Coming to Terms Essay Example for Free

Coming to Terms Essay Her argument was based fully on fast food restaurants adopting ideas from fine dining restaurants . Falk inserts an inordinate amount of her own feelings on the topic and doesn’t analyze the subject as well as she should have. She focuses mainly on the fast food business while lacking in her analysis of fine dining. She also should have made the paper more about what caused the changes in the restaurant business instead of the changes themselves. In the essay Falk has many examples of foods and restaurants that have changed and became noticed for their modern style, such as Panera Bread and Chipotle. She appeals to a large audience by adding examples many people can relate too. On the other hand, her article is extremely biased in multiple ways. She makes too many generalizations that may not particularly be true in some cases. For example she states, â€Å" the fact that people today hate to make choices, preferring to have the best of both worlds † (Falk,33). This may not be exactly true for everyone. She uses the previous quote to support her argument in saying that since people are so indecisive quick casual would be a good alternative. Another instance is when she states, â€Å"There are significantly more calories at table service restaurants† (Falk, 35). The prior quote shows her bias towards dine-in restaurants because she only uses negative examples of fine dining. Furthermore, her essay is very restricted. She aims her essay towards adults and college students with her use of language and examples of certain restaurants; But a lot of her writing makes you think otherwise. The core of her essay is stating that quick casual is the new alternative to fine and fast food dining. Though she never takes into consideration the ideas of being a vegetarian or that college students have dining halls or even the fact that not all people eat out. She had good arguments but they did not affect the people they were meant to affect. One of her main argumentative statements is at the very end of her essay when she says, â€Å"The country is focused on problems with obesity and poor eating habits .. until major changes are made, food prepared at home will almost always be healthier than food eaten away from home† (Falk,36) . These type of statements should have been more prominent in the essay, she only brings up this type of conflict in the last paragraph and nowhere else. By tying in the eating at home or the obesity aspect more, she would have had a strong argument. As mention earlier, if she touched on all the aspects possible that would have made her essay more relevant Some of her most outstanding focuses were â€Å"Trend Mapping† and the â€Å"Trickle Down Theory†. Trend mapping helps culinary experts predict which menu items will be popular in the future. The trickle down theory helps quick casual restaurants enhance their menu with more fine dining dishes. These ideas help customers make smart choices. I was impressed with her inclusion of these two innovations because they go right along with her topic and fit into the main idea . Even though her essay was poorly structured at some points, there were also some good points throughout. I feel that her style was very laid back and readable because she used places her target audience have been and can relate to, as examples. Brenda Falk creates this article with the objective of describing the many similarities between the food industry and that the in between â€Å"quick casual† style is the most convenient. She successfully describes these similarities and elaborates on the new innovative style but never fully creates a legitimate argument. If she discussed more on the topic of eating at home or the factor of money or even brought in some positives of fine dining, that could have created a stronger argument. She has a great sense of organization and style but needs to focus more on her analysis of the topic.

Calculation of Body Surface Area (BSA) for Blood Volume

