By Q. Elber. Northeastern State University.
However cheap ventolin 100 mcg free shipping asthmatic bronchitis qvar, the mass of the Earth is so large that its acceleration due to the jump is negligible cheap ventolin 100mcg without a prescription asthma treatment vicks. After the body leaves the ground order ventolin 100 mcg otc asthma humidifier, the only force acting on it is the force of gravity W buy ventolin 100 mcg otc asthma symptoms pictures, which produces a downward acceleration g on the body. At the maximum height H, just before the body starts falling back to the ground, the velocity is zero. The initial velocity for this part of the jump is the take-o velocity v given by Eq. Experi- ments have shown that in a good jump a well-built person generates an average reaction force that is twice his/her weight (i. The distance c, which is the lowering of the center of gravity in the crouch, is proportional to the length of the legs. For an average person, this distance is about 60 cm, which is our estimate for the height of a vertical jump. The height of a vertical jump can also be computed very simply from energy considerations. The work done on the body of the jumper by the force F during the jump is the product of the force F and the distance c over which this force acts (see Appendix A). At the full height of the jump H (before the jumper starts falling back to ground), the velocity of the jumper is zero. At this point, the kinetic energy is fully converted to potential energy as the center of mass of the jumper is raised to a height (c + H). It is a common mistake to assume that the height to which a person can jump on the moon increases in direct proportion to the decrease in weight. That is, if a person can jump to a height of 60 cm on Earth, that same person can jump up 6. Note that the ratio H /H 11 is true only for a particular choice of F in the calculation (see Exercise 3-2). The additional height is attained by using part of the kinetic energy of the run to raise the center of gravity o the ground. Let us calculate the height attainable in a running jump if the 1 2 jumper could use all his/her initial kinetic energy ( mv ) to raise his/her body 2 o the ground. If this energy were completely converted to potential energy by raising the center of gravity to a height H, then 1 2 MgH mv (3. Then we must remember that the center of gravity of a person is already about 1 m above the ground. With little extra eort, the jumper can alter the position of his body so that it is horizontal at its maximum height. Thus, our nal estimate for the maximum height of the running high jump is v2 H + 1. Obviously, it is not possible for a jumper to convert all the kinetic energy of a full-speed run into potential energy. In the unaided running high jump, only the force exerted by the feet is available to alter the direction of the running start. The situation is quite dierent in pole vaulting, where, with the aid of the pole, the jumper can in fact use most of the kinetic energy to raise his/her center of gravity. These gures would agree even more closely had we included in our estimate the fact that the jumper must retain some forward velocity to carry him/her over the bar. A solution is required for the range R, the distance at which the projectile hits the Earth (see Fig. In other words a maximum range is obtained when the projectile is launched ata45 angle. In order to maximize the distance of the jump, the launching velocity and therefore also the resultant force should be directed at a 45 angle. We will assume as before that a jumper can generate with his feet a force equal to twice the body weight. The magnitude of the resultant force (Fr) and the angle at which the legs must apply the force to the body are obtained from the following considerations. W e will again assume that the force that launches the jumper is applied over a Section 3. The push-o force (2W) generated by the legs provides the vertical component of the launching velocity. The acceleration produced by the net force is 2W W W a g m W/g If the push-o force acts on the jumper over a distance of 60 cm (the extent of the crouch) and if it is directed entirely in the vertical y direction, the vertical component of the velocity vy during the jump is given by 2 2 2 vy 2as 2 g 0. When an object moves through the air, the air molecules have to be pushed out of its way. The resulting reaction force pushes back on the body and retards its motionthis is the source of uid friction in air. We can deduce some of the properties of air friction by sticking our hand outside a moving car. Clearly, the greater the velocity with respect to the air, the larger is the resistive force. By rotating our hand, we observe that the force is greater when the palms face the direction of motion. We therefore conclude that the resistive force increases with the velocity and the surface area in the direction of motion. Because of air resistance, there are two forces acting on a falling body: the downward force of gravity W and the upward force of air resistance. From Newtons second law (see Appendix A), we nd that the equation of motion in this case is W Fa ma (3. If the body falls from a suciently great height, the velocity reaches a magnitude such that the force due to air resistance is equal to the weight. Past this point, the body is no longer accelerated and continues to fall at a constant velocity, called the terminal velocity vt. At the terminal velocity, the downward force of gravity is canceled by the upward force of air resistance, and the net acceleration of the body is zero. The weight of an object is proportional to the volume, which is in turn proportional to the cube of the linear dimension L of the object, 3 W L The area is proportional to L2. From this height, a person hits the ground at a speed of v 2gs 14 m/sec (46 ft/sec) Let us assume that this is the speed with which any animal can hit the ground without injury. At this speed, the force of air resistance on an animal the size of man is negligible compared to the weight. A simple calculation shows that a mouse can fall down a 100-m mine shaft without severe injury. Air friction has an important eect on the speed of falling raindrops and hailstones. Without air friction, a 1-cm diameter hailstone, for example, falling from a height of 1000 m would hit the Earth at a speed of about 140 m/sec. As it is, air friction slows the hailstone to a safe terminal velocity of about 8. The energy required to perform the work is obtained from the chemical energy in the food eaten by the animal. In general, only a small fraction of the energy consumed by the muscles is converted to work. For example, in bicycling at a rate of one leg extension per second, the eciency of the muscles is 20%.
