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A problem with this classic verse is that the eighth cranial nerve repre- marily of motor (efferent) neurons that convey impulses away sented by and in the jingle generic oxytrol 5 mg with amex, which used to be referred to as auditory, from the CNS. Hence, the are motor only; all motor nerves contain some proprioceptor following topical mnemonic: “On old Olympus’s towering top, a fat vi- fibers (see fig. Actually, numerous olfactory nerves relay sensory impulses of smell from the mucous membranes of the nasal cavity Knowledge Check (fig. Olfactory nerves are composed of bipolar neurons that function as chemoreceptors, responding to volatile chemical 1. The tongue responds to tastes and pain and moves to ma- particles breathed into the nasal cavity. Make a quick sketch of the brain and the bodies of olfactory neurons are positioned within the mucosa, tongue to depict the relationship between the CNS and primarily that which covers the superior nasal conchae and ad- the PNS. The axons of these neurons pass through motor innervation of the tongue. List the structures of the nervous system that are consid- ered part of the PNS. II Optic Nerve The optic nerve, another sensory nerve, conducts impulses from the photoreceptors (rods and cones) in the retina of the eye. Each CRANIAL NERVES optic nerve is composed of an estimated 125 million nerve fibers that converge at the back of the eyeball and enter the cranial cav- Twelve pairs of cranial nerves emerge from the inferior surface ity through the optic canal. The optic nerve fibers pass posteriorly from the optic chiasma to the thalamus via the optic tracts. In the thala- Objective 3 Describe the clinical methods for determining mus, a majority of the fibers terminate within certain thalamic cranial nerve dysfunction. A few of the ganglion-cell axons that reach the thalamic nuclei have collaterals that convey impulses to the superior colli- culi. Synapses within the thalamic nuclei, however, permit im- Structure and Function pulses to pass through neurons to the visual cortex within the of the Cranial Nerves occipital lobes. Other synapses permit impulses to reach the nu- clei for the oculomotor, trochlear, and abducens nerves, which Of the 12 pairs of cranial nerves, 2 pairs arise from the forebrain regulate intrinsic (internal) and extrinsic (from orbit to eyeball) and 10 pairs arise from the midbrain and brain stem (fig.

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The greatest challenge for informational approaches to malpractice reform is the tension between disclosing 272 Sage information and producing information (69) generic 5mg oxytrol with amex. Indeed, the breakthrough insight of the patient safety movement is that creating a “safe environ- ment” in which information can be shared and analyzed is central to improving complex professional processes. Accordingly, patient safety advocates have criticized the malpractice system for chilling information generation and exchange (70,71). Along these lines, it is eminently reasonable to strengthen peer review protections for safety- related information so that true “near misses” and internal analyses are immune from discovery and use in litigation. However, the line be- tween information that should be shared (at least with individual pa- tients) and information that should be reserved for professional quality improvement will never be easy to draw. Therefore, researchers should explore other ways to generate information about medical errors, in- cluding public subsidies (72). PUTTING THE PIECES TOGETHER Assembling the elements discussed in the previous sections into a coherent malpractice reform proposal has its own set of challenges. Although a detailed analysis of reform vehicles is beyond the scope of this chapter, one can identify three potential sources of change that could overcome political gridlock and more closely link malpractice policy to overall health policy. Federally Funded State Demonstration Projects In November 2002, the IOM issued a report entitled Fostering Rapid Advances in Health Care: Learning From System Demonstrations (73), which recommended that the federal government sponsor a series of state-based demonstration projects to test solutions to persistent health policy problems. The report responded to a request from the Secretary of Health and Human Services for innovative approaches to five areas of health care: chronic care, primary care, information technology, health insurance coverage, and liability. The liability recommendation included two options for “patient-centered, safety-focused, non-judi- cial compensation”: provider-based early payment and statewide administrative resolution. Under the first option, provider organizations that elected to participate in a given state would receive limited immu- nity from tort suits and federal subsidies for excess liability coverage in exchange for establishing systems for detecting and preventing medical errors and promptly paying economic loss and predefined noneconomic damages for identified classes of avoidable injuries. Under the second option, all health care providers in the state would be subject to a fed- Chapter 17 / New Directions in Liability Reform 273 erally funded, state-run administrative adjudication system for avoid- able injuries based on predetermined schedules of noneconomic dam- ages, which would replace open-ended tort liability.

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Ryan EA buy generic oxytrol 2.5 mg line, Reiss E (1984) Oncogenous osteomalacia: Review Pseudohypoparathyroidism - An example of “Seabright- of the world literature of 42 cases. Curr Ther Endocrinol Metab 5:492-495 pseudohypoparathyroidism (PH) and pseudo-pseudohy- 56. Steendijk R, Hauspie RC (1992) The pattern of growth and poparathyroidism (PPH). Differentiation from other syn- growth retardation of patients with hypophosphataemic vita- dromes associated with short metacarpals, metatarsals and min D-resistant rickets: longitudinal study. Glorieux FH, Marie PJ, Pettifor JM, Delvin EE (1980) Bone of shortening of the bones of the hands in PHP and PPHP – a response to phosphate salts, ergocalciferol and calcitriol in hy- comparison with brachydactyly E, Turner’s syndrome, and pophosphatemic vitamin D-resistant rickets. Milgram JW Compere CL (1981) Hypophosphatemic vitamin pseudohypoparathyroidism Semin Musculoskel Radiol D refractory osteomalacia with bilateral pseudofractures. O’Malley SP, Adams JE, Davies M, Ramsden RT (1988) The with secondary hyperparathyroidism and osteitis fibrosa. Polisson RP, Martinez S, Khoury M et al (1985) Calcification Feldman D, Glorieux FH, Pike JW (eds). Chapter 60, Vitamin of entheses associated with X-linked hypophosphatemic os- D, Elsevier Academic Press, San Diego, California, pp 967-994 teomalacia. Adams JE, Davies M (1986) Intra-spinal new bone formation Clin North Am 19:582-598 and spinal cord compression in familial hypophosphataemic 37. Glorieux FH, St-Arnaud R (1997) Vitamin D vitamin D resistant osteomalacia. Hardy DC, Murphy WA, Siegal BA et al (1989) X-linked hy- Vitamin D, Academic Press, San Diego, California, pp 755- pophosphatemia in adults: prevalence of skeletal radiographic 764 and scintigraphic features. Econs MJ, Samsa GP, Monger M et al (1994) X-linked hy- dent rickets Type II, resistance of target organs to 1,25-dihy- pophosphatemic rickets: a disease often unknown to affected droxyvitamin D. McCance RA (1947) Osteomalacia with Looser’s nodes Radiol Clin North Am 29:97-118 (Milkman’s syndrome) due to raised resistance to vitamin D 40.