Digging Essay

Nidhi Ranjalkar English 10 Block E Ms. Wilkins 30/08/2012 DIGGING The poem ‘digging’ is the first in poet Seamus Heaney’s collection ‘Death of a Naturalist’ (1966). This poem has a free structure, which allows the poet to express his feelings of pride and the value of his as well as his ancestors’ work.The poet may not be following his father and grandfather’s footsteps in the area of work which is potato farming but that doesn’t mean he does not respect, value and take pride in the work that they did. This poem clearly reflects the complex feelings of a son who has chosen to break away from the family tradition and forge a new path for himself. The author talks about the family’s potato farm. Through this poem he shows respect and pride towards their work. He succeeds by painting a scene using different types of imagery.He uses visual, auditory, olfactory and tactile imageries to paint a picture. This technique makes reade rs feel present as if they had just stepped into the moist potato field. The title ‘Digging’ refers to the act of hard labour. The reader can immediately picture a scene of a man hard at work digging the ground. Seamus Heaney is not a farmer. He does not dig the ground for potatoes nor does he work in the hot fields every day. He is an author who uses his pen to dig deep into his surroundings, deep into the emotions and convey them through his writing.Heaney starts off the poem by comparing his pen to a gun. He uses this image to convey the idea of ‘the pen is mightier than the sword. ’ He uses this visual imagery to tell his readers that he uses his pen, as his ancestors’ used their spade, to make a living. Also by the line â€Å"The squat pen rests, as snug as a gun,† we get a feeling that Heaney likes his work and doesn’t mind earning his living by writing. Digging in the hot fields is no easy task. It is tiring, frustrating and toug h.Heaney understands this and to show it he uses words like ‘gravely ground’ and ‘straining rump ‘where he emphasizes on the adjectives like ‘gravely’ and ‘staining’. When he says â€Å"Till his straining rump among the flowerbeds, Bends low† we can visualize an old man with a heavy spade in his hand, sweating, bending low, straining his back, digging. He uses that line to explain how hard his father worked and this line also reflects a bit of his pride for his father who worked tirelessly in the farms every day.Heaney also uses olfactory imagery to give the readers a feeling of the scene. â€Å"The cold smell of potato mould, the squelch and slap of soggy peat†¦Ã¢â‚¬  emanates an odor of potato mould, soggy peat and it helps imagine the scene to understand the poem. By doing this Heaney manages to bring the scene alive and the reader feels as if he is standing near the potato field can smell these odors and the reader ’s face immediately scrunches up in disgust.Heaney also uses tactile imagery to give us a sense of touch which helps us to make a connection. â€Å"Loving their cool hardness in our hands† shows the readers that he and his ancestors’ are satisfied with their work and take pleasure in doing it. The poet talks about loving the cool hardness of the potatoes in his hands. It also shows us the sense of happiness and satisfaction experienced by the father and the grandfather after their work has been done and successfully completed. Digging’ by Seamus Heaney is a poem based on the different work line between the past and the present generations and the value of hard work and determination for all work whether it is ours or not. The poet uses all these imageries to paint a clear scene in our minds which makes us appreciate the poem better. It also gives us a better understanding of what the poet is trying to say. Through his use of imagery, Heaney communicates h is ancestors’ determination, the advantages of hard work and the importance of loyalty to one’s family.

Care Values and Communication in a Hospital setting Essay

The care values are a set of rules and guidelines that every care practitioner has to follow in order to provide services to their clients. The overall aim of the standards is to improve client’s quality of life by ensuring that each person gets the care that is most appropriate for them as an individual. The three main care values are Confidentiality, Equality and Diversity and Individual rights and beliefs. By achieving these care values we can improve the quality of care and allow all patients to be treated as an individual with respect. Slideshare.net (2012) http://www.slideshare.net/j.slack/what-is-the-care-value-base (Accessed: 22 January 2013) Confidentiality is an important principle in health and social care as it imposes boundaries on the amount of personal information and data that can be disclosed without consent. Confidentiality is where a person disclosing personal information expects their privacy to be protected, such as in a relationship of trust. However in some situations confidentiality can be countered, when there is public interest in others being protected from harm. UCeL (2012_ http://www.ucel.ac.uk/rlos/confidentiality/ (Accessed: 22 January 2013) Confidentiality is very important because as healthcare workers our ability to correctly diagnose and treat our patients depends on getting a correct medical and social history, and having our patients trusts us. If a patients feels that the professional would share this information they may not give them the truth and without that important information they could make the wrong diagnosis and wrong treatment. Yahoo answers (2012) http://uk.answers.yahoo.com/question/index?qid=20070820014312AAuFE9q (Accessed: 25 January 2013) Confidentiality can be used in oral communication in a hospital setting, For example if a patients approached their GP about a private and embarrassing problem they would be expected to show that patient respect and not to share the information given with anyone else. An example of a time where this could be shared is if their GP wanted to send them for tests and had to inform a specialist about their condition. Another type of communication is written this could be used to promote confidentiality as all paper based records must be locked away in a filing cabinet and only be accessed by those authorised to. Also to access your own records you must write a letter and wait approval for this. Also for documents written on the computer there are various passwords and back up options for if the server goes down or a records is deleted. An example of how confidentiality can be used in computerised communication would be having passwords and automatic locks on staff’s computers and email accounts so only they can access their own patient’s information and no other members of staff or unauthorised persons. The last type of communication is specialist one example of how this can be used in confidentiality is if a person has hearing barriers and has to use sign language to communicate with their doctor. If their doctor is giving those results or information on their health and has to use sign language they may need an interpreter and the patients may want to use a quiet and enclosed room with the blinds shut just in case anybody else can see the sign language being used and understands it. Another care value is Equality and Diversity. This means treating everyone equally regardless of their colour, age, gender, ethnicity, sexual orientation, disability etc. This is different to treating people the same as different people have different needs, so individuality should be taken in to account. For example, it would not be equal treatment to provide two different people with information about the services available written in English, if one of those people spoke another language and could not understand English. Wiki.Answers (2012) http://wiki.answers.com/Q/What_does_equality_and_diversity_mean_in_health_and_social_care (Accessed: 22 January 2013) We live in an increasingly diverse society and need to be able to respond appropriately and sensitively to this diversity. Learners in the healthcare setting will reflect this diversity around gender, race and ethnicity, disability, religion, sexuality, class and age. Successful implementation of equality and diversity in all aspects of work ensures that colleagues, staff and students are valued, motivated and treated fairly. London Deanery (2012) http://www.faculty.londondeanery.ac.uk/e-learning/diversity-equal-opportunities-and-human-rights/what-is-equality-and-diversity (Accessed: 25 January 2013) One example of how Equality and Diversity can be used in oral communication in a hospital setting is that a doctor would speak differently to a child than they would to an adult as children may not be able to understand some of the information they are being told if they used big words and medical jargon. Doctors should also use a slower pace and soft tone when speaking to younger patients and ask them regularly if they understand what is being said although they normally have a parent or guardian to accompany them. An example of how Equality and Diversity can be used in written communication would be if a patient cannot read or speak English they may have to produce leaflets in their language so they understand their condition or illness and what treatment is needed more clearly. An example of how Equality and Diversity can be used in computerised communication would be having audio descriptions and talking pages on the NHS website so that people with sight barriers can still access the information they have to offer. The last type of communication is specialist and an example of how this can promote equality and Diversity is if a patient doesn’t speak English they may need a translator to assist the patient in talking to the doctor and to assist the doctor diagnosing the patient. This allows the patient to get the medical attention they require and are entitled to without them learning a second language which makes them equal but also individual. Individual’s rights and Beliefs means being treated as an individual according to our own needs, every individual wants to be treated fairly, in the care sector it is of the utmost importance that a service user is treated fairly and also treated with love, care and respect. The individual rights are respect, choice, dignity, protection, and equality, access to information, non-discrimination, and effective communication. They also have the right to their own beliefs and a doctor must respect a patients beliefs and choice’s when treating them. Wiki.Answers (2012) http://wiki.answers.com/Q/What_is_individual_rights_in_health_and_social_care (Accessed: 22 January 2013) When working within a health and social care sector based environment is to ensure that each service user feels that they can trust you as the service provider.

We Have Taken the City by H. Leon Prather Sr Essay

We Have Taken the City by H. Leon Prather Sr - Essay Example The essay begins with the description of the status of black Americans particularly in Wilmington, North Carolina wherein before the racial massacre happened, the black Americans had been more superior, powerful, business minded people, had greater opportunity in terms of livelihood compared to the white Americans. The description of the status of the black Americans gives the reader clarity in this essay for them to follow the story. Names of these black Americans who have a good status were also mentioned in the first place in the essay which has a minor role but memorable role in the story of the Wilmington racial massacre, such as Thomas C. Miller, a black businessman and Alexander Manly, black editor. To continue, in the year 1894 and 1896, North Carolina’s Populist Party fused with the Republic Party to have power of the state government which was known as the Fusionists. Although they won, in the year 1898 election, the Democratic Party was able to have a government con trol at the state level which was the starting point of violence and frightening if blacks by the Red Shirts, these are the once that acts in behalf of the Democratic Party, that want to eliminate black voting. ... In order to destroy the image of the black Americans to the South Carolina, news, pictures and stories were published and spread throughout saying that black American men were attacking white women and Alexander Manly, denied the charges and defending it through his article. This made the white supremacist angry and so after the election they created different committees and wanted Manly to be evicted and cease the newspaper to be published but because of no response from the side of Manly, Alfred Moore Waddell led an armed group to the Daily Record office and they destroyed the equipment and burned down the building of the black American newspaper. After the black Americans heard about what happened, they assembled themselves throughout Wilmington. On that day, the riot and gunfire took place. It was said that with the use of telegraphs flashed news of the racial violence, democratic leaders in other parts of the Northern Carolina towns and cities sent their military forces and gave help to the white people which led many numbers of black people to die. The way the writer of this essay illustrates and describes how the riot was done was very clear although in the end no one knows and no one can estimate the number of deaths among the blacks. Even the movements of the riders were properly and clearly described. The directions of the places, movements of the people and the exact location of the people were also clearly illustrated which really makes this essay interesting although there exact words that were quoted and it’s a little difficult to understand and connect it with the situation. The quoted word example is â€Å"When we

