Medication Guide

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 Medication Guide

(Medication Guide)

Introduction

WHO ranked major depressive disorder (MDD) as the third leading cause of disease burden, projected to be the leading cause of disease burden by 2030. Depression, in general, is the first-ranking cause of disability worldwide. It affects individuals across all populations, ages, and ethnicities. Still, it is significant among vulnerable populations like the elderly, youth, and individuals with physical illnesses like obesity, diabetes, and other chronic conditions. Older adults are at an increased risk of developing MDD, a typical cause of geriatric psychiatric disorders and a significant risk factor for disability and mortality among older patients (Zenebe et al., 2021). Depression is the most common mental health issue among older adults despite being undiagnosed in half of the cases. The paper address major depressive disorder among older adults, including causes, symptoms, diagnosis, and medications. (Medication Guide)

 Medication Guide

Major Depressive Disorder Causes and Symptoms

MDD etiology is multifactorial, including environmental, biological, genetic, and psychosocial factors. MDD is mainly attributed to neurotransmitter abnormalities, particularly dopamine, norepinephrine, and serotonin. It is indicated by the use of various antidepressants like selective serotonin receptor inhibitors, serotonin-norepinephrine receptor inhibitors, and dopamine-norepinephrine receptor inhibitors in treating depression (Bains et al., 2022). MDD is highly prevalent among mental health conditions, with a lifetime prevalence of around 5 to 17% and an average of 125. The disease is more common among women than men, almost double, and among individuals without close interpersonal relationships, such as those who are divorced, separated, or widowed, which is the case among many older adults (Bains et al., 2022). Most people with MDD present with symptoms including pervasive low and depressed mood, decreased interest and enthusiasm in previously pleasured activities, guilt and worthlessness feelings, low energy, poor or impaired concentration, and changes in appetite (Bains et al., 2022). These individuals also experience psychomotor retardation, agitation, sleep disturbances, and suicidal thoughts. (Medication Guide)

 

Figure 1: MDD causes and symptoms

MDD Diagnosis for the Elderly

Older people are a valuable resource in society, but many age-related actors influence their health and well-being by exposing them to multiple physical and mental illnesses. The elderly population is growing, and it will be the case going into the future, which has extensive economic, social, and health consequences in the world and the United States. The increasing aging population is attributed to reduced mortality and fertility rates and improved quality of life over the past two decades, leading to increased life expectancy. In 2019, older people aged 60 years and over were 1 billion, and the number will rise to 1.4 million by 2030 and to over 2.1 billion by 2050, and by then, 80% will live in low- and middle-income countries (Zenebe et al., 2021). With the increasing aging population, the incidence of mental health problems is also expected to increase, with depression being the most prevalent disorder. This population is categorized as vulnerable because of the high disease encounter associated with aging and the likelihood of experiencing multiple conditions that impede their functioning, including mobility, which is a barrier to healthcare access. (Medication Guide)

Figure 2: Depression prevalence by age

MDD among older adults is diagnosed through comprehensive psychiatric evaluation of the individual and mental health examination. The practitioners conduct a history and physical assessment, including medical history, family history, social history, alcohol and substance use history, and psychiatric history (Bains et al., 2022). Among older adults, collateral information from family members or friends is immensely important in psychiatric evaluation because, in some cases, older adults experience cognitive decline and judgement impairment. A comprehensive physical examination, including a neurological examination, is conducted to help diagnose and rule out any root cause, organic or medical, of depressive symptoms. The diagnosis follows the ICD-10 or the DMS-5 criteria. According to the DMS-5 criteria, five of the following symptoms must be present for a diagnosis to be made: difficulty sleeping, loss of interest or pleasure, feelings of inadequacy or helplessness, fatigue or erratic energy, difficulties concentrating or listening intently, fluctuations in appetite or weight, psychomotor issues, suicidality, and depressed mood. (Medication Guide)

Medication Treatment Options

Various modalities, including pharmacological, psychotherapeutic, interventional, and lifestyle changes, are used to treat major depressive disorder. Medication treatment includes FDA-approved medications, including all antidepressants, which are equally effective but with varying side effects profiles. Selective serotonin reuptake inhibitors (SSRIs) are the first line of treatment and include fluoxetine, sertraline, citalopram, paroxetine, and fluvoxamine (Bains et al., 2022). However, SSRIs can increase agitation and anxiety and cause indigestion, diarrhea or constipation, appetite and weight loss, dizziness, dry mouth, or blurred vision. Serotonin-norepinephrine reuptake inhibitors (SNRIs) are often used among patients with comorbid pain disorders (Bains et al., 2022). SNRIs include venlafaxine, milnacipran, duloxetine, and levomilnacipran. However, these drugs can cause nausea, dry mouth, dizziness, headache, and excessive sweating. (Medication Guide)

Patients can also be prescribed serotonin modulators like vilazodone, trazodone, and vortioxetine (Bains et al., 2022). Despite their high effectiveness, serotonin modulators can lead to gastrointestinal adverse reactions, central nervous system adverse reactions, bleeding, sexual dysfunction, and hyponatremia. Possible treatment also includes atypical antidepressants like bupropion and mirtazapine, often prescribed as augmenting agents when an individual develops sexual side effects after using SSRIs or SNRIs (Bains et al., 2022). Common side effects of atypical antidepressants include lightheadedness, dizziness, and dry mouth. Additionally, mood stabilizers and antipsychotics help improve antidepressant effects (Bains et al., 2022). However, the patient can experience blurred vision, dry mouth, drowsiness, muscle tremors, and weight gain after taking mood stabilizers and antipsychotic medications.  (Medication Guide)

Figure 3: Antidepressants commonly used to treat MDD

Medication Considerations of Medication Examples Prescribed

Older adults are vulnerable individuals, and most are experiencing multiple comorbidities and taking multiple drugs simultaneously. Therefore, optimizing drug therapy for older adults is crucial to ensure their safety and reduce the risk of medication-related complications. Prescribing medication among older adults is a complex process, and the practitioner has to consider the patient’s physiological status, drug effectiveness and toxicity, and potential side effects (Rochon & Schmader, 2019). Avoidable adverse drug events should always be evaluated when prescribing for older adults. The practitioner has to consider and review current drug therapy, discontinue ineffective therapy, review avoidable drug-drug interaction, and appropriate use of prescribed drugs or medication adherence. (Medication Guide)

SSRIs are commonly prescribed to treat MDD and used as first-line treatment. However, safety considerations for prescribing SSRIs are paramount to avoid complications like adverse drug events, drug-drug interactions, disabling side effects, and fatality. When prescribing SSRIs or selecting a specific SSRI, it is imperative to consider common possible complications like vascular events, which are life-threatening, patients at a higher risk of cardiovascular risk, and relevant comorbidity and co-medication (Mortensen & Andersen, 2022). Additional considerations include potential interaction with particular foods and drinks and the presence of diseases like diabetes, epilepsy, and kidney disease. The practitioner should evaluate current drug therapy because SSRIs can interact with some over-the-counter painkillers and herbal remedies.  (Medication Guide)

Monitoring Labs and Comorbid Medical Issues

To date, there are no diagnostic laboratory tests available to diagnose MDD. However, labs can be used to exclude other medical illnesses that present symptoms as MDD, including complete blood cell (CBC) count, thyroid tests, fasting blood glucose tests, and folate and vitamin B12 tests. These lab tests are a vital consideration, especially for individuals experiencing multiple comorbidities, to determine the presence of depressive symptoms by excluding potential links to other illnesses presenting as MDD (Wainberg et al., 2021). The comorbidity of MDD with chronic illnesses like diabetes, obesity, and eating disorders should be monitored to determine how the pathologic processes associated with the diseases interact (Almeida et al., 2020). Other comorbid medical issues with MDD include psychotic disorders, OCP, anxiety disorders, and substance use. Their association with MDD must be evaluated to develop a comprehensive patient treatment plan and education plan. Identifying comorbidities is vital for accurate diagnosis and developing treatment and management strategies.  (Medication Guide)

Special Considerations

When working with MDD patients, it is vital to consider laws like the Mental Healthcare Act of 2017 that explicitly describes the rights of individuals with mental illnesses, specifying ethical and legal responsibilities practitioners and the government have (Bipeta, 2019). The law corresponds with the fundamental rights of human beings and ethical principles, including autonomy, non-maleficence, beneficence, justice, confidentiality, informed consent, and boundary violations. Ethical issues and dilemmas associated with autonomy, respect of persons, informed consent, and beneficence can arise when working with MDD patients, hence the need for ethical imperatives like ensuring confidentiality and privacy, respecting autonomy and the law, demonstrating compassion, beneficence, and promoting justice, honesty, and fidelity (Bipeta, 2019). For instance, older people with cognitive decline need surrogates or caregivers to offer informed consent and address autonomy and confidentiality issues.

Cultural considerations are imperative in treating depression, especially for ethical or racial minorities. The epidemiology of depression varies across various racial and ethnic groups. This variability is due to contextual factors in the different groups, including cultural beliefs and practices, cultural adaptations, and intersectionality (Cardemil et al., 2020). Moreover, every culture looks at mental health differently, and practitioners should consider these differences in treating depression. Social determinants of health, including socio-economic status, family relationships, educational attainment, social isolation, and supportive relationships, should be considered when treating MDD because of their influence on development and progression of depression and healthcare access and service utilization for depression.   (Medication Guide)

Figure 4: Ethical issues in psychopharmacology

Resources to Follow Up for more information

Multiple resources available in the community can offer more information regarding depression, including the National Alliance on Mental Illness (NAMI), Anxiety and Depression Association of America (ADAA), National Suicide Prevention Lifeline, American Psychological Association (APA), National Institute of Mental Health (NIMH), and Centers for Disease Control and Prevention (CDC) Division of Mental Health. These resources or institutions publish information on their websites accessible to the general public in search of further information on depression. The institutions are on a mission to reduce mental health concerns’ impact on American communities, hence providing a wealth of information and services accessible to all. (Medication Guide)

Prescription Examples

The patient will initially be prescribed FDA approved SSRIs, including citalopram, escitalopram, and fluoxetine.

