• Home

Anatomy homework help

CriteriaRatingsPts

This criterion is linked to a Learning OutcomeSubjective Data (CC, HPI, PMH, Allergy identification, Medication Reconciliation, Social History, Family History, Health Promotion, and ROS)

PT105-CO2

5 pts

Level 5

All elements of subjective data are adeptly documented and demonstrate consistent information across all aspects represented.

4.5 pts

Level 4

All elements of subjective data are appropriately documented and demonstrate consistent information across all aspects represented.

4 pts

Level 3

All elements of subjective data are satisfactorily documented but do not demonstrate consistent information across all aspects represented.

3.5 pts

Level 2

All elements of subjective data are either not satisfactorily documented or do not demonstrate consistent information across all aspects represented.

3 pts

Level 1

All elements of subjective data are not satisfactorily documented and do not demonstrate consistent information across all aspects represented.

0 pts

Level 0

No elements of subjective data are evidenced in the assignment.

5 pts

This criterion is linked to a Learning OutcomeObjective Data (Relative to the information documented in the CC, HPI, PMH, and ROS)

PT105-CO2

5 pts

Level 5

All elements of objective data are adeptly documented and demonstrate consistency.

4.5 pts

Level 4

All elements of objective data are appropriately documented and demonstrate consistency.

4 pts

Level 3

All elements of objective data are satisfactorily documented but do not demonstrate consistency.

3.5 pts

Level 2

All elements of objective data are either not satisfactorily documented or do not demonstrate consistency.

3 pts

Level 1

All elements of objective data are not satisfactorily documented and do not demonstrate consistency.

0 pts

Level 0

No elements of objective data are evidenced in the assignment.

5 pts

This criterion is linked to a Learning OutcomeAssessment (Information documented in the CC, HPI, PMH, ROS and the objective data.)

PT105-CO2

5 pts

Level 5

Assessment designations and other elements in this section are adeptly documented and demonstrate congruence.

4.5 pts

Level 4

Assessment designations and other elements in this section are appropriately documented and demonstrate congruence.

4 pts

Level 3

Assessment designations and other elements in this section are satisfactorily documented but do not demonstrate congruence.

3.5 pts

Level 2

Assessment designations and other elements in this section are either not satisfactorily documented or do not demonstrate congruence.

3 pts

Level 1

Assessment designations and other elements in this section are not satisfactorily documented and do not demonstrate congruence.

0 pts

Level 0

Assessment designations and other elements in this section are not evidenced in the assignment.

5 pts

This criterion is linked to a Learning OutcomePlan (Demonstrate application of current clinical practices for the identified assessment designations, and demonstrates congruence of information across all aspects represented.)

PT105-CO2

5 pts

Level 5

Elements of the plan are adeptly documented.

4.5 pts

Level 4

Elements of the plan are appropriately documented.

4 pts

Level 3

Elements of the plan are satisfactorily documented but either does not demonstrate assessment of current practices or are incongruent across aspects.

3.5 pts

Level 2

Elements of the plan are either not satisfactorily documented, or does not demonstrate assessment of current practices or are incongruent across aspects.

3 pts

Level 1

Elements of the plan are either not satisfactorily documented, does not demonstrate assessment of current practices and are incongruent across aspects.

0 pts

Level 0

Elements of a plan are not evidenced in the assignment.

5 pts

This criterion is linked to a Learning OutcomeWriting

5 pts

Level 5

The paper exhibits a superior command of written English language conventions. The paper has no errors in mechanics, grammar, or spelling.

4.5 pts

Level 4

The paper exhibits a strong command of written English language conventions. The paper has no errors in mechanics, grammar, or spelling that impair the flow of communication.

4 pts

Level 3

The paper exhibits a satisfactory command of written English language conventions. The paper has minor errors in mechanics, grammar, or spelling that impact the flow of communication.

3.5 pts

Level 2

The paper exhibits a limited command of written English language conventions. The paper has frequent errors in mechanics, grammar, or spelling that impede the flow of communication.

3 pts

Level 1

The paper exhibits little command of written English language conventions. The paper has errors in mechanics, grammar, or spelling that cause the reader to stop and reread parts of the writing to discern meaning.

0 pts

Level 0

The paper does not demonstrate a command of written English language conventions. The paper has multiple errors in mechanics, grammar, or spelling that cause the reader difficulty discerning the meaning.

5 pts

Total Points: 25

Anatomy homework help

You may use the Introduction previously, but do not copy and paste other portions of your work.

1. Discuss the health issue in the chosen country/community.

2. Is the same health issue present in the United States?

3. Identify an intervention (or interventions) that would address the identified health issue. There is no specified number of interventions required, but if education is chosen as an intervention it cannot be the only intervention. Would the proposed interventions differ between the chosen country and the U.S.?

Refer to the Rubric for how the paper will be evaluated

Suggested headings:

Title (centered)

Health Issue (centered)

Introduction paragraph goes under this heading

Impact and Importance (left justified)

Consequences of not Addressing (left justified)

SDOH (left justified)

Comparison to US (centered)

Impact (left justified)

Similarities and Differences (left justified)

SDOH (left justified)

Interventions (centered)

Similarities and Differences (centered)

Conclusion

Be sure to include a paragraph under the centered headings, as well as the left justified headings

Anatomy homework help

video presentation, you are playing the role of a nurse recruiter who has been asked to present at a jobs fair for community health nursing.  You will have 5 minutes to speak. 

Compare and contrast the role of the nurse in the schools, home health, and occupational health.

· Summarize nursing challenges associated with each of the roles.

· Explore professional standards used by nurses in each of these roles.

· Relate any prior professional experiences you had with nurses in these roles and your perspective related to the impact on the health of aggregates.

· Share your professional experiences with any of the various community nursing roles. What impact did this specialty have on community health?

Completion of this assignment addresses the following objectives:

Module Objectives:

1. Differentiate between the roles and functions of the school nurse, parish nurse, home health and occupational health nursing.

2. Compare and contrast practice models for nursing in the community.

3. Explain professional standards and educational requirements for nursing roles in the schools, home health, and occupational health.

 

Course Objectives:

1. Analyze the specialization of community health nursing based on knowledge synthesized from the humanities, sciences, nursing theory and research.

5. Explore the role of the nurse in the care of individuals, families, and aggregates in the community.

8. Collaborate with members of the health care team to coordinate nursing care in the community.

 

Anatomy homework help

Mod 4 WA Rubric

Scoring Rubric: Nursing Process Case Study

Criteria

Points

received

Types and reporting of subjective/objective data

2.5

Priority nursing diagnosis

2

Two goals for nursing diagnosis

2

Four nursing interventions for nursing diagnosis (0.5 point per intervention). You need a reference for your nursing interventions.

2

Summary of how effective nursing intervention

.5

Correct grammar, sentence structure and punctuation.

1

Total

10

Anatomy homework help

“A Spill at Parsenn Bowl” by Elaine S. Chapman Page 

by
Elaine S. Chapman
Department of Biology
Illinois College, Jacksonville, IL

Part I – The Slopes
Elaine was enjoying a pleasant day on the ski slopes at Winter Park. When she got on the lift to the top
of Parsenn Bowl (, ft), the weather was fi ne—windy, but sunny. During the - or -minute ride,
the weather changed suddenly; it became a white-out, with icy surface snow, blowing snow, a very strong
wind, and extremely low visibility. Many people fell as they got off the lift, including Elaine. However, she
got up and joined her family members as they stood, wondering just how they were going to get down
the mountain. Meanwhile, the lift closed due to the terrible conditions (-mile-an-hour wind and a
temperature of −° F). As she adjusted her stance, Elaine somehow twisted and fell again, which resulted
in external rotation of her right knee. Th ere was no pain at the time and she thought she could get up and
prepare to get down the mountain, but her knee was too unstable. While she sat on the icy surface, her
husband notifi ed the lift operator to call the Ski Patrol. In about  minutes they arrived and put her on a
sled, which they skied down the slope; when they reached the Ski Patrol headquarters, they transferred the
sled to a snowmobile and promptly got her down the mountain and into the emergency room.

Questions

. What mechanisms did Elaine’s body employ to maintain homeostasis?
a. Where are the sensors for cold?
b. Where is the “thermostat” of the body located?
c. What is the eff ector (i.e., what tissues are involved) for the blood vessel constriction? For the

shivering?
. What areas of the body would be the most vulnerable to frostbite?

A Spill at Parsenn Bowl:
Knee Injury and Recovery

“A Spill at Parsenn Bowl” by Elaine S. Chapman Page 

Part II –The Emergency Room
Paramedic and Ski Patrol member Mondo brought Elaine into the emergency room and began to examine
her. He quickly removed her ski boots, checked the dorsalis pedis pulse, and told her to take off her parka; an
assistant brought blankets and hot chocolate. At that time Elaine was not experiencing intense pain, but she
was shivering uncontrollably. Th e pain was relatively localized to the medial surface of her right knee, and the
knee was already considerably swollen. He indicated that there was probably damage to a ligament or two.
Elaine was then moved to the Mile-High Clinic for further evaluation.

Questions

. Why was Elaine instructed to remove her parka?

. Why was she shivering?

. Why was the knee swollen?

. Where would the dorsalis pedis pulse be taken? Why?

. How do the bones that comprise the knee joint fi t together?

. What structures are associated with the medial surface of the knee?

“A Spill at Parsenn Bowl” by Elaine S. Chapman Page 

Part III –The Mile-High Clinic
In the clinic, Elaine was examined by a nurse practitioner and sent for an X-ray, which showed swelling but
no fracture. Th e nurse practitioner performed a Lachman test on Elaine’s knee; the results were so positive
that they could be seen across the room. In fact, an orthopedic surgery resident was brought in so that he
could feel and see fi rsthand the contrast between a positive Lachman test (on her right knee) and a negative
test (on the left, uninjured knee). A positive Lachman is essentially diagnostic of complete rupture of the
anterior cruciate ligament (ACL). Further examination confi rmed injury to the medial collateral ligament.
Elaine was instructed to see an orthopedist at home and given crutches and a brace as well as some pain
medication because her knee was not stable enough to walk and was beginning to hurt. In addition, she was
told to keep her leg elevated and put ice on her knee—and defi nitely not use the hot tub.

Questions

. What type of injuries would be identifi ed most clearly on an X-Ray? Why?

. What is a positive Lachman maneuver/test?

. What is the purpose of the leg elevation and ice? (Wasn’t she already high enough and cold enough?)

. Why was she instructed not to use the hot tub?

“A Spill at Parsenn Bowl” by Elaine S. Chapman Page 

Part IV –Seeing the Orthopedic Surgeon #1
Th e day after she arrived home, Elaine saw Dr. Scott. He ordered an MRI, which confi rmed the injury. He
suggested that she consider reconstructive surgery on her knee. While some patients elect to avoid surgery,
they are at much higher risk of developing osteoarthritis earlier, and the instability of their knee makes them
more likely to fall again. Th irty years ago most surgeons would not have suggested surgery for this injury,
particularly in someone aged , and the surgical techniques were not as successful as they are now. Because
Elaine was a fairly active individual prior to the accident, Dr. Scott encouraged her to have reconstruction of
the anterior cruciate ligament, and he referred her to another orthopedic surgeon who did that surgery on a
routine basis.

Questions

. Why did Dr. Scott order an MRI?

. What diff erence does age make in terms of the healing process?

. What is osteoarthritis?

“A Spill at Parsenn Bowl” by Elaine S. Chapman Page 

Part V – Seeing the Orthopedic Surgeon #2
After viewing the MRI and talking with Elaine, Dr. Leutz strongly advised her to have reconstructive surgery
on the ACL and to use conservative therapy on the partially torn medial collateral ligament. First, though,
he wanted her to “pre-hab”—that is, take physical therapy for several weeks—in order to have the knee and
leg in the best possible shape before the surgery. She was also instructed to use a more substantial brace. Dr.
Leutz described the procedure: either a cadaver tendon OR the middle third of her patellar tendon would be
removed and used to replace the ACL, which would be removed. Elaine opted to use her own tendon.

Five weeks later, Elaine went in for surgery. She was given a drug used for conscious sedation as well as a
general anesthetic. Th rough the arthroscope the surgeon noted signifi cant injury to both the medial and
lateral menisci, which he repaired with sutures and screws. Th e pieces of the torn ACL were removed. A
superfi cial incision was made in the midline of her right knee and a piece of patellar tendon was removed,
along with the attaching small pieces of bone to use for the grafting procedure. Unfortunately, when the
piece of patellar bone was chiseled out, the patella itself fractured. Th e fracture was repaired with metal
screws, the incision was closed, and Elaine was discharged from the hospital.

Questions

. What are the primary movements of the knee joint?

. What muscle groups are the most important in fl exion and
extension of the knee?

. What happens to muscle and bone tissue when they are not
used?

. Why could a tendon be used to replace a ligament? Hint:
think histology.

. Consider the overall structure of the knee joint. (You may
wish to draw a picture or label a diagram.) What type of
membrane lines the joint? What is its function? Was it cut
in any way during the surgery?

. Of the structures injured (patella, MCL, ACL, menisci),
which will heal the fastest? Why?

. Every incision will form some sort of scar. What is the term
for scarring of a tissue? What cell type is most important for
scar formation?

“A Spill at Parsenn Bowl” by Elaine S. Chapman Page 

Case copyright © by the National Center for Case Study Teaching in Science. Originally published September ,  at
http://www.sciencecases.org/knee_injury/case.asp. Licensed photo in title block of doctor explaining MRI of a knee in top view
©Bernhard Lelle | Dreamstime.com. Licensed illustration of knee in Part V ©axel kock | Fotolia.
Please see our usage guidelines, which outline our policy concerning permissible reproduction of this case study.

Part VI – Resolution
Physical therapy began two days after the surgery. With the aid of crutches, a wheelchair, and a brace,
Elaine was able to return to work in about ten days. She continued the physical therapy at the rehab clinic
and on her own for six months. With the assistance of a titanium brace, she was able to play tennis nine
months after the surgery. One year following the injury she went skiing again … but did not venture up
to Parsenn Bowl.

Anatomy homework help

Axial Muscles Lab Sheet

This sheet is designed to help you learn all about axial muscles. These muscles are numbered and questions concerning these muscles have been asked. When asked a question about a muscle, write the number, and spell out the muscle. If the muscle has already been mentioned, writing just the number will suffice

Answers are to be written in blue

For example: Q: Which muscle is used in chewing?

A: 5. (Orbicularis Oris.)

1

2

4

3

5

8

6

9

10

13

12

11

14

15

16

7

17

18

19

20

22

21

24

23

25

26

28

27

30

29

32

31

33

34

35

36

37

38

39

40

43

41

47

42

46

48

44

45

49

50

51

53

52

55

54

56

57

58

59

57

1. These muscles are bellies of the digastric muscle____________

2. This muscle is called the Orbicularis oculi________

3. This muscle is called the Platysma _______

4. This muscle located close to the neck in humans is very prominent in frogs ____________

5. These muscles are attached to the hyoid bone___________

6. This muscle elevates the mandible and contracts during chewing ___________

7. This muscle is the Depressor Labii Inferioris ______

8. This muscle is the Depressor Anguli Oris _________

9. This muscle is responsible for lifting up the upper lip_________

10. These muscles are the Zygomaticus major and minor muscles respectively ________________

11. This muscle is attached to the sternum, the mastoid process and clavicle___________

12. Doing crunches, leg raises, and planks will strengthen this muscle _____

13. This muscle is the Orbicularis Oris _________

14. This muscle popularly referred to as the “six-pack” muscle stabilizes the pelvis during walking ________

15. These obliques muscles are engaged during lateral flexion_________

16. These muscles contract during breathing_________

17. These muscles contract actively when individual’s sit-up straight in a chair for a long time___________

18. This muscle is well defined in trumpet players__________

19. These facial muscles contract when people smile________

20. These muscles elevate the hyoid bone to facilitate swallowing ________

21. These muscles depress the hyoid bone _________

22. What is the difference between the origin and the insertion of a muscle?

23. These muscles contract when people frown______________

Anatomy homework help

AP4: Identifying design choices in a Broadway production (2022)

While you view the two videos of the musical you chose, identify examples of each design element and give specific description, as well as how the design element adds to the audience’s understanding of the production. For example, if one actor is in a spotlight while the actors are in the dark, you would write that lighting in that scene was used to focus the audience rather than full lighting which would not be as effective.

Which production videos did you choose for this assignment?

Production Videos

The Lion King

War Horse

Wicked

PRODUCTION CHOSEN:

Design Elements


Describe specific examples used in the production and how those choices affect the audience’s connection to the scenes.



Scenic Design


Sound Design


Lighting Design


Prop Design

(Prop Choices)


Costume Design


Makeup & Hair Design


Project Score


Instructor’s Comments

Anatomy homework help

Animal Abuse and Animal Rights

5lides: My Critique of __________________

This exercise is designed to help you shape your argument in your own voice while incorporating statistics and charts to support it.

You will present a five-slide presentation exploring some form of animal abuse or animal cruelty or the need [or not] for an animal rights movement.

Each slide will represent one section of the standard MLA essay.

Let’s take a look at how we will get that done.

Your Title Here on Every Slide

The first slide

Lists the title of the presentation at the top

Begin your text with a hook

Keep the information short, but interesting

End with your thesis statement

As it is a slide presentation, please include some nice graphics; Use bullet points, arrows, or other icons to set off your points

Your Title on Every Slide

The second slide

This will begin the defense of point one, issue one, situation one

Even if you are not using complete sentences, make sure your points make sense, are complete, and are presented consistently

You do not have to have more than a few sources for this exercise. The point is to help you organize your argument in a standard MLA essay.

This slide should end with a transition to the next issue.

Your Title on Every Slide

The third slide

Here, you continue your defense or critique.

Remember to incorporate statistics.

Make good use of graphics to help make your point.

As did the second slide, this slide should end with a transition to the next issue.

Your Title on Every Slide

Don’t give up. This is the end of the argument and it should be strong.

Use statistics, charts or graphs, make use of quote boxes for effect.

Use graphics of your subject for effect – nothing too horrific.

End the presentation on this slide by tying all your points together, so you segue back to your thesis statement in the summary.

Your Title on Every Slide

Slide five is the conclusion of your presentation.

Wrap up your argument by restating your most important points

Be certain to give some space to those who disagree (do that in the introduction as well).

You may close with final numbers, or a prediction of what would happen if everyone heeded your message.

Anatomy homework help

Stage Areas for a Proscenium or Thrust State (using the 9-areas model)

NOTICE THAT THE STAGE AREAS ARE FROM THE ACTOR’S POINT OF VIEW.
OBVIOUSLY, THIS IS BECAUSE THE ACTOR NEEDS TO USE THIS TERMINOLOGY TO
IDENTIFY WHERE HE/SHE IS BEING ASKED TO STAND OR MOVE. BECAUSE THE
ACTOR’S POINT OF VIEW IS MOST IMPORTANT, THE OTHER STAFF MEMBERS
(DIRECTOR, SCENIC DESIGNER, LIGHTING DESIGNER, PROP MASTER,
CHOREOGRAPHER, STAGE CREW) MUST ADJUST TO USING THIS SAME AREA
NOTATION, EVEN THOUGH IT IS A REVERSAL OF WHAT THE STAFF SEES AS THEY SIT
IN THE AUDIENCE (OR IN THE LIGHTING BOOTH) DURING REHEARSALS.

NOTE THAT THERE ARE ALSO MORE DETAILED AREA IDENTIFICATION (e.g. a 15-area
model) AND THAT SOMETIMES THE STAGE RIGHT AND STAGE LEFT DESIGNATIONS
ARE GIVEN OTHER NAMES (RC & LC). ALSO, ARENA STAGES DO NOT USE THESE
TERMS SINCE THERE IS NO DOWNSTAGE OR UPSTAGE WHEN THE AUDIENCE IS
SEATED ON ALL SIDES OF THE STAGE.

Anatomy homework help

Endocrine System Anatomy

This sheet is designed to help you learn about the Anatomy Endocrine System. Several endocrine organs have been labelled A- J. When asked a question about an organ, be sure to name the organ before answering the question.

Answers are to be written in blue

Q: Which one of the labeled organs produces testosterone?

A: A, Kidney

Diagram  Description automatically generated

1) Which one of the labeled organs produces testosterone?

2) Which one of labelled organs produces estrogen?

3) Which one of the labelled organs produces GnRH?

4) Which one of the labelled organs produces prolactin?

5) Which one of the labelled organs produces a hormone which is very important in metabolism regulation?

6) Which one of the labelled organs produces melatonin?

7) Which one the labelled organs produce luteinizing hormone and follicle stimulating hormone?

8) Which one of the labelled organs produces a hormone necessary for the regulation of urine production?

9) Which one of the labelled organs produces a hormone responsible for the implantation of a blastocyte in the uterus?

10) Which one of the labelled organs produces a hormone responsible for the production of red blood cells?

11) Which one of the labelled organs produces a hormone responsible for the production of a hormone called ANP?

12) Releasing factors are hormones usually produced by this labelled organ?

13) Which one of the labelled organs produces a hormone responsible for the production of a hormone necessary for the absorption of glucose?

Anatomy homework help

CLINICAL SOURCEBOOK (PORTFOLIO): Each student will develop a Clinical
Sourcebook of useful neurogenic diagnostic/therapy materials for each disorder, such as readings
for collecting language samples, good quality pictures to use in testing for prosopagnosia,
therapy techniques for cognitive rehabilitation, etc. This sourcebook is a major class requirement,
intended to serve as a professional tool for clinical activities in adult rehabilitation. As you move
through your disability’s courses, you will be adding to your sourcebook (e.g., motor speech,
voice, communication modalities). You are to find and develop your informational content based
on what works for you as a quick reference in preparation for Level 4.

So create a booklet with everything that that is Aphasia, including stroke, TbI, motor speech.
This needs to include conditions, definitions, pictures, treatments..and so on.

Anatomy homework help

Why Does Grandpa Ignore Grandma?
A Case Study in Hearing Loss

by
Benjamin F. Timson and Scott D. Zimmerman

Biomedical Sciences Department
Missouri State University, Springfi eld, MO

Scanning electron micrographs showing a human sensory hair cell (left) and a hair bundle (right).

Part I—Introduction
Carla Marie Jackson, a first semester graduate student in Audiology, was having difficulty staying awake in
her early afternoon class. “I knew I shouldn’t have eaten such a big lunch,” she thought to herself as her head
jerked up for the third time in the past  minutes. She glanced at the clock and groaned when she realized
 minutes still remained in the period—Professor Wilson would take every bit of that, plus more! Her mind
began to drift to the upcoming spring break that would begin next week, when suddenly something Professor
Wilson said took her back to an experience she had while visiting her grandparents the previous Christmas.

Carla was named for her maternal grandparents, Carl and Marie Wojahowski. She loved them both dearly
even though there couldn’t have been two more different people in the world. Grandpa Carl was a calm and
loving man who spent his working career as an auto mechanic in the small northeastern Wisconsin town
of Marinette. Grandma Marie was a -foot--inch ball of fire with a high-pitched shrill voice who always
wanted to accomplish more than was physically possible in a day. Te only time she relaxed was when she
slept. Grandma and Grandpa lived eight miles west of town in a two-story house with a wrap-around porch
on a -acre farm. Carla’s mother, Kathy, the youngest of Carl and Marie’s six children, had married Bob
Jackson, who she met in college, and they had raised their family  hours away in St. Louis. Carla was the
oldest of their fi ve children.

Many of Carla’s favorite childhood memories were of times she spent on the farm in the summers and at
Christmas. She loved sitting on the porch with Grandpa Carl and working with him in his garden and
orchard. He had tremendous patience with her as he showed her how to till the soil and care for the plants.
She also loved working with Grandma Marie in the kitchen, although the pace and intensity was much
greater than working with Grandpa in the yard. Preparing Christmas dinners was hectic as Grandma barked
orders for six hours. Everything had to be perfect and if she did something wrong Grandma was “on her case”
immediately. Carla smiled to herself when Grandma’s shrill voice cut the air, “Didn’t I tell you to cut those
potatoes a quarter inch thick!” Grandma always meant well. She just got too excited, Carla always reminded
herself. Besides, Grandma didn’t yell at her nearly as much as she yelled at Grandpa.

Professor Wilson now had Carla’s attention as he discussed age related problems affecting the auditory
system. Carla thought back to a specific event the previous Christmas as she and her Mom prepared
dinner under the watchful eye of Grandma Marie while Grandpa Carl and her Dad sat in the living room

“Why Does Grandpa Ignore Grandma? A Case Study in Hearing Loss” by Timson & Zimmerman Page 

watching the Green Bay Packers play the Chicago Bears on tv. Carla almost laughed out loud in class as she
remembered the situation.

Grandma Marie: Daddy, would you take the garbage out to the trash can?

Grandpa Carl (not responding to Grandma): Wow, Bob, did you see that play? I don’t think he caught
the ball! I bet this one will be challenged.

Grandma Marie (her voice a bit more shrill): Daddy, I told you to take the garbage out to the trash can!
Now get out of that chair and do it!

Grandpa Carl (still does not respond)

Grandma Marie (turning to Carla): He never listens to me! Every time I tell him to do something he
just ignores me!

Carla: I don’t think he can hear you, Grandma. He’s pretty far away and the tv is going.

Grandma Marie (comes into the living room, behind Grandpa Carl, trying to remain calm): Daddy, I
asked you to take the garbage out to the trash can. Now please get out of that chair and do it.

Grandpa Carl (noticing Grandma, turns around, then turns and looks at Bob with a confused expression on
his face)

Bob (calmly): She would like you to take the garbage to the trash can.

Grandpa Carl: Oh, OK. (he gets up and heads to the kitchen to get the garbage)

Grandma Marie (now furious, screaming at Grandpa): You’ll listen to him, but you won’t listen to me! I
don’t know why I have put up with you for the past  years!

Grandpa Carl (calmly heads to the kitchen to get the garbage, confused by Grandma’s frustration)

Questions

. What is the general purpose of the sensory nervous system and the specific purpose of the auditory
system?

. Trace the path of sound from the outer ear to interpretation by the brain, detailing what happens
at each step in the pathway.

. What are the environmental factors that might have prevented Grandpa Carl from hearing
Grandma Marie?

. Why was Bob able to hear Grandma Marie when Grandpa Carl could not.

“Why Does Grandpa Ignore Grandma? A Case Study in Hearing Loss” by Timson & Zimmerman Page 

Part II—The Check-Up
After thinking about the information provided by Professor Wilson in class Carla decided to go to Wisconsin
during spring break and take Grandpa Carl, who was now , to an audiologist to look into his condition.
She knew she might have some trouble with Grandma Marie because she was not at all convinced that
Grandpa had anything wrong with him. In her mind, Grandpa just did not pay attention to her when
she was talking to him. Carla remembered her mother suggesting to Grandma at Christmas that she take
Grandpa to a doctor to check his hearing. “He doesn’t have any hearing problems. He just won’t listen to me.
Selective hearing loss is what I call it. Besides, doctors never really do anything for you other than tell you
what you already know and take your money; I have no use for them,” Grandma had said.

Carla called her mother and told her what she had discovered in class and that she would like to take
Grandpa Carl to an audiologist to see if there was anything they could do for him. Kathy knew her mother
would have difficulty with her father going to the doctor, but after  years she had learned how to handle
her mother. “You set up an appointment for Grandpa and I’ll deal with your grandmother, but whatever you
do, don’t tell either of them what we are up to,” she told Carla.

Two days later Carla and her mother were making the trip north to the farm and house they both loved.
Tey arrived late on Saturday evening and within an hour Kathy had the fireplace blazing. While Grandpa
stared at the fire, mother, daughter, and granddaughter had a wonderful conversation catching up on all that
had happened since they were together at Christmas.

“Mom, could you take me over to Menominee to see the place where you grew up and to visit Grandma and
Grandpa’s graves?” Kathy asked her mother at breakfast on Wednesday morning. “Carla has some studying
to do and I know Dad likes to take a late morning nap so I thought maybe we could spend the day together
retracing my heritage.”

“I would love to, Kathy, you were always my sentimental child,” her mother responded. “Have a productive
study time,” Kathy said, winking at Carla as she and Grandma headed out the door.

Tirty minutes later Carla found Grandpa sitting on the porch reading the morning paper. “Let’s go for a
ride, Grandpa,” she said, “I have someone I would like you to meet. I think you’ll like her.”

Carla took her grandfather to Dr. Susan Dlugopolski, an audiologist in Marinette who had recently
graduated from the University of Wisconsin—Madison and come back to the town where she had grown up.
Grandpa Carl had worked with Susan’s grandfather at the Chrysler dealership in Marinette for  years and,
while Grandpa and Susan did not know each other well, her outgoing and friendly demeanor immediately
put him at ease.

For the next  minutes Susan carefully explained to Grandpa Carl and Carla that there were a number of
things that could contribute to hearing loss as an individual ages, a condition known as presbycusis. Carla
listened intently to her explanations, asked many questions, and learned as much in half an hour as she had
all semester long in class. Like many people she always learned more when she could put facts into some
context, and this experience with her grandfather provided a wonderful learning opportunity.

Following some testing, Susan informed both Grandpa Carl and Carla that she found signifi cant hearing
loss, but she did not fi nd significant metabolic dysfunction in the cochlea, nor did she fi nd signifi cant
dysfunction of the auditory nerve. To illustrate some of the main points of their discussion, Susan showed
Carla and Grandpa Carl the following chart.

“Why Does Grandpa Ignore Grandma? A Case Study in Hearing Loss” by Timson & Zimmerman Page 

Questions
. Provide a precise definition of presbycusis and identify the classic types of the disorder.
. What do the data suggest might be the likely cause of Grandpa Carl’s hearing problems?
. What are the physiological mechanisms that might lead to this hearing loss?
. What, if any, possible treatments could improve Grandpa Carl’s hearing?

Source Information for Graph: Redrawn with minor updates by David R. Hill, Prof. Emeritus, University of Calgary. Versions
of this diagram appear in several places across the decades. You will find it in the th edition of Best & Taylor’s Physiological Basis
of Medical Practice (Te Williams & Wilkins Co., Baltimore, —J.R. Brobeck editor, page –). Tey attribute it to J.C.R.
Licklider’s chapter in S.S. Steven’s book Handbook of Experimental Psychology (John Wiley: New York , page ). Licklider
attributes it to C.T. Morgan’s Physiological Psychology (McGraw-Hill: New York ) “after Bunch, ” (Bunch, CC, “Age
variations in Auditory Acuity,” Arch. Otolaryng. , Vol , pages –).

Image Credit: Photos courtesy of Carole M. Hackney and David N. Furness, MacKay Institute of Communication and
Neuroscience, School of Life Sciences, Keele University, Staffordshire, ST5 5BG, UK. Used with permission.
Copyright ©  by the National Center for Case Study Teaching in Science.
Originally published // at http://www.sciencecases.org/hearing_loss/hearing_loss.asp
Please see our usage guidelines, which outline our policy concerning permissible reproduction of this work.

“Why Does Grandpa Ignore Grandma? A Case Study in Hearing Loss” by Timson & Zimmerman Page 

Anatomy homework help

Module 04 Homework Assignment

· Use the information presented in the module folder along with your readings from the textbook to answer the following questions.

1. Describe the different morphological types of viruses and give examples of each type:

a. Helical

b. Icosahedral

c. Complex

2. Compare and contrast the multiplication of bacteriophages versus the multiplication of animal viruses:

3. Describe how arthropods can act as mechanical vectors and biological vectors:

4. Describe five (5) characteristics of fungi and how they differ from other microorganisms:

5. Describe common characteristic of protozoans (protists). Name three (3) protozoans that are human parasites:

6. What are helminths? Name and describe three (3) that can cause problems in humans:

Confidential & Proprietary © Rasmussen 2017

Anatomy homework help

Gender Swaying Pre Conception Assignment Gender Swaying Pre Conception Assignment

 

Instructions

Watch the “

how to conceive a boy or a girl video

” before doing this assignment. For this assignment, in your own words explain steps a couple could take to determine the gender of an unconceived child. Be sure to mention what actually works and what is myth. The word count should be around 250 words.

 

Instructions

Watch the “

how to conceive a boy or a girl video

” before doing this assignment. For this assignment, in your own words explain steps a couple could take to determine the gender of an unconceived child. Be sure to mention what actually works and what is myth. The word count should be around 250 words.

Anatomy homework help

Unit 7 Assignment – Resource List: 15 points
Students will be able to perform an internet search to locate scholarly research in the
field of physical therapy. Each student must be able to locate clinical practice
guidelines, meta-analysis studies, and evidence-based practice for specific topics in
physical therapy.

Using available resources, textbooks, and journals that expand understanding of
physical therapy practice and interventions, respond to the items below. 0.5 points will
be deducted per error.

For #1-11, use APA citation formatting (no website links).

Find and cite the following:

1. Cochrane review for aquatic exercise and osteoarthritis

2. Cochrane review for exercise and fibromyalgia

3. APA citation for an orthopedic textbook written only for PTAs published after
2018.

Find and cite (no links) a research article related to physical therapy on the following
topics:

4. Laser/Light Therapy

5. Cryotherapy

6. Biofeedback

7. Diathermy

8. Hydrotherapy

9. Ethics

10. That concerns PTA education:

11. That uses a standardized assessment tool on an orthopedic, neurologic, or
pediatric population:

Respond:

12. Besides the APTA’s PT Journal, list 2 other prominent journals that include
research by and for PTs and PTAs?

13. List 2 prominent websites (that you have not accessed already in this class) that
are accessed by PTs and PTAs and serve as resources to improve their clinical
knowledge and level of patient care.

  • Unit 7 Assignment – Resource List: 15 points

Anatomy homework help

Robin Sandos 

#26:  Define nutrient vs Macronutrient and list the six major categories of nutrients



COLLAPSE

Top of Form

Dr. Masucci & fellow students,


#26:  Define nutrient vs Macronutrient and list the six major categories of nutrients

RESEARCH

Nutrient “is any ingested chemical that is absorbed into the tissues and used for growth, repair, or maintenance of the body” (Saladin et al, 2021, p. 977).  There are six major categories of nutrients: water, carbohydrates, lipids, proteins, minerals, and vitamins.  Macronutrients are ingested in fairly large amounts.  Examples of macronutrients are water, carbohydrates, lipids, and proteins (Saladin et al, 2021, p. 977).  Water is the major component of our body fluids.  Carbohydrates are the primary source of energy for the body.  Carbs provide immediate fuel and form most stored energy reserves in our body.  Fats help the body make hormones and act as solvents for hormones and essential fat-soluble vitamins.  Fats have the highest caloric content of any macronutrient and deliver the most substantial amount of energy.  Proteins help to give your body the essential amino acids which is crucial for cellular structure.  In the event of intense nutrient depletion, the muscles in the body can be used to provide energy known as muscle atrophy or muscle wasting (RMHP, 2022).

Micronutrients examples are minerals and vitamins that only need small amounts to be ingested (Saladin et al, 2021, p. 977).  There are several nutrients that can be synthesized by the body when they are unobtainable from one’s diet.  However, the body cannot synthesize essential nutrients.  Examples of essential nutrients are minerals, vitamins, nine of the amino acids, and one to three of fatty acids and it is vital that these are contained within in one’s diet (Saladin et al, 2021, p. 977).

Macronutrient (other than water) offer energy that enables the body to grow new cells and tissues, conduct nerve impulses that allow us to sense and interact with our environment, develop and repair new tissues, and regulate vital bodily processes, like fueling muscles, regulating the central nervous system, creating enzymes, eliminating waste, and much more” (RMHP, 2022).

CRITICAL THINKING

It is important for athletes to know and understand his/her nutritional needs for their said sport and/or competition.  An appropriate diet offers the athlete with enough energy and nutrients to meet the demands of training and exercise.  Athletes usually need more calories and macronutrients to sustain strength and energy to compete at their absolute best for their said sport.  Furthermore, athletes may need more vitamins, minerals, and other nutrients for peak recovery and performance as well as consider their meal timing and make sure they consume sufficient hydration.

(wc 420)

References:

RMHP. (2022). What are micronutrients and macronutrients – RMHP. WHAT ARE MICRONUTRIENTS AND MACRONUTRIENTS. Retrieved February 25, 2022, from https://www.rmhp.org/blog/2020/august/what-are-micronutrients-and-macronutrients

Saladin, K. S., Gan, C. A., & Cushman, H. N. (2021). Anatomy & Physiology: The unity of form and function. McGraw-Hill Education.

Anatomy homework help

7. (Rebecca)

Importance of Physical activity in venous return



COLLAPSE

Top of Form

Research:

As the heart beats faster and harder during exercise, cardiac output is increased as well as blood pressure.   Venous return is increased by muscle contractions via the skeletal muscle pump.  The increase in venous return increases cardiac output.   When a person is inactive, venous pooling occurs.   This means that blood accumulates in the limbs, due to venoous pressure being too low to push the weight of the blood upward.  This can occur in people who stand for long periods at a time such as cashiers, barbers, etc.   This can also occur when sitting too long during a long flight.   Sometimes cardiac output will even drop so low that it causes the person to get dizzy or pass out.    Military jet pilots actuallly wear pressurized G suits to prevent this from happening.  

Critical Thinking:

When I used to stand too long at work, while wearing a lead vest and opearting a fluoroscope, I had developed spider veins.   I was only in my 20’s!  I had to have them treated with sclerotherapy.   This is a procedure in which the doctor injects the vein with saline.    You then must wear compression hose for a while to aid in healing.   It was successful, and luckily my job after that allowed me to have the perfect balance of sitting and standing, which I read helps to prevent this.   However my most recent job requires me to do a lot of walking and standing, but I wear my compression socks to  help prevent the development of new spider veins.  I also participate in aerobic exercise a few times a week.  So my mom once developed blood clots just from a 3 hour car ride!    She was of course at a higher risk, being that she has factor V leiden clotting disorder.  But, as you see,  venous pooling can be life threatening in some cases, if you don’t seek treatment.    That being said, we can see how very important exercise is in maintaining that circulation.  So if you have a job that requires you to sit or stand for long periods at a time, you should definately invest in some compression hose, as well as take regular breaks whenever possible to either get up and walk around, or take a breather and get off of those feet! 

Word Count:

403

Reference:

Saladin,K.(2020):  Anatomy and Physiology.  The unit of form and function(9th ed.).McGraw Hill Education.

Bottom of Form

Anatomy homework help

Sheralee redona

#37 Hypothalamus and body temperature: factors that cause variations in body temperature



COLLAPSE

Top of Form


Research:

   As we’ve learned, the hypothalamus controls different portions of our body and one of them is that it regulates our body temperature. Our body temperature depends on when, where, and in whom it is measured, and it fluctuates about 1.8 degrees Fahrenheit in a 24 hour cycle. (Saldin 2021 pg.999) For instance, in the early mornings, our body temperature tends to be at it lowest, while in the late afternoon, our temperature is a little higher.

   The most essential body temperature are core and the shell temperature. The core temerature are the organs in the cranial, thoracic, and abdominal cavities. The best estimate of core temperature is obtainable with ease is the rectal; this is usually between 99-99.7 degrees Fahrenheit, but it can reach as high as 101 degrees Fahrenheit in active children and some adults. (Saldin 2021 pg. 999) The shell temperature is closer to the surface, mainly on the skin and oral temperature. Shell temperature also fluctuates as a result of processes that serve to maintain a stable core temperature. For example, heat that is loss from the body, the temperature would be slightly lower than a rectal. Adult oral temperatue ranges between 97.9-98.6 degrees Fahrenheit, but the highest could go to 104 degrees Fahrenheit during hard exercise.

   Bood circulation is also crucial to thermoregulation in that we depend on blood flow to carry metabolic heat from the body core to the shell; this leads to where it can be dissipated into the environment. If this process did not happen, we would die of hyperthermia as metabolic heat raises the core temperature beyond survivable range. (Saldin 2021 pg. 999)


Critical thinking:

   Since most of my family members are in the medical field, they have taught me that in situations when a person is running a high temperature or a fevor, this would indicate that our body is fighting an infection that weakens the virus, and at the same time stimulates the immune response. When the immune system detects a presence of a virus in our body, it signals the hypothalamus to turn up the heat, and as a result this leads to a person experiencing a fever. It is crucial in those moments to montior our body temperature that way it does not spread to others or the infection worsens.

W.C 384


Reference:

Saldin, Kenneth. Anatomy and Physiology:The Unit of Form and Function. 9th Edition. McGraw Hill.

Bottom of Form

Anatomy homework help

Module 10 Lab Assignment – Documentation of an Examination of the Peripheral Vascular System

Module 10 Lab Assignment – Documentation of an Examination of the Peripheral Vascular System

Top of Form

Bottom of Form

Module 10 Content

1.

Top of Form

You will perform a history of a peripheral vascular problem that your instructor has provided you or one that you have experienced and perform a peripheral vascular assessment. You will document your subjective and objective findings, identify actual or potential risks, and submit this in a Word document to the drop box provided.

Peripheral Vascular System Assignment

Submit your completed assignment by following the directions linked below. Please check the Course Calendar for specific due dates.

Save your assignment as a Microsoft Word document. (Mac users, please remember to append the “.docx” extension to the filename.) The name of the file should be your first initial and last name, followed by an underscore and the name of the assignment, and an underscore and the date. An example is shown below:

Title:

Documentation of problem based assessment of the peripheral vascular system.

Purpose of Assignment:

Learning the required components of documenting a problem based subjective and objective assessment of peripheral vascular system. Identify abnormal findings.

Course Competency:

Select appropriate physical examination skills for the cardiovascular and peripheral vascular systems.

Instructions:

Content: Use of three sections:

0. Subjective

0. Objective

0. Actual or potential risk factors for the client based on the assessment findings with no description or reason for selection of them.

Format:

1. Standard American English (correct grammar, punctuation, etc.)

Resources:

Chapter 5: SOAP Notes: The subjective and objective portion only

Sullivan, D. D. (2012). Guide to clinical documentation. [E-Book]. Retrieved from http://ezproxy.rasmussen.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=nlebk&AN=495456&site=eds-live&ebv=EB&ppid=pp_91 >

Smith, L. S. (2001, September). Documentation do’s and don’ts. Nursing, 31(9), 30. Retrieved from http://ezproxy.rasmussen.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=107055742&site=eds-live >

Documentation Grading Rubric- 10 possible points

Levels of Achievement

Criteria

Emerging

Competence

Proficiency

Mastery

Subjective

(4 Pts)

Missing components such as biographic data, medications, or allergies. Symptoms analysis is incomplete. May contain objective data.

Basic biographic data provided. Medications and allergies included. Symptoms analysis incomplete. Lacking detail. No objective data.

Basic biographic data provided. Included list of medications and allergies. Symptoms analysis: PQRSTU completed. Lacking detail. No objective data. Information is solely what “client” provided.

Basic biographic data provided. Included list of medications and allergies. Symptoms analysis: PQRSTU completed. Detailed. No objective data. Information is solely what “client” provided.

Points: 1

Points: 2

Points: 3

Points: 4

Objective

(4 Pts)

Missing components of assessment for particular system. May contain subjective data. May have signs of bias or explanation of findings. May have included words such as “normal”, “appropriate”,
“okay”, and “good”.

Includes all components of assessment for particular system. Lacks detail. Uses words such as “normal”, “appropriate”, or “good”. Contains all objective information. May have signs of bias or explanation of findings.

Includes all components of assessment for particular system. Avoided use of words such as “normal”, “appropriate”, or “good”. No bias or explanation for findings evident Contains all objective information

Includes all components of assessment for particular system. Detailed information provided. Avoided use of words such as “normal”, “appropriate”, or “good”. No bias or explanation for findings evident. All objective information

Points: 1

Points: 2

Points: 3

Points: 4

Actual or Potential Risk Factors

(2 pts)

Lists one to two actual or potential risk factors for the client based on the assessment findings with no description or reason for selection of them. Failure to provide any potential or actual risk factors will result in zero points for this criterion.

Brief description of one or two actual or potential risk factors for the client based on the assessment findings with description or reason for selection of them.

Limited description of two actual or potential risk factors for the client based on the assessment findings with description or reason for selection of them.

Comprehensive, detailed description of two actual or potential risk factors for the client based on the assessment findings with description or reason for selection of them.

Points: 0.5

Points: 1

Points: 1.5

Points: 2

Bottom of Form

Anatomy homework help

The efficacy of using YouTube on student’s knowledge acquisition and retention and critical thinking in human anatomy course

Background

Internet and user-generated content have made a huge impact on anatomy instruction in recent years. Social media sites like Facebook, YouTube, Twitter, Flickr, and Instagram are just a few examples (Moran, 2011). Faculty-run Facebook Pages at the University of Sharjah, for example, were found to be beneficial in boosting anatomy knowledge beyond the scope of traditional lecture formats (Jaffar, 2014). Another study at the University of Southampton found that medical students benefited from utilizing Twitter to aid their learning in a neuro anatomy curriculum (Hennessy, 2016). More than 78% of second-year medical and radiation therapy students said that YouTube was their primary source for anatomy-related video clips, according to a study conducted at Dublin College (Barry, 2016). First-year medical students in Venezuela were found to use YouTube videos to learn about the human anatomy, according to a separate research ((Reverón, 2016).

The effectiveness of utilizing cadaver dissection in enhancing anatomical knowledge of students and hands on experience for future doctors.

When it comes to practicing surgery, anatomical knowledge is necessary for students’ clinical skills acquisition and is particularly important (Abdullatif, 2020). A three-dimensional view of the human body is gained by dissection, which enhances students’ regional and systemic anatomy knowledge, as well as reinforcing what they acquired in lectures and tutorials (Ghosh, 2017). Dissection practice improves medical students’ cognitive abilities and attention spans, as well as their physical endurance, which is a prerequisite for medical students to practice dissection (Romo-Barrientos, 2019).

The effects of using protection on student’s perception in medical and allied health schools.

Prosections have been used instead of full-body dissection in some schools because of the unavailability of donated bodies and the reduced amount of time allocated for dissection practice in today’s integrated curricula (Habbal, 2009). This allows students to spend more time studying structures instead of spending hours looking for and investigating them in dissection classes. In medical education, advances in preservation techniques, plastinated specimen production, and rapidly rising technology have all led to an increase in the use of prosected specimens and multimedia-based methodologies. With regard to exploring, visualizing and comprehending the interrelationships between structures, prosections have been deemed useful (Drake, 2014).

Reference

Moran, M., Seaman, J., & Tinti-Kane, H. (2011). Teaching, Learning, and Sharing: How Today’s Higher Education Faculty Use Social Media. Babson Survey Research Group.

Jaffar, A. A. (2014). Exploring the use of a Facebook page in anatomy education. Anatomical sciences education7(3), 199-208.

Hennessy, C. M., Kirkpatrick, E., Smith, C. F., & Border, S. (2016). Social media and anatomy education: Using twitter to enhance the student learning experience in anatomy. Anatomical sciences education9(6), 505-515.

Barry, D. S., Marzouk, F., Chulak‐Oglu, K., Bennett, D., Tierney, P., & O’Keeffe, G. W. (2016). Anatomy education for the YouTube generation. Anatomical sciences education9(1), 90-96.

Reverón, R. R. (2016). The use of YouTube in learning human anatomy by Venezuelan medical students. MOJ Anat & Physiol2(7), 00075.

Abdellatif, H. (2020). Time spent in practicing dissection correlated with improvement in anatomical knowledge of students: experimental study in an integrated learning program. Cureus12(4).

Ghosh, S. K. (2017). Cadaveric dissection as an educational tool for anatomical sciences in the 21st century. Anatomical sciences education10(3), 286-299.

Romo Barrientos, C. (2019). José Criado-Álvarez J, González-González J, et al. Anxiety among medical students when faced with the practice of anatomical dissection. Anat Sci Educ12, 300-309.

Drake, R. L., McBride, J. M., & Pawlina, W. (2014). An update on the status of anatomical sciences education in United States medical schools. Anatomical sciences education7(4), 321-325.

Habbal, Omar. (2009). The State of Human Anatomy Teaching in the MedicalSchools of Gulf Cooperation Council Countries. Present and future perspectives. Sultan Qaboos University medical journal. 9. 24-31.

Anatomy homework help

The efficacy of using YouTube on student’s knowledge acquisition and retention and critical thinking in human anatomy course

Background: In recent years, there has been a major shift toward the utilization of internet and user-generated content in anatomy education. Facebook, YouTube, Twitter, Flickr, and Instagram are just a few examples of social media platforms (1). For instances, a research at the University of Sharjah discovered that a faculty-run Facebook Page was useful in enhancing anatomy knowledge beyond typical classroom lectures (2). For instance, a research at the University of Sharjah discovered that a faculty-run Facebook Page was useful in enhancing anatomy knowledge beyond typical classroom lectures. Another study conducted at the University of Southampton discovered that using Twitter to help students’ learning in a neuroanatomy module had a beneficial impact on medical students (3). According to a study conducted at Dublin College, the vast majority of second-year medical and radiation therapy students surveyed had used web-based platforms to source information, with 78 percent using YouTube as their primary source of anatomy-related video clips [4]. This is consistent with the findings of another study, which found that 85 percent of Venezuelan first-year medical students used YouTube videos to study human anatomy (5).

The effectiveness of utilizing cadaver dissection in enhancing anatomical knowledge of students and hands on experience for future doctors.

Anatomical knowledge is essential for students’ clinical skills acquisition, particularly when practicing surgery(6). The most commonly considered method for professional training and skill development among future doctors was dissection(7). Dissection gives students a valuable three-dimensional image of the human body, which not only improves their regional and system anatomy knowledge but also reinforces what they learned in lectures and tutorials(8)

Medical students’ cognitive ability and attention span improve as a result of dissection practice, as well as their physical endurance, which is an important prerequisite for medical students (9).

Students prefer dissection to models and prosections because it allows them to gain a better comprehension of the course objectives and a better three-dimensional understanding of the human anatomy (10).


The effects of using protection on student’s perception in medical and allied health schools .

Many programs have shifted from full-body dissection to prosections due to a shortage of donated bodies and a reduction in time allocated for dissection practice in modern integrated curricula. This cuts down on contact hours and allows students to spend more time studying structures that they might otherwise spend hours looking for and exploring in dissection classes(11). Many modern anatomy curricula propose an increased use of nontraditional teaching modalities such as cadaveric plastination, prosections, non-cadaveric models, and computer-based imaging(12). The use of prosected specimens and multimedia-based methods in teaching anatomy has expanded due to advancements in preservation procedures, manufacture of plastinated specimens, and fast increasing technology in medical education (13,14). Prosections have been viewed as useful for exploring, visualizing, and understanding interrelations of structures

1- M. Moran, J. Seaman, and H. Tinti-Kane, Teaching, Learning, and Sharing: How Today’s Higher Education Faculty Use Social Media, Babson Survey Research Group. Babson College, Babson Park, MA, USA, 2011

2- A. A. Jaffar, “Exploring the use of a facebook page in anatomy education,” Anatomical Sciences Education, vol. 7, no. 3, pp. 199–208, 2014.View at:

3- C. M. Hennessy, E. Kirkpatrick, C. F. Smith, and S. Border, “Social media and anatomy education: using twitter to enhance the student learning experience in anatomy,” Anatomical Sciences Education, vol. 9, no. 6, pp. 505–515, 2016.

4- D. S. Barry, F. Marzouk, K. Chulak-Oglu, D. Bennett, P. Tierney, and G. W. O’Keeffe, “Anatomy education for the YouTube generation,” Anatomical Sciences Education, vol. 9, no. 1, pp. 90–96, 2016.

5- R. R. Reverón, “The use of YouTube in learning human anatomy by Venezuelan medical students,” MOJ Anatomy & Physiology, vol. 2, no. 7, p. 75, 2016.

6- Abdellatif H. Time Spent in Practicing Dissection Correlated with Improvement in Anatomical Knowledge of Students: Experimental Study in an Integrated Learning Program. Cureus. 2020;12(4):e7558. Published 2020 Apr 6. doi:10.7759/cureus.7558

7- Perception of medical students towards the clinical relevance of anatomy.Moxham BJ, Plaisant O

Clin Anat. 2007 Jul; 20(5):560-4.

8- Cadaveric dissection as an educational tool for anatomical sciences in the 21st century.

Ghosh SK

Anat Sci Educ. 2017 Jun; 10(3):286-299.

9- Anxiety among medical students when faced with the practice of anatomical dissection. Romo Barrientos C, José Criado‐Álvarez J, González‐González J, et al. Anat Sci Educ. 2019;12:300–309.

10- Paying respect to human cadavers: we owe this to the first teacher in anatomy. Ghosh SK. Ann Anat. 2017;211:129–134. 

11- Human cadaveric dissection: a historical account from ancient Greece to the modern era. Ghosh SK. https://synapse.koreamed.org/DOIx.php?id=10.5115/acb.2015.48.3.153Anat Cell Biol. 2015;48:153–169.

12- Review of anatomy education in Australian and New Zealand medical schools. Craig S, Tait N, Boers D, McAndrew D. ANZ J Surg. 2010;80:212–216.

13- An update on the status of anatomical sciences education in United States medical schools. Drake RL, McBride JM, Pawlina W. Anat Sci Educ.

14- National survey on anatomical sciences in medical education. McBride JM, Drake RL. Anat Sci Educ. 2018;11:7–14.

Anatomy homework help

1. A male footballer has just recently sustained an injury to his knee by damaging his anterior cruciate ligament and his medial meniscus. In your own words, explain the following: 

· the function of the anterior cruciate ligament and medial meniscus

· steps a surgeon takes in repairing damage to the anterior cruciate ligament and medial meniscus 

2. A female skater fractured her femoral bone at the proximal medial aspect close to the tibia-femoral joint. Explain the processes employed by the body in repairing that fracture.  

3. Discuss the differences between 

Gouty and Rhuematoid arthritis.


 

Anatomy homework help

The efficacy of using YouTube on student’s knowledge acquisition and retention and critical thinking in human anatomy course

Background

Internet and user-generated content have made a huge impact on anatomy instruction in recent years. Social media sites like Facebook, YouTube, Twitter, Flickr, and Instagram are just a few examples (Mike, 2011). Faculty-run Facebook Pages at the University of Sharjah, for example, were found to be beneficial in boosting anatomy knowledge beyond the scope of traditional lecture formats (Akram, 2014). Another study at the University of Southampton found that medical students benefited from utilizing Twitter to aid their learning in a neuro anatomy curriculum (Hennessy, 2016). More than 78% of second-year medical and radiation therapy students said that YouTube was their primary source for anatomy-related video clips, according to a study conducted at Dublin College (Barry, 2015). First-year medical students in Venezuela were found to use YouTube videos to learn about the human anatomy, according to a separate research (Guerin, 2020).

The effectiveness of utilizing cadaver dissection in enhancing anatomical knowledge of students and hands on experience for future students.

When it comes to practicing surgery, anatomical knowledge is necessary for students’ clinical skills acquisition and is particularly important (Abdullatif, 2020). A three-dimensional view of the human body is gained by dissection, which enhances students’ regional and systemic anatomy knowledge, as well as reinforcing what they acquired in lectures and tutorials (Ghosh, 2017). Dissection practice improves medical students’ cognitive abilities and attention spans, as well as their physical endurance, which is a prerequisite for medical students to practice dissection (Romo-Barrientos, 2020).

The effects of using protection on student’s perception in medical and allied health schools.

Prosections have replaced full-body dissection in some schools because of the unavailability of donated bodies and the reduced amount of time allocated for dissection practice in today’s integrated curricula (Omar, 2009). This allows students to spend more time studying structures instead of spending hours hunting for and investigating them in dissection classes, which reduces the amount of time students are in contact with each other. There is a growing trend in modern anatomy courses to incorporate non-traditional teaching methods including computer-based imaging and cadaveric plastination (Craig, 2010). In medical education, advances in preservation techniques, plastinated specimen production, and rapidly rising technology have all led to an increase in the use of prosected specimens and multimedia-based methodologies. With regard to exploring, visualizing and comprehending the interrelationships between structures, prosections have been deemed useful (Drake, 2014.

Reference

Guerin, C., Aitchison, C., & Carter, S. (2020). Digital and distributed: learning and teaching doctoral writing through social media. Teaching in Higher Education25(2), 238-254.

Mustafa, A. G., Taha, N. R., Alshboul, O. A., Alsalem, M., & Malki, M. I. (2020). Using YouTube to learn anatomy: Perspectives of Jordanian medical students. BioMed Research International2020.

Hennessy, C. M., Royer, D. F., Meyer, A. J., & Smith, C. F. (2020). Social media guidelines for anatomists. Anatomical sciences education13(4), 527-539.

Gayef, A., & ÇAYLAN, A. Use of Youtube in Medical Education. Konuralp Medical Journal13(3), 640-647.

Abdellatif, H. (2020). Time spent in practicing dissection correlated with improvement in anatomical knowledge of students: experimental study in an integrated learning program. Cureus12(4).

Schön, M., Steinestel, K., Spiegelburg, D., Risch, A., Seidel, M., Schurr, L., … & Böckers, A. (2022). Integration of scientific competence into gross anatomy teaching using poster presentations: Feasibility and perception among medical students. Anatomical Sciences Education15(1), 89-101.

Kelsey, A. H., McCulloch, V., Gillingwater, T. H., Findlater, G. S., & Paxton, J. Z. (2020). Anatomical sciences at the University of Edinburgh: Initial experiences of teaching anatomy online. Translational Research in Anatomy19, 100065.

Romo-Barrientos, C., Criado-Álvarez, J. J., Martínez-Lorca, A., Viñuela, A., Martin-Conty, J. L., Saiz-Sanchez, D., … & Mohedano-Moriano, A. (2020). Anxiety among nursing students during their first human prosection. Nurse Education Today85, 104269.

Ghosh, S. K., & Narayan, R. K. (2020). Anatomy of nervous system and emergence of neuroscience: a chronological journey across centuries. Morphologie104(347), 267-279.

Newman, H. J., Meyer, A. J., & Carr, S. E. (2021). Neuroanatomy teaching in Australian and New Zealand medical schools. World Neurosurgery149, e217-e224.

Nicholas, E., Ly, A. A., Prince, A. M., Klawitter, P. F., Gaskin, K., & Prince, L. A. (2021). The current status of ultrasound education in United States medical schools. Journal of Ultrasound in Medicine40(11), 2459-2465.

Rockarts, J., Brewer‐Deluce, D., Shali, A., Mohialdin, V., & Wainman, B. (2020). National survey on Canadian undergraduate medical programs: The decline of the anatomical sciences in Canadian medical education. Anatomical sciences education13(3), 381-389.

M. Moran, J. Seaman, and H. Tinti-Kane, Teaching, Learning, and Sharing: How Today’s Higher Education Faculty Use Social Media, Babson Survey Research Group. Babson College, Babson Park, MA, USA, 2011

A. A. Jaffar, “Exploring the use of a facebook page in anatomy education,” Anatomical Sciences Education, vol. 7, no. 3, pp. 199–208, 2014.View at:.

Hennessy, C.M., Kirkpatrick, E., Smith, C.F., & Border, S. (2016). Social media and anatomy education: Using twitter to enhance the student learning experience in anatomy. Anatomical Sciences Education, 9.

Barry, Denis & Marzouk, Fadi & Chulak‐Oglu, Kyrylo & Bennett, Deirdre & Tierney, Paul & O’Keeffe, Gerard. (2015). Anatomy education for the YouTube generation: Online Video Use in Anatomy Education. Anatomical Sciences Education. 9. 10.1002/ase.1550.

Ghosh S. K. (2017). Cadaveric dissection as an educational tool for anatomical sciences in the 21st century. Anatomical sciences education, 10(3), 286–299. https://doi.org/10.1002/ase.1649

Habbal, Omar. (2009). The State of Human Anatomy Teaching in the MedicalSchools of Gulf Cooperation Council Countries. Present and future perspectives. Sultan Qaboos University medical journal. 9. 24-31.

Craig, S., Tait, N., Boers, D., & McAndrew, D. (2010). Review of anatomy education in Australian and New Zealand medical schools. ANZ journal of surgery, 80(4), 212–216. https://doi.org/10.1111/j.1445-2197.2010.05241.x

Drake, R. L., McBride, J. M., & Pawlina, W. (2014). An update on the status of anatomical sciences education in United States medical schools. Anatomical sciences education, 7(4), 321–325. https://doi.org/10.1002/ase.1468

Anatomy homework help

Your first task is to find two empirical research articles published in good quality, peer-reviewed

journals in the last five years. You should choose articles on the same topic written by different

authors and published in two different journals. The topic should be relevant to your degree

programme. This is a good place to begin your search.

Your assignment should be entirely written in your own words and should begin with the full

Harvard reference for each article, and a brief summary of how you found these articles (no more

than 150 words). The main body of the text should be in 12pt Arial or Times New Roman with 1.5 or

double line spacing. Pages should be numbered.

Your assignment must be written in your own words. Do not copy any words from the work of

others. You will need to cite and reference the work and ideas of others, and may need to quote

directly – it is your responsibility to do this correctly and accurately, in the Harvard style. If you are

unsure about plagiarism then consult the resources on this Canvas site, including this student guide

to plagiarism.

A suggested structure for the main body of the assignment (with some questions to get you thinking)

follows:

Introduction

What interests you about this topic and how is it relevant to your degree programme? Why have you

chosen these two articles? What is each article about? What is the geographical context of each

research article? What are the research questions and how do these compare to each other?

Literature review

Are the literature reviews relevant to the topic? Do the literature reviews miss any important

sources or arguments within the field? Are the reviews similar or different, and can you explain this

similarity or difference? Does each article support the existing literature, or offer a challenge?

Research Philosophy

Is the research philosophy clearly outlined in each article? How would you describe the research

philosophies of the articles? Are they different or similar?

Data Collection

A summary of the way in which the researchers collected data, including information about the

sample/participants. What are the differences in approaches to collecting data? What sort of data

are the researchers collecting? Are the data collection tools and techniques clearly described or

difficult to understand? How do the articles justify their approaches? Do the researchers consider

the advantages and disadvantages of their chosen methods? Did the researchers encounter any

challenges in collecting the data?

Data Analysis

A summary of the way in which the researchers analysed the data. What are the differences in

approaches to analysing the data? Are the data analysis tools and techniques clearly described or

difficult to understand? Do the researchers consider the advantages and disadvantages of their

chosen methods? Did the researchers encounter any challenges in analysing the data?

Research Ethics

Do the authors note any ethical issues with their research, and if so then how do they account for or

overcome these? Are the ethical issues in each article similar or different?

Findings

What are the main findings of each article and how do these compare? Are the findings of each

article reasonable and well-supported by evidence? In what ways are they reasonable or not

reasonable? What are the main contributions of the articles and are these similar or different?

References

A list of all sources that you have cited in your assignment, in the Harvard style, listed in alphabetical

order by author surname.

General notes:

This is primarily an assessment of your ability to find, understand, and write about good quality,

relevant empirical research, as this is the first step for any research project. We know that you

haven’t yet covered the details of data collection and analysis, research ethics etc. in classes and so

we are not expecting you to demonstrate any prior knowledge of these aspects in your writing.

As mentioned above, part of your task is to choose a topic relevant to your degree programme and

find two relevant and suitable empirical research articles. Please do not ask your lecturers and tutors

whether or not you have chosen a relevant topic and/or relevant articles, as your ability to make

these decisions is part of what you are being assessed on.

If you choose to include any tables or figures then these do not count towards your overall word

count

Anatomy homework help

Medical Terminology: Human Disease Project

Topic on (Multiple Sclerosis)

Project 1:
Topic- Multiple Sclerosis

The student will research the disease using a minimum of three references. Such as Center for Disease Control (CDC), the National Institute of Health (NIH) websites, professional journal or scholarly magazine.

The Students will create a presentation that creatively demonstrates what they know about the disease using Prezi, Power point, etc. and upload into Blackboard.

1. Provide a description of the disease.

2. List Signs and symptoms of the disease (use Medical Terminology Words)

3. Is there a cure? Why or why not?

4. Give brief description of why you selected the disease.

The project has two parts First the PowerPoint or something else you chose to use to make your
presentation

AND
the second part is the
3page essay
. Submit a cover sheet with the name of the course, Professors name and his or her own name. The project should not to exceed three typewritten pages in length with 12 point Times New Roman font lettering and double-space. Each
publication or its Internet site
may only be used once. (Use APA Format) and submit in class the actual presentation (Prezi share the link, PowerPoints share the Slides)

Evaluation

Points

Presentation 50

Questions Complete / Medical Terminology words used 50

Format:

Grammar – Typing

APA Format

Organization (order of report)

100







Total 200





Anatomy homework help

BIOS251 OL, Week 7 Lab

Name:

OL Lab 7: Joints

Learning Objectives:

· Identify the structures of the synovial joints and its related functions.

· Identify the structural and functional classification.

· Identify the different types of movements produced by the synovial joints.


Part A:

For this part of the lab you will use Anatomy TV to explore the synovial joints in skeletal system and correlate the anatomical structures to its functions. Please read the instructions before you begin.



