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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

It also includes the presentation of some aspects of heaviness or darkness and lightness discount 400 mg trental free shipping arthritis gloves imak, of density and spar sity purchase trental 400 mg otc arthritis in fingers uk, as well as of multitude and singularity 400 mg trental amex rheumatoid arthritis new treatments. The gross motoric domain of representation involves the movement of arms buy generic trental 400 mg line vitamins for arthritis in fingers, legs, head, torso, lower body, etc. The fine motoric domain of representation involves the movement of fingers, eyes, lips, tongue, etc. Blinking, glittering, shimmering, rus tling, babbling, clicking, tapping, fiddling, dripping, etc. The linguistic domain is mainly concerned with prosodic pattern ing, with the musical? elements of speech, i. The social domain involves the representation of patterns of human interaction, for example of individuals to a group or vice versa. As we?ll see later, particular strategies for structuring musical parts or voices can correspond to particular socialisation patterns. It involves evaluating a situa tion in response to different body states such as posture, muscular tension or relaxation, hormonal stimulation, adrenalin count, etc. It includes evaluation of experience whose verbal conceptualisation is often formulated in polarities like pleasing/painful, happy/sad, beautiful/ugly, love/hate, security/threat, etc. Moreover, any aspect of the emotional domain needs to be qualified by aspects from other domains. Does it make you quiver, shudder, jump, fall over, fall apart, yell, scream, groan or grumble? Is it the pain of a solitary individual or does it more closely resemble a community of suffering? The most important thing? 65 ciated with the sonic and visual/kinetic aspects respectively of the same basic type of movement, as, indeed, are rustle and glisten. Other soni cally similar words like bustle, hustle and hassle not only lend them selves to expression in visual or sonic terms: they also include aspects of social interaction and emotional evaluation. While synaes thesia is used as a clinical term denoting a neurological condition in volving the disturbance of normal perception by the involuntary intrusion of impulses from more than one sensory mode, synaesthesis is no more than a transliteration of? The only terminological trouble here is that synaesthesis and synaesthesia both give rise to the adjective synaesthetic. To avoid further confusion, then, synaesthetic will here qualify any type of perception using more than one sensory mode at the same time. For example: [W]hile cross-sensory metaphors are sometimes described as synaes thetic?, true [sic] neurological synaesthesia is involuntary and occurs in slightly more than four percent of the population (1 in 23 persons) across its range of vari ants. Interference from colour perception is an often cited symptom of synaesthesia (the disorder). Given the connotatively polysemic character of colour, it is doubtful that colours are operative in normal musogenic synaesthesis. Col our itself is not normally associable with elements of musical expression but its often contradictory individual connotations can. The most important thing? understood as a specifically human type of activity which lets us mix elements from any of the six domains of representation into an integral whole. As a meaningful system of non-verbal sound, music lets us engage in interpersonal activity on many levels simultaneously, either by making the music or by respond ing to it individually or together with others. To express ourselves on all these levels at the same time, we don?t need to confront each other with verbal outbursts, bodily display or physical interaction: we can use music instead. In other words, music provides relatively risk-free ac tion to members of the culture producing and using it because it pro vides socio-culturally regulated forms of potentially risky interaction between humans. Imagine, for example, the not uncommon state of mind characterised by a mixture of irritation or resentment and the feeling that is neverthe less a nice day and good to be alive. Using the linguistic domain, you could communicate this single dynamic state of mind directly to a friend, partner, child, parent, or to the authorities, by expressing first your disapproval, then your generally positive mood. You could start by speaking with sharp timbre and choppy delivery, then switch to a smooth, mellifluous voice. Using the fine motoric domain, you could first frown, then smile; or tap your fingers nervously then flutter your eyelids encouragingly; or grit your teeth then relax your mouth. So cially, you could first avoid the people causing the irritation and then welcome them into your company. Using the physical and gross motoric domains of representation, you?d almost have to first beat up the indi vidual[s] causing the irritation, then cuddle them. Emotionally, you?d probably want to first yell and stamp your feet, then sit down and relax; or perhaps you?d first tense your shoulders and clench your fists, then lean back, open your arms and show the palms of your hands. The most important thing? 67 ous paragraph, might well come across as contradictory and confused. It might even cause offence, perhaps even provoke a diagnosis of manic depression. However, thanks to its character of cross-domain represen tation, music is able to mediate that same sort of dynamic as a unified single experience in a socially negotiated and culturally specific sonic form. According to Swedish poet Kristina Lugn, life is the only possibility we have not to be dead (?[L]ivet ar den enda mojlighet vi har att inte vara doda?). Among other review descrip tions of the same piece are impassioned?, worried? and moving. No: they, too, were just giving pallid verbal hints of what they felt the music to be expressing. By combining input from its constituent domains of representation, music forms integral categories of cognition that, from a logocentric viewpoint, seem contradictory or confused, even though those catego ries may correspond more accurately with what we actually feel or im agine on a daily basis: angry on a good day, troubled in beautiful surroundings, sad and elated, vulnerable and euphoric, etc.

