The employer has a duty to provide a good working environment in addition to timely payments, and the employee has a duty to comply with the employer's recommendations.
What is the concept of employee and employer?The difference between employee and employer is mainly described as per the legal aspects of the law. While the employee is the one who provides the service, the employer is the company, which assumes the economic and hiring responsibility.
With this information, we can conclude that The relationship between employee and employer must have mutual respect, respect for the dignity of the employee, as well as the employee must have a posture of a true leader, having this authority and knowing how to impose his authority without being authoritarian.
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A group of nursing students are learning about the factors that underlie recent increases in the incidence and prevalence of antibiotic-resistant microorganisms. What factor is known to contribute to antibiotic resistance
The factor which is known to contribute to antibiotic resistance is the overuse of antibiotics.
Antibiotics :
Antibiotics, also referred to as antibacterial drugs, are medications that stop or inhibit the growth of bacteria. They are used to treat illnesses brought on by bacteria and comprise a variety of potent medications. Alexander Fleming discovered the first antibiotic Penicillin.
Overuse of antibiotics may lead to antibiotic resistance. Increasing patient age, population density, or the usage of inefficient antibiotics are rarely the causes of resistance. Some medical experts worry that people are using antibiotics excessively. They also suggest that this excessive use is a factor in the rise of bacterial illnesses that are resistant to antibacterial drugs.
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According to the 2015-2020 Dietary Guidelines for Americans, ______ is a nutrient of public health concern.
According to the 2015-2020 Dietary Guidelines for Americans, fiber is a nutrient of public health concern.
What is dietary fiber?Dietary fiber is a type of nutrient that is responsible for the normal functioning of the digestive system.
The dietary fiber is able to absorb waste products from foods to be excreted for the digestive system.
In conclusion, according to Dietary Guidelines, fiber is a nutrient of public health concern.
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A nurse is caring for a client who is postoperative following a complete thyroidectomy. Which of the following findings is the priority for the nurse to report to the provider
Airway patency is the finding which has a high priority and should be reported by the nurse to the provider when caring for a a client who is postoperative following a complete thyroidectomy.
What is Thyroidectomy?This type of medical procedure involves the removal of all or a portion of the thyroid gland as a result of different conditions such as the presence of cancerous cells.
Air patency which is referred to as the ease in which an individuals able to breathe using the oral and nasal cavities should be checked to prevent complications and in sever cases death.
This is as a result of the thyroid gland being present in the neck region and close to the windpipe thereby making it the most appropriate choice.
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A nurse manager is teaching the staff about professional negligence and malpractice. Which criteria that establishes malpractice will the nurse include
That duty was breached.
Duty of care was owed to the patient.
Specifically, nursing malpractice or negligence refers to a nurse failing to adequately complete his or her tasks, ultimately resulting in harm to the patient.
What are Malpractices and professional negligence ?A nurse's errors that are considered malpractice include administering the wrong medication, giving the wrong dosage, or giving the medication too early or too late.
A negligence claim may be in connection to variety of circumstances, including incorrect or delayed diagnosis, medication errors or administering the wrong treatment.Anyone suing a health care provider, including a nurse, for malpractice must prove four elements in order to prevail: duty, breach, causation, and harm.Learn more about Malpractices here:
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Pelvic inflammatory disease is a complication in 50% of the cases of ______. a. gonorrhea b. syphilis c. chancroid d. vaginitis
Pelvic inflammatory disease is a complication in 50% of the cases of a. gonorrhea.
Pelvic inflammatory disease :
Pelvic inflammatory disease (PID) occurs when an infection spreads from vaginal area to the cervix, the endometrium (lining of the uterus) and the fallopian tubes. The virus is typically spread through sexual contact. Additionally, it can happen following an infected bowel or an appendix rupture.
Chlamydia and gonorrhea, two sexually transmitted bacterial illnesses, are the most frequent causes of PID. 50% of sexually transmitted PID cases are brought on by chlamydia and gonorrhea. Recently, Mycoplasma genitalium has been identified as another sexually transmitted virus linked to PID.
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The Estimated Average Requirement is the amount of intake sufficient enough to meet the needs of __ % of the population
The Estimated Average Requirement is the amount of intake sufficient enough to meet the needs of 50 % of the population.
What is requirement?A requirement is defined as a need that a specific process aims to satisfy its completion of a goal. Requirement also means the need of something for the completion of a task.
