Alexander the Great’s Legacy

Alexander the Great was one of the best generals the world has ever seen. His determination helped him spread the Greek culture (also called Hellenism) throughout his empire. In a short thirteen years, Alexander conquered the Persians and controlled one of the biggest empires in history. Lead by his fathers prejudice against the Persians and notorious temperament has lead many historians to wonder, was Alexander really great? Alexander's first battle was with the Persians at Granicus River in 334 B. C. E. By the following spring, Alexander controlled the entire western half of Asia minor. The Persian king, Darius the third, tried to stop Alexander but failed at Issus in 333 B. C. E. After his victory Alexander then turned south and by the winter of 332 B. C. E, Alexander controlled Syria, Palestine, and Egypt. In 331 B. C. E Alexander once again fought the Persians at Gaugamella in the Northwest of Babylon. After his victory Alexander entered the Persian capitols of Susa and Persepolis and plundered all of the gold and treasures of the city. Not satisfied with his victory over Persia, Alexander continued to pursue the Persian king Darius the third only to find that he had been killed by one of his own men. This lead Alexander to turn east to India. Exhausted and weary of yet another battle, Alexanders men mutinied against him and forced him to retreat from India. Alexander had created one the biggest empires the world has seen, but unable to leave an heir, it fell just as quickly as it rose after his death at the age of 32. Some speculated that fever or excessive alcohol consumption lead to his death, others believe that he was poisoned. Weather he had plans for a world empire are unknown, but in his fathers final wishes he reported to tell Alexander to † expand your empire for the one I left you is not enough. † Was Alexander really great? Alexander was a self proclaimed decedent of the Gods, claiming that he was related to Hercules. He was known to murder close Friends and advisers if they opposed his wishes and had a ferocious temper. By the end of his reign, Alexander has slaughtered thousand whose only crime was being in his way. His temperament leads one to believe that his armies succeeded for fear of Alexander rather than his leadership. However, Alexander's legacy was profound. He destroyed the Persian empire and and spread Hellenism throughout the lands. Without Alexander, the Greek culture would have fell and died alongside the empire. References: 1. â€Å"Alexander the Great†. Joseph Cortelli. Historyofmacedonia. org Web. 13 July, 2013 2. William J. Duiker, Jackson J. Spielvogel. Cengage Learning: World Civilizations 1. 2009 Manson, Ohio.

Eight Elements of Communication Essay

With the importance of communication placed on the development of the human society, it is indeed necessary to understand the different elements that make it sensible for creating the necessary involvement within the human communities around the .world. To have an overview and understanding of the said elements, this paper shall discuss the different impacts of the elements upon the improvement of human relations within a globally connected society. Â  The discussion of the eight elements shall be discussed separately to individually identify their strong effects on the developmental procedures of the human society. (A) Message Sending Approach Every conversation begins in the process by which the speaker sends the message to the listener. The procedure by which the listener catches the message however depends on the process by which the sender sent the idea that he wants to convey to the listeners. (B) Receiving the Message As it could be observed, the ways by which the listener receive the message depends on the way the speaker primarily sent the idea through the approach that he made in the speech that he adapted while sending the message. (C) Evaluating the Message Evaluation of the message depends on the listener’s background regarding the idea being sent to him. It is through this background that he is able to make careful amends with the ways on how he is to evaluate the idea shared to him through conversation. (D) Understanding the Message Understanding involves the capability of the listener to make connection between the message and what he already knows about the topic being presented in the conversation. (E) Responding to the Message The response that the listener makes on the message that has been sent to him depends on how far he was able to understand the idea that is presented to him. Responding is the way by which the conversation is brought towards the development of continuum. (F) Making the Conversation Work The exchange of thoughts makes conversations work. The effective use of the different elements of communication makes it possible for the listener and the speaker to continue exchanging their ideas. (G) Sending the Right Message through Body Language At some point, the body language of the person speaking coveys at least 40% of the words that he is actually speaking. It is through this that people are able to make amends on the different flaws that the speaker makes during the conversation. (H) The use of Facial Expressions If body language gives 40%of the speech being sent, facial expression at least shares a 20% of the message that is sent to the listener. Through the enumeration and definition of the eight elements of communication, it could be noted that conversations are bound to become effectively disposed through the different background and bodily presentations of the message on the part of both the listener and the sender of the message. Being able to do so makes it possible for people to constantly create possibilities in making conversations work for the best results for the ones involved in the discussion.

