睿学教育Wisdome Education

Barbara Abrams DrPH, RD

• Professor of the Graduate School, Epidemiology, Maternal, Child and Adolescent Health, and Public Health Nutrition

https://publichealth.berkeley.edu/people/barbara-abrams/

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There are at least three types of interventions that the nurse can use Stevenson and Woods state: “Nursing science is the to bring about change keratin intensive treatment vastarel 20 mg purchase fast delivery. The nurse may attempt to domain of knowledge concerned with the adapta- repair damaged structural units by altering the in- tion of individuals and groups to actual or poten- dividual’s set and choice treatment action group order 20 mg vastarel free shipping. The second would be for tial health problems treatment notes purchase vastarel with paypal, the environments that the nurse to impose regulatory and control meas- influence health in humans and the therapeutic in- ures. The nurse acts outside the patient environ- terventions that promote health and affect the con- ment to provide the conditions, resources, and sequences of illness” (1986, p. The linking of instrument behav- demonstrated the usefulness of Johnson’s model in iors to a more general attribute provided not only a clinical practice in a variety of ways. The majority an evidential basis for interpreting the process un- of the research focuses on clients’ functioning in derlying the instrument scores, but also a basis for terms of maintaining or restoring behavioral sys- inferring researchable implications of the scores tem balance, understanding the system and/or sub- from the broader network of the construct’s mean- systems by focusing on the basic sciences, or ing. Anayis Derdiarian’s research program in- found that changes in the aggressive/protective volves both the client and the nurse as agents of subsystem made both direct and indirect effects on action. Derdiarian’s early research tested an instru- changes in other subsystems (Derdiarian, 1990). She focused on of cancer patients (Derdiarian, 1983; Derdiarian & the nurses’ assessment of the patient using the Forsythe, 1983). The re- approach expanded the view of nursing knowledge sults demonstrated by the instrument possessed from exclusively client based to knowledge about content validity, strong internal consistency, and the context and practice of nursing that is model thus strong reliability. Derdiarian also found that a the Johnson model’s eight behavioral subsys- model-based, valid, and reliable instrument could tems. The study also served to further validate her improve the comprehensiveness and the quality of instrument. The measure Derdiarian’s body of work reflects the complex- can be taken as an indicator of the construct of “be- ity of nursing’s knowledge as well as the strategic havioral set. Her arti- work of relations that were tied to observables and cle (Derdiarian, 1991) demonstrated the clear rela- were therefore empirically testable. This validation tionship between Johnson’s theory and nursing study linked a particular measure, the Derdiarian practice. It provided identify the most common nursing diagnoses of evidence that the measure exhibited, at least in part, hospitalized geopsychiatric patients. They found the network of relations derived from the theory of that 30 percent of the diagnoses were related to the the construct. My goal was to determine the causes of instability within and between subsystems (e. My first study (Holaday, 1974) compared the achievement behavior of chronically ill and healthy children. The study showed that chronically ill children differed in attributional tendencies when compared with healthy chil- dren and showed that the response patterns differed within the chronically ill group when compared to certain dimensions (e. Males and children diagnosed at birth attributed both success and fail- ure to the presence or absence of ability and little to effort. The results indicated behavioral system imbalance and focused my attention on interventions directed toward set, choice, and action. The next series of studies used the concept of “behavioral set” and examined how mothers and their chron- ically ill infants interacted (Holaday, 1981, 1982, 1987). Patterns of maternal response provided information re- lated to the setting of the “set goal” or behavioral set; that is, the degree of proximity and speed of maternal response. Mothers with chronically ill infants rarely did not respond to a cry indicating a narrow behavioral set. Further analysis of the data led to the identification of a new structural component of the model-conceptual set. A person’s conceptual set was defined as an organized cluster of cognitive units that were used to inter- pret the content information from the preparatory and perseveratory sets. A conceptual set may differ both in the number of cognitive units involved and in the degree of organization exhibited. The various cognitive units that make up a conceptual set may vary in complexity depending on the situation. Three levels of conceptual set have been identified, ranging from a very simple to a complex “set” with a high degree of connectedness be- tween multiple perspectives (Holaday, 1982). Thus, the conceptual set functions as an information collection and processing unit.

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However symptoms 9 days after iui order 20 mg vastarel free shipping, if an alkyl chain of the cycloalkane has a greater number of carbons treatment vitiligo 20 mg vastarel purchase with mastercard, then the alkyl chain is used as the parent symptoms nausea headache fatigue order vastarel toronto, and the cycloalkane as a cycloalkyl substituent. Open chain alkanes have free rotation about their CÀÀC bonds, but cycloalkanes cannot undergo free rotation, so sub- stituted cycloalkanes can give rise to cis and trans isomers (see Section 3. H H H C2H5 H H = H C2H5 = H5C2 C H H5C2 C H H5C2 H H5C2 2 5 2 5 H cis-1,2-Diethylcyclopentane trans-1,2-Diethylcyclopentane Physical properties of cycloalkenes Cycloalkenes are nonpolar molecules like alkanes. As a result, they tend to have low melting and boiling points compared with other functional groups. Usually alkanes are obtained through refinement or hydrogenation of petroleum and coal. Compounds containing five-membered rings (cyclopentane) and six- membered rings (cyclohexane) are especially common. The coupling reaction of alkyl halides with Gilman reagent (R’2CuLi, lithium organocuprates) also produces alkanes (see Section 5. H2O Selective reduction of aldehydes or ketones, either by Clemmensen reduc- tion (see Section 5. In fact, it is often convenient to regard the hydrocarbon framework of a molecule as an unreactive support for the more reactive functional groups. Combustion or oxidation of alkanes Alkanes undergo combustion reaction with oxygen at high temperatures to produce carbon dioxide and water. Oxidation of saturated hydrocarbons is the basis for their use as energy sources for heat, e. The two smaller cycloalkanes react with hydrogen, even though they are not alkenes. In the presence of a nickel catalyst, the rings open up, and form corresponding acyclic (open chain) alkanes. H H H C Cl H3C C Cl H H Chloromethane Chloroethane Methyl chloride Ethyl chloride Based on the number of alkyl groups attached to the CÀÀX unit, alkyl halides are classed as primary (1 ), secondary (2 ) or tertiary (3 ). Physical properties of alkyl halides Alkyl halides have considerably higher melting and boiling points compared with analogous alkanes. The boiling points also increase with increasing atomic weight of the halogen atom. Thus, alkyl fluoride has the lowest boiling point and alkyl iodide has the highest boiling point. Alkyl halides are insoluble in water as they are unable to form hydrogen bonds, but are soluble in nonpolar solvents, e. The CÀÀX bonds in alkyl halides are highly polar due to the higher electronegativity and polarizabi- lity of the halogen atoms. Halogens (Cl, Br and I) are good leaving groups in the nucleophilic substitution reactions. The electronegativity of halides decreases and the polarizability increases in the order of: F > Cl > Br > I. Often substitution and elimination reactions occur in competition with each other. In general, most nucleophiles can also act as bases, therefore the preference for elimination or substitution is determined by the reaction conditions and the alkyl halide used. Organometallic reagents react readily with hydrogen atoms attached to oxygen, nitrogen or sulphur, in addition to other acidic hydrogen atoms. They react with terminal alkynes to form alkynides (alkynyl Grignard reagent and alkynyllithium) by acid–base reactions (see Section 4. Alkynides are useful nucleophiles for the synthesis of a variety of other compounds (see Section 4. Organolithium reagents react similarly to Grignard reagents, but they are more reactive than Grignard reagents. They react readily with acid chlorides, but do not react with aldehydes, ketones, esters, amides, acid anhydrides or nitriles. Grignard reagents These reagents are prepared by the reaction of organic halides with magnesium turnings, usually in dry ether.

