riley portfolio
TRANSCRIPT
CHARLESRILEYPORTFOLIOCLASSSKILLSINVENTORYCORECOURSESCOURSE SKILLLEARNED DESCRIPTIONOF
SKILLUSETABBEDSKILLAREA
ARTIFACT
NUTR1100 Assesscomponentsofthecurrentfoodsystemsandutilizenewtrendstoaddressgaps.
Analyzethegrowing,harvesting,processing,packaging,transporting,marketing,consuming,anddisposingoffood/foodpackages.
FoodSystems
NUTR1000 Utilizenutrientanalysissoftware.
Utilizepatientdatawithinsoftwareplatformtoanalyzedietaryintakesandcreatenutritionrecommendations.
FoodandNutrition
NutrientAnalysisProject.
NUTR2000 Addressnutrientneedsacrossthelifespan,includingcriticaltimeframes.
Assesspatientneedsatallpointsacrossthelifespanandcreatecomprehensivenutritionintakeplansaccordingly.
FoodandNutrition
ReflectiveJournal/InterviewwithElderlyPatientontheImportanceofNutritionCare.
NUTR2200 Analyzethescientificprinciplesappliedtoselection,storageandpreparationoffoodswithemphasisonfoodmacromolecules.
Preparevariousfoodproductswithmodificationstoanalyzetheeffectsoffoodmakeuponquality,structure,andproperties.
FoodandNutrition
Areviewofnutrientsupplementationintheclinicaltreatmentofdiabetesmellitus.
NUTR2220 Analyzethescientificprinciplesappliedtoselection,storage,andpreparationoffoods.
Preparefoodproductswithmodificationstoassesstheusefulnessoffoodprocessingandpreparationtechniquesonnutritioncare.
FoodandNutrition
Areviewofthefeasibilityofzincandmagnesiumsupplementationinproductsforuseintypeonediabetestreatment.
NUTR2990 Developmentofanawarenessofthephilosophy,goals,organizations,andrequirementsoffood,nutrition,andappliednutritionprofessions.
Prepareacomprehensiveprofessionaldevelopmentportfolioforuseinentrancetonutritionandfoodsciencefields.
ProfessionalDevelopment
NUTR3000 Examinationofthemacro-andmicronutrientsfromascientificstandpoint,includingtheirdigestion,metabolism,andutilizationatthecellularlevel.Evaluationoftherecommendedintakeforthepreventionofchronicdiseaseandhealthmaintenance.
Examinetheclinicalandphysiologicalimportanceofindividualmicro/macronutrients.
FoodandNutrition
Reviewofthephysiologicalandnutritiveimportanceofzinctranscribedpresentation.
NUTR3100 Identifytheimportanceofmedicalnutritiontherapyonthepreventionandtreatmentofdisease,includingoverweight/obesity,hypertension,hyperlipidemia,diabetesmellitus,andkidneydisease.
PreparationofnutritioncareplansforHypertensive,Diabetic,Obese,andKidneyDiseasePatients.
NutritionCareProcess
NutritionCarePlanforHypertensivePatient.
NUTR3600 Applythetheoryofmedicalnutritiontherapy(MNT);communicatinghealthandnutritionadvicetoconsumers;andbehaviorchangemodelsusedinMNT.
Creationofeducationtoolsandclinicalcareguidesforuseinmulticulturalnutritioncareinteractions.
CounselingandEducation
CulturalAnalysisofPacificIslanderPopulationPresentation.NutritionEducationToolwithTypeIdiabeteswithVeganDiet.
NUTR4000
ApplyprinciplesofMedicalNutritionTherapytothecommunitysetting,foodsystems,environmentalnutrition,foodpolicy,andcommunityhealth.
Assessmentofspecificnutritiveandfoodneedsofahighlyspecificpopulationinasemi-isolatedcommunity.
FoodSystems
AssessmentofFoodAccessibilityinTypeIdiabeticchildreninSouthEasternOhio.UNworldfoodprogramagencyeducationalreview.
NUTR4100 Identifytheimportanceofmedicalnutritiontherapyinregardstothepreventionandtreatmentofdisease,includinggastrointestinal,pulmonary,andwastingdiseases,Enteralandparenteralnutrition.
PreparationofNutritionCareplansforGastrointestinal,CysticFibrosis,Immunedeficient,andCancerpatients.
NutritionCareProcess
NutritionCarePlanforB-LymphomaPatient.NutritionCarePlanforGIPatientfocusedonOstomycare.NutritionCarePlanforCysticFibrosisPatents.NutritionCarePlanforImmunocompromisedPatient.CysticFibrosisandPancreaticFunctionEducationalHandOut.
NUTR4901 Demonstrateprofessionaldevelopmentandgrowthinthefieldofnutritionandfoodscience.
Refineprofessionaldocumentsandprofessionalportfolio.
ProfessionalDevelopment
SCIENCE/ANALYSISCOURSESCOURSE SKILLLEARNED DESCRIPTIONOF
SKILLUSETABBEDSKILLAREA
ARTIFACT
BIOS1700 Introductiontothechemistryoflife,cellstructureandfunction,andtheprinciplesofinheritance.
Applyprinciplesofbiologytoconductexperimentsrelatedtobasicgenetics,cellularprinciples,andnaturalselection.
Biology BIOS1705BIOS1710BIOS1715BIOS2210 Introductionto
thehistoryandlifeofmicroorganismswithanemphasisonbacteriaandviruses.
UtilizeprinciplesofmicrobiologytoconductproperlaboratorytechniquestoprepareandanalyzeBiohazardLevel2organismsamples.
Biology BIOS2215
BIOS3010 Structureandgeneralfunctionofallbodysystemswithemphasisonhumanmusculoskeletalsystem,andhumanstructure/functionrelations.
Utilizeprinciplestoconductdissectionsandcadaverobservationstobetterunderstandtheinnerworkingsofthehumanbodyanatomically.
Biology BIOS3015
BIOS3100 Principlesandconceptsofgeneticsasrevealedbyclassicalandmoderninvestigation.
Applycomplexgeneticstoanalyzetheeffectsofgeneticmanipulationandtheeffectofenvironmentalfactorsongeneticmake-upandgeneexpression.
Biology
BIOS3450 Basiccellphysiologythroughmostorgansystems,particularlythoseofhumans.
Conductphysiologicaltestingonbodyfluids,gasexchange,muscleandorganmodelstobetterunderstandcellularandbodilyfunctionsofthehumanbody.
Biology BIOS3455
CHEM1500 Generalcourseinfundamentalchemicalprinciples.Atomicstructure,periodicclassification,bonding,moleconcept,stoichiometrywithproblemsolving,thermochemistry,equilibrium,andgases.
Utilizebasicchemicalprinciplestoconductanalysisofphysicalandchemicalproperties.
Chemistry Determinationof%FluorideintoothpastesamplesusingFluorideIonSelectiveElectrode(FISE).DeterminationofHalfCellPotentialofFerricyanideusingDifferentialPulseVoltammetry.
CHEM1510CHEM1520CHEM2410
CHEM3050 GeneralOrganicchemistryincludingbonding,orbitals,separationtechniques,andexperimenttechniques.
Demonstrateunderstandingoftheprinciplesoforganicchemistrythroughsynthesisoforganicmoleculesinalaboratoryenvironment.
Chemistry LabSafety,procedure,andexecutionsheet.
CHEM3060CHEM3080
CHEM4890 Introductiontobiochemicalconceptsandtechniques,metabolicpathways,andinformationstorageand
Synthesizepreviousunderstandingofbiologyandchemistrytoexplainenzymaticandmetabolicprocessesin
Chemistry
transmission,withemphasisondirectionsofcurrentbiochemicalresearch.
termsofbothplantsandanimals.
MATH1200 Equations,
functionsandgraphs,includinglinearequationsandsystems,polynomials,rationalandradicalexpressions,quadraticequations,exponentialandlogarithmicfunctions,andinequalities.
UtilizeprinciplesofAlgebraandCalculustoapproachcomplexproblemsinanabstract,logicalfashion.
MathematicalReasoning
MATH1350
PHYS2001 Mechanicsof
solidsandliquids,oscillations,heat,thermodynamics.
Demonstrateanunderstandingoffundamental,universalpropertiesofmatterinalaboratoryenvironment.
Physics PHYS2002
PSY2110 Descriptiveand
inferentialstatisticswithemphasisoninferentialstatistics.
Applystatisticalanalysistoconductquantitativehumansubjectresearchinthecollegesetting.
GeneralEducation
BUSINESSCOURSESCOURSE SKILLLEARNED DESCRIPTIONOF
SKILLUSETABBEDSKILLAREA
ARTIFIACT
MGT2000
Understandingofandpracticeinsolvingproblemsfacingmanagersandadministratorsusingconceptsandprinciplesfrombehavioralsciencesandotherapplicabledisciplines.
Applybusinessanalyticstoaddresscomplexbusinesshierarchiesandmachinations.
Businessanalysis
MGT3300
Surveyofhumanresourcemanagementpracticesinareasofhumanresourceplanning,recruitment,selection,traininganddevelopment,performanceappraisal,compensation,discipline,safetyaudits,andpersonnelresearch.
Applyprinciplesofhumanpsychologyandcommunicationtodiffuseconflict,attractclientsandassociates,andadheretobusinesspolicy.
Businessanalysis
SOCIALSCIENCECOURSESCOURSE SKILLLEARNED DESCRIPTIONOF
SKILLUSETABBEDSKILLAREA
ARTIFACT
ANTH1010
Analyzethesimilaritiesanddifferencesinlocal,regional,andglobalculturesinawaythatallowsfortheflowofideasandprinciples.
Conducthumansubjectresearchfocusedonculturaldifferencesinthecollegeenvironment.
GeneralEducation
PSY1010
Surveyoftopicsinexperimentalandclinicalpsychologyincludingphysiologicalbasesofbehavior,sensation,perception,learning,memory,humandevelopment,socialprocesses,personality,andabnormalbehavior.
Utilizetopicstobetterunderstandbasicandcomplexhumaninteractions.
GeneralEducation
COMS1010
Introductoryanalysisoforalcommunicationinhumanrelationshipswithfocusonvarietyofcontextsincludingdyadic,smallgroup,andpubliccommunicationexperiences.
Utilizeprinciplestobuildbetterrelationshipsandmethodsofcommunication.
GeneralEducation
Interpersonalawarenessanddevelopmentactivity.
GENERALEDUCATIONCOURSESCOURSE SKILLLEARNED DESCRIPTIONOF
SKILLUSETABBEDSKILLAREA
ARTIFACT
ENGL1510
Writinginanargumentative/passivefashioninawaytoallowsfortheflowofdiscoursebetweendisciplinesandcultures.
Communicateinafashionthatallowsfortheformulationofcomplexviewpointsfromdifferingstandpoints.
GeneralEducation
HLTH2300
Decomposemedicalterminologyinawaythatleadstooverallunderstandingofmedicaldiscourse.
Communicateinaprofessionalmedicalenvironmentinproperform.
GeneralEducation
EXTRACURRICULARACTIVITY
SKILLLEARNED DISCRIPTIONOFSKILLUSE
TABBEDSKILLAREA
ARTIFACT
AmericanDiabetesAssociationLivingwithDiabetesIncollegeseries
Professionalcommunicationmediatedthroughanorganizationalpartner.
LeveragedbyCollegeDiabetesNetworktowritepieceonDiabetesinCollegeintheireducationalblogseries.
ProfessionalWriting
LivingwithDiabetesinCollege:Charles.
RecommendationtoAADEontransitionaldiabetescarefromchildhoodtoadulthood.
Informingstandardsofpracticeinahealthcaresettingasitrelatestotransitionofcare.
Informedorganizationalandclinicalpartnersastostandardofcarefromthepatientpointofview,andhowthatcanbeleveragedtoprovidebettercare.
ProfessionalWriting
AADEClinicianCareguideforOmnipod.
ProgramProposaltotheAssociationonHigherEducationandDisability
Workingwithaninterdisciplinary,multi-organizationalteamtoproduceeffectiveprogrammingandpolicy.
GeneratedprogramproposalforpresentationatAHEAD2016conference.
ProfessionalWriting
2016CollegeDiabetesNetworkAHEADProposal.
EducationalToolDevelopmentforthoselivingwithTypeIdiabetesinCollege
Workingwithinaresearchteamtoproduceaneffective,resultsbasedtooltoincreasequalityoflife.
Generatededucationaltoolsforuseinaspecificpopulation.
ResearchandProgramDevelopment
DiabetesFactSheetforStudents.
Studytogaugeknowledgeabilityrelatedtodiabetesmellitus
Analyzingbulkdatatofindandcomparetrendsinknowledge
Conductedhumansubjectsresearchtodeterminewhereeducational
ResearchandProgramDevelopment
DiabetesOutreachSupportandEducationfor
atOhioUniversityMainCampus.
baseandassessknowledgedeficits.
materialsneededtobefocused.
StudentsinCollegeKnowledgeabilityStudy.
EducationalToolDevelopmentforFacultyastohowtocreatea“Diabetes”friendlyclassroom.
Gaugingthediscoursebetweenstaff/facultywithstudentslivingwithTypeIdiabetestodiscerngaps.
Interviewedstaffandfacultytodeterminewherethenormwasfailingandwhatcouldbeimproved.
ResearchandProgramDevelopment
CreatingaDiabetes-FriendlyClassroom.
Tabs:BiologyBusinessAnalysisChemistryCHEM2410Determinationof%FluorideintoothpastesamplesusingFluorideIonSelectiveElectrode(FISE)
Introduction
Fluorideisanionthatoccursnaturallyandisregularlyaddedtodrinkingwaterandtoothpaste.Theionisimportantinnaturaldevelopmentofstrongbones.FluoridemustbeconsumedinproperquantitiesorDentalFluorosis;afluorideimbalancemayoccur.Whenfluorideintakereachesextremelevels,kidneydysfunction,poorbonedevelopmentanddeathmayoccurduetotoxicity.Thismeansthatfluoridemustbeproperlymeasuredtoensurehealthyintake.Potentiometricmethodsinvolvethemeasurementofthepotentialofanelectrochemicalcellwithoutdrawingacurrent.Potentiometryisamongthemostcommontypesofanalyticalmeasurement.Theapplicationofpotentiometryrangesfrommeasuringwaterpollutants,measuringmineralconcentrationswithinthebodyorfood,tomeasuringtheamountofCO2dissolvedinseawater.InthisexperimenttheFluorideIonSelectiveElectrode(FISE)willbeemployedtodeterminetheamountofFluorideinatoothpastesample.TheelectrodeinFISEisasolidstate,crystallinemembraneelectrode,whichcanmeasuretheconcentrationofthefluorideioninsolution.Theelectrodeismadeof
asinglemembranecomposedofLaF3withaddedEu2+toincreaseconductivity.Areferenceelectrodeisalsohousedinternallywhichisbondedintoanepoxybody.Thecrystalintheelectrodeisanionicconductorwhichonlyallowsforthemovementofthefluorideion.TheFISEisveryspecificandcanbeeffectedheavilybytemperatureandpH.Itcanbeeffectedasheavilyas2%witha1degreeCelsiuschangeintemperature.Whentheelectrodeisplacedinasolution,themovementoffluorideionsacrossthemembranegeneratesapotentialacrossthesurfaceoftheelectrode.Thispotentialisdependentontheactivityofthefluorideionsinsolution.Thepotentialcanbemeasuredagainstthereferenceelectrodeusingavoltmeter.ThisrelationshipcanbedescribedandillustratedwiththeNerstequation.
E=K-0.0592*log(aF-) Equation1
E=measuredmembranepotential,K=electrodeconstant
aF-=fluorideionactivityinsolution.
Theactivityofanioncanalsobedescribedastheeffectiveconcentrationoffreeionsinsolution.Inthiscase,theactivityoffluorideions,isdescribedastheeffectiveconcentrationoffluorideionsinthesolutionbeingtestedwithFISE.Thetotalionconcentrationofthesolutionbeingtestedincludesbothfreeions,andsomecomplexedions,howevertheelectrodeisonlycapableofrespondingtofreeionsinsolution.TheactivitycoefficientrelatestheactivityoftheFluoridetotheconcentrationoffreefluorideions;
aF=g*CF Equation2
Ionicstrengthisameasureoftheconcentrationofallionsinsolution.Ionicstrengthisadeterminantofionicactivitycoefficients.
m=½SCiZi Equation3
Ci=concentrationofioniZi=chargeofioni.
TheFISEelectrodecanalsorespondtothefluorideionswhichhavecomplexedwithmetalions(commonlyAluminumandIron).Thesecomplexescaninterferewithreadingsoftheelectrodesifpresentinlargeenoughconcentrations.ThisinferenceisdescribedwiththeNikolskii-Eisenmannequation:
Equation4
K=electrodeconstant,R=idealgasconstant,
T=temperatureinKelvin,Zi=chargeontheionofinterest,
ai=activityofspeciesi,aj=activityofinterferingionjwithchargeZj,
kij=selectivityconstantoftheelectrodeforioverj.
Theselectivityconstantisrepresentativeoftheamountofinterferenceduetocomplexedmetal/ionspresentinthesample.TheresultsofourexperimentvalidatedtheNerstequation,andthedifferenceinFluorideionsdeterminedanalyticallyandtheamountofFlourideionsreportedbythetoothpastcompanywasdeterminedtobeapproximately11%.
ProcedureTheexperimentwasconductedaspertheinstructionsprovidedinthelabhandout:ExperimentIV,FISE,CHEM2410L,FallSemester2016.Theprocedurewascompletedtospecification;noalterationsweremade.Table1:InstrumentsEmployed
Instrument Model# CompanyVoltmeter N/a N/aStirrer N/a N/aFluorideElectrode N/a N/a
Table1includesallinstrumentsemployedtoconducttheFISEexperiment.Table2:ChemicalsEmployed
Chemical Supplier Lot# MolecularWeight ExpirationDateSodiumFluoride N/a N/a 41.98817 N/aSodiumChloride N/a N/a 58.44 N/aTISAB N/a N/a N/a N/aToothpaste N/a N/a N/a N/a
Table2includesthechemicalsemployedtoconducttheFISEexperiment,allinformationavailablewasprovidedintable2.
