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In 1831 Faraday dem- onstrated that a moving magnetic field could induce an electric current in a nearby circuit buy generic ezetimibe on-line cholesterol test quiz, a discovery he believed ‘may probably have great influence in some of the most important effects of electric currents’ cheap ezetimibe 10 mg free shipping cholesterol medication lipitor. At the time of this discovery it was already known from Luigi Galvani’s (1737–1798) experiments cheap 10mg ezetimibe otc cholesterol test ottawa, showing that electrical currents could produce muscle contractions, that nervous tissue had something to do with electricity; and in 1838 Carlo Matteucci (1811–1868) had introduced the term ‘muscle current’ to describe the activity of muscle tissue previously referred to as ‘animal electricity’. Ten years later Emil Du Bois-Reymond (1818–1896) demonstrated a direct relationship between electric current and nerve cell activity. Even so, it took until 1939 and the work of Alan Hodgkin and Andrew Huxley to show that brain activity depends upon electrical activity: the brain, then, is a machine that runs on electricity. WALSH These discoveries ushered in the first wave of stimulation studies as a means of reverse engineering brain function. Physiologists began to apply electrical stimulation to the cerebral cortex (the outer surface of the brain), and in doing so were able to produce movements in muscles on the contra- lateral side of the body (the movements of one side of you body are con- trolled by the opposite side of your brain, so magnetic or electrical stimulation of, say, the left half of your brain will cause movements on the right side of your body). Working on dogs and monkeys, David Ferrier used magnetically induced currents to produce a map of cortical function (Figure 10. Progress in brain stimulation was rapid and reached its first peak when Wilder Penfield and his colleagues applied electrical stimulation to the cortex of patients undergoing neurosurgery and were able to work out the way in which body movements were repre- sented in the brain (Figure 10. They also confirmed the location of speech reception and production areas, identified a third speech-related area and stimulated areas that produced specifically tactile or visual sen- sations. There were several limitations to these methods of investigating brain function. The invasive nature of the experiments meant that they could only be carried out in patients who were awaiting surgery and of course this restricts the kinds of experiments one can do. Another important limit was the specificity of the movements or perceptions produced. The motor cortex is required for fine control and important skills such as giving complex hand signals to other road-users, but Penfield’s stimulation elic- ited actions which were ‘not more complicated than those a newborn infant is able to perform’. Some brain regions, however, which Penfield and Rasmussen referred to as ‘elaboration areas’ apparently did not respond to electrical stimulation because the brain does not only produce perceptual and motor outputs but also transforms them: it would be difficult to imagine how stimulation would elicit awareness of a transformation. For example, at some stage in reading, your brain is able to translate printed letters into sounds but stimulation never caused a subject to report any- thing like this. Reading probably seems so automatic that you may even have difficulty imagining that a written word is translated into a sound. The closest you might get is to read something like ‘the door slammed Reverse engineering the human mind 173 Figure 10. Ferrier (1876) mapped the different functions of the macaque brain (a) by direct stimulation of the cortex and transposed the functions to the human cortex (b). The motor homunculus produced by Penfield and Rasmussen from direct stimulation studies. Note that the body is distorted and those areas which produce fine motor actions and manipulations (the hand and the mouth) are disproportionately represented. Reverse engineering the human mind 175 shut’ – I know you heard the door, but that was the image not the transla- tion itself.

