The endocardium does not appear to be increased in thickness or fibrotic, and the cardiac valves do not appear abnormal. Carcinoid heart disease Cor pulmonale Eccentric hypertrophy Systemic hypertensive heart disease Volume overload to the heart 165. A 71-year-old female presents with increasing chest pain and occasional syncopal episodes, especially with physical exertion. Physical examination reveals a crescendo-decrescendo midsystolic ejection murmur with a paradoxically split second heart sound (S2). Pressure studies reveal that the left ventricular pressure during systole is markedly greater than the aortic pressure. Aortic regurgitation Aortic stenosis Constrictive pericarditis Mitral regurgitation Mitral stenosis 166. Latent syphilis Infective endocarditis Rheumatic fever Aortic dissection Congenital defects Cardiovascular System 181 167. Physical examination of an asymptomatic 29-year-old female with a history of rheumatic fever during childhood finds an early diastolic opening snap with a rumbling late diastolic murmur. Aortic regurgitation Aortic stenosis Mitral regurgitation Mitral stenosis Pulmonic stenosis 168. Acute rheumatic fever classically develops in children 1 to 4 weeks after a group A -hemolytic streptococcal (Streptococcus pyogenes) infection of the a. The most characteristic and frequent feature of chronic rheumatic heart disease is the development of a. Vegetations on the endocardium Aschoff bodies within the myocardium Fibrin deposits within the pericardium Stenosis of the mitral valve Incompetence of the pulmonic valve 170. A 31-year-old female presents with fever, intermittent severe pain in the left upper quadrant of her abdomen, and painful lesions involving her fingers and nail beds. History reveals that she had acute rheumatic fever as a child and that when she was around 20 years of age she developed a new cardiac murmur. At the present time one of three blood cultures submitted to the hospital lab grows out a particular organism. Staphylococcus aureus -hemolytic viridans streptococci Candida species Group A streptococci Pseudomonas species 182 Pathology 171. At autopsy, patchy interstitial infiltrates composed mainly of lymphocytes are found, some of which surround individual myocytes. Autoimmune reaction (to group A -hemolytic streptococci) Bacterial myocarditis (due to S. At the time of autopsy of a 39-year-old female who died of complications of systemic lupus erythematosus, several medium-sized vegetations are found on both sides of the mitral valve and tricuspid valve. Turbulent blood flow through an incompetent mitral valve Abnormal secretion of a vasoactive amine Presence of an anticardiolipin antibody Cachexia produced by a hypercoagulable state Bacterial colonization of an abnormal valve 173. A 37-year-old woman presents with prolonged cramps, nausea, vomiting, diarrhea, and episodic flushing of the skin. Additionally, she develops pearly white, plaquelike deposits on the tricuspid valve leaflets. Rheumatic heart disease Amyloidosis Iron overload Hypothyroidism Carcinoid heart disease Cardiovascular System 183 174. A 59-year-old patient receiving chemotherapy with the anthracycline Adriamycin develops severe heart failure. Sections from an endocardial biopsy specimen reveal vacuolization of the endoplasmic reticulum of the myocytes. Dilated cardiomyopathy Hyperplastic cardiomyopathy Hypertrophic cardiomyopathy Obliterative cardiomyopathy Restrictive cardiomyopathy 175. Histologic sections from this area reveal disorganization of the myofibers, which are thicker than normal and have hyperchromatic nuclei. Hypertrophic cardiomyopathy Dilated cardiomyopathy Constrictive cardiomyopathy Secondary cardiomyopathy Endomyocardial fibrosis 184 Pathology 176. The familial form of the abnormality seen in this gross photograph of the heart is a. An autosomal recessive disorder associated with decreased acid maltase formation d. An elderly patient who becomes acutely short of breath presents with the combination of hypotension, elevated jugular venous pressure, and muffled heart sounds. Chronic pericarditis Chronic pericardial effusion Cardiac tamponade Dissecting aortic aneurysm Right heart failure 178.
