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ARTIFACT

NUTR1100 Introductiontofoodsystems

Understandallpartsofafoodsystemandtheimpactsonnutritionalwell-being

FoodandNutrition Finalpaper+culinaryactivity(2)

NUTR1000 3-dayfoodloganalysis Howtoanalyzeastandard3-dayfoodlogandmacronutrientcontent

FoodandNutrition --

NUTR2000 Menuplanningforspecificagegroups

Utilizestandardstocreateamenuthatfulfillspecificmealrequirements

FoodandNutrition Menuplanningworksheet(1)

NUTR2200 SensoryAnalysis Howtoapplyandrecordsensoryanalysisdataoffoodsandbeverages

FoodandNutrition --

NUTR2220 Scienceoffood Howfoodscienceaffectspreparationandendresultsoffood

FoodandNutrition Labreport+TermProject(2)

NUTR2990 Introductiontoportfoliodevelopment

Howtobeginbuildingaprofessionalportfolio ProfessionalDevelopment

--

NUTR3300 Purchase+Budget Howtopurchase,budget,andstandardizerecipesforacommercialkitchen

FoodandNutrition --

NUTR3350 Foodsafetyandsanitation

Howtoapplyfoodsafetyandsanitationinacommercialkitchenonaproductionline

FoodandNutrition --

NUTR3000 Understandingmacro+micronutrientsatthecellularlevel

Howthemetabolismanddigestionofmacro+microscanmaintainhealthstatusandprevent

chronicdiseases

FoodandNutrition BPA+Waterpresentation(1)

NUTR3100 Nutritionanalysisanddiagnosis

UtilizeNutritionistProforassessingdietstocreateanutritiondiagnosis

FoodandNutrition ADInoteform+Nutrientintakesummaryfordiabetesmellitus(2)

NUTR3600 CulturalCounseling Howculturemayfitintocounselingaclientwithspecificculturalnutritionconcerns

CounselingandEducation

TheMiddleEastpresentation(1)

NUTR4901 PortfolioDevelopment Portfoliodevelopmenttoapplytopost-graduation

ProfessionalDevelopment

Personalstatement+resume(2)

NUTR4100 N/A --

NUTR4000 N/A --NUTR4200 N/A --NUTR4920 N/A --

SCIENCE/ANALYSISCOURSES


ARTIFACT

BIOS1030 BasicprinciplesofHumanAnatomyand

Physiology

Howbodysystemsworkbiochemicallyandphysicallytodiagnoseandrecognizemedical

situations

Science --BIOS1300 --BIOS1310 --BIOS2210 IdentificationofFood

MicrobiologyHowmicroorganismspresentinfoodspoilor

enhancetheproductScience --

BIOS2215 --

BIOS2250 DNAAnalysis HowtoreadDNAresultsandmatchDNA Science --

CHEM1200 MolecularStructureIdentification

Howmolecularstructureaffectsreactionswithacidsandbasestoapplytofutureknowledge

Chemistry --CHEM1210 --CHEM3010 --CHEM4890 --

MATH1200 SPSSSoftware Howtoformulateahypothesisandcalculate

statisticaldataforpresentationMath --

PSY2110 --

BUSINESSCOURSES


ARTIFIACT

ACCT1010

ACCT1020

BudgetAnalysisandManagerialAccounting

ConceptsandApplication

Howtobudget,compoundinterest,andassessassetsandliabilities

Business --

Management --

MGT2000 HumanResourcePlanning

HRplanningalongwithtraininganddevelopmentandemploymentlawpractices

MGT3300HIPAAresearchpaper

ECON1030

EconomicAnalysis Howthesystemdeterminesproductionandpricesandforwhatmarkets

Business --

SOCIALSCIENCECOURSES


ARTIFACT

PSY1010

HumanDevelopmentandBehavior

Howclinicalpsychologyutilizesbehavioranddevelopmentforresearchandapplication

GeneralEducation --

ANTH1010

CulturalandBehavioralAnalysis

Understandinghowglobalizationaffectsperceptionsofcultureandhowtoanalyze

culturalbehaviors

--

FINEARTS

TheaterCritic Attendedshowsandbymediumandartisticconcerns

GeneralEducation --

GENERALEDUCATIONCOURSES


ARTIFACT

ENGL1510

RhetoricalAnalysis Analysisofcomplexrelationshipswithnaturalandartificialsystemsintheenvironment

GeneralEducation --

JCOURSE

AstoryofcommunitygardensPrezisample

HLTH2300

MedicalTerminology Abilitytousestandardprefixesandsuffixestoidentifymedicalterms

GeneralEducation --

MINOR/CERTIFICATECOURSES

COURSE SKILLLEARNED DESCRIPTIONOFSKILLUSE TABBEDSKILLAREA ARTIFACTNUTR4320

Identifydiabetessignsandsymptomsaswell

Introductiontodiabetesandhowcertainsignsandsymptomspresentitselfwitheachsection

DiabetesCertificate InterviewwithaDiabetesPatient+Type1DiabetesCaseStudy

asintroductiontocasestudy

ofthediseaseandhowtodiagnoseType1andType2diabetes

NUTR4932 Independentstudy Howtoapplydiabetesknowledgeinapreventionprogram

DiabetesCertificate --

EH3100

AnalysisandRiskAssessment

Analyzingandassessingrisksofpollutiontotheenvironmentofairandwater

EnvironmentalHealthScience

Minor

Air,Water,Wastesblogsample

EH4700

AnalysisandRiskAssessment

Analyzingmodernpublichealthissuesandhowtoimprovequalityoflifeforthe

communitywithsolutionstotheseissues


Minor

HistoryofSmallpoxresearchpaper+CommunityGardensPowerPoint+mental

healthPowerPointEH2000

Technical+

Administrativeprocedures

Safetyconcepts,practices,andproceduresusedtocontroltheenvironment


Minor

ClimateChangeresearchpaper

HLTH2000 Identifybasicpublichealthissues

Howtoviewpublichealthasawholeratherthanonanindividuallevel


Minor

CaseStudy:Obamacare

TAB1:FoodandNutrition

1. IndustrialShift-Nutrition1100

2. CulinaryActivity-Nutrition1100

3. MenuPlanningActivityWorksheet-Nutrition2000

4. StarchesLabReport-Nutrition2220

5. TermProjectLiteratureReview-Nutrition2200

6. DiabetesInterview-Nutrition4920

7. Type1DiabetesCaseStudy-Nutrition4929

8. BPAandWaterPresentation-Nutrition3000

9. NutrientIntakeFormDM-Nutrition3100

10. ADINoteFormHTN-Nutrition3100

IndustrialShift

Ourcurrentfoodsystemisdesignedtofeedthemasses.TheUnitedStatescurrentlyfunctionsonindustrialsized

agriculture.Thisstyleofproductionprovidestheefficiencieswehavecometoknowandloveinourcurrentfoodsystem.

Throughourresearch,wehavefoundthereisnotaonesizefitsallanswer,noristhereonerightwayoftendingtothe

problemsexposedwiththeUnitedStatescurrentfoodsystem.Wewouldliketoaddresstwomajorissueswithourcurrent

foodsystemthatstemfromtheindustrializedagriculture.Theindustrialstyleofagricultureisresponsibleforproducingthe

majorityofthefoodconsumedbyAmericans.Industrialagriculturewasoncehighlysoughtafterforitsefficiencyandability

toyieldprofit.Theimpactofindustrialagriculturehasseemedtobringseveralunintendedconsequences,namely

environmentallyandnutritionally.Theproblemsofindustrializedagriculturerequireashiftofattitudes,policy,and

agriculturaltechniques.

Throughalloftheefficienciesandpolicyassistingourfoodsystemthereseemstobedeadzonesthatleaveselect

groupswithoutaccessandprotection.Ourcurrentfoodsystemseemstobeeconomicallyfueledandpoliticallyregulated.

Industrialagriculturegivesmanypeoplefalsehopetowardsasustainablefoodsystem.

Industrialagricultureisstillthoughtof,bymany,asthemostreliableoptiontopreventmassstarvation.Industrial

agriculturehascreatedcheapfoodfortheconsumers.Thisstyleofagriculturehasalsomadechemicalandfertilizer

companiesextremelyprofitable.Allthewhiletheriseofindustrialagriculturehasgreatlyincreasedtheamountofcrops

producedperacre.Thisincreasehasallowedfewerfarmerstoproducemorefood.Anotherbenefittothemassproduction

andspecializationofagricultureisthereinforcementforinnovation.Throughoutthe1800’ssixtypercentoftheAmerican

economywasdirectlyemployedbyagricultural.AccordingtotheEnvironmentalProtectionAgency(EPA)lessthan1%ofthe

currentUSpopulationisconsideredafarmer(epa.gov).Industrialagricultureisnowcapableofproducingenoughfoodto

exportforadditionalprofits.BymassproducingcropstheUnitedStateshasbecomeaneconomicandagriculturalgiantthatis

capableoffeedingthecountry’spopulation.Feedingthepopulationisgreat,howevertheabilitytoensureweconsistently

havenutrientrichsoilwhileproducingnutrientrichfoodisamajorchallenge.

Aswenowknowthecurrentsystemhascausedsomeunintendedconsequences.Thechemicalsaredestroyingthe

qualityofoursoilandwater.Themassproductionisleadingtothedepletionofvitalnutrientsinourfood.Plants,like

humans,neednutrientstosurvive.Oneofthemajorcritiquesofthecurrentmassproductionofagricultureisthecomplete

disregardfornaturalresources.OranHestermancallsforaparadigmshift.Hecritiquestheentirefoodsystemand

encouragesbetteruseoflandandnaturalresources.

Onewaytoprotectnaturalresourcesistoadoptanorganicstyleofagriculture.Organicagricultureadoptsachemical

freeapproachwhilemaintainingthehealthoftheecosystemandthepeople.Organicfarmingisreliantoncroprotation,

ratherthanchemicals,tocontrolweeds,insects,anddisease(Hesterman,96).Therotationhelpsbytappingintomultiple

layersofsoiltoensuresoilnutrientshavetimetoregenerate.Hestermanraisesacrucialpointaboutwaterandlandby

stating,”Weneedtodecidewhetherwewilltreatwater(andland)asaneconomiccommodity,soldtothehighestbidder,oras

abasicright.”(Hesterman67)Ifwaterandlandarehumanrightsthengovernmentsareforcedtoacknowledgeand

administertheserights.Noperson,norcompany,ismoreimportantthanthegeneralpublic’srights.

Althoughourresourcesareamajorpointofconcern,thequalityandnutritionofthefoodweproduceis,perhaps,the

mostpressingissue.Thefoodweconsumehasadirectandimmediateeffectonourhealth.Themorewetendtotheplants

naturalneedsthemorenutritiousthecropsareforthehumanorganism.InastudyconductedbyKrzysztofSobieralskihe

foundmanysignsthatpointedtowardorganicfarmingbeingmorenutritiousforhumanconsumption.Thecontentsinorganic

foodcontainmorenutrientslikesugars,vitamins,andantioxidants,whiletheconventionallygrown,industrialized,cropsare

contaminatedbypesticidesandnitrates(Sobieralski114).

Organichasmanypositivefeatures,butitisnotwithoutitsownissues.OneissuethatHestermannotedwastheUnited

Statesgovernmenthaspolicytoincentivizethegrowthofcertaincrops.Thisincentivedoesn’tcoverthecropsthatwill

naturallywardoffpestsanddisease.Thisincentiveleavesalotoffarmersreachingforchemicalbasedsolutionstofixthepest

anddiseaseproblem.TheEPAwebsitestatesthatpesticidescanaffectthenervoussystem,irritatetheskinoreyes,the

hormoneorendocrinesysteminthebody,andotherpesticidesmaybecarcinogens.Andthesearegoingonourfoodproducts.

Whilethelikelihoodofthesecasesisslim,itisstillanimportantfactorinourfoodsystemtotakenintoconsideration.

Organicfarmingisagreatwaytocutbackonthegreenhousegasescurrentlycontributingtotheglobalwarming

problem.Syntheticfertilizersusealotoffossilfuelresourcesthatcausethereleaseofgases,suchasmethaneandnitrous

oxide,intotheatmosphere.Chemicalfertilizersposearisktotheenvironment,oftenwithwaterrun-offsthatleakthesetoxins

intoourwatersupplies.

Organicfarmingiseconomicallyfeasible,environmentallydesirable,andnutritionallyadequate.Farmingwithorganic

techniquescanbepartofaholisticapproachtowardsfixingtheproblemsposedbyindustrializedagriculture.Ourcurrent

stateofindustrializedagriculturehaslefttheenvironmentandfoodnutritionallydepleted.Manystudieshaveconcludedthat

organicfarmingisnutritionallysuperiortoconventionalfarmingtechniques.Webelieve,andourresearchhasshown,that

organicfarmingisthebestsubstitutionforindustrialagriculture.Theparadigmshiftwillhappenthroughthepolicyand

informedcitizensthatdemandnutritionallyabundantandenvironmentallysustainablefood.

Thesolutionstomakeagriculturesustainableare:decreasethesizeofproduction,incorporatecroprotation,and

encouragelocalfarmsthroughstipendsandgrants.

SourcesUsed:

Hesterman,O.B.(2011).Fairfood:growingahealthy,sustainablefoodsystemforall.NewYork:PublicAffairs.

Demographics.(n.d.).EPA.RetrievedJune26,2014,from

http://www.epa.gov/oecaagct/ag101/demographics.html

http://www.epa.gov/pesticides/health/human.htm

http://www.nrec.org.uk/organic-farming/

AutumnFunderburg

Module6CulinaryActivity

June18,2014

CasaNueva

CasaNuevaisoneofmyfavoritelocalAthensrestaurants.Casabuyslocallykeepingitsproviderswithina150-mileradius.Theselocalproviders

includeAthensFarmersMarket,JackieO’sBrewery,TheHerbalSageTeaCompany,MushroomHarvest,KingFamilyFarmandmany,many

more.AndCasaNuevaismorethanjustarestaurant;it’salsoabar,providesmusicfromthesurroundingarea,andart.

Localandorganicfoodcanbeveryintimidating.Therearealotofweirdfoodsandcombinationsthatturnpeopleofffromthesetypesof

restaurants.IsaythisbecauseIwasoneofthem.MyfirsttimeinCasaincludedawimpy(butstilldelicious)quesadillawithminimaltoppings.I

didn’tseewhatallthetalkwasaboutthisplacethatIthoughtonlyservedfreshquesadillasandtacosalads.Mysecondtimeprovedmewrong,

however,whenIorderedabreakfastburritothatliterallychangedmylife.

Casacookscanmakeabeautifullywrappedbreakfastburritolikeneverseen(ortasted)before.Itissemi-expensivebutitsdeliciousnessand

heftinesscertainlymakeupforit.Withalistofsalsastochoosefrom,theflavorisneverdull.Mypersonalfavoriteistheblackbeansalsa.It

comeswithasideofgreattastinghomefriesandallthefruitiscutfresh.

Thethingaboutthisrestaurantisthatitisaveryrelaxedatmosphere.It’sacleanhippyvibeandfulloffreshplantsandartthatmakeit

interesting.Nottomentionthefoodismade-to-orderfromallthesedeliciouslocalingredientsmakingmorethanworththewait.AllthetimesI

havebeenthereIhaveneverbeendisappointed.Athensisaverylocalcommunityandweareluckytoliveinacitythatsupportssuch

sustainableandorganiclifestyles.ItisplaceslikeCasathatopenpeople’seyestohowgreatandmouthwateringlocal,freshfoodis.Thereisalot

morecareputintothefoodproductionandcustomersatisfactioniskeyattheserestaurants.It’salsogreatforapersonthatwantsaunique

flavortoaclassicmeal.IwouldvouchforsustainableandorganicfarminganydayanditmakesmefeelgoodtoknowIsupportsuchagreat

cause.

