Vitamin D

Introduction

"Vitamin D, also known as calciferol" is important for the absorption of calcium to build strong bones of the body.

"Medical research shows that there are more tasks for this vitamin and it may play a role in multiple diseases such as asthma, cancer, depression, heart disease and diabetes and even weight gain". The current research is discussing this topic due to the great number of people today having deficiency in Vitamin D so it presents recent information about this topic as it became the talk of the day. Vitamin D is one of the most important vitamins in the body, which is soluble in fat and is stored in the fatty tissues of the body. As it is the primary regulator of the body to balance the level of calcium. Vitamin D helps to provide the bones with the needed mineral and skeletal development.

          The world today has millions of people whose blood level of vitamin D is abnormal. The past decade research results showed how far vitamin D is playing a vital role as a disease fighting factor which raised the importance to investigate about it. Chronic illnesses and infectious diseases are said to affect those people who are having deficiency in vitamin D more probably than normal people. Researches of today are investigating about the needed amount of vitamin D any one requires daily for keeping the bones and raise the person's level of prevention against having diseases.   Vitamin D is considered a kind of nutrients that got into our bodies through eating special foods in addition to the ability of the body to form it as a hormone. Foods rich in this vitamin are few so doctors always suggest their patients with deficiency in vitamin D to have supplements of the vitamin. Some fish have richness of the vitamin such as Tuna and Salmon.

Benefits of Vitamin D

Vitamin D helps in the formation of blood cells, and increasing the immunity, which reduces the risk of cancer. It helps maintaining the necessary levels of insulin. It regulates the immune system, and it is useful in the treatment of rheumatic diseases that most of which are confusing. It reduces losses of calcium in the urine when the patient to eat cortisone derivatives.

Vitamin D helps preserving the mass of muscles which helps the muscles of a person to work properly and do their required exercises, it also helps a person to control high blood pressure, get rid of obesity and be away from the dangers of heart disease and diabetes. It also helps elderly people to have sharp minds and good memory as it enhances the level of brain work and raises its functions' level as it works as an antioxidant which protects the human brain from damage. It also helps the brain to have high learning abilities. (Dowd and Stafford, 2008) The sun is very important for the releasing of vitamin D in the body as vitamin D is able to normalize the levels of cholesterol in the body which in turn prevents a person from having dangerous cardiovascular diseases or diabetes. Vitamin D is also useful for weight loss as people whose levels of vitamin D are low are more liable to obesity than others in addition to the role of the vitamin in helping having a better body composition. (Grimes, 2009) Vitamin D works as a defense line against damages, diseases and other health problems because it organizes the body's immune system and it decreases the person's risk of falling and helps reduces the chances of having cancer. (Chang, 2014)

 What are the causes of vitamin D deficiency?

The lack of eating foods that contain vitamin D and low exposure to the sun can lead to a decrease in amounts of this vitamin in the body. The people with brown skin color more susceptible to vitamin D deficiency as studies proved that the skin's ability to form vitamin D is reduced by the pigment melanin in such dark skins. It also affects people who suffer from obesity. Vitamin D deficiency is one of the common diseases, and its delayed diagnosis is often because of the slow progression of the disease, and because of the nature of civilian life in closed housing apartments and lack of exposure to sunlight. People whose diet is poor in foods rich in vitamin D are usually liable to vitamin D deficiency specially those vegetarians as the vitamin is mostly found in foods that strict vegetarian avoid such as egg yolks, fish meat, liver of beef and milk which is fortified.

Some medical conditions people may have can cause deficiency of vitamin D as inflammatory bowel disease, crohn's disease, cystic fibrosis or celiac disease. There are also medicines that may lead to having deficiency of vitamin D such as some anti-seizure medicines. Age is also a factor which increases the possibility of having deficiency of vitamin D because it was proved by studies that the elder we are, the weaker our bodies are to absorb vitamin D, children and infants are also more liable to the vitamin deficiency if their intake of the vitamin is not adequate.(Drezner, 2014) Kidney disease and liver disease also lead the person with them to have deficiency in vitamin D due to the lack of special enzymes in the affected kidney or liver as such enzymes are responsible for turning vitamin D to the required form the body needs. Intestine disability to absorb the vitamin can also lead to a deficiency in it in the body.  (Schrier, 2010)

Symptoms of vitamin D deficiency

There are many symptoms of vitamin D deficiency such as bones pain which could be a sign of having Osteomalacia which is a disease that affects bones leading to spin bending, legs bowing, weakness of a person's muscles and fragility of the bones which all lead to having high risks for fractions. Weakness of the muscles is another symptom that point to the possibility of having a deficiency in vitamin D as "According to Michael F. Holick, a leading vitamin D expert, muscle weakness is usually caused by vitamin D deficiency because for skeletal muscles to function properly, their vitamin D receptors must be sustained by vitamin D." (Geib, 2012)

