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Training had quickened his mental processes in assessing the threat discount extra super cialis 100mg with mastercard erectile dysfunction medicine in pakistan, allowing him to maintain what tower operators later called an ―eerie calm generic 100 mg extra super cialis with amex erectile dysfunction doctors los angeles. When the tower suggested a runway in New Jersey generic extra super cialis 100 mg mastercard impotence after 50, Sullenberger calmly replied: We’re unable. The last communication from Captain Sullenberger to the tower advised of the eventual outcome: We’re going to be in the Hudson. The crew kept the passengers calm as women, children, and then the rest of the passengers were evacuated onto the boats of the rescue personnel that had quickly arrived. Captain Sullenberger then calmly walked the aisle of the plane to be sure that everyone was out before joining the 150 other rescued survivors (Levin, 2009; National Transportation [1] Safety Board, 2009). Affect is an essential part of the study of psychology because it plays such an important role in everyday life. As we will see, affect guides behavior, helps us make decisions, and has a major impact on our mental and physical health. Because they involve arousal, emotions and motivations are “hot‖—they “charge,‖ “drive,‖ or “move‖ our behavior. When we become aroused, the sympathetic nervous system provides us with energy to respond to our environment. The liver puts extra sugar into the bloodstream, the heart pumps more blood, our pupils dilate to help us see better, respiration increases, and we begin to perspire to cool the body. An emotion is a mental and physiological feeling state that directs our attention and guides our behavior. Whether it is the thrill of a roller-coaster ride that elicits an unexpected scream, the flush of embarrassment that follows a public mistake, or the horror of a potential plane crash that creates an exceptionally brilliant response in a pilot, emotions move our actions. Emotions normally serve an adaptive role: We care for infants because of the love we feel for them, we avoid making a left turn onto a crowded highway because we fear that a speeding truck may hit us, and we are particularly nice to Mandy because we are feeling guilty that we didn‘t go to her party. But emotions may also be destructive, such as when a frustrating experience leads us to lash out at others who do not deserve it. But there are a variety of other personal and social motivations that can influence behavior, including the motivations for social approval and acceptance, the motivation to achieve, and the [2] motivation to take, or to avoid taking, risks (Morsella, Bargh, & Gollwitzer, 2009). As predicted by basic theories of operant learning, motivations lead us to engage in particular behaviors because doing so makes us feel good. Motivations are often considered in psychology in terms of drives, which are internal states that are activated when the physiological characteristics of the body are out of balance, and goals, which are desired end states that we strive to attain. Motivation can thus be conceptualized as a series of behavioral responses that lead us to attempt to reduce drives and to attain goals by comparing our current state with a desired end state (Lawrence, Carver, & Scheier, [3] 2002). Like a thermostat on an air conditioner, the body tries to maintain homeostasis, the natural state of the body‘s systems, with goals, drives, and arousal in balance. When a drive or goal is aroused—for instance, when we are hungry—the thermostat turns on and we start to behave in a way that attempts to reduce the drive or meet the goal (in this case to seek food). As the body works toward the desired end state, the thermostat continues to check whether or not the end state has been reached. Eventually, the need or goal is satisfied (we eat), and the relevant behaviors are turned off. The body‘s thermostat continues to check for homeostasis and is always ready to react to future needs. In addition to more basic motivations such as hunger, a variety of other personal and social motivations can also be conceptualized in terms of drives or goals. When the goal of studying for an exam is hindered because we take a day off from our schoolwork, we may work harder on our studying on the next day to move us toward our goal. When we are dieting, we may be more likely to have a big binge on a day when the scale says that we have met our prior day‘s goals. And when we are lonely, the motivation to be around other people is aroused and we try to socialize. In many, if not most cases, our emotions and motivations operate out of our conscious Attributed to Charles Stangor Saylor. We begin this chapter by considering the role of affect on behavior, discussing the most important psychological theories of emotions. We will discuss how the experience of long-term stress causes illness, and then turn to research onpositive thinking and what has been learned about the beneficial health effects of more positive emotions. Finally, we will review some of the most important human motivations, including