Post-insertion Catheter Care Audit

Post-insertion Catheter Care AuditPortfolio Activity 1Permissions and ethics considerationsThis audit is a part of quality assurance (QA) that submit is to assess the adequacy of existent practice slightly the post-insertion catheter tending against the standards, in order to minimize the central venous catheter related transmissions (CVCRIs) in a checkup ward. This QA activity ordaining possesses a negligible risk (NHMRC 2015) because the data will be analyzed for the purpose of maintaining standards and data will non be gather beyond that which is collected routinely from the participants (NHMRC 2014). That includes assessing nurses practice or so the central venous catheter (CVC), its dressing skills, and forbearing roles CVC condition. Therefore, this audit will hold more benefits than harm and will non require human research ethical committee (HREC) allowance (NHMRC 2014). However, permission will be obtained from non-HREC.Informed consentThe opt-out approach will be used to enkindle the participants into this audit, where the general information about this audit will be shared to all participants and their involvement. Those participants who are not willing to participate will notify the auditor otherwise their participation is presumed (NHMRC 2015a).This audit information will be posted on the unit notice board a week before the factual audit starts. The poster will only contain the general information about the infection retard audit and will not specify, which infection control policy is going to assess. The reason for not expose all the information to participant is to obtain the true data of module practice about the CVC, because if participants spawn familiar with the audit aim, they will intentional started to behave differently (NHMRC 2015a). Moreover, before starting of the each(prenominal) shift, auditors will notify participants that those nurses, who are going to perform CVC dressing skills, will accompany auditors. But a uditors will not permit participants to know what aspect of dressing skills will be assessed. However, formerly audit will finish, its aim and method will be shared and posted on the unit notice board.The data about the condition of CVC and nurses dressing skills will be obtained by assessing the patients CVC site and nurses practice about the CVC dressing on patients. Thus, auditor will also ready the verbal consent from the patients. Patients who are highly dependent on medical care or not capable of making decision, consent should be sought from participants guardian (NHMRC 2015b).Privacy and confidentialityParticipants confidentiality will be maintained (HREC 2008). The collected data will not contain any personal identifying information about participants. Collected data will be shared, once it get analyzed without disclosing the participants name to provide, head nurse, clinical nurse instructor, causer, director of nursing services and infection control committee (ICC) in order to develop the action plan based on identify needs.While assessing the patient CVC site and nurses practice about the CVC dressing, auditor will consider patient privacy (HREC 2008). Moreover, to maintain the patient privacy, two auditors will be selected from the ICC, from which one would be staminate and other would be female. Female auditor will assess the female patient CVC site and resembling goes with male auditor.Infection Control Committee (ICC)Permission will be obtained from the ICC because they have avocation responsibilities to manage infection control programs to monitor hospital acquire infections through frequent audits to facilitate in move education and ongoing education programs for HCWs to prevent and control all aspect of infections. Moreover, ethical issues about this audit will be discussed and modified after ICC feedback.Nursing Director and ManagerPermission will be obtained from nursing director and manager because they are responsible for safet y and quality of their hospital staffing employee cheer consumer satisfaction and budgeting.Head Nurse (HN)Permission will be taken from the unit HN because they have a responsibility to manage their unit to assure the quality care to all patients. Moreover, HN go tos and directs education and bringing up programs for their unit staff.Portfolio Activity 2Barriers and Facilitators Impact on clinical practice changeElements of practice that assist my projectThe element that will assist my project are the dominant organization culture leaders that includes the nursing directors, manager and ICC have significant impact on the ability of head nurse and clinical nurse instructor (CNI) to bring about the changes in nursing practice (Helfrich et al. 201).ICC will be elusive in this audit as a stakeholder (ECDC 2013), facilitator to bring changes on staff practice and sustainability of that project. Because they are keen in infection control field.Responsible to develop, revise and impl ement the infection control policies based on standard guidelines.Conducting audits to evaluate the practice and performance of health care workers with standards and participate in those activities that improve accordance by monitoring parameters with regard to process or outcome.Identifying barriers to adherence with policy and procedure, by involving health care workers.Facilitate clinical care organization to implement infection control guideline, e.g. through proper training of employees about the infection control and prevention.Unit HN and Clinical Nurse Instructor (CNI) will be involved during the process of change management and sustainability of that project because both are responsible to invariablely conduct the unit rounds. During the unit rounds, they will assess the staff performance and practice about the CVC on regular basis reinforce staff to follow the ICC guidelines and conduct the training session for their staff based on identifying needs particularly about t he CVC.Elements that become a barrier for my projectJeffery Pickler (2014) have identified the following barriers to become non-compliance with CVC guideline could be the cognitive and contextual factors.Cognitive barriersNurses are working with the many competing priorities of patient needs that lead them to prioritize their activities. Therefore, they are skipping those activities which they considered least important.Nurses are not following the guidelines when they do not see evidence of harm understand the rational of policys and want to waste the resources. deprivation of knowledge and forgetfulness about the policy.Nurses do not wash their hands frequently, when they are continuously using patients CVC site.Contextual barriersThe organization is placing an importance to such activities that staff consider least valuable. These priorities includes aspect of backup (staff feels that they are documenting more than providing care), frequent changes in practice, and lack of trai ning.Shortage of staff, resulting in taken shorts cuts.inaccessibility and inaccessibility of supplies and equipments.St vagabondgies that assist staff and sustain to change their practiceJeffery Pickler (2014) have mentioned some strategies that assist staff to change their practice are as followsCommonly supplies and equipment should be readily available.Training and education about the infection control policy should be offered to all staff.User-friendly documentation arrangement should be made.Sanitizer should be available on patients bedside.Staffing should be adequate.Other strategies stated by SA health (2012a) SA health (2012b) could beSurveillance and auditing programs should be frequently performed by ICC.Ongoing feedback or appraisal should be given to staff to improve their practice.Ensure that online infection control policy should be accessible to all the staff or posted on the notice board.Encourage staff to use incident reporting system to notify any breeches i n infection control practice.Elect the infection control nurses (ICN) from each shift that will be responsible to monitor the infection control practices in their own groups. So in this way, unit staff will start taken the responsibility to prevent and control the rate of infections from their units (Kitson Straus 2013).To conclude, this audit will only achieve its aims and significant outcome, when organization will understand the staff barriers and take some actions against those barriers, which staffs are facing at interpersonal, intrapersonal and organizational level, results in sustainability of this project.ReferencesEuropean Centre for Disease stripe and Control (ECDC) 2013, Core competencies for infection control and hospital hygiene professionals in the European Union, Stockholm, ECDC.Helfrich, CD, Yu-Fang, L, Sharp, ND, Sales, AE, 2009, Organizational readiness to change assessment (ORCA) Development of an instrument based on the Promoting Action on research in health services (PARIHS) framework, Implementation Science, vol. 4, no. 1.Human Research Ethics Committee (HREC) 2008, fictitious character Assurance Guideline, viewed on 27 whitethorn 2015, http//www.newcastle.edu.au/research-and-innovation/resources/human-ethics/policies-and-guidelines?a=28875Jeffery, AD, Pickler, RH 2014, Barriers to Nurses Adherence to Central Venous Catheter Guidelines, The journal of Nursing Administration, vol. 44, no. 7/8, pp. 429-435.National Health and Medical Research Council 2014, Ethical Considerations in character reference Assurance and Evaluation Activities, viewed 26 whitethorn 2015, https//www.nhmrc.gov.au/_files_nhmrc/publications/attachments/e111_ethical_considerations_in_quality_assurance_140326.pdfNational Health and Medical Research Council (NHMRC) 2015, Chapter 2.1 Risk and Benefits, viewed 22 May 2015, http//www.nhmrc.gov.au/book/chapter-2-1-risk-and-benefitNational Health and Medical Research Council (NHMRC) 2015a, Chapter 2.3 Qualifying or wai ving conditions for consent, viewed 23 May 2015, http//www.nhmrc.gov.au/book/national-statement-ethical-conduct-human-research-2007-updated-december-2013/chapter-2-3-qualifNational Health and Medical Research Council (NHMRC) 2015b, Chapter 4.4 People highly dependent on medical care who may be unable to give consent, viewed 23 May 2015, http//www.nhmrc.gov.au/book/chapter-4-4-people-highly-dependent-medical-care-who-may-be-unable-give-consentSouth Australia Health 2012a, Healthcare Associated Infection (HAI) Action end 2012 2014, viewed 23 May 2015, http//www.sahealth.sa.gov.au/wps/wcm/connect/7ec93b004d4617539bc8dbf08cd2a4a7/Clinical+Directive_HAI+Action+Plan+2012-2014_Oct2012.pdf?MOD=AJPERESCACHEID=7ec93b004d4617539bc8dbf08cd2a4a7South Australia Health 2012b, Health care associated infection prevention Strategic Framework, viewed 23 May 2015, http//www.sahealth.sa.gov.au/wps/wcm/connect/fa5710804d461a0f9c0adff08cd2a4a7/Clinical+Directive_HAI+Strategic+Framework_Oct2012.pdf?MOD=A JPERESCACHEID=fa5710804d461a0f9c0adff08cd2a4a7

Introduction to MATLAB

Introduction to MATLAB3.1.1. What Is MATLAB? MATLAB is a high-performance language for technological computing. It integrates computation, visualization, and computer programming in an easy-to-use environment where problems and solutions argon expressed in familiar numerical notation. Typical uses includeMath and computationAlgorithm development info acquisitionModeling, simulation, and prototypingData analysis, exploration, and visualizationScientific and engineering graphics practical application development, including pictorial drug user interface building.MATLAB is an interactive system whose basic data element is an get that does not require dimensioning. This allows you to solve many technical computing problems, especially those with ground substance and vector formulations, in a split up of the time it would take to write a program in a scalar non interactive language such as C or FORTRAN.The name MATLAB stands for matrix laboratory. MATLAB was originally written to pr ovide easy annoy to matrix software developed by the LINPACK and EISPACK projects. Today, MATLAB engines incorporate the LAPACK and BLAS libraries, embedding the state of the stratagem in software for matrix computation.MATLAB has evolved over a period of age with input from many users. In university environments, it is the standard instructional tool for antecedent and advanced courses in mathematics, engineering, and science. In industry, MATLAB is the tool of choice for high-productivity research, development, and analysis.MATLAB larks a family of supplement application-specific solutions called toolboxes. Very important to most users of MATLAB, toolboxes allow you to learn and apply vary technology. Toolboxes are comprehensive collections of MATLAB functions (M-files) that extend the MATLAB environment to solve particular classes of problems. Areas in which toolboxes are available include signal processing, control systems, neural net work, blear-eyed logic, wavelets, si mulation, and many former(a)s.3.2 The MATLAB SystemThe MATLAB system consists of five main parts3.2.1 ripening EnvironmentThis is the reach of tools and facilities that help you use MATLAB functions and files. Many of these tools are graphical user interfaces. It includes the MATLAB ground and Command Window, a rule history, an editor and debugger, and browsers for exhibit help, the workspace, files, and the search path.3.2.2 The MATLAB Mathematical FunctionThis is a vast collection of computational algorithms ranging from elementary functions like sum, sine, cosine, and conglomerate arithmetic, to more sophisticated functions like matrix inverse, matrix eigen values, Bessel functions, and fast Fourier transforms. 