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Individuals with this disorder fall asleep quickly and have a good sleep efficiency (>90%) order 400 mg trental with mastercard arthritis in fingers photos. They may have difficulty waking up in the morning generic trental 400 mg overnight delivery arthritis ointment, sometimes appearing confused discount 400 mg trental otc arthritis and humidity, combative order trental 400 mg with amex rheumatoid arthritis knuckles, or ataxic. This prolonged impairment of alert? ness at the sleep-wake transition is often referred to as sleep inertia. During that period, the individual appears awake, but there is a decline in motor dexterity, behavior may be very inappro? priate, and memory deficits, disorientation in time and space, and feelings of grogginess may occur. The persistent need for sleep can lead to automatic behavior (usually of a very routine, low-complexity type) that the individual carries out with little or no subsequent recall. For example, individuals may find themselves having driven several miles from where they thought they were, unaware of the "automatic" driving they did in the preceding minutes. For some individuals with hypersomnolence disorder, the major sleep episode (for most individuals, nocturnal sleep) has a duration of 9 hours or more. However, the sleep is often nonrestorative and is followed by difficulty awakening in the morning. For other individ? uals with hypersomnolence disorder, the major sleep episode is of normal nocturnal sleep duration (6-9 hours). In these cases, the excessive sleepiness is characterized by several un? intentional daytime naps. These daytime naps tend to be relatively long (often lasting 1 hour or more), are experienced as nonrestorative. Individuals with hypersomnolence have daytime naps nearly everyday regard? less of the nocturnal sleep duration. Individuals typically feel sleepiness developing over a period of time, rather than experiencing a sudden sleep "attack. Associated Features Supporting Diagnosis Nonrestorative sleep, automatic behavior, difficulties awakening in the morning, and sleep inertia, although common in hypersomnolence disorder, may also be seen in a variety of conditions, including narcolepsy. Approximately 80% of individuals with hyper? somnolence report that their sleep is nonrestorative, and as many have difficulties awak? ening in the morning. Prevaience Approximately 5%-10% of individuals who consult in sleep disorders clinics with com? plaints of daytime sleepiness are diagnosed as having hypersomnolence disorder. Deveiopment and Course Hypersomnolence disorder has a persistent course, with a progressive evolution in the se? verity of symptoms. While many individuals with hypersomnolence are able to reduce their sleep time during working days, weekend and holiday sleep is greatly increased (by up to 3 hours). Awakenings are very difficult and accompanied by sleep inertia episodes in nearly 40% of cases. Hypersomnolence fully manifests in most cases in late adolescence or early adulthood, with a mean age at onset of 17-24 years. Individuals with hypersomnolence disorder are diagnosed, on average, 10-15 years after the appearance of the first symptoms. Hypersomnolence has a progressive onset, with symptoms beginning between ages 15 and 25 years, with a gradual progression over weeks to months. For most individuals, the course is then persistent and stable, unless treatment is initiated. Although hyperactivity may be one of the presenting signs of daytime sleepiness in children, voluntary napping increases with age. Hypersomnolence can be increased temporarily by psychological stress and alcohol use, but they have not been documented as environmental precipitating factors. Viral infections have been reported to have preceded or accompanied hyper? somnolence in about 10% of cases. Diagnostic iVlarlcers Nocturnal polysomnography demonstrates a normal to prolonged sleep duration, short sleep latency, and normal to increased sleep continuity. Some individuals with hypersomnolence disorder have increased amounts of slow-wave sleep. The multiple sleep latency test documents sleep tendency, typically indicated by mean sleep latency values of less than 8minutes. In hypersomnolence disorder, the mean sleep latency is typically less than 10 minutes and frequently 8minutes or less. Functional Consequences of Hypersomnoience Disorder the low level of alertness that occurs while an individual fights the need for sleep can lead to reduced efficiency, diminished concentration, and poor memory during daytime activ? ities. Hypersomnoience can lead to significant distress and dysfunction in work and social relationships. Prolonged nocturnal sleep and difficulty awakening can result in difficulty in meeting morning obligations, such as arriving at work on time. Unintentional daytime sleep episodes can be embarrassing and even dangerous, if, for instance, the individual is driving or operating machinery when the episode occurs. If social or occupational demands lead to shorter nocturnal sleep, daytime symptoms may appear. In hypersomnoience disorder, by contrast, symptoms of excessive sleepiness occur regard? less of nocturnal sleep duration. An inadequate amount of nocturnal sleep, or behaviorally induced insufficient sleep syndrome, can produce symptoms of daytime sleepiness very similar to those of hypersomnoience. An average sleep duration of fewer than 7 hours per night strongly suggests inadequate nocturnal sleep, and an average of more than 9-10 hours of sleep per 24-hour period suggests hypersomnoience. Individuals with inadequate noctur? nal sleep typically "catch up" with longer sleep durations on days when they are free from social or occupational demands or on vacations. Unlike hypersomnoience, insufficient nocturnal sleep is unlikely to persist unabated for decades. A diagnosis of hypersomno? ience disorder should not be made if there is a question regarding the adequacy of noctur? nal sleep duration. A diagnostic and therapeutic trial of sleep extension for 10-14 days can often clarify the diagnosis.