So we can conclude that the Estimated Average Requirement is the amount of intake sufficient enough to meet the needs of 50 % of the population.
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Which BCBS program allows participating members to temporarily access health care from participating providers while away from their home service area for at least 90 days?
The away-from-home care plan allows the participating members to have access to healthcare when they are staying away from home for at least 90 days.
BCBS
The blue cross blue shield companies provide healthcare for their members. It is available in every state and allows its members to avoid unwanted and surprise medical bills. The insurance package covers the charges for hospitalization, various laboratory services, various care plans, etc.
Their away-from-home care plan allows the patients to get insurance when they are staying away from home for at least 90 consecutive days. If they are not staying for 90 consecutive days then they can rely on the Bluecar program. But it is necessary to alert the primary care provider so that they can direct the person to the care facility. The away-from-home care program is ideal for people with kids that reside in other states for various purposes such as studying.
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A community health nurse is reviewing information related to rural hospitals and closures. Which reason would the nurse most likely note as an issue that would force the closure of a rural hospital
Rural hospitals have a high risk for financial problems.
What is the reason there are so few hospitals in rural areas?
The population density is too low to support a large hospital. There are providers available to serve the population and residents are accepting of health care services, but not as many services are needed because of the lower population density.What defines a rural hospital?
According to the US Office of Management and Budget and the US Census Bureau, rural hospitals are those that are not found in a metropolitan area.
Do you think closures of rural hospitals impact hospitals in urban centers?
A study of hospital closures in California found that closing rural hospitals increased mortality for both heart attacks and strokes. This is because of the longer travel times in rural areas, which makes it more likely that closing a small rural hospital will have a negative impact than closing a small hospital in an urban area.Learn more about rural hospital
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Mrs. hernandez has recently moved to a long-term care facility due to declining health. since her admission 7 weeks ago, the nursing assistant notes that she has not received any visitors and that she appears increasingly quiet and withdrawn. the nursing assistant recognizes that mrs. hernandez's declining mood may be a result of what unmet needs
Answer:
lack of social experience
Explanation:
When you get old you either forgot or re-tell your life , old people prefer when young people listen cause it makes them feel young again.
Osteopathic Manual Therapy Reduces Gastrointestinal Dysfunction and Length of Stay for Premature Infants in Neonatal Int
Effect of osteopathic manipulative treatment on gastrointestinal function and length of stay of preterm infants: an exploratory study.
Osteopathic manipulative therapyOMT, or osteopathic manipulative therapy, is a manual therapy approach. Osteopathic manipulative therapy or osteopathic manipulation are other names for OMT. Osteopathic medical doctors (DOs) employ OMT to treat a variety of medical disorders including mechanical pain (pain from a structural imbalance in the muscle, tendon, or bone). OMT is another tool used by DOs to help your body work better and diagnose and prevent disease. The muscles, soft tissues, and joints are gently manipulated by DOs using a variety of OMT techniques. By ensuring that your bones and muscles are properly aligned and balanced, the procedure helps your body to repair itself.
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The nurse is preparing to change the dressing of a client's subclavian central venous catheter using a chlorhexidine gluconate (CHG)- impregnated patch and transparent adhesive dressing. Place the procedural steps in the correct order. All options must be used
The most typical types of dressing used to secure central venous catheters are gauze and tape or transparent polyurethane film dressings like Tegaderm, Opsite, or Opsite IV3000 (CVCs). There aren't any established rules for what kind of attire is most appropriate right now.
Apply clean gloves, put on a face mask, cover the client's face with a mask, and wash your hands.Assess the insertion site after removing the old dressing and CHG-impregnated patchThrow away the clean gloves, wash your hands, and put on sterile gloves.Cleanse the area with CHG using friction for at least 30 seconds, then let it thoroughly air dry.Cover the catheter insertion site with a sterile transparent dressing after applying a CHG patch.learn more about dressing here: https://brainly.com/question/27841978
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Mark has type 2 diabetes. For the past two weeks, his fasting blood glucose level has been below 130 mg/dl. Today, Mark's physician tested his blood. Although the fasting value was 125 mg/dl, she reported that he needs to do a better job of controlling his blood glucose level. Why would the physician make such a recommendation to Mark
Mark's HbA1c is 8.5. So the the physician make such a recommendation to Mark.
