who was the last confederate soldier to surrender?

"The Surrender of the Confederate Armies""The final campaign of the Army of Northern Virginia began March 25, 1865, when Gen. Robert E. Lee sought to break Gen. Ulysses S. Grant's ever-tightening stranglehold at Petersburg, Va., by attacking the Federal position at Fort Stedman.

The assault failed, and when Grant counterattacked a week later at Five Forks, 1-2 April, the thin Confederate line snapped, and Lees skeleton forces abandoned Richmond and Petersburg. Although fighting would continue for the next week, it would be to no avail. Lee was beaten and would ask for surrender terms on April 9. ""This is what most consider to be the end of the Civil War. However, while the war in the East was over, there were still Confederate armies under arms elsewhere. When Lee surrendered to Grant at Appomattox he only surrendered the Army of Northern Virginia. The Confederacy itself could not surrender because by now there was no ""Confederacy."" Richmond had fallen, the government officials had fled, and many of the papers had been burned. It would be up to each commander in the field to surrender his army as the news from the East reached him. The following are brief descriptions of how each Confederate fighting force surrendered. Gen. Robert E. Lee April 9, 1865. Having arranged a truce and sent notes to Lt. Gen. Ulysses. S. Grant requesting a meeting, Confederate Gen. Robert E. lee awaited his response. Shortly after noon, 9 Apr. 1865, Grants reply came and Lee rode into the village of Appomattox to prepare for Grants arrival. Lees aide selected the home of Wilimer Mclean. Lee waited in the parlor. At about 1:30 p.m. Grant arrived with his staff. The 2 generals exchanged greetings and small talk, then Lee brought up the object of the meeting. Grant wrote out the surrender terms himself in an order book and handed it to Lee to read. The terms, proposed in an exchange of notes the previous day, were honorable: Surrendered officers and their troops were to be paroled and prohibited from taking up arms until properly exchanged, and arms and supplies were to be given over as captured property. After Lee had read the terms and added an omitted word, he ordered his aide to write a letter of acceptance. This done, at about 3:45 p.m. the generals exchanged documents. Riding back to his lines, Lee was swarmed by his adoring troops, many nearly hysterical with grief. Trying to soothe them with quiet phrases--you have done all your duty. Leave the results to God...-- he rode slowly on, followed by many who wept and implored him to say that they should fight on. The next day he issued his eloquent farewell to his army. On the morning of 11 Apr., following a spartan breakfast and tearful good-byes from his staff, the general mounted his warhorse, Traveler, and with a Union honor guard left Appomattox for home. Gen. Joseph E. Johnston April 26,1865. Following its strategic defeat at Bentonville, N. C., March 21, 1865, the Confederate army of Gen. Joseph E. Johnston was reduced to perhaps 30,000 effectives, less than half the size of Union Maj. Gen. William T. Sherman's Federal command. Though the Confederates had fought well at Bentonville, their leader had no illusions about stopping his adversary's inexorable march through North Carolina. When Maj. Gen. John M. Schofield's force, joining Sherman at Goldsborough March 24, swelled the Union ranks to 80,000, Johnston saw the end approaching. Dutifully, however, he followed Sherman's resumed march northward April 10. En route the Confederate commander learned of the evacuation of Petersburg and Richmond and of Gen. Robert E. Lee's surrender at Appomattox. This ended his long-held hope of joining Lee to oppose the invaders of the Carolinas. Arriving near Raleigh, Johnston at first attempted to have North Carolina Gov. Zebulon B. Vance broach surrender terms to Sherman. On April 12 Johnston went to Greensborough to meet with fugitive Confederate Pres. Jefferson Davis, whom he persuaded to authorize a peace initiative. Sherman was immediately receptive to peace negotiations, and on the 17th, under a flag of truce near Durham Station, met General Johnston for the first time ""although we had been interchanging shots constantly since May, 1863."" The 2-day conference at the James Bennett home produced peace terms acceptable to both generals. But since these intruded on matters of civil policy (for example, recognition of the existing Southern state governments), officials in Washington quickly rejected the agreement and criticized Sherman's imprudence. Disappointed, the Federal leader informed Johnston that unless more widely acceptable terms were reached, a 4-day armistice would end on the 26th. That day, however, the war-weary commanders met again at the Bennett home and thrashed out an agreement confined to military matters. At once Gen-in-Chief Ulysses S. Grant wired his approval, and May 3 Johnston's once-proud army laid down its arms, closing hostilities east of the Mississippi River. Lt. Gen. Richard Taylor May 4, 1865. At the wars end Confederate Lt. Gen. Richard Taylor, son of former U. S. president Zachary Taylor, held command of the administrative entity called the Department of Alabama, Mississippi, and East Louisiana, with some 12,000 troops. By the end of Apr. 1865 Mobile, Ala., had fallen and news had reached Taylor of the meetings between Gen. Joseph E. Johnston and Maj. Gen. William T. Sherman. Taylor agreed to meet Maj. Gen. E. R. S. Canby for a conference a few miles north of Mobile. On 30 Apr. the 2 officers established a truce, terminable after 48 hours notice by either party, then partook of a ""bountiful luncheon ... with joyous poppings of champagne corks ... the first agreeable explosive sounds,"" Taylor wrote, ""I had heard for years."" A band played ""Hail Columbia"" and a few bars of ""Dixie."" The party separated: Canby went to Mobile and Taylor to his headquarters at Meridian, Miss. 2 days later Taylor received news of Johnston's surrender, of Pres. Jefferson Davis's capture, and of Canby's insistence that the truce terminate. Taylor elected to surrender, which he did 4 May 1865 at Citronelle, Ala., some 40 miles north of Mobile. ""At the time, no doubts as to the propriety of my course entered my mind,"" Taylor later asserted, ""but such have since crept in."" He grew to regret not having tried a last-ditch guerrilla struggle. Under the terms, officers retained their sidearms, mounted men their horses. All property and equipment was to be turned over to the Federals, but receipts were issued. The men were paroled. Taylor retained control of the railways and river steamers to transport the troops as near as possible to their homes. He stayed with several staff officers at Meridian until the last man was gone, then went to Mobile, joining Canby, who took Taylor by boat to the latters home in New Orleans. Lt. Gen. E. Kirby Smith May 26, 1865. From 1862 until the wars end Confederate Lt. Gen.. E. Kirby Smith commanded the Trans-Mississippi Department. By early May 1865 no regular Confederate forces remained east of the Mississippi River. Smith received official proposals that the surrender of his department be negotiated. The Federals intimated that terms could be loose, but Smiths demands were unrealistic. Smith then began planning to Continue the fight. Lt. Gen. U. S. Grant took preliminary steps to prepare a force to invade West Texas should that prove necessary. It did not. The wars last land fight occurred May 12--13 May at Palmito Ranch, where 350 Confederates under Col. John S. ""Rest in Peace"" Ford scored a victory over 800 overconfident Federals under Col. Theodore H. Barrett. But afterward the Confederates learned that Richmond had fallen and Gen. Robert E. Lee had surrendered more than a month earlier. The news devastated their morale, and they abandoned their lines. A similar decay in morale occurred all over the department. On May 18 Smith left by stagecoach for Houston with plans to rally the remnants of the departments troops. While he traveled, the last of the departments army dissolved. On 26 May, at New Orleans, Lt. Gen. Simon B. Buckner, acting in Smiths name, surrendered the department. Smith reached Houston May 27 and learned that he had no troops. Not all of the Trans-Mississippi Confederates went home. Some 2,000 fled into Mexico; most of them went alone or in squad-sized groups, but one body numbered 300. With them, mounted on a mule, wearing a calico shirt and silk kerchief, sporting a revolver strapped to his hip and a shotgun on his saddle, was Smith. Brig. Gen. Stand Watie June 23, 1865. When the leaders of the Confederate Indians learned that the government in Richmond had fallen and the Eastern armies had been surrendered, they, too, began making their plans to seek peace with the Federal government. The chiefs convened the Grand Council June 15 and passed resolutions calling for Indian commanders to lay down their arms and for emissaries to approach Federal authorities for peace terms. The largest force in Indian Territory was commanded by Confederate Brig. Gen. Stand Watie, who was also a chief of the Cherokee Nation. Dedicated to the Confederate cause and unwilling to admit defeat, he kept his troops in the field for nearly a month after Lt. Gen. E. Kirby Smith surrendered the Trans-Mississippi May 26. Finally accepting the futility of continued resistance, on June 23 Watie rode into Doaksville near Fort Towson in Indian Territory and surrendered his battalion of Creek, Seminole, Cherokee, and Osage Indians to Lt. Col. Asa C. Matthews, appointed a few weeks earlier to negotiate a peace with the Indians. Watie was the last Confederate general officer to surrender his command. Source: ""Historical Times Encyclopedia of the Civil War"" edited by Patricia L. Faust This Page last updated 02/10/02 "


how much fluid should you drink a day if you have kidney stones

Here is a weekday example for your sunny, early riser with a job and a lot to do. The plan provides 120 ounces – one gallon – of fluids a day and aims for modest front loading so you do not have to get up at night. It includes a treat – diet coke – which could be any diet drink. It does not favor milk because many people do not like it or cannot tolerate it.

