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Discussion Response
There is a myriad etiology that may culminate in facial pain. Therefore, to successfully curtail the progression of the ailment, it is necessary that a succinct diagnosis is applied. The differential diagnosis calls for a multidisciplinary approach. Chronic facial pain differs from acute facial pain and thus calls for a more specific remedy (Zakrzewska, 2013). A differential diagnosis that begins with the examination of the history of the patient. The history should entail the timing of the diagnosis, the location and radiation, the quality and severity and the relieving of aggravating factors. In 57-year-old adult patients, the signs under differential diagnosis include tearing, stuffy nose, pain of moderate intensity, and pain of moderate intensity (Zakrzewska, 2013). The diagnosis, in this case, entails trigeminal neuralgia. The pain attacks under this diagnosis may be accelerated by alcohol. The pain that results from the initiative lasts for a duration of 2 hours. It further occurs twice or thrice in a week depending on the frequency of alcohol consumption. [“Write my essay for me?” Get help here.]

The diagnostic testing is mainly limited to the head and neck regions (Zakrzewska, 2013). The diagnosis inspection further entails the examination of the skin for swellings, skin lesions and other color changes. This diagnosis tests the head and neck muscles from which it seeks to determine the areas with tenderness. Areas with tenderness comprise the soft and painful points in the organism’s body. It further entails the mechanical movement of the temporomandibular joint (Zakrzewska, 2013). The test of the temporomandibular joints further involves the examination of the crepitus. In differential diagnosis, the cranial nerves are also tested to determine their turgidity. The test further entails the examination of the tough tissues represented by the teeth for decay. The test of oral mucosa is intended to determine soft tissue lesions. Soft tissue lesions indicate the propagation of body pain in the cavities. Disjointed areas of the body are further addressed in the diagnosis.[Need an essay writing service? Find help here.]

Response 1
Altered mental status can be diagnosed using several convalescence tools. It poses a challenge given that it is not a specific disease but a group of symptoms. The first diagnosis entails the Tomography (CT) scan (Dulay & Sharma, 2007). The Tomography CT scan enables the determination of mass lesion and further eases the process of puncturing the lumbar. However, the cost of a CT scan is prohibitive and limits the number of patients who can engage the procedure given their financial limitations. The next diagnosis entails the application of the treatment for TB meningitis (Xiao, et al., 2012). This entails the extension of bacterial medicine to mitigate the acceleration of the disease. The diagnosis is inspired by the absence of organisms in the Gram Stain. Cerebral malaria comprises the last diagnosis. In cerebral malaria, the Cerebrospinal Fluid (CSF) is projected to be clear, and there is the presence of but a few white blood cells (WBCs).

Response 2
Brain scans comprise tests which can be used in the diagnosis of Alzheimer’s Disease. It is instituted when all the other tests have failed to identify a problem. It mainly tests for dementia which is interlinked to Alzheimer’s disease. I would specifically use the MRI scan to determine the progression of the disease in the patient. This is because an MRI scan enables the determination of succinct information on the nature of the blood vessels. It gives information which may have been missed in the initial CT scans. It further assesses the shrinking of the brain which serves as an indicator of the progression of the Alzheimer’s disease. Dementia, which is indicative of the Alzheimer’s disease, is easily discernible through the employment of the MRI scan.[Click Essay Writer to order your essay]


Dulay, M., & Sharma, M. (2007, June). Case 7: Fever and Altered Mental Status. Retrieved November 3, 2016, from HIV Insite: http://hivinsite.ucsf.edu/Insite?page=md-ccl-ca-07

Xiao, H.-y., Wang, Y.-x., Xu, T.-d., Zhu, H.-d., Guo, S.-b., Wang, Z., & Yu, X.-z. (2012). Evaluation and treatment of altered mental status patients in the emergency department: Life in the fast lane. World Journal of Emergency Medicine, 3(4), 270-277.

Zakrzewska, J. M. (2013). Differential Diagnosis of facial pain and guidelines for management.British Journal of Anaesthesia, 111(1), 95-104.


