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Many topics studied in modern sociology were also studied by ancient philosophers in their desire to describe an ideal society hypertension heart attack discount plavix 75 mg without a prescription, including theories of social conflict blood pressure medication enalapril generic plavix 75 mg with mastercard, economics blood pressure chart 16 year old purchase 75mg plavix otc, social cohesion pulse pressure normal rate buy plavix 75mg on line, and power (Hannoum 2003). In the thirteenth century, Ma Tuan-Lin, a Chinese historian, first recognized social dynamics as an underlying component of historical development in his seminal encyclopedia, General Study of Literary Remains. In the eighteenth century, Age of Enlightenment philosophers developed general principles that could be used to explain social life. Thinkers such as John Locke, Voltaire, Immanuel Kant, and Thomas Hobbes responded to what they saw as this OpenStax book is available for free at cnx. Her works were long ignored by the male academic structure, but since the 1970s, Wollstonecraft has been widely considered the first feminist thinker of consequence. The early nineteenth century saw great changes with the Industrial Revolution, increased mobility, and new kinds of employment. It was also a time of great social and political upheaval with the rise of empires that exposed many people-for the first time-to societies and cultures other than their own. Millions of people moved into cities and many people turned away from their traditional religious beliefs. They both thought that social scientists could study society using the same scientific methods utilized in natural sciences. Comte also believed in the potential of social scientists to work toward the betterment of society. He held that once scholars identified the laws that governed society, sociologists could address problems such as poor education and poverty (Abercrombie et al. He believed that using scientific methods to reveal the laws by which societies and individuals interact would usher in a new "positivist" age of history. While the field and its terminology have grown, sociologists still believe in the positive impact of their work. Her writing career began in 1931 with a series of stories titled Illustrations of Political Economy, in which she tried to educate ordinary people about the principles of economics (Johnson 2003). She is also credited with the first systematic methodological international comparisons of social institutions in two of her most famous sociological works: Society in America (1837) and Retrospect of Western Travel (1838). Martineau found the workings of capitalism at odds with the professed moral principles of people in the United States; she pointed out the faults with the free enterprise system in which workers were exploited and impoverished while business owners became wealthy. Much like Mary Wollstonecraft, Martineau was often discounted in her own time by the male domination of academic sociology. He believed that societies grew and changed as a result of the struggles of different social classes over the means of production. At the time he was developing his theories, the Industrial Revolution and the rise of capitalism led to great disparities in wealth between the owners of the factories and workers. Capitalism, an economic system characterized by private or corporate ownership of goods and the means to produce them, grew in many nations. Marx predicted that inequalities of capitalism would become so extreme that workers would eventually revolt. This would lead to the collapse of capitalism, which would be replaced by communism. Communism is an economic system under which there is no private or corporate ownership: everything is owned communally and distributed as needed. Instead, he favored a form of government that allowed market forces to control capitalism.


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Injuries Football Medicine Manual increased physiotherapy efforts blood pressure variability normal purchase plavix 75 mg visa, but sometimes arthroscopic debridement and mobilisation are needed to regain a full range of motion blood pressure pulse 90 buy on line plavix. Late sequelae are more likely to occur if the meniscus has been removed prehypertension define cheap 75mg plavix with amex, articular cartilage lesions have been diagnosed blood pressure medication used for anxiety buy plavix 75 mg online, or if other ligament structures show insufficiency leading to instability or post-traumatic osteoarthritis. All grafts undergo initial necrosis due to avascularity followed by secondary revascularisation. Creeping substitution with the ingrowth of new functional tissue to replace the necrotic tissue is a process that takes about nine to 12 months, during which time the graft is liable to stretch out. For more information about the treatment of meniscus injuries and articular cartilage injuries, see 3. Complete tears with avulsion of a bony fragment from the tibia are seen mostly in young players. While substance tears are rather uncommon, femoral avulsion tears occur more often. Risk factors include previous injuries to the knee, insufficient rehabilitation of a previous injury, insufficient conditioning, weakness of the thigh muscles, hyperlaxity, body contact and foul play. Symptoms and signs A hyperflexion or hyperextension trauma as well as impacts from the side or from the front can result in either an isolated or a combination injury. Injuries Football Medicine Manual 167 sag sign due to a spontaneous posterior displacement of the tibia (Figure 3. The posterior drawer test is a classic test to reveal straight posterior instability. Arthroscopy may give the definite answer about the injury, especially when the ligament is probed. The patient may remain clinically unstable but experience functional stability without any symptoms. Rehabilitation programme During the early phase of the rehabilitation programme, a brace which limits the posterior drawers should be used even during the functional period of training. Active motion can be started immediately and muscle training should be focused on the agonistic quadriceps muscle. Especially during the initial four to six weeks, the hamstrings should not be trained specifically. Many players experience patello-femoral pain and may develop early patello-femoral osteoarthritis. However, each player must be evaluated individually and combination injuries in particular require close follow-up. Fixation of the foot and contracting of the quadriceps muscle leads to anterior translation of the tibia towards its normal position. Concomitant meniscus and articular cartilage injuries require individual attention (see 3. More often a lateral blow or impact to the lower thigh or knee with direct contact may be the cause of valgus stress and external rotation by extrinsic forces. Swelling of the joint is not common and might indicate a more severe injury in the joint itself. Treatment For grade 1 and minor grade 2 injuries (stable knee, partial tear) the rehabilitation programme with weightbearing and early motion may start as early as possible. If there is satisfactory progress leading to full extension, no effusion and decreased tenderness after two to three weeks, the player is advised to optimise his range of motion and muscular strength before returning to training and competition, which usually occurs within four to eight weeks.

