alimentos que funcionam como viagra Canine FIGURE 1-11. can i buy viagra in soho recomendaciones para tomar viagra B It is interesting to note that the dentition of animals can be represented by the same type of formula as described earlier in this chapter. Look at the formulas for animals in Table 1-6 and note that cows have no upper incisors or upper canines. They have three upper and three lower premolars on each side. Did you know that dogs have twice as many premolars as humans if you include uppers and lowers, as well as the right and left sides? Did you know that the tusks on an elephant are maxillary central incisors? Elephants have the largest diastema in the world, large enough for the massive trunk between their central incisors. condom with viagra gel LEARNING EXERCISE 3 beach bar viagra 9.8 why does viagra give me a headache pfizer viagra case study Plus outline characteristics from facial also apply to lingual outline FIGURE 2-6. Within this section, maxillary central and lateral incisors are compared for similarities and differences. These traits are presented for each view of the tooth: facial, lingual, proximal (including mesial and distal), and incisal. what do viagra pills do to women Part 1 | Comparative Tooth Anatomy can you split viagra in half pom juice viagra 9.8 13.4 22.5 6.6 4-7 6.2 5.8 2.5 1.9 canines, the root curvature should not be used to differentiate rights and lefts. Mandibular canine roots are shorter than the roots of maxillary canines.I herbal viagra recipe Maxillary right canine 6 Maxillary left canine viagra potency pill GENERAL REFERENCES Taylor RMS. Variations in form of human teeth: II. An anthropologic and forensic study of maxillary canines. J Dent Res 1969;48:173–182. Web site: http://animaldiversity.ummz.umich.edu/site/topics/ mammal_anatomy/gallery_of_canines.html—University of Michigan Museum of Zoology Animal Diversity Web Gallery of Canines red viagra review 6. ROOTS OF MAXILLARY PREMOLARS FROM THE BUCCAL VIEW The apical end of the root of all single rooted premolars frequently bends distally, but these roots may also be straight or bend mesially.IG Most of the time, the maxillary first premolar is divided into a buccal and lingual root splitting off of a common trunk in the apical thirdH (seen best from the proximal view in Appendix 6h). The buccal roots frequently curve distally near the apex so you can see the tip of the lingual root when it is straighter or bends in a different direction than the buccal root. Both roots comprar viagra bcn TRAITS TO DIFFERENTIATE MAXILLARY RIGHT FROM LEFT PREMOLARS: UNIQUE FROM PROXIMAL VIEWS viagra not helping SECTION III viagra overdose symptoms treatment viagra injection therapy 2nd Premolars 1st Molars viagra experiences dose Crowns wider faciolingually than mesiodistal Oblique ridge present from mesiolingual to distobuccal One transverse ridge mesiobuccal to mesiolingual Parallelogram (or square) shape crown for four-cusp type Three-cusp seconds are heart shaped Four fossae: including large central and cigar-shaped distal Central groove in mesial half does not cross oblique ridge First molars have four cusps plus Carabelli cusp/groove First molars wider on lingual than buccal Second molars have four cusps or three cusps (heart shaped) Mesiolingual cusp much larger than distolingual different forms viagra Incisal third (near incisal edge) Incisal third Incisal/middle junction Middle third or occlusal/middle junction Middle third (near occlusal/middle junction) Occlusal/middle junction Occlusal/middle junction 142 viagra langkawi types of viagra medications 5 viagra te koop bij apotheek 3 1½ 1½ 3¼ 2¼ 3 Comparison of occlusal morphology of primary second molars compared to permanent first molars. The permanent first molars are located just distal to the primary second molars from about age 6 through 11 or 12 years old. Top: The permanent maxillary first molar is larger but otherwise similar to the primary maxillary second molar in overall shape, number of cusps (maybe even a cusp of Carabelli), grooves, ridges (including oblique), and fossae. Bottom: The permanent mandibular first molar is larger but otherwise similar to the primary mandibular second molar in overall shape, number of cusps, grooves, ridges, and fossae. The three buccal cusps, however, are more equal in size on the primary mandibular molar, whereas the distal cusp on the secondary first molar is obviously the smallest. acquisto viagra anonimo “H,” and the buccal groove (dividing the buccal cusps) combined with the distolingual groove (between the large mesiolingual and minute distolingual cusps) forms the distal side of the “H.” The buccal groove between the large mesiobuccal cusp and the indistinct distobuccal cusp is just a slight notch and does not extend onto the buccal surface (Appendix 10l). A groove between the two lingual cusps is present only when the distolingual cusp is definite. Roots of primary maxillary first molars: The three roots (mesiobuccal, distobuccal, and palatal) of the primary maxillary first molar are thin and slender and widely spread apart, with the root furcation very close to the cervical line, so there is very little root trunk (Appendix 10f). b. Unique Traits of Primary Mandibular First Molars Primary mandibular first molars do not resemble any other primary or secondary tooth (Fig. 6-21, teeth L and S, and Fig. 6-20). According to one author, the chief differentiating characteristic may be an overdeveloped mesial marginal ridge (Appendix 10q).9 Cusp size and shape on primary mandibular first molars: The primary mandibular first molar has four cusps. The cusps are often difficult to distinguish, but careful examination of an unworn tooth will reveal (in order of diminishing size) a mesiobuccal, mesiolingual, distobuccal, and the smallest (also shortest) distolingual cusp. The mesiobuccal cusp of the mandibular first molar is always the largest and longest cusp, occupying nearly two thirds of the buccal surface (Appendix 10t; Fig. 6-20A). This cusp is characteristically compressed buccolingually, and its two long cusp ridges extend mesially and distally, serving as a blade when occluding with the maxillary canine.7 The mesiolingual cusp is larger, longer, and sharper than the distolingual cusp. Ridges, grooves, and fossae of primary mandibular first molars: The mesial marginal ridge is so well developed that it resembles a cusp.3 This longer, prominent mesial marginal ridge is positioned more occlusally than the short, less prominent distal marginal ridge. (Compare mesial and distal views in Fig. 6-18 for marginal ridge heights and lengths.) There is also a prominent transverse ridge between the mesiobuccal and mesiolingual cusps (Appendix 10u and Fig. 6-21, teeth L and S). A central groove separates the mesiobuccal and mesiolingual cusps and connects with a shallow mesial marginal ridge groove. A short buccal depression (not really a distinct groove) separates the larger mesiobuccal cusp from the smaller distobuccal cusp but does not viagra sellers in india scary movie 3 viagra MAXILLARY FIRST MOLAR can a 17 year old take viagra Circle the correct answer(s). More than one answer may be correct. Unless otherwise stated, teeth are identified using the Universal Identification System. viagra clinical name 201 Bleeding on probing occurs when bacterial plaque affects the gingival sulcular epithelium, resulting in inflammation in the underlying connective tissue. Bleeding visible from the gingival margin after probing is an important indicator of inflammation (Figs. 7-24A,B and Fig. 7-10B,D,E). 1. TECHNIQUE TO DOCUMENT BLEEDING ON PROBING When bleeding is noted after probing several teeth, teeth that exhibit bleeding can be recorded at each probing site on the chart as a red dot above the probe depth. The percentage of sites that bleed can be calculated by dividing the number of bleeding sites by the number of total sites (where total sites equal the number of teeth present times six probe sites per tooth). Bleeding sites are charted in Figure 7-18, and a percentage has been calculated for four teeth. can you buy viagra in tijuana viagra shaped candy C A sani abacha viagra Chapter 9 | Functional Occlusion and Malocclusion can you mix xanax and viagra viagra siem reap FUNCTIONAL MOVEMENTS WHEN EATING: CHEWING AND SWALLOWING buy viagra topix 1. Horizontal overlap (H) of incisors and canines Using a mirror, measure the horizontal overlap (H in Fig. 9-37) in the following three locations while holding your teeth together in MIP (or on handheld tooth models with teeth tightly closed). 1a. ___ mm = horizontal overlap between the labial surfaces of central incisors at the midline 1b. ___ mm = horizontal overlap between labial surfaces of left canines 1c. ___ mm = horizontal overlap between labial surfaces of right canines first and second molars each have two facial cusps of approximately the same width, neither of which is as wide as the premolars or canine (Fig. B). viagra treatment for ms flomax and viagra together P. NONWORKING SIDE TOOTH RELATIONSHIPS harga viagra 100mg 37.7 8.5 17.0 9.9 26.9 can viagra be harmful 304 viagra in hand luggage 1. CLASS II CARIES: DEFINED Class II lesions form on the smooth proximal surface of posterior teeth just cervical to the proximal contact (Fig. 10-17A and B). It forms due to inadequate plaque removal in the hard to reach interproximal surfaces. Judicious use of dental floss to remove bacterial plaque what works the same as viagra FIGURE 10-28. viagra bei jungen menschen FIGURE 11-5. turkish natural viagra A Gemination. It appears that the left lateral incisor germ split or divided into two since, if that tooth is counted as two, there are five incisors (five arrows), one more than expected. The geminated tooth will generally have a single root and common pulp canal. The facial view is seen in A, and the incisal view of the same mouth is shown in B. FIGURE 11-11. organic viagra products 2. MISPLACED TEETH (TRANSPOSITION) Occasionally, the cells that form a tooth (tooth buds) seem to get out of place, causing teeth to emerge in unusual locations. The most common tooth involved is the maxillary canine seen in Figure 11-36 (20 of 25 cases reported),35 followed by the mandibular canine (Fig. 11-37). Maxillary canines can even be transposed to the central incisor region.36,37 3. TOOTH ROTATION Rotation is a rare anomaly, most common for the maxillary second premolar (Fig. 11-38), sometimes the maxillary incisor, first premolar, or mandibular second premolar.38 A tooth may be rotated on its axis by as much as 180°. 4. ANKYLOSIS Ankylosis [ang ki LO sis] may be initiated by an infection or trauma to the periodontal ligament, resulting in the loss of its periodontal ligament space so the tooth root is truly fused to the alveolar process or bone. These teeth is there a female viagra pill FIGURE 11-36. ruso muere por viagra wordpress viagra hack google B viagra official name Probe in pterygoid canal Infratemporal space Pterygopalatine space (maxillary nerve CN V) Palatine bone Lateral pterygoid plate of pterygoid process viagra 88 keys lyrics Human skull, left side: This lateral view shows the articulation of the bones of the temporomandibular joint, namely, the temporal bones and the mandible. The head of the condyle of the mandible is shaded yellow, and the blue line on the inferior border of the zygomatic process of the temporal bone outlines the concave mandibular (with its articular), fossa. A red line just anterior to it outlines the convex articular eminence. For the mandibular to move forward, the condyles guide the mandible down onto the articular eminence, so the mandible is depressed and the mouth opens. nd y viagra bilder lustig viagra femenino venta farmacias Review Questions pfizer vs teva viagra Buccal nerve (CN V) to cheek Retromolar fossa Lingula Mandibular foramen (inferior alveolar nerve, CN V) Mylohyoid groove (mylohyoid nerve) viagra meaning in tamil Part 3 | Anatomic Structures of the Oral Cavity The vestibule space between the teeth and the lips or cheeks can be divided into the labial vestibule next to the anterior teeth, and the buccal vestibule next to the posterior teeth (premolars and molars). It extends superiorly into a mucosa-lined space next to maxillary teeth, and inferiorly next to mandibular teeth. It is covered with dark pink-colored alveolar mucosa and is rich in blood vessels and minor salivary glands. The tip soft gel viagra tablets quanto custa o viagra em portugal FIGURE 15-7. viagra russian group wiki m Distal does viagra make you sleepy Distal o viagra vor oder nach dem essen how many deaths from viagra n. Mandibular first premolar buccal cusps are more pointed (110 degrees) versus on second premolar, where they are more obtuse or blunt (130 degrees) (facial views). o. Mesial proximal contacts (and marginal ridges) of mandibular second premolars are more occlusal than distal contacts (following the general rule), whereas the reverse is true on mandibular first premolars (EXCEPTION), where mesial contacts (and marginal ridges) are more cervical (facial views). p. Lingual cusps of mandibular first premolars are very small and nonfunctional. On second premolars, the lingual cusps function and are relatively longer (proximal views). q. Lingual cusp tips of mandibular second premolars are positioned to the mesial (or, if there are two lingual cusps, the mesiolingual is the more prominent) (lingual views). r. Mandibular first premolars have a mesiolingual groove separating the mesial marginal ridge from the lingual cusp. Second premolars (three-cusp type) have a lingual groove separating the two lingual cusps (lingual and mesial views). s. Mesial marginal ridges of first premolars slope cervically toward the lingual at about 45 degrees from horizontal. On second premolars they are more horizontal (mesial views). t. The mesial root surfaces of mandibular second premolars are the only premolar root surface (maxillary and mandibular, mesial and distal) not likely to have a midroot depression (best seen on models or actual teeth, not labeled in drawings). u. Mandibular first premolars are the only premolars that have the mesiolingual corner, with its mesiolingual groove and low marginal ridge, pinched or squeezed in, forming about a 45-degree angle with the lingual surface. This makes the occlusal outline somewhat diamond shaped (occlusal views). nitrolingual spray and viagra Sealing the pits and fissures just after tooth eruption may be the most important event in their resistance to caries. viagra hur fungerar det Conventional techniques: Visual observation Tactile inspection Radiography: • Intra-oral periapical radiographs • Bitewing radiographs We simply select the area of interest and the software automatically outlines any consistent alignment of radiolucent features directing our attention to the area of interest for closer examination. viagra inactive ingredients An upper paramedian or upper oblique abdominal incision can be extended through the 8th or 9th intercostal space, the diaphragm incised and an extensive exposure achieved of both upper abdomen and thorax. viagra generico rio de janeiro can you buy viagra over the counter in dubai wards throughout the liver substance, deﬁning the morphological left and right lobes. viagra super active erfahrung artery. This cross-connection means that ligation of the testicular artery is not necessarily followed by testicular atrophy. The pampiniform plexus of veins becomes a single vessel, the testicular vein, in the region of the internal ring. On the right this drains into the inferior vena cava, on the left into the renal vein. Obstetrical pelvic measurements (Fig. 95) halbe viagra nehmen Fig. 107◊The pelvic ligaments seen from above. viagra for copd treatment boots pharmacy viagra cost 169 (perilunate dislocation of the carpus). The dislocated carpus may then reduce spontaneously, only to push the lunate forward and tilt it over so that its distal articular surface faces forward (dislocation of the lunate). 2◊◊The scaphoid may be fractured by a fall on the palm with the hand abducted, in which position the scaphoid lies directly facing the radius. The blood supply of the scaphoid in one-third of cases enters distally along its waist so that, if the fracture is proximal, the blood supply to this small proximal fragment may be completely cut off with resultant aseptic necrosis of this portion of bone (Fig. 127). 3◊◊‘The carpal tunnel syndrome.’ The ﬂexor retinaculum forms the roof of a precio viagra farmacia guadalajara Part 4 The Lower Limb buying viagra in argentina 230 buy viagra bournemouth does expired viagra still work The femoral artery and vein enter the femoral triangle from beneath the inguinal ligament within a fascial tube termed the femoral sheath. This is derived from the extraperitoneal intra-abdominal fascia, its anterior wall arising from the transversalis fascia and its posterior wall from the fascia covering the iliacus. viagra word origin 1◊◊the superﬁcial epigastric vein; 2◊◊the superﬁcial circumﬂex iliac vein; 3◊◊the superﬁcial external pudendal vein. The superﬁcial epigastric vein communicates with the lateral thoracic tributary of the axillary vein via the thoracoepigastric vein. This dilates (and may become readily visible coursing over the trunk), following obstruction of the inferior vena cava. The great saphenous vein communicates with the deep venous system not only at the groin but also at a number of points along its course through perforating veins; one is usually present a hand’s breadth above, another a hand’s breadth below the knee. The skin of the medial aspect of the leg is drained to the deep veins by two or three direct perforating veins which pierce the deep fascia behind the great saphenous vein. 1◊◊The nasopharynx may be inspected indirectly by a mirror passed through the mouth (posterior rhinoscopy) or studied through a rhinoscope passed along the ﬂoor of the nose. Under anaesthesia, it can be palpated by a ﬁnger passed behind the soft palate. 