Sickle Cell Anemia And Hemophilia Biology Essay

Sickle Cell Anemia And Hemophilia Biology Essay Abstract In the following paper, sickle cell anemia and hemophilia disorders were studied extensively. Sickle cell anemia was found to be the disorder where the red blood cells develop into sickle shaped cells due to a mutation of the hemoglobin protein. When the cell becomes sickle shaped, they also become sticky and will clump with other cells in the blood vessel. This can lead to decrease blood flow in that blood vessel which will lead to various effects. Sickle cell anemia is a hereditary disease in that it is passed down generations genetically. The main effect of sickle cell anemia is the decrease in number of red blood cells in the blood and lack of oxygen transport to certain areas of the body. Though are many drugs to help with the pain caused by sickle cell anemia, there is no definitive cure to the disorder. However, the main type of treatment is bone marrow transplant. However this procedure is very risky and not advised unless the symptoms of sickle cell anemia are severe. There is much research being done on sickle cell anemia, but no definitive cure has been found. The life expectancy of patients with sickle cell anemia is from 40 -60 years old and majority of the patients are African descent. Hemophilia is the disorder that prevents the body to stop bleeding. If a person is cut, the body will not form clots to stop the bleeding because people with hemophilia lack a clotting factor. This is also a genetic disorder and is found only on the X chromosome. Hemophilia can be divided into two categories: hemophilia A (lacks clotting factor 8) and hemophilia B (lacks clotting factor 9). About 9 out of 10 people who have hemophilia have type A. Rarely, hemophilia can be acquired. This means that you can develop it during your lifetime. About 18,000 people in the United States have hemophilia. Each year, about 400 babies are born with the disorder. Hemophilia usually occurs only in males (with very rare exceptions). The major signs and symptoms of hemophilia are excessive bleeding and easy bruising. The main treatment for hemophilia is called replacement therapy. Concentrates of clotting factor 8 or clotting factor 9 are slowly dripped in or injected into a vein. These infusions he lp replace the clotting factor thats missing or low. Hemophilia treatment centers are located in many areas of the United States. These centers can provide treatment, education, and support to hemophilia patients, their families, and their health care providers. Sickle Cell Anemia What is Sickle Cell Anemia? Sickle Cell Anemia or sickle cell disease is a blood disorder that is genetic. This disorder affects the red blood cells of the human body and can cause much damage to the body. It causes the red blood cells of the body to become an abnormal shape, usually in the shape of a sickle or crescent. Red blood cells are cells that carry nutrients and oxygen to different organs in the body and carry carbon dioxide back to the lungs. However, Sickle Cell Anemia basically does not allow for the red blood cells to act normally. The way a red blood cell is able to carry the oxygen molecules to the organs is by a protein molecule located on the cell called hemoglobin. This molecule is able to carry oxygen from the lungs to the bodys tissues and return carbon dioxide to the lungs. A defect of this molecule can affect every part of the body that is supplied oxygen by red blood cells which is everything. In Sickle Cell Anemia, the regular hemoglobin is mutated and changes from the normal hemoglobin A to hemoglobin S. the ability for a protein to be mutated that is located on the red blood cells means that this mutation can will be passed down to the persons child, making this disease hereditary. The mutated hemoglobin causes the entire normal red blood cell to become sickle shaped and stickier. The abnormal cells begin to clump together and have a difficult time being transported throughout the body through the blood vessels. When the blood vessels become obstructed by the sickle cells, blood flow decreases in that part of the body. This will cause a lack of oxygen in those areas which, ultimately, leads to those cells death. Another characteristic of Sickle Cell Anemia is that the abnormal red blood cells have a shorter life expectancy. Normal red blood cells usually live up to 120 days and through a process called phagocytosis they are removed from circulation. However, the red blood cells infected with the sickle cell disease live only about 10 to 20 days. This means that the body needs to produce ten times as many red blood cells if the person has Sickle Cell Anemia than a normal person. However, the body cannot produce that many red blood cells that fast. Red blood cells are produced in bone marrow, located in the inner hollow interior portion of bones, by a process called erythropoiesis. The bone marrow cannot produce red blood cells fast enough to replace the dying ones. This will lead to decreased number of red blood cells which can lead to many side effects. Causes of Sickle Cell Anemia Sickle Cell Anemia is a type of disease that someone cannot get unless if they were born with it. This disease is an inherited blood disorder that one is born with. A person is born with genes that give him/her distinctive appearance and personality. They get these genes from their parents, half from each. In Sickle Cell Anemia, there is a specific gene that can be passed down generation which will cause the disorder. This gene, sickle cell gene (HbAS), is a recessive type of gene which means that unless there is another one of it, it will not be expressed. However, that gene will be part of them forever and there will be a 50% chance that their child will have that gene. However, if two people with the sickle cell gene have a child, then there will be a 25 % chance that there child will have the disorder, 50% chance that their child will have only sickle cell gene, and 25% their child will have zero copies of the sickle cell gene. This gene which represents a specific trait will cause the Sickle Cell Anemia. Once the person has the trait, then it will begin to cause the body to make abnormal proteins on the red blood cells called hemoglobin. As discussed earlier, the mutated form of hemoglobin causes the cell to become sickle shaped and cause all sorts of havoc in the body. In addition, a distinctive trait about Sickle Cell Anemia is that once someone gets it, there is no way to get rid of it. Also since this is a genetic disease, there can be different variations of the disease. If a person inherits one sickle cell trait and if the person has the abnormal hemoglobin C (not hemoglobin S which is present in Sickle Cell Anemia), then the person will develop a milder form of the Sickle Cell Anemia disease called HbSC. If a person inherits one sickle cell gene and one gene for beta thalassemia (another type of anemia) which