Evidence Based Practice

March 21, 2010, was not EBP’s date of birth, but it may be the date the approach “grew up” and left home to take on the world.

When the Affordable Care Act was passed, it came with a requirement of empirical evidence. Research on EBP increased significantly. Application of EBP spread to allied health professions, education, healthcare technology, and more. Health organizations began to adopt and promote EBP.

In this Discussion, you will consider this adoption. You will examine healthcare organization websites and analyze to what extent these organizations use EBP.

To Prepare:

· Review the Resources and reflect on the definition and goal of EBP.

· Choose a professional healthcare organization’s website (e.g., a reimbursing body, an accredited body, or a national initiative).

· Explore the website to determine where and to what extent EBP is evident.


By Day 3 of Week 1

Post a description of the healthcare organization website you reviewed. Describe where, if at all, EBP appears (e.g., the mission, vision, philosophy, and/or goals of the healthcare organization, or in other locations on the website). Then, explain whether this healthcare organization’s work is grounded in EBP and why or why not. Finally, explain whether the information you discovered on the healthcare organization’s website has changed your perception of the healthcare organization. Be specific and provide examples.









Burns And Fluid Management in Major Burn Injuries.




Burn injuries lead to a fluid loss which is a problem that leads to morbidity and death. Thus, fluid replacement should form the bases for the modern burn treatment. This paper focuses on treatment of burns and management of fluids as well as reviewing approaches in fluid management to adults with burn injuries.


The objectives of this paper are addressed in a fourfold base. The first objective focuses on addressing the pathophysiology of burns. From this, the reader can understand the clinical progression of the injuries. Secondly, the paper aims at addressing the treatment methods which provides the necessary steps for management of the patient in general and fluid in specific. Finally, the paper aims at creating awareness of the increased demand for more research, publication, and funding to build a clear understanding of burns and fluid loss management.


In 2004 the World Health Organization reported that the rate of deaths resulting from injuries including burns is increasing. Thus, this raises the alarm for fire prevention such as smoke detectors and fire response, i.e., firefighters’ personnel. All these together with health care cost, create an economic burden. Moreover, a fluid loss that accompanies these burns needs to be adequately managed to increase survival of burn patients directly. However, there are controversies in regards right type of fluid management approach for the first 24 hours of a burn injury (Landry et al. 2013). Today, the accepted guidelines being used are liquid replacement formulas that were developed some decades ago.  To this end, current research focuses on the issue of burn patients being over or under fluid resuscitated (Haberal, Abali, & Karakayali 2010).


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Pathophysiology of burn shock

Severe burns occur in necrotic zone area beneath which lies the zone of statist lies. This result to production of inflammation mediators that contribute to increased permeability of the capillary leading to localized burn wound edema. This happens within minutes or hours and presumes the production of reactive oxygen species (Scott et al. 2005). These reactive oxygen species are very toxic cell metabolites which cause the local cellular membrane to dysfunction leading to an immune response. Consequently, decreased Transmembrane cellular potential occurs in both injured and uninjured tissues. Sodium ATPase is disrupted as a result of Cellular membrane dysfunction leading to Sodium ATPase activity. This causes a shift in intracellular sodium contributing to hypovolemic as well as cellular edema. Vasoactive mediators are also activated during heat injury. This causes vasoconstriction of the local surface, vasodilation and increased capillary permeability (Tricklebank 2009).This result to improved transfer of water, plasma proteins and inorganic solutes between the cellular spaces. Also, intravascular hypovolemic and haemoconcentration get to their maximum levels. This leads to fluid loss that needs sustained replacement to prevent end-organ hypoperfusion and ischemia. During this early stage several pathophysiology changes occur, and thus, appropriate fluid management needs implementation (Haberal, Abali, & Karakayali 2010).

Attempts to explain why there are high mortality and morbidity due to fire are being conducted. According to World Health Organization, the common risk factors are alcohol, smoke, cooking ground level stoves, open fires close to homes, setting water heaters to high temperatures and improper electrical wiring (Ahrens 2009)



Due to insufficient data on the right fluid management for burn patients, The American Burn Association provides the guidelines to resuscitative burn shock as they undertake their investigations (Singer, Brebbia, & Soroff 2007).These and other recommendations are discussed below.

Intervention Rationale
Adults whose burns exceed 20% TBSA should go through formal fluid resuscitation based on body size and burned surface area. Since the morbidity and mortality of burns increase with burn size, this intervention is important in helping to determine the burn surface area and put appropriate measures of control in place ( Hettiaratchy, S., & Papini, R. (2004).
Recommend the need to titrate fluid resuscitation regardless of its type, to sustain urine output to 0.5-1,0ml/kg/hr. The second recommendation emerged from the fact that most burn patients were being overenunciated. Meta-analysis of fluid requirement illustrated that the volume administered was more than the formula estimates, and mean urine output was on the high target level. Excessive fluid resuscitation can increase infection risks and complications which can result in death. To maintain a balance between too little and too much fluid is difficult and has led to complains by clinicians that current formulas are hard to follow. Thus, fluid titration should be automated and personalized during resuscitation to achieve better burn care outcomes (Bhat et al. 2004).
During the first 24 hours, formulas used in the initiation of resuscitation should provide 2-4 ml/kg body weight % TBSA of crystalloid. High volumes of hypertonic saline raise plasma sodium levels. This is associated with reduced urine output which is dangerous to patients. Therefore, regular sodium concentrations monitoring is essential because it helps reduce the risk of severe hypernatremia and acute renal failure.
A secondary survey should be conducted to identify other associated injuries All burnt, constricting, or covered in chemical cloths and jewelry should be removed to avoid further injury.  Flowing water should be used to cool and clean burns. Ice water should be avoided as it increases tissue injury ( Singer &Dagum 2008)
Parkland formula should be decreased to 3ml/kg % TBSA. Excessive fluid resuscitation is the major problem when it comes to fluid resuscitation. It can lead to pulmonary edema, acute respiratory distress syndrome, limb compartment syndrome and cerebral edema. Mostly it occurs when patients are under strict hydration and urinary output demands. Thus the need to reduce Parkland formula to 3% TBSA Pruitt Jr, B. A. (2000).  .
High lipid containing products such as Aloe Vera, lotion and honey can be used to treat superficial burns instead of antibiotics. Topical steroids should be avoided in burn treatment as they do not help in reducing inflammation. However, all deep burns require topical antimicrobial or dressing that is absorptive (Jull, A. B., Rodgers, A., & Walker, N. 2008).
Acid burns are not to be neutralized with a base and base burn should not be neutralized with an acid Patients who are burned with chemicals should be first brushed off the chemical and the skin flushed with running water for 30 minutes. Acid burns should not be treated with bases and vice versa. This intervention will reduce burn deterioration by limiting chemical reactions (Singer,  Brebbia, & Soroff 2007)
Initial treatment and assessment of severe burns should be done simultaneously with trauma resuscitation This intervention focuses on making the airways, breathing, and circulation stable. This will help reduce burn morbidity and mortality, related to suffocation. The evaluation involves checking for respiratory distress, smoke inhalation, checking for other injuries and cardiovascular status and defining the level of burn (Hoffman & Weinhouse 2011).
Patients with burns that are less than 10% TBSA can be given oral hydration unless there are complications or burns in mouth or airways. This intervention is important as it reduces the cost of care and complications related to intravenous resuscitation. It also helps to understand that all patients have different systemic responses to fluid loss. Thus, the demand for crystalloids is not the same for all patients.
Antibiotics should not be the common treatment for burns that are not deep Only burns that are deep require antimicrobial treatments (Campbell, Alderson, Smith, & Warttig, 2015).



