Rebecca M. T. Law, BS Pharm, PharmD

• Associate Professor, School of Pharmacy
• Faculty of Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada

It transmits the vestibulocochlear nerve and the motor and sensory roots of the facial nerve treatment dynamics discount 3ml lumigan otc. The internal occipital crest runs upward in the midline posteriorly from the foramen magnum to the internal occipital protuberance; to it is attached the small falx cerebelli over the occipital sinus medications parkinsons disease purchase lumigan 3 ml free shipping. On each side of the internal occipital protuberance is a wide groove for the transverse sinus medicine balls for sale 3ml lumigan for sale. This groove sweeps around on either side medicine norco lumigan 3ml with amex, on the internal surface of the occipital bone symptoms 8 days post 5 day transfer lumigan 3 ml with amex, to reach the posteroinferior angle or corner of the parietal bone medications may be administered in which of the following ways buy generic lumigan 3ml. The groove now passes onto the mastoid part of the temporal bone; at this point, the transverse sinus becomes the sigmoid sinus. The superior petrosal sinus runs backward along the upper border of the petrous bone in a narrow groove and drains into the sigmoid sinus. As the sigmoid sinus descends to the jugular foramen, it deeply grooves the back of the petrous bone and the mastoid part of the temporal bone. Table 5-1 provides a summary of the more important openings in the base of the skull and the structures that pass through them. Mandible the mandible, or lower jaw, is the largest and strongest bone of the face, and it articulates with the skull at the temporamandibular joint. The body of the mandible meets the ramus on each side at the angle of the mandible. Introduction to the Brainstem the brainstem is made up of the medulla oblongata, the pons, and the midbrain and occupies the posterior cranial fossa of the skull. The brainstem has three broad functions: (1) it serves as a conduit for the ascending tracts and descending tracts connecting the spinal cord to the different parts of the higher centers in the forebrain; (2) it contains important reflex centers associated with the control of respiration and Table 5-1 Summary of the More Important Openings in the Base of the Skull and the Structures That Pass Through Them Bone of Skull Structures Transmitted Opening in Skull Anterior Cranial Fossa Perforations in cribriform plate Middle Cranial Fossa Ethmoid Olfactory nerves Optic canal Superior orbital fissure Lesser wing of sphenoid Between lesser and greater wings of sphenoid Greater wing of sphenoid Greater wing of sphenoid Greater wing of sphenoid Between petrous part of temporal and sphenoid Foramen rotundum Foramen ovale Foramen spinosum Foramen lacerum Optic nerve, opthalmic artery Lacrimal, frontal, trochlear oculomotor, nasociliary, and abducent nerves; superior ophthalmic vein Maxillary division of the trigeminal nerve Mandibular division of the trigeminal nerve, lesser petrosal nerve Middle meningeal artery Internal carotid artery Posterior Cranial Fossa Foramen magnum Occipital Hypoglossal canal Jugular foramen Occipital Between petrous part of temporal and condylar part of occipital Petrous part of temporal Internal acoustic meatus Medulla oblongata, spinal part of accessory nerve, and right and left vertebral arteries Hypoglossal nerve Glossopharyngeal, vagus, and accessory nerves; sigmoid sinus becomes internal jugular vein Vestibulocochlear and facial nerves Gross Appearance of the Medulla Oblongata 197 Tentorium cerebelli Midbrain Inferior colliculus Trochlear nerve Superior colliculus Trigeminal nerve Facial and vestibulocochlear nerves Transverse sinus Fourth ventricle Medulla oblongata Gracile tubercle Margin of foramen magnum Transverse process of atlas Glossopharyngeal, vagus, and accessory nerves Spinal part of accessory nerve Vertebral artery Second cervical spinal nerve Transverse process of axis Spinal cord Ligamentum denticulatum Vertebral artery Figure 5-8 Posterior view of the brainstem after removal of the occipital and parietal bones and the cerebrum, the cerebellum, and the roof of the fourth ventricle. Gross Appearance of the Medulla Oblongata the medulla oblongata connects the pons superiorly with the spinal cord inferiorly. The junction of the medulla and spinal cord is at the origin of the anterior and posterior roots of the first cervical spinal nerve, which corresponds approximately to the level of the foramen magnum. The medulla oblongata is conical in shape, its broad extremity being directed superiorly. The central canal of the spinal cord continues upward into the lower half of the medulla; in the upper half of the medulla, it expands as the cavity of the fourth ventricle. On the anterior surface of the medulla is the anterior median fissure,which is continuous inferiorly with the anterior median fissure of the spinal cord. The pyramids are composed of bundles of nerve fibers, called corticospinal fibers, which originate in large nerve cells in the precentral gyrus of the cerebral cortex. The pyramids taper inferiorly, and it is here that the majority of the descending fibers cross over to the opposite side, forming the decussation of the pyramids. Posterolateral to the pyramids are the olives, which are oval elevations produced by the underlying inferior olivary nuclei. In the groove between the pyramid and the olive emerge the rootlets of the hypoglossal nerve. In the groove between the olive and the inferior cerebellar peduncle emerge the roots of the glossopharyngeal and vagus nerves and the cranial roots of the accessory nerve. The posterior surface of the superior half of the medulla oblongata forms the lower part of the floor of the fourth ventricle. The posterior surface of the inferior half of the medulla is continuous with the posterior aspect of the spinal cord and possesses a posterior median sulcus. On each side of the median sulcus, there is an elongated swelling, the gracile tubercle, produced by the underlying gracile nucleus. Lateral to the gracile tubercle is a similar swelling, the cuneate