( )( ) úûù
êëé +÷÷
ø
öççè
æ+= j
iZ
Z
jijii
akaFZRTKE log303.2
Table3:AmountsofReagentsUsedReagent AmountUsedSodiumFluoride 0.04199gSodiumChloride 0.5260gTISAB 50mL
Table3includestheamountofeachreagentusedtoconducttheFISEexperimentingrams.PreparationofStandards:PreparationofStockSolution:
0.100L*0.01mol/1L*41.9881g/1mol=0.04199gNaF+0.5268gNaClSerialDilutionPreparation
IonicStrength AddedNaCl0.001M–10mL0.01M 0.5260gNaCl0.0005M–50mL 0.001M 0.2922gNaCl0.002M–40mL0.0005M 0.3507gNaCl0.0001M–50mL 0.0002M 0.2922gNaCl0.00005M–50mL 0.0001M 0.2922gNaCl
ResultsandDiscussion
Figure1:FluorideCalibrationCurve
y=56.964x- 289.68R²=0.99348
-200 -180 -160 -140 -120 -100 -80 -60 -40 -20 0
1 1.5 2 2.5 3 3.5 4 4.5
Potential(mv)
-logConcentration
Concentrationvs.Potential
Figure1demonstratestherelationshipbetweenthepotentialinmVandthe–logoftheconcentration.Figure1alsodemonstratesthevalidationoftheNerstequationastheslopeofthelineisnearthevalueof59.16mV.Table4:DeterminationofFluorideionpresent
LineEquation
UnknownPotential
(-)logconcentration
concentration(mM)
%fluorideion
%fluoridefromtoothpastetube
%difference
y=56.964x-289.68 -51 4.19 6.45654E-05 0.028%
0.24%11.85
Table4includesthedeterminationoffluorideionpresentinthetoothpastesample.Thisdeterminationwasconductedusingtheequationofthecalibrationlineequation.Usingthisequation,alongwiththeaverageunknownpotentialfoundexperimentally.Usingthispotential,the–logoftheconcentrationwasfound,alongwiththeconcentration.Usingtheconcentration,the%fluorideionwasfoundandthe%differencebetweenthecalculatedpercentageoffluorideionpresentandthereported%fluorideionpresentwascalculatedtobe11%.Thisexperimentwasparticularlysusceptibletoerror,astwodifferentlabteamscollaboratedtocompletetheexperiment.Thisincreasedthepossibilityofexperimentalerrorasdatawaspassedbetweenmanyexperimentersandpossiblylostintransition.Therewasalsocertainlyanerrorinthecalculationsusedtocreatethestocksolutionandthedilutions.Duetoineffectivecommunicationbetweenthelabgroups,thecalculationdataismostdefinitelyincorrectinsomecapacity.Anothersourceoferrorincludesunanticipatedissueswiththetypeoftoothpasteusedincludinghighamountofmetalcomplexingwiththefluorideionsduetotheingredientsofthetoothpasteused.Inthefuture,theseerrorscouldbereducedbyreducingthenumberofgroupsconductingtheexperimenttojustonegroupatatime.Thelabcouldalsoprovidethetoothpastesampletostandardizetheexperimenttoeliminateissuesassociatedwiththeformularyofindividualtoothpastesused.Inconclusion,the%offluorideionspresentinourtoothpastesamplewasobtainedbyexaminingstandardfluoridesolutions.Thiswasdoneusingacalibrationcurveandtheequationoftheline.Thevaluesoftheunknownwerepluggedintotheequationoftheline.Thedifferenceincalculatedvaluesandthegivenvaluewasfoundtobe11%.
Conclusion
Overall,thelabprocedurewasok.However,thebreak-upofworkbetweentwogroupsmadedatacollectionandcalculationsverydifficulttocarryoutasinformationwasnotequallyshared,norwasiteasytoobtainafterthefact.Wewereabletocarryouttheseprocedureswithissues,mainlyduetounequalsharingofinformationanddisarraybetweenthetwogroups.Thecalculationsandexplanationsarequitedifficultasaresomeofthetheorypieces,withouthavingabackgroundinelectrochemistry,andalsonothavingourelectrochemistrylecturesyet.Hopefullythisproblemcanbealleviatedinthefuturebyexpandingthequantitativelaboradjustingclasssizeandnotbreakingonelabbetweentwolabgroups.
Questions1. Overwhatrangeisyourcalibrationcurvelinear?
Thecalibrationcurveislinearovernearlytheentirerangeoftheconcentrations.Itraisesslightlynearthe3mMlevel,however,thisisnegligibleasthecorrelationcoefficientisnearly1.
2.WhatistheslopeofyourcalibrationcurveandhowisthisrelatedtotheNernstianequation?
Theslopeofthecalibrationcurveis56.964.Whenastraightlinewithaslopeof59.16mVisobtained,thenthenerstequationcanbesaidtobevalidated.Inthiscase,wecansaythatthenerstequationissatisfiedduetotheproximitytothetruevalue.
2. WhyissodiumcitrateaddedtotheTISABsolution?
Sodiumcitrateisaddedtocomplexwithpresentmetalionstopreventthemfromcomplexingwiththefluorideions,limitingtheinterference.
3. Whydoeshydroxideinterferewiththefluorideelectrode?
HydroxideinterfereswiththefluorideelectrodebecauseitcomplexeswiththeLaF3crystalitself.Thiscomplexinginterfereswithfluoridedetermination.
4. Whyarethesolutionstransferredtoplasticbeakers?
Theplasticbeakersactasaninsulatorbetweenthelabbenchandthesolution.Thisdisallowsinterferenceduetotemperature.
5. Whyisnonturbulentstirringrequired?
Toensureequaldispersantoffluorideionstotheelectrode.
References
1.Experiment1:CyclicVoltammetryofFerricyanide,LaboratoryHandout,FallSemester2016
2.Harris,DanielC.2010.QuantitativeChemicalAnalysis.8thed.Chapter16:Electrochemical
Techniques.W.H.Freeman,2010.CHEM2410DeterminationofHalfCellPotentialofFerricyanideusingDifferentialPulseVoltammetry
Introduction:
ThepurposeoftheelectrochemistrylabIIIwastolearnmoreaboutthetheory,procedure,andinstrumentsinvolvedinDifferentialpulsevoltammetry.Inthisprocedure,ourgoalistostudy
differentialpulsevoltammetry(DPV)byexaminingthereductionofferricyanidetoferrocyanide.Theequationofthisreactionisgivenas:Fe(CN)63-+e-⇄Fe(CN)64-.
TheinstrumentusedtoconducttheDPVexperimentwasthepoteniostat.Theelectrodesemployedweretheglassycarbonelectrodeastheworkingelectrode,theAg/AgClelectrodeasthereferenceelectrode,andthePlatinumwireastheauxiliaryelectrode.DPVisconductedasotherpulsetechniquesinthatthedifferencebetweenthedecayrateofthechargingcurrentandfaradaiccurrentdirectlyfollowingthepulse.Itisnoteworthythatthechargingcurrentdecaysinanexponentialfashionwhilethefaradaiccurrentdecaysatthefunctionofthesquarerootoftheinverseoftime(1/(time^(1/2))).Someothertermsofnoteinclude:
PulseAmplitude:HeightofrecordedPulse
PulseWidth:PulseDurationSamplePeriod:Periodattheendofthepulsewherethecurrentmeasurementistaken
PulsePeriod:thetimeofonefullpotentialcycle
Thepulsevoltammetryfieldincludesmanydifferentmethods,howeverthemostcommonarenormalpulse,differentialpulse,andsquarewave.First,thereisthenormalpulsemethodwhichinvolvestheapplicationofaseriesofpulsesofincreasingamplitudeoveradurationofbetween1and100milliseconds.Asimilartechniquetothenormalpulsemethodisthedifferentialpulse,whichinvolvestheapplicationofapotentialwhichiskeptatasmallerfixedamplitudecomparedtothenormalpulsemethod.Finally,thereisthesquarewavemethodwhichoftheapplicationofasymmetrical,squarewavepulse,whichissuperimposedonastaircasewaveform.Thenetcurrentforthismethodisobtainedbytakingthedifferencebetweenthenormal(forward)andreversecurrentandiscenteredontheredoxpotentialofthecompoundinquestion.
Whiletherearemanydifferenttypesofpulsevoltammetry,theexperimentfocuswasDifferentialPulse.InDPV,thepotentialisscannedwithaseriesofpulsessimilartoothertypesofpulsevoltammetry,however,DPVisdifferentinthatthepulseiskepttoasmalleramplitude(usuallybetween10-100mV).Thissmallpulseisthenmeasuredontopofabasepotentialwhichisslowlychangedoverthecourseoftheexperiment.Foreachpulse,thecurrentismeasuretwice:firstatapointbeforethepulseandagainattheendofthepulse.Atbothofthesepoints,thechargingcurrenthasbeenallowedtodecaytoensureaccuratemeasurements.Thedifferencebetweenthetwopointsatwhichthepulsewasmeasuredisplottedagainstthepotentialontheresultingvoltammogram.
InexperimentIII,thereductionofferricyanidetoferrocyanidewasstudiedusingthismethod.Withthisreductiveprocessinmind,theamplitudeusedforDPVwas50mV.Thepotentialwasthenchangedfrombasepotential,toamid-levelpotential.Thismid-levelpotentialwasmaintainedfor50msbeforebeingchangedtothefinalpotential.Whenthepotentialexceedsthatofthereductionpotential,nofaradaiccurrentisobserved,whichmeansthedifferenceinchargingcurrentandfaradaiccurrentiszero.However,whenthefaradaiccurrentreachesthereductivecurrent,thecurrentdifferenceismaximized,thendecreasesbacktozero.
DuetothenatureofDPV,thedetectionlimitismuchlowerthanthatofotheranalyticmethods.Thisisduetotheenhancementofthefaradaiccurrentandtheminimizationofthechargingcurrent.Becausethecurrentismeasurebeforeandafterthepulse,theratioofchargingcurrenttofaradaiccurrentisincreaseddrastically.Aftereachpotentialthechargingcurrentquicklydecaystozero,whilethefaradaic
currentincreasesatamuchslowerrate.TheenhancementofthefaradaiccurrentalsoincreasesthesensitivityoftheDPVmethod.Thepulsewillpropagateinthesurfacelayerofthesampleiftheelectroactivecompoundispresentbecause,accordingtotheNerstequationtheconcentrationmustdecreasewiththisnewpotential.
Equation1below,demonstratesthattheheightofeachpeakisproportionaltotheconcentrationoftheelectroactivecompound.
mp t
CnFADip
21
= Equation1
ip:peakcurrent(A),F:Faraday’sconstant,
A:workingareaoftheelectrode(cm2),D:diffusioncoefficientoftheanalyte(cm2/sec),
C:concentrationoftheanalyte(mol/cm3),tm:timeaftertheapplicationofthepotentialwhenthecurrentismeasured(sec)
AccordingtoEquation2below,ifthereactionisreversible,thepeakpotentialisnearlyequaltothestandardpotentialforthehalfreaction.
Ep=E1/2–DE/2Equation2
DE:pulseamplitude(mV).
Afterconductingthisexperiment,itwasfoundthatequation1and2werevalidatedbytheresultsobtained.Theconcentrationwasdirectlyproportionalwiththeheightofeachpeakachieved,andthepeakpotentialwasnearlyequaltothestandardpotentialofthehalfreaction.Theprocedureandresultsareshownbelow.
Procedure:
Theexperimentwasconductedaspertheinstructionsprovidedinthelabhandout:ExperimentIII,DPV,CHEM2410L,FallSemester2016.1Theprocedurewasfollowedtospecification,includingthedeoxygenationofeachsamplebetweentrialsbypurgingwithNitrogengas.Table1includesallavailableinformationregardingtheinstrumentsemployedtocompletethisexperiment.
Table1:InstrumentsEmployed:
Instruments Model# Company
WorkingElectrode N/A BAS
ReferenceElectrode N/A BAS
AuxiliaryElectrode N/A BAS
Potentiostat EpsilonEC-USB BAS
StirringUnit EpsilonRPM250 BAS
Table2includesallavailableinformationregardingthechemicalreagentsemployedtocompleteexperimentIII.
Table2:ReagentsEmployed:
Chemical Supplier LotNumber MolecularWeight ExpirationDate
PotassiumFerricyanide Spectrum OV0185 329.24g/mol N/A
PotassiumNitrate Spectrum QH2542 101.10g/mol N/A
AmountofReagentsUsed:
Calculation#1:DeterminingamountofKNO3neededtoprepare1Lof1Msolution.
TheamountofK3Fe(CN)6ingramstoprepare10mMsolutionwasdeterminedsimilarly.
Table3belowincludestheamountofeachreagentusedingrams.Table3:Amountofreagentsused:
Reagent AmountUsed
PotassiumNitrate 101.10gKNO3
PotassiumFerricyanide 0.814gK3Fe(CN)6
UnknownPotassiumNitrate PreparedbyTA
PreparationofStandards:
Calculation2:DeterminingthevolumeofPotassiumFerricyanideneededtomakestocksolution
8(250)=9.89(x)=202.2mLK3Fe(CN)6neededtopreparea~8mMSolution
250mL(x)=9.89mM(200)=7.912mM
Allserialdilutionswereconductedinasimilarmanner.
Table4belowincludesallinformationavailableonthepreparationofthesolutionsusedinexperiment3.Table4:Preparationofsolution
Concentrations(mM) VolumeofK3Fe(CN)6(mL) VolumeofKNO3(mL)
2 100mL 49.64mL
4 100mL 66.5mL
6 250mL 189.59mL
8 202.2mL 250mL
ResultsandDiscussion:
Table5:HalfCellpotentialofDPVEp(mV) DPVHalfCell
Potential(mV)HDVHalfCellPotential(mV)
CVHalfCellPotential(mV)
LiteratureValueCVHalfCell(mV)
256
128 161 234 225
Usingequation2andtheEpfromthe4mMsamplethehalf-cellpotentialwasfoundtobe128mV.ThevaluecomparesfavorablytothevaluefoundinHDVandCV,whichwere161mVand234mV,respectively.Figure1:DPVofFerricyanideatdifferingconcentrations.
AsdemonstratedinFigure1,theheightofthepeakisproportionaltotheconcentrationoftheelectroactivecompound.Figure2:DPVofUnknownsampleofFerricyanide
0.00E+00
1.00E-05
2.00E-05
3.00E-05
4.00E-05
5.00E-05
6.00E-05
-4.00E-01 -2.00E-01 0.00E+00 2.00E-01 4.00E-01 6.00E-01 8.00E-01 1.00E+00
Curren
t(A)
Potential(mV)
DPVofFerricyanide
2mM
4mM
6mM
8mm
10mM
Figure2showstheresultingvoltammogramoftheunknownsamplewhichwaspreparedbytheTA.
Figure3:CalibrationofDPV
Table4:Concentrationvs.CurrentConcentration Current
2 2.20E-05
0.00E+00
5.00E-06
1.00E-05
1.50E-05
2.00E-05
2.50E-05
-0.4 -0.2 0 0.2 0.4 0.6 0.8 1
Curren
t(A)
Potential(mV)
DPVofUnknownFerricyanide
y=4E-06x+9E-06R²=0.91925
0
0.00001
0.00002
0.00003
0.00004
0.00005
0.00006
0 2 4 6 8 10 12
Curren
t(A)
Concentration(mM)
CalibrationplotofDPV
4 2.21E-056 3.16E-058 4.09E-05
10 5.56E-05Table4includestheEpcurrentforeachconcentrationused.Thisdatawasusedtocreatethecalibrationplotinfigure3.Table5:ConcentrationoftheunknownEquationoftheLine Current mMy=4E-06x+9E-06 2.34E-05 3.6
Table5includestheequationoftheline,theEpoftheunknownandthecalculatedconcentrationusingtheequationandtheEpvalue.
Conclusion:
Overall,thelabprocedurewasveryenjoyable,themethodsinvolvedindoingserialdilutionarefuntocarryoutandstraightforwardonceyoubegintheprocedure.Wewereabletocarryouttheseprocedureswithminimalissues,especiallyafterhavingmoreexperiencewithitaftercompletingexperimentIandII.ThecalculationsandexplanationsarequitedifficultbuthavegotteneasierwhencomparedtoexperimentsIandII,asaresomeofthetheorypieces,withouthavingasolidbackgroundinelectrochemistry,andalsonothavingourelectrochemistrylecturesyet.Hopefullythisproblemcanbealleviatedinthefuturebyexpandingthequantitativelaboradjustingclasssize.
References:
1.Experiment1:CyclicVoltammetryofFerricyanide,LaboratoryHandout,
Chemistry2410L,FallSemester2016
2.Harris,DanielC.2010.QuantitativeChemicalAnalysis.8thed.Chapter16: ElectrochemicalTechniques.W.H.Freeman,2010. 3.Skoog,D.A.,Holler,F.J.,Neiman,T.A.,Voltammetry; in
PrinciplesofInstrumentalAnalysis,SaundersCollegePublishingCompany, Chapter25,1998.4.Wang,J.,PracticalConsiderations;AnalyticalElectrochemistry,JohnWileyandSons, Chapter4,2006.
CHEM3080LabSafety,procedure,andexecutionsheet.BackgroundInfo:
CharlesRiley8/2/16Chem3080;9a-11:50aSeparationandQuantificationoftheComponentsofaReactionMixturesbyGasChromatography(GC)
PhysicalInfo:
ChemicalsUsed:
Compound
SulfuricAcid AmmoniumChloride 1-Butanol
Structure:
MolecularWeight:
98.079g/mol 53.491g/mol 74.1216g/mol
Density:
1.84g/mL 1.53g/cm^3 0.81g/mL
HealthHaz
Corrosiveifincontactwithskinandeyes.Maycausetissuedamage,especiallyifincontact
Slightlyhazardousincaseofskincontact.Irritantifincontactwithskin.
Veryhazardousincaseofskincontact.Maycauseinflammationoftheeyes.
ards:
withmucousmembranes.
Quantity:
1mL
0.0187mol(1mL*1.84g/mL/98.079g/mol)
0.5g
0.0093mol(0.5g*53.491g/mol)
0.5mL
0.0055mol(0.5mL*0.81g/mL/74.1216g/mol)
Discussion:i.)EquimolarMixture:[Butanolusedasstandardforcalculations]
IntegralRRCalc.
Sample:IntegralCorrectedCalc.
MolarRatio
Chlorobut.32.141.166(32.14/27.56)
61.8853.07(61.88/1.166)
53.07:
Butanol27.561(27.56/27.56)
28.2928.29(28.29/1)
28.29:
DibutylEther40.301.462(40.30/27.56)
9.836.72(9.83/1.462)
6.72
ii.)LabQuestionsIftheGCmeasurementperformedonacolumnat100°Cleadstoapoorseparationoftwocompounds,explainwhyanincreaseoftheGCcolumntemperaturemightimprovetheseparation.Whymightanincreaseincolumntemperaturealsoworsentheseparationoftwocompounds?
Anincreaseinthecolumntemperaturewilldecreasetheretentiontime,whichmaymakethepeaksonaGCusingcompoundswithlongerretentiontimeslessbroadandincreaseresolution,thusleadingtoabetterseparationresult.However,anincreaseintemperaturemayworsentheseparationifthetemperatureifraisedtoohigh.Thiscouldleadtosuchasteepdecreaseinretentiontimethatcompoundsmovethroughthecolumnalmostimmediately,leadingtoonlyoneobservablepeak.Thus,makingtheseparationunsuccessful.
GreenChemistry:
WhatisthetaskofthegovernmentorganizationknownasOSHA?WhatareOSHAstandards?PleaseshowoneOSHAstandardforbenzene(acommonchemicalingasoline).
OSHAisanagencyoftheUSdepartmentoflabortaskedwithassuringworkplacesafety,ensuringhealthfulworkingconditions,andenforcingstandards.OSHAstandardsarerulesandregulationswhichemployersmustadheretoinordertoensurethesafetyandhealthofemployees.
OSHAStandardforBenzeneprovidedbelow:“1910.1028(j)(2)(i)
Theemployershallpostsignsatentrancestoregulatedareas.Thesignsshallbearthefollowinglegend:
DANGERBENZENEMAYCAUSECANCERHIGHLYFLAMMABLELIQUIDANDVAPORDONOTSMOKEWEARRESPIRATORYPROTECTIONINTHISAREAAUTHORIZEDPERSONNELONLY”
CounselingandEducationNUTR3600CulturalAnalysisofPacificIslanderPopulationPresentation
A. WhoisclassifiedasaPacificIslander?- ThosewholiveinthePacificIslands- 3classifications
o Polynesians(Hawaii,NewZealand,SamoanIslands,etc.)o Melanesia(NewGuinea,Fiji,SantaCruzIslands,etc.)o Micronesia(IslandsofKiribati,Nauru,Marianas,etc.)
B. StapleFoods- Seafood(particularlyfish)- Pork- Seaweed- Rootvegetablesandtubers- Sweetpotatoes/yams
- Tropicalfruits(pineapple,mango,banana,andpapaya)- Coconuts/Coconutmilk
C. TabooFoods- Someseculartaboosstillexist(e.g.superstitionaroundeatingmice).However,mosthave
diedout.- Somefishingrestrictionsforenvironmentalprotectionpurposes.
