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By H. Phil. Mount Union College.

For one thing cheap 15 gr differin amex skin care products, there is no way to know ahead of time what the effects of a given procedure will be on every person or animal who participates or what benefit to society the research is likely to produce differin 15gr on line acne. In addition cheap differin 15gr visa skin care 11 year olds, what is ethical is defined by the current state of thinking within society quality 15gr differin acne youtube, and thus perceived costs and benefits change over time. The board may suggest modifications to the procedures, or (in rare cases) it may inform the scientist that the research violates Department of Health and Human Services guidelines and thus cannot be conducted at all. Informed consent, conducted before a participant begins a research session, is designed to explain the research procedures and inform the participant of his or her rights during the investigation. The informed consent explains as much as possible about the true nature of the study, particularly everything that might be expected to influence willingness to participate, but it may in some cases withhold some information that allows the study to work. Because participating in research has the potential for producing long-term changes in the research participants, all participants should be fully debriefed immediately after their participation. The debriefing is a procedure designed to fully explain the purposes and procedures of the research and remove any harmful aftereffects of participation. Research With Animals Because animals make up an important part of the natural world, and because some research cannot be conducted using humans, animals are also participants in psychological research. Most psychological research using animals is now conducted with rats, mice, and birds, and the use of [8] other animals in research is declining (Thomas & Blackman, 1992). As with ethical decisions involving human participants, a set of basic principles has been developed that helps researchers make informed decisions about such research; a summary is shown below. Although many people accept the value of such research (Plous, 1996), a minority of people, including animal-rights activists, believes that it is ethically wrong to conduct research on animals. This argument is based on the assumption that because animals are living creatures just as humans are, no harm should ever be done to them. They argue that such beliefs ignore the potential benefits that have and continue to come from research with animals. Research on animals has also led to a better understanding of the physiological causes of depression, phobias, and stress, among other illnesses. In contrast to animal-rights activists, then, scientists believe that because there are many benefits that accrue from animal research, such research can and should continue as long as the humane treatment of the animals used in the research is guaranteed. Researchers assure that participants are given free choice to participate and that their privacy is protected. Give an example from personal experience of how you or someone you know have benefited from the results of scientific research. Science and ethics in conducting, analyzing, and reporting psychological research. Differentiate the goals of descriptive, correlational, and experimental research designs and explain the advantages and disadvantages of each. Explain the goals of descriptive research and the statistical techniques used to interpret it. Summarize the uses of correlational research and describe why correlational research cannot be used to infer causality. Review the procedures of experimental research and explain how it can be used to draw causal inferences. Psychologists agree that if their ideas and theories about human behavior are to be taken seriously, they must be backed up by data. However, the research of different psychologists is designed with different goals in mind, and the different goals require different approaches. A research design is the specific method a researcher uses to collect, analyze, and interpret data. Psychologists use three major types of research designs in their research, and each provides an essential avenue for scientific investigation. Descriptive research is research designed to provide a snapshot of the current state of affairs. Correlational research is research designed to discover relationships among variables and to allow the prediction of future events from present knowledge. Experimental research is research in which initial equivalence among research participants in more than one group is created, followed by a manipulation of a given experience for these groups and a measurement of the influence of the manipulation. May be To create a snapshot of the Allows the development of questions unethical if participants do not Descriptive current state of affairs for further study. Allows testing of expected relationships between and among Cannot be used to draw To assess the relationships variables and the making of inferences about the causal between and among two or predictions. Can assess these relationships between and among Correlational more variables relationships in everyday life events. To assess the causal impact Cannot experimentally of one or more experimental Allows drawing of conclusions about manipulate many important manipulations on a the causal relationships among variables. There are three major research designs used by psychologists, and each has its own advantages and disadvantages. Descriptive Research: Assessing the Current State of Affairs Attributed to Charles Stangor Saylor. This section reviews three types of descriptive research: case studies, surveys, and naturalistic observation. Sometimes the data in a descriptive research project are based on only a small set of individuals, often only one person or a single small group. These research designs are known as case studies—descriptive records of one or more individual’s experiences and behavior. Sometimes case studies involve ordinary individuals, as when developmental psychologist Jean Piaget used his observation of his own children to develop his stage theory of cognitive development. More frequently, case studies are conducted on individuals who have unusual or abnormal experiences or characteristics or who find themselves in particularly difficult or stressful situations. The assumption is that by carefully studying individuals who are socially marginal, who are experiencing unusual situations, or who are going through a difficult phase in their lives, we can learn something about human nature. Sigmund Freud was a master of using the psychological difficulties of individuals to draw conclusions about basic psychological processes. Freud wrote case studies of some of his most interesting patients and used these careful examinations to develop his important theories of personality. One classic example is Freud’s description of “Little Hans,‖ a child whose fear of horses the psychoanalyst interpreted in terms of repressed sexual impulses and the Oedipus [1] complex (Freud (1909/1964). Another well-known case study is Phineas Gage, a man whose thoughts and emotions were extensively studied by cognitive psychologists after a railroad spike was blasted through his skull in an accident. Although there is question about the interpretation of this case study (Kotowicz, [2] 2007), it did provide early evidence that the brain’s frontal lobe is involved in emotion and [3] morality (Damasio et al. An interesting example of a case study in clinical psychology [4] is described by Rokeach (1964), who investigated in detail the beliefs and interactions among three patients with schizophrenia, all of whom were convinced they were Jesus Christ. The people chosen to participate in the research (known as the sample) are selected to be representative of all the people that the researcher wishes to know about (the population). In election polls, for instance, a sample is taken from the population of all “likely voters‖ in the upcoming elections. The results of surveys may sometimes be rather mundane, such as “Nine out of ten doctors prefer Tymenocin,‖ or “The median income in Montgomery County is $36,712. A final type of descriptive research—known as naturalistic observation—is research based on the observation of everyday events. For instance, a developmental psychologist who watches children on a playground and describes what they say to each other while they play is conducting descriptive research, as is a biopsychologist who observes animals in their natural habitats. One example of observational research involves a systematic procedure known as the strange situation, used to get a picture of how adults and young children interact. The data that are collected in the strange situation are systematically coded in a coding sheet such as that shown in Table 2. The baby resists being put down by the adult by crying or trying to climb Maintaining contact back up.

