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The problem buy atarax 10 mg low cost, however discount atarax 25 mg with visa, with the way people collect and interpret data in their everyday lives is that they are not always particularly thorough. Often, when one explanation for an event seems “right,‖ we adopt that explanation as the truth even when other explanations are possible and potentially more accurate. For example, eyewitnesses to violent crimes are often extremely confident in their identifications of the perpetrators of these crimes. But research finds that eyewitnesses are no less confident in their identifications when they are incorrect than when they [3] are correct (Cutler & Wells, 2009; Wells & Hasel, 2008). Furthermore, psychologists have also found that there are a variety of cognitive and motivational biases that frequently influence our perceptions and lead us to draw erroneous conclusions (Fiske & Taylor, 2007; Hsee & Hastie, Attributed to Charles Stangor Saylor. In summary, accepting explanations for events without testing them thoroughly may lead us to think that we know the causes of things when we really do not. Research Focus: Unconscious Preferences for the Letters of Our Own Name A study reported in the Journal of Consumer Research (Brendl, Chattopadhyay, Pelham, & Carvallo, [6] 2005) demonstrates the extent to which people can be unaware of the causes of their own behavior. The research demonstrated that, at least under certain conditions (and although they do not know it), people frequently prefer brand names that contain the letters of their own name to brand names that do not contain the letters of their own name. The research participants were recruited in pairs and were told that the research was a taste test of different types of tea. For each pair of participants, the experimenter created two teas and named them by adding the word stem ―oki‖ to the first three letters of each participant‘s first name. For example, for Jonathan and Elisabeth, the names of the teas would have been Jonoki and Elioki. The participants were then shown 20 packets of tea that were supposedly being tested. The experimenter explained that each participant would taste only two teas and would be allowed to choose one packet of these two to take home. One of the two participants was asked to draw slips of paper to select the two brands that would be tasted at this session. However, the drawing was rigged so that the two brands containing the participants‘ name stems were always chosen for tasting. Then, while the teas were being brewed, the participants completed a task designed to heighten their needs for self-esteem, and that was expected to increase their desire to Attributed to Charles Stangor Saylor. Specifically, the participants all wrote about an aspect of themselves that they would like to change. After the teas were ready, the participants tasted them and then chose to take a packet of one of the teas home with them. After they made their choice, the participants were asked why they chose the tea they had chosen, and then the true purpose of the study was explained to them. The results of this study found that participants chose the tea that included the first three letters of their own name significantly more frequently (64% of the time) than they chose the tea that included the first three letters of their partner‘s name (only 36% of the time). Furthermore, the decisions were made unconsciously; the participants did not know why they chose the tea they chose. When they were asked, more than 90% of the participants thought that they had chosen on the basis of taste, whereas only 5% of them mentioned the real cause—that the brand name contained the letters of their name. For instance, if half of a class of students is told that research concerning attraction between people has demonstrated that “opposites attract‖ and the other half is told that research has demonstrated that “birds of a feather flock together,‖ most of the students will report believing that the outcome that they just read about is true, and that they would have predicted the outcome before they had read about it. The tendency to think that we could have predicted something that has already occurred that we probably would not have been able to predict is called the hindsight bias. Empirical methods include the processes of collecting and organizing data and drawing conclusions about those data. The empirical methods used by scientists have developed over many years and provide a basis for collecting, analyzing, and interpreting data within a common framework in which information can be shared. We can label the scientific method as the set of assumptions, rules, and procedures that scientists use to conduct empirical research. Although scientific research is an important method of studying human behavior, not all questions can be answered using scientific approaches. Statements that cannot be objectively measured or objectively determined to be true or false are not within the domain of scientific inquiry. Values are personal statements such as “Abortion should not be permitted in this country,‖ “I will go to heaven when I die,‖ or “It is important to study psychology.

