Conducting Scholarly Research Essay Example for Free

Conducting Scholarly Research Essay Conducting Scholarly Research The following tutorials and information are mandatory, though no assignment is required to be submitted. The skills developed in these tutorials will be used throughout the nursing program. Evaluating the resources you use One of the major challenges today, with the sheer amount of information available at your fingertips via the Web, is determining the reliability of the information presented. It can be quite difficult to determine the quality, authenticity, and authority of the information you encounter. However, there are a number of tools and skills at your disposal that help to determine if the information you find is trustworthy and of academic quality. Watch the Evaluating Websites tutorial to learn more about how to determine the quality of information found on the Web. Review the tutorial: â€Å"Evaluating Websites,† located at http://tutorials.gcumedia.com/evaluatingWebTutorial/vp02.swf What makes a resource scholarly? Throughout your courses at GCU you will be encouraged to use scholarly resources to support your assignments and discussion questions. But what is a scholarly source? Simply put, a scholarly source is a resource or research created, published, and or written by scholars and professionals in a specific discipline. In addition, a scholarly source should have undergone rigorous fact checking and peer review to ensure the research and information presented is of strong academic quality. The bulk of scholarly resources can be found in books and academic and/or professional journals. A large majority of these are research based. A scholar or professional may publish articles in other resources, such as in magazines, newspapers, and even Web sites and blogs. However, these sources do not go through the rigorous fact checking that is expected from scholarly journals. This rigorous fact checking is called peer review. When a scholar or professional submits their article to be published the journal will send the article to another expert in the field to review the work. The reviewer will look to see that the quality is high, the research sound, and the  conclusions in line with the work presented. If it is approved, it will then be published in the journal. This process gives students like you the added confidence in the resource being used. How to find Scholarly Research The Web is filled with information and resources. It is possible to find scholarly articles and research on the Web. However, most will ask that you pay a fee to read the article. The GCU library has subscribed to a number of the journals so that you do not need to pay to read the research. These journals and articles are contained in collections called Databases. Some are multidisciplinary, but most are specific to a subject area. For instance, in nursing, the strongest databases include CINAHL, OVID, and the ProQuest Nursing Allied Health Source. These can be found on the Nursing subject page in the GCU library. Watch the â€Å"GCU Library Walk Through Tutorial† to learn how to access the library and its vast resources. The â€Å"GCU Library Walk Through Tutorial† is located at http://tutorials.gcumedia.com/libraryWalkThrough/vp02.swf Watch the CINAHL Tutorial to learn more about how to specifically use this nursing specific database. Pay special attention to the section discussing subject headings. Learning to use tools like these will help you design effective search strategies and significantly reduce the time and frustration that comes with research. The CINAHL Tutorial is located at http://tutorials.gcumedia.com/CINAHLTutorial/vp02.swf The GCU library has a number of Librarians and staffed trained specifically to assist you with your research. Please contact them if you have questions or concerns with finding information. They can help walk you through the technical aspects of using a database and assist in developing search strategies that will enable you to find the information you need. Call them at 800.800.9776 ext. 6396641 or email them at using the form at http://library.gcu.edu/AskALibrarian Scholarly Writing Writing will be a large part of the work expected in this program. Scholarly writing can often be intimidating, but there are a number of resources GCU has provided to ease this strain and help you learn to write good scholarly papers. A key to scholarly writing is using evidence to support your arguments. The skills you learn as a researcher will aid you in your writing. The purpose of education is to build your knowledge and the purpose of academia is to contribute to and build the knowledge of the culture as a whole. By taking the research and writings of others and evaluating and adding it as essential pieces of your own research, you then move the knowledge of both yourself and the community to the next step. To enable this process, it is essential to cite where the information is found that is used in your papers. This is why scholars use citation styles, such as APA, to standardize how this is done and allow others to easily follow from where the information has come. This is, of course, in addition to the ethical reasons that argue that one should be acknowledged for the work that is done. Watch the tutorials below to learn more about scholarly writing and what resources are available to you. The Writing Center, located in the Student Success Center Writing in APA Tutorial http://tutorials.gcumedia.com/mediaElement/apa-6th-edition-tutorial/apa-6th-edition-tutorial-v1.1.html Plagiarism Tutorial http://tutorials.gcumedia.com/plagiarismVideo/vp02.swf LoudCloud Tutorial http://tutorials.gcumedia.com/studentWTCTutorial/vp02.swf The Writing Process Tutorial http://tutorials.gcumedia.com/writingProcessTutorial/vp02.swf The Center for Learning Advancement has a number of staff and tutors available to assist you in your academic writing. In addition they have a number of resources available at the click of a button. Find out more at

Phases of Child Development

