Newspapers : A thing of the past

Good Morning, My name is Mohana Soman and I am going to talk about Newspapers. Initially, when we hear ‘Newspapers’, you envision stuffy politicians on the front page, juicy reports of the latest scandal or even a grisly murder case. That, is what the Newspaper has become. From being the one source of true information being passed around as common knowledge, it has become a kind of daily entertainment. Mum may read about some old actress, while Dad mutters about how the country is down in the dumps.I think that Newspapers are a thing of the past. They are because: We can simply get all the information and news we need faster and cheaper from the internet than waiting for the newspaper. Plus if we stop printing newspaper we will be able to save a lot more trees which will help us in the fight against global warming. Nowadays sitting and reading the whole newspaper consumes a lot of time which is a waste of precious time, it is better if we just sit on the internet and typ e what we want and have it in front of us.Therefore the internet is a better and more popular thing than newspapers. Obviously newspapers are not completely ‘a thing of the past' because they still provide news for the elderly and those traditionalists, yet it is inevitable that their death will occur due to the technological progression. Purely for convenience, an hourly publication is more accessible than a daily one. In this day and age, people enjoy ‘being in the know', and they are able to do this by checking for live updates rather than waiting for the newspaper the next day.

Memory of my childhood

I wanted that journey to go on forever. Well, at the beginning anyway. We had left Belgium in the morning, all of us reluctant to arrive at our ‘final destination', but the day progressed. The atmosphere in the car became tense, and the distance on the map didn't seem to change with the passing hours. The inhabitants of the car are completely oblivious to the outside world. My parents were thinking only of their petty arguments and minor discomforts. The landscape changed with the mood, as they began to descend into the routine that they would have taken up every hour or so from now on. The tar on the road sizzled; fantasies distort vision and reflect light into a glazed eye. They only thought of themselves. My little sister, Emma, said â€Å"It's my turn on the Game Boy.† â€Å"No, it's mine.† I said. â€Å"Just give it to Emma. She's youngest.† Mother said. â€Å"Where are we on the map now?† â€Å"I WANT IT NOW!† Emma said. â€Å"I don't know; look for yourself, Mother said, â€Å"Now give Emma the game boy Naz.† â€Å"Can't you all just be quiet? I'm trying to read.† I shouted angrily. â€Å"Don't you speak to me like that young lady† That was the reaction I got from both of my parents as I asked them to keep the noise down. We hadn't moved from this spot for 2 hours. And it was Emma's turn on the Game Boy. And I only wanted to play it to get on Emma's nerves. I could have told them that, but I would have just gotten the same unreasonable reaction, that because I was 10, I didn't have a clue about anything. The noise began to settle as we listened to our repetitive music and the toneless instructions of the navigator. Each of us was thinking about an incident vivid in our own mind, but forgotten by others. We only thought of our own importance, and the mark we left on others. We were self contained and self absorbed. We were heading for Cornwall. For all of us except my dad, it was for the first time in three years. It was understandable that they spent most of the long hours lecturing us on manners while we were caged in the car- we had to make a good impression. They were our family though. Should we really have to make an impression on them? Aren't they supposed to know us better than we even know ourselves? Sometimes things aren't what they are assumed to be though. They suspect the feeling of awkwardness that undercurrents their arrival. It will be smothered by joyfulness, present giving and drink. Concern for each other's appearance makes them interfering. Hills roll past, and the hateful sun is shining straight down onto the car holding them like packed vegetables. Slowly the car crawled down the stretch of motorway, which the sun was slowly melting. The car had been a shelter from the heat at the beginning of the journey, but then we could feel the effects of it. The angrier and more frustrated we got the warmer the car grew. As the batteries ran out, everyone's books were finished, and we still didn't look like we had moved all that much further we ignored each other and concentrated on ourselves. I was thirsty, my arms were itchy with sweat, my legs were cramped, and I still didn't see why I was the one that always had to read Emma a story, ever since Emma was 5 years old. â€Å"Why can't she read it herself?† I said furiously. â€Å"Because, I asked you to do it† My mother answered me angrily. â€Å"Then ask her.† â€Å"She cannot read. And now just do it.† â€Å"Fine, Whatever† So I went on to read ‘We're going on a Bear Hunt' with as much feeling as I would read a recipe. Slowly as we got closer and closer to Cornwall we forgot every reason we had for not wanting to get there. A huge proper Sunday roast, which would no doubt be on the table when we arrived, sounded like heaven. It was our cousin Alan's birthday, and the cake would be huge and covered in chocolate. We had had experiences of birthday cakes before in Cornwall. They were always worth the journey. We had a CD on in the car. It was Robbie Williams. We always listened to Robbie Williams and Van Morrison on long car journeys. Everything seems to merge together after a while though, just drowning out the sound of the car and each other. We were separated and isolated from each other as though in separate cages. We expected no communication. We gave none. We could only think ahead. By the time that there was only about an hour to go of this pain staking driving us were all looking forward to Cornwall like it was the ‘Promised Land'. Every accident was forgotten. We only remembered the food and drink we would be given, the early Christmas and late birthday presents. We were just coming up the drive of the house when the door opened and every single relative I remember, some that I didn't remember, and some that I didn't even know came swarming down the drive. Within minutes we were all crowded round a huge dining table, ready to begin. The accidents were forgotten. They had successfully implanted themselves in this household. They would not let it out of their grasp until they left exhausted and overfed, to return to their ordinary routine of work. Believe that we had had a holiday.

Good Grocers, Inc Research Paper Example | Topics and Well Written Essays - 1000 words

Good Grocers, Inc - Research Paper Example The settlement may provide a cheaper alternative than court proceedings. August, Mayer & Bixby (2013) are of the assumption that court proceedings may dent the publicity of an organization if the plaintiff presents a believable argument. The organization should seek for an outside court settlement as a public relation strategy (August, Mayer & Bixby, 2013). In this case, Ms. Greene requires to be provided with benefits that are offered to employees who work on a part-time basis. The new demand would require more than the $15 per hour wage. In addition, she will be provided with additional incentives that are not provided with contractors. However, before she can be granted the request, the terms and conditions of her contract should be reviewed. If Ms. Greene knew what her contract entailed, she cannot alter the terms of the product. Emerson (2009) asserts that an employee contract binds their relationship with their employer. They further point out that the terms on a contract can only be changed when it is necessary (Emerson, 2009). In this instance, it is not necessary. The store has enough employees, and Ms. Greene supplements the three days her services are

Deciphering Communication Styles between Men and Women Essay

Deciphering Communication Styles between Men and Women - Essay Example For example the communicative style of a child is different from that of teenager or adult. It is the study about communication which has led me understanding the way I interacting with people is more complex than I assume. After studying about communication I have become more observant in communicating with people at home, work and online classrooms. I acknowledge that speaking itself does not constitute communication but equal importance must be given to listening aspect too. It is a two way phenomenon in which, both the speaker and listener have position to comply with. For example, communication between genders has different perspective when closely monitored. When I communicate with my mother and sister I perceive that I am more emotional, but when I talk with my father it is more of action – oriented and practical. As per (Sherwood,2013) â€Å"Women communicate through dialogue, discussing emotions, choices and problems. Males remain action-oriented -- the goal of commu nication is to achieve something†. Communication at Home and Gender concept The communication held at home is different from that of workplace or online classrooms. The communication process at home is informal whereas work place and online class rooms are formal. Communication is a two way process and people involved in it largely makes the nature of it. Communication is an art and interacting with women and men in this as a process largely differ. When I perceive the way in which I communicate with my mother and sister, I can understand I am using a different tone and style. I can understand that inequality does exist while communicating with females and males. My talking style is different with my mother and sister and it takes different direction when communicating with my Father. When communicating with men and women we can understand the functionalism concept in them as both the gender convey inequality. When I talk to my mother I find that she wants to connect to me emo tionally and wants to know about my wellbeing and physical status. My mother talks about choices, problems I encounter and think a lot before giving her decisions. Even my sister wants to achieve emotional satisfaction by communicating with me and be playful with me all time. She likes to argue with me without reason to engage more emotionally with me. However, my father is more serious while communicating and is direct in his speech. He gives practical solution to the problems I encounter in life and is guides me for a better living. According to (Lieberman,2009)â€Å"Men like to tell and give information rather than ask questions. They share experiences as a way of being one-up†. Communication at work place and gender concept Communication at workplace is different from home as the former is a formal environment. In my workplace my main communication is with my manager. My manager is a male and I can identify his communicative style to mostly resemble with my Father. I can find that he is very authoritative in his talking style. He is very reserved person and unlike female colleague is less problem sharing and expressive. When I talk with my female colleague, I find her as a talkative person, who enquires more about my life outside the office. I find her very pacifying compare to my other male colleague. As per (Tannen,2010) â€Å"I have spent more than three decades collecting and analyzing thousands of examples of how women and men interact and have found that men’

Current marine issue Essay Example | Topics and Well Written Essays - 2750 words

Current marine issue - Essay Example tion at the international level via amendments to MARPOL Annex VI is the most effective way that can be followed by the shipping companies to achieve both financial as well as ethical success. To accomplish this, hardwares, including the internal as well as the hardware need to be quality tested and has to be made sure that it is sea worthy. Then importantly, the environment should be made devoid of the dangerous SOx and NOx. For that, variety of technologies is available in the market for the shipping companies. Thus, shipping organizations should understand the serious nature of the problem and put their minds to come up with strategies that can overcome the negative fallout. For every ship management company, the concept of social responsibility is of vital importance. Vital importance in the sense, it is not a compulsion on the part of ship management company to imbue social responsibility in their policies, strategies and goals. However, if it were added, it would function as a right ingredient positively changing the lives of not only the common people but as the well as the organization, both in the financial sense as well as in the image sense. So, ship Management Company has to find ways to initiate plans to cater to the common people in the society and importantly protect or not destroy the environment through eco-friendly measures. They could do this by organizing separate actions or events that will fulfill its social responsibility. Or the ship management companies could do this, by integrating certain policies or rules into their setup, which apart from helping the organization in smooth and effective functioning, also helps to fulfill its so cial responsibility. â€Å"It is worth stressing that being socially responsible means not only complying with relevant legislation, but also going beyond compliance and investing more than required into human capital and the relations with stakeholders† (Fafaliou, Lekakou and Theotokas 2002) Nowadays, management

