Problem Solving

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Unit VIII Problem Solving Worksheet

This assignment will allow you to demonstrate the following objectives:

Describe thermodynamic concepts and their applications.

Extend the first law of thermodynamics to various daily life activities.

Identify the maximum efficiency of a heat engine.

Explain the role of latent heat while phases are changing.

Instructions: Choose 8 of the 10 problems below. Show your work in detail. Answer the questions directly in this template. Before doing this, it is highly recommending that you thoroughly review the four examples in the Unit Lesson.

The efficiency of a Carnot engine is e=1-Tc/TH, where Tc is a temperature of the cold reservoir and TH is a temperature of the hot reservoir. What is the condition to have 100% efficiency? Hint: What is the mathematical condition for Tc/TH to be zero.

Suppose the work done to compress a gas is 100 J. If 70 J of heat is lost in the process, what is the change in the internal energy of the gas? Hint: Use the first law of thermodynamics. The internal energy of a system changes due to heat (Q) and work (W): U=Q-W. The change in internal energy is equivalent to the difference between the heat added to the system and the work done by the system. Think if the work done is to the system or by the system. This determines the sign of W.

An engine’s fuel is heated to 2,000 K and the surrounding air is 300 K. Calculate the ideal efficiency of the engine. Hint: The efficiency (e) of a Carnot engine is defined as the ratio of the work (W) done by the engine to the input heat QH : e=W/QH. W=QH – QC, where Qc is the output heat. That is, e=1-Qc/QH =1-Tc/TH, where Tc for a temperature of the cold reservoir and TH for a temperature of the hot reservoir. The unit of temperature must be in Kelvin.

Mr. White claims that he invented a heat engine with a maximum efficiency of 90%. He measured the temperature of the hot reservoir as 100o C and that of cold reservoir as 10o C. Find the error that he made and calculate the correct efficiency. Hint: The efficiency (e) of a Carnot engine is defined as the ratio of the work (W) done by the engine to the input heat QH : e=W/QH. W=QH – QC, where Qc is the output heat. That is, e=1-Qc/QH =1-Tc/TH, where Tc for a temperature of the cold reservoir and TH for a temperature of the hot reservoir. The unit of temperature must be in Kelvin.

How much energy is needed to change 100 g of 0o C ice to 0o C water? The latent heat of fusion for water L=335,000 J/kg. Hint: The heat (Q) used to change from one phase to another phase of the matter is Q=mL, where L is the latent heat. Its unit is J/kg.

It was determined in the 19th century that the normal human body temperature is 98.6o F. A more recent study found that it is 98.2o F. Express the difference in the temperature in Celsius. Hint: Use the converting formula between Fahrenheit and Celsius scales: F=9/5C +32. Be careful about the unit.

Suppose 0.5 kg of blood flows from the interior to the surface of John’s body while he is exercising. The released energy is 2,000 J. The specific heat capacity of blood is 4,186 J/kgo C. What is the temperature difference between when the blood arrives at the body surface and returns back to the interior of the body? Hint: Use the formula regarding heat Q, specific heat capacity c, mass m, and temperature change dT. Q= cm dT. Please look at p.290 in our textbook. Also, review Example 1 with its solution in Study Guide.

A student does 1,000 J of work when she moves to her dormitory. Her internal energy is decreased by 3,000 J. Determine the heat during this process. Does she gain or lose her heat? Hint: Use the first law of thermodynamics. The internal energy of a system changes due to heat Q and work done W: U=Q-W. Also, look at a similar case, Example 3 with its solution in Study Guide.

In a construction site, 2 kg of aluminum shows the increment of temperature by 5oC. Ignoring the work, what is the change in the internal energy of the material? The specific heat capacity of aluminum is 900 J/kg oC. Hint: The internal energy of a system changes due to heat Q and work done W: U=Q-W. If we ignore, the work, the internal energy U is identical to the heat Q of the system. We know that relation between heat Q, specific heat capacity c, mass m, and temperature change dT; Q= cm dT. That is, U=Q=cm dT.

The input heat of a Carnot engine is 3,000 J. The temperature of a hot reservoir is 600 K and that of a cold reservoir is 300 K. What is the work done? Hint: The efficiency e of a Carnot engine is defined as the ratio of the work done, W, by the engine to the input heat QH : e=W/QH. W=QH – QC, where Qc is the output heat. That is, e=1-Qc/QH =1-Tc/TH, where Tc for a temperature of the cold reservoir and TH for a temperature of the hot reservoir. The unit of temperature must be in Kelvin.

