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Co-Director, Marian University College of Osteopathic Medicine

Median Umbilical Ligament or Fold Is a fibrous cord, the remnant of the obliterated urachus, which forms a median umbili- cal fold of the peritoneum. Lies between the transversalis fascia and the peritoneum and extends from the apex of the bladder to the umbilicus. Is a fibrous cord, the remnant of the obliterated umbilical artery, which forms a medial umbilical fold and extends from the side of the bladder to the umbilicus. Is a fold of the peritoneum that covers inferior epigastric vessels and extends from the medial side of the deep inguinal ring to the arcuate line. Transversalis Fascia Is the lining fascia of the entire abdominopelvic cavity between the parietal peritoneum and the inner surface of the abdominal muscles. Continues with the diaphragmatic, psoas, iliac, pelvic, and quadratus lumborum fasciae. Forms the deep inguinal ring and gives rise to the femoral sheath and the internal spermatic fascia. Subcostal Nerve Is the ventral ramus of the 12th thoracic nerve and innervates the muscles of the anterior abdominal wall. Iliohypogastric Nerve Arises from the first lumbar nerve and innervates the internal oblique and transverse mus cles of the abdomen. Divides into a lateral cutaneous branch to supply the skin of the lateral side of the buttocks and an anterior cutaneous branch to supply the skin above the pubis. Ilioinguinal Nerve Arises from the first lumbar nerve, pierces the internal oblique muscle near the deep inguinal ring, and accompanies the spermatic cord through the inguinal canal and then through the superficial inguinal ring. Gives rise to a femoral branch, which innervates the upper and medial parts of the anterior thigh, and the anterior scrotal nerve, which innervates the skin of the root of the penis (or the skin of the mons pubis) and the anterior part of the scrotum (or the labium majus). Cremasteric reflex is a drawing up of the testis by contraction of the cremaster muscle when the skin on the upper medial side of the thigh is stroked. The efferent limb of the reflex arc is the genital branch of the genitofemoral nerve; the afferent limb is a femoral branch of the genitofemoral nerve and also of the ilioinguinal nerve. Receive lymph from the lower abdominal wall, buttocks, penis, scrotum, labium majus, and the lower parts of the vagina and anal canal. Their efferent vessels primarily enter the external iliac nodes and, ultimately, the lumbar (aortic) nodes. Superior Epigastric Artery Arises from the internal thoracic artery, enters the rectus sheath, and descends on the pos terior surface of the rectus abdominis. Inferior Epigastric Artery Arises from the external iliac artery above the inguinal ligament, enters the rectus sheath, and ascends between the rectus abdominis and the posterior layer of the rectus sheath. Deep Circumflex Iliac Artery Arises from the external iliac artery and runs laterally along the inguinal ligament and the iliac crest between the transverse and internal oblique muscles. Superficial Epigastric Arteries Arise from the femoral artery and run superiorly toward the umbilicus over the inguinal ligament. Superficial Circumflex Iliac Artery Arises from the femoral artery and runs laterally upward, parallel to the inguinal ligament. Anastomoses with the deep circumflex iliac and lateral femoral circumflex arteries. Superficial (External) Pudendal Arteries Arise from the femoral artery, pierce the cribriform fascia, and run medially to supply the skin above the pubis. Thoracoepigastric Veins Are longitudinal venous connections between the lateral thoracic vein and the superficial epigastric vein. Provide a collateral route for venous return if a caval or portal obstruction occurs. Parietal Peritoneum Lines the abdominal and pelvic walls and the inferior surface of the diaphragm. Is innervated by somatic nerves such as the phrenic, lower intercostal, subcostal, iliohypogastric, and ilioinguinal nerves. Visceral Peritoneum Covers the viscera, is innervated by visceral nerves, and is insensitive to pain. Omentum Is a fold of peritoneum extending from the stomach to adjacent abdominal organs. Lesser Omentum Is a double layer of peritoneum extending from the porta hepatis of the liver to the lesser curvature of the stomach and the beginning of the duodenum. Sigmoid mesocolon Consists of the hepatogastric and hepatoduodenal ligaments and forms the anterior wall of the lesser sac of the peritoneal cavity. Transmits the left and right gastric vessels, which run between its two layers along the lesser curvature.