Respiratory problems and having frequent flu infections may tell that a person, especially children, may have deficiency in vitamin D. Another symptom is having high blood pressure or hypertension and it is also associated with headache, stress, depression and anxiety which all could refer to a deficiency in vitamin D. General tiredness, pains, aches and lower back pains are also signs that can tell a person suffers a deficiency in vitamin D. Other symptoms can be falling easily as the high risks of falling is usually associated with a deficiency in vitamin D as "In a report in the Journal of the American Geriatrics Society in February 2004, researchers at the University of Basel in Switzerland showed that elderly women who took a vitamin D supplement plus calcium for three months reduced their risk of falling by 49% compared with consuming calcium alone. Those women who had fallen repeatedly in the past seemed to gain the most benefit from vitamin D."(Chang, 2014) Having difficulties to rise up from sitting positions, difficulties during walking and going upstairs are also associated with the deficiency in vitamin D. (O'Connor, 2014)

Rickets is a disease which clearly tells that a child suffers deficiency in vitamin D and this disease occurs when a child food is not fortified with vitamin D or when the child is not feed with enough amounts of milk. Another symptom is changes of mood and personality as the person who suffers deficiency in vitamin D is usually have bad moods and may suffer depression. (O'Connor, 2014)

Conclusion

          To conclude, it is important to say that vitamin D has been proved by evidence based researches and studies to play a very serious role in helping bodies of both children and adults get many benefits as this vitamin works as a helping factor that leads the body to gain its health greatly. Vitamin D is found in foods we eat or the body can produce it as a hormone but the sun is a condition of absorbing the vitamin in the blood. Vitamin D is mainly found in fish like tuna or salmon, fortified milk, cereals of breakfast, cheeses and beef liver. It can also be taken as a supplement prescribed by the doctor when needed. It helps the body strengthen its bones, prevents many health problems as breathing problems, falls, bones fractions, headache in addition to its ability to strengthen the body immune. Vitamin D deficiency can cause many problems and it occurs when the body is not given the required amounts of vitamin D whether through a poor intake or by not having the enough sunlight needed for releasing vitamin D in the blood. There are also some diseases that weakness the level of vitamin D in the blood. Many symptoms can tell a person has a deficiency in vitamin D such as feeling always tired, weakness of the muscles, bones pain, headache and falling accidents. The current research discussed the previous idea due to the great importance given recently to vitamin D role to the body health.  

U214B

Introduction

Children learn writing and reading through different ways and techniques. They pay attention to many things around them while learning processes and there are many factors that participate in helping them acquire the writing and reading skills such as shape and size of objects around them as well as other factors. In this TMA the process of learning how to read and write in children will be discussed through analyzing the emergent literacy at children, issues related to how children acquire literacy, the way children learn the various systems of writing to write scripts out of symbols and embodied knowledge.  

Body

Emergent literacy is a process in which children acquire the basic principles of literacy, learn to understand the written and read world around them through many factors such as the environment of the community they are in, the degree of education of the people they live with or the degree of encouragement they get to read or write. Children participate in literacy practices but in their own way as they don't have to read and write properly in early ages as they may recognize things by their figures like restaurant names, signs in the street or labels but not with their letters forms. Literacy is related to many activities done by adults as reading books, writings e-mails, using notebooks, writing shopping lists and writing using computer keyboards and children at early age before they are taught how to read and write notice such activities and imitate them in a try to do as the adults do in order to prove that they have abilities just like those adults around them. They could use images, pictures or signs to express their literacy experience by pointing to them, drawing them or even talking with them. There are factors that affect the process of emergent literacy such as the way that the child sees the world as, the listened language that children get and the degree of communication in the environment the child is living in as this makes it differs from a child to another how emergent literacy is acquired and expressed. (Arab Open University, U214B Course Book 2 Communicating in English, Unit 3)

Literacy acquisition is a process that happens to the child in very early ages and happens due to many surrounding elements of life and there are many relevant issues to it. The environment the child is in decides the type and amount of gained literacy by the child. Children can find many different visual symbols that contain English words or letters during the day at home, in the street, in a supermarket, names of the street signs or shops, TV advertisements, snacks bags or letters that point to specific things or places such as M which stands for the famous restaurant loved by children "McDonald's" which is called logograms and this is the same thing as pictograms which means a child recognizes a place for example by a picture such as pictures figure schools, hospitals or WC for men and WC for women. Children do not deal with literacy as it is only written texts but there are many elements engaged in their comprehension for graphics, signs, codes and marks which could be found in computer games, movies, streets, maths signs and they could recognize things that contain letters of other languages. Children who are at the preschool age are affected with the literacy practices they face in the community they live in which reflects on how much they acquire and how far they are successful in doing emergent literacy practices as some communities do not give literacy matters great interest as other communities, then the child responds to literacy according to adults' value for it and the degree of attention they give to the child. There are different ways in directing children towards literacy as in some communities imaginative heard stories are appreciated more than other practices, some think that children must deal directly with printed papers and books, others prefer pictures to tell meanings and some communities give much interest to teach children how to write and read in the same way of schools which results in children with different emergent literacy practices. (Arab Open University, U214B Course Book 2 Communicating in English, Unit 3)

