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You must try to distinguish information that is based on empirical research from information that is based on opinion purchase voveran 50 mg visa, and between valid and invalid data discount voveran 50mg without a prescription. The following material may be helpful to you in learning to make these distinctions safe voveran 50mg. The techniques for evaluating the validity of websites are similar to those that are applied to evaluating any other source of information. This information can help you determine the author‘s (or organization‘s) purpose in publishing the website. Is the data being summarized from objective sources, such as journal articles or academic or government agencies? Does it seem that the author is interpreting the information as objectively as possible, or is the data being interpreted to support a particular point of view? Consider what groups, individuals, and political or commercial interests stand to gain from the site. Is the website potentially part of an advocacy group whose web pages reflect the particular positions of the group? Material from any group‘s site may be useful, but try to be aware of the group‘s purposes and potential biases. Also, ask whether or not the authors themselves appear to be a trustworthy source of information. Many useful web pages appear as part of organizational sites and reflect the work of that organization. You can be more certain of the validity of the information if it is sponsored by a professional organization, such as the American Psychological Association or the American Psychological Society. Try to check on the accuracy of the material and discern whether the sources of information seem current. Reputable websites will probably link to other Attributed to Charles Stangor Saylor. Try to check the accuracy of the information by reading at least some of these sources yourself. It is fair to say that all authors, researchers, and organizations have at least some bias and that the information from any site can be invalid. But good material attempts to be fair by acknowledging other possible positions, interpretations, or conclusions. A critical examination of the nature of the websites you browse for information will help you determine if the information is valid and will give you more confidence in the information you take from it. Because all research has the potential to be invalid, no research ever “proves” a theory or research hypothesis. Internal validity is greater when confounding variables are reduced or eliminated. Scientists use meta-analyses to better understand the external validity of research. The researchers labeled the glasses with only an “M” (for Pepsi) or a “Q” (for Coke) and asked the participants to rate how much they liked the beverage. The research showed that subjects overwhelmingly preferred glass “M” over glass “Q,” and the researchers concluded that Pepsi was preferred to Coke. Determine the criteria that were used to select the studies and report on the findings of the research. Basic research and applied research inform each other, and advances in science occur more rapidly when both types of research are conducted. The results of psychological research are reported primarily in research reports in scientific journals. These research reports have been evaluated, critiqued, and improved by other scientists through the process of peer review. The methods used by scientists have developed over many years and provide a common framework through which information can be collected, organized, and shared. In addition to requiring that science be empirical, the scientific method demands that the procedures used be objective, or free from personal bias. Scientific findings are organized by theories, which are used to summarize and make new predictions, but theories are usually framed too broadly to be tested in a single experiment. Therefore, scientists normally use the research hypothesis as a basis for their research. Scientists use operational definitions to turn the ideas of interest—conceptual variables—into measured variables. Decisions about whether psychological research using human and animals is ethical are made using established ethical codes developed by scientific organizations and on the basis of judgments made by the local Institutional Review Board. These decisions are made through a cost-benefit analysis, in which the costs are compared to the benefits. If the potential costs of the research appear to outweigh any potential benefits that might come from it, then the research should not proceed. Descriptive research is designed to provide a snapshot of the current state of affairs. Descriptive research allows the development of questions for further study but does not assess relationships among variables. The results of descriptive research projects are analyzed using descriptive statistics. Correlational research assesses the relationships between and among two or more variables. It allows making predictions but cannot be used to draw inferences about the causal relationships between and among the variables. Linear relationships between variables are normally analyzed using the Pearson correlation coefficient. The goal of experimental research is to assess the causal impact of one or more experimental manipulations on a dependent variable.

