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Individuals such as teacher evaluation or education- with mental retardation have a wide al development purchase fosamax 35 mg without a prescription, in addition to adaptive range of abilities as well as disabilities cheap fosamax 70mg without prescription. A variety of other factors, extent of support needed varies with the such as environment and stimulation, also individual and with his or her circum- help to determine intellectual functioning stances. Some individuals with mental and adaptive capability, so test results are Common Psychiatric Disabilities 177 not always absolute. During school age, they only intellectual capacity but also adaptive may attain some elementary self-care skills functioning must be considered. In Classification of Mental Retardation adulthood, they may live in community group homes or with their families. Generally, individuals with individuals in this category of mental mild mental retardation are considered retardation have an associated central capable of attaining intellectual function nervous system disorder, visual and/or up to a sixth-grade level. During their pre- hearing impairment, severe motor and school years, they are generally capable of physical disabilities, and lack of expressive attaining social and communication skills language skills. Because of the severity of consistent with their peers; consequently, the condition, most individuals require some individuals may not be distinguish- close supervision and provision of most able from other children in their age daily care. Individuals with mild retardation a consistent caretaker and to a low-stim- may be able to obtain employment and ulus environment. The opinions and expectations most Generally, individuals in this category can people have about themselves are influ- live independently in the community. Individuals with mod- tations or lack of belief in individuals’ abil- erate mental retardation often attain ity to achieve are communicated, the intellectual function at the second-grade chances for individuals to progress in at- level, but they may require more supervi- taining goals are diminished. Because a sion in activities of daily living, although number of inaccurate and stereotypical they can usually manage self-care. Pro- ideas about individuals with mental retar- cessing abstract information is generally dation still exist, barriers to reaching opti- difficult. Individuals with moderate men- mal function and independence continue tal retardation are usually capable of learn- to be present. Although societal and em- ing some vocational skills, although they ployer attitudes are changing slowly, may function best in a supervised work there is continued need for education and environment, such as a sheltered work- integration of individuals with mental shop or supported employment situation. They are Although all individuals with mental generally able to live in the community, retardation can experience stresses due to but in supervised settings. Individuals with severe specific stresses because they may appear mental retardation generally have limit- normal to others and consequently limi- ed communication skills and poorly devel- tations may not be recognized as a disabil- 178 CHAPTER 6 PSYCHIATRIC DISABILITIES ity. Lack of acceptance and devaluation cluded in this category, two of the most can resultant in low self-esteem and iso- common are autism and Asperger’s disorder. In more severe Autism cases, a psychiatric disorder may be devel- oped as a means of coping. Autism has shown a steady increase in incidence since it was first described in Vocational Issues in Mental Retardation 1943 (Merrick, Kandel, & Morad, 2004). Considered one of a family of develop- The level of occupational functioning mental disabilities, autism (autistic disor- for individuals with mental retardation der) is a disorder of brain function that has depends to some extent on the degree of a broad range of behavioral consequences, disability. Because mental retardation is including impairment in reciprocal social often accompanied by other medical con- interaction and impairment in verbal ditions, the physical limitations associat- and nonverbal communication (American ed with any medical condition must also Psychiatric Association, 2000). Individuals with mental symptoms may include repetitive and retardation usually perform better in a stereotyped mannerisms, intense preoccu- structured environment.