Bhat, S., Humphries, Y. M., Gulati, S., Rylah, B., Olson, W. E., & Twomey, J. (2004). The problems of burn resuscitation formulas: A need for a simplified guideline. J Burns Wounds3(7).

Campbell, G., Alderson, P., Smith, A. F., & Warttig, S. (2015). Warming of intravenous and irrigation fluids for preventing inadvertent perioperative hypothermia. status and date: New, published in, (4).

Haberal, M., Abali, A. E. S., & Karakayali, H. (2010). Fluid management in major burn injuries. Indian journal of plastic surgery: official publication of the Association of Plastic Surgeons of India43(Suppl), S29.

Hettiaratchy, S., & Papini, R. (2004). ABC of burns: Initial management of a major burn: II—assessment and resuscitation. BMJ: British Medical Journal329(7457), 101.

Hoffman, R. S., & Weinhouse, G. L. (2011). Management of moderate and severe alcohol withdrawal syndromes. UpToDate. Waltham (MA): UpToDate.

Jull, A. B., Rodgers, A., & Walker, N. (2008). Honey as a topical treatment for wounds. Cochrane Database Syst Rev4

Landry, A., Geduld, H., Koyfman, A., & Foran, M. (2013). An overview of acute burn management in the Emergency Centre. African Journal of Emergency Medicine3(1), 22-29

Pruitt Jr, B. A. (2000). Protection from excessive resuscitation:“pushingS the pendulum back”.

Scott, J. R., Muangman, P. R., Tamura, R. N., Zhu, K. Q., Liang, Z., Anthony, J., … & Gibran, N. S. (2005). Substance P levels and neutral endopeptidase activity in acute burn wounds and hypertrophic scar. Plastic and reconstructive surgery115(4), 1095-1102.

Singer, A. J., & Dagum, A. B. (2008). Current management of acute cutaneous wounds. New England Journal of Medicine359(10), 1037-1046.

Singer, A. J., Brebbia, J., & Soroff, H. H. (2007). Management of local burn wounds in the ED. The American journal of emergency medicine25(6), 666-671.

World Health Organization (2004). The global burden of disease

Ahrens, M. (2009). Smoke alarms in US home fires. Quincy, MA: National Fire Protection Association, Fire Analysis and Research Division.Pham, T. N., Cancio, L. C., & Gibran, N. S. (2008). American Burn Association practice guidelines burn shock resuscitation. Journal of Burn Care & Research29(1), 257-266.

Haberal, M., Abali, A. E. S., & Karakayali, H. (2010). Fluid management in major burn injuries. Indian journal of plastic surgery: official publication of the Association of Plastic Surgeons of India43(Suppl), S29.

Tricklebank, S. (2009). Modern trends in fluid therapy for burns. burns35(6), 757-767.


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Definition of Alzheimer’s disease

Focused Ultrasound Therapy as A Means to Treat Alzheimer’s Disease


Definition of Alzheimer’s disease

The Alzheimer’s Association defines Alzheimer’s disease as a type of dementia which leads to problems with memory, thinking as well as behavior (What is Alzheimer’s, n.d.). The term dementia is used to define deterioration in mental ability that is serious enough to obstruct a person’s daily life. The World Health Organization (WHO) reports that Alzheimer’s disease is the most common form of dementia and that 60-70% of dementia cases are due to Alzheimer’s (Dementia, 2017). The Centers for Disease Control and Prevention (CDC) further defines Alzheimer’s as a progressive disease which begins with slight memory loss and can probably result in the loss of the capability to have conversations. The disease affects the part of the brain that controls memory, thinking, and language (Alzheimer’s disease, n.d.). About 5.5 million Americans were diagnosed with the disease as of 2013 (Hebert, Weuve, Scherr, & Evans, 2013). The 2017 estimates placed this number at 5.5 million when it comes to the prevalence. The Alzheimer’s Association reports that this illness is the 6th leading cause of deaths in the US.  More facts show that the disease mostly affects those above the age of 65 and that over 60% of these cases are women. The figures also show that 1 in 10 of the elderly has the condition. When it comes to global figures, over 20 million had dementia by 2011, and most of these cases were due to Alzheimer’s (Reitz, Brayne & Mayeux, 2011). Epidemiology reports by WHO showed that 50 million people had dementia by the end of 2017 where most of these cases are also Alzheimer’s (WHO, 2017).

