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By Q. Sinikar. The Rockefeller University.

Which of Freud’s stages of development marks the transition to adult sexuality during 7 discount raloxifene 60mg otc menstruation youngest age. Latency stage with an understanding of reversibility buy raloxifene 60 mg online menopause vaginal itching, relations between numbers, and loss of b. Formal operational stage biologic processes is credited to which of the following theorists? An increased incidence of teenage ing and deductive reasoning occurs during pregnancy can be linked to substance which of the following stages of development? Which of the following are components of Freud’s theory of psychoanalytic development? Which of the following concepts are Multiple Response Questions components of Erikson’s theory of psychosocial development? Growth and development are differentiated describe the developmental stages and and integrated. Within each developmental level, certain external control as the child learns to con- milestones can be identified. Few adults ever reach stage 6 of the the effects of environment and nutrition devel- postconventional level. Substance abuse by a pregnant woman expectations, and societal values are increases the risk for congenital anomalies adopted. Failure to thrive cannot be linked to punishment and obedience orientation, emotional deprivation. Abuse of alcohol and drugs is more prevalent or physical consequences of authority’s in teenagers who have poor family relation- disapproval. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Place the following stages of Sigmund Freud’s others’ viewpoints into his/her own theory of psychoanalytic development in the understanding of truth. Freud identified the underlying stimulus for human behavior as sexuality, which he called b. The stage of Piaget’s theory of cognitive development is characterized by the use of abstract thinking and deductive reasoning. Levinson and associates based their theory of ory of development (developmental tasks) in human development on the organizing the order in which they occur: concept of. Learning sex differences; forming concepts; Part A with the appropriate example listed in getting ready to read Part B.

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The outcome is the potential for experimenter bias cheap raloxifene 60mg amex menopause vaginal discharge, a situation in which the experimenter subtly treats the research participants in the various experimental conditions differently buy raloxifene 60 mg otc breast cancer 900, resulting in an invalid confirmation of the research hypothesis. In one study demonstrating experimenter bias, [4] Rosenthal and Fode (1963) sent twelve students to test a research hypothesis concerning maze learning in rats. Although it was not initially revealed to the students, they were actually the participants in an experiment. Six of the students were randomly told that the rats they would be testing had been bred to be highly intelligent, whereas the other six students were led to believe that the rats had been bred to be unintelligent. In reality there were no differences among the rats given to the two groups of students. The rats run by students who expected them to be intelligent showed significantly better maze learning than the rats run by students who expected them to be unintelligent. They evidently did something different when they tested the rats, perhaps subtly changing how they timed the maze running or how they treated the rats. To avoid experimenter bias, researchers frequently run experiments in which the researchers are blind to condition. This means that although the experimenters know the research hypotheses, they do not know which conditions the participants are assigned to. In a double-blind experiment, both the researcher and the research participants are blind to condition. For instance, in a double-blind trial of a drug, the researcher does not know whether the drug being given is the real drug or the Attributed to Charles Stangor Saylor. Double-blind experiments eliminate the potential for experimenter effects and at the same time eliminate participant expectancy effects. While internal validity refers to conclusions drawn about events that occurred within the experiment, external validity refers to the extent to which the results of a research design can be generalized beyond the specific way the original experiment was conducted. Generalization refers to the extent to which relationships among conceptual variables can be demonstrated in a wide variety of people and a wide variety of manipulated or measured variables. Psychologists who use college students as participants in their research may be concerned about generalization, wondering if their research will generalize to people who are not college students. And researchers who study the behaviors of employees in one company may wonder whether the same findings would translate to other companies. Whenever there is reason to suspect that a result found for one sample of participants would not hold up for another sample, then research may be conducted with these other populations to test for generalization. Recently, many psychologists have been interested in testing hypotheses about the extent to [5] which a result will replicate across people from different cultures (Heine, 2010). For instance, a researcher might test whether the effects on aggression of viewing violent video games are the same for Japanese children as they are for American children by showing violent and nonviolent films to a sample of both Japanese and American schoolchildren. If the results are the same in both cultures, then we say that the results have generalized, but if they are different, then we have learned a limiting condition of the effect (see Figure 2.

