Critically explain the pathophysiology of anorexia.

Conc of Pathophys of NSg peers response
· respond to peers thoughtfully, add value to the discussion, and apply ideas, insights, or concepts from scholarly sources, such as: journal articles, assigned readings, textbook material, lectures, course materials, or authoritative websites. For specific details and criteria, refer to the discussion rubric in the Menu (?) or in the Course Overview Weekly Discussion Guidelines. 
1st peer post
Samantha WootenSep 11, 2023 at 9:31 AM
Marshall (2022) reports “In anorexia nervosa’s cycle of self-starvation, the body is denied the essential nutrients it needs to function normally.  Thus, the body is forced to slow down all of its processes to conserve energy, resulting in serious medical consequences” (P. 1). Marshall also surmises that lab work up on a patient may look normal, but this does not rule out impending death, death could happen quickly by cardiac arrest caused by electrolyte imbalances (2022. P. 1). 
Cultural and environmental implications affect a large amount of people within all ethnicity, gender, and age however women are largely targeted, the University of East Anglia state “his quite obvious connection between eating disorders and cultural expectations surrounding femininity is woefully neglected in much treatment” (P. 1).  With the technology boom in recent years this is ever more present for this population, a social media environment instills these behaviors in today’s society.  
Financial implications that cause anorexia include lack of income and homelessness. Underprivileged populations have no choice but to sacrifice food to prioritize other necessities. Chan (2023) reports 64.7 billion being spent on eating disorders per year, with 23,560 hospitalizations yearly (p. 1). 
In the ED with 16-year-old Jonathan Collins coming into the facility for anorexia nursing interventions would include evaluating the patients diet/exercise regimen and educate on proper diet and exercise with adequate fluid intake. Identify coping strategies and emotions related to weight, allowing the patient time to think and express how they’re feeling. This will allow underlying causes to surface for treatment. Lastly, addressing body images issues. Targeting these fears will allow the patient to accept a healthy body weight to maintain health and stay out of the hospital (Belleza, August 9, 2023. P. 1). 
According to Miller, Grinspoon, and Ciampa (2020) vital signs with anorexia tend to include a slower than normal heart rate, hypotension, and hypothermia. Lab values tend to include anemia and in some cases thrombocytopenia. Sodium levels average around 122, with normal levels being 135-145. Average potassium in patients with anorexia being 1.9 with normal values being 3.4-4.8. All of these values contribute to cardiac arrest via electrolyte imbalance. In some anorexia patients there are dysrhythmias due to electrolyte imbalances and hypovolemia. Also of note with women populations are menstrual dysfunction and osteoporosis (P. 1). 
Treatment includes a combination of psychotherapy, family therapy, and medicine according to St. Lukes Hospital (2015), they also state “A combination of treatments can give the person the medical, psychological, and practical support they need. Cognitive behavioral therapy, along with antidepressants, can be an effective treatment for eating disorders. Complementary and alternative (CAM) therapies may help with nutritional deficiencies” (P. 1). 
 
references
Belleza, M. August 9, 2023. Eating disorders: Anorexia & Bulimia Nervosa. Nurse Labs.
Eating Disorders: Anorexia & Bulimia Nervosa – Nurseslabs

Chan, T. H. 2023. Report: Economic Costs of Eating Disorders. Harvard School of Public Health.
Report: Economic Costs of Eating Disorders | STRIPED | Harvard T.H. Chan School of Public Health

Marshall, D. 2022. Anorexia Nervosa. National eating disorders association.
Anorexia Nervosa | National Eating Disorders Association

Miller, K. Grinspoon, S. Ciampa, J. (Marh 14, 2020). Medicla Findings in Outpatients with Anorexia Nervosa. JAMA internal medicine. Doi:10.1001/archinte.165.5.561.
St. Lukes Hospital. April 23, 2015. Complementary and Alternative Medicine of Anorexia Nervosa. A Division of Ebix.
Anorexia nervosa | Complementary and Alternative Medicine | St. Luke’s Hospital (stlukes-stl.com)

University of East Anglia. November 13, 2017. Eating disorder treatments need to consider social, cultural implications of the illness. Science Daily.
Eating disorder treatments need to consider social, cultural implications of the illness | ScienceDaily

