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By: William A. Weiss, MD, PhD
- Professor, Neurology UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA
https://profiles.ucsf.edu/william.weiss
I know that must sound pretty fucking stupid discount 0.25mg dostinex with mastercard womens health weight loss, but in the film trusted 0.5 mg dostinex menopause cream, it worked (although it probably helped to buy generic dostinex 0.5mg on line menopause symptoms icd 9 be eleven years old when you saw it) purchase dostinex 0.25mg line breast cancer humor. At one point the Tingler got into a movie theater, killed the projectionist, and somehow shorted out the electricity. At that moment in the theater where you were watching the movie, all the lights went out and the screen went dark. Now as it happened, the only thing that could get the Tingler to let go of your spine once it had attached itself was a good loud scream, which changed the quality of the adrenaline it fed on. And at this point, a narrator on the soundtrack cried out, "The Tingler is now in this theater! During one imported Italian turkey, the Night Evelyn Came Out of the Grave (nifty title! During Jack the Ripper, a 1960 example of "Hammer horror" written by Jimmy Sangster, the black and white film turned to gruesome color during the last five minutes, when the Ripper, who has unwisely chosen to hide in an elevator shaft, is squished under a descending car. There is an interesting similarity between the scene in which the little girl kills her mother with a garden trowel in Night of the Living Dead and the climactic scene in the Birds, where Tippi Hedren is trapped in the attic and attacked by crows, sparrows, and gulls. Both of these scenes are classic examples of how dark and light can be used selectively. We will remember, most of us, from our own childhoods that a lot of light had the power to vanquish imagined evils and fears, but sometimes a little light only made them worse. It was the streetlight outside that made the branches of a nearby tree look like witch fingers, or it was the moonlight streaming in the window that made the jumble of toys pushed away in the closet take on the aspect of a crouching. Hedren carries which provides this strobe effect (also mentioned in connection with Looking for Mr. If there had been no such thing as darkness, the makers of horror movies would have needed to invent it. We all understand about the "gross-out," which is fairly easy to achieve,* but it is only in the horror movies that the gross-out?that most childish of emotional impulses-sometimes achieves the level of art. Even the very worst horror movies sometimes achieve a moment or two of success on this level. Dennis Etchison, a fine writer in the genre, reminisced fondly with me on the phone one day not too long ago about a brief sequence in the Giant Spider Invasion where a lady drinks her morning hi-potency vitamin cocktail, all unknowing that a rather plump spider fell into the blender just before she turned it on. In the eminently forgettable film Squirm, there is that one unforgettable moment (for all two hundred of us who saw the picture) when the lady taking a shower looks up to see why the water stopped coming and sees a showerhead clogged with dangling nightcrawlers. In Maniac, directed by former soft-core filmmaker William Lustig, there is the incredible moment when the homicidal ding-dung (Joe Spinell) carefully scalps one of his victims; *I can remember, as a kid, one of my fellow kids asking me to imagine sliding down a long, polished bannister which suddenly and without warning turns into a razorblade. As noted previously, good horror movies often operate most powerfully on this "wanna-look-at-my-chewed-up-food? Like punk rock music, the horror movie capable of delivering the good gross-out wallop finds its art in childish acts of anarchy?the moment in the Omen where the photographer is decapitated by a falling pane of glass is art of the most peculiar sort, and one cannot blame critics who find it easier to respond to Jane Fonda as a wholly unbelievable screen incarnation of Lillian Hellman in Julia than to stuff like this. But the gross-out is art, and it is important that we have an understanding of this. If, on the other hand, the audience has come to like and understand?or even just to appreciate?the characters they are watching as real people, if some artistic link has been formed there, blood can fly everywhere and the audience cannot remain unimpressed. Yet people walk out of other Peckinpah films?Bring Me the Head of Alfredo Garcia, Cross of Iron? yawning. We identify with the woman who is unknowingly drinking the spider on a level that