Wednesday, October 30, 2019

Celebrity endorsement in the women's fragrance market and its effect Essay

Celebrity endorsement in the women's fragrance market and its effect on the UK consumer behaviour - Essay Example This is the null hypothesis proposed and the findings from the study would prove whether or not it is valid. If it is not, the alternative hypothesis would prove to be true, i.e., celebrity endorsement does not influence consumer behaviour positively in favour of the products. The birth of the modern perfumery industry occurred during the colonial era, when the riches and wealth accumulated by the European countries from their colonies enabled the maintenance of the perfect economic climate for the development of perfumes using the technique of enfleurage (www.perfume2000.com). The first perfume was produced in 1882, known as â€Å"fougere royale† using the process of enfleurage. This process uses purified fats in a process similar to maceration which produces pomades that are washed with alcohol, and it produces the finest oils possible. While the fragrance industry is a 25 billion dollar industry, it is one of the poorest performing sectors in the cosmetic industry. Although it would initially appear that the women’s fragrance market is very successful because there are so many new fragrances being launched every year, i.e., about 300 approximately, the reality is that only a few of those fragrances are well received and survive long enough to extend production into another year (Business Wire, 2007). On the other hand, there are some perfumes which have a long standing reputation and customers are very loyal to particular brands. One significant example of this is the Chanel group of perfumes and especially Chanel no: 5, which has been popular among women for many decades. This holds good despite the fact that celebrity endorsement of perfumes can be expensive; for instance the advertisement for Chanel no: 5 using Nicole Kidman cost  £18 million for use over a duration of five years (www.fashion-era.com). There are two approaches to consumer behavior. The

Monday, October 28, 2019

Macbeth Analysis Essay Example for Free

Macbeth Analysis Essay The extract before me is from Macbeth written by William Shakespeare in the year 1606. It is from Act 1 Sc 7. It takes place in a room at Macbeths castle at Inverness. The extract primarily deals with the ploys that Lady Macbeth uses to persuade her husband Macbeth to commit the crime of murdering King Duncan. Two important themes are bought out in this extract, one is about the creation of gender roles and stereotypes and the second one is about appearances often being deceptive. The extract begins with Macbeth telling Lady Macbeth We shall proceed no further in this business. This is obviously referring to something which has happened before in the scene. Macbeth has been contemplating the consequences of this murder. He conceives a very apocalyptic vision of how the angels of heaven are gonna be coming and spreading the news of this murder all across. The angels are gonna be pleading for Duncans virtues and the people are gonna be actually crying and there be like a flood of tears which will drown the Earth. So, he tells Lady Macbeth that he does not wish to do away with his golden reputation, he does not want to lose its gloss and therefore, he does not want to proceed with the bloody business as he calls it. Lady Macbeth is obviously very affected by this and she ends up trying to accuse Macbeth of being unmanly. She uses adjectives like pale, green. She compares him to the poor cat in the adage. She is trying to drive the wedge between him and his doing and his desire to achieve the throne and his lack of action. Now, Lady Macbeth says, what beast was it then that made you break this enterprise to me. This is a reference to Act 1, Sc 5 because in Act 1 Sc 5, Macbeth tells Lady Macbeth about the prophecies that the witches had made and how he is supposed to become the King of Scotland after becoming the Thane of Cawdor. Now, Lady Macbeth is just wedging upon those lines saying that when you dared to commit this to me, that is when you were a man and now if you are actually gonna commit the deed of murder, you are gonna commit the heinous crime of regicide, you will be even more the man. Lady Macbeth reasons out that the time and the place were not appropriate to kill Duncan at that time but now since he has come into our battlements, he is in our castle as our guest, we are supposed to kill him. Lady Macbeth is surprised that Macbeth is losing his resolve at this time. Lady Macbeth goes on to create a very grotesque image that shows that the milk of human kindness is actually not present in her. She says that she has suckled the baby at her breast and she knows how tender it is to love the babe that milks me and she says that if she had ever said that she had committed to anyone that I am going to be killing my child, she would have actually plucked his mouth out of her nipple and dashed his brains out against the wall. This is a very grotesque image produced by Lady Macbeth has produced. This makes it clear to us that Lady Macbeth has been dehumanised, defeminised in all ways. Thus, she has achieved her wish which she asked from the spirits. She is totally unwomanly and does not have any maternal instincts. She is actually a reminder of the character Medea from the play Medea written by Euripedes because Medea had self-decided to kill her own children. Now, we see that the scene has become progressively darker with Lady Macbeth creating images of death and Macbeth ends up contemplating the possible consequences if we should fail. We should see that there are several times when Macbeth and Lady Macbeth talk about each other as being one. They perpetually use we. Macbeth has never said that i am gonna fail at the murder. He says that we should fail. This shows that there is a sense of togetherness and they are partners not only in greatness but also in crime. So, Lady Macbeth immediately retaliates but then at this time there is a shift in tone. It becomes much more pragmatic because she divulges the plan of the murder to Macbeth. There is a metaphor used over here, its about stringed instruments, now just as you take the string and you create the appropriate tension by tying it to the right peg. Similarly, Lady Macbeth expects that Macbeth decides to be headstrong and resolute and decides to screw his courage to the sticking place. If he does so, they will certainly not fail. She goes on to discuss the plan of murder with Macbeth. She says that when Duncan will be asleep and in all probability, he is likely to sleep due to his long journey. The two sentinels outside his room are gonna be intoxicated by Lady Macbeth using wine, drugs. She will make sure that they are so drunk that they will lose thier memory which has been described as the warder of the brain. The receipt of reason will not be there. Reason will actually be distilled out of their brains. They will not be able to understand anything. They will actually behave like swine and sleeping in that manner. Lady Macbeth sees it as golden opportunity to perform the murder. She once again, as I said, talks about them being one. She says what cannot you and I perform upon the unguarded Duncan? when in fact the murder is going to be committed by Macbeth alone. Lady Macbeth is obviously very important partner in his crime. Now, Lady Macbeth further tells him that they are gonna be taking the daggers and staining the officers with the blood. She expects the officers to bear the guilt of our great quell. Now, the use of the word guilt over here is very important and it is also very ironic because it is not like they do not do away with thier guilt ever. In fact, they leave in torment of the very murder. Lady Macbeth in Act 5, Sc 1 in the sleep-walking soliloquy is a woman who has completely lost her senses. She is leaving under intense emotional pressure and she is the one who is not able to sleep anymore. So, it shows that they are actually guilty of the crime. Macbeth himself in Act 2 Sc 2 does not wish to even go back to the scene of the crime again. So, it shows that even though they are gonna be staining the sentinels with blood. In fact, both of them are gonna be living in horror of the deed. Now, Macbeth seems to be quite convinced and he asks Lady Macbeth to bring forward male children only because the undaunted mettle should compose nothing but males. Now, this is very significant because it is about the creation of the gender stereotypes. In the Shakespearean area, it was expected of men to be embodiment of valour, courage and ruthlessness to some extent and woman on the other hand were expected to be more submissive and incapable of coming up with wicked plans. However Lady Macbeth is an exception to this rule because she comes across as one who is so resolute and cold, so devoid of pity that this is something which should be there only in men. Macbeth once again questions his wife and asks her that if they are gonna marking the two sleepy sentinels with blood, would it not see that they have done it. Lady Macbeth says that while they will be hysterically crying and lamenting the death of Duncan, suspicion will never fall upon them. Macbeth finally capitulates to all its wifes persuasions and he seems to have bend up each corporal agent to this terrible feat. This is a very important line in the building up of the tragic hero because Macbeth is gonna be himself responsible for his fate. He has decided to put his heart and soul into committing so heinous a crime and he is indeed gonna be bearing indeed the consequences of it as we see later in the play. The scene ends with a couplete that rhymes which is typical of Shakespeare. It says that Away, and mock the time with fairest show: false face must hide what the false heart doth know. So, it recounts the theme that appearances are often deceptive. This theme has been running throughout the play. It all began with King Duncan in Act 1 Sc 2 when he wished that he would be able to recognise people by simply looking at their faces. It is also present in Act 1 Sc 5 when Lady Macbeth asks her husband to look like the innocent flower but be the serpent under it. This time Macbeth is the one who is actually telling his wife that she is suppose to be having composure, she is suppose to conceal her ulterior motives and her false face must hide the real intentions that she has. In conclusion, i can say that there is a big contrast between the characters of Macbeth and Lady Macbeth. Macbeth is the one who is contemplating the fear of failure. He says that we should fail, what would happen. He is no doubt ambitious but at the same time he also comes across as a rational being.

