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Mar
30

Material Love and The Modes of Nature

What do we call material love in our world? What we call “love” in this world is simply the self-centered desire to enjoy the “beloved” object. So our love for something or someone is dependent upon whether or not our senses are being pleased.

For example, people generally love animals such as cats because of the sensual attraction to soft fur, or dogs because of the dog’s desire to please the master. But, very few people are interested in embracing a cockroach, because a cockroach is displeasing to our senses. However, a cockroach is a living entity with feelings like any other due to its essential spiritual nature.

When we think that we are experiencing a loving mood with some other creature, we are illusioned because we are unaware of their consciousness which is not “at one” with ours. It is thinking of its own gratification.

When one loves Krishna, one will love all living entities equally and truly, because of the spiritual family relationship that is there. Krishna tells us that we are all His “parts and parcels”, His sons and daughters. A devotee of Krishna has no hatred for any living entity, just pure, unselfish love.

A Krishna conscious person is able to properly express this unselfish love and benefit all living entities, because he is aware of their real self-interest. However others, even if they are well-intentioned, can never give any real help to the self–the soul in the body. Material help is temporary. Spiritual help is eternal.

The real self-interest of all living entities is Krishna consciousness.

The Modes of Nature by Krishna. The Bhagavad-gita informs us that all conditioned souls are forced to act helplessly by , the impulses born of the modes of material nature. The soul is thinking that he is acting by his own volition but in actuality the modes are shaping the soul’s desires and actions.

There are three modes of nature: goodness, passion, and ignorance. According to the specific combination of the three modes that a soul is affected by, he acts accordingly. The three modes combine to provide the impulses for every conceivable type of activity in this world, just as the three primary colors can be combined to yield all the colors of the spectrum.

According to the combination of modes, one is attracted to certain types of eatables. For example, the pig is very enthusiastic to partake of stool (which human beings consider abominable), because the pig loves food in the mode of ignorance. Food in the mode of goodness is sweet, juicy, fattening, and palatable. Food in the mode of passion is too bitter, too sour, too salty, pungent, dry, and hot. Food in the mode of ignorance is decomposed, tasteless, stale, putrid, and unclean (such as meat).

A devotee is only interested in eating food that has been offered to Krishna which purifies his consciousness, and helps him in his spiritual progress.
1. Bhagavad-gita 3.5
2. Bhagavad-gita 17.8
3. Bhagavad-gita 17.9
4. Bhagavad-gita 17.10

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 March 30th, 2017  
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Jan
17

Modes of Mechanical Ventilation

Mechanical ventilation is required when there is a respiratory failure. There are two situations that lead to respiratory failure:
Ventilatory (Hypercapnia respiratory failure)
It can be caused caused by slowed respiratory function, chest wall abnormalities and respiratory muscle fatigue.
Inefficient Gas Exchange (Hypoxic respiratory failure)
It can be caused by an intrapulmonary shunt, ventilation-perfusion mismatch, decreased Functional Residual Capacity (FRC).

The main objectives of mechanical ventilation are maintaining adequate gas exchange, resolving respiratory distress, reducing breathing effort for patients and allowing lung healing.

Different modes of mechanical ventilation
There are three modes in mechanical ventilation.
Pressure Controlled Ventilation
Volume Controlled Ventilation
Dual Control Modes

Pressure Controlled Modes of Ventilation
In this mode, the ventilator delivers a preset pressure. So, the tidal volume of breath varies according to the resistance and elasticity of the patient’s respiratory system. The advantage of pressure controlled mode is that the gas is distributed equally throughout the lungs and a major disadvantage in this mode is that tidal volumes may vary because of changes in pulmonary mechanics. This mode needs close monitoring, which limits its usage in many patients in emergency departments.

Pressure-Controlled Ventilation (PCV)
During pressure-controlled ventilation, two pressure levels are kept constant:
The lower pressure level
The upper pressure level
It does not allow the patient to trigger breaths. It delivers breaths at the preset pressure. The volume and the decelerating flow will vary according to the changes in the lung mechanics.
The inspiratory flow pattern decreases exponentially and results in reduction of peak pressures and improvement of gas exchange.
The major disadvantage is that there is no guarantee for specific volume especially when lung mechanics are changing.

Pressure Support Ventilation (PSV)
It is used to enhance spontaneous breathing. This is flow-cycled and the duration of inspiration depends on the lung mechanics of the patient.
The patient can determine the inflation volume and frequency of respiratory, but not pressure.
This mode ensures guaranteed minimum frequency (backup frequency). If the breathing frequency of the patient is lower than the backup frequency or there is no spontaneous breathing, then the machine-triggered flow-cycled mandatory breaths are applied with the set upper pressure.

Pressure Controlled Inverse Ratio Ventilation (PCIRV)
In this mode, pressure is continuously adjusted downward and the time spent by the lungs on inhalation is greater than exhalation for proper gas exchange.
The reduced expiratory time leads to risks of auto lower pressure level and hemodynamic deterioration.

Airway Pressure Release Ventilation (APRV)
Airway pressure release ventilation mode is the time cycled pressure control mode.
PRV releases pressure temporarily on exhalation. This mode results in higher average airway pressures.
This mode enables patients to spontaneously ventilate at both low and high pressures unlike typical ventilation occurring at the high pressure.

Volume controlled modes of ventilation
In volume-controlled ventilation modes, the set tidal volume is supplied by the ventilator at a constant flow. The inspiratory pressure is variable and changes according to lung mechanics of the patient. This mode results in increased patient comfort and AutoFlow can be enabled. A major disadvantage of this method is that the high airway pressures may be generated resulting in barotrauma. Nevertheless, close monitoring and use of pressure limits are helpful in avoiding this problem. Volume-controlled ventilation modes are not available for the neonatal patient category.

Assist-Control Ventilation (ACV)
It is also known as Continuous Mandatory Ventilation (CMV). In this mode, the patient can trigger the ventilator to get breath.
If the patient fails to trigger the device within the preset time, the machine will automatically give breath.
The device delivers the present volume of breath when triggered by the patient.

Synchronized Intermittent-Mandatory Ventilation (SIMV)
In this mode, the machine delivers a preset volume of breathes at a preset rate and guarantees a certain number of breaths.
In addition, the patient is able to breathe spontaneously between machine breaths. Because the mandatory breaths are synchronized to coincide with spontaneous respiration.
Disadvantages of SIMV are increased effort of breathing and a tendency to reduce cardiac output, which may extend ventilator dependency. The addition of pressure support on top of spontaneous breaths can reduce the workload of breathing.

Dual control modes
Pressure Regulated Volume Control (PRVC)
In this mode, the machine delivers a set of tidal volumes at the minimum pressure level needed.
The ventilator automatically adjusts the inspiratory pressure control level according to the changes in the mechanical properties of the lungs.
The limitation of this mode is that the decrease in pressure support levels can result in hypoxemia.

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 January 17th, 2017  
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