can be 0 or + then the person will either severe case of Sickle Cell Anemia (if HbS Beta 0- thalassemia) or a milder case of it (if HbS beta +-thalassemia). Symptoms of Sickle Cell Anemia Even though that people are born with Sickle Cell Anemia, the symptoms do not appear until after 4 months of age. The symptoms of Sickle Cell Anemia can be divided into three categories: symptoms related to anemia, symptoms related to pain, and symptoms that arise due to disorder. The first category deals with how the lack of red blood cells can affect the body. The most common symptom is fatigue because in order for the body to function and stay alert, it needs oxygen which is what anemia decreases. In addition, anemia causes dizziness, headaches, pale skin, chest pain, coldness in the hands and feet, and shortness of breath. These are all caused by the lack of oxygen reaching certain areas of the body. The second category deals with symptoms that are related to pain. A person with Sickle Cell Anemia is likely to express pain throughout their body which is called sickle cell crisis. This occurs when there is a mass of sickle cells in the blood vessels. With decreased blood flow to organs and limbs, there is usually sharp pain and organ damage. This crisis also has a range on how painful the pain is. If it is an acute pain, then the pain will be mild to severe and may last from hours to days. On the other hand, chronic pain will last for a lot longer period of time and will be hard to bear and mentally draining. This pain may severely limit your daily activities. The final category deals with the complications of Sickle Cell Anemia. This category examines certain complications that arise in certain areas of the body due to the Sickle Cell Anemia. The first complication is called Hand-Foot Syndrome. This occurs when the mass of sickle cells block a blood vessel in the limbs of the body. This will cause there to be pain, swelling, and/or fever. This is syndrome is one of the first signs an infant may have Sickle Cell Anemia. The next complication arises in the spleen. The spleen filters out abnormal red blood cells and helps fight infections. If a person has Sickle Cell Anemia, the spleen may become enlarged due to all of the sickle cells getting stuck in the spleen. If the spleen becomes enlarged, then the person will feel weak, have pale lips, higher respiration rate, extreme thirst, and abdominal pain. To treat the enlarged spleen, the patient should get a blood transfusion. Another complication that can occur is infections. Since Sickle Cell Anemia affects the immune fighting organ, the spleen, both young and old patients will have a hard time fighting infections. Young children who have a damaged spleen will most likely die in a few days due to the infections. Some common infections a child may get are pneumonia, meningitis, influenza, and hepatitis. Another life threatening complication due to Sickle Cell Anemia is acute chest syndrome. This occurs when there is sickle cells trapped in the lungs which may lead to the patient developing pulmonary arterial hypertension. This is when the lungs are damaged which make it hard for the heart to pump blood through the lungs. This will lead to elevated heart rate and pressure. A complication that is common with children is their delayed growth and puberty. This is caused by the shortage of red blood cells in the body. Young children will grow slower and reach puberty later than normal children. Adults will be thinner and smaller than normal adults. A more serious complication that can arise in adults however, is a stroke. Sickle Cell Anemia can cause both types of strokes in adults: a blood vessel in the brain is blocked or a blood vessel bursts. Both types of strokes lead to learning disabilities, brain damage, paralysis, or even death. Sickle Cell Anemia can also lead to priapism. This is when a male Sickle Cell Anemia patient will have painful unwelcomed erections. This will occur because the sickle cells block the blood flow out of an erect penis. Since sickle cells have a shorted life span, they break down too fast for the body to remove them from the body. When a red blood cell dies, it will release the hemoglobin protein in the form of bilirubin. The bilirubin will form stones in the gallbladder called gallstones. This will cause the patient to feel pain, nausea, vomiting, fever, sweating, chills, clay-colored stools, or jaundice. Jaundice is when the skin color of a patient turns to a yellowish color because of elevated bilirubin level in the blood. A more severe symptom of Sickle Cell Anemia are ulcers or sores that begin as small, raised, crusted sores on the lower third of the leg. Leg sores occur more often in males than in females. These sores usually appear between the ages of 10 and 50. The cause of sickle cell ulcers isnt clear. The number of ulcers can vary from one to many. Some heal quickly, but others persist for years or come back after healing. The last major complication of Sickle Cell Anemia is multiple organ failures. This may be one of the more rare complications but is one of the most dangerous. If too many of your organs fail, then there is a high probability that you will die. Though only a few of the symptoms of Sickle Cell Anemia have been presented, there are many more which can lead to serious damage to the body if gone unattended. Demographics Though Sickle Cell Anemia is a worldwide disease, it is most common in people who come from Africa, South America, Central America, specifically panama, the Caribbean islands, Turkey, Greece, Italy, other Mediterranean countries, India, and Saudi Arabia. Statistically, 1 in every 500 African American births has the sickle cell disease and about 1 in every 1,000 Hispanic Americans have the disease. About 2 million people carry the sickle cell trait in America and about 1 in 12 African Americans carry the trait in America. There have been close to 72,000 cases of Sickle Cell Anemia in America and the prevalence rate in America is 0.10% or 272,000 people. The deaths from Sickle Cell Anemia are close to 500 deaths per year. Diagnosis One way someone can find out if they have Sickle Cell Anemia is by a simple blood test. When a baby is born, he/she will go through a series of newborn screening exams which test for diseases or disorders the baby may have. A blood test will show if the baby has the disease or if he/she has only the trait. Once the tests are conformed by a second test, the baby will be sent to a hematologist who is a specialist in blood diseases and disorders for further guidance. There is also a way for a parent to know if their child will have sickle cell anemia before he/she is born. Doctors do this by taking a sample of amniotic fluid or tissue from the placenta and testing it for sickle cell anemia gene instead of the hemoglobin the gene makes. Treatment Treatment for sickle cell anemia can be divided in to the three categories that were created for the