Discussion Question: When posting this week, think about a patient that you felt a bit stuck as to what may be causing their cough? What decision did you ultimately make, and why?A cough is often a presenting chief complaint and has several differential diagnoses. Choose one differential diagnosis for cough and discuss the presenting symptoms, diagnostic testing, and treatment.

Use APA 6th edition format. Use in text citation. Use at least 2 scholarly journals.

Respond to each classmate response at least 1 paragraph

(approx100words) .Be respectful. Use APA 6th edition.Use in text citation also.

Timothy’s Response

According to Silvestri and Weinberger (2017), the symptom of a cough, which is responsible for approximately 30 million clinician visits annually in the United States, is one of the most common symptoms for which outpatient care is sought. In an outpatient pulmonary practice, evaluation and management of persistent cough can account for up to 40 percent of the practice volume. Cough can be classified based upon the duration of the cough; within each category are likely diagnostic possibilities. Acute cough exists for less than three weeks and is most commonly due to an acute respiratory tract infection. According to File (2018), acute bronchitis is a common clinical condition characterized by cough, with or without sputum production, which lasts for at least five days. It is typically self-limited, resolving within one to three weeks. Acute bronchitis is a lower respiratory tract infection involving the large airways (bronchi) without evidence of pneumonia that occurs in the absence of chronic obstructive pulmonary disease. According to File (2018), acute bronchitis is one of the most common conditions encountered in clinical practice. It accounts for approximately 10 percent of ambulatory care visits in the United States, or 100 million visits per year. The incidence of acute bronchitis is highest in late fall and winter when transmission of respiratory viruses peaks. Symptoms result from inflammation of the lower respiratory tract and are most frequently due viral infection. Treatment is focused on patient education and supportive care. Antibiotics are not needed for the great majority of patients with acute bronchitis but are greatly overused for this condition. Reducing antibiotic use for acute bronchitis is a national and international healthcare priority. According to File (2018), Acute bronchitis should be suspected in patients with cough for at least five days (often one to three weeks) who do not have clinical findings suggestive of pneumonia (eg, fever, tachypnea, rales, signs of parenchymal consolidation) and do not have chronic obstructive pulmonary disease. For most patients, the diagnosis can be made based upon the history and physical examination. Testing is generally reserved for cases in which pneumonia is suspected, clinical diagnosis is uncertain, or when results would change management (eg, a positive influenza test result in a patient who meets criteria for antiviral therapy). The primary reason for obtaining a chest radiograph is to exclude pneumonia; reasonable indications for suspecting pneumonia and obtaining imaging include abnormal vital signs (pulse >100/minute, respiratory rate >24 breaths/minute, temperature >38°C [100.4°F], or oxygen saturation <95 percent) and signs of consolidation on chest examination (rales, egophony, or tactile fremitus). The last reason for obtaining a chest radiograph would be because of a mental status or behavioral changes in patients >75 years old, who may not mount a fever. According to File (2018), the treatment for most patients with acute bronchitis, symptoms are self-limited, resolving in about one to three weeks. Reassurance and symptom control are the cornerstones of care. Antibiotics are not recommended for routine use. For patients who request antibiotics, we encourage having an explicit discussion on the risks and benefits of their use. For the great majority of patients, use of antibiotics does not hasten recovery or prevent complications but puts patients at increased risk of adverse effects including potentially severe complications such as Clostridium difficile infection and anaphylaxis. For patients with acute bronchitis who are bothered by cough, offering nonpharmacologic options for cough relief such as throat lozenges, hot tea, honey, and/or smoking cessation or avoidance of secondhand smoke is a reasonable first step. For patients with acute bronchitis who desire medication for cough relief, we suggest offering over-the-counter (OTC) medications, such as dextromethorphan or guaifenesin. Most patients with acute bronchitis recover without complications within 1 to 3 weeks and do not require follow-up but should be educated on features that warrant concern such as new-onset fever, difficulty breathing, symptoms lasting >3 to 4 weeks, or bloody sputum.

