1.2: What’s in a Name?
Introduction
In act 2, scene 2 of William Shakespeare’s Romeo and Juliet , Juliet declares: “What’s in a name? That which we call a rose by any other name would smell as sweet.” Unfortunately, Juliet’s point of view doesn’t extend to the world of disability, where names do matter (Wehmeyer, 2013). This is particularly true for the disability previously called mental retardation . The historical record shows that whenever new names have been introduced to identify and describe this disability, those names have eventually been abandoned because of the stigma they’ve acquired (Tassé, 2013).  Like the other terms, they were eventually absorbed into popular language and used as insults to demean or belittle someone or someone’s behaviour (Special Olympics Inc., 2014). Insults like “What a retard” and “That’s so retarded” are common examples. While these insults are often aimed at individuals without disabilities, it is important to know that they have been formed from negative perceptions and attitudes about persons with mental retardation.
In The Cloak of Competence , Robert Edgerton (1967) wrote, “to find oneself regarded as a mental retardate is to be burdened by a shattering stigma” (p. 205).  Although Edgerton’s terminology is now out of date, concern about the effects of stigma on the lives of people with intellectual impairment remains.
 A variety of alternative names have emerged throughout the world and within individual countries (Ford, Acosta, & Sutcliffe, 2013). The world still struggles, however, to find a common language that is both respectful and effective in its ability to communicate to all stakeholders. Such language is needed so that proper identification occurs, needed supports are provided, and suitable environmental adjustments are made (Schalock & Luckasson, 2013).
In this chapter, we discuss the evolution of the clinical or official language that has been used to discuss intellectual impairment. We start with a discussion of the purpose of naming and then move to a description of names that have historically and more recently been applied. Guidelines for choosing an appropriate name are provided along with information on how intellectual impairment is currently viewed and diagnosed. Throughout the chapter, the impact of naming or labelling on people with intellectual impairment is discussed, and implications for caregivers are identified.
The Purpose of Naming
Naming refers to assigning a specific term or label to someone or something. In the field of disability, naming is the product of a systematic process of investigation known as diagnosis. Assigning a name, term, or label to an individual or the individual’s disability is a powerful statement that can convey important messages about how that individual is perceived and valued, and how human relationships will take place (Davis, 2004; Luckasson & Reeve, 2001; Schalock, 2011).
In the field of disability, correctly identifying and naming the disability that a person experiences is important for a number of reasons. Naming enables needed services and supports to be deployed and provides the opportunity to remove physical and social barriers that prevent individuals from expressing their capabilities. Naming also makes funding available for needed services and supports. On a broader level, naming encourages research and communication about a particular disability. This can be important to improving conditions experienced by individuals with the disability.
 Membership in this class was often assigned simply because individuals were thought to look or walk “funny,” or because they were poorly coordinated. Others were singled out because they did not speak, were not successful in school, or appeared to not act their age. The first broadly used term in North America was feeble-minded . The term became common in the early part of the 1900s and was eventually divided into diagnostic categories, or levels, of feeble-mindedness: moron, imbecile, and idiot. These approximated the later categories of mild, moderate, and severe/profound mental retardation, and were assigned on the basis of IQ score, after the IQ system was developed and popularized in the early 20th century (Walsh, 2002).
By the middle of the 20th century the terminology shifted, with terms such as mental deficiency and mental defective emerging in an attempt to counteract the negative connotations of feeble-minded . Over time, the idea that individuals were deficient and defective, and by extension not quite good enough, was replaced by the concept of developmental rate . This term suggested that persons with intellectual impairment were “slow” or developmentally arrested. The term mental retardation was used to represent this position.
In 1961, the American Association on Mental Deficiency (now the American Association on Intellectual and Developmental Disabilities or AAIDD) issued its new diagnostic and classification manual.  The category borderline mental retardation was also included, and referred to individuals who fell between 15 and 30 IQ points (between one and two standard deviations) below the average IQ of 100. In 1973, the borderline category was eliminated as IQ standards changed, so that people with IQs from 70 to 85 were no longer considered to have mental retardation. This meant that, overnight, the population of people theoretically considered to have mental retardation (at least on the basis of IQ score alone) decreased from about 16% to 3% of the general population. This reinforced the understanding that, to a large extent, mental retardation (although under new names) was and remains a socially constructed entity based on expectations of intellectual functioning. Those expectations can vary from time period to time period and from society to society, though individuals with significant disability are identifiable across all time periods and societies.
 The result was that well before the end of the 20th century, a challenge led by advocacy organizations deemed use of the label as no longer appropriate.
 The following are some examples of replacement terms:
- Mental handicap or developmental handicap. While these terms were once popular, labels that include the word handicap or handicapped have largely been replaced with disability . Disabilities are impairments in functioning that can be physical or intellectual, or both in combination. Handicaps, on the other hand, are social or environmental obstacles imposed by society, institutions or individuals on persons with disabilities (Finkelstein, 1993). For example, the absence of a wheelchair ramp at the entrance to a building imposes a handicap on individuals who use wheelchairs. Likewise, failure to provide an individual’s usual communication device imposes a handicap by preventing that individual from effectively communicating his or her needs, wants, thoughts, or interests in social situations. In addition, the word handicap echoes an earlier time when persons with disabilities were commonly required to beg on the street for survival—to literally extend their caps in hand for charitable donations (Darrow & White, 1997).
- Developmental disability. The term developmental disability is commonly used in Canada and some other countries to refer to intellectual impairment. However, in the United States, developmental disability is also viewed as an umbrella term that includes individuals who have intellectual or physical impairments, or a combination of both, that occur during the developmental period (National Association of Councils on Developmental Disabilities, 2014). Examples of disabilities that fall under the heading of developmental disability are epilepsy, cerebral palsy, and autism, as well as intellectual impairment. When the population characteristics of all people with developmental disabilities are examined, only about one-quarter of them have an intellectual impairment sufficient to apply the former label mental retardation (Warren, 2000). The lack of specificity associated with the term developmental disability can lead to confusion when communicating with individuals or groups outside the jurisdictions that use the term.
- Mental disability. In its Vulnerable Persons Living with a Mental Disability Act, the Province of Manitoba (Manitoba, 2014) uses the term mental disability to refer to persons with intellectual impairment. This is a term, however, that some people in the mental health field also claim. One problem with this term is that it can cause confusion between the concepts of mental illness and intellectual impairment.
- Learning disability. In the United Kingdom, the term learning disability is used, having replaced the term mental subnormality . In North America, however, learning disability refers to persons with specific learning disabilities that do not impede general intellectual functioning. Dyslexia is an example of a specific learning disability. Many school districts, however, choose to apply a learning disability label to students with mild intellectual impairment to avoid the stigma associated with the label mental retardation (Warren, 2000).
- Developmental delay. The term developmental delay has been used when discussing intellectual impairment. However, while individuals with intellectual impairment commonly experience developmental delays, not all individuals with developmental delays experience intellectual impairment.
Guidelines for Choosing the Right Name
The name chosen to represent a disability has crucial implications for individuals to whom that name is applied. Therefore choose the name, term, or label with deliberate care. In the end, the name given to a disability should be able to meet the following standards (Luckasson & Reeve, as cited in Schalock & Luckasson, 2013):
- The name should be specific and refer to a single disability. It should allow the disability to be differentiated from other disabilities.
- The name should possess attributes that permit it to be accepted and used consistently by all stakeholders. Examples of stakeholders are individuals, families, service and support providers, professional organizations, advocacy groups, academics, researchers, government representatives, and policymakers.
- The name should effectively represent the current state of knowledge and be able to integrate new knowledge as it appears.
- The name should be functional in definition, diagnosis, classification, and planning of supports.
- The name should have the capacity to communicate important values that are held for the named group of people.
Intellectual Disability
The term intellectual disability is increasingly understood to meet the guidelines above (Schalock, 2011). It is a term commonly used by the research community and scholarly journals, and increasingly by the larger international community. Countries that have adopted this term include Australia, New Zealand, the Netherlands, Ireland, Israel, the United States, and the Scandinavian countries. In the United States, President George W. Bush signed an executive order in 2003 that renamed the President’s Committee on Mental Retardation as the President’s Committee for People with Intellectual Disabilities (Ford, Acosta, & Sutcliffe, 2013). And, in 2010, the U.S. Senate and the House of Representatives passed Rosa’s Law (S 2781—111th Congress, 2009), changing references in federal legislation from mental retardation and mentally retarded to intellectual disability and individual with intellectual disability .
