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After picking up waste products from the filters inside the wall of the capsule buy cipro 500mg without a prescription, the capillaries come back together to form efferent arterioles cheap cipro line, which then branch to form the peritubular purchase cipro 500 mg otc, or second order cipro 1000 mg visa, capillary bed surrounding the convoluted tubules, the loop of Henle, and the collecting tubule. The capillaries come together once again to form a small vein that empties blood into the renal vein to depart the kidneys. Each glomerulus and its surrounding Bowman’s capsule make up a single renal corpus- cle where basic filtration takes place. Like all capillaries, glomeruli have thin, membra- nous walls, but unlike their capillary cousins elsewhere, these vessels have unusually large pores called fenestrations or fenestrae (from the Latin word fenestra for “window”). Focusing on filtering To understand how the renal corpuscles work, think of an espresso machine: Water is forced under pressure through a sieve containing ground coffee beans, and a filtrate called brewed coffee trickles out the other end. Hydrostatic pressure forces fluids across the glomerular membranes, which capture about 125 milliliters of material per minute in the Bowman’s capsules. So despite 125 milliliters of material coming out of the blood every minute, only 1 milliliter of urine is generated each minute. This is a matter of simple subtraction: Reabsorption of about 100 milliliters per minute takes place in the proximal convoluted tubules. The distal convoluted tubules return 12 milliliters, and the collecting tubules return about 5 milliliters. That totals 124 milliliters of reabsorption per minute and explains the 1 milliliter of urine that comes out when all is said and done. While all this filtering and absorption is going on, the kidneys also sometimes secrete an enzyme called renin (also known by its more complicated chemical name of angiotensinogenase) that converts a peptide generated in the liver, called angiotensino- gen, into angiotensin I. Try this explanation, instead: The kidneys work to ensure that systemic blood pressure remains high enough for them to do their filtering job properly. That’s what a vasoconstrictor is: a substance that causes blood vessels to narrow, increasing the pressure of the fluids moving through them. Rising blood pressure also triggers the adrenal glands perched atop each kidney to release aldosterone, causing the renal tubules to absorb more sodium and pumping up blood volume. The correct sequence for removal of material from the blood through the nephron is a. Afferent arteriole → Glomerulus → Proximal convoluted tubule → Loop of Henle → Distal convoluted tubule → Collecting tubule b. Afferent arteriole → Glomerulus → Distal convoluted tubule → Loop of Henle → Proximal convoluted tubule → Collecting tubule c. Afferent arteriole → Collecting tubule → Glomerulus → Proximal convoluted tubule → Loop of Henle → Distal convoluted tubule d. Efferent arteriole → Proximal convoluted tubule → Glomerulus → Loop of Henle → Distal convoluted tubule → Collecting tubule 11. Distal convoluted tubules Chapter 12: Filtering Out the Junk: The Urinary System 199 Getting Rid of the Waste After your kidneys filter out the junk, it’s time to deliver it to the bladder. Surfing the ureters Ureters are narrow, muscular tubes through which the collected waste travels. About 10 inches long, each ureter descends from a kidney to the posterior lower third of the bladder. Like the kidneys themselves, the ureters are behind the peritoneum outside the abdominal cavity, so the term retroperitoneal applies to them, too. It also has a middle layer of smooth muscle tissue that propels the urine by peristalsis — the same process that moves food through the digestive system. So rather than trickling into the bladder, urine arrives in small spurts as the muscular contractions force it down. The tube is surrounded by an outer fibrous layer of connective tissue that supports it during peristalsis. Ballooning the bladder The urinary bladder is a large muscular bag that lies in the pelvis behind the pubis bones. There are three openings in the bladder: two on the back side where the ureters enter and one on the front for the urethra, the tube that carries urine outside the body. The neck of the bladder surrounds the urethral attachment, and the internal sphincter (smooth muscle that pro- vides involuntary control) encircles the junction between the urethra and the bladder. When full, the bladder’s lining is smooth and stretched; when empty, the lining lies in a series of folds called rugae (just as the stomach does). When the bladder fills, the increased pressure stimulates the organ’s stretch receptors, prompting the individual to urinate. The male and female urethras Both males and females have a urethra, the tube that carries urine from the bladder to a body opening, or orifice. Both males and females have an internal sphincter con- trolled by the autonomic nervous system and composed of smooth muscle to guard the exit from the bladder. Both males and females also have an external sphincter com- posed of circular striated muscle that’s under voluntary control. The female urethra is about one and a half inches long and lies close to the vagina’s anterior (front) wall. The external sphinc- ter for the female urethra lies just inside the urethra’s exit point. Several openings appear in this region of the urethra, including a small opening where sperm from the vas deferens and