Sodexo Dietetic Internships

Disease Specific Rotation Assignment – Diabetes

Intern Name: Holly Murphy

Part 1: Medical Abbreviations and Terminology

Briefly define the abbreviations (don’t just spell them out, add a little bit more info) and terminology below:

BKA – below the knee amputation (as opposed to an AKA or above the knee amputation). Untreated,
uncontrolled diabetes may result in the necessity for amputation.1

Dawn Phenomenon—An increase in blood glucose in the early morning (5am to 9am), most likely due to
increased glucose production in the liver after an overnight fast (cortisol and growth hormone stimulate
GNG). Not the same as rebound effect.1

Diabetic Neuropathy—A type of nerve damage that presents with diabetes, often in legs and feet.
Symptoms range from pain and numbness in extremities to problems with digestive system, urinary
tract, blood vessels and heart. May be mild to disabling to fatal.1

DKA—A severe form of hyperglycemia. Life threatening and commands prompt medical attention.
Occurs more often in T1DM, but is also a risk for T2DM during acute illness or when insulin deficient.
Symptoms: nausea, vomiting, stomach pain, fruity or acetone breath, Kussmaul respirations, mental
status changes.1

Euglycemia—maintenance of normal blood sugar levels.1

Gastroparesis—A syndrome of delayed gastric emptying in the absence of mechanical obstruction and
cardinal symptoms including early satiety postprandial fullness, nausea, vomiting, bloating, and upper
abdominal pain.1

HHNK—Hyperglycemic hyperosmolar non-ketotic coma occurs when there is an abnormally high level of
serum glucose without ketoacidosis. There is sufficient insulin available to avoid ketosis, but there isn’t
enough to metabolize the glucose and thereby relieve the hyperglycemia. It can occur as a complication
of borderline DM, in pancreatic disorders that interfere w production of insulin, as a complication of
extensive burns and in conditions marked by an excess of steroid therapy, or acute stress conditions,
such as infection. May also develop during parenternal nutrition, hemodialysis, or peritoneal dialysis.1

SBGM—Self blood glucose monitoring. Daily home glucose monitoring records an individual’s glucose
level at the very moment the measurement is taken. This information can assist w daily eating patterns
and medications as necessary to maintain glycemic control.1

CGM—Continuous glucose monitoring uses a device that communicates w a sensor placed under the
skin which transmits the blood glucose reading to the receiver device, which is worn around the waist
(like a pager). This allows for continual reading of blood glucose levels every 5 minutes. Not meant to
replace SMBG but does provide a more detailed picture of fluctuations.1

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 FBS—Fasting blood sugar. Normal = <100mg/dL ; 100-1125mg/dL = prediabetes ; 126 mg/dL or higher
on 2 separate tests  diabetes1

SOMOGYI effect—early morning hyperglycemia that occurs as a result of nighttime hypoglycemic

episodes.

Part 2: Pertinent Medications

For the following classes of medications, list a brief description of the class of meds and names of common types
and what it is its primary use and mode of action and any pertinent nutrition-related side effects or interactions
that dietitians should be aware of:

Class Generic Trade Action Susceptibility Nutrient side

Name to effects/interactio
hypoglycemi ns
a
Sulfonylureas Oral Dymelor, Stimulates Avoid alcohol
(1st hypoglycemic Diabinese, insulin
Generation) Tolinase, secretion
Orinase
Sulfonylurea Oral Glipizide, Glucotrol, Stimulates Yes  or  appetite,
s (2nd hypoglycemic Glipizide- Glucotrol insulin wt.
Generation) GITS, XL, secretion Oral/GI:
Glyburide DiaBeta, Dyspepsia,
Micronase nausea, diarrhea,
, Glynase, constipation.
PresTab, Avoid alcohol
Amaryl Contraindicated
for patients w
renal insufficiency
Biguanide Antihyperglycemi Metformin Glucophag Decreases No Metallic taste,
c agent, e hepatic dyspepsia; avoid
Biguanide glucose alcohol; Anorexia,
production, stable wt or  wt,
increases  folate and B12
insulin abs.  risk lactic
uptake in acidosis; Caution
muscles w  hepatic
function, not with
 renal function
Meglitinide Insulin Repaglinide Prandin, Stimulates Yes Tooth disorder;
secretagogue; Nateglinide Starlix insulin N/V; diarrhea,
Oral secretion in constipation; limit
hypoglycemic; presence of alcohol; Take 15
Meglitinide glucose; to 30 min before
short acting meal