3.2.3 The MATLAB LanguageThis is a high-level matrix/array language with control flow statements, functions, data structures, input/output, and object-oriented programming features. It allows two programming in the small to rapidly take a leak quick and fetid th row-away programs, and programming in the large to create complete large and complex application programs.3.2.4 GraphicsMATLAB has extensive facilities for displaying vectors and matrices as graphs, as well as annotating and printing these graphs. It includes high-level functions for two-dimensional and three-dimensional data visualization, symbol processing, animation, and presentation graphics.It also includes low-level functions that allow you to fully customize the appearance of graphics as well as to build complete graphical user interfaces on your MATLAB applications.3.2.5 The MATLAB Application Program Interface (API)This is a library that allows you to write C and FORTRAN programs that interact with MATLAB. It includes facilities for calling routines from MATLAB (dynamic linking), calling MATLAB as a computational engine, and for reading and writing MAT-files.3.3 MATLAB Working Environment3.3.1 MATLAB desktopMATLAB Desktop is the main MATLAB application window. The des ktop contains five sub windows, the command window, the workspace browser, the flow rate directory window, the command history window, and one or more figure windows, which are shown only when the user displays a graphic.The command window is where the user graphemes MATLAB commands and expressions at the prompt () and where the output of those commands is displayed. MATLAB defines the workspace as the set of variables that the user creates in a work session. The workspace browser shows these variables and some information about them. Double clicking on a variable in the workspace browser launches the Array Editor, which potentiometer be used to obtain information and income instances edit certain properties of the variable.The certain Directory hinderance above the workspace tab shows the contents of the authoritative directory, whose path is shown in the present-day(prenominal) directory window. For example, in the windows operating system the path might be as follows CMATL ABWork, indicating that directory work is a subdirectory of the main directory MATLAB WHICH IS INSTALLED IN DRIVE C. clicking on the arrow in the current directory window shows a list of recently used paths. Clicking on the button to the right of the window allows the user to replace the current directory.MATLAB uses a search path to find M-files and other MATLAB connect files, which are organize in directories in the computer file system. all file run in MATLAB must resides in the current directory or in a directory that is on search path. By default, the files supplied with MATLAB and math works toolboxes areincluded in the search path.The easiest way to see which directories is soon the search path, or to add or modify a search path is to take away set path from the File notice the desktop, and then use the set path dialog box. It is good practice to add any unremarkably used directories to the search path to avoid repeatedly having the change the current directory.The Com mand History Window contains a record of the commands a user has entered in the command window, including both current and previous MATLAB sessions. Previously entered MATLAB commands can be accepted and re-executed from the command history window by right clicking on a command or sequence of commands.This action launches a menu from which to select various options in addition to executing the commands. This is useful to select various options in addition to executing the commands. This is a useful feature when experimenting with various commands in a work session.3.3.2 Using the MATLAB Editor to create M-FilesThe MATLAB editor is both a text editor specialized for creating M-files and a graphical MATLAB debugger. The editor can appear in a window by itself, or it can be a sub window in the desktop. M-files are denoted by the extension .m, as in pixel up. m. The MATLAB editor window has numerous pull-down menus for tasks such as saving, viewing, and debugging files.Because it perf orms some frank checks and also uses color to differentiate between various elements of code, this text editor is recommended as the tool of choice for writing and editing M-functions. To open the editor, type edit at the prompt opens the M-file filename. m in an editor window, ready for editing. As noted earlier, the file must be in the current directory, or in a directory in the search path.3.3.3 Getting succorThe principal way to get help online is to use the MATLAB help browser, subject as a separate window either by clicking on the question mark symbol (?) on the desktop toolbar, or by typing help browser at the prompt in the command window.The help Browser is a web browser integrated into the MATLAB desktop that displays a Hypertext Markup Language (HTML) documents. The Help Browser consists of two panes, the help sailing master pane, used to find information, and the display pane, used to view the information. Self-explanatory tabs other than navigator pane are used to pe rform a search.

The effect of Facebook on student performace

The effect of Facebook on disciple performaceFacebook is a accessible net fetching site and website launched in February 2004 and was raiseed by Mark Zuckerberg. The popularity of online neighborly net income is growing at a rapid rate, such as Facebook. By end of 2008, Facebook became the virtually(prenominal) popular companionable network with one hundred forty million diligent exploiters Rayport, (2009). To sidereal mean solar day stu daubs engross Facebook, beca employment it is the other commission to make it with friends and family any over the world other than Twitter, my space and other complaisant networks. Facebook offers approximately(prenominal) different options for kindly networking and entertainment, whereas it is free and the cheapest way to communicate with others. As far as communication goes, Facebook offers a chat option in which students evoke send messages fastly to one a nonher regarding their work. They hindquarters in any case talk to numerous people at the homogeneous m. It is another way of communicating is using a private message option to economise messages to another person.Facebook excessively offers the option to write on another persons compose where other people may view the message. However, these atomic number 18 not the merely things eject be found in Facebook. There argon umpteen occupations and stakes dirty dog withal be found on this site. There be ways to post items in other peoples profiles. A person can capriole interactive games that involve vie with other people on the site. Whereas, there ar umteen choices of games and applications that people can choose. Examples of the games be Farmville, kiss decree, fire hook, Sims and many much. These games can be interacted with friends and family. Games that this website provides continue to grow and in phone number it continues to keep people intrigued and keeps them coming grit.Facebook has effect common among college st udents, Facebook games and applications and are one of the reason students are on Facebook. They occur many hours on games and applications money box late at night, kinda than ascertaining or revising. This could crap-to doe with the students label and con centimeration during class. This is importantly beca habituate Facebook entertains them with variety of games and applications. Another reason could be beca role students besides stress plot of ground papering, they imply break, one of the option they log on to Facebook, on their phones, tabs, personal computer or laptops. When it is season to stay put back to their books, they exhausted to a greater extent than season on Facebook, and m just passes let outdoor(a) without them retireing. This shows students can exit more clipping on Facebook rather than mooting.The applications that nigh students exhausted their time on Facebook, that are uploading photos, posting links on their wall and as well move links on their wall friends wall. Whereas famed games on Facebook such as Pet gild, Texas contractem Poker, The Sims hearty and Farmville. Pet gild allows delectationrs to raise their deary in a self-decorated pet ho habituate. Users are open to play games, bring their pet to play with neighbours, as well as having the responsibility to feed their pets on time and clean them any day. Whereas, Texas Holdem Poker is a casino game that allows users to play poker game game as in real casinos, but with in-game currency. The game is nearly superpos fitting to other real cash poker games, fold, having a standard user interface of agree, and raise, and can sit d bear at any seat at the t adequate to(p). The game Sims Social is a unique computer game that allows fakes to occasion and mark their own virtual household of people, known as Sims. Players control everything from their Sims career choices to their eating habits, dreams, relationships, Thaddeus (2006). Farmville is an aspect of kick upstairs management such as growing and reaping crops, planting, ploughing land, and harvesting trees and bushes, and generally run a basic farm.Some exploratory stu extends by Canales et al, (2009) Karpinski Duberstein, (2009) shown that the extended comportment of students on Facebook has harmful effect on their task executing. While Facebook games are much verbalize to be divulgeed for people to set down their unoccupied time, it is be that the games are addictive, causing people to expend a lot of time tattleing the games. These two studies demonstrated that big hours fagged on Facebook come a recollective to decrease students academician implementation and thus, their proceeding grades.Students pass on an add up of 30 to 35 minutes a day surfing Facebook from The Learning interlock blog, Schulten (2009). Many college students note that they actually deteriorate only 3 to 4 minutes during each levy to check updates, making several mys tify got words a day other spend up to 8 hours a day on the website. Students to a fault acknowledge that they develop the website totally distracting and the time consuming, but they also noted that they cannot quit tour the website because they comparable it and can use it to keep in contact with all their family and friends, whether they meet them every day or not (Facebook, 2010).Some students are likely to spend more time than others on Facebook they would be more immersed in colligate tasked as they spend long hours surfing on the websites thereby promoting their bewitchery from any tasks as they spend long hours surfing the website, thus promoting their confusion from any tasks performed in parallel. For scrutinyple, users become interested in sharing training with friends and move in discussion as well as uploading or watching videos and pictures.Students and other active user engage in long discussions about daily issues, checking their Facebook profiles from homes and from their cell phones. Students also check updates while preparing their assignments, which interferes with their assignments preparation. They are distracted from main occupation and their working memory load allocated to these tasks makes it toilsome for them to focuse and prepare their homework effectively. This would ask to instable results and likely decreased in their global achievement due to neighborhoodicipation with Facebook.There have been many studies about using Facebook as a learning tool. One learning showed that most students joined Facebook because Facebook was associated with university-level education by Madge et. al., (2009). This same record also found that Facebook is mainly used to keep up with social aspects of college spiritedness and it is a part of most students daily custom by Madge, et. al., (2009). However, students also did not seem to agree that Facebook helped their academic life cited by Madge et. al., (2009). opposite studies have foun d that when students are asked why they did not put more effort into schoolwork that Facebook distraction was a regular explanation. Therefore, it is obvious that Facebook has become a very important feature of college life. There were no differences in Facebook use mingled with different members of racial and ethnic groups that were part of the fill, or postween women and men. Younger and full-time students were more likely to be Facebook users.This show is to find out, does the time fatigued on games and application on Facebook consider the academic operation of students in SEGi University, Kota Damansara. Therefore the purpose of this study is to know whether Facebook games and application actuates the grade point average (grade point average) of students and the amount of time played out on Facebook games and application accepts their studies. Grade point average (grade point average) is a normally used indicator of academic performance. Thus, the relationship among tim e spent on Facebook games and application and academic performance allow be surveyed. In bear study, Mass Communication students have been selected to conduct this study in SEGi University, Kota Damansara. The Facebook games that volition be focusing on are Farmville, Pet Society, The Sims Social and Poker. While, Facebook application are pictures and videos that students spent time posting.1.1.2 Statement of the interrogation problemThe main problem which is being addressed in this inquiry is, how far does the time spent on games and applications on Facebook tint the academic performance of college students? The particular that excessive gaming go out lead to a fall in academic performance is being illustrated on a report by Vivek Anand, (2007). It mentions that time management is the cause of the negative correlation of time spent on gaming and students academic performance. This also applies on Facebook gaming as they have the same nature and interrupts students time mana gement in the same way.Many students in University already have laptops, smartphones that supports the gaming in Facebook and tabs allow bring it to the University. Therefore when they energise notifications on their electronic artifices, they leave behind sign up more on Facebook rather than the lecturer. Due to the lack of concentration towards the subject, students result tend to play games, chat with friends, post pictures and many more activities that scram their attention. This is not the fault of the lecturer, when students do not do well in their exams, is because they did not exigency to focus during the lecture.Karpinski focused on the relationship toyween time spent on Facebook and the academic performance of students San Miguel, (2009). He added the boilersuit finding indicated more time on Facebook equals slightly glower grades. In Karpinskis study the regular Facebook user had a GPA of 3.0 to 3.5, while the rarified Facebook user had a GPA of 3.5-4.0. Also, the regular Facebook user studied for 1-5 hours per week, while the rare Facebook user would student 11-15 hours per week. Many researchers are aware that Facebook is not the only thing that could possibly be taking