The Identity Game

Have you ever played the Identity Wheel game? Here is a copy of the gameboard....

When you fill it out... what do you find? Here is what mine looks like:

My identity wheel doesn't really have much diversity in it at all. basically... it is a quick and easy people labeler. It took me about three minutes to fill out and I wasn't really surprised to say that it doesn't really tell anyone much about me that isn't already pretty obvious. I am a 41 year old, European ancestry white girl who considers herself to be heterosexual with some minor disabilities. I have had a multitude of low paying high responsibility jobs for most of my life in the medical field that have included working with adolescents in crisis and detox, emergency medicine and pharmaceutical distribution in both hospital and retail areas. I work 6 days a week almost all year to break $20,000 a year, am divorced with one child, and no military experience (had little interest and when recruited my physical stuff disqualified me.) I was born in Rhode Island, grew up in Colorado and Las Vegas and then moved to Maine 15 years ago and will probably stay here for the rest of my time here. I still have parents and family out west and I am trying to complete a college degree. I am a strong believing Mormon (LDS) with very unorthodox views so I do not fit in the orthodox church mold very well.

One thing that came to mind as I was filling this out was how simple it seemed to me and as I wrote down my sexual identity, gender, etc... I had an image of a teenager looking at the paper and hesitating.... Should they write down what they feel in their heart... or what other people would write down for them. In some ways this diversity wheel can also be used to obscure identity to try and fit in better in the society and culture you reside in. So while I found it pretty simple to fill out, I am also pretty comfortable with who I am at this stage of my life. For anyone who doesn't necessarily fit in the normative modes, each piece of the pie can come with hesitation and decision.

It also doesn't cover the aspects that make me who I am. My desires and dreams are no where and do not even leave any hints on this wheel and depending on when it is filled out, so much can change. I was married once and can get married again. I am interested in adoption so maybe I will add more children to my home... doubt it, but who knows. Even the boxes that seen clear such as religion do not tell how I interact with my religion and its teachings nor how other adherents around me change the religious experience for me. An interesting activity thought.

If you complete the activity for yourself, what does it tell you? Are you willing to share?


Bloodborne Pathogens Answer Key

Here are the answers I promised for the test I posted yesterday. I have also included some page numbers in the manual for those who are so inclined and have a manual. :)

1. A - (p. 4)

2. A - (p. 5 (6)

3. C - (p. 5)

4. B - (p. 4, 5)

5. C - (p. 4)

6. A - (p. 7)

7. D - (p. 8-9)

8. A - (p. 16-17)

9. B - (p. 9-10)

10. D - (p. 4)

11. D - (p. 9)

12. C - (p. 11)

13. A - (p. 5)

14. D

15. B - (p. 9-10)

16. D

17. B

18. C

19. D

20. B - (p. 5)

21. B - (p. 5)

22. D - (p. 9-10)

23. C - (p. 3, 11)

24. D

25. B - (p. 5)

pictures from: http://gotpulse.com/Bloodborne-Pathogen-Training.html


Bloodborne Pathogens Course Practice Test

As a Basic Life Support Instructor, I sometimes take the time to create practice tests for students to see how well the information has been maintained. The American Heart Association doesn't always have a test for a class and I sometimes have students ask for a pretest to get ideas on what the class covers. I wrote this test a few years ago and thought I would put it here for people to use. I will post the answers for it tomorrow. :)

1. What are Bloodborne Pathogens?
A. Germs in the blood that make people sick
B. Germs in the air that make people sick
C. Germs in all bodily fluids that make people sick
D. Germs in the environment that make people sick

2. Bloodborne pathogens training teaches....
A. How to act if an exposure to a bloodborne pathogen occurs
B. The employee to quickly leave the scene of a blood spill
C. How to clean up a blood spill without personal protective equipment
D. Safe handling of blood without wearing gloves

3. What does the 'P' in PACT stand for?
A. Power
B. Pathogen
C. Protect
D. Pulmonary

4. The main ways bloodborne pathogens can enter the body and make you sick include...
A. Picking up a towel with a small drop of blood while wearing gloves
B. Getting stuck with a sharp object that has blood on it
C. Wearing gloves with blood on them
D. Wearing gloves and picking up a container that has blood inside it

5. Which one of these symptoms is not a symptom of HIV/ AIDS?
A. Swollen glands and unexplained fever
B. Poor appetite with rapid weight loss
C. Manic or strong energy
D. Increased chance of catching other illnesses

6. Universal precautions refers to what?
A. Treating all bodily fluids as if it is infectious.
B. Wearing UV sunglasses outside.
C. Never leaving your house.
D. Protecting yourself against Universal aliens.