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Prothrombin time also Plasma albumin in patients with nephrotic syndrome is low purchase raloxifene 60 mg women's health center of houston, shows a moderate correlation with drug clearance by the liver generic raloxifene 60 mg with amex womens health haverhill. Clearances of indocyanine green, antipyrine and lido- between microsomal enzyme activity from liver biopsy speci- caine have also been disappointing. Even Currently, therefore, cautious empiricism coupled with an in very severe disease, the metabolism of different drugs is not awareness of an increased likelihood of adverse drug effects affected to the same extent. It is therefore hazardous to extrapo- and close clinical monitoring is the best way for a prescriber to late from knowledge of the handling of one drug to effects on approach a patient with liver disease. Weigh risks against hoped for benefit, and minimize non- the liver should be employed. Monitor response, including adverse effects (and occasionally drug concentrations), and adjust therapy Absorption of drugs is altered in liver disease because of portal accordingly. Portal/systemic anastomoses allow the passage of common precipitants of hepatic coma. Drugs that are known to cause idiosyncratic liver disease ciclosporin, which must therefore be started in low doses in (e. Oral contraceptives are not advisable if there is active liver disease or a history of jaundice of pregnancy. Low plasma potassium provokes encephalopathy: avoid in cirrhosis, and that of phenytoin is increased by up to 40%. Potassium-sparing It is particularly important to appreciate this when plasma drugs, such as spironolactone, are useful. Avoid drugs that cause fluid overload or renal failure apy, as unless the therapeutic range is adjusted downward, (e. Increased Vd of several anticoagulants and fibrinolytics) whenever possible, drugs (e. Myxoedematous patients are extremely sensitive to digoxin, whereas unusually high doses are required in thyrotoxicosis. Patients with hypothyroidism are exceptionally sensitive to There is no significant difference in half-life between these opioid analgesics, which cause profound respiratory depres- groups, and a difference in Vd has been postulated to explain sion in this setting. This is probably due to reduced metab- the alteration of plasma concentration with thyroid activity. Changes in renal function, which occur with changes in thy- roid status, complicate this interpretation. These changes in renal function influence elimination, and the reduced plasma Key points levels of digoxin correlate closely with the increased creatinine Disease profoundly influences the response to many drugs clearance in thyrotoxicosis. Other factors including enhanced by altering pharmacokinetics and/or pharmacodynamics. There is no widely measured biochemical marker heart disease which would be exacerbated if an excessive (analogous to serum creatinine in chronic renal failure) steady-state thyroxine level were achieved. His liver and spleen are not palpable in the presence of ical nephrology, 3rd edn. Comment It is a mistake to try to eliminate ascites too rapidly in patients with cirrhosis.

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He identified the presence in animals of “human” qualities such as courage and devotion discount raloxifene 60mg amex womens health lebanon pa, and Darwin’s other books include The Variations of Ani- “human” emotions purchase raloxifene 60mg with mastercard menstruation thesaurus, including pride, jealousy, and mals and Plants under Domestication (1868), Insectivo- shame. After examining these and other common men- rous Plants (1875), and The Power of Movement in tal functions, such as memory, attention, and dream- Plants (1880). He was awarded membership in the Lon- ing, Darwin concluded that the mental difference be- don Geological Society in 1836 and won election to the tween humans and the higher animals is one of degree Royal Society in 1839. The Survival of Charles Darwin: A Biogra- mals (1872), Darwin posited that human emotional ex- phy of a Man and an Idea. New York: Random House, pressions have evolved over time because of their link 1984. The Autobiography of Charles Darwin, 1809- For example, an animal baring its teeth in rage is literally 1882. Darwin on Man: A Psychological Study of or flight” reaction, a heightened state of nervous arousal, Scientific Creativity. Daydreaming Darwin’s final contribution to psychology was the A temporary escape from daily reality by forming publication in 1877 of Biographical Sketch of an Infant, mental pictures, usually in spontaneous, brief based on a detailed log he had kept on the development episodes, of other experiences. This milestone in the history of child psychology was probably the first Daydreams are a form of imagination. One seminal idea expressed in dreams, the person forms a mental image of a past expe- this short work is that the individual’s development par- rience or of a situation that he or she has never actually allels the development of the species to which it belongs. A daydream may be triggered by a situation, a memory, or a sensory input (sight, Darwin’s work had far-reaching influences on the taste, smell, sound, touch). Its emphasis on the individual’s adaptation to the environment helped es- The daydreamer may use these mental pictures to tablish the “functional” view of the mind and of human escape from reality temporarily, to overcome a frustrat- behavior, influencing such thinkers as John Dewey ing situation, or to satisfy hidden wishes. When the daydreamer’s daily routine is disrupt- ed—a driver misses an exit on the freeway continuously, or a student does not hear the teacher assigning home- Deductive reasoning work—he or she may want to consider whether the day- dreams are a symptom of a psychological problem. Although most psychologists view daydreams as generally healthy and natural, this was not always the Deductive reasoning is a way of reasoning that re- case. In the 1960s, for example, textbooks used for train- lates two or more general concepts or conditions to a ing teachers provided strategies for combating daydream- specific case. For example, a child learns that birds fly ing, using language similar to that used in describing south in October, and that a robin is a bird, he will use drug use. Sigmund Freud felt that only unfulfilled indi- deductive reasoning to conclude that a robin will fly viduals created fantasies, and that daydreaming and fan- south in October. By the late with inductive reasoning, which uses a specific obser- 1980s, most psychologists considered daydreams a natur- vation to reach a general conclusion. Similar to dreams experienced during sleep, day- dreams occur in cycles set by biological cycles of tem- perature and hormone levels (psychologists estimate that the average person daydreams about every 90 minutes), Defense mechanisms and peak around the lunch hour (noon to 2 p. Day- Unconscious strategies for avoiding or reducing dreaming first occurs for most people during childhood, threatening feelings, such as fear and anxiety. Children who have The concept of the defense mechanism originated positive, happy daydreams of success and achievement with Sigmund Freud (1856-1939) and was later elabo- generally continue these types of mental images into rated by other psychodynamically oriented theorists, no- adulthood; these daydreamers are most likely to benefit tably his daughter Anna Freud (1895-1982).

