By K. Sebastian. University of Texas Medical Branch.

The teachings of many religions are based on the social responsibility norm; that we should generic cialis black 800mg on line erectile dysfunction doctors in south africa, as good human beings cialis black 800 mg lowest price erectile dysfunction bipolar medication, reach out and help other people whenever we can. How the Presence of Others Can Reduce Helping Attributed to Charles Stangor Saylor. When the police interviewed Kitty‘s neighbors about the crime, they discovered that 38 of the neighbors indicated that they had seen or heard the fight occurring but not one of them had bothered to intervene, and only one person had called the police. Video Clip: The Case of Kitty Genovese Was Kitty Genovese murdered because there were too many people who heard her cries? Two social psychologists, Bibb Latané and John Darley, were interested in the factors that [11] influenced people to help (or to not help) in such situations (Latané & Darley, 1968). The model has been extensively tested in many studies, and there is substantial support for it. Social psychologists have discovered that it was the 38 people themselves that contributed to the tragedy, because people are less likely to notice, interpret, and respond to the needs of others when they are with others than they are when they are alone. Latané and Darley (1968) demonstrated the important role of the social situation in noticing by asking research participants to complete a questionnaire in a small room. Some of the participants completed the questionnaire alone, whereas others completed the questionnaire in small groups in which two other participants were also working on questionnaires. A few minutes after the participants had begun the questionnaires, the experimenters started to let some white smoke come into the room through a vent in the wall. The experimenters timed how long it took before the first person in the room looked up and noticed the smoke. The people who were working alone noticed the smoke in about 5 seconds, and within 4 minutes most of the participants who were working alone had taken some action. On the other hand, on average, the first person in the group conditions did not notice the smoke until over 20 seconds had elapsed. And, although 75% of the participants who were working alone reported the smoke within 4 minutes, the smoke was reported in only 12% of the groups by that time. In fact, in only 3 of the 8 groups did anyone report the smoke, even after it had filled the room. You can see that the social situation has a powerful influence on noticing; we simply don‘t see emergencies when other people are with us. Were the cries of Kitty Genovese really calls for help, or were they simply an argument with a boyfriend? The problem is compounded when others are present, because when we are unsure how to interpret events we normally look to others to help us understand them, and at the same time they are looking to us for information. The problem is that each bystander thinks that other people aren‘t acting because they don‘t see an emergency. Believing that the others know something that they don‘t, each observer concludes that help is not required. Even if we have noticed the emergency and interpret it as being one, this does not necessarily mean that we will come to the rescue of the other person. The problem is that when we see others around, it is easy to assume that they are going to do something, and that we don‘t need to do anything ourselves. Diffusion of responsibility occurs when we assume that others will take action and therefore we do not take action ourselves. The irony again, of course, is that people are more likely to help when they are the only ones in the situation than when there are others around. Perhaps you have noticed diffusion of responsibility if you participated in an Internet users group where people asked questions of the other users. Did you find that it was easier to get help if you directed your request to a smaller set of users than when you directed it to a larger number of [13] people? Markey (2000) found that people received help more quickly (in about 37 seconds) when they asked for help by specifying a participant‘s name than when no name was specified (51 seconds). Of course, for many of us the ways to best help another person in an emergency are not that clear; we are not professionals and we have little training in how to help in emergencies. People who do have training in how to act in emergencies are more likely to help, whereas the rest of us just don‘t know what to do, and therefore we may simply walk by.