Results in death Is immediately life-threatening Requires in-patient hospitalisation or prolongation of existing hospitalisation Results in persistent or significant disability/incapacity or substantial disruption of the ability to conduct normal life functions Is a congenital abnormality or birth defect Is an important medical event that may jeopardise the patient or may require medical intervention to prevent one of the outcomes listed above. Every effort should be made to obtain a resolution for all events, even if the events continue after discontinuation/study completion. Wherever possible the reporting Investigator uses the clinical, rather than the laboratory term (eg, anaemia versus low haemoglobin value). Guidelines for management of patients with hepatic function abnormality are outlined in Appendix H. It may be an increase in the severity of the disease under study and/or increases in the symptoms of the disease. Deaths All deaths that occur during the study, or within the protocol-defined follow-up period after the administration of the last dose of study drug, must be reported as follows:! The laboratory variables to be measured are presented in Table 5, Table 6 and Table 7. Table 6 Albumin Alkaline phosphatase a Clinical chemistry (serum or plasma) Glucose Lactate dehydrogenase Lipaseb Magnesiumb Potassium Sodium Total bilirubina Total protein b Alanine aminotransferasea Aspartate aminotransferasea Amylaseb Bicarbonate Calcium Chloride Creatinine (creatinine clearance) Gamma glutamyltransferase a b c c Urea or blood urea nitrogen, depending on local practice Uric acidb Tests for aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and total bilirubin must be conducted concurrently and assessed concurrently. Creatinine clearance, magnesium, amylase, lipase, and uric acid tested at Screening Day 1 (unless screening laboratory assessments are performed within 3 days prior to Day 1) and every 4 weeks thereafter. A complete physical examination will be performed and will include an assessment of the following (as clinically indicated): general appearance, respiratory, cardiovascular, abdomen, skin, head and neck (including ears, eyes, nose and throat), lymph nodes, thyroid, musculo-skeletal (including spine and extremities), genital/rectal and neurological systems. This group also contains patients who are fully active, as in Grade 0, but only with the aid of analgesics. Up and about more than 50% of waking hours Capable of only limited self-care, confined to bed or chair more than 50% of waking hours Completely disabled, unable to carry out any self-care and confined totally to bed or chair. It takes about 20 to 40 minutes for patients to complete all 3 questionnaires and the patients are asked to only fill out questionnaires that have been validated to be relevant to their specific type of cancer; hence the burden to the patient is moderate. Preliminary studies indicate that the 5L version improves upon the properties of the 3L measure in terms of reduced ceiling effect, increased reliability and an improved ability to differentiate between different levels of health (Janssen et al 2008a, Janssen et al 2008b, Pickard et al 2007). It is important that the significance and relevance of the data are explained carefully to participating patients so that they are motivated to comply with data collection. Tumour biopsies will be stored at AstraZeneca/MedImmune Research and Development (R&D) or an appropriate vendor selected by AstraZeneca/MedImmune. Blood (plasma or serum) samples will also be collected for analysis of circulating soluble factors in relation to immune status at baseline and in response to treatment. AstraZeneca/MedImmune will not provide biomarker research results to patients, their family members, any insurance company, an employer, clinical study Investigator, general physician or any other third party, unless required to do so by law. Table 8 is a guide to the approximate volume of blood that will be drawn from each patient, based on the assumption that each patient remains in the study on treatment for 3 months and attends all the planned visits. Quintiles keeps oversight of the entire life cycle through internal procedures, monitoring of study sites and auditing of external laboratory providers. Extra precautions are taken to preserve confidentiality and prevent genetic data being linked to the identity of the patient. The Investigator will ensure the distribution of these documents to the applicable Ethics Committee, and to the study site staff. The Investigator should submit the written approval to AstraZeneca before enrolment of any patient into the study. AstraZeneca should approve any modifications to the Informed Consent Form that are needed to meet local requirements. The Investigator will contact AstraZeneca immediately if contacted by a regulatory agency about an inspection at the centre. Discuss with the Investigator(s) (and other personnel involved with the study) their responsibilities with regard to protocol adherence, and the responsibilities of AstraZeneca or its representatives. This will be documented in a Clinical Study Agreement between AstraZeneca and the Investigator. The Principal Investigator will ensure that appropriate training relevant to the study is given to all of these staff, and that any new information relevant to the performance of this study is forwarded to the staff involved.
