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In our example 15 mg prevacid mastercard, the soni®cation method proved valuable in the dynamic following of some param- eters of brain electrical activity that would be otherwise hard to perceive 15 mg prevacid sale. Finally, the new generation of programming environments signi®cantly re- 202 PERCEPTUALIZATION OF BIOMEDICAL DATA duce implementation e¨orts, providing support for the most frequently used functions. For example, there is no need to support a change of viewpoint in a VRML-based model, because it is supported directly by the VRML viewer. A proposed VRML-based visualization and soni®cation environment requires only a standard Web and VRML browser; therefore, it is applicable both to standalone workstations and to distributed telemedical applications. Further development of our environment shall incorporate real head models derived from MRI recordings, which will enable functional mapping of brain activity to anatomic regions. However, physiological characteristics of human perception limit the number of perceived parameters and their dynamics. Multimodal data presentation could increase throughput, introduce new data streams, and improve temporal resolution. In our environment, graphics remains the primary physical media; acoustics sound is an extended information channel. Owing to the lack of gen- eral insights into VRUI design space, the art of designing multimodal parame- ters is still required. For every application, multimodal parameters must be chosen to maximize the separation of changes in the perceptual domain. Acoustic rendering could create synesthetic extension of a selected data channel or present a new parameter. In the presented environment, visualization is used to show animated 3-D topographic maps of brain electrical activity. Soni®ca- tion is employed either as a synesthetic presentation of a selected visualized score or to render complex biomedical data derived from an input dataset. Soni®cation improved the possibility of assessing the genuine dynamics and perceiving the inherent spatiotemporal patterns of brain electrical activity. Integrating virtual reality and high performance computing and communications for real-time molecular modeling. Foundations of multimodal representations: a taxonomy of repre- sentational modalities. Computers, communication and usability: design issues, research and methods for integrated services. A critical review of clinical applications of topographic mapping of brain potentials. Visual information processing of computed topo- graphic electrical activity brain maps. ISBNs: 0-471-38863-7 (Paper); 0-471-21669-0 (Electronic) CHAPTER 8 Anatom ic VisualizeR: Teaching and Learning Anatom y with Virtual Reality HELENE HOFFMAN, MARGARET MURRAY, ROBERT CURLEE, and ALICIA FRITCHLE San Diego School of Medicine La Jolla California, USA 8. The resultant product, VisualizeR, is a virtual environment (VE) designed to support the teaching and learning of any subject that requires an understanding of three-dimensional (3-D) structures and complex spatial rela- tionships. Moreover, the ¯exible and extensible Visual- izeR architecture accommodates the needs of a wide variety of di¨erent teach- ing approaches and provides the capability for dynamic and unstructured student exploration (4, 5). While still considered the gold standard against which alternatives are judged, current educational methodsÐa combi- nation of lectures and laboratory dissectionsÐfall short of instilling the requi- site 3-D conceptualization, retention, and application of anatomic knowledge to clinical-problem solving (7). These pedagogical challenges are further com- plicated by shortened anatomy curricula owing to competition from other courses (8, 9); the desirability of less dependence on human cadavers because of scarcity, costs, aesthetics, and environmental concerns (10); and reductions in hours and resources (including faculty) available for wet laboratory coursework (11). At the same time, many curricula are including greater amounts of ana- tomic information, including conceptually challenging 3-D relationships (8, 12), a need that could be well met by VR-based anatomy resources. The resulting information was neither new nor surprising to individuals who have spent signi®cant time teaching human anatomy to medical students. However, organizing the ®ndings and articulating them as educational and developmental goals was an important ®rst step in the development process. It also established that once developed, Anatomic VisualizeR±based anatomy lessons could be used either as adjuncts to or as replacements for the current practices in anat- omy education. Anatomic VisualizeR provides a virtual dissecting room in which students and faculty can directly interact with 3-D models (anatomic, schematic, etc. Instructional activities, organized into learning modules, can be selected from a collection of previously developed learning modules or can be specially developed using the associated lesson authoring environment. Modules can be created for individual instruction, for presentation in large group settings, and for other curricular contexts.