Cellphone Addiction

Negative effects of cell phone addiction include isolation and unbalanced priorities. There are effective solutions for treating the addiction, once you identify the symptoms. Symptoms of Cell Phone Addiction Take a step back and ask yourself how important your cell phone is to your day. If your phone use reduces the quality of your life, you may have an addiction. Perhaps you carry the gadget around with you even when you do not leave home; you look at the screen as you walk and constantly check it for missed calls. Another symptom is you feel the need to have the device with you at the dinner table and look at apps rather than talking to family members over meals. Is your cell phone constantly in your hand or within your line of vision? You obsess over the item; your obsession is a cell phone addiction. Look at your phone bill. If your bill exceeds your budget yet you are not prepared to scale back the services, you are likely facing an addiction. Another factor to consider is whether the gadget is getting in the way of your social life. Perhaps you cancel lunches with friends in favor of staying home to keep up with social networks via your mobile. When the device gets in the way of your real life events in a negative way, you likely have a cell phone addiction. Causes There are many causes of the addiction. The cell phone may be just one part of a larger addiction to technology in general. After all, many smartphones are equipped with apps to play games, browse the internet, and send emails. Online social media networks are growing rapidly. There are several, with the big players including Facebook, Twitter, and Pinterest. Your friends and family members are joining networks too. You often â€Å"talk† to one another on the networks as your schedules keep you too busy to meet face to face. If you have made new online friends through the networks, your cell phone provides a way to connect with these people when they live in other cities and even in other countries. You trade media links, such as articles and photos. The interaction is fun and you begin to spend more time daily on your mobile device. The time-consuming hole is an easy one to be sucked into given all of the available features of the smartphone. http://christywrites. hubpages. com/hub/cell-phone-addiction-the-symptoms-and-methods-of-treatment Cellphone Addiction Negative effects of cell phone addiction include isolation and unbalanced priorities. There are effective solutions for treating the addiction, once you identify the symptoms. Symptoms of Cell Phone Addiction Take a step back and ask yourself how important your cell phone is to your day. If your phone use reduces the quality of your life, you may have an addiction. Perhaps you carry the gadget around with you even when you do not leave home; you look at the screen as you walk and constantly check it for missed calls. Another symptom is you feel the need to have the device with you at the dinner table and look at apps rather than talking to family members over meals. Is your cell phone constantly in your hand or within your line of vision? You obsess over the item; your obsession is a cell phone addiction. Look at your phone bill. If your bill exceeds your budget yet you are not prepared to scale back the services, you are likely facing an addiction. Another factor to consider is whether the gadget is getting in the way of your social life. Perhaps you cancel lunches with friends in favor of staying home to keep up with social networks via your mobile. When the device gets in the way of your real life events in a negative way, you likely have a cell phone addiction. Causes There are many causes of the addiction. The cell phone may be just one part of a larger addiction to technology in general. After all, many smartphones are equipped with apps to play games, browse the internet, and send emails. Online social media networks are growing rapidly. There are several, with the big players including Facebook, Twitter, and Pinterest. Your friends and family members are joining networks too. You often â€Å"talk† to one another on the networks as your schedules keep you too busy to meet face to face. If you have made new online friends through the networks, your cell phone provides a way to connect with these people when they live in other cities and even in other countries. You trade media links, such as articles and photos. The interaction is fun and you begin to spend more time daily on your mobile device. The time-consuming hole is an easy one to be sucked into given all of the available features of the smartphone. http://christywrites. hubpages. com/hub/cell-phone-addiction-the-symptoms-and-methods-of-treatment

Statistics and Ethics Essay Example | Topics and Well Written Essays - 1500 words

Statistics and Ethics - Essay Example These issues arise from the initial stages, intermediary and final stages. The initial stages comprise of formulating the goals and objectives of the research, design and data collection, this stage major ethical challenge is due to the political influence, personal beliefs and other influential people who intend to limit the ethical nature of the research. Intermediary stage comprises of data organization, the analysis, and presentation. The major issues in this stage are poor handling of data leading to data tampering and poor interpretation of data that lead to false results. Finally, in the final stages, most statistical conclusions and inferences are mistaking correlation with causality and misinterpretation of data to ensure benefits of some benefactors. These ethical issues are based on deception or discrimination of which decision is better than the other is. Cases of Statistical Issues and Responses Based on Ethics Theories Personal values are very important when an individu al is faced with a dilemma situation. The individual’s decision-making is based on the source of his personal values. These values result in the need to lie or not to lie based on the ethical theory he derives his personal values. The following are cases that portray the relationship of personal values and ethical theories in their decision-making. A person’s values derived from rights theory will decide not to deceive if he acknowledges that deception would violate the rights of an individual.