2◊◊The nasopharyngeal tonsils (adenoids) are prominent in children but usually undergo atrophy after puberty. When chronically inﬂamed they may all but ﬁll the nasopharynx, causing mouth-breathing and also, by blocking the auditory tube, deafness and middle ear infection. 3◊◊The Eustachian tube provides a ready pathway of sepsis from the pharynx to the middle ear and accounts for the frequency with which otitis media complicates infections of the throat. 4◊◊The middle ear can be intubated through a catheter passed into the Eustachian tube. The catheter is passed along the nasal ﬂoor to the posterior wall of the nasopharynx. Its curved tip is then rotated laterally so that it lies in the pharyngeal recess; it is then withdrawn over the Eustachian cushion to slip into the oriﬁce of the auditory tube. is viagra really good Intervertebral disc with central nucleus pulposus Termination of spinal cord Fig. 233◊(a) Longitudinal section through the lumbar vertebrae showing a normal and a prolapsed intervertebral disc. (b) MRI through a normal lumbar spine and sacrum. Note the excellent anatomical details. Sacral promontory can girls have viagra mtf viagra Blood supply whats does viagra do The facial nerve (VII) viagra inventor albanian * Although the origin of the word scut is obscure, it probably represents an acronym for “some common unfinished task” or “some clinically useful training.” how long has viagra been around (See example page 31.) Should include entry date of problem, date of problem onset, problem number. (With initial problem list, the more severe problems are numbered first. After the initial list is generated, problems are added chronologically.) List problem by status: active or inactive. TO ENSURE BRAND NAME DISPENSING, PRESCRIBER MUST SPECIFY “DISPENSE AS WRITTEN” ON THE PRESCRIPTION.* *This can vary by state; some require that you write “Brand Medically Necessary” to specify a brand name and not a generic. virtual viagra hypnosis Male pattern baldness (alopecia, androgenic type in both men and women), trauma and hair pulling, congenital, tinea capitis, bacterial folliculitis, telogen arrest, anagen arrest (chemotherapy/radiation therapy), alopecia areata, discoid lupus smoking weed and taking viagra Clinician’s Pocket Reference, 9th Edition buy viagra sussex pfizer viagra annual sales 4 Laboratory Diagnosis: Chemistry, Immunology, and Serology Overnight Test: does viagra reduce refractory period herbal viagra suppliers australia 3–6 months Dehydration Nephrosis, (only known malnutricause) tion, chronic liver disease ThyroxineInflammation, Nephrosis, binding neoplasia α1-antiglobulin, trypsin antitrypsin, deficiency lipoproteins, (emphyglycoprotein, sema transcortin related) Haptoglobin, Inflammation, Severe liver glycoprotein, infection, disease, macroglobulin, neoplasia, acute ceruloplasmin cirrhosis hemolytic anemia Transferrin, Cirrhosis, Nephrosis glycoprotein, obstructive lipoprotein jaundice IgA, IgG, IgM, Infections, AgammaglobIgD, IgE collagen ulinemia, vascular hypodiseases, gammaleukemia, globulinemyeloma mia,nephrosis joomla viagra spam • 6.5–1.25 Practically speaking, the FTI is equivalent to the free thyroxine. Useful in patients with clinically suspected hyper- or hypothyroidism. Determined as follows: Thyroxine (Total T4) × T3 RU consecuencias de consumir viagra buy viagra cream men ZINC over the counter pills that work like viagra 4.73–5.49 [4.73–5.49] 4.15–4.87 [4.15–5.49] 4.8 4.7 4.6 4.5 4.6 4.7±0.9 5.1 5.1±1.0 viagra myasthenia gravis Autoimmune hemolytic anemia (leukemia, lymphoma, collagen–vascular diseases), hemolytic transfusion reaction, some drug sensitizations (methyldopa, levodopa, cephalosporins, penicillin, quinidine), hemolytic disease of the newborn (erythroblastosis fetalis) • Normal <30 µg albumin/mg creatinine Used to determine which patients with diabetes are at risk for nephropathy. Clinical albuminuria occurs at >300 µg albumin/mg creatinine. Base test on two or three separate determinations over 6 mo. Diabetic patients with levels between 30–300 µg have microalbuminuria and are usually initiated on ACE inhibitor or angiotensin receptor blocker. darf man viagra online bestellen Clinician’s Pocket Reference, 9th Edition viagra substitute for women taking out of date viagra 143 No dependable alternative Amphotericin B Potassium iodide 1–5 mL tid Amphotericin B what happens when viagra expires ↓ viagra hypertrophic cardiomyopathy how much is viagra in dubai Actual bicarbonate is 6 mmol/L, which is very close to the expected of 5 mmol/L. Thus, a pure metabolic gap acidosis is present from DKA. 170 340 680 1700 — — — 170 170 170 180 <10 170 170 how often can you take viagra 100mg Hypernatremia (Na+ >144 mEq/L [mmol/L]) Mechanisms: 9 has viagra killed anyone citalopram viagra interaction • Decreased motor strength, orthostatic hypotension, ileus • ECG changes, such as flattening of T waves, “U” wave becomes obvious (U wave is the upward deflection after the T wave.) viagra lot numbers Can Usually Receive* Blood From does viagra really work for men Platelet Transfusion Formula: viagra blindness 2012 COMMON INDICATIONS Maximum Daily Dose: Adults >50 kg: 100 mg iron; Peds <5 kg: 25 mg iron, 5–10 kg: 50 mg iron, 0–50 kg: 100 mg iron The iron–dextran is supplied in an injectable form of 50 mg (Fe)/mL. The calculated dose should be added to TPN at 2 mL/L until the entire dose has been given. viagra patent expiration date europe caution in monitoring total fluids to prevent overload. viagra teenager safe viagra sales 2008 Thoracic wall entry site Level of skin incision Intercostal muscles Pleura Intercostal vein, artery and nerve 13 13 viagra side effects stuffy nose Materials viagra protease inhibitors FIGURE 13–15 Basic anatomy for a lumbar puncture. viagra user ratings Clear or turbid Ͼ1.016 Ͼ3 g/100 mL Ͼ0.5 Ͼ0.6 Ͼ200 IU Ͼ1 Yes Ͼ1000/mm3 Ͼ2500/mm3 PMNs early, monocytes later Ͼ100 RBC/mm3 gloria viagra wiki Ileus does viagra enhance performance uso de viagra en diabeticos Draping the patient is usually done by the surgeon and assistants. Watch how they do it, and consider helping at a later date. It is harder to keep sterile than it looks. 18 Forced Vital Capacity (FVC): super viagra cream co diovan viagra Heart rate <60 bpm Heart rate >100 bpm fruit flavoured viagra with a regular PR and RR interval and a rate between 60 and 100 bpm (Figure 19–5) Normal sinus rhythm with a heart rate >100 bpm and <180 bpm (Figure 19–6) Clinical Correlations. Anxiety, exertion, pain, fever, hypoxia, hypotension, increased sympathetic tone (secondary to drugs with adrenergic effects [eg, epinephrine]), anticholinergic effect (eg, atropine), PE, COPD, AMI, CHF, hyperthyroidism, and others viagra doctor exam Multifocal atrial tachycardia. V1 viagra falls psych full episode 384 getting viagra in mexico what should i tell my doctor to get viagra Action what happens if you give viagra to a woman FIGURE 20–12 Functional residual capacity (FRC) and critical closing volume (CCV). TLC = total lung capacity; RV = residual volume. viagra 20mg preis 421 Ventilator Setting Changes black ant vs viagra Stress Ulceration i cant afford viagra Treatment who sells the best generic viagra The most commonly used agents are listed on the inside covers for quick reference. viagra multiple intercourse 1 mg/mL in 5-mL vial Adults. 5 mg slow IV q 5 min, total 15 mg viagra generika rezeptfrei apotheke viagra did nothing DOSAGE: Adults. IV bolus: 100 µg of 1:10,000 over 5–10 min. IV inf: 1–4 µg/min. Peds. IV inf: 0.1–0.3 µg/kg/min, max 1.5 µg/kg/min viagra hiv medication 469 reliable generic viagra sites DOSAGE: DOSAGE: can viagra kill sperm can you take viagra after drinking alcohol Immune System Agents 22 viagra generika 50mg kaufen does viagra jelly work Amrinone (Inocor) Used for emergency cardiac care (see Chapter 21) ACTIONS: DOSAGE: breaking viagra in half cost effectiveness of viagra Bisoprolol (Zebeta) Carbidopa/Levodopa (Sinemet) internationale apotheke viagra Adults. 250–500 mg PO tid–qid. Peds. 20 mg/kg/d in 3–4 ÷ doses Tabs 250, 500 mg; caps 250, 500 mg viagra overdose cartoon does viagra keep you erect after ejaculation Clorazepate (Tranxene) [C] Pernicious anemia and other vitamin B12 deficiency states Dietary supplement of vitamin B12 DOSAGE: Adults. 100 µg IM or SC qd for 5–10 d, then 100 µg IM 2×/wk for 1 mo, then 100 µg IM monthly. Peds. 100 µg/d IM or SC for 5–10 d, then 30–50 µg IM q 4 wk SUPPLIED: Tabs 25, 50, 100, 250, 500, 1000 µg; inj 30, 100, 1000 µg/mL NOTES: Oral absorption highly erratic, altered by many drugs and not recommended; for use with hyperalimentation (see Chapter 12) viagra anti geisha _______ mp3 viagra vendu en france Open-angle glaucoma α-Adrenergic agonist 1 gtt into eye q12h SUPPLIED: 0.1% soln viagra photosensitivity 22 COMMON USES: ACTIONS: cuantas veces puedo tomar viagra COMMON USES: ACTIONS: como usar el viagra yahoo COMMON USES: viagra information pack COMMON USES: ACTIONS: DOSAGE: viagra contraindications nitrates herbal viagra deutschland Nefazodone (Serzone) effexor and viagra together COMMON USES: ACTIONS: DOSAGE: Neomycin, Bacitracin and Polymyxin B (Neosporin Ointment) (see Bacitracin, Neomycin and Polymyxin, page 502) Neomycin, Colistin, and Hydrocortisone (Cortisporin-TC Otic Drops) Neomycin, Colistin, Hydrocortisone, and Thonzonium (Cortisporin-TC Otic Suspension) phuket pharmacy viagra strongest herbal viagra activity Psychotic disorders Dopamine and serotonin antagonist DOSAGE: ↑ to max of 20 mg/d SUPPLIED: Tabs 5, 7.5, 10 mg NOTES: May take many weeks to titrate to therapeutic dose; cigarette smoking will decrease levels can i take viagra with simvastatin COMMON USES: ACTIONS: DOSAGE: what over the counter pills work like viagra viagra for sale perth w a ACTIONS: DOSAGE: COMMON USES: diary of a viagra wife Arthritis and pain NSAID; inhibits prostaglandin synthesis DOSAGE: 150–200 mg bid SUPPLIED: Tabs 150, 200 mg viagra oil for men 6 7 8 9 10 viagra retail price walgreens ACTION: COMMON USES: can you take more than 100mg of viagra Tretinoin, Topical [Retinoic Acid] (Retin-A, Avita) TABLE 22–1 Quick Guide to Dosing of Acetaminophen Based on the Tylenol Product Line viagra cijena hrvatska Low Intermediate Intermediate how much does viagra go for on the street semangka viagra alami High viagra spanish translation 79 30 year old taking viagra OPP/OMT approach Education The number of training programs in massage has increased dramatically in the past decade, in part because of an increasing public demand for complementary approaches to health care. Currently, there are more than 800 massage training programs in the USA; education requirements for massage therapists vary from state to state12. Depending on the state and the individual institution, massage training programs may lead to a certificate, diploma or associate’s degree. At least one school in California (International Professional School of Bodywork) has offered a master’s degree in bodywork. Massage therapy schools teach communications skills, Eastern and Western bodywork modalities and philosophies, anatomy, physiology, pathology, kinesiology, business practices, ethics and first aid/cardiopulmonary resuscitation. In addition to classroom studies, students participate in supervised clinical internships. Some schools and colleges offer or require externships as well, which are typically conducted in hospitals, hospices, assisted care organizations, athletic departments and corporations3. Massage and bodywork schools throughout the country are accredited by several independent organizations including the Accrediting Commission of Career Schools and Colleges of Technology (ACCSCT), the Accrediting Council for Continuing Education and Training (ACCET), the Council on Occupational Education (COE) and the Commission on Massage Therapy Accreditation (COMTA). Credentialing In 2001, the American Massage Therapy Association estimated13 that there were between 260 000 and 290 000 massage therapists and massage students in the USA, about double the number estimated in 1996. Licensing requirements for massage therapists differ between states12. The National Certification Board for Therapeutic Massage and Bodywork (NCTMB) developed and administers the first national certification examination in therapeutic massage and bodywork, which is used by several states as a credentialing requirement. In 30 states plus the District of Columbia, massage therapists must be licensed, registered or certified by the state in order to practice14. In some states, including Massachusetts and California, regulations vary within the state (between townships, cities or counties). Most states require at least 500 hours of education to apply for permission to practice. Some states require ongoing continuing education credits in the field. Massage therapy referrals A recent study15 found that both patients and massage therapists believe that pain reduction is most affected by the therapist’s accurate choice of technique. Another recent investigation16 concluded that manual therapists (chiropractors) have different degrees of effectiveness even when utilizing the same technique. These studies suggest that specific training, experience and credentials contribute to a patient’s successful experience with massage. Kalauokalani and colleagues17 suggested that patients with positive expectations of massage are more likely to have a successful treatment experience (Figure 1). Referrals for professional members of the American Massage Therapy Association can be found through inquiries at viagra time limit Kidney Bladder ladies viagra videos Naturopathic medicine in neurological disorders el viagra hace mal al corazon viagra alternative philippines 210 viagra patient education Complementary therapies in neurology is pfizer viagra available in india Old Greeks: Hippocrates, Galen, Areteus Africa, South America: Shamanic traditions viagra 50 mg directions Non-prescription and non-pharmacological therapies for dementia quanto costa il viagra da 50 mg 32. Das A, Shanker G, Nath C, et al. A comparative study in rodents of standardized extracts of Bacopa monniera and Ginkgo biloba: anticholinesterase and cognitive enhancing activities. Pharmacol Biochem Behav 2002; 73: 893–900 33. Stackman RW, Eckenstein F, Frei B, et al. Prevention of age-related spatial memory deficits in a transgenic mouse model of Alzheimer’s disease by chronic ginkgo biloba treatments. Exp Neurol (in press) 34. Gohil K. Genomic response to herbal extracts: lessons from in vitro and in vivo studies with an extract of Ginkgo biloba. Biochem Pharmacol 2002; 64:913–l7 35. Frolich L, Riederer P. Free radical mechanisms in dementia of Alzheimer type and the potential for antioxidative treatment. Drug Res 1995; 45:443–6 36. Markesbery W. Oxidative stress hypothesis in Alzheimer’s disease. Free Radical Biol Med 1997; 23:134–47 37. Pitchumoni S, Doraiswamy M. Current status of antioxidant therapy of Alzheimer’s disease. J Am Geriatr Soc 1998; 46:1566–72 38. McGeer PL, Schulzer M, McGeer EG. Arthritis and anti-inflammatory agents as possible protective factors for Alzheimer’s disease. Neurology 1996; 47:425–32 39. McGeer PL, McGeer EG. The inflammatory response of brain: implications for therapy of Alzheimer disease and other neurodegenerative diseases. Brain Res Brain Res Rev 1995; 21: 195–218 40. Oken BS, Storzbach DM, Kaye JA. The efficacy of Ginkgo biloba on cognitive function in Alzheimer’s disease. Arch Neurol 1998; 55: 1409–15 41. Hofferberth B. The efficacy of EGb 761 in patients with senile dementia of the Alzheimer type; a double-blind placebo-controlled study on different levels of investigation. Hum Psychopharmacol 1994; 9:215–22 42. Wesnes K, Simmons D, Rook M, et al. A doubleblind placebo-controlled trial of tanakan in the treatment of idiopathic cognitive impairment on the elderly. Hum Psychopharmacol 1987; 2:159–69 43. Le Bars PL, Katz MM, Berman N, et al. A placebo-controlled, double-blind, randomized trial of an extract of Ginkgo biloba for dementia. J Am Med Assoc 1997; 278:1327–32 44. Kanowski S, Hermann WM, Stephan K, et al. Proof of efficacy of the Ginkgo biloba special extract EGb 761 in outpatients suffering from mild to moderate primary degenerative dementia of the Alzheimer type or multiinfarct dementia. Pharmacopsychiatry 1996; 29:47–56 45. Rai GS, Shovlin C, Wesnes KA. A doubleblind placebo controlled study of Ginkgo biloba extract (‘Tanakan’) in elderly outpatients with mild to moderate memory impairment. Curr Med Res Opin 1991; 12:350–5 46. Le Bars PL, Kieser M, Itil KZ. A 26-week analysis of a double-blind placebo-controlled trial of the Ginkgo biloba extract EGb761 in dementia. Dement Geriatr Cogn Disord 2000; 11:230–7 47. Maurer K, Ihl R, Dierks T, et al. Clinical efficacy of Ginkgo biloba special extract EGb 761 in dementia of the Alzheimer type. J Psychiatr Res 1997; 31:645–55 48. van Dongen M, van Rossum E, Kessels A, et al. The efficacy of ginkgo for elderly people with dementia and age-associated memory impairment: new results of a randomized clinical trial. J Am Geriatric Soc 2000; 48: 1183–94 49. Rigney U, Kimber S, Hindmarch I. The effects of acute doses of standardized Ginkgo biloba extract on memory and psychomotor performance in volunteers. Phytother Res 1999; 13:408–15 50. Wesnes KA, Ward T, McGinty A, et al. The memory enhancing effects of a Ginkgo biloba/ Panax ginseng combination in healthy middle-aged volunteers. Psychophamacology 2000; 152:353–61 51. Mix JA, Crews D, W Jr. A double-blind, placebo-controlled, randomized trial of Ginkgo biloba extract EGb 761 in a sample of cognitively intact older adults: neuropsychological findings. Hum Psychopharmacol 2002; 17:267–77 resveratrol viagra As expected, this study has generated a great deal of excitement in Parkinson’s disease patients. The author has received numerous phonecalls from our Parkinson’s disease patients who wish to be started on coenzyme Q10. Should every Parkinson’s disease subject be on coenzyme Q10? ‘Not just yet’, according to Dr Shults, the leading author of the study39. Dr Shultz emphasized that the findings were preliminary and that the Parkinson Study Group hopes to seek funding for a larger study with 400 patients. He recommended against endorsing coenzyme Q10 as a therapy because it is not regulated by the Food and Drug 5. Tu PH, Gurney ME, Julien JP, et al. Oxidative stress, mutant SOD1, and neurofilament pathology in transgenic mouse models of human motor neuron disease. Lab Invest 1997; 76:441–56 6. Engelhardt JI, Siklos L, Appel SH. Altered calcium homeostasis and ultrastructure in motoneurons of mice caused by passively transferred anti-motoneuronal IgG. J Neuropathol Exp Neurol 1997; 56:21–39 7. Siklos L, Engelhardt JI, Alexianu ME, et al. Intracellular calcium parallels motoneuron degeneration in SOD-1 mutant mice. J Neuropathol Exp Neurol 1998; 57:571–87. 