Saturday, October 26, 2019

Parent and Teenager Relationships Essay -- Papers Adolescent Teens Gro

Parent and Teenager Relationships As a child begins to enter adolescence, there appears to be a rise in conflict between the adolescent and parents. The amount of conflict differs from family to family and is dependent on many factors. It is mainly due to the changing characteristics and growing of the adolescent and the way in which the rest of the family adjusts to these changes. Adolescence is a time of challenge and change for both teens and parents. Teens are at a stage in life where they face a multitude of pressing decisions -- including those about friends, careers, sex, smoking, drinking, drugs and parental values. At the same time, they are confronted with profound physical, social and emotional changes. Myths of adolescence are perpetuated because adults do not spend the time and effort learning about normal, expected changes during this period. It is much easier for us to put a label on people rather than to try to understand them. The teen years are truly "high speed, high need" years. Here are some concepts of conflict and some areas to look out for. While most parents realize there are normal struggles between parents and teens as their sons and daughters struggle for independence and identity, they are often shocked by the length and intensity of the conflict. They are stunned by apparent rejection of some of their most sacred values and confused by their teenagers "acting up" and "acting out." In attempting to become psychologically independent of their parents, teens often attempt to move completely away from any control or influence by their parents. When the rejected teenager reaches the limit of patience and tolerance, he or she lashes out -- rejecting the family, the school, the church, the s... ...en. As a parent you also have to make sure you have certain expectations that need to be followed. You have to expect cooperation and courtesy at home as well as to be able to get a good night?s sleep without worrying where your teenager is. There are no magic, easy solutions. However, a parent is wise to communicate absolute support to a young teenager by letting them know that you love them and will always be there for them. As an adult, you must model acceptable adult behavior in all situations. If you can say "I'm sorry I got angry," or "I apologize for criticizing you before listening to all you have to say," teens will have more respect for all adults. It is also useful to remind young teenagers that it is easier to treat them as adults if they act like adults. And it is very useful to adult parents to remember that they were once teenagers themselves.

Thursday, October 24, 2019

honorable mexicans :: essays research papers

Introduction There are many people that have impacted on the country Mexico. Some of the famous people were presidents, musicians, astronauts and writers. They have showed Mexico many important things and helped to improve their technology. Here is the information on some of these famous people. Pedro Infante: Pedro was the greatest Mexican idol, and he was born in the beautiful port of Mazatlan, Sinaloa, on November 18, 1917. When people in Mexico hear his name they remember his beautiful songs and films. He became one of the best singers and actors in Mexico. He worked as a barber and a carpenter before he joined the group "La Rabia". He got nominated seven times for the award "Ariel". In 1959 something very unexpected happened, the plane that he traveled smashed into land and he died. He was buried on April 18, 1959 in the presence of a hundred and ten thousand people in Mexico city. He wrote over three hundred songs and took part in over sixty one films. Over forty years ago hi life ended but he is still remembered in hearts everywhere. Rodolfo Neri: Rodolfo was the first Mexican astronaut to go into outer space for NASA. He spent seven days in outer space aboard a space shuttle called Atlantis, carrying out multiple experiments and placing in orbit the Mexican satellite Morelos 2. This showed the world that mexico that Mexico could be a leader in technology. It also showed that this country would be able to send people into outer space and that Mexico could teach people who are interested to be astronauts. Everisto Quintanilla Rojas: Everisto invented the color T.V. It first started in 1934 and that was when the first experiments were done. When he was 17 years old he went to a school that taught science and when he graduated he used that knowledge and started to invent the color t.v. He also created the first two Mexican satelites that were called Morelos i & ii. This man made a difference for Mexico because not only did he give Mexico color t.v's but they also got to speak to people in 23 other other countries outside of North America. honorable mexicans :: essays research papers Introduction There are many people that have impacted on the country Mexico. Some of the famous people were presidents, musicians, astronauts and writers. They have showed Mexico many important things and helped to improve their technology. Here is the information on some of these famous people. Pedro Infante: Pedro was the greatest Mexican idol, and he was born in the beautiful port of Mazatlan, Sinaloa, on November 18, 1917. When people in Mexico hear his name they remember his beautiful songs and films. He became one of the best singers and actors in Mexico. He worked as a barber and a carpenter before he joined the group "La Rabia". He got nominated seven times for the award "Ariel". In 1959 something very unexpected happened, the plane that he traveled smashed into land and he died. He was buried on April 18, 1959 in the presence of a hundred and ten thousand people in Mexico city. He wrote over three hundred songs and took part in over sixty one films. Over forty years ago hi life ended but he is still remembered in hearts everywhere. Rodolfo Neri: Rodolfo was the first Mexican astronaut to go into outer space for NASA. He spent seven days in outer space aboard a space shuttle called Atlantis, carrying out multiple experiments and placing in orbit the Mexican satellite Morelos 2. This showed the world that mexico that Mexico could be a leader in technology. It also showed that this country would be able to send people into outer space and that Mexico could teach people who are interested to be astronauts. Everisto Quintanilla Rojas: Everisto invented the color T.V. It first started in 1934 and that was when the first experiments were done. When he was 17 years old he went to a school that taught science and when he graduated he used that knowledge and started to invent the color t.v. He also created the first two Mexican satelites that were called Morelos i & ii. This man made a difference for Mexico because not only did he give Mexico color t.v's but they also got to speak to people in 23 other other countries outside of North America.

