2019, The Pennsylvania State University, Cronos's review: "Order cheap Zenegra - Safe Zenegra".
Carpet Cleaner Whether you rent a machine or have a cleaning service proven 100mg zenegra, don’t use the carpet shampoo they want to sell purchase zenegra online now, even if they “guarantee” that it is all natural and safe discount zenegra. If you are just mak- ing one pass on your carpet, use the borax, alcohol, boric acid, and iodine. Health Improvement Recipes Black Walnut Hull Tincture This new recipe is four times as strong as the previous one, so it is called Black Walnut Hull Tincture Extra Strength. Your largest enamel or ceramic (not stainless steel, not aluminum) cooking pot, preferably at least 10 quarts Black walnuts, in the hull, each one still at least 50% green, enough to fill the pot to the top Grain alcohol, about 50% strength, enough to cover the walnuts Vitamin C powder, 1 tsp. The walnut is inside, but we will use the whole ball, uncracked, since the active ingredient is in the green outer hull. Pour into glass jars or bottles, discarding walnuts, and add more vitamin C (1 tsp. If the glass jar has a metal lid, put plastic wrap over the top before screwing on the lid. It is stronger than the concentrate made with just a few black walnuts in a quart jar (my earlier recipe), because there are more walnuts per unit liquid. In addition, you will not dilute it before use (although when you take it, it will usually be in water). If you are not going to use all of them in this batch, you may freeze them in a resealable plastic bag. To reduce air exposure, fill the pot as much as possi- ble, without touching the plastic wrap, while still keeping a snug fitting lid. Even more importantly, the glass jars or bottles you use to store your tincture should have as little air space as possible, without touching the plastic wrap on top. The idea is not to have partial jars, with a lot of air space, sitting for longer than a month or so. Remember, never use any kind of purchased water to make tincture or you will pollute it yourself. Black Walnut Hull Tincture (Regular Strength) This is the potency I used originally. The Extra Strength recipe is four times as potent as the original recipe, so it must be diluted in quarters. Black Walnut Hull Extract (Water Based) This recipe is intended for alcoholic persons: cover the green balls in the 10 quart (non-metal) pot with cold tap water. For use: in programs calling for Extra Strength Black Wal- nut Hull Tincture use four times as much of this water based recipe (8 tsp. Important Note: do not use bottled or purchased water to make this tincture or you could pollute it with isopropyl alco- hol! They can not be killed by zapping, because the high frequency current does not penetrate the bowel contents. Although most bowel bacteria are beneficial, the ones that are not, like Salmonellas, Shigellas, and Clostridiums are ex- tremely detrimental because they have the ability to invade the rest of your body and colonize a trauma site or tumorous organ. These same bacteria colonize a cancer tumor and prevent shrinking after the malignancy is stopped. One reason bowel bacteria are so hard to eradicate is that we are constantly reinfecting ourselves by keeping a reservoir on our hands and under our fingernails. You will know you succeeded when your tummy is flat, there is not a single gurgle, and your mood improves! Enemas If you should fail to have a bowel movement in a single day it is a serious matter. An ill person cannot afford to fill up fur- ther with the ammonia, the toxic amines, and toxic gasses that bowel bacteria produce. For many of us, the rectum and sigmoid colon have bal- looned out into a pocket due to past times of constipation. But in just a few weeks of daily cleansing, the pocket will shrink and may even disappear. Parasites and bad bacteria can escape being killed if they are in the diverticulum. Your entire bowel health can be turned around by killing the invaders of this diverticulum. Two ways of killing rectal parasites are with Lugol’s or Black Walnut Tincture enemas. Do an enema daily for one week to improve bowel function, alternating the above varieties. Giving Yourself The Perfect Enema Any drop you spill and everything you use to do the enema will somehow contaminate your bathroom. This may be workable for the small squeeze- bottle of ready-made solution you can purchase. It is quite impossible, though, if you are elderly, have painful knees or are simply ill and must try to take in a whole quart from a complex apparatus. Wipe away the grease that comes with it on the appli- cator; it is sure to be a petroleum product and be tainted with benzene. After filling the container with the enema solution, run some through the tubing until the air is out of it and close the pinchcock. At any time you may close the valve, withdraw the applicator, and place it on the grocery bag. Cleaning up the apparatus, the bathroom, and yourself: This topic is seldom discussed, but very important. Notice that some bowel contents have entered the container by reflux action, which is unavoidable. For this reason you must never, never use anybody else’s apparatus, no matter how clean it looks. Repeat until it appears clean; this is appearance only; you must now sterilize it. Fill it with water and add Lugol’s iodine or povidone iodine until in- tensely red in color. Pour the rest through a bamboo strainer into a sterile pint jar (glass) and several freezable containers. Find fresh parsley at a grocery store that does not spray its produce (ask the owner). Dose: each morning, pour together ¾ cup of the root mix- ture and ½ cup parsley water, filling a large mug. Do not drink it all at once or you will get a stomach ache and feel pressure in your bladder. You need to do the Kidney Cleanse for six weeks to get good results, longer for severe problems. Some notes on this recipe: this herbal tea, as well as the parsley, can easily spoil.
