Note: In the Reading Assignment sections of the rest of the course lessons, you will find questions about the readings. These questions are provided to help focus your attention while reading Shakespeare’s plays and to help you develop ideas for the writing assignments. You do not need to submit your answers to the reading questions, since they are not graded.

As you read A Midsummer Night’s Dream, think about the following questions:

1. What is the “ancient privilege of Athens” that Egeus begs for?
2. What options does Theseus offer to Hermia if she refuses to marry Demetrius?
3. Why does Helena tell Demetrius about Hermia and Lysander’s plan to elope?
4. Describe Hermia’s dream when she’s in the woods; what happens after she awakes?
5. Notice when Lysander describes his love as rational; are his actions motivated by reason?
6. How does Oberon describe the creation of the love potion? How might we interpret the significance of this narrative in relation to the rest of the play?
7. Look for allusions to other mythological characters, such as Philomela. Why do the fairies call on Philomel to protect the Fairy Queen? Does their incantation work? How might these allusions influence our reading of Shakespeare’s play?
8. What happens to Hermia and Helena’s relationship when they are in the woods?
9. How does the play-within-the-play of Pyramus and Thisbe reflect events in the main play?
10. Why does Shakespeare frame the sub-narratives in this play within the marriage of Theseus and Hippolyta? Keep in mind that many of the members of Shakespeare’s audience (any men who had attended grammar school) would be familiar with the mythology of these two characters. According to Greek mythology, Theseus and Hippolyta have a son, named Hippolytus, but their marriage ends soon afterwards (in some versions Hippolyta dies and in others, Theseus abandons her). Theseus marries another woman, Phaedra, who tries to seduce Hippolytus. When he rejects her, she accuses him of rape and kills herself. Then, Theseus curses his son, who soon dies a violent death. In light of this myth, why does Shakespeare frame this play with the marriage of Theseus and Hippolyta? How might the myth of Hippolytus influence our interpretation of this play’s themes about love, marriage, and power?
11. One of the main themes in this play focuses on the relationship between the mortal world and the fairy world, and between reason and imagination.  Towards the end of the play, Theseus exclaims,

You are a lab manager and you have been informed that the complete blood count (CBCs) results of 7 patients have been reported prior to finalizing the quality control results (pertaining to those patient results). You review the case and prepare to analyze the nonconformance event (NCE).

Post your responses to each of the following:

1. What defines this event as a nonconformanceevent (NCE)?  Please explain your answer.
2. Perform a root cause analysison the above NCE. Describe at least 2-3 root causes for your NCE in your answer.
3. Outline your corrective action plan. List 2-3 possible actions that will prevent your NCE from occurring in the future.

Kevin U. is a 54-year-old divorced male who presents for his three-month diabetes evaluation.  Kevin is a high school graduate who previously worked as a self-employed logger but now raises beef cows and does some crop farming on the family farm.  Patient is referred for continued diabetes education from his Endocrinologist, Dr. Pehling.  Kevin is accompanied today by his mother and reports it is acceptable to discuss his medical care in her presence.  Kevin presents with his blood glucose meter and denies any learning limitations or physical limitations such as hearing, visual or behavioral which would affect his ability to comprehend the information provided.

Social History

Kevin is one of two children. His sister is alive, reports her as healthy and is a mother to three healthy children.  Father is deceased, cause of death pulmonary fibrosis.  Mother is alive with diagnosis of osteoporosis, HTN, and hypocholesteremia.  Kevin has one son who is 30 years old and healthy.

Kevin was diagnosed with type 1 DM at the age of 18 months.  He denies any hospitalizations for hypoglycemia or hyperglycemia/DKA other than his first diagnosis.  Currently, he is experiencing hypoglycemia unawareness so he limits his driving to only local areas and will check his BG before starting the vehicle; glucose tablets and glucagon are readily available.  Two surgeries are documented with one being a same day surgery 14 years ago to repair an inguinal hernia and most recently had a cataract removed from his LT eye.  Right eye is free from cataracts at this time.  Immunizations are up to date, last pneumococcal vaccine documented as 2015, Tdap 03/14/2014, and influenza vaccine received every year.  Kevin reports as a child he did experience chicken pox, strep throat, and viral illnesses.  Review of medical record shows a positive titer for mumps and rubella.  No known tick exposure, but due to his history of working as a logger, a Lyme titer should be considered.  Colonoscopy completed in 2014.  Diverticulitis was present with one polyp removed.  Last PSA was in 2016 with result of 3.0.

Kevin denies any immediate family members who have mental illness or substance abuse.

Denies tobacco use presently; however, he did chew tobacco when he was in his early 20’s.