Prescription 1

Date of Issue: March 23, 2023

Patient Name: N.D.

Drug Name: Citalopram

Dosage Form: Tablet

Quantity Prescribed: 20 mg PO qDay, increasing to 40 mg/day after 1 week

Clinician Name: J.M.

Prescription 2

Date of Issue: March 23, 2023

Patient Name: N.D.

Drug Name: Escitalopram

Dosage Form: Tablet

Quantity Prescribed: 10 mg PO qDay; may increase to 20 mg/day after 1 week

Clinician Name: J.M.

Prescription 3

Date of Issue: March 23, 2023

Patient Name: N.D.

Drug Name: Fluoxetine

Dosage Form: Tablet

Quantity Prescribed: 20 mg PO qDay initial, and consider gradual increase after several weeks by 20mg/day, not exceeding 80 mg qDay

Clinician Name: J.M.

Conclusion

Major depressive disorder is a disabling illness among older adults and a significant contributor to the disease burden. MDD co-occurs with other illnesses, mostly age-related, including diabetes, psychotic disorders, anxiety disorders, and eating disorders, that make MDD treatment and management challenging. Pharmacological treatments effectively address MDD; SSRIs are prescribed as the first-line treatment modality. Considering that older people experience multiple comorbidities and are taking multiple drugs, it is vital to consider potential side effects, drug interactions, adverse events like complications, medication adherence, and drug effectiveness and appropriateness when prescribing medication for MDD. Legal, ethical, cultural, and social actors influence MDD development, progression and treatment perception, and these must be considered when working with MDD patients. More information on MDD can be obtained from CDC, ADAA, APA, NIMH, and NAMI websites and online publications. (Medication Guide)

References

Almeida, S. S., Zizzi, F. B., Cattaneo, A., Comandini, A., Di Dato, G., Lubrano, E., Pellicano, C., Spallone, V., Tongiani, S., & Torta, R. (2020). Management and Treatment of Patients With Major Depressive Disorder and Chronic Diseases: A Multidisciplinary Approach. Frontiers in psychology, 11, 542444. https://doi.org/10.3389/fpsyg.2020.542444

Bains, N., Abdijadid, S., & Miller, J. L. (2022). Major depressive disorder (nursing). In StatPearls [Internet]. StatPearls Publishing.

Bipeta R. (2019). Legal and Ethical Aspects of Mental Health Care. Indian journal of psychological medicine, 41(2), 108–112. https://doi.org/10.4103/IJPSYM.IJPSYM_59_19

Cardemil, E. V., Noyola, N., & He, E. (2020). Cultural Considerations in Treating Depression. Handbook of Cultural Factors in Behavioral Health: A Guide for the Helping Professional, 309-321.

Mortensen, J. K., & Andersen, G. (2022). Safety considerations for prescribing SSRI antidepressants to patients at increased cardiovascular risk. Expert opinion on drug safety, 21(4), 467–475. https://doi.org/10.1080/14740338.2022.1986001

Rochon, P. A., & Schmader, K. E. (2019). Drug prescribing for older adults. Dostpuno na https://www. uptodate. com/contents/drug-prescribing-for-older-adults. Pristupljeno.

Wainberg, M., Kloiber, S., Diniz, B., McIntyre, R. S., Felsky, D., & Tripathy, S. J. (2021). Clinical laboratory tests and five-year incidence of major depressive disorder: a prospective cohort study of 433,890 participants from the UK Biobank. Translational Psychiatry, 11(1), 380.

Zenebe, Y., Akele, B., W/Selassie, M., & Necho, M. (2021). Prevalence and determinants of depression among old age: a systematic review and meta-analysis. Annals of general psychiatry, 20(1), 55. https://doi.org/10.1186/s12991-021-00375-x

 
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Topic 5 DQ 1 Replies

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Topic 5 DQ 1 Replies

Reply to Maratas

Hello, Maratas. (Topic 5 DQ 1 Replies)

Thank you for an informative and elaborative discussion. Research is done for various purposes, but the aim is always to develop usable and beneficial outcomes that can be used to enhance and inform practice. Indeed statistically significant results are not always clinically significant, but they are useful in informing researchers whether the outcomes of their research are due to chance or due to some factor of interest. A statistically significant result means that it is real and not due to luck in the sample selection. Clinically significant results help improve practice, treatment, or patient care. For instance, a drug with positive effects can be said to have clinical significance. (Topic 5 DQ 1 Replies)

References

Sharma H. (2021). Statistical significance or clinical significance? A researcher’s dilemma for appropriate interpretation of research results. Saudi journal of anaesthesia, 15(4), 431–434. https://doi.org/10.4103/sja.sja_158_21

 

Reply to Schott

Hello, Schott.

Thank you for the great post. Statistically significance results can be clinically significance, but not always. Statistical significance means that the results from data generated through an experiment or testing is likely to be linked to a particular cause rather than occurring by chance. It helps researchers determine the relationship between variables. Some variables have weak effects, but their results are statistically significant. However, the effect has to be considerable for a result to be considered clinically significant. For instance, a treatment intervention or research experiment that helps a patient to a point they recover from their illness would be categorized as clinically significant. (Topic 5 DQ 1 Replies)

References

Ranganathan, P., Pramesh, C. S., & Buyse, M. (2015). Common pitfalls in statistical analysis: Clinical versus statistical significance. Perspectives in clinical research, 6(3), 169–170. https://doi.org/10.4103/2229-3485.159943

 

Reply to Blake

Hello, Blake.

I enjoyed reading you discussion for its clarity and comprehensiveness. Indeed clinicians should adopt current best evidence to inform medical and clinical decisions. Statistical significance shows that the results of a research study can relied on, are real, and are not due to chance. Researchers can determine that a relationship between two variables exists and is authentic through statistical significance. I concur that the results or effects of a relationship must be large enough to be considered clinically significant. For instance, the Covid-19 vaccine was allowed for use in treating the virus after researchers determined the effect was large enough to help patients recover. Clinical significance also means that the effects outweighs the costs and any inconveniences that are linked to the intervention or information obtained from research. (Topic 5 DQ 1 Replies)

Topic 5 DQ 1 Replies

References

Sharma H. (2021). Statistical significance or clinical significance? A researcher’s dilemma for appropriate interpretation of research results. Saudi journal of anaesthesia, 15(4), 431–434. https://doi.org/10.4103/sja.sja_158_21

 
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Future of Work Paper

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Future of Work Paper

(Future of Work Paper)

The social, technological, and ethical issues that will shape the future of the U.S. workplace

The world is technology-driven, where people, especially businesses and organizations, adopt technology to improve productivity, effectiveness, efficiency, and the general quality of life. Automation, in particular, is one for the future and part of the new workplace. Automation will impact the jobs lost and gained, workforce transition, and the type of jobs created to adapt to the changes (Wang & Siau, 2019). Moreover, automation will potentially impact workforce skills and wages. The transition can be challenging because of the potential occupational shifts and job loss due to displacement by automation adoption, although there might be enough jobs to ensure full employment. The current scenario has few fully automated jobs, but most of these jobs could be automated, which means changes and a significant transformation for all workers (Wang & Siau, 2019). It is not necessarily that the adoption of automation will cause employment decline because automation will also mean the creation of new roles and responsibilities. However, technology feasibility beyond human labor substitution will impact the speed of automation. (Future of Work Paper)

Society is also changing significantly, profoundly impacting the working world, including the nature of work, the people needed to do the work, and work expectations, standards, and regulations. Society is transitioning to a knowledge economy where knowledge and information are perceived as the most valuable resource (Wang & Siau, 2019). Employees are more responsible for updating themselves based on the new knowledge. This trend will continue, affecting employees’ roles and responsibilities and the scope of work. The US is also experiencing increased diversity, a trend that will continue to grow into the future. For instance, women are a growing part of the workplace, and it is predicted that women will be the majority of the workforce in the future (Köllen, 2021). Also, the US is generally highly ethnically diverse, meaning that the workforce is becoming more ethnically diverse. Sexual orientation, especially the recognition of queer people in the workplace, is also a growing trend, significantly impacting workforce composition, ethical standards, and workplace rules and regulations. Increased diversity is positive in the workplace as it is associated with increased productivity, creativity, and job satisfaction.

The rise in automation, societal changes like increased diversity, remote working, and the use of online platforms to engage employees and customers raise ethical issues that can potentially impact the future of work. There is a change in the perception of work due these trends, but there are also ethical concerns like data privacy and confidentiality, justice and fairness, transparency, and bias that should be addressed (Bourhis et al., 2019). The government and businesses have to develop new measures to regulate these growing trends, including working-from-home policies, justifiable standards of using online platforms and automated tools for workplace engagement and business transactions, and justice and fairness associated with increased diversity at the workplace (Schwartz et al., 2020). There would be more privacy and access controls, accountability, fairness, and transparency rules to address ethical issues in the future. (Future of Work Paper)

The impact of the COVID-19 pandemic on remote work, the use of artificial intelligence, and other workplace trends

Covid-19 disrupted society and accelerated some trends like remote work and artificial intelligence. The long-term influence of the pandemic on labor demands, workforce skills, and labor occupations is immense, especially with the growing trend of remote work. Remote work is the most apparent impact of the pandemic on labor, with a considerable increase in employees working from home (McKinsey & Company, 2021). Most companies realized and are realizing that about 20 to 25 percent of the workforce could work from home for most of the work days without a loss in productivity (McKinsey & Company, 2021). Many organizations consider creating flexible workspaces after positive experiences with remote work, especially a reduction in office costs, travel costs, and overall office space.

