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Biology

Pediatric Assessment of an Infant

Malay Blojay, Cristen Schultz, Sarah Hess, Seaneh Yancy

General Survey

General appearance, well flexed arms and legs, normal skin color

Full range of motion, inspect for spontaneous movements

Does the infant appear well-fed? Do they smell and look well bathed?

Does the infant respond to environmental stimuli?

Vital Signs

Normal Vital Signs for Infants:

HR: 100-160 bpm

RR: 30-60 bpm (0-6months) 24-30 bpm (6-12 months)

BP: 65-90/45-65 mmHg (0-6 months) 80-100/55-65 mmHg (6-12 months)

Temp: 97.8 F-99.5 F (Axillary)

How do you measure them?

HR: Radial

RR: Count breaths over 30 seconds or 1 minute

BP: Upper arm is most accurate

Temp: Axillary is easiest with infants

Neurological

How do you assess the level of alertness, affect, and responsiveness

01

What are the age appropriate fine and gross motor coordination, strength, and reflexes

02

How do you assess the 12 cranial nerves for the age group

03

Integumentary

Assess for color, texture, temperature nails, and rashes.

Common, normal benign papular lesions:

Erythema Toxicium- flesh colored papule on a red base

Resolves within 1st week

Pustular melanosis- pustules without erythema, can rupture

If rupture, lasts for months

Both found on face and trunk

Milia- white papules

Resolve within first few weeks

Found on nose 

Luango- fine hair.           

https://www.ncbi.nlm.nih.gov/books/NBK558943/ 

measure

HEENT

Head

Observe appearance, shape, and symmetry 

Soft-spots (fontanels)

Measure circumference

Ears

Assess formation, color, tympanic membrane, and canal.

Eyes

Assess pupil size, shape, accommodating to light, and discharge

Nose

Nares patent, symmetric septum, and discharge 

Throat

Tonsil size, mucosa, epiglottis, and voice

https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=90&ContentID=P02336 

Respiratory

1.Observe for chest expansion of the infant

2.Observe for symmetrical movements, appropriate chest diameter

3.Auscultate for wheezing, stridor, cough, grunting

4.Inspect nose for patency

5.Assess work of breathing

  -Rate

 -Head bobbing

-Retractions

-Nasal Flaring

Cardiovascular

Abdominal

Assess

Respirations

Abdomen shape- dome shaped

Bilateral equal femoral pulses

Voiding within 24 hours of birth

Auscultate 

Bowel sounds within 2 hours of birth 

Palpate

Abdomen should be soft

https://www.duq.edu/academics/schools/nursing/newborn-assessment/chest 

Genitourinary

For male and female

Musculoskeletal

https://www.youtube.com/watch?v=U8yWdmnFoFQ 

Video link of an assessment on (age range)

 I(2022

References

Gantan, Elizabeth, F. (2021). National Library of Medicine. Neonatal Evaluation.

Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK558943/ (2022). University of 

(2021). Rochester Medical Center. Assessments for Newborn Babies. Retrieved from: https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=90&ContentID=P02336 

(2021) Duquesne Univeristy. Chest and Abdomen. Retrieved from: https://www.duq.edu/academics/schools/nursing/newborn-assessment/chest 

Jarvis, C. (2016). Physical Examination & Health Assessment. Elsevier. 

Biology

MD III

Afternoon Simulation

Vincent Brody- COPD with Spontaneous Pneumothorax

The below activities are required to be completed before you arrive to simulation. Completing the below criteria is your “ticket to enter” the simulation. Please have all prework completed by Monday at 2359. Anyone that does not submit the clinical prep work will receive a failure for the simulation experience. Submitting this completed clinical document prior to simulation is important in order to be prepared for the clinical day. If this prep work is not completed, you will not be allowed to participate in the simulation (please be advised that simulations are limited, so make-up is not an option. If the simulation is not completed for this course you will fail to meet the objectives and not pass this course-both lecture and clinical).

Describe the Pathophysiology of a Pneumothorax? What are causes of a pneumothorax? What are the different types of pneumothorax? (Include at least 5 sentences along with in-text citations.) (30 minutes)

1. Complete the Pathophysiology diagram below by using the ATI Med/Surg ebook or your Ignatavicius Med-Surg Text located in your lecture course shell regarding COPD. (See Chapters 28 & 30, pg. 539, pp. 637-638 in Ignatavicius Med/Surg Book for more information.) (1hr)


References:

COPD

(define)

Health Promotion and Disease Prevention:

[Text]

Risk Factors

Document two Nursing Diagnosis and two Goals for your client:

[Text]

[Text]

Lab Tests/ Diagnostics

[Text]

Nursing Interventions

[Text]

Client Education

Medications (list only)

[Text]

Multidisciplinary Care

Possible Complications

[Text]

[Text]

[Text]

Biology

MD III

SIM DAY 1- Morning Simulation

Jennifer Hoffman- Acute Severe Asthma

The below activities are required to be completed before you arrive to the simulation. Completing the below criteria is your “ticket to enter” the simulation. Please have all pre-work submitted by Monday at 2359 prior to the simulation day. If this is not completed, you will not be allowed to participate in the simulation (please be advised that simulations are limited, so make-up is not an option. If the simulation is not completed for this course you will fail to meet the objectives and not pass this course-both lecture and clinical).

Complete the Pathophysiology diagram below by using the ATI Med/Surg ebook or your Ignatavicius Med-Surg Text located in your lecture course shell regarding Status Asthmaticus. (chapter 30) (1hr)


1. Complete the table below (1hr)

Complete the table below on medications using a Drug eBook.

Graphical user interface, text, application  Description automatically generated

Drug Name

Indications

Pharmacokinetics

Contraindications/Precautions

Nursing Implications

Implementation

Patient/family teaching

Evaluation

Albuterol 5mg in 3 mL

Ipratropium Bromide 0.5mg in 2.5mL normal saline via nebulization

Methylpred-nisolone IV 125mg

2. Complete the table below (30 min.)

Complete the table below on lab values using the Lab and diagnostic ebook (example below).

Graphical user interface, text  Description automatically generated with medium confidence

Lab Name

Rationale

Normal Ranges

Indications

Nursing Implications

ABG Analysis (What are normal results?)

pH:

CO2:

HCO3:

What ABG findings would you expect with hyperventilation?

What ABG findings would you expect with hypoventilation?

References:

Status Asthmaticus

(define)

Health Promotion and Disease Prevention:

[Text]

Risk Factors

Document two Nursing Diagnosis and two Goals for your client:

[Text]

[Text]

Lab Tests/ Diagnostics

[Text]

Nursing Interventions

[Text]

Client Education

Medications (list only)

[Text]

Multidisciplinary Care

Possible Complications

[Text]

[Text]

[Text]

Biology

BIOLOGY 1406

Remember when I suggested you all place a dry hand under the Dyson hand dryer to see if the air starts out hot even though it normally feels cold when your hands are wet? Whether you did try it or not, explain how the chemical structure of water molecules and the types of bonds the water molecules form and break causes the air to feel cold when your hands are wet even though the air itself it actually hot. Make sure to describe this clearly using terms learned in Chapter 2 about the types of bonds and energy involved.

Explain why carbon atoms always form 4 covalent bonds when they are part of molecules. Make sure to explain fully terms about atoms and bonding learned from chapter 2.

Starch and cellulose are both polysaccharides made from the same monomer: glucose. Each is a long polymer chain of glucose monomers attached to one another, but somehow these two polysaccharides are able to perform very different functions in a plant. Explain how starch and cellulose are different at a structural level, and how these differences allow them to perform such different functions (make sure to tell me what those functions are).

Describe the structure and function of a phospholipid. In your response, make sure to describe the parts that compose a phospholipid, the name of the covalent bond between these monomer parts, and explain how this structure allows phospholipids to perform their function in living cells using terms like polar/nonpolar and hydrophobic/ hydrophilic. You may draw a figure to help you answer the question, but a drawing alone is not an explanation-you must explain it..

Biology

Find a movie, TV series, novel, short story (fiction or nonfiction) or even real-life experience that you think demonstrates NATURAL SELECTION in action. Examples I gave in the lecture are excluded. You have to come up with your own scenario from what you watched.

Based on the story you watched, identify the population undergoing natural selection, selection agent & adaptation of individuals in the population. Predict the future characteristics of the individuals in the evolving population in response to the selection agent.

    • 2

    Biology

    Read this short article. 

    https://www.livescience.com/16493-people-planet-earth-support.html (Links to an external site.)

    Evaluate their basis in coming up with the carrying capacity value and then decide whether you agree or disagree with their estimate of earth’s carrying capacity for humans.

    Base your opinion on your own understanding of the concept of “carrying capacity” & your understanding of human’s way of life. Consider human “quality of life” or “standard of living” factor when you answer the question yourself.  

      • 3

      Biology

      You may send your answers only, as long as the problems they refer to are clear. 

      1. Carbon-14 has atomic number 6 and mass number 14. How many protons, neutrons and electrons

      does it have?

      ______ protons, ______ neutrons, ______ electrons

      For 2-3, choose among the following and write the number.

      (1) Hydrogen bond (2) ionic bond (3) covalent bond

      2. What kind of bond is the polypeptide bond between amino acids in proteins? ______

      3. What kind of bond is effective between two strands of DNA? ______

      4. [True or False?] The amino acid Alanine, which has CH3 as the side chain, is likely to be exposed to

      water. True _____ False _____

      5. What kind of biological molecules perform essential life functions such as catalysis, molecular

      transport, communication and cell structure? ______

      (1) Carbohydrate (2) lipids (3) proteins (4) nucleic acids

      For 6-7, choose from the following and write the number.

      (1) nucleus (2) Golgi body (3) ribosome

      6. DNA are enclosed in this part of the cell. ______

      7. Protein synthesis happens here. ______

      8. What is the basic building unit of proteins? _____

      (1) ribose sugar (2) nucleotide (3) fatty acid (4) amino acid

      For 9-11, choose from the following and write the number.

      (1) Primary structure (2) secondary structure (3) tertiary structure

      9. alpha helix and beta sheet _____

      10. amino acid sequence of proteins _____

      11. three dimensional folding of proteins _____

      12. If a segment of DNA reads as 5’ – TTTGCCAAAA – 3’, what would be the sequence of

      corresponding portion of the other strand of the DNA? ______________________________

      13. If a segment of DNA reads as 5’ – TTTGCCAAAA – 3’, and is transcribed into mRNA, what would

      be the sequence of that mRNA? ______________________________

      14. [True or False?] Meiosis preserves the number of chromosomes. True _____ False _____

      For questions 15-20, refer to the following and use the number 1-5 for your answer.