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The constructed of healing and fighting is also involved in the trans- lodge is usually a round or oval-shaped dome medicine of the wolf order vastarel without a prescription, rep- action medications interactions 20 mg vastarel order amex. The origin of the sweating ceremony is resentative of the womb and sometimes called ascribed to the buffalo treatment 4th metatarsal stress fracture vastarel 20 mg order on-line, and buffalo skull is always ‘Mother Earth’s womb’. Movements are performed itation and martial art, which originated in ancient slowly, softly, and gracefully with smooth, even China. Many practitioners say words for “Supreme Ultimate Force” and based on practicing t’ai ch’i offers improved posture, align- first learning to feel and then to direct an energy ment, and/or movement patterns, all of which, known as chi (or qi). Taoism, a reflective, mystical Chinese philosophy first associated with the scholar and mystic Lao Tzu tea, herbal Beverage made from various herbs, (Laozi), an older contemporary of Confucius. Lao such as chamomile tea to induce relaxation and Tzu wrote and taught in the province of Hunan in calm an upset stomach. Although Taoism has many elements, the major Thai massage Dating back to ancient times and concept is that the world is steeped in beauty and originating in northern India, a combination of should be viewed and treated with great reverence. Thai massage is worked on titioners, a long connection with the I Ching, a Chi- a floor with the client dressed in comfortable loose nese system of divination. It is performed in gentle, rhythmic the eight basic I Ching trigrams and the five ele- movements designed to energize and balance the ments of Chinese alchemy (metal, wood, fire, body. Similar to acupressure and shiatsu, it has water, and earth) with the 13 basic postures of t’ai been nicknamed “yoga for the lazy. There are also focuses on the major meridians, also called energy other associations with the full 64 trigrams of the I lines or Nadis, which run throughout the body. In ated with the Chinese concept of yin-yang—the contrast to traditional Chinese medicine, which dynamic duality (male/female, active/passive, uses acupuncture to manipulate the pressure dark/light, forceful/yielding, etc. More information on the school, the number of exercises varies from is available at www. Energy field cues energy fields, a scientific nursing intervention for- may be perceived by the practitioner as sensations mally developed in the early 1970s by Dolores such as heat, cold, tingling, or whatever is intuited. The Therapeutic Touch practitioner seeks of energy between the patient and practitioner, to repattern the recipient’s weakened or compro- unruffling is a clearing or smoothing of the energy mised energy flow and stimulate the immune sys- field, especially in areas that are distressed. Once centered, the prac- Thomson, Samuel Leader of a movement of titioner “scans,” or assesses, the patient’s energy herbalists who patented his system of herbal medi- field in order to perceive cues, that is, indicators of cine in 1813 and sold the rights to others who imbalance in the energy field. They became known as Thom- lying down as the practitioner uses the palms of his sonian practitioners, and by 1839, there were or her hands to “connect” with the energy that sur- 100,000 in the United States. The Eclectics, who established many schools massage technique, as opposed to massages that in major American cities, published an official phar- involve pressure, oils, or forceful manipulation, macopoeia in 1854, which by 1909 reached its 19th that helps release tension in joints. The method edition, but because of the emergence of new drugs was developed by Dr. Milton Trager, who spent 50 and a growing pharmaceutical industry, the last of years expanding his theories. Born in Chicago in the Eclectic schools, in Cincinnati, Ohio, shut down 1908 with a congenital spinal deformity, Trager in 1939. Today’s schools of naturopathy provide overcame his disability and improved his body to courses in natural and holistic medicine practices athletic status. When he was in his late teens his including traditional Chinese medicine, homeopa- family had moved to Miami Beach, Florida, where thy, Ayurveda, nutrition, and herbal medicine. His trainer was tincture A liquid homeopathic remedy, usually so impressed by the results that Milton was with an alcohol base. At age 42 he applied to 70 medical schools before being accepted by Universi- tongue analysis Also called jihva, a system of dad Autonoma de Guadalajara in Mexico, where a diagnosis in Ayurvedic medicine based on observ- clinic was set up for him to continue his work in ing characteristics of the tongue. He continued to practice and (similar mapping of the soles of the feet is seen in teach for the next 20 years and cofounded the reflexology); ailments that include sensitive colon, Trager Institute in 1980. There are now thousands delicate heart, kidney disorder, bronchitis, pneu- of certified practitioners around the world. More ins in the colon or gastrointestinal tract, and information is available at www. Face, lips, nail, and eye evaluations are Transcendental Meditation Practiced by 5 mil- also used in Ayurvedic diagnostic measures.