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SGLT-2 Antidiabetic Dapaglifozi Farxiga,  renal Yes, when Abdominal pain,
Inhibitors agent for adult n Invokana glucose taken w N, constipation; 
T2DM Canagliflozi reabsorptio insulin & wt  thirst,
n n; urinary insulin hypovolemia,
glucose secretagogu dehydration,
excretion es polydipsia; not w
severe hepatic or
renal function
DDP-4 Antidiabetic Sitagliptin, Januvia, & Not usually, Caution w
inhibitors agent for adult saxagliptin; Onglyza, prolongs unless grapefruit/related
T2DM linagliptin; Tradjenta, incretin combined citrus;  wt;
alogliptin Nesina hormone with other abdominal pain.
levels (GLP- therapies Constipation;
1, GIP) that cause diarrhea,
hypoglycemi gastroenteritis,
a N/V, rare-
pancreatitis
GLP - Antihyperglycemi Bydureon, Exenatide Enhances Not usually  appetite, 
Analog c; Incretin Byetta glucose unless gastric emptying,
Mimetic protein, dependent combined w dyspepsia, N/V,
Parenteral only insulin sulfonylurea GERD, diarrhea
(SC) secretion,
suppresses
glucagon
secretion,
slows
gastric
emptying
Insulin: Rapid Insulin Humalog, Recombinen Yes Alcohol w caution
Acting Novolog, t human as it 
Apidra insulin hypoglycemic
Insulin: Short HumulinR, Yes effect,  wt w
Acting ReliOn T2DM, Transient
Insulin: Humulin N Yes edema, vision
Intermediate changes, caution
Acting w  renal or
Insulin: Lantus, Yes hepatic fnctn,
Extended Levemir, hyper- or hypo-
Long Acting Tresiba thyroidism
1, 2

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Part 3: Pertinent Labs and Procedures
Answer the following questions below regarding labs used to diagnose and manage diabetes:

1. What are considered normal blood sugar levels?

2. What are the criteria for diagnosing diabetes and pre-diabetes?

3. What does Hgl A1C measure and why is it a good tool for monitoring blood sugar levels?

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 Glycosylated hemoglobin assays (hemoglobin A1c or A1c) measure the amount of glucose bound
to hemoglobin. It is a good tool for monitoring blood sugar levels because the higher the glucose
concentration in the blood, the more hemoglobin is glycated.1

4. Why is SBGM important in the management of diabetes?

Self blood glucose monitoring is important in the management of diabetes because this data can
assist in adjusting daily eating patterns and medications necessary to maintain glycemic control.
It is also useful in identifying patterns and ways in which food, exercise, and other factors affect
glycemic control. Adjustments to the treatment program can be made immediately in order to
prevent hyperglycemia, hypoglycemia, and long-term complications of diabetes.1

5. How is CGM different from accucheck/fingerstick measurements?

Continuous glucose monitoring uses a device that communicates with a sensor placed right
under the skin as opposed to the fingerstick method in which accuracy is user dependent. The
sensor transmits the blood glucose reading to a receiver device worn at the waist like a pager
every 5 minutes. This method provides a more detailed picture of glucose fluctuations and can
help direct a more detailed insulin prescription.1

6. How is sliding scale insulin used in the acute hospital setting? What are the advantages and
disadvantages?
Sliding scale insulin therapy refers to the progressive increase in the pre-meal or nighttime
insulin done, based on pre-defined blood glucose ranges. It approximates daily insulin
requirements. The amount of CHO eaten at each meal is pre-set. The same long-acting insulin
dose is taken no matter what the blood glucose level is.3
According to the American Diabetes Association, the sole use of sliding scale insulin therapy is
strongly discouraged in the inpatient hospital setting.4

Advantages:
 Less calculations3
Disadvantages:
 Doesn’t accommodate changes in insulin needs related to snacks, stress or activity
 You still need to count CHO3
 Less effective in covering a pre-meal high blood sugar b/c the high blood glucose
correction and food bolus cannot be split.3

Part 4: Pathophysiology
Answer the following questions below like you are explaining it to one of your peers. Do not copy and paste
textbook information. The answers don’t need to be exhaustive. Focus on what would be important for a dietitian
to know. Provide references for each of your answers.

