Relationship Between Zinc and Heart Disease

Relationship Between Zinc and Heart Disease Otoniel Santiago Shanil Juma, PhD Cardiovascular disease (CVD) is the number one common cause of morbidity and death in all ethnicities. There are many contributing factors associated to this disease, which include: atherosclerosis, type 2 diabetes, high cholesterol, lack of physical activity and obesity1-3. Despite the many studies performed in these areas, nutrition and nutritional status play a major role in the decrease of CVD. One area that has been look at for almost a decade is the relationship of micronutrients in preventing the onset of cardiovascular disease. Although there are still many controversies in the areas of diet and obesity, the role of micronutrients especially zinc, have been closely studied to identify if its levels have any effect in reducing or potentially inducing cardiovascular disease. The purpose of this report will be to briefly discuss how zinc levels may play a role in promoting cardiovascular disease or preventing it. Zinc Functions Zinc is known as one of the essential trace elements vital for maintaining normal physiology and cellular functions in the body.1 It was during the 1960’s that zinc deficiency was discovered after it was found that dwarfism and delayed sexual maturation were related to zinc. This discovery lead to an increase in clinical studies in order to understand the critical role of zinc in human physiological growth and its relation to other conditions such as, dermatitis, impaired taste, and impaired immunity to name a few.1 Nonetheless, the role of zinc is not completely understood. This trace element has only been known for the past 50 years, but it has been clearly documented that it can improve an array of conditions like acute diarrhea in children, the common cold, and reduction of oxidative stress, the making of genetic material and wound healing. In all, zinc plays a major role in protein synthesis, thus, making it one of the most essential micronutrient needed for optimal healt h in the human body. Zinc and Heart Disease Zinc has been known for its many protective capacities and functions. However, low zinc levels have been associated with age, disease and lack of nutritional intake. It has been found that zinc deficiency increases the inflammatory response caused by increased vascular oxidative stress.2 For instance, in patients with type 2 diabetes suffering from cardiovascular disease, it was found that zinc serum levels were low3. Despite the fact that low serum zinc levels were found to be an independent factor for heart disease in patients with type 2 diabetes, non-diabetic patients who suffered from CVD was related to lower consumption of zinc.3 Zinc deficiency can also be associated to malabsorption caused by gastric conditions such as Chron’s disease and celiac sprue, or conditions like diabetes which increase zinc loss due excessive urinary output4. A study conducted by Frustaci et al, looked at selenium and zinc deficiency to identify if cardiac malfunction could occur with individuals who suffer from intestinal malabsorption. The study found that there was a great association of between the deficiency of selenium and zinc and the degeneration of cardiomyocytes5. Although this study looked into two micronutrients, it is important to point out that zinc played a major role in this study. As mentioned previously, zinc is an essential trace element that works in nearly over 300 enzymes exerting catalytic, structural, and regulatory functions4, 5. In addition to these functions, a deficiency of zinc can cause cell apoptosis and necrosis due to its role in growth and development. On the other hand, selenium has been associated with the Keshan disease that causes progressive dilated cardiomyopathy5. Both elements serve as antioxidants detoxifying cardiomyocytes from free radicals and a deficiency of any of these two elements can cause a decline a cardiac function5. Patients in this study were treated with a selenium/zinc infusion of 13.6 mg/d/wk for about six months. The group was divided into two groups consisting of one group of (A2, n=8) and another (A1, n= 10).5 All patients in group A1 received cardiac catherization, and an endomyocardial biopsy, while the A2 group were only treated with anti-heart failure therapy. Nonetheless, after the six months was completed group A1 showed an improvement in their left ventricle dimension when compared to the A2 group who only received supportive therapy5. The study determined that a selenium and zinc cardiomyopathy can occur in patients with intestinal malabsorption and that an infusion of both elements can improve a nd possibly prevent the malabsorption associated cardiomyopathy5. In another study conducted by Soinio et al, after a seven year period follow up on both non-diabetic patients and type 2 diabetic patients, it was found that there was an increase in mortality from CVD in patients with lower serum levels of zinc (≠¤14.1 µmol/l) then those who did not (14.1>  µmol/l)3. Most patients on this study were between the ages of 45-64 and the population consisted of 1,050 patients from West and East Finland where 526 were men and 470 were women. Each participant was examined for zinc serum levels after a 12hr fast. Zinc serum levels were determined through atomic absorption spectrotometry after 10 years from stored samples. Out of the 1,050 participants 156 died of coronary heart disease and 254 patients suffered a myocardial infarction. The rest of the surviving participants were divided in groups of non-insulin treated and insulin treated subjects. Those with insulin treatment had a 15.3  µmol/l of fasting serum zinc levels when compared to the non-insulin treatment that had 15.8  µmol/l fasting serum zinc levels. However, after breaking the result into quartiles the results were that low serum levels were an independent risk factor for coronary heart disease for coronary heart disease and fatal/non-fatal myocardial infarctions in patients with type 2 diabetes3. Nonetheless, most of the lower serum zinc levels found in diabetics was related to urinary zinc excretion when compared to non-diabetics. It is important to point out that zinc play critical role in the synthesis and function of insulin and the inhibition of pathways that can lead to apoptosis and possibly the upregulation caspase genes3. In this study zinc was added to in vitro insulin preparations to extend the time of insulin action. Despite insulin being added to the treatment of 149 of the participants with type 2 diabetes, serum zinc levels had no considerable changes between the two groups. Thus, there is a possibility that zinc supplementation may be useful to prevent atherosclerotic complications in type 2 diabetes individuals3. Another study showed that coronary artery disease was more prevalent among