has nothing to do with her character; we identify with her solely as a human being in a situation which has suddenly turned rotten-in other words, the gross-out serves as the means of a last-ditch sort of identification when the more conventional and noble means of characterization have failed. The Man with the X-Ray Eyes marks the point where this strange two-step creature came out of its cocoon, I think. The screenplay was written by Ray Russell, the author of Sardonicus and a number of other novelsamong them the rather overripe Incubus and the much more successful Princess Pamela. In the Man with the X-Ray Eyes, Ray Milland plays a scientist who develops eyedrops which enable him to see through walls, clothing, playing-cards, you name it; a kind of super-Murine, if you will. Our eyes are one of those vulnerable chinks in the armor, one of those places where we can be had. But surely you remember that *This might lead to the accusation that my definition of the horror movie as art is much too wide?that I just let in everything. That is not true at all?movies like Massacre at Central High and Bloody Mutilators work on no level. Like our other facial equipment, eyes are something we all have in common?even that old poop the Ayatullah Khomeini has a pair. But to the best of my knowledge, no horror movie has ever been made about a nose out of control, and while there has never been a film called the Crawling Ear, there was one called the Crawling Eye. We all understand that eyes are the most vulnerable of our sensory organs, the most vulnerable of our facial accessories, and they are (ick! So when Milland dons shades for the second half of the movie, we become increasingly nervous about what might be going on behind those shades. It becomes a kind of Lovecraftian horror movie, but in a sense that is different?and somehow purer?than the sort of Lovecraftiness used in Alien. The Elder Gods, Lovecraft told us, are out there, and their one desire is to somehow get back in?and there are lines of power accessible to them, Lovecraft intimates, which are so powerful that one look at the sources of these lines of power would drive mortal men to madness; forces so powerful that a whole galaxy aflame could not equal its thousandth part. It is one of these power sources, I think, that Ray Milland begins to glimpse as his sight continues to improve at a steady, inexorable pace. Milland has seen through everything to the very edges of the universe and beyond, and what he has found there is driving him crazy. He drives his car to a deserted spot (that bright Presence hanging before his eyes all the time) and whips off his shades to reveal eyes which have gone an utter, glistening black. But I have heard rumors?they may or may not be true-that the final line of dialogue was cut from the film as too horrifying.
Cross-language speech perception: Evidence for perceptual reorganization during the first year of life generic 0.25mg dostinex free shipping women's health center west bloomfield. The goal of this chapter is to discount dostinex 0.25 mg without prescription women's health issues list investigate the fundamental buy dostinex 0.25 mg on-line breast cancer youth socks, complex generic 0.5mg dostinex fast delivery womens health clinic, and essential processes of human development. Development refers to the physiological, behavioral, cognitive, and social emotional changes that occur throughout human life, which are guided by both genetic predispositions (nature) and environmental influences (nurture). We will begin our study of development at the moment of conception, when the sperm unites with the egg, and then consider prenatal development in the womb. Each of the age periods of development has its unique physical, cognitive, and emotional changes that define that period of life. For example, children around the world reach major language stages in a similar order (Parish Morris, Golinkoff, & Hirsh-Pasek, 2013). We begin to be influenced by our environments, even while still in the womb, and these influences remain with us throughout our development. The Germinal Stage: Within several hours, the 23 chromosomes from the egg and the 23 Figure 7. This is the beginning of the germinal stage, which lasts from conception to implantation in the uterine wall, approximately 10-14 days. The earliest differentiation is between cells on the inside of the zygote and the cells on the outside. The cells on the outside will form the protective environment that will provide support for the new life throughout the pregnancy. While the inner layer of embryonic cells is busy forming the embryo itself, the outer layer is forming the surrounding protective