Effect of Anticoagulant on Blood Calcium

Effect of Anticoagulant on Blood Calcium Effect of Anticoagulant: Can Heparin Produce Negative Bias in the Determination of Total Blood Calcium? Soma Santra1, Manju Soni2, Ajay Soni2, Swati Kotwal ­Ã‚ ­1* KEY WORDS:  Quality control, pre-analytical, serum calcium, kit method, o-CPC Abstract Calcium is a vital element in the body which plays an important physiological role as it act as a second messenger in many biochemical pathways. Accurate results of total and ionic calcium level plays a pivotal role in patient care and management. Measurement of serum calcium helps to identify many clinical disorders. Many preanalytical conditions affect the blood calcium estimation. The aim of this study is to evaluate the effect of heparin, used as an anticoagulant on total blood calcium assay. Blood specimen from 10 healthy subjects were collected and the difference in total calcium contraction in plasma and serum samples was assessed. No significant changes were observed when plasma levels were compared with the serum values with p value of 0.56. Deming regression analysis yielded the equation: 1.02 Ãâ€" (serum total calcium value) + 0.28 mg/dl. The bias value was -0.109 mg/dl (95% CI: -0.248 0.030 mg/dl) for total calcium levels assayed using either tube was acceptable. Total calcium values did not significantly differ when either plasma or serum was used with the spearman correlation coefficients (r value) of 0.98. In conclusion, heparinized tubes can be used for the determination of total blood calcium. The use of plasma sample has an advantage in an emergency laboratory setting due to less processing time. Keywords:  Calcium, Heparin, Quality control, Preanalytical, Phlebotomy, Blood collection device Introduction In recent years, there has been an increasing effort by international committees and working groups to develop quality standards for the pre-analytical phase, including the proper use of anticoagulants in sample collection (1, 2). Anticoagulants are additives that inhibit the clotting of blood; they are used only on ensuring that the concentration of the substance to be measured is changed as little as possible before the analytical process (3). The preanalytical laboratory testing takes two major steps: Blood collection and processing (4). The ionic calcium level in blood is recognized to be falsely decreased either due to dilution or binding effects of heparin, which is applied as an anticoagulant (5). The CSLI recommends the use of lyophilized calcium-balanced heparin syringes (6, 7) for collecting specimens for ionized calcium measurement. It has been proposed that ionized calcium levels can be affected by excess of heparin present in blood (8), although it was believed that the clinical significance was minimal (9). In this study, we are determining the effect of heparin on assay of total blood calcium to analyze preanalytical error in the collection of blood samples. Materials and Methods This study was approved by Swami Vivakanand Medical Mission ethical Committee. Informed consent was obtained from the donors. For evaluation of the effect of heparin on total blood calcium assay, blood samples were obtained from the 10 subjects. Blood samples were sequentially obtained by single venipunture from an antecubital vein in BD PresetR lithium heparin tubes (Ref. No. 367884) and BD vacutainer serum (Ref. No. 367812). All the subjects were between 18 50 years age group including both genders. Plasma levels of total calcium were compared to the serum calcium, which was used as a reference here. After the blood withdrawal, samples were then recapped into individual containers, followed by sample centrifugation. The plasma and serum samples were separated within 30 minutes of blood collection. Commercially available biochemical kit (Liquid Gold, Span diagnostic, India) by Arenazo-III method was used for total calcium Assay. Within 2 hours after collection, total calcium was me asured in all samples in triplicate and mean was used for further analysis. Data were evaluated using Analyse-it software (version 2.26). For all statistical comparisons, p values less than 0.05 were considered significant. Data concordance was evaluated via Deming regression analysis. The mean of differences (bias) and limits of agreement was calculated using the Bland and Altman method (10). Differences between total calcium level obtained from plasma and serum were compared using the paired t-test. Correlations were determined via calculation of Spearman correlation coefficients (r values).  ­Ã‚ ­Ã‚ ­Ã‚ ­ Results The total calcium values of samples analyzed in the present study ranged from 8.69 10.47 mg/dl and the mean total calcium values obtained using BD lithium Heparin was 9.34  ± 0.18 mg/dl whereas that for serum samples was 9.48  ± 0.18 mg/dl with SD of ≠¤0.57 (Table 1) by 1-way ANOVA. The Spearman correlation coefficient was r = 0.98 (p Discussion Serum is the preferred sample which is used by many laboratories for biochemical testing since it avoids the addition of anticoagulants that may interfere with some analytical methods or alter the true concentration of the parameters being measured. The use of serum or plasma in clinical pathology remains controversial. However, analyte stability is greater in serum than in plasma (11, 12) and differences between plasma and serum test results have often been documented (13). Moreover, in stored samples, the formation of fibrin strands is lower in serum than in plasma and therefore, there is lesser risk of occlusion in automated biochemical analyzers. However the use of plasma is preferred in some centres as it separates quickly saving preanalytical time thus reducing the total testing period (TTP); secondly, 15–20% more plasma sample can be obtained from the same volume of blood than the serum sample and lastly, with plasma there are no coagulation-induced changes or interferences (3). Heparin has been generally recommended as the most suitable anticoagulant for plasma collection (14) due to its physiological acceptance in vivo. Although in previous reports, a significant differences in selected parameters have been found between heparinized plasma and serum samples (13, 15). In our study, serum and heparinized plasma yielded similar results with no significant changes in total blood calcium assay this confirms the views of Thorensen, S.I.,et al (15) who also reported similar observations; and this adds up to the observation of Ladenson, J., et al (13) in which clinically significant changes were observed in ionic calcium observations on use of heparinized plasma over serum results.. We found that the Spearman correlation coefficient was 0.98, indicating a good correlation, when total calcium test results when plasma and serum were compared. Deming regression analysis yielded the slope of the regression line that did not approximate unity, suggesting that, in addition to the presence of a small constant bias, a small and non-significant proportional difference also existed between the test results obtained upon use of the two tube types (16). The total calcium assay bias was -0.109 mg/dl. The criteria of acceptable limits imprecision for total calcium ass ay is 1mg/dl and medically allowable error is 0.37 mg/dl (17, 18). In the present study, we observed that the total calcium concentrations of plasma samples were slightly lower than serum samples with no clinically significant differnece and the bias values were smaller than US CLIA 1988 targets. Although collection of blood samples from the patients administered with heparin prior to the collection may hold in excess of heparin, increasing