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At the normal pH of plasma (74) and, therefore, of the glomerular filtrate, we find that about 80% of the phosphate is in the base (divalent) form and 20% is in the acid (monovalent) form As the tubular fluid is acidified in the collecting ducts, most of the base form combines with secreted hydrogen ions By the time the minimum intratubular pH of 44 is reached, virtually all the base (HPO422) has been converted to acid (H2PO42) Therefore, secreted hydrogen ions that combined with the base form are excreted, and the bicarbonate that was generated intracellularly in the process enters the blood How much phosphate is available for this process The amount is somewhat variable, depending on a number of factors (see 10), but a typical plasma concentration is about 1 mmol/L, of which about 90% is free (the rest being loosely bound to plasma proteins) At a GFR of 180 L/day, the total filtered load of phosphate is about160 mmol/day The fraction reabsorbed is also variable: from 75% to 90% Thus, unreabsorbed divalent phosphate available for buffering is roughly 40 mmol/day In other words, the kidneys can excrete hydrogen ions, using the phosphate buffer system, at a rate of about 40 mmol/day However, the availability of phosphate cannot be easily upregulated to increase acid excretion There are other organic buffers in the urine, and under certain conditions these may appear in the tubular fluid in sufficient quantities to allow them also to act as important buffers A particularly important example is a patient with uncontrolled diabetes mellitus Because of metabolic processes that result from insulin deficiency, such a patient may become extremely acidotic due to the excess production of acetoacetic acid and -hydroxybutyric acid At normal plasma pH,

Coach Lombardi preached to his players that most games are won by only a few specific plays Since no one knew which play was going to win the game, each player had to give 100 percent on every play

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LOMBARDI RULE #7

For many organizations, battery life is one of the most critical elements when choosing a device Once again, it all depends on your users needs

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these species completely dissociate to yield the anions -hydroxybutyrate and acetoacetate (and hydrogen ions) These anions are filtered at the renal corpuscle but are only partly reabsorbed because they are present in great enough quantities to exceed the renal reabsorptive Tms Accordingly, they are available in the tubular fluid to buffer a portion of the hydrogen ions being secreted by the tubules However, their usefulness in this role is limited by the fact that their pKs are low: approximately 45, meaning that only at very low pH will the secreted hydrogen ions combine with them At the limiting urine pH of 44 only half of them have actually combined with a hydrogen ion The rest remain in the base form

The goal of winning the championship, therefore, had to be built on the foundation of a thousand small victories It depended on each player seeing the connection between his individual effort and winning the championship It depended on motivation and inspiration by degree: people being encouraged by each small victory to move on to the next challenge

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INVOLVE KEY PLAYERS When my father joined the New York Giants as an assistant in 1954, he brought a reputation of being an outstanding high school and college coach, but he was new to professional football He understood the running game, but was not well grounded in the passing attack as the pros played it He might have taken the stance, Hey, I m the coach; you ll do it my way Instead, he chose to ask some of the veteran players for help During his first training camp, after the evening meeting Lombardi would walk over to the players dorm and kick around a play he had put in that afternoon Could it be run better Once veteran players like Frank Gifford, Charlie Conerly, and Kyle Rote understood that Lombardi was sincere in asking for their help, they opened up and shared their knowledge with him During film work with both the Giants and Packers, there was a surprising amount of interplay between the coaches and players

Issues to consider when evaluating the battery operation include: How long will your users need to operate devices on their own power source This will determine the necessary battery life of the device What types of batteries does the device operate on Many small devices such as pagers and PDAs operate on standard AA or AAA batteries that are inexpensive and easily stocked What adapters are available Can they plug into standard automobile cigarette lighters like most phones Does the device offer in-cradle recharging What is the recharge time required If used with a wireless modem, does the modem utilize the device s battery or have its own power source If it uses the device s power, add in extra time to the required battery life for normal operation How large or heavy is the battery and charger If the device was vehicle-mounted, can it utilize the vehicle s power or battery

W H AT I T TA K E S T O B E # 1

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