By Z. Fasim. Centenary College of Louisiana. 2018.
If the hippocampus is damaged buy doxycycline 200 mg low cost, a person cannot build new memories 200 mg doxycycline free shipping, living instead in a strange world where everything he or she experiences just fades away discount 200 mg doxycycline fast delivery, even while older memories from the time before the damage are untouched cheap 100mg doxycycline visa. The Cerebral Cortex Creates Consciousness and Thinking All animals have adapted to their environments by developing abilities that help them survive. Some animals have hard shells, others run extremely fast, and some have acute hearing. Human beings do not have any of these particular characteristics, but we do have one big advantage over other animals—we are very, very smart. You might think that we should be able to determine the intelligence of an animal by looking at the ratio of the animal’s brain weight to the weight of its entire body. The elephant’s brain is one thousandth of its weight, but the whale‘s brain is only one ten- thousandth of its body weight. On the other hand, although the human brain is one 60th of its body weight, the mouse’s brain represents one fortieth of its body weight. Despite these comparisons, elephants do not seem 10 times smarter than whales, and humans definitely seem smarter than mice. What sets humans apart from other animals is our larger cerebral cortex—the outer bark-like layer of our brain that allows us to so successfully use language, acquire complex skills, create tools, and  live in social groups (Gibson, 2002). In humans, the cerebral cortex is wrinkled and folded, rather than smooth as it is in most other animals. This creates a much greater surface area and size, and allows increased capacities for learning, remembering, and thinking. Although the cortex is only about one tenth of an inch thick, it makes up more than 80% of the brain‘s weight. The cortex contains about 20 billion nerve cells and 300 trillion synaptic  connections (de Courten-Myers, 1999). Supporting all these neurons are billions more glial cells (glia), cells that surround and link to the neurons, protecting them, providing them with nutrients, and absorbing unused neurotransmitters. For instance, the myelin sheath surrounding the axon of many neurons is a type of glial cell. The glia are essential partners of neurons, without which the  neurons could not survive or function (Miller, 2005). The cerebral cortex is divided into two hemispheres, and each hemisphere is divided into four lobes, each separated by folds known as fissures. If we look at the cortex starting at the front of the brain and moving over the top (see Figure 3. Following the frontal lobe is the parietal lobe, which extends from the middle to the back of the skull and which is responsible primarily for processing information about touch. Then comes the occipital lobe, at the very back of the skull, which processes visual information. Finally, in front of the occipital lobe (pretty much between the ears) is the temporal lobe, responsible primarily for hearing and language. Functions of the Cortex  When the German physicists Gustav Fritsch and Eduard Hitzig (1870/2009) applied mild electric stimulation to different parts of a dog‘s cortex, they discovered that they could make different parts of the dog’s body move. Furthermore, they discovered an important and unexpected principle of brain activity. They found that stimulating the right side of the brain produced movement in the left side of the dog‘s body, and vice versa. This finding follows from a general principle about how the brain is structured, called contralateral control. The brain is wired such that in most cases the left hemisphere receives sensations from and controls the right side of the body, and vice versa. Fritsch and Hitzig also found that the movement that followed the brain stimulation only occurred when they stimulated a specific arch-shaped region that runs across the top of the brain from ear to ear, just at the front of the parietal lobe (see Figure 3.