Instructions:

1. Use the link below to log into Anatomy TV via Chamberlain Library.


https://library.chamberlain.edu/az.php?q=.

2. Select Anatomy TV under popular databases to access the site.

3. Select the ‘skeletal system’ tile:


4. From the skeletal system module, select the interactive learning module

on the left hand side of the page.


Analysis of Joints
:

5. Select the interactive learning: Joints

Select the ‘synovial joints’ interactive circled in red.

6. On the image identify and select a one anatomical structure at a time.

The selected region will appear highlighted.

7. Use the controls at the bottom of the page as required. Follow the recommendations

provided for each structure.

8. Take a screen shot of the image or save the image using the download icon on

the right hand side tab.

9. Create a word document titled “lastname_Lab 7”. Import the image into the document. Use the functions ‘Insert’ and ‘tool’ (shapes) on word to label the images.

10. In a complete sentence, write the functional role of the selected anatomical structure

under the image.

11. Save the file before you proceed to the next structure.

12. Follow these steps to analyze all the structures listed below.

a. Femur

b. Tibial collateral ligament

c. Joint capsule

d. Supratellar bursa

e. Tibia

f. Medial meniscus

Use the layer controls to remove/add layers ending on layer 10 and rotation controls to rotate the model to frame 9 for the following structures.

g. Synovial fluid

h. Patella

i. Patellar ligament

j. Articular hyaline cartilage

k. Fat pad


Part B: Read the case study. In your own words and in complete sentences answer the questions
:

John, a 75-year-old man, was diagnosed with osteoarthritis in his knee five years ago. Recently his condition worsened and so decided to see a doctor. John’s doctor ordered a radiograph imaging in order to visualize his knee joint.

a. What is osteoarthritis? What symptoms will John experience? (3 points)

b. What type of joint is the knee? (1 point)

c. What is the meniscus in the knee and state its function? (2 points)

d. What is the role of articular cartilage in a synovial joint? (2 points)

e. What is the role of synovial fluid? (2 points)


Part C: Movements of Synovial Joints
:
Critical thinking Questions:


In your own words and in complete sentences answer the following questions
:

a. What are the movements involved when you shrug your shoulders? What is the functional classification of the shoulder joint?(3 points)

b. Identify the type of movement at the hip and shoulder joints when you perform jumping jacks? ( 2 points)

c. Why do individuals with overpronation might exhibit uneven wear on the inside of the midsole? ( 2 points)

d. What are the joints and the movements involved when kicking a soccer ball? (3 points)

Grading Rubric: 

Activity 

Deliverable 

Points 

Part A

Lab report on Synovial Joints

10

Part B & C

Answer all the questions

· Part B

· Part C

10

10

Total  

Complete all lab activities  

30

Anatomy homework help

Module 11 Lab Assignment – Documentation of Complete Head to Toe Physical Assessment

Module 11 Lab Assignment – Documentation of Complete Head to Toe Physical Assessment

Top of Form

Bottom of Form

Module 11 Content

1.

Top of Form

You completed your full head-to-toe assessment skills demonstration last week and now will document your results. Continue to document only the objective findings for this section without bias or explanation. Remember if you can’t feel something then it is “nonpalpable,” if you can’t hear something just state they were not heard such as no bowel sounds heard (unless you listened for the full five minutes which we wouldn’t want to do for our purposes – then you could document absent bowel sounds). Be descriptive if necessary but at the same time be brief.

Complete Head-to-Toe Physical Assessment Assignment.docx

Submit your completed assignment by following the directions linked below. Please check the 
Course Calendar
 for specific due dates.

Bottom of Form

Title:

Documentation of the complete head to toe physical assessment.

Purpose of Assignment:

To demonstrate the ability to document the findings of an objective head to toe assessment and identify abnormal findings.

Course Competency:

Demonstrate physical examination skills of the skin, hair, nails, and musculoskeletal system.

Prioritize appropriate assessment techniques for the gastrointestinal, breasts, and genitourinary systems.

Demonstrate physical examination skills of the head, ears, and eyes, nose, mouth, neck, and regional lymphatics.

Apply assessment techniques for the neurological and respiratory systems.

Select appropriate physical examination skills for the cardiovascular and peripheral vascular systems.

Instructions:

Content:

· Objective findings including short descriptive paragraph of findings for each section.

· Actual or potential risk factors for the client based on the assessment findings with description or reason for selection of them.

Format:

· Standard American English (correct grammar, punctuation, etc.)

Resources:

Chapter 5: SOAP Notes: The subjective and objective portion only

Sullivan, D. D. (2012). Guide to clinical documentation. [E-Book]. Retrieved from http://ezproxy.rasmussen.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=nlebk&AN=495456&site=eds-live&ebv=EB&ppid=pp_91

Smith, L. S. (2001, September). Documentation do’s and don’ts. Nursing, 31(9), 30. Retrieved from http://ezproxy.rasmussen.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=107055742&site=eds-live

Documentation Grading Rubric- 20 possible points

Levels of Achievement

Criteria

Emerging

Competence

Proficiency

Mastery

Objective

(16 Pts)

Missing components of assessment for particular system. May contain subjective data. May have signs of bias or explanation of findings. May have included words such as “normal”, “appropriate”,
“okay”, and “good”.

Failure to provide any objective data will result in zero points for this criterion.

Includes all components of assessment for particular system. Lacks detail. Uses words such as “normal”, “appropriate”, or “good”. Contains all objective information. May have signs of bias or explanation of findings.

Includes all components of assessment for particular system. Avoided use of words such as “normal”, “appropriate”, or “good”. No bias or explanation for findings evident Contains all objective information

Includes all components of assessment for particular system. Detailed information provided. Avoided use of words such as “normal”, “appropriate”, or “good”. No bias or explanation for findings evident. All objective information

Points: 11

Points: 14

Points: 15

Points: 16

Actual or Potential Risk Factors (4 Pts)

Lists one to two actual or potential risk factors for the client based on the assessment findings with no description or reason for selection of them. Failure to provide any potential or actual risk factors will result in zero points for this criterion.

Brief description of one or two actual or potential risk factors for the client based on the assessment findings with description or reason for selection of them.

Limited description of two actual or potential risk factors for the client based on the assessment findings with description or reason for selection of them.

Comprehensive, detailed description of two actual or potential risk factors for the client based on the assessment findings with description or reason for selection of them.

Points: 1

Points: 2

Points: 3

Points: 4

Points: 12

Points: 16

Points: 18

Points: 20

Anatomy homework help

Section 20.3 #6. Cause and Effects of Edema  



COLLAPSE

Top of Form

 Section 20.3 #6. Cause and Effects of Edema  

Research:  

After surgery you may get some swelling, a condition called edema can cause this. Edema is extra fluid trapped in bodily tissues. Edema can be found in many parts of the body, but it is most common in the lower extremities (Legs, Feet, ankles, etc.) Edema has 3 causes. One being increased capillary filtration. Increases in capillary permeability, hydrostatic pressure, or decreased osmotic pressure can all result in an increased capillary filtration rate. (Edema 2022) Causes of increased capillary permeability include immune reactions such as bacterial infections, toxins, burns, etc. Causes of increased capillary hydrostatic include high venous pressure such as heart failure.  

The second cause is reduced capillary reabsorption. Capillary reabsorption depends on oncotic pressure which is proportional to the concentration of blood albumin (Saladin, p.744) ) A lack of albumin produces edema which reduces the reabsorption of tissue fluid. Things such as liver disease often led to lower levels of protein in the body (hypoproteinemia) and edema. The third cause is obstructed lymphatic drainage. The lymphatic system is a network of one-way vessels that collect fluid from the tissues and return it to the bloodstream. (Saladin, p.744) Blockage of these vessels can intervene with fluid drainage which causes swelling.   

If edema is left untreated it can lead to painful swelling, difficulty walking, skin ulcers, itchiness, and scarring. Some ways to treat edema are elevating the limb it is affecting higher than the heart, water pills prescribed by a physician, completing exercises, ted hose, low salt diet, etc.  

Critical Thinking: 

This is an important topic to me because I see patients daily with edema. It mostly effects geriatric population, and pregnant woman but it can affect any age. It is important to get edema treated as soon as possible. Some lower extremity exercises I have patients complete to decrease edema are leg kicks, marches, ankle pumps, etc. I educated my patients the importance of completing exercises as well as elevating limbs to decrease edema to increase mobility. Edema can affect someone’s daily tasks due to being in so much pain caused from edema.  

Word Count- 388

 

  References  

Edema. Edema – an overview | ScienceDirect Topics. (n.d.). Retrieved February 20, 2022, from 
https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/edema#:~:text=Increases%20in%20capillary%20permeability%2C%20hydrostatic,infections%2C%20ischemia%2C%20and%20burns

Saladin, K. S., Gan, C. A., & Cushman, H. N. (2021). Anatomy & Physiology: The unity of form and function. McGraw-Hill Education  

Bottom of Form

Anatomy homework help

Assignment


QUESTIONS

1.

2.
Systemic lupus erythematosus (SLE) has been described as an autoimmune disorder which targets vital organs such as the heart, lungs, kidney and the skin. Describe the patho-physiology, symptoms, effects and treatment of this disease. 

3. According to the WHO, the covid-19 virus is an infectious disease caused by the SARS-CoV-2 virus. Describe the origin, patho-physiology, effects and treatment options of this virus.

4.
Sleep Apnea
 is a disorder characterized sub-optimal supplies of oxygen to the body during sleep.  Describe the pathogenesis, pathophysiology, effects and treatment of this disorder.

 

Anatomy homework help

Medical Terminology: Intro

PT116 Unit 1 Assignment

Combining Forms

Meaning

aden/o

carcin/o

cardi/o

chem/o

cis/o

dennat/o

enter/o

gastr/o

gynec/o

hemat/o

hydr/o

immun/o

laryng/o

nephr/o

neur/o

ophthalm/o

otlo

path/o

pulmon/o

rhin/o

Prefixes

Meaning

a-

an-

ante-

ant-i

auto-

brady-

contra-

de-

dys-

endo-

epi-

eso-

eu-

ex-

exo-

extra-

hetero-

homo-

hydro-

hyper-

hypo-

in-

inter-

intra-

macro-

micro-

myo-

neo-

pan-

para-

per-

peri-

post-

pre-

pro-

pseudo-

retro-

sub-

supra-

tachy-

trans-

ultra-

un-

bi-

hemi-

mono-

multi-

nulli-

poly-

primi-

quadri-

semi-

tetra-

tri-

Suffixes

Meaning

-algia

-cele

-cyte

-dynia

-ectasis

-gen

-genesis

-genic


-ia

-iasis

-iatry

-ism

-itis

-logist

-logy

-lysis

-lytic

-malacia

-megaly

-oid

-oma

-osis

-pathy

-phobia

-plasia

-plasm

-ptosis

-rrhage

-rrhagia

-rrhea

-rrhexis

-sclerosis

-stenosis

-ule

-centesis

-ectomy

-ostomy

-otomy

-pexy

-plasty

-rrhaphy

-gram

-graph

-graphy

-meter

-metry

-scope

-scopy

Page| 2

Anatomy homework help

Name: ____________________ Cohort ____ Date: __________ PT 116 – Pathophysiology


Guided Reading – Ch 7 Inflammation and Healing

1. What is inflammation?

2. What agents are used to treat inflammation?

3. What does “RICE” stand for?

4. List and define the 3 given methods of wound healing.

5. What is granulation tissue?

6. What is collagen?

7. List the 3 phases of healing.

8. How are scars formed?

9. What are adhesions?

10. What is keloid?

11. What are the 3 stages of bone healing (and their time frames)?

Anatomy homework help

“Blood Disease Report.”  Please write a 3-page, double-spaced report on one of the following Blood Diseases: 

· Anemia.

· Hemophilia.

· Leukocytosis.

· Polycythemia vera.

· Sickle cell disease.

· Thalassemia.

· Von Willebrand disease.

 A 12 font-Times New Roman should be used.  You will be penalized for extra spacing and inappropriate margins.  The margins of this report should be 1.5 on the left and right sides. In your     3-page report, tell how your selected blood disease affects the different body systems.   Describe how this disorder relates to the health of African American health services. Please include appropriate reference at the end of 3rd page.  Maximum 120 points, due March 6, 2022.  Extended to 3/13/22.

Anatomy homework help

1. Imagine if you were walking along the beach and cut the bottom of your foot open from a sharp piece of beach debris. Prepare a written paper of at least 1000 words that includes the following:

A. Discuss components of blood that participate in wound healing and discuss their roles in the wound healing process.

B. Using specific examples, compare the process by which a hormone and a neurotransmitter will be secreted in response to this accident.

C. Examine the action of a neurotransmitter compared to that of a hormone on the physiology of the heart and blood vessels as a result of sustaining this injury.

Your paper should be formatted as a proper research paper with an introduction and conclusion. Do not simply follow the bullet points above, but really think about what you have learned and how that relates to other material we have covered and knowledge you have from other courses you may have taken. The Research and Report assignments in this course are capstone assignments for each module. You should be integrating everything that you learned in the textbook, explorations, discussions, and lab activities into your papers.

All references must be cited using APA Style format. Use what you have learned from this module to complete the assignment, in some cases, you may need to conduct additional research using research databases.

Anatomy homework help


Sample of Annotated Bibliography —— NRSE 3700J

Pruitt, S. M., Hoyert, D. L., Anderson, K. N., Martin, J., Waddell, L., Duke, C., Honein, M. A.,

& Reefhuis, J. (2020, September 18). Racial and ethnic disparities in fetal deaths —

United States, 2015-2017. MMWR Morb Mortal Wkly Rep 2020, 69(37), 1277-1282.

http://dx.doi.org/10.15585/mmwr.mm69371

The article provides a summary and an analysis of the data regarding fetal deaths in the United States between the years of 2015 and 2017. A fetal death is one that occurs at less than 20 weeks gestation. Fetal death report data in three populations were analyzed. The three populations were: (a) Black women, (b) White women, and (c) Hispanic women. There was an attempt to collect data from all 50 states and the District of Columbia in those jurisdictions that more than 50% of the fetal death reports had a cause of death specified. Fetal mortality rates were collected nationally and by the mothers’ state of residence, race and Hispanic origin, age, and multiple-gestation pregnancy. The cause of fetal death was categorized into 45 ranked causes of death. During the time period studied the fetal mortality rate among Black women was more than twice the rate among White women and Hispanic women. The rate was higher for women younger than 20 years and older than 40 years than it was for women between the years of 20 and 39 years. The fetal mortality rate varied by US state with the rates generally higher in the southern US. Alabama reported the highest rate among White women while the rates in New Jersey, West Virginia, and Mississippi were the highest among Black women. The five most common causes of fetal death were reported.

The report was well written with several tables and figures illustrating the data. The authors cite a limitation of the data, namely that the cause of death is not consistently recorded even in those jurisdictions where the cause of fetal death is a required part of the data reporting. The article provides a good introduction to data about fetal death rates in the US and suggests other sources for a more in-depth study of fetal death rates.

It is disturbing to realize that this level of discrepancy among groups of women in the US exists. Too often we (US citizens) view ourselves as having the best health care in the world. We cannot justify that claim when there is this level of difference in fetal death rates among these three populations of women.

Anatomy homework help

1

Social Determinants of Health in Kenya

Kenya is an ethnically diverse middle-income nation in East Africa with 54.7 million people. Most of the Kenyan population is the youth because of years of a high fertility level and reduced mortality rate among children aged five and below following successful health promotion programs, especially programs that increase the rate of vaccination. According to Ngaruiya et al. (2019), more than 40% of Kenyans are aged 15 years and below, with 55% having the age between 15 years and 64 years, and only 4% of the population is 65 and above.

Cardiovascular disease (CVD), diabetes, and cancer are Kenya’s highest priority health issues. Identifying the health concerns is grounded on various global indicators of priority health problems, including considering prevalence rates, mortality rates, and even conditions identified as a top priority in the Healthy People 2030. In Kenya, cardiovascular is one the leading cause of death-causing 13% of total deaths. In addition, 50% of the county’s population is pre-hypertensive, while 25% of Kenyans aged between 18 and 69 years have heart disease. Secondly, cancer is the third highest death cause in the country, with an incidence rate of 47,887 per annum (Mbau et al., 2021). New cancer cases are estimated to increase by about 120% in 20 years. Diabetes is also a significant health problem in the country, with an expected prevalence of 3.3%, estimated to reach 4.5% by 2025.

Through prevalence and mortality rates health indicators, cardiovascular disease is the highest priority health issue in Kenya. Cardiovascular is responsible for 365,744 deaths annually, accounting for 13% of the total deaths in the country. In addition, 25% of hospital admissions in the country are cardiovascular disease-related patients. Various risk factors, including increased intake of tobacco, alcohol, and low intake of vegetables and fruits, are responsible for the high CVD cases in Kenya. For example, 11.6% of adults and 9.9% of youths below 15 years of age use tobacco, whereas 86.1% of adults are at risk of passive or second-hand tobacco smoking (Mwenda et al. 2018). Additionally, 24.8% of young people are exposed to passive smoking, increasing their risk of developing the condition.

Economic stability is the primary social determiner of health, with the most impact on the increased cardiovascular disease in Kenya. Many Kenyans have limited access to healthcare because of the ineffective care system following low funding for the health system. The national healthcare budget ranges between 5.5% and 9.5%, lower than the national target of 15% as set by (KHSSP) Kenya Health Sector Strategic Plan. 23% of sick Kenyans lack access to healthcare due to the high care costs, poor health literacy, and long traveling distances to seek healthcare services. Limited healthcare access and quality play a vital role in the high CVD prevalence and death rate. Many Kenyans in remote areas face the challenge of quality healthcare and accessibility due to a lack of resources and facilities. Many Kenyans have to travel long distances to major cities to access facilities to get quality healthcare.

A large Kenya population lives in poverty due to a lack of job opportunities and other factors, including inadequate rains in the country. Many low socioeconomic Kenyans cannot afford healthy lifestyles, including healthy, nutritious diets, and lack resources for physical activities (Mercer et al. 2019). One million people in Kenya live below the poverty line. As their primary source of entertainment and social activities, many have resulted in smoking and alcoholism, which are major risk factors for cardiovascular diseases. Other factors that increase the rate of CVD include stress, anxiety, and obesity. Due to economic struggles, many Kenyans struggle with stress and obesity due to poor nutrition. Poor diet is one of the significant risk factors attributed to CVD. Many Kenyans rely on processed food with high fat and sugar levels due to the affordability and accessibility of healthy food.

Lastly, people may not afford travel costs to major hospitals or out-of-pocket payments for health care with low-income status. Such people end up not getting the treatment needed, resulting in death, with adequate healthcare financing policy, resulting in the provision of healthcare facilities and in communities and professional expertise to provide healthcare services. Having health care facilities close to every community will encourage individuals to seek treatment and prevent other morbidities. Community healthcare professionals are experts in educating, preventing diseases, and helping manage existing problems. They will provide resources that address basic needs such as food and basic health education that promote a healthy lifestyle. These strategies will help promote and improve health outcomes in Kanya.

Conclusively, Kenya is a middle-economy country with 54.7 million people. Cardiovascular disease, cancer, and diabetes are significant diseases affecting lives in Kenya, with cardiovascular disease being one of the leading causes of death. Cardiovascular leading prevalence and mortality rates can be attributed to low-income and limited access to health and quality social determiners of health. Improving health system funding policy and providing infrastructures that will provide accessible health care services will help reduce the prevalence of CVD in Kenya.

References

Mbau, L., Fourie, J. M., Scholtz, W., Scarlatescu, O., Nel, G., & Gathecha, G. (2021). Kenya Country Report. CARDIOVASCULAR JOURNAL OF AFRICA, 32(3), 161-167. https://world-heart-federation.org/cvd-roadmaps/wp-content/uploads/sites/3/Kenya-Country-Report.pdf

Mercer, T., Njuguna, B., Bloomfield, G. S., Dick, J., Finkelstein, E., Kamano, J., … & Akwanalo, C. (2019). Strengthening Referral Networks for Management of Hypertension Across the Health System (STRENGTHS) in western Kenya: a study protocol of a cluster randomized trial. Trials20(1), 1–13. https://doi-org.proxy.library.ohio.edu/10.1186/s13063-019-3661-4

Mwenda, V., Mwangi, M., Nyanjau, L., Gichu, M., Kyobutungi, C., & Kibachio, J. (2018). Dietary risk factors for non-communicable diseases in Kenya: findings of the STEPS survey, 2015. BMC Public Health, 18(3), 1-8. https://doi-org.proxy.library.ohio.edu/10.1186/s12889-018-6060-y

Ngaruiya, F. W., Ogendi, G. M., & Mokua, M. A. (2019). Occupational health risks and hazards among the fisherfolk in Kampi Samaki, Lake Baringo, Kenya. Environmental Health Insights, 13, 1178630219881463. https://doi-org.proxy.library.ohio.edu/10.1177/1178630219881463

30th March 2022

Terry Thomas, Community Health Worker

I write to inform you about the significant impact social determiners of health (SDOH) have on health outcomes and inequalities in our society. This email is directed to the health workers as community healthcare workers help people in the community they serve to meet their unique needs, including guiding and navigating them towards the healthcare and social system. SDOH involve environmental conditions where individuals are born, learn, live, worship, play, and age that impact their health, quality of life and functioning outcomes, and risk (Moise, 2020). The main domains of SDOH include accessibility to quality education, economic stability, social and community context, healthcare quality and access, education, neighborhood, and built environment. These factors are central to determining the population’s health outcomes.

Economic stability has a significant impact on the prevalent cardiovascular disease in Kenya. Many people in the country live in poverty, with 1,000,000 Kenyans living below the poverty line. Poor Kenyas cannot afford healthy lifestyles, including healthy diets and physical activities. The majority of Kenyans do not practice healthy lifestyles. They have a low intake of fruits and vegetables, increased intake of processed foods, and smoking and alcoholism, increasing the risk of developing cardiovascular disease. The high cost of living has left Kenyans stressed and obese due to poor nutrition (Mbau et al., 2021). This low-income population does not afford enough to engage in physical activities and other healthy practices like good diets. Limited access to quality care is another SDOH affecting CVD in the country. The national healthcare is funded below the 15% target set by (KHSSP) Kenya Health Sector Strategic Plan. According to Ooms et al. (2021), 23% of patients in the country do not access care services because of the high care costs, long traveling distances, and low health literacy levels.

References

Mbau, L., Fourie, J. M., Scholtz, W., Scarlatescu, O., Nel, G., & Gathecha, G. (2021). Kenya Country Report. CARDIOVASCULAR JOURNAL OF AFRICA, 32(3), 161-167. https://world-heart-federation.org/cvd-roadmaps/wp-content/uploads/sites/3/Kenya-Country-Report.pdf

Moise, I. K. (2020). Variation in Risk of COVID-19 Infection and Predictors of Social Determinants of Health in Miami-Dade County, Florida. Preventing Chronic Disease17, 1–5. https://doi-org.proxy.library.ohio.edu/10.5888/pcd17.20035

Ooms, G. I., van Oirschot, J., Waldmann, B., von Bernus, S., van den Ham, H. A., Mantel-Teeuwisse, A. K., & Reed, T. (2021). The Current State of Snakebite Care in Kenya, Uganda, and Zambia: Healthcare Workers’ Perspectives and Knowledge, and Health Facilities’ Treatment Capacity. American Journal of Tropical Medicine & Hygiene104(2), 774–782. https://doi-org.proxy.library.ohio.edu/10.4269/ajtmh.20-1078

Anatomy homework help

© 2020 Indian Journal of Endocrinology and Metabolism | Published by Wolters Kluwer ‑ Medknow628

Abstract

Original Article

IntRoductIon
As per the latest World Health Organization (WHO) report,
cardiovascular diseases (CVDs) are the leading cause of
mortality at a global level (31%) as well as in India (27%).[1]
Above this, 78% of all noncommunicable disease (NCD)
deaths and 85% of premature adult NCD deaths occur in
low and middle income countries.[1] Among the total NCD
deaths, nearly half (47%) of them contributed by major
NCDs (CVDs and DM), followed by accidents (20%) and
cancer (12%).[2] The Global Action Plan (GAP) endorses 25%
reduction in premature mortality by 2020 and 80% availability
of affordable all essential medicines and technologies for NCD

treatment.[3] As per Sustainable Developmental Goals (SDGs),
India has committed to reduce the premature mortality due
to NCDs by one third by 2030, using various modalities of
NCDs prevention and treatment.[4,5] The National Health

Background: As committed by India in Global Action Plan, Sustainable Development Goals and National Health Policy 2017, India has
the responsibility to provide accessible, affordable noncommunicable disease care to the people. Our study aimed to find out the burden of
cardiovascular risk factors among hypertension and diabetic patients, through a community-based screening, in a remote rural area of South India.
Methods: A special program named “Chunampet Rural–Cardiovascular Health Assessment and Management Program” (CR-CHAMP) was
launched in August and September 2017 in a Rural Health Training Center (RHTC), functioning under a private medical college in South India.
In this program, participants with hypertension (HT) and diabetes (DM) were line listed from 10 remote villages, and then history, initial
biochemical, hormonal, and hematological screenings were done to assess the cardiovascular diseases (CVDs) risk factors among these patients,
following which special consultation was offered in RHTC. Results: Out of 415 eligible patients with HT and DM, 389 were approached;
among them, 328 were willing to participate and were screened initially; among them, 235 were attended special consultation. Higher CVD
risk was found in 21%. Prevalence of chronic kidney disease was 14%, deranged lipid profile was more than 50%, metabolic syndrome
was 49%, anemia was 68%, abnormal waist-hip ratio was 56%, abdominal obesity was 59%, and overweight and obesity using body mass
index (BMI) was 59%. Females’ participation was more in our community-based screening procedure (66%) than male participation (34%).
Conclusion: CR-CHAMP demonstrated feasibility and value of implementing a screening program for high-risk individuals with HT and
DM for CVD risk through existing primary care in a remote rural area of South India. This will help the National Program and policymakers
to plan for interventions in the remote rural area in future.

Keywords: Cholesterol, diabetes, hypertension, public health, screening

Access this article online

Quick Response Code:
Website:
www.ijem.in

DOI:
10.4103/ijem.IJEM_528_19

Address for correspondence: Dr. Ariarathinam Newtonraj,
Department of Community Medicine, Pondicherry Institute of Medical

Sciences, Puducherry ‑ 605 014, India.
E‑mail: newton2203@gmail.com

This is an open access journal, and articles are distributed under the terms of the Creative
Commons Attribution‑NonCommercial‑ShareAlike 4.0 License, which allows others to
remix, tweak, and build upon the work non‑commercially, as long as appropriate credit
is given and the new creations are licensed under the identical terms.

For reprints contact: reprints@medknow.com

How to cite this article: Newtonraj A, Selvaraj K, Purty AJ,
Nanda SK, Arokiaraj MC, Vincent A, et al. Feasibility and outcome of
community-based screening for cardiovascular disease risk factors in a
remote rural area of South India: The Chunampet rural–cardiovascular
health assessment and management program. Indian J Endocr Metab
2019;23:628-34.

Feasibility and Outcome of Community‑based Screening for
Cardiovascular Disease Risk Factors in a Remote Rural Area
of South India: The Chunampet Rural–Cardiovascular Health

Assessment and Management Program
Ariarathinam Newtonraj, Kalaiselvi Selvaraj1, Anil J. Purty, Sunil K. Nanda2, Mark C. Arokiaraj3, Antony Vincent, Mani Manikandan

Departments of Community Medicine, 2Biochemistry and 3Cardiology, Pondicherry Institute of Medical Sciences, Puducherry, 1Department of Community Medicine,
All India Institute of Medical Sciences, Nagpur, Maharashtra, India

Newtonraj, et al.: CVD risk assessment in a rural India

629Indian Journal of Endocrinology and Metabolism ¦ Volume 23 ¦ Issue 6 ¦ November-December 2019

Policy of India (NHP-India) rolled out in 2017 has thrown
more emphasis on reversal of growing incidence of NCDs
by preventive and curative approach and integration of NCD
diagnosis and management with all levels of health care
services. NHP-India also assured free availability of drugs
for selected NCDs throughout the year in all health centers,
especially at primary health care level.[6] At present, there
is a screening strategy for diagnosis of selected NCDs with
the help of ASHAs (Accredited Social Health Activists)
and ANMs (Auxiliary Nurses Midwives) at primary care
level under NPCDCS (National Program for Prevention and
Control of Diabetes Cardiovascular Diseases and Stroke)
program. This program also ensures the availability of drugs
to major NCDs through NCD clinics. These are the clinics
where high-risk individuals for CVDs [Diabetes (DM)
and Hypertension (HT) patients] attending. These clinics
open up a new opportunity to screen and assess the HT
and DM patients for appropriate management and referral
at the primary care level itself. This targeted approach at
the primary care setting will help in achieving the main
goal of SDG, GAP, and NHP-India by reducing premature
mortality. This study assesses the feasibility of such targeted
screening in a primary care setting. Another important thing
is India is a country where about 70% of population lives
in rural area. In a recent study conducted in a rural area of
South India has estimated high prevalence of cardiovascular
diseases (CVDs) risk and therefore raised a question whether
rural population India are neglected from getting proper
NCD health care services.[7] Considering all the above facts,
our study aimed to find out the burden of cardiovascular risk
factors through a community-based screening, in a remote
rural area of South India.

methods
Setting
Chunampet Rural Health Training Center (RHTC) is an
MCI (Medical Council of India) recognized rural health
training center for training of undergraduate and postgraduate
medical students, which is functioning under Department
of Community Medicine under a private medical college
named Pondicherry Institute of Medical Sciences (PIMS),
Puducherry. This center is located in a remote rural area,
about 30 km away from the main campus. This center is
functioning with more than 20 medical and paramedical
staffs round the clock, providing both hospital-based
care and community-based care to the rural community.
Apart from this, this center is also functioning along with
the Government Primary Health Center (PHC), which is
located 100 feet away in terms of delivering government
health programs and training interns. This RHTC covers
10 villages around the health center. Individuals residing
in these 10 villages are enrolled in an electronic database
called CHIMS (Community Health Information Management
System).[8,9] CHIMS also captures self-reported morbidity
status like DM, HT, Asthma, etc.

Voluntary screening
In the view of observance of World Heart Day in September
2017, a voluntary screening and management program was
launched in August 2017 to screen the high-risk population
for various cardiovascular risk factors and the program was
named as CR-CHAMP (Chunampet Rural–Cardiovascular
Health Assessment and Management Program). Patients with
a history of HT and DM were invited to participate in this
program. Line of action was divided into two major parts, first
was Line listing and initial screening of high-risk individuals
for cardiovascular risk factors and the second was providing
special consultation on the day of World Heart Day.

Line listing and initial screening
Line listing of the high-risk individuals was extracted from the
already existing electronic database (CHIMS). After line listing,
participants were approached house to house and invited to
participate in this program, following detailing of the program.
Support from village head man also sought to disseminate this
information to the participants to participate in this program.
Nearby 3 villages (Illedu, Chunampet, and Kavanur) within
walkable distances (2 km) were invited to come to the center.
For the other distant villages, 2 days of camps were arranged
in each village to facilitate these individuals to participate in
this program. Oral consent was obtained before participation.
Data was collected with a pretested proforma containing
(i) demographic details, (ii) family history and common CVDs
risk factors including smoking, alcohol, DM, HT, etc., and
(iii) investigations including fasting serum for cholesterol
profile, urea, creatinine, thyroid-stimulating hormone (TSH),
fasting plasma sugar, and blood for hemoglobin. Hemoglobin
was tested using Sahli’s Hemoglobinometer method in RHTC.
Plasma and serum of each patient were collected in a separate
tube transferred from the village to RHTC. In RHTC, these
samples were centrifuged, separated, and transferred into
Eppendorf tubes. Then, the samples were transferred to main
campus (PIMS), where rest of the analysis was done. Even
though we have facility to analyze the tests in RHTC, samples
were transferred to main hospital for better reliability of the
test, because the main hospital labs are accredited with National
Accreditation for Testing and Calibration Laboratories (NABL)
(NABL ref no: MC 2629). Tests were performed using fully
Automated Chemistry Analyser (Cobas Integra 400 plus) and
Fully Automated Chemiluminescence Analyser (Cobas e411).
Creatinine tested bykinetic colorimetric assay based on the
Jaffé method, glucose tested byenzymatic reference method
with hexokinase, TSH tested based on Sandwich principle,
cholesterol and triglycerides by enzymatic-colorimetric
method, and HDL and LDL by homogeneous enzymatic
colorimetric assay.

Special consultation
After this initial screening, a special consultation was offered
to all those participated in the initial screening on the day
of World Heart Day (29th September 2017), where the
participants were invited to RHTC. Cardiologist, Diabetologist,

Newtonraj, et al.: CVD risk assessment in a rural India

Indian Journal of Endocrinology and Metabolism ¦ Volume 23 ¦ Issue 6 ¦ November-December 2019630

Ophthalmologist, and Neurologist consultations were
provided. All patients who have attended and unable to attend
were linked to Government Primary Health Center’s NCD
clinic for regular medications and follow-up. NCD clinic is a
special clinic on every Friday, running under National Health
Program (NPCDCS), in every PHCs to manage patients with
NCDs coming under their service area. This clinic is mainly
attended by patients diagnosed with DM, HT, or CVDs. In
Chunampet, NCD clinic is running in Government PHC with
the help and support of RHTC interns and doctors. In our
study, all the investigations, consultations, and medications
were provided free of cost as a service to rural community.
Patients required special attention were referred to tertiary
hospital (PIMS).

To carry out this program, a team of eight interns, three
Medical Social Workers (MSWs), and one lab technician
were formed and a 2 days training was imparted regarding
data collection, sample collection, separation, labelling of
samples, and transport of samples to PIMS. The whole activity
was supervised by two Assistant Professors from Department
of Community Medicine Qualified as MD in Community
Medicine. Ethical Committee approval was obtained from
PIMS ethical committee (Reference Number – RC-18/55) as
per Indian Council of Medical Research (ICMR) Guideline
2017.[10] Data entry and analysis: Data was double entered
using Epidata software V.3.1 and analysis and Chi-square
tests were done using SPSS Version 22.0.[11] Mapping of the
villages was done using QGIS Software, Version 2.18.16.[12]’

Operational definitions
Following operational definitions were used while analyzing
the data. Obesity: for Indian population, BMI 18.5 to 22.9 is
normal, 23 to 24.9 is considered as overweight, and BMI of
25 to 29.9 is considered as obese class 1 and ≥30 is considered
as obese class 2. Abdominal obesity: If waist circumference
is ≥90 cm for men and ≥80 cm for women. Waist Hip Ratio
(WHR): Normal WHR is <0.85 for women and <0.95 for men.[2]
High salt intake was defined as consuming salt more than 5 g
per day. Smoking was defined as usage of any smoke form of
tobacco products in the last 1 year and current alcoholic was
if a person consumed alcohol at least once in the last 1 year.[13]
Dyslipidemia: Following definitions were used based National
Cholesterol Education Program (NCEP) guidelines,[14,15]
Hypercholesterolemia—serum cholesterol levels ≥200 mg/dl
(≥5.2 mmol/l), Hypertriglyceridemia—serum triglyceride
levels ≥150 mg/dl (≥1.7 mmol/l), Low HDL cholesterol—
HDL cholesterol levels <40 mg/dl (<1.04 mmol/l) for
men and <50 mg/dl (<1.3 mmol/l) for women, High LDL
cholesterol—LDL cholesterol levels ≥130 mg/dl (≥3.4 mmol/l),
High total cholesterol to HDL‑C ratio: Total cholesterol to
HDL-C ratio of ≥4.5, Isolated hypercholesterolemia: Serum
cholesterol ≥200 mg/dl and triglycerides <150 mg/dl, Isolated
hypertriglyceridemia: Serum triglycerides ≥150 mg/dl and
cholesterol <200 mg/dl, Isolated low HDL‑C: HDL-C ≤40 mg/dl
(male) and ≤50 mg/dl (female) without hypertriglyceridemia
o r h y p e r c h o l e s t e r o l e m i a . M e t a b o l i c s y n d ro m e w a s

defined based on the International Diabetes Federation
Global Consensus Definition, where the individual must
have central obesity (waist circumference ≥90 cm for
men and ≥80 cm for women) with two or more of the
following four criteria (i) triglycerides 150 mg/dl or greater,
(ii) HDL-cholesterol <40 mg/dl in men and <50 mg/dl in
women, (iii) BP 130/85 mmHg or greater, and (iv) fasting
glucose 100 mg/dl or greater.[16,17] Estimated Glomerular
Filtration Rate (eGFR) was calculated using Chronic Kidney
Disease Epidemiology Collaboration (CKD-EPI) equation
and the participants having eGFR ≤60 ml/min/1.73 m2 were
classified as CKD.[18] Based on American Thyroid Association
and American Association of Clinical Endocrinologists
(ATA/AACE) guideline, hypothyroidsm was classified
based on TSH (Thyroid Stimulating Hormone) level, where
TSH>=10 is classified as Overt hypothyroidsm, 4.5–9.0 as
highly abnormal TSH, 2.5–4.4 as intermediate abnormal
and <2.5 as normal.[19] Based on WHO criteria, anemia was
classified as hemoglobin <13 mg/dl for men and <12 mg/dl
for women.[20]

Results
In a total of 415 cases line listed from CHIMS electronic
database, 389 were approached and invited for the screening
program. Among the 389 invited, 328 voluntarily participated
in the initial screening program (response rate = 84.3% for
initial screening), rest were either not available during our visit
or were not willing to participate. Among the 328 participated
in the initial screening, 235 were visited the RHTC for special
consultation (response rate for special consultation = 60.4%),
rest were either not interested or unable to attend the special
consultation on that specific day due to other commitments.

Line listing of Diabetes and Hypertension cases
from 10 villages (n = 415)

Invitation to participate in this programme, n = 389

Part 1: Initial Screening of Individuals (n = 328, response rate = 84.3%)
(a) Facility based screening for three villages
(b) Community based screening for seven villages
(c) Tool: Questionnaire, Fasting Blood sugar, Serum Creatinine, Cholesterol profile, Thyroid
Stimulating Hormone

26 were unable to contact

61 were not participated

303 data were included for
final analysis

Referred and managed through NCD clinic
Higher referral for cases required special attention

93 were not participated

Part 2: Special consultation (n-235)
Ophthalmologist, Cardiologist, Diabetologist
consultation.

25 data excluded (partial
and contains missing data)

Figure 1: Flow diagram of Chunampet rural–Cardiovascular health
assessment and management program (CR‑CHAMP)

Newtonraj, et al.: CVD risk assessment in a rural India

631Indian Journal of Endocrinology and Metabolism ¦ Volume 23 ¦ Issue 6 ¦ November-December 2019

Table 1: Sociodemographic and laboratory findings of the Diabetes (DM) and Hypertension (HT) patients in a
remote rural area of South India: Chunampet Rural‑Cardiovascular Health Assessment and Management Program
(CR‑CHAMP)

Variables n=303 HT only
n=102 n (%)

DM only
n=76 n (%)

Both DM&HT
n=125 n (%)

Overall
n=303 n (%)

Chi‑square

Gender 0.23
Male 28 (27) 29 (38) 46 (37) 103 (34)
Female 74 (73) 47 (62) 79 (63) 200 (66)

Occupation 0.46
Farming in own land 28 (27) 21 (28) 24 (19) 73 (24)
Farming as a daily wage 34 (33) 24 (32) 51 (41) 109 (36)
Others 40 (40) 31 (40) 50 (40) 121 (40)

Education 0.06
Illiterate 59 (58) 31 (41) 69 (55) 159 (52)
Literate 43 (42) 45 (59) 56 (45) 144 (48)

Percapita income 0.55
<=2000 67 (66) 51 (67) 85 (68) 203 (67)
2001-4000 28 (28) 20 (26) 37 (30) 85 (28)
>4000 07 (7) 05 (7) 03 (2) 15 (05)

Work-related physical activity 0.01
Sedentary 38 (40) 11 (16) 28 (24) 77 (28)
Moderate 48 (50) 51 (75) 76 (64) 175 (62)
vigorous 09 (10) 06 (09) 14 (12) 29 (10)
Smoker 30 (30) 09 (12) 30 (24) 69 (23) 0.02
Current alcoholic 11 (11) 05 (07) 16 (13) 32 (11) 0.40

BMI 0.56
Underweight 16 (16) 07 (9) 14 (11) 37 (12)
Normal 26 (25) 23 (30) 38 (30) 87 (29)
Overweight 18 (18) 18 (24) 16 (13) 52 (17)
Obese 42 (41) 28 (37) 57 (46) 127 (42)
Abdominal obesity 57 (56) 45 (59) 77 (62) 179 (59) 0.68
Waist-hip ratio above normal 56 (55) 43 (57) 70 (56) 169 (56) 0.97
High salt intake 79 (78) 49 (64) 99 (79) 227 (75) 0.05
Anemia 68 (67) 44 (58) 95 (76) 207 (68) 0.02

TSH levels 0.98
>=10 04 (04) 02 (03) 03 (03) 09 (03)
4.5-9.9 10 (10) 7 (09) 12 (09) 29 (10)
2.5-4.4 31 (30) 22 (29) 35 (28) 88 (29)
<2.5 39 (38) 32 (42) 57 (46) 128 (42)
Not tested 18 (18) 13 (17) 18 (14) 49 (16)
Hypercholestrolemia 44 (43) 39 (51) 58 (46) 141 (47) 0.55
Hypertriglyceridemia 33 (32) 33 (43) 55 (44) 121 (40)
Low HDL 75 (74) 52 (68) 81 (65) 208 (69) 0.37
High LDL 45 (44) 33 (43) 52 (42) 130 (43) 0.92
High Total Cholesterol-HDL ratio 59 (58) 46 (61) 74 (59) 179 (59) 0.93
Isolated Hypercholestrolemia 25 (25) 17 (22) 21 (17) 63 (21) 0.33
Isolated hyper triglyceridemia 14 (14) 11 (15) 18 (14) 43 (14) 0.98
Isolated low HDL-C 31 (30) 18 (24) 30 (24) 79 (26) 0.47
Metabolic syndrome 44 (43) 33 (43) 70 (56) 147 (49) 0.09
Chronic Kidney disease 14 (14) 08 (11) 19 (15) 41 (14) 0.64
CVD high risk 13 (13) 05 (07) 46 (37) 64 (21) <0.01

CVD Risk <0.01
<10% 60 (59) 60 (79) 52 (42) 172 (57)
10-<20% 29 (28) 11 (15) 27 (22) 67 (22)
20-<30% 05 (05) 04 (05) 24 (19) 33 (11)
30-<40% 02 (02) 00 (00) 08 (06) 10 (03)
40 and above 06 (26) 01 (01) 14 (11) 21 (07)
Bold: Chi-square – P<0.05 is significant

Newtonraj, et al.: CVD risk assessment in a rural India

Indian Journal of Endocrinology and Metabolism ¦ Volume 23 ¦ Issue 6 ¦ November-December 2019632

Among the data of 328 attended initial screening, 25 data were
excluded due to incomplete data and 303 were included for
analysis [Figure 1]. Characteristics of patients participated in
the study are shown in Table 1. Among 303 analyzed, “HT
only” participants were 102, “DM only” participants were 76,
and “DM and HT” participants were 125. If a participant is
initially line listed as known HT but has been newly diagnosed
as DM, then while analysis this participant was considered as
having both HT and DM and the same for known DM with
newly diagnosed HT. Among the studied variables, significant
association of HT only or DM only or HT and DM group
with CVD risk, anemia, smoking, and physical activity was
noted (P < 0.05).

dIscussIon
This is one of a unique study demonstrating the feasibility of
CVD risk screening among the high-risk individuals (HT and
DM), with the help of existing primary health care setting in
a remote rural area of South India. This study demonstrated
initial steps in assessing the CVD risk burden. This is a type
of translational research (moving from research to practice).

In our study, while assessing CVD risk based on WHO chart,
risk score was expected to be higher in this group as HT and
DM are one of the predictors while calculating CVD risk.
In our study higher CVD risk was found in 21%, which is
double when compared to general population.[21] Prevalence
of CKD (chronic kidney disease) was 14% in our study,
which is also two times higher than the prevalence in general
population of South India (6.3%).[22] As per Tamilnadu Kidney
Research Foundation study, Diabetic Nephropathy is the most
common cause in South India (31%), whereas hypertensive
nephrosclerosis contributes 13%.[23] In our study, nearly half of
the participants have deranged lipid profile and when compared
to a similar study from general population, the prevalence
is almost double in all the lipid profile parameters.[14]
Prevalence of metabolic syndrome (MS) is also higher in our
study group (49%). This HT, DM, and MS association is a
well-established one.[24,25] TSH level was abnormal (>=4.5)
among13% of the individuals. We have included TSH in our
study as recent evidences showing hypothyroidsm is one
of the important risk factors for CVDs.[19,26] Approximately,
10% of patients with type 1 diabetes mellitus will develop
chronic thyroiditis during their lifetime, which leads to the
insidious onset of subclinical hypothyroidism.[19] Anemia
was noted in more than two-third of the population (68%).
Anemia was more common among the “HT and DM group”
when compared to other groups (76%, P = 0.02). This is worse
than the national data from general population in rural area
of South India (56.9% for females and 24.3% for male).[27]
Anemia is one of the major issues in rural population. NCD
clinics will get additional opportunity to treat anemia based
on national guideline (Iron Plus Initiative- India and Anemia
Mukt bharat).[28,29] Lifestyle factors like sedentary physical
activity during work time (28%), high-salt intake (75%),
smoking (23%), and alcohol (11%) were found to be higher

in our study group. Prevalence of sedentary physical activity
during work time and smoking were more among the “HT only
group” (40%, P = 0.01 and 29%, P = 0.02). More attention
needs to be paid in these aspects while managing these
patients for better long-term outcomes.[30] More than half of
the participants were classified as obese in our study (abnormal
waist-hip ratio of 56%, abdominal obesity of 59%, overweight
and obese using BMI of 59%). This is an alarming risk factor
and is two times higher than the general population in the
same area (25%).[27] Females’ participation was higher (66%)
in our study when compared to males (34%), maybe because
females are available during our house visits and screening
camps in the village, whereas most of the males were going
out for work. In terms of health care seeking behavior, females
prefer local, culturally accepted, and easily accessible facilities.
In such situation, our study in rural areas provided additional
opportunity to mainstream and reduce gender bias in health
care-seeking.[31] This will also prevent the females from seeking
healthcare from illegal medical practitioners.

This screening could be replicated in a similar setting in India
and other parts of the world. India being a second populous
country, having 70% population in rural area, having more than
600 medical colleges both private and government and having
a mandatory Rural Health Training Centers in each medical
college as per government norms, most of the steps of this
program could be replicable in such settings with the help of
affiliated Medical Colleges.[32] Our study is also an example of
public-private partnership in rural area. For the Government
Primary Health Centers which are not affiliated with medical
colleges, even though entire procedure would not be replicable,
most of the initial screening steps could be replicable in their
rural setup with the help of grass root level workers [Accredited
Social Health Activists (ASHAs) and Auxiliary Nurses
Midwives (ANMs)] and with the help of medical team and
NCD clinics available in PHCs. Similar to developed countries,
our study also strengthens the emerging family medicine
concept in India. In this study, lab-based findings not only
helped in pharmacological management but also helped to
convince and counsel the patients in non-pharmacological
managements related to smoking, alcohol, exercise, and diet.
This type of accountability to the serving population will
have positive impact on reducing mortality and morbidity in
future. India being a major contributor of NCDs, this study will
help the policymakers to take policy decisions at rural health
care level to achieve global and national targets committed
in SDG, GAP, and NHP India. This study may also help the
policymakers to implement such a similar screening program
in RHTCs and PHCs.

An important limitation in our study was entire procedure may
not be replicable in other similar settings, as we got extensive
support from our medical college. Our study was mainly
directed toward finding out additional CVD risk factors among
already known HT and DM patients and a 1-day consultation
offers a limited treatment. This study has been done only in
one RHTC. As a way forward, this initiative may be tried

Newtonraj, et al.: CVD risk assessment in a rural India

633Indian Journal of Endocrinology and Metabolism ¦ Volume 23 ¦ Issue 6 ¦ November-December 2019

in multicentric setting in future. Patient’s treatment-seeking
behavior and response to the treatment could also be studied
in future. Future follow-up cohort has been started for these
patients to assess the outcome.

conclusIon
CR-CHAMP demonstrated the feasibility and value of
implementing a screening program for high-risk individuals
with CVD risk through an existing primary health care
setting in a remote rural area of South India. This will help
the National Health Program and policymakers to plan for
screening, intervention, and better management of major
NCDs in rural India.

Acknowledgement
We acknowledge following interns participated in this program
Leeann Esmeralda Zachariah, Goutham Kumar, Kitty Soosan,
Sushmita Cherian, Keerty Raj, Kasmira Robin George, Bennet
Joseph, Minitta Maria Regy.

Declaration of patient consent
The authors certify that they have obtained all appropriate
patient consent forms. In the form, the patients have given their
consent for their images and other clinical information to be
reported in the journal. The patients understand that their names
and initials will not be published and due efforts will be made
to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship
Nil.

Conflicts of interest
There are no conflicts of interest.

RefeRences
1. World Health Organization. Non Communicable Diseases country

Profile 2018 [Internet]. 2018. Available from: https://www.who.int/
nmh/publications/ncd-profiles-2018/en/. [Last cited on 2019 Aug 02].

2. Ministry of Helath and Family Welfare Government of India.
National Programme for Prevention and Control of Cancer, Diabetes,
Cardiovascular Diseases and Stroke. New Delhi; 2017.

3. World Health Organization. Global Action Plan for the Prevention
and Control of Noncommunicable Diseases 2013-2020. World Health
Organization; 2013.

4. Assembly G. Sustainable Development goals. SDGs), Transform our
world. 2015;2030.

5. World Health Organization. World Health Statistics 2016: Monitoring
Health for the SDGs Sustainable Development Goals. World Health
Organization; 2016.

6. Ministry of Helath and Family Welfare Government of India. National
Health Policy 2017 [Internet]. 2018. Available from: https://mohfw.gov.
in/sites/default/files/9147562941489753121.pdf.

7. Swaminathan K, Veerasekar G, Kuppusamy S, Sundaresan M,
Velmurugan G, Palaniswami NG. Noncommunicable disease in rural
India: Are we seriously underestimating the risk? The Nallampatti
noncommunicable disease study. Indian J Endocrinol Metab
2017;21:90-5.

8. Vincent A, Keerthana K, Damotharan K, Newtonraj A, Bazroy J,
Manikandan M. Health care seeking behaviour of women during
pregnancy in rural south India: A qualitative study. Int J Community
Med Public Heal 2017;4:36369.

9. Newtonraj A, Arun S, Bazroy J, Tovia S. Lay perspectives on causes

and complications of hypertension; and barrier to access health care by
known hypertensive patients: A qualitative study from a rural area of
South India. Int J Community Med Public Heal 2017;4:704-7.

10. Indian Council of Medical Research. National Ethical Guidelines
for Biomedial and Health Research Involving Human Participants
[Internet]. 2017. Available from: https://www.icmr.nic.in/sites/default/
files/guidelines/ICMR_Ethical_Guidelines_2017.pdf. [Last cited on
2019 Aug 07].

11. Epidata Association. Epidata Software [Internet]. 2014. Available from:
https://www.epidata.dk/about.htm#about. [Last cited on 2019 Aug 08].

12. QGIS Group. QGIS-The Leading Opensource Desktop GIS [Internet].
2019. Available from: https://qgis.org/en/site/. [Last cited on
2019 Aug 08].

13. World Health Organization. The STEPS Instrument and Support
Material [Internet]. 2016. Available from: http://www.who.int/chp/
steps/instrument/en/. [Last cited on 2019 Jun 25].

14. Joshi SR, Anjana RM, Deepa M, Pradeepa R, Bhansali A,
Dhandania VK, et al. Prevalence of dyslipidemia in urban and rural
India: The ICMR–INDIAB study. PLoS One 2014;9:e96808.

15. Expert Panel on Detection, Evaluation, and Treatment of High Blood
Cholesterol in Adults. Executive summary of the third report of the
national cholesterol education program (NCEP) expert panel on
detection, evaluation, and treatment of high blood cholesterol in adults
(Adult Treatment Panel III). JAMA 2001;285:2486-97.

16. International Diabetes Federation. The IDF Consensus Worldwide
Definition of Metabolic Syndrome [Internet]. 2006. Available from:
https://www.idf.org/component/attachments/attachments.html?id=705
&task=download. [Last cited on 2019 Nov 12].

17. Parikh R, Mohan V. Changing definitions of metabolic syndrome. Indian
J Endocrinol Metab 2012;16:7.

18. Levey AS, Stevens LA, Schmid CH, Zhang Y (Lucy), Castro AF,
Feldman HI, et al. A new equation to estimate glomerular filtration rate.
Ann Intern Med 2009;150:604.

19. Garber JR, Cobin RH, Gharib H, Hennessey JV, Klein I, Mechanick JI,
et al. Clinical practice guidelines for hypothyroidism in adults:
Cosponsored by the American Association of Clinical Endocrinologists
and the American Thyroid Association. Thyroid 2012;22:1200-35.

20. World Health Organization. Haemoglobin Concentrations for the
Diagnosis of Anaemia and Assessment of S

Anatomy homework help

Academic Medicine, Vol. 90, No. 1 / January 2015 25

Perspective

As of January 2014, 87% of American
adults use the Internet.1 A 2004 study
of health care professionals found that
64% use e-mail to communicate with
each other for work-related purposes.2
According to the Pew Research Internet
Project, 18- to 29-year-olds are the
most frequent e-mail users, so we can
expect this figure to increase as more
young physicians enter the workforce.1
Simultaneously, the Internet is becoming
increasingly accessible with the rising
prevalence of smartphones and porta ble
handheld devices.3 As e-mail is now a fre-
quent method of workplace cor re spon-
dence, it is imperative for users to have an
understanding of appropriate etiquette
and proper professional e-mail use.

Physicians use e-mail for a multitude
of purposes: to obtain consults, both
formal and “curbside”; communicate
with patients; collaborate on scholarly
projects; perform administrative duties;
and conduct routine communication.
E-mail technology also expands the scope

of telemedicine, allowing for remote
consultation, radiographic assessment,
and patient care. Facile e-mail use and
appropriate e-mail communication skills
are vital to this growing field.

The Case for Evidence-Based
E-mail Guidelines for Physicians

Imagine receiving an e-mail from a
colleague. There is no subject line. It
is written in all capital letters, uses
abbreviations or slang terminology and
poor grammar, employs questionable
humor, and even includes sensitive
patient details. Its origin is from
a personal e-mail account, not a
professionally affiliated account, and
its signature line is more suitable
for informal communications than
workplace correspondence (see Box 1 for
an example). Although this is an extreme
example, such an e-mail demonstrates
several features that may be deemed
unprofessional, and even illegal, while
highlighting the challenge of using e-mail
in a professional setting.

These issues are of tremendous
importance when e-mail is used for
communication between physicians
and patients. Maintaining a
professional rapport through electronic
correspondence and ensuring the security
and confidentiality of transmitted patient
data are paramount concerns. The
American Medical Association (AMA)

and American Medical Informatics
Association (AMIA) recognized these
challenges and have published consensus
guidelines for physician-to-patient e-mail
use.4,5

Despite the attention paid to physician-
to-patient e-mail use, there are no
evidence-based guidelines addressing
the use of e-mail among physicians.3
Many online sources and lay publications
promote guidelines for professional
e-mail etiquette; however, these
guidelines may not address the unique
needs of physicians. Serious legal and
ethical issues may arise when e-mail is
used between physicians that are not fully
covered by simple etiquette. Our goal is to
briefly summarize the literature relating
to professional e-mail use between health
care providers, to discuss the challenges
of e-mail use within health care, and
to offer our recommendations for
professional e-mail use.

Developing the Guidelines: A
Literature Search

To inform our development of
professional e-mail guidelines, a
comprehensive search of the literature
was performed by one of us, an
experienced medical librarian (T.W.E.),
using the following databases: Ovid
MEDLINE, PubMed (for non-MEDLINE
records), Embase, the Cochrane Library,
CINAHL, PsycINFO, Communication

Abstract

E-mail is now a primary method of
correspondence in health care, and
proficiency with professional e-mail use is
a vital skill for physicians. Fundamentals
of e-mail courtesy can be derived from
lay literature, but there is a dearth of
scientific literature that addresses the
use of e-mail between physicians. E-mail
communication between providers
is generally more familiar and casual
than other professional interactions,

which can promote unprofessional
behavior or misunderstanding. Not
only e-mail content but also wording,
format, and tone may influence clinical
recommendations and perceptions of
the e-mail sender. In addition, there are
serious legal and ethical implications
when unprofessional or unsecured
e-mails related to patient-identifying
information are exchanged or included
within an electronic medical record. The

authors believe that the appropriate
use of e-mail is a vital skill for
physicians, with serious legal and
ethical ramifications and the potential
to affect professional development
and patient care. In this article, the
authors analyze a comprehensive
literature search, explore several facets
of e-mail use between physicians, and
offer specific recommendations for
professional e-mail use.

Acad Med. 2015;90:25–29.
First published online August 26, 2014
doi: 10.1097/ACM.0000000000000465

Please see the end of this article for information
about the authors.

Correspondence should be addressed to Dr. Malka,
Department of Emergency Medicine, 1701 N. Senate
Blvd., AG012, Indianapolis, IN 46202; telephone:
(317) 777-3196; e-mail: sarahterez@gmail.com.

Professional E-mail Communication Among
Health Care Providers: Proposing Evidence-
Based Guidelines
S. Terez Malka, MD, Chad S. Kessler, MD, MHPE, John Abraham, MD,
Thomas W. Emmet, MD, MLS, and Lee Wilbur, MD

Perspective

Academic Medicine, Vol. 90, No. 1 / January 201526

& Mass Media Complete, and Google
Scholar. Searches were conducted
between October 3 and 12, 2012, and all
databases were searched from inception.
We also reviewed bibliographies of
relevant studies for additional references.
Database-specific subject headings
and keyword variants for each of the
three main concepts—electronic mail,
communication, and physicians—were
identified and combined (detailed search
strategy available upon request). We
limited results to the English language,
but no other limits were applied.
Ultimately, 4,185 titles and abstracts
were independently reviewed by two

of us (T.M. and J.A.) for relevance.
We identified 15 articles that directly
discussed interprofessional physician
e-mail use: 9 editorials or commentaries
and 6 journal articles.

Benefits and Drawbacks of E-mail
Use in an Inpatient Setting

We identified three studies that surveyed
physicians and nurses using e-mail for
communication in an inpatient setting.
O’Connor and colleagues6 performed a
survey of providers within an intensive
care unit communicating by e-mail over
an encrypted cellular network via portable

handheld device. Wu and colleagues7
performed a mixed-method assessment of
nursing and physician communication via
handheld wireless device on an inpatient
medicine service. A third survey-based
study by Singarella and colleagues8
assessed physician opinions on e-mail use
and also analyzed the content of e-mails
sent. Across all studies, survey respondents
reported that response times were more
rapid and e-mail was easier to use than
alternative methods such as written
correspondence, phone calls, and paging.
Over 90% of those surveyed by O’Connor
and colleagues6 felt that patient care was
improved as a result of e-mail use because
of the efficiency of e-mail communication.

Several negative impacts of e-mail
use were also identified by survey
respondents. E-mail was deemed to
be less efficient when subject matter
was complex, requiring more than one
initial e-mail and reply. There was also
frequent discordance between senders’
and recipients’ perceptions of a message’s
urgency. Singarella and colleagues8 noted
that e-mail users uniformly assumed
a more casual tone and were more apt
to make grammatical errors than those
communicating by telephone or in writing.
The most frequently cited negative impact
in these studies was a reduction in face-
to-face communication which potentially
weakened interpersonal relations.6–8

A further concern is the security of
transmitted patient information.
Although these studies explored the use
of e-mail on handheld devices provided
by the hospital, none commented
explicitly on how these devices were
encrypted and secured. None of the
studies specify if the messages sent on
these devices assume a formal place
within the patients’ charts or electronic
medical records (EMRs). Discussion of
a patient’s condition with a “casual tone”
or in an e-mail fraught with grammar
errors is concerning if these e-mails are
considered a part of the EMR. If e-mails
are not included within the patient
record, care must be taken to document
these communications when they lead to
a change in management plan or affect
the patient’s clinical care.

The question of e-mail use in the
inpatient setting highlights both positive
and negative elements of workplace
e-mail. In the studies we reviewed, users
of e-mail for communication within

Box 1
Before-and-After Examples of Workplace E-mail Communications, Illustrating
Unprofessional and Professional Tone and Components

Example 1: Inappropriate use of workplace e-mail

————————————————————————————————

From: doctorawesome@aol.com

To: orthorules@hotmail.com

Hey

THIS IS JOE FROM THE ER. GOT A PT FOR U!! HAHA I KNO U ORTHO DOCS LOVE A BROKE BONE,
AND THIS ONE HAS 2 LOL! TIB/FIB FRACS. 60 yo named Ned Carson, fall dwn stairs

Later

Joe

DR. JOE ACULA

ER PHYSICIAN

“A flower cannot blossom without sunshine, and man cannot live without love.” —Max Muller

————————————————————————————————

Example 2: Appropriate use of workplace e-mail

————————————————————————————————

From: EMphysician@hospital.edu

To: orthodoc@hospital.edu

Subject: consultation

Dear Dr. Smith,

Good evening, I wanted to consult you regarding a patient (see encrypted attachment for name
and medical record number). He is a 60-year-old male, with a history of hypertension who fell
down three steps today at home, sustaining a displaced right tibia-fibula fracture. Please call me
directly if you need additional information. Thank you.

Regards,

Joe Acula, MD

General Hospital Emergency Department

555-555-5555

————————————————————————————————

Perspective

Academic Medicine, Vol. 90, No. 1 / January 2015 27

inpatient teams felt that e-mail improved
their efficiency and had a positive impact
on speed and ease of communication.
However, issues with professionalism
were identified in all three studies.
Primary areas of concern were the casual
tone of e-mail use, the lack of timely
response to e-mails perceived as urgent,
and the resulting decrease in verbal
communication. We believe that these
studies emphasize the need to maintain
professional formality in workplace
e-mail communications, and we suggest
that e-mail should be avoided when the
issue is complex or time-sensitive. In
addition, when e-mail is used specifically
for the purpose of communicating
secure patient data, specific hospital
guidelines should be in place to ensure
the confidentiality of these transmissions
and to address the appropriate
documentation of these transactions
within the patient medical record.

How E-mail Composition May
Affect Professional Reputation

Our literature review also pointed toward
further consequences of unprofessional
versus professional e-mail use. A study of
surgery residents published in the Journal
of Surgical Education sent 100 e-mail
examples to physicians in training.9
The most negatively rated features were
the presence of a colored background,
atypical fonts, lack of a subject line,
and lack of a formal salutation. E-mails
containing these negatively perceived
characteristics were “likely to result in
a negative perception of the sender and
delays in response time.” Conversely,
respondents were more likely to perceive
senders as professional and pleasant when
they sent e-mails that employed positively
perceived features such as a descriptive
subject line, formal greeting and closing
line, and proper grammar and spelling.

This study demonstrated that attention
to e-mail composition is critical to
professional reputation. E-mail wording
and formatting affected not only the
receivers’ perception of the sender but
also the likelihood of a timely response.
Therefore, we recommend that medical
students receive training in composing
professional e-mails and timely
feedback when unprofessional e-mail
characteristics are identified. Further,
physicians should be aware of poorly
regarded e-mail features and strive to
avoid them in work-related e-mails.

A Call for Formality

The studies summarized above confirm
the importance of appropriate e-mail use
and raise crucial issues of basic etiquette,
professionalism, patient confidentiality,
and legal concerns. The majority of
scholarly articles that we reviewed
discussing appropriate use of e-mail are
opinion based or anecdotal and offer
commonsense recommendations for
professional e-mail use that address some
of the above concerns. These guidelines
mirror the common professional e-mail
use guidelines suggested in business
literature and make intuitive sense. In
specific, authors recommend maintaining
a high degree of formality when using
e-mail for work-related correspondence
and note that current e-mail use is
predominantly casual.

We believe that observing these common-
sense etiquette guidelines and erring
towards formality in work-related e-mail
communications is best practice. Some
specific suggestions relating to formality
include avoiding background colors,
unusual text patterns, abbreviations, and
“emoticons.” E-mails should be proofread
for proper grammar and spelling prior to
sending.10–17 See Box 1 for a revised e-mail
that incorporates these recommendations.