Afferent arteriole → Collecting tubule → Glomerulus → Proximal convoluted tubule → Loop of Henle → Distal convoluted tubule d discount cialis black 800mg online erectile dysfunction treatment yahoo. Efferent arteriole → Proximal convoluted tubule → Glomerulus → Loop of Henle → Distal convoluted tubule → Collecting tubule 11 discount cialis black 800 mg visa impotence versus erectile dysfunction. Distal convoluted tubules Chapter 12: Filtering Out the Junk: The Urinary System 199 Getting Rid of the Waste After your kidneys filter out the junk, it’s time to deliver it to the bladder. Surfing the ureters Ureters are narrow, muscular tubes through which the collected waste travels. About 10 inches long, each ureter descends from a kidney to the posterior lower third of the bladder. Like the kidneys themselves, the ureters are behind the peritoneum outside the abdominal cavity, so the term retroperitoneal applies to them, too. It also has a middle layer of smooth muscle tissue that propels the urine by peristalsis — the same process that moves food through the digestive system. So rather than trickling into the bladder, urine arrives in small spurts as the muscular contractions force it down. The tube is surrounded by an outer fibrous layer of connective tissue that supports it during peristalsis. Ballooning the bladder The urinary bladder is a large muscular bag that lies in the pelvis behind the pubis bones. There are three openings in the bladder: two on the back side where the ureters enter and one on the front for the urethra, the tube that carries urine outside the body. The neck of the bladder surrounds the urethral attachment, and the internal sphincter (smooth muscle that pro- vides involuntary control) encircles the junction between the urethra and the bladder. When full, the bladder’s lining is smooth and stretched; when empty, the lining lies in a series of folds called rugae (just as the stomach does). When the bladder fills, the increased pressure stimulates the organ’s stretch receptors, prompting the individual to urinate. The male and female urethras Both males and females have a urethra, the tube that carries urine from the bladder to a body opening, or orifice. Both males and females have an internal sphincter con- trolled by the autonomic nervous system and composed of smooth muscle to guard the exit from the bladder. Both males and females also have an external sphincter com- posed of circular striated muscle that’s under voluntary control. The female urethra is about one and a half inches long and lies close to the vagina’s anterior (front) wall. The external sphinc- ter for the female urethra lies just inside the urethra’s exit point. Several openings appear in this region of the urethra, including a small opening where sperm from the vas deferens and ejacu- latory duct enters, and prostatic ducts where fluid from the prostate enters. The membranous urethra is a small 1- or 2-centimeter portion that contains the external sphincter and penetrates the pelvic floor. The cavernous urethra, also known as the spongy urethra, runs the length of the penis on its ventral surface through the corpus spongiosum, ending at a vertical slit at the end of the penis. The and urinary systems is complete in male urethra runs through the the human same “plumbing” as the male reproductive system. The internal sphincter found at the junction of the bladder neck and the urethra is composed of a. Smooth muscle tissue Spelling Relief: Urination Urination, known by the medical term micturition, occurs when the bladder is emptied through the urethra. Although urine is created continuously, it’s stored in the bladder until the individual finds a convenient time to release it. Mucus produced in the blad- der’s lining protects its walls from any acidic or alkaline effects of the stored urine. When there is about 200 milliliters of urine distending the bladder walls, stretch recep- tors transmit impulses to warn that the bladder is filling. Afferent impulses are trans- mitted to the spinal cord, and efferent impulses return to the bladder, forming a reflex arc that causes the internal sphincter to relax and the muscular layer of the bladder to contract, forcing urine into the urethra. The afferent impulses continue up the spinal cord to the brain, creating the urge to urinate.

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In addition cheap cialis black 800mg overnight delivery erectile dysfunction 40, the paper highlights the role of adherence in treatment success buy cheap cialis black 800mg erectile dysfunction protocol pdf download free, which has implications for understanding placebos and compliance with medical/ clinical recommendations. A cognitive–behavioural approach to pain regards pain as a perception that involves an integration of four sources of pain-related information: s Cognitive, e. The cognitive–behavioural approach to pain therefore aims to reduce pain by focusing on these different sources of pain-related information. The central role of self-control In particular, the cognitive–behavioural approach to pain aims to improve the indi- vidual’s self-control over the pain. Turk and Rudy (1986) summarize the objectives of interventions to improve self-control as follows: s Combat demoralization. They are taught to reconceptualize their problems so that they can be seen as manageable. If patients have previously received several forms of pain treatment, they may believe that nothing works. They are taught to believe in the cognitive behavioural approach to pain treatment and that with their cooperation the treatment will improve their condition. Chronic pain sufferers may have learnt emotional and behavioural coping strategies that may be increasing their pain, such as feeling consistently anxious, limping or avoiding exercise. Once aware of the automatic emotions and behaviours that increase their pain, pain sufferers are taught a range of adaptive coping responses. Chronic pain sufferers may have learnt to attribute any success to others and failure to themselves. Any effectiveness of the cognitive behavioural treatment should persist beyond the actual treatment intervention. Therefore, pain sufferers are taught how to anticipate any problems and to consider ways of dealing with these problems. Within this model of pain treatment, Basler and Rehfisch (1990) set out to examine the effectiveness of a cognitive behavioural approach to pain. In addition, they aimed to examine whether such an approach could be used within general practice. Methodology Subjects Sixty chronic pain sufferers, who had experienced chronic pain in the head, shoulder, arm or spine for at least six months, were recruited for the study from general practice lists in West Germany. Subjects were allocated to either (1) the immediate treat- ment group (33 subjects started the treatment and 25 completed it); or (2) the waiting list control group (27 subjects were allocated to this group and 13 completed all measures). Design All subjects completed measures at baseline (time 1), after the 12-week treat- ment intervention (time 2) and at six-month follow-up (time 3). Subjects in the control group completed the same measures at comparable time intervals. Measures At times 1, 2 and 3, all subjects completed a 14-day pain diary, which included measures of: s Intensity of pain: the subjects rated the intensity of their pain from ‘no pain’ to ‘very intense pain’ every day. The subjects also completed the following measures: s The state–trait anxiety inventory, which consists of 20 items and asks subjects to rate how frequently each of the items occurs. In addition, at six-month follow-up (time 2), subjects who had received the treatment were asked which of the recommended exercises they still carried out and the physicians rated the treatment outcome on a scale from ‘extreme deterioration’ to ‘extreme improvement’. The treatment intervention The treatment programme consisted of 12 weekly 90- minute sessions, which were carried out in a group with up to 12 patients. This component aimed to educate the subjects about the rationale of cognitive behaviour treatment. The subjects were encouraged to take an active part in the programme, they received information about the vicious circle of pain, muscular tension, demoralization and about how the programme would improve their sense of self-control over their thoughts, feelings and behaviour. The subjects were taught how to control their responses to pain using progressive muscle relaxation. They were given a home relaxation tape, and were also taught to use imagery techniques and visualization to distract themselves from pain and to further improve their relaxation skills. The subjects were asked to complete coping cards to describe their maladaptive thoughts and adaptive coping thoughts. The groups were used to explain the role of fear, depression, anger and irrational thoughts in pain.