tubercle, produced by the underlying cuneate nucleus. Internal Structure As in the spinal cord,the medulla oblongata consists of white matter and gray matter, but a study of transverse sections of this region shows that they have been extensively rearranged. This rearrangement can be explained embryologically by the Internal Structure 199 expansion of the neural tube to form the hindbrain vesicle, which becomes the fourth ventricle. The extensive lateral spread of the fourth ventricle results in an alteration in the position of the derivatives of the alar and basal plates of the embryo. To assist in understanding this concept, remember that in the spinal cord, the derivatives of the alar and basal plates are situated posterior and anterior to the sulcus limitans, respectively, and in the case of the medulla oblongata,they are situated lateral and medial to the sulcus limitans, respectively. The internal structure of the medulla oblongata is considered at four levels: (1) level of decussation of pyramids, (2) level of decussation of lemnisci, (3) level of the olives, and (4) level just inferior to the pons. See Table 5-2 for a comparison of the different levels of the medulla oblongata and the major structures present at each level. Level of Decussation of Pyramids A transverse section through the inferior half of the medulla oblongata. The neural crest cells will form the first afferent sensory neurons in the posterior root ganglia of the spinal nerves and the sensory ganglia of the cranial nerves. As these fibers cross the midline, they sever the continuity between the anterior column of the gray matter of the spinal cord and the gray matter that surrounds the central canal. The fasciculus gracilis and the fasciculus cuneatus continue to ascend superiorly posterior to the central gray matter. The nucleus gracilis and the nucleus cuneatus appear as posterior extensions of the central gray matter. The substantia gelatinosa in the posterior gray column of the spinal cord becomes continuous with the inferior end of the nucleus of the spinal tract of the trigeminal nerve. The fibers of the tract of the nucleus are situated between the nucleus and the surface of the medulla oblongata. The lateral and anterior white columns of the spinal cord are easily identified in these sections, and their fiber arrangement is unchanged. Level of Decussation of Lemnisci A transverse section through the inferior half of the medulla oblongata,a short distance above the level of the decussation of the pyramids, passes through the decussation of lemnisci, the great sensory decussation. The decussation of the lemnisci takes place anterior to the central gray matter and posterior to the pyramids. It should be understood that the lemnisci have been formed from the internal arcuate fibers, which have emerged from the anterior aspects of the nucleus gracilis and nucleus cuneatus. The internal arcuate fibers first travel anteriorly and laterally around the central gray matter. They then curve medially toward the midline, where they decussate with the corresponding fibers of the opposite side. The nucleus of the spinal tract of the trigeminal nerve lies lateral to the internal arcuate fibers. The lateral and anterior spinothalamic tracts and the spinotectal tracts occupy an area lateral to the decussation of the lemnisci. They are very close to one another and collectively are known as the spinal lemniscus. The spinocerebellar, vestibulospinal, and the rubrospinal tracts are situated in the anterolateral region of the medulla oblongata. Level of the Olives A transverse section through the olives passes across the inferior part of the fourth ventricle. Internal Structure 201 Posterior median sulcus Fasciculus gracilis Nucleus gracilis Fasciculus cuneatus Nucleus cuneatus Spinal tract of trigeminal nerve Spinal nucleus of trigeminal nerve Spinal root of accessory nerve Medial longitudinal fasciculus B A Lateral corticospinal tract Posterior spinocerebellar tract Lateral spinothalamic tract Anterior spinocerebellar tract Central canal Pyramid Medial accessory olivary nucleus Decussation of pyramids Anterior median fissure A Fasciculus gracilis Central canal Nucleus gracilis Fasciculus cuneatus Nucleus cuneatus Internal arcuate fibers Spinal tract of trigeminal nerve Spinal nucleus of trigeminal nerve Spinal root of accessory nerve Inferior olivary nucleus Lateral spinothalamic tract Hypoglossal nucleus Medial longitudinal fasciculus Posterior spinocerebellar tract Anterior spinocerebellar tract Hypoglossal nerve B Decussation of medial lemnisci Pyramid Figure 5-11 Transverse sections of the medulla oblongata. Olivary Nuclear Complex the largest nucleus of this complex is the inferior olivary nucleus. The gray matter is shaped like a crumpled bag with its mouth directed medially; it is responsible for the elevation on the surface of the medulla called the olive. The cells of the inferior olivary nucleus send fibers medially across the midline to enter the cerebellum through the inferior cerebellar peduncle. Afferent fibers reach the inferior olivary nuclei from the spinal cord (the spino-olivary tracts) and from the cerebellum and cerebral cortex. The anterior cochlear nucleus is situated on the anterolateral aspect of the inferior cerebellar peduncle,and the posterior cochlear nucleus is situated on the posterior aspect of the peduncle lateral to the floor of the fourth ventricle. The Nucleus Ambiguus the nucleus ambiguus consists of large motor neurons and is situated deep within the reticular formation. The emerging nerve fibers join the glossopharyngeal, vagus, and cranial part of the accessory nerve and are distributed to voluntary skeletal muscle. Central Gray Matter the central gray matter lies beneath the floor of the fourth ventricle at this level. The nucleus ambiguus, referred to above, has become deeply placed within the reticular formation. The connections and functional significance of these nuclei are described in Chapter 11. Vestibulocochlear Nuclei the vestibular nuclear complex is made up of the following nuclei: (1) medial vestibular nucleus, (2) inferior vestibular