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This enzyme was originally designed to see us through times of famine or down time due to injury or illness, but today it keeps storing extra calories, especially fat calories, as excess body fat we do not need The Second Law of Thermodynamics states that any energy system left to its own will break down and fall apart Entropy is the name of the force that makes all energy systems fall apart Entropy is the body s natural transformation from matter to energy Everything in nature is subject to entropy The matter that comprises your body experiences the natural state of entropy, so it eventually returns to the vast storehouse of universal energy from which it originally came.

A team that reaches the performing stage does not become free of con ict. Rather, it is able to bring con ict into the open and resolve it without undue loss of time or energy. The stages of storming and norming require attention and time to be given to people processes. Under time pressure, groups all too easily attempt to bypass these, usually with unfortunate results. Where con ict or differences are ignored, the pool of potential energy available to the group is siphoned off into inattention, creation of diversions, backbiting, minority reporting and splitting off. Or members stay politely at the forming stage, working around the differences between them rather than working through them. Even without conscious attention, a set of de facto norms will emerge that will re ect the habits of the dominant forces in the group either the majority, or the strongest personalities, or those with the best connections outside the group. These habits will become imposed by default. They are unlikely to re ect the best pattern for the group s members as a whole (Box 6.5).

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In the long term, it will lead to anaemia and a reduction of oxygen to the tissues Poor nutrition has long been considered to be a factor in pressure ulcer development although research results are inconsistent (Langer et al, 2003; Mathus-Vliegen, 2001) Some studies, such as those of Berlowitz and Wilking (1989), Brandeis et al (1994) and Williams et al (2000), found impaired nutritional intake to be a factor in pressure ulcer development Guenter et al (2000) found that newly hospitalised patients with grade 3 or 4 pressure ulcers had malnutrition The factors that may lead to malnutrition are discussed in 2 Body weight should also be considered Very emaciated patients have no padding over bony prominences and so have less protection against pressure On the other hand, very obese patients are dif cult to move.

Figure 2.28 Closed loop frequency response This method of transposing open loop frequency response to closed loop response is tedious when high orders of D are involved. There are, however, much more straightforward graphical tools that are readily available to provide the analyst with an immediate visualization of closed loop behavior directly from the open loop response. These alternative graphical methods are developed in the following section.

This energy, then, is potentially capable of replenishing itself as matter once again and so this perfectly balanced process of the recycling of energy and matter, of life and creation itself, goes on and on The human body was designed for wellness, not illness Every single one of your 100 trillion cells is made to function extremely well and cohesively to give you dynamic mental and physical vitality and well-being Nature, in the Divine Blueprint, has skillfully allowed the plant kingdom to continually capture the life force of the sun This is the process of photosynthesis, which allows plants steeped in sunlight and infused with the energy of rain and rich soil to literally manufacture oxygen, protein, vitamins, minerals, phytonutrients, fiber, cell salts, antioxidants, essential fatty acids and energy..

Unless great care is taken, they may be dragged rather than lifted in the bed Another problem of the obese patient is that moisture from sweating may become trapped between the rolls of fat, causing maceration Both of these types of patient may also have a poor nutritional status Incontinence of urine can contribute to maceration of the skin and thus increase the risk of friction Constant washing because of either urinary or faecal incontinence removes natural body oils, drying the skin Urinary incontinence may be caused by the use of diuretics or sedatives Diarrhoea may cause incontinence in the elderly or immobile patient and is a side effect of some antibiotics There is no clear evidence as to whether incontinence is a risk factor for pressure ulcer development or not Baumgarten et al (2003a) found faecal incontinence to be a risk factor whereas Reed et al (2003) did not.

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