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A matching vaccine will require knowledge of the pandemic strain cheap extra super levitra 100 mg with amex, and until the next pandemic begins buy generic extra super levitra online, we will not know for certain what that strain will be buy extra super levitra 100mg on-line. Current efforts are working with a number of strains buy genuine extra super levitra line, mostly H5 strains, as this seems to be the most likely origin at the present time. The cells could be grown on microcarri- ers – glass beads – to enable high volume culture (Osterholm 2005). Attenuating the virulence of the virus is important, considering the increased mortality rate of the current highly pathogenic H5N1 avian influenza when it does enter hu- man hosts. While the H5N1 mortality rate in humans at present doesn’t neces- sarily reflect the mortality rate in an eventual pandemic, serious attention must be paid to the pathogenicity of the current H5N1 strain before it can be used in a vaccine. This may open even more doors for potential reassortment, however, and it may take considerable time to demonstrate safety in certain populations, such as the elderly and chil- dren. These vaccines will likely never be used, and are being developed to demonstrate that when the actual pandemic vaccine is needed, the principle is sound, and the technology is in place and proven on previous vaccines – hence the term “mock vaccine”. The important Pandemic Vaccine 141 aspect is the development of established vaccines that do not need lengthy studies before they can enter the market. They need to contain viral antigens humans have not had previous exposure to, such as the H5N1 antigens, and companies need to take them through clinical trials to determine immunogenicity, dose, and safety, and ultimately be licensed for use in the same stringent procedures used for other vac- cines. Currently, an expedited system is in place for the inactivated influenza vaccines against seasonal human influenza – the whole process, from the identification of the strains to be used, to the injection in the consultation room, takes about 6-8 months, because the vaccine is an established one, and only certain aspects need to be con- firmed prior to release. Production capacity In an ideal world, 12 billion doses of monovalent vaccine would be available in order to administer two doses of vaccine to every living human being. Currently, the world’s vaccine production capacity is for 300 million doses of tri- valent vaccine per year. This amounts to 900 million doses of monovalent vaccine, if all production were shifted to make a pandemic vaccine. Considering that at least two doses will be needed, the current capacity serves to provide for only 450 million people. This is further complicated by the fact that the dose of antigen that will be required is not yet known, but studies indicate that it may be higher than current human influenza vaccines (Fedson 2005). The world has suffered from vaccine shortages before – recently in the 2004/5 winter season, and closer to the threatening situation, in the pandemic of 1968. Furthermore, many countries do not have their own production facilities, and will rely on those countries that do. Transition Osterholm asks (Osterholm 2005), “What if the pandemic were to start …” – tonight – within a year – in ten years? The New England Journal of Medicine had an interview with Dr Osterholm, which is available online for listening to or for downloading: http://content. Vaccine and drug production would have to be escalated – for much later in the pandemic, as this will not make a difference in the short term. The world’s healthcare system would have to plan well in order to cope with distribu- tion when they become available – at present, it is doubted that it could handle the distribution and administration of the vaccines, never mind trying to handle that 142 Vaccines under the pressure placed on it by a pandemic. Vaccines may only be available for the second wave of the pandemic, which tends to have a higher mortality than the initial wave. If the pandemic starts in a year’s time, it is likely that we will then have some expe- rience in developing mock vaccines, so that a vaccine could be produced relatively quickly using a variety of the technologies currently under investigation. There would still be a significant delay, and it is likely that there would still be insufficient quantities, with rationing required. If the pandemic is delayed by a few years, we may well have the required vaccine production capacity to minimise the disastrous consequences. Strategies for expediting the development of a pandemic vaccine Shorten the time between emergence of a pandemic virus and the start of commer- cial production. This will require adopting a centralized evaluation team to examine the find- ings of the studies and give clearance for the use of the vaccine. The vaccine needs to become established through “mock” trials in order to be able to be expedited in this way – then, like the current influenza vaccine, it is known, and only brief studies are required to confirm immunogenicity and safety. Increased production capacity must be developed worldwide – for example, changing to cell culture vaccines. Another important means to improve pro- duction is to increase consumption – using more of the current vaccine today will not only decrease the burden of current influenza disease, as well as help- ing to prevent reassortment in humans infected with two strains of virus, but will ultimately enable production to be increased. Antigen sparing methods, such as intradermal injection, need to be researched more thoroughly, as they provide for a potential saving in antigen – the 1 µg of antigen (per strain) in current vaccines could be lowered considerably. If we th could use one 8 of the dose, our current 900 million monovalent doses could be expanded to 7. Adjuvants need to be evaluated – if immunogenicity can be enhanced, less an- tigen would be required for a protective immune response. Mock-up vaccines must be developed and tested in clinical trials to determine the most antigen sparing formulation and the best vaccination schedule (Fedson 2005, Kilbourne 2005). Controversies A number of controversies surrounding the development of a new influenza vaccine need to be dealt with (Fedson 2005, Osterholm 2005). Financial – patents exist for the plasmid-based methods of making virus in cell culture and the legal implications in various countries need to be examined and ad- dressed. Rationing – in the event of vaccine shortage, higher risk groups will need vaccina- tion first, along with those working on the front lines to control the pandemic. In such an event, the definition of “high risk group” may need to be revised – will it include children, for instance? Liability issues – due to increased vaccination with current vaccines, greater atten- tion must be paid to liability. Several countries have legislation that limits and/or covers certain liability for vaccine companies – encouraging such legislation will make vaccine companies feel more free to develop new vaccines, and increase the supply of current vaccines. When the time comes for rapid entry of pandemic vac- cines into general use, such legislation will be important. Organising Barnett employs a Haddon Matrix to show what sort of planning needs to be done at different stages of the pandemic, from pre-pandemic to post-pandemic (Barnett 2005). In 2001, the Global Agenda for Influenza Surveillance and Control was established (Webby 2003, Stohr 2005). Its role is to enhance our surveillance abilities, in order to better detect a pandemic, and prepare for influenza seasons until then. It needs to help solve the contro- versies over financing, patents and intellectual property, equity for developing countries and countries not producing vaccine, and rationing of vaccine when sup- plies do not meet the demands of a population of more than 6 billion people. We need an international approach to public funding that will pay for the excess production ca- pacity required during a pandemic. Journal of Infectious Diseases, 1997, vol 176, suppl 1, Pandemic Influ- enza: Confronting a Re-emergent Threat http://www. Influenza Vaccination in Pregnancy: Practices Among Obstetrician-Gynecologists --- United States, 2003--04 Influenza Season. Effectiveness and cost-benefit of influenza vaccination of healthy working adults: A randomized controlled trial. Report of meeting on the development of influenza vaccines with broad spectrum and long-lasting immune responses, World Health Organization, Geneva, Switzerland, 26-27 February 2004. Multiple gene segments control the temperature sensitivity and attenuation phenotypes of ca B/Ann Arbor/1/66. Safety, vaccine virus shedding and immunogenic- ity of trivalent, cold-adapted, live attenuated influenza vaccine administered to human im- munodeficiency virus-infected and noninfected children. Safety and immunogenicity of a Pro- teosometrade mark-trivalent inactivated influenza vaccine, given nasally to healthy adults. An improved reverse genetics system for influ- enza A virus generation and its implications for vaccine production. The efficacy and cost effective- ness of vaccination against influenza among elderly persons living in the community. Live attenuated influenza vaccine, trivalent, is safe in healthy children 18 months to 4 years, 5 to 9 years, and 10 to 18 years of age in a community-based, nonrandomized, open-label trial. Influenza vaccination of health care workers in long- term-care hospitals reduces the mortality of elderly patients. Production of pilot lots of inactivated influenza vaccines from reassortants derived from avian influenza viruses - Interim biosafety risk assessment. Effect of simultaneous admini- stration of cold-adapted and wild-type influenza A viruses on experimental wild-type influ- enza infection in humans. In this chapter the role of the most important of these tests will be discussed as well as their advantages and limitations. However the best diagnostic test has little value without appropriate good quality specimen collection and correct patient information. Laboratory Diagnosis of Human Influenza Appropriate specimen collection Respiratory specimens The timing of specimen collection is very important since the yield is the highest for respiratory specimens obtained within four days of onset of symptoms.