In this way purchase zenegra online from canada, free electrons transfer the increase in the internal energy down the rod buy cheap zenegra. Materials such as metals discount zenegra 100mg fast delivery, which contain free electrons, are good conductors of heat; materials such as wood, which do not have free electrons, are insulators. However, for problems involving living systems, it is often more convenient to express K in units of Cal cm/m2-hr-C◦. This is the amount of c heat (in Cal units) per hour which ﬂows through a slab of material 1 cm thick and 1 m square per C◦ temperature diﬀerence between the faces of the slab. Fluid from the denser region ﬂows into the rareﬁed region, causing convection cur- rents. When the ener- getic molecules in the heated convection current come in contact with a solid material, they transfer some of their energy to the atoms of the solid, increasing the internal energy of the solid. The amount of heat transferred by convection per unit time Hc is given by Hc KcA(T1 − T2) (9. Electromagnetic radi- ation is itself energy (called electromagnetic energy), which in the case of a moving charge is obtained from the kinetic energy of the charged particle. Because of internal energy, particles in a material are in constant random motion. Both the positively charged nuclei and the negatively charged elec- trons vibrate and, therefore, emit electromagnetic radiation. In this way, inter- nal energy is converted into radiation, called thermal radiation. The amount of radiation emit- ted by vibrating charged particles is proportional to the speed of vibration. Because the elec- trons are much lighter than the nuclei, they move faster and emit more radiant energy than the nuclei. At high temperatures, some of the electromagnetic radiation is in the visible region, and the body is observed to glow. When electromagnetic radiation impinges on an object, the charged par- ticles (electrons) in the object are set into motion and gain kinetic energy. Other materials, such as quartz and certain glasses, transmit the radiation without absorbing much of it. Such reﬂecting and transmitting materials cannot be heated eﬃciently by radiation. The rate of emission of radiant energy Hr by a unit area of a body at temperature T is 4 Hr eσT (9. The temperature is measured on the absolute scale, and e is the emissivity of the surface, which depends on the temperature and nature of the surface. Emission and absorption of radiation are related phenomena; surfaces that are highly absorptive are also eﬃcient emitters of radiation and have an emissivity close to 1. Conversely, surfaces that do not absorb radiation are poor emitters with a low value of emissivity. A body at temperature T1 in an environment at temperature T2 will both 4 emit and absorb radiation. The rate of energy emitted per unit area is eσT , 1 4 and the rate of energy absorbed per unit is eσT. If a body at a temperature T1 is placed in an environment at a lower tem- perature T2, the net loss of energy from the body is 4 4 Hr eσ T − T (9. Diﬀusion is the main mechanism for the delivery of oxygen and nutrients into cells and for the elimination of waste products from cells. On a large scale, diﬀusive motion is relatively slow (it may take hours for the colored solution in our example to diﬀuse over a distance of a few centimeters), but on the small scale of tissue cells, diﬀusive motion is fast enough to provide for the life function of cells. Although a detailed treatment of diﬀusion is beyond our scope, some of the features of diﬀusive motion can be deduced from simple kinetic theory. Consider a molecule in a liquid or a gas which is moving away from the starting point 0. The molecule has a thermal velocity v and travels on the average a distance L before colliding with another molecule (see Fig. As a result of the collision, the direction of motion of the molecule is changed randomly. On the average, however, after a certain number of collisions the molecule will be found a distance S from the starting point. A statistical anal- ysis of this type of motion shows that after N collisions the distance of the molecule from the starting point is, on the average, S L N (9. A frequently used illustration of the random walk examines the position of a drunkard walking away from a lamppost. If the length of each step is 1 m, after taking 100 steps he will be only 10 m away from the lamppost although he has walked a total of 100 m. After 10,000 steps, having walked 10 km, he will be still only 100 m (on the average) from his starting point. Let us now calculate the length of time required for a molecule to diﬀuse a distance S from the starting point. Therefore, the mean free path of a diﬀusing molecule is short, about 10−8 cm (this is approximately the distance between atoms in a liquid). Gases are less densely packed than liquids; consequently, in gases the mean free path is longer and the diﬀusion time shorter. In a gas at 1 atm pressure, the mean free path is on the order of 10−5—the exact value depends on the speciﬁc gas. Consider a cylinder containing a nonuniform distribu- tion of diﬀusing molecules or other small particles (see Fig. Although this solution for the diﬀusion problem is not exact, it does illustrate the nature of the diﬀusion process. The