Uncategorized – Page 55 – Julliethewriter

Advances in Technology

Introduction

Technological advancement is the order of the day in the 21st century. This comes along with plenty of positive value addition to the human life. An advance in technology is brought about by the rapid expansion of research and development sector in the multi-national companies. A perfect example of a company that invests in research and development is; Samsung technologies. This is one of the revolutionary companies that work day and night towards investing in new technologies. The rapid discovery of electrical appliances such as; microwave LED television, iPod, 7D technology, computers, cable internet and health technologies are enough evidence to support the rapid evolution of technological advancements.

Investing in health technology is one of my strategic investment areas. Developing a machine that helps HIV patients to reduce the number of viruses in the body by only exposing oneself to rays, without necessarily swallowing the anti-retroviral drugs is among my key investment plans in technology. Out of 9 billion of the planet’s population, 973 million people suffer from HIV. This exposes better side of the remaining earth’s people to contracting this disease. Therefore, to contain this menace, a machine that kills 95% of HIV virus inside the body of the victim is my technological investment goal.

Across the globe, HIV virus is a menace to every living population. This virus affects both the victims and the people close to the victim. This health technology reduces the number of deaths from the HIV patients. Thus, it works closely to saving more and more lives that are lost day-to-day from this dangerous disease. It also cuts on the budget of the victims in buying the drugs. Constant use of the drugs means a negative effect on one’s budget. This technology cuts on the victim’s expenditure by 300%. A victim needs to go for this type of treatment only twice a year, as a result, a significant reduction of budget expenditure is a notable thing to the society.

In conclusion, advancements in technology are the key strategic goals of any individual in the 21st century. This is due to its efficiency and simplicity. It doesn’t have plenty of negative impacts to the population using it.

Works Cited;

“Health Care Technology Today.” PT In Motion 5.5 (2013): 36-45.

Mount Kilimanjaro

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Mount Kilimanjaro

Mount Kilimanjaro for an extended period, has been termed as “The Shining Mountain.” A number of scientists articulate Kilimanjaro’s crest might soon stand out no more. In line with Professor Lonnie who is a lecturer at Ohio State University, the mountain’s ice fields could vanish by 2020. In his article published on October 18, in the years 2002 in the journal Science, Lonnie and his cowriters depict that the ice on the peak that formed over 11,000 years before has declined by 82 percent greater than the preceding century. The writers establish that the current, theatrical decline in the mountain’s ice top is predominantly remarkable given its diligence through numerous earlier shifts in ambiance, including a relentless 300-year-long dearth that effected human inhabitants living in the expanse approximately 4,000 years ago.

The images depict two angle views of the mountain on the month of February in 1993, as well as on the month of February in 2000. These representations were obtained by the Landsat 5 along with Landsat 7 satellites, correspondingly. The pictures illustrate extremely vegetated topography (green colors) just about the bottom of Kilimanjaro, whilst the foliage is comparatively sparred up the boundaries of the 19,335-foot stratovolcano. The light tans at elevated elevations illustrate rock, and naked land facade, exposing the crisscrossing drainage terrains stamped into Kilimanjaro’s countenance over the times by precipitation and snowmelt. At this point, the pictures have been swathed over a digital height model to provide a better intellect of the mountain’s 3D outline. It must be depicted that the disparities in the summit’s manifestation, in these prospects, are outstanding in large part to cyclic disparities in snow cover. It is never feasible to differentiate cyclic snow from frost in these representations; thus they cannot be employed as a sign of the velocity of the ice loss.

The initial well-certified atlas of the ice spheres atop Kilimanjaro was done in 1912. As a minimum, four surveys done from 1912 disclose, there has existed a continuing decline in the amount of the frost. Mount Kilimanjaro was instigated well-known in the western humankind by the highly praised essayist Ernest Hemingway who inscribed the small story “The Snows of Kilimanjaro” in periods of 1930’s. When one reflects on Africa, snow is typically one of the final aspects that come to mentality, other than Mount Kilimanjaro located in the region of Tanzania had a significant snow and ice topped peak for more than 11,000 years. The use of “had” is because the snow is speedily fading. It is yet an additional illustration of how an aspect so enduring has fallen casualty to man’s disparaging ways.

Mt Kilimanjaro’s significance far surpasses a pleasant photo chance or insight for a work of fiction. The ice ceiling was extremely significant to the adjacent area and was as well the basis of the Nile River. Numerous villages bank on the snow and frost liquefied water. Living things on the plains neighboring Kilimanjaro are presently vanishing and numerous plants are as well at jeopardy. Despite the reality that there is still several disputes amid the scientific society as to what is the basis of the diminishing ice; the universal consensus is global warming associated climate alteration. It is a strange characteristic this creation and the next creation have been onlookers to a number of the utmost global ecological mayhems for millions of years; along with maybe a “benefit” that people would wish not to encompass. No person would have contemplated that a creature, man, could precise such a duty so rapidly across the whole globe; even in locales that no person has hardly visited.

Summary

The decline of Kilimanjaro’s ice top has turned out to be the placard infant for the outcomes of universal warming. A number of scientists, elected officials and Media have been spiritual in censuring human actions. Nevertheless, fresh research depicts that the origins of Mt. Kilimanjaro’s well-established glacier decline is far extra multifaceted, probably effecting from a normal climate change that happened over 120 years that passed. This is lengthily before extensive use of fossil power. Therefore, scientific proof notifies us that the reduction of Kilimanjaro’s ice ceiling is merely an element of the recede and gush of the never-ending sequence of nature. This symbolizes an ideal instance of why methodical “accord” does not match scientific reality. This is the motive why people ought not act in rush, centering their deeds on methodical closes that have not been methodically scrutinized and analyzed regardless of being extensively quoted.

Analysis

The decline of Kilimanjaro’s ice top (not be puzzled with the “snows” of the mountain, which still change with the weather conditions) has grown to be the placard child for the outcomes of human-centered universal warming. The account is easy to enlighten – particularly with an associated series of snaps depicting the decrease of the mountain’s ice top. Any person can perceive the theatrical changes. Judgments of contemporary inspections with momentous photographs and journalism accounts merely seem to endorse the story (The Center for Science and Public Policy, 2). Melting ice appears to be an ideal symbol for universal warming; certainly, famous scientists, chief media outlets, in addition to, affiliates of the U.S. governing body have all associated melting ice with people-stimulated climate change.