Calculation of Body Surface Area (BSA) for Blood Volume CHAPTER 25 Calculation of Body Surface Area, Circulating Blood Volume,  Requirement of Blood Products Namita Mishra, Sudha Rawat, Vishva Nath Sharma BODY SURFACE AREA (BSA) Body surface area (BSA) is the area of the external surface of the body, expressed in square meters (m2). In physiology and medicine, the body surface area is the measured or calculated surface of human body. It is used to calculate metabolic, electrolyte, nutritional requirements, drug dosage, and expected pulmonary function measurements. BSA is a measurement used in many medical tasks. For many clinical purposes BSA is a better indicator of metabolic mass than body weight because it is less affected by abnormal adipose mass. Nevertheless, there have been several important critiques of the use of BSA in determining the dosage of medications with a narrow  therapeutic index  like many chemotherapy medications. USES OF THE BSA To gain an appreciation of the true required glomerular filtration rate (GFR) renal clearance is usually divided by the BSA. To calculate a better approximation of the required cardiac output as for example in children, cardiac index is used. Cardiac output = Cardiac Index / BSA Chemotherapy is often dosed according to the patient’s BSA. Glucocorticoid dosing is also expressed in terms of BSA for calculating maintenance doses or to compare high dose use with maintenance requirement. CALCULATION OF BSA It is difficult to actually measure the surface area of the human body so various calculations have been published to arrive at the BSA without direct measurement. The most widely used is the Du Bois formula: BSA = 0.007184 X W0.425 X H0.725 A commonly used and simple one is the Mosteller formula: 0R BSA = ( [ H X W]/ 3600)1/2 Where H = Height W = weight for example : Patient’s weight = 65 Kg Patient’s height = 165 cm BSA = ([65 X 165])/3600)1/2 BSA= 1.72 m2 Recently, a weight-based formula was validated in the pediatric age group that does not include a square root, making it easier to use. It is [4Wkg+7]/[90+Wkg]. AVERAGE VALUES Average BSA for various weights: WEIGHT (Kg) BSA (m2) 1.5 4 0.13 – 0.26 4.1 – 9 0.26 – 0.48 9.1 – 14 0.48 – 0.56 14.1 – 20 0.56 – 0.71 20.1 – 26 0.71 – 0.84 26.1 34 0.84 – 1.0 34.1 – 50 1.0 – 1.4 50.1 66 1.4 – 1.63 Over 66.1 Over 1.63 EFFECTIVE CIRCULATING VOLUME Blood volume is the volume of blood (both red blood cells and plasma) in the circulatory system of any individual. A typical adult has a blood volume of approximately between 4.7 and 5 liters, with females generally having less blood volume than males. Blood volume (BV) can be calculated given the hematocrit (HCT; the fraction of blood that is red blood cells) and plasma volume (PV): BV = PV/ (1-HCT) Diagnostic technologies are commercially available to measure human blood volume. A recent radio nucleotide study called BVA (Blood Volume Analysis)-100, provides a measure of Red Blood Cells and Plasma with 98% accuracy. BLOOD VOLUME ESTIMATION WEIGHT (kg) BLOOD VOLUME ( ml/kg) New born to 10 85 11 to 20 80 21 to 30 75 31 to 40 70 Above 40 65 CIRCULATING VOLUME OF THE CPB CIRCUIT PRIMING VOLUME: the minimum amount of fluid (hemic or non hemic fluid) used to de- air the complete cardiopulmonary bypass (CPB) circuit is called priming volume or the circulating volume of CPB circuit. Priming of the CPB circuit is an important task for the perfusionist. Generally the main objectives of priming are: To deair the CPB circuit To check for any leaks in the circuit To check for any mistake in the assembling of the circuit To meet the need for the extra volume required to prime the CPB circuit as the patient’s blood volume is not sufficient enough to prime the CPB circuit. For achieving sufficient hemodilution. It is a standard practice to use a non blood CPB prime because of the benefits of hemodilution and concerns about blood borne diseases. The total priming volume is determined by the hardware selected for the circuit to be employed. Following are the tables showing the volume required to de-air various oxygenators, arterial filters and tubing. CPB CIRCUIT AND TOTAL PRIMING VOLUME WITH VARIOUS WEIGHT GROUP