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Pathways described above regulate the calibre of all cerebral vas- culature in response to physiological and other metabolic needs cheap prevacid 30mg without prescription. The sympathetic chain is sectioned below T1 ganglion but the procedure is called cervical because it was often performed through a cervical incision purchase 15 mg prevacid visa. Providing that the chain is sectioned below T1 ganglion, which receives preganglionic impulses from the spinal cord, there will remain an adequate sympathetic supply to the head. PART V VISION, EYE MOVEMENTS, HEARING AND BALANCE: OPTIC, OCULOMOTOR, TROCHLEAR, ABDUCENS AND VESTIBULOCOCHLEAR NERVES Chapter 20 THE OPTIC NERVE (II) 20. Perception is the function of the retina, optic nerve, tract, radia- tion and cortex. Eyeball sensations such as pain, touch and pressure are mediated by the ophthalmic nerve,and the facial nerve inner- vates orbicularis oculi muscle. This Chapter deals with the optic pathway: eye movements and their control come later. The optic nerve is the name given to the path- way between the eyeball and the optic chiasma. As in the olfactory system, the primary sensory neurons are bipolar and are confined to the sensitive epithelium (retina), the axons of secondary sensory neu- rons forming the optic nerve, chiasma and tract. Rods and cones in deepest parts of neural layer, with terminal processes of rods and cones in contact with pigment layer. Optic chiasma Optic nerve Optic foramen Pituitary Internal carotid stalk artery Mammillary body Optic tract Midbrain Lateral geniculate body Optic radiation Visual (occipital) cortex *Fibres to pretectal nuclei (see 20. The optic nerve (II) 117 Optic nerve, chiasma, tract • Optic nerve passes posteriorly from eyeball, surrounded by meninges,subarachnoid space,cerebrospinal fluid (CSF). About half way between eyeball and optic canal, optic nerve is penetrated by central artery (branch of ophthalmic artery) and vein of retina. At chiasma, fibres from nasal portion of each retina (impulses from temporal visual fields) cross to optic tract of opposite side. Some axons bifurcate sending branches to midbrain for visual reflexes (see below). LGB, optic radiation, visual cortex • In LGB, axons of retinal ganglion cells synapse with cell bodies of neurons forming optic radiation. These mediate visual reflexes and are 118 Vision, eye movements, hearing and balance connected to the pretectal nuclei (for the pupillary light reflex) and the superior colliculus and medial longitudinal fasciculus (for lens accommodation, eye movements, etc. These reflexes and control mechanisms depend upon many other structures and are considered in Chapter 22. Bilateral internal carotid artery aneurysms would cause a binasal hemianopia – even more uncommon. Thus, destruction of the right optic tract would cause a left homony- mous hemianopia. Consult a detailed neuroanatomy or ophthalmology text if you want more information. Exudates, haemorrhages and abnormalities of blood vessels may be seen on retinoscopy and may be signs of generalized disease processes (e. This will occlude the central vein before the central artery (venous blood is at a lower pressure). The retina will be engorged with blood and the optic disc will bulge into the vitreous. This is papilloedema, visible on retinoscopy – a reliable sign of raised intracranial pressure. This is one of the explanations given for the phenomenon of macular sparing in which vision at the macula may be preserved even though the surrounding areas of the visual cortex are no longer functional. As the two layers of the retina grow, they approach each other and the cavity is obliterated as the two layers become contiguous. The two layers give rise to the inner 120 Vision, eye movements, hearing and balance neural layer and the outer pigment layer. The potential space between them can open up in certain conditions, for example poor vascular perfusion. This is not so for other cranial nerves in which myelin is manufactured by Schwann cells.