clotting time in the collection tube and thereby increasing the potential for the establishment of latent fibrin in the preanalytical phase. Preanalytical variables associated with blood collection should be further standardized to ensure the accuracy of test results. It is impractical to expect tube manufacturers to test out their subway systems on all possible assay platforms; this is a project for individual research laboratories. Conclusion We conclude that heparinized tubes are suitable for sample collection for total calcium assay. With the use of heparin tubes use faster processing of blood samples can be possible, which is valuable in an emergency setting and in intensive care units. Moreover, single sample can be used for multiple purpose, including both hematological and biochemical analyses. References Guder, W.G., Ehret, W., da Fonseca-Wollheim, F., Heil, W., Muller Plate, O., Topfer, G. Serum, plasma or whole blood? Which anticoagulant to use? Laboratory Medicine 22, 1998: 297–312. World Health Organization. Use of Anticoagulants in Diagnostic Laboratory Investigations. vol. 1 WHO/DIL/LAB/99, Geneva, 1999: 1–64. Guder, W.G. The quality of diagnostic samples. Blood Gas News 10, 2001: 18–24. Raffick A.R. Bowen, Glen L. Hortin, Gyorgy Csako, Oscar H. Otaà ±ez, Alan T. Remaley. Impact of blood collection devices on clinical chemistry assays. Clinical Biochemistry 43, 2010, 4–25. Sachs C, Rabouine P, Chaneac M, Kindermans C, Dechaux M. In vitro evaluation of a heparinized blood sampler for ionized calcium measurement. Ann Clin Biochem. 199; 28:240–244. National Committee for Clinical Laboratory Standards. Ionized calcium determinations: precollection variables, specimen choice, collection, and handling; proposed guideline. Villonova, PA: NCCLS; 2001. NCCLS Document C31-A. Cheung Soo Shin, Chul Ho Chand, Jeong Ho Kim. Liquid Heparin Anticoagulant Produces More Negative Bias in the determination of Ionized Magnesium than Ionized Calcium. Yonsei Med J., 2006; Apr: 47(2):191–195. Ritter C, Ghahramani M, Marsoner HJ. More on the measurement of ionized magnesium in whole blood. Scand J Clin Lab Invest Suppl. 1996;224:275–280. Toffaletti JG, Wildermann RF. The effects of heparin anticoagulants and fill volume in blood gas syringes on ionized calcium and magnesium measurements. Clin Chim Acta. 2001;304:147–151. Bland JM, Altman DG:Statistical methods for assessing agreement between two methods of clinical measurement.Lancet, 1986,1:307–310. Boyanton B.L. Jr, Blick KE: Stability studies of twenty-four analytes in human plasma and serum. Clin Chem2002,48:2242–2247. Narayanan S:The preanalytic phase an important component of laboratory medicine. Am J Clin. Pathol2000,113:429–452. Ladenson, J., Lii-Mei, B., Michael, M.D., Kessler, G., Heinz, J. Serum versus heparinized plasma for 18 common chemistry tests. Is serum the appropriate specimen? American Journal of Clinical Pathology 62, 1974: 545–552. Burtis, C.A., Ashwood, A.R., 2008. Tietz Fundamentals of Clinical Chemistry, Sixth ed. WB Saunders, Philadephia, pp. 31–43, 42-62. Thorensen, S.I., Havre, G.N., Morberg, H., Mowinckel, P. Effects of storage time on chemistry results from canine whole blood, heparinized whole blood, serum and heparinized plasma. Veterinary Clinical Pathology 21, 1992: 88–94. Martin RF: General deming regression for estimating systematic bias and Ä ±ts confidenceÄ ±nterval in method-comparison studies.Clin Chem2000, 46:100–104. US Dept. Of Health and Human Services. Medicare, Medicaid, and CLIA Programs: regulations implementing the Clinical Laboratory Improvement Amendments of 1988 (CLIA). Final rule. Fed Regist 1992;57:7002-186. Desirable specifications for total error, imprecision, and bias, derived from intra- and inter-individual biologic variation. http://www.westgard. com/biodatabase1.htm.

