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Foods to avoid: • Refined buy cheap forzest on-line, starchy carbohydrates (white bread/rice/pasta) and sugars (candy purchase forzest 20mg amex, sweets) stick on the teeth and lead to plaque and tartar formation purchase cheap forzest. Lifestyle Suggestions • Brush your teeth after meals and at bedtime and floss daily. Replace your brush every three to four months or even more often if the bristles are worn down. Electric toothbrushes are very effective and may be helpful especially for those with arthritis or problems with dexterity. Use gentle pressure; the tips of the brush do the cleaning, so it isn’t necessary to use force. To properly floss, use about 18 inches of floss, hold the floss taut and bent around each tooth, and scrape up and down each side of each tooth. Be gentle as you lift the floss toward the gum line as strong pressure may cause the gums to bleed. Some research has found that it can improve symp- toms of periodontal disease (bleeding gums and loose teeth). Studies have found that those who are deficient in vitamin C are at increased risk of gum disease and supplementing can help to reduce symptoms. Vitamin E: Antioxidant properties help protect against free radicals produced by white blood cells attracted to diseased gums. When we see more hairs than usual in the shower or the hairbrush, we suddenly wonder whether we might be losing our hair. It’s comforting to know that the human body sheds ap- proximately 100 of its 100,000–150,000 strands of hair every day and new ones grow to take their place. What is commonly known as male- pattern baldness is an inherited condition called androgenetic alopecia and it may begin as early as age 20. Male hair loss is distinguished by a receding hairline or widow’s peak and thinning on the crown. For 40–50 per- cent of women, hair may begin to thin after age 50 (typically after menopause). Women tend to see their hair thin throughout the head, but most visibly on the crown. Significant hair loss for women before age 50 is rare and usually triggered by hormonal fluctuations, stress, or a secondary health concern. Other kinds of hair loss include: H Alopecia areata: This form of hair loss is characterized by patchy baldness or bald spots. It affects both men and women equally, both adults and children, but it is rare, affecting less than 2 percent of the population. Hair loss due to alopecia areata is usually triggered by an immune system disorder. Anagen effluvium: This condition occurs when hair in the growth phase falls out prematurely. Prescription medications used for the treatment of cancer are the most common cause of this condition. Chemotherapy patients may lose up to 90 percent of their hair as a result of anagen effluvium. Telogen effluvium: A natural part of the hair growth cycle includes a resting phase called telogen, which involves 10 percent of hair at any given time. Telogen effluvium occurs when up to 30 percent of hairs on the head are in the resting phase at any given time. This condition may be caused by physical or emotional stress, and hair growth will return to normal as stress is eased. The health of your hair is a reflection of the overall state of your health, so it is im- portant to address hair loss from a multipronged approach that includes both the use of standard medical treatments to slow hair loss, and nutritional and lifestyle changes to address and improve health. Hair loss due to aging and genetics must be treated as early as possible to stabi- lize hair loss and stimulate regrowth. Minoxidil is a vasodilator (a drug that causes the blood vessels in the body to become wider) 254 and was originally introduced as a blood pressure–lowering drug. When it was found to have an added benefit on hair loss and regrowth, it was reformulated as a topical 2 percent solution and is now sold over the counter. It has been shown to benefit approximately 40 percent of people who use it for hair loss as early as two months after the initial application. Studies show hair weight and hair counts increase with the 2 percent solution, and more so with the 5 percent solution where hair weight increased by 45 percent. Another recommended treatment for hair loss is finasteride (Propecia), an oral prescription medication taken once daily for life. It has been shown to stop hair loss in 83 percent of cases and to stimulate regrowth in 66 percent of cases. While there are no foods that directly stimulate increased hair growth, choose foods that supply the body with a rich supply of vitamins, minerals, antioxidants, fibre, and protein. Foods to include: • Ensure adequate protein intake as protein is necessary for hair growth. Choose lean sourc- es of protein (fish, poultry, lean cuts of meat, beans, nuts, seeds, and soy). Meat, poultry, and fish also contain iron, which is required for proper hair growth. Foods to avoid: • Caffeine and alcohol can deplete the body of nutrients and also raise adrenal levels, which can trigger hair loss. Foods high in salt include processed and snack foods, deli meats, and the salt shaker. When the body is deprived of sufficient protein, through strict dieting and calorie restriction, it will shut down all production of hair in order to divert all of its energies toward conserving vital body organs. The body will save protein by shifting healthy hairs that are in a normal growth phase (anagen) into a sudden rest- ing phase. Lifestyle Suggestions • Regular exercise and healthy sleep habits will increase circulatory and overall health, pro- moting healthy hair. According to one report, smokers were four times more likely to have grey hair than non-smokers and were more prone to hair loss. Supplements of biotin may strengthen hair, stimulate new hair growth, slow hair loss, and prevent greying, particularly in those who are deficient in this nutrient. Essential fatty acids: A deficiency can cause hair loss; supplements can help improve the health of scalp and hair. Orthosilicic acid: Enhances collagen formation and makes hair stronger and thicker. Taking silicon supplements will not yield the same results as silicon is poorly absorbed. Orthosilicic acid is the bioavailable (usable) form of silicon and is available in Canada under the name BioSil. In this study, half of the participants massaged a combination of 256 essential oils of thyme, rosemary, lavender, and cedarwood onto their scalps each day.