To boost potassium intake cheap 15 gr differin with mastercard skin care gadgets, eat more bananas purchase 15 gr differin amex skin care steps, oranges and orange juice order differin 15gr with amex acne 911, avocado purchase 15 gr differin with amex acne xia, peaches, and tomatoes. Excessive sugar intake has been linked to diabetes, obesity, elevated triglycerides, tooth decay, poor immune function, emotional swings, and other health problems. Refined (white) sugar contains propyl alcohol, which cannot be broken down in the body. Accumulation of this chemical in the intestines can disrupt diges- tion and be toxic to the body. The World Health Organization recommends restricting consumption of added sugar—including sugar from honey, syrups, and sweetened drinks/juices—to less than 10 percent of calories. Fruit contains natural sugar (fructose), but it also provides vitamins, minerals, and fibre. Artificial sweeteners such as aspartame and saccharin should be avoided because they have been linked to headaches, mental illness, brain damage, and cancer. It can provide up to 300 times the sweet- ening power of sugar without the calories. It is also highly addictive—abrupt withdrawal, even if you drink only one cup of coffee daily, can cause headaches, irritability, and fatigue within hours of missing your usual drink. Black tea and green tea contain approximately 35–45 mg, but the effects of caffeine are blunted by an amino acid (theanine), which has a calming effect. Alcohol and what it is mixed with floods the body with excess calories, which can contribute to weight gain. Next, work on slowly making healthier food choices, such as cutting out fast food, eating more vegetables, drinking more water, or limiting your sugar or caffeine intake. By gradually making changes, you will be more likely to stick with your nutritional plan. Take time to plan your meals, so that you are not reaching for fast food or un- healthy snacks. By following a healthy diet you will notice that you have more energy, a better mood, and an overall improved sense of well-being. You will notice recommendations throughout this book for exercise, as virtually every parameter of health can be im- proved with exercise. Numerous studies have shown that regular exercise cuts your risk of chronic, debilitating diseases such as heart disease (by reducing cholesterol and blood pressure), osteoporosis, cancer, diabetes, and prevents premature death! It is also essential to develop and maintain both a healthy body weight and muscular strength. Plus it offers emotional benefits, as exercise reduces stress and anxiety, and improves sleep and overall emotional well-being. With today’s busy, fast-paced lifestyle, exercise usually falls to the bottom of the priority list while it should be at the top. Lack of time is the most common excuse, so below I show you how to boost the activity in your lifestyle. Many people find they don’t have the energy to exercise, yet they don’t realize that exercise actually gives them more energy. Some are concerned about health problems (arthritis and back problems), yet exercise can actually benefit and improve these problems. Regardless of your health status, age, or current fitness level, there are activities that you can do to improve your health. So now that we have put aside the common obstacles, let’s take a look at the various types of exercise and how to build them into our lifestyle. Examples include brisk walking, swimming, biking, aerobics, dancing, and rollerblading. These exercises help burn calories, and also improve car- diovascular and respiratory (lung) function by conditioning the lungs to use more oxygen while increasing your heart’s efficiency (decreasing heart rate). If you are currently not exer- cising, then start slowly—five minutes on your first day and then increase gradually. Morning is best because you will have more energy and will continue to burn calories for several hours afterward. To determine the intensity level for optimal cardiovascular (and fat-burning) ben- efits, check your heart rate. The activity should increase your heart rate to 60–80 percent of your maximum rate for 30 minutes or longer. Beginners should aim for 60 percent, while more advanced exercisers can aim for 80 percent. For example, if you are 40 years old: 220 – 40 = 180 60–80 percent of 180 = 108–144 You should keep your heart rate between 108 and 144 beats per minute for 30 minutes. Other ways to gauge your intensity level are: Breath sound check: Your breathing should be heavier and audible. For example, when a brisk 30-minute walk becomes easy, add hand weights or walk on hills. This can be achieved with weightlifting, ex- ercise machines, bands/tubes, using your own body weight, or lifting heavy objects. These activities are particularly important for older adults because they help prevent and slow the muscle and bone loss that occurs with aging. Try to spend 20–30 minutes three to four times a week doing resistance activities. For example, do chest and triceps on Monday, back and biceps on Wednesday, and legs and shoulders on Friday. Pick two exercises per body part and do two or three sets of 8–12 repetitions of that exercise. This is largely due to a very powerful amino acid in protein—essential to early muscle repair—called leucine. Stretch slowly and gently, breathe deeply, and hold each position for at least 10 seconds. Guidelines from the National Academy of Sciences and the Institute of Medicine (used by Canada and the United States) recommend that, regardless of weight, adults and children should spend a total of at least one hour each day in moderately intense physical activity. This recommendation takes into consideration the increased caloric intake of our population, our lack of activity, and our rising prevalence of obesity. Otherwise, try to set aside an hour three to four times a week and on the other days, use some of the above ideas to work more movement into your day. In fact, it has been found that those who work out five times a week lose three times as much fat as those who exercise only two or three times weekly. Aerobic activities do