An Investigation into Human Stampedes During Festival; Critical Analysis of Madhya Pradesh Stampede

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“An Investigation into Human Stampedes during festival; Critical Analysis of Madhya Pradesh Stampede. (2013)”


Abstract

The purpose of this paper is to investigate, how and why the fatalities of the Madhya Pradesh Stampede took place. This paper will critically investigate the crowd management at the time of stampede and the reason behind the crowd behaviour. This paper will examine the mismanagement of the crowd at the time of the stampede, and How the officials act on the crowd during the incident. It will also talk about the crowd density during the stampede and how important it is to understand the evaluation of crowd density before the festival event.

The paper will talk about risk assessment matrix and evaluation of this incident using FIST which consist the ‘force’ which creates the difficulty of movement and compressive asphyxia (deprivation of oxygen). This paper will be examined about the eyewitnesses of the incident and their views on the management and it will talk about the negligence of the government.


Key Words

Crowd Density, Crowd Behaviour, Crowd Management, Human Stampede,


Introduction

This paper will critically investigate the incident occurred on 13th of October in 2013 in      Datia district of Madhya Pradesh in central part of India. Where 115 deaths and 110 people were critically injured due to Human stampedes at temple which was in rural area of Datia district.

Experts says true stampede and crushes happen rarely unless until people start run away to escape from fire or any other fear and crushing, by human in such “stampede” situations barely causes fatal injuries. Benedictus (2015) in a similar manner people were crushed because of panic were broke at Ratangarh Temple in Madhya Pradesh on bridge. (Bbc news 2013) Mass gathering events in India or any other part of the world could be hazardous due to Human Stampedes. Illyas et al. (2013). On 13th October 2013, during Navratri festival of Hindu, near the Ratangarh Mata Temple in Datia district of Madhya Pradesh killed 115 people and 110 were injured due to Human stampede bust on a bridge.

This paper will be critically analysing the Human stampedes during religious function and mass gathering emergencies at that time. Illyas et al. (2013) have examined the common cause of Human stampedes and concluded from case studies that an intentional act, or a simple accident or a small rumour can light spark in crowd. In the similar manner in Madhya Pradesh rumour were spread that bridge was about to collapse as result of which people got panicked and start pushing their way off and some of them got drowned due to jumping in the Sindh river because of chaos created.


PRE-DISASTER

Anthony J.C. De Sa a state official informed The Hindu, a daily newspaper, that number of people who were there on bridge was about 25,000,which was built on Sindh River and 7 meters wide, stampede happened due to rumour about bridge’s railing broke.(The New York  Times,2013) Earlier at the same place (in 2006), 56 pilgrims were died after being washed away by the Sindh River’s water. As a result of which, the state government constructed a bridge over the Sindh. (The Times of India,2013)


  • Mismanagement of Crowd

Crowd management should be started in the early phase of an event and its not an operational activity which we can do during an event. Ancliffe (2017) After 2006 catastrophe, the bridge was built on the Sindh river by the state government, but the calamity took place on it purportedly due to poor crowd management that assembled in large numbers. (The Times of India).

The nature of the crowd and sociology of crowd is very important to understand the crowd management, according to the Elias Canetti (1973) noble prize winner there might be five characteristics of a crowd; and in religious festival like this crowd wants to grow and crowd seems to become denser with a moving direction. Tarlow,P (2002).

Stampedes are very frequent during religious festivals and stampedes at Madhya Pradesh during Navratri killed 115 people which was second stampede at the same place within seven years of time more surprisingly these events happened repeatedly in India, but they receive very little attention from disaster planners and scientific community. Frederick M and Edbert (2011)

Frederick M and Edbert (2011) stated that randomly or impromptu mass collection had so far, the highest relative fatality rate assumed to be largely attributable to absent or severely poor crowd-control measures.

A precise way to crowd management could have ward off recent accidents in bigger crowd events. (Martella et. al 2016) bigger religious festival always have the higher chances of human stampede as the number of devotees is not predictable.

Therefore, crowd management of bigger events has become specialised field of research; and we have number of consultancies in this field. (Bowdin,G et al 2006)


  • Negligence of Government

Fig. 1. Human stampede fatalities recorded during the period 2000-2012 (Illyas et al. 2013)

From the above table it can be seen human stampede occurrence have influenced characteristics, uncertainty and complexity, a little negligence can cause irreparable loss. All government around the world is focusing how to control and prevent the human stampede large gathering and how to reduce the risk in large scale activities. Illyas et al. (2013) However according to the previous experience 2006 stampede precaution should have been taken by the government to prevent this 2013 stampede.

The pie chart on the left have shown that maximum number of stampedes that occurs, are from religious mass gathering. When we have enough information available from the last stampede than government would have taken any precaution so that this 2013 stampede can be saved. There was no prearrangement for primary medical and drinking water. (The Economic Times 2013)

Fig. Classification of human stampedes disasters in India. (Illyas et al. 2013)


DURING-DISASTER


  • FIST

The model which will work to understand the causes of crowd disaster is FIST which means Force Information Space and Time (FIST).

It is difficult to control force which was there in the crowd, mostly when the exit and entrance of the event is from the same place. In the Madhya Pradesh stampede it was an open space but the number of the devotee was huge in amount and there was only one bridge to reach to the temple that’s why when a rumour was spread the crowd got confused in which direction they should move, this situation build an unorganised crowd flow due to crowd confusion.

Information plays a vital role in event as further steps will be taken based on the information available. There was an information of the previous stampede in year 2006 at the same place that was the reason they have built a bridge over the Sindh river, for the devotes as it will be more convenient for them to reach to the temple by bridge. But again, stampede took place due to large number of unexpected devotes in the festive gathering and rumour were spread that bridge was about to collapse.