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After care: The arms must be splinted with card board so that the child can not touch the wound buy generic extra super levitra 100mg online. Crying must be prevented by good nursing care and lifting the mother to spend much of her time with the child purchase extra super levitra 100mg otc. Soft feeds are given by spoon well back on the tongue and followed by sterile water buy generic extra super levitra 100 mg online. Cleft palate: is treated similarly by paring the adages and suturing after cutting on either side generic extra super levitra 100 mg otc. Preparation The child should be admitted well before operation to be accustomed with the environment. The two most common types of club foot are: Talipes equinovarus Talipes calcaneovalgal Both types are usually bilateral. In Talipes equinovarus, the foot is fixed in palantar fixation and deviates medially i. Delay makes correction more difficult, since the bones and muscles of the leg develop abnormally, and the tendons will be shortened. In infancy, the application of cast to hold the foot in correct position may be used the nurse may be responsible for immobilization and holding the child during cast application. If this measure fails to correct, the surgery on the tendons and bones may be done in early childhood, and the leg and food placed in a cast. If the child has undergone operation and cast has been applied the nurse must watch for evidence of impairment of circulation or sensation and bleeding, i. The nurses circle the area of discoloration and write the time this was done on the cast. After operation it is necessary to change the cast every three weeks to bring the foot gradually into normal position and ensure permanent correction. When the cast is no longer needed exercise may be required and parents need advice to return for checkup. The clinical manifestation is a swelling at the umbilicus which is covered with skin. Treatment and Responsibilities of the Nurse • Most small umbilical hernias disappear without treatment, but large ones may require operation. A normal diet and fluid may be given; pressure dressing applied at the time of operation must be kept clean and dry to prevent wound contamination. Congenital Hypertrophic pyloric stenosis This is a common surgical condition of the intestinal tract in infancy. It occurs most frequently in some family strain, in first- born infants, and in males. Pathologically, there is an increase in size of the circular musculature of the pylorus. The musculature is greatly thickened, and the resulting tumor like mass constricts the lumen of the pyloric canal. Clinical manifestations and x-ray, finding The symptoms appear in infants 2-4 weeks old. The vomiting is at first mild, becomes progressively more forceful until it is projectile. The signs of pyloric stenosis, dehydration with poor skin turgor, distention of the epigastrium and an olive-shaped mass, located by palpation, in the right upper quadrant of the abdomen. If barium is added to the feeding, an x-ray film will show the enlargement of the stomach, and the narrowing and enlargement of the pylorus, increased peristaltic waves, and an abnormal retention of the barium in the stomach. Treatment 66 Pediatric Nursing and child health care Pyloromyotomy involving longitudinal splitting of the hypertrophied circular muscle of the pylorus without incising the mucus membrane allow more food to pass through. Preoperative care • Correction of fluid and electrolyte imbalance since a dehydrated infant is at surgical risk. The mortality rate is low, proceeded operation is undertaken before the infant has become too dehydrated and malnurished. In severe case this will prevent the scape of urine, so that the fore skin is distended during mictaration, and the infant screams with pain and strains during the act. Paraphimosis, a condition due to a tight foreskin being pushed up and constrict the circulation, causing swelling of the parts below so that the foreskin cannot be pushed down again, and requiring operative treatment. Treatment: - Circumcision, cutting away the foreskin - After this operation the wound must be kept clean, antiseptic dressing applied, and the parts cleansed after passing of the urine. It may occur in almost in any area of the spina but most common in lumbosacral region. It is the most common developmental defect of the central nervous system occurring in about one of 1000 newborn infant. Meningocele, in which the meninges protrude through the opening in the spinal canal. Meningomylocele, in which both the spinal cord and the meninges protrude through the defect in the bony rings of the spinal canal. Spina bifida occulta: The majority of patients with spina bifida occulta have no symptoms. There is no need for treatment unless neurological symptoms indicate that the 69 Pediatric Nursing and child health care defect is greater than was thought. If there is possibility that the spinal cord may be involved in the defect, surgical treatment is indicated. Meningocele: On examination the newborn infant is found to have a defect on the spinal column large enough to protrude through the opening. There is generally no evidence of weakness of the legs, the infant straitens and kicks in normal manner, or if lack of spincter control, though this is difficult to a certain in the newborn. Hydrocephalus may be an associated finding or may be aggravated after operation for a meningocele. Meningomyelocele: In this condition an imperfectly developed segment of the spinal cord as well as the meninges, protrudes through the spina bifida in the lumbosacral region. There may be a minimal weakness to a complete flaccid paralysis of the legs and absence of sensation in the feet. Operation removes a cosmetically unacceptable deformity, prevents infection and in many instance improves the neurological deficit since obstruction is removed from the nerve path ways. Prompt surgical