Wednesday, October 23, 2019

Global Business Cultural Analysis: France Essay

This paper will focus on the many elements and dimensions of France and the affect it has on the business that takes place locally and internationally. There will be constant comparisons and contrasts between France and the United States of America taking place throughout this entire research article. I will focus on how the elements and dimensions of the culture separately are adapted by the locals and integrated into everyday life and business. I will also give insight on how to conduct business in France for other countries, mainly the United States, by talking about the countries imports and exports and certain important factors that outside business should know in order to successfully enterprise. The information and suggestions offered in this paper will range from communication and business dress attire, to social structures and Geert Hofstede analysis; all of which should improve the knowledge of foreign businesses and help them adapt in order to maintain and/or obtain success internationally in the country of France.? Global Business Cultural Analysis: France  What is a global business cultural analysis? From looking and several examples and finding information on this country, I have come to the conclusion that it is a description of the country and how its culture contributes to or restricts the business environment. As many of us may already know, culture plays a major part in a lot within a country. For one, culture dictates communication. Culture also the mannerisms of the people that are within the country. So, just to clear up any confusion, culture is a major part of a country and how it conducts itself, especially how it conducts business. It would be only right that if one was trying to conduct business in a country, they would need to understand the culture of the country in order to successfully interact with the people of the country in hopes of promoting and maintaining a highly active and flourishing business. With that being the case, I will focus my attention on the major elements and dimensions of culture in France. I will also describe how these elements and dimensions are integrated by the people of France when conducting business within this nation. Lastly, I will compare and contrast the culture and business of France with the culture and business of the United States and explain what a United States company would have to do in order to conduct business in France successfully. Communication One of the most important elements of culture in any and every country is communication. Communication comes in two different forms, verbal and nonverbal. Of course verbal is talking and actually saying what you mean and non verbal would be things such as hand gestures and body movements. In France, the official language is of course French. According to A Practical Guide to French Business by Alston, Hawthorne, and Saillet, â€Å"The French consider their language a central part of their cultural heritage, their â€Å"patrimoine,† and fluency in French is a major part of how French and non-French are evaluated. It is almost impossible to be fully accepted, or respected, when one does not speak French well† (2003 p. 43). The French appreciate when people not of the nation attempt to speak French but get irritated when it is spoken incorrectly according to Alston et al (2003). I can personally vouch for this because I had a French teacher that became visibly bothered when learned words or phrases were butchered and not used in the correct context. The French language is so important to the people of France, the government does not allow advertisements to be a mixture of languages. For example, if a store decided to display a sign that said, â€Å"Como is life? † it would be illegal and subject to a fine by the French government. The United States differ greatly in this aspect. There are a lot of examples of mixed languages, especially in entertainment such as movies and sitcoms. The French are very unique when it comes to conversation. They have a great appreciation for it, however, they tend to enjoy arguments and disagreements. They look at these things as interesting. They value someone that can argue with great skill. This is a complete contrast of the United States. We tend to try to avoid arguments and look down upon it. We try to be liked and attempt to agree with people that we are trying to build a relationship with or hold a conversation with. The French would rather voice their opinions and appear non-hypocritical than to agree or compromise how they feel. When it comes to interacting with people, France and the United States differ greatly. The people of France tend not to smile or have an expression when meeting new people. In the United States, we tend to smile and greet people as we have known them for a very long time. Edward MacNeal talks about growing up in a bicultural environment and noticing the differences between French and American interactions. He states in his journal French-American Misunderstandings, â€Å"†¦the French don’t smile at people they don’t know. They think it’s hypocritical† (2003). This nature is why many Americans view French people to be rude or snobbish. MacNeal also says that the American assumption is that we are all friends and the French assumption is that we are all strangers. This very assumption could hinder interaction between people of the two nations. So with that being said, when doing business with the French, be sure to address them by Sir or Madame rather than by their names. One should always approach them with no expression because a sign of expression, such as a smile, could be viewed as phony or fake. When communicating with the French, you should be mindful of the volume of your voice and be sure to make eye contact. Americans are known to be a little bit louder than the French would like. We tend to offend them by our loud talking and blaring laughter. The French are seen as very intimidating to Americans because of the intensity and vast amount of eye contact they make. Like I stated earlier, communication can also be non-verbal. Many actions and behaviors are observed by the French as well. Matt Priest (2012) notes that the French are very casual when it comes to punctuality. If you were to show up late to a meeting, you would probably be easily forgiven by many French professionals. Americans value punctuality a lot more than the French. You would mostly likely be the topic of discussion after the meeting. Speaking of conducting business, Mr. Priest also gives us insight by telling us that the French prefer to do business over lunch as opposed to any other meal. The French value privacy. They do not tend to like unannounced visits, so it is very important to let them know if you are planning to visit. Americans and the French have a little in common when it comes to communication. We both greet with a brief handshake, followed by a bit of eye contact. However, according to Matt Priest’s France Business Etiquette, Culture & Manners, French handshakes are not as firm as American handshakes. When conducting business, most people speak English, as English has become the common language within international business. According to Organization Communication in France: An Overview of Current Research, â€Å"†¦English has progressively and irremediably become the de facto Lingua Franca since the end of World War II†¦Ã¢â‚¬  (Cooren & Grosjean, 2010). Americans are similar to the French when it comes to business attire. We both recommend dress to be conservative. Bright colors are usually avoided by both counterparts and flashy, overpowering, and glitzy accessories are not encouraged according to the International Business Center (Priest, 2012). Conservative clothing is usually preferred when conducting any kind of business internationally. Religion The dominant religion in France is Roman Catholic. According to the World Factbook of France, about 83-88% of the population of the country is Roman Catholic (2012). Religion plays a major role in the operations and actions of the people of France. The International Business Center tells us that for the countries that have over 50% of the population that practice the Catholic religion, there is a dimension of the Geert Hofstede analysis called the Uncertainty Avoidance that correlates positively with this statistic (2012). The Geert Hofstede analysis will be discussed later on throughout this paper. According to Edward J. Woell, â€Å"Catholic belief and practice continued to shape French national identity throughout the modern era† (2009). The national identity of France was also molded by the Declaration of the Rights of Man and of the Citizen. This document is very similar to the United States Constitution and even though both societies say there is a separation of church and state, they were both created and influenced by religious beliefs. This very idea is the justification of many laws implemented in France and the United States together. Back in the nineteenth century, France had a belief of spreading its culture around the world on civilizations that were considered wrong or backwards. They believed their culture was the hands down best and most appropriate way to live and conduct oneself. Since France was rooted in the Catholic religion, that would imply that they were spreading their religious beliefs on other civilizations and people of other areas. As you you will see a little further through this article, France has continued to spread its beliefs on people, especially the people that are occupants of the country. There are several examples that show the influence religion has had on the actions and even laws of the people of France. One of the most recent events that was influenced by religion was the banning of the burqa. A burqa is a full body veil that is worn by Muslim women. The banning of the burqa started with not allowing the burqa to be worn in the schools in France. According to Ellen Wiles’s article Headscarves, Human Rights, and Harmonious Multicultural Society: Implications of the French Ban for Interpretations of Equality, headscarves and any signs or clothing that demonstrate ones religious affiliation (2007). This article also pulls a passage directly from the rule that was passed by legislation on the issue of the schools ban on religious clothing, â€Å"Article L. 41-51 of the French Education Code provides: â€Å"In state primary and secondary schools, the wearing of signs or dress by which pupils overtly manifest a religious affiliation is prohibited. † (Legislation passed on March 15, 2004)† (2007). The French government was not happy there. They passed a law on September 14, 2010, that would ban the wearing of the burqa in public. Right Vision News tells us, â€Å"A woman who repeatedly insists on appearing veiled in public can be fined 150 euros and ordered to attend re-education classes. There are much ore severe penalties for anyone found guilty of forcing someone else to hide his or her face â€Å"through threats, violence, constraint, abuse of authority or power for reason of their gender. â€Å"Clearly aimed at fathers, husbands or religious leaders who force women to wear face-veils, and applicable to offences committed in public or in private, the law imposes a fine of 30,000 euros and a year in jail† (2011). 150 euros equals out to about 200 United States dollars and 30,000 euros is about 40,000 United States dollars. This is a very harsh punishment for something that is considered a part of some people’s custom. People argued that this would infringe on the religious freedom of the individuals in the society; however, since the majority religion is Roman Catholic, this ban fits perfectly into the identity of the people that actively practice the Catholic religion. The government of France, like I stated earlier, was shaped by religious beliefs. The argument of the government of France for banning the burqa was that it hindered inequality and promoted submissive behavior. However, many people question this argument. As we all know, France is very conscientious of their appearance. The burqa does not display the Roman Catholic religion but actually has a negative connotation to other people that still view Muslim as terrorist because of the extremist group called the Taliban. The United States has taken a very different approach. Just recently, a mosque was built near ground zero of the bombing that took place on September 11, 2001. In the United States, the majority religion is Christianity. The idea of the construction of the mosque received lots of opposition but it was ultimately approved for construction by the members of the United States federal government. This was one of the most extreme signs of the support of religious freedom in the country, or better yet, a more absolute signal of separation of church and state. As we all know, the United States pushed their beliefs on people as well, which is very similar to France. We came overseas from Britain and persuaded the Native American people to adapt our ways. We taught them our ways of hunting and even our way of survival. Most importantly, we taught the Natives our religious ways. The same goes for modern day America as well. Though slightly more subtle, we influence people today with our religious beliefs. Christianity is embedded into our culture and is forced upon people through the many rules and amendments. I guess you can say that about just about any country, however, not all countries are backed or rooted in religious beliefs. For instance, the national religion of China is atheist. That is strictly enforced by the government of the country and displays of other religions are subject to punishment. Ethics and Etiquette This section will not just focus on ethics, but more so business ethics. First off, ethics, according to Google’s dictionary, is â€Å"Moral principles that govern a person’s or group’s behavior† (2012). This is the perfect definition for the ethics of a culture because it is the principles that govern the people and it influences the decisions and actions of certain groups of people as well. Business ethics is defined by Chris MacDonald as, â€Å"critical, structured examination of how people & institutions should behave in the world of commerce. In particular, it involves examining appropriate constraints on the pursuit of self-interest, or (for firms) profits, when the actions of individuals or firms affects others† (2012). Business ethics influence how certain companies and businesses interact with one another to conduct business activities. Some of France’s ethics and values were discussed earlier in the article, but let us talk about these set of governing principles in detail to see how they affect interaction between the people of the country. French people value their language as I stated earlier and the history of the country. The French language and its importance was fore mentioned in the communication section, so let us discuss the importance of history on the people of this country. According to The ins and outs of doing business in Europe: Germany, France, Russia, and the emerging markets of Eastern Europe, â€Å"Ignorance of French history, culture, literature, and so on is demonstratively looked down upon† (Gray 2005). The French pride themselves on the long history of their country and the influence they have had on the world throughout the years. They also place importance on inheritance. This value of inheritance goes hand in hand with the importance of social classes in France. Social classes and structures will be discussed later in this article. The French place strong value on friendship. Friendships to the French are very similar to being family related to Americans. We Americans tend to make many friends with moderate devotion or dedication whereas, the French do not make as many friends but build very strong relationships. Mr. Edward MacNeal states on the topic of friendship in both the United States and France, â€Å"Friendship in America may imply nothing beyond a momentary conjunction of place or interest, and even those you consider as your friends probably don’t know your other friends. Friendship in France usually implies a lifelong commitment. One takes on a more active burden of concern for friends in France than most Americans would knowingly accept. Your obligations to a friend in France might be likened to those you would have to a family member that you personally selected. In France, then, one shies from making friends casually and most of one’s friends probably do know each other† (2003). With this in mind, it is beneficial for one to make friends with their employers. True, you do want to become an ally of your boss, but be sure not to try to hard because like I stated before, the French despise phony demeanors and are very critical of hypocritical behavior. The best way to meet someone new in France is to be introduced by a mutual third party. This is true because of the great emphasis that is placed on friendship. Remember, in France, all of your friends will likely know one another. Like MacNeal said, friendships are lifelong commitments; so, once you become friends with your boss, you can expect them to help you in any way they can and the actions should remain mutual. I will now discuss the business etiquette of the French people because this is going to be very important for people of different nations that intend to conduct business with the French. Firstly, when greeting anyone, be sure to address them by Monsieur or Madame, no matter the circumstance. This is considered formal and is regarded as more polite. It is always important to remember to never confuse business with personal in France. France rarely uses humor in the workplace. It is seen as unprofessional. The French value intellect over all. Like I mentioned earlier, the best meal to discuss business is lunch.

