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Antigenic structure: Group-specific antigens Species-specific antigens Clinical Features: Clinical illness is due to the invasion and multiplication of rickettsiae in the endothelial cells of small blood vessels buy bimat 3ml lowest price. It manifests with fever quality 3ml bimat, headache, malaise, skin rash and enlargement of liver and spleen. Hosts and vectors of the medically important rickettsiae Organism Disease Hosts Vectors 1. It causes epidemic or louse-borne typhus and the milder recrudescence form, Brill-Zinser disease. Clinical Features: It is transmitted by self-inoculation of the organism by scratching after bite by infected louse(Pediculous humanus corporis and pediculous humanus capitis). The illness manifests with sudden onset of fever, headache, malaise, prostration and skin rash. Epidemics of the disease are associated with overcrowding, cold weather, lack of washing facilities and fuel, famine and war. The disease is milder than louse-borne typhus and occurs in those individuals living or working in highly rat-infested area. Laboratory diagnosis: Specimen: Serum for serological tests The serological tests to diagnose typhus are: 1. The smallest living micro-organism capable of free living in nature self-replicating on laboratory media. Highly pleomorphic due to absence of rigid cell wall, instead bounded by a triple-layered “unit membrane”. Have enzyme systems and make their own proteins, lipids, nucleic acids and vitamins. The elementary body is reorganized into reticulate body in the host cell which is specifically adapted for intracellular growth. The reticulate body grows and divides many times to form inclusions in the host cell cytoplasm. With in 24-48 hours of developmental cycle, the reticulate bodies rearrange them selves into infective elementary bodies and released after host cell rupture. Antigenic structure: Group-specific antigen Species-specific antigen Chlamydia trachomatis. Appearance in giemsa’s stain Elementary body -------- Purple Reticulate body---------- Blue Host cell cytoplasm----- Blue. Appearance in iodine stain Brown inclusions in host cell cytoplasm because of glycogen matrix surrounding the particle. Incubation period is 3-10 days Route of transmission is through indirect contact like eye-to- eye by infected fingers or sharing towels. It manifests as a chronic keratoconjunctivitis producing scarring and deformity of the eyelids, corneal vascularization and opacities which may lead to blindness. Laboratory diagnosis: Specimen: Conjunctival scraping from upper tarsal conjunctivae. Culture: Mac coy cells or embryonated eggs Serology: Immunofluorescent tests Treatment: Erythromycin Tetracycline Control measures:. Females------ Urethritis Cervicitis Pelvic inflamatory diseases If complicated in females, it causes infertility and ectopic pregnancy. Neonatal inclusion conjunctivitis and neonatal pneumonia Transmission is during passage through the infected birth canal. Laboratorydiagnosis: Specimen: Endocervical scraping Culture: mac coy cells Serology: Enzyme immunoassay for group-specific antigen. On the basis of their life habits, microorganism is classified as saprophytes or parasites. Saprophytes : Mode of life of free-living organisms which obtain their nourishment from soil and water. Commensalism: The ability to live on the external or internal surface of the body with out causing disease. Invasiveness of micro-organism A high degree of bacterial invasiveness is usually associated with severe infection. Mode of release from bacteria Excreted by released on bacterial death 295 living cell (Integral part of cell wall) 4. Collagenase: Degrade collagen, which is major protein of fibrous connective tissue. Hyaluronidase: (Early spreading factor) hydrolyzes hyaluronidic acid, which is the ground substance of connective tissue. Lecithinase: Splits lecithin of cell membrane into phosphorylcholine and glycerides. Many layered impermeable barrier to invasion of the tissues by microorganisms from the environment.