nucleus, (3) lateral vestibular nucleus, and (4) superior vestibular nucleus. The medial Internal Structure 205 Mesencephalic nucleus of trigeminal nerve Oculomotor nucleus Trochlear nucleus Mandibular division Ophthalmic division Maxillary division Trigeminal motor nucleus Abducent motor nucleus Facial nucleus Superior salivatory nucleus Inferior salivatory nucleus Nucleus ambiguus of glossopharyngeal, vagus, and accessory nerves Dorsal nucleus of vagus Nucleus of tractus solitarius Hypoglossal nucleus Trigeminal ganglion Sensory root of trigeminal nerve Main sensory nucleus of trigeminal nerve Dorsal cochlear nucleus Spinal nucleus of trigeminal nerve Substantia gelatinosa Anterior gray horn of spinal cord Figure 5-16 Position of the cranial nerve nuclei within the brainstem. They receive nerve fibers from the cerebral cortex and send efferent fibers to the cerebellum through the anterior external arcuate fibers. The pyramids containing the corticospinal and some corticonuclear fibers are situated in the anterior part of the medulla separated by the anterior median fissure. The medial lemniscus forms a flattened tract on each side of the midline posterior to the pyramid. These fibers emerge from the decussation of the lemnisci and convey sensory information to the thalamus. The medial longitudinal fasciculus forms a small tract of nerve fibers situated on each side of the midline posterior to the medial lemniscus and anterior to the hypoglossal nucleus. It consists of ascending and descending fibers, the connections of which are described on page 208. The inferior cerebellar peduncle is situated in the posterolateral corner of the section on the lateral side of the fourth ventricle. The spinal tract of the trigeminal nerve and its nucleus are situated on the anteromedial aspect of the inferior cerebellar peduncle. The anterior spinocerebellar tract is situated near the surface in the interval between the inferior olivary nucleus and the nucleus of the spinal tract of the trigeminal nerve. The spinal lemniscus, consisting of the anterior spinothalamic, the lateral spinothalamic, and spinotectal tracts, is deeply placed. The reticular formation, consisting of a diffuse mixture of nerve fibers and small groups of nerve cells, is deeply placed posterior to the olivary nucleus. The reticular formation represents, at this level, only a small part of this system,which is also present in the pons and midbrain. The glossopharyngeal, vagus, and cranial part of the accessory nerves can be seen running forward and laterally through the reticular formation. The hypoglossal nerves also run anteriorly and laterally through the reticular formation and emerge between the pyramids and the olives. The lateral vestibular nucleus has replaced the inferior vestibular nucleus, and the cochlear nuclei now are visible on the anterior and posterior surfaces of the inferior cerebellar peduncle. The anterior surface is convex from side to side and shows many transverse fibers that converge on each side to form the middle cerebellar peduncle. There is a shallow groove in the midline, the basilar groove, which lodges the basilar artery. On the anterolateral surface of the pons, the trigeminal nerve emerges on each side. Each nerve consists of a smaller,medial part,known as the motor root, and a larger, lateral part, known as the sensory root. In the groove between the pons and the medulla oblongata, there emerge, from medial to lateral, the abducent, facial, and vestibulocochlear nerves. It forms the upper half of the floor of the fourth ventricle and is triangular in shape. The posterior surface is limited laterally by the superior cerebellar peduncles and is divided into symmetrical halves by a median sulcus. Lateral to this sulcus is an elongated elevation, the medial eminence, which is bounded laterally by a sulcus, the sulcus limitans. The inferior end of the medial eminence is slightly expanded to form the facial colliculus, which is produced by the root of the facial nerve winding around the nucleus of the abducent nerve. The floor of the superior part of the sulcus limitans is bluish-gray in color and is called the substantia ferruginea; it owes its color to a group of deeply pigmented nerve cells. Lateral to the sulcus limitans is the area vestibuli produced by the underlying vestibular nuclei. Groove for basilar artery Cerebral peduncle of midbrain Superficial transverse pontine fibers Motor root of trigeminal nerve Sensory root of trigeminal nerve Abducent nerve Roots of facial nerve Pons Vestibulocochlear nerve Middle cerebellar peduncle Glossopharyngeal nerve Cerebellum Roots of vagus nerve Olive Accessory nerve Pyramid Hypoglossal nerve Medulla oblongata Figure 5-17 Anterior surface of the brainstem showing the pons. Gross Appearance of the Pons 207 Substantia ferruginea Midbrain Trochlear nerve Median sulcus Superior cerebellar peduncle Medial eminence Sulcus limitans Vestibular area Facial colliculus Middle cerebellar peduncle Pons Striae medullares Inferior cerebellar peduncle Medulla oblongata Figure 5-18 Posterior surface of the brainstem showing the pons. Cavity of fourth ventricle Medial longitudinal fasciculus Facial colliculus Vestibular nuclei Inferior cerebellar peduncle Reticular formation Middle cerebellar peduncle Spinal tract and nucleus of trigeminal nerve Superior medullary velum Superior cerebellar peduncle Nucleus of abducent nerve Motor nucleus of facial nerve Medial lemniscus Transverse pontine fibers Facial nerve Abducent nerve Trapezoid body Groove for basilar artery Bundles of corticospinal and corticonuclear fibers Pontine nuclei Figure 5-19 Transverse section through the caudal part of the pons at the level of the facial colliculus. The spinal nucleus of the trigeminal nerve and its tract lie on the anteromedial aspect of the inferior cerebellar peduncle. The trapezoid body is made up of fibers derived from the cochlear nuclei and the nuclei of the trapezoid body. The basilar part of the pons, at this level, contains small masses of nerve cells called pontine nuclei. The corticopontine fibers of the crus cerebri of the midbrain terminate in the pontine nuclei.

