CoverModule 1.0. Homeostasis, Membranes, Electrophysiology and ANS (Essay Questions)1.1. Homeostasis1.1.1. Homeostasis Defined1.1.2. Homeostatic Control Systems1.1.3. Feedback Response Loop1.2. Cell Transport; Water & Solutes1.2.1. Fluid Compartments1.2.2. Osmosis1.2.3. Diffusion of Solutes1.2.4. Active Transport1.2.5. Bulk Transport1.3. Electrophysiology1.3.1. Ions and Cell Membranes1.3.2. Membrane Potentials1.3.3. Graded Potential1.3.4. Action Potentials1.3.5. Refractory Periods1.3.6. Propagation of an Action Potential1.4. THE SYNAPSE1.5. THE AUTONOMIC NERVOUS SYSTEM1.5.1. Organization of the Nervous System1.5.2. Structural Organization of the ANS1.5.3. The SNS and the PNS1.5.4. The Enteric Nervous System1.5.5. Physiology of the ANS1.5.6. Neurotransmitters of the ANS1.5.7. Receptors of the ANS1.5.8. Actions of the Autonomic Nervous System1.5.9. Table of Actions for the SNS and PNS and Some Common DrugsModule 2.0. Skeletal Muscle and Special Senses2.1. Structural Organization of Skeletal Muscle2.2.1. Neuromuscular Junction, Excitation-Contraction Coupling2.2.2. Muscle Contractures and Cramps2.3. Whole Muscle Contraction, Fiber Type, Fatigue and Muscle Pharmacology2.3.1. Motor Units2.3.2. Factors that Influence the Force of Contraction2.3.3. Energy Source for Muscle Contraction2.3.4. Skeletal Muscle Fiber Types2.3.5. Fatigue2.3.6. Muscle Pharmacology2.4. Smooth Muscle2.4.1. Smooth Muscle Contraction2.5. Control of Body Movement2.5.1. Voluntary Control of Muscle2.5.2. Reflexes2.6. Taste and Smell2.6.1. Taste2.6.2. The Sense of Smell2.7. Vision2.7.1. Structure of the Eye2.7.2. Focusing Light on the Retina2.7.3. Converting Light to Action Potentials2.7.4. The Retina2.7.5. Phototransduction2.7.6. Receptive Fields2.8. Hearing and Equilibrium2.8.1. The Nature of Sound2.8.2. The Hearing Apparatus2.8.3. Sound Vibrations to Action Potentials2.8.4. The Sense of Balance and EquilibriumModule 3.0. Cardiovascular System3.1. Structure of the Heart3.1.1. Chambers and Circulation3.2. Cardiac Cell Action Potentials3.2.1. Action Potentials in Cardiac Muscle Cells3.2.2. Action Potentials in Cardiac Autorhythmic cells3.2.3. Cellular Mechanisms of Inotropy and Chronotropy3.3. Electrophysiology of Heart Muscle3.3.1. Heart Conduction System3.3.2. Electrocardiogram (ECG)3.3.3. Abnormal ECG - Current of Injury3.4. The Cardiac Cycle3.4.1. Cardiac cycle3.4.2. Cardiac Measurements and Pressure Volume Loops3.5. Blood vessels and Blood Pressure3.5.1. Arteries and Veins3.5.2. Capillaries3.5.3. Blood Pressure Regulation and Shock3.5.4. Capillary Exchange3.5.5. Myogenic and Paracrine Regulation of Vasoconstriction and