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By K. Sugut. Fitchburg State College.

Specifically buy 0.4mg flomax fast delivery, if higher harmonics provide amplifica- tion of subtle high-frequency inputs discount flomax 0.2 mg on-line, they should facilitate the detection of these signals flomax 0.4 mg, e flomax 0.2mg low price. Where higher harmonics pose a potential challenge to the benefits of vibrissa resonance is in the place coding model of discrimination proposed above discount 0.4 mg flomax free shipping. Fundamental resonance frequencies and higher harmonics represented in the same position of the somatotopic map could create ambiguity in the interpretation of these signals by a sensing animal. That said, the pattern of positional activation — the specific regions of the map activated by a fundamental and higher harmonics — should still have a unique spatial signature that could be used to decode the frequency applied to the vibrissa. Thus, if higher harmonics are meaningfully expressed in relevant perceptual contexts, we predict that they will facilitate the detection of high frequency stimuli, and may contribute to or undermine the discrimination or identification of high frequency input. MODULATION OF WHISKING VELOCITY Rats may actively modulate their sensory exploration strategy to enhance or suppress the impact of vibrissa resonance. During whisking, rats typically engage in a series of bouts of whisking with significant variation in the rate of vibrissa motion between bouts. By searching over a variety of velocities, the rat can circumvent potential problems posed by the limited range of frequencies amplified by the vibrissa resonances expressed in a given sample of vibrissae. Further, comparison of activation evoked by faster or slower whisk cycles, combined with knowledge of the position of optimal activation within the pad (e. The suggestion that velocity modulation may assist perception of spatial textures through generation of different frequency inputs is consistent with recent studies of human perception of textured surfaces using a probe: Under these conditions, variation in the velocity of sampling is observed to impact roughness judgments. MODULATION OF VIBRISSA DAMPING Active sensing may also be engaged at the level of the follicle. Given that vibrissa resonance may not facilitate the perception of contact (or could even impair pro- cessing, for example, by introducing “ringing” in the system when precise contact times are desired), an intriguing hypothesis is that a perceiving rodent could modulate the expression of vibrissa resonance by regulating damping in the follicle (e. Initial calculations suggest that damping by the follicle would be particularly rele- vant for relatively shorter vibrissae, particularly microvibrisssae, but may not signifi- cantly affect the biomechanics of longer vibrissae. The follicle surrounding the base of a greek arc macrovibrissa, for example, occupies only ~0. As such, the longer posterior vibrissae may be more important for encoding airborne signals. TEMPORAL CODING AND VIBRISSA RESONANCE Vibrissa resonance is obviously not required for the vibrissa sensory system to demonstrate temporal coding of high frequency stimuli. Differential frequency amplification in response to sinuso- idal stimuli26 or to vibrissa contact with a complex surface,42 is more robust 10–100 msec following the onset of sensory stimulation. An even higher relative number of RSUs were observed to demonstrate tuning over the epoch from 100–500 msec, although the incidence of neurons driven by any frequency was decreased for this epoch. The onset response could encode initial vibrissa contact and/or somatotopic position, while the later sus- tained/developing response could encode the frequency of vibrissa motion. The map in SI may dynamically evolve over the first 100 msec, transitioning from a map representing space to one representing frequency. This temporal distribution of signals could help resolve an important ambiguity in the place code proposed above, specifically, that a given place in a map also has a somatotopic assignment in addition to a frequency meaning. Several other mechanisms, including the integration across multiple vibrissae in an isofrequency column, and fine temporal cues, could also help resolve this potential interpretive problem. The time constant that determines the rate of resonant amplification is not constant across vibrissae. Just as the biomechanical properties of the vibrissae generate a resonance frequency map, they also provide a latency gradient. Longer posterior vibrissae that possess lower frequency resonance tuning require a longer rise time and shorter anterior vibrissae a shorter rise time (Figure 2. The synchrony generated by their simul- taneous activation could enhance the neural representation of frequency-specific signals. This shift in onset latency as a function of position in a cortical map has precedent in the primate AI map, where a latency gradient is also observed although in AI it runs approximately perpendicular to the axis of the isofrequency bands. VIBRISSA RESONANCE AND FINE TIMING OF ACTION POTENTIAL ACTIVITY In addition to these larger timescale temporal implications of vibrissa biomechan- ics, vibrissa resonance may also affect the fine timing of peripheral and cortical neural activity. Vibrissa Resonance and Trigeminal Temporal Coding Several studies have described the temporal following properties of trigeminal ganglion neurons, suggesting that temporally precise high frequency information is represented in the initial processing of the vibrissa sensory system. This finding, together with an absence of firing away from the resonance peak in mean firing rate tuning curves, led to the observation of tuning of the temporal following properties of trigeminal neurons. Examples of high frequency following and tuning of trigeminal single units are shown in Figure 2. Top Peri-stimulus time histograms (PSTHs) are plotted as a function of frequency of stimulation (ordinate) and time (abscissa).

