An R afer the component name means that it is required in the citation; an O afer the name means it is optional compazine 5 mg low cost. Author/Editor (R) | Author Afliation (O) | Title (R) | Connective Phrase (R) | Book Information (R) | Location (Pagination) (R) | Part (R) 266 Citing Medicine Author/Editor of a Contribution to a Book (required) General Rules for Author/Editor • List names in the order they appear in the text • Enter surname (family or last name) frst for each author • Capitalize names and enter spaces within surnames as they appear in the document cited on the assumption that the author approved the form used discount compazine 5mg otc. To simplify rules for English-language publications order compazine 5 mg visa, this rule ignores some conventions used in non- English languages ⚬ Treat letters marked with diacritics or accents as if they are not marked Å treated as A Ø treated as O Ç treated as C Ł treated as L à treated as a ĝ treated as g ñ treated as n ü treated as u Box 132 continues on next page... Names in non-roman alphabets (Cyrillic, Greek, Arabic, Hebrew, Korean) or character-based languages (Chinese, Japanese). Romanization, a form of transliteration, means using the roman (Latin) alphabet to represent the letters or characters of another alphabet. Tis rule ignores some conventions used in non-English languages to simplify rules for English-language publications. An organization such as a university, society, association, corporation, or government body may be an author. International Union of Pure and Applied Chemistry, Organic and Biomolecular Chemistry Division. American College of Surgeons, Committee on Trauma, Ad Hoc Subcommittee on Outcomes, Working Group. American Academy of Pediatrics, Committee on Pediatric Emergency Medicine; American College of Emergency Physicians, Pediatric Committee. Tis rule ignores some conventions used in non-English languages to simplify rules for English-language publications. Separate the surname from the given name or initials by a comma; follow initials with a period; separate successive names by a semicolon and a space. If you abbreviate a word in one reference in a list of references, abbreviate the same word in all references. Marubini E (Istituto di Statistica Medica e Biometria, Universita degli Studi di Milano, Milan, Italy), Rebora P, Reina G. Tis rule ignores some conventions used in non-English languages to simplify rules for English-language publications. Moskva becomes Moscow Wien becomes Vienna Italia becomes Italy Espana becomes Spain Examples for Author Affiliation 8. Contributed chapter with author address included Title of a Contribution to a Book (required) General Rules for Title • Enter the title of the chapter or other contribution as it appears in the original document, in the original language • Capitalize only the frst word of a title, proper nouns, proper adjectives, acronyms, and initialisms • Use a colon followed by a space to separate a title from a subtitle unless some other form of punctuation (such as a question mark, period, or an exclamation point) is already present • Follow non-English titles with a translation whenever possible; place the translation in square brackets • End a title with a period unless a question mark or exclamation point already ends it Specific Rules for Title • Titles not in English • Titles in more than one language • Titles containing a Greek letter, chemical formula, or another special character Box 144. Diagnostika i kompleksnoe lechenie osnovnykh gastroenterologicheskikh zabolevanii: klinicheskie ocherki. Tis rule ignores some conventions used in non-English languages to simplify rules for English-language publications. Base molecular de la expresion del mensaje genetico [Molecular basis of gene expression]. Diagnostika i kompleksnoe lechenie osnovnykh gastroenterologicheskikh zabolevanii: klinicheskie ocherki [Diagnosis and complex treatment of basic gastrointestinal diseases: clinical studies]. If a chapter or other contribution is presented with equal text in two or more languages, as ofen occurs in Canadian publications: • Give all titles in the order in which they are found on the title page • Place an equals sign with a space on either side between the titles • List all the languages, separated by commas, afer the pagination • End the list with a period Example: Le genome: avancees scientifques et therapeutiques et consequences sociales = Te