By O. Musan. Pacific Northwest College of Art.

One contemporary physi- Although aromatherapy is usually considered cian helped a young girl with cancer to manage safe order eriacta no prescription erectile dysfunction doctor in pune, precautions must be taken by those with pain by administering a conventional pain medica- asthma (many oils can set off bronchial spasms) or tion accompanied by a whiff of rose oil with each allergies order eriacta 100mg without a prescription erectile dysfunction 5-htp, pregnant women (sage eriacta 100 mg overnight delivery impotence exercises for men, rosemary order genuine eriacta line impotence herbs, and dose. Eventually the girl needed only the fragrance juniper oils may trigger uterine contraction), and to feel relief from the pain. Throughout the history infants and young children, who may be hypersen- of psychology, it has been known that an odor sig- sitive to a potent essential oil. For aromatherapy organizations, attributes of creating art, and the Museum of see Appendix I. Art therapists believe that whatever his kind of work may be, he becomes an making art is a cathartic, healing experience, as inventive, searching, daring, self-expressive crea- well as an opportunity to release conscious or ture. He unconscious (and perhaps painful) feelings in an disturbs, upsets, enlightens, and opens ways for a atmosphere of “play. Where those who are not cuss the painting, collage, drawing, or sculpture, artists are trying to close the book, he opens it and for example, in a nonjudgmental, noncritical way, shows there are still more pages possible. According to The Power to Heal: rapid healing, and as a protective and preventive Ancient Arts & Modern Medicine (Prentice Hall Press, measure against illness” (from Healthy Healing: An New York, 1990), “Art critics and psychotherapists Alternative Healing Reference. The formula can adjust the massage and exercises according to for the flush consists of ascorbate vitamin C or the age and physical status of each client. Ester powder with bioflavonoids, one-half tea- The Aston Training Center may be contacted at spoon taken every 20 minutes to bowel tolerance P. Stypsis is the Greek word meaning to “use an astringent,” particularly asthi Bone, one of the seven dhatus (basic vital to stop bleeding. Developed by the dancer athma In Ayurvedic medicine, the soul or unique Judith Aston, who recovered from injuries sus- spirit that exists in the body and, after death, goes tained in two automobile accidents, Aston-Pattern- to another physical body. Specific techniques include “arc- ing,” or the flexion and extension of the entire attunement An aspect of Reiki training, often body, and “spiraling,” which is geared toward called Reiki initiation, in which students are cere- relaxation of painful muscles and joints, as well as monially brought into harmony, awareness, and other movements and exercise drills. Aston-Pat- responsiveness with the principles and techniques terning practitioners may also suggest that an indi- of Reiki practice. Sensory ing disorder, or cardiac, circulatory, or respiratory hallucinations may accompany an aura in paroxys- problems. Nor is it recommended for those on long- mal attacks; for example, the Dutch artist Vincent term steroid or anticoagulant therapy. Some other- van Gogh was said to suffer from epilepsy or some wise healthy people may experience fatigue and sort of seizure disorder (which could have been pain from the intense sessions or be emotionally linked to substance addiction and other problems), resistant to the training. A competent practitioner and he remembered after an attack was over that 12 auricular therapy he had seen the color yellow, an image that stayed (12) Super Learning—a combination of essences to with him a long time. Schultz, autogenic training aims to help individu- als deliberately control their autonomic nervous sys- auricular therapy A branch of traditional Chi- tem, the part of the entire nervous system that nese medicine that includes acupuncture, this type focuses on involuntary bodily functioning—the geared solely to the ear in order to treat headaches, heart, the smooth muscles, the adrenal medulla, and particularly migraines, arthritis, and stomach ail- the salivary, gastric, and sweat glands, among other ments, and for use as a pain-management option. It is the sympathetic system that the essences include (1) Alpine mint bush—for responds to stressors, and the parasympathetic sys- revitalization from mental and emotional exhaus- tem that induces relaxation. Stimulation of the parasympathetic nerves tal energies, and effects of old traumas; (6) Iso- produces a reduction in blood pressure, vasodila- pogon—for poor memory, premature senility, tion, pupillary contraction, thin saliva, and stubborn, and controlling personality, and inability reduced heart rate. The series of mental ance, and fluid retention; (8) Spinifex—for oral and exercises, performed three times daily for 15 min- genital herpes, chlamydia, cuts, scrapes, and other utes at a time, centers on certain words or phrases skin conditions; (9) Sturt Desert Pea—for deep sor- that, for the individual, will produce a relaxation row, emotional pain; (10) Sturt Desert Rose—for response. There are two groups of autogenic exer- guilt, lack of self-esteem, lack of morality or convic- cises; the first group has six exercises that use tion; (11) Radiation—a combination of essences to phrases (an example is “My arms are warm and help combat the effects of radiation therapy for can- heavy”) that prompt one’s attention to physiologi- cer, solar and nuclear radiation, electromagnetic cal changes brought about by relaxation. The sec- energies; negative environmental energies, and ond group, known as intentional exercises, is Ayurveda 13 geared to helping one release physical and emo- icine in New York; and the Richard and Hinda tional tension with activity such as crying, shout- Rosenthal Center for Alternative and Complemen- ing, on punching pillows. Training sessions, private tary Medicine at Columbia University in New York or in small groups, last an hour and continue for City. It has been reported that during include an evaluation of antitumor effects of Semi- the training some people experience an “autogenic carpus anacardium (an Ayurvedic phytomedicine, discharge,” a temporary exacerbation of symptoms, or plant extract). Initial reports over the last three which is considered part of the healing process. Further study clinical experiments and is said to be beneficial for seeks to determine whether semicarpus or other ailments that include anxiety and panic disorder, Ayurvedic medicine has the direct ability to kill hypertension, and other stress-related problems. Asthma, immune diseases, and various diseases Ayurveda Named from the Sanskrit word mean- and conditions that affect women are the subjects ing “knowledge of life,” a set of principles for of additional studies. A randomized, controlled healing based on the idea that three main types of cross-over-type study of an herbal-yoga treatment energy form everything in the universe, including regimen to treat asthma is under way at the Cen- the human body, and as the rudiments of life itself tral Council for Research in Ayurveda and Siddha must be considered in the cycle of growth, main- Medicine, and Ayurvedic herbal treatments for per- tenance, and deterioration. Ayurveda, most com- imenopausal symptoms, premenstrual syndrome, monly defined as the practice of ancient Hindu or and