Phases of Child Development Joanne Boyden Children are individual and unique; however most will follow a similar pattern of development with some variation in reaching of milestones. Child development can be divided into five different, but very much interlinking areas. Physical development looks at how children develop physically. This can be split into fine motor skills such as drawing, writing, gross motor skills such as kicking a ball and locomotive skills i.e. walking, running. Between the ages of 0-3 years is a period of rapid physical development. Newborns are governed by reflexes until by the age of three, children are moving, crawling walking and have the fine motor skill to manipulate toys and feed themselves. Between the ages 3-7 years movements are more coordinated, confidence is growing and fine motor skills are more refined e.g. cutting, writing, drawing. Gross motor skills such as running, kicking a ball are more confidently achieved. Between the ages of 7-12 years children often take part in hobbies and interests and this enhances their skills e.g. dance. Fine motor skills are controlled for drawing, playing instruments and sewing. These are influenced by environment and opportunity. Girls at this age can start to show signs of puber ty and therefore care should be shown for example when getting change for PE. 12-16 years is a time when children are growing in both height and strength. Cognitive development looks as how a child develops intellectually, it covers the basic principles of how children think and learn. This is dependent upon the experiences and opportunities that the child is given from an early age. Between the ages 0-3 children look at the world around them enjoy repetitive activities with the prediction of outcome. Children start from the beginnings of object manipulation to imaginative play and jigsaw completion. 3-7 years children are becoming more skilled at number and writing and learn how to read. 7-11 years children start to develop their own ideas and show preference. They enjoy simple puzzles and problem solving. 12-16 years children have very specific ideas and preference. They need support to feel good about themselves and that they belong. Communication Development focuses on the way children communicate and covers things such as speech, non verbal communications, reading, and writing. Early experience is vital to the development of communication. Between the ages 0-3 years stimulation is of great importance. Children go from crying to communicate to smiles, babbling and towards the end of 2/3 using words and simple sentences. 3-7 years children ask lots of questions and can talk about past and futures tense with more confidence. By about the age of five communication becomes key to friendship development and children enjoy telling jokes. 7-12 years children are fluent speakers and can think about and discuss ideas in more abstract ways. Social and emotional development looks at how children develop relationships both with others and themselves. Children need confidence to become independent of adults. Between 0-3 years children form very strong attachments to their primary carer. 3-7 years children play together but need strong guidance and boundaries. 7—12 years is often thought of as ‘the calm before the storm’ and children tend to be quite settled and have strong groups of friends. 12-16 years is an age where confidence and esteem is most fragile. Children bodies are changing and peer pressure is paramount. Children need to be supported and guided in a loving and sensitive way. Good positive role models are key at this age when peer pressure is at its highest. Moral Development encompasses the decisions made by children and is linked to social and emotional development. The environment a child is in strongly effects how they develop socially and morally. Between the ages of two and three children begin to understand the word No and need constant support to guide them in the right direction. 3-5 years children can follow simple rules and need good consistent boundaries to follow. Praise and reinforcement of behaviour is key. Between 5-7 years children enjoy games with rules. For example a child may start to enjoy football as they can follow rules and kick the ball showing the link between physical and moral development as well and having the social skills to communicate. 7-9 years children enjoy being given some responsibility. At school this may take the form for example of paint monitor. By the ages of 9-11 children begin to become a lot more aware of the feelings of others around them until their teens when children should have a very go od understanding of what is right and wrong and also how their behaviours and actions affect other people. Many theorists have attempted to explain how children develop in particular how they develop cognitively. One of the most influential is that of Albert Bandura and the Social Learning theory. His theory is based upon the assumption that children learn through modelling the behaviour of others. This covers both positive and negative behaviour. For example if a child sees their parents fighting they will take on this aggressive behaviour thus impacting on their social and emotional development. Jean Piaget suggested that children develop cognitively by going through a series of set stages. This implies that all children go through the same processes at the same age and develop at the same rate. Piaget states that learning is based upon experience. Len Vygotsky extended this to state that adults must support and scaffold a child’s learning experience and devised the theory of Zone of proximal development. A child who is not provided with this scaffold and support will not reach their full potential developmentally. Another very influential theory is that of BF Skinner and Positive reinforcment. This theory states that children will repeat behaviour that is rewarded and cease behaviour that is ignored. This can be seen in schools with the likes of sticker rewards. Many factors both personal and external can influence a child development. Personal factors are those which occur through nature or a person’s genetics and include pregnancy and birth problems, health issues and disabilities. For example a child may be born with a specific genetic disability such as Down’s syndrome. â€Å"Downs syndrome is a genetic condition caused by the presence of an extra chromosome 21 in the body’s cells† Around one in every 1000 babies