individuals with diabetes4. In the same study patients with coronary artery disease had higher urinary excretion of zinc when compared to those without coronary artery disease. In addition there was no association with the zinc levels and diseased arteries, but there was an increase in urinary zinc loss and the number of diseases arteries4. In relation to diabetes mellitus similar to the study performed by Soinio et al, patients with diabetes excreted greater amounts of zinc when compared to normoglycemic individuals4. Regardless of the zinc loss linked to diabetes mellitus and polyuria, zinc concentration was not associated with the onset of coronary arterial disease. The loss of zinc, on the other hand, correlated to the severity of the coronary artery disease. Consequently, the loss of zinc causes a shift of zinc from the intracellular fluid to the extracellular fluid to maintain homeostasis. Thus, affectin g zinc dependent enzymes such as the activating nuclear factor Ä ¸B and the reduction of nitric oxide bioavailability and the macrophage-mediated oxidative modification of LDL cholesterol along with the inflammatory cascades associated with it that ultimately promote atherogenesis4. On the other hand, zinc only accounts for about 0.1% of total body pool and zinc plasma concentrations are an insensitive marker for whole body reserves. Thus, the use of the urine zinc/24hour ratio is a better marker to reflect the risk of coronary artery disease. This was compared to other studies that identified that children from parents with coronary artery disease had higher zinc urinary levels. Suggesting that genetically predisposed children with coronary artery disease have in a long term, ongoing zinc losses taking place before the manifestations of clinical symptoms4. Yet, the question still remains whether supplementation of zinc in individuals with low zinc serum levels could prove to be beneficial to prevent or eliminate cardio arterial disease. In relation to children Sadoh looked if there was any relationship in loss of serum zinc levels with congenital heart diseases and pneumonia. Sadoh looked at 41 Nigerian children with confirmed congenital heart disease and 41 without congenital heart disease. Because congenital heart diseases with left or right shunt are associated with pulmonary over-circulation, which leads to congestive heart failure, the loss of serum zinc levels seem to be increased with pneumonia6. In addition, it has been shown that patients with heart failure who are also receiving diuretic therapy are prone to develop zincuria. The medications associated with zincuria are thiadize and angiostenin converting enzyme inhibitors. In poor countries like Nigeria, children are forced to live with chronic heart failure and the bronchopneumonia, which as mentioned previously can cause low zinc levels. Another possibility for these children to have low zinc serum levels can be related to poor food intake and absorption that arises from the malnutrition they are exposed to6. All participants were evaluated for congenital heart disease and any febrile conditions that would had altered results. In any case, patients would have had to resolve the febrile condition prior to the commencement of the study. Patients were seen every month for seven months were 3 ml of blood was collected from each person. Serum zinc levels were evaluated using the Dogan et al method and atomic absorption spectrophotometer6. The results showed that the mean zinc levels in children congenital heart disease was 101.3 ± 21.6  µg/dl when compared to the controlled who had 106.5  ± 18.3  µg/dl. In children less than one years of age, the mean serum zinc was the highest at 102.6  ± 30.7  µg/dl when compared to children ten years and older at the lowest levels 94.8  ± 12.4  µg/dl. Sadoh also compared children with bronchopneumonia whose zinc levels were lower 89.5  ± 15.0  µg/dl indicating an increase loss of zinc due to the disease. When compared to children without bronchopneumonia, the zinc levels were at 103.9  ± 22.2  µg/dl6. This study showed that congenital heart failure along with complications such as bronchopneumonia increases the chances of low zinc serum levels. Zinc plays a major role as an acute phase reactant in bronchopneumonia thus, causing its depletion in children with both of these conditions. Whether the patients with severe pneumonia usually have low zinc serum levels, the combination of both pneumonia and congenital heart disease make patients more susceptible to low zinc levels. The same is applied to patients with chronic congenital heart disease, although their levels seem to be lower due to the use of diuretics as a treatment. In all cyanotic congenital heart disease patients had higher levels of zinc when compared to those with acyanotic congenital heart disease6. In this study no zinc supplementation was used, but it can be safe to say that a supplementation could have resulted in improvement of both conditions as seen in the previous studies. Conclusion Zinc appears to have protective effects in coronary artery disease and cardiomyopathy in individuals suffering from type 2 diabetes and children with congenital hearts diseases. Intracellular zinc plays a critical role in the oxidative stress reduction protecting from the inflammatory response caused atherosclerosis, type 2 diabetes, and other diseases. Zinc supplementation has been shown to improve cardiac function and prevent further damage. Thus, its investigation, although emerging in the cardiovascular disease research, its mechanism needs to be better understood in order for it to be used as a preventative and treatment of cardiovascular disease. References Little PJ, Bhattacharya R, Moreyra AE, Korichneva IL. Zinc and Cardiovascular Disease.Nutrition26.11/12 (2010): 1050-057. Abdel-Khalek Abdel-Salam N, Wessam Aly W, Ahmed Hamza S, Mosfata Fahmy H, Kamel Mortagy A. Relation between zinc level and one year mortality among elderly patients with heart failure.Egyptian J H Med. 2014;54:11-14. Soinio M, Marniemi J, Laakso M, Pyà ¶rà ¤là ¤ M, Lehto S, Rà ¶nnemaa T. Serum zinc level and coronary heart disease events in patients with type 2 diabetes. Diabetes Care. 30:523-528, 2007. Giannoglou G, Konstantinou D, Kovatsi L, Chatzizisis Y, Mikhailidis D. Association of Reduced Zinc Status With Angiographically Severe Coronary Atherosclerosis: A Pilot Study.Angiology. July 2010;61(5):449-455. Frustaci A, Sabbioni E, Fortaner S, Farina S, del Torchio R, Tafani M, Morgante E, Ciriolo MR, Russo MA, Chimenti C. Selenium- and zinc-deficient cardiomyopathy in human intestinal malabsorption: preliminary results of selenium/zinc infusion. European Journal Of Heart Failure. February 2012; 14(2):202-210. Sadoh WE, Sadoh AE. Serum zinc values in children with congenital heart disease. African Health Sciences. September 2013; 13(3):601-606.