Diseases
This abnormality is seen in postmenopausal women, who develop pruritic white plaques of the vulva. Inflammatory skin diseases, such as chronic dermal inflammation, squamous hyperplasia (characterized by epithelial hyperplasia and hyperkeratosis), and vulvar intraepithelial neoplasia (characterized by epithelial atypia or dysplasia), can also present with leukoplakia. A term related to leukoplakia is vulvar dystrophy, but this refers specifically to either lichen sclerosis or squamous hyperplasia. Because the latter is sometimes associated with epithelial dysplasia, it is also referred to as hyperplastic dystrophy. The male counterpart of lichen sclerosis, called balanitis xerotica obliterans, is found on the penis. The latter is Reproductive Systems Answers 405 seen clinically as pruritic, red, crusted, sharply demarcated maplike areas. Histologically, these malignant lesions reveal single anaplastic tumor cells surrounded by clear spaces ("halos") infiltrating the epidermis. These cells are characterized by having clear spaces ("halos") between them and the adjacent epithelial cells. However, a side effect of this therapy proved to be a particular form of adenocarcinoma, clear cell carcinoma. The tumor, which carries a poor prognosis, has at least three histologic patterns. One is a tubulopapillary configuration, followed by sheets of clear cells and glands lined by clear cells, and solid areas of relatively undifferentiated cells. Many of the cells have cytoplasm that protrudes into the lumen and produces a "hobnail" (nodular) appearance. Prior to the development of adenocarcinoma, a form of adenosis consisting of glands with clear cytoplasm that resembles that of the endocervix can be seen. This has been termed vaginal adenosis and may be a precursor of clear cell carci- 406 Pathology noma. Clinically, adenosis of the vagina is manifested by red, moist granules superimposed on the pink-white vaginal mucosa. The diagnosis of endometritis depends on finding inflammatory cells within the endometrium that are not present during the normal menstrual cycle. Polymorphonuclear leukocytes (neutrophils) are normally present during menstruation, while a stromal lymphocytic infiltrate can be seen at other times during the menstrual cycle. Lymphoid aggregates and lymphoid follicles may also be seen in normal endometrium. Therefore the presence of any of these types of leukocytes is not diagnostic of endometritis. Acute endometritis is usually caused by bacterial infection following delivery or miscarriage and is characterized by the presence of neutrophils in endometrial tissue that is not menstrual endometrium. The histologic diagnosis of chronic endometritis depends on finding plasma cells within the endometrium. The latter is characterized histologically by the presence of caseating granulomas with Langhans giant cells. Decidualized stromal cells are the result of the effects of progesterone and are seen normally in the late secretory phase or in patients who are pregnant. The ectopic endometrial tissue may be located within the myometrium or it may be found outside of the uterus. The former type, consisting of nests of endometrial stroma within the myometrium, is called adenomyosis. It is thought to result from the abnormal downgrowth of the endometrium into the myometrium. Ectopic endometrial tissue outside of the uterus is called endometriosis and histologically reveals endometrial glands, stroma, and hemosiderin pigment (from the cyclic bleeding). Repeated cyclic bleeding in patients with endometriosis can lead to the formation of cysts that contain areas of new and old hemorrhages.