net ﬂux from one region to another depends on the diﬀerence in the density of the diﬀusing particles in the two regions. The ﬂux increases with thermal velocity v and decreases with the distance between the two regions. In our previous illustration of diﬀusion through a ﬂuid, where L 10−8 cm and v 104 cm/sec, the diﬀusion coeﬃcient calculated from Eq. By comparison, the measured diﬀusion coeﬃcient of salt (NaCl) in water, for example, is 1. Thus, our simple calculation gives a reasonable esti- mate for the diﬀusion coeﬃcient. The diﬀusion coeﬃcients for biologically important molecules are in the range from 10−7 to 10−6 cm2/sec. Oxygen, nutrients, and waste products must pass through these membranes to maintain the life functions. In the simplest model, the biologi- cal membrane can be regarded as porous, with the size and the density of the pores governing the diﬀusion through the membrane. If the diﬀusing molecule is smaller than the size of the pores, the only eﬀect of the membrane is to reduce the eﬀective diﬀusion area and thus decrease the diﬀusion rate. If the diﬀusing molecule is larger than the size of the pores, the ﬂow of molecules through the membranemaybebarred.
Blood flows from the arteries to the veins because the total potential and kinetic energy is greater in the arteries than in the veins order zenegra paypal. Blood vessels are compliant generic zenegra 100mg visa, not rigid tubes buy 100mg zenegra overnight delivery, and can distend and collapse to changes in pressure. The farther above the heart the lower the hydrostatic pressure, and thus the more collapsed (less distended) the vessels are. Therefore, gravity does not effect the direction of blood flow, but it does decrease the hydrostatic pressure above the heart - decreasing vessel size, increasing resistance, decreasing flow - potentially resulting in ischemia. Previously we talked about resistance as an important property of the circulation. Another important physical property is compliance, which is the ability of a vessel to change its size relative to the pressure of the fluid inside it. On the arterial side, the heart pumps out a bolus of blood into the proximal or "elastic" arteries, which can distend and accommodate the ejected blood. The arteries store up energy as they distend and then return that energy when they elastically recoil, as shown in the figure below. If the arteries were stiff instead of compliant, the heart would have to generate a much higher pressure to eject an equal volume of blood, as though banging into a brick wall instead of hitting a wall made of rubber. Thus, individuals with less compliant arteries, as occurs with aging, have a higher pulse pressure (the difference between systolic and diastolic pressures) compared to individuals with very compliant arteries who have lower pulse pressure. The overall effect of arterial compliance is to reduce the work of the heart and provide a smooth, steady flow. The veins are also compliant, but they operate in a much lower pressure range, as shown below. Small changes in pressure on the venous side result in significant changes in vessel size and therefore substantial changes is venous blood volume. Thus, the compliance of the veins allows them to serve as the storage site for the vast majority of the blood volume. The force causing compliant vessels to stretch and distend is usually described as wall tension or wall stress. Wall tension can be thought of as the force (per unit length) trying to pull the vessel apart at the seams as shown in the figure below. Referring to the figure below, equating these forces for a thin-walled vessel of radius r gives: 2T = P (2r) Note that the effective distance over which the pressure acts is 2r not r, as this accounts for the component of the pressure force opposite to the tension. That is because force is pressure x area, so increasing the radius increases the area which increases the force and the tension. Arteries are not thin-walled - they have thick walls in order to distribute the tension. Therefore, wall stress () is the preferred measure for the internal force exerted on a vessel wall, as it takes into account the wall thickness (w). The thicker the wall, the less the stress: = T/w = Pr/w Physics of Circulation - Michael McConnell, M. If one imagines a slight weakening of the wall of the aorta in a small region, one can picture that the wall would distend slightly more than the regions around it. From conservation of mass, the velocity (v) would be slower in the distended region as it has a larger cross- sectional area (A). This will only make it more likely that the region will weaken and distend further, continuing in a positive feedback cycle. The figure below shows this progression in an abdominal aortic aneurysm, the most common site of occurrence. The natural history of this condition is continued dilatation over years with increased risk of rupture, especially when the diameter becomes greater than 5 centimeters. Note that the formation of a mural thrombus may help to compensate by reducing the effective vessel diameter and increasing the effective wall thickness. This laminar flow is due to the frictional or viscous drag of the fluid, which makes the fluid move more slowly closer to the vessel