environment that will help the embryo survive the pregnancy. This environment Photo by Lunar Caustic consists of three major structures: the amniotic sac is the fluid-filled reservoir in which the embryo (soon to be known as a fetus) will live until birth, and which acts as both a cushion against outside pressure and as a temperature regulator. The placenta is an organ that allows the exchange of nutrients between the embryo and the mother, while at the same time filtering out harmful material. Finally, the umbilical cord links the embryo directly to the placenta and transfers all material to the fetus. All the major aspects of the growing organism have been formed in the embryonic phase, and now the fetus has approximately seven months to go from weighing less than an ounce to weighing an average of 6 to 8 pounds. By the third month, the fetus is able to curl and open its fingers, form fists, and wiggle its toes (Berk & Myers, 2016). The fetus begins to develop its senses, becoming able to distinguish tastes and respond to sounds. If all goes well, a baby is born sometime around the 38 Source th 40 week of pregnancy. About 45% of pregnancies result in a miscarriage, often without the mother ever being aware a pregnancy had occurred (Moore & Persaud, 1993). Although the amniotic sac and the placenta are designed to protect the embryo, teratogens, substances that can harm the fetus, may cause problems. Teratogens include general environmental factors, such as air pollution and radiation, but also the cigarettes, alcohol, and drugs that the mother may use. Cigarette smoking, for example, reduces the blood oxygen for both the mother and fetus and is correlated with the infant being born underweight. There is no known safe level of alcohol consumption during pregnancy, and consequently the U. Fathers? alcohol use has also been correlated with teratogenic defects (Champagne, 2010). Additionally, maternal drug abuse is of major concern, and is considered one of the greatest risk factors facing unborn children (March of Dimes, 2015). They are more likely to do so when they occur in larger amounts, for longer time periods, and during the more sensitive phases, as when the fetus is growing most rapidly (Berger, 2005). The most vulnerable period for many of the fetal organs is very early in the pregnancy during the embryonic stage, often before the mother even knows she is pregnant. The ultrasound is a test in which sound waves are used to examine the fetus, and it is one of the main screening tests. Ultrasounds are used to check the fetus for defects or problems including neural tube defects, chromosomal abnormalities (such as Down syndrome), genetic diseases, and other potentially dangerous conditions. It can also find out the age of the fetus, location of the placenta, fetal position, movement, breathing and heart rate, amount of amniotic fluid in the uterus, and number of fetuses. Most women have at least one ultra sound during pregnancy, but if problems are noted, additional ultrasounds may be recommended. Early diagnosis Thinkstock of prenatal problems can allow medical treatment to improve the health of the fetus. Development refers to the physical, cognitive, and social-emotional changes that occur throughout life, which are influenced by both nature and nurture. What behaviors must a woman avoid engaging in when she decides to try to become pregnant, or when she finds out she is pregnant? Watch the following video and consider whether a textbook or a video presentation is better able to explain prenatal development. This program includes 5 one-hour videos covering the lifespan from infancy through old age. Define puberty and distinguish between primary and secondary sexual characteristics.
Multi-institutional registry for prostate cancer radiosurgery: a prospective observational clinical trial trusted 0.5 mg dostinex women's health center of lansdale. Androgen suppression and radiation vs radiation alone for prostate cancer: a randomized trial proven dostinex 0.5mg menstruation running. Duration of androgen suppression before radiotherapy for localized prostate cancer: radiation therapy oncology group randomized clinical trial 9910 order 0.25 mg dostinex mastercard menstruation young age. Long-term followup of a randomized study of locally advanced prostate cancer treated with combined orchiectomy and external radiotherapy versus radiotherapy alone generic 0.5mg dostinex with amex women's health week 2013. Combined androgen deprivation therapy and radiation therapy for locally advanced prostate cancer: a randomised, phase 3 trial. 