Polyhydramnios and a sibling with cystic fibrosis would alert the nurse to the risk of the newborn having an intestinal obstruction.
An intestinal obstruction is a blockage that prevents food or liquid from flowing through the small or large intestines (colon).
An intestinal obstruction is a blockage that prevents food or liquid from flowing through the small or large intestines (colon). Fibrous bands of tissue (adhesions) in the abdomen that form after surgery; hernias; colon cancer; certain drugs; or strictures from an inflammatory intestine caused by certain illnesses, such as Crohn's disease or diverticulitis, can all cause intestinal obstruction.
Without treatment, the clogged intestinal portions can die, causing major difficulties. However, with appropriate medical attention, intestinal blockage is frequently treatable.
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true or false: a negative result to either a tst or igra test shows that a patient is indeed negative for tb.
What anterior pituitary hormone stimulates mammary gland colostrum production in late pregnancy?.
Answer:
Prolactin increases milk protein synthesis by boosting mammary gland ductal development and epithelial cell proliferation.
Explanation:
what aspects of the topic readings do you find the most interesting? what is your view of the analysis of disease and healing in the readings? explain.
The sickness could be considered to as a physical disorder, per the readings.
Even while a disease's typical response is a biological one, there are also social and psychological aspects to it.In order to comprehend moral discourse in comparison to other types of speech and writing, the metaethicist is concerned.My personal interpretation of illness and recovery from the readings is that it is the duty of a professional nurse to provide patients with the specialized spiritual care they require throughout the healing process.Scientism The reading's discussion on scientism's worldview was the one I found most fascinating. I was unfamiliar with and had never heard of this subject. Scientism adherents concur that the only trustworthy means for obtaining any correct knowledge are scientific procedures.To know more about physical disorder
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which one of the following is not a potential health consequence associated with the over-use of antibiotics? group of answer choices irritable bowel syndrome can develop. beneficial bacteria may not recover in our bodies. increased risk of excessive weight loss. allergies and asthma may be more likely to develop. increased risk of infection by pathogenic bacteria.
Increased risk of excessive weight loss is not a potential health consequence associated with the over-use of antibiotics.
What Is Overuse of Antibiotics?When antibiotics are used unnecessarily, it is known as antibiotic overuse. The invention of antibiotics is among the biggest medical achievements. However, overusing them has led to the development of resistant microorganisms (bacteria that are harder to treat).
The effectiveness of antibiotics against some germs has been declining over time. This may lead to more serious diseases such pneumococcal infections, skin infections, and tuberculosis (which can cause pneumonia, ear infections, sinus infections, and meningitis).
What Takes Place When Antibiotics Are Used Too Much?Colds and other viral illnesses cannot be treated with antibiotics, and they may even breed bacteria that are more difficult to get rid of.
When taken too frequently or for the wrong reasons, antibiotics can alter bacteria to the point where they no longer work to destroy them. This is known as bacterial resistance or antibiotic resistance. Some microorganisms are now resistant to even the strongest medications currently available.
Antibiotic resistance is a growing problem. The Centers for Disease Control and Prevention refer to it as "one of the most important public health challenges in the globe".
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which pre-competition meal will probably give a basketball player the greatest benefit without negative side effects? two slices of pepperoni pizza and a diet soda fried chicken and mashed potatoes and gravy two cups of whole-wheat pasta with tomato sauce, a slice of bread and a glass of water two donuts and a glass of chocolate milk
Two cups of whole-wheat pasta with tomato sauce, a slice of bread and a glass of water as a pre-competition meal will probably give a basketball player the greatest benefit without negative side effects.
The correct option is c.
What is a pre-competition meal?You can get the calories, nutrients, and fluids you need for an athletic competition at a pre-competition meal. Your pre-competition meal should provide you with the fuel you need to perform well and keep you from getting hungry while you're competing. Additionally, it gives you the additional fluids you need to stay hydrated.
When should you eat a pre-competition meal?Having adequate fuel to last the duration of the athletic event is the aim of the pre- competition meal. Your pre-competition meal should provide you the energy you need to perform, as well as the ability to avoid weariness, lessen hunger pangs, and hydrate yourself. Three to four hours prior to the event, consume your pre-competition meal.