Advocacy organizations such as The Arc, Inclusion International, and Special Olympics use the term intellectual disability . The Canadian Association for Community Living and People First of Canada also use this term, although both intellectual disability and developmental disability are accepted and usage can vary by region. Community Living Ontario mentions that it adopted the term intellectual disability “largely to conform with growing national and international use of the term” (Community Living Ontario, 2014).
In addition to the countries and organizations just mentioned, the three principal sources for defining and diagnosing intellectual disability already use or will soon use the term intellectual disability . These sources are the 11th edition of the AAIDD’s diagnostic manual; the fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5); and the 11th revision of the World Health Organization’s International Classification of Diseases (ICD-11) (Tassé, 2013). The World Health Organization is expected to adopt the term in 2015. Of particular importance is that the ICD is used by 70% of the world’s clinicians, with a similar percentage of services and supports receiving funding based on the diagnostic criteria specified in the ICD (Wehmeyer, 2013). To avoid use of the word disability , the term disorders of intellectual development has also been discussed.
People with Intellectual Disabilities: Using People-First Language
Advocates, self-advocates, and professional groups generally agree that labels should not act as personal nouns to represent individuals. For example, statements such as “Rashid is an epileptic” or “Maria is intellectually disabled” should be avoided. Individuals are much more than the disabilities they happen to experience. They are not defined by their disabilities. Instead, “people-first language” should be used to introduce the presence of disability. Statements such as “Rashid is a young man with (or, who has) epilepsy” or “Maria has Down Syndrome” or “Maria is a person who lives with intellectual disability” represent people-first language. Unless there is a reason to do so, mentioning an individual’s disability is not even needed. Consider how you might describe someone who does not have a disability: for example, “Rani has a very dry sense of humour” or “Ampreet has such a warm and caring manner” or “Sarah has a mischievous streak.”
This agreement that people-first language should frame conversations about intellectual disability extends to agreement that possessive language should be avoided when talking about conditions that are associated with intellectual or other disabilities. This means, for example, that the apostrophe and letter s should be removed when referring to Down’s syndrome. Down syndrome is, therefore, the terminology of choice (although some self-advocates prefer to say that they have Up syndrome ). This avoids the paternalism in naming conditions, disorders, and diseases for the persons who first identified them.
What Is Intellectual Disability?
Intellectual disability affects general learning, so an individual with an intellectual disability can be expected to take longer to learn and to encounter a lower learning ceiling. How low the learning ceiling is depends on the severity of disability, exposure to learning opportunities, and availability of supports. While intellectual disability places limits on an individual’s ability to understand and use new or complex information, the disability is not presented in isolation from the surrounding environment. Disability and individual functioning then, is “always an interaction between features of the person and features of the overall context in which the person lives” (World Health Organization, 2002). Equally important is that each person’s features include strengths as well as limitations and that these strengths can contribute to effective functioning within environments. This has important implications for the person-centred planning process.
From a diagnostic point of view, the AAIDD states, “Intellectual disability is characterized by significant limitations both in intellectual functioning and in adaptive behaviour as expressed in conceptual, social, and practical skills. This disability originates before age 18” (Schalock et al., 2010, p.1). Intellectual functioning is determined by IQ testing, with an IQ below 70 to 75 establishing eligibility for a diagnosis of intellectual disability. The five-point IQ range is recognition that IQs are not perfect measures, and that a score of 70 on a single IQ test actually means that the true score is likely plus or minus 5 IQ points, somewhere between 64 and 76. Adaptive behaviour refers to behaviours or skills that individuals acquire as they grow and develop. These lead to increasing levels of independence and social responsibility within the individual’s culture and community. These behaviours or skills are referenced to norms and take into account the expectations of particular societies for individuals at different ages. In the context of intellectual disability, the presence or absence of limitations in adaptive behaviour is determined by outcomes achieved on adaptive behaviour assessments. Conceptual, social, and practical skills are categories of adaptive behaviour. They include skills in language, reasoning, writing, social judgment, interpersonal communication, personal and domestic care, money management, and job responsibilities (American Psychiatric Association, 2013).
In essence, adaptive behaviour is the outward expression of intellectual functioning. As a consequence, diagnosis of intellectual disability depends on measurable limitations in adaptive behaviour as much as it depends on limitations in IQ outcomes (see Table 2.1). This suggests that there is no reason to apply a label of intellectual disability to someone if that person is able to function satisfactorily within his or her environment, regardless of IQ score.
Table 2.1 Diagnosis of intellectual disability
| IQ Above 70–75 | IQ Below 70–75 | |
| No significant adaptive behaviour limitations | NO intellectual disability | NO intellectual disability |
| Significant adaptive behaviour limitations | NO intellectual disability | YES intellectual disability *Plus: occurs before age 18 |
Classification
Like people everywhere, people with intellectual disability are not all the same. The range includes individuals with “few, if any, self-preservation skills who require round-the-clock supports, to individuals who differ very little from the general population” (Walsh, 2002, p. 73). Classification systems are in part recognition that the name or label intellectual disability is an inadequate description of how the disability is expressed by each individual. This is reflected in classification categories that differentiate either levels of intellectual disability or intensities of support needs.
Levels of intellectual disability are specified by two of the three major diagnosis and classification systems, the DSM-5 and the ICD-10 (soon to be ICD-11). When an individual is diagnosed with intellectual disability, he or she is assigned a level of mild, moderate, severe, or profound intellectual disability. In contrast, the AAIDD chooses to assess for support needs across a variety of everyday domains or areas of functioning. Instead of focusing on limitations or individual deficits that are invariably associated with levels of intellectual disability (“He can’t do that. … he’s severely retarded!”), this shift in thinking takes as its starting point “considerations of what it will take to enable people to function successfully in typical environments” (Wehmeyer, 2013, p. 124).
Intensities of support needs are classified as intermittent , limited , extensive , and pervasive . For any individual, these may vary from domain to domain and from time to time, depending on events and circumstances. Intensities of support needs are described as follows:
- Intermittent . Support is periodic and of short duration. An example is support during lifespan transitions such as job loss, family member loss, or an acute medical crisis. During the time that it is given, this support may be of high or low intensity.
- Limited . Support is more consistent but not intense. An example of this support is time-limited employment training.
- Extensive . Regular support (e.g., daily) is provided in some environments. For example, long-term support may be required in the home or work environments.
- Pervasive . Intense and constant supports are provided in all environments. These supports have life-sustaining potential, and typically involve more staff members and intrusiveness than extensive or limited supports. Keep in mind, however, that intermittent supports may be high intensity during the time that they are provided (Luckasson et al., 2002).
The Impact of Names Beyond the Hurt Feelings: Implications for Service and Support
As has been stressed throughout this chapter, the names or labels that we use to talk about people with disabilities reveal something important about the way society views them. As a result, the names or labels (and the perceptions that underlie them) have an impact on how we interact with persons with disability. For example, when adults with intellectual disabilities are viewed as “eternal children” and referred to as “kids,” as was the case within many large, traditional institutional settings, their possibilities become limited by the expectations that we commonly hold for children. In practice, this has meant that adults with intellectual disabilities have been talked to in a childlike manner and have been required to participate in child-oriented activities. This means that they are not provided with opportunities to develop and prosper beyond the confines of the restrictive points of views of others. By implication, people with intellectual disabilities will never achieve the status of a valued adult.
From the point of view of service and support systems, negative impressions and expectations associated with disability-related names or labels sometimes mean that labelled individuals do not received services that would be given to non-labelled individuals. For example, an impatient mental health professional may dismiss concerns of a support provider about a person with intellectual disabilities and a suspected mental health disturbance, with a comment such as “What do you expect? She’s mentally retarded!” Reiss and colleagues (1982) refer to this practice as “diagnostic overshadowing” : the tendency to diminish the importance of unexpected or symptomatic behaviour as merely representative of intellectual disability. This form of stereotyping and prejudice is demeaning. In part, it has contributed to the comparatively poorer health and shorter lifespan experienced by people with intellectual disabilities. It is important, therefore, for service and support providers to confront their own misconceptions and prejudices, should they exist. Other people’s misconceptions and prejudices might then be corrected for the well-being of people with intellectual disabilities.
When service and support providers understand the impact of names and language and the attitudes that support them, they are better equipped to understand appropriate names and language to use, as well as language to avoid.