References

File, T. M. (2018). Acute bronchitis in adults. UpToDate. Retrieved from https://www.uptodate.com/contents/acute-bronchitis…

Silvestri, R. C., & Weinberger, S. E. (2017). Evaluation of subacute and chronic cough in adults. UpToDate. Retrieved from https://www.uptodate.com/contents/evaluation-of-su…

April’s Response

Community-Acquired Pneumonia

A cough is produced when irritant receptors in the central airways or stretch receptors in the distal airways are stimulated. While normally a protective mechanism, a cough is considered abnormal when it is painful, persistent, or productive (Ainslie, 2009). Community-acquired pneumonia (CAP), a leading cause of global morbidity and mortality, is just one of the many differential diagnoses for cough. While CAP can be caused by both bacterial and viral causes, the most common pathogens are categorized as either typical bacteria, atypical bacteria, or viral (Ramirez, 2018).

Signs and Symptoms of CAP

CAP can vary from mild to severe cases, with severity depending on the intensity of local and systemic immune responses. In addition to cough, which may be with or without sputum production, additional symptoms of CAP include dyspnea, pleuritic chest pain, fever, chills, fatigue, and malaise. The sputum produced in CAP may be yellow, green, or rust colored. Upon examining the individual with CAP, the provider may note tachypnea, increased work of breathing, tactile fremitus, egophony, dullness to percussion, and adventitious ling sounds including rales, crackles, and rhonchi. Tachycardia, hypotension, and altered mentation may be signs of sepsis associated with more severe cases of CAP (Ramirez, 2018).

Diagnostic Testing

According to Ramirez, the above signs and symptoms are nonspecific and therefore inadequate for the diagnosis of CAP without chest imaging. When considered alongside the presenting symptoms, the demonstration of an infiltrate on a chest radiograph can lead to a definitive diagnosis of CAP. While a chest x-ray is adequate in the majority of patients, a CT of the chest may be indicated in those who are immunocompromised or have been exposed to certain pathogens. Labwork, including a CBC, CMP, lactic acid, blood cultures, and sputum cultures, may be indicated with moderate to severe cases of suspected CAP (Ramirez, 2018).

Treatment of CAP

The Pneumonia Severity Index (PSI), which ranks patients according to their mortality risk, can be useful in determining whether outpatient or inpatient treatment in indicated. Antibiotics are the mainstay of outpatient treatment, the selection of which is determined by the prediction of the most likely pathogen, local susceptibility, and the presence or absence of comorbidities (Uphold & Graham, 2013). An empiric antibiotic regimen that targets both typical and atypical pathogens is often selected. For individuals who warrant hospital admission, intravenous antibiotics are often necessary, and the empiric antibiotic regimen should be expanded to cover additional pathogens (Ramirez, 2018). A number of tables and algorithms exist to aid clinicians in making an appropriate choice. Once the pathogen has been identified via culture, target therapy should be implemented (Uphold & Graham, 2013).

References

Ainslie, G. (2009). Assessment of cough. African Journals Online CME, 27, 68-71.

Ramirez, J. A. (2018, September 17). Overview of community-acquired pneumonia in adults. Retrieved from https://www.uptodate.com/contents/overview-of-community-acquired-pneumonia-in-adults?search=pneumonia&source=search_result&selectedTitle=3~150&usage_type=default&display_rank=3#H3728463829

Uphold, C. R. & Graham, M. V. (2013). Clinical guidelines in family practice (5th ed.). Gainesville, FL: Barmarrae Books, Inc.

Note: The company mentioned herein is merely a hypothetical organization with characteristics developed to enable students to respond to the assignment. You may create and / or make all necessary assumptions needed for the completion of this assignment if those assumptions are consistent with the facts presented. Do not make assumptions which obviate the need to conduct a legal analysis of the issues.

Scenario

Earlier this year, Paul Mason and his wife Chardonnay Mason went to Rivertown and Gregory Ford, Dodge and Chryslers LLC. to purchase a new car. Last time the Masons bought a car was in 1990 when they bought their current car, a 1991 Plymouth Voyager van. The Mason’s daughter, Rosé recently gave birth to the Masons’ first grandchild and the proud grandparents were excited to be taking a road trip from Macon, Georgia to Freehold, New Jersey, to see the new addition to the Mason family. They knew that the old Plymouth had seen better days and that it might not make the 2,000 plus mile round-trip. The Masons were leaving for New Jersey in the morning, so they needed a new car and fast. When the Masons met with the salesperson at R&G, they explicitly stated that they were on a fixed income and could afford no more than $400 per month in the form of a car note. They were, however, willing to trade in their old van toward the purchase of the new car.

