Centerville psychiatric (CP) is a for-profit psychiatric hospital in a large town with two other free-standing psychiatric hospitals and with four general hospitals that have smaller psychiatric units. CP attempts to distinguish itself from its competitors by claiming to offer better doctors and more state-of-the-art structured treatment programs that combine intensive counseling and drug therapy for acute episodes for serious mental illness (so-called nervous breakdowns). This treatment approach contrasts with that in general hospitals, which is unstructured, much shorter in duration, and often administrated by non-specialists, and contrasts with other specialized psychiatric hospitals that offer long-term custodial treatment for more chronic conditions.

Consistent with its long-standing bylaws, CP’s medical staff presently consists of only board-certified psychiatrists, which are specially trained M.D.s. Alfred Zock, Ph.D. is a psychologist of good reputation with an active counseling and therapy practice in Centerville. He has decided to break the mold by applying for medical staff privileges at CP. The major practical difference between psychiatrists and psychologists is that only the former can prescribe drugs; psychologists are limited by state licensing laws to “couch therapy.” In the past, psychologists have been allowed to see CP patients who were under their care before coming to CP, but only if a staff psychiatrist approved and supervised the psychologist. Dr. Zock would like to admit his own patients directly and treat them at CP without supervision or prior approval. He has admitting privileges at one of the general hospitals in town, but he finds their facilities unsatisfactory.

They existing psychiatrists oppose Dr. Zock’s admission because they like things the way they are, for both clinical and financial reasons. The hospital administration is also not in favor, partly because it does not want to antagonize its medical staff in a competitive hospital market where they can take their patients elsewhere, and partly because reimbursement rates under managed care insurance are usually higher for drug therapy their own psychologist to be their primary physician.

            As a lawyer for CP, advise it on the safest way to exclude Dr. Zock. Consider whether to use primarily quality or economic criteria, whether to act under the existing bylaws or to change them and then consider Dr. Zock individually. Consider what procedures to follow in making these decisions.

Questions to answer….

As a lawyer for Centerville Psychiatric Hospital,

Advise it on the safest way to exclude Dr. Zock.

Consider whether to use primarily quality or economic criteria,

Whether to act under the existing bylaws or to change them,

And finally consider Dr. Zock individually.

Consider what procedures to follow

Include references.

SOMATIC CASE STUDIES

You are working in a nearly empty small-town emergency department in the middle of the night when a young woman, a Ms. Harriman, comes in holding her abdomen and sobbing. She is doubled over in pain and says, “I think I have stomach or pancreatic cancer!” She moans and says she is nauseated and says, “I threw up blood at home! Hematemesis!”

You and another intern nurse get her into a bed and draw the curtains. You hold a bedpan for her, but she doesn’t vomit. Instead, she says right away, “Is Dr. Collins on tonight? I need to see Dr. Collins. He knows my case. I’m fine alone for a moment. Just please go get him.”

You explain to her that you need to check her vital signs first, but she becomes agitated and says, “You’re wasting time! My BP isn’t elevated, my pulse and respirations, all that’s fine. I might be slightly pyretic, but I’m fine. Just please get him. Dr. Collins already knows me. Go!”

Just then you are called away by another doctor anyway, so you do leave briefly.

As it happens, Dr. Collins is on duty. You don’t relay her special request for him, but you do tell him about her as he comes away from another patient.

“Sandi Harriman?” he says. His shoulders slump, and he puts a hand to his forehead. “Not again. How many times—.” Then he looks at you. “No, I think it’s better if someone else sees her.”

You are slightly puzzled by this, but the other doctor on duty tonight, Doctor Metz, is standing nearby reviewing a chart and looks up and says, “Ah, Ms. Harriman. Yes, I agree. I’ll see her.”

Neither of them rushes to her side, however.

Suddenly Ms. Harriman makes peculiar, loud retching sounds. You return to her and see thick dark coffee-ground emesis, similar to that seen with serious abdominal disorders, including cancer. You take the pan from her, and the other intern brings her a clean pan and begins the assessment process.

