Chapter 35 Flashcard

Chapter 35

Parasite Rex essays

Parasite Rex essays Parasite Rex was a complex book describing the life of a parasite. In todays society, parasites are seen as useless creatures that live their lives at the expense of anothers, but Carl Zimmer portrays them in a much different light. He brilliantly displays that parasites have received a poor reputation but are in fact a major contributor to life on earth today. The beginning of the book describes how early scientists discovered parasites. Leeuwenhoek, Steenstrup and Koch, just to name a few, were the early scientists that discovered small creatures that seemed to infest others. One scientist, Ray Lankester, is responsible for parasites vicious reputation. He studied the parasite known as Sacculina, a parasite that inhabits crabs. He thought that it was born as a free-living organism that degenerated into a parasite, giving up the majority of its body to inhabit the body of another. Zimmer proved that these scientists were wrong about the evolution of the Sacculina, when in fact they are not degenerates, but rather very complex life forms. The book continues on to describe the lives of several other parasites. One group is known as blood flukes, which inhabit the liver. One fluke, Schistosoma mansoni, lives in snails as their intermediate host where it waits to get into a human. Like all parasites, Schistosoma is specially adapted to survive the turmoil of the human body. It can navigate inside the abdominal cavity as if it had a road map. Along side the blood fluke is mentioned other parasites including Hookworms, Tapeworms and Trichinella. Parasitic wasps lay their eggs inside caterpillars where they feed upon the guts and intestines, sparing the vital organs. One particular parasite mentioned is Plasmodium, the parasite that causes malaria and is transmitted by hungry mosquitoes. Plasmodium has a very complex way of infecting the body and like all parasites can gracefully evade the immune system. The nex...

Organizing Essay Example | Topics and Well Written Essays - 1000 words

Organizing - Essay Example Furthermore, the paper entails valued suggestions, which will assist the company in mitigating the key challenges. Discussion Reorganization is considered to be a major part of any business who files for bankruptcy, as it is considered that reorganization can either dissolve a firm or help the business to attain a leading position in the global platform (United States Court, n.d.). The plan that has been designed with respect to the reorganization proposed by GM is stated here under: Development of a Competitive Product Mix along with a Balanced Cost Structure It is measured that GM is listed among those automobile organization that owes many well reputed automobile brands like Chevrolet, GMC, Cadillac, and Isuzu among others. The first reorganizational plan of the company inculcate to rationalize its vehicle brands by discontinuing well-known automobile brands like Hummer and many others and focusing on its core brands. The company then planned to reduce its name plates by 25% which is estimated to increase around 80% by 2014. GM is considered to be one of the oldest automobile companies in the world, which also implies the same for their dealers. However, it has been found that the dealers of the company are comparatively outdated in comparison to the other competitors resulting in decreased marginal sales of their products. In this regard the company planned to reshape its dealer and expand it dealership in all major part of its operating area. Additionally, the company merged its four product development organization, which was located in diversified part of the globe to foster effectiveness of reorganizational plan and to maximize the cost. Furthermore, these strategies will assist the company to develop better vehicles for its customers. It has also been identified that though the company has reduced its total labor cost by 28% from 2004 till 2008. However, there was no significant outcome of the implemented policies. It is also estimated that the company spends about $100 billion on retiree benefits irrespective of its losses (General Motors Corporation, 2009). The main issue that can act as a barrier for the company is the increasing cost of raw materials. The plan that has been made by the company has been estimated with the current prevailing cost of raw materials which are likely to increase in the future. Additionally the plan of refurnishing the existing dealers may be a challenging task which would require adequate amount of time (Kunze, 2012). Compliance with the Federal Environmental Regulation The second plan that has been proposed by the company i.e. GM is to develop vehicles to meet up the environmental regulation passed by the government of the United States of America. The company also developed plans to manufacture alternative fuel vehicles, adapting the company’s technological aspects in countries like Brazil. The increasing pollution has forced the government of different countries to pass laws that set guid elines for automobile industry to manufacture vehicle accordingly. In this aspect the company has planned to replace some of its higher authorities to maintain an effective structural management in Brazil, as it accounts about 60% of the vehicle sale in the South American region (Higgins, 2013;

