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For Consumer psychology is a pursuit that is likely to ex- example cheap 100mg dilantin otc, black and yellow have the lowest contrast ef- pand now that an estimated $5 billion worth of products fect dilantin 100 mg on line, which means the largest percentage of the popula- were purchased online by the spring of 2000 buy dilantin 100mg on-line. Online shop- tion can clearly detect the difference between these two ping habits might differ drastically from catalogue sales or colors generic 100 mg dilantin with visa. These trends are just beginning to be to mark school buses and many traffic signs. Jane Spear Control group Further Reading In an experiment that focuses on the effects of a Asker, Jennifer L. In such an experiment, in Conversion reaction which there are two groups of subjects, the group that is A psychological disorder characterized by physical exposed to the condition or factor is called the experi- symptoms for which no physiological cause can be mental group. For example, in a hypothetical study of the influence of the presence This condition was first described by Sigmund of loud music on the test performances of children, the Freud as conversion hysteria because it involved the control group would consist of the group of children not conversion of a repressed emotional problem to a physi- exposed to the loud music during the test. Today, conversion reaction is classified as scores would be compared with the experimental group, a somatoform disorder in the American Psychiatric As- the group of children who were exposed to loud music sociation’s Diagnostic and Statistical Manual of Men- during the test. Conversion reaction is a very rare condition, ac- counting for about 2 percent of all psychiatric diag- Further Reading noses, and usually first appears during adolescence or Atkinson, Rita L. San early adulthood, generally when an individual is under Diego: Harcourt Brace Jovanovich, 1987. Another source of “secondary gain” is the attraction of attention, sympathy, and sup- port that the patient may need but is unable to obtain in Convergent thinking other ways. The ability to narrow the number of possible solu- tions to a problem by applying logic and knowl- Some of the most common symptoms of conversion edge. Other physical com- ford, a psychologist well-known for his research on cre- plaints include tremors, abdominal pain, and speech im- ativity. Guilford posited that a prime component of cre- pairments such as aphonia, the inability to speak above ativity is divergent thinking, the capacity to arrive at a whisper. Sometimes a person will experience anesthe- unique and original solutions and the tendency to consid- sia in only one part of the body, such as “glove anesthe- er problems in terms of multiple solutions rather than sia,” which affects the hand only up to the wrist, al- just one. Convergent thinking, which narrows all options though such a problem could have no physiological ori- to one solution, corresponds closely to the types of tasks gin since there is no cut-off point between the nerves of usually called for in school and on standardized multi- the hand and arm. In contrast, creativity tests designed to docrine glands or autonomic nervous systems. If the assess divergent thinking often ask how many different symptoms of a conversion disorder are prolonged, they answers or solutions a person can think of to a specific may produce physiological damage by interrupting the question or problem. Some researchers have claimed that normal functioning of the body, and psychological creative achievement actually involves both divergent damage by inducing excessive dependence on family and convergent thinking—divergent thinking to generate members and other persons. The Standard Edition of the Complete Psy- Further Reading chological Works of Sigmund Freud. There are several different types of correlations; the most commonly used is called the Pear- A technique used to measure the likelihood of two son Product-Moment Correlation. See also Research methodology; Scientific method Psychologists are often interested in deciding whether two behaviors tend to occur together. Sometimes two measurements are associated so that when the value of one increases, so does the other— Cortex a positive correlation. On the other hand, one value may increase systematically as the other decreases—a nega- See Neocortex tive correlation. For example, the number of correct answers on a stu- dent’s test is generally positively related to the number of hours spent studying. Students who produce more correct Counseling psychology answers have spent more hours studying; similarly, fewer correct answers occur with fewer hours spent studying. An area of psychology which focuses on nurturing the development potential of relatively healthy in- One could also see whether the number of wrong dividuals in all areas of their lives. This pat- tern is likely to produce a negative correlation: a greater While the counseling psychologist may diagnose, number of wrong answers is associated with less study assess, and treat adjustment difficulties, they often ad- time. That is, the value of one variable increases (wrong dress problems which are more moderate than those en- answers) as the other decreases (hours spent studying). Clients of coun- Correlations allow an assessment of whether two seling psychologists are people who need help coping variables are systematically related within a group of in- with the stresses of everyday life, and the focus is on dividuals. A single person may show behavior that dif- strengthening their existing resources rather than over- fers from most of the rest of the group. The given student might study for many hours and still not counseling psychologist may use a number of tools in perform well on a test.