8. Haverkamp LJ, Appel V, Appel SH. Natural history of amyotrophic lateral sclerosis in a database population: validation of a scoring system and a model for survival prediction. Brain 1995; 118:707–19 9. Engelhardt JI, Tajti J, Appel SH. Lymphocytic infiltrates in the spinal cord in amyotrophic lateral sclerosis. Arch Neurol 1993; 50:30–6 10. Younger DS, Rowland LP, Latov N, et al. Lymphoma, motor neuron diseases, and amyotrophic lateral sclerosis. Ann Neurol 1991; 29:78–86 11. Engelhardt JI, Appel SH. IgG reactivity in the spinal cord and motor cortex in amyotrophic sclerosis. Arch Neurol 1990; 47: 1210–16 12. Aguirre T, Van Den Bosch L, Goetschalckx K, et al. Increased sensitivity of fibroblasts from amyotrophic lateral sclerosis patients to oxidative stress. Ann Neurol 1998; 43:452–7 13. Rosenberg PA, Amin S, Leitner M. Glutamate uptake disguises neurotoxic potency of glutamate agonists in cerebral cortex in dissociated cell culture. J Neurosci 1992, 12:56–61 14. Carpenter S. Proximal axonal enlargement in motor neuron disease. Neurology 1968, 18: 841– 51 15. Cote F, Collard JF, Julien JP. Progressing neuronopathy in transgenic mice expressing the human neurofilament heavy gene: a mouse model of amyotrophic lateral sclerosis. Cell 1993, 73:35–46 16. Wong N, He BP, Strong MJ. Characterization of neuronal intermediate filament protein expression in cervical spinal motor neurons in sporadic amyotrophic lateral sclerosis (ALS). J Neuropathol Exp Neurol 2000; 59: 972–82 17. Bensimon G, Lacomblez L, Mekiinger V. A controlled trial of riluzole in amyotrophic lateral sclerosis. ALS/Riluzole Study Group (see comments). N Engl J Med 1994; 330:585–91 18. Lacomblez L, Bensimon G, Leigh PN, et al. Dose-ranging study of riluzole in amyotrophic lateral sclerosis. Amyotrophic lateral sclerosis/riluzole study group II (see comments). Lancet 1996; 347:1425–31 19. Miller RG, Rosenberg JA, Gelinas DF, et al. Practice parameter: the care of the patient with amyotrophic lateral sclerosis (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology: ALS Practice Parameters Task Force. Neurology 1999; 52:1311–23 20. Desport JC, Preux PM, Tmong TC, et al. Nutritional status is a prognostic factor for survival in ALS patients. Neurology 1999; 53: 1059–63 21. Newsom-Davis IC, Lyall RA, Leigh PN, et al. The effect of non-invasive positive pressure ventilation (NIPPV) on cognitive function in amyotrophic lateral sclerosis: a prospective study. J Neurol Neurosurg Psychiatry 2001; 71: 482–7 22. Kleopa KA, Sherman M, Neal B, et al. Bipap improves survival and rate of pulmonary function decline in patients with ALS. J Neurol Sci 1999; 164:82–8 23. Wasner M, Klier H, Borasio GD. The use of alternative medicine by patients with amyotrophic lateral sclerosis. J Neurol Sci 2001; 191:151–4 24. Carter O, Bromberg M. The use of herbal supplements and vitamins by patients with amyotrophic lateral sclerosis. ALS 2002; 3(suppl 2): 119 25. Meydani M. Vitamin E. Lancet 1995; 345: 170–5 26. Norris FH, Denys EH. Nutritional supplements in amyotrophic lateral sclerosis. Adv Exp Med Biol 1987; 209:183–9 huanarpo el viagra peruano viagra uses children improve when treated with the elimination diet. Detailed dietary information is available through the web site of the Feingold Association. INTRODUCTION The purpose of this chapter is to increase the awareness and knowledge regarding complementary and alternative medicine (CAM) and broadly defined psychiatric conditions in the hope of making this information relevant to the practice of clinical neurology. The claims, prevalent beliefs and research evidence for several commonly used treatments or practices will be summarized for the topics of anxiety, depression, schizophrenia, substance abuse and sexual dysfunction. Other topics generally included in psychiatric diagnostic categories such as dementia are covered in other portions of this book (see Chapter 18). The mental, emotional and behavioral characteristics of patients with neurological conditions can complicate the neurological diagnostic picture and influence the patient’s response to their condition as well as their response to treatment. The extensive use of CAM in the USA and in all parts of the world has been well documented, and physicians must be aware of CAM treatments and practices that also may influence the diagnostic picture as well as interfere with or potentiate standard medical treatments. The use of CAM by patients and the reasons for this use can reveal attitudes and beliefs regarding treatment of any kind. A recent survey by Astin indicated that CAM users found CAM to be more congruent with their values, beliefs and philosophical orientations toward health and life1. Thus, CAM utilization may serve as a means to achieve the understanding that is important in the establishment of rapport with patients and their families. In addition, there are a significant number of physicians who believe in the efficacy of at least some CAM treatments and refer patients to CAM practitioners, as well as practicing some CAM treatments themselves2. While these considerations are not ‘psychiatric’ in the sense that they are indicative of pathology, they are indicative of the ‘psychology’ of individuals and their referring physicians that may have a bearing on their attitudes and responses to their neurologic and co-morbid psychiatric conditions. This is particularly important when dealing with multicultural populations where the basic understanding and interpretation of broadly defined psychiatric conditions and characteristics may be considerably different from those of the majority population. prendre du viagra a 20 ans is chinese herbal viagra safe Transmission in the somatosensory system can be suppressed within the DH as a result of segmental and descending inhibitory controls. This inhibition can occur (Figure 3.2): 21 can you buy viagra over the counter in greece 5 viagra first sold mulher pode tomar viagra masculino • • • • 44 can u buy viagra over the counter in the uk viagra torte gedicht • • • These behavioural models have been rigorously characterized for their validity and reproducibility and are in common use today. They are however limited because the measurement of pain is often an approximation. Measurement involves a high degree of subjectivity between: billy ray charles viagra • viagra na recepte czy nie Actual pain match (49.0ºC) Predicted pain match (49.3ºC) Clinical pain rating (55) can i use viagra to last longer can taking viagra cause impotence • • 13 viagra substitute over the counter australia 3b 19 20 21 22 23 medicament similaire au viagra viagra hotline number (g) Intercostobrachial nerve (following breast surgery). (h) Saphenous and sural nerves (after varicose vein stripping). There is a strong correlation between the severity of post-operative pain and chronic pain following breast cancer surgery and thoracotomy. Minimising preand post-operative pain may reduce the incidence of long-term pain. Traumatic or surgery amputation is a frequent cause of chronic pain. In assessing pain post-amputation, it is useful to distinguish between phantom sensation, phantom pain and stump pain (Figure 15.2). viagra sell by date Pain severity is an important predictor. However, because pain severity is subjective, it is inﬂuenced by numerous factors other than physical pathology. Remifentanil Ester hydrolysis by Independent of renal Carboxylic acid derivative; 10–21 min non-speciﬁc and and hepatic clearance 300–1000x less potent plasma esterases; than the parent drug N-dealkylation is a very minor pathway Pethidine N-demethylation, hydrolysis Renal (1–25%) depending on urinary pH; not removed by dialysis Norpethidine has 50% the analgesic potency of pethidine; not removed by dialysis 2.4–7 h el viagra se vende bajo receta Clearly, many of these factors are present in ICU patients. When using NSAIDs prophylactic treatment for gastric ulceration should be given (proton pump inhibitors being more effective than antihistamines and sucrulfate). The use of cyclo-oxygenase (COX)-2 inhibitors in the critically ill warrants caution. It was hypothesized that they may have a lower risk of gastrointestinal complications (bleeding, perforation or obstruction) than traditional NSAIDs because the COX-2 isoform inhibitors have no effect on thromboxane adenosine type 2 receptors (A2) production. The CLASS and VIGOR studies (non-ICU patients) both showed unequivocal beneﬁt over traditional NSAIDs. However, COX-2 inhibitors are not ideal ICU agents. By decreasing prostaglandin I2 (PGI2) production they may tip the natural balance between prothrombotic thromboxane A2 and anti-thrombotic PGI2, thus potentially increasing thrombotic cardiovascular events. how to use viagra capsule for the patient by making sure that rescue analgesics are taken promptly. vegetable viagra pills Depletion of ATP can young guys take viagra viagra comprimidos 25 Persistence of local contractile activity viagra frei bestellen • • Research tests newt gingrich viagra of the normal range of reactions to pain, rather than the seeking of psychopathology. donde venden viagra en mexico Tricyclic antidepressants or antiepileptics in neuropathic pain. High dose steroids for raised intracranial pressure headache. dr frost viagra Management of post-operative pain does viagra really work men • va hospital viagra The treatment components of established CRPS should be directed at the predominant pathology (Table 25.4). The most recent review of therapeutic strategies was performed by Kingery (1997): viagra yang aman viagra annual sales 2010 Preventative can you take viagra with antidepressants • does viagra cause acne Key points viagra x ray backscatter • • An NNT of 1 describes an event that occurs in every patient given the treatment, but in no patient in a comparator group. This could be described as the donde puedo conseguir pastillas viagra 257 disadvantages of taking viagra medicament equivalent au viagra Orphanin FQ is viagra legal in china Table 40.4 Functional classiﬁcation of drugs acting at opioid receptors Functional type Pure MOP agonists Partial MOP agonists Agonist/antagonist at KOP/MOP Action at several receptor/ channel sites Examples Morphine, fentanyl Buprenorphine (also acts at KOP) Pentazocine Tramadol, pethidine hercules viagra The majority of opioid drugs in use are MOP agonists. In an attempt to avoid some of the unwanted actions of the pure agonist, partial agonists and does nitric oxide work like viagra Euthanasia does viagra work without stimulation Ethical considerations in pain research Key points national viagra day Guidelines may be helpful in optimising riskbeneﬁt ratios and decreasing practice variation (where appropriate). For local guidelines to be effective: – Development should utilise known evidence/ regional guidelines and include all likely users. – Dissemination must be actively pursued. – Implementation will require regular audit feedback. – Review dates should be incorporated at the outset. viagra canadian pharmacy problems Pain of recent onset and (probably) limited duration, usually having an identiﬁed temporal and causal relationship to injury or disease. Used to describe conditions, such as post-operative pain, pain following trauma or pain associated with acute exacerbations of chronic pancreatitis or sickle cell disease. Nerve transmitting information from the periphery to the central nervous system. Pain producing substance. A normally non-painful stimulus is perceived as painful (humans), for example light touch can become painful after a burn. Or, in animals, a lower level of stimulus than normal induces nociceptive behaviour. A negatively charged ion. Nerve impulses propagated in direction opposite to that in which the ﬁbre usually conducts. Method by which a cell secretes a substance which effects changes upon its own behaviour. Transection or severing of an axon. Commonly leads to nerve cell death. A positively charged ion. Pain that persists beyond the point at which healing would be expected to be complete, or that occurring in disease processes in which healing does not take place. It may be accompanied by severe psychological and social disturbance. Patients with no evidence of tissue damage may experience chronic pain. A diagnostic term that usually implies a persisting pattern of pain that may have arisen from organic causes, but which is now compounded by psychological and social problems and behavioural changes. Small proteins secreted by cells as intra-cellular messengers. Differ from hormones in that they are released from a variety of cells, rather than specialised glands. Usually act in autocrine or paracrine fashion (not endocrine). Nerve transmitting information from the central nervous system to the periphery. Inﬂammation of the attachment of a tendon to a bone. Having a varied chemical composition. The perception of a painful stimulus as more painful than usual in humans, or a more intense behavioural response observed in animals than usual for a given nociceptive stimulus. Increased sensitivity to stimulation. cheap viagra gels INTRODUCTION positive side effects of viagra 39 what happens if you take viagra with alcohol solely based on some symptoms resolution may create further problems including a second brain injury with all these consequences including fatality. The major problem with return-to-play criteria is related to the lack of prospective experimental data on individual responses to concussion. For instance, neuropsychological data (such memory and other cognitive scores) and subjective symptoms reported by injured athletes are often uncorrelated. Moreover, symptom reports document variability in patient responses, even though they experience a similar type of concussive blow. A more complex situation is observed when athletes have experienced two or more concussive blows. Following multiple brain injuries, symptoms resolution and recovery from injury are quite individual and most often unpredictable. Therefore, it is a real challenge for medical practitioners to make a decision regarding the time at which injured athletes are ready for a safe return to sport participation. There are many factors that should be taken into consideration before allowing an athlete to return to play after a concussion. Among these are: clinical history, number of previous concussions, severity of previous brain injuries, current results of clinical evaluation, etc. In general, if an athlete has any symptoms on the field or outside, this athlete should not be allowed to resume athletic practices, especially in contact sports. Another general rule that should be observed, is that criteria for return to sport participation in asymptomatic athletes should be the same for all sports, regardless of the degree of contact or use of protective devices. If neuropsychological evaluation is used, special caution should be exercised by medical practitioners, because the athlete's