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Gradual potent steroids can cause local vasoconstriction and massive tapered withdrawal is less hazardous medicine dictionary cheap vastarel 20 mg buy online. However medications for factor 8 discount vastarel 20mg mastercard, even in doses administered systemically can cause hypertension due to patients who have been successfully weaned from chronic treat- generalized vasoconstriction medications known to cause nightmares order vastarel 20mg. The receptor–glucocorticosteroid unusual if the daily glucocorticosteroid dose is lower than the complex translocates to the nucleus, where it binds to gluco- amount usually secreted physiologically. This increases the transcription of various their underlying condition and also on the dose and duration of signal transduction proteins. Sodium and water retention, potassium loss Haematological Lowers lymphocyte and eosinophil counts; Florid complexion and increases neutrophils, platelets and polycythaemia clotting tendency Alimentary Increases production of gastric acid and pepsin Anorexia and nausea Dyspepsia; aggravation of peptic ulcer Cardiovascular system Sensitizes arterioles to catecholamines; Hypotension, fainting Hypertension, enhances production of angiotensinogen. High-dose intravenous hydrocortisone is used short term At physiological concentrations, it plays little if any part in to treat acute severe asthma (usually followed by oral pred- controlling blood glucose, but it does cause hyperglycaemia nisolone) or autoimmune inflammatory diseases (e. Hydrocortisone cream is relatively low in potency and Glucocorticosteroids – major side effects is of particular use on the face where more potent steroids are contraindicated. Hydrocortisone is rapidly absorbed from the gastro-intestinal • Metabolic effects including hyperglycaemia and tract, but there is considerable inter-individual variation in hypokalaemia occur rapidly, as does insomnia and mood disturbances. Treatment must therefore inflammatory potency of synthetic glucocorticoids be re-evaluated regularly and if long-term use is deemed essen- increases. Prednisolone is considered in musculoskeletal systems, and for immunosuppression in progressive rheumatoid arthritis when other forms of treatment transplant patients. Low doses of prednisolone may drome) is due to either a tumour or hyperplasia of the zona be symptomatically useful in the short-term management of glomerulosa of the adrenal cortex. Clinical features include noc- patients with severe articular symptoms from systemic lupus turia, hypokalaemia, hypomagnesaemia, weakness, tetany, erythematosus and larger doses may be appropriate for limited hypertension and sodium retention. Spironolactone and periods in such patients with steroid-responsive forms of eplerenone are mineralocorticoid antagonists (see Chapters 31 glomerulonephritis or with progressive central nervous system and 36) that compete with aldosterone and other mineralocorti- involvement. They Other diseases where prednisolone may be indicated are used as potassium-sparing diuretics and to treat primary or include severe asthma and some interstitial lung diseases, e. The immunosuppressant effect of prednisolone is Fludrocortisone (9-α-fluorohydrocortisone) is a potent syn- further utilized in transplantation, usually in combination with thetic mineralocorticoid, being approximately 500 times more ciclosporin or azathioprine, in order to prevent rejection powerful than hydrocortisone. Benign haematological disorders for which pred- steroid receptor and mimics the action of aldosterone. It under- nisolone is indicated include autoimmune haemolytic anaemia goes significant presystemic metabolism, but unlike aldos- and idiopathic thrombocytopenic purpura and is an essential terone is active by mouth. It is used as replacement therapy in component of chemotherapeutic regimens for lymphoma and patients with adrenocortical insufficiency. It is generally reserved for a few distinct indications, including: • Mineralocorticoids mimic aldosterone’s effects on the distal nephron, causing sodium retention and potassium excretion. It is used to prolong the action of local anaesthetics (via sone as a mineralocorticoid. Tumours of the adrenal medulla that of cortisol secretion, allows aldosterone production to secrete adrenaline and other pharmacologically active cate- continue. Current concepts – corticosteroid insuffi- • The adrenal cortex secretes three major hormones. New England Journal of Medicine 2003; • Glucocorticosteroids, primarily in the form of 348: 727–34. Pharmacology • Aldosterone controls Na /K ion exchange in the distal Reviews 2000; 52: 513–56. New England • The adrenal medulla secretes adrenaline (epinephrine) Journal of Medicine 1998; 339: 1828–34. Antiinflammatory action of glucocorticoids – has had chronic asthma, which is normally controlled with new mechanisms for old drugs. Pharmacology and Therapeutics 2002; but approximately 12 hours post-operatively he becomes 96: 23–43. Mechanisms of disease – disorders of aldosterone biosyn- post-operatively, he remains hypotensive on pressor agents thesis and action.

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Positive symptoms chlamydia vastarel 20mg for sale, negative treatment lichen sclerosis purchase generic vastarel canada, and aversive reinforcements can contribute to desired changes in behavior treatment 4 ringworm purchase vastarel 20mg mastercard. The privileges and penalties are individually deter- mined as caregiver learns the likes and dislikes of client. In 2009, the Centers for Disease Control and Prevention reported that in the United States 1. These include autistic disorder, Rett’s disor- der, childhood disintegrative disorder, pervasive developmen- tal disorder not otherwise specified, and Asperger’s disorder. Onset of the disorder occurs before age 3, and in most cases it runs a chronic course, with symptoms persisting into adulthood. Studies with both monozygotic and dizygotic twins have also provided evidence of a genetic involvement. Certain developmental problems, such as postnatal neu- rological infections, congenital rubella, phenylketonuria, and fragile X syndrome, also have been implicated. Failure to form interpersonal relationships, characterized by unresponsiveness to people; lack of eye contact and facial re- sponsiveness; indifference or aversion to affection and physical contact. In early childhood, there is a failure to develop coop- erative play and friendships. Impairment in communication (verbal and nonverbal) char- acterized by absence of language or, if developed, often an immature grammatical structure, incorrect use of words, echolalia, or inability to use abstract terms. Bizarre responses to the environment, characterized by resis- tance or extreme behavioral reactions to minor occurrences; abnormal, obsessive attachment to peculiar objects; ritualis- tic behaviors. Common Nursing Diagnoses and Interventions for the Client with Autistic Disorder (Interventions are applicable to various health care settings, such as in- patient and partial hospitalization, community outpatient clinic, home health, and private practice. Intervene to protect child when self-mutilative behaviors, such as head banging or other hysterical behaviors, become evident. A helmet may be used to protect against head banging, hand mitts to prevent hair pulling, and appropriate pad- ding to protect extremities from injury during hysterical movements. Try to determine if self-mutilative behaviors occur in response to increasing anxiety and, if so, to what the anxiety may be attributed. Offer self to child during times of increasing anxiety, in or- der to decrease need for self-mutilative behaviors and provide feelings of security. Anxiety is maintained at a level at which client feels no need for self-mutilation. Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence ● 23 Long-term Goal Client will initiate social interactions (physical, verbal, nonver- bal) with caregiver by discharge from treatment. Convey a manner of warmth, acceptance, and availability as cli- ent attempts to fulfill basic needs. These characteristics enhance establishment and maintenance of a trusting relationship. The autistic client may feel threatened by an onslaught of stimuli to which he or she is unaccustomed. Support client with your presence as he or she endeavors to relate to others in the environment. The presence of an individual with whom a trusting relationship has been established provides a feeling of security. Client uses eye contact, facial responsiveness, and other nonverbal behaviors in interactions with others. Long-term Goal Client will have established a means for communicating (verbally or nonverbally) needs and desires to staff by time of discharge from treatment. Consistency facilitates trust and enhances caregiver’s ability to under- stand child’s attempts to communicate. Anticipate and fulfill client’s needs until satisfactory com- munication patterns are established. Anticipating needs helps to minimize frustration while child is learning com- munication skills. Use the techniques of consensual validation and seeking clarification to decode communication patterns. These techniques work to verify the accuracy of the message received, or to clarify any hid- den meanings within the message.

