By O. Felipe. Dean College. 2018.

Muscles contribute to posture generic 25 mg promethazine fast delivery, produce body Cardiac muscle shares similarities with heat generic 25mg promethazine otc, and act as a protective covering for internal both skeletal and smooth muscles. They skeletal muscle, it is striated, but it produces have the ability to be excited by a stimulus, contract, rhythmic involuntary contractions like relax, and return to their original size and shape. Whether muscles are attached to bones or to internal • Smooth muscles, also called involuntary or organs and blood vessels, their primary responsibility visceral muscles, are muscles whose actions is movement. The contraction of smooth muscle is sion of blood through the arteries, and contraction of controlled by the autonomic (involuntary) the bladder to eliminate urine. With the exception of rotation, these movements are in pairs of opposing functions. Motion Action Adduction Moves closer to the midline Abduction Moves away from the midline Flexion Decreases the angle of a joint Extension Increases the angle of a joint Rotation Moves a bone around its own axis Pronation Turns the palm down Supination Turns the palm up Inversion Moves the sole of the foot inward Eversion Moves the sole of the foot outward Dorsiflexion Elevates the foot Plantar flexion Lowers the foot (points the toes) Biceps brachii Brachioradialis Orbicularis oculi Masseter Deltoid Sternocleidomastoid Triceps brachii Brachialis Triceps Trapezius brachii Brachioradialis Pectoralis major Rectus abdominus Gluteus maximus Biceps femoris Gastrocnemius Soleus Achilles tendon Figure 10-1. Attachments large area of a particular bone, the attachment is Muscles attach to bones by fleshy or fibrous attach- called an aponeurosis. Although these fibers distribute this connective tissue penetrates the bone itself. This arrangement local- tive tissue converges at the end of the muscle to izes a great deal of force in a small area of bone. When the fibrous attachment spans a are highly adapted for resisting strains and are one Anatomy and Physiology 269 of the principal mechanical factors that hold bones prevent anterior-posterior displacement of the close together in a synovial joint. An example are articular surfaces and to secure articulating bones the cruciate ligaments of the knee that help to when we stand. It consists of (2) com- minerals, and produce blood cells within bone pact bone that forms a cylinder and sur- marrow (hematopoiesis). Together with soft tis- rounds a central canal called the (3) sue, most vital organs are enclosed and protected medullary cavity. For example, bones of the skull protect also called marrow cavity, contains fatty yel- the brain; the rib cage protects the heart and low marrow in adults and consists primarily lungs. In addition to support and protection, the of fat cells and a few scattered blood cells. Movement is possible epiphysis (plural, epiphyses) are the two because bones provide points of attachment for ends of the bones. As muscles what bulbous shape to provide space for contract, tendons and ligaments pull on bones muscle and ligament attachments near the and cause skeletal movement. The epiphyses are covered with found within the larger bones, is responsible for (6) articular cartilage, a type of elastic hematopoiesis, continuously producing millions connective tissue that provides a smooth of blood cells to replace those that have been surface for movement of joints. Bones serve as a storehouse for miner- reduces friction and absorbs shock at the als, particularly phosphorus and calcium. In addition, the epi- the body experiences a need for a certain miner- physes are made up largely of a porous al, such as calcium during pregnancy, and a suffi- chamber of (7) spongy bone surrounded cient dietary supply is not available, calcium is by a layer of compact bone. Red bone known as cancellous bone, enclosed in a thin marrow is also responsible for the forma- surface layer of compact bone. Examples of tion of white blood cells (leukopoiesis) short bones include the bones of the ankles, and platelets. In growing bones, bones include vertebrae and the bones of the the inner layer contains the bone-forming middle ear. Because blood • Flat bones are exactly what their name sug- vessels and osteoblasts are located here, the gests. They provide broad surfaces for muscu- periosteum provides a means for bone repair lar attachment or protection for internal and general bone nutrition. Examples of flat bones include bones periosteum through injury or disease usually of the skull, shoulder blades, and sternum. The periosteum also serves as a • Long bones are found in the appendages point of attachment for muscles, ligaments, (extremities) of the body, such as the legs, and tendons. Various types of projections are evident in bones, (7) Spongy bone some of which serve as points of articulation. Depressions and (contains yellow marrow) openings are cavities and holes in a bone. They (2) Compact bone provide pathways and openings for blood vessels, nerves, and ducts. For anatomical purposes, the human skeleton is divided into the axial skeleton and appendicular skeleton. It contributes to the formation of body cavities and provides protection for internal organs, such as the brain, spinal cord, and organs enclosed in the tho- rax. The axial skeleton is distinguished with bone (4) Distal epiphysis color in Figure 10–4. Sutures are Table 10-2 Surface Features of Bones This chart lists the most common types of projections, depressions, and openings along with the bones involved, descriptions, and examples for each. Becoming familiar with these terms will help you identi- fy parts of individual bones described in medical reports related to orthopedics. Surface Type Bone Marking Description Example Projections • Nonarticulating • Trochanter • Very large, irregularly • Greater trochanter of the femur surfaces shaped process found only on the femur • Sites of muscle