Also, Covid-19 accelerated the adoption of artificial intelligence. Covid-19 accelerated digital transformation, offering business leaders vital lessons and insights, especially what AI and data analytics can bring to the business. Examples of AI and data analytic tools adopted during and after the pandemic include direct-to-customer business. More companies accelerated their AI and analytics adoption, and there is a promising trend that AI will become mainstream technology (McKinsey & Company, 2021). Businesses are optimistic about AI’s role in the future in increasing the efficiency of business processes, the development of new business models, and the creation of new products and services. (Future of Work Paper)

Future of Work Paper

The argument for increasing the use of robots and artificial intelligence (AI) in the workplace

Adopting robotics and artificial intelligence in the workplace is inevitable, and individuals should brace themselves for a future full of robots and AI technologies and tools working alongside them. Robotics and AI applications are growing, creating new opportunities and challenges for businesses and significant workplace changes (Howard, 2019). A combination of robotics and AI has already revolutionized everyday life. It is necessary to find a way to co-exist and adapt them to make life easier for everyone. Robotics have increased accuracy and efficiency in surgical processes, reduced the cost of production, and reduced human involvement in risky jobs like machine operations, industry-complex roles, dealing with hazardous materials, and disaster response (Madakam et al., 2019). Robots complement human skills and should not be viewed as threats but as solutions to critical human problems, especially with an aging workforce and declining expertise in fields like engineering and medicine.  (Future of Work Paper)

Pros and cons of a universal basic income, a guaranteed federal job, and a reduced workweek

The world is working towards more equality by addressing poverty and unemployment. The creation of the universal basic income (UBI) would help reduce poverty rates and income inequality, enhances physical and mental health, increases higher education accessibility, can potentially improve wages, eliminates the need for government programs, fosters entrepreneurship, and protects individuals from economic shocks (Estlund, 2019). However, UBI is costly, reduces work incentives, encourages laziness, gives additional income to individuals who do not need it, conflicts with self-worth by reducing a job to only a source of income, and does not address the underlying cause of poverty like poor health and lack of educational skills. Creating a guaranteed federal job is a move to make society more equitable, sustainable, and prosperous (Estlund, 2019). It is a form of remaking the economic order by making having a job a fundamental right (Estlund, 2019). Positives include increasing state and local tax revenues, enhancing the bargaining power of labor, and addressing society’s most critical needs like eldercare and nursing shortages. However, categorizing a job as a fundamental right would be burdensome to the government and potentially make people entitled because they understand the government is their last resort.

The reduced work week has long been considered an approach to address employees’ health and well-being. Working for fewer days has been associated with a reduced risk of burnout and improved productivity (Estlund, 2019). It would help achieve a better work-life balance, increase focus and productivity, and reduce travel costs. However, understaffing makes its adoption challenging, it might be incompatible with some people, and it may force people to forego after-work activities because they work more hours during the working days. Nonetheless, I would recommend reducing the work week because it looks beyond income and pay and seeks to address employees” health and well-being. (Future of Work Paper)

Another change in the future workplace that could significantly benefit humankind

I recommend a shift in the physical space and remodeling it as companies shift to a flexible workforce, where some employees work remotely for most of the work days. In the future, companies should seek to alter their footprint and layout because the in-person work will substantially transform, and the workspace should be in tune with the people’s objective. For instance, eliminating pre-pandemic cubicles would create a more collaborative, community-focused, and innovative workspace that allows continuous engagement between in-person employees and remote workers (Ayoko & Ashkanasy, 2020). Also, creating video-conference rooms and online workspaces would twin into remote work and more flexible workspaces, allowing companies to tap talents around the country without the need to report physically. (Future of Work Paper)

References

Ayoko, O. B., & Ashkanasy, N. M. (2020). The physical environment of office work: Future open plan offices. Australian Journal of Management, 45(3), 488-506.

Bourhis, P., Demartini, G., Elbassuoni, S., Hoareau, E., & Rao, H. R. (2019). Ethical challenges in the future of work. Bulletin of the Technical Committee on Data Engineering.

Estlund, C. (2019). Three big ideas for future of less work and three-dimensional alternative. Law and Contemporary Problems, 82(3), 1–44.

Howard, J. (2019). Artificial intelligence: Implications for the future of work. American journal of industrial medicine, 62(11), 917-926.

Köllen, T. (2021). Diversity management: A critical review and agenda for the future. Journal of Management Inquiry, 30(3), 259-272.

Madakam, S., Holmukhe, R. M., & Jaiswal, D. K. (2019). The future digital work force: robotic process automation (RPA). JISTEM-Journal of Information Systems and Technology Management, 16.

McKinsey & Company. (2021). The future of work after COVID-19. https://www.mckinsey.com/featured-insights/future-of-work/the-future-of-work-after-covid-19

Schwartz, J., Denny, B., Mallo, D. (2020). Ethics and the future of work: From “could we” to “how should we.”

Wang, W., & Siau, K. (2019). Artificial intelligence, machine learning, automation, robotics, future of work and future of humanity: A review and research agenda. Journal of Database Management (JDM), 30(1), 61-79.

 
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Community Assessment and Representative Interview Analysis

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Community Assessment and Representative Interview Analysis

(Community Assessment and Representative Interview Analysis)

Community Assessment and Representative Interview Analysis

 

Part I: Assessment

The selected community site is a community health center in Winston-Salem. The physical assessment focuses on secondary prevention/screening for vulnerable populations, in this case, older adults 65 years and above. The primary purpose of the assessment was to identify key health needs and problems through systematic and comprehensive data collection and analysis to give the organization robust information regarding the current health status, needs, and issues affecting the target population and the community at large. The assessment also assessed the community’s partnerships, funding sources, and health priorities. (Community Assessment and Representative Interview Analysis)

The assessment findings indicate that the community health center has a steering community comprised of public health officers, hospital and healthcare professionals, EMS providers, law enforcers, public school system representatives, and community organizations as partners. The steering community addresses common health issues in the community. The assessment also found that the community has health priorities that include preventing chronic disease and related health conditions, promoting behavioral health, including reducing drug overdose and fostering mental health, improving life expectancy, preventing infectious diseases, and addressing social health determinants, particularly poverty and poverty education. The results also indicate funding sources for the community health center vary. Primary funding sources include reimbursements from Medicaid, Medicare, and private insurance. The center also receives federal and state grants; some are funded by the HRSA’s Community Health Center Fund (CHCF). Federal grant funding is through the Health Center Program. The community health center also has partnerships with the public school system, community organizations, epidemiology and surveillance program, and the local church association, especially the Union Baptist Church. (Community Assessment and Representative Interview Analysis)

Part II: Interview

The interview was conducted in a community health center in Winston-Salem. The interview topic was secondary prevention/screenings for a vulnerable population. The target population was individuals 65 years and above. The interview focused on the health needs of this population. The nursing manager at the community health center was involved in the interview. The interview was in-person at the community health center. The purpose of the interview was to understand the role of the nurse manager in the community, common health issues the community health center faces, and the role of public health in addressing environmental issues the community faces, notably pollution from various industries like tobacco and cigarette, brewers, and textile, the barriers and challenges in the community that hamper the community health center from delivering quality, safe, equitable, and affordable care, and the community’s health priorities based on the identified health needs and issues. The determination of these interview aspects would help understand the current state of health in the community and the various health needs that must promptly address to promote a healthy community. (Community Assessment and Representative Interview Analysis)

Interview Questions

  1. What is the role of the nursing manager at this community health center?
  2. What are the common health issues faced at the community health center?
  3. What is the role of public health in addressing environmental issues facing the community?
  4. What are the barriers and challenges of delivering equitable, quality, and safe care in the community?
  5. What are the community’s health priorities?

References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10353612/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9847055/

 
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Scenario and Alternative Futures

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Scenario and Alternative Futures

(Scenario and Alternative Futures)

Organizations define their vision through strategic planning that helps identify their goals and objectives and strategies to achieve them within the desired framework. Planning for the future is a business best practice to remain relevant and sustainable. However, future planning needs an understanding of the potential situation, which can be accomplished through scenario frameworks that help organizations prepare for various alternative futures. Scenario frameworks provide organizational leaders with plans, budgets, and predictions to prepare the business for growth and the potential effects of future events. This paper provides a synthesis of various scenario frameworks and the application of a scenario framework to a pharmaceutical industry case study. (Scenario and Alternative Futures)

Part 1: Scenario Synthesis

Framework
Main Idea		 Day & Schoemaker, (2020) Godet & Roubelat, (2003) Hussain et al., (2017) Ramirez et al. (2017) Your Synthesis
A.

Changes and the future of organizations.

 

 Unwarranted changes like new regulations, market entries, and environmental changes present new opportunities and challenges for companies Organizations face dramatic changes, and have to respond accordingly. Technological changes are rampant and business need technology foresight to keep a breast Organizations experience unprecedented changes like natural disasters, disruptive innovation, economic changes, and unexpected political events. May changes occurring in the business world are unwarranted and unpredictable, but have significant impact on organizations, their operations, and their future. Some of the unprecedented changes include new regulations, market entries, environmental changes, including natural disasters, technological changes, economic changes, and disruptive innovation
B.

Change anticipation.