… Language to AVOID
Key Points for Caregivers
- Avoid describing people with intellectual disabilities as all the same. For example, avoid using the word the , as in the intellectually disabled , when talking about individuals with intellectual disabilities. This form of description treats people with disabilities as objects and interferes with recognizing each person’s uniqueness.
- Avoid referring to individuals as particularly remarkable or interesting because they are people with intellectual disabilities. Language that sets individuals or groups apart as somehow special or unusual because of their disability actually reduces their value as human beings. This includes praising someone as “brave” or “courageous,” simply because that person has an impairment.
- Avoid using language that expresses pity for a person with disability or for their family. For example, avoid comments such as “It’s just so unfair (or “What a shame” or “What a pity” or “How awful”) that your son has to live with such a disability.”
- Avoid polite terms or language that is vague and confusing. Though some terms sound sensitive, such as differently abled or developmentally challenged , those terms only indicate that a disability exists. They do not actually identify the disability.
- Avoid using language that labels a person with an intellectual disability as someone who suffers from, is a victim of, or is afflicted with the disability. These descriptions give negative suggestions about the person with the disability.
- Avoid using language that describes people with intellectual disabilities as having lower status. For example, by describing people without disabilities as “normal,” individuals with disabilities are suggested to be “abnormal.” This can suggest that people with disability are not good enough to belong to the preferred group, normal .
… Language To USE
Key Points for Caregivers
- Use language that is respectful, caring, and kind, and that communicates that the person is valued.
- Use language that is appropriate to age and culture. For example, when meeting an older adult, a common custom may be to use a greeting such as “I am pleased to meet you Mr. Dodge. May I call you Henry?” rather than presuming that Mr. Dodge can be called Henry simply because he has intellectual disability.
- Use language that is preferred by the person living with the disability. For example, members of the People First self-advocacy organization in Great Britain prefer to say that they experience learning difficulties instead of saying that they have intellectual disability, or a learning disability.
- Use the person’s name and discuss issues in the same way that you would discuss issues when talking with or talking about someone who does not live with intellectual disability.
- Treat each person as a person first, and with the understanding that using diagnostic labels is required only rarely and only in highly specific situations.
Conclusion
In this chapter we have discussed the evolution of language used to talk about people with intellectual disabilities. The value of naming has been described, as have been the negative consequences associated with names that were historically applied to people with intellectual disabilities. Guidelines for choosing an appropriate name have been listed, with the term intellectual disability identified as the name or label that has widespread national and international use and appears to meet standards for selection. The importance of using people-first language to frame discussion has been emphasized, stressing that the labels and diagnoses assigned to individuals do not define individuals.
This chapter has included a definition of intellectual disability, along with a description of the criteria used to diagnose intellectual disabilities. The value of classifying disability according to intensities of support needs, rather than on the basis of level of disability, has been described. Finally, implications for service and support providers have been discussed from the point of view of the impact that names and language can have on people with intellectual disabilities.
Chapter Audio for Print
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References
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Commonwealth of Australia (2013). Communicating with people with disability: National guidelines for emergency managers: Handbook 5 (1st ed.). Retrieved from www.em.gov.au/Publications/Australianemergencymanualseries/Documents/CommunicatingwithPeoplewithDisabilityNationalGuidelinesforEmergencyManagers.PDF
Community Living Ontario (2014). What is intellectual disability? Retrieved from www.communitylivingontario.ca/about-us/what-intellectual-disability
Darrow, A.A. & White, G.W. (1997). Sticks and stones … and words CAN hurt: Eliminating h andicapping language . Retrieved from www.rtcil.org/products/RTCIL%20publications/Media/Sticks%20and%20Stones.pdf
Davis, K. (2004). What’s in a name: Our only label should be our name: Avoiding the stereotypes. The Reporter , 9(2), 10–12. Retrieved from http://www.iidc.indiana.edu/index.php?pageId=364
Edgerton, R.B. (1967).  Los Angeles: University of California Press.
Finkelstein, V. (1993). Disability: A social challenge or an administrative responsibility? In J. Swain, V. Finkelstein, S. French, & M. Oliver (Eds.), Disabling barriers—Enabling environments (pp. 26–33). London: Sage.
Ford, M., Acosta, A., & Sutcliffe, T.J. (2013). Beyond terminology: The policy impact of a grassroots movement. Journal of Intellectual and Developmental Disabilities , 52(2), 108–112. doi:10.1352/1934-9556-51.2.108
Luckasson, R., Borthwick-Duffy, S., Buntinx, W.H.E., et al., (2002). Mental Retardation: Definition, classification, and systems of supports (10th ed. ). Washington, DC: American Association on Mental Retardation.
Lukasson, R. & Reeve, A. (2001). Naming, defining, and classifying in mental retardation. Mental Retardation, 39 (1), 47–52. doi:10.1352/0047-6765(2001)039<0047:NDACIM>2.0C);2
Manitoba (2014). The vulnerable persons living with mental disability act . Retrieved from https://web2.gov.mb.ca/laws/statutes/ccsm/v090e.php
National Association of Councils on Developmental Disabilities (2014). What are developmental disabilities? Retrieved from www.nacdd.org/about-nacdd/what-are-developmental-disabilities.aspx
Reiss, S, Levitan, G.W., & Szyszko, J. (1982). Emotional disturbance and mental retardation: Diagnostic overshadowing. American Journal of Mental Deficiency, 86 (6), 567–574. S 2781—111th Congress. (2009). Rosa’s Law . Retrieved from https://www.govtrack.us/congress/bills/111/s2781
Schalock, R.L. (2011). The evolving understanding of intellectual disability. Journal of Intellectual and Developmental Disabilities, 36 (4), 223–233. doi:10.3109/13668250.2011.624087
Schalock, R.L., Borthwick-Duffy, S.A., Bradley, et al., (2010). Intellectual disability: Definition, classification, and systems of supports (11th ed.). Washington DC: American Association on Intellectual and Developmental Disabilities.
Schalock, R.L. & Luckasson, R. (2013). What’s at stake in the lives of people with intellectual disability? Part I: The power of naming, defining, diagnosing, classifying, and planning supports. Journal of Intellectual and Developmental Disabilities, 51(2), 86–93. doi:10.1352/1934-9556-51.2.086
Special Olympics Inc. (n.d.).
Special Olympics Inc. (2014). How “retardation” went from a clinical description to a word of derision. Retrieved from http://www.r-word.org/r-word-why-pledge.aspx#.UvUr5DlgO5Q
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7.1: Collaboration Within the Interprofessional Team Introduction
Learning Objectives
- Collaborate with interprofessional team members when providing client care
- Manage conflict among clients and health care staff
- Perform procedures necessary to safely admit, transfer, and/or discharge a client
- Assess the need for referrals and obtain necessary orders
- Describe how the health care team meets the needs of diverse patients in a variety of settings
- Identify strategies to ensure productive, effective team functioning
All health care students must prepare to deliberately work together in clinical practice with a common goal of building a safer, more effective, patient-centered health care system. The World Health Organization (WHO) defines interprofessional collaborative practice as multiple health workers from different professional backgrounds working together with patients, families, caregivers, and communities to deliver the highest quality of care. [1]
Effective teamwork and communication have been proven to reduce medical errors, promote a safety culture, and improve patient outcomes. [2] The importance of effective interprofessional collaboration has become even more important as nurses advocate to reduce health disparities related to social determinants of health (SDOH). In these efforts, nurses work with people from a variety of professions, such as physicians, social workers, educators, policy makers, attorneys, faith leaders, government employees, community advocates, and community members. Nursing students must be prepared to effectively collaborate interprofessionally after graduation. [3]
The Interprofessional Education Collaborative (IPEC) has identified four core competencies for effective interprofessional collaborative practice. This chapter will review content related to these four core competencies and provide examples of how they relate to nursing.
- World Health Organization. (2010). Framework for action on interprofessional education & collaborative practice. https://www.who.int/publications/i/item/framework-for-action-on-interprofessional-education-collaborative-practice ↵
- AHRQ. (2015, July). TeamSTEPPS: National implementation research/evidence base. https://www.ahrq.gov/teamstepps/evidence-base/safety-culture-improvement.html ↵
- National Academies of Sciences, Engineering, and Medicine. (2021). The future of nursing 2020-2030: Charting a path to achieve health equity. The National Academies Press. https://doi.org/10.17226/25982 ↵


2.5: Equilibrium Analysis for Concurrent Force Systems
If a body is in static equilibrium, then by definition that body is not accelerating. If we know that the body is not accelerating then we know that the sum of the forces acting on that body must be equal to zero . This is the basis for equilibrium analysis for a particle.