Metronidazole is a non-competitive inhibitor of microsomal Presystemic metabolism is not limited to the liver buy 100mg dilantin visa, since the gastro-intestinal mucosa contains many drug-metabolizing enzymes (e discount dilantin 100 mg amex. Pronounced first-pass metabolism by isoenzyme(s) of target drug either the gastro-intestinal mucosa (e generic dilantin 100 mg online. Liver disease increases the bioavailability of some drugs with extensive first-pass extraction (e purchase dilantin 100 mg without a prescription. For example, in the case of estradiol, which is excreted in bile as a glucuronide conjugate, bacteria-derived enzymes cleave the glucuronide so that free drug is available for reabsorption in the terminal ileum. A small proportion of the dose (approximately 7%) is excreted in the faeces under normal circumstances; this increases if gastro-intestinal dis- ease or concurrent antibiotic therapy alter the intestinal flora. They have distinct isoenzyme forms Variability in first-pass metabolism results from: and are critical for phase I reactions. Genetic variations – for example, the bioavailability of pharmacologically active, as well as being chemically hydralazine is about double in slow compared to fast reactive, and can be hepatotoxic. Presystemic hydroxylation of metoprolol and glucuronidation, sulphation, methylation). Drugs that increase liver blood flow have similar effects to protease inhibitors, quinolones, metronidazole) and food – for example, hydralazine increases propranolol dietary constituents (e. Dissecting the func- and Emergency Department by her sister, having swal- tion of P450. Cytochrome P450: nature’s most versatile biological cata- down with vodka six hours previously, following an argu- lyst. Interindividual variability in inhibition and induction taking St John’s wort for several weeks. In paracetamol overdose, the usual pathway of elimination Pharmacogenetics 2004; 14: 1–18. Polar substances are eliminated efficiently by the drug or drug metabolite (Figure 6. The contribution of renal kidneys, because they are not freely diffusible across the tubu- excretion to total body clearance of any particular drug is lar membrane and so remain in the urine, even though there is a concentration gradient favouring reabsorption from tubular to interstitial fluid. Renal elimination is influenced by several Free drug enters processes that alter the drug concentration in tubular fluid. In contrast, molecules with a Can be affected by other molecular weight of 66000 (including plasma proteins and drugs: main site for interactions in the drug–protein complexes) do not pass through the glomerulus. Renal Loop of Henle impairment (Chapter 7) predictably reduces the elimination of drugs that depend on glomerular filtration for their clearance (e. Drugs that are highly bound to albumin or α-1 3 Passive reabsorption Distal tubule acid glycoprotein in plasma are not efficiently filtered. These are relatively non-specific in their structural requirements, and share some of the characteristics Ionized, lipid-insoluble drug of transport systems in the intestine. Because secretion of free drug occurs up a concentration gra- dient from peritubular fluid into the lumen, the equilibrium and between unbound and bound drug in plasma can be dis- turbed, with bound drug dissociating from protein-binding B H H. Tubular secretion can therefore eliminate drugs effi- ciently even if they are highly protein bound. Thus high pH favours A , the charged form of the weak probenecid competitively inhibits the tubular secretion of acid which remains in the tubular fluid and is excreted in the methotrexate. The extent to which urinary pH affects renal excretion of The renal tubule behaves like a lipid barrier separating the weak acids and bases depends quantitatively upon the pKa of high drug concentration in the tubular lumen and the lower the drug. The critical range of pKa values for pH-dependent concentration in the interstitial fluid and plasma. For highly lipid-soluble drugs, reabsorption is so effec- which is excreted unchanged. Diuresis may be induced deliberately in order to nary screening tests more difficult.