Use the formula, e=1-Tc/TH. Please review the Example 4 with its solution in Study Guide. Once you evaluate, you can find the work done of the system using the formula, e=W/QH

 
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Progress Check 2 Research Investigation

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SCS 200 Research Investigation Progress Check 2 Guidelines and Rubric

Overview: Throughout Theme: Performing the Research Investigation, you have been guided through continuing your work on Project One (a research investigation), which you will continue to work on in Theme: Tailoring the Message to an Audience and formally submit to your instructor at the end of Week 5. This assignment provides you with an important opportunity to get valuable instructor feedback on the progress you are making and to ensure you are on the right track for your later submission.

Prompt: Throughout Theme: Performing the Research Investigation, you have had opportunities to fine-tune your selected social sciences issue and begin exploring academic sources that can support your continued research on your issue. As you complete this work throughout Theme: Performing the Research Investigation, you should continue to build from the previous work you completed and submitted in Research Investigation Progress Check 1. Specifically, in this assignment, you will submit the Project One elements listed below for review by your instructor.

In Theme: Performing the Research Investigation, learning block 4-2 (page 1), you completed the following work, building from your work in Theme: Exploring Social Science Issues:

I. Introduction A. Describe the issue in the social sciences that you have selected to investigate.

Why is this issue significant?

In Theme: Performing the Research Investigation, learning block 4-2 (page 3), you completed the following work:

I. Introduction B. Describe at least three social science resources that you could use to investigate

the issue you selected. Your sources must be relevant to your issue and must be of an academic nature appropriate for the issue. In your description, consider questions such as these: What are the similarities and differences in the content of your sources? What makes them appropriate and relevant for investigating your issue? What was your thought process when you were searching for sources? How did you make choices?

In Theme: Exploring Social Science Issues, learning block 4-3 (page 2), you completed the following work:

II. Body A. Identify the social science principles that apply to your issue. In other words,

which principles of social science apply to the issue you selected? B. Explain how the principles you identified apply to your issue. In other words, how

are the social science principles you identified relevant to your issue?

In Theme: Performing the Research Investigation, learning block 4-3 (page 3), you completed the following work:

III. Conclusion A. Based on your investigation, develop a research question related to the issue you

selected. In other words, what would you like to know more about? B. Explain how a social scientist would go about investigating the research question

you developed. In other words, what would the next steps be if a social scientist were to continue researching your question?

In Theme: Performing the Research Investigation, learning block 3-3 (page 3), learning block 4-1 (page 3), and learning block 4-2 (page 3), you began working on the following section of the prompt:

IV. Provide a reference list that includes all of the social science resources you used to investigate your issue and question. Ensure that your list is formatted according to current APA guidelines (or another format with instructor permission).

Please note that the numbering included above directly aligns with the numbering of these elements as they are presented in the Project One Guidelines and Rubric document.

Rubric Guidelines for Submission: Submit your progress check assignment as a Microsoft Word document with double spacing, 12-point Times New Roman font, and one-inch margins. Your submission should be 2 to 4 pages in length. Any citations should be formatted according to APA style.

Critical Elements Proficient (100%) Needs Improvement (80%) Not Evident (0%) Value

Introduction: Issue Describes selected issue in social sciences and its significance, reflecting an initial understanding of the issue and the social sciences

Describes selected issue in social sciences and its significance, but with gaps in detail or clarity

Does not describe selected issue in social sciences or its significance

13

Introduction: Social Science Resources

Describes at least three relevant and appropriate social science resources that could be used to investigate selected issue

Describes at least three social science resources that could be used to investigate selected issue, but with gaps in appropriateness, relevance, or detail

Does not describe at least three social science resources that could be used to investigate selected issue

13

Body: Identify Principles Identifies social science principles that apply to issue, citing sources

Identifies social science principles that apply to issue, but with gaps in accuracy or citation

Does not identify social science principles that apply to issue

13

Body: Explain Principles Explains how identified principles apply to issue, citing sources

Explains how identified principles apply to issue, but with gaps in detail, clarity, or citation

Does not explain how identified principles apply to issue

13

Conclusion: Research Question

Develops research question related to selected issue, based on investigation

Develops research question related to selected issue, but question is not based on investigation

Does not develop research question related to selected issue

13

Conclusion: Social Scientist

Explains how a social scientist would go about investigating research question

Explains how a social scientist would go about investigating research question, but with gaps in clarity, detail, or logic

Does not explain how a social scientist would go about investigating research question

13

Reference List Provides reference list that includes all social science resources used to investigate issue and question, ensuring that list is formatted according to current APA guidelines

Provides reference list that includes all social science resources used to investigate issue and question, but list has gaps in adherence to current APA formatting guidelines