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I would differentiate the inner and outside of the Google Complex in order to better describe the architecture. This is because these two convey different themes to the visitors. The inside of the office complex tells of vastness, freedom and interaction. If it were a book, its title would have been vastness, freedom and interaction. First of all, the offices are vast. It doesn’t matter where one is standing or sitting because to every side, one experiences a vastness of space. The space is magnified by the fact that most of the offices are made of transparent glass and many other employees work in an open space.

The fact that one can comfortably see several offices and its occupants at either side of the complex gives it an element of vastness. Moreover, the vastness given by that atmosphere is enough to give one a sense of being in an environment of unlimited imagination. Secondly, there is an element of freedom within the office complex. On looking at most of the offices, there is an element of the occupier being and working in their comfort zone (Google Locations – Company – Google n.p). Most of the offices are furnished and arranged in a manner that is consistent to the likes of the occupier. For example, while some offices are designed as tents, others are in the form of unevenly stacked shelves and others have a carpet that resembles a football turf and even a place to chain a bicycle. [“Write my essay for me?” Get help here.]

All these aspects ooze of freedom inside the office complex. Psychologically, working in such an environment of freedom entices one to operate at the optimum. Just standing there made me sigh as I opened my mind to enjoy the freedom aura. Lastly, there is the element of interaction and collaboration due to the designs of the office (Google Locations – Company – Google n.p). The whole of the office feels like an open office even when some offices are very distant apart. The collaboration aspect of the office feeling is further magnified by the fact that there seems to be people walking around almost every time and everyone knows everyone. The use of glass highlights the collaborative feeling because communication seems to flow easy between employees due to the ease of communicating visually or verbally around the office.

The Yahoo office arrangement is quite different but also quite similar to Google’s. First of all, there is the freedom of expression as highlighted by the differences in the furnishing and decoration of the inside of the offices. There is no standard or uniform manner of interior decoration. As a result, every occupant seems to be free to set up their office equipment and arrange it in a manner of their liking. Moreover, the furniture also seemed to be of each person’s unique liking. For example, some employees had white leather chairs while others brown office chairs. As a result, I experienced the feeling of freedom that is essential for innovation.

However, the manner of partitioning the office robs the complex of the feeling of vastness as well ability to freely interact (“Home | About Yahoo” n.p). While most of the office is open, a good portion of the office is partitioned using solid material. Even though the partitions are colorfully decorated and painted, there is a feeling of isolation among the employees. As one enters one office, there is the overbearing feeling of locking out the rest of the colleagues out. I personally felt that the interior design does not optimize on interaction unless one is walking along the long corridors.

The posters on the walls are mostly of apps and software icons (“Home | About Yahoo” n.p). The interaction is limited because it is not possible to absorb every inch of the building from one position. In other words, there is the feeling of formality due to the interior design of most of the office blocks. I felt that such a design does not encourage as much innovation as possible because for a company that is in an industry defined by ability to innovate continuously, the lack of thorough interaction may be a hindrance to teamwork.

There is the overbearing feeling that this is a typical office with freedom and interaction meant to take place outside of the offices. Moreover, due to the interior of the office complex, there is little if any interaction with the nature. I was not able to spot vegetation inside the office complex. It is also not possible to interact with the nature outside while inside most of the offices because of the size of the buildings. For most occupants of the top floors, the much they can see are the top trees and that is not exactly a manner of interaction between man and nature in the office.

In my visit, to the Google complex, my eyes and ears were the most involved senses in experiencing the organization. The eyes were the primary senses on work with the ears playing a supporting role. For example, I would just go and stand at one position and absorb all the surrounding with my eyes. The ears would pick up some conversations within the office as the interaction between the employees took place.

I especially experience that interaction is enhanced by the design and openness of the offices because a person seated at the office can see a lot of the movement around and interact with the other workers. Moreover, one can also easily interact with the environment outside given that the architecture allows for a smooth transition between the inside and outside, when tired, one feels that they can easily just face outside and breath in some inspiration from the nature outside and feel energized. I certainly felt so myself.