Vasodilation3.6. Blood3.6.1. Composition of Blood3.6.2. Hematopoeisis3.6.3. Breaking Down Red Blood Cells3.6.4. HemostasisModule 4.0. Urinary and Respiratory Systems4.1. Function and Structure of the Kidney4.1.1. Urinary System Function4.1.2. Functional Anatomy of the Urinary System4.1.3. The Nephron: Functional Unit of the Kidney4.1.4. The Renal Corpuscle: Bowman's Capsule4.2. Physiology of Urine Production4.2.1. Filtration4.2.2. Renal Clearance4.2.3. Tubular Reabsorption4.2.4. Urine Concentration and Dilution4.2.5. Hormonal Regulation of Urine Production4.3. Acid/Base Balance4.3.1. Buffers4.3.2. Acid/Base Disturbances4.4. The Respiratory System4.4.1. Respiratory System Structure and Function4.4.2. Respiratory Membrane4.4.3. Respiratory pressures and Inspriation/Expiration4.4.4. Alveoli and Surfactant4.4.5. Pneumothorax4.5. Gas Exchange and Transport4.5.1. Gas Laws4.5.2. Partial Pressure Gradients in the Lung4.5.3. Alveolar Gas Equation4.5.4. Oxygen and Carbon Dioxide Transport in the Blood4.5.5. Alveolar Ventilation4.5.6. Ventilation/Perfusion Ratio4.6. Chronic Bronchitis and Emphysema4.6.1. Respiratory Control by the Medulla Oblongata4.6.2. Chemicals that Regulate VentilationModule 5.0. Digestive, Endocrine and Reproductive Systems5.1. Functional Anatomy of the Digestive System5.1.1. Layers of the Digestive Tract5.1.2. Enteric Nervous System5.1.3. Organs of the Digestive System5.2. Digestion5.2.1. Carbohydrates5.2.2. Proteins5.2.3. Lipids5.2.4. Lipoproteins5.3. Regulation of Digestive Secretions5.4. Endocrine System5.4.1. Overview of the Endocrine System5.4.2. Hormone Receptors5.4.3. Hormones of the Body5.4.4. Other Hormones: Melatonin and Pheromones5.5. The Hypothalamus and Pituitary Gland5.5.1. Structure and Function of the Hypothalamus and Pituitary Gland5.5.2. The Posterior Pituitary5.5.3. The Anterior Pituitary5.5.4. Growth Hormone5.5.5. Prolactin5.5.6. Thyroid Hormones5.5.7. Adrenal Hormones5.6. Pancreas5.6.1. Insulin and Glucagon5.6.2. Diabetes Mellitus5.7. Reproductive System Anatomy5.7.1. Female Reproductive Anatomy5.7.2. Male Reproductive Anatomy5.7.3. Sexual Development at Puberty5.7.4. Male Reproductive Endocrine Axis5.7.5. Spermatogenesis5.7.6. Female Reproductive System: Oogenesis5.7.7. Ovulation and Fertilization5.7.8. The Ovarian Cycle5.7.9. The Uterine Cycle5.7.10. PregnancyAppendix A. GenderAppendix B. The Placebo EffectB.2.1. The Placebo EffectB.2.2. Examples of the Placebo EffectB.2.3. How do Placebos Work?B.2.4. Are Placebos Ethical?B.2.5. How do we validate actual effectiveness of placebosB.2.6. Tips for evaluating scientific evidenceB.2.7. What about Faith Healings
Appendix A