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In several cases safe 400 mg trental ginger for arthritis in dogs, experimenter fraud would have had to discount 400 mg trental amex arthritis knee orthotics involve the active collusion on the part of several teams of two or more experimenters purchase trental 400mg on-line arthritis neck facet disease. Rhine argued fo�cefully that such assumptions were scarcely sufficient cause to 400 mg trental mastercard arthritis umbrella dismiss the carefully observed experimental data. One of the more carefully controlled studies was the Pearce-Pratt series, carried out in 1933 with Dr. In these experiments, the agent and his subject were separated in different buildings over 100 yards apart. In order to eliminate the possibility of cheating, both placed their records in a sealed package handed to Rhine before the two lists were compared. The total number of guesses was 1,850 of which one would expect one-fifth, or 370, to be correct by chance. The probability these results could have occurred by chance is much less than one in a hundred million. That is not to say, however, that psi research met with general acceptance in the United States or in other countries. The work of the psi researchers was simply ignored by many universities and the major scientific publications. Price had carefully studied the data and he frankly admitted the best experiments could only be faulted by assuming deliberate fraud, or an abnormal mental condition, on the part of the scientists. Rather than accept a miracle, he suggested accepting the position of the eighteenth-century philosopher, David Hume, who said those who report miracles should be dismissed as liars. In subsequent experiments psi researchers have generally (but, inevitably, not always) eliminated such defects. Official recognition of the experimental competency of psi researchers did not come until December of 1969 when the American Academy for the Advancement of Science granted affiliate status to the researchers in the Parapsychological Association. In the "letters" column of Science for January 28, 1972, there appeared a brief note from Dr. Price titled "Apology to Rhine and Soal," in which Price expressed his conviction that his original article was highly unfair to both S. As a response to criticism psi researchers have slowly, sometimes erratically and sometimes steadily, improved the quality of their experiments while continuing to obtain data which they believe is anomalous. John Palmer argues that, while psychic researchers have not proven the existence of psi, they have established a scientific anomaly that cannot be explained away by skeptics. Some honest skeptics, meanwhile, while contining to reject the psi hypothesis, reluctantly acknowledge that some of the research deserves careful scrutiny from the mainstream scientific community. Increases or decreases in blood and lymph volume, resulting from emotional responses, are measured by this instrument. Douglas Dean conducting a plethysmograph study A telepathic agent in another room then concentrated on different names, some of which were known to be emotionally significant to the subjects. The results indicated changes in the blood volume which significantly correlated with the emotionally laden target messages. This finding was c Birmed in a second series of studies conducted by Dean and Carroll B. Most of the subjects were totally unaware of the changes in their blood supply which were responding to the target material. A similar study was conducted by Charles Tart in which subjects were hooked up to a plethysmograph, an electroencephalograph, and a device for measuring galvanic skin response. However, their physiological measurements showed abrupt changes when the shocks were administered to the agent in ano@�er room. Using equipment which monitored brain waves and eye movements, the investigators could determine accurately when subjects were having dreams. By waking the subjects at these times they were then able to obtain immediate reports of the dream contents. Earlier in the day, in another room, the telepathic senders had concentrated on target pictures designed to create a particular impression. In one such test, telepathic transmission was obtained by having about 2,000 persons attending a Grateful Dead rock concert focus on a color slide projection image and attempt to send it to the dream laboratory 45 miles away in Brooklyn. Many of these individuals were in altered states of consciousness from the music and the ingestion of psychedelic drugs. Psychologist David Foulkes at the University of Wyoming, in consultation with the Maimonides team, attempted unsuccessfully to replicate the dream studies. Hansel, a psychologist at the University of Wales in England, attributed the failure to tighter controls against fraud in the Wyoming experiments, whereas dream researcher Robert Van de Castle from the University of Virginia, one of the subjects in both the Wyoming and the Maimonides experiments, stressed the debilitating effect of the skeptical attitude of the Wyoming team. In 1985, Yale University psychologist Irvin Child published a review of the Maimonides dream studies in the American Psychologist. Child, Professor Emeritus of Psychology, Yale University the experiments have received little or no mention in the pertinent psychological literature. When these studies were reviewed, Child claims that they were so severely distorted as to given an entirely erroneous impression of how they were conducted. Child used the example of the dream research to illustrate the general point that books by psychologists purporting to offer critical reviews of psi research do not use the scientific standards of discourse prevalent in psychology. The first stage of these sessions is to instill confidence in his subjects that they could visualize clear mental images containing accurate extrasensory information. This process, according to Ryzl, continued until the subject was able to perceive clairvoyantly with accuracy and detail. Finally, Ryzl attempted to wean the subject away from his own tutelage so that he or she could function independently. While still in Czechoslovakia, Ryzl claimed to have used this technique with some 500 individuals, fifty of whom supposedly achieved success. A particularly notable series of experiments were described in 1910 by EmilIe Boirac, rector of the Dijon Academy in France, which produced what he described as an "externalization of sensitivity. The most striking experiments were those in which the subject was told to project his sensibility into a glass of water.

