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The inner most layer of the ureters is the a) Mucosa b) Muscularis c) Adventitia d) Longitudinal layer e) Circular layer 3 buy 375mg keftab visa antibiotics kill candida. The kidney function in all of the following except a) Acid – base balance b) An endocrine organ c) By removing metabolic waste d) By removing excess carbon dioxide e) By maintaining osmotic concentration 4. An increased volume of urine formation would follow:- a) Inhibition of tubular sodium re-absorption b) A fall in plasma osmolarity c) A fall in plasma volume d) a and b e) a, b and c 5. The volume or chemical makeup of these fluids whenever deviates even slightly from normal, disease results. The correct proportion of water and electrolytes in the water and proper acid base balance are necessary for life to exist. Loss of 10% of total body water usually produce lethargy, fever and dryness on mucous membrane and a 20% loss is fatal. Extra cellular fluids found as interstitial fluid (the immediate environment of body cells), blood plasma and lymph, cerebrospinal, synovial, fluids of the eye & ear, pleural, pericardial, peritoneal, gastrointestinal and glomerular filtrate of the kidney. The concentration of water in the interstitial fluid is slightly higher than the concentration of water in plasma. The plasma proteins are responsible for this difference 354 Human Anatomy and Physiology A B Figure: 13. Hydrostatic pressure: it is the force exerted by a fluid against the surface of the compartment containing fluid. Osmotic pressure: Is the pressure that must be applied to a solution on one side of a selectively permeable membrane to prevent the Osmotic flow of water across the membrane from a compartment of pure water. When there is shift in the pressure of water to wards the interstitial space, accumulation of fluid in the space occur. Such accumulation of water produces distention of the tissue which appears as puffiness on the surface of the body. Causes of edema may be plasma protean leakage decreased protein synthesis, increased capillary or venous hydrostatic pressure, obstructed lymphatic vessels and inflammatory reaction. Under normal condition water is taken in to and excreted from the body, so it matches to maintain homeostasis. Drinking of water is regulated by nervous mechanism (thirst center in the brain) together with hormonal mechanism (Antidiuretic hormone). Kidneys are the organs regulated by homeostatic feed back response they are responsible for excreting most of the water from the body. These three electrolytes are particularly important in maintaining body function and normal water distribution among the fluid compartment. Enzymes, hormones and the distribution 360 Human Anatomy and Physiology of ions can all be affected by the concentration of hydrogen H ion. H Homeostatic maintenance of an acceptable P range in the extra cellular fluid is accomplished by three mechanisms: 1. This task is accomplished in renal tubules, where + hydrogen & ammonium ions are secreted in to urine, when H is excreted sodium is exchanged. Movement of water from one body compartment to another is controlled by a) Atmospheric pressure b) Hydrostatic pressure c) Osmotic pressure d) a & c only e) b & c only 364 Human Anatomy and Physiology 4. The function of electrolytes in the body include a) Contributing to body structure b) Facilitating the movement of water between body compartments c) Maintaining acid – base balance d) a and b only e) a, b, & c 5. Reproduction by means of sexual intercourse produces new human beings and hereditary traits to be passed from both parents to their children’s. The sex hormones play an important role both in the development and function of the reproductive organ and in sexual behavior & drives. By third fetal month it stats is to descend and by the seventh month of fetal life it passes through the inguinal canal. Because the tests hang in scrotum out side the body their temperature is of cooler than the body temperature by 3 Degree Fahrenheit. Next to tunica albuginea is Tunica Vaginals, which is a continuation of membrane of abdomino-pelvic cavity. Each test contain 800 lightly coiled Semniferous Tubules which produce thousands of sperm each second.