A THIRST FOR VARIETY

A THIRST FOR VARIETYBy Jill Harris I have heard this one million times from patients in my practice. Make stones? Drink water. Water, water, and more water. Drink it all day long, all night long. Just drink water. What about other fluids? Are they safe? Are they high in oxalate? Will they count toward your daily intake? Is caffeine a problem? Your Physician Prescribes How Much I will be offering as much variety as I can, and encouraging you to drink, but the volume you need comes from your physician. This applies especially to my two day long examples. I made them to provide very large amounts of fluids for those who need them. If your physician prescribes less, just scale my recommendations back. Under no circumstances should you follow a fluid prescription in this post unless it fits with your physician’s specific recommendations for you. Some Beverages Raise Stone Risk Understanding what you can and can’t drink for stone prevention can be exhausting. I just released a course called The Kidney Stone Prevention Course to help you understand how to implement your physician’s prescribed treatment plans. What Did People Who Developed Stones Drink? Perhaps the most useful study of this matter is by Ferraro and colleagues. Two large groups of nurses and one group of physicians have been followed for many years to ascertain habits and diets that appear healthy or unhealthy. Some of the people in each group developed kidney stones. Most, as expected, did not. Because diet habits were closely monitored by well established questionnaires over the years, the scientists could determine which beverages, my particular concern here, were associated with a higher or lower risk of becoming a stone former. The amounts are important to keep in mind. For coffee and tea it was 8 ounce servings. For juices, a small glass. For carbonated drinks and beer a glass, bottle or can. For wine a 5 ounce glass. Servings were graded from less than 1 weekly, over the range of 1, 2-4, 5-6 weekly, and more than 1 serving a day. A significant effect meant that as the amounts increased, the risk of new stones increased or decreased in rough proportion – there was a ‘dose’ effect. Winners and losers Sugar sweetened colas and non-cola drinks were associated with development of kidney stones. Punch was also associated with more stones. But drinks with sugar in them were not all bad. Apple juice, grapefruit juice, and tomato juice did not raise or lower risk of stones. Coffee, decaffeinated coffee, tea, red wine, white wine, orange juice, and beer were the winners. People who used more had a lower risk of new stones. No Special Effect on Stones We already mentioned apple, grapefruit and tomato juices. Add to them liquor, artificially sweetened sodas – cola and non-cola (clear sodas), whole and skim milk, and water itself. Water Is Not Your Only Option Nothing is totally off limits when it comes to increasing fluids. The main point is that you do, indeed, increase them. If having a soda here and there helps you maintain your ultimate daily fluid goal, then by all means, treat yourself once in a while. I am certainly not advising you to have as many Coke’s as you would like, nor am I advocating that you drink very large amounts of coffee all day long, even if coffee drinking lowers risk of stones. What I am saying is that all fluids count and water is NOT your only option. Other beverages help provide variety but my principle is to use them in moderation. This post will help you decide which other beverages you might incorporate into your diet to help raise your total daily fluid intake. Keep in mind that you need to take into consideration other medical conditions you may have that will contraindicate some of these choices. Review your version of my plan with your physician to be sure. Pucker Up!Lemonade is an excellent way to increase your total daily fluid intake and raise your urine citrate level. Citrate is a molecule that binds to calcium so that calcium does not have the chance to bind with phosphate or oxalate. It also slows the formation of stone crystals. Both actions decrease your risk of forming new kidney stones. Lemonade use was not part of the large beverage study I have already quoted, but is thought to be beneficial for stone prevention, or at least not a specific risk like sugared drinks. The Best Tasting Ones The Huffington Post polled people on the best store bought lemonades. The winner was Whole Foods brand 365 Pasteurized Lemonade. The next two best were Simply Lemonade and another Whole Foods product, brand 365 Organic Lemonade. Read the whole article and let us know which ones you like. Unfortunately, all three winners have extra sugar added to them. Simply Lemonade seems free of extra sugar, but comments to a review of the product document added cane and beet sugars. Sugar in any form can raise kidney stone risk , and sugared drinks raise risk of stones – as I have already pointed out. Of course sugared drinks promote weight gain, and raise blood glucose and insulin. But if you follow my moderation principle some of these tasty treats are fine. ‘Some’ means some. My Favorite for You I recommend Crystal Lite™ lemonade for my patients, as it is a no calorie alternative. The other reason I love this for you is its convenience. Here is a link for “ on the go” packets. Another recent post on this site points out that those who need potassium citrate treatment can use this beverage in place of some of their pills. Make Your Own You can also just squeeze some fresh lemons to add to your water. If you don’t have time to always buy, cut up, and squeeze fresh lemons, here is an excellent, convenient, alternative: Pre-made concentrate. I get it at Whole Foods, but you can find it at Walmart and Amazon as well. In order to increase your citrate level with a recipe that has been tested in a research experiment, you need to add one half cup of Real Lemon© to 7 1/2 cups of water. The Whole Foods concentrate may work as well, but has not been tested. Got Milk? Adding low fat, skim or 2% milk is a great way to increase your daily fluid intake and also help you to increase your diet calcium intake. For those of us who are lactose intolerant, here are lactose free alternatives. Lots of Calcium and Protein Getting normal amounts of calcium into your diet (about 1000 mg/day) is necessary for your bone health. An 8 ounce glass of milk contains about 305 mg of calcium. Two percent contains 295 mg. You can check the amounts for all milks at the site. There is a lot of protein (8 grams) and other nutrients, too. The protein content is the same whether for fat free or whole milk. Not So Many Calories As You Might Think Milk is a calorie bargain. An 8 ounce glass of 2% has only 120 calories, and 1% 105 calories. Soda Pop The Skinny on Diet Sodas Having a diet soda a few times a week will add to your overall fluid intake and, as I have already pointed out, does not increase risk of forming kidney stones to a significant extent. But, unlike milk and lemonade, most sodas offer you no health benefits. There May be Real Risks There may indeed be drawbacks. For example, in one study, risk of hip fracture seemed related to diet soda intake in women. There is Risk By Association Among diabetic young men, use of diet, but not sugared, sodas was associated with higher average blood glucose. This was ascribed not so much to the beverages as to the generally unhealthy life style of those who consumed larger amounts of such beverages. Likewise, in another study, diet sodas were associated with new onset of type 2 diabetes in men. But with full adjustment for other factors that might predispose to diabetes, the effect of diet soda disappeared. It seems as if men who were trying to lose weight, or compensate for high diabetic risk, preferentially used diet sodas. Cola vs Uncola Given that there are drawbacks to sugared sodas and no benefits to diet sodas, what about the clear sodas – the non-cola drinks, as a special case? The clear sodas have citric acid instead of phosphoric acid. We have already presented the chart of citrate levels in clear soda and you can read it over yourself: Higher is better. Likewise, in the same post, this site has presented the case for the use of beverages as a source of citrate in place of expensive potassium citrate pills.7UP and Sprite have no caffeine which may be an advantage for some people. The Final Verdict Think of diet sodas as a treat, probably not a good protection against stones. The higher urine volume is offset by what else is in the soda. It is not something to have all the time. Diet soda may increase hip fracture risk in older women. Sugared sodas raise risk of stones, so just avoid them except for a special treat once in a while. Given the high price of potassium citrate pills, many patients may need to use high citrate beverages, which are clear sodas, as a supplement. For those who do not need supplemental citrate, and there are very many stone formers in this category, the clear sodas serve no special purpose except for variety and taste. Unless you are using high citrate beverages to replace potassium citrate pills, limit how many times a week you are choosing soda as an alternative to water. I would recommend no more than 3 cans a week. If you’re somebody who drinks it every day, start weaning yourself off of it. Try substituting a La Croix for each can of soda. It is carbonated and flavored, but without the calories, sugar, and yucky stuff that soda has in it. Wake Up and Sip The Coffee I drink one cup of coffee every morning. Not the 72 ounce cup you can get at Dunkin’ Doughnuts, just one true cup. I need it, I love it, and I will not do without it. There is no doubt that coffee can contain considerable oxalate. Instant coffee has even more oxalate per gram than the regular coffees. The question is whether drinking coffee increases urine oxalate, which has not been determined. I suspect it does not because coffee drinkers have a lower, not a higher kidney stone risk. In the same prospective study I quoted for sodas, caffeinated coffee drinkers had a 26% statistical reduction in new stone onsetcompared to people who did not drink coffee and there was a graded reduction in risk as the amount increased from none, through 1 cup per week, up to 1 cup or more every day. T he decaf drinkers had a 16% reduction. These coffee drinkers were not using coffee as a form of stone prevention. I presume they used it as a pleasurable beverage. So there is something about coffee drinking that offered a protection. The issue is therefore not about kidney stone risk but about how much coffee people should drink every day. That is something you need to discuss with your physician. But, I cannot imagine anyone will use coffee, even iced coffee, as more than a small fraction of the many liters of fluid needed daily for stone prevention. Terrible Teas? Every patient I have worked with (thousands at this point) has told me that they have been told NEVER, EVER, to drink tea. Tea is known to be high in oxalate. It is true that tea is a higher oxalate beverage, but if you drink it in moderation, a cup here and there will not increase your risk of forming new stones and does add to your total daily fluid intake. In support of what I just said, in the same study I have already quoted in the prior paragraph, tea drinkers had an 11% reduction in stones. Even though a cup or more of tea every day appears to decrease stone risk, tea, and iced tea, are not a reasonable source for the majority of the large quantities of fluid used in stone prevention. Tea is like coffee: A source of some fluids and variety. Lovely Libations The very important epidemiological study on beverages which I have been quoting offers perhaps a little surprise: Wine drinkers (5 ounce glass between 1 per week and 1 or more a day) had a progressive reduction in stones of 31% to 33%. Beer drinkers (1 can between 1/week and 1 or more daily) had an even higher reduction of 41%. None of these quantities are like the scale of water drinking, or even milk drinking. These are like coffee and tea: Pleasure drinks. Overall, your alcohol intake is between you and your physician; drinking in excess is never advisable. One glass of wine, or one can of beer a day may confer real benefits for stone reduction. In between rounds, remember to raise a glass to your old friend water. Your body will thank you the next day. Sport Drinks I have not encountered very many patients who use sport drinks in important quantities. Maybe I travel in the wrong circles. Sweetened sport drinks all have the obvious disadvantages of their sugar in relation to stones, and, of course, for weight control. None were remarkable sources for citrate. They are like the sodas: Occasional treats to break up monotony. Juicy News If you want risk reduction specific to a juice, orange juice, 1 or more small glasses a day, was effective ( 12% reduction ). Apple, grapefruit, and tomato juices had no effect. But the lack of an effect is not critical here. The study refers to a small glass daily and did not test larger volumes for urine dilution. Given that none of the juices increased risk, I see no reason larger volumes cannot be used as part of the day’s fluids, apart from the problem of calories – from sugar. Although cranberry juice may help in protecting you from recurrent UTI’s, no studies have shown it reduces kidney stone risk. A Day In The Life How do these suggestions play out in normal day life? Let’s take a look at an example weekday and weekend day. For those of you who are trying to increase urine citrate, we have a whole post to help you. These are Examples; Your Physician Sets The Amounts I have already said this and say it again. These examples are for very large volumes of fluid. They show you how you can achieve such large volumes with variety. Your physician will tell you how much to drink. Scale back these examples to match what you are told. Perfection Is Not a Realistic Goal You may notice that depending on your day you may drink less than your goal. You may not reach your intended goal every day. It is OK. You are not going to be perfect every single day. Try your best on most days, and if you have a really bad one, just make up for it on the following day. Monday – A Weekday Fluid Plan That Provides 120 ounces (~1 gallon)