In order to solve for any unknowns in our sum of forces equation, we actually need to turn the one vector equation into a set of scalar equations. For two dimensional problems, we will split our one vector equation down into two scalar equations. We do this by summing up all the \(x\) components of the force vectors and setting them equal to zero in our first equation, and summing up all the \(y\) components of the force vectors and setting them equal to zero in our second equation.
\[ \sum \vec{F} \, = \, 0 \]
\[ \sum F_x \, = \, 0 \, ; \,\,\, \sum F_y \, = \, 0 \]
We do something similar in three dimensional problems except we will break all our force vectors down into \(x\), \(y\), and \(z\) components, setting the sum of \(x\) components equal to zero for our first equation, the sum of all the \(y\) components equal to zero for our second equation, and the sum of all our \(z\) components equal to zero for our third equation.
\[ \sum \vec{F} \, = \, 0 \]
\[ \sum F_x \, = \, 0 \, ; \,\,\, \sum F_y \, = \, 0 \, ; \,\,\, \sum F_z \, = \, 0 \]
Once we have written out the equilibrium equations, we can solve the equations for any unknown forces.
Finding the Equilibrium Equations:
The first step in finding the equilibrium equations is to draw a free body diagram of the body being analyzed. This diagram should show all the known and unknown force vectors acting on the body. In the free body diagram, provide values for any of the know magnitudes or directions for the force vectors and provide variable names for any unknowns (either magnitudes or directions).
Next you will need to chose the \(x\), \(y\), and \(z\) axes. These axes do need to be perpendicular to one another, but they do not necessarily have to be horizontal or vertical. If you choose coordinate axes that line up with some of your force vectors you will simplify later analysis.
Once you have chosen axes, you need to break down all of the force vectors into components along the \(x\), \(y\) and \(z\) directions (see the vectors page in Appendix 1 if you need more guidance on this). Your first equation will be the sum of the magnitudes of the components in the \(x\) direction being equal to zero, the second equation will be the sum of the magnitudes of the components in the \(y\) direction being equal to zero, and the third (if you have a 3D problem) will be the sum of the magnitudes in the \(z\) direction being equal to zero. Collectively these are known as the equilibrium equations .
Once you have your equilibrium equations, you can solve them for unknowns using algebra. The number of unknowns that you will be able to solve for will be the number of equilibrium equations that you have. In instances where you have more unknowns than equations, the problem is known as a statically indeterminate problem and you will need additional information to solve for the given unknowns.
Example \(\PageIndex{1}\)
The diagram below shows a 3-lb box (Box A) sitting on top of a 5-lb box (box B). Determine the magnitude and direction of all the forces acting on box B.
- Solution
Example \(\PageIndex{2}\)
A 600-lb barrel rests in a trough as shown below. The barrel is supported by two normal forces (\(F_2\) and \(F_3\)). Determine the magnitude of both of these normal forces.
- Solution
Example \(\PageIndex{3}\)
A 6-kg traffic light is supported by two cables as shown below. Find the tension in each of the cables supporting the traffic light.
- Solution
Example \(\PageIndex{4}\)
A 400-kg wrecking ball rests against a surface as shown below. Assuming the wrecking ball is currently in equilibrium, determine the tension force in the cable supporting the wrecking ball and the normal force that exists between the wrecking ball and the surface.
- Solution
Example \(\PageIndex{5}\)
Barrels A and B are supported in a foot truck as seen below. Assuming the barrels are in equilibrium, determine all forces acting on barrel B.
- Solution
Example \(\PageIndex{6}\)
Three soda cans, each weighing 0.75 lbs and having a diameter of 4 inches, are stacked in a formation as shown below. Assuming no friction forces, determine the normal forces acting on can B.
- Solution
Example \(\PageIndex{7}\)
The skycam shown below is supported by three cables. Assuming the skycam has a mass of 20 kg and that it is currently in a state of equilibrium, find the tension in each of the three cables supporting the skycam.
- Solution
Example \(\PageIndex{8}\)
A hot air balloon is tethered to the ground with three cables as shown below. If the balloon is pulling upwards with a force of 900 lbs, what is the tension in each of the three cables?
- Solution


4.5: Outcome- Strategic Planning Tools
What you’ll learn to do: show how common analytic tools are used to inform the organization’s strategy
When a company is developing its strategy, it is faced with a vast array of considerations and choices. It needs to take into account its resources and capabilities, the strength of existing customer relationships, the competitive landscape, the economic and legal environments, important societal trends—the list of inputs goes on and goes on. Then, based on that information, it must devise a plan—a strategy—that contains the best options for addressing the inputs. But which inputs are most important, and which options should be included in the strategy? To answer these questions, businesses have at their disposal a number of strategic planning tools that help to simplify, organize, and focus both the inputs and the possible strategy options. In this section you’ll learn about three: the SWOT analysis, the Boston Consulting Group matrix, and the strategic growth matrix.
The specific things you’ll learn in this section include:
- Conduct a SWOT analysis and describe how it informs the organization’s marketing strategy
- Explain how businesses use the Boston Consulting Group matrix to inform growth strategies
- Explain how businesses use the strategic growth matrix to inform growth strategies
Learning Activities
The learning activities for this section include the following:
- Reading: SWOT Analysis
- Reading: BCG Matrix
- Reading: Strategic Opportunity Matrix
- Self Check: Strategic Planning Tools
Contributors and Attributions
- Outcome: Strategic Planning Tools. Provided by : Lumen Learning. License : CC BY: Attribution


9.7: Notes
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1 Although in the National Archaeological Museum at Athens I had the opportunity to examine some Pylian tablets that appear to be cut deliberately (I thank Dr Lena Papazoglou-Maniouda- ki for granting me permission to examine the tablets), an understanding of the overall practice of cutting the Pylian tablets can be achieved only once this corpus is published.
2 Such tablets are: Vc(1) 64 ⊕ Xd 170 ⊕ Vc(1) 7540; Vc(1) 81 ⊕ Vc(1) 199; Vc(1) 108 ⊕ Vc(1) 184; Vc(1) 125 ⊕ Vc(1) 312; Xd 179 ⊕ Xd 191; Xd 216 ⊕ Xd 287; Xd 123 ⊕ Vc(1) 108 ⊕ Vc(1) 184; Vc(1) 181 ⊕ Xd 7838; Xd 7933 ⊕ I/3-28 (Driessen 1987: 156 – 157, 162, pls I – III).
3 These tablets are: Vd 62, Vc 64, Vd 136, Vd 137, Vd 138, Vd 7545 + 137 and possibly Vc 7529.
4 Vc 216 is a very interesting tablet from this point of view. It has an incomplete word since it is broken in the middle of the fourth sign. On the left edge the number one precedes the word. It has been suggested that this tablet was cut at the wrong place and that the number actually referred to the word inscribed before the preserved one (Chadwick 1968: 18).
5 Tablets: #120 (inscribed on both sides, but with a line on only one side); four-sided bars: #050 (a line on only one side), #057 (lines on three sides), #059 (two parallel lines on one side), #061 (on all four sides), #063 (on two sides), #095 (two pairs of two parallel lines on one side), #111 (still visible on one side, the rest of the document is badly damaged), #112 (on three sides), #113 (on three sides), #116 (on one side); two-sided bars: #089 (on both sides), #092 (on one side), #109 (on one side), and one line on the two-sided bar from Kato Syme . The numbering of the inscriptions follows the classification in Olivier and Godart 1996. For the Kato Syme document, not included in the corpus, see Lebessi et al . 1995.
6 Vertical lines are present on some Hieroglyphic seals as well, where they divide syllabic signs or sign-groups, for example #283.α, #297.δ and #298.δ (Olivier 1995: 176) .


4.11: Taking stock
In this chapter, we have engaged with a range of critiques that have been voiced about the capability approach, or debates that have developed in the capability literature. While I hope that I have been fair in representing all viewpoints, I have in many cases argued for a particular way of looking at the problem, and in a significant number of cases argued that critiques must be reformulated in order to be sound, or did not sufficiently appreciate the modular structure of the general capability approach or the distinction between the capability approach and capability theories . Several of the critiques presented in this chapter had bite as a critique of a particular type of capability theory, but not of the capability approach in general.