closure of the skin defect preferably within 24 to 48 hours after birth is done to prevent meningeal irritation. Responsibilities of Nurse post operatively: • Observing and reporting of all signs and symptom of the infant’s condition. The accumulation of fluid in the ventricles generally enlarges the infants skull, since the suture are not closed and the bones are soft. Treatment: should be started as soon as the clinical manifestations are observed, before damage to the brain itself. Ventriculovenostomy (shunting from the ventricle through the internal juqular vein to the right atrium of the heart), ventriculo peritoneostomy, ventriculoureterostomy, and lumbar subara- chnoid pertoneostomy. The prognosis is dependant to a great extent on the promptness of treatment and the kind of operation performed. Responsibility of the Nurse: ƒ Observing the degree of irritability and changing vital signs should be reported promptly. Postoperative care: - The temperature, pulse and respiration should be observed every 15 minutes until the infant is reactive. Bilirubin is the main pigment formed in humans during the catabolism 73 Pediatric Nursing and child health care of the hem component of hemoglobin. Either excessive production or defective elimination of bilirubin causes jaundice. Discuss the role and responsibility of nurse in identifying and caring for a child with congenital abnormality at birth 2. What measures would you take concerning parents who had a baby with congenital abnormality? This is mainly the stage of development, when the body systems become more efficient 76 Pediatric Nursing and child health care Harmful environmental factors, such as infections like rubella (German measles) in the mother, or exposure to certain drugs or X-rays may interfere with the development of the fetus at this stage. Malnutrition or amaemia in the mother, or other disease of placenta like malaria interfering with its blood supply, will stop the fetus growing properly. The infant: growth and development is a continuous process, but it often goes fast for a while and slows down before going fast again. The infant needs a relatively large amount of water, energy, and protein while growing so fast. At birth the head is a quarter of the whole body length but in an adult it is only one eight. Head Circumference: The head grows 12 cm in circumference in the first 12 months, but 6 cm of this is in the first three months; during the next three months it grows 3 more cm and 78 Pediatric Nursing and child health care the rest of the year another 3cm.

Increase in the swelling of the brain (raised Intracranial tension) buy extra super levitra 100mg otc, seizure purchase 100mg extra super levitra visa, hydrocephalus order extra super levitra uk, subdural effusion or subdural empyema (abscess between the membranes of the brain) or brain abscess buy 100mg extra super levitra with mastercard, hearing loss, venous thrombosis, vasculitis etc. This disease starts with low grade fever, headache, weakness, anxiety and therefore, initially it is not diagnosed and the disease advances in the absence of proper treatment leading to unconsciousness and seizures etc. These medicines have severe side effects on the kidney, liver, ears etc and thus should be administered carefully. Viral Encephalitis : This is an extremely fast spreading disease in which the patient gets fever, headache, sudden behavioural changes, depression, photophobia. This disease quickly damages the cells of the brain and many times leaves residual damage in the body, like memory loss, seizures or behavioral changes. Sometimes, the virus affects only the membranes of the brain causing viral meningitis, which is not a very serious disease in comparison. If the disease is diagnosed in the initial stage, immediate treatment can save life and disabilities, e. Similarly, there are some other viruses affecting the brain, they are called slow virus, and they destroy the brain cells slowly, in months and years. Medicines which are available are hardly effective and in most of the cases the patient is pushed to the brink of death. Falciparum Malaria : Malarial organisms are a part of the micro-organisms, but they are completely different from the virus and bacteria and belong to protozoa group. When the Anopheles female mosquito bites a human, along with the sting the sporozoites of the malarial parasite enter the blood stream and within a short period enter the liver cells. Ultimately, the cells of the liver rupture and innumerable merozoites enter blood and then enter the red blood corpuscles. When a female Anopheles mosquito bites a malarial patient and sucks the blood, gametocytes also reach the stomach of the mosquito and there, in the stomach new sporozoites develop, which enter the blood stream of another person through the sting of the mosquito. The rest of the merozoites, which are present in the blood cells continue with the process of development, division and growth. Eventually, these red cells also rupture and innumerable merozoites are released in the blood stream and enter other red cells. This is also the cause of anemia (pallor or decrease in the hemoglobin levels) after frequent bouts of malaria. Thus, malarial parasites continue their life cycle in female anopheles mosquito and humans and keep the disease as well as themselves alive. These malarial parasites infect all the stages of the red blood corpuscles (Vivax infects only the newly formed blood cells) 1 to 2% of the total blood cells get infected. Thus the number of infected blood cells is considerably more and the resulting anemia is also more severe. Blood Test for Confirmation of Diagnosis : If the required blood test is carried out carefully, malarial parasites are normally seen in the blood cells in a peripheral smear. In falciparum malaria, the proportion of malarial parasite being more they can be seen very easily in the blood test, but in vivax type of malaria the numbers