different types of symptoms. The first category was the pain category. To treat the pain caused by sickle cell anemia, pain killers and fluids are used. To treat the pain, fluids and pain killers are used because the fluids will prevent dehydration which is caused by the disease. The pain killers that doctors prescribe can include acetaminophen, nonsteroidal anti-inflammatory drugs, and narcotics which include meperidine, morphine, oxycodone and others. Another drug that doctors use for sickle cell anemia is hydroxyurea. This drug will reduce the number of pain crises the patient experiences. This drug does not treat the pain crises when they occur but prevents them from occurring at all. Also research has found that this drug will reduce organ damage and improve growth of children. The treatment discussed in the next category, symptoms that deal with Anemia, can help treat anemia. The treatment is called blood transfusion and is used to treat severe cases of anemia. Blood transfusion is a procedure where blood is given to the patient by an intravenous line. This is done to replace the dead red blood cells that were a result of the disease. The last category dealt with complications that arise due to sickle cell anemia. One complication that can be treated is an infection. Due to the reduced number of red blood cells, the human immune system is weakened and children will be at risk for harmful infections. One infection that usually kills children is pneumonia. To treat pneumonia, children should take vaccines regularly. Also to treat other infections, antibiotic medicines and blood transfusion may be used. To treat the acute chest syndrome that arises from sickle cell anemia, the patient must get treated with oxygen, blood transfusions, and antibiotics. The main medication for this complication is the same one that reduces the number of pain crises, hydroxyurea. To prevent and treat patients with sickle cell anemia that experience strokes, the patient should get ultrasound scans of their heads. This will allow the doctor measure the blood flow to the brain see if there are any complications due to the sickle cell disease. The ulcers in the leg can be treated with pain killers, cleansing solutions, creams or ointments, and skin grafts (for severe ulcers). And lastly, to treat the gallstones, surgery may be needed to remove them from the gallbladder. Surgery can also be used to help patients that have priapism. Since the discovery of sickle cell anemia, doctors have been working hard to find new treatments for the disease. In recent years, there have been new and experimental treatments that help patients with the disease. One of these treatments is bone marrow transplant. Since the sickle cell anemia affects the red blood cell production, it was thought that replacing the material the produces the cells may help people with the disease. After numerous trials, it has been shown that bone marrow transplant is somewhat of a cure. However, the procedure is very dangerous and lead to serious side effects or even death. Due to this risk, only young patients and people with significant symptoms or problems get the treatment. The procedure is still being researched. Another experimental treatment is gene therapy. Gene therapy is when researchers insert the normal gene for hemoglobin creation into the bone marrow of infected patients. Researchers hope that the normal genes will begin to produce the correct hemoglobin or if they can cancel the sickle cell gene by turning it off in babies. In addition, researchers are producing new drugs that may help patients. On drug has butyric acid in it which can increase the amount of normal hemoglobin in the blood. Another drug has nitric oxide in it which makes the actual sickle cells less sticky which will lead to less blocked blood vessels. The final drug contains decitadine. This will increase the amount of certain hemoglobin protein that carries more oxygen. Though there are many drugs that seem that they will work, there still more research to be done. Research Due to the severity of sickle cell anemia, there are many doctors working hard to find a definitive cure. One research that may help with finding a cure dealt with the prevalence of pulmonary hypertension in adults with sickle cell disease. The research group studied the mechanism of its development, and its prospective prognostic significances. They performed Doppler echocardiographic assessments of pulmonary-artery systolic pressure in 195 consecutive patients (82 men and 113 women with the average age of 36). The pulmonary hypertension was prospectively defined as a tricuspid regurgitant jet velocity of at least 2.5 m per second. Patients were followed for a mean of 18 months, and data were censored at the time of death or loss to follow-up. The group reached the following results. They determined that the Doppler-defined pulmonary hypertension occurred in 32 percent of patients. Multiple logistic-regression analysis, with the use of the dichotomous variable of a tricuspid regurgitant jet velocity of less than 2.5 m per second or 2.5 m per second or more, identified a self-reported history of cardiovascular or renal complications, increased systolic blood pressure, high lactate dehydrogenase levels (a marker of hemolysis), high levels of alkaline phosphatase, and low transferrin levels as significant independent correlates of pulmonary hypertension. The fetal hemoglobin level, white-cell count, and platelet count and the use of hydroxyurea therapy were unrelated to pulmonary hypertension. A tricuspid regurgitant jet velocity of at least 2.5 m per second, as compared with a velocity of less than 2.5 m per second, was strongly associated with an increased risk of death and remained so after adjustment for other possible ri sk factors in a proportional-hazards regression model. They came to the following conclusions. They believed that the pulmonary hypertension, diagnosed by Doppler echocardiography, is common in adults with sickle cell disease. It appears to be a complication of chronic hemolysis, is resistant to hydroxyurea therapy, and confers a high risk of death. Social Impact Though many believe that living with sickle cell anemia is impossible, that is not true. The infected people can live like any other person with just a few deviations. The only negative thing about living with sickle cell anemia is that the life expectancy is between 40 and 60 years old. However a person can live longer if they maintain a healthy lifestyle, control the complications that arise from the disease, and if they learn the correct ways to cope with the pain. A healthy life style means you eat healthy foods or foods that contain certain vitamins that may help your body cope with the disease. An example of a vitamin would be folic acid. Also doctors advise patients to drink plenty of water so he/she wont become dehydrated. To help prevent and control the complications of sickle cell anemia, the patient