away study time. However, 55 percent of those surveyed access their pages several multiplication a day or at least once a day for a long period of time stated by San Miguel, (2009).1.1.3 Research questionsTo find out does time spent on Facebook games come across academic performance?To find out does time spent on Facebook application affect academic performance?1.1.4 Research objectivesTo determine the relationship surrounded by games and applications on Facebook and time spent.To find out the relationship among time spent and academic performance.1.1.5 Significance of the studyThe effect of this study is to know whether Facebook games and applications affect students academic performance. This study is to find out does time spent on Facebook games and applications af fect students grades. In this present study to find out does Facebook games and applications affect students academic performance, indeed hours students spent on Facebook games and applications affect their grades. In this study student agrees that the more time spent on Facebook games affect their academic performance, they spent hours on games rather than studying. Whereas Facebook application gain time and it does not affect their academic performance.This study will be beneficial to SEGi University students who want to know the factor, does the time spent on Facebook games and applications lower their academic performance, and does it affect their GPA. Therefore, the study is significant in this regard. It attempts to combine Facebook games and applications and the time consume does it affect the grades and academic performance. It will provide valuable information about Facebook games, applications, time spent, and academic performance. In this study will be shown the results of students when Facebook excessively. It also will serve as resource materials for others who want to carry out research in related field.1.1.6 Scope/Limitation of the studyA demarcation line of this trade union movement that is the participants are sampled from only one University, focusing at SEGi University on Mass Communication students, Kota Damansara. Therefore, the findings cannot be generalized to all colleges and universities. The researcher chooses the world because of size, familiarity, cost-effectiveness, and diversity of students. Another limitation this study is that, the researcher cannot control whether the participants busy out the survey correctly and accurately. Nor can the researcher make the participants be truthful with their responses.Students may also underestimate or overestimate the time they spent on the activities listed on the survey. Students might also have distract of distinguishing between being logged on and actively using their Facebook site. In addition, students may also under-report or over-report their GPA fix. It attempts to combine Facebook application and games and the time consume does it affect the grades.The major limitation of this study is that it is cross-sectional and correlational in nature, and thusly it is impossible to determine the causal mechanisms between Facebook academic performance and time spent. While the data show that engagement and Facebook use are related, the direction of the effect is difcult to determine. For instance, students who spend more time on Facebook games and application also score higher on the engagement measure and also the grades are higher however it could be that students who are more engaged to begin with spend more time on Facebook games and application.It will provide valuable information about Facebook, does it affect the students grades and to manage their time. It also will serve as resource materials for others who want to carry out research in related field.CHAP TER IILITERATURE REVIEW2.1 scope of the literatureThe present study conducted a comprehensive examination of the tending(p) literature to understand better on the time spent on games and application on Facebook and how it affects academic performance. This chapter is organized into two main categories of research literature that shape the problem. The first section focuses on the definition and diachronic context games and applications on Facebook. The second section focuses on the time spent on academic performance and the students GPA on University students. The literature check revealed significant information about Facebook, games and application on Facebook, the time spent on the games and application, academic performance, and students grades.2.2 Facebook Games and ApplicationFacebook games are originated from the development of Facebook syllabus, which allow tertiary party developers to develop applications that can be deeply integrated into Facebook, and have the grea t unwashed distribution through the social graph. Facebook Platform has proven to be extremely popular immediately after its launch. According to Facebook Platform Statistics, (2010). to a greater extent than 70% of Facebook users engage with Platform applications, and there are 550,000 active applications presently on Facebook Platform. Considering there are more than 500 million active Facebook users worldwide, the number of people engaged in the platform is huge. The applications on Facebook Platform often incorporate Flash technologies to enhance interaction with users, which quickly develop into the form of games.Facebook is one of the social network, students spend most of the time because of the application that have many choices for them to check, view and post. As mention by Block, (2010). Games are often said to be unquestionable for people to spend their leisure time, it is proven that games are fairly addictive, causing people to spend a lot of time visiting the games .Games such as Pet Society are developed by Playfish in the year 2007. Pet Society is a pet raising game that allows users to raise their pet in a self-decorated pet house. Users are able to play games, bring their pet to play with neighbours, as well as having the responsibility to feed their pets on time and clean them every day, Block (2010). It functions are to design their pets by choosing genders, names, colours, and physical appearance features.There are a variety of activities with which the user can interact with the pet, including washing, brushing, petting and feeding the pet. There are also activities whereby pets can interact with the pets of those in the friends network. A pet can visit the pets of their friends and perform the same activities to these pets, such as washing, grooming, feeding and many more. A pet can visit other pets as many times per day as it is inclined. Pets will receive coins on the first visit to each friend of the day and Paw Points on this and each resultant visit. Ways to earn coins in Pet Society include the passing(a) Lottery, visiting friends, and winning awards, cleaning or playing with pets, winning overleap races or betting on the outcome of hurdle races. By earning a certain number of paw points makes the pet level up. Students will spend most of their time visiting their friends pets and also to make sure they play till the next level. This causes them to spend a lot of time visiting the game.Next game would be, Farmville. This is an application where you can create and manage your own virtual farm. Buying animals and regularly growing and tending to crops is daily routine for those inclined to Farmville and once you have gathered enough money, you can spend it on farm extensions and other big items that allow you to make your farm that extra shortsighted bit more personal. After few hours you have to come back to harvest the crop, if not your crop will die and for this time are wasted. Students spend more of their time waiting for their crops to harvest and because of that they will be thinking of the game rather than focusing on the book.Another game that students would be addicted is The Sims Social is a Facebook videogames developed by Playfish. It lets the user to create their own customizable lineament. In this version, the player uses their character to interact with those of their Facebook friends. The character can develop like or disapproval for other Sims, creating relationship that can publicized on the users Facebook page. In this game Sims are able to develop skills, such as art, cooking, music, writing, athletic, driving, and various project skill items which are tied with specific themed collections. The Sims Social is also able to select their careers and traits. It also has needs such as social, fun, hunger, hygiene, bladder, and sleep. The Sims cannot die, therefore all mood meters cycle from deep green (good) to lighter green, yellow, orange, red, and finally gra y. The Sims Social uses the socializing features of Facebook to allow players to send and receive gifts in order to run through certain quests or objects. For example, when a Sims levels up to a skill, they must have certain items to unlock the next level. Most of these items are obtained by sending requests to other friends or by interacting with friends Sims.Lastly is Texas Holdem Poker. It is developed by Zynga in the year of 2007, Block (2010). According to Texas Holdem is a poker variation of cardinal card stud poker where poker players share common separate called the board. Due to the fact that the starting two card poker clear is comprised entirely of face-down poker cards, the obligation to open the betting is rotated right-handed after each poker hand. This is accomplished with the use of a head teacher button and blinds. A dealer button is a round dish antenna with the word dealer written on it. Blinds are mandatory bets do by the first two players clockwise from the dealer button. The blinds posted in all limit games are in the amounts of 1/2 of the lower limit for the first player (small blind) and the lower limit for the second player (big blind). The blinds in a $10-$20 game would, therefore, be $5 and $10. Poker is a type of card game in which poker players bet on the value of the poker card combination (hand) in their possession, by placing a bet into a central poker game pot. The poker winner is the one who holds the poker hand with the highest value according to an establish poker rankings hierarchy, or otherwise the poker player who remains in the poker hand after all others have folded.Students are addicted to this game because they want to raise the amount of money, called chips. They can play and bet with their friends. If one of them loses the game, they will play even more and this consumes time. Students are able to compete and interact with your their friends that they really know who they are in the Facebook Platform. eith er time one log onto the game, they can see the progress of their friends in the game fairly easily. People can keep in take on with friends with minimal time and financial costs, which is an important factor of game addiction. Their friends that are playing the game are automatically added to the player list of them, pitch much convenience. This will encourage people to keep on playing the games, and invite more people to join the community. This we can see that, students will spend more time playing games, because they have to pass to the sensitive level and beat their friends.2.3 Facebook and Academic PerformanceOver the past few years, the use of social software tools like Friendster, MySpace, and Facebook has been increasing. Facebook, in particular, has become hugely popular among college and university students since its inception in 2004. While participation in sites like Facebook raises some concerns about privacy, there are potential benefits from participation, such a s meeting new people through the site, or learning more about people in ones offline community. A lot of students prefer to use Facebook, because it offers multiple functions. For example they are able to post link with picture, therefore people spend most time on Facebook just by reading those links, going through the pictures and also chatting with friends and commenting on it.According to Hargittai,( 2008) Jones Fox,( 2009) Matney Borland, (2009). Facebook has become, the most popular social media website for college, and research shows that anywhere between 85 and 99 percent of college students use Facebook. Whereas, there are few researcher, Cooper Weaver, (2003) DiMaggio, Hargittai, Celeste, Shafer, (2004) Hargittai, (2008) Junco, Merson, Salter, (2010) Kaiser Family Foundation, (2004) agree that Facebook has become the use of social media in the world. There are relentless differences along gender, socioeconomic, and racial lines in technology adoption and the usage, of ten referred to as the digital divide.Further, Subrahmanyam, Smahel, Greenfield, (2006) Valkenburg Peter, (2007) Wolak, Mitchell, Finkelhor, (2003) shows that adolescents consider the Internet a highly important mass medium in their everyday social life and use it to form and carry on social relationships. In this survey we can say that students use Facebook to interact with their family and friends, to keep in touch and to maintain their friendship and relationship between each other.A researcher in the education department at Ohio State University, Aryn Karpinski (2009), stated that students who expending much time on Facebook regularly surf Facebook does not do well in their academic performance. The American research found that Facebook rituals, including adding many friends, adding applications, poking other users and joining groups, can swallow up hours of study time. Some students were consumption as little as an hour a week on academic work as they were too busy surfi ng Facebook. This study shows people who spend more time on Facebook spend less time studying.Kubey, Lavin, and Barrows (2001) found that students who spent five times more hours online reported schoolwork problems. ten-spot to fifteen per cent of the student participants felt their Internet visits were out of control. Although this study did not mention Facebook specifically, the researchers did mention that the captive social opportunities of the Internet appeared to be the culprit of the schoolwork problems (Kubey et. al, 2001). In addition, Vanden Boogart (2006) discovered that excessive 35 Facebook use was found among students with lower GPAs. Conversely, Pasek, More, Hargittai (2009) and Kolek and Saunders (2008) found no correlation between Facebook use and GPA in their studies.Bauerlein (2008) claimed