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I understand that the question you are looking for is:
Which pre-competition meal will probably give a basketball player the greatest benefit without negative side effects?
a) Two slices of pepperoni pizza and a diet soda
b) Fried chicken and mashed potatoes and gravy
c) Two cups of whole-wheat pasta with tomato sauce, a slice of bread and a glass of water
d) Two donuts and a glass of chocolate milk
a breakdown in selective attention is most likely to be experienced by those who suffer from
Answer:
schizophrenia
Beta blockers may be used in combination with what other drug to reduce the risk of death or recurrence following a myocardial infarction?
Beta blockers may be used in combination with aspirin to reduce the risk of death or recurrence following a myocardial infarction.
What is the effect of combination of beta blockers and aspirin?According to recent studies, taking low-dose aspirin along with beta-blockers lowers blood pressure and eases anxiety symptoms brought on by bereavement. Aspirin slows the natural coagulation of your blood by having blood thinning effects similar to those seen in drugs called anticoagulants. Medications in the beta blocker class are frequently prescribed to patients with excessive blood pressure. Unwanted clot formation in arteries can significantly raise the risk of heart attack and stroke in persons with heart disease and slow normal blood flow. Beta blockers work by inhibiting the effects of the hormone adrenaline on beta receptors in our body. As a result, our heart is not under as much stress, which in turn lowers the pressure in your blood vessels.
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assuming your protocol allows the administration of nitroglycerin when certain conditions exist, what is the maximum number of tablets to be administered in the prehospital setting?
Assuming your protocol allows the administration of nitroglycerin when certain conditions exist, Three (3) is the maximum number of tablets to be administered in the prehospital setting.
Nitroglycerin sublingual tablets are used to treat bouts of angina (chest discomfort) in patients who have coronary artery disease (narrowing of the blood arteries that feed blood to the heart) (narrowing of the blood capillaries that give blood to the heart) (narrowing of the blood vessels that supply blood to the heart). It is also provided soon before activities that may cause episodes of angina in order to avoid the angina from forming. The medication nitroglycerin belongs to the vasodilators class of medicines. It works by relaxing the blood arteries so the heart does not need to work as hard and hence does not need as much oxygen. Nitroglycerin comes as a sublingual tablet to take beneath the tongue. The pill is generally given as needed, either 5 to 10 minutes before activities that may induce attacks of angina or at the first symptom of an attack. Ask your doctor or pharmacist to explain any instructions on your prescription label that you are unsure about.
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if a split-brain patient sees the word dog in his left visual field and the word house in his right visual field, which picture will he draw with the left hand (note that he is not allowed to speak while drawing)?
A split-brain patient who sees something in his left visual field can point to it with his/her left hand but will be unable of naming it.
The term "split-brain" refers to patients who have their corpus callosum cut to alleviate medically untreatable disease.
Due to the inability of passing information directly between the two brain hemispheres, split-brain patients exhibit abnormal behavior and particularly with respect to language and object recognition.
Split brain is also known as corpus callosum syndrome which is a type of separation syndrome when the corpus callosum that connects her two hemispheres of the brain is cut to some extent. This is a symptom associated by disruption or disruption of connections between hemispheres of the brain.
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the nurse completing a plan of care for a client with cirrhosis who has ascites and 4 pitting edema of the feet and legs identifies a nursing diagnosis of risk for impaired skin integrity. which nursing intervention is appropriate for this problem?
The patient with cirrhosis needs close observation, first-class supportive care, and sound nutrition counseling.
What is cirrhosis?In addition to affecting the liver, cirrhosis affects a number of other complicated organs, including the kidneys, heart, arteries, lungs, gut, and brain. Patients experience a variety of problems as a result, which raises morbidity and death rates and necessitates repeated hospital stays. Patients with cirrhosis need to be closely watched both within and outside of the hospital. In comparison to other chronic diseases, the role of nurses in the care of patients with cirrhosis has not been appropriately highlighted in this context, and there is relatively little knowledge on these patients' nursing needs. The current article reviews nursing care for the various issues that patients with cirrhosis may experience. Multidisciplinary teams should include nurses who have expertise in liver illnesses.
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the nurse is caring for a child who is scheduled for an appendectomy. when the nurse reviews the primary health care provider's preoperative prescriptions, which would be questioned?
The nurse is caring for a child who is scheduled for an appendectomy. when the nurse reviews the primary health care provider's preoperative prescriptions, Administer a Fleet enema.
