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20 May 2019

Childhood Obesity and Technology

The U.S. government has declared obesity in children to be a major national concern. One of the supposed culprits is technology use, based on the idea that the more time children spend with technology, the less time they spend in physical activity. At least one study (discussed in this chapter) has found the reverse to be true. Explain your stand on this, and cite at least one source to support your opinion.

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Bunny GreenfelderLv2

21 May 2019

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An area has two different Anopheles species, both of which can vector Plasmodium, although Plasmodiumdevelops best and is transmitted best by species B. Species A is dominant because its larvae outcompete species B in the main shared breeding sites, small lakes and ponds. Therefore the population of B is currently small. The small lakes and ponds are also the source for the main food source in the region, fish, grown in fish farms. There is grazing land, but other than chickens, the local population does not have livestock. Species A is largely endophagous and endophilic, species B is exophilic. In other sites, both species A and B will also feed on cattle, and B appears to prefer cattle. Both species also like to roost during the hot day in rock overhangs and small caves. To give some context to your answers use the IPM terminology considered in class.

A) The national malaria control agency sends in a new person to develop a malarial control strategy. (S)he recommends oiling the lakes and ponds, and intensive house spraying . Discuss why each of these two options would be a good or bad idea. In your answer consider effects on species A, species B, and malaria incidence. And remember, the idea is to help the local population.

B) Develop an alternative targeted strategy that might work well in this situation. Explain why this would be a good fit. Use only strategies that have been used successfully in the field, and avoid "just spray everything" strategies. Explain why your strategy should work.

After roughly 15 years we have the first malaria vaccine going into phase 4 trials. Meanwhile a Zika vaccine is starting phase 2b trials, only 2-3 years after the first major outbreak in Brazil.

A) Discuss in some detail why it is so much more difficult to develop a vaccine for malaria than for e.g. the Zika or rubella virus. I am looking for at least 2 reasons, and a brief explanation of those reasons. Just stating that one is complex and the other simple is insufficient. If that is what you want to say, back it up with facts.

B) Both the CRISPR bacterial defense system and the adaptive immune system in mammals have means to recognize âsignaturesâ of invading organisms. In what way are the two systems different?

The malaria control team in a given area has access to 5 different drugs, chloroquine, mefloquine, pyrimethamine, amodiaquine, and artimisinin. Nothing else will be available for the foreseeable future. Some resistance to all 5 is already observed.

A) Provide a strategy to maximize the time you can cure malaria using these 5 drugs. Explain why you want to use this strategy (what is the idea behind your plan), and be precise: when do you plan to use what drugs. What are the potential problems you can face and how do you plan to deal with them? Remember, you are working with humans, not robots.

B) Hypnozoites are forms of P. vivax and P. ovale that are dormant, with barely any metabolic activity. After long periods of time (months, a year), they can be re-activated start invading red blood cells, and causing malaria. Explain why artemisinin would or would not be a good drug for people suspected of carrying hyponozoites.

Case Study Section 4 â Nitrogen Metabolism Based on âA Sickeningly Sweet Baby Boy: A Case Study on Autosomal Recessive Inheritanceâ by Jacqueline Washington and Anne Zayaitz (National Center for Case Study Teaching in Science) The Patient: Mathew Miller is a 7-day-old infant that is rushed to the emergency room by his parents Emma and Jacob Miller, Mennonites from Lancaster County, PA. Emmaâs pregnancy and delivery with Mathew was normal but he started having trouble nursing and now has completely stopped feeding. By the time they reach the emergency room Mathewâs limbs were rigid and he had had a seizure. The initial examination showed no infection and his x-rays were normal. The family history collected by the Doctor revealed that Emma and Jacob had had a previous son, Samuel that died at 9 days-of-age. There also is a history of unexplained childhood mortality on both sides of the family; Emmaâs mother had two sisters who died in the first year of their lives and Jacobâs father had a sister who died at 7 months of age. Emma also points out to the Doctor that Mathewâs diaper has a funny smell to it. Blood and urine samples were taken for testing and skin biopsies from Mathew, Emma, and Jacob were taken and tested for enzyme activity. The tests results showed that:

â¢ Mathewâs urine had elevated levels of the branched chain amino acids and their Î±-keto acid derivatives (which caused the sweet smell in his diapers)

â¢ Both Emma and Jacobâs skin biopsies had nearly normal levels of branched chain amino acid metabolism/enzyme activity

â¢ Mathewâs enzyme activity was less than 2% of normal

Question 1: What is the most likely diagnosis for Mathew?