HIPAA, EMRs, and Protected
Patient Data

The U.S. Department of Health and
Human Services defines protected health
information as all “individually identifiable
health information” that is stored or
transmitted in any form, including
electronic.18 Persons or institutions
who fail to ensure the confidentiality
of protected health information are
subject to criminal penalty. However,
the Health Information Portability and
Accountability Act (HIPAA) makes no
clear specifications as to which privacy
features (such as encryption software
or secured networks) are considered
adequate. This leaves ambiguity in the use
of e-mail for transmitting patient data. For
example, you may open an appropriately
encrypted e-mail within your personal
e-mail and then save that message to your
inbox or to your personal laptop, or you
may inadvertently forward an e-mail
containing protected patient data to an
unintended recipient. Smartphones and
other personal handheld devices present
additional concerns—for example, if you

bring your hospital handheld device home
with you in the evening or check your
work-related e-mail in a public location.
The privacy of even securely encrypted
data is of concern in an age of hacking,
computer viruses, and piracy.

The AMIA and AMA attempted to
address some of these inconsistencies
by establishing guidelines for the
use of e-mail in physician-to-patient
communication.4,5 Although these
guidelines were not specifically targeted
to physician to physician communication,
they are the only available evidence-based
guidelines that discuss the protection
of electronically transmitted patient
data. More and more physicians are
using e-mail to discuss patient care or
to share clinical information; therefore,
these guidelines are pertinent to inter-
professional e-mail use as well as com-
munication between physicians and
patients.2

AMIA recommends that printed
guidelines should exist within each
practice that clearly detail the security
mechanisms in place. No correspondence
containing protected patient data should
occur outside of these established security
mechanisms. AMIA further suggests
that e-mail should never be left open
on a workstation screen, that e-mails
containing patient data may never be
forwarded without written permission
from the patient, and that all e-mails
containing patient data be clearly listed
as confidential in the subject or top of the
e-mail message.

Anecdotal accounts suggest that e-mail
containing protected patient data is
routinely being exchanged between
physicians via e-mail with none of the
above safeguards in place. All of us,
for instance, have personally received
unsecured patient information via e-mail
during the preparation of this article.
This is clearly a tremendous professional
liability as well as a medicolegal risk. We
recommend that every institution provide
clear guidelines for acceptable methods of
transmitting secured patient data via e-mail,
based on the AMIA/AMA guidelines, and
that physicians take every effort possible
to ensure the security of patient data when
discussing patients via e-mail.

An additional area of uncertainty is the
documentation of e-mail correspondence.
E-mail is routinely used within the

Perspective

Academic Medicine, Vol. 90, No. 1 / January 201528

workplace for obtaining consults, sharing
interesting cases, providing changeover,
and discussing general patient care.2
In the studies of inpatient team e-mail
use, the transmitted messages were not
necessarily included in the EMR. These
undocumented conversations become a
concerning “blind spot” within the EMR
or paper chart if patient care decisions
result from those interactions. In the event
that these messages are included verbatim
in the EMR, care must be made to ensure
that the content is professional and formal
in nature, which was not the case in the
studies that observed inpatient team e-mail
use.6–8 Additional research is indicated
to fully understand the legal and ethical
risks of using e-mail for the transmission
of patient data and to provide guidelines
for appropriate documentation of e-mail
correspondence within the patient medical
record—electronic or print.

Avoiding the Potential
Ambiguity of E-mail

Another concern noted throughout
the literature and also addressed in the
AMIA/AMA guidelines is the increased
potential for misunderstanding when
communication occurs primarily over
e-mail. With no facial expression, vocal
inflection, or opportunity for real-time
clarification, elements such as humor
may easily be misinterpreted, and an
angry or firm e-mail may come across
more harshly than intended.

A benefit of e-mail is that it is fast
and convenient. The downside to this
accessibility is that it is very easy to
compose an emotional e-mail in the heat
of the moment or a thoughtless e-mail
carelessly that may not convey your
intended message. The AMIA task force
cautions that “irony, sarcasm, and harsh
criticism should not be attempted in
e-mail messages” because “the impersonal
nature and ambiguity of e-mail often
results in real or imagined exaggeration
of animosity toward the recipient.”5

The casual nature of e-mail may also
predispose clinicians to send offhand or
glib e-mails. While unprofessional remarks
are never appropriate in a work setting,
there is an added danger to expressing
these sentiments by e-mail. Comments
that once would have been a casual aside
now may be stored on a hard drive forever,
or within a patient’s EMR, or forwarded
in error to an unintended recipient. Kane

and Sands5 note that “‘deleted’ messages
containing disparaging, flippant, or
incriminating remarks have come back
to haunt physicians.” It is important for
clinicians to be aware that even personal
e-mails may be stored on a central hospital
hard drive, monitored, or available for
retrieval by cellular service providers.

Summary of Recommendations

On the basis of analysis of the available
literature as well as our personal
observations, we suggest a formal set of
evidence-based guidelines for the use of
e-mail in a professional setting:

1. Proofread each e-mail for
proper spelling, grammar, and
punctuation.11,13,15–17

2. Use a meaningful subject line that is
descriptive of e-mail content.10,12,13,15–17

3. Avoid background colors, patterns, all
capitals, and unusual fonts.9–12,14,16,17

4. Avoid humor that may be
misinterpreted.11–13,15

5. Don’t send an e-mail to the wrong
person; be especially careful with reply
all and mass forwarding.11,12,15–17

6. Don’t send emotionally charged
e-mails; consider a direct conversation
for complex or sensitive topics.11–13,17,18

7. Transmit protected patient data
cautiously using a private or secured
computer or handheld device via an
encrypted, secured network. Avoid
sending such data to or from a public
e-mail service such as Gmail, Yahoo,
or Hotmail.4,5

Concluding Remarks

The topic of e-mail communication
between health care providers has been
broadly discussed but, to our knowledge,
is underresearched. Our review of the
literature did not reveal any formal
guidelines or curricula for e-mail use
among physicians. Although e-mail is fast
and convenient, this accessibility has led
to a decrease in formality and increase in
errors and unprofessional behavior. E-mail
recipients form perceptions of e-mail
senders based on the format, content,
and tone of their e-mails. An e-mail that
is perceived as unprofessional may be
less likely to receive a response or may
receive a different response than one that
follows etiquette guidelines. In addition,

serious medicolegal and ethical concerns
arise when e-mails contain patient data or
unprofessional remarks. The appropriate
use of e-mail has the potential to affect
one’s professional reputation and to
influence clinical, and potentially legal,
outcomes. The recommendations we make
for interprofessional e-mail use are based
on the literature review and analysis above.

Funding/Support: None reported.

Other disclosures: None reported.

Ethical approval: Reported as not applicable.

Dr. Malka is assistant professor, Department of
Emergency Medicine, Department of Pediatric
Emergency Medicine, Carolinas Medical Center,
Charlotte, North Carolina.

Dr. Kessler is consulting associate, Department
of Emergency Medicine, Department of Internal
Medicine, Duke University Medical Center, and
deputy chief of staff, Department of Emergency
Medicine, Durham VA Medical Center, Durham,
North Carolina.

Dr. Abraham is a resident physician, Department
of Emergency Medicine, Duke University Medical
Center, Durham, North Carolina.

Dr. Emmet is medical librarian, Ruth Lilly Medical
Library, Indiana University School of Medicine,
Indianapolis, Indiana.

Dr. Wilbur is vice chair and professor, Department
of Emergency Medicine, University of Arkansas for
Medical Sciences, Little Rock, Arkansas.

References
1 Pew Research Internet Project. Internet User

Demographics. http://www.pewinternet.org/
data-trend/internet-use/latest-stats/. Accessed
July 3, 2014.

2 Brooks RG, Menachemi N. Physicians’ use
of email with patients: Factors influencing
electronic communication and adherence to
best practices. J Med Internet Res. 2006;8:e2.

3 Pappas Y, Atherton H, Sawmynaden P, Car J.
Email for clinical communication between
healthcare professionals. Cochrane Database
Syst Rev. 2012;9:CD007979.

4 American Medical Association. Opinion
5.026: The Use of Electronic Mail. Based on
Ethical Guidelines for the Use of Electronic
Mail Between Patients and Physicians. http://
www.ama-assn.org/ama/pub/physician-
resources/medical-ethics/code-medical-ethics/
opinion5026.page. Accessed June 18, 2014.

5 Kane B, Sands DZ. Guidelines for the clinical
use of electronic mail with patients. The
AMIA Internet Working Group, Task Force
on Guidelines for the Use of Clinic-Patient
Electronic Mail. J Am Med Inform Assoc.
1998;5:104–111.

6 O’Connor C, Friedrich JO, Scales DC,
Adhikari NK. The use of wireless e-mail to
improve healthcare team communication. J
Am Med Inform Assoc. 2009;16:705–713.

7 Wu R, Rossos P, Quan S, et al. An evaluation
of the use of smartphones to communicate
between clinicians: A mixed-methods study.
J Med Internet Res. 2011;13:e59.

Perspective

Academic Medicine, Vol. 90, No. 1 / January 2015 29

8 Singarella T, Baxter J, Sandefur RR, Emery
CC. The effects of electronic mail on
communication in two health sciences
institutions. J Med Syst. 1993;17:69–86.

9 Resendes S, Ramanan T, Park A, Petrisor
B, Bhandari M. Send it: Study of e-mail
etiquette and notions from doctors in
training. J Surg Educ. 2012;69:393–403.

10 Bergus GR, Emerson M, Reed DA, Attaluri A.
Email teleconsultations: Well formulated clinical
referrals reduce the need for clinic consultation.
J Telemed Telecare. 2006;12:33–38.

11 Adubato S. Communicating in a high-tech
world. MD Advis. 2008;1:38–41.

12 Solomon GL. E-mail etiquette. Med Econ.
2001;78:61–62, 64, 66.

13 Kauffman M. Don’t hit send! Biomed
Instrum Technol. 2008;42:412.

14 DeVille K, Fitzpatrick J. Ready or not, here
it comes: The legal, ethical, and clinical
implications of e-mail communications.
Semin Pediatr Surg. 2000;9:24–34.

15 Jackson VP, Hennon DB. A primer on e-mail
etiquette. J Am Coll Radiol. 2004;1:712–714.

16 O’Brien JA. Netiquette: E-mail for group
practices. J Med Pract Manage. 2007;22:
201–203.

17 Hills L. E-mail netiquette for the
medical practice employee: 50 do’s and
don’ts. J Med Pract Manage. 2011;27:
112–117.

18 U.S. Department of Health and Human
Services. Summary of the HIPAA Privacy
Rule. http://www.hhs.gov/ocr/privacy/
hipaa/understanding/summary/index.html.
Accessed June 19, 2014.

Anatomy homework help

Running head: Human Anatomy Education 1

Human Anatomy Education 6

The effectiveness of use plastinated prosections on student perception in human anatomy course

Background of the study

In a very long time, the role of human anatomy education in the development of preservation methods for educational prosection in the curriculum has considerably changed. In a number of schools, the active dissection of cadaveric specimens is slowly getting replaced by the methods of prosection and the e-learning resources. Recently, medical schools have been obtaining a big number of plastinated prosections collection so that they can replace the cadaveric specimens in the study of anatomy among the undergraduates (Bradbury & Hoshino, 2018). Plastination method was developed revolutionizing the use of the cadaveric specimens. This method includes removal of water and fats which are later replaced by curable polymers which results to odorless, dryness and durability of the specimens. These inventions and innovations have not only led to the extension of the educational processes in the medical environment, but have also opened new avenues for more development in the field (Hammer, et al.2012).

As much as many institutions have added plastinated prosections as a factor to consider in the teaching of undergraduate education, little attempts have been put in place to determine the effectiveness of using plastinated prosections on students’ knowledge acquisition and long term retention in anatomy education. Moreover, there is lack of studies to evaluate the efficacy of plastinated prosection in the comprehensive understanding of the human anatomy. Therefore, the aim is to determine the efficacy of using plastinated prosection on students’ perception in human anatomy course.

Purpose of the study

The purpose of the study is to assess plastinated prosection method on students’ knowledge acquisition in teaching of human anatomy. In order to understand the plastinated prosection method, the study has to be carried out to compare the traditional methods to the modern methods and rate how the students would understand human anatomy in different methods of educational prosection.

Significance of the study

Most schools have moved to the new methods of preservation in educational prosection. This has led to reduction in the hours that allocated to cadaver dissection as the cadaver dissection is being replaced by simulators and only prosections. These developments in the prosection methods will make it easy for students to understand the whole idea of prosection in details.

Most of the teachers claim that since they started their careers, the incorporation of the new methods in education of prosection to complement the traditional ways of teaching anatomy has helped the students to have a positive approach in learning and makes the students to understand the human body more (Ikeda, et al. 1988).

Objectives of the research and hypotheses

1. To assess outcomes of using the plastinated prosection on student’s perception in human anatomy education

2. To outline the advantages of usage plastinated prosection in human anatomy education.

3. To outline the issues that are involved in choosing the plastinated prosection in anatomy education .

4. To identify the key areas that are involved in the study of preservation methods in prosection.

Methodology

For the study to be successful different methods will be employed. A questionnaire will be developed by different groups of the teaching faculty and then they will be distributed online to the students who study human anatomy to get their response in the plastinated prosection methods of human anatomy. The students will be required to fill the questionnaires anonymously. In the questionnaires, the students will be required to fill information regarding their previous experience with cadaveric specimens, different methods used in cadaveric preservation such as plastinated prosection They will also be asked their view in the learning of human anatomy in general.

After the questionnaire exercise, purposeful sampling will be carried out to recruit students for the purpose of focus. An email will be sent to the students inviting them to attend to the sessions where they will be required to carry out some experiments to determine the different methods of preservation of educational prosection. They will be later put in groups to discuss the following questions:

1. Discuss the experience in learning anatomy with wet cadaveric specimens.

2. Discuss the experience in learning anatomy with plastinated prosection .

The audios will be recorded for the group discussions for future reference.

Conclusion

In conclusion, it is time to evaluate the efficiency of using plastinated prosection on student knowledge acquisition. Several preservation methods can be adopted in the study of prosection in the human anatomy so as to carry out different purposes. The use of body coolers by the use of low temperatures and the use standard high formalin concentrated formulae are just a few of the examples of preservation that have been in use and are evolving as time changes. There are also researches being carried out in order to come up with other and better methods that will bring solution to most of the problems. It is clearly seen the developments of methods of preservation for educational prosection and their impact to the students and teachers as well. They have a lot of learning positive effects and there is need of inventing other methods to make educational prosection more interesting to not only the learners but also the teachers.

References

Bradbury SA, Hoshino K.(2018) An improved embalming procedure for long-lasting preservation of the cadaver for anatomical study. Acta Anat (Basel);101:97-103.

Frølich KW, Andersen LM, Knutsen A, et al. (2014) Phenoxyethanol as a nontoxic substitute for formaldehyde in long-term preservation of human anatomical specimens for dissection and demonstration purposes. Anat Rec;208:271-278.

Ikeda A, Ugawa A, Kazihara Y, et al. (1988) Arterial patterns in the hand based on a three-dimensional analysis of 220 cadaver hands. J Hand Surg; 13:501-509.

Hammer N, Loffler S, Feja C, et al.(2012) Ethanol-glycerin fixation with thymol conservation: a potential alternative to formaldehyde and phenol embalming. Anat Sci Educ;5:225-233.

Shi KQ, Shao SX, Yin WG. (2018) An improved non-formaldehyde tissue p r e s e r v a ti v e . Ad v Ma t Re s;356:360-363.

Anatomy homework help


Digestive System GIPHY assignment

Make a GIPHY using hand drawn images showing the different parts of the alimentary canal (i.e the esophagus, stomach, small and large intestine). Also show the lesser and greater omenta and the mesentery in your GIPHY. It is important that used images are hand drawn by  you and not copied and pasted from the internet. 

Anatomy homework help

TECHNICAL WRITING

A L L I S O N G RO S S , A N N E M A R I E H A M L I N , B I L LY M E RC K , C H R I S RU B I O, J O D I N A A S ,

M E G A N S AVAG E , A N D M I C H E L E D E S I LVA

Open Oregon Educational Resources

Technical Writing by Allison Gross, Annemarie Hamlin, Billy Merck, Chris Rubio, Jodi Naas, Megan Savage, and Michele DeSilva is
licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License, except where otherwise
noted.

C O N T E N T S

Acknowledgements vii

External Link Disclaimer viii

CC BY (Attribution)
Introduction 1

1. PROFESSIONAL COMMUNICATIONS

1.1 Texting 7

1.2 E-mail 8

1.3 Netiquette 10

1.4 Memorandums 12

1.5 Letters 15

2. AUDIENCE ANALYSIS

2.1 Types of audiences 21

2.2 Audience analysis 22

2.3 Adapting your writing to meet your audience’s needs 24

3. PROPOSALS

3.1 Some preliminaries 29

3.2 Types of proposals 30

3.3 Typical scenarios for the proposal 31

3.4 Common sections in proposals 32

3.5 Special assignment requirements 34

3.6 Proposals and audience 35

3.7 Revision checklist for proposals 36

4. INFORMATION LITERACY

4.1 Information formats 39

4.2 The information timeline 42

4.3 The research cycle 43

4.4 Research tools 44

4.5 Search strategies 49

4.6 Evaluate sources 55

5. CITATIONS AND PLAGIARISM

5.1 Citations 61

5.2 Plagiarism 65

6. PROGRESS REPORTS

6.1 Functions and Contents of Progress Reports 69

6.2 Timing and Format of Progress Reports 70

6.3 Organizational Patterns or Sections for Progress Reports 71

6.4 Other Parts of Progress Reports 72

6.5 Revision Checklist for Progress Reports 73

7. OUTLINES

7.1 Creating and using outlines 77

7.2 Developing the rough outline 79

8. CREATING AND INTEGRATING GRAPHICS

8.1 Deciding which graphics to include 83

8.2 Other considerations: audience 84

8.3 Other considerations: placement and context 86

8.4 Samples 87

8.5 Guidelines for graphics: a final review 90

9. ETHICS IN TECHNICAL WRITING

9.1 General Principles 95

9.2 Presentation of information 98

9.3 Typical Ethics Issues in Technical Writing 99

9.4 Ethics and documenting sources 102

9.5 Ethics, Plagiarism, and Reliable Sources 103

9.6 Professional ethics 104

10. TECHNICAL REPORTS: COMPONENTS AND DESIGN

10.1 Cover letter 107

10.2 Cover page 108

10.3 Abstract and executive summary 110

10.4 Table of contents 113

10.5 List of figures and tables 115

10.6 Introduction 117

10.7 Body of the report 119

10.8 Conclusions 124

11. BASIC DESIGN AND READABILITY IN PUBLICATIONS

11.1 On Style Conventions 133

11.2 Concept 1: Know Your Audience 135

11.3 Concept 2: Know your Purpose 141

11.4 Concept 3: Make Your Publication More Inviting Using Basic Principles of
Readability: CRAP

143

11.4 Concept 3: Make Your Publication More Inviting Using Basic Principles of
Readability: CRAP, continued

163

11.4 Concept 3: Make Your Publication More Inviting Using Basic Principles of
Readability: CRAP, continued

168

11.4 Concept 3: Make Your Publication More Inviting Using Basic Principles of
Readability: CRAP, continued

173

11.5 Slides and PowerPoint presentations 179

11.6 Conclusion 181

12. EMPLOYMENT MATERIALS

12.1 Preparation 185

12.2 Resume Formats 189

12.3 Resume Sections and Guidelines 195

12.4 Cover Letters 201

12.5 Next Steps 204

13. COMMUNICATING ACROSS CULTURES

13.1 Understanding Culture 209

13.2 Understanding Cultural Context 211

13.3 Deepening Cultural Understanding 212

13.4 Defining Intercultural Communication 214

14. THINKING ABOUT WRITING

14.1 Getting Curious 219

14.2 Genre, Genre Sets, Genre Systems 221

14.3 Methods for Studying Genres 228

14.4 Conclusion 236

AC K N O W L E D G E M E N T S

About this free online technical writing textbook

Much of this text, published under a Creative Commons license, was originally developed by Dr.

David McMurrey, who is both a technical writer and a college instructor. For more about him and his

original work, please visit his biography page at: https://www.prismnet.com/~hcexres/index.html.

He kindly gave his text a CC-BY license at our request so that we could adapt our text from it. We

extend our sincere appreciation to Dr. McMurrey, the team of consultants at Saylor University whose

work shared via open educational resources is also featured in this text, and the host of educators,

librarians, and professionals who have shared their creations with a Creative Commons license. Our

thanks as well to our colleague, Dr. Eleanor Sumpter-Latham, whose work we consulted and adapted

into this text.

Additional materials have been adapted or created by Annemarie Hamlin, Chris Rubio, and Michele

DeSilva of Central Oregon Community College, and Megan Savage, Jodi Naas, Allison Gross,

and Billy Merck of Portland Community College.

We also extend our gratitude to Open Oregon Educational Resources for the grant funding to

pursue this project and especially to Amy Hofer of Open Oregon for her knowledgeable and helpful

answers to many questions.

TECHNICAL WRITING vii

E X T E R N A L L I N K D I S C L A I M E R

This textbook links to external websites over which the authors have no control. The authors have

made efforts to ensure that external links are accurate and operational, but problems are inevitable. If

you find a problem, please report it to Michele DeSilva at michele.desilva@gmail.com.

viii ALLISON GROSS, ANNEMARIE HAMLIN, BILLY MERCK, CHRIS RUBIO, JODI NAAS, MEGAN SAVAGE, AND MICHELE DESILVA

I N T RO D U C T I O N

Technical writing courses introduce you to some of the most important aspects of writing in the

worlds of science, technology, and business—in other words, the kind of writing that scientists,

nurses, doctors, computer specialists, government officials, engineers, and other such people do as a

part of their regular work. The skills learned in technical writing courses can be useful in other fields

as well, including education and social sciences.

To learn how to write effectively for the professional world, you will study common types of

reports, special format items such as lists and headings, simple techniques for creating and using

graphics in reports, and some techniques for producing professional-looking final copy.

Technical writing courses build on what you have learned in other writing courses. But there is

plenty new to learn! If you currently have a job in which you do some writing, you will discover that

you can put what you learn in your technical writing course to immediate use.

A B O U T T E C H N I C A L W R I T I N G

While technical communication is essential in a wide range of fields and occupations, technical

writing is also a fully professional field of its own with degree programs, certifications,

and—yes!—even theory. It is a good field with a lot of growth and income potential, and an

introductory technical writing course is a good way to start if you are interested in a career in this

field or will work in a career in which writing is a component.

W O R K P L AC E W R I T I N G

However, many students of technical writing courses are not necessarily planning for a career as a

technical writer. That is why this course provides you with an introduction to the kinds of writing

skills you need in practically any technically oriented professional job. No matter what sort of

professional work you do, you are likely to do some writing—and much of it may be technical in

nature. The more you know about some basic technical writing skills, the better job of writing you’re

likely to do. And that will be good for the projects you work on, for the organizations you work in,

and—most of all—good for you and your career.

T H E M E A N I N G O F “ T E C H N I C A L”

Technical communication—or technical writing, as the course is often called—is not writing about a

specific technical topic such as computers, but about any technical topic. The term “technical” refers

to knowledge that is not widespread, that is more the territory of experts and specialists. Whatever

your major is, you are developing an expertise—you are becoming a specialist in a particular technical

TECHNICAL WRITING 1

area. And whenever you try to write or say anything about your field, you are engaged in technical

communication.

I M P O RTA N C E O F AU D I E N C E

Another key part of the definition of technical communication is the receiver of the information—the

audience. Technical communication is the delivery of technical information to readers (or listeners

or viewers) in a manner that is adapted to their needs, level of understanding, and background. In

fact, this audience element is so important that it is one of the cornerstones of this course: you are

challenged to write about technical subjects but in a way that a beginner—a nonspecialist—could

understand. This ability to “translate” technical information to nonspecialists is a key skill to any

technical communicator. In a world of rapid technological development, many people are constantly

falling behind. Technology companies are constantly struggling to find effective ways to help

customers or potential customers understand the advantages or the operation of their new products.

So relax! You don’t have to write about computers or rocket science—write about the area of

technical specialization you know or are learning about. And plan to write about it in such a way that

even Grandad can understand!

R E A L LY T E C H N I C A L W R I T I N G

Keep relaxing, but you should know that professional technical writers do in fact write about very

technical stuff—information that they cannot begin to master unless they go back for a Ph.D. But wait

a minute! The technical documents have to ship with the product in less than nine months! How do

they manage? Professional technical writers rely on these strategies to ensure the technical accuracy

of their work:

• Study of books, articles, reports, websites related to the product

• Product specifications: what the product is supposed to do, how it is designed

• Interviews with subject matter experts: the product specialists, developers, engineers

• Product meetings during the development cycle

• Live demonstrations of the product

• Familiarization with similar, competing products

• Experimenting with working models of the product

• Subject matter experts’ review of technical writers’ work for technical accuracy and completeness

Of course, experienced technical writers will tell you that product development moves so fast that

specifications are not always possible and that working models of the product are rarely available.

That’s why the subject matter experts’ review is often the most important.

T E C H N I C A L- W R I T I N G A N D AC A D E M I C W R I T I N G C O U R S E S

You have probably taken at least one academic writing course before this one, so you will be familiar

with some of the practices of writing for your college classes. The video below will introduce you to

some of the differences between academic and technical writing.

2 ALLISON GROSS, ANNEMARIE HAMLIN, BILLY MERCK, CHRIS RUBIO, JODI NAAS, MEGAN SAVAGE, AND MICHELE DESILVA

In technical-writing courses, the main focus is typically the technical report, due toward the end of the

term. Just about everything you do in the course is aimed at developing skills needed to produce that

report. Of course, some technical-writing courses begin with a resume and application letter (often

known as the cover letter), but after that you plan the technical report, then write a proposal in which

you propose to write that report. Then you write short documents (memos, emails, outlines, drafts)

where you get accustomed to using things like headings, lists, graphics, and special notices—not

to mention writing about technical subject matter in a clear, concise, understandable way that is

appropriate for a specific audience.

Caution: You should be aware that technical-writing courses are writing-intensive. You will

probably write more in your technical-writing course than in any other course you have ever taken. If

you are taking a full load of classes, working full time, and juggling unique family obligations, please

consider whether this is the right time for you to take technical writing. Consult with your professor

about the workload for this class in order to make your decision.

C H A P T E R AT T R I B U T I O N I N F O R M AT I O N

This chapter was derived by Annemarie Hamlin, Chris Rubio, and Michele DeSilva, Central Oregon

Community College, from Online Technical Writing by David McMurrey – CC: BY 4.0

TECHNICAL WRITING 3

1. PROFESSIONAL COMMUNICATIONS

Professional communication in written form requires skill and expertise. From text messages to

reports, how you represent yourself with the written word counts. Writing in an online environment

requires tact, skill, and an awareness that what you write may be there forever. From memos to letters,

from business proposals to press releases, your written business communication represents you and

your company: your goal is to make it clear, concise, and professional.

Chapter Attribution Information

This chapter was derived by Annemarie Hamlin, Chris Rubio, and Michele DeSilva, Central Oregon

Community College, from the following sources:

• Online Technical Writing by David McMurrey – CC: BY 4.0

• Professional Writing by Saylor Academy – CC: BY 3.0

• Communicating Online: Netiquette by UBC Centre for Teaching, Learning and Technology –

CC: BY-SA 4.0

1 . 1 T E X T I N G

Text messages and e-mails are part of our communication landscape, and skilled business

communicators consider them a valuable tool to connect.

Whatever digital device you use, written communication in the form of brief messages, or texting,

has become a common way to connect. It is useful for short exchanges, and is a convenient way to stay

connected with others when talking on the phone would be cumbersome. Texting is not useful for

long or complicated messages, and careful consideration should be given to the audience. Although

texting will not be used in this class as a form of professional communication, you should be aware of

several of the principles that should guide your writing in this context.

When texting, always consider your audience and your company, and choose words, terms, or

abbreviations that will deliver your message appropriately and effectively.

T I P S F O R E F F E C T I V E B U S I N E S S T E X T I N G

• Know your recipient. “? % dsct” may be an understandable way to ask a close associate what the

proper discount is to offer a certain customer, but if you are writing a text to your boss, it might be

wiser to write, “what % discount does Murray get on $1K order?”

• Anticipate unintentional misinterpretation. Texting often uses symbols and codes to represent

thoughts, ideas, and emotions. Given the complexity of communication, and the useful but limited

tool of texting, be aware of its limitation and prevent misinterpretation with brief messages.

• Contacting someone too frequently can border on harassment. Texting is a tool. Use it when

appropriate but don’t abuse it.

• Don’t text and drive. Research shows that the likelihood of an accident increases dramatically if

the driver is texting behind the wheel. 1 Being in an accident while conducting company business

would reflect poorly on your judgment as well as on your employer.

C H A P T E R AT T R I B U T I O N I N F O R M AT I O N

This chapter was derived by Annemarie Hamlin, Chris Rubio, and Michele DeSilva, Central Oregon

Community College, from the following sources:

• Online Technical Writing by David McMurrey – CC: BY 4.0

• Professional Writing by Saylor Academy – CC: BY 3.0

1. Houston Chronicle. (2009, September 23). Deadly distraction: Texting while driving, twice as risky as drunk driving, should be banned. Houston

Chronicle (3 STAR R.O. ed.), p. B8. Retrieved from http://www.chron.com/opinion/editorials/article/Deadly-distraction-Texting-while-

driving-should-1592397.php

TECHNICAL WRITING 7

1 . 2 E – M A I L

E-mail is familiar to most students and workers. It may be used like text, or synchronous chat, and

it can be delivered to a cell phone. In business, email has largely replaced print hard copy letters for

external (outside the company) correspondence, and in many cases, it has taken the place of memos

for internal (within the company) communication.1 E-mail can be very useful for messages that have

slightly more content than a text message, but it is still best used for fairly brief messages. Many

businesses use automated e-mails to acknowledge communications from the public, or to remind

associates that periodic reports or payments are due. You may also be assigned to “populate” a form

e-mail in which standard paragraphs are used, but you choose from a menu of sentences to make the

wording suitable for a particular transaction.

E-mails may be informal in personal contexts, but business communication requires attention to

detail, awareness that your e-mail reflects you and your company, and a professional tone so that it

may be forwarded to any third party if needed. E-mail often serves to exchange information within

organizations. Although e-mail may have an informal feel, remember that when used for business, it

needs to convey professionalism and respect. Never write or send anything that you wouldn’t want

read in public or in front of your company president.

T I P S F O R E F F E C T I V E B U S I N E S S E – M A I L S

As with all writing, professional communications require attention to the specific writing context,

and it may surprise you that even elements of form can indicate a writer’s strong understanding of

audience and purpose. The principles explained here apply to the educational context as well; use

them when communicating with your instructors and classroom peers.

• Open with a proper salutation. Proper salutations demonstrate respect and avoid mix-ups in case

a message is accidentally sent to the wrong recipient. For example, use a salutation like “Dear Ms.

X” (external) or “Hi Barry” (internal). Never use the title Mrs. as you cannot assume a woman is

married. If the gender of a person is not evident, use their entire name, like this: “Dear Sam Jones”

• Include a clear, brief, and specific subject line. This helps the recipient understand the essence of

the message. For example, “Proposal attached” or “Your question of 10/25.”

• Close with a signature. Identify yourself by creating a signature block that automatically contains

your name and business contact information.

• Avoid abbreviations. An e-mail is not a text message, and the audience may not find your wit

cause to ROTFLOL (roll on the floor laughing out loud).

1. Guffey, M. (2008). Essentials of business communication (7th ed.). Mason, OH: Thomson/Wadsworth.

8 ALLISON GROSS, ANNEMARIE HAMLIN, BILLY MERCK, CHRIS RUBIO, JODI NAAS, MEGAN SAVAGE, AND MICHELE DESILVA

• Be brief. Omit unnecessary words.

• Use a good format. Divide your message into brief paragraphs for ease of reading. A good e-mail

should get to the point and conclude in three small paragraphs or less.

• Reread, revise, and review. Catch and correct spelling and grammar mistakes before you press

“send.” It will take more time and effort to undo the problems caused by a hasty, poorly written e-

mail than to get it right the first time.

• Reply promptly. Watch out for an emotional response—never reply in anger—but make a habit of

replying to all e-mails within twenty-four hours, even if only to say that you will provide the

requested information in forty-eight or seventy-two hours.

• Use “Reply All” sparingly. Do not send your reply to everyone who received the initial e-mail

unless your message absolutely needs to be read by the entire group.

• Avoid using all caps. Capital letters are used on the Internet to communicate emphatic emotion

or yelling and are considered rude.

• Test links. If you include a link, test it to make sure it is working.

• E-mail ahead of time if you are going to attach large files (audio and visual files are often quite

large) to prevent exceeding the recipient’s mailbox limit or triggering the spam filter.

• Give feedback or follow up. If you don’t get a response in twenty-four hours, e-mail or call. Spam

filters may have intercepted your message, so your recipient may never have received it.

Figure 1 shows a sample email that demonstrates the principles listed above.

Figure 1. Sample email

From: Steve Jobs <sjobs@apple.com>
To: Human Resources Division <hr@apple.com>
Date: September 12, 2015
Subject: Safe Zone Training

Dear Colleagues:
Please consider signing up for the next available Safe Zone workshop offered by the College. As you know, our department is working toward

increasing the number of Safe Zone volunteers in our area, and I hope several of you may be available for the next workshop scheduled for Friday,
October 9.

For more information on the Safe Zone program, please visit http://www.cocc.edu/multicultural/safe-zone-training/
Please let me know if you will attend.
Steve Jobs

CEO Apple Computing
sjobs@apple.com

C H A P T E R AT T R I B U T I O N I N F O R M AT I O N

This chapter was derived by Annemarie Hamlin, Chris Rubio, and Michele DeSilva, Central Oregon

Community College, from the following sources:

• Online Technical Writing by David McMurrey – CC: BY 4.0

• Professional Writing by Saylor Academy – CC: BY 3.0

TECHNICAL WRITING 9

1 . 3 N E T I Q U E T T E

Netiquette refers to etiquette, or protocols and norms for communication, on the Internet. We create

personal pages, post messages, and interact via online technologies as a normal part of our careers,

but how we conduct ourselves can leave a lasting image, literally. The photograph you posted on your

Facebook page or Twitter feed may have been seen by your potential employer, or that nasty remark

in a post may come back to haunt you later.

Following several guidelines for online postings, as detailed below, can help you avoid

embarrassment later.

K N O W YO U R C O N T E X T

• Introduce yourself.

• Avoid assumptions about your readers. Remember that culture influences communication style

and practices.

• Familiarize yourself with policies on Acceptable Use of IT Resources at your organization. (One

example of a college’s acceptable use policy can be found here: https://www.cocc.edu/

departments/its/network-administration/files/

cocc_acceptable_use_of_information_technology_resources_12.pdf/ )

R E M E M B E R T H E H U M A N

• Remember there is a person behind the words. Ask for clarification before making judgement.

• Check your tone before you publish.

• Respond to people using their names.

• Remember that culture and even gender can play a part in how people communicate.

• Remain authentic and expect the same of others.

• Remember that people may not reply immediately. People participate in different ways, some just

by reading the communication rather than jumping into it.

• Avoid jokes and sarcasm; they often don’t translate well to the online environment.

R E C O G N I Z E T H AT T E X T I S P E R M A N E N T

• Be judicious. What you say online is difficult to retract later.

• Consider your responsibility to the group and to the working environment.

10 ALLISON GROSS, ANNEMARIE HAMLIN, BILLY MERCK, CHRIS RUBIO, JODI NAAS, MEGAN SAVAGE, AND MICHELE DESILVA

• Agree on ground rules for text communication (formal or informal; seek clarification whenever

needed, etc) if you are working collaboratively.

AVO I D F L A M I N G : R E S E A RC H B E F O R E YO U R E AC T

• Accept and forgive mistakes.

• Consider your responsibility to the group and to the working environment.

• Seek clarification before reacting.

• Ask your supervisor for guidance.*

R E S P E C T P R I VAC Y A N D O R I G I N A L I D E A S

• Quote the original author if you are responding to a specific point made by someone else.

• Ask the author of an email for permission before forwarding the communication.

* Sometimes, online behavior can appear so disrespectful and even hostile that it requires

attention and follow up. In this case, let your supervisor know right away so that the right

resources can be called upon to help.

C H A P T E R AT T R I B U T I O N I N F O R M AT I O N

This chapter was derived by Annemarie Hamlin, Chris Rubio, and Michele DeSilva, Central Oregon

Community College, from Communicating Online: Netiquette by UBC Centre for Teaching,

Learning and Technology – CC: BY-SA 4.0

TECHNICAL WRITING 11

Anatomy homework help


Digestive System GIPHY assignment

Make a GIPHY using hand drawn images showing the different parts of the alimentary canal (i.e the esophagus, stomach, small and large intestine). Also show the lesser and greater omenta and the mesentery in your GIPHY. It is important that used images are hand drawn by  you and not copied and pasted from the internet. 

Anatomy homework help

RESEARCH ARTICLE Open Access

Urbanization, ethnicity and cardiovascular risk in
a population in transition in Nakuru, Kenya: a
population-based survey
Wanjiku Mathenge, Allen Foster, Hannah Kuper*

Abstract

Background: Cardiovascular disease (CVD) is the leading cause of death among older people in Africa. This study
aimed to investigate the relationship of urbanization and ethnicity with CVD risk markers in Kenya.

Methods: A cross-sectional population-based survey was carried out in Nakuru Kenya in 2007-2008. 100 clusters of
50 people aged ≥50 years were selected by probability proportionate to size sampling. Households within clusters
were selected through compact segment sampling. Participants were interviewed by nurses to collect socio-
demographic and lifestyle information. Nurses measured blood pressure, height, weight and waist and hip
circumference. A random finger-prick blood sample was taken to measure glucose and cholesterol levels.
Hypertension was defined as systolic blood pressure (SBP) ≥140 mm Hg, or diastolic blood pressure (DBP) ≥90 mm
Hg or current use of antihypertensive medication; Diabetes as reported current medication or diet control for
diabetes or random blood glucose level ≥11.1 mmol/L; High cholesterol as random blood cholesterol level ≥5.2
mmol/L; and Obesity as Body Mass Index (BMI)≥30 kg/m2.

Results: 5010 eligible subjects were selected, of whom 4396 (88%) were examined. There was a high prevalence of
hypertension (50.1%, 47.5-52.6%), obesity (13.0%, 11.7-14.5%), diabetes (6.6%, 5.6-7.7%) and high cholesterol (21.1%,
18.6-23.9). Hypertension, diabetes and obesity were more common in urban compared to rural groups and the
elevated prevalence generally persisted after adjustment for socio-demographic, lifestyle, obesity and cardiovascular
risk markers. There was also a higher prevalence of hypertension, obesity, diabetes and high cholesterol among
Kikuyus compared to Kalenjins, even after multivariate adjustment. CVD risk markers were clustered both across the
district and within individuals. Few people received treatment for hypertension (15%), while the majority of cases
with diabetes received treatment (68%).

Conclusions: CVD risk markers are common in Kenya, particularly in urban areas. Exploring differences in CVD risk
markers between ethnic groups may help to elucidate the epidemiology of these conditions.

Background
Infectious diseases are still the principal cause of death
in Africa [1]. However, among older people coronary
heart disease (CHD) and stroke are emerging as the
leading cause, responsible for more than a quarter of
deaths in people 60 years and over in Africa [2,3]. This
represents a dramatic shift as CHD was virtually
unknown in Africa until recently [4,5]. Stroke is particu-
larly common in Africa in comparison to CHD [6], and

stroke mortality rates and prevalence of disabling stroke
in most African countries are comparable to levels seen
in high-income countries [7-9]. African countries are
therefore experiencing a shift in the epidemiological
transition [10], while retaining a high burden of infec-
tious diseases.
The rise in cardiovascular disease (CVD) is linked to the

increase in hypertension, diabetes, obesity, and high cho-
lesterol observed in Africa in recent years. Obesity [11-14]
and hypertension [11,15-17] are now common throughout
Africa, particularly in urban areas [11,12,14,16,17]. The
number of people with diabetes in Sub-Saharan Africa is
expected to more than double between 2000 and 2030

* Correspondence: hannah.kuper@lshtm.ac.uk
London School of Hygiene & Tropical Medicine, Keppel Street, London
WC1E 7HT, UK

Mathenge et al. BMC Public Health 2010, 10:569
http://www.biomedcentral.com/1471-2458/10/569

© 2010 Mathenge et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly cited.

[18], and diabetes is particularly common in urban areas
[19]. Urbanisation is therefore a key feature in the rise of
CVD. Currently 40% of Africans live in urban areas [20],
and it is estimated that by 2030 half of Africans will live
in urban areas. The Kenyan Luo Migration Study ele-
gantly demonstrated the impact of rural-urban migration
on CVD risk in Africa [21]. Rural migrants to Nairobi
experienced a rise in systolic and diastolic blood pressure
after only one month of migration. In contrast, the effect
of rural-urban migration on blood pressure was not
observed in a recent study in Tanzania, even though phy-
sical activity levels fell and weight increased after migra-
tion [22]. The discrepancy between the two studies may
be because the rural-urban contrast in sodium intake
was smaller in the Tanzanian compared to the Kenyan
study (personal communication). The impact of rural-
urban migration on health may therefore vary depending
on setting.
People of African origin may be particularly vulnerable

to hypertension. The prevalence of hypertension is high
among people of African origin compared to Whites
independent of BMI [23-25], and there is a younger age
at onset in Africa [15] and among people of African des-
cent [26]. Although the same risk markers are largely
responsible for myocardial infarction (MI) across the
globe [27], hypertension was associated with a higher
MI risk in the Black African group than in the overall
INTERHEART group [28]. There may also be greater
difficulty in achieving control [26], and more aggressive
presentation [26,29] and progress [28] of hypertension
among people of African origin. This vulnerability may
be due to lifestyle factors, but may also be influenced by
ethnicity which varies widely within Africa and is linked
to substantial heterogeneity in body composition [14],
which may exert important metabolic effects [30].
The aim of this study was to investigate the relation-

ship of urbanization and ethnicity with the prevalence of
obesity, hypertension, diabetes and high cholesterol in a
study of elderly people in Nakuru district, Kenya.

Methods
Settings and population
Nakuru district has a population of 1.2 million, one
third of which is urban. Nakuru is broadly representa-
tive of Kenya in terms of ethnic diversity and economic
activities. The two dominant ethnic groups are Kikuyus
and Kalenjins. The Kikuyu are related to other Bantu-
speaking peoples of East Africa while Kalenjins are of
Nilotic origin.
During Jan 2007- Dec 2008, a sample of 100 clusters

of 50 people aged ≥50 years were selected across
Nakuru district through probability proportionate to
size sampling, using the electoral role as the sampling
frame. Clusters were classed as “rural” or “urban” using

the classification of the district statistical office. House-
holds were selected within clusters through modified
compact segment sampling [31]. The village leaders pro-
duced a sketch map of the polling area. The polling area
was divided into segments each including approximately
50 people aged ≥ 50 years. One segment was chosen at
random by drawing lots and all households in the seg-
ment were included in the sample sequentially, until 50
people aged ≥50 years were identified. If the segment
did not include 50 people aged ≥50 years then another
segment was chosen at random and sampling continued.
The enumeration team visited households, assisted by

a village guide, and invited all eligible participants aged
≥50 years to the examination clinic which would be
held at a convenient place in the cluster over the subse-
quent two days. Eligible participants were defined as
those aged ≥50 years resident in the cluster (i.e. living
there at least 6 months per year) who had slept in the
house either the night before or were planning on sleep-
ing in the house that night. If an eligible person was
absent then the survey team revisited the household at
least two times.

Examination clinic
Interviews
Participants were interviewed by trained nurses. Infor-
mation was collected on demographic data, education
and assets (building materials of the house – type of
walls, roof, floor and toilet; ownership of household
assets – radio, TV, fridge, phone, cupboard, sofa set,
sewing machine, table, bicycle and vehicle; animal own-
ership – cows, sheep/goats). People were asked whether
their mother tongue was “Kikuyu”, “Kalenjin” or other.
For simplicity, people will be classified as “Kikuyu” and
“Kalenjin” in the text. Information was also collected on
health behaviour (smoking, alcohol use) and health sta-
tus (diagnosis of diabetes or hypertension, family history
and their treatment).
Physical examination
A nurse recorded the blood pressure of participants
three times on the right arm of the participant, at least
five minutes apart after an initial period of five minutes
of rest using the Omron digital automatic monitor
(model HEM907). A medium cuff size was used (to fit
arms 22 to 32 cm). The average of the last two readings
was used as the measures of systolic and diastolic blood
pressure (to nearest 1 mm Hg). A random finger-prick
blood sample was taken to measure glucose (Accutrend
GC system) and cholesterol levels (Accutrend GC sys-
tem). The technical data from the company asserts that
precision is <3% for glucose and <5% for cholesterol
[32]. Weight was measured to the nearest kg using stan-
dard scales to the nearest 0.1 kg (Seca 761 scales) after
the participant had removed all heavy clothing and

Mathenge et al. BMC Public Health 2010, 10:569
http://www.biomedcentral.com/1471-2458/10/569

Page 2 of 12

shoes. Height was measured to the nearest cm while the
participant stood without shoes using a standardized
stadiometer (Leicester Height Measure). For weight and
height the average of two readings was recorded. Waist
and hip circumferences were measured with a tape. The
waist circumference was measured at umbilicus level in
mid-expiration to the nearest 0.1 cm. The hip circum-
ference was measured at the point of largest gluteal cir-
cumference to the nearest 0.1 cm.

Training
The examination team received three weeks of training.
Inter observer variation (IOV) was assessed during the
training weeks at the Nakuru Provincial General Hospi-
tal. IOV on anthropometric variables were done by
repeat measuring of 50 subjects by the two nurses. The
level of agreement required was to the nearest 1 cm for
circumferences and height, and to the nearest 0.5 kg for
weight. The staff were retrained or replaced if IOV
scores indicated poor comparability (kappa < 0.5).

Statistical analysis
Statistical analyses were undertaken using the SAS sta-
tistical package (version 9.2). The four CVD risk mar-
kers considered were hypertension, diabetes, high
cholesterol and obesity. Hypertension was defined as
systolic blood pressure (SBP) was ≥140 mm Hg, or dia-
stolic blood pressure (DBP) ≥90 mm Hg or current use
of antihypertensive medication [33]. Diabetes was
defined as reported current medication (tablets or insu-
lin) or diet control for diabetes or random blood glucose
level ≥11.1 mmol/L [34]. People were categorized as
having high cholesterol if their random blood choles-
terol level was ≥5.2 mmol/L [35]. Obesity was defined as
Body Mass Index (BMI)≥30 kg/m2 [36]. Prevalence esti-
mates for the four CVD risk markers were calculated
taking account of the design effect (DEFF) in estimating
the confidence intervals. The DEFF was not taken into
account for other analyses. A relative index of socio-
economic status (SES) was calculated based on building
materials of the house, ownership of ten household
assets and education status using principal components
analysis [37]. The derived index was divided into quar-
tiles from poorest to least poor.
We assessed the association between rural-urban sta-

tus and, in turn, hypertension, diabetes, high cholesterol
and obesity through logistic regression models. The
models were adjusted in turn for, a) for age (50-59, 60-
69, 70-79, ≥80) and sex, b) age, sex and socio-demo-
graphic factors (SES score in quartiles), c) age, sex, BMI
(<20, 20-25, >25-30, ≥30), waist hip ratio (WHR – in
quartiles), smoking (current, former, never) and alcohol
(current, former, never), d) age, sex, diabetes and high
cholesterol (as appropriate) and e) fully adjusted model.

These models were repeated assessing the association
between the four CVD markers and Kikuyu or Kalenjin
ethnicity, adjusting for urban status in models b and e.
We included an interaction factor in the logistic regres-
sion models for ethnicity to assess whether there was an
interaction between ethnicity and urban status in the
relationship with CVD risk markers. We assessed
the proportion of people receiving medical treatment
among people who were defined as “hypertensive”, and
attempted to identify predictors of treatment status
through logistic regression models. This was repeated
for people with diabetes.
We assessed whether the CVD risk markers were clus-

tered geographically by calculating the DEFF for each of
the variables. We assessed whether there was clustering
of the CVD risk markers within individuals. To do this,
we derived expected frequencies of co-occurrence of
risk markers (hypertension, diabetes, high cholesterol
and obesity) from none through to four risk markers by
combining probabilities, assuming a binomial distribu-
tion and independence between them [38]. We esti-
mated observed to expected ratios for all participants
and then separately for urban and rural groups and for
Kikuyu and Kalenjin groups. We considered that there
was clustering if the observed:expected ratios were high
for no risk markers, low for one risk marker and high
for three or more risk markers. We calculated chi-
square statistics with 3 degrees of freedom to test the
significance of the overall distribution of expected and
observed counts within each group.

Ethical approval
Ethical approval for this work was granted by the Lon-
don School of Hygiene & Tropical Medicine and The
Kenya Medical Research Institute Ethical Committee
and Nakuru District Health Management Team. Infor-
med consent was obtained from the subjects. All people
with other treatable conditions were referred for appro-
priate treatment.

Results
We examined 4,396 (88%) of the 5,010 people invited.
Among those examined 1,437 (33%) lived in urban and
2,959 (67%) in rural areas (Table 1). Urban dwellers
were younger, and had higher education levels and asset
scores than rural dwellers. They were also more likely to
be smokers and obese, than rural participants. Kikuyus
made up 63% of the sample and Kalenjins 23% while
the remaining 15% consisted of other language speakers.
Kikuyus were more likely than Kalenjins to live in urban
areas or to be female, and they had higher levels of edu-
cation and higher SES scores. Kikuyus were less likely to
be current smokers or consumers of alcohol. Kikuyus
were significantly shorter yet heavier than Kalenjins

Mathenge et al. BMC Public Health 2010, 10:569
http://www.biomedcentral.com/1471-2458/10/569

Page 3 of 12

among both men (166 cm vs 168 cm, 64 kg vs 60 kg)
and women (156 cm vs 158 cm, 62 kg vs 58 kg) and
consequently had higher BMIs.
There was a high prevalence of hypertension (50.1%,

47.5-52.6%), obesity (13.0%, 11.7-14.5%), diabetes (6.6%,
5.6-7.7%) and high cholesterol (21.1%, 18.6-23.9%).
Mean SBP and DBP were higher in urban than rural
areas among both men and women (Table 2). Similarly,
mean glucose and cholesterol levels and markers of
obesity were higher in urban than rural men and this pat-
tern was generally repeated among women. The preva-
lence of obesity generally fell sharply with age (Figure 1).
The prevalence of hypertension increased steadily with
age, and was consistently higher in urban than rural areas

(Figure 2). The association between prevalence and age
were less clear for the diabetes (Figure 3) and high cho-
lesterol (data not shown). Meanwhile, SBP increased with
age while DBP decreased, and both remained higher for
people from urban than rural areas across the age groups
(Figure 4). Kikuyus had higher SBP than Kalenjins, but
the differences were less clear for DBP (Table 3). Kikuyus
also had higher levels of glucose, cholesterol, BMI and
waist circumference but not of WHR. Kikuyus were more
likely to be hypertensive, obese or diabetic in all age
groups (Figure 5, 6, 7, 8).
The odds of hypertension was higher in urban than

rural groups after adjustment for age and sex (Odds
ratio – OR = 1.7, 95% CI = 1.5-1.9) (Table 4). The

Table 1 Demographic characteristics and health behavior comparing urban and rural participants, and Kikuyus and
Kalenjins

Urban
(n = 1437)

Rural
(n = 2959)

Age and sex adjusted
OR (95% CI)

Kikuyu
(n = 2760)

Kalenjin
(n = 1015)

Age and sex adjusted
OR (95% CI)

Age

50-59 57% 38% Baseline 40% 40% Baseline

60-69 26% 31% 0.6 (0.5-0.7) 32% 28% 1.2 (1.0-1.4)

70-79 11% 20% 0.4 (0.3-0.5) 17% 20% 0.9 (0.7-1.1)

≥80 6% 11% 0.4 (0.3-0.5) 10% 11% 0.9 (0.7-1.2)

Sex

Men 49% 47% Baseline 44% 53% Baseline

Women 51% 53% 0.9 (0.8-1.0) 56% 47% 1.4 (1.2-1.6)

Language

Kikuyu 65% 62% Baseline

Kalenjin 6% 31% 0.2 (0.1-0.2)

Other 29% 7% 3.3 (2.7-4.0)

Urban 931 (34%) 84 (8%) Baseline

Rural 1812 (66%) 924 (92%) 5.7 (4.5-7.2)

Education

Any 79% 61% 1.4 (1.3-1.6) 71% 51% 1.9 (1.7-2.1)

None 21% 39% Baseline 29% 49% Baseline

SES score

1 (poorest) 8% 33% Baseline 20% 44% Baseline

2 14% 31% 1.6 (1.2-2.0) 26% 27% 2.4 (2.0-2.9)

3 24% 26% 3.1 (2.5-3.9) 27% 20% 3.4 (2.8-4.2)

4 (richest) 54% 11% 16.7 (13.3-21.1) 26% 9% 7.8 (6.0-10.2)

Smoking

Never 70% 70% Baseline 69% 73% Baseline

Current 7% 8% 1.4 (1.1-1.8) 8% 6% 0.5 (0.3-0.6)

Former 23% 22% 1.1 (0.9-1.3) 24% 20% 2.0 (1.6-2.5)

Alcohol

Never 41% 38% Baseline 45% 23% Baseline

Former 41% 46% 0.9 (0.7-1.0) 44% 49% 0.4 (0.3-0.5)

Current 18% 17% 0.9 (0.7-1.1) 11% 28% 0.2 (0.1-0.2)

BMI cat

Underweight 8% 17% 0.7 (0.5-0.9) 12% 21% 0.7 (0.6-0.9)

Normal 41% 54% Baseline 48% 56% Baseline

Overweight 30% 19% 2.1 (1.7-2.4) 25% 15% 1.9 (1.5-2.3)

Obese 20% 10% 2.8 (2.3-3.5) 14% 8% 2.0 (1.5-2.6)

Mathenge et al. BMC Public Health 2010, 10:569
http://www.biomedcentral.com/1471-2458/10/569

Page 4 of 12

association was weakened after adjustment for SES mar-
kers and for obesity, smoking and alcohol, but not after
adjustment for diabetes and cholesterol. In the fully
adjusted model the odds of hypertension remained
higher among urban compared to rural dwellers (1.3,
1.1-1.5). People in urban areas were also more likely to
have diabetes (2.3, 1.8-2.9). The increased odds was
reduced after adjustment for socio-demographic vari-
ables, though adjustment for other CVD risk markers
had less effect. In the fully adjusted model the odds of
diabetes was no longer elevated in urban compared to
rural participants (1.3, 0.9-1.7). No clear association was
apparent between the odds of high cholesterol and
urban status. The pattern for the association between
obesity and urban residence was similar to that for
diabetes.
The odds of hypertension was higher among Kikuyus

compared to Kalenjins (1.6, 1.4-1.8) (Table 5). The asso-
ciation persisted after adjustment for socio-demographic
variables and other CVD risk markers (1.4, 1.2-1.7).
Similarly, Kikuyus were more likely to have diabetes and

high cholesterol, and these associations were not fully
explained by adjustment for potential confounders.
Kikuyus were more likely to be obese compared to
Kalenjin, but not in models adjustment for SES and
urban status. For all four risk markers, the biggest
change in the association occurred after adjustment for
SES and urban status.
There was no interaction between urban status and

ethnicity for these conditions after adjustment for age
and sex (data not shown).
There was substantial variation in the prevalence of

hypertension (range 17-77% (DEFF = 2.9) diabetes
(range = 0-26%; DEFF = 1.8), high cholesterol (range
0-51.2%, DEFF = 4.3) and obesity (range 0-40%, DEFF =
1.8) between clusters. The variation was similar in rural
and urban areas and among Kikuyus and Kalenjins.
Few people had 3-4 (4.5%) or 2 (18.5%) risk markers

and the vast majority of the population had no (37.0%)
or one (40.1%) risk marker (Table 6). Generally rural
dwellers and Kalenjins had fewer risk factors than urban
dwellers and Kikuyus. There was a greater than expected

Table 2 Means (and standard error) of cardiovascular risk markers, by gender and urban-rural status

Urban-rural comparison

Men Women

No. Urban/Rural Urban Rural Age adjusted p-value No. Urban/Rural Urban Rural Age adjusted p-value

Mean SBP 705/1395 143 (24) 140 (24) <0.0001 726/1550 143 (26) 140 (25) <0.0001

Mean DBP 705/1395 84 (14) 81 (13) <0.0001 726/1550 86 (14) 83 (13) <0.0001

Glucose 692/1373 5.8 (2.9) 4.8 (2.0) <0.0001 704/1527 5.7 (2.8) 5.1 (2.3) <0.0001

Cholesterol 698/1342 4.5 (0.9) 4.3 (0.9) 0.0004 718/1514 4.8 (0.9) 4.7 (1.0) 0.08

BMI 700/1385 24 (6) 22 (4) <0.0001 718/1543 27 (6) 24 (6) <0.0001

Waist 703/1390 92 (13) 86 (11) <0.0001 719/1546 96 (13) 89 (13) <0.0001

WHR 703/1390 0.92 (0.07) 0.92 (0.06) 0.0009 718/1546 0.89 (0.06) 0.89 (0.08) 0.34

Figure 1 Age trends in obesity by urban status.

Mathenge et al. BMC Public Health 2010, 10:569
http://www.biomedcentral.com/1471-2458/10/569

Page 5 of 12

frequency of people with 3-4 risk markers than would be
expected by chance, and to a lesser extent a higher fre-
quency of people with no risk markers, except among
Kalenijn. Together, this provides evidence for clustering
of risk markers within individuals, which was more
apparent among rural versus urban dwellers, and among
Kalenjins compared to Kikuyus.
Among people with hypertension, only 323 (15%)

received drug treatment, 38 (2%) received diet treatment
and 7 traditional medicine treatment (0.3%) (Table 7).
Among those on drug treatment, only 98 (29%) had
controlled hypertension. A far higher proportion of peo-
ple with diabetes were receiving treatment (68%), which
included insulin (n = 32), tablets (n = 143) and/or diet

control (n = 43). A further 10 received traditional treat-
ment. For both hypertension and diabetes, treatment
was more among people living in urban areas, women,
older people and those with a higher SES score. Kalen-
jins were less likely to receive treatment for hyperten-
sion than Kikuyus (0.5, 0.3-0.8), but there was no
difference for diabetes.

Sensitivity analysis
We assessed the impact of lowering the threshold ran-
dom blood glucose level for the classification of “dia-
betes”. Lowering the threshold to ≥10 mmol/L added an
additional 13 cases to the original 283 cases (revised
prevalence 6.9%), for ≥9 mmol/L this was 41 cases

Figure 2 Age trends in hypertension by urban status.

Figure 3 Age trends in diabetes by urban status.

Mathenge et al. BMC Public Health 2010, 10:569
http://www.biomedcentral.com/1471-2458/10/569

Page 6 of 12

Figure 4 Age trends in systolic and diastolic blood pressure by urban status.

Table 3 Means (and standard error) of cardiovascular risk markers, by gender and ethnicity

Kikuyu-Kalenjin comparison

Men Women

No. Kikuyu/Kalenjin Kikuyu Kalenjin Age adjusted
p-value

No. Kikuyu/Kalenjin Kikuyu Kalenjin Age adjusted
p-value

Mean SBP 1218/535 142 (24) 139 (23) 0.007 1531/473 142 (26) 136 (24) <0.0001

Mean DBP 1218/535 81 (13) 81 (13) 0.85 1531/473 84 (14) 82 (13) 0.02

Glucose 1209/515 5.5 (2.6) 4.4 (1.7) <0.0001 1516/449 5.5 (2.6) 4.9 (2.0) <0.0001

Cholesterol 1177/524 4.4 (1.0) 4.2 (0.7) <0.0001 1496/466 4.8 (1.0) 4.5 (1.0) <0.0001

BMI 1207/534 23 (5) 21 (4) <0.0001 1519/469 26 (6) 23 (5) <0.0001

Waist 1213/535 89 (12) 86 (11) 0.002 1522/470 91 (14) 88 (13) <0.0001

WHR 1213/535 0.92 (0.07) 0.92 (0.06) 0.24 1521/470 0.88(0.08) 0.90 (0.06) <0.0001

Figure 5 Age trends in obesity by ethnicity.

Mathenge et al. BMC Public Health 2010, 10:569
http://www.biomedcentral.com/1471-2458/10/569

Page 7 of 12

(7.5%), for ≥8 mmol/L this was 84 cases (8.5%) and for
≥7 mmol/L this was 180 cases (10.8%). At the least con-
servative threshold for diabetes (≥7 mmol/L) almost half
of cases (42%) were receiving treatment.

Discussion
This large survey in Kenya highlighted the high preva-
lence of CVD risk markers, particularly in urban areas.
SES was a more important mediator of the association
between the individual CVD risk markers and urban sta-
tus than health behavior or other CVD markers. How-
ever, the urban-rural differences in hypertension and
obesity were not explained fully after adjustment for
SES, obesity, smoking, alcohol or other CVD risk

markers. The prevalence of CVD risk markers was
higher among Kikuyus than among Kalenjins. Again,
these associations were not fully explained after adjust-
ment for the possible confounders, including urban sta-
tus. A high degree of clustering of these risk markers
was apparent, both geographically and within indivi-
duals. The clustering within individuals was more
marked among rural dwellers and Kalenjins, although
they had fewer people with risk factors overall, poten-
tially indicating that there were a few early adopters of
these multiple risk factors compared to the more well
established presence among urban dwellers and Kikuyus.
Only 15% of people with hypertensive were receiving
treatment, and this was particularly low among poorer

Figure 6 Age trends in hypertension by ethnicity.

Figure 7 Age trends in diabetes by ethnicity.

Mathenge et al. BMC Public Health 2010, 10:569
http://www.biomedcentral.com/1471-2458/10/569

Page 8 of 12

Figure 8 Age trends in systolic and diastolic blood pressure by ethnicity.

Table 4 Rural-urban differences in the prevalence of CVD risk markers

Urban
(n = 1431)

Rural
(n = 2945)

Age and sex
adjusted OR
(95% CI)

Age, sex and socio-
demographic adjusted
OR (SES score)

Age, sex, BMI,
WHR, smoking,
alcohol

Age, sex,
diabetes,
cholesterol,
hypertension

Fully
adjusted
model

Hypertension 812 (57%) 1379 (47%) 1.7 (1.5-1.9) 1.4 (1.2-1.6) 1.4 (1.2-1.6) 1.6 (1.4-1.8) 1.3 (1.1-1.5)

Normotensive 619 (43%) 1566 (53%) Baseline Baseline Baseline Baseline Baseline

Diabetic 139 (10.0%) 144 (5.0%) 2.3 (1.8-2.9) 1.3 (1.0-1.7) 2.0 (1.5-2.5) 2.2 (1.7-2.8) 1.3 (0.9-1.7)

Normal 1256 (90.0%) 2756 (95.0%) Baseline Baseline Baseline Baseline Baseline

High
cholesterol

316 (22%) 588 (21%) 1.2 (1.0-1.4) 0.9 (0.8-1.1) 1.0 (0.9-1.2) 1.1 (0.9-1.3) 0.9 (0.7-1.1)

Normal
cholesterol

1100 (78%) 2268 (79%) Baseline Baseline Baseline Baseline Baseline

Obese 287 (20%) 280 (10%) 2.3 (1.9-2.8) 1.3 (1.0-1.6) 2.9 (2.3-3.5) 2.2 (1.8-2.7) 1.5 (1.2-1.9)

Not obese 1131 (80%) 2648 (90%) Baseline Baseline Baseline Baseline Baseline

Table 5 Kikuyu-Kalenjin differences in the prevalence of CVD risk markers

Kikuyus Kalenjins Age and sex
adjusted OR
(95% CI)

Age, sex and socio-
demographic adjusted OR
(SES score and urban)

Age, sex, BMI,
WHR,
smoking,
alcohol

Age, sex,
diabetes,
cholesterol,
hypertension

Fully
adjusted
model

Hypertension 1445 (53%) 420 (42%) 1.6 (1.4-1.8) 1.3 (1.1-1.5) 1.5 (1.3-1.8) 1.5 (1.3-1.7) 1.4 (1.2-1.7)

Normotensive 1304 (47%) 588 (58%) Baseline Baseline Baseline Baseline Baseline

Diabetic 219 (8%) 24 (2%) 3.4 (2.2-5.3) 2.2 (1.4-3.4) 3.4 (2.2-5.4) 3.3 (2.2-5.2) 2.3 (1.5-3.8)

Normal 2506 (92%) 940 (98%) Baseline Baseline Baseline Baseline Baseline

High
cholesterol

648 (24%) 142 (14%) 1.8 (1.5-2.2) 1.6 (1.3-2.0) 1.6 (1.3-2.0) 1.7 (1.4-2.1) 1.5 (1.2-1.9)

Normal
cholesterol

2025 (76%) 848 (86%) Baseline Baseline Baseline Baseline Baseline

Obese 392 (14%) 80 (8%) 1.8 (1.4-2.3) 1.0 (0.8-1.3) 2.0 (1.5-2.7) 1.7 (1.3-2.2) 1.0 (0.7-1.4)

Not obese 2334 (86%) 923 (92%) Baseline Baseline Baseline Baseline Baseline

Mathenge et al. BMC Public Health 2010, 10:569
http://www.biomedcentral.com/1471-2458/10/569

Page 9 of 12

people or rural dwellers. In contrast, more than two
thirds of people with diabetes were receiving treatment,
although this proportion fell if a lower blood glucose
threshold was used for diagnosis of diabetes.
The urban-rural differences in CVD risk markers are

likely to be explained by differences in health behavior,
including diet and physical activity. These urban-rural
differences in lifestyle may in turn explain some of the
differences in CVD risk markers between Kikuyus and
Kalenjins. However, Kikuyu and Kalenjin participants

clearly differed in physical characteristics, such as
height, weight and waist and hip circumferences, and
these may exert metabolic consequences [30], and
explain some of the differences in CVD risk markers.
The prevalence of hypertension in men in our survey

was generally high compared to other world regions, and
exceeded the prevalence in the Established Market
Economies and Latin American Countries for the oldest
age group [15]. For women in our survey the pattern was
more typical to that seen in the sub-Saharan Africa

Table 6 Clustering of risk markers by rural-urban status and ethnicity

No. of risk markers* Total group Urban Rural Kikuyu Kalenjin

Exp** Obs O:E Exp** Obs O:E Exp** Obs O:E Exp** Obs O:E Exp** Obs O:E

0 32.0 37.0 116 24.1 30.0 124 36.3 40.4 111 28.3 33.1 117 44.8 47.0 105

1 47.7 40.1 84 47.4 38.6 81 47.1 40.9 87 47.6 40.3 85 44.6 40.8 92

2 17.9 18.5 103 23.8 24.9 104 15.0 15.3 102 20.8 21.3 102 9.9 10.7 108

3-4 2.3 4.5 193 4.4 6.5 148 1.5 3.5 228 3.2 5.2 165 0.7 1.6 233

Χ
2 (3 df) 71.6 P < 0.0001 27.0 p < 0.0001 39.3 p < 0.0001 40.3 p < 0.0001 6.2 p = 0.10

*Hypertension, obesity, diabetes and high cholesterol.

