Case Study Analysis: Patient Care Coordination for Chronic Conditions

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Questions
Case Study Analysis:
Choose a specific chronic condition (e.g., diabetes, heart disease, asthma).
Identify a case study of a patient with this chronic condition.
Analyze the strengths and weaknesses of the patient’s current care coordination plan.

Answer
1. Introduction
At present, there is an increasing number of people with chronic diseases. The evidence for this claim is in the 133 million Americans, or almost 1 in 2 adults, living with a chronic condition, and this figure is predicted to increase by more than 30% between 2000 and 2020 to 157 million with 81 million having multiple conditions. Projections suggest that chronic diseases will account for three-fourths of the total health care costs in 2023 – more than $4 trillion (Saint T, et al 2000). Chronic diseases are health problems that require ongoing management over a period of years or decades. They include, among others, arthritis, asthma, cancer, COPD, cystic fibrosis, diabetes, cardiovascular disease, and any form of mental retardation. A recent survey identified a total of 139 million Americans living with these diseases. These chronic conditions impact the lives of the people affected in many different ways. In 2000, the Surgeon General’s report on health and behavior revealed that 22% of people living with chronic diseases had limitations in daily activities compared to 3% of those without a chronic condition. People living with chronic condition are also at risk of dying prematurely. It has been shown that 90% of Americans’ annual deaths are caused by chronic diseases and 77% of employer costs are due to productivity losses in employees with chronic conditions. Healthcare providers have also been alerted to pay special attention to their patients living with a chronic condition. In 1998, the National Health Interview Survey (NHIS) reported that 70% of visits to a doctor’s office involved treatments for people with one or more chronic condition. With a large population affected by chronic diseases, care coordination is fundamental in assisting individuals to manage their conditions and improve their overall quality of life. Care coordination is a process that encompasses a wide array of functions and services that help patients with chronic conditions manage their health. Coordination involves organizing patient care and involves information sharing and communication between all participants concerned with a patient’s health to achieve safer and more effective care. Primary care physicians and patients play central roles in care coordination. Information from The Commonwealth Fund analysis in the Tri-Annual National Survey 2007 reported that patients with chronic conditions receive better care from primary care physicians versus specialists. Primary care physicians also report that chronic care management is one of the most challenging aspects of their job. This indicates that care coordination efforts need to improve in linking the efforts of generalists and specialists for patients living with chronic conditions. Improved care coordination ensures that the patient’s needs and preferences for managing their chronic condition are met and that healthcare decisions are agreed upon and followed by the patient. Coordination also supports the self-management of patients to become more involved with their care and in turn achieve clinical and personal goals they have set to improve their overall health. With these points in mind, this paper is centered on the case analysis of a patient named Clarence, living with diabetes, and the coordination efforts between healthcare providers to improve his health outcome.
1.1. Background of the Chronic Condition
Chronic diseases can be difficult to manage. They often need a lot of health services to manage their condition. This is what we call coordination of care. Coordination of care is a fragmented and an ad hoc enterprise with little standardization from patient to patient. Good, clear communication is key to effective care coordination. This is often lacking between primary care physicians and specialists, as well as between these providers and the ancillary services that play such a large role in managing chronic disease, such as pharmacies and laboratories. The way care is often managed and coordinated across the primary and specialty care settings, hospitals, home health agencies, and nursing homes provides an array of dangerous pitfalls for the patients and is an inefficient and expensive way to manage chronic disease. The case for this patient is all too common. This elderly patient has several chronic medical problems: congestive heart failure, hypertension, diabetes, and chronic kidney disease. The plethora of medical issues alone can create its own fragmented care and care coordination impaired by the individual concerns of each specialty involved in this patient’s care. As we detailed the patient’s experience throughout the hospitalization and elegant discussion of the pros and pitfalls of each stage of this patient’s care, it became clear that the systems currently in place provide many obstacles to effective care coordination. Good communication between providers with regard to the patient’s wishes and prior discussions about the care plan is an essential early stage in caring for a patient with chronic disease. Often the patients are not always clear to the physician about their own wishes, and many patients with multiple specialty involvement may have conflicting plans on how to address various issues in their health. This is an instance in which medical decision making becomes complex and difficult. Often a decision on paper A cannot be effectively communicated to provider B. Occurrences like this can lead to the patient’s avoidance of hospitalization for re-admission for an episode of heart failure symptoms.
1.2. Importance of Care Coordination
Care coordination is important to avoid gaps, overlappings, and delays in delivering the care that we need. Coordination may avoid, for example, conflicting treatments among our specialists or duplicate tests. Information is passed on about our needs and the activities of all the people involved in our care. With good information and a clear plan, the activities of the different people involved in our care are more structured and productive. Any changes in our health or the way we are managing our health problem are monitored, and the care plan is revised as necessary. In contrast, without effective care coordination, it is left to us to tell different health professionals what other health professionals are doing for us. We and our family members are forced to understand and keep track of the care that we are receiving and to recognize when it is not going well. Oftentimes, healthcare providers are not even informed about certain treatments or tests that the other providers have ordered. Good care coordination can prevent such burdens on patients and communication errors among providers. Information about changes in the patient’s health can fall through the cracks, with the result that no one takes responsibility for revising the care plan. A chronic care patient’s best choice among treatment strategies may not be considered because different providers are acting independently and no single professional takes responsibility for synthesizing the opinions of the various specialists involved.
2. Case Study Overview
2.1. Patient Profile
2.2. Description of the Chronic Condition
3. Current Care Coordination Plan
3.1. Care Team Composition
3.2. Communication and Information Sharing
3.3. Care Plan Implementation
3.4. Monitoring and Follow-up
4. Strengths of the Current Care Coordination Plan
4.1. Effective Communication Channels
4.2. Comprehensive Care Plan
4.3. Regular Monitoring and Follow-up
5. Weaknesses of the Current Care Coordination Plan
5.1. Fragmented Communication
5.2. Lack of Patient Engagement
5.3. Inadequate Care Plan Updates
6. Opportunities for Improvement
6.1. Enhanced Communication Strategies
6.2. Patient Education and Empowerment
6.3. Integration of Technology
7. Recommendations for Care Coordination Enhancement
7.1. Strengthening Interprofessional Collaboration
7.2. Implementing Patient-Centered Approach
7.3. Utilizing Health Information Exchange
8. Conclusion

