Case Study The Emergency Room With Dka And New Onset...

Pharmacology Case Study of Mr. Z This paper will explore the history and hospital course of Mr. Z., a 23 year old Caucasian male who was admitted on October 11, 2016 to Massachusetts General Hospital for treatment of diabetic ketoacidosis (DKA) and new onset type 1 diabetes mellitus. DKA is an emergency situation that results in 100,000 hospitalizations in the US yearly, a 9% mortality rate, and treatments of reportedly 1 billion dollars per year (Katsilambros, Kanaka-Gantenbein, Liatis, Makrilakis, Tentolouris, 2011). Presenting to the emergency room with DKA is the first manifestation of type 1 diabetes in 30% of cases (Katsilambros et al., 2011). This paper will examine Mr. Z.’s case presentation, pertinent medical history, diagnosis formulation, hospital management, intensive review of his medications, and discussion. Case Presentation Mr. Z. is a pleasant, 23 year old Caucasian male who presented to Massachusetts General Hospital emergency room on October 11, 2016. Mr. Z had initial symptoms of headache for 3 weeks and difficulty concentrating in school. Over the last two weeks he developed extreme blurred vision, polydipsia, polyphagia, and polyuria which was increasing in severity. He also had an unintentional weight loss of 10 pounds over the last three months. He was home for Yom Kippur when his father noticed after fours of fasting that Mr. Z. was diaphoretic, short of breath, dizzy, pale, and was confused. 911 was called and he was brought to the

Mandatory Drug Testing for Welfare Recipients and Public...

Have you ever questioned the tax taken out of your hard-earned money? Questions similar to that are where the money is going and if it is being used properly. In the U.S. news recently those questions have been on a great deal of State’s minds; reaching back to 2003, this issue has been brought up time and time again. The main topic of tax money is the use of assistance money and are the recipients really using the money for the right reasons. There are many problems with the assistance program but the one that comes to mind the most is that many people abuse the money given to buy the essentials and provide, for their family for illegal drugs. The solution that many state representatives have come up with is drug testing as a requirement†¦show more content†¦This determination comes about as many more people are turning to the protection that financial aid provides to get them through the recession. â€Å"Poverty and civil liberties advocates fear the strategy could backfire, discouraging some people from seeking financial aid and making already desperate situations worse† (â€Å"States† FoxNews.com 1). Temporary Assistance for Needy Families, known as TANF, is a program that provides monthly cash benefits to families with the intention of moving adults into employment in two years, max. Each state has the right to set eligibility limits and benefit levels. On average, a single parent family of three receives about $200 a month. TANF recipients in Arizona includes 84,000 people in 38,500 households the majority of that being children. The state’s Joint Legislative Budget Committee has found that the cost of drug testing for one year would charge 3.4 million dollars. This amount does not comprise the cost of treatment for the users (â€Å"States† Alcoholism 6). Barbara Hoberock states: In Oklahoma, recipients use debit like cards, electronic-benefit transfer cards. They are given a certain amount monthly for their mon thly benefit coverage; they cannot withdraw more than they are given. In 2009, 39,145 people were getting assistance through TANF. (1) Even though this just seems to be about saving money, it does have the underlying purpose of seeking those who need assistance with the drug abuse problem. EveryShow MoreRelatedMandatory Drug Testing Should Be Banned1365 Words   |  6 PagesIntroduction Mandatory drug testing has been and ongoing controversial issue over the most recent years. Mandatory drug testing has been subjected to students, athletes, and employees all over the country. However a lot of speculation has been made whether or not welfare recipients in particular should be subjected to mandatory drug testing. According to Besonen, programs such as welfare were created in the 1930s to temporarily aid struggling Americans to help get them back up on their feet. (BesonenRead MoreShould Drug Testing Welfare Recipients? Essay1707 Words   |  7 Pagesuse of drugs is an immense problem in today’s society. The big question is, is it a problem within the welfare system? Drug use isn’t just a problem of poverty; it’s found among all groups and classes. As said in Jamelle Bouies article, The Myth of Drug Use and Welfare, â€Å"The myth of welfare recipients spending their benefits on drugs is just that—a myth. And indeed, in Utah, only 12 peo ple out of 466—or 2.5 percent—showed evidence of drug use after a mandatory screening.† Drug testing welfare recipientsRead MoreDrug Testing : A Controversial Issue Right Now1439 Words   |  6 PagesRUNNING HEAD: Mandatorily Drug Testing Welfare Recipients Does More Harm Than Good Mandatorily Drug Testing Welfare Recipients Does More Harm Than Good Clare M. Pitlik Marist High School Author Note First paragraph: Introduction to history of drug testing welfare recipients Second paragraph: Explains why drug testing welfare recipients is unconstitutional Third paragraph: Explains why drug testing welfare recipients is costly Fourth paragraph: Rebuttals Fifth paragraph:Read MoreDrug Testing Essay1200 Words   |  5 PagesThere is a big question floating in the air around a lot of people today, â€Å"Is drug testing the welfare constitutional or not?