What is type 2 diabetes?Type 2 diabetes is a problem in the body's capacity to regulate and use sugar (glucose) as fuel.This chronic (long-term) disorder causes the bloodstream to circulate with an excessive amount of sugar. Over time, cardiovascular, neurological, and immune system issues might result from excessive blood sugar levels.Even though not all people with type 2 diabetes are overweight, obesity and a sedentary lifestyle are two of the most typical risk factors.Type 2 diabetes does not have a known treatment. But it is manageable. And occasionally it enters remission. Some people can manage their blood sugar levels by leading a diabetes-friendly lifestyle.Learn more about diabetes here:
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The thermic effect of food (tef) is generally equivalent to __________ of the energy content of food ingested.
Generally speaking, the thermic effect of food (TEF) is equal to 10% of the energy content of the food consumed. However, the actual figure will vary on a variety of variables, including age, the timing of the meals, and the macronutrient makeup of the meal (carbs, fat, and protein).
The body uses some of the calories it consumes to digest, absorb, metabolise, and store the food it does not utilise right away, and it also burns some calories as heat. There are other names for this process, including the thermic effect of food (TEF), particular dynamic action, and diet-induced thermogenesis (DIT).
Although the thermic effect of food (TEF), defined as the rise in metabolic rate following the consumption of a meal, has been thoroughly investigated, its significance in controlling body weight is debatable.
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Kids of abusive parents often display ________ attachment, and may run away from their parents in the Strange Situation experiment.
Answer: disorganized attachment
Explanation:
- disorganized attachment is rooted in unpredictable and inconsistent behavior from caregivers during a child's formative years
- this is an insecure style of attachment that develops when kids are raised in an environment that elicits fear, often involving abuse or a lack of reliability
signs of disorganized attachment in children can include:
- attention seeking
- avoidant
- inability to communicate needs
- lack of self-soothing skills
- hyper-focusing
- push-pull dynamic with caregivers
- confusion and ambivalence
hope this helps :)
Trends in weighted vital signs and the clinical course of 44,531 acutely ill medical patients while in hospital.
Background: Little is known about the fluctuations and patterns of a patient's specific vital signs while they are experiencing an acute sickness in the hospital.
Methods:
At the Thunder Bay Regional Health Sciences Centre in Thunder Bay, Ontario, Canada, 44,531 severely unwell medical patients were hospitalized. Each vital sign value was assessed, and weighted points from the VitalPAC Early Warning Score (ViEWS) were assigned to each value.These ViEWS weighted vital signs were averaged every 24 hours for the five days following admission and the five days prior to death or discharge. They were then added to get an approximate picture of each vital sign's course while the patient was in the hospital.Results:
In contrast to the other vital signs, the respiratory rate's weighted ViEWS points rise the highest in patients who pass away in hospitals and fall the most in survivors. Combining respiratory rate with any of the other vital signs weighted points decreased rather than improved the performance of their monitoring system.Conclusion:
The strongest predictor of clinical result is trends in respiratory rate, which can be seen at the bedside and weighted according to ViEWS; modest variations might foretell clinical fate many days in advance.
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Background: Little is known about the fluctuations and patterns of a patient's specific vital signs while they are experiencing an acute sickness in the hospital.
Methods:
At the Thunder Bay Regional Health Sciences Centre in Thunder Bay, Ontario, Canada, 44,531 severely unwell medical patients were hospitalized.
Each vital sign value was assessed, and weighted points from the VitalPAC Early Warning Score (ViEWS) were assigned to each value.
These ViEWS weighted vital signs were averaged every 24 hours for the five days following admission and the five days prior to death or discharge.
They were then added to get an approximate picture of each vital sign's course while the patient was in the hospital.
Results:
In contrast to the other vital signs, the respiratory rate's weighted ViEWS points rise the highest in patients who pass away in hospitals and fall the most in survivors.
Combining respiratory rate with any of the other vital signs weighted points decreased rather than improved the performance of their monitoring system.
Conclusion:
The strongest predictor of clinical result is trends in respiratory rate, which can be seen at the bedside and weighted according to ViEWS; modest variations might foretell clinical fate many days in advance.