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Predicting the risk of lymph node involvement using the pre-treatment prostate specific antigen and Gleason score in men with clinically localized prostate cancer. Androgen suppression plus radiation versus radiation alone for patients with stage D1/pathologic node-positive adenocarcinoma of the prostate: updated results based on national prospective randomized trial Radiation Therapy Oncology Group 85-31. Dose-volume comparison of proton therapy and intensity-modulated radiotherapy for prostate cancer. Patient-reported outcomes after 3-dimensional conformal, intensity-modulated, or proton beam radiotherapy for localized prostate cancer. Intensity-modulated radiation therapy, proton therapy, or conformal radiation therapy and morbidity and disease control in localized prostate cancer. Proton versus intensity-modulated radiotherapy for prostate cancer: patterns of care and early toxicity. American Brachytherapy Society consensus guidelines for transrectal ultrasound guided permanent prostate brachytherapy. Comparative analysis of prostate-specific antigen free survival outcomes for patients with low, intermediate and high risk prostate cancer treatment by radical therapy. Monotherapy for stage T1-T2 prostate cancer: radical prostatectomy, external beam radiotherapy, or permanent seed implantation. Fifteen-year biochemical relapse-free survival, cause-specific survival, and overall survival following I(125) prostate brachytherapy in clinically localized prostate cancer: Seattle experience. Intermediate term biochemical-free progression and local control following 125iodine brachytherapy for prostate cancer. Multi-institutional analysis of long-term outcome for stages T1-T2 prostate cancer treated with permanent seed implantation. Role of hormonal therapy in the management of intermediate to high-risk prostate cancer treated with permanent radioactive seed implantation. Long-term outcome after elective irradiation of the pelvic lymphatics and local dose escalation using high-dose-rate brachytherapy for locally advanced prostate cancer. Randomised trial of external beam radiotherapy alone or combined with high dose-rate brachytherapy boost for localised prostate cancer. Comparison of three radiotherapy modalities on biochemical control and overall survival for the treatment of prostate cancer: a systematic review. High-dose-rate interstitial brachytherapy as monotherapy for clinically localized prostate cancer: treatment evolution and mature results. Second malignancies after radiotherapy for prostate cancer: systematic review and meta-analysis. External-beam radiation therapy for clinically localized prostate cancer: patterns of care studies in the United States. Adjuvant radiotherapy for pathological T3N0M0 prostate cancer significantly reduces risk of metastases and improves survival: long-term followup of a randomized clinical trial. Predicting the outcome of salvage radiation therapy for recurrent prostate cancer after radical prostatectomy. Current status of minimally invasive treatment options for localized prostate carcinoma. Ablative therapy for people with localised prostate cancer: a systematic review and economic evaluation. High-intensity focused ultrasound for prostate cancer: comparative definitions of biochemical failure. Pathologic stage T2a and T2b prostate cancer in the recent prostate-specific antigen era: implications for unilateral ablative therapy. Will focal therapy become a standard of care for men with localized prostate cancer? Focal therapy for localized prostate cancer: a critical appraisal of rationale and modalities. Targeted focal therapy: a minimally invasive ablation technique for early prostate cancer. New and Established Technology in Focal Ablation of the Prostate: A Systematic Review. A core outcome set for localised prostate cancer effectiveness trials: protocol for a systematic review of the literature and stakeholder involvement through interviews and a Delphi survey.
The combination of treatment [58] or do not enter treatment even when it is avail ribavirin and didanosine is strictly contraindicated [55] dostinex 0.5mg discount women's health lose 10 pounds in a month. Active drug or alcohol use is not a treat dovudine can potentiate ribavirin-related anemia cheap dostinex 0.5 mg with mastercard pregnancy x ray lead apron, and order dostinex 0.5mg fast delivery breast cancer in lymph nodes, if other ment contraindication [60] purchase 0.25mg dostinex amex menopause 24 years old. Adapted from [67], with permission toms, and skin rash; more patients taking telaprevir stopped from the American Medical Association. Viral breakthrough consis tent with resistance to telaprevir was observed in a minority of which represents unconjugated or