Work Cited

The Center for Science and Public Policy. White Paper: The Consensus on Kilimanjaro is

Wrong (2003). Web. 15 Jun. 2012. Available at

<http://www.ff.org/centers/csspp/pdf/Kiliman-MAC-4-8-04.pdf>

Movements and Muscles involved in Spiking a Volleyball

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Movements and Muscles involved in Spiking a Volleyball

Volleyball is one of the many sports that are played using a simple technique; the capability to deliver a ball to a net against all efforts of the opposing team. A volleyball spike refers o the strong attacking action carried out by a person to score against the opposing team. Both muscular and skeletal systems are critical to the performance of body movements. A volleyball spike occurs in four key phases, namely the approach, arm cocking, arm acceleration, and follow-up. There are various movements that take place in the shoulder complex when spiking a volleyball. Both the glenohumeral and shoulder joints become elated, horizontally abducted, and externally rotated in preparation for the spike. The joints also go through scapular posterior tilt, trunk extension and right rotation, upward and external rotation and side flexion. The shoulder is classified as a diarthrosis, and its structure type is ball and socket. The main shoulder movements that take place are abduction, rotation, and extension at three degrees of freedom.

Some of the muscles involved in a volleyball spike include hamstrings, quadriceps femoris, gastrocnemius, and biceps brachii. Hamstrings have their origin in ischial tuberosity and insertion is the medial tibial condyle. Because the hamstrings are often activated during spiking, they are deemed eccentric. The quadriceps femoris originates from the femur and ilium. The femus is the thighbone while the ilium is the upper pelvis. The two come together at the kneecap and insert at the tibia. Quadriceps femoris functions concentrically. The gastrocnemius originates in the lateral head, which is the posterolateral aspect of the femure media head condyle. The gastrocnemius is both concentric and eccentric. The biceps brachii originated at the scapula and its insertion of the radial tuberosity of its radius. As regards its functioning, the biceps brachii is concentric.

Advanced writing in discipline

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(Instructors’ name)

(Course)

(Date)

‘Advanced’, ‘Writing’ and ‘Discipline’

This assignment requires all the students taking the advanced writing course to post something about the meanings of the words advanced writing and discipline. The post is supposed to include some definitions from the dictionary and then show how we understand the meaning of these three words. As it follows, I will first define the words as they are discussed in two different dictionaries, and then offer a definition that reflects my own understanding of the terms. In addition to this, I will also demonstrate some of my expectations of this particular course. I will also show what I expect to be covered or taught in the class and how we can our past knowledge and skills in communication and writing in advancing this course.

The Merriam- Webster dictionary has a number of definitions of the word advanced, a few of which only apply to this particular class. One of the most relevant definition of advanced in this dictionary is the one that describes advanced as being more than or being beyond introduction or elementary. Another essential definition describes advanced as much developed beyond or more than the initial stage. A third essential definition from this dictionary is the one that defines advanced as being further away from others when it comes to ideas or progress. One can, therefore, use this word in different circumstances. For instance, one can say advanced biology, chemistry or English class. One can also use the word to form a sentence like, advanced methods of science.

The online Dictionary.com also offers a number of definitions for the word advanced. One of the definitions offered in the dictionary defines advanced as being placed forward or ahead. Another crucial definition derived from this dictionary defines advanced as far or ahead or further along in complexity, progress, skill or even knowledge. Advanced is also shown or defined as embodying or pertaining to ideas, attitudes, and practices. In this case, the word advanced can be used to mean that one is taken or seen as being more liberal or enlightened when compared to the established, standardized or traditional. As it follows, these definitions can be used differently in sentences. One, for instance, can use the second definition of advanced in such sentences as, an advanced class in English, or taking a course in advanced Spanish. I understand the term advanced as any skills, knowledge, ideas, practices or attitudes that have developed more than the normal or usual stages. I understand that one has to learn more and acquire more skills and knowledge about a particular discipline to become advanced in that discipline.

The other word of interest in this post is writing. The term has numerous definitions according to Merriam- Webster dictionary. The dictionary defines writing as the process or act of one who writes or the art or act of forming characters or letter that are visible. The dictionary also defines writing as the practice or act of musical or literary composition. Writing can also be understood as the form or style of composition, or the profession or occupation of a writer. Dictionary.com defines writing as the act of a thing or person who writes. It also defines writing as putting or committing one’s ideas or thoughts into writing. I also have my own understanding of the term writing. I think that writing is not just the ability to put words together or the ability to draw characters or words that are presentable. To me, writing is the ability for one to put characters and syllables together so that they are able to make sense, communicate the intended message and show the level of expertise of that particular individual or writer. As it follows, I do not see someone who is able to take notes in class as a writer; neither can I take the notes the take down as writing. However, if that student is able to answer questions from the same class in the form of writing that show the understanding of the course material, and do it comprehensively and presentably, then I can take him as a writer, because he displays ideas, knowledge and skill.

Discipline is an extremely common word, and it has a number of meanings as presented by a number of dictionaries. The Merriam- Webster dictionary, for instance, offers a number for definitions for the term. It is essential to note that the word holds a number of meanings. For instance, it can be used to mean discipline, it can also be used to stand for a field of study, or training that molds, corrects or perfects moral character and mental faculties. The dictionary also describes discipline as the control obtained from enforcing order and obedience. Dictionary.com also has numerous definitions of the term. Some of these include training or molding to act according to rules. It is also defined as exercise, activity or a regimen that improves or develops a skill. It also defines discipline as punishment inflicted by way of training or correction. All these definitions are applicable in different cases. I understand discipline as a field of study that one chooses to specialize in above others.

These three words can be used together to come up with the term advanced writing discipline. This term can be used to mean a writing course in a certain discipline that is advanced. This writing course could have been covered in several other uncomplicated stages before one becomes qualified to undertake the advanced class. In such a course, it expected that the students would learn ideas; practices, knowledge and skills that will enable them become competent in writing or expressing their ideas through writing. It expected that by the end of the course, all students would have learned or refined their writing skills.

Challenges Facing National Parks’ Management

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Date of Submission:

Challenges Facing National Parks’ Management

Management of national parks and the areas related to them provide not only opportunities but also challenges. The opportunities that it presents are protecting the values of the national parks and provision of people’s enjoyment and appreciation. Challenges include ensuring these places are well protected and that the activities going on in the national parks benefit them and balancing them. National parks’ management also deals with controlling the capacity of visitors visiting the parks in a given time and the population of the wildlife in that given park (Manning, p1).Effective management of national parks is important for preservation and conservation of the wildlife. This essay will look at the various challenges facing the management of national parks and the approaches addressing the challenges.

