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By Y. Falk.

Where phenotypic methods are used accutane 10mg mastercard, another option could be to add a fluroquinolone and one or two second-line injectable agents to the panel of drugs tested 40 mg accutane otc, or replace streptomycin and ethambutol with a fluroquinolone and an injectable agent. To enable better assessment of trends in drug resistance over time, one option might be to keep population-based clusters open throughout the year. Alternatively, molecular testing for rifampicin, or rifampicin and isoniazid, could be conducted for a determined number of cases per month. If a point-of- care test were available, this could simplify the process even further. All cases with rifampicin resistance would be further screened for resistance to second-line drugs, and enrolled on treatment. It is important to distinguish between population-based surveys used for epidemiological purposes, surveys used for programme-related reasons and studies designed to answer research questions. Transmission dynamics and acquisition of resistance are areas that undoubtedly require further research, but are difficult to answer in the context of routine surveillance in most settings. There are several possibilities for improving current surveillance mechanisms using new molecular tools as well as modified survey methods. The Eastern Mediterranean and South-East Asia regions show moderate proportions of resistance, followed by the Western Pacific region. Eastern Europe continues to report the highest proportions of resistance globally and for all first-line drugs. There are important variations within regions, particularly in the Eastern Mediterranean and the Western Pacific regions, and in Europe if Central, Eastern and Western Europe are grouped together (although Central and Western Europe show little variation in resistance across the region). In the Republic of Korea, the slowing in the decline of the notification rate has been attributed to an expanding surveillance system that reaches the private sector. A better programme can reduce the overall number of cases, particularly re-treated cases; however, difficult (resistant) cases may persist. Improvement in laboratory proficiency, particularly the sensitivity and specificity of drug-susceptibility testing, may also affect the observed prevalence of resistance. The scenarios outlined above highlight the importance of evaluating trends in prevalence of drug resistance within the context of relevant programme developments. One limitation is the insufficient quality assurance of drug-susceptibility testing for second-line drugs. Another limitation is that second-line drug-susceptibility testing is not available in most countries. The cost of shipping of isolates and the cost of second-line testing is significant. Myanmar is surveying risk populations, but is currently showing low proportions of second-line drug resistance. Quinolones are widely available in this region; therefore, determining the extent of resistance to this class of drug is a priority, as is establishing cross-resistance between early and later generations of quinolones. Second-line drugs are locally available in most of the countries of the former Soviet Union and have been widely used for a long time. Both of these factors, smear negativity and shorter duration of disease due to mortality, may suggest a lower rate of general transmission. Additional information on risk factors, including history of hospitalization or imprisonment, was not available for this analysis, so the specific reasons for the association are not known. Better surveillance data may help in developing an understanding of the relationship between these epidemics; however, additional studies should be undertaken in several settings to answer the questions that surveys cannot. China and India are estimated to carry 50% of the global burden, with the Russian Federation carrying a further 7%. Prevalence can be estimated by multiplying incidence by the average duration of the disease. In general, duration is expected to be longer because most patients will receive some treatment that will contribute to prolongation of disease rather than curing it. The network has completed 13 rounds of proficiency testing since 1994; and cumulative results indicate an overall high performance. Although overall performance of the network is good, annually, one or two laboratories within the network will show suboptimal performance. This indicates the difficulty of executing high-quality drug-susceptibility testing year after year, and also highlights the importance of internal quality assurance. Results are determined judicially, and through the course of 13 rounds of proficiency testing, “borderline” strains have been encountered, where up to half the network has found these strains to be susceptible and the other laboratories have found them to be resistant. Since round 9, thorough pretesting has been used to exclude such strains from panels, but has not always been successful. Therefore, strains with less than 80% concordance within the network have been excluded from overall performance measures, so that judicial results are not distorted. Over a five-year period, 40 of 600 strains, or approximately 7% of strains included in annual panels, have been excluded. The study on borderline strains has been useful in confirming that the most important factor explaining the variation of the results of panel testing is strain selection. Currently, there is no established gold standard to replace the judicial 80 system. One possible solution would be a definition of “intermediary” resistant results; however, this would require testing at two concentrations. Many high- income countries will test drugs (at least isoniazid) at two concentrations. To date, no study has systematically evaluated all available methods for testing, established critical concentrations for all available second-line drugs, or evaluated a large number of clinical isolates for microbiological and clinical end-points. In July 2007, guidance was developed for the selection of and testing for second-line drugs. Based on evidence or expert consensus (where no evidence was available), a hierarchy was developed recommending drug-susceptibility testing based on both clinical relevance and reliability of the test available. Rifampicin and isoniazid were prioritized, followed by ethambutol, streptomycin and pyrazinamide, and then the second-line injectables (amikacin, kanamycin and capreomycin) and fluroquinolones. The policy guidance is available, and full technical guidelines for the drug-susceptibility testing of second-line drugs became available in 2008. Tests for rapid identification of second-line drug resistance are not yet available. The variation in resistance among countries within the region is relatively narrow; however, roughly half of the data points used to look at the distribution are at least five years old. Only Botswana, Côte d’Ivoire, Sierra Leone and Mpumalanga Province, South Africa, have carried out repeat surveys. Detection of this outbreak was only possible because of the extensive laboratory infrastructure available in the country. It is likely that similar outbreaks of drug resistance with associated high mortality are taking place in other countries, but are not being detected due to insufficient laboratory capacity. Botswana, Mauritania and Mozambique have nationwide surveys under way, and Angola, Burundi, Lesotho, Malawi, Namibia, South Africa, Uganda and Zambia have plans to initiate nationwide surveys over the next year. Nigeria and the Congo plan to begin a survey covering selected districts in their respective countries in 2008. Currently, Botswana and Swaziland are surveying high-risk populations to examine the extent of first and second-line drug resistance; results should be available in early 2008. Malawi, Mozambique, Zambia and Zimbabwe all have plans to conduct similar studies. South Africa has recently conducted a review of the country’s laboratory database and found that 996 (5. Selection and testing practices varied across the country and with time; however, all isolates correspond to individual cases29. Data from this project will be available in early 2008 and, if shown to be comparable with phenotypic testing, may be a useful tool in the expansion of survey coverage in the region as well as in trend analysis. The most critical factor in addressing drug resistance in African countries is the lack of laboratory infrastructure and transport networks that can provide rapid diagnosis. However, if laboratories are to scale up rapidly, coordination of funding and technical agencies will be critical, as will concerted efforts to address the widespread constraints in human-resource capacity in the region. In the last report — though in the same reporting period (2002) — Ecuador showed 4. In North America, Canada has shown low proportions of resistance and relatively steady trends in resistance among both new and previously treated cases. Uruguay showed a decrease in resistance to any drug, but this was not significant. Many countries plan to upgrade laboratory networks because there is increased demand for development of second-line testing capacity.

Any patient suspected to have cholera should be immediately referred to a higher center for better care generic 20 mg accutane with mastercard. In the management of patients with cholera purchase 30 mg accutane mastercard, fluid replacement is less important than antimicrobial therapy. Which one of the following can be taken as an objective data when assessing a patient with food borne diseases? During the nursing care for a patient with diarrhea secondary to food borne diseases, caffeine and carbonated beverage is limited because: A. One of the following nursing interventions is not carried out for a patient with poisoning related to the ingestion of contaminated food with chemical poisons and poisonous plants. Induction of vomiting is not recommended after ingestion of caustic substances or petroleum distillates A. Identify an incorrect statement about the nutritional management of the patient with food borne diseases that has diarrhea. Which one of the following nursing interventions is used to reduce anxiety of a patient with diarrhea secondary to food borne diseases? Providing an opportunity to express fears and worry about being embarrassed by lack of control over bowel elimination. Provision of isolation according to the general rule of body substance isolation, or individual institution adaptation of isolation. For Environmental Health Officers Read the following questions carefully and give the appropriate answer. For Medical Laboratory Technologists Write the letter of your choice for the following questions on separate answer sheet. Food- borne diseases are known to be responsible for a large proportion of adult illnesses and deaths; more importantly, as sources of acute diarrheal diseases, they are known to claim the lives of overwhelming numbers of children every day. In developing countries like Ethiopia, the problem attains great proportions due to many reasons; basic among which are poverty and lack of public health awareness. Although well-documented information is lacking regarding