The results showed that social support had only a small eﬀect on ill-health in those subjects who were employed but had a much larger eﬀect on those who had always been jobless doxycycline 200mg generic. Within the ‘always jobless’ group doxycycline 100 mg discount, those who reported higher levels of social support reported far fewer physical symptoms than those who reported lower social support cheap 100 mg doxycycline overnight delivery. In addition buy cheap doxycycline 100mg on line, subjects who were both unemployed and reported low social support reported more ill-health than all the other subjects. The effects of employment on social support The results were also analysed to examine the long-term eﬀects of employment on both social support and ill-health. Conclusion The results from this study provide support for the relationship between stress (unemployment) and health and suggest that this relationship is mediated by social support. Therefore, ill-health was greatest in those subjects who were both unemployed and who reported low social support. In addition, the results suggest that although social support may act as a mediating factor, it is itself related to employment status, with individuals gaining social support from work colleagues. For example, Friedman and Rosenman (1959) initially deﬁned type A behaviour in terms of excessive competitiveness, impatience, hostility and vigorous speech. Using a semi-structured interview, three types of type A behaviour were identiﬁed. Type A1 reﬂected vigour, energy, alertness, conﬁdence, loud speaking, rapid speaking, tense clipped speech, impatience, hostility, interrupting, fre- quent use of the word ‘never’ and frequent use of the word ‘absolutely’. Type A2 was deﬁned as being similar to type A1, but not as extreme, and type B was regarded as relaxed, showing no interruptions and quieter (e. The Jenkins activ- ity survey was developed in 1971 to further deﬁne type A behaviour. Support for a relationship between type A behaviour and coronary heart disease using the Jenkins activity survey has been reported by a number of studies (Rosenman et al. All subjects were exam- ined at the start of the study for the presence of heart disease and completed the Bortner questionnaire. They were then followed up for morbidity and mortality from heart attack and for sudden cardiac death for an average of 6. The results showed that non-manual workers had higher type A scores than manual workers and that type A score decreased with age. However, at follow-up the results showed no relationship between type A behaviour and heart disease. More recently, however, much research has focused on hostility and aspects of anger expression as the most important personality types to be linked to stress and illness. Hostility has most frequently been measured using the Cook Medley Hostility scale (Cook and Medley 1954) which asks people to rate statements such as ‘I have often met people who were supposed to be experts who were no better than I’, ‘It is safer to trust nobody’, and ‘My way of doing thing I apt to be misunderstood by others’. It seems to be more common in people whose parents were punitive, abusive, interfering and where there was a lot of conﬂict (Matthews et al. As described above individuals vary in their physiological reactions to stress, with some showing greater stress reactivity than others. Researchers have argued that hostility may be the social manifestation of this heightened reactivity. To assess this, Guyll and Contrada (1998) explored the relationship between hostility and stress reactivity and reported that chronically hostile people showed greater reactivity to stressors involving interpersonal interactions than non hostile people. Much research has shown an association between hostility and coronary heart disease. In particular, researchers have argued that hostility is not only an important risk factor for the development of heart disease (e. However, it may not be hostility per se that predicts heart disease but how this hostility is expressed. Similarly, Siegman and Snow (1977) argued that the expression of anger and hostility might be a better predictor of stress reactivity and subsequent health outcomes than the state or either anger or hostility on their own. The link between hostility and heart disease illustrates a role for a physiological pathway with the associated heightened stress reactivity leading to cardiac damage. However, research also suggests that hostility may also impact upon health through two other pathways.