For a polyenergetic photon beam, equation 2 becomes an integral over the full photon spectrum. As the photon energy increases, the maximum energy of the secondary electrons increases, the concept of a localized energy transfer begins to break down and kerma is therefore generally limited to photon energies below 3 MeV. Absorbed Dose the absorbed dose is defined as the mean energy imparted (absorbed) per unit mass. It is a nonstochastic quantity in that one is not measuring single events-the interaction between an incident photon or electron and a molecule- but the mean energy arising through the interaction of the radiation field with the material it passes through. As the mass of a sample decreases the energy per unit mass will become more random (stochastic). Whereas kerma is only defined for neutral particles, absorbed dose applies both to photon and electron beams. Reference 2 applies this definition of absorbed dose in the situation where there is a small volume of the medium, which is thermally isolated from the remainder: Di ј dE dEh dEs ј ю dm dm dm (3) where Di is the mean absorbed dose in the absorber of material i, and mass dm; dE is the mean energy imparted to the absorber by the radiation beam (photons or electrons); dEh is the energy appearing as heat; and dEs is the energy absorbed by chemical reactions (which may be positive or negative). The left-hand relation is independent of the measurement technique while the right-hand relation represents one of the most common methods for determining dose: the measurement of heat. If a state of charged particle equilibrium exists (and assuming no energy losses due to bremsstrahlung) then the absorbed dose will be equal to the kerma (conservation of energy). Air kerma can only be measured using an air-filled ionization chamber but absorbed dose can be determined in a variety of ways. The absolute measurement of absorbed dose has a number of problems (some fundamental, others practical) that limit the accuracy of the result and put constraints on the experimental techniques that can be used. The definition of absorbed is in terms of the energy absorbed in an amount of material. Radiotherapy dose levels are typically < 10 Gy (10 JБkgА1), which represents a very small energy deposition. If one is trying to determine this energy absolutely by measuring the radiation-induced temperature rise (of the order of a few mK) there is a significant challenge in achieving uncertainties < 0. However, since radiation interactions are very material dependent a homogeneous phantom is the chosen medium for reference dosimetry. This immediately presents a problem in that any measuring instrument will perturb the phantom and affect the measurement one wishes to make. For radiotherapy dosimetry, one is not interested in the average dose to the whole phantom (although mean dose or integral dose is required for radiation protection, when considering lifetime dose to organs, etc. Radiotherapy treatments using photon and electron beams produce significant dose variations within a phantom; otherwise, healthy tissue could not be spared. It is therefore important to be able to measure these dose variations, which by implication requires a small detector. Care is required in designing a detector that samples the dose at a point and does not give some unwanted averaging. The experimental geometry is therefore very important and care must be taken in designing experiments, especially when comparing or calibrating dosimeters, so that scattered radiation is properly taken into account. Absorbed dose is also related to the photon energy fluence at a point in a medium irradiated by a photon beam under conditions of transient charged particle equilibrium by m D ј C en b (5) r where b is the ratio of absorbed dose to collision kerma at a point. As written, equation 5 is valid for a monoenergetic photon beam; for a realistic (broad) photon spectrum, the mass­energy absorption coefficient must be averaged over the photon fluence. Under the restrictive conditions that (1) radiative photons escape the volume of interest and (2) secondary electrons are absorbed on the spot (or there is charged-particle equilibrium of secondary electrons), the absorbed dose to medium is given by the electron fluence multiplied by the collisional stopping power. Dose Equivalent this quantity is useful where the effect produced by the same absorbed dose is dependent on the particle type ``delivering' the dose. A radiation quality factor, w is therefore introduced to take account of this and the dose equivalent is defined as the absorbed dose multiplied by this quality factor. One of the biggest practical constraints is that in the measurement of absorbed dose one is not determining some fundamental constant or characteristic of a material. The dose is the effect of a particular radiation field at a point in a particular material and it is therefore not possible to optimise all aspects of a measurement. There are many ``influence quantities' (material, energy spectrum, geometry) so that what may appear to be minor variations from the real measurement problem (dose to a tumor) can result in significant errors being introduced. Ionometry An ionization chamber measures the ionization produced by the incident radiation beam in a mass of air.