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Atherosclerosis Atherosclerosis is a known contributor to the development of VaD because of its involvement in cerebral ischemia and stroke [26, 212]. Importantly, not all cross-sectional studies have identified a relation between carotid atherosclerosis and cognition [218, 228]. Furthermore, conclusions regarding the most affected cognitive domains are currently premature, given that each domain has not been examined with sufficient frequency. Longitudinal research linking carotid atherosclerosis with prospective cognitive decline is more limited. Subclinical disease can typically be measured quickly, painlessly, and noninvasively. At least four subclinical disease states, including atherosclerosis, arterial stiffness, endothelial dysfunction, and left ventricular hypertrophy, have been linked with decrements in concurrent cognitive function and/or prospective cognitive decline. Endothelial Dysfunction Endothelial function represents an important component of vascular health and contributes to the maintenance of vascular homeostasis [247]. Disruptions in vascular homeostasis, mediated by endothelial dysfunction, can precipitate atherogenesis and other harmful vascular events such as transient ischemia, plaque rupture, thrombosis, and infarction. It should be noted that subclinical disease states often co-occur and may act additively or synergistically in the prediction of diminished cognitive function [205]. Manifestations include stable angina, acute coronary syndromes, myocardial infarction, heart failure, sudden death, and silent ischemia. Non-demented cardiac patients have been described as exhibiting dysfunction on tests of memory, fine motor control, and orientation [259]. Others have similarly found cognitive impairment in pre-surgical coronary patients [260]. Other hypothesized mechanisms include a common genetic vulnerability, chronic cerebral hypoperfusion, micro- 86 S. These short-term effects may include decrements across a number of domains of cognitive function, including memory, psychomotor speed, executive functions, and visuoconstructional abilities [270]. Memory and concentration complaints are the most frequently self-reported cognitive changes, though these findings are not always corroborated by neuropsychological data [270, 281]. At least two studies have detected an initial cognitive recovery period ensuing the aforementioned early cognitive decline, followed by a later period of cognitive decline up to 5 years postsurgery [265, 282]. These discrepancies are likely a function of the numerous methodologic differences across studies; Selnes and colleagues [270] describe the prevailing pattern as consistent with cognitive changes observed in patients with mild subcortical vascular disease. We concluded that the findings suggested a continuum of cognitive impairment associated with increasingly severe manifestations of cardiovascular disease. In that regard, risk factors for atherosclerosis are generally the same for all arterial systems and include dyslipidemia, diabetes, hypertension, and smoking. Generalized atherosclerosis may also be related to cognitive dysfunction via increased microemboli. It is characterized by specific clinical symptoms, such as dyspnea and fatigue, and signs on physical examination, such as fluid retention [302]. There is mixed, and very limited, evidence regarding the cognitive consequences of heart transplantation [308]. Although some studies show postsurgical improvement in cognition [312, 313], others show evidence 88 S. Post-transplant neuropsychological function is thus an important area for future study. The neuropathological mechanisms underlying cognitive changes associated with heart failure remain unclear, and relevant mechanistic research is lacking [307]. The primary hypotheses involve multiple cardiogenic emboli and cerebral hypoperfusion associated with insufficient cardiac output [303]. Given that the brain receives a large relative proportion of cardiac output [308], the latter hypothesis appears highly plausible as a contributing factor. Studies in this area frequently refer to frank cognitive impairment (as compared to normative standards or control subjects) or report dementia prevalence. Patterns of performance differ somewhat across the diseases described, but frequently include tests of executive function, motor or perceptuo-motor speed, attention, and memory. We have suggested that there is a multilevel interplay among numerous factors that may serve as proximal and distal mediators of these associations. All of these factors may have independent influences on brain structure and function and cognitive performance or may operate through different meditational pathways. Although we have drawn a linear model for the sake of simplicity, it is critical to note the likelihood of multidirectional associations including interrelations among factors at any given level. Although, to our knowledge, tests of this model are unavailable, we have provided reviews of literature that help us to construct possible conceptual linkages. We have highlighted positive findings in order to illustrate possible patterns of associations. Although findings in each area are indeed mixed, we suggest that the preponderance of evidence points to robust associations. We have suggested previously that test batteries should provide adequate coverage of major domains of cognitive function. Although there is typically pressure to reduce such data for analysis by factor analysis or conceptual clusters, we prefer to analyze univariate tests to maximize information. In clinical neuropsychological assessment, one uses all information available to determine patterns of performance. Relevance of cardiovascular risk factors and ischemic cerebrovascular disease to the pathogenesis of Alzheimer disease: a review of accrued findings from the Honolulu-Asia Aging Study. International Statistical Classification of Diseases and Related Health Problems 10th Revision Version for 2007. Section 34: some risk factors related to the annual incidence of cardiovascular disease and death in pooled repeated biennial measurements. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, National Heart, Lung and Blood Institute: National High Blood Pressure Education Program Coordinating Committee. Relationship between coronary artery calcification and other measures of subclinical cardiovascular disease in older adults. When possible, investigators should include both cognitive and neuroimaging measures in the same study and examine direct tests of mediation. However, work to date suggests associations with quality of life, physical function. Further, there appears to be a continuum of cognitive impairment associated with increasingly severe manifestations of cardiovascular disease. Accordingly, early and aggressive efforts at prevention and intervention are critical to the maintenance of "brain health" and cognitive function across the life span. Heart disease and stroke statistics 2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Blood pressure in adulthood and life expectancy with cardiovascular disease in men and women: life course analysis. Less atherosclerosis and lower blood pressure for a meaningful life perspective with more