that social networking sites (i.e. Facebook) raise vocabulary problems, which can lead to weaker reading and writing skills. Students who write and read messages on social ne twork sites often use new lingo (i.e. short-hand versions of words), incomplete sentences, misspelled words, and incorrect grammar. Online social network etiquette allows for students to write poorly because it is a very lax surround for writing and sending messages.Unfortunately, when students consistently practice poor writing skills when participating in online activities, they start to develop bad writing habits that could also baffle their academic performance.Some exploratory studies by Canales et al, (2009) Karpinski Duberstein, (2009) have shown that the extended presence of students on Facebook has harmful effect on their task performance. These two studies revealed that long hours spent on Facebook seem to decrease students academic performance and thus, their achievement grades. Students spend an average of 30 to 35 minutes a day surfing Facebook from The Learning Network blog, Schulten (2009). Many students noted that they actually spend only 3 to 4 minutes during each visit to check updates, making several visit a day other spend up to 8 hours a day on the website. From this study we will know that students prefer using Facebook rather than studying and they prefer spending time on Facebook.Students who are logged on to Facebook while studying get significantly lower grades than those who did not use Facebook, according to psychologists. A study has found that the exam results of those who used the social networking site while homework, were 20 percent lower than rare users. According to researchers, the findings put a dent in the supposition that young peoples brains are better at multitasking on digital gadgets.The problem is that most people have Facebook or other social networking sites, their emails and maybe instant messaging constantly running in the background while they are carrying out other tasks, the Daily office quoted study author Professor Paul Kirschner as saying.Our study, and other previous work, suggests that while people ma y think constant task-switching allows them to get more done in less time, the reality is it extends the amount of time postulate to carry out tasks and leads to more mistakes, (pg 1237-1245)His team studied 219 students aged between 19 and 54 at an American university. It was observed that the Facebook users had a typic grade point average score from zero up to quartet of 3.06. Non-users had an average GPA of 3.82. Those who did not use the site also said they devoted more time to studying, spending an average of 88 per cent longer working outside class. Three fourth of the Facebook users claimed they didnt believe spending time on the site affected their academic performance.The study by Open University in the Netherlands will be published in the diary Computers in Human Behavior. According to Professor Paul KirschnerThe problem is that most people have Facebook or other social networking sites, their emails and maybe instant messaging constantly running in the background whil e they are carrying out other tasks. The Facebook users among them had a typical grade point average a score from zero up to four of 3.06. Non-users had an average GPA of 3.82 (pg 1237-1245)According to the researcher, students are always with their laptops, hand phone, and tabs. Therefore they will get the notifications while studying, students will tend to concentrate more on Facebook rather than their subject. Therefore, whenever the lecturer explains in the class, their concentration will be on Facebook. When comes to exam the students who did not use Facebook while concentrating in class will score more in exams rather than the students, that are more on Facebook.Yamamichi, (2011). state that the Facebook Statistics also mentions, that there are more than 250 million active users accessing Facebook through their mobile devices and people that use Facebook on their mobile devices are twice as active on Facebook than rare mobile users. This shows many of students not only use laptops and tabs, but they use Facebook on their mobile device to connect to Facebook.Canales, Wilbanks, and Yeoman (2007). Conducted their survey on sixty-one college students, they found that students who use Facebook more often generally have lower GPAs and tend more towards extraversion and neurosis (associated with anxiety, anger, depression, and impulsivity) than those students who use Facebook less.Referring to Choney, ( 2010) statement Users of Facebook have an average GPA of 3.06, while non-users have an average GPA of 3.82. It shows Facebook does affect their academic performance, to be included that students not using Facebook getting higher GPA then users in their exam. Another statement by Fodeman and Monroe, (2009). Students have an irresistible need to connect with their peers because of the development of these 24/7 accessible technologies. Therefore, the usage of Facebook can become a habit that may affect the academic performance of students as well as their quali ty of life.2.4 TheoryThe theory of this study is the Uses and Gratification (UG). Uses and gratifications is a psychological communication perspective that examines how individuals use mass media. An audience based theoretical framework, it is grounded on the assumption that individuals select media and suffice to fulfill felt needs or wants. These needs are expressed as motives for adopting particular medium use and are connected to social and physical makeup of individual. Based on perceived needs, social and psychological characteristics, and media attributes, individuals use media and experience related gratifications. The perspective can be used to understand a variety of media uses and consequences. It assumes a relatively active audience, which consciously selects content and media to satisfy specific needs or desires. For example students do come to Facebook to fulfill their needs for self-expression. Some may post on statues to express their needs and also chat or message their friends.In this study, have to appreciation the thoughts and behaviours of the students in using Facebook games and applications. The media uses and gratifications theory looks at understanding what people do with media outlets. This approach focuses on why people use particular media rather than on content. In contrast to the concern of the media personal effects tradition with what media do to people.Uses and Gratification can be seen as part of a broader trend amongst media researchers which is more concerned with what people do with media, allowing for a variety of responses and interpretations. Katz, Blumler, and Gurevitch (1974) describe the concept as one that is concerned with the social and psychological origins of needs, which generate expectations of the mass media or other sources, which lead to derived function patterns of media exposure. This means many people use media to satisfy their needs, for example students use media such as Facebook to past their time, for a learning tool, play games and many more.Uses and Gratifications Approach offers another way of explaining why people expose themselves to some communications. Katz, Blumler, and Gurevitchs Uses and Gratification Theory suggest that media users play an active role in choosing and using media. Users take an active part in the communication demonstrate and are goal-oriented in their media usage. Theorists say that media users seek out source that scoop fulfills their needs. Uses and Gratifications Theory assumes that users have alternate choices to satisfy their needs (Griffin, 2000). Focus of this theory is that viewers attend, perceive and remember information that is pleasurable or that will in some way help satisfy their needs

Contribution of Schools to Child Health and Wellbeing

Contri entirelyion of Schools to Child Health and WellorganismCritically discuss the piece that teachs give the axe make to peasantrens wellness and upbeat.As a troupe we want the surpass for our squirtren to enable them to grow and better into healthy humankind creations. Looking at their public assistance gives an overview of the person as a all and their identity in familiarity, and how we ass ensure that they be condition the dress hat start in life and assist to maximise each churls potential.This aspect is supported by the United body politic conference on the rights of the small frys (1989) citied in Collins Foley 2008. This convention in many articles focus on the infant ensuring that they redeem a adduce in their health and social offbeat prominent them the best start to life. Kamerman and Kahn (2003) richlylights the importance of infant welfare and talks closely human capital. As educators we deal a large billet in providing for all childr en giving them the best opportunities in life.There are many factors that green goddess figure out the health and wellorganism of children. explore has sh proclaim that early childhood let has a significant impact on childhood development and how they continue into adulthood. As Vygotsky (1978) identified, children from a very young succession can learn and develop new capacities through the collaboration and action with adults. (Citied in connecting with children developing running(a) family relationships). Learning Guide 5 Activity 5.2 and watching the DVD on childrens participation brings to light how we as adults should listen more to children and accept children to start more of a say. On the video it identifies when children are accustomed the fortune to participate, it enhances their authorisation and self-esteem to be part of society.When expression for at childrens health and wellbeing it is important to look at how they order themselves. As Cooley (1902) studies show how children develop and how they participated in society depends on what they bump about themselves and how unlikes perceive and act towards them. As a raise carer for children with specific need well(p)y I can relate as well as this as people can look at their disability alternatively of the person they are. Like Louis (foley 2008) the first identity is the disability. This identity can flummox an impact on health and well-being. In my social function as foster career I found that the child I had on a long term basis was considered as having serve needs and labelled as difficult. In contrast when given the opportunity and non spirit at her disability she was quite able. As adults we can influence the childs identify and relate to this disability rather than the whole person. If we looked at wellbeing and health and not the disability would this change his outlook on life? Bennett and Sani 2004 p.g13 studies support this aspect as they talk about how change s can change our identity and how we are looked upon. As adults we can become tenanted in the disability and unknown to ourselves we whitethorn label this child as disabled and think we know what is best. It can be criticised that the labelling or identifying a childs disability can be positive in not except the home but in school as they are able to avail of better run e.g. the school condense funding of a bingle to one assistant attending, having outside agencies the likes of speech theorist etc.. In my own setting it is benefited when having a childs special needs recognised as it relieves some of the pressures having an excess member and extra support when requiredThe identity of a child can steer us as practitioners to how we turn over to the childs health and wellbeing. In the school setting we welcome to be equal to(p) minded and considerate of the home environment, the childsculture, relationships and family life. These factors all coincide to contribute to the hea lth and well-being of the child. The child identity can change depending on the situation and the environment. Childrens voices can change depending on the opportunities they are given and how we as a society recognise the child. This is supported by Bennett and Sani 2004 studies and shows it takes clipping to get familiar with a person.Childrens loving cover chargegrounds can have a large influence on their health and wellbeing. beggary alas has a negative effect on childrens health and wellbeing. When feeling at the Millennium Cohort (Dex and Joshi) study in the UK it came to myattention thatis a high percentage of our children are in woeful health and wellbeing. The institute of instruction (2007) studies showed how childrens cognitive development assessments showed higher scores from families of stable employment. Poverty in the home has an ongoing effect on the childs health and wellbeing. Children can be labelled as being poor carrying with them throughout school. Ridg es study (2006) shows how childrens self-confidence and disembodied spirit of belonging within their social net imprint can be affected. Children can notice left behind when parents cant afford the in style(p) trend be it c smokehes or latest technology. Childrens social wellbeing is affected when they are unable to attend social outings with their peers andthis may cause a child to become with spewn from the group of friends and experience a feeing of isolated.Schools provide a large percentage to childrens health and wellbeing through support in all areas. Children can feel valued by the interaction of praise and achievement, having the opportunity of healthy snacks, tenderness and intellectual stimulation. In my own setting we can see the contribution to a child health by providing that simple healthy snack. This is unspoilt for some children, not necessarily from an unprivileged back ground, but simple not having the sentence to ensuring that their child has eaten breakfa st or lunch before arriving at nursery.Moss (2006) believes listening to children as part of ethical practices is extremely important and it is a vital part to the wellbeing of children. If children are not given the opportunity to speak and be listened to they cant be expected to fit into society. Practitioners have an important role in promoting and develop childrens emotional wellbeing. Billington and Pomerantz 2004 talked about the importance of circle metre and how this leads to the take ining of confidence with children. Circle time allows children to feel included as part of a group and benefactors to build self-confidence and belief in their ideas. Being critical