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The nurse is caring for a client with a somatic disorder and knows that which interventions would be most helpful to this client
The interventions which would be most helpful to client who has somatic disorder are-
Boost the client's capacity for problem-solving.Analyze any "secondary gains" the client receives from the somatic disease.What is Somatic disorder?A diagnosis of somatic symptom syndrome is made when a person places a great deal of emphasis on bodily symptoms like pain, fatigue, or a shortness of breath to the point where it causes them great suffering and/or functional difficulties.
The person overreacts to the physical ailments in their thoughts, feelings, and behaviors.
Symptoms of somatic disorder are-
much time and effort devoted to symptoms or medical issuesDespite the fact that several symptoms and certain indications may come and go, at least single symptom is always present.a bodily symptom or several symptoms that are upsetting or interfere with daily existenceexcessive sentiments, thoughts, or actions associated with health issues or physical symptoms associated with at one or more of the following:persistent thoughts that are excessive for the severity of the symptomsongoing, extreme concern regarding health or symptomsTo know more about the major somatic symptom disorder, here
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During a well child examination of a 2-year-old child, the primary care nurse practitioner palpates a unilateral, smooth, firm abdominal mass that extends to the flank and does not cross the midline. What is the next course of action that
Refer the child to an oncologist immediately.
Who is an oncologist?A physician who treats cancer and offers medical attention to someone who has been diagnosed with cancer is known as an oncologist. A cancer specialist is another name for an oncologist.
Unilateral, smooth, and firm abdominal mass indicates the signs of cancer in the patient. Therefore the child must be referred to an oncologist who is a cancer specialist.
They'll make a cancer diagnosis and suggest potential treatments. The advantages and drawbacks of each choice will be discussed. Additionally, they coordinate your post-treatment care and supervise your treatment.
I understand the question you are looking for is this:
During a well-child examination of a 2yearold child, the primary care pediatric nurse practitioner palpates a unilateral, smooth, firm abdominal mass that does not cross the midline. What is the next course of action?
a. Order a CT scan of the chest, abdomen, and pelvis
b. Perform urinalysis, CBC, and renal function tests
c. Reevaluate the mass in 1 to 2 weeks
d. Refer the child to an oncologist immediately
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Which of the following is a risk factor for developing diabetes? Ethnicity Gender Dehydration Height
According to the research, ethnicity is a risk factor for developing diabetes.
What is diabetes?It is a serious metabolic disorder that is caused by a disorder in insulin, either a deficiency in the amount that generates an excess of glucose in the blood of the affected subject.
Its development can be significantly influenced by both maternal and paternal race/ethnicity and have different rates of complications.
Therefore, we can conclude that according to the research, ethnicity is a risk factor for developing diabetes.
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John, 68, is currently enrolled in a Medicare Supplement Plan with a stand-alone Prescription Drug Plan. Newly diagnosed with a chronic condition, he calls agent Charles on May 3 to ask if there are plans that will help him manage his condition. Can John enroll in a Chronic Special Needs Plan (C-SNP) that covers his chronic condition?
Yes, he can enroll using his Special Election Period.
What is Medicare Supplement Plan?Medicare Supplement Plan is an insurance plan that helps it's beneficiary to obtain some discounts in health related services rendered to them.
The Medicare Supplement Plan is different from other Medicare plans as it gives the beneficiary an opportunity to predict their medical costs.
The beneficiary on the Medicare Supplement Plan has a right to a free period called Special Election Period which gives the beneficiary the opportunity to enroll in other plans such as Chronic Special Needs Plan (C-SNP) that covers his chronic condition.
Therefore, Mr John who is currently in a Medicare Supplement Plan can enroll in a Chronic Special Needs Plan (C-SNP) that covers his chronic condition.
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A family member brings the client to the clinic for a follow-up visit after a stroke. The family member asks the nurse what he can do to decrease his chance of having another stroke. What would be the nurse's best answer
The nurse’s best answer would be to advice the patient to stop smoking as soon as possible.
What are the main causes of stroke?A stroke is a medical emergency caused due to damage to the brain from interruption of its blood supply.Stroke is mainly caused due to a blocked artery (ischemic stroke) or due to bursting of a blood vessel (hemorrhagic stroke).Symptoms of stroke include trouble in walking, speaking and understanding and may also cause paralysis of the face, arm, or leg.Medications like tPA (clot buster) can minimize brain damage if given at early stages. Overall this disease is incurable.The main causes of a stroke are high blood pressure, tobacco, heart disease, weight, age, medications, and diabetes.Smoking is an important risk factor causing stroke and to prevent stroke a person must quit smoking.Learn more about stroke here:
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A nurse at a long-term care facility is conducting a medication reconciliation for a man who has just moved into the facility. The man is currently taking clopidogrel. The nurse is most justified suspecting that this man has a history of:
It is very reasonable for the nurse to believe that this individual taking clopidogrel, has a background of coronary artery disease.