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Endocrine System © The McGraw−Hill Anatomy buy cheap fosamax 35 mg on line, Sixth Edition Coordination Companies 70mg fosamax visa, 2001 472 Unit 5 Integration and Coordination (a) (b) FIGURE 14. Cortisol and related anti-inflammatory compounds are com- thought that these hormones supplement the sex hormones monly used to treat patients suffering from arthritis and vari- produced in the gonads. They are also frequently used to treat traumatized joints and to suppress the immune rejection of transplanted tis- concentrations in both males and females play a role in deter- sues. Unfortunately, cortisol inhibits the regeneration of connective mining the sex drive. Gonadocorticoids are the sex hormones that are secreted The chromaffin cells of the adrenal medulla produce two by the zona reticularis of the adrenal cortex. The majority of closely related hormones: epinephrine and norepinephrine. Both of these hormones are adrenal androgens, but small quantities of these hormones are classified as amines—more specifically, as adrenal estrogens and progesterones are produced as well. Endocrine System © The McGraw−Hill Anatomy, Sixth Edition Coordination Companies, 2001 Chapter 14 Endocrine System 473 TABLE 14. It is reasonable to expect, therefore, that pro- to those caused by stimulation of the sympathetic division of the longed stress can result in increased susceptibility to disease. In- deed, many studies show that prolonged stress results in an ANS, except that the hormonal effects are about 10 times longer increased incidence of cancer and other diseases. The hormones from the adrenal medulla increase cardiac output and heart rate, dilate coronary blood vessels, increase mental alertness, increase the respiratory rate, and elevate meta- Knowledge Check bolic rate. Diagram and label the layers of the adrenal gland that can The adrenal medulla is innervated by sympathetic neurons. Stress therefore activates the adrenal medulla, as well as the adrenal cortex. List the hormones of the adrenal medulla and describe medulla prepares the body for greater physical performance—the their effects. List the categories of corticosteroids and identify the zones of the adrenal cortex that secrete these hormones. Excessive stimulation of the adrenal medulla can result in de- pletion of the body’s energy reserves, and high levels of corti- costeroid secretion from the adrenal cortex can significantly impair Van De Graaff: Human V. Endocrine System © The McGraw−Hill Anatomy, Sixth Edition Coordination Companies, 2001 474 Unit 5 Integration and Coordination FIGURE 14. These changes are elicited by neural impulses from the hypothalamus that directly influence body tissues and by impulses to the adrenal medulla that secondarily influence the same body tis- sues through the release of epinephrine. The gonads are mixed glands in that they produce GONADS AND OTHER both sex hormones and sex cells, or gametes (see chapters 20 ENDOCRINE GLANDS and 21). The gonads produce sex hormones that control the development and function of the male and female reproductive systems. Addi- Testes tionally, many other organs secrete hormones that help regulate The interstitial cells of the testes produce and secrete the male digestion, metabolism, growth, and immunity. Testosterone controls the development Objective 16 Discuss the endocrine functions of the gonads. It also promotes the male secondary sex Objective 17 Describe the structure and location of the characteristics (see chapter 20) and somewhat determines the pineal and thymus glands and their endocrine functions. The The endocrine function of the ovaries is the production of the male gonads are called testes and the female gonads are called female sex hormones, estrogens and progesterone.

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There are many variations of this model generic fosamax 35 mg without prescription, a commonly used example being the Vogel licking (conflict) test cheap 70 mg fosamax otc. This evaluates the effects of drugs on the punished phase of drinking from a water spout (Vogel et al. However, the increase in baseline fluid intake induced by some anti-anxiety drugs, in the absence of any anxiogenic stimuli, can be a confounding factor. INDUCING ANXIETY IN HUMANS One advantage of studying humans is that it is possible to confirm that a given experimental intervention does actually induce anxiety in the subject. Such measurements will, at best, be indirect indications of what is happening in the brain. As a result, research of anxiety in humans has concentrated on drugs with a known pharmacological target (usually a neurotransmitter receptor) and has compared their effects in anxious patients and normal subjects. Some treatments that induce or 400 NEUROTRANSMITTERS, DRUGS AND BRAIN FUNCTION Figure 19. The apparent delay in the increase in punished responses is due to the reduction in all responses (including unpunished ones) at the start of drug administration. The progressive recovery of unpunished responses reflects the development of tolerance to the sedative effects of the test compound. Note the immediate increase in punished responses and the lack of a decline in unpunished responses, indicating pre-existing tolerance to the sedative effects of the test compound. A full appraisal of this topic is beyond the scope of this chapter but the links between drugs that affect central monoamine transmission