To best determine the load at which your client should be working (either starting from or progressing to), please refer to Chapter 15. The concept of progression may also include the practice of using very modest weights during the initial sessions of an exercise program. Guidelines for the progression of exercise become a factor in the success of individuals who are beginning exercise programs or who are engaging in specific types of exercise programs. Goal-setting is an essential preliminary step when designing an effective training program. An Goal-setting is an essential preliminary step when acronym that can be used to define and quantify designing an effective training program. The three primary resistance training goals are hypertrophy, muscular strength, and muscular endurance. Explaining the specifics of each of these three primary resistance training goals to the client will not only educate them but also help establish strong client­trainer rapport. For example, a client who states that he wants to look more "cut" or "wants bigger biceps" is referring to the aesthetic look of the enlarged muscle groups. Physiologically, hypertrophy occurs when there is an increase in size of the existing muscle fibers. Chapter 6 in this text explores the physiology of hypertrophy of the muscle fibers. A client who states that he or she "wants more stamina" or wants to feel "less winded" after a workout is typically looking for a resistance program that will increase his or her muscular endurance. Note: these recommendations are consistent with the United States Department of Health & Human Services Physical Activity Guidelines for Americans, available at. A common example is what the muscles do during an aerobic workout: the lower body muscles contract and relax thousands of times during a 20-minute run (8). Typically, these are athletes who are looking to improve their performance and are already familiar with resistance-based training programs. However, a client who is just starting out should start with a program that emphasizes hypertrophy or a muscle endurance training program first to acclimate his or her body to this type of training. Cardiovascular Training Cardiovascular training is often referred to as aerobic endurance training or cardiovascular exercise or even more commonly as "cardio" or "aerobics. This aerobic endurance training or cardiovascular exercise mode of training is an integral part of any exercise or even more commonly as "cardio" or "aerobics. Commonly, the goal of many people who begin or continue a cardiovascular program is to "burn fat". As with a resistance training program, the same principle of specificity applies to designing a cardiovascular exercise program. Therefore, the results of a cardiovascular-based program will be more specific to aerobic-based training. In other words, resistance training will not significantly improve maximal aerobic power (10,12). In addition, training that involves one mode of aerobic exercise will not necessarily improve a different mode. For example, a client who has a high level of aerobic endurance as a runner may not be able to achieve that same level of endurance as a cyclist. The muscle activation patterns and oxygen requirement vary greatly among different modes of exercise. As with all types of training programs, cardiovascular training programs are composed of different components. These components are meant to be manipulated in a variety of ways to ultimately produce the desired outcome. These components include the mode of exercise, intensity of exercise, frequency of exercise sessions, and duration of each session. Cardiovascular exercise modes consist of machine- and non­machine-based exercises such as swimming, jump rope, jumping jacks. There are several factors that need to be considered when choosing the mode of cardiovascular exercise for the client. Some of the more popular modes of machine-based cardiovascular exercises include stair stepper, treadmills, rowers, step mills, cycle ergometers, and elliptical trainers. If the Personal Trainer is in a facility that does not have access to equipment, activities such as walking, jogging, running, boxing, swimming, and jumping rope that encompass non­machine-based cardiovascular exercise modes can be utilized.

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