Monday, January 27, 2020

Functions of Norethindrone

Functions of Norethindrone Part V: Compound Summary Synthesized first in 1951, Chemists Luis Miramontes, Carl Djerassi, and George Rosenkranz blended Norethindrone to be the first highly active oral progestogen in Syntex at Mexico City. Norethindrone however is not the first oral progestogen as a use in birth control and many other variations came before, examples being progesterone, ethisterone 19-norprogesterone , and 17ÃŽ ±-methylprogesterone being in chronological order . The drug was put on the market in 1957 and was later combined with another estrogen called Mestranol to create Ortho-Novum in 1963 which happened to be the 2nd only oral contraceptive in the market. This significance of Norethindrone in history can be found that it was the first highly active oral progestogen and was used as an example to follow for later models and drugs like   norethynodrel (1952), and norethandrolone. Norethindrone consists of 3 different elements including :Carbon, Hydrogen, and Oxygen with single, double and triple bonds occurring across the lewis structure. Norethindrone has 1 H-Bond with hydrogen and oxygen with many LDFs and Dipole-Dipole bonds throughout the structure. Being consisted of 20 Carbon, 26 Hydrogen, and 2 Oxygen elements, the total mass of each molecule per atom being contributed to the element all together is 298.41844g/mol, Carbon has 240.215g/mol weighting the most and   having the highest percentage mass with the percentage of 80.49%. The total mass contributed to Hydrogen is 16.20644g/mol with 8.78% percentage mass and lastly Oxygen has the 2nd highest contribution with it having 31.998g/mol and 10.72% of the compound. Solubility is the ability to dissolve in a specific substance as a physical property. Solubility is important in general as it determines what type of reactant will be formed from the products that are soluble. Solubility is important in my specific compound is that my compound is taking in orally, by mouth. The aqueous solubility is important to my drug to guarantee a safe entrance from dissolving in spit and saliva present in the mouth. The general rule of solubility relates to polarity and if a nonpolar substance is present, it dissolves in another nonpolar solvent and if a polar substance is present, it dissolves in a polar solvent. My compound specifically is polar thus melting in any polar solvent like saliva. This being said, my drug compound is aqueously soluble meaning that it will dissolve in water. The main function of norethindrone is to be used as a birth control to prevent pregnancy. The way it prevents pregnancy is that it prevents ovulation from occurring stopping the ovary from being fertilized. When interacting with other drugs norethindrone side effects can have various effects, most of them being moderate. An example of a moderate side effect from an interaction with Norethindrone is its interaction with Axotal, a commonly used product in Aspirin. Norethindrone effectivity may decrease when taking Axotal so using other birth control methods should be used to ensure the best effectivity. A more serious interaction is Norethindrone interaction with accutane, one of the most common medicines for acne. With the use of accutane while pregnant, accutane can cause life threatening birth defects that can form problems with their bone and internal structure including but not limited to the heart, skull, eyes and brain. Less serious effects by itself is an increase in acne , cha nges in weight, and breast pain. Norethindrone is only used as an oral contraceptive using capsules and ingestion to create the effects of the compound. The taking of norethindrone should be monitored carefully as if patients have former cases of strokes, breast cancer and miscarriages in the past, they should be given another prescription. Norethindrone as a modern day relevance is still commonly used as a birth control however the ratings for the drugs arent very good. For the birth control aspect, the reviews are very positive saying that it works, however almost all of the 49 review reflect on a constant problem in excessive bleeding during their menstrual periods as well as severe pain in the breast and pelvic area with weight gain being a smaller portion of the reviews. However, the versions combined with mestranol is not very known and not commonly used compared to Norethindrone by itself.