burn calories, but resistance training plays a stronger role because it builds lean muscle mass, which boosts your metabolism, burns calories, and encourages the body to utilize fat more efficiently as fuel. If you do too much too soon, you may injure yourself or become too discouraged to continue. Here are some important points to keep in mind: • Before you start an exercise program, consult with your doctor, especially if you have any health conditions or are taking medication. Set reasonable goals, be consistent with your exer- cises, and you will see both the physical and emotional rewards. These essential but often overlooked factors are paramount for physical and emotional well-being and disease prevention. In this chapter we take a closer look at the value of sleep, how to get a better night’s rest, and how to deal with stress more effectively. While we think of sleep as a relaxing and passive state, there is actually quite a lot going on in the body during sleep. There are five stages of sleep defined by brain wave activity, muscle tone, and eye movement. During stages three and four, the body goes into a deeper sleep, and the brain produces what are called delta waves. Delta sleep is our deepest sleep, the point when our brain waves are least like what they are when we are awake.

Darkroom safelights must also be used properly differin 15gr mastercard skin care shiseido, including matching the appropriate safelight flter with the type of flms and extraoral screen being used buy cheap differin 15 gr on-line acne antibiotic treatment. However buy differin 15gr skin care procter and gamble, it is important to note that flms are not totally insensitive to the light emanating from appropriate safelights differin 15 gr overnight delivery acne vulgaris. Regardless of the flter used, the safelight must be positioned at least 4 feet away from the work surface area, and bulbs within the safelight should be no stronger than 15 watts. Working time under safelights should also be restricted to as short a time as possible. Variation in milliampere and exposure time will afect only the density (overall blackness of the resulting image) and have no efect on visual contrast (shades of gray). Tey afect the image density equally so that doubling the milliampere setting on the unit will allow the x-ray exposure time to be cut in half and vice versa. Variation in the kilovolt- age setting will, however, afect both density and contrast. However, there can also be an undesirable increase in shades of gray in the images with a loss of distinct blacks and whites, resulting in low visual contrast in the image (Table 10. Te projection geometry when exposing images of a specimen is simple and straightforward. Te receptor should be placed parallel to the denti- tion and the beam should be directed perpendicular to the receptor plane (Figure 10. Ideal imaging in many cases may be improved by resecting the mandible and maxilla. Were it not for this selec- tive sensitivity, x-radiation as a treatment to kill rapidly growing, immature tissues of neoplasms while creating less damage in normal healthy tissues would be inefective. When the damaging energy is delivered directly from the x-ray photon to the molecule, it is deemed a direct efect. Most damage from x-radiation does occur through the ionization or radiolysis of water. Tere are numerous biological molecules that can be adversely afected by x-ray energy, including nucleic acids and proteins. Damage at the cellular level afects the nucleus, cytoplasm, and chromosomes and may result in cell and eventually host death. Given enough ionizing radiation, damage will occur with whole body systems such as the gastrointestinal organs and hematopoetic system. Predicting damage from x-radiation falls follows two distinct models: deterministic and stochastic. Deterministic efects occur with large doses that produce certain types of bodily damage for which a defnite threshold may be determined and damage increases above that threshold. Stochastic efects typically do not have a known threshold, are all or none in efect, and typically relate to cancer and genetic efects. In lieu of a threshold with sto- chastic damage, it is a matter of continuing higher odds of damage as the dose is increased. Dental radiographic exposures are typically low to the point of not reaching threshold doses required to cause deterministic somatic damage such as skin burns, damage to the lens of the eye, or hair loss. However, the 194 Forensic dentistry development of cancer does not have a defned dose threshold. Actual fatal cancer risk for this amount of radiation may be more, less, or none at all; it is scientifcally unproven. For the purpose of this textbook, it is obvious that the greatest concern to the forensic dentist involves protection to the operator from tube head leakage and scatter radiation. However, any measures taken to reduce the exposure dose and scatter radiation to victims also reduce expo- sure and its ill efects to all personnel in the immediate work zone. Te dose limits are established by com- paring to estimated risks of occupational injury in other vocations that are considered to be safe, such as agriculture, construction, and manufacturing. Te yearly maximum for occupationally exposed individuals is 50 mSv per year, and the public limit is one-tenth of that, at 5 mSv per year (Table 10. Note that the cumulative dose becomes more restrictive than the annual dose over time. For example, a person who begins receiving an annual dose of 50 mSv every year will exceed his or her cumulative maximum of 230 mSv at age twenty-three. Primary Posterior Beam X Exit Right ift X Primary Beam Entrance Anterior Figure 10. Operators must be able to stand at least 2 m away from the source of x-ray scatter (i. If the operator cannot stand at this desired distance, a protective barrier or apron must then be provided. Tis is most likely due to the dramatic reduction in exposure times brought about by high-speed flm and even more so by direct digital receptors. Past studies of occupational exposure to a large sample of dental personnel have shown that the typical