A Comprehensive Feasibility Study For The Establishment Of Paintwork T-shirt Printing House

A COMPREHENSIVE FEASIBILITY STUDY FOR THE ESTABLISHMENT OF PAINTWORK T-SHIRT PRINTING HOUSE Introduction Nowadays, printed shirt are almost seen everywhere: school uniforms with the school logos printed on it, advertisements printed on shirts, title of an event, different cartoon characters, quotable phrases and lot more things printed on shirts. There are many processes of transferring a design to a shirt. Computer printed designs, screen printing process, heat transferred images, and painting the shirt itself.In these modern days, things are done in faster ways; that is why computers play varieties of role. Computer printed designs are among the most common in the market today. One can have his own picture printed in a shirt in just an hour or he can even personalize a design that he likes to be printed in his shirt. A design can also be transferred in number of shirts in a clothing company. This computer printed shirt is the focus of this feasibility study. We come up with this pr oduct to compete in the demand of modern days’ consumers.In addition to computer printed shirts, we also come up with the idea having painted designs as an art design exclusive for each company. Images add art to the printed shirts. It livens up the clothing and gives more attraction to those who see it. Universities have their university shirts or organizational shirts, which is sometimes used by the students as their uniforms. Our business is targeting this opportunity for us to give them a uniquely designed t-shirts that will surely be appreciated by the students and other group of people.In addition to this, we also aim to create our exceptional own painted design for some organizations who conduct events and some small companies in the country. The Concept PAINTWORK conceptualized a production enterprise that will be the producer of painted designed and computer printed shirts in some other schools in the country particularly in Polytechnic University of the Philippines (the four owners’ alma mater). We plan to create the products not for retail purposes but as a wholesale supply catering to the needs of the targeted market for their painted shirt uniforms, section shirts, organization shirts, batch hirts and other customized shirts. Nowadays, computer printed shirt designs are common in the market, so as the screen-printed designed shirts. Computer printed designs though are more modern and has more quality with designs. It being an easy process to transfer a design to shirts with exclusive painted design for each company is our unique selling proposition. Our business oriented and hip designs are popular especially with the teenagers, students and the young.We come up with this product believing that we can supply the needs of consumers to have more modernized and likeable designs in its best outcome. Although we are new in this kind of business, we still can promise the best outcome and produce very good quality painted designed computer printed shirts that can be used in events, organizational uniforms, school uniforms and other more occasions. The price will be based on the cost used to create the product. Our painted shirts will surely compete in the market in terms of pricing but we are confident that ours is a product that is worth to be paid for.Objectives As stated in the concept for its creation, PAINTWORK will paint designed shirts that will be used for uniform purposes in school organizations, small companies, events, and some institutions. PAINTWORK is comparable in the market in terms of pricing but the process of production and high quality end product differs. The designs are personally made and manually transferred to the shirt resulting to excellent classy products that will satisfy the consumers.The objective of our company is to be more competitive in the market and to be the leading manufacturer and supplier of paint designed computer printed shirts in the Philippines. * Short Term Objectives * To build a good rapport with the consumers and to the people. * To maintain a good working relationship with all our employees and also to the suppliers. * To be the favoured company of the leading universities and some companies to supply them our shirts with hand painted designs. * Long Term Objectives * Our company’s objective is to be the leading supplier of the printed hirts for the next 5 years in Polytechnic University of the Philippines to be used on the General Assembly of the students of Institute of Accounts, Business and Finance, and also for some universities in the country. * Our business will endeavour to be an excellent company here in the Philippines that will be loved by the Filipinos and eventually we can export our products to other countries. Company Logo Organizational Chart ZAILEEN A. CULATA Sales Supervisor AVEGAIL C. LUCERO Office Supervisor PAULINE AGNES VELASCO Production Supervisor TITO M.PINEDA III General Manager Production workers Assistant PAINTW ORK will be having four main heads for its organizational chart. Every partner will be assigned to each department to assure the harmony and proper management of the entity. The four partners are distributed in four main positions in the company such as general manager, production supervisor, sales supervisor and office supervisor. The establishment will hire three sociable and customer-oriented crews. Two crews will be assigned in printing and editing the t-shirt design; one crew will assist them.Neither of the pioneers will supervise the over-all development of the business. Manpower Requirement 1. Job Title: General Manager * Responsible for the whole organization and the business operation. He is also responsible to the following functions: * Must see to it in carrying out or handling the day-to-day operations of the business. * Must plan out various developments for maximum profitability of the business. * Must render wise decisions for the changes and improvement s of the busi ness operation. * Must assure to every customer that they can produce quality products they needed. 2.Job Title: Production Supervisor * She is responsible for supervising the production workers in the whole process of production and maintenance of the area. She also approves or edits the original design from the business or personalized design from the customers. 3. Job Title: Sales Supervisor * Sales supervisor is responsible for marketing and delivery of the product. She is in charge in dealing with the customers. 4. Job Title: Office Supervisor * She is responsible for supervising the office works. She manages the accountant and the clerk in the office. 5. Job Title: Production Workers They are the ones responsible for transferring the designs to the computer, printing the shirt, drying and packaging of the products. They deal with the whole process of producing the best paint designed computer printed shirts. 6. Job Title: Assistant * Serves as a clerk that assists in all the o ffice works. Services Offered Paintwork will offer services on customized, personalized t-shirt printing and editing design. Products will be made in its highest quality, perfect for corporate gifts, batch shirt, uniforms, give away, couple shirt, university shirts and more.Our aim is to delivering quality garments made to your design and specifications at a competitive price by using the latest printing techniques for any occasion. If you’re in the market for an individually stylized piece of apparel, we’ve got everything you’re ever likely to need! T -shirt printing designs is what we’re all about and regardless of whether you have an idea of your own in mind, or you fancy one of our best sellers, the garments we will supply you with will be of a superior quality. We pride ourselves on the reliability of service we will offer. Actual PlanPAINTWORK will be built outside the Polytechnic University of the Philippines, specifically in Newton’s Plaza, Sta. Mesa, Manila. Initially, the three sociable and customer-oriented crews will handle the production of customized, personalized t-shirts and designs. Rest assured that the ambiance of the establishment is excellent to make customers feel comfortable. Floor Plan Future Plans After six months of operation, PAINTWORK will launch its latest additional product offers such as personalized banners and tarpaulins. After a year, a branch is planned to build but the location is not yet final.These measures are intended to provide the same quality and affordable customized, personalized printing of shirts and advertisement designs to students, companies and others. Facilities The business should have the following facilities to be able to operate: 1. Office * Having an office is necessary to accommodate customers and to serve as an area for people to work. 2. Printing Room * The business needs its own printing room to meet the standard of the consumers in printing t-shirts. The room has m achines for printing and other equipment in need to do the products. 