and • Tubercle • Small, rounded process • Tubercle of the femur ligament attachment • Tuberosity • Large, rounded process • Tuberosity of the humerus Anatomy and Physiology 271 Table 10-2 Surface Features of Bones—cont’d Surface Type Bone Marking Description Example Articulating surfaces • Projections that • Condyle • Rounded, articulating knob • Condyle of the humerus form joints • Head • Prominent, rounded, • Head of the femur articulating end of a bone Depressions and openings • Sites for blood • Foramen • Rounded opening through • Foramen of the skull through vessel, nerve, and nerves a bone to which cranial nerves pass and duct passage accommodate blood vessels • Fissure • Narrow, slitlike opening • Fissure of the sphenoid bone • Meatus • Opening or passage into • External auditory meatus of the a bone temporal bone • Sinus • Cavity or hollow space • Cavity of the frontal sinus con in a bone taining a duct that carries secre- tions to the upper part of the nasal cavity the lines of junction between two bones, especially various cavities and recesses associated with the of the skull, and are usually immovable.

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Patients in the treatment arm were found to have better sensory levels 2 Brain Trauma Foundation buy promethazine 25mg low cost. Concussive symptoms or mental status abnormalities resolve in less than 15 minutes Grade 2 1 order promethazine 25mg mastercard. Concussive symptoms or mental status abnormalities (including amnesia) last more than 15 minutes Grade 3 1. There was a reported advantage of the prolonged dosing of steroids in the subset in which treatment was begun between 3 and 8 hours postin- jury, but there was no difference if steroids were started within 3 hours of injury. Additionally, patients in the 48- hour methylprednisolone group had a higher incidence of severe sepsis and pneumonia than patients in the other two arms, again raising the question of whether the questionable marginal benefits outweigh the risks. Both acute alcohol use and chronic alcohol use have a significant impact on mortality, and, with regard to motor 3 Nesathurai N. Hammond vehicle trauma, the link between alcohol use and death follows a dose- response curve. Failure to recognize the role alcohol plays in trauma represents an opportunity lost. Among the myths related to alcohol use are the fol- lowing two: that alcohol protects against serious injury and that most people injured after consuming alcohol are social drinkers. It focuses on the consequences of problem drinking and the patient’s perception of his/her problem. Studies indicate little difference in the sensitivity and selectivity among these screening tests. The value of early identification cannot be overemphasized, however, and must be coupled with early intervention. Gentillello and colleagues5 at Harborview Medical Center, reported on the creation of a trauma center–based intervention team. After even one inpatient contact, pro- fessional treatment can obtain long-term (defined as 1 year) abstinence rates as high as 64% to 74%, compared to abstinence rates of 10% when treatment is delayed until referral after hospital discharge. Trauma Fundamentals 561 Trauma in Pregnancy Trauma complicates 6% to 7% of all pregnancies. Attention to these details are required to ensure optimal outcome for both patients—the mother and the fetus. A general maxim, however, is that to care best for the fetus, one must take care of the mother. Additionally, systolic blood pressure and diastolic blood pressure decrease 15 to 20mmHg in the first two trimesters; the pulse rate increases by 15 to 20 beats/minute by the third trimester. Fetal distress predates mater- nal distress since the maternal circulation is maintained preferentially. Beyond the 20th week of pregnancy, the gravid uterus may compress the vena cava, resulting in reduced venous return and hypotension. This can be relieved by manual distraction of the uterus or logrolling the patient into the left lateral decubitus position. Fetal heart monitor- ing should be initiated on all patients beyond the 20th week of gesta- tion as soon as possible. The effects of radiation exposure are greatest from 2 to 7 weeks; there is little risk of teratogenesis after 17 weeks, although there is an increased relative risk of childhood malig- nancies. The current recommendation is to limit exposure to less than 5rad, with most radiographic studies delivering millirad doses (Table 31. Current Controversies Not all trauma management decisions fit neatly into the paradigm described in this chapter. The success of Vietnam War era aeromedical evacuation has not been demonstrated fully in an urban setting, and its greatest utility has been demonstrated in rural areas. Recent work by Bickell and colleagues6 supports the radical approach of limiting crystalloid infusion, even in the face of hypotension, in favor of a more rapid evacuation to a location for defin- itive care. More to the point, Feero and colleagues8 identified that unexpected survival correlated with reduced scene time, stressing the importance of triage and transport over interventions that may increase scene time. It is a public health problem of epidemic proportions that transcends geo- graphic boundaries and affects all age groups. An organized and methodologic approach to both trauma care and prevention has proven to be successful wherever practiced. Reappraisal of diagnostic peritoneal lavage criteria for operation in penetrating and blunt trauma. Immediate versus delayed fluid resus- citation for hypotensive patients with penetrating torso injuries. Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries. Practice Management Guide- lines for prophylactic antibiotics in penetrating abdominal injury and in open fractures. Early detection of hemoperitoneum by ultrasound examination of the right upper quadrant: a multicenter study. Computed tomography is inaccurate in estimating the severity of adult splenic injury.