7. The purpose of (rubber) gloving up is to what?
A. Provide a sterile environment.
B. Make you look professional.
C. Keep your fingerprints out of the scene.
D. Protect
8. What is the best way to dispose of needles and other sharps?
A. After using the sharp, carefully dispose of it into a sharps disposal container
B. After using sharp, throw object directly into nearest trash container
C. Cap the needle and discard into a trash container
D. After using the sharp, carefully dispose of it into a biohazard waste bag

9. Washing Hands and skin after exposure
A. is not always necessary
B. is done with soap and large amounts of water
C. is not necessary if gloves are worn
D. is not necessary if waterless hand sanitizers are available and used

10. Which one of these symptoms is not a symptom of Hepatitis?
A. Nausea, vomiting and abdominal pain
B. Damage to the liver
C. Unexplained tiredness
D. Inflammation and contusions all over the body

11. Personal protective equipment may include all but:
A. goggles and/ or face shields
B. gown, apron, booties or shoe covers
C. cap or hood
D. sunglasses and work gloves

12. Biohazard waste warning labels are usually what color?
A. Black
B. Red
C. Orange
D. Yellow

13. What does the 'C' in PACT stand for?
A. Clean
B. Cardiac
C. Control
D. Content

14. An exposure control plan contains specific details and instructions on how to clean up a mess with blood- containing materials. All of the following usually part of that plan except:
A. Use the appropriate personal protective equipment
B. Dispose of cleaning materials and any personal protective equipment in the appropriate waste containers.
C. use absorbent materials to wipe up large amounts of blood
D. watching your co-workers struggle to clean and taping it all for posterity

15. You have cleaned up a blood spill and have removed your gloves. To protect yourself you should also:
A. Use waterless hand sanitizer
B. Wash hands immediately with soap and large amounts of water
C. Go to the break room for a glass of water and to fill out the necessary paperwork
D. Put the gloves in the closest trash can

16. What are the main diseases of concern when discussing the blood borne pathogen standard?

17. How many days can Hepatitis C live in dry blood?
A. 1 day
B. 4 days
C. 7 days
D. 14 days

18. What site of the human body is the most common site for TB disease?
A. Brain
B. Kidneys
C. Lungs
D. Liver

19. Hepatitis B and C can be spread by:
A. Having unprotected sex with an infected person.
B. Blood-to-blood contact with an infected person.
C. Eating food or drinking water infected with feces.
D. Both a and b.

20. Which of these is not a common entry point for bloodborne pathogens to enter the body?
A. Eyes and nose
B. Ears
C. Cuts or injuries in skin surface
D. Mouth

21. What does the 'A' in PACT stand for?
A. Assess
B. Act
C. Asphyxiate
D. Action

22. What is the single most effective form of protection for you and others during a bloodborne pathogen exposure?
A. Vaccination
B. Not eating in contaminated areas
C. Clean clothing
D. Hand washing

23. If you are exposed to potentially infectious materials on the job, you may request a vaccine for which bloodborne disease?
B. Syphilis
C. Hepatitis B
D. Brucellosis

24. Bloodborne pathogens may enter your system through:
A. open sores / skin abrasions
B. dermatitis
C. mucous membranes
D. all of the above

25. What does the 'T' in PACT stand for?
A. Talk
B. Tell
C. Touch
D. Time

Feedback and comments are welcome! Enjoy :)

pictures from: http://floridahomeboundfhb.com/Initial_orientation/Bloodborne/bloodb.php, http://www.slideshare.net/glenbrooksouth/blood-borne-pathogen-training


Bloodborne Pathogens: Introduction and Class Outline

One of the classes that I teach in my spare time is a Bloodborne Pathogens class. It is a class that is recommended for dentists, healthcare providers and other professionals who may deal with blood and other bodily fluids on a frequent basis. I created a basic outline to cover the information in class and I thought I would take some time over the next week to share some of the information that I give to students on a regular basis. I am hopeful that a few people can enjoy and possible use this information in your own lives. Over the next few days I will post my home written pretest along with answers.... Enjoy :)

What are Bloodborne Pathogens?

