By S. Karrypto. Saint Norbert College. 2019.

For example purchase 130mg malegra dxt visa, it has been argued that the emotion of jealousy has survived over time in men because men who experience jealousy are more fit than men who do not order generic malegra dxt line. Despite its importance in psychological theorizing generic 130mg malegra dxt amex, evolutionary psychology also has some limitations. Unlike the fossils that are used to learn about the physical evolution of species, we cannot know which psychological characteristics our ancestors possessed or did not possess; we can only make guesses about this. Because it is difficult to directly test evolutionary theories, it is always possible that the explanations we apply are made up after the fact to account for observed data [9] (Gould & Lewontin, 1979). Nevertheless, the evolutionary approach is important to psychology because it provides logical explanations for why we have many psychological characteristics. Psychodynamic Psychology Perhaps the school of psychology that is most familiar to the general public is the psychodynamic approach to understanding behavior, which was championed by Sigmund Freud (1856–1939) and his followers. Psychodynamic psychology is an approach to understanding human behavior that focuses on the role of unconscious thoughts, feelings, and memories. Freud developed his theories about behavior through extensive analysis of the patients that he treated in his private clinical practice. Freud believed that many of the problems that his patients experienced, including anxiety, depression, and sexual dysfunction, were the result of the effects of painful childhood experiences that the person could no longer remember. Freud’s ideas were extended by other psychologists whom he influenced, including Carl Jung (1875–1961), Alfred Adler (1870–1937), Karen Horney (1855–1952), and Erik Erikson (1902– 1994). These and others who follow the psychodynamic approach believe that it is possible to help the patient if the unconscious drives can be remembered, particularly through a deep and thorough exploration of the person‘s early sexual experiences and current sexual desires. The founders of the school of psychodynamics were primarily practitioners who worked with individuals to help them understand and confront their psychological symptoms. Although they did not conduct much research on their ideas, and although later, more sophisticated tests of their theories have not always supported their proposals, psychodynamics has nevertheless had substantial impact on the field of psychology, and indeed on thinking about human behavior [10] more generally (Moore & Fine, 1995). The importance of the unconscious in human behavior, the idea that early childhood experiences are critical, and the concept of therapy as a way of improving human lives are all ideas that are derived from the psychodynamic approach and that remain central to psychology. Behaviorism and the Question of Free Will Although they differed in approach, both structuralism and functionalism were essentially studies of the mind. The psychologists associated with the school of behaviorism, on the other hand, were reacting in part to the difficulties psychologists encountered when they tried to use introspection to understand behavior. Behaviorism is a school of psychology that is based on the premise that it is not possible to objectively study the mind, and therefore that psychologists should limit their attention to the study of behavior itself. Behaviorists believe that the human mind is a “black box‖ into which stimuli are sent and from which responses are received. They argue that there is no point in trying to determine what happens in the box because we can successfully predict behavior without knowing what happens inside the mind. Furthermore, behaviorists believe that it is possible to develop laws of learning that can explain all behaviors. Watson was influenced in large part by the work of the Russian physiologist Ivan Pavlov (1849–1936), who had discovered that dogs would salivate at the sound of a tone that had previously been associated with the presentation of food. Watson and the other behaviorists began to use these Attributed to Charles Stangor Saylor. For instance, in Pavlov’s research the stimulus (either the food or, after learning, the tone) would produce the response of salivation in the dogs. In his research Watson found that systematically exposing a child to fearful stimuli in the presence of objects that did not themselves elicit fear could lead the child to respond with a fearful behavior to the presence of the stimulus (Watson & Rayner, 1920; Beck, Levinson, & [11] Irons, 2009). In the best known of his studies, an 8-month-old boy named Little Albert was used as the subject. Here is a summary of the findings: The boy was placed in the middle of a room; a white laboratory rat was placed near him and he was allowed to play with it. In later trials, the researchers made a loud sound behind Albert’s back by striking a steel bar with a hammer whenever the