Gender

How do we reconcile current conflicts between biological sex and gender as they pertain to the Plan of Salvation?

Biological sex refers to a person’s biological status as assigned at birth and is categorized as male or female. There are a number of indicators that can be used to assign biological sex, including sex chromosomes, gonads, internal reproductive organs, and external genitalia. Gender refers to the attitudes, feelings, and behaviors that a given culture associates with a person’s biological sex. Gender identity is the personal inner manifestation of those attitudes, feelings, and behaviors. Gender expression is the outward expression of one’s gender identity.

Sometimes, a person’s biological sex and gender identity conflict. As an extreme example, consider psueodohermaphroditism (<1%). These men are born with XY chromosomes (a male biological indicator), but because of deficiencies in one of the male hormones they are born with external genitalia that appear feminine. Thus, they are raised female, but at puberty they begin to secrete male hormones in greater abundance and develop the characteristics of men. As can be imagined a major conflict occurs: Should these individuals change gender or remain female? As a side note, most choose to change and continue life as men. What about less extreme cases where individuals simply “feel” that their biological sex and gender identity do not match? For example, recent research suggests that humans can be born with the biological indicators of a male but who have a brain that is structurally and functionally female, or vice versa (biological female with male brain; Ai-Min Bao and Dick F. Swaab, 2011. Frontiers in Neuroendocriniology). Sexual differentiation of the human brain: relation to gender identity, sexual orientation and neuropsychiatic disorders). Sometimes individuals can even have both male and female reproductive organs, and the gender identity isn’t really known until later in life. In these cases, the parents must choose a gender identity to raise the child. A major question arises then as to whether or not this discrepancy between the traditional biological indicators of sex and the gender identity of the brain is the result of “broken biology” (something gone wrong) or “natural biology” (natural course of biological progression). In other words, is a person with a male body and female brain someone with a disorder or simply someone with another normal variation in gender identity, (a female who happens to have a penis, for example)? Or should we consider the person to be altogether another gender identity that is neither male nor female (binary)? Biological science would suggest that the discrepancy is the result of “broken biology” because statistically, there is an overwhelming amount of evidence (>97%) supporting the “male biology to male gender identity role”.

However, from a social scientific view, because anomalies have been shown to occur in biology, the argument is that discrepancies are occurring because gender identity is a misguided societal construct handed down through the generations. In other words, the only reason a person with a male body and female brain feels any conflict is because of the cultural constraints put on him/her. To the credit of this argument history has proven the devastating effect of using a wrong social construct. As an example, consider the devastating effects toward blacks prior to the civil rights movement. The behavior was the direct result of an incorrect and misguided social construct. In the case of the civil rights movement being able to change the social construct proved essential.

However, what if society puts pressure on changing a social construct in the wrong direction? Consider California’s landmark 1969 no-fault divorce legislation. Society argued that divorce should not be based solely on traditional fault grounds such as adultery, cruelty and desertion, but instead should be viewed as incompatible and irreconcilable differences. Yet, this no-fault divorce ruling has quickly developed some very serious shortcomings. In addition to soaring divorce rates in the 1970’s, courts have failed to provide adequate financial protection to many women and children affected by the divorce. Not to mention the long-lasting psychological and economic damage of divorce. Many commentators are now even concluding that the no-fault divorce revolution has failed. As an added side note, many groups are deciding to discontinue performing sex change operations because they discovered they were not giving patients the hoped for benefit. Additionally, research suggests that the vast majority of children who experience a conflicted sense of gender identity grow out of it.  Findings such as these make the question even more difficult.

The serious question then is whether or not the current societal definition of gender identity is correct as defined or incorrect and needs revision. These questions take time and should take time. In fact, the United States governmental constitution is set up in such a way as to make the process painfully slow and tedious, for this very reason.

Fortunately, we have been given through revealed religion an eternal and unchanging definition of gender identity. According to the document “The Family: A Proclamation to the World” (1995); all human beings—male and female—are created in the image of God. Each is a beloved spirit son or daughter of heavenly parents, and, as such, each has a divine nature and destiny. Gender is an essential characteristic of individual premortal, mortal, and eternal identity and purpose. Additionally, recently the church clarfied the statement as follows: "The intended meaning of gender is biological sex at birth."

From this statement we learn that gender existed in the premortal realm. From President Spencer W. Kimball (April 1977 General Conference, “Our Great Potential), we learn that God took intelligences and gave to them spirit bodies. Joseph Smith received and published a revelation where the Lord taught that “intelligence, or the light of truth, was not created or made, neither indeed can be” (D&C 93:29). These statements suggest that at some point in the distant past, our intelligence became associated with a spirit body.  When Abraham was shown a vision of the premortal spirit family, he referred to many individual spirits as “intelligences that were organized” (Abraham 3: 22-23). The use of the word organized implies a distinguishing characteristic between intelligence, the unembodied existence with no beginning or end, with that of an organized intelligence or spirit. This could also be interpreted to read that intelligences and spirits are synonymous, and that the organization was in terms of hierarchy in heaven (first-born, son of morning, etc.). Perhaps we were organized into families, wards, and stakes? Speculation aside, we do know that spirit “sons and daughters” were eventually sent to earth to take upon themselves an additional organization, that of a physical body. What if, as intelligences, we were given the opportunity to choose to fulfill divine roles as spirit sons or daughters? Perhaps we selected a gender identity role in the pre-mortal realm to work towards that would allow us to fulfill our divine destiny. This gender identity would not have been defined by a mortal body but rather by gender identity roles and expectations that would prepare us for gender identity of mortality. Regardless of whether our gender was created, assigned or allowed as choice, the gender assignment is essential in fulfilling Gods plan for us.