motivation, peer pressure or pressure from coaching staff may be a serious confounding factor. In fact, I am pleased that a special chapter in this book is devoted to the issue of athletes' motivation during neuropsychological assessment both at baseline (before the occurrence of any head trauma) and particularly after concussion. Finally, it cannot be assumed that an athlete is asymptomatic when he or she "feels fine" based on subjective reports, since, as I previously mentioned, subjective feeling may not be correlated with objectively obtained clinical evaluation. Table 16. Cantu guidelines of return to play after a first concussion Grade 1 2 3 Recommendations May return to play if asymptomatic* for one week May return to play if asymptomatic* for one week Should not be allowed to play for at least one month. May then return to play if asymptomatic* for one week is it ok to take viagra with alcohol Table 2. Frequencies of symptom endorsements (in percentage) for the PostConcussion Symptom Scale in concussed athletes (N=52). Symptoms Headache Difficulty Concentrating Feeling Slowed Down Dizziness Nausea Fatigue Feeling Mentally "Foggy" Drowsiness Difficulty Remembering Sensitivity to Light Balance Problems Sensitivity to Noise Trouble Falling Asleep Irritability Sleeping More Than Usual Visual Problems Sleeping Less Than Usual Nervousness Feeling More Emotional Sadness Numbness or Tingling Vomiting % 88.5 82.7 78.8 78.8 77.3 76.9 75.0 73.1 69.2 57.7 55.8 50.0 45.0 38.5 34.6 32.7 30.8 30.8 19.2 19.2 15.4 11.5 inhale viagra In the beginning, traditional paper-and-pencil neuropsychological testing was used to evaluate the acute and more distant effects of sports-related concussion. Various test batteries have been used, though most tap similar abilities that are most often affected by concussion, including memory, attention, processing speed, and reaction time. In the 1989 Barth study of over 2350 collegiate football athletes, cognitive testing was administered at preseason, 1, 5, and 10 days post injury, then at the end of the season. These authors used well-normed neuropsychological tests such as the Trail Making Test A and B (Reitan & Davison, 1974), Paced Auditory Serial Addition Task (Gronwall & Wrightson, 1980), and the Symbol Digit Test (Smith, 1973). On these measures, significant deficits were observed at 24-hours post-injury, with most athletes demonstrating a return to baseline by day 10. When Macciocchi and others (1996) compared the group of concussed athletes from Barth's large study to a control group on the above measures, most athletes evidenced generally equivalent performance to non-injured controls by day 5. In a study of professional rugby players, Hinton-Bayre and colleagues performed baseline assessment of 86 players, 13 of whom sustained concussions over the course of the ensuing season. Neuropsychological tests measuring verbal learning, verbal fluency, executive functioning, attention, processing speed, and psychomotor speed were used. When compared to their own baseline scores, as well as to a matched uninjured control group. viagra lml download aurogra vs viagra concussed athletes. To sum up, by one-week post-injury, regardless of injury status, the magnitude of the change in scores was either medium or large except for the Stroop 1. Table 5. Effect Sizes for Injured and Control Athletes SMB = Suspect Motivation at Baseline Group; HMB = High Motivation at Baseline Group; SS = Standard Score. Note: The case numbers listed above were substituted for the actual identification numbers used in the current study to maintain the highest level of confidentiality for the participants as possible while demonstrating that each of the above scores are associated with different cases within the respective samples. viagra psychological dependence Imaging modalities such as CT and magnetic resonance imaging (MRI) are powerful tools to detect and assess focal injury such as hemorrhagic lesions and edema and brain swelling in severe injury. However, acute and chronic injury at a cellular level is sometimes difficult to discern from normal features by anatomical imaging. Magnetic resonance spectroscopy (MRS) offers a unique non-invasive approach to assess injury at microscopic levels by quantifying cellular metabolites. Most clinical MRI systems are equipped with this option and MRS is thus a widely available modality. For the brain in particular, MRS has been a powerful research tool and has also been proven to provide additional clinically relevant information for several disease families such as brain tumors, metabolic disorders, and systemic diseases. The most widelyavailable MRS method, proton (^H; hydrogen) spectroscopy, is FDA approved for general use and can be ordered by clinicians for patient studies if indicated. The findings obtained with MRS in concussion and more severe head trauma are heterogeneous, reflecting the different time after injury, degree of injury and different physiologic and pathologic response of the brain to injury in individuals. The most important findings are that elevated lactate (and lipids) in apparently normal tissue observed 2-5 days after injury are indicators of severe global hypoxic injury and poor outcome. Also, N-acetyl aspartate (NAA), a marker for "healthy" neurons and axons, is generally reduced in traumatic brain injury signaling neuronal and axonal loss/damage. The extent of NAA reduction after injury is an objective and quantitative surrogate marker for the severity of injury and is useful for outcome prediction. diovan and viagra interaction generic viagra professional sildenafil 100mg EEG and Brain Injury The use of LORETA as a qEEG neuroimaging tool for the evaluation of mild TBI has also been published by Korn et al (2005). In this study the generators for abnormal rhythms in the mild TBI patients were closely related to the anatomical locations as measured by SPECT, thus providing additional concurrent validation of qEEG and TBI. como funciona el viagra en los hombres Skull radiography, available for a century, was long the initial radiographic test for most head injuries. Several views of the skull are taken from various angles. The skull film provides detailed views of the skull, but distinguishes the contents only if air, calcification or other substances render them opaque or radiolucent. Hence its use is reserved for demonstrating fractures, foreign bodies or intracranial air (Fig.l). viswiss vs. viagra Chronic viagra 50mg directions women who have tried viagra 2. 320 least i could do viagra The study employed the three-minute step test protocol from Francis (1990) to measure aerobic fitness. The three-minute step test is one of the most commonly used field tests for predicting oxygen consumption with regards to recovery heart rate. The 3-minute step test has a correlation coefficient of .81 at 26 ascents/min stepping frequency when compared with the Bruce testing protocol (Francis & Brasher, 1992). Instruments used for this protocol consisted of a 16" step bench, data recording forms, stopwatch, and metronome. The protocol for this test required 10-15 subjects at a time to step up and down from a platform in time with a metronome for a total of 3 minutes. Subjects stepped at a rate of 26 steps per minute for the 3-minute period. This rate was maintained using a metronome, which was pre-set at a tempo of 104 to establish the stepping rate. Participants were divided into groups of 10-15 to complete the test. The researchers instructed subjects on how to assess their heart rate in beats per minute using the palpation method to find their pulse prior to the start of the test. This instruction took place in a lecture setting and participants had the opportunity to ask questions and receive assistance in finding their carotid pulse for a 15 second count. Each subject verbally indicated to the researchers that they were able to find their viagra movie love and other drugs viagra buyer usa Permission from pertinent school administrators, coaches and medical staff was obtained prior to data collection. Parental consent and participant assent were also obtained from participants at a brief informational meeting with each team. After each school consented to participate in the study, a site analysis was conducted by the researchers prior to the beginning of the study. This analysis included obtaining a fixed-height bench, which was 16 inches in height for the 3-minute step test. Gymnasium bleachers were used if the height requirements were met measuring from the floor to the top surface of the step. This enabled researchers to accommodate more than one athlete at a time for the aerobic baseline assessment. Computer labs and servers were also examined to make sure that they met the minimum hardware and software requirements to run the ImPACT program. Pilot tests of the 3-minute step assessment were conducted with five volunteers who were then excluded from the study. All ATCs were instructed in the use of the concussion card to identify concussion symptoms presented by their respective athletes. Athletic trainers were given the sideline assessment card, and were reminded to indicate which concussed athletes, if any, experienced PTA. At this time, they also had the opportunity to ask the researchers any questions on what constituted referral for post-concussion testing. Coaches were instructed on how to tabulate practice and game exposures for their players. Prior to baseline testing, participants completed a written demographic form including information on age, height, weight, position, grade, and playing status. Aerobic fitness was then assessed using the 3-minute estimated V02 submaximal step test described earlier. The data were then recorded and inserted into the equation described earlier to estimate V02 max. Approximately 24 hours after the aerobic fitness testing, neuropsychological testing was conducted. Baseline ImPACT testing was PTA"^ viagra grande surface Aerobic Fitness and Concussion can you buy viagra over the counter in jamaica viagra cena sk The current study provided little evidence of any relationships between either aerobic fitness or concussion history, and concussion symptoms and neurocognitive performance. Based on the current findings, concussion symptoms and neurocognitive impairment appear to occur irrespective of 4rt 3.f;;i5U — UJ 3.600- can you buy viagra over the counter in boots free printable viagra coupons Fig,6, Temporal course of the area of Center of Pressure (CP) during static postural task performance with eyes open and eyes closed conditions. X-axis, 1- baseline testing; 2- day 3 post-injury; 3 - day 10 post-injury; 4 - day 30 post-injury. (Re-printed, by permission, from Elsevier: Slobounov, S., Sebastianelli, W., Moss, R. (2005). Alteration of Posture-Related Cortical Potentials in Mild Traumatic Brain Injury. Neuroscience Letters, 383, 251-255.) 1 ;/^ ?:•-;;•' generic viagra penegra tablets Gator; 1977, 1980, 1982, 1987, 1992, 1997 Fiesta; 1979 Liberty; 1983 Aloha; 1988, 1994, 1998 Citrus; 1989 Holiday; 1990, 1992 Blockbuster; 1995 Rose; 1996 Outback. Second in longevity among members of the Penn State football coaching staff, Fran Ganter is in his fourth decade as a member of the Nittany Lion program. In his 28th year as a member of Joe Paterno's brain trust, Ganter has been instrumental in the Nittany Lions' success since his days as a player in the late 1960's. His four years as a player give him 32 consecutive years of association with the Penn State program. The Lions' offensive coordinator and running backs coach, Ganter is the architect of an offense which has ranked no lower than third in rushing and first or second in the Big Ten in total offense and scoring three times in Penn State's five years of conference play. The Lions have proven to be one of the nation's most balanced and prolific offenses under Ganter, averaging at least 30 points per game each of the last seven seasons. In 1997, Penn State averaged 208.6 yards per game rushing and 213.9 yards passing, ranking in the nation's top 25 in rushing, total offense (422.5 ypg.) and scoring (32.7 ppg.). In 1994, Ganter directed what is regarded as one of the top offenses in college football history. Blessed by an abundance of talent, including five National Football League first-round draft picks, Ganter melded their strengths and skills to develop an attack which led the nation in total offense (520.2 yards per game) and scoring (47.8 points per game). The Lions' scoring average was fourth-highest in NCAA history and the squad set 14 team school season marks. Coach Randy Jepson, Men gymnastic team; Head coach Randy Jepson punctuated an already outstanding coaching career by piloting the 2004 Nittany Lions to an NCAA-record 11th national title. His second national coach of the year award highlighted personal achievements, but it is what his team accomplished that the 2004 season will be remembered for. In addition to the team championship, Penn State sophomore Luis Vargas brought home the Lions' first NCAA all-around title since 1973. Senior Kevin Tan also ended his career on a high note, capturing his third-straight Big Ten title and his second-consecutive NCAA title on the still rings. Now, 13 years into his tenure as a head coach at Penn State, Randy Jepson prepares to move forward and sustain the momentum the Lions carried throughout the NCAA championships into years to come. The 2000 National Coach of the Year and 2003 Big Ten Coach of the Year, Jepson has played a significant role in perpetuating the proud winning tradition of the Nittany Lion program, not only as head coach, but as an athlete and assistant coach as well. After guiding his teams to two national championships and men's gymnastics first Big Ten title, Jepson serves as a symbol of the University's proud heritage of the sport. A member of the coaching staff since 1983, Jepson was appointed head coach on July 6, 1992, why does viagra give you a headache magnum drink viagra © The McGraw−Hill Companies, 2001 Mammalian Body Cavities art labeling activity medicamento viagra para que sirve • The scientiﬁc method is the process by which scientists gather information about the material world. 8 comprar viagra online mexico does viagra make you tired Front Matter hard sell the evolution of a viagra salesman wiki Chapter 1 viagra se da fara reteta + viagra aortic stenosis Ca calcium © The McGraw−Hill Companies, 2001 does viagra have any effect on women viagra for men under 50 6 CH 2 viagra generics names celebrities who use viagra H best way to order viagra online Cilia and ﬂagella norxshop products viagra In adipose tissue (Fig. 4.4b), the ﬁbroblasts enlarge and store fat. The body uses this stored fat for energy, insulation, and organ protection. Adipose tissue is found beneath the skin, around the kidneys, and on the surface of the heart. Reticular connective tissue forms the supporting meshwork of lymphoid tissue present in lymph nodes, the spleen, the thymus, and the bone marrow. All types of blood cells are produced in red bone marrow, but a certain type of lymphocyte (T lymphocyte) completes its development in the thymus. The lymph nodes store lymphocytes. Human Organization viagra for menn pris The large intestine, which includes the cecum, the colon, the rectum, and the anal canal, is larger in diameter than the small intestine (6.5 cm compared to 2.5 cm), but it is shorter in length (see Fig. 5.1). The large intestine absorbs water, salts, and some vitamins. It also stores indigestible material until it is eliminated at the anus. The cecum, which lies below the junction with the small intestine, is the blind end of the large intestine. The cecum has a small projection called the vermiform appendix (vermiform means wormlike) (Fig. 5.8). In humans, the appendix also may play a role in ﬁghting infections. This organ is subject to inﬂammation, a condition called appendicitis. If inﬂamed, the appendix should be removed before the ﬂuid content rises to the point that the appendix bursts, a situation that may cause peritonitis, a generalized infection of the lining of the abdominal cavity. Peritonitis can lead to death. The colon includes the ascending colon, which goes up the right side of the body to the level of the liver; the transverse colon, which crosses the abdominal cavity just below the liver and the stomach; the descending colon, which passes down the left side of the body; and the sigmoid colon, which enters the rectum, the last 20 cm of the large intestine. The rectum opens at the anus, where defecation, the expulsion of feces, occurs. When feces are forced into the rectum by peristalsis, a defecation reﬂex occurs. The stretching of the rectal wall initiates nerve impulses to the spinal cord, and shortly thereafter the rectal muscles contract and the anal sphincters relax (Fig. 5.9). Ridding the body of indigestible remains is another way the digestive system helps maintain homeostasis. Feces are threequarters water and one-quarter solids. Bacteria, ﬁber (indigestible remains), and other indigestible materials are in the solid portion. The brown color of feces is due to bilirubin (see page 90), and the odor is due to breakdown products as bacteria work on the nondigested remains. This bacterial action also produces gases. ಆ For many years, it was believed that facultative bacteria (bacteria that can live with or without oxygen), such as Escherichia coli, were the major inhabitants of the colon, but new culture methods show that over 99% of the colon bacteria are obligate anaerobes (bacteria that die in the presence of oxygen). Not only do the bacteria break down indigestible material, they also produce some vitamins and other molecules that can be absorbed and used by our bodies. In this way, they perform a service for us. Water is considered unsafe for swimming when the coliform (nonpathogenic intestinal) bacterial count reaches a certain number. A high count is an indication that a signiﬁcant amount of feces has entered the water. 