      (1) anaphase (2) prophase (3) telophase (4) cytokinesis (5) metaphase

      15. Arrange (1) to (5) in the correct order of occurrence during Mitosis (for example, 1,2,3,4,5)

      ______________________________

      16. Chromosomes unfold and nuclei reappear around them in this step _____

      17. Chromosomes align themselves along the mid-plane of the cell in this step. _____

      18. The cell physically divides into two daughter cells in this step. _____

      19. Chromosomes separate in a well-choreographed manner in this step. _____

      20. DNA condense to chromosomes and mitotic spindles appear in this step. _____

      Biology

      at SciVerse ScienceDirect

      Social Science & Medicine 74 (2012) 1754e1764

      Contents lists available

      Social Science & Medicine

      journal homepage: www.elsevier.com/locate/socscimed

      Feeding her children, but risking her health: The intersection of gender,
      household food insecurity and obesity

      Molly A. Martin*, Adam M. Lippert
      Pennsylvania State University, 211 Oswald Tower, University Park, PA 16802, United States

      a r t i c l e i n f o

      Article history:
      Available online 20 December 2011

      Keywords:
      Overweight
      Obesity
      Gender
      Food insecurity
      Parenting
      Income
      USA

      * Corresponding author. Tel.: þ1 814 863 5508.
      E-mail address: mmartin@pop.psu.edu (M.A. Mart

      0277-9536/$ e see front matter � 2012 Elsevier Ltd.
      doi:10.1016/j.socscimed.2011.11.013

      a b s t r a c t

      This paper investigates one explanation for the consistent observation of a strong, negative correlation in the
      United States between income and obesity among women, but not men. We argue that a key factor is the
      gendered expectation that mothers are responsible for feeding their children. When income is limited and
      households face food shortages, we predict that an enactment of these gendered norms places mothers at
      greater risk for obesity relative to child-free women and all men. We adopt an indirect approach to study
      these complex dynamics using data on men and women of childrearing age and who are household heads or
      partners in the 1999e2003 waves of the Panel Study of Income Dynamics (PSID). We find support for our
      prediction: Food insecure mothers are more likely than child-free men and women and food insecure fathers
      to be overweight or obese and to gain more weight over four years. The risks are greater for single mothers
      relative to mothers in married or cohabiting relationships. Supplemental models demonstrate that this
      pattern cannot be attributed topost-pregnancy biological changes thatpredispose mothers toweight gain or
      an evolutionary bias toward biological children. Further, results are unchanged with the inclusion of physical
      activity, smoking, drinking, receipt of food stamps, or Women, Infants and Children (WIC) nutritional
      program participation. Obesity, thus, offers a physical expression of the vulnerabilities that arise from the
      intersection of gendered childcare expectations and poverty.

      � 2012 Elsevier Ltd. All rights reserved.

      Scholars argue that it takes money to maintain a healthy weight
      in America’s obesogenic environment (Poston & Foreyt, 1999)
      because healthy food is relatively expensive and calorie-dense,
      nutrient-poor food is cheap (Drewnowski & Specter, 2004).
      Although weight is a function of both caloric intake and expendi-
      ture, materialist arguments focus on the costs of food and predict
      greater caloric intake and consequent body fat among low versus
      high income people (Glass & McAtee, 2006). In the U.S., there is
      a strong, negative correlation between income and the likelihood of
      being overweight or obese, but only among women; this is not
      observed among men (for reviews, see McLaren, 2007; Sobal &
      Stunkard, 1989). This sex difference is puzzling, particularly to
      scholars who look beyond individual explanations to consider the
      role of shared environments for health because the majority of men
      and women live together (Casper & Bianchi, 2002) and share
      socioeconomic resources and weight-related behaviors (French,
      Story, & Jeffery, 2001; Mitchell et al., 2003). Given these common-
      alities, one would expect greater similarity between the sexes.

      We hypothesize that the key distinction is not between all
      women and all men, but between mothers and non-mothers. We

      in).

      All rights reserved.

      argue that the confluence of two factors e the experience of food
      insecurity and the gendered nature of childcare e intersect and
      contribute to the observed sex differences in the association of
      income and body weight. Food insecurity is highly correlated with
      poverty (Sarlio-Lähteenkorva & Lahelma, 2001) and occurs when
      a household faces budgetary constraints that limit the quantity or
      quality of food they can purchase (Wunderlich & Norwood, 2006).
      Yet food insecurity is a “managed process” (Radimer, 1990),
      meaning that families strategize and diligently work to avoid
      hunger. That responsibility, however, falls more heavily on women
      given traditional discourses about family life and “women’s work”
      that place greater expectations on women for feeding and
      nurturing their family, especially when children are present
      (DeVault, 1991). Given that food insecurity is correlated with poor
      dietary behavior and obesity (for a review, see Institute of Medicine,
      2011), we assert that food insecurity mediates the association
      between income and weight, but that the management of food
      insecurity intersects with gender to create differential risks for
      obesity between mothers and non-mothers.

      To investigate these dynamics, we study men and women of
      childrearing ages (i.e., 18e55) who are heads or partners of U.S.
      households in the 1999, 2001 and 2003 waves of the Panel Study of
      Income Dynamics (PSID). We test whether the association between

      M.A. Martin, A.M. Lippert / Social Science & Medicine 74 (2012) 1754e1764 1755

      household food insecurity and the likelihood of being overweight
      or obese differs across groups defined by sex and parenthood in
      cross-sectional models of weight status and longitudinal models of
      weight change. We also examine how partner co-residence further
      moderates these processes due to the gendered norms about
      parental custody (Coltrane & Adams, 2003) and the greater prev-
      alence of food insecurity among single parents (Rose, Gundersen, &
      Oliveira, 1998).

      Food insecurity and weight

      Household food security exists along a continuum but can be
      categorized into a four-point ordered scale: food secure, food
      insufficiency, low food security, and very low food security (Bickel,
      Nord, Price, Hamilton, & Cook, 2000; Wunderlich & Norwood,
      2006). Most Americans are food secure, but some face food insuf-
      ficiency, meaning, they worry about having enough money to buy
      food for the month, but actually make no or few changes to their
      diet (Wunderlich & Norwood, 2006). Food insecurity occurs when
      those fears become a reality. Low food security, or not having the
      means to buy the kinds of food desired, reduces the quality and
      variety of people’s diets (Wunderlich & Norwood, 2006). Very low
      food security occurs when people do not have the means to buy the
      quantity of food needed and leads people to skip meals and reduce
      their food intake (Wunderlich & Norwood, 2006). Those with either
      “low food security” or “very low food security” are considered “food
      insecure” (Wunderlich & Norwood, 2006). In 2009, 14.7% of U.S.
      households were food insecure (Nord, Coleman-Jensen, Andrews, &
      Carlson, 2010), while in 2003, the year corresponding to our study,
      the prevalence was 11.2% (Nord, Andrews, & Carlson, 2004).

      Because poverty predicts food insecurity (Sarlio-Lähteenkorva &
      Lahelma, 2001), there are several parallels found in research on the
      roleof food security for body weight. Keyamong them are consistent
      sex differences, such that low food security is linked to being over-
      weight (Adams, Grummer-Strawn, & Chavez, 2003; Dinour, Bergen,
      & Yeh, 2007; Lyons, Park, & Nelson, 2008; Townsend, Peerson, Love,
      Achterberg, & Murphy, 2001) and gaining 5 pounds or more in one
      year (Wilde & Peterman, 2006), but only among women. Very low
      food security is associated with being underweight, but again only
      for women (Wilde & Peterman, 2006).

      Several studies suggest that food insecurity is linked to over-
      weight and obesity due to management strategies people adopt in
      the face of economic constraints. Food insecure individuals are
      more likely to consume high-calorie but nutritionally-poor food to
      avoid feelings of hunger (Dixon, Winkleby, & Radimer, 2001;
      Drewnowski & Specter, 2004; Kirkpatrick & Tarasuk, 2008), eat
      irregular meals or skip breakfast (Kempson, Keenan, Sadani, Ridlen,
      & Rosato, 2002; Ma et al., 2003), and consume less milk, fruit and
      vegetables, especially later in the month (Tarasuk, McIntyre, & Li,
      2007). According to public health and nutrition research, these
      dietary practices are associated with being overweight (Ledikwe
      et al., 2006; Ma et al., 2003) and weight gain (Berkey, Rockett,
      Gillman, Field, & Colditz, 2003). In the next section, we detail
      how the management of food insecurity is gendered.

      Gender, childcare, and food insecurity management

      Traditional discourses about “family” life and “women’s work”
      since the industrial revolution include expectations that women
      are responsible for caring for their family members and managing
      household tasks (Rothman, 1978; Sokoloff, 1980). When children
      are present in the home, those responsibilities multiply (Hays,
      1998) and the gendered division of household labor becomes
      more unequal (Coltrane, 2000). For example, there is greater
      gender equity in the total number of hours spent on housework in

      child-free cohabiting and married couples than among similar
      couples with children (Sanchez & Thomson, 1997; South & Spitze,
      1994). Therefore, mothers are more likely to be subjected to,
      internalize, and reflect traditional gender expectations about their
      roles and responsibilities than child-free women.

      A key feminine responsibility is “feeding the family,” which
      requires a series of tasks: meal planning, monitoring the supply of
      household provisions, shopping, cooking, and cleaning (DeVault,
      1991). Beyond the practical goals, “feeding the family” also
      sustains children’s emotional needs for love, support and security
      (DeVault, 1991).

      In food insecure homes, mothers work hard to prevent hunger
      amongst their children. In a qualitative study with frequently food
      insecure young mothers, all insisted that their children only expe-
      rienced food insufficiency because they adopted several strategies
      to protect them (Stevens, 2010), including prioritizing their chil-
      dren’s needs over their own (McIntyre et al., 2003; Stevens, 2010). As
      DeVault notes “[t]hese women seem to be expressing a heightened
      sense of the more widespread notion that’s women’s own food is
      less important than that prepared for others” (1991, p.199). As one
      woman in a cash-strapped household noted: “If it gets down to it, we
      buy to feed the kids” (DeVault, 1991, p.191).

      To manage food insecurity, mothers adopt a variety of strategies.
      Some strategies focus on grocery shopping, like buying in bulk,
      shopping at different stores to get the best prices, or using coupons
      (DeVault, 1991; Wiig & Smith, 2008). Other strategies involve
      mothers’ food intake. Food insecure mothers skip meals, wait to eat
      until later in the day, or eat less to spare their children from hunger
      and nutritional deprivation (Badun, Evers, & Hooper,1995; DeVault,
      1991; McIntyre, Connor, & Warren, 2000; McIntyre et al., 2003). As
      a result, women in food insecure households are at risk of nutrient
      deficiencies in Vitamin A, folate, iron, and magnesium (Tarasuk &
      Beaton, 1999). We suspect that these behavioral patterns under-
      gird the unexplained sex differences in the association between
      food insecurity and weight (Adams et al., 2003; Dinour et al., 2007;
      Lyons et al., 2008; Olson, 1999; Townsend et al., 2001; Wilde &
      Peterman, 2006) and why food insecurity is typically not corre-
      lated with children’s weight (Gundersen, Garasky, & Lohman, 2009;
      Martin & Ferris, 2007), but for an exception see Gundersen and
      Kreider (2009). Unfortunately we do not have direct measures on
      people’s dietary behavior or food insecurity management practices
      to fully explore this sequence, but we do have the requisite data to
      test our primary hypothesis:

      H1. There is a statistically significant association between food
      insecurity and being overweight or obese for mothers, but not
      child-free women or all men.