dysmenorrhea (painful menstruation) are Indian medicine, originates with the Vedas, the being researched at the Rosenthal Center. Ayurvedic herbal protocols are also under investi- In the Vedas are intricately described medical dis- gation for the treatment of hypertension, genital orders and corresponding treatments, most of herpes, depression, adult-onset diabetes, obesity, which are herbal but may also include simple sur- uterine fibroid tumors, acne, irritable bowel syn- gical procedures. It is said that Vedic physicians drome, chronic constipation, and chronic fatigue invented prostheses—artificial limbs and eyes. See current ers and collaboratively by those involved in tradi- research, http://niam. Selected reading for additional information The largest and most authentic resource of Lad, Dr. John in both traditional Western medicine and Bastyr College Publications, Seattle, Wash. New York: John Wiley & New Delhi, India; the Mount Sinai School of Med- Sons, 2001. The typical dose of a Bach’s tor, and homeopathic physician born in 1887 who flower tincture is four drops on or under the worked at the London Homeopathic Hospital in tongue as often as necessary. Another method for England and who between 1928 and 1932 set forth making flower tinctures is the sun method, in the seven major negative human emotions that which harvested blooms or parts of the plant are correspond with ill-being or illness and developed floated on water in a glass bowl and placed in the remedies (called nosodes, or homeopathic prepara- sunshine for three hours, after which only the tions) for them from specific flowers and plants. At age 43 Bach (pronounced “Batch”) became Bach wrote extensively on his flower remedies, disillusioned with standard medical practice and including the books Heal Thyself and The Twelve decided to pursue his belief that healing involved Healers and Other Remedies (both C. He also specified that after his death, no homeopathic concept of vibrational healing, he more essences were to be added to the 38 existing discovered through his patients that grief, frustra- remedies for the purpose of keeping the system as tion, anxiety, fear, despair, loneliness, and uncer- simple as possible, so individuals would be able to tainty contributed significantly to their physical diagnose their emotional problems and self-treat. For example, the typical beech tree grows to approximately 100 feet tall and its branches span Bach Flower Remedies In addition to being the approximately 80 feet. Bach concluded from this inspiration for several other flower remedies and other growth habits and traits of the beech that made in Australia, California, Europe, and else- its essence could encourage people who are intol- where, the original remedies that are believed to erant, critical, and nonempathetic to open non- employ the life force, or vibrations, of each flower judgmentally to the world’s beauty. To create his to help relieve negativity of varying nature, bal- remedy, he boiled leaves and twigs from the beech ance energy, and thereby encourage physical and tree in water, let them simmer and cool thereafter, emotional healing. Ballentine water Bach added a small amount of brandy (the wrote of flower remedies: “If you have ever tried standard mix per flower or plant substance is 50 to pick blackberries, you know it’s tricky. The milliliters (mL), or one-and-a-half fluid ounces, of vines are covered with sharp spines. The biggest the prepared water to 100 mL, or three fluid and most succulent berries always seem to be a ounces, of brandy). You work 15 16 Bach Flower Remedies your way in edgewise so you can reach a bit fur- such as tea, so the steam can make the alcohol ther. When cool, the drink may be sipped The long branches of the blackberry plant are throughout the day. No matter which actual part of the plant remains in the tincture— way you move, some of those thorns dig in are to be taken until the patient feels relief and deeper. The essence of the black- begins to notice the stimulus of his or her own berry flower is used as a remedy for those who are healing mechanism. Each flower or plant addresses at a point in their lives where they feel stuck— one or more emotional imbalances: unable to find a way to move. He was on the faculty of the Rescue Remedy is a combination of five flower Louisiana State University School of Medicine, essences: star of Bethlehem, rock rose, impatiens, Department of Psychiatry, and studied the cherry plum, and clematis. For 12 years used remedy, it treats feelings of panic, mental he served as president of the Himalayan Institute, numbness, shock, terror, fear of flying, response to and for 18 years as director of its Combined Ther- startling noise—any emotional state of emergency apy Program, in which he developed models of 18 Banerjee, P. This book was originally published in 1979): “The close interrelation between your 1931. The potential Barral visceral manipulation A system of body- exists for thought processes to lead both to disease work that is geared to releasing restrictions and and to good health. This has over his or her physical condition, as a start- therapy is reported to enhance the entire body’s ing point for the rationale of behavioral medicine. In addition, Barral’s to pain and pain relief, and that symptoms of cer- modality may facilitate the release of internalized tain diseases such as asthma, rheumatoid arthritis, emotion. He discovered that the organs have a and colitis are clearly at risk of being aggravated five- to eight-cycle-per-minute rhythm of move- by psychological stress. However, even then the risk nique involves the use of light, precise mechanical versus benefit principle should be applied. You force, which rebalances the organ and helps should not allow yourself to become convinced revive its normal function. Is it not foolish to spend healthy years worried about disease that Bates Method for Improving Eyesight A relax- is not present and may never occur? Many indi- ation system geared toward restoring the natural viduals in previous generations appeared to have use of the eyes and relearning to see developed by faith in their own health. There will be sity and of the College of Physicians and Surgeons enough time for you to work with your physician in New York, Bates practiced at Bellevue, Harlem and to learn how to adjust to an illness if it occurs. You have a right to expect to be as well as pos- the New York Eye Infirmary and taught ophthal- sible for as long as possible. In 1920, Bates wrote The Cure of Imperfect Eyesight by Treatment Without Glasses Beinfield, Harriet, and Korngold, Efrem Pio- (New York: Central Fixation Publishing Co. Bird), which presented his the- medicine in the United States and authors of ory that sight can be deliberately and naturally Between Heaven and Earth: A Guide to Chinese Medicine improved after being diminished by eyestrain, ten- (New York: Ballantine Books, 1991). An individual is connected to sensors that Network and a Harvard Medical School graduate. At a Benson, a medical doctor and chief of the Division time of stress, these signals are recorded by the of Behavioral Medicine at the Deaconess Hospital, machine to inform the person how the body han- teaches at Andover Newton Theological School and dled that stress. The goal of biofeedback is to help conducts medical research, lectures widely, and has recognize these reactions and learn to alter them written several books, including The Relaxation through relaxation techniques.