Component Monday Tuesday Wednesday Thursday Friday

Meat/meatalternate:

8-10ounceequivalentweekly

1ounceequivalentdaily

2oz.chicken,to-be-broiled,breast,meatand

skin,raw

-68calories

-26mgsodium

-1.48gfat

-.319gsat.fat

-0gfiber

-3gcalcium

-.21giron

-.39gzinc

-1vitaminD

-13vitaminA

-.32vitaminE

2oz.beef,ground,97%leanmeat/3%fat,

crumbles,cooked,pan-browned(inspaghetti

sauce)

-94calories

-48mgsodium

3.09gfat

1.522gsat.fat

0gfiber

4mgcalcium

1.86mgiron

4.05mgzinc

2ugvitaminA

1IUvitaminD

.07mgvitaminE

2oz.turkeybreast,lowsalt,prepackagedordeli,luncheonmeat

-66calories

-440mgsodium

.72gfat

.096gsat.fat

0gfiber

2mgcalcium

.1mgiron

.24mgsalt

0ugvitaminA

0IUvitaminD

.02mgvitaminE

1oz.cheese,mozzarella,liteshredded

-75calories

-47.5mgsodium

4.25gfat

3gsat.fat

0gfiber

200mgcalcium

2.7mgiron

200IUvitaminA

.10mgvitaminE

1oz.pepperoni

-138calories

-493mgsodium

12.18gfat

4.161gsat.fat

0gfiber

6mgcalcium

.45mgiron

.70mgzinc

0ugvitaminA

3IUvitaminD

0mgvitaminE

2oz.cheddar,yellow,shredded

-79calories

-203mgsodium

10.24gfat

6.58gsat.fat

0gfiber

506mgcalcium

.08mgiron

234IUvitaminA

.08mgvitaminE

Fruit:

2½cupsweekly

½cupdaily

½credgrapes,raw

-52calories

-2mgsodium

-.12gfat

-.041gsat.fat

-.7gfiber

-8gcalcium

-.27giron

-.05gzinc

-0vitaminD

-50vitaminA

-.14vitaminE

½cnaveloranges,slicedwithnopeel

-40calories

-1mgsodium

.12gfat

.014gsat.fat

1.8gfiber

35mgcalcium

.11mgiron

.07mgzinc

10ugvitaminA

0IUvitaminD

.12mgvitaminE

½cpeaches,raw,sliced

-30calories

-0mgsodium

.19gfat

.015gsat.fat

1.2gfiber

5mgcalcium

.19mgiron

.13mgzinc

12ugvitaminA

0IUvitaminD

.56mgvitaminE

½cpears,raw,sliced

-40calories

-1mgsodium

.11gfat

.018gsat.fat

2.5gfiber

7mgcalcium

.14mgiron

.08mgzinc

1ugvitaminA

0IUvitaminD

.10mgvitaminE

½cunsweetenedapplesauce,canned,noaddedascorbicacid

-51calories

-2mgsodium

.12gfat

.010gsat.fat

1.3gfiber

5mgcalcium

.28mgiron

.04mgzinc

1ugvitaminA

.20mgvitaminE

Vegetable:

3¾cupsweekly

¾cupdaily

• Dark/Green ½ cup weekly

¼clettuce,romaine,raw(tossedsalad)

-2calories

¼clettuce,romaine,raw(tossedsalad)

-2calories

½cbroccoli,cooked,boiled,drained,without

salt

-27calories

-1mgsodium

.04gfat

.005gsat.fat

.2gfiber

4mgcalcium

.11mgiron

.03mgzinc

51ugvitaminA

0IUvitaminD

.02mgvitaminE

-1mgsodium

.04gfat

.005gsat.fat

.2gfiber

4mgcalcium

.11mgiron

.03mgzinc

51ugvitaminA

0IUvitaminD

.02mgvitaminE

-32mgsodium

.32gfat

.062gsat.fat

2.6gfiber

31mgcalcium

.52mgiron

.35mgzinc

60ugvitaminA

1.13mgvitaminE

• Red/Orange ¾ cup weekly

½ccarrots,cooked,boiled,drained,without

salt

-27calories

-6mgsodium

-.14gfat

-.023gsat.fat

-1.8gfiber

-23gcalcium

-.27giron

-.16gzinc

-665ugvitaminA

½csauce,pasta,spaghetti/marinara,ready-to-serve,low

sodium

-65calories

-553mgsodium

.98gfat

.112gsatfat

1.2gfiber

18mgcalcium

.51mgiron

.13mgzinc

¼cupcarrots,cooked,boiled,drained,without

salt

-27calories

-6mgsodium

.07gfat

.015gsatfat

.9gfiber

12mgcalcium

.135mgiron

.08mgzinc

332.5ugvitaminA

¼csauce,pizza,canned,ready-to-serve(on

sandwich)

-34calories

-1mgsodium

.72gfat

.290gsat.fat.

1.3gfiber

34mgcalcium

.57mgiron

.16mgzinc

420IUvitaminA

½ccarrots,cooked,boiled,drained,without

salt

-27calories

-6mgsodium

-.14gfat

-.023gsat.fat

-1.8gfiber

-23gcalcium

-.27giron

-.16gzinc

-0vitaminD

-.80mgvitaminE

22ugvitaminA

1.58mgvitaminE

.40mgvitaminE -665vitaminA

-.80vitaminE

• Beans, Peas (Legumes) ½ cup weekly

¼cpeas,green,cooked,boiled,drained,without

salt

-34calories

-1mgsodium

.09gfat

.016gsat.fat

2.2gfiber

11mgcalcium

.62mgiron

.48mgzinc

16IUvitaminA

.06mgvitaminE

¼cpeas,green,cooked,boiled,drained,without

salt

-34calories

-1mgsodium

.09gfat

.016gsat.fat

2.2gfiber

11mgcalcium

.62mgiron

.48mgzinc

16IUvitaminA

.06mgvitaminE

• Starchy ½ cup weekly

¼ccorn,sweet,yellow,cooked,boiled,drained,

withoutsalt

-33calories

-0mgsodium

.28gfat

¼cbeans,black,matureseeds,canned,lowsodium

-55calories

-83mgsodium

.17gfat

.045gsat.fat

.042gsat.fat

1gfiber

1mgcalcium

.19mgiron

.26mgzinc

4ugvitaminA

.03mgvitaminE

4.1gfiber

21mgcalcium

1.14mgiron

.32mgzinc

.62mgvitaminE

• Other ½ cup weekly

¼ccarrots,raw

-13calories

-22mgsodium

.07gfat

.015gsatfat

.9gfiber

12mgcalcium

.135mgiron

.08mgzinc

332.5ugvitaminA

.40mgvitaminE

¼ccauliflower,raw

-7calories

-8mgsodium

.035gfat

.0175gsat.fat

1.05gfiber

3mgcalcium

.055mgiron

.035mgzinc

.01mgvitaminE

• Additional Vegetable to reach

total 1 cup weekly

½ccauliflower,raw

-13calories

½ccorn,sweet,yellow,cooked,boiled,drained,

withoutsalt

-16mgsodium

.07gfat

.035gsat.fat

2.1gfiber

6mgcalcium

.11mgiron

.07mgzinc

.02mgvitaminE

-33calories

-0mgsodium

.28gfat

.042gsat.fat

1gfiber

1mgcalcium

.19mgiron

.26mgzinc

4ugvitaminA

.03mgE

Grains:

8-9ounceequivalentweekly

1ounceequivalentdaily

• Non-Whole Grain-Rich

2oz.tortillas,ready-to-bake-,flour,refrigerated

-275calories

-666mgsodium

5.52gfat

1.342gsat.fat

2.4gfiber

119mgcalcium

3.07mgiron

.52mgzinc

.18mgvitaminE

• Whole Grain-Rich

2oz.rice,brown,medium-grain,uncooked

(1/2cupcooked)

-218calories

-2mgsodium

1.62gfat

.322gsat.fat

3.5gfiber

20mgcalcium

1.03mgiron

1.21mgzinc

2oz.spaghetti,wholewheat,dry(1/2cup

cooked)

-198calories

-4mgsodium

.80gfat

.147gsat.fat

23mgcalcium

2.07mgiron

1.35mgzinc

2slicesbread(2oz.),multigrain(includes

whole-grain)

-138calories

-198mgsodium

2.20gfat

.453gsat.fat

3.8gfiber

54mgcalcium

1.30mgiron

.88mgzinc

.19mgvitaminE

2slicesbread(2oz.)multigrain(includeswhole-grain),toasted

-138calories

-199mgsodium

2.20gfat

.453gsat.fat

3.8gfiber

54mgcalcium

1.30mgiron

.88mgzinc

.19mgvitaminE

Milk:

5cupsweekly

1cupdaily

1cmilk,low-fat,fluid,1%milk-fat,withadded

vitaminAandvitaminD

-102calories

-107mgsodium


vitaminAandvitaminD

-102calories

-107mgsodium

1cmilk,low-fat,fluid,1%milk-fat,withaddedvitaminAandvitaminD

-102calories

-107mgsodium


vitaminAandvitaminD

-102calories

-107mgsodium


vitaminAandvitaminD

-102calories

-107mgsodium

MenuPlanningWorksheet–K-5ElementarySchool

-2.37gfat

-1.545gsat.fat

-0gfiber

-305mgcalcium

-.07mgiron

-1.02mgzinc

-117IUvitaminD

-142ugvitaminA

-.02ugvitaminE

-2.37gfat

-1.545gsat.fat

-0gfiber

-305mgcalcium

-.07mgiron

-1.02mgzinc

-117IUvitaminD

-142ugvitaminA

-.02ugvitaminE

-2.37gfat

-1.545gsat.fat

-0gfiber

-305mgcalcium

-.07mgiron

-1.02mgzinc

-117IUvitaminD

-142ugvitaminA

-.02ugvitaminE

-2.37gfat

-1.545gsat.fat

-0gfiber

-305mgcalcium

-.07mgiron

-1.02mgzinc

-117IUvitaminD

-142ugvitaminA

-.02ugvitaminE

-2.37gfat

-1.545gsat.fat

-0gfiber

-305mgcalcium

-.07mgiron

-1.02mgzinc

-117IUvitaminD

-142ugvitaminA

-.02ugvitaminE

TotalCalories:

501calories

TotalSodium:

144mg

TotalFat:

5.82g

TotalSaturatedFat:

2.266g

TotalFiber:

8.2g

TotalCalcium:

172mg

TotalIron:

2.47mg

TotalZinc:

TotalCalories:

514calories

TotalSodium:

736mg

TotalFat:

7.47g

TotalSaturatedFat:

3.346g

TotalFiber:

4.1g

TotalCalcium:

401mg

TotalIron:

4.865mg

TotalZinc:

TotalCalories:

398calories

TotalSodium:

768mg

TotalFat:

5.94g

TotalSaturatedFat:

2.206g

TotalFiber:

9.2g

TotalCalcium:

389mg

TotalIron:

2.07mg

TotalZinc:

TotalCalories:

596calories

TotalSodium:

1107.5mg

TotalFat:

10.095g

TotalSaturatedFat:

9.56g

TotalFiber:

13.45g

TotalCalcium:

651mg

TotalIron:

3.725mg

TotalZinc:

TotalCalories:

595calories

TotalSodium:

1061mg

TotalFat:

18.84g

TotalSaturatedFat:

9.59g

TotalFiber:

10.6g

TotalCalcium:

980mg

TotalIron:

5.1mg

TotalZinc:

I. EFFECT OF STARCHES ON PUDDINGS AND

VISCOSITY OF PIE FILLINGS AND PASTES

Autumn Funderburg

Kitchen 4

Section 101

Wednesday 2-5 P.M.

T.A.: Amanda Culley

March 19, 2015

II. Purpose

Starch is a complex carbohydrate consisting of amylose and amylopectin molecules that are organized as granules (Brannan, 57). Amylose

is a linear chain of glucose molecules while amylopectin is a branched chain. Amylose forms the amorphous regions of the starch granule and

amylopectin forms the crystalline region of the starch granule. Amylopectin tends to be more abundant in starches compared to amylose and the

amount of amylose and amylopectin varies from starch to starch. Cereal starches, root starches, and tree starches are the classifications of food

starches. Starch is a thickening agent that is used in many products such as soups, sauces, gravies, salad dressings, and desserts (Brannan, 57). This

lab focuses on cornstarch, rice flour, tapioca, potato starch, and arrowroot. The experiment demonstrates the effect of various starches on different

variations of vanilla puddings and lemon pie fillings. Demonstrated also is the effect of various starches on viscosity of starch pastes as well as a

variation using sugar and acid.

III. Methodology

Procedure A demonstrated variations of vanilla cornstarch puddings. The first variation was homemade vanilla pudding. To start, 3 tablespoons of

cornstarch and 3/8 cup of granulated sugar were mixed in a saucepan. Blended into the mixture were 2 cups of whole milk and 1/8 teaspoon of

salt. The mixture was cooked over medium-low heat and stirred continuously to prevent scorching of the milk. The mixture was heated to a full

boiled and then boiled for 1 minute longer. Next, 1 teaspoon of vanilla extract was added. The pudding was poured into custard cups. One was

covered with aluminum foil and one was left uncovered and both were chilled. The appearance, flavor, and texture were evaluated. The second

variation was cooked vanilla pudding mix. The pudding was prepared as directed on the package and poured into custard cups. One was covered

with aluminum foil and one was left uncovered and both were chilled. The appearance, flavor, and texture were evaluated. The third variation was

instant vanilla pudding mix. One package of instant vanilla pudding was prepared as directed on the package and poured into custard cups. One

was covered with aluminum foil and one was left uncovered and both were chilled. The appearance, flavor, and texture were evaluated. The fourth

and last variation was canned vanilla pudding. One can of vanilla pudding was opened and poured into custard cups. One was covered with

aluminum foil and one was left uncovered and both were chilled. The appearance, flavor, and texture were evaluated.

Procedure B demonstrated the effect of various starches on lemon pie filling. Kitchen 4 used the rice flour starch variation. To start, 2 tablespoons

of rice flour, ½ cup granulated sugar, and a dash of salt were added to a saucepan. Blended in was ¼ cup of cold water. For 3 minutes, ¾ cup of

water was boiled in another saucepan and then added to the starch mixture. The mixture was cooked over medium heat until it was thick and

translucent. It was stirred constantly until it reached a full boil. It was then removed from heat. Some of the hot mixture was poured into a bowl

containing 1 beaten egg. The starch-egg mixture was added back to the remainder of the hot mixture and stirred well. The mixture was cooked

over medium heat and stirred constantly until thick. The mixture was removed from heat and 1 tablespoon of butter, 2 tablespoons of grated lemon

rind, and 2 ½ tablespoons of lemon juice were added and mixed well. The pie filling was poured into custard cups and cooled. The appearance,

flavor, and texture were evaluated.

Procedure C demonstrated the effect of various starches on the viscosity of starch pastes. Kitchen 4 used the rice flour starch variation. To start, 2

tablespoons of rice flour were blended with ¼ cup of cold water to form a smooth paste. After ¾ cup of water was boiled, it was added to the paste

mixture and stirred well. The paste was poured into a saucepan and cooked over medium heat and stirred continuously. The paste was heated until

it thickened and reached a full boil. The starch paste was set to cool to 50°C. A Brookfield test was performed. The paste was poured into a

custard cup.

Procedure D demonstrated the effect of acid and sugar on the viscosity of starch pastes. To start, 6 tablespoons of sugar and 2 tablespoons of

cornstarch were mixed. Next, 4 tablespoons of lemon juice were mixed with ¼ cup of cold water. After, the entire mixture was combined with ¾

cup boiling water. The pH of the paste was measured.

IV. Results

The homemade vanilla pudding, procedure A1, was off-white in color with a glossy sheen, had a vanilla flavor, and was a sticky, smooth texture

that was a gel. The cooked vanilla pudding, procedure A2, was light yellow in color with a glossy sheen, had very little vanilla flavor, and had a

smooth texture that was partial gel. The instant vanilla pudding, procedure A3, was light yellow in color, had a slight vanilla flavor, and had a

smooth texture that was a partial gel. The canned vanilla pudding was very light yellow in color, had a strong vanilla flavor, and had a smooth,

sticky texture that was gel.

Table 1

Procedure A

Pudding Variation Appearance Flavor Texture

Canned Very light yellow, glossy

Strong vanilla flavor Smooth, sticky, gel-like

Cook ‘N’ Serve Light yellow, glossy Little vanilla flavor, bland Smooth, partial gel

Homemade Off-white, glossy Vanilla flavor Sticky, smooth gel

Instant Light yellow Slight vanilla flavor Smooth, partial gel

The lemon pie filling using the rice flour variation was light yellow in color with a glossy sheen, had a strong lemon flavor, and had a

smooth, sticky texture that was gel. The lemon pie filling using the cornstarch variation was yellow in color with a glossy sheen, had a lemon

flavor, and had a gritty, gel texture. The lemon pie filling using the tapioca variation was yellow in color with a glossy sheen, had a strong lemon

flavor, and had a gritty, gel texture. The lemon pie filling using the potato variation was yellow in color with a glossy sheen, had a light lemon

flavor, and had a smooth gel texture. The lemon pie filling using the arrowroot variation was dark yellow in color, had a lemon flavor, and a

sticky, gritty texture.

Table 2

Procedure B

Starch Variety Appearance Flavor Texture Rice Flour

Light yellow, glossy Strong lemon flavor Smooth, sticky, gel-like

Corn Starch Yellow, glossy Lemon flavor Gritty, gel-like

Tapioca Yellow, glossy Strong lemon flavor Gritty, gel-like

Potato Yellow, glossy Light lemon flavor Smooth, gel-like

Arrowroot Dark yellow Lemon flavor Sticky, gritty

Kitchen 1 used 2 tablespoons of cornstarch, ¼ cup of cold water, and ¾ cup of boiling water in the starch paste variation. The viscosity of

the paste at 50°C was determined to be 12.2 million cP and a gel. The viscosity of the paste at room temperature (23°C) was determined to be 9

million cP. Kitchen 2 used 2 tablespoons of potato starch, ¼ cup of cold water, and ¾ cup of boiling water in the starch paste variation. The

viscosity of the paste at 50°C was determined to be 48.2 million cP and a gel. The viscosity of the paste at room temperature (23°C) was

determined to be 94.6 million cP. Kitchen 3 used 2 tablespoons of tapioca, ¼ cup of cold water, and ¾ cup of boiling water in the starch paste

variation. The viscosity of the paste at 50°C was determined to be 10 million cP and a gel. The viscosity of the paste at room temperature (23°C)

was determined to be 25,000 cP. Kitchen 4 used 2 tablespoons of rice flour, ¼ cup of cold water, and ¾ cup of boiling water in the starch paste

variation. The viscosity of the paste at 50°C was not determined, but the paste did gel. The viscosity of the paste at room temperature (23°C) was

determined to be 8 million cP. Kitchen 5 used 2 tablespoons of arrowroot, ¼ cup of cold water, and ¾ cup of boiling water in the starch paste

variation. The viscosity of the paste at 50°C was not determined, but it did not form a gel. The viscosity of the paste at room temperature (23°C)

was determined to be 580 million cP. Kitchen 6 used 2 tablespoons of cornstarch, ¼ cup of cold water, and ¾ cup of boiling water in the starch

paste variation. The viscosity of the paste at 50°C was determined to be 25,000 cP and a gel. The viscosity of the paste at room temperature (23°C)

was determined to be 31,000 cP. Kitchen 7 used 2 tablespoons of potato starch, ¼ cup of cold water, and ¾ cup of boiling water in the starch paste

variation. The viscosity of the paste at 50°C was determined to be 48.2 million cP and a gel. The viscosity at room temperature (23°C) was

determined to be 94.6 million cP. Kitchen 8 used 2 tablespoons of tapioca, ¼ cup of cold water, and ¾ cup of boiling water in the starch paste

variation. The viscosity of the paste at 50°C was determined to be 10 million cP and a gel. The viscosity of the paste at room temperature (23°C)

was not determined.

