By Q. Phil. Kennesaw State University.

The meaning of “caring” in codetermining polar opposites of the humanistic the organization showed that meaning was con- dimensions as the thesis of caring in relation to the stituted within a larger pattern of significance order decadron 1 mg line skin care 7. Social forms and social arrange- Complexity theory has replaced other theories 1 mg decadron with amex acne breakout causes, ments reflect the interplay between cultural systems such as Newtonian physics and even Einstein’s be- of thought and organization. The system reflected liefs that the physical world is governed by law and the symbols of political and economic power and order. New scientific views state that phenomena authority, technology and the law, and the psycho- that are antithetical actually coexist—determinism dynamics of caring in human experience. Middle- with uncertainty and reversibility with irreversibil- range theory embodies the perspective that these ity (Nicolis & Prigogine, 1989). Thus, both linear theories fall between the concrete world of practice and nonlinear and simple (e. One of the tools in the studies of complexity reflects the concrete world of practice and responds is chaos theory. Chaos deals with life at the edge, or to the caring ideal that is unique to nursing. The holographic paradigm in science recognizes Certain nursing theorists have embraced the notion that the ontology or “what is” of the universe or of nursing as complexity in which consciousness, creation is the interconnectedness of all things, that caring, and choice making are central to nursing the epistemology or knowledge that exists is in the (Davidson & Ray, 1991; Newman, 1986, 1992; relationship rather than in the objective world or Ray, 1994, 1998). Holography means that the implicit order from the decisions that were made about the struc- ture of organization (consciousness), the caring Holography means that the implicit order transactions that were engaged in (caring), and the (the whole) and explicit order (the part) effective negotiations or ability to make choices and are interconnected, that everything is a reconcile the system demands with the humanistic holon in the sense that everything is a client care needs (choice making). The theoretical whole in one context and a part in an- processes of awareness of viewing truth or seeing other—each part being in the whole the good of things (caring), and communication, and the whole being in the part. The dialectic of caring (the implicit order) in relation to the various struc- (the whole) and explicit order (the part) are inter- tures (the explicit order) illustrates that there is connected, that everything is a holon in the sense room to consider the theory as holographic. It is the relational aspect of informa- connected—humanistic and spiritual tion that makes it a holistic rather than a mecha- caring and the organizational system— nistic construct. Nursing is being shaped by the that everything is interconnected—humanistic and historical revolution going on in science, social spiritual caring and the organizational system—the sciences, and theology (Harmon, 1998; Newman, whole is in the part and the part is in the whole, a 1992; Ray, 1998; Reed, 1997; Watson, 1997; holon. In these new approaches, con- How can knowledge of caring interconnected- structs of consciousness and choice are central and ness motivate nursing to continue to embrace the demonstrate that phenomena of the universe, in- human dimension within the current economic cluding society, arise from the choices that are or are and technologic environment of health care? Can not made (Freeman cited in Appell & Triloki, 1988; higher ground be reclaimed for the twenty-first Harmon, 1998). Higher ground requires that we make task is to comprehend the relationship between excellent choices. It is therefore imperative that what is given in culture (the jural order) and what is spiritual and ethical caring thrive in complex sys- chosen (the moral and spiritual) between destiny tems. In nursing, the unitary-transforma- Bureaucratic Caring, illustrates that through spir- tive paradigm and the various theories of Newman, itual/ethical caring as the choice point for commu- Leininger, Parse, Rogers, and the holographic nication in relation to the complexity of the Theory of Bureaucratic Caring are challenging sociocultural system, nursing can reclaim higher nursing to comprehend a similar relationship. As noted, a re- Ray, 1991; Ray, 1994a, 1998; Reed, 1997; Vicenzi, vision toward this end is taking place in science White, & Begun, 1997). Nursing has the capacity to make creative and Through “authentic conscience” (Harmon, 1998) moral choices for a preferred future. Spiritual/ethical caring is both a part and a whole, and every part secures its Social- purpose and meaning from each of the parts that Physical Cultural can also be considered wholes. It brings with it a spirit of repentance, hended within as intimacy and spirit (Harmon, seeing in a new way, a change of heart. Because of the crisis of our rela- As the twenty-first century is evolving, nurs- tionship to work, we are challenged to reinvent it. As the Theory of Bureaucratic Caring in touch with others, not only in terms of personal has demonstrated, caring is the primordial gain, but also at the level of service to humanity or construct and consciousness of nursing. Reenvisioning the theory as holographic Work must be spiritual, with recognition of the shows that through creativity and imagina- creative spirit at work in us. Thus, nurses must be tion, nursing can build the profession it the “custodians of the human spirit” (Secretan, wants. The ethical imperatives of caring that join with The new scientific and spiritual approach the spiritual relate to questions or issues about our to nursing theory as holographic will have moral obligations to others. The union of science, ethics, edifying the good through communication and in- and spirit will engender a new sense of teraction involve never treating people simply as a hope for transformation in the work world. Ethical content—as principles of doing good, Nurses can reintroduce the spiritual and eth- doing no harm, allowing choice, being fair, and ical dimensions of caring. The deep values promise-keeping—functions as the compass in our that underlie choice to do good for the many decisions to sustain humanity in the context of po- will be felt both inside and outside organiza- litical, economic, and technological situations tions. Roach (2002) pointed out act on this awareness and no longer surren- that ethical caring is operative at the level of dis- der to injustices and oppressiveness of sys- cernment of principles, in the commitment needed tems that focus primarily on the good of a to carry them out, and in the decisions or choices to few.