3.Sewing Room * It is where the products are being sewed to add design with the t-shirts. Production Process 1. Creating the Design. This is the first step in producing the painted shirt. The design must first be done and drafted for the next step to continue. In this step, the consumers must agree with the design being suggested or pass his personal design. The colors to be used must also be enumerated. 2. Transferring the Design to the Computer. 3. Printing the Shirt Design. This is the main step of this process; this is where the design is being transferred on the shirt. . Drying Drying is very important in this process because once the painted design is not dry, it might be ruined and the shirt will not be used at all. The painted shirt is dried through blowers for quicker drying. 5. Checking of Shirt This step is done to ensure that all the painted shirts will turn out as expected, excellent and with a classy result. 6. Packaging This is the last step of the production process where in the finished painted shirts are placed in a cloth bag as it packaging. After this, the painted shirts can be delivered. Production The process of production was practiced very well and perfected to have a product with a high standard and quality that will be best suited for its consumers. * All employees / workers are trained proficiently and must be very knowledgeable on how the process of production goes as well as the proper use of facilities and equipment. * Materials come from reliable sources with their own safety measures to have a quality and trusted product. * The business also sees to it that there are enough materials so as not to delay the production process.Packaging PAINTWORK Designed shirts are packed in cloth bags. These are better than the usual packaging that comes in plastic sack. Quality Control Our business ensures the quality and unique prints of the shirts to meet the customerâ€℠¢s satisfaction. In order to prove the business’ claim that it is 100% worth to be paid for, we set our guidelines and policies for the workers to follow in the production of our product. Investments The owners made the following investments to meet the goals of the business: EquipmentP35,000 OfficeP 45,000 Initial OperationsP25,000TOTAL COSTP 105,000 The equipment include the sewing machines and the printing machines while the office includes the facilities like tables and chairs in the main office, printing room and sewing room. Profitability Analysis The simplest way of approximating profitability is to assume the expected payment of the consumers and subtract from it the expected expenses. The t-shirt costs P160. 00 – P300. 00. In example, a customer ordered 50 shirts and the quality of its design costs, let’s say, P200. 00 each. 50 shirts X P200. 00 = P10, 000. 00For instance that the cost of expenses on each shirt is P120. 00, the business will earn a prof it of P80. 00 for each shirt, with the total of P4, 000. 00, that is for 50 shirts. The profit of the company depends on the number of shirts a customer will ask. Thus, this computation is in approximation and still subjected for any changes if such is to be proven needed. Operational Expenses As for the computation, operational expenses are estimated to be around P120. 00 per shirt. For instance, there are 50 shirts to be printed (P120. 00 x 50), a total of P6000. 0 is the operational expense incurred. This amount should therefore be watched to monitor the operational expenses of the company. The general manager in this sense should consider allocating the remaining retained earnings as an allowance for PAINTWORK. Break-Even Point Analysis PAINTWORK initially invested P105, 000. 00 which is recoverable immediately after an approximately 5 months of successful regular operations. The management placed the shirts at a price range which is cost effective and considering wholesaler as our major target market.The average price of a t-shirt is P160. 00, more affordable than expected though it has many benefits and price will be stable and not to become a big deal at all. Performance and Appraisal Program The company will conduct an evaluation on the employees in which the supervisor evaluates their performance; the result of the evaluation will be given to the employees indicating the level of their performance areas of improvement. This evaluate will be the basis for the increase of their salary and promotion for employees.The following factors that the company will consider: 1. A manager and employee shall hold formal appraisal meetings once or twice a year. 2. Employees should be given immediate and adequate feedback regarding their performance. The manager and supervisor should maintain a record of critical incident specific situation, task, action and result negative and positive. 3. Managers and supervisors are accountable for evaluating performance in develo ping their subordinates. The manager and supervisor should also be appraising in their performance management skills. 4.The performance appraisal system shall encourage the employee’s participation in the company. Timetable PAINTWORK DATE| ACTIVITIES| START: 2nd week, March – April 2012| Feasibility studies, research and Analysis| 2nd week, March – 2nd week, July 2012| Capital Contribution| 3rd week, April – 2nd week, May 2012| Registration Permit and other Licenses| 1st and 2nd week, April 2012| Canvassing of Raw Materials and Location of the Business| 3rd week, June – 2nd week of July 2012| Setting the Place of the Business| 1st and 2nd week, June 2012| Recruitment and Hiring of Employees| 1st week , August 2012|Purchasing of Raw Materials and Equipment| 4th week, August 2012| Training of Employees| 1st week, September 2012| Ribbon Cutting and Start of the Normal Business Operation|

The Twilight Saga 4: Breaking Dawn 13. Good Thing I’ve Got A Strong Stomach

13. Good Thing I've Got A Strong Stomach Carlisle and Rosalie were off in a flash, darting upstairs. I could hear them debating whether they should warm it up for her. Ugh. i wondered what all house-of-horrors stuff they kept around here. Fridge full of blood, check. What else? Torture chamber? Coffin room? Edward stayed, holding Bella's hand. His face was dead again. He didn't seem to have the energy to keep up even that little hint of hope he'd had before. They stared into each other's eyes, but not in a gooey way. It was like they were having a conversation. Kind of reminded me of Sam and Emily. No, it wasn't gooey, but that only made it harder to watch. I knew what it was like for Leah, having to see that all the time. Having to hear it in Sam's head. Of course we all felt bad for her, we weren't monsters – in that sense, anyway. But I guess we'd blamed her for how she handled it. Lashing out at everyone, trying to make us all as miserable as she was. I would never blame her again. How could anyone help spreading this kind of misery around? How could anyone not try to ease some of the burden by shoving a little piece of it off on someone else? And if it meant that I had to have a pack, how could I blame her for taking my freedom? I would do the same. If there was a way to escape this pain, I'd take it, too. Rosalie darted downstairs after a second, flying through the room like a sharp breeze, stirring up the burning smell. She stopped inside the kitchen, and I heard the creak of a cupboard door. â€Å"Note ear, Rosalie,† Edward murmured. He rolled his eyes. Bella looked curious, but Edward just shook his head at her. Rosalie blew back through the room and disappeared again. â€Å"This was your idea?