Read the following case study describing Roberto’s experience with addiction and then answer the question parts (a), (b), and (c). (Please note that ‘Roberto’ is not a real person, and the experiences described are based on a combination of case studies.)

To demonstrate good academic practice, you should include citations for your sources of information in all parts of this question. You can provide references after each question part, or in one list at the end of all your answers to this question.

Case study: Roberto

Roberto is 70 years old and has had an addiction to alcohol from a very young age. He lives with his wife, Lola, who has taken care of him for many years, but she is now ill. From the age of 12 years, Roberto started to help his parents and older siblings to collect grapes and other fruit for a rich family. Roberto states that at that time it was very common for poor families to start working at a young age as education was not a priority.

Roberto’s parents thought that a bit of wine after lunch was healthy for all ages, so he was given a small glass after lunch from the time he started to work with his family, a habit he could not stop as he grew up. He still consumes wine after lunch every day (although the amount and timings of consumption have escalated).

Roberto is the only sibling to develop an addiction. His two siblings were older than him when they helped in the fields (in their early twenties) and he cannot understand why he is the only one affected as they also had the daily glass of wine.

From the age of 26 to retirement, Roberto worked in a tile factory. He reports that he went to work every day after drinking 3 to 5 glasses of “Sol y Sombra” (a common breakfast alcoholic drink in Spain) in a nearby bar, but that no one noticed as his body got used to large amounts of alcohol and he was barely ever seen intoxicated. He occasionally headed out of work to get these drinks if he had not had time to get them before working hours, or after an unsuccessful attempt to skip his early morning drinking routine. This put him in trouble on repeated occasions at work, but it did not stop him from doing it. He was also involved in several minor accidents at work. Although he denies that they were due to alcohol intoxication, he was suspended several times and referred to a detoxication unit as a condition of keeping his job.

Roberto’s wife Lola reports repeated episodes of aggressiveness at home when she has tried to prevent him from drinking. She has thought about divorcing him more than once because of these episodes, but despite her threats to leave him, he has not stopped drinking. They have two sons who have stopped visiting because of Roberto’s “drinking problem” although they occasionally go home to check on Lola.

Roberto and Lola decided to visit a psychologist at an addiction treatment center, as Roberto needs to be in good shape to take care of his wife while she is ill. He came to the clinic looking unhealthy with some signs of malnutrition. This is commonly seen in people with severe alcoholism who allocate more time to drinking than to other important activities such as eating properly. This is a transcript of three minutes of a recent interview between John, Lola, and a psychologist at the treatment center:

(a)

With reference to Table 1.3 in Topic 5, Section 1.3, identify three pieces of evidence in Roberto’s case study that would meet three different criteria for a substance use disorder as described in the DSM-5 (one piece of evidence for each criterion). In your answer, describe the evidence from the case study and briefly justify why you think the evidence matches the chosen criterion.

Word limit: 200 words

(6 marks)

(b)

How do you think Roberto’s age when he started drinking affected his vulnerability to alcoholism compared with his siblings who did not develop an addiction? Mention two areas of Roberto’s brain that were likely to be undergoing changes when he started drinking and briefly describe their function in relation to addiction.

Word limit: 150 words

(4 marks)

(c)

As part of his treatment, Roberto was recommended to avoid bars and people he drinks with. Why do you think the therapist wanted to prevent Roberto from seeing cues associated with his drinking behavior? Explain your answer based on what you have learned about reward-related learning and cue-evoked relapse, using terminology related to conditioning in your answer.

Word limit: 150 words

Match the lymphoid structure with its function

Peyers patch, lymphoid follicles, lymph nodes, spleen, high endothelial venues

1. Provide a concentrated and organized environment of antigen, antigen-presenting cells, T cells, and B cells  in which naïve B cells and T cells can be activated

2. Capped by an M Cell which allows ready access to sample  antigens from the intestine

3. Macrophages along the marginal sinuses of this blood-filtering organ clean up debris and pathogens and can then serve as antigen-presenting cells to T cells and B cells transiting the organ

4. Described as islands of dendritic cells in a sea of B cells

5. Passages or “doorways” through which B cells and T cells enter secondary lymphoid organs from the blood

In 2014 President Obama issued a memorandum and established a task force to tackle this issue. Out of this effort, Title IX was written and signed into law.

• What does Title IX prohibit educational institutions that receive federal funding from doing? (2 points)
• Does Title IX apply to? Be specific. (2 points)
• When are a student’s rights violated under Title IX specifications? & And what constitutes a violation? (2 points)
• What entity are violations of Title X reported to (1 point)?
• Title IX regulations specify 3 requirements for educational institutions to adhere to. What are two of them? (2 points)

You are the director of the infection control department at a new hospital that is scheduled to open in six months.  You are tasked with developing the infection prevention program for the hospital.

Your submission will demonstrate your knowledge of infection prevention quality metrics and meeting infection control program requirements of overseeing regulatory and accreditation bodies.  Include the following in your submission:

• Diagnostic stewardship
• Healthcare-associated infection metrics
• Performance improvement
• Meeting regulatory and accreditation requirements in Saudi Arabia