Red Yoder Introductory Monologue Script

I understand you want to hear my story; well I’m not much for talking, but I can give you the highlights. There’s a lot that’s happened over my 80 years.
From the top. My name is Sherman Yoder, but I answer to “Red.” No one around here even remembers my real name. I was born in this house in the downstairs bedroom. Mom had already delivered six kids and there was no way I was waiting for Dad to finish feeding the hogs and get Mom to town before I come out. Mom used to love to tell that story.

Dad bought this farmhouse and the first hundred acres right before he went off to WWI. The folks saw good times and bad in this ol’ place and so have I. All my brothers and sisters left the land as soon as they could. I was the only one of the lot to care about this place and want to carry on what Dad started. I really haven’t gone far from this spot in my entire life. The one time I got it in my head to try something different; I wound up in Korea with an Army uniform on. I was glad to get back to this place after that stint and here I’ve been ever since.

Married the neighbor girl Bessie when I got back. Her dad wasn’t so sure that it would work out since she was 8 years younger than me and she intended to go off to the state college. We sure did prove him wrong; we celebrated our 50th anniversary the week before Bessie died. The ladies at the church had the hall all decorated up and we brought Bessie home from the hospital for the afternoon. She was bound and determined to live for that day; no way did she want her friends to go to that much work for her to not show up. I couldn’t believe it when the ladies had to prepare for the reception after we buried Bessie in that same hall one week later. We had such a good life together. That was 10 years ago.

I don’t do much of the farm work anymore. Our son Jon takes care of the crops and the few animals we have. I still go out to the hen house every morning to collect the eggs. I’m a little stiff in the morning, but I get loosened up enough to walk out to gather some fresh eggs to go with my bacon for breakfast. I get in to town at least once a week; on Monday morning me and my buddies meet at the VFW for our coffee and donut break. I get caught up on all the town gossip and we laugh and bellyache about what’s going on in the world.

Three weeks ago I celebrated my 80th birthday. My daughter in law, Judy, organized a big “to do” at the church after the Sunday service with cake and ice cream and all the fixins’ for my party. I had a big piece of cake but skipped the ice cream. Doc Baker was there and I knew he would scold me about too much sugar. Six months ago he told me I had diabetes and I started taking a pill for it, but a few weeks ago he put me on insulin. I figure I should be able to eat what I want; come on, I’m not going to live forever, and it was my favorite cake, German chocolate. I ate it in the kitchen so the Doc wouldn’t see me; wouldn’t you know, his office nurse Helen came in the kitchen with a load of dishes just as I was putting the last bite in my mouth. She just winked at me and smiled.

After the party I went out to the mall with Jon and the grandkids. I’m not one for shopping much, but I needed a new ink cartridge for my printer and the computer store is the one place I like to look around in. Too bad we parked clear on the other end of the mall so the kids could go by their favorite stores for Grandpa to buy them a little something. Jon got real mad at me when I asked if I could sit and rest for a while, so I just kept walking. I guess my new shoes were a little tight; I didn’t feel anything but when I got home there was some blood on my sock, and then I saw a sore on my big toe. It must not be too bad since it’s not hurting except when I try to put my shoes on.

I showed the sore to Jon and Judy the other day and Judy said she would call the doctor to see what she should put on it. Jon gets so irritated when I need extra help; I hope I can just continue to soak my foot in hot water to clean it out. Judy was a nursing assistant out at the old folk’s home for many years; I’m hoping she will be able to help me with this. I like the idea of the home nurses coming out here as long as my VA benefits pay for it. That way they can see that I’m doing just fine living here on my own.

I was searching on the Internet for the best way to treat this sore; there are so many sites that talk about foot sores if you’re a diabetic. Some of those pictures are pretty scary; I can’t sleep at night thinking about what could happen if this doesn’t heal. Of course I haven’t slept through the night for years. Even the couple of beers I have at night when I’m on the computer don’t seem to be helping anymore. Judy sometimes gives the kids Benadryl to help them sleep so I’ve been taking a couple when I go to bed; they seem to help me sleep a little better.