The outside of the Google Complex is unique in that there is a deeper connection with nature. Unlike in many organizations where the outside is mostly taken up by parking lots and harsh weather, in Google, the outside is a place for enjoyment too. If it were a book, it would be referred to as tranquility. On walking between the complexes, the nature outside seems to give a visitor a sense of being at peace with the nature and this not only gives one an element of freshness but also one of inspiration. With plans to take the parking lots deep underground thereby leaving room at the surface for community gardens, bike paths and streams, it will give the complex a feeling of Arcadian retro-futurism. [Need an essay writing service? Find help here.]

Viewed when standing outside, the tranquility comes in the way that nature and architecture seems to co-exist in harmony. This harmony is further maintained by the architecture of the whole complex. The building is of relative low height and this makes sure that they are not domineering to the vegetation outside. Moreover, to compensate for the low height, the complex sprawls out over a large area of land, making sure that it fuses well with the vegetation outside. None seems to impose itself upon the others because there seems to be a little of each everywhere.

The dinosaur skeleton in particular really makes one go way back into a mysterious past. For example, while there are buildings outside among the vegetation, there are also some plants inside the offices. This entire scenario gives one a feeling of fusion between architecture and nature. Out among the plants, I was experiencing nature using more than just the eyes and ears, I could smell and touch the nature. The air smells of freshness and if one was not in such a hurry, they could brush their hands over the vegetation around the complex. I also got the feeling that as one is cycling from one building to another and they are passing through the vegetation, one gets rejuvenated due to the freshness that is felt outside and by the time they reached their intended destinations, the clarity of mind must have been important for their productivity.

The harmony between nature and architecture is absent in the Yahoo complex. Yahoo headquarters was designed to be a modern office complex rather than a complex to host a utopian futuristic community. The buildings are therefore made of glass and metal and huge precast concrete. From their sizes, the building seems very dominant in the landscape of the complex and if I were to write a title, I would probably call it “the domination of man over nature.” I would term it so due to the overbearing nature of the structures over the landscape and the vegetation therein.

Despite their purple and bright yellow accents, there is a sharp contrast between the nature outside and the environment outside. One feels that you cannot have both at the same time- you either have to be outside or inside the buildings. As a result, there is a feeling that nature should stay outside and the people remain inside. The trees and the vegetation around the complex looks more like one that gives aesthetic beauty and balance but does not give a worthy interaction with nature. This is further exaggerated by the contrast between the tall office blocks and the short vegetation outside.
Rather than harmony, one gets the feeling of a conflict between architecture and nature as though one is superimposed on the other. More likely, the nature feels like superimposed on a modern office block. Due to the fact that majority of the space is occupied by tall buildings with vegetation squeezed between the blocks, the vegetation felt like an afterthought. As a result, the complex misses the tranquility of the existence of architecture alongside nature that I had observed in Google Complex.

Another aspect of the complex worth mentioning is the energy that resonates in the complex due to the presence of the several sand volleyball courts and the two small swimming pools. In particular, the volleyball courts seem to be ever busy with people playing. This has an important aspect to the whole complex- it gives it a vibrant aspect that lacks in many organizations. I in particular felt that the energy was both symbolically and psychologically important for Google because it is a fast-growing institution.
The vibrant nature outside is important to the psychology of the employees because it gives one a sense of excitement and energy that is in turn important in raising productivity. It was especially interesting to observe that at no particular time were all the courts empty as there were always some people in the courts sweating it out. The swimming pool was not as busy as the volleyball courts during my visit but maybe the weather may not have been conducive on that day but this was more than compensated by the human traffic in the volleyball courts.

The Yahoo Company matches Google when it comes to the physical amenities for a self-contained community. The design gives room for amenities that support a balanced lifestyle and work and flexible schedules. The Yahoo complex offers a cafeteria, several cafes, game rooms, fitness center and even a training room. Some of these amenities especially the basketball courts are especially fairly large. The basketball, bocce ball and volleyball courts are located where four buildings are angled around a green space that is centrally located. In terms of placement, Yahoo amenities are uniquely placed.

It especially helped the designers because unlike Google, Yahoo complex was planned and designed with the self-contained community in mind. Google bought an already existing complex and had to find spaces to fit in their amenities and this was a challenge. Yahoo had the luxury of having that in mind during the planning and designing phase and it is no wonder that the central green space that features the various courts is uniquely and centrally located. The courts are enticing due to their central location especially when the viewer is at an elevated space above the courts. Just like in Google, there is that sense of vibrant and energetic aura around the complex.