A. Argininemia

B. Diabetes mellitus '

C. Maple syrup urine disease

D. Phenylketonuria

Question2: What enzyme did the skin biopsy test measure?

A. Carbamoyl phosphate synthetase I

B. Alanine aminotransferase

C. Phenylalanine hydroxylase

D. Branched-chain Î±-keto acid dehydrogenase complex

Question 3: This enzyme functions VERY similarly to two other enzymes that we have discussed, what are they?

A. Phosphofructokinase-1 and fructose 1,6-bisphosphatase (FBPAse-1)

B. Pyruvate dehydrogenase complex and Î±-ketoglutarate dehydrogenase complex

C. Urease and arginase

D. Isocitrate dehydrogenase and malate dehydrogenase

Question 4: How did Mathew (and presumably Samuel) inherit the disease if both Emma and Jacob have normal enzyme activity levels?

A. Emma and Jacob must both be carriers for the disease but their one normal gene is enough to maintain enzyme activity levels.

B. The disease can happen spontaneously, there is no genetic link.

C. Jacob is not really the father of the boys.

D. The disease can skip generations.

Question 5: What would be the best diet for Mathew to follow to control his disease?

A. Atkinâs diet (low carbohydrates, high fat, and high protein)

B. Low protein

C. Low fat

D. No special diet will control the disease

Over the next 4 years Mathewâs metabolic disease is controlled by his special diet but he still suffers approximately 3 metabolic crises a year. These occur when amino acids accumulate in his blood leading to the swelling of his brain. Even something as simple as a cold or the flu can affect his amino acid levels and send his metabolism into crisis. Jacob and Emma decide that âWe cannot continue to live in constant fear that a minor infection or a simple cold or ear infection could kill our son. Even though we are doing everything we are supposed to, he is still getting sick and we are afraid we may lose Mathew.â They learn that some children with Mathewâs disease have undergone liver transplants and are effectively cured.

Question 6: How/why would a liver transplant effectively cure Mathewâs condition?

A. A new liver would be able to spread itâs genes throughout the body and correct the genetic disorder.

B. A new liver would more effectively respond to metabolic hormonal control.

C. A new liver would express the functional enzyme needed to metabolize the amino acids causing Mathewâs condition.

D. A new liver would produce more hemoglobin to transport oxygen more effectively.

The family is directed to Dr. Morton of Childrenâs Hospital of Pittsburgh, where transplant experts agree to list Mathew for a liver transplant. Jacob and Emma learn that children who receive a liver transplant have to take strong immunosuppressive drugs for the rest of their lives. It was also clear that there was a 40% possibility that Mathew could reject the liver and need a second transplant (which also might be rejected) or he could die from surgical complications.

Question 7: Assuming the liver transplant was successful and Mathew did not reject the new liver, what type of diet would Mathew be able to/need to eat?

A. He would still need to eat his special diet but he would be at less risk of a metabolic crisis

B. He could eat a normal diet

C. He would need to change to a high protein diet like Atkinâs

D. He would be on an all liquid diet

Question 8: Emma and Jacob decide they want to try to have another child. What would be the chance that this child would also have the disorder that Mathew and Samuel have/had?

A. 0 %

B. 25%

C. 50%

D. 75%

E. 100%

Question 9: If Mathew grew up, got married, and decided to have children, what would be the chance that his children would have the disorder? A. 0%, the liver transplant would have cured him

B. 25%

C. 50%

D. 100%

E. It would depend on his wife, if she was normal than there would be a 0% chance of his children having the disorder but 100% would be carriers, if she was a carrier than there would be a 50% chance of his children having the disorder and a 50% chance that they would be a carrier.

Question 10: The disorder is found in 1 in 200,000 infants throughout the US but 1 in 200 in the Amish and Mennonites of Lancaster County, PA. Why is there such a difference in the prevalence of the disease?

A. There are environmental factors associated with being Amish or Mennonites that increase the prevalence.

B. There is a large amount of genetic similarity within these populations because they tend to marry within the population so recessive disorders such as this are more likely.

C. The gene mutation is preferentially carried in Caucasians so when you average the prevalence across all races in the US the prevalence drops.

D. It is unknown why the prevalence is so much greater in Amish and Mennonites.

I will like you do grammar check, and rewrite it in another form. This is to avoid plagirsm. Thank you.

