Surgery to remove the tumour is typically the first step in treating colon cancer. There may also be a recommendation for further therapies like chemotherapy and radiation therapy.
How easily can colon cancer be cured?When limited to the gut, colon cancer is a very treatable and frequently curable condition. About 50% of patients who have surgery are cured. Surgery is the main route of therapy. Recurrence after surgery is a significant issue and frequently the cause of demise.
Between 3 and 6 weeks following the first diagnosis, definitive resection of colon cancer is best performed. To achieve a slight but meaningful gain in overall survival, every effort should be taken to ensure that patients have final surgery within this time.
Most people who are diagnosed with colon cancer will be treated and live regular lives afterward.
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the nurse is providing care for a patient with a terminal illness. the patient states, "i am finished with feeling so sick. i just want to die." which comment indicates the nurse is experiencing an ethical struggle?
Nurse says, You must have trust in the possibility of a brighter future. Doctors may potentially declare that the condition because of cancer is fatal. This indicates that it will probably result in death within a short time.
It's hard to say how long, although it might be a few weeks to many months states a Nurse. According to a Nurse, You may experience distinct effects, as well as those of the people closest to you. Despite continuing to top the list of causes of mortality, cancer has gradually fewer hospice admissions and deaths due to new developments in cancer treatment. Doctors and nurse states that Less than 1 in 4 deaths in the United States are due to cancer.
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which division of the us department of health and human services (dhhs) is responsible for providing funding for research related to cancer treatment
The National Cancer Institute (NCI) is the top federal organization for cancer education and research. The National Cancer Institute (NCI) was founded in 1937 in accordance with the National Cancer Institute Act, and it is one of the 11 organizations that make up the Department of Health and Human Services (HHS).
What is National Institutes of Health?The United States Department of Health and Human Services' National Institutes of Health (NIH) is the country's medical research organization, making significant discoveries that advance healthcare and save lives. The Food and Drug Administration (FDA) and the National Institutes of Health (NIH) collaborate to advance public health by encouraging the development of new medical treatments and products based on results from fundamental and clinical research. The Nation's medical and behavioral research is overseen by NIH. Its goal is to discover fundamental truths about the nature and function of living systems and to use those truths to improve health, extend life, and lessen disease and impairment.To learn more about National Institutes of Health refer to:
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vegetarians have significantly higher rates of hypertension than the general population. question 13 options: true false
False, vegetarians have significantly higher rates of hypertension than the general population.
Blood pressure that is higher than usual is referred to as high blood pressure or hypertension. Your daily activities affect how your blood pressure changes. High blood pressure may be diagnosed if blood pressure readings are frequently above normal (or hypertension).
Your risk for additional health issues including heart disease, a heart attack, and a stroke increases with your blood pressure levels.
Over time, high blood pressure often increases. It may occur as a result of bad lifestyle decisions, such not engaging in adequate frequent physical activity. Obesity and diabetes are two illnesses that can make you more likely to have high blood pressure. Pregnancy can lead to high blood pressure as well.
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your patient is a 35-year-old man who has been hit by a pickup truck while jogging on the side of a busy road. he is unresponsive. his left leg is twisted and the end of the femur is visible. the scene is secure. as you approach your patient, the first thing you will do is:
Applying pressure in order to halt the bleeding must be our initial action. A femur fracture could be examined by the nurse on the patient.
A common message given by nurses is that each person's distal femur fracture is unique. When the nurse examines the bone, it may shatter transversely down its length or it may split into several fragments. The surface of the bone can get divided into a few (or many) pieces by these femur fractures, which can occasionally extend into the knee joint. The term "intra-articular femur fractures" refers to these kinds of fractures. It may be more challenging to treat intra-articular fractures since they harm the bone's cartilage surface, according to the nurses.
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a nurse is teaching a group of pregnant women about the signs that labor is approaching. when describing these signs, which sign would the nurse explain as being essential for effacement and dilation (dilatation) to occur?
Cervical ripening and softening sign would the nurse explain as being essential for effacement and dilation (dilatation) to occur.
What is Cervical ripening?During pregnancy, the cervix has two main functions. First, it maintains its physical integrity by remaining strong during pregnancy when the uterus expands dramatically. That physical integrity is critical for the developing foetus to remain in the womb until the time of proper delivery. Second, in preparation for labour, the cervix softens and dilates, a process called cervical ripening. These chemical and physical changes are necessary for cervical dilation, labour and delivery of the foetus.