A sample of the coffee-ground emesis is sent immediately to the lab. Dr. Metz attends to Ms. Harriman. You are with him during assessment, as she tells him, “I’ve had jaundice, fatigue, weight loss, nausea and vomiting, and back pain. Last time I had a CT scan, but I really think I need an endoscopic ultrasound. Do you think I should have a pancreatic biopsy? Because I’m thinking that’s the only thing that’s going to tell us for sure if I have pancreatic cancer.”

Dr. Metz says patiently, “Well, first, we need to pinpoint the location and nature of your abdominal pain. How’s your nausea at the moment? Are you comfortable with me palpating your abdomen?”

She nods and lies back, looking at the ceiling. She seems a little relieved.

As the sheet is pulled back and the paper gown lifted, you are surprised to see that Ms. Harriman appears to have had at least one other abdominal procedure.

Just then, the lab technician motions you out into the hallway.

1. What disorder do some of Ms. Harriman’s behaviors most likely indicate? Identify clues that

support your temporary diagnosis; include your speculation of what’s going on with those

coffee grounds.

2. Why might it be difficult to determine the psychological basis for Ms. Harriman’s

somatization?

3. In light of the evidence shown here, what kind of self-assessment may be very important if you

will continue to work with Ms. Harriman?

A study of lawn destroying insects where some yards in a small town were randomly inspected determined the square footage an infestation of insects could eat per day is displayed in the table below. (Show all work for credit, including calculations and complete parts a) Find all variables( SE, z or t, P-value, p hat, etc)

Does the difference in samples give us enough evidence to conclude that there is a difference between grub infestation and cinch infestation? Perform a hypothesis test, and state your conclusion.

he Town of Willingdon adopted the following General Fund budget for the fiscal year beginning July 1:

Required

1. a-1. Prepare the general journal entries to record the adopted budget at the beginning of the fiscal year. (If no entry is required for a transaction/event, select "No Journal Entry Required" in the first account field.)

1. a-2. Show entries in the subsidiary ledger accounts.

Lakeesha Barnett owns and operates a package mailing store in a college town. Her store, Send It Packing, helps customers wrap items and send them via UPS, FedEx, and the USPS. Send It Packing also rents mailboxes to customers by the month. In May, purchases of materials (stamps, cardboard boxes, tape, Styrofoam peanuts, bubble wrap, etc.) equaled $11,350; the beginning inventory of materials was $1,050, and the ending inventory of materials was $950. Payments for direct labor during the month totaled $25,500. Overhead incurred was $18,100 (including rent, utilities, and insurance, as well as payments of $14,050 to UPS and FedEx for the delivery services sold). Since Send It Packing is a franchise, Lakeesha owes a monthly franchise fee of 5 percent of sales. She spent $2,750 on advertising during the month. Other administrative costs (including accounting and legal services and a trip to Dallas for training) amounted to $3,600 for the month. Revenues for May were $102,000.

Required:

1. What was the cost of materials used for packaging and mailing services during May?
$

2. What was the prime cost for May?
$

3. What was the conversion cost for May?
$

4. What was the total cost of services for May?
$

Joanna and Joe both love pizza. They go to a famous pizza bar in mid-town Manhattan called Sloppy Pizza. When they reach there, they hear about a contest that’s going on. They want to share the “Marvellous Pizza” together. That’s an8 slice pizza which is amazing!

The owner tells them to write on a piece of paper how many slices they each want out of the 8 slices of pizza. He puts them on separate tables and makes sure they don’t see each other’s chosen number. Thus the choices are made simultaneously. Each player can ask for any number of slices between 1 and 8 both inclusive, integer numbers only.

If the sum of the numbers they each write is less than or equal to 8, they each get the number of slices they named for free! If the sum of the numbers they each write is greater than8, and their chosen numbers are different, then the one with the smaller number gets the pizza slices theywrote (for free) and the other player is asked to leave. If sum of the numbers they each write is greater than 8, and they choose equal slices, they both get 4 slices each. Each player’s utility is the number of pizza slices he gets to eat.

