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Sin Nombre virus buy torsemide 20mg otc pulse pressure normal rate, the most predominant recovery, usually within a day or two. However, abnormal strain in the United States, is carried by the deer mouse. A similar, but geneti- cally distinct strain was responsible for an outbreak of HPS in logic techniques. This, along with additional epidemio- difficult to demonstrate the actual virus in human tissue or to logic evidence (such as the low rodent population density in grow cultures of the virus within the laboratory, so the major- the area affected) suggest that person-to-person transmission ity of diagnostic tests use indirect means to demonstrate the was possible during this outbreak, a feature unique to any presence of the virus. Treatment of hantavirus infections is primarily support- Black Creek Canal virus has been found in Florida. It is ive, because there are no agents available to kill the viruses predominantly carried by cotton rats. About 6–15% of people who contract virus appear to be deer mice and white-footed mice. Almost half of all people who contract HPS virus has been reported in Louisiana and Texas and is carried will die. It is essential that people living in areas where the by the marsh rice rat. Oklahoma and seems to be associated with the white-footed Preventative measures focus on vector control (elimination of mouse. Monongahela virus, discovered in 2000, has been found rodents), and avoiding rodent infested areas. Hantaviruses that produce forms of hemorrhagic fever Epidemics, viral; Epidemiology, tracking diseases with renal syndrome (HFRS) cause a classic group of symp- with technology; Epidemiology; Hemorrhagic fevers and dis- toms, including fever, malfunction of the kidneys, and low eases; Virology platelet count. Because platelets are blood cells important in proper clotting, low numbers of circulating platelets can result in spontaneous bleeding, or hemorrhage. Patients with HFRS have pain in the head, abdomen, and lower back, and may report bloodshot eyes and blurry vision. Tiny pinpoint hemorrhages, called petechiae, may appear on the upper body and the soft palate in the mouth. The patient’s Hazard Analysis and Critical Control Points (HACCP) refers face, chest, abdomen, and back often appear flushed and red, as to a system that is established and instituted to monitor all if sunburned. Around day eight of HFRS, kidney involvement stages of a processing or manufacturing operation to ensure results in multiple derangements of the body chemistry. Originally, HACCP was devised for the food cause spontaneous bleeding, as demonstrated by bloody urine, processing industry. Now, HACCP has expanded to include bloody vomit, and in very serious cases, brain hemorrhages the manufacture of pharmaceuticals and other products that with resulting changes in consciousness and shock. Chain chemotherapy microorganisms antibiotics Alexander Fleming culture colony mold penicillin S. Waksman contamination bacteria fungi eye infections viruses enzyme- linked immunosorbent assay ELISA T cells B cells antibody inflammation Human Immunodeficiency Virus HIV immunodeficiency deoxyribonucleic acid ribonucleic acid immune system microorganisms Staphylococcus aureus Enterococcus faecium Streptococcus pyogenes Bacillus Calmette-Guerin WORLD OF MICROBIOLOGY AND IMMUNOLOGY IMMUNOCHEMISTRY 292 Immunoelectrophoresis Immunoelectrophoresis Immunofluorescence Isotypes and allotypes Invasiveness and intracellular infection Isotypes and allotypes smallpox pustule induced a mild case of the disease and subse- Nelmes, and inoculated James Phipps, an eight-year-old boy, quent immunity. This practice of inoculation, termed variola- who soon came down with cowpox. Six weeks later, he inoc- tion, reached England by the eighteenth century. Despite the risk, peo- tion, using the Latin word meaning cow, and ple willingly agreed to inoculation because of the widespread meaning cowpox. Within 18 who had been exposed to cowpox, a disease like smallpox months, the number of deaths from smallpox had dropped by only milder, seemed immune to the more severe infection. By continually put forth his theory that cowpox could be used to 1800, over 100,000 people had been vaccinated worldwide. The vaccine It became Jenner’s task to transform a country supersti- could then be transported. For up until the mid – Jenner was honored and respected throughout Europe 1770s, the only documented cases of vaccinations using cow- and the United States. At his request, Napoleon released sev- pox came from farmers such as Benjamin Jesty of Dorsetshire eral Englishmen who had been jailed in France in 1804, while who vaccinated his family with cowpox using a darning needle. Across the Atlantic After observing cases of cowpox and smallpox for a Ocean, Thomas Jefferson received the vaccine from Jenner quarter century, Jenner took a step that could have branded and proceeded to vaccinate his family and neighbors at him a criminal as easily as a hero. However, in his native England, Jenner’s medical removed the fluid from a cowpox lesion from dairymaid Sarah colleagues refused to allow him entry into the College of WORLD OF MICROBIOLOGY AND IMMUNOLOGY KREBS CYCLE 331 Lancefield, Rebecca Craighill Lancefield, Rebecca Craighill In 1947, while at Yale, Lederberg received an offer from resistant to both.