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The human and environ- that practice and research methods must be consis- mental fields are inseparable medications via g-tube order vastarel 20 mg on-line, so one cannot “come tent with the Science of Unitary Human Beings in between treatment xanthelasma eyelid order vastarel without prescription. Therefore abro oil treatment buy vastarel 20mg otc, inconsistent with Rogers’ principle of helicy: that Rogerian practice and research methods must be expected outcomes infer predictability. The princi- congruent with Rogers’ postulates and principles if ple of helicy describes the nature of change as being they are to be consistent with Rogerian science. Within an energy-field perspective, nurses in mutual process assist clients in actual- izing their field potentials by enhancing their Practice ability to participate knowingly in change (Butcher, 1997). The goal of nursing practice is the promotion of Given the inconsistency of the traditional nurs- well-being and human betterment. Nursing is a ing process with Rogers’ postulates and principles, service to people wherever they may reside. Since the 1960s, the nursing process practice methods have been derived from Rogers’ has been the dominant nursing practice method. The nursing process is an appropriate practice methodology for many nursing theories. But currently the most widely used Rogerian practice in later years she asserted that nursing diagnoses model. Barrett’s (1988) practice model was derived were not consistent with her scientific system. Barrett [N]ursing diagnosis is a static term that is quite inap- (1998) expanded and updated the methodology by propriate for a dynamic system... Pattern manifestation knowing is Furthermore, nursing diagnoses are particular- the continuous process of apprehending the istic and reductionistic labels describing cause and human and environmental field (Barrett, 1998). The nursing ian position of the nurse, whereas “knowing” process is a stepwise sequential process inconsistent means to recognize the nature, achieve an under- with a nonlinear or pandimensional view of reality. Intervention means tinuous process whereby the nurse assists clients in to “come, appear, or lie between two things” freely choosing—with awareness—ways to partici- (American Heritage Dictionary, 2000, p. The nurse does not gathered from and about the client, family, or com- invest in changing the client in a particular direc- munity—including sensory information, feelings, tion, but rather facilitates and mutually explores thoughts, values, introspective insights, intuitive with the client options and choices and provides in- apprehensions, lab values, and physiological meas- formation and resources so the client can make in- ures—are viewed as “energetic manifestations” formed decisions regarding his or her health and emerging from the human/environmental mutual well-being. Fifth, all pattern infor- not consistent with Rogers’ postulate of pandimen- mation has meaning only when conceptualized and sionality and principles of integrality and helicy. Synopsis and Rather, acausality allows for freedom of choice and synthesis are requisites to unitary knowing. The goal of Synopsis is a process of deliberately viewing to- voluntary mutual patterning is the actualization of gether all aspects of a human experience (Cowling, potentialities for well-being through knowing par- 1997). The constituents for the development of Rogerian prac- human and environmental fields are inseparable. Cowling (1993b, 1997) refined the Thus, any information from the client is also a re- template and proposed that “pattern appreciation” flection of his or her environment. Physiological was a method for unitary knowing in both and other reductionistic measures have new mean- Rogerian nursing research and practice. For preferred the term “appreciation” rather than “as- example, a blood pressure measurement inter- sessment” or “appraisal” because appraisal is associ- preted within a unitary context means the blood ated with evaluation. Appreciation has broader pressure is a manifestation of pattern emerging meaning, which includes “being full aware or sensi- from the entire human/environmental field mutual tive to or realizing; being thankful or grateful for; process rather than being simply a physiological and enjoying or understanding critically or emo- measure. Pattern apprecia- unitary and not particular by reflecting the unitary tion has a potential for deeper understanding. The first constituent for unitary pattern appreci- The sixth constituent in Cowling’s practice ation identifies the human energy field emerging method describes the format for documenting and from the human/environment mutual process as presenting pattern information. Pattern manifestations emerging nursing diagnoses and reporting “assessment data” from the human/environment mutual process are in a format that is particularistic and reductionistic the focus of nursing care. Next, the person’s experi- by dividing the data into categories or parts, the ences, perceptions, and expressions are unitary nurse constructs a “pattern profile. Third, “pattern appreciation rizing the client’s experiences, perceptions, and requires an inclusive perspective of what counts as expression inferred from the pattern appreciation pattern information (energetic manifestations)” process.

