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This movement of the myosin crossbridges results in a slight displacement (sliding) of the thin filament over the thick filament toward the center of the sarcomere anxiety lymph nodes venlafaxine 150mg mastercard. Activation of the myosin heads is extremely important because it provides the cross-bridges with stored energy to anxiety causes cheapest generic venlafaxine uk move the actin during the power stroke anxiety unspecified icd 10 purchase venlafaxine 75 mg without prescription. On the other hand, activated myosin remains in the resting state awaiting the next stimulus if calcium is not available in sufficient concentration to remove tropomyosin from its blocking position on actin (see step 4b in Figure 2-11). Because each cycle of the myosin cross-bridges barely displaces the actin, the myosin heads must bind to the actin and be displaced many times for a single contraction to occur. Thus myosin makes and breaks its bond with actin hundreds or even thousands of times during a single muscle twitch. In order for this make-and-break cycle to occur, myosin heads must detach from actin and then be reactivated. In a similar manner, the myosin head possesses stored energy, which is released when the myosin heads bind to actin and swivel. The final phase of muscular contraction is muscular relaxation (see point 6 in Figure 2-10 and step 4b in Figure 2-11). Relaxation occurs when the nerve impulse ceases and calcium is pumped back into the sarcoplasmic reticulum by active transport. In the absence of calcium, tropomyosin returns to its blocking position on actin, and myosin heads are not able to bind to actin. Although emphasis is often placed on muscle contraction, the ability to relax a muscle following contraction is just as important. Changes in the Sarcomere during Contraction Much of the evidence supporting the sliding-filament theory comes from observation of changes in the length of a sarcomere during muscular contraction. Diagrams of the sarcomere during rest and during contraction are shown in Figure 2-12, A and Figure 2-12, B, respectively. B, During contraction of the sarcomere, the lengths of actin and myosin filaments are unchanged. Sarcomere shortens because actin slides over myosin, pulling Z discs toward the center of the sarcomere. The I band shortens because the thin filaments are pulled over the thick filaments toward the center of the sarcomere. Thus there is little or no area where the thin filaments do not overlap the thick filaments. The H zone shortens and may disappear because the thin filaments are pulled over the thick filaments toward the center of the sarcomere. If the thin filament overlaps the thick filament for the entire length of the thick filament, there is no H zone. The shortening of the sarcomere is the result of the attachment of the myosin heads with the active site on actin and the subsequent release of stored energy that swivels the myosin crossbridges. This step causes the actin to pull the Z disc toward the center of the sarcomere, which, in turn, causes the sarcomere and hence the muscle fiber length to decrease. All-or-None Principle According to the all-or-none principle, when a motor neuron is stimulated, all of the muscle fibers in that motor unit contract to their fullest extent or they do not contract at all. The minimal amount of stimuli necessary to initiate that contraction is referred to as the threshold stimulus; that is, if the threshold of contraction is reached, a muscle fiber will contract to its fullest extent. This phenomenon is related to the electrical properties of the cell membrane and refers to the contractile properties of a motor unit or a single muscle fiber only, not to the entire muscle. If sufficient pressure is applied to the switch (to reach a threshold for flipping it on), the lights are turned on to their fullest extent. Expanding the analogy to a motor unit, when a light switch that controls a group of lights (such as the overhead lights in a classroom) is turned on, all of the lights connected to it will turn on to their fullest extent. The lights do not become brighter if the light switch is pulled (or pushed) harder. The same is true for an individual muscle fiber or a motor unit: Either a threshold stimulus is reached and contraction occurs, or a threshold stimulus is not reached and contraction does not occur. Muscle Fiber Types Muscle fibers are typically described by two characteristics: their contractile, or twitch, properties and their metabolic properties (Figure 2-13). Metabolic Properties On the basis of differences in metabolic properties, human muscle fibers can be described as glycolytic, oxidative, or a combination of both, oxidative/glycolytic. Despite the ability of all muscle fibers to produce energy by both glycolytic and oxidative processes, one or the other may predominate or the production may be balanced.