exposure is less than the minimum detectable dose, or less than 1 mSv/year. Also, special considerations may be necessary in a disaster morgue setting where numerous individuals are nearby the x-ray source in the dental section. During that operation it was assumed that operators using the device were “safe” based on dose studies conducted by the manufacturer and the device’s approval by the U. Tese studies demonstrated extremely small tube head leakage and backscatter to the oper- ator. Subsequent research simulating morgue usage in a mass fatality setting has confrmed the safety of those working within the dental station. A study simulating doses to those comprising the dental team over a two-week deployment (5,760 exposures) showed that the team member receiving the highest dose at that position (60° to the side of the emanating beam) received an exposure of 0. Tis dose corresponds to 1/200th of the annual occupational limit of 50 mSv and approximately 3. A tomograph is a radiographic presentation Forensic dental radiography 197 of a thin slice of tissue selected from within the object being imaged. Te three planes are also linked to each other so that any entity within the object may be observed from three diferent views in an interactive manner. Te beam is instead three- dimensional and produces three hundred or more full-size images of the selected tissue feld from 360° of rotation about the patient. Where a pixel is a lateral and vertical image unit, the voxel is in the shape of a cube (e. At least two machines currently available scan the subject in the supine position, which makes them suitable as morgue and mass disaster equipment. Any intraoral or extraoral flm image view can be reconstructed from one scan, with the operator having the ability to select any desired slice location and orientation. Tus, it is possible to plot a plane within the confnes of the dental arches and produce a panoramic image without the overlying ghost images and artifacts of conventional panoramic radiography. Te thickness of the panoramic image layer may also be deter- mined in an unlimited manner. Also, computer algorithms correct for the geometric distortions that are present within all plane flm images. Also, a single scan of the victim can later be compared to any possible variety of submitted ante- mortem plane flm images (i. Tis establishes the orientation of the flm series as if the viewer is facing the patient. However, a very common concern in forensic dentistry is the orien- tation of duplicate antemortem radiographs where the dimple of the original flm can be seen but not felt.

Acupuncturists yang means “the sunny side of the mountain” in aim to balance the disturbed energy or the imbal- Chinese medicine discount differin 15gr without a prescription acne xarelto. Yin organs involving nutrition that balances yin and yang (also known as zang) are the liver cheap differin 15gr line skin care associates, heart cheap differin 15 gr otc acne yeast infection, spleen buy 15 gr differin skin care nz, characteristics. Macrobiotic therapists believe that lungs, and kidneys and are considered the solid excessive yin qualities (essentially calm and organs that contain what Chinese medicine calls peacefulness) may result in depression, fatigue the essences—tears, sweat, saliva, mucus, and sex- syndromes, and sleep disorders, and excessive ual secretions. Yin phenomena refer to cold, wet, yang (essentially energy and activity) qualities quiescent, deteriorating, chronic, slow, empty, and may lead to tension, insomnia, hyperactivity, and contracted, and lack of yin generates heat and dry- irritability. Fruits, leafy green vegetables, Yang, which includes bodily functioning and the nuts and seeds, tofu, and some other foods are generation of metabolic heat, decreases when yin considered to be yin. Yang organs (also known as fu) are the bles, seafood, legumes, salt, and cottage cheese are gallbladder, small and large intestines, stomach, considered yang. Yang manifests as birth, warmth, claims that within every yin there is an element of activity, noise, form, and light. This phenomena are heat, dryness, growth, fullness, refers to the ability of each force to take on charac- suddenness, and acuteness. Lack of yang generates teristics of the other or of both to dip into each other cold and dampness. Yogic breathing and exercises have philosophers and the variety of styles of Hatha yoga been widely accepted into the Western mainstream developed over the decades. Yoga has know of yoga relies on Hatha to inspire a spiritual been shown to help lower blood pressure and heart interest in the subject, although yoga may be prac- rate and suppress other bodily functions in order to ticed solely for physical purposes such as stress achieve a state of total relaxation. Perhaps this is why many believe yoga is The language of yoga is Sanskrit, considered the old- best approached not as a mere workout routine, est literary language of India and the basis of many but as a journey to one’s whole, best self. The com- There is much debate about who is responsible for bination of breathing techniques, exercise, medita- the oldest documentation of yoga. According to tion, and “right action” is taught to anyone seeking native Indic tradition, it was a grammarian known to promote or restore health and perhaps adopt the as Patanjali. Other than his brief work, The Yoga belief that this will help unite his or her soul with Sutras of Patanjali, dating back approximately 2,000 God. It is believed that cleansing and strengthening years, little more is known about his life. The text the body and focusing the mind enable the spirit to does not credit Patanjali or anyone else as the connect with the divine. The first person to attribute this classical result of achieving full consciousness or self-realiza- work to him was Vacaspati Mishra, the 10th-cen- tion, also known as atman, and unity with brahman tury author of the Tattva-Vaisharadi commentary (totality). Meditation was the earliest form of yoga, and In 196 aphorisms contained in four chapters Buddha is considered by some to be the first yogi. Hatha