and anxiety are discussed in later sections. Details of findings from research in humans can be found in Ballenger (1990) and Coupland, Glue and Nutt (1992). DRUG TREATMENTS FOR ANXIETY The oldest anti-anxiety agent is undoubtedly alcohol and it is certain that this drug is still routinely self-administered for this purpose. Alternative treatments, such as paraldehyde and chloral hydrate, were also widely used but these too had adverse effects; the former can cause psychosis but the latter is still used as a sedative and anaesthetic agent. It was not until the 1930s that it was recognised that this adverse behavioural effect of barbiturates in fact represented a drug-withdrawal syndrome (Seevers and Tatum 1931). This, together with the overt sedation caused by barbiturates, their narrow therapeutic index and their lethal toxicity in overdose, motivated the search for non- sedative anti-anxiety agents. However, the initial enthusiasm over the use of this compound as a treatment for anxiety rapidly abated because it too proved to be a potent sedative and, of even more concern, it induced dependence and was widely abused. Like their predecessors, but with greater justification, these drugs were claimed to relieve anxiety at non-sedative doses (see Sternbach, Randall and Gustafson 1964). However, the benzodiazepines are members of the sedative/hypnotic group of anti-anxiety drugs, which also include alcohol, meprobamate and the barbi- turates. This means that the liability of all these compounds to induce sedation, or even hypnosis (sleep), is largely a question of dose (Fig. Like their predecessors, the 402 NEUROTRANSMITTERS, DRUGS AND BRAIN FUNCTION Figure 19. BENZODIAZEPINES AND BENZODIAZEPINE RECEPTORS MOLECULAR TARGETS FOR THE GABAA RECEPTOR The first clues to the mechanism of action of benzodiazepines came from landmark experiments (Squires and Braestrup 1977; Moehler and Okada 1977) which showed that ANXIETY 403 Figure 19. Studies of solubilised receptors confirmed that this binding site was a component of the GABAA receptor which incorporates a Cl7 channel. GABA did not compete with [3H]benzodiazepine for binding to this receptor and so it was clear that their binding domains were not the same. It was soon realised that there is an allosteric interaction between them such that binding of [3H]benzodiazepines is increased by GABA (Fig.

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Explain how movements of the basilar membrane can code conditions of the ear 35 mg fosamax with mastercard, nose purchase 70 mg fosamax mastercard, and throat. Explain how the vestibular organs maintain a sense of bal- examine the ears to determine auditory function: (1) an otoscope ance and equilibrium. Some of these occur during the sensitive period of prenatal de- velopment; others, some of which are avoidable, can occur at any time of life. Still other sensory impairments are the result Developmental Problems of changes associated with the natural aging process. The loss of the Eyes and Ears of a sense frequently involves a traumatic adjustment. Fortu- nately, however, when a sensory function is impaired or lost, Although there are many congenital abnormalities of the eyes the other senses seem to become keener to lessen the extent of and ears,most of them are rare. A blind person, for example, compensates some- riod of development is between 24 and 45 days after conception. Most congenital disorders of the eyes and ears are caused Entire specialties of medicine are devoted to specific sen- by genetic factors or intrauterine infections such as rubella virus. It is beyond the scope of this text to attempt a com- prehensive discussion of the numerous diseases and dysfunctions of these organs. Some general comments will be made, however, Snellen’s chart: from Herman Snellen, Dutch ophthalmologist, 1834–1908 Van De Graaff: Human V. Sensory Organs © The McGraw−Hill Anatomy, Sixth Edition Coordination Companies, 2001 Developmental Exposition mesoderm,and endoderm—are involved in the formation of the The Ear ear. Both types of ectoderm (neuroectoderm and surface ecto- derm) play a role. The ear of an adult is structurally and functionally divided EXPLANATION into an outer ear, a middle ear, and an inner ear, each of which The ear begins to develop at the same time as the eye,early dur- has a separate embryonic origin. All three embryonic germ layers—ectoderm, from deep embryonic tissue as one might expect,but rather be- (a) (a1) (a2) (b1) (b2) (b) (c) (d) (e) EXHIBIT II The development of the inner ear. Toward the end of the fourth week,the outer edges of the invaginated otic fovea come together and fuse to form an otocyst. The otocyst further differentiates to form a dorsal utricular portion and a ventral saccular portion. Three separate diverticula extend outward from the utricular por- tion and develop into the semicircular canals, which later func- tion in balance and equilibrium. A tubular diverticulum called the cochlear duct extends in a coiled fashion from the saccular portion and forms the membranous portion of the cochlea of the ear (exhibit II). The spiral organ, which is the functional por- tion of the cochlea,differentiates from cells along the wall of the cochlear duct (Ex. The sensory nerves that innervate the inner ear are derived from neuroectoderm from the developing brain. The differentiating otocyst is surrounded by mesodermal tissue that soon forms a cartilaginous otic capsule (exhibit III).