Does not provide reference list that includes all social science resources used to investigate issue and question

13

Articulation of Response Submission has no major errors related to citations, grammar, spelling, syntax, or organization

Submission has major errors related to citations, grammar, spelling, syntax, or organization that negatively impact readability and articulation of main ideas

Submission has critical errors related to citations, grammar, spelling, syntax, or organization that prevent understanding of ideas

9

Total 100%

 
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HI300 Unit 4 Seminar Option 2

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HI 300: Information Technology and Systems for Healthcare

Unit 4 Seminar

Tonight’s Agenda

Questions from Unit 2 graded assignments

Reminders about academic writing & plagiarism

Week 4 Assignment Review

Discussion Board Example

Investigate clinical decision support applications and provide a summary of at least two of the applications that you find. Please provide facts about each of the applications and answer the following questions:

What does the application do?

How does the application help the user?

VisualDx is a unique clinical decision support system that delivers diagnostic answers where and when physicians need them.

https://www.youtube.com/watch?v=72zhp_6Tcw4

Scenario: Imagine that you are the Director of Health Information for a large hospital. As Director, you sit on various institution-wide committees which govern the organization’s policies. You have seen issues arise that cause you to propose changes in policies, procedures and operations across the hospital. Therefore, you have decided to create a proposal to the CEO and Board of Directors, which you will develop in collaboration with committee teams.

Unit 4 Assignment Breakdown

Task #1: Evaluate, implement and manage electronic applications/systems for clinical classification and coding.

Select two (2) applications/systems for clinical classification and coding (e.g., encoders, computer assisted coding (CAC), etc.) and

Appraise each vendor in terms of:

capacity to evaluate quality coding practices;

possible implementation considerations/issues; and

systems management challenges and training needs

Provide support for one (1) system that you find as the “best option“

explain why this is the best option.

Task #2: Evaluate the accuracy of diagnostic and procedural coding.

Consider the principles and applications of classification systems (e.g., ICD-10, HCPCS) and medical record auditing used within a clinical documentation improvement (CDI) program. Appraise the value and challenges of a quality CDI program by:

defending the need for ongoing CDI program support; and

critique at least three (3) challenges in the CDI process.

Make connections between auditing, accurate diagnostic and procedural coding with classification systems, and CDI programs

Your executive summary should reflect upon the need for CDI and best practices for ensuring compliance.

Task #3: Advocate information operability and information exchange.

Critique one (1) interoperability issue that is possible within the health information exchange (HIE) (e.g., patient identity matching).

Appraise at least three (3) best practices that address the issue.

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Task #4: Evaluate health information systems and data storage design.

Evaluate at least three (3) health information systems (HIS)

select the best health information system

why, explain with rationale

Evaluate at least three (3) data storage designs (e.g., onsite, cloud)

select the best data storage design for disaster recovery purposes

why, explain with rationale

Task #5: Manage clinical indices/databases/registries.

Evaluate three (3) managerial challenges (as hospital’s Director of Health Information) related to:

clinical indices, databases, and registries

Recommend three (3) best practices or policies related to:

management of secondary data sources

Brainstorming – Task #5

Understanding the difference b/t primary and secondary data sources.

Maintaining security and confidentiality

Need to ensuring data quality

Need for clinical documentation (CDI) program

Need for interoperability

Need for compliance with laws, regulations, and accreditation standards.

Need for audit processes

Video Tip #1: Video about Patient Registries https://www.youtube.com/watch?v=_3ZPZ0EKVCE

Task #6: Evaluate data from varying sources to create meaningful presentations.

With respect to data warehousing, appraise at least two (2) approaches in data warehouse design that supports:

quality data management from varying sources;

processing/storage of data throughout the warehouse model;

meaningful output into the presentation layer

Summarize your recommendations in the executive summary.

Chapter 4

15

Brainstorming – Task #6

Top-down, Bottom-Up and Hybrid

Cost, data quality, data marts, data mining

Give a summary of the 2 you choose

Tip #1: Data warehouse design approaches

Tip #2: Data warehouse Overview presentation

Unit 4 Assignments

Discussion

Submit Unit 4 Assignment

Quiz

 
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Airspace Capacity Challenges

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For this assignment, conduct research and consider airspace capacity challenges currently facing the aviation industry. You will select one specific topic that is leading to an airspace capacity challenge to address in your paper (e.g. unmanned systems operations, an increase in commercial air traffic, etc.).