The Alzheimer’s Association reports ten significant signs and symptoms of the disorder. The principal sign is memory loss which causes victims to forget recently learned information. Problem-solving and planning also become a major challenge. Familiar tasks that are usually done daily also become difficult to complete such as recording a television show. The people affected also tend to lose track of time, dates, and seasons. The most common case is whereby they will forget where they are and how they got there. A problem also arises in the use of words both in speaking and writing. This symptom is easily reflected in trouble in following or joining in a conversation. A person affected by Alzheimer’s disease will, therefore, stop mid-conversation and have no idea how to continue. They might also repeat themselves. A problem might also arise in finding the right vocabulary, and this can lead to calling things by their wrong names. Another symptom is the difficulty in comprehending visual images. This can result in difficulty in reading as well as judging of distances. Driving for people with Alzheimer is, therefore, very problematic. Another significant symptom also is the misplacement of things and the lack of ability to retrace steps to find these things. They might, therefore, end up accusing others of stealing which does occur frequently. Another sign is the sudden withdrawal from social activities and also work as well. This is characterized by having trouble in keeping up with favorite things such as sports teams and hobbies. They may also develop anti-social behavior. There is also poor judgment or decision-making which can relay affect their rationale. Grooming becomes an issue as they do not keep themselves clean. A final sign is a change in mood and personality characterized by symptoms such as confusion, depression, fear, anxiety, and even acting suspiciously. Despite all these being signs and symptoms of Alzheimer’s, it is important to understand that some of these symptoms are typical age-related changes which can occur in the elderly. The concern should arise when these signs persist over a period but not when they occur once in a while (10 early signs, n.d.).

There isn’t a cure for Alzheimer’s currently. However, treatments exist which improve both behavioral and cognitive symptoms as more research continues in search of new treatments. Focused ultrasound therapy is one of these treatments, and is quite promising.


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Information about focused ultrasound therapy

Focused Ultrasound therapy is a non-invasive, early stage, and therapeutic technology that possesses the potential to improve the quality of Alzheimer’s patients and also decrease the cost that is associated with the disease. According to the Focused Ultrasound Foundation, this ultrasound technology focuses beams of ultrasonic energy accurately and precisely on targets found in the brain. This is done without harming the adjacent normal tissue. The beams converge at a given region in the brain, whereby the ultrasound produces a range of beneficial effects without any radiations and incisions (Alzheimer’s disease, 2018).

The history of focused ultrasound dates back to 1880 when the Curie brothers discovered piezoelectric effect in certain crystals which led to the evolution of techniques involving high-frequency echo-sounding. Following this in 1915, hydrophones were discovered, which were high-frequency ultrasonic devices. A great step occurred in 1935 when Gruetzmacher found that an ultrasound could be focused. The idea that ultrasound could be intensely focused on diseased tissue within the body surfaced in 1942. Lynn et al. had a view that such focusing would produce extreme heat and non-invasively destroy targeted diseased tissue. The year 1944 saw Lynn and Putcham achieve a milestone by destroying cerebral tissue in animals using focused ultrasound. The first therapeutic use of ultrasound was in 1950 when Leksell designed a specially adapted frame and ultrasound transducer which was applied for the treatment of psychiatric disorders. Another remarkable time in the history of ultrasound was in 1962 when Meyer and Fry used focused ultrasound to treat Parkinson’s disease. Since then, focused ultrasound has been used to treat thyroids, brain cancers, and brain tumors. More advancement has been made through time culminating in 2017 when the first clinical trial of focused ultrasound for Alzheimer’s began in Canada. Focused ultrasound is used in collaboration with Magnetic resonance imaging (MRI) to provide imaging which is important in guiding the ultrasound (Timeline of focused ultrasound,  n.d.).

The Cause of Alzheimer’s disease

Although the cause of Alzheimer’s disease is not yet entirely understood, it is widely agreed by scientists that it is caused by a mixture of various factors such as genetic, environmental, and lifestyle factors that affect the brain over time. Various risk factors have been put forward and are likely to lead to the Alzheimer’s disease. The risk factors of this illness include age, Down syndrome, family history and genetics, sex, mild cognitive impairment, lifestyle and the health of the heart, past head trauma, lifelong learning and social engagement. When it comes to genetics, the risk of developing Alzheimer’s is high if a first relative, whether a sibling or parent, has the condition. Three genes have been identified by scientists, and these are likely to mutate leading to Alzheimer’s. However, this has been found to be a rare cause. The ApoE4 gene, responsible for creating the apolipoprotein E4 protein has been found to be highly associated with the disease. This discovery is however not conclusive. Lifestyle factors that might increase the risk of developing Alzheimer’s include obesity, the lack of exercise, the exposure to smoking, high blood pressure, high blood cholesterol, poor diet, and poorly controlled type 2 diabetes (Reitz & Mayeux, 2014).

Increasing age has been recognized as the highest risk factor for Alzheimer’s, especially after the age of 65. Also, the extra chromosome that causes Down syndrome contains a gene that highly increases the risk of Alzheimer’s. When it comes to sex as a risk factor, women are more likely to develop Alzheimer as compared to men. This has been associated with the fact that women are more likely to live longer. People are also required to involve themselves in lifelong involvement in socially and mentally stimulating activities.

Biological cause of the disease

There are various biological changes that result from Alzheimer’s disease. The illness kills and harms brain cells. The result is lesser cells and much lesser connections among the surviving cells ultimately leading to brain shrinkage. Two abnormalities on the brain tissue can be observed under a microscope for this condition. These include plaques and tangles. These two have been revealed as the hallmarks of Alzheimer’s disease.

Plaques are described as abnormal clusters of beta-amyloid, which are chemically “sticky” proteins that build up in between nerve cells. The result of this protein build-up is the blocking of cell-to-cell signaling at the synapses. These plaques might also trigger an immune response leading to inflammation and the devouring of the disabled cells. Tangles, on the other hand, are twisted fibers of a protein referred to as tau which forms inside dying cells. Tau proteins are significant in the stabilizing of microtubules which are a part of the cytoskeleton and are an integral part of the transport system. These proteins are more common in the Central Nervous system. When tangles form, the twisted strands of tau affect the structure of the microtubules hence the transport of nutrients and other essential supplies through the cells. These cells, therefore, ultimately die. The formation of plaques and tangles has been found to begin in areas of the brain associated with memory and learning, before spreading to other regions (Selkoe, 2015).


Limitations of Drug and Antibody Therapies

Reasons to why these procedures are ineffective

The major treatments for Alzheimer’s at the present include medications for memory loss, whereby a few medications have been approved by the US Food and Drug Administration (FDA). These include memantine and cholinesterase inhibitors which treat cognitive symptoms of Alzheimer’s including confusion, memory loss, and reasoning problems. Antibodies therapy is also being developed for Alzheimer’s. These antibodies are targeted against the amyloid-β (Aβ) peptide which causes plaques. Also, treatments for behavioral changes include providing emotional comfort. These treatments have, however, been found not to be effective. They only help for a time with the symptoms (Schneider et al., 2006).