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Occupational exposure to ionizing radiation in the United States: A comprehensive review for the year 1980 and a summary of trends for the years 1960–1985 medicine cabinet shelves cheap vastarel 20 mg. Radiation safety for the Nomad™ portable x-ray system in a temporary morgue setting symptoms genital herpes buy vastarel 20 mg with mastercard. Historically medications via ng tube order vastarel 20 mg overnight delivery, photography has been the most signifcant method of preserv- ing the physical evidence of patterned injuries in skin. Te need to accu- rately photograph injury patterns as they appear on skin is paramount to the odontologist, pathologist, law enforcement, and the legal system. Since vast amounts of time ofen elapse between the commission of crimes and the trial 203 204 Forensic dentistry of the perpetrator, photographs frequently are the only permanent record of the injuries to the victims. Terefore, it is imperative that the forensic investi- gator be able to properly photograph injury patterns as a means of preserving such evidence. Tis chapter is better understood if the reader has a good grasp of photo- graphic terminology and the skills for operating basic camera equipment. Tere are many publications that can provide the necessary background to improve one’s understanding of the photographic principles described in this chapter. Two readily available and easy reading books are Basic Photography by Michael Langford1 and Te Basic Book of Photography, Fifh Edition, by Tom Grimm. It will also present the historical photographic tech- niques utilizing traditional flm and the exploding era of digital imaging. Tese wavelengths are measured in millionths of millimeters, referred to as nanometers (nm). Photographic images can be recorded on flm emulsions that are sensitive to light wavelengths anywhere between 250 and 900 nm. Visible light, which we see with our unaided human eye, comprises only from 400 to 760 nm. Most modern digital cameras and traditional photographic flms are specifcally designed to record images seen in the visible range of light as we see them However, it is also possible to record images we cannot see when specifcally illuminated in the shorter ultraviolet range (210 to 400 nm) and longer infrared range (750 to 900 nm). Since ultraviolet and infrared radiations are outside the visible range of the spectrum, they are commonly referred to as nonvisible light. Recent genera- tions of digital cameras have been designed to allow the recording of pat- terned injuries in skin using both visible light and nonvisible light. While the electronic transfer of light to magnetic recording media is very diferent than exposing photographic flm, for the most part, the techniques utilized for image capture are basically the same. Photography using nonvisible light requires special techniques to record the injury, including an occasional minor focusing adjustment called focus shif3 that provides correction for the optical properties of lenses that were designed primarily to be used for visible light photography (Table 11. It is this refection of visible light that accounts for the colors seen by the human eye. It is the absorption of all colored light by an object that makes that object appear black. A third reaction that occurs, especially when light strikes human skin, is the transmission and scattering of the energy associated with the light through successive layers of cells until the energy of the light is spent and has dissipated. Te fnal reaction, which occurs when light energy strikes an object, is a molecular excitation called fuorescence (Figure 11. Molecules in tissue absorb the energy from light and release that energy as a fuorescent glow. It only lasts as long as the light’s excitation energy is applied, usually about 100 nanoseconds (10–9 seconds). When light energy of various wavelengths strikes human skin, all four of the previously mentioned events can occur simultaneously. Depending on the wavelength of the source of the incident light and the confguration of the camera, lenses, and flters, it is possible to record, individually, any of the four reactions of skin to light energy (Figure 11. Ultraviolet light only penetrates a few microns into skin, whereas infrared light can penetrate skin to a depth of up to 3 mm. By varying the wavelength of incident light used for illumination and setting up the appropriate confgu- ration of the camera, lens, flters, and flm, it is possible to photograph any of the four events that occur. Tis ability creates an opportunity for interest- ing pictures, especially when looking at bruises and other injuries to skin.

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Haemoglobin S differs from haemoglobin A by the substitution of valine for glutamic acid at position 6 in the $-chain medicine ball 20mg vastarel order with mastercard. Sickled cells have increased mechanical fragility and a shortened survival leading to a haemolytic anaemia medicine joint pain vastarel 20mg order overnight delivery, and also can block small vessels leading to tissue infarction treatment 2 stroke vastarel 20mg buy without a prescription. Sickle cell disease has a very variable clinical course due to a combination of reasons including the haemoglobin F (HbF) level and socio-economic factors. It usually presents in early childhood with anaemia and jaundice due to a chronic haemolytic anaemia, or painful hands and feet with inflammation of the fingers due to dactylitis. This patient is having a pulmonary crisis characterized by pleuritic chest pain, shortness of breath and hypoxia. It is usually precipitated by dehydration or infection (in this case, a sore throat). The principal differential diagnoses of a patient presenting with pleuritic pain and breath- lessness are pneumonia, pneumothorax and pulmonary emboli. Major potential complications of sickle cell disease • Thrombotic: causing generalized or localized bony pains, abdominal crises, chest crises, neurological signs or priapism. This patient should be admitted for rest, intravenous fluids, oxygen and adequate anal- gesia. The definitive investigation is haemoglobin electrophoresis which will demonstrate HbS, absent HbA and a variable HbF level. Partial exchange transfusion may be needed to reduce the level of his sickle cells to less than 30 per cent. He should be followed up by an expert sickle team since this has been shown to reduce admissions and improve quality of care. He may benefit from long-term hydroxyurea which raises the HbF level and reduces the number of crises. She has had the occasional episode of acute cystitis, approximately on a 2-yearly basis. Examination of the cardiovascular and respiratory systems is otherwise unremarkable. Acute appendicitis classically presents with a short his- tory of central abdominal pain which rapidly localizes to the right iliac fossa. There is guard- ing and ‘board-like’ rigidity and rebound tenderness in the right iliac fossa. Untreated, some cases will resolve spontaneously, whereas others will perforate leading to localized or gener- alized peritonitis. Rarely a delayed diagnosis may result in acute appendicitis progressing to an appendix mass consisting of a haemorrhagic oedematous mass in the ileocaecal region. The symptoms of loin pain and presence of blood and protein in the urine mimicking a urinary tract infection suggest the appen- dix may be retrocaecal. Patients with retro-ileal appendicitis often have little abdominal pain, but irritation of the ileum can lead to severe diarrhoea and vomiting. Patients may also present with subacute intestinal obstruction due to intestinal ileus, or urinary reten- tion due to pelvic peritonitis. Differential diagnosis of acute appendicitis • In young adults the differential diagnoses include irritable bowel syndrome, non- specific mesenteric adenitis, ruptured ectopic pregnancy, twisted or haemorrhagic ovarian cysts, infection of the Fallopian tubes and urinary tract infections. The treatment is appendicectomy as soon as urinary tract infection has been excluded. A 62-year-old lady had been admitted 10 days previously to have a right hemicolectomy performed for a cae- cal carcinoma. This was discovered on colonoscopy which was performed to investigate an iron-deficiency anaemia and change in bowel habit. The initial surgery was uneventful, and she was given cefuroxime and metronidazole as routine antibiotic prophy- laxis. Over the next 5 days the patient remained persistently febrile, with negative blood cultures.