ejacu- latory duct enters, and prostatic ducts where fluid from the prostate enters. The membranous urethra is a small 1- or 2-centimeter portion that contains the external sphincter and penetrates the pelvic floor. The cavernous urethra, also known as the spongy urethra, runs the length of the penis on its ventral surface through the corpus spongiosum, ending at a vertical slit at the end of the penis. The and urinary systems is complete in male urethra runs through the the human same “plumbing” as the male reproductive system. The internal sphincter found at the junction of the bladder neck and the urethra is composed of a. Smooth muscle tissue Spelling Relief: Urination Urination, known by the medical term micturition, occurs when the bladder is emptied through the urethra. Although urine is created continuously, it’s stored in the bladder until the individual finds a convenient time to release it. Mucus produced in the blad- der’s lining protects its walls from any acidic or alkaline effects of the stored urine. When there is about 200 milliliters of urine distending the bladder walls, stretch recep- tors transmit impulses to warn that the bladder is filling. Afferent impulses are trans- mitted to the spinal cord, and efferent impulses return to the bladder, forming a reflex arc that causes the internal sphincter to relax and the muscular layer of the bladder to contract, forcing urine into the urethra. The afferent impulses continue up the spinal cord to the brain, creating the urge to urinate. Because the external sphincter is com- posed of skeletal muscle tissue, no urine usually is released until the individual volun- tarily opens the sphincter. Renal artery Chapter 12: Filtering Out the Junk: The Urinary System 203 Answers to Questions on the Urinary System The following are answers to the practice questions presented in this chapter. Irregular sac-like structures for collecting urine in the renal pelvis e Collecting tubule: d. The other answer option can’t be correct because carbon dioxide exits the body through the lungs. Peritoneal refers to the peritoneum, the membrane lining the abdominal cavity; and retro can be defined as “situated behind. Each nephron contains a series of the parts needed to do the kidney’s filtering job. Afferent arteriole → Glomerulus → Proximal convoluted tubule → Loop of Henle → Distal convoluted tubule → Collecting tubule. In short, blood comes through the artery (arteriole) and material gloms onto the nephron before twisting through the near (proximal) tubes, loop- ing the loop, twisting through the distant (distal) tubes, and collecting itself at the other end. Those brush borders provide extra surface area for reabsorption, so it makes sense that they congregate in the first area after filtration. The glomerulus is a collection of capillaries with big pores, so think of it as the initial filtering sieve. These tubules have the most surface area with all those villi brush borders, so they reabsorb the most. The internal sphincter is smooth muscle tissue that prevents urine leakage from the bladder. We go with the guys first because — let’s face it — their biological role in reproduction isn’t as involved as women’s. Then we explain reproduction on the female side of the equation, including a review of the human life cycle from birth to death. But to survive as a species, Ia number of individuals must produce and nurture a next generation, carrying their uniqueness forward in the genetic pool.

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There is some evidence that tai c’hi improves the range of motion of the ankle purchase cipro mastercard, hip and knee in people with rheumatoid arthritis purchase genuine cipro on-line. A study showed that tai c’hi did not improve people’s ability to carry out household chores buy discount cipro on line, joint tenderness buy generic cipro on-line, grip strength or their number of swollen joints nor did it increase their symptoms of rheumatoid arthritis, but people felt that they improved when doing the exercises and enjoyed it. It is also not clear how much, how intense and for how long tai c’hi should be done to see benefits. No difference in balance, flexibility or the number of falls was observed between intervention and controls after 12 months. Based on qualitative theories and intersubjective methods, it involves predictions and therapies shown to be more accurate and effective than those of modern 182 | Traditional medicine medicine in fields from physiology and pharmacology to neuroscience, mind/body medicine and positive health. During the following century several physicians from India reinforced the teachings. Other influences came from Persian (Unani), Greek and Chinese medical systems, and it continues to be practised in Tibet, India, Nepal, Bhutan, Ladakh, Siberia, China and Mongolia, as well as more recently in parts of Europe and North America. It embraces the traditional Buddhist belief that all illness ultimately results from the ‘three poisons’ of the mind: ignorance, attachment and aversion. Tibetan medical theory states that it is necessary to maintain balance in the body’s three principles of function. The imbalances in an individual are revealed by a combination of reported symptoms, pulse diagnosis, tongue diagnosis, and urine analysis. The overall physical appearance of the person and information about their daily habits, and consideration of seasonal influences also contribute to the analysis. The Tibetan pulse diagnosis appears to be derived from the Chinese system, and is taken at the same