Causes and effects of recession in uk Essay Example | Topics and Well Written Essays - 1500 words

Causes and effects of recession in uk - Essay Example The causes and effects of the recession should be examined to help scholars and the local population alike come to full understanding of the worsening situation. Historically the UK has experienced recessions five times between 1974 and 1991. In recent times the economy between July and September 2008, there were signs that the UK was entering a recession when it shrank for the first time in sixteen years. In January of 2009, confirmation that the UK was in recession came from the Office for National Statistics after showing that the gross domestic product fell 1.5pc in the first quarter of 20008. Compared to the 1990s when the economy shrank in a single quarter by 1.2pc this recession is considered to be far worse. There are several causes of the recession in the UK. While the world started to experience a recession the situation in the UK was imminent especially when the United States of America started to decline. International trade is one of the factors of the UK recession. As the economic situations in countries begin to worsen trade suffers because governments in taking several precautions do not trade with other countries as they use to thus making the global recession even worse. Consequently, if imports exceed exports this will have negative effects on the trade gap as was experienced in January 2009. The trade gap went up to  £8.3bn. The Office for National Statistics reported that this was caused by falling exports to non European countries especially the United States. Exports to countries outside of the European Union fell by sixteen percent. Economists have predicted that a weaker pound would have a more positive effect but that was not proven to be so. A signal that domestic d emands for goods were also falling was evident in the figures given for the imports of goods. These imports decreased by 1.8 percent to 28.2bn pounds. The credit crunch experienced in the United States of America was soon felt in the United

HOW IMPORTANT IS RACE TO AMERICAN IDENTITY Essay

HOW IMPORTANT IS RACE TO AMERICAN IDENTITY - Essay Example On the other hand, the history of Asians is another example how race influences American identity especially on the exclusion act of 1882 (Carter 1). The few examples provide evidence on the significance of race in the United States. Race is the variable content that matters most in the United States. Race has shaped itself as the most visible of all cultural differences in the United States. In addition, it has contributed to racial discrimination and bigotry (Carter 1). Moreover, it acts as a means of social inclusion and exclusion to members of a race. This term has also been used as a determinant of social status. This paper seeks to focus on how valuable is the race to the American identity. The important of the race to the American identity is clearly identified from how people from different races are treated. This is seen on the racial status of individuals. In America, individuals have been defined by where they are going rather than what they have been. However, achievements should matter rather than origin. The American dream was that people should be able to participate as equals no matter their background. However, this dream has been thwarted and has led to fragmentation of society since its earliest days. In fact, racial classification leads to disregard of the achievements ideals. For example, the non-whites, whatever their achievements, have been unable to change their racial status (Martin 549). This has been evident since the onset of the civil rights movement. For these reasons, we aspire for the day when all Americans will be treated equally without considering their race. As Martin Luther king puts it, he has a dream where everybody will be treated equa l (Martin 549). He also notes that one day there will be equal treatment in various aspects of the society primarily on education and transportation system. This has led to implementation of legislation to protect individuals from those who

Learning The Portfolio Essay Example | Topics and Well Written Essays - 2250 words

Learning The Portfolio - Essay Example The cost of maintaining the program, personal cost, and the startup cost are examples of expenses that a DE student may encounter during his learning program. However, the success at the university would have a substantial effect on my life. As a practicing nurse, the success in GER 401 would give out a certification of my profession. This means that, without this achievement, I may not be able to advance into my profession. This post will respond to a post that was made by one of my classmates in regards to my earlier post. In his post, Greg argued that despite the fact that distance education students face a number of challenges, startup cost may not be regarded as one of the challenges. He added that the cost of starting up a distance education learning program only depends on the parents and administrators of the program. Even though the cost of starting a distance education is lower than the expected benefits, the startup cost is still extremely high to the students and their fa milies. Aside from the tuition fee for the program, there are other factors like the cost of accessing the Internet, cost of purchasing books and other study materials which may appear to be high to many students. This is a critical concern and should, therefore, never be ignored especially if the challenge of the DE students needs to be addressed. Portfolio Task 2 After locating the given article (Resistance training and older adults’ beliefs about psychological benefits: The importance of self-efficacy and social interaction. Journal of Sport and Exercise Psychology, 29(6), 723–746), the two selected sources from the reference list include: I. Takeshima, N., Rogers, N., Rogers, M., et al. (2008). Functional fitness in older adults varies depending on the mode of exercise. Med Sci Sports Exerc, 39, 2036–2043. II. Layne, J., Sampson, S., Mallio, C., et al. (2008). Success disseminating a strength community-based training program for old adults by professional le aders: the People Exercise Program. Journal of Am Geriatr Society, 56, 2323–2329. The first article was selected because it is an article which targets are similar to that of the given article. This means that both the first article and the given article to discuss the old adults. The second article was also selected since it discusses training just like the given article. Portfolio Task 3 The keyword used while searching for the database: exercise and the aged The database was chosen because it is an academic search premier (EBSCOhost): This database covers arts and literature and medical sciences. The two articles selected include I. McCormack, J. (2000). Looking back and moving forward? Ageing in Australia 2000. Ageing and Society, 20, 623–631. II. Brandon, L, Boyette, L, Lloyd, A, & Gaasch, D. (2004). Resistive training and long-term functions in an old adult. Journal of Aging and Physical Activity, 11, 10–28. Portfolio Task 4 In the article â€Å"The Crisi s of Our Ageing Population and Other Fairytales,† David Gould argues that there existed a prosperous and rich land. The people who lived in that land were growing to be old. In this case, the residents of that land drained the treasure of the country until everything was exhausted (COM, 2002). These people spent their remaining years in misery and poverty, transforming a wasteland economy to their children.

Transition from Middle to High School Essay Example | Topics and Well Written Essays - 500 words

Transition from Middle to High School - Essay Example In support of evidence-based practices, various Web-based collections of "best practices'" are now available, but not all programs included in such databases have been rigorously tested. Three databases that included programs broad enough to be useful in a school setting were selected. Criteria to screen and then assess available studies were used according to the process set out by the Evidence for Policy and Practice Information and Co-ordinating Centre {EPPI-Centre) for non quantitative review's-search, screen, describe, map and refine and appraise and synthesize'. The author has also provided a clear paragraph on the method used for screening and the criteria used for exclusion and inclusion as well. The research findings of the article have highlighted that after 246 programs were located and the initial screening criteria were met, almost 242 were excluded based on the criteria. The four which were left out are as follows: '( I ) School Transitional Environmental Program (STEP); (2) Skills, Opportunity, and recognition (SOAR), formerly Seattle Social Development Project; (3) Positive Action through Holistic Education (Project PATHE), and (4) Fast Track. The results of applying the inclusion criteria are presented in Table I'. A detailed analysis of each of the four has also been provided in the article. The author has provided a very clear and concise discussi

Carry out a critical evaluation of online communities. It is important Essay

Carry out a critical evaluation of online communities. It is important that you carry this out from a business point of view, rather than from a technical. Disc - Essay Example The work of Rheingold has been instrumental in establishing ways in which others define an online community. He argues that virtual communities are social aggregations that emerge from the Internet when enough people carry on a discussion long enough to form personal relationships. This view remains recognizable in what Preece calls the e-commerce perspective of online communities. The early arguments for regarding virtual communities as a marketing tool took a Spartan view of what constitutes a community. Hagel and Armstrong contend that the community integrates content and communication in a computer mediated space. They put an emphasis on member-generated content; a perspective that may have influenced views that ‘any chat or bulletin board’ is regarded as a community by businesses. The development of an economic perspective to online communities may be frowned upon by some, but there has been a surge of interest from businesses eager to gain advantage from building r elationships with customers. The range of business communities now seen on the Web further complicates the definition of an online community. If it is more than a bulletin board, then the boundaries of the shared space and the nature of the interaction have to be identified. In an example of an embedded business community, Preece examines Rei.com. Rei.com has a link from its homepage to its community page. The Lonely Planet community is more embedded in that it has no separation between community’s space and sales space. Jones [14] argues that information exchange is not a sufficiency for a community. This paper takes the perspective that the virtual space of the website constitutes the shared space of Lonely Planet’s community. These accords with the view that the business community is more than the interchange of information between customers, that information interchange is in itself insufficient to form a community and that the company itself draws no borders but

Summative Assessment In Education Research Paper

Summative Assessment In Education - Research Paper Example Why is it important to use authentic materials when teaching the English language? (3 marks) 2. Name six of the materials that can be used to supplement a course book when teaching English. (3 marks) 3. Discuss four methods which can be used to make a lesson more lively (4 marks) 4. Mention five advantages of using a course book while teaching (5 Marks) 5. Mention five best practices associated with the use of a course book (5 Marks) 6. Discuss the four options for use of a course book (8 marks) 7. Give four reasons why it is important to plan a lesson (2 marks) Section B: Lesson plan (30 marks) 1. With the news article and blank lesson plan provided, devise a lesson plan that can be used to teach a certain aspect of grammar. You are free to choose any aspect of your interest, but the lesson plan should include all the stages. Make sure all spaces are filled. Teacher: Room: Observer: Expected numbers: Date & Time: Class Level: Context: Teaching Aids: Learner Objectives: Personal Aims : Anticipated problems for students: Solution: Anticipated problems for teacher: Solution: Procedure Phase Timing Interaction (â€Å"Online TESOL / Online TEFL ITTT Answers†, 2009) Section C: Essay questions (40 marks) Write an essay of about 500 words to discuss one of the following concepts 1. Use a course book in lesson planning to maximize effects. 2. An ideal lesson plan. 3. Benefits of using a lesson plan. Note: your essay must contain a brief introduction and a conclusion. An assessment Triangle and cognitive Learning model In creating my summative assessment, I relied on the concept of the assessment triangle and the cognitive learning model. According to Selah & Khine (2011), the mentioned can provide a guide which helps, when an assessment instrument to support reasoning from evidence is designed, which is my objective. At this point, I feel that it is necessary to apply the concept of an assessment triangle where I considered all its elements. One of the elements o f an assessment triangle that I critically analyzed is cognition. Cognition refers to the theory, data, and a set of assumptions about how student present their knowledge and develop competency in a subject matter domain (Bernholt, 2012). Using the concept I try to align my summative assessment in the best possible way to make it test the level of competency my students have developed during the learning process. To understand this cognitive behavior fully, I decided to use the cognitive learning model. According to Busemeyer & Diederich (2010), this model has a goal of scientifically explaining processes used by the human brain to accomplish complex tasks. Using this model, I was able to understand the cognitive behavior of my students. This has helped me a lot in designing this summative assessment by showing me how the students behaviors interact with the goals we want to achieve through this summative assessments. Another element of as assessment triangle that I have considered is the beliefs element.