Table 3

Procedure C

Starch Type Viscosity (50C) Gel? Viscosity (Room Temp)

Rice Flour N/A Yes 8 million

Cornstarch 12.2 million Yes 9 million

Cornstarch 25,000 Yes 31,000

Tapioca 108 million Yes N/A

Tapioca 10 million Yes 25,000

Potato 48.2 million Yes 94.6 million

Arrowroot N/A No 580 million

Procedure D demonstrated the effects of acid and sugar on the viscosity of starch pastes. Kitchen 1 used 2 tablespoons of cornstarch, 6

tablespoons of sugar, and 1 cup of water in the starch paste variation. The viscosity of the paste was determined to be 4 million cP at 50°C with

little to no gelling. The viscosity at room temperature (23°C) was determined to be 3 million cP. Kitchen 2 used 2 tablespoons of cornstarch, and 1

cup of water in the starch paste variation. The viscosity of the paste was determined to be 25 million cP at 50°C with little to no gelling. At room

temperature (23°C), the viscosity was not determined. Kitchen 3 used 2 tablespoons of cornstarch, 4 tablespoons of lemon juice, and ¾ cup of

water in the starch paste variation. The viscosity of the paste was determined to be 35 million cP at 50°C with gelling. The viscosity of the paste at

room temperature (23°C) was determined to be 35 million cP. Kitchen 4 used 6 tablespoons of sugar, 2 tablespoons of cornstarch, 4 tablespoons of

lemon juice, and ¾ cup of water in the starch paste variation. The viscosity of the paste at 50°C was not determined, but there was partial gelling

of the paste. The viscosity of the paste at room temperature (23°C) was determined to be 13 million cP. Kitchen 5 used 2 tablespoons of

cornstarch, and 1 cup of water in the starch paste variation. The viscosity of the paste at 50°C was not determined, but there was gelling of the

paste. The viscosity of the paste at room temperature (23°C) was determined to be 18,600 cP. Kitchen 6 used 6 tablespoons of sugar, and

additional 2 tablespoons of cornstarch, and 1 cup of water in the starch paste variation. The viscosity of the paste at 50°C was determined to be 4

million cP with little to no gelling of the paste. The viscosity of the paste at room temperature (23°C) was determined to be 3 million cP. Kitchen 7

used 2 tablespoons of cornstarch, 4 tablespoons of lemon juice, and ¾ cup of water in the starch paste variation. The viscosity of the paste at 50°C

was determined to be 6 million cP with gelling of the paste. The viscosity of the paste at room temperature (23°C) was determined to be 20 million

cP. Kitchen 8 used 6 tablespoons of sugar, 2 tablespoons of cornstarch, 4 tablespoons of lemon juice, and ¾ cup of water in the starch paste

variation. The viscosity of the paste at 50°C was not determined but there was partial gelling of the paste. The viscosity of the paste at room

temperature (23°C) was 13 million cP.

Table 4

Procedure D

Variation Viscosity (50C) Gel? Viscosity (Room Temp)

A 25 million Little/none 18,600

B 4 million Little/none 3 million

C 35 million Yes 35 million

D N/A Partial 13 million

V. Discussion

The canned pudding took the least time to prepare of all the pudding variations. The homemade pudding variation took the most time to

prepare. The changes that took place in the pudding mixtures to indicate that gelatinization had occurred included swelling of water into the starch

granules and thickening of the puddings. The gels then had a glossy sheen and were firm.

Agitation was important for this pudding while heating to keep the milk from scorching. However, when cooling, it was important for the pudding

to be left without agitation so as to not disrupt the hydrogen bonds in the pudding (Starch PowerPoint, slide 26). The homemade pudding variation

was the only one to be more off-white in color. This can be attributed to the fact that there is no artificial dyes present as with instant, canned, and

cooked puddings. The process of heating and cooling this pudding was different as well, compared to canned, cooked, and instant puddings.

The starch ingredient present in the instant pudding, the cook‘n’serve pudding and the canned pudding was modified food starch. This starch is

pre-gelatinized and cooked with water to gelatinize. For instant and cooked puddings, the starch is then dehydrated after becoming swollen

resulting in a desirable thickness when water is added (Starch PowerPoint, slide 35). This would also be ideal for commercial canned puddings,

however the starch is rehydrated and then canned. Cornstarch forms a translucent, satisfactory gel and is ideal for instant puddings (McWilliams,

table 9.6). Modified cornstarch, in this case, is used to thicken the pudding much faster than a more conventional non-modified starch. This

includes a lower gelatinization temperature (Aini, 2010). This would explain why the pudding was able to partially gel so quickly for the instant

and cooked puddings. Oxidized cornstarch is used in the food industry for products that require low viscosity and neutral taste (Aini, 2010). The

instant pudding had a very faint vanilla flavor and was light yellow in color. The cook‘n’serve pudding had a very bland flavor and was light

yellow in color. The canned pudding had a light yellow color and a strong vanilla flavor. The stronger flavor in canned pudding can be attributed

to the fact that it has more time to react with the sugar and artificial flavors.

Retrogradation was enhanced in all pudding variations. Refrigerating the puddings speeds up the cooling process of the puddings and the

tightening of the starch network that forms during gelatinization is able to perform more quickly.

Procedure B determined the effect of starch variety on lemon pie filling. All of the variations were a glossy, yellow gel except for the

arrowroot variation. The arrowroot lemon pie filling variation was dark yellow in color and was not gelled. This may be a factor of egg yolk

protein coagulation. Egg yolk added to a gelatinized starch mixture needs to be heat sufficiently for proper coagulation or the cooled thickened

mixture does not gel (Starch PowerPoint, slide 27).

In the case of the pie fillings, the amylose molecules oriented themselves in crystalline regions in retrogradation (Starch PowerPoint, slide

29). All the lemon pie fillings experienced retrogradation except for the potato variation. It was the only filling that did not have a gritty texture

when sampled; it was a smooth gel. The rice flour variation, cornstarch variation, tapioca variation, and arrowroot variation all had texture that

was detected on the tongue.

Procedure C determined the effect of starch variations on starch pastes. Viscosity is the measure of a fluid or gel’s resistance to flow. To

determine a fluid’s viscosity, first find the spindle number used. In most cases in this experiment it was spindle number 7. There are then four

speeds (2, 4, 10, and 20) that help to determine a factor. In most cases in this experiment the speed that was used was 20. Each spindle number and

speed number determine different factors. The dial reading multiplied by the factor number equals the viscosity in centipoises (cps). Viscosity of

starch paste will increase during cooling when the re-association of amylose molecules develops new gel structure (Aini, 2010). Cold viscosity is

the viscosity that is maintained at 50°C for 15 minutes (Aini, 2010). Setback viscosity is the increase in viscosity when the starch paste is cooled

(Aini, 2010).

The viscosity of the starch paste that used the cornstarch variation when cooled to 50°C was determined to be 25,000 cP (.013 x 2M =

25,000) for one kitchen and 12.2 million cP (6.1 x 2M = 12.2M) for another kitchen. The viscosity of the starch paste that used the cornstarch

variation when cooled to room temperature (23°C) was determined to be 31,000 cP (.015 x 2M = 31,000) for one kitchen and 9 million cP (4.5 x

2M = 9M) for another kitchen For both variations the viscosity decreased. This determines that cornstarch pastes are thicker when hot and thinner

when cooled. The cold viscosity of the starch paste that used the rice flour variation when cooled to 50°C was not determined. This was an

experimenter error; the directions were misunderstood and the Brookfield Viscometer was having issues finding a reading. Although the viscosity

of the rice flour starch paste variation was not determined, the product still gelled and the setback viscosity when cooled to room temperature

(23°C) was determined to be 8 million cP (4 x 2M = 8M). The cold viscosity of the starch paste that used the potato starch variation when cooled

to 50°C was determined to be 48.2 million cP (24.1 x 2M = 48.2M). The setback viscosity when cooled to room temperature (23°C) was

determined to be 94.6 million cP (47.3 x 2M = 94.6M). The product gelled. The cold viscosity should be higher in this case because the hotter

potato starch is, the thinner it should be. As the starch paste cooled, the force decreased meaning that the cooler it got, the less viscous the product

became. The cold viscosity of the starch paste that used the tapioca starch variation when cooled to 50°C was determined to be 108 million cP (54

x 2M = 108M) for one kitchen and 10 million cP (5 x 2M = 10M) for another kitchen. The setback viscosity when cooled to room temperature

(23°C) was not determined for one kitchen and was 25,000 cP (.013 x 2M = 25,000) for another kitchen. One kitchen most likely misunderstood

directions and only did one viscometer reading for the starch paste. The second kitchen had a proper reading in which the tapioca starch paste

became more viscous as the product cooled to room temperature. The cold viscosity of the starch paste that used the arrowroot starch variation

when cooled to 50°C was not determined. The setback viscosity when cooled to room temperature (23°C) was determined to be 580 million cP

(290 x 2M = 580M). The product did not gel. This explains the very large viscosity reading meaning the product was not viscous.

As with procedure C, viscosity was measured when acid and sugar were added to the pastes. The same formula was used to determine

viscosity readings in both procedures C and D. To determine a fluid’s viscosity, first find the spindle number used. In most cases in this

experiment it was spindle number 7. There are then four speeds (2, 4, 10, and 20) that help to determine a factor. In most cases in this experiment

the speed that was used was 20. Each spindle number and speed number determine different factors. The dial reading multiplied by the factor

number equals the viscosity in centipoises (cps). Cold viscosity is the viscosity that is maintained at 50°C for 15 minutes (Aini, 2010). Setback

viscosity is the increase in viscosity when the starch paste is cooled (Aini, 2010). Pasting temperatures greatly increase at higher sugar

concentrations, however, the sugar added decreases the viscosity of the paste due to the sugar’s ability to tie up water (Brannan, 57). Acid added to

a starch paste decreases viscosity of the paste by hydrolyzing the starch to form smaller dextrin molecules (Brannan, 57).

The cold viscosity of variation A at 50°C was determined to be 25 million cP (12.5 x 2M = 25M). The setback viscosity of variation A at room

temperature (23°C) was determined to be 18, 600 cP (.009 x 2M = 18,600). There was little to no gelling in this variation. Variation A became

more viscous after the product had cooled to room temperature. The cold viscosity of variation B at 50°C was determined to be 4 million cP (2 x

2M = 4M). The setback viscosity at room temperature (23°C) was determined to be 3 million cP (1.5 x 2M = 3M). There was little to no gelling.

Viscosity should have decreased with the addition of 6 tablespoons of sugar in this variation, however, viscosity increased. Sugar decreases

viscosity because the sugar has the ability to tie up water.

The cold viscosity of variation C at 50°C was determined to be 35 million cP (17.5 x 2M = 35M). The setback viscosity at room temperature

(23°C) was determined to be 35 million cP (17.5 x 2M = 35M). The product gelled. The viscosity of this variation neither increased nor decreased.

With the addition of acid, 4 tablespoons of lemon juice, the viscosity should decrease because the starch is hydrolyzed to form smaller molecules.

The cold viscosity of variation D at 50°C was not determined. The setback viscosity at room temperature (23°C) was determined to be 13 million

cP (6.5 x 2M = 13M). There was partial gelling. If the cold viscosity had been determined, it should have been more viscous than the setback

viscosity. With the addition of 6 tablespoons of sugar and 4 tablespoons of lemon juice, the sugar would tie of the water and the acid would

hydrolyze the starch.

VI. Summary and Conclusions

To conclude, starches are an important component in foods. Both amylose and amylopectin molecules make up starch. The main cereals

that are used as sources of starch include corn, wheat, rice, oat, barley, and rye (McWilliams, 173). Starches are used as thickeners in soups,

sauces, gravies, salad dressings, and desserts (Brannan, 57). Unmodified starches, any grain, root, or tuber starch, are available for commercial

food products (McWilliams, 175). Modified starches are developed with unique characteristics that are useful in instant foods, such as instant

pudding, gravy, and cake mixes. Modified starch allows products to thicken faster and have a lower viscosity and a neutral taste. With many starch

options, the starch needs to be well suited to the specific requirements of the item being formulated in commercial foods (McWilliams, 181).

These requirements can include low-calorie options, mouthfeel, and freeze-thaw stability.

VII. References

Aini, N., & Purwiyatno, H. (2010). Gelatinization properties of white maize starch from

three varieties of corn subject to oxidized and acetylated-oxidized modification.

International Food Research Journal. 17(4). 961-968.

Brannan, Robert. Nutrition 2220 Lab Manual. 2014. Print.

McWilliams, Margaret. (2001). Foods: Experimental Perspectives (4th ed.).

Upper Saddle River, NJ: Prentice Hall, Inc.

Sun, Q., Xing, Y., Qiu, C. & Xiong, L. (n.d). The Pasting and Gel Textural Properties of

Corn Starch in Glucose, Fructose and Maltose Syrup Plos One, 9(4).

EFFECT OF ARTIFICIAL SWEETENERS ON TEXTURE,

SWEETNESS, LIKEABILITY, AND PH VALUES IN BROWNIES

Autumn Funderburg

Nutrition 2220 Science of Food II

April 7, 2015

I. Introduction

Diabetes mellitus is a metabolic disorder involving chronic hyperglycemia with disturbances of carbohydrate, fat, and protein metabolism

resulting from defects in insulin secretion, insulin action, or both. The two main forms of diabetes include type-1 diabetes and type-2 diabetes.

There is a third form, gestational diabetes, which occurs during pregnancy. Hyperglycemia, an excess of glucose in the bloodstream, causes

symptoms of increased thirst (polydipsia), increased urination (polyuria), increased hunger (polyphagia), and weight loss. Long-term damage may

be done to the eyes, kidneys and nerves with an increased risk of heart disease, stroke, and amputation. (WHO, 2015) A selection of natural and

artificial sweeteners has been marketed toward persons with diabetes to maintain short- term and long-term blood glucose homeostasis.

Type-1 diabetes, formerly Insulin-Dependent Diabetes Mellitus (IDDM), is typically caused by autoimmune destruction of the beta cells

of the pancreas, with the presence of certain antibodies in blood. It is a complex disease that is caused by more than one factor; this can include

genes and environmental factors. Type-1 is identified by hyperglycemia due to an absolute deficiency of insulin, a hormone produced by the

pancreas. A patient diagnosed with type-1 diabetes will require life-long exogenous insulin injections. Type-1 presents itself during childhood or

adolescence more often than not. (WHO, 2015)

Type-2 diabetes, formerly Non-Insulin-Dependent Diabetes Mellitus (NIDDM), is associated with obesity, decreased physical activity,

and unhealthy diets. Type-2 is identified by hyperglycemia due to a defect in insulin secretion usually with a contribution from insulin resistance.

This type of diabetes does not always require insulin; blood glucose control is possible with diet and exercise in combination with oral

medications. Development of the disease is presented in adulthood but as become more prevalent in childhood and adolescence. Type-2 diabetes

occurs more frequently in individuals with hypertension, abnormal cholesterol profiles (dyslipidemia) and visceral obesity. Like type-1 it may be

influenced by environmental factors, but is often genetic. (WHO, 2015)

Gestational diabetes is identified by hyperglycemia diagnosed during pregnancy; it is typically resolved within 6 weeks of delivery. It is

caused by what is thought to be interference of pregnancy hormones with insulin action. All pregnant women are tested for diabetes during

pregnancy between 24-28 weeks gestation. Gestational diabetes contributes risks to pregnancy that can include congenital malformations,

increased birth weight, and perinatal mortality. There are also increased risks for the mother including the development of type-2 diabetes later in

life. (WHO, 2015)

When food is ingested into the body, the fats, the proteins, and the carbohydrates are broken down for energy. Carbohydrates are further

broken down into glucose, or blood sugar, and the glucose is then absorbed into the bloodstream. A normal-working pancreas will secrete insulin

in response to rising blood glucose levels; this insulin will act as a key and bind to insulin receptors on cells that will trigger a channel to open to

absorb the glucose from the bloodstream into the cell for energy. In the instance of a patient with type-1 diabetes, the pancreas produces little to no

insulin. After eating, blood glucose levels will rise, but have no insulin production to counteract the spike and attach to insulin receptors on cells

resulting in hyperglycemia. In the instance of a patient with type-2 diabetes, the pancreas produces insulin, but the cells are less receptive to the

insulin produced and resistance occurs. After eating, blood glucose levels will rise, but the insulin will attach to receptors that are less sensitive to

insulin. This makes it harder for the glucose channels to open and glucose is unable to enter the cell efficiently resulting in hyperglycemia.

(Clearly Health, 2008)

In regards to hyperglycemia and blood glucose levels, there are two types of sweeteners: natural sweeteners and artificial sweeteners.

Natural sweeteners are produced by nature without added chemicals. Maple syrup, honey, stevia, molasses, coconut sugar, date sugar, agave

nectar, and xylitol are examples of natural sweeteners existing in nature. (Neacsu, 2014)

Truvía is marketed as a natural sweetener derived from extract of the stevia plant. This sweetener is 300 times sweeter than sugar with no energy

value (Gasmalla, 2014). Although Truvía provides no caloric contributions, it does have 3 unusable carbohydrates deriving from erythritol (Truvía

Company, 2015). Erythritol is a zero calorie sugar alcohol produced by fermentation and is found naturally in some fruits such as grapes and pears

(Truvía Company, 2015). Because erythritol passes through the body without being broken down for calories, it has no effect on blood sugar or

insulin (Truvía Company, 2015). Truvía Baking Blend, however, contains 1 gram of sugar per ½ teaspoon of sweetener. One cup of sugar has

about 190 grams of usable carbohydrate compared to Truvía’s 47 grams of usable carbohydrate per ½ cup of sweetener making Truvía a viable

option for patients with diabetes (Truvía Company, 2015). With no unpleasant aftertaste, it is an ideal component for beverages and foods. It is

shelf stable and useful in cooking and baking (Canada Newswire, 2013).

Artificial sweeteners, also known as sugar substitutes, are derived from naturally occurring substances and used to replace sugar in foods

and beverages (Neacsu, 2014). Along with the many other types of food additives, artificial sweeteners improve food color, taste, texture,

appearance, and durability. There are two types of artificial sweetener: nutritive and non-nutritive. Nutritive sweeteners add some energy value to

food while non-nutritive sweeteners add no energy value to food (Neacsu, 2014). Along with adding virtually no calories to foods and beverages,

artificial sweeteners have a high intensity sweetness that requires a fraction of the amount compared to that of sugar (Neacsu, 2014). Artificial

sweeteners are compatible for patients with diabetes because they have not demonstrated alterations in long-term glucose homeostasis and no

effect on insulin production (Brown, 2011).