**Based on random assortment of four risk marker.

Table 7 Treatment for hypertension and diabetes

Hypertension Diabetes

Drug
treatment *

No
treatment

%
untreated

Multivariate adjusted OR
(95% CI)***

Treatment** No
treatment

%
untreated

Multivariate adjusted OR
(95% CI) ***

Number 323 1868 196 91

Rural 191 621 76% Baseline 86 59 41% Baseline

Urban 132 1247 90% 1.6 (1.2-2.1) 110 32 23% 2.0 (1.1-3.8)

Language

Kikuyu 232 1213 84% Baseline 152 69 31% Baseline

Kalenjin 20 400 95% 0.5 (0.3-0.8) 15 10 40% 0.9 (0.3-2.1)

Other 72 255 78% 1.3 (0.9-1.8) 29 12 29% 0.9 (0.4-2.0)

Age

50-59 128 726 85% Baseline 67 40 37% Baseline

60-69 107 561 84% 1.7 (1.2-2.3) 74 29 28% 1.9 (1.0-3.5)

70-79 57 357 86% 2.0 (1.4-3.0) 34 12 26% 3.3 (1.4-7.9)

≥80 31 224 88% 2.0 (1.2-3.3) 21 10 32% 2.6 (0.9-7.3)

Male 93 923 91% Baseline 92 47 34% Baseline

Female 230 945 80% 3.4 (2.5-4.5) 104 44 30% 1.8 (1.0-3.1)

SES score

1
(poorest)

23 456 95% Baseline 14 11 44% Baseline

2 39 456 92% 1.4 (0.8-2.3) 19 22 54% 0.7 (0.3-2.1)

3 87 493 85% 2.7 (1.7-4.4) 60 24 29% 2.3 (0.9-5.9)

Anatomy homework help

Rubric #4, Annotated Bibliography (M3-A2)

Annotated Bibliography

Area
20 points

Accomplished Proficient Needs Work Unacceptable

Basic components
of annotated bib

8 points

*Minimum of five
(5) references
*All references
are current,
authoritative, and
professional
*All references
are clearly related
to country/health
issue

*Uses at least
four (4)
references
*All references
are current.
*Unclear if some
references are
professional &
authoritative
*At least four (4)
references are
clearly related to
country/health
issue

*Uses fewer than
four (4) sources.
*Not all sources
are professional
or authoritative,
e.g. uses blogs or
organizational
websites
*Some references
older than five (5)
years
*Fewer than four
(4) sources are
related to
country/health
issue

*Uses fewer than
four (4) sources
*Some sources
are older than five
(5) years
*References lack
relationship to
country or health
issue

Content of each
item of 5
annotations

8 points

*Clear evidence of
summary of
information,
evaluation of the
information
presented, and
reflective
thoughts

*Clear evidence of
summary of
information,
evaluation of
information.
*Reflection
attempted; is not
clear

*Evidence of
summary of
information
*Some evidence
of evaluation of
information
*Minimal
evidence of
reflection

*Some evidence
of information
summarized,
*Minimal
evaluation of the
information
*No reflection

Title page
in APA 7th edition
format

4 points

*All spacing
between items of
information
correct
*Items correctly
centered
*No errors in use
of upper & lower
case letters

*No more than 2
errors related to
spacing of
information items
*No more than 1
error in centering
of items
*No errors in use
of upper & lower
case letters

*No more than 4
errors related to
spacing of
information items
*No more than 2
errors in
centering of items
*No errors in use
of upper & lower
case letters

*4 or more errors
in spacing of
information items
*No more than 3
errors in
centering of items
*No errors in use
of upper & lower
case letters

Interpretation of Final Points Accomplished: 20.00 – 18.01 points

Proficient: 18.00 – 16.01 points

Needs Work: 16.00 – 14.01 points

Unacceptable: Less than 14 points

Anatomy homework help

Ethical Practices in Healthcare.

Student’s Name:

Professor’s Name:

Date.

1

Introduction.

Ethical Practices in Healthcare is one of the contemporary healthcare issues I am interested to know more about.

Medical ethics are concerned with examining certain healthcare problem such as clinical case, analyze it and apply logic, facts assessed and values to decide the most appropriate course of action to be taken.

Ethical practices in healthcare sector provides that healthcare workers should;

Recognize existing and emerging healthcare dilemmas.

Make good judgments and decisions.

And take appropriate actions based on their values and with respect to laws that govern them.

2

What are Ethical Issues in Healthcare?

Ethical standards are vital in healthcare organizations.

These ethical standards encompass the filed of applied ethos’s that guide healthcare professionals in making morally acceptable decisions in medical practices as provided in the healthcare regulating policies

Even though being a physician or a nurse is rewarding, working in the healthcare industry can be challenging and present wide range of complex situations ranging from type of care provided to patients to the healthcare resources healthcare units need to execute their duties.

The major reference Point when making ethical decisions in healthcare sector include the following four basic principles;

Autonomy:

Justice:

Beneficence

Non-maleficence

3

Examples of Ethical Issues in Healthcare

 1. Physician-Assisted Suicide (PAS)

The act of intentional killing of oneself with the help of knowledgeable healthcare professional.

Facts about this ethical issue.

Increase pressure of terminally ill patients wanting to die and reduce burden to their family.

Physicians should be in the frontline in promoting good health not taking away lives.

2. Malpractice and Negligence.

Medication errors are ranked 3rd as the leading cause of deaths in united states.

Medical errors are as results of;

Risk nature of the healthcare environment.

Defective medical equipment, tools and technologies results into medical errors that

4

Examples of Ethical Issues in Healthcare.
Cont.…

3 Do-Not-Resuscitate Orders(DNR).

DNR is an order provided by a doctor to instruct care providers not to conduct cardiopulmonary resuscitation (CPR).

When it is not clear whether the patient was capacitated to select Do-Not-Resuscitate Orders.

Also it assumed that Do-Not-Resuscitate Orders may exacerbate existing medical condition promoting further risk of death.

4. Doctor and Patient Confidentiality.

There have been a few cases of patient confidentiality breaches which pose ethical and legal implications to the healthcare professionals in question.

Withholding healthcare information about the patient can be harmful and unethical.

Also sharing of parent’s confidential healthcare information can be unethical

5

Conclusion.

American certain with insurance coverage are facing tough time while seeking healthcare help and other critical services.

Patient healthcare needs are billed according to the quality of care patients need.

It is unethical for healthcare organizations to charge patents over $900 which is too high and does not require complex medical procedures or treatment.

at all costs healthcare professionals should remain honesty, disciplined, fair and respectful, hold highest level of integrity as well as working responsibly and accountable to promote well-being of the patient and the general public.

6

References

 

Einboden, R., & Varcoe, C. (2019). Ethical issues in healthcare for women in the context of violence. Ethical Issues in Women’s Healthcare, 129-148. doi:10.1093/med/9780190851361.003.0007

Florida tech. (2022, January 6). Current ethical issues in healthcare. Retrieved from https://www.floridatechonline.com/blog/healthcare-management/current-ethical-issues-in-healthcare/

Jobstreet. (2018, May 15). 5 most sought-after workplace ethics and behaviour. Retrieved from https://www.jobstreet.com.my/en/cms/employer/5-sought-workplace-ethics-behaviour/

7

Anatomy homework help

Medical Terminology: Musculoskeletal System

PT116 Unit 3 Assignment

Combining Forms

Meaning

ankyl/o

articul/o

carp/o

cortic/o

cost/o

kyph/o

lamin/o

lord/o

medull/o

myel/o

orth/o

ped/o

pod/o

scoli/o

spondyl/o

stern/o

synovi/o

tars/o

extens/o

fasci/o

my/o

myos/o

plant/o

ten/o

vers/o

Suffixes

Meaning

–blast

–clasia

–desis

–listhesis

–porosis

–asthenia

–ion

–kinesia

–tonia

Prefixes


Meaning

ab-

ad-

circum-

e-

in-

Multiple Choice

Highlight or bold the correct answer.

1. The term meaning movement toward the midline is

a. abduction.

b. circumduction.

c. eversion.

d. adduction.

2. A specialist in treating disorders of the feet is a(n)

a. orthopedist.

b. orthotist.

c. podiatrist.

d. physiatrist.

3. The surgical term arthrodesis is defined as

a. surgical fusion of a joint.

b. surgical breaking of a joint.

c. incision into a joint.

d. excision of a joint.

4. The condition that involves an abnormal lateral curve of the spine is

a. lordosis.

b. ankylosis.

c. kyphosis.

d. scoliosis.

Page| 2

Anatomy homework help

Purpose: To analyze how an infographic accomplishes its purpose of presenting complex statistical, scientific, medical, procedural or logistical information in an easily digestible VISUAL format. The following skills and knowledge are essential to success in your professional life beyond this course:

 

Skills:

· Select an infographic conveying complex statistical, scientific, medical, procedural or logistical information in an easily-digestible VISUAL format.

· Write an essay analyzing the application of infographic visual formatting to express complex information simply and visually.

 

Knowledge:

· Describe how infographics present complex information visually.

· Analyze how the infographic might present information that is relevant to you, specifically.

 

Task: Write an essay analyzing how an infographic accomplishes its purpose of presenting complex statistical, scientific, medical, procedural or logistical information in an easily digestible VISUAL format. All steps are highly unique to your specific project, therefore problem-solving and critical thinking skills are necessary.

1. Please view 

LinkedIn Learning: “Data Visualization: Best Practices” with Amy Balliett, (Links to an external site.)




pagetutor.com/trillion

 (Links to an external site.)
 and 

The MegaPenny Project

 (Links to an external site.)
 before starting this assignment.

2. Search online for examples of infographics. Use Google to perform a web search for “infographics.”

3. Consider how the infographic accomplishes its goal of communicating complex statistical, scientific, medical, procedural or logistical information in an easily digestible VISUAL format..

4. Write a 300-word analysis essay, in Times New Roman font, 12-point type size, double-line spacing, and 1-inch margins:

a. Add the following header information:

· Student’s Name

· VIC3400—Visual Design for Globalized Media

· Assignment 5—Infographics Analysis Essay

· Module 9, Assigned Week of _______ (starting date for Module 9).

b. First paragraph should be an introduction of what you plan to write about. Describe your chosen infographic. What is it, where do people see it, what does it consist of, and what is the goal of the message?

c. Second paragraph should describe what information the viewer can derive from the infographic and how you believe the infographic accomplishes its purpose. Explain how the infographic relates to you. For example, in a weather map, explain the significance of the visual symbols that appear in your part of the country. If you were a stock broker, explain when would you buy or sell, based on an infographic of the stock’s performance. If you were a doctor, explain how a diagram of the human body might help a patient understand a medical condition.

d. Third paragraph should summarize or “wrap up” the essay in a satisfying way. In other words, the three paragraphs should, “tell them what you’re going to tell them, tell them, and then tell them what you’ve told them.”

e. Include a digital image of your selected infographic, or include a URL to the location of the infographic on the web.

5. Upload files in the following formats only: Microsoft Word documents (.doc or .docx), Adobe Reader files (.pdf), JPEG image files (.jpg), rich text format (.rtf) or plain text documents (.txt).

6. Post your first-draft in the Module 9 Discussion Forum for reciprocal, constructive feedback from classmates and instructor.

7. Incorporate any changes suggested by your classmates if you feel it will improve your work, and post a revised draft in the Module 10 Discussion Forum, for more reciprocal, constructive feedback.

8. Incorporate any last-minute changes before uploading your final essay to the Assignment 5 submission button (click “Submit Assignment” above).

 

Criteria:

· Assignment submission is a 300-word (minimum) essay analyzing your chosen infographic, which must be “data visualization,” not “promotional.”

· Essay consists of three paragraphs (an introductory paragraph, a main paragraph, and a conclusion), and is written in Times New Roman font, 12-point size, and double line spacing with 1-inch margins.

· Analysis describes what information the viewer can derive from the data visualization infographic and how the infographic relates to you, specifically.

· File is saved in Microsoft Word (.doc or docx) format, Apple Pages (.pages) format, Adobe Reader (.pdf) format, or Rich Text Format (.rtf). Images are copied-and-pasted into or linked to within the word-processed document.

· Student posts first- and revised-drafts in the Module 9 and 10 Discussions, respectively, and participates in a critique.

Anatomy homework help

Roles Assignment

PT 105: 10 points

This is NOT a group assignment. Directions: Complete the table below; use Microsoft Word to complete.

PT

PTA

PT Aide/Tech

Licensure requirements

(according to the state of WI)

Education requirements

Allowable job duties/responsibilities

(what are they ABLE to do?)

Interventions/duties NOT specifically allowed

(what specific items are out of their scope, per the state & APTA?)

N/A

What kind of supervision (i.e. direct, general)
and who is able to supervise?
(according to the state of WI)

N/A

Total: / 7

1. Define the following levels of supervision: (1 point)

General:

Direct:

Direct Personal:

2. According to the APTA, what level of supervision is required for SPTAs in a clinical setting? (1 point)

3. Who is responsible for the care provided by the SPTA? (1 point)

RolesAssign.docx

Anatomy homework help

Engaging the Entire Care Cascade in Western Kenya:
A Model to Achieve the Cardiovascular Disease Secondary Prevention Roadmap Goals

Rajesh Vedanthan*, Jemima H. Kamano†,‡, Gerald S. Bloomfield§, Imran Manji‡, Sonak
Pastakia†,‡,‖, and Sylvester N. Kimaiyo†,‡

*Icahn School of Medicine at Mount Sinai, New York, NY, USA

†Moi University College of Health Sciences, Eldoret, Kenya

‡Academic Model Providing Access to Healthcare, Eldoret, Kenya

§Duke Global Health Institute, Duke Clinical Research Institute, and Duke University School of
Medicine, Durham, NC, USA

‖Department of Pharmacy Practice, Purdue University College of Pharmacy, Indianapolis, IN,
USA

Abstract

Cardiovascular disease (CVD) is the leading cause of death in the world, with a substantial health

and economic burden confronted by low- and middle-income countries. In low-income countries

such as Kenya, there exists a double burden of communicable and noncommunicable diseases, and

the CVD profile includes many nonatherosclerotic entities. Socio-politico-economic realities

present challenges to CVD prevention in Kenya, including poverty, low national spending on

health, significant out-of-pocket health expenditures, and limited outpatient health insurance. In

addition, the health infrastructure is characterized by insufficient human resources for health,

medication stock-outs, and lack of facilities and equipment. Within this socio-politico-economic

reality, contextually appropriate programs for CVD prevention need to be developed. We describe

our experience from western Kenya, where we have engaged the entire care cascade across all

levels of the health system, in order to improve access to high-quality, comprehensive,

coordinated, and sustainable care for CVD and CVD risk factors. We report on several initiatives:

1) population-wide screening for hypertension and diabetes; 2) engagement of community

resources and governance structures; 3) geographic decentralization of care services; 4) task

redistribution to more efficiently use of available human resources for health; 5) ensuring a

consistent supply of essential medicines; 6) improving physical infrastructure of rural health

facilities; 7) developing an integrated health record; and 8) mobile health (mHealth) initiatives to

provide clinical decision support and record-keeping functions. Although several challenges

remain, there currently exists a critical window of opportunity to establish systems of care and

prevention that can alter the trajectory of CVD in low-resource settings.

Correspondence: R. Vedanthan (rajesh.vedanthan@mssm.edu).

All other authors report no relationships that could be construed as a conflict of interest.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of
Health.

HHS Public Access
Author manuscript
Glob Heart. Author manuscript; available in PMC 2016 December 01.

Published in final edited form as:
Glob Heart. 2015 December ; 10(4): 313–317. doi:10.1016/j.gheart.2015.09.003.

A
u
th

o
r M

a
n
u
scrip

t
A

u
th

o
r M

a
n
u
scrip

t
A

u
th

o
r M

a
n
u
scrip

t
A

u
th

o
r M

a
n
u
scrip

t

Cardiovascular disease (CVD) is the leading cause of mortality in the world, with 80% of

CVD deaths occurring in low- and middle-income countries [1,2]. In sub-Saharan Africa,

CVD is the leading cause of death among individuals over age 30 years [3]. In addition to

the epidemiologic burden, CVD threatens to impose a significant economic burden on low-

and middle-income countries [4-6]. Whereas atherosclerotic CVD (particularly stroke) [7]

and CVD risk factors (particularly hypertension) [8] are increasing in Kenya,

nonatherosclerotic CVD remains significant in Kenya, including rheumatic heart disease,

heart failure, and household air pollutionerelated CVD [9,10]. In addition, the country

continues to confront a “double burden” of disease, including a significant burden of human

immunodeficiency virus and other communicable diseases (Figure 1) [11], representing the

evolution of the epidemiologic transition in this country.

Socio-Politico-Economic Realities

Kenya is designated as a low-income country by the World Bank [12], and the average daily

income for a substantial proportion of its population is <U.S. $1 per day [13]. In addition,

total expenditure on health is <5% of gross domestic product, out-of-pocket expenditures are

more than 75% of private spending on health, and government expenditure on health is

<U.S. $40 per capita [14]. Although there is a national health insurance program, it has

traditionally covered only inpatient admissions and is only recently expanding to outpatient

coverage [15].

In Kenya, a Division of Non-Communicable Diseases was formed in the Directorate of

Preventive and Promotive Services within the Ministry of Health. This division is charged

with the responsibility of driving policy response to noncommunicable diseases for the

whole country. It is in the process of concluding the development of a strategic plan for

noncommunicable diseases, as well as ensuring that the national health policy includes

measures to prevent and control noncommunicable diseases. Clear targets have been

designated, and evidence-based interventions have been recommended, including those for

secondary CVD prevention. However, widespread implementation of programs for CVD

prevention is still lacking.

The infrastructure for CVD prevention is challenging. There are insufficient human

resources for health overall [16], and the double burden of disease exacerbates this human

resource shortfall. There are frequent and repeated medication stock-outs, of even the

essential medicines contained on the national formulary [17]. Even when medicines are

available, they often remain unaffordable, are subject to price gouging, and can sometimes

be of uncertain quality [18]. CVD medicines are even less reliably available, especially for

the rural population. In addition, there is a profound lack of facilities, supplies, and

equipment—spanning laboratory facilities, radiology equipment, even sphygmomanometers.

Finally, patients often engage the health care system at advanced and complicated stages of

disease, at which point, prevention efforts are too late and curative efforts are expensive and

sometimes futile.

It is within this socio-politico-economic reality that contextually appropriate programs for

CVD prevention need to be developed. Here, we describe our experience from western

Vedanthan et al. Page 2

Glob Heart. Author manuscript; available in PMC 2016 December 01.

A
u
th

o
r M

a
n
u
scrip

t
A

u
th

o
r M

a
n
u
scrip

t
A

u
th

o
r M

a
n
u
scrip

t
A

u
th

o
r M

a
n
u
scrip

t

Kenya, where we have engaged the entire care cascade across all levels of the health system,

in order to improve access to high-quality, comprehensive, coordinated, and sustainable care

for CVD and CVD risk factors.

Engaging the Entire Care Cascade

Academic Model Providing Access to Healthcare (AMPATH) is a collaboration among the

Moi University College of Health Sciences, the Moi Teaching and Referral Hospital, and a

consortium of North American universities led by Indiana University. This partnership

“leads with care” while addressing the full academic mission that includes education and

research. AMPATH has established a human immunodeficiency virus care system in

western Kenya that has served over 160,000 patients [19,20]. Recently, AMPATH has

leveraged this infrastructure to expand its clinical scope of work to develop a comprehensive

chronic disease management program, focusing initially on CVD, hypertension, and diabetes

[21]. In so doing, the program was guided by the following principles across the entire care

cascade: find, link, treat, and retain. These four principles were embodied in several

initiatives (Table 1): 1) population-wide screening for hypertension and diabetes; 2)

engagement of community resources and governance structures; 3) decentralization of care

services in order to improve geographic access; 4) task redistribution to allow for more

efficient use of available human resources for health; 5) ensuring a consistent supply of

essential medicines; 6) improving physical infrastructure of rural health facilities; 7)

developing an integrated health record across all levels of the Kenyan health system; and 8)

targeted, strategic use of mobile health (mHealth) initiatives to provide clinical decision

support and record-keeping functions for rural clinicians.

By bringing together all of these components, AMPATH has been able to create an

integrated system of chronic disease treatment and prevention services throughout its

catchment area. Community health workers at the village level have received structured

training to provide health education and assist with linkage and retention to chronic disease

care. Nurses in rural dispensaries have been provided specialized training and support in

order to independently manage hypertension and diabetes. Referral networks have been

established that connect dispensaries, health centers, district hospitals, and the Moi Teaching

and Referral Hospital. At the referral hospital, AMPATH has established outpatient

cardiology and diabetes clinics that provide comprehensive, multidisciplinary, and

longitudinal care for patients, many of whom have advanced or complex cardiovascular and

metabolic diseases. Finally, by leveraging the academic partnership and philanthropic

support, the program has built the first inpatient cardiac care unit in western Kenya, which

allows for management, resuscitation, and rehabilitation of critically ill cardiovascular

patients [22]. This integrated and comprehensive system of care provides the foundation for

education, capacity building, and research, in line with the mission of AMPATH. The

program has also launched a community-based outpatient health insurance program to

facilitate greater access by resource-limited rural populations to the integrated care system.

AMPATH has also implemented creative and novel programs to increase access to CVD

medicines. The program has partnered with key stakeholders in the Kenya Ministry of

Health and local communities to establish a network of revolving fund pharmacies [17]. At

Vedanthan et al. Page 3

Glob Heart. Author manuscript; available in PMC 2016 December 01.

A
u
th

o
r M

a
n
u
scrip

t
A

u
th

o
r M

a
n
u
scrip

t
A

u
th

o
r M

a
n
u
scrip

t
A

u
th

o
r M

a
n
u
scrip

t

the rural health center level, each revolving fund pharmacy is located within the government

health center and serves as a backup to the government pharmacy, in order to prevent stock-

outs of essential medicines. The revolving fund pharmacy dispenses medications only when

the medication is out of stock at the government pharmacy, and the generated revenues are

used to restock the pharmacy. At the dispensary level, supply of CVD medications was

previously not available due to the commonly held view and policy that CVD was a health

issue that required more expertise than could be provided at the dispensary level. In this

setting, the revolving fund pharmacy serves as the primary supply for these medications.

Thus, the availability of essential CVD medicines has improved dramatically across all

levels of the health care system [17]. Local communities help to govern and monitor the

operations of each revolving fund pharmacy in order to ensure accountability to the local

population and patients. Demand for these services has increased, leading to the launch of

revolving fund pharmacies throughout the AMPATH catchment area.

The role of primary care clinicians, including nurses, clinical officers, and generalist

physicians, in this entire cascade cannot be understated. They will continue to provide care

to the vast majority of patients attending allopathic care facilities in low-resource, rural

settings. They also are often embedded in communities and have long-standing relationships

with community leaders and governance structures. Therefore, they have a great potential to

raise awareness both among individual patients as well as throughout entire communities.

Because they ultimately care for the bulk of patients in Kenya, these rural primary care

clinicians require appropriate training, mentorship, and support. In addition, they need to be

made aware of the relevant clinical guidelines, and be incentivized and motivated to use and

adhere to them. As has already been described, AMPATH has actively engaged primary care

clinicians with training, mentorship, and support, and those efforts need to continue and be

expanded.

Several challenges remain in terms of developing a roadmap for secondary CVD prevention

in a low-income country such as Kenya. Screening and detection of individuals with risk

factors and subclinical CVD requires the development and dissemination of novel diagnostic

equipment, including low-cost point-of-care technology that is portable and durable.

Simplification of CVD medication regimens, such as a cardiovascular polypill, could

potentially have benefit with respect to affordability and adherence [23]. For individuals

with known CVD, novel strategies to use mHealth to strengthen the link between patients

and providers may improve retention and adherence to care; however, the literature lacks

strong evidence in this regard [24]. New approaches to behavior modification and careful

attention to promoting healthy lifestyles, within the context of socio-politico-economic

constraints and life circumstances, will be required. Poor knowledge of secondary

prevention measures among clinicians needs to be addressed with training, capacity

building, and strong referral networks across the health system. Finally, ensuring high-

quality clinical care with a motivated health workforce can also promote a favorable clinical

experience for patients, thereby improving retention in care and adherence to treatment

regimens.

Vedanthan et al. Page 4

Glob Heart. Author manuscript; available in PMC 2016 December 01.

A
u
th

o
r M

a
n
u
scrip

t
A

u
th

o
r M

a
n
u
scrip

t
A

u
th

o
r M

a
n
u
scrip

t
A

u
th

o
r M

a
n
u
scrip

t

Conclusions

CVD is a global problem, and increasingly so, even for low-income countries. While the

global CVD burden is still on the rise in low-income countries such as Kenya, there exists a

critical window of opportunity to establish systems of care and prevention that can alter the

trajectory of CVD in these settings. Engaging the entire care cascade, in the context of

epidemiologic and socio-politico-economic realities, is a promising way forward to achieve

the roadmap goals for secondary prevention of CVD in low-resource settings.

Acknowledgments

R. Vedanthan is supported by the Fogarty International Center of the National Institutes of Health under Award
Number K01 TW 009218e05.

References

1. Fuster, V.; Kelly, BB. Promoting Cardiovascular Health in the Developing World: A Critical
Challenge to Achieve Global Health. Washington, DC: National Academies Press; 2010.

2. Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for
20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study
2010. Lancet. 2012; 380:2095–128. [PubMed: 23245604]

3. Gaziano, TA.; Reddy, KS.; Paccaud, F.; Horton, S.; Chaturvedi, V. Cardiovascular disease. In:
Jamison, DT.; Breman, JG.; Measham, AR., editors. Disease Control Priorities in Developing
Countries. 2nd. New York, NY: Oxford University Press; 2006. p. 645-62.

4. Bloom, DE.; Cafiero, ET.; Jané-Llopis, E., et al. The Global Economic Burden of
Noncommunicable Diseases. Geneva, Switzerland: World Economic Forum; 2011.

5. Huffman MD, Rao KD, Pichon-Riviere A, et al. A cross-sectional study of the microeconomic
impact of cardiovascular disease hospitalization in four low- and middle-income countries. PLoS
One. 2011; 6:e20821. [PubMed: 21695127]

6. Kankeu HT, Saksena P, Xu K, Evans DB. The financial burden from non-communicable diseases in
low- and middle-income countries: a literature review. Health Res Policy Syst. 2013; 11:31.
[PubMed: 23947294]

7. Etyang AO, Munge K, Bunyasi EW, et al. Burden of disease in adults admitted to hospital in a rural
region of coastal Kenya: an analysis of data from linked clinical and demographic surveillance
systems. Lancet Glob Health. 2014; 2:e216–24. [PubMed: 24782954]

8. Kayima J, Wanyenze RK, Katamba A, Leontsini E, Nuwaha F. Hyper-tension awareness, treatment
and control in Africa: a systematic review. BMC Cardiovasc Disord. 2013; 13:54. [PubMed:
23915151]

9. GBD Compare. Institute for Health Metrics and Evaluation. Kenya: University of Washington;
Available at: http://vizhub.healthdata.org/gbd-compare/ [Accessed October 26, 2015]

10. Moran A, Forouzanfar M, Sampson U, Chugh S, Feigin V, Mensah G. The epidemiology of
cardiovascular diseases in sub-Saharan Africa: the Global Burden of Diseases, Injuries and Risk
Factors 2010 Study. Prog Cardiovasc Dis. 2013; 56:234–9. [PubMed: 24267430]

11. WHO. [Accessed March 7, 2015] Noncommunicable Diseases Country Profiles, 2014: Kenya.
2014. Available at: http://www.who.int/nmh/countries/ken_en.pdf?ua=1

12. World Bank. [Accessed March 16, 2015] Data: Kenya. 2015. Available at: http://
data.worldbank.org/country/kenya

13. UNICEF. [Accessed January 19,2014] Kenya at a Glance 2014. Available at: http://
www.unicef.org/kenya/overview_4616.html

14. WHO. [Accessed March 7,2015] Global Health Observatory. 2014. Available at: http://
www.who.int/countries/ken/en/

Vedanthan et al. Page 5

Glob Heart. Author manuscript; available in PMC 2016 December 01.

A
u
th

o
r M

a
n
u
scrip

t
A

u
th

o
r M

a
n
u
scrip

t
A

u
th

o
r M

a
n
u
scrip

t
A

u
th

o
r M

a
n
u
scrip

t

15. Chuma J, Okungu V. Viewing the Kenyan health system through an equity lens: implications for
universal coverage. Int J Equity Health. 2011; 10:22. [PubMed: 21612669]

16. WHO. [Accessed March 7, 2015] Global Health Workforce Statistics: The 2013 Update. 2013.
Available at: http://www.who.int/hrh/statistics/hwfstats/

17. Manji, I.; Lukas, S.; Vedanthan, R.; Jakait, B.; Pastakia, S. Community based approaches to reduce
medication stock outs in western Kenya; Presented at: Science of Eliminating Health Disparities
Summit 2012; Washington, DC: Dec. 2012

18. WHO. [Accessed March 16, 2015] Essential Medicines and Health Products: Counterfeit
Medicines. 2015. Available at: http://www.who.int/medicines/services/counterfeit/impact/
ImpactF_S/en/index1.html

19. Einterz RM, Kimaiyo S, Mengech HN, et al. Responding to the HIV pandemic: the power of an
academic medical partnership. Acad Med. 2007; 82:812–8. [PubMed: 17762264]

20. AMPATH. [Accessed March 16, 2015] AMPATH Leading With Care: Our Model. 2015.
Available at: http://www.ampathkenya.org/our-model

21. Bloomfield GS, Kimaiyo S, Carter EJ, et al. Chronic noncommunicable cardiovascular and
pulmonary disease in sub-Saharan Africa: an ac-ademic model for countering the epidemic. Am
Heart J. 2011; 161:842–7. [PubMed: 21570512]

22. Binanay CA, Akwanalo CO, Aruasa W. Building sustainable capacity for cardiovascular care at a
public hospital in Western Kenya. J Am Coll Cardiol. 2015 In press.

23. Castellano JM, Sanz G, Penalvo JL, et al. A polypill strategy to improve adherence: results from
the FOCUS project. J Am Coll Cardiol. 2014; 64:2071–82. [PubMed: 25193393]

24. Bloomfield GS, Vedanthan R, Vasudevan L, Kithei A, Were M, Velazquez EJ. Mobile health for
non-communicable diseases in Sub-Saharan Africa: a systematic review of the literature and
strategic framework for research. Global Health. 2014; 10:49. [PubMed: 24927745]

Vedanthan et al. Page 6

Glob Heart. Author manuscript; available in PMC 2016 December 01.

A
u
th

o
r M

a
n
u
scrip

t
A

u
th

o
r M

a
n
u
scrip

t
A

u
th

o
r M

a
n
u
scrip

t
A

u
th

o
r M

a
n
u
scrip

t

Figure 1. Percentage of total deaths by cause, all ages, both sexes
NCD, noncommunicable disease(s). Reproduced, with permission, from World Health

Organization [11].

Vedanthan et al. Page 7

Glob Heart. Author manuscript; available in PMC 2016 December 01.

A
u
th

o
r M

a
n
u
scrip

t
A

u
th

o
r M

a
n
u
scrip

t
A

u
th

o
r M

a
n
u
scrip

t
A

u
th

o
r M

a
n
u
scrip

t

A
u
th

o
r M

a
n
u
scrip

t
A

u
th

o
r M

a
n
u
scrip

t
A

u
th

o
r M

a
n
u
scrip

t
A

u
th

o
r M

a
n
u
scrip

t

Vedanthan et al. Page 8

Table 1
The care cascade (find, link, treat, retain), with associated challenges, responses, and
future directions

Challenges AMPATH Responses Future Directions

FIND Identifying individuals at risk and
individuals with disease

Home-based, door-to-door
screening Community-based
screening

Evaluation of different screening and
detection strategies

Laboratory facilities and diagnostic
equipment not accessible to entire
population

Providing diagnostic
equipment to rural health
facilities

Development and evaluation of low-
cost, point-of-care diagnostic
technology

Mistrust of public sector services Improve relationship with
community leaders and tribal
elders

Continue to engage community and
elicit feedback as to future services and
quality care

Glob Heart. Author manuscript; available in PMC 2016 December 01.

A
u
th

o
r M

a
n
u
scrip

t
A

u
th

o
r M

a
n
u
scrip

t
A

u
th

o
r M

a
n
u
scrip

t
A

u
th

o
r M

a
n
u
scrip

t

Vedanthan et al. Page 9

Challenges AMPATH Responses Future Directions

LINK Excessive distance to health facilities Geographic decentralization
of care services

Further geographic decentralization and
portabilization of care delivery

Low awareness of risks Community health workers
with specialized training

Evaluation of different strategies to
improve linkage to care

Asymptomatic disease at early stages Smartphone-based tailored
behavioral communication

Evaluate mHealth initiatives

Emotional factors (fears) Community health workers
with motivational
interviewing

Engage individuals emotionally as well
as cognitively

Poverty Microfinance initiatives Iteration and improvement of
microfinance

Lack of health insurance Community-based outpatient
health insurance

Iteration and improvement of program

Scale-up of insurance coverage

Poor reputation of public sector
facilities

Community health workers
with motivational
interviewing

Raise awareness of quality
improvement initiatives and improve
desirability of public sector services

Glob Heart. Author manuscript; available in PMC 2016 December 01.

A
u
th

o
r M

a
n
u
scrip

t
A

u
th

o
r M

a
n
u
scrip

t
A

u
th

o
r M

a
n
u
scrip

t
A

u
th

o
r M

a
n
u
scrip

t

Vedanthan et al. Page 10

Challenges AMPATH Responses Future Directions

TREAT Insufficient human resources Task redistribution Evaluation of task redistribution
strategy

Development of optimal health care
provider composition

Inadequate training and knowledge of
management approaches

Targeted training; mHealth
with clinical decision support

Evaluate mHealth initiatives

Poor knowledge of secondary
prevention measures

Training of physicians in
guideline-based practices at
the referral hospital

Capacity building of clinicians at
district hospitals in catchment area

Medication stock-outs Revolving fund pharmacy
with community governance
and oversight

Novel community-based supply chain
solution development

Lack of facilities and equipment Improving physical
infrastructure of rural health
facilities

Continued improvement of rural health
facility infrastructure and equipment

Development of cardiac care
unit

Strengthening referral pathways

Lack of integration of medical records
across levels of care

Integrated electronic health
record with real-time access
for rural clinicians

Improvement and optimization of
health record functionality and clinical
applicability

Lack of health insurance Community-based outpatient
health insurance

Iteration and improvement of program

Scale-up of insurance coverage

Poor provider-patient relationship Incorporate patient-centric
approaches into care model

Iteration and optimization of program

Glob Heart. Author manuscript; available in PMC 2016 December 01.

A
u
th

o
r M

a
n
u
scrip

t
A

u
th

o
r M

a
n
u
scrip

t
A

u
th

o
r M

a
n
u
scrip

t
A

u
th

o
r M

a
n
u
scrip

t

Vedanthan et al. Page 11

Challenges AMPATH Responses Future Directions

RETAIN Low awareness of risks Community health workers
with specialized training

Evaluation of different strategies to
improve retention in care

Asymptomatic disease at early stages Smartphone-based tailored
behavioral communication

Evaluate mHealth initiatives

Emotional factors (fears) Community health workers
with motivational
interviewing

Engage individuals emotionally as well
as cognitively

Poverty Microfinance initiatives Iteration and improvement of
microfinance

Lack of health insurance Community-based outpatient
health insurance

Iteration and improvement of program
Scale-up of insurance coverage

mHealth, mobile health.

Glob Heart. Author manuscript; available in PMC 2016 December 01.

Anatomy homework help

1. An individual finds himself infected by a previously undiscovered pathogen, Transmissio. Prepare a written paper of at least 1000 words that examines the defense system of the body through the following bullet points.

a. What is the body’s initial response? What are long-term effects?

b. Describe the direct players (cells and organs) that participate in the innate vs. adaptive immune response.

c. Mention through what conduit soluble or mobile immune factors reach and interact with the pathogen.

d. Predict the consequences of administering the MMR vaccine in this individual if he is currently infected by Transmissio.

Your paper should be formatted as a proper research paper with an introduction and conclusion. Do not simply follow the bullet points above, but really think about what you have learned and how that relates to other material we have covered and knowledge you have from other courses you may have taken. All references must be cited using APA Style format

Anatomy homework help

Lecture PowerPoint

Accessibility standards-compliant

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Fundamentals of Anatomy & Physiology

Eleventh Edition

Chapter 17

The Special Senses

Lecture Presentation by

Deborah A. Hutchinson

Seattle University

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Learning Outcomes (1 of 2)

17-1 Describe the sensory organs of smell, trace the olfactory pathways to their destinations in the brain, and explain the physiological basis of olfactory discrimination.

17-2 Describe the sensory organs of taste, trace the gustatory pathways to their destinations in the brain, and explain the physiological basis of gustatory discrimination.

17-3 Identify the internal and accessory structures of the eye, and explain the functions of each.

17-4 Describe how refraction and the focusing of light on the retina lead to vision.

3

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Learning Outcomes (2 of 2)

17-5 Explain color and depth perception, describe how light stimulates the production of nerve impulses, and trace the visual pathways to their destinations in the brain.

17-6 Describe the structures of the external, middle, and internal ear, explain their roles n equilibrium and hearing, and trace the pathways for equilibrium and hearing to their destinations in the brain.

4

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

An Introduction to the Special Senses

Special senses

Olfaction (smell)

Gustation (taste)

Vision

Equilibrium (balance)

Hearing

5

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

17-1 Olfaction, the Sense of Smell (1 of 5)

Learning Outcome: Describe the sensory organs of smell, trace the olfactory pathways to their destinations in the brain, and explain the physiological basis of olfactory discrimination.

Olfaction

Sense of smell

Olfactory organs

Located in nasal cavity on either side of nasal septum

Made up of two layers

Olfactory epithelium

Lamina propria

6

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

17-1 Olfaction, the Sense of Smell (2 of 5)

Olfactory epithelium contains

Olfactory sensory neurons

Highly modified nerve cells

Detect dissolved chemicals as they interact with odorant-binding proteins

Supporting cells

Basal epithelial cells (stem cells)

Underlying lamina propria contains

Areolar tissue, blood vessels, and nerves

Olfactory glands (secretions form mucus)

7

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Figure 17-1a
The Olfactory Organs.

The olfactory organ on the right side of the nasal septum.

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Figure 17-1b
The Olfactory Organs.

An olfactory receptor is a modified neuron with multiple cilia-shaped dendrites.

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

17-1 Olfaction, the Sense of Smell (3 of 5)

Olfactory reception

Begins with binding of odorant to G protein-coupled receptor

Creates generator potential (depolarization)

Olfactory pathways

Afferent fibers leave olfactory epithelium

Collect into 20 or more bundles

Penetrate cribriform plate of ethmoid

Reach olfactory bulbs of cerebrum where first synapse occurs

10

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

17-1 Olfaction, the Sense of Smell (4 of 5)

Olfactory pathways

Axons leaving olfactory bulb

Travel along olfactory tract to olfactory cortex, hypothalamus, and limbic system

Olfactory information is the only type of sensory information to reach cerebral cortex directly

All other sensations are relayed from thalamus

11

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Figure 17-2
Olfaction and Gustation
(Part 1 of 2).

a) Olfaction

b) Gustation

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Figure 17-2
Olfaction and Gustation
(Part 2 of 2).

a) Olfaction

b) Gustation

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

17-1 Olfaction, the Sense of Smell (5 of 5)

Olfactory discrimination

We can distinguish thousands of chemical stimuli

Dogs have 72 times more olfactory receptor surface area than humans do

Thus, their sense of smell is more than 10,000 times better than ours

Olfactory receptors are replaced frequently

But total number of neurons declines with age

14

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

17-2 Gustation, the Sense of Taste (1 of 6)

Learning Outcome: Describe the sensory organs of taste, trace the gustatory pathways to their destinations in the brain, and explain the physiological basis of gustatory discrimination.

Gustation (taste)

Provides information about foods and liquids consumed

Gustatory epithelial cells (taste receptors)

Found in taste buds

Distributed on superior surface of tongue and portions of pharynx and larynx

Associated with epithelial projections (lingual papillae) on surface of tongue

15

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

17-2 Gustation, the Sense of Taste (2 of 6)

Types of lingual papillae

Filiform papillae

Provide friction to move food around mouth

Do not contain taste buds

Fungiform papillae

Contain about five taste buds each

Vallate papillae

Contain as many as 100 taste buds each

Foliate papillae

Have taste buds

16

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

17-2 Gustation, the Sense of Taste (3 of 6)

Taste buds

Contain basal epithelial cells (stem cells)

And gustatory epithelial cells

Extend microvilli (taste hairs) through taste pore

Survive about 10 days before replacement

Innervated by cranial nerves that synapse in solitary nucleus of medulla oblongata

Information travels to thalamus and gustatory cortex of insula

17

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Figure 17-3a
Papillae, Taste Buds, and Gustatory Epithelial Cells.

Location of tongue papillae.

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Figure 17-3b
Papillae, Taste Buds, and Gustatory Epithelial Cells.

The structure and representative locations of the four types of lingual papillae. Taste receptors are located in taste buds, which form packets in the epithelium of fungiform, foliate, and vallate papillae.

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Figure 17-3c
Papillae, Taste Buds, and Gustatory Epithelial Cells.

Taste buds in a vallate papilla. A diagrammatic view of a taste bud, showing gustatory epithelial cells and supporting cells.

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

17-2 Gustation, the Sense of Taste (4 of 6)

Gustatory discrimination

Four primary taste sensations

Sweet

Salty

Sour

Bitter

21

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

17-2 Gustation, the Sense of Taste (5 of 6)

Two additional taste sensations

Umami

Pleasant, savory taste imparted by glutamate

Characteristic of broths

Water

Detected by water receptors in pharynx

22

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

17-2 Gustation, the Sense of Taste (6 of 6)

Taste sensitivity

Differs significantly among individuals

Many conditions are inherited

Example: sensitivity to phenylthiocarbamide (PTC)

Number of taste receptors begins declining rapidly at age 50

23

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Figure 17-2
Olfaction and Gustation (Part 3 of 8).

Gustation

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Figure 17-2
Olfaction and Gustation (Part 7 of 8).

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

17-3 Structures of the Eye (1 of 21)

Learning Outcome: Identify the internal and accessory structures of the eye, and explain the functions of each.

We rely more on vision than on any other special sense

Accessory structures of the eye

Provide protection, lubrication, and support

Include

Eyelids

Superficial epithelium of eye

Lacrimal apparatus

26

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

17-3 Structures of the Eye (2 of 21)

Eyelids (palpebrae)

A continuation of skin

Blinking keeps surface of eye lubricated and clean

Palpebral fissure

Gap that separates free margins of upper and lower eyelids

Eyelids are connected at

Medial angle (medial canthus)

Lateral angle (lateral canthus)

27

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

17-3 Structures of the Eye (3 of 21)

Eyelids

Eyelashes

Robust hairs

Help prevent foreign matter from reaching eye

Tarsal glands

Secrete lipid-rich product that helps keep eyelids from sticking together

Lacrimal caruncle

Mass of soft tissue at medial angle of eye

Contains glands producing thick secretions

28

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Figure 17-4a
External Features and Accessory Structures of the Eye.

Gross and superficial anatomy of the accessory structures. ATLAS: Plates 3c; 12a; 16a,b

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

17-3 Structures of the Eye (4 of 21)

Conjunctiva

Mucous membrane covered by an epithelium

Palpebral conjunctiva covers inner surface of eyelids

Bulbar conjunctiva covers anterior surface of eye

Extends to edges of cornea

Conjunctivitis (pinkeye)

Inflammation of conjunctiva

30

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

17-3 Structures of the Eye (5 of 21)

Lacrimal apparatus

Produces, distributes, and removes tears

Lacrimal gland (tear gland)

Produces tears that bathe conjunctival surfaces

Secretions contain lysozyme (antibacterial enzyme)

Fornix

Pocket where palpebral conjunctiva joins bulbar conjunctiva

Receives 10-12 ducts from lacrimal gland

31

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

17-3 Structures of the Eye (6 of 21)

Tears

Collect in lacrimal lake at medial angle of eye

Pass through

Lacrimal puncta (pores)

Lacrimal canaliculi (canals)

Lacrimal sac

Nasolacrimal duct

To nasal cavity

32

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Figure 17-4b
External Features and Accessory Structures of the Eye.

The organization of the lacrimal apparatus. ATLAS: Plates 3c; 12a; 16a,b

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

17-3 Structures of the Eye (7 of 21)

Layers of the wall of the eyeball

Outer fibrous layer

Intermediate vascular layer (uvea)

Deep inner layer (retina)

Orbital fat

Cushions and insulates each eye

34

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

17-3 Structures of the Eye (8 of 21)

Eyeball

Hollow

Filled with fluid

Two interior cavities

Small anterior cavity (contains aqueous humor)

Large posterior cavity (contains vitreous body)

35

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Figure 17-5b
The Sectional Anatomy of the Eye.

Horizontal section of right eye. ATLAS: Plates 12a; 16a,b

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

36

17-3 Structures of the Eye (9 of 21)

Fibrous layer (outermost layer of eyeball)

Sclera

White of the eye

Cornea

Transparent portion

Corneoscleral junction (corneal limbus)

Border between cornea and sclera

37

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Figure 17-5a
The Sectional Anatomy of the Eye.

Sagittal section of left eye. ATLAS: Plates 12a; 16a,b

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

17-3 Structures of the Eye (10 of 21)

Vascular layer (uvea)

Provides route for blood vessels and lymphatics that supply tissues of eye

Regulates amount of light entering eye

Secretes and reabsorbs aqueous humor that circulates within chambers of eye

Controls shape of lens, which is essential to focusing

39

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Figure 17-5c
The Sectional Anatomy of the Eye.

Superior view of dissection of right eye. ATLAS: Plates 12a; 16a,b

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

17-3 Structures of the Eye (11 of 21)

Vascular layer

Iris

Contains blood vessels, melanocytes, and two layers of smooth muscle (pupillary muscles)

Pupillary muscles

Change diameter of pupil (central opening of iris)

41

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Figure 17-6
The Pupillary Muscles.

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

17-3 Structures of the Eye (12 of 21)

Vascular layer

Ciliary body

Attaches to iris

Extends posteriorly to level of ora serrata

Serrated anterior edge of neural layer of retina

Contains ciliary muscle and ciliary processes

Ciliary zonule (suspensory ligament)

Attaches lens to ciliary processes

43

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

17-3 Structures of the Eye (13 of 21)

Vascular layer

Choroid

Vascular layer that separates fibrous and inner layers posterior to ora serrata

Capillaries deliver oxygen and nutrients to retina

44

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

17-3 Structures of the Eye (14 of 21)

Inner layer (retina)

Pigmented layer

Absorbs light that passes through neural layer

Neural layer

Contains supporting cells and neurons

Outermost part contains photoreceptors

Rods and cones

45

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

17-3 Structures of the Eye (15 of 21)

Rods

Do not discriminate colors

Highly sensitive to light

Cones

Provide color vision

Densely clustered in macula

Especially in fovea centralis (fovea)

At center of macula

Site of sharpest color vision

Visual axis is the line from an object to fovea

46

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Figure 17-7a
The Organization of the Retina (Part 1 of 2).

The cellular organization of the retina. The photoreceptors are closer to the choroid than they are to the posterior cavity (vitreous chamber).

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Figure 17-7a
The Organization of the Retina (Part 2 of 2).

The cellular organization of the retina. The photoreceptors are closer to the choroid than they are to the posterior cavity (vitreous chamber).

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Figure 17-7b
The Organization of the
Retina.

A photograph of the retina as seen through the pupil.

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Figure 17-7c
The Organization of the
Retina.

The optic disc in diagrammatic sagittal section.

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

17-3 Structures of the Eye (16 of 21)

Neural layer

Bipolar cells

Synapse with rods and cones

Ganglion cells

Synapse with bipolar cells

Horizontal cells

Extend across neural layer

Amacrine cells

Comparable to horizontal cells

51

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

17-3 Structures of the Eye (17 of 21)

Horizontal and amacrine cells

Facilitate or inhibit communication between photoreceptors and ganglion cells

Alter sensitivity of retina

Optic disc

Circular region just medial to fovea

Origin of optic nerve

No photoreceptors (blind spot)

52

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Figure 17-8
A Demonstration of the Presence of a Blind Spot.

Close your left eye and stare at the plus sign with your right eye, keeping the plus sign in the center of your field of vision. Begin with the page a few inches away from your eye, and gradually increase the distance. The dot will disappear when its image falls on the blind spot, at your optic disc. To check the blind spot in your left eye, close your right eye and repeat the sequence while you stare at the dot.

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

17-3 Structures of the Eye (18 of 21)

Chambers of the eye

Ciliary body and lens divide interior of eye into

Large posterior cavity

Smaller anterior cavity

Divided by iris into anterior and posterior chambers

54

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

17-3 Structures of the Eye (19 of 21)

Aqueous humor

Fluid that circulates within anterior cavity

Also diffuses through posterior cavity

Enters scleral venous sinus (canal of Schlemm) at corneoscleral junction

Reenters circulation at veins in sclera

Intra-ocular pressure

Fluid pressure in aqueous humor

Helps retain eye shape

55

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Figure 17-9
The Circulation of Aqueous Humor.

Aqueous humor, which is secreted at the ciliary body, circulates through the posterior and anterior chambers before it is reabsorbed through the scleral venous sinus.

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

17-3 Structures of the Eye (20 of 21)

Vitreous body

Gelatinous mass in posterior cavity

Helps stabilize shape of eye

Vitreous humor

Fluid portion of vitreous body

57

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

17-3 Structures of the Eye (21 of 21)

Lens

Held in place by ciliary zonule

Lens fibers

Enucleate cells in interior of lens

Filled with crystallins, which provide clarity and focusing power

Cataracts

Loss of transparency in lens

Senile cataracts

Most common form; natural consequence of aging

58

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

17-4 Refraction and Focusing (1 of 3)

Learning Outcome: Describe how refraction and the focusing of light on the retina lead to vision.

Refraction and focusing of light

Light is refracted (bent) as it passes through cornea and lens

Focal point

Specific point of intersection of light rays on retina

Focal distance

Distance between center of lens and focal point

59

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Figure 17-10
Factors Affecting Focal Distance.

Light rays from a source are refracted when they reach the lens of the eye. The rays are then focused onto a single focal point.

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

17-4 Refraction and Focusing (2 of 3)

Astigmatism

Condition where light passing through cornea and lens is not refracted properly

Visual image is distorted

Accommodation

Automatic adjustment of eye to provide clear vision

Lens becomes rounder to focus on nearby objects

Flatter lens allows focus on distant objects

61

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Figure 17-11a
Accommodation.

For close vision: Ciliary muscle contracted, lens rounded. For the eye to form a sharp image, the lens becomes rounder for close objects and flatter for distant objects.

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Figure 17-11b
Accommodation.

For distant vision: Ciliary muscle relaxed, lens flattened. For the eye to form a sharp image, the lens becomes rounder for close objects and flatter for distant objects.

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

17-4 Refraction and Focusing (3 of 3)

Image arriving at retina is miniaturized, upside down, and reversed from left to right

Brain compensates

Visual acuity

Clarity of vision

Standard rating is 20/20

Scotoma

Abnormal, permanent blind spot

May result from compression of optic nerve, damage to photoreceptors, or central damage

64

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Figure 17-12a
Image Formation.

Light from a point at the top of an object is focuse don the lower retinal surface. These illustrations are not drawn to scale because the fovea centralis occupies a small area of the retina, and the projected images are very tiny. As a result, the crossover of light rays is shown in the lens, but it actually occurs very close to the fovea centralis.

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Figure 17-12b
Image Formation.

Light from a point at the bottom of an object is focused on the upper retinal surface. These illustrations are not drawn to scale because the fovea centralis occupies a small area of the retina, and the projected images are very tiny. As a result, the crossover of light rays is shown in the lens, but it actually occurs very close to the fovea centralis.

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Figure 17-12c
Image Formation.

Light rays projected from a vertical object show why the image arrives upside down. (Note that the image is also reversed.) These illustrations are not drawn to scale because the fovea centralis occupies a small area of the retina, and the projected images are very tiny. As a result, the crossover of light rays is shown in the lens, but it actually occurs very close to the fovea centralis.

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Figure 17-12d
Image Formation.

Light rays projected from a horizontal object show why the mage arrives with a left and right reversal. The image also arrives upside down. These illustrations are not drawn to scale because the fovea centralis occupies a small area of the retina, and the projected images are very tiny. As a result, the crossover of light rays is shown in the lens, but it actually occurs very close to the fovea centralis.

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Figure 17-13
Refractive Problems (Part 1 of 5).

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Figure 17-13
Refractive Problems (Part 2 of 5).

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Figure 17-13
Refractive Problems (Part 3 of 5).

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Figure 17-13
Refractive Problems (Part 4 of 5).

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Figure 17-13
Refractive Problems (Part 5 of 5).

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

17-5 Physiology of Vision (1 of 12)

Learning Outcome: Explain color and depth perception, describe how light stimulates the production of nerve impulses, and trace the visual pathways to their destinations in the brain.

Photoreceptors

Rods

Detect presence or absence of photons

Cones

Provide information about wavelengths of photons

Both rods and cones have

Inner segment containing major organelles

Outer segment with membranous discs

Contain visual pigments

74

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

17-5 Physiology of Vision (2 of 12)

Visual pigments

Absorb photons

First step in photoreception

Derivatives of rhodopsin

Opsin (protein) plus retinal (pigment)

Retinal is synthesized from vitamin A

75

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Figure 17-14a
Structure of Rods, Cones, and the Rhodopsin Molecule.

Structure of rods and cones

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Figure 17-14b
Structure of Rods, Cones, and the Rhodopsin Molecule.

Structure of rhodopsin molecule

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved

17-5 Physiology of Vision (3 of 12)

Color vision

Provided by blue cones, green cones, and

Anatomy homework help

Persuasive Letter

When you decide to write a persuasive letter you have:

 Identified a purpose
o Want them to believe or not believe something
o Want them to do or not do something

 Identified your audience
o Can they make decisions
o Can they deliver
o Are they well-versed in the topic/issue

 Experts?
 Leaders in the field?

 Included specific reasons
 Added specific details
 Remained polite

Cheusheva, S. (2017). Writing persuasive request letters: business letter format,
tips and samples. AbleBits. Retrieved from: https://www.ablebits.com/office-
addins-blog/2014/04/04/request-letters-format-samples/

10 tips to write persuasive request letters

Below you will find 10 strategies to write your request letters in such a way that
they convince your reader to respond or act.

1. Know your addressee. Before you start composing you request letter, ask
yourself these questions. Who is my reader and how exactly can they help
me? Are they decision makers or will they just pass along my request to a
senior officer? Both the style and contents of your request letter will depend
on the reader’s position.

2. Do not be verbose. Be clear, brief and to the point. A rule of a thumb is this
– don’t use two words when one would suffice. Just remember the famous
quote by Mark Twain – “I didn’t have time to write a short letter, so I wrote a
long one instead”. A person in his position could afford that, and… he was
not requesting anything : )

3. Make your letter easy to read. When writing a request letter, don’t digress
and don’t confuse your reader by drifting off your main point. Avoid long,
crammed sentences and paragraphs because they are intimidating and hard
to digest. Use simple, declarative sentences instead and break long
sentences with commas, colons and semicolons. Start a new paragraph when
you change a thought or idea.

Here’s a very poor example of a cover letter:
“In every regard, my qualifications appear to be consistent with the desires
expressed by your advertisement and based on the voice of your company’s
blogs, I really think that I was meant to be a [Position] in your company.”

And this is a good one:
“I have good skills and experience in [Your area of expertise] and I would be
most grateful if you consider me for any suitable position.”

Remember, if your request letter looks easy to read, it has a better chance to
be read!

4. Add call to action. Put action in your request letters wherever is possible.
The easiest way is to use action verbs and the active voice rather than
passive.

5. Convince but do not demand. Do not treat your addressees as if they owe
you something. Instead, catch the reader’s attention by mentioning common
ground and emphasize the benefits of acting.

6. Do not be burdensome. Give readers all the information needed and tell
what exactly you want them to do. Simplify the job for the person to respond
– include contact information, direct phone numbers, give links or attach
files, whatever is appropriate

7. Write in a friendly way and appeal to the reader’s feelings. Though
you are writing a business letter, don’t be superfluously businesslike. Friendly
letters make friends, so write your request letters in a friendly way as if you
are talking to your real friend or an old acquaintance. We are all humans,
and it may be a good idea to appeal to humanity, generosity, or sympathy of
your correspondent.

8. Remain polite and professional. Even if you are writing an order
cancellation request or complaint letter, remain polite and courteous, simply
state the issue(s), provide all relevant information and be sure to avoid
threats and calumny.

9. Mind your grammar! Rephrasing a well-known saying – “grammar counts
for first impressions”. Poor grammar like poor manners may spoil everything,
so be sure to proofread all business letters you send.

10.Review before sending. When you have finished composing the letter,
read it aloud. If your key point is not crystal clear, write it over. It’s better to
invest some time in re-writing and get a response, than make it fast and
have your letter thrown away in a bin straight away.

And finally, if you’ve got a response to your request letter or the desired action is
taken, don’t forget to thank the person.

Anatomy homework help

Overview:

Helpful resources:

https://owl.purdue.edu/owl/general_writing/common_writing_assignments/annotated_bibliographies/annotated_bibliography_samples.html

There are a several reasons for creating an annotated bibliography. Frequently, they are used to provide a quick overview of content that is relevant and useful to a topic but was not used as a referenced source in a paper. Sometimes an annotated bibliography stands alone as a document that provides a quick overview of a body of literature. Writing an annotation is good practice in the skill of summarizing the content and relevance of an article.

Instructions

· Review the resources on how to select a credible source and how to write an annotated bibliography.  These resources can be found in the Instructional Materials folder for Module 3.

· There must be a minimum of five (5) documents/sources/references used in the bibliography. The documents must be beyond those required in or used in previous assignments.

· Scholarly and credible JOURNAL articles must be used. Website references CANNOT be included. It’s best to retrieve the articles from the library database and select the “peer-reviewed” tab.

· Chosen articles are to deepen an understanding of the health issue and/or the country selected for the final paper.  The content of the chosen articles must be clearly relevant to the content of the final paper.

· Complete the annotation for each of the five (5) sources.  

. Each annotated article is to be on a separate page

. Reference information will be included at the top of the page. Each source must be listed in correct APA Manual 7th edition format.  If the references appear at the top of each page as is required for this assignment there is NO need for a separate reference page.

. Each annotation must contain a summary of, an evaluation of, and a reflection upon the content.

· You must include a properly formatted APA Manual 7th edition student title page. 

Anatomy homework help

M4-A1: Structure of the SDOH Impact Analysis Assignment

The assignment is to be structured in the following way:

Body of the SDOH paper

References for the SDOH paper

Blank line

Blank line

Blank line

Blank line

Date of email

Salutation

Body of the email

References for the email

Anatomy homework help

The Service Culture Handbook

The Service Culture Handbook
A STEP – BY – STEP GUIDE TO GETTING

YOUR EMPLOYEES OBSESSED
WITH CUSTOMER SERVICE

Jeff Toister

Copyright © 2017 Jeff Toister
All rights reserved.

ISBN-13: 9780692842003
ISBN-10: 0692842004

Table of Contents

Acknowledgements
Introduction

Part 1: Culture Is the Key to Outstanding Customer Service
Chapter 1 How Corporate Culture Guides Your Employees’ Actions
Chapter 2 Why Culture Initiatives Often Fail

Part 2: Building a Customer-Focused Culture
Chapter 3 Defining Your Culture
Chapter 4 Engaging Employees with Your Culture

Part 3: Changing Your Company’s Service DNA
Chapter 5 Aligning Your Business Around a Customer-Focused Culture
Chapter 6 Setting Goals That Drive Your Culture
Chapter 7 Hiring Employees Who Will Embrace Your Culture
Chapter 8 Training Employees to Embody Your Culture
Chapter 9 Empowering Employees to Support Your Culture
Chapter 10 How Leadership Can Make or Break Your Culture
Chapter 11 A Customer-Focused Example
Chapter 12 Making the Commitment to a Customer-Focused Culture

Acknowledgements

MY FIRST BOOK, SERVICE FAILURE, was published in October 2012. People
almost immediately started asking me when I would write another.

I resented that question at first. It’s hard enough to write one book and I
couldn’t believe people were already talking about book number two. Now, I
appreciate all the people who asked the question. It showed they saw
something that I didn’t—I had another book to write.

Michelle Burke and Adriana Perez are fantastic friends who helped
make this book possible in a roundabout way. They connected me with
representatives of the online training video company lynda.com (now
LinkedIn Learning) at a trade show in 2013. One thing led to another, and I
was suddenly making customer service training videos.

My very first video was filmed in August 2013 and formed the seeds for
this book. It’s called Leading a Customer-Centric Culture, and it outlined
what elite companies do to get employees obsessed with service. (Check it
out at www.lynda.com/JeffToister. You’ll need a lynda.com account to view
the course, but you can get a 10-day trial at www.lynda.com/trial/JeffToister.)

Finally, I owe my wife, Sally, an endless amount of gratitude. Her
encouragement continuously inspires me to write.

Introduction

TONY D’AIUTO WANTED TO CREATE an unforgettable experience.
He’s an Airport Operations Center manager at the Tampa International

Airport. Small children often lose a favorite stuffed animal while traveling
through an airport, so D’Aiuto’s goal was to reunite a child with a lost toy in
a fun and unique way.

His plan was to take photos of the toy in various places around the
airport to make it look like the stuffed animal had gone on a big adventure.
He would then return the toy to the child along with photographs of its
journey. D’Aiuto asked a colleague who oversaw the airport’s lost and found
department to alert him the next time a child lost a stuffed animal.

Once the plan was in place, he waited. And waited. It took two months
for it to happen. D’Aiuto was ready when he finally got the call.

A six-year-old boy had lost his stuffed tiger, Hobbes. The boy and his
Tampa-based family had already boarded their outbound flight when Hobbes
was found, so it was too late to return it to them that day. D’Aiuto jumped
into action.