What is the function of the clopidogrel drug?
It is an antiplatelet drug. It stops platelets, a kind of blood cell, from congregating and creating a potentially harmful blood clot. If one has a higher risk of developing blood clots, using clopidogrel can help.Clopidogrel has been shown to reduce the risk of myocardial infarction, stroke, and vascular mortality in people with atherosclerosis and in those who have had coronary stents implanted. ITP, CVA, and hemophilia are not suggested conditions to be treated with it.When not to use clopidogrel?
For some folks, clopidogrel is not a good choice. In order to ensure that this medication is safe for you, let your doctor know if you:
possess an ulcer in the stomach or have had ulcers in the pasthave experienced brain bleeding (a brain hemorrhage)having a bleeding condition, such as hemophiliaLearn more about such problems here:
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The form of malnutrition in which children are of an appropriate height for their age but thinner than they should be is termed
Wasted
Low weight-for-height is known as wasting. It usually indicates recent and severe weight loss, because a person has not had enough food to eat and/or they have had an infectious disease, such as diarrhoea, which has caused them to lose weight.
What is Malnutrition ?Malnutrition is a serious condition that happens when your diet does not contain the right amount of nutrients
Low weight-for-height is known as wastingLow height-for-age is known as stunting.Children with low weight-for-age are known as underweightOverweight and obesity is when a person is too heavy for his or her height.Learn more about Malnutrition here:
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7. Curt is a patient who presents with a signed authorization to release his medical information to another clinic for continuing care.
You are the Release of Information clerk at Rasmussen Clinic. Will you limit the information provided because of the minimum necessary rule? Why or why not? Provide justification for your decision.
Professionally and truthfully, there shouldn't be any limitation whatsoever of what medical information, I would be providing for Curt in his interest to move to another clinic
So in the light of this, I won't limit the medical information I would be giving to Curt
What are health informations?Health information can simply be defined as those personal information about patient's health condition
However, these information includes information about the patient's health condition or illness or injury or any disability
So therefore, professionally and truthfully, there shouldn't be any limitation whatsoever of what I would be providing for Curt in his interest to move to another clinic.
Therefore, I as the Release of Information clerk at Rasmussen Clinic will not limit the information provided.
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An example of the recent geographic spread of a communicable disease includes: A. Chikungunya B. Polio C. Cervical cancer D. Smallpox
An example of the recent geographic spread of a communicable disease includes Chikungunya (Option A).
What is a communicable disease?A communicable disease is any type of transmissible disease that may be passed from one suitable host to another by different types of interactions.
The communicable diseases often can be spread through respiration by coughing or also by blood transmission.
In conclusion, an example of the recent geographic spread of a communicable disease includes Chikungunya (Option A).
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A client who is confused is found walking outside of the inpatient facility. Which of the following should be the nurse's initial action
The client's chair being equipped with a seat alarm.
What about nurse assess?The client exhibiting signs of a deep venous thrombosis should be evaluated by the nurse initially (DVT).The patient who requires a full body lift to enter the wheelchair because of an above-the-knee amputation Assignments are being made by the charge nurse at a long-term care facility.The patient who requires a full body lift to enter the wheelchair because of an above-the-knee amputation.Assignments are being made by the charge nurse at a long-term care facility.To avoid harm, the charge nurse should first remove the nurse from the unit and transfer the clientele of the nurse to another nurse.The morning laboratory results of a client are being faxed to a provider's office by an AP under the supervision of a nurse.
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Raj is considering ways to lose weight. Which weight-loss activity should be classified as unsupported
The weight-loss activity that should be classified as unsupported is the targeted fat removal.
What is weight-loss activity?Weight-loss activity is the type of structure activity that helps to reduce the weight and fat accumulation in the body.
When an individual wants to lose weight, the supported healthy activities include:
prescription weight loss drugs,exercise plans, and eating low cholesterol meals such as vegetables.Fat removal is unhealthy and can put the life of the individual in danger and complications.