The diagnoses presented in this book are intended to be used as guidelines for construction of care plans that must be individualized for each client buy generic eriacta on line erectile dysfunction doctor in patna, based on the nursing assessment cheap 100 mg eriacta overnight delivery erectile dysfunction hypertension drugs. The interventions can also be used in areas in which interdisci- plinary treatment plans take the place of the nursing care plan cost of eriacta erectile dysfunction treatment in bangladesh. The Disorder: A definition and common types or categories that have been identified cheap eriacta 100 mg otc erectile dysfunction drugs for heart patients. Predisposing Factors: Information regarding theories of etiology, which the nurse may use in formulating the “re- lated to” portion of the nursing diagnosis, as it applies to the client. Symptomatology: Subjective and objective data identifying behaviors common to the disorder. These behaviors, as they apply to the individual client, may be pertinent to the “evi- denced by” portion of the nursing diagnosis. Possible Etiologies (“related to”): This section suggests possible causes for the problem identified. Note: Defining characteristics are replaced by “related/risk factors” for the “Risk for” diagnoses. Defining Characteristics (“evidenced by”): This section in- cludes signs and symptoms that may be evident to indicate that the problem exists. Goals/Objectives: These statements are made in client behav- ioral objective terminology. They are measurable, short- and long-term goals, to be used in evaluating the effectiveness of the nursing interventions in alleviating the identified problem. There may be more than one short-term goal, and they may be considered “stepping stones” to fulfillment of the long-term goal. For purposes of this book, “long-term,” in most instances, is designated as “by discharge from treatment,” whether the client is in an inpatient or outpatient setting. Interventions with Selected Rationales: Only those inter- ventions that are appropriate to a particular nursing diagno- sis within the context of the psychiatric setting are presented. Rationales for selected interventions are included to provide clarification beyond fundamental nursing knowledge, and to assist in the selection of appropriate interventions for indi- vidual clients. Important interventions related to communi- cation may be identified with the icon. Outcome Criteria: These are behavioral changes that can be used as criteria to determine the extent to which the nurs- ing diagnosis has been resolved. To use this book in the preparation of psychiatric nursing care plans, find the section in the text applicable to the client’s psychiatric diagnosis. Select nursing interventions and outcome criteria appropriate to the client for each nursing diagnosis identified. Include all of this information on the care plan, along with a date for evaluating the status of each problem. On the evaluation date, document success of the nursing inter- ventions in achieving the goals of care, using the desired client outcomes as criteria. Topics related to forensic nursing, psychiatric home nurs- ing care, and complementary therapies are also included. This information should facilitate use of the book for nurses adminis- tering psychotropic medications and also for nurse practitioners with prescriptive authority. Information is pre- sented related to indications, actions, contraindications and pre- cautions, interactions, route and dosage, and adverse reactions and side effects. Examples of medications in each chemical class are presented by generic and trade name, along with information about half-life, controlled and pregnancy categories, and avail- able forms of the medication. Nursing diagnoses related to each category, along with nursing interventions, and client and family education are included in each chapter. Another helpful feature of this text is the table in Appendix N, which lists some client behaviors commonly observed in the psychiatric setting and the most appropriate nursing diagnosis for each. It is hoped that this information will broaden the un- derstanding of the need to use a variety of nursing diagnoses in preparing the client treatment plan. The book is de- signed to be used as a quick reference in the preparation of care plans, with the expectation that additional information will be required for each nursing diagnosis as the nurse individualizes care for psychiatric clients. The nursing process has been identified as nursing’s scien- tific methodology for the delivery of nursing care. The curricula of most nursing schools include nursing process as a component of their conceptual frameworks. Diagnosis: Identifying the client’s health care needs and selecting goals of care 3. Outcome identification: Establishing criteria for measuring achievement of desired outcomes 4. Planning: Designing a strategy to achieve the goals established for client care 5. Implementation: Initiating and completing actions necessary to accomplish the goals 6. Evaluation: Determining the extent to which the goals of care have been achieved By following these six steps, the nurse has a systematic frame- work for decision-making and problem-solving in the delivery of nursing care. It is an ongoing process that continues for as long as the nurse and client have interactions directed toward change in the client’s physical or behavioral responses. In this step, the nurse identifies the human responses to actual or potential health problems. In some states, diagnosing is identi- fied within the Nurse Practice Acts as a legal responsibility of (Re)Assessment Evaluation Diagnosis Implementation Outcome Identification Planning Figure 1-1: The ongoing nursing process. Nursing diagnosis provides the basis for prescribing the specific interventions for which the nurse is accountable. The concept map care plan is an innovative approach to planning and organizing nursing care. Compared to the commonly used column-format care plans, concept map care plans are more succinct. They are practical, realistic, and time-saving, and they serve to enhance critical-thinking skills and clinical reasoning ability. The nursing process is foundational to developing and us- ing the concept map care plan, just as it is with all types of nursing care plans. Client data are collected and analyzed, nursing diagnoses are formulated, outcome criteria are identi- fied, nursing actions are planned and implemented, and the success of the interventions in meeting the outcome criteria is evaluated. The concept map care plan may be presented in its entirety on one page, or the assessment data and nursing diagnoses may appear in diagram format on one page, with outcomes, inter- ventions, and evaluation written on a second page. Additionally, the diagram may appear in circular format, with nursing diag- noses and interventions branching off the “client” in the center of the diagram. Or, it may begin with the “client” at the top of the diagram, with branches emanating in a linear fashion downward. As stated previously, the concept map care plan is based on the components of the nursing process. Accordingly, the diagram is assembled in the nursing process stepwise fashion, beginning with the client and his or her reason for needing care, nursing diagnoses with subjective and objective clinical evidence for each, nursing interventions, and outcome criteria for evaluation. Various colors may be used in the diagram to designate vari- ous components of the care plan. Lines are drawn to connect the various components to indicate any relationships that exist. Concept map care plans allow for a great deal of creativity on the part of the user, and they permit viewing the “whole picture” without generating a great deal of paperwork. Because they re- flect the steps of the nursing process, concept map care plans also are valuable guides for the documentation of client care. Doenges, Moorhouse, and Murr (2008) state, As students, you are asked to develop plans of care that often con- tain more detail than what you see in the hospital plans of care. This is to help you learn how to apply the nursing process and create individualized client care plans. However, even though much time and energy may be spent focusing on filling the col- umns of traditional clinical care plan forms, some students never develop a holistic view of their clients and fail to visualize how each client need interacts with other identified needs. A new tech- nique or learning tool [concept mapping] has been developed to assist you in visualizing the linkages, enhance your critical think- ing skills, and to facilitate the creative process of planning client care (p. The purpose of this book is to assist students and staff nurses as they endeavor to provide high-quality nursing care to their psychiatric clients. The following is an example of a nursing his- tory and assessment tool that may be used to gather informa- tion about the client during the assessment phase of the nursing process. Family configuration (use genograms): Family of origin: Present family: Family dynamics (describe significant relationships between family members): 2. This might include effects specific to gender, race, appearance, such as genetic physical defects, or any other factor related to genetics that is affecting the client’s adaptation that has not been mentioned elsewhere in this assessment. Environmental factors (family living arrange- ments, type of neighborhood, special working conditions): b. Health beliefs and practices (personal responsibility for health; special self-care practices): Nursing Process: One Step to Professionalism ● 7 c. Precipitating Event Describe the situation or events that precipitated this illness/ hospitalization: V. Anxiety level (circle level, and check the behaviors that apply): Mild Moderate Severe Panic Calm Friendly Passive Alert Perceives environment correctly Cooperative Impaired attention “Jittery” Unable to concentrate Hypervigilant Tremors Rapid speech Withdrawn Confused Disoriented Fearful Hyperventilating Misinterpreting the environment (hallucinations or delusions) Depersonalization Obsessions Compulsions Somatic complaints Excessive hyperactivity Other 2. Mood/affect (circle as many as apply): Happiness Sadness Dejection Despair Elation Euphoria Suspiciousness Apathy (little emotional tone) Anger/hostility 3. Ego defense mechanisms (describe how used by client): Projection Suppression Undoing Displacement Intellectualization Rationalization Denial Repression Nursing Process: One Step to Professionalism ● 9 Isolation Regression Reaction formation Splitting Religiosity Sublimation Compensation 4. Level of self-esteem (circle one): low moderate high Things client likes about self Things client would like to change about self Nurse’s objective assessment of self-esteem: Eye contact General appearance Personal hygiene Participation in group activities and interactions with others 5. Stage and manifestations of grief (circle one): Denial Anger Bargaining Depression Acceptance Describe the client’s behaviors that are associated with this stage of grieving in response to loss or change. Thought processes (circle as many as apply): Clear Logical Easy to follow Relevant Confused Blocking Delusional Rapid flow of thoughts Slowness in thought association Suspicious Recent memory: Loss Intact Remote memory: Loss Intact Other: 7.