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The strength of evidence for effectiveness of any specific counselling and psychotherapy intervention or approach is a function of the number, independence and quality of available effectiveness studies, and the quality of these studies is a function of study design, measurements used and the ecological validity (i. Rather, the scientific evidence showing equivalence of effect for different counselling and psychotherapy interventions justifies a starting point assumption of effectiveness. We recognise the need to improve the evidence-base for the effectiveness of various therapeutic approaches. Introduction A literature review of studies and meta-analyses of the efficacy and effectiveness of psychotherapeutic treatments for depression has been conducted to provide an overview of evidence-based treatment of depression. Table 1 gives an overview of the meta-analyses and Table 2 of the guidelines currently available. There is a volume of literature about the nature, definition, epidemiology and risk factors of depression. This literature review reports selectively about the most important aspects of these areas and gives short summaries from recent literature. Symptoms and diagnosis of depression Depression is highly variable in terms of presentation of symptoms and the duration of these symptoms. Psychotic symptoms such as delusions or hallucinations may occur in severely depressed clients. A major depressive disorder can be diagnosed as either a single episode (first major depressive episode) or recurrent (if one or several major depressive episodes have been experienced previously) and as mild, moderate or severe. Counsellors and psychotherapists could also consider whether the depression is due to a medical condition, substance abuse or a specific stressor as in adjustment disorder. It would be useful to consider whether or not other psychiatric conditions are also present, such as anxiety. Lifetime prevalence rates of 16% and 12-month prevalence rates of 7% have been reported for adults (Kessler et al. A study of depression in Australian adolescents has found a prevalence rate of 14%, with significantly higher rates of depression in girls than boys (18. These gender differences seem to emerge in adolescence and persist throughout adulthood (Pettit & Joiner, 2006). Kessler and colleagues (2003) found that the average episode duration was 16 weeks in their large- scale community study. In a meta-analysis (Posternak & Miller, 2001) with 19 studies (N = 221) it has been found that 20% of clients improved in the short-term without treatment. In an Australian 25-year longitudinal 2 study of the outcome of major depression after inpatient treatment (Brodaty et al. Clients experienced on average three depressive episodes over the 25 years and 58% (25/43) received at least one more inpatient treatment in the 25 years. Of 105 clients who stayed well for at least 5 years, 58% had a relapse (Mueller et al. Comorbid mental disorders have been found in 64% to 79% of individuals suffering from a depressive disorder (Kessler et al. More than half of individuals with a depressive disorder reported severe or very severe role impairment (Kessler et al. Causes and risk factors Knowledge about risk factors and aetiology of depression is important for the development of more effective prevention and treatment programs. Numerous studies have investigated risk factors for depression and focused on the biological (e. Factors which describe stable individual differences such as gender, socio-economic status, race, culture or age have also been shown to be related to depression. A common finding is that the development of depression is determined by multiple, correlating risk factors which probably change over the lifespan (Dobson & Dozois, 2008). Depression also appears to include self-sustaining processes (Pettit & Joiner, 2006). During major depressive episodes, depressed mood and patterns of negative thinking can lead to changes in the patterns of thinking which can stay present even after recovery from the episode. Therefore, it may be that risk factors for onset of depression differ from risk factors for relapses (Dobson & Dozois, 2008). As mentioned earlier, it has been shown that depression is more prevalent in women than in men (Boyd et al. Different theories have been reported such as undetected higher depression rates in men (masked by alcohol and substance use), higher exposure to stressors in women due to lower social status and difficulties with relationships and dependence due to the social role of women (Pettit & Joiner, 2006). A large number of studies, meta-analyses and review articles report convincingly on the effectiveness of psychotherapy as an intervention for depression. Although clinicians often use a combination of approaches, and although there are common factors which are effective across different therapeutic approaches such as the therapeutic relationship, it is important to know about the effectiveness of specific therapeutic approaches. The following section gives an overview of existing research about effectiveness of specific therapeutic approaches. Relationship distress was significantly reduced in the DAvanzo (2008) treatment for depression: A meta- individual therapy couple therapy group. Large effect of marital therapy compared to no DAvanzo (2006) other psychosocial treatment.