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It provides information about the genet- nations buy 3ml bimat fast delivery, including physicians generic bimat 3ml online, psychiatrists, psycholo- ic relations among different species, furthers understand- gists, and social workers. There are several different psy- ing of human behavior, tests the limitations of psycho- chological tests or procedures that designed to assist in logical theories, and aids in the conservation of the nat- the assessment of competence to stand trial. It is a 22-item sentence completion test that requires the test-taker to complete sentence stems, such as: “When I go to court, the lawyer will ______________________. Total scores are calculated with a cutoff score that indicates possible incompetence. The ability of a person charged with a crime to un- Another assessment test is the Competency Assessment derstand the nature and purpose of the criminal proceedings. It consists of a detailed face-to-face interview about various aspects of competent function- ing, including an appreciation of the charges and an un- Defendants in a criminal trial must have the ability derstanding of the various roles of the judge, witnesses, (i. This requirement is a long- Research has shown that when competency evalua- standing and fundamental principle of criminal law. Its tions occur, most (70%) of the defendants who are as- purpose is to ensure that defendants can participate sessed are judged competent. The requirement incompetent tend to have been charged with more seri- refers to the defendant’s competence at the time of the ous crimes, compared to defendants in general. They trial, rather than their psychological state at the time of also are likely to have a history of psychosis, to have a the alleged offense. Rationality is a key issue in compe- serious current mental disorder, and to be poorly educat- tency determinations. Once a defendant is judged to be competent, the legal usually lack the ability to understand, communicate, or proceedings are resumed and a trial takes place. Otherwise the United States, where individual rigor and competition defendant is returned to an institution until competency appear to be nationalistic qualities Americans cherish can be restored. If competency cannot be restored within a capitalist-driven society thrives because of the spirited reasonable period of time (e. Ac- being the serial bomber who built homemade bombs that cording to Sigmund Freud, humans are born screaming killed three people and injured many others between for attention and full of organic drives for fulfillment in 1978 and 1995. Initially, according to this view, we com- the proceedings because of a dispute with his lawyers pete for the attention of our parents—seeking to attract it about his defense. His request to represent himself and either from siblings or from the other parent. Thereafter, an attempted suicide provoked concerns about his com- we are at the mercy of a battle between our base impuls- petence. In her report to the court, ever, that this view of the role of competition in human the psychiatrist said that Kaczynski was not suffering behavior may be incorrect. Thomas Hobbes (1588- from any mental defect that could prevent him from un- 1679), one of the great philosophers of the seventeenth derstanding the nature of the charges, or from assisting century, is perhaps best remembered for his characteriza- his lawyers in mounting a defense. On the other hand, tion of the “natural world,” that is, the world before the she noted that he was suffering from paranoid schizo- imposition of the will of humanity, as being “nasty, phrenia. The that those species best able to adapt to and master the nat- Unabomber case provides a good illustration of a situa- ural environment in which they live will survive, has tion in which a psychological disorder did not necessar- suggested to many that the struggle for survival is an in- ily harm the defendant’s ability to participate meaning- herent human trait which determines a person’s success. Darwin’s theory has even been summarized as “survival of the fittest”—a phrase Darwin himself never used—fur- Timothy Moore ther highlighting competition’s role in success. As it has often been pointed out, however, there is nothing in the concept of natural selection that suggests that competition Further Reading Wrightsman, L. Darwin asserted in The Origin of Species that the strug- gles he was describing should be viewed as metaphors and could easily include dependence and cooperation. Many studies have been conducted to test the impor- tance placed on competition as opposed to other values, Competition such as cooperation—by various cultures, and generally An adaptive strategy that pits one person’s interests conclude that Americans uniquely praise competition as against another’s. In 1937, the world- renowned anthropologist Margaret Mead published Co- Psychologists have long been in disagreement as to operation and Competition among Primitive Peoples, whether competition is a learned or a genetic component based on her studies of several societies that did not prize of human behavior. Perhaps what first comes to mind competition, and, in fact, seemed at times to place a nega- when thinking of competition is athletics. One such society was the Zuni Indians of mistake, however, not to recognize the effect competition Arizona, and they, Mead found, valued cooperation far has in the areas of academics, work, and many other more than competition. Psychologists disagree as to whether competition is a learned or genetic component of human behavior. Natural concepts are often learned through the use Conditioned responses develop in a process called of prototypes, highly typical examples of a category— acquisition, in which the natural or unconditioned stimu- like the robin cited above. Some re- concept learning is through the trial-and-error method of sponses develop more quickly than others; similarly, testing hypotheses. The nature of certain item is an instance of a particular concept; they the conditioned response depends on the circumstances then learn more about the concept when they see in which acquisition occurs. This People learn simple concepts more readily than process is called “delayed conditioning” because the un- complex ones. For example, the easiest concept to learn conditioned stimulus is delayed relative to the condi- is one with only a single defining feature. The response is weaker if the condi- est is one with multiple features, all of which must be tioned and unconditioned stimuli begin together, and be- present in every case, known as the conjunctive concept.