baby touched the rat. After several such pairings of the two stimuli, the child was again shown the rat. In line with the behaviorist approach, the boy had learned to associate the white rat with the loud noise, resulting in crying. Skinner used the ideas of stimulus and response, along with the application of rewards or reinforcements, to train pigeons and other animals. And he used the general principles of behaviorism to develop theories about how best to teach children and how to create societies that were peaceful and productive. Skinner even developed a method for studying thoughts and [12] feelings using the behaviorist approach (Skinner, 1957, 1968, 1972). In terms of the nature-nurture debate, the behaviorists agreed with the nurture approach, believing that we are shaped exclusively by our environments. They also argued that there is no free will, but rather that our behaviors are determined by the events that we have experienced in our past. In short, this approach argues that organisms, including humans, are a lot like puppets in a show who don‘t realize that other people are controlling them. Furthermore, although we do not cause our own actions, we nevertheless believe that we do because we don‘t realize all the influences acting on our behavior. Recent research in psychology has suggested that Skinner and the behaviorists might well have been right, at least in the sense that we overestimate our own free will in responding to the events around us (Libet, 1985; Matsuhashi & [13] Hallett, 2008; Wegner, 2002). The participants were asked, whenever they decided to, to press either of two buttons. Then they were asked to indicate which letter was showing on the screen when they decided to press the button. The researchers analyzed the brain images to see if they could predict which of the two buttons the participant was going to press, even before the letter at which he or she had indicated the decision to press a button. Suggesting that the intention to act occurred in the brain before the research participants became aware of it, the researchers found that the prefrontal cortex region of the brain showed activation that could be used to predict the button press as long as 10 seconds before the participants said that they decided which button to press. Research has found that we are more likely to think that we control our behavior when the desire to act occurs immediately prior to the outcome, when the thought is consistent with the outcome, and when there are no other [15] apparent causes for the behavior. Aarts, Custers, and Wegner (2005) asked their research participants to control a rapidly moving square along with a computer that was also controlling the square independently. When participants were exposed to words related to the location of the square just before they stopped its movement, they became more likely to think that they controlled the motion, even when it [16] was actually the computer that stopped it. And Dijksterhuis, Preston, Wegner, and Aarts (2008) found that Attributed to Charles Stangor Saylor. Because we normally expect that our behaviors will be met with success, when we are successful we easily believe that the success is the result of our own free will. When an action is met with failure, on the other hand, we are less likely to perceive this outcome as the result of our free will, and we are more likely to [17] blame the outcome on luck or our teacher (Wegner, 2003). The behaviorists made substantial contributions to psychology by identifying the principles of learning. Although the behaviorists were incorrect in their beliefs that it was not possible to measure thoughts and feelings, their ideas provided new ideas that helped further our understanding regarding the nature-nurture debate as well as the question of free will. The ideas of behaviorism are fundamental to psychology and have been developed to help us better understand the role of prior experiences in a variety of areas of psychology.

purchase 130 mg malegra dxt free shipping

Abnormal of the selectivity of aspirin for platelet cyclo-oxygenase is leukotriene (Chapter 33) production and sensitivity are probably due to exposure of platelets to high concentrations implicated purchase malegra dxt 130 mg without prescription. In addition buy generic malegra dxt 130 mg on line, aspirin and similar drugs can of aspirin in portal blood buy malegra dxt 130mg line, whereas tissues are exposed to the directly activate eosinophils and mast cells in these lower concentrations present in the systemic circulation. Salicylate is metabolized in the liver by five main parallel path- • Reye’s syndrome, a rare disease of children, with high ways, two of which are saturable (Michaelis–Menten kinetics) mortality, is characterized by hepatic failure and and is also excreted unchanged in the urine by a first-order encephalopathy, often occurring in the setting of a viral process. Urinary elimination They occasionally cause local irritation of the skin, but adverse of salicylate is considerably influenced by pH, being more rapid