It is also possible that gender identity is a characteristic that is developed by degrees in each sphere (ie., pre-mortality, mortality, post-mortality). By acting and being obedient to our unique gender role in each sphere, we further our progress towards returning to Heavenly Father. A logical conclusion might look something like this: Heavenly Father’s only objective is to bring to pass the immortality and eternal life of man (Moses 1:39). Thus, each component of the plan must be designed to accomplish this objective. This plan included gender as an essential component of individual premortal, mortal and eternal identity and purpose. Thus, gender roles as defined in premortal, mortal, and post-mortal existences are part of the plan, and if they are part of the plan they must be necessary. Therefore, by deductive logic, since gender is part of our premortal, mortal and post-mortal existences, it must be necessary to bring to pass the immortality and eternal life of man. Just as other aspects (gender neutral) of our existence must fill the measure of their creation (e.g., learning to care for our bodies, losing ourselves in the service of others, repenting and becoming clean from impurities), perhaps we must also fill the measure of our gender (gender specific), and develop in each sphere (pre-mortal, mortal, post-mortal) our gender until it becomes perfected.

So how does one fill the measure of his or her gender assignment? We first must elucidate the gender expectations. Defining the gender expectation in the pre-mortal realm may not be completely possible, but we know that we were given instructions and training in preparation to obtain a mortal body.  These instructions and training include a plan that would allow us to obtain a physical body, gain experience necessary to progress toward perfection, ultimately realizing our divine destiny. An essential component of the plan was family relationships. Therefore, the teachings and instructions, with regard to gender, must have included familial relationships. An integral part of the family is the ability to bring forth children, thus requiring male and female sexes.

We learn that “marriage between a man and a woman is ordained of God and that the family is central to the Creator’s plan for the eternal destiny of His children” (The Family: A Proclamation to the World). By this definition, marriage can only be fulfilled through a man and a woman. “The first commandment that God gave to Adam and Eve pertained to their potential for parenthood as husband and wife. We declare that God’s commandment for His children to multiply and replenish the earth remains in force. We further declare that God has commanded that the sacred powers of procreation are to be employed only between man and woman, lawfully wedded as husband and wife” (The Family: A Proclamation to the World).

The proclamation further states: We declare the means by which mortal life is created to be divinely appointed. We affirm the sanctity of life and of its importance in God’s eternal plan.

Thus, the attitudes, feelings and behaviors of gender, as they relate to biological sex, need to fall within the parameters that God has established. Two major parameters are as follows:

  1. Marriage is defined between a man and woman
  2. The sacred powers of procreation are to be employed only between man and woman, lawfully wedded as husband and wife

Other parameters include:

  1. Fathers are to preside over their families in love and righteousness and are responsible to provide the necessities of life and protection for their families.
  2. Mothers are primarily responsible for the nurture of their children.
  3. Fathers and mothers are obligated to help one another as equal partners.

Thus, it appears that the primary gender expectations focus on producing and raising posterity. Since these expectations for gender can be established firmly using doctrinal principles, how do we reconcile the observations that in some cases, biological sex, especially as it pertains to brain development and external genitalia, is in direct contradiction to gender identity, preventing fulfillment of these expectations?

Based on arguments established that gender is assigned before birth; any contradiction with biological sex would simply mean that something has gone wrong with the biology.  So are conflicted individuals obligated to follow their brain or their genitalia? Which, the brain or the genitalia, is the best indicator of the gender assigned before birth?