Free nerve endings: These afferent nerve endings are dendrites (branched exten- sions) of sensory neurons that act primarily as pain receptors buy forzest master card, although some sense temperature generic 20mg forzest with visa, touch cheap generic forzest canada, and muscles (including the sensation of “stretch”). Found all over the body, free nerve endings are especially prevalent in epithelial and connective tissue. These small-diameter fibers have a swelling at the end that responds to touch and sometimes heat, cold, or pain. Some of the endings are disc-shaped structures called Merkel discs that function as light-touch recep- tors within the deep layers of the epidermis. Meissner’s corpuscles: These light-touch mechanoreceptors lie within the dermal papillae. They’re small, egg-shaped capsules of connective tissue sur- rounding a spiraled end of a dendrite. Most abundant in sensitive skin areas such as the lips and fingertips, these corpuscles and free nerve endings can sense a quick touch but not a sustained one. Pacinian corpuscles: These deep-pressure mechanoreceptors are dendrites surrounded by concentric layers of connective tissue. Found deep within the dermis, they respond to deep or firm pressure and vibrations. Hair nerve endings: These mechanoreceptors respond to a change in position of a hair. There are two primary temperature receptors, one for heat and one for cold: End-bulbs of Krause: Also known as Krause’s corpuscles, these cold receptors usually activate below 68 degrees F (20 degrees C). They consist of a bulbous capsule surrounding the dendrite and are commonly found throughout the body in the dermis as well as in the lips, the tongue, and the conjunctiva of the eyes. Brushes of Ruffini: Also known as Ruffini cylinders or Ruffini’s corpuscles, these warmth receptors respond to temperatures between 77 degrees and 113 degrees F (25 degrees to 45 degrees C). Found primarily in the dermis and subcutaneous tissue, they’re dendrite endings enclosed in a flattened capsule. Because there are fewer of them than Krause’s end-bulbs and because they lie in deeper tissue, the body is less sensitive to heat than to cold. In addition to the receptors for touch and temperature, the dermis has neuromuscular spindles (also called proprioceptors) that transmit information to the spinal cord and brain about the lengths and tensions of muscles. This information helps provide awareness of the body’s position and the relative position of body parts. End-bulbs of Krause are receptors for cold that usually are activated at temperatures below a. Wigging out about hair Like most mammals, hair covers the entire human body except for the lips, eyelids, palms of the hands, soles of the feet, nipples, and portions of external reproductive organs. But human body hair generally is sparser and much lighter in color than that sported by most other mammals. A thick head of hair protects the scalp from exposure to the sun’s harmful rays and limits heat loss. The average adult has about 5 million hairs, with about 100,000 of those growing from the scalp. Normal hair loss from an adult scalp is about 70 to 100 hairs each day, although baldness can result from genetic factors, hormonal imbalances, scalp injuries, disease, dietary deficien- cies, radiation, or chemotherapy. Each hair grows at an angle from a follicle embedded in the epidermis and extending into the dermis; scalp hairs sometimes reach as far as the hypodermis. Nerves reach the hair at the follicle’s expanded base, called the bulb, where a nipple-shaped papilla of connective tissue and capillaries provide nutrients to the growing hair. Epithelial cells in the bulb divide to produce the hair’s shaft (the part that extends out of the folli- cle). Each scalp hair grows for two to three years at a rate of about ⁄13 to ⁄12 millimeter per day, or 10 to 18 centimeters per year. When mature, the hair rests for three or four months before slowly losing its attachment. Chapter 7: It’s Skin Deep: The Integumentary System 121 Hair pigment (which is melanin, just as in the skin) is produced by melanocytes in the follicle and transferred to the hair’s cortex and medulla cells. Three types of melanin — black, brown, and yellow — combine in different quantities for each individual to pro- duce different hair colors ranging from light blonde to black. Gray and white hairs grow in when melanin levels decrease and air pockets form where the pigment used to be. Hair becomes oily over time thanks to sebum, a mixture of cholesterol, fats, and other substances secreted from a sebaceous (or holocrine) gland found next to each follicle. Attached to each follicle is a smooth muscle called an arrector pili (literally “raised hair”) that both applies pressure to the sebaceous gland and straight- ens the hair shaft, depressing the skin in a pattern called goose bumps or goose pimples. Each hair is made up of three concentric layers of keratinized cells: A central core, called the medulla, consists of large cells containing eleidin that are separated by air spaces; in fine hair, the medulla may be small or entirely absent. A cortex surrounding the medulla forms the major part of the hair shaft with sev- eral layers of flattened cells. The cortex also has elongated pigment-bearing cells in dark hair and air pockets in white hair. The outermost cuticle is a single layer of overlapping cells with the free end pointing upward. The cuticle strengthens and compacts the inner layers, but abrasion tends to wear away the end of the shaft, exposing the medulla and cortex in a pattern known as split ends. Nailing the fingers and