Case Presentation Pathophysiology Research Paper

Case Presentation Pathophysiology - Research Paper Example Coronary artery disease mostly occurs due to atheroma formation and its complications like thrombosis and rupture of atheroma. The arteries can also becomes diseased due to other conditions like polyarteritis, aortitis, connective tissue disorders, congenital anomalies like anamolous coronary artery origin, coronary artery malformation and fistula formation (Zevitz, 2006). Atheroma or atherosclerosis is the patchy focal deposition of plaques in the intima of the arttherosclerosis can affect any artery in the body and coronary arteries are at maximum risk for development of the disease (Maseri et al, 1992). Atherosclerosis begins to develop in the second or third decade of life. Thereafter it gradually progresses. Monocytes which circulate in the blood migrate into the intimal layer of the arteries. After reaching there, they take up low density lipoproteins after oxidization in the plasma. These are then known as lipid-laden foam cells (Zevitz, 2006). When these foam cells die, lipid s are released which develop fatty streaks on the intimal wall. This triggers migration and proliferation of the smooth muscles of the artery wall to form plaques. Over a period of time, collagen rich fibrous tissue surrounds the plague and forms mature fibrolipid plague. These plagues are dangerous because they can either rupture or create a fissure on the intima, allowing blood to enter the fissure. Entry of blood causes disruption of the arterial wall which leads to compromise of vessel lumen, thrombosis and also vasospasm, all of which contribute to decreased blood flow through the vessel. Rarely, the rupture of vessel can cause complete occlusion of the artery resulting in acute coronary artery syndrome (Zevitz, 2006). There are several risk factors which can cause ischemic heart disease, the most which is advanced age. This is because; as the age progresses, the size and the number of plaques increase. Other risk factors include male sex, family history of ischemic heart disea se, hypercholesterolemia, hyperlipidemia, smoking, obesity, hypertriglyceridemia, hyperfibrinogenemia, sedentary lifestyle, diabetes, hypertension, low levels of antioxidants, and poor eating habits (Zevitz, 2006). Ischemic heart disease can manifest as one or more of the following: angina, heart failure, myocardial infarction, arrhythmias and sudden death. Of these angina and myocardial infarction are common. Angina occurs due to imbalance between oxygen demand and blood supply to the heart muscle. The most common manifestation of angina is chest pain (Alaeddini and Shirani, 2006). Angina is caused due to chemical and mechanical stimulation of the sensory afferent nerve endings in the myocardium and coronary arteries. The main mediator of angina is adenosine (Alaeddini and Shirani, 2006). Whenever atherosclerotic plaque decreases the lumen by atleast 50 percent, angina manifests whenever there is increased oxygen demand. When more than 90 percent is blocked, angina manifests even i n rest (Alaeddini and Shirani, 2006). Investigations useful to diagnose angina are graded exercise stress test, stress echocardiography, myocardial perfusion scintigraphy tests, Coronary artery calcium scoring, electrocardiogram, stress electrocardiogram, ambulatory electrocardiogram, selective coronary angiography and intra-aortic balloon counter pulsation. Main treatments include nitroglycerine, betablockers, calcium channel blockers,