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Patients with diabetes insipidus hypertension essential cheap plavix line, whether nephrogenic or central in origin prehypertension at 20 cheap plavix 75mg online, are prone to develop profound hypernatremic dehydration as a result of unremitting urinary free water losses (urine specific gravity < 1 blood pressure normal 75 mg plavix free shipping. The evaluation and treatment of nephrogenic and central diabetes insipidus are discussed in detail in Chapters 22 and 32 arrhythmia prognosis purchase plavix 75 mg with visa, respectively. Treatment includes the use of diuretics, and potentially, concomitant water replacement or even dialysis. The ratio of intracellular to extracellular K+ is the major determinant of the cellular resting membrane potential and contributes to the action potential in neural and muscular tissue. In the kidney, K+ is filtered at the glomerulus, reabsorbed in the proximal tubule, and excreted in the distal tubule. Renal K+ excretion continues for significant periods even after the intake of K+ is decreased. Thus by the time urinary [K+] decreases, the systemic K+ pool has been depleted significantly. Gastrointestinal losses through nasogastric suction or vomiting reduce total body K+ to some degree. However, the attendant volume depletion results in an increase in plasma aldosterone, promoting renal excretion of K+ in exchange for Na+. Diuretics (especially thiazides), mineralocorticoids, and intrinsic renal tubular diseases (eg, Bartter syndrome) enhance the renal excretion of K+. Clinically, hypokalemia is associated with neuromuscular excitability, decreased peristalsis or ileus, hyporeflexia, paralysis, rhabdomyolysis, and arrhythmias. Arrhythmias associated with hypokalemia include premature ventricular contractions; atrial, nodal, or ventricular tachycardia; and ventricular fibrillation. Hypokalemia increases responsiveness to digitalis and may precipitate overt digitalis toxicity. In the presence of arrhythmias, extreme muscle weakness, or respiratory compromise, intravenous K+ should be given. The first priority in the treatment of hypokalemia is the restoration of an adequate serum [K+]. Providing maintenance amounts of K+ is usually sufficient; however, when the serum [K+] is dangerously low and K+ must be administered intravenously, it is imperative that the patient have a cardiac monitor. The severity of hyperkalemia depends on the electrocardiographic changes, the status of the other electrolytes, and the stability of the underlying disorder. If the serum [K+] is greater than 7 mEq/L or if potentiating factors such as hyponatremia, digitalis toxicity, and renal failure are present, more aggressive therapy is needed. If electrocardiographic changes or arrhythmias are present, treatment must be initiated promptly. Calcium should be given only with a cardiac monitor in place and should be discontinued if bradycardia develops. Administration of intravenous glucose and insulin may be needed as a simultaneous drip (0. Unfortunately, some hospital laboratories fail to include ethylene glycol or methanol in their standard toxicology screens, so that these toxins must be requested specifically. This is of critical importance when therapy with fomepizole (4-methylpyrazole) must be considered for either ingestion- and instituted quickly to head off profound toxicity. Ethylene glycol (eg, antifreeze) is particularly worrisome because of its sweet taste and accounts for a significant number of toxin ingestions. Most types of metabolic acidosis will resolve with correction of the underlying disorder, improved renal perfusion, and acid excretion. Ultimately, K+ must be reduced to normal levels by reestablishing adequate renal excretion using diuretics or optimizing urinary flow, using ion exchange resins such as sodium polystyrene sulfonate orally or as a retention enema (0. An increase above normal suggests the presence of an unmeasured anion, such as occurs in diabetic ketoacidosis, lactic acidosis, salicylate intoxication, and so on. Although the base excess (or deficit) is also used clinically, it is important to recall that this expression of acid-base balance is influenced by the renal response to respiratory disorders and cannot be interpreted independently (as in a compensated respiratory acidosis, wherein the base excess may be quite large). Recently, there has been greater interest in the Stewart approach to acid-base disturbances and the calculation of the "strong ion difference," which is beyond the scope of the present discussion. The interested reader is referred to the review by Gunnerson and Kellum listed in the references at the end of this chapter. Thus a normal anion gap acidosis in the absence of diarrhea or other bicarbonate-rich gastrointestinal losses suggests the possibility of renal tubular acidosis and should be evaluated appropriately.