CRM (Tesco) Statistics Project Example | Topics and Well Written Essays - 7000 words

CRM (Tesco) - Statistics Project Example This dissertation basically aimed to achieve an understanding of whether the concepts of customer relationship management which are so effective in industries like banking, airlines etc can also be as useful as they are for the said industries. This research therefore focused on the broad categorization of whether CRM has the power to create customer loyalty and if yes can the same concept be imitated for the retail industry. The Dissertation describes the customer relationship management (CRM) initiatives undertaken by Tesco, the number one retailing company in the United Kingdom (UK), since the mid-1990s. The company's growth and its numerous customer service efforts are discussed. The dissertation then studies the loyalty card scheme launched by the company in 1995. It examines how the data generated through this scheme was used to modify the company's marketing strategies and explores the role played by the scheme in making Tesco the market leader. This dissertation also takes a look at the various other ways in which Tesco tried to offer its customers the best possible service. Finally, the company's future prospects are commented on in light of changing market dynamics, the company's new strategic game plan. Customer relationship management is not a new concept as many organisations have successfully implemented it to achieve better results. The business model of the Dell suggests that how delivering directly to the customers can create strong customer loyalty and help develop the effective customer relationship management within the organisation. In its essence, Customer relationship management is considered as an activity through which organisations try to maintain customer retention and try to develop customer loyalty through that. However information technology has played an important role in the development of CRM not only as a concept but also as a practical reality. However traditionally CRM has remained the domain of some typical and particular industries such as banking, airlines, automobiles, hotels as well as electronic commerce. Retail Industry such as large super stores such as Tesco, ASDA etc has not been able to initiate the same level of CRM as it should have been. As a case study we have chosen Tesco as our reference point for discussing the CRM with specific reference to Tesco. This study will aim to analyze and understand the role of CRM into retail industry and whether CRM can prove useful in Retail Industry. Accordingly research objectives such as the ability of CRM to create customer loyalty, whether CRM has the ability to create the same for retail industry and to finally evaluate the extent of CRM into current industry. Company History History of Tesco can be traced back to the second decade of last century when Jack Cohen started to sell grocessories from a stall in London. The business survived and soon it emerged as the leading grocery providers in the country. Tesco is now the largest retail organisation in UK in

Team Work and Leadership in Construction Literature review

Team Work and Leadership in Construction - Literature review Example Outcomes are associable with aims. The main objective of teamwork is the development through sustainability, delivery of profit to all the shareholders, adding value to customers and rewarding careers to all the team players. Belbin is recognizable for the concept of team roles, which base facts on behavior patterns exhibited in teams. The theory of Beblian Team states that when individuals understand the capability of the role they should play and are conscious of their abilities and strengths in a team, it helps tackle the team environment demands. Roles in Belbins team within the construction environment derive their basis on intellectual styles, behaviors in teams and personality traits. Whereas the Belbins theory helps in identifying characters of human beings in terms of self-confidence, the theory of Tuckman explains that for people to be cohesive and goal oriented, they must undergo four stages (Senaratne & Sexton 2011). The stages include, forming, storming, norming and adjo urnment. The theory is helpful in the explanation of behavior and team development in the construction sector. ... Construction excellence has been the driving force of productivity in the United Kingdom. This is attributable to the supposition that the construction industry is participatory through integrated programs based on the processes of delivering and cultural changes (Boller 2005). Researchers have proved that construction excellence through collaborative leadership has improved performance by increasing competition and production (Chu?, & Cushman 2000). This has improved most industry’s image by changing culture and better engagement with customers and communities (ECI 2004). In the Republic of Philippines, the Naval Mobile Construction has worked in collaboration with the Australian Army Engineers as an element of the Pacific Partnership 2008 (Fryer & Fryer 2004). The programme was part of the civic and humanitarian mission to the South East Asia in which the Seabees conducted engineering civic programmes in Mindanao and Samar cities. The sailors participated in veterinary, dent al and civic programmes in empowering local communities in Philippines. In this aspect, there was a learning curve between the Philippines and the Australian counterparts hence achievement of a learning experience. This took a short time for each party to be acquainted with different trades and techniques. The two teams made great success in development during the training exercise (Green 2011). This was an opportunity in training and imparting leadership, and tactical skills in junior officers to improve building and teamwork in the battalions’ leadership. There was confidence that the talented leaders could execute leadership principles amongst themselves through deployment.

Compassion and Media Representations of Suffering Essay

Compassion and Media Representations of Suffering - Essay Example Compassion Cultivation The decision on how these images are going to be used and how a story is going to be told are left to the decision of the journalists and the editors. These decisions are influenced by different factors which include cultural standards of the primary audience and the expectations of advertisers. The end product is almost always geared towards what will be warranted as interesting by more people in order to attract more advertisers. Media produce materials that evoke compassion because compassion is what calls audience attention. Media positions the audience from a spectator’s point of view, a passive audience that is powerless when it comes to the doing something against the sufferings of victims of natural disasters and manmade crimes. To establish a more intimate relationship between the news content and the audience, media use personal stories that are highly focused on the civilians. Their losses are highlighted, their tears take the places of actual body count and political analysis. By putting feeding the audience the suffering of people who are supposed to be innocence and the fact that audience are unable to do anything to mediate the suffering, the media creates distant suffering. The audience are being conditioned to take into consideration the condition of strangers thousands of miles away. This framework of distant suffering has been so powerful that it has connected politics, audience, and non-profit organizations towards one cause. The growth of technology has afforded more news organizations and even ordinary citizens to access and distribute news and other information. The internet has also stretched the rules on the extent of suffering one may show. More importantly, this continuous flow of information on suffering has heightened the audience’s compassion because of the reinforcement of the fact that they are ultimately powerless to change to anything and even with the privilege of knowing and watching, they cannot do anything. The audience is not anymore allowed to detach themselves from the fate of other people or take refuge in ignorance because they are never safe from the information. Compassion Fatigue Moeller (1999) believes that this formula is also the cause of compassion fatigue. The continuous drive to heighten emotion and ignite interest from the audience is compromising the very essence of journalism. Journalism is supposed to uphold truths and facts without favouring any side. Journalism is about information dissemination. All of these take an inferior place over profitability. As media companies fight for audience, they continue to raise the stakes on how they present their stories without crossing the legal bounds. As a result, the media companies resort to sensationalism. The result is the ever growing concern on the accuracy of information that the audience obtains and the proper emotion that news is supposed to evoke. Chouliaraki (2006) discussed how adventure news e mbodies this situation. She mentioned three critical current events: shootings in Indonesia, a boat accident in India and ‘biblical floods’ in Bangladesh. All of these were given no more than one minute of air time. Important information was also not mentioned in the ‘breaking news’ portion and was not presented in the proper context of the event. This treatment results to a lack of framework for the audience to understand the weight of the event. Th

Assessment Essay Example | Topics and Well Written Essays - 500 words - 4

Assessment - Essay Example The reliability of a subjective test is determined by the degree of its correctness and consistency in providing information regarding the examinee. A reliable test should yield identical results when run multiple times or when used with the same group of students because it is constant in its procedures and criteria. Reliable test results are stable and consistent (McMillan, 2008; Atherton, 2011). Validity is the ability of a test to measure the intended objective. The three types of validity are content, criterion and construct validity. Content validity is achieved if the content of the test matches the intended objectives. Criterion validity is determined by the capability of the test to relate to other external factors. Construct validity considers educational variables while predicting the test results (McMillan, 2008).An example of an objective test is: The reliability of a subjective test can be measured by giving the same test more than once or giving creating two forms of the same test with slight variations. The reliability of such test is measured by calculating the correlation of the consistency. Internal consistency is determined by correlating a half of the assessment with the remaining half. Reliability consistence ranges from 0 to 1.0 with 0 representing absence of reliability while 1 depicts perfect reliability. Test with a reliability coefficient of above 0.8 are considered to be standard while those with a coefficient below 0.5 are considered to be less reliable. Validity is measured by establishing if the test meets or measures the intended objective (McMillan, 2008; Atherton, 2011). Determining the reliability and validity of a test is important since it help in establishing accuracy of the grade obtained using such a test, if a test is valid and reliable the results obtained are considered a true depiction of the students’ level of understanding Formative assessment is used by the teachers or lecturers to obtain