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It becomes progressively more difficult to repeat this procedure because of technical problems. should i take viagra before eating viagra placebo effect CHAPTER 6 Bladder Symptoms viagra best commercial youtube chinese herbal viagra safe Prevention is the key to avoiding bladder infections. THE GASTROINTESTINAL TRACT AND ITS CONTROL celery natural viagra sides effects of viagra YOUR TOTAL HEALTH 146 thesecuretabs viagra 100mg why didn't my viagra work ( m V ) 0.5 0 -0.5 0.5 0 -0.5 0.5 0 -0.5 0.5 0 -0.5 0.5 0 -0.5 MN Ia afferent Fig. 2.8. H reﬂexes in different muscles. (a ) Sketch of the monosynaptic pathway. (b )–(j ) EMG recordings of the H reﬂex at rest (thin lines) and during voluntary activation of the tested muscle (thick lines) for the soleus (b ), tibialis anterior ((c ) TA), quadriceps ((d ) Q), semitendinosus ((e ) ST), abductor pollicis brevis ((f ) APB), ﬂexor carpi radialis ((g ) FCR), extensor carpi radialis ((h ) ECR), biceps brachii (i ) stimulation at Erb’s point), triceps brachii (j ). All reﬂexes were obtained in the same subject (1.80 m tall). units with larger and faster twitch contractions are recruited. This appears to be so in most mus- cles in which the different motor unit types have beeninvestigated: seconddorsal interosseus (Buller, Garnett & Stephens, 1980), soleus (Awiszus & Feist- ner, 1993), ECR(Fig. 8.5(a ); Schmiedet al., 1997) and FCR (Nielsen & Pierrot-Deseilligny, unpublished data). Given this preferential distribution of Ia exci- tatory inputs to motoneurones innervating slow- twitch units, it is not surprising that the soleus H reﬂex may be obtained in all healthy subjects at rest, because the soleus is a homogeneous muscle Organisation and pattern of connections 81 with mainly slow-twitch units (Edgerton, Smith & Simpson, 1975). However, in tibialis anterior (Ashby, Hilton-Brown & St˚ alberg, 1986; Semmler & T¨ urker, 1994) and in abductor digiti minimi (Mazzocchio, Rothwell & Rossi, 1995), the largest responses to Ia input have not been found in low-threshold units. Inhibitory mechanisms limiting the efﬁcacy of the monosynaptic Ia input Presynaptic inhibition of Ia terminals This mechanismreduces thesizeof monosynapticIa EPSPs, and there is a tonic level of presynaptic inhi- bition of Ia terminals (see Chapter 8, pp. 353–4). The larger the maximal soleus Hreﬂex at rest, the smaller the tonic on-going presynaptic inhibition of Ia ter- minals (Meunier & Pierrot-Deseilligny, unpublished data), and this supports the view that variations in the size of the maximal H reﬂex in different subjects (and perhaps in different muscles in the same sub- ject) may reﬂect a different level of tonic presynaptic inhibition. Contamination by oligosynaptic IPSPs Non-reciprocal groupI inhibition(so-called‘Ib’ inhi- bition, seeChapter 6) canlimit thesizeof theHreﬂex (Chapter 1, pp. 14–16). This limitation could also contribute to the absence of a recordable H reﬂex at rest in muscles, such as tibialis anterior, abduc- tor pollicis brevis and ECR, though this would imply that the Ia/Ib balance was then shifted in favour of the Ib input. In these muscles, the appearance of an H reﬂex during a tonic voluntary contraction could involve depression of non-reciprocal group I inhibi- tion to the active motoneurone pool (see Chapter 6, pp. 268–71), together with the increased excitability of the motoneurones. Thresholds for α motor axons and Ia afferents Alternatively, if the threshold for ␣ motor axons was closer to that of Ia afferents, the maximal H reﬂex would probably be smaller and the reﬂex more difﬁ- cult to obtain and, with single motor units, the peak of excitation seen in PSTHs to stimulation at 1 MT would be smaller. Heteronymous monosynaptic Ia excitation in the lower limb Pattern and strength of distribution In striking contrast with data for the cat and baboon hindlimb (see pp. 65–6), connections between some close synergists operating at the same joint are weak or absent in the human lower limb and trans- joint connections are almost the rule. Given the constraints raised above, the conclusions advanced below have generally been conﬁrmed using more than one method. General pattern of heteronymous Ia excitation Table2.1shows thegeneral patternof heteronymous Ia excitation to leg and thigh muscles, estimated from PSTHs (Meunier, Pierrot-Deseilligny & Simon- etta, 1993; Marque et al., 2001). Grey cells represent muscle–nerve combinations with a statistically sig- niﬁcant connectioninhumans. Anattempt has been madetoestimatethestrengthof theexcitation(num- ber of asterisks in each cell, see legend of Table 2.1), based on the average size of the heteronymous peak relative to that of the homonymous peak, both in response to stimulation at 1 MT. As expected, the stronger the connection, the more frequently was it observed: e.g. the strongest connection (from gas- trocnemius medialis to biceps femoris, ﬁve aster- isks) was observed in 21/21 (100%) units and was, on average, 54% of the homonymous peak, whereas the weakest connection (from the intrinsic plantar muscles tobiceps, oneasterisk) was observedinonly 27%of the units andhadanaverage amplitude of 3% of the homonymous peak. Connections between close synergists operating at the same joint At knee level, strong connections exist between the two heads of the quadriceps (vastus lateralis and 82 Monosynaptic Ia excitation Table 2.1. Monosynaptic heteronymous Ia excitation in the lower limb Columns: nerve stimulated: Sol (inferior soleus), GM (nerve to the gastrocnemius medialis), SP (superﬁcial pero- neal), DP (deep peroneal), FN (femoral nerve), TN (tibial nerve at the ankle). Lines: motoneurone pools (MN) investigated with the PSTH method: Sol (soleus), GM (gastrocnemius medialis), Per Brev (peroneus brevis), TA (tibialis anterior), Q (quadriceps), Bi (biceps femoris), ST (semitendinosus). Grey cells indicate the existence of signiﬁcant Ia excitation in humans (crossed cells correspond to homonymous pathways). The number of asterisks indicates the average size of the heteronymous peak relative to the homonymous peak (both recorded using sti- mulationat 1 MT): * <10%; ** between10 and20%; *** between20 and30%, **** between30 and40%; ***** >40% (from Meunier, Pierrot-Deseilligny & Simonetta, 1993; Marque et al., 2001; Marchand-Pauvert & Nielsen, 2002). Connections are compared to those described in the cat (cells with horizontal lines, Eccles, Eccles & Lundberg, 1957) and the baboon (cells with vertical lines, Hongo et al., 1984). With the animal experiments, only connections with a heteronymous EPSP >5% of the homonymous EPSP are shown. medialis), but are absent from semitendinosus to biceps, and doubtful frombiceps to semitendinosus (Bayoumi & Ashby, 1989). At ankle level, there is weak Ia facilitation from gastrocnemius medialis to gastrocnemius lateralis (Mao et al., 1984) and from soleus to gastrocnemius medialis (Meunier, Pierrot-Deseilligny & Simonetta, 1993). There is no Ia excitation fromgastrocnemius medialis to soleus, a ﬁnding conﬁrmed using different techniques: the modulation of the on-going EMG, the H reﬂex or PSTHs (Bouaziz, Bouaziz & Hugon, 1975; Pierrot- Deseilligny et al., 1981; Mao et al., 1984; Meunier, Pierrot-Deseilligny & Simonetta, 1993). Connections linking ankle muscles that are not close synergists There are bidirectional connections between soleus andperoneus brevis (Fig. 2.4), andfromtibialis ante- rior to gastrocnemius medialis. Organisation and pattern of connections 83 Transjoint connections exist between all muscle–nerve combinations tested They canbevery strong(e.g. gastrocnemius medialis to biceps). However, it should be emphasised that conclusions based on stimuli at 1 MT underesti- matethestrengthof theconnections because, as dis- cussedonpp. 77–8, not all Iaafferents areactivatedat this intensity. These connections are not conﬁned to units in the low-threshold range investigated with the PSTH method. Many of the connections have alsobeenobservedwithmethods that explorealarge fractionof themotoneuronepool, e.g. (i) modulation of the H reﬂex for the Ia excitation from gastrocne- mius medialis to quadriceps and biceps motoneu- rones (Pierrot-Deseilligny et al., 1981), and for the Ia excitation from quadriceps to soleus motoneurones (Bergmans, Delwaide &Gadea-Ciria, 1978; Hultborn et al., 1987), and (ii) femoral modulation of the on- going EMG of soleus and tibialis anterior (Meunier et al., 1996). An early peak of peroneal-induced monosynaptic Ia excitation has also been observed in the on-going quadriceps EMG of some subjects (Marchand-Pauvert & Nielsen, 2002). Proximal-to- distal transjoint connections can be explored safely only from the femoral nerve, because it does not contain afferents from distal muscles. Because of the difﬁculty instimulating the nerves to hamstrings without encroaching upon afferents from foot and leg muscles in the sciatic nerve (or of stimulating the posterior tibial nerve without encroaching upon afferents from plantar foot muscles), it has not been possibletodeterminewhether theconnections from legmuscles tohamstrings (andfromfoot toproximal muscles) are bidirectional. Projections to antagonists acting at another joint Aremarkable feature of these transjoint connections is that they oftenlink a muscle or groupof muscles to a pair of antagonistic muscles operating at another joint, e.g. quadriceps to all tested muscles acting at the ankle, soleus to quadriceps and hamstrings, and from intrinsic foot muscles to all leg and thigh muscles. Phylogenetic adaptations In Table 2.1, the connections in the human lower limb are compared to those in the hindlimb of the cat (cells withhorizontal lines, Eccles, Eccles &Lund- berg, 1957) and the baboon (cells with vertical lines, Hongo et al., 1984). Connections between close synergists Theabsenceof connectionsbetweensomeclosesyn- ergists operating at the same joint in humans is pre- dictable because of their weakness in the baboon. Thus, heteronymous Ia excitation from gastrocne- mius medialis to soleus is absent in humans, very small in the baboon and large in the cat (the max- imal heteronymous Ia EPSP is 3% of the maximal homonymous EPSP in the baboon and 41% in the cat). Similarly, the absence of heteronymous con- nections between medial and lateral hamstrings in humans is predictable because they are weaker in the baboon than in the cat. Major differences in organisation The most striking differences involve the presence of heteronymous connections that do not exist in the cat or the baboon or, when they exist, are <5%of the homonymous Ia EPSP (e.g. Ia connections from tri- ceps surae onto quadriceps motoneurones, Edgley, Jankowska&McCrea, 1986; Hongoet al., 1984). Thus, in human subjects, there are transjoint connections between all muscle–nerve combinations tested. The functional implicationsof thesedifferencesinorgan- isationof Ia connections are considered onpp. 92–4. These ‘new’ connections raise questions about whether the term ‘synergists’ should be used func- tionally rather than anatomically. Heteronymous monosynaptic Ia excitation in the upper limb Connections between close synergists Connections have been investigated at wrist level, using the PSTH method. There is bidirectional, 84 Monosynaptic Ia excitation though asymmetrical, heteronymous Ia excitation between the two wrist ﬂexors, FCRand FCU. Electri- cal stimuli at 1 MT applied to the median nerve at elbow level often evoke monosynaptic Ia excitation of FCUunits, whereassimilarstimulationof theulnar nerve rarely evokes signiﬁcant excitation of FCR units (Malmgren & Pierrot-Deseilligny, 1988). An asymmetry has also been demonstrated using per- cussion of the tendons of FCR and FCU(Chalmers & Bawa, 1997), but this was less marked, possibly due to spread of the mechanical stimulus. Weak ECU facilitation by ED Ia afferents has been observed consistently but, in contrast with forearm ﬂexors, there is no evidence for heteronymous Ia excitation at a latency consistent with a monosynaptic linkage between ECR and ECU (Chalmers & Bawa, 1997). Transjoint connections and their phylogenetic adaptation Table 2.2 is arranged qualitatively as is Table 2.1, andshows the patternof transjoint heteronymous Ia excitation in the human upper limb, estimated from PSTHs. Absence of proximal-to-distal projections Again, there are striking differences from data in the cat (cells withhorizontal lines, Fritzet al., 1989). Con- nections from proximal to distal muscles are bet- ter developed in the cat forelimb (triceps to FCR and ECU, biceps to ECR) than in its hindlimb, but are absent in humans (Cavallari, Katz & P´ enicaud, 1992). Because of the difﬁculty in stimulating the medianandulnar innervationof wrist muscles with- out encroaching upon afferents fromhand muscles, it has not been possible to investigate projections fromforearmmuscles ontomotoneurones innervat- ing the intrinsic muscles of the hand. However, given the absence of other proximal-to-distal connections in the human upper limb, it is likely that projections from intrinsic hand muscle are probably also uni- directional (i.e. only distal-to-proximal, see below). Table 2.2. Monosynaptic heteronymous Ia excitation in the upper limb Columns: nerve stimulated: MC (musculo-cutaneous), Tri (nerve of the triceps brachii), Med (median), Rad (radial at the elbow), Uln (ulnar), Med & Uln (wrist) (median and ulnar at the wrist). Lines: motoneurone pools (MN) investigatedwiththe PSTH method: Deltoid, Bi (biceps brachii), Tri (triceps brachii), FCR (ﬂexor carpi radialis), ECR (extensor carpi radialis), FCU (ﬂexor carpi ulnaris), ECU (extensor carpi ulnaris), FDS (ﬂexor digitorumsuperﬁcialis), ED(extensor digitorum), Hand (intrin- sic hand muscles). Grey cells indicate the existence of signiﬁ- cant Ia excitation in human subjects (crossed cells correspond to homonymous pathways). The number of asterisks repre- sents the frequency of occurrence of the heteronymous peak: * <20%; ** between 20 and 60%; *** >60% (from Cavallari & Katz, 1989; Cr´ eange et al., 1992; Cavallari, Katz &P´ enicaud, 1992; Katz et al., 1993; Mazevet &Pierrot-Deseilligny, 1994; Marchand- Pauvert, Nicolas & Pierrot-Deseilligny, 2000 and Lourenc¸o, Iglesias, Pierrot-Deseilligny & Marchand-Pauvert unpublished data). Connections are compared to those described in the cat (cells with horizontal lines; Fritz et al., 1989). Organisation and pattern of connections 85 30 0 5 0 5 0 N u m b e r 7. Discuss nursing responsibilities in handling controlled substances correctly. 8. Discuss the role of the Food and Drug Administration. 9. Analyze the potential impact of drug costs on drug therapy regimens. 10. Develop personal techniques for learning about drugs and using drug knowledge in client care. viagra online no prescriptions uk Cell membrane triverex vs viagra cerealis viagra Greater trochanter of the femur is menhancer viagra To increase client comfort and participation and to avoid tissue damage. Identiﬁcation of anatomic landmarks is mandatory for safe administration of IM drugs. Brain, endothelium, kidneys, platelets jeremy renner viagra interview 103 viagra reviews young men There are no known contraindications to the use of glucosamine, but it should be avoided during pregnancy and lactation and in children, because effects are unknown. 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With amantadine, observe for: (1) CNS stimulation—insomnia, hyperexcitability, ataxia, dizziness, slurred speech, mental confusion, hallucinations what happens if you give a dog viagra INDIVIDUAL ANESTHETIC AGENTS picture of viagra head office in toronto canada Characteristics Uses viagra before sleep viagra patent life Topical anesthesia and regional anesthesia by local inﬁltration, nerve block, spinal, and epidural anesthesia Intravenously to prevent or treat cardiac dysrhythmias (see Chap. 52). (Warning: Do not use preparations containing epinephrine for dysrhythmias.) can i take viagra into thailand b. viagra vitser SECTION 2 DRUGS AFFECTING THE CENTRAL NERVOUS SYSTEM • Record vital signs; cardiovascular, respiratory, and neu• • • facebook viagra spam drugs viagra online kaufen niederlande The SNS is stimulated by physical or emotional stress, such as strenuous exercise or work, pain, hemorrhage, intense emotions, and temperature extremes. Increased capacity for vigorous muscle activity in response to a perceived threat, whether real or imaginary, is often called the ﬁght-or-ﬂight reaction. Speciﬁc body responses include: 1. Increased arterial blood pressure and cardiac output 2. Increased blood ﬂow to the brain, heart, and skeletal muscles; decreased blood ﬂow to viscera, skin, and other organs not needed for ﬁght-or-ﬂight 3. Increased rate of cellular metabolism—increased oxygen consumption and carbon dioxide production 4. Increased breakdown of muscle glycogen for energy 5. Increased blood sugar 6. Increased mental activity and ability to think clearly 7. Increased muscle strength 8. Increased rate of blood coagulation 9. Increased rate and depth of respiration 10. Pupil dilation to aid vision viagra market share 2011 267 100mg viagra not working 1. What are the major differences between the sympathetic and parasympathetic branches of the ANS? 2. What are the major SNS and PNS neurotransmitters? 