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A tissue that’s one layer thick but appears to be multilayered and is composed of cells taller than they are wide is a generic decadron 1mg mastercard skin care solutions. Simple cuboidal Making a Connection: Connective Tissue Connective tissues connect order decadron 1 mg with amex acne-, support, and bind body structures together. Unlike other types of tissues, connective tissues are classified more by the stuff in which the cells lay — the extracellular matrix — than by the cells themselves. The cells that produce that matrix are scattered within it like chocolate chips in ice cream. The load-bearing Chapter 4: The Study of Tissues: Histology 51 strength of connective tissue comes from a fibrous protein called collagen. All connec- tive tissues contain a varying mix of collagen, elastic, and reticular fibers. Following are the primary types of connective tissue: Areolar, or loose, tissue: This tissue exists between and around almost every- thing in the body to bind structures together and fill space. It’s made up of wavy ribbons called collagenous protein fibers, cylindrical threads called elastic fibers, and amorphous ground substance, a semisolid gel. Various cells including lympho- cytes, fibroblasts, fat cells, and mast cells are scattered throughout the ground substance (see Figure 4-2). Dense regular connective tissue: Made up of parallel, densely packed bands or sheets of fibers (see Figure 4-2), this type of tissue is found in tendons as bundles of collagenous fibers attaching muscles to bone and in ligaments as bundles of elastic fibers extending from bone to bone, surrounding a joint, and anchoring organs. Mast cell Fibers of Matrix Collagen fiber clei of fibroblasts Fibroblast Illustration by Imagineering Media Services Inc. Dense irregular connective tissue: Also known as dense fibrous connective tissue, it consists of fibers that twist and weave around each other, forming a thick tissue that can withstand stresses applied from any direction. This tissue makes up the strong inner skin layer called the dermis as well as the outer cap- sule of organs like the kidney and the spleen. Adipose tissue: Composed of fat cells, this tissue forms padding around internal organs, reduces heat loss through the skin, and stores energy in fat molecules called triglycerides. Fat molecules fill the cells, forcing the nuclei against the cell membranes and giving them a ring-like shape. Reticular tissue: Literally translated as “web-like” or “net-like,” reticular tissue is made up of slender, branching reticular fibers with reticular cells overlaying them. Its intricate structure makes it a particularly good filter, which explains why it’s found inside the spleen, lymph nodes, and bone marrow. Part I: Building Blocks of the Body 52 Cartilage: These firm but flexible tissues, made up of collagen and elastic fibers, have no blood vessels or nerve cells (a state called non-vascular or avascular). Cartilage contains openings called lacunae (from the Latin word lacus for “lake” or “pit”) that enclose mature cells called chondrocytes, which are preceded by cells called chondroblasts. A membrane known as the perichondrium surrounds cartilage tissue, which also contains a gelatinous protein called chondrin. There are three types of cartilage: • Hyaline cartilage: The most abundant cartilage in the body, it’s elastic and made up of a uniform matrix pocked with chondrocytes. It lays the founda- tion for the embryonic skeleton, forms the rib (or costal) cartilages, makes up nose cartilage, and covers the articulating surfaces of bones. The sponge-like structure, with the lacunae and chondro- cytes lined up within the fibers, makes it a good shock absorber. It’s found in the intervertebral discs of the vertebral column and in the symphysis pubis at the front of the pelvis. This structure, which makes up the ear lobe and other structures where a specific form is important, tends to bounce back to its original shape after being bent. Bone, or osseous, tissue: Essentially, bone is mineralized connective tissue formed into repeating patterns called Haversian systems. In the center of each system is a large opening, the Haversian canal, that contains blood vessels, lymph vessels, and nerves. The central canal is surrounded by thin membranes called lamellae that contain the lacunae, which in turn contain osteocytes (bone cells). Smaller canali- culi connect the lacunae and circulate tissue fluids from the blood vessels to nour- ish the osteocytes. Like other connec- tive tissues, it has an extracellular matrix — in this case, plasma — in which are suspended erythrocytes (red blood cells), leukocytes (white blood cells), and thrombocytes (platelets). Erythrocytes are concave on both sides and contain a pigment, hemoglobin, which supplies oxygen to the body’s cells and takes carbon dioxide away.