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The motor homunculus produced by Penfield and Rasmussen from direct stimulation studies buy torsemide 10mg on-line pulse pressure too close. Note that the body is distorted and those areas which produce fine motor actions and manipulations (the hand and the mouth) are disproportionately represented. Reverse engineering the human mind 175 shut’ – I know you heard the door, but that was the image not the transla- tion itself. Penfield and Rasmussen were aware of this problem and con- cluded that in these cases stimulation ‘sheds no light upon the function of an area unless the patient is making use of that area at the moment’. What is needed, then, is some way of reverse engineering the brain in action – a means of catching the brain in the act. Another wave of reverse engineering, neuropsychology, began soon after the first and got into full flight with the report by Pierre Paul Broca (1824–1888) that damage to a part of the lower left frontal lobe rendered patients unable to produce speech. The approach taken in neuropsychol- ogy is to investigate the abilities of patients who have suffered brain damage and from the pattern of their deficits to infer something about the function of that region or about the general organisation of the system under investigation. The study of patients with focal brain damage formed perhaps the most important source of knowledge about the organisation and function of the brain for the best part of the twentieth century and the kinds of dissociations demonstrated were both informative and intellectu- ally seductive. Another patient perceived the world totally devoid of colour without suf- fering any marked reductions in movement and form perception. Other specific and curious deficits include the loss of awareness of one half of the body, or of objects, or an inability to name an object presented to the right hand side of the brain when it is disconnected from the left side. All of these examples suggest that the brain is organised into groups of rela- tively specialised areas. In many respects the classic findings of neuropsychology have formed the bedrock of much of what we know about how we see, hear, speak, move and even feel. Nonetheless, neuropsychology has not always influenced theories about how the intact brain carries out tasks. This is partly because nature is a poor surgeon: accidental brain damage is usually spatially diffuse, interrupts several functions, is irreversible and the time of its occurrence cannot be predicted. Another problem with the lesion method in general, even when specific areas can be removed from animals, is that 176 V. Temporal resolution simply refers to the window of time which can be used to look at a func- tion and it is critical when one considers the nature of psychological models of brain function. Our models always contain stages of processing that are part parallel and part serial. In other words, to understand brain processes means understanding them in time as well as space. Knowledge of precisely when the brain carries out specific functions is fundamental to any accurate description of how the brain performs many complex tasks. Indeed the brain may invent some apsects of what you think of as real time. You might think you experience a unified world in which objects have shape and colour and movement – but you are deluded. The brain areas that deal with the different attributes of an object all operate at different paces, perhaps several milliseconds apart (several milliseconds is a long time in the brain – while you’re larding about the brain is doing some impressive housekeeping) and we don’t know how they are brought together in syn- chrony. The stimulation method could not address the role of the elaboration areas and the study of brain damaged patients or lesion studies of animals is hampered by the lack of temporal resolution. What is needed for another wave of reverse engineering, then, is the ability to stimulate the brain while it is doing something, or to be able to reversibly disrupt its function- ing to give the lesion method a temporal dimension. The story of how we are able to achieve both of these takes us back to Faraday. Recall that Faraday discovered electromagnetic induction and we know the brain is a conductor of electricity. It follows that exposing the brain to a changing magnetic field will result in an induced electrical field and therefore neural activity in the brain. This was soon appreciated and as the nineteenth century drew to its close Arsene d’Arsonval (1896) reported the first production of visual percepts (spots or flashes of light called phosphenes) induced by magnetic stimulation (Figure 10. The subject also reported feelings of vertigo and under some conditions muscle contractions as well. One might have thought that d’Arsonval’s discovery would be suffi- cient to generate further studies of brain function by magnetic stimulation, but the technical solutions to this had to wait for the best part of the twen- tieth century until 1985 when Anthony Barker and colleagues at the University of Sheffield successfully stimulated the motor cortex and pro- Reverse engineering the human mind 177 Figure 10. The magnetic pulse was generated by current (up to 8000A) flowing through a small coil held above the subject’s head. The current is dis- charged over a period of 1ms, reaching its peak in as little as 200 s and this produces an intense magnetic pulse (approx.