Your paper must include:

  • The impact of capacity on the current structure of the national airspace
  • An evaluation of the FAA’s National Airspace Systems Plan on current air traffic control systems
  • An assessment of the impact of equipment capacity on national airspace system availability
  • A proposed recommendation to increase the capacity of the national airspace

Your paper must be supported by a minimum of three scholarly references, should be grammatically sound, and free of spelling errors. You must include a properly formatted title page, in-text citations where appropriate, and a reference page formatted according to current APA guidelines. If you have any questions regarding APA requirements, please refer to the current APA manual or ask your instructor.

 
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Choosing A Project Charter

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MGT 312 FINAL PROJECT CONSTRUCTION CHARTER

Project Title: 444 Fourth Avenue Kitchen Renovation

Project Overview/Deliverable This is a project to upgrade a home kitchen. The non-working range will be replaced, and other

appliances upgraded. New electrical circuits will be installed allowing for the installation of a

dishwasher and in-sink disposal. New cabinetry will also be installed in addition to providing

the kitchen with a fresh coat of white paint. A more detailed list of tasks can be found in the

Scope section.

Scope The project includes the following tasks: Removals 1) Removal of old built-in cabinets and trim 2) Removal of old linoleum flooring and sections used as backsplash 3) Removal of old appliances including: oven, range hood, and refrigerator 4) Removal of 2 light fixtures: main ceiling fixture, over-sink fixture 5) Disconnect plumbing and removal of old double basin sink 6) Remove/sand old wall coverings 7) Repair walls/ceiling/subfloor in preparation for new installations Installations 1) Paint ceiling 2) Hang wallpaper 3) Install new cabinets 4) New wire runs installed and inspected by city (subcontracted to electrician) 5) New countertops/backsplash installed (includes sink installation) 6) New laminate tile flooring installation 7) New appliances connected (refrigerator, oven, range hood, dishwasher, disposal) 8) New lighting fixtures installed (main ceiling fixture and over-sink fixture) 9) Door/window/cabinet trim installed

Resources Work

• Grady’s Contracting – General Contractor with three employees

• Lowe’s Home Improvement Store – Design Consultant

• Bill’s Electrical – Electrical Contractor

• Lamtech – Countertop Installer

Budget

$25,000 including a 10% contingency fund of $2,500 to respond to risks.

Major Milestones Milestones Deliverables

Removal of all old kitchen fixtures. Clean work space for design and installation phases.

Electrical work completed. Three new city-inspected circuits for oven,

dishwasher, and disposal.

Wallpaper hung. Prepares walls for cabinet installation.

Cabinetry installed. 7 new cabinets, level and square.

Countertop installation. Slate countertops allow sink/disposal installation, and installation of other appliances.

Appliance installation. Makes kitchen usable for homeowners.

Trim/miscellaneous finishing work. Completes project, adds to home value.

Roles/Responsibilities Customer/Sponsor: Provides overall direction on the project. Responsibilities include: approve the project charter and plan; secure resources for the project; confirm the project’s goals and objectives; keep abreast of major project activities; make decisions on escalated issues; and assist in the resolution of roadblocks.

Name Email

John Barber (homeowner) barberj@gmail.com

Project Manager: Leads in the planning and development of the project; manages the project to scope. Responsibilities include: develop the project plan; identify project deliverables; identify risks and develop risk management plan; direct the project resources (team members); scope control and change management; oversee quality assurance of the project management process; maintain all documentation including the project plan; report and forecast project status; resolve conflicts within the project or between cross-functional teams; ensure that the project’s product meets the business objectives; and communicate project status to stakeholders.

Name Email / Phone

Student Name Email/Phone

Team Members: Work toward the deliverables of the project. Responsibilities include: understand the work to be completed; complete research, data gathering, analysis, and documentation as outlined in the project plan; inform the project manager of issues, scope changes, and risk and quality concerns; proactively communicate status; and manage expectations.

Name Email / Phone

John Grady (Grady’s Contracting) (SPOC) billgrady@gcontracting.com/757-756-9807

Tina Herring (Lowe’s Design) herringt@lowesconsumer.com/757-988-0900

Bill’s Electrical (electrical contractor) Billyb214@hotmail.com/604-456-3254

Cecil Lakota – Lamtech (countertop installer) cecil@lamtechcounters.com/302-899-7700

Success Measurements

• Complete all requirements according to final inspection checklist

• Complete project under the budget constraint of $25,000

• Complete project within a 30-day time frame

 
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Discusion -01-Epid

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Discussion 1-3 EPid ( two pages)

Because it draws from other fields such as biostatistics and social sciences, epidemiology is described as being interdisciplinary. From which aspects of other disciplines do you feel epidemiology borrows? In what ways does epidemiology differ from those disciplines? When responding to your classmates, provide additional connections between epidemiology and other disciplines. Support your response with specific examples.

