Nikolaos J. Skubas, MD, FASE
There may be inflammatory cells in the Anterior uveitis or iritis with ciliary flush but anterior chamber medicine 1800s discount lumigan uk, cataracts may form symptoms hepatitis c buy lumigan 3ml on line, and adhesions may pupil not stuck down develop between the iris and lens medications with sulfa order generic lumigan line. The affected eye is red with the injection particularly being pronounced over the area that covers the inflamed ciliary body (ciliary flush) treatment 02 bournemouth cheap lumigan 3ml. The pupil is small because of spasm of the sphincter, or irregular because of adhesions of the iris to the lens (posterior synechiae). Inflammatory cells may be deposited on the back of the cornea (keratitic precipitates) or may settle to form a collection of cells in the anterior chamber of the eye (hypopyon). It is important to ensure there is no disease in the rest of the eye that is giving rise to signs of an anterior uveitis, such as more posterior inflammation, a retinal detachment, or an intraocular tumour. The intraocular pressure may also rise because inflammatory cells block the trabecular meshwork, and antiglaucoma treatment may be needed if this occurs. Continued inflammation may lead to permanent damage of the trabecular meshwork and secondary glaucoma, cataracts, and oedema of the macula. Keratic precipitates Patients with panuveitis will need systemic investigation and possibly systemic immunosuppression. Acute angle closure glaucoma Acute angle closure glaucoma always should be considered in a patient over the age of 50 with a painful red eye. There is pain in one eye, which can be extremely severe and may be accompanied by vomiting. The patient Features of acute angle closure glaucoma complains of impaired vision and haloes around lights due to Pain Hazy cornea oedema of the cornea. The patient may have had similar Haloes around lights Age more than 50 attacks in the past which were relieved by going to sleep (the Impaired vision Eye feels hard pupil constricts during sleep, so relieving the attack). The Fixed semidilated pupil Unilateral patient may have needed reading glasses earlier in life. A patient with acute angle closure glaucoma may be systemically unwell, with severe headache, nausea, and vomiting, and can be misdiagnosed as an acute abdominal or neurosurgical emergency. Acute angle closure glaucoma also may present in patients immediately postoperatively after general anaesthesia, and in patients receiving nebulised drugs (salbutamol and Acute angle closure ipratropium bromide) for pulmonary disease. The cornea is corneal oedema (irregular hazy and the pupil is semidilated and fixed. Vision is impaired reflected image of light on cornea) and according to the state of the cornea. On gentle palpation the fixed semidilated pupil eye feels harder than the other eye. The anterior chamber seems shallower than usual, with the iris being close to the cornea. If the patient is seen after the resolution of an attack the signs may Increased resistance have disappeared, hence the importance of the history. Iris lax Emergency treatment is needed if the sight of the eye is to be preserved. If it is not possible to get the patient to hospital straight away, intravenous acetazolamide 500mg should be given, and pilocarpine 4% should be instilled in the eye to constrict the pupil. First the pressure must be brought down medically and Iris is taut then a hole made in the iris with a laser (iridotomy) or Build up of aqueous surgically (iridectomy) to restore normal aqueous flow. The pushes iris forward, blocking trabecular other eye should be treated prophylactically in a similar way. If meshwork treatment is delayed, adhesions may form between the iris and Small pupil Semidilated pupil the cornea (peripheral anterior synechiae) or the trabecular meshwork may be irreversibly damaged necessitating a full Acute angle closure glaucoma surgical drainage procedure. If there is a history of trauma, or a red eye after hammering or chiselling, then ocular injury and an intraocular foreign body must be excluded. Subconjunctival haemorrhages are often Subconjunctival seen on the labour ward post partum. If there are no other abnormalities the patient should be reassured and told the redness may take several weeks to fade. If abnormal bruising of the skin is present then consider checking the full blood count and platelets. There may have been a pre-existing lesion in the area that the patient may have noticed before. A pterygium is a non-malignant fibrovascular growth that encroaches onto the cornea. For a pterygium, surgical excision is indicated if it is a cosmetic problem, causes irritation, or is encroaching on the visual axis. Symptomatic relief from the Pterygium associated tear-film irregularities are often helped by the use of topical artificial tear eye drops. Red eye that does not get better Red eyes are so common that every doctor will be faced with a patient whose red eye does not improve with basic management. Bilaterial thyroid eye disease with exophthalmos and Many of the conditions described below will need a detailed conjunctival oedema (chemosis) ophthalmic assessment to make the diagnosis. Consider