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Chan School of Public Health anxiety symptoms while falling asleep generic venlafaxine 75mg on line, Boston anxiety symptoms reddit buy venlafaxine 150 mg lowest price, Massachusetts anxiety symptoms 6 months buy 75 mg venlafaxine otc, United States Kerri Wazny the Hospital for Sick Children, Toronto, Canada Aisha K. Srinath Reddy President, Public Health Foundation of India, New Delhi, India Sevkat Ruacan Dean, Koз University School of Medicine, Istanbul, Turkey Jaime Sepъlveda Executive Director, Global Health Sciences, University of California, San Francisco, San Francisco, California, United States Richard Skolnik Lecturer, Health Policy Department, Yale School of Public Health, New Haven, Connecticut, United States Stephen Tollman Professor, University of Witwatersrand, Johannesburg, South Africa Jьrgen Unьtzer Professor, Department of Psychiatry, University of Washington, Seattle, Washington, United States Damian Walker Senior Program Officer, Bill & Melinda Gates Foundation, Seattle, Washington, United States Ngaire Woods Director, Global Economic Governance Program, Oxford University, Oxford, United Kingdom Nopadol Wora-Urai Professor, Department of Surgery, Phramongkutklao Hospital, Bangkok, Thailand Kun Zhao Researcher, China National Health Development Research Center, Beijing, China 372 Advisory Committee to the Editors Reviewers Diego G. Das Division of Women and Child Health, Aga Khan University, Karachi, Pakistan Mercedes de Onis Growth Assessment and Surveillance Unit, World Health Organization, Geneva, Switzerland Shannon Doocy Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States Karen Edmond University of Western Australia School of Paediatrics and Child Health, Perth, Western Australia, Australia Alex Ergo Broad Band Associates, Yangon, Myanmar Victoria Fan Office of Public Health Studies, University of Hawaii, Honolulu, Hawaii, United States Ingrid K. Friberg Norwegian Institute of Public Health, Oslo, Norway Anna Glasier Society of Family Planning, University of Edinburgh, Edinburgh, Scotland Joseph E. Lanata Instituto de Investigaciуn Nutricional, Lima, Peru Karen Macours Paris School of Economics, Paris, France Matthews Mathai Department of Maternal, Newborn, and Child and Adolescent Health, World Health Organization, Geneva, Switzerland Jeff K. Mullany Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States Omotade Olayemi Olufemi-Julius University of Ibadan Institute of Child Health, Ibadan, Nigeria Walter A. Rowe Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States Enrique Ruelas Institute for Healthcare Improvement, Cambridge, Massachusetts, United States Harhad Sanghvi Jhpiego, Baltimore, Maryland, United States Katherine Seib Emory Vaccine Center, Emory University, Atlanta, Georgia, United States Saba Shahid Indus Hospital, Karachi, Pakistan Karin Stenberg Department of Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland Jorge E. Tolosa Oregon Health & Science University, Portland, Oregon, United States Nana A. Twum-Danso the Bill & Melinda Gates Foundation, Accra, Ghana 374 Reviewers Index Boxes, figures, maps, notes, and tables are indicated by b, f, m, n, and t following page numbers. See also female genital mutilation ill health, defined, 25 infertility, 35­37, 36­37t. See also infertility, involuntary maternal morbidity, 61 official development assistance increase for, 2 reproductive ill health, 25­50. See also abortion; pregnancy data presentation and limitations, 25 overview, 25 unintended pregnancy, 25­28. See Europe and Central Asia cerebral malaria, 246 cesarean section, 121, 122­23, 321 Chad, wasting in, 91b Chan, M. See Child Health Epidemiology Reference Group chikungunya virus, 147 childbirth, 1 active management of, 126­27 cesarean section. See cesarean section checklists for safe childbirth, 18 community-based interventions, 265­66 death at. See also febrile children; specific disease or condition child mortality and, 78­79, 79t, 80f, 263 cost-effectiveness of interventions, 15f, 323­26 cost of interventions, 16t, 17 interventions. See also Ethiopia family planning, 103 febrile