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Tis means that age predictability within each stage consists of an interval of about eight years decadron 0.5 mg discount tretinoin 005 acne. As with the computation of chronological age purchase 1 mg decadron amex skincare for men, the relationship between third molar development and attainment of legal adulthood is quite variable. It was found that if third molar root formation was complete with closed apices and uniform Table 13. Probabilities for the terminal grade (H) presume that, based on other criteria, the subject is less than twenty-fve years of age. Max = Maxilla Mand = Mandible M = Male F = Female width of periodontal ligament (Stage H), there is a high probability that an individual is at least eighteen years old. Te probability that an individual with complete root formation of the mandibular third molars is eighteen or older is 90. In a large multinational study carried out on three samples, it was found that at each stage of third molar development Japanese subjects were on average one to two years older than corresponding German subjects, and South Africans were on average one to two years younger. Tis indicates that if an odontologist uses this technique to assess legal adulthood of an individual, he should consider ethnicity of the subject and refer to appropriate studies for data. Some studies indicate that using a combination of dental and skeletal developmental fndings results in increased accuracy of age estimation. Comparably, Chaillet and Demirjian found that the addition of the third molar to Demirjian’s original seven-tooth method increased accuracy of the estimate. Racemization continues at a markedly reduced rate afer death, so it is also useful for aging archaeological samples. Helfman and Bada frst showed that age can be determined from the enamel or dentin of a tooth by quantifying the relative amounts of the D- and L-forms of aspartic acid. Age estimation using racemization depends on the assump- tions that (1) the aspartic acid has not been replaced by remodeling or by diagenesis since the tooth was formed, and (2) the temperature has been con- stant (as in the human mouth at 37°C). According to the claim put forth by Helfman and Bada in their original publication166 (p. Carolan and coworkers concluded that age estimation based on racemization is similar in reliability to other dental methods. Te atmospheric levels of this isotope had been stable at much lower levels prior to 1955. Since the cessation of testing in 1963 the levels have been decreasing exponentially. Eating those plants and animals that eat those plants causes 14C uptake in the metabolically stable tooth enamel as it is formed. By calculating the levels of 14C with consideration of known tooth development data for the specifc tooth tested, an estimated date of birth can be calculated. Initial tests on twenty-two individuals of known age resulted in estimates that were reported to be accurate within about 1. Te technique is useful only for individuals born afer 1943 since the formation of the enamel of the third molars is completed at approximately age twelve. Tird molar enamel 14C levels of 0 would indicate only that the individual was born before 1944, but even this could be useful forensic information. Teeth samples were collected and prepared at Karolinska Institute, Stockholm, Sweden, and 14C levels were determined by accelerator mass spectrometry at Lawrence Livermore National Laboratory, Livermore, California. Te age at death estimate from aspartic acid racemization analysis combined with the date of birth from 14C levels could, by calculation, provide investigators with the estimated date of death. Collectively, the methods can be applied from before birth (all primary teeth begin formation in the second trimester) into very old age. Improved oral health—fewer caries and less periodontal disease—means that more forensic cases will have teeth (and more teeth) than in the past. A predictable conclusion from this review is that more studies are needed, but not just more of the same. We identify two areas of need: First, Westernized countries are quickly becoming the homes of diverse peoples from around the globe, and the forensic specialist is ill-equipped to account for the range of racial variation. Te problem becomes more complex when a person grows up in one cultural setting, then immigrates to quite another. More studies of ethnically-racially diverse segments of our population are needed. Second, our opinion is that forensic odontology research in age estimation has been lacking in scope and execution, with numerous reports sufering from small sample sizes and restricted analysis.