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If there are 10 births/year in a population size population of size 1000 discount trental 400mg line rheumatoid arthritis juvenile, what is the Consequently order trental 400 mg overnight delivery arthritis in the knee diagnosis, we have birth rate r? If there are 11 deaths/year in a population of size 1000 buy trental 400mg cheap early onset arthritis in neck, what is the Number of births per unit time = rN buy generic trental 400 mg online rheumatoid arthritis definition pdf, mortality rate m? Given the above conditions, what is the net growth rate k for such a We refer to constants such as r,m as parameters. Then:??The function that describes population over time is (by previous results), kt (r? To this end, let us consider the example of a human population and make further simplifying assumptions. Of course, this is quite inaccurate, but a good of people who are fertile (and can give place to start since it is easy to estimate some of the quantities we need. This, number women years fertile number babies per woman too, is a silly assumption, but makes it easy r = population years of life number of years to estimate mortality in the population. We often refer to the constant k as a growth rate constant and we also say that the population grows at the rate of 1. Before leaving our population model, we should remember that our projections hold only so long as some rather restrictive assumptions are made. All these factors suggest that some healthy skepticism? should be applied to any model predictions. This caveat will lead us to think about more realistic models for population growth. Certainly, the uncontrolled exponential growth would not be sustainable in the long run. Growth and doubling In Chapter 10, we used base 2 to launch our discussion of exponential growth and population doublings. We later discovered that base e is more convenient for calculus, having a more elegant derivative. How long would it take a population to double, given that it is growing exponentially with growth rate k? Then kt N(t) = 2N0 and N(t) = N e0, implies that the population has doubled when t satis? We summarize an important observation: In general, an equation of the form dy = ky dt that represents an exponential growth has a doubling time of ln(2) y? We have discovered that based on the uncontrolled growth model, the population doubles every 55 years! After 110 years, for example, there have been two doublings, or a quadrupling of the 2y0 population. Describe the model for the number of radioactive atoms and explain how this leads to a differential equation. Given the initial amount, determine the amount of radioactivity remaining at a future time. Describe the link between half-life of the radioactive material and its decay rate; given the value of one, be able to? Every so often, some radioactive atom emits a particle, and decays into an inert form. For any one atom, it is impossible to predict when this event would occur exactly, but based on the behaviour of a large number of atoms decaying spontaneously, we can assign a probability k of decay per unit time. In this section, we use the same kind of book-keeping (keeping track of the number of radioactive atoms remaining) as in the population growth example, to arrive at a differential equation that describes the process. Once we have the equation, we determine its solution and make a long-term prediction about the amount of radioactivity remaining at a future time. Deriving the model We start by letting N(t) be the number of radioactive atoms at time t. Our goal is to make simple assumptions about the process of decay that allows us to arrive at a mathematical model to predict values of N(t) at any later time t > 0. Mastered Material Check Suppose that at some time t, there are N(t) radioactive atoms. We have thus shown that a description of the population of radioactive atoms reduces to dN =? Above we formulated the entire model in terms of the number of radioac tive atoms. However, as shown below, the same equation holds regardless of the system of units used measure the amount of radioactivity Example 11. We write y(t) = N(t)/A in the form N(t) = Ay(t) and substitute this expression for N(t) in Eqn. Next, we show that an exponential function is an appropriate solution to this problem Example 11. For k > 0 a constant, this is a decreasing function of time that we refer to as exponential decay. Use the model for radioactive decay to predict how much of this material would remain over time. Note: we have used T rather than t to emphasize that units are different in the two calculations done in this example. Convert the Cesium decay time units to days and repeat the calculation of Therefore, Example 11.

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