As a matter of fact, I need to wrap this up now. I promised Jack, my grandson in college, that I’d Skype him in a few minutes. He just started the agronomy program at the university. I love to hear about what he’s learning and give him encouragement to come back to the farm.

Questions:

1. What are Red's strengths?

2. What are your concerns for this patient?

3. What is the cause of your concern?

4. What information do you need?

5. What are you going to do about it?  

6. What is Red experiencing?

You are a Practice Nurse in a small rural medical centre.

Mr Stuart Murray is a 48-year-old Indigenous man living with his family in a small rural town in NSW. Mr Murray has a medical history of type 2 diabetes, obesity and hypertension. Mr Murray drinks at least five schooners of beer and smokes up to 20 cigarettes daily. He is currently suffering from tiredness, breathlessness on exertion, swollen ankles, nausea, itchy skin and aching bones and joints. He passes about 400 mL of urine in 24 hours.

Mr Murray presents to his local medical centre saying he was not feeling well. Mr Murray’s regular medications are metformin and ramipril. You assess Mr Murray and reviews the pathology tests the doctor ordered.

• His blood pressure is 167/95mmHg, pulse 92bpm, respiration rate 24.
• Blood biochemistry reveals: Sodium 132 mmol/L, Chloride 92 mmol/L, Potassium 5.7 mmol/L
• Bicarbonate 20 mmol/L, Urea 27.6 mmol/L, Creatinine 428 umol/L, Hb 82g/L, eGFR 20
• HbA1c 8.6%

Question 11. Maximum word limit 20 words.

You are concerned that Mr Murray is at risk of, or is, developing Chronic Kidney Disease (CKD). Based on the scenario above, list the risk factors for CKD that are applicable to Mr Murray.

Question 12. Maximum word limit 20 words.

List the three recommend tests that form the kidney health check, to determine if Mr Murray is developing CKD.

Question 13. Maximum word limit 10 words.

Based on the physical assessment and the pathology test results, what stage of CKD is Mr Murray currently experiencing?

Question 14. Maximum word limit 300 words.

Mr Murray’s doctor prescribes the following dietary modifications and additional medications.

• Sodium bicarbonate tablet 500mg tds
• Calcium carbonate tablets 600mg tds
• Erythropoietin injection 40,000 units SC weekly
• 1500 mL fluid restriction
• Low potassium and 70-gram protein diet

As the Practice Nurse in the medical centre, you explain to Mr Murray how each of these treatments are related to his failing kidney function, how they will improve his health, and how he should take them. Outline your explanation for each.

Question 15. Maximum word limit 150 words

The doctor tells Mr Murray that he will need to go to the nearest large town for a specialist consultation and treatment. Mr Murray is not sure that he wants to go.

1. What cultural concerns may be raised for Mr Murray by this possibility?
2. Briefly describe strategies that could be implemented to help maintain Mr Murray’s autonomy.
3. Briefly describe strategies that could be implemented to help maintain Mr Murray’s cultural safety.

please provide refrences

You are a Practice Nurse in a small rural medical centre.

Mr Stuart Murray is a 48-year-old Indigenous man living with his family in a small rural town in NSW. Mr Murray has a medical history of type 2 diabetes, obesity and hypertension. Mr Murray drinks at least five schooners of beer and smokes up to 20 cigarettes daily. He is currently suffering from tiredness, breathlessness on exertion, swollen ankles, nausea, itchy skin and aching bones and joints. He passes about 400 mL of urine in 24 hours.

Mr Murray presents to his local medical centre saying he was not feeling well. Mr Murray’s regular medications are metformin and ramipril. You assess Mr Murray and reviews the pathology tests the doctor ordered.

• His blood pressure is 167/95mmHg, pulse 92bpm, respiration rate 24.
• Blood biochemistry reveals: Sodium 132 mmol/L, Chloride 92 mmol/L, Potassium 5.7 mmol/L
• Bicarbonate 20 mmol/L, Urea 27.6 mmol/L, Creatinine 428 umol/L, Hb 82g/L, eGFR 20   
• HbA1c 8.6%

Question 11. Maximum word limit 20 words. (1 mark)

You are concerned that Mr Murray is at risk of, or is, developing Chronic Kidney Disease (CKD). Based on the scenario above, list the risk factors for CKD that are applicable to Mr Murray.