early ophthalmic referral when patients present with red eyes and atypical clinical features or fail to improve with basic management. Orbital problems It is easy to miss someone with early thyroid eye disease and patients can present with one or both eyes affected. Look for associated ocular (for example, lid retraction) and systemic features of thyroid disease. There are several rare but important orbital causes of chronic red eyes, including carotico cavernous fistula, orbital inflammatory disease, and lymphoproliferative diseases. Acute dacrocystitis Eyelid problems Malpositions of the eyelids such as entropion and ectropion often cause chronic conjunctival injection. Nasolacrimal obstruction presents with a watery eye but there can be chronic ocular injection if the cause is lacrimal canaliculitis or a lacrimal sac abscess. A periocular lid malignancy such as basal cell carcinoma or sebaceous (meibomian) gland carcinoma may rarely present as a unilateral chronic red eye. Giant papillary conjunctivitis may occur in patients with ocular allergic disease or in contact lens wearers. If someone is on long term topical drug therapy (for example, for glaucoma) then drug hypersensitivity should be considered, especially if drug instillation causes marked itching or the eyelids have an eczematous appearance. Other causes of chronic red eyes include a subtarsal foreign body, dry eyes, and cicatricial ocular pemphigoid. Fluorescein drops will reveal corneal staining in patients whose red eye syndrome is caused by a corneal problem. Viral infection Adenoviral keratoconjunctivitis may lead to a red, painful eye for many weeks and patients should be warned of this. Patients with refractory adenoviral keratitis may occasionally need topical steroid therapy. This should only be undertaken with Subtarsal foreign body close ophthalmological supervision as it can be hard to wean patients off steroids. Scleral problems Episcleritis and scleritis present with red eyes that do not respond to topical antibiotic therapy. Think of scleritis in any patient presenting with marked ocular pain and injection.
Memory traces A term indicating the change in the nervous system representing an event medications list form effective 3ml lumigan. Misinformation effect When erroneous information occurring after an event is remembered as having been part of the original event symptoms nausea cheap lumigan 3 ml overnight delivery. Mnemonic devices Memory (Encoding treatment zinc toxicity generic 3ml lumigan overnight delivery, Storage treatment whooping cough buy cheap lumigan on-line, Retrieval) 668 A strategy for remembering large amounts of information, usually involving imaging events occurring on a journey or with some other set of memorized cues. Recoding the ubiquitous process during learning of taking information in one form and converting it to another form, usually one more easily remembered. Retroactive interference the phenomenon whereby events that occur after some particular event of interest will usually cause forgetting of the original event. Storage the stage in the learning/memory process that bridges encoding and retrieval; the persistence of memory over time. On the prediction of occurrence of particular verbal intrusions in immediate recall. Planting misinformation in the human mind: A 30-year investigation of the malleability of memory. Paradoxical effects of testing: Repeated retrieval attempts enhance the likelihood of later accurate and false recall. The magical number seven, plus or minus two: Some limits on our capacity for processing information. False recognition in younger and older adults: Exploring the characteristics of illusory memories. Testing the retrieval effort hypothesis: Does greater difficulty correctly recalling information lead to higher levels of memory Forgetting is viewed as an adaptive process that allows us to be efficient in terms of the information we retain. Introduction Chances are that you have experienced memory lapses and been frustrated by them. Maybe you forgot to call your aunt on her birthday or you routinely forget where you put your cell phone. Oftentimes, the bit of information we are searching for comes back to us, but sometimes it does not. Causes of Forgetting Forgetting and Amnesia 673 One very common and obvious reason why you cannot remember a piece of information is because you did not learn it in the first place. If you fail to encode information into memory, you are not going to remember it later on. Usually, encoding failures occur because we are distracted or are not paying attention to specific details. For example, people have a lot of trouble recognizing an actual penny out of a set of drawings of very similar pennies, or lures, even though most of us have had a lifetime of experience handling pennies (Nickerson & Adams, 1979). However, few of us have studied the features of a penny in great detail, and since we have not attended to those details, we fail to recognize them later. Similarly, it has been well documented that distraction during learning impairs later memory. Most of the time this is not problematic, but in certain situations, such as when you are studying for an exam, failures to encode due to distraction