Developing Orientation Program

Med-Veal handles all administrative functions from the time of the referral until the medical report is delivered to the requesting party. Their goal is to focus on providing excellent customer support while providing high level services to clients all over the country. It is a relatively small company, employing fewer than one hundred employees, many Of which are located at the corporate site in Sterling, Virginia. Med-Veal provides an innovative solution to insurance providers by providing medical examiners that are board certified in their specialties and specialties.All physicians that are contracted with Med-Veal are qualified and free from sanctions or judgments that could compromise their credibility on medical reports. They also provide these services through the united States, so they can be relied upon to locate a qualified provider virtually anywhere. Lastly they provide discounted diagnostic service for Worker's compensation insurance providers, again with facilities avai lable all over the country. The corporate human resources team recently conducted a thorough needs assessment in April of 201 3, and found many positive happenings and orgasm already in place in the company.There were however, several issues that they found during this process that needed to be addressed if they wanted to find contain due success in the industry. One major concern that corporate human resources and management felt needed to be addressed immediately was the high turnover rates within the company. The assessment also showed low employee satisfaction, and much of the staff expressed concern with the fact that was no orientation or onboard program in place, and they were often left to learn the job on their own.There was no formal orientation, with employees spending about 30 minutes with one of the human resource managers to discuss benefits and fill out paperwork, and then about a day being trained by fellow employees on how the computer systems work, and how to sched ule patients for various studies or evaluations. Human Resource Development Intervention Once the needs assessment had been completed, human resources determined that changes needed to be put into place in order to improve employee satisfaction levels, to reduce turnover rates, and to employ a more denaturized onboard and orientation process.If was felt that much of the emphasis should be placed on developing an onboard process and training program, and in doing so it was felt that the turnover rates would drop and the satisfaction rates would rise. Therefore an action plan was implemented in order to create an onboard an orientation program. According to author Patricia Duration (2007), there are three key elements of a successful onboard program. These include a clearly identified process, having the support of managers and other organizational leaders, and aging sure there is timely follow up at the close of the orientation class.Because there was no formal onboard program or ori entation program in place, it was quickly realized that these were all areas that required improvement. There was no traditional onboard process. Employees were brought in, and immediately put to work with very little training. The expectation was that they would learn about the values of the company as they worked. Training was limited and provided on the job. This complaint was felt amongst many of the employees, especially those that were in the independent medical evaluation group which requires being very detail oriented, and able to handle many tasks quickly and effectively.There was no clearly defined program to bring new employees up to speed and train them properly on their respective positions. As the human resources team evaluated these events, they realized that the first step was to come up with the objectives of what they want their new onboard and orientation process to accomplish. This starts with creating a proper training program for new hires. Instructional Design Plan In order to address this problem effectively and create an effective unbarring and orientation program it is important to assess what measures need to be taken.It is imperative that human resources has a broad understanding of the learning style of the participants in order to create the proper objectives for the instruction. In this case, what is needed is a plan to create a more comprehensive onboard and orientation. The objective here would be to create an onboard that answers all questions that new employees might have, to make sure that employees are properly oriented to the company and their position, and that training rules are in place so that employees do not feel that they have been placed in a sink or swim situation.Learning Objectives By completing the instructional design plan, and combining that with the results of the needs assessment, as well as feedback from surveys given to management and employees, it is possible for the Human Resources team to be able to de termine what objectives are important for them to meet in order for new orientation classes and onboard sessions to be successful. In this case the first training session will need to focus on the importance of the onboard program.In this particular case, this session needs to involve a ore detailed overview of the company structure, as this will assist new employees in better understanding the inner workings of the company, and know the proper protocol to follow when questions arise. Objective number two relates to the fact that this is a very specific type of work environment, because you are dealing