Impact of Industrial Revolution on American Society Essay

Impact of Industrial Revolution on American Society - Essay Example It is only after the Second Industrial Revolution (1870-1914) that a spurt in the development has occurred, resulting in rapid rise of industrial growth. Macro inventions which explored and discovered path breaking innovations in energy, materials, chemicals and medicine slowed down after 1825 which gave an impetus to advancement in research and the quest for acquiring new knowledge and technologies. This, in turn, has given rise to â€Å"micro inventions† (Mokyr, p.1) assisting the acceleration of production capabilities and infrastructure to sustain the industrial growth’. Thus, the society and lifestyles have undergone a sea change and humans became prosperous. This brought in luxuries and a lot of leisure that resulted in various developments in the world, and America in particular, in terms of economical prosperity, intellectual growth and cultural diversification. Modernization has thus become a powerhouse, dictating the world order. Several factors contributed to this newfound economical, intellectual and cultural upliftment. The first and foremost reason for any change or revolution to take shape is the idea which is nurtured by the intellectuals and thinkers who then analytically put forth their views. These slowly percolated and got assimilated into people’s mind. ... To him it said â€Å"Your diamonds are not in faraway mountains or in distant seas; they are in your own backyard if you will but dig for† (Conwell, p.7) the Prof. Joseph Carter, author of the Acres of Diamonds. Thus, the lecture caught the imagination of the American masses, making their belief strong in finding opportunities and avenues for self development and putting in hard efforts to tap the resources at their disposal. Another great work which swayed the minds of American masses was the poem, The New Colossos, by Emma Lazarus. The fourteen line poem was an ode written by Lazarus to the Statue of Liberty, which was engraved on the entrance door and the famous line ‘Give me your tired, your poor, your huddled masses yearning to breathe free† (Emma Lazarus, The New Colossus, para.1) was enshrined for immortality on the pedestal of the statue. The poem became a beacon of welcome and the statue became an icon of paragon for thousands of immigrants coming from Eur ope and rest of the world. Besides, it became a sign of hope and opportunity in the new world. Another great inspirational work was by Andrew Carnegie known as the Gospel of Wealth. He was a poor Scottish migrant turned millionaire who became the symbol for social mobility, which also was known as ‘The American Dream’ The profits from his steel empire called the ‘ Carnegie Steel Corp.’ made him one of the wealthiest and influential men in American history. Also, he was a great philanthropist who donated more then $350 million to build public libraries and universities. In his essay, the Gospel of Wealth, Carnegie deals in depth with the wealthy and the responsibilities that come with it. On the other hand, how he symbolized the poor and why charity

Breakfast Club Essay Example for Free

Breakfast Club Essay 1. Brian is a perfectionist when it comes to school. Only once has he got any grade under an â€Å"A†. Brian’s parents but a ton of pressure on Brian to perform exceptionally in school. 2. Brian is profiled as a nerd. After he got an â€Å"F† on a shop project he brought a gun into school to kill himself. However, the gun went off while in Brian’s locker so he was given a detention. 3. Brian shows a form of Denial in that when he got the bad grade he wasn’t able to accept it and was going to kill himself. 4. A) I feel that I could trust Brian because he seems like an honest, trustworthy kid. B) If Brian was at CBA I don’t think we would be friends because we don’t have many common interests but it’s possible we might be if we had a lot of classes because Brian is a nice kid. C) On Monday I think Brian will be friends with everyone but Clare. By the end of the year I think he will have had a lot of scholarship offers. In 20 years I think he will have a family and a great job. Andy 1. Andy is a very competitive person who wants to be accepted by his father. In fact the reason he’s so competitive is his father who pushes him to be the absolute best in athletics. 2. Andy is profiled as a jock. One day in the locker room Andy was taping his knee and a smaller weaker kid was getting undressed a few lockers down. Andy thought of his father always talking about how he was so bad in school so Andy beats the kid up and tapes is butt together so he gets detention. 3. Andy uses regression as a defense mechanism by taking his anger and stress out by using physical violence on another smaller kid. 4. A) I don’t think I could trust Andy because stress cause’s him to do dumb things. B) If Andy was at CBA I think we would be friends because we are both involved in sports. However, we might not be because he seems a little weird to me. C) I think on Monday Andy will still hang out with his normal group but also talk to the rest of his detention mates. By t he end of the year I think Andy will be going to college to wrestle. In 20 years I think Andy will have a family of his own, he won’t be talking to his father, and he’ll have a bad knee. John 1. John has a very outgoing but sometimes mean personality. The way he is treated at his own house is what causes john to come across harsh and mean sometimes. 2. John is profiled as a Trouble maker/ Criminal. He pulled the fire alarm in school and that’s his reason for being in detention. 3. Like Andy, John also uses regression as a defense mechanism. For example when the principle takes him out of the room he acts like a little kid and knocks books and papers all over the floor. John has no one to discipline him and tell him not to do this. I actually wouldn’t be surprised if John’s parents did when they got mad. 4. A) I don’t think I could trust john with things such as school work but I do think he would be a person it’s ok to tell things too. B) If John went to CBA I think I would want to be friends with him because he’s very funny. However, we might not be friends because we have different interests. C) I think John will go back to scho ol on Monday and cause trouble as usual but I also think him and Clare will have some sort of a relationship. At the end of the year I think John will leave his home and get a job and living place of his own. In 20 years I think John will have a wife and a low income job.

Steinbecks of Mice and Men and the Pearl Essay Example for Free

Steinbecks of Mice and Men and the Pearl Essay Although John Steinbeck is recognized for the themes of his novels, including the struggles of the working class and social injustice, he is also known for his excellent use of the literary elements. In two of his novels, Of Mice and Men and The Pearl, Steinbeck uses different types of tone, diction, and syntax to enhance meaning and strengthen the impact of his message. In Of Mice and Men Steinbeck presents an innocent tone through his character, Lennie, to create meaning in the piece. The tone is brought out through Lennie’s close following of George, which the reader sees when, â€Å"he pulled his hat down a little more over his eyes the way George’s hat was,† (page 4 OMM). This gives the reader the idea the Lennie looks up to George as a role model, as a son would to his father. This child-like perception of Lennie is present throughout the whole of the story and pulls out a strong emotional factor that gives the piece meaning at the close. Steinbeck uses a different tone, one of realization, to enforce meaning in The Pearl. When Kino’s, â€Å"brain cleared from its red concentration and he knew the sound the keening, moaning, rising hysterical cry from the little cave in the side of the stone mountain, the cry of death,† (page 114 TP). The shift in his thought process shows the reader that Kino’s actions were in protection of the pearl, and not his family. This is one of many scenes in the book that signify the engulfing of Kino’s mind in greed. The neglecting of his family gives the reader a sense of disapproval toward Kino and deepens the meaning in the value of the moral that greed is evil. Steinbeck uses different diction in each of these stories, but it serves a common purpose of helping the reader understand the different characters’ backgrounds and experiences, which increases the meaning of each story. The characters in Of Mice and Men use the unique vernacular of American migrant workers in the 1930s. George uses words like â€Å"ain’t† and â€Å"y’all† and Lennie speaks often about living, â€Å"offa the fatta the lan’,† (page 57 OMM). These examples of informal diction give the reader the idea that Lennie and George are uneducated and poor. This colloquial diction not only enriches the meaning of the story, but also brings the characters to life. In The Pearl, Steinbeck uses calm and simple diction to better portray the depth of the characters’ feelings and moods. For example, through his words, Kino shows that the pearl has become more than just a solution to his problems; it â€Å"has become [his] soul . . . If [he] give[s] it up, [he] shall lose [his] soul, (page 87 TP) John Steinbeck uses syntax to engage the reader and set the mood of each scene in both books. By doing this, the meaning in each scene is deepened. However, the syntax used in The Pearl is different from that used in Of Mice and Men. In The Pearl, Steinbeck uses listings to portray each scene thoroughly. At one point, he describes the evils of one night, when â€Å"the coyotes cried and laughed in the brush, and the owls screeched and hissed over their heads. And once some large animal lumbered away, crackling the undergrowth as it went,† (page 91 TP). This gives the rest of the scene a sense of depth in its meaning due to the fact that the reader knows all that is happening and feels the tension in the atmosphere. Steinbeck’s description of the Salinas River at the beginning of Of Mice and Men consists of one long sentence that picks up on all aspects of the scene. â€Å"On one side of the river the golden foothill slopes curve up to the strong and rocky Gabilan mountains, but on the valley side the water is lined with trees—willows fresh and green with every spring, carrying in their lower leaf junctures the debris of the winter’s flooding; and sycamores with mottled, white, recumbent limbs and branches that arch over the pool,† (page 1 OMM). Through this elongated sentence structure, Steinbeck better portrays the joyfulness and tranquility of the river, which pulls the reader into the scene and creates more meaning in the actions that take place. In both Of Mice and Men and The Pearl, John Steinbeck puts his own twist on tone, diction, and syntax, which gives each novel’s message more importance and meaning. But the meaning itself is always up to the reader to â€Å"take [†¦] from [the novel], and read his own life into it,† (Prologue TP).