Since the four major and strategic building all are neighbors to the courts outside, it gives a sense that whichever office one is in, they feel and experience the energy all around. On my day of observation, the courts were fairly busy as many people were engaged in sports activities in the courts. Coupled by the bright yellow color, the complex felt busy and full of energy.

Mission Statements:
Google’s mission statement is “to organize the world’s information and make it universally accessible and useful”. Its vision statement is “to provide access to the world’s information in one click.” I feel that the Décor of Google reflects its mission. The harmony between architecture and nature within the complex really felt like a place where information is being organized and then released to the public in a manner that is useful. Its vision statement to provide information in a platform that allows one click also felt believable because the complex itself has managed to have so many things available in one complex. [Click Essay Writer to order your essay]

Yahoo’s mission statement is “To connect people to their passions, communities, and the world’s knowledge.” As far as the aspect of connecting people with knowledge is concerned, Yahoo’s décor seems to reflect its mission. However, I felt that décor does not extend to connecting of the people to their passions and communities because of the formal nature of the complex.

Works Cited
Google Locations – Company – Google”. Google.com. N.p., 2016. Web. 9 Dec. 2016.

“Home | About Yahoo”. About.yahoo.com. N.p., 2016. Web. 9 Dec. 2016.


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“Is Equality Tearing Families Apart” Responses
Couples today face many societal pressures on their relationships because of modern ways of thinking, and the lack of traditional familial relationships. Due to these new modern arrangements, many young families find themselves in dual-worker relationships, in sharp contrast to the traditional one-income household. These dual-worker lifestyles offer unique challenges and benefits for families. For instance, it allows couples to share career goals and professional challenges, in addition to allowing women to pursue traditionally male fields, which provides their children with solid role models, and a more independent lifestyle. Further, the onset of the dual-worker household has allowed for greater financial opportunities for families, allowing for lifestyle upgrades, education and retirement funds, travel, and an overall greater disposable income. However, these households also display distinct disadvantages when compared to more traditional ones. Families with dual-worker parents often face issues of fatigue, child care worries, and stress. This can lead to parents feeling guilty for not spending enough time with their children, as well as children feeling like they are an inconvenience to their parents. In addition to this, dual-worker families also face household issues, such as the fair division of chores, and personal challenges, such as deciding to further one’s career at the expense of familial relationships. To combat these issues and to keep relationships strong, pastoral care and meetings can be of great benefit to discuss challenges and keep the lines of communication open between the couples. These pastoral meetings can help couples to discuss their career goals with each other, set priorities, and develop plans and processes to help them conquer household issues, such as chores and child care. Dual-worker households are becoming commonplace, and it is important that these types of families maintain communication between each other and their pastors to help them adjust their lifestyles accordingly. [“Write my essay for me?” Get help here.]

Response 2
While I agree that the church should help to reframe society’s promotion of career ambition over familial relationships, I also believe that with the onset of dual-worker households, this is something that we need to learn how to balance, rather than just reframe. Families need to be able to discuss with each other what the best course of action will be for all of them when new career opportunities arise. While traditionally, the male members of the household would take the driver’s seat in terms of financial responsibilities, I think it’s important to recognize that this model is changing, and that we must adapt our understanding of family models because of it.  These new models will continue to challenge our traditional definitions of husbands and wives within families, and these families must work with each other to redefine what their roles are within their homes, as well as the workplace. If couples keep the lines of communication open, they can ensure that priorities are consistently discussed, and that their relationships remain pleasant and intact. [Need an essay writing service? Find help here.]