with workers compensation, and the specific rules and regulations that each state has.It is understood that many of the new hires do not have specific training in workers compensation programs, and that significant time will need to be spent explaining workers compensation ales and regulations, and how they differ from state to State. The third major objective that needs to be address ed in this program is customer service and the importance of provident excellent service to the customer. New employees need to be trained on how to handle various issues when they arise, while keeping the customer informed of the situation at all times.New staff needs to have an onboard and orientation process of at least two weeks. The first week in the onboard sessions, learning about company culture, and having in-services on customer service. In the second week of employment the new employee should be assigned to a senior team member whom they can shadow and be properly trained in their position. Lesson Plan According to Werner and Decision (201 2), an effective lesson plan lays out the step by step agenda of the training process.In the case of Med-Veal, this lesson plan is being established for a new employee onboard and orientation class. Onboard and orientation are to take place at corporate headquarters in Sterling, Virginia, and this will not change. Or in the case of SST. Choir Hospice, the plan for the new employee orientation class. As previously mentioned the first week will be the onboard process, where they will learn company culture, meet various staff members including members of human resources, management and payroll.A sample lesson plan would be as follows: Med – Veal On – Boarding Day 1 Objective: To Introduce new employees to Med – Veal. To inform them of the corporate culture, history and mission of Med -? Veal. Preparation Required: 1. Physical Environment – This course will be taken in the main conference room. All participants will meet there. 2. Equipment and Materials -? Materials ill be provided by Med – Veal. They will include paper and pen for note taking. Employee handbook will be provided during this session. We will require a laptop and projector set up, to be provided by IT. 3.Instructor 4. Participants -? DB – New Hires to Med -? Veal: Onboard class to be the First Monday of each mo nth as necessary to accommodate new employees. Day 1 9:00 -? 9:30 – Introduction and ice breaker. Have new employees get to know 5 facts about their new coworkers, and share these with the rest of the group. 9:30 – 10:30 Introduction to Med – Veal. This session will include history of Med – Veal, and discussion of the company mission. Also discuss code of ethics. 10:30 – 12:00- Meeting with HER staff. Discussion of benefits, and services offered to Med-Veal employees. 2:00 – 1:00 – Break for Lunch 1 -? 2:30 – Introduction to MIME department. Discuss the purpose of MIME. Overview of breakdowns within the department and the differences that can be found from state to state. Discuss the differences between a deposition, an MIME and a DAME. This section with be covered by Shannon Checker – MIME Manager 2:30-3:30 – Introduction to CICS and Diagnostic Department – Discuss duties of this department. Explain differ ences between CICS and MIME departments. Discuss where the referrals come from. Explain the process of getting referrals, and provide overview of procedures.This section will be covered by Lindsey Jensen -? CICS Manager 3:30 – 3:45 -? Break 3:45 – 4:30 – Introduction to CSS department. Discuss how this department provides support to MIME department. Provide overview of job duties and responsibilities. This section will be covered by Even Wagner -? CSS Manager 4:30 – 5:00 – Review of material covered in day one. Answer any outstanding questions. Provide overview of onboard session for day 2. Instructional Methods The instructional methods for this program will be handled in an lecture setting, using instructor led live programs.There will be discussion Of corporate culture, set in a question and answer forum. With the use of audio visual devices they will be able to provide the necessary information to the new hires. There will also be industry spec ific material presented, as worker's compensation has very specific rules that need to be adhered to. There will be a question and answer period at the end of each session, and then there ill also be testing will be given at the end of each day to determine what the new employees have learned, and what they are retaining.Instructors can then determine based on the testing results where and if any additional training needs to be provided to the individual new hires to ensure that they are retaining the necessary material. These training sessions will be provided during working hours which are from 8:00 AM to 5:00 PM Monday through Friday. They will break for a one hour lunch daily. Once the first week of onboard has been completed the employee will then move on to the second week of the orientation process which will be done in a one on one setting with senior team members.This on the job training will allow new employees to sit with various senior team members to be trained in multi ple aspects of the position, and also for them to see that they have several different resources available to them. This will provide additional support to the new employees not just from management, but also from senior team members who have the experience. By doing this new hires should feel more secure in their job before they begin, and should ultimately reduce the mount of turnover that Med-Veal is facing.