Sodium, Potassium and Urea Measurement

Sodium, Potassium and Urea Measurement Introduction Electrolytes are solutions that conduct electricity. Any molecule that becomes an ion when mixed with water is an electrolyte. Salts such as sodium, potassium, calcium and chloride are examples of electrolytes. When these molecules dissolve in water, they release ions with an electric charge, positive or negative, that attracts or repels other ions during a chemical reaction. In living cells, most chemical reaction occur in an aqueous environment since approximately 75% of the mass of the living cell is water. Normally 70kg man, represent with 42 litres of total body water that contribute for about 60% of the total body weight. (Marshall, 2000). 66% of this water is in the intracellular fluid (ICF) and 33% in the extracellular fluid (ECF). The principle univalent cations in the ECF and ICF are sodium (Na+) and potassium (K+) respectively. Sodium (Na+) Sodium is the major cation of the extracellular fluid (ECF). It represents almost one-half the osmatic strength of plasma. It plays an important role in maintaining the normal distribution of water and osmatic pressure in the ECF compartment. Sodium levels in the body are regulated ultimately by the kidneys (it excrete excess sodium). The main source of sodium is sodium chloride (NaCl- table salt) which is used in cooking. The daily requirement of the body is about 1 2 mmol/day. Sodium is filtered freely by the glomeruli. About 70 80 % of the filtered sodium load is reabsorbed actively in the proximal tubules (with chloride and water passively) and anther 20 25 % is reabsorbed in the loop of Henle (along with chloride and more water). Normal ECF sodium concentration is 135 145 mmol/L while that of the intracellular fluid (ICF) is only 4-10 mmol/L. sodium is lost via urine, sweat or stool. (Marshall, 2000). Hypernatraemia Hypernatraemia (high sodium levels in the blood) may occurs due to increase sodium intake, decrease excretion, dehydration (water loss) or failure to replace normal water losses. It can also occurs because of excessive mineral corticoid (such as Aldosterone) production acting on renal reabsorption. The clinical features of hypernatraemia are non-specific or masked by underlying conditions. Nausea, vomiting, fever and confusion may occur. A history of long standing polyuria, polydipsia, and theist indicates diabetes insipidus. Hypernatraemia is caused by many diseases such as renal failure, Cushings syndrome or Conns syndrome. Conns syndrome is a disease of the adrenal glands involving excess production of a hormone, called aldosterone. Another name for the condition is primary hyperaldosteronism. Hyponatraemia Hyponatraemia (low sodium levels in the blood) is caused by impaired renal reabsorption of sodium. This occurs in Addisons disease of the adrenal gland due to loss of aldosterone producing zona glomerulosa cortical cells. Sodium decreases in severe sweating in a hot climate or during physical exertion such as marathon running. Falsely low serum sodium concentration may be found in hyperlipidaemic states where the sodium concentration in the aqueous phase of the serum is actually normal, but the lipid contributes to the total volume of serum measured. The symptoms are non-specific and include headache, confusion and restlessness. Hyponatraemia is seen in Addisons disease and/or excessive diuretic therapy. (Kumar Clark, 2002) Potassium (K+) It is the major intracellular cation. It is average concentration in tissue cells is 150mmol/L and in RBCs is 105 mmol/L. The body requirement for K+ is satisfied by a dietary intake. K+ is absorbed by the gastrointestinal tract and distributed rapidly, with a small amount taken up by cells and most excreted by the kidneys. Potassium which filtered by the glomeruli is reabsorbed almost completely in the proximal tubules (PT) and then secreted in the distal tubules (DT) in exchange for sodium under the influence of aldosterone. Factors that regulate distal tubular secretion of potassium include intake of sodium and potassium, water flow rate in distal tubules, plasma level of mineralocorticoids, and acid-base balance. Renal tubular acidosis, as well as metabolic and respiratory acidosis and alkalosis also affect renal regulation of potassium excretion. (Kumar Clark, 2002). Hyperkalaemia Hyperkalaemia is high K+ levels in the blood. Potassium is in high concentration within cells than in extracellular fluids. This means that relatively small changes in plasma concentration can underestimate possibly larger changes in intracellular concentrations. In addition, extensive tissue necrosis can liberate large amounts of potassium into the plasma causing the concentration to reach dangerously high levels. The commonest cause of hyperkalaemia is kidney failure causing decreased urinary potassium excretion. Severe hyperkalaemia (> 6.5 mmol/l) is a serious medical emergency needs treatment as fast as possible because of the risk of developing cardiac arrest. Moderate hyperkalaemia is relatively asymptomatic emphasising the importance of regular biochemical monitoring to avoid sudden fatal complications Hypokalaemia Hypokalaemia (low potassium levels in the blood) has many causes; the most common are diuretic treatment (particularly thiazides), hyperaldosteronism and renal disease. Hypokalaemia is often associated with a metabolic alkalosis due to hydrogen ion shift into the intracellular compartment. Clinically, it presents with paralysis, muscular weakness and cardiac dysrhythmais. (Kumar Clark, 2002) Aldosterone Aldosterone is a steroidal hormone secreted by the adrenal cortex. It is the hormone that regulates the bodys electrolyte balance. This hormone synthesized exclusively in the zona glomerulosa region of the adrenal cortex. This zona contains 18-hydroxysteroid dehydrogenase enzyme which a requisite enzyme for the formation of Aldosterone. Aldosterone acts directly on the kidney tubules to decrease the secretion rate of sodium ion (with accompanying retention of water), and to increase the excretion rate of potassium ion. The secretion of aldosterone is regulated by two mechanisms. First, the concentration of sodium ions secreted may be a factor since increased rates of aldosterone secretion are found when dietary sodium is severely limited. Second, reduced blood flow to the kidney stimulates certain kidney cells to secrete the proteolytic enzyme renin, which converts the inactive angiotensinogen globulin in the blood into angiotensin 1. Another enzyme then converts angiotensin I into a ngiotensin II, its active form. This peptide, in turn, stimulates the secretion of aldosterone by the adrenal cortex. Pathologically elevated aldosterone secretion with concomitant excessive retention of salt and water often results in edema. (Kumar Clark, 2002) Urea is a by-product of protein metabolism that is formed in the liver is formed by the enzymatic deamination of amino acids (urea cycle). The immediate precursor of urea is arginine, which is hydrolyzed to give urea and Ornithine. The urea is excreted by the kidneys and Ornithine in the liver combine with ammonia, formed by the catabolism of amino acids, to regenerate arginine and thereby continue the process of urea formation. The blood urea nitrogen (BUN) test measures the level of urea nitrogen in a sample of the patients blood. In healthy people, most urea nitrogen is filtered out by the kidneys and leaves the body in the urine, because urea contains ammonia, which is toxic to the body. If the patients kidneys are not functioning properly or if the body is using large amounts of protein, the BUN level will rise. If the patient has severe liver disease, the BUN will drop. High levels of BUN may indicate kidney disease or failure; blockage of the urinary tract by a kidney stone or tumour; a heart attack or congestive heart failure; dehydration; fever; shock; or bleeding in the digestive tract. High BUN levels can sometimes occur during late pregnancy or result from eating large amounts of protein-rich foods. A BUN level higher than 100 mg/dl, points to severe kidney damage. (Kumar Clark, 2002) Materials and method Please refer to medical biochemistry practical book (BMS2). Result The equation obtained from the graph used to calculate the Urea concentration of patients is: Y = 0.0238 X Where Y = absorbance X = urea concentration Patient 1 = 0.231/0.0238 = 9.7 mmol/L Patient 2 = 0.149/0.0238 = 6.3 mmol/L Patient 3 = 0.188/0.0238 = 7.89 x 10 = 78.9 mmol/L Patient 4 = 0.376/0.0238 = 7.5 mmol/L Discussion The concentration of sodium and potassium for the four patients was measured by using the flame photometer. For the estimation of urea concentration, a standard calibration curve using different standard concentrations been plotted which used to determine the test samples concentrations. In this practical, the abnormal conditions are varying for each of the patients. Addisons disease is a disorder of the adrenal cortex in which the adrenal glands are under active, resulting in a deficiency of adrenal hormones. Addisons disease can start at any age and affects males and females equally. The adrenal glands are affected by an autoimmune reaction in which the bodys immune system attacks and destroys the adrenal cortex. The glands may also be destroyed by cancer, an infection such as tuberculosis, or another identifiable disease. In infants and children, Addisons disease may be due to a genetic abnormality of the adrenal glands. The majority of the clinical features of adrenal failure are due to lack of glucocorticoid and mineralcorticoid. In Addisons disease cortisol levels are reduced which lead, through feedback, to increase corticotrophin-releasing hormone (CRH) and adrenocorticotrophic hormone (ACTH) production. When the adrenal glands become under active, they tend to produce inadequate amounts of all adrenal hormones. Thus, Addisons disease aff ects the balance of water, sodium, and potassium in the body, as well as the bodys ability to control blood pressure and react to stress. In addition, loss of androgens, such as dehydroepiandrosterone (DHEA), may cause a loss of the body hair in women. A deficiency of aldosterone in particular causes the body to excrete large amount of sodium and potassium, leading to low levels of sodium and high levels of potassium in the blood. The kidneys are not able to concentrate urine, so when a person with Addisons disease drinks too much water or loses too much sodium, the level of sodium in the blood falls. Inability to concentrate urine ultimately causes the person to urinate excessively and become dehydrated. Severe dehydration and low sodium level reduce blood volume and can culminate in shock. Dehydration also causes a high blood urea level. In Addisons disease, the pituitary gland produces more corticotrophin in an attempt to stimulate the adrenal glands. Corticotrophin also stimulat es melanin production, so dark pigmentation of the skin and the lining of the mouth often develop. People with Addisons disease are not able to produce additional corticosteroids when they are stressed. Therefore, they are susceptible to serious symptoms and complications when confronted with illness, extreme fatigue, severe injury, surgery, or possibly severe psychological stress. Secondary adrenal insufficiency is a term given to a disorder that resembles Addisons disease. In this disorder, the adrenal glands are under active because the pituitary gland is not stimulating them, not because the adrenal glands have been destroyed. Blood tests may show low sodium level and high potassium level and usually indicate that the kidneys are not working well. The cortisol level may be low and corticotrophin level may be high. However, the diagnosis is usually confirmed by measuring cortisol level after they have been stimulated with corticotrophin. If cortisol level is low, further tests are needed to determine if problem is Addisons or secondary adrenal insufficiency. Patient-1 has very low sodium 116 mmol/L (135-145 mmol/L), high potassium 6.2 mmol/L (3.6-5.0 mmol/L) and high urea 9.7 mmol/L (3.3-7.5 mmol/L). These abnormal results mostly fit Addisons disease. Sodium been lost in urine in exchange with potassium which causes depletion of Na+ in the blood and increase K+ as both cortisol and aldesterone hormones are absent. Urea level is elevated as a secondary to dehydration and could be due to renal perfusion. ACTH measurement can be used to confirm the diagnosis. Conns syndrome is known as primary aldostronism, is due to the hyper secretion of aldesterone, usually by adenoma of the adrenal cortex or loss often nodular hyperplasia. It characterised by sodium retention and potassium depletion, because plasma renin feed back mechanism is depressed. Under normal conditions aldesterone is regulated by the renin angiotensim mechanism. The principle physiological function of aldesterone is to conserve Na+ . It dose this mainly by facilitating the reabsorption of Na+ and excretion of K+ and H+ in the distal renal tubule. Aldesterone also plays a major role in regulating water and electrolytes balance and blood pressure. The renin-angiotension aldesterone system is the most important controlling mechanism, but ACTH, Na+ and K+ also affect aldesterone secretion. The release of the enzyme renin is stimulated by fall in circulating blood volume or renal perfusion pressure and loss of Na+. The enzyme stimulate the osmoreceptors in the hypothalamus which c auses the release of antidiuretic hormone (ADH) from posterior pituitary gland. ADH targets the kidneys to increase the water reabsorption and causes arterioles to constrict. Renin also acts on its substrate and splits off the inactive decapeptide angiotensim I. Then angiotenism-converting enzyme (ACE), present in lung