The key for understanding the space requirement of a crowd depends on how much space is needed for every person. This seems like easy, but it is not, as documents refer to density people per square metre and other refer area per person. All the space for the standing or sitting according to the type of the event. (Still,K.G. 2014)

The role of Time in the crowd management was to determine the maximum number of people in an event at a specific time phase. It depends upon the type of event and their nature. As in relation to the temple stampede in 2013, it was expected the maximum number of devote will be coming in the morning due to the timing of the pray.

UK Cabinet Office (2009) demonstrates that there are various components that form a crowd includes; density, size, novelty, collectivity and time.

In the similar manner all components are combined to develop a crowd at Ratangarh, Madhya Pradesh, more than 5,00,000 people were turned up for the festival. The main worshippers are from Datia, Madhya Pradesh and more than half of the devotees were    there on the bridge approximately 25,000 people about 9 am (03:30 GMT) in the morning on Sunday, 13 October 2013, and a section of the fence or railing was broken. Rumour were spread about the collapse of the bridge due to which crowd got panicked and start pushing each other to find their way to a safest place. Some of the pilgrims jumped into the Sindh river on which the bridge was constructed.


  • REASON OF STAMPEDE

The exact reason of the stampede was not cleared, the reports were conflicting about the reason of this disaster.

  1. It was ninth day of the Navratra festival when stampede happened and it was triggered by the rumour about the bridge collapse, which pilgrims were crossing to make their way towards temple. (NDTV 2015)
  2. According to some eyewitness’s stampede started when police official charged the devotees with their baton, (NEWS 2013) but this allegation was denied by the police.
  3. Other eyewitnesses said that the pilgrim’s group intentionally spread rumour to cut the line of devotees short, (The New York Times 2013) but again Mr. De Sa uttered that bridge was hardly four years old and it was in a good condition.

  • NEGLIGENCE OF POLICE OFFICAL

The Madhya Pradesh government on 15.oct.2013 has suspended 21 government officials, some of them are policemen and it include district magistrate of Datia district, where temple stampede took place. (NDTV 2013)

The main accusation on the policemen was of negligence at the time of stampede.

Chief Minister of Madhya Pradesh Shivraj singh chouhan ordered for a judicial commission to investigate into the allegations of police misconduct and corruption.

The police official was there to protect the crowd from the crushing and shoving due to pushing that was happening due to panicked mob but instead of saving them police official starts beating the crowd with baton as a result stampede triggered. (The New York Times 2013)


  • CROWD BEHAVIOUR AND CROWD DENSITY.

Berlonghi (1995) analysed that crowd behaviours can be categorised into various types spectator, demonstrator, dense or suffocation crowd, violent and escaping crowd. The gathering of people in this Hindu festival is unpredictable as people were flood in from nearby districts to be the part of this holy gathering. In a relation to this incident according to Berlonghi (1995) we can classify this as a dense or suffocation crowd as at a point was impossible for a people to move or do any sort of physical movement. The bridge space was 400meter (1300ft) long and 7meter(23ft) wide and number of devotes who were there on the bridge was 25,000 which was approx. half of the total number of gathering in the event. Crowd density plays a vital role in understanding the crowd disaster and it reaches to critical state when crowd(standing) space is less than about 1.5 sq. feet and if it is below 2 sq. ft. per person it can occurs psychological pressure and dangerous forces. So safest crowd density is below 5sq. ft. (Phelps 2017). In the Madhya Pradesh stampede 2013 if we critically analysed the crowd density the results are 1.19 sq. ft. per person which is come under category of critical crowd density and crowd disaster can happen as number of people who were on the bridge was 25000 and area of bridge is 1300*23=29,900 sq. ft. so crowd density is 1.196 sq. ft.

Pushing people with FORCE exhibits a pressure on the other person which if exceeds from a certain limit can be a cause of death. It hardly takes 15 secs to die for a person if we apply 6227N force on it. In general, 5 people pushing exerts a 3430N force. Therefore, pushing creates a dangerous crowd pressure which might be lethal for old, child and youngster as well. In the similar manner most of the victims of human stampede in Madhya Pradesh were children and women. (BBC 2013)

When a crowd attempt to escape from a life threating situation or from a seen danger it is called escaping crowd and it include shoving and pushing by panicking crowd. (Berlonghi 1995)

In a relation to Berlonghi crowd type Madhya Pradesh stampede crowd can be considered as an escaping crowd when mob tried to escape themselves from a life threating situation that was bridge collapse and some them jumped in the river Sindh. (The Times of India 2013)


AFTER DISASTER

Soon after the stampede took placed the rescue operation were blocked by a 7-km traffic jam which was the only road to the temple and as a result, relatives of the victims started pelting stone on the police officers leaving them wounded. Relief team reached in the afternoon time and incident took place in the morning time at 9:00am (The Hindu 2016)

The delay in the rescue team happened due to unplanning of the government  as they know that during festival season the number of devotes always increased, than they should have installed the emergency ambulance service and more number of police officer to direct the crowd but the three special armed force were sent to the rescue operations by the Inspector General of Police (Law and Order) D. Srenivasa Rao. The Datia Police control room has offered a special helpline number (07522237884) which was there for the victims convenient. (The Hindu 2016)

  • COMPENSATION GIVEN

The Madhya Pradesh government after this mournful experience gave the compensation of Rs. 150,000 for every deceased and Rs. 50,000 was given who were seriously injured and 25,000 to each who suffered minor injuries in the incident. (Times of India 2013)

  • LEGAL ACTION AGAINTS OFFICALS

The congress party representatives declare that correct death toll was higher, which was nearly touching 400. The representatives of the party criticized that the state administration bluffing with the reports and demanded the resignation of Prithviraj chouhan, but BJP ruling party denied the allegations by the congress party playing politics.