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Insert the knife handle effective flomax 0.4mg, and rotate it 90 degrees to open the hole in the membrane order 0.2 mg flomax mastercard. Alternatively 0.2mg flomax free shipping, a hemostat or tracheal spreader can be used to di- late the opening discount 0.4 mg flomax overnight delivery. Insert a small (5–7-mm) tracheostomy tube proven flomax 0.2 mg, inflate the balloon (if present), and secure in position with the attached cotton tapes. A surgical cricothyrotomy should be replaced with a formal tracheostomy after the pa- tient has been stabilized and generally within 24–36 h. Complications • Bleeding, esophageal perforation, subcutaneous emphysema, pneumomediastinum, and pneumothorax, CO2 retention (especially with the needle procedure) CULDOCENTESIS Indications • Diagnostic technique for problems of acute abdominal pain in the female 13 Bedside Procedures 265 • Evaluation of female patient with signs of hypovolemia and possible intraabdominal bleeding • Evaluation of ascites, especially in possible cases of gynecologic malignancy Materials • Speculum • Antiseptic swabs • Povidone–iodine or chlorhexidine • 1% lidocaine • 18–21-gauge spinal needle • 2 (10 mL) syringes and tenaculum Procedure 1. Culdocentesis should be preceded with a careful pelvic exam to document uterine posi- tion and rule out pelvic mass at risk of perforation by the culdocentesis. Inject 1% lidocaine submucosally in the posterior cervical fornix prior to tenaculum application. Traction is improved by application of the tenaculum to the posterior cervical lip. As you move the needle forward through the posterior cervical fornix, apply light pres- sure to the syringe until the air passes. Maintain traction on the tenaculum as you ad- vance the spinal needle to maximize the surface area of the cul de sac for needle entry. After intraabdominal entry, ask the patient to elevate herself on elbows to permit grav- ity drainage into the area of needle entry. Slow rotation of the needle followed by slow removal may enable a pocket of fluid to be 13 found and aspirated. If first culdocentesis attempt is not successful, the procedure can be repeated with a dif- ferent angle of approach. Although perforation of viscus is a possibility, the complication rate has been very low. Fresh blood that clots rapidly is probably secondary to traumatic tap, and the procedure can be repeated. If blood is aspirated, it should be spun for hematocrit and placed into an empty glass test tube to demonstrate the presence or absence of a clot. If pus is aspirated, send specimens for GC, aerobic, anaerobic, Chlamydia, Myco- plasma, and Ureaplasma cultures. Measure the pressures in the popliteal arteries by placing a BP cuff on the thigh. The pressures in the dorsalis pedis arteries (on the top of the foot) and the posterior tibial ar- teries (behind the medial malleolus) are determined with a BP cuff on the calf. Note: The Doppler cannot routinely determine the di- astolic pressure, and a palpable pulse need not be present to use the Doppler. It is equal to the pressure in the ankle (usually the posterior tibial) divided by the systolic pressure in the arm. Indications • Useful in the evaluation of chest pain and other cardiac conditions Materials 13 • ECG machine with paper and lead electrodes • Adhesive electrode pads Procedure 1. It is important to be- come acquainted with your particular machine prior to using it. Instruct the patient to lie as still as possible to cut down on artifacts in the tracing. The standard ECG machine has five lead wires, one for each limb and one for the chest leads. Newer machines have six precordial electrodes, which are all placed in the proper positions prior to performing the procedure. These may be color-coded in the following fashion: • RA: White—right arm • LA: Black—left arm • RL: Green—right leg • LL: Red—left leg • C: Brown—chest 13 Bedside Procedures 267 b. The limb electrodes are flat, rectangular plates held in place by rubber or Velcro straps that encircle the limb; newer machines may use self-adher- ing electrode pads. Place each electrode on the limb indicated, wrist or ankle, usu- ally on the ventral surface. In case of amputation or a cast, the lead may be placed on the shoulder or groin with almost no effect on the tracing.