Chest Pain and Differential Diagnosis

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Question
Submit a research paper in APA format regarding Chest Pain and Di8erential Diagnosis. The student is to pick any three (3) di8erential diagnoses that can be associated with chest pain and their approach in various clinical settings. Research paper due in week 5. See Rubric below Include the following components in your research paper: 1. Title Page 2. Introduction (general) 3. Mention research studies (at least three articles) that validate the information presented in your paper. (Publication date should be no more than five (5) years old). 4. Conclusion 5. References Page Criteria Rating Points Exemplary
Answer

1. Introduction
Differential diagnosis of chest pain is particularly difficult because of the variety of potential causes. It is generally assumed that the more severe the symptoms, the more serious the underlying condition, and thus the differential diagnosis tends to focus on life-threatening cardiac and non-cardiac causes. This is particularly the case in patients with acute onset of severe chest pain and/or other symptoms suggestive of myocardial ischemia. A working knowledge of cardiac and respiratory anatomy, together with an understanding of referral patterns from different regions of the chest, are valuable in formulating a differential diagnosis. This can then be refined by further history and examination; for example, the character and timing of the pain and any exacerbating or relieving factors. With acute pain, it may, however, be difficult to determine these features, and the patient may be too ill to provide a reliable history. In some cases, therefore, the history and examination may serve only to determine the severity and stability of the patient’s condition.
Chest pain is a symptom that is frequently encountered in the practice of emergency medicine. It may present with a variety of clinical conditions ranging from life-threatening diseases to benign ones. On the other hand, differential diagnosis involves differentiation of a condition from others which presents in a similar manner. Failure to do this frequently results in misdiagnosis of the condition, resulting in improper treatment. The aims of the differential diagnosis of chest pain are to exclude life-threatening conditions, determine the underlying cause of the symptoms, and find an accurate diagnosis. This may not always be achieved, and thus a unifying diagnosis is made when no specific organic etiology can be identified. This text will discuss the differential diagnosis of chest pain, working through the acute and chronic cases.
1.1. Definition of Chest Pain
Chest pain is one of the most common symptoms that bring an individual to the emergency department, outpatient clinic, or primary care office. While the majority of patients with chest pain do not have a serious illness, those who do are at risk of significant morbidity and mortality if not diagnosed and treated promptly and effectively. An efficient and directed approach to the patient with chest pain relies on a good understanding of the underlying pathophysiology of the various disease processes that may cause chest pain. It is also important to recognize that atypical presentation of a disease is more common than typical presentation. The mechanism of chest pain can be varied; from simple musculoskeletal discomfort to a life-threatening cardiac or pulmonary event. Chest pain is often categorized into cardiac and non-cardiac causes. However, it is perhaps more useful to classify the pain by the underlying mechanism. This approach allows a better understanding of the disease process and is more clinically relevant, especially as musculoskeletal and gastroesophageal chest pain can often mimic cardiac pain.
1.2. Importance of Differential Diagnosis
Non-cardiac chest pain (CP) can be defined as chest pain emanating from the chest that does not originate from the heart. This seems like a simple enough definition to understand, but in practice, it can be quite the opposite. The term “non-cardiac chest pain” seems to imply that it is chest pain that is not originating from the heart. This would lead one to believe that the origin of pain is musculoskeletal or that of a psychological cause. However, non-cardiac chest pain is defined by intent. It is chest pain that is free of known cardiac cause. This is an important concept to understand. There are many patients that suffer from CP that, in reality, is of known non-cardiac cause. One simple example is a patient with chest wall pain from a viral illness. Often times, this patient will undergo extensive testing or even unnecessary time admitted to the hospital because a cardiologist wants to rule out cardiac cause of the chest pain. A more serious example is the patient who is diagnosed with GERD that is confronted with an atypical presentation such as angina and is hospitalized with suspected unstable angina or MI. The term “non-cardiac chest pain” can sometimes lead to incorrect assumptions and thus lead to unnecessary testing or potentially harmful treatments for the patient’s true underlying cause of CP.
2. Common Causes of Chest Pain
2.1. Coronary Artery Disease
2.2. Gastroesophageal Reflux Disease
2.3. Pulmonary Embolism
2.4. Musculoskeletal Causes
2.5. Anxiety and Panic Disorders
3. Approach to Differential Diagnosis
3.1. History Taking
3.2. Physical Examination
3.3. Diagnostic Tests
3.3.1. Electrocardiogram (ECG)
3.3.2. Chest X-ray
3.3.3. Echocardiography
3.3.4. Stress Testing
3.3.5. Laboratory Tests
4. Differential Diagnosis 1: Coronary Artery Disease
4.1. Risk Factors
4.2. Clinical Presentation
4.3. Diagnostic Approach
5. Differential Diagnosis 2: Gastroesophageal Reflux Disease
5.1. Pathophysiology
5.2. Clinical Features
5.3. Diagnostic Evaluation
6. Differential Diagnosis 3: Pulmonary Embolism
6.1. Pathogenesis
6.2. Signs and Symptoms
6.3. Diagnostic Workup
7. Clinical Settings for Differential Diagnosis
7.1. Emergency Department
7.2. Primary Care Clinic
7.3. Cardiology Clinic
8. Research Studies on Chest Pain and Differential Diagnosis
8.1. Study 1: Title and Findings
8.2. Study 2: Title and Findings
8.3. Study 3: Title and Findings
9. Conclusion
10. References