The major reason for this is that drugs and antibodies are unable to cross the naturally occurring blood-brain barrier which impedes the ability of the drugs the anti-amyloid antibodies to infuse into the central nervous system. This is the reason why focused ultrasound therapy is very promising as it has been able to open the blood-brain barrier in patients with Alzheimer’s disease (Montagne et al., 2015).

Biological reason to why these procedures have limitations

The blood-brain barrier (BBB) is the main challenge for Alzheimer treatment. It is a semi-permeable membrane barrier that is highly selective.  It is a term that describes the unique properties of the Central Nervous System (CNS) microvasculature or rather the smallest systems of blood vessels in the body. These vessels are continuous non-fenestrated vessels meaning that they lack pores in their endothelial cells. They also possess special properties that allow them to tightly regulate molecule, cell, and ion movement between the CNS and the blood. The BBB epithelial cells can tightly regulate the CNS homeostasis due to their highly restricting barrier capacity. These properties allow for the protection of the CNS from pathogens, toxins, injury, inflammation, and disease. It also allows for proper neuronal function. Neurological diseases such as multiple sclerosis, stroke, neurodegenerative disorders, and brain traumas can lead to the partial or full loss of these properties of the BBB. This loss is also a major contributor to the progression and pathology of CNS diseases. Dysfunction of the BBB can also lead to altered signaling homeostasis, ion dysregulation, and other processes that can lead to neuronal dysfunction and degeneration. It is therefore of utmost importance to find a completely safe way of opening up the BBB without leading to these complications (Montagne et al., 2015).

Benefits of Ultrasound Therapy

Reasons to why ultrasound therapy is more beneficial than previous procedures

Studies have shown that when it comes to drug and antibodies treatments, only about 0.1% of the therapeutic antibodies enter the brain due to the BBB. This translates to a very high cost of Alzheimer’s treatment due to the amount of medication required. Ultrasound sound therapy is beneficial in that it can be used to temporarily open the BBB, which increases the uptake of drugs or antibodies hence decreasing the number of expensive treatments. Ongoing research also shows that ultrasound therapy can potentially be used to target plaques and destroy them. Although these are ongoing studies, focused ultrasound therapy is still used to produce therapeutic effects in targeted areas in the brain without having to undergo the side effects that are caused by drug intake (Meng et al., 2017).

Pros and cons of this procedure

The advantages of Focused Ultrasound Therapy include the fact that it is non-invasive. The procedure involves no incisions, electrodes, or even holes in the skulls. The risk of infection and blood clots is therefore greatly reduced. The process also greatly minimizes any damage to the healthy brain that is non-targeted. This therapy can also complement drug therapy through temporary opening the blood-brain barrier. It is, therefore, more cost-effective compared to drug treatment. The cons of this procedure lie in the fact that it is still in its early phases of development. The safety of opening the BBB has not completely been assessed as the implications of repeatedly opening it (Meng et al., 2017).

Trials on Mouse Models

Researchers in Canada have undertaken experimental studies on mice to find out the feasibility of utilizing focused ultrasound therapy to open up the BBB. They used MRI-guided Focused Ultrasound targeting to the hippocampus, which is a brain structure highly relevant for Alzheimer’s, aimed at opening up the BB and improving pathologic abnormalities and behavior. The test was a success with spatial memory improvement being observed in a Tg mouse model of Alzheimer’s disease (Burgess et al., 2014). Furthermore, a report was submitted from the University of Toronto, Canada detailing another mouse model in 2016. The research was focused on the lifespan of one focused ultrasound-mediated BBB treatment in a mouse model of Alzheimer’s. Although this study was successful in imaging of the plaques, it failed to determine the lifespan of one focused ultrasound which is significant in determining the frequency of treatment required for Alzheimer’s disease (Poon & Hynynen, 2016).


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The Future of Ultrasound Therapy

Preclinical studies involving Focused ultrasound and microbubbles have been found to be promising as a big step towards the treatment of the Alzheimer’s disease. It has been found that a combination of focused ultrasound and microbubbles can potentially safely open the blood-brain barrier which can then facilitate and enhance the delivery of anti-amyloid antibodies to the brain. This can go a long way in improving cognition as well as reducing the number of plaques in Alzheimer’s disease models. Focused ultrasound and microbubbles alone in the absence of antibodies have also been found to have similar effects in two different Alzheimer’s models. These models have served as significant preclinical evidence. Clinical trials are therefore underway thus suggesting a promising future of ultrasound therapy and that of Alzheimer’s disease treatment (Miller & O’Callaghan, 2017).


Alzheimer’s disease is a leading cause of death globally due to its lack of a cure. The already existing drugs only treat the symptoms for a while and are therefore considered ineffective. Their ineffectiveness is due to the inability of drugs and antibodies to cross the blood-brain barrier and deliver the treatments. Focused Ultrasound therapy promises to address these shortcomings by being able to open the BBB for the treatments to pass through. Trials on mouse models have already proved successful in opening up the BBB. More tests are still being done on mouse models of Alzheimer’s disease to determine after how long the barrier remains open before human experimental studies are done. More research on the targeting of plaques through MRI-guided focused ultrasound is also recommended. For now, the biggest issue is the safety of the procedure. From the research conducted, MRI-guided Focused ultrasound therapy remains the greatest hope of attaining an effective treatment for Alzheimer’s disease.


Alzheimer’s disease, (2018). Retrieved from https://www.fusfoundation.org/diseases-and-conditions/neurological/alzheimers-disease

Alzheimer’s disease, (n.d.). Retrieved from https://www.cdc.gov/dotw/alzheimers/index.html

Burgess, A., Dubey, S., Yeung, S., Hough, O., Eterman, N., Aubert, I., & Hynynen, K. (2014). Alzheimer disease in a mouse model: MR imaging–guided focused ultrasound targeted to the hippocampus opens the blood-brain barrier and improves pathologic abnormalities and behavior. Radiology273(3), 736-745.

Dementia, (2017). Retrieved from http://www.who.int/mediacentre/factsheets/fs362/en/

Hebert, L. E., Weuve, J., Scherr, P. A., & Evans, D. A. (2013). Alzheimer disease in the United States (2010–2050) estimated using the 2010 census. Neurology80(19), 1778-1783.

Meng, Y., Volpini, M., Black, S., Lozano, A. M., Hynynen, K., & Lipsman, N. (2017). Focused ultrasound as a novel strategy for Alzheimer disease therapeutics. Annals of neurology81(5), 611-617.

