Pathophysiology of HELLP Syndrome

Pathophysiology of HELLP Syndrome Free Online Research Papers A maternity unit is generally filled with happy moments; however, when an obstetrical emergency walks through the door, those times can be hectic and chaotic. All persons involved need to be part of a delicate team who work together in order for the woman and her child to receive the best care and to ensure the most optimum outcome as possible. The preceding case study will show how to effectively manage HELLP syndrome, the acronym for hemolysis, elevated liver enzymes and low platelet count. N.N. is a 26-year old, gravida 2, para 1 at 37 weeks gestation per last menstrual period and early ultrasound. She presented to the labor and delivery unit with a direct statement of â€Å"I had HELLP syndrome with my last pregnancy and I think I have it again.† Her vital signs were: temperature 99.4 F, pulse was 126, respirations 26 and blood pressure was 156/93. Her weight is 185 pounds with a prepregnancy weight noted to be 167 pounds. This patient was placed on external fetal monitoring. The fetal heart rate was noted to be 145 beats per minute with moderate variability and shown to have a reactive strip. There were appropriate accelerations noted and no decelerations. Uterine contractions were shown to be irregular, 3-9 minutes apart lasting 40-60 seconds in duration. The uterine contractions palpated mild. Reflexes were tested and were abnormal at 3+ with clonus, and +2 pitting edema was noted in lower extremities. A cervical exam revealed a soft, thick closed cervix. An IV was started and lactated ringers was hung and infusing at 150 ml per hour. Labs were drawn for CBC, ABO RH and type and screen, comprehensive profile, PT, PTT, and a urinalysis. An ultrasound was ordered to rule out a hematoma on her liver and to check for a placental previa or abruption as well as to check for fetal well being. Her abdomen was soft, but tender to touch with pain in her upper right quadrant. She denied leaking of amniotic fluid and tested negative for nitrazine and ferning. She complained of a headache that she states she has had for two days. Her liver enzymes were elevated with an AST of 906 and ALT of 1042 and hemolysis of LDH at 1123. Her platelets were at 43,000. The urinalysis showed a trace amount of protein as well as ketones and bilirubin. The rest of the urinalysis was within normal limits. The ultrasound was negative for a liver hematoma. It also showed an active, apparent well fetus. She presented with 3+ pitting edema in her lower extremities. The PT, PTT and fibrinogen were within normal limits. The physician on call was immediately called and was on his way in. Because this patient had had HELLP syndrome in the past, it was likely she had it again. There is up to a 25% chance that a woman who has HELLP in previous pregnancies, she will have it again in subsequent pregnancies (Hagl-Fenton, 2008, p. 23.) Women who have had pregnancies complicated with preeclampsia have a 2-12 percent chance of developing HELLP in their pregnancy (Lealbe, Niebyt, Simpson, 2002, p. 956.) Many women who come into a labor and delivery unit are misdiagnosed because the symptoms mimic preeclampsia. The platelet count is one of the key indicators that it is more than preeclampsia, (O’Hara Padden, 1999, p. 829) as well as an increased bilirubin (Lealbe et al., p. 956.) There is not a definitive pathogenesis of HELLP syndrome. The discoveries of this multisystem disease are characterized by â€Å"abnormal vascular tone, vasospasm and coagulation defects† (O’Hara Padden, 1999, p. 830.) HELLP appears to be the last indicator of some attack that leads to microvascular endothelial impairment and â€Å"intravascular platelet activation† (O’Hara Padden, p. 830.) With the activation of the platelets, serotonin and thromboxane A are released, thus resulting in platelet agglutination and aggregation and then continued damage of the epithelium (O’Hara Padden, p. 830.) This can only be corrected by the delivery of the baby, if the gestation is greater than 32 weeks (O’Hara Padden, p. 32.) If the woman presents to a labor and delivery unit and is less than 32 weeks in gestation, medicinal therapeutics are first tried to help keep the patient pregnant as long as safe for her and her baby. Betamethasone 12mg IM is given twice in 24 hours to help mature the lungs of the premature infant. Giving Decadron, 10 mg IV every twelve hours, has been shown to improve many of the laboratory irregularities identified with HELLP syndrome (O’Hara Padden, 1999, p. 33.) Magnesium Sulfate, 4-6 gram bolus, intravenously, should be administered over a 20-30 minute time frame. A 2 gram maintenance dose of magnesium should be continued after the bolus is given. This can help lower the elevated blood pressure of the patient. A magnesium flow sheet should always be used to monitor for signs of magnesium toxicity. Reflexes should be tested each hour to assess for slow, sluggish or hyper reflexes. Visual disturbances, headaches and urinary output