National parks are tourist attraction sites. Tourists can’t be attracted by the national parks if there are no features of interest. It becomes a challenge to the management of the national parks to ensure the national parks have the necessary resources that would invite tourists to the park. The challenge is when it comes to making the decision on what to put up and what to improve in the national parks. The management is required to ensure that the improvements that they make are unique to the features of other tourist attraction sites. Approaches addressing this challenge have been raised such as providing luxury equipment and hotels within the parks. The approach ensures that tourists stay in the park and enjoy their stay as long as they would wish (Davis et al., p12)

The management looks forward to expanding the national parks to increase the volume of visitation as already discussed. The will to expand the national parks is met by one challenge that has troubled the management so much. People living around the national parks tend to encroach on the land holding the national park (James et al., p 162). Cultivation is the main purpose of this behavior of the people. Land encroachment makes it difficult for the management to expand the parks. It instead reduces the size of the land occupied by the park hence reducing the natural habitat. Appropriate measures have been taken to solve this problem. The management has pushed for fencing the area that should be occupied by the national park to avoid invasion by the residents.

National parks’ management aims at protecting the wildlife in the national parks. Protecting wildlife ensures that the national parks stay for as long as possible, and the benefits accrued to the existence of national parks are long term. Poaching has become a threat to this goal of the management. Wild animals such as elephants, leopards, buffaloes and many others are a main area of tourists’ attraction. Residents have made poaching an option to their living (James et al., p163). Elephants in national parks have become extinct due to their valuable tasks. Extinction of elephants and other animals would slowly fade the national parks. Approaches have been raised to address this matter. The wild services have increased the number of trained security to protect the wildlife. There are laws that have been passed to protect the wildlife. It means that if one is accused of poaching can face imprisonment or other charges. Villagers around the parks have also been offered well-defined hunting quotas. These quotas have reduced poaching since the villagers sell the quotas to companies or organizations (James et al., p168).

Training and education are an important aspect in that they install skills and knowledge to individuals. Lack or minimal skills in the management board of national parks has become a challenge lately (Decker et al., p13).Without the required training, it becomes difficult for one to determine certain variables in the national parks. A good example would be determining the wildlife population or evaluate the situation of a habitat (Decker et al., p13).Possession of skills, also helps the management board in making decisions on what should be done. Mostly, when a problem arises the level of skills possessed by the management determines how fast the situation will be handled. The government has offered training facilities and organized training programs to the management. The untrained personnel are taken through training to improve the level of skills in them.

Political pressure is another challenge that faces the management of national parks. As much as the management would like to expand the parks, there exists scarcity in development funds (James et al., p172).This problem is usually as a result of arguments in the political systems on the amount of money to be issued for the national park development. With this, the management and control functions of the park management cannot be met. It happens that the national income earned from tourism activities goes easily to the government. It becomes hard for the funds to be allocated back to the national parks for expansion, hence, delaying the expansion projects that the management has suggested. Pressure is mounted on the management sector instead. The solution to this problem is being worked on where the funding for the parks will be done in a way that it won’t be affected by politics. Through external fund and whenever the park’s wildlife capital has been restored. Park management activities would be financed by tourists and fees from safari hunting (James et al., 173).

Expansion of national parks has led to relocation of many people. It turns the population against the management of the parks. At times, there is a very high population living below living standards. These conditions and the anger in people about the relocation encourage people to practice poaching and at times attack the management directly. The people may also set up forest fires as a revenge mechanism. These extensive forest fires have led to environmental destruction (James et al., p174).Wildlife is destroyed where animals die, and vegetation burn down. Whenever it happens, the management tries as much as it can to put off these fires. It becomes a threat to the management. Extra cost that had not been budgeted for is required to finance for the extinguishing .The management has started an initiative where people are compensated after relocation to avoid this scenario (James et al., 174).

Wildlife damage has become a threat not only to the people around the national parks but also to the management. Wildlife damage is any act by the animals in the park that causes destruction to the property of the households living around the parks (Conover, p7).It happens due to poor protective boundaries between the national parks and the society living near the parks. When the animals break the walls, they cause damages to the crops, cause injuries to the people and some extent deaths. The management is hence faced with the challenge of compensating for the damages. Finances that had not been budgeted for are used. The management is also faced by the challenge of tracing the animals and taking them back to the parks. The activity of tracing the animals back to the park becomes very tiresome and sometimes dangerous. In order to avoid this, construction of strong electric fence round the national parks has been implemented.

In conclusion, the challenges facing the management of national parks are the same from one national park to the other. The management personnel across the national parks should hence, be skilled and with the ability to withstand the challenges. They should also have the ability to bring forward measurements that can address the challenges. Poaching has become the biggest threat to national parks’ management as discussed. It is facilitated by many factors, among them being poor management. In general, the management should enhance its relationship with those that border the parks. A good relationship between them improves the understanding between them, which would reduce such activities. For better handling of challenges to the management, the government considers employing skilled personnel. The management should also be corruption free to enable good utilization of the funds allocated to the national parks.

Works Cited

Manning, Robert. Parks and People: Managing Outdoor Recreation at Acadia National Park: University of Vermont Press, 2009.Print.

Davis E. Davis., Halvorson, Willian. Science and Ecosystem Management in the National Parks: University of Arizona Press, 1996.Print.

Anderson, Terry. James, Alexander. The Politics and Economics of Park Management: Rowman and Littlefield Publishers, USA, 2001.Print.

Decker, Daniel. Riley, Shawn. Siemer, William. Human Dimension of Wildlife Management: JHU Press, 2012.Print.

Conover, Michael. The Science of Wildlife Damage Management: CRC Press LLC, USA, 2002.Print.

Advanced, Writing and Discipline

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(Instructors’ name)

(Course)

(Date)

‘Advanced’, ‘Writing’ and ‘Discipline’

Mount St. Helens

On May 18, 1980, after lying dormant 123 years Mount St. Helens erupted powerfully and had a profound impact on the Pacific Northwest. On that summer day in 1980 Mount St. Helens produced a huge debris avalanche, an explosive lateral blast, lahars and an eruption column. In an instant the countryside and lakes surrounding a great distance around became victims of devastation.

