Global Commodity Chain Paper · Choose either a specific commodity or some aspect of a commodity chain (such as its labor and/or ownership/control conditions; social, economic, environmental, and/or health consequences; political violence/wars; etc.). · Emphasize relationships and activities of labor, capitalists, nation-states, consumers, and the natural environment. · Culture of capitalist/global commodity chains · Karl Polanyi’s Paradox · Negative externalities · Challenges of internalizing externalities (= “sustainability”) · Approximately 750-1000 words of narrative text; college standards of writing · Double-spaced 11 or 12-point Times New Roman font; in-text citations; references section; Chicago, MLA, or APA format. · If you want to focus on Covid-19 (or any other “signature” disease): · What is the global culture of capitalism?  What are "global commodity chains"? What are "negative externalities"?  What is "Karl Polanyi's Paradox"? What are examples of each within the global culture of capitalism? · What are the basic questions to ask about patterns of disease at any point in time and space? · Describe the relationships between (1) culture and disease; (2) cities and disease; (3) environmental change and disease; and (4) human ecology and disease. · What defines a “signature disease” of a specific historical time and pattern of geographic connections? How is Covid-19 an example of a signature disease?  · What are arguments--including the relevance of "Karl Polanyi's Paradox", "global commodity chains," and "negative externalities"-- for healthcare as a global public good (and as a human right), as opposed to healthcare as an individual, commodified choice? Extra Information Whatever specific topic you choose, you need to synthesize the course's fundamental issues by writing on each of the bullet-points below, though you can certainly write briefly on some items and more extensively on others (particularly on your chosen topic). Emphasize relationships and activities of labor, capitalists, nation-states, consumers, and the natural environment. · Culture of capitalism/global commodity chains · Karl Polanyi’s Paradox · Negative externalities · Challenges of internalizing externalities (= “sustainability”) Class, We continue our journey through the research process by looking at the results of data analysis. The lesson explores how researchers test and interpret data that were collected on the sample. You will need to download the Class Survey Hypothetical Results from the Optional Resources to Enhance Learning page and discuss them in the discussions. As you begin preparing for the Nutrition Feeding and Eating Assignment, it is important to realize that the Assignment consists of completion of a 2-3 page summary. Although you are required to access the Nutrition Feeding and Eating module, you are not required to complete this module/quiz. This is optional and completion of this quiz will not count toward your Core Grade. However,.

1. Global Commodity Chain Paper
· Choose either a specific commodity or some aspect of a
commodity chain (such as its labor and/or ownership/control
conditions; social, economic, environmental, and/or health
consequences; political violence/wars; etc.).
· Emphasize relationships and activities of labor, capitalists,
nation-states, consumers, and the natural environment.
· Culture of capitalist/global commodity chains
· Karl Polanyi’s Paradox
· Negative externalities
· Challenges of internalizing externalities (= “sustainability”)
· Approximately 750-1000 words of narrative text; college
standards of writing
· Double-spaced 11 or 12-point Times New Roman font; in-text
citations; references section; Chicago, MLA, or APA format.
· If you want to focus on Covid-19 (or any other “signature”
disease):
· What is the global culture of capitalism? What are "global
commodity chains"? What are "negative externalities"? What is
"Karl Polanyi's Paradox"? What are examples of each within the
global culture of capitalism?
· What are the basic questions to ask about patterns of disease
at any point in time and space?
· Describe the relationships between (1) culture and disease; (2)
cities and disease; (3) environmental change and disease; and
(4) human ecology and disease.
· What defines a “signature disease” of a specific historical time
and pattern of geographic connections? How is Covid-19 an
example of a signature disease?
· What are arguments--including the relevance of "Karl
Polanyi's Paradox", "global commodity chains," and "negative
externalities"-- for healthcare as a global public good (and as a
human right), as opposed to healthcare as an individual,