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Alphanumerically sequenced list of all diagnosis codes divided into 21 chapters based on cause, or etiology, and body system can be found in what section of the icd-10 manual?.
The Index is an alphanumeric list of all diagnosis codes divided into 21 chapters based on cause (or etiology) and body system. Subterms are words that are indented beneath the boldfaced Main Term and describe variations of the condition.
An alphanumeric sequence is one that contains both alphabets and numbers. Along with alphabets and numbers, we can include symbols in this sequence. Alphanumeric data is data that contains both letters and numbers. "1a2b3c," for example, is a short string of alphanumeric characters. The term alphanumeric is frequently used to describe the presence of text that can be entered or used in a field, such as an alphanumeric password field.
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a young client gives birth to twin boys who shared the same placenta. what serious complication are they at risk for?
By sharing the same placenta Twin-to-twin transfusion syndrome (TTTS) is occurred.
TTTS, or twin-twin transfusion syndrome, is an uncommon but deadly illness that can develop during pregnancy. When a placenta is shared by identical twins, this occurs (monochorionic). The placenta develops abnormal blood vessel connections. They permit the fetuses' blood to circulate inequitably. Dehydration affects one twin, known as the donor. High blood pressure appears in the recipient twin, the other twin. The recipient overfills the amniotic sac by excreting too much urine.
The placenta is afflicted with TTTS. The impact varies for every twin. Urine production on the donor twin is below average. The result is inadequate fetal growth and insufficient amniotic fluid. The donor twin excretes more pee than usual. The result is a larger bladder and an excess of amniotic fluid.
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what is the first step in wound treatment, which involves removal of dirt, foreign bodies, damaged tissue, and cellular debris? group of answer choices curettage débridement escharotomy cauterization
Answer:
Escharotomy is the first procedure1. describe the principles of respiratory and cardiovascular anatomy and physiology. 2. describe the function and role of the respiratory and cardiovascular systems in oxygenation. 3. describe age-related differences that influence the care of patients with oxygenation problems. 4. identify factors that affect respiratory and cardiovascular function. 5. perform a cardiopulmonary assessment using appropriate interview questions and physical assessment skills. 6. develop nursing diagnoses that correctly identify problems that may be treated by independent nursing interventions. 7. describe nursing strategies to promote adequate oxygenation and identify their rationale. 8. plan, implement, and evaluate nursing care related to select nursing diagnoses involving oxygenation problems.
1.Pulmonary Ventilation 2.Gas exchange occurs with the intake of oxygen and release of carbon dioxide 3.Respiratory Activity in the INFANT 4.-Integrity of the airway system to transport air to and from lungs.5.Inspection of the patient's breathing pattern 6.oxygenation
Inspiration: the active phase of ventilation; Involves movement of muscles and the thorax to bring air into the lungs.Expiration: the passive phase of ventilation; Movement of air out of the lungs.Made possible by respiration and perfusionOccurs via diffusion (movement of oxygen and carbon dioxide between the air and blood).-Lungs are transformed from fluid-filled structures to air-filled organs.-Properly functioning alveolar system in lungs.
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the nurse is assessing a 5-month-old asian american infant whose mother has brought him to the clinic with reports that the baby is pulling at the ear and is sleepless and crying at night. when assessing the infant's ears, what color cerumen would the nurse expect to find?
Grey colour cerumen would the nurse expect to find.
What is cerumen?Earwax, also known by the medical term cerumen, is a brown, orange, red, yellowish or grey waxy substance that is secreted into the ear canal of humans and other mammals. It protects the skin of the human ear canal, helps clean and lubricate, and protects against bacteria, fungi and water.
Anyone who has accidentally tasted earwax knows that it has a terrible sour taste, inside that earwax is usually acidic. We know that acidic foods also taste acidic, so the different taste of earwax makes sense.
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an 85 year old person has a urinary tract infection. what clinical manifestation does the healthcare professional expect to see in this person?
Seniors experiencing UTIs show a sudden change in behavior and symptoms such as: Frequent falls, confusion and dizziness.
Older people are susceptible to UTIs due to weaker flow of urine. An enlarged prostate in men, also make it difficult to empty the bladder completely. This causes bacteria to be build up in the urine and bladder.