born in the UK will have Down’s syndrome. www.downs-syndrome.org.uk . Down’s syndrome affects all areas of development including physical, social and cognitive. Children’s development can be effected during their time in the womb, for example if the mother smokes or drinks. One of the big problems is that of Foetal Alcohol syndrome (FAS) â€Å"foetal Alcohol syndrome is the leading known cause of intellectual disability† www.drinkaware.co.uk Children with FAS are born with many distinctive features for example small and narrow eyes a smooth area between the nose and the lips as well as hearing and ear problems, weakened immune system and a variety of other issues. Thus a child with FAS may suffer both physically and cognitively. â€Å"The WHO quotes a 2005 US study which estimates that one in every 1000 children are born with FAS† www.drinkaware.co.uk. Similar to FAS is Foetal Alcohol Spectrum Disorder which is thought to affect one in every 100 babies. Rather like autistic spectrum this is an umbrella term to cover babies who are born with some of the symptoms of FAS and symptoms vary from child to child. Another condition that effects a Childs development is Coeliac Disease. â€Å"Coleiac Disease is a lifelong autoimmune disease caused by intolerance to gluten†. www.coeliac.org.uk Symptoms include failure to thrive, diarrhoea muscle wasting, mood and emotional distress. A child suffering from Colieac Disease may need time off school and may have to miss out on a variety of school experiences such as PE dependent upon the severity thus impacting on their physical and social and emotional development. â€Å"Sickle Cell Disease is an inherited blood disorder that occurs when protein call haemoglobin is defective† www.childrenshospital.org. Children suffering may need to dress up warmly and avoid extremes in temperatures. They may need to stay in at playtime and dinner thus missing out in social experience and may have to be given other activities during PE again effecting their physical and social development. As with many of the disorders the child may miss school due to illness. â€Å"Turners Syndrome (TS) is a medical disorder that affects about one in every 2500 girls.† www.kidshealth.org They are usually short in height although this can be treated with hormones, TS effects the girls sexually development and if untreated they would not go through the changes associated with puberty. This would have a detrimental effect on the child both physically and socially and emotionally as they compare their self to others. They can also suffer learning difficulties with maths and activities such as map reading and visual organisation. Another health concern is glue ear. Glue ear effects a child’s hearing and therefore if untreated can have a significant effect on a child’s speech and language development. Approx 1 in 5 children up to the age of two will suffer from some degree of glue ear www.nhs.uk and this is a significant time developmentally for speech and language acquisition. There are also many external factors that can effect a child’s development. For example a child’s financial situation will effect where they live, their diet etc. They may not be given the same opportunities for play though clubs etc and as mentioned before this support their physical, social and moral development. Diet is key to development. A poor diet has been linked to problems such as ADHD. Lack of vitamins and minerals has been linked to many disorders for example lack of iron can lead to anaemia which would leave the child tired and lethargic and even short of breath. Lack of vitamin C can lead to scurvy which was thought to be unheard of in developed countries. However it is becoming more prevalent with a diet lacking fresh fruit and vegetables. All has an impact on the child’s physical development. A big influence on many areas of a child’s development is stress. Stress will hold a child back in all areas. In today’s society a child is under many stressful situations one of the big ones being parental divorce and separation. One area that is coming to light more that effects a child development is that of a child becoming a child carer. It is estimated that in 2011, 175000 children under the age of 18 will be classed as a child carer. www.banardos.com Looking after someone at a young age will affect many areas of development including social as the child has less time to build friendships. The choices a child makes themselves can affect their development. Children are under great peer pressure to conform and this may push them into negative habits such as alcohol and drugs. The role models around the child have a significant impact both positively and negatively. There are many reasons why children’s development may not follow the expected pattern. Social influences may effect a child’s development. As mentioned earlier life experiences such as divorce and parental difficulties can cause significant stress to the child which then impacts their development. The family set up can be stressful for example if the child is a carer. Often parents are poor in areas and this can result in the child being poor. If a parent struggles to read they will struggle to support their child’s literacy skills thus impacting on their communication development. The kind of experiences given at home can impact significantly on development. Parents may not play and converse with their child in a supportive way. They may not attend clubs/ social situations outside the home. The area a child is brought up in can influence their development. The influences around them may be poor. If a child is brought up in a home surrounded by drugs and alcohol, they may chose to do this also. Life experience is critical to many areas of development in p articular cognitive. If a child is not given valuable positive experiences their development may be delayed. Physical problems can effect development as mentioned above, for example glue ear can affect speech and language, tuners syndrome can effect physical development. A child needs to have their very basic needs met for example food, warmth safety before they can begin to develop appropriately. Culture plays an important part in a child’s development. For example parents in western cultures are advised