Consuming alcohol increases the likelihood that people will respond aggressively to provocations discount 50 mg voveran mastercard, and even people who are not normally aggressive may react with aggression when [19] they are intoxicated (Graham purchase voveran 50 mg without prescription, Osgood order voveran 50mg amex, Wells, & Stockwell, 2006). Alcohol reduces the ability of people who have consumed it to inhibit their aggression because when people are intoxicated, they become more self-focused and less aware of the social constraints that normally prevent them from engaging aggressively (Bushman & Cooper, 1990; Steele & Southwick, [20] 1985). Negative Experiences Increase Aggression If I were to ask you about the times that you have been aggressive, I bet that you would tell me that many of them occurred when you were angry, in a bad mood, tired, in pain, sick, or frustrated. And you would be right—we are much more likely to aggress when we are experiencing negative emotions. When we are frustrated we may lash out at others, even at people who did not cause the frustration. In some cases the aggression is displaced aggression, which is aggression that is directed at an object or person other than the person who caused the frustration. Griffit and Veitch (1971) had students complete questionnaires in rooms in which the heat was at a normal temperature or in which the temperature was over 90 degrees Fahrenheit. Aggression is greater on hot days than it is on cooler days and during hot years than during cooler years, and most violent riots occur during the hottest days of [22] the year (Bushman, Wang, & Anderson, 2005). If we are aware that we are feeling negative emotions, we might think that we could release those emotions in a relatively harmless way, such as by punching a pillow or kicking something, with the hopes that doing so will release our aggressive tendencies. Catharsis—the idea that observing or engaging in less harmful aggressive actions will reduce the tendency to aggress later in a more harmful way—has been considered by many as a way of decreasing violence, and it was an important part of the theories of Sigmund Freud. As far as social psychologists have been able to determine, however, catharsis simply does not work. Rather than decreasing aggression, engaging in aggressive behaviors of any type increases [24] the likelihood of later aggression. Bushman, Baumeister, and Stack (1999) first angered their research participants by having another student insult them. Then half of the participants were allowed to engage in a cathartic behavior: They were given boxing gloves and then got a chance to hit a punching bag for 2 minutes. Then all the participants played a game with the person who had insulted them earlier in which they had a chance to blast the other person with a painful blast of white noise. Contrary to the catharsis hypothesis, the students who had punched the punching bag set a higher noise level and delivered longer bursts of noise than the participants who did not get a chance to hit the punching bag. It seems that if we hit a punching bag, punch a pillow, or scream as loud as we can to release our frustration, the opposite may occur—rather than decreasing aggression, these behaviors in fact increase it. At the same time, children are also exposed to violence in movies and video games, as well as in popular music and music videos that include violent lyrics and imagery. Research evidence makes it very clear that, on average, people who watch violent behavior become more aggressive. The evidence supporting this relationship comes from many studies conducted over many years using both correlational designs as well as laboratory studies in which people have been randomly assigned to view either violent or nonviolent material [25] (Anderson et al. Viewing violent behavior also increases aggression in part through observational learning. Video Clip This video shows Professor Albert Bandura describing his studies on the observational learning of aggression in children. Another outcome of viewing large amounts of violent material isdesensitization, which is the tendency over time to show weaker emotional responses to emotional stimuli. When we first see violence, we are likely to be shocked, aroused, and even repulsed by it. However, over time, as we see more and more violence, we become habituated to it, such that the subsequent exposures produce fewer and fewer negative emotional responses. Continually viewing violence also makes us more distrustful and more likely to behave aggressively (Bartholow, Bushman, & Sestir, [26] 2006; Nabi & Sullivan, 2001). Of course, not everyone who views violent material becomes aggressive; individual differences also matter. People who experience a lot of negative affect and who feel that they are frequently rejected by others whom they care about are more aggressive (Downey, Irwin, Ramsay, & [27] Ayduk, 2004). People with inflated or unstable self-esteem are more prone to anger and are highly aggressive when their high self-image is threatened (Baumeister, Smart, & Boden, [28] 1996). For instance, classroom bullies are those children who always want to be the center of Attributed to Charles Stangor Saylor. Bullies are highly motivated to protect their inflated self-concepts, and they react with anger and aggression when it is threatened. There is a culturally universal tendency for men to be more physically violent than women [30] (Archer & Coyne, 2005; Crick & Nelson, 2002). Worldwide, about 99% of rapes and about 90% of robberies, assaults, and murders are committed by men (Graham & Wells, [31] 2001). Both men and women respond to insults and provocation with aggression; the differences between men and women are smaller after they have been frustrated, insulted, or threatened (Bettencourt & Miller, [32] 1996). Research Focus: The Culture of Honor In addition to differences across cultures, there are also regional differences in the incidence of violence in different parts of the United States. As one example, the homicide rate is significantly higher in the southern and the western states but lower in the eastern and northern states. One explanation for these differences is variation in cultural norms about the appropriate reactions to threats against one‘s social status. In short, some men react more violently than others when they believe that others are threatening them. The social norm that condones and even encourages responding to insults with aggression is known as the culture of honor. The culture of honor leads people to view even relatively minor conflicts or disputes as challenges to one‘s social status and reputation and can therefore trigger aggressive responses. Beliefs in culture of honor norms are stronger among men who live or who were raised in the South and West than among men who are from or living in the North and East. The experiments, which were conducted at the University of Michigan, involved an encounter in which the research participant was walking down a narrow hallway.