being less, many times they cannot be seen. Many a times the blood tests are negative in a patient who has self medicated himself and has taken 2 to 4 tablets of chloroquin. If the fever is not cured even then, further investigations should be done to find out the exact cause and treatment given accordingly. It is said that in our country the main reason for the seizures in younger generation is the infection of a parasite named cysticercus, which occurs due to eating meat or unwashed salads. In this case along with the medicines to control the seizures, albendezole or praziquantel are also given in a proper dose by the neurologist. Avoiding meat and salads or if possible eating after washing properly and heating at low temperature can help avoid this disease. Tetanus : This disease occurs due to the toxin produced by a gram positive organism known as clostridium tetani. Finally, it starts affecting the respiratory system and the swallowing muscles and seizures also start. Sometimes when the tetanus limits itself to the wounds, the chances of recovery are more, but in the full blown cases of tetanus, the death rate is around 60% despite treatment. The patient is kept in a dark room and diazepam is given intravenously in proper dose to prevent seizures and spasms. There can be problems like irregular blood pressure, fever, or heart trouble due to the irregularities of the involuntary nervous system, which also have to be treated carefully. These are the general guidelines for the prevention of tetanus because every individual/case has different factors and thus it is for the doctor to decide the treatment for each individual case. This disease is unfortunately still prevalent in our country because of poor hygiene, illiteracy and ignorance. The lack of cleanliness and proper medical services in the villages, thousands of lives, to such a preventable disease. Poliomyelitis : This viral infection of the brain is caused by enterovirus and damages the anterior horn cell of the brain and the spinal cord, which results in handicap. Fortunately, rigorous vaccination drives have nearly eradicated this disease from the face of the earth. Rabies : Rabies is a dangerous viral disease affecting the brain,, which is contracted by the bite of any warm-blooded animal like a dog, monkey, fox etc. In the initial stage there are certain behavioral changes and the patient stays excited and then he may suffer from paralysis etc. Summary : The discussion on various infectious diseases of the brain demonstrates that the infectious diseases of the body and the brain occur due to weakened immunity poor and therefore it is necessary to boost the immune system. An appropriate nutritional diet, with, adequate fruit and vegetable consumption, exercise, cleanliness, drinking boiled water etc. In addition to that, if there is a patient suffering from these infections in the office or at home one should be very careful. The doctors sometimes prescribe an antibiotic or some other medicine to the relatives of such a patient in order to avoid the disease; such medicines should be. Due to the dwindling of these cells, which are the most important defence mechanism of the body, the entire immune system of the body gets affected and the immunity power of the body gradually decreases. Disposable syringes and needles should be used for injections and injections should be avoided for common diseases unless absolutely essential. The patient gets fever, muscular pain, swelling of lymph glands, red spots on the skin, swelling in the throat etc. After this phase various symptoms are seen like swelling of the lymph glands, continuous or frequent fever, ulceration in the mouth and throat, splenomegaly, prolonged coughing, weight loss etc. This test is a screening test and if it is positive, confirmation is done with the help of Western Blot test. Damage to the nerves of the nervous system result in neuritis caused by infectious organisms like Herpes etc. As a result the quality of the patients life can be improved, the infectious diseases can be prevented and the patient can move around and can remain mentally sound. Many a times the doctors use a combination of three medicines whose average monthly expense is around Rs. The irony is that in spite of this expenditure, the disease is neither completely cured nor controlled. Therefore, if the diagnosis of these organisms is done in an early stage and treated immediately these infections can be cured. They cause various common and specific symptoms depending on their size, type, location, properties and histology. Improvement in the surgical techniques and anesthesia, developments in stereo tactic and the micro neurological techniques, remarkable advances in radiation as well as chemotherapy have brightened the future of patients of brain tumors. Out of these many, are cases of cancer -that originate in the brain (primary) like glioma or spread from other parts of the body to the brain. Increased Intracranial pressure: Increase in the size of the tumor increases the pressure inside the skull (a fixed vault) as well as on the brain, causing symptoms like headache on both sides, nausea-vomiting, blackouts, uneasiness and diplopia. All cases of headache do not indicate brain tumor, only in 1 % of the cases, the cause of headache is brain tumor. But if a healthy individual starts experiencing headaches of increasing intensity, it is essential to get examined by a specialist. Therefore there can be a gradual increase of paralysis, speech loss, memory loss or lack of body co-ordination. In some patients there is only a behavioural or a personality change, or loss of bowel or bladder control : 3. Seizures or unconsciousness can also be an important symptom especially if it is accompanied by headache or paralysis; if so immediate investigations are necessary. Usually, only if there is more than one of the above symptoms, the possibility -of a brain tumor in the patient is high.