In addition to maintaining the various types of databases such as pubMed, GeneBank, etc. In addition to the basic databank there are various other types of biological information databases. For example, the Entrez protein database is cross-linked to the Entrez taxonomy database. This allows a researcher to find taxonomic information for the species from which a protein sequence was derived. Taxonomy is a division of the natural sciences that deals with the classification of animals and plants. It can also be used for visualizing sequence data for a genomic region of interest. The Locus Link carries information on the official name and other essential descriptive information about selected genes, which are studied extensively. It is very easy to obtain the information about the rabbit or mouse hemoglobin gene if the information about the human hemoglobin gene is known. If it is similar, this tool will give the percentage homology or similarity between the sequences. Alignment and comparison is carried out using scoring matrices, a statistical method, in which a score will be rewarded (positive value for correct matching) and penalized for a mismatch (negative value for bases or amino acid mismatch) while doing the alignment. Top scoring matches are ranked according to the set of criteria that serve to distinguish between similarities due to genetical or evolutionary relationship or by random chance. If two sequences have homology, the similarity in the sequence is due to a common ancestry. A duplicated gene within a genome may also have sequence homology, but its function may be different. HomoloGene is another specialized database developed for the orthologs and homologs for the human, rat, cow, mouse, zebrafish, etc. This type of database was also developed for microorganisms such as yeast and bacteria. The databases are managed and controlled by a person or team of persons known as curators. They review and check the newly submitted data for all the essential requirements such as biological features, translation of coding regions, use of universal rules, etc. The protein that can be encoded by the gene and its biological functions can be predicted. The phylogenetic relationship of the protein or gene with other known molecules of the same type from other organisms can also be elucidated. There are a number of efficient computer tools available for structural and functional genomic analysis. This polypeptide sequence can be compared with the sequences that are present in the database, the biological function of which is clear, and thus biological function of the new protein can be predicted because of the structural and functional relationship. Regulatory sequences present in genome sequences can be determined using computational tools specialized for that purpose. Phylogenetic relationships can be understood very clearly by studying the homology and similarity between sequences present in the database and also 2. The computational methods for comparing the sequences can give valuable insights into the evolutionary sequences of macromolecules present in unrelated organisms. Thus, with the help of databases and bioinformatics tools it is possible to predict the functions of unknown genes and the relationship with the functioning of other genes present in the genome. What are the major bioinformatics institutes that maintain public databases and computational tools for bioinformatics analysis? Describe the contribution made by Margaret Dayhoff toward the development of bioinformatics. But these are some of the techniques that changed the face of biotechnology forever. Whatever may be the techniques used in biotechnology, the ultimate aim is to make use of the ability of cells to produce certain valuable compounds or the genetic improvements of plants and animals for the benefit of mankind.
A breastfeeding client calls her obstetrician stating that her baby was diagnosed with thrush and that her breasts have become infected as well. How many mL of heparin will the nurse administer if the available concentration of heparin is 5000 units per 0. Other than patellar reflex assessments, which of the following noninvasive assessments should the nurse perform to monitor the client for early signs of magnesium sulfate toxicity? Gestational diabetic clients need not assess their blood glucose levels during the postpartum. They should be encouraged to eat healthy and to exercise in order to prevent the onset of the chronic disease or, at the very least, to delay its onset. A heavy discharge is described as a discharge that saturates a pad in 1 hour or less. The transfusion should be stopped immediately and the reaction reported to the physician and to the blood bank. During the postpartum it acts directly at the site of placental separation to stop uncontrolled bleeding. In this scenario, the uterus is contracted and at the expected location-that is, firm at the umbilicus. The nurse must notify the practitioner for assistance since there is no additional action the nurse can take at this time. There is nothing in the scenario that suggests that this client is high risk for dependent edema. There is nothing in the scenario that suggests that this client is high risk for an alteration in reflex response. However, diaphoresis is normally seen in postpartum clients, and is not in itself indicative of postpartum infection. Because this client had general anesthesia during her surgery, she is high risk for pulmonary complications, including atelectasis and pneumonia. Postoperative C/section clients should turn every 2 hours to prevent stasis of their lung fields. Active range of motion exercises will help to prevent thrombus formation in C/section patients. If the client exercises, she will be much less likely to develop deep vein thrombosis. Although a client may have a slight temperature elevation, an elevated white cell count, and/or be diaphoretic, all three symptoms are normally seen in the postpartum client. The only finding that would make a nurse suspect infection is the malodorous lochial flow. One out of 4 women complains of painful and stiff joints after receiving the injection. Feelings of infanticide are not consistent with the diagnosis of postpartum depression. Difficulty latching babies to the breast is an independent problem from postpartum depression. Some mothers with depression are successful breast feeders, while some mothers who do not experience depression have difficulty latching their babies to the breast. Although hematomas are usually simple bruises, large collections of blood can occur. Because the blood is trapped under the skin, the most common symptom is pain from the blood pressing on the pain sensors. If the ducts are severed, the woman will not be able to transfer the milk produced in her glandular tissue to the baby. Her wound healing may be impaired because of her diabetes and because of her obesity. This question could be written by a surgical nursing professor rather than a parent-child nursing professor. The important pieces of information needed correctly to answer this question are that this client is obese and a type 1 diabetic and that she has had surgery. After the surgeon is notified, the nurse should stay with the patient while another staff member gathers supplies, including a suture removal kit and personal protective equipment as well as sterile saline solution and a large syringe. More important, however, is the fact that the mother will produce antibodies that will be consumed by the baby in the breast milk.