1. How is glucose metabolized? Review and explain briefly from your basic nutrition class.
Include hormones insulin and glucagon.

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 Glucose is metabolized through cellular respiration. Glucose in the blood stream must be taken
up by the cells where this process takes place. Insulin is secreted by the pancreas, which allows
the glucose to enter the body’s cells. Alternatively, when no glucose is present through
consumption of food (during a fast for example), the pancreas will secrete glucagon, signaling
the liver to break down glycogen stores into glucose and to create new glucose molecules via
gluconeogenesis making glucose available to the cells. Once taken up by the cells, glucose goes
through the first step of cellular respiration- glycolysis- in the cytosol of the cell. This is an
anaerobic reaction in which 1 glucose molecule is broken down into 2 pyruvate molecules, and
releasing 2 molecules of ATP + high-energy electrons which are passed to the electron transport
chain (ETC, the last step of cellular respiration).
Oxygen is required for the next stop, whereby the 2 pyruvate molecules enter the mitochondria
of the cell, releasing one carbon from each molecule. The Carbon is released via CO2. The 2
molecules then combine with coenzyme A to produce acetyl-CoA, again releasing high energy
electrons which go to the ETC.
Acetyl-CoA then enters the Citric Acid Cycle where it combines with oxaloacetate to form citric
acid. 2 more carbons are lost as CO2, more high-energy electrons are released and 2 ATP are
produced per glucose molecule.
The final step, the ETC, is where the high-energy electrons go. They are passed down the chain,
allowing hydrogen to be pumped back across the inner mitochondrial membrane using their
energy. As the H+ atoms flow back, their energy is used to create more ATP. Finally, the
electrons are combined with oxygen and hydrogen to form water.5

2. What is the difference between T1DM and T2DM? Include the types of patients that are
diagnosed with each of these?
T1DM- an autoimmune disease in which the body’s immune system destroys the pancreatic
beta cells that produce insulin rendering the body unable to produce its own insulin. The cause
is unknown, but viral infection, genetics, toxin exposure and abnormalities in the immune
system may play a role.5
T2DM-More common. Accounts for 90-95% of cases in the US. The body does not produce
enough insulin to keep blood glucose in the normal range. This can be the result of insulin
resistance, requiring large amounts of insulin to take up enough glucose from the blood stream
to support energy needs. Occurs as a result of genetic and lifestyle factors. Particularly in those
who have a family hx diabetes, obese, excess abdominal fat, sedentary.5 Older adults and
minorities are disproportionately affected.1

3. Describe the 3 signs and symptoms of hyperglycemia that are often used to diagnose the
person with T2DM?
1. Unexplained weight loss – b/c glucose cannot enter muscle and adipose to be used as energy
so the body responds as if it is starving, turning to the breakdown of fat and PRO for fuel
2. Polydipsia- excessive thirst – b/c blood glucose levels rise so high the kidney’s excrete glucose
which draws water w it

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 3.Polyuria- Frequent urination – b/c blood glucose levels rise so high the kidney’s excrete
glucose which draws water with it
4. Blurred vision – b/c excess glucose enters the lens of the eye, drawing in water and causing
lens to swell.1

4. What are the signs and symptoms of hypoglycemia and what are the nutritional
recommendations for correcting hypoglycemia?
 Plasma glucose levels reach 70mg/dL

Fasting hypoglycemia usually presents w neuroglycopenia or inadequate glucose supply
to brain.

Reactive hypoglycemia manifests w symptoms of sweating, palpitations, anxiety, and
tremulousness. May experience some or all of these.

Immediate recovery upon administration of glucose

Symptoms can include blurred vision, headache, feelings of detachment, slurred speech,
weakness. Personality + mental changes range from anxiety to psychosis.

