s marriage to a man who had a history of violent abuse in opposition to girls. The jury found the dealer responsible of fraud, unfair and misleading commerce practices, willful and wanton negligence, and unauthorized appropriation of Fox’s name and likeness. Mail order brides have been in style within the Old West in the United States.

care plan

After coughing up bloody sputum one morning, James Mueller, a 68-year-old retired mill worker, sees his physician. A chest x-ray shows a suspicious density in the central portion of his right lung. Mr. Mueller is admitted to the hospital the following Monday for diagnostic tests.

ASSESSMENT

Anita Sarros, RN, admits Mr. Mueller to the oncology unit and ob- tains a nursing history. Mr. Mueller is married and has three grown children. He worked in a local paper mill for 35 years before retiring at age 62. He describes himself as “pretty healthy,” except for a chronic smoker’s cough. He started smoking as a young man in the army. He has a 50 pack-year smoking history, having smoked a pack a day for 50 years, since age 18. Mr. Mueller says he briefly quit smoking following a small heart attack 3 years ago, but started again after 4 months. On further questioning, Mr. Mueller says his cough has been productive for the past few months, especially in the morning, and that he is shorter of breath than usual with activity.

Mr. Mueller’s examination data include BP 162/86, P 78 and regular, R 20, and T 98.4°F (36.9°C). Color good, skin warm and dry. Inspiratory and expiratory wheezes noted in right chest but good breath sounds throughout. No other abnormal findings are noted on examination. The physician orders early morning spu- tum specimens times 3 days for cytologic examination and schedules a CT scan of the chest the morning after admission.

Mr. Mueller’s CBC shows mild anemia, but remaining routine lab- oratory tests are essentially normal. Sputum cytology is positive for small-cell bronchogenic cancer. The CT scan shows a central mass approximately 4 cm in diameter with involved mediastinal and sub- clavicular lymph nodes. A small mass is also noted on the lumbar spine. After conferring with his physician and an oncologist, Mr. Mueller decides to undergo a trial course of chemotherapy.

1. Establish 3 nursing diagnosis 

2 Establish 3 outcomes

3 establish 5 nursing interventions 

4 1. The oncologist prescribed a chemotherapy regimen of cy- clophosphamide, doxorubicin, and vincristine. mention a significant side effect for each drug and an intervention for addressing/ preventing this side effect ( use chemoman)

Terrorism Homework

Complete the following assignment STRICTLY ADHERING to the below listed instruction, and using APA format.

Complete an incident command case study by investigating a past disaster event for practical lessons learned. You may use any catastrophic disaster or incident response that has required the collaborative use of local, state, and federal resources. In your case study, you must address the following items at a minimum:  Identify a brief overview of the incident, including the agencies involved and the major events of the incidents.  Explain the incident command structure for the event, including providing the ICS chart that was utilized. If the command structure is not clear through your research, develop a suggested ICS chart that could have been used to organize the response. Consider single vs. unified command as well.  Based upon the practical emergency management information you have learned in this course, assess what went well in the response and what went wrong.  Describe the federal resources that were deployed to assist in the response (which emergency support functions were activated?)  What emergency management technologies were utilized in the response? (e.g., radios, incident management software, mapping, etc.)  What lessons were learned from the event that could help improve the national disaster response system? Your final project should be at least five pages in length. All sources used must be referenced; paraphrased and quoted material must have accompanying citations. APA format is required

When Should Mixed Methods Be Used?

 When Should Mixed Methods Be Used?

Prior to beginning work on this discussion, read Chapters 1 and 2 of the Hesse-Biber e-book, Mixed Methods Research: Merging Theory with Practice, and the two required articles for this week. Mixed methods is a current popular methodology. While this type of methodology is useful for some studies, because of its dual nature as both quantitative and qualitative, it is not effective or appropriate for all research.

For this discussion, you will consider the use of mixed methods for the topic you have chosen for your Research Proposal. In your initial post, apply the scientific method to your research topic by defining your research question and determining the method(s) necessary to answer that question. Compare the characteristics and appropriate uses of the different methods and explain if your research question could best be answered through qualitative or quantitative methods, or a mix of both. Identify the dominant method (quantitative or qualitative) for your proposed study. Explain whether or not a mixed methods approach is the best way to study the topic, demonstrating that the second method is not added as an afterthought or merely to impress journal editors who favor mixed methods. If you have decided not to use mixed methods, explain why the study is best completed with either a quantitative or qualitative focus. Justify your design choice and support your position with scholarly sources. Include a discussion explaining how you would apply ethical principles to your design to address concerns which may impact your research.

Personal Marketing Strategy

 Assignment Formatting  

 Document should use Times New Roman 12-point font, single-spaced (with  spacing between sections and/or paragraphs) with margins not exceeding 1-inch. Length of assignment is  approximately 2-4 pages and should also include page numbering.   No plagiarism, copying or cheating. 

Please note that this is part of a final project that is to  create an attractive marketing plan for your own personal and/or professional brand, i.e., “Brand You.” So, used previous assignments to connect all the homework in  the project. Remember that this is a personalized marketing plan about me. 