      We know of only one paper about food insecurity and obesity
      that emphasizes parenthood. With a sample of parents (65% of
      whom were single mothers), Martin and Ferris (2007) found
      a positive association between food insecurity and obesity, but they
      did not explore whether there was a differential association
      between mothers and fathers. Therefore, the current analysis
      makes a significant contribution by offering an initial test of this
      hypothesis.

      The role of marriage and cohabitation

      We predict that the living arrangements of heterosexual men
      and women further condition the differences between mothers and
      non-mothers. Prior research demonstrates that caretaking duties
      among separated parents are largely performed by the custodial
      parent, typically the mother (Furstenberg & Cherlin, 1994;
      Marsiglio, Amato, Day, & Lamb, 2000). Therefore, the risks of
      overweight due to food insecurity should be exacerbated among

      M.A. Martin, A.M. Lippert / Social Science & Medicine 74 (2012) 1754e17641756

      single mothers and relatively lower for mothers in co-residential
      couple households. Likewise, single fathers should be at greater
      risk of obesity when they are food insecure. Unfortunately, we have
      too few single fathers in our data to fully explore this possibility
      because most single parents are single mothers (Casper & Bianchi,
      2002), reflecting a “community division of labor” (DeVault, 1991,
      p.193) whereby women routinely have custody after parents
      separate. Our second hypothesis is:

      H2. The association between food insecurity and being over-
      weight or obese is stronger for single mothers versus married or
      cohabiting mothers.

      It is important to note, however, that the causal relationships
      between overweight, family formation, union dissolution, and
      household food security are complex. In fact, the causal process
      could work in the opposite direction: Overweight women may be
      less likely to form unions and bear children given feminine beauty
      ideals emphasizing thinness (Allon, 1982).

      Alternative explanations

      We predict that food insecurity and its management increases
      the risks of overweight and obesity for mothers given the gendered
      expectations of childrearing. We recognize, however, that there are
      competing explanations and we do our best to address them.

      First, one may agree with our prediction but disagree with our
      interpretation. One may consider any observed risks for mothers as
      reflecting, not childrearing, but biological risks of childbearing. If
      metabolic changes related to pregnancy predispose birth mothers
      to gain weight, then food insecure biological mothers would be at
      greater risk of overweight and obesity than “social” mothers. Such
      differences could also arise if, due to evolutionary pressures,
      mothers are more protective of their biological children (Daly &
      Wilson, 1980). To test whether the experience of pregnancy or
      biological kinship creates unique risks, we conduct two supple-
      mental analyses. First, we restrict our sample to only women living
      with children (50% of the sample) and compare whether the risk of
      obesity for food insecure mothers is lower among women living
      with children they did not give birth to (i.e., they are adoptive, step,
      or foster mothers), controlling for the number of children present.
      Because most women live only with biological children, statistical
      power issues may limit our ability to detect a significant difference.
      Second, we restrict our sample to women who have ever given birth
      by 2003 and examine whether the risks of household food inse-
      curity increase as parity increases, regardless of whether their
      children currently live with her and controlling for her age and
      other demographic characteristics. Because 89% of the women in
      our sample have given birth by 2003, power is less of a problem in
      these analyses. If metabolic changes associated with pregnancy
      undergird our findings, then one would expect those risks to
      accumulate with each birth and, thus, translate into a statistically
      significant interaction between parity and food insecurity among
      biological mothers.

      Second, one might argue that the statistical association between
      food insecurity and overweight is a function of other sociodemo-
      graphic factors besides income. Thus, we control for status char-
      acteristics, like age, education and race/ethnicity in all models.

      Third, one might expect that other mediating factors explain
      these patterns, especially given that we do not have self-reported
      measures of energy intake or, even better, data from doubly-
      labeled water tests to measure their energy intake (Schoeller,
      1990). We test several alternative mechanisms. Because food
      insecure mothers may have fewer opportunities for recreational
      physical activity, we test whether differences in self-reported
      physical activity reduce the association between food insecurity

      and weight among mothers. We also test whether the consumption
      of alcohol or smoking cigarettes explains the observed patterns.
      Because of the stresses associated with poverty and food insecurity
      (Huddleston-Casas, Charnigo, & Simmons, 2009), which would
      likely feel more threatening to parents, food insecure parents could
      be more likely to self-soothe themselves with alcohol and nicotine.
      Yet these behaviors are associated with being overweight (Mokdad
      et al., 2003; Slattery et al., 1992). Lastly, given the longstanding
      debate about whether receiving food stamps (now officially the
      Supplemental Nutrition Assistance Program) increases the risks for
      overweight and obesity (Borjas, 2004; Gibson, 2003; Institute of
      Medicine, 2011), we test whether our results change with the
      inclusion of food stamps receipt. We also include a measure of
      participation in the Women, Infants and Children (WIC) nutritional
      program.

      In sum, we bridge several empirical literatures to develop a new
      theoretical model about how gendered patterns of childcare
      intersect with household economics to increase the risk of over-
      weight among poor, food insecure mothers. We recognize that
      there are several alternative explanations and, thus, do our best to
      test them with the available data. Our aim is to provide an initial
      examination of whether overweight and obesity are physical
      expressions of the vulnerabilities that arise from the intersection of
      gender, parenthood, and poverty.

      Data and methods

      Data

      We use data from the Panel Study of Income Dynamics (PSID)
      because it is the only study that collects data on individuals’ weight,
      income, household food insecurity, and household composition.
      Unfortunately, PSID does not have information about individual’s
      energy intake and food insecurity management.

      PSID is a longitudinal household-based study that began col-
      lecting data in 1968 for a nationally representative sample and an
      oversample of low-income, Southern households (Hill, 1992). The
      PSID contains longitudinal data for all individuals who were ever in
      a PSID household, even if they move out (Hill, 1992). Interviews
      since 1997 are conducted biennially. Given that the PSID has been
      fielded for almost 50 years, sample attrition could pose a problem,
      but several studies have found that attrition has not affected PSID’s
      representativeness (Becketti, Gould, Lillard, & Welch, 1988;
      Fitzgerald, Gottschalk, & Moffitt, 1998). PSID is not representative,
      however, of immigrant groups arriving in the U.S. after 1968.

      We make several restrictions to arrive at our analytic sample.
      First, we must rely on data collected in 1999, 2001, and 2003, the
      years in which PSID collected data on both weight and food inse-
      curity. Second, we restrict our analysis to those who were either the
      head of a PSID household or their marital or cohabiting partner in
      1999, 2001, and 2003 (n ¼ 9935) because PSID only collects data on
      body weight for those individuals. While this provides for
      a consistent sample across the various models, it makes the sample
      more selective with regard to family structure stability. Our
      substantive findings are unchanged, however, in analyses where
      the data are multiply imputed to include anyone who meets the
      restrictions listed below and was ever in the PSID between 1999
      and 2003, regardless of their relationship to the household head.
      Third, we restrict the analysis to heads and partners between the
      ages of 18 and 55 in 1999 (n ¼ 8151) to focus on adults most at risk
      for living with minor children and, thus, the hypothesized patterns.
      The next two restrictions eliminate outlier cases that would chal-
      lenge the statistical homogeneity of our analysis. Fourth, we drop
      those who report being foreign born (n ¼ 82) or who can be
      reasonably assumed to be foreign born because they have five or

      M.A. Martin, A.M. Lippert / Social Science & Medicine 74 (2012) 1754e1764 1757

      fewer years of completed schooling (and the minimum age of
      compulsory schooling in the United States is 16) (n ¼ 51). These
      individuals are unique in both unobserved and observed ways (i.e.,
      their means and correlations for food insecurity, number of chil-
      dren, marital status and weight differ significantly) because the
      PSID is not representative of immigrants. The absence of immi-
      grants reduces the prevalence of food insecurity in the study
      (Borjas, 2004). Fifth, we omit women who are pregnant at the time
      of the 2003 interview (n ¼ 85). Specifically, we omit women
      reporting a live birth in the PSID’s Childbirth and Adoption History
      File within 9 months following their 2003 interview date. After
      these restrictions, our sample is 7931 adults.

      Missingdata dueto item non-response is relatively minor in these
      data. There are actually no missing data for people’s sex, age, part-
      nership status, the number of co-residential children, urbanicity, and
      household income (because the PSID has imputed it). There is minor
      item non-response on food insecurity (n1999 ¼ 9, n2001 ¼ 11,
      n2003 ¼ 20), self-rated health (n2003 ¼ 86), race (n ¼ 129), and
      women’s fertility histories (n ¼ 36). The items with the most missing
      data are body mass index (n1999 ¼ 379 [4% of the original 9935
      sample], n2001 ¼ 257 [3%], n2003 ¼ 305 [3%]) and education
      (n2003 ¼ 596 [6%]). We utilize multiple imputation handle item non-
      response, which replaces missing values with predictions from
      information observed in the sample (Rubin, 1987). We use the
      supplemental program “ice” within STATA 11.0 (Royston, 2005a,b) to
      create five imputed data sets. The imputation models include all of
      the variables and their interactions that are used in the empirical
      models, as well as the respondent’s work status, occupation, and
      region (all in 2003), the number of adults in the household (in 1999,
      2001, 2003), whethertheylivewithayoungchild(ages0e5;in 2003)
      and whether PSID imputed their income. We estimate the empirical
      models for each imputed data set and then combine the results,
      accounting for the variance within and between the imputed
      samples to calculate the coefficients’ standard errors (Rubin, 1987).

      Measures

      Body weight
      We determine people’s weight classification in three steps. First,

      because PSID only has self-reported weight and because self-
      reported weight is generally biased downward among women and
      upward among men (Cawley & Burkhauser, 2006), we use the
      Cawley (2004; Cawley & Burkhauser, 2006) adjustments to improve
      the accuracy of our dependent variable. Specifically, we multiply
      respondents’ self-reported weight by race- and sex-specific coeffi-
      cients from Cawley’s regressions of measured weight on self-
      reported weight. Second, we calculate their body mass index
      (BMI) [weight (kg)/height2 (m2)] from their self-reported height and
      their Cawley-adjusted self-reported weight. Third, we follow World
      Health Organization (2000) guidelines to classify BMI into the
      following weight categories: underweight (BMI < 18.5), normal
      weight (18.5 � BMI < 25), overweight (25 � BMI < 30) and obese
      (BMI � 30). In the cross-sectional models, we predict whether
      a person is (1) normal weight or underweight, (2) overweight, or (3)
      obese in 2003. Because less than 2% of the sample is underweight,
      we cannot model underweight as a separate category. For the
      longitudinal models, we predict their weight change (in pounds)
      between 1999 and 2003, simply calculated as their Cawley-adjusted
      2003 weight minus their Cawley-adjusted 1999 weight.

      Household food insecurity
      We use the U.S. Department of Agriculture’s Food Security Scale

      (Bickel et al., 2000). Respondents were asked a sequential series of
      18 questions if they live with children and 10 questions if they do
      not. The different series are made equivalent (and thus orthogonal

      to the presence of children) in the final 10-point scale and cate-
      gorical measure of food security. Following the USDA’s guidelines,
      households are classified as food insecure (¼1) if they score a 2.2 or
      higher on the Food Security Scale (Bickel et al., 2000). We measure
      their household food insecurity in 2003 and create a longitudinal
      measure that counts the survey years with reported household
      food insecurity between 1999 and 2003 (values: 0, 1, 2, or 3).