D. TypicalFoodPreparationandTechniques- Largelyinfluencedbythosecountriesthatclaimedcontrolofthem.
o IncludesUnitedStates,France,Germany,andBritaino e.g.FrenchinfluenceoncookingstylesonTahitiandpresenceofcornedbeefand
SpaminPacificIslanderdishes- Fishistraditionallyeatenraw,poached,orgrilled.- Coconutisbeingpeeledandeatenwholeormashedintoapastethatisdippedintowarm
coconutmilk.E. FamilyDynamics/FamilyFoodDynamics
- Communityisequivalenttofamily.Muchisshared,includingfood.o Manytimes,fishermentakewhattheyneedfromtheircatchandleavetherestfor
othercommunitymembers.- Otherfamilydynamicsincluderespectforelders,fatherfilingtheroleofheadofthefamily,
andchildrenremainingathomeuntilmarriage.F. FoodTraditions,Celebrations,Customs,andBeliefs
- Kava(pronounced"kah-vah")o nonalcoholic,mildlynarcoticceremonialbeveragemadewiththegroundrootofthe
peppershrubo passedfrompersontopersoninagroupandismeanttorepresenttocoming
togetheroftwofamilieso customaryforFijianvillagevisitorstopresentthevillageexecutiveheadwithKava
- Yaqona(pronounced"yanggona")o mildlyintoxicatingbeverageconsumedduringimportantFijioccasions,likebirths,
weddings,deaths,andthearrivalofadignitaries- Holidaysinclude
o Christianholidays,suchasEasterandChristmaso BastilleDay,aFrenchIndependenceDay,onFrench-speakingislandso July4th-celebratedasKingTaufa'ahauTupouIV'sbirthdayandanationalholiday–
inTonga- Mostcelebrationsareexpectedtoincludedfeasting,music,anddance.Musiciansplaythe
guitarandtraditionalinstrumentslikethepahu(awooddrum),ukelele,uliuli(smallgourds),ipu(largergourds),puili(splitbamboo)andTahitiandrumsmadeoutofhollowedlogs.
G. CommunicationStyles/NonverbalBehaviors- Communicationbasedonfamilyroleandhonor.
o Highvalueplacedonindirect(non-verbal)communication.§ Silenceisusedtocallattentiontoneedsanddesires.
• Bodylanguageandexpressionshelptorelaymessage.Thespeakerisexpectedtointerpretsilenceandaddressneedsaccordingly.
§ Silencealsohelpstoavoidcallingattentiontomistakesandoversightsandmaybeindicativeoffamilyrole(i.e.ifpersonisnottheheadofthefamily).
o Directcommunicationoffeelingsisdiscouraged.§ Seenasshamefulandbreaksobligationtothefamily.
o Mayhideprevioushealthcareinformationand/ordiagnosesinordertoprotectthefamilyreputation.Canbecomeabarriertoclinicalcare.
o Eyecontactisavoided§ Seenasdisrespectful,especiallytoauthority/healthcarefigures
- Etiquetteincludesthewearingofshoesinthehouse.ItisalsoconsideredrudetotouchaFijianonthehead.
NUTR3600NutritionEducationToolwithTypeIdiabeteswithVeganDiet
VeganismandDiabetesRecentresearchshowsthatavegandietcanhelpthosewithdiabetesbettermanagebloodsugarlevels.WhatisDiabetes?Diabetesmellitusisaconditionthatinhibitsthebody’sabilitytomanagesugarlevelsintheblood.Therearetwodifferenttypesofdiabetes: TypeOne TypeTwo
WhatisVeganism?Thevegandietissimilartothevegetariandietinthatitexcludesmeat.Thevegandietjusttakesitastepfurtherandexcludesallanimal-basedfoods,includingeggs,dairyproducts(likemilk,cheese,andyogurt),andmeatbroths.
HowcanveganismhelpsomeonewithTypeTwo?
Researchhasdemonstratedthatsaturatedfats-atypeoffattypicallyfoundinanimal-basedproducts-makesitmoredifficultforinsulintoremovesugarfromtheblood,leadingtohighbloodsugarlevels.Onewaytolowerthistypeoffatinthedietcanbeaccomplishedbyremovinganimal-basedproducts.Thisdecreaseinsaturatedfatintakehelpsinsulintobetterdoitsjob.
HowcanveganismhelpsomeonewithTypeOne?GlycemicIndexisthemeasureofhowhighafoodraisesbloodsugarlevelsoveraperiodoftimeaftereating.ForthosewithTypeOnediabetes,thisisaveryimportantvalue.Foodswithhigherglycemicindexraisebloodsugarlevelsfasterandcanincreasetheselevelsbeforeinsulincanhaveaneffect.Tokeepbloodglucoselevelslower,youshouldtrytoeatfoodswithalowerglycemicindextokeepblood
The body cannot produce an important hormone called insulin which is responsible for taking sugar out of the blood and storing it in the body’s cells.
A person with type one diabetes must use
insulin shots to regulate blood sugar levels
The body is still able to produce insulin, but is either not producing enough or is unable to use it correctly.
Those with type two diabetes can
manage their blood sugar levels with insulin shots or pills, or by maintaining a healthy diet and exercising.
glucoselevelsfromspiking.Thevegandietisrichwiththeselowglycemicindexfoodslikenon-starchyvegetables,fruits,andwholegrains.HowdoIgetstarted?
● Identifyfoodsinyourdietthatcontainanimal-basedproducts.Watchoutforhiddensourcesintheingredientlist-youneverknowwhereyoumightfindthem!
● Easeintoit.Aimtoremoveonemeatproductaday!
● Usemeatalternatives,suchastofuandalmondmilk.Eveneggscanbereplacedwithflaxseeds,applesauce,andhoney!
● Experimentwithprotein-pairing!Removingmeatsfromthedietremovesalotoftheproteinyouwouldotherwisebeeating.Darkleafygreenspairedwithlegumesornutsareagoodwaytomakeupforthelostprotein!
Foradditionalresearch,visit:http://www.pcrm.org/health/diabetes-resourcesFoodandNutritionNUTR1000NutrientAnalysisProject1.Compareyourpercentageofkilocaloriesfromcarbohydratetothatoftherecommendedrange.Site3specificfoodhabitsthatshouldbechangedormaintained.Rec’d%CHO:45%-65% YourCHO%:52% a.IncorporatesmallerportionsoffoodsthataremoreCarbohydrateDense.Foodspackedwithstarch,berries,apples,andwhole-wheatfoodscouldfillthisrole.
b.Insteadofeating3largemeals(~90carbs/meal),eat6smallermealsofabout45-50carbs.Thisamountwouldmakeportioncontroleasier,andcouldhelpcontrolcravingsforhighcarbjunkfoods.c.Asanalternativetothe6meals/daymentionedinb.,continueeating3mealsat90carbs/mealbutincorporate3snacksataround15-30carbspersnack.Thisagainwouldmakeportioncontroleasierandcontrol“highcarbcravings”.
2.Compareyourpercentageofkilocaloriesfromproteintothatoftherecommendedrange.Site3specificfoodhabitsthatshouldbechangedormaintained.
Rec’d%PRO:10%-35% YourPRO%:19%a.SwitchthebulkofmealsfromMeatbasedtoincludemoreDarkGreenswithMeatasa“sidedish”.b.LimitintakeofCheeses,beans,lentils,nutsandseedstolimitnon-animalsourcesofprotein.c.EliminateAnimalsourcesofproteinduringmealtime,andreplaceitwithamoderateamountofnon-animalsources,asitmaybeeasiertocontrolportionsizesthisway.
3.Compareyourpercentageofkilocaloriesfromfattothatoftherecommendedrange.Site3specificfoodhabitsthatshouldbechangedormaintained.
Rec’d%FAT:20%-35% YourFAT%:30% a.Chooseleanercutsofmeatwhencooking,tolimittheintakeofexcessfatfromlessleancuts.b.Limit“snack”and“junk”foodsthatcanbepackedwithfatlikepastryfoodsandpotatoeschips.c.Completelyavoidfastfood,oratleastchooselessfattyoptionsatsuchplaces.Ex.ChooseasaladoverfattyhamburgersandappleslicesinsteadofFrenchfries.
4.Compareyourpercentageofeachtypeoffattothatoftherecommendedranges.SiteONEspecificfoodhabitthatshouldbechangedormaintainedFOREACHTYPEOFFAT.
Rec’d%saturatedfat: <7% Yoursat.fat%:10%
Rec’d%monounsaturatedfat:10%-15%Yourmonounsat.fat%:10% Rec’d%polyunsaturatedfat: 10% Yourpolyunsat.fat%:6%a.Limitintakeofmeatslikesausage,bacon,etc.asthewaytheyarecooked/thethingstheyarecookedincanaddunnecessaryamountsofgrease(SaturatedFats).b.TrytoincorporateFishintothediettoencourageintakeofOmega3FattyAcidsandmonounsaturatedfats.c.Cookwithoilshighinpolyunsaturatedfats.Oilsincluding:Soybean,Corn,andSunfloweroil.
5.Compareyourmilligramsofdietarycholesterolyoutookintothatoftherecommendedranges.Site3specificfoodhabitsthatshouldbechangedormaintained.Rec’d:300mg/day Yours:164.88mga.Continuetolimit“organmeats”inthediet.Theycancontainhighamountsofdietarycholesterol.b.Eatoneegg/daytomakeupforthedifferenceinmyrecommendedamountandactualintake.c.Limitallintakeofshellfishastheycancontributelargeamountsofdietarycholesterol.6.Comparetotalgramsofdietaryfiberyoutookintothatoftherecommendedranges.Site3specificfoodhabitswhichshouldbechangedormaintained.Rec’d:38g Yours:12.31ga.SwitchfromWhiteBreadtoWheatbread.Wholegrainscontainhigheramountsoffiberthanrefinedgrains.b.Keepskinsonfruits,berries,andvegetables.Skinsarehighinfiber.c.Increaseamountsofnuts,beans,andpopcorninsnacks.Allarefiberdenseandeasytoworkintothediet.7.Compareyourmilligramsofdietarysodiumyoutookintothatoftherecommendedranges.Site3specificfoodhabitswhichshouldbechangedormaintained.Rec’d:1500mg Yours:3105.56mga.Eatlesssaltysnackslikepotatoeschips,saltedpeanuts,andsaltedpretzels.b.LimitintakeofSoda,1servingcancontainaround50mgofsodium,whichcanaddupquicklyinpeoplethat
consumelargequantitiesinaday.c.Cookfreshfoods,asopposedtocookingcannedfoods.Cannedfoodsareveryhighinsodiumtopreserve
thefood.8.Listallthevitaminsthatfellbelow75%oftheRDA/DRIinyouraveragedanalysis.ThenforEACHvitamin,listthreerichsources.(Useseparatepieceofpaperifneeded)Folate– Beets,BeefLiver,PintoBeansVitaminC- GrapeFruit,Peppers(Red&Green),StrawberriesVitaminD- FortifiedMilk,Sardines,FortifiedCerealVitaminA– Carrots,SweetPotatoes,CookedSpinachVitaminE- SunflowerSeeds,CanolaOil,WheatGerm
9.Listallthemineralsthatfellbelow75%oftheRDA/DRIinyouraveragedanalysis.ThenforEACHmineral,listthreerichsources.(Useseparatepieceofpaperifneeded)Magnesium–Spinach,BranCereal,BlackBeansPotassium– BakedPotatoes,OrangeJuice,BananasZinc– Oysters,Shrimp,BeefSteak
10.Examineyourthree-dayintakesanddetermineifyouralcoholintakewasmoderate.Discusssomehealthconsequencesofexcessiveintakeand2strategiesyoucouldimplementtomoderateorabstainfromalcoholingestion.Answerthisquestionregardlessofyouralcoholintake.AlthoughIdidnotconsumealcoholinmy3-dayrecordingperiod,thenegativeconsequencesofexcessiveintakeofalcoholincludeLiverDamage,Cardiovasculardisorders,certaincancers,andsomementalhealthissues.Morespecifically,AlcoholcancauseLiverFailure,depression,andanemia.Strategiesthatcouldberecruitedtomoderateorcompletelyabstainfromalcoholuseincludeurgecontrolwithactivitiessuchasexercise,outdooractivities,andotherconstructive“distractions”.Anotherstrategythatmightbeeffectiveistoavoidareaswherepeerpressure/theenvironmentisconducivetodrinkingalcoholinexcess,areaslikebars,parties,etc.
11.Compareyourestimatedenergyrequirementstotheaveragekcalsyoutookin.Basedonthisdata,indicatebelowifyouareinpositive,negative,or“maintenance”energybalance.Basedonthisdata,howfastwouldyougainorloseweightifyoucontinuedthistrend?Refertopage340ofupdatedtexttohelpanswerthisquestion.a.Youraverageestimatedenergyrequirement:2176.0kcalb.Youraveragekcalintake:1592.55kcalc.Basedontheabovedata,Iamin:(Circletheappropriatechoiceforyou)
POSITIVEENERGYBALANCENEGATIVEENERGYBALANCE“BALANCED”ENERGYBALANCE
d.Atthisrate,Iwouldgainorlose,ormaintainatarateof1.17poundsperweek.
NUTR2000ReflectiveJournal/InterviewwithElderlyPatientontheImportanceofNutritionCare Forthepurposeofthisassignment,Iintervieweda66-year-old,caucasian,female.Thesubjectismarried,livingathomewithherhusband.Shehasbeenretiredforfewerthan10years,anddoesnotholdacollegedegree. Whenconductingthenutritionscreeninginitiative,thesubjectwasfoundtohaveascoreof5,indicatingmoderatenutritionrisk.Thesubjectindicatedthatshehadanillness,whichaffectedherdietmarginally(typetwodiabetes),takes3ormoreprescribedmedications,andisnotalwaysablephysicallytoshopforherself.However,thesubjectindicatedthatherhusbanddoestheshopping,negatingtheinabilitytoshopforherself,andsomeofthemedicationssheisprescribedareprescribedinconjunctionwithherdiet.Withthatinmind,Ibelievethatthissubjectisatalowtomoderatenutritionalrisk.
Inmyopinion,Ibelievethatthissubject’sintakeisappropriateforherdiseasestate.Itseemsthatshefollowsherprescribedmealplanveryclosely.Further,sheandherhusbandseemtotakeproactivestepstoeathealthyforthesakeofherhealthcare.Physically,thepatientsseemextremelyhealthyasidefromproblems,whicharosefrommultiplehipreplacementsurgeries.Itseemsthatthesesurgerieshaveledtoaninabilitytoexerciseattributingtoherdiseasestate,andnotfrompoornutrition.Duetothispositiveattitude,adherencetodietaryrecommendations,andalifetimeofhealthyeating,Idonotseehernutritionalriskchanginginthenextsixmonths. Thissubjectwasverynon-typicalinherapproachtonutritionandlifeingeneral.Whilemanyinheragegroupmayhavelostenthusiasmintheirhealthcareduetothe“thebestisbehindme”effectthatmanyelderlyexhibit,sheseemstobecontinuingalifelongpositiveapproachtohealth.Ibelievethiscanmostclearlybeseenwhenlookingatthehealthofherhair,nails,andskin.AllseemtobeveryhealthydespiteherclassificationasoverweightbasedonBMI.Ibelievethatifwecouldgivetheelderlyapositiveoutlookonhealth,theycouldachievebetteroutcomes.Further,weshouldencouragepropernutritionasnormal,andnotsomethingthatisjust“new-fangled”.Weshouldinvokeimagesoftheway“peopleusedtoeat”.Encouragingpeopletoeatfreshfruitsandvegetables,whilelimitingintakeoffriedfoods,foodswithaddedsugar,andhighsodiumfoods.Thisisadauntingtaskhowever,aseconomically,thisisnotrealisticforallelderlypeople.“Healthier”foodstypicallycostmuchmorethanfriedfoods,makingthemhardertoattain,especiallyforelderlylivingonfixedincome. Iwasverygladtoconductthisproject,asitgavemenewinsightintoelderlynutrition.Iwasundertheimpressionthatmostelderlypeoplecaredlittleaboutclinicalnutrition.I’mgladtosaythatmysubjectprovedmewrong.Herpositiveattitude,andgeneralcareforhermealplangavemenewhopeforfuturenutritiontherapyintheolderpopulation.NotesFemale,66yearsofage,Caucasian,Married,Home,HighSchoolEducation,RetiredWhatfoodsdidyoueatregularlywhenyouwereyounger? “Well,livingonafarmnearAmesville,weatemainlywhatwebroughtin fromthefarm.Potatoes,beans,breadandwheatfromthefield,freshmilk fromthedairycows,fresheggsfromourchickens,andwealwayshadfresh meatfromthecowsweraisedforslaughtereveryyear.”Howhasthatchangedasyou’veaged? “I’vehadtypetwodiabetesforafewyearsnow,andItrytosticktowhatmy doctorrecommends.Isticktolowercarbfoods,Idrinkalotofwater,andI eatalotofgreensandvegetables.Whatfoodswarrantedspecialoccasionswhenyouwereyoung? “Well,weateaboutthesamewhenwewerehomefortheholidays,butwhen wewenttotownwemightstopandgetrestaurantfoods,Frenchfriesand cokesandsuch.Wedidn’teatouttoomuchsoitwasprettyspecialwhenwe did.”Arethereanyfoodsthatyouparticularlylikeordislike?Eithernoworinyourchildhood? “I’vealwayslovedvegetables.Tomatoeshavealwaysbeenafavoriteofmine. Icaneatthoseeveryday!I’mnotsureI’veeverfoundafoodIwouldn’teatin particular,IguessIdon’treallycareforsweetstoomuch.”
Haveyourfoodpreferenceschangedovertheyears? “Notparticularly.I’vealwayslovedfruitsandvegetables,eventothisday.”Whodoesthegroceryshopping?Wheredotheyshop? “Thatwouldbemyhusband,Idon’tgetouttoomuchbecauseofmyhip surgery,sohedoesmostofthat.Heusuallyjustgoesdowntheroadto Kroger.” Whoplansthemeal? “I’vegotaprettystrictdietplanfrommydoctor,andbothmyhusbandandI trytofollowitprettyclosely.Iguessyoucouldsaythatmydoctorplansmy meals,wejustcookthem.”Whopreparesthemajorityoftheirmeals?Areothersinvolved? “I’vealwayslovedtocook,and”sodoesmyhusband,sowetendtoshare mealpreparationtime.Whenthekidscometothehousetheyliketohelpout atwell.”DoyoureceiveSeniorFarmer’sMarketvouchers,Meals-on-Wheels,orattendcongregatemealsites? “Iknowwecouldgetthemifwewantedthem,butwehaven’tneededtouse them.We’vebeenblessedwiththat.” Arethereandcultural,ethnic,orregionalinfluencesonyourdiet? “Nonethatcometomind,IeatclosetohowI’vealwayseaten.”Doyouhaveanygoodallergies? “None”Doyoumodifyyourdietinanywaytoprevent,treat,ormanageanychronicdiseases? “Icontrolmyportions,takemymedication,andlimitmycarbintaketo managemytypetwodiabetes,asidefromthatno.”Areyoucurrentlytakingmedications?Approximatelyhowmanyperday?Arethereanydrug/nutrientinteractions?Doesthisconcernyou? “I’vegotaprettyextensivelist.Inaday,Iprobablytakesomewherearound 6-7differentmedications,somefordiabetes,someforpain.Mydoctorshave goneovermydietplanandmedicationslistsmanytimesandthey’venevertoldmethattheywereconcernedwithinteractions,soIguessI’mnot either.”Doyoutakeanyvitaminormineralsupplements?Herbal?Aretheynecessary? “Ijusttakeamultivitaminlikemydoctorrecommended.Noneotherthanthat.IfmydoctortoldmethatIneedtotakethem,thenIprobablyneedtotakethem.Iseenoneednottotakethem.“Doyouthinknutritionisimportanttotreatingchronicdiseases?Howimportantdoyouthinknutritionistocontrollingyourdiabetes? “Absolutelynecessary.Yourbodycan’tfightbackifitdoesn’thavetheright fuel.Asformydiabetes,Iknowthatnutritionisthebiggestpartofmytreatmentasidefrommymedications.Iwouldn’tbeanywherenearwhere mytreatmentisnowwithoutpropernutrition.“Havetherebeenanybarrierstoeatinghealthy? “Notreally.LikeIsaid,I’vealwayseatenhealthy,soit’sbeeneasytofollowmydietandtoeathealthy.”