needs to follow certain instructions and warnings. Some of these instructions and warnings include avoiding decongestants and drugs that tighten blood vessels. Also the patient should avoid living in extreme hot and cold areas or in low oxygen level areas (well above sea level cities). Also doctors recommend that the patient avoid or reduce stress in their life and to avoid jobs that require a lot of physical labor. In addition, the patient should get all of the vaccines and flu shots that are available. Though following doctors recommendations will help a patient, learning and studying different treatments and lifestyle choices on their own can help them a lot. If a patient reads about sickle cell anemia, they will be better equipped to deal with symptoms and complications that may arise. If you or someone in your family has sickle cell anemia, you may want help with the stresses of this lifelong disease. Sickle cell centers and clinics can provide information and counseling. Ask your doctor or the staff at a sickle cell center if there are support groups for families in your area. Talking with others who are facing the same challenges you are can be helpful. Its especially important to find ways to control and cope with pain. Different techniques work for different people, but it might be worth trying heating pads, hot baths, massages or physical therapy. Prayer, family and friends also can be sources of support. If you have a child with sickle cell anemia, learn as much as you c an about the disease and make sure your child gets the best health care possible. A child with sickle cell disease has special needs and requires regular medical care. Your doctor can explain how often to bring your child for medical care and what you can do if he or she becomes ill. Conclusion Sickle cell anemia is a significant disease that must be addressed immediately. The number of people that know about sickle cell anemia is alarmingly low and that must change. People must become aware of the dangers of this disease and must do everything in their power to help prevent it from spreading. This disease can lead to death in infants, children, teens, and adults. It is also a worldwide disorder that needs more attention. This disease, which is genetically passed down to people, needs more people researching it and trying to find cures to. Though there are many doctors hard at work to find a cure, there can be so much more that can be done. Though there is a group of people unaware of this disease, it does not mean the work already done should be neglect. Through the hard work of doctors, we have been able to find almost every symptom of sickle cell anemia and how to treat most of the symptoms. To find a cure for sickle cell anemia, everyone must do their part and help in some way. Hemophilia What is Hemophilia? Hemophilia is a blood disorder that prevents your blood to clot normally. When the body experiences an injury where the person begins to bleed, the body reacts in a very unique manner. Blood is a liquid membrane that is composed red blood cells, white blood cells, and platelets. The purpose of the blood is to transport nutrients and oxygen from the lungs to different areas of the body and to transport carbon dioxide and waste from those areas back to the lungs. Blood also serves as a transport system for white blood cells which are part of the immune system and fighters of the immune system. However, blood also serves as a clotting mechanism. In order for the body to clot an injury, platelets must be able to stick together at the injury site. This stickiness is called the blood clotting factor. Hemophilia is a disorder that causes people to have little to none clotting factor. Hemophilia is usually an inherited disease which does not allow your blood to clot externally or internally. People with hemophilia will have a gene that will cause the clotting factor, a protein, to not work properly which will cause the patient to keep bleeding. The clotting factor is needed to form clots with platelets. Hemophilia can be divided into two major types: hemophilia A or hemophilia B. about 9 out of 10 people who have hemophilia will have type A hemophilia which means the body is missing or has low levels of clotting factor 8. If the person has type B, then they are missing or have low levels of clotting factor 9. In addition, hemophilia is usually genetically acquired but some can develop hemophilia during their lifetime. This can happen if your body forms antibodies (proteins) to the clotting factors in your bloodstream. The antibodies can prevent the clotting factors from working. Causes of Hemophilia A person usually inherits hemophilia but as discussed earlier, they can develop hemophilia during their lifetime. If a disease is inherited, then that means the parents of the patient will also have the gene for the disease. In the case of hemophilia, the gene for hemophilia is located on the X chromosome. Females have two X chromosomes, while males have one X and one Y chromosome. Only the X chromosome carries the genes related to clotting factors. A male who has the abnormal gene on his X chromosome will have hemophilia. A female must have the abnormal gene on both of her X chromosomes to have hemophilia; this is very rare. A female is a carrier of hemophilia if she has the abnormal gene on one of her X chromosomes. Even though she doesnt have the condition, she can pass the gene on to her children. If a father does not have the hemophilia trait but the mother does have only one copy of the gene and they have 2 daughters and 2 sons, then each daughter has a 50 percent chance of inheriting the abnormal gene from her mother and being a carrier. Each son has a 50 percent chance of inheriting the abnormal gene from his mother and having hemophilia. However if the father has hemophilia and the mother has neither hemophilia or the hemophilia trait and they have 2 daughters and 2 sons, then each daughter will inherit the abnormal gene from her father and be a carrier. None of the sons will inherit the abnormal gene from their father, and, therefore, none will have hemophilia. Very rarely, a girl is born with hemophilia. This can happen if her father has hemophilia and her mother is a carrier. In addition to the genes that cause hemophilia, there are other factors that may cause it. One factor is the type of clotting factor that the person is missing. If the person has hemophilia A, then the person lacks clotting factor 8. If the person has hemophilia B, then the person lacks the clotting factor 9. Finally, if the person has Hemophilia C which is rare in the United States, then person has a different inheritance pattern and lacks clotting factor 9. Symptoms of Hemophilia The main symptom of hemophilia is excessive bleeding externally and internally. The extent of bleeding depends on the type and severity of the hemophilia. Children who have mild hemophilia may not have symptoms unless they have excessive