When the potential at the next node exceeds the threshold (somewhere between -70 mV and zero), the Na+ ion channel is stimulated to open. Each of these conductances is associated with an equilibrium potential, represented by a battery in series with the conductance. The net current, which flows into the cell through these channels, has the effect of charging the membrane capacitance, giving the interior of the cell a membrane potential m relative to the exterior. They modeled the time dependency on the ionic conductance by a channel variable or activation coefficients, which indicate the probability of a channel being open. In general, the conductance for a time-dependent channel is written in terms of the channel variable (x), ranging from zero to one, and the maximum conductance. They developed a set of four differential equations to demonstrate action potential of the membrane. There are sophisticated programs, which allow simulating various action potentials. Whenever a short (millisecond range) inward current pulse (in the nano-ampere range) is applied to a patch of axonal membrane, the membrane capacitance is charged and the membrane potential depolarizes. Since tm is very small at these potentials, the sodium current shifts the membrane potential beyond 0 mV. If Iinj = 0, it can be proved that the rest state is linearly stable but it is excitable if the perturbation from the steady state is sufficiently large. Both types of phenomena have been observed experimentally in the giant axon of the squid. Higher temperatures affect the reversal potentials since the Nernst equation is temperature dependent. A multiplication factor for each time constant has been developed to account for temperature. Although the Hodgkin-Huxley model is too complicated to analyze, it has been extended and applied to a wide variety of excitable cells. There are experimental results in both skeletal muscle and cardiac muscle, which indicate that a considerable fraction of the membrane capacitance is not "pure," but has a significant resistance in series with it. Understanding the behavior of ion channels has also allowed simplification of the model. One such is the Fitzhugh-Nagumo model, based on the time scales of the Na+ and K+ ion channels. This fact led Fitzhugh and Nagumo to assume that the Na+ channel is always in equilibrium, which allowed them to reduce the four equations of the Hodgkin and Huxley model to two equations. Developing mathematical models that depict physiological processes at the cellular level depends on the ability to measure required data accurately. One has to measure or record the voltage and/or current across the membrane of a cell, which requires access to inside the cell membrane. Since such measurements involve low-level voltages (in the millivolts range) and have high source resistances, usage of amplifiers is an important part of bioinstrumentation signals 3. Amplifiers are required to increase signal strength while maintaining high fidelity. Although there are many types of electronic amplifiers for different applications, operational amplifiers (normally referred to as op-amps), are the most widely used devices. They are called operational amplifiers because they are used to perform arithmetic operations (addition, subtraction, multiplication) with signals. Op-amps are also used to integrate (calculate the areas under) and differentiate (calculate the slopes of) signals. Modern designs of op-amps are electronically more rugged and normally implemented as integrated circuits. For complete discussion about op-amps, the reader should refer to textbooks related to electrical circuits. One technique to measure electrical activity across a cell membrane is the space clamp technique, where a long thin electrode is inserted into the axon (just like inserting a wire into a tube). Injected current is uniformly distributed over the investigated space of the cell.
Labrador Tea. Voveran.