and plasma, converts angiotensim I to the active angiotensim II which stimulates the release of aldesterone by the adrenal cortex. Aldosterone increases the retention of sodium, chloride ions and water by the kidneys. The laboratory findings include low serum potassium which is a consequence of increased renal potassium excretion, normal or slightly increased sodium in plasma due to increased reabsorption from the renal tubules. Also the renin level will be low and do not rise in response to sodium depletion as they would be in normal persons. In addition, prolonged potassium depletion and hypertension are signs of renal damage. The clinical significance of Coons disease represented with hypertension, muscular weakness and anther neurological manifestation due to loss of K+ which play role in muscles and neurons contraction. Polyuria and thirst secondary to poor renal concentration. Any patient represent hypertension with low potassium concentration should be suspected to have Coons disease. Any patient under diuretic treatment should be monitored overnight as this manifest low potassium. Patient-2 has normal urea level 6.3 mmol/L (3.3-7.5 mmol/L), sodium result is 144 mmol/L, just below the upper limit (135-145 mmol/L) and very low potassium which supports the diagnosis of Coons syndrome. The high aldosterone level in the blood acts on the kidneys to increase the loss of mineral potassium in the urine and facilitate the reabsorption of Na+. Renal failure is the inability of the kidneys to adequately filter metabolic waste products from the blood. Chronic kidney failure is a gradual decline in kidney function which may be explained in terms of a full solute load fall in on a reduced number of functionally normal nephrons. The glomerular filtration rate (GFR) is invariably reduced, associated with retention of urea, creatinine, urate and other organic substances. The kidneys are less able to control the amount and distribution of body water (fluid balance) and the levels of electrolytes (sodium, potassium, calcium, phosphate) in the blood and blood pressure often rise. The kidneys lose their ability to produce sufficient amounts of a hormone (erythropoietin) that stimulates the formation of new red blood cells, resulting in a low red blood cell count (anemia). In children, kidney failure affects the growth of bones. In both children and adults, kidney failure can lead to weaker, abnormal bones. The increased solute load per nephrons impairs the kidneys ability to reduce concentrated urine. As the GFR falls to lower levels retention of Na+ occurs but there is no consistent pattern alteration in plasma Na+ in these cases and in many the results remain normal. Potassium clearance may be increased and raised plasma K+ is uncommon in spite of the tendency for K+ to come out of cells due to the metabolic acidosis that is usually present. However, patients with renal failure are unable to excrete large loads of K+. The level of urea and creatinine will also rise as a result of decreased excretion by the kidneys. Patient-3 has a normal sodium levels 137 mmol/L with a high potassium .8.7 mmol/L and very high urea (78.9 mmol/l) levels which indicates abnormal kidney function. The patient is most probably suffering from chronic renal failure. The numbers of healthy functioning normal nephrons are reduced therefore; there will be a reduction in the execration of urea which will accumulates in the blood. Because of the low GRF, potassium blood levels are increased. The patient must undergo renal dialysis. Diabetic ketoacidosis (DKA) is a common acute complication of insulin-dependent, or type 1 diabetes mellitus (IDDM) due to insulin deficiency which is accompanied by raised plasma concentration of diabetogenic hormones (Adrenaline, Cortisol, Growth hormone and Glucagon ).Before the discovery of insulin in the 1920s, patients rarely survived diabetic ketoacidosis. This complication is still potentially lethal, with an average mortality rate between 5 and 10%. Although the risk of diabetic ketoacidosis is greatest for patients with IDDM, the condition may also occur in patients with non- insulin-dependent diabetes (NIDDM) under stressful conditions, such as during a myocardial infarction. Common symptoms are thirst due to dehydration, polyuria, nausea and weakness that have progressed over several days, which result in coma over the course of several hours. Because of the variable symptoms, diabetic ketoacidosis should be considered in any ill diabetic patient, particularly if the patient presents with nausea and vomiting. Common clinical findings include tachycardia, tachypnea, dehydration, altered mental status and a fruity breath odour, indicating the presence of ketones. Plasma glucose is normally maintained between 4.5 and 8.0mmol/1. Without insulin, most cells cannot use the sugar that is in the blood. Cells still need energy to survive, and they switch to a back-up mechanism to obtain energy. Fat cells begin to break down, producing compounds called ketones. Ketones provide some energy to cells but also make the blood too acidic (ketoacidosis). Since plasma glucose diabetic ketoacidosis exceed the renal threshold; glucose is always present in the urine of patients (glycosuria) with ketoacidosis, the pH of the blood is important in determining the severity of the condition. Blood normally has a pH of 7.35-7.45, maintained by the buffering systems, the most important of which is the bicarbonate buffer system. When acids accumulate in the blood, they dissociate with an increase in hydrogen ion concentration. Bicarbonate can usually neutralise hydrogen ions by incorporating them into water. DKA is associated with electrolyte imbalances; sodium and potassium levels in particular are affected. Serum sodium levels may be low, high or normal. When evaluating the serum sodium level, it is helpful to remember that hyperglycemia causes a shift of free water into the extracellular space, diluting the measured sodium concentration which results in lost of sodium via lie urine as a result of osmotic diuresis. In addition, vomiting, a common feature of ketoacidosis is associated with a loss of sodium from the gastrointestinal tract. This might not always be reflected in the blood results because it is a measure of concentration and, as has already been illustrated, dehydration will be present. Normal plasma sodium levels are maintained between 135 and 145mmol/l, however, despite the actual deficit, patients with DKA might display wide-ranging plasma sodium levels depending on the relative losses of water and sodium. Total body potassium is always depleted in ketoacidosis as potassium is also lost in urine and vomit. The plasma concentration of potassium, however, remains relatively high due to the passage of potassium out of the cells and into the extracellular fluid. One of the mechanisms that normally control the passage of potassium into and out of cells is the sodium/potassium pump. This pump requires intracellular glucose, which is not available in ketoacidosis, consequently, the pump cannot function and potassium leaks out of the cell and into the plasma. Furthermore, potassium is freely exchangeable with hydrogen across the cell membrane. If the hydrogen concentration is high as in DKA, hydrogen will move into the cell in exchange for potassium. So, despite an overall potassium deficit, plasma levels are usually raised in ketoacidosis, at the expense of the body cells. The kidneys can malfunction, resulting in kidney failure that may require dialysis or kidney transplantation. Doctors usu ally check the urine of people with diabetes for abnormally high levels of protein (albumin), which is an early sign of kidney damage. At the earliest sign of kidney complications, the person is often given angiotensin-converting enzyme (ACE) inhibitors, drugs that slow the progression of kidney disease by decreasing blood flow to the kidneys which prevent the kidneys from excreting normal amounts of potassium leads to mild hyperkalaemia. The result obtained for patient-4 corresponding with the clinical findings found in diabetic ketoacidosis. The sodium is reduced (130 mmol/L) and the potassium reading is relatively high (5.8 mmol/L) when compared with the normal reference range. There is a marked increase in urea (15.6 mmol/L) because as mentioned earlier the kidneys can malfunction, resulting in kidney failure that will concentrate fluid in the extracellular compartment. Conclusion Patient 1 is suffering from Addisons disease Patient 2 is suffering from Coons syndrome Patient 3 is suffering from chronic renal failure Patient 4 is suffering from diabetic ketoacidos Questions Calculate the osmolarity (mmol/L) for each patient. Why would patients3s (the diabetic) osmolarity be underestimate? Osmolarity is a property of particles of solute per liter of solution. If a substance can dissociate in solution, it may contribute more than one equivalent to the osmolarity of the solution. The expected osmolarity of plasma can be calculated according to the following formula. Calculated osmolarity (mOsm/kg) = 2*[Na +] + 2*[K+] + (glucose) + (urea) Patient 1 = 2 x 116 + 2 x 6.2 + [glucose] + 9.7 Patient 2 = 2 x 144 + 2 x 2.8 + [glucose] + 6.3 Patient 3 = 2 x 137 + 2 x 8.7 + [glucose] + 78.9 Patient 4 = 2 x 130 + 2 x 5.8 + [glucose] + 15.7 The final result is not obtained as the glucose values are not given, so the calculation can not be done without glucose values. The patient 3 (the diabetic) osmolarity is underestimated because of insulin deficiency, the cells uptake of glucose, which causes hyperglycaemia. What is the abnormality in the clinical condition Diabetes Insipidus, and how does it affect water electrolyte balance? Many different hormones help to control metabolic activities within the body. One of these is called anti-diuretic hormone (ADH) and its function is to help control the balance of water in the body. It does this by regulating the production of urine. ADH is produced by the hypothalamus and then stored in the pituitary gland until it is needed. Diabetes Insipidus usually results from the decreased production of antidiuretic hormone. Alternatively, the disorder may be caused by failure of the pituitary gland to release Antidiuretic hormone into the bloodstream. Other causes of diabetes Insipidus include damage done during surgery on the hypothalamus or pituitary gland; a brain injury, particularly a fracture of the base of the skull; a tumor; sarcoidosis or tuberculosis; an aneurysm (a bulge in the wall of an artery) or blockage in the arteries leading to the brain; some forms of encephalitis or meningitis; and the rare disease Langerhans cell granulomatosis (histiocytosis X). Another type of diabetes Insipidus, nephrogenic diabetes Insipidus, may be caused by abnormalities in the kidneys. Diabetes Insipidus suspected in people who produce large amounts of urine. They first test the urine for sugar to rule out diabetes mellitus. Blood tests show abnormal levels of many electrolytes, including a high level of sodium. The best test is a water deprivation test, in which urine production, blood electrolyte (sodium) levels, and weight are measured regularly for a period of about 12 hours, during which the person is not allowed to drink. A doctor monitors the persons condition throughout the course of the test. At the end of the 12 hours, or sooner if the persons blood pressure falls or heart rate increases or if he loses more than 5% of his body weight, the doctor stops the test and injects Antidiuretic hormone. The diagnosis of central diabetes Insipidus is confirmed if, in response to Antidiuretic hormone, the persons excessive urination stops, the urine becomes mor e concentrated, the blood pressure rises, and the heart beats more normally. The diagnosis of nephrogenic diabetes Insipidus is made if, after the injection, the excessive urination continues, the urine remains dilute, and blood pressure and heart rate do not change. How do diuretics work? And what are the three main groups of diuretics? Diuretics work in the kidneys to increase the elimination of water and electrolytes, thereby causing more urine to form. Because the amount of fluid in the body is lowered, blood pressure goes down, too. Different chemical types work in different areas of the nephrons; so many different classes of diuretics are used. Three of the most common classes of diuretics are: Thiazide and Thiazide-Like Diuretics Drugs containing the chemical Thiazide and similar chemicals like indapamide and metolazone are suggested as the first drugs to try for most people with high blood pressure. They affect the distal convoluted tubule, where large amounts of sodium and water are absorbed back into the body. By blocking the re-absorption process, these drugs force more sodium and more water into the urine to be removed from the body. Thiazides may also relax the muscles in blood vessel walls, making blood flow more easily. Loop Diuretics More powerful than the Thiazide are classes of diuretics that work in the area of the Loop of Henle. These loop diuretics mainly interfere with the bodys re-absorption of chloride, but they also keep sodium from re-entering the blood. Unfortunately, loop diuretics are also more likely to promote the elimination of calcium, magnesium and especially potassium. Shortages of any of these essential electrolytes can cause serious problems such as irregular heartbeats. Potassium-Sparing Diuretics The third common group of diuretics consists of drugs that are much weaker than the Thiazides or the loop diuretics but potassium-sparing diuretics do not reduce potassium levels nearly as much as other kinds of diuretics do. They inhibit aldosterone and/or block sodium reabsorption and inhibit potassium excretion in the distal tubule. Sodium, Potassium and Urea Measurement Sodium, Potassium and Urea Measurement Introduction Electrolytes are solutions that conduct electricity. Any molecule that becomes an ion when mixed with water is an electrolyte. Salts such as sodium, potassium, calcium and chloride are examples of electrolytes. When these molecules dissolve in water, they release ions with an electric charge, positive or negative, that attracts or repels other ions during a chemical reaction. In living cells, most chemical reaction occur in an aqueous environment since approximately 75% of the mass of the living cell is water. Normally 70kg man, represent with 42 litres of total body water that contribute for about 60% of the total body weight. (Marshall, 2000). 