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Gram negative Bacteroides fragilis group colon Prevotella melaninogenica Mouth Fusobacterium Mouth/Colon b medications listed alphabetically order vastarel with paypal. Gram positive Actinomyces Mouth Lactobacilli Vagina Propionibacterium Skin Clostridium Colon 2 symptoms vitamin b12 deficiency discount vastarel 20 mg amex. Gram positive Peptostreptococci Colon clinical features: 260 Representative anaerobic infections Commonly isolated anaerobic bacteria Brain abscess Peptostreptococci Oropharyngeal infection Actinomyces P treatment eating disorders purchase 20mg vastarel fast delivery. Foul smelling discharge due to short chain fatty acid products of anaerobic metabolism. Fatty acid production Treatment: Antimicrobials + Surgery Clindamycin Metronidazole Cefotetan 262 Cefoxitin Piperacillin Penicillin 2. Source of infection: Tuberculous patients Route of infection: Respiratory- Inhalation of droplet nuclei Ingestion of infected milk Disease: Pulmonary and extrapulmonary tuberculosis The disease generally manifests with low-grade persistent fever, night sweating, significant weight loss, fatigue and generalized weakness. Used for observing colony morphology, susceptibility testing, and as selective media 2. Lowenstein-Jensen medium It is the ordinary selective media for tubercle bacilli Raised, dry, cream colored colonies of tubercle bacilli after 3-6 wks of incubation 264 3. Pasteurization of milk and milk products Mycobacterium leprae Characteristics: • Typical acid-fast bacilli, arranged in singly, parallel bundles or in globular masses. Foot pads of mice Armadillos Clinical features: Incubation period is months to years. Clinical triads: Anaesthetic skin patches 266 Peripheral neuritis Presence of acid-fast bacilli from skin lesion Two major types of leprosy 1. Comparison of the two types of leprosy Characteristics Lepromatous leprosy Tuberculoid leprosy 1. Usually positive Laboratory diagnosis: Specimen: Skin scrapings from the ear lobe. Non-viable bacilli stain poorly and unevenly as fragmented, beaded and granular red bacilli. When dry, hold fold of skin tightly between the thumb and forefinger until it becomes pale. Using the sterile blade, make a small cut through the skin surface, 5mm long and 2-3mm deep, where the bacteria is be found. Make a small circular smear of the tissue juice (Cover the cut with a small dressing). Wipe the back of the slide clean, and place in a draining rack for the smears to air-dry (protect from direct sun light). Most are soil saprophytes, but some are human pathogens responsible to cause actinomycosis nocardiosis and actinomycetoma. Large group of gram positive bacilli with a tendency to form chains and filaments. Endogenous members of the bacterial flora in the mouth and lower gastrointestinal tract Actinomycosis Chronic suppurative and granulomatous infection with interconnecting sinus tracts that contain sulfur granules Etiology: Actinomyces israeli Actinomyces naeslundii Characteristics:. Gram positive, facultative anaerobe substrate filaments that grow in co2 enriched condition Pathogenesis and clinical features:. Infection is initiated by trauma that introduces these endogenous bacteria into the mucosa 1. Cervico facial actinomycosis 270 Fluctuant mass with draining fistula in jaw area, and may extend to involve bone and lymphnodes in the head and neck 2. Thoracic actinomycosis Resemle subacute pulmonary infection with extension to chest wall and ribs 3. Abdominal actinomycosis May be secondary to ruptured appendix or ulcer with extensive involvement of abdominal organs Lab. Diagnosis: Specimen: Tissue, pus, sputum Smear: Gram-positive filaments with lobulated sulfur granules Culture: Thioglycolate broth or blood agar incubated anaerobically or co2 enriched condition Biochemical reacrion: Catalase positive/negative Treatment: Penicillin Clindamycin + Surgery Erythromycin Nocardiosis Etiology: Nocardia asteroides complex N. Aerobic gram positive, partially aci fast bacilli Pathogenesis and cloinical features: Route of transmission: Inhalation Usual presentation is subacute or chronic pulmonary infection with dissemination to the brain and skin Lab.