If you can, milk can substitute for water whenever you wish. Wake Up – 6 am1 cup of coffee or tea (5 ounces).5 ounces of milk with cereal One 8 oz glass of water with lemon Mid-morning Three 8 oz glasses of water Lunch One 8 ounce glass of fresh lemonade or diet lemonade beverage One 8 ounce glass of water Mid Afternoon Two 8 ounce glasses of water One (5 ounce) cup of tea Dinner One 8 ounce glass of water before dinner One 8 ounce glass of water during dinner One can of diet soda — 12 ounces toward the end After dinner / before bed One 8 ounce glass of water One cup (5 ounces) of herbal mint tea Saturday – A weekend plan that provides 148 ounces No work for most of us but a lot of chores. Weekends may be a time to up the ante and go over a gallon. Even if you fall short on the weekdays a bit, and likewise on the weekends, these plans are large enough to give you some margin. But it would be ideal to stay on the high side more days than not. You are buying insurance by the day, after all. Wake Up – 8 am1 cup of coffee or tea (5 ounces)One 8 oz glass of water with lemon5 ounces of orange juice Mid-morning Three 8 ounce glasses of water Lunch12 ounces of iced tea8 ounces of water Mid Afternoon One liter of water with workout at gym (about 34 ounces)5 ounces of green tea Two 8 ounce glasses of water Dinner Two 8 ounce glasses of water Two 5 ounce glasses of red wine One 5 ounce decaf The Wrap Up My intention was to convey that water does not have to be the only thing you choose when calculating your daily fluid intake. All fluids DO count toward the total. I think this is important to note, as many patients tell me they hate drinking so much water everyday and then wind up not drinking at all. You can safely add items like diet soda, fruit juices, tea, and alcohol if you do it sparingly throughout the week along with your best friend: water. Personally, I choose water most of the time. It is free, without any calories, supposedly good for my skin, and does a great job of quenching my thirst during the day and after exercise. As a middle-aged woman, it checks all my boxes. Need more support getting in fluids or changing your diet? I have recently put together a private FB page called THE Kidney Stone Diet. It is a group that helps educate you on your physician prescribed treatment plans. I moderate it to keep it clinically sound. Come on over and join the discussion!Return to Walking Tour about Supersaturation Understanding what you can and can’t drink for stone prevention can be exhausting. I just released a course called The Kidney Stone Prevention Course to help you understand how to implement your physician’s prescribed treatment plans.92 Responses to “A THIRST FOR VARIETY”Althea Madigan March 15, 2018I have very recently found this set of information due to results from urinanalysis tests. I have had a history of a couple kidney stones (2010) and over active parathyroid (2 removed 2012), NOW the endocrinologist found, urine is high oxalate, uric acid, sodium, calcium. citric acid was 924; Oxalate acid 61 uric acid 1344 calcium 554 sodium 336 I actual did 2 tests, one with preservative and one with out. I have had a terrible diet and low hydration the past 5 months — my husband was killed in an accident — and honestly I didn’t care. I live on peanut butter and jelly sandwiches, munched on nuts – in general, survived. Question: Each report is followed by “flag Reference Range” is this the range to be inside?? Can return to good hydration bring these numbers back under control? Should I be seeing a urologist in addition to my endo? My primary is recommending return to hydration and a moderate approach that I can live with for diet. – My husband did all the cooking and I was just starting to manage cooking food that he used, many of which are medium to high oxalate. I am totally stressed and trying to figure out how to care for myself and actually “care” about it. Thank you for any advice, comments you can give. Althea Reply Fredric Coe, MDMarch 16, 2018Hi Althea, Firstly, all my sympathies for your terrible loss. As for the urine, the most major problem is the high urine calcium of 554 mg/day. Be sure your blood calcium is normal; possibly your primary hyperparathyroidism is still there. Likewise your urine sodium is very high. But you also mention 2 24 hour urines. I presume this is one of them. Alternatively, have you shown me the sum of both?? It almost looks like it as everything is twice what it should be. Check and post again if you wish. I hesitate to comment on the results further because of uncertainty about what I am looking at – 2 urines together or one. If it is one urine, which one? Regards, Fred Coe Reply Neal Fusner November 27, 2017A friend of mine has suggested I may want to try a green tea that has come on strongly in the USA. It is called Yerba Mate. It is made from the leaves of a South American holly plant (llex paraguariensis). The product being suggested is pure leaf, air dried, never smoked, never aged. As a prolific stone former of over 30 years, I don’t take dietary changes lightly, seeking knowledge before taking action. I was a former Calcium Oxalate stone former that morphed into a brushite former about two years ago. I remain on a reduced calcium, low oxalate diet at the urging of my urologist who has consulted with Dr. Coe regarding my case several times. Is anything currently understood about the oxalate levels of Yerba Mate. Please advise. Thank You, Neal Replyjharris November 27, 2017Hi Neal,I know that green tea is lower in oxalate overall, but do not know the numbers for this particular one. I would suggest you have one a day, in a true portion size and you should be fine. A low calcium diet is not advised and could very well lead to new stones and bone loss. Please discuss this again with your physician!Jill Reply Fredric Coe, MDNovember 29, 2017Hi Neal, Perhaps I have forgotten but I do not think I would have recommended a low calcium diet. I never do. I use a high calcium diet to lower urine oxalate, and low sodium to keep the urine calcium from rising. I would recheck with your urologist. Take a look at the link. As for the tea, Jill Harris has to answer that. Regards, Fred Coe Reply Margaret Kesinger October 1, 2017Can I drink herbal teas with honey while passing a kidney y? Replyjharris October 1, 2017Hi Margaret,You can, but water is best. Have a true cup or two, but mostly water. Warmly, Jill Reply Bill August 18, 2017I use Xylitol to sweeten my Espresso instead of sugar. Is Xylitol high in Oxalate? Or should I switch to sugar? I like to drink about 3 Espresso’s a day, along with plenty of water. I am in the process of trying to figure out why I keep creating kidney stones. I just received results back showing Calcium Oxalate stones from one that I caught, and 48 Urine Analysis showing low urine p H at 5.215 with Urine Calcium at 218 and total Urine Volume was 2.84. I am also a Type 1 Diabetic. I go back to my Urologist on Monday to discuss the results from all tests that Dr. Coe recommended on this website. Thank you for all of the information on this site. Replyjharris August 18, 2017Hi Bill,The sweetener is fine. How is your sodium (Na) on your test? And your citrate levels? Your urine is pretty acidic which does not bode well for a stone former. I wonder since you are a diabetic if you are eating too much protein in order to avoid carbs that will lead to higher blood sugar levels? If so, this could be a problem for your stone condition as well. Would need more info. There are different reasons why and you may want a nutritional consult to help you deal with both problems. You can reach out to me at jillharriscoaching.com to get some help if you like- Hope this addressed your concerns for now- Jill Reply Fredric Coe, MDAugust 19, 2017Hi Bill, YOu might bring up the low urine p H. Although your stones are calcium oxalate you have a high uric acid stone risk and might want to raise that p H. Diabetes itself lowers urine p H and as Jill mentioned a diet protein intake will do the same. Regards, Fred Coe Reply Bill August 19, 2017Thank you both for you prompt replies. I did the 48 hr urine test as you suggested on your site. The first day these were the levels Vol – 2.84. SS Ca Ox – 4.53, Ca – 156, Ox – 37, Cit – 527, SS Ca P – 0.09, p H – 5.215, SS UA – 0.84, UA – 0.362, Na – 59, K – 54, Mg – 96, P – 0.785, Nh4 – 45, CI – 57, Sul – 19, UUN – 11.56, PCR – 1.0 . The second day these were the levels Vol – 3.09. SS Ca Ox – 3.69, Ca – 218, Ox – 33, Cit – 763, SS Ca P – 0.24, p H – 5.493, SS UA – 0.86, UA – 0.563, Na – 136, K – 74, Mg – 139, P – 1.142, Nh4 – 42, CI – 150, Sul – 12, UUN – 10.79, PCR – 0.9 . I have been taking 300mg of Allopurinol since 2009. At that time I had very low p H and had what my urologist called gout of the kidneys. It always felt like I was peeing glass. After being on the Allopurinol for a couple of months, the pain went away. In 2011 I caught a 6mm stone that was a Calcium Oxalate / Uric Acid stone. I had been doing pretty well until last December, when this new series of kidney stones have started. It has been a very painful year. My Urologist has pointed it back to last June when I started a new low carb, high protein diet, and started working out at the gym and lost about 25 pounds. I realized in January that I had added a lot of nuts back into my diet, forgetting that with my history I shouldn’t be eating them. In the last couple of months I found your website, and have made changes to my diet, but just 2 days ago was back at the ER with more pain, and they saw more stones in my kidneys. I just did these urine tests on August 1 & 2, and my blood test last Friday, so now going back to the Urologist on Monday to discuss the results. Any suggestions either of you may have would be greatly appreciated as well. Reply Fredric Coe, MDAugust 21, 2017Hi Bill, you have formed uric acid stones and have a low urine p H – common in diabetes. I would discuss with your physician raising p H with potassium citrate. Allopurinol is without value against uric acid stones as opposed to raising p H. Also mention to your physician that your urine ammonia is a lot higher than your urine sulfate; is this because of potassium delpetion, or are the numbers copied wrong? It was this way in both urine samples. Apart from low p H you have no specific stone risk. Be sure and analyze the new stones – they may contain uric acid. Regards, Fred Coe Reply Bill August 25, 2017Thank you for your reply. My urologist prescribed Potassium Citrate 10m EQ twice a day after meals. The Litholink 24 urine report suggests a recheck after 6 wks, which he also setup for me. I still have pain in my right kidney, and an ultrasound from ER 1 1/2 wks ago noted there are still stones in my kidneys. The most recent stone caught in July (small fragments) was Calcium Oxalate. I showed the urologist your comment about the urine ammonia higher than the urine sulfate, and he was not aware of why this would be. Those numbers are correct as written in the previous comment above. Do I need to eat more foods with potassium as well or make other diet changes? Will the Potassium Citrate dissolve or break up my current stones in my kidneys? If so, how long does that normally take? I am hoping this will get me out of this long episode of pain in my life. Reply Fredric Coe, MDAugust 25, 2017Hi Bill, The stone analysis of calcium oxalate helps. Given the high ammonia I would suspect potassium depletion as a possibility or colonization with a urea splitting organism. K citrate cannot affect Ca Ox stones but can prevent more. I would use it along with the whole kidney stone diet. I see no reason to omit the diet as it is correct one for all US citizens. Regards, Fred Coe Reply Lynn June 22, 2017I’ve been using pure erythritol as a substitute sweetner in my green tea and in my oatmeal. I can’t find any information on the web about it’s oxalate content or it’s effect on forming kidney stones. I see that there are blends of stevia and erythritol which I don’t use, as stevia is high in oxalates. I have a 5mm x 3mm stone in one kidney found by a sonogram. I used to drink 5 or 6 cups of instant coffee everyday which I don’t do anymore. How good (or bad) is erythritol? Reply Fredric Coe, MDJune 24, 2017Hi Lynn, erythritol is a polyol sweetener that has no oxalate nor converts to oxalate that I know of. It is an approved sugar substitute. Chemical stevia has no oxalate, only the plant extract has that. The erythritol has no relationship to stones and is preferable to sugar that can raise urine calcium and could indeed be a stone risk. To prevent your stones follow a plan – here is a good one. Do not rush to this or that possible cause or treatment – never works. Regards, Fred Coe Reply Lynn June 28, 2017Thank you so much for this information, I have found your site on kidney stones to be the best on the web. Replyjharris June 28, 2017Dear Lynn,It makes us very happy to know that it is useful to you. Thanks for taking the time to let us know-Dr. Coe and Jill Reply Luke February 14, 2018Hello…Hmmm… if erythritol is excreted mostly in urine, unchanged, does it have an impact on potential kidney stone formation? Regards Luke Reply Fredric Coe, MDFebruary 14, 2018Hi Luke, No. I looked at its structure. Fred Coe Reply Mark Mc Call June 7, 2017I enjoyed the article and I appreciated the information provided. I had a 7 mm stone a year ago and I have a 6 mm stone now with 2-3 smaller stones in my kidneys so it is time to get serious. My urologist mentioned diet last year but did not provide any guidelines or recommended diets, so I basically forgot about it. The article, while discussing beer and wine, did not mention any spirits. Is that because there is no data, or is there another reason? Do spirits in moderation increase, reduce, or have no effect on stone formation? Reply Fredric Coe, MDJune 8, 2017Hi Mark, spirits have no known effect. If you are getting serious, be sure and read this article – a good summary of how to do it. Regards, Fred Coe Reply Sherri June 7, 2017I just thought I had researched this topic and don’t know how I missed all of your valuable research. I have the common calcium oxalate stones ( 2x in 4 years), and this last time my dr started allopurinol and gave me a list of low oxalate to high oxalate foods. There is so much contradictory information on the web ( reputable sources too) in regards to what is low and what is high in oxalates. UAMS to webmd makes it hard to know which is true. Thank you fo so much clear information and references to your publications!Reply Fredric Coe, MDJune 7, 2017Hi Sherri, Thank you for your support. I hope you can use the site to plan your stone prevention. Take a look at the new guide book. Regards, Fred Coe Reply Nancy May 7, 2017I’m new to kidney stones (no family history), having just had surgery to remove a 6 mm principally calcium stone. The minute I heard it was calcium based, I stopped eating foods rich in calcium, and now have calcium levels at or slightly (.2 – .4) above 10. If I’m tracking you correctly (and this seems somewhat counterintuitive to me), it sounds like I should increase my calcium intake to reduce my blood and urine calcium levels. Is this correct? Reply Fredric Coe, MDMay 8, 2017Hi Nancy, It sounds like your blood calcium is above normal. If so, you may have primary hyperparathyroidism, a not uncommon and curable cause of calcium stones. My article on it is still in preparation but here it is for you – forgive incomplete areas, lack of links out to references, and discussion of surgical cure etc. The parts you most need are in it. Regards, Fred Coe Reply← Older comments Leave a Reply Name (required)Email (will not be published) (required)Website Comment