Aviation Essay Example | Topics and Well Written Essays - 750 words - 3

Aviation - Essay Example This paper will discuss the design of Eurocopter x3, comparing it to conventional designs with reference to aerodynamics. Conventional helicopters have a rotor that is supported above the body/fuselage of the craft. The rotor rotates at high speed to provide the lift required for vertical take off and landing (Watkinson, 2004). In addition, the rotor provides the thrust to make the craft move horizontally and laterally. In addition to the main rotor, the conventional helicopter has a tail rotor to develop thrust in addition to countering the torque produced by the main rotor (Watkinson, 2004). Alternatively helicopters may be fitted with ducted fans or NOTAR systems to perform the same functions. This however, is not the case with Eurocopter’s x3. The Eurocopter x3 Demonstrator is a machine that has been designed as a foundation for the Hybrid Helicopter. What this basically means is that the machine integrates the principles of the helicopter with those of fixed wing crafts with the result being optimized performance. The x3 is based on the design and features of existing models with the main additions being two short wings and the lack of a tail rotor (Vion-Lanctuit, 2010). In addition, each of the two short wings bears a propeller. The x3 has objectively been designed to have the main rotor to provide lift and thrust like other helicopters. The main rotor has five blades which means it has the capacity to provide higher lift and thrust compared to those that have two blades, other factors held constant. The two propellers supported by the short-span fixed wings provide additional thrust thus allowing the machine to achieve speeds that conventional helicopters cannot. Owing to these additional features, the helicopter can reach speeds beyond 230 knots or 267 mph (Whittle, 2012). This speed far exceeds the speed achievable by conventional helicopters which stands at about 140 knots or 160mph at the

Isalmic Studies Essay Example | Topics and Well Written Essays - 1000 words

Isalmic Studies - Essay Example Be it in-law or in blood. Thus, Shi'ites could have descended from the bloodline of the prophet Muhammed, peace upon him. This poetic piece of the Qur'an is quite glaring substantiation to the idea of the Shi'ite. Their shadows may mean descendants, mornings may mean children and young ones, and afternoons may mean the middle and old aged. "And to Allah (alone) falls in prostration whoever is in the heavens and the earth, willingly or unwillingly, and so do their shadows in the mornings and in the afternoons (Surah 13:15), and "whosoever is saved from his own covetousness, such are they who will be the successful" (Surah59:9) In the 7th century, after the death of the prophet Muhammed, peace upon him, a void was left to his position as a leader of a Sunni community. It is a population of believers in Islam. This was initially filled by his friend and father-in-law Abu Bakr. He is the father of Aisha who is the second wife of Muhammed, peace upon him. After Abu Bakr, the leadership was passed on to three more unidentified Muslims. The same post was accepted by Ali the son-in-law of Muhammed, peace upon him. He is the husband of Fatima. Fatima was the daughter of Muhammed, peace upon him, with Kadija. Kadija was the first wife of Muhammed, peace upon him. ... al, 1989). Khawarij in Arabic Kharijite meaning one that departs, dissenter, a member of a Muslim secessionist sect establishing a radically democratic reform community in the 7th century (Webster's Third New International Dictionary, Unabridged). It can then be synonymous to Shia. It is a group originating in the controversies over leadership of the community (The Encyclopaedia Americana International Edition USA, 2002).There were two contenders to the Caliphate then. First the Umayyad's who were a family of power (Perry, 1989). They succeeded in assuming the leadership. Second the Shi'a, Shi'ites, proponents of ascendancy (Perry et. al, 1989). They must be the descendants of the prophet Muhammad, peace upon him. They tried but failed to retake the post (Perry et. al., 1989). Eventually they turned out into Khawarij because they departed. They established a radically democratic and puritanical reform community (Webster's Third New International Dictionary, Unabridged). They adopted some philosophies. They evolved practices different from those of traditional Muslims, known as the Sunni. They did not acknowledge the Umayyad's (Perry et. al. 1989). Over the years, the Umayyad's held the highest position of the caliphate. It gained the support of the greater part of Muslims who were all Arabs (Perry, 1989). So, they to all intents and purposes made extensive triumph escalating Muslim dominion. However, the Umayyad's never saw their inaccuracy. First, it repositioned the Muslim seat of power from Mecca to Damascus in Syria. Second, it gave only Arabs the holdings of prominent positions in the hierarchy. This was to the bitterness of its new members. They were