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A client has opted to receive epidural anesthesia during labor. Which intervention should the nurse implement to reduce the risk of a significant complication associated with this type of pain management
Administration of 500 mL of IV Ringer's lactate
Lactated Ringer's injection is used to replace water and electrolyte loss in patients with low blood volume or low blood pressure. It is also used as an alkalinizing agent, which increases the pH level of the body.
What is Epidural anesthesia ?Epidural anesthesia is often used during labor and delivery, and surgery in the pelvis and legs.
Epidural and spinal anesthesia are often used when: The procedure or labor is too painful without any pain medicinea physician anesthesiologist will insert a needle and a tiny tube, called a catheter, in the lower part of your back. The needle is removed and the catheter left in place for delivery of the medication through the tube as needed.Learn more about Epidural anesthesia here:
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A nurse is working with a nursing assistive personnel (NAP) on a busy oncology unit. The nurse has instructed the NAP on the tasks that need to be performed, including getting patient A out of bed, collecting a urine specimen from patient B, and checking vital signs on patient C, who is scheduled to go home. Which of the following represent(s) successful delegation
1,3,4 Effective delegation is characterized by effective communication, demonstrating respect, and taking initiative.
What is a (NAP)?NAP: Nursing Assistive Personnel
The Function of Nursing Support Staff in Rehabilitation Facilities. In a range of therapeutic settings, including rehabilitation, it is acknowledged that nurse assistants (NAP) contribute significantly to the treatment and welfare of patients. responsibilities and passions for nursing philanthropy, marketing, public relations, alumni relations, and institutional growth.
A nurse explains to the NAP the approach to use in getting the patient up and why the patient has activity limitations. The nurse sees the NAP preparing to help a patient out of bed, goes to assist, and thanks the NAP for her efforts to get the patient up early. The nurse is in patient B's room to check an intravenous (IV) line and collects the urine specimen while in the room.
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Complete Question:
A nurse is working with a nursing assistive personnel (NAP) on a busy oncology unit. The nurse has instructed the NAP on the tasks that need to be performed, including getting patient A out of bed, collecting a urine specimen from patient B, and checking vital signs on patient C, who is scheduled to go home. Which of the following represent(s) successful delegation? (Select all that apply.)
1. A nurse explains to the NAP the approach to use in getting the patient up and why the patient has activity limitations.
2. A nurse is asked by a patient to help her to the bathroom; the nurse leaves the room and directs the NAP to assist the patient instead.
3. The nurse sees the NAP preparing to help a patient out of bed, goes to assist, and thanks the NAP for her efforts to get the patient up early.
4. The nurse is in patient B's room to check an intravenous (IV) line and collects the urine specimen while in the room.
5. The nurse offers support to the NAP when needed but allows her to complete patient care tasks without constant oversight.
Which of the following disease processes would MOST likely cause delayed or dysfunctional wound healing
Diabetes disease processes would most likely cause delayed or dysfunctional wound healing.
What is diabetes?When blood glucose, commonly referred to as blood sugar, is excessively high, it can lead to diabetes. Main source of energy, blood glucose, is obtained from the food.The pancreas produces the hormone insulin, which facilitates the uptake of glucose from food into your cells for use as fuel.Blood glucose (or blood sugar) levels that are elevated in people with diabetes are chronic metabolic conditions that over time cause substantial harm to the heart, blood vessels, eyes, kidneys, and nerves.Diabetes is a metabolic disease or a condition when the blood glucose levels are consistently elevated. In other words, it can be explained as a disorder that develops when the body is unable to effectively use glucose, a substance that provides energy for body cells.Learn more about diabetes here:
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According to the data found in this chapter, which of the following is one of the biggest problems related to safe patient handling and mobility (SPHM)
The biggest problems related to safe patient handling mobility (SPHM) are equipment is unavailable and is underused.
Safe patient handling mobility (SPHM) is assistive handling and mobility technology which can make it safe for caregivers and patients to mobilize them without any injury.
This technology ensures independence and mobility to the quality of patients' life.
Using this technology in early and progressive mobility programs promotes patients' functional status and improves clinical outcomes.
The survey evidence shows that the biggest hurdle is that only 75% of the caretakers have access to this SPHM technology and 25% of them use it consistently.
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