children, 323­24 India universal home-based neonatal care package, 15­16, 335­44. See also community-based interventions; hospitals; primary health centers cost-effectiveness of interventions, 327­28 cost of scaling up, 17­18 interventions for maternal and child mortality and morbidity, 8, 11­13t demand-side interventions, 19 Democratic Republic of Congo. See Congo, Democratic Republic of Demographic and Health Surveys, 26, 51, 60, 85, 96, 174, 176, 188b, 346 demographic dividend, 96, 305, 311­12 dengue fever, 147 depression, 5, 6, 39 child development, effect of maternal depression on, 247 postpartum depression, 60 Dettrick, Z. See oral rehydration solutions overview, 163 persistent, 166­67 preventive interventions, 169b rotavirus, 165, 171­72, 350, 351t subclinical infections, 167 therapeutic interventions, 169­71, 169b transmission and epidemiology, 165­66 tropical enteropathy, 167 vaccines, 171 water, sanitation, and hygiene, 174 watery, 166 zinc supplementation, 173­74 diet. See Integrated Community Case Management integrated management of childhood illness. See also family planning child mortality and, 6, 75 continuum-of-care approach and, 304, 308 family planning and, 96, 97, 98f health consequences of high fertility, 96­97 maternal mortality and, 97 fetal movement counting, 126 fetal shoulder manipulation, 122 financial incentives to improve health, 233. See also conditional cash transfers financial risk protection, 15, 19, 352, 353f, 354­55, 357­58t Firth, S. See community-based interventions cost-effectiveness of training, 321 handwashing by, 175 maternal mortality and morbidity and, 65 midwives. See Integrated Management of Neonatal and Childhood Illness improvements needed, 2 incentives. See conditional cash transfers; performance-based financing; vouchers incontinence, 60 India Accredited Social Health Activists, 101 adolescent-friendly contraceptive services in, 105 benefit-cost ratio in, 311, 314 checklists, use of, 293 Chiranjeevi Yojana program, 291 community-based interventions in, 270. See cost-effectiveness of interventions demand-side, 19 diarrheal diseases, 169­77, 169b early childhood development and, 248­54 family planning, 95­103. See also specific countries cash transfer programs in, 290 early child development, 254 chikungunya in, 147 child mortality (under five) in, 72­75, 73­74t, 80f health care service delivery in, 286­87, 287t maternal mortality, disproportionate burden in, 53, 55, 65 number of hospital beds per 1,000 people in, 286 number of nurses, midwives, and physicians per 1,000 people in, 286 stunting and height-for-age in, 7, 86, 87­88f teenage pregnancy in, 28 unintended pregnancy in, 27­28 unsafe abortion in, 29 Laxminarayan, R. See also specific diseases/conditions and interventions; specific regions and countries accredited hospitals in, 292 benefit-cost ratio for interventions in, 16 child mortality (under five) in, 72­75, 73­74t, 80f, 263 cost of contraceptives in, 17 diarrheal diseases in, 164, 164f family planning in, 95­96 maternal mortality, disproportionate burden in, 53, 115 stunting and height-for-age in, 88f unintended pregnancy in, 27­28, 27t unsafe abortions in, 29, 30­31t low height-for-age. See also child mortality in India, 335, 336f Nepal abortion services in, 106, 107 community-based interventions in, 270 birth attendants, 273 cost-effectiveness of, 277 perinatal packages, 151 contraception in, 102 family planning in, 102 maternal morbidity in, 56 stunting and height-for-age in, 87 neurodevelopmental disabilities, 247 newborns care, 128 febrile, 143 mortality. See also folic acid; malnutrition; vitamin A; vitamin and mineral supplements biofortification, 326, 329 child deaths averted by scaling up, 235f child interventions, 232­36, 234­35t community-based nutrition programs, 270, 271­72t cost-effectiveness of interventions, 177, 326­27 costs of interventions, 328 diarrheal diseases and, 173 early childhood development, 244­45, 244f, 249­51, 254­55 390 Index height-for-age and. See childbirth official development assistance, 2 OneHealth Tool, 304, 304b, 307, 308 Onwujekwe, O.


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