By E. Ben. Northwestern College, Iowa.

It is more rigid than other tissues because it contains inorganic salts mainly calcium phosphate & calcium carbonate clonidine 0.1mg without prescription. Osteons are made up of concentric layers called lamellae discount clonidine 0.1mg without prescription, which are arranged seemingly in wider and wider drinking straws. In the center of the osteons are central canals (haversion canal) , which are longitudinal canals that contains blood vessels, nerves and lymphatic vessels. Central canals, usually have branches called perforating canals /valkmann’s canal that run at right angle to central canal extending the system of nerves and vessels out ward to periosteum and to endosteum. Radiating from each lacuna are tiny canaliculi containing the slender extensions of the osteocytes where nutrients and wastes can pass to and from central canal. Spongy (cancellous) Bone tissue Is in the form of an open interlaced pattern that withstands maximum stress and supports in shifting stress. They are able to synthesize and 63 Human Anatomy and Physiology secrete un-mineralized ground substance, act as pump cell to move calcium and phosphate in and out of bone tissue. Bone in embryo develops in two ways: Intra-membranous ossification, If bone develops directly from mesenchymal tissue. The 64 Human Anatomy and Physiology cartilage it self do not converted into bone but the cartilage is replaced by bone through the process. Endochondrial ossification produces long bones and all other bones not formed by intra-membranous ossification. These are surface markings where muscles, tendons and ligaments attached, blood & lymph vessels and nerves pass. Example: External auditory meatus Groves and sulcus: are deep furrow on the surface of a bone or other structure. Example Medial condyle of femur Head, expanded, rounded surface at proximal end of a bone often joined to shaft by a narrowed neck. The upper part of the lower extremity, between the pelvis and knee, is the thigh; the leg is between the knees an ankle. Made up of horizontal, cribriform plate, median perpendicular plate, paired lateral masses; contains ethmoidal sinuses, crista galli, superior and middle conchae. Forms roof of nasal cavity and septum, part of cranium floor; site of attachment for membranes covering brain. Shaped like large scoop; frontal squama forms forehead; orbital plate forms roof of orbit; supraorbital ridge forms brow ridge; contains frontal sinuses, supraorbital foramen. Slightly curved plate, With turned- up edges; made up of squamous, base, and two lateral parts; contains foramen magnum, occipital condyles, hypo-glossal canals, atlanto-occipital joint, external occipital crest and protuberance. Protects posterior part of brain; forms foramina for spinal cord and nerves; site of attachment for muscles, ligaments. Wedge-shaped; made up of body, greater and lesser lateral wings, pterygoid processes; contains sphenoidal sinuses, sella turcica, optic foramen, superior orbital fissure, foramen 71 Human Anatomy and Physiology ovale, foramen rotundum, foramen spinosum Forms anterior part of base of cranium; houses pituitary gland; contains foramina for cranial nerves, meningeal artery to brain. Made up of squamous, petrous, tympanic, mastoid areas; contain zygomatic process, mandibular fossa, ear Ossicles, mastoid sinuses. Form temples, part of cheekbones; articulate with lower jaw; protect ear ossicles; site of attachments for neck muscles. Fontanels The skeleton of a newly formed embryo consist cartilage or fibrous membrane structures, which gradually replaced by bone the process is called ossification. Function • They enable skull of the fetus to compress as it pass through the birth canal • Permit rapid growth of brain during infancy • Serves as a landmark (anterior fontanel) for withdrawal of blood from the superior sagital sinus • Aid in determination of fetal position prior to birth. In the skull of the fetus there are 6 prominent fontanels: a) The Anterior (frontal) fontanel, between angle of two parietal bones & segment of the frontal bone. They are irregular in shape and begin to close at 1 or 2 months after birth and completed by 12 months. Largest, strongest facial bone; horseshoe-shaped horizontal bony with two perpendicular rami; contains tooth sockets, coronoid, condylar, alveolar processes, mental foramina. Made up of zygomatic, frontal, palatine, alveolar processes; contain infraorbital foramina, maxillary sinuses, tooth sockets. Horizontal plate forms posterior part of hard palate; vertical plate forms part of wall of nasal cavity, floor of orbit. Curved lateral part of (molar) cheekbones; made up of temporal process, zygomatic arch; contain zygomatico-facial and zygomatico-temporal foramina. U-shaped, suspended from styloid process of temporal bone; site of attachment for some muscles used in speaking, swallowing. Orbit has four walls and apex: 78 Human Anatomy and Physiology • The roof of the orbit consists of parts of the frontal & sphenoid bone. Some of the principal openings and And the structures passing through are: Optic foramen (canal) passes optic nerve Superior orbital fissure passes supra orbit nerve and artery. Inferior orbital fissure passes maxillary branch of trigeminal and zygomatic nerve and infra orbital vessel.