PhysicalObservation a.VisuallyOverweight. b.Musclewastinginthelegsduetomultiplehipreplacementswithimproperphysicalactivitypost-op. c.Skin-healthy,Nails–healthy,Hair–healthy,Mouth–healthy d.FullNaturalTeeth e.Nodifficultywithfinemotorskills,motorskillsinthelegsareimpaired.NUTR2200Areviewofnutrientsupplementationintheclinicaltreatmentofdiabetesmellitus.
Diabetesaffectsnearly30millionAmericantoday.Itisaclassofmetabolicandendocrine
diseasescategorizedbyimpairedglucosemetabolism.TypeIdiabetesisadiseaseoftheendocrine
system,involvingthedestructionofthepancreaticbetacells,whichresultsintheinabilityofthebodyto
produceinsulin.TypeIIdiabetesandgestationaldiabetesarebothmetabolicdisordersinwhichthe
bodycellsbecomeresistanttoinsulin.
TypeIdiabetes,historicallyknownasjuvenilediabetes,makesuplessthan10%ofallcasesof
diabetesworldwide.TypeImorecommonlyaffectschildrenandadolescence,withadultonsetbeing
muchrarer.Thistypeofdiabetesresultsfromthedestructionofbetaisletcellsontheendocrineportion
ofthepancreas.Itisthoughtthatthisoccursfromaculminationofmultiplefactors.Thefirstofthese
beinggeneticdispositionthatisthentriggeredbyanenvironmentalfactor,mostlikelyavirus.
TypeIIdiabetes;historicallyknowasadultonsetdiabetes,makesuptheremaining90%ofall
diabetescasesworldwide.TypeIIisametabolicdisorderinwhichcellsbecomeresistanttoinsulin,
disallowingadequatetransportofglucoseintothecell.Thiscausesbloodglucoselevelstorise,andif
nottreatedcanresultincomplicationssuchasretinopathy,nephropathy,andneuropathy.TypeIIcan
betreated,byinlarge,withexercise,healthydiet,andlifestylechanges.Ifthesemethodsdonotyield
intendedresults,insulinandothermedications,whichcontrolsatiety,hunger,andinsulinusage,maybe
addedaswell.
Insulinisahormoneproducedandsecretedbypancreaticbetacells.Thishormoneisthekeyto
glucosemetabolisminthebody.Afterglucoseisconsumed,itistransferredtothebloodstreamfor
circulationtocellsforenergy.Glucosealonecannotcrossthecellmembranewithoutfacilitation
throughGLUT-4(GlucoseTransporterType4),aproteinthatallowsfortransportofglucoseintothecell.
GLUT-4isregulatedbyinsulin.Withoutinsulin,glucosewouldnotbeavailabletobodycellsforenergy.
Becauseofthis,insulinistheprimarytreatmentoptionforuseintypeIdiabetics.Itisdeliveredtypically
viasyringe,flexpen,orpumpinfusionsystems.
AlthoughinsulinisabsolutelyessentialinthetreatmentoftypeIdiabetes,andalsohighly
effectiveinthetreatmentoftypeII,patientsandphysiciansmayseektreatmentsinadditiontoinsulin
toachievehigherlevelsofbloodglucosecontrol.Tothatend,researchershavebeentestingthe
feasibilityofmanynutritivesupplementsandhowtheymayimproveglucosecontrolsincethediscovery
ofinsulin.Amongtheseoptionsincludevitamin,mineral,andmacronutrientadditives.
AlphaLipoicAcid(LA),alsoknownasthiocticacid,isadi-thiolcontainingacidknowntoworkas
anantioxidantinthebody.8Asearlyas1970,LAwasfoundtoinhibittheincreaseinacetyl-CoAand
citrateconcentrationinducedbyoctanoateduringglycolysis.3,13Further,LAwasdiscoveredtoincrease
glucoseuptake,phosphofructokinaseactivity,andincreasetheoverallspeedofglycolysis.3,13Thisisa
step-wiseeffect;normally,acetyl-CoAisinhibitedbyoctanoicacid,however,LAisverysimilarin
structureandalsodemonstratestheabilitytoinhibitrisinglevelsofacetyl-CoA.acetyl-CoAbeinga
precursortocitrate,wheninhibited,alsoinhibitstheriseincitrateconcentration.3,13Citrateisaknown
inhibitorofphosphofructokinase,anenzymewhichpreparesglucoseforentryintoglycolysis.3,13With
thecitrateconcentrationinthecellheldstablebythisinhibitionpathway,glucosecancontinuouslybe
preparedforandentertheglycolysispathway.3,13Thisallowsforanincreaseinglucoseuptakefromthe
bloodstream,leadingtobettercontrolofbloodglucoselevels.3,13
Carnitine(L-carnitine)isabiologicalcompound,whichprimarilytransportslongchainacyl
groupsfoundonfattyacidsintothematrixofthemitochondria,tobebrokendownintoacetyl-CoA
throughbeta-oxidation.Carnitinewasbelievedtobeviableinuseindiabeticpatientsduetoitsrolein
theformationofacetyl-CoA,whichdrivesglucosemetabolismforward.Itwasdemonstratedin1999
thatcontinuousinfusionofcarnitineintobothdiabeticandnon-diabeticpatientsalikeincreasedwhole
bodyglucoseuptake.15Inthediabeticpatientsspecifically,insulinsensitivitywasshowntoincrease,and
glucosetakenupwaspromptlyutilized.15Itwasalsofoundthatplasmalactatelevelsweresignificantly
reducedinthepatientsreceivingcarnitineinfusions.15Thisleadtheresearcherstobelievethatcarnitine
mayservearoleintheactivationofthepyruvatedehydrogenasecomplex,whoseactivityisinhibitedin
insulinresistantindividuals.
Chromiumisatracemineral,meaningitisneededinsmallquantitiesinthebody.However,
chromium’spotentialroleinregulatingbloodglucoselevelswasnotdiscovereduntilthelate50’s,by
SchwarzandMertz.4Thiseffectwasfurtherdemonstratedinhospitalizedpatientsinthe1970’s,where
itwasfoundthatChromiumsupplementationreversedglucoseintolerance.1,4Despitethis,ameta-
analysisconductedin2002,whichevaluated20studiesinvolvingthesupplementationofchromiumin
thosewithandwithoutdiabetes.2Thismeta-analysisfoundthatchromiumsupplementationdidnot
impactbloodglucosecontrolineithertheparticipantswithorwithoutdiabetes.2
CoenzymeQ10,alsoknownasubiquinone,isavitaminlikesubstancefoundprimarilyinthe
mitochondria.ItwaspreviouslythoughtthatCoenzymeQ10mightreduceoxidativestresscauseby
diabetes.10However,ina2002studythiswasnotfoundtobethecase.Seventy-foursubjectswere
given100mgofCoQ10orally,twiceperdayfor12weeks.ItwasfoundthatCoQ10didimproveglycemic
controlandbloodpressure;however,noproofofpreventionofoxidativedamagewasdemonstrated.10
ResearchersconcludedthatmoreresearchisneededtofullyunderstandtheeffectsofCoQ10in
patientswithdiabetes.10
Magnesium,amacromineral,isneededinrelativelylargequantitiesinthebody.Magnesiumis
knowntobeacofactorandprecursortomorethan300enzymes.Meaningthatmagnesiumishighly
involvedinmanybiochemicalpathwaysthroughoutthebody,includingbloodglucosecontrol,
specificallyinglycolysis.9Mg2+isknowntoregulatethefunctionsofhexokinaseand
phosphofructokinase,twoofthemostimportantenzymesinglycolysis.9Tothatend,Harvard’sschoolof
publichealthinvestigatedtheeffectofmagnesiumintakeonbloodglucosecontrolin2004.Their
researchfollowed127,932patientswithnohistoryofdiabetes,cardiovasculardisease,orcanceratthe
timeofbaselinetesting.Thehighestandlowestquintileoftotaldietaryintakeofmagnesiumwas
compared.Itwasfoundthatthoseinthehighestquintileofmagnesiumintakehadasignificantlylower
riskofdevelopingtypeIIdiabetes.Theresearcherswentontorecommenddietshighinmagnesium,
specificallydietshighinwholegrains,nuts,andleafygreenvegetables.
Zinc,likechromiumisatracemineral,thoughttohavearoleinbloodglucosecontrol.5Thefirst
researchintowhetherornotzinccouldlowerbloodglucoselevelscamein2005,whenitwas
administeredtotypeIpatients.ZincwasadministeredorallyatDRIlevels,dailyfor4months.Attheend
ofthe4-monthperiod,HemoglobinA1clevelswerefoundtohaveincreasedduringthestudy.Itwas
concludedthatmoreresearchneededtobecarriedouttodeterminewhetherZincisasuitable
supplementforuseinpatientswithtypeIdiabetes.6MoreresearchintoZinc’seffectswascarriedout
post2005,andameta-analysisof25studieswassubmittedtotheJournalofDiabetologyandMetabolic
Syndromein2012.11Themeta-analysispooleddatafromall25studiesandfoundsignificantreduction
infastingbloodglucoselevels,HemoglobinA1clevels,andLowDensityLipoproteinlevels,
demonstrationthatzincdoeshasabeneficiallyeffectinpatientswithdiabetes,andthatpatientswith
diabetesdidtendtohavelowerplasmazinclevelsthanhealthypatients.11However,theresearchers
failedtodeducetheexactbiologicalmechanismsresponsiblefortheseresults.11Oneexplanationfor
Zinc’seffectonbloodsugarisitsroleinthetransformationofproinsulin,theprecursorforinsulin,to
insulin.Inthismechanism,zincionscombinewithproinsulintoformazinccontaininghexamer,whichis
readilyconvertedtoaninsulinhexamer,whichcanthenbereadilyconvertedintostandardinsulin.7This
isdemonstratedinNPHandregularexogenousinsulins,whichareknowntocontainzincions.7
Manyothernutrientshavebeenstudiedtodeterminetheireffectondiabetestreatments.
Therehasbeenvaryingdegreeofsuccessinthisresearch,andmuchofwhatwasdiscoveredisstill
highlycontroversialandmisunderstood.Themosthighlyresearchedoftheseincludebiotin,carnosine,
dehydroepiandrosterone,omega-3andomega-6fattyacids,andfiber.Thepreliminaryfindingsare
outlinedhereinlessdetail,andmuchofthisresearchisstillforthcoming.Firstly,biotin,whichisa
water-solublevitamin,wasfoundtoincreaseinsulinsensitivity,andinturnbloodglucoselevels,when
administeredinconjunctionwithchromium.However,biotinadministeredintheabsenceofchromium
wasfoundtohavelittleeffectonbloodglucoselevels.Anothernutrientfoundtoeffectinsulin
sensitivityiscarnosine.Inpreliminaryresearch,carnosinecontentinhumanskeletalmusclewasfound
tohaveacorrelationtoinsulinresistance.
Alessresearchednutrient,dehydroepiandrosterone,isalsothoughttoeffectinsulinsensitivity.Other
nutrientsthoughttobeusefulintreatmentindiabetesmellitusincludevitaminB3andC,Omega-3and
Omega-6,andflavonoids,allofwhicharethoughttohavebeneficialeffectsasantioxidantsand/oranti-
inflammatoryagents,leadingtohigherinsulinsensitivityandbetterbloodglucosecontrol.
Inconclusion,therehasbeenmuchresearchonmanydifferentnutritivesupplements.Fewhave
hadasubstantialamountofresearchandhaveprovenresultsintreatingdiabetesmellitus;despitethis,
theexactmechanismsarenotunderstoodatthistime,andmoreresearchisneeded.Inothermore
preliminaryresearch,othernutrientshavebeenfoundtohaveminimalbenefitsinthetreatmentof
diabetesmellitus.
REFERENCES
1“AScientificReview:TheRoleofChromiuminInsulinResistance.”The DiabetesEducatorSuppl(2004):2–14.2Althuis,MichelleD.,NicoleE.Jordan,ElizabethA.Ludington,andJanetT. Wittes.“GlucoseandInsulinResponsestoDietaryChromium Supplements:AMeta-Analysis.”TheAmericanJournalofClinicalNutrition 76,no.1(July2002):148–55.
3Burkart,V.,T.Koike,H.H.Brenner,Y.Imai,andH.Kolb.“DihydrolipoicAcid ProtectsPancreaticIsletCellsfromInflammatoryAttack.”Agentsand Actions38,no.1–2(January1993):60–65.
4Cefalu,WilliamT.,andFrankB.Hu.“RoleofChromiuminHumanHealthand inDiabetes.”DiabetesCare27,no.11(November1,2004):2741–51.doi:10.2337/diacare.27.11.2741.
5Chausmer,A.B.“Zinc,InsulinandDiabetes.”JournaloftheAmerican CollegeofNutrition17,no.2(April1998):109–15.
6deSena,KarineCavalcantiMauricio,RicardoFernandoArrais,Mariadas GraçasAlmeida,DinaMariadeAraújo,MirzaMedeirosdosSantos, VanessaTeixeiradeLima,andLuciadeFãtimaCamposPedrosa. “EffectsofZincSupplementationinPatientswithType1Diabetes.” BiologicalTraceElementResearch105,no.1–3(2005):1–9.
7Emdin,S.O.,G.G.Dodson,J.M.Cutfield,andS.M.Cutfield.“RoleofZincin InsulinBiosynthesis.SomePossibleZinc-InsulinInteractionsinthe PancreaticB-Cell.”Diabetologia19,no.3(September1980):174–82.
8Faust,A.,V.Burkart,H.Ulrich,C.H.Weischer,andH.Kolb.“EffectofLipoic AcidonCyclophosphamide-InducedDiabetesandInsulitisinNon-Obese DiabeticMice.”InternationalJournalofImmunopharmacology16,no.1(January1994):61–66.
9Garfinkel,L.,andD.Garfinkel.“MagnesiumRegulationoftheGlycolytic PathwayandtheEnzymesInvolved.”Magnesium4,no.2–3(1985):60– 72.
10Hodgson,J.M.,G.F.Watts,D.A.Playford,V.Burke,andK.D.Croft. “CoenzymeQ10ImprovesBloodPressureandGlycaemicControl:A ControlledTrialinSubjectswithType2Diabetes.”EuropeanJournalofClinicalNutrition56,no.11(November2002):1137–42. doi:10.1038/sj.ejcn.1601464.
11Jayawardena,R.,P.Ranasinghe,P.Galappatthy,RldkMalkanthi,G.R. Constantine,andP.Katulanda.“EffectsofZincSupplementationonDiabetesMellitus:ASystematicReviewand
Meta-Analysis.”Diabetology &MetabolicSyndrome4,no.1(April19,2012):13.doi:10.1186/1758- 5996-4-13.
12Kelleher,ShannonL.,NicholasH.McCormick,VanessaVelasquez,andVeronicaLopez.“ZincinSpecializedSecretoryTissues:Rolesinthe Pancreas,Prostate,andMammaryGland.”AdvancesinNutrition:An InternationalReviewJournal2,no.2(March1,2011):101–11. doi:10.3945/an.110.000232.
13Lopez-Ridaura,Ruy,WalterC.Willett,EricB.Rimm,SiminLiu,MeirJ. Stampfer,JoAnnE.Manson,andFrankB.Hu.“MagnesiumIntakeand RiskofType2DiabetesinMenandWomen.”DiabetesCare27,no.1 (January1,2004):134–40.doi:10.2337/diacare.27.1.134.
14Mertz,Walter,andKlausSchwarz.“RelationofGlucoseToleranceFactorto ImpairedIntravenousGlucoseToleranceofRatsonStockDiets.” AmericanJournalofPhysiology--LegacyContent196,no.3(February 28,1959):614–18.
15Mingrone,G.,A.V.Greco,E.Capristo,G.Benedetti,A.Giancaterini,A.De Gaetano,andG.Gasbarrini.“L-CarnitineImprovesGlucoseDisposalin Type2DiabeticPatients.”JournaloftheAmericanCollegeofNutrition18,no.1(February1999):77–82.16Singh,HariP.P.,andR.H.Bowman.“EffectofDL-α-LipoicAcidontheCitrateConcentrationandPhosphofructokinaseActivityofPerfused Heartsfrom NormalandDiabeticRats.”Biochemicaland Biophysical Research Communications41,no.3(November9,1970):555–61.sdoi:10.1016/0006-291X(70)90048-3.
NUTR2220Areviewofthefeasibilityofzincandmagnesiumsupplementationinproductsforuseintypeonediabetestreatment
AREVIEWOFTHEFEASIBILITYOFZINCANDMAGNESIUMSUPPLEMENTATIONINPRODUCTSFORUSEIN
TYPEONEDIABETESTREATMENT
CharlesRiley
NUTR2220
4/14/16
INTRODUCTION
Diabetesaffectsnearly30millionAmericanstoday.Itisaclassofmetabolicandendocrine
diseasescategorizedbyimpairedglucosemetabolism.TypeIdiabetesisadiseaseoftheendocrine
system,involvingthedestructionofthepancreaticbetacells,whichresultsintheinabilityofthebodyto
produceinsulin.TypeIIdiabetesandgestationaldiabetesarebothmetabolicdisordersinwhichthe
bodycellsbecomeresistanttoinsulin.
TypeIdiabetes,historicallyknownasjuvenilediabetes,makesuplessthan10%ofallcasesof
diabetesworldwide.TypeImorecommonlyaffectschildrenandadolescence,withadultonsetbeing
muchrarer.Thistypeofdiabetesresultsfromthedestructionofbetaisletcellsontheendocrineportion
ofthepancreas,andtheresultinginabilityofthepancreastoproducethehormoneinsulin.Itisthought
thatthisoccursfromaculminationofmultiplefactors.Thefirstofthesebeinggeneticdispositionthatis
thentriggeredbyanenvironmentalfactor,mostlikelyavirus.
Insulinisahormoneproducedandsecretedbypancreaticbetacells.Thishormoneisthekeyto
glucosemetabolisminthebody.Afterglucoseisconsumed,itistransferredtothebloodstreamfor
circulationtocellsforenergy.Glucosealonecannotcrossthecellmembranewithoutfacilitation
throughGLUT-4(GlucoseTransporterType4),aproteinthatallowsfortransportofglucoseintothecell.
GLUT-4isregulatedbyinsulin.Withoutinsulin,glucosewouldnotbeavailabletobodycellsforenergy.
Becauseofthis,insulinistheprimarytreatmentoptionforuseintypeIdiabetics.Itisdeliveredtypically
viasyringe,flexpen,orpumpinfusionsystems.
AlthoughinsulinisabsolutelyessentialinthetreatmentoftypeIdiabetes,andalsohighly
effectiveinthetreatmentoftypeII,patientsandphysiciansmayseektreatmentsinadditiontoinsulin
toachievehigherlevelsofbloodglucosecontrol.Tothatend,researchershavebeentestingthe
feasibilityofmanynutritivesupplementsandhowtheymayimproveglucosecontrolsincethediscovery
ofinsulin.Alargefocusofthisresearchhasbeenontheinorganicdietaryminerals,principally
MagnesiumandZinc.