Duct plementation ventolin 100 mcg lowest price asthma symptoms pediatric, management of complications such as epithelium in the pancreas buy ventolin 100mcg without a prescription asthma symptoms and rapid heartbeat, salivary and lacrimal glands varices buy cheap ventolin 100mcg on-line asthma symptoms after pneumonia, hyperlipidaemia buy generic ventolin 100 mcg on-line asthma treatment chart. Pa- Asymptomatic patients may have a normal life ex- tients may complain of fatigue and pruritus, followed pectancy. Denition Macroscopy/microscopy A disease of unknown aetiology in which chronic in- Throughout the disease, copper accumulates due to the ammation of the bile ducts leads to stricture formation chronic cholestasis. Chronic inammation of the intra- and extra-hepatic r Associated with many other disorders, such as bile ducts leads to brosis and short strictures form Sjogrens, hypothyroidism, systemic lupus erythe- which obstruct the passage of bile. Patients usually present with progressive jaundice and Raised alkaline phosphatase suggests damage to bile pruritus or ascending cholangitis. Liver biopsy is diagnostic demonstrating concen- tric, (onion-skin) brosis around medium-sized bile Investigations ducts, including those in portal tracts. Corticosteroids, azathiporine and methotrexate have been tried, but have no proven benet. Liver transplantation is used in advanced Supportive,patientsmustnotsmoke,end-stageliverfail- cases. Prognosis Slowly progresses to chronic liver disease with risk of ful- Hereditary haemochromatosis minant hepatic failure, cholangiocarcinoma and hepa- tocellular carcinoma. Aetiology The gene for 1 antitrypsin (Pi, for Protease Inhibitor) Sex is found on chromosome 14. Z is the most abnormal allele, it encodes Aetiology for a defective protein which cannot be excreted from Hereditary haemochromatosis is inherited in an autoso- hepatocytes. The commonest antitrypsin is an extracellular inhibitor of neutrophil mutation is a cysteine-to-tyrosine substitution at amino 1 elastase. Cigarette smoke C282Y mutation, 7599% of homozygotes are clinically probably contributes to this by inhibiting any function- disease free. Clinical features Pigmentationoftheskin(duetoincreasedmelanin),dia- Age betes and hepatomegaly is the classical description of the May present at any age. Arthritis due to calcium pyrophosphate deposi- tion may occur, usually affecting the knees and meta- Sex carpophalangeal joints. Other presenting features in- M = F clude pituitary dysfunction, cardiac enlargement and/or Aetiology failure. In Wilsons disease the mutation is thought to affect the excretion of copper from hepatic lysosomes into the bile. Excess copper in the hepatocytes causes lipid to collect Complications in the cytoplasm. There is increasing inammation and There is a high risk of hepatocellular carcinoma if cir- brosis and untreated, it progresses to cirrhosis. Clinical features Investigations Heterozygous individuals are asymptomatic and usually Diagnosed on liver biopsy. KayserFleischer rings (green/brown rings around the edge of the cornea) are a late diagnostic sign, but are Management variably present. Regular venesection reduces the iron load and the risk Microscopy of cirrhosis and hepatocellular carcinoma. Other man- Excess copper can be seen in the liver using special stain- ifestations are treated symptomatically, e. Itis220 normal, but this also occurs in chronic diabetes, testosterone for gonadal failure. Investigations Reduced serum copper and ceruloplasmin levels (not Prognosis specic and 25% of patients will have normal levels). The earlier the diagnosis and treatment, the better the Urinary copper is high and increases markedly following prognosis. If diagnosed Poor prognostic factors are co-existent biliary tract dis- and treated sufciently early, there is some improvement ease, old