Heroic Criminals Essay

All throughout childhood we are taught that breaking the law is bad and the people who do are criminals and should be punished. Edward Abbey, author of The Monkey Wrench Gang, and Carl Hiaasen, author of Sick Puppy, alter these thoughts. Both novels focus on adventuresome environmentalists who stir up trouble in means of standing up for their beliefs. Both Abbey and Hiaasen construct higher and natural laws over the traditional justice system that gives characters justification for their actions. Ethically we as humans should not side with these rebellious characters, but the theme is so central in the books cover-to-cover that we, as readers, lose sight of morals as the authors manipulate us to become completely invested in these heroic criminals. With sharp uses of characterization and description, Edward Abbey glorifies the art of law breaking and leaves his readers cheering for the heroic criminals. Throughout The Monkey Wrench Gang, the group of four activists set out to destroy bridges, signs, bulldozers and anything else harming the American southwest. From the very beginning, Abbey illustrates a scene full of the workings of the justice system in his prologue. When describing the ceremony to open the bridge he states, â€Å"the bridge stands clear and empty except for†¦a symbolic barrier of red, white and blue ribbon stretched across the bridge from rail to rail† (3). If the sense of patriotism wasn’t evident enough through images of children eating ice cream cones and people drinking Coca-Cola before that, Abbey drapes the bridge in the colors of our nations flag. His portrayal of the project seems to be adored and almost sponsored by America. He uses the writing technique of verisimilitude throughout the prologue to captivate readers and make them anxious to see who disapproves the project. This is a true introduction and welcoming to rebellious characters. As the novel progresses, we become familiar with the gang: Hayduke, Bonnie, Seldom Seen and Doc, as they are driving through billboard signs. Some readers might lose respect for the characters because their actions seem hypocritical and pointless. Their actions are against the law. But then Abbey slowly develops the characters and gives them justification for these criminal actions. He does this with Hayduke criticizing the construction of bridges, â€Å"They can’t do that; it ain’t legal. There’s a law against it. A higher law† (27). The phrase â€Å"higher law† justifies the gang’s destruction because they are taking a stand to save the environment, the beautiful American southwest. As destruction projects get bigger, we find ourselves rooting for these criminals because they are heroes. And we find ourselves captivated in the novel with Abbey’s clever use of an episodic plot. He arranges plot elements into a story and although we aren’t deep into the character’s lives, the focus on episodes drives us forward. As Abbey slowly develops the protagonist characters, he introduces the character, Bishop Love, who we as readers coin as the antagonist. Once again Abbey manipulates our morals as we begin hating the character who could possibly bring down our rebels. Bishop Love exclaims, â€Å"We might get them on the Mann Act come to think of it-crossing the state line for immoral purposes† (296). The fact that the Mann Act was first established to regulate prostitution across state lines cleverly draws us against the bishop’s character and law in general. Abbey’s use of an actual law brings the entire chase back to reality as we still see ourselves siding with the heroic criminals. Abbey actually creates this chase into a war and the heroic criminals become heroic war veterans. As the chase continues, Hayduke once again defines this higher sense of law and justification for war, â€Å"I sat in that rotting jungle every night, playing with my chain, and all I could think about was home. And I don’t mean Tucson†¦I thought about the canyons† (359). This is a very lively twist on the patriotic term war because when we think of war we think of Americans going into another country. Here, Americans are in a war in America against other Americans. And because of this, someone is breaking the law or going against the law. As true as that statement is, we find ourselves naming the criminals as the war heroes through Abbey’s manipulation. Although in the end these heroes are captured and the project seems to be brought to an end, the denouement proves to serve poetic justice. The epilogue consists of Doc, Bonnie and Seldom being almost immediately bailed out of jail, Bishop Love in slow recovery, and the survival of the most prominent environmentalist, Hayduke. Such a fitting ending for our manipulated beliefs. Similarly to Edward Abbey’s manipulation of our morals