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With local ceptors are stimulated discount flomax 0.4mg with visa, further release use cheap 0.4mg flomax, underperfusion of the vasocon- of norepinephrine is inhibited generic 0.4mg flomax with visa. Con- stricted area results in a lack of oxygen versely discount flomax 0.2 mg online, their blockade leads to uncon- (A) generic flomax 0.2mg without a prescription. In the extreme case, local hypoxia trolled release of norepinephrine with can lead to tissue necrosis. Howev- tance veins during change from the su- er, after vasoconstriction subsides, reac- pine to the erect position (orthostatic tive hyperemia causes renewed exuda- collapse: " venous return, " cardiac out- tion of plasma fluid into the interstitial put, fall in systemic pressure, " blood space, the nose is “stuffy” again, and the supply to CNS, syncope, p. Besides rebound congestion, may serve to lower tonus of smooth persistent use of a decongestant entails musculature in the prostatic region and the risk of atrophic damage caused by thereby facilitate micturition (p. This inhibition can be put to therapeutic use in antihypertensive treatment (vasodilation! Sympathetic these would exacerbate “anxiety” or activation gives rise to an increase in “stage fright”. When sympathetic Stage fright, however, is not a disease drive is eliminated during! As a rule, this basic struc- lytics are completely absorbed from the ture is linked to an aromatic nucleus by intestines and subsequently undergo a methylene and oxygen bridge. The presystemic elimination to a major ex- side chain C-atom bearing the hydroxyl tent (A). Variation of the cleus determines whether the com- molecule will create a new patentable pound possess intrinsic sympathomi- chemical, not necessarily a drug with a metic activity (ISA), that is, acts as a novel action. At the usual therapeutic dosage, the high con- centration required for these effects will not be reached. None of these blockers is sufficiently selective to per- Lüllmann, Color Atlas of Pharmacology © 2000 Thieme All rights reserved. Drugs Acting on the Sympathetic Nervous System 95 Isoproterenol Pindolol Propranolol Atenolol! To a lesser degree, release of epineph- Antiadrenergics are drugs capable of rine from the adrenal medulla is also lowering transmitter output from sym- impaired. Their action is hypotensive (indi- (“pharmacological sympathectomy”), cation: hypertension, p. Disorders of extra- permits rapid penetration through the pyramidal motor function with devel- blood-brain barrier. These adverse effects have ting of systemic arterial pressure at a rendered the drug practically obsolete. It is stored instead lease of both norepinephrine (NE) and of NE, but is unable to mimic the func- acetylcholine. Lassitude, dry mouth; es the axonal membrane, thereby im- rebound hypertension after abrupt ces- peding the propagation of impulses into sation of clonidine therapy. Stor- Methyldopa (dopa = dihydroxy- age and release of epinephrine from the phenylalanine), as an amino acid, is adrenal medulla are not affected, owing transported across the blood-brain bar- to the absence of a re-uptake process. Cardiovascular cri- of methyldopa competes for a portion of ses are a possible risk: emotional stress the available enzymatic activity, so that of the patient may cause sympatho- the rate of conversion of L-dopa to NE adrenal activation with epinephrine re- (via dopamine) is decreased. Reserpine, an alkaloid from the Rauwolfia plant, abolishes the vesicular storage of biogenic amines (NE, dopa- mine = DA, serotonin = 5-HT) by inhibit- ing an ATPase required for the vesicular amine pump. The amount of NE re- Lüllmann, Color Atlas of Pharmacology © 2000 Thieme All rights reserved. Inhibitors of sympathetic tone Lüllmann, Color Atlas of Pharmacology © 2000 Thieme All rights reserved. Parasympathetic outflow is chan- nelled from the brainstem (1) through Responses to activation of the para- the third cranial nerve (oculomotor n. Parasympathetic via the ciliary ganglion to the eye; (2) nerves regulate processes connected through the seventh cranial nerve (fa- with energy assimilation (food intake, cial n. Approximately 75% of all because of enhanced peristaltic activity parasympathetic fibers are contained and lowered tone of sphincteric mus- within the vagus nerve. To empty the urinary bladder (mic- the sacral division innervate the distal turition), wall tension is increased by colon, rectum, bladder, the distal ure- detrusor activation with a concurrent ters, and the external genitalia.