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Indicate which bands get shorter during con- traction and explain how this occurs cheap 70mg fosamax with mastercard. Describe how the antagonistic muscles in the brachium can be exercised through both isotonic and isometric contractions 35 mg fosamax sale. Explain why sarcomeres are considered the basic structural components of skeletal muscles, and motor units are considered the basic functional units of muscle contraction. NAMING OF MUSCLES (a) An isometric contraction, in which the muscle stays the same length and (b) an isotonic contraction, in which the muscle shortens. Skeletal muscles are named on the basis of shape, location, at- tachment, orientation of fibers, relative position, or function. Objective 9 Use examples to describe the various ways in which muscles are named. Skeletal muscles are voluntary in that they can be con- sciously contracted. The magnitude of the task determines the One of your tasks as a student of anatomy is to learn the names number of motor units that are activated. Although this may seem task, such as lifting a book, requires few motor units, whereas overwhelming, keep in mind that most of the muscles are paired; lifting a table requires many. Muscles with pennate architecture that is, the right side is the mirror image of the left. To help you have many motor units and are strong and dexterous; however, further, most muscles have names that are descriptive. Identify the muscle on the figure referenced in the text nar- athletic feat involves voluntary activation of more motor units rative and locate it on your own body as well. Feel it contracting beneath your skin and note motor units within a muscle, the secretion of epinephrine (ep'ı˘- the movement that occurs at the joint. Shape: rhomboideus (like a rhomboid); trapezius (like a testes, and ovaries. Because they are soluble in lipids, they readily pass through cell membranes and enter the cytoplasm, trapezoid); or denoting the number of heads of origin: tri- where they combine with proteins to form steroid-protein complexes ceps (three heads), biceps (two heads) that are necessary for the syntheses of specific kinds of messenger RNA molecules. Location: pectoralis (in the chest, or pectus); intercostal mote weight gain in cancer and anorexic patients. It soon became (between ribs); brachia (arm) apparent, however, that steroids taken by bodybuilders and ath- 3. Attachment: many facial muscles (zygomaticus, tempo- letes could provide them with increased muscle mass, strength, and aggressiveness. The use of steroids is now considered illegal ralis, nasalis); sternocleidomastoid (sternum, clavicle, and by most athletic associations. Not only do they confer unfair advan- mastoid process of the temporal bone) Van De Graaff: Human IV. Muscular System © The McGraw−Hill Anatomy, Sixth Edition Companies, 2001 Chapter 9 Muscular System 247 Motor neuron axon Axon terminals Muscle fiber nucleus Motor end plate Myofibril of muscle fiber Mitochondria Synaptic vesicles Neuromuscular cleft Folded sarcolemma Motor end plate Waldrop (a) Axon Motor end plate Muscle fiber (b) FIGURE 9. The motor end plate is the specialized portion of the sarcolemma of a muscle fiber surrounding the terminal end of the axon. A motor neuron and the skeletal muscle fibers it innervates constitute a motor unit. Size: maximus (larger, largest); minimus (smaller, small- est); longus (long); brevis (short) Knowledge Check 5. Relative position: lateral, medial, internal, and external gluteal, perineal, brachial, antebrachial, inguinal, thigh, and popliteal.

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