The criminal proceeding begin at the request of the state government, the Election commission of India, suspended the District collector Mr. Sanket bhondwe, (SP) Superintendent of police, Mr. P. Chandrashekhar Solanki, Sub-divisional magistrate, Revenue (SDM) of Seondha Mr. Mahip Tejaswi, (SDOP) Sub Divisional officer of police of seondha Mr. B.N Basave and all the staff of the seondha Police station. (NDTV 2013)

  • EMERGENCY RESPONSE

It is essential to have an effective emergency plan which we can use at the time of mishap. Poor initial communication was seen with the emergency response time not only in 2013 temple stampede but in Miyun country bridge disaster in China, Akashi firework event in Japan. Soomaroo,L. and Murray,V  (2012)

examined the medical care in crowd gathering suggest that Basic aid should be provided with in 4 min, Life support assistance should be provided and last evacuation from an incident point to safe point should take 30min. Sanders et. al. (1986)

  • RECOMMENDATION

Implementation of the correct plan during the stampede can help response team to act promptly and correctly. Even after evaluating the previous stampede at the same place incident like this could not stop as number of people in these gathering is always unpredictable and implementation of the rescue plan plays a major role. A recommendation to people participating in these festival to check the fire exit and entry-exit point of the event.


CONCLUSION

To conclude the mishap which happened on 13.oct.2019 at Datia district, Madhya Pradesh. The bridge which was built on the river Sindh was jam packed during the incident, the crowd management and risk analysis was not done despite previous stampede. It always seems like we learn a lesson from every incident, so as a recommendation a better management and proper arrangement for the festival will take place. Preplanning of large gathering is a key, which should include major incident planning and health management. As a recommendation emergency medical services should introduce in every large gathering with experience staff. It is always advisable to contact with the local hospital before event so that it will provide aid in emergency response. To ensure crowd safety planning, crowd management should be introduced in the preplanning phase not in an operational phase. Lastly, I would like to sum up that incidents like this should be easily avoid if we have adequate planning and management in pre planning phase of the event.


REFERENCES

[Accessed 13oct,2013]

[Accessed at 19.jan.2017]

Available at:

https://www.thehindu.com/news/national/other-states/91-die-as-rumours-spark-stampede-in-mp-temple/article5231189.ece?homepage=true

[Accessed at 28.may.2016]

  • Still,G.K (2014) ‘Introduction to Crowd Science’ 10(1)pp 32-34
  • Sanders AB, Crisis.,E, Steckle, P. (1986) ‘An analysis of medical care at mass gatherings. Ann Emerg med 15(1) pp.515-519

 

 

 

Alzheimers Pathology and Treatment

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Alzheimer’s

Aging leads to the gradual wearing out of the body cells. Consequently, aging leads to the onset of various diseases such as Alzheimer’s. Alzheimer’s, which is also referred to as AD is a neurodegenerative disease.


History of Alzheimer’s

Alzheimer’s disease was discovered by, a German Psychiatrist, Dr. A. Alzheimer in 1906(Tanzi, 2013). Dr. Alzheimer discovered the malady upon receiving a fifty-one-year-old dementia patient, D. Augusta. The patient exhibited adverse memory loss symptoms. Dr. Alzheimer showed the patient various objects and within minutes, she could not remember what the objects were. At the time, Dr. Alzheimer recorded Augusta’s condition as AWD also referred to as Amnesic-Writing-Disorder.

Dr. Alzheimer would later retire to the Emil Kraepelin laboratory to explore the nature of the disease. Additionally, Auguste died in the first quarter of the year. However, her death brought about a significant milestone in the medical field regarding the development of Alzheimers. Dr. Alzheimer and two Italian physicians studied Auguste’s brain anatomy to determine the cause of the onset of presenile dementia symptoms(Ali, 2012). Dr. Alzheimer presented his discovery to the 37

th



assembly by submitting Auguste’s case. Subsequently, Dr. Alzheimers transformed the diagnosis of dementia from the beginning of the 20

th

Century. Ali (2012) states that the diagnosis shifted from diagnosis of dementia for people aged 45-60+. Additionally, the term Alzheimer was solidly adapted into diagnosis upon the realization that the disease, though rarely occurred in patients below forty-five years.


Clinical features

Progressive memory loss primarily characterizes AD(Tanzi, 2013). In the late stages, the memory loss is highly evident even in the short term memory as witnessed in Auguste’s case above. Moreover, the patient exhibits various behavioral changes such as heightened violence.

Progression of Alzheimer’s into the later stages leads to the deterioration of musculature(Ali, 2012). As a result, the patient’s mobility is affected, inability to feed oneself among other symptoms. However, it should be noted the features mentioned aboveare only observed if external factors such as cardiovascular arrest, Pneumocystis, and many others do not occur culminating in the death of the patient. The average lifespan of the diseases is noted to fluctuate with reports of its existence being as short as four years or as long astwenty-one years. However, studies reveal that the average lifespan existence of the disease is 6.5 years(Tanzi, 2013).


Symptoms of Alzheimer’s disease

AD primarily exists in three stages, namely mild, moderate and severe. During the mild stage is characterized by very subtle symptoms that go unnoticed not only by the patients but also by their immediate family members. The symptoms in the mild stage include spontaneity, increased laziness, forgetting events, difficulty solving problems among others(Ali, 2012).

The moderate stage involves aprogression of the malady into the intermediate stage. In this stage, the patient may exhibit independence in carrying out tasks. However, the patient presents extreme difficulty in solving complex situations or carrying out simultaneous tasks simultaneously(Ali, 2012).

Lastly, the final stage of progression of Alzheimer’s is the severe stage. In this stage, the patient’s memory is significantly affected. Additionally, the patient loses the ability to control voluntary movements such as eating, walking, and control of bowel movement. Eventually, the severe stage is epitomized by the loss of control of involuntary movementssuch as swallowing fluids, food. Furthermore, the patient’s speech is highly incoherent and incomprehensible as they are unable to neither talk nor make out speech. The patients at the end die often due to the inability to swallow food and fluids

.


Diagnosis

Currently, no procedure of diagnosing AD has been developed. As such, diagnosis of AD is not only based on a series of tests and clinical observations carried out on a patient over a period of one to two months but also involves a critical analysis of the patient’ history. The patient’s history includes analysis of both the patient’s medical history as well as that of close family members to note any patterns of the existence of the disease. The history of the extended family is especially prudent when Ad occurs in young patients. Additionally, open interviews with the family members should be carried to aid in early detection of the symptoms of the disease.