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Gram Stain Characteristics of Common Pathogens: Initial lab reports identify the Gram stain characteristics of the organisms buy 0.2 mg flomax mastercard. The lab algorithm for gram-positive and 7 Clinical Microbiology 123 Gram stain Gram stain + Cocci Rods (bacilli) Catalase + Catalase – (clusters) (chains) Clostridium (anaerobe) Staphylococcus Streptococcus Corynebacterium Listeria 7 Bacillus Coagulase + Coagulase – S order flomax 0.4mg free shipping. Clusters; catalase-positive Staphylococcus aureus Clusters; catalase-positive; coagulase- negative; beta-hemolytic; yellow pigment Staphylococcus epidermidis Clusters; catalase-positive; coagulase- positive; skin flora Staphylococcus saprophyticus Clusters; catalase-positive; coagulase- positive Streptococcus spp buy 0.2 mg flomax overnight delivery. Pairs buy flomax 0.2mg free shipping, chains; catalase-negative Streptococcus agalactiae (group B) Pairs discount flomax 0.4 mg on-line, chains; catalase-negative; vaginal flora Streptococcus bovis (group D Pairs, chains; catalase-negative Enterococcus) Streptococcus faecalis (group D Pairs, chains; catalase-negative Enterococcus) Streptococcus pneumoniae Pairs, lancet-shaped; alpha-hemolytic; (Pneumococcus, group B) Optochin-sensitive Streptococcus pyogenes (group A) Beta-hemolytic Streptococcus viridans Pairs, chains; catalase-negative; alpha- hemolytic, Optochin-resistant GRAM-NEGATIVE COCCI Acinetobacter spp. Filamentous, branching pattern Moraxella (Branhamella) Diplococci in pairs catarrhalis Neisseria gonorrhoeae Diplococci in pairs, often intracellular; (gonococcus) ferments glucose but not maltose Neisseria meningitidis Diplococci in pairs;ferments glucose (meningococcus) and maltose Veillonella spp. Common vaginal bacterium; anaerobic Listeria monocytogenes Beta-hemolytic Mycobacterium spp. Lactose-negative, oxidase-negative Aeromonas hydrophilia Lactose-negative (usually), oxidase- positive Bacteroides fragilis Anaerobic Bordetella pertussis Coccoid rod Brucella (brucellosis) Coccoid rod Citrobacter spp. Long, pointed shape; anaerobic Haemophilus ducreyi (chancroid) Gram-negative bacilli Haemophilus influenzae Coccoid rod, requires chocolate agar to support growth Klebsiella spp. Lactose-positive Legionella pneumophila Stains poorly, use silver stain and special media Morganella morganii Lactose-negative, oxidase-negative Proteus mirabilis Lactose-negative, oxidase-negative, indole-negative Proteus vulgaris Lactose-negative, oxidase-negative, indole-positive (continued) 7 Clinical Microbiology 127 TABLE 7–1 (Continued) Gram Staining Pattern and Organisms Identifying Key Features GRAM-NEGATIVE BACILLI Providencia spp. Lactose-negative, oxidase-negative Pseudomonas aeruginosa Lactose-negative, oxidase-positive blue-green pigment Salmonella spp. Lactose-negative, oxidase-negative 7 Serratia marcescens Lactose-negative, oxidative-negative, red pigment Shigella spp. Lactose-negative, oxidase-negative Stenotrophomonas (Xanthomonas) Lactose-negative, oxidase-negative maltophilia Vibrio cholerae (cholera) Gram-negative bacilli Yersinia enterocolitica Gram-negative bacilli Yersinia pestis (bubonic plague) Gram-negative bacilli *Organisms are aerobic unless otherwise specified. Gram stain characteristics of clinically important bacteria are shown in Table 7–1. India Ink Preparation India ink is used primarily on CSF to identify fungal organisms (especially cryptococci). KOH Preparation KOH (potassium hydroxide) preps are used to diagnose fungal infections. Skin scrapings of a lesion are usually obtained by gentle scraping with a #15 scalpel blade (see page 242 for description). A fishy odor from a vaginal prep suggests the presence of Gardnerella vaginalis (see page 291) 3. Put a coverslip over the specimen, and examine the slide for the branching hyphae and blastospores that indicate the presence of a fungus. If dense keratin and debris are present, allow the slide to sit for sev- eral hours and then repeat the microscopic examination. Lowering the substage con- denser provides better contrast between organisms and the background. The positive predictive value of the bacterial pathogen as a cause for the diarrhea is 70%. Mix a small amount of stool or mucus on a slide with 2 drops of Löeffler (methylene blue) stain. Mucus is preferred; if no mucus is present, use a small amount of stool from the outside of a formed stool. Examine the smear after 2–3 min to allow the white cells to take up the stain; then place a coverslip. Increased 7 white cells (usually polys) are seen in Shigella, Salmonella, Campylobacter, Clostridium difficile, and enteropathogenic Escherichia coli infections, as well as ulcerative colitis and pseudo-membranous colitis-related diarrhea. White cells are absent or normal in cholera and in Giardia and viral (rotavirus, Norwalk virus, etc) infections. Tzanck Smear This technique (named after Arnault Tzanck) is used in the diagnosis of herpesvirus infec- tions (ie, herpes zoster or simplex). Clean a vesicle (not a pustule or crusted lesion) with alcohol, allow it to air dry, and gently unroof it with a #15 scalpel blade. Giemsa stain can also be used, however, the sample must be fixed for 10 min with methyl alcohol before the Giemsa is applied. Then use high-power oil immersion to identify multinucleated giant cells (epithelial cells infected with herpes viruses).

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