bleeding from a dental procedure, an accident, or surgery. In addition, the symptoms of hemophilia vary depending on how deficient your clotting factors are. If levels of your deficient clotting factor are very low, you may experience spontaneous bleeding. If levels of your deficient clotting factor are slightly to moderately low, you may bleed only after surgery or trauma. If you bleed spontaneously then you have the following symptoms: many large or deep bruises, joint pain and swelling caused by internal bleeding, unexplained bleeding or bruising, blood in your urine or stool, and prolonged bleeding from cuts or injuries, or after surgery or tooth extraction. Bleeding in the knees, elbows, or other joints is another common form of internal bleeding in people who have hemophilia. This bleeding can occur without obvious injury. At first, the bleeding causes tightness in the joint with no real pain or any visible signs of bleeding. The joint then becomes swollen, hot to touch, and painful to bend. Swelling continues as bleeding continues. Eventually, movement in the joint is temporarily lost. Pain can be severe. Joint bleeding that isnt quickly treated can permanently damage the joint. Internal bleeding in the brain is a very serious complication of hemophilia that can happen after a simple bump on the head or a more serious injury. The signs and symptoms of bleeding in the brain include long-lasting, painful headaches or neck pain or stiffness or convulsions or seizures. Demographics Hemophilia affects 1 in 5,000 male births. About 400 babies are born with hemophilia each year. The exact number of people living with hemophilia in the United States is not known. Currently, the number of people with hemophilia in the United States is estimated to be about 20,000. In the United States, most people with hemophilia are diagnosed at a very young age. Based on CDC data, the median age at diagnosis is 36 months for people with mild hemophilia, 8 months for those with moderate hemophilia, and 1 month for those with severe hemophilia. In about two thirds of cases, there is a family history of hemophilia. The diagnosis of hemophilia is made using a special blood test and most babies can be tested soon after birth. Sometimes prenatal genetic testing is done to diagnose hemophilia before birth. Treatment Though, like sickle cell anemia, there is no definitive cure for hemophilia, there are many treatments that help people cope with the disease. However, the treatments people get is based on the severity of the disease. However there is main treatment for hemophilia; it is called replacement therapy. In this therapy, the missing clotting factor is injected into the body intravenously to replace the clotting factor. Though this treatment sounds good, there is a drawback, the patient has to continuously take injections of the therapy to prevent bleeding. Antifibrinolytic medicines (including tranexamic acid and aminocaproic acid) may be used with replacement therapy. Theyre usually given as a pill, and they help keep blood clots from breaking down. Another complication to this treatment is that the body may develop antibodies that act against the new clotting factor or there might be damage to joints, muscles, or other parts of the body resulting from delays in treatment. Antibodies can destroy the clotting factor before it has a chance to work. This is a very serious problem. It prevents the main treatment for hemophilia (replacement therapy) from working. Antibodies to clotting factor, also called inhibitors, develop in about 20 percent of people who have severe hemophilia A and 1 percent of people who have hemophilia B. When antibodies develop, doctors may use larger doses of clotting factor or try different clotting factor sources. Sometimes, the antibodies go away. Desmopressin (DDAVP) is a man-made hormone used to treat people who have mild to moderate hemophilia A. DDAVP isn

The Vampire Diaries: The Struggle Chapter Six

Stefan sat in the Gilbert living room, agreeing politely with whatever it was Aunt Judith was saying. The older woman was uncomfortable having him here; you didn't need to be a mind reader to know that. But she was trying, and so Stefan was trying, too. He wanted Elena to be happy. Elena. Even when he wasn't looking at her, he was aware of her more than of anything else in the room. Her living presence beat against his skin like sunlight against closed eyelids. When he actually let himself turn to face her, it was a sweet shock to all his senses. He loved her so much. He never saw her as Katherine any more; he had almost forgotten how much she looked like the dead girl. In any case, there were so many differences. Elena had the same pale gold hair and creamy skin, the same delicate features as Katherine, but there the resemblance ended. Her eyes, looking violet in the firelight just now but normally a blue as dark as lapis lazuli, were neither timid nor childlike as Katherine's had been. On the contrary, they were windows to her soul, which shone like an eager flame behind them. Elena was Elena, and her image had replaced Katherine's gentle ghost in his heart. But her very strength made their love dangerous. He hadn't been able to resist her last week when she'd offered him her blood. Granted, he might have died without it, but it had been far too soon for Elena's own safety. For the hundredth time, his eyes moved over Elena's face, searching for the telltale signs of change. Was that creamy skin a little paler? Was her expression slightly more remote? They would have to be careful from now on. He would have to be more careful. Make sure to feed often, satisfy himself with animals, so he wouldn't be tempted. Never let the need get too strong. Now that he thought of it, he was hungry right now. The dry ache, the burning, was spreading along his upper jaw, whispering through his veins and capillaries. He should be out in the woods – senses alert to catch the slightest crackle of dry twigs, muscles ready for the chase – not here by a fire watching the tracery of pale blue veins in Elena's throat. That slim throat turned as Elena looked at him. â€Å"Do you want to go to that party tonight? We can take Aunt Judith's car,† she said. â€Å"But you ought to stay for dinner first,† said Aunt Judith quickly. â€Å"We can pick up something on the way.† Elena meant they could pick up something for her, Stefan thought. He himself could chew and swallow ordinary food if he had to, though it did him no good, and he had long since lost any taste for it. No, his†¦ appetites†¦ were more particular now, he thought. And if they went to this party, it would mean hours more before he could feed. But he nodded agreement to Elena. â€Å"If you want to,† he said. She did want to; she was set on it. He'd seen that from the beginning. â€Å"All right then, I'd better change.† She glanced through the doorway, to the empty living room, and said, â€Å"It's all right. They're almost healed already. See?