Bipolar Assignment Example | Topics and Well Written Essays - 500 words

Bipolar - Assignment Example There are certain forms of medication that are used to control the symptoms of bipolar disorder It is important to note that, bipolar has different types of medications that can help control its symptoms. However, not every patient with bipolar disorder responds to medications in a similar manner. This means that doctors could prescribe different medications before coming to the ones that work best for a particular patient. The types of medications generally used in the treatment of bipolar disorder include atypical antipsychotics, mood stabilizers and antidepressants (Grunze, et.al, 2013). Mood stabilizers are normally the first choice in the treatment of bipolar. Patients with bipolar generally use mood stabilizers for years. There are several mood stabilizers that are good for people with bipolar. First, lithium also known as Lithobid or Eskalith is an effective mood stabilizer for bipolar patients. It treats both manic and depressive episodes. However, lithium could have side effects including restlessness, bloating, dry mouth, acne and joint and muscle pain among other side effects. The doctor should first check the amount of lithium in the body before prescribing the medication. Secondly, anticonvulsants are also used as stabilizers for people with bipolar disorder. They help control moods. Examples of anticonvulsants include Valproic acid, Lamotrigine, gabapentin, oxcarbazepine and topiramate. However, anticonvulsants could have side effects including drowsiness, headache, dizziness, heartburn, constipation and mood swings (McCance & Huether, 2010). Atypical antipsychotics are used to treat the symptoms of bipolar, however, not all the time. They are prescribed among other medications such as antidepressants and they include olanzapine, aripiprazole and quetiapine. These also have side effects that include dizziness, drowsiness, sensitivity to the sun, menstrual problems for women and rapid heartbeat

Research Empirical Studies Coursework Example | Topics and Well Written Essays - 2500 words

Research Empirical Studies - Coursework Example 217-241). The sample data is taken from existing studies, in this case a study from the National Crime Panel that details the determination of available data from mapped an unmapped information sources in crime investigation settings. Such data is then factored into analyses of the effectiveness of law enforcement use of data and information to solve crimes. The thinking is that the more effective use of more information can lead to better law enforcement work as such work relates to crime investigations. The data analysis flows from this look into the availability of data and the degree of law enforcement use of such data (Skogan et al., 1979). The key threat to the validity of the research and its findings is that there is only one data source used, and that is a study that was done six years prior to the conduct of the research being described here. The reliance on one set of data limits the general applicability of research findings. This threat to validity is somehow addressed by the integrity of the institution that conducted that older study, and that the study was on a national scale, implying ample representation and ample population sizes (Skogan et al., 1979). Among the findings are that the status quo, where police leaned on data that they had at their disposal historically for particular crimes, yielded crime investigation outcomes that were far from ideal. On the other hand, the study also noted that there existed a larger amount of information from more sources, including bystanders and witnesses to crimes, than are being collected and used. The implication here is that with more rigorous ways of information collection, crime investigation outcomes would improve. The implications of the findings include that there needs to be a more rigorous attempt to gather data and to put up standard procedures