Church leaders have actually addressed this very question in the handbook for priesthood leaders.  In the handbook individuals are obligated to adhere to their genitalia if they want a temple marriage. This would mean that if you were born biologically a male (based on biological male indicators) you could only marry a biological female and vice versa. Or, you may choose to not marry and still be within the doctrinal parameters as long as you honor the law of chastity. If these individuals decide to follow their brain and change their genitalia (transsexual operation) they can be baptized and receive the Holy Ghost, a gender neutral ordinance, but will not be permitted to hold the priesthood (where applies) or marry in the temple, as these are gender specific ordinances. Thus, we can deduce that when biological anomalies make it difficult to know for sure the gender, and medical action has been taken after accountability, the church policy is to hold off on gender specific ordinances. The scriptures and teachings of LDS doctrine affirm that God loves all of His children and makes salvation available to all. God created the many diverse races and ethnicities and esteems them all equally. As the Book of Mormon puts it, “all are alike unto God.” (2Nephi 26:33). Thus, only God can give instruction as to whom to restrict ordinances to. Because God esteems all equally, the temporary restrictions will not jeopardize their salvation.

However, as mortals we have no right to judge what went wrong. We simply must encourage adherence to the law of chastity and support for the definition of marriage. Even though biologically, marriage may not be attainable for some, the doctrine of the principle of marriage and families is eternal. 

Consider these thoughts from D. Todd Christoffersen: To those who believe anything or everything could be true, the declaration of objective, fixed, and universal truth feels like coercion— I shouldn’t be forced to believe something is true that I don’t like. But that does not change reality. Resenting the law of gravity won’t keep a person from falling if he steps off a cliff. The same is true for eternal law and justice. Freedom comes not from resisting it but from applying it. That is fundamental to God’s own power. If it were not for the reality of fixed and immutable truths, the gift of agency would be meaningless since we would never be able to foresee and intend the consequences of our actions. As Lehi expressed it: If ye shall say there is no law, ye shall also say there is no sin. If ye shall say there is no sin, ye shall also say there is no righteousness. And if there be no righteousness there be no happiness. And if there be no righteousness nor happiness there be no punishment nor misery. And if these things are not there is no God. And if there is no God we are not, neither the earth; for there could have been no creation of things, neither to act nor to be acted upon; wherefore, all things must have vanished away.”

For further thought on the subject, consider this closing parable by Boyd K Packer (For Time and All Eternity, 1993) regarding the unique roles of gender as it pertains to man and woman.

Once a man received as his inheritance two keys. The first key, he was told, would open a vault which he must protect at all cost. The second key was to a safe within the vault which contained a priceless treasure. He was to open this safe and freely use the precious things which were stored therein. He was warned that many would seek to rob him of his inheritance. He was promised that if he used the treasure worthily, it would be replenished and never be diminished, not in all eternity. He would be tested. If he used it to benefit others, his own blessings and joy would increase.

The man went alone to the vault. His first key opened the door. He tried to unlock the treasure with the other key, but he could not, for there were two locks on the safe. His key alone would not open it. No matter how he tried, he could not open it. He was puzzled. He had been given the keys. He knew the treasure was rightfully his. He had obeyed instructions, but he could not open the safe.

In due time, there came a woman into the vault. She, too, held a key. It was noticeably different from the key he held. Her key fit the other lock. It humbled him to learn that he could not obtain his rightful inheritance without her.

They made a covenant that together they would open the treasure and, as instructed, he would watch over the vault and protect it; she would watch over the treasure. She was not concerned that, as guardian of the vault, he held two keys, for his full purpose was to see that she was safe as she watched over that which was most precious to them both. Together they opened the safe and partook of their inheritance. They rejoiced for, as promised, it replenished itself.

With great joy they found that they could pass the treasure on to their children; each could receive a full measure, undiminished to the last generation. Perhaps some few of their posterity would not find a companion who possessed the complementary key, or one worthy and willing to keep the covenants relating to the treasure. Nevertheless, if they kept the commandments, they would not be denied even the smallest blessing.

Because some tempted them to misuse their treasure, they were careful to teach their children about keys and covenants. There came, in due time, among their posterity some few who were deceived or jealous or selfish because one was given two keys and another only one. “Why,” the selfish ones reasoned, “cannot the treasure be mine alone to use as I desire?”

Some tried to reshape the key they had been given to resemble the other key. Perhaps, they thought, it would then fit both locks. And so it was that the safe was closed to them. Their reshaped keys were useless, and their inheritance was lost. Those who received the treasure with gratitude and obeyed the laws concerning it knew joy without bounds through time and all eternity.