Response one

Epidemiology and Other Disciplines

Epidemiology is the “study of the distribution and determinants of health and disease, morbidity, injuries, disability, and mortality in populations” (Friis & Sellers, 2014, p. 743).  Epidemiology was first developed to understand causes of certain diseases such as smallpox and polio among humans. It now also includes the study of factors associated with non-transmissible diseases like cancer. It is described as interdisciplinary as it borrows elements from many other disciplines including microbiology and sociology. Epidemiology utilizes microbiology to help understand specific disease agents and modes of transmission. Microbiological techniques are borrowed to help in revealing sources of outbreaks and to determine sources. Sociology is equally important in epidemiology to aid in the study of social conditions and disease processes. Social sciences also assist epidemiologists in providing different methods on sampling such as measurement, questionnaire development, design, and delivery (Friis & Sellers, 2014). “Social factors have become more important precisely because epidemiological and biomedical knowledge has shifted the causes and consequences of disease from fate, accident, and bad luck to factors that are under some human control” (Link, 2008, p. 367).

Epidemiology differs from other disciplines in its perspective on groups or populations rather than individuals. It contrasts diseases and characteristics relative to different time periods, different places or different groups. It also differs from the physical sciences because it does not investigate the biological mechanism leading from exposure to disease. Epidemiologists can identify modifiable conditions that contribute to the health outcome without also identifying the biological mechanism or agent that lead to the outcome. An example of this is the improvements of environmental hygiene that reduced infectious diseases like cholera, that was possible before the identification of the actual bacteria (Ahrens, Krickeberg, & Pigeot, 2005).

Epidemiological studies are crucial to preventing, controlling and eradicating diseases. The research helps us to understand the incidence and prevalence of diseases, the cost of illness, and the burden of disease on society (Friis & Sellers, 2014). I have attached an article that I read about the role of mathematical modeling and prediction in infectious disease epidemiology that I felt was interesting and relevant to our Epidemiology course.

Mathematical modelling and prediction in infectious disease epidemiology

References

Ahrens, W., Krickeberg, K., & Pigeot, I. (2005). An introduction to epidemiology. New York, New York: Springer, Berlin, Heidelberg.

Friis, R. H., & Sellers, T. A. (2014). Epidemiology for Public Health Practice (5th ed.). Burlington, MA: Jones & Bartlett Learning.

Link, B. G. (2008). Epidemiological Sociology and the Social Shaping of Population Health. Journal of Health and Social Behavior, 49(4), 367–384. Retrieved from: http://www.jstor.org/stable/27638766

less

 
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#6151 Topic: Renaissance Period

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#6151 Topic: Renaissance Period Number of Pages: 1 (Double Spaced) Number of sources: 1 Writing Style: MLA Type of document: Essay Academic Level:High School Category: Music Language Style: English (U.S.) Order Instructions: Renaissance Period Listen perceptively to the “Kyrie” from Missa O Magnum Mysterium by the Renaissance Spanish composer Tomás Luis de Victoria. Play play stop mute max volume 00:00 04:27 No audio loaded. In 5 short paragraphs, describe the attributes of the musical selection, according to the following critical criteria: 1. RECOGNIZE AND DESCRIBE: At least one example of each of the following musical elements : Rhythm, tempo, melody, harmony, timbre, texture, and form that are present in this particular composition, using specific musical terms learnt in the course and descriptive adjectives. Examples of descriptive adjectives might include: a “menacing” melody, “triumphant” dynamics, or a “racing” tempo. Use your imagination! 2. DEVELOP: A conclusion about what the composer was trying to represent. [Might a “racing” tempo represent an attempt to escape from danger or dancing at a celebration?] 3. INTERPRET: The composition’s emotional value, using language that describes emotional states. Does the music express joy, fear, pleasure, optimism, sadness? 4. EVALUATE: The composition’s creative quality: What makes this composition a valuable work of art? 5. ANALYZE: Its personal effect on you. How does this work express aspects of the human condition? Does the music suggest a philosophy for living?

 
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Questions To Answer

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READ CAREFULLY !!! YOU MUST watch the videos in order to answer the 4 questions.

You need to listen to video lectures on Line, Shape and Space.  You’ve also need to view the approx. 12 minute video segments on Vija Celmins, Doris Salcedo, and Julie Mehretu.  I will post a LINKS for all the lectures and videos at the bottom. Again you must see them in order to answer the following questions.

Answer the following questions (MINIMUM OF 550 WORDS)

1)  Which artist’s work did you find most interesting?  Why?