      Sex
      Sex is a dichotomous indicator for whether the person is female

      (1 ¼ yes) or male.

      Children
      PSID participants report the number of children between the

      ages of zero and 17 years currently in the household, regardless of
      their biological relationship to the household head or their partner.
      We create a dichotomous measure indicating children are present
      (¼1) and a count of children present.

      We use the PSID’s Childbirth and Adoption History (1985e2007)
      data to create two variables. First, among those living with children
      in 2003, we determine whether the woman gave birth to every
      child present and create a dichotomous variable equal to one if she
      did not. Because very few women live with a mix of biological and
      non-biological children (N ¼ 14), the results primarily reflect
      whether women who did not give birth to any of the children
      present (N ¼ 307) are different. Second, we calculate the total
      number of children a woman has ever borne.

      In the longitudinal models, we use a variable that equals the
      differencebetween thenumberofchildrenpresentin2003and 1999.

      Partner co-residence
      To compare adults in different residential relationships, we

      estimate models separately for those who are single and those who
      are who are living with a romantic partner, whether married or
      cohabiting.

      Alternative mediating variables
      Supplemental models include the following variables, reported

      in 2003: being a “current smoker” (¼1), the number of alcoholic
      drinks consumed per day (0 ¼ none,1 ¼ less than one a day, 2 ¼ 1 to
      2 per day, 3 ¼ 3 to 4 a day, and 4 ¼ 5 or more a day), bouts of
      “heavy” physical activity during the last month (PSID-provided
      examples include aerobics, running, swimming, strenuous house-
      work), bouts of “light” physical activity during the last month
      (PSID-provided examples include walking, golfing, gardening,
      bowling), receipt of food stamps in 2001 (¼1), and receipt of WIC in
      2002 (¼1).

      Control variables
      To control for confounding variables, we include age (in years),

      education (in years of completed schooling), poor self-rated health
      (0 ¼ “good,” “very good,” or “excellent,” 1 ¼ “poor” or “fair”),
      disability status (1 ¼ at least one limitation in the Activities of Daily
      Living Scale, 0 ¼ none), and metropolitan residence (0 ¼ non-
      metropolitan area, 1 ¼ metropolitan area). Race is measured with
      three dichotomous variables to compare (1) non-Hispanic African
      Americans, (2) Hispanics, and (3) non-Hispanic other racial groups
      to non-Hispanic Whites (the reference category).

      Analysis

      For the cross-sectional analysis, we estimate several ordinal
      logistic regression models in STATA (v. 11) to predict 2003 weight
      categories. The results are substantively similar to those from
      multinomial logistic regression models. (Results available upon

      M.A. Martin, A.M. Lippert / Social Science & Medicine 74 (2012) 1754e17641758

      request.) For the longitudinal models, we make an additional data
      restriction. We omit people who report gaining (n ¼ 73 [averaged
      across imputations]) or losing (n ¼ 50 [consistent across imputa-
      tions]) at least 75 pounds in between 1999 and 2003 because such
      dramatic changes likely reflect a reporting error in either year or
      very unique weight-related experiences. We then use an OLS
      regression to predict their change in weight (in pounds) between
      1999 and 2003.

      All models include PSID 2003 sampling weights to account for
      the PSID’s attrition and oversampling of low-income Southern
      households and, thereby, make the findings generalizable to the
      2003 U.S.-born population. For ease of presentation, we present
      results stratified by sex, but we estimate supplemental models
      using a pooled sample of men and women to directly test whether
      the interaction between food insecurity and the presence of chil-
      dren is significantly different by sex.

      Results

      Table 1 presents weighted descriptive statistics for our full
      analytic sample and for men and women separately. Key among
      these is that over 60% of the sample is overweight or obese in both
      1999 and 2003. On average, women are more likely to be over-
      weight or obese in both years and women gain more weight
      between 1999 and 2003 (p < .01). In 1999, 6.8% of the sample was
      food insecure, while only 4.8% of the sample was food insecure in
      2003. These estimates are lower than the national averages for
      these years, reflecting our restriction to U.S.-born individuals. As
      such, our tests rely on the comparison of small subpopulations.
      There are 174 food insecure men (101 are fathers) and 293 food
      insecure women (196 are mothers). In 2003, the average sample
      member was 39 years old, which partially accounts for the
      observed decline in the proportion living with children between

      Table 1
      Sample means and percentages, weighted and adjusted for sampling design.

      Full sample (N ¼ 7931)
      1999 2003

      Weight, Cawley-adjusted self-report
      Body mass index 28.3 29.2
      Weight classification
      Underweight 1.1% 1.0%
      Normal weight (reference) 34.7% 30.1%
      Overweight 33.6% 33.6%
      Obese 30.6% 35.3%

      Weight change (in pounds), 1999e2003 5.3
      Household food insecurity 6.8% 4.8%
      Household income (in $1000s) e 79,892
      Female (¼1) e 53.1%
      Children
      Co-reside with children (¼1) 55.0% 49.9%
      Number of children present 1.0 0.9
      Relationship to co-residential children (among those living with children)
      All borne by her e e
      Some or all not borne by her e e

      Number of children ever borne e e
      Age (range: 18e55 in 1999) e 39.4
      Education in years (range: 6e17) e 13.5
      Married or cohabiting (¼1) e 73.3%
      Poor or fair self-rated health (¼1) e 11.1%
      Disabled (¼1) e 6.2%
      Race/ethnicity
      non-Hispanic White (reference) e 80.1%
      non-Hispanic African American e 9.9%
      Hispanic e 6.1%
      non-Hispanic other racial group e 3.9%

      Metropolitan residence (¼1) e 76.0%
      Note: Two-tailed tests of a significant difference between men and women are noted as

      1999 and 2003. Half the sample lives with children in 2003 and
      women are slightly more likely than men to live with children
      (p < .05).

      Prior research has consis

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      Replacement Feeding Experiences of
      HIV-Positive Mothers in Ethiopia
      Bogale Abera Woldegiyorgis a & James L. Scherrer b
      a Hawassa College of Teacher Education, Hawassa, Ethiopia
      b Graduate School of Social Work, Dominican University, River
      Forest, Illinois, USA
      Version of record first published: 12 Mar 2012.

      To cite this article: Bogale Abera Woldegiyorgis & James L. Scherrer (2012): Replacement Feeding
      Experiences of HIV-Positive Mothers in Ethiopia, Journal of Community Practice, 20:1-2, 69-88

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      Copyright © Taylor & Francis Group, LLC
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      DOI: 10.1080/10705422.2012.648123

      PART 2: POLICY

      Replacement Feeding Experiences
      of HIV-Positive Mothers in Ethiopia

      BOGALE ABERA WOLDEGIYORGIS
      Hawassa College of Teacher Education, Hawassa, Ethiopia

      JAMES L. SCHERRER
      Graduate School of Social Work, Dominican University, River Forest, Illinois, USA

      The World Health Organization most recent guidelines recom-
      mend that HIV-positive mothers exclusively breastfeed unless
      replacement foods meet the criteria of acceptability, feasibility,
      affordability, sustainability, and safety (AFASS). However, the
      fear of HIV transmission through breastfeeding has pressured
      these mothers into choosing replacement feeding whether they
      meet AFASS criteria or not. This choice has subjected infants
      to malnutrition and related deaths. This qualitative study is
      based on Scheper-Hughes and Lock’s (1987) Three Bodies Model.
      Discussions were carried out in a Prevention of Mother-to-Child
      Transmission Program (PMTCT) in Hawassa, Ethiopia using
      in-depth interviews, key informant interviews and focus groups.
      The study focused on the challenges that HIV positive mothers face
      due to inadequate counseling services, poor economic situations,
      and lack of support and follow up. The Three Bodies Model exposes
      the deficits in the comprehensive delivery of services by PMTCT pro-
      grams. Implications for social work practice and funding policies
      are discussed.

      KEYWORDS replacement feeding, social meanings, PMTCT,
      HIV/AIDS, breastfeeding, mothers

      We acknowledge Haile Michael Tesfahun, Addis Ababa University, School of Social Work,
      for his critical comments on the original thesis. The research was funded through Addis Ababa
      University, School of Social Work.

      Address correspondence to Bogale Abera Woldegiyorgis, Hawassa College of Teacher
      Education, P.O. Box 115, SNNPR, Hawassa, Ethiopia. E-mail: bogale.abera@gmail.com

      69

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      70 B. A. Woldegiyorgis and J. L. Scherrer

      The emergence of the human immunodeficiency virus (HIV) epidemic in
      the past few decades threatened breastfeeding as a safe and healthy method
      of feeding infants in economically distressed parts of the world. The World
      Health Organization (WHO) Update (2007b) recommended that HIV-positive
      mothers exclusively breastfeed their infants unless replacement feeding,
      which does not include breast milk, meets the criteria of accessibility, feasi-
      bility, affordability, sustainability, and safety (AFASS). However, HIV-positive
      mothers often choose replacement feeding whether or not AFASS criteria are
      met, because they fear transmitting the HIV virus to their infants through
      their breast milk. When AFASS criteria are not met, infants are subjected to
      malnutrition, infections, and diseases that may result in death. The purpose
      of this study is to assess the difficulties in replacement feeding experiences
      faced by HIV-positive mothers enrolled in the prevention of mother-to-child
      transmission (PMTCT) program in Hawassa, Ethiopia. The study aims to
      know the challenges HIV-positive mothers faced in their infant feeding
      experience, how community infant feeding practices and social meanings
      influence feeding choice, and how replacement-feeding mothers feel about
      the support and services they receive.

      This qualitative study uses the Three Bodies Model (Scheper-Hughes
      & Lock, 1987) to set up in-depth interviews with HIV-positive moth-
      ers, breastfeeding counselors, and members of the HIV community. The
      interviews were transcribed and analyzed to discover common influences
      on HIV-positive mothers’ decisions to breastfeed, replacement feed, or
      mix feed their infants. In addition, common themes about support and
      information provided to them were explored. The implications for future
      social work community practice are examined and courses of action
      recommended.

      PMTCT OF HIV

      Feeding options for infants of HIV-positive mothers are either exclusive
      replacement feeding or exclusive breastfeeding (Koniz-Booher, Burkhalter,
      de Wagt, Iliff, & Willumsen, 2004). However, both feeding options involve
      risks to child health and survival. Although exclusive breastfeeding is more
      practical, it has a 5% to 15% chance of transmitting HIV to infants (Israel
      & Kroeger, 2003). This incident rate of mother-to-child transmission could
      be reduced through drug intervention, and an awareness of precautions
      such as minimizing the duration of breastfeeding (WHO, 2003). Exclusive
      replacement feeding is an ideal option, because there is no chance of HIV
      transmission. However, it is difficult to apply in resource-limited nations,
      where exclusively replacement fed infants have a six-fold increased risk of
      dying in the first 2 months of life, compared with those who were breastfed
      (WHO, 2008).