is one of seven concepts, or “limbs,” as they are commonly known, limbs of Raja yoga, all of which are thought to be of Raja yoga: yama (moral discipline), niyama (reli- necessary to unite the body, mind, and spirit. Ancient engraved seals Patanjali believed that practicing these eight dis- of deities striking yogic poses have been discovered ciplines and sowing the seed of nonattachment in in the Indus Valley, one of the world’s first urban one’s heart would allow a person to achieve the civilizations, located in what is now Pakistan and ultimate freedom of spirit. These artifacts suggest that yoga is that effect which comes to those who have given must have existed before 3000 B. He also wrote commentaries of the Brahma Gorakhnath, who lived sometime between A. Although there are no known copies of an incarnation of Lord Shiva, he was born in 509 the work remaining, the information imparted B. Legend has it that a crocodile grabbed young (Goraksanatha is a Sanskrit form of Gorakhnath), Shankara’s foot while he bathed in a river. When she niyama (disciplines), which precede asana in Patan- agreed, he uttered a mantra. According to Bengal lit- Govinda, a realized sage, and attained self-realiza- erature, he was born of the matted hair of the god tion (samadhi). As the purest and strongest of ies called Mutts, which exist today throughout yogis, he put the goddess Durga to shame with his India. Gorakhnath has been For studies of logic and metaphysics Shankara’s described as the most influential Indian since work is highly recommended. Ramakrishna Paramhansa As in the Yoga-Sutra, there is no mention of an Ramakrishna Paramhansa (1836–86) was a scholar author. He did not found any mantras, prayers, and psalms dealing with religious organization or claim to know a new path to salva- ceremony and ritual. He grew to realize that different religions lead Sama-Veda, Yajur-Veda, and Artharva-Veda. He was known to say, “As many According to the introduction in the book’s trans- faiths, so many paths” and “Man’s upliftment is the lation by Swami Paramananda, these scriptures main goal in life. The first Eng- master used to say that such names as Hindu, lish translation was that of Raja Ram Mohun Roy Christian, etc. They have all lost their man, the universal reality of consciousness, and the good powers and now only stand as baneful influ- identity of brahman with the inner essence (atman) ences under whose black magic even the best of us of the human being. Well, we will have to work philosophical schools of Vedanta, which is based pri- hard and we must succeed. Adi Shankara (also known as Samkara), one of Swami Vivekananda India’s greatest sages, wrote Advaita Vedanta, the When Swami Vivekananda was born, January 12, Vedanta treatise, among other texts. He became a disciple of Sri Rama- eternal which is beyond the pale of the sense krishna Paramhansa, who renamed him Swami which his reason cannot grasp. There is nothing higher humanitarianism and service to God through ser- than this. He who has achieved it, shall not be vice to others rather than on dogma, as well as on moved by the greatest sorrow. In 1897 this pio- meaning of Yoga—a deliverance from contact with neer of the Vedanta movement in the United States pain and sorrow. Various chapters of so appreciated that he is known as the “patron the Gita deal with renunciation and meditation. Union with The author, poet, and teacher Swami Paramananda God can be achieved by following a divine set of was the youngest monastic disciple of Swami guidelines that fall under the categories of hatha Vivekananda, founder of the Ramakrishna Order, (physical practice), jnana (knowledge), karma the most widely known religious and philanthropic (right action), bhakti (devotion), raja (control of the organization in India. The Hatha Yoga Pradipika He wrote several books, including Change Your Although the Yoga-Sutra is revered by all practi- Mind, A Practical Guide to Buddhist Meditation. A few more Bhagavad-Gita asanas (postures) are described in what is consid- The title of this book-length Sanskrit poem, Bha- ered the bible of the physical component of yoga, gavad-Gita, means “song of the Lord. This 500-page text was gavad Gita is the most widely read scripture in written by Sri Yogindra Svatmarama in the 14th India. Also known as the Gita, it is part of the century and provided the first textual evidence of Mahabharata (Great India), a religious classic of asanas. The story spotlights Lord Krishna and first explains yamas (restraints on behavior), niya- Prince Arjuna on the eve of the battle of Kuruk- mus (observances), asanas (postures), and nutrition. Krishna persuades Arjuna to fight his fear of The second discusses pranoyama (control or the opposing army with the armor of spiritual wis- restraint of energy) and the shatrurmas (internal dom attained through yoga (union with God). The third part talks about mudras (hand In chapter 6 of the Gita, considered the most gestures), bandhas (locks), the nadis (channels of important authority of yoga philosophy, Krishna energy through which prana flows), and the kun- advises Arjuna, “When his mind, intellect and self dalini power. The fourth describes pratyahara (with- (ahamkara) are under control, freed from restless drawal of the senses), dharana (concentration), desire, so that they rest in the spirit within, a man dhyana (meditation), and samadhi (absorption). A lamp does not flicker in a place where no winds Krishnamacharya blow; so it is with a yogic, who controls his mind, Tirumalai Krishnamacharya (1888–1989) receives intellect and self, being absorbed in the spirit much credit for shedding new light on what is now within him. By age intellect and self is stilled through the practice of 12 he was already a serious student of the Vedas. In Yoga, the yogic by the grace of the Spirit within 1924 he opened a school of yoga in Mysore, India. Desikachar, founded yoga 167 the Krishnamacharya Yoga Mandiram, a center for rule, he was jailed in 1909 for terrorist activities. One secret was that yoga can help walls that I was imprisoned; no, it was Vasudeva control the heartbeat.