The big intestine and a small pouch are joined by the appendix. Your stomach's lower right corner is where it is. Immediately removing your appendix is required if you have appendicitis. You risk having a ruptured appendix if you don't take care of it. A medical emergency has occurred. The appendix can be removed surgically using one of two methods. Open appendectomy surgery is the standard procedure. Laparoscopic appendectomy is a more contemporary, less intrusive surgery. surgical appendectomy You create an incision in the bottom right corner of your belly or stomach that is 2 to 4 inches long. The incision is used to remove the appendix. An appendectomy done laparoscopically. Little disturbance is necessary with this approach. That implies that a small incision was unnecessary. In its place, one to three microscopic cuts are formed. One of the cuts is used to insert a laparoscope, a long, thin tube.
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a nurse working in the ed at a level 1 trauma center is notified that casualties from a multivehicle car accident are currently in transit. the nurse's heart is pounding and mouth is dry. what gland is responsible for this nurse's physiologic response? thyroid gland adrenal cortex pineal gland adrenal medulla
The adrenal medulla.
The internal part of the adrenal gland. The adrenal medulla makes chemical compounds consisting of epinephrine and norepinephrine which are concerned with sending nerve indicators.
They produce many essential hormones, together with cortisol, aldosterone, and adrenaline. The adrenal hormones assist adjust numerous bodily features along with metabolism, blood stress, and your body's reaction to pressure.
Blood supply A extensive blood supply is essential to alter adrenal medulla hormones. Adrenal arteries department of blood vessels which includes the inferior phrenic artery, renal artery, and abdominal aorta. Nerve supply The greater splanchnic nerve enables your medulla to communicate with the relaxation of your body.
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what intervention should the nurse implement to help keep a 6-month-old infant calm during a physical assessment?
Encourage the parent to hold the infant. intervention should the nurse implement to help keep a 6-month-old infant calm during a physical assessment
Each stage of infant (0 to 12 month) and toddler (12 to 36 month) development is marked by a different milestone. Each milestone is typically attained by healthy newborns and toddlers within a certain timeframe, but the size of that window might vary widely. The newborn or kid should have symmetrical facial features. You should also look at the child's body posture and motions, nutritional condition, hygiene, mental alertness, and hair texture, thickness, and distribution. Finally, you should check the skin for lesions, bruises, scars, and birthmarks. noting psychological condition and actions.
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medicare is available to those: group of answer choices 60 years and older. with permanent liver failure. with certain disabilities. none of these is correct. flag question: question 2 question 21 pts the part of medicare that is the hospital insurance portion is:
Medicare is available to those with certain disabilities.
Medicare is available to people 65 and older, people with disabilities under the age of 65, and people with End Stage Renal Disease (permanent kidney failure requiring dialysis or transplant).
Medicare is a health-care program. Medical bills are paid from trust funds that those who are covered have contributed to. It primarily serves people over the age of 65, regardless of income, as well as younger disabled people and dialysis patients. Patients pay a portion of hospital and other costs through deductibles.
Medicaid covers millions of Americans, including low-income adults, children, pregnant women, elderly people, and people with disabilities. Medicaid is administered by states in accordance with federal regulations. The program is jointly funded by the states and the federal government.
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29. you arrive on scene with your partner levi to transport a patient that has been throwing up blood that looks like coffee grounds. this sign would lead you to believe that this patient has?
This sign would lead you to believe that this patient has gastrointestinal bleeding
What is GI bleeding?
Gastrointestinal (GI) bleeding is a symptom of a disorder in your digestive tract. The blood often appears in stool or vomit but isn't always visible, though it may cause the stool to look black or tarry. The level of bleeding can range from mild to severe and can be life-threatening.
Vomit that looks like coffee grounds is a sign of gastrointestinal bleeding. Veracity would be bright red blood. Pancytopenia is a reduction in the number of red and white blood cells, and platelets. Hemophagocytic Syndrome is severe hyperinflammation caused by the uncontrolled spread of infection to lymphocytes.
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a patietn who is prescrived a choleterol aborption inhibitor, ezetimibe (zetia), has developed swelling aroudn the eyes, nose and lips. what is the nurses priority action at this time
Zetia is a brand-name prescription drug. It’s FDA-approved to treat certain forms of high cholesterol in adults and in children ages 10 years and older.