If side effect becomes intolerable cheap doxycycline 200 mg visa, a switch to another antidepressant may be necessary cheap doxycycline 100 mg overnight delivery. Serotonin syndrome (may occur when two drugs that potentiate serotonergic neurotransmission are used concurrently [see “Interactions”]) purchase doxycycline 200mg on-line. Most frequent symptoms include changes in mental status purchase doxycycline 100mg overnight delivery, restlessness, myoclonus, hyperreﬂexia, tachycar- dia, labile blood pressure, diaphoresis, shivering, and tremors. The physician will prescribe medications to block serotonin receptors, relieve hyperthermia and muscle Antidepressants ● 443 rigidity, and prevent seizures. The histamine-1 receptor antagonist cyproheptadine is commonly used to treat the symptoms of serotonin syndrome. Supportive nursing measures include monitoring vital signs, providing safety measures to prevent injury when muscle rigidity and changes in mental status are present, cooling blankets and tepid baths to assist with tem- perature regulation, and monitoring intake and output (Prator, 2006). The condition will usually resolve on its own once the offending medication has been discontinued. However, if the medication is not discontinued, the condition may progress to life-threatening complications such as seizures, coma, hypotension, ventricular arrhythmias, disseminated intravascular coagulation, rhabdomyoly- sis, metabolic acidosis, and renal failure (Prator, 2006). Drugs that should be avoided include other antidepressants, sympathomimetics (in- cluding over-the-counter cough and cold preparations), stimulants (including over-the-counter diet drugs), an- tihypertensives, meperidine and other opioid narcotics, and antiparkinsonian agents, such as levodopa. Symptoms of hypertensive crisis include severe occipi- tal headache, palpitations, nausea and vomiting, nuchal rigidity, fever, sweating, marked increase in blood pres- sure, chest pain, and coma. Treatment of hypertensive crisis: Discontinue drug im- mediately; monitor vital signs; administer short-acting antihypertensive medication, as ordered by physician; use external cooling measures to control hyperpyrexia. Application site reactions (with selegiline transdermal system [Emsam]) The most common reactions include rash, itching, ery- thema, redness, irritation, swelling, or urticarial lesions. Priapism (with trazodone) Priapism is a rare side effect, but it has occurred in some men taking trazodone. If the client complains of prolonged or inappropriate penile erection, withhold medication dosage and notify the physician immediately. Priapism can become very problematic, requiring sur- gical intervention, and, if not treated successfully, can result in impotence. Hepatic failure (with nefazodone) Cases of life-threatening hepatic failure have been reported in clients treated with nefazodone. Advise clients to be alert for signs or symptoms sug- gestive of liver dysfunction (e. If after this length of time no improvement is noted, the physician may prescribe a different medication. If these side effects become persistent or interfere with activities of daily living, the client should report them to the physician. To do so might pro- duce withdrawal symptoms, such as nausea, vertigo, insomnia, headache, malaise, nightmares, and a return of the symptoms for which the medication was prescribed. Smoking increases the metabolism of tricyclics, requiring an adjust- ment in dosage to achieve the therapeutic effect. Many medications contain substances that, in combination with antidepressant medication, could precipitate a life-threatening hyperten- sive crisis. If the erection persists longer than 1 hour, seek emergency department treat- ment. Taking bupropion in divided doses will decrease the risk of seizures and other adverse effects. These drugs are believed to readily cross the placental barrier; if so, the fetus could experience adverse effects of the drug. Inform the physician immediately if pregnancy occurs, is suspected, or is planned. Refer to written materials furnished by health care providers for safe self-administration. Serum levels should be taken twice weekly at the initiation of therapy and until therapeutic level has been achieved. Serum levels should be monitored in uncomplicated cases during maintenance therapy every 1 to 2 months. Clonazepam ● Contraindicated in hypersensitivity, acute narrow-angle glaucoma, liver disease, lactation. Oxcarbazepine ● Contraindicated in hypersensitivity (cross-sensitivity with carbamazepine may occur), lactation.