The next and final (and very short!) chapter will not provide a summary of the previous chapters, but rather offer some thoughts and speculations on what the future of the capability approach could look like, which issues will need to be addressed to unlock its full potential, and which limitations will always need to be reckoned with.


4.9: How is Oxygen Saturation Measured?
Oxygen saturation can be measured using a pulse oximetry device, which is a non-invasive method to measure arterial oxygen saturation level. See Figure 4.1 for a pulse oximeter. In critically ill clients, a more invasive and continuous monitoring system is used to measure arterial blood gases through an arterial line. An arterial line is a catheter that is inserted into an artery, usually the radial artery. It provides a way to access blood gases including arterial oxygen saturation (SaO2). Here, we focus on pulse oximetry because it is identified as a vital sign.
Figure 4.1: A pulse oximeter
A pulse oximetry device includes a sensor that measures light absorption of hemoglobin and represents arterial SpO2 (OER #1). Oxyhemoglobin and unoxygenated hemoglobin absorb light differently. The sensor measures “the relative amount of light absorbed by oxyhemoglobin and unoxygenated (reduced) hemoglobin” and compares the amount of “light emitted to light absorbed” (Jarvis, 2014, p. 164). This comparison is then converted to a ratio and is expressed as a percentage of Sp02.
Points to Consider
A pulse oximeter reading reflects arterial oxygen saturation levels, as opposed to venous oxygen saturation levels, because the device only measures light absorption of pulsatile flow: the ‘p’ in Sp02 refers to pulse or pulsatile flow. If pulsatile flow is limited or obstructed, an oxygen saturation level will not be accurate. For example, the compression of a blood pressure cuff will obliterate the pulsatile flow so blood pressure and pulse oximetry should not be taken simultaneously on the same limb.
The sensor is attached using various devices. One is a spring-loaded clip attached to a finger or toe as shown in Figure 4.1. It is used when an intermittent measurement is required. However, this clip is too large for newborns and young children, so for this population, the sensor is taped to a finger or toe. See Figure 4.2. This technique is also used for clients who require continuous monitoring.
Figure 4.2: Pulse oximeter with sensor taped around finger
An earlobe clip is another useful device for clients who cannot tolerate the finger or toe clip or have a condition that could affect the results, such as vasoconstriction and poor peripheral perfusion. Another type of device is taped across the forehead and left in place for continuous monitoring. See Figure 4.3.
Figure 4.3: Pulse oximeter with device across forehead
_________________________________________________________________________
Part of this content was adapted from OER #1 (as noted in brackets above):
© 2015 British Columbia Institute of Technology (BCIT). Clinical Procedures for Safer Patient Care by Glynda Rees Doyle and Jodie Anita McCutcheon, British Columbia Institute of Technology. Licensed under a Creative Commons Attribution 4.0 International License , except where otherwise noted. Download this book for free at http://open.bccampus.ca


18.10: Bibliography
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- Jennifer Hasty, David G. Lewis, & Marjorie M. Snipes
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Avieli, Nur. 2011. “Dog Meat Politics in a Vietnamese Town.” Ethnology 50 (1): 59–78. https://ethnology.pitt.edu/ojs/index...ewArticle/6092 .
Berger, John. (1980) 1991. “Why Look at Animals?” In About Looking , 3–28. New York: Vintage Books.
Boissoneault, Lorraine. 2015. “Leopards, Hippos, and Cats, Oh My! The World’s First Zoo.” JSTOR Daily. November 12, 2015. https://daily.jstor.org/leopards-hip...lds-first-zoo/ .
Boylan, Michael. n.d. “Aristotle: Biology.” Internet Encyclopedia of Philosophy. https://iep.utm.edu/aris-bio/ .
Brightman, Robert. 1993. Grateful Prey: Rock Cree Human-Animal Relationships . Berkeley: University of California Press.
Crocker, Jon Christopher. 1985. Vital Souls: Bororo Cosmology, Natural Symbolism, and Shamanism . Tucson: University of Arizona Press.
DeMello, Margo. 2012. Animals and Society: An Introduction to Human-Animal Studies . New York: Columbia University Press.
Diamond, Wendy. 2011. “Thailand: Buddha’s Animal Kingdom.” HuffPost , September 19, 2011. https://www.huffpost.com/entry/thail...mal-k_b_969662 .
Evans, Katy M., and Vicki J. Adams. 2010. “Proportion of Litters of Purebred Dogs Born by Caesarean Section.” Journal of Small Animal Practice 51 (2): 113–118.
Gadsby, Patricia, and Leon Steele. 2004. “The Inuit Paradox.” Discover , January 19, 2004. https://www.discovermagazine.com/hea...-inuit-paradox .
Harris, Marvin. 1966. “The Cultural Ecology of India’s Sacred Cattle.” Current Anthropology 7 (1): 51–66.
Humane Society of the United States. 2021. “Animals Used in Experiments FAQ.” https://www.humanesociety.org/resour...xperiments-faq .
Hurn, Samantha. 2012. Humans and Other Animals: Cross-Cultural Perspectives on Human-Animal Interactions . London: Pluto Press.
Ingold, Tim, ed. 1994. What Is an Animal? Rev. ed. New York: Routledge.
Ingold, Tim. 2000. “Hunting and Gathering as Ways of Perceiving the Environment.” In The Perception of the Environment: Essays on Livelihood, Dwelling and Skill , 40–60. New York: Routledge.
Istomin, Kirill Vladimirovich, and Mark James Dwyer. 2010. “Dynamic Mutual Adaptation: Human-Animal Interaction in Reindeer Herding Pastoralism.” Human Ecology 38 (5): 613–623.
Kirksey, S. Eben, and Stefan Helmreich. 2010. “The Emergence of Multispecies Ethnography.” In “Multispecies Ethnography,” special issue, Cultural Anthropology 25 (4): 545–576.
Lévi-Strauss, Claude. 1963. Totemism . Translated by Rodney Needham. Boston: Beacon Press.
McKie, Robin. 2011. “Love of Animals Led to Language and Man’s Domination of Earth.” Guardian , October 1, 2011. https://www.theguardian.com/science/...imals-language .
Meyers, Richard, and Ernest Weston Jr. 2020. “What Rez Dogs Mean to the Lakota.” Sapiens , December 2, 2020. https://www.sapiens.org/culture/rez-dogs/ .
Mohnhaupt, Jan. 2020. Tiere im Nationalsozialismus . Munich: Carl Hanser.
Morgan, Lewis Henry. 1868. The American Beaver and His Works . Philadelphia: J. B. Lippincott.
Ostrander, Elaine A., and Robert K. Wayne. 2005. “The Canine Genome.” Genome Research 15 (12): 1706–1716. https://doi.org/10.1101/gr.3736605 .
Peterson, Anna Lisa. 2001. Being Human: Ethics, Environment, and Our Place in the World . Berkeley: University of California Press.
Posey, Darrell A. 1981. “Wasps, Warriors and Fearless Men: Ethnoentomology of the Kayapó Indians of Central Brazil.” Journal of Ethnobiology 1 (1): 165–174. https://ethnobiology.org/sites/defau.../Posey1981.pdf .
Pringle, Heather. 2011. “Earliest American Dogs May Have Been Dinner.” Science , May 6, 2011. https://www.science.org/content/arti...en-dinner-rev2 .
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Savage-Rumbaugh, E. Sue, Jeannine Murphy, Rose A. Sevcik, Karen E. Brakke, Shelly L. Williams, and Duane M. Rumbaugh. 1993. “Language Comprehension in Ape and Child.” Monographs of the Society for Research in Child Development 58 (3–4): i–252.
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Shipman, Pat. (2015) 2017. The Invaders: How Humans and Their Dogs Drove Neanderthals to Extinction . Cambridge, MA: Belknap Press of Harvard University Press.
Snipes, Marjorie M. 1996. “When the Other Speaks: Animals and Place as Social Space in the Argentine Andes.” PhD diss., University of Wisconsin–Madison. ProQuest (AAT 9636601).
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Thompson, Marc. 2008. “Itzcuintle: Ancient Mexican Dog Food.” In “Dogs in the Southwest,” special issue, Archaeology Southwest 22 (3): 9.
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Tuan, Yi-Fu. 1984. Dominance and Affection: The Making of Pets . New Haven, CT: Yale University Press.