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Some call this extra time “crip time”—always longer than the time needed by people without “crippling” impairments (Olkin 1999) order 20 mg torsemide blood pressure medication can you stop. For instance, parents who spend longer walking their child to school have more time together. But the end result is that the people most likely to be exhausted by effort can find their days consumed by mundane routine tasks. Broadly speaking, the interviewees use two basic strategies for conduct- ing daily activities: rearranging their physical environments to facilitate independence and getting human help. In Boston and sur- rounding towns, many buildings date from the mid 1800s through early 1900s, when people had shorter life spans and before accessibility became topical. As Lester Goodall put it, Boston’s architecture offers “vertical liv- ing” while he prefers horizontal. But nationwide, relatively few private houses and small apartment buildings are truly accessible. Cen- 88 / At Home—with Family and Friends sus Bureau 1999a), as did 12 percent of 8. Almost 20 percent of people with major mobility problems say they have difficulties using their bathrooms. None of the homes I visited during the interviews were completely and easily accessible, even in buildings specifically adapted for occupants using wheelchairs. One wheelchair user lives in an old mansion, elegant with or- namental plasterwork, which had been renovated by the neighborhood housing authority explicitly for accessibility. After a chilly, damp ride over in my scooter, I was therefore surprised when the wheelchair entrance, down a ramp to the basement, was locked tight and had no bell or intercom. Waving at two men dressed as janitors, who tensed cautiously, I gesticulated downward, hoping to convince them that my verticality was temporary. I was bedraggled, wet, a woman, and in a wheelchair—probably not a threat. Although several people live in one-story houses, these homes had one or two entry stairs without railings, actually a daunting barrier. Esther Halpern performs a complicated ballet getting into and out of her house: I hold onto the door. Well, actually, I can use the walker, too, as long as somebody holds the door open. Or if I have to do it myself, I could push that door open, hold on, and then push the door to where it would stay open, and then I can get the walker up onto the first step. And then I can lift it and get onto the second step, and then I would release the door.... Every morning, they drop the newspaper right outside the door, beyond the step. But instead of going down the step, I use my grab- ber to pick it up so I don’t have to go up and down the step. Esther’s “grabber” is a rodlike device with pinchers to reach inconveniently placed items. Many people resist changing their houses or decor, living with incon- veniences—and safety risks (chapter 10). One woman with severe back pain has “three stairs to get into my house, but that’s all right. Tina DiNatale installed a grab bar At Home—with Family and Friends / 89 in her bathroom but told the workman,“ ‘I don’t want anything to look too handicapped. A few wealthy people built new houses or performed substantial renovations. But for renters, finding exist- ing and accessible housing with reasonable rents is hard. Lonnie Carter, the disability activist, worried, “Landlords want to rent their apartments at market value. It’s bad news about acces- sible housing—its getting cut for minorities, for whoever you are. But mice was all on the table, the stove, all over the furni- ture they crawled. Then I live in the basement floor, which was like a handicap unit, and it was easy for me. After they start to broke into my house, I got this house where I’m right now.

If you plan to use the same slide on more than one occasion during a 173 presentation purchase torsemide 20mg with amex heart attack age, arrange to have duplicates made to save you and your students the agony of having to search back and forth through a slide series. It is essential to have your slides marked or ‘spotted’ for projection (see Figure 9. When showing your slides, it is rarely necessary to turn off all the lights. Remember that students may wish to take notes and so you should plan to leave some lights on or to dim the main lights. Further advice on using slides is given in Chapter 4 on presenting a paper at a conference. THE VIDEO PROJECTOR This exciting device enables you to project a variety of materials from a computer onto a screen for large and small group viewing. These materials include videos, broadcast television, slides and overheads, multi-media presentations, computer output, and Internet displays. When it is professionally set-up, supported, and used, the video projector is an outstanding presentation tool. In our view, the current situation with video projectors is one that must be approached with caution as it is a good example of the embarrassing immaturity of much educational technology. If you doubt this judgement, have a close look at the systems currently in use with cords and cables every- where, the need for backup computers, incompatible software and systems, the risk of system crashes, and so on! It is probably unwise to rely on a video projector system unless you are very familiar with its use and even then be well prepared with back-up resources. The preparation of your material is covered elsewhere in this chapter, keeping in mind the simple rule that whatever material is used, it must be clearly visible and audible! We urge you to consider producing back-up resources and alternative teaching strategies in case something should go wrong. For example, if you intend to be teaching in an unfamiliar environment or place, take overhead transpar- encies. Equipment preparation can be broken down into under- standing and preparing of the computer hardware and software, the operation of the projector itself, and the way the projector and computer are linked together. These are matters that need to be addressed well before any use of equipment is undertaken before an audience. To believe you can sort matters out in front of an audience is to invite disaster. If you cannot get tuition or expert assistance, take time to study equipment manuals and try out the procedures well in advance of any teaching or presenta- tion commitment. As with all projection equipment, you will need to give consideration to siting your video projector in relation to the room. In particular, review the position and focus of images on the screen, the level of illumination in the area of the screen, and the position of equipment and where you will be speaking in relation to the audience. THE WHITEBOARD AND BLACKBOARD The whiteboard is a ubiquitous presentation tool found in many meeting rooms as well as in classrooms these days. Do take care to use the correct pens with a whiteboard as some can ruin its surface. A dry cloth is often adequate but sometimes you may need to use water, detergent or perhaps methylated spirits. Never use an abrasive cleaner 175 as it will scratch the surface and do irreparable damage to the board. Avoid yellow, red and light colours, as these can be difficult to read from a distance. The blackboard (which these days may be green) is still a commonly used visual aid and the one that you may use frequently, unless you rely exclusively on the overhead or video projector. Few teachers give much thought to the material that they put on the board or to the way they use it. Well-planned and well-used board work is a delight to see and is a valuable ally in presenting information accurately and clearly to your students. Preparation It is important to think ahead about your use of the board and make suitable notations in your teaching notes. Plan your use of the board by dividing the available space into a number of sections.

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