Extravascular fluids create a counter osmotic pressure cheap atarax 25 mg with visa, aggravated by any extravasation/leak of low-weight ‘colloids’ from increased capillary permeability atarax 25 mg low price. Fluid balance in critical illness is complex, and so hypovolaemia necessitates careful fluid management. Webb (1997) identifies three options for treating hypotension: ■ crystalloids ■ colloids ■ inotropes Using inotropes before correcting hypovolaemia (‘dry drive’) causes unpredictable maldistribution of blood flow, tachycardia and increased oxygen demand (Webb 1997). Right ventricular stretching or displacement of the ventricular septum reduces left ventricular filling, which may limit fluid resuscitation (Robb 1997). A major factor in determining their effect is their molecular size (indicated by molecular weight, usually measured in daltons (Da) or kilodaltons (kDa); where ‘molecular weight’ is cited, this is a slightly different measurement, but approximates to daltons). Like any ‘normals’, exact figures vary between authors; as vascular permeability varies with pathologies (see Chapter 25), precise molecular weights are less important than ranges within which molecules are measured. Small molecules and water readily diffuse across cell membranes, providing intracellular hydration. Crystalloids provide total body hydration, but rapid extravasation (normal saline plasma half-life is 15 minutes (Tonnesen 1994)) makes them unsuitable for persistent hypovolaemia whether through external blood loss (e. Rapid infusion of large crystalloid volumes could cause pulmonary oedema (MacIntyre et al. Five per cent glucose (in water) is often used to replace lost body water, but should be avoided with raised intracranial pressure as anaerobic metabolism of glucose produces lactic acid and water increasing oedema (North & Reilly 1994). Crystalloid fluid is unsuitable for the replacement of large volumes of intravascular fluid, and so is not discussed further here. Intensive care nursing 326 Perfusion Tissue perfusion is needed to supply nutrients to cells and remove the waste products of metabolism. Capillary permeability varies greatly, ranging from the “blood-brain barrier (least permeable) to renal glomerular beds (most permeable). Glomerular beds may filter positively charged substances up to 70 kDa (Adam & Osborne 1997), although clearance rate reduces as molecular size increases; the plasma half-life of crystalloids (low molecular weight) is brief, and the half-life of low molecular weight colloids (e. Fluids with larger molecular structures remain intravascularly until metabolised into smaller molecules (which can be excreted). Thus the effects of intravascular fluids depend upon molecular size and metabolic rate. Colloids Colloids are fluids with large molecules (above 10 kDa according to Webb (1991)). People can survive an 80 per cent loss of erythrocytes, but only a 30 per cent loss of blood volume (Williamson 1994), and so blood is normally only given when there is significant loss of erythrocytes (packed cell volumes below 33 per cent or Hb below 10). Since donor blood is foreign protein, immunological reactions (both from cellular and plasma components) can occur; although these are usually limited to mild fever and slight hypotension, anaphylactic shock can occur. Reactions are normally minimised by crossmatching blood between recipient and donor, but emergency situations—where the risk from not giving blood exceeds the risk from the blood itself—may necessitate giving blood without crossmatching (Isbister 1997a). Although whole blood is sometimes used, blood is more often separated into components. Packed cells, fresh frozen plasma, platelets and albumin are the most commonly encountered blood products, although there are a wide range of other products (including various other clotting factors) available to treat specific needs. The increasing chemical instability of blood creates complications; expiry dates on each unit allow 40 days’ shelf life, but as instability is progressive, nurses should be watchful for potential complications, especially as the units near their expiry dates. The most commonly used preservative is citrate, which is metabolised via Krebs’ cycle. Citrate is acidic (Ali & Ferguson 1997); metabolism reduces plasma calcium (Isbister 1997a), potentially affecting muscle (including myocardial) contractility; thus large transfusions of blood may necessitate calcium supplements. A bag of approximately 500 ml whole blood contains 70 ml of preservative (Isbister 1997a), so that in addition to other complications, preservative causes mild haemodilution. Intensive care nursing 328 Cellular metabolism continues during storage (Ali & Ferguson 1997), and so storage time reflects increasing complications. Problems are accentuated with whole blood as leucocytes create an adverse storage environment for most blood components (Isbister 1997a).

Critics of bilingual in- different methods of instruction for students with first struction also cite a 1994 New York City study that re- languages other than English purchase atarax 10mg overnight delivery. English 25 mg atarax fast delivery, and the students are expected to pick up the lan- In spite of the criticism it has aroused, bilingual edu- guage through intensive exposure. Defend- gual, the students may be allowed to ask questions in ers cite a 1991 study endorsed by the National Academy their native language, but the teacher is supposed to an- of Sciences stating that children who speak a foreign lan- swer them in English. A later study, con- ual approach to mastering English, using it in conjunction ducted at George Mason University, tracked 42,000 chil- with the student’s first language. English-only instruction dren who had received bilingual instruction and reported may be offered, but only in some, rather than all, classes. Programs with two- teaching methods aimed at meeting the needs of foreign way bilingual education have had particularly impressive language speakers are considered bilingual education, results. Oyster Bilingual Elementary School in Washing- participants in debates about bilingual education often ton, D. Its sixth graders read at a students study English but are taught all other academic ninth-grade level and have tenth-grade-level math skills. His 1903 book, L’Etude experimentale de l’intelligence, was based on his studies of them. Alfred Binet In 1905, Binet and Theodore Simon created the first 1857-1911 intelligence test to aid the French government in estab- French psychologist and founder of experimental lishing a program to provide special education for men- psychology in France and a pioneer in intelligence tally retarded children. In training—mostly at Jean-Martin Charcot’s neurological 1916, the American psychologist Lewis Terman used clinic at the Salpetriere Hospital—was in the area of ab- the 1908 Binet-Simon scale as the basis for the Stanford- normal psychology, particularly hysteria, and he pub- Binet Intelligence Scale, the best-known and most re- lished