should also be assessed each hour. Platelet activation is believed to participate to the pathogenesis of preeclampsia and HELLP syndrome, which results in hemodynamic changes, vasoconstriction and endothelial injury (Sheu, Shen, Lin, Tzeng, 2002, p. 132.) Formation of Thromboxane A in platelets generally rises during pregnancy (Sheu et al., p. 133) and it has also shown that it is exacerbated when combined with a decrease in prostacyclin (Sheu et al., p. 133.) The hemolysis in HELLP syndrome is microangiopathic hemolytic anemia (O’Hara Padden, 1999, p. 830.) The red blood cells become odd shaped, known as traumatic hemolytic anemia. These red blood cells are seen in the peripheral blood when they are exposed to a large amount of turbulence and may been seen as schistocytes or echinocytes (burr cells) (Lowdermilk, Perry, Bobek, 1997, p. 792.) The persistent vasoconstriction that occurs causes fibrin deposits in the hepatic sinusoids (Leaton Martin, 2001, p. 32.) This block hepatic blood flow and changes liver function (Leaton Martin, p. 32.) The liver swells causing the pain in upper right quadrant as well as epigastric pain. ALT and AST are chief enzymes that initiate intracellular protein metabolism and are generally found in small quantities in the extracellular serum. An elevated AST may occur when there is liver ischemia. An increase in the ALT, found primarily in liver cells, is when the liver fails to function normally in its role of hemoglobin degradation. An increase in the bilirubin may also take place because of the effects on the liver (Lowdermilk et al., 1997, p. 792.) Vasoconstriction of the blood cells can cause limitations on the blood flow, thus hindering the blood from getting to the vital organs of both the mother and the fetus in the complication of decreased organ perfusion. If the placenta is not receiving sufficient blood, the baby can have complications that can be assessed by the fetal monitor. These complications can be seen as variables or decelerations. If the baby has run out of fetal reserves, the baby may not survive due to the lack of placental perfusion. Vasoconstriction has also been associated with intrauterine growth retardation (IUGR) (Robillard, Chaline, Chaouat, Hulsey, 2003, p. 131.) The obstetrician on-call that night was in the hospital within 12 minutes of the call he received. He assessed the patient and looked at the labs that were taken. He rechecked her cervix which showed no change in dilatation. Because of her gestation age of 37 weeks, the decision for an immediate cesarean was brought forth. He was concerned for the possibility of a long labor. The fact that she did not have a favorable cervix and using pitocin to augment her labor, could have had a poor outcome for both the mother and her baby. The time between decision for the cesarean section to incision was 17 minutes. N.N. had a 7lb. 13oz. baby boy. His apgars were eight at one minute and nine at five minutes. APGAR is an acronym for the scale or scoring used to determine how well the baby did after delivery. APGAR stands for activity (muscle tone), pulse, grimace (reflex ability), appearance (color of the newborn), and respirations. Each score rates either 0, 1, or 2. Two is the best a baby can achieve with each section of the scoring tool. This baby had one point taken off for color and tone at one minute and one point taken off for color at five minutes. There was no need for further intensive care for this baby. During the post partum period, the patient recovered without any further problems. The AST and ALT were back within normal limits by the second post partum day. Another ultrasound was done on her liver the second post partum day which showed no evidence of enlargement, bleeding or rupture. There was no evidence of post partum hemorrhage. Urinary output was greater than 30ml per hour after her cesarean section. By the third post partum day, the edema in the lower extremities was down to 1+ edema with no evidence of pitting. Her post op pain was controlled by as needed opioid medications as well as NSAID’s. The first nursing diagnosis that could have been used for this patient was risk for injury: maternal, related to vasospasm, high blood pressure. A second nursing diagnosis could have been anxiety related to fear of disease process and possible outcomes. A third nursing diagnosis could have been altered protection related to decreased platelet count as evidenced by platelet count of 43,000. A fourth nursing diagnosis could have been pain related to post operative procedure. The interventions used for this patient were used to help ensure the positive outcome for herself and her newborn. She was assessed and properly diagnosed within a very short period of time. The interventions that were done were to promote the patients comfort from the pain she was experiencing from both her abdomen and her head. She was placed on her side in order to not obstruct the blood flow from the vena cava; this can happen if the patient is lying flat on her back. She was assured