2)  How did her work relate to the ideas of Shape or Space in Chapter 4?  Both in technical terms, but also conceptually.

Be specific here by using vocabulary from the textbook.  I’m looking for you to be able to apply the language and concepts from the book to the specific works shown in the videos.  Can you expand on the just the actual presence of shape and space and apply these formal elements to their main concept?  Make sure you cite specific works from the video.

3)  How did her work relate to the ideas of Line in Chapter 3?  Both in technical terms, but also conceptually.

Again, be specific by using the terminology from the textbook.  Also, see if you can push the formal element of line to apply to the main concept of the artist.

4)  Compare your answers to questions 1 – 3 with one of the other two artists.  Did this other artist use Shape, Space, or Line differently?  How?

Make sure you cite specific works from the video.

YOU MUST CITE SPECIFIC WORKS FROM THE VIDEO ONLY or the book !

LINKS:

1. Line,shape,space

https://us-lti.bbcollab.com/collab/ui/session/playback

https://us-lti.bbcollab.com/collab/ui/session/playback

2. Vija

https://art21.org/artist/vija-celmins/

3.Doris

https://art21.org/watch/art-in-the-twenty-first-century/s5/doris-salcedo-in-compassion-segment/

4. Julie

https://art21.org/watch/art-in-the-twenty-first-century/s5/julie-mehretu-in-systems-segment/

5.

I attached the TEXTBOOK from where you can see chapter 3 and 4 so you can answer the questions.

 
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Social & Cultural Basis For Community And Primary Health Programs

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Please use this proposal form only; submissions not using this format will not be accepted.

1

Blog Proposal Form

Lab 5: Stakeholder Advocacy for a Current Health Policy Issue NAME/S OF BLOGGER/S:

ABC DEF

Identify no more than 6 major stakeholders. Write the name specific organizations, agencies, associations as stakeholders, not vague or general human groupings (e.g. not “malaria patients” but an actual Association that promoted child health). Remember that legislators, council members and such are the actual policy makers, not the stakeholders per se. Stakeholders must have an actual or potential interest in the policy/issue and an identifiable position on the issue. This can often be discerned from their websites and from news articles. The actual position may currently be in favor, against or even uncommitted.

Fill out the three charts below to complete your blog proposal. Note that your topic may focus on adopting a new policy, repealing an existing policy or pressing for adequate funding and/or implementation of an existing policy.

1. BRIEF DESCRIPTION

Topic: A public health professional’s viewpoint: Creating a national breast cancer screening policy in Jamaica a. Specific Country, State, Local Government concerned: Jamaica b. Nature of the policy issue Breast cancer is the leading cause of cancer death among Jamaican women. Although Jamaica’s age­standardized incidence rate of breast cancer was expected to rise with the introduction of mammography, as it did in other countries, it has remained relatively stable. This discordance may be explained by Jamaica’s under­utilization of mammography services and the lack of a national breast cancer screening policy. In the absence of a national breast cancer screening policy, many cancers will go undetected at early stages when cancer is most treatable. Currently, mammography services are not freely available in the public sector, effectively excluding those who cannot afford mammogram services at a private clinic or pay for the lower cost mammography through the Jamaican Cancer Society (JCS). Furthermore, those women who can afford mammography are less likely to seek screening services without the referral of a physician. In the absence of screening policy, physicians may not provide mammography referrals at screening appropriate ages or when clinically indicated. A national breast cancer policy would standardize age at screening and allocate funding for public sector mammography services. Though many stakeholders support the development of a national breast cancer screening policy, governmental action has been stagnant due to funding limitations.

Please use this proposal form only; submissions not using this format will not be accepted.

2

c. Your/your group’s position on the issue As future public health practitioners, we firmly support the development of a national cancer screening program in Jamaica. We believe that a national screening policy would improve access to mammography services, provide physicians with screening guidelines, and increase awareness of breast cancer among patients. The cost of implementing such a policy should be viewed in the broader context of cost savings from the early detection of breast cancer and thus decreased utilization of expensive late stage cancer care.

2. STAKEHOLDER ANALYSIS Stakeholders Characteristics

Involvement, interest and importance of group concerning the policy issue

Position on Issue: for, against, uncommitted)

1. Jamaica Cancer Society (JCS)

High interest­­Firmly supports early detection of all cancers. High involvement­­Firmly advocates for a national screening policy. JCS provides low­cost mobile mammography services and is seeking to expand mammography accessibility in 2015. High importance­­ Nationally recognized non­profit, non­governmental organization with very high visibility

For the policy

2. Ministry of Health (MoH)

Moderate interest­­Allocates funding to the Regional Health Authorities so they can deliver care according to its National Health Policy and Strategic plan. Low to moderate involvement­­ Though there is a brief mention of cancer control in its National Health Policy, there are no breast cancer specific guidelines. MoH is largely focused constructing policy in accordance with the Millennium Development Goals with an emphasis on decreasing communicable diseases rather than non­communicable diseases. High importance­­the preeminent government organization that is responsible for setting health care priorities, health care delivery and public health.