The results of the data fitting in k1eA ¼ ke0Ae this exercise with the analgesic are Emax 4 generic 60mg raloxifene with amex women's health birth control options. Effect compartment or link models are limited If the partition coefficient buy 60 mg raloxifene mastercard womens health partners, Kp, equals Ce/C at equi- by their applicability to situations in which the librium (steady state), then we can rearrange the equilibrium between plasma and response is due above equation: to distributional phenomena. In reality, there is k V often a delay between occurrence of maximum 1e 1 Ve ¼ drug concentration in the effect compartment and Kpke0 maximum intensity of effect caused by slow devel- Substituting for V in the above equation opment of the effect rather than slow distribution to e (i. The plasma kinetics of (S)-warfarin were described by the fol- This is how the link-model relates the kinetics in lowing mono-exponential expression: plasma to the kinetics of drug in the effect compart- ment. The time to steady state is only governed by 120 the elimination rate constant and not the rate of infusion. It was also possible to estimate As stated before, the intensity of a pharmacologi- the half-life of the apparent first-order degradation. Rather, it may be the net allow for distributional effects embedded in the result of several processes only one of which is observed time delay of the onset of the effect influenced by the drug. The process that is influ- after warfarin administration, was published by enced by the drug must be identified and an Pitsui et al. Setting the baseline value of attempt be made to relate plasma drug concentra- clotting factor activity in the absence of warfarin tion to changes in that process. Warfarin provides a (P0) to a fixed mean of three predose measure- good example of this, as the anticoagulant (hypo- ments, the program can estimate that parameter. Precision increased of compounds emerging from medicinal chemistry when a finite lag time was included in the fitting. These detract from their value in chemical, structure– two cases, however, are especially relevant to the activity analyses). Neither does any of these relationship between animal work and phase I studies approaches uses results of invitro functional assays in which only the simplest effects, such as counter- which emerge from screening of the compounds in action of a painful stimulus or raising/lowering of a biochemistry laboratories. This is a postgraduate textbook, and we wish to convey how in vitro and in vivo data In the future, models will exist which will link of various kinds may be used to help extrapolate constants for in vitro binding to cloned human observed drug effects from simple experimental receptors (Kd), data from in vitro functional assays systems to the more complex clinical situation. The ultimate need is to obtain useful predictions A composite prediction matrix will be applied of response in healthy human subjects (phase I rapidly and accurately to the process of synthesis studies) from observed drug effects in animals or of new compounds for phase I testing. In the shorter term, what can we now do to What are the strengths and weaknesses of these expedite the drug selection process? The use of intrinsic clearance in vitro represents a flow chart illustrating one form of permits predictions between species for the parti- metabolism/pharmacokinetics input into the drug cular enzyme/route of metabolism concerned. Arrows (indicating the flow of humans have qualitatively different routes of work and communication) pointing to the right metabolism for any particular compound, then represent perceived progress, whereas arrows point- this will weaken the predictive value of the in ing tothe leftrepresent ‘disappointments’ (and other vitro observation. The works best for compounds with a high component numbered asterisks indicate continuations. The of nonenzymatic elimination, such as our model ‘flow of time’ is from left to right and from the top compound with approximately 90% excretion as panel to the bottom panel. This prediction weakens as var- tasks that are to be completed, and rectangles in a iations in rates of enzymatic reactions become column within a panel represent work done by more important.