as well as comforted to help to reduce the anxiety that she was feeling from the fear of what was happening to her. From the time she arrived on to the unit, until the time of her cesarean section, the time lapsed was only approximately 45 minutes. Had she not stated that she had, had HELLP syndrome with her first pregnancy, she may have been diagnosed with preeclampsia or another pregnancy related issue. The fact that she told the nursing staff when she arrived helped us by knowing what to order, what to look for when the results came back and how to properly treat her. The physician on call was not her regular physician and had never seen this patient before. As he was assessing this patient, he was also looking through her prenatal to view her history. With the patient’s symptoms, the fact she has had HELLP syndrome in the past and the labs and the radiology reports that came back, this patient had the best possible procedure that gave her the best outcome for her and her baby. Had this patient been under 36 weeks, she would have been transported to a level three hospital. Our hospital is a level one, community hospital and do not generally deliver babies under 36 weeks unless there is a risk to the mother or fetus. If this is the case, the neonatal intensive care unit (NICU) team from the level three hospital is called and informed. HELLP syndrome is a very traumatic and scary disease process for the patient. Without thorough evaluation and assessment of the patient and her fetus, both she and her baby could have been subjected to a very different outcome. Through team work by the medical staff, the nursing staff as well as the rest of the ancillary members that were involved with this patients care, the patient went home, with a healthy newborn, both with no residual damage. References Hagl-Fenton, D. J. (2008, March 2008). Beyond Preeclampsia. RN, 71(3), 22-25. Lealbe, S. G., Niebyt, J. R., Simpson, J. L. (2002). Obstetrics-Normal and Problem Pregnancies (4th ed.). Philadelphia, Pa.: Churchill Livingstone. Leaton, M. B., Martin, P. S. (2001). Dealing with coagulopathies of PIH. Nursing2001, 31(3), 32-35. Retrieved from ProQuest September 16, 2008 Lowdermilk, D. L., Perry, S. C., Bobek, I. M. (1997). Maternity Women’s Health Care (6th Ed.). New York, NY: Mosby. O’Hara Padden, M. (1999, September 1, 1999). HELLP syndrome: Recognition and perinatal management. American Family Physician, 60(3), 829-836. Retrieved from ProQuest September 16, 2008 Robillard, P. Y., Chaline, J., Chaouat, G., Hulsey, T. C. (2003). Preeclampsia/eclampsia and the evolution of the human brain. Current Anthropology, 44(1), 130-134. Retrieved from ProQuest September 30, 2008 Sheu, J. R., Shen, G., Lin, M. Y., Tzeng, W. Y. (2002). The hyperaggregability of platelets from normal pregnancy is mediated through thromboxane A2 and cyclic AMP pathways. Clinical Laboratory Haematology, 24(2), 121-129. Retrieved from ProQuest September 30, 2008 Research Papers on Pathophysiology of HELLP SyndromePersonal Experience with Teen PregnancyArguments for Physician-Assisted Suicide (PAS)The Relationship Between Delinquency and Drug UseLifes What IfsThe Hockey GameGenetic EngineeringWhere Wild and West MeetResearch Process Part One19 Century Society: A Deeply Divided EraTwilight of the UAW

10 Mothers Day Quotes Reveal Why Moms Nag So Much

10 Mothers Day Quotes Reveal Why Moms Nag So Much Most mothers nag their kids. Maybe it is indoctrinated within a mom the day her baby is born. Or maybe she picks up the habit of constantly advising her child, which takes the tone of nagging when it becomes repetitive. Nagging mothers usually had their own mothers nagging them when they were young. While many mothers believe that all mothers try to reinforce beliefs, values, and discipline through repetitive advice, this form of communication usually goes kaput once the child attains teenage. So Is Nagging a Bad Habit? In a 2015 study conducted by  the University of Essex in England, researchers, who studied that habits of over 15000 teenage girls, found that teenage girls were more likely to avoid teen pregnancy, and less likely to remain unemployed if they had nagging moms to push them harder. Many teenagers who had a higher rate of success in their careers, had a nagging mom to back them.   