Uncommitted to the policy

3. Ministry of Finance and Planning (MoFP)

Low/Moderate interest­­Provides funding for training oncology nurses via funds provided to the Culture, Health, Arts, Sports, and Education Fund (CHASE). Low to moderate involvement­­MoFP provides funding to MoH, JCS, and CHASE whom all support breast cancer programs and policies. A grant is also provided to the St. Joseph Hospital which houses the Consie Walters Cancer Hospice. MoFP does not provide funding for direct breast cancer initiatives, but merely supports the health systems and programs for Jamaica. High importance­­MoF has an overall responsibility for developing the Government’s

Uncommitted to the policy

Please use this proposal form only; submissions not using this format will not be accepted.

3

Stakeholders Characteristics Involvement, interest and importance of group

concerning the policy issue Position on Issue: for, against, uncommitted)

fiscal and economic policy framework. 4. Pan American Health Organization (PAHO)

High interest­­Coordinates collaborative efforts with partner organizations to develop and sustain comprehensive cancer control programs (which include breast cancer). High involvement­­Advocates and communicates to raise the priority of breast cancer on the public health agenda. High importance­­World’s oldest international public health agency.

For the policy

5. World Health Organization (WHO)

High interest­­Supports notion that early detection is the foundation for breast cancer control. High involvement­­WHO promotes general public awareness to the issue of breast cancer and the mechanisms to control. WHO also strongly advocates for policies and programs for population­based breast cancer control. High importance­­WHO is the directing and coordinating authority on international health with the UN systems.

For the policy

6.The Breast Health Global Initiative (BHGI)

High interest­­Strives to improve breast health outcomes and access to breast cancer screening, detection and treatment for women in Low and Middle­income Countries (LMCs). High involvement­­BHGI creates guidelines to define best practices with limited resources for early detection, diagnosis and treatment, and health care systems and public policy. High importance­­International alliance of the world’s leading health organizations, agencies, associations, and experts

For the policy

3. WEB LINKS AND RESOURCES Name URL Brief Description ‘Jamaica lacks breast­cancer screening policy’

http://jamaica­gleaner.com/gleaner/2 010 1025/lead/lead6.html

The JCS reports that Jamaica’s absence of a national policy on breast­cancer screening is hampering the island’s fight against the disease.

PAHO Cancer Program

http://www.paho.org/hq/index.php?o ptio n=com_content&view=category&layo ut= blog&id=1866&Itemid=3904

The Cancer Program managed by PAHO advocates for the cancer prevention, screening and early detection, diagnosis and treatment, and palliative care.

The Breast Health Global Initiative (BHGI)

http://portal.bhgi.org/Pages/AboutBH GI. aspx

BHGI is a global initiative that provides guidelines for economically feasible development of breast

Please use this proposal form only; submissions not using this format will not be accepted.

4

Name URL Brief Description cancer control and preventive programs.

WHO http://www.who.int/cancer/detection /brea stcancer/en/

WHO promotes breast cancer control within the context of national cancer control programs and integrated to noncommunicable disease prevention and control through implementation of combined cost­effective and affordable interventions to tackle this highly preventable disease.

Jamaica’s National Health Policy 2006­2015 and Strategic Plan for 2006­2010

http://www.caribbeanelections.com/e Doc s/strategy/jm_strategy/jm_National_H eal th_Policies_2006_2015.pdf

The MoH has a five year strategic planning cycle. The most recent plan too effect in April 2006. Its priorities were set in accordance to the Millennium Development Goals which emphasizes control of communicable diseases with minimal mention of control of noncommunicable diseases like cancer.

Ministry of Finance and Planning Estimated Expenditure report for 2015­2016

http://www.mof.gov.jm/documents/d ocu ments­publications/document­centre/ file/ 928­estimates­of­expenditure­2015­20 1 6.html

MoFP has the primary responsibility of developing and managing the governments fiscal and economical policy framework, but also plays a role in socio­economic development of the country and cost­effective delivery of public services.