the behaviors of eating and sex. The importance of this chapter is not only in helping you gain an understanding the principles of affect but also in helping you discover the important roles that affect plays in our everyday lives, and particularly in our mental and physical health. The study of the interface between affect and physical health—that principle that “everything that is physiological is also psychological‖—is a key focus of the branch of psychology known as health psychology. The importance of this topic has made health psychology one of the fastest growing fields in psychology. Velocity toward goal attainment in immediate experience as a determinant of affect. The unconscious regulation of emotion: Nonconscious reappraisal goals modulate emotional reactivity. The most fundamental emotions, known as the basic emotions, are those ofanger, disgust, fear, happiness, sadness, and surprise. The basic emotions have a long history in human evolution, and they have developed in large part to help us make rapid judgments about stimuli and to [1] quickly guide appropriate behavior (LeDoux, 2000). The basic emotions are determined in large part by one of the oldest parts of our brain, the limbic system, including the amygdala, the hypothalamus, and the thalamus. Because they are primarily evolutionarily determined, the basic emotions are experienced and displayed in much the same way across cultures (Ekman, 1992; [2] Elfenbein & Ambady, 2002, 2003; Fridland, Ekman, & Oster, 1987), and people are quite accurate at judging the facial expressions of people from different cultures. Video Clip: The Basic Emotions Not all of our emotions come from the old parts of our brain; we also interpret our experiences to create a more complex array of emotional experiences. For instance, the amygdala may sense fear when it senses that the body is falling, but that fear may be interpreted completely differently (perhaps even as “excitement‖) when we are falling on a roller-coaster ride than when we are falling from the sky in an airplane that has lost power. The cognitive interpretations that accompany emotions—known as cognitive appraisal—allow us to experience a much larger and more complex set of secondary emotions, as shown in Figure 10. Although they are in large part cognitive, our experiences of the secondary emotions are determined in part by arousal (on the vertical axis of Figure 10. They are determined by both their level of arousal (low to high) and their valence (pleasant to unpleasant). When you succeed in reaching an important goal, you might spend some time enjoying your secondary emotions, perhaps the experience of joy, satisfaction, and contentment. But when your close friend wins a prize that you thought you had deserved, you might also experience a variety of secondary emotions (in this case, the negative ones)—for instance, feeling angry, sad, resentful, and ashamed. You might mull over the event for weeks or even months, experiencing [3] these negative emotions each time you think about it (Martin & Tesser, 2006). Our response to the basic emotion of fear, for instance, is primarily determined by the fast pathway through the limbic system. When a car pulls out in front of us on the highway, the thalamus activates and sends an immediate message to the amygdala. Secondary emotions are more determined by the slow pathway through the frontal lobes in the cortex.

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It’s found in the intervertebral discs of the vertebral column and in the symphysis pubis at the front of the pelvis cheap extra super cialis 100mg without a prescription erectile dysfunction questionnaire uk. This structure generic 100mg extra super cialis otc effective erectile dysfunction treatment, which makes up the ear lobe and other structures where a specific form is important buy 100mg extra super cialis amex erectile dysfunction 5gs, tends to bounce back to its original shape after being bent. Bone, or osseous, tissue: Essentially, bone is mineralized connective tissue formed into repeating patterns called Haversian systems. In the center of each system is a large opening, the Haversian canal, that contains blood vessels, lymph vessels, and nerves. The central canal is surrounded by thin membranes called lamellae that contain the lacunae, which in turn contain osteocytes (bone cells). Smaller canali- culi connect the lacunae and circulate tissue fluids from the blood vessels to nour- ish the osteocytes. Like other connec- tive tissues, it has an extracellular matrix — in this case, plasma — in which are suspended erythrocytes (red blood cells), leukocytes (white blood cells), and thrombocytes (platelets). Erythrocytes are concave on both sides and contain a pigment, hemoglobin, which supplies oxygen to the body’s cells and takes carbon dioxide away. There are approximately 5 million erythrocytes per cubic millimeter of whole blood. Thrombocytes, which number approximately 250,000 per cubic millimeter, are fragments of cells used in blood clotting. Leukocytes are large phagocytic cells (literally “cell that eats”) that are part of the body’s immune system. There