However, many counselors and child psychologists will tell you that nagging does not help the child to improve his or her behavior. If anything at all, it will only make the child not take onus for his actions. Teaching has to allow the child to learn on his own, without being told to do the right thing. So, the long-term effect of nagging is stress for the mother and poor character development for the child. Beneath Every Critical Word, Is a Mothers Genuine Love True, mothers nag at times. But look at it this way. Would you rather have her ignore you? Would you prefer that she looks the other way when you are walking down a wrong path? You may not like her constantly reminding you of your responsibility, but dont underestimate her love for you. Beneath every word of caution, advice, or criticism is a layer of protective love. She wants you to be happy, successful, and healthy. She is concerned about your wellbeing and spends every waking hour thinking of ways to improve your life. So, if you have a critical mother, dont be annoyed with her. She is, after all, your best friend. Make Your Mother Proud. Its Easy to Please Her. You dont need rich, expensive gifts to please her. All you need to do is follow her advice and be a good person. Respect her views, and understand why she has been tough on you while growing up. Mothers have a soft heart and they are easy to please. Appreciate her hard work, and her sacrifices. Your words of appreciation and your undivided attention is all she wants to know that she is loved. Here is a special collection of Mothers Day  quotes for our boldest and gentlest mothers. If you cant say it with words, say it with these quotes. Oscar WildeAll women become like their mothers. That is their tragedy. No man does. Thats his. RajneeshThe moment a child is born, the mother is also born. She never existed before. The woman existed, but the mother, never. A mother is something absolutely new. Agatha ChristieA mother’s love for her child is like nothing else in the world. It knows no law, no pity, it dates all things and crushes down remorselessly all that stands in its path. Helen Hunt JacksonMotherhood is priced; Of God, at price no man may dare/To lessen or misunderstand. Barbara KingsolverIt kills you to see them grow up. But I guess it would kill you quicker if they didnt. Jewish ProverbGod could not be everywhere and therefore he made mothers. Abraham LincolnI remember my mothers prayers and they have always followed me. They have clung to me all my life. Mildred B VermontBeing a full-time mother is one of the highest salaried jobs... since the payment is pure love. Henry BickerstethIf the whole world were put into one scale, and my mother in the other, the whole world would kick the beam. Chinese ProverbThere is only one pretty child in the world, and every mother has it.

Costa coffee Essay Example | Topics and Well Written Essays - 1500 words

Costa coffee - Essay Example Costa coffee Since coffee retailers in the UK largely depend on coffee producing economies therefore, governments of coffee producing economies also influence the operations of coffee shops in UK. For example, Venezuela was the largest coffee exports however, because of government price controls; growers consider growing coffee as not an economically viable option (BBC, 2010). UK government with the support of members of coffee associations is struggling to support the producers of coffee such as through farm certifications, direct-buying initiatives and quality improvement which supports the farmers to improve their position and long term sustainability (British Coffee Association). Economic Population of UK has grown over 60 million people and in 2006, the total population was 60.6 million as compared to 55.9 million in 1971. Moreover, it has been estimated that people above 65 years old will be more in number as compared to individuals below 16 by 2021. Poverty reduction has become an importan t target for UK and government has been able to lift 2.4 million people out of poverty including 800,000 children and government aims to halve child poverty by 2010 and eliminate poverty by 2020. Economic problems faced by coffee producing economies influence the coffee companies in UK because most of the companies are acquiring coffee from these economies. For example, Uganda farmers are facing increasing level of pests and diseases and extremely harsh weather conditions (Butler, 2011). Around 70 percent of the world’s coffee is grown on area less than 10 hectares and most of the famers, out of 25 million in 50 developing economies that produce coffee, sell coffee in small quantities to local traders, manufacturers or exporters. The manufacturers of Coffee in UK are buying green beans from international trading houses or exporters. However, Government of UK is encouraging the companies to buy coffee direct from the famers to access best quality coffee in the long term (Briti sh Coffee Association). Social Consumers are asking for fair deals from suppliers at coffee shops and according to a Concerned Consumer Index Survey, 54 percent of the participants have showed that coffee shops should consider social issues ahead of environmental issues such as treating workers in plantation fairly (Gibbons, 2010). UK Fair trade market has grown from ?493 million in 2007 to ?712.6 million in 2008 and according to survey 72 percent of people are aware that they can buy coffee through fair trade certification. In the period of six months, 36 percent of the people have bought coffee through fair trade and the trend of buying coffee through fair trader is further boosting (Mortimer, 2010). More than 60 million cups of coffee are consumed on average in the UK in one day (British Coffee Association, 2011). The coffee culture is continuously increasing in UK however, because of the economic downturn; consumers in the UK were giving preference to drink coffee at homes rathe r than at coffee shops (Euromonitor, 2011). Consumers in UK are more focusing on taste and quality of coffee and the increasing consumption of coffee at homes is evident from increasing household penetration of coffee pod machines (Euromonitor, 2011). Technological Between 2002 and 2005, the UK internet sales to households have increased by