Located in the state of Washington, St. Helens is considered to be the youngest and most active volcano in the Cascade Range. Although only 12th in height among the major Cascade volcanoes, scientists predict a significant increase in size in the future because the mountain is still in its cone building stage. Mount St. Helens stands atop an older volcano which historically, was probably one of the most explosive peaks in the Pacific Northwest. This assumption is evident through the amount of debris that is scattered for miles over the countryside. The oldest recognized products of the ancestral cone are a pumice layer which is dated at 37,600 years and a weathered mudflow deposit dated at approximately 36,000 years (Harris 1980). Evidence of glacial sediments containing fragments of the earlier mountain are dated at approximately 18,000 years and indicate that Mount St. Helens experienced at least one episode of glaciation. Present day lava content of St. Helens is composed of olivine basalt, dacite, and pyroxene andesite. The ancestral St. Helens, although almost buried beneath the recent core, has left behind much evidence of its previous eruptions. Pumiceous ash blankets the land for hundreds of miles and many valleys are filled with accumulations of explosive rubble. Modern day Mount St. Helens is a result of avalanche debris, explosion rubble and mudflow deposits erupted by its predecessor.

Modern day St. Helens also grew “through the extrusion of at least two large dacite domes and the production of glowing avalanches similar to those erupted by the ancestral volcano” (Harris 1980:171). The famous Spirit Lake surrounding Mount St. Helens is also a result of violent activity. The lake formed when mudflows form the volcano blocked the headwaters of a fork of the Toutle River and the lake was raised over 60feet by mudflows.

Prior to 1980, after over one hundred years of lying dormant, St. Helens had the opportunity to recuperate from its previous eruptions and develop its beautiful shape, rising approximately 3000 meters above sea level. (Sanders 2002) The landscape surrounding the mountain consisted of dense, temperate and coniferous rain forests.

Large areas had been partially modified by timber harvest activity and sparse alpine vegetation occurred at high elevations. Lakes and streams were also common to the area. However, by 1949 endless miles of roads covered the previously solitude mountain. By 1975 there were few roadless areas for hikers and wildlife and most of the trails had been converted to logging road (Williams 1988). According to the U.S Forest Service, timber harvesting had been “quite extensive, primarily on the south and east sides” (Williams 1988:32). The timber industry claimed that clearcutting was an economic necessity essential for providing timber and jobs. Clearcutting moved up Mount. St. Helen streams and efforts to replant the timberline clearcuts failed and once the vegetation was destroyed, the pumice became a desert, and few plants were able to grow. Only the north side of the mountain prior to the 1980 eruption remained in a semi-natural state, although fisheries were damaged by dams and erosion from logging (Williams 1988).

The Cascade Mountains, St. Helen’s being one of them, represent a volcanic arc that is created where the Juan the Fuca tectonic plate is moving eastward and subsiding beneath North America. The plate originated as magma, through rifts in the Juan de Fuca Ridge. The Juan de Fuca Ridge is the remaining northern segment of a larger oceanic feature called the Farallon Ridge. Most of this ridge has been over ridden by the westward drifting North American Plate. The rock that makes up the Juan de Fuca plate is heated to a degree that hot fluids are driven out. These hot fluids, which are mainly composed of water, then penetrate into the overlying wedge of mantle rock and cause chemical interactions that lower melting temperatures in the wedge. This causes blobs of magma to rise through the fractures in the crust and accumulate in chambers beneath the volcanic peaks of the Cascade Range and results in eruptions (Sanders et al. 2002).

Studies by members of the U.S Geological Survey were conducted and the results were published in 1978 by authors Crandell and Mullineaux. Based on the eruptive history and frequency of St. Helens eruptions the authors warned of the likelihood of future eruptions.

In the future, Mount St. Helens probably will erupt violently and intermittently just as it has in the recent geologic past, and these future eruptions will affect human life and healthy, property, agriculture and general economic welfare over a broad area…an eruption is… likely to occur within the next hundred years, and perhaps even before the end of the century” (Sanders et al. 2002:232)

These warnings however, did not reach a wide audience and were not taken very seriously by a majority of the public.

The issue was clouded by misunderstandings by the media, government officials, and even geologists. Two years after the publication by Crandell and Mullineaux Mount St. Helens erupted.

The first sign of activity at Mount St. Helens began On March 16, 1980. A series of small earthquakes were detected and on March 27, after hundreds of earthquakes had been detected, steam explosions blasted a crater through the volcano’s summit ice cap. The crater was estimated to have grown about 1,300 feet in diameter within a week (Brantley et al. nd). Two enormous crack systems had also crossed the entire summit area. 10,000 earthquakes had shaken the volcano by May 17, and the north flank had grown outward to form a noticeable bulge. This indicated to geologists that magma had risen high into the volcano. On the morning of May 18, 1980 and earthquake of magnitude 5.1, shook the volcano and within 20 seconds, the volcano’s bulge and summit slid away in the largest landslide in recorded history. The landslide was about 2.5km^3 (Pringle 1990). Powerful explosions were triggered because the landslide depressurized the volcano’s magma system. “Rocks, ash, volcanic ash and steam were blasted upward and outward to the north. This lateral blast of hot material accelerated to at least 300 miles per hour, the slowed as the rocks and ash fell to the ground and spread away from the volcano.” (Brantley et al. nd) The blast cloud is reported to have traveled as far as 17 miles northward from the volcano. An eruptive column was a result of the blast and rose more than 15 miles in about 15 minutes. The destruction continued as magma erupted from the new crater and a second eruption column was formed.

Just after 12:00pm pyroclastic flows consisting of ash, pumice and gas poured out of the crater, reaching speeds as fast as 80 miles per hour (Brantley et al. nd). The scorching ash quickly mixed with existing ice and snow and began to flow down all sides of the mountain. Debris was picked up on the way and included boulders reaching sizes of up to 20 feet in diameter (Volcano World nd). Strong winds then proceeded to blow the 520 million tons of ash eastward across the United States. 250 miles from the volcano, the city of Spokane, was enclosed in darkness (Brantley et al. nd).

Effects of the 1980 eruption were disastrous. There were 57 human fatalities, mostly due to suffocation from ash inhalation, and thousands of animals were killed including, 7000 big game animals and 12 million salmon. Hundreds of houses in the valley were destroyed, bridges were wrecked and vehicles were demolished. Deposits of mud and debris in the upper reaches of the North Fork Toutle Rive valley were so great that its floor was raised as much as 180 meters and debris dams formed lakes where none had existed before. A flood of water filled with mud, poured into the Cowlitz River and enormous amounts of sediment were dumped into the Columbia River and clogged the shipping channel. “Upstream in the Columbia, more than twenty oceangoing ships were trapped at Portland and Vancouver until the U.S. Army Corps of Engineers deepened the channel with dredges working around the clock” (Sanders et al. 2002:239) Ash clouds were seen drifting across three states, Washington, Idaho and Montana, and the volumes of rock, ice, mud, ash and debris were estimated in the billions of cubic yards.