† When dealing with this we come to many road blocks. We should know and understand the difference in a drug use problem and a psychiatric disorder. Also understanding the difference in substance abuse and substance dependence. Confusing the two could be an issue. When you decide to drug test the welfare there is much more that needs to go into it than just the test to determineRead MoreMandatory Drug Testing For Welfare Recipients1526 Words   |  7 PagesBreez Arann Ms. Holiday English 12 11/04/15 Mandatory Drug Testing for Welfare Recipients When the United States’ welfare program was created during the Great Depression, it was meant to temporarily relieve the burdens of the one-fourth of American families who were unemployed, and struggling financially. President Franklin D. Roosevelt created the Social Security Act in 1935, then amended it in 1939 to create programs to assist families with unemployment compensation, and to create government agenciesRead MoreArgumentative Essay On Homelessness1674 Words   |  7 Pagesindividual that has no primary daytime or nighttime residence. Its residence is where it is not designated for human beings like us to sleep in such as public places or private. Some places may be buses, parks, benches, abandoned cars, transportation stations, trains, etc.†¦ Knowing the life situation they go through should homeless people be alcohol and drug tested before getting any federal help? Scott Walker is a guy who stand out in the crowded field to strive individuals with tough life situation andRead MoreDrug Testing the Less Fortunate 1023 Words   |  4 PagesShould drug testing be a necessity for all state and federal aid programs? Drug testing welfare recipients have been a major issue across the United States for a few years now. Many indicate that if working class people are subject to a test prior to hire or randomly during the duration of employment, why should those that don’t have to work for money not have the same treatment? The government estimated that random annual drug testing for welfare recipients would cost each taxpayer an additionalRead MoreWelfare Reform : Social Welfare Policy1257 Words   |  6 Pages Social Welfare Policy Social Welfare Policy Analysis Eric Dean University of Arkansas Introduction Several states have recently begun to enact legislation that requires welfare recipients to submit to drug tests before they are eligible to receive any public assistance. The purpose of mandatory drug testing is to prevent the potential abuse of taxpayer money, help individuals with drug problems, and ensure that public money is not subsidizing drug habits (Wincup, 2014). WhileRead MoreDrug Testing1837 Words   |  8 PagesMandatory Drug Testing for Welfare Recipients Introduction Mandatory drug testing for welfare recipients is a controversial issue. Should the government hold people accepting government entitlement’s accountable for illegal drug use or would this type of action cross the boundary of civil liberties into an invasion of privacy? The government has a vested interest in getting welfare recipients back into the working population. Holding welfare recipients accountable for illicit drug use onlyRead MoreEssay about Drug Testing For Missouri Welfare Recipients907 Words   |  4 PagesRepresentatives passed a bill and sent it to the senate that would require drug testing for those receiving state Temporary Assistance for Needy Family (TANF) funds. Funding from food stamps, medicare, and public housing would not be affected by this bill (Keller – House). According to Columbia Tribune reporter Rudi Keller, the bill is very similar to the Arizona law which is the only other state that tests welfare recipients. Missouri and Arizona woul d use a questionare and interview which would determine

The Return Midnight Chapter 28 Free Essays

string(152) " could he be so kind, so caring, when anyone in their right mind would know she’d gone mad with jealousy\? Bonnie didn’t understand either\." Elena was nodding slowly. â€Å"It would work with what happened to me. At first I was alone out of my body, but then I saw Bonnie beside me. We will write a custom essay sample on The Return: Midnight Chapter 28 or any similar topic only for you Order Now † Bonnie bit her lip. â€Å"Well †¦the first thing I saw was Elena and we were both flying. I was a little behind her. But Stefan, why do you think I fel asleep and dreamed a whole story? Why can’t my version just be true?† â€Å"Because I think the first thing you’d have done would be to turn the light on – if you real y were lying there awake. Otherwise, you might well have picked up a soap opera – so boring!† Bonnie’s forehead smoothed at last. â€Å"That would explain why nobody believed me even when I told them exactly where the story was! But why didn’t I tel Elena about the treasure?† â€Å"I don’t know. But sometimes when you wake up – and I think you did wake up to have the out-of-body experience – you forget the dream if something interesting is going on. But then you might remember it later if something reminds you of it.