 Companies should prepare for the future by anticipating changes. Companies should anticipate these changes and transform the anticipation into action. Company should adopt mapping the future of technology as an established practice. Organization should explore sources of the changes or uncertainty rather than focusing on preparing for the future. An organization’s strategic planning includes preparing for the future. Companies can prepare for the future by anticipating changes by mapping underlying causes and potential impacts. Notably, exploring the sources of these changes can help companies cope with the uncertainties.
C.

Importance of future surveillance and prediction.

 Periphery surveillance is a critical business success factor Good forecasts can help arrive at the desired objective. Technology foresight helps businesses plan for the future of technology. Periphery surveillance or forecasting the future as accurately as possible is a critical business success factor. Business should have a foresight attitude as part of the strategic planning process.
D.

Predicting the future and its challenges.

 The future is hard to predict, but possible with a scenario planning It is impossible to foretell or forecast the future due to the many uncertainties, which can only be reduced as far as possible Companies should learn to cope with uncertainties rather than focusing on planning for the future. It is impossible and difficult to predict the future or foretell what will happen due to the multiple uncertainties. Business can reduce the uncertainties as far as possible or learn to cope with them rather than investing everything planning for the future.
E.

Scenario frameworks.

 A question-based framework can help survey the periphery more effectively and efficiently Structural analysis, strategy analysis, and morphological methods or probability can help appropriate the anticipation into action. Companies can adopt scenario-driven road mapping to plan for the future of technology. Scenario planning can help companies reshape their long-term strategies. There are multiple ways a business can anticipate changes and change the anticipation into action, including the question-based framework, structural analysis, strategy analysis, and morphological methods or probability, scenario-driven road mapping, or scenario planning.

Scenario and Alternative Futures

Part 2: Scenario Framework for Pharmaceutical Industry

Scenario Framework

Scenario planning or development is an integral part of an organization or industry’s future and begins with assessing the current situation, creating informed assumptions regarding the future, and comparing potential effects and the likely responses of various factors. For instance, over time, there have been predictions about when crude oil would no longer be available. Most predictions are based on scenarios, although they have been widely wrong. The pharmaceutical industry segment, Kenedy (2021, 32541a), involves Brand-name Pharmaceutical Manufacturing based in the US and faces a near future patent protection situation because most essential patents for blockbuster drugs will expire in the next five years (Khaustovich, 2023). Often, the patent’s lifespan is 20 years, and it cannot be renewed, remaining in the public domain after expiring. Therefore, organizations have to prepare for these situations. Scenario planning can provide the company with actionable insights o what to do or expect at the end of the five years. The company needs a 5-year scenario development, which can be achieved using the question-based framework (Day & Schoemaker, 2020).  (Scenario and Alternative Futures)

The Question-based framework is desirable and suitable because it provides insights into how the company can capitalize on the situation or the changes in the industry, including increased competition and economic and global market changes. Looking at the current trend and scenarios, the company can anticipate what is to happen and develop a strategic plan to prepare for the future with clear goals and objectives (Day & Schoemaker, 2020). The question-based framework can help the company survey the periphery more efficiently and effectively. It has three parts: learning from the past, examining the present, and envisioning the future. The organization asks itself multiple questions: What were its past blind sports? What instructive analogues do other industries offer? Who in the industry can help pick up the weak signals and act on them? To learn from the past (Day & Schoemaker, 2020). The present is evaluated by asking about the vital signals the company is rationalizing, what the outliers, unconventional, defectors, and complainers are telling the company, and the peripherals consumers and competitors are thinking about (Day & Schoemaker, 2020). Envisioning the future involves asking about what could hurt or help the company, technologies that could change the game, and any unprecedented scenario that might hamper or disrupt the business. The answer to these questions will help the organization anticipate problems or opportunities appearing on the horizon. (Scenario and Alternative Futures)

Current State Pharma Industry Trends

Multiple pharma industry trends require pharma companies to develop strategic planning that prepares companies for the changes occurring in the future or any disruptions. For instance, artificial intelligence is accelerating drug discovery and development. Many new companies are adopting the technology to address the many pharma industry challenges, including automation to optimize business processes (Khaustovich, 2023). This technology forces current organizations to reshape their strategies to adapt to the changes. The changing market dynamics are forcing the pharma industry to consider flexible production. Minimizing downtime and enhancing productivity is necessary, and flexible production approaches like single-use bioreactors and continuous manufacturing can be valuable. Precision medicine, due to omic and data analysis advancement, is also a current trend that helps pharma researchers and experts understand more the drug interaction with the body (Hartl et al., 2021). Precision medicine means that personalized medicine is becoming more of a reality. The pharma industry will also have to develop scenarios for the future of additive manufacturing using technologies like 3D printers for tissues and cells (Mohammed et al., 2020). This technology means the development of precision pills, microfluidics, and tissue engineering. Lastly, real-world data (RWD) and real-world evidence (RWE) are revolutionizing innovations in the pharma industry by intensifying research and increasing the reliability of discoveries (Breckenridge et al., 2019). Data means the industry can produce new drugs more often while maintaining reliability and real value. (Scenario and Alternative Futures)

Trigger Questions

According to Leufkens et al. (2022), the future of the pharma industry, including drug discovery and development and direction and success, is influenced by current and anticipated scientific advances, socioeconomic, medical need, policy, and geopolitical actors. Also, growing concerns about a global divide could also impact drug accessibility and affordability (Leufkens et al., 2022). Also, it is unclear whether the pharma industry will be more regulated, monitored and guided in the future and whether international and interdisciplinary collaboration and connectivity will affect the operation of the pharma industry. Based on the supported understanding, the executive team should ask itself the following questions:

  1. What scientific advances will realign or impact unwarranted, challenging opportunities relating to drug discovery and development in the future?
  2. What socio-economic, medical need, policy, and geopolitical actors will impact our direction and success?
  3. What if the growing concern regarding the global divide impacts accessibility and affordability or medicines?
  4. What if the future will be more complex with more need for monitoring and guidance in the operations of the pharma industry?
  5. Will international and interdisciplinary collaboration and the increased connectivity advance pharmaceutical science? (Scenario and Alternative Futures)

Conclusion

Strategic planning is integral to a business’s future and sustainability. It can be accomplished through scenario planning, which involves scenario building using past and current events and trends leading to a likely future. Scenario frameworks provide organizations with insights into alternative futures for planning and try to reduce uncertainties as far as possible. An organization can adopt the question-based framework that focuses on learning from the past, evaluating the present, and envisioning the future. (Scenario and Alternative Futures)

References

Breckenridge, A. M., Breckenridge, R. A., & Peck, C. C. (2019). Report on the current status of the use of real‐world data (RWD) and real‐world evidence (RWE) in drug development and regulation. British Journal of Clinical Pharmacology, 85(9), 1874-1877.

Day, G. S., & Schoemaker, P. J. H. (2005). Scanning the periphery. Harvard Business Review, 83(18), 135–148.

Godet, M., & Roubelat, F. (1996). Creating the future: The use and misuse of scenarios. Long Range Planning, 29(2), 164–171.

Hartl, D., de Luca, V., Kostikova, A., Laramie, J., Kennedy, S., Ferrero, E., … & Roth, A. (2021). Translational precision medicine: an industry perspective. Journal of translational medicine, 19(1), 1-14.

Hussain, M., Tapinos, E., & Knight, L. (2017). Scenario-driven road mapping for technology foresight. Technological Forecasting and Social Change, 124, 160–177.

Khaustovich, V. (2023). Industry Report 32541A: Brand Name Pharmaceutical Manufacturing in the US. IBISWorld.

Krishnaveni, C., Arvapalli, S., & Sharma, J. V. C. (2019). Artificial intelligence in pharma industry-a review. International Journal of Innovative Pharmaceutical Sciences and Research, 7(10), 37-50.

Leufkens, H. G., Kusynová, Z., Aitken, M., Hoekman, J., Stolk, P., Klein, K., & Mantel-Teeuwisse, A. K. (2022). Four scenarios for the future of medicines and social policy in 2030. Drug Discovery Today, 27(8), 2252-2260. https://doi.org/10.1016/j.drudis.2022.03.018

Mohammed, A., Elshaer, A., Sareh, P., Elsayed, M., & Hassanin, H. (2020). Additive manufacturing technologies for drug delivery applications. International Journal of Pharmaceutics, 580, 119245.

Ramirez, R., Churchhouse, S., Palermo, A., & Hoffmann, J. (2017). Using scenario planning to reshape strategy. MIT Sloan Management Review, 58(4), 31–37.