can have serious repercussions. It has been known since the pioneering work of Hermann Ebbinghaus (1885/1913) that as time passes, memories get harder to recall. Ebbinghaus created more than 2,000 nonsense syllables, such as dax, bap, and rif, and studied his own memory for them, learning as many as 420 lists of 16 nonsense syllables for one experiment. He found that his memories diminished as time passed, with the most forgetting happening early on after learning. His observations and subsequent research suggested that if we do not rehearse a memory and the neural representation of that memory is not reactivated over a long period of time, the memory representation may disappear entirely or fade to the point where it can no longer be accessed. As you might imagine, it is hard to definitively prove that a memory has decayed as opposed to it being inaccessible for another reason. Critics argued that forgetting must be due to processes other than simply the passage of time, since disuse of a memory does not always guarantee forgetting (McGeoch, 1932). More recently, some memory theorists have proposed that recent memory traces may be degraded or disrupted by new experiences (Wixted, 2004). Memory traces need to be consolidated, or transferred from the hippocampus to more durable representations in the cortex, in order for them to last (McGaugh, 2000). When the consolidation process is interrupted by the encoding of other experiences, the memory trace for the original experience does not get fully developed and thus is forgotten. Both encoding failures and decay account for more permanent forms of forgetting, in which the memory trace does not exist, but forgetting may also occur when a memory exists yet we temporarily cannot access it. This type of forgetting may occur when we lack the appropriate retrieval cues for bringing the memory to mind. You have probably had the frustrating experience of forgetting your password for an online site. Usually, the password has not been permanently forgotten; instead, you just need the right reminder to remember what it is. Retrieval hints can bring back to mind seemingly forgotten memories (Tulving & Pearlstone, 1966). One real-life illustration of the importance of retrieval cues comes from a study showing that whereas people have difficulty recalling the names of high school classmates years after graduation, they are easily able to recognize the names and match them to the appropriate faces (Bahrick, Bahrick, & Wittinger, 1975). The names are powerful enough retrieval cues that they bring back the memories of the faces that went with them. The fact that the presence of the right retrieval cues is critical for remembering adds to the difficulty in proving that a memory is permanently forgotten as opposed to temporarily unavailable. Retrieval failures can also occur because other memories are blocking or getting in the way of recalling the desired memory. For example, you may fail to remember the name of a town you visited with your family on summer vacation because the names of other towns you visited on that trip or on other trips come to mind instead. Interference is also relevant to the example of forgetting a password: passwords that we have used for other websites may come to mind and interfere with our ability to retrieve the desired password. Interference can be either proactive, in which old memories block the learning of new related memories, or retroactive, in which new memories block the retrieval of old related memories. For both types of interference, competition between memories seems to be key (Mensink & Raaijmakers, 1988). Recalling a desired memory in the face of competition may result in the inhibition of related, competing memories (Levy & Anderson, 2002). You may have difficulty recalling the name of Kennebunkport, Maine, because other Maine towns, such as Bar Harbor, Winterport, and Camden, come to mind instead. Forgetting and Amnesia 675 Finally, some memories may be forgotten because we deliberately attempt to keep them out of mind. Over time, by actively trying not to remember an event, we can sometimes successfully keep the undesirable memory from being retrieved either by inhibiting the undesirable memory or generating diversionary thoughts (Anderson & Green, 2001). Imagine that you slipped and fell in your high school cafeteria during lunch time, and everyone at the surrounding tables laughed at you. You would likely wish to avoid thinking about that event and might try to prevent it from coming to mind. One way that you could accomplish this is by thinking of other, more positive, events that are associated with the cafeteria. Eventually, this memory may be suppressed to the point that it would only be retrieved with great difficulty (Hertel & Calcaterra, 2005). Together they can account for the day to-day episodes of forgetting that each of us experience. Typically, we think of these episodes in a negative light and view forgetting as a memory failure. Most people would reason that forgetting that occurs in response to a deliberate attempt to keep an event out of mind is a good thing. No one wants to be constantly reminded of falling on their face in front of all of their friends.