the extent of food-borne diseases in the country, and many cases and outbreaks are unrecognized or unreported, they are unquestionably one of the major reasons or why people of all ages seek medical help. Most food-borne diseases manifest with gastrointestinal symptoms and signs, the latter being uniformly among the top diagnoses in health facilities at all levels. Besides, they commonly lead to epidemics that result in the losses of many lives, accompanied with severe economic repercussions. In these modern days, in which food is usually not consumed immediately following and/or at the site of production, the risks of food-borne diseases are becoming increasingly important; the concern is obviously much more in areas where food storage and preparation safety measures are far below the optimum. The role of well-trained health professionals not only in the prevention and control of food- borne diseases, but also in the recognition of individual cases as well as outbreaks and their timely and proper management in order to reduce mortalities and morbidities is very crucial. Learning Objectives General Upon completion of this module, the learner will be able to recognize, prevent and manage food-borne diseases. Case Study Learning Activity 1 It was during the period of drought and famine that people were getting displaced to other parts of the country. Among them, Fatuma, a 25 years old lady came to the nearby health center with one day history of nausea, vomiting and watery diarrhea. Staffs from the Health Center supervised their temporary residence and come up with the following report: There were about 50 individuals living in four rooms within one compound. There was no toilet in the compound and it was observed that there were indiscriminate human excreta in the compound. Pipe water supply was available in the compound; but the people fetched the water using wide mouthed buckets for storage. Finally the staffs conducted appropriate intervention measures and no similar cases were seen subsequently. Definition of Food borne diseases The term “food borne disease” is defined as a disease usually either infectious or toxic in nature, caused by agents that enter the body through the ingestion of food (1). Epidemiology Although food is a basic human need it can sometimes cause a number of illness arising from pathogenic and toxic substances, which find their way in to food through contamination or spoilage (2). New and re-emerging food-borne illnesses have resulted from recent changes in human demographics, international travel and commerce, microbial adaptations, economic development, technology and industry, eating behavior and land use (5). For example, hemolytic uremic syndrome which is a very important cause of acute renal failure in children is caused by infection with E. But it can be evidenced that these are very common in Ethiopia because of many reasons including poverty, lack of awareness, poor water supply, poor personal hygiene and environmental sanitation, etc. According to the 2002-2003 “Health and Health-related Indicators” published by the Planning and Programming Department of the Federal Ministry of Health of Ethiopia, Helminthic infections were the second leading cause of outpatient visits Dysentery and different parasitic infections were also among the ten top causes of outpatient visits Dysentery was among the leading causes of hospital admissions and deaths The national average access to safe water was 28. Classification and Etiology of Some Food Borne Diseases Food borne diseases are classified into two major categories depending on the causative agent: food-borne poisonings/intoxications and food-borne infections. Food borne infections: are diseases whose etiologic agents are viable pathogenic organisms ingested with foods and that can establish infection. B acterial Typh oid fever Salmonella typh iand parath yph i R aw vegetables and fruits, salads, pastries, un- pasteuriz ed Paratyph oid fever Salmonella paratyph i milk and milk products,meat Sh igellosis Sh igella species A llfoods h andled by unh ygenic workers, potato oregg salad, lettuce,raw vegetables C h olera Vibrio ch olerae F ruits and vegetables wash ed with contaminated water N ontyph oid Salmonella species, e. Salmonella Eggs, poultry, undercooked meals, un-pasteuriz ed dairy Salmonellosis typh imurium products,sea foods,sausages Brucellosis Brucella species, mostly Brucella M ilk and dairy products from infected animals. Viral ViralG E R ota virus, N orwalk virus, calici virus, A ny food ofdaily use with poorh ygiene astro virus Viralh epatitis H epatitis A & E R aw sh ellfish from polluted water,sandwich ,salad, and desserts. Parasitic Taeniasis Taenia species R aw beef,raw pork A moebiasis Entameba h istolytica A ny food soiled with feces Trich inosis Trich nella spiralis Insufficiently cooked pork and pork products A scariasis A scaris lumbricoides F oods contaminated with soil,specially foods th at are eatenraw such as salads,vegetables G iardiasis G iardia lamblia A ny contaminated food item Toxoplasmosis Toxoplasma gondii R aw orundercooked meatand any food contaminated with catfeces? C ryptosporidiosis C ryptosporidium parvum A pple juice,A ny contaminated food item H ydatid disease Ech inococcus granulosus A ny food contaminated with dogfeces Diph yloboth riasis Diph yloboth rium latum R aw orundercooked fish Trich uriasis Trich uris trich uria A ny food contaminated with soil 4. F ungal F ungalInfections A spergillus C ereal,grains,flour,bread,cornmeal,popcorn,peanutbutter, Penicillium apples and apple products,moldy supermarketfoods,ch eese, Y easts dried meats,refrigerated and