Miller, D. B., & O’Callaghan, J. P. (2017). New horizons for focused ultrasound (FUS)–therapeutic applications in neurodegenerative diseases. Metabolism-Clinical and Experimental69, S3-S7.

Poon, C., & Hynynen, K. (2016). LIFESPAN OF ONE FOCUSED ULTRASOUND MEDIATED BLOOD-BRAIN BARRIER TREATMENT IN A MOUSE MODEL OF ALZHEIMER’S DISEASE. Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association12(7), P180.

Reitz, C., Brayne, C., & Mayeux, R. (2011). Epidemiology of Alzheimer disease. Nature Reviews Neurology7(3), 137.

Reitz, C., & Mayeux, R. (2014). Alzheimer disease: epidemiology, diagnostic criteria, risk factors and biomarkers. Biochemical pharmacology88(4), 640-651.

Schneider, L. S., Tariot, P. N., Dagerman, K. S., Davis, S. M., Hsiao, J. K., Ismail, M. S., … & Sultzer, D. L. (2006). Effectiveness of atypical antipsychotic drugs in patients with Alzheimer’s disease. New England Journal of Medicine355(15), 1525-1538.

Selkoe, D. J. (2015). Alzheimer disease. In Rosenberg’s Molecular and Genetic Basis of Neurological and Psychiatric Disease (Fifth Edition) (pp. 753-768).

Timeline of focused ultrasound, (n.d.). Retrieved from https://www.fusfoundation.org/the-technology/timeline-of-focused-ultrasound

What is Alzheimer’s, (n.d.). What Is Alzheimer’s? Alzheimer’s association. Retrieved from https://www.alz.org/alzheimers_disease_what_is_alzheimers.asp

10 early signs, (n.d.) 10 Early Signs and Symptoms of Alzheimer’s. Alzheimer’s association. Retrieved from https://www.alz.org/10-signs-symptoms-alzheimers-dementia.asp


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Business Ethics Chapter 6 – Employee Responsibilities

Multiple Choice Quiz



Which of the following aspects of the relationship between Enron’s special purpose entities (SPE’s) and Enron itself is not particularly egregious?
A) Enron had no reason for forming SRE’s other than to create a deceptive impression that it was in better financial shape that it actually was.
B) Hedging risks by entering into agreements with oneself does not lower risks.
C) Underwriting one’s own risks is not underwriting them at all.
D) Using Enron’s own stock to finance the SPE’s provided a very strong incentive for Enron management to keep its stock value high.
E) All of the above.
F) None of the above.


Which statement is not true of the agency concept?
A) In actual fact, not all agents are employees.
B) Under the common law tradition of the United States, all employees are treated as agents of employers.
C) The primary responsibilities in the employer-agent relationship lie with the employer.
D) The law has described the employee-employer connection as a master-servant relationship.


Select the statement that does not support the narrow view of non-managerial employees’ responsibilities to their employer, the idea that the employer exercises a great deal of control over the nature and terms of employment with very little discretion given to the employee:
A) Employees consent to obeying managers when they take a job.
B) Employees who agree to obey employers are not truly abandoning their own responsibility.
C) The choice of obeying someone’s command or jeopardizing one’s job is a fundamentally coercive situation and, therefore, the consent involved is not fully free.
D) Owners have property rights and have to be protected against the harms they might suffer from employees.


Identify the statement that does not correctly present the fiduciary relationship that is said to exist between managerial employees and employers:
A) Managers have special expertise that owners must rely on, so they are given wider responsibilities .
B) Managers are free from close day-to-day oversight by owners.
C) Because managers have greater freedom from day-to-day supervision by owners, they are not generally understood to have a strong fiduciary duty to always act in the best financial interest of the owners.
D) The legal duties of loyalty, trust, obedience and confidentiality are understood to override the manager’s personal interests.


Identify the statements that reflect the varied owner interests corporate managers are supposed to serve:
A) Investors buy stock because they believe in the company and its products.
B) Investors are playing the stock for short-term gain.
C) Investors see their stock ownership as an investment in a company and its technology.
D) Investors see their stock ownership as a long-term investment for personal retirement and security.
E) All of the above.
F) None of the above.


Which statement describes a managerial action that does not unethically impose costs upon stockholders and other stakeholders?
A) The action imposes unwanted costs on stockholders and stakeholder by giving up some alternatives in favor of others in the interest of maintaining the fiscal stability of the enterprise.
B) A personal interest of a manager hinders the exercise of his or her professional judgment.
C) A portion of some payment is kicked back to the payer as an incentive to make the payment in the first place.
D) Financial advisers receive payments from a brokerage house to pay for research and legal services that should be used to benefit the advisers’ clients, not the advisers’ personal interests.


Select the statement that, ethically speaking, best represents a valid concept of what loyalty to a firm means:
A) Loyalty means a willingness to sacrifice one’s own interest by going above and beyond ordinary employee responsibilities.
B) Loyal employees are expected to sacrifice for the firm even though the firm is not necessarily bound to sacrifice for the employee.
C) Since the model of agency law lays a legal duty of loyalty on employees, employees clearly have a corresponding ethical responsibility to be loyal.
D) While a willingness to sacrifice might be a part of loyalty, it would seem that devotion and faithfulness to a common good is both more essential to loyalty and what explains the willingness to sacrifice.


Identify the statement that challenges Albert Carr’s analogy that, like poker, business is a game that has its own rules and, therefore, is exempt from ordinary requirements of morality:
A) Carr overestimates the prevalence and acceptability of dishonesty within business.
B) Even if business did have its own set of ethical conventions, that fact alone does not exempt it from ordinary ethical evaluations.
C) There are major disanalogies between business and games like poker that weaken the conclusions drawn from Carr’s analogy.
D) Unlike poker games, individual often have no choice but to participate in business practices.
E) All of the above.
F) None of the above.


According to Richard DeGeorge, which statement presents a condition that makes blowing the whistle on a company not just permissible but obligatory?
A) A threat of serious harm exists.
B) The whistleblower has exhausted all internal channels for resolving the problem.
C) The harm to be prevented overrides the harm done to the firm and to other employees.
D) The whistleblower has good reason to believe that blowing the whistle will prevent the harm.


