Mark Corson

By V. Urkrass. Medical College of Pennsylvania and Hahnemann University. 2018.

The absence of any one of these sub- stances causes a child to have soft bone order lithium 150 mg with visa, called rickets 150 mg lithium free shipping. Next order lithium 300 mg without a prescription, the blood supply entering the cartilage brings osteoblasts that attach themselves to the cartilage. As the primary center of ossification, the diaphysis of the long bone is the first to form spongy bone tissue along the cartilage, followed by the epiphyses, which form the secondary centers of ossification and are separated from the diaphysis by a layer of uncalcified cartilage called the epiphyseal plate where all growth in bone length occurs. Compact bone tissue covering the bone’s surface is pro- duced by osteoblasts in the inner layer of the periosteum, producing growth in diameter. Intramembranous ossification: Occurs not along cartilage but instead along a template of membrane, as the name implies, primarily in compact flat bones of the skull that don’t have Haversian systems. The skull and mandible (lower jaw) of the fetus are first laid down as a membrane. Osteoblasts entering with the blood supply attach to the membrane, ossifying from the center of the bone out- ward. The edges of the skull’s bones don’t completely ossify to allow for molding of the head during birth. Instead, six soft spots, or fontanels, are formed: one frontal or anterior, two sphenoidal or anterolateral, two mastoidal or posterolat- eral, and one occipital or posterior. Once formed, bone is surrounded by the periosteum, which has both a vascular layer (remember the Latin word for “vessel” is vasculum) and an inner layer that contains the osteoblasts needed for bone growth and repair. A penetrating matrix of connective tissue called Sharpey’s fibers connects the periosteum to the bone; inside the bone, the medullary cavity is lined by a thin membrane called the endosteum (from the Greek endon, meaning “within,” and, of course, that ever-present Greek word osteon). Following are the basic terms used to identify bone landmarks or surface features: Process: A broad designation for any prominence or prolongation Spine: An abrupt or pointed projection Trochanter: A large, usually blunt process Tubercle: A smaller, rounded eminence Tuberosity: A large, often rough eminence Crest: A prominent ridge Head: A large, rounded articular end of a bone; often set off from the shaft by a neck Condyle: An oval articular prominence of a bone Facet: A smooth, flat or nearly flat articulating surface Fossa: A deeper depression Sulcus: A groove Foramen: A hole Meatus: A canal or opening to a canal Chapter 5: A Scaffold to Build On: The Skeleton 65 Q. Remember that description root blast in biological terms refers of the structural part of the bone, to growth or formation, and the the Haversian system? And check Latin root clast refers to breaking out that root osteo, which comes or fragmentation. Blood vessels entering through Volkmann’s canals reach the bone cells through the a. Fill in the blanks to complete the following sentences: Bones are first laid down as 15. The epiphyseal and diaphyseal areas remain separated by a layer of uncalcified cartilage called the 20. Chapter 5: A Scaffold to Build On: The Skeleton 67 Another very large cell that enters with the blood supply is the 21. Later it helps absorb bone tissue from the center of the long bone’s shaft, forming the 22. After ossification, the spaces that were formed by the osteoclasts join together to form 23. Unlike bones in the rest of the body, those of the skull and mandible (lower jaw) are first laid down as 24. In the skull, the edges of the bone don’t ossify in the fetus but remain membranous and form 25. Use the terms that follow to identify the regions and structures of the long bone shown in Figure 5-1. Compact bone tissue Chapter 5: A Scaffold to Build On: The Skeleton 69 Axial Skeleton: Keeping It All in Line Just as the Earth rotates around its axis, the axial skeleton lies along the midline, or center, of the body. Think of your spinal column and the bones that connect directly to it — the rib (thoracic) cage and the skull. The tiny hyoid bone, which lies just above your larynx, or voice box, also is considered part of the axial skeleton, although it’s the only bone in the entire body that doesn’t connect, or articulate, with any other bone. There are a total of 80 named bones in the axial skeleton, which supports the head and trunk of the body and serves as an anchor for the pelvic girdle. In addition to the hyoid bone, 8 bones form the cranium to house and protect the brain, 14 form the face, and 6 bones make it pos- sible for you to hear. Making a hard head harder Fortunately for the cramming student, most of the bones in the skull come in pairs. In the cranium there’s just one of each of the following: frontal bone (forehead), occipital bone (back and base of the skull), ethmoid bone (made of several plates, or sections, between the eye orbits in the nasal cavity), and sphenoid bone (a butterfly-shaped structure that forms the floor of the cranial cavity). But there are two temporal (hous- ing the hearing organs in the auditory meatus) and parietal (roof and sides of the skull) bones. These bones are attached along sutures called coronal (located at the top of the skull), squamosal (located on the sides of the head surrounding the temporal bone), sagittal (along the midline atop the skull located between the two parietal bones), and lambdoidal (forming an upside-down V — the shape of the Greek letter lambda — on the back of the skull). In the face, there’s only one mandible (jawbone) and one vomer dividing the nostrils, but there are two each of maxillary (upper jaw), zygomatic (cheekbone), nasal, lacrimal (a small bone in the eye socket), palatine (which makes up part of the eye socket, nasal cavity, and roof of the mouth), and inferior nasal concha, or turbinated, bones. Inside the ear, there are two each of three ossicles, or bonelets, which also happen to be the smallest bones in the human body: the malleus, incus, and stapes. The cranial cavity contains several openings, or foramina (the singular is foramen), in the floor of the cranial cavity that allow various nerves and vessels to connect to the brain. The holes in the ethmoid bone’s cribriform plate allow olfactory — or sense of smell — receptors to pass through to the brain. A large hole in the occipital bone called the foramen magnum allows the spinal cord to connect with the brain. The optic foramen allows passage of the optic nerves, whereas the jugular foramen allows passage of the jugular vein and several cra- nial nerves. The foramen rotundum allows passage of the trigeminal nerve, which is the chief sensory nerve to the face and controls the motor functions of chewing.