to lay children on their backs to prevent SIDS. However this can sometimes delay their crawling and rolling over. In some cultures for example among travellers gender plays an important role as an education is not seen as important for females as they are encouraged to become home makers. Children who move to new counties can suffer from a delay in development due to their language barrier; however they do tend to catch up with appropriate support. If delays are suspected early intervention is key to the child’s well being and planning for the future. Without intervention a child can become frustrated and have significantly reduced self esteem and confidence. Children have a health check at around two years to review their development. This reviews how a child is developing physical skills as well as communication and cogntive skills. Any areas for concern can be highlighted. For example a child may need speech and language support at this stage. The earlier an intervention is made the more chance that child has of reaching their full developmental potential. Early years settings are crucial at highlighting any areas for concern and putting support into place as needed. Looking at the example of Turners syndrome if support is not put in place be it emotional and medical the child may suffer severe lack of confidence in their physical appearance. A child with speech and language issues that is not supported very early will miss out on those vital early years of acquisition and may never catch up. Interventions and support take the form of many types dependent upon the type of delay and severity of the delay. References: Burnham Louise, (2008), The Teaching Assistants Handbook, Essex, Heinemann. Beith Kate (2008), Children’s care learning and Development, Essex, Heinemann. www.downs-syndrome.org.uk www.drinkaware.co.uk www.childrenshospital.org. www.kidshealth.org www.nhs.uk www.banardos.com www.wellatschool.org www.coeliac.org.uk

Dilutional Hyponatremia During Intrauterine Adhesion

Dilutional Hyponatremia During Intrauterine Adhesion Severe dilutional hyponatremia in a patient during hysteroscopic of intrauterine  adhesion : A case report YE Yuzhu, LIN Lina Abstract Hysteroscopy is a minimally invasive procedure for the patients of intrauterin adhesion, but may result in potentially disastrous complication labeled transurethral resection of the prostate (TURP) syndrome. Excessive absorption of large scale of distension media under high inflow pressure by openings of venous channels in endometrium, the large volume of transfusion fluid that is beyond the modulation ability of body may produce the most dangerous situation of severe hyponatremia, hypervolemia and hypoosmolality. The consequence of hysteroscopy is mainly determined by the type of distension medium, irrigation pressure,condition of endometrium, preoperative catheterization, type of electrode system and duration of the surgery. A case of hysteroscopic resection of intrauterine adhesion in which severely symptomatic hyponatremia and hypervolemia happended with epidural anesthesia is presented. Key words: Hysteroscopy, hyponatremia, distension medium, infusion pressure, TURP (transurethral resection of the prostate ) syndrome. Introduction Hysteroscopy technique in the detection and treatment of intrauterine diseases plays an dominant role because of its unique feature of minimal invasion and remains the â€Å"gold standard† mean for the diagnosis of uterine disease, but may result in potentially disastrous complication known as TURP syndrome or hyponatremia and hypervolemia. A hysteroscopy precdure requires an intrauterin installation inserting into the uterine cavity accompanied by a suitable type of distention medium including dextrose 5% in water (D5W), 2.7% sorbitol, 0.54% mannitol and saline for the visualization of intrauterine situation. The most common fluid used clinically is D5W for its distinct features of low-viscosity, electrolyte-free, safety and lower cost. TURP syndrome appears when large scale of distension media (D5W) is overly absorbed including the following clinical signs: dyspnea, headache, nausea and vomiting, coma, and even can progress to cerebaral and pulmonary edema. Signs and syndrom es are nonspecific when the conditon is in its early stages and, as a result, it’s easy to be ignored. Vigilance and communication of the whole medical team is extremely required to avoid state of illness aggravating. Early management must be rendered as soon as possible for the critically ill patients by anesthetists. We report a case of a 36-year-old woman who developed TURP syndrome during hysteroscopic of intrauterine adhesion herein. 2. Case Report A 36-year-old, weight 62 kg , no medication or coexisting diseases, ASA physical status II , underwent hysteroscopy treatment because of her reiterative intrauterin adhesion during epidural anesthesia. Past surgical history revealed four times of previous hysteroscopies within the year, both of which were aimed to remedy for her secondary infertility but failed in acquiring satisfactory therapeutic efficacy. There were no positive fingds on the preoperative physical examination and normal values in laborarory results included blood routine test and plasmic electrolytes, and the concerntrations of sodium ion, potassium ion and blood glucose level were 139 mmol/L, 3.47 mmol/L and 4.0 mmol/L, respectively. A 12-lead electrocardiogram showed sinus rhythm. Upon arrival to surgical operating room, 500 ml lactated Ringers solution was dripped intravenously as maintenance fluid after standard monitors were placed. The heart rate was 76 beats per minute, respiratory rate was 18 breathes per minute and the oxygen saturation was 99%. Contiuous epidural anesthesia was performed successfully with 0.5% lidocaine and 0.375% ropivacaine 15ml totally within 15 minutes. Then the patient was placed in lithotomy position and no catheterization was offered because of the short operation period we had anticipated preoperatively although she expressed her micturition desire. The surgery initially proceeded unevenfully with very steady state of hemodynamics. 