They have their own methods of identification discount 15 gr differin otc acne 6 weeks postpartum, which they describe as identifying the energy of the plant – its power to heal purchase differin 15gr mastercard acne types. The location cheap differin 15 gr otc skin care md, identification and collection of the plants require great concentration cheap 15gr differin mastercard acne popping. An infinite number of curative plants can be collected from the forest, but the most commonly used are planted very near to the houses to be avail- able for frequent use; others are planted together with the ritual and edible plants in the chagras. The time of collection of medicinal plants is considered to be important and depends on when the plants are sensed to be more powerful or have positive energy to heal. In general the ethnic groups in Amazonia use their medicinal plants fresh because they consider them to have more healing power than when dried. When available the indigenous groups will use western medicine to treat fractures. However, due to the remote location of many of the communities, the sabedores use the bark of certain trees as a splint which they say heals the bone as well as acting as an analgesic. Examples of traditional curative plant medicines Among the enormous number of plants, below are included a few of those used by sabedores from different tribes in the Amazon forest. Amori (Uitoto language) Preparation The Amori tree, which has not been botanically identified, is found in primary forest. The sabedores record it as having hallucinogenic effects and it is also known as ambil de monte. It is cura- Araracuara, Caquéta medio, Amazonas, tive for nervous conditions, high Colombia, 26 June 1991. In the Caquetá Media geographical area Albahaca is known in the Uitoto language as Jaibikie. According to Sabedor Oscar Román, the plant is used to bathe children to improve their mood and to lower fevers caused by influenza and cough. To treat diarrhoea the plant is prepared in hot water with cinnamon and lemon (see interview 3 in the addendum). As a comparison, we include an example of use of the same plant, Alba- haca (Ocimum micranthum), used by the Quichua ethnic group, Amazon forest, Ecuador. In this case, Sabedor Gabriel Tapuy explains that the plant can be used to treat ‘mal aire’. The plant is collected and passed over the person repeatedly in the form of a cross in order to extract negative energies or ‘clean’ them. According to Sabedor Gabriel, the person who carries out the treatment will feel the arm become heavy if he or she is successful at extracting the ‘mal aire’ (see interview 4 in the addendum). Traditional medicine used in the Colombian Amazon forest | 77 Badea (Passiflora quadrangularis) Sabedor Hilario Rivero Yukuna, originally from Mirití said in an interview in, Leticia, Amazonas, Colombia (see interview 5 in the addendum): Seven leaves of Badea are collected and cooked in water. The plant is used to clean the stomach when suffering painful cramps and diarrhoea. Members of other ethnic groups or pueblos such as Muinas (Uitotos), Muinanes, Andokes, Yukunas and others use the young Badea leaves to cure hepatitis A and B in the early stages: on the first day of treatment, the juice of one leaf is taken, and each following day the juice of another leaf is added until nine leaves are being used; the plant is then suspended for 3 days. On resuming the treatment, the number of leaves taken is reduced by one leaf each day until returning to one leaf (see interview 6 in the addendum). It is also used topically as an anti-inflammatory and to control haemorrhage from a wound; the cold leaf is applied directly to the affected area. Internally it can be taken as an infusion made with the leaves, or taken as the pure juice to lower blood pressure. In order to increase hair growth the leaf is crushed and applied to the head without bathing. The fresh fungus is red in colour, and at this stage is 78 | Traditional medicine Figure 4. After 3 or 4 days the fungus begins to turn white in colour and at this stage of ageing is highly toxic (see interview 8 in the addendum). According to Sabedor Oscar Roman Enokai- (see Traditional medicine used in the Colombian Amazon forest | 79 Figure 4. The fat is removed from the grub and some of it massaged on to the patient’s chest, and the rest is given to the patient to eat. It has also been reported to be used as a cure for haem- orrhagic diseases (bleeding). The limited infor- mation presented here is based on research by the authors, and unless other- wise referenced is based on this work. A particular effort has been made to give credit directly to the sabedores who have given specific information. The authors have recorded ancestral knowledge of healing pueblos or ethnic groups of the Amazon forest. They do not suggest that the plants and other natural products should by used by anyone in any way. As has been reported the sabedores adhere to restrictions and regulations and have a lifetime of experience of survival in tropical forest conditions. Each of these treatments has been used by the sabedores following the necessary restrictions, dosage and