Tuesday, October 22, 2019

Brown v. Board of Education of Topeka and Its Decision essays

Brown v. Board of Education of Topeka and It's Decision essays There have been many attempts to look at the decision in Brown v. Board of Education of Topeka and claim it was erroneous in some respect. One of the most often used is the social policy' argument. Some constitutional scholars believe that the Supreme Court went too far in the decision, far beyond deciding the single issue involved. That issue concerned the need for an African American little girl to go to a black school that required of her a dangerous walk through a rail yard rather than a pleasant walk to a closer school that was all white. It is easy to argue that any decision of any reasonably lofty court in the land makes social policy decisions without benefit of election. Indeed, even lowly courtscity courts in small townsmake social policy decisions by virtue of the need to interpret the law when passing judgment or imposing sentences. A judge in a small town in New York State, for example, gives everyone convicted in his court the lightest possible sentence, 60 days plus two years of parole. Why' Because he knows the career criminals will violate their parole, and then it's an automatic five years up the river, no appeal, no questions asked. (Personal knowledge via In effect, that judge is making social policy. Therefore, criticism of the unanimous ruling in Brown v. Board of Education of Topeka on the grounds that it made social policy is relatively ludicrous. If it is all right for small courts in small towns to make social policy by engineering its use of statutory punishments, then assuredly it would be even more acceptable when the arguably wisest judicial minds sitting on the bench in the United States do the same thing. If the Court did make social policyas arguably it didthere is every reason to believe that the society was ready for the policy being made. The...