But when sadness fills most of your days or worries saturate your mind generic 25mg promethazine mastercard, that’s not so normal discount 25 mg promethazine overnight delivery. Anxiety and depression can affect how you think, behave, feel, and relate to others. The discussion and quizzes in this chapter help you figure out how depression and anxiety affect your life. Don’t freak out if the quizzes in this chapter reveal that you have a few symptoms of anxiety or depression. If your symptoms are numerous and severe or your life seems out of control, you should consult your primary care physician or a mental health professional. These quizzes aren’t meant to replace trained mental health professionals — they’re the only people who can really diagnose your problem. Dwelling on Dismal and Worried Thoughts If you were able to listen in on the thoughts that reverberate through a depressed person’s head, you might hear “I’m a failure,” “My future looks bleak,” “Things just keep on getting worse,” or “I regret so many things in my life. The very darkest thoughts usually lead to depression, whereas anxiety usually stems from thoughts about being judged or hurt. Take the quiz in Worksheet 1-1 to determine if your thoughts reflect a problem with anxiety or depression. Although these thoughts can occur to someone who’s either depressed or anxious (or both), the odd-numbered items are most indicative of depression, and the even-numbered items reflect anxious thinking. However, the more items you endorse, the more you have cause for concern; specifically, if you check more than eight or ten items, you should think seriously about addressing your condition. At the same time, if you very strongly believe in any of these items, you just may have too much anxiety or depression. If you have any thoughts of suicide or utter hopelessness, you should consult your primary care physician or a mental health professional immediately. Chapter 1: Sorting Out Signs of Anxiety and Depression 11 Walking in Quicksand: Apprehensive and Blue Behavior If you were to follow a depressed or anxious person around, you might see some behavioral signs of their emotional turmoil. That’s because depression and anxiety on the inside affect what people do on the outside. For example, a depressed person may look tired, move slowly, or withdraw from friends and family; an anxious person may avoid socializing or have a trembling voice. Take the quiz in Worksheet 1-2 to see if your behavior indicates a problem with anxiety and/or depression. I feel compelled to repeat actions (such as hand washing, checking locks, arrang- ing things in a certain way, and so on). Even-numbered items are most consistent with anxiety, and odd-numbered items largely indicate depression. And, of course, like many people, you may have symptoms of both types of problems. In fact, some people primar- ily suffer from changes in appetite, sleep, energy, or pain while reporting few problematic thoughts or behaviors. These symptoms directly affect your body, but they’re not as easily observed by other people as the behavioral signs covered in the preceding section. Part I: Analyzing Angst and Preparing a Plan 12 Take The Sad, Stressed Sensations Quiz in Worksheet 1-3 to see if your body is trying to tell you something about your emotional state. The symptoms in this quiz can also result from various physical illnesses, drugs in your medicine cabinet, or even your three-cup coffee fix in the morning. Be sure to consult your primary care physician if you’re experiencing any of the symptoms in The Sad, Stressed Sensations Quiz. It’s always a good idea to have a checkup once a year and more frequently if you experience noticeable changes in your body. Although physical sensations overlap in anxiety and depression, even-numbered items in the quiz above are most consistent with anxiety, and the odd-numbered items usually plague those with depression. Reflecting upon Relationships When you’re feeling down or distressed for any length of time, odds are that your relation- ships with those around you will take a hit. Although you may think that your depression or anxiety affects only you, it impacts your friends, family, lovers, co-workers, and acquaintances. Take the quiz in Worksheet 1-4 to see if your emotions are causing trouble with your rela- tionships. Chapter 1: Sorting Out Signs of Anxiety and Depression 13 Worksheet 1-4 The Conflicted Connections Quiz ❏ 1. You guessed it; there’s no cutoff score here to tell you definitively whether or not you’re anxious or depressed. But the more items you check off, the more your relationships are suffering from your anxiety, depression, or both. Odd-numbered items usually indicate prob- lems with depression, and even-numbered items particularly accompany anxious feelings. You may feel somewhat anxious meeting new people and may be uncomfortable in the spotlight — these feelings aren’t necessarily any- thing to be concerned about. However, such issues become problematic when you find yourself avoiding social activities or meeting new people because of your shyness. Plotting Your Personal Problems Profile The Personal Problems Profile provides you with an overview of your problematic symp- toms.

