Category: Medicine and Health

its a topic of choice, so i chose the integration of Advanced Clinical Practitioners within a palliative care setting.
i need to meet the 3 learning outcomes 
i have enclosed an example of someone elses work on a different topic 

Focus on clinical trials and randomised control trials and guidelines. 
Provide citations for everything from articles in APA style, from pubmed and oncology journals. 
Skip introduction and conclusion. Divide the paper into sections: 
1. Surgical Options 1.1. Liver Resection; 1.2. Liver Transplantation
2. Ablation (RFA, MWA, PLA, crioablation etc.)
2. Systemic therapies 2.1 Systemic Chemotherapy 2.2 Targeted Therapies
3. Gene Therapy
4. Combination Therapies
Attached is a file with the draft of the article, to which I want to add the sections mentioned above. 
USE THIS AS A REFERENCE, this particular section was written about immunotherapy: 
Immunotherapy 
There are many surgical treatment options for the treatment of HCC. However, resection or transplantation has limited effectiveness due to a low classification rate for surgery and a high 5-year recurrence rate ranging up to 70% after surgery. [30] This is related to the late diagnosis of HCC, which in most patients is at an advanced stage. Treatment is then based on a combination of targeted therapy, chemotherapy, or radiotherapy. Recently, immunotherapy has also been included in the treatment of HCC.  
Continuous exposure of the liver to bacterial components and dietary antigens from the gastrointestinal tract led to the creation of an immune microenvironment consisting of Kupffer cells, hepatic stellate cells, sinusoidal hepatic endothelial cells, natural killer (NK) cells, gamma-delta T cells, and dendritic cells. [31] When the liver is damaged or infected, the protective response is initiated by cytokines, growth factors, chemokines, and interactions with the immune microenvironment of the liver, the incorrect regulation of which could result in the development of cancer. [32] Zhang et al. in their study found that hypoxia- and inflammation-related hypoxia-inducible factor 1α (HIF-1α) can stimulate the excessive expression of IL-1β in tumor-associated macrophages (TAMs), which, thanks to positive feedback, can induce the production of HIF-1α and facilitates the process of epithelial-mesenchymal transition (EMT) leading to metastatic progression. [33] Other important cytokines involved in the pathogenesis of HCC are IL-6, IL-11, and lncRNA activated by TGF-β (lncRNA-ATB). [32] Patients with HCC usually have an increased number of Tregs, which can inhibit the function of CD8 + T cells and thus the elimination of tumor cells. [34] Additionally, continuous antigen stimulation leads to the exhaustion of T cells and thus an increase in the expression of co-inhibitory signaling molecules such as cytotoxic T-lymphocyte-associated protein 4 (CTLA-4), programmed cell death protein 1 (PD-1) and lymphocyte-activation gene 3 (LAG-3). [35] 
The study of immune checkpoint inhibitors, i.e. monoclonal antibodies directed against extracellular ligands involved in suppressing the antitumor immune response, allowed the recognition on the basis of clinical trials of three categories of molecular targets, PD-1, CTLA-4, and LAG-3, which are intended to restore the antitumor capacity of lymphocytes T. [36] Compared to ICI (immune checkpoint inhibitor) monotherapy, combination therapy targeting several immune checkpoints is associated with better treatment outcomes, but the increased efficacy is associated with potential increase in immune-related adverse events. [32] 
Nivolumab is a human anti-PD-1 IgG4 monoclonal antibody directed against PD-1. [37] It is used as a second-line therapy in the treatment of HCC after approval by the FDA in 2017. The CheckMate 040 (NCT01658878) study evaluated nivolumab in combination with ipilimumab in patients treated with sorafenib as a first-line therapy in the treatment of advanced HCC, while the CheckMate 459 study (NCT02576509) compared nivolumab with sorafenib. The results from the first study led to FDA approval in 2020 of this regimen for the treatment of patients with advanced HCC who were previously treated with sorafenib. The results of the second study showed that there was no significant difference in OS, but the use of immunotherapy showed a lower incidence of grade 3 to 4 adverse effects, and improvement in patients’ quality of life, so nivolumab may be an alternative treatment option for patients who cannot undergo therapy with tyrosine kinase inhibitors or antiangiogenic therapy. [38]. Currently, the monoclonal antibody atezolizumab is known, which binds to the PD-L1 protein (programmed death-ligand 1), blocking the binding site of PD-1. The IMbrave150 study (NCT03434379) compared atezolizumab therapy in combination with the antiangiogenic bevacizumab with a group of patients treated with sorafenib. This study showed statistically significantly better OS and PFS with monoclonal antibody immunotherapy compared to sorafenib. [39, 40] Another known monoclonal antibody is pembrolizumab. The phase II KEYNOTE-224 study (NCT02702414) tested the effectiveness of pembrolizumab monotherapy in patients with HCC previously treated with sorafenib (cohort 1) and with no prior systemic therapy (cohort 2), and the results in the study groups were better in terms of safety profile and OS. [41, 42] Similar effectiveness and safety were demonstrated by pembrolizumab in combination with the best supportive care (BCS) in the phase III KEYNOTE-394 study (NCT03062358), where the study group included Asian patients previously treated with sorafenib or oxaliplatin-based chemotherapy. Compared to the placebo plus BCS group, pembrolizumab showed statistically significant improvement in OS and PFS, as well as in the objective response rate (ORR). The findings of these studies demonstrated a consistent clinical benefit for pembrolizumab monotherapy in advanced HCC. The phase 3 KEYNOTE-937 study (NCT03867084), where pembrolizumab is being tested as adjuvant therapy is undergoing. [43] 