indirect hyperbilirubinemia. Risk factors for grade 4 elevations in liver-enzyme lev liver injury related to viral hepatitis [92?95]. Kaplan-Meier survival curves for the probability of developing cirrhosis in 4 study groups. Liver disease?related mortality rates propriately manage hepatitis B in coinfected patients treated with were 0. Predicting cirrhosis risk based on the level of circulating hepatitis B viral load. A randomized controlled trial and hematologic adverse effects of the treatment regimen. J Infect Dis 1999; concerns about acute or chronic, medication-related hepatic 180:607?13. Long-term incidence of hepatitis B virus resistance to lamivudine in human immunode? Clinical emergence of entecavir resistant hepatitis B virus requires additional substitutions in virus already resistant to lamivudine. N Engl and abstracts of the 13th Conferences on Retroviruses and Oppor J Med 2003;348:808?16. Hepatology bavirin for the treatment of chronic hepatitis C in blacks and non 2006;44:1110?6. Gut 2006;55: ferent clinical outcomes depending on the resistance substitutions 409?14. Dynamic hepatitis C virus and risk factors for severe hepatotoxicity associated with antiretroviral genotypic and phenotypic changes in patients treated with the pro combination therapy. Available at: http: in individuals coinfected with hepatitis C virus and human immu //clinicaltrials. Hepatotoxicity devel trial of investigational drug telaprevir in patients with genotype 1 opment during antiretroviral therapy containing protease inhibitors hepatitis C. Antiretroviral drug toxic A comprehensive hepatic safety analysis of nevirapine in different ity?a challenge for the hepatologist? Antimicrob Agents Che hibitors tipranavir plus ritonavir in treatment-experienced patients: mother 2002;46:716?23. Despite its vital role in maintaining overall health, the liver is routinely ignored by the majority of Canadians. Unfortunately dismissing the liver has dangerous consequences to quality of life and life expectancy but few understand just how high the stakes are. Over a period of only eight years, the death rate from liver disease has risen nearly 30%. Those directly involved in the care of liver disease patients have seen this tragedy play out again and again in hospitals across the country. And yet there is no sense of urgency to collect or evaluate data to measure the true scope of the disease burden nor is there a sense of urgency to deal with it. Alcohol abuse does cause liver disease however a lack of data and a persistent assumption and stigma linking liver disease with only alcohol have made it difficult to overcome both public and government apathy. It is estimated that one in 10 Canadians, or more than three million people, has some form of liver disease. The most common forms of liver disease viral hepatitis, fatty liver disease and liver cancer are all on the rise which means that the increase in death rates from these diseases and their complications will continue to climb if there is no effective intervention. The key findings from this report highlight the gaps in care, missed opportunities for prevention and the human impact of liver disease. Although the precise prevalence is not known, it is likely that more than 500,000 people are chronically infected with the hepatitis B or hepatitis C virus. Those who are infected with hepatitis B or hepatitis C are at risk for the development of cirrhosis, liver failure, and liver cancer. Surveillance: the prevalence of chronic hepatitis B and C and the mortality from these diseases is unknown. However, most disease transmission is from individuals who are chronically infected, and mortality is mostly related to chronic viral hepatitis. Modeling studies have suggested that mortality from hepatitis B and C is increasing, contributing to the general increase in deaths related to liver disease. Unlike some other jurisdictions, there are no official government recommendations regarding screening of other populations for either hepatitis B or hepatitis C. Some provincial governments have support programs for hepatitis B and C, but these are not comprehensive. Less than 10% of hepatitis B patients and less than 25% of hepatitis C patients have been effectively treated. These restrictions are not scientifically based, nor do they conform to clinical practice, but appear to be solely cost based. Hepatitis awareness: Patients and communities where these diseases are prevalent are not aware of the seriousness of these infections and their consequences. Part of this stems from lack of education in the immigrant communities, and part from cultural stigma and cultural concepts of medicine in these communities.