Above = horizontal sections through the abdominal cavity discount doxycycline 100mg line, showing different contrast medium concentrations within the aorta and the aneurysm; below = 3-D reconstruction of the aneurysm; red = aorta; green = thrombotic areas; blue = vein (vena cava inferior order 100mg doxycycline mastercard, partly compressed) quality doxycycline 200mg. Pelvic Cavity in the Male: Vessels and Nerves of the Pelvic Organs 349 17 1 18 2 3 4 19 5 20 6 21 7 22 8 9 23 10 11 12 24 13 14 25 15 26 27 16 Vessels and nerves of the pelvic cavity in the male (medial aspect generic 200mg doxycycline, midsagittal section). Urogenital and Pelvic Diaphragms in the Male 351 1 Right testis (reflected laterally and upward) 2 Bulbospongiosus muscle 3 Ischiocavernosus muscle 4 Adductor magnus muscle 5 Posterior scrotal nerves and superficial perineal arteries 6 Posterior scrotal artery and vein 7 Right artery of bulb of penis 8 Perineal body 9 Perineal branches of pudendal nerve 10 Pudendal nerve and internal pudendal artery 11 Inferior rectal arteries and nerves 12 Inferior cluneal nerve 13 Coccyx (location) 14 Penis 15 Left testis (reflected laterally) 16 Left posterior scrotal artery 17 Deep transverse perineal muscle 18 Left artery of bulb of penis 19 Posterior femoral cutaneous nerve 20 External anal sphincter muscle 21 Anus 22 Gluteus maximus muscle 23 Anococcygeal nerves 24 Acetabulum (femur removed) 25 Ligament of femoral head 26 Body of ischium (cut) 27 Sciatic nerve 28 Coccygeus muscle 29 Levator ani muscle a iliococcygeus muscle b pubococcygeus muscle c puborectalis muscle 30 Prostatic venous plexus 31 Body of pubis 32 Testis Urogenital diaphragm and external genital organs in the male with vessels and nerves (from below). The 21 right half of the pelvis including 20 14 the obturator internus muscle and femur have been removed to 32 display the right half of the levator ani muscle. The left crus penis has been isolated and reflected laterally together with the bulb of the penis. Urogenital and Pelvic Diaphragms in the Male 353 1 Right testis (reflected) 2 Corpus spongiosum of penis 3 Corpus cavernosum of penis 4 Perineal branch of posterior femoral cutaneous nerve 5 Posterior scrotal arteries and nerves 6 Deep artery of penis 7 Deep transverse perineal muscle 8 Right perineal nerves 9 Inferior rectal nerves 10 Inferior cluneal nerve 11 Anococcygeal nerves 12 Left spermatic cord 13 Left testis (cut surface) 14 Dorsal artery and nerve of penis 15 Deep dorsal vein of penis 16 Urethra (cut) 17 Artery of bulb of penis 18 Superficial transverse perineus muscle 19 Left artery of bulb of penis 20 Perineal branch of pudendal nerve 21 Anus 22 External anal sphincter muscle 23 Gluteus maximus muscle 24 Internal pudendal artery and pudendal nerve 25 Sacrotuberous ligament 26 Coccyx 27 Urogenital diaphragm (deep 22 transverse perineus muscle) 28 Tendinous center of perineum (perineal body) 29 Levator ani muscle 30 Anococcygeal ligament 31 Obturator internus muscle 32 Dorsal artery of penis Urogenital diaphragm and external genital organs in the male (from below). The urinary bladder 37 Infundibulum of uterine tube is empty, position and shape of the uterus are normal. Female Urogenital System 355 1 Muscular coat of urinary bladder 2 Folds of mucous membrane of urinary bladder 3 Right ureteric orifice 4 Interureteric fold 5 Internal urethral orifice 6 Vesico-uterine venous plexus 7 Urethra 8 Pubic bone (cut edge) 9 External urethral orifice 10 Vestibule of vagina 11 Left ureteric orifice 12 Trigone of bladder 13 Obturator internus muscle 14 Levator ani muscle 15 Bulb of the vestibule 16 Left labium minus 17 Psoas major muscle 18 Ampulla of rectum 19 Uterus 20 Urinary bladder 21 Promontory 22 Sigmoid colon 23 Uterine tube 24 Head of femur 25 Vagina Coronal section through the female urinary bladder and urethra (anterior aspect). During embryonal development, the 7 uterus and ovary remain within the 25 pelvic cavity where, after puberty, 16 the ovulation takes place. The anterior wall of the vagina has been opened to display the vaginal portion of the cervix. The fimbriae of the uterine tube have been reflected to show the abdominal ostium. Female Internal Genital Organs: Uterus and Related Organs 359 1 Ilio-inguinal nerve 2 Ureter 3 Psoas major muscle 4 Genitofemoral nerve 5 Common iliac vein 6 Common iliac artery 7 Ovary 8 Uterine tube 9 Peritoneum 10 Round ligament of uterus 11 Inferior vena cava 12 Abdominal aorta 13 Superior hypogastric plexus 14 Rectum 15 Recto-uterine pouch (of Douglas) 16 Uterus 17 Vesico-uterine pouch 18 Urinary bladder 19 Iliac crest 20 Pubic symphysis 21 Placenta 22 Amnion and chorion 23 Adnexa of uterus (uterine tube and ovaries) 24 Myometrium 25 Internal orifice of uterus 26 Cervix of uterus 27 Umbilical cord View of the female pelvis showing uterus and related organs (superior aspect). The anterior wall of the uterus has been removed to show the location of the placenta. Main drainage routes of lymph vessels of uterus and its adnexa (indicated by arrows). Female