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Problem situation in the administration of educational agency Problem situation in the administration of educational agency ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS Identify an instance where you encountered or were a part of a problem situation in the administration of your educational agency. Case Study: Problem Proposal Assignment Instructions The goal of this exercise is to develop useful case studies from the experience of students in the class to examine together “in-class” in order to practice using organizational analysis for problem-posing and problem-solving in the workplace. 1.Step One: Identify an instance where you encountered or were a part of a problem situation in the administration of your educational agency. a. Make it a manageable problem, not one that would require extensive analysis. b. Reflect upon the problem situation long enough to refresh yourself on the specifics. 2.Step Two: Having refreshed yourself on the specifics, provide some background information. Use the following questions/instructions to guide you in this step: a. What is the community and agency setting? b. Include fictitious names and agency titles to maintain privacy. c. Describe the problem situation that arose. 3.Step Three: Use the following guidelines in completing this assignment: a. Make sure you address both Steps one and two above. b. Your problem summary is to be 2–3 pages in length. c. References are not required, but if used, must follow current APA formatting guidelines. d. Assignment is to include a title page, be double-spaced, written in 12-point Times New Roman font, and follow current APA formatting guidelines (first person should not be used). Requirements: APA | Case Study | 5 pages, Double spaced Answer preview to identify an instance where you encountered or were a part of a problem situation in the administration of your educational agency. You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes. Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages. Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor. The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument. Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

Genetic pathophysiology of a disease Essay Genetic pathophysiology of a disease Essay ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS This week you were introduced to several diseases that result from a change in the genetic code . Your assignment this week to is to pick one and provide genetic pathophysiology of the disease . You should discuss the signs and symptoms of the disease, the characteristics of the gene that is linked to the disease, the type(s) of mutation that results in the disease, and characteristics of the inheritance of the disease. In addition, please find and integrate a peer-reviewed primary research article that discusses an attribute of the disease. Follow the assignment mutations from the Additional Resources readings. Assignment Expectations: Length should be 1500-1750 words, not including title and references pages (typed, 12 point font, double spaced). Include these subheadings in your paper: summary of the disease, function of the gene linked to the disease, mutation of the gene, and inheritance characteristics Find and integrate a primary research article into one or more of the subsections listed above. You may use the Aspen library resources or a search engine like Google Scholar ( http://scholar.google.com/ Scholar limits your returns to only peer-reviewed articles). An example article can be found here: http://www.pnas.org/content/91/21/9975.full.pdf Support your content with at least (4) citations. Make sure to reference the citations using APA writing style for the presentation. Answer preview to pick one and provide genetic pathophysiology of the disease. You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes. Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages. Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor. The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument. Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

Consider a time in your life when you had to look at something a little closer to make sense of it Consider a time in your life when you had to look at something a little closer to make sense of it ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS Consider a time in your life when you had to look at something a little closer to make sense of it. and write two fully developed paragraphs. In the first paragraph, use rich description and detail to describe the moment. In the second paragraph, explain your method of examining the moment and what you discovered as a result. Answer preview to consider a time in your life when you had to look at something a little closer to make sense of it. You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes. Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages. Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor. The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument. ADDITIONAL INSTRUCTIONS FOR THE CLASS Discussion Questions (DQ) Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words. Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source. One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words. I encourage you to incorporate the readings from the week (as applicable) into your responses. Weekly Participation Your initial responses to the mandatory DQ do not count toward participation and are graded separately. In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies. Participation posts do not require a scholarly source/citation (unless you cite someone else’s work). Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week. APA Format and Writing Quality Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required). Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation. I highly recommend using the APA Publication Manual, 6th edition. Use of Direct Quotes I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly. As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content. It is best to paraphrase content and cite your source. LopesWrite Policy For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me. Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes. Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own? Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score. Late Policy The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies. Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances. If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect. I do not accept assignments that are two or more weeks late unless we have worked out an extension. As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading. Communication Communication is so very important. There are multiple ways to communicate with me: Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class. Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours. Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