Management of Pain in Trigeminal Neuralgia

Management of Pain in Trigeminal Neuralgia Percutaneous management of pain in Trigeminal Neuralgia under computed tomography guidance Corersponding Author Dr. Mitesh Kumar Main Author Dr. Roy Santosham Co Authors Dr. Bhawna Dev Dr. Deepti Morais Dr. Rupesh Mandava Dr. R. Jeffrey Abstract Trigeminal Neuralgia (TN) is a brief, excruciating and perhaps the most severe pain known to man affecting the hemifacial region. It occurs mainly due to tortuous vessel compressing the trigeminal nerves, though in many cases, the exact etiology and pathogenesis remain undetermined. The first line therapeutic option for patients affected by TN is the medical line of management and patients refractory to the same, are offered various invasive procedures like balloon compression, gamma knife surgery, radiofrequency ablation, etc. In this paper, we present percutaneous management of the pain by injecting neurolytic drugs in the foramen ovale under Computed Tomography (CT) guidance as the new and promising technique of treatment in TN. Keywords Trigeminal Neuralgia, percutaneous management, CT guidance, neurolytic drugs Objective To evaluate the efficacy and safety of Computed Tomography guided percutaneous management of pain in trigeminal neuralgia using neurolytic drugs. Introduction Trigeminal Neuralgia is also known as tic douloureux, a term given to this painful disease by Nicolaus Andre in 1756 [1] . TN is a pain which typically is intense, brief, usually unilateral, recurrent shock like involving the branches of fifth cranial nerve [2]. It can be mainly classified into two types. First being, the classical TN (Type I), which is due to neurovascular compression, the most common vessel causing the same being superior cerebellar artery followed by anterior inferior cerebellar artery [3]. Second type is atypical TN (Type II), secondary to causes like trauma, tumor, multiple sclerosis or herpetic infections. The distinction between these two types is mainly based on clinical symptoms [4, 5] as Type I pain is episodic in nature whereas Type II pain is more constant. TN is often called by many as â€Å"the suicide disease† [6] as the patients who suffer from it would rather take their lives than bear the pain. The initial line of treatment for TN is medical management by drugs like Carbamazepine, Gabapentin, Oxcarbazepine among others. Patients of type I TN may also be advised microvascular decompression. Those patients who do not respond or have contraindications to the above mentioned drugs or experience no change in the intensity of the pain are called Refractory TN [7]. Such patients are advised invasive procedures like trigeminal nerve block neurolytic block, radiofrequency ablation, gamma knife surgery and balloon compression. We describe our experience in percutaneous management of pain by injecting neurolytic drugs in the foramen ovale under CT guidance in six patients, suffering from TN. Method and Materials used Pre procedural work up The pre procedural work up included clinical evaluation and thorough reading of the Magnetic Resonance Imaging (MRI) scans of all the patients to rule out any neurovascular conflict. Any patient with neurovascular conflict was considered an exclusion criterion in our study. These patients were reported taking the drugs for TN for over three months with no improvement in the pain. The pain score evaluation was done using Numeric Rating Scale [8] and Wong-Baker Faces Pain Rating Scale [9] as a baseline evaluating point to be compared to the same scoring system after the procedure. Routine investigations such as coagulation profile, liver function test, renal function test, HIV and HbsAg were done before the procedure. Numeric Rating Scale Patients rate pain on a number scale from 0-10, 0 being a depiction for no pain and 10 being the worst pain imaginable. Wong-Baker Faces Pain Rating Scale The Wong-Baker Faces Pain Rating Scale is a pain scale that was developed by Donna Wong and Connie Baker. The scale shows a series of faces ranging from a happy face at 0 (No Pain) to a crying face at 10 (Worst Pain Possible). The patient must choose the face that best describes how they are feeling. In our study, we use the Wong Bakers scale to assess the patients’ pain before and after the procedure. The neurolytic drugs and materials used in the procedure were 22 G spinal needle for block, 25 G needle for skin infiltration, 2% xylocaine , Iohexol Non ionic contrast medium, 100% alcohol, 1ml syringe and normal saline solution. The patient was put in the supine position with head placed in reverse occipitomental position (chin up and neck extended), turned 30 ° to the opposite side of the block. The foramen ovale was identified under CT guidance and a virtual track was made starting from a point which was 2-3cms lateral to the angle of mouth on the skin to foramen ovale (Figure 1). Once the trajectory of the needle and the foramen ovale was confirmed on CT scan, the skin at the point of entry was infiltrated by 2ml of 2% xylocaine using a 25G needle. Then, a 22G spinal needle was inserted at the same point and aimed in the direction of planned trajectory towards the foramen ovale (Figure 2). To prevent the needle from entering the oral cavity, a finger from inside the mouth can be used to guide the same [10]. Though, we did not apply this in any of our patients. Following this, negative aspiration was attempted to check for Cerebro Spinal Fluid (CSF) or blood aspirate. If the aspirate contained CSF or blood then the needle had to be readjusted. Then 0.5ml of mixture made from 1ml of iohexol and 2ml of 2% xylocaine was injected into the target site in order to check the spread of injectant and exact needle tip position. Once the tip of the needle touches the mandibular nerve root, the patient might complain of the exact similar pain which he/she has been suffering, thus confirming the accurate needle tip location. This injectant acts as a diagnostic block if the trigeminal ganglion is the pain generator with xylocaine providing anesthesia prior to alcohol injection. A mixture containing 3ml of 100% alcohol, 1ml of iohexol and 1 ml of saline was made. Of this 1ml of the mixture was injected into the foramen ovale (Figure 3 and 4). Post procedure check scan was performed to rule out any complication. Result Exact position of the needle tip in the foramen ovale was seen in all the six patients thus achieving 100% technical success. All these patients achieved a significant level of relief with an average pain score of two immediately after the procedure. Twenty four hours after the procedure, they rated their reduction of pain at an average pain score of one. Four out of the six patients ie Patient No. 1, 2, 4 and 6 were completely relieved of their pain with one year follow up without taking any medication. In Patient No. 3, the procedure was abandoned as during the diagnostic block, the injectant was seen tracking into CSF cistern and fourth ventricle. Patient No. 5 reported with a similar pain of TN within three months with a pain score of five, little less than the pre-procedure pain score of six. The pain was more severe in the pterygopalatine segment, hence a pterygopalatine block was carried out and the patient had a pain score of one twenty four hours after the procedure. Hence, the initial trigeminal neurolysis was partially successful in this patient. No post procedural complication was seen in any of our patients. Discussion The trigeminal nerve arises from the lateral pons at its superior to mid portion. It travels forward in posterior fossa and merges with the trigeminal ganglion in the Meckels cave. The trigeminal