“Being a hobbyist photographer, I thought I could have some fun and
creativity with the ways I took photos of Hobbes’s adventure during my
lunch break,” said D’Aiuto. He enlisted help from various people around the
airport to photograph Hobbes with airport firefighters, riding on a luggage
cart, by the airport control tower, and elsewhere.

D’Aiuto took his photos to Walgreens, where he used a coupon he had
saved to make a hardbound photo book documenting Hobbes’s adventure. He
then brought Hobbes and the photo book to the airport’s lost and found
department, so the family could retrieve them when they returned from their
trip.

The family had been told that the boy’s stuffed animal was waiting for
them at the airport’s lost and found. They headed there immediately after
their flight landed, eager to reunite Hobbes with their son. It was a touching

reunion, and the boy really enjoyed seeing the pictures of Hobbes on his great
adventure. D’Aiuto’s initiative had taken the traumatic experience of losing a
favorite toy and turned it into something positive and fun. The boy’s mother
was moved to tears at the kindness displayed by D’Aiuto and the rest of the
Tampa Airport staff.

The heartwarming story attracted national media attention. It was
picked up by news outlets such as NPR, CNN, and USA Today.

You just don’t hear customer service stories like this very often.
There are plenty of stories about service failures. Every week, there

seems to be yet another company featured in a news story about shockingly
poor service. Customer service leaders privately tell me they struggle simply
to get their employees to consistently deliver basics such as courtesy,
promptness, and helpfulness.

Why are the stories about outstanding customer service so rare?
It’s not due to a lack of ideas. Bookstores are well stocked with books

explaining how to provide outstanding customer service. Some describe how
companies can create successful service strategies, while others provide tips
and tactics for customer-facing employees.

There are many other places where you can find customer service ideas.
There are conferences, motivational speakers, and seminars galore.
Consultants like me write blog posts, record podcasts, and create videos.
Nearly every customer service professional has attended a customer service
training class at some point during their career.

The stuffed animal photo adventure certainly isn’t a new concept.
D’Aiuto got the idea after reading a similar story about a child who lost a
stuffed lion at a museum in London, England. It’s also been done by a
museum in Canada, and a Ritz-Carlton in Florida did the same thing with a
stuffed giraffe in 2012. The original concept may have come from a story
about a lawn gnome that was stolen from a garden in the mid-1980s and
returned to its owner with a photo album depicting its various adventures. Or
it may have originated from a popular children’s book called Flat Stanley,
which was published in 1964.

I asked D’Aiuto why he went to so much trouble on his own time just to
create a memorable experience for one child. “Tampa International Airport
has a long history of being very people-focused, as opposed to plane-
focused,” he told me. He explained that everyone in the airport, from the
CEO on down, is committed to providing exceptional service. “Our CEO, Joe

Lopano, sets the tone for being efficient and hard-working, but he also fosters
a sense of creativity and fun at the airport which makes employees feel
comfortable enough to take a chance like I did with this little boy’s lost
tiger.”

That’s the real secret that explains why these types of stories are so rare:
Tampa International Airport has done something that few organizations
achieve. The airport has created an environment where employees are
constantly thinking about outstanding service. They proactively look for
ways to make a difference in their customers’ lives, even if it means going far
beyond their regular responsibilities. Employees prioritize passengers over
planes, recognizing that airport operations are really just a means to help
travelers get to wherever they’re trying to go. Perhaps that’s why the airport
is consistently rated one of the best in the U.S. in Condé Nast’s annual
reader’s poll.

In short, employees there are obsessed with service.
The Service Culture Handbook shows you how to create a customer-

focused culture where employees in your organization are obsessed with
service. It’s a step-by-step guide to help customer service teams, business
units, and even entire companies get excited about serving customers at the
highest level.

You’ll get an inside look at companies—like REI, JetBlue Airlines, and
Publix—that consistently rank near the top of their industries for customer
service. You’ll also find profiles of some lesser-known companies that
represent the next wave of legendary customer service organizations. This
book will show you what these elite organizations do that most organizations
don’t.

The Service Culture Handbook is organized into three parts. The first
part examines why creating a customer-focused culture is the key to
outstanding customer service. It also offers some cautionary tales about
companies whose culture initiatives failed.

The second part provides detailed instructions for building a customer-
focused culture. When you use these chapters to clearly define your
organization’s unique culture, you’ll transform the way your employees view
service. The ultimate goal is to get your employees obsessed with
consistently delivering service that’s so amazing it becomes part of your
company’s brand image.

Finally, the third part of the book helps you embed customer focus in

your company’s DNA, so you can sustain the customer-focused culture
you’ve created. Companies that get really good at service will tell you they
have to work at it every day. It’s easy to grow weary or lose focus when
you’ve worked long and hard at achieving a goal. These chapters assist you
in keeping your employees engaged and making outstanding service the way
that your company, department, or team simply does business.

Many chapters contain sample worksheets to help you implement these
concepts. You can download blank copies of the worksheets from this book
at www.serviceculturebook.com/tools. You’ll also find additional tools and
resources on the website, such as access to my Customer Service Tip of the
Week email. You and your employees can sign up for these tips for free.

I recommend that you read each chapter in order, to get a clear picture
of what it takes to create a customer-focused culture. You may be tempted to
pick and choose lessons from this book. Please don’t. This is a complete
recipe for building a customer service culture. Just as you wouldn’t try to
bake a cake without flour or eggs, you shouldn’t try to transform your
organization’s customer service while leaving out an essential ingredient.
Also, it’s a good idea to know exactly what you’re getting into before you
launch a major initiative.

I won’t lie to you. Getting your employees obsessed with customer
service is not easy. It is, however, one of the elements that separates the elite
organizations from the rest. These companies put in the hard work that most
aren’t willing to dedicate themselves to.

Don’t be afraid to use me as a resource as you explore these concepts.
I’m easy to get in touch with:

Call or text: 619-955-7946
Email: jeff@toistersolutions.com
Twitter: @toister
You’ll also find additional analysis, tips, and trends to help you develop

a customer-focused organization on my Inside Customer Service blog at
www.insidecustomerservice.com.

For now, I encourage you to turn to Chapter 1, where you’ll read about
another company whose employees are obsessed with customer service. In
fact, these employees are so customer-focused that they did something that
practically no one else would be willing to do.

Part 1: Culture Is the Key to Outstanding Customer
Service

CHAPTER 1

How Corporate Culture Guides Your Employees’ Actions

THE INTERNAL NETWORK AT RACKSPACE went down and took the phone
system with it. Customers suddenly weren’t able to call. Employees couldn’t
even access the company directory to contact each other.

This was a potential disaster.
Rackspace provides computer hosting services for more than 300,000

customers. These companies run their websites, email, and internal computer
systems on its network. It’s all mission-critical stuff. When there’s a problem,
Rackspace customers need help fast.

A lone technical support agent sprang into action. He tweeted his
personal phone number, letting customers know they could reach him directly
if they needed help. Soon other tech support reps followed suit and tweeted
their numbers, too. For the next four hours, they used Twitter and their cell
phones to serve customers until Rackspace restored its phone service. The
support team typically handles a thousand calls during a four-hour time
frame, so their extraordinary service prevented a lot of unhappy customers.

The stakes were high, but nobody from management told these
employees to tweet their personal phone numbers. It wasn’t part of a
carefully scripted procedure. No one even asked permission. They just did it.

HOW CULTURE CREATES HERO MOMENTS
Imagine the same scenario at nearly any other company. Employees would
feel helpless. A few might lobby their supervisor to go home early. Most
would just sit around and wait for the phone system to come back up.

The corporate communications department might post a message on the
company’s website to let customers know the phones were down. Somebody
might tweet an update on the status of the phone system. That would likely be

the extent of the company’s efforts to alert customers to the problem.
Tweeting personal contact information would be unthinkable. Many

customer service employees are fearful of giving out their last names, let
alone their phone numbers. Employees at the average company would never
take the kind of initiative that happened at Rackspace.

Rackspace isn’t the average company, though. Stories of employees
delivering over-the-top service are common. One rep ordered a pizza for a
customer during a marathon trouble shooting session after she heard him
mention that he was getting hungry. An account manager showed her
appreciation for a visiting client by preparing a home-cooked meal.

The big question is why employees at Rackspace serve their customers
in a way that’s so different from the norm. It’s too simplistic to say that
Rackspace has made a company-wide commitment to provide outstanding
service. Lots of companies make similar claims, but that doesn’t mean they
actually do it.

Their exceptional service isn’t just a product of great training, either.
Training works when you want to show someone how to use a specific skill
or follow a particular procedure. Tweeting personal phone numbers, ordering
pizza for a customer, and preparing a home-cooked meal for a client were all
improvised moves. These actions were neither trained nor scripted.

The real secret to Rackspace’s extraordinary service is their customer-
focused culture. Employees are absolutely obsessed with taking care of their
customers. They have created a unique identity, calling themselves Rackers,
symbolizing the pride employees have in their company. They’ve developed
a special brand of customer service called Fanatical Support® that promises
customers they’ll spring into action and do whatever it takes to help resolve
any issue.

It’s this obsession that leads to customer service hero moments like
tweeting a personal phone number so customers can reach you.

A hero moment occurs any time an employee, a team, or an entire
company rises to the occasion to provide customers with outstanding service.
Hero moments aren’t limited to over-the-top actions. They include everyday
service encounters as well. In his book, Be Your Customer’s Hero, customer
experience strategist Adam Toporek defines it this way1:

“It means being there when the customer needs you and making
your personal interaction with the customer as memorably positive

as possible.”

Let’s face it: the vast majority of customer-service interactions are
unremarkable. They’re neither amazingly good nor frustratingly bad. Think
about the last time you went to the bank, bought a cup of coffee, or ordered
something online. There’s a good chance that nothing particularly
extraordinary happened. It was business as usual.

A few experiences do stand out. We certainly remember the service
failures. But we also remember the hero moments. Maybe you remember a
kind bank teller who helped you avoid a fee. Perhaps there’s a barista at your
local coffee shop who makes you feel special every time he’s there because
he knows your name and your favorite drink. Or there may have been a time
when you were shipped the wrong item, but the friendly customer service rep
made the resolution so easy that you vowed to become a customer for life.

Every customer interaction is an opportunity for a hero moment or a
service failure. Some businesses, like hotels, might have multiple interactions
per day with the same customers. According to the Cornell Center for
Hospitality Research, an average 250-room hotel has 5,000 daily guest
interactions with valets, door people, bell staff, reception, restaurants,
housekeeping, engineering, and other functions.2

The largest businesses might serve millions of customers on a daily
basis. For example, Domino’s Pizza delivers more than one million pizzas
per day, seven days a week. Imagine all the customer service interactions
required to make that happen! About 500,000 of those orders are taken by an
employee (the rest are taken electronically, via their website, smart phone
app, etc.). Employees must also deliver those one million pizzas. That means
Domino’s averages about 1.5 million hero or failure opportunities every day.3

Individual employees at some companies might personally serve dozens
of customers per day. For example:

A typical airline flight might have 150 passengers served by four
flight attendants.
A retail cashier might serve 20 customers (or more) per hour.
A contact center agent might serve 10 (or more) customers per
hour.

It’s impossible for a boss, a policy, or a system to control all these
interactions. Employees must exercise independent discretion at times. This
is a scary reality for customer-service leaders, who worry their employees
will do something wrong.

I’ve spoken to thousands of customer service employees over the years.
Most want to do a good job and make their customers happy. The vast
majority of these employees know how to deliver a hero moment, but they
aren’t actively looking for them. Sometimes the moment arises, but the
employee doesn’t feel empowered to spring into action. These are situations
where the right corporate culture can encourage employees to make good
decisions.

Culture creates hero moments on an individual level, where an
employee strives to deliver the best customer service possible. That employee
feels empowered to do what it takes to makes customers happy and takes
pride in the company he or she works for. You see it in the way the employee
greets customers, solves problems, and goes the extra mile when the situation
demands it.

Culture also creates hero moments on a team level, where a department
works together to serve its customers at a consistently high level. Team
members share a passion for service that’s absolutely contagious. You see it
in their pervasive can-do attitudes and in the way they support each other in a
collective effort to make their customers happy. These employees take pride
in their team, yet always push each other to do even better.

Culture can create hero moments on an organizational level, as well,
where an entire company is dedicated to providing outstanding service.
Strategy, goals, policy, and other corporate decisions are made with the
customer in mind. You see the impact of this customer focus in the legions of
loyal customers who go out of their way to do business with these select
companies.

It’s no wonder that culture is such a hot topic in customer service. So,
what exactly is it?

THE DEFINITION OF CORPORATE CULTURE
Corporate culture can be a nebulous subject. There’s a lot that goes into it,
like mission, vision, and value statements. But while those are some of its
elements, a company’s culture is broader than that.

I turned to Catherine Mattice to get a clear definition. She’s a consultant
and trainer who specializes in helping organizations create a positive
workplace culture. She’s also the author of Back Off! Your Kick-Ass Guide to
Ending Bullying at Work, and her research on the topic has made her an in-
demand speaker at human resources conferences. Mattice has even served as
an expert witness in court cases where corporate culture was a factor.

We met for coffee on a warm, sunny day. The coffee shop had a patio
with just enough shade to make it comfortable. I thought it might be a short
conversation, but we ended up talking for several hours.

We discovered that the challenge in defining culture is that there are so
many valid perspectives. When Mattice helps companies end workplace
bullying, she does so by focusing on their culture. I, too, focus on culture
when I work with companies to help improve customer service. And when
another colleague helps companies with their branding, she begins her efforts
by focusing on their corporate culture, as well. It seems that so many things
companies do can be boiled down to their culture.

Mattice and I agreed that while corporate culture can refer to an entire
organization, it can also refer to a business unit, location, or individual team.
It’s not unusual for groups in different parts of a company to share some
common characteristics, yet also have their own unique identity. You can’t
easily change the entire corporate culture if you’re a store manager for a retail
chain, but you can influence the culture within your particular store.

Mattice shared this definition, which puts it all together:

“Corporate culture is the way an organization’s members think,
act, and understand the world around them.”

Let’s use Rackspace as an example. Rackers certainly think, act, and
understand the world around them differently than employees at most
companies. When faced with an unexpected challenge, such as the phones
going down, Rackers think, “My customers need me. I have to find a way to
help them.” They act to do something about it. Rackers do this because they
understand how critical their services are to their clients’ businesses.

Contrast this to the customer service most of us receive every day.
Many employees think about their job solely in terms of their assigned
responsibilities. They act in accordance with company policies and

procedures, but rarely take initiative. They understand their role, but may not
understand the company’s goals. Or, employees might understand the
company’s goals, but not care about helping to achieve them.

All organizations have a culture. It doesn’t have to be something
intentionally created. In most organizations, culture organically develops over
time through corporate strategy, the decisions of its leaders, the way
employees interact with each other, and many other factors.

It’s natural for a group of people to develop a certain amount of
collective thinking. When you hear people say, “That’s how we do things
around here,” they’re referring to their company’s culture. A few elite
companies, like Rackspace, intentionally strive to cultivate a positive,
customer-focused culture.

That intentionality is what’s missing in many organizations. According
to Mattice, most companies have policies that tell employees what they
should not do. Companies with positive cultures help employees understand
what they should do. Mattice explains that without clear guidance, “People
don’t know how else to act.”

But you can’t tell employees specifically what to do in every situation;
there are too many variables. Instead, an intentionally-guided culture acts as a
compass that consistently points employees in the right direction. That
culture is reinforced when employees encounter a hero moment and make the
right decision.

INSIDE RACKSPACE’S CUSTOMER-FOCUSED CULTURE
Rob La Gesse is the Vice President of Social Strategy at Rackspace. Most
corporate executives in publicly traded companies are hard to contact. Not La
Gesse. I got his phone number when he sent it to me via Twitter.

I asked La Gesse why he shares this information so freely. His
explanation was simple: “I’m in the people business. I want people to find
me.”

He’s not kidding. La Gesse published his cell and home phone numbers
on his blog in 2009. It was 2013 when the Rackspace technical support rep
tweeted his own cell number in order to be accessible to customers in need.
Sharing a personal phone number via social media wasn’t a scripted move,
but it was embedded in the company’s organizational thinking and
exemplified by its leaders.

Accessibility is just one illustration of how Rackspace creates a
customer-focused culture. Another is how it hires employees. According to
La Gesse, the company hires many people who don’t have technical
backgrounds. They come from hospitality, medical, and similar professions
that attract people with natural empathy.

La Gesse shares an example of the type of people they like to hire at
Rackspace. He was attending an offsite meeting at a hotel. The meeting
ended for the day, and the attendees headed off to the hotel’s bar. There were
only three bartenders, who were working like crazy to keep up.

La Gesse ordered a frozen margarita but received a margarita on the
rocks. He was deep in conversation with a colleague and saw the long line at
the bar, so he decided not to bother with getting his order corrected.

A few minutes later, the bartender approached La Gesse with a frozen
margarita. He apologized for the error and told La Gesse that both drinks
were on the house.

La Gesse was impressed. Mistakes can and will happen, especially
during busy times. But it takes a special kind of person to recognize their
mistake and go out of their way to fix it when the customer hadn’t
complained.

He waited for the bar to calm down a bit and then approached the
bartender. La Gesse handed him his business card and said, “You need to be
a Racker.” The bartender was eventually hired by Rackspace. Although he
had no experience working with computer networks, he turned out to be a
perfect fit. He now has a successful career in technical sales.

“I can teach anybody [the computer operating system] Linux,” said La
Gesse. “I can’t teach them to actually care.”

Rackspace specifically looks for people like this, who fit the company’s
customer-focused culture. Here’s a passage from its Fanatical Support
Promise:

We cannot promise that hardware won’t break, that software
won’t fail, or that we will always be perfect. What we can promise
is that if something goes wrong, we will rise to the occasion, take
action, and help resolve the issue.

This isn’t just something that’s tucked into an employee handbook and then

forgotten. This promise is a way of doing business at Rackspace. It’s how
Rackers think, from executive leadership all the way to the employees on the
front lines of customer service.4

Fanatical Support is the first of the company’s six core values:

1. Fanatical Support® in all we do.
2. Results first. Substance over flash.
3. Treat Rackers like friends & family.
4. Passion for our work.
5. Full disclosure & transparency.
6. Committed to greatness.

What truly makes these values special is that they’re ingrained in hiring,
training, and all aspects of guiding the employees’ work. The company even
has a “Culture” page on its website to explain it all:5

“Our Core Values came from us, the employees. They are our
collective thoughts and beliefs encompassed by six values. Our
leadership had no input or vote in them. We wouldn’t even let
them spell check our values. Luckily for us, our bosses are smart
enough to know that telling employees what to think and believe is
a complete waste of time, and just a bad idea all the way around.”

These values truly represent how Rackspace does business. You see this in an
employee tweeting his cell phone number to be accessible to customers in
need. You see it in a bartender who gets hired after going out of his way to
fix a drink order. In fact, you see examples of Fanatical Support® reinforced
every single day at Rackspace.

“You have to constantly work at it,” said La Gesse. “You have to
constantly talk about.”

THE DARK SIDE OF CORPORATE CULTURE
What leaders constantly work at and talk about has a profound impact on a
company’s culture. It shapes how employees think about, act upon, and

understand service. Focus on the wrong things, and a company can
unintentionally develop an anti-customer culture.

Comcast provides a clear warning. It’s generally considered to have
some of the worst customer service in the country. It was rated the worst
internet service provider in the United States by the 2015 American Customer
Satisfaction Index, and third and fourth worst respectively in subscription
television and phone service.6 Comcast also ranked dead last in the 2015
Temkin Customer Service Ratings.7

Comcast has been known to attract national media attention with its epic
service failures. One particular example happened in July 2014. A Comcast
subscriber named Ryan Block called to cancel his service. The customer
service agent inexplicably stonewalled his request. Block was ten minutes
into the call when he decided to record it.8

The recording lasts for approximately eight minutes. On it, you can hear
the Comcast employee repeatedly badgering Block about his decision to
cancel. Block politely asked the agent to cancel his service multiple times,
but the employee continuously tried to talk him into retaining his account.

Block posted the recording online and it quickly went viral. Major news
outlets reported on it. Tom Karinshak, Comcast’s Senior Vice President of
Customer Experience, issued a statement apologizing for the incident:

“We are very embarrassed by the way our employee spoke with
Mr. Block and are contacting him to personally apologize. The
way in which our representative communicated with him is
unacceptable and not consistent with how we train our customer
service representatives.”9

It’s convenient for companies like Comcast to blame a rogue employee for an
embarrassing service failure like this. However, a closer look reveals that the
employee’s actions were completely reflective of Comcast’s corporate
culture.

Canceling an account with Comcast in July 2014 was a difficult task.
The instructions weren’t easy to find on its website

Anatomy homework help

Rubric #1, Discussion Board and Response (for M1-A3, M2-A3, M3-A3, M4-A3)

Use the information in each of the boxes below each category, e.g., accomplished or proficient, to guide you in
meeting the goals of a specific assignment. The final number of points seen below the grid indicate your level
of accomplishment.

Discussion Board and Response

Area Evaluated
20 points each

Accomplished Proficient Needs Work Unacceptable

Organization

3 points maximum

Well organized
Clear introduction
and thesis specified
Intro, thesis, body,
and conclusion flow
easily & with clarity

Organized
Introduction & thesis
present. Lacks some
clarity
Missing one element,
i.e. intro, thesis,
body, conclusion

Lacks a cohesive
argument.
Missing more than
one element

Unorganized
No clear argument
Missing more than
two elements

Completeness

4 points maximum

Addresses all
questions and topics
with sufficient depth

Missed one question
or inadequately
addressed

Missed two
questions or used
unsubstantiated
claims

Three (3) or more
questions missed or
inadequately
addressed

Accuracy/support/
Integration of course
material

4 points maximum

No factual errors
No unsubstantiated
claims
Course material is
integrated to support
comments

No more than one (1)
factual error or
unsubstantiated
claim
Includes some course
material

Adds some additional
information but does
not add much to the
discussion

Three or more
factual errors
Unsubstantiated
claims
Limited or no
inclusion of course
material

Response to peer

3 points maximum
for each response

Constructive
comments
Adds additional
information & depth
to the discussion OR
takes discussion in
new, clear direction

Adds some additional
information but only
expands the depth of
understanding
slightly

May add some
information and does
not add

No new information
provided
Basically a repeat of
original post
Lacks substance

APA & MUGS

3 points maximum

No more than one (1)
error in mechanics of
writing or APA
format
Flow makes sense.

No more than three
(3) errors

No more than five (5)
errors

More than five (5)
errors

Interpretation of Final Points Accomplished: 20.00 – 18.00 points
Proficient: 17.99 – 16.00 points
Needs Work: 15.99 – 14.00 points
Unacceptable: 13.99 – 0 points

Anatomy homework help

Anatomy & Physiology II Research Report and PowerPoint Course Assignment List & Due Date

Monday.
03/21/2022

Scholarly Written Report of Research
Draft must be submitted for feedback to the writing center (see syllabus and
description of assignment in the Research/PowerPoint folder in blackboard shell).

Monday
04/11/2022

PowerPoint must be submitted in PDF
Draft must be submitted for feedback to the writing center (see syllabus and
description of assignment in the Research/PowerPoint folder in blackboard shell).

Student Name Assigned Pathology (Disease)
1. Melissa Albeirus Sjögrens Disease
2. Claudia Artiles Acute Glomerulonephritis
3. Marlene Cabrera Hodgkin’s Disease
4. Vicente Cabrera Addison’s Disease
5. Leandro Capote Multiple Sclerosis
6. Dalmarys Dominguez Retinoblastoma
7. Enrique Fernandez Crohn’s Disease
8. Monica Fernandez Thyroid Cancer
9. Yoselin Flores Throat Cancer
10. Mirella Frias Perez Mononucleosis
11. Devymar Gonzalez Hepatocellular Carcinoma
12. Miranda Gonzalez Esophageal Achalasia
13. Jona Goolsby Pancreatic Cancer
14. Samira Guevara Cirrhosis
15. Alexandra Hoffmann Nasal Cavity Cancer
16. Kristy Kawa Bladder Cancer
17. Fatima Leon Hepatitis A
18. Adriana Lopez Hepatitis B
19. Jennifer Martinez Polycystic Ovary
20. Corina Mercado Chronic Fatigue Syndrome
21. Yonandra Molina Acid-Peptic Disease
22. Marly Mosquera Endometriosis
23. Claudia Rivero Amyotrophic Lateral Sclerosis
24. Halbert Rodriquez salpingectomy ovarian cancer
25. Anyel Rodriquez Gonzalez Psoas abscess disease
26. Jose Sierra Toxoplasmosis
27. Maydoll Sotolongo Sosa Rheumatoid Arthritis
28. Tania Toledo Osteoporosis
29. Johann Torres Paget’s Disease of Bones

If your name is not in the list, please notify your professor (Dr. Cruz-Espaillat)
immediately, via email to be assigned a topic.

30. Whitney Williams Leukemia

Anatomy homework help

BCCC – Bio 202 A & P I Lecture

Research Paper Assignment – 40 points (see rubric for details)

Topic approval due date: Check course schedule
Paper Due Date: Check course schedule

• Research paper topic MUST be prior approved by your instructor by due date.

• Late approvals attract penalty points (-2 pts) and submissions (-2 pts/day late)

• Research papers USED in ANY other semester/course within or outside the
college CANNOT BE SUBMITTED FOR GRADING, Turnitin will Flag it for
plagiarism even though its your own work, as ONE paper cannot be USED more
than ONCE.

Format Instructions:
➢ Write up 4 pages max (Plus 1 Cover Pg and 1 Reference Pg.) Total 6 pages.
➢ Spacing of 1 or 1.5, font size 11 or 12, margins 1” all round.
➢ Use APA format for references, there are instructions in the College Library for your

information.
➢ Direct quotations MUST be LESS than 10% of your paper even if correctly cited.
➢ Research must include at LEAST 6 different reliable, scientific sources
➢ NO Abstract, table of contents or running head required for this paper
➢ Submit your paper on Canvas in the Assignment tab for Plagiarism assessment on

‘Turnitin’ it should not be over 18% matching. If > 18% your paper will be returned
as plagiarized WITH ZERO SCORE.

➢ DO NOT send by email to your instructor, it will not be graded.

You are required to write a critical analysis of the disease of your choice.

Included in this analysis, you will need to explain how the disease you chose

affects the various body systems where relevant.

The following relevant and concise information must (if pertinent) be included in your
write up. Topic selection is within the systems being covered in the course

▪ Name of disease
▪ History of the disease / Demographic Data: Age, sex, race distribution in population.
▪ Description of disease
▪ Anatomy of the system(s) involved
▪ Effects on other body systems
▪ Cause of disease
▪ Signs and symptoms
▪ Diagnosis of the disease
▪ Complications, if any
▪ Treatment and side effects

Conclusion should include the following:

▪ Brief mention of current or proposed research that may significantly impact the
▪ disease.
▪ Prevention strategies if any
▪ Your insight / opinion

NOTE: you must focus on the anatomy & physiology of the disease/disorder. Cover
the normal anatomy & physiology of the organ system affected and then state what the
disease/disorder does to this organ system, and other organ systems. In other words, if
you are picking meningitis, I do not want you to go too much in detail about the
bacteria that causes it but how the bacteria escapes our body’s defenses and what the
bacteria does to other tissues. Also note this is NOT a clinical paper on the disease.

Suggested Topics for the Paper: (Obtain Instructor’s approval of your topic)

Below listed systems are covered in Bio 202, so topic selection MUST be within these systems.

1. The Cell Membrane/physiology: Cystic Fibrosis and other membrane related disorders.

2. Integumentary System / Skin: common diseases, disorders and pathologies of skin including
color disorders

3. Bone: common diseases, disorders and pathologies of bone

4. Joints: common diseases and disorders e.g. Rheumatoid Arthritis. Etc.

5. Muscle Tissue:

• Skeletal – neuromuscular junction, action of blocking agents at NMJ

• Cardiac

• Smooth
6. Endocrine – System: common diseases, disorders and syndromes

7. Nervous System: System: common diseases, disorders and syndromes

• Brain

• Spinal Cord

• Autonomic Nervous System
8. General Senses

9. Special Senses:

• Eye: common refractive errors, diseases and disorders including causes of blindness

• Ear: common hearing disorders, including causes of deafness

10. Any tropical disease related to the above systems

• Your topic for research paper must be approved by the instructor before submission,

send an email request and get approval.

• ONLY ONE DISEASE PER STUDENT, so send in your requests early to get your

choice. IT is FIRST COME FIRST APPROVED.

• If you wish to cover a disorder/ disease that is not on this list, email the instructor for

approval.

Anatomy homework help

image1.png

Medical Terminology: Urinary System

PT116 Unit 5 Assignment

Combining Forms

Meaning

azot/o

bacteri/o

cyst/o

glomerul/o

glycos/o

keton/o

lith/o

meat/o

nephr/o

noct/i

olig/o

protein/o

pyel/o

ren/o

ur/o, urin/o

ureter/o

urethr/o

Suffixes

Meaning

–lith

–lithiasis

–ptosis

–tripsy

–uria

Word Building

Build a term that means:



Meaning

excision of the bladder

bladder pain

surgical crushing of a stone

kidney softening

kidney tumor

kidney disease

ureter stone

narrowing of the urethra

condition of sugar in the urine

condition of pus in the urine

Multiple Choice

Highlight or bold the correct answer.

1. Excision of a kidney is called

a. nephrectomy.

b. nephropexy.

c. nephrotomy.

d. renectomy.

2. A distention of the renal pelvis due to urine collecting in the kidney, often the result of obstruction, is

a. nephrolithiasis.

b. hydronephrosis.

c. cystocele.

d. pyelonephritis.

3. In nephromegaly there is

a. an enlargement in the kidney.

b. a stone present in the kidney.

c. an inflammation of the kidney.

d. a prolapse of the kidney.

4. The abbreviation UTI stands for

a. urethral toxic infection.

b. ureter total inflammation.

c. urinary tract incontinence.

d. urinary tract infection.

5. The medical term for abnormal kidney condition is

a. nephroptosis.

b. nephrosis.

c. nephromalacia.

d. nephritis.

6. The act of voiding urine is called

a. nocturia.

b. micturition.

c. oliguria.

d. urodynia.

7. What is inflammation of the bladder called?

a. nephritis.

b. urinary tract infection.

c. cystitis.

d. pyelitis.

8. What is the medical term for ureteral narrowing?

a. ureterostenosis.

b. ureterolysis.

c. ureterosclerosis.

d. urethrostenosis.

Matching

Match the following:

Match/Answer

Choice



calculus

a. Protrusion of bladder into vaginal wall

b. Urinalysis

c. Decrease in the force of the urine stream

d. A flat abdomen X-ray

e. Commonly seen in children

f. Medication to increase urine volume

g. Involuntary discharge of urine

h. Artificial filtering waste from blood

i. May be caused by spinal cord injury

j. Treatment for kidney stones

k. X-ray of renal pelvis

l. Stone

m. Implantation of a donor kidney

n. Accumulation of urine in renal pelvis

o. Test that grows bacteria in a culture medium

p. Collects uncontaminated urine for testing

q. Feeling need to urinate immediately

r. Blood in the urine

s. Medication to treat bacterial infection

t. Floating kidney

u. Insertion of a flexible tube into the bladder

v. Another term for urination

w. Blood test for kidney function

x. Visual exam of the bladder

y. Inability of the kidneys to filter waste



urgency



enuresis



micturition



hesitancy



hydronephrosis



nephroptosis



cystocele



renal failure



Wilm’s tumor



neurogenic bladder



hematuria



BUN



U/A



IVP



urine C&S



kidneys, ureter, bladder



cystoscopy



catheterization



hemodialysis



ESWL



renal transplant



clean catch specimen



antibiotic



diuretic

Page| 1

image1.png

Anatomy homework help

Digestive Physiology Lab 

2. After watching the Digestion Lab video, write a lab report based on the experiments carried out. 

             Lab Report Scoring Rubric /Guide 

Title: 0.5 points : A suitable title for the experiments should be chosen

Introduction: 2
.5
 points: This paragraph should contain  information about the macro-molecules digested 

                                          in the experiment. You should find this information in the introductory remarks made by                                                the speaker before each experiment. 

Materials & Methods: 1 point: This section should briefly relay the methodology of each experiment carried out. 

Discussion: 3 points. This is the most important part of the report. You should explain the obtained results using                                             information from the speaker and scientific literature. There are a plethora of scientific                                               journals available out there. A great repository to use is PUBMED.

Conclusion : 0.5 point:  This section should contain concluding remarks about the experiments carried out. 

References: 1.5 points: This section, usually on a separate page should contain citations used in the discussion.                                                      References should be written according to APA guidelines 

Formatting: 1 point: This report should be written using APA guidelines. i.e: 
Double Spaced, Times New Roman 12 

                                               font 

3.Submit lab report here Digestive Physiology Lab Report

Anatomy homework help

MODULE 7 Informative and Persuasive Paper

Overview

The final project for NRSES 3700J is a paper of about 1500 words (approximately six [6] pages).
The paper is due in the last module of the course (Module 7). The paper has two purposes:

1. The first purpose is to inform the audience about a health issue that exists in the
country/community selected in Module 1 and reaffirmed in Module 3.

2. The second purpose is to persuade the audience that a specified intervention (or
interventions) would address the health issue in a positive way.

Instructions

1. The paper is to be approximately six (6) pages in length excluding the title page and the
references cited page.

2. The chosen health issue is to be compared to a similar issue in the United States (US).
Use the following questions/topics to focus the paper.

2.1 Discuss the health issue in the selected country/community.

• What is it?
• Who is impacted?
• Why is the chosen health issue important?
• What are the consequences of not addressing the health issue?
• Identify the two (2) or three (3) social determinants of health that have the

most impact on the chosen health issue. Explain the influence.

2.2 Is the same health issue present in the US?

• Who does the health issue impact in the US?
• Compare the size of the health issue in the US with that in the selected

country/community.
• What is similar about the health issue in the two countries?
• What is different about the health issue in the two countries?
• Identify the two (2) or three (3) social determinants of health that have an

impact on the chosen health issue in the US. Explain the influence of
each.

• If the health issue does not exist in the US, explain the reasons for this
being so.

2.3 Identify an intervention (or interventions) that could address the identified health
issue. There is no specified number of interventions required, but if education is
chosen as an intervention it cannot be the only intervention.

• In what ways, if any, would the proposed interventions differ between the
selected country/community and the US?

• If the intervention in the two countries would not differ, explain why they
would not.

Module 7 Final Paper, continued

• Identify the connection between the social determinants of health, the
health issue, and the intervention(s).

• Persuade the audience that the identified intervention(s) would be useful in
addressing the chosen health issue. Again, education cannot be the only
intervention, but it can be used in combination with other interventions.

Technical Aspects of the Paper

1. DO NOT include an abstract.

2. The paper must include:

2.1 A title page formatted according to the student title page information in the APA
Manual 7th edition.

2.2 An introduction that includes a thesis statement.

2.3 The body of the paper supports the thesis organizes and fleshes out the main
ideas, and topics are sequenced so the follow of the thinking/writing makes sense.

2.4 A conclusion.

3. Include a minimum of five (5) references. References must be no older than five (5)
years (unless you are using a seminal or classical piece of literature to make a specific
point). References need to be on a References Cited page following the actual paper.

Acceptable references include peer-reviewed databases, peer-reviewed journal articles,
textbook materials, and any source that has been peer reviewed. References that are not
acceptable include, but are not limited to: UpToDate, Epocrates, Medscape, WebMD,
hospital organization publications, insurance recommendations, and secondary clinical
databases. Do NOT include the annotated bibliography.

4. Use the Times New Roman or Arial font in size 12; one (1) inch margins on all sides;
double spaced throughout according to the format of the APA Manual 7th edition.

5. Use APA Manual 7th edition formatting throughout the paper.

Previous Assignments that May Be Useful

1. Choice of country/community
2. NGO Business Letter
3. SDOH Impact Analysis and Email
4. Introduction to Final Paper
5. Outline of Final Paper
6. Annotated Bibliography
7. Patient Education Materials

CLICK on the link titled “M7 Final Paper Submission” in Blackboard to submit the paper.

Points: 45 Due Date: See the Course Calendar/Checklist

Anatomy homework help

BIOLOGY 210: SKULL BONE ANATOMY VIA VISIBLE BODY


IN-LAB EXERCISES: 0.98 POINTS for each correct label and each correct question answer.

Answer the following:

7a. What is the purpose of the cranium?

7b. How many TOTAL cranial bones are there (if there is a left and a right of a bone, you need to count both of them)?

7c. List the cranial bones here:

8. Click “Facial Bones” in the left-hand menu. The skull will rotate and show you a different set of highlighted bones. Make sure the “book icon” is clicked and answer the following:

8a. How many TOTAL facial bones are there?

8b. List the facial bones here:

8c. Give 5 functions of the facial bones.

· 1.

· 2.

· 3.

· 4.

· 5.

9. Click the Menu button in the upper right-hand menu.

10. Click “10.3 Cranial Bones”. Rotate the model as needed so that it matches the pictures below.

11. Click on each of the bones in the menu on the left. Be able to identify each bone in the pictures that follow.

1.

2.

3.

7.

8.

9.

10.

11.

6.

4.

5.

14.

16.

15.

13.

12.


We will now look at the cranial bones individually and landmarks/bone markings of them. As you click on each name in the left-hand menu, you will need to watch the picture carefully as it will highlight in a teal-blue color.

12. Click on the upper right-hand menu. Click on 10.4 Occipital Bone Landmarks. The Occipital bone will be shown by itself.

13. In the left-hand column, click on “Foramen Magnum”. Click the “book icon” and answer the following:

13a. What passes through this large hole?

14. In the left-hand column, click on “Occipital condyles”. Click the “book icon” and answer the following:

14a. What is the name of the *vertebrae* that articulates (attaches) to this landmark (the vertebrae – NOT the ligament)?

15. Identify these bony landmarks in the picture below.


17. (Click on the green ring)

18.

16. In the upper right-hand corner click the Menu button. Click on 10.5 Temporal Bone Landmarks. The Temporal bone will be shown by itself.

17. In the left-hand column, click on “Zygomatic Process”. Click the “book icon” and answer the following:

17a. What bone does this articulate to?

18. In the left-hand column, click on “Mandibular Fossa”. Click the “book icon” and answer the following:

18a. What bone articulates (connects) here?

19. In the left-hand column, click on “External Auditory Meatus”. Click the “book icon” and answer the following:

19a. What is the purpose of this bony landmark?

20. In the left-hand column, click on “Styloid Process”. Click the “book icon” and answer the following:

20a. The book icon information says that the “styloglossus and stylohyoid” attach here. These are not bones. Look them up either in the Visible Body app or on Google. What *are* they?


21. In the left-hand column, click on “Mastoid Process”. Feel the bump right behind your own ear. You can feel this mastoid process exactly where the picture indicates it is.

22. Identify these bony landmarks in the picture below.


19. (Bony landmark – not the name of the bone)

20.

21.

23.

22.


23. In the upper right-hand corner click the Menu button. Click on 10.6 Frontal Bone Landmarks. The Frontal bone will be shown by itself.

24. In the left-hand column, click on “Supraorbital notches”. Click the “book icon” and answer the following:

24a. What are these notches (which can be full holes) for?

25. Identify the bony landmarks in the picture below.


24. (Bony landmark – not the name of the bone)


26. In the upper right-hand corner click the Menu button. Click on 10.7 Sphenoid Bone Landmarks. The Sphenoid bone will be shown by itself.

27. In the left-hand column, click on “Sella turcica”. Click the “book icon” and answer the following:

27a. What gland sits in this depression?

28. In the left-hand column, click on “Optic foramen”. Click the “book icon” and answer the following:

28a. What passes through these holes (foramen)?

29. Identify these bony landmarks in the picture below.

25. (Click carefully on the grey depression)

26.

30. In the upper right-hand corner click the Menu button. Click on 10.8 Ethmoid Bone Landmarks. The Ethmoid bone will be shown by itself.

31. In the left-hand column, click on “Crista Galli”. Be able to identify this marking in the picture below.

32. In the left-hand column, click on “Cribriform plate”. Be able to identify this marking in the picture below.


33. In the left-hand column, click on “Middle Conchae”. Click the “book icon” and answer the following:

33a. Although this is part of a cranial bone, it extends down into your face. What does this part of this bone do?

34. There is one bony landmark that is not listed in the left-hand menu. Identify it using the picture below.

35. Identify these bony landmarks in the picture below.


27.

28.

29.

30.

36. In the upper right-hand corner click the Menu button. Click on 10.9 Skull Sutures. Answer the following questions using the information in the upper left.

36a. Which suture joins the frontal bone with the two parietal bones?

36b. Which suture joins the two parietal bones together?

36c. Which suture joins the two parietal bones with the occipital bone?

36d. Which sutures join the parietal bones to the temporal bones?

37. Identify the four skull sutures in the pictures below.


31.

32.

33.


34.

38. Click on the upper right-hand menu. Scroll down to 10.11 Facial Skeleton I and click.

39. Be able to identify each bone in the picture that follows. Note that certain bones have a left and a right; include that in your label.


38.

39.

37.

36.

35.

40. In the upper right-hand corner click the Menu button. Click on 10.12 Maxilla Landmarks. Answer the following questions using the information in the upper left.

40a. What process forms your hard palate?

40b. Describe the maxillary sinus.

41. In the left-hand column, click on “Hard Palate”. Be able to identify this marking in the picture below.

42. In the left-hand column, click on “Infraorbital foramen and canal”. Be able to identify this marking in the picture below.


43. There is one bony landmark which is not listed in the left-hand menu. You will need to click on the diagram to identify it in the picture below. Be sure that the green part highlights and not the blue.


40.

42.

41.


44. In the upper right-hand corner click the Menu button. Click on 10.13 Mandible Landmarks. Answer the following question using the book icon information.

44a. What are the three distinctive characteristics of the mandible found in the first sentence?

45. In the left-hand column, click on “Condyle”. Be able to identify this marking in the picture below.

46. In the left-hand column, click on “Mandibular Foramen”. Be able to identify this marking in the picture below.

47. In the left-hand column, click on “Mental Foramen”. Be able to identify this marking in the picture below.

48. There is one bony landmark which is not listed in the left-hand menu. You will need to click on the diagram to identify it in the picture below.


43.

44.

45.

46. (The darker orange line)


49. Click on the upper right-hand menu. Scroll down to 10.14 Facial Skeleton II and click. Using the information in the supper left, answer the following question.

49a. What two body systems utilize the facial bones?

50. Click on each of the bones in the menu on the left. Be able to identify each bone in the pictures that follow. These are much smaller bones and more difficult to distinguish from one another. Rotate the model around and see them from all angles. What things do you see that will help you identify each one?


47.

48.

49. (Give the full name of this bone)

50.

51.

51. Click on the upper right-hand menu. Scroll down to 10.17 Auditory Ossicles and click. Using the information in the upper left-hand corner, answer the following questions.

51. What larger skull bone are these found just deep to?

51b. What is significant about the size of these bones?

51c. Describe how these bones work to accomplish their function.

52. Be able to identify these bones in the picture below.


52.

53.

54.

53. Click on the upper right-hand menu. Scroll up to 10.19 Bones of the Orbit and click.

54. Before you click on the bones in the list on the left, try and click on each one from where you remember they are from earlier in this lab. If you need help, click on the names so the bones highlight.

55. Answer the following questions:

55a. What do the bones of the orbits do?

55b. List the seven bones of the orbits. Click on each one to further learn where they are.

55c. Which ONE of the seven bones could you NOT see just by looking straight into the eye orbits?

56. Identify the seven bones of the orbit in the following picture.


60.

55.

56.

57.

58.

61.

59.

57. Click on the upper right-hand menu. Scroll down to 10.20 Nasal Septum and click. Using the information in the upper left-hand corner, answer the following questions.

57a. What is the purpose of the nasal septum?

57b. What are the components of the nasal septum.

58. Identify the three components of the nasal septum in the picture below.


62.

63.

64.

59. Click on the upper right-hand menu. Scroll down to 10.21 Hyoid and click. Click on “Hyoid” in the left-hand menu and answer the following question.

59a. True or False: The hyoid attaches to the skull by a condyles and a fossa.

60. Be able to identify the hyoid bone in the picture.


65.


TIME TO PRACTICE!

CLICK ON QUIZZES IN THE MAIN MENU.

TAKE QUIZ 10.b AXIAL SKELETON

(this will include some bones not yet studied, as they occur in the rest of the axial skeleton)

Review your Skull Bones and Skull Bone Markings. When you can identify them confidently, check them off.

BONE



BONE MARKINGS/LANDMARKS



Frontal

Supraorbital Foramen of the Frontal Bone

Parietal

Mandibular Fossa of the Temporal Bone

Temporal

Zygomatic Process of the Temporal Bone

Occipital

Mastoid Process of the Temporal Bone

Sphenoid

External Auditory Meatus of the Temporal Bone

Ethmoid

Styloid Process of the Temporal Bone

Nasal

Foramen Magnum of the Occipital Bone

Maxillary

Occipital Condyle of the Occipital Bone

Zygomatic

Optic Foramen of the Sphenoid Bone

Mandible

Sella Turcica of the Sphenoid Bone

Lacrimal

Crista Galli of the Ethmoid Bone

Inferior Conchae

Cribriform Plate of the Ethmoid Bone

Vomer

Perpendicular Plate of the Ethmoid Bone

Malleus

Middle Conchae of the Ethmoid Bone

Incus

Mandibular Condyle of the Mandible

Stapes

Alveolar Process of the Mandible

Hyoid

Mandibular Foramen of the Mandible

Mental Foramen of the Mandible

Alveolar Process of the Maxillary Bone

Hard Palate (Palatine Process) of the Maxillary Bone

Infraorbital Foramen of the Maxillary Bone

Frontal Suture

Sagittal Suture

Lambdoid Suture

Squamous Suture

Septal Cartilage

Anatomy homework help


BEFORE working on this assignment READ the Instructions for the Persuasive

Instructions for Selecting the Country or Community of Interest

You need to select a country from the list below (or US immigrant/refuge community) that will serve as the focus for the final paper.  The same country/community will provide a focus for assignments that occur prior to the final paper.  The thought is that the earlier assignments will assist to clarify aspects of the final paper.  The chosen country/community will be the focus of the following assignments: (a) NGO Business Letter, (b) SDOH Impact Analysis which includes an email to another professional, (c) Annotated Bibliography, and (d) Informative/Persuasive paper. 

The choice of a country or US immigrant/refugee community will provide the focus for several assignments in this course.   The country you choose will be the focus of the NGO Business Letter, the Email to a Healthcare Professional, and the Informative/Persuasive paper.  

1. Choose one of the following countries/communities

·

1. Kenya

1. Botswana

1. Ecuador

1. Peru

1. Thailand

1. Jamaica

1. Yemen

1. Paraguay

1. Sudan

1. Haiti

1. Somalia

1. A specific immigrant or refugee community within the US, e.g. immigrant children from the southern hemisphere or a Muslim group who has recently arrived in the US or non-vaccinated individuals as a population.

 

2. Use both the list of suggested resources found in the Instructional Materials folder and other sources to learn about the selected country, the health of the citizens and/or the healthcare issues in the selected country/community. Helpful resources are:

· Website of the World Health Organization (
https://www.who.int
)

· Website of the Pan American Health Organization (
https://www.paho.org
)

· Websites that addresses immigrant populations is:
https://www.migrationpolicy.org/programs/data-hub/charts/us-immigrant-population-state-and-county

Directions for how to use this website are below the map of the US that appears on the website.

3. Write a paragraph explaining why this particular country/community was selected.  Specifically, what drew you to this country (or population)?

4. Write a paragraph specifying three (3) major health concerns or healthcare issues in the chosen country/community.  Explain why these issues are a concern in the chosen country/community. COVID is not an acceptable health issue. 


5. Choose ONE of the identified health concerns/healthcare issues to serve as a focus for the Informative and Persuasive paper.  Discuss why this issue was chosen over the others.  Make sure that your reasons are explicit.

6. The assignment will be four (4) to six (6) paragraphs in length.  Support your reasoning with two (2) peer-reviewed references and citations.  A properly formatted title page and a reference page are required.  

7.  Consult the following website if you are unsure about how to find peer-reviewed articles (
https://libguides.library.ohio.edu/nursing/scholarly-peer-review).

8. Remember to use APA Manual 7th edition formatting and MUGS (Mechanics, Usage, Grammar, Spelling) guidelines when writing the paper.

Anatomy homework help

Overview:

For this assignment write a letter to a non-governmental organization (NGO). You are seeking the assistance of the NGO in addressing the health issue that you identified in the country/community selected.  You are not required to choose an actual NGO.  You will be using the NGO information we provide rather than researching an actual NGO. 

Instructions

1. Create a business letter to an NGO that is active in the country/community selected. The business letter is to be constructed in a 
block format
. See the 
https://owl/purdue.edu
 site for assistance. 

2. Address the letter to the individual and organization listed in the information section below.   Keep in mind that your reader has a doctoral degree in business and a graduate degree in public health.

3. In this letter you will:

            3.1       Introduce yourself.

3.2       Introduce/explain the identified health issue. Explain your reason for writing that will include your concern about the health issue that you have identified.

3.3       State your recommendation(s) for how to address the identified health issue.

3.4       Acknowledge your awareness of past/current funding (see the information section below).

3.5       Request specific support and/or sponsorship to address the identified health issue. Clearly state your request and how the funds will be used.

3.6       Be persuasive in your explanation of why the support is needed, how the NGO’s mission is connected to described project, and how the NGO’s financial assistance will support the plan designed to address the health issue.

3.6       Close with a strong summary paragraph.

4. Mechanics

4.1       Remember that all references must follow APA Manual 7th edition format.

4.2       The body of the letter is to be 400 to 500 words (approximately two pages). Just the body

4.3       Business letters infrequently contain citations for supporting references.  This one will.  Cite at least two (2) articles and use at least one source that is not course material.

 4.4       Make sure that you proof the letter to ensure that it meets the assignment guidelines.

NGO Information to Use in Letter

1.         Name and address of the NGO is:

Creating Space for Life
Mary Phillips, Executive Director
5555 Fifty-first Street
Plain City, NJ  01012

2.         Mission of the NGO is:  Reaching the poorest of the poor in developing countries to educate, heal, and empower.

3.         The NGO has funded projects in the chosen country previously but not within the past three years.  The last funded project was for a chronic disease prevention project and was funded at the $250,000 level.

4.         Not much information is available for the members of the governing board.  It is known that the executive director ran a large hospital system before joining the NGO.  She has a PhD in business and a master’s in public health (MPH).

Anatomy homework help

M4-A2 Rubric #6, Introduction to Final Paper

Use the information in each of the boxes below each category, e.g., accomplished or proficient,

to guide you in the meeting the goals of a specific assignment. The final number of points seen

below the grid indicate your level of accomplishment.

Introduction to Final Paper

Area Evaluated

10 points

Accomplished Proficient Needs Work

Organization

3 points

*Two or three
paragraphs in length

*No more than one (1)

error in MUGS

*Two or three paragraphs in

length

*No more than two (2)

errors in MUGS

*More than three

paragraphs

*More than two (2)

errors in MUGS

Content

6 points

*Clearly expressed topic

*Transition between

paragraphs adds to

clarity of topic

*Grabs the reader’s

attention

*Ends with a clear and

concise thesis statement

*Topic is identified but is

not clearly expressed

*Transition between

paragraphs is partially

accomplished

*Addresses the reader’s

attention

*Ends with a clear thesis

statement

*Hard to identify the

intended topic

*Transition between

paragraphs is vague and

does not add to clarity

*Minimal effort to get

the reader’s attention

*No clear thesis

statement

APA

1 point

*No APA errors *No more than one (1) error

in APA

*More than one (1)

error in APA

Interpretation of Points Accomplished: 10.00 – 9.00 points

Proficient: 8.99 – 7.50 points

Needs Work: Less than 7.50 points

August 2021

Anatomy homework help

Infographics are excellent tools to attract the attention of a public and present information quickly and clearly. The design that I chose for this project is the perfect example of this, as it effectively summarizes the elements and general trends that are found in a typical piece of this kind. It consists of a description of what should be part of an well-developed infographic in terms of design and content. The goal of the message is to guide anybody that is trying to create one, by advising them on what are the most popular elements that these include. Based on this goal, its intended audience is most likely to see this infographic in educational websites, design classrooms, or even in a school library.

The viewers of this piece can derive from it almost everything they need to know about what constitutes an infographic. Since I am a college student taking a design course, I am exactly its intended audience, and I can relate very closely to it. This infographic reinstates some of the content that we have been learning in this course like the different types of graphs, and the most popular fonts and colors that are used; while also it provides me with new information like the most popular themes and countries that are featured in them. It is especially helpful for me because we are currently studying about them in our class, and since this assignment is an analysis of infographics and I chose an example that also talks about infographics, it is essentially “meta.” From this design any viewer can gather facts like the key information, the different sections, and the average number of credited sources and titles that they should include in one.

With so many elements to take into consideration, creating a fine infographic for the first time can be an overwhelming task to successfully accomplish. This “infographic of infographics” is an excellent tool to guide students like me, my classmates or any person that is looking to create or become familiarized with graphics of this kind.


http://www.ivan.cash/infographic-of-infographics/

Anatomy homework help

Rubric #5: SDOH Impact Analysis (M4-A1)

Remember to use the information in the columns to complete the components of the assignment.

Criteria
30 points possible

Accomplished Proficient Needs Work Unacceptable

Organization

10 points

*Both analysis &
email are present
*Contains
introduction,
body, and
conclusion
*Title page
included
*Two or three
health issues listed
*SDOH identified
& documented
*300-350 word
paper; 200-250
word email
*Minimum of 3
references & 1 is
scholarly

*Both analysis &
email are present
*Contains
introduction, body
and conclusion
*Title page
included
*Two or three
health issues listed
*SDOH identified
& documented
*300-350 word
paper; 200-250
word email
*Fewer than 3
references & not
clear if one is
scholarly

*Both analysis &
email are present
*Contains
minimum of 2 of
intro, body &
conclusion
*Title page
included
*Two or three
health issues listed
*SDOH identified
but not
documented
*Fewer than 300
words in paper;
fewer than 200
words in email
*Fewer than 3
references & none
are scholarly

*Missing either
the analysis or the
email
*Contains no
more than one (1)
of intro, body, or
conclusion
* No title page
*Fewer than two
health issues listed
*No SDOH
identified or
documented
*Fewer than 300
words in paper;
fewer than 200
words in email
*No more than
one (1) reference
& it is not
scholarly

Content

14 points

*Description of
country present
*Focus SDOH is
clearly described
& connected to
the health issue
*Email has brief
description of
concept of SDOH
*Link between
SDOH & health
issue well
explained &
supported

*Description of
country present
*Focus SDOH is
clearly described
but connection to
health issue is not
very clear
*Email has brief
description of
concept of SDOH
*Link between
SDOH & health
issue is explained
& supported

*Vague
description of
country
*Focus SDOH is
described but
connection to
health issue is
vague
*No description of
concept of SDOH
*Link between
SDOH & health
issue is attempted
with some support

*Very little info
on the country
*Lack of focus
SDOH & no
connection to a
health issue
*No description of
concept of SDOH
*Link between
SDOH & health
issue is attempted
but no support

MUGS
3 points

No MUGS errors No more than one
(1) MUGS error

Two or more
MUGS errors

Three or more
MUGS errors

APA
3 points

*Format of all
references in APA
format
*Margins & font
are correct

* No more than
one (1) error in
reference format
*Margins & font
are correct

*No more than 2
errors in reference
formatting
*Either margins or
font incorrect

*No more than 3
errors in reference
formatting
*Either margins or
font incorrect

Interpretation of Points Accomplished: 30.00 – 27.00 points
Proficient: 26.99 – 24.00 points
Needs Work: 23.99 – 21.00 points
Unacceptable: Fewer than 21.00 points

Anatomy homework help

60 Journal of College Science Teaching

C A S E S T U D Y

Resistance Is Futile . . . or Is It? The
Immunity System and HIV Infection
by Annie Prud’homme-Généreux

A
lthough the majority of
people are prone to HIV
infection, some individu-
als remain uninfected de-

spite repeated exposure. This case
study uses the results of the land-
mark paper by Paxton and his col-
leagues (1996) that offered the first
breakthrough in understanding why
some people are protected against
HIV infection. The case study uses
an interrupted progressive disclo-
sure format, during which students
make hypotheses, predict the out-
come of experiments, and compare
their predictions with real data. I
am aware of another case study
developed using Paxton’s paper
(“Rediscovering Biology,” 2011).
The aims, activities, and topics
covered by that case are different,
and I recommend that instructors
review the Rediscovering Biology
case, particularly the excellent mul-
timedia and introductory literature
that accompanies it. This case is
appropriate for first-year biology
students with knowledge of the im-
mune system (cellular and immoral
immunity) and HIV infection.

Objectives
By the end of the case, students will
be able to

• formulate testable hypotheses and
design experiments to investigate
them;

• predict the results of experiments
given competing hypotheses;

• interpret data and compare to pre-
dicted outcomes;

• describe cellular and humoral im-
munity, HIV structure, and HIV
infection; and

• debate the pros and cons of per-
sonal knowledge of HIV immu-
nity.

Classroom management
This case was developed for a
90-minute class but can be adapted
for a longer or shorter class period.
Students should be well versed in
humoral and cellular immunity and
the mechanism of HIV infection be-
fore attempting this case. For each
section of this case, teams of three
to four students are provided with
printed handouts of the case and are
directed to work with their group on
solving the questions. This is always
followed by a large class discussion
during which the inputs of each team
are shared. Use of a whiteboard on
which student volunteers show their
predictions during the class discus-
sion is very helpful.

Following this case, students can
be assigned research projects to
update their knowledge and under-
standing of this issue. Several lines
of investigation are suggested:

• The CCR5 mutation is common
among people of European de-
scent but not among other popula-
tions. Students explore and com-
pare the proposed hypotheses that
explain the evolution of this trait.

• Since Paxton’s paper was pub-
lished, mutations in human genes
other than CCR5, for example in
CCR2, have been shown to pro-
tect against HIV infection or slow
down the progression of the dis-
ease to AIDS. Review what some
of these genes do and how they
are thought to exert their protec-
tive effect (e.g., see O’Brien,
2003; O’Brien & Moore, 2000;
O’Brien & Nelson, 2004).

• Most of the individuals protected
against HIV appear to have more
responsive T

C. What is known
about this mechanism, and what
does it suggest for possible HIV
preventions and cures?

• It is possible that the protected in-
dividual in Group A is not lucky
but rather has more potent anti-
bodies that defend against HIV.
What’s known about this mecha-
nism of protection? How could
this knowledge be used to prevent
or cure HIV infection?

• Lahouassa and colleagues (2012)
reported yet another means of
protection against HIV. This
mechanism involves the protein
SAMHD1, which can protect
macrophages and dendritic cells
from HIV-1 by hydrolyzing and
depleting the cell’s dNTP pool.
Without dNTP, the virus can-
not copy itself into DNA. This
mechanism cannot protect TH
cells, which have greater concen-
trations of dNTPs, nor is it effec-
tive against HIV-2, which makes

61Vol. 41, No. 5, 2012

an enzyme that counteracts SAM-
HD1. Read this article and pro-
pose how this information could
be used to develop strategies in
the fight against HIV.

• Students write an in-class re-
sponse paper discussing the pros
and cons of making genotype
testing at the CCR5 locus readily
available.

Students may work individually or in
teams and communicate the results
of their research in a class presenta-
tion or in a written report.

Case study
Part I: HIV and the immune
system
The vast majority of people are sus-
ceptible to HIV infection. However,
in the 1990s, several individuals no-
ticed that, despite repeated exposure
to the HIV virus, they remained HIV
negative. This could be due to the
fact that these individuals were ex-
tremely lucky, or perhaps there was
something different about them that
made HIV infection less likely.

William Paxton and his colleagues
at the Aaron Diamond AIDS Research
Center in New York became inter-
ested in this phenomenon of HIV
protection. In this case study, you will
retrace the steps and experiments that
these researchers have performed to
understand the mechanism underlying
the protection against HIV (Paxton et
al., 1996).

B e f o r e l o o k i n g a t P a x t o n ’s
research, here are a few questions to
help you review the biology of HIV
infection and the virus’s interactions
with the human immune system.

Questions
1. Which cells are targeted by the

HIV virus? By what molecular
mechanism can the virus discrim-

inate between cell types?
2. Which cells fight HIV infection

and how?
3. HIV eventually causes AIDS, a

failure of the immune system to
work effectively. How does HIV
cause this symptom?

4. Describe the life cycle of the HIV
virus.

5. Consider how HIV infects cells
and reproduces. Also consider
how the immune system fights
off HIV infection. Humans differ
by having mutations that result in
slightly different proteins and im-
mune function. Suggest as many
hypotheses as possible to explain
why some individuals might be
protected against HIV infection.
In other words, where and how
might new viral infections be
stopped? What could be differ-
ent about the people who seem
protected against HIV that caused
viral replication to stop? Come up
with at least three possibilities.

Part II: Paxton’s hypotheses
about HIV-resistant individuals
Paxton and his colleagues had a few
hypotheses about why some of the
individuals exposed to HIV were
protected against this virus.

Super cytotoxic T cells hypothesis.
Perhaps the reason that some indi-
viduals were protected against HIV is
because they had cytotoxic T cells that
were better and faster at recognizing
infected T helper cells. This ability
allowed the immune system to rid the
body of any HIV infection before the
virus could replicate inside T helper
cells and transform these cells into
HIV factories.

Super T helper cells hypothesis.
Perhaps the T helper cells of the
protected individuals were different,
preventing the infection and replica-
tion of the virus inside the cell. There

are many steps necessary for viral
infection and replication inside T
helper cells, and any of them could
be impeded.

Questions
1. Classify each of your proposed

hypotheses into the two catego-
ries proposed by Paxton and his
colleagues (note: some hypoth-
eses may not fit into either cat-
egory).

2. How might you test each of your
hypotheses? Propose an experi-
ment. What are your controls?
Experimental conditions?

Part III: Predictions from
Paxton’s two hypotheses
Paxton and his colleagues recruited
25 volunteers who claimed to have
had repeated exposure to the HIV
virus and yet were not infected with
HIV. He also enlisted the help of 9
individuals not exposed to the HIV
virus (and who tested negative for
the virus). This latter group is the
control, whose response to HIV
should be the same as the majority
of people.

Paxton and his colleagues wanted
to identify which of their two hypoth-
eses might be correct. The problem
with working in vivo is that it is
unethical to expose individuals to
HIV. In addition, in a person the
immune system is complex, with
multiple interactions. To isolate the
action of T helper cells, cytotoxic T
cells, and the HIV virus, Paxton and
his colleagues worked in test tubes.
Paxton isolated T helper cells and
cytotoxic T cells from individuals in
each group. He then performed the
following experiments:

• In one tube, he mixed HIV virus
and T helper cells.

• In another tube, he mixed HIV vi-

62 Journal of College Science Teaching

CASE STUDY

rus, T helper cells, and cytotoxic
T cells.

He monitored the accumulation of
virus in the test tube over time by
measuring the amount of p24 pro-
teins produced over a 14-day period.

Questions
1. Why were HIV and T helper cells

mixed in the presence and ab-
sence of cytotoxic T cells?

2. Use the graphic provided in Fig-
ure 1 to illustrate the results you
would expect to obtain for
a. a normal/control person
b. a protected individual, assum-

ing that the super cytotoxic T
cell hypothesis is correct

c. a protected individual, assum-
ing that the super T helper cell
hypothesis is correct.

Please note that each graph re-
quires two lines (the two test
tubes).

3. How is this experiment able to
differentiate whether the mecha-
nism of protection against HIV

FIGURE 1

Expected results from Paxton’s first in vitro experiment.

is through super T helper cells or
through super cytotoxic T cells?

Part IV: Paxton’s results
Paxton’s results are shown in Figure
2 (adapted from Figure 1 of his pa-
per; Paxton, 1996). The black lines
represent the results of experiments
in which HIV was incubated with T
helper cells, and the red lines rep-
resent experiments where HIV + T
helper cells + cytotoxic T cells were
mixed in the test tube.

The top left graph shows the
data from control individuals. The
other three graphs show the results
obtained from people claiming to
be protected against HIV infection.
Three different patterns were ob-
served in this group of volunteers.
The results of only one person was
categorized as Group A, two people
had results represented in the figure
for Group B, and Group C is made
up of seven people who had different
responses but whose test tubes all
produced less virus in the presence
of TC.

Questions
1. Do cytotoxic T cells provide pro-

tection from HIV in control indi-
viduals?

2. Why might the results of people
claiming to be resistant to HIV
infection differ? Why might their
results be categorized into three
groups?

3. Compare these results with what
you had predicted in the previous
section.
a. Are the results of the controls

as you expected?
b. Which of Paxton’s hypotheses

seem to be validated by the re-
sults of the protected individu-
als? Why?

c. What do you make of the per-
son claiming to be protected in
Group A?