66% of this water is in the intracellular fluid (ICF) and 33% in the extracellular fluid (ECF). The principle univalent cations in the ECF and ICF are sodium (Na+) and potassium (K+) respectively. Sodium (Na+) Sodium is the major cation of the extracellular fluid (ECF). It represents almost one-half the osmatic strength of plasma. It plays an important role in maintaining the normal distribution of water and osmatic pressure in the ECF compartment. Sodium levels in the body are regulated ultimately by the kidneys (it excrete excess sodium). The main source of sodium is sodium chloride (NaCl- table salt) which is used in cooking. The daily requirement of the body is about 1 2 mmol/day. Sodium is filtered freely by the glomeruli. About 70 80 % of the filtered sodium load is reabsorbed actively in the proximal tubules (with chloride and water passively) and anther 20 25 % is reabsorbed in the loop of Henle (along with chloride and more water). Normal ECF sodium concentration is 135 145 mmol/L while that of the intracellular fluid (ICF) is only 4-10 mmol/L. sodium is lost via urine, sweat or stool. (Marshall, 2000). Hypernatraemia Hypernatraemia (high sodium levels in the blood) may occurs due to increase sodium intake, decrease excretion, dehydration (water loss) or failure to replace normal water losses. It can also occurs because of excessive mineral corticoid (such as Aldosterone) production acting on renal reabsorption. The clinical features of hypernatraemia are non-specific or masked by underlying conditions. Nausea, vomiting, fever and confusion may occur. A history of long standing polyuria, polydipsia, and theist indicates diabetes insipidus. Hypernatraemia is caused by many diseases such as renal failure, Cushings syndrome or Conns syndrome. Conns syndrome is a disease of the adrenal glands involving excess production of a hormone, called aldosterone. Another name for the condition is primary hyperaldosteronism. Hyponatraemia Hyponatraemia (low sodium levels in the blood) is caused by impaired renal reabsorption of sodium. This occurs in Addisons disease of the adrenal gland due to loss of aldosterone producing zona glomerulosa cortical cells. Sodium decreases in severe sweating in a hot climate or during physical exertion such as marathon running. Falsely low serum sodium concentration may be found in hyperlipidaemic states where the sodium concentration in the aqueous phase of the serum is actually normal, but the lipid contributes to the total volume of serum measured. The symptoms are non-specific and include headache, confusion and restlessness. Hyponatraemia is seen in Addisons disease and/or excessive diuretic therapy. (Kumar Clark, 2002) Potassium (K+) It is the major intracellular cation. It is average concentration in tissue cells is 150mmol/L and in RBCs is 105 mmol/L. The body requirement for K+ is satisfied by a dietary intake. K+ is absorbed by the gastrointestinal tract and distributed rapidly, with a small amount taken up by cells and most excreted by the kidneys. Potassium which filtered by the glomeruli is reabsorbed almost completely in the proximal tubules (PT) and then secreted in the distal tubules (DT) in exchange for sodium under the influence of aldosterone. Factors that regulate distal tubular secretion of potassium include intake of sodium and potassium, water flow rate in distal tubules, plasma level of mineralocorticoids, and acid-base balance. Renal tubular acidosis, as well as metabolic and respiratory acidosis and alkalosis also affect renal regulation of potassium excretion. (Kumar Clark, 2002). Hyperkalaemia Hyperkalaemia is high K+ levels in the blood. Potassium is in high concentration within cells than in extracellular fluids. This means that relatively small changes in plasma concentration can underestimate possibly larger changes in intracellular concentrations. In addition, extensive tissue necrosis can liberate large amounts of potassium into the plasma causing the concentration to reach dangerously high levels. The commonest cause of hyperkalaemia is kidney failure causing decreased urinary potassium excretion. Severe hyperkalaemia (> 6.5 mmol/l) is a serious medical emergency needs treatment as fast as possible because of the risk of developing cardiac arrest. Moderate hyperkalaemia is relatively asymptomatic emphasising the importance of regular biochemical monitoring to avoid sudden fatal complications Hypokalaemia Hypokalaemia (low potassium levels in the blood) has many causes; the most common are diuretic treatment (particularly thiazides), hyperaldosteronism and renal disease. Hypokalaemia is often associated with a metabolic alkalosis due to hydrogen ion shift into the intracellular compartment. Clinically, it presents with paralysis, muscular weakness and cardiac dysrhythmais. (Kumar Clark, 2002) Aldosterone Aldosterone is a steroidal hormone secreted by the adrenal cortex. It is the hormone that regulates the bodys electrolyte balance. This hormone synthesized exclusively in the zona glomerulosa region of the adrenal cortex. This zona contains 18-hydroxysteroid dehydrogenase enzyme which a requisite enzyme for the formation of Aldosterone. Aldosterone acts directly on the kidney tubules to decrease the secretion rate of sodium ion (with accompanying retention of water), and to increase the excretion rate of potassium ion. The secretion of aldosterone is regulated by two mechanisms. First, the concentration of sodium ions secreted may be a factor since increased rates of aldosterone secretion are found when dietary sodium is severely limited. Second, reduced blood flow to the kidney stimulates certain kidney cells to secrete the proteolytic enzyme renin, which converts the inactive angiotensinogen globulin in the blood into angiotensin 1. Another enzyme then converts angiotensin I into a ngiotensin II, its active form. This peptide, in turn, stimulates the secretion of aldosterone by the adrenal cortex. Pathologically elevated aldosterone secretion with concomitant excessive retention of salt and water often results in edema. (Kumar Clark, 2002) Urea is a by-product of protein metabolism that is formed in the liver is formed by the enzymatic deamination of amino acids (urea cycle). The immediate precursor of urea is arginine, which is hydrolyzed to give urea and Ornithine. The urea is excreted by the kidneys and Ornithine in the liver combine with ammonia, formed by the catabolism of amino acids, to regenerate arginine and thereby continue the process of urea formation. The blood urea nitrogen (BUN) test measures the level of urea nitrogen in a sample of the patients blood. In healthy people, most urea nitrogen is filtered out by the kidneys and leaves the body in the urine, because urea contains ammonia, which is toxic to the body. If the patients kidneys are not functioning properly or if the body is using large amounts of protein, the BUN level will rise. If the patient has severe liver disease, the BUN will drop. High levels of BUN may indicate kidney disease or failure; blockage of the urinary tract by a kidney stone or tumour; a heart attack or congestive heart failure; dehydration; fever; shock; or bleeding in the digestive tract. High BUN levels can sometimes occur during late pregnancy or result from eating large amounts of protein-rich foods. A BUN level higher than 100 mg/dl, points to severe kidney damage. (Kumar Clark, 2002) Materials and method Please refer to medical biochemistry practical book (BMS2). Result The equation obtained from the graph used to calculate the Urea concentration of patients is: Y = 0.0238 X Where Y = absorbance X = urea concentration Patient 1 = 0.231/0.0238 = 9.7 mmol/L Patient 2 = 0.149/0.0238 = 6.3 mmol/L Patient 3 = 0.188/0.0238 = 7.89 x 10 = 78.9 mmol/L Patient 4 = 0.376/0.0238 = 7.5 mmol/L Discussion The concentration of sodium and potassium for the four patients was measured by using the flame photometer. For the estimation of urea concentration, a standard calibration curve using different standard concentrations been plotted which used to determine the test samples concentrations. In this practical, the abnormal conditions are varying for each of the patients. Addisons disease is a disorder of the adrenal cortex in which the adrenal glands are under active, resulting in a deficiency of adrenal hormones. Addisons disease can start at any age and affects males and females equally. The adrenal glands are affected by an autoimmune reaction in which the bodys immune system attacks and destroys the adrenal cortex. The glands may also be destroyed by cancer, an infection such as tuberculosis, or another identifiable disease. In infants and children, Addisons disease may be due to a genetic abnormality of the adrenal glands. The majority of the clinical features of adrenal failure are due to lack of glucocorticoid and mineralcorticoid. In Addisons disease cortisol levels are reduced which lead, through feedback, to increase corticotrophin-releasing hormone (CRH) and adrenocorticotrophic hormone (ACTH) production. When the adrenal glands become under active, they tend to produce inadequate amounts of all adrenal hormones. Thus, Addisons disease aff ects the balance of water, sodium, and potassium in the body, as well as the bodys ability to control blood pressure and react to stress. In addition, loss of androgens, such as dehydroepiandrosterone (DHEA), may cause a loss of the body hair in women. A deficiency of aldosterone in particular causes the body to excrete large amount of sodium and potassium, leading to low levels of sodium and high levels of potassium in the blood. The kidneys are not able to concentrate urine, so when a person with Addisons disease drinks too much water or loses too much sodium, the level of sodium in the blood falls. Inability to concentrate urine ultimately causes the person to urinate excessively and become dehydrated. Severe dehydration and low sodium level reduce blood volume and can culminate in shock. Dehydration also causes a high blood urea level. In Addisons disease, the pituitary gland produces more corticotrophin in an attempt to stimulate the adrenal glands. Corticotrophin also stimulat es melanin production, so dark pigmentation of the skin and the lining of the mouth often develop. People with Addisons disease are not able to produce additional corticosteroids when they are stressed. Therefore, they are susceptible to serious symptoms and complications when confronted with illness, extreme fatigue, severe injury, surgery, or possibly severe psychological stress. Secondary adrenal insufficiency is a term given to a disorder that resembles Addisons disease. In this disorder, the adrenal glands are under active because the pituitary gland is not stimulating them, not because the adrenal glands have been destroyed. Blood tests may show low sodium level and high potassium level and usually indicate that the kidneys are not working well. The cortisol level may be low and corticotrophin level may be high. However, the diagnosis is usually confirmed by measuring cortisol level after they have been stimulated with corticotrophin. If cortisol level is low, further tests are needed to determine if problem is Addisons or secondary adrenal insufficiency. Patient-1 has very low sodium 116 mmol/L (135-145 mmol/L), high potassium 6.2 mmol/L (3.6-5.0 mmol/L) and high urea 9.7 mmol/L (3.3-7.5 mmol/L). These abnormal results mostly fit Addisons disease. Sodium been lost in urine in exchange with potassium which causes depletion of Na+ in the blood and increase K+ as both cortisol and aldesterone hormones are absent. Urea level is elevated as a secondary to dehydration and could be due to renal perfusion. ACTH measurement can be used to confirm the diagnosis. Conns syndrome is known as primary aldostronism, is due to the hyper secretion of aldesterone, usually by adenoma of the adrenal cortex or loss often nodular hyperplasia. It characterised by sodium retention and potassium depletion, because plasma renin feed back mechanism is depressed. Under normal conditions aldesterone is regulated by the renin angiotensim mechanism. The principle physiological function of aldesterone is to conserve Na+ . It dose this mainly by facilitating the reabsorption of Na+ and excretion of K+ and H+ in the distal renal tubule. Aldesterone also plays a major role in regulating water and electrolytes balance and blood pressure. The renin-angiotension aldesterone system is the most important controlling mechanism, but ACTH, Na+ and K+ also affect aldesterone secretion. The release of the enzyme renin is stimulated by fall in circulating blood volume or renal perfusion pressure and loss of Na+. The enzyme stimulate the osmoreceptors in the hypothalamus which c auses the release of antidiuretic hormone (ADH) from posterior pituitary gland. ADH targets the kidneys to increase the water reabsorption and causes arterioles to constrict. Renin also acts on its substrate and splits off the inactive decapeptide angiotensim I. Then angiotenism-converting enzyme (ACE), present in lung