External Genital Organs 361 1 Glans of clitoris 2 Labium majus 3 Vestibule of vagina 4 Hymen 5 Posterior labial commissure 6 Body of clitoris 7 Labium minus 8 External orifice of urethra 9 Vaginal orifice 10 Ureter 11 Adnexa of uterus 12 Prepuce of clitoris 13 Crus of clitoris 14 Greater vestibular glands 15 Anus and internal anal sphincter muscle 16 Median umbilical ligament containing urachus 17 Urinary bladder 18 Infundibulum of uterine tube 19 Ovary 20 Ampulla of uterine tube 21 Suspensory ligament of the ovary 22 Bulbospongiosus muscle and bulb of vestibule 23 Central tendon of perineum (perineal body) 24 External anal sphincter muscle Female external genital organs (anterior aspect). Female external genital organs in relation to internal genital organs and urinary system, isolated (anterior aspect). Urogenital Diaphragm and External Genital Organs in the Female 365 1 Position of pubic symphysis 2 Body of clitoris 3 Prepuce of clitoris 4 Adductor longus and gracilis muscles 1 5 External orifice of vagina and labium minus 6 Posterior labial nerve 7 Perineal body 8 8 Deep artery of clitoris and dorsal nerve of clitoris 2 9 9 Adductor brevis muscle 10 Glans of clitoris 3 10 11 Crus of clitoris and 4 ischiocavernosus muscle 11 12 Bulb of vestibule and bulbospongiosus muscle 13 Anterior branch of obturator nerve 12 14 Labium minus 5 15 Vaginal orifice 16 Posterior labial nerves 13 17 Branches of pudendal nerve 6 18 External sphincter of anus 19 Anus 20 Bulb of vestibule (divided) 21 Dorsal artery of clitoris 22 Superficial transverse perineus muscle 7 23 Perineal branch of posterior femoral cutaneous nerve 24 Levator ani muscle External genital organs in the female (inferior aspect). The clitoris has been 25 Pudendal nerve and dissected and slightly reflected to the right. The prepuce of clitoris has been divided internal pudendal artery to display the glans. The bulb of vestibule has partly been removed; the left labium minus was cut away. The peritoneum at the left half of pelvic cavity has been 9 removed to display uterine tube, vessels, and nerves. Pelvic Cavity in the Female: Coronal and Horizontal Sections 367 1 Ilium 2 Rectum 3 Recto-uterine fold 4 Ovary 5 Uterine tube 6 Urinary bladder 7 Urethra 8 Labium minus 9 Recto-uterine pouch of Douglas 10 Uterus (uterovesical pouch) 11 Ligament of the head of the femur 12 Head of femur 13 Vestibule of vagina 14 Labium majus 15 Anal cleft 16 Coccyx 17 Rectum Coronal section through the pelvic cavity of the female (cf. Horizontal section through the pelvic cavity of the female at level of the urethral sphincter and vagina (from below). The two positions of the forearm essential to manual skills in the human, supination (right arm) and pronation (left arm), are shown. Skeleton of the Shoulder Girdle and Thorax 369 Vertebral column 1 Atlas 2 Axis 3 Third–seventh cervical vertebrae 4 First thoracic vertebra 5 Twelfth thoracic vertebra 6 First lumbar vertebra Ribs 7 First–third ribs True ribs 8 Fourth–seventh ribs 9 Eighth–tenth ribs False ribs 10 Eleventh and twelfth ribs (floating ribs) Clavicle 11 Sternal end 12 Articular facet for sternum 13 Acromial end 14 Articular facet for acromion 15 Impression for costoclavicular ligament 16 Conoid tubercle 17 Trapezoid line 18 Site of acromioclavicular joint 19 Site of sternoclavicular joint Scapula 20 Acromion 21 Coracoid process 22 Glenoid cavity 23 Costal surface Sternum 24 Manubrium 25 Body 26 Xiphoid process Skeleton of shoulder girdle and thorax (anterior aspect). Because of the human body’s upright posture, the upper limb has developed a high degree of mobility. The shoulder girdle is to a great extent movable in the thorax and is connected with the 16 trunk only by the sternoclavicular joint. Vertebral column Scapula 1 Atlas 12 Acromion 2 Axis 13 Spine of scapula 3 Third–sixth cervical vertebrae 14 Lateral angle 4 Seventh vertebra (vertebra prominens) 15 Posterior surface 5 First thoracic vertebra 16 Inferior angle 6 Sixth thoracic vertebra 17 Coracoid process 7 Twelfth thoracic vertebra 18 Supraglenoid tubercle 8 First lumbar vertebra 19 Glenoid cavity 20 Infraglenoid tubercle Clavicle 21 Lateral margin 9 Sternal end 10 Acromial end Thorax 11 Site of acromioclavicular joint 22 Body of sternum 23 Costal arch 24 Angle of ribs 25 Floating ribs Scapula 371 Right scapula (posterior aspect). Scapula A = superior border B = medial border C = lateral border D = superior angle E = inferior angle F = lateral angle 1 Acromion 2 Coracoid process 3 Scapular notch 4 Glenoid cavity 5 Infraglenoid tubercle 6 Supraspinous fossa 7 Spine 8 Infraspinous fossa 9 Articular facet for acromion 10 Neck 11 Supraglenoid tubercle 12 Costal (anterior) surface Right scapula (lateral aspect).