3. 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Once hormone molecules reach a responsive cell, they bind with receptors in the cell membrane (eg, catecholamines and protein hormones) or inside the cell (eg, steroid and thyroid hormones). The number of hormone receptors and the affinity of the receptors for the hormone are the major determinants of target cell response to hormone action. The main target organs for a given hormone contain large numbers of receptors. However, the number of receptors may be altered by various conditions. For example, receptors may be increased (called up-regulation) when there are low levels of hormone. This allows the cell to obtain more of the needed hormone than it can obtain with fewer receptors. Receptors may be decreased (called down-regulation) when there are excessive amounts of hormone. This mechanism protects the cell by making it less responsive to excessive hormone levels. Receptor up-regulation and down-regulation occur with chronic exposure to abnormal levels of hormones. In addition, receptor proteins may be decreased by inadequate formation or antibodies that destroy them. Thus, receptors are constantly being synthesized and degraded, so the number of receptors may change within hours. Receptor afﬁnity for binding with hormone molecules probably changes as well. After binding occurs, the resulting hormone–receptor complex initiates intracellular biochemical reactions, depending on the particular hormone and the type of cell. Many hormones act as a “first messenger” to the cell, and the hormone–receptor complex activates a “second messenger.” The second messenger then activates intracellular structures to produce characteristic cellular functions and products. Steroid hormones from the adrenal cortex, ovaries, and testes stimulate target cells to synthesize various proteins (eg, enzymes, transport and structural proteins) needed for normal cellular function. Second Messenger Systems Three major second messenger systems, cyclic adenosine monophosphate (cAMP), calcium–calmodulin, and phospholipid products, are described in this section. Cyclic AMP is the second messenger for many hormones, including corticotropin, catecholamines, glucagon, thyroidstimulating hormone, follicle-stimulating hormone, luteinizing hormone, parathyroid hormone, secretin, and antidiuretic hormone. It is formed by the action of the enzyme adenyl cyclase on adenosine triphosphate, a component of all cells and the main source of energy for cellular metabolism. Once formed, cAMP activates a series of enzyme reactions that alter cell function. The amount of intracellular cAMP is increased by hormones that activate adenyl cyclase (eg, the pituitary louis ignarro viagra is it bad to take viagra when you don't need it RATIONALE/EXPLANATION These are uncommon with replacement therapy but common with long-term administration of the pharmacologic doses used for many disease processes. Adverse reactions may affect every body tissue and organ. This reaction is likely to occur in clients receiving daily corticosteroid drugs who encounter stressful situations. It is caused by drug-induced suppression of the HPA axis, which makes the client unable to respond to stress by increasing adrenocortical hormone secretion. Most adverse effects result from excessive corticosteroids. This appearance is caused by abnormal fat deposits in cheeks, shoulders, breasts, abdomen, and buttocks. These changes are more cosmetic than physiologically signiﬁcant. However, the alterations in self-image can lead to psychological problems. These changes cannot be prevented, but they may be partially reversed if corticosteroid therapy is discontinued or reduced in dosage. Corticosteroid drugs can cause hyperglycemia and diabetes mellitus or aggravate preexisting diabetes mellitus by their effects on carbohydrate metabolism. Some clients enjoy the drug-induced euphoria so much that they resist attempts to withdraw the drug or decrease its dosage kgr 100 viagra green OVERVIEW 362 how to spike someone with viagra 4. Identify clients at risk for development of hypercalcemia. 5. Discuss recognition and management of hypercalcemia as a medical emergency. 6. Discuss the use of calcium and vitamin D supplements, calcitonin, and bisphosphonate drugs in the treatment of osteoporosis. what happens if you drink alcohol and take viagra mixing percocet and viagra • PO 2.5–7.5 mg daily in divided doses, for 21 d, then 7 d without the drug viagra urban dic viagra effetti collaterali impotenza PO 0.05 mg one to three times daily for 2 wk with addition of progestin for last 2 wk of month posso comprar viagra sem receita medica Implement measures to prevent vitamin disorders; the safest and most effective way to prevent vitamin deﬁciencies is by increasing dietary intake of vitamins: advantages and disadvantages of using viagra Infants receiving formula, 35–50 mg daily for ﬁrst few weeks of life AFTER STUDYING THIS CHAPTER, THE STUDENT WILL BE ABLE TO: viagra indications and usage viagra hepatitis b or cephalosporins 1. Describe characteristics of aminoglycosides in relation to effectiveness, safety, spectrum of antimicrobial activity, indications for use, administration, and observation of client responses. 2. Discuss factors inﬂuencing selection and dosage of aminoglycosides. 3. State the rationale for the increasing use of single daily doses. does viagra kill sperm viagra passover PRINCIPLES OF THERAPY Drug-Susceptible Tuberculosis SELECTED FUNGAL INFECTIONS (Continued) phentermine and viagra interactions Griseofulvin inhibits cell division and reproduction of fungal cells is taking viagra bad for you cheap viagra super p force Routes and Dosage Ranges Generic/Trade Name Oxiconazole (Oxistat) Sulconazole (Exelderm) Terbinaﬁne (Lamisil) Clinical Indications Tinea infections Tinea infections Tinea infections Onychomycosis of ﬁngernails or toenails Adults Topically to skin lesions, once or twice daily for 2–4 wk Topically to skin lesions, once or twice daily for 3–4 wk Tinea infections, topically to skin, once or twice daily for at least 1 wk and no longer than 4 wk Fingernail infections, PO 250 mg daily for 6 wk Toenail infections, PO 250 mg daily for 12 wk Intravaginally, 1 applicator once daily at bedtime for 7 doses (0.4% cream) or 3 doses (0.8% cream) Vaginal suppository, 1 daily at bedtime for 3 d Intravaginally, 1 applicator at bedtime Topically to skin lesions, twice daily for 2–6 wk Topically to skin lesions, 3 times daily Topically to skin twice daily for 2–4 wk Children Safety and efﬁcacy not established Safety and efﬁcacy not established for children <12 y • Interview and observe for adverse drug effects with viagra verkaufszahlen Interferons (IFN) IFN-alpha Leukocytes IFN-beta IFN-gamma Fibroblasts Circulating T cells and natural killer (NK) cells viagra carlos herrera mp3 IL-2 michael douglas viagra Antigens are the foreign (nonself) substances (eg, microorganisms, other proteins, or polysaccharides) that initiate immune responses. Antigens have specific sites that interact with immune cells to induce the immune response. The number of antigenic sites on a molecule depends largely on its molecular weight. Large protein and polysaccharide molecules are complete antigens because of their complex chemical structures and multiple antigenic sites. Smaller molecules (eg, animal danders, plant pollens, and most drugs) are incomplete antigens (called haptens) and cannot act as antigens by themselves. However, they have antigenic sites and can combine with carrier substances to become antigenic. Antigens also may be called immunogens. In discussions of allergic conditions, antigens are often called allergens. how to get prescribed viagra uk • Noncompliance in obtaining recommended immunizations viagra for sale uk only viagra e seus efeitos colaterais RATIONALE/EXPLANATION For immediate treatment of allergic reactions To observe for allergic reactions, which usually occur within 30 min SECTION 7 DRUGS AFFECTING HEMATOPOIESIS AND THE IMMUNE SYSTEM getting viagra in singapore Laboratory Monitoring viagra spokespeople • Interview and observe for tachydysrhythmias, nervousness, insomnia, and other adverse drug effects. viagra safe after expiration date pfizer viagra discounts Dosage of antiasthmatic drugs must be individualized to attain the most therapeutic effects and the fewest adverse effects. Larger doses of bronchodilators and corticosteroids (inhaled, systemic, or both) are usually required to relieve the symptoms of acute, severe bronchoconstriction or status asthmaticus. Then, doses should be reduced to the smallest effective amounts for long-term control. Dosage of theophylline preparations should be based mainly on serum theophylline levels (therapeutic range is 5 to 15 mcg/mL; toxic levels are 20 mcg/mL or above). Blood for serum levels should be drawn 1 to 2 hours after immediate-release dosage forms and about 4 hours after sustained-release forms. In addition, children and cigarette smokers usually need higher doses to maintain therapeutic blood levels because they metabolize theophylline rapidly, and clients with liver disease, congestive heart failure, chronic pulmonary disease, or acute viral infections usually need smaller doses because these conditions impair theophylline metabolism. For obese clients, theophylline dosage should be calculated on the basis of lean or ideal body weight because theophylline is not highly distributed in fatty tissue. secure tabs viagra reviews Lymphatics is there viagra for females IV injection 1 mg/kg, followed by IV infusion of 20–50 mcg/kg/min robin williams viagra full version ity, slows conduction, and prolongs the refractory period. It has long been used to maintain NSR in clients with AF or ﬂutter who have been converted to NSR with digoxin or electrical cardioversion. However, such use is declining because clients may have recurrent AF and have higher mortality rates with long-term quinidine therapy. Quinidine is well absorbed after oral administration. Therapeutic serum levels (2 to 6 mcg/mL) are attained within 1 hour and persist for 6 to 8 hours. Quinidine is highly bound to serum albumin and has a half-life of about 6 hours. It is metabolized by the liver (about 80%) and excreted in the urine (about 20%). In alkaline urine (ie, pH >7), renal excretion of quinidine decreases, and serum levels may rise. Serum levels greater than 8 mcg/mL are toxic. Quinidine’s low therapeutic ratio and high incidence of adverse effects limit its clinical usefulness. The drug is usually contraindicated in clients with severe, uncompensated heart failure or with heart block because it depresses myocardial contractility and conduction through the AV node. Quinidine salts used clinically include quinidine gluconate (Quinaglute), quinidine sulfate (Quinora), and quinidine polygalacturonate (Cardioquin). These salts differ in the amount of active drug (quinidine base) they contain and the rate of absorption with oral administration. The sulfate salt contains 83% quinidine base, and peak effects occur in 0.5 to 1.5 hours (4 hours for sustained-release forms). The gluconate salt contains 62% active drug, and peak effects occur in 3 to 4 hours. The polygalacturonate salt contains 60% active drug, and peak effects occur in about 6 hours. Quinidine preparations are usually given orally. The gluconate and polygalacturonate salts reportedly cause less gastrointestinal (GI) irritation than quinidine sulfate; this is probably related to their lower quinidine content. Oral extended-action preparations of quinidine (Quinidex Extentabs, Quinaglute Dura-Tabs) also are available. Disopyramide is similar to quinidine in pharmacologic actions and may be given orally to adults with ventricular tachydysrhythmias. It is well absorbed after oral administration and reaches peak serum levels (2 to 8 mcg/mL) within 30 to 60 minutes. Drug half-life is 5 to 8 hours. Disopyramide is excreted by the kidneys and the liver in almost equal proportions. Dosage must be reduced in renal insufﬁciency. Procainamide is related to the local anesthetic procaine and is similar to quinidine in actions and uses. Quinidine may be preferred for long-term use because procainamide produces a high incidence of adverse effects, including a syndrome resembling lupus erythematosus. Procainamide has a short duration of action (3 to 4 hours); sustained-release tablets (Procanbid) prolong action to about 6 hours. Therapeutic serum levels are 4 to 8 mcg/mL. Class IB Lidocaine, a local anesthetic (see Chap. 14), is the prototype of class IB. It is the drug of choice for treating serious ventricular dysrhythmias associated with acute myocardial infarction, cardiac surgery, cardiac catheterization, and electrical cardioversion. Lidocaine decreases myocardial irritability (auto- anuncio pele viagra infarction) Cardiac valvular disease Febrile illness Respiratory disorders (eg, chronic lung disease) Exercise Emotional upset Excessive ingestion of caffeine-containing beverages (eg, coffee, tea, colas) • Cigarette smoking • Drug therapy with digoxin, antidysrhythmic drugs, CNS stimulants, anorexiants, and tricyclic antidepressants • Hyperthyroidism • Observe for clinical signs and symptoms of dysrhythmias. Mild or infrequent dysrhythmias may be perceived by the client as palpitations or skipped heartbeats. More severe dysrhythmias may produce manifestations that reﬂect decreased cardiac output and other hemodynamic changes, as follows: • Hypotension, bradycardia or tachycardia, and irregular pulse • Shortness of breath, dyspnea, and cough from impaired respiration • Syncope or mental confusion from reduced cerebral blood ﬂow • Chest pain from decreased coronary artery blood ﬂow. Angina pectoris or myocardial infarction may occur. • Oliguria from decreased renal blood ﬂow • When electrocardiograms (ECGs) are available (eg, 12-lead ECG or continuous ECG monitoring), assess for indications of dysrhythmias. viagra just for fun RATIONALE/EXPLANATION with exercise or other conditions that increase cardiac workload. When coronary arteries are partly blocked by atherosclerotic plaque, vasospasm, or thrombi, blood ﬂow may not be able to increase sufﬁciently. 2. The endothelium of normal coronary arteries synthesizes numerous substances (see Chap. 50) that protect against vasoconstriction and vasospasm, bleeding and clotting, inﬂammation, and excessive cell growth. Impaired endothelium (eg, by rupture of atherosclerotic plaque or the shear force of hypertension) leads to vasoconstriction, vasospasm, clot formation, formation of atherosclerotic plaque, and growth of smooth muscle cells in blood vessel walls. One important substance produced by the endothelium of coronary arteries is NO (also called endotheliumderived relaxing factor). NO, which is synthesized from the amino acid arginine, is released by shear stress on the endothelium, sympathetic stimulation of exercise, and interactions with acetylcholine, histamine, prostacyclin, serotonin, thrombin, and other chemical mediators. NO relaxes vascular smooth muscle and inhibits adhesion and aggregation of platelets. When the endothelium is damaged, these vasodilating and antithrombotic effects are lost. At the same time, production of strong vasoconstrictors (eg, angiotensin II, endothelin-1, thromboxane A2) is increased. In addition, inﬂammatory cells enter the injured area and growth factors stimulate growth of smooth muscle cells. All of these factors participate in blocking coronary arteries. 