Saliva: Functions, Composition and Chemistry

Saliva: Functions, Composition and Chemistry 1-3 Saliva 1-3-1 Secretion and function; The components of saliva essentialy are produced by acinar cells. Saliva is the main product of the salivary glands. It is an acidic, clear, slightly mucoserous exocrine fluid forming a complex mixture of secretions from major and minor salivary glands and gingival crevicular fluid (Humphrey and Williamson, 2001; Kaufman and Lamster, 2002). This mixture of fluids derived from different salivary glands is termed ‘‘whole saliva’’, while the fluid which is secreted by single glands is called ‘‘duct saliva’’ (Edgar, 1992). The constant flow of saliva from the mouth into the gut has a protective action. This flushing effect push, for example, food debris and exogenous and possibly noxious substances into the gut (Tenovuo, 1998). Saliva is an organic fluid that can indicate local and systemic alterations, such that the components of saliva can be related to the immunologic, hormonal, neurologic, metabolic and nutritional state of the individual (Carlson, 2000). Saliva is derived from many types of salivary glands. Each type of salivary gland secretes saliva with composition ,characteristics and properties. The secretions from these different glands have been shown to be different considerably, to be affected by different forms of stimulation and to be complex in composition, time of day, age, diet ,gender, several pharmacological agents and a variety of disease states (Forde et al., 2006; Wong, 2007). 1-3-2 Salivary Composition Saliva is a clear, slightly acidic (pH 6-7) liquid; it consist of: Inorganic components The highest and abundant component in saliva is water (approximately 99%), followed by ions H2PO4–, F–, Na+, Cl– Ca2+, K+, HCO3–,I–, Mg2+, thiocyanate. The ionic composition of saliva is different from the plasma that derived from it. (Humphrey and Williamson, 2001). The hypotonicity hydrates various organic compounds that form a protective coating on the oral mucosa and facilitates taste sensitivity. Resultant bicarbonate act as a buffering agent, also calcium and phosphate neutralize acids that would otherwise inhibit tooth mineral integrity (Humphrey and Williamson, 2001; Van Nieuw Amerongen et al., 2004). Organic components Saliva includes a huge number of organic compounds such as: glucose, cholesterol, urea, uric acid, , fatty acids, mono–, di–, and triglycerides, phosphor and neutral lipids, steroid hormones, glycolipids, amino acids, ammonia and proteins that aid in the protection of oral cavity tissues, including mucins, amylases, agglutinins, glycoproteins, lysozymes, peroxidases, lactoferrin and secretory IgA. It also includes of non-immune factors include cystatins, mucin G1 and G2, lactoferrin, lysozyme, defensins, myeloperoxidase and histatins, (Hicks et al., 2004; Kavanagh and Dowd, 2004; De Smet and Contreras, 2005; Dodds et al., 2005). In addition, these macromolecules form tooth enamel pellicle and a viscoelastic mucosal coat and and cleanse and aggregate debris and bacteria from the oral cavity (Heramia, 2002). Saliva contains growth factors and a variety of antimicrobial constituents (Shugars and Wahl, 1998).There is a strong relationship between functions-constituents of saliva and a number of salivary proteins participate in more than one function. Function of saliva are: mastication, digestion, deglutition, defense (spiting and oxidative stress), protective (antifungal, antibacterial, antiviral activity, lubricant and buffering agent), drug testing, water balance, excretion, chemical communication (kissing or infant salivating) ,speaking, denture retention, tasting, (Greabu, 2001; Battino et al., 2002; Pesce and Spitalnik, 2007; Wong, 2007; Zimmermenn et al., 2007). There is a fact that saliva has been used as diagnostic fluid for more than two thousand years. Ancient doctors of traditional Chinese medicine h ave suggested that blood and saliva are ‘brothers’ in the body and they come from the same origin. It is believed that salivary changes are indicative of the wellness of the patient. Saliva offers some distinctive advantages (Tabak, 2001; Kaufman and Lamster, 2002; Forde et al., 2006; Koka et al., 2006; Pesce and Spitalnik, 2007). Smaller sample aliquots, the possibility of a dynamic study, stress free, greater sensitivity, easy collection procedure and non- invasive, a good cooperation with patients, the possibility to collection somewhere and anywhere, not a trained technician and no special equipment are needed for collection, correlation with levels in blood, potentially valuable for older adults and children , could eliminate the potential risk of contracting infectious disease for both a technician and the patient, more accurate than blood for detection of many oral and systemic diseases, may provide a cost-effective