 Part of the Final Marketing Yourself Plan – 

 When marketing a product, brand, or organization, marketers must always consider the need to  continuously improve their product offerings in order to elevate, or even just maintain, their position in the  marketplace. Such a continuous improvement process starts with understanding where you currently are in  the marketplace (i.e., how your product is perceived in comparison to other products) and what is desired  by your target audiences. At that point you have the challenge to choose which goals to set and how you’ll  try to reach them. If you’ve completed the assignments thus far, you’ve already evaluated Product You with your Raw Materials  Assessment. You also have assessed your target audiences with the Product/Audience Match Strategy. Now  it’s time to set strategic goals and contemplate the actions to reach those goals. Setting goals is a difficult process, mainly because there are so many options available to you. Your personal  and professional branding options are not limited to a mere fork in the road with two choices (à la Robert  Frost’s “The Road Not Taken”). It’s more like hundreds (or even thousands) of choices if you really open your  thinking about what your future could hold. Thus, this assignment will require some degree of self-reflection  to determine where you would like to move your personal brand and/or professional brand over the next  one to five years. 

 Self-Reflection, Objectives, and Strategies 

 The best way to start this goal-setting process is to consider the values you assessed in your Raw Materials  Inventory. If your aspirations for your personal brand and professional brand are developed with your  values in mind, you’ll be more likely to feel motivated to work to achieve them, and you’ll be more likely to  be satisfied when those goals are reached. The next step is to consider how you would like to be perceived by others as you develop your brand. What  would you like people to think about you a year from now? Two years from now? Five or ten years from  now? What type of brand would you like to develop? As you consider these questions, keep in mind the  idea that you want to change not only the “perception” of your brand, but also the underlying “reality” of  that brand. For example, if you want to be perceived as being an expert in mobile marketing, then develop  your knowledge and skills pertaining to mobile marketing and then market that expertise. Always remember that the best way to be perceived as an expert in a particular area is to truly become an expert in  that area. Once you start to have general ideas or goals of what you want for your brand, set specific objectives with  those ideas in mind. Remember to use the SMART method (as explained in one of the assigned videos for  this module) to set useful objectives. Finally, list some strategies, tactics, or actions that will help you reach your objectives. The more descriptive  you are when listing the strategies (as well as the objectives), the more likely you’ll be to complete them 

 Specific Assignment Elements 

 After you have completed the above steps, create a document as follows: 

 1. Cover Page: Name, Panther ID, Major, Minor, Certificate(s), Assignment Title

 2. Introduction: Discuss the purpose for having a personal marketing strategy. 

3. General Branding Goals: Discuss your brand aspirations for one, two, five and/or ten years from  now. Describe how you will want people to perceive you.

4. Specific Branding Objectives: Using the SMART goals method, write at least 5 clear and achievable  objectives that align with your general branding goals.

 5. Strategies/Tactics: To reach your objectives, you’ll need specific strategies or tasks that clearly lead  to those objectives. Discuss the strategies or tactics that will help you reach the objectives that you  listed in Part 4. Have at least two strategies/tactics for each objective. 

6. Synthesis/Summary: Summarize your personal market strategy and provide a synthesis of how the  pieces fit together. 

AMERICAN HISTORY D10

 250 WORD ESSAY

Throughout the 1950s African Americans in northern cities grew increasingly active in opposing discrimination and in protesting white resistance to black progress in housing, education, and employment. Martin Luther King and others embarked on a campaign of nonviolent resistance and demonstrations, which spread to the south. Some of the leadership in the Deep South responded with brutal force, taking a militant stand against change, and in defiance of federal legislation to grant African Americans their civil rights.  

In order to prepare for this discussion forum: 

After you have completed your readings post your response to only one of the following questions:

  1. Identify and list some of the factors that contributed to the success of the Civil Rights movement. Choose one, and discuss its significance to the movement, and explain why you made this particular choice.
  2. “Ironically, the reaction of many southern whites to the civil rights activities may have actually served to help the blacks’ cause.” Agree or Disagree with this statement.  Make sure that you provide evidence to support your argument.

Discussion Forum Grading Information

Programming

1.Create a menu system that does the followingAccepts input valid input for numbers 1, 2, 3, 4, 5 and X. Create the following prompt filling in your own messages for xxxxx.

Press 1 to xxxxx

Press 2 to xxxxx

Press 3 to xxxxx

Press 4 to xxxxx

Press 5 to xxxxx

Press X to Exit

Use a do while loop to get input and a switch statement to validate the input. Hint use a char data type for the input.Display an appropriate error message if user does not give a valid input. 

Display the selection with an appropriate message.

SAVE as midtermprogram1.cpp

—————————————————–

2.   Create a grading program that does the following

Uses a for loop by using a program defined amount to get names and grades of the students 

Use a const int to determine how many students in the for loop. Number of students should be between 3 -5). 

Use the following arrays

string names[num or students];

int grades[num or students];

Use the following functions 

void getNames[string []);

void getGrades[int []);

int getOneGrade() – returns the grade of the student;

Call the getNames functions to input the names of the students using for loop

Loop will begin by getting the name of the student using getline.

cout << “Please enter your name: “; 

getline(cin, name[i]);

Next use a for loop to get all of the grades, 

get the grade for each student using grade[i] = getOneGrade();

getOne Grade should use a prompt, cin and then a do while loop that forces the user to put in a valid input between 0 and 100. Use const int LOW_GRADE and HIGH_GRADE

Note – No 2 grades should be the same in order to do the bonus section. 

Remember to do an ignore before the cin to get the grade.

cin.ignore(20,’n’);

cin >> grades

Put the grade input in a do while loop. Use constants for the lowest and highest allowed grades

Use an if else if to get the string grade with the following specifications. Hint start with the highest grades

96 -100A+

93 – 95A

90 – 92A-

86 – 89B+

83 – 85B

80 – 82B-

76 -79C+

73 – 75C

70 – 72C-

66 -69D+

63 – 65D

60 – 62D-

Below 59F

Use another for loop to display the students’ names and their grades

Calculate and display the average of the grades.

Bonus – Determine and display who had the highest grade

SAVE AS midtermprogram2.cpp