 
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Section 5: Digital Evidence Controls – Computer Forensic Analysis – and Recovering Files

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Section 5: Digital Evidence Controls, Computer Forensic Analysis, and Recovering Files

(Section 5: Digital Evidence Controls, Computer Forensic Analysis, and Recovering Files)

Section 5: Digital Evidence Controls, Computer Forensic Analysis, and Recovering Files

Preserving Information for Forensic Analysis

Digital evidence can be stored and maintained in physical or digital devices. After information collection, it will be moved to physical media for storage and where it can be accessed. The data acquired and the device used for storage are secured until the information is required for forensic analysis. The physical and digital storage systems or a smart management system are integrated to form the evidence management system to be used at the organization. Preservation is required to ensure the legal admissibility of the information stored. The evidence management system will include drive imaging, hash values, and a clear chain of custody (Simon, 2023). Rather than the original information, the company will create images of the evidence that will be used for analysis. The analysist will develop a duplicate of the drive used to store the information to help retain the original evidence for investigation. Investigators can exclusively use the duplicate image rather than the original media. (Section 5: Digital Evidence Controls, Computer Forensic Analysis, and Recovering Files)

Hash values will also aid in preserving the evidence or information generated when duplicates or images of the original media are produced. The hash values will help determine the authenticity and integrity of the duplicates as an exact image of the original information. Hash values will help ascertain if the information was altered at any point, which is a vital part of forensic analysis and admitting the evidence in court if necessary (Simon, 2023). Creating new or editing existing files generates new hash values that can only be accessed using special software. The hash values must match the expected values, and if not, they will help confirm that the evidence was altered. A clear chain of custody is vital in digital evidence preservation. The company forensic analyst or investigator will document all media and evidence transfers on the Chain of Custody (CoC) forms and capture signatures and dates after handing off media. The chain-of-custody paperwork will help determine that the image of the digital evidence is or was under known possession from the time the duplicate or image was created (Simon, 2023). A lapse in the chain of custody would allow the company to nullify the legal value or dependability of the image. Generally, the primary purpose of preserving the evidence is to ensure legal admissibility. (Section 5: Digital Evidence Controls, Computer Forensic Analysis, and Recovering Files)

Digital Evidence Controls

JP Morgan Chase works with a cybersecurity forensic investigator whose main role at the company is to watch over the data and find innovative ways to protect the data. Approaches used to control digital evidence include risk reviews and vulnerability analysis that help identify potential threats. The investigator conducts forensic preservation work and preliminary investigations, adopting established standards (JP Morgan Chase Company, n.d.). The investigator also helps identify violations of the JP Morga Chase Code of Conduct and identifies, collects, and preserves the associated digital evidence. The organization, through the investigator, conducts forensically sound collection and analysis of electronic evidence using different tools to enhance security, compliance, and legal processes. (Section 5: Digital Evidence Controls, Computer Forensic Analysis, and Recovering Files)

JP Morgan Chase preserves network and host-based digital forensics on Microsoft Windows-based systems and other necessary operating systems like LINUX and adopts standard digital forensic and network monitoring tools to plan and carry out forensic support independently. The organization adopts High-Security Access (HSA) systems for forensic investigations. It conducts an enhanced annual screening of users of the systems, including checking criminal and credit backgrounds (JP Morgan Chase Company, n.d.). Additionally, the organization ensures technology governance, risk, and compliance by regularly validating the effectiveness of the controls, assessing risk annually to ensure the implemented controls can protect the organization’s information, and adopting security policies and procedures to govern receipt, transmission, processing, storage, retrieval, access, and presentation of the information. The principle of least privilege is adopted to grant personnel access to the information. Physical facilities hosting the data are restricted and have detective monitoring controls and controls for hazards like fire and water. (Section 5: Digital Evidence Controls, Computer Forensic Analysis, and Recovering Files)

Computer Forensic Tools for Forensic Analysis and File Recovery

The autopsy/the Sleuth Kit will be used for disk analysis. The tool is recommended for its ease of use, extensibility, speed, and cost-effectiveness. The Sleuth kit is a command-line tool that helps conduct forensic analysis of hard drives and smartphone images. The Autopsy is a GUI-based system using the Sleuth Kit in the background (Kaushik et al., 2020). Its modular and plug-in architecture ensures that the user can easily incorporate additional functionality. Law enforcement agencies and organizations can use this tool to investigate activities or events in a computer, analyze disk images, and recover associated files. The tool can analyze both Windows and LINUX disks. The Volatility tool will also help with memory forensics, incident response, and malware analysis. Often, investigations determine what activities occurred at the time of the incident. Volatility is used to link device, network, file system, and registry artifacts to confirm the list of all running processes, active and closed network connections, running Windows command prompts screenshots and clipboard contents that were in progress at the time of the incident (Mohanta et al., 2020). Investigators will use Volatility to assess processes, check command history, and retrieve files and passwords from the system. (Section 5: Digital Evidence Controls, Computer Forensic Analysis, and Recovering Files)

References

JP Morgan Chase Company. (n.d.). Cybersecurity Forensic Investigator. https://www.wayup.com/i-Financial-Services-j-JP-Morgan-Chase-Company-827769314821227/

JP Morgan Chase Company. (n.d.). JPMorgan Chase & Co. Minimum Control Requirements. https://www.jpmorganchase.com/content/dam/jpmc/jpmorgan-chase-and-co/documents/supplier-minimum-control-requirements.pdf

Kaushik, K., Tanwar, R., & Awasthi, A. K. (2020). Security tools. In Information Security and Optimization (pp. 181-188). Chapman and Hall/CRC.

Mohanta, A., Saldanha, A., Mohanta, A., & Saldanha, A. (2020). Memory Forensics with Volatility. Malware Analysis and Detection Engineering: A Comprehensive Approach to Detect and Analyze Modern Malware, 433-476.

Simon, M. (2023). Methods to preserve digital evidence for computer forensics. https://www.criticalinsight.com/resources/news/article/3-methods-to-preserve-digital-evidence-for-computer-forensics

 
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Alterations in Cardiovascular and Respiratory Systems

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Alterations in Cardiovascular and Respiratory Systems

(Alterations in Cardiovascular and Respiratory Systems)

 

Introduction

The cardiorespiratory system operates to serve body organs and tissues with enough oxygen supply in relation to oxygen intake. The physiological interactions between the cardiovascular and respiratory systems are complex and fundamental in optimal patient management. Alterations in these systems, for instance, altered intrathoracic pressure, can be transferred to the heart and lungs, dramatically altering cardiovascular performance (Cross et al., 2020). This paper addresses alterations in cardiovascular and respiratory systems, pathophysiological processes in these systems that contribute to disease systems, how the process affects each other, and ethnic/racial that affect physiological functioning. (Alterations in Cardiovascular and Respiratory Systems)

Alterations in Cardiovascular and Respiratory Systems

Cardiovascular and cardiopulmonary pathophysiologic processes of why the patient presents these symptoms

The patient has gained weight and is experiencing shortness of breath, peripheral edema, and abdominal swelling. A Framingham study shows that the prevalence of arterial pressure is high among overweight individuals. There is a direct correlation between hypertension and body weight in adults (Mendoza et al., 2020). The patient complains of weight gain, which is a likely cause of increased arterial pressure or hypertension, whose first symptom is shortness of breath (Oldroyd et al., 2022). The peripheral edema can be attributed to the high blood pressure due to constricted veins and arteries because any activity that increases capillary pressure, minimizes oncotic pressure, raises endothelial permeability, or impacts lymphatic drainage, can lead to edema. The abdominal swelling can be as a result of a large amount of fluid accumulating in the abdomen, which can be attributed to portal hypertension. (Alterations in Cardiovascular and Respiratory Systems)

How the cardiovascular and cardiopulmonary pathophysiologic processes interact to affect the patient

This case study depicts an alteration in cardiovascular and respiratory or cardiopulmonary systems as a result of weight gain. According to research, excess weight leads to fatty material build-up in the arteries, increasing arterial pressure because of the contractions in the arteries (Mendoza et al., 2020). The increased arterial pressure is a pathophysiological process of the cardiovascular system that leads to an alteration in the cardiopulmonary processes because the body is struggling to supply cells with adequate oxygen, requiring more blood to supply adequate oxygen (Cross et al., 2020). This alteration in the cardiopulmonary system as a result of the cardiovascular system is linked to the patient experiencing shortness of breath. (Alterations in Cardiovascular and Respiratory Systems)

Alterations in Cardiovascular and Respiratory Systems

Racial/ethnic variables that may impact physiological functioning

Most diseases, especially chronic diseases, vary by race and ethnicity. For instance, in the case of cardiovascular diseases, there is a high prevalence of hypertension among black adults, with 59% of black adults experiencing hypertension. Also, the likelihood of developing hypertension is twice among black women than among white women. Type 2 diabetes is more prevalent among American Indians, with 1 in 4 adults developing the disease compared to 1 in 12 whites (Cleveland Clinic, 2022). Regarding heart failure, the risk of a black man experiencing heart failure is 70% compared to a white man and 50% for black women compared with white women (Cleveland Clinic, 2022). Black adults are also more likely to experience coronary artery disease, heart attack, and stroke than other racial and ethnic groups. (Alterations in Cardiovascular and Respiratory Systems)

Modifiable and Non-modifiable Risks

Modifiable factors contributing to these numbers or racial disparities regarding physiological functioning include lifestyles and the living environment that encourages a sedentary lifestyle, minimal physical activity, and unhealthy eating patterns, money and resources to acquire basic needs, quality of education, quality of healthcare in the various communities, resources like nutritious foods, and societal factors like discrimination, violence, and capacity to build supporting relationships (Budreviciute et al., 2020). Some factors, like family history of illness and genetic factors, cannot be modified, but the risk can be reduced by optimizing the modifiable risk factors. (Alterations in Cardiovascular and Respiratory Systems)

Conclusion

Cardiovascular and cardiorespiratory systems interact at an optimal level to ensure optimal body functioning. However, alterations in one system can lead to an alteration in another, contributing to disease systems like shortness of breath, as indicated in the case study. In most cases, cardiovascular pathophysiological processes alter normal cardiorespiratory system functioning. Some races and ethnicities are more likely to develop particular diseases; for instance, black adults are more likely to develop cardiovascular diseases like heart failure, heart attack, stroke, and hypertension, than other races and ethnicities. The risk can be reduced by optimizing modifiable factors like lifestyles, living environment, education level or health literacy, financial ability, and quality of healthcare services. (Alterations in Cardiovascular and Respiratory Systems)

References

Budreviciute, A., Damiati, S., Sabir, D. K., Onder, K., Schuller-Goetzburg, P., Plakys, G., … & Kodzius, R. (2020). Management and prevention strategies for non-communicable diseases (NCDs) and their risk factors. Frontiers in public health, 788.