Ash fall of up to 8cm in Washington and Idaho caused harmful problems clogged air filters that disabled vehicles and short-circuited electrical transformers, resulting in power outages. Breathing was so difficult in some areas that many had to wear masks. Needless to say much of the wildlife in the surrounding area was destroyed. Few trees and plants survived the eruption. “The volcano blew out a large portion of the mountainside and baked several hundred square kilometers of adjacent countryside to 400600 oC. The result was a lifeless moonscape punctuated by the ash-gray, leafless trunks of thousands of blown-down trees” (Life erupts at Mount St. Helens 1997:400)

Following the eruption, thousands of people were evacuated, some by helicopter. Emergency responses that included salvaging lives and property were the first priority. Work crews worked for weeks removing tons of ash from roofs, streets, sidewalks and parking lots. The U.S Army Crops of Engineers worked around the clock, deepening the channel of the Columbia River so that ships could be freed. People sought immediate need for information regarding volcanic events and hazards. As a result an Emergency Coordination Center (ECC) was established in Washington. The ECC consisted of experienced emergency response personal and was staffed 24 hours a day. Information was also provided through public meetings, press conferences, and briefings with government agencies and private businesses. Updates on the status of the volcano were also provided through “volcanic and seismic activity reports.”

Despite all the effort, the destruction and loss resulting from the volcano caused many to experience emotional problems and psychological problems.

“Some people made a scapegoat of Mount St. Helens, blaming the volcano for personal problems unrelated to the eruption” (Sanders et al. 2002:242-243)

Bibliography:

Zeilinga de Boer, Jelle and Donald Theodore Sanders. 2002. Volcanoes in Human History. New Jersey: Princeton University Press.

Harris, Stephen L. 1980. Fire & Ice The Cascade Volcanoes. Revised Edition. Seattle:

The Mountaineers.

Williams, Chuck. 1988. Mount St. Helens National Volcanic Monument. Seattle: The Mountaineers.

Pringle, Patrick. Mount St Helens: A Ten-Year Summary. Washington Geologic Newsletter. Vol. 18, No. 2, May 1990.

Brantley, Steve and Bobbie Myers. Mount St. Helens-From the 1980 Eruption to 2000.

Advanced Physical Assessment D.W.2

Student’s Name

Institution Affiliation

Introduction

Complications of ear pain present in adults and children. The differential diagnoses in such cases areotitis media and otitis externa including other complications. This paper provides an overview of the two conditions and the factors to consider for differential diagnosis.

Otitis Media (OM)

Otitis media is the inflammation/infection of the middle ear. It starts with an infection making it a middle ear infection occurring when fluid blocks the Eustachian tubes. The symptoms include fever, pain, and impaired hearing and in children troubled sleep, irritability, constant crying, and ear pulling (Acton, 2012). The causes are respiratory infection, allergies, exposure to cigarette smoke, tonsillitis, and for infants feeding while lying down.

Otitis Externa (OE)

Otitis externa is inflammation/infection of the external auditory canal or the ear auricle and times both the external auditory canal and the auricle. It is due to a bacterial infection, irritation, fungal infections, or allergic reactions (Osguthorpe& Nielsen, 2011). The signs and symptoms are hearing loss, tinnitus, occasional fever, erythema, itching, severe deep pain, discharge from the ears, cellulitis, ear pressure, edema, and other bilateral symptoms.

Physical Exam Findings

Physical examination of OM involves the middle ear’sotoscopy. Thefindings are the presence of erythema, bulging, cloud-like appearance, immobility of the tympanic, and presence of an effusion with an inflamed ear canal (Acton, 2012). For OE, physical examination is through the palpitation of the tragus. The external ear canal has edema, narrowing of the canal, erythema, and a cloudy and inflamed tympanic membrane.

Difference in Child and Adult Assessment

During assessment the difference is in the position of conducting the assessment. Childrenlie down with their head turned on one side(Acton, 2012). For adults, they are required to sit with the head tilted on the opposite shoulder. Moreover, pulling of pinna is effective in assessment for children.

Essential Health History Questions

The primary questions to be asked to determine the type, cause and extent of the disease including how the infection began and the duration of the infection. In addition, the current prognosis, onset, and past and family history should be sought. These should be impartial and objective to provide a clear hereditary and medical history.

Conclusion

Ear pain is often a diagnostic problem especially examination exhibits no pathophysiology. The pain can be due to inflammation/infection making it vital to conduct a critical assessment while observing the areas discussed above to eliminate any confusion and ensure the provision of the appropriate treatment.

Reference

Acton, Q. A. (2012). Otitis Media: New Insights for the healthcare professional: 2011 Edition: Scholarly Paper. Atlanta, GA: Scholarly Editions.

Osguthorpe, J. & Nielsen, D. (2011). Otitis Externa: Review and clinical update. South African Family Practice, 53(3), 223-229. http://dx.doi.org/10.1080/20786204.2011.10874089

Challenges Faced by Transgender Young Adults – Ethan Smith Letter to the Girl I Used to Be

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Institution of Affiliation

Date

Identity crisis is a common problem among young adults, especially transgender people who experience changes later in their lives. Gender dysphoria is phycological distress that results from an incongruence between an individual’s sex that is assigned at birth and one’s gender identity which they developed later in life. Young adults are at a stage in life that poses a major psychological problem in which a person fails to relate to either socially acceptable gender – male and female. While a person may be born female, and transform later in life to be a male, they may undergo psychological and hormonal changes that they previously not experienced. As a result, most transgender people are vulnerable to symptoms of depression and anxiety as they are not sure whether they will be fully adopted by society for what they have chosen to be and what they were previously. For this assignment, I will analyze the poem, “A letter to the girl I used to be” by Ethan Smith to help understand the challenges that young adults pass through especially those experiencing gender changes.