Question 12. Maximum word limit 20 words. (1 mark)

List the three recommend tests that form the kidney health check, to determine if Mr Murray is developing CKD.

Question 13. Maximum word limit 10 words. (1 mark)

Based on the physical assessment and the pathology test results, what stage of CKD is Mr Murray currently experiencing?

Question 14. Maximum word limit 300 words.

Mr Murray’s doctor prescribes the following dietary modifications and additional medications.  

• Sodium bicarbonate tablet 500mg tds
• Calcium carbonate tablets 600mg tds
• Erythropoietin injection 40,000 units SC weekly   
• 1500 mL fluid restriction
• Low potassium and 70-gram protein diet

As the Practice Nurse in the medical centre, you explain to Mr Murray how each of these treatments are related to his failing kidney function, how they will improve his health, and how he should take them. Outline your explanation for each.

Question 15. Maximum word limit 150 words.

The doctor tells Mr Murray that he will need to go to the nearest large town for a specialist consultation and treatment. Mr Murray is not sure that he wants to go.

1. What cultural concerns may be raised for Mr Murray by this possibility?
2. Briefly describe strategies that could be implemented to help maintain Mr Murray’s autonomy.
3. Briefly describe strategies that could be implemented to help maintain Mr Murray’s cultural safety.

Read the following scenario and answer the questions.

Dr. Henry Duck was working his regular shift as the only doctor working in a small town Emergency Room at around 5:00 pm one day in May when a large tornado struck Dr. Duck’s county directly, causing catastrophic damage and multiple life threatening injuries. Dr. Duck knew that it would make for a long, busy evening treating patients in the Emergency Room, and was ready for the challenge, but did not fully appreciate the Ethical and Moral decisions he would have to make during the evening.

Almost immediately after the tornado passed, the small town’s emergency responders were overwhelmed and neighboring counties’ ambulance and first responder teams helped transport victims of the tornado to Dr. Duck’s emergency room. People were coming in at a rate never seen by Dr. Duck before, with all sorts of varying injuries caused by the tornado. The tornado patients who were coming in were all from different socioeconomic backgrounds, had ages varying from infant to 89 years of age, and included two pregnant women. Dr. Duck was unable to keep up with the heavy flow of incoming patients, which seemed to be never-ending, and began to have to make difficult decisions about who should receive priority in treatment for equally devastating injuries.

At around midnight, Dr. Duck finally felt he was getting the overcrowded emergency room in order and stabilized most of his patients, when the doors of the emergency room flung open. A gunshot victim with life threatening injuries, who was the suspect of a bank robbery in the affluent part of town was being hurried in by police. Almost simultaneously, a woman who underwent complications during a scheduled home delivery of baby twins was rushed through the doors by her concerned and frantic husband who was screaming, “we need help, my wife is going to die! My babies are going to die! Help! Please!” At the same time, Dr. Duck’s beloved 16 year old niece, Daphne, arrived by ambulance with significant, but non- life threatening injuries sustained as a result of a motor vehicle crash.

During the hectic time at the Emergency Room that occurred as a result of the tornado, how would ethical theories and moral judgments impact Dr. Duck’s decisions regarding who to treat first? Would Dr. Duck’s personal values play a role in his decisions?

When the three patients are hurried into the ER at around midnight, who should Dr. Duck treat first and why? What ethical theories apply to this scenario? Does situational ethics, justice and/or bias come into play with the three injured patients who enter the ER around midnight?

Create a case study "Curbing tobacco use in Poland" with the info below.