To analyze the process of Argos' shopping design and supply chain, and Essay

To analyze the process of Argos' shopping design and supply chain, and to implement a business process improvement (My subject - Essay Example They include customer service, procurement, and manufacturing, each of which directly impact into the firm’s performance. They are also classified according to whether they are key or secondary processes; key processes directly impact upon the firm’s mission and strategies (Radhakrishnan & Balasubramanian, 2008). Companies that deliver goods more frequently use methods and techniques involving materials movement and processing. Compared to companies that deliver services, manufacturing and merchandising businesses are more involved in the manipulation of physical resources, and therefore have systems that (1) source raw materials, (2) determine the economic quantity and cost of ordering from suppliers, (3) set standards of quality of materials to be sourced, (4) determine the mode of transportation and the conditions requisite in these various modes, and (5) provide the proper storage facilities with the requisite environmental conditions for as economical a cost as pos sible. These functions pertain to the supply chain, which involves the acquisition and processing of material goods, and their transformation into a form that customers may use. The supply chain also involves making goods available in their present form to the consumers who have need for them. For any manufacturing or merchandising business, the supply chain is ‘a global network of organizations that cooperate to improve the flows of materials and information between suppliers and customers at the lowest cost and the highest speed’ (Govil & Proth, 2002, p.7). The supply chain’s overriding goals is the maximization of customer satisfaction, which strategically is the ultimate objective of the business organization. Efficiencies that may be developed in a firm’s supply chain may result in competitive advantages that other firms may not find easy to imitate (Suhong, et al., 2006). This study will explore the operational processes of an actual firm, specifical ly Argos Ltd., subsidiary of the Home Retail Group. The supply chain management of the company will be the focus of the investigation. The objective of the study shall be to describe and evaluate the various operational processes that are undertaken in the course of managing the supply chain, from the time orders are originated with the suppliers to the moment the product is delivered to the consumers who are ultimately the end users. Argos was chosen as the subject of this research, because its merchandising retail operations provide a variety of opportunities and situations to observe the movement of materials and their distribution to the intended market throughout the length of the supply chain system. The case study enables an indepth analysis of the company, to the extent that secondary data is available, in furtherance of understanding the principles of supply chain management. Chapter 2: Literature review and background Literature review The academic literature on supply cha in management is substantial, prompted by the interest of manufacturing operations managers as to how they may improve efficiency and increase customer satisfaction with their products. The studies focus on various important aspects of supply chain management. Karadeniz (2009) draws attention to the importance of the retail site selection and its relation not only to the market

Climate Change Essay Example | Topics and Well Written Essays - 1750 words

Climate Change - Essay Example The milankovitch theory implies that over time three cyclic events vary the amount of solar radiation that reaches the earth and eventually it causes climate change. According to Burroughs (2007) eccentricity is a cyclical variation that determines the shape of the earth’s orbit around the sun. The more elliptical the earth’s orbit is, the greater the the greater the variation in solar energy that is received at the top of the atmosphere between the earth’s perihelion and aphelion. As the earth rotates on its axis, it wobbles hence changing the timing of the solstices, and equinoxes a process known as the procession of the equinox. Volcanic eruptions eject large amounts of sulphur dioxide gas which reacts water vapor found in the stratosphere to form a dense layer that reduces atmospheric transmission of sun’s incoming radiation. Sun spots, which are caused by the sun’s magnetic field are dark, planet sized regions that appear on the sun’s su rface. These regions are colder than with an average temperature of 4,000K. Climate change can be explained by these factors although they are only some of those which cause climate change. Since 1979, the summer polar ice cap’s size has shrunk more than 20% and this has not only affected the natives but the globe as a whole. The contraction of the arctic ice cap accelerates global warming since the protective, cooling layer over the arctic is melting and hence the earth absorbs more sunlight (Kininmonth 2004). If the arctic is warmer, this will affect weather patterns since the rest of the world will also warm up and eventually food production will decrease. In contrast, most of the world depends on melted glaciers for fresh water supply through lakes and rivers hence their melting will cause short supply of the same. It will also cause shortage of electricity since a great percentage of the world’s population depends on melting glaciers for hydro electric power. Animals, birds and fish will lose their

