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P de Sa purchase hytrin 5 mg line, A Sagar32 Authorship is about publicly putting your name to your research achievements. Academics reap many personal and professional rewards from their research activity in general and their publications in particular. Authorship has a strong currency that brings not only personal satisfaction but also career rewards based on publication counting. Both the number of publications and the quality of the journal are often used to judge research reputations, to assess achievement for promotion, and to measure “track record” for granting bodies who allocate research funds. For these reasons alone, researchers rarely turn down an opportunity to coauthor a paper. With so much at stake, making a decision about authorship can be the most sensitive part of writing a paper. In recognition of this, standard criteria for authorship have been developed. Whatever criteria are used, authorship should always be linked to an identifiable contribution. Journal editors often despair about authorship lists that include people who have done little, if anything, towards the conduct 29 Scientific Writing of the study and exclude people who have done much work, even if they cannot claim responsibility for the entire study. Early decisions tend to be less problematic than decisions made later, because the potential for conflict increases as the rewards attached to authorship increase and coworkers jockey for a higher position in the pecking order. At the Harvard Medical School, authorship disputes constituted 2·3% of issues presented to the ombudsman’s office in 1991–92 and rose to 10·7% in 1996–97. An early decision can clarify the expectations of the research team and avoid the disappointment that inevitably occurs when people live in the hope of an authorship that never eventuates. It is certainly a mistake to put off authorship decisions in the hope that any ill feelings will eventually resolve of their own accord. Authorship is best decided with the use of standard guidelines rather than reliance on an ad hoc grace and favour system. Many research teams use the widely renowned Vancouver guidelines19 shown in Box 2. These guidelines were developed using the wide experience of several senior journal editors with the explicit aim of avoiding honorary and irresponsible authorship.

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It provides good contrast and spatial resolution of lung parenchyma discount 1mg hytrin overnight delivery, mediastinum and bony structures but has the disadvantage that sedation is often required due to the length of examination. Magnetic resonance imaging (MRI): Useful for examining the mediastinum and the chest wall but has the disadvantage that young children will require sedation and frequently general anaes- thetic due to the relatively long imaging times. Scintigraphy: Of value in the investigation of pulmonary embolisms and bony pathology (e. Its use is on the decline as a result of improve- ments in ultrasound and MRI but it has the advantage of facilitating interventional procedures. Age (approximately) Projection Patient position Under 3 months Antero-posterior Supine 3 months to 4 years Antero-posterior Erect 4 years and older Postero-anterior Erect Choice of projection There is no difference in the diagnostic value of an antero-posterior (AP) pro- jection compared to the postero-anterior (PA) projection of the chest in a child less than 4 years of age as the thoracic cage is essentially cylindrical in young children and magnification of mediastinal organs is insignificant11. However, the AP projection is associated with a higher radiation dose to the developing breast, sternum and thyroid, and radiographers should take this into consideration when choosing the radiographic projection. In children under 4 years of age, the AP projection is often preferred due to ease of positioning, immobilisation and maintenance of patient communication. Young children like to see what is going on around them and positioning for an AP projection allows the child to watch the radiographer. A disadvantage of the AP projection is the likelihood of lordosis but this can be prevented by careful technique. This is particularly important if the child’s condition is being mon- itored radiographically as subtle radiographic changes in their condition may be difficult to interpret if the technical (positioning) factors are inconsistent. The fol- lowing descriptions of radiographic positioning are provided as a guide and may be modified depending upon equipment and accessories available. Antero-posterior (supine) The patient is positioned supine with the median sagittal plane at 90° to the image receptor. A 15° foam pad is placed under the upper chest and shoulders to prevent lordosis (Fig. The chin is raised and the arms are flexed and held on either side of the head to prevent rotation (Figs 4. Sandbags and lead rubber are placed over the hips and legs to provide immobilisation of the Fig.