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We collected data on state licensing requirements for each profession keftab 500 mg amex virus 8 states, Respondents self-defined as being in “long-term including addiction-related requirements and recovery” (i. The average reported length of being “clean and sober” was Addiction Facility/Program Licensing and 10 or more years. We collected related to the provision of addiction treatment data on requirements pertaining to staff services. In some cases where key information composition and qualifications, provided could not be identified or where requirements services, quality assurance activities and the use were unclear, we called or e-mailed the relevant of patient outcomes data. Because licensing and certification requirements Case Study of Addiction Treatment are found in a wide variety of laws and regulations and can change on a state-by-state in New York basis, findings from this review cannot be guaranteed to be complete and current. The goal of this work was to provide an in-depth look at one state/city parallel * Using the Lexis/Nexis database to supplement information related to state laws and regulations † available on the Internet. Relevant findings from these analyses and illustrative quotes from key informants are incorporated into the report. If so, do you think it requires some type of intervention or treatment for members other than the addict? Q6 When people are looking for help for an addiction problem, who do they usually turn to or where do they go and why? Q11 Under what conditions does effective treatment of addiction require treatment of co-morbid psychiatric conditions? Is evidence from research findings accessible and understandable to providers, as well as to policymakers and advocacy groups? Q14 What do you think stands in the way of people getting quality, effective treatment and of providers offering quality, effective treatment? Q16 Do you think there should be minimum standards of knowledge, skills and/or training for an individual to provide treatment? Coppola, John, Executive Director, New York Association of Alcoholism and Substance Abuse Providers, Inc. West, Chief Executive Officer and Executive Director, National Association of Drug Court Professionals, National Drug Court Institute Humphreys, PhD, Keith N. The number corresponding to each response option represents the percent, among those responding to the question, that provided the particular response. For each one I mention, please tell me how much of a problem you think it is in your community--a very serious problem, somewhat serious problem, not too much of a problem, or not a problem at all. Now I am going to mention various substances some people may consume and I would like you to tell me what level of use would, in your personal opinion, indicate that a person has a serious problem. To give you an example, some people might say that a person who eats fried foods once a week does not have a problem but if someone eats fried foods several times a day then they do have a serious problem and should seek help to change their diet. Should it be complete abstinence, reduced use, fewer negative consequences from use or the goal should be set by the patient? Suppose someone close to you realized they had a major problem with addiction to alcohol, tobacco, prescription or other drugs, how confident would you be that you knew or could find out where to go or call or send them to get the help they would need: very confident, somewhat confident, not too confident or not at all confident? Would you say you are very confident that you know what treatment for addiction involves, somewhat confident, not too confident, or not at all confident that you know what is really involved when someone gets treatment for addiction? Now I would like to read two views about medicines to treat addictions and have you tell me which one comes closer to your personal point of view. Now I would like to read two views about medicines to treat addictions and have you tell me which one comes closest to your personal point of view. Statement A: It is good news that there are medicines to treat addictions, because addictions are medical conditions that medicine can help. Now I am going to mention some approaches society could take to address the problem of addiction to alcohol, tobacco, prescription and other drugs. For each approach, please tell me how important you think it is--very important, somewhat important, not too important, or not important at all? Are you, yourself, addicted to alcohol, or prescription or other drugs right now, or have you been addicted to them in the past?

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The prostrate adds another fluid to the semen cheap keftab 500mg overnight delivery infection elite cme com continuing education, which makes the sperms more active in swimming to reach the ovum. In males the urethra is about 20­22 cm in length and serves the purpose of urination as well as ejaculation of semen. Vagina: It is a muscular tube lined with membrane comprised of special type of stratified epithe­ lium, well supplied with blood vessels and nerves. It covers the perineal body, which is a wedge­shaped structure between the vagina and lower part of the rectum. This opening is surrounded by finger like processes called fimbriae, one of which is connected to the ovary. The fallopian tubes have walls of muscle and are lined with ciliatd epithelium and covered with peritoneum. It is sent along partly by peristaltic action of the muscles and partly by waving movements of the cilia. The narrow cavity of the uterus has three openings: one into each fallopian tube, and one through the external os of the cervix into the vagina. Ovary: The gonads of the females are called ovaries and the cells that they produce are known as ova or egg cells, each female has a pair of oval shaped structure about the size of a almond. An ovary consists of the following; 1) The germinal epithelium: it is the outer part of the ovary from which the primitive graffian follicles develop. Functions: 1) Produce ova and expel one at approximately 28 days interval during the reproductive life. Oestrogen influence secondary sex characteristics and is responsible for the changes in the accessory organs of reproduction. The progesterone prepares the uterus for the reception of the fertilized ovum, implantation, the development of the placenta, development of the mammary glands, and inducing multiplication of the uterine muscle fibres. In the centre is the nipple, which projects outwards and is pink in the virgin, but pigmented after the first pregnency. During pregnancy hormones from the pituitary and ovaries cause the breasts to increase in size and to secrete a small amount of fluid, which can be expressed from the nipples. Menstrual Cycle This means the cycle of changes that regularly take