Engine performance and Efficiensy Coursework Example | Topics and Well Written Essays - 1250 words - 1

Engine performance and Efficiensy - Coursework Example Theoretically, it is the difference between the gross and net thrust (Momentum drag = Gross thrust – Net thrust). It is computed as: Net thrust is a positive aerodynamic force that causes propulsion of an aircraft in air. It is represented as a summation nozzle thrust and momentum of the jet’s motion. It is a resultant propulsion force produced by the jet engine used in providing thrust (speed) to the aircraft. It is the difference between the gross thrust and the momentum drag on the engine of an aircraft (Net thrust = Gross thrust – Maximum drag). It is usually denoted by T and is calculated as follows: The engine thrust is affected by the flow of air into the engine and is thus a change in the rate of airflow results to a change in the resultant thrust. With net thrust, the increase in the aircrafts speed results to an increase for air fed into the engine, resulting to a higher output. With static thrust, the environmental factors tend to determine the ability of the craft to cause motion. With static thrust, the air speed is kept constant and is not affected by the crafts motion thus differing from the net thrust. b) Calculate the net thrust of a turbo jet flying at 150 M/S with an air mass flow of 50 Kg/S and a jet stream velocity of 300 M/S with a chocked nozzle. The residual gas pressure in the jet stream is 45 KPa gauge, the nozzle area is 0.2M2. Net thrust = gross thrust – momentum drag (T = mVj + Aj (Pj - Pam) – mVi) where Pam is the ambient air pressure in question. Form this equation an increase in the ambient air pressure, while holding all other factors constant results to a decrease in the net thrust of the engine, which being the denominator of the SFC formula results to an increase in the resultant value of the specific fuel consumption. As indicated by the new SFC equation Propulsive efficiency = (2Vi) / (Vi + Vj), where Vi is the speed of the exhaust gases and Vj is the incoming air speed. Increasing the speed of the gas

I Can Change the World One Tooth at a Time! :: Dentistry Admissions Essays

I Can Change the World One Tooth at a Time! Â   Ever since childhood I have enjoyed working with my hands. Whether as an eight year- old gluing together a model car or an adolescent assembling a bookshelf in woodworking class, I thrived on the challenges of precise and meticulous tasks. Throughout high school I have been intrigued by the sciences, but it was not until I read about late-breaking discoveries and research in the field of genetics that my interests in science intensified. When I entered the University of British Columbia (UBC), I naturally chose to specialize in Cell Biology and Genetics. Â   In my sophomore year at UBC, I first began to seriously consider dentistry as a career. At that time, I began to appreciate the important role that dentistry played in my life. Four years earlier, I began an orthodontic treatment program with Dr. Junni Wang to correct a severe crowding problem with my teeth. Both before and during the treatment, I was a most reluctant participant; not many teenagers look forward to braces filling their mouth during their last two years of high school, and I was no different. Â   However, at every monthly check-up for three-and-a-half years the office staff had nothing but kind words of encouragement and optimism. Now after the completion of the treatment I had reason to smile. Dr. Wang helped turn me from a shy adolescent who feared smiling into a confident, outgoing young man. His skills not only brought back my smile, but also my sense of confidence in all aspects of my life. Whereas once I feared drawing attention to myself and thus shied away from leadership posts and debates, now I am a completely different person. Hoping to feel as satisfied and gratified as Dr. Wang must have felt in improving not only my smile but my entire way of life, I look forward to improving the oral health of patients on a daily basis and participating in dentistry' s friendly, team-oriented work environment. Â   After this preliminary ' patient-doctor' exposure to dentistry, I substantially increased my involvement in the field to determine if dentistry really was for me. My participation with the UBC Pre-Dental Society allowed me to communicate with various professionals in the field. I also investigated opportunities to volunteer in the University Dental Clinic or participate in research work.

