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minus HCO2 excreted (mmol/day) 3 Total (mmol/day)

People make a great deal of the rings that are awarded to the teams that win the Super Bowl And because Vince Lombardi s teams won the first two of these contests even before the words super bowl became one word and got capitalized he had the privilege of inventing a few traditions One of these was designing the rings worn by the winners of those championship games The ring that the Green Bay Packers wear for defeating the Oakland Raiders in Super Bowl II has three large diamonds across the face The three diamonds signify the three consecutive world

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Therefore, to know how much new bicarbonate is contributed by glutamine metabolism with ammonium excretion, urinary ammonium excretion (urine flow rate times urinary ammonium concentration) must be measured separately, remembering that for every ammonium excreted a new bicarbonate was added to the blood Thus, the data required for a quantitative assessment of the renal contribution to acid-base regulation in any person are as follows: 1 2 3 Titratable acid excreted Plus NH4+ excreted Minus HCO32 excreted (ie, HCO32 lost from the body because of incomplete reabsorption or HCO2 secretion) 3

There are a few key issues to look at when evaluating reliability: What kind of Service Level Agreements (SLAs) do they offer What is their guaranteed uptime What is the percentage of network downtime What does your partner s network operations center look like What monitoring and troubleshooting tools does it use to support the network Does it have redundant servers and connections to the main operations centers How quickly can it fix things when something goes wrong

and are willing to read between the lines when necessary I believe we can puzzle out the essentials of that model

The total equals net excretion of hydrogen ion or the net HCO32 gain or loss to the body (negative values equal loss, positive values equal gain) Note that there is no term for free hydrogen ion in the urine because, even at a minimum urine pH of 44, the number of free hydrogen ions is trivial Typical urine data for the amounts of bicarbonate contributed to the blood by the kidneys in three potential acid-base states are given in Table 9 2 Note that in response to acidosis,4 as emphasized previously, increased production and excretion of NH4+ is quantitatively much more important than increased formation of titratable acid It should also be emphasized that the data shown for alkalosis are typical of pure alkalosis (ie, alkalosis uncomplicated by other electrolyte abnormalities) As we will see, electrolyte imbalances frequently complicate alkalosis so that the expected values are different from those actually measured

THE LOMBARDI LEADERSHIP MODEL The model began with self-knowledge Consider the following: One of our goals in life has to be to know ourselves, as the ancient Greek axiom put it It is the first step toward self-improvement My father had a strong sense of self He gave a great deal of thought to issues like purpose, truth, faith, humility, and compassion He cultivated these qualities in himself and tried to live them

Network latency refers to time delay between submitting a message and when it is received by the recipient of the message Latencies can be affected by many different factors, including congestion, poor coverage conditions due to natural elements or obstructions, etc These are impossible to calculate and will vary over time There is, however, certain latency inherent to the network technology that can be evaluated on a consistent basis The latency may not be a strong enough reason to dismiss a certain network, but it should be a factor to consider

The suffixes -osis and -emia (meaning in the blood ), as in acidosis or acidemia, are technically different but are often used interchangeably or inappropriately Acidemia means high hydrogen ion concentration in the blood, essentially a pH below the normal range Acidosis means a process adding acid to the blood We can have an acidosis but not an acidemia if the pH is within the normal range and the kidneys are excreting the high acid load as fast as it is added The analogous argument applies to alkalemia and alkalosis As will be seen, the proper distinction between -osis and -emia is usually violated in the common description of acid-base disorders

LOMBARDI RULE #1

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