toes Human nails (which actually are vestigial claws) have three parts: a root bed at the nail base, a body that’s attached to the fingertip, and a free edge that grows beyond the end of the finger or toe. Heavily cornified tissue forms the nails from modified strata corneum and lucidum. A narrow fold of the stratum corneum turns back to form the eponychium, or cuticle. At the base of the nail, partially tucked under the cuticle, the strata thicken to form a whitish area called the lunula (literally “little moon”) that can be seen through the nail. Beneath the lunula is the nail matrix, a region of thickened strata where mitosis pushes previously formed cornified cells forward, making the nail grow. Under the free edge of the nail, the stratum corneum thickens to form the hypony- chium. Nails are pinkish in color because of hemoglobin in the underlying capillaries, which are visible through the translucent cells of the nail. Nails function as an aid to grasping, as a tool for manipulating small objects, and as protection against trauma to the ends of fingers and toes. Sweating the details Humans perspire over nearly every inch of skin, but anyone with sweaty palms or smelly feet can attest to the fact that sweat glands are most numerous in the palms and soles, with the forehead running a close third. Both are coiled tubules embedded in the dermis or subcutaneous layer composed of simple columnar cells. Eccrine glands are distributed widely over the body — an average adult has roughly 3 million of them — and produce the watery, salty secretion you know as sweat.

Part I: Building Blocks of the Body 34 The cell cycle is divided into two distinct phases: Interphase: Sometimes also called the resting stage forzest 20 mg overnight delivery, that label is a misnomer because the cell is actively growing and carrying out its normal metabolic func- tions as well as preparing for cell division forzest 20 mg online. Some cells 20mg forzest for sale, like blood and skin cells, are contin- ually dividing because they have very short life cycles, sometimes only hours. Other cells, such as specialized muscle cells and certain nerve cells, may never divide at all. Slowly, over time Chapter 2: The Cell: Life’s Basic Building Block 35 Answers to Questions on the Cell The following are answers to the practice questions presented in this chapter. Because it has both polar and nonpolar regions, a phospholipid is classified as a(n) 3. Because diffusion has to do with the passive transport of substances other than water. Someone who has been out in the cold too long suffers hypothermia — literally insuffi- cient heat. With more water outside the cell than inside, the membrane would allow osmosis to continue past the breaking point. It’s not just a coincidence that the nucleolus sits at the heart of the genetic powerhouse. None of the other options are involved in cellular respiration or energy production l The most abundant protein in human cells is a. It makes sense that the protein making up much of the cytoskeleton is the most abundant because the cytoskeleton accounts for up to 50 percent of the cell’s volume. Part I: Building Blocks of the Body 36 When you think of a big protein-laden meal, you think of ribs. The correct answer can’t be the lysosome because that’s already a vesicle, and it can’t be the ribosome because you already know that handles proteins. In addi- tion, molecular concentration and agitation also can change cytoplasmic consistency. Fluid-like interior of the cell that may become a semisolid, or colloid L Lysosomes: c. Membranous sacs containing digestive enzymes M – Protein synthesis begins in the cell’s 38. Chapter 3 Divide and Conquer: Cellular Mitosis In This Chapter Following the steps of cell division Understanding the results of errors in mitosis ver had so many places to be that you wished you could just divide yourself in two? Cell division is how one “mother” cell becomes two identical twin “daughter” cells. Cell division takes place for several reasons: G r owth: Multicellular organisms, humans included, each start out as a single cell — the fertilized egg. That one cell divides (and divides and divides), eventually becoming an entire complex being. Injury repair: Uninjured cells in the areas surrounding damaged tissue divide to replace those that have been destroyed. Cell division occurs over the course of two processes: mitosis, which is when the chromo- somes within the cell’s nucleus duplicate to form two daughter nuclei; and cytokinesis, which takes place when the cell’s cytoplasm divides to surround the two newly formed nuclei. Although cell division breaks down into several stages, there are no pauses from one step to another. Cell division as a whole is called mitosis because most of the changes occur during that process. In this chapter, we review the cell cycle (as mitosis also is known), and you get plenty of practice figuring out what happens when and why. The Mitotic Process It may look like cells are living out their useful lives simply doing whatever specialized jobs they do best, but in truth mitosis is a continuous process. When the cell isn’t actively split- ting itself in two, it’s actively preparing to do so. Mitosis may look like a waiting game, but there’s plenty going on behind the scenes. Part I: Building Blocks of the Body 38 Waiting for action: Interphase Interphase is the period when the cell isn’t dividing. It begins when the new cells are done forming and ends when the cell prepares to divide. Although it’s also called a “resting stage,” there’s constant activity in the cell during interphase. Interphase