† Bella whispered, her voice rough as she strained to make it loud enough for me to hear. Forgetting that I could hear just fine. I kind of liked how, a lot of the time, she seemed to forget that I wasn't completely human. I moved closer, so that she wouldn't have to work so hard. â€Å"Don't blame me for this one. Your vampire was just picking snide comments out of my head.† She smiled a little. â€Å"I didn't expect to see you again.† â€Å"Yeah, me, either,† I said. It felt weird just standing here, but the vampires had shoved all the furniture out of the way for the medical setup. I imagined that it didn't bother them – sitting or standing didn't make much difference when you were stone. Wouldn't bother me much, either, except that I was so exhausted. â€Å"Edward told me what you had to do. I'm sorry.† â€Å"S'okay. It was probably only a matter of time till I snapped over something Sam wanted me to do,† I lied. â€Å"And Seth,† she whispered. â€Å"He's actually happy to help.† â€Å"I hate causing you trouble.† I laughed once – more a bark than a laugh. She breathed a faint sigh. â€Å"I guess that's nothing new, is it?† â€Å"No, not really.† â€Å"You don't have to stay and watch this,† she said, barely mouthing the words. I could leave. It was probably a good idea. But if I did, with the way she looked right now, I could be missing the last fifteen minutes of her life. â€Å"I don't really have anywhere else to go,† I told her, trying to keep the emotion out of my voice. â€Å"The wolf thing is a lot less appealing since Leah joined up.† â€Å"Leah?† she gasped. â€Å"You didn't tell her?† I asked Edward. He just shrugged without moving his eyes from her face. I could see it wasn't very exciting news to him, not something worth sharing with the more important events that were going down. Bella didn't take it so lightly. It looked like it was bad news to her. â€Å"Why?† she breathed. I didn't want to get into the whole novel-length version. â€Å"To keep an eye on Seth.† â€Å"But Leah hates us,† she whispered. Us.Nice. I could see that she was afraid, though. â€Å"Leah's not going to bug anyone.† But me. â€Å"She's in my pack† – I grimaced at the words – â€Å"so she follows my lead.† Ugh. Bella didn't look convinced. â€Å"You're scared of Leah, but you're best buds with the psychopath blonde?† There was a low hiss from the second floor. Cool, she'd heard me. Bella frowned at me. â€Å"Don't. Rose†¦ understands.† â€Å"Yeah,† i grunted. â€Å"She understands that you're gonna die and she doesn't care, s'long as she gets her mutant spawn out of the deal.† â€Å"Stop being a jerk, Jacob,† she whispered. She looked too weak to get mad at. I tried to smile instead. â€Å"You say that like it's possible.† Bella tried not to smile back for a second, but she couldn't help it in the end; her chalky lips pulled up at the corners. And then Carlisle and the psycho in question were there. Carlisle had a white plastic cup in his hand – the kind with a lid and a bendy straw. Oh – not clear,now I got it. Edward didn't want Bella to have to think about what she was doing any more than necessary. You couldn't see what was in the cup at all. But I could smell it. Carlisle hesitated, the hand with the cup half-extended. Bella eyed it, looking scared again. â€Å"We could try another method,† Carlisle said quietly. â€Å"No,† Bella whispered. â€Å"No,111 try this first. We don't have time†¦.† At first I thought she'd finally gotten a clue and was worried about herself, but then her hand fluttered feebly against her stomach. Bellareached out and took the cup from him. Her hand shook a little, and I could hear the sloshing from inside. She tried to prop herself up on one elbow, but she could barely lift her head. A whisper of heat brushed down my spine as I saw how frail she'd gotten in less than a day. Rosalie put her arm under Bella's shoulders, supporting her head, too, like you did with a newborn. Blondie was all about the babies. â€Å"Thanks,† Bella whispered. Her eyes flickered around at us. Still aware enough to feel self-conscious. If she wasn't so drained, I'd bet she'd've blushed. â€Å"Don't mind them,† Rosalie murmured. It made me feel awkward. I should've left when Bella'd offered the chance. I didn't belong here, being part of this. I thought about ducking out, but then I realized a move like that would only make this worse for Bella – make it harder for her to go through with it. She'd figure I was too disgusted to stay. Which was almost true. Still. While I wasn't going to claim responsibility for this idea, I didn't want to jinx it, either. Bella lifted the cup to her face and sniffed at the end of the straw. She flinched, and then made a face. â€Å"Bella, sweetheart, we can find an easier way,† Edward said, holding his hand out for the cup. â€Å"Plug your nose,† Rosalie suggested. She glared at Edward's hand like she might take a snap at it. I wished she would. I bet Edward wouldn't take that sitting down, and I'd love to see Blondie lose a limb. â€Å"No, that's not it. It's just that it – â€Å"Bella sucked in a deep breath. â€Å"It smells good,† she admitted in a tiny voice. I swallowed hard, fighting to keep the disgust off my face. â€Å"That's a good thing,† Rosalie told Bella eagerly. â€Å"That means we're on the right track. Give it a try.† Given Blondie's new expression, I was surprised she didn't break into a touchdown dance. Bella shoved the straw between her lips, squeezed her eyes shut, and wrinkled her nose. I could hear the blood slopping around in the cup again as her hand shook. She sipped at it for a second, and then moaned quietly with her eyes still closed. Edward and I stepped forward at the same time. He touched her face. I clenched my hands behind my back. â€Å"Bella, love – â€Å" Tm okay,† she whispered. She opened her eyes and stared up at him. Her expression was†¦ apologetic. Pleading. Scared. â€Å"It tastes good, too.† Acid churned in my stomach, threatening to overflow. I ground my teeth together. â€Å"That's good,† Blondie repeated, still jazzed. â€Å"A good sign.† Edward just pressed his hand to her cheek, curling his fingers around the shape of her fragile bones. Bella sighed and put her lips to the straw again. She took a real pull this time. The action wasn't as weak as everything else about her. Like some instinct was taking over. â€Å"How's your stomach? Do you feel nauseated?† Carlisle asked. Bella shook her head. â€Å"No, I don't feel sick,† she whispered. â€Å"There's a first, eh?† Rosalie beamed. â€Å"Excellent.† â€Å"I think it's a bit early for that, Rose,† Carlisle murmured. Bella gulped another mouthful of blood. Then she flashed a look at Edward. â€Å"Does this screw my total?† she whispered. â€Å"Or do we start counting after I'm a vampire?† â€Å"No one is counting, Bella. In any case, no one died for this.† He smiled a lifeless smile. â€Å"Your record is still clean.† They'd lost me. â€Å"I'll explain later,† Edward said, so low the words were just a breath. â€Å"What?† Bella whispered. â€Å"Just talking to myself,† he lied smoothly. If he succeeded with this, if Bella lived, Edward wasn't going to be able to get away with so much when her senses were as sharp as his. He'd have to work on the honesty thing. Edward's lips twitched, fighting a smile. Bella chugged a few more ounces, staring past us toward the window. Probably pretending we weren't here. Or maybe just me. No one else in this group would be disgusted by what she was doing. Just the opposite – they were probably having a tough time not ripping the cup away from her. Edward rolled his eyes. Jeez, how did anyone stand living with him? It was really too bad he couldn't hear Bella's thoughts. Then he'd annoy the crap out of her, too, and she'd get tired of him. Edward chuckled once. Bella's eyes flicked to him immediately, and she half-smiled at the humor in his face. I would guess that wasn't something she'd seen in a while. â€Å"Something funny?