Many spinal cord injuries happen to late adolescents or young adults at the stage when they are beginning to form relationships 57 ABC of Spinal Cord Injury and establish independence from parents purchase ezetimibe line cholesterol lowering diet tips, and they may be very concerned about their ability to do so buy generic ezetimibe 10 mg on line free cholesterol test orlando. It takes time and the realisation that people do think that they are still worthwhile before necessary self-esteem can return best buy ezetimibe cholesterol ldl. These adjustments are likely to take place after discharge from hospital because then the issues become clearer. Many people find that the initial period after discharge can be very stressful. Work is of varying importance to patients, but most will see it as giving a sense of purpose to their life and crucial to their self-esteem, and will want to return to their former occupation if at all possible. Early contact with the patient’s employer to discuss the feasibility of eventual return to his or her previous job is important. If the degree of a patient’s disability precludes this, some employers are sympathetic and flexible and will offer a job that will be possible from a wheelchair. However, many patients initially find life outside hospital difficult enough, having to cope with their disability and adjust to living again in the community, without having the added responsibility of a job. In these circumstances a period of adjustment at home is advisable before they return to work, as it may be two or three years or longer before a patient is psychologically rehabilitated. If patients are keen to return to their previous job, school, Figure 11. Recommendations are then made to the placement, assessment, and counselling team (PACT) or local education authority, if alterations to the buildings or the installation of Box 11. If patients are considering returning to work, time spent in a rehabilitation workshop can be helpful. In this environment they should be able to test their aptitude for activities such as carpentry, engineering, electronics and computer work, build Box 11. Benefits to assist with disability: Good community support, including practical help with the • Disability Living Allowance (DS 704) tasks of caring, and also the imaginative provision of resources • Attendance Allowance (if over 65 years of age) (DS 702) • Disabled Person’s Tax Credit (information available from the to enable the person and carers to participate in normal Inland Revenue) community activities, are likely to help the process. Tired • Industrial Disablement Benefit (DB1) people who have limited social satisfactions will find it more • NHS Charges and Optical Voucher Values (HC12) difficult to make the necessary adjustments. Studies indicate that people with spinal cord Income maintenance benefits: • Statutory Sick Pay (for 28 weeks) (information available from the injuries are not as psychologically distressed or depressed by Inland Revenue) if in employment and not self employed their injury as able-bodied people, including experienced staff, or imagine. Many people with spinal cord injury do lead active • Incapacity Benefit (IB1 IB203) up to 28 weeks if self-employed fulfilling lives, though this may take time to achieve. If 16–20, or under 25 and in full time education, contributions discounted Finance If not enough contributions Adequate finance is a major factor in determining successful • Income Support (IS20) means tested (SD2) • Severe Disablement Allowance (if eligible) (SD3) if claimed rehabilitation, but many severely disabled people are living in before April 2001. Not only do patients and their families have to cope with all Income Support will “top up” any of the above if income is below the the stresses of injury; they may have to live on a severely reduced assessed needs level. It is also • War Disablement Pension (WPA—leaflet—1) more expensive to live as a disabled person. Disability Living • Housing Benefit and Council Tax Benefit (administered by Allowance, or Attendance Allowance for over 65 year olds, district councils) (RR2) provides some help with the more obvious costs, but no provision • Invalid Care Allowance (SD4) (paid to some carers) exists for tasks such as decorating, repairs, and gardening, which • Working Families Tax Credit (information available from the the disabled person may no longer be able to perform. Inland Revenue) Even if the person receives financial compensation this may (DSS leaflet numbers are given in parentheses) take several years to be granted, and though interim payments 58 Social needs of patient and family can be made, in some circumstances they are not always Table 11.

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In quantitative research you can define your research methods early in the planning stage purchase ezetimibe visa cholesterol ratio 5. You know what you want to find out and you can decide upon the best way to obtain the information generic 10mg ezetimibe visa cholesterol total chart. Also purchase ezetimibe paypal cholesterol test pharmacy, you will be able to decide early on how many people you need to contact (see Chapter 5). However, in some types of qualitative re- search it may be difficult to define your methods specifi- cally. You may decide that semi-structured interviews would be useful, although you’re not sure, in the planning stages, how many you will need to conduct. You may find also that you need to use other methods as the research progresses. Maybe you want to run a focus group to see what people think about the hypotheses you have gener- 34 / PRACTICAL RESEARCH METHODS ated from the interviews. Or perhaps you need to spend some time in the field observing something which has aris- en during the interview stage. De¢ning needs and means It is not necessary to use only one research method, although many projects do this. A combination of meth- ods can be desirable as it enables you to overcome the dif- ferent weaknesses inherent in all methods. What you must be aware of, however, when deciding upon your methods, are the constraints under which you will have to work. There’s no point deciding that a large scale, national post- al survey is the best way to do your research if you only have a budget of £50 and two months in which to com- plete your work. Also, you need to think about the purpose of your re- search as this will help point to the most appropriate methods to use. For example, if you want to describe in detail the experiences of a group of women trying to set up and run a charity, you wouldn’t send them a closed- ended questionnaire. Instead, you might ask to become involved and set up a piece of action research in which you can decide to use interviews and focus groups. Or you might decide to hold two semi-structured interviews with each of the women involved, one at the beginning of their project and one at the end. If your goal is detailed description, you do not need to try to contact as many people as possible. HOW TO CHOOSE YOUR RESEARCH METHODS / 35 Let us return to the three examples in the exercises given in the previous two chapters to find out which would be the most appropriate methods for the research.