approach for the screening of large populations. Advances in the use of saliva as a diagnostic fluid have been affected by current technological developments: enzyme-linked fluorescence technique, Western blot assays, polymerase chain reaction (PCR). Saliva is one of the most important host factors that play a role in prevention of the caries process through its inorganic and organic constituents, besides the physiological functions. The continuous flow of saliva through the mouth removes cariogenic challenges and bathes the dentition with remineralizing ions (Edgar et al., 2005; Fejerskov and Kidd, 2008; Guy, 2012). For that reason saliva plays an important role in the equilibrium between the demineralization and the remineralization of enamel (Choi, 2010). 1-3-3 Diagnostic uses of saliva Saliva is critical for maintaining and preserving the health of oral tissues and has been used to eliminate of many drugs and as a source of non-invasive investigation of metabolism . However, it receives little attention until its quantity diminishes or its quality becomes altered (Axelsson, 2000; Humphrey and Williamson, 2001; Tabak, 2001; Malamud, 2006). At present, saliva represents an increasingly useful auxiliary means of diagnosis (Malamud, 2006). Many researchers have made use of sialochemistry and sialometry to monitoring general health, diagnose systemic illnesses and as an indicator of risk for diseases creating a close relation between systemic and oral health (Gonzà ¡lez and Sà ¡nches, 2003). Recently , saliva has gained attention as an important diagnostic fluid just as for blood and urine. It is now obviuos that saliva contains the same of many biomolecules that are commonly measured in other body fluids. As an example, approximately, 30% of the proteins which found in saliva are also found in blood improving the diagnostic potential of saliva. Saliva tests give us an advantages and preferable in comparison to blood tests due to simple collection being inexpensiv, noninvasive, simple, and with minimal risk of contracting infectious organisms such as HCV, HPV and HIV by the healthcare professional. In addition saliva is an ideal biofluid for children because of no compliances (Pfaffe et al., 2011). Saliva is a plasma ultra filtrate and contains proteins either derived from blood or synthesized in situ in the salivary glands. It contains biomarkers derived from gingival crevicular fluid, mucosal transudate and serum,. Saliva is produced in the acinar cells and acinar cells are connected to the vasculature which enables molecular transportation from blood into saliva. Salivary components may originate entirely from the salivary glands or may be derived from the blood by active transport or passive diffusion (Aps and Martens, 2005). To date, researchers have identified 2, 340 proteins in saliva (Bandhakavi et al., 2009; Schulz and Cooper, 2012). Saliva resembles the plasma proteome in amanner that proteome has a large dynamic range and it is essential to suppress this dynamic range in order to enable low abundant proteins of diagnostic potential. 1-4 Smoking and changes in saliva that can be used diagnostically: It has been known for long time that thiocyanate level are increased in the saliva of smokers and still used as a biomarker of smoking activity (tsuge et al., 2000). Because of thiocyanate is a product present in tobacco smoke, it is also measures the exposure to passive smoking (Ferguson, 1998). Determining the concentration of nicotine and cotinine in biological fluids is widely used in both clinical and epidemiological smoking studies (Hatsukami et al., 2003). Both nicotine and cotinine concentrations are used to measure tobacco consumption, to validate abstinence in smoking cessation programmes and to determine exposure to environmental smoke (Hatsukami et al., 2003). Nicotine, when smoked in cigarettes is absorbed across nasal and buccal membranes. The drug has a rapid onset of action with a half-life of 2 h and can be detected in saliva, urine and blood (Hatsukami et al., 2003). As nicotine is present mainly in the non-ionised form in alkaline pH and it is a weak base (pKa of 8.0), and hence more easily absorbed with increased levels of pH (Ciolino et al., 2001). Thus, salivary pH changes will affect the amount of nicotine that is absorbed across the buccal mucosa (Zevin et al., 1998). Cotinine, the main metabolite of nicotine, is used widely for estimating exposure to nicotine. This pharmacologically inactive compound has a half-life of 20 h (15 40 h), is slowly cleared from the body and it is important to know that Cotinine is specific to tobacco (Hatsukami et al., 2003; Patterson et al., 2003). Urinary levels of cotinine have been shown to be quite variable, because of the differences in nicotine metabolism among individuals (Yang et al., 2001). Generally, cotinine