8,000 mL D5W as the irrigation fluid was delivered throught the hysteroscope by gravity pressure (60cm above the patient), and the irrigation pressure for uterine cavity distending was 150 mmHg. Monopolar electrode system was selected for endometrium resection, and controled the watts of electroresec tion and electrocoagulation within 40 60 watts and 60 80 watts, respectively. Simultaneous ultrasonographic monitoring was used to identify the sickness of uterus wall and uterine cavity size. A total of 1,000 mL of lactated Ringers solution was infused during the 70 minutes of surgery, with a total blood loss of 20 mL. Twenty minutes before the termination of surgery , the patient complainted of difficulty in breathing with simultaneous polypnea, shiver, and sensations of vertigo and nausea. Oxygen saturation dropped from 98% to 90% and recoverd soon after mask oxygen inhalation. Thereupon tramadol 50 mg was administered intravenously, and excellent effect obtained. Approximately 300 mL output of urine when the bladder was squeezed incautiously by ultrasound probe and the patient vomited once just the procedure completed. The patient appeared haziness of spirit-mind but responded appropriately to verbal stimulate. A dorsalis pedis artery blood sample was obtained from the patient , and electrolytes were reported using a blood-gas analyzing device. Results as follows: PH 7.31; Na+, 115 mmol/L; K+, 3.0mmol/L; ionized Ca2+, 0.93 mmol/L; Glucose, 27.8 mmol/L; HCO3—, 18.6 mmol/L. Based on the symptoms mentioned above, TURP syndrome was suspected. An indwelling urinary catheter was inserted immediately and 1,800 mL urine output was collected totlly at twice. A mixture of 50ml 10% saline and 100ml 0.9% saline was dripped to raise sodium concentration, meanwhile metoclopramide 10 mg was used for anti-nausea. But there were no diuretic and insulin used in case of aggravating of hypokalemia. Oxygen saturation maintained in 92% after oxygen mask was removed and with a progressive rise. Vital signs on permission to PACU were as follows: blood pressure, 126/79 mmHg; heart rate, 79 beats per minute; breathing rate, 20 breaths per minute; and oxygen saturation, 96%. The patient was transported to postanesthesia care unit (PACU) for continued treatments and review of blood gas analysis. On our arrival into PACU, arterial blood gas (ABG) analysis was performed when the venous transfusion of the hypertonic saline solution ended, revealing PH 7.36; Na+, 127 mmol/L; K+, 3.0mmol/L; ionized Ca2+, 1.0 mmol/L; glucose, 22.9 mmol/L; HCO3—, 21.5 mmol/L; BE, -3.6 mmol/L. The patient still had low sodium and potassium level from ABG, a mixture of 100ml 10% saline and 100ml 0.9% saline containing potassium chloride 0.5 g was supplemented in low-speed intravenously. Nurse anesthetist was asked to record vital signs every 15 minutes. 16:15~18:05, the patient got her vital signs stablized gradually and oxygen staturation could maintain over 95%. Review of her blood gas analysis showed: PH 7.36; Na+, 137 mmol/L; K+, 3.4mmol/L; ionized Ca2+, 1.0 mmol/L; glucose, 7.2 mmol/L; HCO3—, 23.2 mmol/L; BE, -3.6 mmol/L. The patient recieved 500 ml lactated Ringers solution totally in PACU, with a total urine output of 850 mL(data from PACU anesthetic chart), and sent back to the ordinary ward without any complaints and Alderete scores 10. 2. Discussion Hysteroscopy has gained widely used in diagnostic and therapeutic in gynecologic surgery for many special advantages, but is not devoid of risks especially when hysteroscopy is applied to resection of extensively endometrial lesion. Excessive absorption of irrigation fluid during hysteroscopic surgery from uterine cavity is the main cause of TURP syndrome or water intoxication, of which reported incidence is 0.2% [1]. The TURP syndrome mainly has clinical symptoms in cardiovascular system, respiratory system and nervous system including elevation of blood pressure, bradycardia, dyspnea, pulmonary edema, cerebral hemia and even death. The severity of consequence is associated with multiple factors, analysis of this case were as follows. The patient’s uterine cavity has low compliance and severe adhesion, so an intrauterine pressure (IUP) of 150 mmHg is required to obtain excellent visual conditions of bilateral tubal orifices. 8,000 mL D5W as the irrigation fluid is delivered i nto uterine for uterine distension in 70 minutes operation time. Based on clinical research, the absorptivity of distension media by body is within the range of 10 30 ml/min only when the irrigation pressure is less than 100 mmHg [2]. Therefore, we estimated 700 2,100 mL D5W is absorbed into circulatory system approximately, along with an infusion of 1,000 mL lactated Ringers solution. As a result, 1,700 3,100 mL is administered into blood intravenously at least, and even more. Hyperglycemia caused by excessive absorption of D5W produces hyperglycemic hyperosmolar status and then makes intracellular fluid transfers to outside the cell, which bings about exacerbating of hyponatremia status. The patient received high frequency hysteroscopy procedure in the short term leads to large-scale and severe damage of endometrium, allowing the distension fluid entering into blood circulation more easily, which contributes to hypervolemia in a more faster pace. As one of essential factors, ex cessive irrigation pressure plays a crucial role in distension fuild over absorption in the condition that endometrial venous sinus are widely open in hysteroscopic electric resection. In our case, we have to raise the pressure to 150 mmHg for a clear surgical vision of uterine cavity, therefore, rendering excellent chance for fluid entering into body. No catheterization was performed preoperatively, thus a large amount of fluid accumulates in bladder and circulation system. To sum up, in this case, fluid overload, hyperglycemic hyperosmolar status, high intrauterine pressure, disruption of endometrial vessles and lack of preoperative catheterization lead to a significant increasement of circulating volume and a sharply reduce of plasma colloid osmotic pressure. Extracellular free water in brain are transported from the outside to the inside of the cell, which results in cerebral edema and causes intracranial hypertension. A serious of neurological syndromes develop including dizzin ess, headache, nausea, vomiting, and haziness of spirit-mind. Likewise, as a consequence