There are five types of artificial sweeteners that have been tested and approved by the U.S. Food and Drug Administration including

acesulfame potassium (acesulfame K), aspartame, saccharin, sucralose, and neotame. These products are used both commercially and as tabletop

sweeteners.

Aspartame provides energy value to foods at four calories per packet. Equal is a well-known aspartame-based sweetener. Saccharin

provides no energy value to foods and is much sweeter than table sugar. Although much sweeter than table sugar, it has a bitter aftertaste. Neotame

is between 7,000 and 13,000 times as sweet as table sugar. Neotame provides no energy value to foods and is popular in the commercial food

industry due to the high level of sweetness and the low quantities needed to achieve that sweetness.

Sucralose is the most similar to a carbohydrate in structure, being highly similar to sucrose with the exception of 3 chlorines substituted

for hydroxyl groups (Brown, 2011). It is 600 times as sweet as sucrose, twice as sweet as saccharin, and three times as sweet as aspartame. It is not

broken down by the body when ingested, attributing it as a non-caloric sweetener. Sucralose provides high stability under heat and over a broad

range of pH conditions making it useful in baking or in products that require a longer shelf life. Splenda is a well-known sucralose-based

sweetener. (Neacsu, 2014) Splenda is a viable option for patients with diabetes.

II. Purpose

The objective of this study was to determine the textural and taste differences in brownies when made with regular granulated sugar,

Splenda (sucralose), and Truvía (erythritol, stevia leaf extract, and sugar). The experimental plan was implemented with a penetrometer, a

colorimeter, pH meter, and affective test according to each variation. The penetrometer was used to determine texture and depth of penetration, the

colorimeter was used to determine the color of the brownies, the pH meter was used determine the acidity of the brownie batters, and the affective

test was used to determine which brownie is most liked to least liked in regards to sweetness and taste.

III. Materials and Methods

To begin, all measuring cups were tared on the scale and the ingredients were weighed in grams per each trial and variation. Variation 1 of

Grandma’s Homemade Brownie Recipe called for 2 cups of granulated sugar, ½ cup of cocoa powder, 4 eggs, 1 teaspoon of vanilla extract, 1-½

cups of flour, ½ teaspoon of salt, and 1 cup of butter. To start, the sugar, cocoa, eggs, and vanilla were combined in a large mixing bowl; the flour

and salt gradually added. It was then mixed with an electric mixer at medium speed. For trial 1, the butter was not melted before mixing occurred.

In trials 2 and 3, the butter was melted in the microwave for 25 seconds and blended into the mixture. Using a pH meter, the pH of the brownie

batter was sampled. The batter was then spread in an ungreased 9-inch by 13-inch pan and baked at 350 degrees Fahrenheit for 25 minutes. After

cooling, the brownies were cut into 32 squares. This included 4 rows of 8 brownies. 3 brownies from the middle of the sample were put on a plate

and the depth of penetration and the color were measured. The rest of the brownies were placed on a plate for ranking test samples. This was done

for trials 1, 2, and 3.

Variation 2 of Grandma’s Homemade Brownie Recipe used 2 cups of Splenda in place of the granulated sugar; all variation 1 procedures

were followed. For trial 1 variation 2, the butter was melted in the microwave for 20 seconds before mixing occurred. For trials 2 and 3, the butter

was melted in the microwave for 25 seconds and blended into the mixture.

Variation 3 of Grandma’s Homemade Brownie Recipe used 2 cups of Truvía in place of the granulated sugar; all variation 1 procedures

were followed. For trials 1, 2, and 3 variation 3, the butter was melted in the microwave for 25 seconds and blended into the mixture.

Table 1

Grandma’s Homemade

Brownie Recipe

Ingredient Quantity Weight (T1V1)

Weight (T2V2)

Weight (T3V2)

Sugar

2 cups

1015 g

1015 g

1015 g

Splenda

2 cups 660 g 660 g 660 g

Truvía

2 cups

1013 g 1013 g 1013 g

Cocoa

½ cup

43 g 43 g 43 g

Eggs

4

236 g 236 g 236 g

Vanilla Extract

1 teaspoon

30 g 30 g 30 g

Flour

½ cup

498 g 498 g 498 g

Salt

½ teaspoon

14 g 14 g 14 g

Butter

1 cup

225 g 225 g 225 g

IV. Results

Shown in the Table 2, all of the pH reading averages for the brownie batters read below pH 7 and above pH 6 during trials 1, 2 and 3. The

two highest readings read with trial 1 and variation one using sugar and trial 2 and variation 3 using Truvía; both read near pH 7. No one variation

was much more or much less acidic than another.

Table 2

pH Meter

Brownie Sample Trial 1 Trial 2 Trial 3

Sugar

6.87

6.47

6.44

Splenda

6.47

6.33

6.52

Truvía

6.44

6.99

6.66

Shown in Table 3, brownies made with Truvía and Splenda tended to be softer than brownies made with sugar. In some instances,

brownies made with sugar allowed for greater depth of penetration compared to the other samples (see trial 1, sample 3 and trial 3, sample 1). Trial

3 and samples 1, 2 and 3 made with Splenda had the greatest depth of penetration compared to trials 1 and 2, with trial 1, sample 1; trial 2, sample

1; and trial 2, sample 2 having the least depth of penetration. Trials 1 and 3 of brownies made with Truvía had a much greater depth of penetration

compared to trial 2.

Table 3

Penetrometer

Brownie Sample Trial 1 Trial 2 Trial 3 4 mm 3.0 mm 10.6 mm

Sugar 1

2

5.2 mm

3.5 mm

5.0 mm

3

10.5 mm

4.0 mm

6.1 mm

Splenda 1

2.4 mm

6.0 mm

12.7 mm

2

9.1 mm

9.4 mm

11.8 mm

3

10.5 mm

6.1 mm

11.6 mm

Truvía 1

16.1 mm

4.5 mm

10.5 mm

2

14.4 mm

5.2 mm

12.0 mm

3

16.2 mm

4.9 mm

14.6 mm

Shown in Table 4 are the mean values for the colorimeter. No one variation was more of less different than another variation. On average,

L-values for brownie samples prepared with sugar and Truvía demonstrated that these samples tended to be lighter in color than brownie samples

prepared with Splenda. All samples maintained an a+ value between 10 and 14. All samples maintained a b+ value between 12 and 16. According

to an L*a*b* chromaticity diagram of lightness vs. saturation (Figure 1), when these a+ and b+ values are plotted on a point, it demonstrates all

brownie samples read as a dull color with a dark yellow and dark red hue; in other words: brown. Samples prepared with Splenda had a darker red

and yellow hue compared to brownies prepared with sugar and Truvía.

Table 4

Colorimeter

Brownie Sample Trial 1 Trial 2 Trial 3

Sugar

a+ 13.7 L 34.5 b+ 15.6

a+ 12.6 L 35.7 b+ 15.9

a+ 13.1 L 33.3 b+ 13.6

Splenda

a+ 12.1 L 32.5 b+ 15.2

a+ 11.9 L 28.3 b+ 12.2

a+ 10.2 L 27.8 b+ 12.0

Truvía

a+ 13.1 L 34.3 b+ 15.6

a+ 13.6 L 33.8 b+ 14.6

a+ 12.9 L 31.6 b+ 14.4

Figure 1

Colorimeter Values

Chormaticity Diagram Hue and Saturation

Chromaticity Diagram Lightness vs. Saturation

On a scale of 1 to 3 with 1 being the most sweet and 3 being the least sweet, variation 1 using sugar was found to be the most sweet. Variation 2

using Splenda (sucralose) was found to be the least sweet. This is shown in Table 5 below.

On a scale of 1 to 3 with 1 being the most liked and 3 being the least liked, variation 1 using sugar was found to be the most liked.

Variation 2 using Splenda (sucralose) was found to be the least liked. This is shown in Table 6 below.

Table 5

Sweetness

Trial Variation 1 Variation 2 Variation 3

1

0.8

2.7 2.2

2

1.1

2.6

2.3

3

1.6

2.7

2.0

Average

1.2

2.7

2.2

Table 6

Likeness

Trial Variation 1 Variation 2 Variation 3

1

1.3

2.9 1.8

2

1.4

2.4

2.2

3

1.7

2.5

1.8

Average 1.5 2.6 1.9

V. Discussion

Sugar contributes to the moistness of baked goods, limits the swelling of starch creating a finer texture. Nonacidic conditions contribute to

the browning of the crust. It plays an important role in delaying starch gelatinization and protein denaturation temperatures during cake baking so

that air bubbles can be properly expanded by carbon dioxide and water vapor before batter sets. (Martínez-Cervera, 2012) The variations using

sugar were consistently the densest variation in all three trials. Seven of the 9 samples had the lowest depths of penetration compared to the

variations prepared with Splenda and Truvía. The variations using sugar were consistently the sweetest in all three trials, scoring an average of 1.2

on the ranking scale.

Sucralose can provide the sweetness and crystallization properties of sucrose, however it cannot mimic the structural contribution of

sucrose. To provide this functionality, sucralose must be combined with other substances in baked goods (Martínez-Cervera, 2012). In the

variations using Splenda, alterations were not made to the experiment to maintain the same properties offered by sucrose. The brownie batter

became too thick during the mixing process. The end resulting brownie had little volume. Seven of the nine samples had high depths of

penetration. Although sucralose is 600 times sweeter than sugar, the Splenda variation scored as the least sweet of the three variations with an

average of 2.7.

When preparing the Truvía variation, the improper amounts of sugar were used. Only ¼ cup of Truvía Baking Blend equates to 1 cup of sugar. In

these trials, 2 cups of Truvía were used meaning an additional 1-½ cups of Truvía were added. This should have significantly increased the

sweetness of this variation, however, the variation using sugar was still consistently ranked the sweetest with an average score of 1.9. Stevia also

requires the addition of a bulking agent to fulfill the functionality of sucrose (Shah, 2010). Again, no variations were made to the original recipe to

maintain the same properties offered by sucrose. These brownies were the softest and fluffiest with the greatest depths of penetration of the three

variations; six of the nine were more than 10 mm.

VI. Conclusion

The use of non-caloric sweeteners, both natural and artificial, is on the rise with patients that have diabetes. With no effect on blood glucose levels

and insulin production, these types of sweeteners are ideal sugar substitutes that reduce instances of hyperglycemia. Truvía, a natural sweetener

derived from the stevia plant, is stable under heat conditions and upholds well to changes in pH. Splenda, an artificial sweetener also known as

sucralose, is the closest in structure to carbohydrates. It is stable under heat conditions and upholds well to changes in pH. Both of these products

are shelf stable and therefore viable options in baked goods. While sugar was the strongest candidate for this recipe, Truvía was the strongest

candidate when baking with artificial sweeteners. It resulted in a fluffier, sweeter, well-liked substitute maintaining much of the functionality of

sugar.

VII. References

1. Brown, A, Bohan Brown M, Onken K, Beitz D. Short-term consumption of sucralose,

a nonnutritive sweetener, is similar to water with regard to select markers of

hunger signaling and short-term glucose homeostasis in women. Nutrition

Research [serial online]. December 1, 2011:31:882-888. Available from:

ScienceDirect, Ipswich, MA. Accessed April 15, 2015.

2. Canada N. Truvía® sweetener offers a great-tasting new option to help maintain a

healthier lifestyle with calorie-free sweetness from the stevia leaf. Canada

Newswire [serial online]. June 10, 2013:Available from: Regional Business News,

Ipswich, MA. Accessed April 13, 2015.

3. ClearlyHealth-Patient Ed. What is Type 1 Diabetes? Youtube.

https://www.youtube.com/watch?v=_OOWhuC_9Lw May 2008. Accessed April

13, 2015.

4. ClearlyHealth-Patient Ed. What is Type 2 Diabetes? Youtube.

https://www.youtube.com/watch?v=nBJN7DH83HA May 2008. Accessed April

13, 2015.

5. Gasmalla M, Yang R, Hua X. <Emphasis Type=’Italic’>Stevia

rebaudiana</Emphasis> Bertoni: An alternative Sugar Replacer and Its

Application in Food Industry. Food Engineering Reviews [serial online].

2014;(4):150. Available from: Academic OneFile, Ipswich, MA. Accessed April

13, 2015.

6. Grandma's Homemade Brownies. (2013, May 7). Retrieved April 11, 2015, from

http://www.cooks.com/recipe/ws9ao25e/grandmas-homemade-brownies.html

7. Konica Minolta. Precise Color Communication. Konica Minolta.

http://www.konicaminolta.com/instruments/knowledge/color/pdf/color_communication.pdf.

2007. 2015. Accessed April 14, 2015.

8. Martínez-Cervera S. Sanz T, Salvador A, Fiszman S. Rheological, textural and

sensorial properties of low-sucrose muffins reformulated with

sucralose/polydextrose. LWT- Food Science & Technology [serial online]. March

2012:45(2):213-220. Available from: Academic Search Complete, Ipswich, MA.

Accessed April 13, 2015.

9. NEACSU N. MADAR A. ARTIFICIAL SWEETENERS VERSUS NATURAL

SWEETENERS. Bulletin Of The Transilvania University Of Brasov. Series V:

Economica Sciences [serial online]. January 2014:7(1):59-64. Available from:

Business Source Complete, Ipswich, MA. Accessed April 13, 2015.

10. Shah A, Jones F, Vasiljevic T. Sucrose-free chocolate sweetened with Stevia

rebaudiana extract and containing different bulking agents – effects on

physiocochemical and sensory properties. International Journal Of Food Science

& Technology [serial online]. July 2010;45(7):1426-1435. Available from: Food

Science Source, Ipswich, MA. Accessed April 15, 2012

11. Truvía Company. Healthcare Professionals. Truvía.

http://truvia.com/health#carb-bakingblend. 2015. Accessed April 14, 2015.

12. World Health Organization. Diabetes Programme. World Health Organization.

www.who.int/diabetes/en/. Updated 2015. Accessed April 13, 2015.

Interview/Case Study Project Value: 50 pts

Case Study Objective: To appreciate the complexity of treating and managing diabetes via interviewing an individual with diabetes.

Procedure: This assignment involves interviewing, at length, someone with diabetes (can be type 1, type 2, or gestational). It is estimated that the

interview will take about an hour. It is important that you first get permission from your subject to conduct this interview. Assure them that they can remain anonymous and that the information they share will be kept confidential (that is, it will be used only for the assignment, and their name will not be used in the document you write and submit). You must ensure that you keep this promise

and maintain confidentiality of your interviewee. If not, you will lose points. Also, please let your interviewee know that they can choose not to answer all the questions if they feel uncomfortable. If the interviewee does not answer a particular question, you must indicate that the subject declined to answer that question in your report. If they do not answer more than three questions, you will

have to either come up with three new questions to replace those not answered or interview another person.

Written Report: All written materials should be typed using good writing mechanics, single spaced and submitted via blackboard. Your report will

include the questions and answers for questions 1-10.

Grading: You will be graded on grammar (punctuation, spelling, and sentence structure) and completeness (thoroughly answering each

question). Note that the final summary is worth 10/50 points.

Interview Questions: 1. Disease History:

a. What form of diabetes do you have (type 1, type 2 or gestational)? (Note: some may not know)

“I have type 2 diabetes.” My interviewee is my mother, April.

b. How long have you had this form of diabetes and at what age were you diagnosed? “I have had diabetes for 8 years. I was diagnosed in 2006 at the age of 34.”

c. How did you discover that you had diabetes?

“I noticed that I was tired often and had gained weight and couldn’t lose it. Thirst was another symptom that I was experiencing and so I made the decision to visit a doctor.”

d. Do you have any other chronic disease or relevant condition?

“I have hypothyroidism.”

e. Does anyone else in your family have diabetes? If so, who and what form? April’s grandfather, Jack, had type 2 diabetes and her uncle John was diagnosed with type 2 diabetes at the age of 32. Her

other uncle Dennis also had type 2 diabetes. Her aunt Cindy was diagnosed with type 1 in high school. Lastly, April’s cousin Jesse has type 2 diabetes. Jack is the father of John, Dennis, and Cindy; Jesse is also on this same side of the family

that all has diabetes.

2. Basic Demographics - Include a brief demographic description of the person you select (May want to include more than provided below):

a. Age/sex/race/ethnicity42/Female/Caucasian

b. maritalstatusMarried

c. localfamilysupportN/A

d. livingarrangementsAprillivesinasmallcitytypeneighborhoodwithherhusband,threedogs,andtwocats.

e. inquirewhethertheywerebornandhowlongtheyhavelivedintheircurrentlocationAprilwasborninSpringfield,Ohioandhaslivedinthegeneralareafor42years.

f. Doyouhavehealthinsurancethatcoversthecostsofyourdiabetes?Doesitcoverallorjustpart?“Idohavehealthinsurancethatcoverspartofthecostofmydiabetes.ThehealthinsuranceplanisthroughAetna.”

3. Their understanding of diabetes (we want their perception of the following): a. What is diabetes?

“Diabetes is a disease where your body doesn’t respond properly to insulin or produce it correctly. That’s about all I know.”

b. What caused your diabetes? “That I couldn’t tell you. It’s hereditary, genetics, I know that. And probably poor diet contributed to it. I mean it was

always there, obviously. I think stress contributed to it, also. I was overweight but not by much. Maybe 40 pounds, 50 pounds.”

c. How has diabetes changed your life?

“It sucks. I mean you just- it affects you health wise like when I am sick. Things are different. Stress adds to it. The majority of the time you’re supposed to check your glucose levels to make sure they’re where they should be and food wise

you have to make different food choices. With mine it was a complete change in what I eat, what I can and can’t have. It’s harder to lose weight and hard to maintain a weight. And it’s added other health issues like the high blood pressure, the

high cholesterol, the depression. It’s hard to accept.”

d. How has diabetes changed the life of those closest to you?

“I don’t do what I’m supposed to so it makes them angry that I don’t take care of myself.”

4. Complications:

a. Have you had any health complications (e.g. hypoglycemia , foot problems, kidney problems, cardiovascular problems, eye problems) as a result of your diabetes?