 
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Response-07

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Response one

Toy Factory Cohort Study

If I were the state epidemiologist and I suspected that smoke from the local toy factory was connected to adverse health outcomes among the town’s residents I would conduct a retrospective cohort study to further investigate this concern. Retrospective cohort studies are used when participants already have a known disease or outcome and the residents of the town are suspected of having adverse outcomes or disease. This type of study can look back into the past to determine why participants have the disease and when they have been exposed. The concern of the towns residents is that smoke from the toy factory is causing adverse health outcomes among the town’s residents. In order to conduct this type of study I would use historical data to identify members of the population who have been exposed (or not exposed) to smoke from the local toy factory. These members would be assembled for me to study. Data on relevant events for each resident such as the exposure, the latent period, and the time of any subsequent occurrence of the outcome are collected from existing records and can be analyzed immediately to determine the relative risk of the cohort compared to the control group. This type of cohort study has many advantages as it requires less time to complete, are less expensive and are better for analyzing multiple data. Retrospective studies do have certain limitations as researchers must rely on others for accurate record keeping as they cannot control exposure or outcome assessment. Another cause for concern is significant biases may affect the selection of controls because some key statistics cannot be measured (Friis & Sellers, 2014).

One of the first recognized retrospective cohort studies was Lane-Claypon’s 1926 study of breast cancer risk factors, titled “A further Report on Cancer of the Breast, With Special Reference to its Associated Antecedent Conditions.” This study contained the first published epidemiologic questionnaire. Data abstracted from the published contingency tables included age at menarche, age at menopause, parity, age at marriage, and duration of lactation for each childbirth. This study provided the first epidemiological evidence that low fertility increases breast cancer risk. Lane-Clayton’s study is an excellent example of how one investigator’s work can help develop a field of scientific inquiry (Press & Pharoah, 2010).

References

Friis, R. H., & Sellers, T. A. (2014). Epidemiology for Public Health Practice (5th ed.). Burlington, MA: Jones & Bartlett Learning.

Press, D. J., & Pharoah, P. (2010). Risk Factors for Breast Cancer: A Reanalysis of Two Case-control Studies From 1926 and 1931. Epidemiology, 21(4), 566–572. Retrieved from http://www.jstor.org/stable/25680588

Response two.

As state epidemiologist with a town that has suspicion smoke from the local toy factory was connected to adverse health outcomes among the town’s residents’ I would set up an ambispective cohort study. This design would include retrospective features (historical data) to determine baseline exposure, and prospective features to determine disease developed in the future. A benefit of using historical data is that it is already available this can cut years off the amount of time it will take to conduct the research for the study. Follow-up studies can be conducted to complete gathering of current information of the entire cohort (residents of the town) being studied. In this case the residents of the town. Expense for this type of study is of consideration (Friis & Stellers, 2014). Ideally much of the research and analysis would be able to be done in house, keeping the expense down. A limitation of the study would be residents that have moved away and newer residents. Parameters would need to be identified for inclusion to the cohort based on length of residency. Our community has a lot of seasonal residents, this population should be identified to see if intermittent exposure has any effect on the health outcomes.

There would be immediate concerns from the town residents. These would need to be addressed at the same time. Air quality testing and emissions checks could be tested at the toy factory. Experts would need to be consulted to determine if there were any immediate concerns on a day to day basis. Public relations would need to work closely with the lead for the research. Residents would need to be reassured everything that could be done to maintain their health was being done and to determine if there were any concerns with long term exposure.

Ancona, Badaloni, Mataloni, Bolignano, Bucci, Cesaroni, Forastiere, (2015), conducted a similar study in Rome, Italy. In 2001, they decided to look into the possible health effects the incinerator that had been operating since the 1960’s may have had on the suburb of Rome. They conducted a population-based retrospective cohort study. A Lagrangian dispersion model was utilized to determine the exposure assessment. They examined mortality data and hospital records for admissions and followed the cohort until 2010. They were able to determine that exposure from the incinerator was associated with pancreatic cancer mortality in males and females (HR 1.40 95 percent CI 1.03 – 1.90 in med, HR 1.47 95 percent CI 1.12 – 1.93 in women) and breast mortality in women (HR 1.13 95 percent CI 1.00 – 1.27).

References

Ancona, C., Badaloni, C., Mataloni, F., Bolignano, A., Bucci, S., Cesaroni, G., … Forastiere, F.   (2015). Mortality and morbidity in a population exposed to multiple sources of air pollution: A retrospective cohort study using air dispersion models. Environmental     Research, 137, 467–474. https://doi-org.ezproxy.snhu.edu/10.1016/j.envres.2014.10.036

Friis, R. H., Sellers, T. A. (2014). Epidemiology for Public Health Practice. Burlington, MA:       Jones & Bartlett Learning.

 
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