2. commodified choice?
Extra Information
Whatever specific topic you choose, you need to synthesize the
course's fundamental issues by writing on each of the bullet-
points below, though you can certainly write briefly on some
items and more extensively on others (particularly on your
chosen topic).
Emphasize relationships and activities of labor, capitalists,
nation-states, consumers, and the natural environment.
· Culture of capitalism/global commodity chains
· Karl Polanyi’s Paradox
· Negative externalities
· Challenges of internalizing externalities (= “sustainability”)
Class,
We continue our journey through the research process by
looking at the results of data analysis. The lesson explores how
researchers test and interpret data that were collected on the
sample. You will need to download the Class Survey
Hypothetical Results from the Optional Resources to Enhance
Learning page and discuss them in the discussions.
As you begin preparing for the Nutrition Feeding and Eating
Assignment, it is important to realize that the Assignment
consists of completion of a 2-3 page summary. Although you
are required to access the Nutrition Feeding and Eating module,
you are not required to complete this module/quiz. This is
optional and completion of this quiz will not count toward your
Core Grade. However, completion of the 2-3 page summary is
required and is included in the Core Grade. Please find the
attached instructions to help you prepare for completion of this
assignment.
PREPARING THE ASSIGNMENT

3. View and read any relevant resource material to help you better
understand the concept or solve the problem(s) given. To
complete this assignment log into ATI and select the “Learn”
tab. Click on Skills Modules, and then click the “Nutrition
Feeding and Eating” module. Click on the “lesson” tab and then
open the “Evidence Based Research” tab at the top of the page.
You are not required to complete the module but you must
complete a 2-3 page summary to submit. Please review the
below instructions in its entirety for additional guidance on how
to complete this assignment. Please reach out if you need any
additional guidance.
Remember the upcoming group assignment in Unit 7, and please
contact me with any questions or concerns as your group works
toward the goal of this project.
As always, if you have questions, please post them to the Q & A
Forum, where you and your classmates may view my responses.
ATI Contents on Assignment
Evaluating Nutritional Status
Study 1:
Formative evaluation of the feedback component of Children's
and Adolescents' Nutrition Assessment and Advice on the Web
(CANAA-W) among parents of schoolchildren
Study data
Vereecken, C., Covents, M., Maes, L. & Moyson, T. (2013).
Public Health Nutrition, 16(1), 15-26.
The purpose of this study was to evaluate an online nutrition
tailoring instrument, The Children's and Adolescents' Nutrition
Assessment and Advice on the Web (CANAA-W) among parents
of schoolchildren. Parents (n = 46) of pre-primary and primary-
school children recorded their child's food intake over a 3-day
period with CANAA-W and completed the evaluation
questionnaire online. A subsample participated in focus group
discussions. The findings of the study suggested that parents

4. were enthusiastic about the CANAA-W and a majority (81%)
found the advice comprehensible, logical, and useful. They also
indicated that the advice was helpful to improve their children's
eating habits, and they intend to use it.
Conclusions
The authors concluded that the CANAA-W is a feasible
modality for assessing nutritional status in children and
adolescents, and may be used to provide guidance for parents.
Further studies evaluating the outcomes of using the CANAA-W
are needed.
Study 2:
Validation of the Diet Quality Index for adolescents by
comparison with biomarkers, nutrient and food intakes: the
HELENA study
Study data
Vyncke, K., Cruz, F. E., Fajo-Pascual, M., Cuenca-Garcia, M.,
De Keyzer, W., Gonzalez-Gross, M., et al., (2012). British
Journal of Nutrition, 1-12.
https://journals.cambridge.org/action/displayAbstract?fromPage
=online&aid=8729138
The purpose of this study was to determine whether the Diet
Quality Index for Adolescents (DQI-A) is a good surrogate
measure for adherence to food-based dietary guidelines.
Participants (n = 1,804) were recruited in the Health Lifestyle
in Europe by Nutrition in Adolescence study. Dietary intake was
assessed by two nonconsecutive 24-hour recalls, and a DQI-
score was calculated considering the dietary quality, diversity,
and equilibrium. Associations between the DQI-A score, food
and nutrient intake, and serum biomarkers were investigated.
There was a positive association between the DQI-A score and
intake of nutrient-dense food items, but not total fat intake. The
DQI-A score also had a positive association with some serum
biomarkers, including 25-hydorxyvitamin D,
holotranscobalamin, and n-3 fatty acid.