are, however, relatively few of them — less than 10,000 per cubic millimeter. Thrombocytes Flexing It: Muscle Tissue Although we review how muscles work in Chapter 6, in histology you should know that muscle tissue is made up of fibers known as myocytes. The cytoplasm within the fibers is called sarcoplasm, and within that sarcoplasm are minute myofibrils that contain the protein filaments actin and myosin. These filaments slide past each other during a muscle contraction, shortening the fiber. Following are the three types of muscle tissue (see Figure 4-3): Smooth muscle tissue: This type of tissue contracts without conscious control. Made up of spindle-shaped fibers with large, centrally located nuclei, it’s found in the walls of internal organs, or viscera. Smooth muscle gets its name from the fact that, unlike other muscle tissue types, it is not striated. Cardiac muscle tissue: Also known as myocardium, cardiac muscle tissue is made of branching fibers, each with a central nucleus and alternating light and dark striations. As with smooth muscle, cardiac muscle tissue contractions occur through the autonomic nervous system (involuntary control). Skeletal, or striated, muscle tissue: Biceps, triceps, pecs — these are the mus- cles that bodybuilders focus on. As the name implies, skeletal muscles attach to the skeleton and are used throughout the central nervous system for movement. Muscle fibers are cylindrical with several nuclei in each cell (which makes them multinucleated) and cross-striations throughout. Part I: Building Blocks of the Body 54 Figure 4-3: Muscle tissues: Smooth, cardiac, and skeletal. Smooth muscle cell Intercalated disc Muscle fiber Nuclei Nucleus Nuclei Illustration by Imagineering Media Services Inc. Deltoid Getting the Signal Across: Nerve Tissue There’s only one type of nerve tissue and only one primary type of cell in it: the neuron. Nerve tissue is unique in that it can both generate and conduct electrical sig- nals in the body. That process starts when sense receptors receive a stimulus that causes electrical impulses to be sent through finger-like cytoplasmic projections called Chapter 4: The Study of Tissues: Histology 55 dendrites. From there, the impulse moves through the body of the cell and into another type of cytoplasmic projection (or nerve process) called an axon that hands the signal off to the next cell down the line. The cytoplasmic projection of a neuron that carries impulses away from the cell body is called a. Smooth muscle Part I: Building Blocks of the Body 56 Answers to Questions on Histology The following are answers to the practice questions presented in this chapter. Tubules of the kidney i A tissue that’s one layer thick but appears to be multilayered and is composed of cells taller than they are wide is c. To arrive at the correct answer, consider this question one piece at a time: pseudo is “false,” stratified means “layered” (so you have “false-layered”), and columns are taller than they are wide. Knowing that the Greek word thrombos means “clot” can help you spot the correct answer in this question. Intercalated discs, as you should or will know from studying the circulatory system, are involved in conducting signals for the heart to pump. Chapter 4: The Study of Tissues: Histology 57 C Skeletal muscle tissue has prominent lines across the fiber called d. The other answer choices contain striated tissue, which technically means that they aren’t smooth. F The cytoplasmic projection of a neuron that carries impulses away from the cell body is called c. Each neuron cell usually has only one axon, although it may branch off several times. First we focus on how bones are formed before broadening the view to the axial skeleton (the parts that line up from head to toe) and the appendicular skeleton (the parts that reach out from the central axis). You review how muscles attach to that framework and watch the body take shape before wrapping this newly layered package in the body’s largest single organ: the skin. Chapter 5 A Scaffold to Build On: The Skeleton In This Chapter Getting to know your bones Keeping the axial skeleton in line Checking out the appendicular skeleton Playing with joints uman osteology, from the Greek word for “bone” (osteon) and the suffix –logy, which Hmeans “to study,” focuses on the 206 bones in the adult body endoskeleton. But it’s more than just bones; it’s also ligaments and cartilage and the joints that make the whole assembly useful. In this chapter, you get lots of practice exploring the skeletal functions and how the joints work together. Understanding Dem Bones The skeletal system as a whole serves five key functions: Protection: The skeleton encases and shields delicate internal organs that might other- wise be damaged during motion or crushed by the weight of the body itself. For exam- ple, the skull’s cranium houses the brain, and the ribs and sternum of the thoracic cage protect organs in the central body cavity. Movement: By providing anchor sites and a scaffold against which muscles can con- tract, the skeleton makes motion possible. The bones act as levers, the joints are the fulcrums, and the muscles apply the force.