The second prophage purchase 0.1mg clonidine with mastercard, PhiRv2 has proven to be much more stable buy cheap clonidine 0.1mg online, with less variability among strains (Cole 1999). A bias in the overall orientation of genes with respect to the direction of replication was also found. It was also found that the number of genes that arose by duplication is similar to the number seen in E. The lack of divergence of duplicated genes is consistent with the hypothesis of a recent evolutionary descent or a recent bottleneck in my- cobacterial evolution (Brosch 2002, Sreevatsan 1997, see chapter 2). This flexibility is useful for survival in the changing environments within the human host that range from high oxygen tension in the lung alveolus to microaerophilic/anaerobic condi- tions within the tuberculous granuloma. In total, there are genes encoding for 250 distinct enzymes involved in fatty acid metabolism, compared to only 50 in the genome of E. These proteins are believed to play an important role in survival and multiplication of mycobacteria in different environments (Marri 2006). Pro- teins in this class contain multiple tandem repetitions of the motif Gly-Gly-Ala, hence, their glycine concentration is superior to 50 %. This gene encodes the enzyme in charge of removing oxidized guanines whose incorporation during repli- cation causes base-pair mismatching (Mizrahi 1998, Cole 1999). With the aim of making the information publicly available and the search and analysis of information easier, the Pasteur Institute (http://www. This database is freely available for use on the Internet and is known as the Tuberculist Web Server http://genolist. As more information was generated, databases grew bigger, more experimental information became available, and better and more accurate algorithms for gene identification and prediction were released. The letter C was not included since it usually stands for “comple- mentary”, which means that the gene is located in the complementary strand. As expected, the classes that exhibited the greatest numbers of changes were the un- known category and the conserved hypothetical category (Table 4-1). The re- annotation of the genome sequence allowed the identification of four sequencing errors making the current sequence size change from 4,411,529 to 4,411,532 bp (Camus 2002). Comparative genomics In recent times, new technologies have been developed at an overwhelming pace, in particular those related to sequencing and tools for genome sequence data man- agement, storage and analysis. As of April 2007, 484 microbial genomes have been finished and projects are underway aimed at the sequencing of other 1,155 micro- organisms (http://www. Mycobacteria are not an exception in this titanic genome-sequencing race; since 1998, when the first myco- bacterial genome sequence was published (Cole 1998a); many genome projects have been initiated. Until April 2007, 34 projects on the genome sequencing of different mycobacterial species are finished or in-process. For this reason, these are the strains that have been used as reference strains for comparative genomics both in vitro and in silico. The next step in comparative genomics was the use of genomic subtractive hybridi- zation or bacteria artificial chromosome hybridization for the identification of re- gions of difference among the strains under analysis (Mahairas 1996, Gordon 1999). As a result, they identified 10 regions of difference, including the three previously described (Mahairas 1996). Until 2002, most studies concerning comparative genomics were based on differ- ences among the strain type M. Some excellent reviews are available on comparative genomics, made before the publication of the second M. This strain was considered to be highly transmissible and virulent for human beings (Fleischmann 2002). With the sequence of this second strain, a first approach to the bioinformatic analysis of intraspecies variability became possible. Dark gray filled cells indicate the presence in all strains tested, light gray indicate the presence in some strains, white is absence from all strains tested. These studies have been complemented with data obtained from the genome sequence of a third organism of the M. Sequencing con- firmed the absence of 11 regions of difference, and the presence of only one inser- tion in comparison to the sequenced M. The comparison of the three genomes reflects the high degree of conservation among the members of the M. However, it is important to mention that the greatest degree of variation among these bacilli is found in genes encoding cell wall components and secreted proteins. Some other changes are registered in genes coding for lipid synthesis and secretion as the mmpL and mmpS family of genes. The sequencing of whole genomes of Mycobacterium leprae (Cole 2001), Mycobacterium avium subspecies paratuberculosis (Li 2005) and of other mem- bers of the genus, such as Mycobacterium smegmatis and M.