froz enpasteries 19 Table 2. M ush room poisoning Ph alloidine and alkaloids found Poisonous mush rooms such as species of insome poisonous mush rooms. Staph ylococcalfood Entero-toxinfrom M ilk and milk products, sliced meat, poultry, poisoning staph ylococcus aureus potato salad,cream pastries,eggsalad 2. Perfringens food Strains of C lostridium welch ii/ Inadequately h eated orreh eated meat,poultry, poisoning C. Botulism food poisoning ToxinofC lostridium botlinum H ome-canned foods,low acid vegetables,corn and peas. Bacillus cereus food Entero toxinofBacillus cereus C ereals, milk and dairy products, vegetable, poisoning meats,cooked rice. Ergotism A toxin (ergot) produced by a R ye,wh eat,sorgh um,barley group offungi called C leviceps purpurea 2. A flatoxinfood poisoning A flatoxin produced by some C ereal grains, ground nuts, peanuts, groups offungus (e. L ead, -F ish ,canned food poisoning mercury,cadmium) - F oods contaminated by utensils made or coated with h eavy metals Pesticides and insecticides -R esidues oncrops,vegetables,fruits. A dditives (unauth oriz ed) Various food items wh ere unauth oriz ed additives may be added as coloring agents, sweeteners,preservatives,flavoringagents etc. Pathogenesis: Following ingestion, the bacteria enter the epithelial layer of the small intestine, and are carried by macrophages throughout the body. Clinical features: ¾ After an incubation period of 3-21 days, patients present with prolonged fever, headache, anorexia, chills, malaise, abdominal pain, and diarrhea or constipation. Non-typhoidal Salmonellosis Pathogenesis Following ingestion, the non-typhoidal salmonella organisms reach the bowel where they cause damage to the intestinal mucosa causing inflammatory diarrhea. Clinical Features ¾ The major clinical features are loose, non-bloody stools of moderate volume, nausea, vomiting, fever and abdominal cramps, which are seen following an incubation period of 6 – 48 hours. Shigellosis/Bacillary dysentery It is an acute inflammatory colitis caused by a number of Shigella species. Clinical Features: After an incubation period of 1-7 days, patients present with non-bloody watery diarrhea or gross dysentery with tenesmus accompanied by fever which is o particularly severe in children (40 – 41 C) and abdominal pain. Pathogenesis: ¾ Following colonization of small intestine, the organism releases a potent enterotoxin called cholera toxin. Clinical features: ¾ After an incubation period of 24 – 48 hours, patients experience sudden onset of profuse watery diarrhea accompanied by vomiting. Escherichia coli Infection There are different strains of Escherichia coli which give rise to diarrhea by different mechanisms: 23 1.

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Once these areas have ossified discount accutane 10 mg without a prescription, their fusion to the diaphysis and the disappearance of each epiphyseal plate follow a reversed sequence accutane 40mg mastercard. Thus, the lesser trochanter is the first to fuse, doing so at the onset of puberty (around 11 years of age), followed by the greater trochanter approximately 1 year later. The femoral head fuses between the ages of 14–17 years, whereas the distal condyles of the femur are the last to fuse, between the ages of 16–19 years. Knowledge of the age at which different epiphyseal plates disappear is important when interpreting radiographs taken of children. Since the cartilage of an epiphyseal plate is less dense than bone, the plate will appear dark in a radiograph image. The clavicle is the one appendicular skeleton bone that does not develop via endochondral ossification. During this process, mesenchymal cells differentiate directly into bone-producing cells, which produce the clavicle directly, without first making a cartilage model. Because of this early production of bone, the clavicle is the first bone of the body to begin ossification, with ossification centers appearing during the fifth week of development. It affects the foot and ankle, causing the foot to be twisted inward at a sharp angle, like the head of a golf club (Figure 8. Clubfoot has a frequency of about 1 out of every 1,000 births, and is twice as likely to occur in a male child as in a female child. Most cases are corrected without surgery, and affected individuals will grow up to lead normal, active lives. Hanson) At birth, children with a clubfoot have the heel turned inward and the anterior foot twisted so that the lateral side of the foot is facing inferiorly, commonly due to ligaments or leg muscles attached to the foot that are shortened or abnormally tight. Other symptoms may include bending of the ankle that lifts the heel of the foot and an extremely high foot arch. Due to the limited range of motion in the affected foot, it is difficult to place the foot into the correct position. Additionally, the affected foot may be shorter than normal, and the calf muscles are usually underdeveloped on the affected side. Although the cause of clubfoot is idiopathic (unknown), evidence indicates that fetal position within the uterus is not a contributing factor. Cigarette smoking during pregnancy has been linked to the development of clubfoot, particularly in families with a history of clubfoot. Today, 90 percent of cases are successfully treated without surgery using new corrective casting techniques. The best chance for a full recovery requires that clubfoot treatment begin during the first 2 weeks after birth. Corrective casting gently stretches the foot, which is followed by the application of a holding cast to keep the foot in the proper position. In severe cases, surgery may also be