Saturday, January 18, 2020

The Vampire Diaries: Dark Reunion Chapter Four

Meredith tilted an ironic glance at Matt. â€Å"Hmm,† she said. â€Å"Now, who do you think Elena would call in time of trouble?† Bonnie's grin gave way to a twinge of guilt at Matt's expression. It wasn't fair to tease him about this. â€Å"Elena said that the killer is too strong for us and that's why we need help,† she told Matt. â€Å"And I can think of only one person Elena knows who could fight off a psychic killer.† Slowly, Matt nodded. Bonnie couldn't tell what he was feeling. He and Stefan had been best friends once, even after Elena had chosen Stefan over Matt. But that had been before Matt found out what Stefan was, and what kind of violence he was capable of. In his rage and grief over Elena's death Stefan had nearly killed Tyler Smallwood and five other guys. Could Matt really forget that? Could he even deal with Stefan coming back to Fell's Church? Matt's square-jawed face gave no sign now, and Meredith was talking again. â€Å"So all we need to do is let some blood and cut some hair. You won't miss a curl or two, will you, Bonnie?† Bonnie was so abstracted that she almost missed this. Then she shook her head. â€Å"No, no, no. It isn't our blood and hair we need. We need it from the person we want to summon.† â€Å"What? But that's ridiculous. If we had Stefan's blood and hair we wouldn't need to summon him, would we?† â€Å"I didn't think of that,† Bonnie admitted. â€Å"Usually with a summoning spell you get the stuff beforehand and use it when you want to call a person back. What are we going to do, Meredith? It's impossible.† Meredith's brows were drawn together. â€Å"Why would Elena ask it if it were impossible?† â€Å"Elena asked lots of impossible things,† Bonnie said darkly. â€Å"Don't look like that, Matt; you know she did. She wasn't a saint.† â€Å"Maybe, but this one isn't impossible,† Matt said. â€Å"I can think of one place where Stefan's blood has got to be, and if we're lucky some of his hair, too. In the crypt.† Bonnie flinched, but Meredith simply nodded. â€Å"Of course,† she said. â€Å"While Stefan was tied up there, he must have bled all over the place. And in that kind of fight he might have lost some hair. If only everything down there has been left undisturbed†¦Ã¢â‚¬  â€Å"I don't think anybody's been down there since Elena died,† Matt said. â€Å"The police investigated and then left it. But there's only one way to find out.† I was wrong, Bonnie thought. I was worrying about whether Matt could deal with Stefan coming back, and here he is doing everything he can to help us summon him. â€Å"Matt, I could kiss you!† she said. â€Å"All the girls say that,† he replied calmly at last, with a shrug of mock resignation. It was as close as he'd gotten to lightheartedness all day. Meredith, however, was serious. â€Å"Let's go. We've got a lot to do, and the last thing we want is to get stuck in the crypt after dark.† The crypt was beneath the ruined church that stood on a hill in the cemetery. It's only late afternoon, plenty of light left, Bonnie kept telling herself as they walked up the hill, but goose-flesh broke out on her arms anyway. The modern cemetery on one side was bad enough, but the old graveyard on the other side was downright spooky even in daylight. There were so many crumbling headstones tilting crazily in the overgrown grass, representing so many young men killed in the Civil War. You didn't have to be psychic to feel their presence. â€Å"Unquiet spirits,† she muttered. â€Å"Hmm?† said Meredith as she stepped over the pile of rubble that was one wall of the ruined church. â€Å"Look, the lid of the tomb's still off. That's good news; I don't think we would have been able to lift it.† Bonnie's eyes lingered wistfully on the white marble statues carved on the displaced lid. Hon-oria Fell lay there with her husband, hands folded on her breast, looking as gentle and sad as ever. But Bonnie knew there would be no more help from that quarter. Honoria's duties as protector of the town she'd founded were done. Leaving Elena holding the bag, Bonnie thought grimly, looking down into the rectangular hole that led to the crypt. Iron rungs disappeared into darkness. Even with the help of Meredith's flashlight it was hard to climb down into that underground room. Inside, it was dank and silent, the walls faced with polished stone. Bonnie tried not to shiver. â€Å"Look,† said Meredith quietly. Matt had the flashlight trained on the iron gate that separated the anteroom of the crypt from its main chamber. The stone below was stained black with blood in several places. Looking at the puddles and rivulets of dried gore made Bonnie feel dizzy. â€Å"We know Damon was hurt the worst,† Meredith said, moving forward. She sounded calm, but Bonnie could hear the tight control in her voice. â€Å"So he must have been on this side where there's the most blood. Stefan said Elena was in the center. That means Stefan himself must have been†¦ here.