artery of each wrist, but the method of feeling the pulse and the interpretations differ. Tongue diagnosis is simplified compared with the Chinese system (long disorders are characterised by red and dry tongue, chiba disorders by a yellowish tongue coating, and peigen disorders by a greyish and sticky coating with a smooth and moist texture). Urine analysis is unique to the Tibetan system and may have been introduced from Persia. Physicians inspect the colour, amount of vapour, sediment, smell and characteristics of the foam generated upon Traditional Chinese medicine | 183 stirring, relying on the first urine excreted in the morning. The modern materia medica of Tibet is derived from the book Jingzhu Bencao (The Pearl Herbs), published in 1835 by Dumar Danzhen- pengcuo. The text included 2294 materials, of which 1006 are of plant origin, 448 of animal origin and 840 minerals. The heavier reliance on minerals and animals than on plants, compared with other traditional medical traditions, can readily be understood for a country at such high altitude which is very rocky and supports only small areas of plant growth over much of the terrain. About one-third of the medicinal materials used in Tibetan formulae are unique to the Tibetan region (including the Himalayan area in bordering countries), whereas the other two-thirds of the materials are obtained from India and China. Although Tibetan herbal medicine includes the use of decoctions and powders, for the most part Tibetan doctors utilise pills that are usually made from a large number of herbs (typically 8–25 ingredients). Pills have the advantage of being easy to use and they can be prepared in advance at a medical facility where all the ingredients are gathered together. Due to the vast distances, rough terrain and limited development of Tibet, it was not possible to have the broad range of ingredients available to individual doctors who might compound formulae for decoction, as was often done in Figure 6. Instead, a relatively small variety of pills, prepared at central facili- ties, would be carried by the doctors to their patients. For many doctors, a collection of about two dozen principal formulae would have to suffice. In Lhasa, where there is a large manufacturing facility rivalling pharmaceutical manufacturing facilities in the west (Figure 6. In general, Tibetan remedies emphasise the use of spicy (acrid), aromatic and warming herbs. The climate has a substantial influence on these choices: the high altitude of Tibet means that cold and windy conditions prevail. Ayurvedic medicine relies heavily on spicy herbs for stimulating the digestive system functions, which is understood to be the key to health. Thus, among the commonly used Tibetan herbs are those derived mainly from the ayurvedic system, such as the peppers, cumins, cardamom, clove, ginger and other hot spices, comple- mented by local aromatics such as saussurea and musk. Also, the Tibetan system emphasises astringent herbs, possibly representing an attempt to conserve body fluids and alleviate any inflammation of the mucous membranes. The ‘king’ herb of Tibetan medicine is the chebulic myrobalan (Termi- nalia chebula), an astringent herb that is said to possess all the tastes (different parts of the fruit have different tastes), properties and effects. Despite this emphasis on herbs with properties that are generally needed for the Tibetan climate, cooling and bitter herbs are often required to treat the disease manifestation, as inflammatory processes finally result if the patho- genic influences are not conquered or expelled. Popular herbs used alone and in combination with other herbs are Tibetan rhodiola (Rhodiola rosea), known as stonecrop in the west, indicated for the treatment of dysentery, back pain, lung inflammation, painful and irregular menstruation, leukorrhoea and traumatic injuries, and Hippophae rhamnoides (sea buckthorn), claimed to be effective in treating ischaemic heart disease, eliminating phlegm, improving digestion and stopping coughs. Mongolia is one of the few countries that officially supports its traditional system of medicine. Although herbs are the mainstay of Mongolian medicine minerals, usually in the form of powdered metals or stones, are also used. Water is collected from any source, including the sea, and stored for many years Traditional Chinese medicine | 185 until ready for use. Traditional Bhutanese medicine The Himalayan kingdom of Bhutan is an independent state situated between China and India. It emerged as a unified polity in the early seventeenth century under the rule of an exiled Tibetan religious leader and much of its elite culture, including its medical traditions, were brought from Tibet during this period. Bhutan has evolved a state medical system in which their traditional medicine is an integral part and patients have the choice of treatment under traditional or biomedical practitioners. As with Chinese and Tibetan medicine, the main methods of diagnosis in Bhutanese traditional medicine are feeling the pulse, checking urine, and examining the eyes and tongue, as well as interviewing the patient. A European Union project to support traditional medicine in Bhutan was initi- ated in the year 2000. According to data collected as part of this project, there are about 600 medicinal plants used in Bhutanese traditional medi- cines, out of Bhutan’s 5600 identified species. About 300 of these herbs are used routinely and are at risk for ecological loss due to clearance of trees and over-collection of herbs. The quality of reporting of