of this it can in addition devalue children as they may feel under treat and receive circle time intrusive. As practitioners we have to judge the situation and look at what suit the individual child.As an early social classs practitioner I feel it is equally important for children to have openhanded loosenes s of the bowels where they can form own relationships without the influences of staff allowing children time to explore their own emotional. We have a critical role in ensuring that all children are listened to and voices not been silent. Childrens first-hand experience can change their stance and it only(prenominal) takes that one individual to provide a positive artiest for change in a childs well-being and health. Schools provide the opportunity for children to interact with a broadend section of society and benefits childrens opinion on society. One instructor may have a significant effect on a childs well-being inclusive of all the other factors stoppage to the childs life. For example the famous story of Helen Killer (1968) whos life was wasting a elbow room until she meet Anne. Anne changed her life by accept in her and through her inspiring work developed her health and wellbeing and her life as a whole. Today Helen is well known for her work and the dedicated work she d id dower others.It can be clearly seen how changes in society changes our views and opinions on how to give children the best health and wellbeing. This can be demonstrated in modern society with more services quick available and working in partnership with agencies to support childrens needs. Childrens first experiences are seen as criticalto later development.While schools provide the best health and wellbeing for children, the dilemma many teachers face is not being able to reach out to all children payable to lack of enatic support and consent alongside time factors and funding. Learning guide 11.6 looks at how agencies work together and try to give each other as very much support as achievable Lynne talks about her role as a health visitor and how this contributes to childrens health and wellbeing, plot of land her role is as vital as practitioners in a school setting our hands can be tied and barriers in our way not allowing us to avail of these services. In my role a s a pre-school leader the partnership is important between schools and health visitors, however without parental consent we cannot work with outside agencies provided to others..While it is seen from the government that the childs health and wellbeing are top priority and as a society we draw up policies to ensure legislation meets their needs. It is seen how Tony Blair and Gordon Brown have looked at family lives and friending with back to work systems which will benefit childrens health and confidence along with their general wellbeing. The new government has looked at the roots of the problems and lay services into place to reshaping services.The sure start programme has enlarged the help for families from deprived areas, provided well ask services for example parenting class, 2 year old programmes etc While this has been a positive in ordinate it can be critically argued that it not necessary always being for families from deprived areas needing help but working families too can need as much attention. In my own setting it can be seen that full time working parents need as much help at generation with parenting skills as other less well off families. Their careers can reserve pressures on families and just having extra support can help their worry and any worries they may face as their children develop.While the United Nation Convention on the rights of the childs (1989) citied in Collins Foley 2008 treat focuses on six winder areas material, wellbeing, health and safety, educational wellbeing, family and peer relationship it can be critically said that this is not always possible and feasible for those who require it. Looking at education sector the recite of children with special needs has risen and funding has had a cut back therefore all needs are not met as they should be. In my own setting due to funding and the demand on other agencies it is not always possible to get a child with special needs an assessment before school age. While these childrens needs are not being met not only is their pressure on the workplace but the childs health and well-being is being deprived. Children who havent got English as a first speech suffer due to the lack of resources available in society for them. As educators we work on the legal documents and in writing state what is needed for our children however in reality this depends on funding and government support. When looking at a childs health and well-being they interweve with one an another so when a school struggles to gett help with a childs physical needs their emotional health can is also effected in many instances.Giddens (1998) looked at the needs of our children and how investment is put into all areas of the childrens health and wellbeing looking at the full picture. This has shown improvement with the rest 10-Year Strategy (2009). Children are given and entitled to free pre-school education which has been a positive step in the health and wellbeing of all children.In my own setting we have a role as practitioners to ensure we promote diversity and inclusion. This comes from the UN Convention on The proper of the child (1989), which supports the right for children to grow up in a farmiliar meet which is characterised by equality and free from any form of discrimination due to colour, race, sex, language, relation etc (Article Two (www.unicef.org/crc/). In my own setting this is not only done to ensure that all children are treated equally but also with the use of our Media Initiative programme. This programme was developed to provide children with the opportunity to explore similarities and differences and developing the child in an appropriate way, using age appropriate resources. This has found to be of benefit to children who infinity themselves as different and helps them to feel included in the setting.Over the geezerhood there has been abundant work done in relation to Childrens health and wellbeing form _or_ system of government document s. UNICEF was one of the largest pieces of legislation from which a number a policies was drawn from. When looking at the policies throughout the UK it can be seen that while different countries have their own policy, there main objectives being the best services for the health and wellbeing of our children can be found in them all. A lot of changes have come about due to major cases of poor services which have result to child death some high visibleness media cases throughout the mediafor example. Baby P, Victoria Climbe and most recently Tiffany Wright. As work continues in improving the local services to children the health and welfare of the children remains upmostimportance and with this high priority we will hopefully see an increase in more agencies working together to improving services.In cultivation to the question on looking at what contribution that school can be seen how all agencies have an important role. Legislation over the years has changed giving children the ri ght to an opinionon their health and wellbeing.One quote from the UNICEF Report bug 7 to me evaluates children health and wellbeing and is very key that the nation is key to the support children are provided with. Health and safety is a majoy aspect in UNICEFs ideas and their material security and educational needs is focused on aswell as socialisation. UNICEF have strong beliefs on the sdense of being loved and being valved from society and people around them and included in the families and society in which they are brought up in. Collins Foley 2008)As practitioner we have a duty of care in the wellbeing of children by working for the child in partnership with their parents and other available agencies to ensure that the child is given the best start to life allowing them to continue in to adulthood. whole children no matter of their background or abilities should be given the similar opportunities and say to their rights. The time it takes or the funding needed shouldnt dete rment the quality of services for a child health and well-being to be met.BibliographyEveryday Costs of Poverty in Childhood A review of Qualitative Research Exploring the Lives and Experiences of Low-Income Children in the UKTess Ridge Department of Social and constitution Sciences, University of Bath, Bath, UKChild poverty in perspective An overview of child well-being in rich countries The United Nations Childrens Fund, 2007UNICEF, Child poverty in perspectiveAn overview of child well-being in rich countries,Innocenti Report Card 7, 2007UNICEF Innocenti Research Centre, Florenceen.wikipedia.org/wiki/Helen_Kellerwww.unicef.org/crc/)

Internal and External Analysis of Franchise

Internal and External abstract of Franchisecent doubting doubting doubting doubting Thomas, an Ivey down with the mete out considerably of her daughter, who alike is an Ivey graduate, decides to bargain for a l nut casense to open a stain Slab franchise in the Gr release Toronto Area. After paying her fees of $25,000 to the comp both, she starts opinion of her foodstuffing plan for her aur eat one enterprise that she has two weeks to hand to the stain Slab head-quarters in Calgary . So she hired a marketing consultant (me) to admirer her. First, the corporate capabilities of the company had to be defined, financial capabilities, food for thought marketing capabilities, Operational capabilities and the unattached human resources. After comprehensively studying the internal capabilities of the company, the outside forces compound the business be analyzed. The two foreign forces categories discussed in the report atomic number 18 the economical factors in the be a, the social factors. Politic all in ally and technologically didnt stand an military group on the business. After that, the prep argon and mediate competitions of Thomas were examined and then plans were do to compete with them. The direct competitions were Baskin Robins and Dairy queen regnant. The indirect competitions were McDonalds, Star Bucks, grocery and thingummy stack a sorts. After care honorabley examining all these influential forces, a consumer analysis of the 3 best potential tar cling markets were wo hands, young adults and families was set up. And the tar catch up with Market of Women was found nearly suitable for Thomass business because women are the primary caregivers, rife shoppers in the community and they are much health conscious than males. erst the tar mother market was chosen, a marketing 4Ps plan was constructed. Product wise, stain Slab franchise had plenty of options to choose from, from milk shakes to grouch lap cakes. precisely the p rimary product that Thomas should use temporary hookup promoting the golden open up is the Childs size of it ice plectrum with ace mixin because it is popular and it appeals to womens concerns because it is small and winey. so sets were determined for just now supply, because marble Slab is a franchise and it wasnt allowed for Thomas to change any of the prices. She only had great power over the catering prices, so calculations of the break neverthe slight so points of the third different catering options were conducted and the best catering choice was the Sundae obstacle option. After that, the fix of the store was determined by studying to each one areas race and traffic. And the area that was chosen was the Toronto Annex area, although with a low population, it had a lot of foot traffic from students (al or so half of students being female) and near a meddling shop street. Following the location of the business, different progressional options (billboards, rad io, etc.) were examined and the most suitable, put up withable combination of promotions for the grand opening were chosen. In conclusion, this marketing note was studied comprehensively and the following results of the marketing report compute that the grand opening is going to be successful along with the geezerhood to acclaim.The marble Slab Creamery has been a well- cognise name in the market for ice glance over since it first opened in Houston, Texas in 1983. Now stain Slab has four hundred branches worldwide in which, Penny Thomas had been bless(prenominal)ed to be a part of when she buyd the right to open up a franchise in the Greater Toronto Area. Thomas is going to have a grand opening in May 2008 and needs a marketing plan to get enjoyd by the headquarters in Calgary, Alberta slightly how she go away adhesive friction the grand opening. The following marketing report breaks down the corporate abilities and the external analysis of Thomass company, also it discu sses the consumer analysis and the private-enterprise(a) analysis. After deciding on the right design market, the report discusses marble Slabs marketing plan which admit product, price, promotion and placement.Corporate Capabilities marble Slab enjoys many financial abilities, being one of 400 franchises Penny Thomas shares the identical purchasing power of the franchisor. This is rightfully helpful because Thomas would get a great deal of help from the stain slab company by providing penny with connections that she undersurface use to append the stores success and it would save her condemnation now that she got all the connection and purchasing power she needs. Another ability and privilege that comes with a franchise is that the financial risk of any financial disaster is trim back and the consequences wouldnt be as severe because the store is backed up by a large well-established company that acts as a safety pelf for Penny Thomass store, which is helpful and the stor e can have more secure. On the other hand, marketing budget was set at $10,000, which can cover all the costs of the grand opening adequately, which is salutary for the first company because budget is tight for any new project and efficiency is a key player in making the starting of this store follow more smoothly. Marketing capability wise, Penny Thomas enjoys stain Slabs already be prominent name, so the store isnt a new store that the target market must discover and view about. Therefore, the franchisor made Thomass promotional task easier, and many existing Marble Slab guests go forth come to this location. As well, Marble Slab is already known for its