wall. Counterbalancing this viscous force is an inertial force propelling the fluid forward. The higher the inertial force the less favorable it is for the viscous drag to produce a smooth, laminar flow. This balance between inertial and viscous forces can be quantified with the Reynolds number (Re), which is a dimensionless ratio of inertial to viscous forces. The inertial force is proportional to the density () and the velocity (v) squared: Inertial force = v2 The viscous force is proportional to the viscosity (), the velocity (v), and the inverse of the tube diameter (D): Viscous force = v/D The Reynolds number is the ratio: Re = (v2)/(v/D) = (/) Dv From this equation it is clear that as the density, tube size, and velocity increase, and as the viscosity decreases, inertia is favored. Similarly, viscous drag is favored as the viscosity increases and the other components decrease. Turbulence is characterized by random, disorganized flow in which energy is lost in other forms (heat, sound, etc. The relationship of pressure to flow is no longer linear, as shown in the figure below. Higher pressures are needed to generate increased flows, as pressure is now closer to being a function of the flow squared due to the energy losses. Under normal physiologic conditions, turbulent flow usually occurs only in the proximal aorta and pulmonary artery. In pathologic situations, turbulence can occur where the velocities are high, such as in narrowed blood vessels, stenotic valves, or septal defects. These situations often produce audible murmurs or bruits which can be found on physical examination. Blood viscosity plays an important role in the circulation, with its most profound effect on vascular resistance. Blood is not a simple fluid and viscosity does not remain constant throughout the circulatory system. As blood passes through the smaller vessels of the vascular tree, the viscosity actually falls. The viscosity of plasma alone is quite low, but as the percentage of red blood cells (hematocrit) increases, the viscosity increases up to ten-fold, as shown below. In the large vessels, much larger than the diameter of a red blood cell (approximately 8 microns), the blood acts homogeneously. However, as the vessel diameter drops below approximately 100 microns, the two components tend to behave differently. The red blood cells shun the vessel walls (as pictured below) and tend to concentrate in the fast-moving center, referred to as "axial streaming". This means that the lower viscosity plasma predominates at the interface with the vessel wall, lowering the effective viscosity, while the red blood cells stream on through. In addition, the red blood cells are moving through at a higher velocity compared to the plasma, so they tend to be more spread apart. If one took a snapshot there would appear to be fewer red blood cells per unit plasma than in whole blood, i.
Retinoic acid (conotruncal defects) and dilantin (Ebstein’s malformation cheap zenegra 100mg mastercard, pulmonary stenosis) have been associated with heart defects cheap zenegra american express. Non-steroidal anti-inflammatory drugs may cause early closure of the ductus arteriosus during late gestation order cheap zenegra on-line, leading to physiologic derangements, but not to structural abnormalities. One of the best characterized genetic causes of congenital heart disease is the deletion of a large region of chromosome 22q11, known as the DiGeorge critical region. Recent studies have implicated the transcription factor Tbx1 in the etiology of DiGeorge syndrome and mice with genetic deletion of Tbx1 duplicate many of the clinical findings of patients with this syndrome. Cardiac lesions associated with 22q11 deletions are most often seen in association with either the DiGeorge syndrome or the Shprintzen (velocardiofacial) syndrome. The specific cardiac anomalies fall into the subcategories of conotruncal defects (tetralogy of Fallot, truncus arteriosus, double outlet right ventricle, subarterial ventricular septal defect) and branchial arch defects (coarctation of the aorta, interrupted aortic arch and right aortic arch). Although the risk of recurrence is extremely low in the absence of a parental 22q11 deletion, the risk of recurrence is 50% if one of the parents does carry the deletion. Congenital heart diseases for which chromosomal abnormalities (and some specific gene defects) have been identified. However, because resistance through the pulmonary circulation is lower than through the systemic circulation, left to right shunting will occur. Symptoms may begin in the 4th and 5th decades of life: atrial fibrillation, congestive heart failure, and pulmonary hypertension. Large defects are usually closed surgically during the first six months of life, depending on severity of symptoms (rapid respirations, sweating, trouble eating, failure to thrive). Small defects will often close spontaneously, especially if the defect is small and muscular in location. As long as the systemic vascular resistance is higher than the pulmonary vascular resistance, the shunt will be left to right. However, long term exposure of the pulmonary vascular bed to high pressure and high flow will lead to a progressive increase in medial smooth muscle in resistance arterioles (pulmonary vascular