required, after which the foot typically remains in a cast for 6 to 8 weeks. After the cast is removed following either surgical or nonsurgical treatment, the child will be required to wear a brace part-time (at night) for up to 4 years. Close monitoring by the parents and adherence to postoperative instructions are imperative in minimizing the risk of relapse. Despite these difficulties, treatment for clubfoot is usually successful, and the child will grow up to lead a normal, active life. Numerous examples of individuals born with a clubfoot who went on to successful careers include Dudley Moore (comedian and actor), Damon Wayans (comedian and actor), Troy Aikman (three-time Super Bowl-winning 340 Chapter 8 | The Appendicular Skeleton quarterback), Kristi Yamaguchi (Olympic gold medalist in figure skating), Mia Hamm (two-time Olympic gold medalist in soccer), and Charles Woodson (Heisman trophy and Super Bowl winner). The clavicle is an anterior bone whose sternal end articulates with the manubrium of the sternum at the sternoclavicular joint. The acromial end of the clavicle articulates with the acromion of the scapula at the acromioclavicular joint. This end is also anchored to the coracoid process of the scapula by the coracoclavicular ligament, which provides indirect support for the acromioclavicular joint. The clavicle supports the scapula, transmits the weight and forces from the upper limb to the body trunk, and protects the underlying nerves and blood vessels. It mediates the attachment of the upper limb to the clavicle, This OpenStax book is available for free at http://cnx. Posteriorly, the spine separates the supraspinous and infraspinous fossae, and then extends laterally as the acromion. The proximal humerus consists of the head, which articulates with the scapula at the glenohumeral joint, the greater and lesser tubercles separated by the intertubercular (bicipital) groove, and the anatomical and surgical necks. The distal humerus is flattened, forming a lateral supracondylar ridge that terminates at the small lateral epicondyle. The articulating surfaces of the distal humerus consist of the trochlea medially and the capitulum laterally. Depressions on the humerus that accommodate the forearm bones during bending (flexing) and straightening (extending) of the elbow include the coronoid fossa, the radial fossa, and the olecranon fossa. The elbow joint is formed by the articulation between the trochlea of the humerus and the trochlear notch of the ulna, plus the articulation between the capitulum of the humerus and the head of the radius. The proximal radioulnar joint is the articulation between the head of the radius and the radial notch of the ulna. The proximal ulna also has the olecranon process, forming an expanded posterior region, and the coronoid process and ulnar tuberosity on its anterior aspect. On the proximal radius, the narrowed region below the head is the neck; distal to this is the radial tuberosity. The shaft portions of both the ulna and radius have an interosseous border, whereas the distal ends of each bone have a pointed styloid process. The proximal row contains (from lateral to medial) the scaphoid, lunate, triquetrum, and pisiform bones. The distal row of carpal bones contains (from medial to lateral) the hamate, capitate, trapezoid, and trapezium bones (“So Long To Pinky, Here Comes The Thumb”). The thumb contains a proximal and a distal phalanx, whereas the remaining digits each contain proximal, middle, and distal phalanges. The hip bone articulates posteriorly at the sacroiliac joint with the sacrum, which is part of the axial skeleton. The right and left hip bones converge anteriorly and articulate with each other at the pubic symphysis. The primary function of the pelvis is to support the upper body and transfer body weight to the lower limbs. Located at either end of the iliac crest are the anterior superior and posterior superior iliac spines. The medial surface of the upper ilium forms the iliac fossa, with the arcuate line marking the inferior limit of this area. The posterior margin of the ischium has the shallow lesser sciatic notch and the ischial spine, which separates the greater and lesser sciatic notches. The pubis is joined to the ilium by the superior pubic ramus, the superior surface of which forms the pectineal line. The pubic arch is formed by the pubic symphysis, the bodies of the adjacent pubic bones, and the two inferior pubic rami. The sacrum is also joined to the hip bone by the sacrospinous ligament, which attaches to the ischial spine, and the sacrotuberous ligament, which attaches to the ischial tuberosity. The sacrospinous and sacrotuberous ligaments contribute to the formation of the greater and lesser sciatic foramina. The broad space of the upper pelvis is the greater pelvis, and the narrow, inferior space is the lesser pelvis. Compared to the male, the female pelvis is wider to accommodate childbirth, has a larger subpubic angle, and a broader greater sciatic notch. These are the thigh, located between the hip and knee joints; the leg, located between the knee and ankle joints; and distal to the ankle, the foot. These are the femur, patella, tibia, fibula, seven tarsal bones, five metatarsal bones, and 14 phalanges. Passing between these bony expansions are the intertrochanteric line on the anterior femur and the larger intertrochanteric crest on the posterior femur. On the posterior shaft of the femur is the gluteal tuberosity proximally and the linea aspera in the mid-shaft region. The expanded distal end consists of three articulating surfaces: the medial and lateral condyles, and the patellar surface.