effects are otherwise uncommon. It is less of a respiratory depressant than the opioids anticoagulants via effects on platelets, gastrotoxicity and, and does not cause dependence. Neither toler- should not be given to neonates with hyperbilirubinaemia ance nor drug dependence occur. Ibuprofen has an approximately similar analgesic potency to paracetamol and, in addition, has useful anti-inflammatory Adverse effects and contraindications activity, so it is an alternative to aspirin for painful conditions Nefopam has few severe (life-threatening) effects, although con- with an inflammatory component (e. It is contraindicated in patients with epilepsy, and also reversible cyclo-oxygenase inhibitor, but causes rather less in patients receiving monoamine oxidase inhibitors (see below). These include sweating, including reversible renal impairment in patients who are eld- nausea, headache, dry mouth, insomnia, dizziness and anorexia. It Nefopam is contraindicated in glaucoma, and can cause urinary reduces the efficacy of antihypertensive medication and of retention in men with prostatic hypertrophy. It is extensively metabolized by the liver to inactive com- pounds excreted in the urine. Some anaes- • The main drugs for mild pain are paracetamol, aspirin thetists give synthetic high potency opioids, such as fentanyl, and ibuprofen. Several endogenous peptides with analgesic • Aspirin: properties are widely distributed throughout the nervous sys- – is anti-inflammatory, analgesic and antipyretic; tem. They can be divided into the following three groups: – is uniquely useful for its antiplatelet effect (see Chapters 29 and 30); 1. Opium is derived from the dried milky juice exuded by Blocking opioid receptors with naloxone (see below) has lit- incised seed capsules of a species of poppy, Papaver som- tle effect in normal individuals, but in patients suffering from niferum, that is grown in Turkey, India and South-East Asia. Electrical stimulation of Homer refers to it in the Odyssey as ‘nepenthes’, a drug given areas of the brain that are rich in encephalins and opioid recep- to Odysseus and his followers ‘to banish grief or trouble of the tors elicits analgesia which is abolished by naloxone, implying mind’. A number of notably discreditable events, including the Opium Wars, Neuromodulator ensued from the commercial, social, moral and political inter- ests involved in its world-wide trade and use. Much work has gone into synthesizing morphine analogues in the hope of producing a drug with the therapeutic actions of morphine, but without its disadvantages. Morphine was introduced as a ‘non-addictive’ alternative to opium and this in turn was superseded by diamorphine, which was also believed to be non-addicting! Pain • Morphine is effective in the relief of acute left ventricular relief by acupuncture may also be mediated by encephalin failure, via dilatation of the pulmonary vasculature and release, because it is antagonized by naloxone. Narcotic analgesics exert their effects by binding to opioid • Morphine inhibits cough, but codeine is preferred for this receptors. In addition to their involvement in brain function, the opioid Mechanism of action peptides play a neuroendocrine role. Administration in humans Morphine relieves both the perception of pain and the emo- suppresses the pituitary–gonadal and pituitary–adrenal axis tional response to it. High concentrations of Adverse effects opioid peptides are also present in sympathetic ganglia and Certain patients are particularly sensitive to the pharmacolog- the adrenal medulla. These include the very young, the elucidated, but they may play an inhibitory role in the sympa- elderly and those with chronic lung disease, untreated thetic system. Morphine depresses the sensitivity the sensitivity of the receptors decreases, necessitating an of the respiratory centre to carbon dioxide, thus causing a pro- increased dose to produce the same effect (‘tolerance’). Patients with decreased withdrawal of the drug, endogenous opioids are not sufficient respiratory reserve due to asthma, bronchitis, emphysema or to stimulate the insensitive receptors, resulting in a withdrawal hypoxaemia of any cause are more sensitive to the respiratory state characterized by autonomic disturbances, e. Bronchoconstriction occurs via sweating and piloerection (‘cold turkey’) and abdominal pain. Morphine causes vomiting in 20–30% of patients by stimulation of the chemoreceptor trig- Use ger zone. Dopamine receptors are important and opioid- • The most important use of morphine is for pain relief. The induced emesis is responsive to dopamine-receptor antagonists effective dose is highly variable. Morphine increases smooth muscle requirements (if known) should be taken into account tone throughout the gastro-intestinal tract, which is combined when selecting a dose. The result is constipation with hard • Morphine may be given as an intravenous bolus if rapid dry stool. In • Morphine is effective orally, although larger doses are common with most other opioids it causes pupillary constric- needed