“I have experienced problems with hypoglycemia. It doesn’t happen very often and I have learned not to let it get that far. I get disoriented and zone out and I get a headache; I get tired and I get sick to my stomach.”

b. If yes to the above question, what type of health problems have you experienced as a result of diabetes

and what have you done to treat these conditions? If no, are you concerned about developing secondary health problems and what do you do to prevent their onset?

“Usually when that happens I just eat or know that I need to eat.” “Yes, I am concerned about developing secondary healthy problems but I don’t do much to prevent them, I guess. I mean

sometimes I try a little harder; I try to be a little more aware of what I am eating.”

5. Laboratory values/management:

a. Explain how you monitor your blood glucose. (e.g. How often do you check your blood glucose? When

do you check it? What type of equipment do you use to check it?) “I’m supposed to check it twice a day but I usually only check it if I don’t feel good. But I go to the doctor every three

months for my A1c. I use a glucometer to check my blood sugar. You stick your finger and it has a strip that reads your blood glucose levels.”

b. Do you know your HbA1c and what that means?

“My HbA1c right now is 7.91%. That means that it’s up extremely high, that it’s not good. I know it’s an average of my blood sugars over the past three months.”

c. Do you do any other lab or checks to ensure that you are not experiencing problems due to your diabetes?

“My doctor does my bloodworm every three months and checks all my proteins and all of that. She also checks my thyroid. He does a complete blood work for my diabetes to check my liver and all that and my kidneys.”

d. How often do you see your doctor? What kind of doctor do you see (e.g. family physician,

endocrinologist, diabetologist)? “Family physician and a diabetologist.”

6. Medications or supplement use:

a. Are you currently taking medication for diabetes? If so, what, how often and how long and in what

manner (oral, injection) have they been on this medication. “Both [oral and injection]. Metformin twice a day, or I am supposed to be. I always forget to take it. Lantis insulin

injections once a day. I’ve been on Metformin for 5 years and Lantis I was on for a year and then off it for a little over a year and then I have been back on it for close to a year.”

b. Are you taking medications for a condition/s other than diabetes? If so, what medications, what are they

being taken for? “I take Levistatin for cholesterol; I take ramopril for blood pressure; levathoroxin for my thyroid, and effexor for

depression.”

c. Do you take a vitamin/mineral or herbal supplement? Why do you take this? “Vitamin D for my vitamin D deficiency.”

d. Do you experience any adverse effects from the medicines you take to manage your diabetes?

“The Metformin sometimes upsets my stomach and the blood pressure medication makes me a little sleepy.”

7. Exercise:

a. Do you exercise? If so, how often and what type? If not, why not? “General. Yard work and house cleaning probably two or three times a week I guess. I never fit exercising into my

schedule. Laziness because I work all day and I don’t wanna come home and exercise. No motivation.”

b. What have been your biggest barriers for maintaining an exercise routine?

“My husband is an enabler to laziness. Not intentionally but he just does. He just gives in too easy to me.”

c. How do you think exercise influences your diabetes? “It makes me feel 100% better. It brings my blood sugars down.”

d. Have you ever received instruction on how to exercise properly? If so, by who?

“Not really, no. I went to the gym and had a personal trainer when I was 33 or so, before I found out. I was going to the gym but I wasn’t losing any weight. Which is one of the problems that I asked the doctor about.”

8. Diet:

a. Describe how you modify your diet and the tools you use to modify your diet to manage your diabetes.

(This may be a lengthy answer, but if they don’t provide a lot of detail probe and ask for more information. For example, consider asking if they “watch their diet”. )

“I try and cut out where I can but I don’t cut out enough. I don’t drink regular pop. I drink water at work with my Crystal Light drink mixes. And I drink about 1 Diet Pepsi a day. I sometimes eat breakfast which is normally a Toaster Strudel or a

bagel or a bagel sandwich with eggs. Something fast I can eat on the way to work. And sometimes it’s donuts and sometimes it’s nothing. If my husband packs my lunch I usually have a sandwich of some type (pb&j, ham, bologna), chips,

sometimes canned fruit sometimes fresh fruit, a snack cake. A typical dinner consists of spaghetti or it may be a meat like a pork chop or take out. Sometimes we eat take out 3-4-5 nights. A typical snack is a candy bar or a cookie. Anything that’s

sweet and not good for me. Whatever is easiest. I’d say four out of seven days I eat on a schedule. Usually when I am at work or the days I work. The weekends are sporadic because sometimes I might get up in the morning and start doing yard work and I may have a snack and I just get busy and I might not eat until five o’clock at night or when I realize that I

haven't eaten all day.”

b. Have you received any nutritional education related to diet and diabetes? If so, by who and did you find the education helpful? If not, what sort of nutrition education would you like to receive?

“Yes, by a nutritionist that I saw that was set up through my doctor’s office. Yes, the information was helpful to an extent. What she told me as far has portions helped me but I need to know what my choices are and it needs to be written down in front of me. If I don’t have that I might eat a candy bar because I just don’t know. I wouldn’t have to try and decide on my

own if I had a list.”

c. How important do you think diet is for managing diabetes? Why? “Extremely important because that’s what diabetes basically is. To me that’s the whole disease; it revolves around your

diet.”

d. What have been the biggest barriers for you in maintaining your diet? “My schedule, preparing meals, and I guess basically just knowing what I can have and how big of a portion I can have of

something.”

9. Diabetes related services and support:

a. What professional medical services do you access to help manage your diabetes?

“Just my family doctor.”

b. What community services are available relevant to diabetes (support group, community center, etc.)? “I’m sure that there are some out there, I know they do seminars and stuff on diabetes. It’s nothing I have ever looked up.”

c. Describe your friend or family support system for health management?

“Good, but the people who need to support me most are the worst about enabling like Anthony [husband] and grandma and Angela [sister]. You’ll [Autumn] tell me that I shouldn’t have something. You don’t give in like everybody else. You’re

more strict.”

10. Ohio University has a certificate program in diabetes that strives to educate people about diabetes. As part of the certificate, students can participate in community projects related to diabetes. What is one thing you would like to see

from these students? Or put in a different way, how could these students help you? “I don’t know, I guess just more support like what you do for me like when I want a pop and you just say ‘No, you should have

a water instead.’ A ‘Big Brother Big Sister diabetes program.”

11. Write an additional question for your interview. This should be a question that is not in the given list of questions. Be careful to ask a truly different question, not simply a rewording of a given question.

Q: Do you find it more or less stressful living in the know? As in do you find it easier to ignore the disease and live an unhealthy lifestyle as opposed to maintaining a healthy state?

“Yes, I find it easier sometimes to ignore it because it’s difficult because I guess like some other diseases you know you can see

the affects and with diabetes you don’t realize it sometimes until it’s too late because it’s hard to accept something you don’t understand so much. I mean I understand it somewhat, but it’s hard to think that what you eat can have so many effects and

when you really like food and when you like food that’s bad for you when that’s basically how you’ve eaten your whole life and have to change it. That’s a complete change of how I eat and it’s hard to eat healthy and take care of yourself. And when

you’re used to taking care of everybody else it’s easier to ignore my own health.”

12. Write a 2 paragraph summary of this experience. In the first paragraph, include your overall impression of this person’s health status and their understanding of their condition. In the second paragraph, provide your overview of this

experience. Tell me what you liked and didn’t like as well as how to modify the assignment in future years. (Note: this is worth 10 out of the 50 points so be thorough and thoughtful).

Because the person I interviewed happened to be my mom, I know for a fact that her health status is not well and her understanding of diabetes is very limited. I chose her to be my interviewee specifically because I wanted her to realize that she needs to learn more about this chronic disease. I find it embarrassing that she neglects the effects of diabetes when so many do make an effort to take care of themselves and maintain tight glycemic control. I want her to overcome the hump she has been

stuck in front of for 8 years and find the control she needs. I think it would help in other aspects of life as well. It is a big challenge to conquer something as wild as a disease.

I enjoyed this experience despite why I was conducting the interview. I enjoyed getting insight on the disease one on one with someone that had the disease. Knowing exactly how someone feels is important to me and especially as someone that is going to be working with these types of patients in the future. I think for future assignments it would be nice to ask questions about the psychological side of it as well. I know there were some questions thrown in there, but I would like to go deeper than just

the physical effects. That might be difficult for the interviewee and maybe the interviewer, but I think the deeper insight is important and interesting. There is more than just the physical side of the disease.

Thiscasestudyistobecompletedindependently.Usevalidresourcesandprovidethecitationforsource(s)youuse(classnotes,onlinesource,book).Pleaseanswereachanswerthoroughlymakingsureyouhavethoughtthroughyouransweranddemonstratingwhatyou’velearnedinclass.Donotsimplyregurgitateinformationyoufindfromotherresources.Youshouldtypeyouranswersusinggoodwriting

mechanicsandsubmityourfinalcopyonBlackboardbyFriday,December5that5PM.Thiscaseisworth50points;eachquestionismarkedwithitspointvalue.

InitialAppointment

JSisatwelve-year-oldpre-teenwithinafamilyof6whoenjoyssportsofanykindandavarietyofextracurricularactivitiesofferedathermiddleschoolincludingjournalclub,cheerleading,andband.Perherparent’sreport,sheisveryactiveandsocialand“nevermissesabeat”.They

describeheras“veryhighenergyanddifficulttokeepupwith.”Theyclaimthatshehasneverhadanyseriousmedicalissues;however,justtwoyearsagoshewasdiagnosedwithtype1diabetesandhasbeentreatedwithInsulinDetemirinjectionsonceadayasprescribedbyan

endocrinologist.Accordingtoherparents,herbloodglucoselevelshavebeenwellcontrolledsince.Infact,theywerehopingshecouldgooffhermedicinebecauseshejuststartedplayingsoccerwhichtheysayseemstohelplowerherbloodglucoselevels.

Theyareinthepediatrician’sofficebecauserecently,overthelast6-9months,JShasbeenexperiencingepisodesoffatigue,weakness,andweightloss,whichespeciallyconcernsherparentsassheis5’3”andonly97lbs.Twoweeksagointhefirsthalfofasoccergame,theysaidshe

hadtositthesidelinesbecauseshelookedandfeltweak,appearedpale,andwassweatingprofusely.Aftersittingforaminute,JSdidn’tlookanybetter(orJS’sconditionwasnotimproving)andcomplainedofstillfeelingsickandshaky.Theathletictrainertookhervitalsduringthegame,in87degreeheat,andnotedshehadapulseof54andBPof106/76.Shehadatemperatureof99.2degreesFahrenheit.WithJS’spersonalAccu-Check,shecheckedherbloodglucoselevelsandtoldhermomitwas54mg/dL.TheATCwasimmediatelyconcernedthatJSmaybesufferinglow

bloodsugaranddehydrationandurgedhertoquicklydrinkasodaandeataSnicker’sbar.

Within30minutesofthisepisode,shewastreatedthatafternooninthelocalERfor‘heatexhaustion’perthenurse’sreport.Sincethisepisode,JS’sparentsstatethatshehasn’thadanymorereoccurrencesbuttheyarestillconcernedabouttheirdaughter’shealth.

Duringthepediatricevaluation,JSadmitstothedoctorthatshehasbeeneatingmorejunkfoodlatelybecausesheconstantlyfeelshungry.Shealsoadmitstohavingmoreepisodesliketheonedescribedabove,butshehasn’ttoldherparentsbecauseshedoesn’twanttomissmoresoccer.Shedeniesanychangesinbowel/bladderandvisionandstatesthatsometimesshefeelsgreatwhileothertimesshefeelssick.Whenaskedabouthersleepschedule,shesaidthatshesleepsnormallybutsometimeswakesupinthemiddleofthenightthoughshethinksshehasalwaysdone

this.

Questions:

13. Based on only the above information, what do you think is going on with JS? Explain the physiology of why this is happening. Hint: why was her blood glucose level so low? (4)

I think that JS is experiencing diabetic ketoacidosis (DKA). The pathophysiology is an increased catecholamine response without appropriate insulin compensation. In this case, I think the psychological stress of diabetes and the missed insulin doses are contributing to the DKA.

14. Name 3 of the signs/symptoms that lead you to your answer for question number one. Explain the physiology of these 3

symptoms. (3) Polyphagia, excessive hunger, is one noticeable symptom. This is associated with weight loss because the body is not properly absorbing them because of the absolute deficiency of insulin which prevents the uptake of glucose into insulin dependent tissues. Dehydration and

weakness are two other symptoms.

15. What would you tell JS’ parents who think she can go off her insulin. Support your answer. In other words, is type 1 diabetes treatable without meds? (3)

IwouldtellJS’sparentsthatitisnotpossibleforhertogooffinsulinasatype1diabetic.Type1diabetesistheresultofbetacelldestructionandmeansthatthepatientisinsulindeficient.Exogenousformsofinsulinmustbedistributedbythepatientorbyaninsulin

pumpforthebodytobeabletocontrolbloodglucoselevels.

16. Pharmaceutical management: a. What is Insulin Detemir and what does it do? (2)

InsulinDetemir,orbrandnameLevemir,isatypeofinsulinthatlastsforupto24hourseachperiodofuse.Itisconsideredalong-actinginsulin.LevemirisproducedbyaprocessthatincludesexpressionofrecombinantDNAfollowedbychemical

modification.Thisinsulinisusedtohelpcontrolthebloodsugarlevels.

b. Name 2 other typical medical interventions that could have been used to treat JS. (2) Rapid acting analog insulin such as Lispro, Aspart, or Gluisine are one option. These require more daily injections because the

duration's only 2-4 hours compared to 24 hours, but there is immediate release if taken with meals. These are rapid acting because

they are onset in 15 minutes which is even faster than normal insulin. Another option would be neutral protamine hagedorn (NPH) which has an onset of 2-4 hours. The duration is 6- 10 hours.

c. How are these drugs administered? How frequently are they administered? (1)

These drugs are administered through insulin injections. Many type 1 diabetics use an insulin pump that automatically injects the insulin into the blood stream at certain times depending on the type of insulin. Many times it is administered before a meal.

d. What are 2-3 side effects of this drug? (2)

AswithanyRXdrug,therearesideeffects.SideeffectsofInsulinDetemir

canincluderedness,swelling,oritchingatthesiteofinjection,weightgain,changesinthefeeloftheskin(fatbuilduporfatbreakdown).Someserioussideeffectsincludewheezing,dizziness,shortnessofbreath,andorarash/itchingalloverthewhole

bodyandnotjustsiteofinjection.

e. How do these drugs differ from those used to treat type 2 diabetes? (2) Type 2 diabetics are still able to produce insulin although the body does not

respond well to it. Therefore, those with type 2 may only need to inject insulin at meal times to lower blood glucose levels after eating as opposed to a basal insulin that works for 24 hours.

17. Based on the information given, what test(s) specifically for her diabetes do you think should have been ordered in the ER?

Give a brief rationale. (3) Glucose should have been monitored hourly, vitals should have been monitored every 1-2 hours, BMPs should have been monitored ever 4 hours, and ketones should have been monitored every 8-12 hours. All this would ensure that the DKA was managed properly and that

the patient was back in a normal state.

18. Why do you think JS experiences these symptoms on a somewhat regular basis? Is this common? (2) I think she experiences these on a somewhat regular basis because she doesn't seem to eat right most of the time and continues to strain her

body with high levels of physical activity for soccer. She isn’t managing her diabetes properly.

a. Why is she constantly hungry but losing weight? (2) JS is experiences polyphagia which is excessive hunger. Her body is not able to absorb the nutrients because she is insulin

deficient as a type 1 diabetic. She is not able to uptake glucose into the insulin dependent tissues and is constantly eating to try and counteract this.

b. Provide 2 pieces of valid evidence (not a website but actual evidence) to support your answer (1)

JS isn’t eating a proper diet to stay in control of her diabetes and she is working out on a moderate level which is not helping the situation of polyphagia. Not only does she need to eat more food to counteract her physical activity, she is not getting the proper

nutrients to uptake glucose form the blood stream and deposit it in the proper tissues.

UponretrievalofJS’smedicalrecordsfromtheER,thedoctorwasabletofindoutthatthefollowingtestswereordered(withresultslisted):

CBC:

Hgb:12.7g/dL

Hct:37.2%;

WBC:7,200cmm

RBC:6.2millioncells/cmm

Platelets:387,450/cmm

BMP:

K:3.8mEq/L

Na:137mEq/L

Chloride:102mmol/L

Creatinine:1.1mg/dL

Calcium:9.2mg/dL

BUN:14mg/dL

Bicarbonate:25mmol/L

Glucose:190mg/dL

O2Sat:99%

Chol:130mg/dL

Questions:

3. JS’ blood glucose levels went from 54 mg/dL (as measured at the game) to 190 mg/dL (documented in the ER).

a. Explain why her blood glucose levels changed so drastically. (1)

During the game when she was experiencing symptoms she was given a soda and a snickers bar. Both are sugary foods high in carbohydrates leading to an increase in blood sugar.

b. Is this drastic change unhealthy/bad? Why or why not? (2)

This drastic change is both unhealthy and bad. The drastic change could have a negative effect on the body leading to shock.

c. What could have been done to prevent such a rapid change? (1) The “15” rule could have been applied here. 15 grams of carbohydrates every 15 minutes until blood glucose levels have reached

a normal level.

4. Do you think the heat affected JS blood glucose level? What does research suggest? (3) I think heat affected JS blood glucose level because that would mean more sweat and more loss of fluids. She was active and sweating

more than she would had she been not physically active. This cold promote polydypsia because of the loss of fluids.

5. Provide 2 lifestyle modifications you would recommend JS to make. Be specific. For example, don’t just say ‘eat better’. Instead, describe what better foods she should eat and how frequently she should do that. (2)

Rather than grabbing a candy bar or any other junk food, JS could grab a healthy, low carb snack. Processed foods tend to be high in carbohydrates and low in dietary fiber which could promote hyperglycemia more often. I think JS should also join a diabetes self-

management program that teaches her how to deal with her disease the consequences of not taking care of the body that is under the stress of diabetes.

6. Name and describe one biologically possible reason JS is consistently waking up in the middle of the night? Why does it

occur? (3) JS may be consistently waking up in the middle of the night because she is often experiencing hypoglycemia, or low blood sugar.

