Clinical Director, The Brody School of Medicine at East Carolina University
As you will see from the notes below gastritis diet ėąéā discount bentyl 20mg visa, you do not need to be able to perform the F test yourself to com e up with com m ents like this gastritis diet xtreme purchase cheap bentyl, but you do need to understand what its tails m ean gastritis diet nuts discount bentyl 20 mg visa. The sum m ary checklist in Appendix 1, explained in detail in the sections below, constitutes m y own m ethod for assessing the adequacy of a statistical analysis, which som e readers will find too sim plistic. If you do, please skip this section and turn either to a m ore com prehensive presentation for the non-statistician, the "Basic statistics for clinicians" series in the Canadian Medical Association Journal,1ā4 or to a m ore m ainstream statistical textbook. If you do, you m ight get stuck with non-param etric tests, which arenāt as m uch fun (see section 5. But if outliers are helping your case, even if they appear to be spurious results, leave them in (see section 5. Better still, m ention them briefly in the text but donāt draw them in on the graph and ignore them when drawing your conclusions (see section 5. Alternatively if at six m onths the results are "nearly significant", extend the trial for another three weeks (see section 5. You m ight find that your intervention worked after all in Chinese fem ales aged 52 to 61 (see section 5. N one of the points presupposes a detailed knowledge of the actual calculations involved. The first question to ask, by the way, is "H ave the authors used any statistical tests at all? If they are presenting num bers and 77 H OW TO READ A PAPER claim ing that these num bers m ean som ething, without using statistical m ethods to prove it, they are alm ost certainly skating on thin ice. Have they determined whether their groups are comparable and, if necessary, adjusted for baseline differences? M ost com parative clinical trials include either a table or a paragraph in the text showing the baseline characteristics of the groups being studied. Such a table should dem onstrate that both the intervention and control groups are sim ilar in term s of age and sex distribution and key prognostic variables (such as the average size of a cancerous lum p). If there are im portant differences in these baseline characteristics, even though these m ay be due to chance, it can pose a challenge to your interpretation of results. In this situation, you can carry out certain adjustm ents to try to allow for these differences and hence strengthen your argum ent. To find out how to m ake such adjustm ents, see the section on this topic in D ouglas Altm anās book Practical statistics for medical research. W e can, for exam ple, calculate the average weight and height of a group of people by averaging the m easurem ents. But consider a different exam ple, in which we use num bers to label the property "city of origin", where 1 = London, 2 = M anchester, 3 = Birm ingham , and so on. W e could still calculate the average of these num bers for a particular sam ple of cases but we would be com pletely unable to interpret the result. The sam e would apply if we labelled the property "liking for x", with 1 = not at all, 2 = a bit, and 3 = a lot. Again, we could calculate the "average liking" but the num erical result would be uninterpretable unless we knew that the difference between "not at all" and "a bit" was exactly the sam e as the difference between "a bit" and "a lot". In general, param etric tests are m ore powerful than non-param etric ones and so should be used if at all possible. N on-param etric tests look at the rank order of the values (which one is the sm allest, which one com es next, and so on), and ignore the absolute differences between them. As you m ight im agine, statistical significance is m ore difficult to dem onstrate with non- param etric tests and this tem pts researchers to use statistics such as the r value (see section 5.
The author gastritis gurgling bentyl 20mg without a prescription, however gastritis diet mayo clinic bentyl 20 mg on line, has seen Professor Patrick Wall hold an audience of 400 enthralled using a blackboard gastritis antrum diet purchase bentyl 20 mg mastercard. Again usually used as a teaching aid and has the advantage that the lecturer can face the audience at all times. The requirements for good slides are found in Chapter 4, but remember they require a projector and possibly a projectionist. Slide projectors do go wrong and if you are using dual projection, which can be very effective, then you double the likelihood of problems. This means that the slides have to be inserted into the carousel completely differently from forward projection. You must check this and go through all your slides to see that they are correctly inserted, otherwise your talk can deteriorate into a complete shambles. This is gradually taking over from slides and, if used correctly, is extremely effective. But computer- generated slides can and do go wrong, much more frequently 18 THE THREE TALKS than slides. Your disc must be compatible with the hardware that is in use and you should have been told by the organisers what equipment they have. The biggest danger is that you are using the latest software, but the organisers are not. Great people (and the audience) have been embarrassed by having to wait 15 minutes or more before they have functioning visual aids. A good projectionist is essential if things are to go smoothly and you should talk to them will in advance and have a practice run- through. Day of the lecture Despite your nerves, you must check a number of points when you arrive. You might know him/her, but he/she is unlikely to know you, especially when you are starting out in your career. Lecterns can vary considerably from being very simple to resembling a Boeing 747 cockpit. Check whether you can focus the slides yourself and whether you, or the projectionist, controls the lights. The microphone The best are pinned to your clothing, which allows you some movement whilst talking without the sound level varying; fixed microphones have the disadvantage that you have to ensure that you are talking into it at roughly the same distance all the time, 19 HOW TO PRESENT AT MEETINGS even when you turn to your slides. When you stand up on the podium, pin the microphone on yourself and do it quickly. The pointer This will either be something elongated (billiard cues are favourites) or, more often nowadays, a laser pointer (where the battery is usually on the verge of failing ā check beforehand). If you are worried about a tremor when using a laser pointer, then hold it in both hands whilst steadying yourself by leaning on the lectern. Remember to switch off the laser after making your point, as it is potentially dangerous to leave it on when you turn to face the audience as eyes can be damaged. The classic mistake with slides is to find that the last and "crunch" one has been left in the projector back home where you have been rehearsing. The five-minute talk These are usually the province of the most junior members of the profession, who are told by their seniors that they are going to do it, and they have no say in the matter. Furthermore, the notice is usually short and you will be lucky if you have two weeks; 24 hours is not unusual. Such talks usually involve case reports, or some aspect of an interesting case, with a mini review of the salient features.