due to presystemic metabolism. This provides a useful diagnostic sign in narcotic over- given by mouth initially every four hours, giving dosage or chronic abuse. Patients with prostatic hypertrophy additional doses as needed between the regular doses as a may suffer acute retention of urine, as morphine increases the ‘top-up’, the daily dose being reviewed and titrated. Morphine is metabolized by • Spinal (epidural or intrathecal) administration of combination with glucuronic acid and also by N-dealkylation morphine is effective at much lower doses than when and oxidation, about 10% being excreted in the urine as mor- given by other routes and causes fewer systemic side phine and 60–70% as a mixture of glucuronides. It is useful in those few patients with opioid- occurs in the liver and gut wall, with extensive presystemic responsive pain who experience intolerable side effects metabolism. The dose–plasma concentration relationships for when morphine is administered by other routes. There is an advantage in using properties and contributes substantially to the analgesic diamorphine rather than morphine for this purpose, since action of morphine. Only low concentrations of this active its greater solubility permits smaller volumes of more metabolite appear in the blood after a single oral dose. Morphine-6-glucuronide is eliminated in the respiratory depression of the neonate. This is exacerbated by urine, so patients with renal impairment may experience severe the prolonged elimination t1/2 in neonates of about 22 hours. The birth of opiate- dependent babies born to addicted mothers demonstrates the Drug interactions ability of morphine and its glucuronide to cross the placenta. They are more potent but shorter-acting and are used to treat severe pain or as an Use adjunct to anaesthesia. They can be given those of morphine, although it is more potent as an analgesic intrathecally and via patient-controlled devices. The more rapid central effect of intravenous Use diamorphine than of morphine (the faster ‘buzz’), due to rapid Tramadol is widely used for moderate to severe pain, includ- penetration of the blood–brain barrier, makes this plausible (see ing post-operative pain. Diamorphine is used for the same purposes as mor- by intramuscular or intravenous injection phine. It is more soluble than morphine, and this may be rele- vant to limit injection volume (e.

Epidemiology and Prevalence This viral hepatitis occurs worldwide cheap malegra dxt online american express, with variable prevalence malegra dxt 130 mg generic. It is high- est in countries where hygiene is poor and infection occurs year-round buy malegra dxt cheap online. In temperate climates, the peak incidence is in autumn and winter, but the trend is becoming less marked. In developing countries, the disease occurs in early childhood, whereas the reverse is true in countries where the standard of living is higher. In the United Kingdom, there has been a gradual decrease in the number of reported cases from 1990 to 2000 (83,84). This results from, in part, improved standards of living and the introduction of an effective vaccine. Approximately 25% of people older than 40 years have natural immunity, leaving the remainder sus- ceptible to infection (85). An unpublished study in London in 1996 showed a seroprevalence of 23% among gay men (Young Y et al. Symptoms The clinical picture ranges from asymptomatic infection through a spec- trum to fulminant hepatitis. Infection in childhood is often mild or asymptomatic but in adults tends to be more severe. After an incubation period of 15–50 days (mean 28 days) symptomatic infection starts with the abrupt onset of jaundice anything from 2 days to 3 weeks after the anicteric phase. It lasts for approximately the same length of time and is often accompanied by a sudden onset of fever. Fulminant hepatitis occurs in less than 1% of people but is more likely to occur in indi- viduals older than 65 years or in those with pre-existing liver disease. In pa- tients who are hospitalized, case fatality ranges from 2% in 50–59 years olds to nearly 13% in those older than 70 years (84). Period of Infectivity The individual is most infectious in the 2 weeks before the onset of jaun- dice, when he or she is asymptomatic. This can make control of infection difficult because the disease is not recognized. Routes of Transmission The main route is fecal–oral through the ingestion of contaminated water and food. It can also be transmitted by personal contact, including homosexuals practicing anal intercourse and fellatio. There is a slight risk from blood transfu- sions if the donor is in the acute phase of infection. Transmission occurs during the viremic phase of the illness through sharing injecting equipment and via fecal–oral routes because of poor living conditions (89). Management in Custody Staff with disease should report to occupational health and stay off work until the end of the infective period. Those in contact with disease (either through exposure at home or from an infected detainee) should receive