Hypoglycemia can lead to nightmares and night sweats. Daily physical activity can increase insulin sensitivity which may also lead to night time hypoglycemia.

Follow-upAppointment

6monthslater,JSmeetswithherpediatricianagain.Uponasking,sheadmitstonottakinghermedicineregularly.Shesaysthatsometimesshethinksshedoesn’tneeditandothertimesshe“justdoesn’twanttorelyonamedicinetomakeherbodynormal”.Herparentsalsoaddthatshewasjustrecentlydiagnosedwithdepression,whichreallyworriesthem.Shesaysshefeelslikeshedoesn’tfitinandcan’talwaysdowhatallof

herfriendsaredoing.Thisisanotherreason,shesays,thatsheisn’tcompliantwithhermeds.

Questions:

e. How does JS’ depression impact her diabetes? How does her diabetes impact her depression? (2) Depression can lead to lack of self-care because adjusting to the disease and dealing with the complications can be very stressful on a diabetes patient. Lack of self-care can lead to serious health risks such as anxiety, depression, eating disorders and medication issues.

Antidepressants may increase the risk for diabetes by promoting weight gain, glucose intolerance, and insulin resistance. This can all lead to hyperglycemia, vascular disease, hypoglycemic episodes, and insulin resistance.

f. How does JS’ diabetes impact her family? Elaborate on financial and social aspects. (2).

Parents often carry the blame when a child is diagnosed with type 1 diabetes. It is hard for the family to adjust to the diagnosis as well, leading to potential sabotaged dieting efforts and affects how the siblings are treated. Financially it may be an issue because insurance may

not cover all the diabetes related supplies that are required. Eating a different diet from the rest of the family may also be a financial adjustment. A diabetes diagnosis can lead to the patient feeling left out because they are treated differently and not allowed to eat

spontaneously if blood sugar levels are off.

g. Provide 3 ways in which her friends and family can show support for JS as she deals with diabetes and depression. (3) Family and friends can eat a similar diet as JS to show that it can be done and show that she isn’t being left behind because of her dietary and medical restrictions. The family could also learn her personal beliefs and how she feels about certain activities and dietary restrictions

and make an effort to find out what is important to JS. Her family might be a little more restrictive with her diet in this case to show that they care about her health and well-being and to show that they are not trying to sabotage her efforts.

h. Provide 2 appropriate resources (could be websites, phone apps, books or other sources) JS could utilize to help better understand the disease and its potential complications if not well managed. These resources should have information to help

convince JS of taking better care of herself and better manage her diabetes. (2) TheAmericanDiabetesAssociationhasagreatwebsiteforlearningtomanagediabetesandexplainingthediseaseintermsthatmakeitunderstandable.Thewebsitehasonlinecommunitiesforthosewithdiabetesorthosethatknowsomeonewithdiabetestohelpthe

patientconnectwithothersinthesameposition.Thereisalsoanapplicationonthewebsitethathelpsthosewithdiabetesplanmeansandlogbloodsugarlevelstohelpkeeptrackofdailyreadingsandhelpyourdoctortrackyourprogress.AnotheroptionisthephoneappDiabetesBuddy.LiketheAmericanDiabetesAssociationapplication,ithelpstotrackbloodglucoselevelsandinsulininjectionsallona

dailybasis.Theinformationcanbeeasilysharedwithyourdoctortokeeptrackofmedicalprogressandhealthrecords.

i. Put yourself in JS’ shoes. How do you think you would feel living with diabetes as a 12-year-old? What do you think would be most challenging for you? (2)

I would feel very confused and agitated if I had diabetes as a 12-year-old, or at all. It is very frustrating to have to constantly monitor your body and what you are eating and how you are feeling. I can’t imagine having to actually deal with this every day. I would say it would be more stressful as a child because of things like the spontaneous eating of sweets and always having to be the friend checking blood sugar

before meals. I believe the diet part of the disease is one of the most challenging sides of diabetes.

References:

Mod1,Lecture1-DiabetesClassifications

http://www.rxlist.com/levemir-drug.htm

http://www.nlm.nih.gov/medlineplus/druginfo/meds/a606012.html#side -effects

http://www.diabetes.co.uk/nocturnal-hypoglycemia.html

Nutrient Intake Summary DMProject

Client:SophiaManchegoAge:53Height:5’7’’Weight:180lbs.

InitialFoodLog/Date: SecondFoodLog/Date:

AverageKcalorieIntake

2,885kcal

EstimatedKcalorie-Maintenance

1,900kcal Revised:

EstimatedKcalorie-WeightLoss

2,885-1,900=985kcal/day

6,895/week/3,500=2lbloss/week

Revised:

SourceofKcal InitialFood

Log–kcals.

%ofKcal. Recommended%ofKcal SecondFood

Log–kcals.

%ofKcal

CHO

1,531.99kcal 53.1% 49.8&

Pro

363.52kcal 12.6% 20%

Fat

989.59kcal 34.3% 29.9%

SatFat

192.97kcal 195% 8%

MUSFA

124.68kcal 126% 17%

PUFA

633.34kcal 64% 10%

Sugar,GRAMStotal

498.92kcal

17%

<10%

Nutrient

Initial-Intake RecommendedIntake Second–Intake %Change(+/-)

Protein(g)

91.599g 95g

508.875mg 1,200mg

Calcium(mg)

Iron(mg)

12.708mg 8mg

VitaminC(mg)

42.733mg 75mg

VitaminA

732.640RE 800RE

EXCHANGES PatientIntake RecommendedExchangePattern

Bread/StarchExchanges

13.5 8starch/day

*FruitExchanges

0 4fruit/day

*Meat-MFExchanges

4 2lean

2highfatplantbased

*Milk-LowFatExchanges

0

1

*VegetableExchanges

5

6

*OtherCHO

10 0

DietaryFiber

-- --

SolubleFiber

-- --

*InitialIntakeExchangesarenotedinclientDietRecordNutritionSummary

“RecommendedIntake”ofExchangesisgeneratedfromyourrecommendedexchangepattern

RDNStudent:_________________________________

Reviewed:____________________________Date:_____________

HTNADINoteFORM

Heading Date,Time,andDepartmentA S(1pt)

O(2pt)

53YOFemale,5’7’’,180lbs,38’’waistMedicalHx:TypeIIDM-1year,HTN,Hyperglycemia,Gout

SurgicalHx:cholecystectomyBUN:31mg/dLGlucose:1524mg/dL,475mg/dLCholesterol:205mg/dL

HDL-C45mg/dLHbA-1C:15.2%Averagekcalintake:2885.120kcals

Patientstates:Nostrictdietexceptavoidanceofaddedsalt,highcholesterolfoods,andhigh-sugardesserts;Confusionarosewiththeexchangedietduringpreviousdietinstruction;Themotivationistherebuttheself-efficacytosuccessfullycontrollingbloodsugarsis

not;Admitstonottakingmedicationregularly;Lethargicwithperiodsofvomiting;Alertbutdrowsywithmildconfusion.D PES

#1

(4pts)

PES#2

(4pst)

Excessivefatintake(NI-5.5.2)relatedtophysiologicalcausesdecreasingtotalfatneedsorrecommendationsasevidencedbysurgicalHxofcholecystectomyandelevatedcholesterollevelsof205mg/dLwithreportsoffrequentconsumptionofhigh-risklipidswithtotal

fatintakeat175%ofthedailyrecommendationandsaturatedfatintakeat195%ofthedailyrecommendation.

Intakeoftypesofcarbohydrateinconsistentwithneeds(NI-5.8.3)relatedtofoodandnutritionknowledgedeficitconcerninganappropriateamountofaspecifictypeofcarbohydrateasevidencedbyextremehyperglycemiaat1,524mg/dLand475mg/dL

(administrationdate/day2)withexcessivecarbohydrateintakeat53.1%averagekcaltotalsbutat163%thedailyrecommendation.Thereisanobservationthatthereislimitedknowledgeofcarbohydrateconsumptionwithdiscrepanciesinvolvingtheexchangediet

andcarbohydratecountingtocontrolbloodsugarsaswellasinconsistentuseofdiabetes-relatedmedication.

I (4pts)

Nutritionprescription:ExchangedietNutritionEducation-Application:Skilldevelopment(E-2.2)topracticeandunderstandtheexchangedietandutilizeittoloseweight

andcontrolbloodsugars.NutritionEducation-Content:Nutritionrelationshiptohealth/disease(E-1.4)tounderstandhowcarbohydratesareaffectingbloodsugarsandfatsareaffectingbloodlipidprofilesandbegintoseeacorrelationbetweenthetwowithimprovedbiochemicalresults.

MotivationalInterviewing:promoteself-efficacy,empowertheclient,andplanacourseforchangeandgetcommitment.I(M/E) (.5

pt)Testandmonitorbloodlipidprofile:totalcholesterol,HDL

TestandmonitorHbA1-Ceverythreemonths,bloodglucoselevels Signature

CounselingandEducation

1. The Middle East Presentation- Nutrition 3600

Management

1. HIPAA Human Resources Paper- Management 3300

HIPAA, Technology & the Role of HR Management

Erin Casey, Autumn Funderburg, Rachel Ritzenthaler, Patrick Mylett

In the United States, citizens are fortunate enough to live under government protection where the detailed information of our

health is maintained confidential by law. The only eyes that can view such information are those of the doctors, nurses, registered

dieticians and other health professionals in charge of the cases-- the ones making the health decisions and the insurance companies.

The law to thank for this is HIPAA, which stands for the Health Insurance Portability and Accountability Act of 1996. Although the

law is relatively new, it includes provisions that require confidentiality and protection of health information. The primary goal of the

act was to aid citizens in keeping their health insurance when jobs are lost or changed, but has become more commonly known as the

confidentiality law in hospitals and doctor’s offices.

The law is taken seriously in the healthcare workplace, and is enforced by the U.S. Department of Health and Human Services

(HHS) and complaints are filed with the Office for Civil Rights (OCR). Especially in this new age of technology where critical patient

information is entered electronically the majority of the time, the law is of vital need and importance. Breaching this secured law can

result in many punishments, and is defined by the OCR as “an impermissible use or disclosure under the Privacy Rule that

compromises the security or privacy of the protected health information.” Punishments for violating HIPAA vary widely from a low

fine to jail time (can be a criminal or civil penalty). Additionally, if health information was disclosed for personal gain, profit, or

intended harm the fine raises once again. Not knowing the law is not accepted as a valid excuse in the legal setting, therefore it is vital

that the staff of healthcare facilities are well versed on the topic and know the provisions of the law for themselves. Steps that assist in

preventing a security breach include; run a risk assessment (determine where change needs to be implemented), prepare for the worst

before it occurs (example: antivirus programs on computer systems), have an ongoing employee training program, and buy medical

products that are compliant with the law (such as specific safe technology). All of these areas and steps can lessen occurrence of

breaking the law in a secured health environment and can be a beneficial part of the job of an HR manager in the healthcare facility.

One of the most crucial roles a human resources manager takes on is communicating with employees and gaining their

understanding on workplace policy. In the healthcare environment, HIPAA is an important core policy that every employee must

understand fully to avoid breach of conduct in a medical setting. Places of work that adhere to HIPAA include hospitals, family

practice offices, specialty offices (oncology center, podiatrist, dentist etc.), urgent care facilities, pediatricians and just about any other

medical office that exists. The range that HIPAA affects is wide reaching and extensive, making this an important law to be upheld, as

medical information is passed from office to office, and doctor to doctor. The three most important factors in patient information are

confidentiality, integrity, and accessibility. It is essential that patient information not be disclosed, the information has not been

altered, and it can be accessed by the authorized official when needed. HR management’s role in HIPAA is ensuring employee

understanding, and upholding the standards of the law through training, electronic safeties, and keeping up to date with technological

advances to avoid the breaching one of the most impactful laws in healthcare.

Employee training of HIPAA policies include areas of privacy, security, unsecured breaches, and regulations and how these

policies affect the practice if not properly enforced. A methodical approach is best for understanding and implementing as

modifications continue to be introduced (Salz, 2013).

While employee training is a highly critical aspect of HR management’s role in reducing HIPAA violations, another prevalent

aspect is the issue of growing technology usage that not only threatens privacy but can become an unlawful act if precautions are not

taken. In the past, electronic sources were not used to communicate PHI or “protected health information” that is held or transmitted in

the form of paper or electronic records (Goldstein and Pewen, 2013). Today, electronic communication is deemed affordable,

efficient, and fast compared to the old-fashioned paper methods prior to the 90s. The healthcare industry now relies heavily on

electronic communication sources (Gonzalez, 2014). Under HIPAA, the penalties for maintaining secure protected health information

(PHI) have become greater in increasing years. In 2003, HIPAA decided to tackle the issue of protecting electronic health records. A

security standard known as “The Security Rule” was put into place. In 2005, administrative safeguards were established that ensured

that this security rule was implemented and actively administered by a security official. A rule that adds protection and stronger

security through electronic communications that modifies the Health Information Technology for Economic and Clinical Health

(HITECH) was implemented on September 23, 2013 (Gonzalez, 2014).

As far as administrative standards and technology, this is what is covered: access authorization, security awareness and

training, periodic security updates, protection from malicious software, log-in monitoring, password management, security incident

procedures, contingency plans, data backup plans, disaster recovery plans, emergency mode operation plans, maintenance records,

workstation use, and device and media controls. Policies are continually updated when new challenges are faced (Gonzalez, 2014).

There are a lot of healthcare and HIPAA concerns that pair with the growing increase of technology use. These concerns are

widespread not only through health related activities on electronic devices, but also through everyday app use. In late 2014, 64% of

adults owned a smartphone (Anderson). The United States is rapidly becoming more technologically savvy and major health care

systems are noticing this difference.

Another major concern for protected health information is free e-mail. Many organizations encourage the use of personal or

generic e-mail accounts because of the cost efficiency. These free services, however, are not HIPAA- compliant. For example, Google

reviews every e-mail that passes through the server. Google is not the only non-compliant free e-mail service; this also includes

Yahoo, Hotmail, and AOL. Other HIPAA policies should include security for social media, electronic devices, and text messages.

Employees should not post information regarding a facility, its policies, residents, or staff. Electronic devices must be PHI and QAPI

committee approved (Gonzalez, 2014). Electronic or mobile devices must use password or personal identification numbers and enable

encryption, firewall and security software (Salz, 3013). Text messages should not be used as a form of communication regarding PHI

(Gonzalez, 2014).

According to Catherine Boerner (2015), permission clauses on apps have the ability to access a lot of information that you may

not be aware of. For example, when you download some type of flashlight app, you may be allowing the app to know your precise

location, read your contacts, modify or delete the contents of your USB storage, or use accounts of your device (Boerner). One may

wonder why a flashlight app would even need that type of information. This concern comes into play when an employee is on their

phone at work, where they are connected to the facilities network.

The idea that apps can access personal health information via employee’s phones becomes a problem when employees do not

strictly follow HIPAA regulations. For example, if an employee takes a picture of a patient, or texts about a patient, different apps can

access these and then that information is no longer protected by the facility. Ways that this can be controlled and regulated is by the

health care facilities cracking down on outside electronic usage in the workplace (Ealey). This means that all cellphones, tablets and

other electronic devices that connect to the facilities network, need to be locked up in a locker for the duration of the shift (Ealey).

Also, it may seem easy for an MDS (minimal data set) nurse, who collects and compiles it for further facility research, to download

data from the facility onto their personal laptops to take home (Ealey). The facility is unaware of the different people that have access

to the nurse’s laptop, and this then becomes a very dangerous situation in regards to protecting personal health information. This can

be prevented by, again, locking all personal devices up for the duration of the shift.

Managing the use of electronic devices in the workplace is extremely difficult and can upset employees, especially night shift

workers who have a lot of free time. Handling this issue is a problem grows exponentially as the use of electronic devices rises. Tom

Ealey (2015), a professor at Alma College and a long-term care consultant and compliance expert, says, “Managing risk is a

combination of knowledge, a slight touch of paranoia, training and daily supervision.”

There are many new ways to use technology in the health care system that helps to cut costs and are easy to use. One example

is the use of video chat to meet with a doctor. An app called BlueJeans is taking HIPAA regulations into consideration when creating a

platform for the cyber meetings between patient and doctor. Applications such as BlueJeans are great because they reduce hospital

visits, increase symptoms discovery and diagnosis, provide more available care for high acuity patients, provide more effective triage

consultations, and reduce operational costs all while adhering to HIPAA regulations (BlueJeans). The application does this by

installing network and application firewalls, and providing fully redundant network infrastructure (BlueJeans).

In 2009, the Health Information Technology for Economic and Clinical Health Act (HITECH act) tried to regulate the use of

technology with private health care information. The act promotes the adoption and meaningful use of health information technology

by addressing privacy and security concerns associated with electronic transmission (HHS). With this act, violation fees increased

significantly. The maximum penalty amount is $1.5 million dollars and the lowest penalty significantly increased (HHS). The hope of

HITECH act was to make people in health care facilities more conscious about their own personal electronic devices, along with

devices that the facility provides. It is important that health care facilities make an effort to keep up with the growing use of electronic

devices in order to protect their patients.

There are three strategies aiding in avoidance of HIPAA fines: corporate compliance programs, quality assurance performance

improvement, and overall policies and procedures. Corporate compliance programs ensure that the organization’s current program is

up-to-date and actively implemented. This includes frequent evaluations of online and electronic communications safety and security

as well as appointing a security officer. Quality assurance performance improvement (QAPI) programs use protections provided by

the effective use of a QAPI program. This includes a QAPI committee to approve new HIPAA policies, studies developed to verify

the safety of all electronic documents and communications, and document all the studies, actions taken, and staff trained relating to

safety and security of PHI. Overall policies and procedures ensure that policies and procedures required through HIPAA are created

and executed. This includes reviewing granted access to electronic PHI, terminating access to electronic PHI when the employee is no

longer with the organization, and reporting malicious software and monitor log-in attempts (Gonzalez, 2014).