Do you agree with Milkens view and his argument that a life is priceless Do you agree with Milkens view and his argument that a life is priceless You watched the ”What is a Life Worth?” segment of The Future of Health Care : Meeting of the Minds https://widgets.ebscohost.com/prod/customlink/proxify/proxify.php?count=1&encode=1&proxy=https%3A%2F%2Fgo.openathens.net%2Fredirector%2Fphoenix.edu%3Furl%3D&target=https://fod.infobase.com/PortalPlaylists.aspx?wID=18566&xtid=47312 ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS Respond to the following in a minimum of 175 – 265 words: Do you agree with Milken’s view and his argument that a life is priceless? Why or why not? Support your position by citing professional literature and examples from your experience. Answer preview to do you agree with Milken’s view and his argument that a life is priceless You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes. Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages. Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor. The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument. ADDITIONAL INSTRUCTIONS FOR THE CLASS Discussion Questions (DQ) Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words. Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source. One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words. I encourage you to incorporate the readings from the week (as applicable) into your responses. Weekly Participation Your initial responses to the mandatory DQ do not count toward participation and are graded separately. In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies. Participation posts do not require a scholarly source/citation (unless you cite someone else’s work). Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week. APA Format and Writing Quality Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required). Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation. I highly recommend using the APA Publication Manual, 6th edition. Use of Direct Quotes I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly. As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content. It is best to paraphrase content and cite your source. LopesWrite Policy For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me. Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes. Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own? Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score. Late Policy The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies. Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances. If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect. I do not accept assignments that are two or more weeks late unless we have worked out an extension. As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading. Communication Communication is so very important. There are multiple ways to communicate with me: Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class. Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours. Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

Nursing Informatics Pioneers Essay Nursing Informatics Pioneers Essay Details: Diversity has a significant influence on health care. Studying transcultural health care helps health professionals understand different cultures in order to provide holistic and individualized health care. Review the Purnell Model for Cultural Competence, including the theory, framework and 12 domains. Write 750-1,000 word paper exploring the Purnell Model for Cultural Competence. Include the following: Explain the theory and organizational framework of the Purnell Model, and discuss its relevance to transcultural health care. Nursing Informatics Pioneers Essay ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS Describe Purnell’s 12 domains of culture, and assess how each of these domains plays an active role in the diversity of health care in your specific field. Discuss how this model can be applied when working with different cultures in order to become a more culturally competent health care provider. Cite at least three references, including the course textbook. Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required. You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes. Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages. Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor. The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument. Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

Discussion: biomedical engineering ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Discussion: biomedical engineering there are 3 Q, The first one need to read the article the i will post it , the 2 q and 3 q need to read the note that also i will post Discussion: biomedical engineering let me know if there is anythign missing attachment_1 attachment_2 attachment_3 DEPARTMENT OF MEDICAL HISTORY Department of medical history Ancient Egyptian prosthesis of the big toe Andreas G Nerlich, Albert Zink, Ulrike Szeimies, Hjalmar G Hagedorn Introduction The mummy Up to now, there has been mainly indirect evidence from written sources that the ancient Egyptians practised surgery, and none that their medical treatments also included therapeutic replacement of amputated limbs with prostheses. Medical papyri describe treatment of traumatic lesions, but fail specifically to mention the use of surgery. However, findings such as an externally treated fracture of the forearm with wooden splints1 and a 19th dynasty bone (circa 2100 BC) from a presumably posttraumatic amputation of the forearm with subsequent distal synostotic fusion of radius and ulna,2 do imply that surgical treatment took place in ancient Egypt. Furthermore, a new report3 of a skull with a large posttraumatic osseous defect and missing fracture fragment, but intact internal (dura mater) and external (skin) soft tissue layers, argues in favour of some kind of surgical removal of that fragment. During our palaeopathological survey of human remains in the necropolis of ThebesWest, the large cemetery of the capital of ancient Egypt during the New Kingdom and subsequent periods (about 1550–700 BC), we discovered an Egyptian mummy with an intravital amputation of the big toe. In the additional chamber, we found the fragmented, but otherwise well-preserved mummy of a woman (figure 1). The corpse had been broken into several parts, so that the skull, abdominothoracic torso, right thigh, both shins, and both arms were separate, but could easily be reassembled. All parts of the mummy were extensively wrapped in linen bindings and only the embalmed left thigh and both hands were missing. The torso, probably because of grave robberies, was ventrally disrupted and fragmented. Most of the internal organs were missing and whether their absence was due to the embalming process or to disruption during plundering is unclear. However, a 12 cm segment of aorta, found immediately above the vertebral column, could be anatomically identified. Anthropological investigation of cranial sutures of the skull and symphyseal pubis morphology indicated that the mummy was a 50–60-year-old woman.5 Age of the mummy at death was confirmed by histological examination of incremental lines of the dental cement of a tooth,6 which showed her to be 50–55 years old. The woman was about 169 cm tall, calculated from the length of her long bones.7 A subsequent extensive palaeopathological examination showed that the big toe of the right foot had been amputated. The toe had been removed during her lifetime, because the amputation site was covered by an intact layer of soft tissue, including skin (figure 2, A). The missing toe had been replaced by a wooden prosthesis (figure 2, B), painted dark brown and made up of three separate components. The main component consisted of a longitudinal wooden corpus (12?3·5?3·5 cm) and replaced the toe. This corpus was attached to two small wooden plates (together about 4?2·5?0·3 cm). These plates were fixed to each other by seven leather strings. Discussion: biomedical engineering All wooden parts were