genome: scientifc and therapeutic developments and social consequences. Contributed chapter with a title beginning with a lower-case letter or containing a special symbol or character 10. Contributed chapter with a non-English title Connective Phrase for a Contribution to a Book (required) General Rules for Connective Phrase • Place a space and the word "In" afer the title of the contribution • Follow "In" with a colon and a space Examples for Connective Phrase 1. Standard reference to a contributed chapter Book Information (required) General Rules for Book Information • Cite the book in which the contribution appears according to Chapter 2A Entire Books but omit the Pagination Examples for Book Information 12. Contributed chapter in one volume of a multivolume book Location (Pagination) for a Contribution to a Book (required) General Rules for Location (Pagination) • Begin location with "p. Occasionally, a chapter or other contribution will appear on a page that is not numbered. Contributed chapter with an optional chapter number instead of pagination Part of a Contribution to a Book (required) General Rules for a Part of a Contribution • Cite a part of a contribution, such as a table or fgure, according to Chapter 2A Entire Books Examples for a Part of a Contribution 17. Part of a contributed chapter in one volume of a multivolume book Examples of Citations to Contributions to Books 1. Contributed chapter with optional full first names for authors and editors Erin, Jane N. Vision focus: understanding the medical and functional implications of vision loss. Early focus: working with young children who are blind or visually impaired and their families. Praeger handbook of Black American health: policies and issues behind disparities in health. Sensitivity to movement of confgurations of achromatic and chromatic points in amblyopic patients. Contribution of achromatic and chromatic contrast signals to Fechner-Benham subjective colours. Contributed chapter with a title beginning with a lower-case letter or containing a special symbol or character Brooks M. Valladolid (Spain): Universidad de Valladolid, Secretariado de Publicaciones e Intercambio Editorial; c2002. Imagerie des cancers du pancreas exocrine [Images of cancer of the exocrine pancreas]. Cytokine reference: a compendium of cytokines and other mediators of host defense. Conference Proceedings • Sample Citation and Introduction • Citation Rules with Examples • Examples B. Conference Papers • Sample Citation and Introduction • Citation Rules with Examples • Examples C. Parts of Conference Papers • Sample Citation and Introduction • Citation Rules with Examples • Examples See also: Chapter 12 Papers and Poster Sessions Presented at Meetings A. Sample Citation and Introduction to Citing Conference Proceedings Te general format for a reference to a conference proceedings, including punctuation: - with a title for the book of proceedings as well as a conference title: - with only a conference title: 290 Citing Medicine Examples of Citations to Conference Proceedings Conference proceedings are a collection of the papers presented at a conference, symposium, congress, or other meeting. Tey share many characteristics with books; the major diference in citing them lies in their titles and in the provision of information about the dates and places of the conferences. Tey ofen have two titles: the title of the book of proceedings (ofen the name of the specifc conference) and the title of the conference. Many organizations hold annual numbered meetings, each of which has a specifc topic or theme. Confusion arises if people preparing references to conference proceedings believe that the date and location of the conference take the place of the date and place of publication. Proceedings are frequently published a year or more afer the conference was held, and there is ofen no correlation between the location of the publisher and the location of the conference. Citations to conference proceedings involve placing information about the conference in a prescribed format and order, with prescribed punctuation, regardless of the order and punctuation given in the text. For example, if the title page reads: Society for Laboratory Animal Welfare Forty-third Annual Meeting San Francisco June 3-5, 2005 Te format and order for the citation should be: 43rd Annual Meeting of the Society for Laboratory Animal Welfare; 2005 Jun 3-5; San Francisco.