Slaughter and the Speckled Band Essay Example for Free

Slaughter and the Speckled Band Essay The Two works that I am comparing for this essay are Lamb to the slaughter by Roald Dahl and the Speckled Band by Sir Arthur Conan Doyle. The Speckled band is a stereotypical Sherlock Holmes murder mystery written in 1892 and Lamb to the Slaughter was written some 60 years later by Rhoald Dahl in 1954. We can therefore safely expect their to be many differences in plot and language and some themes, but both share the common themes of murder. Both texts are murder mysteries but there is a single important difference. In TSB we are encouraged to find the solution to the murder by assembling our evidence from the text and drawing conclusions as we see fit. There is, though, a red herring clue included to throw the reader, the most obvious example being the presence and the close association of the Gypsies with Dr Roylott. In LTTS we know who has committed the murder and the details, but the fun is in seeing if she will get caught. Both pieces of text have unusual murder weapons but this is a norm with murder mysteries which continues to this day; the Jonathon Creek series being a popular notable example. The characters in both texts are well worth a mention. In TSB the characters are predictable. The strong, brutal male, Dr Roylott is the murderer and the emphasis is less on who and more on how. I dont think that Sir Arthur Doyle would be allowed to get away with this in either the present day climate or the climate of 1954. Just as Dr Roylott is an obvious murder suspect Helen Stoner is the obvious damsel in distress. The dragged out description of her and her features describe a woman with a figure of thirty but starting to sprout premature grey hair. In TSB the characters are subject to a much longer introduction and time of description. Rhoald Dahl does not do this and hardly describes Mary Maloneys physical appearance at all leaving each individual reader to draw his or her image. The reader though cannot disagree on the mindset of Mary Maloney; she is obsessed with her husband and routines. Even though TSB is written in the first person I think we can still tell more about Mary Maloneys character. Sir Arthur Doyle has not delved too deeply into Dr Watsons thoughts and this is deliberate. The only think that Sir Arthur Doyle concentrates on in Dr Watsons subconscious mind is his admiration of Sherlock Holmes, after all they are the Sherlock Holmes series of books and Dr Watson is only a clever literary narrative tool. In LTTS the characters are less predictable. We know that Sir Arthur Doyle did once try to make his characters actions unpredictable to the extreme by killing off Sherlock Holmes but the pressure of public opinion forced him to resurrect his most famous character. The murderer this time is not the brutal male but the supposedly timid housewife. Notice also that the sex of the murderer has changed. It would be fair to say that this would mirror a change in the opinion of the role of women, there gaining of the vote and there rise to equals of the male sex. The feelings and sympathies we have with the murderers is also worthy of attention. We feel sorry for Mary Maloney up to a point in LTTS because she is six months pregnant and we sympathise with her shock and we recognise that her murder was more of a spur of a moment murder rather than a carefully constructed and well executed murder plot as is the case with DR Roylott. The point where I no longer feel sympathetic was when she laughed at the very end of the text. This displayed a deeper evil that had gone unnoticed before in the text. The feelings we feel for the victims are very different. In TSB we feel sorry for the victim in the text, Helen Stoners sister, who is in the prime of her life and is about to get married. This increases our hatred of Dr Roylott. The victim in LTTS is a man who is leaving his wife who is six months pregnant. His conduct up to the point of his death is rude and arrogant. He uses monosyllabic answers to firmly control his wife. Also when he leaves his wife he is more worried about the effect it may have on his job. We are not too sorry to see him go. The two pieces do have a number of similarities. They both have unusual murder weapons and they both remind us that even respectable, or in the case of Dr Roylott once respectable members of the community can kill, whether that is because of financial or personal reasons. They share common themes such as murder, murder mystery and deceit.

Symptoms of Disseminated Intravascular Coagulation (DIC)