Monday, October 21, 2019

Prelab Work in Organic Chemistry essay

Prelab Work in Organic Chemistry essay Prelab Work in Organic Chemistry essay Experimet Title: Simple Distillation and Characterization of Compounds Separation of ethyl acetate from microscale acetanllide by simple distillation at the semi- level, and characterization by spectroscopy of the two compounds using IR, and NMR by the determination of their physical properties. Experiment Purpose This experiment is purposely carrieed out in order to faclitate the separation of ethyll acetate from acetanilide through the process of simple distillation. This experiment will also seek to identify the IR spectroscopy, melting point, and density of the separated compounds. Questions Distillation: This a method of obtaining more purified liquids or identification of compounds where the initial liquid is first heated up to its boiling point. As the liquid boils, it vaporizes after which it is captured, condensed and collected later. Distillation is applied to the identification as well as purification of compounds. By applying the boiling point of a compound, which is an important physical property, it can be identified from a mixture of several compounds because it can evaporate at that temperature leaving the other compounds. When it comes to distillation as a purification process, the components of a mixture are separated by collecting the condensed compound at different temperatures. This experiment is a demonstration of how to purify a volatile liquid that contains impurities of non-volatile liquid will be done. The volatile component of the initial mixture will be ethyl acetate, which will be captured and condensed as pure ethyl acetate (Carey 72). Distillate: This concentrated liquid product has been extracted after the condensation of vapor in the process of distillation. Forerun fraction: These are usually the first fractions or the transition between fractions that are first distilled in a fractional distillation process. In fractional distillation, the differences of temperature between the points of boiling of the fractions are not large enough, and a series of simple distillations is required. The boiling punt of the forerun fraction is usually low hence, they are discarded being the first. What is the purpose of adding boiling stones to the distillation flask in a simple distillation experiment? The boiling stone is porous and thus contains air within it. Once the stone is heated, as the boiling process of the liquid continues, the air entrapped expands thus forcing its way out of the stone. When this heated gas mixes with superheated liquid it helps in balancing the liquid and the gas phase of the process. Thus, the heat needed in order liquid to change into gas will be reduced, and the transition of the two phases will not be explosive thus bumping fails. Moreover, the boiling stones will ensure even heating of the liquid as well as accelerate the rate of temperature increase. This uniform boil is important in acquiring effective results in distillation, because it will ensure that the light liquid is being distilled out in the process. Since, they inhibit bumping, which may result to the loss of some of the reagents they help in acquiring accurate results (Solomons 44). Objectives of the Experiment The objective is to separate ethyl acetate from acetanilide, which is volatile and non-volatile respectively using simple distillation. Further, the compounds will be analyzed using IR spectroscopy and their respective physical properties such as density and melting point. Procedure The procedure will involve the reaction of the two chemicals in the appropriate condition that would ensure that the expected results are obtained. Limiting reagents The samples to be used will be measured as 50mg of actinide. It will then be put in a conical flask and then 1ml of ethyl acetate will be added using a pipit. A boiling stone will then be added into the mixture. The apparatus will be mounted as shown below and a facet precaution will be taken where the first flask will be mounted on a sand bath.

Sunday, October 20, 2019

The Age of the Ocean Floor

The Age of the Ocean Floor The youngest crust of the ocean floor can be found near the seafloor spreading centers or mid-ocean ridges. As the plates split apart, magma rises from below the Earths surface to fill in the empty void. The magma hardens and crystallizes as it latches onto the moving plate and continues to cool over millions of years as it moves farther away from the divergent boundary. Like any rock, the plates of basaltic composition become less thick and denser as they cool. When an old, cold and dense oceanic plate comes into contact with a thick, buoyant continental crust or younger (and thus warmer and thicker) oceanic crust, it will always subduct.  In essence, oceanic plates are more susceptible to subduction as they get older.   Because of this correlation between age and subduction potential, very little ocean floor is older than 125 million years and almost none of it is older than 200 million years. Therefore, seafloor dating isnt that useful for studying plate motions beyond the Cretaceous. For that, geologists date and study continental crust.  Ã‚   The lone outlier (the bright splash of purple that you see north of Africa) to all of this is the Mediterranean Sea. It is the lasting remnant of an ancient ocean, the Tethys, that is shrinking as Africa and Europe collide in the Alpide  orogeny. At 280 million years, it still pales in comparison to the four-billion-year-old rock that can be found on the continental crust.   A History of Ocean Floor Mapping and Dating The ocean floor is a mysterious place that marine geologists and oceanographers have struggled to fully grasp. In fact, scientists have mapped more of the surface of the Moon, Mars, and Venus than the surface of our ocean. (You may have heard this fact before, and while true, there is a logical explanation as to why.)   Seafloor mapping, in its earliest, most primitive form, consisted of lowering weighted lines and measuring how far the sunk. This was done mostly to determine near-shore hazards for navigation. The development of sonar in the early 20th century allowed scientists to get a clearer picture of seafloor topography.  It didnt provide dates or chemical analyses of the ocean floor, but it did uncover long oceanic ridges, steep canyons and many other landforms that are indicators of plate tectonics.   The seafloor was mapped by shipborne magnetometers in the 1950s and produced puzzling results - sequential zones of normal and reverse magnetic polarity  spreading out from the oceanic ridges. Later theories showed that  this was due to the reversing nature of Earths magnetic field. Every so often (it has occurred over 170 times over the past 100 million years), the poles will suddenly switch.  As the magma and lava cool at seafloor spreading centers, whatever magnetic field is present get ingrained into the rock. The ocean plates spread and grow in opposite directions, so rocks that are equidistance from the center have the same magnetic polarity and age. That is, until they get subducted and recycled under less-dense oceanic or continental crust.   Deep ocean drilling and radiometric dating in the late 1960s gave an accurate stratigraphy and precise date of the ocean floor. From studying the oxygen isotopes of the shells of microfossils in these cores, scientists were able to begin studying the Earths past climates in a study known as paleoclimatology.

Saturday, October 19, 2019

Social Security U6 Essay Example | Topics and Well Written Essays - 250 words

Social Security U6 - Essay Example That makes people stop and say, â€Å"This is a dangerous idea!† Nevertheless, it is clear that the stock market has by now recovered all of the money that it lost during the Great Recession. We need to change peoples' attitudes. Instead of telling them they will be set for life, we need to ensure that they are more responsible for their post-retirement income. Social security is not a constitutional right, and it will not even exist if we do not engage in a number of serious reforms as quickly as possible. If we don't do this as soon as possible, there will be no money left for me or for my children. We will have bankrupted America. All real wealth is generated in the private sector, so it makes sense to turn to the private sector to secure the post-retirement wealth of our seniors. Investing social security money in the stock market can yield major returns and give more control over to our most precious resource: our senior citizens. Brown, Jeffrey R., Jeffrey B. Liebman, an d David A. Wise. Social Security Policy in a Changing Environment. University of Chicago Press, 2009.