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Forward scatter is inversely related to size and characteristic wavelength emitted by the fluorescent side scatter is directly related to size label is detected purchase promethazine 25mg with visa, then the cell bound the labeled D order 25 mg promethazine free shipping. Forward scatter is related to shape and side antibody and is positive for the respective antigen. Since Molecular diagnostics/Apply principles of special they emit green and red light, respectively, they procedures/Flow cytometry/2 can be differentiated in the same sample, allowing 33. Fluorescent dyes most commonly conjugated to two antibodies to be tested simultaneously. Fluorescein isothiocyanate and Texas red simultaneous measurement of more markers. Calcofluor white and Texas red example, different fluorescent dyes can be attached C. Phycoerythrin and fluorescein isothiocyanate to latex beads in different proportions so that up to D. Acridine orange and rhodamine 100 combinations can be discriminated by the optics. Molecular diagnostics/Apply principles of special This allows 100 different markers to be measured in procedures/Flow cytometry/1 the same sample simultaneously. Flow cytometry is used to measure specific plasma proteins and antibodies using fluorescent antibody–coated beads. Tyroid cancer of the gene is involved, giving rise to a 210 dalton Molecular/Apply principles of special laboratory chimeric protein. The absorbance ratio 260:280 was essential thrombocythemia that occurs at disease 1. An absorbance maximum for protein is 280 nm owing to the phenolic rings of tyrosine and tryptophan. Next generation sequencing has made Molecular/Select method/Gene mutation testing/3 clinical applications affordable. Identifying malignant ovarian masses added a laser determines its emission and the base is D. The blocking group and fluorescent dye Molecular/Apply principles of special laboratory are removed and the process repeated for the next procedures/Proteomics/2 base added. A Molecular/Apply principles of special laboratory commercially available test based on proteomics is procedures/Genetic testing/2 available for differentiating malignant from benign ovarian tumors. The test detects the presence of five proteins in serum linked to ovarian cancer, and uses multivariate statistical analysis to derive a number from 1–10 indicating the risk of cancer. A level of maternal contamination below 1% does not guarantee accuracy, but misinterpretation due to maternal contamination is unlikely. Negative genetic tests can be reported, but positive results should be confirmed using cultured cells. K-Ras is used to identify the tissue of origin cancers including colorectal, lung, and pancreatic cancer. A comparison of methods for the determination Answers to Questions 1–3 of alkaline phosphatase is categorized in which domain of educational objectives? B The affective domain of educational objectives Education and management/Apply knowledge of includes those that emphasize values, attitudes, and educational methodology/1 interests that attach a worth to an activity, situation, or phenomenon. Competency examinations use questions of known difficulty and Education and management/Apply knowledge of can be calibrated against established criteria in order educational methodology/1 to evaluate the examinee’s performance. Accuracy of a test Education and management/Apply knowledge of educational testing/1 523 524 Chapter 9 | Education and Management 4. When dealing with the instruction of complex to medical laboratory science students. Te instrumentation, a demonstration by the highest grade was an 85% and the lowest grade instructor is necessary and should include the was a 60%. A quiz as soon as the demonstration is complete educational testing/2 Education and management/Apply knowledge of educational methodology/1 5. A stated competency requirement for a medical laboratory science student is to perform Answers to Questions 4–8 calibration, plot data, and evaluate the acceptability of controls. C This type of test compares the students to each requirement encompasses which educational other rather than grading the students on a set of objective? All of these options of analysis to plot the standards, construct a best-fit calibration line, and determine the Education and management/Apply knowledge of concentration of the controls. The affective educational methodology/3 domain describes the student’s ability to value 6. A chemistry test result from a chemotherapy the results as acceptable or to repeat the patient was within normal limits on Tuesday. B The technologist chose to investigate the situation Monday (“flagged” high and approaching a in order to resolve a discrepancy. Te technologist performing the valuing, and characterization refer to the affective test noted a delta-check error and remembered domain in dealing with the problem presented here.