through characterization and development, Carl Hiaasen uses the same techniques within the theme of criminal heroes. Right off the bat, we meet Twilly who is the definition of activist. We quickly learn that if he doesn’t like something, he takes immediate action. And it’s not with anger that he takes action, but disappointment, â€Å"†¦if I was really pissed, I would’ve done it on a Monday morning, and I would’ve made damn sure my uncle was inside at the time† (19). This is in response to his therapist asking if the reason he blew up a bank was due to the fact that he was angry his uncle made a loan to some â€Å"rotten people† (18). We aren’t really introduced to the proper sense of law as we were in The Monkey Wrench Gang, but such grotesque images of the characters in political positions make us see them as the bad guys and the person who blows up a bank as a hero. More grotesque images develop as we learn about Robert Clapley and his Barbie dolls and Palmer Stoat and his trophies. So even though we want to hate the main characters, we hate who Hiaasen wants us to hate more. With this manipulation technique and Hiaasen’s rapid tonal shifts between parallel characters, we find ourselves not being able to put the novel down. He creates a sense of higher law that gives us a place to go and pretend we’re there with Twilly being a heroic criminal and activist. Hiaasen also does not overstep his boundaries with this sense of higher law as characters are able to resist destruction. In the scene where Twilly and Desie are driving behind a lady in a Lexus who threw her cigarette butt out the window, Twilly wants to put her car up in flames, but he lets off (219). Although we are already on Twilly’s side, the fact that he can resist gives him more respect as a â€Å"criminal. † Once again, in the reader’s eyes, what makes him a hero is how Hiaasen develops the negative characterization of characters like Clapley, Gash and Stoat. In a very grotesque scene between Clapley and Stoat, Stoat explains, â€Å"The important thing is, that nutty kid is finally out of the picture. And, oh yeah, Desie and Boodle are OK, too. Not that I give a shit† (360). Immediately after this is said, â€Å"Clapley finds himself gazing past Stoat, at a dancer performing in a nearby booth†¦Ã¢â‚¬â„¢if only she was taller’† (360). As illustrated, Clapley and Stoat are both sick people and we want them to be punished and destroyed. We are pulling for Twilly to torture them and win. The novel takes shifts towards a focus on the greed of politics where nature is just a victim and Twilly is standing up for it. In another beautiful example of poetic justice, the epilogue is used as a framing device to bring the novel full circle. In one example, the novel begins with Stoat hunting a rhino and ends with him being impaled by one (429). The ending of our other hated character, Robert Clapley, comes full circle as his most prized possessions, Katya and Tish, become, â€Å"†¦a trademark symbol; this order to include but not expressly be limited to such oral and visual depictions as ‘Goth Barbies’, ‘Undead Barbies’, and ‘Double-Jointed Vampire Barbies’† (445). This is a direct occurrence of what Clapley didn’t want to happen and we find ourselves giggling about the fact. The sense of the novel as a political cartoon truly adds to our enjoyment as readers and superb justification of higher law and love for heroic criminals. In conclusion, both Abbey and Hiaasen create a new definition of criminal through manipulating our morals in their development of characters and justifying it with the sense of a higher law. Adventuresome environmentalists deface and destroy many things, yet we find ourselves as readers cheering for them to do so and get away with it. Ethically we should not side with these rebellious characters, but we truly are completely, 100% invested.

The Picture of Dorian Grey by Oscar Wilde - 768 Words

Psychological Freud’s belief was that mental health and psychological wellness requires a harmonious relationship between the different parts of the mind and a lack of harmony can lead to neurosis. Plato invented the original tripartite and Freud expanded on it in 1923. The tripartite is divided into the sections: The Superego, the Ego, and the Id. The Superego is basically the conscience of our mind. The Ego is consciousness created by the combination of the Id and Superego. The Id is having thoughts of instincts and drives which are necessary to satisfy. In Oscar Wilde’s The Picture of Dorian Gray, we see the main characters representing the Superego, Ego, and Id. The Superego is representative of our conscience and is opposite of the id. â€Å"Superego† comes from Latin and really means â€Å"above the ego†. It is the greatest power of our mind. The superego is what most