is divided into subphases, each of which lasts anywhere from a few hours for those cells that divide frequently to days or years for those cells that divide less frequently (nerve cells, for example, can spend decades in interphase). Sorting out the parts: Prophase As the first active phase of mitosis, prophase is when structures in the cell’s nucleus begin to disappear, including the nuclear membrane (or envelope), nucleoplasm, and nucleoli. The two centrioles that have formed from the centrosome push apart to opposite ends of the nucleus. Using protein filaments, they form poles and a mitotic spindle between them as well as asters (or astral rays) which radiate from the poles into the cytoplasm. At the same time, the chromatin threads (or chromonemata) shorten and coil, forming visible chromosomes. The chromosomes divide into chro- matids that remain attached at an area called the centromere, which produces micro- tubules called kinetochore fibers. These interact with the spindle to assure that each daughter cell ultimately has a full set of chromosomes. The chromatids start to migrate toward the equatorial plane, an imaginary line between the poles. Dividing at the equator: Metaphase After the chromosomes are lined up and attached along the cell’s newly formed equa- tor, metaphase officially debuts. The chromatids line up exactly along the center line of the cell (or the equatorial plane), attaching to the mitotic spindle by the centromere. Packing up to move out: Anaphase In anaphase, the centromeres split, separating the duplicate chromatids and forming two chromosomes. The spindles attached to the divided centromeres shorten, pulling the chromosomes toward the opposite poles. In late anaphase, as the chromosomes approach the poles, a slight furrow develops in the cytoplasm, showing where cytokinesis will eventually take place. Chapter 3: Divide and Conquer: Cellular Mitosis 39 Pinching off: Telophase Telophase occurs as the cell nears the end of division. The spindles and asters of early mitosis disappear, and each newly forming cell begins to synthesize its own structure. There’s a more pronounced pinching, or furrowing, of the cytoplasm into two separate bodies, but there continues to be only one cell. The furrow intended to divide the newly formed sister nuclei at last gets to finish the job. Each new cell is smaller and contains less cytoplasm than the mother cell, but the daughter cells are genetically identical to each other and to the original mother cell. Use the terms that follow to identify the stages and cell structures shown in Figure 3-1.

Because experimental research creates initial equivalence among the participants in the different experimental conditions purchase 20mg forzest fast delivery, it allows drawing conclusions Attributed to Charles Stangor Saylor cheap 20 mg forzest otc. Experimental designs are not always possible because many important variables cannot be experimentally manipulated cheap 20 mg forzest. Because all research has the potential for invalidity, research never “proves‖ a theory or hypothesis. Threats to construct validity involve potential inaccuracies in the measurement of the conceptual variables. Threats to statistical conclusion validity involve potential inaccuracies in the statistical testing of the relationships among variables. Threats to internal validity involve potential inaccuracies in assumptions about the causal role of the independent variable on the dependent variable. Threats to external validity involve potential inaccuracy regarding the generality of observed findings. Informed consumers of research are aware of the strengths of research but are also aware of its potential limitations. Chapter 3 Brains, Bodies, and Behavior Did a Neurological Disorder Cause a Musician to Compose Boléro and an Artist to Paint It 66 Years Later? In 1986 Anne Adams was working as a cell biologist at the University of Toronto in Ontario, Canada. She took a leave of absence from her work to care for a sick child, and while she was away, she completely changed her interests, dropping biology entirely and turning her attention to art. In 1994 she completed her painting Unravelling Boléro, a translation of Maurice Ravel‘s famous orchestral piece onto canvas. Each bar of music is represented by a lacy vertical figure, with the height representing volume, the shape representing note quality, and the color representing the music‘s pitch. Shortly after finishing the painting, Adams began to experience behavioral problems, including increased difficulty speaking. Neuroimages of Adams‘s brain taken during this time show that regions in the front part of her brain, which are normally associated with language processing, had begun to deteriorate, while at the same time, regions of the brain responsible for the integration of information from the five senses were unusually well developed (Seeley et al. The deterioration of the frontal cortex is a symptom of frontotemporal dementia, a disease that is associated with changes in artistic and musical tastes and skills (Miller, Boone, Cummings, Read, & Mishkin, [2] [3] 2000), as well as with an increase in repetitive behaviors (Aldhous, 2008). What Adams did not know at the time was that her brain may have been undergoing the same changes that Ravel‘s had undergone 66 years earlier. In fact, it appears that Ravel may have suffered from the same neurological disorder. Ravel composed Boléro at age 53, when he himself was beginning to show behavioral symptoms that were interfering with his ability to move and speak. Scientists have concluded, based on an analysis of his