Arecall memory test is a measure of explicit memory that involves bringing from memory information that has previously been remembered 100mg eriacta amex erectile dysfunction drug companies. We rely on our recall memory when we take an essay test buy line eriacta erectile dysfunction caused by performance anxiety, because the test requires us to generate previously remembered information cheap eriacta express impotence thesaurus. A multiple-choice test is an example of a recognition memory test buy eriacta with a mastercard erectile dysfunction watermelon, a measure of explicit memory that involves determining whether information has been seen or learned before. Recall, such as required on essay tests, involves two steps: first generating an answer and then determining whether it seems to be the correct one. Recognition, as on multiple-choice test, only involves determining which item from [2] a list seems most correct (Haist, Shimamura, & Squire, 1992). Although they involve different processes, recall and recognition memory measures tend to be correlated. Students who do better on a multiple-choice exam will also, by and large, do better on an essay exam (Bridgeman & [3] Morgan, 1996). Measures of relearning (or savings) assess how much more quickly information is processed or learned when it is studied again after it has already been learned but then forgotten. If you have taken some French courses in the past, for instance, you might have forgotten most of the vocabulary you learned. But if you were to work on your French again, you‘d learn the vocabulary much faster the second time around. Relearning can be a more sensitive measure of memory than either recall or recognition because it allows assessing memory in terms of “how much‖ or “how fast‖ rather than simply “correct‖ versus “incorrect‖ responses. Relearning also allows us to measure memory for procedures like driving a car or playing a piano piece, as well as memory for facts and figures. Implicit Memory While explicit memory consists of the things that we can consciously report that we know, implicit memory refers to knowledge that we cannot consciously access. However, implicit memory is nevertheless exceedingly important to us because it has a direct effect on our behavior. Implicit memory refers to the influence of experience on behavior, even if the individual is not aware of those influences. When we walk from one place to another, speak to another person in English, dial a cell phone, or play a video game, we are using procedural memory. Procedural memory allows us to perform complex tasks, even though we may not be able to explain to others how we do them. There is no way to tell someone how to ride a bicycle; a person has to learn by doing it. The ability to crawl, walk, and talk are procedures, and these skills are easily and efficiently developed while we are children despite the fact that as adults we have no conscious memory of having learned them. A second type of implicit memory is classical conditioning effects, in which we learn, often without effort or awareness, to associate neutral stimuli (such as a sound or a light) with another stimulus (such as food), which creates a naturally occurring response, such as enjoyment or salivation. The memory for the association is demonstrated when the conditioned stimulus (the sound) begins to create the same response as the unconditioned stimulus (the food) did before the learning. The final type of implicit memory is known as priming, or changes in behavior as a result of experiences that have happened frequently or recently. One measure of the influence of priming on implicit memory is the word fragment test, in which a person is asked to fill in missing letters to make words. You can try this yourself: First, try to complete the following word fragments, but work on each one for only three or four seconds. I think you might find that it is easier to complete fragments 1 and 3 as “library‖ and “book,‖ respectively, after you read the sentence than it was before you read it. However, reading the sentence didn‘t really help you to complete fragments 2 and 4 as “physician‖ and “chaise. Once a concept is primed it influences our behaviors, for instance, on word fragment tests. Seeing an advertisement for cigarettes may make us start smoking, seeing the flag of our home country may arouse our patriotism, and seeing a student from a rival school may arouse our competitive spirit. Research Focus: Priming Outside Awareness Influences Behavior One of the most important characteristics of implicit memories is that they are frequently formed and used automatically, without much effort or awareness on our part. In one demonstration of the automaticity and [5] influence of priming effects, John Bargh and his colleagues (Bargh, Chen, & Burrows, 1996) conducted a study in which they showed college students lists of five scrambled words, each of which they were to make into a sentence. Furthermore, for half of the research participants, the words were related to stereotypes of the elderly. These participants saw words such as the following: in Florida retired live people Attributed to Charles Stangor Saylor. The purpose of this task was to prime stereotypes of elderly people in memory for some of the participants but not for others. The experimenters then assessed whether the priming of elderly stereotypes would have any effect on the students‘ behavior—and indeed it did. When the research participant had gathered all of his or her belongings, thinking that the experiment was over, the experimenter thanked him or her for participating and gave directions to the closest elevator. Then, without the participants knowing it, the experimenters recorded the amount of time that the participant spent walking from the doorway of the experimental room toward the elevator. Automaticity of social behavior: Direct effects of trait construct and stereotype activation on action. These students had no awareness of the possibility that the words might have been related to the elderly or could have influenced their behavior. Stages of Memory: Sensory, Short-Term, and Long-Term Memory Another way of understanding memory is to think about it in terms of stages that describe the length of time that information remains available to us. But not all information makes it through all three stages; most of it is forgotten. Whether the information moves from shorter-duration memory into longer-duration memory or whether it is lost from memory entirely depends on how the information is attended to and processed. Sensory memory is a memory buffer that lasts only very briefly and then, unless it is attended to and passed on for more processing, is forgotten. The purpose of sensory memory is to give the brain some time to process the incoming sensations, and to allow us to see the world as an unbroken stream of events rather than as individual pieces. In his research, Sperling showed participants a display of letters in rows, similar to that shown in Figure 8. Then, Sperling gave his participants a recall test in which they were asked to name all the letters that they could remember. On average, the participants could remember only about one-quarter of the letters that they had seen. He found that when he cued the participants to report one of the three rows of letters, they could do it, even if the cue was given shortly after the display had been removed. Sperling reasoned that the participants had seen all the letters but could remember them only very briefly, making it impossible for them to report them all. To test this idea, in his next experiment he first showed the same letters, but then after the display had been removed, he signaled to the participants to report the letters from either the first, second, or third row. In this condition, the participants now reported almost all the letters in that row. This finding confirmed Sperling‘s hunch: Participants had access to all of the letters in their iconic memories, and if the task was short enough, they were able to report on the part of the display he asked them to. The “short enough‖ is the length of iconic memory, which turns out to be about 250 milliseconds (¼ of a second). In contrast to iconic memories, which decay very rapidly, echoic memories can last as long as 4 seconds (Cowan, Lichty, & Grove, [7] 1990). This is convenient as it allows you—among other things—to remember the words that you said at the beginning of a long sentence when you get to the end of it, and to take notes on your psychology professor‘s most recent statement even after he or she has finished saying it. In some people iconic memory seems to last longer, a phenomenon known as eidetic imagery (or “photographic memory‖) in which people can report details of an image over long periods of time. These people, who often suffer from psychological disorders such as autism, claim that they can “see‖ an image long after it has been presented, and can often report accurately on that image. There is also some evidence for eidetic memories in hearing; some people report that their echoic memories persist for unusually long periods of time. The composer Wolfgang Amadeus Mozart may have possessed eidetic memory for music, because even when he was very young and had not yet had a great deal of musical training, he could listen to long [8] compositions and then play them back almost perfectly (Solomon, 1995). Short-Term Memory Most of the information that gets into sensory memory is forgotten, but information that we turn our attention to, with the goal of remembering it, may pass into short-term memory. Imagine, for instance, that you are asked to participate in a task such as this one, which is a measure of working memory (Unsworth & Engle, Attributed to Charles Stangor Saylor. Each of the following questions appears individually on a computer screen and then disappears after you answer the question: Is 10 × 2 − 5 = 15? Then, after the six questions, you must list the letters that appeared in each of the trials in the correct order (in this case S, R, P, T, U, Q). But you also need a way to make the best use of your available attention and processing. For instance, you might decide to use a strategy of “repeat the letters twice, then quickly solve the next problem, and then repeat the letters twice again including the new one. The central executive will make use of whatever strategies seem to be best for the given task. For instance, the central executive will direct the rehearsal process, and at the same time direct the visual cortex to form an image of the list of letters in memory. Short-term memory is limited in both the length and the amount of information it can hold. Maintenance rehearsal is the process of repeating information mentally or out loud with the goal of keeping it in memory.