† Bonnie stared into a middle distance, thinking. Stefan was silent, knowing that only she could unravel the riddle for herself. At last Bonnie nodded. â€Å"It could be that way! I woke up and the first thing I thought of was the sweetshop. And after that I never gave another thought to the treasure dream until somebody asked for stories. And it just popped into my head.† Elena pushed the deep blue-green velvet coverlet one way to make it green, then the other way to smooth it into blueness. â€Å"I was going to forbid Bonnie to go on the expedition,†she said: this slave who didn’t have a gem on her body except Stefan’s pendant which hung from a fine chain around her neck, and was Stillin the simplest kind of after-bath robe. â€Å"But if it’s something we have to do, I’d better talk to Lady Ulma. It sounds as if time is precious.† â€Å"Remember – time runs differently here than back on Earth. But we’re supposed to leave in the morning,†Bonnie said. â€Å"Then I definitely need to talk to her – right now.† Bonnie jumped up, excited. â€Å"I’l help!† â€Å"Wait.†Stefan put a gentle hand on Bonnie’s arm. â€Å"I have to say this. I think you’re a miracle, Bonnie!†Stefan knew his eyes must be shining in a way that showed he could hardly rein in his excitement. In spite of the danger – in spite of the Guardians – in spite of everything†¦the largest star bal – ful of Power! He gave Bonnie a sudden impetuous hug, sweeping her off the bed and whirling her before putting her down again. â€Å"You and your precognitions!† â€Å"Oooh†¦Ã¢â‚¬ Bonnie said dizzily, gazing up at him. â€Å"Damon was excited, too, when I told him about the Gateway of the Seven Treasures.† â€Å"You know why, Bonnie? It’s because everybody has heard about those seven treasures – but no one had any idea where they are†¦until you dreamed it. You do know exactly where they are?† â€Å"Yes, if the precognition was true.†Bonnie was flushed with pleasure. â€Å"And you agree that that giant star bal wil save Fel ‘s Church?† â€Å"I’d bet my life on it!† â€Å"Woo-hoo!†cried Bonnie, pumping a fist. â€Å"Let’s go!† â€Å"So you see,†Elena was saying, â€Å"it’l mean twice as much of everything. I don’t see how we can start tomorrow.† â€Å"Now, now, Elena. As we discovered, oh, eleven months ago when you left, any job can be done quickly if we summon enough hands. I am now the regular employer of al those women we used to cal in to make your bal gowns.†As Lady Ulma spoke she quickly and graceful y took Elena’s measurements – why do only one thing when you can do two at once? She glanced at her measuring tape. â€Å"Stillexactly the same as when I last saw you. You must lead a very healthy life, Elena.† Elena laughed. â€Å"Remember, for us it’s only been a few days.† â€Å"Oh, yes.†Lady Ulma laughed, too, and Lakshmi, who was seated on a stool amusing the baby, made what Elena knew was one last appeal. â€Å"I could go with you,†she said earnestly, looking at Elena. â€Å"I can do al sorts of helpful things. And I’m tough – â€Å" â€Å"Lakshmi,†Lady Ulma said gently, but in a voice that wore the hat of authority. â€Å"We’re already doubling the size of the wardrobe needed to accommodate Elena and Stefan. You wouldn’t want to take Elena’s place, would you?† â€Å"Oh, no, no,†the young girl said hastily. â€Å"Oh, Well,†she said, â€Å"I’l take such good care of little Adara that she’s no bother to you while you supervise Elena’s and Stefan’s clothes.† â€Å"Thank you, Lakshmi,†Elena said from her heart, noting that Adara now seemed to be the baby’s official name. â€Å"Well, we can’t let out any of Bonnie’s things to fit you, but we can cal in reinforcements and have a ful set of garments ready for you and Stefan by the morning. It’s just a matter of leather and fur to keep you warm. We use the pelts of the animals up north.† â€Å"They’re not nice, cuddly baby animals, either,†Bonnie said. â€Å"They’re vicious nasty things that are used for training, or they might come up from the dimension below and attack al the people on the northern fringes here. And when they final y get kil ed, the bounty hunters sel the leather and fur to Lady Ulma.† â€Å"Oh, well †¦good,†Elena said, deciding not to make an animAll rights speech just now. The truth was that she was Stillvery shaken by her actions – her reactions – toward Damon. Why had she acted that way? Was it just to let off pressure? She Stillfelt as if she could smack him a good one for taking poor Bonnie away, and then leaving her alone. And†¦and†¦for taking poor Bonnie – and not taking her! Damon must hate her now, she thought, and suddenly the world developed a sickening, out-of-control motion, as if she were trying to balance on a seesaw. And Stefan – what else could he think but that she was a woman scorned, the kind that Hel had no fury like? How could he be so kind, so caring, when anyone in their right mind would know she’d gone mad with jealousy? Bonnie didn’t understand either. Bonnie was a child, not a woman. Although, although, she’d grown somehow – in goodness, in understanding. She was wil ful y blind, like Stefan. But – didn’t that take maturity? Could Bonnie be more of a woman than she, Elena, was? â€Å"I’l have a private supper sent up to your rooms,†Lady Ulma was saying, as she quickly and deftly used the measuring tape on Stefan. â€Å"You get a good night’s sleep; the thurgs – and your wardrobes – wil be waiting tomorrow.†She beamed at allof them. â€Å"Could I have – I mean, is there any Black Magic at all?†Elena stumbled. â€Å"The excitement†¦I’m going to sleep in my room alone. I want to get a good night’s rest. We’re going on a quest, you know?