age and multiple abscesses. Amoebic liver abscess Pyogenic liver abscess Denition Denition Infection of the liver by Entamoeba histolytica. The development of liver abscesses is thought to follow Aetiology/pathophysiology bacterial infection elsewhere in the body. The infection water is food borne and is most common Aetiology/pathophysiology in parts of the world with poor sanitation, e. Infectionmay reach the liver by the portal of trophozoites in the intestine, which are thought to vein from a focus of infection drained by the portal vein, invade through the mucosa gaining entry to the portal e. Infection may also result from a generalised septicaemia or direct spread from the biliary tree. Tender hepatic en- the symptoms are less marked in elderly patients, with largement without jaundice is usual. Macroscopy/microscopy Maybesingle or multiple lesions ranging from a few Investigations millimetres to several centimetres in size. Investigations Guided aspiration and stool ova, cyst and parasite exam- Ultrasound scan is useful for screening, and pus may be ination may demonstrate the organism. Blood cultures, Management liver function tests and inammatory markers should Treated with metronidazole. Hydatid disease Management Repeated ultrasound guided aspirations may be re- Denition quired. Extensive, difcult to approach abscesses are A tapeworm infection of the liver common in sheep rear- drained by open surgery, with soft pliable drains. They are strongly asso- worms Echinococcus granulosus and Echinococcus mul- ciated with the oral contraceptive pill. Clinical features The disease may be symptomless but chronic right up- Primary hepatocellular carcinoma perquadrant pain with enlargement of the liver is the common presentation. The cyst may rupture into the Denition biliary tree or peritoneal cavity and may cause an acute Also called hepatoma, this is a tumour of the liver anaphylactic reaction. Investigations Incidence/prevalence Eosinophilia is common and serological tests are avail- Relatively uncommon in the Western world (23%), but able. Small, calcied cysts may be seen on plain abdom- by far the most common primary tumour of the liver inal X-ray. Percutaneous ultrasound guided ne nee- Sex dle aspiration with injection of scolicidal agents and re- M > F (34:1) aspiration may be used. Large symptomatic cysts may be surgically excised intact taking great care to avoid con- Geography tamination of the peritoneal cavity. High incidence (40% of all cancers) in countries where predisposing factors such as hepatitis B are common, e. Tumours of the liver Aetiology Benign tumours of the liver Tumours arise in a chronically damaged liver especially Benign tumours of the liver must be differentiated from in cirrhosis independent of the cause. Hepatitis B virus malignant tumours such as metastases or primary hepa- carrier states and chronic active hepatitis predisposes to tocellular tumour and cysts or abscesses. There are four primary hepatocellular carcinoma, especially when hep- main types: atitisBinfectionoccursinearlylife. Hepatotoxinssuchas r Cavernous haemangiomas are the most common be- mycotoxinspresentinfood,increasetheincidenceofpri- nign tumours of the liver. Aatoxin, produced by Aspergillus avus, rarely become large and produce pain, enlarged liver is frequently found in stored nuts and grains in tropical or haemorrhage. Sometimes rare syn- mour,whichusuallypresentslateinpatientswhoalready dromes occur such as hypercalcaemia, hypoglycaemia haveaseriousunderlyingpathology,cirrhosis. Theprog- and porphyria cutanea tarda (bullae on the skin follow- nosis is very poor. Median survival is <6 months from ing sun exposure or minor trauma due to a defect in a diagnosis. On ex- The liver is also an important site of growth for lym- amination, the liver is usually enlarged and there may be phomas and leukaemias.