There are many writing systems that children can learn by different methods and techniques. Encoding differs from a writing system to another and this affects young children who learn different languages as each language has its own writing system, English, for example depends on alphabet and its encoding system depends on letters while Chinese is a language that depends on logographic system of encoding writing and Arabic in spite of having letters in its writing system, letters' images change according to where a letter lies whether in the middle of a word, in the front or at the end of a word. (Kenner, C. Al-Khatib, H., Kwok, G., Kam, R. and Tsai, K. 2004) Children who learn through alphabetic systems can understand words if they understand the way letters work to combine words and after that it becomes easy to them to read other different new words, this is not the case with learning through a logograph system as it is harder and could last more time than learning alphabetic languages. The relationship between alphabetic systems in languages depend on letters and between phonemes of such letters as some language could be read by a learner without being understood such as the Finish language for example. As to English, it seems that its writing system is difficult for children at early ages as its orthography has disadvantages as having advantages. Among its disadvantages is that English words include some words with origins from other languages and their pronunciation system is different to be expected as it is not following the English pronunciation system so written letters may not express the right pronunciation of these words. This makes it difficult for young children to understand how to read all English words. (Arab Open University, U214B Course Book 2 Communicating in English, Unit 3)

When children write English different scripts, they have to know many variant things related to symbols such as those different sounds expressed by one symbol as the letter "i" for example as it could be in /pin/, /tide/ or /pain/ and also those letters groups which could give specific pronunciation or be silent such as "th" in /the/ or in /teeth/ or "k" in /knife/ or /know/ or such as "gh" in /cough/ or in /though/. Children also should pay attention to some morphemes which could be read the same when found in any English word such as /ing/, /tion/, /ment/, /ly/ and / ness/ for example. Children who learn English should be taught how syllables are combined together to form words such as turning verbs to nouns by some adding syllables such as /ing/, /ment/ and so on in order to facilitate the process of reading and writing in English in young children. Onset and rime techniques are important when a child learn English written scripts in order to learn how to read syllables combined into words. Yet it is not just to decode a script in order to be literate and read and write a language as children may find more difficulty when they are dictating words they hear to transform them to written texts. Another difficulty is the children spelling trials as they may miss some silent letters or not know symbols combinations. (Kenner, C. Al-Khatib, H., Kwok, G., Kam, R. and Tsai, K. 2002)

Writing is a practice that young children consider as embodied knowledges as children give much interest to how symbols are set together and how they construct words and they have their understandings for the process of creating written texts and then understanding them which what is referred to by "embodied knowledges". This means that children's visual attitudes have a relation in interpreting written words as well as the degree of their attention paid to directionality, spatiality and other measurements when they write English scripts. When children write they have their own methods of producing symbols according to physical directions and effects of other adults' way in writing. As when teaching young Arab children to write in English for example, they will write it from right unless being told to change directions of writing. Symbols also have their own spatiality which means that there are specific stated places for letters of English for example, when teaching young children to write English symbols between two straight lines which is not preferable in Arabic and this is the same when teaching young children how to write capital letters of English to be up lines. In Arabic for example, dots positions can puzzle young children as number of dots can differ to make different symbols from one similar basic origin. Dots are often misused by young children writing Arabic letters which is a visual feature for children who are learning Arabic as a second language and teachers have to remind them with the dots and the proper size of them. Children who are taught English as a foreign language may do some practices like these as in forgetting dots of "i" or "j" for example. (Kenner, C. Al-Khatib, H., Kwok, G., Kam, R. and Tsai, K. 2002)

Conclusion

In conclusion, it is important to refer to the importance of the period of emergent literacy at young children and how it affects their future readiness for learning different languages and that the environment has a great effect on strengthening or weakening the children's ability to learn languages fast and properly. It is important when teaching young children a new language to take care of the way children respond to the language symbols, directionality and spatiality in order to guide them to the best practices in learning languages. It is important to learn about the way children learn writing systems and their understanding of symbols of one language.

U214A

Introduction

Current standard English has been through many stages of change throughout times and ages as it developed to be as it is today. Researchers, lexicographers, linguists and grammarians have shared a lot in this development movement. Till the fourteenth century, it was not preferred by the Great Empire to use English as an official language to use by upper classes.  French and Latin were better as high languages and lower classes used English. Yet this changed since the fifteenth century to reach top changes in the seventeenth century. English codification history is going to be discussed in this assignment including dictionaries' use, including words in dictionaries and prescriptive and descriptive dictionaries.  