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Non-selective monoamine Changes in urinary pH alter the excretion of drugs that are oxidase inhibitors (e medications 7 rights order vastarel 20 mg line. In the past he had had a mitral valve replaced medicine 6 year in us order discount vastarel, and he had been on warfarin ever since medicine zofran safe 20 mg vastarel. Two weeks later the patient was again admitted, this time drowsy and complaining of headache Salicylate Probenecid Salicylate toxicity after mildly bumping his head on a locker. Fresh frozen plasma was Digoxin Spironolactone Increased plasma administered and neurosurgical advice was obtained. Comment Amiodarone digoxin This patient’s warfarin requirement increased during treat- Verapamil ment with rifampicin because of enzyme induction, and the dose of warfarin was increased to maintain anticoagu- lation. When rifampicin was stopped, enzyme induction gradually receded, but the dose of warfarin was not from urine (e. Consequently, the patient became over-anti- coagulated and developed a subdural haematoma in line urine). Key points • There are three main types of adverse interaction: – pharmaceutical; – pharmacodynamic; – pharmacokinetic. In principle, they should be easy to anticipate, Association and Royal Pharmaceutical Society of Great Britian, but they can cause serious problems (e. They occur when one drug influences the actions from in vitro data: impact of incorporating parallel path- way in which another is handled by the body: ways of drug elimination and inhibitor absorption rate constant. Herbal medicines and acute contraception); medical emergency admissions to hospital. British Journal of (b) distribution – competition for binding sites seldom Clinical Pharmacology 2007; 63: 247–8. Herb–drug interactions: Review and assess- (c) metabolism – many serious interactions stem from ment of report reliability. Common inhibitors include many antibacterial Clinical Microbiology and Infection 2006; 12 (Suppl. However, there are also dominant pat- Variability in drug response between individuals is due to genetic terns of inheritance that lead to much more common varia- and environmental effects on drug absorption, distribution, tions within the population. Balanced polymorphisms of drug metabolism or excretion (pharmacokinetics) and on target protein metabolizing enzymes are common. Different ethnic popula- (receptor) or downstream protein signalling (pharmacodynam- tions often have a different prevalence of the various enzyme ics). The func- ations change the coded protein because the genetic code is tion of this enzyme (e. This much-hyped ‘personalized morphine); medicine’ has one widely used clinical application currently, that • phenformin – excessive incidence of lactic acidosis (in of genotyping the enzyme thiopurine methyl-transferase (which poor metabolizers). Pharmacogenetic vari- pump inhibitors (omeprazole, lansoprazole, pantoprazole) ation was first described after the finding of a nine-fold range and some anticonvulsants, e. Isoniazid hepatitis may be 15 more common among rapid acetylators, but the data are conflicting. Approxi- 5 mately 40% of patients treated with procainamide for six months or longer develop antinuclear antibodies. Slow acety- 0 lators are more likely to develop such antibodies than rapid 0 2 4 6 8 10 12 acetylators (Figure 14. Acetylator polymorphism produces a bimodal distribution into fast and slow acetylators. British Medical Journal 1960; 2: susceptible to hydralazine-induced systemic lupus erythe- 485, by permission of the editor. Heterozygotes, as well as homozygotes, are rapid acetylators because rapid metabolism is autosomal dominant. The rapid acetylator pheno- type is most common in Eskimos and Japanese (95%) and The usual response to a single intravenous dose of suxa- rarest among some Mediterranean Jews (20%). This I I 9 has several polymorphisms leading to altered protein expres- 0 0 2 4 6 8 10 12 77 sion/activity. Effects of drug transporter polymorphisms on Time to conversion (months) drug disposition depend on the individual drug and the Figure 14. Genetic variation in serotonin transporters influences the effects of antidepressants, such 0. This explains approximately 40% of the variability in concentration corrected for variable daily dose). Warfarin resistance (requirement concentrations were measured one to two hours after oral hydralazine doses of 25–100mg in 24 slow and 11 fast for very high doses of warfarin) has been noted in a few pedi- acetylators.

Charles, 50 years: General interest and re- adolescent psychiatrists, all of whom have at least five search focusing on the cause and treatment of this condi- years of additional training beyond medical school in the tion have grown in recent years because the number of fields of general and child and adolescent psychiatry. They reported that the components of the model were not good predictors and only perceived susceptibility was related to condom use. Experts for the prosecution in a criminal bitemark case may be pressured to provide a “positive link” between the putative biter and the bitemark. These drug–protein complexes decrease the concentration of free drug in the circulation.

Chris, 38 years: If you have trouble reading or pronouncing an ingredient, chances are you should avoid that food. Two German 20 Forensic dentistry physicians, members of the faculty of Santiago University, performed a second autopsy. For instance, consider the well-known case of Phineas Gage, a 25-year-old railroad worker who, as a result of an explosion, had an iron rod driven into his cheek and out through the top of his skull, causing major damage [2] to his frontal lobe (Macmillan, 2000). He had returned from Nigeria 3 weeks earlier and was finishing off his prophylactic malaria regime.

Vibald, 22 years: On examination, she is ill and unable to give a cardiac catheterization to define his coronary anatomy and history, and has a heart rate of 160 beats per minute (regu- to identify whether he would benefit from some revascular- lar) and blood pressure of 80/60mmHg. 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. It should be possible to associate all changes to data with the person making those changes by use of timed and dated (electronic) signatures. Research has shown that antioxidant supplements can prevent worsening of this condition and further vision loss.

Jared, 24 years: This has made him feel unwell and he has complained to his wife of fatigue, anorexia and feeling thirsty. Cowling (1998) proposed that a case- nomenology and the Rogerian science of unitary oriented approach is useful in Rogerian research, human beings: because case inquiry allows the researcher to attend to the whole and strives to comprehend his or her [G]iven the congruency between Husserlian phenom- enology and the Rogerian conceptual system, a essence. That image might help you remember that childhood experiences were an important part of Freudian theory. She hypothesized that aging may be the Components result of the failure of redundant systems.

Phil, 34 years: Studies in molecular genetics have not yet identified the particular genes responsible for schizophrenia, but it is evident from research using family, twin, and adoption studies that [18] genetics are important (Walker & Tessner, 2008). Traditionally inotropes are measured in micrograms per kilogram per minute (see below), or variants (e. The tip of the tongue elevates slightly, pushing against the hard palate, sliding food onto the back of the tongue, and ultimately propelling it toward the pharynx. Nebulized antibiotics are the injection site is governed by muscle blood flow, and this also sometimes used in children with cystic fibrosis and recur- varies from site to site (deltoid vastus lateralis gluteus max- rent Pseudomonas infections.

Mojok, 28 years: More current research that has controlled for these factors has found that, although bilingual children may in some cases learn language somewhat slower than do monolingual children [23] (Oller & Pearson, 2002), bilingual and monolingual children do not significantly differ in the final depth of language learning, nor do they generally confuse the two languages (Nicoladis & [24] Genesee, 1997). Nursing practice encompasses senting self to colleagues and to patients and fami- multiple realms of responsibility, yet there is with lies as a professional with intent and direction. Te laws governing sample collection and whether an individual must be convicted of a violent crime or simply arrested before uploading the profle varies from state to state. Videbech and Ravnkilde (2004) found that the hippocampus was smaller in depressed subjects than in normal subjects, and this may be the result of reduced neurogenesis (the process of generating new neurons) in depressed people (Warner- [15] Schmidt & Duman, 2006).

Urkrass, 39 years: A subsequent amendment to this Special studies guideline (Federal Register, 4 December 1997) adds a further proviso that the highest dose in a It is not uncommon in drug development programs carcinogenicity study need not exceed 1500 mg for specific toxicities to be uncovered. There is no evidence that this occurs with the small is the anticoagulant of choice in pregnancy in preference to amount of progestogen (or oestrogen) present in the oral con- unfractionated heparin. As a visiting Further Reading consultant at the University of Natal in South Africa in Allport, G. The human becoming practice methodology Applications flows from these beliefs and delineates a way of au- This section of the chapter describes the applica- thentically living these beliefs.