He suggested that the conscious patients were able to appraise their situation whereas the unconscious ones were not cheap eriacta 100mg without a prescription erectile dysfunction is often associated with quizlet. However cheap eriacta uk erectile dysfunction doctor near me, in contrast to these studies some research indicate that appraisal may not always be necessary buy generic eriacta 100mg on-line natural erectile dysfunction pills reviews. In line with this possibility some researchers have identified ‘repressors’ as a group of individuals who use selective inattention and forgetting to avoid stressful information (Roth and Cohen 1986) buy eriacta 100 mg online erectile dysfunction nclex. Such people show incongruence between their physiological state and their level of reported anxiety. For example, when confronted with a stressor they say ‘I am fine’ but their body is showing arousal. This suggests that although appraisal may be central to the stress response there may be some people in some situations who deny or repress their emotional response to a stressor. Lazarus has argued that an event needs to be appraised as stressful before it can elicit a stress response. It could be concluded from this that the nature of the event itself is irrelevant, it is all down to the individual’s own perception. However, research shows that some types of events are more likely to result in a stress response than others. Salient events: People often function in many different domains such as work, family and friends. For one person, work might be more salient whilst for another their family life might be more important. Swindle and Moos (1992) argued that stressors in salient domains of life are more stressful than those in more peripheral domains. Overload: Multitasking seems to result in more stress than the chance to focus on fewer tasks at any one time. Therefore a single stressor which adds to a background of other stressors will be appraised as more stressful than when the same stressor occurs in isolation – commonly known as the straw which broke the camel’s back. Ambiguous events: If an event is clearly defined then the person can efficiently develop a coping strategy. If however, the event is ambiguous and unclear then the person first has to spend time and energy considering what coping strategy is best. This is reflected in the work stress literature which illustrates that poor job control and role ambiguity in the workplace often result in a stress response. Uncontrollable events: If a stressor can be predicted and controlled then it is usually appraised as less stressful than a more random uncontrollable event. For example, experimental studies show that unpredictable loud bursts of noise are more stressful than predictable ones (Glass and Singer 1972). Self-control and stress Recently, theories of stress have emphasized forms of self-control as important in under- standing stress. This is illustrated in theories of self-efficacy, hardiness and feelings of mastery. In 1987, Lazarus and Folkman suggested that self-efficacy was a powerful factor for mediating the stress response. Self-efficacy refers to an individual’s feeling of confidence that they can perform a desired action. Research indicates that self-efficacy may have a role in mediating stress-induced immunosuppression and physiological changes such as blood pressure, heart rate and stress hormones (e. For example, the belief ‘I am confident that I can succeed in this exam’ may result in physiological changes that reduce the stress response. This shift towards emphasizing self-control is also illustrated by Kobasa’s concept of ‘hardiness’ (Kobasa et al. Hardiness was described as reflecting (a) personal feelings of control; (b) a desire to accept challenges; and (c) commitment. It has been argued that the degree of hardiness influences an individual’s appraisal of potential stressors and the resulting stress response. Accordingly, a feeling of being in control may contribute to the process of primary appraisal. Karasek and Theorell (1990) defined the term ‘feelings of mastery’, which reflected an individual’s control over their stress response. In summary, most current stress researchers consider stress the result of a person environment fit and emphasize the role of primary appraisal (‘is the event stressful? This research has highlighted two main groups of physiological changes (see Figure 10. This results in the production of catecholamines (adrenalin and noradrenalin, also known as epinephrine and norepinephrine) which cause changes in factors such as blood pressure, heart rate, sweating and pupil dilation and is experienced as a feeling of arousal. Catecholamines also have an effect on a range of the bodies tissues and can lead to changes in immune function. This results in the production of increased levels of corticosteroids the most important of which is cortisol which results in more diffuse changes such as the management of carbo- hydrate stores and inflammation. These changes constitute the background effect of stress and cannot be detected by the individual. They are similar to the alarm, resistance and exhaustion stages of stress described by Seyle (1956). In addition, raised levels of the brain opiods beta endorphin and enkaphalin have been found following stress which are involved in immune-related problems. The physiological aspects of the stress response are linked to stress reactivity, stress recovery, the allostatic load and stress resistance. Stress reactivity Changes in physiology are known as ‘stress reactivity’ and vary enormously between people. For example, some individuals respond to stressful events with high levels of sweating, raised blood pressure and heart rate whilst others show only a minimal response. This, in part, is due to whether the stressor is appraised as stressful (primary appraisal) and how the individual appraises their own coping resources (secondary appraisal). However, research also shows that some people are simply more reactive to stress than others, regardless of appraisal. Two people may show similar psychological reactions to stress but different physiological reactions. In particular, there is some evidence for gender differences in stress reactivity with men responding more strenu- ously to stressors than women and women showing smaller increases in blood pressure during stressful tasks than men (Stoney et al. Stress reactivity is thought to be dispositional and may either be genetic or a result of prenatal or childhood experiences. However, there is great variability in the rate of recovery both between individuals as some people recover more quickly than others and within the same individual across the lifespan. Allostatic load: Stress recovery is linked with allostatic load which was described by McEwan and Stellar (1993). They argued that the body’s physiological systems constantly fluctuate as the individual responds and recovers from stress, a state of allostasis, and that as time progresses recovery is less and less complete and the body is left increasingly depleted. Stress resistance: To reflect the observation that not all individuals react to stressors in the same way, researchers developed the concept of stress resistance to empha- size how some people remain healthy even when stressors occur (e. Stress resistance includes adaptive coping strategies, certain personality characteristic and social support. Stress reactivity, stress recovery, allostatic load and stress resistance all influence an individual’s reaction to a stressor. Laboratory setting Many stress researchers use the acute stress paradigm to assess stress reactivity and the stress response. This involves taking people into the laboratory and asking them either to complete a stressful task such as an intelligence test, a mathematical task, giving a public talk or watching a horror film or exposing them to an unpleasant event such as a loud noise, white light or a puff of air in the eye. The acute stress paradigm has enabled researchers to study gender differences in stress reactivity, the interrelationship between acute and chronic stress, the role of personality in the stress response and the impact of exercise on mediating stress related changes (e. Naturalistic setting Some researchers study stress in a more naturalistic environment. Naturalistic research also examines the impact of ongoing stressors such as work-related stress, normal ‘daily hassles’, poverty or marriage conflicts. These types of studies have provided important information on how people react to both acute and chronic stress in their everyday lives. Costs and benefits of different settings Both laboratory and naturalistic settings have their costs and benefits: 1. The degree of stressor delivered in the laboratory setting can be controlled so that differences in stress response can be attributed to aspects of the individual rather than to the stressor itself. Researchers can artificially manipulate aspects of the stressor in the laboratory to examine corresponding changes in physiological and psychological measures. Laboratory researchers can artificially manipulate mediating variables such as control and the presence or absence of social support to assess their impact on the stress response. The laboratory is an artificial environment which may produce a stress response which does not reflect that triggered by a more natural environment. Naturalistic settings allow researchers to study real stress and how people really cope with it. However, there are many other uncontrolled variables which the researcher needs to measure in order to control for it in the analysis. Physiological measures Physiological measures are mostly used in the laboratory as they involve participants being attached to monitors or having fluid samples taken. However, some ambulatory machines have been developed which can be attached to people as they carry on with their normal activities. They can also take blood, urine or saliva samples to test for changes in catecholamine and cortisol production. Self-report measures Researchers use a range of self-report measures to assess both chronic and acute stress. Self- report measures have been used to describe the impact of environmental factors on stress whereby stress is seen as the outcome variable (i. They have also been used to explore the impact of stress on the individual’s health status whereby stress in seen as the input variable (i.