Magnesium,amacromineral,isneededinrelativelylargequantitiesinthebody.Magnesiumis
knowntobeacofactorandprecursortomorethan300enzymes.Meaningthatmagnesiumishighly
involvedinmanybiochemicalpathwaysthroughoutthebody,includingbloodglucosecontrol,
specificallyinglycolysis.4Mg2+isknowntoregulatethefunctionsofhexokinaseand
phosphofructokinase,twoofthemostimportantenzymesinglycolysis.4Itisbelievedthatproper
magnesiumintakecanassistinbloodglucosecontrolbyregulatingglycolysis,allowinginsulintobetter
carryoutitsfunction.
Zinc,atracemineral,isthoughttohavearoleinbloodglucosecontrol.1ResearchintoZinc’s
effectswascarriedoutpost2005,andameta-analysisof25studieswassubmittedtotheJournalof
DiabetologyandMetabolicSyndromein2012.5Themeta-analysispooleddatafromall25studiesand
foundsignificantreductioninfastingbloodglucoselevels,HemoglobinA1clevels,andLowDensity
Lipoproteinlevels,demonstratingthatzincdoeshasabeneficialeffectinpatientswithdiabetes,and
thatpatientswithdiabetesdidtendtohavelowerplasmazinclevelsthanhealthypatients.5One
explanationforZinc’seffectonbloodsugarisitsroleinthetransformationofproinsulin,theprecursor
forinsulin,toinsulin.Inthismechanism,zincionscombinewithproinsulintoformazinccontaining
hexamer,whichisreadilyconvertedtoaninsulinhexamer,whichcanthenbereadilyconvertedinto
standardinsulin.3ThisisdemonstratedinNPHandregularexogenousinsulins,whichareknownto
containzincions.3Itisthoughtthatproperzincintakecanincreasetheeffectivenessofinsulinby
assistinginthenormalactionpathwayofinsulin.
Overthecourseofthefollowingexperimentalprocess,thefeasibilityoftheadditionofdietary
zincandmagnesiumintofoodproductswhichmaybeeasilyincorporatedintothedietwillbetested.To
assessthisfeasibility,magnesiumandzincwillbeaddedtoapplesauce,tobeevaluatedforalterationsin
color,flavor,andoverallflavor.
OBJECTIVE
Thepurposeofthisexperimentistoassessthechangesinflavor,color,andviscosityimposed
onsplendasweetenedapplesaucebytheadditionofzincandmagnesium.Usingacontrolsampleof
plainsplendasweetenedapplesauce,zincsupplementedapplesauce,magnesiumsupplementedapple
sauceandapplesaucesupplementedwithbothzincandmagnesium,onesensorypanel,andtwo
objectivetestswillbeconducted.Theexactcolorvaluesofeachsamplewillbedeterminedusinga
standardcolorimeter,whileviscosityofeachsamplewillbedeterminedusingastandardBrookfield
viscometer.Todeterminethevariabilityinflavoramongthecontrolandvariations,a5-pointscalewill
beprovidedtoasensorypanel.Thepanelwillevaluateeachsampleforflavoronthisscale,with1being
thebestflavorand5beingtheworstflavor.
MATERIALSANDMETHODS
Toconductthisexperiment,andevaluatetheeffectofMagnesiumandZinconapplesauce,four
differentvariationswerecreated.Thiswasaccomplishedbyfirstmakingastandardapplesaucerecipe
using10Macintoshrecipe,2/3cupofsplenda,and5cupsofwater.Thestandardrecipewascreatedby
firstpeelingandcuttingtheapplesintosmallchunks.Thechunkswerethenwashedandplacedinatall
cookingpotwith5cupsofwater.Thewaterandappleswereleftontheoventopovermedium-high
heatuntiltheapplehadcookeddown.Oncethechunkedapplehadcookeddownintoapplesauce,the
splendawasaddedandstirredin.Thisstandardrecipewasthendividedintofourseparatecontainers.
Withinthefirstcontainer,thecontrolsamplewasplaced.Inthesecondcontainer,26mgofcrushed
purezincsupplementswereaddedtothestandardrecipe.Inthethirdcontainer,64mgofcrushedpure
magnesiumsupplementswereaddedtothestandardrecipe.Inthefinalcontainer,26mgofcrushed
purezincsupplementsand64mgofcrushedpuremagnesiumsupplementswereaddedtothestandard
recipe.Theamountofsupplementaddedwaskeptsomewhatlowinordertopreventacuteover
consumptionofthemineralsintestsubjectsduringtasting.
Thismethodologywasconductedonthreeseparateexperimentationdays.Oneachday,each
variationwasprovidedtothe16participantsforaffectivetesting.Eachparticipantwasaskedtoratethe
tasteofeachvariationonaLikertscalerangingfrom1-5,with1havingthebestflavor,and5havingthe
worstflavor.Theneachvariationwassubjectedtocolorimetrytestingandviscositytesting.The
colorimetrytestwasconductedusingastandardcolorimeter,withl,a-andb+valuesbeingrecorded.
TheviscositytestwasconductedusingastandardBrookfieldviscometer,usinga#1spindleandaspeed
of10.Eachcolorimetryandviscositytestwasconductedthreetimesoneachexperimentationday.
RESULTS
Table1
AverageAffectiveresultsforApplesauceVariations
ExperimentationDay
Experiment
ControlZinc
Supplement MagnesiumSupplementZn+Mg
Supplement1 1.2 2.5 3.7 3.92 1.3 2.9 2.8 4.63 1.4 2.1 3.8 4.0Note:Withintable1,theaveragesofeachofthreetrialsfortheaffectivetestforeachvariationis
provided.Thisdatawasattainedbysimpletastetastingconductedby16individualsusingaLikertstyle
scale.Thescaleusedincludedvaluesrangingfrom1-5,with1beingthebesttasting,and5beingthe
worsttasting.
Table2
AverageColorimetryofApplesauceVariations
Type Trial Lvalue a-Value b+valueControl 1 61.0 1.1 2.0
2 60.9 1.2 2.0 3 60.9 1.3 2.2
ZincSupplement 1 61.9 3.2 3.5
2 61.9 3.2 3.6 3 62.0 3.2 3.6
MagnesiumSupplement 1 62.6 0.2 7.5
2 62.8 0.2 7.5 3 62.8 0.2 7.6
Zn+MgSupplement 1 57.1 5.0 0.5
2 57.2 4.9 0.5 3 57.2 5.0 0.6Note:Withintable2,theaveragesofeachofthreetrialsfortheobjectivecolorimetrytestforeach
variationisprovided.Thisdatawasattainedbyusingastandardcolorimetertoattainl,a-,andb+
values.
Table3
AverageViscosityofApplesauceVariations
Sample Trial DialReading Viscosity(mPa*s)Control 1 12.8 128.3
2 12.7 126.7 3 12.9 129.0
ZincSupplement 1 14.5 145.3
2 14.5 145.0 3 14.6 145.7
MagnesiumSupplement 1 13.2 131.7
2 13.2 132.0 3 13.2 132.0
Zn+MgSupplement 1 15.1 150.7
2 15.1 151.0 3 14.9 149.0Note:Withintable3,theaveragesofeachofthreetrialsfortheobjectiveviscositytestforeachvariation
isprovided.ThisdatawasattainedbyusingastandardBrookfieldViscometertoattainthedialreading.
Thespindleusedwasthe#1spindle,ataspeedof10.Usingthesevalues,thefactorwasfoundtobe10.
Theviscositywascalculatedbymultiplyingthedialreadingbythefactor.
DISCUSSION
Uponanalyzingthedata,afewkeyconclusionscanbedrawn.Intable1,itcanbeseenthatthe
controlsampleofapplesaucewasindicatedtohavethebesttasteacrossallexperimentationdays.The
averagereportedflavoracrossallthreedaysforthecontrolsamplewas1.2,thehighestaverageamong
thesamples,whiletheZincandMagnesiumsample,onaverage,hadtheworstflavorwithanaverageof
4.2.Thezincandmagnesiumaffectiveaverageswerefoundtobe2.5and3.43respectivelyacrossthe
threeexperimentaldays.Itcanbeseenthatzincseemstohavelessofaneffectontheflavorofthe
applesauce,whilemagnesiumhadmoreofaneffectonflavor.Whenthetwocometogetherinthelast
variation,theflavorisperceivedasworsethantheadditionofeithersinglemineral.Itmaybepossible
tosupplementzincintoapplesauceproductswithminimaleffectontheperceptionofflavor,butmore
researchisneededtodeterminetheexactamountofzincneededtominimalizetheeffectonflavor.
Intable2,itisseenthatalthoughtheapplesaucevariationsweresimilarincolor,uponcloser
evaluation,thesamplesvariedacrossallrecordedvalues.Inthecaseofthelvalue(thelightness+or
darkness-ofthesample),wasthehighestinthemagnesiumcontainingsamples,andthelowestinthe
ZincandMagnesiumcontainingsample.Thisshowedthatthesamplewiththemostaddedsupplements
wasthedarkestsample.Thisshouldnotbesurprising,asthehighertheamountofsoluteaddedtoa
food,thedarkerthatfoodshouldbe.Inthecaseofthea-value(theredness+orgreenness-ofthe
samples),themagnesiumvaluewasfoundtohavethelowestvalue,whilethezincandmagnesium
samplewasfoundtohavethehighestvalue.Thiscouldbeseenevenwithoutcolorimetry.Thezincand
magnesiumsupplementedsamplewasvisiblygreenincolorwhentestingwasconducted.
Inthecaseoftheviscositytesting,itcanbeseenintable3thatwhiletheviscositiesaresimilar,
theydifferenoughtowarrantdiscussion.Thecontrolsamplewasfoundtobethemostviscosewithan
averageof128mPa*sacrossthethreeexperimentationdays,whilethezincandmagnesium
supplementedsamplewasfoundtobetheleastviscosewithanaverageof150.23mPa*s.Further,it
wasseenthatonaverage,themagnesiumsupplementedsamplewasmoreviscosethanthezinc
sample.Thiswasnotsurprising,asthecontrolsamplehasnoadditivethatcoulddecreasetheviscosity.
Themagnesiumsamplewasthesecondmostviscose,whichcanbeexplainedbymagnesium’slesser
molecularweightwhencomparedtozinc,yieldingahigherviscositythanthezincsupplemented
sample.
CONCLUSION
Inconclusion,ithasbeendemonstratedthattheflavor,color,andviscositywereindeed
effectedbytheadditionofzincandmagnesium.Despitethebenefitsoftheaddedzincandmagnesium
inthediet,itmaynotbelucrativetoaddthesemineralstocommonfoodproducts.Inthecaseof
applesauce,theadditionofthementionedmineralsgenerallymadetheproduct’sflavorworst.Thiswas
demonstratedbythecontrolgroupreceivingthebestflavorrating,withthesupplementedvariations
havingprogressivelyworseflavorrating.Itwasalsodemonstratedthetheadditionofthesupplements
drasticallychangedthecoloroftheproduct.Theadditionofsupplementsmadetheapplesaucedarker
andgreeneringeneral.Thisisnotthemostappealingappearanceandmayprovedifficulttomarketto
thosewithtypeonediabetes.Finally,itwasdemonstratedthattheadditionofthesemineralsmadethe
applesaucelessviscose.Itisnotclearifthiswouldaffectthemarketabilityoftheapplesauceassome
maypreferthickerapplesaucewhileothersmaypreferlessthickapplesauce.Inevaluatingtheflavor,
colorandviscosityinresponsetotheadditionofzincandmagnesium,itwasfoundthatitmaynotbe
feasibletoaddthesemineralstofoodproductstoassistintreatmentoftypeonediabetes,butmore
researchisneededtodetermineatwhatconcentrationtheseaddedmineralsbegintoeffectthe
characteristicsoftheproduct,andifthiseffectcanbeminimalizedandtheproductsputtomarket.
REFERENCES
1Chausmer,A.B.“Zinc,InsulinandDiabetes.”JournaloftheAmerican CollegeofNutrition17,no.2(April1998):109–15.
2deSena,KarineCavalcantiMauricio,RicardoFernandoArrais,Mariadas GraçasAlmeida,DinaMariadeAraújo,MirzaMedeirosdosSantos, VanessaTeixeiradeLima,andLuciadeFãtimaCamposPedrosa. “EffectsofZincSupplementationinPatientswithType1Diabetes.” BiologicalTraceElementResearch105,no.1–3(2005):1–9.
3Emdin,S.O.,G.G.Dodson,J.M.Cutfield,andS.M.Cutfield.“RoleofZincin InsulinBiosynthesis.SomePossibleZinc-InsulinInteractionsinthe PancreaticB-Cell.”Diabetologia19,no.3(September1980):174–82.4Garfinkel,L.,andD.Garfinkel.“MagnesiumRegulationoftheGlycolytic PathwayandtheEnzymesInvolved.”Magnesium4,no.2–3(1985):60– 72.
5Jayawardena,R.,P.Ranasinghe,P.Galappatthy,RldkMalkanthi,G.R. Constantine,andP.Katulanda.“EffectsofZincSupplementationonDiabetesMellitus:ASystematicReviewandMeta-Analysis.”Diabetology &MetabolicSyndrome4,no.1(April19,2012):13.Doi:10.1186/1758- 5996-4-13.
6Kelleher,ShannonL.,NicholasH.McCormick,VanessaVelasquez,and VeronicaLopez.“ZincinSpecializedSecretoryTissues:Rolesinthe Pancreas,Prostate,andMammaryGland.”AdvancesinNutrition:An InternationalReviewJournal2,no.2(March1,2011):101–11. Doi:10.3945/an.110.000232.7Lopez-Ridaura,Ruy,WalterC.Willett,EricB.Rimm,SiminLiu,MeirJ. Stampfer,JoAnnE.Manson,andFrankB.Hu.“MagnesiumIntakeand RiskofType2DiabetesinMenandWomen.”DiabetesCare27,no.1 (January1,2004):134–40.Doi:10.2337/diacare.27.1.134.
NUTR3000
Reviewofthephysiologicalandnutritiveimportanceofzinctranscribedpresentation.Slide1:ZincIntoday'spresentation,wewillbetakingabrieflookatZinc.Slide2:IntroductionAfterwatchingthispresentation,youwillgainadeeperunderstandingofthemicronutrientzinc,theimpactofzinconnormalphysiology,somegoodsourcesofZinc,recommendationsforZinc,andhowZincisabsorbedintothebody.ItshouldfirstbenotedthatZincisanessentialmicronutrient,meaningitmustbetakeninthroughnormaldietoradietarysupplement.Zincisahighlyinvolvedmicronutrient,playingapartincatalyticactivityinenzymes,immunefunction,normalproteinsynthesis,woundhealing,DNAsynthesis,andcelldivision.Zincalsoplaysanimportantsupportroleinnormalgrowthanddevelopmentduringpregnancy,childhood,adolescence.Zincisalsorequiredforpropersenseoftasteandsmell.Itisalsoworthnotingthatthebodydoesnothavespecializedzincstorage,therefore,zincintakemustremainconsistentthroughoutthelifespan.Slide3:GoodSourcesofZincThemainsourcesofzincincluderedmeatsandpoultryaswellasshellfishandfortifiedproducts.Zincisalsoabsorbedbetterwithanimalproteininthediet.Zincisalsocommonlysupplemented.Commonzinccontainingsupplementsincludezincgluconate,sulfateandacetate.Someotherlesstypicalsourcesincludehomeopathicmedicationsforcoldtreatmentandsomedentureadhesivecreams.Slide4:RecommendationsAspertheDRIssetbytheFoodandNutritionBoard,thecurrentRDAsforzincarelistedhere.ItshouldbenotedthattheRDAformalesinthe14-19-year-oldagerange,ishigherthaninfemalesinthesameagerange.Thisisduetozinc'skeyroleinsexualmaturationinmales.Slide5:Digestion&AbsorptionBeforezinccanbeabsorbeditmustfirstbehydrolyzedfromaminoacidsandnucleicacids.Theexactprocessisnotyetknownhowever;itisbelievedthattheacidicpHofthestomachandupperduodenumallowszinctoseparatefromfoodwiththehelpofproteasesandnucleases.Zincabsorptionthentakes
placeinthesmallintestineintheduodenumandupperjejunum.Mostoftheabsorptionofzincisaccomplishedthroughcarrier-mediatedtransport.ZIP4isthemostcommontransporterused.Itcarrieszincintothecytosolofenterocytes.Zinccanalsoenterenterocytesbydiffusionacrosstheirtightjunctions.ThismayoccurwhentherearenotenoughZIP4carriers.Tobetransported,Zincisboundtobloodproteins,likealbumin,thentakentotheliver.TheliverthanreleasesZincintocirculation.Incirculation,zincmaybeboundtoalbuminbutmayalsobindtootherproteinsfortransport.Thereisnospecificstoragesiteforzinchoweverzinccanberecycledwhenintakeislow.NormallyzincisexcretedmostlythroughtheGItract,butsomelossalsooccursthroughthekidneys,andthroughtheskin.Slide6:FactorsinfluencingZincAbsorptionSomewherebetween10-80%ofzincintakeisabsorbedduetodifferentfactorsthatcanincreaseordecreasetheabsorption.Typically,ligandsincreasetheabsorptionbecausezinccanbindtosulfurandnitrogeninthem.Ligandsmayalsoservearoleinhelpingzinctoremainsoluble.Forreasonsunknown,pancreaticsecretionsalsoappeartoincreasetheabsorptionofzinc.Anacidicenvironmentisalsokeythereforeanythingthatreducestheacidityoftheintestinaltractmayinhibitzincabsorption.Thiscanincludebothoverthecountermedications,likeantacidsandcertainprescriptionmedicationsthatwewilltalkaboutinanupcomingslide.Foodsmayalsodecreaseabsorptionofzincwhenzincbindswithphyticacid,oxalicacid,polyphenols,copper,ironorcalciuminthem.Ontheotherhand,iftheenvironmentistooacidicthatcanalsodecreasetheabsorption.Slide7:NutrientInteractionsAnumberofothermineralscanalsointeractwithZinc.Largeamountsofcopper,iron,andcalciumalldecreasezinc'savailability.Highintakeofzincitselfcandecreasetheamountofzincthatisabsorbed.Zinccanalsoinfluencevitamins.ItincreasestheabsorptionoffolateanditisessentialtothefunctioningofvitaminA.Slide8:HistoryofZincDeficiencyZincdeficiencywasfirstdiscoveredinthemiddleeastinchildrenandadolescentswhowereundersizedandunderdevelopedrelativetotheirage.Itwasattributedtothetypicaldietoftheregionwhichwashighinphyticacidfromlegumesandwholegrainsbutlowinanimalproteinslikepoultryandmeat.Thehighfiberandphytateswouldbindthezincallowinglesstobeabsorbed.Laterageneticdisorder,acrodermatitisenteropathica,waslinkedtozincdeficiency.Thisleadtomoreresearchandunderstandingofzinc.Slide9:SymptomsofZincExcess&DeficiencyTodaymoreisknownaboutzinc,however,researchhasbeenlimitedthusfarbyalackofspecificbiomarkersthatindicatezincstatus.Also,themethodsinwhichsomestudieshavemeasuredzincarerelativetopopulationsandnottransferabletoindividuals.Theimagetotherighthighlightssomecommonsymptomsofexcessanddeficiency.Inaddition,aULissetat40mgperdaysincetoxicitycanoccuratdosesgreaterthan50mgperday.Toxicityislesslikelytobestrictlyfromfoods.Itismorelikelywithsupplementationeitherdirectsupplementsoraspartofanoverthecounterproduct,likecoughdrops.Slide10:DeficiencyZincdeficiencyoccursacrossaspectrumwithmarginaldeficiencybeingmorecommonthanseveredeficiency.Itisawidespreadproblemwithover2billionpeoplehavingsomelevelofdeficiency.Mostatriskarechildrenindevelopingworlds.Thiscanleadtoimpairedphysicalorneurological
development.Inadequatezinclevelscontributetochildhoodmortalitybydecreasingthefunctioningoftheimmunesystemleavingindividualssusceptibletoinfections.Insomeinstances,individualsmayalsohavevisualdefectsespeciallyinnightvisionduetoinsufficientvitaminA.Zincisacomponentofretinolbindingproteins;theproteinisnecessarytotransportvitaminAintheblood.Incasesofseveredeficiencyoutcomesaremoresevereasyoucanseewhencomparingthelistontherighttothelistontheleft.Slide11:MapAsyoucanseefromthemapZincdeficiencyexistsinmuchoftheworld.Slide12:AtriskIndividualsforZincDeficiencyThelistofpeoplewhomaybeatriskforsomelevelofzincdeficiencyisquitelong.Pleasetakeamomenttoreviewthelist.Slide13:PregnancyZinchasproventobeaveryimportantmicronutrientduringpregnancy.TheRDAforzincforpregnantwomenis11mg/dayforadultsand12mg/dayforteenagers.Studiesshowthat82%ofpregnantwomenworldwidehaveinsufficientzincintake,however,deficienciesforpregnantwomenintheU.S.arerare.Someconsequencesofzincdeficiencyduringpregnancyincludelowbirthweight,prematuredelivery,laboranddeliverycomplicationsorcongenitalanomalies(birthdefects).Somereviewsofzincsupplementationtrialshavefoundthatzincsupplementationduringpregnancywereassociatedwitha14%reductioninprematuredeliveries.Thiseffectwasmainlyseeninthelow-incomewomen.Otherstudieshaveshownthatalthoughzincdeficiencycanhavedevastatingeffects,theeffectsofsupplementationonpregnancyoutcomeshavelimitedbenefits.Thiswasmoreinhealthyaverageadults.Becauseofthis,itishypothesizedthatzinchomeostaticadjustmentsduringpregnancyimproveutilizationtoprovidetheincreasedzincneeds,lesseningsomeimmediatedetrimentaleffects.Slide14:LactationTheRDAforzincduringlactationrisesslightlyto12mg/dayinadultsand13mg/dayinteenagers.Zincconcentrationsinbreastmilkslowlydeclineduringthefirst6months.Itstartsoutwith2-3mg/dayinmilkduringthefirstmonth.Thisamountdeclinesto1mg/dayby3monthsandcontinuestodeclinetoabout0.5mg/dayaround6months.Thehighneedsforzincduringearlylactationaremetbyusingmaternalzincpools.30%ofthebody’stotalzincisstoredinbonetissue.Becauseofthehighneedsforzincduringthefirst6monthsofexclusivebreastfeeding,about4-6%ofmaternalbonemassislostduringthistime.Manywomenhavereportedthatmaternalzincsupplementshavebenefits.Oneexampleofthisisthattheyslowtherateofdeclineinmilkconcentrationsduringlactationwhichcanbeaproblemforsomebreastfeedingmothers.Otherreportsshowarelationshipbetweenzincsupplementationandbreastfeedingretentionrates.Slide15:InfancyInfants’ages0-6monthshaveanadequateintakerecommendationof2mg/dayandinfantsages7-12anAIof3mg/day.Zincdeficiencyininfantscancauseproblemsthatwillaffecttherestoftheirlives.Deficiencyininfancyandchildhoodisassociatedwithreducedimmunocompetenceandincreasedinfectiousdiseasemorbidity.Zincsupplementationininfantsisassociatedwithasignificantlylowermortalityrate.Thisissignificantbecausecalcium,phosphorus,folateandironsupplementswerenotassociatedwithmortalityreduction.Zincsupplementsinsmallforgestationalageinfantscanresultinsubstantialreductionininfectiousdiseasemorbidity.Slide16:Children
Zincisanimportantmineralforgrowthanddevelopment,andisespeciallyimportantforyounggrowingchildren.ThecurrentRDAvalueforchildrenages4-8is5mg/dayandforchildrenages9-13is8mg/day.Ifchildrenarenotconsumingadequatesourcesofironintheirdietorexperiencingsymptomsofdeficiency,supplementationmayberequired.Slide17:GrowthandSexualDevelopment
Zincisakeymineralforsexualgrowthanddevelopment.Azincdeficiencycanresultindwarfismandhypogonadism,butwithpropersupplementationgrowthanddevelopmentwillimprove.