ganglion is located lateral to the cavernous sinus. It gives three divisions ophthalmic (V1) segment which emerges from superior orbital fissure, maxillary (V2) from foramen rotundum and mandibular (V3) from foramen ovale. The trigeminal nerve provides sensation for the face, mouth and supplies the muscles of mastication. TN mostly involves maxillary division and mandibular division of trigeminal nerve though it may also involve the ophthalmic division as well. The reported annual incidence rate of TN is about 4.5 per 100,000 persons [11] but the actual figures may be even much higher because of diagnostic challenges associated with the disease. TN is more common in females than males with a ratio of 3:2 and is usually seen after 50 years of age [11]. Trigeminal nerve block is an upcoming treatment in TN patients who are refractory to medical line of management. It relieves the pain and also reduces the side effects of drugs which are used for the treatment. Earlier studies were mainly done using x-ray or fluoroscopic guidance which had its own limitations in terms of image quality and two dimensional views. In contrast to this, CT scan provides excellent and direct visualization of foramen ovale leading to correct placement of needle [12] and thus scoring over fluoroscopy. This reduces the chances of injecting neurolytic agents at improper locations and thereby reduces the side effects. In our cases, initial check CT scan was done by injecting 1ml of iohexol to determine whether the needle is in exact location. This doubly ensured us about the location as well as the spread of injectant. This was different from previous studies done using fluoroscopy where a diagnostic block using xylocaine had to be given in order to confirm the location of the needle tip. We used a mixture of 3ml of 100% alcohol, 1ml of iohexol and 1ml of saline for trigeminal neurolysis however, Han et al stated that trigeminal nerve block with high concentration of lidocaine (10%) is capable of achieving an intermediate period of pain relief, particularly in patients with lower pain and shorter duration of pain prior to the procedure [13]. Alcohol spreads easily and should be used cautiously. The other agents which can be used but were not used in our study are phenol and glycerol. The side effects that may follow the procedure are numbness and hypoesthesia in the entire trigeminal nerve distribution. There can be abolition of corneal reflexes which can produce exposure keratitis and dryness of eyes. Improper injection of alcohol into CSF space can lead to arachnoiditis/ meningitis. CASE 1, 2, 4 and 6 These patients were suffering from trigeminal neuralgia with pain score ranging from six to eight before the procedure. All these patients have been taking carbamazepine for more than three months with no relief from pain. MRI showed no neurovascular conflict. These patients had a significant relief of pain with pain score at three months and twelve months being zero. None of these patients had to take oral medicines after the procedures. Fig 1: Site marked for needle Fig 2: Tip of the needle in foramen insertion ovale Fig 3: Dispersion of injectant in Fig 4: 3D reconstruction showing the foramen ovale needle tip in foramen ovale. Case 3 This eighty year old male came with complains of left sided trigeminal neuralgia. He had been taking carbamazepine for four months with no change in pain intensity. The procedure had to be abandoned as after injecting the diagnostic block, the injectant was seen tracking into the CSF cistern in the cerebello pontine angle and fourth ventricle (Figure 5). Fig 5: CT scan showing needle tip in the left foramen ovale Case 5 This forty seven year old female came with complains of right sided trigeminal neuralgia. She had been taking carbamazepine for three months without any relief in pain. MRI scans showed no neurovascular conflict. The procedure was successful with pain score of one immediately after and at twenty four hours after the procedure (Figure 6). However, this patient came back within three months of the procedure complaining of pain, which was more in the pterygopalatine segment. A pterygopalatine block was done with resultant pain score of one at twenty four hours after the procedure and two at nine months of the procedure. Hence, this patient showed partial response to trigeminal neurolysis carried out initially. Fig 6: CT scan showing the tip of the needle in right foramen ovale. Conclusion Percutaneous injection of alcohol, iohexol and saline mixture at the verge of foramen ovale under CT guidance is an effective and promising method to relieve pain in patients of TN refractory to medical line of management. This technique is inexpensive, cost effective and a relatively painless procedure. Being a minimally invasive technique, the chances of any infection and other post operative complications are less. Since our study involved only six patients, this technique needs to be further evaluated on a large sample size to substantiate the result of this procedure. Having said the above, we would like to emphasize that our initial experience of this procedure was quite impressing. Abbreviations TN Trigeminal Neuralgia CT Computed Tomography CSF Cerebro Spinal Fluid MRI – Magnetic Resonance Imaging References Andre ´ N. Traite ´ sur les maladies de l’ure`thre. Paris: Delaguette, 1756 Merskey H, Bogduk N. Classification of chronic pain: descriptions of chronic pain syndromes and definitions of pain terms. Seattle: IASP Press; 1994. P. 59-71 Jannetta PJ. Microvascular decompression of the trigeminal nerve for tic doloreux. In: Youmans ed. Neurological surgery 4th edn. WB Saunders Co. Philadelphia. 1996: 3404-15 Cruccu G, Gronseth G, Alksne J, et al. AAN-EFNS guidelines on trigeminal neuralgia management. Eur J Neurol. 2008; 15 (10): 1013-28 Gronseth G, Cruccu G, Alksne J, et al. Practice parameter: the diagnostic evaluation and treatment of trigeminal neuralgia (an evidence based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology and the European Federation of Neurological Societies. Neurology. 2008; 71 (15): 1183-90 Michael D. Chan, Edward G. Shaw, Stephen B. Tatter. Radiosurgical Management of Trigeminal Neuralgia. In: editor Pollock Bruce, Intracranial Stereotactic Radiosurgery, an Issue of Neurosurgery Clinics. Elseiver Health Sciences. 2013. pp. 613-621 Cruccu G, Truini A. Refractory Trigeminal Neuralgia. Non-surgical treatment options. CNS Drugs. 2013 Feb;27(2):91-6. doi: 10.1007/s40263-012-0023-0. Hartrick CT, Kovan JP, Shapiro S (December 2003). The numeric rating scale for clinical pain measurement: a ratio measure? Pain Pract 3 (4): 310–6. doi:10.1111/j.1530-7085.2003.03034.x. PMID 17166126. Wong-Baker FACES Pain Rating Scale Foundation: Retrieved 6 December 2009. Michael J. Cousins In: trigeminal nerve block. Cousins and Bridenbaughs Neural Blockade in Clinical Anesthesia and Pain Medicine. Lippincott Williams Wilkins, 29-Mar-2012, 410 Allan B. Wolfson, Gregory W. Hendey, Louis J. Ling, Carlo L. Rosen, Jeffrey J. Schaider, Ghazala Q. Sharieff. In: Bell’s palsy and trigeminal neuralgia. Harwood-Nuss Clinical Practice of Emergency Medicine. Lippincott Williams Wilkins. June 23, 2009, 786 Và ­ctor Whizar-Lugo MD, Francisco Anzorena-Vallarino MD, Roberto Cisneros-Corral MD, Ricardo Valdez-Jeres MD, Rogelio Hernà ¡ndez-Velazco DDS. Use of Computed Tomography Guide for Trigeminal Alcohol Neurolysis. Anestesia en Mexico: Volume 20 No. 1 (January-April 2008) Han KR, Kim C, Chae YJ, Kim DW. Efficacy and safety of high concentration lidocaine for trigeminal nerve block in patients with trigeminal neuralgia. Int J Clin Pract. 2008 Feb;62 (2):248-54. Epub 2007 Nov 23.