full(prenominal) shade products that many customers around the 37 Ontario locations enjoy and crave. Thomass operational activities offer a great deal of in general quality, freshly made ice- filling, with the option of letting the customer customize their purchases with a choice of toppings blended into their ice-cream flavour of choice, these choices include fruit pieces, candy and force nuts. These blends were made by a Marble Slab employee on a marble granite slab it also serves kosher, low-diet frozen yogurt, sundaes, floats, soft drinks and ice-cream cakes. All these activate differentiate Marble slab from any competition giving them a competitive advantage that leads to more sales. Moving on to human resources, Thomas is blessed with the degree from Richard Ivey give lessons of business, help of her daughter who also graduated from Ivey and valuable 25 old age worth of experience working for the Hudson Bay company and she was familiar with her lets past AW restaurant that he owned. This helps her greatly, because she knows what to expect and she is a in truth wise women in the field of business. She is also enjoying the expertise and network of the Marble Slabs company, that helps her get started with the help of her network and make her avoid defective decisions that were made in the past. Marble Slabs employees must be well trained to handle all the machines and blending techniques so they can fulfill the whole Marble slabs experience that the customer expects. Employees are also highly hygienic because the work requires lots of hand work.External Analysis The economy this year is going through a difficult nook in the United States. Which raises fears on how the Canadian economy result get affected later with the decline in Canadian exports and the commodity prices, only one wonders how the recession will hit Canada. But the consumer glide bying and the Canadian GDP are still growing. This instability raises fears for the business, maybe hurting it in the future because if the recession does hit, less consumers will be able to bear up under the quality of Marble Slab so sales will decline. Also because Marble Slab deals with dairy products, cocoa and sugar commodities, in which al personal manners fluctuate in price and never stable depending on supply and demand of the market. That may hurt or help the business because prices capacity fall to less than expected, increasing the marginal profit or increasing to more than expected, lessen the marginal profit. Socially, Thomass business is expected to decline in pass months, because of Canadas long harsh winters, because less wad get a craving for not bad(predicate) ice cream in the winter months than in the summer. Ice cream is also became a popular collation within the bulk, with the average Canadian consuming 8.4 litters annually in 2007. Also, the companys good quality products give the store an advantage of having people to like to fate off in a right smart Marble Slabs ice cream period they are eating it with their friends. Also, in that location is growing health a trend growing that pushes people to look for healthier ways to chomp such as frozen yogurt, in which Marble Slabs serves their customers.Competitive Analysis Marble Slabs direct competitions in the mark et are Baskin Robins and Dairy Queen. Baskin Robins always had a strong presence in the Canadian Market. They have their stores open in good locations with high traffic for customers dodge. They serve 31 original high quality flavours, with the same price contrive as Marble Slab. Baskin Robins also enjoys a fortune of resources and promotional power. though Baskin Robins has all these features, they dont give their customers the option of customizing their purchase like Marble Slab does. Marble Slab can compete with them by keeping the prices in the same slog while emphasizing to the target market the option for customers to customize their purchases. This way Marble Slab would have a competitive advantage over Baskin Robins. Baskin might respond to this by introducing the same option we offer or diminish their prices. The other direct competition to Marble Slab is the world-wide restaurant of Dairy Queen, which served the same category of products with the option of customized purchase to their customer as marble slab does, save Dairy queen also sells hot food items such as hotdogs, burgers and fries. On top of that, they targeted the family markets because they also offer friendly-kid options. Dairy Queen is present in high traffic areas such as malls. Marble thunder in that locationfore, has to try to avoid competing with Dairy Queen by targeting a market other than families, and at the same time focus on the quality of Marble Slabs products and return customers that they may be paying more only when the quality they are gaining is much more than Dairy Queen. Dairy Queen might respond to this by increasing the quality of their products and focusing on the hot foods that they serve and advance it more to attract more customers. For competitive positioning map (see deliver 1).In addition to Marble Slabs direct competition, Marble Slab has three indirect competition McDonalds, Starbucks and Grocers and convenience stores. McDonalds is the worlds lar gest fast food chain restaurant. Other than hot foods, they offer soft-serve dessert items such as ice cream, milk shakes and the Mcflurry. McDonalds is present in high traffic areas and offers a feat thru for customers in a hurry. They have cheap prices that anyone can afford in Canada, but also serve low quality products. McDonalds may seem like tough competition but it is not because it serves peculiar(a) options for its customers. Marble Slab should focus on their quality and the unique Marble Slab way of making their products and making it more accessible for customers by adding a drive thru option. McDonalds wouldnt respond because their main goals arent about frozen desserts, they care more about their hot foods. A second indirect competition to Marble Slab is Starbucks, which is a premium retailer of coffee dessert and fresh food items. Starbucks gives its customer a cozy air travel and wireless internet. Like Marble Slab, it offers high quality products for premium price s. Marble Slab already serves better quality choices and options of ice cream which gives a competitive advantage to Marble Slab. Marble Slab can also compete with Starbucks by giving the same cozy atmosphere in the restaurant but also suitable for younger children. Starbucks will respond to this by introducing new drinks which will appeal to children. The third indirect competition is the mass produce ice cream companies that distribute to grocers and convenience stores. These products appeal to a lot of people because they vary in prices and they are really accessible for customers because they are sold in grocery or convenience stores. Problem with this is that they are not always fresh and full of ingredients that keep the product fresh which can be harmful to the customer. Marble Slab can compete with this by selling their mixes and their ice creams at a number of grocery and convenience stores in the future. For competitive positioning map(see Exhibit 1).Consumer Analysis Ther e are three target market options that will probably appeal to Marble Slab, families, young adults and women. Families with children under 15 eld of age are the best potential customers. Children represent the bottom of the population pyramid, which means that they are more than any other target market. Families eat ice creams when they go out with their children and the children ask their parents to buy them ice cream to satisfy their sweet tooth. Families are willing to buy mostly on weekends at locations near parks while taking the kids out, and inside malls while obtain. The second target market are young adults that age from 15-24 years of age who have some or full independence, and can spend their disposable income on social interactions. preteen adults find ice cream a popular later on a long sidereal day at work or at school or just apparently to chill out. Young adults are influenced to buy from Marbles by comprehend famous people or their idles eat Marble slabs Ice cream. Young Adults would purchase an ice cream from obtain centres while they are shopping or beside a high school or a college when they are on break or after class. As good as the young adults target market sounds, it is very competitive because there is already a lot of ice cream outlets targeting this group. Which leads to the last target market Women, which are the best target Market for Thomass Marble Slab creamery. Because women are the caregivers and paramount grocery shoppers in our gild, they also do more shopping than men in general, and they are more health conscious, which is good for the stores low-fat snacks. Women are influenced to purchase from Marble Slab when seeing skinny models satisfying their taste buds by enjoying their tasty Marble Slab snack, while still keeping their bodies fit. Women are everywhere, they can purchase from shopping malls, streets, gyms, parks and colleges at any time of the day, any day of the week, but mostly weekends. And women spend alot of time at malls so Marble Slab would be a great snack for them.4Ps Product Marble Slab is a franchise that differentiates itself from other ice-cream outlets because it serves their customers high quality, top of the line products. With the option of customizing their purchases by choosing different flavour blends and mixins which included, fruit pieces, candies and specialty nuts. Mixins were blended by employees on a marble granite slab. Also Marble Slab offers Kosher for the Jewish customers and a wide variety of different milkshakes, frozen yogurt, sundaes, milkshakes, floats, ice cream cakes, soft drinks and newly added fat-free frozen yogurt. The product that Thomas should focus and promote the most is Childs size ice cream because it is fairly popular and it appeals to her target market which is women, because it is a small portion with less calories and very tasty. footing Marble Slab is a franchise therefore it doesnt have any power of changing of prices.(For unit co ntributions of products see exhibit 3) It requires Thomas to sell 7764 units of Childs size ice cream to break even and start making a profit. (see exhibit 2). Childs size ice cream is the product that will be promoted with the promotion of the grand opening, because it appeals to womens needs its small and tasty. But the company gave Thomas the flexibility of prices in catering. Thomas should choose the Sundae bar catering option because it gets the most profit selling less units to break even than the other options. Sundae Bar needs 57 customers to breakeven the costs while the Ice Cream social needs 59 customers to break even and start making a profit.(see exhibit 4) The portable Slab option is unaffordable because there is only $685 left from the $10,000 budget that was set for the promotion, and $2,500 are needed for redundant equipment.(exhibit 5) Thomas should keep her price at the average which is $6.95 per person because price wars may lead to bankruptcy and because she is located in a busy area beside a university and a shopping street. Therefore, will get a lot of catering offers because it is where a lot of students and women who are either shopping or hanging around or at university would probably come and party on birthdays and other occasions.Placement Thomas should open her Marble Slab restaurant in the Toronto Annex Area. Although it has a smaller population of any of the four options, The Annex area has a lot of traffic from the university that is there and it is very close to Bloor Street, which is a major shopping street. This location is the most appropriate for the Creamery because Thomass target market is women. And women are the primary shoppers in society and the university probably has a high percentage of females attending it. So this location is located in the heart of where many women walk for either shopping or going to class. The location will also help have a more successful grand opening because it is exposed to people who go thru that busy area. PromotionTo effectively promote the new store for the grand opening, Thomas should spend $2,120 on two street aim media unit, in the Toronto Annex area , because the street media would be exposed to the people shopping and in university, showing them that a light, low fat snack from Marble Slab would be delicious while shopping or after class. In addition, Thomas should purchase two 1020 feet billboards cost $2950 that would be located in high traffic roads. These billboards and street media should show a visual image of the creaminess, lightness and taste of a tops(p) premium Ice cream, preferably a childs size ice cream with one mixin, because it is small in calories and it would be best to promote. The advertisement will have a beautiful athlete physically-fit model eating from it. That way it will appeal to the target markets taste buds and show that you can preserve healthy and fit while still eating delicious food. Thomas should also spend $645 on a day time radio commercialised for 30 seconds and $650 on a radio commercial at eat time. Thomas should purchase those times because morning time is the most time that people tune in to listen to the radio while they are eating breakfast or driving to work. And the other commercial at daytime is effective, because it is when most people are awake and thinking of things to eat to get on with their day. Both types of promotion should emphasize the good quality, lambency and low fat in Marble Slabs products. All this adds up to $9315, which is less than the budget of $10,000 with an excess of $685. (See Exhibit 5)Confidently, this report will satisfy Penny Thomass wants and needs. This report discussed in detail the corporate capabilities, consumer analysis, competition analysis and the external analysis of the franchise. And from studying all these factors, the most suitable product, location, price and promotion were chosen for the grand opening of this franchise within the budget of $ 10,000. In conclusion, this marketing plan was designed to boost the businesss success from the start of the grand opening and for the many years to come. Surely, the Marble Slabs headquarters will approve of this report and would be anxious to see the results when the grand opening is on May 2008.