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Relora: A combination of magnolia and phellodendron generic extra super cialis 100 mg without prescription erectile dysfunction doctor pune, which reduces stress without caus- ing drowsiness discount extra super cialis 100mg mastercard erectile dysfunction in diabetes patients. It also helps in the production of important neurotransmitters that are required for mood and proper sleep 100 mg extra super cialis for sale erectile dysfunction johnson city tn, and it provides support for cardiovascular and immune function. Eat a healthy diet that is rich in vegetables, fruits, legumes, nuts, and seeds, and choose lean protein and healthy fats. Reduce or eliminate processed fast foods, caffeine, refined starches, sugar, alcohol, and tobacco. Areas of the brain commonly affected by stroke are those that control movement, speech, vision, and sensation. Stroke is a medical emergency that requires immediate treat- ment to minimize damage to the brain and disability. They occur when blood clots or other particles block arter- ies to your brain and cause severely reduced blood flow (ischemia). This deprives your brain cells of oxygen and nutrients, and cells may begin to die within minutes. This can result from a number of conditions that affect your blood vessels, such as uncontrolled high blood pressure (hypertension) and weak spots in your blood vessel walls (aneurysms). S Stroke is a major cause of death in Canada, but your chance of surviving a stroke today is much greater than it was a few decades ago. About half of all people who have a stroke recover to some degree, although about one-third of first strokes are fatal, so early detection and prevention are critical. It causes the same signs and symptoms as a stroke, but it lasts for a short time (few minutes to hours) and then disappears. Weakness: Sudden loss of strength or sudden numbness in the face, arm, or leg, even if temporary. Trouble speaking: Sudden difficulty speaking or understanding or sudden confusion, even if temporary. This drug can improve your chances of a full recovery, but it is effective only if given within three hours of initial symptoms. This drug does not work for hemorrhagic stroke, and can actually worsen the problem. If you are at risk of ischemic stroke, your doctor may give you anti-coagulant drugs, such as warfarin (Coumadin) or anti-platelet drugs such as aspirin, clopidogrel (Plavix), or ticlopidine (Ticlid). A carotid endarterectomy involves an incision in your neck to expose your carotid artery and remove the plaques. This involves insertion of a balloon-tipped catheter into the obstructed artery to open it up. Surgical procedures can be done for the treatment and prevention of hemorrhagic S stroke. Aneurysm clipping involves placing a tiny clamp at the base of the aneurysm to keep it from bursting. Dietary Recommendations Foods to include: • Boost fibre intake by eating lots of whole grains, vegetables, fruits, beans, nuts, and seeds, which will help lower cholesterol levels, improve blood sugar control (essential to prevent diabetes), and help with weight management. Colourful fruits and vegetables contain an- tioxidants that help reduce the risk of atherosclerosis and heart disease. Apples, oranges, tomatoes, and bananas are a particularly good source of potassium, which can help lower blood pressure. Try to eat three servings per week of fresh cold-water fish such as salmon, trout, herring, mackerel, and tuna. Nuts contain fibre and nutrients such as vitamin E, alpha-linolenic acid, magnesium, potassium, and arginine, which are important for heart health. Although nuts are high in calories, some studies have found that increasing nut consumption by several hundred calories per day does not cause weight gain. Substituting as little as 20 g per day of soy protein for animal protein can significantly lower cholesterol. Foods to avoid: • Foods high in cholesterol should be minimized (organ meats, egg yolks, and whole milk products). S • High-glycemic foods (white bread and refined starches) raise blood sugar levels and in- crease the risk of diabetes. Avoid adding salt to foods and minimize eating processed and fast foods such as deli meats, snacks (chips, pretzels), french fries, and burgers. Conversely high potassium intakes have been associated with a lower risk of stroke. Some of the protective effects of potassium lie in its ability to lower blood pres- sure. Foods high in potassium include bananas, potatoes, oranges, raisins, artichokes, avocados, spinach, nuts, seeds, lima beans, cod, chicken, and salmon. Smoking contributes to atherosclerosis, increases the risk of blood clots, reduces the oxygen in your blood, increases your blood pressure, and makes your heart work harder. Losing even 5–10 percent of excess weight can lower cholesterol and blood