DISCUSSION: PATIENT PREFERENCES AND DECISION MAKING

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DISCUSSION: PATIENT PREFERENCES AND DECISION MAKING

Changes in culture and technology have resulted in patient populations that are often well informed and educated, even before consulting or considering a healthcare need delivered by a health professional. Fueled by this, health professionals are increasingly involving patients in treatment decisions. However, this often comes with challenges, as illnesses and treatments can become complex.

What has your experience been with patient involvement in treatment or healthcare decisions?

In this Discussion, you will share your experiences and consider the impact of patient involvement (or lack of involvement). You will also consider the use of a patient decision aid to inform best practices for patient care and healthcare decision making.

To Prepare:

· Review the Resources and reflect on a time when you experienced a patient being brought into (or not being brought into) a decision regarding their treatment plan.

· Review the Ottawa Hospital Research Institute's Decision Aids Inventory at 
https://decisionaid.ohri.ca/Links to an external site..

· Choose “For Specific Conditions,” then 
Browse an alphabetical listing of decision aids by health topic.

· After you have chosen a topic (or condition) and a decision aid, consider if 
social determinants of healthLinks to an external site. were considered in the treatment plan Social determinants of health can affect a patient's decision as these are conditions in the patient's environment, such as economic stability, education access, health care access and quality, neighborhood, and social and community context.

·
NOTE: To ensure compliance with HIPAA rules, please 
DO NOT use the patient's real name or any information that might identify the patient or organization/practice.

Post a brief description of the situation you experienced and explain how incorporating or not incorporating patient preferences, 
social determinants of health
Links to an external site.
, and values impacted the outcome of their treatment plan. Be specific and provide examples. Then, explain how including patient preferences, social determinants of health, and values might impact the trajectory of the situation and how these were reflected in the treatment plan. Finally, explain the value of the patient decision aid you selected and how it might contribute to effective decision making, both in general and in the experience you described. Describe how you might use this decision aid inventory in your professional practice or personal life.

(Please Note: The underlined “social determinants of health” in the above content is meant to hotlink to the following Walden webpage and content:

Social Determinants of Health – Social Determinants of Health – Academic Guides at Walden 
Links to an external site.

University)

LEARNING RESOURCES


Required Readings

· Hoffman, T. C., Montori, V. M., & Del Mar, C. (2014). 

The connection between evidence-based medicine and shared decision makingLinks to an external site.
. 
Journal of the American Medical Association, 312(13), 1295–1296. doi:10.1001/jama.2014.10186

· Kon, A. A., Davidson, J. E., Morrison, W., Danis, M., & White, D. B. (2016). 

Shared decision making in intensive care units: An American College of Critical Care Medicine and American Thoracic Society policy statementLinks to an external site.
. 
Critical Care Medicine, 44(1), 188–201. doi:10.1097/CCM.0000000000001396

· Opperman, C., Liebig, D., Bowling, J., & Johnson, C. S., & Harper, M. (2016). 

Measuring return on investment for professional development activities: Implications for practiceLinks to an external site.
. 
Journal for Nurses in Professional Development, 32(4), 176–184. doi:10.1097/NND.0000000000000483

· Schroy, P. C., Mylvaganam, S., & Davidson, P. (2014). 

Provider perspectives on the utility of a colorectal cancer screening decision aid for facilitating shared decision makingLinks to an external site.
. 
Health Expectations, 17(1), 27–35. doi:10.1111/j.1369-7625.2011.00730.xThe Ottawa Hospital Research Institute. (2019). 

Patient decision aidsLinks to an external site.
. Retrieved from https://decisionaid.ohri.ca/

Week 3 ion channel —3 Peer Response 800w. due9-20-23

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Week 3 ion channel —3 Peer Response 800w. due9-20-23

Instructions:

Please read and respond to the two peers' initial postings for week 2 below. Consider the following questions in your responses.

Compare and contrast your initial posting with those of your peers.  