• Microorganisms present in the blood of persons who are infected with them (germs that make people sick)
What are examples of diseases that are caused by bloodborne pathogens?
• Hepatitis B infection -HBV-
Symptoms of Hepatitis – yellowing of skin or whites of the eyes, tired, abdominal pain, gastrointestinal problems including nausea and diarrhea, loss of appetite, damage to liver (can lead to death)
• Hepatitis C infection – HCV- can live in dried blood at least six hours and up to four days. (Hepatitis A is NOT transmitted by blood - it is transmitted by eating)
• Human Immunodeficiency Virus - HIV-, which causes AIDS – extreme tiredness, poor appetite with (rapid) weight loss, fever, swollen glands, etc. (affected person will get other illnesses easier (immunosupression) and can lead to death)

The Goal of this class is to discuss and reduce exposures as well as how to stay safe in environments and situations where exposures are more likely to happen!

How are bloodborne pathogens transmitted?
• By blood-to-blood contact only!
• Not by casual contact such as hugging, shaking hands, sneezing
Which body fluids may contain BBP?
• Human blood, semen
• Not urine, feces, vomit - unless visibly contaminated with blood
What are 'Universal Precautions'?
• You must treat all human blood as though it may contain any bloodborne pathogen... treat all bodily fliuds as if they are none to be infectious.
• You cannot tell if someone is infected by looking at them because many of these diseases do not show symptoms
What are the routes of infection of BBP in the general population or Most Common Forms/Paths of Exposure?
• Sexual contact
• Sharing needles among injecting drug users
• Mother to unborn child
What are the routes of infection of BBP in the workplace?
• Puncture or cut from a contaminated sharp object (needle, broken glass). This is the highest risk!
• Contact with broken skin (cut, hangnail, dermatitis including slight damage from shaving)
• Contact with mucous membranes of eyes, nose, mouth
Make a PACT, Know How to Act!
P - Protect : Protect yourself from blood or blood-containing materials
A - Act : Act quickly and safety
C - Clean : Clean the area that has blood or blood – containing materials
T - Tell : Tell your supervisor about the incident
How can I protect myself at work?
• Wear gloves if you need to touch human blood, used condoms or any item that can be or is suspected to be contaminated.
• Do not pick up needles or syringes with your hands. Use tongs or broom and dustpan.
• Do not use your hands to compress trash (to make more room in the bag). (A good rule is to not put your hands anywhere that you can not see everything they might touch)
• Use disinfectant to wipe up blood.
• Always wash your hands after you remove your gloves.
• Always wash your hands before you eat lunch and before you leave at the end of the day.

What should I do if I am stuck or cut with a contaminated sharp object (such as a needle stick or cut from broken glass, or if I get blood on an open cut, or in my mouth or eyes)?
• Wash the exposed area well
• Follow your companies procedures for notifying your Infection Control manager as set up in your company's Blood Borne Pathogens control guidelines
• Exposure control plan should include
• all job classifications that have chance of exposure to blood
• list of all tasks and procedures through which exposure may occur and are performed by employees
• methods of compliance to protect employees
• procedure for how to review problems

Are there vaccines available to prevent any of these diseases?
• There is a vaccine to prevent Hepatitis B that is given in three shots over a six month period
• You may get them through your physician or local health center or immunization clinic.
• Cost varies- some employers and health insurances will pay for these shots... never hurts to ask. :)

Feedback and comments are welcome! :)

pictures from: http://www.ehow.com/list_6822351_list-bloodborne-pathogens.html, http://www.emsworld.com/article/10320719/borne-free,