1. Model the game in strategic form
2. Solve for all pure strategy Nash

1. A study claims residents in a suburban town spend 1.8 hours per weekday commuting. A researcher wanted to see if this claim was true by sampling 101 adults. The mean and standard deviation of time spent commuting per weekday is shown below:

             X=2.1 s=0.5

1. Can you support the claim (a=.05) that the mean time spent commuting per weekday is more than 1.8 hours. Show all steps (Design, Data, Conclusion).

2. In designing the test shown in part a, the researcher was concerned about the power of the test if the actual time commuting was 1.9 hours. Under the test described in Part a, Power was calculated to be only 64%. Determine the probability of making Type II error (given Ha is true) for this design.

3. How would the following modifications to the design affect the power
   (choose one answer)?
   

   1. Change the sample size to 200: increase power or reduce power
      

   2. Change significance level to 1%: increase power or reduce power
      

   3. Change actual commuting time to 1.95 hours: increase power or reduce power

Carver Lumber sells lumber and general building supplies to building contractors in a medium-sized town in Montana. Data regarding the store's operations follow:

- Sales are budgeted at $350,000 for November, $320,000 for December, and $300,000 for January.
- Collections are expected to be 90% in the month of sale, 8% in the month following the sale, and 2% uncollectible.
- The cost of goods sold is 75% of sales.
- The company purchases 60% of its merchandise in the month prior to the month of sale and 40% in the month of sale. Payment for merchandise is made in the month following the purchase.
- Other monthly expenses to be paid in cash are $24,700.
- Monthly depreciation is $16,000.
- Ignore taxes.

Reference: 9-23

Accounts payable at the end of December would be:

The following table gives the total weekly output of bicycles at Al’s Bicycle Town.

Table 1

Complete this table.

Draw the graphs of the marginal product (MP) and the average product (AP).

To learn how to plot the data in Excel, see  https://www.youtube.com/watch?v=B3U9tDcoNeI

Where do the AP and MP curve cross?

The cost of 1 worker is $2000 per month. Total fixed cost is $4000 per month.

Complete Table 2 using your answers from Table 1 and by computing total variable cost (TVC) and total cost(TC).

Table 2

Draw the graphs of the TC and TVC curves. What is the relationship between these two curves?

Complete Table 3 by using your answers from the previous Tables and calculating the AVC, ATC, and MC.

Draw the graphs of the ATC, AVC, and MC curves. What is the relationship between the ATC and AVC curves? Between the MC and AVC curves?

85. A 25-year-old man is a resident of a small town near London. He likes to eat beefsteak. He develops

      a severe progressive neurologic disease characterized by psychiatric symptoms, cerebellar signs, and

      dementia.

86. A 40-year old woman with many lifetime sexual partners is diagnosed with cervical cancer.

      This cancer is common worldwide and has a sexually transmitted viral etiology. The causative

       agent of human cervical cancer is

87. A 50-year-old male went to the ER because of meningitis symptoms. He complained of

       headaches and stiff neck. His hobby is racing and raising pigeons. He is HIV positive and

       routinely takes his anti-retrovial drugs. A lumbar puncture is formed and budding encapsulated yeast

       are identified after an India ink preparation was done.

88. A 30-year-old florist presents at her physician’s office complaining of a ulcerated lesion on her left hand after being pricked by a rose thorn. The doctor notices abcesses running along the lymphatic channels. This dimorphic fungi is

89. A 25-year-old spelunker who lives in Mississippi has a pulmonary infection that is getting worse.

      His Xray shows an infiltrate or darkened left lobe. Sputum showed pear shaped macroconidia and     

      Staining of colonies showed spores resembling sunflowers in bloom’

90. A 30-year-old immigrant from Central America presents with a mild respiratory infection. He

      only has mild changes in his lungs and gave a positive skin test. Sputum was stained and thick

      walled spherical yeast resembling a mariner’s wheel or a boatman’s wheel were seen.