Response 3
I appreciate the analysis you provided, and believe that there are many factors at play in the degradation of traditional family make-ups and values. To expand on your point of modern societal pressures and pastoral care, I believe that couples can combat these issues by laying out any career goals and aspirations upfront. By discussing these issues early, the couples can plan for each other’s goals and can let each other grow, while picking up the slack in terms of familial responsibilities. For instance, if one individual’s career is taking off, and the other’s is holding steady, they can decide such that one of them can further pursue their career, while the other takes a greater responsibility of the children and household chores. Through this sort of communication, I believe that couples can alleviate the stress of dual-worker households, and can maintain strong relationships with each other and their children. [Click Essay Writer to order your essay]


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Metabolic Disorder Syndrome in People with Severe Mental Illnesses

Metabolic syndrome is a condition that comprises several disorders like obesity, glucose intolerance, insulin resistance, dyslipidemias, hypotension and cardiovascular disease. Metabolic syndrome is largely associated with mental illnesses. Schizophrenics have been the main targets when assessing for this condition due to their likelihood of living unhealthy lifestyles (one of the risk factors). Use of certain antipsychotic medications could also predispose the individual to metabolic disorders. It is therefore thought that metabolic syndrome is an interaction of socioeconomic status, lifestyle, genetic factors and use of neuroleptics (Ganguli et al., 2011). This paper therefore talks about metabolic disorders in people with severe mental illnesses, health trends of schizophrenics and pathophysiology of the conditions.

Population of Interest
Antipsychotics vary in the ability to induce weight gain with some having greater propensity than others. Patients on neuroleptics have been found to have more abdominal fat deposition than normal members of the society. Such increase in weight could then result into other conditions such as diabetes, hypotension and other cardiovascular conditions. However, some conditions like type-2 diabetes may be brought about by the illness itself. For instance, it has been found that unaffected relatives of schizophrenics record high rates of the illness. This is a clear indicator of genetic relationships between these conditions (Thakore et al. 2005). [“Write my essay for me?” Get help here.]

Health Trends in People with Schizophrenia
Mortality rates in people with schizophrenia have been on the rise despite improvements in the healthcare. It is estimated that mortality rates in schizophrenia patients is 2-3 times higher than for the general population. Natural deaths and cardiovascular diseases were the main cause of these mortalities. Suicide and unspecified violence also contributed. All these were attributed to the unhealthy lifestyles adopted by these patients due to the illness (Osby et al., 2000).

There has been varying information on the epidemiologic information about metabolic disorders in patients with severe mental disorders. Prevalence rates for schizophrenic patients under medication ranges from 11 % to 69 % while that for patients not taking medications being 4 % to 26 %.  Generally metabolic disorders are more prevalent in schizophrenic patients than as observed in the general population. Increase in age also increases the prevalence of metabolic disorders. However, there is no association between the prevalence and demographic and clinical variables (Malhotra et al., 2013).

Current trends
Antipsychotic treatment is crucial in reducing mortalities resulting from schizophrenia. It has been observed that, though mortalities resulting from schizophrenia are high, there are reduced cases of mortality with antipsychotic treatment rather than with no treatment. Atypical antipsychotics also do not increase cardiovascular mortality and morbidity as is the case with conventional (Bushe et al., 2010).
Despite improvements achieved through the use of atypical antipsychotics in schizophrenia

patients, weight gain, high serum prolactin among other side effects has been noted. Insulin insensitivity and type-2 diabetes have also been largely associated with the use of atypical antipsychotics. It has however been noted that patients that use atypical antipsychotics have lower risks of developing metabolic disorders than those using conventional antipsychotics (Ollendorf et al., 2004).

Studies show that metabolic disorders are likely to develop in young people suffering from schizophrenia and on antipsychotics treatment. Higher prevalence for metabolic disorders is seen from ages 15-25 years and continues to increase with age. This striking finding also correlates with that in the normal population since increased prevalence for metabolic disorders is also observed in the general population (De Hert et al., 2006).

Population health considerations
Schizophrenic patients experience high rates of mortality and morbidity as compared to the general population. These patients have a shorter lifespan by approximately 20 years than people not suffering from the disease. This is mainly due to suicide, cancer and cardiovascular diseases resulting from metabolic disorders. It therefore becomes the responsibility of clinicians to be keen and single out any risks for cardiovascular diseases like abdominal obesity and hypertension. Combination of these two or more such risks further predisposes the individual to cardiovascular diseases.[Need an essay writing service? Find help here.]