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      Replacement Feeding Experiences in Ethiopia 71

      Over 530,000 new cases of pediatric HIV infection occur each year
      throughout the world, primarily due to mother-to-child transmission of HIV
      (WHO, 2007a). In resource-rich settings, prenatal transmission rates of 2%
      or less are achieved with the use of a combination of antiretroviral, obstet-
      rical interventions and avoidance of breastfeeding. HIV-positive mothers in
      such settings can safely provide formula to their infants so that they can
      avoid breastfeeding. In resource-limited settings, however, alternatives to
      breastfeeding do not usually meet the requirements of AFASS for many HIV-
      infected women. HIV-positive mothers tend to overestimate that all breastfed
      babies will be HIV-infected. As a result, they exclusively replacement feed
      their infants, even though AFASS criteria are not met (Koniz-Booher et al.,
      2004). A study in Tanzania showed that replacement feeding is rare in a
      breastfeeding culture, because the community believes that infants cannot
      survive without breast milk (Leshabari, Blystad, & Moland, 2007). Thus,
      exclusive replacement feeding in early infancy violates the rules of good
      motherhood. Those who practice it are considered failures as mothers. As a
      result, the community pressures HIV-positive mothers to mix breastfeeding
      with replacement feeding.

      Replacement feeding also has some negative socially constructed mean-
      ings (Leshabari et al., 2007). Replacement-feeding mothers are thought to
      be concerned more about their body shape than child rearing, and to
      engage in extramarital affairs, or to be HIV positive. Njunga’s (2008) study in
      Malawi recommended that PMTCT programs should take into consideration
      the spectrum of such cultural factors that influence experiences, behav-
      ior, and attitudes (Sevelius, 2011). Partners and/or family members of the
      replacement-feeding mothers may attempt to exert control over her feeding
      method (Koniz-Booher et al., 2004). Unless partners and family members are
      involved in the infant feeding decision, adherence to replacement feeding
      will be challenging (Aubel, 2011). These mothers also face the challenge pre-
      sented to them by rapidly changing recommendations from WHO (Moland
      et al., 2010). The WHO (2001) guidelines recommend that mothers meet
      AFASS criteria before choosing replacement feeding as the form of nutri-
      tion for their infants (Koniz-Booher et al., 2004; Koricho, Moland, & Blystad,
      2010). If AFASS criteria cannot be met, these mothers should exclusively
      breastfeed their infants. These guidelines were in effect until 2007, when
      WHO shifted the focus to breastfeeding first and AFASS criteria second.
      They were changed again in 2009, and still again in 2010, to reflect ongo-
      ing research in what would keep infants of HIV-positive mothers, and the
      mothers themselves, healthy. Current guidelines differ significantly from
      those of 2001, yet many postnatal counselors have been trained only to
      the 2001guidelines (Moland et al., 2010; WHO, 2010).

      AFASS criteria may impose significant economic challenges for moth-
      ers choosing to replacement feed in Ethiopia (Koricho, 2008). Health care
      centers may provide formula for replacement feeding of infants, but often

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      72 B. A. Woldegiyorgis and J. L. Scherrer

      it is not enough. Mothers are then forced to use replacement feeding meth-
      ods that do not meet AFASS criteria. The issue is further complicated by
      the fact that health service counselors only examine the affordability por-
      tion of AFASS and nothing else. Even the availability of free formula may
      not ensure that the decision to replacement feed translated into successful
      practice (Koniz-Booher et al., 2004). Besides knowing their HIV status and
      having access to free or subsidized formula, these mothers needed proper
      advice from counselors, partner or family involvement, better educational
      level, assistance with being the primary income provider, and participation
      in structured PMTCT programs. Instead, HIV-positive mothers were often
      exposed to conflicting messages from the local mission hospital, family
      members, and traditional healers (Bond, Chase, & Aggleton, 2002).

      Mothers using replacement feeding in a breastfeeding culture faced
      criticism from the community and were given some negative social mean-
      ings, which PMTCT programs overlooked. However, a study of HIV-positive
      mothers in Botswana (Nyblade, Kidd, & Field, 2000) indicated that moth-
      ers were able to override any traditional norms by prioritizing their infants’
      health. This, coupled with the benefits of follow-up counseling (Matovu,
      Bukenya, Musoka, Kikonyogo, & Guay, 2002), was hampered by a slow
      and crippled program beginning that has limited access to HIV/AIDS-related
      services. As a result, replacement-feeding mothers were trapped between
      the demand of the health care system wanting mothers to either exclusively
      breastfeed or exclusively replacement feed and the community cultural prac-
      tice demanding them to mix feed. They also struggled with the control efforts
      from their partner and in the home environment (Aubel, 2011; Bland, Rollins,
      Coutsoudis, & Coovadia, 2002).

      Mulugeta’s (2008) study of economic and social adaptations of women
      in Addis Ababa, Ethiopia, found that HIV-positive mothers using replace-
      ment feeding methods employed various strategies to cope with the
      challenges facing them. They entered formal and informal employment sec-
      tors, diversified survival strategies, went on informal migration, minimized
      household expenditures, changed dietary habits, and sought the support of
      family members, friends, and other kin. Informal associations also provided
      crucial supportive roles. Generally, replacement feeding in resource-poor
      settings caused more harm than good to infant survival and became a source
      of fear and challenge for mothers in Africa who could not afford to buy even
      their own meals. This was supported by Sethuraman et al.’s (2011) study of
      rural Vietnamese HIV-positive mothers. They found that replacement feed-
      ing occurred early out of necessity and social pressure even though AFASS
      criteria were not met.

      PMTCT of HIV services are being rendered in all hospitals in regional
      towns and in satellite health centers in Ethiopia (Amare & Deneke, 2003).
      According to the Ethiopian Federal Ministry of Health (2007), the preven-
      tion of HIV transmission from infected women to their infants is one of

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      Replacement Feeding Experiences in Ethiopia 73

      the strategies of PMTCT. A behavior surveillance survey in Ethiopia found
      that HIV/AIDS-prevention programs have some impact on knowledge about
      HIV/AIDS (Federal Ministry of Health, et al., 2006). However, neither the
      increase in knowledge of HIV/AIDS nor the WHO Update (2007b) rec-
      ommendation that infant feeding counseling and support for HIV-positive
      women be provided during pregnancy and for 2 years after the infant’s birth
      have led to corresponding behavior change (Federal Ministry of Health,
      2009). According to a World Bank (2008) report, to date only 2% of HIV-
      positive pregnant women needing PMTCT have benefited from the service
      in Ethiopia. In 2006, only 2,028 pregnant women received Nevirapine, of
      whom only 1,341 took a complete course for themselves and their infants.
      Although 1,400 sites are planned to have PMTCT services by the end of
      2007, only 184 sites provided the services.

      THE THREE BODIES MODEL

      The results of these studies can be synthesized using Scheper-Hughes
      and Lock’s (1987) conceptual framework, The Three Bodies Model
      (see Figure 1). The framework analyzes the body using three different
      approaches, representing three levels of analysis. The first level is the indi-
      vidual body, which is the lived experiences of the body self and the meaning
      attached to these experiences. The second level is the social body, which
      refers to the body as a natural symbol with which to think about nature,
      society, and culture. The social body is developed through being a member
      of a particular social or cultural group. The third level is the body politic,
      referring to the regulation, surveillance, and control of bodies.

      Social Body:
      Infant feeding

      culture and
      social

      meanings

      Coping Strategies

      Exclusive
      Replacement
      Feeding (ERF)

      Politic Body:

      Control in
      home and

      health care
      systems

      Individual Body:

      Feeding
      challenges,

      perceptions, and
      fears

      FIGURE 1 The three bodies and exclusive replacement feeding. Source. Developed by the
      authors from the concepts presented in Scheper-Hughes and Lock (1987)

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      74 B. A. Woldegiyorgis and J. L. Scherrer

      Incorporated in this framework are feeding-related challenges that HIV-
      positive mothers face: fears regarding feeding choice, influences and social
      meanings of community infant feeding practices, and controls exerted over
      the HIV-positive mother in the home environment and by the health care
      system. HIV-positive mothers are faced with the infant feeding dilemma of
      exposing their infants to HIV infection through breastfeeding, or replace-
      ment feeding which, although HIV-free, exposed infants to malnutrition
      and infectious diseases. In addition, because breastfeeding is socially con-
      structed as being an essential feature of motherhood, replacement feeding
      reflects negatively on the mother’s commitment to motherhood and her chil-
      dren. Husbands, mothers, mother-in laws, friends, and communities apply
      pressure to the HIV-positive mother at least to mix breastfeeding with
      replacement feeding. Finally, the HIV-positive mother is faced with chal-
      lenges in implementing the requirements of the health care system with
      limited resources. According to Leshabari (2007), the interconnectedness
      and dynamics of these influences and challenges are well illustrated by this
      framework.

      RESEARCH METHODS

      The study was conducted in 2009 in Hawassa, Ethiopia, a small city of
      about 157,879 residents (Federal Democratic Republic of Ethiopia, Office of
      Population Census Commission, Central Statistics Agency, 2010). Participants
      in the study were drawn from Hawassa Referral Hospital (HRH), Tilla
      Association of Women Living with HIV/AIDS (Tilla), and key informants
      from the community. HRH is the only government hospital in the city and it
      provides free PMTCT services to Tilla members, most of whom replacement
      feed their infants. An ethnographic research design was used, to obtain
      a holistic picture of the infant feeding practices of HIV-positive mothers.
      Selection of participants sought to obtain respondents representing each of
      the Three Bodies. Seven exclusive-replacement-feeding mothers who used
      varied methods of replacement feeding such as formula, cow’s milk, and
      gruel represented the individual body. The respondents were selected using
      maximum variation sampling, a technique that purposefully selects a wide
      range of variations on a dimension of interest (WHO, 1994). None of these
      mothers completed high school. Their family income is less than $20 US per
      month. Their average age was 27 years. All were married except one. Their
      family size ranged between three and 10 children. Four counselors in HRH
      and Tilla represented the body politic and were selected by intensity sam-
      pling, a sampling technique that focuses on excellent, but not necessarily
      extreme, examples of the phenomenon (Ulin, Robinson, Tolloy, & McNeill,
      2002). Their experience in infant feeding counseling ranged from 1 year to
      6 years. Three female Infant Feeding Counselors, who have a diploma in

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      Replacement Feeding Experiences in Ethiopia 75

      nursing, from HRH and one male nurse, who has a Bachelor of Science in
      nursing, from Tilla participated in this part of the study.

      Key community members, selected by homogenous sampling (Ulin
      et al., 2002) and divided into two focus groups of seven members, rep-
      resented the social body. This sampling technique is typically used to select
      people with similar characteristics and a common identity to discuss and
      share their experiences in focus groups. One focus group consisted of older
      (ages 30–40) HIV-positive women from Tilla who did not participate in
      the individual interviews. The other focus group consisted of older (ages
      45–65) HIV-positive men from the Union of Iddirs of People Living With
      HIV/AIDS. Iddirs are community-based organizations set up for arranging
      burial ceremonies of a deceased member, comfort the family on the loss
      of the beloved one, and support one another during problematic situations.
      Currently, the government has started to include them in efforts to solve
      community problems like helping orphans and other development activities.