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Such a phase shift of the normal circadian rhythm induces a malaise similar to that experienced by nocturnal shift workers hypertension case study buy generic plavix 75mg line. These symptoms could compromise training in the days before departure; furthermore hypertension diagnosis jnc 7 buy plavix with paypal, the manoeuvre leads to a partial adjustment only hypertension nursing interventions order 75 mg plavix otc. Nevertheless blood pressure control chart purchase discount plavix on-line, a shift of one to two hours for one to two days prior to long-haul flights could be of benefit when a large phase advance is required, by ensuring the physiological adjustment is initiated in the correct direction. There is no physiological adaptation to repeated disturbances of the circadian rhythm, so individuals do not necessarily adjust any better (or worse) than in previous journeys. Airline staff as well as occasional travellers experience jet lag, although the long-term health consequences of frequent long-haul flights are unknown. Female flight attendants experience secondary amenorrhea, linked to interactions between female reproductive hormones and altered melatonin rhythms. Female football players are as vulnerable as their male counterparts to effects of jet lag but the syndrome has not been examined in detail in this group. Pharmacological approaches to adjustment Pharmacological agents have been proposed as a first line means of ameliorating the effects of jet lag. These substances include both stimulants and soporifics, although effectiveness depends on their phase-shifting properties i. Extracts of melatonin and its synthetic analogues have gained in usage but as yet no single pill has been identified as an antidote to jet lag. Some substances used in military contexts for countering jet lag might be considered for use by athletes. These drugs include treatments for narcolepsy, attention deficit disorder and other conditions with modafinil (banned in-competition for athletes), methylphenidate, pemoline, and related agents. Caffeine may help maintain daytime alertness but can cause unwanted effects in recovery sleep if taken too late in the evening. Benzodiazepines are the drugs used in sleeping pills and known as the minor tranquillisers; they are helpful in initiating sleep but not necessarily maintaining it. Benzodiazepines such as diazepam and loprazolam have longer half-lives than temazepam and can cause hangovers that impair performance the following morning. So-called non-benzodiazepines like zolpidem interfere less 1600 Leg strength (N) 1500 1400 1300 07. Zolpiden, zopiclone and zalephon have short half-lives and affect short-term memory less than other benzodiazepines but were ineffective in reducing jet lag in travellers between Figure 2. Zopiclone appeared to have some benefit by hastening re-adjustment of the rest-activity rhythm and restoring the phase relationship between the rhythms of sleep and core temperature. Melatonin has been suggested as the best chronobiotic therapy for jet lag due to the key role of the endogenous hormone in regulating circadian rhythms. Although not available in Europe except on prescription, it can be purchased off-the-shelf in some countries. It has been found to be ineffective in travellers between the United Kingdom and Australia, the main difficulty being the timing of administration to suit its phase-response curve. Melatonin administered in the evening and before the fall in body temperature to its trough should advance the body clock whereas a phase delay follows ingestion after the body temperature has reached its nadir. The hormone causes drowsiness in preparation of the body for sleep but has no hangover consequences the following morning. The advice to athletes has been to refrain from using melatonin, unless the individual has already had positive experiences with it and knows its precise effects on him or her. It is important to avoid long naps at midday since these rests will have a counter-productive effect of anchoring circadian rhythms to home time. In contrast, light exercise, exposure to daylight and social activities can allow external factors to aid the adjustment, the individual being encouraged to retire early to bed on the first evenings. Once the individual has adapted to the new time zone, an afternoon nap can be encouraged. Following a long-haul flight eastwards, a short lie-in can be taken for the first one or two mornings. Exercise and exposure to bright light should be avoided in the morning, since these stimuli could promote a phase delay rather than the required phase advance when administered before the trough in core body temperature. In a large group of travellers between the United Kingdom and Australia, more people adjusted by a 14-hour delay than by a ten-hour phase advance.

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