5. Conclusions
The authors concluded that the data supported good validity of
the DQI-A by confirming expected associations with food and
nutrient intake and some serum biomarkers. Further research
evaluating the application of this tool in clinical practice is
needed to determine clinically meaningful outcomes.
Evidence-Based ResearchIdentifying those at risk for
malnutrition
Here are several studies, reviews, and guidelines that address
current research about best practices. We suggest that
healthcare providers access the entire research study and assess
the study’s quality and generalizability before applying the
findings to their own clinical practice.
Problem
Risk for inadequate or imprecise identification of patients with
imbalanced nutrition
Study Question
What methods can be used to identify those at risk for
malnutrition?
· Study 1
· Study 2
· Study 3
Beyond malnutrition screening: Appropriate methods to guide
nutrition care for aged care residents
Study data
Isenring, E. A., Banks, M., Ferguson, M., & Bauer, J. D. (2012).
Journal of the Academy of Nutrition and Dietetics, 112(3), 376-
381.
The purpose of this study was to determine the concurrent
validity of several malnutrition screening tools and
anthropometric parameters against validated nutrition
assessment tools in aged care residents. In this observational
study, 127 long-term residents over 50 years of age underwent a

6. nutritional assessment using screening tools and anthropometric
measurements to evaluate risk of malnutrition. The nutrition
screening tools evaluated included the Malnutrition Screening
Tool (MST), Malnutrition Universal Screening Tool (MUST),
Mini Nutritional Assessment-Short Form (MNA-SF), and the
Simplified Nutritional Assessment Questionnaire. Nutritional
status was assessed by Subjective Global Assessment (SGA),
Mini Nutritional Assessment (MNA), body mass index (BMI),
corrected arm muscle area, and calf circumference. Residents
were rated as either well-nourished or malnourished according
to each nutrition assessment tool.
Conclusions
The authors concluded that the MST, MUST, MNA-SF, and
anthropometric screens corrected arm muscle area and calf
circumference have acceptable concurrent validity compared
with validated nutrition assessment tools and can be used to
triage nutrition care in the long-term care setting.
Study 2:
Population-specific short-form mini nutritional assessment with
body mass index or calf circumference can predict risk of
malnutrition in community-living or institutionalized elderly
people in Taiwan
Study data
Tsai, A. C., Chang, T. L., Wang, Y. C., & Liao, C. Y. (2010).
Journal of the American Dietetic Association, 110(9), 1328-
1334.
The purpose of this study was to determine whether the cut
points for body mass index (BMI) based on the population or
calf circumference as an alternative would improve the
predictive ability of the short-form Mini Nutritional Assessment
(MNA). The study used a convenience sample of 301
community-living, 109 care center-living, and 68 nursing home-
living people, 65 years or older. The researchers evaluated the

7. short-form MNA in three versions: the original, a Taiwan
version that used population-specific BMI cut points, and a
Taiwan version that substituted calf circumference for BMI. The
results were compared with the long-form MNA as a reference.
The results showed that using population-specific BMI cut
points improved the predictive ability of the short-form MNA,
whereas replacement of BMI with calf circumference further
improved the predictive ability of the scale.
Conclusions
The authors concluded that using BMI cut points of the target
population improves the predictive ability of the Mini
Nutritional Assessment, and that calf circumference can be an
acceptable alternative to BMI. Because measuring calf
circumference is easier and less time-consuming than measuring
BMI, the modified tool can make periodic nutritional screening
an easier job and routine nutritional screening a more realistic
goal in geriatric care.
Study 3 :
Comparison of the prevalence of malnutrition diagnosis in head
and neck, gastrointestinal and lung cancer patients by three
classification methods
Study data
Platek, M. E., Popp, J. V., Possinger, C. S., DeNysschen, C. A.,
Horvath, P., & Brown, J. K. (2011). Cancer Nursing, 34(5),
410-416.
The purpose of this study was to compare the prevalence of
malnutrition diagnosis by three classification methods using
data from medical records of comprehensive cancer center. The
records of 227 patients hospitalized with head and neck,
gastrointestinal, or lung cancer were reviewed for malnutrition
using three methods of evaluating malnutrition: diagnosed
malnutrition ICD-9 codes, in-hospital nutritional assessment
conducted by registered dietitians, and body mass index (BMI).
The prevalence of malnutrition ranged from 8.8% based on BMI