levels depend of degree of exposure to ETS. increased cotinine levels were predictors of an Increased number of cigarettes smoked at home (Mannino et al., 2001). The study in adolescents in Tenerife established correlation between the degree of ETS exposure and cotinine levels in saliva . The highest values noticed in active smokers who smoked at least more than ten cigarettes daily, was 341.1 ng/mL. The smokers who smoked fewer number cigarettes, average value of cotinine was 142.7 ng/mL, while in passive smokers it was 4.2 ng/mL. In the same study, it is established that persistent cough , bronhospasm as well as infections of lower respiratory tract, are more frequent in adolescents with higher concentrations of cotinine (Suarez, 2001). 1-4-1 Amylases: Salivary ÃŽ ±-amylase is the first enzyme in the gastrointestinal tract for extracting caloric value from food. However, beyond the primary role of ÃŽ ±-amylase to begin digestion of sugars, carbohydrates and complex starches,. salivary ÃŽ ±-amylase is known be a important marker of stress. It has also been found that salivary ÃŽ ±-amylase may be influenced by psychological and behavioral factors and processes (Kivlighan, 2006). Human salivary amylase hydrolyses ct-I- 4 glycoside bonds in starch, yelding maltotriose, maltose, glucose and dextrins as final products. In spite of and having similar composition and immunological activity and playing the same role as pancreatic amylase (Liang et al., 1999), these enzymes have different molecular weights, catalytic properties and isoelectric points, (Liang et al., 1999). Salivary amylase exists in two families: family A is glycosylated while family B is nonglycosylated. At least six izoenzymes have been recognized (Liang et al., 1999). Although playing an important role in the initial digestion of starch (Tseng et at., 1999), the importance of salivary amylase in digestion has been shown to be minor compared to pancreatic, as people who lack it jul to show any digestive perturbations. However, salivary amylase has many important intra-oral functions such as participation in ACDP, modulation of intra-oral microflora and affimity for hydroxyapatite, (Scannapieco et al., 1995; Gong et al., 2000). The catalytic activity of salivary amylase also participate in degradation of sticky starch rich foods which are retained in dental surfaces and theft transformation in slow glucose releasing devices which may play quite a role in dental caries pathogenesis (Tseng et al., 1999). It has been suggested that amylase represent between 40 to 50% of the total protein produced by salivary gland, most of the enzyme being synthesized in the parotid gland (Noble, 2000). Human submandibular saliva and parotid saliva contain about 45 mg and 30 mg of amylase, respectively, per 100 mg of protein However, it has also been suggested that amylase makes up about 1/3 of the total protein content in parotid saliva, and the content would be lower in whole saliva (Pedersen et al., 2002). The concentration of amylase increases with the increase of salivary flow rate, and it is generally considered to be a reliable marker of serous cell function (Almstà ¥hl et al., 2001). Amylase is also present in human acquired pellicle in vivo (Yao et al., 2001). Fasting has been found to decrease whole saliva amylase levels and activity (Mà ¤kinen, 1989). The amylase concentrations has been found to be reduced in radiation-induced hyposalivation (Almstà ¥hl et al., 2001). During chewing, some starch is hydrolyzed into dextrins and glucose by salivary ÃŽ ±-amylase but the degree of hydrolysis ranges considerably (1 to 27%) depending on the type of food (Woolnough et al., 2010). variation in human salivary ÃŽ ±-amylase activity has been reported, with values ranging between 50 and 400 U.mL-1 60 (Kivela et al., 1997; Mandel et al., 2010). An indirect measure of ÃŽ ±-amylase activity, which is particularly relevant to food application (Gonzalez et al., 2002), can be obtained by measuring the decrease in viscosity of starch pastes with the addition of ÃŽ ±-amylase (Collado Corke, 1999). This assay has been used to study the relationship between sensory analysis of starch thickness perception, ÃŽ ±-amylase activity, starch paste and mechanical properties (Evans et al., 1986; de Wijk et al., 2004; Mandel et al., 2010). Furthermore, the effect of decreased starch viscosity (due to ÃŽ ±-amylase activity) affects saltiness perception (Ferry et al., 2006) and aroma release (Ferry et al., 2004; Tietz et al., 2008). Amylomaltase-treated starches were found to be particularly good fat substitutes in yoghurts and a loss of instrumentally-measured firmness thats because ÃŽ ±-amylase was reported in those systems (Alting et al., 2009). It is therefore accepted that ÃŽ ±-amylase has a significant 70 impact on a number of critical starch