of irrigation fluid overload and dilution of the plasma protein concentration, pulmonary hydrostatic pressure elevated, leading to the accurrence of acute pulmonary edema and pulmonary interstitial edema. The ventilation/perfusion imbalance occurs, and then manifests in dyspnea, hypoxemia and a sustained downward trend of oxygen saturation, etc. Timely recognition and urgent corresponding treatment measures should be taken in the early course of water intoxication to prevent the condition deteriorated. In a general way, for every liter of hypotonic fluid absorbed, the serum sodium concentration will decrease by 10 mmol/L(10 mEq/L) [3]. The result of ABG analysis of the patient’s dorsalis pedis artery blood sample indicates severe hyponatremia (Na+ à ¯Ã‚ ¼Ã…’à ¨Ã‚ ¯Ã‚ ¥Ãƒ §Ã‚ »Ã‚ ¼Ãƒ ¥Ã‚ Ã‹â€ Ãƒ ¥Ã‚ ¾Ã‚  à ¥Ã‚ ¤Ã¢â‚¬Å¾Ãƒ §Ã‚ Ã¢â‚¬  Ãƒ ¤Ã‚ ¸Ã‚ Ãƒ ¥Ã‚ ½Ã¢â‚¬Å"à ¥Ã‚ Ã‚ ¯Ãƒ ©Ã‚ -à §Ã¢â‚¬ ¢Ã¢â€ž ¢Ãƒ ¦Ã‚ °Ã‚ ¸Ãƒ ¤Ã‚ ¹Ã¢â‚¬ ¦Ãƒ ¦Ã¢â€š ¬Ã‚ §Ãƒ §Ã‚ ¥Ã… ¾Ãƒ §Ã‚ »Ã‚ Ãƒ §Ã‚ ³Ã‚ »Ãƒ §Ã‚ »Ã… ¸Ãƒ ¥Ã‚ ¹Ã‚ ¶Ãƒ ¥Ã‚ Ã¢â‚¬ËœÃƒ §-†¡(à ©Ã†â€™Ã‚ ­Ãƒ ¦Ã‚ Ã†â€™Ãƒ ¯Ã‚ ¼Ã‚ ¶Ãƒ ¯Ã‚ ½Ã…’à ¯Ã‚ ½Ã‚ Ãƒ ¯Ã‚ ½Ã‹â€ Ãƒ ¯Ã‚ ½Ã‚ Ãƒ ¯Ã‚ ½Ã¢â‚¬Å"à £Ã¢â€š ¬Ã¢â€š ¬Ãƒ ¯Ã‚ ¼Ã‚ ®Ãƒ ¯Ã‚ ¼Ã‚ ¦Ãƒ ¯Ã‚ ¼Ã… ½Ãƒ ¯Ã‚ ¼Ã‚ ¨Ãƒ ¯Ã‚ ½Ã¢â€ž ¢Ãƒ ¯Ã‚ ½Ã¢â‚¬Å"à ¯Ã‚ ½Ã¢â‚¬ Ãƒ ¯Ã‚ ½Ã¢â‚¬ ¦Ãƒ ¯Ã‚ ½Ã¢â‚¬â„¢Ãƒ ¯Ã‚ ½Ã‚ Ãƒ ¯Ã‚ ½Ã¢â‚¬Å"à ¯Ã‚ ½Ã†â€™Ãƒ ¯Ã‚ ½Ã‚ Ãƒ ¯Ã‚ ½Ã‚ Ãƒ ¯Ã‚ ½Ã¢â‚¬ °Ãƒ ¯Ã‚ ½Ã†â€™Ãƒ £Ã¢â€š ¬Ã¢â€š ¬Ãƒ ¯Ã‚ ½Ã¢â‚¬â„¢Ãƒ ¯Ã‚ ½Ã¢â‚¬ ¦Ãƒ ¯Ã‚ ½Ã¢â‚¬Å"à ¯Ã‚ ½Ã¢â‚¬ ¦Ãƒ ¯Ã‚ ½Ã†â€™Ãƒ ¯Ã‚ ½Ã¢â‚¬ Ãƒ ¯Ã‚ ½Ã¢â‚¬ °Ãƒ ¯Ã‚ ½Ã‚ Ãƒ ¯Ã‚ ½Ã… ½Ãƒ £Ã¢â€š ¬Ã¢â€š ¬Ãƒ ¯Ã‚ ½Ã‚ Ãƒ ¯Ã‚ ½Ã¢â‚¬  Ãƒ £Ã¢â€š ¬Ã¢â€š ¬Ãƒ ¯Ã‚ ½Ã‚ Ãƒ £Ã¢â€š ¬Ã¢â€š ¬Ãƒ ¯Ã‚ ½Ã…’à ¯Ã‚ ½Ã‚ Ãƒ ¯Ã‚ ½Ã¢â‚¬â„¢Ãƒ 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Ã‚ ¸Ãƒ ¦Ã¢â‚¬ Ã‚ ¶Ãƒ ©Ã¢â‚¬ ¡Ã‚ Ãƒ ¨Ã‚ ¾Ã‚ ¾1000 à ¯Ã‚ ½Ã… ¾2000 ml à ¦- ¶Ãƒ ¥Ã‚ Ã‚ ³Ãƒ ¥Ã‚ ºÃ¢â‚¬ Ãƒ ¥Ã‚ Ã…“à ¦Ã‚ ­Ã‚ ¢Ãƒ ¦Ã¢â‚¬ °Ã¢â‚¬ ¹Ãƒ ¦Ã…“ ¯:Issacson KBà ¯Ã‚ ¼Ã… ½ Complications of hysteroscopyà ¯Ã‚ ¼Ã‚ »Jà ¯Ã‚ ¼Ã‚ ½Ãƒ ¯Ã‚ ¼Ã… ½ Obstet Gynecol Clin North Amà ¯Ã‚ ¼Ã…’1999à ¯Ã‚ ¼Ã…’26(1):39à ¯Ã‚ ¼Ã‚ 51à ¯Ã‚ ¼Ã… ½ )à ¯Ã‚ ¼Ã…’à ¦Ã‚ £Ã¢â€š ¬Ãƒ ¦Ã‚ µÃ¢â‚¬ ¹Ãƒ ¨Ã‚ ¡Ã¢â€š ¬Ãƒ ¦Ã‚ ¸Ã¢â‚¬ ¦Ãƒ ©Ã¢â‚¬â„¢Ã‚   à §Ã‚ ¦Ã‚ »Ãƒ ¥Ã‚ ­Ã‚ Ãƒ ¦Ã‚ µÃ¢â‚¬Å"à ¥Ã‚ ºÃ‚ ¦Ãƒ ¯Ã‚ ¼Ã…’à ¦Ã‚ £Ã¢â€š ¬Ãƒ ¦Ã‚ µÃ¢â‚¬ ¹Ãƒ §Ã¢â‚¬ Ã… ¸Ãƒ ¥Ã¢â‚¬ËœÃ‚ ½Ãƒ ¤Ã‚ ½Ã¢â‚¬Å"à ¥Ã‚ ¾Ã‚ Ãƒ £Ã¢â€š ¬Ã‚ Ãƒ ¨Ã‚ ¡Ã¢â€š ¬Ãƒ ¦Ã‚ °Ã‚ §Ãƒ ©Ã‚ ¥Ã‚ ±Ãƒ ¥Ã¢â‚¬â„¢Ã…’à ¥Ã‚ ºÃ‚ ¦Ãƒ ¥Ã¢â‚¬â„¢Ã…’à ¥Ã‚ °Ã‚ ¿Ãƒ ©Ã¢â‚¬ ¡Ã‚ Ãƒ £Ã¢â€š ¬Ã¢â‚¬Å¡Ãƒ ¯Ã‚ ¼Ã‹â€ 4à ¯Ã‚ ¼Ã¢â‚¬ °Ãƒ ©Ã… ¡Ã‚ Ãƒ ¦- ¶Ãƒ §Ã¢â‚¬ ºÃ¢â‚¬ËœÃƒ ¦Ã‚ µÃ¢â‚¬ ¹Ãƒ ¨Ã‚ ¡Ã¢â€š ¬Ãƒ §Ã¢â‚¬ Ã‚ µÃƒ ¨Ã‚ §Ã‚ £Ãƒ ¨Ã‚ ´Ã‚ ¨Ãƒ §Ã… ¡Ã¢â‚¬Å¾ à ¥Ã‚ Ã‹Å"à ¥Ã…’-à ¯Ã‚ ¼Ã…’à ¥Ã‚ Ã… ¡Ãƒ ¥Ã‹â€ Ã‚ °Ãƒ ¦- ©Ãƒ ¦Ã…“Å ¸Ãƒ ¥Ã‚ Ã¢â‚¬ËœÃƒ §Ã… ½Ã‚ °Ãƒ ¤Ã‚ ½Ã… ½Ãƒ ©Ã¢â‚¬â„¢Ã‚  Ãƒ ¨Ã‚ ¡Ã¢â€š ¬Ãƒ §-†¡Ãƒ ¯Ã‚ ¼Ã…’à ¦- ©Ãƒ ¥Ã‚ ¤Ã¢â‚¬Å¾Ãƒ §Ã‚ Ã¢â‚¬  Ãƒ ¦- ©Ãƒ ¦Ã‚ ²Ã‚ »Ãƒ §Ãƒ ¯Ã‚ ¼Ã…’à ©Ã‹Å" ²Ãƒ ¦Ã‚ ­Ã‚ ¢Ãƒ §-†¦Ãƒ ¦Ã†â€™Ã¢â‚¬ ¦Ãƒ ¦Ã‚ Ã‚ ¶Ãƒ ¥Ã…’-à £Ã¢â€š ¬Ã¢â‚¬Å¡Ãƒ ¯Ã‚ ¼Ã‹â€ 5à ¯Ã‚ ¼Ã¢â‚¬ °Ãƒ ¦Ã…“ ¯Ãƒ ¥Ã‚ Ã… ½ à ¥Ã‚ ¿Ã¢â‚¬ ¦Ãƒ ©Ã‚ ¡Ã‚ »Ãƒ §Ã‚ §Ã‚ ¯Ãƒ ¦Ã… ¾Ã‚ Ãƒ ¨Ã‚ ·Ã… ¸Ãƒ ¨Ã‚ ¸Ã‚ ªÃƒ §-†¦Ãƒ ¤Ã‚ ºÃ‚ ºÃƒ §Ã… ¡Ã¢â‚¬Å¾Ãƒ ¤Ã‚ ½Ã¢â‚¬Å"à ¥Ã‚ ¾Ã‚ Ãƒ ¥Ã‚ Ã‹Å"à ¥Ã…’-à £Ã¢â€š ¬Ã¢â‚¬Å¡ à ¦Ã‚ °Ã‚ ´Ãƒ ¤Ã‚ ¸Ã‚ ­Ãƒ ¦Ã‚ ¯Ã¢â‚¬â„¢Ãƒ ¥Ã…“ ¨Ãƒ ¥Ã‚ ¤-à §Ã‚ §Ã¢â‚¬ËœÃƒ ¦Ã¢â‚¬ °Ã¢â‚¬ ¹Ãƒ ¦Ã…“ ¯Ãƒ ¤Ã‚ ¸Ã‚ ­Ãƒ ¯Ã‚ ¼Ã…’à ¥Ã‚ °Ã‚ ¤Ãƒ ¥Ã¢â‚¬ ¦Ã‚ ¶Ãƒ ¨Ã¢â‚¬ ¦Ã¢â‚¬ Ãƒ ©Ã¢â‚¬ ¢Ã…“à ¦Ã¢â‚¬ °Ã¢â‚¬ ¹Ãƒ ¦Ã…“ ¯Ãƒ ¯Ã‚ ¼Ã…’à ¥Ã…’†¦Ãƒ ¦Ã¢â‚¬ ¹Ã‚ ¬Ãƒ ¥Ã‚ ®Ã‚ «Ãƒ ¨Ã¢â‚¬ ¦Ã¢â‚¬ Ãƒ ©Ã¢â‚¬ ¢Ã…“à £Ã¢â€š ¬Ã‚ TURPà §Ã‚ ­Ã¢â‚¬ °Ãƒ ¯Ã‚ ¼Ã…’à ¨Ã¢â‚¬ ¹Ã‚ ¥Ãƒ ¤Ã‚ ¸Ã‚  à ¤Ã‚ ºÃ‹â€ Ãƒ ¤Ã‚ »Ã‚ ¥Ãƒ ©Ã‚ «Ã‹Å"à ¥Ã‚ ºÃ‚ ¦Ãƒ ©Ã¢â‚¬ ¡Ã‚ Ãƒ ¨Ã‚ §Ã¢â‚¬  Ãƒ ¯Ã‚ ¼Ã…’à ¥Ã‚ °Ã¢â‚¬  Ãƒ ¥Ã‚ ¸Ã‚ ¦Ãƒ ¦Ã‚ Ã‚ ¥Ãƒ ¤Ã‚ ¸Ã‚ ¥Ãƒ ©Ã¢â‚¬ ¡Ã‚ Ãƒ §Ã… ¡Ã¢â‚¬Å¾Ãƒ ¥Ã‚ Ã… ½Ãƒ ¦Ã… ¾Ã…“à ¯Ã‚ ¼Ã…’à ¦Ã¢â‚¬ °Ã¢â€š ¬Ãƒ ¤Ã‚ »Ã‚ ¥Ãƒ ¥Ã…“ ¨Ãƒ ¤Ã‚ ¸Ã‚ ´Ãƒ ¥Ã‚ ºÃ…  Ãƒ ¤Ã‚ ¸Ã…  Ãƒ ¤Ã‚ ¸Ã¢â€š ¬Ãƒ ¦- ¦Ãƒ ¥Ã‚ Ã¢â‚¬ËœÃƒ §Ã… ½Ã‚ °Ãƒ ¦Ã‚ °Ã‚ ´Ãƒ ¤Ã‚ ¸Ã‚ ­Ãƒ ¦Ã‚ ¯Ã¢â‚¬â„¢Ãƒ ¥Ã‚ ¿Ã¢â‚¬ ¦Ãƒ ©Ã‚ ¡Ã‚ »Ãƒ ¥Ã‚ Ã…   à ¦- ¶Ãƒ ¥Ã‚ ¤Ã¢â‚¬Å¾Ãƒ §Ã‚ Ã¢â‚¬  Ãƒ ¯Ã‚ ¼Ã…’à ©Ã‹Å" ²Ãƒ ¦Ã‚ ­Ã‚ ¢Ãƒ ¦Ã‚ Ã‚ ¶Ãƒ ¥Ã…’-à ¨Ã¢â€š ¬Ã…’à ¥Ã‚ Ã‚ ±Ãƒ ¥Ã‚ Ã…  Ãƒ §-†¦Ãƒ ¤Ã‚ ºÃ‚ ºÃƒ §Ã¢â‚¬ Ã… ¸Ãƒ ¥Ã¢â‚¬ËœÃ‚ ½Ãƒ £Ã¢â€š ¬Ã¢â‚¬Å¡ Reference [1] Jansen FW, Verdevoogd CB, Ulzen KV, et al. Complications of hysteroscopy: aprospective multicenter study [J], Obstet Gynecol, 2000, 96 (2): 266 270. [2] Rhymer JS, Bell TS, Perry KC, et al. Hyponatremia following transurethral resection of the postate [J].Br Jurol, 1985, 57(4): 450à ¯Ã‚ ¼Ã‚ 452. [3] Prost AM, Liberman RF, Harlow BL, Ginsburg ES. Complication of hysteroscopic surgery: predincting patients at risk. Obster Gynccol. 2000; 96:517-520 [4] Cooper JM Brady RM. Intraoperative and early post-operative complications of operative hysteroscopy. Obstetric and Gynecology Clinics of North America 2000; 27: 347-365 [5]Romer T. Benefit of GnRH analogene treatment for hysteroscopic surgery in patients with bleeding disorders [J].Gynecol.Obstet Invest,2003,50:112-120. [6]Murdoch JA. Tong JG. Anesthesia for hysteroscopy. Anesthesiol Clin North Am. 2001;19:125-140 [ J ].à ¤Ã‚ ¸Ã‚ ­Ãƒ ¥Ã¢â‚¬ ºÃ‚ ½Ãƒ ¥Ã‚ ¾Ã‚ ®Ãƒ ¥Ã‹â€ Ã¢â‚¬ ºÃƒ ¥Ã‚ ¤-à §Ã‚ §Ã¢â‚¬ËœÃƒ ¦Ã‚ Ã¢â‚¬Å¡Ãƒ ¥Ã‚ ¿-,2009,9(12):1097-109 à ¨Ã¢â‚¬Å¾Ã‚ ±Ãƒ ©Ã‚ «Ã¢â‚¬Å"à ©Ã… ¾Ã‹Å"à ¯Ã‚ ¼Ã… ¡Witz CA, Silverberg KM, Burns WN, Schenken RS, Olive DL. Complications associated with the absorption of hysteroscopic fluid media. Fertil Steril 1993;60:745-56.

Essay --

Influenza or flu is caused by RNA viruses of the family orthomyxoviridae, that affects the nose, throat, and lungs- the respiratory system. The common symptoms are: fever and respiratory problems, such as cough, sore throat,stuffy nose, as well as headaches and muscle aches. Influenza viruses are spread mainly by droplets made from people coughing, sneezing or talking while having the flu. These droplets can land in the mouths or noses of people or can inhaled into the lungs. It is least common for the virus to spread by touching an infected surface then their mouth or nose. Flu viruses are divided into 3 categories, A, B, C. A and B are responsible for problems in the respiratory system that typically occurs during the winter. Influenza types C is quite different from A and B. Type C only cause mild respiratory symptom or none at all. According to CDC, no one knows exactly how many people die from the flu infection each year. There are four main reasons for this. First of all, states are not required to report influenza related deaths that are older than the age of 18. Second, se...