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You should ask your GP proven 15 mg prevacid, neurologist or occupational or speech therapist for a referral to a specialist centre if possible safe prevacid 30 mg. Some of the concerns relate to the most appropriate diet for someone with MS, and others relate to the swallowing mechanism, which can be affected in a range of ways in MS. Although many people do not develop swallowing difficulties – it depends very much on the particular areas in which demyelination has taken place – when there are problems, they can be difficult to manage easily. There are a number of different causes for this difficulty (the medical term is ‘dysphagia’), depending on exactly which muscles are affected in the journey of food and drink from the mouth to the stomach. Problems might be linked to the chewing process, or to the muscles that push the food or drink towards the throat, or to those muscles that coordinate the swallowing process through the throat and oesophagus to the stomach. Of course, there may be other problems, such as food particles remaining in the mouth that could create problems in breathing, for food particles can accidentally get into the airways to the lung. However, normally, the problems that people with MS experience are ones related to delays in the swallowing process, and a slowing down of the passage of food and drink through the throat area. You may also have difficulty in swallowing liquids, especially those that are less viscous and ‘dense’. This is because the liquids pass 129 130 MANAGING YOUR MULTIPLE SCLEROSIS through the mouth ‘too fast’ before the slower moving muscles have a chance to coordinate swallowing, so you may end up coughing and choking, as liquids run into your airway to your lungs. Usually this problem is solved by thickening the liquids, so that they pass through your mouth more slowly. Professional help with swallowing As soon as you notice any difficulties with swallowing, it is worth asking the advice of your GP or neurologist at this early stage. Increasingly there are more formal evaluations of swallowing problems in order to try and understand exactly where the problems lie. Sometimes this assessment may include what is called ‘videofluoroscopy’, which allows the process of your swallowing to be seen on X-ray following a barium swallow. Occasionally it may also include an endoscopic examination – this involves passing a small fibreoptic tube through and past the throat so that additional information can be obtained. Professional help for swallowing difficulties centres on teaching exercises to try and: • strengthen your muscles involved in swallowing; • enhance the coordination of your breathing and swallowing (so as to avoid choking); • strengthen the muscles controlling your lips and tongue that help in managing the food in your mouth in preparation for swallowing. Self-help in relation to swallowing It is possible to give general guidelines as to what you can do yourself to help swallowing, although it must be remembered each person has slightly different problems, and thus not every strategy will work for everyone. However, things to try yourself include: • changing the type and preparation of your food – solid foods, particularly those that are only half chewed, are much more difficult to swallow than those which are softer, so you may need to consider chopping or blending food; • changing the ways in which you eat and swallow – eating little and often may help; • exercising to strengthen the relevant muscles as much as possible; • making sure that you do not talk (or laugh) and eat at the same EATING AND SWALLOWING DIFFICULTIES; DIET AND NUTRITION 131 time – problems of swallowing can often be linked to trying to do two things at once! In MS, coordination of the swallowing reflex with the amount of saliva you have may become a problem. It is not that you are producing more saliva, but the swallowing of it becomes far more noticeable. In general you have to become more conscious of the process of swallowing, and try and systematically swallow. Indeed swallowing exercises may help you and, paradoxically, by stimulating more regular production of salivation through sucking a sweet (preferably sugar free! A problem often arises when you ‘forget’ to swallow for a period of time and then suddenly notice the saliva. You might try a sequence of events as you eat or drink a little at a time, based on the following: ‘Hold your breath, swallow, clear your throat, then swallow again. Some people still have great difficulty but, if food or drink gets into your lungs, which could possibly lead to pneumonia, then more drastic action may be required. The time being taken to eat and drink may also be now so substantial that you run the risk of not getting adequate nutrition or liquids over a period of time. If this happens, then you may find yourself losing weight, getting weaker and having further problems. It is an important decision to move from normal feeding by mouth (oral feeding and drinking) to non-oral feeding, where food is directly channelled into the stomach (often avoiding the mouth and swallowing completely), but this step may be necessary if problems with nutrition and/or concern over choking becomes substantial. For example, after certain kinds of surgery in hospital, not associated with MS, people may be fed on a short-term basis through a tube that passes through the nose and then through the throat directly to the stomach (a ‘nasogastric tube’). This particular kind of arrangement has to be temporary because the throat and nose may become irritated after a while.

