Estimated savings-first year, $120,000
Estimated savings-second year, $300,000
Estimated savings-third, fourth, and fifth years,
              add 7 percent to each previous year
Estimated one-time costs-first year, $450,000
Estimated additional operating costs-first year, $110,000
Estimated additional operating costs-second year, $140,000
Estimated additional operating costs-third, fourth, and fifth years, add 7
Percent to the previous year
Federal income tax rate-48 percent
Present value of $1 at 20 percent-first year (calculate with Excel formula)
Present value of $1 at 20 percent-second year, (calculate with Excel formula)
Present value of $1 at 20 percent-third year, (calculate with Excel formula)
Present value of $1 at 20 percent-fourth year, (calculate with Excel formula)
Present value of $1 at 20 percent-fifth year, (calculate with Excel formula)

Case study Josh Wallace

Demographic data

Josh Wallace is an indigenous 20-year-old second-year university student. He likes to write music and plays several musical instruments, including the didgeridoo. He is studying music at university and hopes to compose music for orchestras. Josh works part-time as a barista in a coffee shop and performs with an indigenous dance group. He lives in the city with his mother’s sister, her three teenage children, and Uncle Bill, the brother of his grandmother. Josh’s parents live in a large regional town. His parents are teachers who work in a ‘Flexi- school’. He has two younger siblings. His parents are very active in the local indigenous community.

Past Medical-Surgical and Psychiatric history.

At the age of 14, Josh experienced mental health issues because of problems at home. Firstly, his uncle, a man in his early 50’s, completed suicide. And then both his parents experienced illness. His mother was diagnosed with depression several months after his father recovered from a life-threatening illness. After Josh returned to school where he was a boarder, he found himself crying in his room at night because he felt sad all the time. He began to self-harm. He didn’t want to talk to his friends because he thought he might be considered weak, and he didn’t want to worry his family. His Year 9 Coordinator, Mr. Adams, noticed a change in Josh, who was usually an outgoing and active participant in the school community. Mr. Adams arranged a meeting, and at that time he noted the cuts on Josh’s arms. Josh was referred to the school counselor and the school nurse, and he was eventually referred to as Child and Youth Mental health services (CYMHS). He was seen on a regular basis by a team including a mental health nurse. He was prescribed Fluoxetine 20 mg. With support from family, the school, and CYMHS, he put in place strategies to benefit his recovery. He was discharged from CYMHS when he turned 18. He decided to accept support from the services offered at Headspace and attended three appointments over a 6 - month period when he was 19. Mid last year, Josh has experienced the death by completed suicide, of his 21-year-old cousin Luke. His cousin lived in a regional area, and Josh was unable to join family members because of his study commitments. At present, he is enrolled in a summer intensive unit, because he failed a unit in the second semester. The teacher is dismissive of students who do not speak up, and Josh has been targeted for comments on several occasions. Josh is the only indigenous student in the tutorial group, and he does not know anyone else. Josh also misses his girlfriend Aimee. She is on placement for four weeks, and Josh does not have a car to visit her. Josh has experienced shortness of breath and chest pain during rehearsals with his dance group. He hadn’t told anyone, believing it was probably muscle pain. Last night he experienced chest pain prior to leaving the house to attend rehearsals. It became so bad he thought he was going to die and alerted his Aunt Alice for help. He was transported to the local emergency department for assessment. Josh is told he has experienced a panic attack. No physical abnormalities were detected in ECG or blood, and he will be referred to his GP, and to Headspace for follow up appointments.

Presenting History

Josh arrives for his appointment at Headspace. He is accompanied by his Aunt Alice. Josh is unkempt, disheveled, and looks sad. His voice is monotone and flat, and he has poor eye contact. He tells you “I am sorry to worry everyone, it was just a panic attack- I can never get things right.” He says he feels worried and on edge all the time, and has difficulty concentrating. His Aunt tells you Josh has been isolating himself Faculty of Health | School of Nursing, Midwifery & Paramedicine in his room, and has missed a couple of shifts at the coffee shop and some tutorials on campus. He also becomes easily irritated, yelling at his cousins and his Aunt. This is not his usual behavior.

Q. What historical and cultural issues need to be considered when caring for Josh?

II. What are the signs and symptoms of depression? Considering the case study, describe the different types of behavior and verbal responses, that may indicate Josh may be experiencing depression?

III. What is meant by culturally safe practice and what are the key skills that nurses need to develop to provide culturally safe practice for Josh?