Cleveland Clinic. (2022). How Race and Ethnicity Impact Heart Disease. https://my.clevelandclinic.org/health/articles/23051-ethnicity-and-heart-disease/

Cross, T. J., Kim, C. H., Johnson, B. D., & Lalande, S. (2020). The interactions between respiratory and cardiovascular systems in systolic heart failure. Journal of Applied Physiology, 128(1), 214-224.

Mendoza, M. F., Kachur, S. M., & Lavie, C. J. (2020). Hypertension in obesity. Current Opinion in Cardiology, 35(4), 389-396.

Oldroyd, S. H., Manek, G., Sankari, A., & Bhardwaj, A. (2022). Pulmonary Hypertension. In StatPearls. StatPearls Publishing.

 
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Memorandum: Critical Incident Analysis 

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Memorandum: Critical Incident Analysis

(Memorandum: Critical Incident Analysis)

Memorandum: Critical Incident Analysis

TO: CEO

FROM: Student Name/position in the company

DATE: March 8, 2023

SUBJECT: Critical Incident Analysis

There are six claims of wrongful deaths, and most are Covid-19 related. Only one of the wrongful death claims involves a machinery accident. The following information provides details of the analysis for each case: (Memorandum: Critical Incident Analysis)

Bhashar Quan

Bhashar Quan died after potentially contracting Covid-19 at the workplace. The complaint attributes the death to a lack of health and safety considerations at the workplace. The complaint accused the company of failing to be proactive in implementing the CDC’s Covid-19 protocols which contributed to the virus contraction and eventually death. If the case is proven, the company is liable under the Occupation Safety and Health Act, which requires employers to ensure the safety of employees at the workplace (Michaels & Wagner, 2020). This complaint is high risk because the employee’s representatives have threatened legal action if the requested settlement of over $2M is not provided for the wrongful death claim. (Memorandum: Critical Incident Analysis)

The plaintiff argues that the company is liable for the wrongful death of Bhashar Quan for not implementing proper Covid-19 health and safety standards per the CDC’s guidelines. However, the company can defend itself by proving the employee contracted the virus outside the company premises and that it implemented Covid-19 safety rules per CDC and OSHA’s guidelines. The plaintiff has a case if they can prove that the company did not enforce Covid-19 protocols.

In this case, it is difficult to determine whether the employee contracted the virus at work or outside the workplace. Per the interviews, an individual was instructed to collect individual temperatures before entering the premise. This individual should be interviewed to determine if Bhashar Quan and other employees who died from Covid-19 showed any signs of fever and what steps the company took to address the issue. Additionally, employees that worked closely with Quan should be interviewed regarding any signs Quan might have shown related to Covid at the workplace. (Memorandum: Critical Incident Analysis)

Michael Haskill

The employee died from an accident attributed to negligence. Michael Haskill died from a fatal accident after being hit by a forklift that an employee drove; the complainant claims without proper certification and experience to operate the machine. The company is liable for ensuring the safety of employees per the Occupational Safety and Health Act which requires employers to ensure the safety of employees at the workplace (Michaels & Wagner, 2020). The complaint is high risk because the complainant has reached an attorney and requested compensation of $2.5M for the wrongful death of Haskill, without which the case will proceed to court. (Memorandum: Critical Incident Analysis)

The plaintiff claims that negligence from the company’s side led to the wrongful death of Michael Haskill. Negligence claims arise from the fact that the company allowed an individual without proper qualifications and experience to operate a machine. CapraTek has to prove no negligence or shift liability to the specific employee that caused the accident to avoid liability. The company has to prove that the employee in question is qualified and experienced to operate the machine before shifting liability. No witnesses have been involved in this case, leaving many unanswered questions regarding the accident’s circumstances. In this case, an interview with witnesses would help clear any uncertainties and determine whether the claim is justifiable.  (Memorandum: Critical Incident Analysis)

Susan Harewood

The claim of the wrongful death of Susan Harewood is Covid-related. The complainant argues that Susan Harewood contracted the virus at the workplace due to the lack of health and safety considerations. The claim points to the company’s negligence by failing to enforce necessary Covid-19 measures that contributed to the wrongful death of Harewood. If the claim is substantiated, the company is liable under the Occupational Safety and Health Act, which requires employers to ensure the safety of employees at the workplace for failing to adjust the workplace to adapt to Covid-19 protocols (Michaels & Wagner, 2020). This case is high risk because Harewood’s parents have threatened legal action if a settlement of $6M is not made. (Memorandum: Critical Incident Analysis)

The plaintiff’s case is based on proof of negligence and the company’s failure to implement Covid-19 protocols to protect employees from the virus per the CDC’s provisions. The company can avoid liability by proving the employee did not contract the virus at the workplace and that it implemented necessary measures per CDC’s and OSHA’s guidelines. The company also has to prove that the employee is essential, and the selection was considerate of all factors regarding employees that were required to continue working at the office. The court has to determine whether the employee contracted the virus at the workplace, which is the basis of the claim and a claim the company denies.

James Clarke

The claim of James Clarke’s wrongful death points to him contracting the virus at the workplace due to a lack of health and safety considerations. There is also a mention of negligence on the company’s side for failing to be proactive and implementing CDC’s guidelines as early as possible to prevent infections. Additionally, the complainant argues that the company was requested to close, but it did not. If the claim is proven, the company is liable under the Occupational Safety and Health Act, which requires employers to ensure the safety of employees at the workplace for failing to adjust the workplace to adapt to Covid-19 protocols (Rothstein, 2022). This case is high risk because Clarke representatives have threatened legal action if a settlement of $2.575M is not made. (Memorandum: Critical Incident Analysis)

The plaintiff’s case is based on proof of negligence and the company’s failure to mitigate Covid-19 by adopting necessary measures to protect employees from the virus per the CDC’s provisions and closing down per the “local officials'” recommendation. The company can avoid liability by proving the employee did not contract the virus at the workplace and that it implemented necessary measures per CDC’s and OSHA’s guidelines. The company also has to prove that the employee is essential, and the selection was considerate of all factors regarding employees that were required to continue working at the office. The court has to determine whether the employee contracted the virus at the workplace, which is the basis of the claim and a claim the company denies. The local official’s recommendation claim for the company to close is still unanswered because, per the interviews, the company officials deny seeing such a recommendation and deem the company essential. Local officials should be interviewed to substantiate the matter.

Richard Howell

The claim of Richard Howell’s wrongful death points to him contracting the virus at the workplace due to a lack of health and safety considerations. Per the claim, the company failed to implement and enforce necessary measures per CDC’s guidelines as early as possible to prevent infections. If the claim is proven, the company is liable under the Occupational Safety and Health Act, which requires employers to ensure the safety of employees at the workplace for failing to adjust the workplace to adapt to Covid-19 protocols (Rothstein, 2022). This case is high risk because Howell’s representatives have threatened legal action unless the company covers the insurance demand. (Memorandum: Critical Incident Analysis)

The plaintiff’s case is based on proof that the employee contracted the virus in the workplace. The company failed to mitigate Covid-19 by adopting necessary measures to protect employees from the virus per the CDC’s provisions. The company can avoid liability by proving the employee did not contract the virus at the workplace and that it implemented necessary measures per CDC’s and OSHA’s guidelines. The employee is deemed essential, and the company has to prove that the selection considered the employee’s safety. Determining whether the employee contracted the virus at the workplace is challenging, and the plaintiff and the defendant must prove their claims.

Boris Senty

The claim of Boris Senty’s wrongful death points to him contracting the virus at the workplace due to a lack of health and safety considerations. Their attorney mentions negligence on the company’s side for failing to be proactive and implementing CDC’s guidelines as early as possible to prevent infections. If the claim is proven, the company is liable under the Occupational Safety and Health Act, which requires employers to ensure the safety of employees at the workplace for failing to adjust the workplace to adapt to Covid-19 protocols (Rothstein, 2022). This case is high risk because Senty’s attorney has threatened legal action but wants the case to be settled outside the court, requesting a $2.5M settlement. (Memorandum: Critical Incident Analysis)

The plaintiff’s case is based on proof of negligence and the company’s failure to mitigate Covid-19 by adopting necessary measures to protect employees from the virus per the CDC’s provisions. The company can avoid liability by proving the employee did not contract the virus at the workplace and that it implemented necessary measures per CDC’s and OSHA’s guidelines. The company also has to prove that the employee is pivotal to the company, and the selection was considerate of all factors regarding employees that were required to continue working at the office because the employee would have worked at home. The court has to determine whether the employee contracted the virus at the workplace, which is the basis of the claim and a claim the company denies.