      Data collection instruments consisted of open-ended questions to
      guide interviews and focus group discussions. These instruments were
      produced from WHO standard questionnaires, reports, and readings on
      HIV-positive mothers’ infant feeding experiences. The concepts included
      were: HIV-positive mothers’ replacement feeding experiences and their per-
      ceptions of these; community infant feeding culture and meaning attached
      to feeding practices; the influence on mothers’ choice of feeding by her
      family and relatives and by the health facility; and the coping strategies
      exclusive-replacement-feeding mothers used to manage these environmental
      demands. The instruments were pretested at HRH and Tilla with respon-
      dents who did not participate in the actual study, and modified based on
      the pretest results. Written consent was obtained from all of the participants.
      Participation was voluntary and the participants were told of their right to
      withdraw without giving a reason at any time and to request that their data
      be excluded. The rights of participants to refuse answers for a few or all
      interview questions were respected. Each participant was given $1.75 US for
      his or her time spent in the study.

      There were some potential risks to the study participants. HIV-positive
      infant-feeding mothers who have not disclosed their status could have been
      rejected by their husbands, physically abused, or divorced. The community
      members could have breached confidentiality of information discussed in
      the focus group. Their participation in the study could have affected the
      services they receive from HRH. The nurse counselors’ job might be endan-
      gered for revealing actions of their health facilities that compromised the
      quality of infant feeding follow-up visits. These risks were discussed with
      the participants, as well as an explanation of how they would be minimized.
      To reduce these potential risks, the names of participants were coded to
      protect identifying information. Written commitments were obtained from
      the participants to respect the confidentiality of the interviews. Interviews

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      76 B. A. Woldegiyorgis and J. L. Scherrer

      and focus group discussions were conducted in Amharic and tape recorded.
      Participants were told they could speak without being tape-recorded
      whenever they chose. In addition, field notes recording environmental
      setting and verbal and nonverbal information during the interviews were
      taken.

      Data analysis involved first transcribing the tape recordings of the inter-
      views and discussions. The Amharic transcripts were then translated into
      English and the English translations were analyzed. When the information
      from different data sources did not agree, the original Amharic transcripts
      were consulted either to reconcile contradictions or to present divergent
      interpretations. The data were analyzed in five steps as suggested by Ulin
      et al. (2002). The translated transcripts and field notes were read and reread
      carefully to become familiar with the text. Emerging themes were coded
      using informant and researcher concepts. Principal themes and subthemes
      were identified through data display. The most essential concepts and rela-
      tionships were made visible through condensation of the data. Finally,
      interpretations were made by identifying and explaining core meanings of
      the data, communicating the essential ideas of the participants, and remain-
      ing faithful to their perspectives. All information obtained in the study was
      maintained on a secure computer that was password protected.

      FINDINGS

      The Individual Body: Mothers and Replacement Feeding

      Three themes around replacement feeding challenges were evident in the
      interviews with the mothers. The first theme was that replacement-feeding
      mothers do not get proper infant feeding counseling. Neglecting other
      AFASS criteria, counselors only asked mothers if they could afford to buy
      the replacement foods. The counseling focused on scaring mothers about
      the possibility of infecting their infants and favoring the choice of formula
      feeding. The mothers were sometimes exposed to conflicting counseling
      messages as noted by a mother of three:

      A home-care provider advised me to exclusively breastfeed the child for
      6 months. I began exclusive breastfeeding as per her advice. However,
      when I went to Referral Hospital, the doctor told me that the infant
      had been fed the virus. I was shocked and planned to immediately stop
      breastfeeding. In the hospital, the child spent 24 hours without having
      any food until the virus he had been sucking was “removed.” After all the
      virus is removed from his stomach, I began cow’s milk. (Selam, personal
      communication, March 26, 2009)

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      Replacement Feeding Experiences in Ethiopia 77

      The mothers were orally informed about replacement feeding but they
      were given no demonstration during the counseling. Fathers were not
      involved in infant feeding counseling because they did not accompany the
      mothers and their infants to the counseling room. HIV-positive mothers were
      not instructed on preparing for the delivery of their child, by bringing for-
      mula or cow’s milk and a feeding bottle to replacement feed their infants
      after delivery, resulting in infants waiting long hours until the replacement
      food was found in the town. There were no follow-up visits by HRH on
      how well, or even if, the replacement-feeding mothers were implementing
      the instructions they had been given on replacement feeding.

      The second theme that evolved was on the challenges in maintaining
      replacement feeding that met AFASS criteria. Economics presented the major
      challenge. Most of the mothers began with formula, but changed to cow’s
      milk and then to mitin, a gruel-type of substance made from different types
      of grains, because that was what they could afford. Other common replace-
      ment foods identified by the mothers are raw milk, boiled cow’s milk, abish
      or fenugreek, a soup made from a local plant, and atmit, a gruel made from
      one kind of grain. Only one mother was able to feed her infant formula
      for 6 months. The others all stopped much sooner, some after only 1 week.
      An infant feeding counselor noted:

      I don’t think mothers sustainably adhere to their feeding choice. Market
      situation and their income do not match. Lots of replacement-fed children
      are malnourished and admitted to the hospital. They get balanced diet
      in the hospital and recover. When these children go home, mothers
      cannot properly feed them and you see the same child in the therapeutic
      feeding center next month. There is a cycle of malnutrition. They go
      to hospital, get better, go home, and are malnourished and admitted to
      hospital again. This shows that the mother couldn’t sustainably provide
      replacement feeds. (Tibebu, personal communication, April 7, 2009)

      Some of the reasons for this lack of sustainability include mothers who
      stayed at home to care for their children and could not go out to earn addi-
      tional income. Most of the fathers have no regular income to contribute
      toward purchasing replacement food. As a result, the nutrition of other fam-
      ily members was neglected because the family’s economic resources went
      for purchasing the replacement food. In addition, sustainability was threat-
      ened by a policy of providing mothers with infant nutritional support for
      only a week or a month at a time at most. A mother of triplets described her
      dilemma in sustaining her feeding choice:

      The counselors told me to exclusively replacement-feed the infants or
      exclusively breastfeed them. When I and my husband examine it, this
      is very useful for one child. However, ours are three and neither of the

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      78 B. A. Woldegiyorgis and J. L. Scherrer

      choices was feasible for us. My breast milk will not suffice for three of
      them. We could not afford to buy replacement feed for them. I haven’t
      thought they will survive. One of them died after 2 months. I suspect
      it could be due to starvation. Then I was worried about the survival of
      the other two and feed them everything thought to be good for infants.
      (Tarikua, personal communication, April 3, 2009)

      Most of the study mothers overcame these challenges in their replacement
      feeding by shifting the nutritional support that they received for themselves
      from a nongovernmental organization (NGO) to their infants, which resulted
      in compromising their own health. They also coped by cutting back family
      expenditures, creating additional income sources, and immediately taking
      infants to health institutions whenever they became ill.

      The third theme that became evident was the mothers’ fears of replace-
      ment feeding their infants. They have doubts about the nutritional adequacy
      of their replacement feeding method. Most of the study mothers (5/7) feared
      the possibility that other nursing mothers who could breastfeed their infants
      would be HIV-positive, thus exposing their infants to the virus. Almost all
      mothers (6/7) feared that they did not show love to their infants because
      they replacement fed rather than breastfed them. A mother of one child
      noted:

      I think I missed a lot due to replacement feeding. I began to worry just
      as I got pregnant. One day I was exploring my breast and milk began to
      flow. When I thought that I couldn’t breastfeed my child, I wept for the
      whole night. I feel that my child would not love me because I have not
      breastfed her. I often ask, “How do I make her know I love her? How do
      I express my love to my child?” Though I devoted my full time t

      Biology

      Hello Im looking for someone to complete a online lab using https://www.scienceinteractive.com/  tonight  at 11:59pm eastern time.  The lab is Introduction to Microscopy- Antaomy 

      Biology

      2 Metrics

      Background

      In the United States our measurements are usually based on the imperial system from Great Britain. This British system of measurements which includes units such as feet, pounds and gallons has deep historical roots. For example, the foot is thought to be the length of the foot of King Henry I of England in the 12th century whereas the pound is based on the Roman word libra (lb) which is the equivalent to the weight of 7,000 grains. Scientists, however, decided to adopt a different measurement system because of its tremendous advantages.  The metric system (see table 1), the most commonly used standardized system worldwide, not only covers a large scale and its measurements are also in consistent units of 10 (see table 2) which makes calculations simpler.

      Since many people in the United States are used to the imperial system, we must become familiar with the metric system. Often we need to convert between the two systems. Below are some helpful conversions.

      Conversions Between Imperial and Metric Systems

      1 kg = 2.2 pounds

      1 km = 0.62 miles

      1 m = 39.37 inches

      1 inch = 2.54 cm

      1 l = 1.06 quarts

      The following activity will help you review the scientific method as well as work with the metric system. To learn more about the history of how the metric system was implemented, you can watch this video:

      Title: __________________________________________________________________________

      (Note: At the end of the experiment, you will create a title.)

      Background 

      Observation and question: People have observed that a person with a longer upper or lower limb tends to be taller. We then asked the question: “Is the length of a person’s upper limb directly proportional to his/her height?” Two measurements (variables) are directly proportional if, for example, as one amount increases, the other amount increases at the same rate. The upper limb spans from the armpit to the end of the fingertip. 

      Hypothesis and prediction: If the length of a person’s upper limb is directly proportional  to height, then the ratio of upper limb length to height for all subjects must be constant, i.e., the same.

      Purpose

      · Use the metric system

      · Review steps of the scientific method

      Materials

      Measuring tape/tool  or meter stick or measuring app on phone: Ruler for Android (Links to an external site.)
      , Measure App on Apple or piece of paper (8.5 x 11) to use as a measuring device    

      3-4 human subjects                

      1 calculator

      Procedure

      1. Pick 3-4 subjects from group members.

      2. Each subject puts right arm straight out (parallel to the ground).

      3. Using the meter stick or measuring tape/tool, measure upper limb length (from arm pit to the end of the finger tip) of subject 1 in cm.

      4. Record measurement in Table 1 below.

      5. If subject 1 does not know height, then measure height in inches and cm.

      6. Practice converting height in inches to cm. Show work below.

      7. Record height of subject 1 in cm in Table 1 below.

      8. Calculate ratio of upper limb to height of subject 1 and record in Table 1.

      9. Repeat measurements and calculations for all subjects and record in Table 1.

       

      Results:

      Table 1. Comparison of Limb Length to Height in Group Subjects

      Subject

      Measured Upper Limb Length (cm)

      Height* (cm)

      Ratio of Upper Limb Length to Height = Upper Limb Length (cm)/Height (cm)

      1.

      2.

      3.

      4.

      * 1 inch = 2.54 centimeters

      Subject 1, 2, 3 and 4 had a ratio of upper limb length to height of

      _____, _____ , _____ and ____ respectively. 

      Average of group subjects’ ratio of upper limb length to height was  __________.