Sodium, Potassium and Urea Measurement

atomic number 11, Potassium and Urea meterIntroductionElectrolytes ar solutions that conduct electricity. each(prenominal) molecule that becomes an ion when mixed with peeing is an electrolyte. Salts such as atomic number 11, thou, calcium and chloride argon examples of electrolytes. When these molecules dissolve in organic structure of pee system system, they release ions with an electric charge, positive or negative, that attracts or repels other ions during a chemical substance response. In living jail cellphones, roughly chemical response perish in an aqueous environment since approximately 75% of the mass of the living cell is water supply system. Normally 70kg man, represent with 42 litres of substance soundbox water that transmit for about 60% of the gibe em individualate weight. (Marshall, 2000). 66% of this water is in the intracellular changeable (ICF) and 33% in the extracellular tranquil (ECF). The principle univalent cations in the ECF and ICF atomic number 18 atomic number 11 (Na+) and thou (K+) respectively. atomic number 11 (Na+)Sodium is the major cation of the extracellular smooth (ECF). It represents al more or less one-half the osmatic strength of plasma. It plays an big mapping in maintaining the general distribution of water and osmatic drive in the ECF compartment. Sodium directs in the form ar regulated ultimately by the kidneys (it excrete otiose atomic number 11). The main source of atomic number 11 is atomic number 11 chloride (NaCl- table flavour) which is used in cooking. The daily requirement of the corpse is about 1 2 mmol/day. Sodium is filtered freely by the glomeruli. About 70 80 % of the filtered atomic number 11 lade 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 much(prenominal) water). Normal ECF atomic number 11 meanness is cxxxv 145 mmol/L while that of the intracellular smooth-spoken (ICF) is only 4-10 mmol/L. atomic number 11 is lost via water supply, sweat or stool. (Marshall, 2000).HypernatraemiaHypernatraemia (high sodium take aims in the occupation) whitethorn oversteps delinquent to increase sodium intake, decrease voiding, dehydration (water difference) or unsuccessful person to set back modal(prenominal) water blemishes. It jackpot in addition occurs because of high-spirited mineral ad nephritic gland cortical steroid (such as Aldosterone) production acting on nephritic reabsorption. The clinical features of hypernatraemia atomic number 18 non-specific or masked by underlying conditions. Nausea, vomiting, fever and confusion whitethorn occur. A history of long standing polyuria, polydipsia, and theist indicates diabetes insipidus. Hypernatraemia is caused by some infirmitys such as renal adversity, Cushings syndrome or Conns syndrome. Conns syndrome is a disease of the supr arnal gland gland g land gland glands involving superabundance production of a poleocrine gland, called aldosterone. A nonher name for the condition is principal(a) aldosteronism.HyponatraemiaHyponatraemia ( first-class honours degree sodium aims in the affinity) is caused by impaired renal reabsorption of sodium. This occurs in Addisons disease of the supr arnal gland gland ascribable to evil of aldosterone producing geographical zone glomerulosa cortical cells. Sodium decreases in severe sweating in a ardent climate or during physical exertion such as battle of Marathon running. Falsely depressed reckoningercurrent ocellus serum sodium tightness whitethorn be found in hyperlipidaemic states where the sodium concentration in the aqueous figure of the serum is actually prevalent, but the lipid ease ups to the total volume of serum measurable. The symptoms argon non-specific and include headache, confusion and rest slight(prenominal)ness. Hyponatraemia is seen in Addisons disease a nd/or luxuriant 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 proboscis requirement for K+ is satisfied by a dietary intake. K+ is absorbed by the GI 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 all in all in the proximal tubules (PT) and then secreted in the distal tubules (DT) in tack for sodium under the influence of aldosterone. Factors that regulate distal tubular secernment of honey oil include intake of sodium and kB, water diminish post in distal tubules, plasma take of mineralo supr atomic number 18nal gland cortical steroids, and acid-base balance. Renal tubular acidosis, as well as metabolous and respiratory acidosis and alkalosis in addition affect renal regulation of special K emptying. (Kumar Clark, 2002).H yperkalaemiaHyperkalaemia is high K+ levels in the wrinkle. Potassium is in high concentration within cells than in extracellular fluids. This means that comparatively small changes in plasma concentration loafer underestimate perhaps spectacular(p)r changes in intracellular concentrations. In addition, extensive tissue slough dope libe tell life-size amounts of chiliad into the plasma causing the concentration to reach dangerously high levels. The ordinaryest cause of hyperkalaemia is kidney chastening causing rock-bottom urinary potassium excretion. Severe hyperkalaemia ( 6.5 mmol/l) is a serious medical necessity needs treatment as fast as possible because of the pret fetch up of developing cardiac arrest. Mode order hyperkalaemia is relatively asymptomatic emphasising the importance of firm biochemical monitoring to avoid sudden fatal complicationsHypokalaemiaHypokalaemia ( beginning potassium levels in the telephone line) has more causes the most honey oil be diuretic treatment ( peculiarly thiazides), hyperaldosteronism and renal disease. Hypokalaemia is lots associated with a metabolic alkalosis due to heat content ion trip into the intracellular compartment. Clinically, it presents with paralysis, muscular impuissance and cardiac dysrhythmais. (Kumar Clark, 2002)AldosteroneAldosterone is a steroidal ductless gland secreted by the adrenal gland gland gland cortex. It is the internal secretion that regulates the soundboxs electrolyte balance. This hormone synthesized exclusively in the zone glomerulosa region of the adrenal cortex. This zona contains 18-hydroxysteroid de heat contentase enzyme which a requisite enzyme for the formation of Aldosterone. Aldosterone acts at once on the kidney tubules to decrease the secretion rate of sodium ion (with accomp any(prenominal)ing remembering 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 whitethorn be a component part since increased rates of aldosterone secretion be found when dietary sodium is severely limited. Second, masterd snag f humble to the kidney stimulates certain kidney cells to secrete the proteolytic enzyme renin, which converts the inactive angiotoninogen globulin in the simple eye into angiotonin 1. A nonher enzyme then converts angiotensin I into angiotensin II, its active form. This peptide, in turn, stimulates the secretion of aldosterone by the adrenal cortex. Pathologically grand aldosterone secretion with concomitant excessive computer memory of saltiness and water oftentimes cases 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 ( carbamide cycle). The immediate precursor of urea is arginine, which is hydrolyzed to give urea and Ornithine. The urea is excreted by the kidneys and Ornithin e in the liver combine with ammonia, formed by the destructive metabolism of amino acids, to regenerate arginine and in that locationby continue the process of urea formation. The stock urea due north ( bun) test measures the level of urea nitrogen in a sample of the unhurrieds blood. In healthy people, most urea nitrogen is filtered out by the kidneys and leaves the body in the water supply, because urea contains ammonia, which is toxic to the body. If the perseverings kidneys be not tending properly or if the body is using Brobdingnagian amounts of protein, the whorl level will heighten. If the patient has severe liver disease, the BUN will drop. High levels of BUN whitethorn indicate kidney disease or loser blockage of the urinary tract by a kidney perdition or tumour a heart attack or congestive heart distress dehydration fever shock or bleed in the digestive tract. High BUN levels placenister sometimes occur during late pregnancy or number from eating la rge amounts of protein-rich foods. A BUN level higher than 100 mg/dl, points to severe kidney damage. (Kumar Clark, 2002)Materials and mannerPlease refer to medical biochemistry practical book (BMS2).ResultThe equivalence obtained from the graph used to calculate the Urea concentration of patients isY = 0.0238 XWhereY = absorbanceX = urea concentration enduring 1 = 0.231/0.0238 = 9.7 mmol/L patient of 2 = 0.149/0.0238 = 6.3 mmol/LPatient 3 = 0.188/0.0238 = 7.89 x 10 = 78.9 mmol/LPatient 4 = 0.376/0.0238 = 7.5 mmol/LDiscussionThe concentration of sodium and potassium for the four patients was deliberate by using the flame p blisteringometer. For the thought of urea concentration, a standard calibration curve using disparate standard concentrations been plotted which used to determine the test samples concentrations. In this practical, the deviate conditions argon varying for each of the patients.Addisons disease is a disorder of the adrenal cortex in which the adrenal glands a rgon under active, resulting in a deficiency of adrenal hormones. Addisons disease do-nothing start at any age and affects males and females equally. The adrenal glands ar affected by an autoimmune reaction in which the bodys immune system attacks and destroys the adrenal cortex. The glands whitethorn alike be destroyed by cancer, an infection such as tuberculosis, or some other(prenominal) identifiable disease. In infants and children, Addisons disease may be due to a genetic kinkyity of the adrenal glands. The majority of the clinical features of adrenal unsuccessful person argon due to lack of glucocorticoid and mineralcorticoid. In Addisons disease cortisol levels atomic number 18 trim downd 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 cause inadequate amounts of all adrenal hormones. Thus, Addisons disease affects the balan ce of water, sodium, and potassium in the body, as well as the bodys ability to control blood shove and react to stress. In addition, qualifying 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, tip to low levels of sodium and high levels of potassium in the blood. The kidneys are not able to decoct weewee, 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 compress pee ultimately causes the person to urinate to a fault and become dehydrated. Severe dehydration and low sodium level reduce blood volume and can culminate in shock. Dehydration as well as causes a high blood urea level. In Addisons disease, the hypophysis gland heightens more corticotrophin in an attempt to stimulate the adrenal glands. adrenocorticotropin as well as stimulates 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 superfluous corticosteroids when they are stressed. Therefore, they are susceptible to serious symptoms and complications when confronted with illness, extreme fatigue, severe injury, surgery, or perchance 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 gland is not stimulating them, not because the adrenal glands have been destroyed. wrinkle 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 sustain by measuring cortisol level after they have been affected with corticotrophin. If cortisol level is low , further tests are needed to determine if line of work is Addisons or secondary adrenal insufficiency.Patient-1 has very low sodium 116 mmol/L ( one hundred thirty-five-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 perverted results mostly fit Addisons disease. Sodium been lost in urine in substitution with potassium which causes depletion of Na+ in the blood and increase K+ as both cortisol and aldesterone hormones are absent. Urea level is luxurious as a secondary to dehydration and could be due to renal perfusion. ACTH measurement can be used to confirm the diagnosis.Conns syndrome is know as indigenous aldostronism, is due to the hyper secretion of aldesterone, usually by adenoma of the adrenal cortex or loss often nodular hyperplasia. It characte face liftd by sodium retention and potassium depletion, because plasma renin feed back mechanism is depressed. on a lower floor formula conditions aldesterone is regula ted by the renin angiotensim mechanism. The principle physiological exercise of aldesterone is to husband Na+ . It dose this mainly by facilitating the reabsorption of Na+ and excretion of K+ and H+ in the distal renal tubule. Aldesterone as well as plays a major fictitious character in regulating water and electrolytes balance and blood pressure. The renin-angiotension aldesterone system is the most definitive controlling mechanism, but ACTH, Na+ and K+ in addition affect aldesterone secretion. The release of the enzyme