8. to 26% of all cases based on dietitian assessment.
Conclusions
The authors concluded that implementing a validated tool that
can be used by various healthcare practitioners, including
nurses, should be considered in order to meet the Joint
Commission requirement of a nutritional screening of patients
within 24 hours of admission.
Study 1:
Malnutrition in a sample of community-dwelling people with
Parkinson's disease
Study data
Sheard, J. M., Ash, S., Mellick, G. D., Silburn, P. A., & Kerr,
G. K. (2013). PLOS One, 8(1), e53290.
The purpose of this study was to provide an estimate of the
extent of malnutrition in community-dwelling people who have
Parkinson's disease. The Subjective Global Assessment (SGA)
and Patient Generated Subjective Global Assessment (PG-SGA)
were used to assess nutritional status in 125 participants who
have Parkinson's disease. In addition, body weight, standing or
knee height, mid-arm circumference, and waist circumference
were measured. There were 19 (15.2%) who were moderately
malnourished. The symptoms most influencing intake were loss
of appetite, constipation, early satiety, and problems
swallowing.
Conclusions
The authors concluded that malnutrition remains under-
recognized and undertreated in people who have Parkinson's
disease, and that regular screening of nutritional status is
needed, with a focus on identifying problems that affect intake
so that appropriate interventions can be implemented.
Study 2:
Nutritional risk index as a predictor of postoperative wound

9. complications after gastrectomy
Study data
Oh, C. A., Kim, D. H., Oh, S. J., Choi, M. g., Noh, J. H., Sohn,
T. S., Bae, J. M., & Kim, S. (2012). World Journal of
Gastroenterology, 18(7), 673-678.
The purpose of this study was to determine the association
between the nutritional risk index score and postoperative
wound complications in patients undergoing gastrectomy.
Patients undergoing curative gastrectomy (N = 669) were
included in this retrospective study. Medical records of the
patients were analyzed to determine the nutritional risk index
score on the fifth postoperative day and the rate of
postoperative wound complications. The nutritional risk index
score showed a malnutrition rate of 84.6% among postoperative
patients. However, postoperative wound complications only
occurred in 9.86% of the sample. Of the patients with wound
complications, 94% were malnourished.
Conclusions
The authors concluded that malnutrition immediately after
surgery may play a significant role in the development of wound
complications in patients undergoing gastrectomy. Interventions
designed to address malnutrition in this population are needed
to determine whether they can decrease wound complications
postoperatively.
Study 3:
Risk for malnutrition related to specific health conditions
Study Question
What specific health conditions increase the risk of
malnutrition?
· Study 1
· Study 2
· Study 3
Risk of malnutrition is associated with mental health symptoms
in community living elderly men and women: The Tromso Study

10. Study data
Kvamme, J., Gronli, O., Florholmen, J., & Jacobsen, B. K.
(2011). BMC Psychiatry, 11, 112.
The purpose of this study was to evaluate the relationship
between malnutrition and mental health in community-living
elderly individuals. A cross-sectional survey with 1,558 men
and 1,553 women aged 65 to 87 years was conducted to assess
nutritional status using the Malnutrition Universal Screening
Tool (MUST) and mental health using the Symptoms Check List
10. The risk of malnutrition was found in 5.6% of men and 8.6%
of women. Significant mental health symptoms were reported by
3.9% of men and 9.1% of women. There was a positive
association between the risk of malnutrition and both significant
and subthreshold mental health symptoms in men and women.
Conclusions
The authors concluded that impaired mental health was strongly
associated with the risk of malnutrition in community-living
elderly men and women. Interventions to address malnutrition
should also incorporate methods of addressing mental health,
particularly anxiety and depression.
Study Question
What associations exist between nutritional status and health
outcomes?
Study 1:
Role of nutritional status in predicting quality of life outcomes
in cancer – a systematic review of the literature
Study data
Lis, C. G., Gupta, D., Lammersfeld, C. A., Markman, M., &
Vashi, P. G. (2012). Nutrition Journal, 11, 27.
The purpose of this systematic review was to determine the role
of nutritional status in predicting quality of life in cancer
patients. Major databases were used to identify publications of