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This is because the polar bear is white in color 78 In the above figure you see the light portion as a figure safe 20 mg accutane, you will see a water glass or candle holder discount accutane 10 mg fast delivery, if you see the dark portion as a figure, you will see two faces. Either one is a figure against background Grouping of stimuli in perceptual organization: ­ Stimuli are grouped into the smallest possible pattern that has meaning. Important principles of grouping are proximity, similarity, symmetry, closure and continuation Proximity: ­ When objects are close to each other, the tendency is to perceive than together rather than separately. We see three sets of two lines each and not six separately lines Proximity Similarity: ­ Items that most closely resemble each other or perceived as units In above figure the circles and triangles are seen as two vertical rows of triangles and one row of circles and not three horizontal rows of triangles and circles Symmetry: ­ Items that form symmetrical units are grouped together We see three sets of brackets. We do not see six unconnected lines Closure: ­ Items are perceived as complete units even though they may be interrupted by gaps Continuation: ­Anything which extends itself into space in the same shape, size and color with­ out a break in perceived as a whole figure. We do not see a straight line with small semi­ circles above and below it Perceptual constancies: ­ Perceptual constancies refers to our tendency to perceive objects as relatively stable and unchanging despite changing information. Perceptual constancies 1) Space constancy 2) Sex constancy 3) Brightness and color constancy 4) Perception of space binocular depth cues 5) Visual monocular clues Types of perceptual constancies: ­ 1) Observer characteristics: ­ Depends greatly on past experience and learning 2) Depth perception: ­ Is the ability to perceive space and distance accurately 3) Binocular cues: ­ Helps in the perception of depth by integrating and synchronizing the images of both the eyes. According to psychologist Ward, “it is the complete psychosis involving cognition, pleasure – pain and conation”. The difference between motives and emotions are as follows: Emotions are usually aroused by external stimuli and that emotional expression is directed toward the stimuli in the environment that arouses it. Motives on the other hand, are more often aroused by internal stimuli and naturally directed towards certain objects in the environment. Most of the motivated behaviour has some affective or emotional accompaniment although we may be too pre occupied in our striving towards goal. The bodily effects of pain, hunger, fear and rage have all the emotions of characteristically, negative polarity. The sympathetic system is responsible for the following changes: 1) Blood pressure and heart rate increases. Nerve impulses with sympathetic system, which reach adrenal glands located on the top of the kidneys, trigger the secretion of hormones. Theories of emotion: James theory or emotion proposes the following sequences of events in emotional state. The major objection to James Lang theory came from Cannon who pointed out 1) That changes do not seem to differ very much from one emotional state to another. James Langes Theory Perception of Activation of Feed back to brain emotion Visceral and from bodily producing skeletal responses produce stimulus responses experience of emotion Canon theory Messages to cortex produce experience Perception of Stimulus processed by of emotion emotion Thalamus, which producing simultaneously send stimulus messages to the cortex and other parts of the body Messages from thalamus activates visceral and skeletal responses Emotion when sufficiently intense can seriously impair the process that control organized behavior. Motion pictures and recording of children’s cries indicate that the infants’ response to stimuli designated to arouse emotion are very diffuse and lacking in organization. Emotional shocks and hurts suffered by individuals at an early age can handicap them as long as they live. Children sooner or later acquire the capacity for experiencing negative emotions such as anger, fear, and also sorrow or grief to an intense degree. This capacity develops, before the child is mature enough to use language, to formulate his experience in words. These improvements in the young child’s ability to respond in specific ways to situations that arouse him, parallel the development of his mental and motor abilities. As the child’s intellectual and motor capacity matures, he acquires large variety of means and forms of expression such as overt and direct to more graded covert and indirect. If a person may mask intense feeling of anger tat occurs when someone hunts his pride very sharply and then still harboring his anger may explode on another occasions because of a very trivial affront. The most important factors in