†Al the truth. Al a lie. â€Å"Of course, I’l have a bottle sent to – â€Å"Lady Ulma hesitated and then quickly recovered. â€Å"To your room, but why don’t we al have a nightcap now? It looks just the same outside,†she added to Stefan, the newcomer, â€Å"but it’s real y rather late.† Elena drank her first glass in one draft. The attendant had to refil it immediately. And again a moment later. After that her nerves seemed to relax a bit. But the seesaw feeling never entirely left, and though she slept alone in her room, Damon didn’t visit to quarrel with her, mock her, or kil her – and certainly not to kiss. Thurgs, Elena discovered, were something like two elephants stitched together. Each had two side-by-side trunks and four wicked-looking tusks. Each also had a high, wide, long ridged tail, like a reptile. Their smal yel ow eyes were placed al around their domelike heads, so that they could see 360 degrees around, looking for predators. Predators that could take down a thurg! Elena imagined a sort of saber-toothed cat, enormous, with a milk-white pelt big enough to line several garments of hers and Stefan’s. She was pleased with her new outfits. Each one was essential y a tunic and breeches, soft, pliable, rain-shedding leather on the outside; and warm, luxurious fur on the inside. But they wouldn’t be genuine Lady Ulma creations if that was al there were to them. The inner bodysuit of white fur was reversible and removable so you could change depending on the weather. There were triple-thick wind-around col ars, which trailed behind or could be turned into scarves that wrapped a face up to the eyes. The white pelts spil ed out of the leather at the wrists to make mittens you couldn’t lose. The guys had straight leather tunics that just met at the breeches, and fastened with buttons. The girls’tunics were longer and flared out a bit. They were neatly fringed, but not stained or dyed except for Damon’s, which, of course, were black with sable fur. One thurg would carry the travelers and their baggage. A second, larger and wilder looking, would carry heating stones to help cook human food and al the food (it looked like red hay) that the two thurgs would eat on the way to the Nether World. Pelat showed them how to move the giant creatures, with the lightest of taps of a very long stick, which could scratch a thurg behind its hippo-like ears or give it a ferocious tap at that sensitive spot, signaling it to hasten forward. that sensitive spot, signaling it to hasten forward. â€Å"Is it safe, having Biratz carry al the thurg food? I thought you said she was unpredictable,†Bonnie asked Pelat. â€Å"Now, miss, I wouldn’t give her to you if she wasn’t safe. She’l be roped to Dazar so al she has to do is fol ow,†Pelat replied. â€Å"We ride these?†Stefan said, craning his neck to get a look at the smal , enclosed palanquin on top of the very large animal. â€Å"We have to,†Damon said flatly. â€Å"We can hardly walk al the way. We’re not al owed to use magic like that fancy Master Key you used to get here. No magic but telepathy works up at the very top of the Dark Dimension. These dimensions are flat like plates, and according to Bonnie, there’s a fracture, just at the far north of this one – not too far from here, in other words. The crack is smal by dimensional standards, but big enough for us to get through. If we want to reach the Gatehouse of the Seven Treasures we start on thurgs.† Stefan shrugged. â€Å"All right. We’re doing it your way.† Pelat was putting a ladder up. Lady Ulma, Bonnie, and Elena were weeping and laughing over the baby together. They were Stilllaughing as they left on their way. The first week or so was boring. They sat in the palanquin on the back of the thurg named Dazar, with a compass from Elena’s backpack dangling from the roof. They general y kept al the sides of the palanquin’s curtains rol ed up, except the one facing west, where the bloated, bloody red sun – too bright to look at in the higher, cleaner air outside the city – constantly loomed on the horizon. The view al around them was dreadful y monotonous – mind-bendingly so, with few trees and many miles of dried brown grassy hil s. Nothing interesting to a non-hunter ever showed up. The only thing that changed was as they traveled farther north, it got colder. It was difficult for al of them, living in such close quarters. Damon and Elena had reached an equilibrium – or at least a pretense – of ignoring each other, something Elena would never have imagined could be possible. Damon made it easier by working on a different sleep cycle than the others – which helped to guard them as the thurgs trudged onward, day and night. If he was awake when Elena was, he would ride outside the palanquin, on the thurg’s enormous neck. They both had such stiff necks, Elena thought. Neither of them wanted to be the first to bend. Meanwhile those inside the palanquin began to play little games, like picking the long dried grasses from the side of the road and trying to weave them into dol s, fly whisks, hats, whips. Stefan proved to be the one who made the tightest weave, and he made fly whisks and broad fans for each of them. They also played various card games, using stiff little place cards (had Lady Ulma thought they might give a dinner party on the way?) as playing cards, after careful y marking them with the four suits. And of course, the vampires hunted. Sometimes this took quite a long time, since game was scarce. The Black Magic Lady Ulma had stocked helped them stretch the time between hunts. When Damon visited the palanquin, it was as if he were crashing a private party and thumbing his nose at the hosts. Final y Elena couldn’t stand it any longer, and had Stefan float her up the side of the thurg (looking down or climbing up were definitely not options) while flying magic Stillworked. She sat down on the saddle beside Damon and gathered her courage. â€Å"Damon, I know you have a right to be angry with me. But don’t take it out on the others. Especial y Bonnie.