Select the statement that is not a criticism of insider trading:
A) The insider benefits inappropriately by buying or selling the stock at a price below or above what the market will demand when the inside information is made public.
B) An insider can benefit by trading on bad news as well as good, and this might be an incentive to work against the firm’s best interests.
C) The insider’s action sends the correct message to the market, reflecting the stock’s true value, moving the market toward equilibrium.
D) The insider’s information is often used without the firm’s permission in a way that harms the stockholder’s interests.

Stress Management & problem-solving strategies

What Other Suggestions Would You Give To Help Angela Manage Her Stress?


  • What problems does Angela appear to have right now, and what problem-solving strategies might Angela use to approach her problems?

The problem Angela appears to have right now is she is overwhelmed and stressed at work, and it is following her home. Angela also started going to school, which is (or can be), a huge stressor all by itself. It really does not help that the person she brought in to help take the stress from her is making her work life harder. She is also developing some unhealthy habits to cope with stress, which in turn will affect her health. Angela should practice some self-care as opposed to self-destruction.

The problem-solving skills I would suggest using to approach her problem are taking a step back, calming herself, and being open to having a much-needed conversation with everyone around her. “Successful problem-solving in the workplace takes the same tools as it does in every other place: respect, kindness, and honesty (Post, 2010).” I would suggest she implements respect, kindness, and honesty while practicing active listening and doing some team-building exercises. If nothing else, it can boost morale and ultimately boost production.

  • What are some conflict-resolution strategies Angela could implement to resolve her issues?

Some conflict-resolution strategies Angela could implement to resolve her issues with the employees’ making errors and shipping delays, is approach the employees with some humility. Get down to the root of the issues. They are people just like her with their own stressors. The issue may be the employees are rushing through orders to meet a deadline and making silly mistakes. They can hire a few extra people to help take the load from the other employees or stretch the deadline.

To reach a resolution with her supervisor she should sit down with him and “use this sentence to open up discussion: “I feel (emotion) when (action or words said) because (unexpected result) (Woodfill, 2009).” It is super important, when having a conversation to resolve conflict, that you do not place blame on people. Using “I feel” can help you appropriately express how you are feeling and how certain actions are affecting you without pointing the finger. People are much more receptive when they do not feel attacked.

To reach a resolution at home I would suggest Angela sit down and just let her family know what is going on. Be open and honest with her partner and child. It is way easier said than done but Angela needs to leave work life at work and home life at home. She works to live, not lives to work. I would suggest they schedule out some family time once or twice a week where they can reconnect as a family or at least as a couple.

  • What assumptions is Angela making about her new supervisor?

The assumptions Angela’s making about her new supervisor are that he does not respect her, and he is constantly telling her how to do her job. I feel like she thinks he is trying to undermine her when, in fact, he may just be trying to make suggestions to help make the job easier for her. I know I can be stubborn and set in my ways and that makes it hard for me to be receptive to other ideas. I do not usually feel undermined, but I can understand why someone would. I strongly believe respect is earned and not given. The new supervisor could feel like Angela does not respect him; therefore, he is not going to give the respect back. Especially after Angela lost her temper at the meeting.

  • What role (if any) might communication (or miscommunication) play in this scenario?

Miscommunication and communication are playing a role in this scenario. Angela may not be communicating properly and that leads to miscommunication. Not only that but, more than likely, she is not listening to people effectively. Angela is incredibly frustrated. For me, it is so easy to get stuck in my own head. When that happens, nobody can tell me anything. Also, when I am angry or stressed out, I have a tough time expressing exactly what I am trying to say. I have to walk away from the situation, calm down and think about what I am going to say next. I usually write it down so I can be clear and concise. That helps me from saying something I would regret.

  • What suggestions can you give Angela for managing her stress?

Some suggestions I would give Angela for managing her stress are, if she can afford it, taking some time off work to reset and relax. I would also suggest Angela started doing some daily self-care. For example, running or meditating. Meditation is the practice of an extended state of contemplation for achieving calm, psychological balance, and well-being (Longe, 2022).” I would recommend she meditates in the morning to start her day off right and after work so she can leave work at work and enjoy her family. Running can help get some anger and stress out while increasing her energy levels. The last thing I would suggest is making sure that she starts eating well again. It is so important to properly nourish your body. It will help boost her energy, keep her brain from getting “foggy,” and she will start to sleep better. It may also be a good idea for Angela to seek professional help from a counselor or therapist if she continues to have a hard time managing her stress on her own. They will be able to give her some coping mechanisms to help her in a situation where she would normally lose her temper.

Meditation. (2022). In J. L. Longe (Ed.), The Gale Encyclopedia of Psychology (4th ed., Vol. 2, pp. 774-778). Gale. https://link.gale.com/apps/doc/CX8273700515/HWRC?u=lirn55593&sid=bookmark-HWRC&xid=d68c21f2Links to an external site.

Post, P. (2010, April). Taking care of business: how to handle tricky issues on the job. Good Housekeeping250(4), 143+. https://link.gale.com/apps/doc/A224775997/PPVC?u=lirn55593&sid=bookmark-PPVC&xid=215ae896Links to an external site.

Woodfill, W. (2009). Conflict Resolution: Thinking It Through. School Library Journal55(10), 55. https://link.gale.com/apps/doc/A209901912/PPVC?u=lirn55593&sid=bookmark-PPVC&xid=23ed16ecLinks to an external site.

Benchmark- Personal Worldview Paper

Benchmark- Personal Worldview Paper

As a nurse leader, it is important to understand a variety of leadership models and styles. This will help you adapt to different settings and apply strategies to support and inspire others. It may also be necessary to apply models in different professional settings to satisfy certification requirements. Write a 1,250-1,500-word paper about your personal model of leadership, including the following:

Model of Leadership: Part A

Describe your personal model of leadership.

Compare your personal leadership model to servant leadership, transformational leadership, and at least one other model of leadership.

How does your personal model of leadership prepare you to employ strategies for effectively leading diverse teams and fostering interdisciplinary collaboration as you implement your leadership project?

Personal Worldview: Part B

Describe your personal worldview. Include the religious (Christian), spiritual, and cultural elements that you think most influence your personal philosophy of practice and attitude towards leadership.

Describe how your professional leadership behaviors inspire others.

Use a minimum of three peer-reviewed resources (published within the last 5 years) as evidence to support your views.

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required. This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite.

Benchmark Information

This benchmark assignment assesses the following programmatic competencies:

MSN Leadership in Health Care Systems

6.3: Employ strategies for effectively leading diverse teams and fostering interdisciplinary collaboration.