However cheap 5mg compazine with amex, chronic sleep deprivation appears to accelerate aging of the brain compazine 5mg, causes neuronal damage buy compazine from india, and leads to nighttime elevations in the stress hormone cortisol (see the chapter “Insomnia” for improving sleep quality). Exactly how much sleep is required by an individual varies from one person to the next and from one stage of life to another. A one-year-old baby requires about 14 hours of sleep a day, a five-year-old about 12, and adults about 7 to 8. As people age their sleep needs may decline (the research is not clear), but so does their ability to sustain sleep, probably as a result of decreased levels of important brain chemicals such as serotonin and melatonin. The elderly tend to sleep less at night but doze more during the day than younger adults. Normal Sleep Architecture The Importance of Dreams Dreams are very important to our physical and mental well-being. A dream is a sequence of sensations, images, and thoughts passing through a sleeping person’s mind. We also use the word dream to refer to a wish, fantasy, desire, or fanciful vision. The famous author Anatole France said something about dreams and life that we think really hits home: “Existence would be intolerable if we were never to dream. During this time the test group reported increased irritability, anxiety, and appetite. Some ancient cultures considered the content of dreams to be more significant than the events of their waking lives, but the modern view of dreams was initially swayed a bit by fears that dreams might undermine moral conduct or that they are meaningless, the result of random nerve firings or physical discomfort. The emerging view is a more holistic one, as it recognizes that dreams have both physiological and psychological causes. Modern psychology became fascinated with dreams through the work of Sigmund Freud, who saw dreams as the window to the soul. Freud’s classic view was that dreams were safe expressions of impulses and desires buried in the subconscious mind. Carl Jung, Alfred Adler, and William Stekel, as well as other psychologists who followed them, developed their own theories on the meanings and interpretations of dreams. Dreams allow us an opportunity to view what is being imprinted on our subconscious mind. For example, if you are suffering from indigestion or a peptic ulcer and experience a violent dream where you are getting stabbed in the stomach, we would not recommend trying to uncover some deep psychological issue. The problem with trying to interpret every dream is that not every dream will be meaningful. Nonetheless, we think it is important to examine every dream for possible clues for personal growth. If you are interested in learning more about dreams, we recommend going to the website of the International Association for the Study of Dreams (asdreams. This organization is “dedicated to the pure and applied investigation of dreams and dreaming. Final Comments Just like the other four cornerstones of good health, the importance of a health-promoting lifestyle cannot be overstated. These simple lifestyle choices will have a profound effect on your health and the quality of your life. Many health conditions are either entirely or partially related to sleep deprivation or disturbed sleep. A Health-Promoting Diet Let your food be your medicine and let your medicine be your food. Most naturopathic physicians utilize these principles to help educate and inspire their patients to attain a higher level of wellness. It is now well established that certain dietary practices can either cause or prevent a wide range of diseases, particularly chronic degenerative diseases such as heart disease, cancer, and other conditions associated with aging. In addition, more and more research indicates that certain diets and foods offer immediate therapeutic benefit. There are two basic facts underlying the diet-disease connection: (1) a diet rich in plant foods (whole grains, legumes, nuts and seeds, fruits, and vegetables) is protective against many diseases that are extremely common in Western society, and (2) a low intake of plant foods is a causative factor in the development of these diseases and provides conditions under which other causative factors are more active. The Importance of a Plant-Based Diet Although the human gastrointestinal tract is capable of digesting both animal and plant foods, a number of physical characteristics indicate that Homo sapiens evolved to digest primarily plant foods. Specifically, our 32 teeth include 20 molars, which are perfect for crushing and grinding plant foods, along with 8 front incisors, which are well suited for biting into fruits and vegetables. Our jaws swing both vertically to tear and laterally to crush, but carnivores’ jaws swing only vertically. Additional evidence that supports the body’s preference for plant foods is the long length of the human intestinal tract. Carnivores typically have a short bowel, whereas herbivores have a bowel length proportionally comparable to that of humans. They eat mainly fruits and vegetables but may also eat small animals, lizards, and eggs if given the opportunity. Only 1% and 2%, respectively, of the total calories consumed by gorillas and orangutans are animal foods. Because humans are between the weights of the gorilla and orangutan, it has been suggested that humans are designed to eat around 1. Although most primates eat a considerable amount of fruit, it is critical to point out that the cultivated fruit in American supermarkets is far different from the highly nutritious wild fruits these animals rely on. Wild fruits have a slightly higher protein content and a higher content of certain essential vitamins and minerals, but cultivated fruits tend to be higher in sugars. Cultivated fruits are therefore very tasty to humans, but because they have a higher sugar composition and also lack the fibrous pulp and multiple seeds found in wild fruit that slow down the digestion and absorption of sugars, cultivated fruits raise blood sugar levels much more quickly than their wild counterparts. Wild primates fill up not only on fruit but also on other highly nutritious plant foods. As a result, wild primates weighing 1/10th as much as a typical human ingest nearly 10 times the level of vitamin C and much higher amounts of many other vitamins and minerals. Other differences in the wild primate diet are also important to point out, such as a higher ratio of alpha-linolenic acid (an essential omega-3 fatty acid) to linoleic acid (an essential omega-6 fatty acid). In fact, it has been theorized that a shift in dietary intake to more animal foods may have been the stimulus for brain growth. The shift itself was probably the result of limited food availability that forced early humans to hunt grazing mammals such as antelope and gazelles. Archaeological data support this association: the brains of humans started to grow and become more developed at about the same time as evidence shows an increase in bones of animals butchered with stone tools at sites of early villages. Improved dietary quality alone cannot fully explain why human brains grew, but it definitely appears to have played a critical role. With a bigger brain, early humans were able to engage in more complex social behavior, which led to improved foraging and hunting tactics, which in turn led to even higher-quality food intake, fostering additional brain evolution. Data from anthropologists looking at hunter-gatherer cultures are providing much insight as to what humans are designed to eat; however, it is very important to point out that these groups were not entirely free to determine their diets. Regardless of whether hunter-gatherer communities relied on animal or plant foods, the incidence of diseases of civilization, such as heart disease and cancer, is extremely low in such communities. Domesticated animals have always had higher fat levels than their wild counterparts, but the desire for tender meat has led to the breeding of cattle that produce meat with a fat content of 25 to 30% or more, compared with less than 4% for free-living animals and wild game. Domestic beef contains primarily saturated fats and is very low in omega-3 fatty acids.