and plasma, converts angiotensim I to the active angiotensim II which stimulates the release of aldesterone by the adrenal cortex. Aldosterone increases the retention of sodium, chloride ions and water by the kidneys. The laboratory findings include low serum potassium which is a consequence of increased renal potassium excretion, normal or slightly increased sodium in plasma due to increased reabsorption from the renal tubules. Also the renin level will be low and do not rise in response to sodium depletion as they would be in normal persons. In addition, prolonged potassium depletion and hypertension are signs of renal damage. The clinical significance of Coons disease represented with hypertension, muscular weakness and anther neurological manifestation due to loss of K+ which play role in muscles and neurons contraction. Polyuria and thirst secondary to poor renal concentration. Any patient represent hypertension with low potassium concentration should be suspected to have Coons disease. Any patient under diuretic treatment should be monitored overnight as this manifest low potassium. Patient-2 has normal urea level 6.3 mmol/L (3.3-7.5 mmol/L), sodium result is 144 mmol/L, just below the upper limit (135-145 mmol/L) and very low potassium which supports the diagnosis of Coons syndrome. The high aldosterone level in the blood acts on the kidneys to increase the loss of mineral potassium in the urine and facilitate the reabsorption of Na+. Renal failure is the inability of the kidneys to adequately filter metabolic waste products from the blood. Chronic kidney failure is a gradual decline in kidney function which may be explained in terms of a full solute load fall in on a reduced number of functionally normal nephrons. The glomerular filtration rate (GFR) is invariably reduced, associated with retention of urea, creatinine, urate and other organic substances. The kidneys are less able to control the amount and distribution of body water (fluid balance) and the levels of electrolytes (sodium, potassium, calcium, phosphate) in the blood and blood pressure often rise. The kidneys lose their ability to produce sufficient amounts of a hormone (erythropoietin) that stimulates the formation of new red blood cells, resulting in a low red blood cell count (anemia). In children, kidney failure affects the growth of bones. In both children and adults, kidney failure can lead to weaker, abnormal bones. The increased solute load per nephrons impairs the kidneys ability to reduce concentrated urine. As the GFR falls to lower levels retention of Na+ occurs but there is no consistent pattern alteration in plasma Na+ in these cases and in many the results remain normal. Potassium clearance may be increased and raised plasma K+ is uncommon in spite of the tendency for K+ to come out of cells due to the metabolic acidosis that is usually present. However, patients with renal failure are unable to excrete large loads of K+. The level of urea and creatinine will also rise as a result of decreased excretion by the kidneys. Patient-3 has a normal sodium levels 137 mmol/L with a high potassium .8.7 mmol/L and very high urea (78.9 mmol/l) levels which indicates abnormal kidney function. The patient is most probably suffering from chronic renal failure. The numbers of healthy functioning normal nephrons are reduced therefore; there will be a reduction in the execration of urea which will accumulates in the blood. Because of the low GRF, potassium blood levels are increased. The patient must undergo renal dialysis. Diabetic ketoacidosis (DKA) is a common acute complication of insulin-dependent, or type 1 diabetes mellitus (IDDM) due to insulin deficiency which is accompanied by raised plasma concentration of diabetogenic hormones (Adrenaline, Cortisol, Growth hormone and Glucagon ).Before the discovery of insulin in the 1920s, patients rarely survived diabetic ketoacidosis. This complication is still potentially lethal, with an average mortality rate between 5 and 10%. Although the risk of diabetic ketoacidosis is greatest for patients with IDDM, the condition may also occur in patients with non- insulin-dependent diabetes (NIDDM) under stressful conditions, such as during a myocardial infarction. Common symptoms are thirst due to dehydration, polyuria, nausea and weakness that have progressed over several days, which result in coma over the course of several hours. Because of the variable symptoms, diabetic ketoacidosis should be considered in any ill diabetic patient, particularly if the patient presents with nausea and vomiting. Common clinical findings include tachycardia, tachypnea, dehydration, altered mental status and a fruity breath odour, indicating the presence of ketones. Plasma glucose is normally maintained between 4.5 and 8.0mmol/1. Without insulin, most cells cannot use the sugar that is in the blood. Cells still need energy to survive, and they switch to a back-up mechanism to obtain energy. Fat cells begin to break down, producing compounds called ketones. Ketones provide some energy to cells but also make the blood too acidic (ketoacidosis). Since plasma glucose diabetic ketoacidosis exceed the renal threshold; glucose is always present in the urine of patients (glycosuria) with ketoacidosis, the pH of the blood is important in determining the severity of the condition. Blood normally has a pH of 7.35-7.45, maintained by the buffering systems, the most important of which is the bicarbonate buffer system. When acids accumulate in the blood, they dissociate with an increase in hydrogen ion concentration. Bicarbonate can usually neutralise hydrogen ions by incorporating them into water. DKA is associated with electrolyte imbalances; sodium and potassium levels in particular are affected. Serum sodium levels may be low, high or normal. When evaluating the serum sodium level, it is helpful to remember that hyperglycemia causes a shift of free water into the extracellular space, diluting the measured sodium concentration which results in lost of sodium via lie urine as a result of osmotic diuresis. In addition, vomiting, a common feature of ketoacidosis is associated with a loss of sodium from the gastrointestinal tract. This might not always be reflected in the blood results because it is a measure of concentration and, as has already been illustrated, dehydration will be present. Normal plasma sodium levels are maintained between 135 and 145mmol/l, however, despite the actual deficit, patients with DKA might display wide-ranging plasma sodium levels depending on the relative losses of water and sodium. Total body potassium is always depleted in ketoacidosis as potassium is also lost in urine and vomit. The plasma concentration of potassium, however, remains relatively high due to the passage of potassium out of the cells and into the extracellular fluid. One of the mechanisms that normally control the passage of potassium into and out of cells is the sodium/potassium pump. This pump requires intracellular glucose, which is not available in ketoacidosis, consequently, the pump cannot function and potassium leaks out of the cell and into the plasma. Furthermore, potassium is freely exchangeable with hydrogen across the cell membrane. If the hydrogen concentration is high as in DKA, hydrogen will move into the cell in exchange for potassium. So, despite an overall potassium deficit, plasma levels are usually raised in ketoacidosis, at the expense of the body cells. The kidneys can malfunction, resulting in kidney failure that may require dialysis or kidney transplantation. Doctors usu ally check the urine of people with diabetes for abnormally high levels of protein (albumin), which is an early sign of kidney damage. At the earliest sign of kidney complications, the person is often given angiotensin-converting enzyme (ACE) inhibitors, drugs that slow the progression of kidney disease by decreasing blood flow to the kidneys which prevent the kidneys from excreting normal amounts of potassium leads to mild hyperkalaemia. The result obtained for patient-4 corresponding with the clinical findings found in diabetic ketoacidosis. The sodium is reduced (130 mmol/L) and the potassium reading is relatively high (5.8 mmol/L) when compared with the normal reference range. There is a marked increase in urea (15.6 mmol/L) because as mentioned earlier the kidneys can malfunction, resulting in kidney failure that will concentrate fluid in the extracellular compartment. Conclusion Patient 1 is suffering from Addisons disease Patient 2 is suffering from Coons syndrome Patient 3 is suffering from chronic renal failure Patient 4 is suffering from diabetic ketoacidos Questions Calculate the osmolarity (mmol/L) for each patient. Why would patients3s (the diabetic) osmolarity be underestimate? Osmolarity is a property of particles of solute per liter of solution. If a substance can dissociate in solution, it may contribute more than one equivalent to the osmolarity of the solution. The expected osmolarity of plasma can be calculated according to the following formula. Calculated osmolarity (mOsm/kg) = 2*[Na +] + 2*[K+] + (glucose) + (urea) Patient 1 = 2 x 116 + 2 x 6.2 + [glucose] + 9.7 Patient 2 = 2 x 144 + 2 x 2.8 + [glucose] + 6.3 Patient 3 = 2 x 137 + 2 x 8.7 + [glucose] + 78.9 Patient 4 = 2 x 130 + 2 x 5.8 + [glucose] + 15.7 The final result is not obtained as the glucose values are not given, so the calculation can not be done without glucose values. The patient 3 (the diabetic) osmolarity is underestimated because of insulin deficiency, the cells uptake of glucose, which causes hyperglycaemia. What is the abnormality in the clinical condition Diabetes Insipidus, and how does it affect water electrolyte balance? Many different hormones help to control metabolic activities within the body. One of these is called anti-diuretic hormone (ADH) and its function is to help control the balance of water in the body. It does this by regulating the production of urine. ADH is produced by the hypothalamus and then stored in the pituitary gland until it is needed. Diabetes Insipidus usually results from the decreased production of antidiuretic hormone. Alternatively, the disorder may be caused by failure of the pituitary gland to release Antidiuretic hormone into the bloodstream. Other causes of diabetes Insipidus include damage done during surgery on the hypothalamus or pituitary gland; a brain injury, particularly a fracture of the base of the skull; a tumor; sarcoidosis or tuberculosis; an aneurysm (a bulge in the wall of an artery) or blockage in the arteries leading to the brain; some forms of encephalitis or meningitis; and the rare disease Langerhans cell granulomatosis (histiocytosis X). Another type of diabetes Insipidus, nephrogenic diabetes Insipidus, may be caused by abnormalities in the kidneys. Diabetes Insipidus suspected in people who produce large amounts of urine. They first test the urine for sugar to rule out diabetes mellitus. Blood tests show abnormal levels of many electrolytes, including a high level of sodium. The best test is a water deprivation test, in which urine production, blood electrolyte (sodium) levels, and weight are measured regularly for a period of about 12 hours, during which the person is not allowed to drink. A doctor monitors the persons condition throughout the course of the test. At the end of the 12 hours, or sooner if the persons blood pressure falls or heart rate increases or if he loses more than 5% of his body weight, the doctor stops the test and injects Antidiuretic hormone. The diagnosis of central diabetes Insipidus is confirmed if, in response to Antidiuretic hormone, the persons excessive urination stops, the urine becomes mor e concentrated, the blood pressure rises, and the heart beats more normally. The diagnosis of nephrogenic diabetes Insipidus is made if, after the injection, the excessive urination continues, the urine remains dilute, and blood pressure and heart rate do not change. How do diuretics work? And what are the three main groups of diuretics? Diuretics work in the kidneys to increase the elimination of water and electrolytes, thereby causing more urine to form. Because the amount of fluid in the body is lowered, blood pressure goes down, too. Different chemical types work in different areas of the nephrons; so many different classes of diuretics are used. Three of the most common classes of diuretics are: Thiazide and Thiazide-Like Diuretics Drugs containing the chemical Thiazide and similar chemicals like indapamide and metolazone are suggested as the first drugs to try for most people with high blood pressure. They affect the distal convoluted tubule, where large amounts of sodium and water are absorbed back into the body. By blocking the re-absorption process, these drugs force more sodium and more water into the urine to be removed from the body. Thiazides may also relax the muscles in blood vessel walls, making blood flow more easily. Loop Diuretics More powerful than the Thiazide are classes of diuretics that work in the area of the Loop of Henle. These loop diuretics mainly interfere with the bodys re-absorption of chloride, but they also keep sodium from re-entering the blood. Unfortunately, loop diuretics are also more likely to promote the elimination of calcium, magnesium and especially potassium. Shortages of any of these essential electrolytes can cause serious problems such as irregular heartbeats. Potassium-Sparing Diuretics The third common group of diuretics consists of drugs that are much weaker than the Thiazides or the loop diuretics but potassium-sparing diuretics do not reduce potassium levels nearly as much as other kinds of diuretics do. They inhibit aldosterone and/or block sodium reabsorption and inhibit potassium excretion in the distal tubule.