The Secret of Ella and Micha Chapter 19

Ella The next day is lighter somehow, like I've been buried in the sand and someone has finally dug me out. Micha seems happier too, although I can tell he's still hurting, so I work on keeping his mind distracted. â€Å"So what did you do to it?† I ask Micha as I circle the back end of his car with my hands on my hips, taking in the scratches and dings in the black paint, which look worse in the sunlight. â€Å"I took it for a very intense joy ride.† A lazy grin stretches across his face as he puts his head beneath the hood to examine the engine. I plant my butt on the edge where he's working and cross my leg over my knee. â€Å"At least tell me you won? And that the scratches and dings were totally worth it.† â€Å"Of course. They're always worth it,† he says with a hidden meaning that only the two of us could ever understand. Gripping the edge, I lean back over the engine and give him a peck on the cheek. He grins, tosses a greasy rag onto the ground, and pinches my ass. A squeak comes out of my mouth as I jump from the pinch and fall toward the engine. Pushing myself back up, I get grease all over my arms and backside. I hop off the hood, trying to clean the grease off with my hands, but it's only making a bigger mess. Micha laughs at me as he retrieves a new tool box from the top shelf. â€Å"That's a good look for you.† I stick out my tongue and turn to leave. â€Å"Where are you going?† he asks. I hold up my greasy hands. â€Å"Thanks to you, I have to go take a shower and wash my clothes.† A wicked look dances in his eyes. â€Å"I have grease all over me to. I think I may need to come in there with you.† My stomach flips thinking about last night. I keep backing up toward my house with my eyes on him. â€Å"I'll tell you what. If you can catch me, you can shower with me.† His eyes scroll my body as he sucks his lip ring in between his teeth. â€Å"Is that a challenge, pretty girl?† I try not to smile as I exit the garage into the sunlight, but it's too much and my lips turn upward. I take off toward my house and his footsteps head after me. I jump the fence gracefully, but by the time I reach the back door, his arms are circling my waist. He spins me around and picks me up effortlessly. Hooking my legs around his waist, he opens the door and gets us into the kitchen. He glances around the room and cocks an eyebrow. â€Å"Is Lila here?† I shake my head slowly. â€Å"She's with Ethan.† â€Å"What about your dad?† â€Å"He went to work.† His aqua eyes darken and I can't help but kiss him. I feel him walking, traveling somewhere as our tongues entwine together. I run my fingers through his hair grabbing onto as much of him as possible, shutting my fear away and basking in the moment. Without breaking his lips away from mine, he carries me into the downstairs bathroom. When I hear the shower water turn on, I pull my lips away from his. Before I can ask what he's doing, he sets me down underneath the warm water. I let out a scream as my clothes are drenched. â€Å"See, this way you're washing your clothes and taking a shower at the same time.† He grins and tips the showerhead down so it hits more of me. I seize the front of his T-shirt and yank him forward, so he stumbles into the running water. He braces his hands on the walls, and water sprays over his hair and drips down his face. I smile at him innocently and allow the water to stream down my body. â€Å"Now you're all clean too.† He shakes his head, then shoves away from the wall and jumps all the way into the shower with me. He shuts the curtain and seals us inside the steam. His jeans and T-shirt are sopping wet and beads of water drip into his eyes. I run my hand across his forehead over a spot of grease and then through his hair. He aims the shower head down on me and I tip my head back into the flow. He combs his fingers through my hair sensually and his other hand comes down on the wall behind me as he gathers some of my hair into his hand. Pulling at the roots, he leads me toward him for a deep, watery kiss. Steam surrounds us and makes the passion inside my body ignite. Panic starts screaming inside my head, but I tell it to shut up and suck the water off his lips as I find the bottom of his shirt to lift it over his head. He pulls back and helps me out, slipping it off and tossing it to the side, instantly reuniting his lips with mine. My fingers trace along the lines of his muscles and the pattern of the tattoo on his rib cage; the lyrics to the first song he ever wrote. His hands explore my hips, my waist, then up my shirt. Finally, I just take it off for him and then he unhooks my bra. Our bare chests crash together as we continue to kiss underneath the hot water. Minutes later, the rest of our clothes are in a pile by our feet and I can hardly think straight. The way he touches me, kisses me – nothing has ever felt like this before. He sucks on my breast and licks the water off my skin on my bare stomach, continuing to go down until his tongue finds the right spot. I fall back against the wall as a scream claws up my throat and I lose total control over my body. This time I don't mind. Micha After Ella comes apart, I turn the water off and grab a towel off the hook. She raises her arms above her head, keeping her eyes on me as I wrap the towel around her. â€Å"What?