Source: http://www.rxlist.com/script/main/art.asp?articlekey=96541
What are the magnitude and direction of the resultant (identified with respect to the horizontal) under the condition where all three muscles exert a force of 1,000N? Calculate: (a) the joint reaction force (Rx, Rz) and (b) the 202 Biomechanics Achilles tendon force, Mt [personal communication with Dr. With his 2-ft-long arm (the weight is 5% of the total body weight), he tries to hit a tennis ball using a 0. Assume that all movements occur in the frontal plane and the arm is acting at 10 inches from the joint. You want to analyze the forces and moments at the L5 lumbar disc seen in her technique compared to the "proper" technique. Using the information given in the table, answer the following: (a) How large is the bending moment on the L5 disc when the patient is making the bed while bending over? Assume that the line of application of the erector spinae muscle force is perpendicular to the disc, independent of its degree of inclination [personal communication with Dr. Weight of head and trunk 340N Weight of arms Moment of arms Bending over: arms c-of-g 0. Body Part Head Torso Arm Moment Mass (kg) Arm Length (cm) 4 30 2 5 2 15 7 Anterior chest N/A the pair of erector spinae muscles is symmetrically distributed on either side of the spine. They act at 1 cm from the center of rotation of the spine in the anteroposterior direction. What is the required force generated by the erector spinae muscles in order to allow the child to carry this weight? Assuming that they are the only muscles acting, will the child be physically able to lift this weight [personal communication with Dr. You are serving as a consultant on the case and have been asked to estimate the forces and moments at the elbow. You could assume that the waving motion is: pure curvilinear motion, only in the coronal plane, and rotation of the forearm at the elbow about the axis of the humerus (arm). Calculate: (a) the segment angle at the above five time points; (b) the angular velocity and acceleration of the forearm/hand complex, given the above data; and (c) the force and moment at the elbow after 10. One day he is in a hurry to get to work and increases the velocity from 0 to 10 m/s. She wants to hit the volleyball, for which she jumps with an average vertical ground reaction force of 750N for 0. If Mike Tyson has to stop the motion, what average amount of force must be applied over a period of 0. Just before he is about to cross an intersection, he snaps to attention and realizes that he is in danger of being struck by a car. Answer with an integer (1, 2, 3, and so on), but support your answer with calculations. Assume that the cross-sectional area of the femur can be approximated by a circle with a diameter of 2. Assume now that the individual is walking and therefore all of the weight is occasionally on one leg. Assume that the "body" is 6 feet long and that the body can be completely modeled as bone. Would the resulting stress be greater than the failure strength of bone [personal communication with Dr. If the observed extension is 70 m, then: (a) What are the axial stress and axial strain? Show that the hoop stress and longitudinal stress have same magnitude in this case. A 10-cm-long tubular steel of internal diameter of 10 mm and a wall thickness of 1 mm is considered for a stent application. The possible loads include axial (F), torsional (Tx), and internal pressure (P) loads.
Provider-to-provider handoff is one way to ensure continuity of care under these conditions. However, there is no publicly available information on how often or in what fashion those handoffs take place. Whether temporary or permanent, separation from military service presents another challenge to continuity of care. Reserve Component members who return to their communities may also require continued care. Efforts are under way to address the compatibility and electronic transmission of patient health information between these systems; however, sharing of patient records across the systems still presents a challenge for continuity of care. Transition to post-military, civilian life requires navigating a new health care system, an experience that leaves many individuals resigned to not seeking care. The Mental Health Task Force recommended provider-to-provider handoffs to guide transition to civilian care (Department of Defense Task Force on Mental Health, 2007b). Some military servicemembers pay for community-provided treatment out of pocket to avoid the stigma associated with receiving mental health care on base. However, the negative attitudes within the military culture associated with having and treating a mental disorder are a major barrier to care that must be addressed systemwide (Department of Defense Task Force on Mental Health, 2007a). More-comprehensive and more-coordinated care and services can also be achieved through case management. A final transition issue concerns timeliness and consistency of disability decisions. The availability and characteristics of these local initiatives are varied, and many may offer innovative approaches for increasing access to mental health care for returning servicemembers and veterans. For example, through some programs, servicemembers may access online lists of providers offering counseling services to returning military servicemembers and receive free counseling and psychotherapy from licensed mental health care providers. Faith-based organizations provide counseling and retreat programs to returning servicemembers to facilitate the post-deployment transition. We note that many of these programs lack rigorous evaluation or information on whether they offer evidence-based treatment services. Concerns about quality of mental health