1. How are they similar or how are they different?

2. What information can you add that would help support the responses of your peers?

3. Ask your peers a question for clarification about their post.

4. What most interests you about their responses? 

5. Summaries at least 1 evidence based article that supports there point.

Please be sure to validate your opinions and ideas with citations and references in APA format.

·
Response 1 400 words

·

·
Week 3 Discussion: Ion Channels

Compare and contrast the two different major classes of ion channels.

The two different major classes of ion channels are ligand-gated ion channels and voltage-gated ion channels, both of which are membrane proteins that play a vital role in regulating cell membrane potential and neuron communication (Stahl, 2021). Ligand-gated ion channels are also referred to as ionotropic receptors, this is because LGIC is both a receptor and channel and thus serves a dual function (Stahl, 2021). LGIC are made of amino acids and contain multiple binding sites to bind ligands such as neurotransmitters, ions, and drugs, allowing ions to either bind to a receptor or travel through the channel (Stahl, 2021). Voltage-gated ion channels are channels that mediate nerve conduction, action potential, and neurotransmitter release (Stahl, 2021). These channels are controlled by the change in ionic charge or voltage across the cell membrane (Stahl, 2021). Voltage-gated ion channels tend to be more selective, allowing the influx of only one ion at a time, whereas ligand-gated channels are less selective in nature and allow different types of ions to pass through the channel (Alberts, 2002).

Explain the difference between full agonists, partial agonists, antagonists, and inverse agonists.

An agonist is a ligand that binds to a receptor changing its state to result in a response (Stahl, 2021). The difference between full agonist, partial agonist, antagonist, and inverse agonist is that a full agonist leads to maximum signal transduction, whereas a partial agonist does not reach maximum signal transduction even with full receptor occupancy and can act as an antagonist in the presence of a full agonist (Stahl, 2021). Antagonists, on the other hand, is a ligand that binds to a receptor inhibiting its agonist-stimulated response (Stahl, 2021). Inverse agonists are ligands that when binding to a receptor cause a decrease in signal transduction, thus, their effect is the opposite of an agonist (Stahl, 2021).

References

Alberts, B. (2002). Ion channels and the electrical properties of membranes. Molecular Biology of the Cell – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK26910/

Stahl, S. M. (2021). Stahl’s Essential Psychopharmacology. https://doi.org/10.1017/9781108975292

Response 2. 400 words

1.
Compare and contrast the two different major classes of ion channels.

To start this discussion board I would like to define what are ion channels. Ion channels are membrane proteins, which play a major role in regulating cellular excitability. There are 3 major ion channels but for this homework assignment, I will compare and contrast voltage-gated ion channels and Ligand-Gated Ion Channels (LGIC).

·
Ligand-gated ion channels open when a chemical ligand such as a neurotransmitter binds to the protein (Libretexts, 2023).

·
Voltage channels open and close in response to changes in membrane potential (Libretexts, 2023). Ion channels can be classified by how they respond to the environment.

·
Ligand-gated ion channel’s permeability is greatly increased when some type of chemical ligand binds to the protein structure (Libretexts, 2023)

·
Voltage-gated channels respond to disturbances in cell membrane potential and are highly selective for specific ions such as sodium, potassium, calcium, and chloride (Ratan, 2018).

1.
Explain the difference between full agonists, partial agonists, antagonists, and inverse agonists.


Full agonists


Partial agonist


Antagonist


Inverse agonists

A molecule or chemical compound that can bind to a receptor and activate the receptor therefore causing a biological response (Agonist, partial agonist, antagonist, inverse agonist, 2019)

A molecule or chemical compound that can bind to a receptor and “weakly activate the receptor below maximum response (Agonist, partial agonist, antagonist, inverse agonist, 2019)

A molecule or chemical compound that binds to the receptor but does not cause any activation in the receptor, therefore not causing any biological response (Agonist, partial agonist, antagonist, inverse agonist, 2019)

Molecule of chemical compound that can bind to a receptor leading to deactivation, and decreasing the baseline activity of the receptor (Agonist, partial agonist, antagonist, inverse agonist, 2019)

 

 

 

 

References:

Agonist, partial agonist, antagonist, inverse agonist. PharmaEducation. (2023, August 11). https://pharmaeducation.net/agonist-partial-agonist-antagonist-inverse-agonist/

Libretexts. (2023, January 17). 10.5b: Ion Channels. Medicine LibreTexts. https://med.libretexts.org/Bookshelves/Anatomy_and_Physiology/Anatomy_and_Physiology_(Boundless)/10%3A_Overview_of_the_Nervous_System/10.5%3A_Neurophysiology/10.5B%3A_Ion_Channels

Ratan , N. (2018, October 26). Types of ion channels in the body. News. https://www.news-medical.net/health/Types-of-Ion-Channels-

discussion 5 psycho

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 Analyze and apply critical thinking skills in the psychopathology of mental health patients and provide treatment and health promotion while applying evidence-based research.Scenario:

Vee is a 26-year-old African-American woman who presents with a history of non-suicidal self-injury, specifically cutting her arms and legs, since she was a teenager. She has made two suicide attempts by overdosing on prescribed medications, one as a teenager and one six months ago; she also reports chronic suicidal ideation, explaining that it gives her relief to think about suicide as a “way out.”

When she is stressed, Vee says that she often “zones out,” even in the middle of conversations or while at work. She states, “I don’t know who Vee really is,” and describes a longstanding pattern of changing her hobbies, style of clothing, and sometimes even her job based on who is in her social group. At times, she thinks that her partner is “the best thing that’s ever happened to me” and will impulsively buy him lavish gifts, send caring text messages, and the like; however, at other times she admits to thinking “I can’t stand him,” and will ignore or lash out at him, including yelling or throwing things. Immediately after doing so, she reports feeling regret and panic at the thought of him leaving her. Vee reports that, before she began dating her current partner, she sometimes engaged in sexual activity with multiple people per week, often with partners whom she did not know.

Questions:

Remember to answer these questions from your textbooks and NP guidelines. At all times, explain your answers. 

  1. Describe the presenting problems.
  2. Generate a primary and differential diagnosis using the DSM5 and ICD 10 codes.
  3. Discuss which cluster the primary diagnosis belongs to.
  4. Formulate and prioritize a treatment plan.

Submission Instructions:

  • Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.  Your initial post is worth 8 points.
  • You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.) 
  • All replies must be constructive and use literature where possible.
  • Please post your initial response by 11:59 PM ET Thursday, and comment on the posts of two classmates by 11:59 PM ET Sunday.
  • Late work policies, expectations regarding proper citations, acceptable means of responding to peer feedback, and other expectations are at the discretion of the instructor.
  • You can expect feedback from the instructor within 48 to 72 hours from the Sunday due date.

Discussion 7

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Discuss the safety and effectiveness of alternative and complementary medicine for the treatment of specific

illnesses such as cancer, diabetes, and hypertension.  Share your opinions about holistic and allopathic care.

Would have any conflicts or concerns supporting a patient who chooses holistic or allopathic medicine?

Instructions: 

Post your discussion to the Moodle Discussion Forum.  Initial post must be made by Day #3.  Word limit 500 words. Please make sure to provide citations and references (in APA, 7th ed. format) for your work.  

What Sort of Leader Is Needed?

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Case Study

Two new associate-degree graduates were hired for the pediatric unit. Both worked three 12-hour shifts a week; Jan worked the day-to-evening shift and Rosemary worked the night shift. Whenever their shifts connected, they would compare notes on their experience. Jan felt she was learning rapidly, gaining clinical skills and beginning to feel at ease with her colleagues.

Rosemary, however, still felt unsure of herself and often isolated. There have been times that she was the only registered nurse on the unit all night. The aides and LPNs were very experienced, but Rosemary feels she is not ready for that kind of responsibility. Rosemary knows she must speak to the nurse manager about this, but she’s called several times, and she’s never available. The shift assignments are left in the staff lounge by an assistant.

Questions

Your discussion post should answer the following questions in a well-constructed commentary. Use references, in APA format, where appropriate.