AresearcherstudyinginIranwaspresentedwitha21-year-oldman"wholookedlikea10-year-oldboy",hesaid.Hereferredtohisgenitaliaas"infantile",thepatientexperiencedgrowthretardationandtesticularatrophyamongstothersymptoms.Uponexamination,theresearcherconcludedaZincdeficiencywasresponsiblefortheproblems.
Dataconcludedzincsupplementationiscapableofa12.7–15.2cmgrowthin1yearandthegenitaliacanbecomenormalagainwithin3–6months.
In1972,astudywascarriedoutinvolving15menand2women,ages19-20,allconsideredmalnourished.Onegroupreceivedawell-balanceddietwithaplacebocapsule,thesecondgroupreceivedawell-balanceddietwithacapsulecontaining27mgZinc,andthethirdgroupreceivedthewell-balanceddietwithnosupplementation.Resultsreported"Thezinc-supplementedgroupgainedconsiderablyinheightandshowedevidenceofearlyonsetofsexualfunctionasdefinedbynocturnalemissioninmalesandmenarcheinfemalescomparedwiththosereceivingonlyawell-balanceddiet".
Slide18:Diabetes
Zincisthoughttoplayakeyroleinthesynthesisofinsulin.Asearlyasthe1980’sresearchersobservedaninteractionbetweenZincionsandproinsulin,theprecursormoleculeofinsulin.Researchersbelievedthatproinsulinformedazinccontaininghexamer,whichisreadilyconvertedintoaninsulinhexamer,whichcanthenbeconvertedintoinsulin.
Infact,oldertypesofinsulinlikeNPHandRegularcontainzincionsinsolution.Whenlookingatindividualswithbothtypesofdiabetes,researchersobservedsomekey
differencesfromhealthyindividuals.Individualswithtypeonewerefoundtobezincdeficientinalmostallcases.Thosewithtypetwowerefoundtohavedecreasedzincbloodserumlevelsandhyperzincuria,orhighlevelsofzincintheurine.Otherresearcherscontinuedthisresearchandfoundthatinindividualswithhigherserumzinccontent,theriskofdevelopingtypetwodiabeteswasdrasticallylower.Slide19:ImmunologyZinchasmanydifferentroleswithintheimmunesystem.Itinfluencesthegrowthanddevelopmentofthehumanbody,andalsoplaysabigroleinfightingagainstinfection.Withoutzincinthesystem,ourbodieswouldbepredisposedtoinfectionandnotbeabletobuildupanimmunityagainstpathogens.Withzincinthesystemthough,ourliversareabletoreacttosuchimmuneresponsesfasterandcanexcretethenecessaryhormones.Slide20:Immunology
Zinchasfourdifferentrelationshipswithintheimmunesystem.Thedietaryrelationshipisthemostimportantbecausewithoutit,theotherthreerelationshipswouldnotbeabletocontinue.Zincneedstobetakeninandabsorbeddailyintocirculationsothatitcanbeavailablefornotonlytheimmunesystembutforalltheorgansinourbody.
OnceZincistakenin,itcaninfluencehoworgansfunctionandaffecttheimmunesystembybeingacofactortoover300differentkindsofenzymes.Zinc'sroleasacofactorismostlyastructuralrolewithsomeformsofenzymaticactivity.
Thedirectrelationshipofzincontheimmunesystemisthatitisinvolvedintheproductionandfunctionofwhitebloodcells,orleucocytes.Oncethesecellsarematured,theyareabletofightinfectioninallpartsofthebodybywayofcirculation.
Zincalsohasaminorroleininfluencingimmunostimulantswhichleadtomonokineandlymphokinesecretion,aswellaslymphocyteproliferation.Thesesecretionsactasmacrophagesthatareabletometabolizeendotoxinsinthebody.Slide21:Immunology
Aspreviouslystated,theroleofzincintheimmunesystemislargelyaffectedbyhowmuchistakeninandultimatelyavailableforuse.Whenthereisapathogenandtheimmunesystemistryingtofightitoff,Zinc’sroleistorecruitneutrophilstothesiteasanimmuneresponse.WhenZinclevelsarehigh,theNaturalKillercellthatisresponsibleforthephagocytosisofneutrophilsisinhibited,leadingtorapidhealing.Ontheotherhand,whenzinclevelsarelow,theNaturalKillercellisnotstoppedandthereforephagocytizestheneutrophilsandmacrophagesthatareresponsibleforhealingwhichmakesrecoverytimelonger.Slide22:Neurological
Ithasbeenuniversallyacceptedinthemedicalcommunitythatzincmetalions(Zn2+)areessentialtoproperfunctionofthebrain.Zincdysregulationhasbeenlinkedtoalarge(andgrowing)listofneurologicaldiseases,notably,Alzheimer’s,Parkinson’sSchizophrenia,Pick’s,etc.
OurunderstandingofthefulleffectofZinconproperneurologicalfunctionisstillinitsinfancy,however,zinchasbeenimplicatedinimproperDNA,RNAandproteinsynthesisduringbraindevelopmentininfants.Duetothis,ithasbeenhypothesizedthatzincdeficiencythroughoutthelifespanmayattributetothedevelopmentoftheneurologicaldiseasesmentionedabove.ItshouldbenotedthatzincsupplementationhasbeenusedtotreatWilson’sdisease,achrodermatitisenteropathica,andsometypesofschizophreniawithgreatsuccess.
FoodSystemsNUTR4100AssessmentofFoodAccessibilityinTypeIdiabeticchildreninSouthEasternOhioTitleand/orBriefDescriptionoftheLeadOrganization
AreviewoftheaccesstonutritioneducationservicesbychildrenwithTypeIDiabetesinAthensCounty.StatementoftheNutritionalProblem
Forthisassessment,theresearcherswillreviewtherateoffoodinsecurityandaccesstonutritioneducationdeficitsinchildrenage6to16livingwithTypeIDiabetes.DefinitionoftheCommunity
Forthepurposesofthisassessment,wewillbetargetingchildrenage6to16livingwithtypeonediabeteswithinAthensCounty,Ohio.PurposeoftheAssessment
Theoverallpurposeofthisassessment,istoidentifythelevelofaccesstonutritioneducationandhealthfulfoodsbyourtargetpopulation.Thisassessmentalsoaimstoexploretheunderlyingcausesofthepotentiallackofnutritioneducationandhealthfulfoodswithinourtargetpopulation.
TargetPopulation
Thetargetpopulationforthisassessmentincludesallthosebetweentheagesof6to16livingwithtypeonediabetes,withlimitedaccesstonutritioneducationandcare,whomaybestrugglingtomanagetheirconditionwithoutthesenutritionbasedservices.GoalsandObjectivesoftheNeedsAssessment
● Goal1:Toprovidemoreavailabilityandaccesstoquality,nutritionalcare.○ Objective1:EducateparentsonwhatTypeIDiabetesisandtheimportanceof
managingTypeIDiabetesintheirchildren.○ Objective2:EducateparentsonhowtogroceryshopandcookfortheirTypeIDiabetic
child.● Goal2:ToendfoodinsecurityintheAthensCounty.
○ Objective1:Educateparentsandfamiliesontransportationoptions.○ Objective2:Educateparentsonfoodsourcelocations
Ouroverallgoalsofourneedsassessmentaretoprovidemoreavailabilityandaccesstoquality,
nutritionalcareandtoendfoodinsecurityintheAthensCounty.Duetolimitedaccesstohealthcare,manychildrenwithType1Diabetesarenotreceivingtheeducationtheyneedinregardstooptimizingtheiroverallhealth.Qualitydiabetesmanagementiscrucialtopreventchronicdiseasesinthefuture.Foodinsecurityisanotherissue,whichiswhywewanttoprovidewaystoaccessaffordable,healthyfoodmoreeasily.
Tomeetourgoals,wecameupwithaplanofaction.Wewilldesigneducationalhandoutswhichsummarizewhatdiabetesisandwhydiabetesmanagementissoimportant.Thehandoutswillalsoincludecomponentstoahealthydiet.Alistofresourcestofoodwillalsobelistedonthehandouts,consideringalargeamountoffamiliesinthecommunityarefoodinsecure.ThesehandoutswillbepassedouttobothhealthcarefacilitiesandschoolsacrosstheAthensCounty.
Tomakesuretheeducationisprovidedtoourpopulationinneed,wewillbehandingoutthehandoutstoallthefacultystaffintheschools.ThiswillensureeverysinglediabeticchildintheAthensCommunityreceivesthegeneralinformationtheyneed.Wewillalsomakesurealldoctorsandendocrinologistspassoutthehandoutstotheirtype1diabeticpatients.Anothergoaltoourplanofactionistohaveanutritionistcomeintoalltheschoolstotalkaboutwhyahealthydietissoimportantforoverallhealth.Notonlywillthisbenefitourtargetedpopulation,butitwillalsobenefitallchildrenintheAthensCommunity.Ourlastgoalforourplanofactionistomailoutoremailoutaninvitationtoalltheparentswithchildrenwithtype1diabetes,invitingthemtoattendaparent/childCHIPbasedprogram.Itwillincludedoctors,RD’s,teachers,parents,andstudents.Thisprogramwillalsoincludegrocerystoretours,cookingdemos,anddiabeteseducationworkshops.
Toensurethatouractionplanisimprovingourtargetpopulation’soverallhealth,wewillmonitorandevaluatecertainaspects.Wewillfirstseeifthereisanoverallimprovementinthechildren’sbiochemicalvalues,suchasbloodglucoseandHbA1C.Wewillalsorecordwhatchildrenare
eatingatlunch,inhopesthatoverallfruit,vegetable,wholegrainandmilkconsumptionincreaseandlesssugaryandprocessedfoodarebeingconsumed.Wewillalsorecordhowmanyparents/childrenattendtheCHIPprogramevents.
DataCollectedBackgroundConditions
InAthensCounty-Ohio,only16.1%ofresidentsundertheageof65arereportedtohavehealth
insurancecoverageperthe2010-2014UnitedStatesCensusBureau.3Frompreviousresearchithasbeenfoundthatduetothelackoflackofnutritioncarecoverage,nearly45,000annualdeathsareassociatedwiththislackofhealthinsurance.Fromthisstudy,ithasbeenfoundthatthosewhodonothavehealthinsurancehaveahigherriskofdeathevenafterthesocioeconomic,healthbehaviorsandbaselinehealthperanewstudypublishedonlinetodaybytheAmericanJournalofPublicHealth.45,000annualdeathsareabouttwoandahalftimeshigherthananestimatefromtheInstituteofMedicine(IOM)in2002.4Inconclusion,therateofdeathincreasesinthosewhodidnothavehealthinsurancecoverage.CommunityCharacteristics
InAppalachia,itisestimatedthat48.8%ofhouseholdsaresaidtobefoodinsecureperdata
collectedin2004.6Comparatively,thenationalrateoffoodinsecurityisestimatedat14%ofhouseholds.Whenahouseholdissaidtobefoodinsecurethereisalackoftransportation,healthyfoodisnotavailableatalltimes,andthehealthyandbasicfoodsarehighlypriced.
Appalachianculturemaybeacontributortowhyitishardtomaintainahealthydiet,makingitharderforindividualswithdiabetestomanagetheirglucoselevels.MostAppalachianstaplefoodsarefriedfoodshighinfat.Somecommondishesincludechickenanddumplings,cornbread,greenbeans,biscuitsandgravy,andfriedapplepies/desserts.Also,theAppalachiancommunityhasstruggledwithfoodinsecurityovertheyears.Grocerystoresandfarmer’smarketshavebeendecreasing,makingitharderforfamiliestoaccessfreshandlocalfoods.Fastfoodcompanieshavealsoincreasedinavailability.TheseeatinghabitsintheAppalachianculturemaycontributetowhyobesityratesaresohigh,andwhyitmakesdiabetesmanagementachallenge.EnvironmentalCharacteristics
InAthensCounty-Ohio,thereare36physicians’officesthatthecommunitymembercangotoforhealthneeds.9ThefacilitieswherethereisnutritioncareinAthensCounty-Ohioare:WIC,O’blenessHospital(OhioHealth),TheDiabetesandEndocrineCareCenter(DECC)withinDiabetesInstitute(managedbyUniversityMedicalAssociates(UMA)inpartnershipwiththeHeritageCollegeofOsteopathicMedicine).8
AthensCountyhas49outof1,606householdswithoutvehiclesthataremorethanone-halfmilefromaSupermarketmeaningAthensCountydoesnothavearelativelyhighnumberofhouseholds(49of1,606totalhouseholds(3%))withoutvehiclesthataremorethan1/2milefromaSupermarket.11 AthensCountyhasapublictransitservicethatoffersfivedailyroutes.Thepublictransportationsystemislimited,butithasseengrowthinrecentyears.ThemostsignificantpartofthesystemistheAthenscitybusservice.ThebusestravelallaroundthecityandouttothevillageofThePlainswhichisapartofAthensCounty.Currently,thebusesdonottravelanywhereelseinthecounty.Thebussystem
providesavaluableservicetopeoplelivinginsideAthensandThePlains.ThebussystemdoesnotofferanyserviceonSunday,though,andmainlyonlyoperatesbetween7a.m.and7p.m.duringtheweek,soitisnotavailableatalltimeswhenpeoplemayneedtransportationtotheSupermarkets.1Inaddition,manypeoplewithoutreliabletransportationoftheirowncannotaffordtoliveinAthensCountyandlivewherethepublictransitservicedoesnottravel.Thesepeopleneedsomesortofassistancetogettohealthcareappointments,work,jobinterviewsandtootherappointments. Alongwiththepublictransitservice,AthensCountydoeshavesometaxiservicesthatprovidetransportationinthecityandintheoutlyingareas,butthisserviceiscouldbetooexpensiveformanyresidentsbecauseoftheirlevelofincome.
Forseniorcitizensandlowincomearearesidents,orindividualswithdisabilities,HAPCAPstartedtheAthensonDemandTransitinNovember.2Thisserviceoperatesfrom8a.m.until9p.m.MondaysthroughSaturdaysandprovidestransportationtoandfrommedicalappointmentsandsocialservicesappointments.Asspaceisavailable,theprogramwillalsoofferridestoworksites,grocerystoresandotherlocations.Theprogramcurrentlyhastwominivans,whileadditionalminivanswillbeadded.Ifthisvaluableservicecanbeexpandedtoprovideadditionaltransportationoptions,itwillbeatremendousbenefittothecommunity.