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Penetrating bites involving arteries order dilantin 100 mg on-line, nerves purchase 100 mg dilantin with mastercard, muscles 100mg dilantin with amex, tendons discount dilantin 100mg free shipping, the hands, or feet, resulting in a moderate to serious facial wound, or crush injuries, also require immediate referral. A full forensic documentation of the bite should be made as detailed in Chapter 4. Note if there are clinical signs of infection, such as erythema, edema, cellulitis, purulent discharge, or regional lymphadenopathy. Wound closure is not generally recom- mended because data suggest that it may increase the risk of infection. This is particularly relevant for nonfacial wounds, deep puncture wounds, bites to the hand, clinically infected wounds, and wounds occurring more than 6–12 hours before presentation. Head and neck wounds in cosmetically important areas may be closed if less than 12 hours old and not obviously infected. Viruses • Dog bites—outside of the United Kingdom, Australia, and New Zealand, rabies should be considered. In the United States, domestic dogs are mostly Infectious Diseases 265 vaccinated against rabies (57), and police dogs have to be vaccinated, so the most common source is from racoons, skunks, and bats. Antibiotic Prophylaxis Antibiotics are not generally needed if the wound is more than 2 days old and there is no sign of infection or in superficial noninfected wounds evalu- ated early that can be left open to heal by secondary intention in compliant people with no significant comorbidity (58). Antibiotics should be considered with high-risk wounds that involve the hands, feet, face, tendons, ligaments, joints, or suspected fractures or for any penetrating bite injury in a person with diabetes, asplenia, or cirrhosis or who is immunosuppressed. Coamoxiclav (amoxycillin and clavulanic acid) is the first-line treatment for mild–moderate dog or human bites resulting in infections managed in pri- mary care. For adults, the recommended dose is 500/125 mg three times daily and for children the recommended does is 40 mg/kg three times daily (based on amoxycillin component). It is also the first-line drug for prophylaxis when the same dose regimen should be prescribed for 5–7 days. If the individual is known or suspected to be aller- gic to penicillin, a tetracycline (e. In the United Kingdom, doxycycline use is restricted to those older than 12 years and in the United States to those older than 8 years old. Anyone with severe infection or who is clinically unwell should be referred to the hospital. Tetanus vaccine should be given if the primary course or last booster was more than 10 years ago. If the person has never been immunized or is unsure of his or her tetanus status, a full three-dose course, spaced at least 1 month apart, should be given. General Information Respiratory tract infections are common, usually mild, and self-limit- ing, although they may require symptomatic treatment with paracetamol or a nonsteroidal antiinflammatory. These include the common cold (80% rhi- noviruses and 20% coronaviruses), adenoviruses, influenza, parainfluenza, and, during the summer and early autumn, enteroviruses. Special attention should be given to detainees with asthma or the who are immunocompromised, because infection in these people may be more serious particularly if the lower respiratory tract is involved. The following section includes respiratory pathogens of special note because they may pose a risk to both the detainee and/or staff who come into close contact. General Information and Epidemiology There are five serogroups of Neisseria meningitidis: A, B, C, W135, and Y. In the United Kingdom, most cases of meningitis are sporadic, with less than 5% occurring as clusters (outbreaks) amongst school children. Between 1996 and 2000, 59% of cases were group B, 36% were group C, and W135 and A accounted for 5%. There is a seasonal variation, with a high level of cases in winter and a low level in the summer. The greatest risk group are the under 5 year olds, with a peak incidence under 1 year old. In Sub-Saharan Africa, the dis- ease is more prevalent in the dry season, but in many countries, there is back- ground endemicity year-round. Routine vaccination against group C was introduced in the United King- dom November 1999 for everybody up to the age of 18 years old and to all first- year university students. As a result of the introduction of the vaccination pro- gram, there has been a 90% reduction of group C cases in those younger than under 18 years and an 82% reduction in those under 1 year old (60,61). An outbreak of serogroup W135 meningitis occurred among pilgrims on the Hajj in 2000.