The purpose of this research is to explain some advantages and disadvantages of the implementation of the electronic medical record in a general hospital and specific units such as Neonatal intensive care unit. Also, it will emphasize different challenges that physician face when using the eMR as well as some solutions they offered in order to help them to overcome the challenge of typing. Most importantly, it will focus on the beneficial use of the eMR such as reduced time when charting specially in nursing as they spend a lot of time when documenting, it will reduce the time in half when using electronic medical record. Also, the research will review how the electronic medical record can enhance the quality of care to the patient. The electronic medical record will provide all the information needed by the physicians or any health care provider when giving care especially the critical patient who needs a quick intervention. This reseach will provide some information on how the eMR can improve quality of care. On the other hand, it will be discussed how the use of eMR can affect the relationship between a health care provider and the patient. As we know, health care providers have to keep a professional but close relationship with their patients in order to provide care and give the best intervention. However, when a health care provider uses electronic medical record some information might be lost when typing from a paper-based system into the eMR. The journals discuss multiple solutions to overcome and to reduce the risk of losing important information of our patient when typing or scanning the information into the eMR. Ventura, M.L., Battan, A.M., Zorloni, C., Abbiati, L., Colombo, M. Farina, S., & Tagliabue, P. (2011). The electronic medical record: pros and cons. The journal of maternal- fetal and neonatal medicine, 24(1), 163-166. doi: 10.3109/14767058.2011.607582 In this journal, researchers want to implement an electronic medical record in a neonatal intensive care unit. This system will enhance critical patientâs treatment because it will implement bedside clinical observation with machine monitoring data, and results from the laboratory. The time of charting for nurses was reduced but medical staff complained about the lack of automation in the reports. Through this journal researchers demonstrate that even though electronic medical record is beneficial because it reduces the charting time, it also can increase the risk for system error which can be fatal for the patients. In conclusion, electronic medical record should be reviewed for any complication that can influence patientâs life. Fox, G. S. (2014). The people versus the electronic medical record, last Thursday. Acad Pshychiatry, 38, 368-372. doi: 10.1007/s40596-014-0042-x In this journal, physicians express their concern about the use of electronic medical record. Physicians believe that the use of technology interferes with the face to face discussion between patients and doctors. Physician stated that the essential and precious communication has been diminished for both care givers and patients. Indeed, I believe with the use of electronic medical record, the lack of interaction and eye contact between the care giver and patient is increasing. This journal is really relevant within the nursing profession because it raises awareness of how important it is to keep the essential of communication between patients and health care providers. In brief, health care providers should find other way to obtain and record patient information to support the doctors and patient relationship. Ossoff, R. H., Thomason, C. D., & Appleton, J. (2010). Challenges with the electronic medical record. Journal of Health Care Compliance, 12(6), 51-54. Retrieved from http://search.proquest.com/docview/822639350?accountid=3455 The authors in this article examine the different challenges that doctors are facing with the use of electronic medical record. Firstly, physicians have to take training to learn how to use the system. However, to overcome the challenge of typing, physicians proposed an idea of creating well detailed templates that list all organs systems. Indeed, templates should be used just as a baseline of information, to help the users to remember the key elements while adding the patientâs information. This is a good point in documentation because even though templates are easier to fill out, medical staff should keep in mind that documentation should be well detailed. Although the templates might be well detailed, it is better to write your own finding when assessing a client. As the authors mention, templates should be used only as a baseline information. The population of interest regarding this journal will be health care providers and people that might want to go into the health care profession. Perez, S., & Keijzers, G. (2012). Missing data in the electronic medical record. Emergency medicine Australasia, 24 (4), 465. doi: 10.1111/j.1742-6723.2012.01564.x The authors of this research explain the problems that caused the transition from paper-based system to electronic medical record. With the implementation of the eMR all paper-based data are scanned into the eMR using pdf files and then destroyed. This caused many missing information in the eMR because they were destroyed before being verified in the eMR. Some solutions were addressed in this journal including; depositing the data collection sheets and separating them from the medical charts and placing them in the data collection boxes. This might decrease the loss of a patientâs important information. In brief, this journal addresses a very important topic about the importance of completely transferring the patientâs information into the eMR. Also, it creates an awareness to keep paper documentation even though the eMR is present. Hoffman, M.A., & Williams, M.S. (2011). Electronic medical records and personalized medicine. Hum genet, 130, 33-39. doi: 10.1007/s00439-011-0992-y The authors emphasize two important aspects of a fully functional electronic medical record. Firstly, it is necessary to present patients or clinicians with a high quality context detailed information when providing care. Secondly, the users must combine clinical information from different sources in order to guide the clinician to improve intervention for a given patient. According to this journal, the use of electronic medical record can increase quality of providing care. As health care professionals our main goal is to provide the best intervention to our patient and this journal proved that the use of eMR can improve the intervention given to the patient. This is because it can give doctors a quick access to patientâs information in a critical scenario or even when just proving care.