† she breathed. â€Å"Jacob,† he answered. She looked over with another weary smile for me. â€Å"Jake's a crack-up,† she agreed. Great, now I was the court jester. â€Å"Bada bing† I mumbled in weak rim-shot impression. She smiled again, and then took another swig from the cup. I flinched when the straw pulled at empty air, making a loud sucking sound. â€Å"I did it,† she said, sounding pleased. Her voice was clearer – rough, but not a whisper for the first time today. â€Å"If I keep this down, Carlisle, will you take the needles out of me?† â€Å"As soon as possible,† he promised. â€Å"Honestly, they aren't doing that much good where they are.† Rosalie patted Bella's forehead, and they exchanged a hopeful glance. And anyone could see it – the cup full of human blood had made an immediate difference. Her color was returning – there was a tiny hint of pink in her waxy cheeks. Already she didn't seem to need Rosalie's support so much anymore. Her breathing was easier, and I would swear her heartbeat was stronger, more even. Everything accelerated. That ghost of hope in Edward's eyes had turned into the real thing. â€Å"Would you like more?† Rosalie pressed. Bella's shoulders slumped. Edward flashed a glare at Rosalie before he spoke to Bella. â€Å"You don't have to drink more right away.† â€Å"Yeah, I know. But†¦ I want to† she admitted glumly. Rosalie pulled her thin, sharp fingers through Bella's lank hair. â€Å"You don't need to be embarrassed about that, Bella. Your body has cravings. We all understand that.† Her tone was soothing at first, but then she added harshly, â€Å"Anyone who doesn't understand shouldn't be here.† Meant for me, obviously, but I wasn't going to let Blondie get to me. I was glad Bella felt better. So what if the means grossed me out? It wasn't like I'd said anything. Carlisle took the cup from Bella's hand. â€Å"I'll be right back.† Bella stared at me while he disappeared. â€Å"Jake, you look awful,† she croaked. â€Å"Look who's talking.† â€Å"Seriously – when's the last time you slept?† I thought about that for a second. â€Å"Huh. I'm not actually sure.† â€Å"Aw, Jake. Now I'm messing with your health, too. Don't be stupid.† I gritted my teeth. She was allowed to kill herself for a monster, but I wasn't allowed to miss a few nights' sleep to watch her do it? â€Å"Get some rest, please,† she went on. â€Å"There're a few beds upstairs – you're welcome to any of them.† The look on Rosalie's face made it clear that I wasn't welcome to one of them. It made me wonder what Sleepless Beauty needed a bed for anyway. Was she that possessive of her props? â€Å"Thanks, Bells, but I'd rather sleep on the ground. Away from the stench, you know.† She grimaced. â€Å"Right.† Carlisle was back then, and Bella reached out for the blood, absentminded, like she was thinking of something else. With the same distracted expression, she started sucking it down. She really was looking better. She pulled herself forward, being careful of the tubes, and scooted into a sitting position. Rosalie hovered, her hands ready to catch Bella if she sagged. But Bella didn't need her. Taking deep breaths in between swallows, Bella finished the second cup quickly. â€Å"How do you feel now?† Carlisle asked. â€Å"Not sick. Sort of hungry†¦ only I'm not sure if I'm hungry or thirsty, you know?† â€Å"Carlisle, just look at her,† Rosalie murmured, so smug she should have canary feathers on her lips. â€Å"This is obviously what her body wants. She should drink more.† â€Å"She's still human, Rosalie. She needs food, too. Let's give her a little while to see how this affects her, and then maybe we can try some food again. Does anything sound particularly good to you, Bella?† â€Å"Eggs,† she said immediately, and then she exchanged a look and a smile with Edward. His smile was brittle, but there was more life on his face than before. I blinked then, and almost forgot how to open my eyes again. â€Å"Jacob,† Edward murmured. â€Å"You really should sleep. As Bella said, you're certainly welcome to the accommodations here, though you'd probably be more comfortable outside. Don't worry about anything – I promise 111 find you if there's a need.† â€Å"Sure, sure,† I mumbled. Now that it appeared Bella had a few more hours, I could escape. Go curl up under a tree somewhere†¦. Far enough away that the smell couldn't reach me. The bloodsucker would wake me up if something went wrong. He owed me. â€Å"I do,† Edward agreed. I nodded and then put my hand on Bella's. Hers was icy cold. â€Å"Feel better,† I said. â€Å"Thanks, Jacob.† She turned her hand over and squeezed mine. I felt the thin band of her wedding ring riding loose on her skinny finger. â€Å"Get her a blanket or something,† I muttered as I turned for the door. Before I made it, two howls pierced the still morning air. There was no mistaking the urgency of the tone. No misunderstanding this time. â€Å"Dammit,† I snarled, and I threw myself through the door. I hurled my body off the porch, letting the fire rip me apart midair. There was a sharp tearing sound as my shorts shredded. Crap. Those were the only clothes I had. Didn't matter now. I landed on paws and took off toward the west. What is it?I shouted in my head. Incoming,Seth answered. At least three. Did they split up? I'm running the line back to Seth at the speed of lightLeah promised. I could feel the air huffing through her lungs as she pushed herself to an incredible velocity. The forest whipped around her. So far, no other point of attack. Seth, donot challenge them. Wait forme. They're slowing. Ugh – its sooff not being able to hear them. I think†¦ What? I think they've stopped. Waiting for the rest of the pack? Shh. Feel that? I absorbed his impressions. The faint, soundless shimmer in the air. Someone's phasing? Feels like it,Seth agreed. Leah flew into the small open space where Seth waited. She raked her claws into the dirt, spinning out like a race car. Got your back, bro. They're coming,Seth said nervously. Slow. Walking. Almost there,I told them. I tried to fly like Leah. It felt horrible being separated from Seth and Leah with potential danger closer to their end than mine. Wrong. I should be with them, between them and whatever was coming. Look who's getting all paternal,Leah thought wryly. Head in the game, Leah. Four,Seth decided. Kid had good ears. Three wolves, one man. I made the little clearing then, moving immediately to the point. Seth sighed with relief and then straightened up, already in place at my right shoulder. Leah fell in on my left with a little less enthusiasm. So now I rank under Seth,she grumbled to herself. First come, first served,Seth thought smugly. ‘Sides, you were never an Alpha's Third before. Still an upgrade. Under my baby brother is not an upgrade. Shh!I complained. don't care where you stand. Shut up and get ready. They came into view a few seconds later, walking, as Seth had thought. Jared in the front, human, hands up. Paul and Quil and Collin on four legs behind him. There was no aggression in their postures. They hung back behind Jared, ears up, alert but calm. But†¦ it was weird that Sam would send Collin rather than Embry. That wasn't what I would do if I were sending a diplomacy party into enemy territory. I wouldn't send a kid. I'd send the experienced fighter. A diversion?Leah thought. Were Sam, Embry, and Brady making a move alone? That didn't seem likely. Want me to check? I can run the line and be back in two minutes. Should I warn the Cullens?Seth wondered. What if the point was to divide us?I asked. The Cullens know something's up. They're ready. Sam wouldn't be so stupid†¦,Leah whispered, fear jagged in her mind. She was imagining Sam attacking the Cullens with only the two others beside him. No, he wouldn't,I assured her, though I felt a little sick at the image in her head, too. All the while, Jared and the three wolves stared at us, waiting. It was eerie not to hear what Quil and Paul and Collin were saying to one another. Their expressions were blank – unreadable. Jared cleared his throat, and then he nodded to me. â€Å"White flag of truce, Jake. We're here to talk.