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Emotionally compazine 5 mg amex, he totally ignores them order compazine 5 mg without a prescription, much as William James recommended totally ignoring evil and unhappy "facts" to feel happy cheap compazine 5 mg line, and as James T. Mangan recommends totally ignoring adverse situations in the en- vironment, to feel poised. Then, within the context of this goal-striving structure—we respond and react appropri- ately, that is, in a manner which will further our progress and serve our own ends. If responding and reacting to negative feedback does not take us further down the road to our own goal—or serve our ends, then there is no need to respond at all. And, if response of any kind gets us off course, or works against us—then no response is the appropriate response. We must be sensitive to negative feedback data which advises us when we are off course, so that we can change direction and go forward. Our ship must not be tossed and rocked and perhaps sunk by every passing wave, or even a serious storm. As Prescott Lecky expressed it, "The same attitude must be maintained in spite of environ- mental changes. It keeps us from being tossed about, knocked off course, or "shaken up," by every wave or ripple in the environment. Not satisfied with over- responding to actual minor stimuli in the actual environ- ment, many of us create straw men in our imaginations, and emotionally respond to our own mental pictures. In addition to those negatives which actually exist in the en- vironment, we impose our own negatives: This or that may happen; What if such and such happens. When we worry, we form mental pictures—adverse mental pictures of what may exist in the environment, of what may hap- pen. Remember, your nervous system can- not tell the difference between a real experience and one that is vividly imagined. As far as your emotions are concerned, the proper response to worry pictures is to totally ignore them. Analyze your environment—be- come more aware of what actually exists in your environ- ment—and respond and react spontaneously to that. Then, your response will be appropriate—and you will have no time to notice or respond to a fictitious environ- ment. Your First Aid Kit Carry these thoughts with you as a sort of first aid kit: Inner disturbance, or the opposite of tranquility, is nearly always caused by over-response, a too sensitive "alarm reaction. You cure old habits of over-response, you extinguish old conditioned reflexes, when you practice delaying the habitual, automatic, and unthinking response. Use the quiet room in your mind technique both as a daily tranquilizer to tone down nervous response, and to clear your emotional mechanism of "carry-over" emotions Which would be inappropriate in a new situation. Practice Exercise: Create in your imagination a vivid mental picture of yourself sitting quietly, composed, un- moved, letting your telephone ring, as outlined earlier in this chapter. Then, in your daily activities "carry over" the same peaceful, composed, unmoved attitude by re-. Say to yourself, "I am let- ting the telephone ring" whenever you are tempted to "obey" or respond to some fear-bell or anxiety-bell. Next, use your imagination to practice non-response in various sorts of situations: See yourself sitting quietly and un- moved while an associate rants and raves. See yourself going through your daily tasks one by one, calmly, com- posed, unhurried, in spite of the pressures of a busy day. See yourself maintaining the same constant, stable course, in spite of the various "hurry-bells" and "pressure-bells" in your environment. See yourself in various situations which have in the past upset you—only now you remain "set," settled, poised—by not responding. Your Spiritual Thermostat Your physical body has a built-in thermostat, itself a servo-mechanism, which maintains your inner physical temperature at a steady 98. It is able to function properly in the environment because it does not take on itself the climate of the environment. You also have a built-in spiritual thermostat which en- ables you to maintain an emotional climate and atmo- sphere in spite of the emotional weather around you. Yet, your spiritual thermostat is just as necessary for emotional health and well-being as your physical thermostat is for physical health. When playing by himself, or with friends, or in small tournaments where the stakes are low, his play is flawless. People Who Come into Their Own in a Crisis For example, John Thomas, the record-breaking high- jumper from Boston University, often performs better in competition than in practice. The manager frequently turns down the man with the highest batting average, for a player who is known to "come through in the clutch. Many women are charming