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Yon, Sophia. 2002. A New Perspective on Barking in Dogs ( Canis familiaris ). Journal of Comparative Psychology 116(2):189-93.
Zorn, Elayne. 1995. “(Re-)Fashioning Identity: Late Twentieth-Century Transformations in Dress and Society in Bolivia.” In Contact, Crossover, Continuity: Proceedings of the Fourth Biennial Symposium of the Textile Society of America, September 22–24, 1994 , 343–354. Los Angeles: Textile Society of America. https://digitalcommons.unl.edu/tsaconf/1057/ .


26.4: Acid-Base Balance
Learning Objectives
- Identify the most powerful buffer system in the body
- Explain the way in which the respiratory system affects blood pH
Proper physiological functioning depends on a very tight balance between the concentrations of acids and bases in the blood. Acid-balance balance is measured using the pH scale, as shown in Figure \(\PageIndex{1}\). A variety of buffering systems permits blood and other bodily fluids to maintain a narrow pH range, even in the face of perturbations. A buffer is a chemical system that prevents a radical change in fluid pH by dampening the change in hydrogen ion concentrations in the case of excess acid or base. Most commonly, the substance that absorbs the ions is either a weak acid, which takes up hydroxyl ions, or a weak base, which takes up hydrogen ions.
Buffer Systems in the Body
The buffer systems in the human body are extremely efficient, and different systems work at different rates. It takes only seconds for the chemical buffers in the blood to make adjustments to pH. The respiratory tract can adjust the blood pH upward in minutes by exhaling CO 2 from the body. The renal system can also adjust blood pH through the excretion of hydrogen ions (H + ) and the conservation of bicarbonate, but this process takes hours to days to have an effect.
The buffer systems functioning in blood plasma include plasma proteins, phosphate, and bicarbonate and carbonic acid buffers. The kidneys help control acid-base balance by excreting hydrogen ions and generating bicarbonate that helps maintain blood plasma pH within a normal range. Protein buffer systems work predominantly inside cells.
Protein Buffers in Blood Plasma and Cells
Nearly all proteins can function as buffers. Proteins are made up of amino acids, which contain positively charged amino groups and negatively charged carboxyl groups. The charged regions of these molecules can bind hydrogen and hydroxyl ions, and thus function as buffers. Buffering by proteins accounts for two-thirds of the buffering power of the blood and most of the buffering within cells.
Hemoglobin as a Buffer
Hemoglobin is the principal protein inside of red blood cells and accounts for one-third of the mass of the cell. During the conversion of CO 2 into bicarbonate, hydrogen ions liberated in the reaction are buffered by hemoglobin, which is reduced by the dissociation of oxygen. This buffering helps maintain normal pH. The process is reversed in the pulmonary capillaries to re-form CO 2 , which then can diffuse into the air sacs to be exhaled into the atmosphere. This process is discussed in detail in the chapter on the respiratory system.
Phosphate Buffer
Phosphates are found in the blood in two forms: sodium dihydrogen phosphate (Na 2 H 2 PO 4 - ), which is a weak acid, and sodium monohydrogen phosphate (Na 2 HPO 4 2- ), which is a weak base. When Na 2 HPO 4 2- comes into contact with a strong acid, such as HCl, the base picks up a second hydrogen ion to form the weak acid Na 2 H 2 PO 4 - and sodium chloride, NaCl. When Na 2 HPO 4 2- (the weak acid) comes into contact with a strong base, such as sodium hydroxide (NaOH), the weak acid reverts back to the weak base and produces water. Acids and bases are still present, but they hold onto the ions.
HCl + Na 2 HPO 4 → NaH 2 PO 4 + NaCl
(Strong Acid) + (Weak Base) → (Weak Acid) + (Salt)
NaOH + NaH 2 PO 4 → Na 2 HPO 4 + H 2 O
(Strong Base) + (Weak Acid) → (Weak Base) + (Water)
Bicarbonate-Carbonic Acid Buffer
The bicarbonate-carbonic acid buffer works in a fashion similar to phosphate buffers. The bicarbonate is regulated in the blood by sodium, as are the phosphate ions. When sodium bicarbonate (NaHCO 3 ), comes into contact with a strong acid, such as HCl, carbonic acid (H 2 CO 3 ), which is a weak acid, and NaCl are formed. When carbonic acid comes into contact with a strong base, such as NaOH, bicarbonate and water are formed.
NaHCO 3 + HCl → H 2 CO 3 + NaCl
(Sodium Bicarbonate) + (Strong Acid) → (Weak Acid) + (Salt)
H 2 CO 3 + NaOH → HCO 3- + H 2 O
(Weak Acid) + (Strong Base) → (Bicarbonate) + (Water)
As with the phosphate buffer, a weak acid or weak base captures the free ions, and a significant change in pH is prevented. Bicarbonate ions and carbonic acid are present in the blood in a 20:1 ratio if the blood pH is within the normal range. With 20 times more bicarbonate than carbonic acid, this capture system is most efficient at buffering changes that would make the blood more acidic. This is useful because most of the body’s metabolic wastes, such as lactic acid and ketones, are acids. Carbonic acid levels in the blood are controlled by the expiration of CO 2 through the lungs. In red blood cells, carbonic anhydrase forces the dissociation of the acid, rendering the blood less acidic. Because of this acid dissociation, CO 2 is exhaled (see equations above). The level of bicarbonate in the blood is controlled through the renal system, where bicarbonate ions in the renal filtrate are conserved and passed back into the blood. However, the bicarbonate buffer is the primary buffering system of the IF surrounding the cells in tissues throughout the body.
Respiratory Regulation of Acid-Base Balance
The respiratory system contributes to the balance of acids and bases in the body by regulating the blood levels of carbonic acid (Figure \(\PageIndex{2}\)). CO 2 in the blood readily reacts with water to form carbonic acid, and the levels of CO 2 and carbonic acid in the blood are in equilibrium. When the CO 2 level in the blood rises (as it does when you hold your breath), the excess CO 2 reacts with water to form additional carbonic acid, lowering blood pH. Increasing the rate and/or depth of respiration (which you might feel the “urge” to do after holding your breath) allows you to exhale more CO 2 . The loss of CO 2 from the body reduces blood levels of carbonic acid and thereby adjusts the pH upward, toward normal levels. As you might have surmised, this process also works in the opposite direction. Excessive deep and rapid breathing (as in hyperventilation) rids the blood of CO 2 and reduces the level of carbonic acid, making the blood too alkaline. This brief alkalosis can be remedied by rebreathing air that has been exhaled into a paper bag. Rebreathing exhaled air will rapidly bring blood pH down toward normal.
The chemical reactions that regulate the levels of CO 2 and carbonic acid occur in the lungs when blood travels through the lung’s pulmonary capillaries. Minor adjustments in breathing are usually sufficient to adjust the pH of the blood by changing how much CO 2 is exhaled. In fact, doubling the respiratory rate for less than 1 minute, removing “extra” CO 2 , would increase the blood pH by 0.2. This situation is common if you are exercising strenuously over a period of time. To keep up the necessary energy production, you would produce excess CO 2 (and lactic acid if exercising beyond your aerobic threshold). In order to balance the increased acid production, the respiration rate goes up to remove the CO 2 . This helps to keep you from developing acidosis.
The body regulates the respiratory rate by the use of chemoreceptors, which primarily use CO 2 as a signal. Peripheral blood sensors are found in the walls of the aorta and carotid arteries. These sensors signal the brain to provide immediate adjustments to the respiratory rate if CO 2 levels rise or fall. Yet other sensors are found in the brain itself. Changes in the pH of CSF affect the respiratory center in the medulla oblongata, which can directly modulate breathing rate to bring the pH back into the normal range.
Hypercapnia , or abnormally elevated blood levels of CO 2 , occurs in any situation that impairs respiratory functions, including pneumonia and congestive heart failure. Reduced breathing (hypoventilation) due to drugs such as morphine, barbiturates, or ethanol (or even just holding one’s breath) can also result in hypercapnia. Hypocapnia , or abnormally low blood levels of CO 2 , occurs with any cause of hyperventilation that drives off the CO 2 , such as salicylate toxicity, elevated room temperatures, fever, or hysteria.