3. Sympathetic nervous system stimulation normally produces dilation of coronary arteries, tachycardia, and increased myocardial contractility to handle an increased need for oxygenated blood. Atherosclerosis of coronary arteries, especially if severe, may cause vasoconstriction as well as decrease blood ﬂow by obstruction. viagra billig einkaufen viagra joke pills Hypertension is persistently high blood pressure that results from abnormalities in regulatory mechanisms. It is usually defined as a systolic pressure above 140 mm Hg or a diastolic pressure above 90 mm Hg on multiple blood pressure measurements. Primary or essential hypertension (that for which no cause can be found) makes up 90% to 95% of known cases. Secondary hypertension may result from renal, endocrine, or central nervous system disorders and from drugs that stimulate the SNS or cause retention of sodium and water. Primary hypertension can be controlled with appropriate therapy; secondary hypertension can sometimes be cured by surgical therapy. The Sixth Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure, published in 1997, classiﬁed blood pressures in adults (in mm of Hg), as follows: • Normal = systolic 130 or below; diastolic 85 or below • High normal = systolic 130 to 139; diastolic 85 to 89 • Stage 1 hypertension (mild) = systolic 140 to 159; diastolic 90 to 99 • Stage 2 hypertension (moderate) = systolic 160 to 179; diastolic 100 to 109 b. In clients with severe atherosclerosis, especially those with unilateral or bilateral stenosis of renal arteries, ACE inhibitors can impair renal blood flow and worsen renal impairment (ie, increase blood urea nitrogen [BUN] and serum creatinine). This may require stopping the drug. In addition, some clients without renal artery stenosis have developed increased BUN and serum creatinine levels. Although these are usually minor and transient, the drug may need to be discontinued or reduced in dosage. c. Approximately 25% of clients taking an ACE inhibitor for heart failure experience an increase in BUN and serum creatinine levels. These clients usually do not require drug discontinuation unless they have severe, preexisting renal impairment. In clients with severe heart failure, whose renal function may depend on the activity of the renin–angiotensin– aldosterone system, management with an ACE inhibitor may worsen renal impairment. However, acute renal failure rarely occurs. d. The mechanisms are unclear, but ACE inhibitors also have renal protective effects in hypertensive clients with some renal impairment and clients with diabetic nephropathy. A possible mechanism is less damage to the endothelium and less vascular remodeling (ie, less narrowing of the lumen and less thickening of the wall). e. The elimination half-life of most ACE inhibitors and their active metabolites is prolonged in clients with renal impairment. Dosage may need to be reduced with benazepril, lisinopril, quinapril, and ramipril. 4. Angiotensin II receptor blockers also inhibit the renin–angiotensin–aldosterone system and may produce effects similar to those of the ACE inhibitors. As with ACE inhibitors, some clients with severe heart failure have had oliguria or worsened renal impairment. These drugs are also likely to increase BUN and serum creatinine in clients with stenosis of one or both renal arteries. Dosage reductions usually are not required for clients with renal impairment. However, ﬂuid volume deﬁcits (eg, from diuretic therapy) should be corrected before starting the drug, and blood pressure should be monitored closely during drug therapy. Clients on hemodialysis may have orthostatic hypotension with telmisartan and possibly other drugs of this group. 5. Most beta blockers are eliminated primarily by the kidneys and serum half-life is prolonged in clients with renal impairment. Most of the drugs should be used with caution and in reduced dosages. Dosage of metoprolol does not need to be reduced. An additional consideration is that cardiac output and blood pressure should not be lowered enough to impair renal blood ﬂow and aggravate renal impairment. 6. Calcium channel blockers are often used in clients with renal impairment because, in general, they are effective and well tolerated; they maintain renal blood ﬂow even how much does viagra cost on a private prescription pomegranate like viagra Distal tubule You are caring for a client with severe heart disease who is being treated for hypertension and heart failure. Medications include enalapril (Vasotec) 10 mg qd and Lasix 40 mg bid. What assessment data are important to collect before administering these medications? can you take viagra with ramipril viagra 25 mg vs 100mg minimal daily requirement of potassium is unknown, usual recommendations are 40 to 50 mEq daily for the healthy adult. Potassium loss with diuretics may be several times this amount. Some foods (eg, bananas) have undeserved reputations for having high potassium content; actually, large amounts must be ingested. To provide 50 mEq of potassium daily, estimated amounts of certain foods include 1000 mL of orange juice, 1600 mL of apple or grape juice, 1200 mL of pineapple juice, four to six bananas, or 30 to 40 prunes. Some of these foods are high in calories and may be contraindicated, at least in large amounts, for obese clients. Also, the amount of carbohydrate in these foods may be a concern for clients with diabetes mellitus. e. Restricting dietary sodium intake. This reduces potassium loss by decreasing the amount of sodium available for exchange with potassium in renal tubules. 2. Hyperkalemia (serum potassium level >5 mEq/L) may occur with potassium-sparing diuretics. The following measures help prevent hyperkalemia: a. Avoiding use of potassium-sparing diuretics and potassium supplements in clients with renal impairment b. Avoiding excessive amounts of potassium chloride supplements c. Avoiding salt substitutes d. Maintaining urine output, the major route for eliminating potassium from the body Tiroﬁban (Aggrastat) viagra overdose video what would happen if you give a dog viagra Little information is available about the use of anticoagulants in children. Heparin solutions containing benzyl alcohol as a preservative should not be given to premature infants because fatal reactions have been reported. When given for systemic anticoagulation, heparin dosage should be based on the child’s weight (approximately 50 units/kg). Safety and effectiveness of LMWHs (eg, enoxaparin) have not been established in children. Warfarin is given to children after cardiac surgery to prevent thromboembolism, but doses and guidelines for safe, effective use have not been developed. Accurate drug administration, close monitoring of blood coagulation tests, safety measures to prevent trauma and bleeding, avoiding interacting drugs, and informing others in the child’s environment (eg, teachers, babysitters, health care providers) are necessary. Antiplatelet and thrombolytic drugs have no established indications for use in children. CHAPTER 57 DRUGS THAT AFFECT BLOOD COAGULATION maxifort vs viagra viagra generika telefonisch bestellen ORGANS OF THE DIGESTIVE SYSTEM Oral Cavity viagra mercado libre mexico recurrence. In general, the rates of ulcer healing with sucralfate are similar to the rates with H2RAs. Adverse effects are low in incidence and severity because sucralfate is not absorbed systemically. Constipation and dry mouth are most often reported. The main disadvantages of using sucralfate are that the tablet is large; it must be given at least twice daily; it requires an acid pH for activation and should not be given with an antacid, H2RA, or PPI; and it may bind other drugs and prevent their absorption. In general, sucralfate should be given 2 hours before or after other drugs. king abdullah wikileaks viagra 4. Differentiate the major types of antidiarrheal drugs. 5. Discuss characteristics, effects, and nursing process implications of commonly used antidiarrheal agents. ayurvedic equivalent of viagra 6–12 y: Motion sickness, PO 25 mg up to three times daily (maximal daily dose 75 mg) gold viagra yan etkileri 2. Most antiemetic agents are available in oral, parenteral, and rectal dosage forms. As a general rule, oral dosage forms are preferred for prophylactic use and rectal or parenteral forms are preferred for therapeutic use. 3. Antiemetic drugs are often ordered PRN (as needed). As for any PRN drug, the client’s condition should be assessed before drug administration. 4. The use of antiemetic drugs is usually short term, from a single dose to a few days. can females take male viagra 909 IV, IM, SC 0.25–0.5 units/kg once or twice weekly welche farbe hat viagra • • does viagra make men last longer lettuce viagra NURSING ACTIONS NURSING ACTIONS is viagra safe for men with high blood pressure 1 drop in affected eye(s) twice daily 1–2 drops in each eye 4–6 times daily at regular intervals 1–2 drops twice daily 1 drop in affected eye(s) q8–12h 1 drop in affected eyes 4 times daily, for up to 2 wk 1–2 drops in affected eye(s) 4 times daily, for up to 3 mo 1–2 drops twice daily Solution or suspension 1–2 drops q1h daytime, q2h nighttime until response; then 1 drop q4h Postoperative inﬂammation, 1–2 drops 4 times daily, starting 24 h after surgery, for 2 wk Ointment thin strip 3–4 times daily until response, then once or twice daily Solution 1 drop q1–2h until response, then less often Ointment thin strip 3–4 times daily until response, then once or twice daily Allergic conjunctivitis, 0.2%, 1 drop in affected eye(s) 4 times daily Keratitis, 0.5%, 1–2 drops in affected eye(s) 4 times daily Postoperative inflammation, 0.5%, 1–2 drops in affected eye(s) 4 times daily starting 24 h after surgery and continuing for 2 wk Nonsteroidal Anti-inﬂammatory Drugs Diclofenac (Voltaren) Treatment of inﬂammation after cataract surgery Flurbiprofen (Ocufen) Ketorolac (Acular) Suprofen (Profenal) Inhibition of pupil constriction during eye surgery Treatment of ocular itching due to seasonal allergic conjunctivitis Inhibition of pupil constriction during eye surgery buy viagra online utah How Can You Avoid This Medication Error? what happens if you take 2 viagra at once Drugs ingested by the pregnant woman reach the fetus through the maternal–placental–fetal circulation, which is completed about the third week after conception. On the maternal side, arterial blood pressure carries blood and drugs to the placenta. In the placenta, maternal and fetal blood are separated by a few thin layers of tissue over a large surface area. Drugs readily cross the placenta, mainly by passive diffusion. Placental transfer begins approximately the ﬁfth week after conception. When drugs are given on a regular schedule, serum levels reach equilibrium, with fetal blood usually containing 50% to 100% of the amount in maternal blood. After drugs enter the fetal circulation, relatively large amounts are pharmacologically active because the fetus has low levels of serum albumin and thus low levels of drug binding. Drug molecules are distributed in two ways. Most are transported to the liver, where they are metabolized. Metabolism occurs slowly because the fetal liver is immature in quantity and quality of drug-metabolizing enzymes. Drugs metabolized by the fetal liver are excreted by fetal kidneys into amniotic ﬂuid. Excretion also is slow and inefﬁcient owing to immature development of fetal kidneys. In addition, the fetus swallows some amniotic ﬂuid, and some drug molecules are recirculated. Other drug molecules are transported directly to the heart, which then distributes them to the brain and coronary arter- viagra stop stop stop russian lyrics pills like viagra at walmart the fetus; carbon monoxide decreases the oxygen available to the fetus. Chronic fetal hypoxia from heavy smoking has been associated with mental retardation and other long-term effects on physical and intellectual development. Overall, effects of smoking are dose related, with light smoking (<1 pack/day) estimated to increase fetal deaths by 20% and heavy smoking (1 or more packs/day) increasing deaths by 35%. Cocaine, marijuana, and heroin are illegal drugs of abuse, and their use during pregnancy is particularly serious. Cocaine may cause maternal vasoconstriction, tachycardia, hypertension, cardiac dysrhythmias, and seizures. These effects may impair fetal growth, impair neurologic development, and increase the risk of spontaneous abortion during the ﬁrst and second trimesters. During the third trimester, cocaine causes increased uterine contractility, vasoconstriction and decreased blood ﬂow in the placenta, fetal tachycardia, and increased risk of fetal distress and abruptio placentae. These life-threatening (text continues on page 970) 973 gloria viagra x factor what happens if a woman takes male viagra lactation SOMATOSENSORY is filagra the same as viagra viagra pill markings 50 theater) and other personal experiences (a conversation with a friend about the intended target) to arrive at a new location. The heart of declarative memory, then, is the process of making associations and the ability to retain relational information over time. The hippocampal region is not required for immediate recall. The prefrontal cortex manages working memory and neighboring areas are involved in the maintenance and manipulation of ongoing working memory. The amygdala is a center that mediates emotional memory and modulates the strength and persistence of memories in other memory systems. Prospective memory has a declarative component (what needs to be recalled) and a temporal or contextual component (when or where the intention or action is to be carried out). Prospective recall involves a frontal lobe network that enables a person to carry out an intention after a delay. Cerebral trauma often impairs this function. Other specialized areas of the brain allow for rich and stable new associations. Memories of faces and complex visual patterns, for example, are encoded in the inferotemporal cortex, those for words in the midtemporal cortex, memory tasks related to spatial relationships in the superior parietal cortex, and multimodal memory tasks in the posterior parietal and prefrontal cortices. Priming, an implicit learning strategy, facilitates recognition by using a cue, such as the first letters of a word. The cue biases a subsequent response in the correct direction toward recall. For example, a whole word is recalled after a subject is given only the first syllable of the word. Priming is not sensitive to associations with other knowledge. Priming systems handle information about physical form and structure, rather than about the meanings and associative properties of objects and words.312 Priming strategies rely on perceptual representations stored by modality-specific memory subsystems, such as those that process word forms and visual objects. Each hemisphere, in fact, may store different representations. For example, changing the font of letters did not affect word-stem priming when fragments of a word were presented to the left hemisphere, but it did impair recognition when presented only to the right hemisphere.313 Priming is a valuable strategy for working with amnestic subjects following a traumatic brain injury, herpes encephalitis, and posterior cerebral artery viagra phuket pharmacy vigamed ou viagra glutaminergic transmission by dopamine, leading to LTP. Of interest, dopamine agonists improve executive and working memory aspects of cognition in patients with Parkinson’s disease and for some patients with frontal traumatic injuries.358–360 FUNCTIONAL IMAGING Research on working memory, as well as all other aspects of cognitive processing, is a work in progress. Data from functional imaging and TMS studies continue to create and partially settle controversies about how specific regions process mneumonic and executive functions. Since focal and global brain injuries often degrade some of these processes, the clinician needs to consolidate a few of the major anatomical and physiological hypotheses. Most studies support the finding that the mid-dorsolateral and mid-ventrolateral prefrontal regions play different roles, regardless of whether the task involves spatial, visual, or verbal working memory.348 The ventrolateral area, including BA 47, is involved in the active retrieval of one or a few pieces of information and the sequencing of responses based upon what information is being stored. For example, right mid-ventral BA 47 was activated primarily when subjects held five verbally given numbers in mind and were asked to repeat them. Thus, this region may carry out active, lowlevel encoding strategies, such as rehearsal and intentional retrieval. If asked to listen to five numbers and repeat them in reverse order, the left dorsolateral area and BA 47 are activated. A more dorsal activation also occurs in BA 46 and 9 when the task requires a person to monitor or manipulate, for example, a set of spatial locations held in working memory and make comparisons with new stimuli. This spatial memory task activates BA 9 and 46/9 on the right. Activation studies also sugggest that prefrontal cortex is organized by fairly separable storage and executive processes.349 The attention and inhibition requirements of a task, for example, especially activate the anterior cingulate. One controversy is whether the DLPFC is primarily involved in the maintenance and monitoring of items in working memory or in maintaining a record of the selection of responses. An fMRI study dissected out the finding that during a spatial working memory task, mainte- doctor won't prescribe viagra Chapter EXPERIMENTAL CASE STUDIES 2–4: Dendritic Sprouting After Hemispherectomy viagra price in kerala tion, receive nutrients from the host and graft, and allow diffusion of embedded neurotrophins and other molecules. Indeed, the biocompatible microenvironment may be designed to incorporate neurons, glia, and blood vessels and release molecules on demand over time. Thus, growth cones coaxed into the polymer graft may also be coaxed out of it so they make functional connections. Surgeons may implant, in the near future, smart biopolymers with feedback sensors or an architecture that releases embedded substances and cell types on demand. A more sophisticated