is chinese white watercolor transparent

ce Florida Artist John Bowen increases his palette of colors and adds texture to his paintings by mixing zinc white gouache with his transparent watercolors.by M. Stephen Doherty Many watercolorists avoid using Chinese white or zinc white gouache with their transparent watercolors because they think they might appear to be lazy or breaking rules.

Expand Your Options by Adding Zinc White Gouache to Transparent Watercolors

"Mixed Media Photo Referen

But there are just as many artists who like expanding their range of creative options by changing the physical appearance of their paints with the addition of opaque white paints. For example, Burton Silverman wrote an entire book— Breaking the Rules of Watercolor (Watson-Guptill Publications, New York, New York)—exploring the benefits of adding body color, gouache, or zinc white to watercolors and applying the mixtures to hot-pressed board. Pots 2002, watercolor and zinc white gouache, 39 x 30. Collection the artist. John Bowen's award-winning paintings certainly demonstrate the options available to an artist who uses a combination of opaque and transparent paints. ""Sometimes I paint with just transparent colors, but most of the time I see a distinct advantage to mixing zinc white gouache with the colors to create certain visual effects,"" he explains. ""This allows me to paint light values over dark, adding strong textural effects that can't be created with just transparent colors. ""For example, I can create appropriate textures by scratching the watercolor paper with sandpaper, an X-acto knife, or a single-edge razor blade and then painting over those rough areas with a mixture of zinc white and watercolor paint,"" Bowen explains. ""I might also apply the combination of paints with a Q-tip, spatter it from the tip of a toothbrush, or drop table salt into the wet paint. I also use drybrush techniques to add lines, speckles, and rough marks. I can then paint over the established texture with lighter colors or glazes of transparent color. It's fun to try a variety of techniques until I find the ones that enhance the appearance of a stone wall, marble column, metal trellis, brick façade, plank of wood, or rusted farm implement. ""Cypress Hill 2005, watercolor and zinc white gouache, 19 1/2 x 27. Private collection. Because the zinc white gouache adds such variety to the appearance of the paints, Bowen finds it easy to work with a limited palette of colors. ""I have about 30 different colors I use at various times in my watercolor palette, but I try to keep it down to five or six tube colors on a particular painting,"" he explains. ""I can use the paint right from the tube or adjust it with varying amounts of zinc white for my special effects. That provides variety while bringing harmony to the colors within a picture. I mix almost everything on the palette and not on the surface of the paper. ""Bowen sometimes adjusts the appearance of these colors by adding Winsor & Newton's Granulation Medium, which causes the pigment to particulate and take on a mottled appearance. ""Some colors, such as manganese blue, automatically particulate as they dry; but the Winsor & Newton medium can create a similar look with other colors. I've also used some of their other watercolor mediums to vary the final look of the paints. Vizcaya Garden 2005, watercolor and zinc white gouache, 20 x 38. Private collection. ""I know all these effects can become gimmicks, but if they are used to achieve an artist's concept I think they have real value,"" Bowen explains. ""I believe all these aids are out there to be used tastefully to create certain effects for different images, and practicing with them can create wonderful results. ""Most of Bowen's paintings are created from photographs taken as he travels throughout his home state of Florida and around the United States. ""I love painting scenes from small towns around Florida—especially in the Keys—and about 90 percent of my watercolors are of the state,"" he explains. ""But I've also enjoyed painting scenes from New England and California. Amusingly, I won a prize in an exhibition in Colorado for a painting I did of Marin County, California. ""Bowen uses an HB graphite pencil to draw the outlines of the major shapes either by projecting the photographs onto a sheet of 300-lb Arches rough watercolor paper with an Artograph projector or by looking at two or more photographs of the same location. If a scene is particularly complicated, he might first draw the image on a sheet of tracing paper, work it up, and then transfer it onto the watercolor paper; but in most cases he works directly on the painting surface. The watercolor paper is stapled onto a board and the edges are taped to create a white border around the edges. Morning 2002, watercolor and zinc white gouache, 43 x 31½. Private collection. On some occasions, Bowen will make a small color study of a subject to establish the most appropriate composition and palette of colors. Otherwise, he starts painting the largest shapes within the scene using washes of transparent color. ""I almost always paint the sky first with a blend of wet-in-wet washes because that's usually my biggest concern,"" he explains. ""If I spend too much time on the sky, it usually looks overworked, so I try to first determine what colors I want to use so I can execute it quickly and precisely. Then I jump around the picture bringing each section up to the same level of completion before I resolve any one area with detail. ""I'm somewhat impatient when I paint, so I let one area dry while I am working on another, and then I go back to it when it's ready for the next layer of color. If I'm uncertain what to do, I prop the painting up against a wall and look at it for a day or so until I can clearly identify what more needs to be done. I'll even write notes to myself about what I'm planning so I don't waste time when I start painting again. I often save those pages of notes because they can be useful when I'm painting another watercolor and want to remember how I achieved certain effects that proved to be appealing. That's particularly useful when the textures I created involved several steps and combinations of colors. ""Florida Foliage 2005, watercolor and zinc white gouache, 30 x 38. Private collection. Most of the paints Bowen uses are manufactured by Winsor & Newton, but he also uses some from Daniel Smith and Sennelier, including a Sennelier Chinese orange that is an excellent alternative to burnt sienna because of its brilliance. He uses mostly round synthetic-hair brushes, but he has a few larger flats (1/4"", 1/2"", 1"", and 2"") for applying washes and broad glazes of color. He even uses inexpensive housepainting brushes for applying the initial background washes of color. As Bowen is working, he reviews a list of items that will help him create better paintings. ""I have a tendency to get absorbed in the painting process, so I remind myself to pay attention to four important aspects of a good painting,"" he explains (see sidebar). ""Composition has been so important to me throughout my career that I start thinking about it when I take the reference photographs, but it always helps to re-evaluate a scene when I'm translating it onto the watercolor paper. ""Bougainvillea on Fence 2003, watercolor and zinc white gouache, 29 x 38. Collection the artist. During the course of painting, Bowen will apply several layers of wash to the paper, especially in the darker areas of the scene. ""I prefer to build up the darks rather than apply heavy mixtures of color in one stroke,"" he explains. ""That way I can layer several colors and develop a richer tone and, at the same time, avoid going too dark in value. ""Painting is a solitary pursuit, but Bowen makes an effort to meet with other artists. ""I studied with Diane Nance for two years and really got a lot out of her critiques as well as the comments from the other students,"" he explains. ""I try to mingle with other artists whenever I can because I really enjoy their company and I learn a lot that I can take back to my studio. ""About the Artist The earliest influences on John Bowen's art career were his father, who drew in pen-and-ink and painted in oil and pastel; three art-instruction books written by Ted Kautzky; and his teacher at Irvington High School, Ludlow Thurston. Bowen's paintings have been exhibited in a number of galleries and art festivals, and they have won major awards in those competitions. He has also been invited to participate in several museum and university-gallery exhibitions. He is a signature member of both the Florida Watercolor Society and the Gold Coast Watercolor Society, and is associated with the International Society of Marine Painters and Allied Artists of America. For more information on Bowen, visit his website: www.johnbowenwatercolorist.com. M. Stephen Doherty is the editor-in-chief of American Artist. Author Artists Network Staff Comments (3)Anonymous Log in to Reply HOW DO YOU SEARCH FOR ARTICLES? August 1, 2006 at 4:43 pm Anonymous Log in to Reply Hello, thank you for the tip on adding gouache to Watercolor great idea, will try next painting.. question I have is what to use to preserve the total gouache paintings not thick but varied washes and lift off method, besides the glossy spray finish? DDNovember 14, 2006 at 1:38 pm Anonymous Log in to Reply Very Nice! Please read my post I’m Adolf, new here! Good Bye!February 22, 2007 at 1:13 am Leave a Reply You must be logged in to post a comment. "