Friday, October 18, 2019

Italian Immigration and class politics Essay Example | Topics and Well Written Essays - 500 words

Italian Immigration and class politics - Essay Example The second period happened in the early 90’s with a composition of mostly refugees from Eastern Europe. The third phase coincided with implementation of immigration policies that sought to integrate immigrants. Prior to 1990 the media portrayed a migrant as black and nomadic. Since 1991 the image is that of a gypsy type people from Eastern Europe. During the three periods the media also showcased migrants in a folkloric image, as being marginalized, and a more recent image as one participating in criminal activities. The stance taken by the media towards immigrants has been inconsistent ranging from arguments that immigration can be beneficial to the Italian economy to fuelling the public’s fear and antipathy towards foreigners. Generally the media ignores the suffering and exploitation of migrants and sometimes blame immigrants for racist acts committed against them. The newspapers that are connected to the political left show more tolerance while those connected to the political right are more anti-foreigner. The media’s portrayal of migrant women changed from domestic helpers in the first period to a more stable family oriented woman with the arrival of Islamic women, to those predominantly black victims of human trafficking in recent years. The Italian Communist party has been constantly changing. The party started in 1921 when it broke away from the socialist party in order to take a path that was more fundamentally communist. In 1944 Palmiro Togliatti outlined a new direction for the party. He preferred the party to operate through a policy of alliances, including recognition of the monarch and the Catholic Church. This new thrust ended in 1947 but in 1956 Togliatti again tried to continue with his pro democratic plan. The years following this thrust found the party in isolation partially due to the development and evolvement of other political and social groups. It wasn’t an attractive option for neither the far right nor the far left. Their

Business Process Outsourcing Research Proposal Example | Topics and Well Written Essays - 750 words

Business Process Outsourcing - Research Proposal Example Therefore, it will be our endeavour to figure out; Therefore, using reliable secondary sources of data would certainly yield the information related to certain cases which have been highlighted in the mainstream media. Haley (2003) contends that a number of researchers have opted to conduct secondary research instead of primary research, primarily because of the cost of conducting such a research and limited opportunities for conducting primary research. Some reliable secondary sources for this research would be the document from NASSCOM, one of India's premier institution representing the software and IT industry; Data available from reputed international organisation like WTO and ILO. Newspaper reports like; Will also prove handy to understand what's going on inside the glittering ITES buildings. In order to assess the opinion of all major stakeholders in the outsourcing industry, we can plan out interviews/ questionnaire surveys with; iii. Some ITES workers. It must be emphasised here that these workers are discouraged from shelling out information to outsiders. But, it needs bit of convincing and an undertaking on the part of the researcher to the effect that, this research is being carried out primarily for academic purpose, and it won't be used for any other purpose. iv. Some union leaders from India like those from UNITES, and some international union leaders like those from UNI Global union. This will help us in knowing both sides of the story. v. Seeking the opinion of someone from the medical profession will also help in correlating the physiological and psychological disorders. Information thus collected will help us in making the comparisons and further investigating the trend. In order to determine the possible implications and significance of the US/UK shifts in the outsourcing industry in India, an interview questionnaire shall be prepared which will seek answers from the respondents accordingly. Part A of the questionnaire will contain the demographic characteristics of the respondents which will serve as the profile of the respondents. This will include their gender, age, employment, and affiliations profile. Part B will determine the behaviour and attitudes of the respondents as to how they perceive the working in graveyard shifts Part C will assess and identify the possible impl

Thursday, October 17, 2019

Potential Problems with Illegal Immigration Essay

Potential Problems with Illegal Immigration - Essay Example There is evidence of job competition between natives and immigrants, since the latter are typically employed in jobs shunned by natives (e.g., seasonal agriculture, working with toxic chemicals, etc.) even under conditions of high unemployment among the native-born. The hidden consensus seems to be that expelling the foreigners and their offspring who are already integrated would be too costly and disruptive (Som and Momblanco 2006). Meanwhile, the consolidation of immigrant communities, especially in big cities acts as a magnet for new entrants. For instance, "illegal Mexican immigrants have found good jobs in industries associated with the housing bubble. Large numbers of immigrants work at jobs in the construction, landscaping, and road construction industries" (Thornton, 2007). Some employers prefer to hire illegal foreign workers and some feel that they have no alternative. Wage stagnation is another problem caused by illegal immigrants in the USA. The role of compensation and its effect on wages and on the behavior of the unemployed has been put forward as one of the reasons for higher unemployment levels. Four aspects of unemployment benefit that could affect behavior of jobless workers. These are eligibility conditions; generosity of benefits; duration of benefits; and efforts made by authorities to prevent malingering. Following Jacobe (2006): "the current wage stagnation is a cause of the influx of a huge number of illegal immigrants who violate U.S". The evidence demonstrates that benefits played important role in unemployment and demands additional spending on social services for unemployed population. Illegal immigration becomes a burden for healthcare and health-related services. Following Porter (2006): "While many Americans without health insurance struggle to pay for medical care, U.S. hospitals provide at least $200 million a year in uncompensated emergency medical care to illegal immigrants" (p. 66). Defining needs as rational drives implies a corresponding conception of health. Being a critical concept supporting (or subverting) practical judgments about healthcare practice and health policy, the concept of 'health' is as contested as the concept of 'needs' (Som and Momblanco 2006). The government cannot deprive illegal immigrant a right to receive primary care but it deprives many native citizens healthcare insurance and healthcare services. The policy debate about healthcare needs is a response to conflicting demands on health policy and healthcare resources. Current government practices that disproportionately site municipal and hazardous waste disposal facilities in low -income and minority neighborhoods native citizens with the least access to quality health care. Operatively a basic and adequate standard of health care is the minimum level of care, the core entitlement that should be guaranteed to all members of society. "There is a lack of proportion between the medical resources and the burden of disease and that there is a human right to equal access" (Dwyer 2004, p. 34). Basic health care covers a wide range of common health services needed to maintain, restore, or provide functional equivalents (where possible) to adequate species functioning. It includes at least some preventive, curative, mental health,

Homeland Security Case Study Example | Topics and Well Written Essays - 1250 words

Homeland Security - Case Study Example The actions of this department are what are amalgamated into the term Homeland security. The main focus of this formation is to deal with issues of the domestic population, building the necessary infrastructure to deal with both internal and the external aggressions and threats, sovereignty and the protection of the U.S territory. Inside the United States of America, the â€Å"Homeland Security† concept recombines and extends to the state agencies’ entities and responsibilities. The Homeland security research lays down the composition and formation of the Homeland Defense and the Homeland Security. These include the Transportation Security Administration, the Secret Service of the United States, United States Citizenship and Immigration Services, Americas Immigration and Customs Enforcement, Border and Customs Protection and the United States Coast Guard. Others Include the Federal Emergency Management Agency, the United States National Guard, among other departments adding up to one hundred and eighty-seven companies. The functions of the Homeland security are a major responsibility of the state (Berman & Flint, 2003). There have been several issues that affect the United States of America and that the Department Of Homeland Security has been grappling to deal with over years and presently. These issues include terror attack threats, immigration, capabilities, resource allocation, civil liberties, incident response, transportation security, intelligence, biotechnology, cyber security, infrastructure, funding allocation, border control among other issues. This paper will focus on cyber security threat that has been a challenge to the United States of America’s Homeland security. Cyber threats have been a challenge, both in past and present, to the United States. The policy makers and the Department of Homeland Security have been working hard to deal with issues relating to cyber security. The fight has been backed up by the use of