books on hypnosis (Le magnetisme animal, with searched intelligence test in the United States. Fere in 1886) and suggestibility (La suggestibilite, authored Les enfants anormaux (Abnormal Children) 1900). From 1895 until his death in 1911, Binet served (1907) with Simon and published Les idees modernes as director of France’s first psychological laboratory at sur les enfants (Modern Ideas on Children) in 1909. Binet See also Intelligence quotient; Mental retardation had been interested in the psychology of—and individual differences in— intelligence since the 1880s and pub- Further Reading lished articles on emotion, memory, attention, and Wolf, Theta Holmes. With one eye closed, align the pencil with Binocular depth cues are based on the simple fact the edge of a doorway, window, or other vertical line in that a person’s eyes are located in different places. Close the eye, open the other, and observe cue, binocular disparity, refers to the fact that different the position of the pencil: it will have jumped. Binocu- optical images are produced on the retinas of both eyes lar disparity describes this phenomenon of different im- when viewing an object. Biofeedback has been applied with The second cue, called binocular convergence, is success to a variety of clinical problems, ranging from based on the fact that in order to project images on the migraine headaches to hypertension. The closer the perceived object is, the more they formation about physiological processes of which they must rotate, so the brain uses the information it receives are normally unaware, such as blood pressure or heart about the degree of rotation as a cue to interpret the dis- rate. Yet another cue to depth recorded, and the information is relayed back to the per- perception is called binocular accommodation, a term son through a changing tone or meter reading. With that refers to the fact that the lens of the eye changes practice, people learn strategies that enable them to shape when it brings an image into focus on the retina. The muscular activity necessary for this accommodation For example, persons trying to control their blood pres- acts as a signal for the brain to generate perception of sure levels may see a light flash whenever the pressure depth and distance. They may then try to remem- See also Vision ber and analyze what their thoughts or emotions were at that moment and deliberately repeat them to keep the Further Reading pressure level low. The Object Stares Back: On the Nature of See- The biofeedback training may continue for several ing. Even- tually they will need to produce the desired response without electronic feedback, a goal which can be accom- Biofeedback plished through various methods. They may practice the learned response at the end of the training session or at A technique that allows individuals to monitor home between sessions. There can also be random trials their own physiological processes so they can learn to control them. An alternate strate- gy is the gradual and systematic removal of the feedback signal during the training sessions over a period of time. Biofeedback originated with the field of psy- After the initial training is completed, subjects may re- chophysiology, which measures physiological responses turn to the biofeedback facility to assess their retention as a way of studying human behavior. Today, Biofeedback training has been used in treating a biofeedback is also associated with behavioral medicine, number of different clinical problems.

He says that the falls have not been associated with any chest pain or palpitations order 10 mg atarax mastercard. On two or three occasions he has hurt his knees on falling order 25mg atarax otc, and on one other occasion he hit his head. He has an occasional cough with some white sputum but he cannot remember whether he was coughing at the time of any of the falls. He was diagnosed as having hypertension at a routine well man clinic 4 years ago, and has been on treatment with a diuretic, bendrofluazide and doxazosin, for this. The blood pressure has been checked in the surgery on three or four occasions and he was told that it has been well controlled. He was found to have a high fasting blood sugar 6 months before and had been advised a diabetic diet. The heart sounds are normal and there is nothing abnormal to find on examination of the respi- ratory system or gastrointestinal system. In the nervous system, there is a little loss of sensation to light touch in the toes, but no other abnormalities. Some more information in the history about the circumstances of these falls would be helpful. On further enquiry, it emerges that the falls are most likely to occur when he gets up from bed first thing in the morning. The afternoon events have occurred on getting up from a chair after his post-lunch doze. This was verified by measurements of standing and lying blood pressure – the diagnostic criteria are a drop of 15 mmHg on standing for 3 min. This showed a marked postural drop with blood pressure decreasing from 134/84 to 104/68 mmHg. This is most likely to be caused by the antihypertensive treatment; both the alpha-blocker which causes vasodilatation and the diuretic might contribute. Another possible candidate for a cause of the postural hypoten- sion is the diabetes which could be associated with autonomic neuropathy. In this case the diabetes is not known to have been present for long and there is evidence of only very mild peripheral sensory neuropathy. Diabetic autonomic neuropathy is usually associated with quite severe peripheral sensory neuropathy, with or without motor neuropathy. Clinically, it is easily mistaken for atrial fibrillation because of the irregular rhythm and the variation in strength of beats. It may be associated with episodes of bradycardia and/or tachycardia which could cause falls. The positive intrathoracic pressure during coughing limits venous return to the heart. The cough is usually quite marked and he might be expected to remember this since he gives a good account of the falls otherwise. Neck movements with vertebrobasilar disease, poor eyesight and problems with balance are other common causes of falls in the elderly. A neurological cause, such as transient ischaemic episodes and epilepsy, is less likely with the lack of prior symptoms and the swift recovery with clear consciousness and no neuro- logical signs. Another diagnosis which should be remembered in older people who fall is a subdural haematoma. The doxazosin should be stopped and another antihypertensive agent started if necessary. The blood pressure rose to 144/86 mmHg lying and 142/84 mmHg standing, indicating no significant postural hypotension, with reasonable blood-pressure control. On direct questioning she says that she has felt increasingly tired for around 2 years. She was diagnosed with hypothyroidism 8 years ago and has been on thyroxine replacement but has not had her blood tests checked for a few years. Her other complaints are of itching for 2–3 months, but she has not noticed any rash.