and gracious when talking with one person or a small informal group, but become tongue-tied, awkward, and dull at a formal dinner, or a big social occasion. On the other hand, I know a little lady who comes into her own only under the stimulus of a big occasion. Even her facial features seem to undergo a change and you find yourself thinking of her as a beautiful woman. There are students who do extremely well in day-to-day class work, but find their minds a blank when taking an examination. There are other students who are ordinary in class work, but do extremely well on important ex- aminations. If you react improperly, a crisis can rob you of the skill, control, and ability that you ordi- narily have to call upon. The so-called "money player" in sports, in business, or in social activities—the person who comes through in the clutch—who performs better under the stimulus of chal- lenge, is invariably the person who has learned either consciously or unconsciously to react well to crisis situa- tions. In order to perform well in a crisis we need to (1) learn certain skills under conditions where we will not be over- motivated; we need to practice without pressure. The crude inept stroke that he used to rescue himself becomes "fixed" and it is difficult for Mm to learn better ways of swimming. Because of his ineptness he may perish in a real crisis where he is re- quired to swim a long distance. Tolman, psychologist and expert on animal behavior at the University of California, says that both animals and men form "brain maps" or "cognitive maps" of the environment while they are learning. In the future, if this one way happens to be blocked, the animal becomes frustrated, and fails to discern alternative routes or detours. He de- velops a "one response," cut and dried, preconceived, and tends to lose the ability to react spontaneously to a new situation. Tolman found that if rats were permitted to learn and practice under non-crisis conditions, they later per- formed well in a crisis. For example, if rats were per- mitted to roam about at will and explore a maze when well fed and with plenty to drink, they did not appear to learn anything. Later, however, if the same rats were placed in the maze while hungry, they showed they had learned a great deal, by quickly and efficiently going to the goal. Other rats which were forced to learn the maze under the crisis of hunger and thirst, did not do so well.

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In non-elective procedures on obese patients or those with an abdominal fluid accumulation generic compazine 5mg free shipping, proper in- tubation is mandatory to ensure a patent airway purchase compazine toronto. Preanesthetic Stabilization and Preparation Nutritional Therapy For elective procedures 5mg compazine for sale, inadequate diets should be corrected three to four weeks before surgery. For spe- cific nutritional requirements and nutritional support of surgical patients, see Chapters 3, 15 and 40. Fluid Therapy Fluid therapy is an important aspect of supportive care that should be provided to avian patients. With their In comparison to catheters in peripheral vessels, intraosseous high metabolic rate, birds rapidly become dehy- cannulas are much easier to maintain. Intraosseous cannulas placed in the tibiotarsus can also be used in critically ill patients drated. Correcting dehydration will dramatically im- for intermittent fluid, blood or drug administration. This to observe from outward signs, and depth should be balanced electrolyte solution protects renal function monitored by combining information obtained from better than sugar solutions. The rates will vary ids administered to anesthetized birds should be depending on the species (Table 39. Most avian Beats Per Minute Breaths per Minute patients, however, are unstable and cannot tolerate Budgerigar 600-750 55-75 such a high rate and volume of fluid administration. Some Parrot 120-780 10-20 newer analyzers use small volumes (10 µl) of serum, Ostriches4 60-72 2-20 providing clinicians access to actual values to use in assessing the status of their patients. If no means of Anatomic locations to evaluate the reflex response to determining the bicarbonate deficit is available and pain or touch in avian patients include palpebra, the patient is dehydrated or critically ill, the admini- cornea, cloaca, propatagium, cere, interphalangeal stration of 1 mEq/kg of bicarbonate at 15 to 30 min- area, pupils (response to light) and pectoral mus- ute intervals to a maximum of 4 mEq is suggested. Fasting In a light plane of anesthesia, the patient has a Recommendations concerning fasting of birds prior palpebral, corneal and pedal reflex but has lost vol- to anesthesia have varied from no fasting to an over- untary motion. This proc- light reflex (pupillary response to light) was delayed ess takes overnight in large birds and four to six and the nictitating membrane moved slowly over the hours in smaller birds. The loss of a corneal reflex (no gency, a patient with food in the crop should be held reflex closure of the lid after touching the peripheral upright during the induction procedure, with a finger cornea with a dry swab) was considered to indicate blocking the esophagus just below the mandible. If a gauze over the choanal slit to prevent food entering patient becomes too deep, all reflexes will be lost and the nasal cavity, turning the bird upside down and the respiratory rate will be slow and irregular. The flutter is often an early indicator that an animal is esophagus can then be packed with gauze, and the head and neck positioned on an upward slant to minimize the chances of passive regurgitation. An excellent plane of anesthesia for most procedures can be accomplished by reaching a depth of anesthesia where wing tone has just disap- peared. If injectable agents have been used, the tra- ditional planes of anesthesia may not be present, making evaluation of the patient more challenging. Body Temperature Physiologically, birds are actually less efficient ho- motherms than mammals and as a result undergo more rapid changes in body temperature during an- esthesia. Besides a loss of physiologic re- sponses to reduced core temperature, hypothermia is also induced during surgery by removal of large ar- three to five minutes to give an accurate reading. A more practical option is a tympanic scanner,d which ratory tract, by the liberal use of alcohol, by body contact with a cold conductive surface and by the gives a reading in five to six seconds. Even with supplemental are easy to use by applying the probe to the outer heat, it is not unusual to have rapid reductions in surface of the ear. Tympanic temperatures are con- sistently slightly higher than cloacal temperatures. Any degree of hypothermia compromises the patient’s ability to re- cover from anesthesia. While supplemental heat will Heart Monitoring not prevent the drop in core temperature seen with anesthesia, it does tend to reduce the speed of heat Heart rate in avian patients can be monitored in loss. Palpation at the point of maximum intensity is possible in some patients (see Table 39. All patients undergoing long surgical procedures Peripheral pulses can be used but are often difficult should be placed on water circulating heating pads. Auscultation via a Keep in mind that these devices need at least a stethoscope is possible, although the chest may be 20-minute warmup period before they reach the pre- difficult to reach once the patient is draped for sur- set temperature. Esophageal stethoscopes equipped with pediat- mize the amount of alcohol used in the surgical scrub ric tubing can be used for auscultation of the heart in and instead use chlorhexidine or povidone iodine to avian patients the size of Amazon parrots and larger. Body tem- This monitoring system allows direct auscultation of perature loss may also be minimized through the use the heart without having to go near the surgical field. Hypothermia occurs in birds despite their be- can be used, but are extremely positional in nature ing placed on water circulating pads. Some oximetry units provide pulse rates up to 250 Body temperature (normal=105 to 107°F28) can be bpm; these units are easy to use and are not posi- constantly monitored during anesthesia to properly tional like the doppler. A patient under tained in a surgical plane of anesthesia, the heart anesthesia will experience a time-related reduction rate remained above 450 bpm. As a bird gets deeper, the use in avian patients, they are less reliable for smaller T-waves become smaller and may totally disappear. Appropriate responses to patients with de- As the depth further increases, the R-wave will in- creased blood pressure values include reduction of anes- crease in magnitude and the S-wave is reduced. Respiratory Rate Respiratory rates during anesthesia should be slow Blood Gases and regular (see Table 39. Hyperventilation or Arterial blood gases can be assessed directly by run- rapid jerky motions are indications of ensuing prob- ning arterial samples on a blood gas machine. An increase in the respiratory rate may indi- not practical for most practitioners and it may in- cate that a bird is entering a lighter plane of anesthe- volve taking multiple blood samples, a procedure sia, that the bird is having difficulty breathing that smaller patients cannot tolerate. An oximeter records the percentage of cir- it is often difficult to observe respiratory effort. Oximeters are not as sensi- with the lower tidal volumes of birds will also make tive at direct determination of arterial blood gases, it