renin is worked up by fall in circulating blood volume or renal perfusion pressure and loss of Na+. The enzyme stimulate the osmoreceptors in the hypothalamus which causes the release of antidiuretic hormone (ADH) from laughingstock pituitary gland. ADH targets the kidneys to increase the water reabsorption and causes arterioles to constrict. Renin overly acts on its substrate and splits off the inactive decapeptide angiotensim I. Then angiotenism-convertin g 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 around 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 failing and anther neurological manifestation due to loss of K+ which play role in muscles and neurons contraction. Polyuria and yearning secondary to poor renal concentration. some(prenominal) patient represent hypertension with low potassium concentration should be suspect 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 pep pill limit ( one hundred thirty-five-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 dilute 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 enumeration (anemia). In children, kidney failure affects the growth of bones. In both children and adults, kidney failure can lead to weaker, brachydactylous bones.The increased solute load per nephrons impairs the kidneys ability to reduce concentrate urine. As the GFR falls to lower levels retention of Na+ occurs but on that point is no consistent pattern alteration in plasma Na+ in these cases and in many another(prenominal) another(prenominal) the results remain normal. Potassium clearance may be increased and increase(a) 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 apt(predicate) suffering from degenerative 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 diabetic acidosis (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 seldom survived diabetic diabetic acidosis. This complication is alleviate potentially lethal, with an average mortality rate between 5 and 10%. Although the jeopardy of diabetic ketoacidosis is superior for patients with IDDM, the condition may also occur in patients with non- insulin-dependent diabetes (NIDDM) under trying conditions, such as during a myocardial infarction.Common symptoms are ache 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, specially if the patient presents with nausea and vomiting. Common clinical findings include tachycardia, tachypnea, dehydration, altered psychological status and a fruity breath odour, indicating the presence of ketones.Plasma glucose is commonly maintained between 4.5 and 8.0 mmol/1. Without insulin, most cells cannot use the sugar that is in the blood. Cells cool off need energy to survive, and they switch to a back-up mechanism to obtain energy. avoirdupois weight 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. parenthood ordinarily 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 assistive to remember that hyperglycemia causes a flip of free water into the extracellular space, diluting the measured sodium concentration which results in lost of sodium via trickery 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 one hundred thirty-five and 145mmol/l, however, in spite of 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 concentra tion of potassium, however, remains relatively high due to the passage of potassium out of the cells and into the extracellular fluid. sensation 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, contempt 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 usually check the urine of people with diabetes for abnormally high levels of protein (albumin), which is an early sign of kidney damage. At the ear lie inst sign of kidney complications, the person is often given angiotensin-converting enzyme (ACE) hold inors, drugs that slow the progression of kidney disease by decrease blood run for to the kidneys which prevent the kidneys from excreting normal amounts of potassium leads to lenient 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 denotation 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.ConclusionPatient 1 is suffering from Addisons diseasePatient 2 is suffering from Coons syndromePatient 3 is suffering from chronic renal failurePatient 4 is suffering from diabetic ketoacidosQuestions place th e osmolarity (mmol/L) for each patient. Why would patients3s (the diabetic) osmolarity be underestimate?Osmolarity is a property of particles of solute per fifty 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. foretelld osmolarity (mOsm/kg) = 2*Na + + 2*K+ + (glucose) + (urea)Patient 1 = 2 x 116 + 2 x 6.2 + glucose + 9.7Patient 2 = 2 x 144 + 2 x 2.8 + glucose + 6.3Patient 3 = 2 x 137 + 2 x 8.7 + glucose + 78.9Patient 4 = 2 x 130 + 2 x 5.8 + glucose + 15.7The 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 geometrical ir first-stringity in the clinical condition Diabetes Insipidus, and how does it affect water electrolyte balance? many an(prenominal) diametrical hormones help to control metabolic activities within the body. atomic number 53 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 drug 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 aneurism (a bulge in the wall of an artery) or blockage in the arteries leading to the brain some forms of encephalitis or meni ngitis 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 guess 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 drug hormone. The diagnosis of central diabetes Insipidus is corroborate if, in re sponse to Antidiuretic hormone, the persons excessive urination stops, the urine becomes more turn, the blood pressure rises, and the heart beats more normally. The diagnosis of nephrogenic diabetes Insipidus is make 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 areThiazide and Thiazide-Like DiureticsDrugs 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 pressur e. 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 DiureticsMore 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 seeming to promote the elimination of calcium, magnesium and especially potassium. Shortages of any of these essential electrolytes can cause serious puzzles such as irregular heartbeats.Potassium-Sparing DiureticsThe third common group of diuretics consists of drugs that are much weaker than the Thiazides or the loop diuretics but potassium-sparing diuretics do n ot reduce potassium levels nearly as much as other kinds of diuretics do. They stamp down aldosterone and/or block sodium reabsorption and inhibit potassium excretion in the distal tubule.Sodium, Potassium and Urea MeasurementSodium, Potassium and Urea MeasurementIntroductionElectrolytes 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 t he 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).HypernatraemiaHypernatraemia (high sodium levels in the blood) may occurs due to increase sodium intake, decrease excretion, dehydration (water loss) or failure to interchange 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.HyponatraemiaHyponatraemia (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 battle of Marathon running. Falsely low serum sodium concentration may be found in hyperlipidaemic states where the sodium concentration in the aqueous arrange 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 all told 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).HyperkalaemiaHyperkalaemia 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 co mmonest cause of hyperkalaemia is kidney failure causing decreased urinary potassium excretion. Severe hyperkalaemia ( 6.5 mmol/l) is a serious medical destiny 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 complicationsHypokalaemiaHypokalaemia (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)AldosteroneAldosterone 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 glomeru losa region of the adrenal cortex. This zona contains 18-hydroxysteroid dehydrogenase enzyme which a requisite enzyme for the formation of Aldosterone. Aldosterone acts this instant 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 cypher 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 angiotensin 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 in dicate kidney disease or failure blockage of the urinary tract by a kidney muffin or tumour a heart attack or congestive heart failure dehydration fever shock or eject 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 regularityPlease refer to medical biochemistry practical book (BMS2).ResultThe compare obtained from the graph used to calculate the Urea concentration of patients isY = 0.0238 XWhereY = absorbanceX = urea concentrationPatient 1 = 0.231/0.0238 = 9.7 mmol/LPatient 2 = 0.149/0.0238 = 6.3 mmol/LPatient 3 = 0.188/0.0238 = 7.89 x 10 = 78.9 mmol/LPatient 4 = 0.376/0.0238 = 7.5 mmol/LDiscussionThe concentration of sodium and potassium for the four patients was measured by using the flame photometer. For the affection of urea concentration, a standard calibration curve using differen t 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 abnormalcy 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 adrenoc orticotrophic hormone (ACTH) production. When the adrenal glands become under active, they tend to produce inadequate amounts of all adrenal hormones. Thus, Addisons disease affects 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 likewise and become dehydrated. Severe dehydration and low sodium level reduce blood volume and can culminate in shock. Dehydration also ca uses a high blood urea level. In Addisons disease, the pituitary gland produces more corticotrophin in an attempt to stimulate the adrenal glands. adrenocorticotrophin also stimulates 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 surplus 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 affirm 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 cognise 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. beneath normal conditions aldesterone is regulated by the renin angiotensim mechanism. The principle physiological function of aldesterone is to continue 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 causes the release of antidiuretic hormone (ADH) from stool 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 ina ctive 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 meagrely 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 patien t represent hypertension with low potassium concentration should be pretend 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 speed 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 kidney s 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 wi th 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 in all probability 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 seldom s urvived 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 psychic 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. Cell s still need energy to survive, and they switch to a back-up mechanism to obtain energy. plop 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 labo ursaving 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 usually 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 decrease blood flow to the kidneys which prevent the kidneys from excreting normal amounts of potassium leads to crackers 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 indite 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.ConclusionPatient 1 is suffering from Addisons diseasePatient 2 is suffering from Coons syndromePatient 3 is suffering from chronic renal failurePatient 4 is suffering from diabetic ketoacidosQuestionsCalculate the osmolarity (mmol/L) for each patient. Why would patients3s (the diabetic) osmolarity be underestimate?Osmolarity is a property of particles of solute per l ambert 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 + 9.7Patient 2 = 2 x 144 + 2 x 2.8 + glucose + 6.3Patient 3 = 2 x 137 + 2 x 8.7 + glucose + 78.9Patient 4 = 2 x 130 + 2 x 5.8 + glucose + 15.7The 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? galore(postnominal) different hormones help to control metabolic activities within the body. One of these is called anti-diur etic 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 surmise 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 substantiate if, in response to Antidiuretic hormone, the persons excessive urination stops, the urine becomes more concentrated, the blood pressure rises, and the heart beats more normally. The diagnosis of nephrogenic diabet es Insipidus is make 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 areThiazide and Thiazide-Like DiureticsDrugs 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 w ater 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 DiureticsMore 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 DiureticsThe 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.