Prior to 2009, HIPAA fines were $100 per violation and $25,000 for identical violations during a calendar year. Proceeding

2009, the fines have been increased and include four violation categories: Did not know they were violating the law with fines ranging

from $100 to $50,000; Reasonable cause with fines ranging from $1,000 to $50,000; Willful neglect- Corrected with fines ranging

from $10,000 to $50,000; and Willful neglect- Not corrected with fines set at $50,000. All violations of an identical provision in a

calendar year are set at $1.5 million for all four violation categories (Gonzalez, 2014). The Omnibus Rule institutes assessment of

violations based on the number of individuals affected, the length of the noncompliance, and the severity of culpability (Goldstein and

Pewen, 2013).

Not knowing the law is not accepted as a valid excuse in the legal setting, therefore it is vital that the staff of healthcare

facilities are well versed on the topic and know the provisions of

the law for themselves and for their patients confidentiality. The education of the HIPAA act is a crucial component for incoming

employees into the healthcare field. A main goal of the human resource department is to emphasize the importance of HIPAA as well

as implement education within the staff. Hospitals and other healthcare related businesses typically now include HIPAA education and

violation prevention tactics into the training process. Another key role of the HR department is to remain aware of the growing usage

of technology and to keep up to date with technological advances to avoid breaching one of the most impactful laws in healthcare.

The HIPAA act has only been around for just under 20 years. Although this act is been around for what seems like a short

amount of time, it has made a large impact on how the healthcare system gives and receives client information. Healthcare systems are

continually changing and improving the way they uphold this act in accordance to how quickly technology is evolving. HR

departments are a critical component in protecting the privacy of their patients and upholding regulations and standards of the HIPAA

act. They are necessary in reducing the prevalence of HIPAA violation and punishment measures. As the Health Insurance Portability

and Accountability Act continues to evolve, so does the human resource department.

References:

Anderson, M. (2015, April 1). 6 facts about Americans and their smartphones. Retrieved November 23, 2015, from http://www.pewresearch.org/fact-tank/2015/04/01/6-facts-about-americans-and-their-smartphones/

BlueJeans. (2015). Telehealth-Data Sheet. Retrieved from http://bluejeans.com/sites/default/files/uploaded_images/Blue Jeans Telehealth Data Sheet.pdf

Breach Notification Rule. (n.d.). Retrieved November 23, 2015, from http://www.hhs.gov/ocr/privacy/hipaa/administrative/breachnotificationrule/index.html

Boerner, C. (2015). HIPAA and Apps on Smartphones. Just Having a Mobile Devices Policy and Procedure Is Not Enough, 37-66. Ealey, T. (2015). HIPAA meets BYOD. Long-Term Living. Goldstein, M. M., & Pewen, W.F. (2013). The HIPAA Omnibus Rule: implications for public health policy and practice. Public

Health Reports (Washington, D.C.: 1974), 128(6), 554-558. Gonzalez, E. (2014). Complying with HIPAA. Long-Term Living: For The Continuing Care Professional, 63(1), 16-19. HHS. (2009). HITECH Act Enforcement Interim Final Rule. Retrieved from

http://www.hhs.gov/ocr/privacy/hipaa/administrative/enforcementrule/hitechenforcementifr.html

HR's Role in HIPAA Security Compliance. (2008, March 26). Retrieved November 23, 2015, from http://corporate.findlaw.com/human-resources/hr-s-role-in-hipaa-security-compl iance.html

Reality of HIPAA Violations and Enforcement. (2013, October 18). Retrieved November 23, 2015, from https://www.hipaa.com/the-reality-of-hipaa-violations-and-enforcement/

Salz, T. (2013). HIPAA: Training critical to protect patients, practice.. Medical Economics, 90(18), 43. What is HIPAA. (2015, March 18). Retrieved November 23, 2015, from

http://www.dhcs.ca.gov/formsandpubs/laws/hipaa/Pages/1.00WhatisHIPAA.aspx

GeneralEducation

1. Community Garden Prezi- English 3100J


1. Case Study: Obamacare- Health 2000 2. Climate Change Research Paper- Environmental Health 2000

3. Smallpox Research Paper- Global Public Health London 4. Community Gardens PowerPoint- Global Public Health London

5. Mental Health PowerPoint- Global Public Health Costa Rica 6. Oceanic Dead Zones Blog Sample- Environmental Health 3100

CaseStudy#3:ObamacarePrefatoryNote:Ifyouhavecompletedanearliercasestudyyoudonotneedtocompletethisassignment.

INSTRUCTIONS:ReadChapters26and27,andthenreadthetwoadditionalPDFfilesdescribingthePatientProtectionandAffordableCareActof2010(a.k.a.,“Obamacare”).Respondtothesequestions.Eachquestionwillrequireafact-basedresponse;youropinionisnotbeingsolicitedexceptinquestion10.Youarebeingaskedtoanswerthequestionsbasedoninsightsandinformationsuppliedinthiscourse,fromthetextbookorothersourcesyoumaywishtoreference.Eachanswerwillrequireathoughtful,well-articulatedreply.Thisassignmentisdueby6:00pm,Sunday,August3rd,2014.Sendittomeat:[email protected].

QUESTIONS:

1. What are the basic goals of the PPACA? The PPACA requires that all Americans have health insurance or pay a fine. The PPACA also included an expansion of coverage for young adults on their parents’ plan up to age 26 and aims to expand Medicare and Medicaid. No one can be turned down for pre-existing conditions nor dropped when illness occurs. PPACA will offer more preventative care and more care for chronic conditions.

2. How are these goals directly related to the 10 essential services of Public Health? You may need to refer back to Chapter 1 of the text if you’ve forgotten all ten. Give one example of how each goal addresses one or more of the 10 PH essential services. Obamacare sets out to plan and implement sound health policies that support individual and community efforts; this goes along with essential service 5. It also seeks to make sure that people receive the medical care that they need and evaluate and improve programs. Essential service 7 is the main mandate in the PPACA. The Medicaid income requirement was altered to fit more people under the bill. Essential service 9, evaluate and improve programs, is seen in the states freedom to potentially implement the act in the best way that suits the state. Essential service 10, support innovation and identify and use best practices, coincides with the portion that pays doctors by the quality of care and not the quantity. This ensures the best care is given to the patient.

3. Describe healthcare spending in the USA as related to other countries.

HealthcarespendingintheUSAisthemostexpensiveintheworld.Agingpopulation,continualdevelopmentofnewmedicaltechnologyandhightechprocedures,administrativecosts,andfinancialincentivesformedicalprovidersaresomeofthemainreasonsastowhycostsareincreasing.

4. What are the one or two most notable characteristics of USA healthcare funding as compared to other OECD countries? TheUSspendsmoreonmedicalcareperpersonmorethananyothercountryintheworld.AttwicetheaverageofagroupofcountriesthataremembersofOECD,$7990wasspentonhealthcostspereachAmerican.AlthoughtheUSspendsmoreonmedicalcareperperson,thereisnoevidencethatAmericansarehealthieroverall.SpendingasapercentageofgrossdomesticproductishigherintheUSaswell.

5. We’ve already learned early in the class that PH can be controversial. List as many such aspects of Obamacare as you can. Obamacare is seen as an act that is making individuals and businesses do something that they are not willing to do because the government has more control over healthcare. An example is the mandate that took place in 2014. If one can afford insurance but does not purchase insurance, a fee is charged. There is also a small tax increase, .9%, for those that make more than $200,000 a year, which many may see as an issue regardless of how little that affects the taxes already being paid for this income level. Businesses that have more than 50 employees must now offer health insurance. While this may be relieving to some, it is perhaps a hassle to the businesses.

6. Relate Obamacare to 3 of the problems with the US Healthcare system(s) as described in chapters 26 and 27 of Schneider. It is well known that the US has cases of extreme obesity and chronic illnesses related to obesity and poor eating habits. Obamacare established a section that requires chain restaurants to disclose nutritional information that has the potential to affect the choices made by customers. The main problem in the US health system is that too much money is spent with not enough to show for it. Obamacare seeks to make sure that more people have health insurance coverage and this, in turn, can decrease long term spending and ensure preventable diseases are prevented. With rising costs, Obamacare has the goal to focus on the best ways of targeting health care practices that are the best use of money and time. Again, in the long run, this will decrease health care costs and develop a more efficient system.

7. About how many pages is the PPACA as published in 2010?

The PPACA as published in 2010 was 955 pages.

8. Discuss exactly what Obamacare does with respect to Medicaid. Explain why this would be expected to have a

beneficial effect on the overall public health of Americans. Medicaid is accessible by everyone up to 133% of the poverty line. This will allow those that are not poor enough to qualify for Medicaid to now qualify. A majority of these that were uninsured did not previously qualify. This can reduce long run costs and lead to better outcomes when people are sick. This also covers more children. More issues can be taken care of sooner rather than later, affecting long-term health and overall public health of Americans.

9. If congress or the courts do not change Obamacare, when will all of its provisions be fully implemented? TheprovisionsofObamacarewillbefullyimplementedbytheyear2020afteraten-yearplanbeginsin2010.

10. (opinion). Pick the one or two most important aspects of Obamacare as it relates to YOU. Are you in favor of these changes? Opposed? Explain why you selected the provisions of the Act you did, and give your rationale for your decision. The main mandate in the act I am in favor of is the fact that Medicaid is accessible by everyone up to 133% of the poverty line. I find this extremely important for the health of our nation. Without insurance people get sick and let diseases fester and in turn it is more draining of public resources in the long run. Why not offer everyone the chance to get preventative, regular care to drive down costs and improve our health as a nation. This is especially important for children. Children are developing and those are who will be experiencing many of the long-term effects of this PPACA and that is extremely important. Another portion of the act that began taking place this year is that doctors’ pay will be determined by the quality of their care and not how many people they treat. I think this is important in maintaining quality care to patients rather than speeding through things and making mistakes causing more damage in the long run. The whole reason for this Obamacare plan is to ensure quality care so it is only fair that doctors are utilizing this opportunity to better the health of the United States rather than just making money. Lastly, chain restaurants are required to disclose nutritional information in hopes that those ordering will make the best choice. As a nutrition major, I think this is extremely important. It may not have an effect on all that see it, but it may have an effect on more than thought. I have hopes that this will encourage the restaurants to rethink their style and offer more genuinely healthy options instead of options disguised as healthy but are not really so.

ClimateChangeandDeforestationand

itsEffectonGlobalPublicHealth

AutumnFunderburg

OhioUniversity

Hippocrateswasoneofthefirsttodiscoveralinkbetweentheenvironmentandhealthofhumanbeings.Hetooknote

thatphysiciansofthetimeshouldhave“dueregardoftheseasonsoftheyear,andthediseaseswhichtheyproduce,andthe

statesofthewindpeculiartoeachcountryandthequalitiesofitswater(McMichael,2003).Varyingamonggeographiesand

topographies,environmentalhealthimpactsmaybepositiveornegative,butispredictedbyscientiststobepredominantly

negative(McMichael,2003).Environmentalhealthconditionsplayasignificantroleinfoodtravelandimportation,famine,

starvation,socialcollapseandthedisappearanceofwholepopulations(McMichael,2003).Theseconditionsmayleadtosocial

unrestthatmayincluderobberies,riots,cannibalism,andanimaldiseaseproliferation(McMichael,2003).Climatechangeand

deforestationareimportanttothegeneralwellbeingofasociety,withthepotentialtoimpactfoodproductionlevelsandthe

spreadofinfectiousdiseases.

TheUnitedStatesandtheworldareexperiencingclimatechange:increasesintemperatures,globalrisingofsealevels,

andmanytypesofextremeweather.Allarebecomingmorefrequentandmoresevere(U.S.GlobalChangeResearchProgram,

2015).AccordingtoFigure1.5onpage10ofClimateChangeandHumanHealth,thefirstdirectlyaffectedareaistheregional

weather.Thiscanincludeheatwaves,extremeweather,temperature,andprecipitation.Thismayhaveaseasonallinkand,for

example,amildwintercanleadtosummerseasonalchangesinvolvingextremeheatwavesmorethantypicaloftheregion.

Theseregionalweatherchangesaffectmicrobialcontaminationpathways,transmissiondynamics,agro-ecosystemsand

hydrology,andsocioeconomicconditionsanddemographicconditions.Thisinturn,hasaneffectonhealththatcaninclude

temperaturerelatedillnessanddeath,extremeweatherrelatedhealtheffects,airpollution-relatedhealtheffects,waterand

foodbornediseases,vectorborneandrodentdiseases,effectsoffoodandwatershortages,mental,nutritional,infectionsand

otherhealtheffects(McMichael,2003).Climatechangeanddeforestationmaygohand-in-handinmanyinstances.Human

inducedclimatechangeandhumaninduceddeforestation,alongwithdestructionofotherecosystems,isleavingtheseareas

undercapacitytobufferimpactsofextremeweathereventssuchasfires,floodsandseverestorms.(U.S.GlobalChange

ResearchProgram,2015).

Abundanceanddistributionofdiseases,specificallyvectorbornediseases,isaffectedbymanyphysicalandbiotic

factors.Physicalfactorsincludetemperature,precipitation,humidity,surfacewater,andwind;bioticfactorsinclude

vegetation,hostspecies,predators,competitors,parasites,andhumaninterventions(McMichael,2003).MalariaandDengue,

transmittedviamosquito,aretwoofthesemainvectorbornediseasesthatisontheriseanddifficulttocontrol.Onestudyhas

shownthatthechangeinvectorecologyhasalteredlocaldiseaseincidenceandprevalence,aswell.(PattanayakandYasuoka,

2008).

Theparasitehostingthemalariaviruscannotbesustainedinveryhightemperatures.Thismeansthatinareasofhigh

heatthatseeevenaminorincreaseintemperaturesmayexperienceadecreaseintransmissionofmalariabecausethe

physiologicaltolerancelimithassurpassedthatwhichthemosquitocanhandle.However,inlow-temperatureareas,asmall

increaseintemperaturewouldhavetheoppositeeffectontransmissionanditmayincrease.(Edwards,Hales,andKovats,

2003)Inareasofhighrainfallthatseewarmerweatherconditionsandhumiditymayseeanincreaseintransmissionofdengue.

Theseweatherconditionsareidealforbreedingmosquitoes.(Edwards,Hales,andKovats,2003)

Inadditiontoclimatechange,deforestationalsoplaysamajorroleinlocalecosystemsandhumandiseasepatterns.

Microclimatesarealtereddramaticallybecausedeforestationreducesshade,altersrainfallpatterns,augmentsairmovement

andchangesthehumidityregime.Biodiversityisreducedandsurfacewateravailabilityisincreased.Theseenvironmentaland

climaticchangescanresultinprolongedseasonalmalariatransmission.(PattanayakandYasuoka,2008)

Therearemanyotheremergingdiseases,namelyviruses,whicharesurfacingfromecologicallydamagedpartsofthe

earth.Manyemergefromthetatterededgesoftropicalrainforests,thelargestreservoirsforviruses,andtropicalsavannas

thatareexperiencingincreaseinhumanpopulations.Theseemergingvirusesinclude,butarenotlimitedto,Lassa,RiftValley,

Oropouche,Rocio,Q.Guanarito,VEE,Monkeypox,Chikungunya,Machupo,Junin,Mokola,Duvenhage,LeDantec,theKyasanur

Forestbrainvirus,HIV,theSmlikiForestagent,Crimean-Congo,Sindbis,O’nyongnyong,Marburg,EbolaSudan,EbolaZaire,and

EbolaReston(Preston1994).

Climatechangemayleadtodroughtandfireswithintropicalforestsandthisforestlosscanleadtofurtherclimate

change,causingevenfurtherforestloss(Butler,26);itisaviciouscycle.Thisdamagecanbedevastatingtothepopulations

thatrelyonforestsasasourceofnutrition.Nutritionalqualityofruraldietsisenhancedbyforestfoodsbecauseofthelarge

availabilityofmicronutrients(vitaminsandminerals)andphytochemicals.Benefitsfromtheseforestfoodsincludeantioxidant

functions,hypoglycemicfunctions,andmodificationanddetoxicationofpotentialcarcinogens.(Vinceti,Euzaguirre,andJohns,

2008)

Cerealgrainproductionismostlikelytobeaffectedbyclimatechange.Itaccountsfor70%ofglobalfoodenergymaking

itatargetresearchtopic.Decreasesordisruptionsinthefoodsupplywillnegativelyaffectpopulationsinisolatedareaswith

pooraccesstomarketsanddevelopingcountrieswhereaverylargeportionofthepopulationisundernourished.(Githekoand

Woodward,2003)

BrownandKelleyintroduceanissueinvolvingphysicians’lackoftrainingandknowledgewhenitcomesto

environmentalhealtheffects.Physiciansarethemosttrustedsourcesofmedicalinformation,buttheyareamongtheleast

informedregardingenvironmentalhealtheffects(BrownandKelley,2000).Physicianswithindistanceoftoxicwastesitesare

likelytobetiedtosourcesofpolitical,economic,andsocialpowermakingitmoredifficulttotargetthesourceof

environmentalhealtheffectsandthehazardsproducingtheseeffects.InonestudyinColorado,physiciansseemedhelpless

whenitcametotacklinggeneralenvironmentalhealthissuesandaren’tsurehowtoapproachtheproblem.Privatehealth

professionalsarefailingtolookatalargerpublichealthissueleavingagapinthehealthsystem.(Brown,andKelley,2000)

Contributingtotheoverallproblem,thereisashortageoftrainedoccupationalandenvironmentalmedicinephysiciansto

educatenewphysicians,alackofinformationontoxicsubstancespresentintheenvironment,andthewidespreadperception

amongphysiciansthatenvironmentaldiseaseisdifficulttodiagnose(BrownandKelley,2000).Intheinstanceofdeforestation,

thereisalackofattentionpaidinthehealthfieldtopeoplelivinginforestsbecauseforesthaveasmallpopulation,resources

arelimited,andhealthplannerseekmoreforthemoney(PierceColfer,2008).