Availability heuristic the tendency to judge the frequency or likelihood of an event by the ease with which relevant instances come to mind symptoms 0f parkinsons disease buy 3ml lumigan free shipping. Applied to aggression medicine prescription drugs lumigan 3 ml on-line, catharsis is the belief that acting aggressively or even viewing aggression purges angry feelings and aggressive impulses into harmless channels treatment kitty colds buy 3 ml lumigan with amex. Hostile attribution bias the tendency to perceive ambiguous actions by others as aggressive 4 medications generic lumigan 3 ml on-line. Hostile expectation bias the tendency to assume that people will react to potential conflicts with aggression. Hostile perception bias the tendency to perceive social interactions in general as being aggressive. Violence Aggression intended to cause extreme physical harm, such as injury or death. Weapons effect the increase in aggression that occurs as a result of the mere presence of a weapon. Violent video-game effects on aggression, empathy, and prosocial behavior in Eastern and Western countries. Sex differences in aggression between heterosexual partners: A meta-analytic review. The reduction of human aggression: A field study of the influence of incompatible reactions. Threatened egotism, narcissism, self-esteem, and direct and displaced aggression: Does self-love or self-hate lead to violence The effects of reward and punishment in violent video Aggression and Violence 819 games on aggressive affect, cognition, and behavior. I wish I were a warrior: the role of wishful identification in effects of violent video games on aggression in adolescent boys. Alcohol and violence: Epidemiology, neurobiology, psychology, and family issues, (pp. Flies on the wall are less aggressive: Self distanced reflection reduces angry feelings, aggressive thoughts, and aggressive behaviors. The development of aggressive behavior during childhood: What have we learned in the past century Naturalistic studies of aggressive behavior: Aggressive stimuli, victim visibility, and horn honking. Schroeder People often act to benefit other people, and these acts are examples of prosocial behavior. Such behaviors may come in many guises: helping an individual in need; sharing personal resources; volunteering time, effort, and expertise; cooperating with others to achieve some common goals. The decision of whether or not to help is not as simple and straightforward as it might seem, and many factors need to be considered by those who might help. In this module, we will try to understand how the decision to help is made by answering the question: Who helps when and why Social psychologists began trying to answer this question following the unfortunate murder of Kitty Genovese in 1964 (Dovidio, Piliavin, Schroeder, & Penner, 2006; Penner, Dovidio, Piliavin, & Schroeder, 2005). A knife-wielding assailant attacked Kitty repeatedly as she was returning to her apartment early one morning. At least 38 people may have been aware of the attack, but no one came to save her. More recently, in 2010, Hugo Alfredo Tale-Yax was stabbed when he apparently tried to intervene in an argument between a man and woman. As he lay dying in the street, only one man checked his status, but many others simply glanced at the scene and continued on their way. Trying to understand why people do not always help became the focus of bystander intervention research. Defining the situation: the role of pluralistic ignorance the decision to help is not a simple yes/no proposition. Sometimes help comes quickly; an onlooker recently jumped from a Philadelphia subway Helping and Prosocial Behavior 824 platform to help a stranger who had fallen on the track. But some situations are ambiguous, and potential helpers may have to decide whether a situation is one in which help, in fact, needs to be given. To define ambiguous situations (including many emergencies), potential helpers may look to the action of others to decide what should be done. Relying on others to define the situation and to then erroneously conclude that no intervention is necessary when help is actually needed is called pluralistic ignorance (Latane & Darley, 1970). When people use the inactions of others to define their own course of action, the resulting pluralistic ignorance leads to less help being given. In situations in which help is needed, the presence or absence of others may affect whether a bystander will assume personal responsibility to give the assistance. If the bystander is alone, personal responsibility to help falls solely on the shoulders of that person. Although it might seem that having more potential helpers around would increase the chances of the victim getting help, the opposite is often the case. Knowing that someone else could help seems to relieve bystanders of personal responsibility, so bystanders do not intervene. On the other hand, watch the video of the race officials following the 2013 Boston Marathon after two bombs exploded as runners crossed the finish line. Despite the presence of many spectators, the yellow-jacketed race officials immediately rushed to give aid and comfort to the victims of the blast. Each one no doubt felt a personal responsibility to help by virtue of their official capacity in the event; fulfilling the obligations of their roles overrode the influence of the diffusion of responsibility effect. There is an extensive body of research showing the negative impact of pluralistic ignorance and diffusion of responsibility on helping (Fisher et al. These studies show the tremendous importance potential helpers place on the social situation in which unfortunate events occur, especially when it is not clear what should be done and who should do it. Other people provide important social information about how we should act and what our personal obligations might be. But does knowing a person needs help and accepting responsibility to provide that help mean the person will get Helping and Prosocial Behavior 825 assistance The costs and rewards of helping the nature of the help needed plays a crucial role in determining what happens next. If the needed help is of relatively low cost in terms of time, money, resources, or risk, then help is more likely to be given. Lending a classmate a pencil is easy; confronting the knife-wielding assailant who attacked Kitty Genovese is an entirely different matter. As the unfortunate case of Hugo Alfredo Tale-Yax demonstrates, intervening may cost the life of the helper. The potential rewards of helping someone will also enter into the equation, perhaps offsetting the cost of helping. If helpful acts are recognized by others, helpers may receive social rewards of praise or monetary rewards. Potential helpers consider how much helping will cost and compare those costs to the rewards that might be realized; it is the economics of helping. Order lumigan 3ml with visa. I Cut My Wrists So Justin Bieber Will Stop Smoking Weed.
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