Analysis of Two Articles on Autism and Screening Tools

For an assignment, I chose two articles to study, analyze, and review on autism to understand some of the differences in focus and rhetoric used by writers to educate and hold their desired target audience. The first article was originally published in Valley Health Magazine in April 2014 and was written by Amanda Nicolson Adams. The primary focus of this article is to discuss autism and its prevalence along with the causes, screening tools, and treatments that are available for those who are diagnosed. The author has broken the article into sections so that she can concisely and specifically cover these topics without a lot of overlap or potential confusion. I chose this article for its well laid out design which is quite user friendly as well as its even tone and concisely listed information.
Dr. Adams begins the article with a quick overview on the increase of autism diagnoses in the United States and what the diagnosis actually describes in terms of its behaviors, physical and language difficulties, and the classification of ASD as a neurological disorder. The article states that hard numbers concerning the prevalence of individuals affected by autism can only be estimated due to the differences in sources and environments that affect diagnosis and treatment. “However, even conservative estimates place autism as more prevalent in pediatrics than cancer, diabetes, spina bifida, and Down syndrome combined.” Though research has confirmed that there are some biological and genetic markers, none of them are fully reliable for accurate diagnosis. A short discussion on the potential causes of autism that researchers have been able to identify make it clear that this disorder is widely misconstrued, and even with the enormous amounts of research that have been performed to discover and tabulate the precise causes, there is no clear consensus and no clear preventative measures that can be taken by parents and caregivers.

When discussing screening tools, Adams focuses on giving parents the information to begin the process of screening their children as soon as they recognize potential signs that their children may not be developing among the normal guidelines. The two tools that she recommends are the M-CHAT (Modified Checklist for Autism in Toddlers) and CARS (Childhood Autism Rating Scale). Both tools can be scored fairly quickly and the two potential negatives that she sees for these tests are that the tests can potentially create high false positives towards diagnosis and that some parents see the possibility that their child could potentially be wrongly diagnosed as a reason for not utilizing the screening tools. Her recommendation to “Screen anyway, treat anyway” is followed by the idea that early intervention treatment has no downside for the child and would help any child whether neuro-typical or autistic.

The article then closes with a discussion of treatments that are recommended for use in early intervention including ABA (Applied Behavioral Analysis), Floortime/ Relationship Development Model (RDI), Complementary and Alternative Medicine (CAM), and sensory based treatments. Her consensus is that ABA is the most effective treatment model with decades of research supporting it and that it works for children with autism “exceptionally well because of its precise teaching methodology and focus” on the strengths and weaknesses of each individual participant.

The second article for this assignment is titled, “The Modified Checklist for Autism in Toddlers: An Initial Study Investigating the Early Detection of Autism and Pervasive Developmental Disorder.” It was originally published in 2001 when the M-CHAT was being developed and studied for effectiveness and flaws. While the article is not the most current on this particular screening tool, I found myself continuously drawn back to it due to its uniqueness. In my experience, it is uncommon to find an article that discusses new research and ideas and how they are presented with the openings and recognition that newer, more comprehensive research may modify and transmute the original research into a new object altogether. Being able to look at a tool that is widely used now while in its infancy seemed like a wonderful opportunity that I have always have the ability to do, but have never felt motivated enough to attempt and complete. How could I ignore this perfect circumstance?

The article quickly summarized what autism disorder is and how important early intervention is for children in order to achieve more positive outcomes as they grow up, ending with “…there is no standard and easily administered screening instrument for young children.” Discussion on the gap between a parent’s first concerns about their child’s development and a visit to a specialist followed by a diagnosis suggests that having a quick, accurate, and easy way to identify children that need intervention as early as possible is an important and needed tool for both parents and professionals in the hopes of being able to intervene with at risk children as quickly as possible in their lives.

The paper continues on discussing the correlation with deficits and problem behavior that early intervention can minimize or change whereas behaviors can be harder or impossible to change when the individual is older and the brain has less flexibility. Recognizing that many of these at risk individuals also have unusual sensory responses to their environment and that many ‘signs’ of autism that are used to diagnose a child at 20+ months could be tracked and looked for at 18 months, the authors agree that a tool that would specifically help pediatricians more easily determine and refer at risk toddlers for early intervention would be optimal. The paper discusses the known useful characteristics of a screening device and then mentions the current tools available for use which include the Autism Behavior Checklist, the E-2 Form of the Diagnostic Checklist, the Behavior Rating Instrument for Autistic and Atypical Children, and the Autism Diagnostic Observation Schedule- Generic. Continuing by discussing the problems with the current screening tools used, the authors guide the discussion to the newest tool under development called the M-CHAT (Modified Checklist for Autism in Toddlers). It is an extension for one of the older tests which has been modified to not rely only on the observations of the pediatrician or heath care professional, but also on the observations and thoughts of the parent/caregiver. The rest of the article places its focus on how the M-CHAT works and evidence for its usefulness.