† â€Å"Another lecture?†Damon asked, giving her a look that would freeze a flame. â€Å"No, just a – a request.†She couldn’t bring herself to say â€Å"a plea.† When he didn’t answer and the silence became unbearable, she said, â€Å"Damon, for us – we’re not going on a quest for treasure out of greed or adventure or any normal reason. We’re going because we need to save our town.† â€Å"From Midnight,†a voice just behind her said. â€Å"From the Last Midnight.† Elena whirled to stare. She expected to see Stefan holding Bonnie clasped to him hard. But it was only Bonnie at her head level, hanging on to the thurg ladder. Elena forgot she was afraid of heights. She stood up on the swaying thurg, ready to climb down on the sun side if there wasn’t enough room for Bonnie to sit down fast in the driver’s saddle. But Bonnie had the slimmest hips in town and there was just room for al three of them. â€Å"The Last Midnight is coming,†Bonnie repeated. Elena knew that monotonous voice, knew the chalk-white cheeks, the blank eyes. Bonnie was in trance – and moving. It must be urgent. â€Å"Damon,†Elena whispered. â€Å"If I speak to her, she’l break trance. Can you ask her telepathical y what she means?† A moment later she heard Damon’s projection. What is the Last Midnight? What’s going to happen then? â€Å"That’s when it starts. And it’s over in less than an hour. So†¦ no more midnights.† I beg your pardon? No more midnights? â€Å"Not in Fel ‘s Church. No one left to see them.† And when is this going to happen? â€Å"Tonight. The children are final y ready.† The children? Bonnie simply nodded, her eyes far away. Something’s going to happen to all the children? Bonnie’s eyelids drooped to half mast. She didn’t seem to hear the question. Elena needed to hold on to something. And suddenly she was. Damon had reached across Bonnie’s lap and taken her hand. Bonnie, are the children going to do something at midnight? he asked. Bonnie’s eyes fil ed and she bowed her head. â€Å"We’ve got to go back. We have to go to Fel ‘s Church,†Elena said, and scarcely knowing what she was doing, unclasped Damon’s hand and climbed down the ladder. The bloated red sun looked different – smal er. She tugged at the curtain and almost bumped heads with Stefan as he rol ed it up to let her in. â€Å"Stefan, Bonnie’s in trance and she said – â€Å" â€Å"I know. I was eavesdropping. I couldn’t even catch her on the way up. She jumped onto the ladder and climbed like a squirrel. What do you think she means?† â€Å"You remember in the out-of-body experience she and I had? A little spying on Alaric? That’s what’s going to happen in Fel ‘s Church. Al the children, al at once, just at midnight – that’s why we have to get back – â€Å" â€Å"Easy. Easy, love. Remember what Lady Ulma said? Nearly a year here came out to be only days in our world.† Elena hesitated. It was true; she couldn’t deny it. Still, she felt so cold†¦ Physical y cold, she realized suddenly, as a blast of frigid air swirled around her, cutting through her leather like a machete. â€Å"We need our inner furs,†Elena gasped. â€Å"We must be getting near the fracture.† They yanked down the palanquin covers and secured them and then hastily rummaged through the neat cabinet that was set on the rump of the thurg. The furs were so sleek that Elena could fit two under her leather easily. They were disturbed by Damon coming inside with Bonnie in his arms. â€Å"She stopped talking,†he said, and added, â€Å"Whenever you’re warm enough, I suggest that you come out.† Elena laid Bonnie down on one of the two benches inside the palanquin and piled blanket after blanket over her, tucking them in around her. Then Elena made herself climb back up. For a moment she felt blinded. Not by the surly red sun – they had left that behind some mountains, which it turned a pink sapphire color – but by a world of white. Seemingly endless, flat, featureless whiteness stretched out before her until a bank of fog obscured whatever was behind it. â€Å"According to legend, we should be headed toward the Silver Lake of Death,†Damon’s voice said from behind Elena. And, oddly, throughout al this chil , his voice was warm – almost friendly. â€Å"Also known as Lake Mirror. But I can’t change into a crow to scout ahead. Something’s hindering me. And that fog in front of us is impenetrable to psychic probing.† Elena instinctively glanced around her. Stefan was Stillinside the palanquin, obviously Stilltending to Bonnie. â€Å"You’re looking for the lake? What’s it like? I mean, I can guess why it might be cal ed Silver and Lake Mirror,†she said. â€Å"But what’s the Death bit?† â€Å"Water dragons. At least that’s what people say – but who has been there to bring back the story?†Damon looked at her. He took care of Bonnie while she was in trance, Elena thought. And he’s talking to me at last. â€Å"Water†¦dragons?