† She bent down. â€Å"I'll do it,† Matt said gruffly. â€Å"You hold the light.† With a plastic picnic knife from Meredith's car he scraped at the encrusted stone. Bonnie swallowed, glad she'd had only tea for lunch. Blood was all right in the abstract, but when you were actually confronted with so much of it-especially when it was the blood of a friend who'd been tortured†¦ And then, thought Bonnie, she faked her own death to get Stefan and Damon to stop fighting over her. But it didn't work. They hated each other more than ever, and she hated both of them for that. She'd gone back to the vampire who made her, and over the years she'd turned as evil as he was. Until at last all she wanted to do was destroy the brothers she had once loved. She'd lured them both to Fell's Church to kill them, and this room was where she'd almost succeeded in doing it. Elena had died stopping her. â€Å"There,† Matt said, and Bonnie blinked and came back to herself. Matt was standing with a paper napkin that now held flakes of Stefan's blood in its folds. â€Å"Now the hair,† he said. They swept the floor with their fingers, finding dust and bits of leaves and fragments of things Bonnie didn't want to identify. Among the detritus were long strands of pale gold hair. Elena's-or Katherine's, Bonnie thought. They had looked much alike. There were also shorter strands of dark hair, crisp with a slight wave. Stefan's. It was slow, finicky work sorting through it all and putting the right hairs in another napkin. Matt did most of it. When they were through, they were all tired and the light sifting down through the rectangular opening in the ceiling was dim blue. But Meredith smiled tigerishly. â€Å"We've got it,† she said. â€Å"Tyler wants Stefan back; well, we'll give him Stefan back.† And Bonnie, who had been only half paying attention to what she was doing, still lost in her own thoughts, froze. She'd been thinking about other things entirely, nothing to do with Tyler, but at the mention of his name something had winked on in her mind. Something she'd realized in the parking lot and then forgotten afterward in the heat of arguing. Meredith's words had triggered it and now it was suddenly all clear again. How had he known! she wondered, heart racing. â€Å"Bonnie? What's the matter?† â€Å"Meredith,† she said softly, â€Å"did you tell the police specifically that we were in the living room when everything was going on upstairs with Sue?† â€Å"No, I think I just said we were downstairs. Why?† â€Å"Bonnie, if you're trying to suggest Tyler was the murderer, it just won't wash. He's not smart enough to organize a killing spree, for one thing,† Meredith said. â€Å"But there's something else. Meredith, last year at the Junior Prom, Tyler touched me on my bare shoulder. I'll never forget it. His hand was big, and meaty, and hot, and damp.† Bonnie shivered at the recollection. â€Å"Just like the hand that grabbed me last night.† But Meredith was shaking her head, and even Matt looked unconvinced. â€Å"Elena's sure wasting her time asking us to bring back Stefan, then,† he said. â€Å"I could take care of Tyler with a couple of right hooks.† â€Å"Think about it, Bonnie,† Meredith added. â€Å"Does Tyler have the psychic power to move a Ouija board or come into your dreams? Does he?† He didn't. Psychically speaking, Tyler was as much a dud as Caroline. Bonnie couldn't deny it. But she couldn't deny her intuition, either. It didn't make sense, but she still felt Tyler had been in the house last night. â€Å"We'd better get moving,† Meredith said. â€Å"It's dark, and your father's going to be furious.† They were all silent on the ride home. Bonnie was still thinking about Tyler. Once at her house they smuggled the napkins upstairs and began looking through Bonnie's books on Druids and Celtic magic. Ever since she'd discovered that she was descended from the ancient race of magic workers, Bonnie had been interested in the Druids. And in one of the books she found a ritual for a summoning spell. â€Å"We need to buy candles,† she said. â€Å"And pure water-better get some bottled,† she said to Meredith. â€Å"And chalk to draw a circle on the floor, and something to make a small fire in. I can find those in the house. There's no hurry; the spell has to be done at midnight.