InplacessuchasAfricaofficialsandprojectmanagersfornaturalresourcemanagementandruraldevelopmenthave

notconsideredHIV/AIDSandhumanhealthtobetheirconcernandhaveleftittostaffthathavenotconsideredthenatural

environmentasanimportantaspectoftheirwork(Lopez,2008).Forestresourcesofferfood,medicinalplants,andfunctionas

asourceofcashincomeforthosesufferingfromHIV/AIDS(Lopez,2008).Medicinalplants,whetherherbalortraditional,come

fromtreeroots,bark,leavesandfruits.ForthosewithHIV/AIDS,theseplantsassistinsupportingthestrengthsoftheimmune

systemandimproveappetites(Lopez,2008).Alongwiththis,propernutritionisextremelyimportantinHIVandAIDSpatients.

PropernutritiondelaysthedevelopmentofAIDSandextendslifeexpectancyandproductivityofthosethathavedeveloped

thesymptomsofAIDS.Forestsharvestleaves,mushrooms,flowers,fruits,roots,tubers,insects,andlargemammalsandallare

anarrayoffoodsources.Thereisarangeofforest-basedproductsthatareavailabletosupplyacashincomeforthosethatare

sufferingfrompooreconomicconditionsofdealingwithHIV/AIDS.Treesofferfirewood,charcoal,herbalremediesandwild

foods.(Lopez2008)Forestsaresignificantintheroleofsocioeconomicconditionsofcommunities.Theybenefitthe

populationssurroundingthemandwithhumandeforestationontherise,thesebenefitswillnolongerbeutilized.Itisupto

publichealthandprivatehealthofficialstotakeastandontrainingandpreservation.

Forestsarecomplexandrich.Forestlandsplaycriticalrolesinreservoirsoffoodplantsforcommunitieswithdiffering

lifestyles.Thiscanincludehunter-gathererpopulationstopopulationslivingatthemarginoftheforesttoagricultural

communities(Vinceti,Euzaguirre,andJohns,2008).Simultaneously,climatechangeanddeforestationaredecreasingthe

qualityandthequantityofforests(Butler,2008).Slowchangesinclimaticconditionsmayallowhumanpopulationstimeto

adapt.Forexample,peopleorcommunitiesmaydevelopnewwaysofcopingwith,orattenuating,risingresidential

temperatures.Abruptclimatechangesdonotallowsuchopportunities.(GithekoandWoodward,2003)

Whateffortsareweputtingforthasanationandgloballytocounteractthisclimatechangeanddeforestation?TheU.S.

GlobalChangeResearchProgramwasfoundedbyPresidentialInitiativein1989andmandatedbyCongressintheGlobal

ChangeResearchactof1990(U.S.GlobalChangeResearchProgram,2015).Thisactwasformedtodevelopandcoordinate“a

comprehensiveandintegratedUnitedStatesresearchprogramwhichwillassisttheNationandtheworldtounderstand,

assess,predict,andrespondtohuman-inducedandnaturalprocessesofglobalchange”(U.S.GlobalChangeResearchProgram,

2015).TheGlobalChangeResearchProgramhasorganizedTheNationalGlobalChangeResearchPlan2012-2021thatreflects

recommendationsfrommultiplereportsoftheNationalAcademies.Thisincludeslisteningsessionswithstakeholdersaround

thecountryandcollaborativeplanningamongtheU.S.GlobalChangeResearchProgrammemberagencies.Thisplanconnects

thefundamentalhumanandEarthsystemresearchwithcredibleinformationintoacoordinatedeffortforthefuturebenefitof

theNation(U.S.GlobalResearchProgram,2015).Thesetypesofassessmentsarevaluabletoriskmanagers,decision-makers,

andthepublic.Theinformationmaybeutilizedtopromoteeducation,training,andpublicawarenessofthepotentialhealth

impactsofclimatechange.(GrambschandMenne,2003)

Policieshavebeenarrangedfordevelopingnationstocelebratetraditionalmedicineandmerelyacknowledgingthe

needtopaymoreattentiontotheresourcesthatforestsoffer(Fowler,2008).Thisbeganin1978whentheWorldHealth

OrganizationreleaseditsAlmaAtaDeclarationthatproposedastrategyforimprovingthehealthstatusofpeoplearoundthe

world.Thisfolloweda1977strategytoinvestinresearchontraditionalmedicine.TheAlmaAtaDeclarationencouragesits

memberstatestouseindigenousmedicalpractitionersinpublichealthprograms.Thishasleadtovariousinternational

organizationsjoiningwiththeWorldHealthOrganizationtopromotetheuseofintegrativemedicine.Theseincludethe

AssociationofSouth-EastAsianNations,thePan-AmericanHealthOrganizations,theWorldBank,theWorldHealthAssembly,

andtheUnitedNationsChildren’sFund.TheAlmaAtaDeclarationseekstoassemblethetraditionalhealersandtraditional

birthattendantsintroprofessionalassociationsbecausethisputstheminabetterpositiontoreceivemedicaltraining.(Fowler,

2008) Itisinthesetimesofsicknessandchildbirththatthemajorityofpeoplewillseekoutthesetraditionalhealersdespite

theestablishmentofhospitalsandhealthcenters(Cunningham,Shanley,andLaird,2008).

Itisevidentthatenvironmentalhealthplaysalargeroleinthehealthofindividuals.Protectingoutplanetandutilizing

itsresourcesproperlywouldbeextremelybeneficialinthelongrunandhelpourplanetanditsinhabitantstogrow

simultaneously.Thisincludesrecognizingthepeopleandprofessionalsbehindthesciencetocontributepositivelytothis

environmentissueforthegreatergoodofpublichealthandgeneralwellbeing.

References

Ali,Robbie;Allotey,Pascale;Butler,Colin;Manuel,Cesario;PierceColfer,Carol

J.;Cunningham,Tony;Dounias,Edmond;Dudley,RichardG.;Eyzaguirre,Pablo;Fowler,Cynthia;Fröde,Alexander;

Froment,Alain;Gardner,RobertW.;Gollin,Lisa;Gómez,GaleGoodwin;Gonalez,Jean-PaulJ.;Gouilh,MeriadegAr;

Gyapong,Margaret;Johns,Timothy;Kozanayi,Witness;Lahm,SallyA.;Laird,Sarah;Leroy,EricA.;Limberg,Godwin;

Lopez,Pascal;McMillen,Heather;Nemarundwe,Nontokozo;Pattanayak,SubhrenduK.;Persoon,GerardA.;Reynes,

Jean-Marc;Roble,MariaNanetteRamiscal;Shanley,Patricia;Smith,KirkR.;Tiani,AnneMarie;Vinceti,Barbara;

Yasuoka,Junko.(2008).HumanHealthandForests:AGlobalOverviewofIssues,Practice,andPolicy.CarolJ.Pierce

Colfer(Ed.).London,UK:Earthscan.

Kroll-Smith,Steve;Brown,Phil;andGunter,ValerieJ.(2000).Illnessandthe

Environment:AReaderinContestedMedicine.SteveKroll-Smith,etall

(Ed.).NewYork,NewYork:NewYorkUniversityPress

McMichael,A.J.,Campbell-Lendrum,D.H.,Corvalán,C.F.,Ebi,K.L.,Githeko,

A.K.,Scheraga,J.D.,Woodward,A.(2003).ClimateChangeandHuman

Health:RisksandResponses.McMichael,A.J.,etall(Ed.).WorldHealthOrganization:Geneva.

Preston,Richard.(1994).TheHotZone.NewYork,NewYork:RandomHouse,

Inc.

A History of Smallpox Including Origin,

Vaccination, Epidemics, and Eradication

Autumn Funderburg

Ohio University

Variola virus (VARV), otherwise known as smallpox, is a contagious disease caused by a viral infection (Baker-Blocker, 2013). VARV

has one distinct trait: pathogenic specificity to humans; the variola virus is not susceptible to animals. It is believed that smallpox first made an

appearance in African agriculture around 10,000 B.C., evolving from a cowpox strain virus present on camels. This newly evolved strain spread

then to Egypt via traveling merchants (Hsu, 2013). It was in Egypt that the earliest known lesions from smallpox were found on well-preserved

Egyptian mummies; specifically, the mummy was that of Ramses V. The virus spread to Europe and was prominent in the Middle Ages (Stefan,

2005). Brought then to the Americas in the 1520s by the Spanish conquistadors, it was deadly for the native populations of America (Barnard,

2014).

The variola virus consists of two strains: variola major and variola minor. Variola major is the lethal strain while variola minor is the

milder form of the two strains that is different genetically from the major strain. Smallpox can be spread via physical contact, airborne droplets,

and through contact with scabs carried on fabrics such as bedding, towels, or clothing (Baker-Blocker, 2013). The incubation period for the virus

is between seven to seventeen days. Symptoms begin with common flulike headaches, muscle aches, and vomiting. As the virus progresses, a rash

forms on the skin, eyes, throat, and internal organs (Barnard, 2014). The rash has four stages progressing from lesions (any damage to tissue) to

fluid-filled vesicles to pustules (small blisters that contain pus) to scabs (Baker-Blocker, 2013). The lesions form on the face first, more often than

not, and are highly contagious. Smallpox will remain contagious until all the scabs have separated from the skin; this stage usually leaves scars on

the body. Smallpox may lead to serious complications that can include dehydration, blindness, scarring, sterility in men, and death.

Before modern virology and the germ theory, it was thought that diseases were a form of divine punishment. However, in the 18th century

a scientific connection had been established between smallpox and immunity. A smallpox epidemic occurred in Boston, Massachusetts in 1721. It

was during this epidemic in Boston that the correlation between disease and public health was recognized in America. How smallpox spread was

still unknown leading to home quarantining and patient isolation (Kass, 2012). Streets were cleaned, garbage was removed, and government

regulations for incoming and outgoing ships were enforced. While these regulations were helpful, it did not entirely stop the spread of smallpox.

Reverend Cotton Mather, a Harvard graduate with interest in science and medicine, convinced Dr. Zabdiel Boylston to start a variolation program

to stop the spread of smallpox (Stefan, 2005). Variolation was simply the process of introducing pus from a pustule off a smallpox victim to a non-

immune person (Stefan, 2005). Mortality rates dropped among those that had been inoculated, and the variolation program was deemed successful.

While this process did not originate in America, Boylston and Mather helped to spread the process throughout all the colonies of New England.

Fast-forwarding to the American Revolution when a major epidemic occurred, yet again, in Boston, Massachusetts. There was one issue

with inoculation: those inoculated suffered from the smallpox virus as though they had naturally acquired smallpox. This meant that contagion was

highly likely unless practiced under strict quarantine, making inoculation highly controversial (Fenn, 2003). The disease was beginning to affect

healthy soldiers under George Washington. Smallpox had been endemic in England for sometime before the epidemics in New England therefore,

the British soldiers were more likely to be inoculated. Variolated British soldiers guarded war zones while non-variolated American Soldiers were

falling victims to defeat and to smallpox. It was after this that George Washington required that all his soldiers be variolated before beginning new

military operations (Stefan, 2005). Beginning in the spring of 1977, American forces went through inoculation at West Point, Morristown, Valley

Forge, Alexandria, Dumfries, and Fairfax (Fenn, 2003).

The disease quickly moved westward, attacking susceptible populations and then

South, striking Mexico City in 1779 (Fenn, 2003). This led to more southern travel down into the South American Continent and back up into

North America to Texas and New Mexico leading to epidemics in 1780. These epidemics targeted not only revolutionary troops, but Native

American tribes as well. With Native American horse trade, the disease made its way to Canada back down into Missouri. These epidemics lasted

from 1776-1782.

Twelve years later, in the year 1794, Benjamin Jesty was one of the first to recognize the connection between the cowpox virus and

smallpox immunity. Jesty used the pus of cowpox lesions found on the udders of dairy cows in an attempt to protect his family from an outbreak

of smallpox (Stefan, 2005). Using a lancet, he transferred the pus from the udder lesions to the arms of his wife and two sons (Stefan, 2005). Jesty

is recognized as the first to vaccinate against smallpox; however, he did not follow the vaccination with scientific evidence or trials. His

vaccination was ill received after his wife’s arm became badly infected from the cowpox inoculation. After physical and verbal abuse from his

local community, Jesty and his family moved away. Years later Jesty had his two sons variolated with the smallpox virus and no symptoms

showed. This validated Jesty’s theory, however for fear of more abuse from the local community, he did not publicize his findings. (Jesty, 2010)

Following in the footsteps of Jesty, Edward Jenner experimented with vaccinations against smallpox using cowpox material. After hearing

tales of dairymaids being naturally protected from smallpox after being exposed to cowpox, he made the decision to utilize these cowpox lesions,

similar to Jesty. The subject of vaccination was an 8-year-old boy named James Phipps. Jenner used the pus from a cowpox lesion off the hand of

a dairymaid. The symptoms of the cowpox variolation caused mild fever and discomfort and, after nine days, loss of appetite and a cold sweat.

The next day there was vast improvement and Phipps was no longer showing symptoms. Several months later, Jenner performed the same

inoculation procedure on Phipps using the pus from a smallpox lesion and no disease developed. (Stefan, 2005) With the vaccination deemed

complete, he published a small booklet, An Inquiry into the Causes and Effects of the Variolae Vaccinae, a disease discovered in some of the

western counties of England, particularly Gloucestershire and Known by the Name of Cow Pox, and was now in search of more volunteers in

which to perform his newly discovered vaccination. It was not easy convincing the public, however, and many resisted vaccination. It was

slandered by powerful doctors of the time as unsafe and unnatural. Dr. Benjamin Mosely is considered the leader of the anti-vaccination

movement. Mosely performed inoculations and feared that vaccinations would steal his source of income. He arranged political cartoons and

propaganda with rumors that people would transform into cows if they used Jenner’s method. (Kean, 2013) Jenner fought back against the

resistance with science. His dedication to the eradication of smallpox and scientific evidence credit him as the first to successfully perform a

purposeful vaccination in the year 1796. With the help and support of surgeon Henry Cline, Dr. George Pearson, and Dr. William Woodville,

vaccination reached most European countries by 1800 (Stefan, 2005).

The vaccinations were effective, however, immunity was not life-long. It was later discovered that immunity from the virus after

vaccination is around 10 years (Mackelprang, 2005). The cowpox strain was becoming weak the more it was used because of ongoing passage. In

1896, Dr. Edward Ballard contributed an important factor to Jenner’s vaccination discovery: to regain strength of and enhance the virus strain,

cowpox must be deliberately passed back into the calves. This allowed for mass production of sufficient supplies of the cowpox material for

vaccination. (Hsu, 2013)

While vaccination had been considered successful, it was slow to spread. It was in short supply much of the time and hot climates proved

difficult for storage of the vaccine. Researchers developed a dried form of the smallpox vaccination in the 1920s, but its quality was inconsistent.

In 1949, freeze-drying was discovered to be an effective method in sustaining the vaccine and was used commercially by 1954. The vaccine was

now able to withstand tropical climates without refrigeration, unlike the non-freeze-dried version, and was able to last months. (PBS, 1998)

The first worldwide plan to abolish smallpox was formed by the World Health Organization in 1948. At this point in time, there were still

90 countries with a smallpox threat. Another worldwide plan to abolish smallpox was formed by the World Health Organization in 1958. Neither

plan was successful until the formation of the Smallpox Eradication Programme in 1966. (PBS, 1998) At this point in time there were still an

estimated 10 to 15 million cases of smallpox worldwide (Mackelprang, 2005). The Smallpox Eradication Programme had a ten-year plan to

combat the disease on a global scale (WHO, 2010). Starting with the poorest countries, the program slowly but surely continually helped to

eradicate smallpox country by country. It is the first human infection that has been completely eradicated by mankind (Jesty, 2010). The last three

cases of smallpox were reported in Somalia in 1977 and England in 1978 and, after a 150-year-old long journey, smallpox was declared officially

eradicated by the World Health Organization in 1980. (PBS, 1998)

In the event of a smallpox outbreak, the Advisory Committee on Immunization Practices (ACIP) has recommended that there is one

smallpox response team per state. The team is a group of health professionals that provide care to patients with smallpox. With a low risk of an

epidemic, the general population generally does not receive the smallpox vaccination. (Margolis, 2009) There are only two locations in the world

that have a sample of the smallpox virus. This includes the CDC in Atlanta and the Soviet Union in Russia.

More recently, there has been the threat of using smallpox as a biological weapon in an act of bioterrorism. Smallpox is one of the four

main microorganisms that pose a potential threat. Being the only viral threat, smallpox is unresponsive to antibiotics. The other three potential

threats are bacterial threats and include botulism, anthrax, and plague; all are responsive to antibiotics. Because the general population is not

vaccinated it is susceptible to exposure from an attack if bioterrorism were to occur. While an outbreak is unlikely, strategies have been created to

respond to an intentional smallpox release if one were to strike including approaches for a population-wide vaccination on first presentation of

symptoms, a preemptive population vaccination, and a ring vaccination. (Mackelprang, 2005)

“The speckled monster,” as it was once known, is one of the most historical viruses to date. It led to the decline of many populations all

over the world throughout its years of endemics and epidemics. Despite its negative connotation, smallpox contributed a great deal to the world of

science with the help of Benjamin Jesty and Edward Jenner. The discovery of variolation and vaccination opened doors for public health and the

prevention of many other diseases including polio, typhoid, hepatitis, and rubella.

References

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policies, practices, and implications for social work. Social Work, 50(2), 119-127. doi:10.1093/sw/50.2119

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Association: Japha, 49(4), 566-568. doi:10.131/JAPhA.2009.09522

Morgan, A.J. (2013). Edward jenner and the discovery of vaccination—an appeal for the

Edward jenner museum. Vaccine,31(43), 4933-4934. doi:http://dx.doi.org/10.1016/j.vaccine.2013.07.046.

Smith, R.P. (2013). Lesions. Magill’s Medical Guide (Online Edition).

World Health Organization declares smallpox eradicated 1980. (1998, January 1).

Retrieved March, 29, 2015, from http://www.pbs.org/wgbh/aso/databank/entries/dm79sp.html

WellWorksNutritionVolunteer

1. Crispy Turkey Tostada Recipe- WellWorks H20 Challenge 2. Green Bean Casserole Recipe- WellWorks H20 Challenge

3. Sodium PowerPoint- HeartWorks Sodium Class 4. Women’s Day Handout- WellWorks and Baker Center

5. Coffee Day PowerPoint- WellWorks Bulletin Board 6. The Smoothie Formula- WellWorks

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