2nd peer post
Kira DespinsSep 11, 2023 at 3:20 PM
1. Thoroughly explain the pathophysiology of anorexia. Use a scholarly or authoritative source to support your answer.
Anorexia is a medical condition summarized by an inadequate intake of nutrients to regulate an individual’s weight to reduce their BMI and be ‘thin’.  It causes physiological imbalances such as amenorrhea and psychological imbalances such as an obsessive-compulsive need to exercise or an all-encompassing fear of gaining weight. This population exhibits body dysmorphia.  Once begun, this disease is persistent in select populations (Klein, 2004).
1. Examine each of the following three factors related to this disease process. Support all three with a scholarly source.
Cultural:  Western culture perpetuates a standard of beauty based on being thin.  This standard is propagated through social media outlets. Klein (2004) summarizes that popular media not only emphasizes the need to be a thing but perpetuates it through advertisements such as marketing diet fads and fitness trends.
Financial: Relating to the treatment of anorexia, a study by Gatt et al. (2014) found significant household financial stress for those seeking treatment for their eating disorder.  They compared treatment costs to being the second highest after cardiac artery bypass surgery.  As the disease is notoriously difficult to manage by oneself, it would be prudent to establish funding for this patient population so all individuals can access treatment without causing significant burdens on themselves and their families.
Environmental implications: Nature vs. nature has been heavily debated in pursuing the best understanding of anorexia. Klinger (2012) highlights that from an environmental perspective, children who have been neglected and/or abused are more prone to develop anorexia.
1. Identify 3-5 priority nursing interventions for the client in the emergency department.
-Cardiac monitoring due to electrolyte imbalance
-Fall risk prevention related to weakness
-Blood glucose monitoring related to low nutrient intake
1. Describe labs and diagnostic testing you would want to include in client’s plan of care and why. What are critical indicators? Support with a scholarly source.
Metevir, a nutrition counselor, highlights the importance of the following lab and diagnostic tests in anorexic patients (2022):
1. Vital sign monitoring, such as bradycardia, can signify a weak heart-conserving energy.
2. EKG to detect abnormal heart rhythm due to weakened heart muscles.
3. Complete metabolic panel to look for electrolyte imbalances in kidney and liver health. Hypokalemia would be a critical indicator.
4. Blood glucose tests as low food intake results in less glucose, which our brains depend upon
5. Hematology detects if our blood carries enough oxygen to perfuse our organs adequately.
6. Bone density test as low food intact can result in reduced hormone output, leading to weak and brittle bones.
 
1. What members of the interdisciplinary team need to be included for holistic patient-centered care? Provide a rationale and support with a scholarly source.
I believe that family members and friends are included in any team to support and care for those treated with anorexia.  Knowing the care plan, these individuals can best provide care and support to the patient while out of the hospital, setting them up for success.  Joy et al. (2003) believe that a physician, mental health professional, and nutritionist are also integral components of the care team as it affect an individual physically and mentally, and each has an overlapping specialty to assist the patient best.  In an emergency department setting, involving a social worker or case management is integral to establishing resources for patients seeking help in an outpatient or in-patient setting. 
 
References
Gatt, L., Jan, S., Mondraty, N., Horsfield, S., Hart, S., Russell, J., Laba, T. L., & Essue, B. (2014). The household economic burden of eating disorders and adherence to treatment in Australia. BMC Psychiatry, 14. 
https://doi.org/10.1186/s12888-014-0338-0

Joy, E., & Wilson, C., & Varechok, S. (2004). The multidisciplinary team approach to the outpatient treatment of disordered eating. Curr Sports Med Rep, 331(6), 6. https://pubmed.ncbi.nlm.nih.gov/14583163/#:~:text=Team%20members%20include%20a%20physician,of%20individuals%20with%20disordered%20eating.
Klein, D. A., & Walsh, B. T. (2004). Eating disorders: clinical features and pathophysiology. Physiology & Behavior, 81(2), 359–374. 
https://doi.org/10.1016/j.physbeh.2004.02.009

Klinger, D. (2012). Genes or environment: What causes eating disorders? GoodTherapy. 
https://www.goodtherapy.org/blog/genes-environment-what-causes-eating-disorders

Metevier, J. (2022). The eating disorder medical test and nutrition lab guide. Integrated Care Clinic. https://integratedcareclinic.com/blog/the-eating-disorder-medical-test-and-nutrition-lab-guide/#:~:text=Metabolic%2FElectrolyte%20Labs,your%20sugar%20and%20protein%20levels