brain. Neuropsychological correlates of hypertension: review and methodologic considerations. Elevated blood pressure and decreased cognitive function among school-age children and adolescents in the United States. Untreated blood pressure level is inversely related to cognitive functioning: the Framingham Study. Pulse pressure and pulse wave velocity are related to cognitive decline in the Baltimore Longitudinal Study of Aging. Nonlinear relations of blood pressure to cognitive function: the Baltimore Longitudinal Study of Aging. A longitudinal study of blood pressure in relation to performance on the Wechsler Adult Intelligence Scale. The association between midlife blood pressure levels and late-life cognitive function. Hypertension and neuropsychological performance in men: interactive effects of age. Gender differences in the relation of hypertension to cognitive function in older adults. Interactive relations of central versus total obesity and blood pressure to cognitive function. Lower cognitive function in the presence of obesity and hypertension: the Framingham Heart study. Diagnosis of hypertension and high blood pressure levels negatively affect cognitive function in older adults. Effects of age and hypertension status on cognition: the Veterans Affairs Normative Aging Study. Plasma total cholesterol level as a risk factor for Alzheimer disease: the Framingham Study. Metabolic cardiovascular syndrome and risk of dementia in Japanese-American elderly men. Obesity and vascular risk factors at midlife and the risk of dementia and Alzheimer disease. Cholesterol as a risk factor for dementia and cognitive decline: a systematic review of prospective studies with meta-analysis. Serum cholesterol changes after midlife and late-life cognition: twenty-oneyear-follow-up study. Decline in cognitive performance in aging twins: heritability and biobehavioral predictors from the National Heart, Lung, and Blood Institute Twin Study. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Prediction of first events of coronary heart disease and stroke with consideration of adiposity. Elevated body mass index is associated with executive dysfunction in otherwise healthy adults. Relation between central adiposity and cognitive function in the Maine-Syracuse Study: attenuation by physical activity. Cognitive function in normalweight, overweight, and obese older adults: an analysis of the Advanced Cognitive Training for Independent and Vital Elderly Cohort. Association of body mass index with cognitive function in elderly hypertensive Japanese. Use of multiple biomarkers to improve the prediction of death from cardiovascular causes. Should C-reactive protein be added to metabolic syndrome and to assessment of global cardiovascular risk Interleukin-6 covaries inversely with hippocampal grey matter volume in middle aged adults. Cognitive decline and markers of inflammation and hemostasis: the Edinburgh Artery Study. Inflammatory markers and cognition in well-functioning AfricanAmerican and white elders. Interleukin-6 and risk of cognitive decline: MacArthur studies of successful aging. Cerebral small vessel disease and C-reactive protein: results of a crosssectional study in community-based Japanese elderly. C-reactive protein, carotid atherosclerosis, and cerebral small-vessel disease: 88. The effect of body mass index on global brain volume in middle aged adults: a cross sectional study. C-reactive protein is linked to lower cognitive performance in overweight and obese women. Report of the expert committee on the diagnosis and classification of diabetes mellitus. The relationships between atherosclerosis, heart disease, type 2 diabetes and dementia. Complications Trial/Epidemiology of Diabetes Interventions and Complications Study Research Group. Increased glucose levels are associated with episodic memory in nondiabetic women.

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The first chapter describes the frequency and nature of self-harm in patients with schizophrenia and determines whether personality features, defined as temperament and character dimensions, as well as impulsivity features, are predictors of self-harm behaviors in patients with schizophrenia. Chapter Two provides a broad overview of suicide incidence among males in different regions and eras marked by the social factors that are commonly suggested to be related to male suicidality: political turmoil, economic recession and unemployment, war, and access to lethal means. Chapter Three discusses clinical insight for understanding suicidal behaviour among those with origins on the Indian sub-continent. Human behavior is of fundamental importance not only to the individual, but to the community and all of humanity. Now that humans have acquired the capability of interfering with or destroying living systems, it is of great consequence to the planet itself. With this in mind, the book Understanding Human Behavior: Theories, Patterns, and Developments is the result of inviting several leading innovative thinkers to consider how they could contribute to a discussion of understanding human behavior. Their perspectives differ in approach and focus, but they all confirm the great complexity of the topic, and they show that science has hardly scratched its surface. The eight chapters of this volume are dominated by considerations of how the behavior of humans began and developed in the distant past, during the evolution of early humans. But this describes only effects or symptoms of a condition pertaining to today, without considering how it came about, i. This is examined in several chapters of this book, together with apparent historical trajectories of human behavior in an attempt to explore its etiology. Other contributions investigate more specific aspects of human behavior, including those recorded in history and even in modern times. In summary, this volume provides a well-rounded investigation into current cutting-edge understanding of the origins and nature of human behavior. Holden (Bond University, Robina, Australia) In series: the World of Psychology: Therapeutic, Relational, Teaching Edited by: Ami Rokach (Department of Psychology, the Center for Academic Studies, Yehuda, Israel and York University, Toronto, Canada) 2016. This book is about the endings of at least some of those stories, the stories of victims who strive to overcome and even triumph in the end. This book is a collection of research perspectives and personal stories exploring the various pathways for overcoming victimhood. It is hoped that they might offer an inspiration for others and encourage others to stay on the path to find a positive ending. Victim Victorious is an examination of the ways in which victims come to rise above the challenges that they face. Victims may be innocent bystanders, and in no way responsible for their victimhood. To assist in this task, this book chronicles the pathway of prejudice and how the pain and the damage experienced by individual victims may be overcome by effort, by and on their own behalf. A range of professionals, philosophers, psychologists, criminologists and critical theorists offer their thoughts on how people might overcome victimhood. The second half of the book features insider views of victimhood; in this section, the victims speak for