written notes and letters, [4] that Ravel was also experiencing the effects of frontotemporal dementia (Amaducci, Grassi, & Boller, 2002). If Adams and Ravel were both affected by the same disease, this could explain why they both became fascinated with the repetitive aspects of their arts, and it would present a remarkable example of the influence of our brains on behavior. Our behaviors, as well as our thoughts and feelings, are produced by the actions of our brains, nerves, muscles, and glands. In this chapter we will begin our journey into the world of psychology by considering the biological makeup of the human being, including the most remarkable of human organs—the brain. We’ll consider the structure of the brain and also the methods that psychologists use to study the brain and to understand how it works. We will see that the body is controlled by an information highway known as the nervous system, a collection of hundreds of billions of specialized and interconnected cells through which messages are sent between the brain and the rest of the body. And we will see that our behavior is also influenced in large part by the endocrine system, the chemical regulator of the body that consists of glands that secrete hormones. Although this chapter begins at a very low level of explanation, and although the topic of study may seem at first to be far from the everyday behaviors that we all engage in, a full understanding of the biology underlying psychological processes is an important cornerstone of your new understanding of psychology. We will consider throughout the chapter how our biology influences important human behaviors, including our mental and physical health, our reactions to drugs, as well as our aggressive responses and our perceptions of other people. This chapter is particularly important for contemporary psychology because the ability to measure biological aspects of behavior, including the structure and function of the human brain, is progressing rapidly, and understanding the biological foundations of behavior is an increasingly important line of psychological study. Maurice Ravel and right-hemisphere musical creativity: Influence of disease on his last musical works? A neuron is a cell in the nervous system whose function it is to receive and transmit information. The axons are also specialized, and some, such as those that send messages from the spinal cord to the muscles in the hands or feet, may be very long—even up to several feet in length. To improve the speed of their communication, and to keep their electrical charges from shorting out Attributed to Charles Stangor Saylor. The myelin sheath is a layer of fatty tissue surrounding the axon of a neuron that both acts as an insulator and allows faster transmission of the electrical signal. Axons branch out toward their ends, and at the tip of each branch is a terminal button. Neurons Communicate Using Electricity and Chemicals The nervous system operates using an electrochemical process (see Note 3. An electrical charge moves through the neuron itself and chemicals are used to transmit information between neurons. Within the neuron, when a signal is received by the dendrites, is it transmitted to the soma in the form of an electrical signal, and, if the signal is strong enough, it may then be passed on to the axon and then to the terminal buttons. If the signal reaches the terminal buttons, they are signaled to emit chemicals known as neurotransmitters, which communicate with other neurons across the spaces between the cells, known as synapses. Video Clip: The Electrochemical Action of the Neuron This video clip shows a model of the electrochemical action of the neuron and neurotransmitters. The electrical signal moves through the neuron as a result of changes in the electrical charge of the axon. Normally, the axon remains in the resting potential, a state in which the interior of the neuron contains a greater number of negatively charged ions than does the area outside the cell. When the segment of the axon that is closest to the cell body is stimulated by an electrical signal from the dendrites, and if this electrical signal is strong enough that it passes a certain level or threshold, the cell membrane in this first segment opens its gates, allowing positively charged sodium ions that were previously kept out to enter. This change in electrical charge that occurs in a neuron when a nerve impulse is transmitted is known as the action potential. Once the action potential occurs, the number of positive ions exceeds the number of negative ions in this segment, and the segment temporarily becomes positively charged. The electrical charge moves down the axon from segment to segment, in a set of small jumps, moving from node to node. When the action potential occurs in the first segment of the axon, it quickly creates a similar change in the next segment, which then stimulates the next segment, and so forth as the positive electrical impulse continues all the way down to the end of the axon. As each new segment becomes positive, the membrane in the prior segment closes up again, and the segment returns to its negative resting potential. In this way the action potential is transmitted along the axon, toward the terminal buttons. The entire response along the length of the axon is very fast—it can happen up to 1,000 times each second. An important aspect of the action potential is that it operates in an all or nothing manner. What this means is that the neuron either fires completely, such that the action potential moves all the way down the axon, or it does not fire at all.