†she asked him and she made her voice friendly, too. As if they’d just met. They were starting over. â€Å"I’ve always suspected kronosaurus, myself,†Damon said. He was right behind her now; she could feel him blocking the icy wind – no, more than that. He was generating an envelope of heat for her to stand in. Elena’s shivering stopped. She felt for the first time that she could unwrap her arms from clutching herself. Then she felt a pair of strong arms folding around her, and the heat abruptly got quite intense. Damon was standing behind her, holding her, and al at once she was very warm indeed. â€Å"Damon,†she began, not very steadily, â€Å"we can’t just – â€Å" â€Å"There’s a rock outcropping over there. No one could see us,†the vampire behind her offered – to Elena’s absolute shock. A week of not speaking at all – and now this. â€Å"Damon, the guy in the palanquin just below us is my – â€Å" â€Å"Prince? Don’t you need a knight, then?†Damon breathed this directly into her ear. Elena stood like a statue. But what he said next rocked her entire universe. â€Å"You like the story of Camelot, don’t you? Only here you’re the queen, princess. You married your not-quite-fairy-tale prince, but along came a knight who knew even more of your secrets, and he cal ed to you†¦Ã¢â‚¬  â€Å"He forced me,†Elena said, turning to meet Damon’s dark eyes straight on, even as her brain screamed for her to let it go. â€Å"He didn’t wait for me to hear his cal . He just†¦took what he wanted. Like the slavers do. I didn’t know how to fight – then.† â€Å"Oh, no. You fought and fought. I’ve never seen a human fight so hard. But even when you fought, you felt the cal of my heart to yours. Try to deny that.† â€Å"Damon – why now – al of a sudden†¦?† Damon made a move as if to turn away, then turned back. â€Å"Because by tomorrow we may be dead,†he said flatly. â€Å"I wanted you to know how I felt about you before I died – or you did.† â€Å"But you haven’t told me a word about how you feel about me. Only about what you think I feel about you. And I’m sorry that I slapped you the first day I was here, but – â€Å" â€Å"You were magnificent,†Damon said outrageously. â€Å"Forget it now. As for how I feel – maybe I’l get a chance to real y show it to you someday.† Something sparked inside Elena – they were back to fencing with words, as they had been when they’d first met. â€Å"Someday? Sounds convenient. And why not now?† â€Å"Do you mean that?† â€Å"Do I habitual y say things I don’t mean?† She was waiting for some kind of apology, some words spoken as simply and sincerely as she had been speaking to him. Instead, with the utmost gentleness, and without glancing around to see if anyone was watching them, Damon cupped Elena’s scarf-bound cheeks with his bare hands, pul ed the scarf just below her lips with his thumbs, and kissed her softly. Softly – but not briefly, and something in Elena kept whispering to her that of course she had heard his cal from the moment she first saw him, first felt his aura cal to her. She hadn’t known that it was an aura then; she hadn’t believed in auras. She hadn’t believed in vampires. She’d been an ignorant little idiot†¦ Stefan! A voice like crystal sounded off two notes in her brain, and suddenly she was able to step back from Damon’s embrace and look at the palanquin again. No sign of motion there. â€Å"I have to go back,†she told Damon brusquely. â€Å"I have to know what’s going on with Bonnie.† â€Å"You mean to see what’s going on with Stefan,†he said. â€Å"You needn’t worry. He’s fast asleep, and so is our little girl.† Elena tensed. â€Å"You Influenced them? Without seeing them?†It was a wild guess, but one side of Damon’s mouth crooked up, as if congratulating her. â€Å"How dare you?†she said. â€Å"To be honest, I don’t know how I dare.†Damon leaned in close again, but Elena turned her cheek, thinking, Stefan! He can’t hear you. He’s dreaming about you. Elena was surprised at her own reaction to that. Damon had caught and held her eyes again. Something inside her melted in the intensity of his steady black gaze. â€Å"I’m not Influencing you; I give you my word† – in a whisper. â€Å"But you can’t deny what happened between us the last time we were in this dimension.†His breath was on her lips now – and Elena didn’t turn aside. She trembled. â€Å"Please, Damon. Show some respect. I’m – oh, God! God! â€Å" â€Å"Elena? Elena! Elena! What’s wrong? â€Å" Hurts – that was al Elena could think. A terrible agony had lanced through her chest on the left side. As if she’d been stabbed through the heart. She stifled a scream. Elena, talk to me! If you can’t send your thoughts, speak! Through numb lips, Elena said, â€Å"Pain – heart attack – â€Å" â€Å"You’re too young and healthy for that. Let me check.†Damon was unfastening her top. Elena let him. She could do nothing for herself, except gasp, â€Å"Oh God! It hurts!† Damon’s warm hand was inside her leather and furs. His hand came to rest slightly to the left of center, with only her camisole between his probing fingers and her flesh. Elena, I’m going to take the pain away now. Trust me. Even as he spoke, the stabbing anguish drained. Damon’s eyes narrowed, and Elena knew he’d taken the pain into himself, to analyze it. â€Å"It’s not a heart attack,†he said a moment later. â€Å"I’m as sure as I can be. It’s more as if – Well, as if you’d been staked. But that’s sil y. Hmm†¦it’s gone now.† For Elena it had been gone since he’d taken it, protecting her. â€Å"Thank you,†she breathed, suddenly realizing that she had been clinging to him, in utter terror that she was dying. Or that he was. He gave her a rare, ful , genuine smile. â€Å"We’re both fine. It must have been a cramp.