themselves about their experience and how they have endeavored to break through their victimhood. This book is less about identifying and proscribing the behaviors of perpetrators and more about the efforts that victims can undertake to heal themselves as they journey towards resilience and victory. Visual Spatial Attention: Functions, Influences and Performance Lana Haynes In series: Psychology Research Progress 2016. Many events in our daily lives require that we allocate attentional resources towards relevant information in the environment. However, we are constantly presented with more information than we can possibly attend to at any given moment. Once a region of space has been selected by visual spatial attention, the objects and features Understanding Self-Harm: Prevalence, Predictors and Treatment Options Elizabeth Bell In series: Psychiatry - Theory, Applications and Treatments 2017. In this book, Chapter One examines visual spatial attention and its functional role in a variety of cognitive tasks. Chapter Two reviews the different ways in which the various mechanisms of selective attention have been cortically and otherwise classified into low and high levels of processing and to disentangle some of the confusion that may have arisen as a result of inconsistent usage of terminology and concepts in the field. The last chapter discusses studies which use computer simulations to estimate the effect of noise correlation upon the performance benefit gained from cues. Asbestos have been used in many different environments, including industrial and home construction projects, vehicles, railroads and shipyards, to name a few. Asbestos have significantly affected many lives, particularly individuals and their families who have experienced substantial direct or indirect occupational exposure to asbestos as well as asbestos-containing products and equipment. Many diseases and conditions are reported to have a direct or indirect causal link to asbestos exposure. This book summarizes the historical background, current knowledge and advancements concerning asbestos and its related diseases in a simple, easy to understand and concise format. The first chapter covers asbestos mineralogy, industrial applications, occupational and environmental exposure as well as methods of fiber analysis. The second chapter focuses on asbestos pathogenesis, including asbestos levels in the environment and various worksites, the biological effects of asbestos fibers and factors determining its toxicity. The third chapter provides an overview of asbestos-related diseases such as asbestosis, pleural diseases, lung cancer and mesothelioma. Each section also includes a discussion of cause and causation, clinical presentation, pathology, diagnosis, treatment, prognosis and surveillance. The fourth chapter outlines the basic concepts of biostatistics and epidemiology, criteria in establishing the causal relationships, the occupational approach of environmental diseases and current standards and regulations. This book serves as an easy to read, quick reference presented in a bulleted format that allows readers to quickly and easily review the information. It is a useful resource for occupational medicine specialists, healthcare providers and environmental scientists who are interested in understanding asbestos and managing asbestos-related diseases. War and posttraumatic stress disorder go, unfortunately, hand in hand, and war seems to be raging around us no matter where we are on the globe. More common than not, scientific literature addresses trauma suffered by those who directly experienced war. However, research has not adequately addressed the effects that war has on those who have not participated in combat, but who live with those who have. The family members, mainly the spouses, welcome these soldiers back to everyday life and consequently experience secondary trauma related to the damaging effects that the war had on those soldiers. This book brings a firsthand account of women who greet their traumatized family members that return from the battleground and attempt to integrate into a society that does not understand what they went through. Each chapter describes the experiences of such women, and how they triumph despite very difficult and unfavorable home conditions. Chapters end with a commentary by a clinical psychologist of the women, their experiences, the effects of those experiences, and what ultimately helped them triumph. Biological Implications of Human Mobility Slawomir Koziel, Raja Chakraborty and Kaushik Bose (Polish Academy of Sciences, Anthropology Unit, Wroclaw, Poland) In series: Public Health in the 21st Century 2016. This book outlays the possible influence of some important aspects of human migration and social mobility on the biological characters of human populations, including their health and well-being. It contains ten contributions from different researchers working in this area of research. Ghosh) reveals the influence of educational and occupational positions on clinical hypertension among adult males from the eastern part of India. Preparedness, Planning and Challenges Gerald Vasquez In series: Public Health in the 21st Century 2016. Past communicable diseases, such as the recent Ebola epidemic, have resulted in many deaths and highlight the potential economic cost of disruptions to air travel and the U. Nicholas Mascie-Taylor discusses the impact of regional migration and social mobility on variation in adult height, weight and Body Mass Index, which is evidenced from a British cohort study. In Chapter Eight, Gomula and Koziel highlight from a study in Poland the effect of social mobility of fathers on maturity, measured by the age at menarche in their daughters. In the next chapter, Missoni and Sarac review dietary and lifestyle characteristics in the Eastern Adriatic Islands of Croatia in the backdrop of recent economic transition, urbanisation and migration. The tenth chapter contributed by Singh and Kirchengast compares demographic health related characteristics and reproductive behaviours between Punjabi women residing in Punjab and in Vienna, Austria. This book will be useful for researchers dealing with biological implications of human mobility. It may be of particular interest to human biologists, biological anthropologists, epidemiologists, demographers, economists and other researchers dealing with biological implications of human mobility. Target Audience: Postgraduate students and academic researchers in the fields of biological anthropology, human biology, epidemiology, economists, demographers and allied health professionals. Caribbean Adolescents: Misuse and Abuse of Alcohol Cecilia Hegamin-Younger and Joav Merrick (Department of Public Health and Preventive Medicine, St. When an economy is fueled by the alcohol industry, which is a powerful and a resource-intense industry, governments who lack technical capacity and financial resources to combat the alcohol industry may fear the economic impact of restrictive alcohol polices. How can a country address the public health concerns from alcohol misuse and abuse Because alcohol is no ordinary commodity, the public has a right to understand and expect a more enlightened approach to the development and implementation of an alcohol policy.