 Body

Since centuries pasted, English was not in the same position as it is today as processes of standardizations and codifications of the language have left their effects on it in many linguistic aspects. Latin and French have left their effect on English to make it a hybrid one by taking some words and rules of the two languages. King Henry IV was the first English speaking king to rule England in 1399 but this did not make English as the official used language till there was a standard version of it after centuries as English importance became clear to authors and there was an urgent need for having a unique language for all people. Printing was presented by William Caxton in England which aroused the speech about the importance of having English standardized. Virgil's Aenoid English translated version by Caxton also aroused such speech in 1490. The London variant of the language was used by Caxton which limited the use of his book at that time. The London variant of English was used by the government as in official writings in the fourteenth century end in documents of the Chancery of Westminster by the clerks then which made its use to prevail all over England and became spreading for writing. (Arab Open University, English in the World, Unit2) Elaboration of function is a stage that followed this as northern dialects were not favored to be used by writers who used to encourage other writers to use English variant which is a standard one. English standardization encountered its first stages that were elaborated after deciding that Chancery was the variety of English which was best in the seventeenth century beginnings.  After this stage, it was time for language codification which was meant to process the language and limit variations of language by making a basis of rules and words of English which were acceptable as this occurred by writing the dictionaries and important books written in English between the seventeenth century and the nineteenth century period. (Hickey, 2012)

There was a great interest in writing dictionaries because they were important for many reasons. The urgent need for dictionaries was a social demand so as to have a language variety which is socially accepted and a political demand also for having one unique version of the English language to be used widely by limiting varieties use so as to produce a variety that is an only representative of England as the British Empire was widened a lot in the eighteenth century with a very energetic trade movement with different areas of the world. Having one standardized variant of English was a social demand due to the high classes of the London society and the ruling classes effects were clear in the lexicographers' attitudes in stating one version which was highly prestigious for being used by writers and educators. Thus, the need for having grammar books appeared so as for teaching purposes so as to let all people learn the standard English. According to what happened of setting rules of the English language, grammarians' role was minimized as this was the time of adopting such rules practically.  This was the time that witnessed political changes as for example, Great Britain included Scotland as a part of it in 1707 which made it important to have dictionaries with all English words recorded and to have all the language varieties within and this also meant to have one variant version of the language to express the nation as a whole to refer to its unity. Spelling and pronunciation were also detected to be recorded within dictionaries correctly.( Grobman, 2014) Samuel Johnson had his dictionary which was prepared according to the London variant as he chose words spelling according to it, he meant to make a safe record of the language so as not to be changed or affected with outer effects. He prescribed some specific words so as to be acceptable and other words to be barbarous which reflects the social effect on language standardization. This dictionary was very respectable and considered one of the basic references to the English language. . (Arab Open University, English in the World, Unit2) 

The first dictionary to be considered as monolingual was the Table Alphabetical dictionary for Cawdrey in 1604 but at the same time the dictionary of Samuel was preferable to it and better than it due to its being made carefully by Johnson and as he made it as a basis for inclusion of words that lasted for more than one hundred and fifty years as a linguistic reference. He was very keen on keeping the right spelling of words to fix language basics by keeping its lexicon besides his technique of noting about each word uses and its classification to be acceptable or not. Johnson was interested in including both hard words and simple words to have all used English words in his dictionary and this was a beginning for compiling dictionaries rules that lasted till our current times. Johnson was the first to set rules of inclusion for English words which was and still is a criteria for making good dictionaries. Users of a dictionary always look for words' meanings according to their researches' purposes as for example those who work in commerce look for terms related to commercial life and it is better for them to look up words in specialized dictionaries. Traditional criteria of complying words depends on printing and written work on adding new words but today's criteria differs as there are new words that join the language daily and are widely used by English speakers all over the world such as "blogging" which means to write in a blog, "buzzing" which means to alert someone or take interest by new things or "App" which means applications of software. Attestation is a new factor of the modern inclusion of words which means proving a word validity by evidences such as specifying a time for the word to be trusted as one year or more of being used. (Lynch, 2002)

There is a question which was usually asked by linguists which is:" Should dictionaries be prescriptive or descriptive?"  Some linguists see that the prescriptive approach is better as it enable them to prescribe the language main rules that keep the structure of a language, its lexicon and semantics. Others prefer the descriptive approach which provides a description of the language and how it could be used. Prescriptivism supports the validity of a unique language variety rather than all other varieties of the language. It also provides a chance of having a model that asserts accuracy and basics of the traditional language while descriptivism is more flexible in accepting the different acceptable language verities as long as they are preferred by the language users. The prescriptive approach which is a traditional one is well represented by the dictionary of Samuel Johnson as it provides its users with techniques of words usage correctly and to keep a record of the formal words of English which do not belong to slangs or language that is locally used. This supports students of the English language and the writers who seek formal use of the language. The descriptive approach can be applied by the descriptive dictionaries where words are defined and described through the ways they are used but they do not advise their users regarding how to use words. The current dictionaries of today differ in their approaches but most of them follow the descriptive approach giving their users the available descriptions and definitions of words but without a big emphasis or advice on usage. (Hitchings, 2005)

 Conclusion

Standardization and modification of the English language have encountered many stages and this was throughout times and over different ages which left their effects on the language variants to reach the current English we know today. Many linguists and grammarians added too much to the language processing and among them there was Samuel Johnson who was well recognized and still is one of the basic representatives of the formal English language that was preferred by the prestigious classes and by the ruling class then. His dictionary was a significant reference for English users, writers and educators with its classification of words and the criteria used in it by Johnson for words inclusion and techniques of compilation followed that saved the basics of the language and benefited many researchers and lexicographers. 