Wednesday, October 16, 2019

Potential Problems with Illegal Immigration Essay

Potential Problems with Illegal Immigration - Essay Example There is evidence of job competition between natives and immigrants, since the latter are typically employed in jobs shunned by natives (e.g., seasonal agriculture, working with toxic chemicals, etc.) even under conditions of high unemployment among the native-born. The hidden consensus seems to be that expelling the foreigners and their offspring who are already integrated would be too costly and disruptive (Som and Momblanco 2006). Meanwhile, the consolidation of immigrant communities, especially in big cities acts as a magnet for new entrants. For instance, "illegal Mexican immigrants have found good jobs in industries associated with the housing bubble. Large numbers of immigrants work at jobs in the construction, landscaping, and road construction industries" (Thornton, 2007). Some employers prefer to hire illegal foreign workers and some feel that they have no alternative. Wage stagnation is another problem caused by illegal immigrants in the USA. The role of compensation and its effect on wages and on the behavior of the unemployed has been put forward as one of the reasons for higher unemployment levels. Four aspects of unemployment benefit that could affect behavior of jobless workers. These are eligibility conditions; generosity of benefits; duration of benefits; and efforts made by authorities to prevent malingering. Following Jacobe (2006): "the current wage stagnation is a cause of the influx of a huge number of illegal immigrants who violate U.S". The evidence demonstrates that benefits played important role in unemployment and demands additional spending on social services for unemployed population. Illegal immigration becomes a burden for healthcare and health-related services. Following Porter (2006): "While many Americans without health insurance struggle to pay for medical care, U.S. hospitals provide at least $200 million a year in uncompensated emergency medical care to illegal immigrants" (p. 66). Defining needs as rational drives implies a corresponding conception of health. Being a critical concept supporting (or subverting) practical judgments about healthcare practice and health policy, the concept of 'health' is as contested as the concept of 'needs' (Som and Momblanco 2006). The government cannot deprive illegal immigrant a right to receive primary care but it deprives many native citizens healthcare insurance and healthcare services. The policy debate about healthcare needs is a response to conflicting demands on health policy and healthcare resources. Current government practices that disproportionately site municipal and hazardous waste disposal facilities in low -income and minority neighborhoods native citizens with the least access to quality health care. Operatively a basic and adequate standard of health care is the minimum level of care, the core entitlement that should be guaranteed to all members of society. "There is a lack of proportion between the medical resources and the burden of disease and that there is a human right to equal access" (Dwyer 2004, p. 34). Basic health care covers a wide range of common health services needed to maintain, restore, or provide functional equivalents (where possible) to adequate species functioning. It includes at least some preventive, curative, mental health,

Tuesday, October 15, 2019

Case Study on Business Strategy in the Australian Solar Energy Essay

Case Study on Business Strategy in the Australian Solar Energy Industry - Essay Example Appropriately enough most cutting edge research on implementing solar energy solutions is also being carried out in Australia. Various new companies and old ventures have begun to frequent the Australian solar energy market. CBD Energy is one such company with a two decades old history in the alternative energy industry. (ASX, 2011) This text will attempt to analyse the internal strengths and weaknesses possessed by CBD Energy that will enable it to deal with the solar energy industry effectively. 2. Analysis of the firm's internal resources and/or capabilities Competitive Advantage CBD Energy possesses significant competitive advantages against its competition within the Australian market. CBD is strongly connected to international global renewable companies such as Datang, SOLON, Tianwei and Oelmaier Technologies which ensure that technological access and supply are always available. This is essential as the global solar energy products manufacturing industry is finding itself unde r increased pressure to fulfil customer orders due to inflated demand. Moreover CBD has begun to assemble solar inverters as of January 2011 and had produced 500 units by February 2011 while annual projections put the figure at 20,000 units. This will ensure that CBD has alternative revenue streams in place as well and this will also ensure that CBD has critical components available at its disposal in required quantities at all times. Another significant advantage displayed by CBD is its ability to assemble key components for PV installations on rooftops. Most other companies in the Australian solar industry market do not have the requisite expertise as yet. This aids in reducing input costs, getting government tenders as these products are made in Australia and ensure timely access to required components. The recent opening of an office in China will enhance CBD’s manufacturing standing and will aid its efforts to manage outsourced components. (CBD Energy, 2011a) Consequentl y the lowered prices will encourage a new wave of buyers to invest in solar technology as it becomes more affordable for individual family units. Analysis of Resources Resources Indicators Financial Share value has been unsteady for the last fiscal year; Investors and speculators are pulling out. Organisational Employees are well paid. Physical Company is expanding its manufacturing and servicing capabilities. Technological Company’s resources are being updated continuously with new installations; Continuous improvement in products and services is underway. Human The management team is composed of experts from respective fields. Innovation New methods are being developed for servicing and installations. Reputation Sales are going up indicating developing market reputation. CBD is presenting a mixed picture in terms of its key resources. In terms of its financial resources, the share value of the company has been declining steadily (ASX, 2011) over the entire year (see Appendi x â€Å"A†). While some pressure may be attributed to a low performing stock exchange market but a major reason is the removal of accrued profits to support business expansion. Traded volumes have also remained low. Various speculators and investors are also pulling their stock out of the company although the key investors are still in place (see Appendix â€Å"