Informal reasoning considers emotion to be a way of connecting with and understanding the world generic prevacid 30 mg free shipping. The fact that emotion occasionally misleads no more invalidates it as a means of understanding for informal reasoning than the existence of illusions invalidates sensory perception as a whole prevacid 15 mg on-line. Informal reasoning "weighs," it "sifts," it "balances" and it tries to "see what fits. It starts with established values but expects that they will have to be renewed and sometimes reworked as they are instantiated in new experience. The problems of informal reasoning have been well detailed, including casualness, sloppiness, susceptibility to certain fallacies, distractibility and bias. Empirical, informal reasoning about means and ends has been compared unfavorably with formal reasoning. However, sweeping conclusions about the inefficacy of informal judgments on how best to attain purposes should not be made until their true scope and application are recognized. The field of clinical medicine contains abundant examples which should demonstrate why premature conclusions about the broad failure of informal reasoning should not be made. Such conclusions have been based on a very narrow set of instances in which clinical judgment has been found wanting. The proliferation in clinical medicine of algorithms, protocols and rigid standards of care has occurred in response to a profound distrust of informal reasoning derived only from examination of these very limited and circumscribed situations. If only there were atomic and static meaning-units whose relationships could be elaborated using formal rules; if only there were fungible and quantifiable value units for measuring the worth of inputs and outcomes across all situations and contexts; if only clinical reality would conform itself to such concepts so that their logical relations would mirror cause and effect in full blooded experience: then we could decide how to think and act in a truly rigorous fashion. We could plug solid "data" into a prognosticator, generate ironclad diagnoses, enter the health desiderata and read off the best action plan. The trouble is that logical atomism (the idea that all meaning is reducible to minimal bits) binary truth functional logic (the division of all propositions into only the categories "true" and "false") and formal set theory work only for certain games, proofs and machines and to solve only strictly replicable problems. Even real atoms cannot be understood apart from their relations to an uncertain world. Complex entities still further defy understanding through analytical resolution into static bits. We know that a human is not just composed of elementary bits of matter arranged in dimensional bits of space. Human functioning on many levels is not susceptible to description in these terms. Contrary to the fond hopes of expert "consensus committees," the failures of clinical decision making do not often result from a failure to think formally and/or uniformly. Indeed, many decisions later thought to be faulty result from the inherent ambiguity of percepts and values as well as the unpredictability in principle of clinical reality. Correctable failures mostly derive from the oldest causes: ignorance, greed, haste, fatigue, lack of imaginative reflection, deficient resources and overconfidence. The main body of this chapter will first lay out some newly appreciated kinds of 12 CHAPTER 1 embodied, imagistic and imaginative cognitive structures at work in all empirical reasoning and then show specifically how they contribute to our multiple senses of causation and their distinct logics. Given the importance of multiple causal logics in clinical problem solving, it should become apparent that restricting ourselves to the use of only one is counterproductive. IMAGINATIVE STRUCTURES AND THEIR USE IN CAUSAL REASONING Recent work in linguistics and cognitive science reveals previously obscure struc- tures used to reason about goal setting and achievement. Forms of thought and language which were heretofore mostly implicit and rather automatic have now been made explicit and exposed to scrutiny. I will contend in this chapter that once such cognitive structures are unveiled, their justification in terms of use becomes more apparent. Not only are we learning how they have been used and why, but also we can now imagine how to use them better. Natural languages are wondrous tools for communicating about experience and therefore for dealing with it. As John Austin pointed out in proposing speech act theory, words carry meaning many ways. Imagination and emotion are two aspects of meaning which are among the orphans of formal logic.

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