care, including the care provided within these programs, are discussed in the next section, Quality of Mental Health Care. These initiatives may increase access to mental health care for servicemembers and their families. But before these individuals can access these services, they must be aware of them. State-based programs that integrate services Systems of Care: Challenges and Opportunities to Improve Access to High-Quality Care 275 and provide comprehensive lists of available resources may help servicemembers and their families locate appropriate services. In the following subsection, we describe other personal, social, and cultural factors that may impede use of the array of services described above. In this subsection, we examine social, cultural, and personal factors that impede or facilitate access to mental health care for servicemembers. The Department of Defense Task Force on Mental Health (2007) identified the stigma of mental illness as a significant issue preventing servicemembers from seeking help for mental health problems and made recommendations to dispel stigma. Below, we discuss the variety of potential influences and meanings of the term stigma, then we review specific attitudinal barriers to mental health use for military servicemembers. The term stigma is referred to in multiple places as it relates to care seeking behaviors in mental health, and in fact it is referenced and discussed in the DoD Task Force on Mental Health. To more fully appreciate these issues, we first discuss the definition of this term in order to draw distinctions among the various subtypes of stigma. Stigma is a term that can refer to various types of social, cultural, and personal factors affecting access to mental health care. In the social science literature, it is defined as a "negative and erroneous attitude about a person, a prejudice, or negative stereotype" (Corrigan and Penn, 1999, p. When negative attitudes about those who experience mental health conditions or who receive mental health care are widely held by military servicemembers, these pose a significant hurdle to effective mental health assessment and treatment. In the discussion below, we consider the general consequences of negative attitudes associated with mental health conditions, the profound presence of negative attitudes associated with mental health problems in military culture, specific types of attitudes and concerns that serve as barriers to mental health care, and DoD recommendations to mitigate the effects of stigma. Negative attitudes associated with mental health conditions appear at societal, individual, and institutional levels.
Emilia comes in and discovers the murder, whereupon Othello tells her Desdemona was unfaithful and that Iago knew the whole story. In front of everyone, Emilia accuses her husband of bringing on the murder of Desdemona, and an enraged Iago stabs her. These dramatic, actionfilled tales provided Elizabethan playwrights with a gold mine of source material. As you will see, Shakespeare changed some of the details, but the basic plot is the same. There once lived in Venice a Moor, who was very valiant and of a handsome person; and having given proofs in war of great skill and prudence, he was highly esteemed by the Signoria1 of the Republic, who in rewarding deeds of valor advanced the interests of the State. It happened that a virtuous lady of marvelous beauty, named Disdemona, fell in love with the Moor, moved thereto by his valor; and he, vanquished by the beauty and the noble character of Disdemona, returned her love; and their affection was so mutual that, although the parents of the lady strove all they could to induce her to take another husband, she consented to marry the Moor; and they lived in such harmony and peace in Venice that no word ever passed between them that was not affectionate and kind. Now it happened at this time that the Signoria of Venice made a change in the troops whom they used to maintain in Cyprus, and they appointed the Moor commander of the soldiers whom they dispatched thither. The government of Venice, made up of the Duke, or doge, and a council of noblemen. The zookeepers exercised prudence when dealing with the tigers, knowing that wild animals can be unpredictable. But Disdemona, who had no other happiness in the world than the Moor, and who rejoiced to witness the testimony of his valor her husband had received from so powerful and noble a Republic, was all impatient that he should embark with his troops, and longed to accompany him to so honorable a post. And all the more it vexed her to see the Moor so troubled; and not knowing what could be the reason, one day, when they were at dinner, she said to him, "How is it, O Moor, that when so honorable a post has been conferred on you by the Signoria, you are thus melancholy? The first could not be otherwise than serious to me, for all the toil you would have to bear, and every danger that might befall you, would cause me extreme anxiety and pain. Yet, were I to leave you behind me, I should be hateful to myself, since in parting from you I should part from my own life. And in truth I should think you loved me little, were you to leave me here in Venice, denying me to bear you company, or could believe that I would liefer bide3 in safety here than share the dangers that await you. Prepare then for the voyage with all the readiness which the dignity of the post you hold deserves. Now amongst the soldiery there was an Ensign,4 a man of handsome figure, but of the most depraved nature in the world. This man was in great favor with the Moor, who had not the slightest idea of his wickedness; for, despite the malice lurking in his heart, he cloaked with proud and valorous speech and with a specious presence