Chinese Army Unit 61398 as an Advanced Persistent Threat

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Question

Answer
1. Introduction
The question is emerging about why detection and prevention of APTs was so low in 2013. The low detection is happening because target industries lack the capability to detect APT activities. APT attackers have high skill to cover up their activities and delete traces, making it hard to detect. Another reason is that the capabilities of traditional security measures such as anti-virus, intrusion detection and prevention, and firewall are not enough to detect and prevent APT. The existing security measures are only capable of detecting known attacks and malware, whereas APT attackers are using new malware and attack methods to compromise the target efficiency. Known malware and attack methods are actually still of minor use. This is what happened to Coca-Cola. Even though they have an information security program and traditional security measures, these are not enough to prevent their information from APT attacks. In 2009, Coca-Cola detected an APT attack plot on their networks. The attacks involved a group of hackers who were using advanced malware and remote system administration tools to gain unauthorized access to Coca-Cola’s network and affect the company’s operations. These APT attackers were trying to build persistence to stay within Coca-Cola’s network and steal sensitive information for a long time. But unfortunately, from 2009 to 2012, Coca-Cola lost its sensitive files to APT attackers. The results of forensic investigation on data stored in Coca-Cola’s breached systems have found that the malware had already deleted traces and the attackers had cleaned the remote administration tools. This investigation was conducted after Coca-Cola received reports of its sensitive files being copied by malware to unknown locations. In this case, migration of data from a well-known location, the unusual deleted file evidence, and support from reports can be indications of APT attacks.
1.1 Definition of Advanced Persistent Threat
Although the term “advanced persistent threat” has been popular since the early 2000s, it actually dates back to 2006. It is widely believed that the origin of the term APT comes from the United States Air Force. It is thought that they were the first people to use the term to describe a specific type of cyber threat. This belief is strengthened by a quote from a Lt. Col. Greg Rattray in 2009 stated, “The Airforce, by 2006, had identified the complete process of an advanced threat.” This quote shows that by that year they had a complete understanding of the processes and life-cycle of APT.
APT should not be confused with the term AET (Advanced Evasion Technique) which was proposed by network security firm Stonesoft. AET refers to means and methods that penetrate and exploit IT network vulnerabilities, while effectively evading network security systems, appliances, and controls. The AET attacks are the delivery and exploitation phase in the Cyber Kill Chain SM, the APT is the overarching structure and framework for the entire cyber kill chain.
An advanced persistent threat (APT) is a wide-ranging, sophisticated, sustained, and targeted attack against a specific group of people with the aim of achieving a specific agenda. An APT attack includes a number of different steps and a lot of different techniques often spanning a long period of time (such as several months or years). Anti-forensics methods, such as attempts to delete or alter log files, and false data injection, can also be and are often used in APT attacks, increasing the difficulty and complexity of detecting the attack and attribution.
1.2 Overview of Chinese Army Unit 61398
Chinese Army Unit 61398 is a cyber-warfare information operations unit of the People’s Liberation Army (PLA) of China. Though there is no public information about this unit’s numerical designator, it is commonly referred to by the identifier “61398”. Analysts have confirmed that APT activity surrounding Operation Shady RAT is being conducted using the resources of 61398, and APT attacks are traced back to infrastructure around Shanghai. It is unknown how many people work for 61398, but the number is suspected to be quite large and most likely staffed by a variety of military and civilian personnel. This is deduced from the sheer number of English-speaking APT operators observed online in Operation Shady RAT data who may or may not be native English speakers and the wide range of network intrusions into all sectors from this particular threat group.
2. History of Chinese Cyber Espionage
2.1 Early Cyber Espionage Activities
2.2 Emergence of Chinese Army Unit 61398
3. Tactics, Techniques, and Procedures
3.1 Target Selection and Reconnaissance
3.2 Exploitation and Delivery of Malware
3.3 Command and Control Infrastructure
3.4 Data Exfiltration Techniques
4. Notable Cyber Attacks Linked to Unit 61398
4.1 Operation Aurora
4.2 Operation Shady RAT
4.3 Operation Aurora Panda
5. Motivations and Objectives
5.1 Economic Espionage
5.2 Military and Political Intelligence Gathering
5.3 Support for Chinese Industries
6. International Response and Diplomatic Impact
6.1 Accusations and Denials
6.2 Diplomatic Tensions and Consequences
7. Countermeasures and Defense Strategies
7.1 Network Segmentation and Isolation
7.2 Intrusion Detection and Prevention Systems
7.3 Employee Education and Awareness Programs
7.4 Incident Response and Recovery Plans
8. Future Implications and Trends
8.1 Evolution of Chinese Cyber Operations
8.2 Collaboration with Other Threat Actors
8.3 Impact on Global Cybersecurity Landscape

Climate Change and the Christian Community

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Questions
In each of our weekly forums we will be using the “three R approach.” 
Ideally, your post should be about three paragraphs long and be completed by Wednesday evening.  
1. Resonate: What did you agree with? What spoke to you? 
2. Resist: What did you disagree with? What did you struggle with? 
3. Relevant: What did you take away from you this week? How can this material be applied to your life and others?
Video on Stephen Matthew.  
This is all about our climate change with the Christian community and the world.