Weight Group (Kg) Boot Size (inches) Venous line Size (inches) Arterial line Size (inches) Total Priming Volume (ml) 0-4 1/4 1/4 1/4 450 4.1-8 3/8 1/4 1/4 600 8-12 3/8 3/8 1/4 800 12.1-25 3/8 3/8 3/8 1100 >25 1/2 1/2 3/8 1800 TUBING SIZE WITH VOLUME (ml/feet) SIZE (inch) VOLUME (ml/feet) 3/32† 1.8 1/8† 2.5 3/16† 5 1/4† 9.65 3/8† 21.7 1/2† 38.6 SPECIFIC CONSIDERATIONS: In cases where patient is deeply cyanotic the size of the oxygenator and tubing size is selected keeping in mind the requirement of higher degree of hemodilution and higher requirement of arterial blood flows because of the presence of large (or major) aorto-pulmonary collaterals (MAPCA’s). MAPCAs arise from the aorta or its large branches and supply blood to the pulmonary arteries, because of blockade of the main pulmonary arteries. These MAPCAs ‘steal’ part of the cardiac output of the aorta and this results in reduced systemic perfusion and thus increased pump flows are required during CPB in cyanosed patients with MAPCAs to compensate for this ‘stolen’ cardiac output. CACULATION OF BLOOD AND BLOOD PRODUCT REQUIREMENT The hematocrit (HCT), also known as packed cell volume (PCV) or erythrocyte volume fraction (EVF) is the volume percentage (%) of red blood cells in blood. It is normally about 45% for men and 40% for women. It is considered an integral part of a person’s complete blood count along with hemoglobin concentration, white blood cell count, and platelet count. Haemoglobin concentration is reduced as a normal consequence of CPB with hemodilution. Thus the hematocrit that will result from the hemodilution caused due to priming volume of the CPB circuit should be determined. Several calculations are required to assess hemodilution and blood product requirements. To determine the effects of hemodilution, the volume concentration formula is used. C1 X Pt BV = C2 X TVon CPB Where Pt BV = patient’s blood volume ( patient’s body weight X blood volume factor) TVon CPB = total volume on CPB (total priming volume + patient’s total blood volume) C1 = Pre bypass hematocrit of the patient (%) C2 = calculated hemodilutional hematocrit (%) A decision must be made initially regarding the desired hematocrit during cardiopulmonary bypass. Based on the results of the randomized clinical study from Children’s Hospital, Boston ,it seems reasonable to consider a hematocrit of 25% to be the minimal acceptable hematocrit for any cardiopulmonary bypass condition. When the desired hematocrit has been selected the amount of bank blood that must be added to the prime should be calculated. Prime RBC vol = {[C3]x[Pt BV + PV]} {Pt RBC vol} Where Prime RBC vol = volume of blood required in prime C3 = desired HCT on bypass Pt BV = patient’s blood volume ( patients body weight X blood volume factor) PV = total priming volume of the CPB circuit to be used Pt RBC vol = patient’s blood volume X patient’s pre bypass hematocrit For example: Patient’s weight = 5 Kg Pre bypass hematocrit (C1) = 40% Patients blood volume (Pt BV) = 5 X 85 = 425 ml (85 is blood volume factor for 5 Kg) PV (total priming volume of the CPB circuit to be used) = 600ml TVOn CPB = (600 + 425) = 1025ml Calculated hemodilutional HCT (%) (C2) = C1 X Pt BV / TVon CPB = 40 X 425 / 1025 = 16.5 % 16.5 is the hematocrit on bypass. If there is a certain desired hematocrit, then to achieve that hematocrit, the amount packed RBCs if needed for the same patient can be calculated as follows: C3 (desired HCT) = 30 % Pt BV = 425 ml PV = 600 ml TV On CPB = (Pt BV + PV) = (425 + 600) = 1025 ml Pt RBC vol = 425 X 0.40 = 170 Prime RBC vol = {[C3]X [Pt BV + PV]}-{Pt RBC vol} = {[0.30] X [1025]}-{170} = 137.5 Volume of RBCs needed in prime = 137.5 The hematocrit of packed RBCs is 70% thus 137.5/0.70 = 196 ml 196 ml of packed RBCs are needed to achieve a hematocrit of 30%. Thus, 196 ml of the clear prime fluid is removed from the priming volume to account for the added packed RBCs. Therefore the calculation of priming volume now has 196 ml of packed RBCs and 404 ml of prime (crystalloid or colloid). In some cyanotic cases where the patient’s pre bypass hematocrit