Motivation Plan. About my mentor Essay Example for Free

Motivation Plan. About my mentor Essay Tangie Stevenson works for Medicredit Corporation, which is a Management and Recovery Agency, better known as The Outsource Group. This agency is a third party collection agency which a third-party collection agency is as agency that was not a party to the original contract between a creditor first-party and a debtor second-party. In most cases, a third-party collection agency is used once internal first-party collection efforts have been considered unsuccessful. First-party collection agency usually lasts for a period of months before the debt is turned over to a third-party collection agency. A creditor assigns accounts to a third-party collection agency for a fee. The fee differs depending on a wide variety of factors ranging from the collection agency that the creditor chooses to work with, to the number and type of accounts that will be submitted on a routine basis. The fee can be as simple as a flat fee per account submitted or a performance percentage fee on each amount that is collected. In some cases, it may be a combination of both. It is dependent upon the relationship that is agreed upon. As a collections manager Tangie oversee’s all activities related to the company’s credit and collections. She is responsible for formulating, implementing, and maintaining credit and collections policies, monitoring collections and past due accounts, reporting on the activities of the accounts receivable department, and ensuring timely collection of customer accounts receivables. She also provides training, direction, and evaluation of credit and collections employees. In addition to overseeing the collection department staff, she tracks customer feedback through the review of incoming letters, emails, and phone calls and the analytical data collected through outside reporting agencies. She also identifies errors or glitches in collection procedures and recommends solutions to increase collections on delinquent accounts while ensuring customer satisfaction and retention. The Plan I have established a plan to keep the employees in Tangie’s department motivated and satisfied. Keeping employees motivated and satisfied are important elements of not only getting the most out of your employees, but also in retaining your best employees. The best employees are always in high demand, and will change companies if they are not kept motivated and satisfied at work. It doesn’t matter what you build, invent or sell; your organization can’t move forward without people. CEOs, company founders and managers the world over know that keeping the teams beneath them moving forward together in harmony means the difference between winning and dying. The plan that can be applied to Tangie’s department that would increase the motivation, satisfaction and performance would be to first, have the team members build ownership among themselves. They must feel as if they own the place and not just work here. Once of the principles of self-managed teams is to organize around a whole service or product. One way to inspire this feeling is to have each of the members become familiar with what the other members are doing, allowing them to bring their ideas for improvement to the table and have input in the entire process. If the roles are too specialized, have each of the members of the team exchange responsibilities often. This all makes them feel like â€Å"it’s mine†, and most people, when it’s theirs, really don’t want to fail. Next, you must trust the employees to leave their comfort zones. This means to allow them to do more than one specific task, it will allow them to grow and become more confident in their abilities while making them feel more valuable to the organization. Even though as a manager it may feel like allowing individuals to try new things presents a risk to productivity or places workers outside of their established place, it heads off other issues. The bigger risk is having people get burnt out or bored. Then, is to keep the team informed; business leaders have a clearer perspective on the bigger picture than their employees do. It’s really important to tell subordinates what’s going on. What a manager may take for common knowledge about how things are going or what challenges are down the road, employees should be informed of. Spreading the intel lets everyone in on the lay of the land and at the same time strengthens the feeling among workers that they are an important asset to the organization. Then, is the fact that your employees are adults so treat them as such. This is also important when it comes to motivation and satisfaction in the organization. Employees need to be dealt with in a respectable manner. In any organization there is going to be bad news. It could have to do with the individual or the company as a whole but just remember to treat employees accordingly. As a manager, if you choose to keep people in the dark about trying times or issues, the fallout could be more serious than the issue itself. When people are left out, they tend to make things up. An important part of the plan is to remember that money matters, but not as much as you think. Compensation packages are a big deal when employees are hired, but once hired the motivation tends to go downhill. The motivation then comes from things like the challenge of the work, the purpose of the work, the opportunity to learn, and the opportunity to contribute. Last, is to reward and recognize employees if they’ve done something truly outstanding. Instead of telling others that your employees are doing such a great job, take the time to bring a specific person into your office or write an email or note along with that person’s paycheck to let him know that his work is truly outstanding. Rewarding them with small gifts like tickets to a movie, a gift certificate to a grocery store or even highly wish for tickets to a sports game is a good reward. Reward employees with time off, you will be astounded to see how quickly your employees get to work when you offer to let them leave a little early or if you give them the option of coming to work a little late the next day. Reference Forbes. (2013). 7 Ways to Keep Your Employees Happy (And Working Really Hard). Retrieved from http://www.forbes.com/sites/karstenstrauss/2013/09/08/7-ways-to-keep-your-employees-happy-and-working-really-hard/