  1. To what extent is this problem due to a failure to lead? Who has failed to act?
  2. What style of leadership was displayed by Rosemary? The nurse manager?
  3. How effective was their leadership? What are your suggestions for Rosemary?

PP presentation

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Introduction

As a current or future nurse leader, you may be called upon to present to stakeholders and leadership about projects that you have been involved in or wish to implement. The ability to communicate a plan—and potential implications of not pursuing such a plan—to stakeholders effectively can be critically important in creating awareness and buy-in, as well as building your personal and professional brand in your organization. It is equally important that you know how to create compelling presentations for others' delivery and ensure that they convey the same content you would deliver if you were the presenter.

You are encouraged to complete the Evidence-Based Practice: Basics and Guidelines activity before you develop the presentation. This activity consists of six questions that will create the opportunity to check your understanding of the fundamentals of evidence-based practice as well as ways to identify EBP in practice. The information gained from completing this formative will help promote success in the Stakeholder Presentation and demonstrate courseroom engagement—it requires just a few minutes of your time and is not graded.

Demonstration of Proficiency

· Competency 1: Explain strategies for managing human and financial resources to promote organizational health.

· Explain how the interdisciplinary plan could be implemented and how the human and financial resources would be managed.

· Competency 2: Explain how interdisciplinary collaboration can be used to achieve desired patient and systems outcomes.

· Explain an organizational or patient issue for which a collaborative interdisciplinary team approach would help achieve a specific improvement goal.

· Competency 3: Describe ways to incorporate evidence-based practice within an interdisciplinary team.

· Summarize an evidence-based interdisciplinary plan to address an organizational or patient issue.

· Propose evidence-based criteria that could be used to evaluate the degree to which the project was successful in achieving the improvement goal.

· Competency 5: Apply professional, scholarly, evidence-based communication strategies to impact patient, interdisciplinary team, and systems outcomes.

· Slides are easy to read and error free. Detailed speaker notes are provided.

· Organize content with clear purpose/goals and with relevant and evidence-based sources (published within 5 years) with an APA formatted reference list with few errors.

Professional Context

This assessment will provide you with an opportunity to sharpen your ability to create a professional presentation to stakeholders. In this presentation, you will explain the Plan-Do-Study-Act cycle and how it can be used to introduce the plan (P), implement the plan (D), study the effectiveness of the plan (S), and act on what is learned (A) to drive continuous improvement. By using this cycle, the stakeholders will have a tool and a proposal to expand on these ideas to drive workplace change and create improved processes to solve an interprofessional collaboration problem.

Scenario

In addition to summarizing the key points of Assessments 2 and 3, you will provide stakeholders and/or leadership with an overview of project specifics as well as how success would be evaluated—you will essentially be presenting a discussion of the Plan, Do, and Study parts of the PDSA cycle. Again, you will not be expected to execute the project, so you will not have any results to study. However, by carefully examining the ways in which your plan 
could be carried out and evaluated, you will get some of the experience of the thinking required for PDSA.

When creating your PowerPoint for this assessment, it is important to keep in mind the target audience: your interviewee's organizational leadership. The overall goal of this assessment is to create a presentation that your interviewee could potentially give in his or her organization.

Instructions

Please follow the Capella 
Guidelines for Effective PowerPoint Presentations [PPTX]. If you need technical information on using PowerPoint, refer to 
Capella University Library: PowerPoint Presentations.

Be sure that your plan addresses the following, which corresponds to the grading criteria in the scoring guide. Please study the scoring guide carefully so you understand what is needed for a distinguished score.

· Explain an organizational or patient issue for which a collaborative interdisciplinary team approach would help achieve a specific improvement goal.

· Summarize an evidence-based interdisciplinary plan to address an organizational or patient issue.

· Explain how the interdisciplinary plan could be implemented and how the human and financial resources would be managed.

· Propose evidence-based criteria that could be used to evaluate the degree to which the project was successful in achieving the improvement goal.

· Communicate the PowerPoint presentation of the interdisciplinary improvement plan to stakeholders in a professional manner, with writing that is clear, logically organized, and respectful with correct grammar and spelling using current APA style.