Mostly, older people recover from urinary tract infection at home with use of an antibiotic. Older women who develop UTIs frequently should be given an estrogen cream to apply regularly.
UTIs in older people as well as in younger men would require a longer duration of antibiotic therapy than UTIs in young women. Women usually do not have complicated infections.
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a parent has brought her 2-week-old infant to the emergency department due to the infant's persistent and increasing jaundice. laboratory testing reveals indirect bilirubin level is 28 mg/dl (479 µmol/l), but otherwise a normal physical assessment. which intervention will most likely be prescribed for this infant?
Phototherapy should be advice as the infants bilirubin level is 28 mg/dl .
A level of indirect bilirubin at or above 20-25 mg/dl may cause irritation in some areas of the brain. This is called acute encephalopathy (inflammation of the brain). If the bilirubin remains very high, above 25 mg/dl, babies can be at risk for significant brain damage. This very rare condition is called kernicterus.
Phototherapy is treatment with a special type of light (not sunlight). It's sometimes used to treat newborn jaundice by making it easier for your baby's liver to break down and remove the bilirubin from your baby's blood.
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a client is admitted for evaluation of cerebral aneurysm. which assessment finding is of greatest importance in prioritizing nursing care to this client?
A weak or thin area on a brain artery that balloons or bulges out and fills with blood is referred to as a cerebral aneurysm (also known as a brain aneurysm). The nerves or brain tissue may be compressed by the bulging aneurysm.
What is cerebral aneurysm?A weak or thin area on a brain artery that balloons or bulges out and fills with blood is referred to as a cerebral aneurysm (also known as a brain aneurysm). The nerves or brain tissue may be compressed by the bulging aneurysm. Additionally, it could burst or rupture, leaking blood into the nearby tissue (called a hemorrhage). The majority of intracranial aneurysms form between the skull's base and the brain's bottom. The aneurysm may rupture or leak, resulting in potentially fatal bleeding.Usually, an unruptured aneurysm has no symptoms. A sudden, excruciating headache is a major sign of a ruptured aneurysm. Blood pressure drugs and surgeries to stop a future rupture are two treatments for aneurysms that have not ruptured.Typical issues that could result in nausea and vomiting include: food sensitivities stomach or intestinal infections, such as food poisoning or the "stomach flu." stomach contents (food or fluids) leaking upward (also called gastroesophageal reflux or GERD).To learn more about cerebral aneurysm refer to:
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a client who is complaining of nausea and vomiting postoperatively receives a prescription for metoclopramide (reglan) 10 mg iv. the medication is available in vials containing 5 mg/ml. how many ml should the nurse administer? (enter numeric value only.)
The nurse should administer only 2ml of the prescribed medication.
What is medication?A medication can be described as a drug used to diagnose, cure, treat, or prevent disease.
If a client who is complaining of nausea and vomiting postoperatively receives a prescription for metoclopramide (reglan) 10 mg iv. the medication is available in vials containing 5 mg/ml, the nurse should administer 2ml of the prescribed metoclopramide (reglan).
There are generally 4 types of medication one can come across and they include:
General Sales List.Pharmacy Medicines.Prescription Only Medicines.Controlled Drugs.Medication can serve the following purposes :
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the nurse is assessing a client with an older arteriovenous (av) graft for hemodialysis access in the left arm. the client reports significant pain to the distal left arm. capillary refill in the left hand is greater than 4 seconds. which should the nurse assess before contacting the health care provider?
Answer:
Explanation:
pulse, movement, check for numbness, a fuzzy feeling. take blood work make sure the client is stable. than contact a health care provider
Answer: Check AV graft for complications (good to check other vitals and utilise your nursing assessment skills, but this could be an emergent problem so act quickly as to not delay calling the Doctor!)
Explanation:
An arteriovenous (AV) graft is a surgically constructed vascular access point inside the blood vessel structure of the patient's arm (think like adding a straw between a vein and and artery). It is used to exchange (in and out) blood during hemodialysis (when you use a machine to clean to blood such as when kidneys are failing). AV grafts however necessary have some risky possible complications including Ischemic Steal Syndrome and thrombosis. So check the AV graft, assess area surrounding it (already done to some extent with getting cap refill), and call the doctor!