EL120 AOU

Question1=400 words

Introduction

Human being race is mainly has a very important distinguishing characteristic that makes him prior to all creatures which is language communication. In the current assignment, there will be discussions of linguistics and language study in addition to presenting definitions for branches included in linguistics science for the purposes of understanding languages, linguistics and language learn.

Body

A language is a word that could have the definition of : the way of communication among human being that is practiced by a system of mind that uses units, symbols and signals which could differ from a language to another. To define linguistics we can say that it is the study of language using scientific methods and strategies that use analytical techniques that detect evidence based theories of studying language and this language can be studied generally or to study a language on its own such as English, Italian or any other language spoken in a specific area. Each language bears its own elements and components but there are main components shared in most languages such as phonology system, lexicon and others. Studying the components of a language makes it easy to master this language quickly and perfectly. (Taylor et al, 2001) Any language consists of main components and these components include phonology which represents phonemes functions, morphology which represents words formed by morpheme units, lexicon that represents the words, syntax which concerns with rules and grammar points, semantics that cares for meanings and how sentences are meaningful and discourse which cares for sentences relations. (gamu, 2014) There are many different branches of linguistics which are all set for the best study of language components as the general linguistics, comparative linguistics descriptive linguistics,  anthropological linguistics, , applied linguistics, historical linguistics, psycholinguistics and corpus linguistics and each branch has its main functions of language study as for example: the general linguistics is based on using theories for studying language, the comparative linguistics makes compared studies on different languages, anthropological linguistics studies the relation of language and culture of human beings and the descriptive linguistics is based on different descriptions of the methods of language speaking.  

Conclusion

Human beings is blessed by the language communicative way which helped in mankind progress on Earth. Languages are based on systems and has main components which form these systems and linguistics is a science that consists of branches set for studying languages to understand everything about them and to make people master them.

Question2=400words

 Introduction

adults and children are both able to learn and acquire foreign languages and their abilities to learn fast and master the languages may differ. This assignment is discussing how age could play a role in learning foreign languages and it tries to find out if children can learn foreign languages faster and better than adults or not according to previous researches and experiences.  

Body

There are linguistics researches that say that it is better to learn a foreign language in childhood as the chances of fast learning is bigger and that the adults are not as good as children in acquiring a new language because some researchers found out that there are parts in child's mind that automatically respond to learning a foreign language. (Tippin, 2011)There is an opinion says that children do not take the matter seriously that's why they learn easier as they think it is a game and specially when the language is presented in a funny way.(International Linguists Community Online, 2014). Yet many opinions and studies say that the adults are better and faster in learning new foreign languages than children due to their awareness and determination to learn if put in a good learning environment and as they are having the advantage of abstract thinking that enables them to master a foreign language easily and quickly. The cognitive abilities of a child are not as ripen as those of an adult according to researches of Pringannti in addition to the fact that training adults is much more important than thinking of their age when teaching them a foreign language as Kara Morgan-Short and Michael Ullmann  suggested in their researches. (Lebowitz, 2012) The methods used by teachers in presenting a foreign language decides how much success can learners gain whatever age they are as for example the listening matter should come first before reading and writing in order to enable aged learners to acquire good pronunciation. Methods of testing and measuring language learning also make great differences when adult are learning a foreign language. Another factor that makes adults' learning harder is that teacher do not accept their mistakes easily as with children. (Ausubel, 2014)

Conclusion

Training and good learning environment are main important factors needed for teaching both children and adults a foreign language in addition to find out problems that learners face and age is not a deciding factor in learning foreign languages.

Sickle cell disease

Sickle cell disease is a serious blood disease which can be found in very early ages and it leaves great effects on patients' quality of life. Nursing care provided to patients with sickle cell disease must be very caring and nurses must provide their best work to patients. Sickle cell is a disease that affects cells of blood and it is a chronic illness. Millions of people around the world have sickle cell disease, the people whose ancestors are from Africa, Central America, South America, Mediterranean countries; India and Saudi Arabia are more liable to have the disease. About 90,000 to 100,000 persons from America have the disease. (CDC, 2014) In KSA, the disease is prevailing in the Eastern and Southern regions more than other regions. (AlQurashi et al, 2008) Sickle cell was chosen because it endangers lives of new born children and adolescents and affects patients' quality of life. The female patient is a 13 years old Saudi was suffering from pain in the abdomen when being admitted at hospital in 22-11-2014, at the pain numeric scale, the number was 7. Her history shows that she was diagnosed to be affected with Sickle Cell Disease as a child. A holistic perspective is used to provide the patient with care as all her needs are clear. This assignment is a case study and a reflection about nursing care provided to a patient with sickle cell disease suffering severe abdominal pain. It will provide a presentation for female patient profile and her family's profile.