This occurs particularly Other causes of heel pain exist in addition to calcaneal in connection with a pes cavus order hytrin 5mg otc. A soft-bedded heel in the apophysitis, although these are all rare in children and shoe is therapeutically effective. In a study of 369 stress fractures in the Finnish army, the meta- Sever’s disease involves chronic pain in the hollow along- tarsals were the second commonest site, at 13%, after the side the Achilles tendon that occurs particularly in ath- tibia ( Chapter 3. The history is usually one of letic individuals who undertake intensive training. Clinical exami- quence of movements during sport, in which case a minor nation reveals pronounced tenderness behind the 2nd or shoe modification (e. Often the shoe Other metatarsals are only very rarely affected at the must be optimized in a series of trials. Stress fractures can occur at the base of against cortisone injections as these can lead to avascular the 5th metatarsal, particularly if the foot is in an abnor- necrosis of the Achilles tendon. The x-ray shows thick- Haglund’s deformity is a spur-like projection of the ening of the cortical bone and possibly central osteolysis bone over the attachment of the Achilles tendon. The fracture itself is not always visible and, if so, extremely rare in adolescents. A more common condi- rarely as a typical as a fracture gap, but rather as a more tion is posterolateral exostosis, in which the bone projects or less diffuse osteolysis resulting from repair processes. A laterally over the calcaneus slightly in front of the Achilles bone scan shows strong uptake. Rather than a genuine exostosis, this The most important differential diagnosis is an os- is more of an anatomical variant, although it can lead teoid osteoma ( Chapter 3. Widening volves cortical thickening and increased uptake on the the footwear is much more useful than surgical chisel- bone scan. Moreover, the osteolysis of the stress fracture ing, since the subsequent scar is more irritating than the can easily be misinterpreted as a nidus of an osteoid former »exostosis«. The most important distinguishing feature is part of the heel, then an insertion tendinosis of the plantar the fact that the pain in a stress fracture is load-related, 428 3. Brunner best way to achieve this is by fitting a below-knee cast, which immobilizes the fracture and effectively stops the The foot represents the lever arm over which the triceps patient from practicing sport.

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J Pediatr Orthop 21: 488–94 femoral neck in severe slipped capital femoral epiphysis purchase hytrin 5 mg with visa. Loder RT, Nechleba J, Sanders JO, Doyle P (2005) Idiopathic slipped 322: 43–7 capital femoral epiphysis in Amish children. Dietz FR (1994) Traction reduction of acute and acute-on-chronic 543-9 slipped capital femoral epiphysis. Engelhardt P (1994) Spontanverlauf der Epiphyseolysis capitis femo- femoral epiphysis. Fish JB (1994) Cuneiform osteotomy of the femoral neck in the treat- Mass Index and slipped capital femoral epiphysis. Ganz R, Gill TJ, Gautier E, Ganz K, Krügel N, Berlemann U (2001) Surgi- tal femoral epiphysis with a spica cast. A technique with full access to the 1522–9 femoral head and acetabulum without the risk of avascular necrosis. Mooney JF, Sanders JO, Browne RH, Anderson DJ, Jofe M, Feldman J Bone Jt Surg Br 83: 1119–24 D, Raney EM (2005) Management of unstable/acute slipped capital 16. Glorion C, Gaucher S, Langlais J, Odent T, Lechevallier J (2005) femoral epiphysis: results of a survey of the POSNA membership. Goodman WW, Johnson JT, Robertson WW (1996) Single screw fixa- der hormonal influence of puberty. Karger, Basel New York (Reconstr tion for acute and acute-on-chronic slipped capital femoral epiphy- Surg Traumatology, vol 10) sis. Hansson L (1982) Osteosynthesis with the hook-pin in slipped capi- Wachstumsalter. Herman MJ, Dormans JP, Davidson RS, Drummond DS, Gregg JR etiological factor in degenerative hip disease. J Bone Joint Surg (Br) (1996) Screw fixation of grade III slipped capital femoral epiphysis. Puylaert D, Dimeglio A, Bentahar T (2004) Staging puberty in slipped 20.

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