Answer
1. Resonate
Stories of the impacts of climate change tend to not resonate with the above populations as they do with smaller population centers and subsistence farmers in poor regions. Where it does begin to have an impact, questions about whether it was caused by anthropogenic or natural factors may lead to varied answers. Nevertheless, they agree that if it is an issue that is impacting the poor and will continue to do so in the future, that this is unacceptable.
According to reports from the Pew Center on Religion and Public Life, U.S. religious groups that feel climate change is a serious problem are in the minority. The most concerned tend to be Mainline Protestants and Catholics, and it appears that Evangelicals and Black Protestants tend to be the least concerned. At the same time, all of these groups tend to think that they personally are less concerned than their compatriots. This data could suggest that many simply do not know about climate change and what sort of impact it could have; but it could also suggest that no matter how much is known, it isn’t seen as an urgent problem.
Importance of preserving God’s creation. There are clearly some Christians who believe that climate change is just not an important issue – if it is even an issue at all. There are others who care deeply about the issue, and yet when surveying the public at large, climate change never quite makes it to a position of priority.
1.1. Agreeing with the importance of addressing climate change
Climate change has become a very significant issue in recent years. It has become a reason for concern in all areas of society, even in the Christian community. To some, it may seem odd that an issue which is often politically charged should gain real attention within Christianity. However, when one carefully examines the issue in terms of Christian ethics and morality, it becomes quite clear that climate change is an issue which should be of great importance to all Christians. The world’s climate is a key part of all God’s creation. When this climate is disrupted in ways which harm the poor and powerless, damage other species and ecosystems, and threaten the well-being of the earth itself, it is a clear violation of commands to love our neighbors, to care for the poor, and to be stewards of creation. Most of the impact of climate change now and in the future represents a quite unfair burden on those in the poorer countries, who are the least equipped to deal with rapid change, and who have often done the least to cause the problem. This is a matter of injustice, and God is a God of justice. These issues are very complex and are not productively addressed in the polarized political environment in which climate change is often placed. However, it is clear that this is a moral issue, and it is the duty of Christians to consider the moral implications of climate change, and to advocate on behalf of the world’s poor and of future generations.
1.2. Finding common ground between climate change and Christian values
Creation care is a value shared by most Christians regardless of their theological persuasion. Despite the debate over how one interprets Genesis and the issue of dominion over creation, most agree that humans are called to be stewards of the earth. Discussions about the earth being a precious gift from God and it being loaned to present and future generations are common. The impact of climate change and damage to the environment upon future generations is a clear indication that there is a moral issue surrounding the way we are treating the earth. People are now accustomed to hearing about climate change in political and economic terms, but there are few who recognize it as a spiritual and moral issue. It is an opportunity for the church to remind people of the importance of living a life that is consistent with their values and beliefs. By addressing the issue of climate change in such a way, it will engage Christians from all traditions and provide an opportunity to make a difference in the world.
To proffer solutions, it is important to understand the problem. Although many Christians may disagree with issues surrounding global warming and environmental degradation, it is hard to ignore the implications upon humankind and the earth. Many of the fundamental issues of climate change are intertwined with Christian values such as justice for the poor and preservation of creation. The effects of climate change will no doubt impact the world’s poor more than anyone else, and it is these people who have contributed least to the problem. Recent natural disasters such as the tsunami in Southeast Asia or Hurricane Katrina have shown how poor communities are the most vulnerable to such calamities. Although these events may not be a direct result of climate change, it is an example of what we can expect in the future to a greater extent. Scriptures such as “speak up for those who cannot speak for themselves, for the rights of all who are destitute…” (Proverbs 31:8) resonate with the issues surrounding climate change and its effects on the poor.
2. Resist
2.1. Disagreeing with the prioritization of other issues over climate change
2.2. Struggling with the integration of scientific evidence and religious beliefs
3. Relevant
3.1. Taking away the urgency of climate action from the discussions
3.2. Applying climate change knowledge to personal lifestyle choices
3.3. Considering the impact of climate change on future generations
4. Stephen Matthew’s Video
4.1. Overview of Stephen Matthew’s perspective on climate change and Christianity
4.2. Analyzing the key arguments presented in the video
4.3. Reflecting on the potential influence of Stephen Matthew’s message
5. Climate Change and the Christian Community
5.1. Understanding the role of the Christian community in addressing climate change
5.2. Exploring the intersection of faith and environmental stewardship
5.3. Examining the challenges and opportunities for collaboration between Christians and environmental activists
6. Conclusion
6.1. Summarizing the key takeaways from the discussions
6.2. Emphasizing the importance of collective action in tackling climate change

Cognitive Theorists’ Approach to Depression and Suicidal Ideation

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Question
Discuss how cognitive theorists (Kelly, Beck, and Ellis) might address a client with depression and suicidal ideation. After reviewing cognitive therapies in your textbook, what interventions might you suggest. Explain and justify your response.
2. In what ways can spirituality or religious beliefs, or lack of, influence an individual’s personal decision-making process, and how might this impact the choices they make in various areas of their life, such as relationships, career, and personal goals?