Management of Shoulder Dystocia: A Reflective Essay

Management of Shoulder Dystocia: A Reflective Essay Title: A reflective essay on how you would manage a shoulder dystocia as an obstetric emergency in a stand alone midwife led unit.   Undergraduate Degree Level Essay 1,000 Words Essay The condition of shoulder dystocia is diagnosed when the delivery of the foetal head is prevented by the impaction of one of the foetal shoulders within the mother’s pelvis. Simple head traction or episiotomy alone will not resolve the condition Shoulder dystocia is a complication of labour which is notoriously difficult to manage. It has a high complication rate and an increased rate of mortality. A number of studies have highlighted the fact that management is not always optimal. (Crofts, et al. 2006). Two UK studies produced similar findings that avoidable factors were identifiable in 66% of the perinatal deaths associated with shoulder dystocia. The definition of â€Å"avoidable factors† being a different management would have produced a better outcome. This malpresentation occurs in about 2% of vaginal deliveries and common associated morbidities include permanent brachial plexus injury, fracture of the clavicle, foetal haematoma and hypoxic brain injury. (Draycott, et al. 2008). Because the majority of cases of shoulder dystocia occur in the absence of predictable risk factors, all healthcare professionals in charge of a delivery should have an optimal plan to resolve shoulder dystocia in the safest way possible in any given circumstance. Management The management of shoulder dystocia is a subject that has acquired a large literature in its own right. It is therefore not appropriate to discuss it in great detail. Many of the studies done on the subject have identified a number of â€Å"critical tasks† in the delivery process. These include recognizing shoulder dystocia, asking for additional help, calling for paediatricians to be attend the delivery, applying gentle downward traction on the fetal head, placing the patient in McRoberts position, and applying appropriate suprapubic pressure. (Deering, et al. 2005) A number of mechanisms have been advised in the literature and these include rotational manoeuvre (Rubins or Woodscrew), episiotomy, delivery of the posterior arm, fracture of clavicle, symphysiotomy, all-fours manoeuvre, a cephalic replacement (Zavenelli) manoeuvre if other manoeuvres were not successful. (Crofts et al. 2008) Predisposing factors. Shoulder dystocia appears to occur in cases where there are no discernable predisposing factors however, there are some conditions that appear to make it more likely. The strongest single predictor appears to be foetal macrosomia. A number of authorities have suggested that maternal obesity is an association of the condition, but the meticulous study by Robinson showed conclusively that it was only obesity in diabetic mothers (that was associated with macrosomia) that had a high incidence of shoulder dystocia. Other causes of obesity did not have this association. (Robinson, et al. 2003) Gonen was able to report that a critical weight appeared to be 4,500 g with 33% of infants over this weight having shoulder dystocia and only 2% who were under it. (Gonen, et al. 1996) Birth position There appears to be considerable controversy regarding the ideal birth position. The McRoberts position (with maternal hips in flexion), combined with suprapubic pressure, has been reported as resolving 50% of identified cases of shoulder dystocia (German, et al. 1997). It is thought to achieve its effect through a rotation of the symphysis pubis and flattening of the sacrum. This, together with fundal pressure, is believed to reduce the possibility of the anterior shoulder being impacted under the symphysis pubis. There are some reports of the possibility of increased maternal morbidity (Heath, et al. 1999) and lack of effect (Beall, et al. 2003) Reflection. On a personal note, I have reflected on my own practice in dealing with cases of shoulder dystocia. As a result of researching this essay I have resolved to further explore the evidence base for dealing with the situation, because critical analysis of some of the papers read have challenged some of the ideas that I had previously believed to be true. In particular, I note papers which have analysed the behaviour of the responsible clinician in cases of shoulder dystocia and have been concerned about the frequent lack of paediatric back up. This has been identified as a failure on the part of the lead clinician, who is often so engrossed in the management of the condition that back up is simply overlooked. I have personally experienced cases where this has occurred and believe that a high degree of assertiveness is required if I see that it has been overlooked in the future. References Beall M H, Spong C Y, Ross M G (2003) A Randomized Controlled Trial of Prophylactic Maneuvers to Reduce Head-to-Body Delivery Time in Patients at Risk for Shoulder Dystocia. Obstetrics Gynecology 2003; 102: 31 35 Crofts J F, Bartlett C, Ellis D, Hunt L P, Fox R, Draycott T J (2006) Training for Shoulder Dystocia : A Trial of Simulation Using Low-Fidelity and High-Fidelity Mannequins : Obstetrics Gynecology 2006; 108 : 1477 1485 Crofts J F, Bartlett C, Ellis D, Winter C, Donald F, Hunt L P, Draycott T J (2008) Patient-actor perception of care: a comparison of obstetric emergency training using manikins and patient-actors. Qual. Saf. Health Care, February 1, 2008; 17 (1): 20 24. Deering S, Satin A J (2005) Evaluation of Residents Delivery Notes After a Simulated Shoulder Dystocia. Obstet. Gynecol., February 1, 2005; 105 (2): 448 449. Draycott T J, Crofts J F, Ash J P, Wilson L V, Yard E, Sibanda T, Whitelaw A. (2008) Improving Neonatal Outcome Through Practical Shoulder Dystocia Training. Obstet. Gynecol., July 1, 2008; 112 (1): 14 20. German R B, Goodwin T M, Souter I, Neumann K, Ouzounian J G, Paul R H. The McRoberts’ maneuver for the alleviation of shoulder dystocia: How successful is it? Am J Obstet Gynecol 1997; 176 : 656 – 61. Gonen R, Spiegel D, Abend M. Is macrosomia predictable and are shoulder dystocia and birth trauma preventable? Obstet Gynecol 1996; 88 : 526 – 9. Heath L T, Gherman R B. Symphyseal separation, sacroiliac joint dislocation and transient lateral femoral cutaneous neuropathy associated with McRoberts’ maneuver. J Reprod Med 1999; 44 : 902 – 4 Robinson H, Tkatch S, Mayes D C, Bott N, Okun N. (2003) Is Maternal Obesity a Predictor of Shoulder Dystocia? Obstetrics Gynecology 2003; 101 : 24 27 ############################################################### 12.8.08 Word count 1,060 PDG Different Medicinal Plants: Use Of Different Medicinal Plants: Use Of MEDICINAL PLANTS This section consist a list of sub-groups that gives information about Introduction, Importance, Systems of medicine, Utilization of medicinal plants. Introduction to Medicinal plants: About 250,000 higher plant species on earth, more than 80,000 species are reported to have at least some medicinal value and around 5000 species have specific therapeutic value. Herbs are staging a comeback and herbal renaissance is happening all over the globe. The herbal products today symbolize safety in compare to the synthetics that are considered as unsafe to human and environment. Even though herbs had been priced for their medicinal, flavoring and aromatic qualities for centuries, the synthetic products of the modern age surpassed their importance, for a while. However, the blind dependence on synthetics is over and people are returning to the herbals with hope of safety and security. Over three-quarters of the world population relies mainly on plants and plant extracts for health care. More than 30% of the entire plant species were used for medicinal purposes. (Joy, P.P., 2001) Herbals in world market: It is estimated that world market for plant derived drugs may account for about Rs.2, 00,000 crores. Presently, Indian contribution is less than Rs.2000 crores. The annual production of medicinal and aromatic plants raw material is worth about Rs.200 crores. This is likely to reach US $5 trillion by 2050. It has been estimated that in developed countries such as United States, plant drugs constitute as much as 25% of the total drugs, while in fast developing countries such as China and India, the contribution is as much as 80%. Thus, the economic importance of medicinal plants is much more to countries such as India than to rest of the world. (Joy, P.P., 2001) Biodiversity of herbals in India: India is one of the worlds 12 biodiversity centers with the presence of over 45000 different plant species. Indias diversity is UN compared due to the presence of 16 different agro-climatic zones, 10 vegetation zones, 25 biotic provinces and 426 biomes (habitats of specific species). Among these, about 15000-20000 plants have good medicinal value. However, only 7000-7500 species are used for their medicinal values by traditional communities. In India, drugs of plant origin have been used in traditional systems of medicines such as Unani and Ayurveda since ancient times. The Ayurveda system of medicine uses about 700 species, Unani 700, Siddha 600, Amchi 600 and modern medicine around 30 species. About 8,000 herbal remedies have been included in Ayurveda. The Rig-Veda (5000 BC) has recorded 67 medicinal plants, Yajurveda 81 species, Atharvaveda (4500-2500 BC) 290 species, Charak Samhita (700 BC) and Sushrut Samhita (200 BC) had described properties and uses of 1100 and 1270 species respectively, in compounding of drugs and these are still used in the classical formulations, in the Ayurvedic system of medicine. (Joy, P.P., 2001) Sources of medicinal drugs: The drugs are derived either from the whole plant or from different organs, like leaves, stem, bark, root, flower, seed, etc. Some drugs are prepared from excretory plant product such as gum, resins and latex. Plants, especially used in Ayurveda can provide biologically active molecules and lead structures for the development of modified derivatives with enhanced activity and /or reduced toxicity. Some important chemical intermediates needed for manufacturing the modern drugs are also obtained from plants (Eg. ÃŽÂ ²-ionone).The forest in India is the principal(diosgenin, solasodine) repository of large number of medicinal and aromatic plants, which are largely collected as raw materials for manufacture of drugs and perfumery products. The small fraction of flowering plants that have so far been investigated have yielded about 120 therapeutic agents of known structure from about 90 species of plants. Some of the useful plant drugs include vinblastine, vincristine, taxol, podophyllo toxin, camptothecin, digitoxigenin, gitoxigenin, digoxigenin, tubocurarine, morphine, codeine, aspirin, atropine, pilocarpine, capscicine, allicin, curcumin, artemisinin and ephedrine among others. (Joy, P.P., 2001) History of herbal medicine: Ayurveda, Siddha, Unani and Folk (tribal) medicines are the major systems of indigenous medicines. Among these systems, Ayurveda is most developed and widely practiced in India. Ayurveda dating back to 1500-800 BC has been an integral part of Indian culture. The term comes from the Sanskrit root Au (life) and Veda (knowledge). As the name implies it is not only the science of treatment of the ill but covers the whole gamut of happy human life involving the physical, metaphysical and the spiritual aspects. Ayurveda is gaining prominence as the natural system of health care all over the world. Today this system of medicine is being practiced in countries like Nepal, Bhutan, Sri Lanka, Bangladesh and Pakistan, while the traditional system of medicine in the other countries like Tibet, Mongolia and Thailand appear to be derived from Ayurveda. Phytomedicines are also being used increasingly in Western Europe. Recently the US Government has established the Office of Alternative Medicine at the National Institute of Health at Bethesda and its support to alternative medicine includes basic and applied research in traditional systems of medicines such as Chinese, Ayurvedic. (Joy, P.P., 2001) Disadvantages: A major lacuna in Ayurveda is the lack of drug standardization, information and quality control. Most of the Ayurvedic medicines are in the form of crude extracts which are a mixture of several ingredients and the active principles when isolated individually fail to give desired activity. This implies that the activity of the extract is the synergistic effect of its various components. About 121 (45 tropical and 76 subtropical) major plant drugs have been identified for which no synthetic