Zetia can cause mild or serious side effects.Serious side effects from Zetia aren’t common, but they can occur.Don’t take an extra dose to make up for your missed dose. Doing this can raise your risk of side effects. Zetia inhibits the intestinal absorption of cholesterol and phytosterols, resulting in a decrease in the transport of intestinal cholesterol to the liver.A decrease in the transport of intestinal cholesterol to the liver reduces stores of hepatic cholesterol. This in turn increases clearance of cholesterol from the blood.Zetia’s mechanism of action is considered complementary to that of statins and fenofibrate.To know more about medicines visit:
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a nurse is observing a new nurse employee perform an abdominal assessment. the nurse determines the new nurse employee requires additional instruction if which action is performed?
a nurse is observing a new nurse employee perform an abdominal assessment. the nurse determines the new nurse employee requires additional instruction if Right lower quadrant is performed.
The largest cavity (space) in the body is the abdomen. It holds a number of the body's organs and is located between the chest and the pelvis. These organs include the intestines, stomach, and liver. The region of the body where the upper thighs meet the lowest part of the abdomen is known as the groin. By placing the flat of the hand on the abdominal wall and applying firm, consistent pressure, one can perform a deep abdominal palpation. Two-handed palpation may be advantageous (Figure 93.2), especially when assessing a mass. In this situation, the upper hand is used to apply pressure and the lower hand is used for feeling.
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the nurse is caring for a pregnant client who was diagnosed with acquired immunodeficiency syndrome (aids) and asks the nurse if she will be able to breastfeed the infant after delivery. which response by the nurse is appropriate?
The response that is more appropiate is that breast-feeding is contraindicated.
Why is breastfeeding contraindicated when you have AIDS?There are risks of transmission of AIDS through breastfeeding since it is a bodily fluid such as blood, semen or vaginal fluids that can transmit AIDS. The mother could breastfeed if she was taking anti-aids medication and it can be accompanied with an anti-aids treatment for the baby.
Although the risk of other diseases by not feeding the baby with breast milk is greater than the contagion of aids since breast milk contains substances that protect the baby's immune system.
Therefore, we can confirm that breast-feeding is contraindicated.
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a client is admitted with a stage four pressure ulcer that has a black, hardened surface and a light-pink wound bed with a malodorous green drainage. which dressing is best for the nurse to use first
Wet to moist dressing is best for nurse to use first.
What is moist dressing?
With this type of dressing, a wet (or moist) gauze dressing is put on your wound and allowed to dry. Wound drainage and dead tissue can be removed when you take off the old dressing. A moist wound environment has several benefits that result in faster and better quality of healing. It facilitates autolytic debridement, reduces pain, reduces scarring, activates collagen synthesis, facilitates and promotes keratinocyte migration over the wound surface, and supports the presence and function of nutrients, growth factors, and other soluble mediators in the wound microenvironment.
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a woman complains of severe abdominal and pelvic pain around the time of menstruation that has gotten worse over the last 5 years. she also complains of pain during intercourse and has tried unsuccessfully to get pregnant for the past 18 months. these symptoms are most likely related to:
Endometriosis and Primary dysmenorrhea.
The menstrual cycle is a sequence of herbal changes in hormone production and the structures of the uterus and ovaries of the woman's reproductive system that makes pregnancy viable. The ovarian cycle controls the production and launch of eggs and the cyclic launch of estrogen and progesterone.
The first day of a woman's period is day 1 of the menstrual cycle. periods remaining around 2 to 7 days, and women lose approximately 3 to five tablespoons of blood in a period, says Belfield. a few girls bleed extra heavily than this, but assistance is available if heavy durations are trouble. find out approximately treatments for heavy periods.
Length ache occurs whilst the muscular wall of the womb tightens moderate contractions constantly arise in your womb, however, they're normally so slight that maximum girls can't experience them.
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a patient, who recently received a transfusion of three units of red cells, is dat-positive with an igg specificity. what would be the best method to identify the patient's phenotype?
The best method to identify the patient's phenotype is by polymerase chain reaction-based assay.
What is transfusion?
A process whereby whole blood or isolated blood components are injected into a patient's vein and thereafter into their bloodstream. The blood might have been taken from the patient and kept in storage until it was needed, or it might have been donated by someone else likewise known as transfusion.