PET and SPECT scans can be used to analyze brain activity of the patient and also to determine whether the brain size is degenerating otherwise known as shrinking as shown in figure 1 below. However, analysis of neuroimaging cannot be used to make a diagnosis of AD. Nonetheless, physicians specializing in brain disorders are capable of making an AD diagnosis with 85 – 90 percent accuracy. Moreover, the need for specialty physicians in diagnosing is strongly urged owing to the resemblance of the symptoms of AD to those of VD also referred to as vascular dementia. Moreover, MSE is also known as Mental Status Exams should be performed to rule out the existence of depression or psychosis. The MSE is mainly used to solidify the existence of dementia in a patient. Thereafter, further tests on the intellectual capabilities may be carried out to determine the type of dementia, which in this case the primary focus is Alzheimer’s.

Figure 1. A neuroimaging of the brain showing brain activity at different stages of Alzheimer’s. Retrieved from (Berkley, 2009).


Pathology

Amyloid and neurofibrillary tangling characterize AD. The entanglementis clearly depicted under a microscope(Berkley, 2009). Furthermore, AD is characterized by significant brain atrophy that explains the memory loss and loss of body coordination(Tanzi, 2013). The temporal lobe, frontal lobe cortex, parietal lobe and the cingulate cortex exhibit degeneration traits. Subsequently, the neural processes in the brain are hindered hence affecting the patient’s memory, speech, and even mobility problems.A plethora of neurotransmitters is significantly reduced. Among the neurotransmitters that significantly reduce are acetylcholine, serotonin, norepinephrine, and somatostatin. However, glutamate levels are frequently heightened.

Figure 2. A microscopic picture of the entanglement of plaque and amyloids. Retrieved from (alz, 2016).


Treatment

Various treatment programs have been developedfor the treatment of Alzheimer’s. Among the leading treatment programs designed are Acetylcholinesterase inhibitors, NMDA antagonists, tobacco and Ginkgo biloba. Nonetheless, Ginkgo biloba treatment programs have been noted to be the most efficient owing to its reduction in cognitive impairment. Recent studies reveal that Biloba similar to approved treatment Dopenzil is effective in helping improve memory loss. However, current clinical developments show that a vaccine for AD may be very effective. The vaccine should work towards making the system aware of any decrease in the neurotransmitters and glutamate levels. Resultantly, the immune system makes the appropriate adjustments to prevent degeneration of brain regions, namely the frontal lobe cortex and parietal lobe.

To sum up, AD isnoted to be very common, mostly among the elderly. AD is a form of dementia that initially had been misdiagnosed as an amnesic writing disorder.AD is especially detrimental to the patient and is a leading cause of mortality of senior citizens. AD, especially when on the severe phase has very adverse effects. However, in the mild stage, AD is treatable. Therefore, family members should be vigilant enough to notice early warning signs such as laziness, spontaneity, anger outbursts.

References

  • Ali, N. (2012).

    Understanding Alzheimer’s.

    Washington: Rowman & Littlefield Publishers.
  • alz,. (2016). alzheimers – Google Search. Google.com. Retrieved 2 April 2016, from https://www.google.com/search?q=alzheimers&espv=2&biw=1366&bih=681&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjcvenLm_DLAhXBORQKHdwuCHEQ_AUIBygC#tbm=isch&q=alzheimer%27s+brain+plaques+and+tangles&imgrc=trX9Z7ROSXu35M%3A
  • Berkley,. (2009). 07.14.2009 – Researchers find early markers of Alzheimer’s disease. Berkeley.edu. Retrieved 2 April 2016, from http://www.berkeley.edu/news/media/releases/2009/07/14_alzheimers.shtml
  • Tanzi, R. E. (2013). A brief history of Alzheimer’s disease gene discovery.

    Journal of Alzheimer’s Disease

    , 33.

Create a strategic group map showing the interrelationship between the environmental forces and the organization

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Create a strategic group map showing the interrelationship between the environmental forces and the organization

 

Analyze the external environment
Select a health care provider organization in the local community (or nationally), preferably a hospital, a physician group practice, or even a nursing home chain. Conduct an external environmental assessment for the organization along the lines described in chapter 5 of your textbook. You can get this information from the company’s Web site, other Web sites, journal articles, and other sources. Be sure to cover all the basic categories of environmental factors. Draw a diagram showing the environmental forces you have identified and the interrelationships among them and with the organization.
For this assignment, your report should be at least four pages in length, in current APA edition format and should include the following information:
The steps to externally evaluate the firm
Description of two environmental forces that may have some impact – positive or negative – on the organization or business.
Create a strategic group map showing the interrelationship between the environmental forces and the organization
Description of two critical issues specific to the organization, its industry and its customers.
Textbook:
(Moseley III, George B. Managing Health Care Business Strategy. Jones & Bartlett Publishers, May 2008.)
Attachments:
hcm401_lasa_2_template.doc
Business management homework help
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Walden module 6 pathophysiology knowledge check | NURS 6501 – Advanced Pathophysiology | Walden University

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QUESTION 1 – 4

A 21-year-old male college student was brought to Student Health Services by his girlfriend who was concerned about changes in her boyfriend’s behaviors. The girlfriend says that recently he began hearing voices and believes everyone is out to get him. The student says he is unable to finish school because the voices told him he was not smart enough. The girlfriend relates episodes of unexpected rage and crying. Past medical history noncontributory but family history positive for a first cousin who “had mental problems”. Denies current drug abuse but states he smoked marijuana every day during his junior and senior years of high school. He admits to drinking heavily on weekends at various fraternity houses. Physical exam reveals thin, anxious disheveled male who, during conversations, stops talking, cocks his head and appears to be listening to something. There is poor eye contact and conversation is rambling.