Hamlar, 45 years: The electrophile takes two electrons of the six-electron p system to form a s bond to one of the carbon atoms of the benzene ring. The effectiveness of a drug can be influenced by interactions with food, herbal remedies, and other drugs that alter or modify the drug’s action. Meaning-in-context: Refers to meaningful or un- the emic and etic raw data and holistic findings. For Further Reading example, all children will develop an ability to speak Bee, Helen.

Pakwan, 49 years: Pharmacokinetics of gamma-hydroxybu- tyric acid in alcohol dependent patients after single and repeated oral doses. All noble gases are inert, because their atoms have a stable electronic configuration in which they have eight electrons in the outer shell except helium (two electrons). Ensuring That Research Is Ethical Making decisions about the ethics of research involves weighing the costs and benefits of conducting versus not conducting a given research project. Elderly More than 30% of all prescriptions and more than 50 percent of all over-the- counter medications in the United States are consumed by patients who are over 60 years of age.

Curtis, 31 years: The medulla sends an impulse down the 60 mm is appropriate for the average spinal cord to the respiratory muscles adult). Cefixime: A cephalosporin antibiotic that is resistant to the destructive beta-lactamase enzyme of many bacteria. An example of a mally, he observed that his posture was similar, heart or feeling affirmation is “My life is heroic. Management in Custody It is only necessary to wear gloves when examining the head for what- ever reason.

Cole, 62 years: Consequently, molecules of water join together transiently in a hydrogen-bonded lattice. She found the procedure very uncomfortable and developed similar symptoms of abdominal pain during the procedure. Liver function will need to be measured to monitor enzyme levels as a guide to progress. Given the discussion about the causes of negative moods and depression, what might people do to try to feel better on days that they are experiencing negative moods?

Aschnu, 55 years: Although it is used in infant formulas, there are no data supporting that use either. Touch communicates warmth, caring, and support, and is an essential part of the enjoyment we gain from our social [7] interactions with close others (Field et al. The abstract expands on the potential significance of the findings: “Previous research indicates that long-term meditation practice is associated with altered resting electroencephalogram patterns, suggestive of long lasting changes in brain activity. Types of pain experienced following cardiac surgery include: ■ bone pain (sharp/throbbing) ■ visceral pain ■ muscle pain (harvest site) ■ cardiac/angina pain ■ neurogenic pain ■ psychogenic pain (anxiety) Patterns may be: ■ continuous ■ sudden/spasm Continuous analgesia may alleviate underlying/continuous pain (including anxiety- related pain), but nurses should observe for breakthrough (usually spasm) pain.

Bradley, 27 years: Professor and the activities of self-care are learned according Georges Evers at the Catholic University of Leuven to the beliefs and practices that characterize the in Belgium has developed an extensive program of cultural way of life of the group to which the indi- research based on the theory. Nomenclature of aldehydes and ketones The common names of aldehydes are derived from the corresponding carboxylic acids by replacing -ic acid by -aldehyde; e. Ear infections, known medi- cally as Otitis Media, are a non-contagious infection of the middle ear, just behind the eardrum. In cases such as divorce and child custody, a jury trial is not allowed in most jurisdictions.

Innostian, 65 years: Journal of ment to measure mothers’ performance of self-care activities Gerontological Nursing, 17(6), 39–43. Therefore, temperature, wind conditions, method of delivery, for- mulation and potential barriers (such as clothing, masks, and eye protection), and ability to decontaminate interject variability into the response. Parenteral Medications Parenteral medication is a medication that is administered to a patient by an injection or by an intravenous flow. In retrospect it may have been prudent to have more closely monitored her ery- thropoietic therapy and once her Hb 12g/dL stopped it as this may have avoided her neurological event.

Hatlod, 64 years: In what is commonly known as the “dip and wax 62 hypnotherapy method,” the patient dips a hand or other body area. That same blood, freshly loaded with oxygen, then returns to the left side of the heart through the pulmonary veins where it enters the second circuit. Paratyphoid fever is milder than typhoid fever Complications: Intestinal perforation Lower gastrointestinal bleeding Dissenmination to different body organs including meninges and brain Mortality rate Untreated cases: 10-15% Treated cases: < 1% 2. Traditionally medicines were made freshly each day by boiling the prepared herbal ingredients (jamu godok) using a lumpang (small iron mortar), pipisan, parut (grater) and kuali (clay pot).

Cronos, 37 years: In contrast, progressive muscle relaxation resulted in an increase in heart rate during the training session. Vasoactive mediators (part of normal homeostasis) relax smooth muscle in arterioles, but venules remain constricted; the resulting pressure gradient forces plasma into interstitial spaces (oedema). Oximetry is the most widely used means of respiratory monitoring, but limitations include ■ oxygen availability to tissues and SpO2 are not identical as • relationship between SaO2 to PaO2 is complex (oxygen dissociation curve—see Chapter 18) • reduced erythrocyte counts reduces oxygen carriage but not SaO2. Bread soaked in wine is recommended as an eye compress and green leaves may be applied to inflamed eyes.

Lukjan, 35 years: Studies have also used a range of methods for their interventions including leaflets, videos, lectures and discussions. About 1 in 50 people, mostly men, lack functioning in the red- or green-sensitive cones, leaving them only able to experience either one or two colors (Figure 4. The moon illusion refers to the fact that the moon is perceived to be about 50% larger when it is near the horizon than when it is seen overhead, despite the fact that both moons are the same size and cast the same size retinal image. What skills do you need to develop to meet the needs of those entrusted to your care?

Asaru, 41 years: Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. However, it is claimed that, in almost all cases, the adverse effects have not been defi- nitely attributed to kava-kava and in most cases they were associated with liver damage from alcohol or pharmaceutical drugs. Clinical Trial Framework, Schedule 1024, Food National Statement on Ethical Conduct in and Drug Regulations. The strategies outlined in the following sections help you discard distortions and straighten out your thinking.

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• Asgeirsdottir LP, Agnarsson U, Jonsson GS: Lower extremity blood flow in healthy men: effect of smoking, cholesterol, and physical activity-a Doppler study, Angiology 52:437, 2001.
• Dromerick AX, Meschia JF, Kumar A, et al. Simultaneous bilateral thalamic hemorrhages following the administration of intravenous tissue plasminogen activator. Arch Phys Med Rehab 1997;78:92.