† I ask her, because I can tell she's thinking deeply about something. â€Å"Nothing.† She shrugs casually, but her cheeks turn a little pink. â€Å"It's just that if I would have known all along that it felt that good, I probably wouldn't have fought it so hard.† â€Å"Well, I'm glad you think I'm that good,† I tease her snatching another towel and tying it around my waist. She nibbles on her lip apprehensively as she crosses her arms and rests back against the wall. â€Å"Alright, pretty girl,† I demand. â€Å"What are you thinking about?† She lets her lip pop free. â€Å"It just doesn't seem fair that I'm the one that gets to have all the fun.† I try not to get too excited, because let's face it, she's a runner. â€Å"I'm sure I'll have plenty of fun by myself later.† She reaches forward hesitantly and yanks the towel off my waist. â€Å"That was smooth,† I say, gripping the edge of the counter, fighting to stay calm. Her eyes travel over my body. â€Å"I learned from the best.† She runs her fingers softly along my swollen cock, making me harder than I already am. â€Å"Fuck, Ella,† I say, leaning back against the door and letting go. Ella I have no idea what the hell came over me and I'm not going to over analyze it. I can finally breathe again and that's all that matters. Letting things take their course might be exactly what we both need. Micha wraps a towel around his waist looking happier than I've ever seen him. He kisses me, sucking my bottom lip gently into his mouth, before pulling away and staring into my eyes. â€Å"You're so beautiful.† Smiling, I stare down at our wet clothes balled up in the corner. â€Å"Now what do we do?† He licks his lips and braces his hands on the wall, trapping my head between his arms. â€Å"We could do it again.† I swat his chest, pretending that he's being silly, even though I do want to do it again. â€Å"I mean how do we get out of here? Our clothes are soaking wet and I'm not putting mine back on.† He shrugs and leans away. â€Å"No one's home so keep the towel on you and run upstairs.† I eye over his lean chest. â€Å"Yeah, but what about you?† â€Å"You can go get me some clothes after you get dressed†¦ if you want to.† His lips tug into a flirty grin. I start to say something, but the back door slams shut and Lila and Ethan's voices float from the kitchen. â€Å"Well, there goes that plan,† Micha says with laughter in his tone. I tighten the towel around me and we wait for them to leave, but after a while, it's clear they're not going anywhere. â€Å"I'll go out there,† Micha says and heads for the door. I pull him back by the arm. â€Å"You're in a towel.† â€Å"Obviously.† â€Å"But they'll see you and know something was up.† He cocks his head to the side, his eyes scrutinizing me. â€Å"Is that a bad thing?† I hug my arms around myself. â€Å"No, it's just that†¦ what are we going to tell them we were doing?† â€Å"I'm sure they'll figure it out,† he says. â€Å"Why is this upsetting you?† â€Å"It's not,† I reply, deciding to just be honest. â€Å"It's just that†¦ this is like the realest thing I've had in a long time and it scares me a bit.† He tucks a strand of my damp hair out of my eyes. â€Å"I know it does, but you'll be okay – we'll be okay.† I nod quickly and then move away from the wall, straightening my shoulders. â€Å"Are you coming back after you change?† He plants a kiss on my forehead. â€Å"Where else would I go?† I move out of his way and he walks out the door in his towel, like he's not embarrassed at all. He leaves the door cracked behind him and seconds later I hear the sound of Lila's shocked voice followed by the laughter of Ethan. A few seconds later footsteps head my way. â€Å"Oh Ella,† Lila says through the crack in the door. â€Å"Can I come in?† Holding the towel on, I open the door about half way. â€Å"Could you go get me some clothes, please? Mine are soaking wet.† She covers her mouth, stifling her laughter. â€Å"Sure. I'll be right back.† She comes back with a pair of red shorts and a grey tank top. I get dressed and we meet Micha and Ethan out in the garage. Micha's wearing a pair of loose fitted jeans and his favorite Pink Floyd t-shirt, and he tries not to smirk when he sees me, but Ethan doesn't hold back. â€Å"Have fun this morning?† he asks me and I punch him in the arm. â€Å"Ow,† he fakes hurt and then glances down at the engine. â€Å"Dude, you ripped this thing to shit. What the fuck did you do to it?† â€Å"I took it down to Taylor Bay and drag raced it,† he says with a shrug. â€Å"I guess I pushed it too hard.† â€Å"Then where'd the dents come from?† I question, peering underneath the hood. â€Å"I had an unfortunate run in with another car,† he says, with a twinkle in his eye as he captures my gaze. â€Å"But I still won.† Ethan sighs and slams the hood shut. â€Å"Get in and we'll take it to the shop.† We pile into the car and Micha drives it up on the grass to maneuver it around Ethan's truck parked in the center of the driveway. We drive down the road toward the shop holding hands over the console, listening to Lila and Ethan chat about their day, something so simple, but so meaningful. When Micha pauses at a stop sign, Mikey's cherry red Camaro rolls up to the side of us. He points at Micha's car and then one of his friends mockingly waves. â€Å"Fucking asshole,† Ethan mutters from the backseat. I roll down the window. â€Å"Is there a problem?