Physics of Snowboarding :: physics snowboard sport sports

In snowboard as in any other sport the athlete has to be thinking at all times, analyzing the situation that surrounds you, make split decisions, and even perform quick calculations in your head. Where this happens most in snowboarding is when the snowboarder is going to performs some type of aerial trick off of a jump. There are a lot of things that a snowboarder has to be aware of and be thinking about before he hits the jump. How far do I need to go to make the landing? How fast do I need to be going when I hit the jump? If I am going to spin, how fast should I so that I can make it around in time? The list goes on and on. Some other factors that can come into play are: snow conditions, the type of snowboard, and experience of the rider. Which are much more advanced topics, and way beyond the scope of what we're worrying about here. What I am mainly going to be looking at are the basic characteristics of your average snowboard jump. So how much speed should I have to hit the jump with? Well to answer this question you first have to know how far you have to go to clear the landing of the jump so that you donà ­t land in the flats and break you knees or go to far and break your back. If the jump that you need to clear is 20 feet long you will have to be going at a certain speed. So, what is that speed? Well you can figure this out by knowing what angle you built the jump at, the height of the jump and the distance to the landing. It is fairly easy to find the velocity by using the equation for a trajectory. Now that you know how to find all of the correct parts of your jump to clear it successfully you can now add some difficulty and variety to the trick by spinning while in the air. Since you know the distance and your velocity from before you can find out what your air time was. Once you have all of that info you can use it to solve for what your angular velocity should be depending of how much you want to spin. That way you can make sure that you'll complete the spins in time to spot your landing and get ready for impact.