Marijuana Essay -- Agriculture Illegal Drugs Essays

Marijuana The third largest agricultural good in the nation and a ten billion-dollar industry has nothing to do with the agriculture we are use to. This good is Marijuana, an illegal drug. It is "the most widely used illicit drug in America" n(Gold v). In Florida alone, marijuana sales are greater than all businesses except tourism (Gold v). What is marijuana? Marijuana, a plant, known as Cannabis Sativa, labeled that by Carolus Linnaeus in 1753 (Grinspoon 1), is "one of nature's hardiest specimens" (Abel ix). It can survive in any climatic condition possible, and flourishes like weeds do. Marijuana acts like a weed, stealing all the sunlight and nutrients around it. The soil needed for growing marijuana for its intoxicant, is dry thin soil, along with horse or cow manure (Grinspoon 40). It can grow to be from three to twenty feet at maturity (Abel ix), and grows at a rapid speed. Germination of the plants occurs simultaneously. Life shows six days after planting, and after two weeks, strong h ealthy leaves should have grown (Grinspoon 40). The marijuana plant is dioecious, which means that it grows separate male and female plants. The male plant is usually taller than the female plant, and dies after its flowering cycle (Abel 4). The female plant is bushier and "secretes a resin that covers the flowering tops and nearby leaves" (Abel 5). This resin is secreted by glandular hairs that are found on the leaves and is used to protect the marijuana plant from water loss (Gol...

Possible that one can fulfill the responsibilities of a professional role while lacking personal integrity

Turn on hit highlighting for speaking browsers by selecting the Enter button Show highlighting Abstract (summary) Transcendentalist One of the basic tenets of the CPA profession is to serve the public interest. Working with the Winchester County Association and the Business Council of Winchester, it took weeks for the task force of about 20 Caps to attend budget hearings and various meetings, well as to pore over the proposed budget. Caps have much to offer working n concert with local governments.Fiscal responsibility is a shared responsibility among all Interested parties the public, the business community, the private sector, and the government. The difference between a tenuous budget situation and a more stable financial environment could very well be the participation of Caps. As a member of the public, and even more so as a CPA, it is his obligation to get involved. Full text Translated text Turn on search term navigation One of the basic tenets of the CPA profession Is to serv e the public Interest.So as New York State struggles with its fiscal woes – along with at least 35 other states that needed to close budget shortfalls as of press time – who better than Caps to try to help at the local level to reduce the budgetary burden on the taxpayer? This is exactly what happened in Westchester County. Members of the Naysayer's Westchester Chapter volunteered to review Westchester County $1. 8 billion budget and offer insight on how the county could reduce a proposed 4. 9% Increase In taxes.Working with the Westchester County Association and the Business Council of Westchester, It kook weeks for thetas force of about 20 Caps to attend budget hearings and various meetings, as well as to pore over the proposed budget. The project was done pro bono, with each of the volunteers dedicating between five and 10 hours to producing an analysis of the budget. The upshot? The county government formally adopted the $1. 8 billion budget, but county taxes Incre ased by 2. 9% Instead of 4. 9%. Did Caps' Involvement In the dialogue have an Impact? I'd Like to think so.This particular case wasn't about setting policy; it was about setting precedent. As the New York Times noted (Jennifer Stealthier, â€Å"New Year but No Relief for Strapped States,† January 5, 2010), state budgets all across discounter are being prepared with the knowledge that the federal stimulus money that was available last year – and kept many states' proverbial heads above water – is now gone. The tide is rising again. Caps as Part of the Process responsibility is a shared responsibility among all interested parties – the public, the business community, the private sector, and the government.Difference between a tenuous budget situation and a more table financial environment could very well be depreciations of Caps. The reality L's that even Caps can't fix a local government's fiscal woes in one budget year. But you can start now. Become a fam iliar face. Introduce yourself to your local elected and government officials. As a member of the public, and even more so, as a CPA, it is your obligation to get involved. Every government needs a watchdog, including local governments. Watchdogs are not adversarial bulldogs, but they're not passive lapdogs, either.With newspapers laying off Journalists by the thousands, taxpayers are in dire need of financial watchdogs who can help them make sense of the government's numbers. This isn't an indictment of the budgeting process performed by our local governments. This is about governments and Caps working together. Caps are the trusted advisors to businesses that range from the comer newsstand to global corporations. And while businesses are a different animal from governments, there are certainly some similarities, which means that Caps can lend their expertise in an advisory capacity.The federal government, and most states, are in a budgetary crisis. Elected and governmental officia ls are being forced to choose between raising taxes and cutting services. They should have more options. And perhaps they would have those options if more citizens were involved in the budgetary process – especially Caps. Sidebar Who better than CRASS to try to help at the local level to reduce the budgetary burden on the taxpayer?

The journey to my grave

It was a bright Thursday afternoon and it was finally time for recess. I hade just survived double English and all my energy had been drained from trying to stay awake, let alone paying any attention to what was going on in lesson. I made my way out of the classroom and walked down the long corridors of the school building towards my locker- alone. It had only been a week and a half since I had started high school and I hadn't yet managed to make any friends but I had expected it, since I had started a month later than all the other first years. Everyone seemed to already have been divided into his or her groups. I liked keeping to myself, as it was crystal clear I wasn't needed. After placing my books in my locker I made my way to the school canteen. As always there was nothing appealing in the canteen that tempted me so I just helped myself to a chocolate muffin. Having paid for my lunch I made my way to the table in the corner of the hall where I sat everyday- alone. I placed my muffin on the table and sat down to eat. The canteen was filling up and I noticed that every table in the canteen had different types of people seated at it; the cheerleader table was at the front where all the cheerleaders sat. Beside them, was the Ashley table where Ashley's group sat, which beside herself included her two best friends. The sixteen tables behind them were where the ordinary people sat and ate their lunch. Last but not least there were the geeks who sat behind everyone else. Finally there was me and I sat alone, behind everyone else. Since the day I had started high school know one had spoken to me in a friendly manner but only teased me and called me names, so it was a huge surprise when Ashley and her group came up to my lunch table wanting to ask me something. Hey†¦ uh †¦ Megan. How are you? ‘ Oh my god I couldn't believe it. Ashley was actually talking to me. I had to reply, I mean it wasn't everyday Ashley came up to talk to me. ‘Uh †¦ yes†¦ I'm†¦ I'm fine. Thanks for asking. ‘ I could feel my face getting hot, I couldn't believe I was so tongue tied but I wasn't to blame anyone who went to my high school would have been in the state I was in. ‘ Helen can you meet us in the girls lavatory and make sure no one knows you are coming to see us. Its best if know one knows. ‘ It was the happiest days in my life. Having finished my muffin I rushed down to the girls lavatory beaming with joy. Once reaching the girls lavatory I pushed open the door and searched for Ashley and her group. There was know one there so I decided to wait. A little while later they came in and checked if all the cubicles were empty once they were satisfied Ashley asked me the most unexpected question ever. ‘Listen Helen me and the girls were thinking of making our group a foursome and who else would be better to have than you. So do you want to join us? ‘ Of course I did. Who wouldn't? ‘Yeh†¦ sure†¦ I mean I would love