However discount cialis black 800mg without prescription impotence causes, this method does give better values for structures that are not in the minimum energy state generic cialis black 800mg with visa impotence definition. The best fit values are obtained by looking at related structures with known parameter values and using the values from the parts of these structures that most resemble the structure being modelled. Parameter values are also stored in the data bases of the molecular modelling computer programs. In the former case commercial packages usually have several different force fields within the same package and it is necesary to pick the most appropriate one for the structure being modelled. To use the commercial force field, the values of the relevant parameters together with the initial atomic coordinates are fed into the force field equation. This initial energy value is minimized by the computer iteratively (consecutive repetitive calculations), changing the values of the atomic coordinates in the equation for the force field until a minimum energy value is obtained. The values of the atomic coordinates corresponding to this minimum energy value are used to visualize the model on the monitor screen in an appropriate format (see Figure 5. The second method assembles the initial model from models of structural fragments held in the database of a molecular modelling program (Figure 5. Initially these fragments are put together in a reasonably sensible manner to give a structure that does not allow for steric hindrance. At this point it is necessary to check that the computer has selected atoms for the structure whose configur- ations correspond to the types of bonding required in the structure, in other words, if an atom is double bonded in the structure, the computer has selected a form of the atom that is double bonded. These checks are carried out by matching a code for the atoms on the screen against the code given in the manual for the program and replacing atoms where necessary. At this stage the structure displayed is not necessarily in its minimum potential energy conformation. The molecule with H H the relevant functional group O and/or structure is selected. Fragments are joined to each other by removing hydrogen atoms (See shaded boxes in step 1) at the points at which the fragments are to be linked. As a result of this change, the structure on the monitor screen assumes a conformation corresponding to a minimum energy state. This conformation may be presented in a number of formats depending on the requirements of the modeller (see Figure 5. The energy minimizing procedure also automatically twists the molecule to allow for steric hindrance. It stops when the force field reaches the nearest local minimum energy value even though this value is not necessarily the lowest minimum energy value for the structure (Figure 5. The use of molecular dynamics gives the structure kinetic energy which allows it to overcome energy barriers, such as Y, to reach the global minimum energy structure of the molecule Consequently, it may be necessary to use a more sophisticated computer procedure, molecular dynamics (section 5. This final structure may be moved around the screen and expanded or reduced in size. It can also be rotated about the x or y axis to view different elevations of the molecule. The molecular mechanics method requires considerably less computing time than the quantum mechanical approach and may be used for large molecules containing more than a thousand atoms. This means that it may be used to model target sites as well as drug and analogue molecules. As well as being used to produce molecular models, it may also be used to provide information about the binding of molecules to receptors (see section 5. However, molecular mech- anics is not so useful for computing properties, such as electron density, that are related to the electron cloud. Furthermore, it is important to realize that accuracy of the structure obtained will depend on the quality and appropriate- ness of the parameters used in the force field. Moreover, molecular mechanical calculations are normally based on isolated structures at 0 K and do not nor- mally take into account the effect of the environment on the structure. Molecular dynamics programs allow the modeller to show the dynamic nature of molecules by simulating the natural motion of the atoms in a structure. This motion, which is time and temperature dependent, is modelled by includ- ing terms for the kinetic energy of the atoms in the structure in the force field by using equations based on Newton’s laws of motion. The solution of the these force field equations gives coordinates that show how the positions of the atoms in the structure vary with time. The appearance of the this picture will depend on the force field selected for the structure and the temperature and time interval used for the integration of the Newtonian equations.

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