†His gaze had dropped to her lips. â€Å"Do I deserve a kiss?† â€Å"I†¦Ã¢â‚¬ He had comforted her; he had taken the terrible pain away. How could she sanely say no? â€Å"Just one,†she whispered. A hand under her chin. Her eyelids wanted to melt closed, but she widened her eyes and wouldn’t let them. As his lips touched hers, his arm around her†¦changed somehow. It was no longer trying to restrain her. It seemed to be wanting to comfort her. And when his other hand stroked her hair softly at the very ends, crushing the waves gently, and just as gently smoothing them out, Elena felt a rush of shivering warmth. Damon wasn’t deliberately trying to batter her with the strength of his aura, which at the moment was fil ed with nothing but his feelings for her. The simple fact, though, was that although he was a new-made vampire, he was exceptional y strong and he knew al the tricks of an experienced one. Elena felt as if she had stepped into clear calm water, only to find herself caught in a fierce undertow that there was no resisting; no bargaining with; and certainly no possibility of reaching by reason. She had no choice but to surrender to it and hope that it was taking her, eventual y, to a place she could breathe and live. Otherwise, she would drown†¦but even that possibility didn’t seem so dire, now that she could see the tide was made of a chain of little moments strung like pearls. In each one of them was a tiny sparkle of admiration that Damon had for her: pearls for her courage, for her intel igence, for her beauty. It seemed that there was no slightest motion she had made, no briefest word that she had said, that he had not noticed and locked in his heart as a treasure. But we were fighting then, Elena thought to him, seeing in the undertow a sparkling moment when she had cursed him. Yes – I said you were magnificent when you were angry. Like a goddess come to put the world to rights. I do want to put the world to rights. No, two worlds: the Dark Dimension and my home. But I’m no goddess. Suddenly she felt that keenly. She was a schoolgirl who hadn’t even finished high school – and it was in part because of the person who was kissing her wildly now. Oh, think of what you’re learning on this trip! Things that no one else in the universe knows, Damon said in her mind. Now pay attention to what you’re doing! Elena paid attention, not because Damon wanted her to, but because she couldn’t help it. Her eyes drifted shut. She realized that the way to calm this maelstrom was to become part of it, neither giving in nor forcing Damon to, but by meeting the passion in the undertow with what was inside her own heart. As soon as she did, the undertow became wind, and she was flying and not drowning. No, it was better than flying, better than dancing, it was what her heart always yearned for. A high Stillplace where nothing could ever harm them or disturb them. And then, when she was most vulnerable, the pain came again, dril ing through her chest, a little to the left. This time Damon was so mindlocked with her that he felt it from the beginning. And she could hear clearly a phrase in Damon’s mind: staking is just as effective on humans as it is on vampires, and his sudden fear that this was a precognition. In the swaying little room, Stefan was asleep holding Bonnie by his side, with the sparkling of Power engulfing them both. Elena, who had a good grip on the palanquin’s ladder, vaulted the rest of the way inside. She put a hand on Stefan’s shoulder and he woke. â€Å"What is this? Is something wrong with her?†she asked, with a third question: â€Å"Do you know?†buzzing around in her head. But when Stefan lifted his green eyes to her, they were simply worried. Clearly he was not invading her thoughts. He was focused entirely on Bonnie. Thank God, he’s such a gentleman, Elena thought for the thousandth time. â€Å"I’m trying to get her warm,†Stefan said. â€Å"After she came out of trance, she was shivering. Then she stopped shivering, but when I took her hand, it was colder than ever. Now I’ve put an envelope of heat around her. I guess I dozed off for a little while after that.†He added, â€Å"Did you find anything?† I found Damon’s lips, Elena thought wildly, but she forced herself to blank out the memory. â€Å"We’re looking for Lake Silver Death Mirror,†she said. â€Å"But al I could see was white. The snow and the fog seem to go on forever.† Stefan nodded. Then he careful y went through the motions of plucking apart two layers of air and slid in a hand to touch Bonnie’s cheek. â€Å"She’s warming up,†he said, and smiled. It took a long while before Stefan was satisfied that Bonnie was warm. When he did, he gently unwrapped her from the heated air that had formed the â€Å"envelope†and lay her on one bench, coming to sit with Elena on the other. Eventual y Bonnie sighed, blinked, and opened her eyes. â€Å"I had a nap,†she said, obviously aware that she had lost time. â€Å"Not exactly,†Elena said, keeping her voice gentle and reassuring. Let’s see, how did Meredith do this? â€Å"You went into trance, Bonnie. Do you remember anything about it?† Bonnie said, â€Å"About the treasure?† â€Å"About what the treasure is for,†Stefan said quietly. â€Å"No†¦No†¦Ã¢â‚¬  â€Å"You said that this was the Last Midnight,†Elena said. As far as she could remember, Meredith was pretty direct. â€Å"But we think you were talking about back at home,†she added hastily, seeing terror leap in Bonnie’s eyes. â€Å"The Last Midnight – and no morning afterward,†Bonnie said. â€Å"I think – I heard someone saying those words. But no more.