Note: I think getting blood work would be a very bad idea before calling the doctor as blood work should be ordered by the Health Care Provider not the nurse (nurses don't write lab orders). Even if the nurse say had a prewritten lab which needed to be drawn, blood work can take a longtime, AV graft complications would likely not show in lab results (as blood flow not blood content is likely the problem), and the fact the the patient has a AV graft leads a nurse to worry about AV complications as a first culprit. Thus blood work should probably not be taken at this time!
You are working in an outpatient surgical clinic in the preoperative holding area. Each patient is monitored with a
pulse oximeter. You check Mrs. O'Shaughnessy's fingers and notice that they are cold to the touch and have poor blood
return. What should you do?
You check Mrs. O'Shaughnessy's fingers and notice that they are cold to the touch and have poor blood the very first thing i will do that i will check all vital signs (blood pressure, heart rate, respiratory rate, temperature) refer to the physician in charge of the patient. In this patient who looks pale with a slight grimace on general survey, with irregular and bounding pulses, the differential diagnoses with be: (1) cardiac pathology, (2) hemorrhagic shock, or (3) severe anemia. The attending physician shall be informed immediately for the proper management to be ordered.
What are the basic diagnosis administered to the patient?The basic diagnosis administered to the patient are (blood pressure, heart rate, respiratory rate, temperature) refer to the physician in charge of the patient. In this patient who looks pale with a slight grimace on general survey, with irregular and bounding pulses, the differential diagnoses with be: (1) cardiac pathology, (2) hemorrhagic shock, or (3) severe anemia.
Therefore, the very first thing i will do that i will check all vital signs (blood pressure, heart rate, respiratory rate, temperature) refer to the physician in charge of the patient.
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a nursing student is preparing to administer the drug bethanechol to a client with urinary retention. after researching the drug’s actions and uses, the student demonstrates understanding of the drug by identifying it as which type of medication? select all that apply.
wo nurses are checking a unit of packed red blood cells (prbcs) for client compatibility prior to infusion. what action should the primary nurse take after completing this process
Bring back a unit of PRBCs to the blood bank. The PRBC unit that was provided to the unit does not match the blood compatibility label. Red blood cells that have been packaged together and utilised for transfusions.
Tranfusions are also known as PRBCs, RBCs, and packed cells. This unit needs to be returned to the blood bank so that the proper unit may be acquired. A PRBC transfusion is often administered when the patient has had significant blood loss or anaemia that is manifesting as noticeable symptoms. The indication for transfusion is based on surrogate indicators, such as the haemoglobin (Hb) concentration, in addition to clinical criteria because the clinical signs of anaemia are nonspecific. A red blood cell transfusion may be given to a patient who has anaemia, a condition in which the body lacks adequate red blood cells, or iron deficiency. This kind of transfusion improves the body's oxygenation while raising the patient's haemoglobin and iron levels.
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for which of the following enteric illnesses is a chronic carrier state most likely to develop? check all that apply. question 11 options: a) cholera b) salmonella enterocolitis c) typhoid fever d) campylobacter enterocolitis e) shigella enterocolitis
The enteric illnesses are a chronic carrier state most likely to develop for a) cholera b) salmonella enterocolitis c) typhoid fever d) campylobacter enterocolitis e) shigella enterocolitis are all applicable or accurate.
The microorganisms that cause intestinal illness, such as bacteria, viruses, and parasites, are most likely to cause enteric illness, a chronic carrier state. These enteric bacteria can cause gastrointestinal infections including salmonella enterocolitis, shigella enterocolitis, and campylobacter enterocolitis. These are all gram-positive bacteria that enter the body orally when contaminated food or drink is consumed. Thus, all of these are used or accurate.
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a client is scheduled for a spinal fusion to treat spinal stenosis. for which reason might the nurse anticipate surgery being delayed because of the risk for postoperative complications?
Patients who get spinal stenosis in the spine are given braces to wear while recovering (often 3 to 6 months), whenever they are up and about. There should be no lifting by the client.
The patient doesn't have to stay in bed. It is not required to use anti-rejection medications for this operation. When there is not enough room inside the spine, spinal stenosis develops. The spinal cord and spine-traveling nerves may be compressed as a result. The neck and lower back are the parts where spinal stenosis mostly develops. Symptomless spinal stenosis can occur in some people. Other people may feel discomfort, tingling, numbness, and muscle weakness. Over time, symptoms in the spine could worsen.