easier to monitor respiration. The induces a rapid decrease in heart rate that returns to probe is small and requires only one wire so it is normal shortly after ceasing gas administration. Additionally, many oximeters are actually pulse oximeters that produce Apnea monitors do work in birds; however, less ex- an audible beep, allowing the anesthetist to monitor pensive units may not be sensitive enough to detect heart rate as well as oxygen saturation levels. A device that attaches to the endotracheal tube is reading below 80% should be considered life-threat- heavy, and precautions must be taken to keep the ening. Most birds will maintain an oxygen saturation weight of the monitor from kinking small diameter between 80 to 85% when self-ventilating. Blood Pressure Blood pressure can be monitored directly or indi- Anesthetic Emergencies rectly and should remain above 100 mm Hg. Except in a research situation, it is unlikely that most prac- With careful assessment of patients, conscientious titioners are going to opt for direct blood pressure supportive care and thorough monitoring, many an- monitoring due to the cost and invasiveness of the esthetic-related emergencies can be prevented. If the patient is not intubated, an air sac Press on sternum 40 to 50 cycles/min tube should be placed or the animal should be immedi- Intubate or apply air sac tube ately intubated. Patients should be recovered where they can rate should be carefully monitored and resuscitation be easily observed. Birds should not be left unsuper- should continue until the bird is breathing unassisted. Birds that show respiratory arrest should be resched- uled for the procedure; a second or third episode of Recovery from injectable anesthetics will be much apnea in these cases is often followed by cardiac arrest. Anesthetic recovery is best ac- Cardiac Arrest complished by wrapping the bird in a towel to pre- Cardiac arrest represents a poor prognosis.

The 2) posterior barbules contain 3) ridges that connect with the hooks (open Remiges are large order compazine 5mg, stiff cheap 5 mg compazine, well de- arrow) found on the 4) anterior barbules order compazine overnight delivery. This interlocking mechanism makes the feathers waterproof and improves their insulating capacity. The spaces between the tracts can facilitate the ally asymmetric in form and have clinical evaluation of the skin. The remiges that region and its underlying integumentary compo- arise from the periosteum of the metacarpus are nents is called an apterium. The Terms used to describe parts of a feather are listed in primaries are counted from proximal to distal (dig- Table 24. The The feather is composed of a long, central tapering number of primary and secondary feathers varies shaft that is divided into the hollow base (quill, cala- among species. Bristles are characterized by a stiff, tapered rachis with no barbs except at the proximal end. They are usually found around the mouth, nostrils and eyes and are believed to serve a sensory func- tion. The follicu- lar wall has an abundant supply of sensory nerve fibers, and the papil- lae, pulp and feather muscles are also well innervated. Downs (juvenile and definitive) are small, fluffy, Herbst’s corpuscles at the base of wholly plumulaceous feathers with a short or ab- feather follicles are believed to detect subtle ground sent rachis. Definitive down feathers occur on various parts of the body as part of the adult plumage. Powder down are specialized down feathers that disintegrate and produce a powder (keratin) that Rachis The long, solid, tubular portion of the shaft above the skin. It is a thickened continuation of the calamus is spread through the feathers during preening. The rachis contains pith, They are found throughout the body among the which is composed of air-filled keratinized epithelial down and contour feathers. The calamus and der down feathers frequently have soiled-appear- proximal portion of the rachis are vascularized in the developing feather (pin feather). Vane or The portion of the feather that extends to either side of vexillum the rachis and is composed of the barbs and their Semiplumes have a long rachis and entirely plu- associated structures. They occur in feather tracts of (soft, downy) or pennaceous (compact and closely knit) their own or are found along the margins of con- depending on the individual type of feather. Pulp The mesodermal component of the growing feather consisting of vascular connective tissue. The pulp re- Hypopnea (afterfeathers) are structures at- gresses as the feather grows and is absent in the tached to the underside of a feather at the superior normal mature feather. They may consist only of barbs or have Pulp caps Keratinizing epidermis that covers the distal extremity a shaft and plumulaceous