Roe v. Wade, 410 US 113 (1973), held that the Due Process Clause includes an inherent “right to privacy” of which affords women the right to choose to have an abortion.  This reasoning followed in a long line of cases addressing the fundamental right to privacy.  The Supreme Court recently overruled  Roe in  Dobbs v. Jackson Women’s Health Organization, 597 US ____ (2022), and held that the right to an abortion is not a fundamental right protected by the Due Process Clause.   a.  Is  Dobbs limited to issues surrounding abortion, or does it challenge prior court holdings establishing the fundamental right to privacy? 

1. The Supreme Court in 
Duncan v. Louisiana, 391 U.S. 145 (1968), held that the right to a jury trial is a fundamental right incorporated to the States through the 14th Amendment.  Part of the Court’s reasoning emphasized the necessary protections afforded to the accused.  The Supreme Court subsequently ruled in, 
District Attorney’s Office v. Osborne, 557 U.S. 52 (2009), that an accused does not have a due process right under the United States Constitution to obtain evidence for the purpose of conducting DNA testing to prove actual innocence.  

a.  Is the above statement a complete and accurate assessment of the holdings in 
Duncan and 
Osborne?  Explain.  

b.  If the Due Process Clause is designed to protect the rights of an accused, how do you reconcile the holdings in 
Duncan and 
Osborne?  

2.  The Supreme Court in 
Roe v. Wade, 410 US 113 (1973), held that the Due Process Clause includes an inherent “right to privacy” of which affords women the right to choose to have an abortion.  This reasoning followed in a long line of cases addressing the fundamental right to privacy.  The Supreme Court recently overruled 
Roe in 
Dobbs v. Jackson Women’s Health Organization, 597 US ____ (2022), and held that the right to an abortion is not a fundamental right protected by the Due Process Clause.  

a.  Is 
Dobbs limited to issues surrounding abortion, or does it challenge prior court holdings establishing the fundamental right to privacy? 

b.  If the impact of 
Dobbs minimizes the fundamental nature of the right to privacy, what impact could this have in the field of criminal justice? Explain.  

Discuss potential causes of dirty data and key strategies that can be used to ensure the consistency of clean data, while using various healthcare technologies.

HIMA360-A risk analysis is one way to assess or identify the risks associated with a project. It can also provide an understanding of the project’s strengths and weaknesses. Imagine that you were recently assigned to look at the risks of duplicate medical record numbers at your hospital. The risk scale for this project is from 1 to 9; with 1 being the lowest, 9 is the highest. You discover that the risk severity for duplicate medical records is at level 6. What does this tell you about the problem of duplicate record numbers at the hospital? What action plans can you put in place to decrease the level of risk severity?          
HIMA410-Healthcare technologies can provide an opportunity to improve the quality of the data but does not eliminate them. One of the most important steps in data analytics is to verify that data sources are accurate, in order to produce usable information. Data cleansing is used to identify and correct data discrepancies and inaccurate information – often referred to as “dirty data.” Discuss potential causes of dirty data and key strategies that can be used to ensure the consistency of clean data, while using various healthcare technologies.

You are a medical professor in charge of creating college assignments and answers for medical college students. You design and conduct lectures, evaluate student performance and provide feedback through examinations and assignments. Answer each question separately. Include and Introduction. Provide an answer to this content

HIMA360-A risk analysis is one way to assess or identify the risks associated with a project. It can also provide an understanding of the project’s strengths and weaknesses. Imagine that you were recently assigned to look at the risks of duplicate medical record numbers at your hospital.The risk scale for this project is from 1 to 9; with 1 being the lowest, 9 is the highest. You discover that the risk severity for duplicate medical records is at level 6. What does this tell you about the problem of duplicate record numbers at the hospital? What action plans can you put in place to decrease the level of risk severity?          
HIMA410-Healthcare technologies can provide an opportunity to improve the quality of the data but does not eliminate them. One of the most important steps in data analytics is to verify that data sources are accurate, in order to produce usable information. Data cleansing is used to identify and correct data discrepancies and inaccurate information – often referred to as “dirty data.” Discuss potential causes of dirty data and key strategies that can be used to ensure the consistency of clean data, while using various healthcare technologies.