† She was as skittish as a wild colt. Elena reminded her about time running differently between the two worlds but it didn’t seem to comfort her. Final y, Elena just sat by her and held her. Her head was spinning with thoughts of Damon. He’d forgiven her. That was good, even though he’d taken his own time about it. But the real message was that he was wil ing to share her. Or at least wil ing to say he would to get in her good graces. If she knew him at all, if she ever agreed – oh, God, he might murder Stefan. Again. After al , that was what he had done when Katherine had had the same sentiment. Elena could never think of him without longing. She could never think of him without thinking of Stefan. She had no idea what to do. She was in trouble. How to cite The Return: Midnight Chapter 28, Essay examples

Social Cues in Virtual Community-Free-Samples-Myassignmenthelp.com

Question: Are Virtual Communities Real? Answer: Can Virtual Community be regarded a real community? A community is comprised of people who remained bonded together via beliefs, characteristics of location which make them have a feeling of acceptance and heard. This remains true for both face to face and virtual (online) community. Nevertheless, some differences exist in dynamics of both, and this is able to affect the quality of friendships we build and attempt to sustain with a community. Considering the dynamics and benefits of face to face community, as opposed to a virtual community, we observe that virtual community falls short in ways which make people query whether, indeed it is a real community or not (Reuter, Heger and Pipek 2013). People currently depend on virtual community because of convenience of socialization at any time or place in the course of our busy lives. In virtual community, communication remains restricted as people only relies on the other individuals words on Facebook, Twitter and Snapchats to mention a few. In writing, however, we are only able to put across our thoughts but not attitudes alongside tone of voice that remain as vital behind the written words. Building effective relationship is limited by lack of social cues in virtual community. People give a false sense of pride in life which is self-edited and really not the one they really are living making virtual to be a deceiving platform (Liao, To and Hsu 2013). A face-to-face community enjoy various qualities which are missing in virtual community. For example, the ability to get to know individuals one is interacting with, not merely who they seem to be as in virtual community. Communication remains clear with utilization of tone of voice and body language (Kunz and Seshadri 2015). Moreover, physically being there with an individual makes a great difference. We can build memories as well as strengthen our relationships with individuals we are getting together with in a community and sharing a meal. However, in virtual community, we are unable to enjoy many events like birthday parties, beach barbecues and weddings in a manner we do in a real context like face-to-face community. The ill-fated reality stays that people are a culture deprived of a real community. Even currently with all of the means to remain connected virtually, people are still never getting enough real community. People are continually seeking to fill the gap of experiencing a culture which emerges from spending time as well as partaking in life with family and friends in a face-to-face community. This remains unfortunate since as human beings, people crave real interactions with others and albeit the virtual communities are providing the increased accessible means to remain in touch with family and friends, virtual communities are never providing people the desired real human interaction. Having weighed real and virtual communities against each other, it remains essential to conclude and determine whether virtual communities can hence become real. In fact, the primary distinction between virtual and real communities lies in common place of living as well as communication face to face. Real community members see one another daily, inhabit same territory, and hence their communication stays sort of unavoidable. Things appear difference with virtual communities as member never meet, yet might own same close relationships (Grabher and Ibert 2013). From my viewpoint, virtual community cannot become real absolutely, since individuals can fathom nature of one another solely when they see one another and communicate face-to-face. Nevertheless, contemporary virtual communities have made some advances at this juncture via the use of web cameras, microphones amongst other gadgets permitting them to develop close relationships. References Grabher, G. and Ibert, O., 2013. Distance as asset? Knowledge collaboration in hybrid virtual communities. Journal of Economic Geography, 14(1), pp.97-123. Kunz, W. and Seshadri, S., 2015. From virtual travelers to real friends: Relationship-building insights from an online travel community. Journal of business research, 68(9), pp.1822-1828. Liao, C., To, P.L. and Hsu, F.C., 2013. Exploring knowledge sharing in virtual communities. Online Information Review, 37(6), pp.891-909. Reuter, C., Heger, O. and Pipek, V., 2013, May. Combining real and virtual volunteers through social media. In ISCRAM