There are various ways to structure your presentation; following is one example:

·
Part 1: Organizational or Patient Issue.

· What is the issue that you are trying to solve or improve?

· Why should the audience care about solving it?

·
Part 2: Relevance of an Interdisciplinary Team Approach.

· Why is using an interdisciplinary team relevant, or the best approach, to addressing the issue?

· How will it help to achieve improved outcomes or reach a goal?

·
Part 3: Interdisciplinary Plan Summary.

· What is the objective?

· How likely is it to work?

· What will the interdisciplinary team do?

·
Part 4: Implementation and Resource Management.

· How could the plan be implemented to ensure effective use of resources?

· How could the plan be managed to ensure that resources were not wasted?

· How does the plan justify the resource expenditure?

·
Part 5: Evaluation.

· What would a successful outcome of the project look like?

· What are the criteria that could be used to measure that success?

· How could this be used to show the degree of success?

Again, keep in mind that your audience for this presentation is a specific group (or groups) at your interviewee's organization and tailor your language and messaging accordingly. Remember, also, that another person will ultimately be giving the presentation. Include thorough speaker’s notes that flesh out the bullet points on each slide.

Additional Requirements

·
Number of slides: Plan on using one or two slides for each part of your presentation as needed, so the content of your presentation will be 8–12 slides in length. Remember that slides should contain concise talking points, and you will use presenter's notes to go into detail. Be sure to include a reference slide as the last slide of your presentation.

·
Number of references: Cite a minimum of 3 sources of scholarly or professional evidence that support your central ideas. Resources should be no more than five years old.

·
APA formatting: Make sure that in-text citations on your slides and in your notes pages and reference slide reflect current APA Style and Format.

Portfolio Prompt: Remember to save the final assessment to your ePortfolio so that you may refer to it as you complete the final Capstone course.

nursing knowledge

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The development of nursing knowledge is an ongoing process. Discuss the case for the ongoing development and use of nursing grand theories and conversely, make a case for the obsolescence of nursing grand theories for today’s practice and research.

Require 400 words and at least 3 scholarly references no later than 5 years old. 

No Plagiarism 

discussion 1 pharm

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A 23-year-old biracial (Black Asian) female arrives at the clinic for an evaluation. She has lost 30 pounds in 6 weeks without trying. She complains of feelings of guilt about her symptoms and everyday sadness that does not go away.  She also states she is not able to stay asleep and has difficulty concentrating.  Her family is Jamaican and has used herbal teas, not a psychiatrist in the past to treat these symptoms.

  • Discuss how the principles of good prescribing should be applied to this case.  
  • Describe a cultural consideration that may affect medication adherence for this patient.

Submission Instructions:

  • Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.  Your initial post is worth 8 points.
  • You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.) 
  • All replies must be constructive and use literature where possible.
  • Please post your initial response by 11:59 PM ET Thursday, and comment on the posts of two classmates by 11:59 PM ET Sunday.
  • Late work policies, expectations regarding proper citations, acceptable means of responding to peer feedback, and other expectations are at the discretion of the instructor.
  • You can expect feedback from the instructor within 48 to 72 hours from the Sunday due date.

Case study preschool child

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Read the following case study and answer the reflective questions. Please provide evidence-based rationales  citation and references for your answers. APA, 7th ed. must be followed.

Ricky, age 4 years, arrives in the clinic with his mother. Ricky lives with his mother and father, who both work full-time, and his infant sister. Their extended family lives in a different state more than 100 miles away. Both parents are of average height and in good health. Ricky’s mother mentions that Ricky often expresses frustration, particularly in regard to food. Conflict over food occurs every day. Mealtime is a battle to get him to eat, unless his mother feeds him. Ricky’s baby sister seems to tolerate all baby foods but requires her mother to spoon-feed. Ricky’s mother is quite frustrated and concerned that he will become malnourished. Reflective 

Questions

1. What additional assessment information would you collect? 

2. What questions would you ask, and how would you further explore this issue with the mother? 

3. In what ways does the distance of the extended family influence this family’s approach to health promotion? 

4. What factors would you consider to determine whether malnourishment is a factor in this family?

40ABCD

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Introduction

Nurses at the baccalaureate level in all practice areas are involved in nursing informatics through interaction with information management and patient care technologies. Nurses must not only demonstrate knowledge of and skills in health information and patient care technologies, but also how to use these tools at the bedside and organizational levels. Moreover, nurses need to recognize how information gathered from various health information sources can impact decision making at the national and state regulatory levels.