. Do not write who you are in the answer.

Provide a brief introduction of your critical analysisAnalysis of the Social Problem. Discuss the socioeconomic, demographic, and political background or context of the social problem. Discuss the values and theories that influenced public discussions of the problem.Explain why this social problem is important to you and how it relates to theSocial Work values stated in the NASW Code of Ethics.

Students must select a social problem and an existing federal social welfare policy developed as a response to the social problem. Your choice of the existing social welfare policy must be approved by the instructor by no later than the second week of class.
Review workshop number 4: Housing ” Section 8 Housing Choice Vouchers”
After selecting the social problem and the existing federal social welfare policy, write a critical analysis of no less than six (6) pages, not counting references and cover pages. This assignment is due during the last week of class and is worth 30% of the final grade. Students must write using the latest APA format, including in-text citations and references and at least five (5) academic references. Students must use the following outline to guide the development of your written response.
Outline:• IntroductionProvide a brief introduction of your critical analysisAnalysis of the Social ProblemDiscuss the socioeconomic, demographic, and political background or context of the social problemDiscuss the values and theories that influenced public discussions of the problem.Explain why this social problem is important to you and how it relates to theSocial Work values stated in the NASW Code of Ethics.
The description of the selected federal social welfare policy o Briefly summarize the policy and briefly describe the process by which the policywas approved. Identify and explain the historical, economic, social, and political context of the country, when the policy was introduced and approved.Describe the population and situation that the policy addresses.What is the impact of this policy on different population groups? (Equity)What are the social implications of the policy for the vulnerable populations? ExplainWhat consequences does the policy have on the focused problem? (Effectiveness)What are the unintended effects of this policy? (Unintended effect)Assess how the selected social welfare or economic policy impacts the delivery of and access to social services.• Analysis of the policy statementSelect a theoretical framework to analyze how the goals, objectives, values and cost elements of the policy are in line with your analysis of the social problem.What is the financial cost of this policy? Is this policy technically feasible? Do the significant policy sponsors view the policy as acceptable?
What are the benefits?Research two (2) publications of the policy that you chose, and summarize the research questions, methods, and implications of the analyses.? Do the analyses suggest practices that engage in the advancement of social, economic, and environmental justice? Why or why not? Explainyour answer.
• Conclusion
Critically analyze the strengths and/or weaknesses of the policy.? Explain how the policy responds to or resolves the social problem, taking into consideration the social work values as stated in the NASW Code ofEthics.Critically analyze whether the policy represents an advance or a setback for social justice and human rights.Critically analyze the implication of the policy for the Social Work profession to promote social, economic, and environmental justice.Do you have any recommendations regarding this policy?Do you consider that this policy needs to be amended, replaced, or removed?Why or why not? Explain your answer
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When pipetting how should you treat volatile organic compounds differently than water-based solutions?

Name: (0.25 points) Be sure to include your full name (First and Last).
Date: (0.25 points) You can use a MM/DD/YYYY or DD/MM/YYYY format, or type out the date
Experiment #: (0.25 points) Be sure the experiment number matches the Lab Module.
Title: (0.25 points) The title of the experiment should also match the title given in the Lab Module.
Purpose: (1 point) This section should be written in complete sentences using third person, and present or past tense. The purpose should include the goal of the experiment. If there is more than one part to the experiment you may summarize all goals in this section. This short description should make it clear what skills or knowledge should be gained from the completion of the experiment.
Procedure: (2 points) The procedure should be a step by step set of instructions that is detailed enough that someone could use it to replicate the experiment. This is very similar to a recipe in cooking. You can write this section using paragraphs, numbered lists, or bullet points, however it should be written in complete sentences (third-person, present or past tense), and well-organized. If there is more than one part to the experiment, you can have multiple subsections in the procedure.
Be sure to include a procedure for:
Part 1:

The different types of pipettes
How to use a pipette
The precision experiment
The accuracy experiment

Part 2:

SDS-Page Electrophoresis
Agarose Gel Electrophoresis

Data/Results/Calculations: (2 points) In this section you should organize all the observations and data that was collected as part of the experiment, being sure to clearly label each measurement and/or part of the experiment. You may wish to construct a data table for a neat and professional looking report. Please note that screen shots from the lab video of data are not permitted.
Be sure to include data/results/calculations for:
Part 1:

Pipette Precision (Variable Volume vs. Graduated Glass Pipette)

Mass Data
Calculated Volume
Mean
Standard Deviation

Pipette Accuracy (Variable Volume vs. Graduated Glass Pipette)

Set Volume
Measured Volume
Difference

Part 2:

SDS-Page

Data Table
Equation from Plot of Log MW vs. Rf
Calculation of MW of P2
Calculation of MW of P2

Agarose Gel

Which dog is the unknown?