pressure. Moderate-intensity activities, such as brisk walking, biking, or swim- ming, can reduce cholesterol and blood pressure and help with weight management. If you have diabetes or are at risk for diabetes, work on improving your blood sugar levels with exercise and a low-glycemic diet. Top Recommended Supplements Citicoline: A form of the B-vitamin choline that has neuroprotective properties, citicoline prevents brain damage due to lack of oxygen, helps restore key membrane components called phospholipids, and counteracts the effects of membrane-injuring molecules known as free radicals. Seven studies have shown that treatment with choline within 14 days of onset of ischemic or hemorrhagic stroke can significantly reduce death and disability. This is a specialty supplement that is available through natural health care practitioners. Policosanol: Several studies have shown that it can significantly reduce blood clotting (com- parable to aspirin). Do not combine with other blood thinners such as aspirin unless advised by your health care provider. B-vitamins: Lower levels of homocysteine, an amino acid linked to increased risk of stroke in many studies. Folic acid, vitamin B6, and vitamin B12 can lower homocysteine levels, but studies have not yet demonstrated whether this will result in a decreased risk of stroke. Con- sider a B-complex or take a multivitamin that provides 50–100 mg of the B-vitamins. It may be helpful for both the prevention and treatment of stroke (improving recovery). Dosage: 120– 240 mg daily, standardized to 6 percent terpene lactones and 24 percent flavone glycosides.

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Renal cross-transplantation and conduit arteries are replaced by less compliant collagen experiments in several animal models of hypertension purchase 100 mg extra super cialis otc erectile dysfunction caused by hemorrhoids, as well causing arterial stiffening and systolic hypertension 100 mg extra super cialis amex sublingual erectile dysfunction pills, which is as observations following therapeutic renal transplantation in common in the elderly buy generic extra super cialis 100 mg erectile dysfunction prevention. Excretion of salt and The sympathetic nervous system is also important in the water controls intravascular volume. Secretion of renin influ- control of blood pressure, providing background α receptor- ences vascular tone and electrolyte balance via activation of the mediated vasoconstrictor tone and β receptor-mediated cardiac renin–angiotensin–aldosterone system. Sympathetic activity varies rapidly to adjust for changes in cardiovascular demand with alterations in posture and physical activity. It is also activated by emotional states Heart Peripheral resistance Kidneys such as anxiety, and this can result in ‘white-coat’ hyperten- sion. A vasoconstrictor peptide, endothelin, released by the endothelium contributes to vasoconstrictor tone. Conversely, endothelium-derived nitric oxide provides background active vasodilator tone. Cardiovascular drugs work by augmenting or inhibiting these processes, see Figure 28. The fullness of the circulation is controlled by the kidneys, which play a critical role C calcium channel antagonists; in essential hypertension. Older people as stroke, but in uncomplicated hypertension B drugs may be and people of Afro-Caribbean ethnicity often have a low less effective than other classes. Other antihypertensive drugs plasma renin and in these patients a class C or D drug is useful in specific circumstances include α-adrenoceptor preferred. It is better to use such combinations than to use very high doses of single drugs: this seldom works • Few patients with persistent systemic arterial hypertension have a specific aetiology (e. If possible, diuretics should be withheld for one or two days • Use non-drug measures (e. An A drug is preferred for these unless angiotensin in this way, it also inactivates bradykinin – a there is some reason to avoid it (e. This should be borne in mind particularly in ageing patients with atheromatous Angiotensin I disease. This is even more important when such Angiotensin receptor patients are also prescribed potassium supplements blocker and/or potassium-sparing diuretics. Many of problematic depending on renal function and concomitant these agents have long half-lives permitting once daily dosing; drug therapy (see Adverse effects and Drug interactions captopril is an exception. It is often mild, but can be have a potentially adverse interaction with potassium-sparing troublesome. The cause is unknown, but it may be due to diuretics and potassium supplements, leading to hyper- kinin accumulation stimulating cough afferents. Sartans kalaemia, especially in patients with renal impairment, as (see below) do not inhibit the metabolism of bradykinin mentioned above. Provided that the drug