Based on the observed behaviors and information from girlfriend, the APRN believes the student has schizophrenia.

Question 1 of 4:

Describe the positive symptoms of schizophrenia and relate those symptoms to the case study patient.

Question 2 of 4:

Explain the genetics of schizophrenia.

Question 3 of 4:

The APRN reviews recent literature and reads that neurotransmitters are involved in the development of schizophrenia. What roles do neurotransmitters play in the development of schizophrenia?

Question 4 of 4

The APRN reviews recent literature and reads that structural problems in the brain may be involved in the development of schizophrenia. Explain what structural abnormalities are seen in people with schizophrenia.

QUESTION 1 – 6

A 34-year-old female was brought to the Urgent Care Center by her husband who is very concerned about the changes he has seen in his wife for the past 3 months. He states that his wife has had been depressed and irritable, has complaints of extreme fatigue, has lost 10 pounds and has had insomnia. He has come home from work to find his wife sitting in front of the TV and not moving for hours. In the past few days, she suddenly has become very hyperactive, has been talking incessantly, has been easily distracted and seems to “flit from one thing to another.”. She hasn’t slept in 3 days. The wife went on an excessive shopping spree for new clothes that resulted in their credit card being denied for exceeding the line of credit. The wife is unable to sit in the exam room and is currently pacing the hallway muttering to herself and is reluctant to talk with or be examined the ARNP. Physical observation shows agitated movements, rapid fire speech, and hyperactivity. Based on the history and observable symptoms, the APRN suspects that the patient has bipolar type 2 disorder. The APRN refers the patient and husband to the Psychiatric Mental Health Nurse Practitioner for evaluation and treatment.

Question 1 of 6:

Discuss the role genetics plays in the development of bipolar 2 disorders.

Question 2 of 6:

Explain how the hypothalamic-pituitary-adrenal (HPA) system may be associated with bipolar type 2 disease.

Question 3 of 6:

Discuss the role inflammatory cytokines play in the development and exacerbation of bipolar type 2 symptoms

Question 4 of 6:

Discuss the role of the amygdala in bipolar disorder.

Question 5 of 6:

How does neurochemical dysregulation contribute to bipolar disorders?

Question 6 of 6:

What is the current status of the use of nutraceuticals in management of depression?

QUESTION 1 – 2

A 27-year-old female presents to the Emergency Room, with a chief complaint of palpitations, rapid heart rate, sweating, tremors, and inability to catch her breath. The symptoms started about 10 hour ago and have gotten worse. She states she has some chest pain that remains constant no matter what. She also has numbness and tingling around her mouth and lips. She says she knows something “terrible is going to happen”. She denies having any similar episode in the past. Past medical history noncontributory. Social history significant for recent stressor of applying for medical school and taking the Medical College Admission Test (MCAT). She had not received the results prior to the episode but is sure that the failed the test. Says she doesn’t know if anyone else in her family has had similar episodes. Physical exam reveals a thin, anxious appearing female who is profusely sweating despite cool ambient air temperature. BP 176/88, Pulse 136, and respirations 26. Electrocardiogram negative for evidence of myocardial infarction and all lab data within normal limits except for mild respiratory alkalosis. The patient’s symptoms are subsiding and the patient states she is feeling better. The APRN suspects the patient has just experienced a panic attack.

Question 1 of 2:

What are panicogens and how do they contribute to the development of panic attack symptoms?

Question 2 of 2:

How does the GABA-benzodiazepine (BZ) receptor systems contribute to panic attacks/disorders?

QUESTION 1 – 2

A 21-year-old female college junior makes an appointment to see the APRN in the Student Health Clinic. The student tells the APRN that it has gotten harder and harder for her to attend classes, especially her history class where the class is preparing for the semester’s end presentations. She says she is terrified to speak to the class and is considering dropping the class so she will not have to present. She has a significant impairment in social activities and has resigned from her sorority. She is unable to go to the library to study as she feels everyone is looking at her and mocking her. She admits to having some of these symptoms in high school, but the guidance counselor was able to work with her to decrease some of her symptoms. Past medical history noncontributory except for the milder symptoms exhibited in high school. Family history noncontributory. Social history positive for anxiety related to social situations that has had a negative impact on both her scholarly and social endeavors. The APRN diagnoses the student with social anxiety disorder (SAD).

Question 1 of 2:

Describe the areas of the brain that are associated with social anxiety disorder.

Question 2 of 2:

How is oxytocin associated with SAD?

QUESTION 1 – 2

A 36-year-old female comes to see the APRN in clinic with a chief complaint of “I’m so and I feel all keyed up all the time”. She states she feels restless, keyed up, and on edge most of the time. She fatigues easily and has difficulty concentrating and says her mind goes blank. She admits to being irritable and snapping at her coworkers which she worries will affect her job. She says the symptoms have been present for about 8 or 9 months. and Increased muscle tension. She has had difficulty falling asleep or stay sleeping. Further questioning revealed that prior to her symptoms, her parents got divorced which has been a great stressor for her. Past medical history noncontributory. Social history positive for a case of “nerves” when she was in high school that seemed to resolve after she graduated from college. No drug or alcohol history. The APRN believes the patient has generalized anxiety disorder (GAD).

Question 1 of 2:

Discuss the role of neurotransmitters in the expression of GAD.

Question 2 of 2:

Explain the structural brain changes that occur in people with GAD.

QUESTION 1 – 2

A 27-year-old man comes to the Veteran’s Administration Hospital at the insistence of his fiancée who accompanies him to the appointment. She tells the APRN that her fiancée has not “been the same” since he returned from his second tour in Iraq. He was an infantryman with a local Marine Reserve unit and served 2 tours and was honorably discharged. Since his return, he has had difficulty sleeping, and says he “sleeps with one eye open” and fears sleep. Deep sleep brings vivid nightmares. He grudgingly admits to having experienced several traumatic events during his second tour of duty. He is unwilling to discuss them and will not reveal specific details. He is short tempered and irritable and is afraid to be around people as he doesn’t want to snap at people and alienate them. He startles easily at loud noises, especially the sounds of cars backfiring. He admits to thinking there are threats everywhere and spends an excessive amount of time searching for them but never finding any. He has intrusive memories almost every day and says he really isn’t interested in doing much of anything. He is very worried that these symptoms are irreparably hurting his relationship with his fiancée who he loves very much. The APRN diagnoses him with post-traumatic stress disorder (PTSD).