what would happen if you start car without maf sensor plug connected

The MAF sends readings to your computer, which then uses them to adjust the mixture of fuel/air in the combustion chamber. If there is no MAF you will be getting all kinds of misfires and very bad fuel economy. In the long run, it's probably cheaper to replace the MAF. You can also try spraying the wires in the sensor with some carb cleaner. Alot of the time the MAF is just dirty and doesn't actually need replacement. EDIT: Ooops, I meant contact cleaner.

Cars & Transportation Maintenance & Repairs Can you drive without a mass airflow sensor?we need a new one and is very expensive to replace and was wondering if u can drive with it unplugged. without breaking down Follow 6 answers Answers Relevance Rating Newest Oldest Best Answer: Your car should run, but very poorly. And it will get worse as time goes by. Whatever you do, don't spray the hot-wire (assuming it is one of those type) with carb cleaner, or you will definitely need a new one. Use only an aerosol electronics cleaner, preferably CRC brand. Do not physically touch it with anything, and make sure it's dry before re-installing it and starting the motor. Source (s): ASE Certified Techcatmandew · 9 years ago1 0 Comment You can, but your car will throw all kinds of SES codes and will run like crap.

Anonymous · 9 years ago0 1 Comment The engine will start but shut down seconds after. The car is being suffocated of air since the sensor cant register its receiving any at all. Check a junk yard or have yours rebuilt or buy a rebuilt to help save money3000GT of Va · 9 years ago0 2 Comment The lights furniture are not in basic terms lights furniture, they have a shape to them or words in them. If it looks like an engine and it somewhat is orange, it skill there's a concern with the engine like it is not working. If it somewhat is pink and says brake, it skill your brake is set. or maybe it somewhat is orange and says ABS or SRS. this would recommend Anti lock brake device or your air luggage have a concern. If it somewhat is blue, it skill your severe beams are on. green may well be a cruise administration indicator. rather if it says cruise. seem heavily at it and it will actually enable you comprehend what it somewhat is.easterly · 1 year ago0 0 Comment The car can run without it, but I don't think the engine's computer will be so forgiving. But, if you unplug it, try it. Just as a short term temp fix.rick29148 · 9 years ago0 0 Comment YES YOU CAN DRIVE IT THAT WAY. ONLY THING IS YOU WILL BE WASTING WAY MORE GAS THIS SENSOR MEASURES THE AMOUNT OF AIR GOING INTO YOUR ENGINE. ALSO YOUR CHECK ENGINE LIGHT WILL ALWAYS BE ON. BETTER TO FIND ONE AT A JUNK YARD OR ON EBAY. Source (s): CERTIFIED DIESEL MECHANICCarlos · 9 years ago0 0 Comment Maybe you would like to learn more about one of these? Train To Be a Project Manager Explore Best Car Covers Official March Madness Gear Get a Master's Degreee Online


what is nic teaming

NIC teaming is a feature of Windows Server, so it can be used for any network traffic, including virtual machine networking traffic. NIC teaming is set up at the hardware level (physical NIC). By default, a Windows Server can team up to 32 physical network adapters.

"RECOMMENDED MOST POPULAR1 Microsoft Honolulu Brings Web-Based Management Tools to the Desktop2 Harnessing the Power of Power Shell Aliases3 11 Load Balancers You Need to Know in 20184 Checking the Status of Services on Windows Clients5 Remotely Managing Hyper-V Hosts Using Power Shell Working with NIC Teaming in Windows Server 2012By Nirmal Sharma ( Send Email) Posted January 13, 2014Of the many networking features introduced in Hyper-V 3.0 on Windows Server 2012, several were added to enhance the overall capability for networking virtual machines (VMs). One of the features introduced in Hyper-V 3.0 is a collection of components for configuring NIC teaming on virtual machines and the Windows operating system. Originally designed for Windows Server 2012, NIC Teaming can also be used to configure teamed adapters for Hyper-V virtual machines. Since our primary focus in this article is to provide an overview of NIC Teaming in Windows Server 2012 and later versions, we will not cover in detail the steps needed to configure NIC Teaming for operating systems and virtual machines. In earlier versions of Hyper-V (version 1.0 and version 2.0), the Windows operating system did not provide any utility to configure NIC Teaming for physical network adapters, and it was not possible to configure NIC teaming for virtual machines. A Windows administrator could configure NIC teaming on Windows by using third-party utilities but with the following disadvantages: Support was provided by the vendor and not by Microsoft. You could only configure NIC Teaming between physical network adapters of the same manufacturer. There are also separate management UIs for managing each third-party network teaming if you have configured more than one teaming. Most of the third-party teaming solutions do not have options for configuring teaming options remotely. Starting with Hyper-V version 3.0 on Windows Server 2012, you can easily configure NIC Teaming for Virtual Machines. This article expounds on the following topics: NIC Teaming Requirements for Virtual Machines NIC Teaming Facts and Considerations How NIC Teaming works NIC Teaming Requirements for Virtual Machines Before you can configure NIC Teaming for virtual machines, ensure the following requirements are in place: Make sure you are running minimum Windows Server 2012 version as the guest operating system in Virtual Machine. Available physical network adapters that will participate in the NIC Teaming. Identify the VLAN number if the NIC team will need to be configured with a VLAN number. NIC Teaming Facts and Considerations It is necessary to follow several guidelines while configuring NIC Teaming, and there are also some facts you should keep in mind that are highlighted in bullet points below: Microsoft implements a protocol called "" Microsoft Network Adapter Multiplexor "" (explained shortly) that helps in building the NIC Teaming without the use of any third-party utilities. Microsoft's teaming protocol can be used to team network adapters of different vendors. It is recommended to always use the same physical network adapter with the same configuration, including configuration speed, drivers, and other network functionality, when setting up NIC Teaming between two physical network adapters.

Only two physical network adapters in teaming can be assigned to a virtual machine. In other words, a network teamed adapter cannot be attached to a virtual machine if it contains more than two physical network adapters. NIC Teaming can only be configured if there are two or more 1 GB or two or more 10 GB physical network adapters. Teamed network adapters will appear in the ""External Network"" configuration page of Virtual Machine settings. NIC Teaming can also be referred to as NIC bonding, load balancing and failover or LBFO. How Does NIC Teaming Work? Microsoft developers have designed a new protocol for NIC Teaming specifically. The new protocol, known as Microsoft Network Adapter Multiplexor, assists in routing packets from physical network adapters to NIC teaming adapters and vice versa. This protocol is responsible for diverting the traffic from a teamed adapter to the physical NIC. The protocol is installed by default as part of the physical network adapter initialization for the first time. The Microsoft Network Adapter Multiplexor protocol is checked in the teamed network adapter and unchecked in the physical network adapters that are part of the NIC Teaming. For example, if there are two physical network adapters in a team, the Microsoft Network Adapter Multiplexor protocol will be disabled for these two physical network adapters and checked in the teamed adapter as shown in the below screenshot: As shown in the above screenshot, the Microsoft Network Adapter Multiplexor protocol is unchecked in the properties section of the Physical Network Adapter named ""PNIC5,"" and the Microsoft Network Adapter Multiplexor protocol is checked in the property of ""Hyper-VTeaming"" teamed network adapter. ""Hyper-VTeaming"" is a teamed network adapter. Any network traffic generated from the teamed adapter will be received by one of the physical NICs participating in the Teaming. The teamed adapter talks to the Microsoft Network Adapter Multiplexor protocol bound in the physical NIC. If this protocol is unchecked in one of the physical network adapters, then the Teamed adapter will not be able to communicate with the physical network adapters participating in the Teaming. Third-party teaming utilities might have a different protocol designed for this, but the one offered by Microsoft can be used with any vendor network card — so this protocol is vendor- and network adapter-independent. Nirmal Sharma is a MCSEx3, MCITP and Microsoft MVP in Directory Services. He has specialized in Microsoft Technologies since 1994 and has followed the progression of Microsoft Operating System and software. In his spare time, he likes to help others and share some of his knowledge by writing tips and articles on various sites and contributing to Solution IDs for www. Dynamic-Spot Action.com. Nirmal can be reached at nirmal_sharma@mvps.org. Follow Server Watch on Twitter and on Facebook "


how to prepare jars for canning

Remove lids and rings from jars. Place the number of jars you'll need on top of the rack in your stock pot. Fill pot (and jars) with water to cover, place a lid on the pot and bring it to a boil. Put your lids in a small saucepan and bring them to the barest simmer on the back of the stove. While the canning pot comes to a boil, prepare your product.