one is currently available. The scientific study of traditional medicines, derivation of drugs through bio prospecting and systematic conservation of the concerned medicinal plants is of great importance. Unfortunately, much of the ancient knowledge and many valuable plants are being lost at an alarming rate. Red Data Book of India has 427 entries of endangered species of which 28 are considered extinct, 124 endangered, 81 vulnerable, 100 rare and 34 insufficiently known species (Thomas, 1997).There are basically two scientific techniques of conservation of genetic diversity of these plants. They are the in situ and ex situ method of conservation. (Joy, P.P., 2001) In Situ conservation of medicinal plants: It is only in nature that plant diversity at the genetic, species and eco-system level can be conserved on long-term basis. (www.ggssc.net) It is necessary to conserve in distinct, representative bio geographic zones inter and intra specific genetic variation. Ex situ conservation of medicinal plants: A. Ethno-medicinal plant gardens: Creation of a network of regional and sub-regional ethno-medicinal plant gardens which should contain accessions of all the medicinal plants known to the various ethnic communities in different regions of India. This chain of gardens will act as regional repositories of our cultural and ethno medicinal history and embody the living traditions of our societys knowledge of medicinal plants. (www.ggssc.net) Current status: There are estimated to be around 50 such gardens in the country ranging from acre to 40 acres some of them were set up by an All India Health Network (AHN). More recently a network of 15 such gardens has been set up in 3 states of South India with the initiative of FRLHT. One of the gardens is located in TBGRI, (Tropical botanical garden research institute) Palode at Thiruvananthapuram. B. Gene banks: In India there is a large number of medicinal plant species are under various degrees of threat. The precautionary principles would suggest that an immediate and country-wide exercise be taken up to deposit seeds of wild medicinal plants with a first priority to known Red listed species and endemic species. Current status: The department of bio-technology, Government of India has recently taken the initiative to establish 3 gene banks in the country. One is with ICAR at the NBPGR (National Bureau of plant genetic Resources) Campus, the second is with CIMAPs, (Central Institute of Medicinal and Aromatic plants) Luck now and the third with TBFRI in Thiruvananthapuram. C. Nursery network: The most urgent and primary task in order to ensure immediate availability of plants and planting materials to various user groups is to promote a nationwide network of medicinal plant nurseries, which will multiply all the regional specific plants that are used in the current practice of traditional medicine. These nurseries should become the primary sources of supply of plants and seed material that can be subsequently multiplied by the various users. Current status: Planting material for 40 odd species of medicinal and aromatic plants is reportedly available in the ICAR and CSIR (CIMAP) network. In South India FRLHT (Foundation for Rural Revitalization of Local Health Tradition) has recently set up a network of 55 supply nurseries. D. Cultivation of medicinal plants: Figures projecting demand and trade in medicinal plant species globally indicate a step upward trend in the near future. One estimate puts the figure of world trade in medicinal plants and related products at US $ 5 trillion by A.D. 2050 (world bank report , 1996).The demand so far has been met mainly from wild sources. This cant go on for much longer; policy intervention is urgently needed to encourage and facilitate investments into commercial cultivation of medicinal plants. (Joy, P.P., 2001) Cultivation of medicinal plants is inversely linked to prevalence of easy and cheap collection from the wild, lack of regulation in trade, cornering of the profits from wild collection by a vast network of traders and middlemen and absence of industrys interest in providing buy-back guarantees to growers. Current status: In the Govt. sector agro-technology of 40 odd species has been developed by ICAR Agricultural University System and CSIR (CIMAOs RRL, Jammu and Jorhat). In recent years industries like Dabur, Zandu, Indian Herbs, Arya Vaidya Shala, and Arya Vaidya Pharmacy and others have made some symbolic efforts to initiate cultivation. Since1984 NABARD (National Bank of Agricultural and Rural Development) has formulated schemes for financing cultivation and processing of medicinal plants. E. Community based enterprises: The income generated by the traditional medicine industry benefits small section of the society. A strong case exists for promotion of community level enterprises for value addition to medicinal plants through simple, on site techniques like drying, cleaning, crushing, powdering, grading, packaging etc. This will also increase the stake of rural communities in conservation and change the skewed nature of income distribution of the industry. Current status: Three community based enterprises are known in south India, one in Gandhi gram Trust, (Dindigul), Premade development Society (Peer made) Kerala and the third by VGKK in B.R.Hills, Mysore. Importance of Herbal Medicines: Herbal medicines are prepared from a variety of plant material such as leaves, stems, roots, bark, etc. They usually contain many biologically active ingredients and are used primarily for treating mild or chronic ailments. (www.ggssc.net) Herbal remedies can also be purchased in the form of pills, capsules or powders, or in more concentrated liquid forms called extracts and tinctures. They can apply topically in creams or ointments, soaked into cloths and used as compresses, or applied directly to the skin as poultices. A combination therapy integrating ayurveda and allopathy whereby the side effects and undesirable reactions could be controlled can be thought of. Studies can show that the toxic effects of radiations and chemotherapy in cancer treatment could be reduced by Ayurvedic medications and similarly surgical wound healing could be accelerated by Ayurvedic medicines. Modern science and technology have an essential role to play in the process. Systems of Medicine: There are mainly 3 systems of medicine practiced in the world today. They are, Modern System of medicine or Allopathy: This system was developed in the Western countries. In this system drugs (tablets, capsules, injections, tonics etc.) are manufactured using synthetic chemicals and / or chemicals derived from natural products like plants, animals, minerals etc. This system also uses modern equipment for diagnosis, analysis, surgery etc. Medicines or drugs of this system is often criticized for its treatment of the symptoms rather than the cause of the disease, harmful side effects of certain drugs and for being out of reach of common / poor people due to the high cost of drugs and treatment. This system is used in all the countries of the world today. (www.ggssc.net) Alternative Medicine or Traditional System: Different countries of the world developed independently their own traditional systems of medicine using locally available materials like minerals and products of plants and animals. (www.ggssc.net) The World Health Organization (WHO) is giving importance to these alternate medicine systems to provide Primary Health Care to millions of people in the developing countries. Development of herbal medicine: China developed the Chinese system of medicine, which is practiced in China, Singapore, Taiwan, Japan and other countries. In India, Ayurveda (developed in North India), Siddha (developed in Tamil Nadu) and Nagarjuna (developed in Andhra Pradesh) systems of medicine were developed. Ayurveda is practiced in Sri Lanka, Pakistan and Bangladesh also. Herbo-mineral is another traditional system used in India and other neighbouring countries. Drugs (balms, oils, pills, tonics, paste etc) are manufactured and marketed in these systems. (Joy, P.P., 2001) Advantages of traditional medicine: Traditional systems of medicine continue to be widely practiced on many accounts. Population rise, inadequate supply of drugs, prohibitive cost of treatments, side effects of several allopathic drugs and development of resistance to currently used drugs for infectious diseases have led to increased emphasis on the use of plant materials as a source of medicines for a wide variety of human ailments. Folk Medicine or tribal medicine: The medicinal systems followed by various tribals of different countries are popularly known as folk or tribal medicine. In the system, the medicine man or the doctor of the tribe who has the knowledge of treating diseases, keeps this knowledge as a closely guarded secret and passes it to the next generation by word of mouth. No written texts on these systems are available and different tribes follow different time tested methods. The treatment is often associated with lengthy and mystic rituals, in addition to prescription of drugs (decoctions, pastes, powders, oils, ashed materials etc.). Generally speaking, folk medicine can also be regarded as a traditional system of medicine. The basic aim of all the above systems of medicine is to alleviate the sufferings of human beings and their domesticated animals. (www.ggssc.net) Other Systems of medicine: Yoga, Acupressure, Acupuncture, Reiki, Magneto therapy, Pyramid therapy, Flower therapy, Homeopathy, Nature Cure or Naturopathy etc. are some of the other systems of medicine practiced in different parts of the world today. Utilization of Herbal Plants: The utility of medicinal plants has four major segments they are, Medicinal plants utilized in indigenous or traditional systems of medicines (ISM) Ayurveda, Siddha, Unani and Homeopathy systems of medicines , OTC (over the country, non-prescription) items / products involving plant parts, extracts galenicals etc. , Essential oils , Phyto pharmaceuticals or plants used in modern systems of medicine. (www.ggssc.net) Medicinal plants used in Traditional Systems of Medicine: As its name implies, it is the part of tradition of each country which employs practices that have been handed down from generation to generation. An important feature of traditional therapy is the preference of practitioner for compound prescriptions over single substance/drug as it is being held that some constituents are effective only in the presence of others. This renders assessment of efficacy and eventually identification of active principles as required in international standards much difficult than for simple preparation. In India, earlier the medicines used in indigenous systems of medicines were generally prepared by the practicing physicians by themselves, but now this practice has been largely replaced by the establishment of organized indigenous drug industries. It is estimated that at present there are more than 1, 00,000 licensed registered practitioners of Ayurveda, Siddha, Unani medicine or Homeopathy. In fact reliable data on availability in different regions of country as well as supply and demand of medicinal plants used in production of indigenous medicines are not available. (www.ggssc.net) Plants-parts, extracts and galenicals of medicinal herbs: The direct utilization of plant material is not only a feature of ISM in the developing world but also in developed countries like USA, UK, Germany etc., the various herbal formulations are sold on health food shops. Preparation of decoctions, tinctures, galenicals and total extracts of plants also form a part of many pharmacopoeias of the world. The current trend of medicinal plants based drug industry is to procedure standard extracts of plants as raw material. (www.ggssc.net) Essential Oils from herbal plants: The essential oil industry was traditionally a cottage industry in India. Since 1947, a number of industrial companies have been established for large scale production of essential oils, oleoresins and perfumes. The essential oil from plants includes Ajowan oil, Eucalyptus oil, Geranium oil, Lavender oil, Palmarosa oil, Patchouli oil, Rose oil, Sandalwood oil, Turpentine oil and Vetiver oil. Phyto-pharmaceuticals of medicinal plants: During the past decades, bulk production of plant based drugs has become an important segment of Indian pharmaceutical industry. Some of the Phyto-pharmaceuticals which are produced in India at present include Morphine, codeine, papaverine (Papaver somniferum), quinine, quinidine, cinchonine and cinchonidine (Cinchona sp., C.calisaya, C. Hyoscine, hyoscyamine (Hyocyamus Niger and H. muticus), colchicine (Gloriosa superbad, Colchicum luteum and Iphigenia stellata), cephaeline and emetin (Cephalis ipacacuanha), sennosides A B (Cassia angustifolia and C. acutifolia), reserpine, rescinnamine, ajmalicine and ajmaline (Rauvolfia serpentina); vinblastine and vincristine, ajmalicine (raubacine) (Catharanthus roseus); guggul lipid (Commiphora wightii); taxol (Taxus baccata); artemisinin (Artemisai annua) etc. (www.ggssc.net) CLASSIFICATION OF HERBAL PLANTS: They are classified according to the part used, habit, habitat, therapeutic value etc, besides the usual botanical classification.Based on Therapeutic value they are classified as follows. Anti malarial : Cinchona officinalis, Artemisia annua ,Anticancer : Catharanthus roseus, Taxus baccata ,Antiulcer : Azadirachta indica, Glycyrrhiza glabra , Antidiabetic : Catharanthus roseus, Momordica charantia , Anticholesterol : Allium sativum Anti inflammatory : Curcuma domestica, Desmodium gangeticum , Antiviral : Acacia catechu Antibacterial : Plumbago indica , Antifungal : Allium sativum , Antiprotozoal : Ailanthus sp., Cephaelis ipacacuanha , Antidiarrhoeal : Psidium guava, Curcuma domestica , Hypotensive : Coleus forskohlii, Alium sativum , Tranquilizing : Rauvolfia serpentina , Anaesthetic : Erythroxylum coca , Spasmolytic : Atropa belladona, Hyoscyamus niger , Diuretic : Phyllanthus niruri, Centella asiatica , Astringent : Piper betel, Abrus precatorius Anthelmentic : Quisqualis indica, Punica granatum , Cardio tonic : Digitalis sp., Thevetia sp. Antiallergic : Nandina domestica, Scutellaria baicalensis ,Hepatoprotective : Silybum marianum, Andrographis paniculata. (Joy, P.P., 2001) Safety of medicinal plants: The safety and effectiveness of alternative medicines have not be been scientifically proven and remains largely unknown. A number of herbs are thought to be likely to cause adverse effects. Furthermore, adulteration, inappropriate formulation, or lack of understanding of plant and drug interactions have led to adverse reactions that are sometimes life threatening or lethal. Proper double-blind clinical trials are needed to determine the safety and efficacy of each plant before they can be recommended for medical use. Although many consumers believe that herbal medicines are safe because they are natural, herbal medicines may interact with synthetic drugs causing toxicity to the patient, may have contamination that is a safety consideration, and herbal medicines, without proven efficacy, may be used to replace medicines that have a proven efficacy. (Joy, P.P., 2001) Eg: Ephedra has been known to have numerous side effects, including severe skin reactions, irritability, nervousness, dizziness, trembling, headache, insomnia, profuse perspiration, dehydration, itchy scalp and skin, vomiting, hyperthermia, irregular heartbeat, seizures, heart attack, stroke, or death. Poisonous plants which have limited medicinal effects are often not sold in material doses in the United States or are available only to trained practitioners, these include: Aconite, Arnica, Belladonna, Bryonia, Datura, Gelsemium, Henbane, Male Fern Phytolacca, Podophyllum andVeratrum. Furthermore, herbs such as Lobelia, Ephedra and Eonymus that cause nausea, sweating, and vomiting, have been traditionally prized for this action. Plants such as Comfrey and Petasites have specific toxicity due to hepatotoxic pyrrolizidine alkaloid content. There are other plant medicines which require caution or can interact with other medications, including St. Johns wort and grapefruit. (Phytotherapy , www.wikipedia.com) INTRODUCTION TO DIABETES MELLITUS In recent years, developed nations have witnessed an explosive increase in the prevalence of diabetes mellitus (DM) predominantly related to lifestyle changes and the resulting surge in obesity. The metabolic consequences of prolonged hyperglycemia and dyslipidemia, including accelerated atherosclerosis, chronic kidney disease, and blindness, pose an enormous burden on patients with diabetes mellitus and on the public health system. (Goodman Gilmans, 2006) In 1869, a German medical student, Paul Langerhans, noted that the pancreas contains two distinct groups of cells the acinar cells, which secrete digestive enzymes, and cells that are clustered in islands, or islets, which he suggested, served a second function. Direct evidence for this function came in 1889, when Minkowski and von Mering showed that pancreatectomized dogs exhibit a syndrome similar to diabetes mellitus in humans (Goodman Gilmans,2006) In the early 1900s, Gurg Zuelzer, an internist in Berlin, attempted to treat a dying diabetic patient with extracts of pancreas. Although the patient improved temporarily, he sank back into a coma and died when the supply of extract was exhausted. E.L. Scott, a student at the University of Chicago, made another early attempt to isolate an active principle in 1911. Using alcoholic extracts of the pancreas Scott treated several diabetic dogs with encouraging results; however, he lacked clear measures of control of blood glucose concentrations, Between 1916 and 1920, the Romanian physiologist Nicolas Paulesco found that injections of pancreatic extracts reduced urinary sugar and ketones in diabetic dogs. Although he published the results of his experiments, their significance was fully appreciated only years later. (Goodman Gilmans, 2006) Banting assumed that the islets secreted insulin but that the hormone was destroyed by proteolytic digestion prior to or during extraction. Together with Charles Best, he attempted to overcome the problem by ligating the pancreatic ducts. The acinar tissue degenerated, leaving the islets undisturbed; the remaining tissue then was extracted with ethanol and acid. Banting and Best thus obtained a pancreatic extract that decreased the concentration of blood glucose in diabetic dogs. (Goodman Gilmans, 2006) Insulin was purified and crystallized by Abel within a few years of its discovery. Sanger established the amino acid sequence of insulin in 1960, the protein was synthesized in 1963, and Hodgkin and coworkers elucidated insulins three-dimensional structure in 1972. Insulin was the hormone for which Yalow and Berson first developed the radioimmunoassay (Goodman Gilmans, 2006) Insulin regulation is achieved by the coordinated interplay of various nutrients, gastrointestinal hormones, pancreatic hormones, and autonomic neurotransmitters. Glucose, amino acids, fatty acids, and ketone bodies promote the secretion of insulin. The islets of Langerhans are richly innervated by both adrenergic and cholinergic nerves. Stimulation of a2 adrenergic receptors inhibits insulin secretion, whereas b2 adrenergic receptor agonists and vagal nerve stimulation enhance release. In general, any condition that activates the sympathetic branch of the autonomic nervous system (such as hypoxia, hypoglycemia, exercise, hypothermia, surgery, or severe burns) suppresses the secretion of insulin by stimulation of ÃŽÂ ±2-adrenergic receptors. Predictably, ÃŽÂ ±2 adrenergic receptor antagonists increase basal concentrations of insulin in plasma, and ÃŽÂ ²2 adrenergic receptor antagonists decrease them. The sugar is more effective in provoking insulin secretion when taken orall y than when administered intravenously because the ingestion of glucose (or food) induces the release of gastrointestinal hormones and stimulates vagal activity. Several gastrointestinal hormones promote the secretion of insulin. The most potent of these are gastrointestinal inhibitory peptide (GIP) and glucagon like peptide 1 (GLP-1). Insulin release also is stimulated by gastrin, secretin, Cholecystokinin, vasoactive intestinal peptide, gastrin-releasing peptide, and Enteroglucagon. (Goodman Gilmans, 2006) Distribution: Insulin circulates in blood as the free monomer, and its volume of distribution approximates the volume of extracellular fluid. Under fasting conditions, the pancreas secretes about 40 mg (1 unit) of insulin per hour into the portal vein to achieve a concentration of insulin in portal blood of 2 to 4 ng/ml (50 to 100 minutes/ml) and in the peripheral circulation of 0.5 ng/ml (12 minutes/ml) or about 0.1 nM. After ingestion of a meal, there is a rapid rise in the concentration of insulin in portal blood, followed by a parallel but smaller rise in the peripheral circulation. (Goodman Gilmans, 2006) Half Life: The half-life of insulin in plasma is about 5 to 6 minutes in normal subjects and patients with uncomplicated diabetes. This value may be increased in diabetics who develop anti-insulin antibodies. (Goodman Gilmans, 2006) Metabolism: Degradation of insulin occurs primarily in liver, kidney, and muscle. About 50% of the insulin that reaches the liver via the portal vein is destroyed and never reaches the general circulation. Insulin is filtered by the renal glomeruli and is reabsorbed by the tubules, which also degrade it. Severe impairment of renal function appears to affect the rate of disappearance of circulating insulin to a greater extent than does hepatic disease. Peripheral tissues such as fat also inactivate insulin, but this is of less significance quantitatively. The important target tissues for regulation of glucose homeostasis by insulin are liver, muscle, and fat, but insulin exerts potent regulatory effects on other cell types as well. Insulin is the primary hormone responsible for controlling the uptake, use, and storage of cellular nutrients. (Goodman Gilmans, 2006) DIABETES MELLITUS: Diabetes mellitus (DM) consists of a group of syndromes characterized by hyperglycemia; altered metabolism of lipids, carbohydrates, and proteins; and an increased risk of complications from vascular disease. Most patients can be classified clinically as having either type 1 or type 2 DM. Criteria for the diagnosis of DM have been proposed by several medical organizations. The American Diabetes Association (ADA) criteria include symptoms of DM (e.g., polyuria, polydipsia, and unexplained weight loss) and a random plasma glucose concentration of greater than 200 mg/dl (11.1 mM), a fasting plasma glucose concentration of greater than 126 ml/dl (7 mM), or a plasma glucose concentration of greater than 200 mg/dl (11 mM) 2 hours after the ingestion of an oral glucose load In the United States, about 5% to 10% of all diabetic patients have type 1 DM, with an incidence of 18 per 100,000 inhabitants per year. A similar incidence is found in the United Kingdom. The incidence of type 1 DM in Europe varies with latitude. The highest rates occur in northern Europe (Finland, 43 per 100,000) and the lowest in the south (France and Italy, 8 per 100,000). The one exception to this rule is the small island of Sardinia, close to Italy, which has an incidence of 30 per 100,000. However, even the relatively low incidence rates of type 1 DM in southern Europe are far higher than the rates in Japan (1 per 100,000 inhabitants). There are more than 125 million persons with diabetes in the world today, and by 2010, this number is expected to approach 220 million. (Goodman Gilmans, 2006) Both type 1 and type 2 DM are increasing in frequency. The reason for the increase of type 1 DM is not known. The genetic basis for type 2 DM cannot change in such a short time; thus other contributing factors, including increasing age, obesity, sedentary lifestyle, and low birth weight, must account for this dramatic increase. In addition, type 2 DM is being diagnosed with remarkable frequency in preadolescents and adolescents. Up to 45% of newly diagnosed children and adolescents have type 2 DM. There are genetic and environmental components that affect the risk of developing either type 1 or type 2 DM Types: Diabetes can be divided into two groups based on their requirements for insulin includes, (Pharmainfo.net) Type I: Insulin- dependent diabetes mellitus [IDDM] Type II: Non- insulin dependent diabetes [NIDDM] Type I: Insulin dependent diabetes mellitus: A burst of insulin secretion normally occurs after ingestion of a meal in response to transient increase in the levels of circulating glucose and amino acids. In the post operative period, low, basal levels of circulating insulin are maintained through beta cell secretion. However type one diabetic has virtually no functional beta cells. Treatment: Type I diabetic must rely on exogenous (injected) insulin in order to control hyperglycemia, maintain acceptable levels of Glycosylated hemoglobin (HbA1C) and avoid ketoacidosis. The goal in administering insulin to type I diabetic is to maintain blood glucose concentrations as close to normal as possible and