In addition, consider these quotes. Neil Anderson (April 2016), “While a child’s earthly situation may not be ideal, a child’s spiritual DNA is perfect because one’s true identity is as a son or daughter of God.” D. Todd Christofferson; “Fatherhood is much more than a social construct or the product of evolution. The role of father is of divine origin."

Elder Oaks taught: “Be careful how you characterize yourself. Don’t characterize or define yourself by some temporary quality. The only single quality that should characterize us is that we are a son or daughter of God. That fact transcends all other characteristics, including race, occupation, physical characteristics, honors, or even religious affiliation. We have our agency, and we can choose any characteristic to define us. But we need to know that when we choose to define ourselves or to present ourselves by some characteristic that is temporary or trivial in eternal terms, we de-emphasize what is most important about us, and we overemphasize what is relatively unimportant. This can lead us down the wrong path and hinder our eternal progress” (BYU-devotional address, 2006)

From President Hinckley (1st Presidency: 1990, A city on a hill)

Unless the world alters the course of its present trends (and that is not likely); and if, on the other hand, we continue to follow the teachings of the prophets, we shall increasingly become a peculiar and distinctive people of whom the world will take note. For instance, as the integrity of the family crumbles under worldly pressures, our position on the sanctity of the family will become more obvious and even more peculiar in contrast, if we have the faith to maintain that position.

As the growing permissive attitude toward sex continues to spread, the doctrine of the Church, as consistently taught for more than a century and a half, will become increasingly singular and even strange to many.

As the consumption of alcohol and the abuse of drugs increase each year within the mores of our society, our position, set forth by the Lord more than a century and a half ago, will become more unusual before the world.

As government increasingly assumes the burden of caring for all human needs, the independence of our social services and the doctrine which lies behind that position will become more and more important.

As the Sabbath increasingly becomes a day of merchandising and entertainment, those who obey the precept of the law, written by the finger of the Lord on Sinai and reinforced by modern revelation, will appear more unusual.

It is not always easy to live in the world and not be a part of it. We cannot live entirely with our own or unto ourselves, nor would we wish to. We must mingle with others. In so doing, we can be gracious. We can be inoffensive. We can avoid any spirit or attitude of self-righteousness. But we can maintain our standards. The natural tendency will be otherwise, and many have succumbed to it.

In 1856, when the Latter-day Saints were largely alone in the Western valleys, some people thought we were safe from the ways of the world. To such talk, President Heber C. Kimball of the First Presidency responded: “I want to say to you, my brethren, the time is coming when we will be mixed up in these now peaceful valleys to that extent that it will be difficult to tell the face of a Saint from the face of an enemy to the people of God. Then, brethren,” he went on, “look out for the great sieve, for there will be a great sifting time, and many will fall; for I say unto you there is a test, a Test, a TEST coming, and who will be able to stand?” (Orson F. Whitney, Life of Heber C. Kimball, Salt Lake City: Bookcraft, 1945, p. 446.)

 I do not know precisely the nature of that test. But I am inclined to think the time is here and that the test lies in our capacity to live the gospel rather than adopt the ways of the world.

I do not advocate a retreat from society. On the contrary, we have a responsibility and a challenge to take our places in the world of business, science, government, medicine, education, and every other worthwhile and constructive vocation. We have an obligation to train our hands and minds to excel in the work of the world for the blessing of all mankind. In so doing we must work with others. But this does not require a surrender of standards.

In conclusion, it is unlikely that our current political entities will accept the doctrine of gender as set forth in “The Family: A Proclamation to the World” as a defining factor in determining gender social constructs. As a result, we can expect that the current societal construct of gender to slowly dissolve away. Consider the decision in Oregon (June 2016) to add a new gender identity category, that of non-binary (neither male nor female). The only argument that we will be left with is the same argument that is the foundation of the Church of Jesus Christ of Latter Day Saints. The argument referred to is the existence of prophets and their ability to receive revelation from God!  Perhaps the purpose of the gender line in the proclamation is meant to ensure that those of us with clear gender identity fulfill our gender roles rather than to condemn those without a clear understanding of their gender identity.

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