Answer
1. Introduction
The introduction provided by David Lester is brief but straight to the point and covers all necessary areas. Lester starts by discussing the severity of the healthcare issue that is depression and quotes a Spanish saying “There is no greater pain than being blind in Granada” which he changes to “There is no greater pain than depression.” A short account of the symptoms and severity of depression is discussed, and then Lester moves onto the topic of suicide. Suicide is a sensitive topic but a necessary one in the field of psychology and healthcare. People relate great sadness and negativity to suicide as something people feel is “the easy way out,” but as Lester points out, “The act of suicide is one of shooting oneself in the head while one in dead aim at one’s foot,” essentially stating that people are self-destructive rather than simply destructive of life, and suicide is the ultimate reflection of this. This puts the severity of depression into an easily understandable perspective. Lester concludes his introduction with an outline of the theoretical development of cognitive theory and finishes with a statement of what he will discuss in this book. This introduction is suitable with no major flaws.
Cognitive Theory of Depression and Suicidal Behaviour by David Lester opens up with a clear and to the point introduction that states the implications of cognitive theories and their strategic development. Tony Beck’s Cognitive Theory and Therapy of Anxiety and Depression also opens with an explicit introduction about the extent of the problem of depression and its link with suicide. In this essay, I will give an overview of these introductions and compare them to my own introduction to the topic of cognitive theories and depression, specifically outlining what I have done differently and the reasons for this.
1.1. Overview of cognitive theorists
As cognitive theory offers an explanation of the onset and maintenance of depression, theories are best researched using causally related treatment studies. i.e. the most convincing tests of a theory come from studies where the cause of a particular disorder or disorder symptoms is manipulated and a change in the dependent variable is observed. Beck has described depression as a disorder of negative thinking, and there is much empirical evidence showing that when depressed people make inferences about self, world, and future they characteristically do so in a negative way, and the same is true for their interpretations of ongoing experience. Following on from this, there is now a large body of research showing that depression is associated with memory biases for mood congruent material and the use of cognitive avoidance strategies. This is only a very general overview of the research within depression, suffice to say Beck’s model has enjoyed a great deal of empirical support and as such it has been adapted and extended so that it can offer a cognitive theory of depression in all its richness and diversity. This is important as according to Beck, a good theory of depression should be able to explain how a single etiological mechanism can cause a disorder with such a wide range of different symptoms.
Research within the field of cognitive psychopathology has now been extended to the field of clinical psychology and there have been a large number of studies of depression and more recently studies of other psychological disorders. Major Depressive Disorder, hereafter referred to as depression, is diagnosed according to the standards provided in the Diagnostic and Statistical Manual of Mental Disorders edited by the American Psychiatric Association. Symptoms of depression include loss of interest or pleasure, significant change in weight or appetite, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue or loss of energy, feelings of worthlessness or excessive guilt, and impaired concentration or indecisiveness. In its severe form, depression is a highly debilitating, long-lasting, and pervasive condition.
Cognitive theory is a theoretical model of mental disorder that postulates that a relatively small number of recurrent cognitive processes are implicated in the various forms of psychopathology. Of these, cognitions that negatively bias the interpretation of ongoing experience or otherwise inferred meaning of an event or stimulus are seen as particularly important. Beck’s (1967) influential model is exemplary. This model holds that depressive symptoms are caused by the latent cognitive structures within the mind. When these cognitive structures take on a negative schema, they can activate a negative self-referent cognitive process when the person is faced with a situation that resembles a particular schema. This can lead to the production of a series of negatively biased automatic thoughts. It is these thoughts that cause the overt psychological and behavioral symptoms of depression. Following on from this, negative automatic thoughts are thought to arise from underlying cognitive errors.
1.2. Importance of addressing depression and suicidal ideation
Depression is a serious and debilitating illness, which affects mental, emotional, and physical health of an individual. It is often reflected in low mood, feeling of sadness, and aversion to activity. Depression increases cognitive vulnerability to negative schema about self, world, and future. A recent research (NIMH, 1999) shows that depression is the top contributor for the suicide and suicide rate is higher in the elderly person, who have medical illnesses, college educated and who live alone, suicide risk is always higher in presence of the symptoms of hopelessness. About 60-70% of people who committed suicide suffer with major depression or bipolar (manic-depressive) disorder and people in this group are the most treatable great proportion of suicide can be averted by the effective treatment of depression and other psychiatric illnesses. Suicidal persons directly express their negative self-schema and hopelessness in a way they talk about their selves and future, and their feeling towards leaving and escaping from an intolerable situation reflect the state of cognitive deconstruction which increasingly becomes activated when hopelessness and negative schema intensifies and diversifies. As Brown and others have suggested, suicidal act is the final common pathway of a broad range of biological and psychiatric states said to increase the risk of such behavior, it can be the consequence of impulsive, aggressive act or carefully planned and executed by the individual who would otherwise make considered rational decision. Cognitive theory of suicide states that suicidal intent is correlated with strong feelings of hopelessness and helplessness, and absence of alternative way of solving the problems, when the hopelessness and helplessness is too severe then the individual will become focused on taking his own life.
2. Cognitive Theories and Depression
2.1. Albert Ellis’ Rational Emotive Behavior Therapy (REBT)
2.1.1. Challenging irrational beliefs
2.1.2. Identifying and disputing negative thoughts
2.1.3. Developing rational alternatives
2.2. Aaron Beck’s Cognitive Therapy (CT)
2.2.1. Recognizing and restructuring negative automatic thoughts
2.2.2. Examining cognitive distortions
2.2.3. Behavioral activation techniques
2.3. George Kelly’s Personal Construct Theory
2.3.1. Identifying and modifying negative constructs
2.3.2. Constructive alternativism
2.3.3. Role of core beliefs in depression
3. Interventions for Depression and Suicidal Ideation
3.1. Psychoeducation on cognitive distortions
3.1.1. Teaching clients about common cognitive distortions
3.1.2. Providing examples and exercises for recognition
3.2. Cognitive restructuring techniques
3.2.1. Guided thought records
3.2.2. Socratic questioning
3.2.3. Cognitive reframing
3.3. Behavioral activation strategies
3.3.1. Setting achievable goals
3.3.2. Encouraging pleasurable activities
3.3.3. Monitoring and challenging negative behaviors
4. Conclusion
4.1. Summary of cognitive theorists’ approach
4.2. Importance of addressing depression and suicidal ideation
5. References

College Teacher Burn-out and Strategies for Alleviation

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Questions
Required: This PowerPoint must include the meaning of College Teacher burn-out and the causes? What are some fun things College teachers can do to alleviate teacher burn out?  
Submission: 5 PowerPoint slides, APA format, must include colorful pictures, laughter, and 1-2 fun activities for teachers. 
Answer
1. Introduction
At a time when American higher education is under increased scrutiny from the general public, governing boards, and government officials, there is a documented increase in job-related stress for faculty and administrators. This stress, if not managed effectively, can lead to burnout and a variety of negative consequences for individuals and their institutions. It affects the quality of teaching, student-teacher interaction, and the climate of learning and leadership in postsecondary institutions. Although faculty at all types of institutions are experiencing increased levels of stress, research suggests that those at two-year colleges and regional comprehensive universities are especially prone to burnout (Bryson, 2013). This may be related to the fact that postsecondary professionals at institutions that serve as the primary entry point to higher education for underprepared and disadvantaged students face an environment that is inherently stressful. The same can be said for teaching and student affairs faculty at institutions that serve minority and underrepresented groups.
This essay is designed to explore and clarify the new phenomenon of faculty syndrome and its effects; identify the factors that contribute to college teacher burnout; heighten awareness about the importance of addressing this problem and suggest strategies for individuals and institutions to cope with and alleviate burnout. This section provides an overview of the nature and extent of faculty burnout and the consequences for the individuals affected, students and institutions. Subsequent sections identify the causes of burnout; discuss the various ways in which individuals respond to and cope with stressful work situations, and suggest strategies for individuals and colleges to reduce job-related stress and prevent burnout. Later sections will address the role of academic leaders and administrators in dealing with faculty burnout. The essay closes with an annotated bibliography of books and articles that will provide readers with additional resources to help them understand, recognize and cope with faculty burnout.
1.1 Definition of College Teacher Burn-out
In order to consider college teachers’ burnout and strategies for alleviation, it is firstly necessary to understand the phenomena being addressed. ‘Burnout’ is a state of chronic physical and emotional depletion comprising lowered vitality, depression, and a cynical, negative attitude towards oneself and others. There are three key words here – ‘state’, ‘chronic’ and ‘depletion’. It is a psychological concept referring to a person’s reaction to chronic interpersonal stress, and this reaction is defined by the three descriptors above. It is a gradual process, building up over time, with the person not realizing what is happening until they reach complete exhaustion. It is this chronic and gradual process of depletion which marks it different from other stress conditions. The depletion represents a state of having lost all resources, and the person can see no end to their feelings and has nothing left to give. The consequences of this are negative changes in the person’s attitude and behavior, and this may be noticed by others around them. Burnout is not a mental illness, as the symptoms can be seen as the body’s adaptive response to a stressful work situation. However, it can have serious effects on a person’s mental and physical health, and it is not something that will go away of its own accord.
1.2 Importance of Addressing Teacher Burn-out
From a teacher’s perspective, prevention and early intervention are the key to promoting teacher well-being and effective practice. The nine symptoms of burnout are fairly predictable and have been shown to unfold in a consistent sequence. The sequence begins with the teacher’s characteristic enthusiasm for the job. When this enthusiasm is channeled into an impossibly high set of expectations for self and students, the teacher may become frustrated that students do not appreciate all the effort put into class preparations. This frustration leads to disillusionment regarding teaching and a very strong desire to be doing anything other than teaching. As the teacher begins to distance him/herself from the students emotionally, a sense of impending failure can lead to guilt and anxiety. This negative self-perception and sense of failure is inevitably confided to close others who may try to reduce the teacher’s feeling of failure by giving advice on how to teach better. This advice is usually interpreted by the teacher as one more indication that others are not satisfied with his/her performance. This can lead to alienation from colleagues and further withdrawal from the job. Any intervention in this downward spiral must be multifaceted and aimed at increasing teacher skills and self-efficacy while decreasing the classroom demands that incited the initial enthusiasm to unrealistic levels.
Addressing college teacher burnout is important in making all the stakeholders aware of the disease that has been eating up the teachers from inside and reflects on all their actions. This disease has a severe impact on the life of the teacher, students, and the college management. It has been said that teaching is the noblest of all professions, but the disease has made it one of the most abusive and tiring work. The disease starts eating into the teacher very slowly and affects all areas of his/her life, be it personal or professional. It is also said that the teacher is vital for students’ learning. It is not only the method, material, and students’ interest that matter, but the motivation from the teacher plays a large role in student learning.
2. Causes of College Teacher Burn-out
2.1 Workload and Time Management
2.2 Lack of Support and Resources
2.3 Emotional and Mental Exhaustion
3. Strategies for Alleviating Teacher Burn-out
3.1 Prioritizing Self-Care
3.2 Establishing Work-Life Balance
3.3 Seeking Professional Development Opportunities
3.4 Building Supportive Relationships
3.5 Incorporating Mindfulness and Stress-Relief Techniques
4. Fun Activities for College Teachers
4.1 Engaging in Hobbies and Interests
4.2 Participating in Social Events and Gatherings
4.3 Exploring Nature and Outdoor Recreation
4.4 Traveling and Exploring New Places
4.5 Trying New Sports or Fitness Activities
5. Conclusion