attributes during eating (Engelen Van Der Bilt, 2008), thickness perception being the main one. In literature reviews, there appeared to be a great variation in sensory analysis of thickness perception for the same starch-thickened food system which could be due to the natural variation of ÃŽ ±-amylase activity between donors. Recently, ÃŽ ±-amylase concentration variations in saliva has been linked to genetic differences (Mandel et al., 2010) and this was suggested as an explanation for the natural variation observed in thickness perception of starch-thickene systems. Moreover, sAA levels are influenced by numerous factors which may lead to variability among individual, thus again undermining the accuracy of sAA as a biomarker for fatigue. For instance, studies have shown that cigarette smoking decreases basal ÃŽ ±-amylase activity in saliva and that people who chronically drink alcohol have decreased levels of amylase (Rohleder and Nater, 2009). Activity of amylase was decreased in passive smokers compared to healthy group (Rezaei and Sariri 2011). Similar results have been reported by Granger et al who found lower salivary amylase activity for mothers, not for infants as a result of tobacco smoking exposure (Granger et al., 2007). The results showed also a decrease in salivary amylase smokers as compared to non-smokers were recorded by (Sariri et al., 2008). It was explained that inhibition of salivary amylase by cigarette smoke may be caused by the interaction between SH groups of the enzyme moleculesand smoke aldehydes. Moreover, the percentage of the enzymatic inhibition showed a negative correlation with the basal level of salivary reduced gluthation (GSH). Regular exposure of passive smokers to cigarette smoke may accumulate in their saliva a smoke aldehydes leading to their interaction with –SH group of amylase. Another study by Greabu et al. Concluded that exposure to cigarette smoke caused a significant decrease in salivary uric acid and amylase. (Greabu et al., 2007). 1-4-2 Proteins: Human whole saliva has a protein content of about 0.5 to 3 mg/mL, and parotid saliva has a protein content of about 0.4 to 4 mg/mL, while sublingual and submandiblar saliva of about 0.6 to 1.5 mg/mL. The protein concentration is independent from the flow rateand is rather stable, Besides maintaining buffer capacity and osmolarity, salivary proteins are also involved in several specific functions. The number of distinct salivary proteins is roughly between 100 and 140 (Wilmarth et al., 2004; Yao et al., 2003), from which 30.40 % are produced by the salivary glands, whereas other proteins are originated from serum, from mucosal and/or immune cells, or from microorganisms (Wilmarth et al., 2004). The most important proteins of glandular origin are alpha-amylase, glycoproteins with blood-group substances, cystatins, epidermal growth factor (EGF), gustin, histatins (HRPs), lactoferrine, lysozyme, mucins, salivary peroxi dase, proline-rich proteins (PRPs) and statherin. The most important serum derived proteins are albumin, alpha1-antitrypsin, blood-clotting factors (VIII; IXa; XI) and members of the fibri- nolytic system (proactivators, traces of plasminogen activator). Most important proteins that originate from immune cells are myeloperoxidase, calprotectin (Ca2+ binding L1 leukocyte pro- tein), cathepsin G, defensins, elastase, immunoglobulins (90% to 98% sIgA, 1% to 10% IgG, a few IgM, IgD, IgE). Finally, the most important protein constituents of microbial (unknown) or mixed origin are fibronectin, alpha2-macroglobulin, , DNases, RNases, kallikrein, streptococcal inhibitor, secretory leukocyte protease inhibitor (SLPI), , molecular chaperone (Hsp70), and cystein peptidases. (Data are summarized in Table 1-2). The most important proteins involved in oral ecosystem maintenance are, lysozyme, agglutinins and histidine , lactoferrin, peroxidases, proline-rich proteins, as well as secretory immunoglobulin A and immunoglobulins G and M (Lià ©bana et al., 2002), Moreover, saliva contains a many types of proteins and some of them might have protective properties. Additionaly, proteins can protect the tooth structure by the formation of a salivary pellicle when tooth are exposed to saliva (Siqueira et al., 2007). This pellicle may act as a barrier for acids (Dawes, 2008). In hyposalivation, caries process and erosive wear are phenomena that occur simultaneously (Lajer et al., 2009). With respect to the development of caries it was proposed that the salivary pellicle derived from whole saliva has a preventive role (Featherstone et al., 1993). Concentration of salivary total protein did not show considerable variation in passive smokers compared to control (Rezaei and Sariri2011). A similar result was obtained for salivary protein concentration in school children with smoker parents (Granger, 2007).