The text, “A letter to the girl I used to be,” highlights the story of a young man in his early 20’s narrating the changes and challenges that he faced when transforming from a female to a male. According to the poem, Ethan describes how it feels to be trapped inside the wrong body. He writes to a young girl, a female version of his younger self named Emily. Previously, he was a girl, but presently, he is a male. In the poem, Ethan goes back to the days when he was Emily, and here he experiences numerous challenges. For example, he states that every time she goes to watch baseball, a voice he no longer recognizes whispers “Ethan, do you remember? When you were gonna be the first girl in the major leagues-Seattle Mariners. Rally Cap.” By this, Ethan is referring to him as a young girl who reminds him of the time, he was young and wanted to be the first girl baseball league player. When Ethan was Emily, he wanted to be a baseball player, but maybe his ambitions have changed since transforming from a female to a male, and this is why he is conflicted about his past and present interests.

Identity crisis is a common problem among young adults, especially transgender people who experience changes later in their lives. Gender dysphoria is phycological distress that results from an incongruence between an individual’s sex that is assigned at birth and one’s gender identity which they developed later in life (Zucker, 2017). Young adults are at a stage in life that poses a major psychological problem in which a person fails to relate to either socially acceptable gender – male or female. While a person may be born female, and transform later in life to be a male, they may undergo psychological and hormonal changes that they previously not experienced. As a result, most transgender people are vulnerable to symptoms of depression and anxiety as they are not sure whether they will be fully adopted by society for what they have chosen to be and what they were previously. For this assignment, I will analyze the poem, “A letter to the girl I used to be” by Ethan Smith to help understand the challenges that young adults pass through especially those experiencing gender changes.

A common problem faced by the transgender population is social stigma (Verbeek et al., 2020), and this is a problem that has been highlighted in Ethan’s poem. According to the poem, before Emily converted to Ethan, she pretended not to care about what people said to her, “Didn’t let anyone tell you to wear shorts above your knees| Didn’t care if boys thought your hair fell on your shoulders just right.” Based on this, we learn that there is a certain manner in which boys and girls are expected to adhere to the norms in society, including having girls wear shorts above their knees to slightly reveal their thighs and have long hair that falls between their shoulders. While girls are expected to adhere to these values and norms, Emily was different, she could wear long shorts that covered her knees and just like a boy she had short hair that didn’t fall between her shoulders. It is because of this that she felt completely out of place and uncomfortable whenever she was close to her peers.

While being uncomfortable might not be a big issue, it is the beginning of the development of stigma, where everyone else doesn’t want to be associated with the transgender population. According to Ethan, stigma occurred whenever she was out with other girls. In the poem, he states that “But with girls, sleepovers meant the space between your should and hers| Was a 6-inch fatal territory.” Looking at the choice of words from the quote indicates how Emily was lonely from the stigma she experiences from hanging out with her friends. As a transgender, it is difficult to hang out with females as they might perceive transgenders to be dangerous. To females, transgenders are more masculine and are not supposed to invade their private space. According to Ethan, every time Emily went out for sleepovers, she had to keep it to herself, and could not get close to other girls during bedtime; the only space allowed to her was the space between her shoulders and other girls, meaning that she could not even get hug other girls goodbye without them perceiving a suggestive motive from her. While it might not what she wants, she can’t prevent them from perceiving her that way, and therefore, she had to observe a 6-inch distance not to distract the girls. To Emily, she was just there physically, but not because she felt entitled to hanging out and going for sleepovers as it made her feel out of place.

Due to increased identity conflict coupled with stigmatization, many of the transgender including adolescents find it difficult to live, and as a result, contemplate suicide (Kuper, Adams & Mustanski, 2018). Discrimination is one of the major issues that have led the transgender population to develop low self-esteem and confidence. Transgenders are a special group in that they are vulnerable to discrimination by the community, peers in school as well as in access to health services. As a result, these people feel that they don’t belong to society and they can only do so by conforming to the societal ascribed sex of either male or female. With everyone being on their neck all the time, transgenders may feel isolated from the normal population. For example, in schools or other public institutions, there are no specialized facilities meant to be solely utilized by the transgender population. Such facilities include restrooms that place the transgender people in a dilemma, not knowing which to use; if they use the male restrooms, they might not feel comfortable, and the same if they happen to use the female restrooms. As a result, these people, especially adolescents who at their age suffer an identity crisis, and such seemingly rejections may result in these individuals contemplating suicide.

According to Ethan in his poem, “A Letter to the Girl I Used to Be,” there are indications that she might have faced discrimination and stigmatization, and these could be the precursors for contemplating suicide. Based on the quote, “The year you turned eleven| Was the first time you said out loud that you didn’t want to live anymore,” is indicative that she wanted to commit suicide, kill herself for the tribulations she faced as a girl. Most girls start menstruation at the age of around 12 years but might get it at any time between ages 10- and 15-years (Sawyer et al., 2018). Emily was eleven years, implying that she was in the bracket age of menstruation. Being a transgender, it might have been difficult to deal with her new situation, and this inflicted her with psychological problems that led her to consider getting Emily out of the picture. It wasn’t easy for her to make such a decision as it took almost another eleven years to get Emily out. According to the poem, after having several sessions in therapy, Emily saw it impossible to make it to 21. His decision indicates how conflicted she was and she wanted to put her suffering to an end. According to Ethan, “In therapy you said you wouldn’t make it to 21| On my 21st birthday I thought about you| You were right.” According to the quote, Ethan remembers back during Emily’s therapy sessions how she said she wouldn’t make it to 21, an implication that Emily needed to be killed for another person to survive.

Another major challenge that is faced by the transgender population is the mixed salutation in professional references including in academics (Vincent, 2018). When transgender people need to be saluted, they might feel embarrassed being referred to by the gender with which they don’t like to be associated with, and as a result of this, it keeps many people from making salutations. While saluting a person Mrs., Mr. or Miss can be a gesture of respect, it can be at times an embarrassment. For example, a transgender woman who wants to be associated with the male sex may be offended to be referred to as a Miss or Mrs. Similarly in college, it would be a dilemma to provide a salutation to a transgender person without hurting them.

This issue has been highlighted in the poem, “Letter to the Girl I Used to Be,” in that it highlights what Ethan could have expected, and this is why he decided to perform the procedure to remove the female elements from his body, thus enabling him to stand upright. Through this, Ethan could fully be described and saluted as a Mr. in his future endeavors and this including in his upcoming college graduation. In the poem, Ethan states that “But now you will never hear “Emily Smith” announced at a college graduation,” and this tells it all that he feared what might have transpired if Emily was still inside him. It can also be the same issue that had forced Emily to contemplate suicide, to kill herself as she felt not to be part of Ethan’s life. She had no hope of making it to 21 when Ethan’s male features would have completely erased her, but some elements of her such as the breasts could still be seen.