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The lift must be maintained so that the feet are T10–L2 Swing through and four point with calipers placed the same distance in front of the crutches as they started behind purchase ezetimibe 10mg cholesterol levels different units. The patient moves one crutch forward order cheap ezetimibe line cholesterol medication equivalent chart, transfers body weight on to the adjacent leg buy discount ezetimibe line cholesterol levels in shrimp, and then moves the opposite leg forward by using latissimus dorsi to “hitch” the hip. The step must be short; if too L4–L5 May or may not require calipers large a step is taken the patient will fall, as he or she cannot recover Wheelchair not required balance. May require sticks or other walking aid All the above depend on age, stature, amount and control of spasticity, any pre-existing medical condition, and the individual’s motivation. Young children have arms that are relatively short in Further reading relation to the trunk, so they should not attempt independent transfers. The child may therefore need to be readmitted and • Association of Swimming Therapy. London: A & C Black, 1992 necessary throughout childhood, adolescence, and early adult • Bromley I. A guide for life to ensure that adjustments are made to braces, calipers, and physiotherapists, 5th edition. Edinburgh: Churchill wheelchair to maintain good posture and correct growth. Edinburgh: Churchill Livingstone, 1995, pp 429–38 52 10 Occupational therapy Sue Cox Martin, David Grundy The months in hospital after a spinal cord injury are an extremely difficult period for patients as they gradually adjust to what may be a lifetime of disability. Occupational therapists are concerned with assisting patients to reach the maximum level of functional physical and psychological independence depending on the extent of the impairment, their home and social situation. Whalley Hammell suggests independence is not a physical state but more an attitude in which an individual takes on responsibility, solves problems, and establishes goals. Empowering an individual to make an informed choice about the way they choose to live their Figure 10. The skills of the occupational therapist lie in assisting patients to overcome their difficulties, often by considering alternative methods and equipment to assist them with personal care, domestic tasks, and communication. The occupational therapist is also involved with advising people on home modifications, mobility including wheelchairs, driving and transport, returning to work, college or school, and the pursuit of leisure activities and hobbies. Hand and upper limb management Individual assessment of the hand and upper limb of tetraplegic patients is essential to maintain their hands in the optimum position for function. Hand management of patients with incomplete lesions needs close monitoring and if motor function improves activities are performed to enable the patient to achieve their maximum potential. Tetraplegic patients with active wrist extensors should be encouraged to participate in activities to strengthen these muscles and to facilitate the use of their tenodesis grip.

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Examples of growth factors are as such: epidermal type of cell division called meiosis buy generic ezetimibe on-line cholesterol medication heart attack, which allows each sex cell growth factor (EGF) generic ezetimibe 10mg fast delivery cholesterol levels gpnotebook, fibroblastic growth factor (FGF) order ezetimibe line cholesterol levels of athletes, produced to contain half of its original amount of DNA, in platelet-derived growth factor (PDGF), insulin-like growth anticipation of doubling it again when an egg and a sperm factor (IGF), or by hormones. After Meiosis, also known as reduction division, consists of mitosis, they act again stimulating the daughter cells to grow, two successive cell divisions in diploid cells. Therefore, FGF and PDGF divisions are similar to mitosis, but differ in that the chromo- are also termed competence factors, whereas EGF and IGF are somes are duplicated only once, not twice. The result of meio- termed progression factors, because they keep the process of sis is four haploid daughter cells. Growth factors are in the sex organs (gonads), the daughter cells are the gametes also classified (along with other molecules that promote the (spermatozoa or ova), which contain hereditary material. Hormones are also pro- halving the number of chromosomes in the sex cells, meiosis mitotic signals. For example, thyrotrophic hormone, one of the assures that the fusion of maternal and paternal gametes at fer- hormones produced by the pituitary gland, induces the prolif- tilization will result in offspring with the same chromosome eration of thyroid gland’s cells. In other words, meiosis compensates known as growth hormone or somatotrophic hormone (STH), for chromosomes doubling at fertilization. The two successive is responsible by body growth during childhood and early ado- nuclear divisions are termed as meiosis I and meiosis II. Each lescence, inducing the lengthening of the long bones and pro- is further divided into four phases (prophase, metaphase, tein synthesis. Estrogens are hormones that do not occupy a anaphase, and telophase) with an intermediate phase (inter- membrane receptor, but instead, penetrate the cell and the phase) preceding each nuclear division. It is important to such as cell-to-cell adhesion, factors of adhesion to the extra- note that the purpose and final products of mitosis and meio- cellular matrix, or soluble factor such as TGF beta (tumor sis are very different. These molecules are the DNA replicates (makes an exact duplicate of itself), result- the products of a class of genes called tumor suppressor genes. Each copy is a sister synthesize proteins that enhance the stimuli started by growth chromatid, and the pair are still considered as only one chro- factors, amplifying the mitotic signal to the nucleus, and/or mosome. The first phase of meiosis I, prophase I, begins as the promoting the accomplishment of a necessary step of the cell chromosomes come together in homologous pairs in a process cycle. When each phase of the cell cycle is completed, the pro- known as synapsis. Homologous chromosomes, or homo- 104 WORLD OF MICROBIOLOGY AND IMMUNOLOGY Cell cycle and cell division logues, consist of two chromosomes that carry genetic infor- with cell organelles to cause the breakdown and reconstruction mation for the same traits, although that information may hold of the nuclear membrane, the formation of the spindle fibers, different messages (e. MPF appears to work sage for eye color, but one codes for blue eyes while the other in a cycle, with the proteins slowly accumulating during inter- codes for brown). The fertilized eggs (zygotes) of all sexually phase, and then rapidly degrading during the later stages of reproducing organisms receive their chromosomes in pairs, meiosis. In effect, the rate of synthesis of these proteins con- one from the mother and one from the father. During synapsis, trols the frequency and rate of meiosis in all sexually repro- adjacent chromatids from homologous chromosomes “cross ducing organisms from the simplest to the most complex.

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