randomized controlled trials of traditional Chinese medicine: a survey of 13 randomly selected journals from mainland China. The Predicaments and Future of the Search for the Nature of Disease in Traditional Chinese Medicine. The State Administration of Traditional Chinese Medicine of the People’s Republic of China. Anthology of Policies, Laws and Regulations of the People’s Republic of China on Traditional Chinese Medicine. Complementary therapies in a local health care setting part 1: is there a real public demand? Miniscalpel-needle versus trigger-point injection for cervical myofascial pain syndrome: A randomised comparative trial (Letter). Fatal and adverse events from acupuncture: allegation, evidence and the implications. An outbreak of post-acupuncture cutaneous infection due to Mycobacterium abscessus. Broken needle in the cervical spine: A previously unreported complication of Xiaozendao acupuncture therapy. Acupuncture adverse effects are more than occasional case reports: results from questionnaires among 1135 randomly selected doctors and 297 acupuncturists. The effectiveness of acupuncture in the management of acute and chronic low back pain. Acupuncture for low back pain: results of a pilot study for a randomised controlled trial. A randomised controlled trial of acupuncture care for persistent low back pain: cost effectiveness analysis. The effectiveness of acupuncture in treating acute dental pain: a systematic review. Acupuncture for chronic headache in primary care: large, pragmatic, randomised trial. Randomised trial of acupuncture compared with conventional massage and ‘sham’ laser acupuncture for treatment of chronic neck pain.

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When the sample is large enough and the time frame long enough buy 500 mg cipro amex, the potential findings of such a study can provide rich and important information about how people change over time and the causes of those changes cheap cipro master card. The drawbacks of longitudinal studies include the cost and the difficulty of finding a large sample that can be tracked accurately over time and the time (many years) that it takes to get the data purchase generic cipro line. In addition buy cheap cipro 1000 mg, because the results are delayed over an extended period, the research questions posed at the beginning of the study may become less relevant over time as the research continues. Cross-sectional research designs represent an alternative to longitudinal designs. In a cross- sectional research design, age comparisons are made between samples of different people at different ages at one [37] time. In one example, Jang, Livesley, and Vernon (1996) studied two groups of identical and nonidentical (fraternal) twins, one group in their 20s and the other group in their 50s, to determine the influence of genetics on personality. They found that genetics played a more significant role in the older group of twins, suggesting that genetics became more significant for personality in later adulthood. Cross-sectional studies have a major advantage in that the scientist does not have to wait for years to pass to get results. On the other hand, the interpretation of the results in a cross-sectional study is not as clear as those from a longitudinal study, in which the same individuals are studied over time. Most important, the interpretations drawn from cross-sectional studies may be confounded by cohort effects. Cohort effects refer to the possibility that differences in cognition or behavior at two points in time may be caused by differences that are unrelated to the changes in age. The differences might instead be due to environmental factors that affect an entire age group. For [38] instance, in the study by Jang, Livesley, and Vernon (1996) that compared younger and older twins, cohort effects Attributed to Charles Stangor Saylor. The two groups of adults necessarily grew up in different time periods, and they may have been differentially influenced by societal experiences, such as economic hardship, the presence of wars, or the introduction of new technology. As a result, it is difficult in cross-sectional studies such as this one to determine whether the differences between the groups (e. Attachment styles refer to the security of this base and more generally to the type of relationship that people, and especially children, develop with those who are important to them. Give an example of a situation in which you or someone else might show cognitive assimilation and cognitive accommodation. Consider some examples of how Piaget’s and Vygotsky’s theories of cognitive development might be used by teachers who are teaching young children. Consider the attachment styles of some of your friends in terms of their relationships with their parents and other friends. Breast-fed infants respond to olfactory cues from their own mother and unfamiliar lactating females. Exploratory behavior in the development of perceiving, acting, and the acquiring of knowledge. Systems in development: Motor skill acquisition facilitates three- dimensional object completion. Young infants’ reasoning about hidden objects: Evidence from violation-of-expectation tasks with test trials only. From infant to child: The dynamics of cognitive change in the second year of life. Transforming schools into communities of thinking and learning about serious matters. Self-recognition in young children using delayed versus live feedback: Evidence of a developmental asynchrony. The development of self-esteem vulnerabilities: Social and cognitive