† She tugged her lacy collar down, twisting her head to one side. Stefan stared, mesmerized, at the two round marks on the fine-grained skin. They were a very light, translucent burgundy color, like much-watered wine. He set his teeth and forced his eyes away. Looking much longer at that would drive him crazy. â€Å"That wasn't what I meant,† he said brusquely. The shining veil of her hair fell over the marks again, hiding them. â€Å"Oh.† â€Å"Come in!† As they did, walking into the room, conversations stopped. Elena looked at the faces turned toward them, at the curious, furtive eyes and the wary expressions. Not the kind of looks she was used to getting when she made an entrance. It was another student who'd opened the door for them; Alaric Saltzman was nowhere in sight. But Caroline was, seated on a bar stool, which showed off her legs to their best advantage. She gave Elena a mocking look and then made some remark to a boy on her right. He laughed. Elena could feel her smile start to go painful, while a flush crept up toward her face. Then a familiar voice came to her. â€Å"Elena, Stefan! Over here.† Gratefully, she spotted Bonnie sitting with Meredith and Ed Goff on a loveseat in the corner. She and Stefan settled on a large ottoman opposite them, and she heard conversations start to pick up again around the room. By tacit agreement, no one mentioned the awkwardness of Elena and Stefan's arrival. Elena was determined to pretend that everything was as usual. And Bonnie and Meredith were backing her. â€Å"You look great,† said Bonnie warmly. â€Å"I just love that red sweater.† â€Å"She does look nice. Doesn't she, Ed?† said Meredith, and Ed, looking vaguely startled, agreed. â€Å"So your class was invited to this, too,† Elena said to Meredith. â€Å"I thought maybe it was just seventh period.† â€Å"I don't know ifinvited is the word.† replied Meredith dryly. â€Å"Considering that participation is half our grade.† â€Å"Do you think he was serious about that? He couldn't be serious,† put in Ed. â€Å"Ray? Oh, Ray. I don't know, around somewhere, I suppose. There's a lot of people here.† That was true. The Ramsey living room was packed, and from what Elena could see the crowd flowed into the dining room, the front parlor, and probably the kitchen as well. Elbows kept brushing Elena's hair as people circulated behind her. â€Å"What did Saltzman want with you after class?† Stefan was saying. â€Å"Alaric,† Bonnie corrected primly. â€Å"He wants us to call him Alaric. Oh, he was just being nice. He felt awful for making me relive such an agonizing experience. He didn't know exactly how Mr. Tanner died, and he hadn't realized I was so sensitive. Of course, he's incredibly sensitive himself, so he understands what it's like. He's an Aquarius.† â€Å"With a moon rising in pickup lines,† said Meredith under her breath. â€Å"Bonnie you don't believe that garbage, do you? He's a teacher; he shouldn't be trying that out on students.† â€Å"He wasn't trying anything out! He said exactly the same thing to Tyler and Sue Carson. He said we should form a support group for each other or write an essay about that night to get our feelings out. He said teenagers are all very impressionable and he didn't want the tragedy to have a lasting impact on our lives.† â€Å"Oh, brother,† said Ed, and Stefan turned a laugh into a cough. He wasn't amused, though, and his question to Bonnie hadn't been just idle curiosity. Elena could tell; she could feel it radiating from him. Stefan felt about Alaric Saltzman the way that most of the people in this room felt about Stefan. Wary and mistrustful. â€Å"Itwas strange, him acting as if the party was a spontaneous idea in our class,† she said, responding unconsciously to Stefan's unspoken words, â€Å"when obviously it had been planned.† â€Å"What's even stranger is the idea that the school would hire a teacher without telling him how the previous teacher died,† said Stefan. â€Å"Everyone was talking about it; it must have been in the papers.† â€Å"But not all the details,† said Bonnie firmly. â€Å"In fact, there are things the police still haven't let out, because they think it might help them catch the killer. For instance,† she dropped her voice, â€Å"do you know what Mary said? Dr. Feinberg was talking to the guy who did the autopsy, the medical examiner. And he said that there was no blood left in the body at all. Not a drop.† Elena felt an icy wind blow through her, as if she stood once again in the graveyard. She couldn't speak. But Ed said, â€Å"Where'd it go?† â€Å"Well, all over the floor, I suppose,† said Bonnie calmly. â€Å"All over the altar and everything. That's what the police are investigating now. But it's unusual for a corpse not to haveany blood left; usually there's some that settles down on the underside of the body. Postmortem lividity, it's called. It looks like big purple bruises. What's wrong?† â€Å"Your incredible sensitivity has me ready to throw up,† said Meredith in a strangled voice. â€Å"Could we possibly talk about something else?† â€Å"You weren't the one with blood all over you,† Bonnie began, but Stefan interrupted her. â€Å"I don't know,† said Bonnie, and then she brightened. â€Å"That's right, Elena, you said you knew – â€Å" â€Å"Shut up, Bonnie,† said Elena desperately. If there ever were a placenot to discuss this, it was in a crowded room surrounded by people who hated Stefan. Bonnie's eyes widened, and then she nodded, subsiding. Elena could not relax, though. Stefan hadn't killed Mr. Tanner, and yet the same evidence that would lead to Damon could as easily lead to him. Andwould lead to him, because no one but she and Stefan knew of Damon's existence. He was out there, somewhere, in the shadows. Waiting for his next victim. Maybe waiting for Stefan – or for her. â€Å"I'm hot,† she said abruptly. â€Å"I think I'll go see what kinds of refreshmentsAlaric has provided.† Stefan started to rise, but Elena waved him back down. He wouldn't have any use for potato chips and punch. And she wanted to be alone for a few minutes, to be moving instead of sitting, to calm herself. Being with Meredith and Bonnie had given her a false sense of security. Leaving them, she was once again confronted by sidelong glances and suddenly turned backs. This time it made her angry. She moved through the crowd with deliberate insolence, holding any eye she accidentally caught. I'm already notorious, she thought. I might as well be brazen, too. She was hungry. In the Ramsey dining room someone had set up an assortment of finger foods that looked surprisingly good. Elena took a paper plate and dropped a few carrot sticks on it, ignoring the people around the bleached oak table. She wasn't going to speak to them unless they spoke first. She gave her full attention to the refreshments, leaning past people to select cheese wedges and Ritz crackers, reaching in front of them to pluck grapes, ostentatiously looking up and down the whole array to see if there was anything she'd missed. She'd succeeded in riveting everyone's attention, something she knew without raising her eyes. She bit delicately down on a bread stick, holding it between her teeth like a pencil, and turned from the table. â€Å"Mind if I have a bite?