A Beginner's Guide to Canning

A Beginner's Guide to Canning In a Pickle Jarred, canned, pickled, and preserved. Marisa Mc Clellan50 Printer-Friendly Version [ Photographs: Marisa Mc Clellan]

I've been writing about pickling and canning here for months without ever offering a primer on the mechanics of canning. Without further delay, here it is, complete with a bit of canning history, reasons for the current canning resurgence and even a bit of troubleshooting, should your preserving project go awry.

A Bit of History People have been preserving food since our very first days. Early techniques included drying, smoking, fermentation and packing in fat (a method we know these days as confit). Later came vinegar pickles, jams (often sealed with wax or more fat) and suspension in alcohol. Still, none of these approaches led to reliably preserved foods. There was always some risk of spoilage. In the late 1700s, Napoleon Bonaparte was looking for a way to dependably preserve food for his troops and so offered a cash prize to anyone who could produce a better method. After much experimentation, a French cook named Nicolas Appert discovered the packing, heating and sealing technique that essentially what we use today. Home canning has been popular in the U. S. since the late 1850s, when John L. Mason invented the first reusable jar with a screw-on lid. Canning technology gradually improved and in 1915, Alexander H. Kerr developed the two-part canning lid that we still use tod

ay. Mechanics of Canning The mechanics behind canning are fairly simple. You fill a clean jar with prepared food, apply the flat lid and the threaded ring to the jar and submerge the filled jar in boiling water for a prescribed amount of time (times vary widely, depending on what you're canning).

When you remove the hot jar from the water, the heat begins to escape, taking with it any air left in the jar. The escaping oxygen pulls the lid down, creating an airtight seal. A food-safe sealing compound embedded into the lid aids in the maintenance of the seal. High-acid food preserved in this manner will keep happily for at least a year. In the last 60+ years, as food production became heavily industrialized and the full-service grocery store became the norm, home canning experienced a drastic drop-off in popularity. It went from being a seasonal necessity (how else would you preserve the bounty of your kitchen garden and fruit trees?) to a neglected art, still practiced in more rural areas, but nearly abandoned by city dwellers. Thanks to the soft economy, concerns over industrial food safety and a desire among many of us to have more control about what's in our food, home canning has once again become popular. However, for those who didn't grow up watching their mothers or grandmothers, the process can be intimidating. Take heart! It's not nearly as hard as you think. What You'll Need To get started canning, take stock of your current kitchen supplies. You should gather: Tongs A wide-mouth funnel A variety of measuring cups A jar lifter**If you're going to do a lot of canning, I do recommend this tool. It's saved me from a number of hot water burns over the years. Vessels: A large, wide, non-reactive pot like an enameled Dutch oven is a good vessel for cooking preserves. A deep stockpot makes an excellent canning pot. Just pop a round rack or kitchen rag into the bottom of the pot so that the water can circulate fully around the jars. Let's Get Canning!Here's how you do the actual work of canning. Find a recipe from a reliable source like the Ball website, the National Center for Home Food Preservation or a cookbook with tested recipes. Gather your ingredients. Always work with the freshest produce you can find.

When your recipe is complete, remove the jars from the canning pot (pouring the water back into the pot as you remove the jars) and lay them out on a clean towel on your counter. Carefully fill your jars with your product. Depending on the recipe, you'll need to leave between ¼ and ½ an inch of headspace (that's the room between the surface of the product and the top of the jar). Wipe the rims of the jar with a clean, damp paper towel or the edge of a kitchen towel. Apply lids and screw the bands on the jars to hold the lids down during processing. Carefully lower the filled jars into the canning pot. You may need to remove some water as you put the jars in the pot. A heat-proof Pyrex measuring cup is the best tool for this job. Once the pot has returned to a boil, start your timer. The length of the processing time will vary from recipe to recipe. When your timer goes off, remove the jars from the water bath promptly. Place them back on the towel-lined countertop and let them cool. The jar lids should begin to ping soon after they've been removed from the pot. The pinging is the sound of the seals being formed and the center of the lids will become concave as the vacuum seal takes hold. After the jars have cooled to room temperature, remove the bands and check the seals. You do this by grasping the jar by the edge of the lid and gently lifting it an inch or two off the countertop. The lid should hold fast. Once you've determined that your seals are good, remove the rings and wash the jars well to remove any sticky residue. Store your jars in a cool, dark place (with the rings off, please) for up to a year. Jars that don't seal can be refrigerated and used first. Uh Oh.. Troubleshooting Why didn't my jars seal? This happens for a few different reasons. There may have been a bit of product on the rim of the jar, making it hard for the lid to get a good hold. The sealing compound on the lid wasn't fully softened before you applied it. Was your product piping hot when it went into the jars? If not, there may not have been enough heat in the jar to create the necessary vacuum effect. Help! I seem to have lost some product during processing!This is a normal experience, known as siphoning. It happens sometimes when a hot jar experience rapid temperature change. The swift cooling can sometimes force product out of the jar. It's not something to worry about unless it interferes with the seal. Just wash your jars well and store as usual. To prevent it in the future, take care to remove all trapped air bubbles inside the jar before canning. You can also let jars sit in the canner for a few minutes when the time is up, off the heat and with the lid removed, so that the temperature change isn't as shocking to the jars. Canning Hotline Any other questions? Leave them in the comments below!Marisa Mc Clellan Marisa Mc Clellan is a food writer, canning teacher, and dedicated pickler who lives in Center City Philadelphia. Find more of her jams, pickles and preserves (all cooked up in her 80-square-foot kitchen) at her blog, Food in Jars. Her first book, also called Food in Jars, will be published by Running Press in May 2012.50 Printer-Friendly Version Filed Undercanning in a pickle


siamese cats types of breeds

ese The Siamese is a medium-sized, light-colored cat with stunning sapphire eyes. It is one of the most ancient breeds. There are two types of Siamese: traditional and show. The Sho w Siamese is very angular, elegant and slender breed. The Traditional Siamese is more round and chunky. Personality: Siamese cats are very active, talkative and curious cats.

Siamese

Siam

They are also very playful and can be taught certain tricks. They get on well with children and dogs. Origin Thailand, ancient Life Span 15-20 years Other Names Siamese Tweet Siamese Build Information Size Medium The Siamese is a medium-sized, light-colored cat with stunning sapphire eyes. It is one of the most ancient breeds. There are two types of Siamese: traditional and show. The Show Siamese is very angular, elegant and slender breed. The Traditional Siamese is more round and chunky. Behaviour and Personality Kid Friendliness Affection Level Activity Level Siamese cats are very active, talkative and curious cats. They are also very playful and can be taught certain tricks. They get on well with children and dogs. Appearance Grooming Minimal (Regular Brushing, nail trimming and tooth cleaning)Are you a Siamese Parent? Make your dog famous and share your pictures with our community!Upload a Pet Photo Leave a review of this Breed Write your review Click stars to rate!Share my review on Facebook Post Review Is this information incomplete? Help us improve this dog breed profile, by submitting your information here. Siamese Pet Insurance When adding a dog or cat to your family you want to make sure your pet is happy, healthy and protected. During its lifetime your pet is exposed to many illnesses and diseases and some breeds are affected by a congenital disease which is a condition existing at birth. At these moments when your pet is ill or maybe needs surgery, you want to be protected for the unexpected and high veterinarian costs. Insure your Siamese Learn more about pet insurance here to keep your pet healthy and request your FREE Quote now!Similar Cat Breeds Our website does not take any position with or against designer dog breeds or mixed breeds. We also stay neutral about the buying or adoption of pets. Our main goal is to keep users informed about the dog breeds and the multiple options they might have when getting a new pet.


what causes hepatomegaly

Hepatomegaly is enlargement of the liver beyond its normal size. Certain conditions such as infection, parasites, tumors, anemias, toxic states, storage diseases, heart failure, congenital heart disease, and metabolic disturbances may all cause an enlarged liver.

Hepatomegaly

Hepatomegaly Overview

Review Date 4/24/2017Updated by: Michael M. Phillips, MD, Clinical Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A. D. A. M. Editorial team.


what causes hypoxemia in pulmonary edema

. I. Hypoventilation: Hypoxemia develops when the pulmonary alveoli are inadequately ventilated. Clinically, the hallmark of inadequate ventilation is hypercapnia, an elevated systemic arterial P CO2 (P a CO2 > 43 mm Hg). The most common cause of hypoventilation is depression of the medullary respiratory center by drugs.

Four Causes of Hypoxemia

Four Causes of Hypoxemia Page history last edited by PBworks 11 years, 10 months a

go Four causes of hypoxemia: Abnormal ventilation/perfusion ratios as the major cause of hypoxemia. Lisa Ebihara MD-Ph D, Department of Physiology and Biophysics Read Chapter 5 of West, Respiratory Physiology 7th ed.