Discussion Questions: (2 points)
How is a glass pipette similar and different from an automatic pipettor?
What is the difference between accuracy and precision?
When pipetting how should you treat volatile organic compounds differently than water-based solutions?
Is electrophoresis an analytical or preparative technique? Explain giving one piece of evidence in your rationale.
Conclusion: (2 points) The conclusion section should be a well developed paragraph (at least 6 sentences), separate from the Data/Results/Calculations section. It should be written in complete sentences (third-person, present or past tense) and should summarize the results of the entire experiment(s). You should emphasize what important concepts were explored, what the results showed, what conclusions can be drawn, and how the purpose of the experiment was accomplished.
Be sure to include:
Which pipette was the more precise?
Which pipette was the more accurate?
Notes: The notes section is where you should put information that does not belong in other sections. This would include background information, or anything else that you deem important that was not directly related to performing the experiment

Read the article and select one of the “functions” to research.  Locate a minimum of two (2) current nursing research articles related to the selected “function” to compare and contrast to this classic nursing research article. 

Research Assignment: Changes in Professional Practice
This activity is designed to help the student compare nursing research to current nursing practice.  In the classic research article, The Hazards of Immobility (1967), Download The Hazards of Immobility (1967),the effects of immobility on the functions of various body systems are discussed, as well as the nursing interventions utilized to prevent these effects.
The student will Read the article and select one of the “functions” to research.  Locate a minimum of two (2) current nursing research articles related to the selected “function” to compare and contrast to this classic nursing research article. 

You are a medical professor in charge of creating college assignments and answers for medical college students. You design and conduct lectures, evaluate student performance and provide feedback through examinations and assignments. Answer each question separately. Include and Introduction. Provide an answer to this content

Develop a PICO(T) question to address the clinical issue of interest you identified in Module 2 for the Assignment. This PICOT question will remain the same for the entire course.

To Prepare:

Review the Resources and identify a clinical issue of interest that can form the basis of a clinical inquiry.
Develop a PICO(T) question to address the clinical issue of interest you identified in Module 2 for the Assignment. This PICOT question will remain the same for the entire course.
Use the key words from the PICO(T) question you developed and search at least four different databases in the Walden Library. Identify at least four relevant systematic reviews or other filtered high-level evidence, which includes meta-analyses, critically-appraised topics (evidence syntheses), critically-appraised individual articles (article synopses). The evidence will not necessarily address all the elements of your PICO(T) question, so select the most important concepts to search and find the best evidence available.
Reflect on the process of creating a PICO(T) question and searching for peer-reviewed research.

The Assignment (Evidence-Based Project)
Part 2: Advanced Levels of Clinical Inquiry and Systematic Reviews
Create a 6- to 7-slide PowerPoint presentation in which you do the following:

Identify and briefly describe your chosen clinical issue of interest.
Describe how you developed a PICO(T) question focused on your chosen clinical issue of interest.
Identify the four research databases that you used to conduct your search for the peer-reviewed articles you selected.
Provide APA citations of the four relevant peer-reviewed articles at the systematic-reviews level related to your research question. If there are no systematic review level articles or meta-analysis on your topic, then use the highest level of evidence peer reviewed article.
Describe the levels of evidence in each of the four peer-reviewed articles you selected, including an explanation of the strengths of using systematic reviews for clinical research. Be specific and provide examples.

Explain a way to qualitatively assess program performance. Why is this an effective way to assess it?

 
Week 9 Assignment: Costs and Benefits of Performance Improvement
Preparation
Complete the following:

Research the costs and benefits associated with the changes required to bring the government programs in your chosen country (from the Unit 3 assignment) up to the standards exemplified by the best practices of the model country you identified in the Unit 5 assessment.
Research and consider ways to measure the benefits of program performance.