The synapses provide a remarkable function because they allow each axon to order 0.5 mg dostinex with amex women's health clinic rockingham wa communicate with many dendrites in neighboring cells discount dostinex 0.25mg with amex menstruation judaism. Because a neuron may have synaptic connections with thousands of other neurons dostinex 0.5mg for sale pregnancy mode, the communication links among the neurons in the nervous system allow for a highly sophisticated communication system cheap 0.25 mg dostinex with amex promensil menopause 90. A neurotransmitter is a chemical that relays signals across the synapses between neurons. The dendrites will admit the neurotransmitters only if they are the right shape to fit in the receptor sites on the receiving neuron. For this reason, the receptor sites and neurotransmitters are often compared to a lock and key (Figure 3. When neurotransmitters are accepted by the receptors on the receiving neurons their effect may be either excitatory. If the excitatory effects of the neurotransmitters are greater than the inhibitory influences of the neurotransmitters, the neuron moves closer to its firing threshold, and if it reaches the threshold, the action potential and the process of transferring information through the neuron begins. This process occurs in part through the breaking down of the neurotransmitters by enzymes, and in part through reuptake, a process in which neurotransmitters that are in the synapse are reabsorbed into the transmitting terminal buttons, ready to again be released after the neuron fires. Neurotransmitters regulate our appetite, our memory, our emotions, as well as our muscle action and movement. Drugs that we might ingest?either for medical reasons or recreationally?can act like neurotransmitters to influence our thoughts, feelings, and behavior. Anagonist is a drug that has chemical properties similar to a particular neurotransmitter and thus mimics the effects of the neurotransmitter. Because dopamine produces feelings of pleasure when it is released by neurons, cocaine creates similar feelings when it is ingested. An antagonist is a drug that reduces or stops the normal effects of a neurotransmitter. When an antagonist is ingested, it binds to the receptor sites in the dendrite, thereby blocking the neurotransmitter. When the poison enters the brain, it binds to the dendrites, stops communication among the neurons, and usually causes death. They are related to the compounds found in drugs such as opium, morphine, Released in response to behaviors such and heroin. Serotonin Involved in many functions, including mood, appetite, sleep, and aggression. Describe the structures and function of the old brain? and its influence on behavior. Explain the structure of the cerebral cortex (its hemispheres and lobes) and the function of each area of the cortex. In each animal the brain is layered, and the basic structures of the brain are similar (see Figure 3. The innermost structures of the brain?the parts nearest the spinal cord?are the oldest part of the brain, and these areas carry out the same the functions they did for our distant ancestors. The old brain? regulates basic survival functions, such as breathing, moving, resting, and feeding, and creates our experiences of emotion. Mammals, including humans, have developed further brain layers that provide more advanced functions? for instance, better memory, more sophisticated social interactions, and the ability to experience emotions. Humans have a very large and highly developed outer layer known as the cerebral cortex (see Figure 3. Medical, science, and nature things: Photography and digital imagery by Scott Camazine. The cortex provides humans with excellent memory, outstanding cognitive skills, and the ability to experience complex emotions. The Old Brain: Wired for Survival the brain stem is the oldest and innermost region of the brain. The brain stem begins where the spinal cord enters the skull and forms the medulla, the area of the brain stem that controls heart rate and breathing. In many cases the medulla alone is sufficient to maintain life?animals that have the remainder of their brains above the medulla severed are still able to eat, breathe, and even move. The spherical shape above the medulla is the pons, a structure in the brain stem that helps control the movements of the body, playing a particularly important role in balance and walking. The job of the reticular formation is to filter out some of the stimuli that are coming into the brain from the spinal cord and to relay the remainder of the signals to other areas of the brain. The reticular formation also plays important roles in walking, eating, sexual activity, and sleeping. Above the brain stem are other parts of the old brain that also are involved in the processing of behavior and emotions (see Figure 3. The thalamus is the egg-shaped structure above the brain stem that applies still more filtering to the sensory information that is coming up from the spinal cord and through the reticular formation, and it relays some of these [1] remaining signals to the higher brain levels (Guillery & Sherman, 2002). The thalamus is also important in sleep because it shuts off incoming signals from the senses, allowing us to rest. The cerebellum (literally, little brain) consists of two wrinkled ovals behind the brain stem. People who have damage to the cerebellum have difficulty walking, keeping their balance, and holding their hands steady. Also, the cerebellum contributes to emotional responses, helps us discriminate between different sounds and textures, and is [2] important in learning (Bower & Parsons, 2003). The limbic system is a brain area, located between the brain stem and the two cerebral hemispheres, that governs emotion and memory. The amygdala consists of two almond-shaped? clusters (amygdala comes from the Latin word for almond) and is primarily responsible for regulating our perceptions of, and reactions to, aggression and fear.
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