HAPCAPalsooperatesaMobilityManagementProgramthathelpstocoordinatetransportationservicesallacrossthecounty.CoordinatorLantzReppworksinavarietyofwaystohelpAthensCountyresidentsaccessthedifferentprogramsavailablewhilehealsoexploresnewopportunitiestoimprovetransportationoptionsforallAthensCountyresidents.SocioeconomicCharacteristics
AthensCounty-Ohiohasahighlevelofpovertyandlowmedianhouseholdincomereportedbythe2010-2014UnitedStatesCensusBureau.Accordingtocensusdata,Athenscountyhasapovertyrateof29.9%.3Thislevelisnearlydoublethenationalrateof14.5%,andis13%higherthantheAppalachiarateof17%.3Alsoaccordingtocensusdata,themedianhouseholdincomeintheUnitedStatesis$53,657,whilethemedianinAthensCountyis$33,773.3
ThelevelofeducationthatparentsinAthensCounty-Ohioisreportedbythe2010-2014UnitedStatesCensusBureau.Accordingtothemostrecentcensusdata,88.0%ofresidents,ages25yearsorolder,inOhiohaveahighschoolgraduateorhigherwhile89.4%ofAthenscountyresidentshaveahighschoolgraduateorhigher.3Itisreportedthat25.6%ofresidents,ages25yearsoldorolder,inOhiowhile28.8%ofresidentsinAthensCountyhavebachelor’sdegreeorhigher.3TargetPopulationData
Approximately48.8%ofhouseholdsinAthensCountyarefoodinsecureaccordingtoUSCensus
data.3Itcanbeestimatedthatnearlyhalfofourtargetpopulationliveinfoodinsecurehouseholds.OnlythreelocationsinAthensCountyoffernutritioncounselinggearedtowardsourtargetpopulation.ThethreelocationsthatprovidethisserviceareO'blenessMemorialHospital,WIC,DiabetesEndocrineCenter.9ExecutiveSummary-1-2paragraphsonStep3(seeBlackboard) AthensCounty-OhioislocatedinruralAppalachia,consideredinpovertyduetolowincomelevelsandfoodinsecurewithOhioUniversitylocatedinthecenterofthecommunity.ThehealthstatusofAthensCountyis“uncontrolled”duetolackofnutritioneducation,lowlevelsofhealthinsurance,foodinsecurity,andhighpovertylevels.TherearemanyhealthproblemsinAthensCountywithlittleto
notransportationtoreceivehealthcareorgettonutritiousfood.ThecurrentresourcesavailabletoresidentsareDiabetesOutreachSupportandEducationforStudents(DOSES),DiabetesandEndocrineCenter,OhioUniversityDiabetesInstitute,AthensKidsClub,CollegeDiabetesNetworkandO’blenessHospital.Thehealthcareavailableforthetargetpopulationisindicativeoftheaccessofthelargercommunity,servicesandsupplementalcaremaynotbeavailableinthisarea.Thewidespreadlackofhealthinsurancedisallowsthecommunityfromaccessinthecarethattheyneed.Thehealthstatusrelatestoenvironmentalandsocialcharacteristicsbypopulationnothavingalargeamountofhealthcareprovided.ThereisahighlevelofpovertyandlowmedianhouseholdincomeinAthensCounty.
InAthensCounty,thehouseholdsaresaidtobefoodinsecurewhichmeansthereisalackoftransportation,healthyfoodisnotavailableatalltimes,andthehealthyandbasicfoodsarehighlypriced.Thereisalackoftransportationavailabletocommunitymemberstoreceivehealthcarefromthe36physicianofficesandthethreelocationsthatprovidenutritioneducation.WhiletheeducationlevelofadultsishighinAthensCountycomparedtoratesinOhio.Finally,thepovertylevelinAthensCountyishighcomparedtonationalratesmeaningtheoverallstateofthetargetpopulationisaffectedbythislowlevelofincome.Feedback
Toensurethatourneedsassessmentisbeingputintoactionappropriately,wewouldwantto
advertiseourmissionandgoalstothetargetpopulationweareprovidingfor.Sinceourtargetpopulationisforchildrenfromages6-16withtype1diabetes,wewouldwanttoadvertisetothechildrenaswellastheparents.Therefore,wewouldhaveanarticleintheAthensNewspapertospreadtheawarenesstothegeneralpopulation,thatwayparentscanseetheavailablenutritionresourcesfortheirchildrenwithtype1diabetes.WewouldalsopassoutflyersindoctorofficesaswellasprovideflyersinalltheschoolsacrosstheAthensCounty.Childrencanthentakehometheflyerstotheirparents.Webelievetheawarenesswouldbeeffectivelyspreadthisway.References:1AthensPublicTransit."FullMapandSchedule."AthensPublicTransit.Web.27Apr.2016.2AthensCountyJobandFamilyServices."LackofTransportation."Athensoh.org.Web.27Apr.2016.3Census."PopulationEstimates,July1,2015,(V2015)."AthensCountyOhioQuickFactsfromtheUSCensusBureau.Web.27Apr.2016.4Cecere,David."NewStudyFinds45,000DeathsAnnuallyLinkedtoLackofHealthCoverage."HarvardGazette.Web.27Apr.2016.5DeWitt,David."StudyChroniclesTransportationChallengesforPoor."TheAthensNEWS.Web.27Apr.2016.6FeedingAmerica."FindYourLocalFoodBank."FeedingAmerica.Web.27Apr.2016.7Flasher,WanemaC."Ohioline."CulturalDiversity:EatinginAmerica-Appalachian.Web.27Apr.2016.8Mezitis,Nicholas."OhioUniversity."DiabetesandEndocrineCareCenter.Web.27Apr.2016.
9SimplyMap."OULibrariesEZProxy."OULibrariesEZProxy.Web.27Apr.2016.10Sohn,Mark."AppalachianFood."MountainPromise.Web.27Apr.2016.11USDA."USDAERS-GototheAtlas."USDAERS-GototheAtlas.Web.27Apr.2016.NUTR4100UNworldfoodprogramagencyreview
GeneralEducation
COMS1010InterpersonalawarenessanddevelopmentactivityAftercompletingChapter6,IfeelthatmyinterpersonalskillsneedthemostworkintheSelfDisclosurearea.Thebookdefinesitasthe“processofmakingintentionaldisclosuresaboutyourselfthatotherswouldbeunlikelytoknow”.Myproblemis,Inevergaugehowfastorhowslowtheprocessshouldbegoing,orifwhatI’mdisclosingcouldbeusedtohurtmeinthelongrun.Ithinkthisstemsfromamilitaryfamilythatvaluessecurity.Ineverliketoleakinformationaboutmyselfthatcouldbeusedbyothersagainstme,evenifitisasignificantother.I’vealwaysbeenafraidtoletslipthewronginformationonlytohaveitblowupinmyfacelater.Irealizethatself-disclosureisakeycomponentforanyrelationship,andIdoeventuallydisclosedelicateinformationaboutmyselfinarelationship,butbecauseI’msowithholdingofinformation,Ineverknowwhatinformationtogiveatwhatpoint.Whatseemssmalltosomeoneelsemightbetheworldtomeandwiththatinmind,it’sdifficultformetogiveouteventhesmallestdetails.Turningtothebookforassistance,I’vefoundthatoutofalltheskillbuildingtoolsthatitoffers,Ifind1.)Beingwillingtodiscloseand2).Graduallyincreasingdisclosureastherelationshipdevelopstobethemosthelpful.Togettothatpointofbeingwillingtodisclose,IbelievethatImustfindsomeonethatIsharealotofsimilaritieswithandhavebeenaroundforawhile.Arelationshipthatcatchesfireabittooquicklyisprobablynotidealforme,asIdon’tknowhowwellIcantrusttheotherperson.So,Ithinkmyfirststeptoimprovemyinterpersonalcommunicationistotrytoallowmyselftotrustpeople.FromthereIwillstartassmallascomfortablypossibleinmydisclosuresandtrytoexplaintotheotherpersonthatalthoughmydisclosuresmaybesmall,I’mtryingtotrustthepersonandletthemknowme,andthatittookagreatefforttodiscloseinformationtothem.FromthereIneedtocomfortablenavigatemywaytomoreintimateinformationuntilIcandisclosethingsthatImayhaveonlyevertoldthatperson.AfewothertipsfromthebookIfoundtobehelpfulincluderevealinginformationatthesamepaceandwiththesamedepthastheotherpersonandnotdisclosingnegativeinformationuntiltherelationshipiswellestablished.LikeIsaidabove,I’veneverbeengoodatjudgingwhatinformationIshoulddiscloseatwhatpointintherelationshipbeforethisclass.Ifyouare“pinging”offtheamountofinformationthattheotherpersongivesyou,itmightallowthebuildingoftrusttooccurquickerasyouhavecomparableinformationabouteachother,whichallowsforaspecialtypeofbondbetweenthepair.Thesecondtipmightseemobvious,butweallhavethosemomentswherewemightaccidentallysaysomethingwedidn’tmeantoandbestuckinthepit.Ithinkingeneralthough,it’sagoodtip;youdon’twanttomakeyourselflookbadwhileyouarestilltryingtobuildastrongrelationship.Waituntiltherelationshipiswellestablishedandwhatyouperceivedasnegativeinformationmightbesomethingthetwopeoplecanlookbackandlaughat.MathematicalReasoning
NutritionCareProcessNUTR3100ADIMENoteforHypertensivePatient
A
62-year-oldmale,hypertensive.Ht:5’9”,Wt:110kgBMI:32.5
Medications:CholestyramineMedicalHistory:Hypercholesterolemia,HypertrigylceridemiaLabValues:
Cholesterol:265mg/dLLDL:160mg/dLHDL:35mg/dLApoA:75mg/dL
ApoB:142mg/dL
Triglycerides:200mg/dLBloodPressure:160/100
EER:2626.9kcalEstimatedEnergyIntake:2390kcalBMI:32.5DietBehaviors:Patientdoesnotcook
often.Statesthathiex-wifedidmostofthecooking.Throughhiscareer,hebecameaccustomedto
greasyfastfoods,andhasnointerestinlearningtocook.Believescookingisn’tworthhistimeandalso
statesthathealthyfoodtastesbland.
D
Excessivefatintake(NI-5.5.2)relatedtoadietabnormallyhighfatdietasevidencebyHDL<45mg/dL,
LDL>130mg/dL,cholesterollevelsof265mg/dL,andtriglyceridelevelsof200mg/dL
Notreadyforlifestylechange(NB-1.3)relatedtounwillingnesstocookhealthyfoodinthehome,as
evidencedbypatientindicationofalackofinterestincookingasitisperceivedtobeawasteoftime.
I
Fatmodifieddiet(ND-1.2.5)usingaslowintroductiontotheMediterraneandiettolowerserumlipid
levels,increaseintakeofantioxidants,andpromoteoverallhealth.
OutcomeGoals:1.DecreaseSerumLDLandCholesterol2.IncreaseserumHDL3.Decreasefattyfood
intake4.Increaseintakeoffruits,vegetables,fish,andnuts
ActionGoals:Patientagreestocookinthehome.Patientagreestoshopforfatreducedfood.Patient
agreestomodifydiettoincludeelementsoftheMediterraneanlifestyle.
I(M/E)
Willfollow-upwithpatientinonemonthtoassesssuccessofattemptedchanges.Whennewserumlab
valuesbecomeavailable,clinicalwillusethesenewvaluestoassesssuccessofthissetofchangesand
reevaluateisnecessary.
4.Increaseintakeoffruits,vegetables,fish,andnuts
ActionGoals:Patientagreestocookinthehome.Patientagreestoshopforfatreducedfood.Patient
agreestomodifydiettoincludeelementsoftheMediterraneanlifestyle.
I(M/E)
Willfollow-upwithpatientinonemonthtoassesssuccessofattemptedchanges.Whennewserumlab
valuesbecomeavailable,clinicalwillusethesenewvaluestoassesssuccessofthissetofchangesand
reevaluateisnecessary.
NUTR4100NutritionCarePlanforB-LymphomaPatient
Heading
DDx:____pointsDx:____pointsDx:____points
A
(EachPES
statementis
worth4points)
UnsupportedBeliefsaboutnutritionrelatedsubjects(NB-1.2)relatedtodesireforacureforachronicdiseasethroughtheuseofalternativetherapyasevidencedbyreported“anti-cancer”faddiet,energyandproteinintakeimbalances,andintakeofalternativedietarysupplements.Malnutrition(NC-4.1)relatedtophysiologicalcausesincreasingnutrientneedsandnutritionrelatedknowledgedeficitasevidencedbydailyenergyintakeof<75%(1718kcal)estimatedenergyrequirement,dailyproteinintakeof<RDA(68.7g),andunintendedweightloss.
MasticatoryDifficulty(NC-1.2)relatedtoxerostomiaasevidencedbyoralmanifestationofcancerdiagnosis.
I(M/E)I:____pointsM/E:____points
PIntervention:6.5
pts
M/E;2.5pts)
1.)RecommendIncreasedEnergyDiet(ND-1.2.2.2)andTextureModified;EasytoChewDiet(ND-1.2.1.1)Recommend2000kcal/day,texturemodifieddiet,withfrequentfeedings,toensureahealthfuldiettoallowthepatienttosuccessfullyundergochemotherapytreatment.
2.)Achievepropernutrientintakethroughdietarymeans,whileeliminatingunnecessarysupplementswhenneeded.
3.)Outlineprioritymodificationsasrelatedtocancerdiagnosis.Specifically,propercaloric,protein,andcarbohydrateneeds.
4.)ProvideNutritioncounseling,focusingonself-managementandstressmanagement.
Outcomegoals:
IncreaseEnergyandProteinIntake.
Employeasytochewdiettoalleviatemasticatorydifficulty.
Actiongoals:Patientagreestodiscontinuecurrent“anticancerdiet”infavorofageneralhealthfuldiet.Patientagreestoadopt2000kcal/daydiet,incorporatingproperproteinintakeof~70g/day.Patientagreestokeepafoodloginordertoensuretheconditionsofahealthfuldietarebeingmet.Patientsfamilyagreestodiscontinueuseof“anticancerdiet”andundergofoodandnutrition-relatededucationtograsptheimportanceofahealthfuldietasitrelatestocancer.
Willfollowupwithpatientin3months,thenevery6monthsfollowingthefirstfollowuptoreviewpatientfoodlogtoassessadherencetonewdietplan.
Signature-1pt
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Overallimpressionofthenote.Writingstyle,neatness
NUTR4100NutritionCareplanforGIpatientfocusingonOstomyCare
Heading
A(3pts)
S
Patientstatesahistoryofhavinga“funny”stomach”(historyofasensitivestomach).Patientstatesthatshediscontinuedthemodifiedfiberdietaftershe“feltbetter”anddidn’tfeelitnecessarytocontinuethediet.Patientstatesthatshehasa“goodappetite”.Patientstatesthatherconditionhasgottenworseinthepastyear,especiallyinthespring.
O
AnthropometricsAge:53Height:5’4”Weight(6moprior):170lbsWeight(Admission):165lbsBMI(6moprior):29.27BMI(Admission):28.4IdealBodyWeight:120lbs%IdealBodyWeight:137%UsualBodyWeight:170lbs%UsualBodyWeight:97%TotalEnergyExpenditure:2077kcal/day
BiochemicalHgb:11g/dLHct:35%WBC:13*10^3
ClinicalSeverePaininlowerleftquadrantSevereConstipationanddiarrheaDiverticulitisintheSigmoidanddescendingcolonRectalBleeding
Diet/LifestylePatientisactive;ManagesFamilyFarmwithHusbandNormalDietuntildiverticulitisdiagnosisLowfiberdietprescribed;notfollowedtocompletionNutrientAnalysis(FromRecall):Kcal/day:1762.35kcalDailyGoal:1840kcal
Protein:103.54gCarbohydrates:76.54gFat:122gSodium:620.37mgPotassium:2403.6mgMagnesium:914mgVitaminC:87mgIron:17.5mgHistoryHypertension–Father’sSideCerebrovascularAccident–BrotherMultipleMyocardialInfarctions–FatherStroke–FatherIntestinalCancer–MotherAbdominalpaininlowerleftquadrantIncreasedFlatus
DDx:____pointsDx:____pointsDx:____points
A
(EachPES
statementis
worth4points)
FoodandNutrition-RelatedKnowledgeDeficit(NB-1.1)relatedtolackofpriornutritioneducationrelatingtocolostomybasednutritionasevidencedbychangeindiverticulitisdiagnosisandcolectomyrequiringtheuseofacolostomyLimitedAdherencetoNutrition-RelatedRecommendations(NB-1.6)relatedtofoodandnutrition-relatedknowledgedeficitconcerninghowtomakenutrition-relatedchangesasevidencedbyinconsistentcompliancewithnutritionplanrelatedtodiverticulitisdiagnosis.AlteredGastrointestinalFunction(NC-1.4)relatedtoalterationingastrointestinaltractstructureasevidencedbycolectomyprocedure.
NUTR4100NutritionCareplanforCysticFibrosisPatient
I(M/E)I:____pointsM/E:____points
PIntervention:6.5
pts
M/E;2.5pts)
NutritionEducation(E-1)relatedtorecommendedmodificationspertainingtoacolostomy,thepurposeoftherecommendedmodificationsastheyrelatetothecolostomyandoverallhealth.OutcomeGoals:ModifyDiettoensurehealthycolostomyPreventblockageofostomyActiveGoals:ClientagreestoattempttoincorporatehigherfiberfoodsintothedietClientagreestoincreasefluidintakeClientagreestoadheretoaregularmealscheduleClientagreestoavoidfooditemsthatmayresultinacloggedostomyClientagreestokeepalogofmonitoringandmanagementbehaviorsonadailybasisWillfollowupwithpatientafter1monthandthenevery3monthsafterwardstoassessadherencetointerventiongoalsbyevaluatingpatientself-adherencescores,theabilityofthepatienttorecallnutritiongoals,andalogofself-managementandself-monitoringdailyasagreedupon.
Signature-1pt
WritingStyle
Overallimpressionofthenote.Writingstyle,neatness
Heading
A(3pts)
S
Patientstatesthathehasbeenexperiencingfrequentcramping.Patientstatesthathehasbeenexperiencingfrequent,severediarrheawhileatschool.Patientstatesthatheexperiencesabnormallylargevolumeoffecalexertionwheneatingchipsandcheese.Patient’sparentsstatethattheyhavebeenrestrictingfatintactduetoabnormalfecalsmell,statingthatit“can’tbegoodforhim.”Patient’sparentsstate“atleasthe’sgettingenoughcalories”whendiscussingtheirlackofknowledgeonwhattypeofdiettheyshouldbefacilitating.
O
AnthropometricsAge:10y.o.Height:1.31mWeight(Admission):22.75kgBMI(Admission):13.2ApproximateIdealBodyWeight:31.75%IBW:71.65%TotalEnergyExpenditure:REE=(22.7*wt+495)=1011kcalTEE=REE*(AC+DC)=1920kcalDER=TEE*(0.93/CFA)=2100kcalTSF:4.5mmArmcircumference:16.70cm
BiochemicalHbA1C=7.1%
ClinicalManifestationofclubbingofthefingersandtoes.Patientappearspaleandextremelythin.
Diet/LifestylePatientisactive,contentandwellbehaved.Noaltereddietspecifiedasofyet.Dietplanisregularastoleratedbythepatient.Parentshavegoodhealthinsuranceandthemeanstoprovidefoodandadequatecare.NutrientAnalysis(FromRecall):Kcal/day:1153Protein:48gCarbohydrates:217gFat:103.77g(9%)
Sodium:2144mgPotassium:2274mgMagnesium:173mgVitaminC:108mgIron:9mgVitaminA:362ugRAEVitaminD:5ugVitaminE:1mgATVitaminK:49ugHistoryPatient’ssiblingpassedatayoungage;CFrelated
DDx:____pointsDx:____pointsDx:____points
A
(EachPES
statementis
worth4points)
InadequateFatIntake(NI-5.5.1)relatedtoalterationingastrointestinaltractfunctionasevidencedbyestimatedfatintakesbelowtherecommendedlevelandfatmalabsorptioncausedbycysticfibrosis.InadequateVitaminA,D,E,&Kintake(NI-5.9.1)relatedtophysiologicalcausesincreasingnutrientneedsrelatedtoimpairedfatutilizationduetocysticfibrosisasevidencedbyestimatedvitaminintakebelowtherecommendedlevel.ImpairedNutrientUtilization(NC-2.1)relatedtoimpairedexocrinefunctionofthepancreasasevidencedbycysticfibrosisdiagnosis.
I(M/E)I:____points
PInterven-tion:6.5
pts
M/E;
Increasedfatdiet(ND-1.2.5.1)tomeetphysiologicalneed,andtoaccountformalabsorptioncausedbycysticfibrosis.IncreasedVitaminA,D,E,&Kdiet(1.2.10)tomeetphysiologicalneed,andtoaccountformalabsorptionoffatascausedbycysticfibrosis.