pro- phylactic treatment as soon as possible (see Subheading 8. History and Examination Aide Memoir • Has the detainee traveled to Africa, South East Asia, the Indian subcontinent, Central/South America, or the Far East in the last 6–12 months? To minimize the risk of acquiring disease in custody, staff should wear gloves when dealing with the detainee and then wash their hands thoroughly. Any bedding or clothing should be handled with gloves and laundered or incinerated according to local policy. Detainees reporting contact with dis- ease should be given prophylactic treatment as soon as possible (see Sub- heading 8. Two doses of vaccine given 6–12 months apart give at least 10 years of protection. It is not necessary for a forensic physician to be able to diagnose the specific disease but simply to recognize that the detainee/staff member is ill and whether he or she needs to be sent to the hospital (see Tables 8–10). This is best achieved by knowing the right questions to ask and carrying out the appropriate examination. Universal precau- tions for prevention of transmission of human immuno-deficiency virus, hepatitis B virus and other bloodborne pathogens in health-care settings. Risk factors for horizontal transmission of hepatitis B in a rural district in Ghana. Intrafamilial transmission of hepa- titis B in the Eastern Anatolian region of Turkey. The role of the parenteral antischistosomal therapy in the spread of hepatitis C virus in Egypt. Prevention of varicella: recommenda- tions of the Advisory Committee on Immunization Practices. Outcome in newborn babies given anti-varicella zoster immunoglobulin after perinatal maternal infection with varicella zoster virus. Methicillin- resistant Staphylococcus aureus, Epidmiologic observations during a community acquired outbreak. Bacteriology of skin and soft tissue infections: comparison of infections in intravenous drug users and individuals with no history of intravenous drug use. Bacteriological skin and subcutaneous infections in injecting drug users—relevance for custody. Isolation and identification of clostridium spp from infections associated with injection of drugs: experiences of a microbio- logical investigation team. Right ventricular needle embolus in an injecting drug user: the need for early removal. Departments of Emergency Medicine and Pediatrics, Lutheran Gen- eral Hospital of Oak Brook, Advocate Health System. Efficacy of meningococcal serogroup C conjugate vaccine in teenagers and toddlers in England. Ciprofloxacin as a chemoprophylactic agent for meningococcal disease— low risk of anaphylactoid reactions. Prelimi- nary annual report on tuberculosis cases reported in England, Wales, and N. Control and preven- tion of tuberculosis in the United Kingdom: Code of Practice 2000. A prospective study of the risk of tuberculosis among intravenous drug users with human immunodeficiency virus infection. The chest roenterogram in pulmo- nary tuberculosis patients seropositive for human immunodeficiency virus type 1. Epidemiological determinants of spread of causal agents of severe acute respiratory syndrome in Hong Kong. Age-specific antibody prevalence to hepatitis A in England: implications for disease control.

In most people the ability to speak purchase cheap malegra dxt online, write buy malegra dxt 130mg line, and understand language is located in the left hemisphere generic 130mg malegra dxt mastercard. It is also superior in coordinating the order of complex movements—for example, lip movements needed for speech. The right hemisphere, on the other hand, has only very limited verbal abilities, and yet it excels in perceptual skills. The right hemisphere is able to recognize objects, including faces, patterns, and melodies, and it can put a puzzle together or draw a picture. Although Gazzaniga‘s research demonstrated that the brain is in fact lateralized, such that the two hemispheres specialize in different activities, this does not mean that when people behave in a certain way or perform a certain activity they are only using one hemisphere of their brains at a time. We normally use both hemispheres at the same time, and the difference between the [23] abilities of the two hemispheres is not absolute (Soroker et al. Across cultures and ethnic groups, about 90% of people are mainly right-handed, whereas only 10% are primarily left- [24] handed (Peters, Reimers, & Manning, 2006). This fact is puzzling, in part because the number of left-handers is so low, and in part because other animals, including our closest primate relatives, do not show any type of handedness. The existence of right-handers and left-handers provides an interesting example of the relationship among evolution, biology, and social factors and how the same phenomenon can be understood at different levels of analysis (Harris, [25] 1990; McManus, 2002). Ultrasound scans show that 9 out of 10 fetuses suck the thumb of [26] their right hand, suggesting that the preference is determined before birth (Hepper, Wells, & Lynch, 2005), and the [27] mechanism of transmission has been