Another major challenge faced by the transgender population includes hormonal imbalance, which manifests feminine or masculine characteristics in an individual (Agana et al., 2019). A transgender woman may have higher levels of estrogen, but at the same time, these levels may be lower or in level with a normal woman’s estrogen levels. However, in order to support masculine characteristics during puberty, some transgender women may experience high levels of testosterone, and this can encourage the build-up of masculine characteristics including the breaking of voice, broadening of the chest as well as the growth of facial hair. While some of these traits may manifest in low quantities, they might not be desirable for a woman to have, and therefore, it can be a precursor to self-isolation and depression to many transgender populations, and this also happens to men as well.

The hormonal problem has also been highlighted in the poem, “A Letter to the Girl I Used to Be,” where Ethan describes the physical changes that took place in order to eliminate Emily out of the equation. For example, Ethan states that “When the prescribed testosterone started taking effect,” to imply that he was put under a hormonal program to help boost his testosterone levels, making him more of a male than a female. Exogenous testosterone is a hormone used in transgender men to induce virilization and suppress feminizing characteristics (Shergill et al., 2019), and this might have been used to bring out more of Ethan and suppress Emily.

It is the dream of every woman to get married, get pregnant and bring up her family with love and affection. Transgender men and transmasculine people have the ability to get pregnant; these people get pregnant at rates similar to people who identify as women and have more planned pregnancies than cis women (Brandt et al., 2019). While it is easy to get pregnant, giving birth can be a problem, and even taking care of the children can even be more difficult since it will be difficult for the children to identify with. It is because of this reason, that many of the transgender declines getting pregnant and instead seek to transform into men. This concept of parenting and getting pregnancy challenges have been highlighted in the poem, “A Letter to a Girl I Used to Be,” in which Ethan highlights the potential problems he could have encountered if he wanted to have children. Ethan remembers how Emily loved to have children, but after transforming to Ethan, these dreams were foregone.

Ethan states that “I thought about your children, how I wanted them too,” indicating that both in the form of Emily and Ethan, wanted to have children. However, transforming into Ethan complicated issues made it worse in that a man could not get pregnant. Despite the fact that transgender men can get pregnant, getting to take care of the child might be another challenge. It is impossible to get the affection of a child if they dint breastfeed, and this is a common problem. According to the poem, Ethan states that “I let a doctor remove your breasts so I could stand up straighter,” indicating that Emily was no longer there to have her breasts. Instead, Ethan had to remove the breasts so that he could stand upright like a man. With the surgery, it would have been difficult to feed a baby. Ethan states that Now even if I somehow had those children, I wouldn’t be able to nourish them,” which means that he cannot nourish children as he is now a man.

Another major challenge faced by transgender is depression and anxiety which occurs when they are transforming from male to female or female to male (Chodzen et al., 2019). While these individuals might have suffered identity conflict for long, at times they might have given up and sunk into depression which is a common defense mechanism. However, when an opportunity arises to choose the right identity, they might get excited, but this is just the beginning of a long night scare. While the transformation might be successful, it leaves a scar that is not easy to hide and thus not easy to forget. For example, Ethan states that “A 19 you started to fade| I tried to cross you out like a line in my memoir,” indicating that Ethan was ready to take over from Emily. However, he wanted to erase Emily completely, crossing her out like a memoir, but this didn’t happen. Ethan states that “I wished I could erase completely,” not because he didn’t like her, but he no longer wanted to be associated with her feminine characteristics which made him feel uncomfortable. The phrase, “I wished” means that he could not do as he intended, and thus, parts or scars that belonged to Emily remained to be a reminder of her existence. According to Ethan, “And maybe I’m misunderstanding the definition of death| But even though parts of you still exist| you are not here,” a summation of the scars left, the suffering that Ethan still goes through in his daily living.

In conclusion, being transgender can be a big challenge especially if society does not appreciate people as they are regardless of their age, race or gender. Based on the poem, “A Letter to the Girl I Used to Be,” by Ethan Smith, there are various challenges faced by the transgender population, both at a personal and societal level. Some of the major challenges include discrimination from peers and other members of society which makes the transgender population develop stress leading to depression. Also, at personal levels, the transgender population may suffer an identity crisis, which results from the conflict about who they are, a girl or a boy. Furthermore, the goals in life differ by gender, and this continues to be a nightmare for transgenders.

References

Agana, M. G., Greydanus, D. E., Indyk, J. A., Calles Jr, J. L., Kushner, J., Leibowitz, S., … & Cabral, M. D. (2019). Caring for the transgender adolescent and young adult: Current concepts of an evolving process in the 21st century. Disease-a-Month, 65(9), 303-356.

Brandt, J. S., Patel, A. J., Marshall, I., & Bachmann, G. A. (2019). Transgender men, pregnancy, and the “new” advanced paternal age: A review of the literature. Maturitas, 128, 17-21.

Chodzen, G., Hidalgo, M. A., Chen, D., & Garofalo, R. (2019). Minority stress factors associated with depression and anxiety among transgender and gender-nonconforming youth. Journal of Adolescent Health, 64(4), 467-471.

Ethan Smith. “A Letter to the Girl I Used to Be.” Retrieved from: https://youtube.be/Lkn06Y8prDUKuper, L. E., Adams, N., & Mustanski, B. S. (2018). Exploring cross-sectional predictors of suicide ideation, attempt, and risk in a large online sample of transgender and gender nonconforming youth and young adults. LGBT health, 5(7), 391-400.

Sawyer, S. M., Azzopardi, P. S., Wickremarathne, D., & Patton, G. C. (2018). The age of adolescence. The Lancet Child & Adolescent Health, 2(3), 223-228.

Shergill, A. K., Camacho, A., Horowitz, J. M., Jha, P., Ascher, S., Berchmans, E., … & Brook, O. R. (2019). Imaging of transgender patients: expected findings and complications of gender reassignment therapy. Abdominal Radiology, 44(8), 2886-2898.

Verbeek, M. J., Hommes, M. A., Stutterheim, S. E., van Lankveld, J. J., & Bos, A. E. (2020). Experiences with stigmatization among transgender individuals after transition: A qualitative study in the Netherlands. International journal of transgender health, 21(2), 220-233.

Vincent, B. W. (2018). Studying trans: recommendations for ethical recruitment and collaboration with transgender participants in academic research. Psychology & Sexuality, 9(2), 102-116.

Zucker, K. J. (2017). Epidemiology of gender dysphoria and transgender identity. Sexual health, 14(5), 404-411.