Lifestyle psychiatrics should have vast knowledge on the metabolic risks associated with treatments for schizophrenics before initiating any treatment. Establishing a risk profile based on the genetic, lifestyle and medical factors is very crucial for before initializing treatment procedures for these patients. Low risk strategies such as encouraging healthy lifestyles, frequent checkup and monitoring weight, glucose and lipid levels is highly recommended after every treatment (Van Gal et al. 2006).

Pathophysiology and Mechanisms of Metabolic Disorders and Schizophrenia
Adverse effects of antipsychotic medications are largely associated with metabolic disorder syndrome. It has also been found that some of the metabolic disorders like insulin intolerance and diabetes appear at early stages of the disease when even no medication has been started. Despite the fact that all the risk factors for metabolic disorders are known, it is difficult to control them all.

The etiology and pathophysiology of it is not well understood with majority of the hypotheses revolving around lifestyle and dietary habits, antipsychotic drug adverse effects and alterations of hypothalamic pituitary-adrenal axis. Unhealthy dietary habits facilitate obesity which increases the risk for developing cardiovascular diseases; antipsychotic drugs interfere with lipid and carbohydrate metabolism resulting into obesity and diabetes while interference with the hypothalamic pituitary-adrenal axis causing obesity of the trunk.[Click Essay Writer to order your essay]

Pathophysiological Consequences
Metabolic disorder syndrome precipitates cardiovascular diseases through various mechanisms. To start with, reduced insulin sensitivity and high blood sugar levels increase the chance for diabetes. More so this leads to type-2 diabetes which further increases the chances for cardiovascular diseases like hypertension. Obesity on the other hand leads to increased lipid levels and could cause arteriosclerosis that may lead to fatal heart diseases like hypertension or heart attack.

Role of Advance Practice Nurse
The increased prevalence of metabolic syndrome is worrisome for medical providers in general and more so for providers who treat at-risk populations such as persons with SMI. The treatment of SMI appears to be primarily treated with pharmacological treatments. The advanced practice nurse (APN) must be adept pharmacotherapeutics with an expert understanding of the medications prescribed to treat the illnesses in this population. The APN must be proficient in interventions to manage metabolic syndrome. Interventions to include lifestyle modifications and use of metabolic agents and switching medications as needed. Lastly, the APN is well-qualified to lead research into these phenomena and add to the current knowledge base (Mwebe et al. 2016).

Bushe, C. J., Taylor, M., & Haukka, J. (2010). Review: Mortality in schizophrenia: a measurable clinical endpoint. Journal of psychopharmacology24(4 suppl), 17-25.

De Hert, M., Van Winkel, R., Van Eyck, D., Hanssens, L., Wampers, M., Scheen, A., & Peuskens, J. (2006). Prevalence of diabetes, metabolic syndrome and metabolic abnormalities in schizophrenia over the course of the illness: a cross-sectional study. Clinical Practice and Epidemiology in Mental Health2(1), 1.

Ganguli, R., & Strassnig, M. (2011). Prevention of metabolic syndrome in serious mental illness. Psychiatric Clinics of North America34(1), 109-125.

Malhotra, N., Grover, S., Chakrabarti, S., & Kulhara, P. (2013). Metabolic syndrome in schizophrenia. Indian Journal of Psychological Medicine35(3), 227–240.

Mwebe, H. (2016). Physical health monitoring in mental health settings: A study exploring mental health nurses’ views of their role. Journal of Clinical Nursing.

Ollendorf, D. A., Joyce, A. T., & Rucker, M. (2004). Rate of new-onset diabetes among patients treated with atypical or conventional antipsychotic medications for schizophrenia. Med Gen Med6(5).

Ösby, U., Correia, N., Brandt, L., Ekbom, A., & Sparén, P. (2000). Time trends in schizophrenia mortality in Stockholm county, Sweden: cohort study. Bmj321(7259), 483-484.

Thakore, J. H. (2005). Metabolic syndrome and schizophrenia. The British Journal of Psychiatry186(6), 455-456.

Van Gaal, L. F. (2006). Long-term health considerations in schizophrenia: metabolic effects and the role of abdominal adiposity. European neuropsychopharmacology16, S142-S148.