† Think it's true?Seth asked. Makes sense, but†¦ Yeah,Leah agreed. But. We didn't relax. Jared frowned. â€Å"It would be easier to talk if I could hear you, too.† I stared him down. I wasn't going to phase back until I felt better about this situation. Until it made sense. Why Collin? That was the part that had me most worried. â€Å"Okay. I guess I'll just talk, then,† Jared said. â€Å"Jake, we want you to come back.† Quil let out a soft whine behind him. Seconding the statement. â€Å"You've torn our family apart. It's not meant to be this way.† I wasn't exactly in disagreement with that, but it was hardly the point. There were a few unresolved differences of opinion between me and Sam at the moment. â€Å"We know that you feel†¦ strongly about the situation with the Cullens. We know that's a problem. But this is an overreaction.† Seth growled. Overreaction? And attacking our allies without warning isn't? Seth, you ever heard of a poker face? Cool it. Sorry. Jared's eyes flickered to Seth and back to me. â€Å"Sam is willing to take this slowly, Jacob. He's calmed down, talked to the other Elders. They've decided that immediate action is in no one's best interest at this point.† Translation: They've already lost the element of surprise,Leah thought. It was weird how distinct our joint thinking was. The pack was already Sam's pack, was already â€Å"them† to us. Something outside and other. It was especially weird to have Leah thinking that way – to have her be a solid part of the â€Å"us.† â€Å"Billy and Sue agree with you, Jacob, that we can wait for Bella†¦ to be separated from the problem. Killing her is not something any of us feel comfortable with.† Though I'd just given Seth crap for it, I couldn't hold back a small snarl of my own. So they didn't quite feel comfortablewith murder, huh? Jared raised his hands again. â€Å"Easy, Jake. You know what I mean. The point is, we're going to wait and reassess the situation. Decide later if there's a problem with the†¦ thing.† Ha,Leah thought. What a load. You don't buy it? I know what they're thinking, Jake. WhatSam's thinking. They're betting on Bella dying anyway. And then they figure you'll be so mad. . . That I'll lead the attack myself.My ears pressed against my skull. What Leah was guessing sounded pretty spot-on. And very possible, too. When†¦ if that thing killed Bella, it was going to be easy to forget how I felt about Carlisle's family right now. They would probably look like enemies – like no more than bloodsucking leeches – to me all over again. I'll remind you,Seth whispered. know you will, kid. Question is whether I'll listen to you. â€Å"Jake?† Jared asked. I huffed a sigh. Leah, make a circuit – just to be sure. I'm going to have to talk to him, and I want to bepositive there isn't anything else going on while I'm phased. Give me a break, Jacob. You can phase in front of me. Despite my best efforts, I've seen you naked before – doesn't do much forme, so no worries. I'm not trying to protect the innocence of your eyes, I'm trying to protect our backs. Get out of here. Leah snorted once and then launched herself into the forest. I could hear her claws cutting into the soil, pushing her faster. Nudity was an inconvenient but unavoidable part of pack life. We'd all thought nothing of it before Leah came along. Then it got awkward. Leah had average control when it came to her temper – it took her the usual length of time to stop exploding out of her clothes every time she got pissed. We'd all caught a glimpse. And it wasn't like she wasn't worth looking at; it was just that it was so not worth it when she caught you thinking about it later. Jared and the others were staring at the place where she'd disappeared into the brush with wary expressions. â€Å"Where's she going?† Jared asked. I ignored him, closing my eyes and pulling myself together again. It felt like the air was trembling around me, shaking out from me in small waves. I lifted myself up on my hind legs, catching the moment just right so that I was fully upright as I shimmered down into my human self. â€Å"Oh,† Jared said. â€Å"Hey, Jake.† â€Å"Hey, Jared.† â€Å"Thanks for talking to me.† â€Å"Yeah.† â€Å"We want you to come back, man.† Quil whined again. â€Å"I don't know if it's that easy, Jared.† â€Å"Come home,† he said, leaning forward. Pleading. â€Å"We can sort this out. You don't belong here. Let Seth and Leah come home, too.† I laughed. â€Å"Right. Like I haven't been begging them to do that from hour one.† Seth snorted behind me. Jared assessed that, his eyes cautious again. â€Å"So, what now, then?† I thought that over for a minute while he waited. â€Å"I don't know. But I'm not sure things could just go back to normal anyway, Jared. I don't know how it works – it doesn't feel like I can just turn this Alpha thing off and on as the mood strikes. It feels sort of permanent.† â€Å"You still belong with us.† I raised my eyebrows. â€Å"Two Alphas can't belong in the same place, Jared. Remember how close it got last night? The instinct is too competitive.† â€Å"So are you all just going to hang out with the parasites for the rest of your lives?† he demanded. â€Å"You don't have a home here. You're already out of clothes,† he pointed out. â€Å"You gonna stay wolf all the time? You know Leah doesn't like eating that way.† â€Å"Leah can do whatever she wants when she gets hungry. She's here by her own choice. I'm not telling anyone what to do.† Jared sighed. â€Å"Sam is sorry about what he did to you.† I nodded. â€Å"I'm not angry anymore.† â€Å"But?† â€Å"But I'm not coming back, not now. We're going to wait and see how it plays out, too. And we're going to watch out for the Cullens for as long as that seems necessary. Because, despite what you think, this isn't just about Bella. We're protecting those who should be protected. And that applies to the Cullens, too.† At least a fair number of them, anyway. Seth yelped softly in agreement. Jared frowned. â€Å"I guess there's nothing I can say to you, then.† â€Å"Not now. We'll see how things go.† Jared turned to face Seth, concentrating on him now, separate from me. â€Å"Sue asked me to tell you – no, to beg you – to come home. She's brokenhearted, Seth. All alone. I don't know how you and Leah can do this to her. Abandon her this way, when your dad just barely died – â€Å" Seth whimpered. â€Å"Ease up, Jared,† I warned. â€Å"Just letting him know how it is.† I snorted. â€Å"Right.† Sue was tougher than anyone I knew. Tougher than my dad, tougher than me. Tough enough to play on her kids' sympathies if that's what it took to get them home. But it wasn't fair to work Seth that way. â€Å"Sue's known about this for how many hours now? And most of that time spent with Billy and Old Quil and Sam? Yeah, I'm sure she's just perishing of loneliness. ‘Course you're free to go if you want, Seth. You know that.† Seth sniffed. Then, a second later, he cocked an ear to the north. Leah must be close. Jeez, she was fast. Two beats, and Leah skidded to a stop in the brush a few yards away. She trotted in, taking the point in front of Seth. She kept her nose in the air, very obviously not looking in my direction. I appreciated that. â€Å"Leah?† Jared asked. She met his gaze, her muzzle pulling back a little over her teeth. Jared didn't seem surprised by her hostility. â€Å"Leah, you know you don't want to be here.† She snarled at him. I gave her a warning glance she didn't see. Seth whined and nudged her with his shoulder. â€Å"Sorry,† Jared said. â€Å"Guess I shouldn't assume. But you don't have any ties to the bloodsuckers.