† Shock snapped her eyes wide open and froze her breath. Her mind jammed, refusing to acknowledge what was going on, and leaving her helpless, vulnerable, in the face of it. But though rational thought had disappeared, her senses went right on recording mercilessly: dark eyes dominating her field of vision, a whiff of some kind of cologne in her nostrils, two long fingers tilting her chin up. Damon leaned in, and, neatly and precisely, bit off the other end of the bread stick. In that moment, their lips were only inches apart. He was leaning in for a second bite before Elena's wits revived enough to throw her backward, her hand grabbing the bit of crisp bread and tossing it away. He caught it in midair, a virtuoso display of reflex. His eyes were still on hers. Elena got in a breath at last and opened her mouth; she wasn't sure what for. To scream, probably. To warn all these people to run out into the night. Her heart was pounding like a triphammer, her vision blurred. What are you doing here? she thought. The scene around her seemed eerily bright and unnatural. It was like one of those nightmares when everything is ordinary, just like waking life, and then suddenly something grotesque happens. He was going to kill them all. â€Å"Elena? Are you okay?† Sue Carson was talking to her, gripping her shoulder. â€Å"I think she choked on something,† Damon said, releasing Elena's wrist. â€Å"But she's all right now. Why don't you introduce us?† He was going to kill them all†¦ â€Å"Elena, this is Damon, um†¦Ã¢â‚¬  Sue spread an apologetic hand, and Damon finished for her. â€Å"Smith.† He lifted a paper cup toward Elena. â€Å"La vita.† â€Å"What are you doing here?† she whispered. â€Å"He's a college student,† Sue volunteered, when it became apparent that Damon wasn't going to answer. â€Å"From – University of Virginia, was it? William and Mary?† â€Å"Among other places,† Damon said, still looking at Elena. He hadn't glanced at Sue once. â€Å"I like to travel.† The world had snapped into place again around Elena, but it was a chilling world. There were people on every side, watching this exchange with fascination, keeping her from speaking freely. But they were also keeping her safe. For whatever reason, Damon was playing a game, pretending to be one of them. And while the masquerade went on, he wouldn't do anything to her in front of a crowd†¦ she hoped. A game. But he was making up the rules. He was standing here in the Ramseys' dining room playing with her. â€Å"He's just down for a few days,† Sue was continuing helpfully. â€Å"Visiting – friends, did you say? Or relatives?† â€Å"Yes,† said Damon. â€Å"You're lucky to be able to take off whenever you want,† Elena said. She didn't know what was possessing her, to make her try and unmask him. â€Å"Luck has very little to do with it,† said Damon. â€Å"Do you like dancing?† â€Å"What's your major?† He smiled at her. â€Å"American folklore. Did you know, for instance, that a mole on the neck means you'll be wealthy? Do you mind if I check?† â€Å"I mind.† The voice came from behind Elena. It was clear and cold and quiet. Elena had heard Stefan â€Å"But do you matter?† he said. The two of them faced each other under the faintly flickering yellow light of the brass chandelier. Elena was aware of layers of her own thoughts, like a parfait. Everyone's staring; this must be better than the movies†¦ I didn't realize Stefan was taller†¦ There's Bonnie and Meredith wondering what's going on†¦ Stefan's angry but he's still weak, still hurting†¦ If he goes for Damon now, he'll lose†¦ And in front of all these people. Her thoughts came to a clattering halt as everything fell into place. That was what Damon was here for, to make Stefan attack him, apparently unprovoked. No matter what happened after that, he won. If Stefan drove him away, it would just be more proof of Stefan's â€Å"tendency toward violence.† More evidence for Stefan's accusers. And if Stefan lost the fight†¦ It would mean his life, thought Elena. Oh, Stefan, he's so much stronger right now; please don't do it. Don't play into his hands. Hewants to kill you; he's just looking for a chance. She made her limbs move, though they were stiff and awkward as a marionette's. â€Å"Stefan,† she said, taking his cold hand in hers, â€Å"let's go home.† She could feel the tension in his body, like an electric current running underneath his skin. At this moment, he was completely focused on Damon, and the light in his eyes was like fire reflecting off a dagger blade. She didn't recognize him in this mood, didn't know him. He frightened her. â€Å"Stefan,† she said, calling to him as if she were lost in fog and couldn't find him. â€Å"Stefan,please. â€Å" And slowly, slowly, she felt him respond. She heard him breathe and felt his body go off alert, clicking down to some lower energy level. The deadly concentration of his mind was diverted and he looked at her, and saw her. â€Å"All right,† he said softly, looking into her eyes. â€Å"Let's go.† She kept her hands on him as they turned away, one clasping his hand, the other tucked inside his arm. By sheer force of will, she managed not to look over her shoulder as they walked away, but the skin on her back tingled and crawled as if expecting the stab of a knife. Instead, she heard Damon's low ironical voice: â€Å"And have you heard that kissing a red-haired girl cures fever blisters?† And then Bonnie's outrageous, flattered laughter. On the way out, they finally ran into their host. â€Å"Leaving so soon?† Alaric said. â€Å"But I haven't even had a chance to talk to you yet.† He looked both eager and reproachful, like a dog that knows perfectly well it's not going to be taken on a walk but wags anyway. Elena felt worry blossom in her stomach for him and everyone else in the house. She and Stefan were leaving them to Damon. Right now she had enough to do getting Stefan out of here before he changed his mind. â€Å"I'm not feeling very well,† she said as she picked up her purse where it lay by the ottoman. â€Å"Sorry.† She increased the pressure on Stefan's arm. It would take very little to get him to turn back and head for the dining room right now. â€Å"I'm sorry,† said Alaric. â€Å"Good-bye.† They were on the threshold before she saw the little slip of violet paper stuck into the side pocket of her purse. She pulled it out and unfolded it almost by reflex, her mind on other things. There was writing on it, plain and bold and unfamiliar. Just three lines. She read them and felt the world rock. This was too much; she couldn't deal with anything more. â€Å"What is it?† said Stefan. â€Å"Nothing.† She thrust the bit of paper back into the side pocket, pushing it down with her fingers. â€Å"It's nothing, Stefan. Let's get outside.† They stepped out into driving needles of rain.