Major League Baseball Essay -- Persuasive Baseball Sports Athletics Es

Major League Baseball Professional sports are a competition between the greatest athletes in the world. And when I go to a game, that’s exactly what I expect to see. Sports are entertainment. There is no room for purity and respecting the limits that athletes had in the past. Modern athletes should utilize all the resources that they have available to them. This includes steroids, which enhance an athlete’s performance. After all, performance is what really matters. The sport that has gotten the most attention on the subject of steroids is Major League Baseball. Due to the suspected prevalence of them from the late 80’s up until the present day, the so-called baseball purists now question all the records and achievements of suspected users from that period. Meanwhile, these same purists celebrate the same achievements of an athlete like Babe Ruth. Former player Gary Gaetti said, "I don't know if they should test or not but I don't think it's fair to Babe Ruth, Mickey Mantle, Roger Maris and those guys ... but take it to the next step, what is the purpose of the testing and what are you going to do about it?" he said, adding he was never on the juice.† (Maxwell 1). He played his entire career in a game with no African-Americans, they were forbidden from playing in Major League Baseball even though many of them could have competed with the players of that time. So tell me what’s worse, achieving something against the best competition while using steroids or do...

Metaphysics, Epistemology and George Orwells Nineteen Eighty-Four (198

Metaphysics, Epistemology and Orwell's 1984 Since the beginning of recorded time, philosophers have pondered questions of metaphysics (what exists, what is real) and epistemology (how we know what exists and is real, our proof). However in George Orwell's 1984, the need to answer these questions no longer exists for the majority, as the ruling party has created a new reality for its citizens, one in which what is real and what truly exists cannot be questioned. But on the flip side, the protagonist of 1984, Winston Smith, finds himself constantly searching for what is real in his life, and in a larger sense, in the society and world that surrounds him. In its simplest terms, metaphysics can be seen as a question of what it is that we know to be real, what truly exists. In a deeper sense, as defined by Aristotle, metaphysics attempts to understand the fundamental nature of all reality. Closely related to metaphysics is epistemology. Epistemology looks to define what knowledge is, how it is obtained, and what it is that makes anything knowledge at all. It serves to establish proof, a warrant for what we consider to be real, thus validating our knowledge of our own reality. Within 1984, Orwell, or rather "The Party" has created Big Brother, a larger-than-life character known to all citizens, uniting and influencing all of Oceania. To the citizens of Oceania, there is no question that Big Brother does not exist. To them Big Brother is real, he exists in the flesh just as the rest of the citizens of the nation. Almost no one entertains the proposition that he is merely a character, created to enforce party agendas and goals. His face appears in movies, on posters; he is virtually everywhere. Citizens are ... ...are being told. They will never know if what they are being told is the truth and will never distinguish between what is actually true and what is just mindless babble and propaganda. Works Cited Anderson, Alan. "Metaphysics: Multiple Meanings." April 14, 2000. May 31, 2000. Floyd, Nathan T. "Rhetoric & Epistemology." November 29, 1995. May 31, 2000. Khoury, Jonathan A. "1984 in 1996: How Orwell's 1949 Classic Describes our Government." May 31, 2000. Orwell, George. 1984. New York: Harcourt Brace Jovanovich, Inc., 1949. Hyperlinks http://websyte.com/alan/metamul.htm metaphysics http://www.lcc.gatech.edu/gallery/rhetoric/terms/epistemology.html epistemology http://members.aol.com/jonkhoury/1984.htm 1984

Nineteen Eighty-Four, George Orwell :: essays research papers fc

Topic 1: What warning does the novel carry for readers at this point in time about where their society is heading? Introduction NINETEEN EIGHTY-FOUR’s society carries a warning to our society about where we might be heading. However I believe that we are already at a parallel with the society in NINETEEN EIGHTY-FOUR . Taking the focus of the media it becomes very clear that our society is very similar to the one in NINETEEN EIGHTY-FOUR if to a lesser extent. Looking at the media shows that the media have control over what we know and therefore what we think. Therefore who ever controls the media controls our thoughts, both here and in NINETEEN EIGHTY-FOUR . By showing the similarities between NINETEEN EIGHTY-FOUR and our world through the media it becomes clear that our society is very closely related to that of NINETEEN EIGHTY-FOUR . Control of our knowledge The media controls our knowledge of the outside world. If we don’t listen to the news we don’t find out what is happening in other countries. The media can be very selective about what stories they broadcast; they will broadcast the news that they think the public will want to hear. An example of this in our world was the September 11 attacks. We heard lots of news about how approximately 7000 people died but we didn’t hear about: o  Ã‚  Ã‚  Ã‚  Ã‚  The floods in India which killed thousands of people o  Ã‚  Ã‚  Ã‚  Ã‚  The 32700(approx) people who died from hunger and curable diseases on September 11. In NINETEEN EIGHTY-FOUR Ingsoc controls the media. They decide what the people need to know and so effectively control their knowledge. If the party says that Oceania is at war with Eastasia then for all the people know it is. This is also true if the party says that Oceania is at war with Eurasia. Effectively the media controls our knowledge – we know what they choose to broadcast. Control of media Every media group is controlled by somebody. Whoever controls it controls what is broadcast to the public. The extreme case of this is in NINETEEN EIGHTY-FOUR . The party controls the media and so all stories go through them. They broadcast what they think it is necessary for the people to know and that is the end of the story. The party is basically the media and everything they say is always correct. If it turns out to be incorrect they change their records so that it is correct.