Renal Regulation of Acid-Base Balance
The renal regulation of the body’s acid-base balance addresses the metabolic component of the buffering system. Whereas the respiratory system (together with breathing centers in the brain) controls the blood levels of carbonic acid by controlling the exhalation of CO 2 , the renal system controls the blood levels of bicarbonate. A decrease of blood bicarbonate can result from the inhibition of carbonic anhydrase by certain diuretics or from excessive bicarbonate loss due to diarrhea. Blood bicarbonate levels are also typically lower in people who have Addison’s disease (chronic adrenal insufficiency), in which aldosterone levels are reduced, and in people who have renal damage, such as chronic nephritis. Finally, low bicarbonate blood levels can result from elevated levels of ketones (common in unmanaged diabetes mellitus), which bind bicarbonate in the filtrate and prevent its conservation.
Bicarbonate ions, HCO 3 - , found in the filtrate, are essential to the bicarbonate buffer system, yet the cells of the tubule are not permeable to bicarbonate ions. The steps involved in supplying bicarbonate ions to the system are seen in Figure \(\PageIndex{3}\) and are summarized below:
- Step 1: Sodium ions are reabsorbed from the filtrate in exchange for H + by an antiport mechanism in the apical membranes of cells lining the renal tubule.
- Step 2: The cells produce bicarbonate ions that can be shunted to peritubular capillaries.
- Step 3: When CO 2 is available, the reaction is driven to the formation of carbonic acid, which dissociates to form a bicarbonate ion and a hydrogen ion.
- Step 4: The bicarbonate ion passes into the peritubular capillaries and returns to the blood. The hydrogen ion is secreted into the filtrate, where it can become part of new water molecules and be reabsorbed as such, or removed in the urine.
It is also possible that salts in the filtrate, such as sulfates, phosphates, or ammonia, will capture hydrogen ions. If this occurs, the hydrogen ions will not be available to combine with bicarbonate ions and produce CO 2 . In such cases, bicarbonate ions are not conserved from the filtrate to the blood, which will also contribute to a pH imbalance and acidosis.
The hydrogen ions also compete with potassium to exchange with sodium in the renal tubules. If more potassium is present than normal, potassium, rather than the hydrogen ions, will be exchanged, and increased potassium enters the filtrate. When this occurs, fewer hydrogen ions in the filtrate participate in the conversion of bicarbonate into CO 2 and less bicarbonate is conserved. If there is less potassium, more hydrogen ions enter the filtrate to be exchanged with sodium and more bicarbonate is conserved.
Chloride ions are important in neutralizing positive ion charges in the body. If chloride is lost, the body uses bicarbonate ions in place of the lost chloride ions. Thus, lost chloride results in an increased reabsorption of bicarbonate by the renal system.
DISORDERS OF THE...
Acid-Base Balance: Ketoacidosis
Diabetic acidosis, or ketoacidosis, occurs most frequently in people with poorly controlled diabetes mellitus. When certain tissues in the body cannot get adequate amounts of glucose, they depend on the breakdown of fatty acids for energy. When acetyl groups break off the fatty acid chains, the acetyl groups then non-enzymatically combine to form ketone bodies, acetoacetic acid, beta-hydroxybutyric acid, and acetone, all of which increase the acidity of the blood. In this condition, the brain isn’t supplied with enough of its fuel—glucose—to produce all of the ATP it requires to function.
Ketoacidosis can be severe and, if not detected and treated properly, can lead to diabetic coma, which can be fatal. A common early symptom of ketoacidosis is deep, rapid breathing as the body attempts to drive off CO2 and compensate for the acidosis. Another common symptom is fruity-smelling breath, due to the exhalation of acetone. Other symptoms include dry skin and mouth, a flushed face, nausea, vomiting, and stomach pain. Treatment for diabetic coma is ingestion or injection of sugar; its prevention is the proper daily administration of insulin.
A person who is diabetic and uses insulin can initiate ketoacidosis if a dose of insulin is missed. Among people with type 2 diabetes, those of Hispanic and African-American descent are more likely to go into ketoacidosis than those of other ethnic backgrounds, although the reason for this is unknown.
Chapter Review
A variety of buffering systems exist in the body that helps maintain the pH of the blood and other fluids within a narrow range—between pH 7.35 and 7.45. A buffer is a substance that prevents a radical change in fluid pH by absorbing excess hydrogen or hydroxyl ions. Most commonly, the substance that absorbs the ion is either a weak acid, which takes up a hydroxyl ion (OH - ), or a weak base, which takes up a hydrogen ion (H + ). Several substances serve as buffers in the body, including cell and plasma proteins, hemoglobin, phosphates, bicarbonate ions, and carbonic acid. The bicarbonate buffer is the primary buffering system of the IF surrounding the cells in tissues throughout the body. The respiratory and renal systems also play major roles in acid-base homeostasis by removing CO 2 and hydrogen ions, respectively, from the body.
Review Questions
Q. Which of the following is the most important buffer inside red blood cells?
A. plasma proteins
B. hemoglobin
C. phosphate buffers
D. bicarbonate: carbonic acid buffer
Answer: B
Q. Which explanation best describes why plasma proteins can function as buffers?
A. Plasma proteins combine with bicarbonate to make a stronger buffer.
B. Plasma proteins are immune to damage from acids.
C. Proteins have both positive and negative charges on their surface.
D. Proteins are alkaline.
Answer: C
Q. The buffer that is adjusted to control acid-base balance is ________.
A. plasma protein
B. hemoglobin
C. phosphate buffer
D. bicarbonate: carbonic acid buffer
A. respiratory system
B. renal system
C. digestive system
D. metabolic rate of cells
Answer: A
Q. Bicarbonate ion concentrations in the blood are controlled through the ________.
A. respiratory system
B. renal system
C. digestive system
D. metabolic rate of cells
Answer: B
Q. Which reaction is catalyzed by carbonic anhydrase?
A. HPO 4 2- + H + ⇔ H 2 PO 4-
B. CO 2 + H 2 O ⇔ H 2 CO 3
C. H 2 PO 4- + OH - ⇔ HPO 4 2- + H 2 O
D. H 2 CO 3 ⇔ HCO 3- + H +
Answer: B
Critical Thinking Questions
Q. Describe the conservation of bicarbonate ions in the renal system.
A. Bicarbonate ions are freely filtered through the glomerulus. They cannot pass freely into the renal tubular cells and must be converted into CO 2 in the filtrate, which can pass through the cell membrane. Sodium ions are reabsorbed at the membrane, and hydrogen ions are expelled into the filtrate. The hydrogen ions combine with bicarbonate, forming carbonic acid, which dissociates into CO 2 gas and water. The gas diffuses into the renal cells where carbonic anhydrase catalyzes its conversion back into a bicarbonate ion, which enters the blood.
Q. Describe the control of blood carbonic acid levels through the respiratory system.
A. Carbonic acid blood levels are controlled through the respiratory system by the expulsion of CO 2 from the lungs. The formula for the production of bicarbonate ions is reversible if the concentration of CO 2 decreases. As this happens in the lungs, carbonic acid is converted into a gas, and the concentration of the acid decreases. The rate of respiration determines the amount of CO 2 exhaled. If the rate increases, less acid is in the blood; if the rate decreases, the blood can become more acidic.
Glossary
- hypercapnia
- abnormally elevated blood levels of CO 2
- hypocapnia
- abnormally low blood levels of CO 2


13.1C: Identification of Chromosomes and Karyotypes
- Describe a normal human karyotype and discuss the various abnormalities that can be detected using this technique
Identification of Chromosomes
The isolation and microscopic observation of chromosomes forms the basis of cytogenetics and is the primary method by which clinicians detect chromosomal abnormalities in humans. A karyotype is the number and appearance of chromosomes. To obtain a view of an individual’s karyotype, cytologists photograph the chromosomes and then cut and paste each chromosome into a chart, or karyogram, also known as an ideogram.
In a given species, chromosomes can be identified by their number, size, centromere position, and banding pattern. In a human karyotype, autosomes or “body chromosomes” (all of the non–sex chromosomes) are generally organized in approximate order of size from largest (chromosome 1) to smallest (chromosome 22). However, chromosome 21 is actually shorter than chromosome 22. This was discovered after the naming of Down syndrome as trisomy 21, reflecting how this disease results from possessing one extra chromosome 21 (three total). Not wanting to change the name of this important disease, chromosome 21 retained its numbering, despite describing the shortest set of chromosomes. The X and Y chromosomes are not autosomes and are referred to as the sex chromosomes.