IV. Identify the psychotropic medication previously prescribed for the treatment of the symptoms of depression experienced by Josh, and consider the importance of effective monitoring, consumer experiences (side effects) and safety factors;

Today, interest rates on 1-year T-bonds yield 1.5%, interest rates on 2-year T-bonds yield 2.55%, and interest rates on 3-year T-bonds yield 3.4%.

a. If the pure expectations theory is correct, what is the yield on 1-year T-bonds one year from now? Be sure to use a geometric average in your calculations. Round your answer to four decimal places. Do not round intermediate calculations. ________ %

b. If the pure expectations theory is correct, what is the yield on 2-year T-bonds one year from now? Be sure to use a geometric average in your calculations. Round your answer to four decimal places. Do not round intermediate calculations. ___________%

c. If the pure expectations theory is correct, what is the yield on 1-year T-bonds two years from now? Be sure to use a geometric average in your calculations. Round your answer to four decimal places. Do not round intermediate calculations. ________%

4.   John is a 16-year-old who loves to play soccer. His 18-year-old brother, Andre, passed out while playing basketball and has now been diagnosed with long QT syndrome (LQT1). The cardiologist involved suggests that all Andre’s siblings should have a cardiac examination, including an electrocardiogram (ECG), before they play sports. John’s ECG shows a borderline QT prolongation during activity, so the cardiologist recommends genetic testing. John tests positive for the same mutation in the gene KCNQ1 (LQT1) that Andre has, and he is told that he must stop playing soccer. He is counseled to take up a less intense sport, like golf. John is clearly upset and wants to know why this is happening to him. He feels just fine and does not understand why he cannot play his favorite sport.
A.   What is the connection between sports restrictions and Long QT syndrome
B.   How can understanding the genetics help to predict who might be affected by Long QT syndrome if someone in the family is already affected.
C.   How and in what terms will you explain to John why these modifications in exercise are necessary

Please ans them both.14

What is the firm's total change in cash from the prior year to the current year?

What is the firm's cash flow from financing?

A 59-year-old man with headaches, double vision, dizziness, and ataxia

Chief Complaint

A 59-year-old, right-handed male was admitted to the hospital with a chief complaint of occipital headaches of 4 days duration.

History of Chief Complaint

Three days prior to admission, the patient noted a sudden onset of diplopia on forward gaze and a sensation of dizziness. These complaints resolved within twenty-four hours. He experienced several episodes of dizziness and diplopia over the next 24 hours. One day prior to admission he noted a relatively sudden onset of dizziness, diploia and clumsiness in the right hand. These complaints have persisted since that time.

Medical History

The patient had been under treatment for hypertension for 6 years duration with blood pressures in the range of 180/110.

General Physical Examination

The patient was alert, oriented, and cooperative; he was a well-nourished man of medium height who appeared his stated age. Funduscopic examination revealed clear optic disc with sharp borders. The external auditory canal was patent and uninflamed. Pharynx and larynx were non-reddened. A grade II/W bruit was present over the right carotid artery. His blood pressure was elevated (192/96). Peripheral pulses were intact at the ankle and wrist. Respirations were normal. His chest was clear to auscultation: skin was warm and of normal texture; abdomen was soft with no tenderness, lumps, or masses. No edema was present in the extremities; no lymphadenopathy was present in the cervical or inguinal areas.

Neurologic Examination

Mental Status. The patient was awake and oriented with respect to person, place, and time. Memory was appropriate for his age. Speech was articulate and meaningful and he could follow three and four-step commands.

Cranial Nerves. Extraocular movements were full, but tine patient complained of diplopia made worse by lateral gaze to the left. Nystagmus was present on left lateral gaze. The right pupil measured 3 mm, the left was 5 mm, but both responded to light and accommodation. Ptosis of the right eyelid and decreased sweating on the right side of the face (anhidrosis) were also present. Hearing was diminished in both ears to high frequencies. He admits to a feel of dizziness that he describes as the world moving around him. Pain, but not touch sensation, was decreased on the right side of the face with the exception of some sparing around the lips and nasal region. The right corneal reflex was diminished. Facial expressions were full and symmetric. The uvula deviated to tile left, and there was deficient elevation of the right side of the palate. There was also a suggestion of hoarseness.

Motor System. Strength was intact throughout the body; deep tendon reflexes were intact and symmetric. An ataxia was evident in the right upper extremity on finger-tapping, hand-patting, and finger-to-nose tests. A side-to-side intention tremor was present. Ataxia was also present in the right lower extremity, on heel-to-shin and tibia-tapping tests.

Sensory Examination: He had a mild analgesia to pinprick on the left side of the body, the left "'arm, and the left leg. Position, vibration, and touch modalities were intact throughout the entire body.

1. Does the patient exhibit a language or memory deficit or an alteration in consciousness or cognition? 2. Are signs of cranial nerve dysfunction present? If so, which cranial nerves? 3. Are there any changes in motor functions, such as reflexes, muscle tone, movement, or coordination? 4. Are any changes in sensory functions detectable? 5. Based on the answers to the above questions, at what level in the neuraxis is this lesion most likely located? 6. Is the pathology focal, multifocal, or diffuse in its distribution within the nervous system? 7. What is the clinical-temporal profile of the neurologic pathology in this patient: acute or chronic; progressive or stable? 8. Based upon your answers to the above two questions describe the pathology occurring in this patient. 9. If you feel this patient’s pathology is the result of a vascular accident, what vessels are most likely involved?