† Midnight was a long time coming. Meredith bought the necessary items at a grocery store and brought them back. They ate dinner with Bonnie's family, though no one had much of an appetite. By eleven o'clock Bonnie had the circle drawn on the hardwood floor of her bedroom and all the other ingredients on a low bench inside the circle. On the stroke of twelve she started. With Matt and Meredith watching, she made a small fire in an earthenware bowl. Three candles were burning behind the bowl; she stuck a pin halfway down the one in the center. Then she unfolded a napkin and carefully stirred the dried flakes of blood into a wineglass of water. It turned rusty pink. She opened the other napkin. Three pinches of dark hair went into the fire, sizzling with a terrible smell. Then three drops of the stained water, hissing. Swift on the heel thou comest, Thrice summoned by my spell, Thrice troubled by my burning. Come to me without delay. She read the words aloud slowly, three times. Then she sat back on her heels. The fire went on burning smokily. The candle flames danced. â€Å"And now what?† Matt said. â€Å"I don't know. It just says wait for the middle candle to burn down to the pin.† â€Å"And what then?† â€Å"I guess we'll find out when it happens.† In Florence, it was dawn. Stefan watched the girl move down the stairway, one hand resting lightly on the banister to keep her balance. Her movements were slow and slightly dreamlike, as if she were floating. Suddenly, she swayed and clutched at the banister more tightly. Stefan moved quickly behind her and put a hand under her elbow. â€Å"Are you all right?† She looked up at him with the same dreaminess. She was very pretty. Her expensive clothes were the latest fashion and her stylishly disarrayed hair was blond. A tourist. He knew she was American before she spoke. â€Å"Yes†¦ I think†¦Ã¢â‚¬  Her brown eyes were unfocused. â€Å"Do you have a way to get home? Where are you staying?† â€Å"On Via dei Conti, near the Medici chapel. I'm with the Gonzaga in Florence program.† Damn! Not a tourist, then; a student. And that meant she'd be carrying this story back with her, telling her classmates about the handsome Italian guy she'd met last night. The one with night-dark eyes. The one who took her back to his exclusive place on Via Tornabuoni and wined her and dined her and then, in the moonlight, maybe, in his room or out in the enclosed courtyard, leaned close to look into her eyes and†¦ Stefan's gaze slid away from the girl's throat with its two reddened puncture wounds. He'd seen marks like that so often-how could they still have the power to disturb him? But they did; they sickened him and set a slow burning in his gut. â€Å"What's your name?† â€Å"Rachael. With an a.† She spelled it. â€Å"All right, Rachael. Look at me. You will go back to your pensione and you won't remember anything about last night. You don't know where you went or who you saw. And you've never seen me before, either. Repeat.† â€Å"Good. Do you have money to get back? Here.† Stefan pulled a fistful of crumpled lire-mostly 50,000 and 100,000 notes-out of his pocket and led her outside. When she was safely in a cab, he went back inside and made straight for Damon's bedroom. Damon was lounging near the window, peeling an orange, not even dressed yet. He looked up, annoyed, as Stefan entered. â€Å"It's customary to knock,† he said. â€Å"Where'd you meet her?† said Stefan. And then, when Damon turned a blank stare on him, he added, â€Å"That girl. Rachael.† â€Å"Was that her name? I don't think I bothered to ask. At Bar Gilli. Or perhaps it was Bar Mario. Why?† Stefan struggled to contain his anger. â€Å"That's not the only thing you didn't bother to do. You didn't bother to influence her to forget you, either. Do you want to get caught, Damon?† Damon's lips curved in a smile and he twisted off a curlicue of orange peel. â€Å"I am never caught, little brother,† he said. â€Å"So what are you going to do when they come after you? When somebody realizes, ‘My God, there's a bloodsucking monster on Via Tornabuoni'? Kill them all? Wait until they break down the front door and then melt away into darkness?