The right ventricle extends downward toward where the heart rests against the diaphragm order dilantin 100mg without a prescription. A circular opening into the pulmonary trunk is covered by the pulmonary semilunar valve purchase dilantin 100 mg without a prescription, so- called because of its three crescent-shaped cusps buy cheap dilantin 100 mg. When the ventricle relaxes cheap dilantin 100 mg on-line, the blood from the pulmonary artery tends to flow back toward the ventricle, filling the pockets of the cusps and causing the valve to close. The atrial surface of the tricuspid valve is smooth, but the side toward the ventricle is irregular, forming a ragged edge where the chordae tendineae attach. These fibrous cords, which are attached to nipple-shaped projec- tions called papillary muscles in the ventricle’s wall, prevent blood from flowing back into the atrium. Cardiac muscle in the ventricle’s wall is in an irregular pattern of bun- dles and bands called the trabeculae carneae. Longer and more conical in shape, the left ventricle’s tip forms the apex of the heart. This ventricle’s chordae tendineae are fewer, thicker, and stronger, and they’re attached by only two larger papillary muscles, one on the front (anterior) wall and one on the back (posterior). Its opening to the aorta is protected by the aortic semilunar valve, composed of three half-moon cusps that are larger, thicker, and stronger than the pulmonary valve’s cusps. Between these cusps and the aortic wall are dilated pockets called aortic sinuses, which are openings for the coro- nary arteries. Use the terms that follow to identify the heart’s major vessels shown in Figure 10-2. The cavity in the heart that contains the areas called the sinus venarum cavarum and a blind pouch called the auricle is the a. The atrioventricular opening between the right atrium and right ventricle is covered by the a. Four structures play key roles in this dance — the sinoatrial node, atrioventricular node, atrioventricular bundle, and Purkinje fibers. Rather than both contracting and conducting impulses as other cardiac muscle does, these structures specialize in conduction alone, setting the pace for the rest of the heart. Following is a bit more information about each one: Sinoatrial node: This node really is the pacemaker of the heart. Located at the junction of the superior vena cava and the right atrium, this small knot, or mass, of specialized heart muscle initiates an electrical impulse that moves over the musculature of both atria, causing atrial walls to contract simultaneously and emptying blood into both ventricles. Atrioventricular node: The impulse that starts in the S-A node moves to this mass of modified cardiac tissue that’s located in the septal wall of the right atrium. Also called the A-V node, it directs the impulse to the A-V bundles in the septum. Atrioventricular bundle: From the A-V node, the impulse moves into the atri- oventricular bundle, also known as the A-V bundle or bundle of His (pronounced “hiss”). The bundle breaks into two branches that extend down the sides of the interventricular septum under the endocardium to the heart’s apex. Purkinje fibers: At the apex, the bundles break up into terminal conducting fibers, or Purkinje fibers, and merge with the muscular inner walls of the ventricles. The pulse then stimulates ventricular contraction that begins at the apex and moves toward the base of the heart, forcing blood toward the aorta and pulmonary artery. One of the best ways to detect cardiac tissue under a microscope is to look for undu- lating double membranes called intercalated discs separating adjacent cardiac muscle fibers. Gap junctions in the discs permit ions to pass between the cells, spreading the Chapter 10: Spreading the Love: The Circulatory System 171 action potential of the electrical impulse and synchronizing cardiac muscle contrac- tions. Potential problems include fibrillation, a breakdown in rhythm or propagation of the impulses that causes individual fibers to act independently, and heart block, an interruption that causes the atria and ventricles to take on their own rates of contrac- tion. Left atrium Sinoatrial node (pacemaker) Purkinje fibers Atrioventricular node Figure 10-4: Right atrium The conductive Purkinje fibers system of the heart. Wolters Kluwer Health — Lippincott Williams &Wilkins A healthy heart makes a “lub-dub” sound as it beats. The first sound (the “lub”) is heard most clearly near the apex of the heart and comes at the beginning of ventricu- lar systole (the closing of the atrioventricular valves and opening of the semilunar valves). It’s lower in pitch and longer in duration than the second sound (the “dub”), heard most clearly over the second rib, which results from the semilunar valves clos- ing during ventricular diastole. Defects in the valves can cause turbulence or regurgita- tion of blood that can be heard through a stethoscope.

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