place in the lining of the uterus (endometrium) under the influence of hormones with the outward sign of menstruation or monthly period of females. When no fertilised ovum arrives in the uterus, the endometrium breaks down and results in the menstrual flow. After menstruation, there is a period of repair for the endometrium, followed by a resting period and slow growth. During the middle of this resting period a new ovum is discharged from the ovary (ovulation) The menstrual cycle contains the following phases. Menstruation 5 days Period of repair 6 days Resting period with ovulation 10 days Total 28 days Ovulation usually takes place midway between the beginning of two menstrual periods. Hormones and the reproductive system Hormones are most important in the working of the reproductive organs. At puberty, hormones from the anterior pituitary gland stimulates the sex glands (ovary in the female, testes in the male) to produce their sex hormones. In the female, oestrogen, promotes development of the female sex organs and tissue growth for the development of feminine features. The knowledge of basic principles of psychology is significant in taking care of nurse herself and also in her interaction with the patient. The nurses should understand that the fulfillment of basic needs as given below is imperative in achieving one’s own self actualization. Our attitude & emotional expressions are also learned behavior Learning is defined as the mental activity by means of which knowledge, skill, attitude, apprecia­ tions and ideas are acquired, resulting in modifications of behaviors Factors influencing learning: ­ It is depends upon the following factors 1) Nature of the learner 2) Nature of the learning material 3) Nature of the learning situations Nature of the learner:­ Perception ­ Sense organs are the gateways to acquire knowledge. Process of perception should be perfect Organic defects ­ Visual defects, hearing impairment and infections Fatigue ­ Strain, loneliness, lack of fresh air, sunlight and compulsive learning causes fatigue. It depends only with learner’s will power Age & learning ­ The capacity of learning improves up to 23 years & declines after 40 years Nature of learning:­ Meaningful learning easier than learning with out knowing the meaning of the learning method 74 1) Definite goal: ­ With a clear goal in mind the student works towards a definite purpose. Regular and frequent review of the amount of progress being made towards the goal promotes effective leaning 3) Distribution of practice board: ­ Shorter practice period are more effective than longer periods this will reduces the mental fatigue 4) Whole versus part method: ­ Whole method should be adopted with easy unit and difficult material can be learned in small units 5) Logical learning: ­ Logical learning calls for an arrangement and also assimilation with ideas in minds.

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Table 58 displays the risk differences and elements for the synthesis of evidence for this comparison order 250mg keftab visa antibiotic resistance global threat. In two of these, risk differences favored selective 81 antihistamine to avoid moderate sedation (13 percent ) and unspecified severity sedation (28. Statistically nonsignificant differences also 81 83 favored selective antihistamine to avoid severe sedation and unspecified severity sedation. It is unclear whether effects were reported consistently based on differences in classification schemes across trials. Forty-one percent of patients were in a 83 trial that reported a statistically nonsignificant result. Evidence was insufficient to conclude that either comparator is favored to avoid sedation. The 81 risk of bias was considered high based on poor trial quality and insufficient adverse event 83 surveillance. Evidence was insufficient to conclude that either comparator is favored to avoid headache. Evidence was insufficient to support using either oral or nasal antihistamine to prevent common adverse events of sedation, headache, bitter aftertaste, and nosebleed. For bitter aftertaste, it is unclear whether future comparative trials would observe similar effects because all of the included trials used an older formulation of the currently available product. Synthesis and Evidence Assessment 84-87 All four trials that reported efficacy outcomes also reported adverse events (N=886). Table 59 displays the risk differences and elements for the synthesis of evidence for this comparison. Risk differences were not statistically significant, but favored oral antihistamine to avoid 84- sedation in both (0. Unspecified sedation was reported by four trials 87 with risk differences ranging from 1 percent in favor of oral antihistamine to 5 percent in favor of nasal antihistamine; none were statistically significant. Evidence was insufficient to conclude that either comparator is favored to avoid sedation. Evidence was insufficient to conclude that either comparator is favored to avoid headache. Thirty- 87 five percent of patients were in a trial that reported a statistically nonsignificant difference. Evidence was insufficient to conclude that either comparator is favored to avoid a bitter aftertaste. It is important to note that all trials reporting on this outcome used an older 151 Table 59. Risk differences were 0 percent in one and 1 87 percent (not statistically significant) favoring oral antihistamine in the other. Evidence was insufficient to conclude that either comparator is favored to avoid nosebleeds. Oral Selective Antihistamine Versus Intranasal Corticosteroid Key Points 95 90-93, 99 Of six trials that reported harms, one was 15 days in duration and five were 4 weeks in duration. Evidence from these trials was insufficient to support the use of either oral selective antihistamine or intranasal corticosteroid to avoid headache or nosebleed. Synthesis and Evidence Assessment 90-93, 95, 99 Six of 13 trials reporting efficacy outcomes also reported adverse events of interest (N=2038). Table 60 displays the risk differences and elements for the synthesis of evidence for this comparison. This trial was included in the synthesis of evidence only to assess consistency of effect. This trial was the only one to perform active surveillance for local corticosteroid effects (rhinoscopy). In three trials the risk difference favored intranasal corticosteroid (1-2 percent, none statistically significant) to avoid headache, and in 93, 99 two the risk difference favored oral selective antihistamine (4 percent and 8 percent, neither 90 statistically significant). The risk 90 difference in this 15-day trial was 2 percent favoring intranasal corticosteroid to avoid headache. The observed effect was not consistent across trials, even when considering only 4-week trials, and imprecise. Evidence was insufficient to conclude that either comparator is favored to avoid headache.