The Message in the Music Essay -- Song Analysis Essays Compare Contras

The Message in the Music Music means many different things to many different people. To a listener, a song is sometimes for four simple minutes of entertainment, but sometimes it is much more. Sometimes, a song is a message from the artist. This is much the same way from the opposite end of the spectrum. An artists message can get so complex that it is completely lost on the listener. This essay is about song analysis. I will be analyzing two songs performed by the same artist but performed with two different bands. Although performed by different groups, the music is similar and so is the message. The two bands being examined are Tool and A Perfect Circle. These are both considered rock bands and work within the same industrial vein. The bands major theme is that of religion. Unlike the popular religious music praising the Lords name on high, this music takes a drastic U-turn in the road to divinity by speaking of Jesus Christ the Savior in a sarcastic and uncaring tone. Lead singer Maynard James Keenan is an atheist. Although I feel these are excellent songs, I do not support the views taken, or supposedly taken, by the band. In the song Eulogy, the artist criticizes the Lord throughout the entire song as well as taking a sarcastic attitude when shedding a good light on Him. In the beginning of the song, the band sings, He had a lot to say. He had a lot of nothing to say. Well miss him. Were gonna miss him. The group is claiming that He might have had a lot to say, but it really amounted to nothing, maybe because they felt he didnt really mean anything he said. When saying that they are going to miss him, it seems like they have set themselves in a time when Jesus was about to be crucified and is saying they will miss... ... show how he no longer declares this savior his own. The song ends with the chorus which pretty much says the same thing, except when making reference to the spear, he uses the word spiteful, not hateful. Spiteful works much better in place of hateful. It make the listener realize that after all the things Jesus put them through that they are finally getting back at him, or spiting him. Both of these are excellent songs, simply for the fact that they have good melodies, strong choruses and insightful lyrics that make the listener think. For these facts, I will continue to listen to and enjoy these songs. Despite that, through analyzing the lyrics, Ive found messages that contradict my own personal beliefs. It goes to show that music can have a deeper and much different impact on peoples lives if they just take an extra minute to think about what they are hearing.

Gluttony in Doctor Faustus Essay -- Doctor Faustus Essays

Gluttony in Doctor Faustus    Doctor Faustus is a scholar who questions all knowledge and finds it lacking.   Because none of his learning will allow him to transcend his mortal condition, he rejects God and forms a pact with Lucifer all the while pursuing the arts of black magic.   Of course, this is one more propaganda piece of Western Christianity attempting to argue that knowledge is dangerous and confining instead of rewarding and liberating.   It also suggests a Protestant parallel in its representation that one who believes in everything ends up believing in nothing.   However, if we cast aside its use as a socio-economic, ideological tool of manipulation, we can explore its character, action and themes without suffering too much offense as open-minded scholars.   In a play of five acts, twenty scenes and more than 70 pages of typed text, Gluttony, one of the seven deadly sins, consumes a mere 13 lines.   While such economy of space and expression is atypical of Gluttony, it is not typical of Marlowe who surfeits our senses with images of gluttonous, swollen, and surfeited allusions.   In fact, Faustus appears to be a fathead because his head has become swollen in self-conceit due to his attempt to understand more than it is within the power of humans to know.   According to Marlowe (23-24), "Till swoll'n with cunning, of a self-conceit,/His waxen wings did mount above his reach/And melting, heavens conspired his overthrow!/For falling to a devlish exercise/And glutted now with learning's golden gifts/He surfeits upon cursed necromancy/Nothing so sweet as magic is to him/Which he prefers before his chiefest bliss-/And this the man that in his study sits." Gluttony, personified, only has two dialogue exchanges with Faus... ...demption. WORKS   CITED Fitzhenry, R. I.   Barnes & Noble Book of Quotations.   New York, Barnes & Noble Books, 1986. Marlowe, C.   Doctor Faustus.   Barnet, S. (ed.) New York, Signet Classics, 1969. The student may wish to begin the essay with several of the following quotes: Puritanism - the haunting fear that someone, somewhere may be happy.  H. L. Mencken Christianity might be a good thing if anyone ever tried it.  George Bernard Shaw Men prefer to believe that they are degenerated angels, rather than elevated apes.  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   W. Winwood Roade As for a future life, every man must judge for himself between conflicting vague interests.  Ã‚  Ã‚  Charles Darwin God is dead.  Ã‚  Ã‚  Ã‚  Ã‚   F. Neitzsche When a man is freed of religion, he has a better chance to live a normal and wholesome life.   Sigmund Freud   (Barnes & Noble Book of Quotations, 310-312)