As more specific alpha stimulation can be achieved with noradrenaline discount voveran 50 mg line, high dose dopamine is an undesirable overdose cheap 50 mg voveran mastercard. Alpha stimulation causes greater renal vasoconstriction than the vasodilation from dopamine receptor stimulation voveran 50mg sale, and so high dose dopamine reduces urine output. Amrinone/Inocor , Milrinone/Primacor , Enoximone, Bipyridine, Imidazole) therefore prolong vasodilatory effects of nitric oxide, causing ■ inodilation ■ positive inotropy. Thus, increasing both cardiac output and diastolic relaxation, without down-regulation. Phosphodiesterase inhibitors have far longer half-lives than adrenergic agonists, and so may be given by bolus. Central blood pressure can be increased by increasing heart rate (chronotrope), increasing stroke volume (β 1 stimulation or phosphodiesterase inhibition) or increasing systemic vascular resistance (alpha stimulation). Beta1 stimulation, the traditional mainstay on inotrope practice, creates problems of down-regulation, necessitating progressively higher doses. This chapter has also discussed renal dopamine since it is classified as an ‘inotrope’; however, there is little indication for the use of inotropic dopamine. Alpha stimulation (from adrenaline or nor adrenaline) can usefully raise central blood pressure by increasing systemic vascular resistance, but complications from peripheral (and gut) ischaemia should be considered. Further reading Nurses wishing to read more about specific drugs should follow up references cited in relevant sections of the text. A nursing overview is given by Graver (1992), but most literature is inevitably medical or pharmacological. Of medical texts, Hinds & Watson (1996) offers comprehensive application of drugs; Evans (1998) is a valuable recent addition to the nursing literature. Many articles discuss individual inotropes, or the specific effects of individual drugs. Manufacturers’ recommendations differ between systems, and so readers should adapt the material in this chapter to the systems used. Peritoneal dialysis and haemodialysis are briefly described, but nurses regularly using these therapies should resource specific texts on them. Plasmapheresis uses similar circuits to haemofiltration (usually used intermittently rather than continuously), and so most principles of haemofiltration apply to plasmapheresis. Haemofiltration considerably increases nursing workload; while caring for patients receiving haemofiltration can be rewarding, nurses should understand the potential complications. The terminology used to describe modes often varies between units (and in literature); ‘haemodialysis’ and ‘haemofiltration’ are interchanged and variously interpreted (Table 35. Material referring to ‘haemofiltration’ in this chapter also applies to variants (diafiltration, plasmapheresis) unless stated otherwise. Renal replacement therapies mimic normal renal function by placing semipermeable membranes between the patient’s blood and a collection Table 35. Filtration is the passage of fluid through this filter; dialysis is a similar movement of solutes. In the human kidney, both occur passively at the glomerular bed and actively as filtrate passes through renal tubules. While technically separate functions, in practice filtration necessarily contains solutes, while osmotic pressure of solutes on either side of the filter inevitably influences filtration. Peritoneal blood and dialysis fluid (infused through an abdominal catheter) achieves equilibrium of most solutes. Using fluids with large (glucose) molecules, excess body fluid is drawn by osmosis into dialysate, then removed by negative pressure (usually gravity). Peritoneal dialysis has many limitations, including: ■ limited dialysate volumes (abdominal distension causes pain, lung splinting and impairs major organ perfusion) ■ solute removal is limited by filtrate-to-plasma concentrations (toxin levels are reduced, not eliminated) ■ loss of albumin and other large molecules (the peritoneum is highly permeable) ■ peritonitis ■ contraindications (e. Haemodialysis (and haemodiafiltration) combines diffusion, ultrafiltration and convection; toxin removal is so efficient that a few (3–5) hours treatment once or twice each week enables people with chronic renal failure to live fairly normal lives. However complications of haemofiltration include ■ cardiovascular instability ■ disequilibrium syndrome ■ immunological deficiency ■ limited water and solute removal These complications can be especially problematic with critical illness. Hypotensive episodes are twice as likely with haemodialysis as with haemofiltration (Henderson 1987). However caused, disequilibrium syndrome rarely occurs, but when it does it can be distressing for both patients and others; neurological effects include confusion, aggression, nausea/vomiting, muscle twitching, lethargy, blurred vision and possible coning. Critical illness and sedation can mask many of these symptoms, but not the discomfort problems for patients. Removing intravascular fluid encourages replacement by extravascular fluid, but limited transfer occurs during the few hours of haemodialysis, whereas continuous treatments (e. It mimics human glomerular filtration, as plasma is forced under pressure through a semipermeable Haemofiltration 347 membrane (ultrafiltration), and solutes are drawn across the membrane by convection. Unlike the human kidney, haemofiltration (and haemodialysis) cannot selectively reabsorb. Ultrafiltrate volumes are large (although smaller than healthy human ultrafiltrate), so that large infusions are needed to mimic reabsorption. Driving pressure was therefore the differential between a patient’s arterial and venous blood pressures. Anticoagulation was added to prevent thrombus formation in extracorporeal circuits; replacement fluid was given to mimic tubular reabsorption. Manufacturers are rationalising terminology by renaming ‘arterial’ circuits ‘afferent’ and ‘venous’ circuits ‘efferent’; this follows human renal physiology, and is logical, and so although not (as yet) universal, it is used here. Compared with haemodialysis, haemofiltration: ■ enables filtration despite hypotension ■ improves cardiovascular stability ■ enables more gentle removal of solutes (less disequilibrium) ■ removes significantly larger fluid volumes High-speed haemofiltration for short periods may achieve better clearance than haemodialysis, but circuits are relatively costly and time-consuming to prime, and the use of intermittent filtration is almost exclusively confined to hospitals with on-site renal units (Amoroso et al.