Angels Demons Chapter 49-50

49 Langdon and Vittoria stood alone now outside the double doors that led to the inner sanctum of the Secret Archives. The decor in the colonnade was an incongruous mix of wall-to-wall carpets over marble floors and wireless security cameras gazing down from beside carved cherubs in the ceiling. Langdon dubbed it Sterile Renaissance. Beside the arched ingress hung a small bronze plaque. ARCHIVIO VATICANO Curatore: Padre Jaqui Tomaso Father Jaqui Tomaso. Langdon recognized the curator's name from the rejection letters at home in his desk. Dear Mr. Langdon, It is with regret that I am writing to deny†¦ Regret. Bullshit. Since Jaqui Tomaso's reign had begun, Langdon had never met a single non-Catholic American scholar who had been given access to the Secret Vatican Archives. Il gaurdiano, historians called him. Jaqui Tomaso was the toughest librarian on earth. As Langdon pushed the doors open and stepped through the vaulted portal into the inner sanctum, he half expected to see Father Jaqui in full military fatigues and helmet standing guard with a bazooka. The space, however, was deserted. Silence. Soft lighting. Archivio Vaticano. One of his life dreams. As Langdon's eyes took in the sacred chamber, his first reaction was one of embarrassment. He realized what a callow romantic he was. The images he had held for so many years of this room could not have been more inaccurate. He had imagined dusty bookshelves piled high with tattered volumes, priests cataloging by the light of candles and stained-glass windows, monks poring over scrolls†¦ Not even close. At first glance the room appeared to be a darkened airline hangar in which someone had built a dozen free-standing racquetball courts. Langdon knew of course what the glass-walled enclosures were. He was not surprised to see them; humidity and heat eroded ancient vellums and parchments, and proper preservation required hermitic vaults like these – airtight cubicles that kept out humidity and natural acids in the air. Langdon had been inside hermetic vaults many times, but it was always an unsettling experience†¦ something about entering an airtight container where the oxygen was regulated by a reference librarian. The vaults were dark, ghostly even, faintly outlined by tiny dome lights at the end of each stack. In the blackness of each cell, Langdon sensed the phantom giants, row upon row of towering stacks, laden with history. This was one hell of a collection. Vittoria also seemed dazzled. She stood beside him staring mutely at the giant transparent cubes. Time was short, and Langdon wasted none of it scanning the dimly lit room for a book catalog – a bound encyclopedia that cataloged the library's collection. All he saw was the glow of a handful of computer terminals dotting the room. â€Å"Looks like they've got a Biblion. Their index is computerized.† Vittoria looked hopeful. â€Å"That should speed things up.† Langdon wished he shared her enthusiasm, but he sensed this was bad news. He walked to a terminal and began typing. His fears were instantly confirmed. â€Å"The old-fashioned method would have been better.† â€Å"Why?† He stepped back from the monitor. â€Å"Because real books don't have password protection. I don't suppose physicists are natural born hackers?† Vittoria shook her head. â€Å"I can open oysters, that's about it.† Langdon took a deep breath and turned to face the eerie collection of diaphanous vaults. He walked to the nearest one and squinted into the dim interior. Inside the glass were amorphous shapes Langdon recognized as the usual bookshelves, parchment bins, and examination tables. He looked up at the indicator tabs glowing at the end of each stack. As in all libraries, the tabs indicated the contents of that row. He read the headings as he moved down the transparent barrier. Pietro Il Erimito†¦ Le Crociate†¦ Urbano II†¦ Levant†¦ â€Å"They're labeled,† he said, still walking. â€Å"But it's not alpha-author.† He wasn't surprised. Ancient archives were almost never cataloged alphabetically because so many of the authors were unknown. Titles didn't work either because many historical documents were untitled letters or parchment fragments. Most cataloging was done chronologically. Disconcertingly, however, this arrangement did not appear to be chronological. Langdon felt precious time already slipping away. â€Å"Looks like the Vatican has its own system.† â€Å"What a surprise.† He examined the labels again. The documents spanned centuries, but all the keywords, he realized, were interrelated. â€Å"I think it's a thematic classification.† â€Å"Thematic?† Vittoria said, sounding like a disapproving scientist. â€Å"Sounds inefficient.† Actually†¦ Langdon thought, considering it more closely. This may be the shrewdest cataloging I've ever seen. He had always urged his students to understand the overall tones and motifs of an artistic period rather than getting lost in the minutia of dates and specific works. The Vatican Archives, it seemed, were cataloged on a similar philosophy. Broad strokes†¦ â€Å"Everything in this vault,† Langdon said, feeling more confident now, â€Å"centuries of material, has to do with the Crusades. That's this vault's theme.† It was all here, he realized. Historical accounts, letters, artwork, socio-political data, modern analyses. All in one place†¦ encouraging a deeper understanding of a topic. Brilliant. Vittoria frowned. â€Å"But data can relate to multiple themes simultaneously.† â€Å"Which is why they cross-reference with proxy markers.† Langdon pointed through the glass to the colorful plastic tabs inserted among the documents. â€Å"Those indicate secondary documents located elsewhere with their primary themes.† â€Å"Sure,† she said, apparently letting it go. She put her hands on her hips and surveyed the enormous space. Then she looked at Langdon. â€Å"So, Professor, what's the name of this Galileo thing we're looking for?† Langdon couldn't help but smile. He still couldn't fathom that he was standing in this room. It's in here, he thought. Somewhere in the dark, it's waiting. â€Å"Follow me,† Langdon said. He started briskly down the first aisle, examining the indicator tabs of each vault. â€Å"Remember how I told you about the Path of Illumination? How the Illuminati recruited new members using an elaborate test?† â€Å"The treasure hunt,† Vittoria said, following closely. â€Å"The challenge the Illuminati had was that after they placed the markers, they needed some way to tell the scientific community the path existed.† â€Å"Logical,† Vittoria said. â€Å"Otherwise nobody would know to look for it.† â€Å"Yes, and even if they knew the path existed, scientists would have no way of knowing where the path began. Rome is huge.† â€Å"Okay.† Langdon proceeded down the next aisle, scanning the tabs as he talked. â€Å"About fifteen years ago, some historians at the Sorbonne and I uncovered a series of Illuminati letters filled with references to the segno.† â€Å"The sign. The announcement about the path and where it began.† â€Å"Yes. And since then, plenty of Illuminati academics, myself included, have uncovered other references to the segno. It is accepted theory now that the clue exists and that Galileo mass distributed it to the scientific community without the Vatican ever knowing.† â€Å"How?† â€Å"We're not sure, but most likely printed publications. He published many books and newsletters over the years.† â€Å"That the Vatican no doubt saw. Sounds dangerous.† â€Å"True. Nonetheless the segno was distributed.† â€Å"But nobody has ever actually found it?† â€Å"No. Oddly though, wherever allusions to the segno appear – Masonic diaries, ancient scientific journals, Illuminati letters – it is often referred to by a number.† â€Å"666?† Langdon smiled. â€Å"Actually it's 503.† â€Å"Meaning?† â€Å"None of us could ever figure it out. I became fascinated with 503, trying everything to find meaning in the number – numerology, map references, latitudes.† Langdon reached the end of the aisle, turned the corner, and hurried to scan the next row of tabs as he spoke. â€Å"For many years the only clue seemed to be that 503 began with the number five†¦ one of the sacred Illuminati digits.† He paused. â€Å"Something tells me you recently figured it out, and that's why we're here.† â€Å"Correct,† Langdon said, allowing himself a rare moment of pride in his work. â€Å"Are you familiar with a book by Galileo called Dialogo?† â€Å"Of course. Famous among scientists as the ultimate scientific sellout.† Sellout wasn't quite the word Langdon would have used, but he knew what Vittoria meant. In the early 1630s, Galileo had wanted to publish a book endorsing the Copernican heliocentric model of the solar system, but the Vatican would not permit the book's release unless Galileo included equally persuasive evidence for the church's geo centric model – a model Galileo knew to be dead wrong. Galileo had no choice but to acquiesce to the church's demands and publish a book giving equal time to both the accurate and inaccurate models. â€Å"As you probably know,† Langdon said, â€Å"despite Galileo's compromise, Dialogo was still seen as heretical, and the Vatican placed him under house arrest.† â€Å"No good deed goes unpunished.† Langdon smiled. â€Å"So true. And yet Galileo was persistent. While under house arrest, he secretly wrote a lesser-known manuscript that scholars often confuse with Dialogo. That book is called Discorsi.† Vittoria nodded. â€Å"I've heard of it. Discourses on the Tides.† Langdon stopped short, amazed she had heard of the obscure publication about planetary motion and its effect on the tides. â€Å"Hey,† she said, â€Å"you're talking to an Italian marine physicist whose father worshiped Galileo.† Langdon laughed. Discorsi however was not what they were looking for. Langdon explained that Discorsi had not been Galileo's only work while under house arrest. Historians believed he had also written an obscure booklet called Diagramma. â€Å"Diagramma della Verita,† Langdon said. â€Å"Diagram of Truth.† â€Å"Never heard of it.† â€Å"I'm not surprised. Diagramma was Galileo's most secretive work – supposedly some sort of treatise on scientific facts he held to be true but was not allowed to share. Like some of Galileo's previous manuscripts, Diagramma was smuggled out of Rome by a friend and quietly published in Holland. The booklet became wildly popular in the European scientific underground. Then the Vatican caught wind of it and went on a book-burning campaign.† Vittoria now looked intrigued. â€Å"And you think Diagramma contained the clue? The segno. The information about the Path of Illumination.† â€Å"Diagramma is how Galileo got the word out. That I'm sure of.† Langdon entered the third row of vaults and continued surveying the indicator tabs. â€Å"Archivists have been looking for a copy of Diagramma for years. But between the Vatican burnings and the booklet's low permanence rating, the booklet has disappeared off the face of the earth.† â€Å"Permanence rating?† â€Å"Durability. Archivists rate documents one through ten for their structural integrity. Diagramma was printed on sedge papyrus. It's like tissue paper. Life span of no more than a century.† â€Å"Why not something stronger?† â€Å"Galileo's behest. To protect his followers. This way any scientists caught with a copy could simply drop it in water and the booklet would dissolve. It was great for destruction of evidence, but terrible for archivists. It is believed that only one copy of Diagramma survived beyond the eighteenth century.† â€Å"One?† Vittoria looked momentarily starstruck as she glanced around the room. â€Å"And it's here?† â€Å"Confiscated from the Netherlands by the Vatican shortly after Galileo's death. I've been petitioning to see it for years now. Ever since I realized what was in it.† As if reading Langdon's mind, Vittoria moved across the aisle and began scanning the adjacent bay of vaults, doubling their pace. â€Å"Thanks,† he said. â€Å"Look for reference tabs that have anything to do with Galileo, science, scientists. You'll know it when you see it.† â€Å"Okay, but you still haven't told me how you figured out Diagramma contained the clue. It had something to do with the number you kept seeing in Illuminati letters? 503?† Langdon smiled. â€Å"Yes. It took some time, but I finally figured out that 503 is a simple code. It clearly points to Diagramma.† For an instant Langdon relived his moment of unexpected revelation: August 16. Two years ago. He was standing lakeside at the wedding of the son of a colleague. Bagpipes droned on the water as the wedding party made their unique entrance†¦ across the lake on a barge. The craft was festooned with flowers and wreaths. It carried a Roman numeral painted proudly on the hull – DCII. Puzzled by the marking Langdon asked the father of the bride, â€Å"What's with 602?† â€Å"602?† Langdon pointed to the barge. â€Å"DCII is the Roman numeral for 602.† The man laughed. â€Å"That's not a Roman numeral. That's the name of the barge.† â€Å"The DCII?† The man nodded. â€Å"The Dick and Connie II.† Langdon felt sheepish. Dick and Connie were the wedding couple. The barge obviously had been named in their honor. â€Å"What happened to the DCI?† The man groaned. â€Å"It sank yesterday during the rehearsal luncheon.† Langdon laughed. â€Å"Sorry to hear that.† He looked back out at the barge. The DCII, he thought. Like a miniature QEII. A second later, it had hit him. Now Langdon turned to Vittoria. â€Å"503,† he said, â€Å"as I mentioned, is a code. It's an Illuminati trick for concealing what was actually intended as a Roman numeral. The number 503 in Roman numerals is – â€Å" â€Å"DIII.† Langdon glanced up. â€Å"That was fast. Please don't tell me you're an Illuminata.† She laughed. â€Å"I use Roman numerals to codify pelagic strata.† Of course, Langdon thought. Don't we all. Vittoria looked over. â€Å"So what is the meaning of DIII?† â€Å"DI and DII and DIII are very old abbreviations. They were used by ancient scientists to distinguish between the three Galilean documents most commonly confused. Vittoria drew a quick breath. â€Å"Dialogo†¦ Discorsi†¦ Diagramma.† â€Å"D-one. D-two. D-three. All scientific. All controversial. 503 is DIII. Diagramma. The third of his books.† Vittoria looked troubled. â€Å"But one thing still doesn't make sense. If this segno, this clue, this advertisement about the Path of Illumination was really in Galileo's Diagramma, why didn't the Vatican see it when they repossessed all the copies?† â€Å"They may have seen it and not noticed. Remember the Illuminati markers? Hiding things in plain view? Dissimulation? The segno apparently was hidden the same way – in plain view. Invisible to those who were not looking for it. And also invisible to those who didn't understand it.† â€Å"Meaning?† â€Å"Meaning Galileo hid it well. According to historic record, the segno was revealed in a mode the Illuminati called lingua pura.† â€Å"The pure language?† â€Å"Yes.† â€Å"Mathematics?† â€Å"That's my guess. Seems pretty obvious. Galileo was a scientist after all, and he was writing for scientists. Math would be a logical language in which to lay out the clue. The booklet is called Diagramma, so mathematical diagrams may also be part of the code.† Vittoria sounded only slightly more hopeful. â€Å"I suppose Galileo could have created some sort of mathematical code that went unnoticed by the clergy.† â€Å"You don't sound sold,† Langdon said, moving down the row. â€Å"I'm not. Mainly because you aren't. If you were so sure about DIII, why didn't you publish? Then someone who did have access to the Vatican Archives could have come in here and checked out Diagramma a long time ago.† â€Å"I didn't want to publish,† Langdon said. â€Å"I had worked hard to find the information and – † He stopped himself, embarrassed. â€Å"You wanted the glory.† Langdon felt himself flush. â€Å"In a manner of speaking. It's just that – â€Å" â€Å"Don't look so embarrassed. You're talking to a scientist. Publish or perish. At CERN we call it ‘Substantiate or suffocate.' â€Å" â€Å"It wasn't only wanting to be the first. I was also concerned that if the wrong people found out about the information in Diagramma, it might disappear.† â€Å"The wrong people being the Vatican?† â€Å"Not that they are wrong, per se, but the church has always downplayed the Illuminati threat. In the early 1900s the Vatican went so far as to say the Illuminati were a figment of overactive imaginations. The clergy felt, and perhaps rightly so, that the last thing Christians needed to know was that there was a very powerful anti-Christian movement infiltrating their banks, politics, and universities.† Present tense, Robert, he reminded himself. There IS a powerful anti-Christian force infiltrating their banks, politics, and universities. â€Å"So you think the Vatican would have buried any evidence corroborating the Illuminati threat?† â€Å"Quite possibly. Any threat, real or imagined, weakens faith in the church's power.† â€Å"One more question.† Vittoria stopped short and looked at him like he was an alien. â€Å"Are you serious?† Langdon stopped. â€Å"What do you mean?† â€Å"I mean is this really your plan to save the day?† Langdon wasn't sure whether he saw amused pity or sheer terror in her eyes. â€Å"You mean finding Diagramma?† â€Å"No, I mean finding Diagramma, locating a four-hundred-year-old segno, deciphering some mathematical code, and following an ancient trail of art that only the most brilliant scientists in history have ever been able to follow†¦ all in the next four hours.† Langdon shrugged. â€Å"I'm open to other suggestions.† 50 Robert Langdon stood outside Archive Vault 9 and read the labels on the stacks. Brahe†¦ Clavius†¦ Copernicus†¦ Kepler†¦ Newton†¦ As he read the names again, he felt a sudden uneasiness. Here are the scientists†¦ but where is Galileo? He turned to Vittoria, who was checking the contents of a nearby vault. â€Å"I found the right theme, but Galileo's missing.† â€Å"No he isn't,† she said, frowning as she motioned to the next vault. â€Å"He's over here. But I hope you brought your reading glasses, because this entire vault is his.† Langdon ran over. Vittoria was right. Every indictor tab in Vault 10 carried the same keyword. Il Proceso Galileano Langdon let out a low whistle, now realizing why Galileo had his own vault. â€Å"The Galileo Affair,† he marveled, peering through the glass at the dark outlines of the stacks. â€Å"The longest and most expensive legal proceeding in Vatican history. Fourteen years and six hundred million lire. It's all here.† â€Å"Have a few legal documents.† â€Å"I guess lawyers haven't evolved much over the centuries.† â€Å"Neither have sharks.† Langdon strode to a large yellow button on the side of the vault. He pressed it, and a bank of overhead lights hummed on inside. The lights were deep red, turning the cube into a glowing crimson cell†¦ a maze of towering shelves. â€Å"My God,† Vittoria said, looking spooked. â€Å"Are we tanning or working?† â€Å"Parchment and vellum fades, so vault lighting is always done with dark lights.† â€Å"You could go mad in here.† Or worse, Langdon thought, moving toward the vault's sole entrance. â€Å"A quick word of warning. Oxygen is an oxidant, so hermetic vaults contain very little of it. It's a partial vacuum inside. Your breathing will feel strained.† â€Å"Hey, if old cardinals can survive it.† True, Langdon thought. May we be as lucky. The vault entrance was a single electronic revolving door. Langdon noted the common arrangement of four access buttons on the door's inner shaft, one accessible from each compartment. When a button was pressed, the motorized door would kick into gear and make the conventional half rotation before grinding to a halt – a standard procedure to preserve the integrity of the inner atmosphere. â€Å"After I'm in,† Langdon said, â€Å"just press the button and follow me through. There's only eight percent humidity inside, so be prepared to feel some dry mouth.† Langdon stepped into the rotating compartment and pressed the button. The door buzzed loudly and began to rotate. As he followed its motion, Langdon prepared his body for the physical shock that always accompanied the first few seconds in a hermetic vault. Entering a sealed archive was like going from sea level to 20,000 feet in an instant. Nausea and light-headedness were not uncommon. Double vision, double over, he reminded himself, quoting the archivist's mantra. Langdon felt his ears pop. There was a hiss of air, and the door spun to a stop. He was in. Langdon's first realization was that the air inside was thinner than he had anticipated. The Vatican, it seemed, took their archives a bit more seriously than most. Langdon fought the gag reflex and relaxed his chest while his pulmonary capillaries dilated. The tightness passed quickly. Enter the Dolphin, he mused, gratified his fifty laps a day were good for something. Breathing more normally now, he looked around the vault. Despite the transparent outer walls, he felt a familiar anxiety. I'm in a box, he thought. A blood red box. The door buzzed behind him, and Langdon turned to watch Vittoria enter. When she arrived inside, her eyes immediately began watering, and she started breathing heavily. â€Å"Give it a minute,† Langdon said. â€Å"If you get light-headed, bend over.† â€Å"I†¦ feel†¦Ã¢â‚¬  Vittoria choked, â€Å"like I'm†¦ scuba diving†¦ with the wrong†¦ mixture.† Langdon waited for her to acclimatize. He knew she would be fine. Vittoria Vetra was obviously in terrific shape, nothing like the doddering ancient Radcliffe alumnae Langdon had once squired through Widener Library's hermetic vault. The tour had ended with Langdon giving mouth-to-mouth to an old woman who'd almost aspirated her false teeth. â€Å"Feeling better?† he asked. Vittoria nodded. â€Å"I rode your damn space plane, so I thought I owed you.† This brought a smile. â€Å"Touche.† Langdon reached into the box beside the door and extracted some white cotton gloves. â€Å"Formal affair?† Vittoria asked. â€Å"Finger acid. We can't handle the documents without them. You'll need a pair.† Vittoria donned some gloves. â€Å"How long do we have?† Langdon checked his Mickey Mouse watch. â€Å"It's just past seven.† â€Å"We have to find this thing within the hour.† â€Å"Actually,† Langdon said, â€Å"we don't have that kind of time.† He pointed overhead to a filtered duct. â€Å"Normally the curator would turn on a reoxygenation system when someone is inside the vault. Not today. Twenty minutes, we'll both be sucking wind.† Vittoria blanched noticeably in the reddish glow. Langdon smiled and smoothed his gloves. â€Å"Substantiate or suffocate, Ms. Vetra. Mickey's ticking.†