The female patient is at Grade seven at school. She is a sister for three other sisters and a brother. She likes watching T.V, playing computer games and singing. She dislikes hospital, medicines and she seems to be afraid from treatment. Her family seems to be caring and loving as they are the source of information. Her height is 147 cm and weight is 50 kg. The patient suffers sickle cell disease since childhood and she was admitted to the hospital due to having severe pain in her abdomen. It was a sickle cell crisis. Her past history of the illness included sickle cell strokes, fever and acute chest syndrome. Her family health history includes her father having strokes and diabetes and her mother suffers high blood pressure and she has an aunt who suffers sickle cell anemia. She was received in ER, her pain was measured by numeric Scale and she received morphine and hydromorphone by IV, daily folic acid and she got Tradol orally. I began a discussion with the patient who seemed to be afraid but sooner she liked me and talked about her feelings of shyness as she can't swim in the club with her friends and she said she doesn't like hospital stays she has to do from time to time and that this makes her sad for long times, she was thinking that she is deprived of playing and having a good life as her mates but I told her that she is fine and that she can enjoy many things in life as music, reading and surfing the net so she smiled and liked my words. Her food was small meals including vegetables and fruits, enough fluids and 8 glasses of water daily. I focused mainly on her breathing behavior as she had severe cough and I was very keen on preventing any possible complications related to respiratory problems. I discussed her about the possible reasons that caused her the pain, she answered that the weather was very cold and her clothes were not heavy. She has enough sleeping periods as she slept for eight hours at night and three hours in the afternoon without sleeping medications. Her family supports her in moving a little and took her to walk for 20 minutes in the hospital yard every day. Hemoglobin rates were monitored and I compared them with baseline levels. A patient with sickle cell disease has some specific signs and symptoms such as having abnormal genes.  Patients with sickle cell disease may also suffer symptoms associated with anemia such as fatigue, pallor and weakness, their Hgb and Het are usually reduced in addition to having reticulocyte count. They usually suffer severe unbearable pain. Patients of sickle cell disease may suffer acute chest syndrome, cerebrovascular accident which is stroke, priapism and or splenic sequestration crisis. Their sickle cells of the blood usually form microvascular occlusions that could cause infarct or ischemia in patient's tissues or organs.  (Hazinski, 2012)  Pain crisis are also signs of sickle cell disease as pain is characterized with being very severe coming in episode attacks that could affect many places such as the legs, arms, back or abdomen. Fever, high temperature and stress are also possible signs of the disease. (Tamparo and Lewis, 2011)

Sickle cell disease can be defined as a disease which is mostly inherited and it causes problems in hemoglobin globin genes as the disease's transmitting occurs as an autosomal recessive trait. (Nagelhout and Plaus, 2013) It can also be referred to as a blood disease which is very serious and has a few types as sickle cell anemia. The oxygen flow in the patient's body is not normal as the sickle cells do not last as normal red cells of the blood.( Bjorklund, 2010) Diagnosing sickle cell disease presenting in a person can be suggested when there is normocytic, macrocytic hemolytic anemia, high lactate dehydrogenase levels and a clinical history which is compatible.(Goldman and Schafer, 2011)  Sickle cell disease diagnosing requires many tests such as the standard CBC, hemoglobin electrophoresis (used to measure blood hemoglobin types and the sickle cell test which can identify the blood's abnormal hemoglobin which could be found. Sickle cell disease can be treated by using blood transfusions which could help stop its symptoms and prevent the disease's complications. Prenatal tests are useful for prevention procedures as they can identify fetus HbB genes. Treatment can also be done by using painkillers and fluid intake. Painful crises associated with SCD can also be well managed by hydroxyurea which is an antitumor drug which showed its effectiveness in treating SCD pain crises. (Wailoo and   Pemberton, 2008) Medications for patients with sickle cell disease can be used according to the symptom the patient suffers as pain can be treated with painkillers as aspirin, ibuprofen, morphin, perfalgan, Tradol and or opioid and they are taken daily with doses not more than 100ml three or four times daily.(University of Maryland Medical Centre, 2014) Anemia can be treated by blood transfusions with caution so as to avoid having diabetes or other diseases, they could be made for the patient every three or four weeks. Vaccinations should be presented for patients with SCD especially children to keep them away from infections. (CDC, 2014)

 Goals of care were set according to the patient's case. There were two actual goals which are: reducing the patient's pain to a level that she accepts and helping the patient to breath easily by preserving her ventilation to be adequate and not causing complications. There were two potential goals which are: keeping the patient protected from infections and keeping the patient protected from falls due to the painkillers she took.  According to  (Boyle and  Andrews, 2008) a nurse should have strategies for pain management such as pain assessment, identifying reasons for pain by building a good nurse patient relationship and confirming the transcultural concepts when applying such strategies and this what I really tried to do with the female patient as everything about her was recorded in notes but I think I would have done better job by filing everything about her on my computer. The pain scale was used to measure pain level, the right medications were used with her and her vital signs were monitored as I checked her temperature from time to time as I learnt to do this which is clear according to (Nettina et al,2013) that reported the importance of nursing interventions to check temperature of the patient which prevents fever. I was very keen on keeping the patient's breathing as adequate as possible as she suffered difficulties with cough and shortness of breath and the pain caused her to have breathing difficulties. (Nettina et al,2013)