The authors of this book provide new research in the study of restorative and transitional justice treatment group buy generic lumigan 3ml online. Powell 248 Social Sciences In series: Social Perspectives in the 21st Century Edited by: Jason L treatment 247 generic lumigan 3 ml line. This authentic book explores the concept of aging and its relationship to victimization and death in contemporary culture xerostomia medications side effects buy lumigan 3ml on line. Healthcare and welfare have emerged as key vehicles used to legitimize and position the identities that older people adopt in contemporary modernity medications zithromax lumigan 3ml on line. Both contain continually changing technologies that function to mediate relations between older people and the State 25 medications to know for nclex 3ml lumigan for sale. Medico-technical policies medications 126 safe lumigan 3 ml, victimization policies and care management discourses have been presented as adding choice and reducing limitations associated with adult aging. However, they also represent an increase in professional control that can be exerted on lifestyles in older ages and thus, the wider social meanings associated with that part of life. This book presents an original theoretical analysis based on a critical interpretation of the work of Michel Foucault and the application of aging. The book identifies the interrelationship between health professions and older people in terms of power, surveillance and normalization. The book highlights how and why older people are the subjects of legitimizing professional gazes through the dark side of modernity: being managed, being victims, being abused and existential questions of death are critically examined with clear links to policy, theory and practice. In order to attain a state of psychological wellness, our basic psychological needs, which are the desire for autonomy, relatedness and competence, must be satisfied. If these needs are attained, people are therefore motivated to function optimally and at their fullest potential. In addition to satisfying basic human psychological needs, a supportive environment is required as well. In the case of this book, the family is presented in each chapter as the hypothetical environment for optimal functioning of the individual. The chapters highlight the role of family structure, family conflict, family involvement, adverse experiences within the family, parenting styles and practices. Self-Determination Theory: A Family Perspective includes reviews and primary research studies from authors in South Africa, Portugal, Belgium and Nigeria. Target Audience: this book is aimed at parents, researchers, policy and programme specialist, theorists, psychologists, social workers, academics and health professionals. This new book compiles research summaries of top professionals in the field of social issues research from a number of different focuses in this important field. Rituals: Past, Present and Future Perspectives Edward Bailey In series: Focus on Civilizations and Cultures 2016. Rituals promote the ability to attribute meaning to our lives because rituals are profound structures that define the continuity of experience between the past, present and future. In this book, Chapter One reviews rituals as a storytelling process and social-action descriptor. Chapter Two provides a summary on trade networks in objects for the traditional Day of the Dead offering at Ozumba Tianguis. Chapter Three gives an introduction of a methodology for Quantitative Semiotics within a Systemic Approach and is conjoined by the ethnohistorical method for studying the preparations of the cempaxuchitl flower for the Day of the Dead offerings as carried out by two families. Chapter Five examines issues in perinatal care and the spaces they are carried out, through the lens of ritual. Chapter Six explores the transition to motherhood in the context of migration through deep interviews with South American pregnant women who migrated to Italy. Chapter Seven examines ritual meaning to understand ritual functioning in the Italian and Chile contexts. Chapter Nine provides a review on the importance of rituals in understanding mass homicide. Social Security and Retirement Benefits: Programs, Perspectives and Future Directions Allison Clark In series: Social Welfare Policies and Programs Patterns, Implications and Prospects 2016. Social Support: Gender Differences, Psychological Importance and Impacts on Well-Being Cedric Castillo In series: Social Issues, Justice and Status 2016. Social support represents an important protective factor against stress both directly (see the main effect hypothesis) and as a mediator. Nevertheless, it fosters health but at the same time may create a burden for those who work as caregivers and perceive the strain of their professional responsibility. This book discusses gender differences, the psychological importance and impacts on well-being of social support. Chapter One presents some theoretical consideration about health and social support from a gender perspective. Chapter Three outlines empirical research on the determinants of gender-specific effects in tonic or stress-related physiological responses, along with potential mechanisms responsible for gender-specific effects. Chapter Four Self-Determination Theory: A Family Perspective Nicolette Vanessa Roman and Eugene Lee Davids (Child, Family and Community Research Unit, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa) In series: Social Issues, Justice and Status 2016. The theory of self-determination is an evidence-based theory that has been shifted from a conceptual perspective to practical implementation for the past four decades. The theory is grounded within positive Social Sciences 249 investigates the relationship between social support and both hedonic and eudaimonic well-being controlling for the effects of fluid intelligence and personality traits Italian high school students. Chapter Five creates a better understanding of universal (etic) and unique (emic) social support patterns of aging adults around the world. Chapter Six investigates the mediating role of social support in the relationships between the religious meaning system and psychological well-being. Chapter Seven discusses the importance of taking the central role of social support in the etiology and prognosis of a cardiac disease into account in cardiac rehabilitation and preventive programs. Socioeconomic Status: Influences, Disparities and Current Issues Geoffrey Perkins In series: Social Issues, Justice and Status 2016. Chapter Three examines socioeconomic and racial disparities in child health and health outcomes. Chapter Four analyzes attitudes toward poverty and the government safety net programs in relationship to income and party affiliation, and investigates theories to better understand the polarized attitudes toward socioeconomic status, inequality and poverty in America. Chapter Six reports the findings of two questionnaire surveys focusing on the effects of socioeconomic status and trait self-control on seeking relationships. Particularly the "religion" of Global Civilization is analyzed and eventually the conclusion is rather pessimistic, since this religion is de facto "business" with its limited ethics and social responsibility. The book finally defines Wise Civilization and paths of its implementation, under the condition that people will be not only knowledgeable, but wise and inspired mainly by right spirituality. This book analyzes a new phenomenon in civilization: the transformation of the current "Information Wave" into virtual civilization. In the 21st century, the "real-space" of the world civilization, due to the massive, network-intensive use of computers world-wide, gained the virtual space known as cyberspace. For the first time in 6,000 years of human civilization, society has become a quantum society, which can be real and virtual at the same time. Even for those who do use them, cyberspace access requires some