follow-up by the relevant sabedor. Photography Unless otherwise stated, photographs were taken by Ann Mitchell and Blanca de Corredor. Theoretical proposal for an innovative study of the cognitive mechanisms of cultural adaptation. Plantas de los Dioses Orígenes del uso de los alucinógenos (Plants of the Gods – Origins and use of hallucinogens). Ministry of National Education; Amazon Fund Programme; Coordina- tion of Amazon Education; Fundación Caminos de identidad (Foundation of Paths of Identity), 1996: 12–13, 16–18, 29. Cross-cultural adaptation in urban ethnobotany: The Colombian folk pharmacopoeia in London. Sabedores, Sabedoras: Metodos de recuperación, preservación y manejo de la selva y de la várzea. Wisemen, wisewomen: Methods of recuperation, preservation and management of the forest and varzea. Interview with Sabedor Rene Moreno Vaneo, Cocama ethnic group, Leticia, Amazonas Colombia 23/11/08. Interview with Sabedor Oscar Román Enokayai-, Araracuara, Caquetá medio 26/6/91 3. Interview with Sabedor Oscar Román Enokayai-, Sabedora Alicia Sánchez Román, Tomás Román 9/4/89 4. Interview with Sabedor Gabriel Tapuy, ethnic group: Quichua del Napo, Amazon forest, Ecuador 26/11/94. Interview with Sabedor Hilario Rivero Yukuna, Yukuna ethnic group from Mirití, Amazonas, Colombia. Interview with Sabedores: Placido Mendoza Ethnic group Uitoto Muina, Araracuara, Amazonas; Oscar Román Enokayai- Ethnic group Uitoto Muina Araracuara, Amazonas; Cacique Eduardo Paki-, Muinane, del Resguardo Villa Azul, Caquetá medio, heart of the Colombian tropical forest. Interview with Sabedor Joa¯o Costa Rios Filho, Ethnic group Quichua, Leticia, Amazonas, Colombia 22/11/08. Interview with Sabedor Isaias Román Sánchez, Muina, Uitoto ethnic group, who has inherited the career of his father: elder: Oscar Román Enokai- 19/2/98. Interview with Sabedor Oscar Román Enokayai- and his son Tomás Román, Uitoto, Araracuara, Caquetá medio, Colombia 1989. Interview with Sabedora Alicia Román Sánchez, Uitoto, Araracuara, Caquetá medio, Amazonas, Colombia 7/4/92. Interview with Sabedor Oscar Román Enokayai- and his son Tomás Román, Uitoto, Araracuara, Caquetá medio, Colombia 27/6/91.

Mechanism of action Pharmacokinetics β-Adrenoceptor antagonists reduce cardiac output (via nega- β-Adrenoceptor antagonists are well absorbed and are only tive chronotropic and negative inotropic effects on the heart) generic differin 15gr fast delivery acne back, given intravenously in emergencies 15gr differin with visa skin care in 30s. Slow-release preparation for hypertension buy discount differin 15 gr line skin care institute, angina central nervous system side effects (e proven 15 gr differin skin care 90210. Mechanism of action Calcium-channel blockers inhibit Ca2 influx through volt- Drug interactions 2 age-dependent L-type calcium channels. Cytoplasmic Ca • Pharmacokinetic interactions: β-adrenoceptor antagonists concentrations control the contractile state of actomyosin. This muscle, reduce peripheral vascular resistance and lower arte- causes accumulation of drugs such as lidocaine that have rial blood pressure. Drugs that block voltage-dependent Ca2 channels are used to • Ankle swelling (oedema) is common, often troublesome, treat angina (see Chapter 29) and supraventricular tachydys- but not sinister. There are • The negative inotropic effect of verapamil exacerbates three classes: dihydropyridines, benzothiazepines and pheny- cardiac failure. Slow-release preparations improve its choice, especially in older patients and Afro-Caribbeans, profile in this regard. Amlodipine is has a half-life of two to three days and produces a persistent taken once daily. The daily dose can be increased if needed, antihypertensive effect with once daily administration. The photosensitive) and purpura, which may be dose–response curve of diuretics on blood pressure is remark- thrombocytopenic or non-thrombocytopenic. However, adverse metabolic effects (see below) are dose related, so increasing the dose is seldom appropriate. They begin to The effects of thiazide diuretics described above contraindi- act within one to two hours and work for 12–24 hours. Loop cate their use in patients with severe renal impairment (in diuretics are useful in hypertensive patients with moderate or whom they are unlikely to be effective), and in patients with a severe renal impairment, and in patients with hypertensive history of gout. It is prudent to discontinue diuretics temporarily in patients Mechanism of action who develop intercurrent diarrhoea and/or vomiting, to Thiazide diuretics inhibit reabsorption of sodium and chloride avoid exacerbating fluid depletion. Excessive salt intake or a low glomerular filtration rate interferes with their antihypertensive effect. Natriuresis is therefore prob- Drug interactions ably important in determining their hypotensive action. During chronic treatment, total peripheral vascular Diuretics indirectly increase Li reabsorption in the proximal resistance falls slowly, suggesting an action on resistance tubule, by causing volume contraction. The main adverse effects are hyperkalaemia (especially in patients with renal impairment) and, with Drugs