Question 1 of 2:

Describe the changes seen in the brain structure in patients with PTSD.

Question 2 of 2:

Briefly discuss the role glucocorticoids may have on the development of PTSD.

QUESTION 1 – 2

A 17-year-old male high school junior comes to the clinic to establish care. He recently moved from a relatively urban area to a very rural area and has just started his junior year in a new school. The mother states that she has noticed that her son has been frequently washing his hands and avoids contact with any dirty or soiled object. He uses paper towels or napkins over the knob on a door when opening it. According to the mother, this behavior has just appeared since moving. The patient, upon close questioning, admits that he is “grossed out” by some of the boys in the boys’ room since they use the toilet and do not wash their hand afterwards. He is worried about all the germs the boys are carrying around. Past medical history is noncontributory. Social history -lives with parents and 2 siblings in a house in a new town. Is an honors student. Based on these behaviors, The APRN thinks the patient has obsessive-compulsive disorder (OCD).

Question 1 of 2:

What is primary pathophysiology of OCD?

Question 2 of 2:

Describe the role the dorsal anterior cingulate cortex (dACC) has in reinforcement of obsessive behaviors.

Review The Joint Commission resource found in topic materials, which provides some guidelines for creating spiritual assessment tools for evaluating the spiritual needs of patients.

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Review The Joint Commission resource found in topic materials, which provides some guidelines for creating spiritual assessment tools for evaluating the spiritual needs of patients.

Details:
This assignment requires you to interview one person and requires an analysis of your interview experience.
Part I: Interview
Select a patient, a family member, or a friend to interview. Be sure to focus on the interviewee’s experience as a patient, regardless of whom you choose to interview.
Review The Joint Commission resource found in topic materials, which provides some guidelines for creating spiritual assessment tools for evaluating the spiritual needs of patients. Using this resource and any other guidelines/examples that you can find, create your own tool for assessing the spiritual needs of patients.
Your spiritual needs assessment survey must include a minimum of five questions that can be answered during the interview. During the interview, document the interviewee’s responses.
The transcript should include the questions asked and the answers provided. Be sure to record the responses during the interview by taking detailed notes. Omit specific names and other personal information through which the interviewee can be determined.
Part II: Analysis
Write a 500-750 word analysis of your interview experience. Be sure to exclude specific names and other personal information from the interview. Instead, provide demographics such as sex, age, ethnicity, and religion. Include the following in your response:
1. What went well?
2. Were there any barriers or challenges that inhibited your ability to complete the assessment tool? How would you address these in the future or change your assessment to better address these challenges?
3. How can this tool assist you in providing appropriate interventions to meet the needs of your patient?
4. Did you discover that illness and stress amplified the spiritual concern and needs of your interviewee? Explain your answer with examples.

What is the difference between the physiology of pitting and nonpitting edema?

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What is the difference between the physiology of pitting and non pitting edema?

Case Study:

Case Study Posting Requirements

  1. Make sure all of the topics in the case study have been addressed.
  2. Cite at least three sources; journal articles, textbooks or evidenced-based websites to support the content.
  3. All sources must be within five years.
  4. Do not use .com, Wikipedia, or up-to-date, etc., for your sources.

Case Study 1

Concepts of Altered Health in Older Adults

Joseph P. is an 82-year-old male living at home. He is in overall good health and enjoys taking long walks as often as possible. During his walks, he likes to stop for a cold glass of fruit juice at the local cafeteria. On cold or rainy days, he rides a stationary bicycle at home for 30 minutes to “stay in good shape.”

  1. What physiological factors would typically increase Joseph’s risk of falling while walking outdoors?
  2. What are the common changes in blood pressure regulation that occurs with aging?
  3. Joseph enjoys fruit juice when he walks. Considering the renal system in the older adult, why would dehydration be a particular concern?

Case Study 2

Structure and Function of the Kidney

Rivka is an active 21-year-old who decided to take a day off from her university classes. The weather was hot and the sun bright, so she decided to go down to the beach. When she arrived, she found a few people playing beach volleyball, and they asked if she wanted to join in. She put down her school bag and began to play. The others were well prepared for their day out and stopped throughout the game to have their power drinks and soda pop. Several hours after they began to play, however, Rivka was not feeling so good. She stopped sweating and was feeling dizzy. One player noted she had not taken a washroom break at all during the day. They found a shaded area for her, and one of the players shared his power drink with her. Rivka was thirstier than she realized and quickly finished the drink.

  1. In pronounced dehydration, hypotension can occur. How would this affect the glomerular filtration rate of the kidney? What actions by the juxtaglomerular apparatus would occur to restore GFR?
  2. What is the effect aldosterone has on the distal convoluted tubule? Why would the actions of aldosterone be useful to Rivka in her situation?
  3. What does a specific gravity test measure? If someone tested the specific gravity of Rivka’s urine, what might it indicate?

Case Study 3

Disorders of Fluid and Electrolyte Balance

Amanda is an 18-year-old with anorexia nervosa. She was recently admitted to an eating disorders clinic with a BMI of 13.9, and although she was a voluntary patient, she was reluctant about the treatment. She was convinced she was overweight because her clothes felt tight on her. She complained that even her hands and feet “were fat.” One of her nurses explained that a protein in her blood was low. The nurse further explained that, as difficult as it may be to believe, eating a normal healthy diet would make the “fat hands and feet” go away.

  1. What protein do you suspect the nurse was referring to? How would a deficiency in this protein contribute to edema?
  2. What is the difference between the physiology of pitting and nonpitting edema?
  3. Because of her weakened condition, Amanda was moved around the ward in a wheelchair when she was not on bed rest. How does this affect her edematous tissues?