Occasional alcohol intake in the form of beer once every two weeks and reports smoking marijuana for the past ten years every evening to help with the neuropathy pain in hands and feet.  CAGE is negative.  Blood glucose meter was down loaded, and readings are reviewed.  Patient on average has been monitoring his blood glucose one to three times a day with average reading being 197.

Allergies

There is a documented reported allergy to Penicillin.  Mother reports that when he was in elementary school and was being treated for strep throat, he developed rash two days into the prescription.  Mom is unsure of any further details, just that the physician told her never to take penicillin again.

Current Medications

Lantus 65 units SQ twice daily

Humalog- insulin to carb ratio of 1:6 with a correction scale of 2 units for every 50 above BG of 150.  Administer SQ thirty minutes before each meal

Atorvastatin 80 mg daily

Lisinopril 20 mg one daily

Multivitamin daily

Mega Red 500 mg daily

Aspirin 81 mg daily

Gabapentin 300 mg one tablet three times a day

Melatonin 6 mg by mouth every evening

Glucagon kit to be used as needed for hypoglycemia

Viagra 100 mg ½ – 1 tablet as needed

Lab results

Total cholesterol of 198                                  A1c 8.8                                                ALT 51

LDL 140                                                           Cr 1.9                                                   PSA 3.0

HDL 40                                                            GFR 42                                                 HGB 14.6

Triglyceride 155                                              AST 45                                                 PLT 286,000

RUMAL 268                                                     Glucose 260                                        TSH 2.6

Vitamin D 45

Chief Complaint

Kevin’s main complaint today is the burning and tingling sensation he is experiencing in his hands and feet.  Has been using gabapentin with minimal relief, applies CBD oil twice daily which he reports provides immediate short term relief.  Kevin does state the marijuana does provide the best relief for him.  He also voices his frustration with the State of Minnesota’s process for medical marijuana and lack of markets in his area.

Blood glucose readings have been in the 200-300 range, and he is happy with this.  Kevin prefers to have his numbers higher due to his hypoglycemic unawareness.  Last episode of low BG was three weeks ago; he reportedly was ill with a GI bug, limited oral intake but continued to take insulin.  His son stopped for a visit and found him unresponsive and did administer glucagon.

Kevin continues to exercise daily by walking 2 miles on his indoor treadmill; denies any shortness of breath or chest pain with this activity.

Physical Exam

Patient is noted to be alert and orientated times 4.  PEARL, mild film noted over RT eye, possible beginning of cataract. Peripheral vision screen is completed and noted to be intact.  Denies any burning or itching of eyes.  Denies any nasal congestion or drainage, nasal polyp in RT nare noted on exam.  Dental caries are noted, ear exam completed with no redness of ear canal or turbinate’s, no drainage noted.  Whisper test completed, and hearing noted to be intact.  Neck negative for any lymphadenopathy, no carotid bruits noted, and thyroid is noted to be with in normal size, no lumps or abnormalities noted.  No jugular vein distention noted. Cardiac is noted to S1 & S2, negative for murmur.  Lungs auscultate clear, and Kevin denies any shortness of breath.  Abdomen is soft and non-tender with bowel sounds being present. Dullness is noted to percussion over liver and noted to be 8 cm midclavicular line, no abnormalities noted on palpitation.  Spleen is intact.

Spine is midline with no deformities noted.  Genital exam deferred due to his mother’s presence.  Distal and central pulses are present and are a +2. Skin exam reveals topic dermatitis on his bilateral posterior elbows, bilateral hand and lower leg redness.  No open areas are noted.   A foot exam completed including a monofilament exam.  There is a callous noted on the bottom of his RT foot, below his great toe.  No open areas are noted.  A monofilament exam completed 5/10 on RT foot and an 8/10 on LT foot. Onychomycosis noted on bilateral nail beds.  There is no evidence of Charcot joint; Kevin does see a Podiatrist for nail care every three months.