11. research studies that used nutritional status as one of the
predictor variables and quality of life as one of the outcome
measures. Of the 26 included studies, 24 concluded that better
nutritional status was associated with a better quality of life.
One study supported this association only in high-risk patients,
and one study did not support an association between nutritional
status and quality of life.
Conclusions
The authors concluded that nutritional status is a strong
predictor of quality of life in cancer patients and recommended
that more providers implement the American Society of
Parenteral and Enteral Nutrition (ASPEN) guidelines for
oncology patients, including nutritional screening, nutrition
assessment, and intervention as appropriate.
What associations exist between nutritional status and health
outcomes?
Study 2:
Nutritional support for liver disease
Study data
Koretz, R. L., Avenell, A., & Lipman, T. O. (2012). Cochrane
Database of Systematic Reviews, 2012, Articles 5, CD008344
The purpose of this systematic review was to assess the
beneficial and harmful effects of parenteral, enteral, and oral
nutritional supplements on the mortality and morbidity of
patients who have underlying liver disease. Randomized clinical
trials comparing groups of patients with any underlying liver
disease who did or did not receive parenteral, enteral, or oral
nutritional supplements were identified through large databases.
Of the 37 trials identified, only one was at low risk of bias.
Most of the findings did not find any significant differences.
There were several trials suggesting improved serum nutritional
biomarkers, lower rates of infection, and fewer complications
with parenteral or enteral nutrition. However, the one trial of

12. low risk for bias found an increased risk of death in patients
receiving supplements.
Conclusions
The authors concluded that the data on providing parenteral,
enteral, or oral nutritional supplements to patients with liver
disease do not provide compelling evidence to justify routine
use. Data from well-designed randomized controlled trials with
an untreated control group are needed in order to determine
recommendations.
Problem
Adherence issues related to interventions for improving
nutritional status
Study Question
What type of interventions improve adherence to
recommendations on nutritional intake?
· Study 1
Interventions to enhance adherence to dietary advice for
preventing and managing chronic diseases in adults
Study data
Desroches, S., Lapointe, A., Ratté, S., Gravel, K., Légaré, F.,
Turcotte, S. (2013). Cochrane Database of Systematic Reviews,
2013, Issue 2. Art. No.: CD008722.
The purpose of this review was to assess the effects of
interventions for enhancing adherence to dietary advice for
preventing and managing chronic diseases in adults.
Randomized controlled trials that evaluated interventions
enhancing adherence to dietary advice for preventing and
managing chronic diseases in adults were included if the
primary outcome was the patient’s adherence to dietary advice.
Of the studies identified, 38 were included involving 9,445
participants. Among studies that measured diet adherence
outcomes between an intervention group and a control/usual

13. care group, 32 out of 123 diet adherence outcomes favored the
intervention group. Four favored the control group, whereas 62
had no significant difference between groups. Interventions
shown to improve at least one diet adherence outcome were
telephone follow-up, video, contract, feedback, nutritional
tools, and more complex interventions, including multiple
interventions. However, these interventions also show no
difference in some diet adherence outcomes compared to a
control/usual care group, making inconclusive results about the
most effective intervention to enhance dietary advice. There
was no significant effect on long-term adherence or outcomes.
Studies investigating interventions such as a group session,
individual session, reminders, restriction, and behavior change
techniques reported no diet adherence outcome showing a
statistically significant difference favoring the intervention
group. Overall, the studies were generally of short duration and
low quality, and adherence measures varied widely.
Conclusions
The authors concluded that there is a need for long-term, good-
quality studies using more standardized and validated measures
of adherence to identify the interventions that should be used in
practice to enhance adherence to dietary advice in the context of
a variety of chronic diseases.