The CTLA-4 protein, a CD28 homolog, prevents the binding of CD28 to CD80 and CD86, which is necessary for optimal T-cell activation. Moreover, it reduces the activity of helper T cells, increasing Treg activity, which leads to suppression of the immune response. A phase I/II study (NCT02519348) compared tremelimumab, a monoclonal antibody against CTLA-4, in combination with durvalumab (T300+D) with tremelimumab or durvalumab monotherapy. The results showed that combination therapy was associated with overall treatment benefits and the most encouraging benefit-risk profile due to unique pharmacodynamic activity. [44] In the phase III HIMALAYA study (NCT03298451) the T300 + D regimen and durvalumab monotherapy were evaluated versus sorafenib. T300 + D, which a single dose is known as STRIDE (Single Tremelimumab Regular Interval Durvalumab) displayed efficacy and a favorable benefit-risk profile versus sorafenib. [45] The regimen of two ICIs that block CTLA-4 and PD-L1 is the first-line treatment for adults with advanced or unresectable HCC in the EU. [46] 
LAG-3 present in CD8+ T cells binds to MHC class II molecules, and its increased expression correlates with dysfunction of T cells. [32] Zhou et al. showed that after using antibodies against PD-L1, TIM-3 (mucin domain containing-3), or LAG-3 (lymphocyte-activation gene 3), T lymphocytes respond to HCC antigens. [47] TIM-3 is present in TAM cells, and its increased expression correlates with poor prognosis of HCC patients. [48] The effectiveness of TIM-3-targeted therapies remains uncertain, but studies are currently underway using the anti-TIM-3 antibody, Colbolimab, LY3321367, or sabatolimab. [49]  
Due to the role of TGF-β in creating a tumor microenvironment conducive to growth and metastasis, as well as by hindering the infiltration of T lymphocytes into the tumor center, blocking the action of this cytokine has become another therapeutic target. [32] The discovery of the synergism of the effect of TGF-β blockade and anti-PD-L1 antibodies allowed the consideration in a clinical trial (NCT02423343) of the combination of galunisertib with nivolumab in the treatment of recurrent or refractory non-small cell lung cancer (NSCLC) or hepatocellular carcinoma (HCC). The results showed that the combination is well tolerated. [50] The ongoing phase III CheckMate 9DX study (NCT03383458) is investigating if nivolumab will improve recurrence-free survival (RFS) compared to placebo in HCC patients who have undergone resection or local ablation but are at high risk of recurrence. A bifunctional inhibitor bintrafusp (M7824) targeting PD-L1 and the extracellular domain of TGFβR2 was also created, which have been tested in studies: NCT02517398, NCT02699515, NCT03840915, and NCT04246489. The recurring bleeding adverse events were reported, so the dose reduction was chosen. Further investigation is needed to evaluate the effectiveness of bintrafusp. [51] 
ICIs can be combined not only with each other, but also with radiotherapy, FGFR inhibitors, tyrosine kinase inhibitors (TKI), SBRT, TACE, or chemotherapy. The combination of ICI + TKI in the first-line setting of metastatic disease is being investigated in several phase III trials, such as, the LEAP-002 trial (NCT03713593) evaluating lenvatinib plus pembrolizumab compared with placebo, and the trial NCT03764293 with evaluation of camrelizumab (SHR-1210) plus apatinib vs. sorafenib. [32, 52] The ORIENT-32 trial (NCT03794440) evaluated the combination of sintilimab (a PD-1 inhibitor) plus IBI305, a bevacizumab biosimilar, versus sorafenib. The results showed that the combination has significantly greater OS and PFS than sorafenib which could provide a novel treatment option for patients with unresectable, HBV-associated HCC patients. [53] 
In a phase II study (NCT03092895), previously untreated patients with advanced primary HCC received a combination of camrelizumab (anti-PD-1) plus FOLFOX4 (fluorouracil + calcium folinate + oxaliplatin) or GEMOX (gemcitabine and oxaliplatin). The results showed tolerability and preliminary antitumor activity. [54] The aim of the phase III study (NCT03605706) is to demonstrate the effectiveness of the combination of camrelizumab with FOLFOX4 compared to placebo with FOLFOX4 in the treatment of HCC. [36] ICI can also be used in combination with TACE, whose safety and effectiveness are being investigated in the phase II/III TACE-3 study (NCT04268888), IMMUTACE study (NCT03572582), TRIPLET study (NCT04191889) and LEAP-012 study (NCT04246177). [36] The combination of radiotherapy (SBRT) and ICI (Atezolizumab/Bevacizumab) is being explored in clinical trial NCT04857684. The evaluation of this therapy is being investigated in the other clinical trial NCT05137899 in HCC patients with the presence of portal vein tumour thrombus (PVTT). [55] (Table ) 
Thanks to CRISPR-Cas9 technology, there has been a revolution in CAR-T immunotherapy. The treatment involves genetic modification of T lymphocytes using retroviruses or lentiviruses, which causes proliferation when a specific antigen is recognized, and when the appropriate number is reached, the lymphocytes are injected into the patient to kill cancer cells. The action is hindered by inhibitory receptors on the surface of T cells such as PD-1, CTLA-4, and LAG-3, which may lower the effectiveness of CAR-T. [32] CRISPR-Cas9, by disrupting the expression of genes encoding these surface receptors, can significantly increase the effectiveness of CAR-T. [56, 57] Due to the fact that interleukins such as IL-12, IL-15, IL-18, and IL-7 are overexpressed through retrovirus or lentivirus, which may lead to T cell exhaustion by producing too many cytokines, CRISPR/Cas9 can be used to knock out the TRAC gene. Without this gene, cytokine production will be inhibited. [58] CAR-T therapy is an opportunity for patients with strong anti-cancer properties, as well as a great opportunity to identify new checkpoints of the immune system. [32] Currently, more than 20 phase I/II CAR-T cell clinical trials for HCC are ongoing. [59] 