Deliverable
Complete the following:

Describe briefly the scope of changes needed to raise your chosen country’s care standards to the levels reached by your model country. Limit your focus to a single program, department, or initiative relative to the issue and area you chose to focus on in your Unit 3 assignment. Document any assumptions you make.
Discuss a significant benefit of the program from the perspective of either the government or the health care consumer.
Identify and discuss the major costs (that is, personnel, education, equipment, et cetera) associated with implementing the described changes.
Identify a source (private, NGO, or government) that could be a likely or reasonable source to help fund this quality improvement project. Explain your reasoning.
Consider performance measures to assess program performance. Complete both of the following:

Qualitative: Explain a way to qualitatively assess program performance. Why is this an effective way to assess it?
Quantitative: Discuss a model that you would choose to quantitatively assess the program performance. Why is this an effective way to assess it?

Additional Requirements
Your paper should meet the following requirements:

Create a presentation that reflects on your proposed problem of interest and evaluates sampling techniques that would create a meaningful study pertaining to this problem.What are the advantages and disadvantages of the sampling method(s) you plan to use?

 
In this assignment, you will create a presentation that reflects on your proposed problem of interest and evaluates sampling techniques that would create a meaningful study pertaining to this problem.
Step 1: Reflect on your proposed research question or problem of interest.
Step 2: Consider different sampling techniques.
Think about how you would compare and contrast the following sampling techniques:

Simple Random Sample
Stratified Random Sample
Cluster Random Sample
Systematic Random Sample

Consider which of these sampling techniques you might employ for your research study. What are the advantages and disadvantages of each?
Step 3: Consider who your audience might be if you were to deliver your presentation in person.

What would you want them to know about this topic?
What would you expect them to already know?

Step 4: Create a 10- to 12-slide presentation that that evaluates and briefly summarizes the various sampling techniques listed in Step 2. Describe the sampling technique(s) you will use in your research and explain how your choice of sampling technique(s) will help you to create a meaningful study cohort.
Address the following questions in your presentation:

Who/what will your proposed sample consist of?
How will subjects be recruited?
Are there any special considerations about your population of interest that might pose barriers to obtaining a sample?
What are the advantages and disadvantages of the sampling method(s) you plan to use?
What potentials for error and bias related to sampling exist?

Step 5: Review your presentation to ensure that you are using best practices for formatting slides.

Include a title screen and summary screen.
Avoid making slides too text heavy or dense with text. As a guideline, limit text on each slide to five bullet points of six words each.
If using graphics, be sure that they are professional, reinforce your points, and are not used merely for decoration.
Be sure to add what you would say if delivering the presentation to a live audience in the notes section of each slide.

Make sure that the format of your presentation is professional and visually attractive. Cite any sources in APA format.

You will interview the parent of a student currently or previously enrolled in special education, a student currently or previously enrolled in special education, a special education teacher, or a paraprofessional. After you complete the interview, you will write a summary of the interview.

For this assignment, you are to read a journal article about a topicThe report is to be 5-7 pages in length. Please be sure to use both a title page and works cited page. (title and works cited pages do not count toward the overall page count of your review) You are also encouraged to follow the MLA or Chicago formats to develop this report. Please double-space your review. And in your works cited page, please list the name of the article that you will be summarizing and analyzing. This an example of the type of the format you should follow:“Argentina in 1983: Reflections on the Language of the Military and George Orwell,” by Alberto Ciria. Canadian Journal of Latin American and Caribbean Studies, Vol. 11, No. 21 (1986), pp. 57-69.In terms of the content of the report, I am looking for two main points of discussion. First, you should devote the first half of the report to a summary of the main points that the author is trying to convey to the reader. To help you to address this issue, consider some of these questions: What type of article is this? Is the author presenting an original feature, or is he/she conducting a book review? If this is a book review, what book (or books) is being reviewed? What is the author’s purpose for writing this article? What is the author’s academic or professional background?As for the second point of discussion, this is where you provide your opinion or perceptions of the article. In other words, what did you think about it? What were the strengths or weaknesses of the article? How did the article relate to the class? You are definitely encouraged to write in first person singular (I feel that…, I think..) as you provide your opinions. As a general rule of thumb, your review should be about 60% summary and 40% commentary. Thus a 5-page review with about 3 & 1?2 pages summary and 1 & 1?2 pages commentary is an ideal proportion.