Health Condition: Tobacco is the second deadliest threat to adult health in the world and causes 1 in every 10 adult deaths. It is estimated that 500 million people alive today will die prematurely because of tobacco consumption. More than three quarters of the world's 1.2 billion smokers live in low- and middle-income countries, where smoking is on the rise. By 2030, it is estimated that smoking-related deaths will have doubled, accounting for the deaths of 6 in 10 people. In the 1980s, Poland had the highest rate of smoking in the world. Nearly three-quarters of Polish men aged 20 to 60 smoked every day. In 1990, the probability that a 15-year-old boy born in Poland would reach his 60th birth­day was lower than in most countries, and middle-aged Polish men had one of the highest rates of lung cancer in the world.

Intervention or Program: In 1995, the Polish parliament passed groundbreaking tobacco-control legislation, which included:

the requirement of the largest health warnings on cigarette packs in the world;

a ban on smoking in health centers and enclosed workspaces;

a ban on electronic media advertisement; and

a ban on tobacco sales to minors.

Health education campaigns and the "Great Polish Smoke-Out" have also raised awareness about the dangers of smoking and have encouraged Poles to quit.

Impact: Cigarette consumption dropped 10 percent between 1990 and 1998, and the number of smokers declined from 14 million in the 1980s to under 10 million at the end of the 1990s. The reduction in smoking led to:

10,000 fewer deaths each year;

a 30 percent decline in lung cancer among men aged 20 to 44;

a nearly 7 percent decline in cardiovascular disease; and

a reduction in low birth weight.

The Spread of Government Deposit Insurance Throughout the World: Is This a Good Thing? For the first 30 years after federal deposit insurance was established in the United States, only six countries emulated the United States and adopted deposit insurance. However, this began to change in the late 1960s, with the trend accelerating in the 1990s, when the number of countries adopting deposit insurance topped 70. Government deposit insurance has taken off throughout the world because of growing concern about the health of banking systems, particularly after the increasing number of banking crises in recent years (documented at the end of this chapter). Has this spread of deposit insurance been a good thing? Has it helped improve the performance of the financial system and prevent banking crises? The answer seems to be “no” under many circumstances. Research at the World Bank has found that, on average, the adoption of explicit government deposit insurance is associated with less banking sector stability and a higher incidence of banking crises. * Furthermore, on average, deposit insurance seems to retard financial development. However, these negative effects of deposit insurance occur only in countries with weak institutional environments: an absence of rule of law, ineffective regulation and supervision of the financial sector, and high corruption. This situation is exactly what might be expected because, as we will see later in this chapter, a strong institutional environment is needed to limit the moral hazard incentives for banks to engage in the excessively risky behavior encouraged by deposit insurance. The problem is that development of a strong institutional environment may be very difficult to achieve in many emerging market countries. We are left with the following conclusion: Adoption of deposit insurance may be exactly the wrong medicine for promoting stability and efficiency of banking systems in emerging market countries.

Discuss the positive and negative impacts of this type of insurance.

Marsh & McLennan Companies is the largest provider of insurance brokerage services in the world. It holds itself out to its clients as a fiduciary that will act solely on clients’ behalf in purchasing insurance policies for them. Starting in 1987, Emerson Electric Company hired Marsh to act as its fiduciary in procuring various insurance policies, such as excess liability, aircraft, and international. Emerson paid Marsh substantial amounts of money to recommend insurance policies that met its needs at the lowest possible price. Unknown to Emerson, Marsh embarked on a business plan in the early 1990s in violation of its fiduciary duties to Emerson: Marsh entered into agreements with insurance companies under which the insurers agreed to pay Marsh monies in consideration of Marsh’s pledge to direct business to them. These agreements were referred to by various names such as placement service agreements or market service agreements. These documents were referred to as “ kickbacks.” At no time did Marsh’s disclose the nature or extent of kickbacks that it was receiving. As a result of Marsh’s breach of its fiduciary duties, Emerson paid an inflated price for its insurance policies. Additionally, Marsh directed Emerson to make its premium payments through Marsh itself, rather than directly to the insurance companies. The checks were made payable to Marsh. Unbeknownst to Emerson, Marsh did not immediately forward the premium payments to the insurers; instead, for a period of time before the insurance companies would be paid, Marsh would invest Emerson’s premium payments to earn interest, which it retained as profit. In Marsh’s 2003 Annual Report, it referred to this revenue item as “ fiduciary interest income.” Is this considered a breach of fiduciary duty? Why or why not? [ Emerson Electric Co. v. Marsh & McLennan Companies ( Mo. Ct. App 2011). Case No. 22054– 00569, www. courts. mo. gov, accessed September 6, 2011.]