Hector Dosales, one of R&G’s most aggressive salespersons, convinced the Masons to buy a new Chrysler 200. By the time the Masons were ready to buy, it was after 9:00 p.m. and the dealership was soon closing. To speed things along, Hector had the Masons sign blank form contracts that he would fill out the next day. Among the blank contracts that the Mason’s signed were a “Retail Installment Sales Contract”, a “Retail Buyer’s Order”, and an “Odometer Disclosure Form”. When Paul Mason asked about the terms of the deal, Hector said not to worry about it. He would structure things so that the payments would be under their $400 limit. When Paul asked how much he was getting for his trade-in, Hector said, “Don’t worry about it. I’ll make sure you get a fair price.” While the various forms were being signed, Chardonnay, who has a weak bladder, excused herself and in the confusion neglected to sign the Retail Buyer’s Order.

The next day when Hector was filling out the sales documents, he was having difficulty getting the car payments under the $400 per month limit he had promised. While reviewing the forms, he noticed that the Odometer Disclosure Form indicated that the Masons’ van had only 58,528 miles on it. Due to the exceptionally low mileage on the vehicle, Hector was able to substantially raise the trade-in value, thereby reducing the car payments to just under $400 per month. The Odometer Disclosure Form had, in fact, been completed by Mary Jane, one of the clerks working at the dealership.

After Hector had completed the sales documents and while the Masons were on their road trip, Hector attempted to place the sales documents with a third-party finance company. Because of the Masons’ low monthly income and poor credit history, no one was willing to purchase the contract. In the meantime, the Masons’ van was sent to auction. A Carfax report quickly indicated that the correct mileage on the vehicle was 154,000 miles not 54,528 miles. In fact, service records from R&G’s service department, where the Masons regularly brought the car for maintenance, clearly indicated that the car had over 100,000 miles on it. Because of the high mileage, the Van sold for $800 at auction, despite the $2,800 Hector had indicated as a trade value.

When the Masons returned home, they were contacted by the service department of R&G and asked to bring in their new car for a complimentary service and detailing. When the Masons arrived, they surrendered the keys to the new Chrysler and were subsequently asked into a meeting with Hector and Felicia Fees, head of the finance department at R&G. Felicia informed the Masons that they did not qualify for financing the new car and that unless they had the cash to buy it, they would have to return the car. Of course, the Masons did not have the money to buy the car and told Felicia that they could just keep the car and they would take their old car back. Felicia informed the Mason’s that their van had already been sold at auction. Moreover, the Masons would be responsible for the usage of the new car at the standard lease mileage rates of .45c per mile. Since they drove the car 2,500 miles, they owed the dealership $1,125. Subtracting the $800 R&G received for the Masons’ van at auction, Felicia demanded payment from the Masons of $325. Needless to say, the Masons refused.

The Masons have filed suit against R&G in Magistrate Court in Macon, Georgia, to recover the value of their van which they claimed to be the $2,800 Hector listed in the sales documents. (Magistrate Courts are low level courts that handle, among other things, small claims matters.) R&G has moved to dismiss the case and compel the Masons to arbitrate any claims they might have in accordance with the Arbitration clause contained in the Retail Buyer’s Order, which reads as follows:

“Buyer and Dealer agree that all claims, demands, disputes and controversies of every kind or nature that may arise between them concerning any of the negotiations leading to the sale of the vehicle, the terms and provisions of the sale, the performance or condition of the vehicle, or any other aspects of the vehicle and its sale shall be settled by binding arbitration. … Without limiting the generality of the foregoing, it is the intention of the Buyer and the Dealer to resolve by binding arbitration all disputes between them concerning the vehicle, its sale and its condition, including disputes concerning the terms and conditions of the sale, the condition of the vehicle, any damage to the vehicle, the terms and meaning of any of the documents signed or given in connection with the sale, any representations, promises or omissions made in connection with negotiations for or sale of the vehicle, or any terms, conditions or representations made in connection with the financing, credit life insurance, disability insurance, and vehicle service contract purchased or obtained in connection with the vehicle.”

The Retail Buyer’s Order also contained the following provisions:

“If the purchase of the vehicle is being financed, Buyer understands that the sale is contingent upon obtaining approval of the financing by the financing agency. In the event that the vehicle has been delivered to Buyer but financing approval is not obtained, Buyer agrees to immediately return the vehicle to the Dealer.”