NUTR4100NutritionCarePlanforImmunocompromisedPatient
M/E:____points
2.5pts) NutritionEducationpertainingtonutritionrelationshiptodisease(E-1.4)toensurethepatientandhisparentsareknowledgeableofdietaryneedsinrelationtohiscysticfibrosiscareandmanagement.OutcomeGoals:Modifydiettoensurerecommendedintakeoffatsandfatsolublevitamins.Preventmalnutritionandmanagemalabsorptionasitrelatestocysticfibrosis.Educateboththepatientandhisparenttothenutritiveneedsassociatedwithcysticfibrosistoensurequalityoflife.ActiveGoals:Clientagreestoattempttomodifythediettoincorporateahigherpercentageoffats.Client’sparentsagreetoattendtheNutritionEducationsessiontoensuretheirunderstandingthatahigherfatintakeisrequiredtomaintainthehealthoftheirson.Clientagreestoincorporatefoodsintothedietwhicharehigherinthefatsolublevitaminstoensurehealthyintake.Clientagreestokeepalogoffoodsbeingincorporatedintothediettomeettheincreasedfatandfatsolublevitaminneedstodemonstrateself-sustainabilityinmanagingthenewdiet.Willfollowupwiththepatientin1monthandthenevery3monthsafterwardstoassesscompliancewiththeinterventiongoalsbyevaluatingpatientself-adherencescores,parentadherencescores,andfoodlogreview.
Signature-1pt
WritingStyle
Overallimpressionofthenote.Writingstyle,neatness
Heading
D Dx: ____points Dx: ____points Dx: ____points
A
(Each PES
statement is
worth 4 points)
Inadequate energy intake (NI-1.2) related to decreased ability to consume sufficient energy as evidenced by patient statements regarding difficulty eating and soreness in the mouth and sustained weight loss since diagnosis. Masticatory Difficulty (NC-1.2) related to soft tissue disease as evidenced by patient statements on soreness of the mouth and HIV diagnosis. Unintended weight loss (NC-3.2) related to physiological causes increasing nutrient needs due to prolonged illness as evidenced by 82 %UBW, 96 %IBW, and weight gain recommendations by attending physician.
I (M/E) I: ____points M/E: ____points
P Interven-tion: 6.5 pts
M/E;
2.5 pts)
Nutrition education related to nutritional relationship to HIV using the cognitive-behavioral theory using social support to increase energy intake using a pureed texture diet. Outcome goals: Increase Energy Intake Decrease discomfort involved in eating Action Goals: Patient agrees to increase the number of calories eaten per day. Patient agrees to utilize a pureed diet to increase the volume of food eaten per day Patients partner agrees to support the patient in undertaking the pureed diet. Referral: Collaboration with attending physician to ensure overall health
NUTR4100CysticFibrosisandPancreaticFunctionEducationalHandOut
Signature- 1pt
Writing Style
Overall impression of the note. Writing style, neatness
ProfessionalDevelopmentProfessionalWritingLivingwithDiabetesinCollege:Charles
Foryoungadultslivingwithdiabetes,preparingforcollegecanbeadifficulttime.Managingdiabeteswhiletryingtomakesenseofanewworld,socialnetworkandexpectationscanbeespeciallychallenging.You’renotalone!Therearemanyresourcesinplacetohelpsupportthistransition.
ThefollowingarestoriessharedbyCollegeDiabetesNetwork(CDN)Students,involvedinCDN’sStudentAdvisoryCommittee(SAC),abouttheirexperiencesheadingofftocollege,andnavigatinglifeoncampus,withdiabetes.
TheCollegeDiabetesNetworkprovidesprogramsforyoungadultswithdiabetestohelpmaketheircollegeexperiencesaferandmoresuccessful.TheAmericanDiabetesAssociationisworkingwithCDNtohelpfurtherthisgoal.
NameandAge:Charles,21School:OhioUniversity,AthensCampus,Classof2017WhenIwasdiagnosedat14yearsold,myworldturnedupsidedown.Atthetime,IthoughtIwasgoingtoenlistintheMarineCorpsdirectlyoutofhighschool.Type1diabeteshadotherplansforme.AfterIhadacceptedIwouldbeattendingcollegeafterhighschool,IhadagoodideaofwhereIwantedtogo.OhioUniversitywasonlya20-minutecommutefromhome,hadtheonlyosteopathicmedicalschoolinthestate,anditevenhadaDiabetesInstitutewhereresearchscientists,clinicians,educatorsandstudentsmettoimprovethequalityoflifeforthoseaffectedbydiabetes.Itwastrulytheperfectschoolforme.Becausethecampuswassoperfectlysuitedtome,Ididn’tlooktoodeeplyintotheirmedicalaccommodationsorhealthservicesforstudents.Mydoctor’sofficeislessthanathree-minutedrivefromcampus,whichisahugeadvantage.EverythingIneededforcollege,forlifewithtype1ingeneral,wascloseathand.Thismademytransitionintocollegerelativelysimple—dareIsayeasy.Iknowothersaren’taslucky.ButtherealtransitionformewashowIinteractedwithmydiabetes.Type1canbestrainingonaperson,andsomemayevenfeelashamedbyit.ButpleasetrustmewhenIsaythattellingsomeoneaboutyourconditionisoneofthebestthingsyoucando.Thismaynotbetheeasiestthingforeveryonetodo.Talkingaboutitisareliefinitsownright.Onceyoucan“own”yourdiabetes,thenthereisnothingitcanthrowatyouthatyoucan’tovercome—butthatfirstrequiresyou
toembraceitandunderstandhowitcanaffectyourlife.Informthepeoplearoundyousotheycanhelpyouownit.Imakeeveryefforttocoexistwithmydiseaseratherthantofightit,andthatrequiresthepeopleclosesttometohaveadeepunderstandingofmydiabetesandwhattodointheeventofacrisis.Youneverhavetogoitalone!InmyhometownofGlouster,Iknowofthreeotherpeoplewithtype1diabetes.TwoofthemwenttothesamehighschoolasIdid.Youcouldsaythatoutsideofdiabetescamp,whichIattendedinthesummer,myinteractionswithotherpeoplewithtype1werenearlynon-existent.Thischangedinmysophomoreyearofcollege,whenmydoctorandsomeofthenutritionfacultyapproachedmeaboutstartingaclubforpeoplewithdiabetes.TheclubwouldgoontobecometheOhioUniversitychapteroftheCollegeDiabetesNetwork.Helpingtoco-foundthisgrouphashadaprofoundimpactonme.I’veconnectedwithleadersinthediabetessector,whichhasmademereevaluatehowIwanttocontinueintomycareer.Iwanttoworktowardbettertreatmentmethodsandtheever-elusivecure,butIalsowanttoworkoutsidethetraditionalrealmofmedicine.Iwanttosupportmypeerstofindthebestcourseoftreatmentratherthandictatingwhatthatmeans.Iwanttotreatthepeopleandnotjustthedisease.Iknowwhatit’sliketobeonthepatientsideofhealthcare;it’simportanttomakeitmorepersonal.EversincejoiningCDN,I’vebecomethe“diabetesguy”oncampus.Inhelpingtofoundourchapter,ImadecontactsinourDiabetesInstitute,ourmedicalschoolandourlocaldiabetesprograms.Iwasneverafraidoftalkingaboutmydiabetesbeforeenteringcollege,butinworkingwithCDNalongwithotherorganizations,Ibecameaself-proclaimedexpertintellingpeopleaboutit.Myfriendsandcoworkerscouldprobablytellyoumoreabouttype1diabetesthanyourtypicalperson,basedontheamountofinformationIpassontothem.Ifyou’reheadingofftocollegewithdiabetes,donotbeafraidtogetinvolved!Youneverknowwhois“touchedbydiabetes,”andyoumightbesurprisedbywhoisinterestedinworkingwithyouorevenjustsittingdownandhavingaconversationaboutdiabetes.Takeitfromsomeonewhowentitaloneallfouryearsofhighschool.Youcantackleyourdiabetesallbyyourself,itwillneverbeatyouunlessyouletit.Buthavingpeopleclosetoyouwhocanhelpyouwhenyouneedit—thatcanmakebeatingdiabetesalltheeasier.TheCollegeDiabetesNetwork(CDN)isa501c3non-profitorganization,whosemissionistousethepowerofpeers,accesstoresources,andgrassrootsleadershiptofillthegapsexperiencedbyyoungadultswithdiabetesandmaketheircollegeexperiencesaferandmoresuccessful.CDN’svisionistoempoweryoungadultswithdiabetestothriveinalltheirpersonal,healthcare,andscholasticendeavors.CDNhasover80campuseswith60+affiliatedchapters.Sign-upformoreinformationhere.DiabetesForecastmagazineandtheCollegeDiabetesNetworkrecentlypublisheda“ThriveGuideforYoungAdults”withtipsfordoingcollegewithdiabetes.Visitdiabetesforecast.organddiabetes.orgformoreinformation.
AADEClinicianCareguideforOmnipodIwasdiagnosedonMay8thof2008;atthetime,Iwas14yearsold.IstartedonNovologandLantusflexpensforthefirstsixmonths.IthentransitionedtotheOmnipodinNovemberof2009.IwasfortunateinthatIwasn’tevertreatedasachild.Itooktheinitiativeinmycare,beingolderformydiagnosisandbeingmoreabletotakecareofmyselfwithminimal(butnolessprecious!)helpfrommyparents.IhadanamazingDiabetologist.Hetreatedmenotasasickchild,butasaresponsibleadult,inchargeofmyowntreatment.Iwasnevertoldwhatmymethodofcarewouldbe.Hemaderecommendation,explainedtheprosandcons,andletmechoose,forthemostpart,whatwewoulddo.Youcouldalmostsaythatmytransitionfromchildcaretoadultcarehappenedatmytimeofdiagnosis.Thisiswhathasmademesosuccessfulinmyself-care.Idon’tresentmanagingmytypeonebecauseIalwayshadasay.Iwasalwaystheoneincontrolofmydisease,nottheotherwayaround.Iwouldsaythatishighlevelofautonomy,backedbyanexcellenthealthcareprovider,andamazingfamilysupportmadeitsothereweren’tany“roughspots”inmytreatmentfrommytimeofdiagnosisuntilnow.Lookingback,Iwouldn’thavechangedathing.Fromthis,Iwouldhopethatprovidersacknowledgeafewthings:First,diabetesisaself-caredisease.Mostofthecaredoesnotoccurinthepresencehealthcareprovider.Therefore,providersshouldgivetheirpatientsthereins.Iftheyarewellinformedoftheoptions,thebenefitsandthepotentialdownsides,theyshouldbetheonetomaketreatmentdecisions.Thisleadstohigherdiseaseefficacy,betterself-care,andahigherqualityoflife.Second,diabetes“child-care”shouldnotdiffertoogreatlyfromadultcare,butinsteadshouldbetreatedastypeonecare,ratherthangeneral“diabetes”care.Wecannothopeforthosewithtypeonetothrivewhenbeingtreatedasiftheyhavetypetwo,norviceversa.Thetwoaresimilar,butshouldnotbetreatedasthesame.Ultimately,theparentsandprovidershouldhaveagreaterinfluenceoncareforyoungerchildren,buttheymustbeallowedtolearnandgrow.2016CollegeDiabetesNetworkAHEADProposalAHEAD2016:ExcellenceandEquity;AccessonCollegeCampusesKeywords:ProgramInnovations,CampusCollaboration,ChronicDisease,Access,EquityProgramTitle:AccessibilityToolkitforStudentsLivingwithDiabetesProgramAbstract:Studentswithdiabetesmayfacedifficultyinproperlynavigatingaccessibilityservicesontheircampus.Duetothenatureofdiabetesasaself-care/self-advocacydisease,studentsmaynotseekaccommodations,orevenrealizethattheyqualifyforaccommodations.Asdiabetesandotherchronicillnessescontinuetogrowinthecollegeagedpopulation,campuseswillneedtoembraceinnovativestrategiestoengagestudentswiththeseconditions.Withoutseekingtheassistanceofaccessibilityservices,thesestudentsmayfaceunduehardshipincollege.Inresponsetothedisconnectbetween
studentsandaccessibilityservices,theCollegeDiabetesNetworkassembledaCampusAdvisoryCommittee,amulti-disciplinaryteamofcampusprofessionalsandorganizationalpartnerscommittedtosupportingyoungadultswithdiabetes,toidentifythegapsfacedbythispopulation.TheCollegeDiabetesNetworkhopestobridgethesegapsbydevelopingatoolkitforcampusaccessibilitystafftohelpbettersupportthesestudents.ProgramDescription:SincethefoundingoftheCollegeDiabetesNetwork(CDN),campusadministratorsandclinicalprovidershavesharedincidencesofstudentsdroppingoutofcollegeduetothedifficultyassociatedwithdiabetesmanagementwhileoncampus.Additionally,studentshavealsoreportedtheirstrugglesinnavigatingcampuslife,resultinginnegativepsychosocialandphysicalhealthoutcomes.Whilemanystudentslivingwithdiabetesdofindeffectivewaystobalanceself-careandcollegelife,thechallengesmanystudentsmayfacecannotbeignored.Notonlycanthesedifficultiesaffectthestudent’soverallhealth,itmayalsoaffecttheirabilitytothriveacademicallyandsociallywhileincollege.Toaddresstheseissues,CDNassembledtheCampusAdvisoryCommittee(CAAC),amulti-disciplinaryteamofcampusprofessionalsandorganizationalpartnerstoassessthegapswhichstudentswithdiabetesmayface.ThroughtheworkoftheCAAC,CDNhadidentifiedchallengescampusesmayfaceinservingthispopulation,anddevelopedaroadmapforanewprogramminginitiativethroughCDNtoaddressthesegaps,andassistcampusprofessionalsinprovidingequitablesolutionstobettersupportthispopulation.ThecommitteewasassembledonJuly29th-July31st,inBoston,Massachusetts.Overthecourseofsummitmeeting,thecommitteeidentifiedtwomajorgapswhichattributetothestrugglesofstudents.Thosebeingself-advocacyburnoutandthelackofawarenessamongststudentswithdiabetesofdiabetesbeingaqualifierforacademicaccommodationsundertheAmericanswithDisabilitiesAct.Diabetesisalmostentirelyaself-carecentereddisease.Thismaydrivestudentstoapointinwhichtheyareexhaustedwithconstantself-advocacy.Itwastheopinionofthecommitteethatinorderforstudentstoreachtheirmaximumpotential,campusprofessionalsmusthelptofacilitatetheshiftofthefullburdenofadvocacyfromthesolelythestudent,andensureopenandhonestchannelsofcommunicationtoensurestudentaccessandsuccess.Thecommitteealsotookunderconsiderationthedifferencesamongcampuseswhichmayleadtodisconnectsbetweenstudentsandaccessibilityservices,suchaslackof/limitedfundingandstaff,limitedtraining/knowledgeinthesectorofdiabetes,andcampuspolitics.Intheefforttoensurethatthesolutionstothesegapscanbeimplementedatcollegecampusesofanytypeandofanysize,thecommitteedevelopedtheconceptfortheCampusToolkitforDisabilityServiceCoordinators.Thetoolkitwillservetoeducateandassistdisabilityservicecoordinatorsastohowtheycanengagewithstudentswithdiabetestoremovetheonusandconstantself-advocacyfromthestudents.Eachtoolkitwithincludegeneralinformationregardingthementalandphysicalburdenswhichcanbecausedbydiabetesinordertobetterinformthetypesofaccommodationswhichthesestudentsmayapplyfor.Thetoolkitwillbedevelopedin2017andpilotedat25campusesnationwide.Usingevaluationsfrompilotcampuses,thetoolkitwillbeformallylaunchedin2018.ThissessionwilldetailthevisionofCollegeDiabetesNetworkastohowcampusadministratorsandstudentscanbetterconnecttoensureequityandexcellenceinthesupportofstudentslivingwithdiabetesoncampus.Further,thefindingsoftheCampusAdvisoryCommitteewillbediscussed,andthedevelopment,testing,andcontentsoftheCDNCampusToolkitforDisabilityServiceCoordinatorswillbe
outlinedanddiscussed.Ifsessionattendeesareinterested,theywillbeprioritizedaspilotrecipientstoreceivethetoolkit.Outcomes:1.)Understandtheimpactdiabeteshasonastudents’academicandsocialsuccessatcollege,andwhataccommodationsarecommonlyrequestedbystudentswithdiabetes.2.)Understandtheresourcesandmaterialsavailabletocampusprofessionalsanddisabilityservicecoordinatorstoassistinsupportingstudentswithdiabetes.3.)BeabletoassesstheneedforaprogramsuchastheCDNCampusToolkitforDisabilityServiceCoordinatorsontheirowncampuses,andelecttorequestapilottoolkit.PreferredSessionLength
• 60-minuteconcurrentsessions:Break-outpresentations.Amaximumof12presentationswillbeofferedsimultaneously,andinsomeconcurrentblockstherewillbefeweroptions.
• 60-minuteroundtablepresentations:Thesehighlyinteractivediscussionsessionsshouldfocusonaprovocativeorinnovativetopic.Proposersshouldbesuretohighlightdiscussionquestionsandexpectedoutcomesintheirpresentationdescriptions.Bynecessity,theaudiencesizewillbelimited.
• AHEADTalks(15-20minutes):RecognizingtheimpactofTEDTalks,weareexcitedtoexploretheeffectivenessofshort,dynamictalksinpresentingprovocative,novel,andinspirationalideasthatchallengetraditionalperspectives.ConferenceplannerswillworkcloselywiththoseacceptedtopresentAHEADTalkstoofferguidanceandreview.
Presenters:MargaretCamp|MeD,DirectorofStudentAccessibilityServices,ClemsonUniversity,AHEADrepresentativeTomThompson|InterimDirector,DisabilitySupportServices,CaliforniaStateUniversity–Fullerton,AHEADrepresentativeCharlesRiley|Student,CDNChapterleaderofDOSESatOhioUniversity
Physics
ResearchandProgramDevelopmentDiabetesFactSheetforStudents
DiabetesOutreachSupportandEducationforStudentsinCollegeKnowledgeabilityStudy
Creatingadiabetesfriendlyclassroom
DOSES: Diabetes Outreach, Support and Education for Students For more information contact DOSES at [email protected]
In case of emergency call 911 or the OUPD at (740) 593-1911. What is diabetes?- Diabetes is any metabolic disorder resulting in chronic polyuria (excessive urine output).- Diabetes mellitus is the most prevalent. - Type 1 accounts for 5% to 10% of cases in the U.S., and is an autoimmune disease. - Type 2 accounts for 90% to 95% of cases in the U.S., and results from insulin resistance.
What’s in a number?- Normal blood glucose level: 70-100 mg/dL- Blood glucose levels can fluctuate during times of stress (e.g., midterms or finals), illness, and exercise. - Running to class is the #1 cause of hypoglycemia for students with diabetes.- Hypoglycemia is a condition characterized by abnormally low blood glucose levels (less than 70 mg/dL is a LOW). - Hyperglycemia is the technical term for high blood glucose levels (greater than 180 mg/dL is a HIGH).
What is considered a diabetic emergency?- Severe hypoglycemia can lead to seizures, unconsciousness, coma, and even death. If you notice any of these symptoms, dial 911 immediately.- While you wait for help to arrive, see if anyone in the room has raisins, juice, regular soda, hard candies, anything that could help raise the student’s blood glucose levels.- The student may also be carrying a glucagon pen, which can be injected into the individual’s buttock, arm or thigh to treat a severe hypoglycemic event.
What can you do to help?- Students are not required to disclose, so look for the blue DOSES wristband, part of the welcome kit they receive when they register with Student Accessibility Services.- Include language in your syllabus encouraging students to come to you with…- Permit diabetic students to eat or drink during lecture to avoid hypoglycemia.- Allow diabetic students to adjust their insulin pump or check blood glucose levels during class. Insulin pump alerts may sound like a cell phone.- Be flexible. In case of blood glucose emergencies, excuse students from class and accept a medical provider’s note at a later date. Also be aware that students with diabetes may be late to class because they had to treat their diabetes symptoms.