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The Foundation concentrates its resources on activities in education buy extra super levitra with a visa, the environment purchase 100mg extra super levitra, global development and population generic extra super levitra 100 mg visa, performing arts cheap extra super levitra 100 mg on line, and philanthropy, and makes grants to support disadvantaged communities in the San Francisco Bay Area. He firmly believed that the more people understood about basic economics the happier and more prosperous they would be. Kazanjian Economics Foundation Inc, in 1949 as a philanthropic, nonpolitical educational organization to support efforts that enhanced economic understanding. Guided by the belief that every life has equal value, the Bill & Melinda Gates Foundation works to help all people lead healthy, productive lives. In developing countries, it focuses on improving people’s health with vaccines and other life-saving tools and giving them the chance to lift themselves out of hunger and extreme poverty. In the United States, it seeks to significantly improve education so that all young people have the opportunity to reach their full potential. The Maxfield Foundation supports projects with potential for high impact in science, education, sustainability, and other areas of social importance. We support the creation, sharing, and proliferation of more effective, more affordable educational content by leveraging disruptive technologies, open educational resources, and new models for collaboration between for-profit, nonprofit, and public entities. The Bill and Stephanie Sick Fund supports innovative projects in the areas of Education, Art, Science and Engineering. Knowing where our textbooks are used can help us provide better services to students and receive more grant support for future projects. If you’re using an OpenStax textbook, either as required for your course or just as an extra resource, send your course syllabus to contests@openstax. This textbook was written to increase student access to high- quality learning materials, maintaining highest standards of academic rigor at little to no cost. About OpenStax OpenStax is a nonprofit based at Rice University, and it’s our mission to improve student access to education. Our adaptive learning technology, designed to improve learning outcomes through personalized educational paths, is being piloted in college courses throughout the country. Through our partnerships with philanthropic foundations and our alliance with other educational resource organizations, OpenStax is breaking down the most common barriers to learning and empowering students and instructors to succeed. About OpenStax Resources Customization Anatomy and Physiology is licensed under a Creative Commons Attribution 4. Because our books are openly licensed, you are free to use the entire book or pick and choose the sections that are most relevant to the needs of your course. Feel free to remix the content by assigning your students certain chapters and sections in your syllabus, in the order that you prefer. The custom version can be made available to students in low-cost print or digital form through their campus bookstore. OpenStax is committed to remaining transparent about all updates, so you will also find a list of past errata changes on your book page on openstax. About Anatomy and Physiology Coverage and Scope The units of our Anatomy and Physiology textbook adhere to the scope and sequence followed by most two-semester courses nationwide. The development choices for this textbook were made with the guidance of hundreds of faculty who are deeply involved in teaching this course. These choices led to innovations in art, terminology, career orientation, practical applications, and multimedia-based learning, all with a goal of increasing relevance to students. We strove to make the discipline meaningful and memorable to students, so that they can draw from it a working knowledge that will enrich their future studies. Unit 1: Levels of Organization Chapters 1–4 provide students with a basic understanding of human anatomy and physiology, including its language, the levels of organization, and the basics of chemistry and cell biology. They also focus particularly on how the body’s regions, important chemicals, and cells maintain homeostasis. Chapter 1 An Introduction to the Human Body Chapter 2 The Chemical Level of Organization Chapter 3 The Cellular Level of Organization Chapter 4 The Tissue Level of Organization 2 Preface Unit 2: Support and Movement In Chapters 5–11, students explore the skin, the largest organ of the body, and examine the body’s skeletal and muscular systems, following a traditional sequence of topics. This unit is the first to walk students through specific systems of the body, and as it does so, it maintains a focus on homeostasis as well as those diseases and conditions that can disrupt it. Chapter 5 The Integumentary System Chapter 6 Bone and Skeletal Tissue Chapter 7 The Axial Skeleton Chapter 8 The Appendicular Skeleton Chapter 9 Joints Chapter 10 Muscle Tissue Chapter 11 The Muscular System Unit 3: Regulation, Integration, and Control Chapters 12–17 help students answer questions about nervous and endocrine system control and regulation. In a break