Nutrition interventions for reactive hypoglycemia might include small, frequent meals that include
complex CHO, fiber and a PRO. Avoid simple CHO including candy, sugar, sweets, jellys and jams,
honey, soda, alcohol. Carbohydrate counting.1

5. What is insulin resistance and how does it contribute to T2DM?

Insulin resistance occurs when the body’s cells lose their sensitivity to the action of insulin.
Therefore, larger amounts of insulin are required in order for cells to take up enough glucose
from the blood stream to supply energy for the body. Further, all of the glucose consumed in
the diet, remains in the blood stream.1

6. What are the major macro and microvascular complications associated with uncontrolled
diabetes?
 Long-term complications of uncontrolled DM include damage to the heart, blood
vessels, kidneys, eyes, nerves.
 Damage is believed to be a result of prolonged exposure to high blood glucose levels.
 When blood glucose is high it binds to proteins leading to blood vessel damage and
abnormalities in blood cell function.
 Damage to large blood vessels  increased risk heart disease and stroke (risk for these
is 2 to 4x higher in people w diabetes)
 Damage to small blood vessels and nerves lead to kidney failure, blindness, nerve
dysfunction.5

7. Explain how ketosis occurs and why it is dangerous to the patient with diabetes?
Since glucose cannot enter muscle and adipose to be used as energy, the body the body
responds as if it is starving, turning to the breakdown of fat and PRO for fuel. The breakdown of
fatty acids/FA metabolism produces ketone bodies which are released into the blood and can be
used as fuel (ketosis). However, in T1DM they are produced far more rapidly than they can be

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 used and therefore accumulate leading to ketoacidosis, which is a leading cause of dead for
people w T1DM.1
8. What is gestational diabetes? How is it diagnosed and what women are at the greatest
risk for gestational diabetes?

Gestational diabetes is a form of diabetes that occurs in women during pregnancy.

-May be caused by hormonal changes

-high levels of glucose in mother’s blood increase risk of complications for baby and
delivery.

-Usually goes away after delivery but mother is at an increased risk of developing T2DM
later in life.5

Part 5: Review of MNT

Answer the following questions below in your own words. Do not copy and paste textbook information. The
answers don’t need to be exhaustive. Focus on what would be important for a dietitian to know. Provide
references for each of your answers.

Review the 2014 American Diabetes Association general recommendations for MNT:
http://care.diabetesjournals.org/content/37/Supplement_1/S5.full#sec-14

1. Discuss the differences between a traditional food list (exchange) diet and carbohydrate
counting. Discuss the situations for one method to be used vs the other as an education tool
for a patient?
An Exchange diet separates foods by their nutritional content. These include: starch, fruit, veg,
dairy, Meat (very lean, lean, medium-fat, OR high-fat), and fat. A pre-defined serving size of a
food item in one of these categories has the same content of kcal, g of fat, PRO and CHO as all of
the others within that same category. Someone on this plan, has follows a meal plan which
allows them a certain number of exchanges at each meal and they have the flexibility to
“budget” or “spend” their exchanges how they choose to throughout the day. This may be a
better educational tool for someone trying to manage their weight. Someone with T2DM who is
taking insulin to control their diabetes may want to rely on CHO counting.5
When CHO counting, the number of carbs included in a meal must be determined in order to
calculate the dosage of insulin necessary to absorb said carbs from the blood stream. This
dosage is injected manually or via a pump. Every serving or portion of CHO is equal to 15g CHO
counts, that is every 15g CHO = 1 CHO choice.5
2. Make a table of the American Diabetes Association’s “Choose Your Foods” Food lists for
Diabetics (you don’t need to have the actual “Choose your Foods” booklet from the ADA to do
this. You can google the ADA exchange lists, or you the one that should be in your undergrad
textbook).
Include the Food List, examples of foods and portion sizes and grams of CHO, protein, fat and
calories for each group.

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 CHO (g) PRO (g) FAT (g) KCAL EXAMPLES
CARBOHYDRATES
Starch: breads, cereals + 15 0-3 0-1 80 1/2c cooked rice/pasta, ½ english
grains; starchy vegetables, muffin, 1/2c green
crackers + snacks; beans, peas/corn/sweet potato, 1/3c
peas, lentils baked beans, 1/2c cooked
beans/lentils
Fruits 15 - - 60 1 apple. 1/2c applesauce, 17
grapes, 1 kiwi
MILK
Fat free, low fat, 1% 12 8 0-3 100 Incudes milk + yogurts
Reduced fat, 2% 12 8 5 130
Whole 12 8 8 150
SWEETS, DESSERTS, & OTHER 15 VARIES VARIES VARIES 1/2c cranberry juice cocktail, 1/12
CARBS cake, 1 choco chip cookie
NON-STARCHEY VEGETABLES 5 2 - 25 1/2c cooked or 1c raw: broccoli,
beets, cauliflower, bean sprouts,
eggplant, sugar snap peas
MEAT & MEAT SUBSTITUTES
Lean - 7 0-3 45 2 egg whites, 1oz canned salmon,
1oz sausage 3g fat/oz
Medium Fat - 7 4-7 75 1oz ricotta cheese, 1 whole egg,
sausage 4-6g fat/oz
High fat - 7 8+ 100 2 slices pork bacon, 1oz sausage
gfat/oz
Plant-based proteins - 7 VARIES VARIES 1/4c tempeh, 4oz tofu
FATS - - 5 45 Cream + dairy fats, 6 almonds,
1tsp canola/olive/penut oil
ALCOHOL VARIES - - 100 12 fl oz beer, 5 fl oz dry wine, 1.5fl
oz liquor