According to  (Hughson et al, 2012), the patient position is very important to prevent breathing difficulties as the upright position or the semi upright can help the patient breath easily and I did this as I raised the bed to higher position with regard to the patient's rest and comfort, this was useful for her but I think I should have used pillows to add more comfort for the patient.  (Hughson et al, 2012) suggested that oxygen therapy is also useful to prevent breathing difficulties. I tried to keep watching the patient to administer oxygen for her when it is needed. This was very helpful for her and she appreciated this, I tried to educate the patient and her family regarding methods for breathing management at home such as relaxing techniques and be away from stress and exhaustion. (Moyeet, 2009) The patient was in risk of infection due to her being hospitalized so many precautions were taken to help her. Hands hygiene was a first care point that I used to make sure that my hands are very clean before and after dealing with X as according to (Elsevier Health Sciences, 2008), hygiene is the nurse's responsibility and glove and masks use are very essential to prevent the patients from infections. I did not use the mask too much but in future I will do, I suggest that all nurses should not work without masks at all and I think everyone in the care unit or in the hospital should be keen on wearing masks and gloves to prevent infections.

 The patient was at risk of falling as she was a teenager and the medications she used to take as painkillers made her liable to fall so I ensured her safety through many procedures to prevent falls. According to (Iyer, 2006) mobility and fall preventing are the nurse's responsibility as nurses should make sure that beds do not make the patient liable to falls, family members should be educated regarding watching the patient and bell ringing when falls occur and the nurse could help the patient wear good type foot wear that prevent falls. I was doing my best to ensure the bed's safety by providing the patient with a bed with surrounding rails to prevent her from falling, provide the family with a bell and a stick to help the patient walk. I also tried to put the patient in a room near the nursing room but this was not possible so I suggest that hospitals and all healthcare organizations should take this into consideration as patients who are in risk of falls should be put as near as possible to the nurse's room. Pain was well managed and reached zero in the female patient discharge day, breathing was good, the patient did not get any infections and she did not fall. I learned too much experience in nursing care and practice which will help me in the future as a registered nurse. As an educator, I can provide families of patients with sickle cell disease with information about home management for pain crises and other symptoms of SCD. (Iyer, 2006)

   Conclusion

Sickle cell disease is a case that affects the blood and it has great impact on patients as it affects quality of life greatly. People with African origin are the most to be carrying the disease. Testing is very important in diagnosing SCD as there are a number of tests to diagnose it. There are many signs that tell a person has sickle cell disease such as having abnormality in the genes. Symptoms related to sickle cell disease can include pain, fever, fatigue and weakness. Nursing care for a patient with sickle cell disease must be well planned so as to help achieving goals of care and help protect the patient from complications and injuries that may happen due to lack of care during time of hospitalization. The information got from literature added to real life situation experience will be very useful for future work, more researches should be done regarding treatment and management of sickle cell disease and its symptoms. The current assignment is a case study and a reflection about nursing care provided to a patient with sickle cell disease suffering severe abdominal pain. Skills got and learnt through this experience were too many and useful for nurses' practice in pain management and patients' assessment to set the right goal of care and apply them to reach the best quality of care level provided to hospitalized patients of sickle cell disease.

  

E301B

Introduction

Literary texts have been improving throughout times and gave rise to complex and Implicatures widely. Meanings within texts are various and different in functions as well as the different levels of literariness. The linguistic levels can show how good a literary text is and gives a good chance for assessing and evaluating literary texts according to many measurements. The current assignment is discussing literary texts rise up throughout history and the various levels that signifies the texts quality according to the violation of maxims as Grice and others suggested in addition to discussing the semantics and meanings of texts and how to judge the quality of literary texts through assessing and evaluating literary texts.

Body

Violating Grice's maxims

Quantity, quality, relation and manners are all among the maxims that when are violated by authors in writing literary texts, creativity abilities appear to strengthen the nature of such texts and improve their complex. Grice suggested that words have functions that differ according to the meanings speakers mean by saying the words in different situations which provides a wide range of meaning usage by words. Implicature was late presented by Grice to improve the theory of meanings he suggested then he suggested his cooperative principle of conversations so it was his maxims that are to be violated by as many people as possible so as to produce new understandings of the words and different meanings for one word or one phrase so as not to measure a word or a phrase from one only perspective but to find out new meanings that makes literary texts more distinguished and expressive. The interpretation process depends on relating different maxims to each other whether by violating maxims or by not violating them at all and just take the simple meanings and direct meanings of words. Speakers can suggest the different implicatures of words by their intentions while speaking but this also refers to how the listeners can get the meanings or being unable to get them as they are meant by the speakers. Implicatures as suggested by Grice can be made by many elements such as metaphors, parallelism, deviation and foregrounding. In literature, violating those maxims results in different creative figures of speech which raises the texts quality and provides unique texts that differ from a writer to another and that distinguish a literary age from another and this violation is the tool that produces poetry, verse and all images that can be recreated throughout times to enrich the literature and give authors chances to be creative.  (Grice, 1975)