Evaluation and Plan

Review of lab work shows elevated cholesterol, A1c, glucose, RUMAL, creatinine/GFR and liver labs.  Total cholesterol is with the recommended range of <200. However the LDL is out of range at 140.  Recommended level for LDL is <100.  LDL is also known as the “bad cholesterol which also has a genetic component.  Better diet control and exercise can assist the atorvastatin in lowering the LDL and raising the HDL to a level of >50.  “People with high blood triglycerides usually also have lower HDL cholesterol. Genetic factors, type 2 diabetes, smoking, being overweight and being sedentary can all lower HDL cholesterol.” (heart.org, 2018) On average for past three months, Kevin’s glucose has been in the range of 180-200.  This is documented by his A1c.  The A1c is an average of glucose readings over the past 2-3 months.  It is measured by the amount of glucose that is attached to red blood cells circulating in the body.  This is an acceptable A1c reading for a brittle type 1 diabetic who is experiencing hypoglycemic unawareness.  Adjusting insulin to lower the A1c could have a detrimental effect on the individual, so no changes will be recommended regarding insulin.   Kevin has been a diabetic for over fifty years and his kidneys are being stressed.  This is based on his RUMAL (the amount of albumin/protein released in system when kidneys are stressed) Kevin’s results are >300 which is considered moderate kidney disease.  Normal RUMAL is up to 30, mild kidney disease is 30-300, and >300 shows moderate kidney disease.  Consider increasing the dose of his ACE inhibitor to 40 mg once daily.  The creatinine is elevated at 1.9, normal range being 0.5-1.5.  The creatinine shows how kidneys are functioning, but the GFR which shows how the kidneys are filtering is diminished at 45.  Any result <60 is considered a sign of kidney disease. If the dose of ACE inhibitor is increased, careful monitoring of renal functions and electrolytes is needed. The liver functions test AST is used to detect a liver injury or active or chronic liver problem.  The normal range for males is 8-46.  The ALT which is mildly elevated at 51.  This test is used to detect liver injuries or long-term liver disease.  Normal range is 5-40.  The slight elevation could be related to use of atorvastatin or could be related to “fatty liver.”  Monitoring should be completed every three months.

The benefits of diet and exercise and how simple changes can improve blood pressure, glucose readings and cholesterol results should be reviewed in detail with Kevin and his mother.  A referral to a dietician should be considered.  Encourage Kevin to continue to see the Podiatrist every three months for foot exams and nail care.  Consider Penicillin testing for the questionable allergy to penicillin when he was a child. One can question if the rash was related to the strep infection or the medication.  Completing a penicillin challenge could prove beneficial in the future if he should develop a foot ulcer which needs antibiotic coverage. A Lyme titer should be completed to determine if Lyme disease is enhancing his neuropathy pain in hands and feet.  One could consider a referral to a vascular surgeon for ABI assessment and evaluation for peripheral vascular disease.  Further referrals for massage therapist, acupuncture or physical therapy should be considered.  Medication change from gabapentin to Lyrica could also be considered.  Encourage Kevin to continue to monitor blood glucose before driving farm equipment or his vehicle.  Review automobile safety; if there is an accident which involves a person with diabetes, their license is automatically suspended until a provider deems the individual safe behind the wheel.  The potential to be with out a driver’s license could be months to lifetime.  Blood glucose should be monitored before meals and at bedtime, minimum of four times a day.  EKG should be completed, for baseline comparison.  Reinforce the need for dental exam every six months along with regular Ophthalmologist visits for dilated eye exams.  Kevin will be seen back in three months for evaluation of diabetes and discussion following referrals to the recommended providers.

Let’s pretend you have been invited to talk to one of the following groups on healthy relationships, parenting, or domestic violence :

a. high school or college students

b. families at a human services agency

c. victims of abuse

Review the documents on equality, power and control tactics and “Coalition Against Domestic Violence” files that contain information that is given to help and educate individuals, children, and families in New Mexico (just an example) on domestic violence.

Decide on

1. the audience

2. topic you want to speak on

Then,

1. prepare a one page handout/flyer for your presentation/talk.

2. research and include statistics, information on the topic and the resources available for California residents who may be facing the issue you have selected to present on.

3. turn in your hand-out as a pdf. attachment

Question 1: How did the Power and Influence section impact your understanding of leadership in organizations? Give examples to support your conclusions. (400 words)

Question 2: How did the Servant Leadership section impact your understanding of leadership in organizations? Give examples to support your conclusions. (400words)

Question 3: How did the Transformational Leadership section impact your understanding of leadership in organizations?Give examples to support your conclusions. (400 words)

Question 4: Describe how this class has impacted your views on effective leadership. Describe how you intend to be an effective leader in your (future) organization. (500 words).

Topic of the Master of Public Health Capstone Project: A Systematic Review of Refugee Women’s Mental Health.

Pre-approved literature to include as part of the 25 sources required:

1. Refugees’ experiences of healthcare in the host country: a scoping review Elisabeth Mangrio1,2* and Katarina Sjögren Forss1,2

2. Gender-related mental health differences between refugees and non-refugee immigrants- a cross-sectional register-based study Anna-Clara Hollander1*, Daniel Bruce1, Bo Burström1 and Solvig Ekblad1,2

3. Social Determinants of Immigrant Women’s Mental Health Intersecting Sexual and Reproductive Health and Disability in Humanitarian Settings: Risks, Needs, and Capacities of Refugees with Disabilities in Kenya, Nepal, and Uganda Mihoko Tanabe1 • Yusrah Nagujjah

4. Maternal depression in Syrian refugee women recently moved to Canada: a preliminary study Asma Ahmed1, Angela Bowen2* and Cindy Xin Feng3

5. Review Article: Social Determinants of Immigrant Women’s Mental Health Mahin Delara1,2

Answer the following questions in essay format, supporting your answers with references to the course materials and the literature. Be sure to cite all sources you use in your answers, and include a reference list at the end.