      Average of all class subjects’ ratio of upper limb length to height was   _________.

       

      Discussion/Conclusion (~1 sentence each):  

      1. Do your results support or reject the original hypothesis? Explain your answer.

      2. Based on an analysis of your data and the class data, what conclusions can you make?

      3. Describe one future experiment you would like to do to extend or make these findings more reliable.

       

      Metric System Practice Problems (Optional) 

      Note: For metric system, know how to convert within the metric system (ie. meters to mm, mg to grams). Also, know how to convert between the metric and imperial system.

      1. A pen is approximately 12 (µm mm cm   m).  Circle one.

      2. A chair is approximately 2 (nm cm m km) high. Circle one.

      3. Convert the value on the left into the unit indicated on the right of the equation below.  Show work.

      a. 2,346 m = ____ km

      b. 5 ft, 9 in = _____ cm (1 inch = 2.54 cm)

      c. 6 km = _____ miles (1 km = 0.62 miles)

      d. 208 mL = ____ L

      e. 2.67 kg = _____ g

      f. 80 nm = ______ m

      4. Joe weighs 152 pounds. What is his weight in kg? Show work. (1 kg = 2.2 pounds)

      5. Mary’s height is 175 cm. Mark’s height is 5 ft 6 in. Who is taller?

      Explain and show work. (1 inch = 2.54 cm)

      (Hint: convert Mary’s height into inches, OR convert Mark’s height into cm)

      Biology

      Online Activity

      Introduction:

      Choose a medical health concern that you’re interested in and write an introductory paragraph based on the research you find on the topic.

      Body: (3 Paragraphs)

      for the next two paragraphs find something from each one of the two readings that you can connect to cultural event you chose. Reference or quote what you find from each reading that connects to the cultural event in your two paragraphs. The two paragraphs should be about: 1- Immunology, 2- Nutrition, and you have to connect them to your medical health concern.

      Use 3 online sources for your intro or body paragraphs. Provide the link for the online sources in the references sheet.

      Conclusion

      References:

      Reference 3 online sources you used for your essay.

      Essay must be 4 paragraphs long and must follow the prompts above.

      Graphical user interface, text, application  Description automatically generated

      Biology

      3 Solubility in Water

       Background

      Organisms are made up of mostly water. The human body, for example, may be up to 70% water. This is because water is used for numerous functions such as digestion, absorption, transport, insulation, temperature buffer and medium for metabolic reactions. However, it will not be able to perform these tasks unless molecules dissolve in it. Hence, most of the molecules that are inside the body of organisms are water soluble (can dissolve in water).  

      These water soluble molecules mix well with water because they are alike; they have a charge and are said to be polar. The charges on polar molecules like water and the molecules of the soluble substances attract each other, making these soluble substances hydrophilic (waterloving). In contrast, the lipids of the cell membrane are nonpolar or hydrophobic (water-hating) and serve as a barrier to the passage of polar molecules across the membrane. 

      Lipid substances such as vegetable oil and steroids are nonpolar. They are soluble in other lipids but not in water. Such nonpolar molecules are, therefore, able to diffuse into the cells by passing through the lipid layers of the membrane.

      Detergents have a special property. They can literally act as a bridge between the polar and nonpolar worlds.  One end of the detergent molecule is polar and dissolves in water; the other end is nonpolar and can dissolve in fats and oils.  Molecules such as detergent that have both polar and nonpolar regions are called amphipathic.

      Hypotheses and predictions

      · If a substance is polar, then it will dissolve in polar substances such as water.

      · If a substance is nonpolar, then it will not dissolve in water, but instead will dissolve in nonpolar substances such as oil.

      Purpose

      · To demonstrate solubility of different substances in water.

      · To determine the effect of adding detergent to a mixture of water and a nonpolar substance.

       

      Materials for DIY (Do-it-yourself) experiment

      · Water                                      

      · Oil (ie. vegetable or olive oil)           

      · Food coloring (liquid or powder such as Kool-Aide or Jello mix)

      · Dish soap or detergent

      · Jar with lid

      · Spoon to stir

       

      Procedure for DIY experiment

      (*if your group does not have above materials, please see alternative assignment at end of lab) 

      1. Half-fill a jar with water.

      2. Add a few drops of food coloring into water & stir using spoon. Record your observations in the table. Take a picture.

      3. Add oil into the jar with water & food coloring until it is about ¾ full, cover with lid tightly & shake. Wait about 1 min & record your observations in the table. Take a picture.

      4. Add dish soap or detergent into the same jar & cover tightly again. Shake the jar gently and immediately record your observations in the table. Take a picture.

      5. Wash out the jar & return all materials to their proper place.

      Results

      Table 1. Results of combining various substances with water

      Solvent 

      Substance added

      Observations (number of layers. color of layer/s)

      Is the substance added soluble in water?   Yes or No

      Water

      Food coloring

      Water + Food coloring

      Oil

      Water+Food coloring+Oil

      Dish soap

      Submit a picture of your jar at the end of the experiment with this assignment.

       

      Alternative Procedure if group does not have above materials

      Materials

      · Water             

      · Vegetable oil

      · Potassium permanganate (KMnO4)

      · Detergent

      · Capped Test tube

      · Scoops for detergent & potassium permanganate (KMnO4)

      Procedure

      1. Pour 5 ml of water into a test tube.

      2. Add 5 mL of vegetable oil into a test tube. Cap the test tube. Shake the tube gently. Let rest for one minute. Record your observations in the table.

      3. Using forceps, add 2 crystals of KMnO4 into the same tube. Be careful not to add too many. Cap and shake the tube Record your observations in the table.

      4. Add a pinch of detergent to the same tube. Shake the tube gently and immediately record your observations in the table.

      5. Wash out the test tube & return to proper place.

      Solvent 

      Substance added

      Observations (number of layers. color of layer/s)

      Is the substance added soluble in water?   Yes or No

      Water

      Oil

      Water + oil

      KMnO4

      Water + Oil + KMnO4

      Detergent

      Submit a picture of your jar at the end of the experiment with this assignment.

      Discussion/Conclusion

      1.

      1. a. Did the food coloring (or KMnO4 if you did not perform the experiment) dissolve in water? _______ (Y/N)

         b. Explain the observation/s that support/s your answer in 1a.

         c. Is food coloring (or KMnO4) polar, nonpolar or both? ________________

       

      1.

      2. a. Did oil dissolve in the water? ________ (Y/N)

         b. Explain the observation/s that support/s your answers in 2a.

         c. Is oil polar, nonpolar or both? ________________

       

      1.

      3. Soaps & detergents are said to be amphipathic.   What does this term mean?

       

      1.

      4. a. Did the dish soap (or detergent) dissolve in the water? ________ In the oil? _______

         b. Explain the observation/s that support/s your answer in 4a.

         c. Is detergent polar, nonpolar or both? ________________

       

      1.

      5. Using your knowledge of dish soap’s polarity, explain how dish soap or detergent “cleans” our greasy, dirty dishes?

       

       

      *Alternative procedure used in “Solubility in Water Lab” Video if your group does not have necessary materials:

      Materials

      (used in already performed experiment)

      ·  Water                                        

      ·  Vegetable oil                

      · Potassium permanganate (KMnO4) 

      · Detergent

      · Capped Test tube                     

      · Scoops for detergent & potassium permanganate (KMnO4)

      Procedure (read through)  

      1. Pour 5 ml of water into a test tube.

      2. Add 5 mL of vegetable oil into a test tube. Cap the test tube. Shake the tube gently. Let rest for one minute. Record your observations in the table.

      3. Using forceps, add 2 crystals of KMnO4 into the same tube. Be careful not to add too many. Cap and shake the tube Record your observations in the table.  

      4. Add a pinch of detergent to the same tube. Shake the tube gently and immediately record your observations in the table.

      5. Wash out the test tube & return to proper place.

      biology

      Directions:

      Jose is a 55-year-old Hispanic, male, migrant worker who speaks limited English. He presented to the emergency room with complaints of edema of the scrotum, urinary retention, and hematuria. He does not have any pertinent past medical history. He is married and has five young children. He states he has been having problems for a while but delayed seeing the doctor because of his work schedule and limited money. The doctor performs a digital rectal examination in the office and finds that Jose’s prostate is enlarged.

      Male reproductive disorders can make a great impact on the patient’s life. Based on the case study, answer the following questions in your discussion post.

      Reply Post

      1. Discuss three potential barriers that you would anticipate when providing care to Jose based on his age and culture.

      2. Provide an example of how you would overcome each of the three barriers through the implementation of multidimensional care strategies.

      biology

      Please, follow instructions
      Purpose of Assignment

      · Utilize the appropriate technology and/or references/resources, demonstrating accurate use, in order to access reliable data and information that support evidence-based practice in the care of diverse clients during pregnancy.

      · Differentiate the various components of basic physiological needs as it relates to pregnancy and health practices, including but not limited to associated concepts of.

      · Evaluate data and information gathered during client care, simulated scenarios, and/or case studies related to promoting nutritional health during pregnancy, nursing care strategies to address the common discomforts of pregnancy, essential components and standards of prenatal care, fetal growth and development stages in order to determine knowledge and wisdom gained through critical thought processes to optimize client outcomes and quality improvement.

      · Demonstrate a basic understanding of communication practices necessary for client-centered care and interdisciplinary collaboration in terms of knowledge, skills, and attitudes.

      Competency

      Apply appropriate nursing care interventions for clients during pregnancy, labor, and birth.

      Scenario

      You are a registered nurse (RN) working in a Women’s OB/GYN Clinic. Elizabeth Jones, 37 years old, presents to the prenatal clinic after missing her last 2 menstrual cycles. Her home pregnancy test was positive. An ultrasound at the clinic confirms pregnancy. Gestational age is calculated to be 10 weeks. An initial assessment of Ms. Jones’s medical and obstetrical history is as follows.

      Obstetric/Gynecologic (OB/GYN) history: Uncomplicated spontaneous vaginal delivery at 39.2 weeks (3 years ago); Cesarean section x 1 at 37.5 weeks for non-reassuring fetal heart tones (1.5 years ago); abnormal Papanicolau (PAP) smear x2, + human papilloma virus (HPV), colposcopy within normal limits

      Medical history: Chronic hypertension (HTN) x 5 years;

      Allergies: Penicillin

      Social history:

      · (+) tobacco, “occasional” per client (pt), <5 per/day currently, has smoked “off and on” for 15 years

      · (+) cocaine use, states she has not used any cocaine/drugs for > 1 year; (-) alcohol use

      · Abusive partner with first pregnancy, states she has a new partner x 4 years

      · Depression, currently not taking meds for treatment (tx)

      Medications: Prenatal vitamins; Labetalol 200mg BID;

      Family history: Insulin-dependent diabetes mellitus (mother); HTN and heart disease (father); breast cancer (maternal grandmother, deceased)

      Instructions

      Write a two to three-page analysis of this scenario that answers the following questions:

      1. What should the nurse consider related to caring for a client with a history of domestic abuse, drug use, sexually transmitted diseases and depression?