Prepare published findings in appropriate general ideas are kept in mind as one uses findings journals 20 mg forzest free shipping. To provide a different focus from traditional nurs- Again discount forzest 20mg, flexibility exists with the ethnonurs- ing cheap forzest 20 mg with mastercard, Leininger developed the unique three modes of ing data processing, but the above steps help to care to incorporate theory findings (refer to sunrise conceptualize the process and thus promote the re- enabler, Figure 20–1). The three modes are: culture searcher’s ability to perform a systematic investiga- care preservation or maintenance; culture care ac- tion that has credibility and meets other qualitative commodation or negotiation; and culture care evaluation criteria. The theorist has pre- dicted that the researcher can use ethnoresearch Culture Care Theory findings to guide nursing judgments, decisions, and actions related to providing culturally congruent and Nursing Practice care (Leininger, 2002). Leininger prefers not to use Over the past five decades, the culture care theory, along with the ethnonursing method, have been Leininger prefers not to use the phrase used by nurse researchers to discover knowledge nursing intervention because this term that can be and has been used in nursing practice. Instead, the term nursing ac- research colleagues have used the culture care the- tions and decisions is used, but always with the ory and the ethnonursing method to focus on the clients helping to arrive at whatever actions or de- care meanings and experiences of 100 cultures cisions are planned and implemented. The modes (Leininger, 2002); they discovered 187 care con- fit with the clients’ or peoples’ lifeways and yet are structs in Western and non-Western cultures therapeutic and satisfying for them. The nurse can (Leininger, 1998), as reported in the Journal of draw upon scientific nursing, medical, and other Transcultural Nursing (1989 to 1999). Active helping-assisting or facilitative acts; active helping; participatory involvement with clients is essential presence (being physically there); understanding to arrive at culturally congruent care with one or all (beliefs, values, lifeways, and environmental); con- of the three action modes in order to meet clients’ nectedness; protection (gender related); touching; care needs in their particular environmental con- and comfort measures (McFarland, 2002). The use of these modes in nursing care is care constructs are the most critical and important one of the most creative and rewarding features of universal or common findings to consider in nurs- transcultural and general nursing practice with ing practice, but care diversities must also be con- clients of diverse cultures. Although many of these dominant care It is most important (and a shift in nursing) to constructs may be found in certain cultures, diver- carefully focus on the holistic dimensions, as de- sities will also be found. The ways in which culture picted in the sunrise enabler, to arrive at therapeu- care is applied and used in specific cultures will re- tic culture care practices. All the factors in the flect both similarities and differences among (and sunrise enabler (which include worldview and sometimes within) different cultures. Next, three technological, religious, kinship, political-legal, ethnonursing studies will be reviewed with focus economic, and educational factors, as well as cul- on the findings, which have implications for nurs- tural values and lifeways, environmental context, ing practice. The culture care theory, along with the findings relevant to the culture care of Lebanese the ethnonursing method, are powerful means for Muslim Americans using Leininger’s three modes new directions and practices in nursing. Incorpo- of nursing decisions and actions to provide cultur- rating culture specific care into client care is essen- ally congruent and responsible care. The study fo- tial to practice professional care and to be licensed cused on the care for Lebanese Muslims in the as registered nurses. Luna’s research Luna found that female modesty was an impor- findings and the nursing practice implications re- tant cultural care value for Lebanese women; this lated to the home and community context in the was reflected in requests by female clients to have late 1980s remain important as health care shifts only female nurses, physicians, and other care- from hospital care services to home or community givers. Luna discovered that attending a clinic in a care practice was accomplished by nurses negotiat- Midwestern United States urban context was often ing for these women to have female caregivers a new and different approach to health care for whenever possible, which would promote health, Lebanese Muslim women, especially during preg- well-being, and client satisfaction with care. Luna’s study revealed that cluding Lebanese Muslim men in health teaching many women relied on the traditional midwife in and discharge planning, Luna discovered a way to Lebanon for home deliveries. The routine of use culture care preservation that recognized the monthly and weekly visits to the prenatal clinic was family as a unit, rather than focusing on the indi- incongruent with what these clients had experi- vidual. In the United States, ization of the family should be preserved as a social prenatal care in the clinic context involved long structure feature, which acknowledges males for waiting periods with the husband missing work to their roles in family care continuity rather than take his wife to each appointment. Examination by being narrowly interpreted as males always being in a male physician was culturally incongruent for the control. Negative stereotypes held by nurses about women, so culture care negotiation and repatterning the Arab males’ reluctance to participate in the was essential for culturally congruent care. Luna birth process were also discovered, often presenting described the clinic as culturally decontextualized a barrier to giving nursing care. To counter this, for clients and their families because the prenatal Luna suggested the nurses use culture care preser- care and the environmental clinic context in which vation to maintain and support the generic