† Damon met his gaze directly, challengingly, that faint smile still clinging about his lips. â€Å"Why not?† he said. â€Å"Damn you!† said Stefan. â€Å"Listen to me, Damon. This has got to stop.† â€Å"I'm touched at your concern for my safety.† â€Å"It isn't fair, Damon. To take an unwilling girl like that-â€Å" â€Å"Oh, she was willing, brother. She was very, very willing.† â€Å"Did you tell her what you were going to do? Did you warn her about the consequences of exchanging blood with a vampire? The nightmares, the psychic visions? Was she willing for that?† Damon clearly wasn't going to reply, so he went on. â€Å"You know it's wrong.† â€Å"As a matter of fact, I do.† With that, Damon gave one of his sudden, unnerving smiles, turning it on and off instantly. Damon tossed away the orange. His tone was silky, persuasive. â€Å"Little brother, the world is full of what you call ‘wrong,' † he said. â€Å"Why not relax and join the winning side? It's much more fun, I assure you.† Stefan felt himself go hot with anger. â€Å"How can you even say that?† he flashed back. â€Å"Didn't you learn anything from Katherine? She chose ‘the winning side.' â€Å" â€Å"Katherine died too quickly,† said Damon. He was smiling again, but his eyes were cold. â€Å"And now all you can think about is revenge.† Looking at his brother, Stefan felt a crushing weight settle on his own chest. â€Å"That and your own pleasure,† he said. â€Å"What else is there? Pleasure is the only reality, little brother-pleasure and power. And you're a hunter by nature, just as much as I am,† Damon said. He added, â€Å"I don't remember inviting you to come to Florence with me, anyway. Since you're not enjoying yourself, why don't you just leave?† The weight in Stefan's chest tightened suddenly, unbearably, but his gaze, locked with Damon's, did not waver. â€Å"You know why,† he said quietly. And at last he had the satisfaction of seeing Damon's eyes drop. Stefan himself could hear Elena's words in his mind. She'd been dying then, and her voice had been weak, but he'd heard her clearly. You have to take care of each other. Stefan, will you promise? Promise to take care of each other? And he had promised, and he would keep his word. No matter what. â€Å"You know why I don't leave,† he said again to Damon, who wouldn't look at him. â€Å"You can pretend you don't care. You can fool the whole world. But I know differently.† It would have been kindest at this point to leave Damon alone, but Stefan wasn't in a kind mood. â€Å"You know that girl you picked up, Rachael?† he added. â€Å"The hair was all right, but her eyes were the wrong color. Elena's eyes were blue.† With that he turned, meaning to leave Damon here to think it over-if Damon would do anything so constructive, of course. But he never made it to the door. â€Å"It's there!† said Meredith sharply, her eyes on the candle flame and the pin. Bonnie sucked in her breath. Something was opening in front of her like a silver thread, a silver tunnel of communication. She was rushing along it, with no way to stop herself or check her speed. Oh, God, she thought, when I reach the end and hit – The flash in Stefan's head was soundless, lightless, and powerful as a thunderclap. At the same time he felt a violent, wrenching tug. An urge to follow- something. This was not like Katherine's sly subliminal nudging to go somewhere; this was a psychic shout. A command that could not be disobeyed. Inside the flash he sensed a presence, but he could scarcely believe who it was. this was a psychic shout. A command that could not be disobeyed. Inside the flash he sensed a presence, but he could scarcely believe who it was. Stefan! It's you! It worked! Bonnie, what have you done? Elena told me to. Honestly, Stefan, she did. We're in trouble and we need- And that was it. The communication collapsed, caving in on itself, dwindling to a pinpoint. It was gone, and in its aftermath the room vibrated with Power. Stefan and his brother were left staring at each other. Bonnie let out a long breath she hadn't realized she'd been holding and opened her eyes, though she didn't remember closing them. She was lying on her back. Matt and Meredith were crouched over her, looking alarmed. â€Å"What happened? Did it work?† Meredith demanded. â€Å"It worked.† She let them help her up. â€Å"I made contact with Stefan. I talked to him. Now all we can do is wait and see if he's coming or not.† â€Å"Did you mention Elena?† Matt asked. â€Å"Yes.† â€Å"Then he's coming.†