Q1)How does the mortality experience of Indians differ from that of the general population in Canada?

Q2) Give two examples each of primary, secondary, and tertiary prevention activities. Explain the differences between each level of prevention.

Q3) Discuss three situations in which the opportunity to be healthy depends in part on conditions that are beyond the individual’s power to provide for and control.

Q4) Briefly describe the seven essential steps in the development of a preventive program. Apply these steps to a brief description of a public health program that is not related to HIV infection.

Q5) Using the information provided below, answer the specific questions in italics.
You have been asked to investigate an outbreak of gastrointestinal illness among students at a university residence. On the evening of Day 1, 411 students were living in the residence.
All food is prepared in the residence kitchen. Due to the quantity of food required, some dishes are prepared in advance and refrigerated. Breakfast is served from 0700–0800, lunch from 1100–1200, dinner from 1700–1830.
Between 22:30 on Day 1 and 08:00 on Day 2, 47 students visited the infirmary complaining of gastrointestinal illness. Physicians were notified and came at once to examine the afflicted students. Specimens of stool and vomitus were collected from those presenting with symptoms of diarrhea and vomiting.
It soon became apparent that the outbreak involved considerably more students than the number who sought help. Questionnaires were quickly prepared and distributed to all of the students to determine the nature and extent of the outbreak. The 304 questionnaires which were returned revealed 110 cases of gastroenteritis.
a. Calculate the attack rate for the residence based on preliminary data collected in the infirmary.
b. Among the students returning the questionnaire, what proportion developed gastroenteritis?
c. Calculate the ratio of attack rates as determined by the questionnaire and the information from the nursing station.
d. What might explain the apparent difference?

Q6) Compare the incidence and prevalence of infectious and parasitic diseases, pneumonia, and infections of the central nervous system in Indians and the general population of Canada. Explain the differences.

Q7) Contrast the mortality of Indian populations from accidents and injuries with the pattern in Canada as a whole.

Q8) Construct a “Haddon’s Matrix” for burns in children.

Q9) Discuss the principles you would use to determine whether a screening program should be implemented for a specific health problem. In your answer, you should discuss the concepts of sensitivity, specificity, and predictive value, and should suggest criteria on which an implementation decision could be based.

Q10) Find and read the highest court level decision in the Canadian case of McArdle Estate v. Cox, and answer the following questions:
a)What court levels decided this case, in what jurisdiction, and when? Provide all legal citations.
b)In no more than 300 words, write a summary of the case. Describe the relevant facts, the legal issues, and the reasons for decision of the highest court level judgment.
c)In a claim against a health provider for professional negligence, does the law always protect a health provider who has followed an established standard of practice or are there exceptions? Explain and identify the sources of law to support your explanation.

Between 1936 and 1938, the Works Progress Administration sponsored a Federal Writers’ Project dedicated to chronicling the experience of slavery as remembered by former slaves. African-American men and women who were born into slavery were interviewed by WPA workers. Their stories were recorded, transcribed, and combined into one of the largest oral history collections in American history.

Assignment:

Step 1: Go to the following site: Slave Narratives from the Federal Writer’s Project 1936-1938-

Look through as much as you can. This includes all the articles/essays provided under Articles and Essaysas well as all of the sub-pages provided under the header of “An Introduction to the WPA Slave Narratives”  There is SO MUCH good information in here. You will get a lot out of the additional research! It is very important to get a full understanding of this entire project.
Step 2: Select a slave narrative to read at one of the following sites:

Step 3: Construct your essay (please write in paragraph form and use complete sentences) by answering the following questions about the narrative you selected:

Who did you select?
How old were they? Where were they from?
What did they talk about?
Was their account a more optimistic or pessimistic (positive or negative) account of their past?
What can you learn from this transcript about slavery? What can you learn from this transcript about the Great Depression? (Note: Saying anything along the lines of “the source didn’t mention the Great Depression” is NOT an acceptable answer to this question. If you can’t find an answer – dig deeper)
Do you think it is a legitimate source to study history from?
Can you think of any factors that may cause these not to be a legitimate source?
What is your overall opinion about using the slave narratives to study from?

Managing a Crisis

Crisis management and crisis communications are specialized business disciplines. In times of crisis, companies can act in a number of ways; from ignoring the situation and hoping it passes in the next news cycle to aggressively defending itself after the fact. Smart companies have plans that can be used in any crisis situation.

Using the company developed in the Unit 4 Individual Project, select a crisis that negatively affects the business from a legal or image standpoint. Develop a series of scenario statements that you write ahead of time that you will present to the management and legal departments so that they may be used swiftly in a time of crisis.