disease). Patients at this time are not suitable candidates for surgical repair and must be considered for heart-lung transplantation. Defect in primum atrial septum Congenital Malformations Of The Heart - Gerald Berry, M. Patients with trisomy 21 are at risk of prematurely elevated pulmonary vascular resistance and more rapid development of Eisenmenger Syndrome. Note the presence of left-to-right shunting at both atrial and ventricular levels. Anatomy: In normal newborns, functional closure of the ductus usually occurs within the first 48 hours. Total anatomical closure is complete in 35% of infants at two weeks, 90% at two months and 99% at one year. Clinical presentation: In the first few hours of life, before the pulmonary vascular bed has fully vasodilated, the pulmonary vascular resistance is close to systemic, and the shunt through the ductus is small. As the pulmonary bed dilates in the first day of life, flow through the ductus will increase, left- to-right. Anatomy: The pulmonary valve may be tricuspid with fused leaflets, bicuspid, or unicuspid. Stenosis may occur in the subvalvar area, supravalvar area, or in the peripheral pulmonary arteries. Clinical presentation: Patients usually present with a heart murmur but rarely with clinical symptoms unless very severe. Moderate to severe stenosis can usually be treated successfully with balloon valvuloplasty in the catheterization lab. Anatomy: The aortic valve may be tricuspid with fused leaflets, bicuspid, or unicuspid (a bicuspid valve is present in up to 2% of the population). Stenosis may occur in the subvalvar area or supravalvar area (often associated with William’s syndrome). Management: Mild aortic stenosis does not require intervention, although a bicuspid aortic valve may develop calcification and worsening stenosis in the fourth through seventh decades of life. Moderate stenosis can usually be treated with balloon valvuloplasty in the catheterization lab. Anatomy: Coarctation usually occurs in the region of the descending aorta immediately opposite the insertion of the ductus arteriosus (juxtaductal). Isolated juxtaductal coarctions (formerly known as the “adult” type) can present at any age from newborn to adulthood, depending on how severe the obstruction is. Clinical presentation: If severe, coarctation can present with respiratory distress, failure to thrive, and even cardiovascular collapse in early infancy; this often occurs when the ductus closes, narrowing the juxtductal area further. If a coarctation is milder, intercostal arteries enlarge to provide a bypass for blood flow, causing a radial-femoral delay on physical exam and “rib notching” on chest X-ray. Hypertension or decreased femoral pulses are often the only presenting features, although claudication may occur. Management: Surgical correction is the procedure of choice for coarcation of the aorta in infancy and childhood. The earlier the time of repair, the higher the likelihood of recurrence later in life. Infants with severe pulmonary stenosis will present with cyanosis in the immediate newborn period, often as soon as the ductus arteriosus closes. Infants with very mild pulmonic stenosis have a balanced circulation and will not be cyanotic (“pink tets”). Older children in whom the condition has not been corrected will manifest cyanosis, clubbing of the distal fingers (hypertrophic osteoarthropathy) and squatting after exertion. Management: Cyanotic neonates usually undergo complete repair at the time of presentation, although a few centers advocate placement of a Blalock-Taussig shunt between the aorta and pulmonary artery and deferring primary repair until the patient is approximately one year old. Mildly cyanotic or acyanotic patients undergo elective repair within the first 3-6 months of life. Long term outlook is dependent on the degree of pulmonary regurgitation after the repair, the incidence is higher when the valve annulus is small, requiring the surgeon too place a trans-annular patch. Physiologically, the systemic and pulmonary circulations are in parallel rather than in series. Surgical repair used to involve creating a baffle between the right and left atria, to tunnel blood flow from the systemic veins to the mitral valve and thereafter from the left ventricle to the pulmonary artery; pulmonary venous return is tunneled to the tricuspid valve, thereafter to the right ventricle and then out the aorta. An important component of this repair besides switching the aorta and pulmonary artery, is the requirement to also move the coronary arteries from the right ventricular outflow to the left ventricular outflow. Figure 6: Representative oxygen saturations in a patient with d-transposition of the great vessels and intact ventricular septum. Physiologic effects of increasing hemoglobin concentration in left-to-right shunting in infants with ventricular septal defects. The role of nitric oxide, endothelin, and prostaglandins in the transition of the pulmonary circulation. Figure Credits: Congenital Heart Lesions Section All figures in this section have subsequently been reprinted in Bernstein D. The father had an operation for congenital heart disease and indicates that he was told that he has a deletion of part of one of his chromosomes, but cannot remember which one.