polymer assembly could contain simple neural networks for the host CNS to incorporate. For example, a biohybrid microprobe was described that may stimulate encapsulated neurons implanted into the spinal cord.263 Externally controlled stimulation of the polymer via a microelectrode array may further help regenerate axons into nerve stumps or gray matter targets. viagra sublingual tablet well as local action potentials. In visual cortex, for example, an estimated 0.4 spikes per second per neuron accounts for each 1% fMRI signal change in area V1.6 Inhibition may be less metabolically demanding than excitation,10 so the BOLD signal may owe much of its origin to excitatory inputs, but the contributions of excitatatory and inhibitory influences are controversial. The mechanism of BOLD contrast, then, may be better ascribed to the input and intracortical processing of an activated region, rather than its spiking output. Blood oxygenation level dependent signals and neural responses have a fairly linear relationship for brief stimuli.9 After the start of a task, fMRI signals peak within several seconds followed by a ramp-like how long does viagra last once taken Functional Neuroimaging of Recovery viagra parent company Neuroscientific Foundations for Rehabilitation ananas viagra can then be tested to see if they better engage and help to train and reorganize these neural networks. Serial studies of task activations may be needed far more often during an intervention to determine if and how the treatment nurtures the brain map of neural reorganization. viagra 100 mg normal dosage is viagra halal or haram The Rehabilitation Team what company owns viagra decade. The creation of a virtual environment based upon the typical surrounds of a patient allows practice in carrying out home and community activities. Patients on an inpatient unit could wear goggles connected to a computerized program of a 3-dimensional replication of familiar scenes or a set of architectural barriers. The therapists train the patients in wheelchair maneuvering, problem-solving, and self-care skills in the virtual environment. Real-time feedback in normal environments may, however, allow the physical and occupational therapist to provide better cues for learning skills and for solving visuoperceptiual problems. The technology for virtual environments is being driven by academic and industry researchers in many countries. (See, for example, http://www. e-motek.com/products/medical/caren.) Computerized motor learning may also be feasible using VR technologies that provide 3dimensional feedback and guidance for movements and draw upon hypotheses regarding motor control.95 For example, software programming can incorporate information from an accelerometer or Pohlhemus (Vermont, U.S.) magnetic sensors placed on the arm or from fiber-optic wires in a glove or entire body suit.96 One commercial product embeds resistive sensors in a glove to record movements at all joints as the fingers bend and take the shape of a grasped or pinched object (CyberGlove, Immersion Corp., San Jose, CA). These systems show limb or body movements in real time on a projected computer screen or goggles. The movements may take any form, such as a cartoon of the arm, stick figure lines, or whatever interesting figure is programmed. Subjects then, for example, observe their hands reaching and placing items into virtual mail slots that shift in their locations and sizes.97 The subject gets feedback at the schedule chosen by the therapist regarding performance and results for parameters such as spatial accuracy, trajectory in reaching an end point, range of motion across joints, and speed of movements, as well as the degree of finger individuation or precision in pinching during a series of virtual tasks. Virtual reality can provide insight into movement disorders related to apraxia, Parkinson’s disease, and hemiparetic stroke.98 Studies of small numbers of subjects suggest that virtual environment training paradigms in patients with brain injury may generalize to realworld activities.99 Such training can be pro- impaired expression and comprehension of language, the therapist’s first challenge is to quickly obtain reliable verbal or gestural “yes–no” responses. Otherwise, aphasic patients may feel isolated, even angry and frustrated, and may withdraw from those around them. Initial treatments for aphasia often deal with tasks that relate to self-care, the immediate environment, and emotionally positive experiences. As specific syndromes of impairments evolve during assessment and treatment, a variety of specific techniques can be applied. One note of caution. Some patients become upset and withdraw from therapists and family or friends whom they perceive to be talking down to them. Nothing turns them away from therapy more than seemingly irrelevant, simple, repetitive tasks. The inpatient and outpatient rehabilitation team and family help the aphasic person most when they show patience and use consistent techniques to aid expression and comprehension. Different models of conceptualizing language lead to variations in the approaches that may be taken.137 Models include (1) modalityspecific, (2) linguistic, (3) language module processing, (4) minor hemisphere mediation, (5) functional communication, and (6) hybrid therapy approaches. Each therapy task in each of these models has its rationale, drawn from small group studies of normal and impaired subjects. Without greater knowledge of the cognitive architecture of language, however, these models will have limited success for aphasia therapy.138 Future models may combine information about processing single words, sentences, and discourse with the mem- viagra jokes email SOCIAL WORKERS tosh.0 viagra cm/second 5 10 20 30 45 100 125 meters/minute 3 6 12 18 27 60 76 feet/second 0.16 0.33 0.66 0.98 1.48 3.28 4.10 km/hour 0.18 0.36 0.66 1.08 1.62 3.60 4.50 mph 0.11 0.22 0.45 0.67 1.01 2.24 2.80 girlfriend took viagra No heel off beste alternative viagra 261 viagra for recreational purposes aurogra 100 viagra _____ viagra vencido efectos 7 6 5 4 3 2 1 does enzyte work like viagra ued research, measures of QOL have become one of the expected outcome measures in clinical trials of physical, pharmacologic, and surgical interventions. The tools offer interesting insights about disability as well. For example, these measures have shown that the strongest predictor of life satisfaction among disabled adults was satisfaction with leisure activities.171 In another study, a battery of instruments revealed that following a stroke, patients had greater depression, caused more stress for their relatives, and were less socially active than a control group.172 In a study of MS, a QOL instrument showed the impact of the disease in meaningful ways that the EDSS did not.173 Clinical trials, at least those that face the inspection of the U.S. Food and Drug Adminis- Assessment and Outcome Measures for Clinical Trials best viagra medicine in india how long does viagra stay in your system drug test 198718; viagra shop in bangkok 382 grouping of patients make good sense for some experimental designs of stroke rehabilitation interventions. Duncan and colleagues also showed the value of relating impairment groups to functional and quality of life outcomes.139 The investigators examined the cumulative probabilities of achieving a BI score over 60 or over 90 within 14 days of stroke and 1, 3, and 6 months after stroke for four impairment groups: motor (M) only, motor and sensory (SM), motor and hemianopia (MH), and sensorimotor and hemianopia (SMH). The 360 patients who survived the stroke represented all eligible stroke patients from 12 hospitals in greater Kansas City. The patients were alert and had been living at home at the time of the first evaluation. The investigators employed the lower extremity portion of the Fugl-Meyer index as their measure of motor impairment, using a cutoff score of 28 points out of a possible 34 points to identify patients with less than normal hip flexor power (see Chapter 7). The level of disability correlates especially with motor function of the leg.141 Sensory and visual field function was defined as present or absent based on the NIH Stroke Scale (NIHSS). Between 1 and 3 months after the stroke, the probability of achieving a BI score of 60 or greater (often adequate for a discharge to the home) rose from 80% to 90% for M, from 70% to 85% for SM, from 35% to 70% for MH, and from 12% to 53% for SMH. Table 9–9 compares the cumulative probabilities of reaching a BI score of 60 and of 90 or better at 6 months for the patients in the is viagra habit forming 468. 469. 470. 471. 472. 473. 474. 475. 476. 477. 478. kinds of viagra tablets cascara sandia viagra 479. 484 is viagra a banned substance does indian viagra work Rehabilitation of Specific Neurologic Disorders FIGURE dabur viagra example of how skin maintains homeostasis, consider the effects of an increase in atmospheric temperature. The skin possesses sensors (nerve receptors) that detect temperature change. When a rise in temperature is detected, the network of blood vessels in the skin, aided by the nervous system, dilate and more blood reaches closer to the surface of the body where heat can be removed by conduction. The sweat glands increase production, and the body is cooled by sweat evaporation until body temperature reaches normal values. Other skin functions include manufacturing vitamin D and eliminating waste products. The skeletal system (see Figure 1.4B) comprises the bones, bone marrow, and joints of the body. The skeletal system’s major functions are to support the body, provide an area for muscle attachment (bones), food equivalent to viagra dangers of herbal viagra Sternum Upper limb bones Ribs Cartilage Vertebrae Sacrum Electron donated Na Na do catholic institutions cover viagra Lysosomes viagra opposite effect viagra and sperm fertility A Table 1.2 best place to buy viagra online yahoo answers After a month free viagra sample pack australia pills like viagra in stores Trapezius muscle Clavicle Sternocleidomastoid muscle Suprasternal notch FIGURE fruits like viagra thuoc viagra bao nhieu tien Palmaris longus Superior articular facet productos naturales similares viagra viagra kalp krizine neden olurmu Coracoclavicular ligament (conoid) Clavicle who makes viagra for women vertebrae are L-shaped when viewed laterally. The articular surfaces are covered with cartilage and marked by elevations and depressions that ﬁt each other and make the joint stronger. quartier latin academia viagra Ischiofemoral ligament Patella does viagra helps in premature ejaculation can you take viagra while drinking alcohol Interosseous talocalcaneal ligament The Massage Connection: Anatomy and Physiology viagra 50 mg precio mexico A viagra song good morning lyrics how much will viagra cost when it goes generic 4.10. Organization of Muscle Fibers Glucose buy viagra jelly online uk ceshte viagra ATP pfizer v teva viagra Motor unit Frontalis Procerus Procerus Temporalis Corrugator Obicularis oculi: Orbital Palpebral Zygomatic arch Levator labii superioris Zygomaticus: Major Minor Risorius Depressor anguli oris Mentalis Platysma Masseter Buccinator Obicularis oris Depressor labii inferioris Depressor anguli oris Risorius Mentalis Nasalis pilule viagra pour femme can you buy genuine viagra online Condyle of mandible Medial pterygoid Ramus of mandible reputable online viagra store Xiphoid process The Diaphragm comment acheter viagra au maroc how much does viagra cost at rite aid F icariin vs viagra Compartments in the Leg 22 year old taking viagra Musculocutaneous nerve, (C5, C6) Draws the eyebrows together, resulting in vertical wrinkles in forehead Draws medial angle of the eyebrow inferiorly to wrinkle skin transversely over the bridge of nose red pill like viagra Coronoid process and ramus of mandible Medial surface of mandibular ramus and angle Condyle of mandible and temporomandibular joint sandia sirve como viagra can viagra be taken with blood pressure medication Superior surface of ﬁrst two ribs Rectus abdominis viagra tablets buyers Latissimus dorsi viagra for 27 year old Chapter 4—Muscular System does viagra cause weight loss wo kann man viagra legal kaufen Posterior view youtube scary movie viagra O Insertion Extends the metatarsophalangeal joints of digits 1–4 and assists in extending the interphalangeal joints of digits 2–4 L5, S1 Action Nerve Supply Muscle Diagram viagra social media es malo tomar viagra siendo joven Receptors can viagra cause death (emotional experience) e viagra stories challenging erectile dysfunction Medullary raphe Medullary raphe nucleus nucleus how to make desi viagra Chapter 5—Nervous System viagra gegen vorzeitigen samenerguss Posterior Spinal cord Right anterior corticospinal tract Left lateral corticospinal tract is there a viagra equivalent for women harga viagra di indonesia A Resting Coma is a state of unconsciousness from which a person cannot be aroused by even the most intense external stimuli. Usually it is a result of trauma that affects the reticular activating system. Ingestion of drugs or poisons or chemical imbalances associated with certain diseases may also cause coma viagra off patent 2012 The Massage Connection: Anatomy and Physiology brewdog viagra viagra al femminile pillola rosa PINEAL GLAND Vas deferens Pubic symphysis Corpus spongiosum Penis Corpus cavernosum Epididymis Glans penis Testis Urethral orifice types of herbal viagra 427 is there anything stronger than viagra viagra multiple doses The Perineum 8.17. Structure of Capillary, Vein, and Artery does viagra helps premature ejaculation Arterial Supply to the Brain obamacare viagra sex offenders watermelon viagra blogs Regulation of the Cardiovascular System 3. A. viagra ohne rezept expressversand viagra allo mam tekst Immunity Nonspeciﬁc defenses are present from birth, and they include physical barriers, phagocytic cells, immunologic surveillance, liberation of a variety of chemicals, inﬂammation, and fever. can i take viagra if i dont have ed can you fail a drug test from viagra The opening and closure of the eustachian tubes are responsible for the sudden change in hearing (popping in the ears) that occurs when swimming under water or ascending to high altitudes. When a person has a cold or sore throat, the inﬂammation and edema in the pharynx can result in closure of the eustachian tube opening and may affect hearing. With time, the air in the tube may get absorbed into the blood vessels, producing a partial vacuum in the region and severe ear pain. The latter is more common in babies because the opening is small. In babies, because the short eustachian tube makes it easier for infections in the throat to spread to the ear, middle ear infection often accompanies upper respiratory tract infection. Pulmonary venule Bronchiole Capillaries viagra stays in system Inspiration is an active process where the muscles of respiration (see Figure 10.10 and Table 1) contract to increase the thoracic volume. The major muscle of in- viagra cowboy commercial Volume/Capacities in Men and Women (Normal Values) taking too many viagra 5,000 mL viagra ft mc mimo - na jem anyone ever buy viagra online Transport of Carbon Dioxide AUTOREGULATION IN TISSUE quick med viagra viagra verschreibungspflichtig deutschland 571 viagra halal or haram 572 Opening of parotid duct (near second maxillary molar) Parotid duct Tongue viagra posologie vidal FIGURE natural supplements like viagra Because the absorptive capacity of the colon is great, it is a practical route for administration of drugs, especially in children. Anesthetics, steroids, and painkillers are all rapidly absorbed by this route. how long does viagra stay in your system for drug test chewable viagra mexico Small intestine Glomerular capillary Bowman's capsule can you take 2 50mg viagra does viagra harm you Normal filtration natural viagra holland and barrett One effect of massage is the potential increase of urine production. Massage aids the movement of ﬂuid from the interstitial compartment into the systemic circulation. The resultant increase in blood volume is counteracted by an increase in urine volume. Such effects are more signiﬁcant in those persons with edema. The increase may be as high as three to four times the normal rate of urine formation. With the increase in urinary volume, an increase in excretion of the products accumulated in the edema ﬂuid can be expected. Massage promotes excretion of nitrogenous wastes and other ions, as evidenced by an increase in urinary levels after treatment.1,2 By stimulating large nerve ﬁbers (gate control theory), massage can reduce pain originating from the urinary tract by reducing reﬂexive muscle spasm and inhibiting pain perception. It has the potential to reduce pain by local reﬂex mechanisms as well. It is important for the therapist to elicit a complete history related to the urinary system during the visit. Clients with pain in the low back region associated with fever; those with a history of change in color, frequency, or volume of urine; and those with pain on passing urine should be referred to a physician.3 History of sudden increase in weight could be a result of
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