Religious Language and Concepts in Romeo and Juliet

Religious Language and Concepts in Romeo and Juliet The epistle of Saint John unequivocally states, â€Å"Love comes from God† (1 John 4:7). This statement not only explains the source of love but it also provides a means to understand both love and God. If love is from God, then an understanding of love can be derived from knowing God. Thus, the converse, knowing love provides a level of knowledge concerning God, is true. In light of this conclusion, it only seems natural that the two should intersect when trying to describe one another. William Shakespeare employs Christian language and concepts in the play Romeo and Juliet to not only effectively conveys the gravity of love but also to provide metaphorical undertones to the play’s conclusion. It is apparent that Shakespeare intentionally used religious language and concepts in order to elicit the implications that are attached with the words. By glossing over these words as two-dimensional adjectives much of Shakespeare’s beauty and genius is lost and the intrinsic harmony connecting love and God is unknown to the reader. The play Romeo and Juliet is steeped in religious language and constructions. The possible examples are numerous and wide ranging, but some are used to convey love while others are used to drive the thematic plot. For organizational purposes, the usages of religious language that help convey the meaning of love will be addressed first followed by an explication of the thematic usages or religious language. An excellent example of how Shakespeare implements religious language and concepts in order to describe the transcendent emotion of Love is in Romeo and Juliet’s first meeting. While courting Juliet, Romeo says, â€Å"My lips, two blushing pilgrims, ready stand, To smooth that rough touch with a tender kiss. † (1:5:97-98) Prior to this statement Romeo had equated Juliet with a holy shrine and he then employs the religious concept of pilgrimage in the following lines. On a very surface level, this makes sense considering that a holy shrine is an end goal and pilgrims, like lips moving in for a kiss, travel to the end goal. However, it seems rather evident that Shakespeare meant much more than simply making a comparison for movement in this statement. The term pilgrim calls to mind the departure from a known place into an unknown, holy land for the sake of obtaining salvation. By using ‘pilgrim’ to describe the kiss shared between the two lovers implies that Romeo and Juliet are going to depart from their current love-starved world and move into a holy world of love. Another example of where Shakespeare implements religious language is when Romeo says, â€Å"I take thee at thy word: Call me but love, and I’ll be new baptized; henceforth I never will be Romeo. (2:2:49-51) Again, as in the previous statement, Shakespeare implemented religious language in order to describe how love is a transcendent and unearthly entity. In the realm of Christianity, Baptism is the sacramental shedding of earthly imperfections and wedding of the soul to Heaven’s dominion. Romeo’s statement uses the word and concept of baptism to express that by being called Juliet’s lover, Romeo would shed his earthly self an d enter the world of love where his name would no longer matter. Both of these statements allow Shakespeare to describe the transcendence of love, and logically the only way to describe the transcendence of love is by implementing religious words and concepts that are themselves transcendent. It is rather evident why Shakespeare employed religious language instead of using secular or earthly language and concepts. As stated previously, both love and God are entities that find their origin outside of earthly confines. The fact that both love and God manifest themselves on earth creates a dilemma when one attempts to describe their essence. Trying to describe God or love with words that are limited to earth’s confines is similar to the proverbial square peg in a round hole. This is why it would not be conducive for Shakespeare to describe love with secular or earthly words. The inadequate secular language would lose much of love’s weight and Shakespeare’s genius would be repressed. Shakespeare’s usage of religious language not only allows for better description of love itself but Shakespeare also uses it as a vehicle for metaphor. The central message of Christianity is the redemptive sacrifice of the ‘unblemished lamb’, Jesus Christ, known as the Gospel. When Romeo kisses Juliet and says, â€Å"Thus from my lips, by yours, my sins are purged. † (1:5:109) The purging of sins inevitably draws up thoughts about the Gospel within the reader’s mind and although the metaphor is not brought to denouement within just this one line, the groundwork is set out. Later in the play, Juliet says in regards to performing her mock-death, â€Å"Things that, to hear them told, have made me tremble; And I will do it with out fear or doubt, To live an unstained wife to my sweet love. † (4:1:86-88) This line again is drenched in Gospel metaphor. The word ‘unstained’ is a queue for the reader that this line is not merely a secular, two-dimensional statement and with this in mind, Juliet seems to share much of Jesus Christ’s emotions in the biblical account of Him praying in the Garden of Gethsemane. Both Jesus and Juliet are apprehensive of their looming deaths, both admit that they are afraid, and both choose to confront their fears with confidence. With both this line and the previously