The chromosome “arms” projecting from either end of the centromere may be designated as short or long, depending on their relative lengths. The short arm is abbreviated p (for “petite”), whereas the long arm is abbreviated q (because it follows “p” alphabetically). Each arm is further subdivided and denoted by a number. Using this naming system, locations on chromosomes can be described consistently in the scientific literature.
Although Mendel is referred to as the “father of modern genetics,” he performed his experiments with none of the tools that the geneticists of today routinely employ. One such powerful cytological technique is karyotyping, a method in which traits characterized by chromosomal abnormalities can be identified from a single cell. To observe an individual’s karyotype, a person’s cells (like white blood cells) are first collected from a blood sample or other tissue. In the laboratory, the isolated cells are stimulated to begin actively dividing. A chemical called colchicine is then applied to cells to arrest condensed chromosomes in metaphase. Cells are then made to swell using a hypotonic solution so the chromosomes spread apart. Finally, the sample is preserved in a fixative and applied to a slide.
The geneticist then stains chromosomes with one of several dyes to better visualize the distinct and reproducible banding patterns of each chromosome pair. Following staining, the chromosomes are viewed using bright-field microscopy. A common stain choice is the Giemsa stain. Giemsa staining results in approximately 400–800 bands (of tightly coiled DNA and condensed proteins) arranged along all of the 23 chromosome pairs. An experienced geneticist can identify each chromosome based on its characteristic banding pattern. In addition to the banding patterns, chromosomes are further identified on the basis of size and centromere location. To obtain the classic depiction of the karyotype in which homologous pairs of chromosomes are aligned in numerical order from longest to shortest, the geneticist obtains a digital image, identifies each chromosome, and manually arranges the chromosomes into this pattern.
At its most basic, the karyotype may reveal genetic abnormalities in which an individual has too many or too few chromosomes per cell. Examples of this are Down Syndrome, which is identified by a third copy of chromosome 21, and Turner Syndrome, which is characterized by the presence of only one X chromosome in women instead of the normal two. Geneticists can also identify large deletions or insertions of DNA. For instance, Jacobsen Syndrome, which involves distinctive facial features as well as heart and bleeding defects, is identified by a deletion on chromosome 11. Finally, the karyotype can pinpoint translocations, which occur when a segment of genetic material breaks from one chromosome and reattaches to another chromosome or to a different part of the same chromosome. Translocations are implicated in certain cancers, including chronic myelogenous leukemia.
During Mendel’s lifetime, inheritance was an abstract concept that could only be inferred by performing crosses and observing the traits expressed by offspring. By observing a karyotype, today’s geneticists can actually visualize the chromosomal composition of an individual to confirm or predict genetic abnormalities in offspring, even before birth.
Contributions and Attributions
- hemizygous. Provided by : Wiktionary. Located at : http://en.wiktionary.org/wiki/hemizygous . License : CC BY-SA: Attribution-ShareAlike
- OpenStax College, Biology. October 16, 2013. Provided by : OpenStax CNX. Located at : http://cnx.org/content/m44481/latest...ol11448/latest . License : CC BY: Attribution
- Robert Bear and David Rintoul, Extensions of the Laws of Inheritance. October 31, 2013. Provided by : OpenStax CNX. Located at : http://cnx.org/content/m47304/latest/ . License : CC BY: Attribution
- Structural Biochemistry/Chromosomes. Provided by : Wikibooks. Located at : en.wikibooks.org/wiki/Structu...ry/Chromosomes . License : CC BY-SA: Attribution-ShareAlike
- autosome. Provided by : Wiktionary. Located at : en.wiktionary.org/wiki/autosome . License : CC BY-SA: Attribution-ShareAlike
- wild type. Provided by : Wiktionary. Located at : en.wiktionary.org/wiki/wild_type . License : CC BY-SA: Attribution-ShareAlike
- OpenStax College, Chromosomal Theory and Genetic Linkage October 16, 2013. Provided by : OpenStax CNX. Located at : http://cnx.org/content/m44481/latest...e_13_01_01.jpg . License : CC BY: Attribution
- Robert Bear and David Rintoul, Extensions of the Laws of Inheritance. October 31, 2013. Provided by : OpenStax CNX. Located at : http://cnx.org/content/m47304/latest/ . License : CC BY: Attribution
- OpenStax College, Biology. October 16, 2013. Provided by : OpenStax CNX. Located at : http://cnx.org/content/m44481/latest...ol11448/latest . License : CC BY: Attribution
- homologous recombination. Provided by : Wikipedia. Located at : en.Wikipedia.org/wiki/homolog...0recombination . License : CC BY-SA: Attribution-ShareAlike
- synapsis. Provided by : Wiktionary. Located at : en.wiktionary.org/wiki/synapsis . License : CC BY-SA: Attribution-ShareAlike
- linkage. Provided by : Wiktionary. Located at : en.wiktionary.org/wiki/linkage . License : CC BY-SA: Attribution-ShareAlike
- OpenStax College, Chromosomal Theory and Genetic Linkage October 16, 2013. Provided by : OpenStax CNX. Located at : http://cnx.org/content/m44481/latest...e_13_01_01.jpg . License : CC BY: Attribution
- Robert Bear and David Rintoul, Extensions of the Laws of Inheritance. October 31, 2013. Provided by : OpenStax CNX. Located at : http://cnx.org/content/m47304/latest/ . License : CC BY: Attribution
- OpenStax College, Chromosomal Theory and Genetic Linkage October 16, 2013. Provided by : OpenStax CNX. Located at : http://cnx.org/content/m44481/latest...e_13_01_02.jpg . License : CC BY: Attribution
- OpenStax College, Chromosomal Theory and Genetic Linkage October 16, 2013. Provided by : OpenStax CNX. Located at : http://cnx.org/content/m44481/latest...e_13_01_03.png . License : CC BY: Attribution
- OpenStax College, Biology. October 16, 2013. Provided by : OpenStax CNX. Located at : http://cnx.org/content/m44483/latest...ol11448/latest . License : CC BY: Attribution
- karyotype. Provided by : Wiktionary. Located at : en.wiktionary.org/wiki/karyotype . License : CC BY-SA: Attribution-ShareAlike
- translocation. Provided by : Wiktionary. Located at : en.wiktionary.org/wiki/translocation . License : CC BY-SA: Attribution-ShareAlike
- autosome. Provided by : Wiktionary. Located at : en.wiktionary.org/wiki/autosome . License : CC BY-SA: Attribution-ShareAlike
- OpenStax College, Chromosomal Theory and Genetic Linkage October 16, 2013. Provided by : OpenStax CNX. Located at : http://cnx.org/content/m44481/latest...e_13_01_01.jpg . License : CC BY: Attribution
- Robert Bear and David Rintoul, Extensions of the Laws of Inheritance. October 31, 2013. Provided by : OpenStax CNX. Located at : http://cnx.org/content/m47304/latest/ . License : CC BY: Attribution
- OpenStax College, Chromosomal Theory and Genetic Linkage October 16, 2013. Provided by : OpenStax CNX. Located at : http://cnx.org/content/m44481/latest...e_13_01_02.jpg . License : CC BY: Attribution
- OpenStax College, Chromosomal Theory and Genetic Linkage October 16, 2013. Provided by : OpenStax CNX. Located at : http://cnx.org/content/m44481/latest...e_13_01_03.png . License : CC BY: Attribution
- NHGRI human male karyotype. Provided by : Wikipedia. Located at : en.Wikipedia.org/wiki/File:NH..._karyotype.png . License : Public Domain: No Known Copyright
Key Points
- A normal human karyotype contains 23 pairs of chromosomes: 22 pairs of autosomes and 1 pair of sex chromosomes, generally arranged in order from largest to smallest.
- The short arm of a chromosome is referred to as the p arm, while the long arm is designated the q arm.
- To observe a karyotype, cells are collected from a blood or tissue sample and stimulated to begin dividing; the chromosomes are arrested in metaphase, preserved in a fixative and applied to a slide where they are stained with a dye to visualize the distinct banding patterns of each chromosome pair.
- A karyotype can be used to visualize abnormalities in the chromosomes, such as an incorrect number of chromosomes, deletions, insertions, or translocations of DNA.
Key Terms
- autosome : any chromosome other than sex chromosomes
- karyotype : the observed characteristics (number, type, shape etc) of the chromosomes of an individual or species
- translocation : a transfer of a chromosomal segment to a new position, especially on a nonhomologous chromosome