people would call the conscience or where a god would be. The Superego is a basis for how we view the world, social norms, and morals. Also, as the Superego portrays the conscience, it holds our sense of wrong and right. We have to follow the needs of the Superego or else we might feel some guilt or shame. Freud said that the Ego is the mediator between the Id and Superego and the outside world. For the Ego to do its job, it has to delay the desires of the Id until it is socially acceptable to give the Id the needs. So our conscious-driven Ego is a balance of the Id and Superego, evening out our primal needsShow MoreRelatedThe Picture of Dorian Grey by Oscar Wilde800 Words   |  3 PagesOne of Oscar Wilde’s most challenging themes, not only in his writing, but also in his professional life, is that of formulating an authentic identity in the realism of a hedonistic, pleasure-seeking lifestyle without boundaries. 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While both novels share similarities in their use of syntax, as well as their overall structure, The Picture of Dorian Grey and Frankenstein are almost complete opposites when it comes to the execution of these elements. The use of syntax in The Picture of Dorian Grey and Frankenstein are utilized forRead MoreProposal for A Narcissistic study of The Picture of Dorian Grey919 Words   |  4 Pagesï » ¿ A Narcissistic study of The Picture of Dorian Grey General Overview Oscar Wilde’s The picture of Dorian Grey’s novel is about a young man named Dorian Gray, the subject of a painting by artist Basil Hallward. Basil is impressed by Dorians beauty and believes his beauty should not be wasted and it is responsible for a new mode in his art. Dorian meets Lord Henry Wotton, a friend of Basils, and becomes enslaved by Lord Henrys world view. He shows him a new hedonism, and suggests the only thingsRead MoreEssay on Oscar Wildes Success at a Gothic Novel1489 Words   |  6 PagesIn this essay I will be looking at how successful Oscar Wilde was at creating a gothic novel. I will be using Edgar Alan Poe’s short story The Fall of the House of Usher and the film Bram Stokers, Dracula and the The Picture of Dorian Gray. In this essay I will be looking at how successful Oscar Wilde was at creating a gothic novel. I will be using Edgar Alan Poe’s short story ‘The Fall of the House of Usher’ and the film ‘Bram Stokers, Dracula’ and the earlier version ‘Nosferatu’ asRead MoreImmortal Literary Combat: Against Nature vs. Thoreau1290 Words   |  5 Pagesis to Dorian Grey, as Henry David Thoreau is to Christopher Mccandless; The story of Des Esseintes, in the book â€Å"À rebours† changed Dorian Grey, it, among other things, influenced him to commit horrible atrocities like manipulation, and murder. Just as Henry David Thoreau’s book â€Å"Walden,† along with many other great literary works, enlightened and influenced Chris Mccandless to go back-packing across the country in pursuit of a life full of adventure, simplicity, and contingency. Dorian Grey andRead MoreCompare And Contrast The Picture Of Dorian Grey And The Count Of Monte Cristo1191 Words   |  5 PagesIn both Oscar Wilde’s The Picture of Dorian Grey and Alexandre Dumas’s The Count of Monte Cristo the main characters are lend to believe in a greater notion of life. Specifically, Oscar Wilde and Alexandre Dumas appear to illustrate the idea that one cannot better themselves through others. Both protagonists, Dorian Grey and Edmond Dantà ¨s fail to recognize and act on their own fortune and, consequently, seek out to better themselves which eventually leads to their downfall. In both The PictureRead MoreIs Masculinity Defined Within The Comedy?2332 Words   |  10 Pagesforms but specifically in the portrait â€Å"Dr. Pozzi At Home† by John Singer Sargent and the book â€Å"The picture of Dorian Grey† by Oscar Wilde. The question I want to address is how was masculinity defined in the victorian era by these artist and how did this have an affect on society and their perception of the victorian man. There were many controversies, a mighty significant one surrounding Oscar Wilde, about how these artist defined masculinity and how they presented the victorian man with not onlyRead More Essay on the Human Spirit in Frankenstein and Picture of Dorian Grey757 Words   |  4 Pages Similarities of the Human Spirit innbsp;Frankenstein and The Picture of Dorian Greynbsp;nbsp;nbsp; nbsp; The human spirit is one of the most beautiful forces in the world, but it is also one of the most vulnerable. In the novels Frankenstein by Mary Shelley and The Picture of Dorian Grey by Oscar Wilde, this idea of the human spirit is portrayed clearly. Both novels have similar aspects about the human spirit, but they also have their differences. Both novels have main characters who