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M Peyer’s patches are masses of lymphatic nodules found in the distal portion of the small intes- tines 1 mg decadron with amex acne 911 zit blast. You may be tempted to write “thoracic duct” here order 1mg decadron free shipping skin care zarraz paramedical, but that’s incorrect because the duct is the largest vessel, not the largest organ. P In the center of the nodules of the lymph node are areas called germinal centers. When you read “germinal,” think of the word “germinate,” and then think of a place where lymphocytes can sprout and mature. Chapter 12 Filtering Out the Junk: The Urinary System In This Chapter Putting the kidneys on clean-up duty Tracking urinary waste out of the body f you read Chapter 9 on the digestive system, you may be chewing on the idea that undi- Igested food is the body’s primary waste product. We make more of it than we do feces — in fact, our bodies are making small amounts of urine all the time — and we release it more often throughout the day. Most important, urine captures all the leftovers from our cells’ metabolic activities and jettisons them before they can build up and become toxic. In addition, urine helps maintain homeostasis, or the proper balance of body fluids. In short, the urinary system Excretes useless and harmful material that it filters from blood plasma, including urea, uric acid, creatinine, and various salts Removes excess materials, particularly anything normally present in the blood that builds up to excessive levels Maintains proper osmotic pressure, or fluid balance, by eliminating excess water when concentration rises too high at the tissue level In this chapter, we look at how the urinary system collects, manages, and excretes the waste that the body’s cells produce as they go about busily metabolizing all day. You practice iden- tifying parts of the kidneys, ureter, urinary bladder, and urethra. Examining the Kidneys, the Body’s Filters The kidneys are nonstop filters that sift through 1. Humans have a pair of kidneys just above the waist (lumbar region) toward the back of the abdominal cavity. While sometimes the same size, the left kidney tends to be a bit larger than the right. The last two pairs of ribs surround and protect each kidney, and a layer of fat, called perirenal fat, pro- vides additional cushioning. Kidneys are retroperitoneal, which means that they’re posterior to the peritoneum. The renal capsule, or outer lining of the kidney, is a layer of collagen fibers; these fibers extend outward to anchor the organ to surrounding structures. Each kidney is dark red, about 4 ⁄12 inches long, and shaped like a bean (hence the type of legumes called kidney beans). The portion of the bean that folds in on itself, referred to as the medial border, is concave with a deep depression in it called the hilus, or hilum. The hilus opens into a fat-filled space called the renal sinus, which in turn contains the renal pelvis, renal calices, blood vessels, nerves, and fat. Immediately below the renal capsule is a granular layer called the renal cortex, and just below that is an inner layer called the medulla that folds into anywhere from 8 to 18 conical projections called the renal pyramids. Between the pyramids are renal columns that extend from the cortex inward to the renal sinus. The tips of these pyramids, the renal papillae, empty their contents into a collecting area called the minor calyx. It’s one of several sac-like structures referred to as the minor and major calyces which form the start of the urinary tract’s “plumbing” system and collect urine transmitted through the papillae from the cortex and medulla. Although the number varies between individuals, generally each of two or three major calyces branches into four or five minor calyces, with a single minor calyx surrounding the papilla of one pyra- mid. Urine passes through the minor calyx into its major calyx and then on into the ureter for the trip to the bladder. Going molecular At the microscopic level, each kidney contains hundreds of thousands of tiny tubes known as uriniferous tubules, or nephrons. At one end, each nephron is closed off and folded into a small double- cupped structure called a Bowman’s capsule, or the glomerular capsule, where the actual process of filtration occurs. This tube straightens to form a structure called the descending loop of Henle and then bends back in a hairpin turn into another structure called the ascending loop of Henle. This tubule connects to a collecting tubule that it shares with the output ends of many other nephrons. The collecting tubules open into the minor calyces of the renal pelvis, which in turn open into the major calyces. Because of their role as the body’s key filters, the kidneys receive about 20 percent of all the blood pumped by the heart each minute. A large branch of the abdominal aorta, called the renal artery, carries that blood to them.

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