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By E. Candela. LeMoyne-Owen College.

Jerre R zyprexa 20mg with visa, Hansson G order zyprexa 7.5mg visa, Wallin J, et al (1996) Long-term results after realignment opera- tions for slipped capital femoral epiphysis. J Bone Joint Surg 78B:745–750 Retrospective Evaluation of Slipped Capital Femoral Epiphysis 1 1 1 1 Meishuu Ko , Kouji Ito , Keiji Sano , Naoki Miyagawa , 2 2 Kengo Yamamoto , and Youichi Katori Summary. We treated 16 patients (16 hips) with slipped capital femoral epiphysis (12 boys and 4 girls) encountered during the previous 16-year period. The evaluation items were chief complaint, mecha- nism of injury, initial diagnosis, disease type, radiographic findings, physique and endocrinological abnormalities, treatment methods, and complications. The disease type was acute slip in 2 patients, chronic slip in 8, and acute on chronic slip in 6. Mild slip was observed in 10 patients, moderate slip in 5, and severe slip in 1. Surgery was performed in all patients; Southwick intertrochanteric osteotomy was performed in 5 patients and in situ pinning in 11. Concerning surgical complications, methicillin-resistant Staphy- lococcus aureus infection developed in 1 patient and k-wire breakage in 1. Limitation of motion remained in 6 hips, but no hip pain, and normal gait was attained. Slipped capital femoral epiphysis, Retrospective evaluation, Osteotomy, In situ pinning, Early diagnosis Introduction The report in 2004 by the Multicenter Study Committee of the Japanese Pediatric Orthopaedic Association showed a definite increase in patients with slipped capital femoral epiphysis during the previous 25-year period in Japan. However, physi- cians other than pediatric surgeons are infrequently aware of slipped capital femoral epiphysis and do not include this entity in diseases for differential diagnosis; there- fore, its diagnosis rate is low. In addition, there are no treatment methods with established evidence at present. We encountered 16 patients with slipped capital 1Department of Orthopedic Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji, Tokyo 193-0944, Japan 2Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan 69 70 M. Subjects and Methods The subjects were 16 patients (12 boys and 4 girls) encountered during the previous 16-year period. The evaluation items were chief complaint, mechanism of injury, initial diagnosis, disease type, radio- graphic findings such as the slipping angle, physique and endocrinological abnor- malities, treatment methods, and complications. For radiographic evaluation, the head–shaft angle on frontal images and the pos- terior tilting angle in the frog-leg position were measured, and the right–left differ- ence was regarded as the slipping angle. The severity of the disease was evaluated mainly based on the posterior tilting angle. Results The chief complaint was hip joint pain in 11 patients, pain from the hip joint to the knee in 3, pain from the hip joint to the thigh in 1, femoral pain in 1, and lower limb pain in 1. The mechanism of injury was sports in 8 patients, falling during running in 1, falling on the stairs in 1, long-distance walking in 1, and unknown in 3: most patients had relatively mild injuries. The mean interval between the onset of symp- toms to the initial visit to the hospital was 69 days and that from the initial visit to diagnosis was 30 days. The duration until diagnosis was relatively short in patients with acute slip but considerably longer in some patients with chronic or acute on chronic slip. The coefficient of the correlation between the onset of symptoms and diagnosis was 0. The initial treatment was performed by an orthopedic surgeon in 11 patients, a surgeon in 3, a pediatrician in 2, and a bonesetter in 1. The initial diagnosis was slipped capital femoral epiphysis in 5 patients, absence of abnormalities in 3, Perthes disease in 2, unknown in 2, and growing pain, transient synovitis of the hip, and femoral neck fracture in 1 each. At the time of the visit to our hospital, a correct diagnosis was soon made in all patients. The disease type was acute slip in 2 patients, chronic slip in 8, and acute on chronic slip in 6. Mild slip (between 0° and 30°) was observed in 10 patients, moderate slip (between 30° and 60°) in 5, and severe slip (>60°) in 1 (Fig. The mean interval between the onset of symptoms and the initial visit to the hos- pital was 69 days and that from the first visit to diagnosis was 30 days.

