A 13-year-old female presents with fatigue, pallor, and decreased exercise tolerance. She reports heavy menstrual periods since menarche, lasting 7 to 8 days and requiring frequent pad changes. Her diet is limited, and she often skips breakfast. Exam shows conjunctival pallor but is otherwise normal. What is the most appropriate next step?

A 30-year-old female presents with vaginal itching and thick white discharge for 3 days. She reports having three similar episodes over the past 6 months, each temporarily improving with over-the-counter treatment. She recently completed a course of antibiotics. She denies fever, pelvic pain, or abnormal bleeding. On exam, there is vulvar erythema and thick, white, clumpy discharge without odor. What is the most appropriate next step?

A 4-year-old female presents with dysuria, urinary frequency, and new daytime accidents for 2 days. She is afebrile, active, and eating normally. Her mother reports bubble baths several times per week and says the child wipes independently. Abdominal exam is benign, and there is no flank pain. What is the most appropriate next step?

A 21-year-old female presents for routine care. She is sexually active and has never had cervical cancer screening. She reports no symptoms. What is the most appropriate next step?

A 17-year-old female presents with decreased need for sleep, increased energy, and racing thoughts for one week. She denies substance use and has no prior psychiatric history. What is the most appropriate next step?

Part 2 – Merck & Co. Inc: (C) Non-GAAP Income and Non-GAAP EPS from Continuing Operations Non-GAAP income is an alternative view of the Company’s performance that Merck is providing because management believes this information enhances investors’ understanding of the Company’s results since management uses non-GAAP measures to assess performance. Non-GAAP income excludes certain items because of the nature of these items and the impact that they have on the analysis of underlying business performance and trends. The excluded items (which should not be considered non-recurring) consist of acquisition- and divestiture-related costs, restructuring costs, income and losses from investments in equity securities, and certain other items. These excluded items are significant components in understanding and assessing financial performance. In fiscal year 2017, Merck reported GAAP income of $1.9 billion and a much higher non-GAAP income of $5.0 billion, inclusive of acquisition and divestiture-related costs of $2.9 billion. Required: In your opinion, which one of these two measures should investors rely on in estimating future income for Merck? Explain. 

Mandatory audit firm rotation has been implemented in the European Union, but not in the United States (US). Based on the readings covered in class, do you believe that audit/financial reporting quality would be improved if mandatory audit firm rotation was implemented in the US? Use any evidence from academic research covered in your class readings to defend your position.

Part 1 – Merck & Co. Inc: Merck & Co., Inc. is an American multinational pharmaceutical company. Below is information excerpted from Merck & Co. Inc.’s 10-K disclosure on various issues for the 2017 fiscal year.  (A) Investigations As previously disclosed, in November 2014, the Company was advised by the staff of the SEC that it was commencing an informal inquiry concerning Vioxx. On January 28, 2015, the Company announced that it received notice that the SEC issued a formal notice of investigation. Also, the Company has received subpoenas from the U.S. Department of Justice (the “DOJ”) requesting information related to the Company’s research, marketing and selling activities with respect to Vioxx in a federal health care investigation under criminal statutes. In addition, as previously disclosed, investigations are being conducted by local authorities in certain cities in Europe in order to determine whether any criminal charges should be brought concerning Vioxx. The Company is cooperating with these governmental entities in their respective investigations (the “Vioxx Investigations”). The Company cannot predict the outcome of these inquiries; however, they could result in potential civil and/or criminal dispositions. As previously disclosed, the Company has received a number of Civil Investigative Demands (“CID”) from a group of Attorneys General from 31 states and the District of Columbia who are investigating whether the Company violated state consumer protection laws when marketing Vioxx. The Company is cooperating with the Attorneys General in responding to the CIDs. In addition, the Company received a subpoena in September 2016 from the State of California Attorney General seeking documents and information related to the placement of Vioxx on California’s Medi-Cal formulary. The Company is cooperating with the Attorney General in responding to the subpoena.   (B) Reserves The Company currently anticipates that a number of Vioxx Product Liability Lawsuits will be tried throughout 2017. A trial in the Oregon securities case is scheduled for 2017, but the Company cannot predict whether this trial will proceed on schedule or the timing of any of the other Vioxx Shareholder Lawsuit trials. The Company believes that it has meritorious defenses to the Vioxx Lawsuits and will vigorously defend against them. In view of the inherent difficulty of predicting the outcome of litigation, particularly where there are many claimants and the claimants seek indeterminate damages, the Company is unable to predict the outcome of these matters, and at this time cannot reasonably estimate the possible loss or range of loss with respect to the Vioxx Lawsuits. The Company has not established any reserves for any potential liability relating to the Vioxx Lawsuits or the Vioxx Investigations, including for those cases in which verdicts or judgments have been entered against the Company, and are now in post-verdict proceedings or on appeal. In each of those cases the Company believes it has strong points to raise on appeal and therefore that unfavorable outcomes in such cases are not probable. Unfavorable outcomes in the Vioxx Litigation (as defined below) could have a material adverse effect on the Company’s financial position, liquidity and results of operations.   Required: Given the disclosures about the investigations instigated by the SEC and the DOJ, how do you think investors would respond to these disclosures about the investigations and reserves (be specific).

Convert the measurement. 24 yd to feet

Storytellers across all cultures, whether they use the printed word or film format, become a part of a larger dialogue regarding social, cultural, and political values.  After reading Adichie’s “The Headstrong Historian” for our last class session/lesson, write a 500-750 word response essay that analyzes how and why “Headstrong Historian” engages with some of the concerns of, and inherent questions posited by, postcolonial theorists today. That is to say, you previously thought about how colonization impacts Nwamgba and her family in our last comprehension quiz. NOW, you will explain how and why this short story is considered a work of postcolonialism. Be sure to keep in mind that you must demonstrate a clear understanding of postcolonialism, contemporary world literature, and literary analysis.  Reminders: No works cited page is required, but you do need evidence to support your claims in essay, but you absolutely must identify the author and title in your introduction. Use indented Paragraphs. The five paragraph strategy is appropriate for timed essays (exam essays). Use this to your advantage. Introductions and Conclusions must have four sentences minimum. Body paragraphs must have five sentences minimum. You must use three or more paragraphs. Write 500-700 words. The minimum requirement of 500 words is set by Blinn. I have never had a student NOT hit 500 words, IF they plan a five paragraph essay, and maintain the minimum number of sentences per paragraph mentioned above. You are typing this into a text box– you do not need to double space (but you can), but DO leave a space between paragraphs AND DO indent for new paragraphs.