barbs. As the pulp regresses, the keratinized caps Filoplumes are fine, hair-like feathers with a remain and are visible as horizontal bars crossing the lumen of the calamus. Some red coloration in the appendages Pigments of birds is caused by vascularization and not pigment Melanins disposition. When combined, create black, brown, red- dish brown, yellow, red, purple and chestnut red-appear- blanching can be used to determine if an area is ing colors. Carotenoids The normal iridescent glow of the feathers may be Bright red, orange, yellow. Cannot be synthesized and induced in part by lipids derived from the keratino- must be derived from ingested plants. This “glow” is frequently absent in birds with Carotenes and xanthophylls clinical abnormalities and returns as a bird responds Xanthophylls are more readily absorbed from food than to therapy. It is interesting to note that abnormally colored Noniridescent colors do not change with the angle of view feathers may return to normal without a molt. As birds electroencephalographic activity following the re- respond to therapy for hepatitis, these feathers will moval of feathers suggest that it is a painful proce- 16 return to a normal white coloration, presumably be- dure. Clinically, the removal of a feather will fre- cause biliverdin-laden, keratinocyte-produced lipids quently stimulate movement in an anesthetized bird are replaced with lipids that do not contain at the same anesthetic plane that can be used to biliverdin. Yellow or red pigments derived from the uropygial Feather Color gland can be spread on the feathers where the pig- The color of feathers is determined by two factors: the ment remains bright until it fades due to oxidation pigments that are deposited at the time of develop- from exposure to air and light. In a healthy bird, ment, and structural features of the feather that alter feathers maintain their bright pigmentation through the absorption or reflection of light (Table 24. These the addition of newly synthesized oils during preen- structural features of the feather can be inherent in the ing. These mechanisms for imparting color to a development of the feather or can be induced by mate- feather would allow changes in feather pigmentation rials that are placed on the feathers after development. Birds If a feather reflects all wavelengths of light, it appears receiving higher fat diets would be expected to pro- white; if it absorbs all wavelengths of light, it appears duce a lipid-rich, keratinocyte-derived uropygial black. Dark-colored feathers appear to be more durable gland secretion that may enhance the color and than light-colored ones. The pigmentation of feathers may serve to absorb or In poultry, a lack of pigmentation (achromia) has repel heat (light), warn predators, act as a camouflage been associated with dietary deficiencies in lysine, or function in mating displays. Lysine deficiency has not been barbs and barbules to scatter and reflect varying wave- found to alter the pigmentation of cockatiel feathers lengths of light causes the iridescent glow of the feath- but deficiencies of choline or riboflavin will cause ers. Blue colors are created by the barbs interacting to abnormal pigmentation (see Chapter 31). Both reflect blue light while allowing other wavelengths of melanism and albinism have been reported in a vari- light to be absorbed by darker melanin granules. Abnormal yellow, red and pink feath- ers may be noted in Amazon parrots and African Grey Parrots, and it has been suggested that these are associated with hepatopathies, renal dysfunction or systemic disease. Psittacine beak and feather dis- ease has been implicated in some cases of the abnor- mal occurrence of red feathers in African Grey Par- rots. Molt Soft keratin structures (skin, comb, wattles, cere) undergo constant replacement through the slough- ing of the outer cornified layer (Figure 24. Old or damaged outer layers of hard keratin structures (rhamphotheca and metatarsal spurs) are replaced through normal wear. The thick, horny heel pads on the back joints of woodpecker, toucan and barbet neonates are molted at fledging. In cases of malnu- trition or systemic disease, hyperkeratotic layers of the rhamphotheca can accumulate and be peeled off with a blunt instrument. Molting is the process whereby the growth of a new feather causes the shedding of an old feather. The single generation of feathers that occurs as a result of a molt is collectively known as plumage. Excessively dry, flaky skin can be an indication of malnutrition or organopathies. In this cockatoo, a heavy molt and ers present on the body at one time, regardless of sloughing of sheets of the epidermis were induced by changing the when they first appeared, are called the feather coat.

By M. Malir. University of San Francisco.