It is about the analysis of a case study of a psychotherapy session. Title, a presentation of the case study, clinical formulation and treatment plan need to be mentioned. 2000 words, in English, in APA 7 style, both the format of the text and references. Attached is the file with the detailed instructions of the work (assessment brief), the subject I am interested in is the 3rd. Also attached is the file with details on formulation and treatment plan as well as some psychotherapeutic techniques that can be used depending on the case study. Finally, attached is the conative conceptualization diagram, which can be included in the clinical formulation.

the professor has not given us any pronunciation as he gave us oral instructions. Specifically, he told us to find a topic related to the subject of speech therapy, in which no systematic review has been done in the last five years, and to write a systematic review on this topic. He did not give us a specific scope, as he told us that he was interested in the structure and simply told us that if the work is good it can be published.

You will identify the health issue (My health issue is Medicaid), health policy, and potential barriers and solutions. You will then cover your professional goals (pick any) /objectives in relation    to the health issue/health policy and describe how you plan to address any barriers or contribute to a solution.

This essay is typically very well-developed, provides an argument (both sides), contains significant evidence from sources, and is anywhere from 10 – 20 pages double-spaced with an additional bibliography at the end. 
Content – intro and conclusion full and effective, clear, descriptive thesis statement, main points are discussed with significant depth, significantly  informative regarding topic. Appropriate facts and debate. Effective persuasion and/or argument that supports opinions with evidence. Sources well-chosen and credible. Essay structure is clear and logical. Effective use and integration of source material. Moves much beyond a report and is a synthesized essay with a distinct author’s voice integrated with scholarly research.
Topic – How to maintain a healthy life style in America. Undoubtedly, there is a pressing issue concerning weight in America. The public is influenced by mixed messages when it comes to what to eat and how much. Food choices have become based on taste and emotion. Also, we have been constructed to think we have to clean our plates leading to obesity as an epidemic. The food pyramid is currently upside down, therefore adapting to the theory smaller portions also mean more nutritional and wider variety of food. 

Read the Chapter on African Religious Health Assets Program in Holman, Beholden. 
Read: https://thriving.us/vital-conditions/faith/ (downloadable pdf)
Students will craft a journal of their reflections and engagement after each class session
(roughly 500-700 words or an alternative media, if approved). 

Read: Neighborliness. Whole book. Dr. David Docusen. LCL in urban US.
Review website: https://www.goedgedacht.org/ 
READ: chapter on African Religious Health Assets Program in Holman, Beholden. On reserve. And PDF from Prof..

Read: https://projects.iq.harvard.edu/files/rshm/files/jama_balboni_2022_sc_220002_1660748706.29282_1.pdf
Students will craft a journal of their reflections and engagement after each class session
(roughly 500-700 words or an alternative media, if approved). 

READ: Religion and the Health of the Public. Chapter 4, 5, 6.
Students will craft a journal of their reflections and engagement after each class session
(roughly 500-700 words or an alternative media, if approved).