stated line it is relatively clear that Shakespeare created certain parallels between Juliet and Jesus Christ. These parallels come to an ultimate conclusion at the play’s conclusion. At the end of scene five, when both Romeo and Juliet are dead, it becomes evident that Shakespeare’s metaphor of Christ has come to conclusion. After both of the families realize that their respective children are dead they give up their long held resentment towards each other. This reconciliation seems to echo the reconciliation found after Jesus Christ’s death. Obviously, in no way is Juliet an airtight allegory for the Gospel. However, these statements and constructions are undeniable in their intentional resemblance to Christ and the Gospel story. Shakespeare manipulating his plot to facilitate the Gospel metaphor implies that he felt strongly about the need to use God to describe love. Jesus Christ came from heaven and through His death brought salvation for the sinful world. Juliet embodied love and through her death brought reconciliation to the town of Verona. Shakespeare, through his metaphors, is attempting to convey a very weighty assessment on love. The metaphor conveys that love is not of this world but instead from God and thus to know either God or love is to know something of both. It also suggests that love has a very real salvation within it, the ability to reconcile relationships and transcend earthly pettiness. It seems ironic that despite the fact that God created the world, worldly terms fall short of describing His essence. Likewise, it is equally ironic that love, an entity that seemingly controls the vast majority of all human interactions in one way or another, is not readily described by commonplace terms. Juxtaposing these two ironies makes it evident as to why William Shakespeare implemented religious terminology and metaphors in order to fully convey the essence of love. Romeo and Juliet were undoubtedly in love with each other and it is fitting that their holy love could not be constrained by either the unholy confines of Verona or of secular diction.

Dissertation Writing Essay

A dissertation basically refers to a treatise that is stating a certain academic position; it is a lengthy study backed by intensive research with an aim of making a vital contribution to a specific field of study or topic. The key to writing an excellent dissertation lies in conducting an extensive and rigorous research. There are a number of requirements that have to be put into consideration if a research project is to be successful. A research project is meant to contribute to an existing body of knowledge and not in any way be applied for any individual’s self-enlightment. It should not be conducted for the sole purpose of comparing data or show the existing differences or relationship between any two set pf data Finally the question; to be tackled should not be limited to either yes or no answers. A yes or no answer will not contribute to the studies as per the core of the dissertation. The knowledge gathered in research project should be geared towards providing important insights about the topic or the research problem (S. Joseph l. 2007) I have a lot of interest in health studies and have in the past engaged in a lot of research on the various aspects and problems affecting the human body and the solutions to such problems. The past researches have seen me contribute to the existing body of knowledge and were in no way meant for self-enlightment. The nature of the research problem: â€Å"Evaluation and management of patient with cardio-Pulmonary diseases† is itself an indicator that the solutions will not be found by comparing any set of data or show any inter-relationships or differences existing between that data. The research aims at looking at the ways to provide effective management of cardio- pulmonary diseases in an effort to fill any existing gaps. Many researches have been conducted but have not been comprehensive and may have left certain gaps. This will be the sole drive of this dissertation. Question 3 Cardiopulmonary disease refers to diseases that inhibit the function-ability of the heart and the lungs. These diseases can have a long time impact on a person physical and mental well standing. Randie A, et al, 1999). A large proportion of the population continues to search for ways to enable them cope with heart ailments and complications. These complications are among the most of the highest killers. Many more are at a higher risk of getting cardio-pulmonary diseases as time passes by, especially as they advance in age. Management of these ailments involves astronomical costs raging from hospitalization and medical costs. The government, individuals, and the employees feel these costs. This cost is in terms of the direct costs in addition to disability expenses. (www. cardiumhealth. com) A lot of research has been conducted in this aspect. This research seeks to explore further this topic. It will focus at filling the gaps that have been left by the prior researchers. Management of many health complications and issues need to be not only cost efficient but also meant to endure that hope and effective care is given to the patients. It should be geared towards ensuring that the patients are healthy and remain productive. Hence the research problem would aim at looking at ways through which management of patients with cardiopulmonary disease can be done cost effectively. It aims to provide more information towards how this can be achieved as well as evaluating