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Keeping records When you begin your background research discount 2.5 mg zyprexa amex, keep accurate records of what data was gathered from which source as this will save you plenty of time and frustration later buy 2.5 mg zyprexa with amex, especially when you come to write your research proposal, or final report. A useful way to organise your background research is to have two files – one for primary research and one for secondary research. Each file can be divided into topics with the relevant notes slotted into each. Primary research For the primary research file, notes from each contact can be separated by a contact sheet which gives the name of the person, the date and time you met and a contact num- ber or address. Secondary research In the secondary research file, each page of notes can be headed by details of the publication in the same format that will be used in the bibliography – author and initials; date of publication; title of publication; place of publica- HOW TO CONDUCT BACKGROUND RESEARCH / 45 tion and publisher. If it is a journal article, remember to include the name of the journal; the page numbers of the article and the volume and number of the journal. It is also useful to include the location of this publication so that it can be found easily if needed again (website or li- brary shelf location). TABLE 2: SOURCES OF BACKGROUND INFORMATION PRIMARY SECONDARY Relevant people Research books Researcher observation Research reports Researcher experience Journal articles Historical records/texts Articles reproduced online Company/organisation records Scientific debates Personal documents (diaries, etc) Critiques of literary works Statistical data Critiques of art Works of literature Analyses of historical events Works of art Film/video Laboratory experiments SUMMARY X There are two types of background research – primary and secondary research. X Primary research involves the study of a subject through firsthand observation and investigation. X Secondary research involves the collection of informa- tion from studies that other researchers have made of a subject. X Any information obtained from secondary sources must be carefully assessed for its relevance and accu- racy. X Notes from primary and secondary sources should be carefully filed and labelled so that the source can be found again, if required. X When noting details for books, reports or articles which may appear in the final report, include all the details which would be needed for the bibliography. By now you should have decided what type of peo- ple you need to contact. For some research projects, there will be only a small number of people within your research population, in which case it might be possible to contact everyone. However, for most pro- jects, unless you have a huge budget, limitless timescale and large team of interviewers, it will be difficult to speak to every person within your research population. SAMPLING Researchers overcome this problem by choosing a smaller, more manageable number of people to take part in their research. In quantitative research, it is believed that if this sample is chosen carefully using the correct procedure, it is then possible to generalise the re- sults to the whole of the research population. For many qualitative researchers however, the ability to generalise their work to the whole research population is not the goal. Instead, they might seek to describe or explain what is hap- pening within a smaller group of people. This, they believe, might provide insights into the behaviour of the wider re- search population, but they accept that everyone is different 47 48 / PRACTICAL RESEARCH METHODS and that if the research were to be conducted with another group of people the results might not be the same. Market research- ers use them to find out what the general population think about a new product or new advertisement. When they re- port that 87% of the population like the smell of a new brand of washing powder, they haven’t spoken to the whole population, but instead have contacted only a sam- ple of people which they believe are able to represent the whole population. When we hear that 42% of the popula- tion intend to vote Labour at the next General Election, only a sample of people have been asked about their voting intentions. If the sample has not been chosen very care- fully, the results of such surveys can be misleading. Imagine how misleading the results of a ‘national’ survey on voting habits would be if the interviews were conducted only in the leafy suburbs of an English southern city. Probability samples and purposive samples There are many different ways to choose a sample, and the method used will depend upon the area of research, re- search methodology and preference of the researcher. Ba- sically there are two main types of sample: X probability samples X purposive samples. In probability samples, all people within the research po- pulation have a specifiable chance of being selected.

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For Lindsay purchase zyprexa 10mg overnight delivery, using the mind to self-heal means having more of an overall awareness of her body rather than using visualization techniques: “I can be lying down and be having some muscle tightness or some pain and I feel like I can send my awareness down in my body to smooth out those muscles discount 2.5mg zyprexa with amex, and run it like a pulse of energy, and smooth them out as if there were hands smoothing them out, and I feel better. I think that you can open up you blood vessels if you have arterial sclerosis, but this takes a lot of believing in order for it to work. These informants told me that everything on earth, as well as in the universe, is composed of energy that can be mobilized to heal. I believe that you can give energy to others, you can actually send it to others. I’ve found that with yoga and reflexology and therapeutic touch, they all work, whether the person believes in them or not, because it comes from the practitioner trying to direct energy. For exam- ple, in describing how crystal therapy works, Jane told me, “It’s drawing energy from the power within the earth and it’s used for healing. And a great part of all of this is acknowledging where these energies are coming from. According to Marie, “Reiki is channelling of universal energy through hands to you, and you do with the energy what you need to do, wherever the healing needs to take place. You have to believe that there’s this power within these rocks and that the power comes from another source and it’s a living thing, so that’s a part of my spirituality. However, I did find a connection between participation in alternative spirituality and beliefs about a specific alternative healing technique. To be precise, it is not that people who participate in new age or non-mainstream spirituality are any more likely than those who do not to believe in the concept of healing energy. Rather, the distinction lies in what they believe to be the source of this energy. While most of the people who took part in this research believed in the concept of healing energy, informants who participated in new age or non-mainstream spirituality were more likely to believe the source of this energy to be metaphysical, originating in God, spirit, or the universe. In contrast, those informants espousing mainstream religious beliefs drew on scientific paradigms in attributing the origin of healing energy to the fact that the earth, and all things on it, are composed of energy. In the end, these people define alternative healing by comparing it to, and differentiating it from, allopathic healing. In doing so they use a variety of distinguishing criteria comprising three broad categories: the focus and purpose of therapy, the nature of the client/practitioner relationship, and alternative healing techniques. While different informants focus on different distinguishing criteria, they all use allopathic medicine as their reference point in defining alternative healing. For example, whether or not an informant’s emphasis is on attitude, caring, or time is not as important as the fact that what defines the nature of the alternative client/practitioner relationship is that it somehow differs from the negative standard of the doctor/patient relationship. Holism, a key component of these informants’ alternative model of healing, also figures prominently in their alternative model of health. Like many concepts associated with alternative health care, holism is a complex, and at times ambiguous, term. In the following chapter I examine in more detail the concepts, including holism, that make up these informants’ alternative model of health. However, this does not mean that these people see nothing distinct about alternative therapies, as is plain from the meaning they give to their model of alternative health. See also Dunfield (1996); Furnham and Bhagrath (1993); Furnham and Forey (1994); McGuire (1983); and Pawluch et al. See Saks (1997b) and Coward (1989) for a critical assessment of the argument that holism is exclusive to alternative health care. See also Fulder and Munro (1985); Furnham and Smith (1988); Glik (1988); Goldstein et al. What is understood to be alternative health varies dependent on who is giving meaning to the con- cept and in which social context that definition occurs. However, this does not mean that we can not discuss alternative health; rather, what is necessary is that we specify in what context meaning is invoked (Low 2001). In this case, the model of alternative health I discuss below is based on the subjective perspectives of Canadian lay users of alternative therapies. As I have demonstrated, the people who spoke with me sought out alternative health care to solve problems for which they found no redress in other quarters.

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