3. What is the appropriate diet for gestational diabetes and how do high blood sugar levels
affect the neonate?
Diet:
 Monitor type and amount of CHO consumed  whole grains, low glycemic index options are
best. CHO counting and food journaling may be recommended.
 Distribute meals between 3 meals 2 to 3 snacks each day to maintain even blood sugar levels
 Limit milk consumption to 1c/day
 Limit fruit portions and eat whole fruits in place of juice
 Avoid added sugars (read labels!), no soda
 Eat breakfast- avoid sugary cereals, focus on PRO, whole grains, fats

A mother’s high blood sugars will affect her unborn baby because baby received nutrients from the
mother’s blood. He/she will store the extra sugars as fat, increasing the chances of birthing a large- or
very-large for gestational age baby. This increases chance of C-section delivery, injuries/birth trauma, low
blood sugar and mineral levels when baby is born (“sugar baby”), jaundice, pre-term birth and temporary
breathing problems. There is some evidence to show that these children may be more susceptible to
obesity, weight problems and even predispose them to diabetes later in life. 1

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Part 6: Case Study

Background
Frank is a 67 YO black male who lives at home with his wife. They live on social security and a small
pension. They are active in their local church, like to go for walks and enjoy listening to music. He
presents to the hospital with a fever, blurry vision and a non-healing cut on his foot. He states he has
been awakened often during the night to urinate.

Past Medical History

Frank denies any personal history of diabetes, but has been treated for high blood pressure on a beta
blocker. He has no history of previous hospitalizations or other illnesses.

Social History
Frank is married with 4 grown children. Since he retired 2 years ago, he has gained 15 pounds. He is
currently 5’ 10” and weighs 210 pounds. Frank has one sibling, a 49-year-old brother, who has no known
medical problems. Both his parents have high blood pressure and are overweight.

Patient’s Values (fasting)

Plasma glucose 145 mg/dL, A1C 8.0%, Chol 230 mg/dL, HDL 38 mg/dL, LDL 140 mg/dL, TG 200 mg/dL

Medical Diagnosis
Based on his history and laboratory data, Frank was diagnosed with Type 2 diabetes. He was counseled
to lose weight, begin a regular exercise program, and referred to an outpatient diabetes program.

The RDN interviewed Frank and obtained a 24 hour recall. Information obtained
1 large bowl of oatmeal (Frank heard that oatmeal is good for his heart)
2 eggs fried in butter
Breakfast (7am)
Coffee with ½ & ½ and 2 sugars
1 glass of orange juice
Lunch (2pm) 1 sandwich on a roll or white bread
2 chicken legs, broiled
1 big cup of rice with butter
Dinner (6pm)
Carrots with butter
Pudding for dessert
1 big bowl of popcorn with butter
Snack (8pm)
2 beers

Case Questions:

1. What is Frank’s BMI, IBW, and % IBW?

BMI = 210/(702)*703 = 30.129
BMI = 30 = OBESE

IBW (men) = 106 (for 1st 5 ft) + 6lbs (each additional inch)
IBW =106 + 6(10) = 166lbs

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 % IBW = 210/166 * 100
%IBW = 126.5%

2. Assess Frank’s energy, protein, and fluid needs. Show your calculations and indicate
predictive equations used.

210lbs = 95.2544kg

5’10” = 177.8cm

Mifflin-St. Jeor (male) = 10W + 6.25H – 5(age) +5

Activity Factor = 1.5 (light)
Stress Factor = 1 (not stressed))

=10(95.2544) + 6.25(177.8cm) – 5(67) + 5 = 1,733.794

=1,733.794 x 1.5 x 1 = 2,600.691
=2,600kcal/day

Fluid Needs (Age 65+) = 25cc/kg/day = 25*95.2544 = 2,381.36cc = 10 cups fluid/day

PRO Needs (unstressed) = .8g/kg/day = .8*95.2544= 76.2g PRO/day

3. What do Frank’s symptoms and laboratory values indicate about his glycemic and lipid
control? Do you think he has insulin resistance? How do you justify your answer?