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a client with poor skin turgor, dry mucous membranes, and decreased urinary output is admitted to the acute care facility. which actions should be included in the plan of care? select all that apply.
A client with poor skin turgor, dry mucous membranes, and decreased urinary output is admitted to the acute care facility therefore the plan of care will be administering I.V. and oral fluids and is denoted as option A.
What is Skin turgor?This is referred to as the elasticity of the skin and it is used to test if a person is dehydrated or not. In a situation where it takes longer for your skin to return to its usual position after being stretched then it signifies dehydration.
Dehydration is very dangerous as the fluids in the body are at a minimum value thereby resulting in a decreased urinary output and a dry mucous membranes.
Administering I.V. and oral fluids is the care needed in this scenario as it helps to replenish the lost fluids and nutrients which is why option A was chosen as the correct choice.
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The options are:
A. Administering I.V. and oral fluids
B. Clustering necessary activities throughout the day
C. Assessing color, odor, and amount of sputum
D. Monitoring serum albumin and total protein level
upstream focus addresses the root cause of disease and manufacturers of illness by taking into account which factors?
Environmental & socioeconomic factors that root cause of disease and manufacturers of illness.
The list of diseases' underlying causes that you've all been waiting for external invasion by organisms such as bacteria, viruses, and parasites that are more powerful than your body's defense's, Trauma includes physical, mental, and emotional abuse as well as accidents, injuries, and repetitive action. emotions (thoughts and feelings that haven't been processed often "stick" in the system), Constitution (genetics mixed with family environment) (genetics combined with family environment), Diet (kind, quality, and quantity of food being eaten) (type, quality, and quantity of food being eaten), Sexual activity, toxicity, and energetic toxins—electromagnetic radiation from power lines, computers, cell phones, tablets, and other electronic devices—are the three most recent causes of illness. Sexual activity can include sexually transmitted diseases and too much or too little of it can lead to energetic imbalances.
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a client presents to the emergency department with abnormal bleeding and abdominal pain that is later attributed to gallbladder disease. which diagnosis should the medical team first suspect?
A patient who arrives to the emergency room with unusual bleeding and abdominal pain that is later diagnosed as gallbladder disease is suspected of having a vitamin K deficiency.
vitamin K deficiency comes in two primary varieties. Plants are the source of vitamin K1 (phylloquinone), particularly leafy green vegetables like spinach and kale. Menaquinone, a form of vitamin K2 produced naturally in the digestive tract, functions similarly to K1.
Coagulation, or more commonly known as blood clotting, depends heavily on vitamin K deficiency. In order to stop excessive bleeding both within and outside the body, clotting is a process.
Discomfort between the chest and pelvic areas is referred to as abdominal pain. It's possible for abdominal pain discomfort to be severe, dull, sharp, achy, or crampy. Also known as a stomachache.
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a client with a recent history of intermittent bleeding is undergoing capsule endoscopy to determine the source of the bleeding. when explaining this diagnostic test to the client, what advantage should the nurse describe
The advantages of the noninvasive test should be described by the nurse.
The noninvasive visualization of the mucosa throughout the small intestine is possible with capsule endoscopy. Biopsies cannot be collected without bowel preparation. This procedure allows for visualization of the entire GI tract but not the peritoneal cavity. The benefits of minimally invasive surgical techniques include: less pain. Recovery time after surgery is reduced. Return to work sooner.The primary distinction between invasive and non-invasive tests is that invasive tests are performed by cutting or entering a body part with medical instruments, whereas non-invasive tests are performed without breaking the skin or entering the body. Deep palpation, x-rays, and blood pressure checks are examples of non-invasive tests.
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a nurse researcher analyzes data trends of obesity in both the united states and globally. what statistics does the nurse determine is true regarding the epidemiology of obesity? select all that apply.
A nurse researcher analyzed trends in obesity data in the United States and data globally. The statistics determined by nurses regarding the epidemiology of obesity include:
Over 600 million adults have obesity worldwideThe prevalence of obesity has more than doubled since 1975The prevalence of obesity in the United States is the highest in the worldThe United States (US) is the country with the highest obesity rate in the world. This makes the US government make obesity a problem that needs to be considered, for the health of its citizens. In recent years, health observers have categorized obesity as the spread of a deadly disease.