Consequently buy clonidine 0.1mg low price, community interventions are a heterogeneous group of measures aimed at avoiding or reducing substance consumption or the damage associated with it best clonidine 0.1mg. The same will be done for the interventions realized within community prevention, looking at what they entail and how they are classified. We will review the main risk factors, such as certain societal characteristics that can be considered predisposing to drug consumption, as well as the conditions of recreational contexts that contribute to substance consumption. Definition The concept of risk factor comes from classical epidemiology, and refers to the frequency and distribution in the population of certain causal agents associated with the occurrence of a given pathology. In this sense, Clayton (1991) defines risk factor as that “individual attribute and/or feature, social condition and/or environmental context which increases the possibility of drug use/abuse (beginning), or a transition in the level of involvement in them. On the other hand, we will understand as protective factor every individual attribute and/or feature, social condition and/or 3 Analysis of Drug Use Prevention on a Community-wide Scale environmental context that inhibits, reduces or attenuates the possibility of the use/abuse of drugs, or a transition in the level of involvement in them”. Traditionally, researchers, clinicians and other professionals working in the field of drug dependency prevention and treatment have addressed their work by assuming a prior approach, a model to guide them and help explain the why behind the initiation and maintenance of substance consumption. In turn, this theoretical premise allows them to design and direct their interventions towards specific objectives and not others considered of less etiological importance. Currently, the approach most accepted by the scientific community, and therefore taken up by public administration in its policies to fight against drug use, is the Bio-Psych-Social Model; an integrative model that aims to address prevention, treatment and rehabilitation from a multidisciplinary approach. The model we present situates the individual at the center of a complex system of influences and interactions that modulate the likelihood of an initial substance use occurring or that this use be sustained and strengthened. All of this generates a dynamic network whose result determines the level of risk we are exposed to and our ability to resolve critical life situations. In the center is the person who provides a structure of biological and psychological intrapersonal factors. From this perspective, the personality profile, genetic makeup and biological vulnerability to suffering certain types of mental or physical disorder will partially determine the person´s ability to adapt to his or her social environment and the likelihood of initiating a first substance use. The next level, called micro social, corresponds to the reference groups with which the individual most intimately coexists. These groups are in order of 4 Daniel Lloret Irles and José Pedro Espada Sánchez appearance: family, school and friends. Each groups together a number of specific factors that influence the individual by increasing or decreasing the chance of confronting an initial substance use. The individual is not considered a passive person at the mercy of the influence of micro social groups. Quite the contrary, their active participation in them results in dialectical pressures that make each case unique. Research seeks the common denominators and relationship patterns among factors that recur most frequently to estimate the risk of substance use and design preventive interventions. Risk factors derived from these groups are numerous, and it is not the objective of this course to dwell on them. Among the other factors are: parenting styles, parental modeling, group and/or family attitudes about substance use, peer pressure from the group of friends towards substance use, school adaptation and information about drugs and their effects. Agents acting at this level are more abstract social entities, but no less influential: the media, public administration, industry and society in its broadest sense. Among them a system of values is constructed in which some values predominate over others that remain secondary. In Western societies, where drug use has increased relentlessly since the sixties, criticism has been raised about the promotion of a series of values that are in line with the economic system, but are the basis of a vision of man built on limitless individual enrichment. General Characteristics of Risk/Protective Factors Non-determinism Drug use is a multifactorial phenomenon (i. Although risk factors have been identified that explain the initiation or maintenance of substance with greater accuracy and probability, their presence is not sufficient to predict the emergence of substance use behavior. The complexity of the relationships between risk/protection factors and drug use precludes a simple and reductionist explanation, and a causal relationship between one or more risk factors and drug use cannot be established. Research has only been able to demonstrate associations between certain situations and drug use, but it has not been able to demonstrate the causality potential of these factors. General 6 Daniel Lloret Irles and José Pedro Espada Sánchez While some factors such as accessibility to substances, the presence of family models of substance use or erroneous information about drugs and their effects are considered specific to the initiation and maintenance of drug use, a larger part of the risk factors that have been identified as predictors of drug use are also risk factors for other problem behaviors. For example, general factors such as the lack of affection during childhood, the lack of clear norms or having lived in an environment without access to educational and/or social resources also explain the emergence of other maladaptive behaviors manifested in, among others, violence, poor school adjustment, and unwanted pregnancies. Likewise, numerous studies have shown that the presence of aggression in parental figures is a wide spectrum factor (i. For example, it is held that the vulnerability to micro social risk factors to which an adolescent is exposed depends on the presence of psychological risk factors. For example, an individual who has low assertiveness or inadequate social skills would be more susceptible to group pressure. The results of studies conclude that risk factors exponentially increase in force when joined together.