Frank is hyperglycemic with uncontrolled blood sugars. An 8% A1C corresponds to

~183mg/dL blood sugar reading on average.

Franks cholesterol levels (total, LDL) are borderline high. His HDL is low, a major risk
factor for hear disease. Hiw TGs are HIGH.

Yes, Frank has insulin resistance. He has uncontrolled blood sugars, estimated at on
average around 183mg/dL. These sugars are floating around in his blood stream, unable
to be taken up by his cells because they are desensitized to the insulin and require a
greater amount of insulin than normal. This is essentially, T2DM which we know Frank
has been diagnosed with.

4. After reviewing Frank’s medical record, give specific non-dietary advice on how he
could improve his glycemic control.
-Self monitor blood glucose
-Move more! Start extending his walks, park further from stores and destinations he
goes to and walk the extra distance.

5. Would you counsel him using a food list or recommend that he count carbohydrates?
Why?

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 I would recommend that Frank learn to CHO count. Frank has been diagnosed w T2DM and
will need to begin administering insulin in proper dosage to the amount of CHO he
consumes at each meal. It will be helpful to Frank to know what proportion CHO he should
be eating, and how to evenly distribute these servings throughout his day for glycemic
control.

6. What specific dietary substitutions / recommendations would you give to Frank?

(see chart below)

The RDN interviewed Frank and obtained a 24 hour recall.

Your specific recommendations
Information obtained
*1/2c cooked oatmeal
1 large bowl of oatmeal (Frank heard that
*Skip the OJ, cut it w water if
oatmeal is good for his heart)
Breakfast necessary to wean down or eat 1/4c
2 eggs fried in butter
(7am) oatmeal + ½ small orange
Coffee with ½ & ½ and 2 sugars
*Cook eggs in EVOO or Smart Balance
1 glass of orange juice
*Try sugar substitute
Salad topped w sandwich proteins + 1
Lunch (2pm) 1 sandwich on a roll or white bread slice 100% whole wheat bread OR 1c
whole wheat croutons
*Skip the pudding (save for “snack”)
*1/3c Brown rice
2 chicken legs, broiled
*1/2c cooked carrots
1 big cup of rice with butter
Dinner (6pm) *Use margarine w sterols/stanols like
Carrots with butter
Smart Balance in place of butter
Pudding for dessert
*Great job w broiled chicken! Maybe
replace legs w breast
*1/2 c sugar free Jello pudding
OR
1 big bowl of popcorn with butter
Snack (8pm) 1.5c popcorn w 1tsp Smart Balance
2 beers
OR
1 beer

References:

1. Nelms M, Sucher K, Lacey K. Nutrition Therapy and Pathophysiology. Boston, MA: Cengage Learning; 2016.
2. Pronsky Z, Elbe D, Ayoob K. Food Medication Interactions 18th Edition. Birchrunville, Pa: Food-Medication
Interactions; 2015.
3. UCSF Diabetes Education Online. Sliding Scale Therapy. Last updated: Accessed: August 30, 2017.
https://dtc.ucsf.edu/types-of-diabetes/type2/treatment-of-type-2-diabetes/medications-and-
therapies/type-2-insulin-rx/sliding-scale-therapy/
4. American Diabetes Association. Diabetes Care 2016 Jan; 39(Supplement 1): S99-
S104. https://doi.org/10.2337/dc16-S016
<http://care.diabetesjournals.org/content/39/Supplement_1/S99 >

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 5. Smolin L, Grosvenor M. Nutrition. Science and Applications- Third Edition. Hoboken, NJ: John Wiley &
Sons, Inc.; 2013.

Copyright © 2017 by Sodexo, Inc. All rights reserved by Sodexo. No part of the contents of this assignment may be reproduced, adapted, translated or
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