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In each example cheap levitra extra dosage 60mg on line, you can see how the meaning becomes clearer when the correct words are used purchase levitra extra dosage 60mg without a prescription. In the first example, diagnosis is not an event that can recur in an individual and so the term less often diagnosed is inappropriate. The second example suggests that a rat can be culled more than once, which is clearly impossible. The third example suggests that atopy, symptoms, and asthma increase in adults as they put on more weight rather than saying that overweight people have a higher prevalence of symptoms, as is intended. The word correlate has a specific statistical meaning and should only be used in this context. The word should not be used in a general sense to suggest that two factors are related in some way. Word order For your born writer, nothing is so healing as the realization that he has come upon the right word. The following classified advertisement which appeared in a local newspaper is a good example of incorrect word order: Stock horse stallions standing at stud: Reverlee and Freckles Oak. Readers should not have to reorganise words to decipher the correct meaning. Neither should readers have to get to the end of a sentence to find out what they needed to know at the beginning. In the first example, the word asthma is used incorrectly as an adjective and, because the increase in prevalence is the topic of the sentence, this phrase is better placed at the beginning. This sentence benefits from making the sentence into one main clause and from removing some of the prepositions. In the fourth example, the transition word however is misplaced within the sentence. Transition words or conjunctions do their job in maintaining flow better if they are used at the beginning of a sentence rather than interrupting the subject–verb–object flow. Also, the word current is better used as an adjective to further describe the type of information than as the adverb currently to describe the verb. The order in which you present the information in each sentence also depends on the context in which you are writing and the audience you are writing for. Sentences that work best 198 Writing style are those in which the subject of the sentence is the main topic of your study. In this way, you provide the most important information at the beginning of the sentence and you set the context correctly. For example, you may have conducted a cross-sectional study in which you measured the risk of children developing gastrointestinal infections and investigated whether this was associated with breastfeeding. The data may be from the same study but your choice of word order is important for delivering a clear message to your audience. Infant feeding context Breastfeeding significantly reduced the incidence of gastrointestinal infections in infancy. Epidemiological context There was a lower incidence of gastrointestinal infections in breastfed infants. One fun thing to do with numbers is to arrange 1 to 9 in a magic square so that the rows, columns and diagonals all have the sum of 15. Creating flow Writing, when properly managed, … is but a different name for conversation. Laurence Sterne (1713–1768) 199 Scientific Writing Clarity depends on a smooth flow of ideas and a smooth transition between sentences and between paragraphs. In addition to making your paragraphs look nice, it is important to create flow because this allows the mind to travel along a path to instant understanding. Fellow researchers and clinicians need to be able to read your text once and understand what it means without their thoughts being left in temporary suspension at unexpected junctions. No reader wants to endure endless “stop and think” pauses to decipher how an idea in one sentence links to the ideas in the next. There are two main methods for maintaining a flow of ideas from one sentence to the next. One method is to use conjunctions or transition words to link sentences. Classical transition words, such as although, therefore, however, for example, etc. Nevertheless, you cannot keep using transition words throughout a paragraph.

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Over time order levitra extra dosage 40mg overnight delivery, DM results in small- and large-vessel vascular complications and neuropathies cheap 40 mg levitra extra dosage mastercard. Other systemic effects of prolonged diarrhea are dehydration, elec- trolyte imbalance, and weight loss. It may involve the interver- tebral disk, vertebral end plates, or both. It is an acquired disor- der of platelet function, with diffuse or widespread coagulation occurring within arterioles and capil- laries all over the body. Diverticulosis refers to the presence of outpouchings (diverticula) in the wall of the colon or small intestine, a condition in which the mucosa and submucosa herniate through the mus- cular layers of the colon to form outpouchings con- taining feces. Down syndrome: A genetic disorder attributed to a chromosomal aberration referred to as trisomy 21. Down syndrome is characterized by muscle hypo- tonia, cognitive delay, abnormal facial features, and other distinctive physical abnormalities. Distinct physical characteristics include a large tongue, poor muscle tone, a flat face, and heart problems. Duchenne’s muscular dystrophy: Progressive fatal disorder of the skeletal muscles beginning in early childhood caused by a hereditary sex-linked gene on the X chromosome. Dupuytren’s contracture: A finger deformity character- ized by the formation of a flexion contracture and thickening band of palmar fascia, usually involving the third and fourth digits accompanied by pain and decreased extension. Characterized by progressive fibrosis (increase in fibrous tissue) of the palmar aponeurosis, resulting in the shortening and thicken- ing of the fibrous bands that extend from the aponeu- rosis to the bases of the phalanges. These fibrous bands pull the digits into such marked flexion at the metacarpophalangeal joints that they cannot be straightened. It may be caused by neurologic conditions, local trauma and muscle damage, or mechanical obstruction. Diseases, Pathologies, and Syndromes Defined 399 dysplasia: A general diagnostic category that indi- cates a disorganization of cells in which an adult cell varies from its normal size, shape, or organiza- tion. Dystonia is both a symptom and the name for a collection of neurologic disorders char- acterized by these movements and postures. In chronic pulmonary disease, there is a characteristic increase beyond the normal in the size of air spaces distal to the terminal bron- chiole with destructive changes in the alveolar sac walls. It is usually red- dish, lobulated, and well circumscribed, resem- bling a cauliflower in shape. Epstein-Barr virus (EBV): Also known as infectious mononucleosis, it is an acute infectious disease caused by EBV, a member of the herpes virus group. Erb’s palsy: A paralysis of the upper limb resulting from a traction injury to the brachial plexus at birth. Erb-Duchenne palsy affects the C5 to C6 nerve roots, whole-arm palsy affects C5 to T1, and Klumpke’s palsy affects the C8 and T1 (lower plexus) nerve roots. Diseases, Pathologies, and Syndromes Defined 401 facioscapulohumeral dystrophy: A mild form of muscular dystrophy beginning with weakness and atrophy of the facial muscles and shoulder girdle. The inability to close the eyes may be the earliest sign; the face is expressionless when laughing or crying, forward shoulders and scapular winging develop, and the person has difficulty raising the arms overhead. Psychological factors include anxiety, confu- sion, disorientation, and depression. Physiologic causes include neurologic sensory and motor impairment, anal distortion secondary to traumatic childbirth, sexual assault, hemorrhoids, and hem- orrhoidal surgery; altered levels of consciousness; and severe diarrhea. Fibromyalgia has been defined as pain that is wide- spread with multiple tender points. It is primarily a disorder of movement with ataxic gait the most common presenting symptom. Disinhibition and apathy are common clinical dysfunctions of the frontal lobe. The person may lack insight into the deficits; therefore, behavior can be difficult to control. Gallstones are stone-like mass- es called calculi (singular: calculus) that form in the gallbladder as a result of changes in the normal components of bile. Diseases, Pathologies, and Syndromes Defined 403 gangrene: Death of body tissue usually associated with loss of vascular (nutritive, arterial circulation) supply, and followed by bacterial invasion and putrefaction. Dry and moist gangrene result from loss of blood circulation due to various causes; gas gangrene occurs in wounds infected by anaerobic bacteria, leading to gas production and tissue breakdown. It is not a single disease but rep- resents a group of the most common stomach dis- orders.