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the nurse cares for a client with obesity and discusses the increased risk of certain cancers related to obesity. which cancers will the nurse include in the teaching? select all that apply.
Breast, Colorectal, Cervical are the type of cancers nurse include in the teaching.
A condition known as cancer occurs when some body cells grow out of control and spread to other body regions. Since the human body contains billions of cells, cancer can develop practically everywhere. Human cells typically proliferate and divide (via a process called cell division) to create new cells as the body requires them. Cells die when they are old or injured, and new cells replace them.
When this routine process fails, aberrant or damaged cells begin to proliferate and develop when they shouldn't. Tumors tissue growths can develop from these cells. Tumors can either be cancerous or not (benign).
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a pregnant client at 10 weeks' gestation is receiving education by the nurse about the importance of abstaining from alcohol while pregnant. what statement made by the client demonstrates an understanding of the education provided?
To stop the emergence of a fetal alcohol spectrum disorder, abstain from alcohol. The client's decision to abstain from alcohol while pregnant may help to prevent congenital illnesses including fetal alcohol spectrum disorders.
Fetal alcohol spectrum disorders are congenital conditions brought on by the mother's consumption of an unknown amount of alcohol while the foetus is still in the developing phases of growth. Although abstaining from alcohol won't prevent all congenital abnormalities, clients should be informed about a range of preventative steps to avoid interfering with the fetus's growth, development and fetal alcohol spectrum disorder. Idiopathic illnesses are those for which the underlying etiology is unknown. Pregnancy substance use has little impact on a hereditary illness because it is genetic in nature.
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siu al on behalf of the u.s. preventive services task force. screening for breast cancer: u.s. preventive services task force recommendation statement. ann intern med. 164(4):279-96, 2016.
For women 50 to 74 years old, the USPSTF advises biennial screening mammography. (B recommendation) It should be up to each woman to decide whether to begin mammogram screening before turning 50.
This advice is applicable to asymptomatic women 40 years of age and older who do not have breast cancer that has already developed, have not had a high-risk breast cancer lesion previously diagnosed, and who are not at high risk for breast cancer due to a known underlying genetic mutation (such as a BRCA1 or BRCA2 gene mutation, other familial breast cancer syndrome, or a history of chest radiation as a child).mammography is a very serious issue in middle aged women.
Effectiveness of breast cancer screening in reducing breast cancer-specific and all-cause mortality, as well as the incidence of advanced breast cancer and treatment-related morbidity; harms of breast cancer screening; test performance characteristics of digital breast tomosynthesis as a primary screening strategy.
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a nurse is caring for a client with malignant hypertension whose blood pressure has increased by 40 mm hg during the past hour. the nurse goes to lunch and fails to report the change to the physician. the nurse is at risk for being charged with:
Nurse is caring for a client with malignant hypertension pressure has increased by 40 mm hg the nurse fails to report the change to the physician. the nurse is at risk for being charged with negligence.
The arteries in the body are impacted by high blood pressure, a physician frequent ailment. Hypertension is another name for it. When you have high blood pressure, the blood's constant strain against the artery walls is excessive. Blood pressure is measured in millimeters of mercury and physician indicates how hard the heart must work to pump blood (mm Hg). A value of 130/80 mm Hg or greater is generally considered to be hypertension.
stage one hypertension. The upper number lies between 130 and 139 mm Hg, while the lower number lies between 80 and 89 mm Hg.
hypertension in stage 2. If the bottom number is 90 mm Hg or greater, the top number must be at least 90 mm Hg.
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what would you tell someone who is considering taking chromium supplements for weight loss and diabetes?
There have been no proven benefits of taking chromium supplements in weight loss and diabetes, therefore i'd suggest them to quit using those supplements.
What are the effects of chromium on body composition and weight loss?Chromium is a necessary vitamin that controls how carbohydrates and lipids are broken down. Humans and agricultural animals frequently consume less chromium than is ideal through their normal diets. In addition to altering how glucose, insulin, and lipids are metabolized, chromium has also been shown to enhance lean body mass and lower body fat percentage, which may help people lose weight. Animal studies support chromium's effects on body composition, which strengthens their validity despite the fact that they are debatable.
The way chromium affects a subject depends on their diet, the type and amount of supplemental chromium they take, and the length of the study. Nutritional studies have not found any evidence of chromium's harmful effects.
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