used in essential hypertension spironolactone, oestrogen-like effects of gynaecomastia, breast • Diuretics: thiazides (in low dose) are preferred to loop tenderness and menstrual disturbance. They may precipitate gout and worsen glucose tolerance or dyslipidaemia, but they reduce the risk of stroke and other vascular events. Heart failure, heart block or Use claudication can be exacerbated in predisposed patients. They are particularly useful in patients with Phenoxybenzamine irreversibly alkylates α-receptors. Patients of African descent tend toma for surgery, but has no place in the management of to respond poorly to them as single agents. The main its use is limited by severe postural hypotension, especially adverse effect on chronic use is cough; losartan, an following the first dose. Effects on vascular obstruction (Chapter 36), and is useful in men with mild event rates are unknown. Adverse effects • First-dose hypotension and postural hypotension are adverse effects. Neither spironolactone nor the more selective (and much more expensive) eplerenone is licensed for treating essential hyper- tension. They are used to treat Conn’s syndrome, but are also Pharmacokinetics effective in essential hypertension (especially low renin essen- Doxazosin has an elimination half-life of approximately 10–12 tial hypertension) and are recommended as add-on treatment hours and provides acceptably smooth 24-hour control if used for resistant hypertension by the British Hypertension Society once daily. Long-term high-dose use not understood to severe hypertension: causes systemic lupus-like syndrome in β-antagonist in combination susceptible individuals with diuretic. Retains a place in severe hypertension during pregnancy α-Methyldopa Taken up by noradrenergic Hypertension during Drowsiness (common); depression; nerve terminals and converted pregnancy. Occasionally hepatitis; immune haemolytic anaemia; to α-methylnoradrenaline, useful in patients who drug fever which is released as a false cannot tolerate other drugs transmitter. Co-administration of a β-adrenoceptor tension unresponsive to other drugs, combined with a antagonist is usually required. Prolonged use is precluded β-adrenoceptor antagonist to block reflex tachycardia and a by the development of cyanide toxicity and its use requires loop diuretic because of the severe fluid retention it causes. It used to be widely used as part of ‘triple ther- Coombs’ test is also not uncommon: rarely this is associated apy’ with a β-adrenoceptor antagonist and a diuretic in with haemolytic anaemia. Other immune effects include drug patients with severe hypertension, but has been rendered fever and hepatitis. Its mechanism is uptake into central neu- largely obsolete by better tolerated drugs such as Ca2 antag- rones and metabolism to false transmitter (α-methylnor- onists (see above). Large doses are associated with a lupus- adrenaline) which is an α2-adrenoceptor agonist. Moxonidine is another centrally acting drug: it acts for severe hypertension in this setting although nifedipine is on imidazoline receptors and is said to be better tolerated than now preferred by many obstetric physicians. Her blood pressure is events with an antihypertensive regimen of amlodipine adding 196/86mmHg. She had had a small stroke two years previ- perindopril as required versus atenolol adding bendroflumethi- ously, which was managed at home, and from which she azide as required, in the Anglo-Scandinavian Cardiac Outcomes made a complete recovery. She smokes ten cigarettes/day, does hypertensive patients randomized to doxazosin vs chlorthalidone – not drink any alcohol and takes no drugs. The remainder of The Antihypertensive and Lipid-Lowering Treatment to Prevent the examination is unremarkable. This patient’s blood pressure on two further hypertensive patients randomized to angiotensin-converting occasions is 176/84 and 186/82mmHg, respectively. Journal of the American Medical Association harm has been done already) and the suggestion of drug 2002; 288: 2981–97. Oxford: Blackwell Science, (e) An α1-blocker would be a sensible first choice of drug, 1994. Central imidazoline (I1) receptors as targets of cen- (f) Aspirin treatment should be considered. Comment Treating elderly patients with systolic hypertension reduces their excess risk of stroke and myocardial infarction. The absolute benefit of treatment is greatest in elderly people (in whom events are common). Treatment is particularly desirable as this patient made a good recovery from a stroke. She was strongly discouraged from smoking (by explaining that this would almost immediately reduce the risk of a fur- ther vascular event), but she was unable to stop. Continued smoking puts her at increased risk of stroke and she agreed to take bendroflumethiazide 2. Ischaemic heart disease is nearly always caused by atheroma (Chapter 27) in one or more of the coronary arteries. The object of defining these factors is to improve them in haemodynamics can reduce angina. This is in a constant stable pattern, but in some patients attacks occur at discussed in Chapters 27, 28 and 37.

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