One consistent pattern over time has been • Expanding imaginal margins involves focusing that if the theory does help 300 mg lithium, if it does enhance qual- on the imaging process lithium 150 mg with visa. Expanding imaginal ity of care and quality of work life buy lithium 300mg lowest price, then it also has margins while engaging with others in coming The Teaching-Learning Process and the Theory of Human Becoming The teaching-learning process confronts the familiar-unfamiliar all-at-once. From a human becoming perspective, teaching-learning is a process of engaging with others in coming to know. The Seeker, in engaging with others, participates in simultaneous processes of coming to know at an explicit-tacit level. In imag- People who embrace this human becoming per- ing valued possibilities, one is already moving spective of teaching-learning participate in foster- with those possibilities. Naming the new in the process of engaging with others in coming to know cocreates the meaning References of the moment. Weathering the storm: Persevering • Going with content-process shifts involves a syn- through a difficult time. Parse’s theory of human becoming in prac- coming to know involves the intentionality of tice with hospitalized adolescents. Feeling uncomfortable: Children in fam- to know involves honoring the tensions of con- ilies with no place of their own. The lived experience of feeling very tired: • Giving meaning involves ascribing value to ideas A study of adolescent girls. The lived experience of struggling with know involves creating one’s personal reality in making a decision in a critical life situation. A commitment to honoring people’s mosphere for conversation while being attentive choices. Research evaluating human becoming know involves participating in discerning dis- in practice. Such understanding un- Interpretation with the human becoming community change concepts. This leader: A transformational role that addresses human diver- presence involves an attentive, being with the sity. Innovations in ing with others in coming to know involves nurse retention and patient centered care. Research in Nursing • Growing story involves giving meaning to abstract & Health, 25, 58–67. Translating nursing conceptual frame- works and theory for nursing practice in the parish commu- comprehending personal realities. True presence through music for persons Advanced Practice Nursing Quarterly, 2(4), 79–84. Nursing Science model of health ministry: Living Parse’s theory of human be- Quarterly, 16, 232–238. Struggling to go along when you do not be- Parish Nurse Symposium: Parish nursing: Ministering through lieve. The lived experience of serenity: Using Parse’s re- Resource Center—Advocate Health Care. Nursing Science practice: An evaluation study of Parse’s theory of human be- Quarterly, 7, 104–112. Canadian Journal of Nursing Leadership, 12(4), New York: National League for Nursing Press. Of life immense in passion, pulse, and University of Colorado Health Sciences Center, Denver. Standards of nursing and the winds of practice and Parse’s theory of human becoming. Nursing Science Quarterly, becoming theory: Living true presence in nursing practice. Applying Parse’s the- of Toronto, 550 University Avenue, Toronto, Ontario, Canada ory to perioperative nursing: A nontraditional approach. Nursing research: becoming theory in practice in an acute care psychiatric set- Qualitative methods. Nursing Science Quarterly, 6, for nurses teaching and learning Parse’s theory of human be- 130–139. The global context of nurs- coming theory: A manual for the teaching-learning process. Hope: An international human becoming per- guided research on the lived experience of hope. Nursing Science Quarterly, human becoming hermeneutic study of a theme from 10, 124–130. The lived experience of feeling loved: A Qualitative inquiry: The path of sciencing (pp. Beyond objectivism and relativism: Illuminations: The human becoming theory in practice and re- Science, hermeneutics, and praxis. Comparison of three Parse method stud- of life and the human becoming theory: Exploring disci- ies on feeling very tired. The nurse theorists: Portraits of excellence: York: National League for Nursing Press. The lived experience of health for hospitalized the oldest old living in Scotland: A phenomenological study. The American Nurses Association code Behavioural Research Unit, Toronto-Sunnybrook Regional of ethics: A reflection on the ethics of respect and human dig- Cancer Centre, Toronto, Canada. Development of gerontological nursing the- approach to Parse’s theory-based practice. Human subjectivity: The cocreation of with nurses guided by Parse’s theory of human becoming.