delicately manufactured and the major corpus of the prosthesis perfectly shaped like a big toe, even including the nail. A broad textile lace was fixed to the small plates and to the prosthetic corpus, which was tied around the forefoot (see figure 2, B), fixing the toe firmly in place. This construction provided sufficient stability to keep the prosthesis in the correct position, and allow the user to move without major restrictions. Careful inspection revealed clear marks of use on the sole of the prosthetic toe (figure 2, C). Further examination of the forefoot by macroscopy, plain radiology, and computed tomograms (CT) showed that the first metatarsal bone was somewhat demineralised, and that extensive osteophytic osseous overgrowth of the amputation end had taken place (figure 2, D). By contrast, the other metatarsals, as well as the digits, were shaped and mineralised regularly, and did not show pathological features. However, CTs of the mummified soft tissues revealed small peripheral arterial cross-sections with irregular and focal calcifications of the small arterial walls, suggesting segmental or focal peripheral arteriosclerosis (figure 3, A). The aortic segment, found in the mummy’s abdomen, revealed an The Thebes-West tomb During an excavation campaign at the necropolis of Thebes-West (Sheik-Abd-el-Gurna), by the German Institute of Archaeology, Cairo, and the Supreme Council of Antiquities in Egypt, we investigated the human remains of burial chamber TT-95, one of the tombs of the nobles. This tomb was built during the 18th dynasty (circa 1550–1300 BC) by a high royal official and, according to archaeological findings, was originally used by members of his family. However, in subsequent periods, the tomb complex was reused as a burial place by others. This practice holds particularly true for an additional burial chamber located at the end of a shaft originating from the transverse hall of the burial chapel. The room was built in the third intermediate period (circa 1065–650 BC) and the presence of cartonnage and coffin fragments (yellow type coffins), and funerary pottery, typical of the 21st and 22nd dynasty (circa 1065–740 BC),4 suggests that it was used during that period. Lack of funerary material from later periods excludes its subsequent use. Therefore, the remains of several individuals found in the chamber were archaeologically dated to the early third intermediate period (21st/22nd dynasty). Lancet 2000; 356: 2176–79 Departments of Pathology (Prof A G Nerlich MD, A Zink PhD, H G Hagedorn MD), and Diagnostic Radiology (U Szeimies MD), Ludwig-Maximilians-University Munich, D 80337 München, Germany Correspondence to: Prof A G Nerlich (e-mail: [email protected]) 2176 THE LANCET • Vol 356 • December 23/30, 2000 For personal use only. Not to be reproduced without permission of The Lancet. DEPARTMENT OF MEDICAL HISTORY Figure 2: Views of right foot and prosthesis A, well-healed amputation area covered by intact layer of skin. B, wellcrafted wooden prosthesis, attached to the forefoot by a textile lace. C, basal surface of prosthesis showing abrasion of the wooden surface and several scratch marks indicating intravital use. D, radiograph showing bony overgrowth of the first metatarsal indicating longstanding intravital amputation of the big toe. Note the enhanced demineralisation of the first metatarsal. Discussion: biomedical engineering Figure 1: A complete overview of the mummy after reconstruction and indicated severe calcifying arteriosclerosis of the aorta (macroangiopathy). Further inspection of the mummy revealed, on several cross-sections through the bones, slight mineral deficiency (mild osteopenia) which was, however, restricted to the bones of both legs and did not obviously affect the trabecular structure of the vertebral bodies, the long bones of the arms, or the ribs. This pattern of osteopenia excludes age-related or hormonally-induced osteoporosis such as is commonly seen in present-day people, and suggests that a general disuse of the legs might have been the underlying cause. Since both legs were affected, an isolated disease of the side with the prosthesis is unlikely. Finally, we noticed severe abrasion of all teeth, presumably caused by dental wear. Such wear is a feature generally seen in ancient Egyptian populations and is assumed to result from sand and debris from stone mills found in food, particularly in bread.8 In addition, six teeth had carious processes and one of these showed an apical inflammatory process, as is frequently seen in these people.8 Three teeth had been lost during life. Discussion irregular distension of the arterial walls and focal severe calcifications. This observation was confirmed by radiographs taken from an aortal segment (figure 3, B) THE LANCET • Vol 356 • December 23/30, 2000 We describe possibly the oldest known intravital limb prosthesis. Up to now, several investigators have reported prosthetic replacements of limbs in ancient Egyptian 2177 For personal use only. Not to be reproduced without permission of The Lancet. DEPARTMENT OF MEDICAL HISTORY Figure 3: CT scans of forefoot proximal to the amputation site (A) and radiological examination of a segment of abdominal aorta (B) Of note are small arterial vessels (arrow) in (A) which show calcification of the vessel wall, and severe calcifications indicating major arteriosclerosis in (B). mummies. However, their findings suggest that the replacements were made to prepare the mummy for its afterlife. For example, a previously found forearm prosthesis of an elderly man from the Ptolemeic period (332–30 BC) revealed attempts by embalmers to complete the mummy for the afterlife.9 Gray10 has detailed further similar prosthetic replacements of limbs. Similarly, a wooden prosthesis of the nose of a male mummy from the Roman period (about 1st century AD)11 is believed to have been added after death to restore the mummy’s external integrity, and not for aesthetic reasons during life, since it was attached to the mummy by a delicate rope turned around the skull and fixed tightly to the mandibula.11 There is also a debate about two dental prostheses found several years ago near Cairo (Saqqara, 4th dynasty, and El-Qatta, Ptolemeic period).12,13 The teeth were initially interpreted as intravitally used dental prostheses, however, the absence of dental wear and dental calculus on the teeth argues against use in life.14 Recently, CT analysis of a female mummy from the Albany Institute of History and Art (Albany, NY) provided evidence that the right big toe of this corpse had been replaced by a prosthesis.15 However, only CT investigation of this object exists, and whether the prosthesis had been used during life or if it had been added after death remains unclear.Discussion: biomedical engineering Furthermore, both the source and function of this prosthesis are uncertain, because measurement of the radiological density suggests that the toe consisted of some form of high-density ceramic; a material unknown in ancient Egypt. Notably, the mummy comes from the Theban necropolis and dates back to the 21st dynasty, thereby closely resembling the 2178 spatial and temporal origin of our case. A further example of an ancient Egyptian toe prosthesis is housed in the Egyptian department of the British Museum. This prosthesis, made from a certain kind of cartonnage, had been brought to the British Museum in 1881 and also originated from Thebes. Although no information is available on the individual who used the toe, distinct signs of wear and subsequent