Abnormally low oxygen in the blood is caused by one or more of the following: (1) Hypoventilation; (2) diffusion impairment; (3) right to left shunt (usually in the lungs, but can be in the heart); (4) abnormal ventilation/perfusion ratios

The effect of hypoventilation on alveolar and system arterial P CO2 and P O2 will be illustrated an example of a man with normal lungs who takes an overdose of barbiturates which depresses his medullary respiratory center, such that alveolar ventilation is depressed by half while CO 2 output remains normal. Blood gas analysis obtained with the patient breathing room air showed a P a O2 of 50 mm Hg and a P a CO2 of 80 mm Hg. When the patient was given 27% O 2 to breath his P a O2 rose to ~100 mm Hg. Keep in mind the two most basic formulas in respiration: P a O2 = P i O2 - P CO2 /R and P a CO2 = V CO2 /V A x KThis example illustrates that: PAO2 is depressed approximately to the same extent that PACO2 is elevated. Even a 50% decrease in alveolar ventilation leaves PAO2 at 50 mm Hg, a value high enough to produce 80% saturation of Hb with O2. The hypoxemia that is caused by hypoventilation can be remedied by administering air that is only slightly enriched with O2. II. Impairment of diffusion: this means that equilibration does not occur between the P O2 in the pulmonary capillary blood and alveolar gas. Recall that the diffusion capacity of the lung for a gas is equal to: DL (gas) = net rate of transfer/ΔP gas betw. alveolus & capillary Figure 1 shows the time course of the rise in P O2 as the red blood cell moves through the capillary. Under typical resting conditions, the capillary P O2 reaches that of alveolar gas when the red cell is about one-third of the way along the capillary. Even when the capillary transit time is shortened by exercise, the capillary blood equilibriates completely with alveolar air. However, in some abnormal circumstances when the diffusion properties of the lung are impaired, the blood does not reach the alveolar value by the end of the capillary. Diffusion limitation seldom causes systemic hypoxemia at rest, but may cause hypoxemia during exercise when there is less time for equilibration with alveolar gas. Figure 1. Changes in PO2 along the pulmonary capillary. On exercise, the time available for O 2 diffusion across the blood-gas barrier is reduced. A thickened alveolar wall slows the rate of diffusion. From JB West, Pulmonary Physiology-The Essentials, 7th ed. Diseases in which diffusion impairment may contribute to hypoxemia include asbestosis, sarcoidosis and diffuse interstitial fibrosis. Impaired diffusion is also likely to develop when P AO2 is abnormally low, such as at high altitudes. Here, the impairment occurs because the ΔP for O 2 -diffusion is low. Also, when the diffusion pathway is thickened, hypoxemia may not develop until the patient exercises (Why?). Some important points-Carbon dioxide elimination is generally thought to be unaffected by diffusion abnormalities. This is because the diffusion of CO 2 is ≥20X faster than O 2. Clinically, significant hypercapnia (elevations in arterial PCO2) is never caused by a diffusion defect. Hypoxemia can be easily corrected by breathing an enriched oxygen mixture. III. Shunt: Blood returning to the right heart and entering the lungs through the pulmonary artery is called mixed venous blood. If some the cardiac output bypasses functioning lung through a shunt, then arterial blood will be a mixture of normally oxygenated blood and poorly oxygenated mixed venous blood. A shunt can occur in one of two situations: An anatomic shunt occurs when blood bypasses the lung through an anatomic channel, such as from the right to left ventricle through a ventricular septal defect. A physiological shunt occurs when a portion of the cardiac output goes through the regular pulmonary vasculature without coming into any contact with alveolar air. Physiological shunting is often seen in conditions such as pulmonary edema, pneumonia, and collapse of a portion of the lung (pneumothorax). The following example will illustrate the effect of a large pulmonary shunt caused by occlusion of the right main bronchus. Figure 2 (circled number- PCO2)This example illustrates that: Shunting of blood through unventilated alveoli produces hypoxemia. Note that the arterial O 2 content is a weighted average of mixed venous and end-capillary O 2 content. You can find arterial P O2 from arterial O 2 content by working back through the dissociation curve, but not by averaging mixed venous and end-capillary partial pressures of O 2. Since shunted blood contacts no air, increasing the fraction of inspired oxygen F IO2 will not improve oxygenation (except by adding more dissolved oxygen to the normally oxygenated blood)P a CO2 will usually be normal or low because increased alveolar ventilation (stimulated by hypoxemia) lowers P a CO2. On page 59 of his text, West gives a formula by which the fraction of shunted blood can be approximated. West writes the formula as: Wherein C C’O2 is the oxygen content of ideal end-pulmonary capillary blood based on the alveolar gas equation; C a O2 is the arterial oxygen content; C VO2 is the oxygen content of mixed venous blood. End-capillary O 2 is a calculated assuming that end-capillary P O2 is in equilibrium with the P O2 in alveolar gas; the other contents are measured. This is a straightforward mixing calculation based on conservation of matter (O 2 ); the derivation is given in West p. 48-49. When the values from the blood of a normal person are placed in the equation, it is found that no more than 5% of venous blood is shunted through the lung. This “natural shunt” is due to the addition of venous blood to the pulmonary vein from the bronchial blood supply, and the addition of coronary venous blood to the left ventricle from the Thebesian veins. IV. Ventilation-perfusion abnormalities V/Q ratio determines the P O2 and P CO2 for an individual alveolar-capillary unit.

Figure 3 nicely illustrates the relationship between PAO2 and PACO2 as the V/Q ratio is changed. From JB West, Pulmonary Physiology-The Essentials, 7th ed. V/Q imbalance is the most common cause of hypoxemia, a result of lung units with low V/Q ratios. An extreme case is easy to grasp – the left lung gets all the ventilation and no blood flow; the right lung gets no ventilation and all the blood flow. In this case, you have a big dead space and a big shunt.