Advanced Practice Registered Nurses

Student’s Name

Institutional Affiliation

Professor’s Name

Date

Advanced Practice Registered Nurses

Introduction

Advanced Practice Registered Nurses (APRNs) are registered nurses who have completed the necessary training in both clinical practice and advanced education and often offer medical services in community-based organizations. Adding to the prerequisite nursing teaching and certification necessary for all Registered Nurses, APRNs should hold at least a Master’s degree. APRNs are composed of clinical nurse experts, nurse midwives, nurse practitioners, and nurse anesthetists, and they all play a crucial role in future health care development (American Nurses Association, n.d). This paper discusses the favorable effects that APRNs care coordination may have on patient care in different clinical settings. Specifically, the describes the different ways in which APRNs may implement care management and care coordination in a specific health setting, ways in which EHR and information technology affect patient care, challenges and barriers associated with the implementation of coordination practices in clinical settings, and how APRN advocacy at the federal, state, and local levels affect legislative practices.

How an APRN Can Implement Care Coordination and Care Management Activities in an Healthcare Setting

The employment of APRNs to offer patient care in a wide range of clinical settings can positively impact the quality of patient services offered in the health setting by making sure that clients receive the services and treatments they need, monitoring patients for severe reactions to treatment or medications, and offering other essential patient support services. Additionally, advanced practice registered nurses can work together with other associates of the care team to establish a patient-centered treatment plan adapted to meet the patient’s specific needs.

According to Donelan et al. (2019), advanced practice registered nurses have been instrumental in developing and leading care management and care coordination programs in acute care hospitals. These programs are consistent with the ultimate goal of fulfilling the health care needs of those patients who suffer from complex chronic illnesses. In acute care hospitals, APRNs work with physicians to develop patient treatment plans and keep records of patients’ severe reactions to specific treatments.

How Information Technology and Electronic Health Records Influence Patient Care and Coordination

Electronic health records and information technology are vital in improving patient care and coordination since they help doctors and nurses efficiently and quickly access patient information. Therefore, implementing information systems is crucial in every health care setting as it provides improved access to evidence, thus; improving evidence-based nursing and patient care quality. Information technology offers many opportunities for developing and transforming patient care and coordination which include; dropping the rate of human mistakes, simplifying the burden of care coordination, improving the quality of clinical results, observing data over time, and making practices more efficient. In addition, using health information technology in health care facilities could improve patient safety by decreasing the occurrence of medication errors, the possibility of adverse drug reactions, and the proportion of non-compliance with best practices (Alotaibi, 2017).

Additionally, electronic health records promote patient care and coordination by enabling doctors taking of patients in various health care settings to share and continually update clients’ clinical data and then display the patient’s data in logical clinical groupings that can be readily accessed by other doctors in the health care setting. Also, practitioners can monitor their patients’ development over time and identify potential issues or problem areas with a higher degree of precision due to electronic health records.

Facilitating Factors, Barriers, and Challenges Related to Adopting Care Coordination Practices in Healthcare Settings

In healthcare settings, there are several factors that, when combined, stimulate the implementation of care coordination approaches. On the other hand, a number of challenges and issues also need to be resolved. Both facilitating factors and barriers to implementing care coordination can be identified at the organizational, individual, and interpersonal levels. Facilitating factors related to the implementation of care coordination in healthcare settings include; the availability of community resources that support care coordination, improved functionality of the clinical information technology, a growing trend in the healthcare sector toward assessing and rewarding excellence, and the increased petition for coordinated health care by the patients, payers, and other stakeholders (Lin et al.,2018). Other facilitating factors are the improved interactions between the patients and clinicians.

Some of the challenges and barriers to the implementation of care coordination in healthcare facilities include; the absence of financial incentives designed to encourage participation in care coordination on the part of healthcare providers and the overall lack of understanding and awareness of care coordination among healthcare practitioners, patients, and other people. Another barrier is the patient population which influences how care coordination practices are used (Lin etal., 2018).

How APRN Advocacy at the Local, State and Federal Levels Influences Legislative Practices and Effect this have on the Future of Advanced Nursing Practice in my Home State

At the local level, APRNs can recommend the city councils and all other local legislative authorities about the need to increase responsibilities and power for APRNs, which will assist them in obtaining support from the general public. This may help guarantee that the needs of the people who are supposed to be governed by the laws and regulations are met, both now and in the future. Besides, APRNs educate local policymakers on the benefits of their vast training and experience in order to enhance healthcare delivery and access for all.

At the state level, advanced practice registered nurses can work with regulatory agencies and state legislators to alter the laws and regulations that govern their professional practice. This may help ensure that patients receive the highest possible health care quality available. According to Brom et al. (2018), at the state level, the Full practice authority ensures that APRNs work within the scope of their training and allows the patients to find a qualified doctor independently. Lastly, at the federal state, APRNs and members of congress may work together to modernize the rules and regulations that govern the advanced nursing practice. This allows nurses to continue providing innovative patient care while maintaining the highest standards.

Conclusion

All health care facilities need to employ APRNs as they are responsible for the treatment and diagnosis of illnesses, as well as providing advice to the general public on matters about health, managing chronic diseases, and participating in ongoing education to stay abreast of any methodological, technological, or other improvements in the field.

References

Advanced Practice Registered Nurses (APRN) | American Nurses Association. ANA. Retrieved 15 September 2022, from https://www.nursingworld.org/practice-policy/workforce/what-is-nursing/aprn/.

Alotaibi, Y. K., & Federico, F. (2017). The impact of health information technology on patient safety. Saudi medical journal, 38(12), 1173. DOI: 10.15537/smj.2017.12.20631Brom, H. M., Salsberry, P. J., & Graham, M. C. (2018). Leveraging health care reform to accelerate nurse practitioner full practice authority. Journal of the American Association of Nurse Practitioners, 30(3), 120. DOI: 10.1097/JXX.0000000000000023Donelan, K., Chang, Y., Berrett-Abebe, J., Spetz, J., Auerbach, D. I., Norman, L., & Buerhaus, P. I. (2019). Care management for older adults: The roles of nurses, social workers, and physicians. Health Affairs, 38(6), 941-949. https://doi.org/10.1377/hlthaff.2019.00030Lin, C. C. C., Dievler, A., Robbins, C., Sripipatana, A., Quinn, M., & Nair, S. (2018). Telehealth in health centers: key adoption factors, barriers, and opportunities. Health Affairs, 37(12), 1967-1974.