Claims

You are the Magistrate Judge in Macon County Georgia and have to decide this case. The Masons make the following claims in the complaint:

1. There never was a contract in this case since the contract documents were not completed at the time they were signed. Since they did not contain the essential elements of a contract, no contract was formed.
2. Since there was no contract, sale of the van was the tort of conversion and they are entitled to the value of the van which the defendant’s own statements value at $2,800.

The defendant answered the complaint and moved to dismiss and to compel arbitration. The answer made the following statements:

1. There was a contract because the actions of the parties indicated intent to make a contract.
2. The Masons signed an arbitration agreement, and under the law are required to bring their claims before an arbitrator and not the courts.
3. The Masons have been unjustly enriched by the use of the new Chrysler and must pay the reasonable value of that use.
4. The Masons committed fraud by signing a false Odometer Disclosure Form. Because of their fraud, the Masons are estopped from recovering anything on the value of the van.

Assignment Requirements

Write a three to four (3-4) page court opinion in which you rule on this case. In preparing this opinion, you must:

1. Decide whether this court should hear this case or dismiss the case and direct the parties to binding arbitration in accordance with the Retail Buyer’s Order. Support your response. 
   Note: Please read the facts of the case very carefully as you attempt to resolve this issue.
2. Decide whether or not a contract exists between the Masons and R&G. Support your response. Note: Be sure that you analyze the facts to reach your conclusion. Merely stating your conclusion without a supporting legal analysis is not sufficient.
3. Decide one (1) of the other remaining issues presented above. That is, decide whether R&G committed the tort of conversion with the 1990 van, or whether the Masons were unjustly enriched by the use of the new car, or whether the Masons committed fraud and should be estopped from recovering the value of the van.
4. Use at least two (2) quality academic or legal resources in this assignment, such as a government Website, Law school Websites, Restatements of laws, and other treatises of Law.  Your paper must include internal citations indicating the sources of your legal statements. 
   Note: Wikipedia and other Websites do not qualify as academic or legal resources.
5. Format your assignment according to the following formatting requirements:
   1. Typed, double spaced, using Times New Roman font (size 12), with one-inch margins on all sides.
   2. Include a cover page containing the title of the assignment, the student’s name, the professor’s name, the course title, and the date. The cover page is not included in the required page length.
   3. Include a reference page. Citations and references must follow APA format. The reference page is not included in the required page length.

Please write a paper (single-spaced within paragraphs, double-spaced between paragraphs, 12 PT Times Roman font) answering the following questions:

Coca-Cola is a current leader in China’s competitive soft drink market because of substantial investments of time and money. However, changing consumer preferences for healthier products, coupled with an increasing number of competitors, both traditional and non-traditional, threaten that competitive position.

INTRODUCTION: Summarize the Coca-Cola Case in your own words.

PORTER’s FIVE FORCES: Use Porter’s five-force analysis to assess the nature of China’s soft drink industry in comparison to industry dynamics in more developed soft drink markets (e.g., the US). What are the main differences and similarities?

CORPORATE PARTNERSHIPS: Different types of corporate partnerships are common in the development of China’s beverage industry. Discuss the historical reasons and rationale behind different corporate partnership strategies. What motivates companies to seek joint ventures (JVs), M&A, and other types of strategic cooperation in China’s beverage market?

PROPOSED M&A OF HUIYUAN: Across a wide range of industries, from beverages to automobiles, China’s antimonopoly law plays a prominent role in governing corporate strategic options, particularly among larger foreign firms. Discuss this law’s role in Coke’s proposed M&A of Huiyuan. What types of corporate behavior does the law govern? What are some recent examples of its application?

SWOT ANALYSIS: What strategic options exist for Coke at the point of this new acquisition? What are the strengths and weaknesses of its current market position, using a SWOT analysis as the main framework of discussion?

CONCLUSION: What do you think are the financial implications for Coke today? Use Value Line at the University Library and download the Value Line page for Coke (Ticker symbol: KO). Use that to help you make an informed decision.

Discussion Question: Religion Creative Design

In this post you will be creative and design a “new” religion that builds upon some of the elements of Shinto while perhaps incorporating traditions from other religions and institutions. In your post consider some of the essential traits of Shinto-respect for nature, emphasis on cleanliness and purification, love of beauty, and use of ritual. Build upon those traits with other elements that you value. For this post, you can even draw upon nonreligious elements-for example, business and technology. Use your textbook and other resources to assist you with this week’s discussion post.

Initial post due Wednesday by 11:59 p.m. with a response to two of your classmates due Friday by 11:59 p.m.