Pneumonic plague: Ip is 1-3 days Profuse mucoid or bloody expectoration with signs of pneumonia 3 discount eriacta amex erectile dysfunction age 35. Septicemic plague Fever order 100mg eriacta amex why alcohol causes erectile dysfunction, vomiting order cheapest eriacta erectile dysfunction doctors in texas, diarrhea discount 100mg eriacta otc erectile dysfunction 25, hypotension, altered mentation, renal and heart failure, intra vascular coagulopathy Lab. Formalin-killed vaccine for travellers to hyperendemic areas and high risk persons Yersinia enterocolitica and Yersinia pseudotuberculosis Non-lactose fermenting gram negative rods Urease positive Oxidase negative Y. Human infection occurs by contaminated food and drinks from domestic animals or rodents Y. Human infection results from ingestion of food and drinks contaminated by animalfeces Antigenic structure. Diagnosis: Specimen: Stool, blood, rectal swab Culture: Grow in routine enteric media Biochemical tests for species identification Treatment: Fluid replacement for enterocolitis (Antibiotics not required) rd Cephalosporin (3 generation) + Aminoglycosides for sepsis/ meningitis Prevention and control: Conventional sanitary precautions 2. Found in human and animal intestine, water, soil and moist environment in hospitals. Invasive and toxigenic, produces infections in patients with abnormal host defenses Antigenic characteristic:. Exotoxin A: Cytotoxic by blocking protein synthesis Clinical features: Pathogenic only when introduced into areas devoid of normal defenses eg. Urinary tract infection- chronic, complicated Urinary tract infection and associated with indwelling catheter. Otitis externa- Malignant external ear infection in poorly treated diabetic patients. Laboratory diagnosis: Specimen: pus, urine, sputum, blood, eye swabs, surface swabs Smear: Gram-negative rods Culture:. Obligate aerobe, grows readily on all routine media over O wide range of temperature(5-42 C). Bluish-green pigmented large colonies with characteristic “fruity” odor on culture media. Species of medical importance: Vibrio cholerae-01 Vibrio cholerae Characteristics:. Readily killed by heat and drying; dies in polluted water but may survive in clean stagnant water, esp. All strains possess a distinctive O antigen and belong to subgroup I with subdivision into three serotypes; Ogawa, Inaba, Hikojima. ElTor biotype is more resistant to adverse conditions than Classical diotype of V. Little value in identification Clinical features: Route of infection is fecal-oral route. Laboratory diagnosis: Specimen: Stool flecks Smear: Gram-negative motile curved rods Motility of vibrios is best seen using dark-field microscopy. Presumptive diagnosis: Inactivation of vibrios in a wet preparation after adding vibrio antiserum. Observe for large yellow sucrose-fermenting colonies after 18-24 hrs of incubation. Stricly microaerophilic bactria requiring 5-10% o2 and 10% co2 enriched environment. Species of medical importance: 254 Campylobacter jejuni Campylobacter coli Campylobacter jejuni and Campylobacter coli Characteristics: ƒ Gram-negative non-spore forming motile rods with comma, S or ‘gull-wing’ shapes. Enterotoxin Clinical features: 4 Inoculum dose: 10 organisms Source of infection is contaminated food, drinks,and unpasteurized milk The organism multiply in small intestine, invade the epithellium and produce inflammation Campylobacter enteritis manifests with fever, headache, malaise, crampy abdominal pain and bloody mucoid diarrhea, and usually self-limited enteritis in a week period 255 Laboratory diagnosis: Specimen: Stool Microscopy: Typical ‘gull-wing’ shaped gram-negative rods. Typical darting motility of the bacteria under dark field microscopy or phase contrast microscopy Culture: Grow best at 420c on selective media but can be cultured at 37 oc. Watery and spreading or round and convex colonies on solid media at low oxygen tension. Treatment: Erythromycin Shorten the duration of fecal shedding of bacteria Helicobacter pylori General characteristics:. Spiral-shaped gram negative, microaerophilic, motile rods with polar flagella Antigenic structure: Pili Protease U rease Pathogenesis and clinical features: Route of entry: Ingestion of contaminated food and drinks Familial clustering of H. Diadnosis: Specimen: Gatric biopsy, serum Smear: Giemsa or silver stain Culture: Skirrow’s media Tanslucent colonies after 7 days of incubation Biochemical reaction:. Legionnaires disease: Pneumonic presentation with high fever, chills, dry cough, hypoxia, diarrhea, and altered mentation 2. Lack superoxide dismutase and catalase, and susceptible to the lethal effects of oxygen and oxygen radicals. Most anaerobic infections are caused by “moderately obligate anaerobes”, and polymicrobial in nature caused by combination of anaerobes, facultative anaerobes and aerobes. Gram negative Bacteroides fragilis group colon Prevotella melaninogenica Mouth Fusobacterium Mouth/Colon b. Gram positive Actinomyces Mouth Lactobacilli Vagina Propionibacterium Skin Clostridium Colon 2. Gram positive Peptostreptococci Colon clinical features: 260 Representative anaerobic infections Commonly isolated anaerobic bacteria Brain abscess Peptostreptococci Oropharyngeal infection Actinomyces P. Foul smelling discharge due to short chain fatty acid products of anaerobic metabolism. Fatty acid production Treatment: Antimicrobials + Surgery Clindamycin Metronidazole Cefotetan 262 Cefoxitin Piperacillin Penicillin 2. Source of infection: Tuberculous patients Route of infection: Respiratory- Inhalation of droplet nuclei Ingestion of infected milk Disease: Pulmonary and extrapulmonary tuberculosis The disease generally manifests with low-grade persistent fever, night sweating, significant weight loss, fatigue and generalized weakness. Used for observing colony morphology, susceptibility testing, and as selective media 2. Lowenstein-Jensen medium It is the ordinary selective media for tubercle bacilli Raised, dry, cream colored colonies of tubercle bacilli after 3-6 wks of incubation 264 3. Pasteurization of milk and milk products Mycobacterium leprae Characteristics: • Typical acid-fast bacilli, arranged in singly, parallel bundles or in globular masses. Foot pads of mice Armadillos Clinical features: Incubation period is months to years. Clinical triads: Anaesthetic skin patches 266 Peripheral neuritis Presence of acid-fast bacilli from skin lesion Two major types of leprosy 1. Comparison of the two types of leprosy Characteristics Lepromatous leprosy Tuberculoid leprosy 1. Usually positive Laboratory diagnosis: Specimen: Skin scrapings from the ear lobe. Non-viable bacilli stain poorly and unevenly as fragmented, beaded and granular red bacilli. When dry, hold fold of skin tightly between the thumb and forefinger until it becomes pale. Using the sterile blade, make a small cut through the skin surface, 5mm long and 2-3mm deep, where the bacteria is be found. Make a small circular smear of the tissue juice (Cover the cut with a small dressing). Wipe the back of the slide clean, and place in a draining rack for the smears to air-dry (protect from direct sun light). Most are soil saprophytes, but some