Both of these articles covered some of the same information to make sure that their audience understood the terms and concerns of the author. Both articles discussed Autism Spectrum Disorder, the behavior and deficits that are typically manifest in it (regardless of individual differences), and the importance of early intervention. The authors of these articles wanted to stress the use of screening tools to get children who are at risk into early intervention programs quickly- preferably as infants and toddlers so that there is less ‘wasted’ intervention time and more opportunity for positive change for the individual. As the article from Valley Health appears to be targeted to the average individual or parent, the author keeps the information pretty simple. The journal paper is targeted to a different audience, but also keeps the focus of its information on its chosen topic of the M-CHAT as a screening tool. The audiences that are targeted by the writings are very different and so will tend to be more variable for the targeted group. Lastly, both pieces of writing mention that while there are many kinds of treatment for autism available, the safest and most effective treatments are those that have been scientifically studied and tested.

In some ways, there were significant differences in the articles. In the Valley Health article, Adams made the case for treatments and tests that she preferred over others (the M-CHAT was a preferred screening tool.) The Journal article mentions many screening tools, but spends its focus on the M-CHAT as the article is written to share the initial research and information collected on its use. Adams uses her article to introduce autism and many basic questions people have – her focus is to really answer many basic questions that people have while the M-CHAT article is more focused on the screening tool itself and its differences from other tools available for use.

A few things that I learned from reading these articles was how differently articles are written based on their target audience. Even when the information is the same and agreed upon by both sources, the presentation and information about the topics can be very different. The Valley Health article was more generalized, which makes sense if you think that its target audience is the general public while the journal article was much more focused and had a more precise scope on the information it shared. It was useful to discover how many different screening tools there are to try and assess children and their strengths and weaknesses. I appreciated the recognition of both articles of how much parents themselves need to be involved in the process of diagnosis and treatment. A useful assignment indeed.


Holiday Letter 2015

For those who didn't get a copy of the Christmas newsletter this year, here it is in all its fun. Send me your address if you want one this next holiday. :)

This year has been a year of much joy. I have so much to be grateful for. During this year, I have gained a good job and found a wonderful place to rent and to stay and plant myself for the next few years. I have developed some new friendships and maintained and strengthened others. I became a nationally certified medical assistant this year and I am within a few semesters of graduating with my bachelor’s degree. My health is improving over time and except for overworking, I feel like I am doing so well. If there is one thing I have discovered this year, it is a tentative stability that I am hopeful to carry into the New Year and I will fight like mad to keep it.

Brock is doing very well. He is healthy and seems genuinely happy with life. His joy in books, love of animals and enthusiasm for food is a wonder to behold. He has fallen into responsibility and adoration of three accidentally homed ferrets and his heart is full of them and the joy of life. Spending time with him fills my mind and heart with a beauty and love I have rarely felt in my life.

I end this year feeling peace and joy and I hope for the same for all of you. Thank you – each of you – for being a part of my life… for being the wonderful people you are… for living as you do. Merry Christmas and a Wonderful New Year to you all. May we all be blessed this next year and bless those around us with our service and love.


A Nativity Metaphor

One of the things that I love about Christmas time is the varied opportunities to set up nativity scenes with my Bug. He has loved them since he was less than a year old and with fascination would reach towards the animals until one was handed to him. At this point in my life I have three incomplete sets of nativity pieces that with much laughter and smiles are carefully set up next to each other. Every year, the different pieces end up moving around the room as Joseph may be dragged off by a cat or Bug's service dog may casually pick one up when we are not looking and chew it to bits... or they even move when we use the pieces to recreate stories. These stories can be the birth of Christ as told in the Gospel of Luke or can become as varied as the barn scene in "The Last Battle" by C.S. Lewis. Sometimes, we just play farm and feed and tend to the animals that come with these nativity sets- always cows and sheep, but sometimes donkeys, horses, and even camels. Over the years I have worked pretty hard to make sure that my son understands that the nativity story with the animals is a tradition and is fun, but is very much not what the scriptures describe the events of the birth of Christ to be. The nativity tradition, while beautiful and fun, is not scriptural and in some ways seems to take away from the importance and the struggle of the event itself that we Christians celebrate - the birth of our Savior.