sort of commercial transactions-oriented activities (ex. This book evaluates the phenomenon of virtuality: Is this a temporary technological phantom or is it going to stay forever Is it a new technological wave of civilization or is it a new civilization itself Since this editor argues it is a new civilization, a characterization of virtual society will be given. Also, if this is a new civilization, what is its religion (since every civilization is characterized by a religion) As a new civilization, virtual society will promote certain ways of practicing daily life. These new ways will be characterized and evaluated as a new kind of societal divide. Is virtuality a positive tool which will enhance the quality of our lives, or will it provide stronger inequality among skillful and unskillful users As a new landscape of civilization its development will be predicted within the framework of several possible futures of real civilization which can be perceived today. This kind of prediction involving the architecture and development of cyberspace and real-space in the context of contemporary civilizations such as African, Chinese, Japanese, Hindu, Buddhist, Western, Eastern, Islamic, and Global will be evaluated in this book. Will this civilization enhance the real civilization or will it leave many of us behind in a divided environment created by the rise of virtuality Celinski (Private Practice in Psychology, Toronto, Canada) In series: Religion and Spirituality In series: Focus on Civilizations and Cultures 2016. This book investigates the state of civilization in the 21st century, which is characterized by the transformation of Western Civilization into Global Civilization and the resulting Great Recession, triggered by the financial crisis in the United States in 2008. Since the state of former Western Civilization is steadily worsening, the question is rising whether civilization is sustainable at all. To answer this question, 20 authors, members of the International Society for the Comparative Study of Civilizations (from several countries and continents) investigate the aspect of human spirituality, and whether its actual level of development is able to steer the sustainable development of civilization The current Second Great Crisis is characterized by 16 analyzed crises, such as; population, ecological, strategic resources, education, administration, technique, science, religion, and similar crises. Do we have human and societal potential for transcending this crisis of civilization This book took the task of conceptualizing Western civilization in the 21st century. It examines Western Civilization and its encounters from a viewpoint of the impact of rising Global civilizations in the 21st century. This political and technological success of Western civilization in the last 500 years triggered a dream of spreading around the globe Democracy and liberal Capitalism. Western society was held together by Christian morality (regardless whether someone was a believer or a nonbeliever or agnostic). The medicine for all shortcomings faced by Western civilization in the 21st century is offered by Al Gore in his book "The Future: Six Drivers of Global Change" (2013). The author of this book argues that vice versa, the rise of certain technologies are the main reason for the decline of Western civilization. These kind of issues will be investigated in this book and the message is not optimistic, since Westerners, when are poor are wise, and when are better off are stupid. The first three chapters on resistance and propulsion were included for this purpose. The second purpose was to describe, what the author believes, is the major propulsive mechanism swimmers use: shoulder adduction. A third purpose was to comment on some of, the many "fads" and misconceptions about stroke mechanics that abound in our sport. His final reasoning behind writing this book was to speculate on some theories about stroke mechanics he developed over the years. The efficacy of these theories have yet to be validated by research, but are worth considering nonetheless. These purposes were met by the individual chapters on each competitive stroke, plus a chapter on stroke rates and stroke lengths. This book is not a continuation of the Swimming Faster series, although it contains some of the same information. Therefore, the author purposely changed the title to reflect his purpose in writing it. It contains descriptions and summaries of the most important research on swimming hydrodynamics over the last several decades, in his opinion. The descriptions of stroke mechanics are supported by photographs of some of the greatest swimmers in the world, both past and present. They were made from in-competition videos where one can see how they really swim, as opposed to what they think they should be doing, which is what one often sees in pool demonstrations and out-of-competition instructional videos. It has been 12 years since the author published the 3rd edition of the Swimming Faster series and time has not stood still. Research has continued at a rapid pace, using increasingly sophisticated methodology to improve our knowledge of the training process. In this book, the author shares what he learned with members of the competitive swimming community throughout the world. It is a source for coaches and athletes to improve their knowledge of the scientific aspects of training. It should also help readers become familiar with the sometimes confusing terms used by sports scientists so they can read the results of their studies with understanding. This is so they will not have to copy the training of successful coaches without understanding why it was beneficial and how it might be modified to become even more useful within their surroundings. He uses his own experiences with running, which span sixteen years as well as the commentaries of other athletes. It is the inner experience of the person who transforms that can be shared with another person to provide an accessible model to follow. In the world of coaching, the information provided in this book can be used to effectively challenge a person who lacks achievement in their life by awakening their own internal dynamics. Gymnastics Performance and Motor Learning: Principles and Applications Thomas Heinen (University of Hildesheim, Germany), Ivan Cuk (University of Ljubljana, Slovenia), Ruben Goebel (Qatar University, Qatar), and Konstantinos Velentzas (Bielefeld University, Germany) In series: Sports and Athletics Preparation, Performance, and Psychology Social Sciences 251 2016. The book Gymnastics Performance and Motor Learning: Principles and Applications is a state-of-the-art discussion forum for topics that are of high interest in the field of gymnastics. Experts from different countries and with different scientific backgrounds such as psychology, pedagogy, training science, sports science, and movement science provide a number of significant contributions covering recent theoretical developments, current research evidence, as well as implications for practical applications concerning the different gymnastics disciplines. Topics discussed in the book include gymnasts gaze behavior in complex skills, spotting and guiding techniques, observational learning, augmented feedback, imagery, mental rotation, directional tendencies, interpersonal coordination, lost skill syndrome, performance indicators, as well as apparatus developments. Given the wide range of topics, Gymnastics Performance and Motor Learning: Principles and Applications may be an important source of information for graduate students, researchers, and practitioners (coaches and gymnasts) who work in the field of gymnastics. Traditionally shaped by commercial forces, demographic, market, and ecological shifts are changing the nature of U. The purpose of this book is to provide guidance for Agency consideration in its deliberations pertaining to development and maintenance of enduring and sustainable high quality saltwater recreational fisheries.