Part V: The super T helper cell
mechanism
From the results of this experi-
ment, it is apparent that the person
in Group A has either been lucky so
far or exhibits a mode of protection
not anticipated by Paxton’s team. In-
dividuals in Group B do not appear
to be infected by the HIV virus at all
(super T helper cells). The remaining
protected individuals exhibit differ-
ent degrees of infection with very ac-
tive cytotoxic T cells to slow down
the progression of new infections
(super cytotoxic T cells).

Paxton’s team was particularly
interested in protected subjects
in Group B and in investigating
the mechanism of their protection
against HIV. To investigate this, they
performed an experiment in which
they mixed purified T helper cells
from control or protected individu-
als with different strains of HIV-1.
The goal was to determine whether
all HIV-1 strains could infect the T
helper cells from protected individu-

63Vol. 41, No. 5, 2012

als. HIV-1, the most common form
of the virus and the one responsible
for the pandemic, can be classified
into two different types:

• M-tropic (also called nonsyncitia-
inducing (NSI) or R5 HIV-1)
strains

• T-tropic (also called syncitia-in-
ducing (SI) or X4 HIV-1) strains.

This turned out to be a very in-
formative experiment. About the
same time, two other papers were
published that clarified some of the
differences between these two strains
of virus.

• M-tropic HIV-1 strains must bind

to two cell surface proteins to en-
ter and infect a cell (Dragic et al.,
1996):
u CD4 protein
u β-chemokine receptor CCR5

• Conversely, T-tropic HIV-1 strains
use different proteins to enter
and infect a cell (Feng, Broder,
Kennedy, & Berger, 1996):
u CD4 protein
u α-chemokine receptor CXCR4

Armed with this information,
we can look back at the experiment
performed by Paxton’s team and
investigate whether CD4, CCR5,
CXCR4, or another protein is mutated
and “different” in individuals that are
protected against HIV. Here is the
design of this experiment.

• In one tube: Mix HIV-1 (T-tropic
strain) + T helper cells from a
control person.

• In another tube: Mix HIV-1
(T-tropic strain) + T helper cells
from a protected person.

• Monitor the appearance of p24 in
the test tube (i.e., production of
new virus) over time.

FIGURE 2

Summary of results obtained by Paxton and his team for the first in
vitro experiment. Adapted by permission from Macmillan Publishers
Ltd: Nature Medicine 2(4): 412–417, copyright 1996.

64 Journal of College Science Teaching

CASE STUDY

• In one tube: Mix HIV-1 (M-tropic
strain) + T helper cells from a
control person.

• In another tube: Mix HIV-1
(M-tropic strain) + T helper cells
from a protected person.

• Monitor the appearance of p24 in
the test tube (i.e., production of
new virus) over time.

Questions
1. Let’s assume that protected in-

dividuals in Group B have an
altered CD4 protein (a mutation
in the CD4 gene) compared with
controls that renders the pro-
tein unrecognizable by gp120 on
HIV. Use the graphs in Figure 3
to draw the results you expect to
obtain from the previously men-
tioned experiment. Remember
that each graph should have two
lines and review which proteins
are required for infection by the
two strains.

2. Let’s assume that protected indi-
viduals in Group B have an al-
tered CCR5 protein (a mutation
in the CCR5 gene) compared with
controls. Use the graphs in Figure
4 to draw the results you expect to
obtain from the previously men-
tioned experiment. Remember
that each graph should have two
lines and review which proteins
are required for infection by the
two strains.

3. Let’s assume that protected indi-
viduals in Group B have an al-
tered CXCR4 protein (a mutation
in the CXCR4 gene) compared
with controls. Use the graphs in
Figure 5 to draw the results you
expect to obtain from the previ-
ously mentioned experiment.
Remember that each graph should
have two lines and review which
proteins are required for infection
by the two strains.

FIGURE 3

Results expected if controls and protected individuals differ in their
CD4 protein.

FIGURE 4

Results expected if controls and protected individuals differ in their
CCR5 protein.

65Vol. 41, No. 5, 2012

Part VI: Why some people are
protected against HIV
A summary of Paxton’s results is
shown in Figure 6 (from Figure
4 of his paper). The black lines
show the results using T helper
cells from controls and the blue
lines the results using T helper
cells from protected individuals
in Group B. Several different
M-tropic and T-tropic strains of
HIV-1 were used, all producing
similar results.

Questions
1. Which of your hypothesized

graphics do the results most re-
semble?

2. On the basis of this information,
what is the mechanism of HIV
protection in Group B?

3. Are these people protected against
all forms of HIV out there? What
are the implications?

4. In biology, the terms resistance
and immunity have different
meanings. Resistance is a preex-
isting mutation in an organism
that confers protection against
a threat or challenge such as a
virus. Resistance is used in the
same manner as “antibiotic resis-
tance” in bacteria. Immunity re-
fers to an active response of the
immune system to the challenge
of a foreign particle that con-
fers protection upon the organ-
ism. You have investigated many
forms of protections against HIV.
Which of these constitute resis-
tance and which of them consti-
tute immunity?

Note: Detailed teaching notes and
the answer key may be found at
the National Center for Case Study
Teaching in Science at http://sci-
encecases.lib.buffalo.edu/cs/col-
lection. n

FIGURE 6

Summary of results obtained by Paxton and his team for the second in
vitro experiment. Adapted by permission from Macmillan Publishers
Ltd: Nature Medicine 2(4): 412–417, copyright 1996.

FIGURE 5

Results expected if controls and protected individuals differ in their
CXCR4 protein.

66 Journal of College Science Teaching

CASE STUDY

References
Dragic, T., Litwin, V., Allaway,

G. P., Martin, S. R., Huang, Y.,
Nagashima, K. A., . . . Paxton, W.
A. (1996). HIV-1 entry into CD4+
cells is mediated by the chemokine
receptor CC-CKR-5. Nature,
381(6584), 667–673.

Feng, Y., Broder, C. C., Kennedy, P.
E., & Berger, E. A. (1996). HIV-1
entry cofactor: functional cDNA
cloning of a seven-transmembrane
G protein-coupled receptor. Science,
272, 872–877.

Lahouassa, H., Daddacha, W.,
Hofmann, H., Ayinde, D., Logue,
E.C., Dragin, L., . . . Margottin-
Goguet, F. (2012). SAMHD1
restricts the replication of human

immunodeficiency virus type 1 by
depleting the intracellular pool of
deoxynucleoside triphosphates.
Nature Immunology, 13, 223–228.

O’Brien, S. J. (2003). Chapter 12:
Genetic guardians. In Tears of the
cheetah: The genetic secrets of our
animal ancestors (pp. 198–221).
New York, NY: St. Martin’s Press.

O’Brien, S. J., & Moore, J. P. (2000).
The effect of genetic variation in
chemokines and their receptors on
HIV transmission and progression
to AIDS. Immunological Reviews,
177, 99–111.

O’Brien, S. J., & Nelson, G. W. (2004).
Human genes that limit AIDS.
Nature Genetics, 36, 565–574.

Paxton, W. A., Martin, S. R., Tse,

D., O’Brien, T. R., Skurnick, J.,
VanDevanter, N. L., . . . Koup, R. A.
(1996). Relative resistance to HIV-1
infection of CD4 lymphocytes from
persons who remain uninfected
despite multiple high-risk sexual
exposures. Nature Medicine, 2,
412–417.

Rediscovering Biology. (2011). The
genetics of resistance to HIV
infection. Retrieved from http://
www.learner.org/courses/biology/
casestudy/hiv.html

Annie Prud’homme-Généreux (apg@
questu.ca) is Founding Professor in the
Life Sciences Department at Quest Uni-
versity Canada in Squamish, British Co-
lumbia, Canada.

NEW
ONLY $329

Introducing

The most powerful, connected, and versatile
data-collection device available for STEM education

Temperature probe sold separately.

Anatomy homework help

PT 105 Unit 4 Assignment – Laws and Regulations Group Presentation

PT 105 Unit 4 Assignment – Laws and Regulations Group Presentation

Criteria

Ratings

Pts

This criterion is linked to a Learning OutcomeContent

PT105-CO1

10 pts

Level 5

Demonstrates the ability to construct a clear and insightful problem statement/thesis statement/topic statement with evidence of all relevant contextual factors.

8 pts

Level 4

Demonstrates the ability to construct a problem statement, thesis statement/topic statement with evidence of most relevant contextual factors, and problem statement is adequately detailed.

6 pts

Level 3

Begins to demonstrate the ability to construct a problem statement/thesis statement/topic statement with evidence of most relevant contextual factors, but problem statement is superficial.

4 pts

Level 2

Demonstrates a limited ability in identifying a problem statement/thesis statement/topic statement or related contextual factors.

2 pts

Level 1

Demonstrates the ability to explain contextual factors but does not provide a defined statement.

0 pts

Level 0

There is no evidence of a defined statement.

10 pts

This criterion is linked to a Learning OutcomeWriting

10 pts

Level 5

The paper exhibits an excellent command of written English language conventions. The paper has no errors in mechanics, grammar, or spelling.

8 pts

Level 4

The paper exhibits a good command of written English language conventions. The paper has no errors in mechanics or spelling with minor grammatical errors that impair the flow of communication.

6 pts

Level 3

The paper exhibits a basic command of written English language conventions. The paper has minor errors in mechanics, grammar, or spelling that impact the flow of communication.

4 pts

Level 2

The paper exhibits a limited command of written English language conventions. The paper has frequent errors in mechanics, grammar, or spelling that impede the flow of communication.

2 pts

Level 1

The paper exhibits little command of written English language conventions. The paper has errors in mechanics, grammar, or spelling that cause the reader to stop and reread parts of the writing to discern meaning.

0 pts

Level 0

The paper does not demonstrate command of written English language conventions. The paper has multiple errors in mechanics, grammar, or spelling that cause the reader difficulty in discerning the meaning.

10 pts

This criterion is linked to a Learning OutcomeDelivery

10 pts

Level 5

The delivery of materials included appropriate eye contact, good volume and tone, effective vocal clarity, effective gestures, and a clear alignment to notes or outline.

8 pts

Level 4

The delivery of materials included appropriate eye contact, good volume and tone, vocal clarity, gestures, and significant alignment to notes or outline.

6 pts

Level 3

The delivery of materials included eye contact, audible volume and tone, vocal clarity, and some alignment to notes or outline.

4 pts

Level 2

The delivery of materials included some eye contact, audible volume and tone, vocal pauses (um, like, and-a, uh etc.) were evident some alignment to notes or outline.

2 pts

Level 1

The delivery of materials included occasional eye contact, volume and tone were inconsistent, vocal pauses (um, like, and-a, uh etc.) were frequent and some alignment to notes or outline.

0 pts

Level 0

The delivery of materials included minimal to no eye contact, volume and tone were inconsistent, vocal pauses (um, like, and-a, uh etc.) were frequent and lacked alignment to notes or outline.

10 pts

Total Points: 30

Anatomy homework help

104

Courtesy of Mark Tuschman.

CHAPTER 2
Health Determinants, Measurements,
and the Status of Health Globally

LEARNING OBJECTIVES

By the end of this chapter, the reader will be able to do the following:

■ Describe the determinants of health
■ Define the most important health indicators and key terms related to measuring health

status and the burden of disease
■ Discuss the status of health globally and how it varies by country income group, region,

and age group

C
o
p
y
r
i
g
h
t

2
0
2
0
.

J
o
n
e
s

&

B
a
r
t
l
e
t
t

L
e
a
r
n
i
n
g
.

A
l
l

r
i
g
h
t
s

r
e
s
e
r
v
e
d
.

M
a
y

n
o
t

b
e

r
e
p
r
o
d
u
c
e
d

i
n

a
n
y

f
o
r
m

w
i
t
h
o
u
t

p
e
r
m
i
s
s
i
o
n

f
r
o
m

t
h
e

p
u
b
l
i
s
h
e
r
,

e
x
c
e
p
t

f
a
i
r

u
s
e
s

p
e
r
m
i
t
t
e
d

u
n
d
e
r

U
.
S
.

o
r

a
p
p
l
i
c
a
b
l
e

c
o
p
y
r
i
g
h
t

l
a
w
.

EBSCO Publishing : eBook Comprehensive Academic Collection (EBSCOhost) – printed on 8/20/2021 10:46 AM via OHIO UNIVERSITY LIBRARIES
AN: 2247214 ; Richard Skolnik.; Global Health 101
Account: s8447892.main.eds

105

M
Vignettes

aria is a poor woman who lives in the highlands of Peru. She is from an ethnic group
called Quechua. In Peru, poor people tend to live in the mountains and be indigenous, be

less educated, and have worse health status than other people. In Eastern Europe, the same
issues occur among ethnic groups that are of lower socioeconomic status, such as the Roma
people. In the United States, there are also enormous health disparities, as seen in the health
status of African Americans and Native Americans, compared to white Americans. If we want to
understand and address differences in health status among different groups, how do we
measure health status? Do we measure it by age? By gender? By socioeconomic status? By
level of education? By ethnicity? By location?

Yevgeny is a 56-year-old Russian male. Life expectancy in Russia in 1985 was about 64 years
for males and 74 years for females. It then fell to about 59 years for males and 72 years for
females in 2001, before rising again to 67 for males and 77 for females in 2016. What does
life expectancy at birth measure? What are the factors contributing to the earlier decline in life
expectancy at birth in Russia? What has happened to trends in life expectancy in other
countries? Which countries have the longest and shortest life expectancies, and why?

Sarah is a 27-year-old woman in northern Nigeria. While women in high-income countries very
rarely die of pregnancy-related causes and have a maternal mortality ratio of about 10 per
100,000 live births, the maternal mortality ratio for women in low-income countries like Sarah is
about 500 per 100,000 live births. This is 50 times higher than that in the best-off country
income group. What does the maternal mortality ratio suggest about a country? What does it
say about the status of women in that country? What does it indicate about the access of
women to obstetric and emergency obstetric care of appropriate quality?

Abdul is a 4-year-old in northern India. For every 1,000 children born in South Asia in 2016,
about 50 will die before their fifth birthday. The rate of child death is even higher in sub-Saharan
Africa. In the cohort of 1,000 children born there in 2016, almost 80 will die before they are five.
These two regions have the worst child mortality rates.

1 2 3

4

5

EBSCOhost – printed on 8/20/2021 10:46 AM via OHIO UNIVERSITY LIBRARIES. All use subject to https://www.ebsco.com/terms-of-use

106

The Importance of Measuring Health Status
If we want to understand the most important global health issues and what can be done to
address them, then we must understand what factors have the most influence on health status,
as well as how health status is measured.

This chapter, therefore, covers two distinct but closely related topics. The first section concerns
what are called . That section examines the most important factorsthe determinants of health
that relate to people’s health status. The second section reviews some of the most important
indicators of health status and how they are used.

EBSCOhost – printed on 8/20/2021 10:46 AM via OHIO UNIVERSITY LIBRARIES. All use subject to https://www.ebsco.com/terms-of-use

107

The Determinants and Social Determinants of Health
Why are some people healthy and some people not healthy? When asked this question, many
of us will respond that good health depends on access to health services. Yet, as you will learn,
whether or not people are healthy depends on a large number of factors, many of which are
interconnected, and most of which go considerably beyond access to health services.

The World Health Organization (WHO) defines the as the “range ofdeterminants of health
personal, social, economic and environmental factors which determine the health status of
individuals or populations.” WHO defines the social determinants of health as the “conditions in
which people are born, grow, live, work and age.”

There has been considerable writing about the determinants and social determinants of health,
which different organizations depict in a range of ways. The next section builds on the work of a
number of actors and agencies. It briefly discusses the determinants and social determinants of
health and how they influence health. It is essential to understand these concepts if one wants
to understand why people are healthy or not and what can be done to address different health
conditions in different settings. shows one way of depicting the determinants ofFIGURE 2-1
health.

6

7

EBSCOhost – printed on 8/20/2021 10:46 AM via OHIO UNIVERSITY LIBRARIES. All use subject to https://www.ebsco.com/terms-of-use

108

FIGURE 2-1 The Determinants of Health

Reproduced from Dahlgren, G., & Whitehead, M. (1991). .Policies and strategies to promote social equity in health

Stockholm, Sweden: Institute for Futures Studies. Retrieved from http://www.iffs.se/media/1326

/20080109110739filmZ8UVQv2wQFShMRF6cuT.pdf

EBSCOhost – printed on 8/20/2021 10:46 AM via OHIO UNIVERSITY LIBRARIES. All use subject to https://www.ebsco.com/terms-of-use

109

The first group of factors that helps to determine health relates to the personal and inborn
features of individuals. These include genetic makeup, sex, and age. Our genetic makeup
contributes to what diseases we get and how healthy we are. One can inherit, for example, a
genetic marker for a particular disease, such as Huntington’s disease, which is a neurological
disorder. One can also inherit the genetic component of a disease that has multiple causes,
such as breast cancer. Sex also has an important relationship with health. Males and females
are physically different, for example, and may get different diseases. Females face the risks
involved in childbearing. They also get cervical and uterine cancers that males do not. Females
have higher rates of certain health conditions, such as thyroid and breast cancers. For similar
reasons, age is also an important determinant of health. Young children in low- and
middle-income countries often die of diarrheal disease, whereas older people are much more
likely to die of heart disease, to cite one of many examples of the relationship between health
and age.

Individual lifestyle factors, including people’s own health practices and behaviors, are also
important determinants of health. Being able to identify when you or a family member is ill and
needs health care can be critical to good health. One’s health also depends greatly on how one
eats, or if one smokes tobacco, drinks too much alcohol, or drives safely. We also know that
being active physically and getting exercise regularly is better for one’s health than is being
sedentary.

The extent to which people receive social support from family, friends, and community also has
an important link with health. The stronger the social networks and the stronger the support
that people get from those networks, the healthier people will be. Of course, culture is also an
extremely important determinant of health.

8

9

EBSCOhost – printed on 8/20/2021 10:46 AM via OHIO UNIVERSITY LIBRARIES. All use subject to https://www.ebsco.com/terms-of-use

110

Living and working conditions also exert an enormous influence on health. These include, for
example, housing, access to safe water and sanitation, access to nutritious food, and access to
health services. Crowded housing, for example, is a risk factor for the transmission of
tuberculosis. The lack of safe water and sanitation, coupled with poor hygiene in many settings,
is one of the major risk factors for the diarrheal disease that is associated with so much illness
and death in young children. Nutrition is central to health, beginning at conception, and families
have to be able to access appropriate foods to promote good health. Of course, even if other
factors are such important determinants of health, one’s health depend on access todoes
appropriate healthcare services. Even if one is born and raised healthy and engages in good
health behaviors, access to health services of appropriate quality is important to maintaining
good health. To address the risk of dying from a complication of pregnancy, for example, one
must have access to health services that can carry out an emergency cesarean section if
necessary. Even if the mother has had the suggested level of prenatal care and has prepared
well in all other respects for the pregnancy, in the end, certain complications can only be
addressed in a healthcare setting.

PHOTO 2-1 The circumstances in which people live have a profound impact on their health.

This is a slum in Jakarta, Indonesia. In what ways would living here influence the health of the

slum dwellers?

© Nikada/E+/Getty Images.

EBSCOhost – printed on 8/20/2021 10:46 AM via OHIO UNIVERSITY LIBRARIES. All use subject to https://www.ebsco.com/terms-of-use

111

A range of socioeconomic factors, including culture, education, and socioeconomic status, are
important determinants of health. The broader environment is also a critical health determinant.
Socioeconomic status refers to a person’s economic, social, and work status. It is highly
correlated with educational attainment. People with higher educational attainment have better
economic opportunities, higher socioeconomic status, and more control over their lives than
people of lower educational status. As one’s socioeconomic status improves, so does his or her
health.

More specifically, education is a powerful determinant of health for several reasons. First, it
brings with it knowledge of good health practices. Second, it provides opportunities for gaining
skills, getting better employment, raising one’s income, and enhancing one’s social status, all of
which are also related to health. Studies have shown, for example, that the single best predictor
of the birthweight of a baby is the level of educational attainment of the mother. Most of us
already know that throughout the world there is an extremely strong and positive correlation
between the level of education and all key health indicators. People who are better educated
eat better, smoke less, have less obesity, have fewer children, and take better care of their
children’s health than do people with less education. It is not a surprise, therefore, that they and
their children live longer and healthier lives than do less well-educated people and their
children.

Culture also exerts a profound impact on health. Culture shapes how one feels about health
and illness, how one uses health services, and the health practices in which one engages. In
addition, the gender roles that are ascribed to women in many societies also have an important
impact on health. In some settings, women may be treated more poorly than men and this, in
turn, may mean that women have less income, less education, and fewer opportunities to
engage in employment. All of these militate against their good health.

The environment, both indoor and outdoor, is a powerful determinant of health. Related to this
is the safety of the environment in which people work. Although many people know about the
consequences of outdoor air pollution for health, fewer people are aware of the consequences
of indoor air pollution to health. In many low- and middle-income countries, families, and usually
women, cook indoors with poor ventilation, thereby creating an indoor environment that may be
full of smoke and that increases the risk of respiratory illness and asthma. The lack of safe
drinking water and sanitation is a major contributor to ill health in poor countries. In addition,
many people in those same countries work in environments that are unhealthy. Because they
lack skills, socioeconomic status, and opportunities, they may work without sufficient protection
from hazardous chemicals, in polluted air, or in circumstances that expose them to occupational
accidents.

10

11

EBSCOhost – printed on 8/20/2021 10:46 AM via OHIO UNIVERSITY LIBRARIES. All use subject to https://www.ebsco.com/terms-of-use

112

PHOTO 2-2 The lack of access to safe water and sanitation causes people to seek water from

unsafe sources and is a major risk factor for child deaths. Children are shown here washing

their dishes in a river. What can be done to improve access to safe water and sanitary disposal

of human waste in resource-poor environments?

Courtesy of Mark Tuschman.

The approach that governments take to different policies and programs in the health sector and
in other sectors also has an important bearing on people’s health. People living in a country that
promotes high educational attainment, for example, will be healthier than people in a country
that does not promote widespread education of appropriate quality because better-educated
people engage in healthier behaviors. A country that has universal health insurance is likely to
have healthier people than a country that does not insure its entire population because the
uninsured may lack needed health services. The same would be true, for example, for a country
that promoted safe water supply for its entire population, compared to one that did not.

As we think about the determinants of health, we should be aware that increasing attention is
being paid to the social determinants of health. In 2005, WHO created a Commission on the
Social Determinants of Health. WHO published the commission’s report in 2008. The report
highlighted some of the following themes :12

EBSCOhost – printed on 8/20/2021 10:46 AM via OHIO UNIVERSITY LIBRARIES. All use subject to https://www.ebsco.com/terms-of-use

113

■ Health status is improving in some places in the world but not in others.
■ There are enormous differences in the health status of individuals within countries, as well

as across countries.
■ The health differences within countries are closely linked with social disadvantage.
■ Many of these differences should be considered avoidable, and they relate to the way in

which people live and work and the health systems that should serve them.
■ People’s life circumstances, and therefore their health, are profoundly related to political,

social, and economic forces.
■ Countries need to ensure that these forces are oriented toward improving the life

circumstances of the poor, thereby enabling them to enjoy a healthier life as well. The global
community should also work toward this end.

We should also note the importance to health of child development, including the ways in which
families nourish and care for infants and young children, beginning at conception. Being born
premature or of low birthweight can have important negative consequences on health over the
life course. There is a strong correlation between the nutritional status of infants and young
children and the extent to which they meet their biological and intellectual potential, enroll in
school, or stay in school. In addition, poor nutritional status in infancy and early childhood may
be linked with a number of noncommunicable diseases later in life, including diabetes and heart
disease. There is also considerable evidence that a range of stressors, including poverty,
abuse, and discrimination, have a powerful impact on the health of children that may continue
through adulthood.

Finally, as we think about the determinants and social determinants of health, it is important to
consider how, directly and indirectly, different factors influence health. One framework for such
consideration is shown in . This framework places the determinants of health intoFIGURE 2-2
three categories based on the directness of their influence on health: root causes at the
macro/societal level; underlying causes at the meso/community level; and proximal causes at
the immediate/interpersonal level. Viewing the determinants of health in this manner should
also be helpful in assessing why health conditions exist and what can be done to address them.

13

14

EBSCOhost – printed on 8/20/2021 10:46 AM via OHIO UNIVERSITY LIBRARIES. All use subject to https://www.ebsco.com/terms-of-use

114

FIGURE 2-2 Selected Examples of Root, Underlying, and Immediate Determinants of Health

Modified with permission from Bouwman, L., Wentink, C., & Ormond, M. (2017, April 6). Global Health, W3 Tutorial 3:

Determinants [Powerpoint Slides], Based on Northridge.

EBSCOhost – printed on 8/20/2021 10:46 AM via OHIO UNIVERSITY LIBRARIES. All use subject to https://www.ebsco.com/terms-of-use

115

Key Health Indicators
It is critical that we use data and evidence to understand and address key global health issues.
Some types of health data concern the health status of people and communities, such as
measures of life expectancy and infant and child mortality, as discussed further hereafter. Some
concern health services, such as the number of nurses and doctors per capita in a country or
the indicators of coverage for certain health services, such as immunization. Other data
concern the financing of health, such as the amount of public expenditure on health or the
share of national income represented by health expenditure.

There are a number of very important uses of data on health status. We need data, for
example, to know from what health conditions people suffer. We also need to know the extent
to which these conditions cause people to be sick, be disabled, or die. We need data to carry
out disease surveillance. This helps us understand if particular health problems such as cancer,
influenza, polio, or malaria are occurring, where they are infecting people, who is getting
infected, and what might be done to address these conditions. Other forms of data also help us
to understand the burden of different health conditions, the relative importance of them to
different societies, and the importance that should be given to dealing with them.

If we are to use data in the previously mentioned ways, then it is important that we use a
consistent set of indicators to measure health status. In this way, we can make comparisons
across people in the same country or across different countries. There are, in fact, a number of
indicators that are used most commonly by those who work in global health and in development
work. These are listed and defined in .TABLE 2-1

15

EBSCOhost – printed on 8/20/2021 10:46 AM via OHIO UNIVERSITY LIBRARIES. All use subject to https://www.ebsco.com/terms-of-use

116

TABLE 2-1 Key Health Status Indicators

The section that follows will examine these key indicators of health status in two ways, first by
World Bank region and second by country income group. The graphics will reflect a number of
points quite starkly:

■ There is a very strong correlation between country income group and health status. The
lower the income group, the lower the status; the higher the income group, the higher the
status.

■ In all cases, sub-Saharan Africa has the worst health indicators of all World Bank regions,
and South Asia has the second worst health indicators.

You will understand better as you progress in your study of global health that part of the
relatively low health status of sub-Saharan Africa and South Asia related to the fact that theseis
are the two regions with the lowest per capita income. However, as you will read about here
and elsewhere, their relatively low health status also has to do with government policies and
programs, the lack of safe water and sanitation, low levels of education, and a number of other
factors.

EBSCOhost – printed on 8/20/2021 10:46 AM via OHIO UNIVERSITY LIBRARIES. All use subject to https://www.ebsco.com/terms-of-use

117

It is also important to understand that country income level does not have to determine a
country’s health status. Rather, as you will also read about throughout this text and elsewhere,
resource-poor countries that make wise policy choices in fair ways enable better health forcan
their people than their income level might suggest. This has certainly been the case for a
number of countries whose development history is well known, such as Cuba, Sri Lanka, and
China. Thus, it will be essential as you think about key issues in global health to always keep in
mind questions about which policies can help to achieve the best health for any population at
the least cost and in fair, doable, and sustainable ways. In light of all this, let us now turn to
exploring the specific health indicators.

Among the most commonly used indicators of health status is . Lifelife expectancy at birth
expectancy at birth is “the average number of additional years a newborn baby can be
expected to live if current mortality trends were to continue for the rest of that person’s life.”

In other words, it measures how long a person born today can expect to live, if there were
no change in their lifetime in the present rate of death for people of different ages. The higher
the life expectancy at birth, the better the health status of a country. In the United States, a
high-income country, life expectancy at birth in 2016 was about 79 years; in Jordan, a
middle-income country, life expectancy was 74 years; in Sierra Leone, a very low-income
country, life expectancy was 52 years.

FIGURE 2-3 shows life expectancy at birth by country income level. This figure shows an
exceptional correlation between country income group and life expectancy. It also shows the
range of life expectancy across country income groups, from 63 years in low-income countries
to 29 percent higher, or 81 years, in high-income countries.

16

(p58)

17

EBSCOhost – printed on 8/20/2021 10:46 AM via OHIO UNIVERSITY LIBRARIES. All use subject to https://www.ebsco.com/terms-of-use

118

FIGURE 2-3 Life Expectancy at Birth by World Bank Country Income Group, 2016

Data from The World Bank. (n.d.). Data: Life expectancy at birth, total (years). Retrieved from https://data.worldbank

.org/indicator/SP.DYN.LE00.IN?end=2016&locations=XD-XT-XN-XM&start=2016&view=bar

FIGURE 2-4 shows life expectancy by World Bank region. It reflects the points noted
previously, with sub-Saharan Africa and South Asia having the lowest life expectancy. It is also
important to note that the region with the highest life expectancy has a life expectancy that is 19
years, or about 30 percent, greater than the region with the lowest life expectancy.

EBSCOhost – printed on 8/20/2021 10:46 AM via OHIO UNIVERSITY LIBRARIES. All use subject to https://www.ebsco.com/terms-of-use

119

FIGURE 2-4 Life Expectancy at Birth by World Bank Region, 2016

Data from The World Bank. (n.d.). Data: Life expectancy at birth, total (years). Retrieved from https://data.worldbank

.org/indicator/SP.DYN.LE00.IN?end=2016&locations=Z4-ZG-8S-ZJ-Z7-ZQ&start=2016&view=bar

The is a measure of the risk of death that is associated with childbirth.maternal mortality ratio
Because these deaths are more rare than infant and child deaths, the maternal mortality ratio is
measured as “the number of women who die as a result of pregnancy and childbirth
complications per 100,000 live births in a given year.” The rarity of maternal deaths and
the fact that they largely occur in low-income settings also contribute to maternal mortality being
quite difficult to measure. Very few women die in childbirth in rich countries; for example, the
maternal mortality ratio in Sweden in 2016 was 4 per 100,000 live births. On the other hand, in
very poor countries, in which women have low status and where there are few facilities for
dealing with obstetric emergencies, the ratios can be over 700 per 100,000 live births, as they
were in 2016, for example, in the Central African Republic, Liberia, Nigeria, Somalia, and South
Sudan. In the worst-off country for maternal health, Sierra Leone, the maternal mortality ratio is
estimated to be 1,360 per 100,000 live births.

16(p28)

18

EBSCOhost – printed on 8/20/2021 10:46 AM via OHIO UNIVERSITY LIBRARIES. All use subject to https://www.ebsco.com/terms-of-use

120

FIGURE 2-5 gives the maternal mortality ratio by country income group, and FIGURE 2-6
shows the same data by World Bank region.

FIGURE 2-5 Maternal Mortality Ratio by World Bank Country Income Group, 2015

Data from The World Bank. (n.d.). Data: Maternal mortality ratio (modeled estimate, per 100,000 live births). Retrieved

from https://data.worldbank.org/indicator/SH.STA.MMRT?end=2014&locations=XM-XD-XT-XN&start=2014&view

=bar

EBSCOhost – printed on 8/20/2021 10:46 AM via OHIO UNIVERSITY LIBRARIES. All use subject to https://www.ebsco.com/terms-of-use

121

FIGURE 2-6 Maternal Mortality Ratio by World Bank Region, 2015

Data from World Bank. (n.d.). Data: Maternal mortality ratio (modeled estimate, per 1,000 live births). Retrieved from

https://data.worldbank.org/indicator/SH.STA.MMRT?end=2015&locations=Z4-8S-ZG-Z7-XU-ZJ-ZQ&start=2015

&view=bar

As suggested earlier, the pattern of the maternal mortality ratio, by both country income group
and region, is similar to that for life expectancy. However, the differences among regions and
country income groups are even greater. The low-income group, with the worst maternal
mortality ratio, has a 50 times greater ratio than the high-income group. Sub-Saharan Africa has
a ratio that is 42 times greater than in North America. Many people believe that the maternal
mortality ratio is the indicator that is most sensitive to a country’s overall development status
and best reflects the place of women in different societies.

EBSCOhost – printed on 8/20/2021 10:46 AM via OHIO UNIVERSITY LIBRARIES. All use subject to https://www.ebsco.com/terms-of-use

122

Another important and widely used indicator is the . The infant mortalityinfant mortality rate
rate is “the number of deaths of infants under age 1 per 1,000 live births in a given year.”
This rate is expressed in deaths per 1,000 live births. In other words, it measures how many
children younger than 1 year of age will die for every 1,000 who were born alive that year. Each
country seeks as low a rate of infant mortality as possible, but we will see that the rate varies
largely with the income status of a country. Afghanistan, for example, had an infant mortality
rate in 2016 of 53 infant deaths for every 1,000 live births, whereas in Sweden only about 2
infants die for every 1,000 live births. shows the infant mortality rate by countryFIGURE 2-7
income group. shows the infant mortality rate by World Bank region.FIGURE 2-8

FIGURE 2-7 Infant Mortality Rate by World Bank Country Income Group, 2016

Data from The World Bank. (n.d.). Data: Mortality rate, infant (per 1,000 live births). Retrieved from https://data

.worldbank.org/indicator/SP.DYN.IMRT.IN?locations=XD-XT-XN-XM

16(p28)

19

EBSCOhost – printed on 8/20/2021 10:46 AM via OHIO UNIVERSITY LIBRARIES. All use subject to https://www.ebsco.com/terms-of-use

<

Anatomy homework help

MODULE 7 Informative and Persuasive Paper

Overview

The final project for NRSES 3700J is a paper of about 1500 words (approximately six [6] pages).
The paper is due in the last module of the course (Module 7). The paper has two purposes:

1. The first purpose is to inform the audience about a health issue that exists in the
country/community selected in Module 1 and reaffirmed in Module 3.

2. The second purpose is to persuade the audience that a specified intervention (or
interventions) would address the health issue in a positive way.

Instructions

1. The paper is to be approximately six (6) pages in length excluding the title page and the
references cited page.

2. The chosen health issue is to be compared to a similar issue in the United States (US).
Use the following questions/topics to focus the paper.

2.1 Discuss the health issue in the selected country/community.

• What is it?
• Who is impacted?
• Why is the chosen health issue important?
• What are the consequences of not addressing the health issue?
• Identify the two (2) or three (3) social determinants of health that have the

most impact on the chosen health issue. Explain the influence.

2.2 Is the same health issue present in the US?

• Who does the health issue impact in the US?
• Compare the size of the health issue in the US with that in the selected

country/community.
• What is similar about the health issue in the two countries?
• What is different about the health issue in the two countries?
• Identify the two (2) or three (3) social determinants of health that have an

impact on the chosen health issue in the US. Explain the influence of
each.

• If the health issue does not exist in the US, explain the reasons for this
being so.

2.3 Identify an intervention (or interventions) that could address the identified health
issue. There is no specified number of interventions required, but if education is
chosen as an intervention it cannot be the only intervention.

• In what ways, if any, would the proposed interventions differ between the
selected country/community and the US?

• If the intervention in the two countries would not differ, explain why they
would not.

Module 7 Final Paper, continued

• Identify the connection between the social determinants of health, the
health issue, and the intervention(s).

• Persuade the audience that the identified intervention(s) would be useful in
addressing the chosen health issue. Again, education cannot be the only
intervention, but it can be used in combination with other interventions.

Technical Aspects of the Paper

1. DO NOT include an abstract.

2. The paper must include:

2.1 A title page formatted according to the student title page information in the APA
Manual 7th edition.

2.2 An introduction that includes a thesis statement.

2.3 The body of the paper supports the thesis organizes and fleshes out the main
ideas, and topics are sequenced so the follow of the thinking/writing makes sense.

2.4 A conclusion.

3. Include a minimum of five (5) references. References must be no older than five (5)
years (unless you are using a seminal or classical piece of literature to make a specific
point). References need to be on a References Cited page following the actual paper.

Acceptable references include peer-reviewed databases, peer-reviewed journal articles,
textbook materials, and any source that has been peer reviewed. References that are not
acceptable include, but are not limited to: UpToDate, Epocrates, Medscape, WebMD,
hospital organization publications, insurance recommendations, and secondary clinical
databases. Do NOT include the annotated bibliography.

4. Use the Times New Roman or Arial font in size 12; one (1) inch margins on all sides;
double spaced throughout according to the format of the APA Manual 7th edition.

5. Use APA Manual 7th edition formatting throughout the paper.

Previous Assignments that May Be Useful

1. Choice of country/community
2. NGO Business Letter
3. SDOH Impact Analysis and Email
4. Introduction to Final Paper
5. Outline of Final Paper
6. Annotated Bibliography
7. Patient Education Materials

CLICK on the link titled “M7 Final Paper Submission” in Blackboard to submit the paper.

Points: 45 Due Date: See the Course Calendar/Checklist

Anatomy homework help

Make a GIPHY using hand drawn images showing the different parts of the alimentary canal (i.e the esophagus, stomach, small and large intestine). Also show the lesser and greater omenta and the mesentery in your GIPHY. It is i

Anatomy homework help

Overview:

Useful resources: Nordquist, R. (2018, July 5). Examples of great introductory paragraphs.  https://www.thoughtco.com/introductory-paragraph-essays-and-reports-1691081

The Writing Center. (2018). Introductions.  https://writingcenter.unc.edu/tips-and-tools/introductions/

Introductions to a paper are used to introduce the topic, capture the audience’s attention and convince/encourage them to read the rest of the paper, and to define the scope of the paper that follows.  Introductions should be brief usually three or four sentences.  When addressing a complex topic an introduction may require two paragraphs of three to four sentences each.  Typically the thesis statement is the last sentence of an introduction.

The thesis statement tells the reader the main idea of the paper.  Frequently the thesis sentence includes the writer’s opinion plus a sharing of the organization, content, and purpose of the paper.

Instructions

· You are to write the introduction for the final paper that is due in Week 7.  You may want to review the requirements of that paper before writing the introduction.  The instructions for the final paper can be found in the Instructional Materials for Module 1.

· This assignment provides you with the opportunity to begin the organization of the final paper.  Think about the overall message you wish to convey in the final paper.  The introduction will set the stage for the reader and make them want to learn more so they will then continue to read.  The introduction will end with a conclusive statement that will let the reader know where the author’s thinking is headed.

· Given the required length of the final paper the introduction needs to be two (2) or three (3) paragraphs.   The word count is to be between 250 and 400 words.  Use the professional writing style, e.g., do not use first person.

·

Anatomy homework help

“It’s Just Stress, Right?” by Sheri L. Boyce Page 

by
Sheri L. Boyce
Department of Biological Sciences, Messiah College, Grantham, PA

Part I – Frustration
Ellie dropped her backpack beside the chair in Dr. Kern’s offi ce and sat down with a sigh. Her hands trembled
as she glanced again at the graded exam in her hand.

“It’s no better than the last one,” she mumbled. “I really, really tried this time, Dr. Kern. I did all the reading
assignments before and again after class. I completed all of the study guide questions and rewrote my notes
and made fl ash cards and studied with straight-A Cassie every week. But it didn’t make any diff erence. I still
failed it.” She sniffl ed loudly and reached for the box of tissues on Dr. Kern’s desk.

Dr. Kern sat back and thought for a moment while Ellie made use of several tissues. Ellie was a junior in
Dr. Kern’s physiology course and had struggled from the start of the semester. One-on-one help sessions and
diff erent study strategies hadn’t seemed to help. “I know how discouraged you must be, Ellie. Tell me again
what you do when you sit down to study.”

“I read and review my class notes and reread the assigned sections in the book. But for some reason I can’t
concentrate on much of anything for very long and, even when I can, I don’t remember what I’ve studied
by the next day. It’s so frustrating to spend so much time studying and not retain anything. If I fail this class,
my GPA might drop enough that I’ll lose my scholarships. I’m so stressed that I can’t sleep, even when I try.”

Ellie broke off , and Dr. Kern gently tried to encourage her. “Let’s not give up hope yet. Sometimes you have
to use new study methods for a while until you start to see some benefi ts. Let’s also take a look at your exam
and see if there’s a pattern in the questions you missed.”

Ellie sniffl ed again. “OK, but I’m not very hopeful. I’ve been thinking about changing my major. All these
upper-level courses seem so hard … there’s so much to learn in such a short time and I just don’t seem to get
it even though everyone else does. I can’t stand the stress anymore.”

“Perhaps talking this over with your parents or a trusted friend would help,” Dr. Kern suggested. She noted
Ellie’s strikingly large blue eyes that gave her a permanent look of surprise. Ellie was also quite thin, almost
to the point of being too thin. Dr. Kern paused and chose her words with care. “I also know there are terrifi c
folks over at the health center who are experts in how to deal with stress.”

Ellie gave a small, noncommittal smile and pushed a shaking hand through her hair. “Th anks, I’ll think
about it. See you in class on Monday.”

However, Ellie didn’t come to class on Monday or Wednesday. She emailed Dr. Kern that she most likely
had a sinus infection and would miss class on Friday to see a doctor. Dr. Kern shook her head at Ellie’s
misfortune; missing a week of class was not going to make it any easier for Ellie to pull up her grade.

It’s Just Stress, Right?
A Case Study on the Endocrine System

“It’s Just Stress, Right?” by Sheri L. Boyce Page 

Questions

. Note anything unusual about Ellie’s behavior or appearance.

. What do you think might be going on with Ellie that could cause her diffi culties? Consider both
physical and psychological causes.

“It’s Just Stress, Right?” by Sheri L. Boyce Page 

Part II – Health Center
Ellie sat in a small exam room of the student health center, feverish and with a throbbing headache. A sinus
infection right before midterms was not what she needed.

Dr. Simmons entered in a rush and took a quick look at her chart. “Hmm … fever, headache, green nasal
discharge that you’ve had for two weeks. Sounds like your sinuses have been invaded by something nasty.
Does this hurt?” He pressed his thumbs on Ellie’s cheeks, which nearly sent her through the ceiling. “Yep.
Let’s try some antibiotics to clear that up.”

He reached for his prescription pad, but stopped and glanced at Ellie’s face again. “Your eyes protrude a bit.
Have they always been that way?” He turned her face to look at her profi le and frowned slightly.

Ellie had no idea what her eyes had to do with her sinus infection. “I haven’t noticed. But I’ve been so
stressed lately that I don’t notice a lot of things.” She paused and then continued, “My little brother did start
calling me ‘Bug Eyes’ this summer, but he’s just an annoying -year-old.”

Dr. Simmons nodded and then gently palpated her neck. He looked at her chart again. “Your blood pressure
and pulse are elevated. Your fever might account for that, but there could be something else going on here.”
Ellie felt a small knot form in her stomach. Th is was supposed to be a simple sinus infection, nothing more.

Dr. Simmons began to fi re questions at her. Did she have trouble sleeping? Did she often feel nervous or
“jittery”? Had she lost weight recently? Did she often feel like the room was too warm? Did she have frequent
bowel movements or diarrhea?

Ellie’s head spun. “Uh, y-yeah, but I’m just stressed, you know, with classes. Aren’t all those things just signs of stress?”

“Th ey certainly can result from stress, and I see a lot of students where that is the case. However, there is a
slight swelling in the front of your neck. Th at combined with your other symptoms suggests that perhaps
your thyroid gland isn’t functioning quite the way it should. I’d like to take a look before we assume your
symptoms are all due to stress. Let’s start with some simple blood tests and see what we fi nd.”

He scribbled a lab order and smiled kindly. Ellie grabbed the papers and left, feeling worse than when she
fi rst came in.

Questions

. Where is the thyroid gland located?

. List the hormones secreted by the thyroid and describe their general actions.

. Protrusion of the eyes is called exophthalmos. How is it related to thyroid dysfunction? What causes it?

. What is the signifi cance of the slight swelling in Ellie’s neck?

. Based on the information you have at this point, do you think Ellie’s thyroid gland is hyperactive or
hypoactive? Explain your answer.

. Dr. Simmons ordered blood tests to measure Ellie’s levels of thyroid hormone and thyroid-stimulating
hormone (TSH or thyrotropin). If Ellie has a hyperactive thyroid, what are the expected results? What
are the anticipated results if she has a hypoactive thyroid?

“It’s Just Stress, Right?” by Sheri L. Boyce Page 

Part III – Thyroid Trouble
Once again, Ellie sat in the exam room waiting on Dr. Simmons. He fl ew in the door, grabbed a stool and,
to Ellie’s relief, got right to the point. “Well, your blood work does show some problems with your thyroid.
Your TSH levels are lower than they should be, your T4 levels are a bit high and your T3 levels are very high.
Th ose results suggest that you might have Graves’ disease, which means that your thyroid is releasing too much
thyroid hormone. Since thyroid hormones are responsible for your metabolic rate, that explains why your
heart rate and blood pressure are elevated, why you’ve felt nervous and can’t sleep, and why you’ve lost weight
even though you aren’t dieting.”

Ellie’s mind whirled. “Sooooo, could this also be why I can’t concentrate when I try to study and why I can’t
seem to remember anything?” Maybe there was still some hope for her in Dr. Kern’s physiology class.

“Well, maybe,” Dr. Simmons answered. “Some studies suggest that excess thyroid hormone is correlated with
decreased attention, concentration, and working memory. In other words, your thinking might not be as
clear as it should be. However, other experts argue that it’s the anxiety and nervousness that cause patients
to feel their thinking is impaired, even though there is no actual impairment. Th e good news is that with
treatment patients report an improvement in their cognitive abilities, regardless of the underlying cause.”

Ellie felt a twinge of relief. “Oh, good! Th at will certainly help my grades. But why is my thyroid releasing
too much hormone? And you said my TSH levels were low. Isn’t TSH a thyroid hormone? If my thyroid is
too active, shouldn’t it be high instead of low?”

Ellie has just asked some very good questions. If you were Dr. Simmons, how would you answer her?

Questions

. What is causing Ellie’s thyroid to secrete too much hormone?

. Is Ellie correct in thinking that TSH is a thyroid hormone? Why is her TSH level low instead of high?

“It’s Just Stress, Right?” by Sheri L. Boyce Page 

Part IV – Options
Dr. Simmons continued. “I’m going to refer you to a local endocrinologist, someone who specializes in
disorders like this. She will probably order a radioactive iodine uptake test and a thyroid scan to confi rm that
you have Graves’ disease and determine the best way to treat it.”

At Ellie’s look of alarm, he explained. “Don’t worry … the amount of radioactivity is very small and not
harmful, so you won’t start to glow. Th e thyroid gland incorporates iodine into its hormones, and if we tag
the iodine with radioactivity, we can measure the amount of iodine taken up by the thyroid.”

Ellie jumped in. “And if my thyroid is overactive, it will use more iodine than it should, right?”

“Exactly,” responded the doctor. “Assuming that your uptake is elevated, there are several ways to treat your
condition. Unfortunately, we can’t cure it. However, there are some medications that can help, and another
procedure that involves radioactive iodine. Surgery to remove the thyroid is also an option, although not
a common one anymore. Th e endocrinologist will evaluate your test results and help you choose the best
treatment. Until then, I’m going to prescribe a beta-blocker that should help lower your heart rate and
reduce that nervous feeling you’ve had.”

Several weeks later, Ellie dropped her backpack beside the chair in Dr. Kern’s offi ce and sat down with her
latest physiology exam and a smile. “I think there’s hope!”

“I agree. Tell me about this dramatic turn-around,” Dr. Kern smiled in return. Ellie was still very thin and her
blue eyes startlingly wide. However, the fi dgeting and shakiness were gone and the overall impression was
one of calmness and purpose.

Ellie explained how a sinus infection led to discovery of her thyroid disorder. “I’m taking some medication
now until the radioactive iodine treatment becomes eff ective, and I feel so much better. I can sleep, I can
concentrate, and I think I can pull up my grade enough to pass the course!”

Dr. Kern smiled again. “So often signs of stress are just that, but occasionally there is another explanation.
I’m so glad you found out what was going on sooner rather than later, and I’m sure this will reduce your
stress levels even further. We’ll look for even better results on the next exam.”

Ellie laughed. “Oh, it covers the thyroid gland. I think I can ace that part!”

Questions

. Ellie is a -year-old female. Do some research on the average age of onset and any gender diff erences
in Graves’ disease to see if Ellie’s diagnosis is unusual.

. How are beta-blockers like propranolol helpful as an initial treatment for Graves’ disease? Do they
have any eff ect in reducing thyroid hormone levels or do they counter the eff ects of the hormones?

. After Ellie’s diagnosis of Graves’ disease was confi rmed by the uptake test, her endocrinologist
explained several options for long-term treatment, which are listed below. For each treatment, describe
the major advantages and disadvantages.

“It’s Just Stress, Right?” by Sheri L. Boyce Page 

Title block image credit: Licensed photo ©Ustyujanin | Dreamstime.com.
Case copyright © by the National Center for Case Study Teaching in Science. Originally published February ,  at
http://www.sciencecases.org/just_stress/case.asp.
Please see our usage guidelines, which outline our policy concerning permissible reproduction of this case study.

a. Anti-thyroid medications (methimazole, propylthiouracil)—these medications slow the
production of thyroid hormones.

b. Radioactive iodine—a stronger dose of radioactive iodine is given to gradually destroy the thyroid
gland.

c. Surgery—part or all of the thyroid gland is removed.

Anatomy homework help

VOL. 131, NO. 1, JANUARY 2018 OBSTETRICS & GYNECOLOGY e43

Importance of Social Determinants of Health and
Cultural Awareness in the Delivery of Reproductive
Health Care

ABSTRACT: Awareness of the broader contexts that influence health supports respectful, patient-centered
care that incorporates lived experiences, optimizes health outcomes, improves communication, and can help
reduce health and health care inequities. Although there is little doubt that genetics and lifestyle play an important
role in shaping the overall health of individuals, interdisciplinary researchers have demonstrated how the conditions
in the environment in which people are born, live, work, and age, play equally as important a role in shaping health
outcomes. These factors, referred to as social determinants of health, are shaped by historical, social, political,
and economic forces and help explain the relationship between environmental conditions and individual health.
Recognizing the importance of social determinants of health can help obstetrician–gynecologists and other
health care providers better understand patients, effectively communicate about health-related conditions
and behavior, and improve health outcomes.

Recommendations
The American College of Obstetricians and Gynecologists
makes the following recommendations for obstetrician–
gynecologists and other health care providers to improve
patient-centered care and decrease inequities in repro-
ductive health care:

• Inquire about and document social and structural
determinants of health that may influence a patient’s
health and use of health care such as access to stable
housing, access to food and safe drinking water, util-
ity needs, safety in the home and community, immi-
gration status, and employment conditions.

• Maximize referrals to social services to help improve
patients’ abilities to fulfill these needs.

• Provide access to interpreter services for all patient
interactions when patient language is not the clini-
cian’s language.

• Acknowledge that race, institutionalized racism, and
other forms of discrimination serve as social deter-
minants of health.

• Recognize that stereotyping patients based on pre-
sumed cultural beliefs can negatively affect patient
interactions, especially when patients’ behaviors are
attributed solely to individual choices without recog-
nizing the role of social and structural factors.

• Advocate for policy changes that promote safe and
healthy living environments.

Background
Traditional biomedical explanations of disease tend to
focus on biologic and genetic factors as well as indi-
vidual health behavior as determinants of who gets sick
and from what conditions. Although there is little doubt
that genetics and lifestyle play an important role in shap-
ing the overall health of individuals, interdisciplinary
researchers have demonstrated how the conditions in the
environment in which people are born, live, work, and
age, play equally as important a role in shaping health
outcomes (1–5). These factors, referred to as social deter-
minants of health, are shaped by historical, social, politi-
cal, and economic forces and help explain the relationship

ACOG COMMITTEE OPINION
Number 729 • January 2018 (Replaces Committee Opinion Number 493, May 2011)

Committee on Health Care for Underserved Women
This Committee Opinion was developed by the American College of Obstetricians and Gynecologists’ Committee on Health Care for Underserved
Women in collaboration with committee members Carolyn Sufrin, MD, PhD, Autumn Davidson, MD, MS, and Glenn Markenson, MD.

Copyright ª by The American College of Obstetricians
and Gynecologists. Published by Wolters Kluwer Health, Inc.

Unauthorized reproduction of this article is prohibited.

e44 Committee Opinion Importance of Social Determinants of Health OBSTETRICS & GYNECOLOGY

between environmental conditions and individual health
(6). It is well established that social determinants of
health are responsible for a large proportion of health
inequities that exist in the United States. Awareness of the
broader contexts that influence health supports respectful,
patient-centered care that incorporates lived experiences,
optimizes health outcomes, improves communication, and
can help reduce health and health care inequities. Social and
structural factors account for more than one third of total
deaths in the United States in a year, and evidence sug-
gests that addressing social needs of individuals results in
improved overall health (7–9).

Social and Structural Determinants of
Health
Social and structural determinants of health describe
environmental conditions, both physical and social, that
influence health outcomes. Physical conditions such as
lack of access to safe housing, clean drinking water, nutri-
tious food, and safe neighborhoods contribute to poor
health. Socio-political conditions such as institutional
racism; police violence targeting people of color; gender
inequity; discrimination against lesbian, gay, bisexual,
transgender, queer, or questioning (LGBTQ) individu-
als; poverty; lack of access to quality education and jobs
that pay a livable wage; and mass incarceration all shape
behavior and biological processes that ultimately influ-
ence individuals’ health and the health of communities
(5, 10–12). Such social conditions not only influence
individual health but also work to create cycles that per-
petuate intergenerational disadvantage.

Social determinants of health have been shown
to affect many conditions treated by obstetrician–
gynecologists, including but not limited to preterm
birth, unintended pregnancy, infertility, cervical cancer,
breast cancer, and maternal mortality (13). Obstetrician–
gynecologists and other health care providers should
seek to understand patients’ health care decision making
not simply as patients’ individual-level behavior, which
at times may appear foreign or irrational to health care
providers, but rather as the result of larger systems that
create and maintain inequalities in health and health
care. Recognizing the importance of social determinants
of health can help obstetrician–gynecologists and other
health care providers better understand patients, effec-
tively communicate about health-related conditions and
behavior, and improve health outcomes.

The social determinants of health approach also
acknowledges intersectionality—the overlapping catego-
ries of social identities such as gender, race, class, disabil-
ity status, and sexual orientation and related structures of
oppression and discrimination as they manifest in health
care and outcomes. The reproductive justice framework
acknowledges this interconnected nature of social and
structural forces as they come to bear, in part, on people’s
sexual and reproductive health (14). Relatedly, a shared

history and daily experiences of discrimination among
patients of color might negatively influence their health
outcomes and feelings about health care systems (15).
For some, this may be expressed as avoiding care, mis-
trusting health care providers, or not following recom-
mended treatments; this also may be true for LGBTQ
patients seeking sexual and reproductive health care
(16). Immigration status also is a social and structural
determinant of health. For example, an undocumented
immigrant may not access health care because of lack
of coverage, or may fear deportation if she presents to a
health care facility (17, 18).

A patient-centered approach to care recognizes the
role of such historical and contemporary forces in clini-
cal encounters. For example, a pregnant patient with
gestational diabetes who has not checked her blood
sugars may be labeled as irresponsible or noncompliant.
An approach that recognized the effect of social determi-
nants of health may probe deeper and discover that the
patient lacks stable housing and forgets to bring her glu-
cometer each time she moves to another family member’s
or friend’s house. Communicating with this patient about
the importance of blood sugar control as the only strategy
to address glycemic control would be ineffective. Rather,
working with social services to address her housing issues
would more likely enable her to manage her diabetes.

Another example is a pregnant patient with poor
weight gain who is evaluated for medical comorbidities
when deeper probing into the etiology reveals she was
fired from her job and cannot afford enough food for
herself and her two children. Ordering tests or discussing
the importance of good nutrition in pregnancy would
be meaningless if not accompanied by referrals for food
assistance. Another commonly encountered scenario
influenced by social determinants of health is the ability
of patients to arrive at scheduled appointments on time.
Many low-income women rely on often unreliable public
transportation and may arrive late to appointments and
be forced to reschedule, which creates the impression of
nonadherence. Such examples highlight the importance
of inquiry into the underlying reasons for these care
challenges. In fact, asking about certain social factors can
be time-saving in some circumstances and can help to
address systematic barriers to health care. This strategy
has been shown to reduce clinician burnout, decrease
health disparities, and also may reduce health care spend-
ing (19).

Most physicians recognize the importance social
determinants play in health outcomes. In one survey,
85% of physicians felt that patients’ social needs were as
important to address as their medical ones, yet 80% felt
they were not confident in addressing them (20). Indeed,
addressing the root cause of many of these problems
requires wide-reaching, policy-level changes, and most
health care settings are generally under-resourced to
address the social needs of individual patients. However,
tools have been developed to assist clinicians in screening

Copyright ª by The American College of Obstetricians
and Gynecologists. Published by Wolters Kluwer Health, Inc.

Unauthorized reproduction of this article is prohibited.

VOL. 131, NO. 1, JANUARY 2018 Committee Opinion Importance of Social Determinants of Health e45

from a particular country to learn about cultural specifici-
ties of that group, recognize variations within that group,
and understand the overlaying general experience of
being an immigrant.

Instead of “competence,” which mistakenly implies
that culture is a skill that one can master, other ways
to recognize that culture matters in certain clinical
encounters include cultural humility, cultural awareness,
cross-cultural care, and cultural respect (24–26). These
approaches include the clinician being humble about rec-
ognizing the limits of her or his knowledge of a patient’s
situation, avoiding generalizing assumptions, being aware
of clinicians’ and patients’ biases, ensuring mutual under-
standing through patient-centered communication, and
respectfully asking open-ended questions about patients’
circumstances and values when appropriate (27).

Practical Tools
Although attention frequently is focused on reducing
health inequities through public health initiatives and
state and national policies, obstetrician–gynecologists
and other health care providers can have a significant
effect by designing their own clinical practice with
an awareness of the importance of the key social and
structural determinants of health. Even small changes
in practice can make a significant difference with mini-
mal financial sacrifices if deliberate planning is done to
address these determinants. Some changes to consider
include the following:
• Screening for Social Determinants of Health—

Provide patient-completed intake questionnaires,
expanded medical history questions, and integrated
electronic medical records prompts. When purchas-
ing or customizing electronic medical records for the
office, obstetrician–gynecologists and other health
care providers should request structured fields that
capture information on social and behavioral deter-
minants (12, 21, 28, 29) (see Table 1).

• Medical–Legal Partnerships—Obstetrician–gynecologist
practices that are part of a community health care
clinic or network should encourage the facility to
establish medical–legal partnerships. This involves
colocating legal services in the same site as the clinic,
which enables patients to receive assistance with
problems such as toxic environmental exposures
in their homes, access to stable housing, legal aid
for immigration challenges, and other legal matters
that directly affect individuals’ health. Medical–legal
partnerships are available in many federally funded
health care clinics and have been shown to positively
affect health outcomes, including adverse pregnancy
outcomes such as low birth weight (5, 30). Individual
obstetrician–gynecologist practices may not be able
to have such services on location, but relationships
can be developed with existing medical–legal part-
nerships to provide needed services.

for some conditions, such as food insecurity and housing
instability, and to incorporate these questions into elec-
tronic medical records (19, 21). Including social indicator
prompts in physician encounter tools has been shown
to increase referrals to social services (19). Providing
referrals to housing or food services while patients are
in the clinic can improve their health care usage (19).
These and other strategies have been described in an
approach called “structural competency” (5). This frame-
work recognizes that the way society is structured (for
example, through racial, economic, and gender inequali-
ties) influences clinical interactions and health outcomes.
Structural competency aims to help clinicians intervene
on these upstream contributions to disparate health out-
comes, and also to recognize that these structural expla-
nations have limitations and are not comprehensive (5).

Cultural Awareness, Humility, and
Sensitivity
In the 1990s, a concerted recognition emerged among
health care professionals and educators that patients
come from diverse cultural backgrounds that may influ-
ence their understanding of health and illness, interac-
tions with health care providers and institutions, and
engagement with treatment recommendations (22). This
was formalized into the framework of “cultural compe-
tence,” which provided health care professionals with
tools to address cultural differences in their patient care
interactions. It aims, in part, to understand patients’
health-related behaviors as resulting from their cultural
beliefs—beliefs that may influence patients’ health care-
decision making.

Although this approach has elevated discussions of
diversity in health care settings, an over-emphasis on
culture frequently conveys stereotyped representations
of individuals from various ethnic groups while also
overlooking diversity within groups by equating indi-
vidual beliefs with group beliefs (23). Categorizations
like race and class often are reduced to cultural posi-
tions, rather than complex political, social, historical, and
economic phenomena. Moreover, cultural competency
overlooks the cultural dimensions of health care systems
and clinicians themselves. It also suggests that we can
be “competent” in another person’s culture, when cul-
ture itself is not a skill to be mastered. The emphasis on
cultural beliefs thus tends to simplify patients’ behavior
into simple, individual choices, which impedes a deeper
understanding of complex interactions of the social,
economic, political, and environmental circumstances of
patients’ lives.

Despite the limitations of a cultural competence
approach, it is nonetheless critical for health care provid-
ers to recognize that both patients and clinicians hold
their own set of values stemming from individual life
experience and, in some cases, cultural backgrounds. It
may be especially helpful, for instance, for a clinician
working in a locale with a large population of immigrants

Copyright ª by The American College of Obstetricians
and Gynecologists. Published by Wolters Kluwer Health, Inc.

Unauthorized reproduction of this article is prohibited.

e46 Committee Opinion Importance of Social Determinants of Health OBSTETRICS & GYNECOLOGY

small steps can have a significant effect on health out-
comes at the individual level and can help reduce health
inequities at a population level.

For More Information
The American College of Obstetricians and Gynecologists
has identified additional resources on topics related to this
document that may be helpful for ob-gyns, other health
care providers, and patients. You may view these resources
at www.acog.org/More-Info/SocialDeterminants.

These resources are for information only and are not
meant to be comprehensive. Referral to these resources
does not imply the American College of Obstetricians
and Gynecologists’ endorsement of the organization, the
organization website, or the content of the resource. The
resources may change without notice.

• Liaisons with Community-Based Social Needs
Programs—Obstetrician–gynecologists and other
health care providers should develop partnerships
with social workers and local community advocates
who provide assistance with basic resources such as
food pantries and home utility bills. Patients in need
may feel less inhibited from using assistance pro-
grams when the obstetrician–gynecologist frames
the referral letter to the community assistance pro-
gram as a prescription, for example, to promote a
healthy pregnancy. For more details on methods
linking physicians to community social services see
the Health Leads website at www.healthleadsusa.org.

• Interpreter Services—Language barriers can be
partially addressed by having professional inter-
preters available when the patient’s language is not
the clinician’s language (see Committee Opinion
No. 587, Effective Patient–Physician Communica-
tion). In-person interpretation can enhance inter-
personal interactions, but when this is not possible,
using a phone service or video interpretation ser-
vice is a good option with high patient-satisfaction
ratings (31).

• Transportation and Logistics—Underserved popu-
lations often have difficulties obtaining transporta-
tion to health care facilities. Therefore, access to
public transportation should be considered when
planning office locations. In addition, underserved
women often must bring family members to an
office visit. In order to facilitate attendance at health
care appointments, obstetrician–gynecologists and
other health care providers should avoid making
arbitrary rules that prevent children and other family
members from attending office visits.

Conclusion
Social and structural determinants of health affect health
outcomes as much as biological and individual level
factors. Although cultural competency is advocated to
improve patient–health care provider communication
with the ultimate goal of reducing racial and ethnic
inequities in health outcomes, the model has significant
limitations. Obstetrician–gynecologists and other health
care providers should be aware of these limitations and,
rather than solely explain health inequities by cultural
differences, recognize that inequities are largely the result
of forces that influence health at a point upstream from
individual behavior. By understanding these inequities
as manifestations of larger social pathologies, health care
providers may begin to address patient needs in a deeper
and more effective way. Obstetrician–gynecologists and
other health care providers may address social determi-
nants of health by implementing key practices such as
employing multilingual staff, ensuring adequate inter-
preter services, partnering with medical–legal organiza-
tions, and engaging with community resources. These

Table 1. Sample Screening Tool for Social Determinants of
Health 

Domain Question

Food In the last 12 months, did you ever eat
less than you felt you should because
there was not enough money for food?

Utility In the last 12 months, has your utility
company shut off your service for not
paying your bills?

Housing Are you worried that in the next 2 months,
you may not have stable housing?

Child care Do problems getting childcare make it
difficult for you to work, study, or get to
health care appointments?

Financial resources In the last 12 months, have you needed to
see a doctor but could not because of cost?