refurbishment suggest that this prosthesis was also used during life.16 These observations provide compelling evidence that the surgical expertise to carry out toe, and possibly other amputations, sometimes followed by prosthetic replacement, was present in Egypt during this period. The big toe usually bears about 40% of walking weight and its replacement is, therefore, of certain importance to the user’s physical integrity. The loss of this digit results in a transfer of weight to the end of the first metatarsal, resulting in instability while standing and in limping when attempting to run. Use of a prosthesis would have solved these problems. In addition to the amputation and prosthetic replacement of the big toe, we present evidence that the underlying pathological condition could have arisen from clinically significant systemic arteriosclerosis, since radiographs and CT scans show severe arteriosclerotic macroangiopathy of the aorta with extensive calcifications and arteriosclerotic microangiopathy of small arterial vessels of the affected foot. We cannot speculate on whether this amputation was done by surgery or if it took place naturally. Traumatic loss of the toe, however, is unlikely. Unfortunately, we were not able to do further CT scans on other body regions of the mummy. THE LANCET • Vol 356 • December 23/30, 2000 For personal use only. Not to be reproduced without permission of The Lancet. DEPARTMENT OF MEDICAL HISTORY The presence of arteriosclerosis in ancient Egyptian mummies has been repeatedly documented.17,19 In our case, the arteriosclerotic lesions affected not only the major arterial vessels, but also small peripheral vessels, suggesting a metabolic disorder such as diabetic angiopathy. Although this diagnosis cannot be substantiated, and there are of course several other major contributing factors possibly involved, we suggest that ischaemic gangrene could have led to amputation of the big toe. 5 6 7 8 9 Acknowledgments This study was supported by a grant from the Deutsche Forschungsgemeinschaft (Ne 575/3-3). We thank several co-workers, in particular, Christin Weyss and Ulrike Hobmeier, for their help in the field work; the cooperating group of Egyptologists for their continuous and effective support, in particular Andrea Loprieno, Daniel Polz, and Rainer Stadelmann; Deutsches Archaeologisches Institut Kairo; and the Supreme Council of Antiquities of Egypt. Discussion: biomedical engineering The analysis of dental age was kindly supplied by A Cipriano. References 1 2 3 4 Smith E, Dawson W. Egyptian mummies. London; Allen & Unwin, 1924. Brothwell DR. Moller-Christensen V. A possible case of amputation dated to c. 2000 BC. Man 1963; 244: 192–94. Nerlich AG, Zink A, Szeimies U, Hagedorn H, Rösing FW. Skull trauma in ancient Egypt and evidence for early neurosurgical therapy. Presented at International colloquium on cranial trepanation in human history. Arnott R, Breitwieser R, Lichterman B, eds. Birmingham: University of Birmingham, 2000: 36–37 (abstract). Ikram S, Dodson A. The mummy in ancient Egypt. Cairo: American University in Cairo Press, 1998. THE LANCET • Vol 356 • December 23/30, 2000 10 11 12 13 14 15 16 17 18 19 Ferembach D, Schwidetzky I, Stloukal M. Empfehlungen für die Alters: und Geschlechtsdiagnose am Skelett. Homo 1979; 30: 1–32. Condon K, Charles DK, Cheverud JM, Buikstra JE. Cementum annulation and age determination in Homo sapiens: II) Estimates and accuracy. Am J Phys Anthropol 1986; 71: 321–30. Bach H. Zur Berechnung der Köperhöhe aus den langen Gliedmassen weiblicher Skelette. Anthrop Anz 1965; 20: 20–21. Harris JE, Storey AT, Ponitz PV. Dental disease in the royal mummies. In: Harris JE, Wente EF, eds. An x-ray atlas of the royal mummies. Chicago: University of Chicago Press, 1980: 328–45. Gray PHK. Radiography of ancient Egyptian mummies. Med Radiograph Photograph 1967; 43: 34–44. Gray PHK. Embalmer’s restorations. J Egypt Archaeol 1967; 52: 138–40. Merei G, Nemeskeri J. Bericht über eine bei einer Mumie verwendete Nasenprothese. Z ägypt Sprach Altertumskun 1959; 84: 76–78. Junker H. Bericht über die Grabungen auf dem Friedhof des AR bei den Pyramiden von Giza. Denkschrift Kaiserl Akad Wissenschaft Wien, Phil-hist Kl, 1929; 69: 256. Harris J, Iskander Z, Farid S. Restorative dentistry in ancient Egypt: an archaeological fact. J Michigan Dent Ass 1975; 57: 401–04. Hoffman-Axthelm W. Zahnprothetik im alten Ägypten: eine archäologische Tatsache? Quintessenz 1976; 11: 155–63. Wagle WA. Toe prosthesis in an Egyptian human mummy. Am J Radiol 1994; 162: 999–1000. Reeves N. New lights on ancient Egyptian prosthetic medicine. In: V Davies, ed. Studies in honour of Egyptian antiquities: a tribute to TGH James. London: British Museum, Occasional paper 123, 1999: 73–77. Discussion: biomedical engineering Long AR. Cardiovascular renal diseases. Arch Pathol 1931; 12: 92–94. Ruffer MA. On Arterial lesions found in Egyptian mummies (1580 BC–525 AD). J Pathol Bacteriol 1911; 15: 453–62. Sandison AT. Degenerative vascular disease in the Egyptian mummy. Med Hist 1962; 6: 77–81. 2179 For personal use only. Not to be reproduced without permission of The Lancet. BME 201 Found. of BME Fall 2017 HW #3 Due Friday, October 27 Name: 1. You may work together but each person should turn in his/her own work in his/her own handwriting. Problems #1 (20 pts) _____________ #2 (20 pts) _____________ #3 (12 pts) _____________ /52 Total: _______________ 1. Biomaterials [20 pts] Read the article “Ancient Egyptian prostheses of the big toe,” by A.G. Nerlich, Al. Zink, U. Szeimies, and H.G. Hagedorn in Lancet, 2000; 356: 2176-79. The article can be found in our Kodiak classroom. Answer the following questions related to the article: A. The mummy described in the article is estimated to originate from what time period (range of dates)? B. How did the researchers estimate the age and sex of the woman was mummified? C. The big toe usually bears what percentage of walking weight? Why is this important to the researchers’ conclusion that the prosthetic toe was used during the woman’s life (as opposed to being created as part of a burial ritual)? D. What are some possible reasons why the woman had the prosthetic toe that are postulated by the researchers? 2. Artificial Organs Part I [20 pts] The hemodialysis unit shown below contains 10,000 fibers, and each fiber has a diameter of 300 ?m and is 20 cm long. Fiber cross-section 20 cm 300 ?m Figure adapted from http://www.homedialysis.org A. What is the total surface area for contact between blood and dialysate? Display your answer in m2. [10 pts] B. What is the volume of blood contained in the fibers (in total)? Display your answer in mL. [10 pts] 3. Artificial Organs Part II [12 pts] A dialyzer is operating with a blood flow rate of 250 mL/min, so that the outlet concentration of urea is 10 mg/dL when the inlet concentration is 60 mg/dL. A. What is the clearance, CL, for this device operating under these conditions? Display your answer in units of mL/min. [10 pts] B. The target extraction ratio for the device is 0.9. Did the device meet the target specification? Show your work and explain your answer. [2 pts] … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