Romeo and Juliet Essay Example for Free

Romeo and Juliet Essay William Shakespeare, one of the most famous playwrights of all time, was born in Stratford upon Avon in 1564 and died in 1616. He was one of eight children of John Shakespeare, a local town official and glove maker, and Mary Arden. In 1982 Shakespeare married Anne Hathaway at only eighteen. They had three children together, Susanna, and twin Judith and Hannet. Sadly Hannet tragically died at eleven. Shakespeare was known for performing at the Globe theatre with the Chamberlains Men. He wrote 37 plays in his lifetime and one of his most famous plays was Romeo and Juliet. I am going to compare lines 1-100 of Act One, Scene One from the text of the two film versions; Franco Zeffirellis version and Baz Luhrmanns version. The text opens with the prologue, which gives a brief outline of the story, it is 14 lines long, and is therefore typical of what is known as a sonnet. It is about two families from Verona, both of similar status; both hate the other due to an ancient feud, the lovers, Romeo and Juliet both from each of the families take their own lives for their love. Their death makes their parents see sense. Shakespeare has deliberately revealed the ending in the prologue so that the audience may judge the characters and the events up to the final tragedy. Act One Scene One begins in a public place. It starts like a comedy with word-play and puns from Gregory and Sampson, both servants of the Capulet house. They boast about what they would do to the Montagues. One pun used is Well not carry coals. This means well not stand for any insults. No, for then we should be colliers. This means if we do stand for any insults then we shall be coal sellers or coal miners which were probably regarded as dirty and poor people in their day. Sampson uses rude language, to boast about what they would do to any Montagues Therefore I will push Montagues men from the wall, thrust his maids to the wall. Sampson thinks that love is just a matter of brutal conquest of another body. This part of the scene is very boastful and light hearted, until Abraham and a servant, both from the Montague house enter and the scene turns instantly threatening and tension increases. Sampson and Gregory turn from being boastful to serious, in a way this is ironic because when the they were joking, they were not afraid of saying about what they would do to the Montagues, but now when they come across the Montagues they become unsure as to whether to torment them or not, because Gregory says How, turn thy back and run? Hes unsure whether to provoke the Montagues. But Sampson is not as afraid as Gregory, so he decides to provoke them by biting his thumb at Abraham and the servant. Biting thumbs was regarded as an insult in that day. Both houses start bantering at each other, both speaking politely with a threatening undertone. Gregory says Do you Quarrel sir? Which is do you fight. The Capulets crave for a fight by aggravating the Montagues, but the Montagues are not up for a fight. At this point Benvolio enters and Gregory says Here comes one of my master kinsmen. But he is not referring to Benvolio because he is a Montague. He is referring to Tybalt who is approaching. So the Capulets start the fight themselves when Sampson says Draw if you be men, Gregory remember thy washing blow. The word washing blow means in this context, a slashing blow, which is a sword move. They then fight but there is no description of what happens. Benvolio who is against fighting stops the fight, but then Tybalt who is a Capulet enters and he offers Benvolio to fight . Turn thee Benvolio, look upon thy death. Tybalt is an aggressive character and when he enters he is spoiling for a fight and he does not believe in peace, this is evident when Benvolio says I do but keep the peace. Benvolio tries to restore the peace because he is a peacemaker. Tybalt does not believe that Benvolio is trying to stop the fight so he threatens Benvolio What, drawn and talk of peace? I hate the word . have at thee coward. Then Tybalt attacks Benvolio and a huge brawl follows, but this time the citizens and the officer attempt to break up the fight. The mood is now chaotic. Old Capulet and Lady Capulet enter. Old Capulet wants to be involved in the fight Give me my long sword, ho. Lady Capulet replies A crutch, a crutch! Meaning a crutch might be better because he is too old to fight. Then enters Old Montague and Lady Montague, he also wants to fight but Lady Montague attempts to stop him by restraining him. The two heads of the families seem foolish and try to stand up for their family by trying to be involved in the fight. Then Prince Escalus enters with his train, these are his guards in our context. He is in charge of Verona and he breaks up the fight between the two families. He is furious with them both. He gives a long speech to the two families. He compares their behaviour to beasts You men, you beasts, that quench the fire of your pernicious rage He also says that there have been three civil brawls between the two families in Veronas streets. He has had enough of it and the pointless fighting has disrupted the social life of the city. Their punishment if this happens again would be paid with their lives. Many of the characters from the two families seem to act first and think later. For instance some characters jump into a fight without thinking of the consequences. The fight breaks out quickly between the two families which proves the point that some of the characters act first, think later. These first 100 lines prepare the audience for the haste and speed which plays a big part in the coming tragedy of the deaths of Romeo and Juliet and it prepares for the fights that take place later on in the play. The Franco Zeffirelli film version of the play is set in the 15th century in the town of Verona in Italy which is the ideal setting to the play. The first scene which I am going to study is set on a bright sunny morning in the town market. The costumes worn are authentic to the 15th century, these include tight leggings known as Hose and close fitted jackets known as doublets worn by the men. The two families also wear the livery of their household. The Montagues livery is blue and grey and the Capulets livery are red and orange. The film introduces with a prologue, just like the text. As the Prologue is being spoken, the film shows a number of views of Verona. While this is being shown, music authentic to the time is played along with it. The prologue is correct to the text but the last two lines are cut out. After the prologue, the film goes straight to Veronas market, the public place. This market setting is authentic with its old sandstone buildings and its bustling market. Sampson, Gregory and another Capulet who is not included in the text, are walking through the market joking and being a nuisance to some of the citizens by kicking them for a joke. This portrays the Capulets as trouble makers. The mood is boastful and light hearted, which is faithful to the text. The film does not include the conversation about Colliers and Montague maids spoken between the Capulets. But it starts on line 25 when Gregory says The quarrel is between our masters and us their men. Sampson replies to this Tis all one. This is correct to the text, but it misses all the lines afterwards where Gregory says Here comes the house of the Montague. The Montagues consist of three people here, Abraham and two other Montagues not named. They are shown buying items from a market stall, you see them thanking the stall keeper and being polite to the citizens, Zeffirelli portrays the Montagues as nice people even though there is no evidence of this in the text. The banters between the two families are started just like the text. Sampson bites his thumb at the Montagues. This is also known as an insult in the film. The banters between them are correct to the text. After Abraham says You Lie. The Montagues walk away from the Capulets because they dont want to start any trouble. This is evidence to suggest that the Montagues are nice people. Sampson retaliates to this because he craves for a fight. He deliberately trips up the older member of the three Montagues. This is not included in the text. Sampsons retaliation makes Abraham angry and he declares the fight by saying Draw if you be men. This is actually said by Sampson in the text. Then Sampson completes the sentence from the text Gregory, remember thy washing blow. The brawl starts with both sides charging at each other. The scene is now in the streets of Verona near the market. The citizens help the Montagues break up the brawl by grabbing hold of the Capulets. Then Benvolio enters, he stops the fight and says his lines from the text, but in addition to this he says The prince expressly forbids fighting on Veronas streets. This is not in the text. Then Tybalt with a lot more of Capulets men enter, he laughs in a threatening way and the mood suddenly gets threatening, he and Benvolio say their lines, which are correct to the text. Benvolio is cowardly towards Tybalts will to fight, and the brawl begins again. The mood is chaotic and hot because it is set on a bright and hot street. During the fight, Tybalt injures Benvolio and he says hi thee home? Fragment. This means youre a coward and you should go home, Tybalt says it in a boastful way. The film shows the fight with lots of chaos, colours, close ups, lots of action, aerial shots of fighting, village people trying to stop the fight, things flying through the air, explicit bits like people being killed, there is no evidence of this in the play, it is hard to see who people are, such as who is Montague and who is Capulet. At one point during the fight, Zeffirelli shows us the two households. He shows Old Capulet gathering his men and charging out into the chaotic fight. There is no conversation between Old Capulet and Lady Capulet, despite this being in the original text. Zeffirelli also shows us Old Montague gathering his men to go and join the fight, and Lady Montague attempting to stop him. At this part the conversation between Old Montague and Lady Montague is correct to the text, but it misses parts out.

Monday, October 14, 2019

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.