are human pathogens responsible to cause actinomycosis nocardiosis and actinomycetoma. Large group of gram positive bacilli with a tendency to form chains and filaments. Endogenous members of the bacterial flora in the mouth and lower gastrointestinal tract Actinomycosis Chronic suppurative and granulomatous infection with interconnecting sinus tracts that contain sulfur granules Etiology: Actinomyces israeli Actinomyces naeslundii Characteristics:. Gram positive, facultative anaerobe substrate filaments that grow in co2 enriched condition Pathogenesis and clinical features:. Infection is initiated by trauma that introduces these endogenous bacteria into the mucosa 1. Cervico facial actinomycosis 270 Fluctuant mass with draining fistula in jaw area, and may extend to involve bone and lymphnodes in the head and neck 2. Thoracic actinomycosis Resemle subacute pulmonary infection with extension to chest wall and ribs 3. Abdominal actinomycosis May be secondary to ruptured appendix or ulcer with extensive involvement of abdominal organs Lab. Diagnosis: Specimen: Tissue, pus, sputum Smear: Gram-positive filaments with lobulated sulfur granules Culture: Thioglycolate broth or blood agar incubated anaerobically or co2 enriched condition Biochemical reacrion: Catalase positive/negative Treatment: Penicillin Clindamycin + Surgery Erythromycin Nocardiosis Etiology: Nocardia asteroides complex N. Aerobic gram positive, partially aci fast bacilli Pathogenesis and cloinical features: Route of transmission: Inhalation Usual presentation is subacute or chronic pulmonary infection with dissemination to the brain and skin Lab. Spirochete consist of protoplasmic cylinder bounded by a cell wall and outer membrane. There is an axial filament or endoflagella between the cell wall and outer membrane. Not cultured in artificial media, in fertilized eggs and tissue culture, but the saprophytic Reiter strain grows in anaerobic culture. Remain viable in the blood or plasma store at 4 c at least for 24 hrs (transmitted via blood transfusion) Antigenic structure:. Primary stage: Hard chancre: Clean-based, non-tender, indurated genital ulcer with inguinal lymphadenopathy. Secondary stage: Manifests with generalized maculopapular rash condylomata lata and white patches 274 in the mouth. There may be syphilitic meningitis, nephritis, periostitis, hepatitis and retinitis. Primary and secondary syphilis are rich in spirochete from the site of the lesion and patients are highly infectious. Early latent stage: Relapse of symptoms and signs occur, and patients are infectious. Tertiary stage: Manifesting with gumma(granulomatous lesion) in bone, skin and liver; meningovascular syphilis, syphilitic paresis, tabes dorsalis, syphilitic aortitis and aortic aneurysm. One third of cases seems spontaneously cured during primary and secondary syphilis but no clear evidence 2.

Some of these anaphylatoxins cause the release of vasoactive amines which increase vascular permeability (see also p order 100 mg eriacta with amex impotence vasectomy. Additional chemotactic activities attracts granulocytes which attempt to phagocytize the complexes eriacta 100mg without a prescription erectile dysfunction 23 years old. When these phagocytes die order discount eriacta impotence 25, their lysosomal hydrolytic en- zymes are released and cause further tissue damage safe 100 mg eriacta erectile dysfunction boyfriend. There are two basic patterns of immune complex pathogenesis: & Immune complexes in the presence of antigen excess. The acute form of this disease results in serum sickness, the chronic form leads to the de- velopment of arthritis or glomerulonephritis. Serum sickness often resulted from serum therapy used during the pre-antibiotic era, but now only occurs rarely. Inoculationwith equine antibodies directed against humanpathogens, or bacterial toxins, often induced the production of host (human) antibodies against the equine serum. Because relatively large amounts of equine serum were administered for such therapeutic purposes, such therapy would result Kayser, Medical Microbiology © 2005 Thieme All rights reserved. Usage subject to terms and conditions of license 114 2 Basic Principles of Immunology in the induction of antigen-antibody complexes—some of which were formed in the presence of antigen excess—and occasionally induced a state of shock. The so-called Arthus reaction is observed when an individual is exposed to repeated small 2 doses of an antigen over a long period of time, resulting in the induction of complexes and an antibody excess. Further exposure to the antigen, particu- larly dermal exposure, induces a typical reaction of edema and erythema which peaks after three to eight hours and disappears within 48 hours, but which sometimes leads to necrosis. Arthus-type reactions often represent occupational diseases in people exposed to repeated doses of environmental antigens: farmer’s lung (thermophilic Actinomyces in moldy hay), pigeon breeder’s lung (protein in the dust of dried feces of birds), cheese worker’s lung (spores of Penicillium casei), furrier’s lung (proteins from pelt hairs), malt-worker’s lung (spores of Aspergillus clavatus and A. This delayed skin reaction can serve as a test to confirm immunity against intracellular bacteria or parasites. Autoimmune T cells are usually directed against autoantigens that would otherwise be ignored (since they are only expressed in the extralymphatic periphery). Usage subject to terms and conditions of license Transplantation Immunity 115 basic protein in multiple sclerosis, against collagen determinants in poly- arthritis, and against islet cell components in diabetes. Interspecies re- jection is additionally contributed to by antibodies, and intolerance between complement activation mechanisms. Methods for reducing, or preventing, rejection include general immunosuppression, tolerance induction by means of cell chimerism, and sequestering of the transplanted cells or organ. This type of reaction results when immunologically respon- sive donor T cells are transferred to an allogeneic recipient who is unable to reject them (e. Usage subject to terms and conditions of license 116 2 Basic Principles of Immunology secondary lymphatic organs. Indeed the same foreign transplantation anti- gens are hardly immunogenic when expressed on fibroblasts or on epithelial or neuroendocrine cells, unless these cells are able to reach local lymphoid tissue. This can be achieved by using anti-T-cell antibo- dies, anti-lymphocyte antisera, and complement or magnetic bead cell-se- paration techniques. However, it is noteworthy that complete elimination of mature T cells leads to a reduction in the acceptance rate for bone marrow transplants, and that it may also weaken the anti-tumor effect of the trans- plant (desirable in leukemia). Bone Marrow Transplants Today & Reconstitution of immune defects involving B and T cells & Reconstitution of other lymphohematopoietic defects & Gene therapy via insertion of genes into lymphohematopoietic stem cells & Leukemia therapy with lethal elimination of tumor cells and reconstitution with histocompatible, purified stem cells, either autologous