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This observation became known as the “three-ion criterion” [1] and was applied in practice buy discount promethazine 25 mg. Criteria concerning the performance of analytical methods and the interpretation of results were established in the European Union in 2002 [4] promethazine 25mg cheap. Slightly deviating criteria for relative ion abundances have been established by other organizations (table 3. Moreover, this will depend on the point of view: more stringent 84 Chapter 3 criteria result in an increased probability of false negative results whereas less strict criteria result in an increased probability of a false positive result [3]. It was concluded that, although the current criteria are a good starting point for confirmation of the identity of a compound, an additional procedure is needed to determine the (un)certainty of this qualitative result. Database A contains molecular mass data and was extracted from the eMolecules database [26], which contains over 5. Because residue analysis focusses on small molecules, only the compounds having a molecular weight of 100-1000 were taken into account. Of these, all compounds containing at least one carbon in combination with at least oxygen, nitrogen, sulphur and/or phosphorous were selected because these compounds can most likely be ionised by electrospray ionisation. All salts and metal containing compounds were removed from the dataset, which resulted in a total of over 5. Database B contains product ion spectra data and is constructed from the product ion spectra of 3629 compounds obtained from our own research, the Massbank database [27] and literature [28-35]. The combination of precursor ion mass and product ion mass, and the corresponding neutral losses, were included in the database, resulting in a total of 18314 entries. Reference standards of 126 model compounds consisting of veterinary drugs, growth promoters and pesticides, were obtained from Sigma-Aldrich (St. Using the selected parameters, multiple linear regression was carried out to establish an optimal linear model. Max(P(Mpd),P(Mnl)) is the maximum of P(Mpd) or P(Mnl) to represent a worst case situation. These parameters are determined based on the databases and empirical models presented in this chapter. Next, P(I) is compared to an a priori established criterion to rank the method selectivity, e. Based on the result, corrective measures can be taken to obtain additional selectivity like the selection of another or an additional product ion. On the obtained data, they carried out probability matching based upon the probability theory which states that if a number of events occur with a certain probability, the probability of all these events to occur simultaneously is the multiplication of all the individual probabilities. This overall probability was considered a measure for the uniqueness of a spectrum and thus for selectivity. Probability matching of selectivity Selectivity is a parameter that can be expressed in terms of the uniqueness of a compounds’ characteristics, in other words in terms of the probability of the occurrence of another compound possessing the same characteristics, P(I). If P(I) is high, the probability of an incorrect confirmation result is high and thus the method selectivity is considered low, whereas if P(I) is low the system used can be considered as highly selective. The selectivity of the monitored transitions is directly related to the m/z of the precursor ion(s), Mpc, and the product ions, Mpd. This is a severe underestimation of the selectivity of the method and can only be overcome by increasing the total number of spectra in the database. Therefore independent probability matching is proposed here, in which the individual probabilities of Mpc, Mpd1 and Mpd2 are multiplied. The selectivity of the precursor ion(s) is given by the probability of the occurrence of compounds showing the same precursor ion mass: P(Mpc). The selectivity of the product ions is related to the product ion mass (Mpd) itself, but also to the resulting neutral loss (Mpc-Mpd). For instance a product ion of m/z 400 has a low probability, but if it origins from a precursor ion of m/z 418, and thus if a neutral loss of water (18 Da) is involved, this transition should be considered non-selective. In the proposed worst case approach, the selectivity of the product ion is determined by selecting the highest of either P(Mpd) or the probability of the corresponding neutral loss, P(Mnl). Then the total probability of the occurrence of the selected characteristics, P(I) is calculated by formula 3. Obviously, some dependencies will exist, for example singly charged precursor ions always result in product ions al lower m/z. Therefore no exact quantitation of P(I) is obtained in this work, but rather a very good estimate. The result should therefore not be considered as a quantitative measure, but as a ranking tool for selectivity, e. The calculated value of P(I) in relation to the ranking of selectivity depends on fitness for purpose [1] and other factors affecting method selectivity like the preceding sample preparation procedure. In this work the applied sample preparation procedure is not taken into account in calculating P(I). Furthermore, if a derivatization procedure is used in the sample preparation procedure, e. Note that in this approach the relative ion abundances are not taken into account, whereas this would usually result in additional certainty on the identity of the compound. Therefore, the method presented here is on the safe side and gives an overestimation of the true P(I).

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