linked to a gene on the X chromosome (Jones & Martin, 2000). It has also been observed that left-handed people are likely to have fewer children, and this may be in part because the mothers of left-handers are more prone to miscarriages and other prenatal problems (McKeever, Cerone, Suter, & Wu, [28] 2000). In the past, left-handed children were forced to write with their right hands in many countries, and this practice continues, particularly in collectivistic cultures, such as India and Japan, where left- handedness is viewed negatively as compared with individualistic societies, such as the United States. For example, [29] India has about half as many left-handers as the United States (Ida & Mandal, 2003). There are both advantages and disadvantages to being left-handed in a world where most people are right-handed. This may explain in part why left-handers suffer [30] somewhat more accidents than do right-handers (Dutta & Mandal, 2006). Despite the potential difficulty living and working in a world designed for right-handers, there seem to be some advantages to being left-handed. Throughout history, a number of prominent artists have been left-handed, including Leonardo da Vinci, Michelangelo, Pablo Picasso, and Max Escher. Because the right hemisphere is superior in imaging and visual abilities, there may be some advantage to using the left hand for drawing or painting (Springer & [31] Deutsch, 1998). Left-handed people are also better at envisioning three-dimensional objects, which may explain why there is such a high number of left-handed architects, artists, and chess players in proportion to their numbers [32] (Coren, 1992). However, there are also more left-handers among those with reading disabilities, allergies, and [33] migraine headaches (Geschwind & Behan, 2007), perhaps due to the fact that a small minority of left-handers owe [34] their handedness to a birth trauma, such as being born prematurely (Betancur, Vélez, Cabanieu, & le Moal, 1990). In sports in which handedness may matter, such as tennis, boxing, fencing, or judo, left-handers may have an advantage. They play many games against right-handers and learn how to best handle their styles. Right-handers, however, play very few games against left-handers, which may make them more vulnerable. In other sports, such as golf, there are fewer left-handed players because the handedness of one player has no effect on the competition. The fact that left-handers excel in some sports suggests the possibility that they may have also had an evolutionary advantage because their ancestors may have been more successful in important skills such as hand-to-hand combat [35] (Bodmer & McKie, 1994). At this point, however, this idea remains only a hypothesis, and determinants of human handedness are yet to be fully understood. Other areas of the cortex act as association areas, responsible for integrating information. Body parts requiring the most control and dexterity take up the most space in the motor cortex. Body parts that are the most sensitive occupy the greatest amount of space in the sensory cortex. Consider your own experiences and speculate on which parts of your brain might be particularly well developed as a result of these experiences. Which brain hemisphere are you likely to be using when you search for a fork in the silverware drawer? Which brain hemisphere are you most likely to be using when you struggle to remember the name of an old friend? Do you think that encouraging left-handed children to use their right hands is a good idea? Long-term potentiation in the amygdala: A cellular mechanism of fear learning and memory. Positive reinforcement produced by electrical stimulation of septal area and other regions of rat brain. Self-stimulation of the brain: Its use to study local effects of hunger, sex, and drugs. Electric excitability of the cerebrum (Über die Elektrische erregbarkeit des Grosshirns). Extensive piano practicing has regionally specific effects on white matter development. From the left to the right: How the brain compensates progressive loss of language function. Observations on visual perception after disconnexion of the cerebral hemispheres in man. Processing of basic speech acts following localized brain damage: A new light on the neuroanatomy of language. Cultural influences on handedness: Historical and contemporary theory and evidence. Right hand, left hand: The origins of asymmetry in brains, bodies, atoms, and cultures. A note on Corballis (1997) and the genetics and evolution of handedness: Developing a unified distributional model from the sex-chromosomes gene hypothesis. Family size, miscarriage-proneness, and handedness: Tests of hypotheses of the developmental instability theory of handedness. Left-handedness: Association with immune disease, migraine, and developmental learning disorder. Compare and contrast the techniques that scientists use to view and understand brain structures and functions. One problem in understanding the brain is that it is difficult to get a good picture of what is going on inside it.