culture the care was provided were not congruent with the care practices of men, which included surveillance, clients’ cultural values, beliefs, and practices (Luna, protection, and maintenance of the family. Luna discovered some dominant and uni- Still another finding from Luna’s study was the versal care constructs for Lebanese Muslim men, discovery of the importance of religious rituals to which included surveillance, protection, and main- many Muslim clients as an essential component of tenance of the family. For Lebanese women, the providing care within their cultural context (Luna, dominant and universal care constructs included 1989, 1994). Luna found that some Muslims pray emphasizing the positive attributes of educating three to five times a day, and others do not pray at the children and maintaining a family caring envi- all. During the culturalogical assessment (in the ronment according to the precepts of Islam. A hospital context), Luna suggested the nurse should number of generic or folk care practices were dis- ask about the client’s wishes regarding prayer. For instance, the female network in the an important cultural expression for their health Lebanese Muslim culture is very important at the and well-being. She also suggested that nurses prac- time of birth; Lebanese women come together to tice culture care accommodation for clients by ne- care for one another and offer practical and emo- gotiating with a social service organization that tional assistance for new immigrants who are served Arab clients in order to gather written and struggling to survive in a new cultural context such video materials in the Arabic language related to as the United States. Nurses should vation to maintain these generic care practices for avoid direct confrontation and spend considerable the health and well-being of clients. Many resi- cluding emphasizing the health and well-being of dents from both cultural groups participated in the both the mother and the baby. Residents assisted In 1999, Wehbeh-Alamah conducted a two-year other residents to the dining room, checked on oth- ethnonursing study using the culture care theory ers who did not appear for meals in the dining and studied the generic health-care beliefs, prac- room (care as surveillance of others), and assisted tices, and expressions of Lebanese American in ambulation of those who were not able to walk Muslim immigrants in two Midwestern U. This focus on other care versus only Her findings, which confirmed many of Luna’s self care was a form of culturally congruent care from 1989, included the discovery of specific that residents desired in order to maintain healthy generic folk care beliefs on practices that required and beneficial lifeways in an institutional setting. These included pro- staff as these generic care practices were integrated viding for prayer while facing east five times a day; into professional nursing care. Many African American residents desired spiritual or re- gender care findings were similar to those from ligious care and had some diverse aspects of such Luna’s study, revealing a persistence of many re- care rooted in their respective cultures. The find- lated care patterns over time as predicted in the ings of both universality and diversity within the culture care theory. However, the women in pattern of religious or spiritual care supported Wehbeh-Alamah’s study believed the absence of ex- Leininger’s theory, which states that “culture care tended family members in the United States had in- concepts, meanings, expressions, patterns, fluenced male family members’ thinking about the processes, and structural forms of care are different appropriateness of men caring for family members. Anglo American residents received a and participation in direct caregiving by Muslim more formal type of care from their churches, such men (Wehbeh-Alamah, in press). Currently, as a minister coming to the retirement home to Wehbeh-Alamah is conducting an ethnonursing do a worship service or a church choir traveling study of the culture care of Syrian American to the retirement home to entertain the residents. In addi- The nurses at the retirement home practiced tion to discovering the culture care meanings, be- culture care preservation by maintaining the in- liefs, and practices of this group, she will compare volvement of churches in the daily lives of both cul- this study with her previous studies to arrive at uni- tural groups to help residents face living in a versal and diverse care findings among Muslim im- retirement home with increasing disabilities related migrants from diverse cultures living in the United to aging and handicaps, and even dealing with the States. This study revealed their elderly relatives enhanced the health and life- care implications for nurses who practice in retire- ways of both Anglo and African American elders ment homes, nursing homes, apartments for the in the retirement home setting. In contrast with the Anglo In 2000, McFarland & Zehnder (in press) con- American findings, African American spouses, chil- ducted a two-year ethnonursing study of the cul- dren, extended family members, and nonkin who ture care of German American elders living in a were considered family reflected the care pattern of nursing home in a small Midwestern city in the families helping elderly residents. Their findings, which confirmed great grandchildren, nieces, nephews, grandnieces, many of McFarland’s (1997) earlier findings, in- and grandnephews, as well as church members or cluded many care beliefs and practices that required friends who were considered family and were re- culture care preservation. German American elder ferred to as brothers, sisters, or daughters, were in- care practices included caring for fellow residents volved in caring for African American elders. The by assisting confused residents to find their assigned nursing staff recognized the importance of family seat in the dining room or making items for the an- involvement in the care of residents and practiced nual bazaar to raise money to buy flowers for the culture care preservation to maintain culture spe- nursing home courtyard garden, thereby benefit- cific family care practices for residents from each ting all of the residents.