Transportation In the last 12 months, have you ever had
to go without health care because you did
not have a way to get there?

Exposure to violence Are you afraid you might be hurt in your
apartment building, home, or neighborhood?

Education/health Do you ever need help reading materials
literacy you get from your doctor, clinic, or the
hospital?

Legal status Are you scared of getting in trouble
because of your legal status? Have you
ever been arrested or incarcerated?

Next steps If you answered yes to any of these
questions, would you like to receive
assistance with any of those needs?

Modified from Health Leads. Social needs screening toolkit. Boston (MA): Health
Leads; 2016; and Bourgois P, Holmes SM, Sue K, Quesada J. Structural vulnerabil-
ity: operationalizing the concept to address health disparities in clinical care. Acad
Med 2017;92:299–307.

Copyright ª by The American College of Obstetricians
and Gynecologists. Published by Wolters Kluwer Health, Inc.

Unauthorized reproduction of this article is prohibited.

VOL. 131, NO. 1, JANUARY 2018 Committee Opinion Importance of Social Determinants of Health e47

19. Gottlieb L, Sandel M, Adler NE. Collecting and applying
data on social determinants of health in health care settings.
JAMA Intern Med 2013;173:1017–20. 

20. Robert Wood Johnson Foundation. 2011 physicians daily
life report. 

21. Estabrooks PA, Boyle M, Emmons KM, Glasgow RE,
Hesse BW, Kaplan RM, et al. Harmonized patient-reported
data elements in the electronic health record: supporting
meaningful use by primary care action on health behaviors
and key psychosocial factors. J Am Med Inform Assoc
2012;19:575–82. 

22. Saha S, Beach MC, Cooper LA. Patient centeredness, cul-
tural competence and healthcare quality. J Natl Med Assoc
2008;100:1275–85. 

23. Kleinman A, Benson P. Anthropology in the clinic: the
problem of cultural competency and how to fix it. PLoS
Med 2006;3:e294. 

24. Tervalon M, Murray-Garcia J. Cultural humility versus
cultural competence: a critical distinction in defining physi-
cian training outcomes in multicultural education. J Health
Care Poor Underserved 1998;9:117–25. 

25. Carrillo JE, Green AR, Betancourt JR. Cross-cultural pri-
mary care: a patient-based approach. Ann Intern Med
1999;130:829–34. 

26. National Institutes of Health. Cultural respect. Bethesda
(MD): NIH; 2017. Available at: https://www.nih.gov/
institutes-nih/nih-office-director/office-communications-
public-liaison/clear-communication/cultural-respect.
Retrieved September 12, 2017. 

27. DasGupta S. Narrative humility. Lancet 2008;371:980–1. 
28. Adler NE, Stead WW. Patients in context—EHR capture of

social and behavioral determinants of health. N Engl J Med
2015;372:698–701. 

29. Health Leads. Social needs screening toolkit. Boston (MA):
Health Leads; 2016. 

30. Teufel J, Heller SM, Dausey DJ. Medical-legal partnerships
as a strategy to improve social causes of stress and disease.
Am J Public Health 2014;104:e6–7. 

31. Locatis C, Williamson D, Gould-Kabler C, Zone-Smith L,
Detzler I, Roberson J, et al. Comparing in-person, video,
and telephonic medical interpretation. J Gen Intern Med
2010;25:345–50. 

References
1. Pridan D. Rudolf Virchow and social medicine in historical

perspective. Med Hist 1964;8:274–8. 
2. Kleinman A. Patients and healers in the context of culture:

an exploration of the borderland between anthropology,
medicine, and psychiatry. Berkeley (CA): University of
California Press; 1981. 

3. Link BG, Phelan J. Social conditions as fundamental causes
of disease. J Health Soc Behav 1995;(Spec No):80–94. 

4. Heiman HJ, Artiga S. Beyond health care: the role of
social determinants in promoting health and health equity.
Issue Brief. Menlo Park (CA): Henry J. Kaiser Family
Foundation; 2015. 

5. Metzl JM, Hansen H. Structural competency: theorizing a
new medical engagement with stigma and inequality. Soc
Sci Med 2014;103:126–33. 

6. World Health Organization. Rio political declaration on
social determinants of health. Geneva: WHO; 2011. 

7. Galea S, Tracy M, Hoggatt KJ, Dimaggio C, Karpati A.
Estimated deaths attributable to social factors in the United
States. Am J Public Health 2011;101:1456–65. 

8. Blumenshine P, Egerter S, Barclay CJ, Cubbin C, Braveman
PA. Socioeconomic disparities in adverse birth outcomes: a
systematic review. Am J Prev Med 2010;39:263–72. 

9. Berkowitz SA, Hulberg AC, Standish S, Reznor G, Atlas SJ.
Addressing unmet basic resource needs as part of chronic
cardiometabolic disease management. JAMA Intern Med
2017;177:244–52. 

10. Kim D, Saada A. The social determinants of infant mortal-
ity and birth outcomes in Western developed nations: a
cross-country systematic review. Int J Environ Res Public
Health 2013;10:2296–335. 

11. National Academies of Sciences, Engineering, and
Medicine. A framework for educating health professionals
to address the social determinants of health. Washington,
DC: The National Academies Press; 2016. 

12. Bourgois P, Holmes SM, Sue K, Quesada J. Structural vul-
nerability: operationalizing the concept to address health
disparities in clinical care. Acad Med 2017;92:299–307. 

13. Racial and ethnic disparities in obstetrics and gynecol-
ogy. Committee Opinion No. 649. American College
of Obstetricians and Gynecologists. Obstet Gynecol
2015;126:e130–4. 

14. Gilliam ML, Neustadt A, Gordon R. A call to incorporate a
reproductive justice agenda into reproductive health clini-
cal practice and policy. Contraception 2009;79:243–6. 

15. Premkumar A, Nseyo O, Jackson AV. Connecting
police violence with reproductive health. Obstet Gynecol
2017;129:153–6. 

16. Health care for transgender individuals. Committee
Opinion No. 512. American College of Obstetricians and
Gynecologists. Obstet Gynecol 2011;118:1454–8. 

17. Health care for unauthorized immigrants. Committee
Opinion No. 627. American College of Obstetricians and
Gynecologists. Obstet Gynecol 2015;125:755–9. 

18. Quesada J, Hart LK, Bourgois P. Structural vulnerability
and health: Latino migrant laborers in the United States.
Med Anthropol 2011;30:339–62. 

Copyright January 2018 by the American College of Obstetricians and
Gynecologists. All rights reserved. No part of this publication may be
reproduced, stored in a retrieval system, posted on the Internet, or
transmitted, in any form or by any means, electronic, mechanical,
photocopying, recording, or otherwise, without prior written permis-
sion from the publisher.

Requests for authorization to make photocopies should be directed
to Copyright Clearance Center, 222 Rosewood Drive, Danvers, MA
01923, (978) 750-8400.

The American College of Obstetricians and Gynecologists
409 12th Street, SW, PO Box 96920, Washington, DC 20090-6920

Importance of social determinants of health and cultural awareness
in the delivery of reproductive health care. ACOG Committee Opinion
No. 729. American College of Obstetricians and Gynecologists.
Obstet Gynecol 2018;131:e43–8.

Copyright ª by The American College of Obstetricians
and Gynecologists. Published by Wolters Kluwer Health, Inc.

Unauthorized reproduction of this article is prohibited.

Anatomy homework help

RESEARCH ARTICLE Open Access

Adequacy of control of cardiovascular risk
factors in ambulatory patients with type 2
diabetes attending diabetes out-patients
clinic at a county hospital, Kenya
Mercy W. Kimando1, Frederick C. F. Otieno1* , Elijah N. Ogola1 and Kenn Mutai2

Abstract

Background: Type 2 diabetes is associated with substantial cardiovascular morbidity and mortality arising from the
high prevalence of cardiovascular risk factors such as hypertension, dyslipidaemia, obesity, poor glycaemic control
and albuminuria. Adequacy of control of these risk factors determines the frequency and outcome of cardiovascular
events in the patients. Current clinical practice guidelines emphasize primary prevention of cardiovascular disease in
type 2 diabetes. There is scarce data from the developing countries, Kenya included, on clinical care of patients
with type 2 diabetes in the regions that are far away from tertiary health facilities. So we determined the adequacy
of control of the modifiable risk factors: glycaemic control, hypertension, dyslipidemia, obesity and albuminuria in
the study patients from rural and peri-urban dwelling.

Methods: This was a cross-sectional study on 385 randomly selected ambulatory patients with type 2 diabetes
without overt complications. They were on follow up for at least 6 months at the Out-patient diabetes clinic of
Nyeri County Hospital, a public health facility located in the central region of Kenya.

Results: Females were 65.5%. The study subjects had a mean duration of diabetes of 9.4 years, IQR of 3.0–14 years.
Their mean age was 63.3 years, IQR of 56-71 years.
Only 20.3% of our subjects had simultaneous optimal control of the three (3) main cardiovascular risk factors of
hypertension, high LDL-C and hyperglycaemia at the time of the study. The prevalence of cardiovascular risk factors were
as follows: HbA1c above 7% was 60.5% (95% CI, 55.6–65.5), hypertension, 49.6% of whom 76.6% (95% CI, 72.5–80.8) were
poorly controlled. High LDL-Cholesterol above 2.0 mmol/L was found in 77.1% (95% CI 73.0–81.3) and Albuminuria
occurred in 32.7% (95% CI 27.8–37.4). The prevalence of the other habits with cardiovascular disease risk were: excess
alcohol intake at 26.5% (95% CI 27.8–37.4) and cigarette-smoking at 23.6%.
A modest 23.4% of the treated patients with hypertension attained target blood pressure of <140/90 mmHg. Out of a
paltry 12.5% of the statin-treated patients and others not actively treated, only 22.9% had LDL-Cholesterol of target
<2.0 mmol/L.
There were no obvious socio-demographic and clinical determinants of poor glycaemic control. However, old age above
50 yrs., longer duration with diabetes above 5 yrs. and advanced stages of CKD were significantly associated with
hypertension. Female gender and age, statin non-use and socio-economic factor of employment were the significant
determinants of high levels of serum LDL-cholesterol.
(Continued on next page)

* Correspondence: cfotieno@gmail.com
1Department of Clinical Medicine and Therapeutics, College of Health
Sciences, University of Nairobi, Nairobi, Kenya
Full list of author information is available at the end of the article

© The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Kimando et al. BMC Endocrine Disorders (2017) 17:73
DOI 10.1186/s12902-017-0223-1

(Continued from previous page)

Conclusion: The majority of the study patients attending this government-funded health facility had high prevalence of
cardiovascular risk factors that were inadequately controlled. Therefore patients with type 2 diabetes should be risk-
stratified by their age, duration of diabetes and cardiovascular risk factor loading. Consequently, composite risk factor
reduction strategies are needed in management of these patients to achieve the desired targets safely. This would be
achieved through innovative care systems and modes of delivery which would translate into maximum benefit of
primary cardiovascular disease prevention in those at high risk. It is a desirable quality objective to have a higher
proportion of the patients who access care benefiting maximally more than the numbers we are achieving now.

Background
The prevalence of cardiovascular disease is strikingly in-
creased in persons with diabetes more than those with-
out diabetes [1]. Cardiovascular events make about
eighty (80%) percent of the morbidity and mortality in
the patients with type 2 diabetes [2].
Type 2 diabetes mellitus is often co-morbid with the

cardiovascular risk conditions that include: modifiable
ones, being hypertension, dyslipidemia, obesity, smoking
and poor glycemic control, and the non-modifiable ones
of aging and genes that have been associated with en-
hanced cardiovascular morbidity. The developed world
has experienced improved care and outcomes in patients
with type 2 diabetes but quite a high proportion of
treated patients have not achieved desired targets in glu-
cose, blood pressure and cholesterol control [3].
Sub-Saharan Africa, like the rest of the world, is ex-

periencing an increasing prevalence of diabetes alongside
other non-communicable diseases. The prevalence of
diabetes ranges from.
4.3% in sub-Saharan Africa, 6.7% in Europe, 10.5% in

North America and the Caribbean to 10.9% in the
Middle East and North Africa [4]. These numbers pro-
ject the care demands of people with type 2 diabetes
now and in the future that sub-Saharan Africa may not
be adequately prepared for.
The INTERHEART study, which included participants

from sub-Saharan Africa, identified nine cardiovascular
risk factors, (diabetes, hypertension, dyslipidaemia,
smoking, obesity, unhealthy diet, physical inactivity,
alcohol consumption, psychosocial stresses), that ex-
plained more than 90% of the coronary events in the
study [5]. That the prevalence of cardiovascular risk fac-
tors in type 2 diabetes is high, and the consequences of
clinical events is burdensome to patients, their families,
and society cannot be overemphasized.
Factors that affect optimal control of these risk factors

include access to care, cost of medication and care,
socio- economic factors at national and individual levels
and psychosocial support system [6]. Sustained adequate
cardiovascular risk factor control in a high proportion of
patients with type 2 diabetes remains elusive. Therefore
more studies are needed, especially in resource-

constrained settings, to evaluate the care provision for
Quality Improvement, to determine the proportions of
patients not attaining targets and underlying reasons to
intervene on. This study was conducted to audit the care
provided to patients with type 2 diabetes in the public
health facility.

Methods
Study design and population
This was a cross-sectional study conducted over 4-
month period between December 2014 and March 2015
at the diabetes out-patient clinic in Nyeri level 5
hospital, a public health facility. About 7000 patients
with diabetes (both types 1 and 2, old and new) were
seen in the previous calender year. This was an audit of
the clinical care delivered to the patients with type 2
diabetes at this health facility.
This clinic is held once-weekly on Fridays except on

public holidays. It has dedicated staff of a Medical Offi-
cer, Nurses and an Educator who is a dietitian, but not
specifically trained in diabetes care. Their activities at
the clinic include weight and height measurements,
Blood Pressure determination, and random blood
glucose (after the patient has paid for this test). There
are only a very small number of patients who perform
self-monitoring of blood glucose. Diabetes Education for
Self-Management is offered to the clinic attendees as a
group, individual approach is only an occasional
encounter.
The participants targeted were patients with file diag-

nosis of type 2 diabetes, previously diagnosed the stand-
ard way by the primary physician. The patients were
randomly selected from amongst the clinic attendees of
the day. Those included in the study were aged 30 years
and above, on follow-up for at least 6 months, on either
oral anti-diabetic medication alone or in combination
with insulin or diet-only. The flow chart, Fig. 1, below
depicts the enrolment process.

Ethics, consent and approval
The study was approved by the Depart of Clinical
Medicine and Therapeutics and the Ethics Review
Committees of UoN/KNH and of the Nyeri County

Kimando et al. BMC Endocrine Disorders (2017) 17:73 Page 2 of 11

hospital. Full explanation was given to the eligible pa-
tient and informed written consent was obtained from
each subject before enrolment (Fig. 2).

Study assessments and clinical methods
A complete history was taken from each study partici-
pant for socio-demographic information, relevant clin-
ical information on the diabetes mellitus including its
treatment and any hypertension or cardiovascular
disease. Social habits of alcohol intake and cigarette
smoking were documented. The age was verified with
patient’s national identity card. The marital status was
recorded as reported by the study patient. The last pre-
scription and/or the file notes of the last review was
used to corroborate the treatment information. Full
clinical examination was performed.
Blood pressure was measured by the doctor after the

study participant had rested for about 10-min from the
time of arrival. While seated with the arm in a

comfortable position at the level of the heart, systolic
blood pressure was taken at the 1st Korotkoff sound and
the diastolic blood pressure taken at the disappearance
of Korotkoff sound on a manual mercury sphygmoman-
ometer, both values were measured to the nearest
mmHg. The presence of hypertension was taken at BP
≥140/90 mmHg, as classified per JNC 8 [7]. Waist and
Hip circumferences were measured in centimeters on
the transverse plane at the level of the narrowest part of
torso between the lowest rib and the top of pelvis as
seen on the anterior view at the end of normal expir-
ation for waist circumference. This was at the level of
greater trochanter on the transverse plane for hip cir-
cumference. Waist hip ratio (WHR) was calculated as a
ratio of Waist Circumference to Hip Circumference [8]
and classified as per the NCEP/ATP III guidelines re-
spectively [9]. Height was measured on the patient
standing without shoes, the back against the wall on
tape, to the nearest ten centimeter. Weight was taken on

Fig. 1 A flow chart of subject recruitment, enrolment into and activities in the study

Fig. 2 Bar Chart depicting selected Cardiovascular Risk Factors in control and the number at risk amongst the study subjects

Kimando et al. BMC Endocrine Disorders (2017) 17:73 Page 3 of 11

an electronic weighing machine to the nearest 0.5 kg.
Body mass index (BMI) was calculated as weight in
kilograms divided by height in meters squared and
classified [10].

Laboratory methods
The patients were advised to come to the diabetes clinic
day, every Friday morning fasted. An 8 ml- venous blood
sample was asceptically drawn from the cubital fossa. A
six (6) ml-sample was collected in clot-activated vacutai-
ners for serum lipid profile and the remaining 2 ml-sam-
ple into EDTA vacutainer for HbA1c determination. The
samples were stored in cool boxes with dry ice carbon
dioxide at 2 to 8 °C, then delivered to the laboratory of
the University’s Department of Clinical medicine for as-
says later. HBA1c was processed by glycohemoglobin
ion exchange resin method from ERBA MANNHEIM
Gmbh at the laboratory. HbA1c > 7.0% was considered
sub-optimal control.
Lipid profile was analyzed using Human Gmbh kit.

Total cholesterol was measured using the CHOD-PAP
method based on Trinders Methodology, a calorimetric,
enzymatic test for cholesterol with lipid clearing factor.
HDL cholesterol was measured using human cholesterol
liqui-color Phosphatungstic Acid method, end-point kit.
Triglycerides were measured using GPO-PAPA
METHOD, a colorimetric, enzymatic method with glyc-
erophosphate oxidase. LDL-cholesterol was computed
from the formula: [LDL-chol] = [Total chol] – [HDL-
chol] – ([TG]/2.2) where all concentrations are given in
mmol/L. LDL-Cholesterol above 2.0 mmol/L was con-
sidered high.

Urinary albumin
Creatinine ratio was determined using the CLINITEK
Microalbuminuria reagent strips. CLINITEK Microal-2
Strips provided albumin-to-creatinine ratio results in
one minute once the strip was placed in an analyzer
after being dipped in urine. Estimated glomerular filtra-
tion rate was calculated on Cockroft-Gault formula [11].

Data management and statistics
The data collected were entered into a spreadsheet and
cleaned before analysis. Statistical analysis was done in
SPSS version 21.0. Descriptive data such as socio-
demographic (age, gender, marital status, level of
education and employment status) and clinical character-
istics (treatment information, Blood Pressure, categories
of metabolic control) were summarized into percentages
and means/medians. Prevalence of cardiovascular risk
factors were presented as proportions of the total number
of patients studied or with the risk factor. In addition,
variables associated with the cardiovascular risk factors
were analyzed. All the associations/comparisons were

determined using Chi-square/Fisher’s exact test for cat-
egorical variables and Student t-test for comparison of
means. Odds ratios at 95% confidence intervals (CIs) were
calculated as estimates of relative risks of having poor
control of cardiovascular risk factors among patients. Lo-
gistic regression model was used to determine independ-
ent predictors. Statistical significance was interpreted at a
p-value of less than 0.05.

Results
We enrolled 385 patients with type 2 diabetes into the
study. The baseline characteristics are presented in the
Tables 1, 2, 3 and 4. The key cardiovascular risk factors
were: Hypertension, Obesity, high LDL-cholesterol,
Hyperglycaemia and Albuminuria.
There was predominance of female subjects at 65.5%,

with mean age 62.1 (12.0) years, younger than the males
with 65.7 (11.8) years. The females had a relatively
modest formal education, where about 80% of them had
either no education or primary level (less or equal to
7 years in school) compared to 54.9% of the males with
the same.
Almost half of our study population, 49.6% had hyper-

tension and 69.4% of them were on either Angiotensin
Receptor Blocker (ARBs) or Angiotensin Converting
Enzyme Inhibitors (ACEis), 63.0% on Calcium channel
blockers (CCBs) and 47.8% on a diuretic. Note that there
were patients on combinations, CCBs with either ARBs
or with ACEis or with diuretics. There were no gender
differences.
Regarding treatment of hyperglycaemia, the majority,

68.1% of the study patients were on oral agents only and
12.0% were using combined oral agents with insulin. Just
17.1% were on insulin-only therapy. Glycaemia control
was optimal in 39.5%.There were no significant differ-
ences in quality of glycaemic control between males and
females.
Concerning lipid profile, most patients, 79.2% had nor-

mal HDL, 54.5% had high triglycerides and 77.1% had
high LDL-cholesterol. Females had higher serum levels
of LDL–Cholesterol and total cholesterol than the males.
Thirty two (32.7%) percent had albuminuria.
Using the body mass index, 40% were overweight

(BMI 25.0–29.9 kg/m2) while 22.3% were obese (BMI ≥
30.0.kg/m2). Other measures of obesity of waist-hip ratio
and waist circumference gave different prevalence of
obesity, 92.7% and 58.2% respectively. The body habitus
of high waist circumference meant more abdominal em-
phasis in most of the study subjects. The physical activ-
ity of the study subjects was not quantified in this study.

Discussion
The burden of type 2 diabetes in sub-Saharan Africa is
rising and expected to multiply further, [7] consequently

Kimando et al. BMC Endocrine Disorders (2017) 17:73 Page 4 of 11

their health sector will face an increasing case-loads of
cardiovascular morbidities attributable to diabetes in
years to come. The objective of this study was to audit
the care of patients with type 2 diabetes attending an
out-patient clinic in a public hospital.
There were more females, 65.5% in our study, prob-

ably reflecting gender-related health-seeking behavior in
Kenya because prevalence of type 2 diabetes in Kenya,

Table 1 Clinical and laboratory characteristics of the study
subjects

Variable Frequency (%)

BMI, mean (SD), kg/m2 26.7 (4.6)

Categories, n (%)

Underweight (<18.5) 6 (1.6)

Normal (18.5–25) 139 (36.1)

Overweight (25–29.9) 154 (40.0)

Obese (≥30) 86 (22.3)

Blood Pressure (BP) mmHg

Hypertensive, BP > 140/90 mmHg
or on treatment

191 (49.6)

Normal BP 194 (50.4)

Hypertension treatment, Users,

ACEi’s/ARBs 132 (69.4)

Calcium channel blocker(CCBs) 120 (63.0)

Diuretics(thiazides, Spironolactone,
Furosemide)

90 (47.8)

Glucose-lowering treatment

Diet-only 11 (2.9)

Oral Glucose-lowering
Agents(OGLAs)-only

262 (68.1)

Insulin-only 66 (17.1)

Combined Oral Glucose-lowering
Agents and Insulin

46 (12.0)

Glycemic control

Mean HbA1c, % 8.3(3.0)

Poor (HbA1c > 7%) 233 (60.5)

Good (HbA1c ≤ 7%) 152 (39.5)

Total cholesterol, mean (SD), mmol/L 4.6 (1.2)

Categories, n (%)

High ≥4.12 88 (22.9)

Normal, <4.12 297 (77.1)

HDL, mean (SD), mmol/L 1.3 (0.9)

Categories, n (%)

Low ≤1.00 80 (20.8)

Normal >1.00 305 (79.2)

Triglycerides, mean (SD), mmol/L 1.7 (1.0)

Categories, n (%)

High, >1.7 210 (54.5)

Normal ≤1.7 175 (45.5)

LDL, mean (SD), mmol/L 2.4 (0.9)

Categories, n (%)

High, >2.0 297 (77.1)

Normal ≤2.0 88 (22.9)

Albuminuria

Albuminuria 126 (32.7)

Normal 259 (67.3)

The socio-demographic characteristics of the 385 patients who were
included in the study are shown in Table 2 below

Table 2 Socio-Demographic characteristics of the study
patients

Variable Overall
n = 385(100%)

Female
n = 252(65.5%)

Male
n = 133(34.5%)

Mean age (SD) years 63.3 (12.1) 62.1 (12.0) 65.7 (11.8)

Marital status

Married 258(67.7) 138 (54.8) 120 (45.2)

Separated 3(0.8) 2 (0.8) 1 (0.8)

Single, unmarried 22(5.7) 19 (7.5) 3 (2.3)

Widowed 102 (26.5) 93 (36.9) 9 (6.8)

Level of Formal Education

None 51 (13.2) 48 (19.0) 3 (2.3)

Primary (1–7 years
in school)

227 (59.0) 157 (62.3) 70 (52.6)

Secondary
(8–12 years)

90 (23.4) 40 (15.9) 50 (37.6)

Tertiary (above
12 years)

17 (4.4) 7 (2.8) 10 (7.5)

Employment Status

Employed 172(44.7) 123(48.8) 49(36.8)

Unemployed 213(55.3) 129(51.2) 84(63.2)

There was a female preponderance at 65.5% and more than 70% of them had
either no formal education or a modest one of primary school level

Table 3 Prevalence of selected cardiovascular risk factors in the
study subjects

Cardiovascular Risk Factors Prevalence 95% CI

Poor Glycemic control, HbA1c ›7.0% 60.5% 55.6–65.5

Poorly controlled Hypertension,
BP ≥ 140/90 mmHg

76.6% 72.5–80.8

LDL Cholesterol, >2.0 mmol/L 77.1% 73.0–81.3

Obesity, BMI ≥30 kg/m2 22.3% 18.4–26.5

Obesity, Waist Circumference 58.2% 53.5–62.9

>102 cm males

> 88 cm females

Obesity, Waist – Hip Ratio 92.7% 89.9–95.3

>0.9 males

>0.8 females

Albuminuria 32.7% 27.8–37.4

Cigarette-smoking, self-reported 23.6%. 19.9–28.5

The prevalence of uncontrolled hypertension, high LDL-Cholesterol and
obesity (by WHR) was high, above 75% as shown in the table above

Kimando et al. BMC Endocrine Disorders (2017) 17:73 Page 5 of 11

T
a
b
le

4
Lo
g
is
ti
c
re
g
re
ss
io
n
o
f
fa
ct
o
rs
in
flu
en

ci
n
g
th
e
ca
rd
io
va
sc
u
la
r
ris
k
fa
ct
o
r
co
n
tr
o
l
in

th
e
st
u
d
y
su
b
je
ct
s

Va
ria
b
le

G
ly
ce
m
ic
co
n
tr
o
l

H
yp
er
te
n
si
o
n

LD
L-
C
h
o
le
st
er
o
l

Sm
o
ki
n
g

Po
o
r
co
n
tr
o
l

O
R
(9
5%

C
I)

P
va
lu
e

H
yp
er
te
n
si
ve

O
R
(9
5%

C
I)

P
va
lu
e

H
ig
h
LD

L
O
R
(9
5%

C
I)

P
va
lu
e

Sm
o
ke
r

O
R
(9
5%

C
I)

P
va
lu
e

A
g
e >
50

ye
ar
s

19
8
(5
9.
8)

0.
8
(0
.4

1.
5)

0.
48
6

16
5(
49
.8
)

4.
7
(2
.6

8.
5)

<
0.
00
1

25
1
(7
5.
8)

0.
5
(0
.2

1.
2)

0.
12
9

84
(2
5.
4)

2.
0
(0
.9

4.
3)

0.
09
1

<
=
50

ye
ar
s

35
(6
4.
8)

1.
0

26
(4
8.
1)

1.
0

46
(8
5.
2)

1.
0

8
(1
4.
8)

1.
0

G
en

d
er

Fe
m
al
e

15
4
(6
1.
1)

1.
1
(0
.7

1.
6)

0.
74
4

11
9
(4
7.
2)

0.
8
(0
.5

1.
2)

0.
19
7

20
6
(8
1.
7)

2.
1
(1
.3

3.
4)

0.
00
3

2
(0
.8
)

0.
0
(0
.0
0–
0.
02
)

<
0.
00
1

M
al
e

79
(5
9.
4)

1.
0

72
(5
4.
1)

1.
0

91
(6
8.
4)

1.
0

90
(6
7.
7)

1.
0

M
ar
it
al
st
at
u
s

M
ar
rie
d

15
3
(5
9.
3)

1.
0

13
2
(5
1.
2)

1.
0

19
8
(7
6.
7)

1.
0

83
(3
2.
2)

1.
0

Se
p
ar
at
ed

2
(6
6.
7)

1.
4
(0
.1

15
.3
)

0.
79
7

2
(6
6.
7)

1.
9
(0
.2

21
.3
)

0.
59
9

2
(6
6.
7)

0.
6
(0
.1

6.
8)

0.
68
5

1
(3
3.
3)

1.
1
(0
.1

11
.8
)

0.
96
6

Si
n
g
le
,u
n
m
ar
rie
d

16
(7
2.
7)

1.
8
(0
.7

4.
8)

0.
22
2

9
(4
0.
9)

0.
7
(0
.3

1.
6)

0.
35
9

19
(8
6.
4)

1.
9
(0
.5

6.
7)

0.
30
7

2
(9
.1
)

0.
2
(0
.0

0.
9)

0.
03
9

W
id
o
w
ed

62
(6
0.
8)

1.
1
(0
.7

1.
7)

0.
79
6

48
(4
7.
1)

0.
8
(0
.5

1.
.3
)

0.
48
3

78
(7
6.
5)

1.
0
(0
.6

1.
7)

0.
95
6

6
(5
.9
)

0.
1
(0
.1

0.
3)

<
0.
00
1

Ed
u
ca
ti
o
n

N
o
n
e

31
(6
0.
8)

1.
0

27
(5
2.
9)

1.
0

41
(8
0.
4)

1.
0

3
(5
.9
)

1.
0

Pr
im

ar
y

13
8
(6
0.
8)

1.
0
(0
.5

1.
9)

0.
99
9

11
2
(4
9.
3)

0.
9
(0
.5

1.
6)

0.
64
2

17
9
(7
8.
9)

0.
9
(0
.4

1.
9)

0.
80
7

49
(2
1.
6)

4.
4
(1
.3

14
.7
)

0.
01
6

Se
co
n
d
ar
y

54
(6
0.
0)

1.
0
(0
.5

2.
0)

0.
92
7

45
(5
0.
0)

0.
9
(0
.4

1.
8)

0.
73
7

69
(7
6.
7)

0.
8
(0
.3

1.
9)

0.
60
8

35
(3
8.
9)

10
.2
(2
.9

35
.2
)

<
0.
00
1

Te
rt
ia
ry

10
(5
8.
8)

0.
9
(0
.3

2.
8)

0.
88
6

7
(4
1.
2)

0.
6
(0
.2

1.
9)

0.
40
3

8
(4
7.
1)

0.
2
(0
.1

0.
7)

0.
01
1

5
(2
9.
4)

6.
7
(1
.4

31
.9
)

0.
01
7

Em
p
lo
ym

en
t
st
at
u
s

U
n
em

p
lo
ye
d

78
(6
2.
4)

1.
0

65
(5
2.
0)

1.
0

95
(7
6.
0)

1.
0

15
(1
2.
0)

1.
0

Em
p
lo
ye
d

14
(6
0.
9)

0.
9
(0
.4

2.
3)

0.
88
9

8
(3
4.
8)

0.
5
(0
.2

1.
2)

0.
13
4

17
(7
3.
9)

0.
9
(0
.3

2.
5)

0.
83
0

4
(1
7.
4)

1.
5
(0
.5

5.
2)

0.
48
0

Se
lf-
em

p
lo
ye
d

88
(5
9.
1)

0.
9
(0
.5

1.
4)

0.
57
3

69
(4
6.
3)

0.
8
(0
.5

1.
3)

0.
34
8

12
4
(8
3.
2)

1.
6
(0
.9

2.
8)

0.
13
9

27
(1
8.
1)

1.
6
(0
.8

3.
2)

0.
16
4

Re
ti
re
d

53
(6
0.
2)

0.
9
(0
.5

1.
6)

0.
74
8

49
(5
5.
7)

1.
2
(0
.7

2.
0)

0.
59
6

61
(6
9.
3)

0.
7
(0
.4

1.
3)

0.
27
9

46
(5
2.
3)

8.
0
(4
.1

15
.9
)

<
0.
00
1

A
lc
o
h
o
l

Ye
s

63
(6
1.
8)

1.
1
(0
.7

1.
7)

0.
76
4

56
(5
4.
9)

1.
3
(0
.8

2.
1)

0.
21
3

70
(6
8.
6)

0.
5
(0
.3

0.
9)

0.
01
7

80
(7
8.
4)

82
.1
(3
8.
9–
17
3.
2)

<
0.
00
1

N
o

17
0
(6
0.
1)

1.
0

13
5
(4
7.
7)

1.
0

22
7
(8
0.
2)

1.
0

12
(4
.2
)

1.
0

D
u
ra
ti
o
n
o
f
d
is
ea
se

>
5
ye
ar
s

13
3
(6
1.
0)

1.
1
(0
.7

1.
6)

0.
72
9

10
8
(8
1.
7)

2.
0
(1
.2

3.
3)

0.
00
4

17
5
(8
0.
3)

1.
4
(0
.9

2.
3)

0.
14
3

48
(2
2.
0)

0.
9
(0
.6

1.
5)

0.
72
4


5
ye
ar
s

10
3
(5
9.
2)

1.
0

83
(6
8.
8)

1.
0

11
6
(7
3.
9)

1.
0

37
(2
3.
6)

1.
0

O
b
es
it
y

O
b
es
e,
BM

I≥
30

kg
/m

2
58

(6
7.
4)

1.
5
(0
.9

2.
4)

0.
13
6

46
(5
3.
5)

1.
2
(0
.8

2.
0)

0.
41
4

65
(7
5.
6)

0.
9
(0
.5

1.
6)

0.
69
6

15
(1
7.
4)

0.
6
(0
.3

1.
1)

0.
11
1

Kimando et al. BMC Endocrine Disorders (2017) 17:73 Page 6 of 11

T
a
b
le

4
Lo
g
is
ti
c
re
g
re
ss
io
n
o
f
fa
ct
o
rs
in
flu
en

ci
n
g
th
e
ca
rd
io
va
sc
u
la
r
ris
k
fa
ct
o
r
co
n
tr
o
l
in

th
e
st
u
d
y
su
b
je
ct
s
(C
on

tin
u
ed
)

Va
ria
b
le

G
ly
ce
m
ic
co
n
tr
o
l

H
yp
er
te
n
si
o
n

LD
L-
C
h
o
le
st
er
o
l

Sm
o
ki
n
g

Po
o
r
co
n
tr
o
l

O
R
(9
5%

C
I)

P
va
lu
e

H
yp
er
te
n
si
ve

O
R
(9
5%

C
I)

P
va
lu
e

H
ig
h
LD

L
O
R
(9
5%

C
I)

P
va
lu
e

Sm
o
ke
r

O
R
(9
5%

C
I)

P
va
lu
e

N
o
t
o
b
es
e,
BM

I‹3
0
kg
/
m

2
17
5
(5
8.
5)

1.
0

14
5
(4
8.
5)

1.
0

23
2
(7
7.
6)

1.
0

77
(2
5.
8)

1.
0

C
KD

/K
D
IG
O
st
at
u
s

St
ag
es

3,
4
an
d
5

86
(5
7.
3)

0.
8
(0
.5

1.
2)

0.
30
7

91
(6
0.
7)

2.
1
(1
.4

3.
2)

0.
00
1

11
6
(7
7.
3)

1.
0
(0
.6

1.
7)

0.
94
3

38
(2
5.
3)

1.
1
(0
.7

1.
8)

0.
59
7

St
ag
es

1
an
d
2

14
7
(6
2.
6)

1.
0

10
0
(4
2.
6)

1.
0

18
1
(7
7.
0)

1.
0

54
(2
3.
0)

1.
0

In
th
is
lo
g
is
ti
c
re
g
re
ss
io
n
,
th
e
va
ri
ab

le
s
w
er
e
in
d
ep

en
d
en

tl
y
an

al
yz
ed

fo
r
th
e
se
p
ar
at
e
ca
rd
io
va
sc
u
la
r
ri
sk

fa
ct
o
rs

b
u
t
p
re
se
n
te
d
o
n
a
si
n
g
le

ta
b
le
.T
h
e
O
d
d
s
R
at
io
s
ar
e
u
n
ad

ju
st
ed

Kimando et al. BMC Endocrine Disorders (2017) 17:73 Page 7 of 11

like the study of Ayah R. and Wanjiru R. et al., in Kibera,
Nairobi [12], did not show any gender difference in
prevalence of diabetes.
Our patients were mainly from rural dwelling, had low

formal education where only 27.8% had attained second-
ary education and above, in favour of males. The gener-
ation of our study population, mean age of 63.3 years,
was born in the pre-independent Kenya, when most
people did not attend school. Although most of them
lacked formal education, they reported self-employment
with relative socio-economic stability.
Social determinants of disease in people are important.

Socio-economic stability notwithstanding, formal
education has a bearing on health literacy. A strong as-
sociation between low formal education and worse
health literacy has been demonstrated in some studies
[13, 14], which may translate into poor health status
[15]. Socio-economic position influences access to care,
healthcare behaviour and processes of care [16]. Over
86% of our patients had visited the clinic 3–4 times in
the previous 12 months, meaning they had access to
care. It is uncertain how many visits to healthcare
provider would be sufficient in a 12-month period in
chronic care but the hospital’s capacity to offer quality
healthcare also counts. Overall, this study registered low
proportions of subjects with desired levels of control of:
glycaemia of HbA1c ≤7% at 39.5%, Blood pressure < 140/
90 mmHg was 23.4%, and Low density lipoprotein
cholesterol (LDL-C), ≤2.0 mmol/L was 22.9%. Access to
care is better in the County hospitals but the quality of
care still falls below expectations. The SMBG is curtailed
by frequent changes in glucometer types and their strips
from suppliers [17].
The mean HbA1c was 8.2%, with a predominance of

poor glycaemic control. The study patients had had dia-
betes for more than 5 years (mean duration of diabetes
of 9.4 years), but only 29% were on insulin therapy,
either in combination or as sole therapy, suggesting that
the glucose-lowering treament may not have been inten-
sified. Clinical inertia [18] of care providers and poor
adherence to therapies by patients [19, 20] are docu-
mented contributors to poor glycaemic control amongst
patients with diabetes. We found no predictor of
glycaemic control amongst the factors analyzed. In our
local context, poor adherence is usually occasioned by
circumstances of lack of medications in the public
hospital and inability of the patients to afford them else-
where in private pharmacies [17]. Though we did not
assess adherence, it was evident that some of our
patients were not taking medications prescribed but not
available/dispensed in the hospital pharmacy.
Almost half, 49.6% of the study subjects had hyperten-

sion, only 33.4% of the treated patients were on target at
the time of evaluation. The subjects with hypertension

were older (64 yrs. versus 58 yrs), had diabetes for longer
and a significant proportion at higher stages (3, 4, 5) of
CKD than those without hypertension. The mean sys-
tolic and diastolic blood pressures were 143.6 mmHg
and 81.4 mmHg respectively. Over two-th

Anatomy homework help

Rubric #2 Country/Community Selection (M2-A1)

Area
15 points

Accomplished Proficient Needs Work

Identification of
country & why

3 points

*Identifies the country
or community
*Explains why the
specific
country/community
chosen

*Identifies the country
or community
*Superficial
explanation of choice

*Identifies the country
or community
*No explanation of
choice

Identifies health issues
in chosen
country/community

2 points

*Identifies several
health issues

*Does not identify
health issues

*Does not identify
health issues

Choice of health issue

3 points

*Identifies a specific
health issue
*Explain why this issue
chosen

*Identifies a specific
health issue
*Superficial
explanation of choice

*Identifies specific
issue
*Does not explain the
choice

Issue is a concern

5 points

*Explains why the issue
is a concern in the
country/community
*Provides strong
support for the
explanation

*Explains why the issue
is a concern in the
country/community
*Little support for the
explanation

*Attempts to explain
why the issue is a
concern in the
country/community
*Minimal or no support
for the explanation

Technical aspects

2 points

*No APA errors
*No MUGS errors

*No more than two (2)
APA errors
*No more than two (2)
MUGS errors

*More than two (2)
APA errors
*More than two (2)
MUGS errors

Interpretation of points: Accomplished 15.00 – 13.01 points
Proficient 13.00 – 10.50 points
Needs Work Less than 10 points

Anatomy homework help

The fourth and final paper (CP4) will be your entire capstone paper. It will combine the first three papers, and also include an introduction, conclusion, references, and inclusion of subheadings or transition writing necessary to incorporate your previous works. It should also include the changes and edits I’ve suggested for your prior 3 papers.

Anatomy homework help

11/11/2020 Unit 8 Assignment – Presentation

https://herzing.instructure.com/courses/14201/assignments/376314?module_item_id=809774 1/3

Points

Submitting

Locked: Content, Points & Availability Dates

Unit 8 Assignment – Presentation

75

a text entry box, a website url, a media recording, or a file upload

Due For Available from Until

Dec 21 at 11:59am Everyone – –

Unit 8 Assignment – Presentation

Locked

 Published  Edit 

No Content

11/11/2020 Unit 8 Assignment – Presentation

https://herzing.instructure.com/courses/14201/assignments/376314?module_item_id=809774 2/3

Criteria Ratings Pts

22.5 pts

18.75 pts

15.0 pts

3.75 pts

3.75 pts

Content 22.5 pts
Level 5
Accurate and
complete
explanation of key
concepts drawing
upon relevant
literature. Listeners
able to develop an
understanding of
the material.

20.25 pts
Level 4
For the most
part,
explanations of
concepts are
accurate and
complete.
Listeners gain
good knowledge
of the topic.

18.0 pts
Level 3
Explanations of
concepts are
accurate, but
needs
improvement.
Listeners gain
some
knowledge from
the topic.

15.75 pts
Level 2
Explanations of
concepts are
somewhat
inaccurate and
incomplete.
Listeners gain
minimal new
insights.

13.5 pts
Level 1
Explanation
of concepts
are
inaccurate
and
incomplete.
Listeners
gain no new
insights.

0.0 pts
Level 0
Not
submitted.

Fact Sheet 18.75 pts
Level 5
Presenter’s graphics
explain and reinforce
screen text and
presentation.

17.0 pts
Level 4
Presenter’s graphics
explain and relate to
screen text and
presentation.

15.25 pts
Level 3
Presenter’s
graphics
support text
and
presentation.

13.5 pts
Level 2
Presenter’s
graphics are
unrelated to
topic.

11.75 pts
Level 1
No
graphics
included.

0.0 pts
Level 0
Not
submitted.

System Demo/Role Play 15.0 pts
Level 5
Appropriate to topic,
clearly
representative of
topic, creative,
accurate
representation of
topic.

8.0 pts
Level 4
Aspects
there, but not
excellent. All
elements of
topic
present.

4.0 pts
Level 3
Elements
mostly
present, but
not clear or
easily
followed.

2.0 pts
Level 2
Elements
somewhat
present, but not
clear or easily
followed. Need
more details.

1.0 pts
Level 1
Unclear,
unable to
follow, not
representative
of topic.

0.0 pts
Level 0
Role play
was not
present in
the
presentation.

Organization 3.75 pts
Level 5
Information in
logical,
interesting
sequence
which
audience can
follow. Ideas
well
reinforced
with relevant
examples.

3.4 pts
Level 4
Information
in logical
sequence
which
audience
can follow.
Could use
better
examples to
support
ideas.

3.0 pts
Level 3
Audience has
some
difficulty
following
presentation/
information.
Needs better/
supportive
examples.

2.7 pts
Level 2
Audience has
difficulty
following
presentation/
information.
Needs better/
supportive
examples.

2.4 pts
Level 1
Audience cannot
understand
presentation/information,
because there is no
consistent flow of
information.

0.0 pts
0
Organization
needs major
revisions.
There is no
flow of
information.

Visual Aids

PowerPoints
other props (besides the
required one)

3.75 pts
Level 5
At least one,
appropriate and
excellent visual aid
–fully reinforces
presentation.

3.4 pts
Level 4
One, good visual
aid. Appropriate
and at least
represents topic of
presentation.

3.0 pts
Level 3
One or more visual
aid, but average
representation of
topic of
presentation.

2.7 pts
Level 2
One visual aid
but poor
representation
of topic of
presentations

2.4 pts
Level 1
No
visual
aids.

0.0 pts
Level 0
Not
submitted.

11/11/2020 Unit 8 Assignment – Presentation

https://herzing.instructure.com/courses/14201/assignments/376314?module_item_id=809774 3/3

Total Points: 75.0

Criteria Ratings Pts

3.75 pts

3.75 pts

3.75 pts

Documentation/Citations 3.75 pts
Level 5
All sources
of facts and
examples
fully
documented.

3.4 pts
Level 4
Most
sources of
facts and
examples
documented.

3.0 pts
Level 3
Sources of
facts and
examples
partially
documented.

2.7 pts
Level 2
Sources of facts
and examples
partially
documented. Some
issues with the
documentation.

2.4 pts
Level 1
Sources of facts
and examples
partially
documented.
Several issues with
documentation.

0.0 pts
Level 0
No sources
of facts and
examples
documented.

Speaking Skills 3.75 pts
Level 5
Poised,
articulate;
proper
volume;
steady rate;
good
posture and
eye contact;
enthusiasm;
confidence.
Proper and
consistent
use of
medical
terminology,
concepts,
terms
pronounced
properly.

3.4 pts
Level 4
Clear
articulation but
not as
polished.
Some
inconsistencies
with volume,
rate, posture.
Good eye
contact and
enthusiasm
use of medical
terminology,
concepts,
terms
pronounced
properly.

3.0 pts
Level 3
Student uses
some verbal
fillers (“Uh, you
know, hmm, I
mean, It’s
like”). Hardly
any
mispronounced
words.
Moderate eye
contact and
enthusiasm.

2.7 pts
Level 2
Inaudible or too loud; no
eye contact; rate too
slow/fast;
disinterested/monotone.
Student uses excessive
verbal fillers (“Uh, you
know, hmm, I mean, It’s
like”) and
mispronounced words,
inappropriate use of
medical terminology.

2.4 pts
Level 1
Speaking
skills need
attention.
Several
issues with
speaking in
front of
others for
the
presentation.

0.0 pts
Level 0
Did not
make it
through the
presentation
or did not
present.

Dress 3.75 pts
Level 5
Business
professional attire: –
Men: Suit, Dress
shirt, tie, dress shoes
-Women: Business
suit (skirt or slacks),
1-3 inch heeled
business shoes,
softly / not excessive
jewelry (accessories)
-(skirt length: mid-
knee or below, no
deep slits) -no visible
piercings (except for
earrings) or tattoos –
well-groomed and
neat

3.4 pts
Level 4
Mostly
business
professional
attire.

3.0 pts
Level 3
Business casual: –
Men: Long sleeve,
tie, dress shoes –
Women: Slacks,
Skirts, blouses,
business shoes,
appropriate/soft
jewelry
(accessories) –
(skirt length: no
shorter than 4”
above knee, no
deep slits) – no
visible piercings
(except for
earrings) or tattoos
– well-groomed and
neat

2.7 pts
Level 2
Herzing
Uniform
Khakis /
Polos
Tennis
shoes
Appropriate
to outfit
shoes

2.4 pts
Level 1
Inappropriate
dress.
Examples
include:
Message t-
shirt and
jeans, hat or
caps for men
and women,
scrubs,
inappropriate
length skirts,
slits, stilettos,
flip-flops,
shorts

0.0 pts
Level 0
Completely
inappropriate
dress.

Anatomy homework help

1. Imagine you are a physician preparing a talk detailing the impact of obesity on the respiratory and digestive systems. Prepare a written paper of at least 1000 words that examines the following bullet points:

a. What regulatory mechanisms (both physical and chemical) help maintain homeostasis in the respiratory and digestive systems?

b. How does excess weight cause imbalances that result in medical conditions?

c. What are the physiological impacts of the three different types of bariatric surgeries (gastric band, gastric sleeve, and gastrointestinal bypass)?

Your paper should be formatted as a proper research paper with an introduction and conclusion. Do not simply follow the bullet points above, but really think about what you have learned and how that relates to other material we have covered, and knowledge you have from other courses you may have taken. The Research and Report assignments in this course are capstone assignments for each module

All references must be cited using APA Style format

Anatomy homework help

Image credit: “Haitian women sit on rubble from a collapsed building in Port-au-Prince, Haiti, January 20, 2010. U.S. and international military
units and civilian aid agencies are conducting humanitarian and disaster relief operations as part of Operation Unifi ed Response after a 7.0-mag-
nitude earthquake caused severe damage near Port-au-Prince Jan. 12, 2010. (DoD photo by Master Sgt. Jeremy Lock, U.S. Air Force/Released).
VIRIN: 100121-F-1644L-018.” http://www.defenseimagery.mil/imagery.html#guid=e6810a76b342d95e1c9a6abf449ff cc3b352ba44.

NATIONAL CENTER FOR CASE STUDY TEACHING IN SCIENCE

by
Susan B. Chaplin
Department of Biology
University of St. Thomas, St. Paul MN

Girl Pulled Alive
from Ruins, 15 Days
after Earthquake

Part I – The Facts of the Case
I read the headlines, almost unbelieving. From all that disaster in Port-au-Prince, Haiti, in January 2010, a miracle
occurred; someone was still alive, more than two weeks after the buildings collapsed around her. Th e paper reported
that Darlene Etienne, a 17-year-old university student, was found in the rubble of a home near the university, very
dehydrated, groaning weakly, but still conscious, with a very weak pulse and low blood pressure. Rescuers gave her
oxygen and water and immediately evacuated her to a French military hospital ship for treatment.

“She was defi nitely within hours or perhaps minutes of death,” said one rescuer. “It’s exceptional that she managed to
survive this long,” said another. “In fact, it is rare for anyone to survive more than 72 hours without water, and no
survivors have been documented in any earthquake after 14 days.”

How did Darlene manage to survive? Was it due to her ability to conserve her body water, or did she somehow gain
access to a meager supply of water while still buried?

Questions

1. What are the physical signs and symptoms of progressive dehydration, such as Darlene might have experienced?
2. What do we know so far about Darlene’s physiological responses to her prolonged ordeal?

References

Refer to the following website for information about dehydration:
Signs and Symptoms of Dehydration

http://www.symptomsofdehydration.com/
Th e site includes physiological characteristics associated with progressive states of dehydration.

NATIONAL CENTER FOR CASE STUDY TEACHING IN SCIENCE

“Girl Pulled Alive from Ruins, 15 Days after Earthquake” by Susan B. Chaplin Page 2

Part II – Calculating Darlene’s Water Balance
Th e physiological consequences of Darlene’s entrapment in the
earthquake rubble were dehydration, starvation, and potentially
heat exposure from daytime temperatures near 35°C (95°F)
and high humidity. However, let’s look fi rst at just her ability
to survive the dehydration of being buried for 15 days.

First, we should consider where water is “stored” in the body
that could be tapped during Darlene’s prolonged entrapment.

Questions

3. Based on the diagram to the right, list the major water
compartments of the body, and explain how water
moves between them. What is the 60-40-20 rule for
body water?

4. Assuming that Darlene did NOT have access to water
during her entrapment, how would her body begin to
lose water? What are the specifi c avenues of water loss?

5. How might the body immediately begin to reduce
those avenues of water loss in Question #4? What
important physiological refl exes would minimize the rate of water loss from those specifi c avenues?

6. How would changes in blood fl ow to specifi c organs help Darlene resist dehydration? Consider how reduction
of function in particular organ systems might help conserve water.

7. Calculation of Darlene’s water loss—Enter answers in the spaces and table below as directed.
a. Let’s assume that Darlene weighs about 55 kg (~120 lb). Based on the 60-40-20 rule, how much total body

water (in liters) does Darlene have? Record your answer below.
b. Most humans can withstand only a 12% loss of total body water before they progress to clinical shock. Th e

lethal body water loss for humans is 20% of total body water. Based on these estimates, how many liters of
body water can Darlene aff ord to lose? Record your answer below.

c. Data from published studies on women show that water loss varies as a function of age, weight, and
environment. Values range from 2.7 L/day for young female adults (Sawha et al., 2005) to 3.3 L/day in
active (but not exercising), young female students (Westerterp et al., 2010). How many days without water
could Darlene survive at this rate of dehydration, assuming a maximum of 12% body water loss? Record
your answer in the table below.

d. Are these water loss values (in 7c) of any use in predicting how much water Darlene might have lost per day?
Justify your answer.

e. Th e absolute bare minimum water loss possible for humans, with all compensating mechanisms in force, is
about 1.2–1.4 L/day (approximately 6 cups of liquid). How many days could Darlene survive at this rate of
water loss? Record your answer in the table below.

f. At the absolute minimal rate of water loss (7e) and maximal tolerance of dehydration (20% of total body
water from 7b), how many days without water could Darlene survive? Record your answer in the table
below.

g. Now, based on these calculations, could Darlene have survived 15 days without water? Explain the basis for
your answer.

7a. Total body water in liters (55 kg human)______________________________________
7b. 12% of total body water in liters ____________________________________________
7b. 20% of total body water in liters ____________________________________________

Extracellular
Fluid

20% of
Body Weight

Intracellular
Fluid

40% of
Body Weight

Solid Matter
40% of

Body Weight

Joint fluid

Lymph fluid Fluid surrounding
brain

Plasma

Fluid in stomach
and intestines

Cells

Tissue Matter

Bone

NATIONAL CENTER FOR CASE STUDY TEACHING IN SCIENCE

“Girl Pulled Alive from Ruins, 15 Days after Earthquake” by Susan B. Chaplin Page 3

Condition Rate of water loss Survival time in days

7c. Average water loss for young adult females, 12% total body water
loss

2.7 L/day

7c. Average water loss during summer for European women (55 kg),
12% total body water loss

3.3 L/day

7e. Absolute minimal water loss possible in humans, 12% total body
water loss

1.2-1.4 L/day

7f. Absolute minimal water loss possible in humans, 20% total body
water loss

1.2-1.4 L/day

Image credit: “Members of Fairfax County Urban Search and Rescue conduct a
rescue operation in a collapsed section of the Hotel Montana in Port-au-Prince,
Haiti during a search for survivors of a 7.0 magnitude earthquake. Th e unit
was activated by the U.S. Agency for International Development. Eight people,
including 7 Americans, have been rescued from the rubble of the hotel.” PORT-
AU-PRINCE, Haiti (Jan. 14, 2010) 100114-N-6266K-033 (U.S. Navy photo by
Mass Communication Specialist 1st Class Joshua Lee Kelsey/Released) http://www.
navy.mil/view_single.asp?id=79928

NATIONAL CENTER FOR CASE STUDY TEACHING IN SCIENCE

“Girl Pulled Alive from Ruins, 15 Days after Earthquake” by Susan B. Chaplin Page 4

Part III – Finding other Explanations for Darlene’s Survival
Darlene’s survival was indeed miraculous, but was it based in part on who she was, where she lived (Haiti), and the
particular conditions to which she was exposed? Survival can sometimes depend on the smallest of advantages.

Questions

8. Would a middle-aged, northern European (or American) male tourist in Haiti have fared as well as Darlene?
Are there physiological advantages of being a young female, born and raised in Haiti? Describe how these
characteristics might have given her an advantage. In answering this question, consider the following:
a. Could being buried in rubble in the warm, humid environment of Haiti have been an advantage for

Darlene’s survival? Explain how.
b. Does age, weight, or sex aff ect water loss or water requirements (see Sawha et al., 2005)?
c. Does the fact that Darlene was born and raised in Haiti matter? Describe the role that heat acclimation

might play in her water balance.
9. Darlene survived a prolonged period of starvation, an additional physiological challenge for her body.

Paradoxically, starvation might actually off set and/or minimize some water loss. How?

References

Refer to the following website for information about dehydration:
Sawka, M., S.N. Cheuvront, and R. Carter. 2005. Human water needs. Nutrition reviews 63: S30-S39.

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA435156&Location=U2&doc=GetTRDoc.pdf
Westerterp, K.R., G. Plasqui, and A.H.C. Goris. 2005. Water loss as a function of energy intake, physical activity,

and season. British Journal of Nutrition 93: 199-203.
http://journals.cambridge.org/action/displayFulltext?type=1&fi d=917992&jid=BJN&volumeId=93&issueId=0
2&aid=917980

NATIONAL CENTER FOR CASE STUDY TEACHING IN SCIENCE

“Girl Pulled Alive from Ruins, 15 Days after Earthquake” by Susan B. Chaplin Page 5

Case copyright held by the National Center for Case Study Teaching in Science, University at Buff alo, State University of New
York. Originally published January 3, 2011. Please see our usage guidelines, which outline our policy concerning permissible
reproduction of this work.

Part IV – An Answer?
Some residents thought that Darlene had been trapped in a bathroom, where she was showering at the time of the
earthquake. Darlene told rescuers she had a little Coca-Cola with her when the earthquake struck – but was there
enough precious liquid for her to survive 15 days? From the newspaper article at the beginning of the case, we know
that Darlene probably did not exhibit the maximal dehydration that would have resulted in her losing consciousness
(i.e., >12% body water loss).

Questions

10. Based on your calculations above, how much water would Darlene have needed to consume daily to reduce the
rate of her dehydration such that she lost a maximum of only 10% of her body water after 15 days?

Image credit: “Search and Rescue teams from France,
Haiti, Turkey, Fairfax County, Va. and members
of the U.S. Air Force 23rd Special Tactics Squadron
place Hottline Lozoma, a 25-year-old Haitian
woman, on a stretcher after extracting her from the
rubble of a collapsed market. Units from all branches
of the U.S. military are conducting humanitarian
and disaster relief operations as part of Operation
Unified Response after a 7.0 magnitude earthquake
caused severe damage in Haiti Jan. 12.” PORT-AU-
PRINCE, Haiti (Jan. 19, 2010) 100119-N-8878B-767
(U.S. Navy photo by Mass Communication
Specialist 2nd Class Michael C. Barton/Released)
http://www.navy.mil/view_single.asp?id=80347

Anatomy homework help

173

8
Healthcare Research and
Academic Writing (Part 2):
Finding and Using Sources

T
his chapter focuses on the strategies involved in gathering and integrating infor-
mation in order to write the sort of research-oriented academic documents
explored in chapter 7. The wider-ranging preliminary investigation into a subject

that occurs during the prewriting stage and helps you to narrow down from that subject
to a topic, then from topic to thesis (or statement of purpose) gives way as the drafting
stage progresses to a more concentrated and detailed engagement with source mate-
rials, one that both shapes and is shaped by the developing focus and direction of
your essay or report. Over the course of the research process, student writers may find
themselves having to seek out answers to many important questions. Where do I look
for sources, and how do I search for them effectively? How do I know if the sources I
find are useful (or scholarly)? How do I get the information I want to use out of those
sources and into my essay or report? What is appropriate documentation, and how
(or why) am I supposed to do it? The goal of this chapter is to offer something by way
of an answer to most, if not all of these.

FINDING SOURCES

Among the first things to consider as you undertake research for a particular assign-
ment is what type of sources you are required to use. Is there an assigned limit with
respect to number or type? If not, how many should you be aiming to employ in your
paper and of what sort? First, consider the important contextual details of purpose and
audience. Since you are writing something either to persuade a well-educated, expert
reader (i.e., your instructor) or to inform that reader about your topic, the sources you
marshal to the task of helping you address your audience most effectively need to be
relevant, authoritative, and scholarly. A scholarly source refers to any research-based
book, journal article, or essay written by someone with academic qualifications and
affiliation, published by a reputable or university-associated press or in an academic
journal, and searchable by way of your university or college library’s system of databases.
Journal articles tend to take slight precedence over books with respect to perceived
importance and quality, primarily due to the fact that journal articles represent the
most current published research in a field, and currency is an especially desirable char-
acteristic for a source in the health sciences (and the sciences generally).

Part III: Fundamentals of Successful Healthcare Writing174

Scholarly sources can be categorized as either primar y or secondar y. A
primary source is a first-hand account of something: an experiment, a course of
research, an ongoing study. Lab reports and research articles constitute primary sources,
as do dissertations and conference papers, published or otherwise. A secondary source
consists of anything that draws upon, analyzes, and interprets primary material but
doesn’t write up research of its own. Literature reviews, critical analysis essays, refer-
ence works (e.g., dictionaries and encyclopedias), and textbooks like this one are
examples. One possible strategy for moving from a general subject to a more specific
topic during the prewriting stage is to focus initially on secondary sources only, seek-
ing out things like review articles, which summarize the prevailing thinking on and
discussion of a subject and therefore allow you to find out about some of the topics
scholars have addressed. Once you have settled on one or two such possible topics for
your own paper, shift your focus to primary sources that document research on those
topics, and see what’s out there that engages and interests you the most (Hofmann,
2013). Note that the essay or report that you end up producing (by way of this method
or any other) will most likely draw upon and cite both primary and secondary sources.
However, some instructors may limit you to using one type or the other in a given
assignment, most often primary.

Sometimes, assignment instructions might specify that you are to use only
peer-reviewed sources in your paper. And indeed, being peer-reviewed is an important
characteristic of the best, often most authoritative scholarly writing. As the condition
of its publication, a peer-reviewed source has been rigorously vetted for quality by a
group of experts in the subject area. It has been deemed credible and authoritative
enough to make a contribution to the ongoing scholarly conversation and (potentially)
to be used by other researchers as a source in the future. The peer-review process is a
standard part of academic publishing, and it is a way of signalling to other academic
readers that a book or essay or journal article has sufficient scholarly merit. Note that
most databases now allow you to focus your search on peer-reviewed sources only.
And if you are in doubt as to whether or not a book or a journal is peer-reviewed, read
its publication details or a description of its editorial practice, either by following the
link to that book or journal in your library’s catalogue (as in the screenshot below), or
by going directly to the publisher’s website.

Searching in Databases

In terms of seeking out scholarly source material, the best places to go are the discipline-
specific subscription databases available through your university or college library. For

Screenshot: Publication
details for Journal of
Nursing Management
(Academic Search
Complete, Western
Libraries).

Chapter 8: Healthcare Research and Academic Writing (Part 2) 175

healthcare-related disciplines, some of the notable ones are AMED, CINAHL, Medline,
ProQuest Nursing and Allied Health Source, PsycINFO, PubMed, and SCOPUS. A
more widely available, general scholarly search tool such as Google Scholar is also a
fi ne place to start, as is Academic Search Complete. Even a non–healthcare specifi c
database like the MLA International Bibliography might prove useful, for some topics
related to narrative medicine and healthcare communication in particular. Regardless
of where you start or what search tools you employ, to fi nd sources eff ectively you need
to be able to recast your topic as a set of searchable terms that you can then alter and
adjust as need arises—need usually being determined by the number and quality (or
lack thereof ) of the sources your search yields.

As an example, let’s imagine that you are asked to write a report on living with
Parkinson’s disease. You decide in trying to narrow down to a possible topic that you
want to look at some of the treatment options available to Parkinson’s patients, then
go from there. What are the main concepts that inform your topic? How might those
become workable search terms?

Look for nouns and noun phrases, and ignore function words (prepositions and
conjunctions) and even verbs:

Treatment options for Parkinson’s patients. [Main concepts = Treatment options,

Parkinson’s (since “patients” seems redundant, considering the focus on treatment,

something that is necessarily patient-oriented)]

One strategy is to search each concept separately, then combine the searches. Here,
however, since “treatment options” is imprecise and applicable to any sort of disease
or ailment, you can anticipate getting an unmanageable number of sources, and that
is an unproductive and discouraging way to start. Th us, search both of these terms
together, using “AND” to link them. Note that you will have to put “treatment options”
in quotation marks to ensure it gets searched as a phrase. Using the database PubMed
to start, the combination of “treatment options” and “Parkinson’s” gets you 284 sources.

Th is is a fairly unmanageable number of sources to skim through, even just by look-
ing at titles and reading abstracts where necessary. You might notice some common
terms recurring in the titles and descriptions of the sources you turn up, and those can
help you narrow your focus a little more, hopefully leading to at least slightly fewer
results. One of the recurrent terms in this search pertaining to Parkinson’s treatment
options is “brain stimulation.” What happens when that gets turned into a concept
added to our search string?

Part III: Fundamentals of Successful Healthcare Writing176

All of a sudden, you have reduced the number of sources considerably (from 284 to
40). Th ere is no reason that you can’t look at all 40 here in some detail before making
a decision about whether or not you will have enough useful research to proceed with
this particular topic, or whether you will have to alter your search again to broaden it a
bit, perhaps generalizing the specifi c surgical intervention “brain stimulation” into the
more inclusive category “brain surgery,” or perhaps adding a synonym: “Parkinson’s OR
‘movement disorders.’” Going the other way, if you want to focus things even more, you
could make the third term “deep brain stimulation,” and/or you could apply some limits
on source date and type (e.g., only within the last fi ve years, only peer-reviewed articles).