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In a triple bond two atoms share three pairs of electrons and form a s bond and two p bonds buy bimat 3 ml overnight delivery. Sodium (Na) loses a single electron from its 3s orbital to attain a more 2 2 6 stable neon gas configuration (1s 2s 2p ) with no electron in the outer shell safe bimat 3ml. The total number of electrons in the valence shell of each atom can be determined from its group number in the periodic table. The shared electrons are called the bonding electrons and may be represented by a line or lines between two atoms. The valence electrons that are not being shared are the nonbonding electrons or lone pair electrons, and they are shown in the Lewis structure by dots around the symbol of the atom. Usually they are very reactive, and are believed to play significant roles in aging, cancer and many other ailments. In neutral organic compounds, C forms four bonds, N forms three bonds (and a lone pair), O forms two bonds (and two lone pairs) and H forms one bond. Lewis structure shows the connectivity between atoms in a molecule by a number of dots equal to the number of electrons in the outer shell of an atom of that molecule. When drawing Lewis structures, it is essential to keep track of the number of electrons available to form bonds and the location of the electrons. The number of valence electrons of an atom can be obtained from the periodic table because it is equal to the group number of the atom. For example, hydrogen (H) in Group 1A has one valence electron, carbon (C) in Group 4A has four valence electrons, and fluorine (F) in Group 7A has seven valence electrons. The remaining six valence electrons are with the fluorine atom in the three nonbonding pairs. H In the periodic table, the period 2 elements C, N, O, and F have valence electrons that belong to the second shell (2s and three 2p). In period 3, elements Si, P, S and Cl have the valence electrons that belong to the third shell (3s,three3p and five 3d ). The shell is only partially filled with eight electrons in 3s and three 3p, and the five 3d orbitals can accommodate an additional ten electrons. For these differences in valence shell orbitals available to elements of the second and third periods, we see significant differences in the covalent bonding of oxygen and sulphur, and of nitrogen and phosphorus. Although oxygen and nitrogen can accommodate no more than eight electrons in their valence shells, many phosphorus-containing compounds have 10 electrons in the valence shell of phosphorus, and many sulphur-containing compounds have 10 and even 12 electrons in the valence shell of sulphur. So, to derive Lewis structures for most molecules the following sequence should be followed. If an atom other than hydrogen has fewer than eight electrons then move unshared pairs to form multiple bonds. Lewis structures are useful as they show what atoms are bonded together, and whether any atoms possess lone pairs of electrons or have a formal charge. A formal charge is the difference between the number of valence electrons an atom actually has when it is not bonded to any other atoms, and the number of nonbonding electrons and half of its bonding electrons. Thus, a positive or negative charge assigned to an atom is called a formal charge. The decision as to where to put the charge is made by calculating the formal charge for each atom in an ion or a molecule. For þ example, the hydronium ion (H3O ) is positively charged and the oxygen atom has a formal charge of þ1. So, only five electrons effectively belong to oxygen, which is one less than the valence electrons. Elements of the second period, including carbon, nitrogen, oxygen and fluorine, cannot accommodate more than eight electrons as they have only four orbitals (2s, 2px,2py and 2pz) in their valence shells. An atom that gains electrons becomes an anion, a negatively charged ion, and an atom that loses electrons becomes a cation, a positively charged ion. Atoms decrease in size as they go across a period, and increase in size as they go down a group and increase the number of shells to hold electrons. The energy required for removing an electron from an atom or ion in the gas phase is called ionization energy. Atoms can have a series of ionization energies, since more than one electron can always be removed, except for 2. In general, the first ionization energies increase across a period and decrease down the group. Ionic bonds Ionic bonds result from the transfer of one or more electrons between atoms. The more electronegative atom gains one or more valence electrons and hence becomes an anion. The less electronegative atom loses one or more valence electrons and becomes a cation. A single- headed arrow indicates a single electron transfer from the less electro- negative element to the more electronegative atom. Thus, ionic bonds consist of the electrostatic attraction between positively and negatively charged ions.

