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  <head>
    <title>001-01 Foundations</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Homeostasis and physiological foundations">
      <outline text="Regulated stability">
        <outline text="Cells need a stable surrounding environment"/>
        <outline text="Homeostasis is dynamic, not fixed">
          <outline text="Variables fluctuate around useful ranges"/>
        </outline>
        <outline text="Receptor, control centre, effector"/>
        <outline text="Negative feedback opposes the disturbance">
          <outline text="Rising temperature increases heat loss"/>
          <outline text="Rising glucose: insulin promotes uptake and storage"/>
          <outline text="Dominant pattern because it stabilises"/>
        </outline>
        <outline text="Positive feedback amplifies to an endpoint">
          <outline text="Cervical stretch, oxytocin, stronger contraction"/>
          <outline text="Amplifying steps in blood clotting"/>
          <outline text="Needs a stopping condition"/>
        </outline>
      </outline>
      <outline text="Membrane transport">
        <outline text="Bilayer separates intracellular and extracellular fluid">
          <outline text="Oxygen and carbon dioxide cross the lipid region"/>
          <outline text="Ions and polar molecules need proteins"/>
        </outline>
        <outline text="Diffusion and facilitated diffusion follow gradients">
          <outline text="No direct cellular energy required"/>
        </outline>
        <outline text="Osmosis toward more non-penetrating solute"/>
        <outline text="Tonicity predicts long-term cell volume">
          <outline text="Hypotonic: cell swells; hypertonic: cell shrinks"/>
        </outline>
        <outline text="Active transport moves against the gradient">
          <outline text="Sodium-potassium pump: 3 sodium out, 2 potassium in"/>
          <outline text="Gradients support voltage, volume, signalling"/>
        </outline>
        <outline text="Endocytosis and exocytosis move larger material"/>
      </outline>
      <outline text="Compartments and concentration">
        <outline text="Plasma and interstitial fluid form extracellular fluid"/>
        <outline text="Capillary walls and cell membranes as barriers">
          <outline text="Plasma proteins more restricted than water"/>
        </outline>
        <outline text="Sodium outside, potassium inside">
          <outline text="Maintained dynamically, not by a sealed wall"/>
        </outline>
        <outline text="Concentration is amount divided by volume">
          <outline text="Water loss concentrates, water gain dilutes"/>
          <outline text="Cannot reveal compartment size or total content"/>
        </outline>
      </outline>
      <outline text="Tissues as functional systems">
        <outline text="Epithelium covers, lines, forms glands">
          <outline text="Tight packing and junctions make barriers"/>
        </outline>
        <outline text="Connective tissue supports, binds, stores, transports">
          <outline text="Cells separated by extracellular matrix"/>
          <outline text="Bone, cartilage, fat, tendon, blood"/>
        </outline>
        <outline text="Muscle converts chemical energy into force">
          <outline text="Skeletal, cardiac, smooth roles differ"/>
        </outline>
        <outline text="Nervous tissue detects, processes, communicates">
          <outline text="Neurons signal, glia support and insulate"/>
        </outline>
      </outline>
      <outline text="Integration across levels">
        <outline text="Cells, tissues, organs, organ systems cooperate"/>
        <outline text="Failure at one level propagates">
          <outline text="Low oxygen delivery limits respiration"/>
          <outline text="Less ATP weakens transport and ion gradients"/>
          <outline text="Eventually organ function is impaired"/>
        </outline>
      </outline>
      <outline text="Cellular energy and protein traffic">
        <outline text="Glycolysis in cytosol yields pyruvate and little ATP"/>
        <outline text="Citric acid cycle feeds the electron transport chain">
          <outline text="Proton gradient drives ATP synthase"/>
          <outline text="Oxygen is the final electron acceptor"/>
        </outline>
        <outline text="Oxygen deprivation hits excitable tissue fast">
          <outline text="Pumps fail, voltage and calcium destabilise"/>
        </outline>
        <outline text="Rough ER, Golgi, then sorting to destination"/>
        <outline text="Lysosomes digest, peroxisomes oxidise fatty acids"/>
        <outline text="Cytoskeleton shapes, transports, separates chromosomes"/>
        <outline text="Protein function controlled at many levels">
          <outline text="Fast modification or slow gene expression"/>
        </outline>
      </outline>
      <outline text="Cell communication and adaptation">
        <outline text="Contact, local, synaptic, hormonal signals"/>
        <outline text="Receptor binding changes intracellular pathways">
          <outline text="Amplification enlarges small signals"/>
          <outline text="Termination stops activity after the stimulus"/>
        </outline>
        <outline text="Down-regulation with persistent high stimulation">
          <outline text="Explains tolerance and altered sensitivity"/>
        </outline>
        <outline text="Up-regulation with low stimulation"/>
        <outline text="Gap junctions couple cardiac and smooth muscle"/>
        <outline text="Tight junctions preserve compartments"/>
        <outline text="Anchoring junctions distribute mechanical stress"/>
      </outline>
      <outline text="Tissue repair and regeneration">
        <outline text="Haemostasis, inflammation, proliferation, remodelling">
          <outline text="Collagen reorganises, tensile strength improves"/>
        </outline>
        <outline text="Epithelia and blood-forming tissue renew rapidly"/>
        <outline text="Liver has substantial regenerative capacity"/>
        <outline text="Cardiac muscle and central neurons replace poorly">
          <outline text="Fibrosis keeps structure but loses function"/>
        </outline>
      </outline>
      <outline text="Physiological reserve and ageing">
        <outline text="Reserve is maximum capacity minus baseline"/>
        <outline text="Much reserve lost before resting values change">
          <outline text="Exercise, illness, ageing, stress expose limits"/>
          <outline text="Failure appears first under demand"/>
        </outline>
        <outline text="Ageing narrows the workable range">
          <outline text="Water, concentrating ability, vessels, immunity, muscle"/>
          <outline text="Same disturbance may exceed compensation"/>
        </outline>
        <outline text="Interpret measurements with function and context"/>
      </outline>
    </outline>
  </body>
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