Case Study 4

Disorders of Acid–Base Balance

Shauna is a healthy, fit 28-year-old who decided to go on a 2-week tour of Mexico for young singles. One hot afternoon in a small market community, she grabbed some fruit juice from a street vendor. Several hours later, she developed abdominal cramping and diarrhea. The diarrhea became so severe that she missed 3 days of the tour and stayed in her hotel room. By the end of her illness, she felt weak and tired. Her head ached, but the mild fever had disappeared, and she was able to join her new friends for the rest of the tour.

  1. What is the acid–base imbalance Shauna might have experienced and its etiology?
  2. What are the functions and importance of the bicarbonate buffer system in the body?

Case Study 5

Disorders of Renal Function

Fred, a fit and healthy 44-year-old, was working outside one warm summer afternoon. When he returned home by the end of the day, his lower back felt sore and he felt nauseated. His wife made him dinner, but he was not hungry and chose to go to bed instead. Fred’s symptoms progressed, and soon he was rolling on the bed with excruciating pain. He said his back hurt as well as his stomach and groin area. The pain would ease off only to return a short while later, and when it did, Fred would begin to sweat and run to the bathroom to vomit. His wife became concerned and started the car. When his symptoms abated, she helped him into the car and rushed him to the hospital.

  1. At the hospital, an abdominal radiograph showed the presence of renal calculi in Fred’s right ureter (urolithiasis). What is the mechanism of stone formation in the kidney? What is the role of citrate in the kidneys?
  2. Why would the administration of calcium supplements be useful for a patient with calcium oxalate stones?
  3. Hydronephrosis can be a complication of renal calculi. What is hydronephrosis? How does back pressure occur in a kidney, and what physiological mechanism is responsible for nephron damage when back pressure is present?

Case Study 6

Acute Renal Injury and Chronic Kidney Disease

Will is a 68-year-old male with a history of hypertension. Eight months ago, he started regular dialysis therapy for ESRD. Before that, his physician was closely monitoring his condition because he had polyuria and nocturia. Soon it became difficult to manage his hypertension. He also lost his appetite, became weak, easily fatigued, and had edema around his ankles. Will debated with his physician about starting dialysis, but she insisted, before the signs and symptoms of uremia increased, the treatment was absolutely necessary.

  1. What is the difference between azotemia and uremia?
  2. Two years ago, Will’s physician told him to decrease his protein intake. In spite of what the physician ordered, Will could not stop having chicken, beef, pork, or eggs at least once a day. Why did his physician warn him about his diet?
  3. Will’s feelings of weakness and fatigue are symptoms of anemia. Why is he anemic?
  4. Knowing what you do about Will’s history, why is left ventricular dysfunction a concern for his physician?

Case Study 7

Disorders of the Bladder and Lower Urinary Tract

Alvita is a frail 89-year-old woman residing in a nursing home. She is able to move slowly around the residence with the use of a walker, but appreciates when her daughter is there to hold her arm and walk alongside her. When one of the health care staff changes Alvita, her daughter helps. Alvita’s incontinence has progressed, particularly over the last six years since she has resided in the nursing home. Alvita can smile at her lack of bladder control, however, and says that her incontinence really began when she was a young woman, just after the birth of her second daughter.

  1. Alvita’s mobility is limited. How does this affect continence in the elderly?
  2. Shortly after the birth of her second daughter, Alvita experienced mild incontinence, particularly after laughing or coughing. What was she experiencing? What is the pathophysiology behind this type of incontinence?

6-3 Discussion: Confidence Intervals

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6-3 Discussion: Confidence Intervals

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The B&K Real Estate Company sells homes and is currently serving the Southeast region. It has recently expanded to cover the Northeast states. The B&K realtors are excited to now cover the entire East Coast and are working to prepare their southern agents to expand their reach to the Northeast.

B&K has hired your company to analyze the Northeast home listing prices in order to give information to their agents about the mean listing price at 95% confidence. Your company offers two analysis packages: one based on a sample size of 100 listings, and another based on a sample size of 1,000 listings. Because there is an additional cost for data collection, your company charges more for the package with 1,000 listings than for the package with 100 listings.

Sample size of 100 listings:
  • 95% confidence interval for the mean of the Northeast house listing price has a margin of error of $25,000
  • Cost for service to B&K: $2,000
Sample size of 1,000 listings:
  • 95% confidence interval for the mean of the Northeast house listing price has a margin of error of $5,000
  • Cost for service to B&K: $10,000

The B&K management team does not understand the tradeoff between confidence level, sample size, and margin of error. B&K would like you to come back with your recommendation of the sample size that would provide the sales agents with the best understanding of northeast home prices at the lowest cost for service to B&K.

In other words, which option is preferable?

  • Spending more on data collection and having a smaller margin of error
  • Spending less on data collection and having a larger margin of error
  • Choosing an option somewhere in the middle

For your initial post:

  • Formulate a recommendation and write a confidence statement in the context of this scenario. For the purposes of writing your confidence statement, assume the sample mean house listing price is $310,000 for both packages. “I am [#] % confident the true mean . . . [in context].”
  • Explain the factors that went into your recommendation, including a discussion of the margin of error

For your response posts to your peers, choose two different confidence intervals for your responses. Do you think the agents would prefer a different confidence interval than their management? What advantages and disadvantages would there be in having different confidence intervals for the agents? Explain your thought process and reasoning in your response.

Compare vulnerable populations. Describe an example of one of these groups in the United States or from another country. Explain why the population is designated as vulnerable. Include the number o

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Compare vulnerable populations. Describe an example of one of these groups in the United States or from another country. Explain why the population is designated as “vulnerable.” Include the number of individuals belonging to this group and the specific challenges or issues involved. Discuss why these populations are unable to advocate for themselves, the ethical issues that must be considered when working with these groups, and how nursing advocacy would be beneficial.