the villainy of his soul with such art that he was to all outward show another Hector or Achilles. In the same Company there was a certain Captain of a troop, to whom the Moor was much affectioned. And Disdemona, for this cause, knowing how much her husband valued him, showed him proofs of the greatest kindness, which was all very grateful to the Moor. Now the wicked Ensign, regardless of the faith that he had pledged his wife, no less than of the friendship, fidelity and obligation which he owed the Moor, fell passionately in love with Disdemona, and bent all his thoughts to achieve his conquest; yet he dared not to declare his passion openly, fearing that, should the Moor perceive it, he would at once kill him. He therefore sought in various ways, and with secret guile, to betray his passion to the lady. But she, whose every wish was centered in the Moor, had no thought for this Ensign more than any other man, and all the means he tried to gain her love had no more effect than if he had not tried them. But the Ensign imagined that the cause of his ill success was that Disdemona loved the Captain of the troop; and he pondered how to remove him from her sight. The love which he had borne the lady now changed into the bitterest hate, and, having failed in his purposes, he devoted all his thoughts to plot the death of the Captain of the troop and to divert the affection of the Moor from Disdemona. The criminal was completely depraved-no amount of rehabilitation could make him fit to rejoin society. But knowing the singular love the Moor bore to Disdemona, and the friendship which he had for the Captain, he was well aware that, unless he practiced an artful fraud upon the Moor, it were impossible to make him give ear to either accusation: wherefore he resolved to wait until time and circumstance should open a path for him to engage in his foul project. Not long afterwards it happened that the Captain, having drawn his sword upon a soldier of the guard, and struck him, the Moor deprived him of his rank; whereat Disdemona was deeply grieved, and endeavored again and again to reconcile her husband to the man. This the Moor told to the wicked Ensign, and how his wife importuned him so much about the Captain that he feared he should be forced at last to receive him back to service.
The severity of the disease is roughly correlated with the number of copies of the trinucleotide repeat unit. Mildly affected individuals can again have gametes in which a second round of expansion has occurred. In humans, the drug thalidomide taken during pregnancy caused phenocopies of the rare genetic disease phocomelia, children were born with severe limb defects. It is inherited only through the egg, sperm mitochondria never contribute to the zygote population of mitochondria. The further apart the genes are the more opportunity there will be for a chiasma to occur between them. When they get so far apart that there is always a chiasma between them then they are inherited independently. The frequency with which the genes are separated at miosis can be measured and is the basis for the construction of genetic linkage maps. They all have a short arm and long arm separated by a primary constriction called the centromere. The centromere is the location of spindle attachment and is an integral part of the chromosome. It is essential for the normal movement and segregation of chromosomes during cell division. Cytogenetically normal humans, for example, have 46 chromosomes (44 autosomes and two sex chromosomes). Cattle, on the other hand, have 98 Molecular Biology and Applied Genetics 60 chromosomes. This ratio is an important parameter for chromosome identification, and also, the ratio of lengths of the two arms allows classification of chromosomes into several basic morphologic types. Germ cells (egg and sperm) have 23 chromosomes: one copy of each autosome plus a single sex chromosome. One chromosome from each autosomal pair plus one sex chromosome is inherited from each parent. Mothers can contribute only an X chromosome to their children while fathers can contribute either an X or a Y. Cytogenetic analyses are almost always based on examination of chromosomes fixed during mitotic metaphase. Metaphase chromosomes differ from one another in size and shape, and the absolute length of any one chromosome varies depending on the stage of mitosis in 99 Molecular Biology and Applied Genetics which it was fixed. However, the relative position of the centromere is constant, which means that that the ratio of the lengths of the two arms is constant for each chromosome. Centromere position and arm ratios can assist in identifying specific pairs of chromosomes, but inevitably several or many pairs of chromosomes appear identical by these criteria. The ability to identify specific chromosomes with certainty was revolutionized by discovery that certain dyes would produce reproducible patterns of bands when used to stain chromosomes. Importantly, each chromosome displays a unique banding pattern, analogous to a "bar code", which allows it to be reliably differentiated from other chromosomes of the same size and centromeric position. Chromosome Abnormalities Although chromosome abnormalities can be very complex there are two basic types: numerical and structural. Numerical abnormalities Numerical abnormalities involve the loss and/or gain of a whole chromosome or chromosomes and can include both autosomes and sex chromosomes. Generally chromosome loss has a greater effect on an individual than does chromosome gain although these can also have severe consequences. Nearly all autosomal monosomies die shortly after conception and only a few trisomy conditions survive to full term.
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