Comparing Walmart Financial Statements under IFRS and GAAP

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Question
Prior to beginning work on this discussion forum, read Topic 6 International Accounting Standards in Appendix A in the course textbook, Using Financial Accounting. Next, review the Walmart Case Study.
Compare and contrast the differences in the Walmart financial statements if the company were to use International Financial Reporting Standards (IFRS) rather than Generally Accepted Accounting Principles (GAAP). Be sure to discuss specific accounting differences between the two.
Debate the pros and cons this would create for Walmart. Be sure to be specific and support any opinions.
Describe any legal or ethical challenges this convergence may create using the country you selected in prior courses.

Answer
1. Introduction
Globalisation is happening in the world, and the movement toward IFRS might seem like a natural evolution of U.S. accounting standards. However, IFRS is more principle-based while U.S. GAAP and has developed rules over time. IFRS is also more detailed and precise than IAS. The movement of IFRS might sound good for the global economy, but people do not like changes. It is evident that the U.S. will resist IFRS convergence until it has seen that the development of IFRS is successful and will benefit the U.S. economy. Until full convergence, there will be a long period where both standards are used domestically and internationally (Mala, 2010). This issue is important because Walmart operates globally, and will also affect accounting students, since most accounting students study U.S. GAAP and IFRS is not a main course yet.
Walmart is a US public multinational corporation, which operates a chain of discount department stores and warehouse stores. Walmart was incorporated in 1969 and trades publicly on the New York Stock Exchange. Walmart is the second largest public corporation according to the Fortune Global 500 list in 2013, the world’s largest give store retailer with over 2 million employees worldwide, and is the biggest private employer in the world. Walmart is a family-owned business and is the biggest grocery retailer in the United States. It has stores in more than 50 countries under 69 different banner names (Farfan, 2012).
1.1. Background information
After the accounting scandals in the early 2000s, the International Accounting Standards Board and the Financial Accounting Standards Board have attempted to work towards a unified set of accounting standards between the IAS/IFRS and the US GAAP. It is believed that one set of accounting standards will provide a greater degree of transparency of a company’s position. Throughout this paper, the accounting policies of Walmart are reviewed and the effects of the IFRS convergence on these are highlighted. I’ll also take a look at their financial statements taking note of any defined effects through changes in accounting policy or errors with relation to the Restatements provided. Walmart has faced continual issues over the years in regards to producing reliable financial statements. Between misrepresented amounts to errors in classes of inventory, Walmart has undergone several restatements of their financial statements communicated the need for a change in accounting policies to better represent them accurately. It has taken Walmart several restatements to understand the effect of changes in inventory levels. With the mistakes made it is clear that another guideline and/or standard would have helped Walmart in understanding and representing the effects of changes in inventory with relation to LIFO liquidations. This can be clearly seen with the changes in inventory levels from 2009 to 2010. By moving their operation towards Canada from the US, Walmart showed a drastic reduction in levels of inventory by over $1 billion. This had no effect on cost of sales when represented, when in actuality it must have been assumed that all inventory under previous acquisition cost was sold in Canada.
1.2. Purpose of the comparison
The purpose of this comparison is to assess the financial statements under IFRS and U.S. GAAP to determine whether there are economic consequences from reporting to investors, creditors, or other stakeholders. A high quality financial reporting system can build a basis for a capital market in a country and attract international capital to flow into that country, which in turn has a significant impact on the economic growth in that country. A major development in the world of financial reporting is the convergence of IFRS and U.S. GAAP. In 2001, the IASB and FASB agreed to work together, in mutual respect and in the best interest of investors and others, as a way to bring the two sets of standards closer. In February 2006, the IASB and FASB set forth a plan for convergence where projects would be undertaken but a revised standard in order for IFRS and U.S. GAAP to align, and potentially result in elimination of difference between the two standards for particular issues. This plan included many phases and continual assessment and monitoring from both boards. Although this was the case, in 2012, the SEC made an announcement that it would no longer provide a statement that indicates whether or not IFRS would be incorporated into U.S. capital markets. This was due to a number of reasons that include separate discussions on future reporting standards for US domestic issuers and the oversight and infrastructure funding of IFRS. A decision has yet to be made, however, the standard setting environment continues to evolve along with potential global acceptance of IFRS. For these reasons, Walmart was chosen as a company to compare financial statements. With many countries still having their own, in some cases unique set of accounting standards, companies engaging in international business or investments are faced with having to convert their financial statements into various standards. This can be an extremely complex process, inhibiting comparison of financial statements and in some cases misinterpretation due to language barriers and lack of understanding of a particular standard. As of the company’s 2011 annual report, Walmart has retail outlets in 15 different countries, each faced with a separate local standard and the potential for varying global acceptance of IFRS. It would be in these companies’ best interests to follow the developments in the standards environment and prepare for the potential adoption of IFRS. For this reason, these comparisons may, in fact, provide an understanding of what future changes may affect the way in which Walmart reports its financial position and performance.
2. Overview of International Financial Reporting Standards (IFRS)
2.1. Explanation of IFRS
2.2. Key principles of IFRS
3. Overview of Generally Accepted Accounting Principles (GAAP)
3.1. Explanation of GAAP
3.2. Key principles of GAAP
4. Comparison of Walmart Financial Statements under IFRS and GAAP
4.1. Income statement differences
4.1.1. Revenue recognition
4.1.2. Expense recognition
4.2. Balance sheet differences
4.2.1. Valuation of assets and liabilities
4.2.2. Treatment of intangible assets
4.3. Cash flow statement differences
4.3.1. Classification of cash flows
4.3.2. Treatment of interest and dividends
5. Pros of Walmart adopting IFRS
5.1. Enhanced comparability with global companies
5.2. Simplified financial reporting for multinational operations
5.3. Access to international capital markets
6. Cons of Walmart adopting IFRS
6.1. Costs of transitioning to IFRS
6.2. Potential loss of industry-specific guidance
6.3. Increased complexity in financial reporting
7. Legal challenges of convergence in the selected country
7.1. Impact on local laws and regulations
7.2. Compliance with international standards
7.3. Potential conflicts between IFRS and local laws