Introduction to Finite Element Analysis ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Introduction to Finite Element Analysis Introduction to Finite Element Analysis homework if you need anything just text me attachment_1 ME 474 / BME 488 Homework 4 Due: 02/17/2020 @ 6:00 PM When submitting this homework, include a pdf of your written work as well as any MATLAB (.m) or Excel (.xls, .xlsx) files used to solve the problems. Make sure your work is well documented and easy to follow. 1. The members of the truss shown in the figure below have a cross-sectional area of 15 cm2 and are made of aluminum alloy (E = 70 GPa). Determine the deflection of each joint, the stress in each member, and the reaction forces. Verify your results. 2. The members of the truss shown in the accompanying figure have a cross-sectional area of 8 cm2 and are made of steel (E = 200 GPa). Determine the deflection of each joint, the stress in each member, and the reaction forces. Verify your results. … Introduction to Finite Element Analysis You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes. Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages. Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor. The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument. ADDITIONAL INSTRUCTIONS FOR THE CLASS Discussion Questions (DQ) Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words. Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source. One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words. I encourage you to incorporate the readings from the week (as applicable) into your responses. Weekly Participation Your initial responses to the mandatory DQ do not count toward participation and are graded separately. In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies. Participation posts do not require a scholarly source/citation (unless you cite someone else’s work). Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week. APA Format and Writing Quality Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required). Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation. I highly recommend using the APA Publication Manual, 6th edition. Use of Direct Quotes I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly. As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content. It is best to paraphrase content and cite your source. LopesWrite Policy For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me. Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes. Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own? Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score. Late Policy The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies. Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances. If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect. I do not accept assignments that are two or more weeks late unless we have worked out an extension. As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading. Communication Communication is so very important. There are multiple ways to communicate with me: Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class. Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours. Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

Problem With Payment Structures In Health Care Industry Problem With Payment Structures In Health Care Industry Identify a significant problem with one of the three payment structures used in the health care industry across the care continuum (from DQ 1) and propose a solution from one of the other two payment structures MY FIRST PATIENT AS A MEDICAL STUDENT was a victim of the United States health care system. A fifty-year-old man who died of a heart attack shortly upon arriving at the hospital, this particular gentleman had been experiencing chest pain for over a year. But he had forgone a doctor’s visit because he had let his health insurance lapse due to its high cost. He is by no means alone. Sadly, the United States manages to leave 47 million Americans—about 17.7 per- cent of the country’s nonelderly population—uninsured.1 Of these uninsured Americans, 61 percent stated they either could not afford the cost of insurance or lost coverage after being laid off.2 ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS Yet, remarkably, 55 percent of Americans do not approve of the Affordable Care Act (ACA).3 In 2010, the Demo- cratic Congress passed the ACA—better known as Obamacare—in an effort to increase coverage for those individuals without health insurance. The Republican House of Representatives has voted numerous times to repeal the law, and the GOP has made the legislation the central target of its partisan attacks. At first glance, this concerted opposition would appear to be the result of a lack of understanding on the part of the public, or merely political theatrics. Indeed, a Pew Research poll has indicated that, despite the displeasure with the ACA, 75 percent of Americans do not know how the law would impact them personally.4 However, is there, in fact, any real cause—beyond blind partisanship—to be dissatisfied with the ACA? Such an essential policy cannot be analyzed within the proverbial political echo chamber; policy makers and ordinary Ameri- HARVARDKENNEDYSCHOOLREVIEW.COM64 cans alike must objectively examine the merits and shortcomings of the law, several years after its passage. Without this more nuanced analy- sis, Americans resign themselves to blindly take sides in a partisan war that threatens the future of our health care system, our economy, and the well-being of American citizens. To adequately understand the suc- cesses and failures of the law, we need to return to the bill’s origins: Massachusetts, circa 2006. This journey back in time reveals a truth that conforms to neither of the carefully cultivated liberal or conservative talking points: the ACA, modeled on Massachusetts health reform and facing similar political and practical constraints, largely addresses access to health care and quality improvements but does not sufficiently confront the out-of-con- trol growth of health care costs. Under then-Governor Mitt Romney, Massachusetts discovered a successful recipe for universal cover- age that would also satisfy important industry stakeholders.5 It is not sur- prising, then, that these same policy ingredients would reappear years later in the ACA. However, these policy choices do not necessarily rep- resent the best, most affordable solu- tion to providing increased health coverage; instead, they represent the policies that could both achieve expanded health coverage and also survive the Massachusetts political process. The ACA has many complex parts, including Medicaid expansion, Medicare reform, and incentives for changing the current fee-for-service reimbursement method, but the legis- lation contains no direct measure to decrease the per-unit cost of medical services—unjustifiably higher in the United States than anywhere in the world.6 The ACA, like Massachusetts reform, accomplishes its primary objective: expand health care access in a politically constrained environ- ment. At the time, cost control was, by necessity, an ancillary concern. Yet the inability of the ACA to sufficient- ly address cost control will ultimately erode our health care system un- less future reforms are made. What, therefore, should be our focus? We must shift the conversation away from repealing the ACA and toward tackling the equally massive problem of excessive costs. Problem With Payment Structures In Health Care Industry MASSACHUSETTS HEALTH CARE REFORM During the 2006 health care fight, Governor Romney had one primary goal: to ensure the passage of health care legislation that would effectively expand health coverage, even if that meant not addressing every aspect of the health care conundrum, particu- larly cost control. ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS He and his allies in the legislature capitalized on a win- dow of opportunity to pass reform, utilizing valuable lessons from their predecessors who failed at the same task. Massachusetts’s health reform would ultimately prove a success because the politicos behind the bill provided a policy framework that managed to both expand coverage and also garner the support of key stakeholders, such as businesses and health care industries that had previ- ously opposed reform. But it was precisely this push to satisfy key stakeholders that, while pivotal to the legislation’s passage, would also leave skyrocketing costs unsolved. Romney’s interest in health care reform was driven by necessity. In TO ADEQUATELY UNDERSTAND . . . THE LAW WE NEED TO RETURN TO THE BILL’S ORIGINS: MASSACHUSETTS, CIRCA 2006. VOLUME XIV 65 2004, a federal waiver for a Mas- sachusetts Medicaid program was up for renewal. This waiver provided $385 million annually to fund safety net hospitals and was to be renewed every five years by the U.S. Depart- ment of Health and Human Services (DHHS). Contrary to expectations, in the wake of President George W. Bush’s reelection, the DHHS denied renewal. The result was disastrous; the state would lose $1 billion in federal funding over the next three years. Problem With Payment Structures In Health Care Industry Governor Romney and mem- bers of the Massachusetts legislature scrambled to find a solution. They eventually proposed to the DHHS that rather than use the waiver to support safety net hospitals, they cover 600,000 uninsured with the available funds. Essentially, they would create universal health care in Massachusetts with the aid of government subsidies. The DHHS, excited at the prospect, accepted their proposal.7 In the words of Dr. John Mc- Donough, former cochair of the Massachusetts Joint Committee on Health Care and former Senior Advisor on National Health Reform to the U.S. Senate Committee on Health, Education, Labor and Pen- sions: “Massachusetts put a financial gun to its head that made passage of universal coverage legislation a policy, political, and financial neces- sity and the Bush administration provided the bullets.”8 Romney, who had shown little interest in universal coverage pre- viously, needed to find a path for covering Massachusetts’s uninsured, and he needed to do it quickly. The majority of the uninsured were between the ages of eighteen and sixty-four, comprising healthy young adults, individuals who could not afford coverage, and the poor, who were Medicaid-eligible but had not enrolled.9 Romney needed to target these uninsured groups through a com- bination of private marketplace re- forms and government assistance. He was not the first to attempt this bal- ancing act. In 1988, Massachusetts Governor Michael Dukakis tried but failed to pass a bill that would have dramatically expanded health coverage in the state. He attempted this partly through a policy called pay-to-play, in which employers with six or more employees would be mandated to provide health insur- ance, and infuriated business owners in the process. Many of the individuals who had worked on the Dukakis health care reform still carried scars from the 1988 defeat. They did not want to face a repeat experience. Nancy Turnbull, a professor at the Harvard School of Public Health, recounts the key lesson from the Dukakis health care push: without the support of business and other health care industries, reform efforts were bound to fail.10 Consequently, Romney’s health bill would need to cover Mas- sachusetts’ uninsured, be financially feasible, and also manage to gain the support of businesses. Additionally, he needed to achieve all of this with- out upsetting the national Republi- can Party and his future presidential aspirations.11 The lessons of previous attempts, and the incentives facing the health care industry, led the legislature to craft a bill standing on three main policy legs (see Figure 1). Each proved essential to the success of the plan—and would later appear in the ACA as well.12 The first leg involved systemic reform of health insurance in Mas- sachusetts. This had two major elements. One was guaranteed issue, which eliminated insurers’ ability to deny coverage based on preexisting conditions. The other element was the development of a marketplace— the Commonwealth Connector— where employers and individuals could buy coverage. The idea of an exchange was particularly popular among Republicans, who favored private competition in the health market.13 The second policy leg was an in- dividual mandate to purchase health coverage or pay a fine. Originally, the Heritage Foundation (a conservative think tank) and other Republicans had proposed the mandate as an alternative to President Bill Clinton’s failed health care bill in 1993.14 Romney worried that the mandate would be too radically conservative. However, the Urban Institute (a non- partisan economic and social policy research group) and other groups emphasized to him the perceived fi- nancial importance of the mandate.15 Universal Coverage Subsidies for Low-Income Residents Sys- temic Health Insurance Reform Individual Mandate Figure 1 — John McDonough’s three- legged policy to achieve universal health care coverage. Problem With Payment Structures In Health Care Industry HARVARDKENNEDYSCHOOLREVIEW.COM66 essential stakeholders. Overall, stakeholders believed this reform bill would benefit them.18 This story would largely repeat itself during the passage of the national health care bill, and the result would look remarkably similar. Importantly, Massachusetts’s health reform can teach us a valu- able lesson relevant to the ACA as well: improving access, while politi- cally challenging, has proved easier than fixing cost. Today, 98 percent of Massachusetts residents have health coverage, but this increase in the in- sured population did not reduce the state’s health care costs—the highest health expenditures in the nation, at $9,728 per capita, compared to a median of $6,795.19 This high cost is not a result of the 2006 reform, but was not corrected by the legislation either (see Figure 2). BIRTH OF THE AFFORDABLE CARE ACT IN 2010 Like Romney, Obama faced the challenge of expanding access while countering reluctant stakehold- ers. Consequently, it should be no surprise that the ACA shares similar characteristics and unaddressed is- sues with the Massachusetts legisla- tion. This includes the lack of truly effective cost control. Despite the public’s uncertainty regarding health care, many politi- cians in Washington understood the impact it was having on the economy and the well-being of many Ameri- cans. In illustration of this point, during the 2008 presidential election, even while the economy was head- ing into a recession, candidates from both parties discussed their plan to reform the health care system. With the election of Obama, and with Democratic control of both the House and Senate, the passage of national health care reform suddenly seemed possible. Yet like Romney before him, Obama needed the support of key stakeholders. A wide array of com- peting interests had ensured that national health care reform had been discussed, attempted, and abandoned numerous times during the past cen- tury by presidents from both political parties, including Franklin Roosevelt, Richard Nixon, and, most recently, Bill Clinton.20 Since 1998, major health care stakeholders have spent over $5.36 billion lobbying Washing- ton, more than was spent in the same Figure 2 — Massachusetts versus United