factors in developmental psychopathology. The influence of temperament and mothering on attachment and exploration: An experimental manipulation of sensitive responsiveness among lower-class mothers with irritable infants. Attachment, maternal sensitivity, and infant temperament during the first year of life. Attachment security in infancy and early adulthood: A twenty-year longitudinal study. Forecasting friendship: How marital quality, maternal mood, and attachment security are linked to children’s peer relationships. The construction of experience: A longitudinal study of representation and behavior. Summarize the physical and cognitive changes that occur for boys and girls during adolescence. Adolescence is defined as the years between the onset of puberty and the beginning of adulthood. In the past, when people were likely to marry in their early 20s or younger, this period might have lasted only 10 years or less—starting roughly between ages 12 and 13 and ending by age 20, at which time the child got a job or went to work on the family farm, married, and started his or her own family. Today, children mature more slowly, move away from home at later ages, and maintain ties with their parents longer. For instance, children may go away to college but still receive financial support from parents, and they may come home on weekends or even to live for extended time periods. Thus the period between puberty and adulthood may well last into the late 20s, merging into adulthood itself. In fact, it is appropriate now to consider the period of adolescence and that of emerging adulthood (the ages between 18 and the middle or late 20s) together. During adolescence, the child continues to grow physically, cognitively, and emotionally, changing from a child into an adult. The body grows rapidly in size and the sexual and reproductive organs become fully functional. At the same time, as adolescents develop more advanced patterns of reasoning and a stronger sense of self, they seek to forge their own identities, developing important attachments with people other than their parents. Particularly in Western societies, where the need to forge a new independence is critical (Baumeister & Tice, [1] 1986; Twenge, 2006), this period can be stressful for many children, as it involves new emotions, the need to develop new social relationships, and an increasing sense of responsibility and independence. Although adolescence can be a time of stress for many teenagers, most of them weather the trials and tribulations successfully. For example, the majority of adolescents experiment with alcohol sometime before high school graduation. Although many will have been drunk at least once, relatively few teenagers will develop long-lasting drinking problems or permit alcohol to Attributed to Charles Stangor Saylor. Similarly, a great many teenagers break the law during adolescence, but very few young people develop criminal careers (Farrington, [2] 1995). The use of recreational drugs can have substantial negative consequences, and the likelihood of these problems (including dependence, addiction, and even brain damage) is significantly greater for young adults who begin using drugs at an early age. Physical Changes in Adolescence Adolescence begins with the onset of puberty, a developmental period in which hormonal changes cause rapid physical alterations in the body, culminating in sexual maturity. Although the timing varies to some degree across cultures, the average age range for reaching puberty is between 9 and 14 years for girls and between 10 and 17 years for boys (Marshall & Tanner, [3] 1986). Puberty begins when the pituitary gland begins to stimulate the production of the male sex hormone testosterone in boys and the female sex hormonesestrogen and progesterone in girls. The release of these sex hormones triggers the development of the primary sex characteristics, the sex organs concerned with reproduction (Figure 6. These changes include the enlargement of the testicles and the penis in boys and the development of the ovaries, uterus, and vagina in girls. In addition, secondary sex characteristics (features that distinguish the two sexes from each other but are not involved in reproduction) are also developing, such as an enlarged Adam‘s apple, a deeper voice, and pubic and underarm hair in boys and enlargement of the breasts, hips, and the appearance of pubic and underarm hair in girls (Figure 6. The enlargement of breasts is usually the first sign of puberty in girls and, on average, occurs between ages 10 and 12 [4] (Marshall & Tanner, 1986). Boys typically begin to grow facial hair between ages 14 and 16, and both boys and girls experience a rapid growth spurt during this stage. The growth spurt for girls usually occurs earlier than that for boys, with some boys continuing to grow into their 20s. A major milestone in puberty for girls is menarche, the first menstrual period, typically [5] experienced at around 12 or 13 years of age (Anderson, Dannal, & Must, 2003). The age of menarche varies substantially and is determined by genetics, as well as by diet and lifestyle, since a certain amount of body fat is needed to attain menarche. Girls who are very slim, who engage in strenuous athletic activities, or who are malnourished may begin to menstruate later. Even after menstruation begins, girls whose level of body fat drops below the critical level may stop having their periods. The sequence of events for puberty is more predictable than the age at which they occur.

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