Concert Report: Instrument Era Genre Artists Composers and Personal Reflections

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Question
Write a 15 to 20-sentence report for the concert, focusing on the instrument, era, genre, artists, composers, and personal reflections.
Classic Rock:

Concert Details:
   – Instrument: Identify the primary instrument(s) featured in the concert.
   – Era: Determine the historical era or period the music represents.
   – Genre: Categorize the music into a specific genre (e.g., baroque, classical, jazz, pop, rock).
   – Artists: Note the names of performers, bands, or orchestras involved.
   – Composers: Identify the composers of the pieces performed.
Personal Reflections (20 sentences):
   – Initial Impressions: Describe your expectations before attending the concert.
   – Instrumental Mastery: Reflect on the technical skill of the performers and their mastery of the chosen instruments.
   – Emotional Impact: Discuss how the music made you feel emotionally. Did it evoke specific emotions or memories?
   – Historical Context: Explore any historical or cultural context relevant to the era or genre of the concert.
   – Favorite Moments: Highlight specific moments or pieces that stood out to you.

Answer
1. Instrument
The bassoon is one of the most unique and amusing looking instruments because of its long and thin shape. It may be played multiple ways, either being held horizontally or vertically, but there is no difference in sound or technique. It is a two-part instrument and is made of heavy wood. It’s probably the heaviest of all woodwind instruments. The bassoon is played with a double reed, so it is similar to the oboe but much more difficult to control. The double reed refers to two reeds tied together to form the instrument. This is supposedly a reference to a time when the bassoon was crafted from a single piece of wood and the player had to use their own double reed to make music. It has a wide range of sound and is used to play many different kinds of styles of music. Due to its complexity and difficulty, it has a very low chance of being played by a non-professional or a beginner musician. The instrument’s cost is average for an instrument, but it is still very expensive due to the maintenance of replacing and ordering reeds or any other replacement parts.
1.1. Key features of the instrument
The marimba is played with wooden, rubber, or yarn-wrapped mallets. The performer strikes the wooden keys, creating a bright, metallic sound that fades quickly. Other keyboard instruments (piano, celesta, harpsichord) share some similarities with the marimba, but none of these instruments’ mechanisms and materials produces the characteristically warm and percussive attack and sustain of the marimba. Keyboard percussion instruments are now more isolated in this category of sound generation. This idea is important to understand because it links the marimba to other keyboard percussion instruments, providing a future basis for marimba concerti and ensemble pieces. The marimba would not evolve into the exciting solo and ensemble instrument that it now is had its design and sound production not kept it largely isolated from the family of keyboard instruments.
1.2. Historical significance of the instrument
The historical significance of the harpsichord is mainly due to it being the main keyboard instrument in the Baroque period. It has been said that the sound of the harpsichord is the sound of the Baroque era. It evolved over a period of 150 years in response to changes in musical style and to the musical needs of composers. By the end of the Renaissance, the harpsichord had attained the shape in which it was to persist for about 200 years. Both France and Italy have played a large role in the history of the harpsichord. It is widely accepted that in the 15th century, the harpsichord had spread to many countries in Europe. Reaching a peak during the 17th century, especially in France, the harpsichord developed in terms of visual design, mechanical action, and sound quality. In France, two schools of construction exist: the Ruckers school and the Blanchet school. The Ruckers school produced intricate instruments featuring paintings or intricate inlay materials. However, such instruments may not play well from a musical perspective. Despite this intricacy, many Ruckers harpsichords were later converted into the plainer Blanchet design, demonstrating a musical emphasis during the later part of this period. In Italy, the harpsichord underwent mainly mechanical improvements. The most significant of the Italian builders were the Grimaldis, who developed an action which made it quick to play in contrast with the heavier sound of the French instrument. The harpsichord did not develop with the same success in England and Germany, both countries preferring the Clavichord and the Virginals. The harpsichord eventually became outdated in the late 18th century, being succeeded by the piano, although it has had a modern revival with interest in historically informed performance.
1.3. Notable performers of the instrument
Notable performers of the piano: It is far too difficult to encapsulate all of the world’s most famous pianists within one small list, given the monumental influence of the instrument. Many of the greatest composers themselves were pianists, so we have excluded them based on principal instrument to the composer’s title, i.e. F. Liszt would not be included as a pianist. We are left with no shortage of names no less. The Russian School of pianists has long been heralded as one of the most influential in history. From the incomparable audiences in artistry such as Sofronitsky and Richter, to the legendary teaching lineage from Goldenweiser to Neuhaus and Zak, pianists of Russian pedigree have wielded formidable prominence for close to a century. It is difficult to speak of great pianists without venerating Claudio Arrau, whose concert career spanned over eighty years. His recording of Beethoven’s ‘Hammerklavier’ sonata is still considered one of the most distinguished ever captured. Other notable pianists relevant to particular aspects of Beethoven interpretation include D’Albert, notable for his role in the Austro-German tradition and Schnabel whose recordings are seen as essential in appreciating the composer.
2. Era
2.1. Overview of the era
2.2. Key characteristics of the era’s music
2.3. Influential composers of the era
3. Genre
3.1. Definition and characteristics of the genre
3.2. Evolution of the genre over time
3.3. Notable works within the genre
4. Artists
4.1. Biographies of the performing artists
4.2. Previous notable performances by the artists
4.3. Awards and recognition received by the artists
5. Composers
5.1. Background information on the composers
5.2. Major works composed by the composers
5.3. Influence of the composers on the music industry
6. Personal Reflections
6.1. Overall impression of the concert
6.2. Emotional impact of the music performed
6.3. Memorable moments or performances during the concert