This year after Thanksgiving, I happily brought out the nativity sets for setting up. As usual, Bug and I sat down and placed them in the places we wanted. We added real hay and shavings to one of the stables and it always feels wonderful to sit back and look at the different groups. The sets are quite easy to tell apart as one is a Fisher Price plastic set, a hand carved wood set and a paper mache set that was hand painted for me by the young women of my branch a few years ago. I noticed this year that as the pieces began to be moved and scattered around the house, my son clearly had a very different image in his mind as he put them back and by the time that Christmas Day arrived, I had a very different nativity scene to view. So at a terribly early hour of the morning, while everyone else opened presents, I found my eyes and my thoughts drawn back towards the nativity scene in front of me. What I saw was three small smiling babies in the center of a large group which was then surrounded by animals and then the people. In some ways it looked a bit like how I feel about the sun.... the edges are easily seen but looking at the center is too bright, too hard.... too much. After the required present opening and fun, I chatted with Bug about the nativity and some of the same things that I saw as I looked down were emotions and ideas that he had been trying in a small way to suggest. Here are our thoughts:

1. How people picture the Savior can vary greatly on their perspective. His race, skin color, culture, facial expressions, etc... are things that are developed created by each of us and our religious culture. While every single person may see the Savior, his life, and his commandments differently, for those who celebrate his birth and life, we tend to see him as the center of our heart- the nucleus of our living soul. This is where Jesus Christ should be - in our minds and hearts, our thoughts and hopes. In essence, he should be our center and our life should revolve around him and our relationship with him.

2. The animals were set around him as a protection. Animals are pure and live the lives that they have been set to lead on this earth. They are here to live, to teach us, to sometimes feed us and to help us to recognize the divine all around us. As such, most animals will likely recognize the Christ in the flesh before we human beings shall and as each creature recognizes its spiritual heart, they will surround him in joy and protect him from harm.

3. People are on the outside of the circle as we are frail, easily distracted and of skewed perspectives. When we look at pictures of Christ with his mother and images that celebrate his birth, for many the joy is in the rest of the image behind the holy child... the cow in the next stall, the sheep standing next to a shepherd, the donkey tied up nearby. When we perform the nativity story in plays, each of the actors in the nativity are likely to play their character to the hilt and in most traditional nativities, they are more animals than people. So the majority of the action comes from the animals as well as the majority of the space taken up. As I discovered to my cost last year, telling a friend that having animals in a Nativity scene isn't scriptural can seriously get you gossiped and talked about even when the comment was mentioned in a closed door, private meeting. I was really surprised at how offended someone could get over the idea that Christ wasn't surrounded from his first earthly breath with joyous, happy livestock crowding in toward the manger for a better look. As Bug told me, "We see what we want to see, animals see what is there."

I look back a week later on this experience and find myself pretty pleased and tearful. I am grateful for an amazing and thoughtful child who is kind and empathetic and good-hearted. I am grateful that even with some of his learning challenges, Bug is aware of how to live a good life and is able to understand many human frailties and stumbling blocks. He also seems to understand where the Savior should be in our lives... in our hearts, the focus.... the center of our being. This is a Christmas gift I will never forget and always be grateful for. Tomorrow, my son will be 14 years old. I look forward to celebrating his birthday with him and eating cake. I am thankful for the gifts he has given me... especially these thoughts. Love you Bug. :)


It's Time...

I have had a nice sabbatical over the last several months and I am ready to begin again. Writing is such a part of my head and my heart that I am thrilled at the idea f starting again. I have some outlines on topics for this year - history fans, etc... will have quite a few things that they will enjoy. As I head to sleep on this beautiful evening on the first evening of this year, may we all sleep well and tell someone that we love them and how much they mean to us today. Let start a great new year together! And if you have any specific requests for the year, please share in the comments. :)