Can anyone considerably dumb down what this abstract is telling me? I feel like reading this is like reading Latin to me. Can someone help me break down what is being said. Thank you so much.

Methyltransferase Set7/9 regulates p53 activity by interacting with Sirtuin 1 (SIRT1)

Numerous studies indicate that Sirtuin 1 (SIRT1), a mammalian nicotinamide adenine dinucleotide (NAD+ )-dependent histone deacetylase (HDAC), plays a crucial role in p53-mediated stress responses by deacetylating p53. Nevertheless, the acetylation levels of p53 are dramatically increased upon DNA damage, and it is not well understood how the SIRT1–p53 interaction is regulated during the stress responses. Here, we identified Set7/9 as a unique regulator of SIRT1. SIRT1 interacts with Set7/9 both in vitro and in vivo. In response to DNA damage in human cells, the interaction between Set7/9 and SIRT1 is significantly enhanced and coincident with an increase in p53 acetylation levels. Importantly, the interaction of SIRT1 and p53 is strongly suppressed in the presence of Set7/9. Consequently, SIRT1-mediated deacetylation of p53 is abrogated by Set7/9, and p53-mediated transactivation is increased during the DNA damage response. Of note, whereas SIRT1 can be methylated at multiple sites within its N terminus by Set7/9, a methylation-defective mutant of SIRT1 still retains its ability to inhibit p53 activity. Taken together, our results reveal that Set7/9 is a critical regulator of the SIRT1-p53 interaction and suggest that Set7/9 can modulate p53 function indirectly in addition to acting through a methylation-dependent mechanism.

p21waf1/cip1 | posttranslational modifications | tumor suppression

I think because there are so many names and players, and being unfamiliar with the terms, it's hard for me to understand.

Any help would be greatly appreciated. Thank you. I will gladly give a good rating.

Think about these three major ideas of the Enlightenment: 1) Political - Locke and Rousseau -Government by contract between the people and the rulers and popular sovereignty – i.e. inviolable constitutions are contracts and 2) Economic - Adam Smith – freedom to pursue individual economic self-interests benefits all of society – i.e. free-market capitalism.  3) Social - Jefferson - All people created equal and freedom is a natural right. Remember that these ideas (three key premises of 19^th century liberalism dating to the Enlightenment) share the stage with nationalism, imperialism, and industrialization.

Remember that LIBERALISM is the most direct descendant of the ideas of the Enlightenment.

Answer the following questions for the 1800s: (If you have examined and completed the notes, you will not have a problem answering these questions.)

Generally, considering the liberal reform efforts of 1) western Europe, 2) the US, 3) Canada, 4) Latin America, 5) the Ottoman Empire, 6) Russia, 7) China, 8) Japan, and 9) Africa, think about which nations/regions were able to implement real and long-lasting political, social, and economic reform during the1800s based on the ideas of Locke, Rousseau, and Smith as described above?

Answer the following:

1) Name one country/region (from the list above) that successfully established REAL and LASTING liberal reforms (not just on paper). ______________________ (Think results) 10pts.

2) In one sentence, provide one example OF THIS SUCCESS to justify your answer. Be specific. (They did good things for the people is not a specific answer..... Who did? What people? What good did they do politically, socially, or economically...?) 40pts.

3) Name one country/region (from the list above) that failed to implement REAL and LASTING liberal reforms. _______________________ (Think results) 10pts.

4) In one sentence, provide one example to justify your answer. Be specific. (It caused an economic or political crisis is not a specific answer..... What or who caused? What happen to the economy? What happened politically? Who suffered? ) 40pts.