to be part of your group. ‘ This was the happiest day of my life, apart from the fact that she didn't know my name properly. I was going to be part of her group and not any old group but Ashley Roberts group. ‘Kool, but as you know this isn't any old group. This is my group,' she really emphasized on the word â€Å"my†, ‘and it is the best in the whole school. So you have to go through a simple initiation test, don't worry we all went through it. If you pass, it means you are worthy of joining our group and if not you go back to what you were. ‘ I should have known there would be a catch. I guess it was worth the try, if I passed I would've officially been part of the best group in the whole school. ‘All you have to do is come to my house tomorrow and stay the night. Katie and Serena' Her two best friends, ‘will also be there. We will tell you what will consist in your test tomorrow when you come round. You can go now and oh yeh I will give you my address tomorrow but remember just don't tell anyone, and I mean anyone about our little discussion. ‘ The final bell of the day rang and it was finally time to go home. I placed my books into my bag and made my way for home. After ten minutes I reached home and let myself in. I could hear my mum rattling the dishes in the kitchen and also talking to my little baby brother. ‘Hi mum, I'm home. Guess what happened today. You wont believe it. ‘ I was dying to tell her that I had made a new friend and that I might have a chance to join her group. ‘Go on tell me what happened today. ‘ ‘Well this girl, Ashley Roberts who is the popular girl in school asked me to join her group but she said I have to pass a little test to see if I am capable of being in their group so she invited me to her house tomorrow for a sleepover. Can I go? I could see the look on her face she wasn't sure about the whole idea. ‘I'm not quite sure about this test thing. ‘ she replied with a worried look on her face. I'm sorry to say this to you but I cant let you go this time I mean you hardly even know her. I'm sure she will understand. ‘ Understand. She thought she would understand. My mother had absolutely no idea about this whole thing. If I didn't get into this group my life would have been over. I would have had to stay a loner all throughout my high school life. ‘But mum' I couldn't let her win this battle not this time my whole high school life was at stake here. You can't do this. You don't understand. You have to let me go, please. ‘ my eyes were burning as tears blurred my vision. I couldn't let her see that she had won so I stormed out of the room slamming the door shut on my way out. I was enraged by my mothers decision of not letting me go to Ashley's house. She just didn't understand that I had to go. It was about my future. I had made up my mind I was going to go to Ashley's house no matter what. There was too much at stake here. I needed to make mum realise that I could take care of my self and nothing would have happened if she had let m go. The next day I came back from school and went straight to my room to pack my clothes for the sleepover. I was going to go to the sleepover no matter what. After packing my things I went downstairs to eat dinner and then told mum I was going to bed early because I was not feeling well. I went to my room and picked up my bag and plucked up the courage to sneak out of the window. I did it I was out I realised that if I stood around I would get caught so I quickly took out Ashley's address and made my way to her house. It was about 6 blocks away from where I lived and took me about twenty minutes to get there. Once I reached her house it was seven thirty. Before I could actually knock on the door Ashley came and opened the door. Without saying a word she took me to her room as if she didn't want anyone to know I had arrived. There I met both Katie and Serena too. I was told by Ashley that I had to keep my voice down as her parents weren't aware that I was present in the house. For some odd reason I began to regret that I had come to Ashley's house. I was here now and I had to go through with whatever the girls had in plan as my initiation test. Ok listen Helen. We have all decided what your test should be based upon. Let me warn you though it is going to be quite hard. The girls don't think you will be up to the challenge. ‘ It was Ashley talking. Oh no the thing I had been dreading most. Well at least I wont have to do anything in school which could embarrass me. So I guess the girls had spared me the humiliation. ‘Just tell me what you want me to do. Don't worry I'm up to it. By the way my name is Megan. ‘ I had come this far I wasn't going to let myself down now. ‘That's the spirit. Well we have decided to test how brave you are so we have decided that tonight being a Friday the thirteenth your test will be that you have to go to the near by grave yard and sit next to a grave for a whole hour, and before leaving place a flag, which we will give to you, on the surface of the grave so that we know that you actually stayed there. As proof that you did stay there for a whole hour we will give you a stop watch which you will start as soon as you sit next to the grave and bring back to us when your time is up. ‘ I got the shock of my life when I heard what I had to do. I should have stayed home and done as I was told, I guess I now realised that my mum was right. By coming here I have only landed my self into more trouble. I couldn't let myself down. I wanted to be in the group so desperately now. Ashley told me that we were going to leave at exactly eleven thirty so that we would be there a little before twelve. While I would be inside the grave yard Katie, Serena and Ashley would go back home and then come back to collect me. They also told me I had to sit next to a specific grave, it was Jack Hunters. Rumours have it that on every Friday the thirteenth anyone who sits next to Jacks grave, and is still there by midnight, has his or hers soul pulled out from their body and into jacks grave. Many people have tried to sit next to jacks grave but have never returned. ‘Come on its time to go. ‘ Called out Katie in a silent whisper. It was time for my test and no matter what I wasn't going to back out from it. The four of us crept downstairs and made our way out of the house without making a single noise. The street was dark with only a few light lamps in the far distance which shone some light on the path we were taking. We finally reached the main gates to the entrance of the grave yard. I was told to climb over the gates. When I had climbed over I realised that I was on my own from here on. Serena told me that the grave I was meant to sit next to was at the far end and will fall on my right hand side. I saw the girls making their way back and I knew I couldn't follow them. I had to lead in the opposite direction. There were still five minutes to twelve as I sat down and made my self comfortable. All this jack and the whole soul pulling thing was all made up, I knew it. How can a dead person who mind you doesn't even have a soul of his, own possibly take another persons. It was insane, it was a story which had crossed its limits. None of it was true. It couldn't be. Could it? At this stage I was talking to myself. I began questioning my own beliefs. I looked at my watch to see how much time had gone by. I couldn't believe it, only two minutes had passed since I had started the stopwatch which was given to me. All of a sudden I felt something behind me, as if it were breathing heavily onto my neck. I was too afraid to look back. I wanted to run. Run free from this place-I was being held down. Something had paralysed me, I couldn't move. I tried harder- nothing happened. In my struggle to break free from the web of danger I was in I caught a glimpse of the time and it was exactly twelve. It was happening to me. My soul was being sucked into Jacks grave. My ribs were hurting me so badly. My whole body felt as if it were being forced into a tiny hole. My whole body was overlapping it self and I could do nothing. I needed air. I was running out of air. When I tried breathing in big gashes of air to maybe prolong my death, nothing happened. All I could do was wait for my life to end. I remembered mum, I wondered what she was going to go through. I should have listened to her. She was right but I was so arrogant and selfish that I had to have my way. I hope she could forgive me as all she had in the world were me and my little brother. There it happened. Exactly on that thought. I breathed in my ounce of air. Jack finally got what he had wanted-his soul, my soul. I Megan Taylor till today regret entering the gates of the grave yard I entered three years ago, and till this day I regret it. Little did I know at the time that the friend I thought I had gained, planned this malicious act of indecency.