Friday, January 10, 2020

Facilitating Case Management Essay

Why is it important for a case manager to develop rapport with a client? Provide three examples of how rapport can be generated. 2. Why are statutory requirements necessary? What impact do they have on the case manager’s role? 3. What information might you need to gather from the families of clients? 4. List two elements that may be considered to be characteristics of a complex case. 5. Describe two strategies you may employ when dealing with a client with complex issues. 6. Case management plans must be developed in order to reflect the initial assessment of needs. Why is it essential that these plans be designed in consultation with clients? 7. Casework processes should be continually monitored for effectiveness. a) List two reasons why this is necessary. b) How should monitoring be undertaken? 8. If changes to a case plan are required, who should be consulted prior to the changes being made? 9. Why is cultural consideration important as part of case management planning? 0. Outline three strategies you think a workplace needs to have for including cultural awareness in the planning process? 11. You are a Team Leader in a Community Service Organisation and your organisation has just employed a new case worker. Describe two strategies that can help facilitate casework consultation between staff to maximise their performance in their new role. Best practice and promoting high-quality case management 12. What is meant by the term ‘best practice case management’? Why is best practice a significant service delivery benchmark? 13. How can case workers benefit from appropriate leadership, support, advice, supervision and challenges? In what ways might these improve service delivery? 14. Legislation, organisational policies and procedures can change over time. How might case management leaders support case managers in keeping up to date with organisational policies and procedures?

Thursday, January 2, 2020

Emotional Damage, Hidden Truths, and Accepting...

Emotional Damage, Hidden Truths, and Accepting Responsibility in J.D. Salinger’s The Catcher in the Rye When one finds themselves in a reader’s position, they search for things in the novel that they can relate to. J. D. Salinger wrote a story that contained countless topics that people, past, present and future, can relate to in several ways. The novel follows the story of a troubled boy named Holden who leaves school due to his poor academic performance, an altercation with his roommate, and complications with his emotions due to the traumatic loss of his brother. He quickly understands how his narrow view of the world will lead him into trouble when he finds himself alone. The reader accompanies Holden through his stressful experiences†¦show more content†¦Although Holden is in treatment, the reader begins to question if it is truly helpful. Holden repeatedly argues with himself over whether his prescribed therapy sessions are working for him or not, and it seems that they really are not (Brooks n.p.). In the end, Holden regains his sense of reality, but one is left questioning if his sanity will ever be found. Holden’s life experiences may seem normal to the average human being, but in his mind those events are far from normal. During his childhood years Holden’s parents failed at teaching him life values and morals, which played an effective role in him losing his vision of the perfect world that has no flaws. Allie’s death was the worst of the bunch, forcing his mind to bottle up in sadness and despair, causing Holden to be hospitalized. As stated previously, Holden losing his brother Allie caused him a great deal of stress and confusion; it portrays the death of Allie as the biggest downfall in his emotional status. It is obvious that the stability of Holden’s mind is far gone with little hope of return, the only possible way that he can regain his sanity is to repair the emotional damages left by his unfortunate experiences. Through the course of the novel The Catcher in the Rye, Holden Caulfield displays to his readers that he is no longer mentally stable by his actions. Holden hints at his mental disability but it has already been obvious to his