This will clearly result in severe hypoxemia. In less extreme cases, a portion of the lung may be relatively underventilated and another portion of the lung may be relatively overventilated. The effect of such a mismatch between ventilation and perfusion is examined more closely below. In Figure 4, P a O2 is plotted against the arterial oxygen content. Note that the curve is nearly flat in the range of physiologic P a O2 values (above 70 mm Hg) and falls steeply below 60 mm Hg. Points representing oxygen contents from three separate alveolar-capillary units are also shown. These units have V/Q ratios of 0.1, 1.0, and 10.0. Note that the average oxygen content after all the blood is mixed (18.5 ml O 2 /100 ml) is lower than the oxygen content from a normal unit (19.5 ml O 2 /100 ml). Figure 4. Oxygen dissociation curve: P a O2 vs. oxygen content. Oxygen content from alveolar-capillary units with V/Q ratios of 0.1,1, and 10 are, 16, 19.5, and 20 ml O 2 /100 ml blood. Lines are drawn for each content to its point on the dissociation curve. The average oxygen content, 18.5 ml O 2 /100 ml) is lower than the oxygen content from the normal unit (19.5 ml O 2 /100 ml). Hyperventilation of some units does not add enough oxygen to balance out thelow oxygen content from the hypoventilated units. The result is a final oxygen content determined mainly by the low V/Q areas. V/Q imbalance will also cause an increase in P CO2 in the poorly ventilated alveoli. Nevertheless, systemic arterial P CO2 will remain normal because the hypoxemia stimulates increased ventilation in rest of the lung. The reason why increasing ventilation can lower Ca CO 2 but cannot raise Ca O 2 has to do with the shape of the oxygen and the carbon dioxide dissociation curves (Figure 5). The carbon dioxide curve is nearly linear over the physiological range of P a CO2 ’s and its slope is much steeper than the slope of the oxygen dissociation curve. Thus a reduction in alveolar P CO2 and corresponding increase in alveolar PO 2 due to hyperventilation cause a large decrease in the carbon dioxide content but only a small increase in oxygen content. Figure 5. V/Q imbalance and the dissociation curves for carbon dioxide and oxygen. v/Q represents low V/Q units and V/Q represents high V/Q units. The hyperventilation in the remainder of the lung increases the physiological dead space (V DAS) of the lung. The increase V DAS represents “wasted ventilation” because it is not able to raise the P O2 of the pulmonary venous blood to normal. In most lung diseases in which ventilation is sufficiently impaired to produce hypoxemia, V DAS is increased. Hypoxic vasoconstriction (covered in an earlier lecture) will decrease blood flow to the pulmonary capillaries of the poorly ventilated alveoli. This will diminish the extent of the V/Q mismatch, and thus diminish the extent of hypoxemia. An example of a condition in which the primary disorder is a high V/Q ratio is pulmonary embolism as shown in the figure below. Figure 6Important facts to understand regarding pulmonary embolism are: Theoretically, hypoxemia should not develop in response to occlusion of an artery, and occlusion of a small branch does not produce hypoxemia. Clinically, occlusion of a pulmonary artery or a major branch of it often does result in hypoxemia. The reasons for the hypoxemia are several. First, sudden loss of a large portion of the pulmonary circulation greatly increases resistance to flow. The resulting increase in pulmonary artery pressure may lead to interstitial edema. The increased pulmonary arterial pressure and the interstitial edema increase the width of the diffusion pathway. Also, blood flows through the pulmonary capillaries more rapidly, leaving less time for diffusion. The edema also decreases the compliance of the lung thereby increasing the work of breathing. Clinically, dyspnea (difficult breathing) often results from a large embolism. Second, the occluded region probably releases vasoconstrictor substances (serotonin has been suggested), which further increase resistance to blood flow and the work that the right heart must perform. Third, pulmonary shunts develop in some patients with pulmonary embolisms. West (in his pulmonary pathophysiology text) suggests that A-V anastomoses always exist in the lung, but they are normally closed. The high pulmonary arterial pressures in patients with large pulmonary embolisms cause these anastomoses to open. In a patient with a large pulmonary embolism, the end-expired P CO2 will be considerably lower than the arterial P CO2. These two values are normally about equal, because the end-expired P CO2 represents alveolar P CO2. In pulmonary embolism, many of the alveoli are unperfused, and contribute no CO 2 to the expired air. V DAS is abnormally large. V. Differences in V A /Q ratios in the normal lung: Base versus Apex For mechanical reasons that will be described in subsequent lectures, in an upright subject. Q and V A are greater at the base of the lung than in the apex. While the apex is poorly ventilated and poorly perfused, its perfusion is even poorer than its ventilation. The effect of this is a very high V A /Q ratio at the apex. This relationship is illustrated in Figure 5.8 amd 5.9 from JB West, Pulmonary Physiology-The Essentials, 7th ed. The effect of the high V A /Q ratio at the apex (and the lower ratio at the base) on the alveolar P O2, P CO2 and pulmonary capillary p H is illustrated in Figure 5.10 from West. Notice that in spite of the lower V A /Q ratio at the base, (1) Hb in basal pulmonary capillaries is 95% saturated with O 2; (2) total O 2 uptake and CO 2 egress is far greater at the base of the lung than at the apex. VI. Distribution of ventilation:perfusion ratios (a specialty of West): By using a technique that we need not be concerned with, it is possible to determine how much blood flow (Q) and how much alveolar ventilation (V A) is distributed to lung regions with a particular V A /Q ratio. Not surprisingly, in people with normal pulmonary systems, most V A and most Q goes to lung regions with a V A /Q ratio of about 1 (Figure 5.13 from West). In a patient (Figure 5.14 from West) with obstructive lung disease (chronic bronchitis and emphysema), considerable blood flows to very poorly ventilated regions (V A /Q=1), and at the same time, considerable ventilation goes to lung regions that are poorly perfused (V A /Q=1.0-10). This dramatically illustrates V A /Q mismatch which West maintains is the most common cause of hypoxemia. VII. Measurement of V A /Q mismatch: The extent of V A /Q mismatch can be estimated by measuring V D (physiologic dead air space) using a formula developed on page 18-19 of West: V D /V T = (P a CO2 -P CO2 (mixed exp) )/P a CO2 wherein: V D /V T is the ratio of physiologic dead air space to tidal volume. P a CO2 is the measured arterial P CO2. Patients with V A /Q almost always have uneven ventilation causing the alveoli to empty unevenly. For this reason, end-expired air is not a reliable measure of P a CO2. Arterial P CO2 (P a CO2) is the best estimate of P a CO2 obtainable. P CO2 (mixed exp) is the P CO2 of mixed expired air which, of course, contains a mixture of physiologic DAS and alveolar air. V D /V T is 0.2-0.35 in normal nonexercising subjects. In patients with V A /Q mismatch, it is greater than 0.35 and can even be 0.5, i.e. half the ventilation is “wasted”. Another way of estimating V A /Q mismatch is to measure systemic arterial PO2 and then compare this value with the ideal alveolar P O2. In other words, determine the alveolar-arterial O 2 difference. The ideal alveolar P O2 is estimated from the alveolar gas equation which was developed in an earlier lecture. In a subject with a normal pulmonary system, the alveolar-arterial O 2 difference is only about 5 mm Hg. In a subject with V A /Q mismatch, the difference can be much larger (40 mm Hg). Of course, an alveolar-arterial difference will also be seen in hypoxemia caused by pulmonary or intracardiac shunt. Shunt can be distinguished from V A /Q mismatch because the latter’s hypoxemia is correctable by breathing 100% O 2. VENTILATION-PERFUSION MISMATCH IN RESPIRATORY DISEASESVentilation-perfusion abnormalities occur in many pulmonary diseases. These diseases include obstructive, restrictive and vascular pulmonary diseases. The main pathology and clinical problems observed in several different pulmonary diseases are discussed below: OBSTRUCTIVE DISEASESChronic Obstructive Pulmonary Diseases (COPD)1. Pure emphysema (COPD type A)Pathology: Areas of greatly enlarged air spaces with disruption of alveolar walls. V DAS (physiological dead space). Large increase due to alveoli with high V A /Q ratio. Enlarged air spaces have much reduced blood perfusion. Shunt: Minimal. Absence or minimal presence of unventilated alveoli. Alveoli with low V A /Q ratio: Small increase, due to some shift in blood flow from capillary deprived (emphysematous) air spaces to normal alveoli and consequential small drop in V A /Q in the latter. Diffusion impairment: None Hypoxemia: Mild (P a O2 = ~80) due to low V A /Q regions (see above). (A-a)P O2 = 10-15 (air breathing). Hypercapnia: None (P a CO2 = ~ 40). As long as V E is increased to compensate for increase in physiological dead space, P a CO2 is normal. Acid/base problems: None as long as P a CO2 is normal. Tissue oxygenation: Normal.2. Pure chronic bronchitis (COPD type B)Pathology: Abundant mucous secretions in bronchial tree and narrowing of small airways due to inflammation and wall edema. V DAS: Small to moderate increase in alveolar dead space ventilation due to small areas with high V A /Q ratio. Shunt: Minimal. Absence or minimal presence of unventilated alveoli. Alveoli with low V A /Q ratio: Large increase, due to excessive blood flow to poorly ventilated alveoli. Some compensation is provided by hypoxic vasoconstriction. Diffusion impair. : None. Hypoxemia: Significant to severe (P a O2 = 40-70) due to low V A /Q regions. (A-a)P O2 = 20-50 (air breathing). Hypercapnia: Moderate (P a CO2 = ~50). Increased airway resistance due to bronchial obstruction and narrowing of small airways results in chronic hypoventilation. Acid/base problems: Minimal to moderate acidosis, in spite of increased P a CO2, due to compensatory retention of bicarbonate by the kidneys. Tissue oxygenation: Normal as long as severe hypoxemia is compensated by increase in RESTRICTIVE DISEASES1. Interstitial pulmonary fibrosis Pathology: Thickening of alveolar wall due to interstitial infiltration with lymphocytes, plasma cells and collagen fibers. V DAS: None or minimal. Shunt: Minimal. Absence or minimal presence of unventilated alveoli Alveoli with low V A /Q ratio: Moderate amount due to some reduction of ventilation in alveoli with relatively normal blood flow. Diffusion impair. : Minimal at rest, in spite of several fold increase in the alveolar gas-to-blood distance, due to the great diffusion reserve available (normally blood gases equilibrate with alveolar gases in the first third of the time spent in an alveolar capillary), but significant with exercise, due to increased velocity of blood circulation (reduced time spent in alveolar capillary). Hypoxemia: Moderate at rest (P a O2 = ~80) due to low V A /Q regions (see above), but significant with exercise due to diffusion impairment added to effect of low V A /Q regions. Hypercapnia: Absent. Usually there is mild hypocapnia (P a CO2 = 30-40) probably due to stimulation of receptors in the lung (stretching of airways due to increased lung recoil). Acid/base problems: Mild alkalosis, as long as the hypocapnia is not compensated by a drop in bicarbonate. Tissue oxygenation: Normal as long as hypoxemia is compensated by increased Q. VASCULAR DISEASES1. Pulmonary edema Pathology: Accumulation of fluid in alveolar air space and in alveolar wall, most often caused by left ventricular failure resulting in increased hydrostatic pressure in pulmonary capillaries and pulmonary veins. V DAS: None or minimal. Shunt: Significant, due to unventilated alveoli because of intra-alveolar fluid. Alveoli with low V A /Q ratio: Moderate amount, due to partial airway obstruction by fluid and regional V A /Q drop. Diffusion impair. : Minimal at rest, in spite of interstitial fluid, due to the great diffusion reserve available (see above). Hypoxemia: Moderate (P a O2 = 70-80) due to shunted regions (V A /Q = 0)and regions with low V A /Q ratio. Hypercapnia: Absent of mild hypocapnia due to stimulation of receptors in the lungs, and to hypoxemia if P a O2 drops below ~70 mm Hg. Acid/base problems: None or mild alkalosis, as long as the hypocapnia is not compensated by a drop in bicarbonate. Tissue oxygenation: Normal as long as hypoxemia is compensated by increased Q.2. Pulmonary embolism Pathology: Acute occlusion of branches of the pulmonary artery most often caused by thrombi that had come loose from the walls of deep veins of lower extremities, pelvic regions, inferior vena cava or right heart. V DAS: Significantly increased, depending on the size of the affected area, due to drastic reduction of regional alveolar perfusion (large regional increase in V A /Q). Shunt: Significant, due to blood flow through unventilated alveoli in infracted regions (hemorrhagic atelectasis) and opening of A-V anastmoses. Alveoli with low V A /Q ratio: Significant amount, due to redistribution of blood flow from obstructed arteries to normal lung regions. This results in excessive perfusion of normally or poorly ventilated alveoli with sizable drop in regional V A /Q. Diffusion impair. : Minimal to moderate, due to increased regional blood flow velocity resulting in reduced transit time. Hypoxemia: Moderate (P a O2 = 70-80) due to shunted regions (V A /Q = 0)Hypercapnia: Absent or mild hypocapnia due to the effect of hypoxemia on chemoreceptors, if P a O2 drops below ~70 mm Hg. Acid/base problems: None or mild alkalosis. Tissue oxygenation: Normal as long as hypoxemia is compensated with increased Q.

Four Causes of Hypoxemia


is saugatuck center for the arts nonprofit

ls. The Saugatuck Center for the Arts won alongside Fortune 100 companies and national non-profits including the Intel Corporation, the Smithsonian, General Motors, Map Quest, Pfister, United Way, and more.

News Sports Entertainment Life Obituaries E-Edition Cars Jobs Homes Classifieds Contests Subscribelog in Site Site Archive Creative Excellence: Saugatuck Center for the Arts receives award Friday May 13, 2016 at 3:06 PMThe winners of the 22nd Annual Communicator Awards have been announced by the Academy of Interactive and Visual Arts, and a local winner has emerged. Sentinel staff The winners of the 22nd Annual Communicator Awards have been announced by the Academy of Interactive and Visual Arts, and a local winner has emerged. The Saugatuck Center for the Arts (SCA) won “Best Branded Content–Nonprofit” for its 2015 Mason Street Warehouse Cabaret promo video. With more than 6,000 entries received from across the U. S. and around the world, from media companies, advertising agencies, and marketing firms, the Communicator Awards is the largest and most competitive advertising awards program honoring creative excellence for advertising, marketing, and communications professiona

SCA Sales and Marketing Manager Angela Peavey created the winning piece along with her team of marketing interns. Peavey herself is an Emmy-nominated director and producer and in the last three years has won 10 film and video awards, but the Communicator Award marks her first for the Saugatuck Center for the Arts.“I’m happy to bring my video expertise to my position at the Saugatuck Center for the Arts,” said Peavey. “I’m thankful that the SCA board and staff believe in my vision and are supportive of my marketing endeavors.”Linda Day, executive director of the Academy of Interactive and Visual Arts said of the awards, “The work entered in the 22nd Annual Communicator Awards serves as a benchmark in gauging the innovative ideas and capabilities of communications and marketing professionals around the world. Each year, our entrants continue to amaze by reinventing the ways we communicate and market in an ever-changing industry.” She added, “On behalf of the entire Academy, we want to congratulate this year’s Communicator Award Entrants and Winners for their passion and dedication. We are honored to be given the opportunity to recognize such outstanding work.”The Saugatuck Center for the Arts, located at 400 Culver Street, Saugatuck, is a non-profit organization dedicated to creating a more vibrant lakeshore community in West Michigan and beyond. For more information about the SCA and upcoming events, visit sc4a.org or call 269-857-2399.