EVALUATING YOUR SOURCES

Regarding the amount of source material you end up employing in the course of putting
together your essay or report, it matters much less than how useful and credible that
source material is. And it is, in fact, possible to employ too many sources in a paper,
especially when it is short. You defi nitely need to produce a document that comes
across as very well informed and that looks like it is conforming to the basic expec-
tations of scholarly writing—namely, that it will incorporate and appropriately cite
published research. Th at said, you do not want to hand in something that reads wholly
like a pastiche of other people’s words and ideas, with little or no evidence of any

Strategies for Skimming Journal Articles

In order to fi nd and gather information as effi –
ciently as you can during the course of your
research, you need to be able to assess quickly
and accurately which sources are going to warrant
closer attention. To do that, you have to know what
information to look for in a journal article and
where to fi nd it. Since the abstract provides a brief

summary of the article’s contents, start there, then
skip down to the very end and see what the discus-
sion and/or conclusion section says regarding key
fi ndings and their signifi cance. If the article seems
like it might be helpful to you, then go back and
start at the beginning, reading the introduction
and seizing on the research questions or hypoth-
esis that defi nes the purpose of the study before
making your fi nal decision as to usefulness.

Chapter 8: Healthcare Research and Academic Writing (Part 2) 177

distillation, framing, or analysis of those words/ideas on your part. Thinking gener-
ally about differences between exposition and argument, per our discussion of those
modes in the previous chapter, a report—being a more information-based type of writ-
ing and one less outwardly indicative of your own ideas or opinions—may be likely to
have a higher number and concentration of source citations than an essay. But that
is certainly not always going to be the case. In the end, there is no particular amount
of source material to have in mind when you are getting your research together. You
need as many sources as you need to do whatever it is your essay or report is trying to
do, however unhelpful that may sound. Quality always takes precedence over quantity.

But how do you assess the quality of a source? While not all peer-reviewed sources
are going to be equally useful to you, in terms of overall authority and trustworthiness,
there is usually little to question about a scholarly book or article. The problem tends to
be with non-scholarly sources, particularly those you find online. And note that when
we say online, we are referring to the “open” internet accessible to anyone, not to the
“closed,” subscription-only databases that students are able to access through their
campus libraries. It is a retrograde approach to think that student writers in particular
will limit their research to academic databases alone or that only scholarly sources can
be of use in academic writing. Though scholarly books and articles should certainly
comprise the majority of the material upon which you draw in essays and reports,
some well-chosen non-scholarly sources—newspaper or magazine articles, websites,
blogs, wikis, social media postings—can have much to offer by way of usefully supple-
menting your research material. Go back to the sample scholarly essay in chapter 7,
and look at the way some of the ongoing conversation about healthcare wait times in
Canadian media sources (e.g., the National Post and CBC News) is used to frame the
argument regarding the benefits of adopting a two-tier system. Particularly if your
topic is a timely, relevant one that has been subject to discussion in the media, some-
times the most up-to-date information you can get will come from online sources.

Be sure, however, to think very critically about whether or not such sources have
intrinsic value that recommends their inclusion in your paper—whether or not they
seem to offer you something useful that your scholarly sources don’t. If an online
source doesn’t provide anything new or salient with respect to information or offer an
approach that might enhance your discussion, then you should not bother with it. But
if and when you do consider using a source you find via Google (or Bing or another
search engine), there are several questions you then need to pose in order to evalu-
ate its potential merit:

■ Who or what is responsible for or behind the source? Is the site sponsored by
an organization? Is it affiliated with an institution? If there is any corporate
or institutional affiliation, what can you find out about the sponsor? Might
there be some sort of political or professional bias inflecting the information
or skewing its presentation? Are you being “sold” something, literally or
figuratively? Is the site trying to get you to act or to buy something by relying
heavily on appeals to pathos, perhaps presenting an especially rosy or
particularly dire picture of things? Assuming there is a lack of objectivity as
a function of the site’s personal, political, or professional investment in a

Part III: Fundamentals of Successful Healthcare Writing178

topic, does that pose a problem? Remember that much of your ethos as an
academic writer derives from the quality and authority of your sources, and in
academic writing authority and objectivity are very closely related.

■ Who is the author? Is there one? What are his or her credentials? What is his
or her ethos? Figuring out who wrote a scholarly book or article is never an
issue, but figuring out the same with respect to an internet source can often
be quite difficult. Not having an identified author isn’t necessarily a deal
breaker, but you need to think very carefully about the source’s credibility on
other grounds.

■ What is the nature and quality of the information presented? Are citations
provided? Frequently, they won’t be, which can make accuracy difficult to
discern. Importantly, though, does the information have intrinsic merit?
Does it present information not available elsewhere and/or does it present
that information in a way that other (scholarly) sources can’t or don’t? Is it
multimedia dependent, for example? That’s one of the important, potentially
productive ways an online source might differ from a print source. The other,
as we have noted, is in terms of currency. Is the source more up-to-date than
anything else you’ve come across? Remember that the very thing that can
make the information in an online source so useful—its potential timeliness—
also speaks to one of the most problematic things about online sources in
terms of authority, namely that they are inherently unstable and prone to
alteration in ways that print sources are not.

One other thing to note: before evaluating any online source, try to parse the URL back
to the homepage first, in the same way you would want to assess a book in its entirety
by starting back at the beginning—with the author note, blurb, table of contents, intro-
duction—not just picking it up in medias res (in the middle of things). You need to get
the full picture of any source at issue in order to assess it fairly and in a fully informed
manner.

USING SOURCES: AVOIDING PLAGIARISM

What does it mean to plagiarize, and why is it so important to understand what is at
stake in plagiarism, with a view to avoiding it at all costs in your academic writing?
Plagiarism is academic dishonesty that entails taking credit for someone else’s intel-
lectual property, whether intentionally or not. Determining just what constitutes
the intellectual property of another, however, can sometimes be tricky. The useful
definition of plagiarism provided by the American Psychological Association (APA)
publication manual—perhaps the most authoritative source on correct procedures for
academic writing, particularly for those in healthcare fields—acknowledges the occa-
sionally murky nature of intellectual property ownership in a passage that cautions
against presenting

Chapter 8: Healthcare Research and Academic Writing (Part 2) 179

the work of another as if it were [your] own work. This can extend to ideas as well
as written words. If authors model a study after one done by someone else, the
originating author should be given credit. If the rationale for a study was suggested
in the Discussion section of someone else’s article, the person should be given
credit. Given the free exchange of ideas, which is very important to the health of
intellectual discourse, authors may not know where an idea for a study originated.
If authors do know, however, they should acknowledge the source; this includes
personal communications. (2010, p. 16)

Essentially, the intellectual property of others encompasses any words, ideas, and even
inspiration you draw from things you have read (or people you have spoken to) in the
course of preparing to write a document. In order to avoid plagiarism, you are required
to acknowledge any and all of the sources you draw upon by citing your debt to them
appropriately within your essay or report, using a standard citation style (such as
APA), and also providing full bibliographic details in a list of references.

The practice of citing sources throughout your researched writing is referred to
as documentation. When in doubt as to whether or not you should cite a particu-
lar source, the very fact that you are at least thinking on some level that you need to
should be reason enough to cite it. Though overciting is possible (since sources of
material considered standard information within a particular field of study—major
historical facts such as dates, or facts readily available in a wide variety of reference
works—need not be acknowledged), it is by far the lesser of two evils when the other
option is unintentional plagiarism. So be vigilant about citing anything you think you
need to. Following good academic procedure is never wrong, nor is being a fair person
who gives credit where it is due.

Most colleges and universities use some sort of plagiarism-checking program, such
as Turnitin, and these have made the detection of problems with integrating and docu-
menting sources virtually effortless. In our experience, the majority of student writers
who have any sort of issue with source acknowledgement or incorporation do not know-
ingly take credit for someone else’s work with malicious intent. Instead, they usually
plagiarize unintentionally due to one (or both) of two possible issues: they lack sufficient
familiarity with their research material or knowledge of how to incorporate research
into their writing; they have been too careless in taking notes from their sources (by
failing, perhaps, to distinguish between direct quotations and their own paraphrase,
or by not copying down correct page numbers). Students can help to prevent careless-
ness that results from haste by planning ahead and giving themselves sufficient time
for the prewriting processes of rhetorical situation assessment and information gath-
ering. Problems that arise out of a lack of knowledge or of comfort with using sources,
however, can really only be addressed by learning the correct techniques for incorpo-
rating and acknowledging your research and by practising those techniques. To recall
the preamble to our overview of grammar, punctuation, and style in chapter 6, prac-
tice makes permanent when it comes to the fundamentals of clear, effective writing.
The same can be said for the basics of effective source citation and documentation.

Part III: Fundamentals of Successful Healthcare Writing180

Summary

Information drawn from research sources can be integrated into your essay or report
in only three ways. You can summarize it, paraphrase it, or quote it directly. In all
instances, the information being drawn from elsewhere must be documented via
in-text citation (and corresponding bibliographic entry). A summary distills key ideas
from a source and condenses material presented at much greater length in the origi-
nal into perhaps a paragraph or less in your paper, depending of course on the length
and complexity of the original material being summarized. In the previous chapter,
we discussed summary in a couple of different contexts: in an article review, as the
means of providing the necessary context for your critical analysis; and in the literature
review portion of a formal report, which offers an overview of the relevant contempo-
rary and historical research published on your topic. There are two other particular
academic writing contexts wherein effective summary is absolutely essential: abstracts
and annotated bibliographies.

Abstracts precede scholarly research articles in all disciplines, and they are a
standard component in most types of report. As we mentioned earlier in this chapter,
abstracts provide an important heuristic for readers, since they offer a brief but accu-
rate summary of an article or report’s contents in a single paragraph (approximately
300 words or fewer in the case of research articles, 150 or fewer for most lab reports).
One of the keys to writing an effective abstract is to save it for the very end, after your
article or report has been completed. That way, writing the abstract will truly be a
summative, backward-looking exercise. You will presumably have arrived at a better
sense of what it is you actually accomplish in your article or report and/or in the course
of the research it discusses. There is actually quite a lot riding on a being able to write
a clear, effective abstract, since readers will very often determine whether or not your
work is interesting or worth reading solely on the basis of the abstract.

In an annotated bibliography, full bibliographic information for sources is accom-
panied by brief descriptions (usually three to five sentences at most) that summarize
the content and offer some sort of evaluative commentary that speaks to the relevance
and overall quality of the source (including its potential limitations or shortcomings).
Here are a couple of examples of annotated bibliography entries for sources used in
the sample scholarly essay with which our previous chapter concludes.

Flood, C. M., & Haugan, A. (2010). Is Canada odd? A comparison of European
and Canadian approaches to choice and regulation of the public/private
divide in health care. Health Economics, Policy and Law, 5, 319–41. doi: 10.1017/
S1744133110000046

Flood and Haugan investigate the ongoing debate over allowing a privatized
healthcare option into the Canadian system by way of the famous Chaoulli case
from 2005, which asked if it was constitutional for the Quebec government to ban
private insurance for medically necessary care in the face of long wait times. Flood
and Haugan describe the shortcomings of and failures within this case, such as
what steps were neglected and what was overlooked. They utilize six major features

Chapter 8: Healthcare Research and Academic Writing (Part 2) 181

of Canadian healthcare legislation and use this information to draw comparisons
between five European countries. The Chaoulli case is a strong case study to utilize
within my research because it brought healthcare issues to the forefront of national
discussions and debates and highlighted the inefficiencies and inadequacies
within the Canadian healthcare system. Although this case took place in Quebec
under the Quebec Health Insurance Act, its information is still very applicable to
Canada as a whole. The comparative analysis between countries provides insight
on how Canada’s system can be improved and where shortcomings lie. Although
this comparison is generally useful, not all of the conclusions made by the authors
are applicable to the Canadian system due to cultural, structural, and political
differences between countries.

Johnson, A. P., & Stuart, H. (2009). Health services research in Canada. In R.
Mullner (Ed.), Encyclopedia of health services research. (pp. 559–65). Thousand
Oaks: SAGE Publications.

Johnson and Stuart begin their essay by providing a brief historical overview of
Canada’s healthcare system and its main goals and objectives, focusing on the
idea of health information as well as health service research within Canada. This
focus is important as it gives a substantial background as to why and how policies
and infrastructures have been implemented within Canada, and explores the
continuous developments research institutes and governments have been making
in order to stay informed and make decisions based on qualified and substantiated
research. This is a useful source because it provides an informative history of
the Canadian healthcare system. It also describes how and why research is so
important and the effects it has on policy makers, which in turn influences how
health care is provided to citizens. While this article does not specifically focus on
the two-tiered healthcare model within Canada, it still offers research that suggests
how such a model might affect the delivery of care.

Annotated bibliographies may be assigned to take the place of literature review compo-
nents or to provide a snapshot of your research in progress as you begin to move from
prewriting to the drafting stage. In the latter case, the annotation can provide helpful
notes that allow you to remember what you thought about a source in relation to your
particular piece of writing (as in the first example above). Regardless of their specifics,
all annotated bibliographies are impelled by the same important concern a literature
review has of demonstrating some broad knowledge of what has been published on
your topic and helping you to situate the place of your essay or report within an ongo-
ing scholarly discussion.

To write an effective summary of any sort, you need to be very familiar with the
source you are using. Read it over thoroughly, then (in a process akin to critical read-
ing) go back over it slowly—or over the particular portion of the document you want to
summarize—taking time to identify the key ideas by underlining or highlighting them.
After that, try articulating the relevant points in brief, wholly in your own words. And
when you have done that to your satisfaction, try combining those rewritten points

Some annotations
may demonstrate a
reflective aspect in

offering some sense
of how or why a

particular source fits
into the writer’s essay

or report.

Part III: Fundamentals of Successful Healthcare Writing182

together in a more condensed and concise manner. Go back and check your draft
summary against the original to ensure both that you have covered all the ideas and
that you have done so in language and syntax different from the source.

Paraphrase

In paraphrasing, you follow more closely the author’s presentation of material (in
terms of length and detail) than you do when summarizing, but you still cast things
in your own words. While summary is useful for providing your reader with a broad-
strokes overview of a source, paraphrase is better for a closer engagement with, or more
focused use of, your primary or secondary research materials. If you want to present an
author’s argument or an aspect of her position in a manner and at a length more akin
to the original, but you don’t deem the original’s words striking or interesting enough
to be worth quoting directly, then paraphrase. As with summary, though, when you
paraphrase, it is not enough that your version differs from the original at the level of
diction; you need to strive for structural (grammatical and syntactical) difference too
in order to avoid plagiarism. Also like summary, any paraphrase you include must be
cited accordingly, with author’s name and source date. Note that APA style does not
demand that you include a page number in your citations of summary or paraphrase,
even though a paraphrase in particular will necessarily seize on a portion of the original
that is found on a specific page or couple of pages, something that won’t necessarily be
the case with summary. Still, according to the APA manual, when making reference to
a point of content from another work by way of paraphrase, “you are encouraged”—but
not required—“to provide a page or paragraph number especially when it would help
an interested reader locate the relevant passage in a long or complex work” (p. 171).

Because paraphrase entails something more like a one-to-one relationship with
your source in terms of length, you need to be wary of the strong potential to produce
a version of a passage that is not sufficiently distinct from the original in all ways.
Remember that effective paraphrase involves rewriting entirely: not merely chang-
ing words but reframing how ideas are conveyed with respect to grammar and syntax.
The following example illustrates an attempt to paraphrase part of chapter 3’s descrip-
tion of the benefits of attentive listening that falls short by focusing too much on the
particulars of diction and not doing enough to recast the original passage on a broader
structural level.

Original passage:

“Many patients, even routine users of the healthcare system or those who have

developed prolonged professional relationships with their physicians, home care

nurses, therapists, dentists, or any type of healthcare provider, are not surprisingly

often intimidated during interviews or assessment and may be reluctant to make

self-disclosures. It is therefore imperative that practitioners take the time to critically

absorb all dimensions of a patient’s narrative, and allow the patient to self-edit with the

understanding that the process is more confession than interrogation.”

Chapter 8: Healthcare Research and Academic Writing (Part 2) 183

Ineffective paraphrase:

Lots of patients, even those who regularly seek medical care or who have fostered close

relationships with their doctors, nurses, physiotherapists, or other sorts of healthcare

practitioners over an extended period of time, are still wary of revealing personal

information in the context of being assessed or examined. Healthcare professionals

must thus be patient and vigilant about taking in all aspects of their patients’ personal

stories; they need to give patients the freedom to self-edit, due to what needs

Anatomy homework help

This is not a complete list of acceptable resources, but rather a means to jump start your
research.

Resources on Countries

 BBC News. (2018). Country profiles. Retrieved from:
http://news.bbc.co.uk/2/hi/country_profiles/default.stm

 Centers for Disease Control and Prevention. (2018). Where we work. Retrieved from:
https://www.cdc.gov/globalhealth/countries/

 Central Intelligence Agency. (2018). The world factbook. Retrieved from:
https://www.cia.gov/library/publications/resources/the-world-factbook/

 Country Watch. (2018). Retrieved from: http://countrybriefing.countrywatch.com/
 Encyclopedia of the Nations. (2018). Retrieved from:

http://www.nationsencyclopedia.com/
 Global Edge. (2018). Global business knowledge. Michigan State University. Retrieved

from: https://globaledge.msu.edu/
 NationMaster. (2018). Compare countries on just about anything! Retrieved from:

http://www.nationmaster.com/au
 Pan American Health Organization. (2018). Retrieved from: http://www.paho.org/hq/
 U.S. Department of State. (2018). A-Z list of countries and other area pages. Retrieved

from: https://www.state.gov/misc/list/index.htm
 United Nations. (2018). Millennium development goals and beyond 2015. Retrieved

from: http://www.un.org/millenniumgoals/
 World Health Organization. (2018). Countries. Retrieved from:

http://www.who.int/countries/en/
 World Health Organization. (2018). World health report. Retrieved from:

http://www.who.int/whr/en/

Immigrant/Refugees

 American Immigration Council. (2018). Fact sheet: Immigrants in Ohio. Retrieved from:
https://www.americanimmigrationcouncil.org/research/immigrants-ohio

 Cap4Kids. (2015). Retrieved from: http://cap4kids.org/columbus/immigration-refugee-
services/resources-for-all-immigrants-and-refugees/

 Centers for Disease Control (2013). Refugee Health Guidelines. Retrieved
from: http://www.cdc.gov/immigrantrefugeehealth/guidelines/refugee-guidelines.html

 City of Columbus. (2018). New American Initiative. Retrieved from:
https://www.columbus.gov/crc/New-American-Initiative/

 Community Refugee & Immigration Services (CRIS) (2018). Retrieved from:
http://www.crisohio.org/

 Ethiopian Tewahedo Social Services. (2018). Retrieved from: https://www.ethiotss.org/
 Kleinman, A. & Benson, P. (2006). Anthropology in the clinics. The problem of cultural

competency and how to fix it. PLOS Medicine, 3 (10), 1673-1676
 Fazel, M., Reed. R.V, Panter-Brick, C. & Stein, A. (2012). Mental health of displaced and

refugee children resettled in high-income countries: risk and protective factors. The
Lancet, 379, 266-282. DOI:10.1016/S0140- 6736(11)60051-2

 Migration Policy Institute. (2018). Retrieved from: https://www.migrationpolicy.org/

 Padilla, Y.S., & Villablobos, G. (2007). Cultural responses to health among Mexican
Americans women and their families. Community Health, Supplement 1, 30(15), S24-
S33.

 Pereira, K.M., Crosnoe, R., Fortuny, K., Pedroza J.M., Ulvestad, K. Weiland,
C., Yoshikawa, H., Chaudry, A. (2012, May). Barriers to Immigrants’ Access to Health
and Human Services Programs. U.S. Department of Health and Human Services.
Retrieved from: http://aspe.hhs.gov/hsp/11/ImmigrantAccess/Barriers/rb.shtml

 Population Reference bureau. (2013, October). Elderly immigrants in the United
States. Today’s Research on Aging, No. 29. Retrieved
from:http://www.prb.org/Publications/Reports/2013/us-elderly-immigrants.aspx

 Quesada, J., Hart, L.K. & Bourgois, P. (2011). Structural vulnerability and health: Latino
migrant laborers in the United States. Medical Antrhopology, 30 (4), 339-
362.doi:10.1080/01459740.2011.576725.

 United Nations. (2018). Demographic and social statistics: International migration.
Retrieved from: https://unstats.un.org/unsd/demographic-
social/sconcerns/migration/index.cshtml

 Viruell-Fuentes, E. S., Miranda, P.Y., &, S. (2012). More than culture: Structural racism,
intersectionality theory, and immigrant health. Social Science & Medicine, 75 (2), 2099-
2106. https://doi.org/10.1016/j.socscimed.2011.12.037

Anatomy homework help

LOST IN THE
DESERT!

by
David Evans

Natural Sciences
Penn College/PSU
Williamsport, PA

Part I: July 13th, AM

Mark, a white, 35-year-old male weighing approximately 70 kilogram (kg) started a three-hour drive
across the desert on US 95 from Yuma, Arizona, to Blythe, California. He set out at 7 AM on what was
expected to be a very hot July day. He anticipated that it would take him about three hours to reach
Blythe—plenty of time to make his 11 AM appointment with Sarah, his fiancée. When he failed to
appear by noon, Sarah became concerned and called the highway patrol.

By 12:30 PM, Search and Rescue Officer Maria Arroyo, who was patrolling nearby, reported finding an
abandoned car on the side of the road with a damaged radiator that matched Sarah’s description of
Mark’s vehicle. Maria noticed shoe prints leading into the desert toward some low mountains in the
distance. At that point Maria called for helicopter assistance, consulted her GPS, and relayed the exact
coordinates to base.

By 1 PM Henry Morningstar, paramedic and a member of the helicopter crew, reported a shirtless,
hatless man wandering down a desert wash. The local radio station reported at about the same time that
the air temperature was hovering at 105° F in the shade (and there was darned little of that). The relative
humidity was less than 5%. The helicopter crewmembers spotted a man staggering on the desert. They
realized they had found Mark. His driver’s license identified him as the missing man. Mark was still
conscious but clearly delirious. Henry also noted that Mark was weak, nauseous, disoriented, and
complained of a headache. His blood pressure was quite low—70/50—and he was not sweating despite
the oppressive heat. His body temperature was also high—105°. The patient was diagnosed as having
heat stroke. The paramedic also noted first degree burns on his face and back.

Suddenly, Susan Liu, the pilot, reported that they had lost radio contact with the hospital. It was all up to
Henry now!

Given the conditions, what should Henry do to try to save Mark? He must decide very quickly.
Mark has very little time left and may not survive the trip by helicopter to the hospital. Gather
into your groups and use your textbooks as resources to gather for information about what
Henry should do. What has caused Mark’s weakness, nausea, disorientation, headache, and low
blood pressure? Why isn’t he sweating?

2

Part II: July 13th, PM

Henry started oral rehydration with an isotonic solution containing electrolytes, glucose, and water.

Why didn’t the paramedic give Mark distilled water rather than an electrolyte/glucose solution?

As Mark recovered in the hospital, he related what happened to him earlier in the day. Since he was a
newcomer to desert areas, he saw no need to bring UV A/B sunblock or extra water on his trip from
Yuma to Blythe. Mark recalled seeing a coyote dart out between two bushes and he seemed to recollect
hitting the animal. The area was so isolated that his cell phone was useless. He waited by the car for a
while but then, about 10 AM, as the sun climbed, he saw a large body of water in the distance, possibly,
he thought, the Colorado River. The “river” was, in reality, a mirage, as he realized later after he had
walked some distance. He then started to become confused and could not find his way back to the
highway. Eventually he became very hot and threw away his shirt and hat.

Why did Mark become disoriented? How would you test your ideas to see if you are right? What
does your group think based on the information in the text?

Part III: Subsequent Months

After he left the hospital, Mark saw extensive new melanin formation in his skin. Much later Mark
noticed some new moles on his shoulders. The moles grew, changed color, and bled.

What should Mark be concerned with regarding these moles? He talked to dermatologist Dr.
Charles Culp about the moles. What tests might Dr. Culp conduct after removing the moles?

Final Set of Case Questions

1. Define the terms in the case study highlighted in boldface.

2. Assuming that Mark lost around 4 liters of water, what percentage of his body water did he lose?
Would you expect his urinary volume to decrease or increase during his trek? Please explain
your answer.

3. Why was Mark’s blood pressure so low? Would his pulse rate decrease or increase? Please
explain. Why was Mark dizzy and disoriented?

4. Assume that Mark had an unopened six-pack of beer in his car. Would it have been a good idea
for Mark to bring the beer along in case he got thirsty? Why or why not?

5. What vitamin would Mark have in greater amounts in his body after that day?

6. What did Mark do that increased his chance of burns?

7. Why would Mark’s skin have looked red within the first few hours of his adventure rather than
redness developing hours and days later as a result of “sunburn”?

Image Credit: Photo of the view southwest from Palm Canyon by John Crossley, The American Southwest
(http://www.americansouthwest.net/). Used with permission.

Date Posted: 06/08/02 nas

Anatomy homework help

104

Courtesy of Mark Tuschman.

CHAPTER 2
Health Determinants, Measurements,
and the Status of Health Globally

LEARNING OBJECTIVES

By the end of this chapter, the reader will be able to do the following:

■ Describe the determinants of health
■ Define the most important health indicators and key terms related to measuring health

status and the burden of disease
■ Discuss the status of health globally and how it varies by country income group, region,

and age group

C
o
p
y
r
i
g
h
t

2
0
2
0
.

J
o
n
e
s

&

B
a
r
t
l
e
t
t

L
e
a
r
n
i
n
g
.

A
l
l

r
i
g
h
t
s

r
e
s
e
r
v
e
d
.

M
a
y

n
o
t

b
e

r
e
p
r
o
d
u
c
e
d

i
n

a
n
y

f
o
r
m

w
i
t
h
o
u
t

p
e
r
m
i
s
s
i
o
n

f
r
o
m

t
h
e

p
u
b
l
i
s
h
e
r
,

e
x
c
e
p
t

f
a
i
r

u
s
e
s

p
e
r
m
i
t
t
e
d

u
n
d
e
r

U
.
S
.

o
r

a
p
p
l
i
c
a
b
l
e

c
o
p
y
r
i
g
h
t

l
a
w
.

EBSCO Publishing : eBook Comprehensive Academic Collection (EBSCOhost) – printed on 8/20/2021 10:46 AM via OHIO UNIVERSITY LIBRARIES
AN: 2247214 ; Richard Skolnik.; Global Health 101
Account: s8447892.main.eds

105

M
Vignettes

aria is a poor woman who lives in the highlands of Peru. She is from an ethnic group
called Quechua. In Peru, poor people tend to live in the mountains and be indigenous, be

less educated, and have worse health status than other people. In Eastern Europe, the same
issues occur among ethnic groups that are of lower socioeconomic status, such as the Roma
people. In the United States, there are also enormous health disparities, as seen in the health
status of African Americans and Native Americans, compared to white Americans. If we want to
understand and address differences in health status among different groups, how do we
measure health status? Do we measure it by age? By gender? By socioeconomic status? By
level of education? By ethnicity? By location?

Yevgeny is a 56-year-old Russian male. Life expectancy in Russia in 1985 was about 64 years
for males and 74 years for females. It then fell to about 59 years for males and 72 years for
females in 2001, before rising again to 67 for males and 77 for females in 2016. What does
life expectancy at birth measure? What are the factors contributing to the earlier decline in life
expectancy at birth in Russia? What has happened to trends in life expectancy in other
countries? Which countries have the longest and shortest life expectancies, and why?

Sarah is a 27-year-old woman in northern Nigeria. While women in high-income countries very
rarely die of pregnancy-related causes and have a maternal mortality ratio of about 10 per
100,000 live births, the maternal mortality ratio for women in low-income countries like Sarah is
about 500 per 100,000 live births. This is 50 times higher than that in the best-off country
income group. What does the maternal mortality ratio suggest about a country? What does it
say about the status of women in that country? What does it indicate about the access of
women to obstetric and emergency obstetric care of appropriate quality?

Abdul is a 4-year-old in northern India. For every 1,000 children born in South Asia in 2016,
about 50 will die before their fifth birthday. The rate of child death is even higher in sub-Saharan
Africa. In the cohort of 1,000 children born there in 2016, almost 80 will die before they are five.
These two regions have the worst child mortality rates.

1 2 3

4

5

EBSCOhost – printed on 8/20/2021 10:46 AM via OHIO UNIVERSITY LIBRARIES. All use subject to https://www.ebsco.com/terms-of-use

106

The Importance of Measuring Health Status
If we want to understand the most important global health issues and what can be done to
address them, then we must understand what factors have the most influence on health status,
as well as how health status is measured.

This chapter, therefore, covers two distinct but closely related topics. The first section concerns
what are called . That section examines the most important factorsthe determinants of health
that relate to people’s health status. The second section reviews some of the most important
indicators of health status and how they are used.

EBSCOhost – printed on 8/20/2021 10:46 AM via OHIO UNIVERSITY LIBRARIES. All use subject to https://www.ebsco.com/terms-of-use

107

The Determinants and Social Determinants of Health
Why are some people healthy and some people not healthy? When asked this question, many
of us will respond that good health depends on access to health services. Yet, as you will learn,
whether or not people are healthy depends on a large number of factors, many of which are
interconnected, and most of which go considerably beyond access to health services.

The World Health Organization (WHO) defines the as the “range ofdeterminants of health
personal, social, economic and environmental factors which determine the health status of
individuals or populations.” WHO defines the social determinants of health as the “conditions in
which people are born, grow, live, work and age.”

There has been considerable writing about the determinants and social determinants of health,
which different organizations depict in a range of ways. The next section builds on the work of a
number of actors and agencies. It briefly discusses the determinants and social determinants of
health and how they influence health. It is essential to understand these concepts if one wants
to understand why people are healthy or not and what can be done to address different health
conditions in different settings. shows one way of depicting the determinants ofFIGURE 2-1
health.

6

7

EBSCOhost – printed on 8/20/2021 10:46 AM via OHIO UNIVERSITY LIBRARIES. All use subject to https://www.ebsco.com/terms-of-use

108

FIGURE 2-1 The Determinants of Health

Reproduced from Dahlgren, G., & Whitehead, M. (1991). .Policies and strategies to promote social equity in health

Stockholm, Sweden: Institute for Futures Studies. Retrieved from http://www.iffs.se/media/1326

/20080109110739filmZ8UVQv2wQFShMRF6cuT.pdf

EBSCOhost – printed on 8/20/2021 10:46 AM via OHIO UNIVERSITY LIBRARIES. All use subject to https://www.ebsco.com/terms-of-use

109

The first group of factors that helps to determine health relates to the personal and inborn
features of individuals. These include genetic makeup, sex, and age. Our genetic makeup
contributes to what diseases we get and how healthy we are. One can inherit, for example, a
genetic marker for a particular disease, such as Huntington’s disease, which is a neurological
disorder. One can also inherit the genetic component of a disease that has multiple causes,
such as breast cancer. Sex also has an important relationship with health. Males and females
are physically different, for example, and may get different diseases. Females face the risks
involved in childbearing. They also get cervical and uterine cancers that males do not. Females
have higher rates of certain health conditions, such as thyroid and breast cancers. For similar
reasons, age is also an important determinant of health. Young children in low- and
middle-income countries often die of diarrheal disease, whereas older people are much more
likely to die of heart disease, to cite one of many examples of the relationship between health
and age.

Individual lifestyle factors, including people’s own health practices and behaviors, are also
important determinants of health. Being able to identify when you or a family member is ill and
needs health care can be critical to good health. One’s health also depends greatly on how one
eats, or if one smokes tobacco, drinks too much alcohol, or drives safely. We also know that
being active physically and getting exercise regularly is better for one’s health than is being
sedentary.

The extent to which people receive social support from family, friends, and community also has
an important link with health. The stronger the social networks and the stronger the support
that people get from those networks, the healthier people will be. Of course, culture is also an
extremely important determinant of health.

8

9

EBSCOhost – printed on 8/20/2021 10:46 AM via OHIO UNIVERSITY LIBRARIES. All use subject to https://www.ebsco.com/terms-of-use

110

Living and working conditions also exert an enormous influence on health. These include, for
example, housing, access to safe water and sanitation, access to nutritious food, and access to
health services. Crowded housing, for example, is a risk factor for the transmission of
tuberculosis. The lack of safe water and sanitation, coupled with poor hygiene in many settings,
is one of the major risk factors for the diarrheal disease that is associated with so much illness
and death in young children. Nutrition is central to health, beginning at conception, and families
have to be able to access appropriate foods to promote good health. Of course, even if other
factors are such important determinants of health, one’s health depend on access todoes
appropriate healthcare services. Even if one is born and raised healthy and engages in good
health behaviors, access to health services of appropriate quality is important to maintaining
good health. To address the risk of dying from a complication of pregnancy, for example, one
must have access to health services that can carry out an emergency cesarean section if
necessary. Even if the mother has had the suggested level of prenatal care and has prepared
well in all other respects for the pregnancy, in the end, certain complications can only be
addressed in a healthcare setting.

PHOTO 2-1 The circumstances in which people live have a profound impact on their health.

This is a slum in Jakarta, Indonesia. In what ways would living here influence the health of the

slum dwellers?

© Nikada/E+/Getty Images.

EBSCOhost – printed on 8/20/2021 10:46 AM via OHIO UNIVERSITY LIBRARIES. All use subject to https://www.ebsco.com/terms-of-use

111

A range of socioeconomic factors, including culture, education, and socioeconomic status, are
important determinants of health. The broader environment is also a critical health determinant.
Socioeconomic status refers to a person’s economic, social, and work status. It is highly
correlated with educational attainment. People with higher educational attainment have better
economic opportunities, higher socioeconomic status, and more control over their lives than
people of lower educational status. As one’s socioeconomic status improves, so does his or her
health.

More specifically, education is a powerful determinant of health for several reasons. First, it
brings with it knowledge of good health practices. Second, it provides opportunities for gaining
skills, getting better employment, raising one’s income, and enhancing one’s social status, all of
which are also related to health. Studies have shown, for example, that the single best predictor
of the birthweight of a baby is the level of educational attainment of the mother. Most of us
already know that throughout the world there is an extremely strong and positive correlation
between the level of education and all key health indicators. People who are better educated
eat better, smoke less, have less obesity, have fewer children, and take better care of their
children’s health than do people with less education. It is not a surprise, therefore, that they and
their children live longer and healthier lives than do less well-educated people and their
children.

Culture also exerts a profound impact on health. Culture shapes how one feels about health
and illness, how one uses health services, and the health practices in which one engages. In
addition, the gender roles that are ascribed to women in many societies also have an important
impact on health. In some settings, women may be treated more poorly than men and this, in
turn, may mean that women have less income, less education, and fewer opportunities to
engage in employment. All of these militate against their good health.

The environment, both indoor and outdoor, is a powerful determinant of health. Related to this
is the safety of the environment in which people work. Although many people know about the
consequences of outdoor air pollution for health, fewer people are aware of the consequences
of indoor air pollution to health. In many low- and middle-income countries, families, and usually
women, cook indoors with poor ventilation, thereby creating an indoor environment that may be
full of smoke and that increases the risk of respiratory illness and asthma. The lack of safe
drinking water and sanitation is a major contributor to ill health in poor countries. In addition,
many people in those same countries work in environments that are unhealthy. Because they
lack skills, socioeconomic status, and opportunities, they may work without sufficient protection
from hazardous chemicals, in polluted air, or in circumstances that expose them to occupational
accidents.

10

11

EBSCOhost – printed on 8/20/2021 10:46 AM via OHIO UNIVERSITY LIBRARIES. All use subject to https://www.ebsco.com/terms-of-use

112

PHOTO 2-2 The lack of access to safe water and sanitation causes people to seek water from

unsafe sources and is a major risk factor for child deaths. Children are shown here washing

their dishes in a river. What can be done to improve access to safe water and sanitary disposal

of human waste in resource-poor environments?

Courtesy of Mark Tuschman.

The approach that governments take to different policies and programs in the health sector and
in other sectors also has an important bearing on people’s health. People living in a country that
promotes high educational attainment, for example, will be healthier than people in a country
that does not promote widespread education of appropriate quality because better-educated
people engage in healthier behaviors. A country that has universal health insurance is likely to
have healthier people than a country that does not insure its entire population because the
uninsured may lack needed health services. The same would be true, for example, for a country
that promoted safe water supply for its entire population, compared to one that did not.

As we think about the determinants of health, we should be aware that increasing attention is
being paid to the social determinants of health. In 2005, WHO created a Commission on the
Social Determinants of Health. WHO published the commission’s report in 2008. The report
highlighted some of the following themes :12

EBSCOhost – printed on 8/20/2021 10:46 AM via OHIO UNIVERSITY LIBRARIES. All use subject to https://www.ebsco.com/terms-of-use

113

■ Health status is improving in some places in the world but not in others.
■ There are enormous differences in the health status of individuals within countries, as well

as across countries.
■ The health differences within countries are closely linked with social disadvantage.
■ Many of these differences should be considered avoidable, and they relate to the way in

which people live and work and the health systems that should serve them.
■ People’s life circumstances, and therefore their health, are profoundly related to political,

social, and economic forces.
■ Countries need to ensure that these forces are oriented toward improving the life

circumstances of the poor, thereby enabling them to enjoy a healthier life as well. The global
community should also work toward this end.

We should also note the importance to health of child development, including the ways in which
families nourish and care for infants and young children, beginning at conception. Being born
premature or of low birthweight can have important negative consequences on health over the
life course. There is a strong correlation between the nutritional status of infants and young
children and the extent to which they meet their biological and intellectual potential, enroll in
school, or stay in school. In addition, poor nutritional status in infancy and early childhood may
be linked with a number of noncommunicable diseases later in life, including diabetes and heart
disease. There is also considerable evidence that a range of stressors, including poverty,
abuse, and discrimination, have a powerful impact on the health of children that may continue
through adulthood.

Finally, as we think about the determinants and social determinants of health, it is important to
consider how, directly and indirectly, different factors influence health. One framework for such
consideration is shown in . This framework places the determinants of health intoFIGURE 2-2
three categories based on the directness of their influence on health: root causes at the
macro/societal level; underlying causes at the meso/community level; and proximal causes at
the immediate/interpersonal level. Viewing the determinants of health in this manner should
also be helpful in assessing why health conditions exist and what can be done to address them.

13

14

EBSCOhost – printed on 8/20/2021 10:46 AM via OHIO UNIVERSITY LIBRARIES. All use subject to https://www.ebsco.com/terms-of-use

114

FIGURE 2-2 Selected Examples of Root, Underlying, and Immediate Determinants of Health

Modified with permission from Bouwman, L., Wentink, C., & Ormond, M. (2017, April 6). Global Health, W3 Tutorial 3:

Determinants [Powerpoint Slides], Based on Northridge.

EBSCOhost – printed on 8/20/2021 10:46 AM via OHIO UNIVERSITY LIBRARIES. All use subject to https://www.ebsco.com/terms-of-use

115

Key Health Indicators
It is critical that we use data and evidence to understand and address key global health issues.
Some types of health data concern the health status of people and communities, such as
measures of life expectancy and infant and child mortality, as discussed further hereafter. Some
concern health services, such as the number of nurses and doctors per capita in a country or
the indicators of coverage for certain health services, such as immunization. Other data
concern the financing of health, such as the amount of public expenditure on health or the
share of national income represented by health expenditure.

There are a number of very important uses of data on health status. We need data, for
example, to know from what health conditions people suffer. We also need to know the extent
to which these conditions cause people to be sick, be disabled, or die. We need data to carry
out disease surveillance. This helps us understand if particular health problems such as cancer,
influenza, polio, or malaria are occurring, where they are infecting people, who is getting
infected, and what might be done to address these conditions. Other forms of data also help us
to understand the burden of different health conditions, the relative importance of them to
different societies, and the importance that should be given to dealing with them.

If we are to use data in the previously mentioned ways, then it is important that we use a
consistent set of indicators to measure health status. In this way, we can make comparisons
across people in the same country or across different countries. There are, in fact, a number of
indicators that are used most commonly by those who work in global health and in development
work. These are listed and defined in .TABLE 2-1

15

EBSCOhost – printed on 8/20/2021 10:46 AM via OHIO UNIVERSITY LIBRARIES. All use subject to https://www.ebsco.com/terms-of-use

116

TABLE 2-1 Key Health Status Indicators

The section that follows will examine these key indicators of health status in two ways, first by
World Bank region and second by country income group. The graphics will reflect a number of
points quite starkly:

■ There is a very strong correlation between country income group and health status. The
lower the income group, the lower the status; the higher the income group, the higher the
status.

■ In all cases, sub-Saharan Africa has the worst health indicators of all World Bank regions,
and South Asia has the second worst health indicators.

You will understand better as you progress in your study of global health that part of the
relatively low health status of sub-Saharan Africa and South Asia related to the fact that theseis
are the two regions with the lowest per capita income. However, as you will read about here
and elsewhere, their relatively low health status also has to do with government policies and
programs, the lack of safe water and sanitation, low levels of education, and a number of other
factors.

EBSCOhost – printed on 8/20/2021 10:46 AM via OHIO UNIVERSITY LIBRARIES. All use subject to https://www.ebsco.com/terms-of-use

117

It is also important to understand that country income level does not have to determine a
country’s health status. Rather, as you will also read about throughout this text and elsewhere,
resource-poor countries that make wise policy choices in fair ways enable better health forcan
their people than their income level might suggest. This has certainly been the case for a
number of countries whose development history is well known, such as Cuba, Sri Lanka, and
China. Thus, it will be essential as you think about key issues in global health to always keep in
mind questions about which policies can help to achieve the best health for any population at
the least cost and in fair, doable, and sustainable ways. In light of all this, let us now turn to
exploring the specific health indicators.

Among the most commonly used indicators of health status is . Lifelife expectancy at birth
expectancy at birth is “the average number of additional years a newborn baby can be
expected to live if current mortality trends were to continue for the rest of that person’s life.”

In other words, it measures how long a person born today can expect to live, if there were
no change in their lifetime in the present rate of death for people of different ages. The higher
the life expectancy at birth, the better the health status of a country. In the United States, a
high-income country, life expectancy at birth in 2016 was about 79 years; in Jordan, a
middle-income country, life expectancy was 74 years; in Sierra Leone, a very low-income
country, life expectancy was 52 years.

FIGURE 2-3 shows life expectancy at birth by country income level. This figure shows an
exceptional correlation between country income group and life expectancy. It also shows the
range of life expectancy across country income groups, from 63 years in low-income countries
to 29 percent higher, or 81 years, in high-income countries.

16

(p58)

17

EBSCOhost – printed on 8/20/2021 10:46 AM via OHIO UNIVERSITY LIBRARIES. All use subject to https://www.ebsco.com/terms-of-use

118

FIGURE 2-3 Life Expectancy at Birth by World Bank Country Income Group, 2016

Data from The World Bank. (n.d.). Data: Life expectancy at birth, total (years). Retrieved from https://data.worldbank

.org/indicator/SP.DYN.LE00.IN?end=2016&locations=XD-XT-XN-XM&start=2016&view=bar

FIGURE 2-4 shows life expectancy by World Bank region. It reflects the points noted
previously, with sub-Saharan Africa and South Asia having the lowest life expectancy. It is also
important to note that the region with the highest life expectancy has a life expectancy that is 19
years, or about 30 percent, greater than the region with the lowest life expectancy.

EBSCOhost – printed on 8/20/2021 10:46 AM via OHIO UNIVERSITY LIBRARIES. All use subject to https://www.ebsco.com/terms-of-use

119

FIGURE 2-4 Life Expectancy at Birth by World Bank Region, 2016

Data from The World Bank. (n.d.). Data: Life expectancy at birth, total (years). Retrieved from https://data.worldbank

.org/indicator/SP.DYN.LE00.IN?end=2016&locations=Z4-ZG-8S-ZJ-Z7-ZQ&start=2016&view=bar

The is a measure of the risk of death that is associated with childbirth.maternal mortality ratio
Because these deaths are more rare than infant and child deaths, the maternal mortality ratio is
measured as “the number of women who die as a result of pregnancy and childbirth
complications per 100,000 live births in a given year.” The rarity of maternal deaths and
the fact that they largely occur in low-income settings also contribute to maternal mortality being
quite difficult to measure. Very few women die in childbirth in rich countries; for example, the
maternal mortality ratio in Sweden in 2016 was 4 per 100,000 live births. On the other hand, in
very poor countries, in which women have low status and where there are few facilities for
dealing with obstetric emergencies, the ratios can be over 700 per 100,000 live births, as they
were in 2016, for example, in the Central African Republic, Liberia, Nigeria, Somalia, and South
Sudan. In the worst-off country for maternal health, Sierra Leone, the maternal mortality ratio is
estimated to be 1,360 per 100,000 live births.

16(p28)

18

EBSCOhost – printed on 8/20/2021 10:46 AM via OHIO UNIVERSITY LIBRARIES. All use subject to https://www.ebsco.com/terms-of-use

120

FIGURE 2-5 gives the maternal mortality ratio by country income group, and FIGURE 2-6
shows the same data by World Bank region.

FIGURE 2-5 Maternal Mortality Ratio by World Bank Country Income Group, 2015

Data from The World Bank. (n.d.). Data: Maternal mortality ratio (modeled estimate, per 100,000 live births). Retrieved

from https://data.worldbank.org/indicator/SH.STA.MMRT?end=2014&locations=XM-XD-XT-XN&start=2014&view

=bar

EBSCOhost – printed on 8/20/2021 10:46 AM via OHIO UNIVERSITY LIBRARIES. All use subject to https://www.ebsco.com/terms-of-use

121

FIGURE 2-6 Maternal Mortality Ratio by World Bank Region, 2015

Data from World Bank. (n.d.). Data: Maternal mortality ratio (modeled estimate, per 1,000 live births). Retrieved from

https://data.worldbank.org/indicator/SH.STA.MMRT?end=2015&locations=Z4-8S-ZG-Z7-XU-ZJ-ZQ&start=2015

&view=bar

As suggested earlier, the pattern of the maternal mortality ratio, by both country income group
and region, is similar to that for life expectancy. However, the differences among regions and
country income groups are even greater. The low-income group, with the worst maternal
mortality ratio, has a 50 times greater ratio than the high-income group. Sub-Saharan Africa has
a ratio that is 42 times greater than in North America. Many people believe that the maternal
mortality ratio is the indicator that is most sensitive to a country’s overall development status
and best reflects the place of women in different societies.

EBSCOhost – printed on 8/20/2021 10:46 AM via OHIO UNIVERSITY LIBRARIES. All use subject to https://www.ebsco.com/terms-of-use

122

Another important and widely used indicator is the . The infant mortalityinfant mortality rate
rate is “the number of deaths of infants under age 1 per 1,000 live births in a given year.”
This rate is expressed in deaths per 1,000 live births. In other words, it measures how many
children younger than 1 year of age will die for every 1,000 who were born alive that year. Each
country seeks as low a rate of infant mortality as possible, but we will see that the rate varies
largely with the income status of a country. Afghanistan, for example, had an infant mortality
rate in 2016 of 53 infant deaths for every 1,000 live births, whereas in Sweden only about 2
infants die for every 1,000 live births. shows the infant mortality rate by countryFIGURE 2-7
income group. shows the infant mortality rate by World Bank region.FIGURE 2-8

FIGURE 2-7 Infant Mortality Rate by World Bank Country Income Group, 2016

Data from The World Bank. (n.d.). Data: Mortality rate, infant (per 1,000 live births). Retrieved from https://data

.worldbank.org/indicator/SP.DYN.IMRT.IN?locations=XD-XT-XN-XM

16(p28)

19

EBSCOhost – printed on 8/20/2021 10:46 AM via OHIO UNIVERSITY LIBRARIES. All use subject to https://www.ebsco.com/terms-of-use

<

Anatomy homework help

1. Discuss the roles of sodium, calcium and potassium ions in an generation of an action potential. 

2.  An action potential need to be generated prior to the synaptic communication between neuron cells. How will you explain what an action potential is to a 6 year child. 

3. Physically, marathon runners and body-builders look distinctively different. Discuss in detail how the training regiments of the afore-mentioned athletes affects the difference in the types of muscles fibers they have.  


Submission Instructions

Anatomy homework help

M4-A1 SOCIAL DETERMINANTS OF HEALTH IMPACT ANALYSIS

Purpose

The purpose of this assignment is to increase your knowledge of the link between social

determinants of health (SDOH) and a high priority health issue in the country chosen for the final

paper and to share that information with another health care provider.

Overview

Several factors come together to create an individual’s health status. The conditions in which

people are born, live, work, and age can be as influential in determining an individual’s health

status as the quality of diagnosis and treatment. Health care professionals need to understand the

influence of these underlying conditions to deliver the best health care possible. A good example

of how these factors are intertwined is the Carter Center’s work in eradicating the guinea worm

in Africa and Asia. To quote from the website:

When The Carter Center began leading the international campaign to eradicate Guinea
worm disease in 1986, there were an estimated 3.5 million cases in at least 21 countries in

Africa and Asia. Today, that number has been reduced by more than 99.99 percent. In
2020, 27* human cases of Guinea worm disease were reported worldwide. Between

January 1 and June 30 of 2021 five human cases have been reported.

https://www.cartercenter.org

One of the major strategies used to reach this goal was teaching individuals to filter drinking

water and to not go into water if infected. This was difficult for several reasons: (a) lack of

health care practitioners in the largely rural area, (b) the insecurity in some areas related to

conflict, and (c) cost of filtration equipment. The coordination of effort across several

organizations led to the success.

The group of factors included in the SDOH are: (a) economic stability, (b) education access and

quality, (c) social and community context, (d) health care access and quality, (e) neighborhood

and built environment. Review the resources listed in the Instructional Materials for this module

to learn more about the SDOH.

The focus of this assignment is twofold: (a) to strengthen your understanding of the impact of at

least one of the social determinants of health on a priority health issue in the country you have

chosen as the focus for the final paper and (b) to share that understanding with another health

care professional. You will write a 300-to-350 word paper plus an email (200-250 words) that

meet the following criteria:

SDOH Impact paper, continued

1. The paper will contain an introduction, a body, and a conclusion. An appropriately

formatted student paper title page must be included. See the relevant section of the APA

Publication Manual, 7th ed.

2. Provide a short description of the country.

3. Identify the (2 or 3) health issues with the highest priority in the chosen country.

Document these choices. Choose one as the focus for the rest of this document. Describe

the global health indicators you are using to identify the priority health issue.

4. Identify the SDOH that has the most impact on the chosen health issue. Be sure to fully

describe the SDOH and make the connection between it and the health issue very clear.

5. Include a minimum of three (3) references. One (1) reference must be a scholarly article.

References must be no more than five (5) years old. There are no exceptions to this

requirement. The Skolnik article may be used but does not count as one of the three

references. For this one paper the list of references does not need to be on a separate

page.

6. The email will begin two double spaces below the last reference. Start the reference with

the date. Format the rest of the email as described in the Instructional Materials section

of this module.

7. Direct the email to any healthcare provider who is NOT a nurse. Make sure that the

discipline of the healthcare provider is clear in the email. You do not know whether this

healthcare provider is or is not aware of the SDOH literature; consequently, SDOH

information must be provided without offending the healthcare professional.

• Provide a brief description of the concept of SDOH.

• Explain the link between the SDOH and the identified healthcare priority. It is

possible that more than one of the SDOH categories will be applicable.

• Support your choices with scholarly references. You must use a minimum of

three (3) references. These references may be the same as those used in the paper

part of this assignment if they are clearly appropriate. Again, the Skolnik article

may be used but does not count as one of the two required references.

• The length of the email is to be between 200 and 250 words.

CLICK on the link titled “M4-A1 SDOH Impact ANALYSIS/EMAIL Submission Area” to

submit the assignment.

Point Value: 25

Due Date: See Course Calendar/Checklist

See Rubric #5 for evaluation/grading guidelines

August 2021

Anatomy homework help

Title of your Presentation
Heading

• Bullet point info (don’t need to use the title of topic)

• Info…….

Heading

• Info

• Info…. As many of these as you need

Heading –

• Topic: info….

• Info….

• Info….

• Info….

• As many as you need

• Topic: info…..

• Info…..

• As many as you need

• Brainstem: info

• Info: as many as you need in style you want

• Midbrain-involved in auditory & visual responses & motor function

Heading
Topic – info ……

Topic – info ….

Topic-info in short bursts of words….

Topic- “

info always in short bursts of words….

DIAGRAM

**This is just a Fact Sheet example of MANY DIFFERENT styles you can use, that use the bullet point (not sentence style) formatting This is just to

give you an idea You can put boxes in whatever order you want, use the amount you want/need Come up with your style, etc At the end of

the day, make it look professional , make it legible, don’t use all caps, etc… Make it your own with all the required elements 🙂

Text as

you

need/

where

you need

to

Topic/Heading
• Info

• Info

• Info

• Info

• Info

• Info

Conditions/Heading
Topic – info

• Info

• Info

• Info

• Medication: Generic and example of brand name

• Info

Topic

• Info

• Info

• Medication: Generic and example of brand name

• Info

Topic

• Info

• Info

• Info

• Medication: Generic and example of brand name

• Info

References (also called Citations—either one is fine)

Lksdjflkjwlekrj all in APA format
Lwkerjlekrjelrkjelrkj
Lwkjerlkwjerljkwelrjk
Wejrlwkejrlwkerj
Lwkejrlwkerjlwerj
Alskdjfasldkfj
Sldkfjlsfjk
Lasdfkja;lsfjk
Alsdkjflsdfjk
Sdfjalsdkfj
Sdlfkjalsdfjkalsdf
Laskdfjlasdkfj
Lasdkjflasdfjk
Font can even be this small for the references

Hormones Secreted by _____________

• Hormone Name – quick summary phrase on its function

• >>>>

• >>>>

• >>>>

• >>>>>

Remember, this was all just an example,
not required, style.

Group members Names

Anatomy homework help

Rubric #3, Business Letter to NGO (M3-A1)

Remember to use the criteria in each column to assist you in meeting the criteria for the assignment.

Criteria
20 points

Accomplished Proficient Needs Improvement Unacceptable

Organization/thesis

5 points maximum

*Letter well
organized
*Clear introduction
*Clear purpose
*Well-developed
body and conclusion

Missing one of the
four (4) elements

*Missing two (2)
elements
*Lacks a cohesive
argument

*Missing three (3) or
more elements
*No clear argument

Content

8 points maximum

*Easily read coverage
of all major points
* Purpose is clearly
stated, attainable,
and fundable
*References are
appropriate &
suitably placed

*Coverage of most of
the major points
*Purpose is vague
but has potential to
be attainable and
fundable
*References are
appropriate; one is
suitably placed

*Missing two (2) or
more of important
points
*Purpose not clear &
no indications of how
would be attained or
fundability
*References present

*Missing three (3) or
more of important
points
*Totally misses the
point of this
assignment
*References missing

MUGS
3 points maximum

*No more than two
(2) MUGS errors

*Three (3) to five (5)
MUGS errors

Six (6) to eight (8)
MUGS errors

More than eight (8)
MUGS errors

Audience

4 points maximum

*No errors in suitable
tone and language
for the format
*Use of culturally
appropriate
references
*Language
unambiguous and
unlikely to be
misunderstood

*One (1) or two (2)
errors in use of tone
and language
*No use of
appropriate cultural
reference when
needed
*Mostly clear & likely
to be understood

*Tone and language
are not inappropriate
BUT one or the other
or both are too
informal
*Appropriate cultural
reference is not used
(if needed)
*Not very clear and is
easily misunderstood

*Tone and language
are inappropriate
*No evidence of
cultural
appropriateness
*Easily
misinterpreted or
misunderstood

Interpretation of Final points Accomplished: 20.00 – 18.01
Proficient: 18.00 – 16.01
Needs Work: 16.00 – 14.01
Unacceptable: Less than 14 points

Anatomy homework help

Please read

Purpose

The purpose of this assignment is to increase your knowledge of the link between social determinants of health (SDOH) and a high priority health issue in the country chosen for the final paper and to share that information with another health care provider.

Overview

Several factors come together to create an individual’s health status. The conditions in which people are born, live, work, and age can be as influential in determining an individual’s health status as the quality of diagnosis and treatment. Health care professionals need to understand the influence of these underlying conditions to deliver the best health care possible. A good example of how these factors are intertwined is the Carter Center’s work in eradicating the guinea worm in Africa and Asia. To quote from the website: 

When The Carter Center began leading the international campaign to eradicate Guinea worm disease in 1986, there were an estimated 3.5 million cases in at least 21 countries in Africa and Asia. Today, that number has been reduced by more than 99.99 percent.  In 2020, 27* human cases of Guinea worm disease were reported worldwide. Between January 1 and June 30 of 2021 five human cases have been reported. 
https://www.cartercenter.org
 

One of the major strategies used to reach this goal was teaching individuals to filter drinking water and to not go into water if infected.  This was difficult for several reasons:  (a) lack of health care practitioners in the largely rural area, (b) the insecurity in some areas related to conflict, and (c) cost of filtration equipment.  The coordination of effort across several organizations led to the success.

The group of factors included in the SDOH are: (a) economic stability, (b) education access and quality, (c) social and community context, (d) health care access and quality, (e) neighborhood and built environment. Review the resources listed in the Instructional Materials for this module to learn more about the SDOH.  

Instruction

The focus of this assignment is twofold: (a) to strengthen your understanding of the impact of at least one of the social determinants of health on a priority health issue in the country you have chosen as the focus for the final paper and (b) to share that understanding with another health care professional.  

You will write a 300-to-350 word paper plus an email (200-250 words) that meet the following criteria:

· The paper will contain an introduction, a body, and a conclusion.  An appropriately formatted student paper title page must be included.  See the relevant section of the APA Publication Manual, 7th ed.

· Provide a short description of the country.

· Identify the (2 or 3) health issues with the highest priority in the chosen country.  Document these choices.  Choose one as the focus for the rest of this document. Describe the global health indicators you are using to identify the priority health issue.

· Identify the SDOH that has the most impact on the chosen health issue.  Be sure to fully describe the SDOH and make the connection between it and the health issue very clear. 

· Include a minimum of three (3) referencesOne (1) reference must be a scholarly article. References must be no more than five (5) years old.  There are no exceptions to this requirement. The Skolnik article may be used but does not count as one of the three references.  For this one paper the list of references does not need to be on a separate page. For this one paper the list of references does not need to be on a separate page. List the references (using correct APA 7th edition format) after the body of the paper. See the format for the structure of this assignment in the Instructional Materials folder 
click here.
 

· The email will begin two double spaces below the last reference for the body of the paper. Start the email with the date. Format the rest of the email as described in the instructions for this assignment.

· Direct the email to any healthcare provider who is NOT a nurse.  Make sure that the discipline of the healthcare provider is clear in the email.  You do not know whether this healthcare provider is or is not aware of the SDOH literature; consequently, SDOH information must be provided without offending the healthcare professional.

. Provide a brief description of the concept of SDOH.

. Explain the link between the SDOH and the identified healthcare priority.  It is possible that more than one of the SDOH categories will be applicable. 

. Support your choices with scholarly references. You must use a minimum of three (3) references. These references may be the same as those used in the body of the paper if they are clearly appropriate. Skolnik may be used but does not count as one of the three (3) references.

. The length of the email is to be between 200 and 250 words.

Anatomy homework help

12 ways bad web design can hurt your online
business
Schiff, Jennifer Lonoff . CIO ; Framingham (Mar 2, 2017).

ProQuest document link

ABSTRACT (ENGLISH)
[…]whether you hire a professional web designer or plan to design your site yourself, if you want your online

presence to look professional – and keep potential customers from bouncing – avoid these web design no-nos.

Having an inconsistent style “If your site has a dissonant color palette, does not follow typographical best

practices ([regarding] kerning, leading, tracking, etc.) or uses inconsistent typography [multiple fonts and font

sizes], it will not project professionalism to your audience,” and it will likely turn off prospective customers, says

Pamela Webber, CMO, 99designs. Not making your logo clickable/go to the home page “According to KoMarketing,

36 percent of visitors will click the company logo to reach the home page,” says Laura Casanova, creative director,

ONTRAPORT. Using obviously fake or stock images “While the use of stock photography may enhance elements of

your website’s design, using these photos to represent your people [or products can come across as cheesy or

inauthentic],” says Russell Frazier, digital marketing specialist, Visigility. Legal disclaimers will still be allowed, of

course, but [sites] trying to get your email address before allowing you to read a blog post [or whatever content you

were searching for] may start to [see a] drop…

FULL TEXT
Today, thanks to a number of DIY tools and services, just about anyone can design a website. But that doesn’t

mean everybody should. However, whether you hire a professional web designer or plan to design your site

yourself, if you want your online presence to look professional – and keep potential customers from bouncing –

avoid these web design no-nos.

[ Related: 8 keys to ecommerce success ]

1. Using a splash page

“Splash and [entrance] pages really have no value in today’s online world,” says Janyer Dominguez, vice president

of web development, iPartnerMedia. “They [just] run up your website’s bounce rate because users can’t

[immediately] find what they’re looking for, so they [leave].”

Instead of using a splash page, “your website should have a standard home page,” he says. “If you want to

communicate a message or trigger an interaction, then use a modal or popup window. Using a standard home

page [also] helps with SEO.”

2. Having an inconsistent style

“If your site has a dissonant color palette, does not follow typographical best practices ([regarding] kerning,

leading, tracking, etc.) or uses inconsistent typography [multiple fonts and font sizes], it will not project

professionalism to your audience,” and it will likely turn off prospective customers, says Pamela Webber, CMO,

99designs. To avoid style conflicts and create a consistent look for your web or ecommerce site, “be sure to create

a brand style guide first and follow it consistently throughout your website design.”

3. Confusing navigation

Don’t make it hard for visitors to navigate your site and find what they are looking for quickly (in just a click or two).

Keep navigation simple by using a horizontal menu with short descriptive labels (typically no more than seven

items) across the top of each page, with one level of dropdown menus. Also, be sure to include a search box at the

top of each page, either in the upper-left or upper-right corner.

[ Related: 5 digital retail trends that will be big in 2017 ]

4. Not making your logo clickable/go to the home page

“According to KoMarketing, 36 percent of visitors will click the company logo to reach the home page,” says Laura

Casanova, creative director, ONTRAPORT. But if the logo isn’t clickable, they may think the site is broken and leave.

“To easily make your logo clickable, just put your <img> tag between an opening <a> tag and a closing </a> tag,

and it becomes active and clickable.”

5. Using too many (big) images (or animations or videos)

“Images [and animations and videos] are weighty, and too many on a web page can significantly slow down your

site,” says Webber.

And “an Adobe study found that 39 percent of people will stop engaging with a website if the images take too long

to load,” says Casanova. “At the risk of losing almost half your visitors, use a free online image optimizer, such as

Optimizilla, to reduce your image’s pixel count without compromising quality, ensuring a shorter load time for

visitors.”

You should also consider “offering optimized/lightweight versions of pages for those with slow connections,” says

Webber.

6. Using graphics for text

“All text on a website should be crawlable by search engine bots,” says Dominguez. However, “having images as

text prevents search engines from crawling your website, which in turn will reflect negatively on your SEO. Images

as text will also make your website slower. [So] refrain from using images as text at all cost.”

[ Related: 6 things retail CIOs need to keep in mind in 2017 ]

7. Using obviously fake or stock images

“While the use of stock photography may enhance elements of your website’s design, using these photos to

represent your people [or products can come across as cheesy or inauthentic],” says Russell Frazier, digital

marketing specialist, Visigility. “We all know the smiling lady with the headset does not work for you. Pull out your

own camera or hire a local photographer to take real photos of your team [and products]. Your prospective

customers will find this far more authentic” and will be more likely to trust and buy from you.

8. Not embracing white space

“By using white space, your content delivers a greater impact to the reader,” says Sarah Matista, marketing

manager, Vistaprint Digital. “We’ve all seen sites that are chock full of text and graphics. They’re distracting, and

you end up retaining very little, if any, information. That’s the opposite of your website’s purpose. [Instead] use

discretion and include more white space.”

9. Having automated music or sound

“Sites should not have automated music or sound,” states Ed Brancheau,CEO, Goozleology. “Yes, it’s sometimes

okay to have a video be automated to catch the visitor’s attention, but automated audio is jarring and problematic.

In split tests that we ran, automated audio so drastically reduced on-page time that we never even consider it

anymore.”

10. Overusing interstitials

“Interstitials are web pages displayed before or after an expected content page,” says Adam Gingery, SEO

specialist and copywriter, DMi Partners. “Not only are interstitials unbelievably annoying, but Google recently

announced a penalty for overly intrusive interstitials. Legal disclaimers will still be allowed, of course, but [sites]

trying to get your email address before allowing you to read a blog post [or whatever content you were searching

for] may start to [see a] drop in [their] rankings,” and an increase in their bounce rate.

“Stuffing a page with too many interstitials – [whether] full-screen, po