The vaccine targets certain types of the bacteria 20 mg forzest mastercard, even if it is a resistant type discount forzest online, and reduces the overall number of infections purchase forzest 20mg without prescription, including those that are caused by resistant strains. The first version of the vaccine was introduced in 2000 and reduced the frequency of antibiotic-resistant infections, but it did not protect against a particular strain of S. This strain became increasingly resistant to antibiotics and caused more infections because the vaccine did not offer protection. A new version of the vaccine, 129 approved for use in 2010, protects against serotype 19A. For some infections, laboratory tests for guiding treatment are not easily available or the turn-around time is slow or incomplete. For these infections, healthcare providers rely on treatment guidelines for proper management of infections. While many of these infections are mild and do not require treatment, antibiotics can be lifesaving in severe infections. Antibiotic resistance compromises our ability to treat these infections and is a serious threat to public health. Preventing resistant enteric infections requires a multifaceted approach and partnerships because bacteria that cause some infections, such as salmonellosis and campylobacteriosis, have animal reservoirs, while other bacteria, such as those that cause shigellosis and typhoid fever, have human reservoirs. This national public health surveillance system tracks antibiotic resistance among Salmonella, Campylobacter, and other bacteria transmitted commonly through food. The lab also confirms and studies bacteria that have new antibiotic resistance patterns. This use contributes to the emergence of antibiotic-resistant bacteria in food-producing animals. Resistant bacteria in food-producing animals are of particular concern because these animals serve as carriers. Resistant bacteria can contaminate the foods that come from those animals, and people who consume these foods can develop antibiotic-resistant infections. Antibiotics must be used judiciously in humans and animals because both uses contribute to not only the emergence, but also the persistence and spread of antibiotic- resistant bacteria. Scientists around the world have provided strong evidence that antibiotic use in food- producing animals can harm public health through the following sequence of events: • Use of antibiotics in food-producing animals allows antibiotic-resistant bacteria to thrive while susceptible bacteria are suppressed or die. Because of the link between antibiotic use in food-producing animals and the occurrence of antibiotic-resistant infections in humans, antibiotics should be used in food-producing animals only under veterinary oversight and only to manage and treat infectious diseases, not to promote growth. Preventing Infections Efforts to prevent foodborne and other enteric infections help to reduce both antibiotic- resistant infections and antibiotic-susceptible infections (those that can be treated effectively with antibiotics). With that information, experts develop specific strategies to prevent those infections and prevent the resistant bacteria from spreading. Since then, antibiotics have saved millions of lives and transformed modern medicine. During the last 70 years, however, bacteria have shown the ability to become resistant to every antibiotic that has been developed. And the more antibiotics are used, the more quickly bacteria develop resistance (see the Antibiotic Resistance Timeline in this report). Anytime antibiotics are used, this puts biological pressure on bacteria that promotes the development of resistance. When antibiotics are needed to prevent or treat disease, they should always be used. But research has shown that as much as 50% of the time, antibiotics are prescribed when they are not needed or they are misused (for example, a patient is given the wrong dose). Like every other drug, antibiotics have side effects and can also interact or interfere with the effects of other medicines. This inappropriate use of antibiotics unnecessarily promotes antibiotic resistance. The more that antibiotics are used today, the less likely they will still be effective in the future. Therefore, doctors and other health professionals around the world are increasingly adopting the principles of responsible antibiotic use, often called antibiotic stewardship. Stewardship is a commitment to always use antibiotics only when they are necessary to treat, and in some cases prevent, disease; to choose the right antibiotics; and to administer them in the right way in every case. Effective stewardship ensures that every patient gets the maximum benefit from the antibiotics, avoids unnecessary harm from allergic reactions and side effects, and helps preserve the life-saving potential of these drugs for the future. Efforts to improve the responsible use of antibiotics have not only demonstrated these benefits but have also been shown to improve outcomes and save healthcare facilities money in pharmacy costs. Therefore, new antibiotics will always be needed to keep up with resistant bacteria as well as new diagnostic tests to track the development of resistance. Adverse drug event: When therapeutic drugs (example, antibiotics) have harmful effects; when someone has been harmed by a medication. Aminoglycoside: A type of antibiotic that destroys the functioning of gram-negative bacteria. Antibiotic: Type of medicine made from mold or bacteria that kills or slows the growth of other bacteria. Antibiotic class: A grouping of antibiotics that are similar in how they work and how they are made. Antibiotic growth promotion: Giving farm animals antibiotics to increase their size in order to produce and sell more meat. Antibiotic resistance: The result of bacteria changing in ways that reduce or eliminate the effectiveness of antibiotics. Antibiotic stewardship: Coordinated efforts and programs to improve the use of antimicrobials. For example, facilities with antibiotic stewardship programs have made a commitment to always use antibiotics appropriately and safely—only when they are needed to prevent or treat disease, and to choose the right antibiotics and to administer them in the right way in every case. Antimicrobial: A general term for the drugs, chemicals, or other substances that either kill or slow the growth of microorganisms. Among the antimicrobial agents in use today are antibacterial drugs (which kill bacteria), antiviral agents (which kill viruses), antifungal agents (which kill fungi), and antiparisitic drugs (which kill parasites). Antimicrobial resistance: The result of microorganisms changing in ways that reduce or eliminate the effectiveness of drugs, chemicals, or other agents used to cure or prevent 192 infections. In this report, the focus is on antibiotic resistance, which is one type of antimicrobial resistance. Azithromycin: A macrolide antibiotic used to treat infections caused by gram-positive bacteria and infections such as respiratory tract and soft-tissue infections. Bacteria can be helpful, but in certain conditions can cause illnesses such as strep throat, ear infections, and bacterial pneumonia. Beta (β)-lactamase enzyme: A chemical produced by certain bacteria that can destroy some kinds of antibiotics. Broad-spectrum antibiotic: An antibiotic that is effective against a wide range of bacteria. Carbapenem: A type of antibiotic that is resistant to the destructive beta-lactamase enzyme of many bacteria. Carbapenems are used as a last line of defense for many bacteria, but increased resistance to carbapenems has made them less useful.

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