Preparation

To successfully prepare for this assessment, you will need to complete these preparatory activities:

· Review assessment resources and activities.

· Conduct independent research on the nursing knowledge and skills necessary to interact with health information and patient care technology.

· Focus your research on current resources available through peer-reviewed articles, professional websites, government websites, professional blogs, wikis, job boards, and so on.

· Consult the 
BSN Program Library Research Guide for help in identifying scholarly and authoritative sources.

· Interview peers in your network who are considered information technology experts.

· Ask them about how information technology advances are impacting patient care at the bedside, at the organizational level, and beyond.

Scenario

For this assessment, assume you are a nurse attending a meeting of your state’s nurses association. A nurse informaticist conducted a presentation on her role and its impact on positive patient and organizational outcomes in her workplace. You realize that your organization is undergoing many technological changes. You believe this type of role could provide many benefits to your organization.

You decide to pursue proposing a nurse informaticist role in your organization. You speak to your chief nursing officer (CNO) and human resources (HR) manager, who ask you to prepare a 4–5 page evidence-based proposal to support the new role. In this way, they can make an informed decision as to whether the addition of such a role could justify the return on investment (ROI). They need your proposal before an upcoming fiscal meeting.​ 
This is not an essay, but instead, it is a proposal to create a new Nurse Informaticist position.

One important part of this assessment is the justification of the need for a nurse informaticist in a health care organization and references from relevant and timely scholarly or professional resources to support the justification for creating this nurse informaticist position. The term justify means to show or prove that the nurse informaticist position brings value to the organization. This justification must include evidence from the literature to support that this position will provide a return on investment for the organization.

Proposal Format

The chief nursing officer (CNO) and human resources (HR) manager have asked you to include the following headings in your 
proposal and to be sure to address the bullets following each heading:

Nursing Informatics and the Nurse Informaticist

· What is nursing informatics?

· What is the role of the nurse informaticist?

Nurse Informaticists and Other Health Care Organizations

· What is the experience of other health care organizations with nurse informaticists?

· How do these nurse informaticists interact with the rest of the nursing staff and the interdisciplinary team?

Impact of Full Nurse Engagement in Health Care Technology

· How does fully engaging nurses in health care technology impact:

· Patient care?

· Protected health information (security, privacy, and confidentiality)?

· In this section, you will explain evidence-based strategies that the nurse informaticist and interdisciplinary team can use to effectively manage patients' protected health information, particularly privacy, security, and confidentiality. Evidence-based means that they are supported by evidence from scholarly sources.

· Workflow?

· Costs and return on investment?

Opportunities and Challenges

· What are the opportunities and challenges for nurses and the interdisciplinary team with the addition of a nurse informaticist role?

· How can the 
interdisciplinary team collaborate to improve quality care outcomes through technology?

Summary of Recommendations

· What are 3–4 key takeaways from your 
proposal about the recommended nurse informaticist role that you want the CNO and the HR manager to remember?

· This is the section where the justification for the implementation of the nursing informaticist role is addressed. Remember to include evidence from the literature to support your recommendation.

Additional Requirements

·
Written communication: Ensure written communication is free of errors that detract from the overall message.

·
Submission length: 4–5 double-spaced pages, in addition to title and references pages.

·
Font: Times New Roman, 12 point.

·
Citations and References: Cite a 
minimum of three current scholarly and/or authoritative sources to support your ideas. In addition, cite a 
minimum of one current professional blog or website to support your central ideas. 
Current means no more than five years old.

·
APA formatting: Be sure to follow APA formatting and style guidelines for citations and references. For an APA refresher, consult the 
Evidence and APA page on Campus.