Conservation of Natural Resources and Sustainable Practices

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question
The human population depends on various natural resources, plants, and other members of the animal kingdom for our survival and lifestyles. Take a day in your life at home and at work and think of items or ways you could reduce or do away with. In what ways does the reduction promote resource depletion? As a nurse, how would you advocate for mitigating unrestricted consumption and its effects on the human population and health? (USLOs 5.1, 5.2)
OR
Take any two finite/non-renewable resources and discuss ways to conserve them or promote their sustainable use. How do the effects of resource depletion intersect with socioeconomic status, gender, race/ethnicity, and health outcomes? Explain. Next, in what ways can nurses encourage sustainability in their personal and professional settings? (USLOs 5.1, 5.2, 5.3, 5.4)
Answer
1. Introduction
With increasing globalization of the economy and competitive industrial growth, the pattern of consumption, production, and marketing has become complex. Global consumption of natural resources has increased rapidly because of population growth, urbanization, and changed lifestyles. Industrialized countries have employed technological and institutional means to exploit resources to meet the growing consumption demand. This has put severe stress on the availability of resources. Developing countries are also following suit in consuming the resources. Sooner or later, if this consumption trend continues, it will lead to economic degradation and cause a high cost for future generations. This calls for an urgent need to conserve natural resources. Now the question arises: what do we mean by resource conservation? Why is it needed? What will be the impact of unrestricted consumption of resources? What are the ways to conserve resources and sustain development? This study is an attempt to answer such questions.
All the activities of man are directly or indirectly interwoven with the natural resources of Earth. All the industries based on agricultural raw materials, minerals, fuels, etc. are products of natural resources. In fact, life itself is a gift of nature – vegetables, animals, water, and the atmosphere. Man is the most precious resource, utilizing all the natural resources for life. The development of human civilization has been closely linked with the availability of natural resources. Now, these resources have been overutilized to feed the large human population. According to some estimates, 85% of resources have been consumed in the last 100 years.
1.1 Importance of Natural Resources
Importance of natural resources. Natural resources are those things that are in the environment and obtained from it. They are the gift of nature and make the life of humans very comfortable and easy. They are an essential part of our lives. They are the things which are limited in nature. Natural resources have been classified into various types. The most common classifications are: – Biotic and abiotic. – Renewable and non-renewable. Renewable natural resources are those which can be generated again and are virtually unlimited. The major types of such resources are air, water, soil, and forests. On the other hand, non-renewable resources are those which are available in a limited quantity and can be exhausted. Such resources include coal, oil, natural gases, and minerals. The word resource is a vast term. It is essentially a functional concept; it only has meaning in human reflection upon human needs for inputs to maintain or increase the functioning of their life. It is hard to overestimate the importance of human resources. It is a necessity for life and no substitute for it will exist. Without resources, human life would be a very short and squalid affair, in no way approximating its current meaning. The issue which society must consider is not whether to use resources; this is its inevitable act in pursuit of survival and betterment. Rather, it is how to use them.
1.2 Impact of Unrestricted Consumption
Presently, about 80% of the raw material and 90% of its uses come from natural resources, and only 1% has been closed into biological cycles (Narayanan, 2005). Natural resources are being used so much: land, water, air, wildlife, nonrenewable resources, and human capacities and needs to meet development goals and objectives. Unrestricted consumption of natural resources will have a negative impact on the environment. If land is an important natural resource for economic development in third world countries, this will occur at the expense of the land itself and its health, especially when there is no proper land use planning and controls. Conversion of forest land to agriculture land is a controlled way for economic development, but it will affect the fertility of the soil. Not to forget rampant deforestation, which is mainly for its timber being exported or for land cleared up for commercial plantations or conversion to rural land with no regulations. All of this would decrease the quality and quantity of forest resources.
2. Ways to Conserve Natural Resources
2.1 Reduce, Reuse, and Recycle
2.2 Energy Conservation
2.3 Water Conservation
2.4 Sustainable Agriculture
2.5 Forest Conservation
3. Intersection of Resource Depletion and Socioeconomic Status
3.1 Disparities in Access to Resources
3.2 Environmental Justice Issues
3.3 Impact on Economic Development
4. Intersection of Resource Depletion and Gender
4.1 Gendered Impacts of Resource Depletion
4.2 Gender Equality and Sustainable Practices
4.3 Women’s Role in Conservation Efforts
5. Intersection of Resource Depletion and Race/Ethnicity
5.1 Disproportionate Effects on Minority Communities
5.2 Environmental Racism
5.3 Promoting Environmental Equity
6. Intersection of Resource Depletion and Health Outcomes
6.1 Health Impacts of Resource Depletion
6.2 Vulnerable Populations and Health Disparities
6.3 Promoting Health through Sustainable Practices
7. Nurses’ Role in Encouraging Sustainability
7.1 Education and Advocacy
7.2 Incorporating Sustainability in Healthcare Practices
7.3 Promoting Sustainable Lifestyles