Literature in readers' minds

Thinking has many ways by which people can learn and know what literature is such as defining it according to the text inherent features as the language functions can vary to provide deviation or parallelism. Functions also can signify the texts' nature such as the poetic features that reform and re-evaluate the text to produce it with new and more creative roles. There is also the cognitive approach which provides a broad space for studying the psychological sides and the processes that minds of readers have when a reader reads or listens to a literary text as this approach depends on how readers receive texts, understand them and evaluate them by their minds to judge their levels of literary quality. Readers minds can be good tools of evaluation as readers who read literary texts whether they are poems, novels or whatever literary works they belong to can have each reader's own imaginary contexts which can be given to readers through the hidden meanings that lie behind the concrete meanings of words but being within a literary work is what attracts readers to look for more deep or hidden meanings behind a word. Readers receive the non-literary texts and understand them directly which cannot happen with the complex literary works carrying lots of meanings. Reading any text which is not supposed to be a piece of literature is a process that use directions of language that describe reality and not imagination as meanings in such texts do not change even if the texts themselves were reordered which is a matter that do not happen in literary texts as reality is not a reference sought in literary texts. Literary texts attract the attention of readers by the images and the word plays that interest and attract special readers' minds.

(Arab Open University, The Art of English: literary creativity and its readings. Units1 and 2)

Literariness in literary and non-literary texts

Literariness is not only poetry but all fiction works that are based on a poetic language of images, imagination, figures and deep meanings are literariness elements yet non- literary texts can also be included among elements of literariness. According to many researchers as Carter, there are features found in literary and non-literary texts such as medium independence, text patterning, semantic density and others and the literary texts include more features than the non-literary ones. To detect the literariness levels in a text, this can be happen by focusing on text patterning or the semantic patterning. An author who is good can employ literariness in his works properly so as to add great literary value to the text by using literariness levels and poetic elements to enhance meanings. Literary value can be assessed and evaluated by finding the text literary form and its non-literary form and how they are related to each other, as there should be a balance between these two elements. According to Bradford, closure resistance is a tool for evaluating literary texts according to each text value which could be measured by studying the text poetic elements and how they are related to the concrete text. Texts production is a process that requires high quality stylistic tools so as to choose a suitable stylistic form for a literary text by selecting the main linguistic elements which raise the text literariness and literary value as words, semantics and syntax, then meanings can differ according to the codes produced by such elements and this what makes a literary text more valuable than another one. Having special effects on a text can be caused by styling and this effect can be easily then conveyed to the readers as styling can lead to having meanings in the texts which cannot be made by other technique of adding effects. (Widdowson, 1975)

The poetic function

Improving the value of a literary text includes adding poetic function to it so as to enrich the language and add the required effects on readers so as to look for what is hidden behind words' meanings. The poetic function also can add effects to non-literary texts in order to attract the listeners with expressions that leave effects on their minds directly and indirectly. Repeating elements is a basic feature of poetic functions and this could occur to rhyme, words or any other text elements in order to produce extra meanings. The existence of the poetic function should not be more than other functions existence such as the referential function for example so that texts cannot be very hard to reach the readers. Language and context should be related to each other in a text with the balance that readers need. The poetic language uses metaphors and images to arouse readers' eagerness to think of more meanings of a word. Yet metaphors should not be presented solely within a literary text, conceptual representation must be taken into consideration of authors when it comes to add metaphors ad images. Judging a text according to what it carries of poetic elements and how the poetic function plays a role in raising the value of the text requires skills of analyzing the text and learning how it is written and formed into linguistic patterns, how it is balanced between literary and non literary elements and how it is valued by readers themselves.    

Conclusion

The current assignment dealt with literary texts that give rise to implicatures and how violating the maxims can help adding more value to the literary texts. The literariness is a very important concept in literary as it can tell how good a text is and it can provide the authors with the chance to produce more valuable texts with the required effects on readers by changing meanings and add deeper effects on words and semantics. Syntax and phonology use is also a helping factor in producing better texts as well as using the metaphors and the poetic language which should be carefully used by authors so as not to devalue their texts when the metaphors are not properly used.

chronically ill children

Chronically ill children are those children who have any one of the known chronic illnesses such as diabetes, cancer or others and it is known that a chronic illness is that kind of disease that lasts for a long time that is recorded by researchers and medical studies by staying for more than three months in long and it can't be totally cured so it has many complications and effects that harm the child with a chronic illness and this affects the family who owns a child suffering a chronic illness. 

There are many trends in dealing with a chronically ill child such as the following ones: 
1.School care
This should be done by teachers, nurses at school, parents and other workers in the school who should be aware of how to deal with the chronically ill child physically and psychologically as there should be monitoring for the child in order to avoid injuries and harms in addition to helping the child cope with his condition and receive his education easily. The school administration should also be careful that the child may be absent for long times as a result of long periods of hospitalization. The school nurse has an important role in providing care for the chronically ill child and explaining the case to teachers and managers at school. 
2. Nursing care 
nursing care should depend on the type of illness the child suffers, the type of treatment he receives and the individual needs of each child. Nurses should be careful of the medicament the child takes and there should be daily or weekly home visitations for the child in order to keep following his treatment.