Te death would then be investigated by the physician-coroner order 150mg lithium with mastercard, with the attendant potential confict of interest buy lithium 300 mg lowest price. Independence from other agencies must be considered an absolute requirement for optimal death investigation buy lithium 150 mg with mastercard. As early as 1928 the National Research Council stated bluntly that the ofce of coroner is anachronistic and “has conclusively demonstrated its incapacity to perform the functions customarily required of it. A recent report by the National Academy of Science also discusses inherent problems with the coroner system. Partially because of these shortcomings with the coroner system, the medical examiner system came into being. Te title of medical examiner is not a medical designation, but a governmental title, and it is defned difer- ently by various jurisdictions (usually at the state level). In 1877, the Massachusetts General Laws established physician medi- cal examiners in Sufolk County and the remainder of the commonwealth, appointed by the governor for seven-year terms. Tese physicians assumed the duties of the coroner, but only in the case of deaths known to have come about by violent means. Tese physicians also were not able to perform autopsies on their own authority, but required an order from another ofcial, such as the district attorney, to authorize this procedure. In the reformed system, the medical examiner took on all the investigative duties of the coroner, whose ofce was abolished. Deaths of prisoners or those not attended by physicians were also included in the medical examiner’s jurisdiction. When discussing the ofce of medical examiner, it is necessary to defne the term forensic pathology. Te term forensic derives from the Latin word forensis for “before the forum,” or relating to argument and discussion. Pathology is the study of disease, or a medical specialty devoted to the diagnosis of disease by laboratory means. Forensic pathology can be defned as the subspecialty of medicine devoted to the medical investigation of death. It is one of many components of the modern forensic sciences, and is a subspecialty of the medi- cal specialty of pathology. In the United States, training in forensic pathology death investigation systems 41 requires completion of a course of medical study, culminating in a doctor of medicine or doctor of osteopathy degree, completion of three or more years of residency training in anatomic pathology, completion of an accredited year of fellowship training in forensic pathology in an accredited training program (usually a large medical examiner’s ofce), and passage of national certifcation tests in both anatomic and forensic pathology, administered by the American Board of Pathology. Te physician can then use the title of forensic pathologist and is considered board certifed in that feld. Te formation of an academic specialty of forensic pathology owes much to early chairs of forensic medicine established in Europe and Scotland, but the frst endowed chair of legal medicine in the United States was established at the Harvard Medical School in 1937. Forensic pathology was frst recognized as a medical subspecialty in 1959, when examinations were administered and the frst cadre of physicians was certifed as forensic pathologists. Over the years, the medical examiner system has been refned somewhat to include some fairly standard elements. Forensic pathologists working under the direction of a coroner should not be referred to as medical examiners, since the coroner is the actual ofcial imbued with the authority to investigate and certify death, not a physician. In this way, the ofce of medical examiner becomes a professional position, not a political one, and the ofce holder is not concerned with currying favor with an electorate and periodically campaigning for reelection. Te sole authority for investigation and certifcation of deaths in his or her jurisdictional area, and is independent of law enforcement, pros- ecutorial, or judicial agencies. Only a trained and experi- enced physician has the knowledge to obtain and analyze such data and to synthesize a rational cause and manner of death conclusion from it. During the frst half of the twentieth century, medical examiner systems progressively replaced coroner jurisdictions throughout the United States. At this time, the populations of twenty-two states are served solely by medical examiners, eleven by coroners, and seventeen by a combination of medical examiner and coroner systems. Some medical examiner states are under the authority of a statewide medi- cal examiner. For instance, in Texas, justices of the peace perform coroner duties in counties without a medical examiner. For these reasons, it is difcult to efectively categorize medicolegal death investigation systems in the United States, as the various systems ofen have little resemblance to each other. In early times, records of birth and death were kept inconsistently, if at all, but in 1538, clergy in England were required to keep a ledger of births, deaths, and marriages in their parishes. Tis custom of registration persisted for many years, but gradually became a death investigation systems 43 Table 4. Tis change was given further impetus during infectious epidemics of the nineteenth century, when it came to be appreciated that it would be worthwhile to keep track of the numbers of deaths occurring as an infectious contagion progressed. Modern death certifcation is a function of state governments, and all jurisdictions in the United States have a common requirement that the death of a person be ofcially documented, with attes- tation of the cause and manner of death by a physician, medical examiner, coroner, or other ofcial. Te document serving this purpose is referred to as a death certifcate, and requirements regarding its use and fling are set forth by a state department of health, vital records, or equivalent. Standard Certifcate of Death, which is in turn based on World Health Organization recommendations. Many states are also moving toward a standardized digital death registration process that promises to make gathering of demographic and epidemiologic data much simpler and more efective. First, as has been noted above, a developed society has an interest in documenting death investigation systems 45 the birth and death of its citizenry in order to provide for transfer of estates, administration of societal programs, payment of insurance settlements, etc. Te tracking of deaths from an epidemiologic viewpoint allows for better public health surveillance in a society, be it related to epidemic diseases or public safety issues.