a child’s emotional development and the affection that he receives from his parents, peer group and society. The more genuine the parents love for the child, the, more the child tends to feel free to love other people. All physiological healthy nurses are likely to feel some affection for patients in their charge or with whom they have a chance to associate even though the children are not their own. Their un­ loved person may suffer in connection with the development of positive attitudes and concepts concern­ ing his own worth. This personality is not fixed state but dynamic totality, which is continuously changing due to interaction with the environment. Definition of personality: In the words of Munn, it is characteristic integration of an individual’s structure. In the words of Gorden Allport, “personality is the dynamic organization within the individual of those psychophysical systems, that determine his unique adjustment to his environment” The personality is the organization of the internal and external activities. Personality is the total quality of behavior, attitudes, interests, capacities, aptitudes and behavior patterns, which are manifested in his relation with the environment. However as a person genetic inheritance interacts with and is shaped by environmental factors, the emerges a self structure that becomes an important influence in shapijgn further development and behavior. A trait is an enduring and consistent characteristic of a person that is observed in a wide variety of situations. In fact All port and Odbert have listed 17,593 words in English, which are adjectives standing for personality traits. Norman listed 5 terms extroversion, agreeableness, consciousness, and emotional stability and culture. In situations of worry, panicking, stress and over emotionality a high level activity could affect performance adversely in academic work of pupils, resulting in learning disabilities. The type personality: It is older than the trait approach, which depends upon modern statistical procedures. The athletic and asthenic type of body build, go with what is known as schizothyme personality and the pyknic body goes with cyclothymic personality. Psychological theory of personality: Personality theories are grouped under three major heads 1) Psychodynamic theories. Psychodynamic theories of personality: Psychoanalytic theories of personality are referred to as psychodynamic theory. This theory at­ tempts to understand personality in terms of mental functions may be rational, irrational, conscious or unconscious. Freud’s theory of psychoanalysis emphasizes man as dynamic system of energies and main store­ house of such energies in unconscious. From anxiety, defense mechanism or unconscious attempts to reduce anxiety by denying or destroying realty,. The technique of Eric Berne’s transactional refers to wholesome transaction from childhood to adulthood. Then from 5 up to early adolescence sexual force is subordinated which marks the latency, period and finally the genital stage of heterosexuality. Carl Jung differs from Freud in taking a more positive and optimistic attitude towards human nature believing that people not only try to gratify their instincts but also try to develop their potential. Jung agreeing with Freudian view of unconsciousness, which represents the accumulated experi­ ences, and culture of the human species throughout its evolutionary development from primitive times. To Erickson, personality is the resultant from interaction between the needs of a person and the demands of a society at a particular stage of development. Ego identify crisis during adolescence and now an individual resolves such crisis determines personality characteristics. Svilan has stressed the interpersonal nature of personality and has laid on the acquisition of language as a means of normal personality development. Social learning theories of personality: These theories say that consistency of behavior, results not only from rigid personality traits but also from other factors like environmental stability. Dollard and Miller pointed fear, as an important factor in personality development as it acts as a powerful motive or drive in the promotion of learning. A person’s behavior depends upon the specific nature of the situation, how the situation is appraised by him as well as past reinforcement of behaviour in similar situations. Behaviorists theories of personality: Behavourists is such a skinner emphasize that conditioning alone is not adequate to explain human character and personality. These theories emphasize the existence of positive growth promoting forces in personality beyond more conflict resolution or tension reduction and also stresses present rather than past experiences. Maslow and Carl Roger both dealt on humanistic and psychoanalytic theories on growth and self actualization. An individual with a strong positive self – concept seek growth and have pleasant productive relation with others.