Symptoms of Disseminated Intravascular Coagulation (DIC) Pathophysiology Disseminated intravascular coagulation (DIC) is an acquired syndrome that occurs when a stimulus pathologically activates intravascular coagulation and fibrinolysis resulting in an unbalanced hemostasis (Cunningham, 1999; Huether McCance, 2008; Wada, 2008). The initiation of DIC starts with the release of tissue factor (TF) by the endothelial cells or white blood cells (WBCs). TF are present on many different cell types including lungs, brain, and placenta. The release of TF is subsequent to a variety of causes including trauma, ischemia, excessive metabolic stress, tumors, infectious organisms, exposure to cytokines and endotoxins (Baglin, 1996; Vinay, Abul, Nelson, Richard, 2007). The release of endotoxin is the means by which gram-negative sepsis triggers DIC (Vinay et al., 2007). These endotoxins are a structural component in gram-negative bacteria released when the bacteria are lysed. TF then reacts with coagulation factor VII leading to the common pathway and activation of co agulation factor X (Huether McCance, 2008, p. 498). This complex pathway leads prothrombin to convert to thrombin, which transforms fibrinogen to fibrin (Huether McCance, 2008, p. 542) Excess activation of the coagulation pathway results in an overload of circulating thrombin leaving numerous fibrin clots in circulation (Cunningham, 1999). Fibrinolysis is also decreased during DIC. The main component of fibrinolysis is plasmin, a fibrin-eating enzyme that is activated by the clotting pathway to control the fibrin clots in the vessels (Huether McCance, 2008). These micro-thrombi in the vasculature of organs cause tissue ischemia and dysfunction. Although fibrinolytic properties are present in the body, production is inadequate to control the systemic deposits of fibrin clots (Cunningham, 1999; Huether McCance, 2008). DIC also places the patient at risk for hemorrhage due the rapid consumption of platelets and coagulation factors result in primary hemostasis failure (Bliss Wallace-Jonathan, 2008; Huether McCance, 2008). The failure and dysfunction of both the formation and stabilization pathways of clots bleeding from multiple sites are seen (Bliss Wallace-Jonat han, 2008). Relevant Signs and Symptoms The signs and symptoms of disseminated intravascular coagulation present in a multitude of possibilities. In this specific patient with gram-negative sepsis leading to DIC may present with spontaneous bruising, prolonged bleeding from venipuncture sites, and bleeding from three different sites. There are also many other possible sites including the nose, gums, mucosa, eyes, arterial lines, or surgical wounds (Bliss Wallace-Jonathan, 2008; Wada, 2008). Depending on where the fibrin clots have deposited, other symptoms may manifest as ischemia or organ failure occurs such as in the kidneys, heart, lungs, or in the brain. There is a possibility of hemorrhaging into a closed compartment, which may lead to shock (Huether McCance, 2008). Lab values during DIC are also of great importance. There is no specific test for DIC but a combination of PT (prothrombin time), aPTT (activated partial thromboplastin time), fibrinogen, platelet count and d-dimmer are used to assist in the diagnosis of DIC (Cunningham, 1999). Since many disorders can cause an increase of each of these lab values, it is important to use the whole picture to make the diagnosis. Treatment Treatments for DIC focus on elimination of the cause, controlling the coagulation and formation of clots, and maintain or return organ function (Huether McCance, 2008). In this case study, the elimination of the gram-negative bacteria is one treatment. This essential treatment of antibiotic therapy has already started one hour ago. Another course of treatment is administration of blood products to resupply the body with the depleted clotting factor, platelets, thrombin, and plasmin in an attempt to reduce or eliminate the bleeding (Bliss Wallace-Jonathan, 2008). Administration of fresh frozen plasma (FFP) along with cryoprecipitate and platelet concentrates replaces the clotting factors in patients with active bleeding (Bliss Wallace-Jonathan, 2008). Research on heparin use in DIC found successful in the treatment of DIC in some patients in an attempt to reduce the coagulation pathway activation though not recommended in septic DIC (Huether McCance, 2008; Bliss Wallace-Jonathan, 2008). Clinical trials have made a case for the specific treatment of septic DIC. Antithrombin III appears to be an effective treatment (Bliss Wallace-Jonathan, 2008; Huether McCance, 2008). Organ function requires fluid resuscitation for restoration of blood pressure as well as urine and cardiac output. Outcomes Prognosis varies depending on the underlying disorder. The outcome also depends on the magnitude of thrombi in the vascular system. The patient has a 10%-50% chance of dying with the diagnosis of DIC (Wada, 2008). The rate increases in patients with sepsis though there still is a possibility of a positive outcome. With rapid detection and treatment, DIC can be reversed. Conclusion Disseminated intravascular coagulation (DIC) References Baglin, T. (1996, March 16). Disseminated intravascular coagulation: diagnosis and treatment. British Medical Journal, 312, 683-688. Retrieved from www.galegroup.com Bliss, T. T., Wallace-Jonathan, J. (2008). Hematological and coagulation changes in sepsis. In Competency-based critical care (pp. 17-25). doi: 10.1007/978-1-84628-939-2 Cunningham, V. L. (1999, July). A review of disseminated intravascular coagulation: presentation, laboratory diagnosis, and treatment. Medical Laboratory Observer, 31(7), 42-50. Retrieved from www.generalonefile.com Huether, S., McCance, K. (2008). Understanding pathophysiology (4th ed.). St. Louis, MO: Mosby Elsevier. Vinay, K., Abul, A. K., Nelson, F., Richard, M. N. (2007). Robbins basic pathology (8th ed.). St. Louis, MO: Saunders Elsevier. Wada, H. (2008). Disseminated intravascular coagulation. In Recent advances in thrombosis and hemostasis 2008. doi: 10.1007/978-4-431-78847-8