† Leah very deliberately looked at her brother and then at me. â€Å"So you want to watch out for Seth, I get that,† Jared said. His eyes touched my face and then went back to hers. Probably wondering about that second look – just like I was. â€Å"But Jake's not going to let anything happen to him, and he's not afraid to be here.† Jared made a face. â€Å"Anyway, please, Leah. We want you back. Sam wants you back.† Leah's tail twitched. â€Å"Sam told me to beg. He told me to literally get down on my knees if I have to. He wants you home, Lee-lee, where you belong.† I saw Leah flinch when Jared used Sam's old nickname for her. And then, when he added those last three words, her hackles rose and she was yowling a long stream of snarls through her teeth. I didn't have to be in her head to hear the cussing-out she was giving him, and neither did he. You could almost hear the exact words she was using. I waited till she was done. â€Å"I'm going to go out on a limb here and say that Leah belongs wherever she wants to be.† Leah growled, but, as she was glaring at Jared, I figured it was in agreement. â€Å"Look, Jared, we're still family, okay? We'll get past the feud, but, until we do, you probably ought to stick to your land. Just so there aren't misunderstandings. Nobody wants a family brawl, right? Sam doesn't want that, either, does he?† â€Å"Of course, not,† Jared snapped. â€Å"We'll stick to our land. But where is your land, Jacob? Is it vampire land?† â€Å"No, Jared. Homeless at the moment. But don't worry – this isn't going to last forever.† I had to take a breath. â€Å"There's not that much time†¦ left. Okay? Then the Cullens will probably go, and Seth and Leah will come home.† Leah and Seth whined together, their noses turning my direction in synchronization. â€Å"And what about you, Jake?† â€Å"Back to the forest, I think. I can't really stick around La Push. Two Alphas means too much tension. ‘Sides, I was headed that way anyway. Before this mess.† â€Å"What if we need to talk?† Jared asked. â€Å"Howl – but watch the line, ‘kay? We'll come to you. And Sam doesn't need to send so many. We aren't looking for a fight.† Jared scowled, but nodded. He didn't like me setting conditions for Sam. â€Å"See you around, Jake. Or not.† He waved halfheartedly. â€Å"Wait, Jared. Is Embry okay?† Surprise crossed his face. â€Å"Embry? Sure, he's fine. Why?† â€Å"Just wondering why Sam sent Collin.† I watched his reaction, still suspicious that something was going on. I saw knowledge flash in his eyes, but it didn't look like the kind I was expecting. â€Å"That's not really your business anymore, Jake.† â€Å"Guess not. Just curious.† I saw a twitch from the corner of my eye, but I didn't acknowledge it, because I didn't want to give Quil away. He was reacting to the subject. â€Å"I'll let Sam know about your†¦ instructions. Goodbye, Jacob.† I sighed. â€Å"Yeah. Bye, Jared. Hey, tell my dad that I'm okay, will you? And that I'm sorry, and that I love him.† â€Å"I'll pass that along.† â€Å"Thanks.† â€Å"C'mon, guys,† Jared said. He turned away from us, heading out of sight to phase because Leah was here. Paul and Collin were right on his heels, but Quil hesitated. He yelped softly, and I took a step toward him. â€Å"Yeah, I miss you, too, bro.† Quil jogged over to me, his head hanging down morosely. I patted his shoulder. â€Å"It'll be okay.† He whined. â€Å"Tell Embry I miss having you two on my flanks.† He nodded and then pressed his nose to my forehead. Leah snorted. Quil looked up, but not at her. He looked back over his shoulder at where the others had gone. â€Å"Yeah, go home,† I told him. Quil yelped again and then took off after the others. I'd bet Jared wasn't waiting super-patiently. As soon as he was gone, I pulled the warmth from the center of my body and let it surge through my limbs. In a flash of heat, I was on four legs again. Thought you were going to make out with him,Leah snickered. I ignored her. Was that okay?I asked them. It worried me, speaking for them that way, when I couldn't hear exactly what they were thinking. I didn't want to assume anything. I didn't want to be like Jared that way. Did I say anything you didn't want me to? Did I not say something I should have? You did great, Jake!Seth encouraged. You could have hit Jared,Leah thought. wouldn't have minded that. I guess we know why Embry wasn't allowed to come,Seth thought. I didn't understand. Not allowed? Jake, didya see Quil? He's pretty torn up, right? I'd put ten to one that Embry's even more upset And Embry doesn't have a Claire. There's no way Quil can just pick up and walk away from La Push. Embry might So Sam's not going to take any chances on him getting convinced to jump ship. He doesn't want our pack any bigger than it is now. Really? You think? I doubt Embry would mind shredding some Cullens. But he's your best friend, Jake. He and Quil would rather stand behind you than face you in a fight. Well, I'm glad Sam kept him home, then. This pack is big enough.I sighed. Okay, then. So we're good, for now. Seth, you mind keeping an eye on things for a while? Leah and I both need to crash. This felt on the level, but who knows? Maybe it was a distraction. I wasn't always so paranoid, but I remembered the feel of Sam's commitment. The total one-track focus on destroying the danger he saw. Would he take advantage of the fact that he could lie to us now? No problem!Seth was only too eager to do whatever he could. You want me to explain to the Cullens? They're probably still kinda tense. I got it. I want to check things out anyway. They caught the whir of images from my fried brain. Seth whimpered in surprise. Ew. Leah whipped her head back and forth like she was trying to shake the image out of her mind. That is easily the freakin' grossest thing I've heard in my life. Yuck. If there was anything in my stomach, it would be coming back. Theyare vampires, I guess, Seth allowed after a minute, compensating for Leah's reaction. mean, it makes sense. And if it helps Bella, it's a good thing, right? Both Leah and I stared at him. What? Mom dropped him a lot when he was a baby,Leah told me. On his head, apparently. He used to gnaw on the crib bars, too. Lead paint? Looks like itshe thought. Seth snorted. Funny. Why don't you two shut up and sleep?

Evaluation Of A Telephone Based Peer Support Intervention...

When nurses understand research, they can begin to implement changes that will benefit client care and outcomes. However, many nurses do not know how to read research studies and are unable to advocate for change in their practice. The purpose of this paper is to critically appraise a research article titled, Quasi-Experimental Evaluation of a Telephone-based Peer Support Intervention for Maternal Depression by Letourneau, N., et al. (2014) by evaluating and critiquing sections of the study. The objective of this paper is to determine if the study provided valid and reliable information that can be used to implement into nursing practice. Research Problem The research problem the researchers are purposing is that there is a need to find acceptable and efficient treatments to prevent the long-term effects of postpartum depression (PPD) in mother-child interaction and the development of the child. This study is essential to nursing because it is nurses that may initially detect PPD in postpartum patients, as well, early detection is crucial to get treatment right away. The nurse can play a significant role in ensuring that his or her patient receives proper treatment. Research Purpose The purpose of the study is to examine TBPS and if it is an effective intervention (independent variable) for mothers with depression (dependent variable) who are one to twenty-four months postpartum. In addition, the researchers are examining the satisfaction level of the TPBS line forShow MoreRelatedSmoking Cessation Of Pregnancy : Review Of Current Strategies9414 Words   |  38 PagesFax: +61299266521 Email: gemma.figtree@sydney.edu.au 7 ABSTRACT: Cigarette smoking in pregnancy is a universal problem that compels us to continuously explore different strategies aimed at increasing high quit rates in this population group. 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