States per capita health care expenditures. Source: Graph based on data from Health Care Expenditures per Capita by State of Residence, Kaiser Family Foundation. Finally, the third policy element involved the passage of subsidies for individuals at 100 percent to 300 percent of the poverty level. This was partly made possible by an agreement between Romney and the DHHS. The annual $385 million previously dedicated to safety net hospitals would now support these subsidies and enable universal cover- age.16 Each of these legs would prove essential to the success of universal health coverage. Guaranteed issue without individual mandate would permit individuals to avoid purchas- ing insurance until they are sick, known as adverse selection. Several states, including Kentucky, New Hampshire, and Washington, saw health care premiums soar when they implemented guaranteed issue with- out a mandate as well.17 However, in theory, the combination of the man- date and guaranteed issue reduces adverse selection and stabilizes costs. To avoid punishing those individuals who cannot afford the coverage of- fered to them in the marketplace, the state must also provide subsidies for low-income individuals. Problem With Payment Structures In Health Care Industry Crucially, this three-legged approach also had the support of VOLUME XIV 67 time period by the oil and defense industries combined.21 The pharma- ceutical industry was prepared to spend $200 million either fighting or supporting the national health care reform bill.22 For their part, the Clintons discovered the importance of these industries the hard way: the American public was in favor of health care reform when Clinton began his fight, but after months of negative advertisements supported by the health industry, opinions evolved, and health care passage failed. Obama, eager to avoid Clinton’s mistakes, presented stakeholders with the opportunity to shape policy. In a meeting called by the Senate Task Force, a room of gathered stakehold- ers was provided with three options for health care reform, which had been given the names Constitution Avenue, Independence Avenue, and Massachusetts Avenue: respectively, undergoing a major overhaul (single payer, etc.) of the current system; implementing more limited reforms (possibly tax credits and smaller mar- ket reforms to incentivize purchasing insurance); and adopting the Mas- sachusetts reform as a template. After hours of discussion, the stakeholders voiced unanimous support for the Massachusetts Avenue approach. Faced with similar incentives on a national scale as in Massachusetts, public and private stakeholders sup- ported a bill that, not surprisingly, would achieve near-universal cover- age in a similar manner to Massachu- setts’s reform.23 After two years of work, the ACA would be voted into law in 2010. In total, the ACA has nine titles and one amendment. Title I of the two thousand–page legislation reflects the bill’s Massachusetts ori- gins, employing the same three policy legs to expand health coverage to the uninsured.24 Thus, the ACA came to be defined by the same characteristics that allowed Massachusetts’s health reform to successfully increase ac- cess to health insurance. Foolishly, many Republicans tend to ignore the conservative bona fides of the ACA’s essential characteristics and ignore their role in allowing the legislation to grow insurance coverage. Repub- lican Senators Orrin Hatch (Utah), Tom Coburn (Oklahoma), and Rich- ard Burr (North Carolina) put the most recent repeal effort, in January 2014, forward. This proposal would repeal the individual mandate, the subsidies for the poor, and remove many of the protections against dropping care based on preexisting conditions.25 Such a proposal would, in effect, undermine precisely the pil- lars necessary for expanding health coverage. To make matters worse, their plan also cancels Medicaid for the working poor. People like my first patient would once again be faced with health coverage they could not afford. Despite all its shortcomings, repealing the current iteration of the ACA is no solution to America’s health care needs. Rather, we need policy that builds on the successes of the ACA, while addressing the remaining problems unanswered by the current law. THE FAILURE TO ADDRESS COST Massachusetts’s reform and the ACA—not to mention the various Republican suggestions—ultimately do too little to address the root cause of increasing health care cost: the unit price for health care services. Nor were they intended to achieve such a formable goal. Massachu- setts’s experience suggests that while an individual mandate is essential to maintaining basic financial feasibility, the policies that allow for expanded coverage are not going to fix the price tag of health care. Problem With Payment Structures In Health Care Industry The ACA—and its Massachu- setts prototype—achieves only small victories in controlling costs. In the case of the ACA, these include THE ACA . . . ACHIEVES ONLY SMALL VICTORIES IN CONTROLLING COSTS. PHOTO: FLICKR/CARBONNYC HARVARDKENNEDYSCHOOLREVIEW.COM68 Endnotes 1 Garfield, Rachel, Rachel Li- cata, and Katherine Young. The Uninsured at the Starting Line: Find- ings from the 2013 Kaiser Survey of Low-Income Americans and the ACA. Henry J. Kaiser Family Foun- dation, 6 February 2014. 2 Henry J. Kaiser Family Founda- tion. Key Facts About the Uninsured Population. Henry J. Kaiser Family Foundation, 26 September 2013. 3 Jones, Jeffrey M. “Americans’ Ap- proval of Healthcare Law Declines.” Gallup, 14 November 2013. 4 Pew Research Center for the People and the Press. As Health Care Law Proceeds, Opposition and Uncertainty Persist. Pew Research Center, 16 September 2013. 5 McDonough, John E. Inside Na- tional Health Reform. University of California Press, 2012. 6 Anderson, Gerard F. et al. “It’s the Prices, Stupid: Why the United States Is So Different from Other Coun- tries.” Health Affairs 22(3): 89-105, May 2003. 7 McDonough, Inside National Health Reform. 8 Ibid. 9 Garfield, Licata, and Young, The Uninsured at the Starting Line. 10 Turnbull, Nancy. Lecture on Massachusetts Health Care Reform, John F. Kennedy School of Govern- ment at Harvard University, 5 Febru- ary 2014. 11 McDonough, Inside National Health Reform. 12 McDonough, John. Interview with the author on Massachusetts and the ACA, 15 January 2014. 13 McDonough, Inside National Health Reform. port politicians through campaign donations and aggressive political adverting. Who suffers from this boundless profiteering? The Ameri- can public. One in three Americans report struggling to pay medical expenses. Those households strug- gling to pay for health insurance are the true fatality of this health care industrial complex. If we are going to figure out how to address the cost of health care, however, Congress will not only need to relearn how to pass legislation, but also must do so without stake- holders blocking cost control efforts. At first blush such a task seems near impossible, foretelling a bleak future for the American health care system and economy. Yet Massachusetts, enjoying the success of universal coverage and some of the best quality care in the country, is now beginning to study methods of aggressively address- ing rising health care costs and has passed three bills directly targeting this issue. Notably, in 2012 Mas- sachusetts set annual spending limits on health care costs. Vermont is also discussing ways to address cost by moving to a single payer system. Once more, the country may need to turn to