Without friction we could not walk safe ventolin 100 mcg asthma treatment nursing; nor could we balance on an inclined plane (see Exercise 2-2) trusted ventolin 100 mcg juvenile asthma symptoms. Friction also produces undesirable wear and tear and destructive heating of contact surfaces ventolin 100mcg on line asthma treatment of albuterol q2 q1. Both nature and engineers attempt to maximize friction where it is necessary and minimize it where it is destructive discount 100 mcg ventolin overnight delivery asthma graph. Friction is greatly reduced by introducing a uid such as oil at the interface of two surfaces. A natural example of such lubrication occurs in the joints of animals, which are lubricated by a uid called the synovial uid. Assume that she is wearing leather-soled shoes and that she is standing in a vertical position as shown in the gure. The force parallel to the surface Fp, which tends to cause the sliding, is Fp W sin (2. When the joints are in motion, these large forces produce frictional wear, Section 2. Frictional wear at the joints is greatly reduced by a smooth cartilage coating at the contact ends of the bone and by synovial uid which lubricates the contact areas. When a person walks, the full weight of the body rests on one leg through most of each step. Because the center of gravity is not directly above the joint, the force on the joint is greater than the weight. Since the radius of the joint is about 3 cm, the joint slides about 3 cm inside the socket during each step. Furthermore, this work would be dissipated into heat energy, which would destroy the joint. Therefore, the work expended in counteracting friction and the resul- tant heating of the joint are negligible. Studies indicate that by the age of 70 about two-thirds of people have knee joint problems and about one-third have hip problems. The catsh has such a joint connecting its dorsal spine n to the rest of its skeleton (Fig. Since the coecient of friction between the n bone and the skeleton is high, the frictional force tends to lock the n in the up position. In order to remove the n, a force must be applied in a predominantly vertical direction with respect to the underlying skeleton. The shaded block represents the movable n bone, and the horizontal block is the spine holding the n. The dimensions shown in the gure are to be used in the calculations required for Exercise 2-3. The applied force tips the bone, and as a result reaction forces are set up at points B and C. The components of these forces normal to the n-bone surface produce frictional forces that resist removal of the bone. Calculation of some of the properties of the locking mechanism is left as an exercise. Calculate the minimum value for the coecient of friction between the bones to prevent dislodging of the bone. In pure translational motion all parts of the body have the same velocity and acceleration (Fig. In pure rotational motion, such as the rotation of a bar around a pivot, the rate of change in the angle is the same for all parts of the body (Fig. Many motions and movements encountered in nature are combinations of rotation and translation, as in the case of a body that rotates while falling. Theequationsoftranslationalmotionforconstantaccelerationarepresented in Appendix A and may be summarized as follows: In uniform acceleration, the nal velocity (v) of an object that has been accelerated for a time t is v v0 + at (3. In the crouched position, at the start of the jump, the center of gravity is lowered by a dis- tance c. During the act of jumping, the legs generate a force by pressing down on the surface. Although this force varies through the jump, we will assume that it has a constant average value F. Because the feet of the jumper exert a force on the surface, an equal upward-directed force is exerted by the surface on the jumper (Newtons third law). This force acts on the jumper until her body is erect and her feet leave the ground. The acceleration of the jumper in this stage of the jump (see Appendix A) is F W F W a (3. However, the mass of the Earth is so large that its acceleration due to the jump is negligible. After the body leaves the ground, the only force acting on it is the force of gravity W, which produces a downward acceleration g on the body. At the maximum height H, just before the body starts falling back to the ground, the velocity is zero. The initial velocity for this part of the jump is the take-o velocity v given by Eq. Experi- ments have shown that in a good jump a well-built person generates an average reaction force that is twice his/her weight (i. The distance c, which is the lowering of the center of gravity in the crouch, is proportional to the length of the legs. For an average person, this distance is about 60 cm, which is our estimate for the height of a vertical jump. The height of a vertical jump can also be computed very simply from energy considerations. The work done on the body of the jumper by the force F during the jump is the product of the force F and the distance c over which this force acts (see Appendix A). At the full height of the jump H (before the jumper starts falling back to ground), the velocity of the jumper is zero. At this point, the kinetic energy is fully converted to potential energy as the center of mass of the jumper is raised to a height (c + H). It is a common mistake to assume that the height to which a person can jump on the moon increases in direct proportion to the decrease in weight. That is, if a person can jump to a height of 60 cm on Earth, that same person can jump up 6. Note that the ratio H /H 11 is true only for a particular choice of F in the calculation (see Exercise 3-2). The additional height is attained by using part of the kinetic energy of the run to raise the center of gravity o the ground. Let us calculate the height attainable in a running jump if the 1 2 jumper could use all his/her initial kinetic energy ( mv ) to raise his/her body 2 o the ground. If this energy were completely converted to potential energy by raising the center of gravity to a height H, then 1 2 MgH mv (3. Then we must remember that the center of gravity of a person is already about 1 m above the ground. With little extra eort, the jumper can alter the position of his body so that it is horizontal at its maximum height. Thus, our nal estimate for the maximum height of the running high jump is v2 H + 1.