To take the absolute number correctly into consideration discount clonidine 0.1mg overnight delivery, the sample findings need to be extrapolated purchase clonidine 0.1mg otc. Based on the relative prevalence of the 15 combinations of drug resistance possible with four drugs and the four resistance modes, i. We also try to cast light on the most probable pathways for the creation of drug resistance. Drug susceptibility test results to the four main antituberculosis drugs were obtained for 90 080 cases (77 175 new cases and 12 905 previously treated cases). In order to learn more about drug resistance patterns within the drug-resistant subset of isolates and to be able to compare differences between new and previously treated case groups, due to possible amplification, we also analysed the data taking as denominator the total number of drug- resistant cases in order to determine proportions, which are also expressed as percentages. From analysis of the data using the total number of cases examined as denominator, we can make the following general statements: • Among new cases, the most frequent drug-resistant types globally are H (3. From the analysis of the data using the total number of drug-resistant cases as denominator, we can make the following general statements: • Among new cases globally, monoresistance represented the majority of the drug resistance problem (60. The proportions of triple and quadruple resistance have been combined to facilitate interpretation. The last four were under the coordination of the Mycobacteriology Unit of the Prince Léopold Institute of Tropical Medicine, Antwerp, Belgium. The following results reflect the overall performance of all laboratories that took part in this proficiency testing exercise from 1994 to 2002. The cumulative sensitivity was 99% for isoniazid, 98% for rifampicin, and 91% for both streptomycin and ethambutol. The cumulative specificity was 98% for both rifampicin and isoniazid, 93% for ethambutol, and 91% for streptomycin. Efficiencies of 100% were found for rifampicin and isoniazid, 97% for ethambutol, and 92% for streptomycin. Intralaboratory reproducibility of results in the two identical pairs of 10 isolates tested was 98% for isoniazid and rifampicin, 96% for ethambutol, and 91% for streptomycin. The number of countries participating in the project has increased nearly threefold since the first report. Performance criteria for the Supranational Laboratory Network have been developed, four new laboratories are candidates to join, and nine rounds of proficiency testing have been completed. Guidelines for the surveillance of drug resistance in tuberculosis have been revised, and a fourth version of software to analyse drug resistance has been developed. Most importantly, global results of the project are fuelling discussions about policy implications. The areas represented in this project are those with at least the minimum requirements to conduct surveillance, and it is likely that the worst situations have not yet been uncovered. The data reported in this third phase of the Project have reinforced many of the conclusions drawn in its first and second reports, and contribute to a more in-depth analysis of dynamics and trends. Despite the inclusion of different countries in each phase of the project, the medians for most resistance parameters were similar in all reports, but the outliers varied. Though the Global Project has been operating since 1994 very few countries have reported data for all nine years. Data from repeated surveys employing comparable methodologies over several years are essential to determine with any certainty in which direction prevalence of drug resistance is moving. A better programme can result in the reduction of the overall number of re-treated cases; however, difficult (resistant) cases may persist. Improvement in laboratory proficiency, particularly the sensitivity and specificity of drug susceptibility testing, may also affect the observed prevalence of resistance. The scenarios outlined above highlight the importance of evaluating trends in prevalence of drug resistance within the context of relevant programme developments. Only Botswana, Sierra Leone, and Mpumalanga Province, South Africa, have carried out repeat surveys. In general, drug resistance in the region is low, but the trends in Botswana and Mpumalanga Province in South Africa indicate that it is increasing. Botswana in particular showed a significant increase in prevalence of any resistance. Sierra Leone, with two data points in the first and second reports, showed very little change in prevalence of resistance. Reported prevalence of resistance from recent surveys in Algeria and the Gambia was very low, and only slightly higher in Zambia, confirming the low levels of resistance in the region reported in previous phases in the project. A survey in the city of Kinshasa, Democratic Republic of Congo, reported results for combined cases only. It will be important to conduct a nationwide survey, as urban centres in general report higher prevalence of resistance than the national average. Regular reports of drug shortages and high default rates from treatment over this period have given further evidence of conditions for increasing drug resistance. In contrast, data from a previous province-wide survey in Western Cape, not included in the Global Project but following the accepted methodology, indicated relatively stable levels of drug resistance. Prevalence of resistance found in the 2001–2002 survey was nearly the same as those reported in the 1993 survey. In the recent survey, it was the only province where there was not significant under detection of retreatment cases, i.