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Symptomatic treatment is generally used for spastic torticollis in the form of heat order 40mg levitra extra dosage amex, massage levitra extra dosage 40 mg otc, and intermittent cervical traction, providing there is no evidence of true cervical vertebral instability. Resolution is generally abrupt in inflammatory and atlantoaxial rotary displacements. Subluxation of the radialhead “Pulled elbow” is most commonly seen in children between one and five years of age. It occurs following an injury sustained in which the child’s forearm or hand is being held and the child attempts to fall away, or is lifted from 73 Muscular dystrophies the ground by the hands. The children tend to carry the forearm in a “lame” position of forearm pronation, and elbow flexion supported by the other hand (Figure 4. Supination of the forearm or pressure over the radial head increases the discomfort. True subluxation or dislocation of the radial head from its position against the capitellum has never been demonstrated radiographically or pathologically. The condition occurs when longitudinal traction is applied to the forearm with the arm extended and the forearm pronated. It is believed that a portion of the annular ligament becomes interposed between Figure 4. The characteristic location of a popliteal cyst between the radial head and capitellum and then semitendinosus and gastrocnemius muscles. The mechanism of production of subluxation of the radial head, and the forearm held in pronation. Reduction and the characteristic position of the upper extremity at presentation. A palpable and sometimes audible “click” often accompanies the immediate relief of pain. Regardless of the exact anatomic abnormality, the condition in nearly all cases will resolve as the child reaches the end of the first decade of life. In roughly 20 percent of the cases, recurrences will be encountered, although treatment of the individual event is identical. Initial treatment generally consists of a simple reduction, sling, posterior splint, or occasional long arm cast for a brief period ranging from two to three days to two weeks. Parents experiencing repeat “subluxation” should be instructed on the reduction maneuver of supination of the forearm. Persistent discomfort following reduction may on occasion necessitate a longer period of immobilization. Muscular dystrophies Although there are several muscular dystrophies in childhood, three types are seen From toddler to adolescence 74 with some degree of regularity: progressive muscular dystrophy; limb-girdle dystrophy; and facio-scapulo-humeral dystrophy. By far the most prevalent form of dystrophy seen in clinical practice is the sex-linked progressive dystrophy of the Duchenne type. The disease is produced by an abnormality in the gene for the production of dystrophin. Absence or marked reduction of dystrophin results in destabilization of the muscle cell membrane which allows creatine kinase to leak into the serum with progressive loss of muscle mass and replacement by fibro-fatty tissue. This disease occurs in males, and a positive family history is frequently obtained. Initially there is symmetrical weakness of the pelvic girdle muscles followed later by generalized progressive weakness in the area of the shoulder girdle and eventually even progressing distally. Pseudohypertrophy of the calf is characteristic, but not purely diagnostic. Cardiac involvement is nearly always present, and generally death occurs from cardiopulmonary failure prior to 20 years of age. Commonly a history of falling easily, difficulty climbing stairs and difficulty jumping or running is obtained. Involvement of the hip extensor muscles produces a flexion deformity at the hips and a lumbar lordosis. The foot and ankle are held in equinus as a result of gastrocnemius contracture. Involvement of the hip abductors results in a “waddling” type of wide base gait. This maneuver generally reflects the degree of quadriceps weakness and the inability to straighten the knee, forcing the child to literally crawl up his legs with his hands, pressing first on the knees and then the thighs to gain an erect posture. Clinical diagnosis is established by assessing the abnormal gait, examining for specific areas of muscle weakness, the presence of a normal 75 Muscular dystrophies neurologic sensory examination, but diminished or absent biceps and knee jerks.

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