is more, the blood is diluted to obtain an optimal hematocrit during cardiopulmonary bypass in order to decrease the viscosity of the blood to improve tissue perfusion and to prevent hemolysis. Thus the effect of priming fluid added to dilute the blood can also be calculated as: TVon CPB X C4 = TVon CPB 1 X C5 WHERE TVon CPB = total volume on CPB (total priming volume + patient’s total blood volume) = 1025ml C4 = Hematocrit (of cyanotic patient) on bypass = 0.60 TVon CPB1 = total volume on CPB after adding 500 ml of priming fluid to the CPB circuit. TVon CPB1 = (1025 + 500) = 1525 ml C5 = the new (affected) Hematocrit Thus C5 = (1025 X 0.60) / 1525 = 0.40 40 % is the new hematocrit achieved after adding 500 ml of priming fluid. FIBRINOGEN A critical consideration is plasma fibrinogen dilution. Normal plasma fibrinogen levels are 150-400 mg./dL. The infant/ pediatric patients relative low blood volume with priming requirements of the ECC circuit causes the fibrinogen concentration to be adversely diluted. During CPB, it is desirable to maintain the plasma fibrinogen concentration above 100 mg./dL. in order to prevent impairment of post-CPB hemostasis. Given an example of a 5 Kilogram patient with blood volume of (5 x 85) 425 ml, pre bypass hematocrit of 55%, hematocrit on CPB of 25%, priming volume of 800ml of the circuit to be used for CPB and fibrinogen level of 275 mg/dl. To calculate the effect of priming, patient’s plasma volume is calculated by following formula: BV = PV/ (1-HCT) PV = (1-HCT) X BV Thus PV = (1-0.55) X 425 = 191ml PV = 191ml Patient’s fibrinogen = 191 X 275 mg/100ml = 525 mg Number of milligrams required = (425 + 800 ) X (1.00-0.25) = 9.19 dl If the goal is 100mg/dl, then 919 mg of fibrinogen are needed. Amount of fibrinogen to be added = 919 – 525 = 394mg. 394 mg of fibrinogen must be added to the prime to achieve a goal of 100 mg per dl. FFP usually contains 200 mg of fibrinogen per dl. Thus ml of FPP needed = (394/200) X 100 = 197 ml. Now for the calculation of priming volume the 197ml of the prime fluid (crystalloid or colloid) is replaced by FPP. Thus the clear prime volume becomes 603ml. Suggested reading Jianfeng Wang, Eiji Hihara. A unified formula for calculating body surface area of humans and animal. Eur j Appl Physiol.2004;92:13-17 Dill DB, Costill DL. Calculation of percentage changes in volumes of blood, plasma, and red cells in dehydration. J. Appl. Physiol. 1974; 37(2):247-248. Tarazi RC .Pulmonary blood volume. Eur Heart J.1985Oct;6SupplC:43 Tarazi RC . Blood volume.. Eur Heart J.1985;6SupplC:41-42

Two Conceptions of Freedom or Two Appearances of a single Conception? E

In his essay "Two Concepts of Liberty," Isaiah Berlin distinguishes between two conceptions of freedom, namely negative and positive conception of freedom. Basically he defines negative liberty as the absence of coercion. He states: "To coerce a man is to deprive him of freedom" (121). According to him, coercion is the intention to interfere in the freedom of an individual. Thus, absence of coercion is absence of deliberate, intentional coercion. For him, negative liberty requires an immune area, away from the obtrusive action of other people. For the accomplishment of freedom "[s]ome portion of human existence must remain independent of the sphere of social control" (126) However, achievement of negative liberty, creation of the immune area from coercion, is contingent upon the authority to be kept at bay. Therefore, the position of authority, which entails coercive powers, should be controlled in order to make them accountable to the people, whose fre edom, immunity from coercion depends on. Positive liberty, on the other hand, is, not freedom from coercion, but freedom to determine one's own destiny: it is self-determination. In this sense positive liberty is a necessary condition of human being, right to choose, right to determine ones behavior. Berlin maintains that the negative and positive concepts of liberty are "at no great logical distance from each other," but in reality they are profoundly divergent, in fact irreconcilable,...