the existing patient management methods and (criteria) and how they can be improved to meet this objective. Questions 2 The problem statement for the dissertation topic is:† Ensuring cost effective evaluation and management of patients with cardiopulmonary diseases. Cost effectiveness refers to provision of certain services or goods with the minimum possible costs. It is not meant rather to compromise the quality of those services. Management of any disease is a costly affair and takes toll on those all involved. There are many ways through which these diseases can be managed but they involve high costs that are increasingly becoming hard to meet as the ailments become more prevalent in the population. The nature of care and health needs for an individual patient would vary depending on the level of recovery. Some may be acute while others are outpatient. Specific demands of the individuals would mean specific cost levels (NYU Medical Centre, 2007). The costs would vary from nursing, therapy, counseling alongside many others. Management of cardiopulmonary disease would involve coming up with ways through which the patients would access self-care, proper medication, and information on proper nutrition and a healthier lifestyle (www. vnsny. org). A research conducted in this line would provide vital information on how the above activities would be provided cost effectively. It would be able to address more on a topic that has overtime been widely tackled but has failed to provide a definite solution, not just in heart and lungs complications but also on other health complications as many revolve around the same key issues. Again this research recognizes the need of quality care and hence will not seek at reaching a method that compromises the quality of health care to reduce on costs. If properly conducted it will provide answers and save on costs associated with management of these diseases. The reviewed research problem statement for the dissertation would be: â€Å"Ways for coming up with cost effective ways of evaluating and managing patients with cardio-pulmonary diseases. † The initial problem statement is not grammatically correct and could not make a lot of sense on its own. The statement starts with a continuous verb- â€Å"ensuring†, this is not understandable at a first glance. The statement as it stands does not offer a reader enough clues as to what the research is going to focus on, it is not clear what is the appropriate link between cost effectiveness and cardio-pulmonary diseases. A good research statement should be able to provide a sense of inter-relationship between the problem and the dissertation topic. It fails also to provide a limit or the point of focus that the research is to take. A research problem statement should provide a clear guidance on the content of the research or the study. It should have clear demarcated limits of the research. It should provide a specific scope to guide the research on what is to be tackled and what is to be left out. The initial problem statement is too general and is confusing to a reader. A researcher might be misguided to focus on the different ways of managing patients with cardio-pulmonary diseases and fail to come up with the best cost effective methods for these diseases management. A good statement hence should be one that points out clearly what is expected of the research in a manner that is devoid of any ambiguities. It should be all comprehensive and not meant to confuse the reader on what specifically it is aiming to investigate by giving a general idea of the objective and the purpose of the study. The edited version of the research answer will provide the solutions the study is looking for. Looking at it will give a clear and informative idea of what the paper will entail, it gives a limit and the scope, which the researcher will follow. It will limit the researcher to the best and the most cost effective way of evaluating and managing cardiopulmonary diseases with no room for irrelevancy (web. mit. edu) The way the statement has been framed ensures that the researcher comes with the necessary answers to the arising questions. It has no room for a yes or no answer or any need to make comparisons. The solutions will be elaborative and seeking to give the specific methods for cost efficiency. In tackling this research problem, the researcher will have to conduct intense research, gathering of data and relevant information. It will include the use of case studies, questionnaires, and interviews among other data collection strategies. The researcher will have to interview experts in the health field as well as the patients to get a grasp of the situation at hand. This will take time. It will also require a high allocation of financial resources to cater for all those requirements. A critical analysis of this research problem leaves no doubt in my mind that this is exactly what I would wish to investigate. I wish to scrutinize the ways that can be used to bring cost efficiency in patient’s management. For further analysis of the appropriateness of the research problem, I showed it to my colleagues in class for their review. Opinion was that the research problem statement requires more revision to ensure that it captures all aspects of the existing research problem and what the research seeks to tackle.  