† Mikey laughs and aims a finger at the hood. â€Å"What'd ya do to that poor thing? It sounds like it's dying.† â€Å"It sounds a lot better than your piece of shit car on a good day,† I retort, sitting up and sticking my head out the window. â€Å"Ella,† Lila says from the backseat, shocked. â€Å"Let her go,† Ethan says. â€Å"She's very entertaining when she gets this way.† Mikey's greasy black hair shines in the sun as he pokes his head out of the car. â€Å"You can keep talking, but it ain't going to do no good since you're both too chicken shit to race me. You guys proved that at the last race.† â€Å"Only because your small size was unimpressive,† I say with an innocent bat of my eyelashes. That pisses him off. He jumps out of the car and Micha pulls me back in and leans over the console, resting an arm around my shoulder protectively, knowing that Mikey's the kind of guy that would hit a girl. Mikey glances up the street before crouching down next to the door. â€Å"If you two think you're so tough then prove it,† he says with a venomous tone. â€Å"The Back Road, nine o'clock.† â€Å"I'm pretty sure she already explained to you that your car isn't worth our time,† Micha says evenly. â€Å"So back the fuck off and get back in your car.† â€Å"The Back Road, nine o'clock,† he repeats slowly before backing away and climbing into his car. â€Å"And I'm sure with the noises your car's making, it should be a pretty fair race.† He revs his engine, proving something, before speeding off through the intersection, leaving tire marks on the asphalt. â€Å"What a jerk,† Lila says from the backseat. â€Å"Getting in your face like that – who does that?† I turn to Micha with a guilty face. â€Å"I'm sorry.† He delicately sketches his finger along my lips and sighs. â€Å"It's okay. We'll figure something out†¦ Besides you can make it up to me later.† â€Å"We can't fix your car that fast, man.† Ethan leans over the console, shoving the sleeves of his black shirt up to his elbows, revealing several tattoos on his arms. â€Å"It's nowhere close to being in racing condition.† â€Å"I know,† Micha replies and starts driving again. â€Å"I guess we'll just have to go in there blind.† â€Å"It could fall apart if you push it too hard,† Ethan cautions. â€Å"Then you'd be back to square one with it.† â€Å"Wait a minute.† Lila holds up her hands in front of her. â€Å"You guys aren't seriously going to race him, are you?† â€Å"We have to,† Ethan and Micha say at the same time. Lila glances at me for an explanation. â€Å"Why?† Ethan slumps back in the seat and brings his knee up as he turns to Lila. â€Å"It's how things work around here. If we don't, then we'll get hounded for it for the rest of our lives.† â€Å"Okay†¦Ã¢â‚¬  Lila says jolting in the seat as the car hits a pothole. â€Å"What's wrong with that?† Ethan rifles for a way to explain it to her, brushing his dark hair out of his eyes. â€Å"It'd be like getting picked on every day in school by everyone in the school.† Lila tucks her hands under her legs. â€Å"That doesn't sound very fun.† â€Å"Exactly, so you can understand why we have to race.† He folds his arms and directs his attention back to Micha. â€Å"Go to the shop, man and we'll see what we can get fixed before it's time to go.†

The Teachings of the Bible as an Understanding of the Scientific Knowledge Free Essay Example, 1750 words

The idea of disclaimers placed in school books such as the teaching of evolution is not intended to influence or dissuade the Biblical version of Creation or any other concept has been lawfully established to be unconstitutional ( Freiler , 2000). An instructor also has the constructional right to teach evolution ( Epperson v. Religious theories of creation may be incorporated into school curriculums as a comparative example of what some religious groups accept as fact. The foundations of scientific and intellectual integrity cannot accept the teaching of the religious theories of creation as an alternative point of view to evolution. This is because science involves the constant attempt to disprove hypotheses while religion simply accepts what has been written to be true. Religion is based on faith that is never questioned while science is based on the knowledge that is constantly questioned ( Epperson v. Creationism, creation science, and the intelligent design theory are similar terms that religious factions have used to explain origins of the universe that they want to be inserted into public education. Those that subscribe to creationism believe that God created the universe and then created a man according to the explanation of creation offered in the Bible. We will write a custom essay sample on The Teachings of the Bible as an Understanding of the Scientific Knowledge or any topic specifically for you Only $17.96 $11.86/page Creationists make much of their case around the claim that evolution has yet to be proven, yet it has been proven in the same way that scientists prove any other profoundly and commonly held scientific theory. Creationists are requiring a high level of verification from evolutionary theorists.