6.7: Model professional leadership behaviors to motivate and inspire others.



Rubric Criteria

Personal Model of Leadership

13.5 points

Leadership Model Comparison (B)

13.5 points

Diverse Teams and Interdisciplinary Collaboration

9 points

Personal Worldview

13.5 points

Inspiration (B)

13.5 points

Thesis, Position, or Purpose

6.3 points

Development, Structure, and Conclusion

7.2 points


4.5 points

Mechanics of Writing

4.5 points


4.5 points

Total90 points


NUR 3178 – Assignment #2

Instructions: 1. Read and familiarize yourself with all the Ayurvedic resources in Lesson 2 (Web links, Videos, Journal Articles, etc.) 2. Use the Internet to further explore Ayurvedic Medicine, and answer the following questions: Give an example of how Ayurvedic Medicine can empower patients. Describe the impact that Ayurvedic Medicine can have on the global community. Identify Ayurvedic resources within a specific community. 3. Assignment should be 2-3 pages, including: title page reference page according to APA Writing Style spacing and margin settings (APA Style)





Interpersonal Communications

interview/talk with someone you have a close relationship with (such as spouse, friend, sibling, student advisor, etc.) about how you communicate or are labeled. Use the Johari Window Diagram to diagram how you communicate with them.  What would you both put in the four quadrants? What insights can you draw from this diagram and how does that person see you? Was this your reflected appraisal of yourself? How did things move from the Hidden quadrant to the Open quadrant, or from your Blind to Open quadrant, with that person?

Do you agree with the guidelines in the textbook for enriching the self toward maintaining a healthy identity? Share why you agree or don’t agree. Apply what you’ve learned this week and write one goal you’ve created to improve your self-concept. Provide a detailed analysis of yourself incorporating the reading and textbook material.

Your paper should be 500 – 750 words

250 Words Min For Each Question And 150 Words Summary For Each Question – APA FORMAT


250 words min response on the following items and upload it in the discussion board:

1. Describe a project that suffered from scope creep. Could it have been avoided? How?

2. Can scope creep be a good thing? When?

3. What can organizations do to successfully manage inevitable changes in scope that are good for business?


250 words min response

At work, we regularly need to speak with others either face to face, by phone, or in virtual meetings. Provide 2 examples of verbal communication you have had this week. What form were your communications in (Face to face, phone, virtual, etc.)? Did you face any challenges in your communications? In what ways could you strive to improve your communication at work?

Strategic Management concepts in an organization


Using the textbook and 2 additional articles of your choice (use LIRN to research this), please write a 4 to 5-page paper that answers the following:

(1) Discuss 3 key strategic management concepts that you believe are useful to any manager in any organization. You can choose to describe any 3 concepts (except SWOT).

(2) Explain the strategic importance of each of these 3 concepts and why they are useful.

(3) Provide a few examples of real-life companies which have used these types of strategic management concepts to support their strategy.


  • Each individual paper should be 4 to 5 pages long, not counting cover page and bibliography.
  • The essay must be submitted in Microsoft Word “.doc” file format, and need to be formatted in proper APA 7th Edition style.
  • The cover page and reference page/s are not included in the above-stated page requirement. These should be in addition to page requirements.
  • Each paper requires a minimum of at least three outside peer-reviewed sources for your references.

o   Acceptable/credible sources include: Academic journals and books, industry journals, and the class textbook.


After reading “No One’s a Mystery” by Elizabeth Tallent, answer the questions below.  As always, students who respond fully, who use details from the readings, who have fresh and thoughtful insights, who interact with their classmates, and who use standard English will receive the higher grades.

  1. When looking at the work from a feminist perspective, what impression do you get of Jack, the female narrator, and their relationship as you read the first paragraph?  Make sure to reference specific character details from the text, rather than your own experiences or opinions, to support your answer.

For my eighteenth birthday Jack gave me a five-year diary with a latch and a little key, light as a dime. I was sitting beside him scratching at the lock, which didn’t seem to want to work, when he thought he saw his wife’s Cadillac in the distance, coming toward us. He pushed me down onto the dirty floor of the pickup and kept one hand on my head while I inhaled the musk of his cigarettes in the dashboard ashtray and sang along with Rosanne Cash on the tape deck. We’d been drinking tequila and the bottle was between his legs, resting up against his crotch, where the seam of his Levi’s was bleached linen-white, though the Levi’s were nearly new. I don’t know why his Levi’s always bleached like that, along the seams and at the knees. In a curve of cloth his zipper glinted, gold.

Delaware County Community College

Delaware County Community College (DCCC) will challenge you to grow academically and socially. Its curriculum certifies graduates as possessing the skills, attitudes, and values needed to succeed in the global marketplace.

The award-winning DCCC faculty is among the best; its facilities state-of-the-art; and the 123-acre park-like campus located in suburban Philadelphia safe and friendly. DCCC has established transfer, dual admission and dual buy thesis paper enrollment agreements with more than 40 public and private four-year universities to make transfer easier.

DCCC’s campus is located in an attractive, safe community near the friendly, small town of Media. DCCC is 14 miles (22 km) west of Philadelphia, Pennsylvania, one of the largest cities in the United States. In Philadelphia you will find a wide variety of cultural events, sports teams, music, museums, theater, films, shopping, and nightlife. There are also many ethnic restaurants in the area. Since its founding, Philadelphia has been home to many different cultures and includes large Asian, Hispanic, European, and Middle Eastern populations.

Philadelphia International Airport is about 10 miles (16 km) away. New York City, Washington, D.C., the beaches of the Atlantic coast and the beautiful Pennsylvania countryside are easy trips by car or train.

Academic Programs

DCCC offers more than 70 programs of study in academic transfer, technical, vocational degree and certificate programs. Schedules are flexible as classes are taught during the day and on evenings and weekends. Some students even take advantage of classes offered through the television or online.

English as a Second Language (ESL) Programs

DCCC offers English courses designed to help individuals of all ages learn the language. Whether you speak and understand little English or simply need to improve your skills, our courses can meet your needs. A placement test is given to indicate your current skill level. Students in our English as a Second Language classes benefit from:

Separate subjects in reading, writing, listening and speaking

Various levels of instruction, from elementary to advanced

Computer-aided learning

Small group tutoring for all classes

English-language skills instruction designed to prepare students for everyday life and future study

Transfer Opportunities

The vast majority of international students who attend DCCC complete associate degrees and transfer to four-year institutions in pursuit of baccalaureate degrees. Agreements with 89 other colleges and universities assist with a smooth transition between schools. With an average grade point average of 3.65, DCCC international student graduates consistently transfer to top universities across the United States.