The revised problem statement would be: â€Å"What would it take to ensure cost efficiency in evaluation and management of patients with cardiopulmonary diseases? † Developing the dissertation topic or title is one of the most laborious tasks. List of research topics should be made in the bid to evaluate and choose the best and the most striking title. (www. unc. edu). An evaluation of the above checklist will provide a useful insight for arriving and developing the best dissertation topic. In choosing dissertation topic, it is imperative that one analyses what he/she is best at. It would be a plus to research a topic that you are well versed with its major concepts and that you have a lot of interest in to avoid generalization (www. c. s. purdue. edu). The fact that a research is not conducted for a persons own self interest does not mean that one should not pick a topic that he/she has interest in, what it means is that the researcher should not use that opportunity to satisfy his personal curiosities but rather should aim at researching for knowledge’s sake. In selecting this dissertation topic it is important that I ensure that the topic I have chosen is appropriate to my studies, it should be appropriate to the subject at hand. The topic should not be very wide as not to be manageable due to the possible time constraints. I will also have to put into consideration my instructors interest, it should be a topic that they will approve of and something they believe is within my scope of studies (www. disertation-writing. net). It is advisable to incorporate my peers view on the appropriateness of my topic, through their review I can get important tips to apply when selecting that topic. The importance of originality should be underscored, this makes the topic should have a sense of novelty and be interesting to the researcher as well as the reader as it seeks to unearth discoveries that have not been there before. The topic should be created and not stumble upon or found in the library books (Dr. Sally Jensen, 2000). These tips as well the above-learnt checklists should assist me to come up with an appropriate topic for my dissertation.

Phoneme Definition and Examples in English

In linguistics, a phoneme is the smallest sound unit in a language that is capable of conveying a distinct meaning, such as the s of sing and the r of ring. Adjective: phonemic. Phonemes are language-specific. In other words, phonemes that are functionally distinct in English (for example, /b/ and /p/) may not be so in another language.  (Phonemes are customarily written between slashes, thus /b/ and /p/.) Different languages have different phonemes. Etymology: From the Greek, sound Pronunciation: FO-neem Examples and Observations The central concept in phonology is the phoneme, which is a distinctive category of sounds that all the native speakers of a language or dialect perceive as more or less the same...[A]lthough the two [k] sounds in kicked are not identical—the first one is pronounced with more aspiration than the second—they are heard as two instances of [k] nonetheless...Since phonemes are categories rather than actual sounds, they are not tangible things; instead, they are abstract, theoretical types or groups that are only psychologically real. (In other words, we cannot hear phonemes, but we assume they exist because of how the sounds in languages pattern as they are used by speakers.) (Thomas E. Murray, The Structure of English:  Phonetics, Phonology, Morphology. Allyn and Bacon,  1995)Two points need to be stressed: (1) the most important property of a phoneme is that it contrasts with the other phonemes in the system, and hence (2) we can only speak of the phoneme of some part icular speech variety (a particular accent of a particular language). Languages differ in the number of phonemes they distinguish...but every valid word in every language necessarily consists of some permissible sequence of that languages phonemes. (R.L. Trask,  A Dictionary of Phonetics and Phonology. Routledge, 2004) An Alphabetical Analogy: Phonemes and Allophones The concepts of phoneme and allophone become clearer by analogy with the letters of the alphabet. We recognize that a symbol is a despite considerable variations in size, colour, and (to a certain extent) shape. The representation of the letter a is affected in handwriting by the preceding or following letters to which it is joined. Writers may form the letter idiosyncratically and may vary their writing according to whether they are tired or in a hurry or nervous. The variants in the visual representations are analogous to the allophones of a phoneme, and what is distinctive in contrast to other alphabetic letters is analogous to the phoneme. (Sidney Greenbaum, The Oxford English Grammar. Oxford University Press, 1996) Differences Between Members of a Phoneme We cannot rely on the spelling to tell us whether two sounds are members of different phonemes. For example...the words key and car begin with what we can regard as the same sound, despite the fact that one is spelled with the letter k and the other with c. But in this case, the two sounds are not exactly the same...If you whisper just the first consonants in these two words, you can probably hear the difference, and you may be able to feel that your tongue touches the roof of the mouth in a different place for each word. This example shows that there may be very subtle differences between members of a phoneme. The sounds at the beginning of key and car are slightly different, but it is not a difference that changes the meaning of a word in English. They are both members of the same phoneme. (Peter Ladefoged and Keith Johnson, A Course in Phonetics, 6th ed. Wadsworth, 2011)