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This disorder is charac- terized by a pattern of socially irresponsible generic bimat 3ml fast delivery, exploitative bimat 3 ml amex, and guiltless behavior, as evidenced by the tendency to fail to conform to the law, to sustain consistent employ- ment, to exploit and manipulate others for personal gain, to deceive, and to fail to develop stable relationships. The individual must be at least 18 years of age and have a his- tory of conduct disorder before the age of 15. The features of this dis- order are described as marked instability in interpersonal relationships, mood, and self-image. The instability is sig- nificant to the extent that the individual seems to hover on the border between neurosis and psychosis. Symptoms include exagger- ated expression of emotions, incessant drawing of atten- tion to oneself, overreaction to minor events, constantly seeking approval from others, egocentricity, vain and de- manding behavior, extreme concern with physical appear- ance, and inappropriately sexually seductive appearance or behavior. This disorder is char- acterized by a grandiose sense of self-importance; pre- occupation with fantasies of success, power, brilliance, beauty, or ideal love; a constant need for admiration and attention; exploitation of others for fulfillment of own desires; lack of empathy; response to criticism or failure with indifference or humiliation and rage; and preoccupa- tion with feelings of envy. This disorder is charac- terized by social withdrawal brought about by extreme sensitivity to rejection. Symptoms include unwillingness to enter into relationships unless given unusually strong guarantees of uncritical acceptance; low self-esteem; and social withdrawal despite a desire for affection and accep- tance. Individuals with this disorder passively allow others to assume responsibility for major areas of life because of their inability to func- tion independently. They lack self-confidence, are unable to make decisions, perceive themselves as helpless and stu- pid, possess fear of being alone or abandoned, and seek constant reassurance and approval from others. This dis- order is characterized by a pervasive pattern of perfec- tionism and inflexibility. Interpersonal relationships have a formal and serious quality, and others often perceive these individuals as stilted or “stiff. Oppositional defiant disorder in childhood or adolescence is a predisposing factor. Many of the behaviors associated with the various personal- ity disorders may be manifested by clients with virtually every psychiatric diagnosis, as well as by those individuals described as “healthy. Individuals with personality disorders may be encountered in all types of treatment settings. They are not often treated in acute care settings, but because of the instability of the borderline client, hospitalization is necessary from time to time. The indi- vidual with antisocial personality disorder also may be hospital- ized as an alternative to imprisonment when a legal determination is made that psychiatric intervention may be helpful. Because of these reasons, suggestions for inpatient care of individuals with these disorders are included in this chapter; however, these inter- ventions may be used in other types of treatment settings as well. Undoubtedly, these clients represent the ultimate challenge for the psychiatric nurse. The term “borderline” came into being because these clients’ emotionally unstable behavior seems to fall on the border between neurotic and psychotic. Cummings and Mega (2003) have suggested a possible serotonergic defect in clients with borderline personality disorder. Cummings and Mega (2003) stated: These functional imaging studies support a medial and orbitofrontal abnormality that may promote the impulsive aggression demonstrated by patients with the borderline personality disorder (p. The decrease in serotonin may also have genetic implications for borderline personality disorder. Sadock and Sadock (2007) report that depression is common in the family backgrounds of clients with borderline person- ality disorder. They stated: These patients have more relatives with mood disorders than do control groups, and persons with borderline personality disorder often have mood disorder as well (p. Studies have shown that many indi- viduals with borderline personality disorder were reared in families with chaotic environments. Lubit and Finley- Belgrad (2008) stated, “Risk factors [for borderline per- sonality disorder] include family environments character- ized by trauma, neglect, and/or separation; exposure to sexual and physical abuse; and serious parental psychopa- thology such as substance abuse and antisocial personality disorder. In some instances, this disorder has been likened to posttraumatic stress disorder in response to childhood trauma and abuse. For example, symptoms such as intrusion, avoidance, and hyperarousal may emerge during psychotherapy. Awareness of the trauma-related nature of these symptoms can facilitate both psychotherapeutic and pharmacological efforts in symptom relief (p. This theory suggests that the basis for borderline personality lies in the ways the child relates to the mother and does not separate from her. Mahler and associates (1975) define this process in a series of phases described as follows: • Phase 1 (Birth to 1 month), Autistic Phase. The child views the self as an extension of the parenting figure, although there is a developing awareness of external sources of need fulfillment. The child is beginning to recognize that there is separ- ateness between the self and the parenting figure. This phase is characterized by increased locomotor function- ing and the ability to explore the environment indepen- dently.

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