Interviewer Evaluation

Unanswered Question and Additional Individuals to be Interviewed

There are multiple unanswered questions the investigator needs to ask for the determination of the case. For instance, the investigator should ask how the company determined whether an employee acquired the virus within the workplace or outside the workplace. How would the company prove or defend against the claim that employees acquired the virus at the workplace? What strategies were in place to determine infected and infected employees? What was the procedure undertaken after the company identified a particular employee is infected? Was the company aware that some employees displayed symptoms but allowed them to continue operating as indicated in some letters? Did the selection criteria of essential employees consider race and ethnicity because most letters show people of color complaining that the workplace was full of new and black employees? To answer these questions, the employee that was assigned the responsibility of checking daily temperatures before employees entered the premises should be interviewed to determine whether, on a particular day, an employee with elevated temperatures was allowed to continue working. The Human Resource Manager and the Head of Operations should be interviewed further on the steps taken to determine whether an infection was acquired at the company or outside, steps taken after an employee displayed symptoms and the selection criteria of essential employees that are deemed biased and discriminatory by new and black employees. The supervisors of the employees who died wrongfully should be interviewed because they are the closest to the employees and are accused of failing to listen to the employees’ grievances. Supervisors will help answer whether some employees displayed symptoms but continued to work as claimed in the complaint letters. This additional information will help determine the liability of the company and defend against the negligence claims in the complaint letters. (Memorandum: Critical Incident Analysis)

Selection of Key Employees Interviewed 

The interview shows robustness in the interview process, including the selection of employees to interview, including Nathaniel Matthews, Chief Operations Officer, Chicago Headquarters; Marcus Norris, Director of Operations, Illinois Plant; Renee Martin, Director of Human Resources, Georgia Plant; Anthony Tsu, Director of Human Resources, Alabama Plant; and Matt Hayes, Director of Staffing, Alabama Plant. These individuals are responsible for making critical decisions that impact the company operations and have a greater say in implementing necessary safety measures to protect employees from Covid-19 and selecting which essential employees. The selection was based on the level of knowledge and authority these employees have in the company. The employees selected know about the company operations and decisions made during Covid-19 and are directly answerable to these decisions. For instance, they were all involved in a meeting arranged by Nathaniel Matthews concerning preparation for Covid-19, measures taken, selection of essential employees, and how the company responded to the stay-at-home order or request. Therefore, the selection was thorough, choosing employees with adequate information for the determination of the cases.

Facts Gathered

The facts gathered are adequate for the determination of the cases and the development of the defense. The interviewer obtains information on when and how the company implemented precautionary measures to protect employees from Covid-19, including the provision of PPE and social distancing rules, the selection criteria for essential employees, when the company held the meeting to respond to Covid-19, what the meeting entailed, who was involved, policy development regarding Covid-19 precautions, the difference in the policies for the various plants, and the content of the policies developed. The interview also gathers facts on the protocol followed to institute changes, the current state of the situation, and whether some workers could have worked from home. Additionally, the interviewer collects information regarding how the company responded to special employees or those with additional needs like pregnancy or disability. These facts are adequate to help the company defend itself and determine liability. (Memorandum: Critical Incident Analysis)

Thoroughness of Interview Questions

The interviewer asks necessary and thorough questions specific to the complaints to understand the company’s liability per the claims. The interviewer asks about when and what precautions were developed, policies developed, the difference in policies for the various plants, selection of essential employees, the protocol followed to implement precautions in the various plants, how the company identified infected individuals, people responsible for instituting changes and selected staff to work onsite or at home, considerations for special needs employees, and how the company responded to workers breaking the rules, or whether the interviewees saw anyone breaking the rules. These questions are necessary to determine the company’s liability and inform the defense team of facts surrounding the various complaints. Furthermore. The questions are probing, and the interviewer ensures a process where one question’s answer leads to another question until a particular fact is thoroughly unraveled. If a particular question is not answered adequately by a specific interviewee, the investigator raises the question again when interviewing the next individual with more knowledge and authority over the elements of the question. For instance, the selection criteria question is raised in all interview scenarios until the last individual, Matt Hayes, who other interviewees confirm he selected essential employees. These probing questions were thorough in gathering the needed facts. (Memorandum: Critical Incident Analysis)

Confidentiality of Interview Transcript

The details of the interviews are recorded and will remain confidential, requiring the employees not to disclose the details to anyone without authorization from CapraTek’s General Counsel, Marjorie Schmidt. The interviewer spells out the confidentiality requirements at the beginning of every interview to ensure the interviewee understands the rules and promises to abide by the confidentiality requirement. The interviewer also specifies confidentiality limits and who owns the confidentiality rights, which is the company and specifically the General Counsel.

Omissions by the Interviewer

However, the interviewer failed to ask the employees whether there was physical proof of fliers or posters that indicated the implementation of Covid-19 rules. It would be necessary to determine whether the employees can prove that necessary measures were implemented to ensure employee safety. The interview also omits information on how the company responded when an employee was infected, the contact tracing procedures and process at the company, whether all employees were tested after one was identified as sick, and what protocols are in place regarding employees getting sick at the plant. This information is also critical in the determination of the cases and the defense efforts. (Memorandum: Critical Incident Analysis)

Confidentiality of the Interview Transcript

Regarding confidentiality and privilege considerations, the interview details should remain confidential and not be shared with anyone without authorization. This interview is for an independent investigation to help the company with the defense; no unauthorized person should know about it. Specific details shared by the interviewed employees, including the selection process of essential and non-essential employees, which most claims say was biased, can prove the company is liable in some cases, which might put the employees at loggerheads with the company or coworkers. Therefore, the personal data of the specific employees should be between the interviewer and the employee and remain anonymous, only the fact gathered from the interviews should be disclosed for defense purposes.

The facts gathered from the interviews indicate that the company was not proactive in implementing Covid-19 measures, did not implement necessary safety measures per the CDC’s and OSHA’s guidelines, train employees to protect themselves against the virus, and adopted a biased approach toward selecting essential employees. If the plaintiff’s attorney obtained these facts, they could be used at trial against the wishes of CapraTek.

The employer cannot guarantee the complete confidentiality of the employees interviewed. However, the investigator must ensure the confidentiality of those involved in the investigation to ensure the integrity of the process is not compromised and the reputation of the parties involved is not ruined (Kilborn & Wise 2018). The employees should not discuss the investigation details with coworkers until it is complete. Lastly, per the NLRB ruling, the employer and the investigator should protect witnesses from potential danger. (Memorandum: Critical Incident Analysis)

References

Kilborn, A., & Wise, P. (2018). Rethink Requiring Confidentiality for Investigations. Society for Human Resource Management. https://www.shrm.org/topics-tools/employment-law-compliance/rethink-requiring-confidentiality-investigations

Michaels, D., & Wagner, G. R. (2020). Occupational Safety and Health Administration (OSHA) and worker safety during the COVID-19 pandemic. Jama, 324(14), 1389-1390.

Rothstein, M. A. (2022). The OSHA COVID-19 case and the scope of the Occupational Safety and Health Act. Journal of Law, Medicine & Ethics, 50(2), 368-374.

 
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PICOT-D Draft

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PICOT-D Draft

(PICOT-D Draft)

Problem Statement

It is not known if the implementation of a new IPV policy would impact IPV identification among IPV victims, current and potential.

Purpose Statement

The purpose of this quality improvement project is to determine if the implementation of a new IPV policy would impact IPV identification among current and potential IPV victims. The project will be piloted over an eight-week period in an urban primary care clinic. (PICOT-D Draft)

PICOT-D Draft

PICOT-D Question

Among current and potential IPV victims, how does the implementation of a new IPV policy compared with the current IPV policy affect IPV cases identification rates within an 8-week period when looking at an individual’s self-report of experiencing IPV ever in the lifetime of their referent relationship and the standardized frequency within two months before interview. (PICOT-D Draft)

Primary Quantitative Research Articles

Homan et al. (2020), Sangeetha et al. (2022), and Clithero et al. (2016) were selected as relevant, valid, reliable, and appropriate research support for the project topic. The articles are quantitative and published within 7 years the anticipated graduation date. Homan et al. (2020) explores quantitative methods of IPV analysis, aiming to gather valuable information of people perception of why they chose to stay or leave or both an abusive relationship. This study is relevant to the research topic as it provides valuable insights into understanding perception of abusive relationship and how different people respond to IPV. Sangeetha et al. (2022) and Clithero et al. (2016) address advocacy and policy as interventions to addressing intimate partner violence. These studies provide insights into the proposed intervention and how it can be adopted as a health policy at the workplace to guide IPV identification to foster early intervention and prevention of pervasive abusive relationships that have detrimental impact on the victim. (PICOT-D Draft)

 

References

Homan, C. M., Schrading, J. N., Ptucha, R. W., Cerulli, C., & Ovesdotter Alm, C. (2020). Quantitative Methods for Analyzing Intimate Partner Violence in Microblogs: Observational Study. Journal of medical Internet research, 22(11), e15347. https://doi.org/10.2196/15347

Sangeetha, J., Mohan, S., Hariharasudan, A., & Nawaz, N. (2022). Strategic analysis of intimate partner violence (IPV) and cycle of violence in the autobiographical text–When I Hit You. Heliyon, 8(6), e09734. https://www.sciencedirect.com/science/article/pii/S2405844022010222

Clithero, A., Albright, D., Bissell, E., Campos, G., Armitage, K., Solan, B., & Crandall, C. (2016). Addressing Interpersonal Violence as a Health Policy Question Using Interprofessional Community Educators. MedEdPORTAL : the journal of teaching and learning resources, 12, 10516. https://doi.org/10.15766/mep_2374-8265.10516

 
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Analyzing Liability 2

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Analyzing Liability 2

(Analyzing Liability 2)

Summary

The complaint letter is by Mr. Thomas Lee about his disappointment with the company for failing to ensure a secure workplace for individuals from all backgrounds and nationalities. Mr. Lee is an American of Chinese origin who complains of racial discrimination at the workplace after being accused of bringing COVID-19 to the workplace because he is Chinese. The employee presented a verbal complaint to the supervisor, who failed to listen to him and questioned Mr. Lee’s customs and beliefs. Mr. Lee says the workplace is hostile and intimidating, and he has received threats from other employees who have singled him out for allegations of spreading the virus on the basis of his origin and ethnicity, sending him negative messages through texts, emails, social media and telephone. Mr. Lee continues to point out that several people have died after exposure to Covid-19, insisting the company’s lapse in judgement and preparedness was the primary reason. Furthermore, another letter by Karen Small, also a security guard, seems to confirm the allegation because she points out that she thinks she acquired the virus from Mr. Lee, who the company allowed to spread the disease. Mr. Lee is an American Citizen and has lived in Alabama almost his life and cannot contemplate why he is being singled out for spreading the virus on the mere basis of being Chinese. Mr. Lee says the company has done nothing to address the situation and lacks leadership, which encourages the behavior. He is considering a lawsuit if the issue is not dealt with. (Analyzing Liability 2)