a progressive state for inspiration.31 We have expanded health care access; the legislation is a success in achieving this main goal. But without addressing the projected growth in health care costs, our health system threatens to engulf our economy, cause premiums to rise to levels unaf- fordable to even the middle class, and add millions to the already substan- tial group of uninsured in America. It is time for Congress to place the needs of ordinary citizens above those of powerful businesses, build on the progress already made under the ACA, and pass truly transforma- tive legislation that will decrease the unit price of health care. incentives for alternative payment methods, Medicare reforms, and penalties to hospitals for readmis- sion, but none of these will nearly be sufficient. Ultimately, we need to address why health care is so much more expensive in the United States than anywhere else in the world. The growth rate for health care costs in the United States is twice that of the general economic growth rate, and health care spending constitutes 18 percent of total gross domestic product (GDP). It is predicted that if this growth continues, by 2037 one in four American dollars will go to pay for health care, a proportion, the Congressional Budget Office argues, that is unsustainable.26 In contrast, Japanese citizens uti- lize their health care system twice as much as Americans, including almost three times the MRI usage, and are among the healthiest individuals on the planet. Japan also has universal coverage for its citizens.27 Simultane- ously, the nation spends a fraction of what we do for medications, medi- cal procedures, and diagnostic tests. Perhaps we get better-quality care for this high cost? In fact we do not; the deaths due to medical error dur- ing surgery is more than three times higher in the United States than in Japan.28 Stakeholders such as pharmaceu- tical companies, the health insurance industry, physicians, and hospitals have been making fortunes in the past three decades while Americans have watched their premiums con- tinue to rise as they struggle to afford health coverage. Unfortunately, filling the pockets of these wealthy indus- tries has made them powerful. The top five health insurance companies have been doing pretty well also, and in 2011 made $3.3 billion in prof- its.29 And lastly let us not forget the physicians, who make up the largest portion—27.2 percent—of all the top 1 percent of earners in the United States.30 This wealth translates into power when these profits help sup- Thomas C. Kingsley is a joint 2014 MD/MPH Candidate at the Universi- ty of Massachusetts and the Harvard School of Public Health. VOLUME XIV 69 14 McDonough, Interview on Massachusetts and the ACA; Mc- Donough, Inside National Health Reform. 15 Turnbull, Lecture on Massachu- setts Health Care Reform. 16 Garfield, Licata, and Young, The Uninsured at the Starting Line; McDonough, Inside National Health Reform. 17 McDonough, Inside National Health Reform. 18 Turnbull, Lecture on Massachu- setts Health Care Reform. 19 Henry J. Kaiser Family Founda- tion. Health Care Expenditures per Capita by State of Residence. Henry J. Kaiser Family Foundation, 2009. 20 Altman, Stuart, and David Shactman. Power, Politics, and Universal Health Care: The Inside Story of a Century-Long Battle. Pro- metheus Books, 2011; McDonough, Inside National Health Reform. 21 Brill, Steven. “Bitter Pill: Why Medical Bills Are Killing Us.” Time, 4 April 2013, 16-55. 22 Cummings, Jeanne. “Wield- ing Influence in Health Care Fight.” Politico, 28 December 2009. 23 McDonough, Inside National Health Reform; McDonough, Inter- view on Massachusetts and the ACA. 24 McDonough, Interview on Mas- sachusetts and the ACA. 25 Jost, Timothy Stoltzfus. “Be- yond Repeal—A Republican Pro- posal for Health Care Reform.” New England Journal of Medicine 370(10): 894-896, 6 March 2014. 26 Congressional Budget Office. The 2013 Long-Term Budget Out- look. Congressional Budget Office, 17 September 2013; Congressio- nal Budget Office. The Budget and Economic Outlook: 2014 to 2024. Congressional Budget Office, 4 Feb- ruary 2014; Emanuel, Ezekiel et al. “A Systemic Approach to Containing Health Care Spending.” New Eng- land Journal of Medicine 367(10): 949–954, 2012. 27 Kondo, James. “The Iron Triangle of Japan’s Health Care.” BMJ 330(7482): 55–56, January 2005; Babazono, Akira et al. “Does Income Influence Demand for Medi- cal Services Despite Japan’s ‘Health Care for All’ Policy?” International Journal of Technology Assessment in Health Care 24(1): 125-130, Winter 2008; Hashimoto, Hideki et al. “Cost Containment and Quality of Care in Japan: Is There a Trade-Off?” Lancet 378(9797): 1174–1182, 24 Septem- ber 2011. 28 Organization for Economic Co- operation and Development. Health Policies and Data. 29 Ubel, Peter. “Is the Profit Mo- tive Ruining American Healthcare?” Forbes, 12 February 2014. 30 White, Jeremy et al. “The Top 1 Percent: What Jobs Do They Have?” New York Times, 15 January 2012. 31 Mechanic, Robert E., Stuart H. Altman, and John E. McDonough. “The New Era Of Payment Reform, Spending Targets, and Cost Contain- ment in Massachusetts: Early Les- sons for the Nation.” Health Affairs 31(10): 2334–2342, October 2012. Copyright of Kennedy School Review is the property of President & Fellows of Harvard College and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder’s express written permission. However, users may print, download, or email articles for individual use. Problem With Payment Structures In Health Care Industry Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

Nursing Theories and Nursing Practice Research Nursing Theories and Nursing Practice Research Nursing Theory The materials are in those books: Smith, M. & Parker, M. (2014). Nursing Theories and Nursing Practice . (4th ed.). Philadelphia, PA: F. A. Davis Company. ISBN-13: 978-0-8036-3312-4 Chapter 21: Katharine Kolcaba’s Comfort Theory Chapter 22: Joanne Duffy’s Quality-Caring Model ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS Answer preview to Nursing Theories and Nursing Practice. (4th ed.). You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes. Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages. Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor. The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument. Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

HSN/476: Healthcare Policy And Financial Management HSN/476: Healthcare Policy And Financial Management Wk 4 Discussion – Capitalism in Health Care [due Thurs] Discussion Topic Top of Form This week, you watched the “Capitalism and Health Care ” segment from The Future of Health Care: Meeting of the Minds from the Wk 1 University Library Readings . Here is the link for this video: CNBC LLC, 2010: The Future of Health Care: Meeting of the Minds (43:37). [Video File]. Films on Demand . Respond to the following in a minimum of 175 words: Do you believe there is a failure or success of capitalism in health care? Support your position by citing professional literature or examples from your experience. ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS Answer preview to do you believe there is a failure or success of capitalism in health care You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes. Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages. Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor. The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument. Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10