is stopped promptly, Use such renal impairment is reversible. Clinical trial data on this combination in heart fail- ure are discussed in Chapter 31. The explanation is uncertain, but one pos- sibility is that they have less effect on central (i. See Chapter 32 for use of β-adrenoceptor antagonists in car- They are, however, useful in hypertensive patients with an diac dysrhythmias. Used in the latter part of pregnancy Oxprenolol Non-selective Hepatic hydroxylation/glucuronidation Partial agonist mean pressure, but also to reduce the rate of rise of the arterial Adverse effects and contraindications pressure wave. Classification of β-adrenoceptor antagonists • Airways obstruction – asthmatics sometimes tolerate a small dose of a selective drug when first prescribed, only β-Adrenoceptors are subdivided into β1-receptors (heart), to suffer an exceptionally severe attack subsequently, and β2-receptors (blood vessels, bronchioles) and β3-receptors β-adrenoceptor antagonists should ideally be avoided (some metabolic effects, e. However, even cardioselective drugs are haz- • Decompensated heart failure – β-adrenoceptor antagonists ardous for patients with asthma. There is little • Peripheral vascular disease and vasospasm – β-adrenoceptor hard evidence supporting their superiority to antagonists for antagonists worsen claudication and Raynaud’s most indications although individual patients may find such a phenomenon. This is theoretically an advantage in treating • Heart block – β-adrenoceptor antagonists can precipitate or patients with hypertension. Mechanism of action Pharmacokinetics β-Adrenoceptor antagonists reduce cardiac output (via nega- β-Adrenoceptor antagonists are well absorbed and are only tive chronotropic and negative inotropic effects on the heart), given intravenously in emergencies. Slow-release preparation for hypertension, angina central nervous system side effects (e. Mechanism of action Calcium-channel blockers inhibit Ca2 influx through volt- Drug interactions 2 age-dependent L-type calcium channels. Cytoplasmic Ca • Pharmacokinetic interactions: β-adrenoceptor antagonists concentrations control the contractile state of actomyosin. This muscle, reduce peripheral vascular resistance and lower arte- causes accumulation of drugs such as lidocaine that have rial blood pressure. Drugs that block voltage-dependent Ca2 channels are used to • Ankle swelling (oedema) is common, often troublesome, treat angina (see Chapter 29) and supraventricular tachydys- but not sinister. There are • The negative inotropic effect of verapamil exacerbates three classes: dihydropyridines, benzothiazepines and pheny- cardiac failure. Slow-release preparations improve its choice, especially in older patients and Afro-Caribbeans, profile in this regard. Amlodipine is has a half-life of two to three days and produces a persistent taken once daily. The daily dose can be increased if needed, antihypertensive effect with once daily administration. The photosensitive) and purpura, which may be dose–response curve of diuretics on blood pressure is remark- thrombocytopenic or non-thrombocytopenic. However, adverse metabolic effects (see below) are dose related, so increasing the dose is seldom appropriate. They begin to The effects of thiazide diuretics described above contraindi- act within one to two hours and work for 12–24 hours. Loop cate their use in patients with severe renal impairment (in diuretics are useful in hypertensive patients with moderate or whom they are unlikely to be effective), and in patients with a severe renal impairment, and in patients with hypertensive history of gout. It is prudent to discontinue diuretics temporarily in patients Mechanism of action who develop intercurrent diarrhoea and/or vomiting, to Thiazide diuretics inhibit reabsorption of sodium and chloride avoid exacerbating fluid depletion. Excessive salt intake or a low glomerular filtration rate interferes with their antihypertensive effect. Natriuresis is therefore prob- Drug interactions ably important in determining their hypotensive action. During chronic treatment, total peripheral vascular Diuretics indirectly increase Li reabsorption in the proximal resistance falls slowly, suggesting an action on resistance tubule, by causing volume contraction. The main adverse effects are hyperkalaemia (especially in patients with renal impairment) and, with Drugs used in essential hypertension spironolactone, oestrogen-like effects of gynaecomastia, breast • Diuretics: thiazides (in low dose) are preferred to loop tenderness and menstrual disturbance. They may precipitate gout and worsen glucose tolerance or dyslipidaemia, but they reduce the risk of stroke and other vascular events. Heart failure, heart block or Use claudication can be exacerbated in predisposed patients.


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