How to Break a Bad Habit Essay

Research says that 40 percent of our actions are habits not conscious decisions. A Habit is defined as â€Å"a settled or regular tendency or practice, especially one that is hard to give up†. Generally habits are good things; but what about the bad habits- biting your nails, smoking, procrastination, etc.? Habits are learned, therefore they can’t just be deleted, but they can be replaced by more desired behaviors. Many people have habits that they want to break, but they feel like they can’t do it, the idea of it seems impossible or too difficult to challenge. Breaking a habit is easier than it seems. In order to break a bad habit we must first define the habit. What is the behavior you want to stop and why do you want to stop it? Many people are on board the idea of breaking a habit without being sure they really want to make the change and why they want to make the change. Once you recognize the habit you want to stop and the reason as to why you want/ need to stop it you then need to identify what triggers this habit. Many habits are habitual behaviors that have evolved because they have been rewarded in some way. Most bad habits come out as a way of dealing with situations that may cause stress, anger, boredom, etc. For example, many people who smoke look at it as a stress reliever. In order to break a habit it is important to identify what triggers the habit. What is the cue that sets you off? Is it a time a day, a memory, an emotion? Ask yourself â€Å"do I do this habit whenever blank occurs?† Once you are able to define whether it is a situational or emotional context that triggers the habit you are better able to find ways to break the habit and develop another healthier way of achieving the same reward. Next we need to identify the reinforcement and replace it with something that gives you the same satisfaction. What are you really getting out of this action/habit? This can be a really difficult step. By smoking you can get unhealthy skin, the risk of lung cancer, brown teeth, but it relieves your stress and so it’s justifiable, right? What can you do that is better for yo u and will give you the same satisfaction? For example you smoke because for you it relieves stress after you smoke you feel a sense relieve. What else gives you a sense of relief? Go to the gym, listen to music, chew gum, or cook. Visualize your success, in your mind practice breaking the habit by imagining yourself engaging in the desired  behaviors rather than the old ones. For example, if your goal is to eat better than visualize yourself in the kitchen preparing health meals. Visualize that in a short period of time you will lose the 10 pounds you’re trying to lose. Remember it is okay to think about the habit you’re trying to break, just remember to visualize and remind yourself of the outcome from breaking this bad habit. Support is very important when breaking a habit. When trying to break a habit tell supportive people about your plan, it’s a great feeling to have support and encouragement. Invite friends to call you out when you slip up and there be consequences. An example of this would be if you’re trying to stop cursing; keep a swear jar and every time you slip up you have to put a dollar or an amount you would hate to give up into your husband/wife/support jar as well as your own jar. Stick to this whenever you slip up. Eventually you’ll become more cautious of the things you’re saying because you’ll get tired of paying up. Habits are created when a behavior is rewarded in some way as I mentioned earlier. With that being said find a way to reward yourself for good behavior. For example, if you’re trying to break the habit of being late to class, you can reward yourself with something you like, like a caramel flan latte from Starbucks that you love so much every day that you’re on time to class, until the reward is no longer needed. However, the most successful reward will be the one that comes after that breaking that habit. Lastly, when breaking a bad habit, be patient. Behavioral training is a long process, and breaking a habit take time. Studies show that in most cases it takes 28 days to break a habit. However, reality is a lot more complicated and it progress depends on the individual and the habit. The first few days will be the hardest, but it important to stay focused and think about the outcome. There will be times when you want to give up there may even be times when you slip up but you must continue to push. Remember to you can do it!

Government Of The People By Abraham Lincoln - 1330 Words

INTRO Democracy is eloquently described by Abraham Lincoln as government of the people, by the people, for the people . The quote by Lincoln though, is perhaps the most straightforward, compelling explanation ensuring that even the laymen understand the fundamentals of the term. The subject matter that is required in this essay is to determine differences in the quality of democracy. This is regarded as the dependant variable, which is the outcome that needs explanation. This can be explained using the independent variables, the economic factors and cultural factors which will be used to explain the phenomena of the dependant variable. 3 countries will be looked at in this essay to explain the given theories. The countries are Tunisia, Algeria and Libya. All 3 countries have been picked having many similarities but when it comes to the quality of democracy, they vary. All 3 countries are vastly Muslim, they border each other and they are all situated in the north Africa. However the Pol ity score of each country differs with Tunisia Algeria and Libya scoring 7, 2 and 0 respectively. Libya s polity score was taken that of 2014. In measuring the difference in quality of democracy it needs to be ensured that the countries are as similar as possible therefore enabling the difference in the quality of democracy distinguishable. MEASURE OF DV(POLITY) THEORY The first of the independent variable ,focuses on economic factors. According to Lipset() there needs to be aShow MoreRelatedAbraham Lincolns Diction In The Gettysburg Address1054 Words   |  5 PagesThe United States was in a Civil War. The President at the time, Abraham Lincoln, did all he could to lead the union to victory. With the Civil War being the deadliest war that the United States had ever been a part of, as Commander-In-Chief, Lincoln had to convince his soldiers to persevere and claim victory to save the nation. 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