A tiny needle will be inserted into a vein during a blood transfusion, typically in the arm or hand. After that, a rubber tube transports the blood from a bag to the needle, which is inserted into the patient's vein. Vital indicators will be closely watched throughout the treatment.
Therefore, The best method to identify the patient's phenotype is by polymerase chain reaction-based assay.
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a patient comes down with severe diarrhea while in a foreign country. because he can't consume much food, his body compensates by using energy sources other than carbohydrates. this would result in
Traveler's diarrhea is a digestive tract disorder that commonly causes loose stools and abdominal cramps.
What is diarrhea?Traveler's diarrhea is a digestive disorder characterized by loose stools and abdominal cramps. It is caused by consuming tainted food or drinking tainted water. Fortunately, most people's traveler's diarrhea isn't serious — it's just unpleasant.
When you travel to a place where the climate or sanitary practices differ from those at home, you are more likely to get traveler's diarrhea.
To reduce your chances of getting traveler's diarrhea, watch what you eat and drink while on the road. If you do get traveler's diarrhea, it will most likely go away on its own. When traveling to high-risk areas, it's a good idea to bring doctor-approved medications with you in case the diarrhea persists or becomes severe.
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the nurse is administering an intravenous solution 250 ml to be infused over 2 hours. how many ml/hour should the nurse program the infusion pump
125 ml/hour should the nurse program the infusion pump when she is administering an intravenous solution 250 ml to be infused over 2 hours.
An external infusion pump is a medical tool used to carefully administer fluids to patients. Infusion pumps come in a wide range of varieties and are used in a number of settings and for a variety of purposes. Infusion pumps can supply fluids in big or little amounts, and they can be used to deliver nutrition or pharmaceuticals, such as antibiotics, painkillers, insulin or other hormones, or hormones, antibiotics, or chemotherapeutic drugs. Some infusion pumps are primarily intended for stationary use next to a patient's bed. Others, referred to as ambulatory infusion pumps, are made to be worn or portable. A medical gadget called an infusion pump helps patients receive fluids like nutrition and drugs in precisely measured volumes.
250 ml : 2 hours = X ml : 1 hour
250 = 2X
X = 250 / 2
= 125 ml/hr
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when discussing the use of a fluticasone and salmeterol inhaler with the parent of a child diagnosed with asthma, the nurse should teach the parent that the medication will be most effective if it is administered at which time?
Fluticasone and salmeterol are usually used two times a day, in the morning and the evening, 12 hours apart.
Why are fluticasone and salmeterol used?
The combination of these two medicines, fluticasone and salmeterol is used to treat difficulty breathing, coughing, shortness of breath, wheezing, and chest tightness that is caused by asthma. This combination is also used to prevent and treat shortness of breath, coughing, wheezing, and chest tightness caused by chronic obstructive pulmonary disease.
Fluticasone is classified under steroids. Salmeterol is classified under long acting beta agonists (LABAs).
Salmeterol relaxs and opens the air passages of the lungs, thereby making it easier to breathe, whereas fluticasone reduces swelling in the airways.
So hence, fluticasone and salmeterol are usually used two times a day, in the morning and the evening, 12 hours apart.
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the nurse is caring for a client who is scheduled to receive several vaccinations. which vaccine is an example of a live attenuated vaccine? measles, mumps and rubella vaccine tetanus toxoid hepatitis a vaccine influenza
Measles, mumps, and rubella vaccine are the example of a live attenuated vaccine.
The MMR vaccine offers excellent protection against measles, mumps, and rubella as well as against the complications brought on by these illnesses. According to the U.S. vaccination schedule, recipients of the MMR vaccine are typically thought to be permanently immune to measles and rubella. While MMR offers the majority of people excellent protection against the mumps, immunity to the disease may deteriorate over time and some people may no longer be immune to the disease later in life. In the event that you are at risk due to a mumps outbreak, you could require an extra dosage.The effectiveness of the MMR vaccine against measles, mumps, and rubella after one dose is 93%, 78%, and 97%, respectively.The MMR vaccine is 97% effective against measles and 88% effective against mumps when given in two doses.To know more about vaccine check the below link:
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after surgery an adolescent has a patient-controlled analgesia (pca) pump that is set to allow morphine delivery every 6 minutes. which statement indicates to the nurse that the family understand instructions about pca pump?