The most common transfer schools are:


More Resources

About Our Students and Programs
Daytona Beach Community CollegeDaytona Beach Community College
How to write a play
How to write a metaphorHow to write a metaphor

How to write a good abstract

The Long Cycle Process of case analysis

The case analysis will evaluate your ability to analyze and report on a case study specific to your area of specialization. Your response to this assessment should include a thorough and detailed analysis of the case study you have been assigned that is well-researched.

Below, you will find the required format and the recommended approach you should take to analyze the case study. A detailed rubric is provided that will provide the grading criteria that will be used to assure you meet the quality guidelines.

The process you should use for analyzing a case study is:

  • Read all assigned readings, view all videos, and review the grading rubric from ADMG 700 before proceeding.
  • Review all coursework related to your specialization.
  • Use the Learning with Cases book (Erskine, Leenders, & Mauffette-Leenders, 2007) to help you work through the case study process.
  • Read the case study using the Short-Cycle approach to familiarize yourself with the case.
  • Read the case study using the Long-Cycle approach to analyze the case.
  • Draft your analysis of the case.
  • Prepare and submit your analysis following the guidelines listed below.

You will have two weeks to complete your paper. The case study must be completed within the time allowed. Your case study analysis is a multi-page document, written in APA format. You must cite all sources used to support the information written in this paper. Your recommendations must be supported using research and concepts from your specialization coursework. Your case analysis paper should be free from spelling and grammatical errors.

Required Format

Your written analysis should have the following sections:

  1. Title page (in accordance with APA format)
  2. Table of contents
  3. Executive summary
  4. Problem statement
  5. Problem and Data analysis
  6. Alternatives
  7. Key decision criteria
  8. Alternatives analysis and evaluation
  9. Recommendation
  10. Action and implementation plan
  11. Appendices (if any)

Note: Sections 3-11 should be level one headings in your paper.

Case Study Analysis Steps

Analysis of the case should take the following steps:

  1. Draft the problem statement
  2. Analyze the case
  3. Generate alternatives
  4. Develop key decision criteria
  5. Analyze and evaluate alternatives
  6. Recommend and justify the preferred alternative
  7. Developing an action/implementation plan
  8. Write the executive summary

Problem Statement

The problem statement should be a clear, concise statement of exactly what needs to be addressed. At most, it should be two sentences. One sentence is preferred.

You may find yourself rewriting this problem statement several times as you continue with your analysis.

Analyze the Case

When analyzing the case, you should determine how the issues in the case came about, who in the organization is most affected by the issues, any constraints, and any opportunities for improvement. You should NOT be generating or discussing any alternatives. This analysis is should further develop and substantiate your problem statement. This section should be used to summarize the basics of your case analysis. It should not be used to simply retell the case scenario.

Generate Alternatives

Each alternative you develop should offer a different way in which the problem could be resolved. Typically, there are many alternatives that could solve the issues in the case. Some alternatives may be discussed in the case. You should develop your own alternative(s) as well. It is very likely that the alternatives presented in the case are not sufficient to solve the problem. Things to remember at this stage are:

  1. Be realistic.
  2. The alternatives should be mutually exclusive.
  3. Not making a decision pending further investigation is not an acceptable decision for any case study that you will analyze.
  4. If you recommend doing nothing as your strategy, you must provide clear reasons why this is an acceptable alternative.
  5. Avoid providing one desirable alternative and two other clearly undesirable alternatives.
  6. Any alternative should be able to be implemented successfully.

Each alternative should have a level two heading.

Key Decision Criteria

Once the alternatives have been identified, a method of evaluating them and selecting the most appropriate one needs to be used to arrive at a decision. Develop the key decision criteria you will use to select the alternative you wish to implement. These criteria should address the issues/opportunities you have previously identified. Key decision criteria should be:

  1. Brief
  2. Measurable
  3. Related to your problem statement and alternatives.

Each criterion should be a level two heading. A description of the criterion and how it will be used should follow each heading.

Evaluation of Alternatives

Measure each alternative against the key decision criteria. Each alternative should also be a level two heading. Describe how each of the alternatives do not meet, meet, or exceed the key decision criteria. You may also wish to write up a pros-and-cons list for each alternative.

At the end of this section, include a summary table that lists each alternative and the key decision criteria.


Recommend one, and only one, of your alternatives. Justify your recommendation using the key decision criteria that you previously developed.

Action and implementation plan

Discuss how the recommended course of action will be implemented. Include costs, schedule, and scope in this plan. Include any stakeholders and their responsibilities.

Executive summary

The executive summary should summarize the entire analysis and should be written last. It should be directed toward an executive in the organization that is being analyzed. It should stand on its own and not be longer than one page.

The goal of an executive summary is for an executive to be able to read it and make a decision. If the executive wishes more detail, the executive will then read the more detailed analysis.

Process for Analyzing a Case Study (Erskine, Leenders, & Mauffette-Leenders, 2007)

The Short Cycle Process

  1. Quickly read the case. If it is a long case, at this stage you may want to read only the first few and last paragraphs. You should then be able to answer the following questions:
    1. Who is the decision maker in this case, and what is their position and responsibilities?
    2. What appears to be the issue (of concern, problem, challenge, or opportunity) and its significance for the organization?
    3. Why has the issue arisen and why is the decision maker involved now?
    4. When does the decision maker have to decide, resolve, act or dispose of the issue?
    5. What is the urgency to the situation?
  2. Take a look at any exhibits to see what numbers have been provided.
  3. Review the case subtitles to see what areas are covered in more depth.
  4. Review the case questions, if any have been provided.

The Long Cycle Process

The Long Cycle Process consists of:

  1. A detailed reading of the case
  2. An analysis of the case.

When you are doing the detailed reading of the case study, look for the following sections:

  1. Opening paragraph: introduces the situation.
  2. Background information: industry, organization, products, history, competition, financial information, and anything else of significance.
  3. Specific area of interest: marketing, finance, operations, human resources, IT, or integrated
  4. The specific problem or decision(s) to be made.
  5. Alternatives open to the decision maker, which may or may not be stated in the case.
  6. Conclusion: sets up the task, any constraints or limitations, and the urgency of the situation.