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Based on the principles of emergency medicine raloxifene 60mg generic menstruation moon cycle, what are the three priority considerations in the diagnosis of this patient? On physical examination you observe vaginal trauma and scattered bruising and abrasions discount 60mg raloxifene otc menstruation blood clot. Which of the following medications should be offered to the patient in this scenario? Ceftriaxone, azithromycin, metronidazole, antiretrovirals, emergency contraception b. Ceftriaxone, azithromycin, tetanus, metronidazole, antiretrovirals, emergency contraception Abdominal and Pelvic Pain 101 116. His past medical history includes prostate cancer, left total hip replacement, appendectomy 25 years ago, right iliac artery aneurysm repair 5 years ago, incisional hernia repair 4 years ago, and irritable bowel syndrome. He recalls having similar pain 1 week ago that resolved sponta- neously after 10 minutes. He was recently well and reports no fever, diar- rhea, urinary frequency, or dysuria. Which of the following is an important predisposing factor for the devel- opment of the condition seen in this individual? Provide oxygen via face mask, give morphine sulfate, and order a transvaginal ultrasound. She tells you that she has had this similar presentation four times over the past 2 months. Which of the following extraintestinal manifestations is associated with Crohn disease but not ulcerative colitis? During this time, she has been to the clinic twice, with negative urine cul- tures each time. Her condition has not improved with antibiotic therapy with sulfonamides or quinolones. Which of the following organisms is most likely responsible for the patient’s symptoms? He also describes nausea and vomiting and states he usually drinks 6 pack of beer daily, but has not had a drink for 2 days. Examination shows voluntary guarding and tenderness to palpation of his epigastrium. Admit to the hospital for medical management and supportive care Abdominal and Pelvic Pain Answers 74. The typical patient with mesenteric ischemia may initially present with “pain that is out of proportion to the examination” (ie, although the patient is in pain, the abdomen is neither rigid, nor signif- icantly tender on physical examination). Abdominal distention and peri- toneal signs are late findings and signal the presence of bowel infarction. Although rare, the finding of gas in either the bowel wall (pneumatosis intestinalis) or in the portal venous system is strongly suggestive of intesti- nal infarct. Rotavirus, typ- ically a disease of young children and Norwalk virus are the most frequent etiologic agents.

It should be noted that the anatom- ical left and right lobes of the liver do not reflect the internal distribution of the hepatic artery discount raloxifene 60 mg amex menstruation 3 times a month, portal vein 60 mg raloxifene overnight delivery breast cancer shirts, and biliary ducts. With these structures, used as criteria, the left lobe includes both the caudate and quadrate lobes, and thus the line dividing the liver into left and right functional lobes passes through the gallbladder and inferior vena cava. The three main hepatic veins drain segments of the liver that have no visible external Liver (ventral aspect) (transparent drawing illustrating margins of peritoneal folds). In this case the accessory pancreatic duct represents the main excretory duct of the pancreas. Vessels of the Abdominal Organs: Portal Circulation 303 1 2 3 7 8 9 4 5 10 11 6 Tributaries of portal vein (blue) and branches of superior mesenteric artery (red) (anterior aspect). Stomach and transverse 33 Superior rectal artery colon have been removed and the liver elevated. Vessels of the Abdominal Organs: Inferior Mesenteric Artery 305 Vessels of the retroperitoneal organs. Direction of the inferior mesenteric artery and its anastomosis with the middle colic artery (arrow = Riolan’s anastomosis). Greater omentum and transverse colon have been reflected, the intestine partly removed. The normally retrocecally located vermiform appendix has been replaced anteriorly. Dissection of the Abdominal Organs 307 1 Diaphragm 2 Costal margin 3 Transverse colon 4 Ascending colon with haustra 5 Free taenia of cecum 6 Ileum 7 Cecum 8 Falciform ligament of liver 9 Liver 10 Stomach 11 Gastrocolic ligament 12 Jejunum 13 Sigmoid colon 14 Vermiform appendix 15 Terminal ileum 16 Meso-appendix 17 Mesentery Abdominal organs in situ. Ascending colon, cecum, and vermiform Variations in the position of the vermiform appendix. The transverse colon with mesocolon has been raised and the small intestine reflected. Dissection of the Abdominal Organs: Upper Abdominal Organs 311 Upper abdominal organs (anterior aspect). Thorax and anterior part of diaphragm have been removed and the liver raised to display the lesser omentum. Red arrows: 26 Pancreas routes of the arterial branches of celiac trunk to liver, stomach, 27 Lesser sac (omental bursa) duodenum, and pancreas (posterior aspect). The gastrocolic ligament has been divided and the whole stomach raised to display the posterior wall of the lesser sac. The lesser omentum has been removed and the lesser curvature of the stomach reflected to display the branches of the celiac trunk. Dissection of the Abdominal Organs: Upper Abdominal Organs 315 Arteries of upper abdominal organs (anterior aspect). The stomach, superior part of duodenum, and celiac ganglion have been removed to reveal the anterior aspect of the posterior wall of the lesser sac (omental bursa) and the vessels and ducts of the hepatoduodenal ligament. The gastrocolic ligament has been divided, the transverse colon and the stomach replaced to display the pancreas and superior mesenteric vessels. The stomach has been removed, the liver raised, and the duodenum anteriorly opened.