Associated U.S. laws or regulations and how they are relevant to the identified liability

First Mr. Lee complains of racial discrimination at the workplace, which is addressed by Title VII of the Civil Rights Act of 1964. This Act makes it illegal to discriminate against people on the mere basis of their color, race, religion, national origin or sex. For example, Hahn et al. (2018) provide that this Act is fundamental in ensuring racial and ethnic equity and eliminating discriminatory behavior, implying the Act corresponds to the identified liability of preventing racial discrimination based on color, race, gender, or nationality. The law protects all employees from retaliation if they decide to forward a claim on discrimination at the workplace. Mr. Lee also points out that most people acquired and were exposed to the virus because of the company’s lapse in judgement and preparedness, which is addressed by the Occupational Safety and Health Act of 1970, which requires employers to keep the workplace free from hazardous conditions, stressing employees’ rights to information regarding the dangers in their job. For example, in Michaels & Wagner (2020), employers are required by law to offer an environment that protects employees from COVID-19 per OSHA provisions. Michaels & Wagner (2020) provides that only employers can make the workplace safe by enforcing OSHA guidelines, and a failure to do so is considered a non-adherence and non-compliance. This scenario implies that the OSHA is relevant to the identified liability of keeping employees safe from Covid-19 at the workplace. The law also protects employees from being punished if they decide to exercise their rights per OSHA. (Analyzing Liability 2)

The potential harm to the company, its employees, and its workplace culture that could result from a lawsuit emanating from the selected complaint

If the company is found liable for non-compliance with Title VII, it could face penalties for intentional discrimination, enforced as either compensatory or punitive damage up to a maximum provided by the Title VII of the Civil Rights Act of 1964 according to the number of employees in the company. The company would have to pay either back pay, compensatory damages, or punitive damages. For instance, in Lund (2020), the case, titled Bostock v. Claton County, involves the Supreme Court upholding non-discrimination based on race and sex, against which an employer is liable and faces paying compensatory damages. This case implies that if the company is found liable under the interpretation of Title VII of the Civil Rights Act, it would have to pay compensatory damages to Mr. Lee. The confirmation of liability would affect other employees, especially of other nationalities, who have experienced the same and may choose to also forward their case. This liability would label the workplace as toxic, discriminatory, and lacking diversity. If the company is found liable under OSHA for failing to protect its employees from Covid-19 exposure, it could face penalties based on the type of violation, ranging between $15,625-$156,259 per violation. Dealing with litigations for OSHA non-compliance will be costly for the company. For instance, Sadeh et al. (2022) address the cost impact of Covid-19 OSHA citations and specify that fines for non-compliance and regulatory violations have a significant cost impact on a company. If the company is found liable, it means that the company would also be liable for all other Covid-19-related cases, amounting to millions of dollars of fines and compensatory damages that would be detrimental to the company’s finances. It would also mean that the work environment is unsafe, and the company cannot protect its most valuable resource, leading to a demoralized workforce. (Analyzing Liability 2)

Analyzing Liability 2

Realistic preventative measures that could have avoided legal liability

The company has to promote diversity in the workplace by developing and enforcing anti-harassment and anti-discrimination policies that condemn discrimination based on race, color, gender, ability or disability, sexual orientation, and other identifiers. The company should protect employees from bullying and harassment. Cross-cultural or cultural sensitivity training and education would be necessary to ensure a discrimination-free environment. For example, Shepherd (2019) offers evidence supporting cross-cultural training, including diversity training, anti-racism raining, and micro-aggression training, effectiveness in enhancing cultural competence, safety, humility, and intelligence, which are integral in ensuring a workplace free from discrimination, harassment, and intimidation. The training would include all employees because there are allegations of lapse in conduct and professionalism among low-level employees and supervisors. The training program would ensure that all employees respect cultural and racial differences, act professional in conduct and speech, refuse to instigate, participate, or condone discrimination and harassment, and avoid race-based or culturally offensive acts, including humor and pranks (Shepherd, 2019). Systematic factors contribute to discrimination, harassment, and retaliation in the workplace. Therefore, the company should develop an effective internal complaints procedure and ensure such issues are addressed internally to avoid legal liability. These procedures, coupled with dispute resolution systems can help prevent discrimination and harassment as provided by Dobbin and Kalev (2020), who offer guidelines for making discrimination and harassment systems better. (Analyzing Liability 2)

Individuals and departments that would need to be involved in the proposed measures

Mr. Lee complained of harassment on a daily basis, from a fellow security guard to the supervisor. This case implies a lack of cultural sensitivity and awareness across employees of all levels. Therefore, all employees, including supervisors and managers, will be involved in the proposed measures, particularly the cross-cultural or cultural sensitivity training and education. The Human Resources Department will be involved because it is responsible for outlining disciplinary action policies and procedures to respond to actions or behavior that violate the company’s policies. It will help formulate and enforce anti-harassment and anti-discrimination policies and formalize the internal complaints procedure to orient all employees on the code of discipline. (Analyzing Liability 2)

Viable legal defenses the company could assert in a litigation context in order to defeat the complainant’s claims

The complainant has the duty to prove that he experienced racial discrimination at the workplace, which seems a serious case because the allegations are confirmed in other complaints, implying that employees think Mr. Lee spread the virus under the company’s watch. The company would also have to prove beyond doubt that Mr. Lee did not experience racial discrimination or that if he did, it was unintentional because only intentional racial discrimination is ruled as non-compliance. The company can also counter the claim by stating a lack of substantial evidence indicating that Mr. Lee experienced racial discrimination. The company has to show current policies that protect employees from racial discrimination and how it enforced these policies to respond to the complaint. Mr. Lee is accused of spreading the virus because he is Chinese. If the company can prove that indeed Mr. Lee brought the virus to the workplace, it can avoid legal liability. In the interview transcript, interviewees provide that the company developed safety rules and measures per CDC to protect employees from Covid-19 exposure. It has to prove this claim with substantial evidence to avoid legal liability, given that other complaint letters point to the lapse of judgement and preparedness as the primary cause of over 70% of infections and several wrongful deaths. The company has to convince the jury that employees acquired the virus outside the workplace, which is beyond the control of the employer, to avoid legal liability. (Analyzing Liability 2)

Ethical implications of the scenario and measures that address ethical issues

The primary ethical principles associated with this scenario include fairness, respect, responsibility, and protection from harm. Racial discrimination and harassment in the workplace are perceived as ethical failing due to a culture or practices of disrespect, unfairness, and harm (Elias & Paradies, 2021). It is a violation of human rights due to an unjustified distinction created by the nature of the work environment or policy failures. Racial discrimination impacts negatively the work environment and the company at large. Employees who are harassed and singled out by other employees, including managers and supervisors, feel unheard and unprotected by the company. It creates a toxic environment, forming divides between employees that are detrimental to the company. Employees of other racial and ethnic minorities or nationalities would fear engaging or collaborating meaningfully when the company does not protect them from harassment and discrimination. It would mean increased absenteeism, turnover, poor performance, bad PR, loss of income and litigation, and damaged relationships with other companies that employ an anti-racist or anti-discrimination approach. (Analyzing Liability 2)

Under the ILPA Industry Code of Conduct Guidelines, all individuals should be treated equally in an organization, and a company should not tolerate discrimination based on age, gender, race, religion, sexual orientation, family status, disability, marital status, or political beliefs (Institutional Limited Partners Association, 2018). The company can enforce such measures to prevent ethical failing and unethical behavior as a measure to promote ethical conduct in the workplace. The company should condemn discrimination and racism, protect employees from bullying and harassment, and promote a diverse and inclusive environment where employees respect each other’s differences. (Analyzing Liability 2)

References

Dobbin, F., & Kalev, A. (2020). Making discrimination and harassment complaint systems b(Analyzing Liability)etter. WHAT WORKS?, 24.

Elias, A., & Paradies, Y. (2021). The Costs of Institutional Racism and its Ethical Implications for Healthcare. Journal of bioethical inquiry, 18(1), 45–58. https://doi.org/10.1007/s11673-020-10073-0

Hahn, R. A., Truman, B. I., & Williams, D. R. (2018). Civil rights as determinants of public health and racial and ethnic health equity: health care, education, employment, and housing in the United States. SSM-population health, 4, 17-24.

Institutional Limited Partners Association. (2018). Code of conduct: harassment, discrimination and workplace violence: Guidelines for the private equity ecosystem.

Lund, N. (2020). Unleashed and Unbound: Living Textualism in Bostock v. Clayton County. Clayton County (July 14, 2020). Federalist Society Review, 21, 20-15.

Michaels, D., & Wagner, G. R. (2020). Occupational Safety and Health Administration (OSHA) and worker safety during the COVID-19 pandemic. Jama, 324(14), 1389-1390.

Sadeh, H., Mirarchi, C., Shahbodaghlou, F., & Pavan, A. (2022). Predicting the trends and cost impact of COVID-19 OSHA citations on US construction contractors using machine learning and simulation. Engineering, Construction and Architectural Management, (ahead-of-print).

Shepherd, S. M. (2019). Cultural awareness workshops: limitations and practical consequences. BMC Medical Education, 19(1), 1-10.

 
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