or allogenic. This also applies to transplants between monozygotic twins or genetically identical animals (syngeneic transplants). However, transplants between non-related or non-inbred animals of the same species (allogeneic transplants), and transplants between individuals of different species (xeno- geneic transplants) are immunologically rejected. These include the occurrence of natural cross-reactive antibodies, and a lack of complement in- activation by anti-complement factors (which are often species-incompatible and therefore absent in xenogeneic transplants), which together often results in hyperacute rejection within minutes, hours, or a few days—that is before any specific immune responses can even be induced. Three types of transplant rejection have been characterized: & Hyperacute rejection of vascularized transplants, occurring within min- utes to hours and resulting from preformed recipient antibodies reacting Kayser, Medical Microbiology © 2005 Thieme All rights reserved. Usage subject to terms and conditions of license Immune Defects and Immune Response Modulation 117 against antigens present on the donor endothelium, resulting in coagulation, thromboses, and infarctions with extensive necrosis. This is accompanied bya perivascular and prominent occurrence of T lymphocyte infiltrates. This is caused by low-level chronic T-cell responses, and can be mediated by cellular and hu- moral mechanisms. This can include obliterative vascular intima prolifera- tion, vasculitis, toxic, and immune complex glomerulonephritis. Methods of implanting foreign tissue cells or small organs strictly extralymphatically, without inducing immune responses, are currently undergoing clinical trials (i. Immune Defects and Immune Response Modulation & Immune defects are frequently acquired by therapy or viral infections, or as a consequence of advanced age. Immunomodulation can be attempted using interleukins or monoclonal antibodies directed against lymphocyte surface molecules or antigenic peptides. Immunostimulation is achieved using adjuvants or Kayser, Medical Microbiology © 2005 Thieme All rights reserved. Usage subject to terms and conditions of license 118 2 Basic Principles of Immunology the genetically engineered insertion of costimulatory molecules into tumor cells. Immunosuppression can be induced globally using drugs, or specifi- cally using antibodies, interleukins or soluble interleukin receptors; this can also be achieved by means of tolerance induction with proteins, peptides, or cell chimerism. More frequent congenital defects involve selective deficiencies, for example a relative-to-absolute IgA deficiency, normally being more prominent in in- fants than later in life. Childrenwith such deficiencies are more susceptible to infection with Haemophilus influenzae, pneumococci, and meningococci. General consequences of immune defects include recurring and unusual in- fections, eczemas, and diarrhea. Immunoregulation This area of immunology is difficult to define and remains elusive. Antigens represent the most important positive regulator of immunity; since there is simply no immune stimulation when antigens have been eliminated or are absent. In relatively rare cases, cyto- Kayser, Medical Microbiology © 2005 Thieme All rights reserved. Although attractive 2 hypothesis, for most cases such regulatory pathways have only proved dis- appointing theoretical concepts, and as such should no longer be employed in the explanation of immunoregulation. However such conditions probably fail to model normal situations, therefore they cannot accurately indicate whether these feedback mechanisms have a role in regulating the immune system as a whole. Immunostimulation The aim of immunological treatment of infections and tumors is to enhance immune responsiveness via the use of thymic hormones (thymopoietin, pen- tapeptides), leukocyte extracts, or interferons. Components of streptococci and Streptomyces, eluates and fractions of bacterial mixtures, and the related synthetic substance levami- sole are also used. The role of Toll-like receptors in these adjuvant effects is becoming increasingly understood, with a major role of these molecules being to link non-specific innate resistance to specific immunity. This concept utilizes local chronic or acute infections with the aim of achieving inflammation surrounding, or direct infection of, tumor cells re- sulting in their cytolytic destruction. Administration of monoclonal antibodies directed against adhesion mo- lecules and accessory molecules or cytokines and cytokine receptors. This method is sometimes used as a means of limiting cytomegaly or Epstein-Barr virus infection of bone marrow recipients. These are used as specific toxin transporters, administered directly, or with liposomes bearing anchored antibodies and containing a toxin or cytostatic drug. Usage subject to terms and conditions of license Immunological Test Methods 121 Immunological Test Methods Antigen and Antibody Assays 2 Immunoprecipitation in Liquids and Gels Immunoprecipitate. Maximum precipitation results when both reaction partners are present in an approximately equivalent ratio (Fig. In anti- body excess, or antigen excess, the amount of precipitate is considerably re- duced. This technique allows for a qua- litative evaluation of whether certain antibodies or antigens are present or not, plus determination of the degree of relationship between antibodies and antigens. It also provides information on whether different antigenic de- Immunoprecipitation Fig. The immune complexes are precipitated with the help of co-precipi- tating reagents (e. The precipitate is thoroughly washed to re- move unbound antigen, then dispersed into solu- tion once again (e. Usage subject to terms and conditions of license 122 2 Basic Principles of Immunology terminants are localized on the same, or on different, antigens; or whether different antibodies can bind to the same antigen (Fig. This is a quantitative antigen assay based on a predetermined standard curve (Fig. This method measures the amount of light scatter as a quan- tification of precipitation turbidity. The antibodies react by migrating in the gel, either without an electric field, or simultaneously within the electric field; and either in the same dimension as the antigens or in a second vertical step (“rocket” electrophoresis). In the first in- stance serum proteins are electrophoretically separated within a thin agarose gel layer. A trough is then cut into the agar, next to the separated sample and parallel to the direction of migration along the entire migration distance, and anti-serum is applied to the trough. The antibodies diffuse into the gel, and precipitation lines are formed wherever they encounter their antigens. The antigens and antibodies are pipetted into troughs within the gel and diffuse through this medium (the numbers des- ignate the epitopes present). Where they meet lines of precipitation (known as precipitin bands) develop, indicating immune complex formation. In b, three independent precipitin bands form, indicating that the antibodies differentiate three different epitopes on three different anti- gens.