with the traditional sequence of topics, the special senses are integrated into the chapter on the somatic nervous system. The chapter on the neurological examination offers students a unique approach to understanding nervous system function using five simple but powerful diagnostic tests. Chapter 12 Introduction to the Nervous System Chapter 13 The Anatomy of the Nervous System Chapter 14 The Somatic Nervous System Chapter 15 The Autonomic Nervous System Chapter 16 The Neurological Exam Chapter 17 The Endocrine System Unit 4: Fluids and Transport In Chapters 18–21, students examine the principal means of transport for materials needed to support the human body, regulate its internal environment, and provide protection. Chapter 18 Blood Chapter 19 The Cardiovascular System: The Heart Chapter 20 The Cardiovascular System: Blood Vessels and Circulation Chapter 21 The Lymphatic System and Immunity Unit 5: Energy, Maintenance, and Environmental Exchange In Chapters 22–26, students discover the interaction between body systems and the outside environment for the exchange of materials, the capture of energy, the release of waste, and the overall maintenance of the internal systems that regulate the exchange. Chapter 22 The Respiratory System Chapter 23 The Digestive System Chapter 24 Nutrition and Metabolism Chapter 25 The Urinary System Chapter 26 Fluid, Electrolyte, and Acid–Base Balance Unit 6: Human Development and the Continuity of Life The closing chapters examine the male and female reproductive systems, describe the process of human development and the different stages of pregnancy, and end with a review of the mechanisms of inheritance. Chapter 27 The Reproductive System Chapter 28 Development and Genetic Inheritance Pedagogical Foundation and Features Anatomy and Physiology is designed to promote scientific literacy. Throughout the text, you will find features that engage the students by taking selected topics a step further. Aging explores the effect aging has on a body’s system and specific disorders that manifest over time. Career Connections presents information on the various careers often pursued by allied health students, such as This OpenStax book is available for free at http://cnx. Students are introduced to the educational requirements for and day-to-day responsibilities in these careers. Everyday Connections tie anatomical and physiological concepts to emerging issues and discuss these in terms of everyday life. Many features include links to the University of Michigan’s interactive WebScopes, which allow students to zoom in on micrographs in the collection. These resources were vetted by reviewers and other subject matter experts to ensure that they are effective and accurate. We strongly urge students to explore these links, whether viewing a video or inputting data into a simulation, to gain the fullest experience and to learn how to search for information independently. Dynamic, Learner-Centered Art Our unique approach to visuals is designed to emphasize only the components most important in any given illustration. The art style is particularly aimed at focusing student learning through a powerful blend of traditional depictions and instructional innovations. The strongest line is used to highlight the most important structures, and shading is used to show dimension and shape. Color is used sparingly to highlight and clarify the primary anatomical or functional point of the illustration. This technique is intended to draw students’ attention to the critical learning point in the illustration, without distraction from excessive gradients, shadows, and highlights. Full color is used when the structure or process requires it (for example, muscle diagrams and cardiovascular system illustrations). By highlighting the most important portions of the illustration, the artwork helps students focus on the most important points without overwhelming them. Micrographs Micrograph magnifications have been calculated based on the objective provided with the image. If a micrograph was recorded at 40×, and the image was magnified an additional 2×, we calculated the final magnification of the micrograph to be 80×. Please note that, when viewing the textbook electronically, the micrograph magnification provided in the text does not take into account the size and magnification of the screen on your electronic device. Instructor resources require a verified instructor account, which you can apply for when you log in or create your account on openstax. Partner Resources OpenStax Partners are our allies in the mission to make high-quality learning materials affordable and accessible to students and instructors everywhere. Gordon Betts, Tyler Junior College Peter Desaix, University of North Carolina at Chapel Hill Eddie Johnson, Central Oregon Community College Jody E. Johnson, Arapahoe Community College Oksana Korol, Aims Community College Dean Kruse, Portland Community College Brandon Poe, Springfield Technical Community College James A. Heyden Contributing Authors Kim Aaronson, Aquarius Institute; Triton College Lopamudra Agarwal, Augusta Technical College Gary Allen, Dalhousie University Robert Allison, McLennan Community College Heather Armbruster, Southern Union State Community College This OpenStax book is available for free at http://cnx.