      2. Document the considerations of yourself as the professional nurse in regards to self-awareness; be aware of attitudes, values and beliefs that you hold related to clients from different social backgrounds so that care is not affected negatively.

      3. What conditions are in Mrs. Jones history that would cause concern during pregnancy, labor, and birth?

      4. What concerns should be discussed with Ms. Jones before she leaves her appointment?

      Each answer to your question should include the following:

      · A correct answer with thorough development of the topic

      · Gives clinical examples

      · Include evidence from scholarly sources

      · Appropriate use of medical terminology

      Format

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

      · Logical, original and insightful

      · Professional organization, style, and mechanics in APA format

      Biology

      MD III

      Afternoon Simulation

      Vincent Brody- COPD with Spontaneous Pneumothorax

      The below activities are required to be completed before you arrive to simulation. Completing the below criteria is your “ticket to enter” the simulation. Please have all prework completed by Monday at 2359. Anyone that does not submit the clinical prep work will receive a failure for the simulation experience. Submitting this completed clinical document prior to simulation is important in order to be prepared for the clinical day. If this prep work is not completed, you will not be allowed to participate in the simulation (please be advised that simulations are limited, so make-up is not an option. If the simulation is not completed for this course you will fail to meet the objectives and not pass this course-both lecture and clinical).

      Describe the Pathophysiology of a Pneumothorax? What are causes of a pneumothorax? What are the different types of pneumothorax? (Include at least 5 sentences along with in-text citations.) (30 minutes)

      1. Complete the Pathophysiology diagram below by using the ATI Med/Surg ebook or your Ignatavicius Med-Surg Text located in your lecture course shell regarding COPD. (See Chapters 28 & 30, pg. 539, pp. 637-638 in Ignatavicius Med/Surg Book for more information.) (1hr)


      References:

      COPD

      (define)

      Health Promotion and Disease Prevention:

      [Text]

      Risk Factors

      Document two Nursing Diagnosis and two Goals for your client:

      [Text]

      [Text]

      Lab Tests/ Diagnostics

      [Text]

      Nursing Interventions

      [Text]

      Client Education

      Medications (list only)

      [Text]

      Multidisciplinary Care

      Possible Complications

      [Text]

      [Text]

      [Text]

      biology

      Describe the Pathophysiology of a Pneumothorax? What are causes of a pneumothorax? What are the different types of pneumothorax? (Include at least 5 sentences along with it)

      1. Complete the Pathophysiology diagram below

      References:

      COPD

      (define)

      Health Promotion and Disease Prevention:

      [Text]

      Risk Factors

      Document two Nursing Diagnosis and two Goals for your client:

      [Text]

      [Text]

      Lab Tests/ Diagnostics

      [Text]

      Nursing Interventions

      [Text]

      Client Education

      Medications (list only)

      [Text]

      Multidisciplinary Care

      Possible Complications

      [Text]

      [Text]

      [Text]

      Biology

      MD III

      SIM DAY 1- Morning Simulation

      Jennifer Hoffman- Acute Severe Asthma

      The below activities are required to be completed before you arrive to the simulation. Completing the below criteria is your “ticket to enter” the simulation. Please have all pre-work submitted by Monday at 2359 prior to the simulation day. If this is not completed, you will not be allowed to participate in the simulation (please be advised that simulations are limited, so make-up is not an option. If the simulation is not completed for this course you will fail to meet the objectives and not pass this course-both lecture and clinical).

      Complete the Pathophysiology diagram below by using the ATI Med/Surg ebook or your Ignatavicius Med-Surg Text located in your lecture course shell regarding Status Asthmaticus. (chapter 30) (1hr)


      1. Complete the table below (1hr)

      Complete the table below on medications using a Drug eBook.

      Graphical user interface, text, application  Description automatically generated

      Drug Name

      Indications

      Pharmacokinetics

      Contraindications/Precautions

      Nursing Implications

      Implementation

      Patient/family teaching

      Evaluation

      Albuterol 5mg in 3 mL

      Ipratropium Bromide 0.5mg in 2.5mL normal saline via nebulization

      Methylpred-nisolone IV 125mg

      2. Complete the table below (30 min.)

      Complete the table below on lab values using the Lab and diagnostic ebook (example below).

      Graphical user interface, text  Description automatically generated with medium confidence

      Lab Name

      Rationale

      Normal Ranges

      Indications

      Nursing Implications

      ABG Analysis (What are normal results?)

      pH:

      CO2:

      HCO3:

      What ABG findings would you expect with hyperventilation?

      What ABG findings would you expect with hypoventilation?

      References:

      Status Asthmaticus

      (define)

      Health Promotion and Disease Prevention:

      [Text]

      Risk Factors

      Document two Nursing Diagnosis and two Goals for your client:

      [Text]

      [Text]

      Lab Tests/ Diagnostics

      [Text]

      Nursing Interventions

      [Text]

      Client Education

      Medications (list only)

      [Text]

      Multidisciplinary Care

      Possible Complications

      [Text]

      [Text]

      [Text]

      Biology

       

      Directions:

      Instructions

      Discuss pharmacological versus non-pharmacological nursing interventions used for pain management during labor and birth. List two different classifications of drugs used for pain relief during labor and birth, and include potential side effects of the drugs on the fetus. Also, describe two nursing interventions by the nurse to provide comfort during labor and birth that could be considered as non-pharmacological and the expected outcomes.

      Discuss how the nursing interventions align with one of the six QSEN competencies and why?

      Resources

      Biology

       

      Directions:

      Jose is a 55-year-old Hispanic, male, migrant worker who speaks limited English. He presented to the emergency room with complaints of edema of the scrotum, urinary retention, and hematuria. He does not have any pertinent past medical history. He is married and has five young children. He states he has been having problems for a while but delayed seeing the doctor because of his work schedule and limited money. The doctor performs a digital rectal examination in the office and finds that Jose’s prostate is enlarged.

      Initial Post

      Male reproductive disorders can make a great impact on the patient’s life. Based on the case study, answer the following questions in your discussion post.

      1. Discuss the potential disease processes and signs and symptoms related to the disease process that Jose may be exhibiting?
      2. How would you provide multidimensional care to include cultural, psychosocial, spiritual, physical, and emotional needs for Jose?

      Reply Post
      1. Discuss three potential barriers that you would anticipate when providing care to Jose based on his age and culture.
      2. Provide an example of how you would overcome each of the three barriers through the implementation of multidimensional care strategies.

      biology

      Complete the Pathophysiology diagram below:


      1. Complete the table below (1hr)

      Complete the table below on medications using a Drug eBook.

      Graphical user interface, text, application  Description automatically generated

      Drug Name

      Indications

      Pharmacokinetics

      Contraindications/Precautions

      Nursing Implications

      Implementation

      Patient/family teaching

      Evaluation

      Albuterol 5mg in 3 mL

      Ipratropium Bromide 0.5mg in 2.5mL normal saline via nebulization

      Methylpred-nisolone IV 125mg

      2. Complete the table below (30 min.)

      Complete the table below on lab values using the Lab and diagnostic ebook (example below).

      Graphical user interface, text  Description automatically generated with medium confidence

      Lab Name

      Rationale

      Normal Ranges

      Indications

      Nursing Implications

      ABG Analysis (What are normal results?)

      pH:

      CO2:

      HCO3:

      What ABG findings would you expect with hyperventilation?

      What ABG findings would you expect with hypoventilation?

      References:

      Status Asthmaticus

      (define)

      Health Promotion and Disease Prevention:

      [Text]

      Risk Factors

      Document two Nursing Diagnosis and two Goals for your client:

      [Text]

      [Text]

      Lab Tests/ Diagnostics

      [Text]

      Nursing Interventions

      [Text]

      Client Education

      Medications (list only)

      [Text]

      Multidisciplinary Care

      Possible Complications

      [Text]

      [Text]

      [Text]

      Biology

      Please answer each question seperately.

      1. Humans are unable to digest cellulose. No animal, in fact, can digest cellulose with their OWN digestive enzymes. Knowing this, predict what you think is actually responsible for digesting cellulose in a cow’s stomach. Why? 

       2.Propose a model for how what you identified in the question above is able to break down cellulose (i.e. what bonds are broken, what type of reaction is taking place) 

       3. Diagram the reaction that would take place to break bonds between two glucose monomers. (The best approach to answer this question is to hand draw and then insert the image as your answer). 

      4.  Cattle industries will often add antibiotics in their feed. What is the purpose of antibiotics? Why might cattle industries use them? You may use online resources to research this.  

       

      5. Examine the chart (attached below). What happens to the rumen microbial population after cattle are given antibiotics? How might this affect their digestion?

      6.  Discuss the pros and cons to antibiotic use in cattle. 

       

      7. Do you think that antibiotics should be used in farming? Justify your response. You may use online resources to research this.

      • 5

      Biology

       New Employee Handbook and Reference Guide (Final Applied Assignment)

      Biology

       Question 1;Discuss the role of hormones in sugar regulation and the management of sugar abnormalities. 

      Biology

      Key points on the assessments:

      Try your hand at MCQs, as practice does make you better at them> I have linked in a few on-line MCqs for you to try in the assessment section of the module

      Important points: Answer the question, not what you think the question is. Irrelevant material will not gain you marks, but will waste your time writing for no gain.

      Accuracy in the terms used and use of the appropriate terms for appropriate processes is important.

      Errors in major facts, will limit your possible marks, such errors include such as calling B cells T cells or vice versa, getting innate and adaptive mechanisms mixed up or confusing MHC classes and T cell co-receptors etc are marked as we read them, not how we think you meant to write it.

      Organize your answer so that it has a logical progression. For instance if describing the structure and associated functions of an antibody, start with the core details of the number of proteins involved in making up a generic IgG, the overall structure etc, then drill down into the details of domain structures, bonds, locations of named types of variation etc, class specific differences – of course for antibodies, mentioning the wide range of receptors for antibodies (the Fc receptors) gives context to functionality, as does mentioning the different properties and generalized tissue localizations of the different classes. A diagram is very handy in such cases, providing it is both labelled appropriately and marked as a figure (ie fig 1, fig 2) and then mentioned in the text appropriately (ie see figure 1…)

      So above all, answer the question to you fullest ability, without wandering off into irrelevant material or topics…


      ASSESSMENT INSTRUCTIONS

      Please refer to any further instructions that accompany this document on Moodle

      Question choice/format 

      Word limit per question (including figure legends; excluding references section, if relevant) 

      2000 words

      Document format for submission (PDF or Word or either) 

      PDF or Word SUBMITTED TO MOODLE

      References required (citations in text and references section at the end)? 

      Not required

      Figure format(s) accepted (e.g. hand-drawn, composed in Powerpoint, and/or pasted from books/papers)  

      Labelled diagrams may be inserted where necessary to support your answer, but should preferably be hand-drawn and the image placed into the document, rather than taken from an existing work. If taken from an existing work, authorship of the image should be acknowledged in the legend to the figure.

      Additional details/instructions:

      Please include the question number and your ID number in the filename submitted.

      QUESTION

      1. What is the evidence that complement is important in protection against meningococcal disease (40%)? How do meningococci (Neisseria meningitidis) protect themselves from the actions of complement (60%)?