Exploring The Novel Poisonwood Bible And Macbeth English Literature Essay

The drama Macbeth by William Shakespeare and the fresh Poisonwood Bible by Barbara Kingsolver, are literary plants that explore the deep desires of self fulfilment. While many different literary devices are outstanding in both plants, this paper will concentrate on the intervention of subjects by both writers. Namely the subjects of power and control. These subjects are best highlighted in Lady Macbeth from Macbeth and Nathan Price from the Poisonwood Bible. These two characters best develop the subjects of power and control through their shared features of aspiration, use and pitilessness. Ambition is a reoccurring tool of character development in both The Poisonwood Bible and Macbeth, employed by the writers to stress the overall subjects of power and control. Nathan is a clergyman from America in the Congo trying to conform the small town of Kilanga to the Catholic religion. His aspiration and motivations are powered by fright and blind religion in God, coupled with desire for personal power-which he self interestedly translated into taking control of the small town and holding power over the people. He besides believes that if he does non finish the undertaking he will be unable to come in heaven. His aspiration begins to over power his judgement, his ability to ground and his construct of household, which causes the small town people to beat up against him to seek and re derive their freedom and independency hence exercising their ain signifier of power and re-enforcing the overall subjects. Unlike Nathan ‘s gradual and increased aspiration, Lady Macbeth â₠¬Ëœs aspiration is instantly apparent from the beginning of the drama, and merely grows as the desire for the throne and its power direct her over the border. She right off begins to piece a program to kill King Duncan in order to put her hubby Macbeth in line for the throne. This compulsion drives her insane, and like Nathan her ability to ground, her judgement and her scruples are clouded by her demand for power and control. She acted in ways that showed that she would halt at nil in order to derive the throne even if it meant slaying. Both characters became so ambitious in their efforts to derive power and wield control, that it finally drives them to their ain deceases. Manipulation is another changeless, though more subtly employed, word picture tool in both plants. She manipulated Macbeth into killing Duncan, in order to derive the rubric of King and Queen. Lady Macbeth ironically, felt excessively guilty to kill Duncan herself-due to resemblance to her father-however, had no scruple or concern for Macbeths witting when she manipulated him into killing his friend. In order to carry through this she began oppugning Macbeth ‘s manhood, seeking to convert him that he was emasculate -hence weaker so she, so she and that he could non step up to the undertaking of killing Duncan. This mental use made him oppugn his judgement, which led to him going really baffled. In the terminal her uses were successful, assisting her achieve the power and control she so greatly desired. Nathan like Lady Macbeth, abused his household in order to acquire what he wanted. The villagers had become so fed up with Nathan seeking to command them and their faith that the y rebelled, killing all the white people in their small town. Nathan ‘s married woman and kids are in secret fixing to get away to America, but Nathan, out of fright of solitariness, begins to mistreat and pull strings his married woman, and endanger the lives of his kids, in order to acquire them to stay in the small town and let him to go on his quest. This maltreatment and use allowed Nathan to recover power and control over his household, while doing them even more anguish as they impotently watch the deceases of many people they loved. Both Lady Macbeth and Nathan ‘s uses and evident deficiency of guilt over them, show to the audience merely how pitiless both characters are. This pitilessness is a 3rd of import manner the characters are both developed and the subjects enriched. Nathan is so determined to complete the quest God sent him to make that he forgot his ethical motives and committed awful Acts of the Apostless in order to obtain power over the small town people and control over his household ensuing in the loss of many guiltless lives. His chief distressing act of pitilessness was working his girls and coercing them to remain in the Congo so that he could keep his control over them while the villagers fought for their freedom. These egoistic actions resulted in the decease of his four girls and married woman, go forthing him entirely. Lady Macbeth was far more pitiless so Nathan, upon hearing that Macbeth was to be king she immediately began to inquire God to do her into more of a adult male in order to be able to perpetrate slaying. â€Å" Come, you spirits that tend on moral ideas, unsex me here, aˆ?aˆ?And make full me, from the Crown to the toe, Top-full of direst inhuman treatment. aˆ?aˆ?A Make midst my blood. â€Å" ( Lady Macbeth- Act 1 scene V ) . She lost her scruples wholly and began to move without witting in the effort to derive the throne, her symbols of power and control. Lady Macbeth increasingly becomes more pitiless, until she does non even question the idea of killing Duncan in order to be following in line to the throne, she is over whelmed in her ain desires, that she forgot about everything else that use to affair. Throughout both Macbeth and the Poisonwood Bible both writers develop their several characters of Lady Macbeth and Nathan Price by foregrounding their picks and actions through aspiration, use and pitiless action. These characters therefore serve to foreground the overall subjects of power and control in both plants. Both Nathan and Lady Macbeth sacrificed everything for power and control non recognizing the true cost. Nathan losingss his full household and is left to populate entirely, and Lady Macbeth looses her saneness, driving herself to take her ain life. Their battle for power and control wrecked many lives and in the terminal their several triumphs was so little that it all did non look worth the attempt. COMPARATIVE ESSAY Having†¦ Lady Macbeth from Shakespear ‘s Macbeth and Nathan Price from the Poisonwood Bible By: Tori Skot For: Ms.Zaikos January 7, 2008