Keep in mind that only you should press the PCA pump's button. The nursing team is informed by an alert when the pump is empty.
What is patient-controlled analgesia ?
With patient-controlled analgesia (PCA), you can choose when to receive a dose of pain medication. In some circumstances, PCA may be a more effective method of pain management than calling for help (usually a nurse) to provide painkillers.
What is surgery ?
Surgery can entail physically altering human tissues and organs by cutting, abrading, suturing, or other means.
By pressing the button when you experience pain, the PCA pump is safe to use, but it won't provide the medication if it's not yet time for another dose. Keep in mind that only you should press the PCA pump's button. The nursing team is informed by an alert when the pump is empty.
Therefore, Keep in mind that only you should press the PCA pump's button. The nursing team is informed by an alert when the pump is empty.
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according to the physical activity pyramid, you should participate in activities to increase you muscular fitness more often than activities to increase your aerobic fitness. true false
This statement is false.
The physical activity Pyramid describes a Frequency, intensity and Time (suit) system for each different form of hobby. Tips are included for the usage of the bodily interest Pyramid efficiently and properly.
Reduce the threat of many unfavourable fitness results and chronic illnesses, including type 2 diabetes, weight problems, coronary heart sickness, high blood pressure, many forms of most cancers, despair, tension, and dementia. assist you attain and hold a healthful weight via burning energy.
Resistance education and weightlifting are styles of workout which can improve muscular power and people that enhance muscular staying power encompass biking, swimming, long-distance running and circuit education. Normal electricity or resistance education is vital for usual health and might advantage people of any age.
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Answer:
B.) False
Explanation:
a 65-year-old man who does not have housing presents to your emergency department with a report of fever, productive cough, and shortness of breath. he has a 40 pack-year history of smoking and daily alcohol consumption. his chest radiograph demonstrates a right upper lobe lung infiltrate with an air-fluid level. what is the most likely etiology for this finding?
The most likely etiology for this finding Administration of supplemental oxygen nebulized albuterol and ipratropium oral prednisone.
A suitable technique for assessing chest stretch is for the examiner to place a hand with the thumb on the posterior aspect of the chest wall at the T9 or T110 level and pinch a small fold of skin. Complicated bacterial pneumonia is the most common cause of pleural effusion in developing countries with more than 40% of pneumonia-infected patients having pleural effusion.
The lateral position taken with a horizontal X-ray beam is the most sensitive X-ray projection for detecting pleural effusions. After the placenta has been delivered these contractions help put pressure on the bleeding vessels in the area where the placenta was attached. If the uterus does not contract sufficiently these vessels will bleed freely. increase. This is the most common cause of postpartum bleeding.
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a woman at 10 weeks' gestation comes to the clinic for an evaluation. which assessment finding should the nurse prioritize?
Cell-free DNA testing/Non-invasive prenatal screening (NIPS): This blood test checks for fetal DNA in the mother's blood. It's done to see whether the fetus is at risk for a chromosomal disorder, and can be done from 10 weeks on.
What is gestation?
Gestation is the period of development during the carrying of an embryo, and later fetus, inside viviparous animals (the embryo develops within the parent).
It is typical for mammals, but also occurs for some non-mammals. Mammals during pregnancy can have one or more gestations at the same time, for example in a multiple birth.
things that should be done at 10th week pregnancy
1.Continue to take prenatal vitamins.
2.Continue to drink about 10 to 12 glasses of water a day.
3.Map out a healthy sleep routine.
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a pregnant client is positive for the human immunodeficiency virus (hiv). the nurse educates the client and determines that there is a need for further teaching if the client makes which statement?
Breast-feeding my newborn will be the best option for baby.
What is human immunodeficiency virus (HIV)?Human immunodeficiency virus (HIV) is a chronic disease that attacks the immune system, increasing your risk of serious infections or cancer. If HIV is not treated, it can progress to acquired immunodeficiency syndrome (AIDS), a severe form of HIV infection. There is no cure for HIV, but there are HIV prevention and treatment options.
Who is HIV affecting?An estimated 1.1 million people in the United States have HIV. Two out of every three new diagnoses are given to African Americans and Hispanics/Latinos. Both men and women are susceptible to infection. Men who have s-ex with other men, transgender women who have s-ex with men, and people who inject drugs are more likely to get HIV. HIV prevalence is higher in some communities.
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