(References needed)

Does implementing purposeful rounding and bedside reporting improve HCAHPS scoin attempt to improve quality measuin a skilled/ long-term environment?Theoretical (Conceptual) Framework Tsection should include the theoretical (conceptual framework) which supports your project.

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Does implementing purposeful rounding and bedside reporting improve HCAHPS scoin attempt to improve quality measuin a skilled/ long-term environment?Theoretical (Conceptual) Framework Tsection should include the theoretical (conceptual framework) which supports your project.

 

PICOT: Does implementing purposeful rounding and bedside reporting improve HCAHPS scoin attempt to improve quality measuin a skilled/ long-term environment?Theoretical (Conceptual) Framework Tsection should include the theoretical (conceptual framework) which supports your project. Describe a theory or model to serve as the foundation for your project. Tmay be a nursing theory or a theory from another discipline if pertinent and applicable.Please use > Patricia Benner?s nursing theory to Put Thinking into Action. When nurses run into obstacles or problems which may arise? the critical thinking process must ensue with proactive and prudent interventions.Synthesis of the LiteratureSynthesize at least 10 research studies and/or systematic reviews, not summary articles. Tis all about the evidence rather than someone else?s opinion of the evidence. Do not use secondary sources; you nto get the article, read it, and make your own decision about quality and applicability to your question even if you did find out about the study in a systematic review. The studies in tsection must relate directly to your PICOT question. Address the similarities, differences, and controversies.Practice RecommendationsSo. . . using available evidence, what is the answer to your question? Tsection is for you to summarize the strength of the body of evidence (quality, quantity, and consistency), make a summary statement, and give a recommendation for practice change. Tsection should include the recommendation for practice based on the evidence. Perhaps you have found that one subset of your population does fair better with the intervention but the rest of the patients do just as well with the standard practice that you used as your comparison. You might want to design an algorithm and include it in as a figure. Perhaps you found substantiation for usual practice and you recommend reinforcement and education regarding tbest practice.Project PlanTsection should begin with a description of your change model and why it was selected as the model for tspecific change. You should learn about the model from a primary source (i.e., do not cite a textbook). The model that you select should be appropriate to the change that you are recommending (i.e., individual change or organizational change). You may use a change model or an EBP model which describes the process of implementing an EBP change. Use that model to describe the practice change that you recommend even if that is reinforcement and education regarding the status quo. Your change process should be specific to your setting. You can make each step of the model a level 2 heading (title case and flush left) and then describe how you would implement that step of the change in your selected setting. Your change process must be specific to your question and the answer that you found through your literature review and your setting. It should be a well thought-out process using the model as a guide. Describe the setting for your project.Described Setting:?The setting is a healthcare setting which offers primary, secondary, and tertiary levels of care on many levels for retired geriatric patients age 65+. We also offer services to those who meet admission criteria for local community residents. We only accept Medicare A, Private Insurance, and Private PayEvaluation and Data AnalysisTsection must include how you are going to evaluate the planned change project including formative and summative criteria for evaluation and time points for the evaluation. Remember that you must evaluate the outcome(s) identified in your PICOT question. Describe and include any tool(s) that are to be used in your project evaluation and discuss the reliability and validity of the tool(s). Discuss planned analysis of your evaluation data.References:

Address how information technology assists in risk management, continuous monitoring, business continuity planning and disaster recovery of a business

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Address how information technology assists in risk management, continuous monitoring, business continuity planning and disaster recovery of a business

DISASTER RECOVERY AND CLOUD COMPUTING
Assignment Overview
It is important to assure the continuous and proper operation of information systems in business continuity planning and information recovery in disaster recovery, as we have discussed in the previous module. The relationship between information systems and disaster recovery has another perspective—how information system is leveraged to manage disasters.

Information systems and telecommunication infrastructures have long been critical in emergency management. We sometimes heard about from the news how a three-year-old kid even knows to call 911 to seek help in emergency. Nowadays, 70% of 911 calls are from mobile phone. FCC requires 911 calls to be transmitted even if a mobile phone doesn’t subscribe to any plan (FCC). Various apps for smartphones exist for emergency management. This is just a beginning.

FCC (2012), FCC Wireless 911 Services.

Continuity_Compliance (2011), Disaster Preparedness Apps List for Smartphone.

Need C. (2011), Disaster Preparedness 2011: Smart Phones Enhanced with Nanotube Hazmat Detectors Bring a New Dimension to Preparedness.

Chan, W. K. (2012). Operational Effectiveness of Smartphones and Apps for Humanitarian Aid and Disaster Relief , Naval Post Graduate School Thesis. https://calhoun.nps.edu/handle/10945/17338

The Internet, of course, is also a means of help. Please check out the two websites below and see how the websites may help in the time of disaster or emergency.

FEMA, http://www.fema.gov/

Disaster Assistance Program, http://www.disasterassistance.gov/

Geographic Information System (GIS) is another example of information systems that is widely applied in disaster management. The following three presentations show comprehensively how GIS and other information systems have been applied in disaster management and emergency response:

Cyber Risk Assessment and Management: https://staysafeonline.org/re-cyber/cyber-risk-assessment-management/

Lucus-McEwen, V. (2011) If you haven’t heard about crisis commons yet….http://www.emergencymgmt.com/emergency-blogs/campus/Crisis-Commons-Monitors-Turkey-Earthquake-102311.html

Heaton, B. (2013). How emergency managers can benefit from big data. http://www.emergencymgmt.com/disaster/Emergency-Managers-Big-Data.html?page=2

A less considered or known is probably how digitization itself has helped preservation of assets that might be totally lost in a disaster. Please briefly review the following. The key is to be exposed to this perspective. You don’t need to know of the details.

Video (2015). Digital Preservation and Nuclear Disaster: An Animation

British Library (2012), British Library Digital Preservation Strategy.

AABC (2012), The Archives Association of British Columbia Archivist’s Toolkit: Preservation and Emergency Planning.