Reinus and colleagues (23) retrospectively evaluated the medical records of 115 consecutive patients who had seizures after acute trauma and underwent a noncontrast cranial CT gastritis symptoms back purchase bentyl 20 mg overnight delivery. An abnormal neurologic examination predicted 95% (19 of 20) of the positive CT scans p < gastritis diet journals bentyl 20 mg visa. Of the 325 patients studied with CT scans chronic gastritis liver disease generic 20mg bentyl fast delivery, 134 (41%) had clinically signiļ¬cant results. Bradford and Kyriakedes (25) reported an evidence-based review (limited evidence) of diagnostic tests in this population. Predictors of abnormal CT scans in patients with new onset of seizures had the following risk factors: head trauma, abnormal neurologic ļ¬ndings, focal or multiple seizures (within a 24-hour period), previous CNS disorders, and history of malignancy. The article concludes that there are supportive data to perform CT scanning in the evaluation of all ļ¬rst-time acute seizures of unknown etiology. Summary of Evidence: Magnetic resonance imaging is the neuroimaging study of choice in the workup of ļ¬rst unprovoked seizures (moderate evi- dence). The probability is higher in patients with partial seizures and focal neurological deļ¬cit (Fig. Neuroimaging is advised in children under 1 year of age and in those with signiļ¬cant unexplained cognitive or motor impairment, or prolonged postictal deļ¬cit. Signiļ¬cant neuroimaging ļ¬ndings impacting medical care are found in up to 50% of adults and in 12% of children. This ļ¬gure illustrates the higher sensitivity of MRI in the detection of cortical dyspla- sia. The transverse CT (A) is compared to the MRI (B) in a child with intractable epilepsy and postural pla- giocephaly. The region of cortical dysplasia in the left parasagittal frontal lobe is clearly seen only on the MRI exam by the loss of grayāwhite matter interface and the increased T2-weighted signal intensity. Neuroimaging in ļ¬rst unprovoked seizure % of Author Patients CT/MRI positives Comments Shinnar et al. One level II study (moderate evidence) was found describing a cohort study in which neuroimaging studies were performed in 218 of 411 children (26); CT was performed in 159 and MRI in 59 cases. The cohort was followed for a mean of 10 years and none of the patients had evidence of neoplasm (accepted as the reference standard); 21% of the 218 exams were abnormal. The most frequent diagnoses were encephalomalacia (16 cases) and cerebral dysgenesis (11 cases). A level III (limited evidence) case series study of 300 adults and children with an unexplained ļ¬rst seizure was reported by King et al. Com- puted tomography was performed in 28 of the 38 cases, with lesions on MRI being concordant with MRI in only 12 cases. Magnetic resonance imaging was done in 50 patients with generalized epilepsy and only one had a neoplasm causing partial epilepsy. In pediatric studies, neuroimaging diagnostic performance was similar to that in the adult literature according to an evidence-based study by Hirtz et al. However, the overall effect of neuroimaging on medical management was less in children than in adults (28). Chapter 11 Neuroimaging of Seizures 201 The role of CT in evaluating children with new-onset unprovoked seizure was analyzed in a retrospective (limited evidence) study by Maytal et al. The seizure eti- ology was clinically determined to be cryptogenic in 33 patients. Two of these children (6%) had abnormal nonspeciļ¬c CT ļ¬ndings that did not require intervention. In a level III (limited evidence) study of 408 adults, CT scanning found tumors in 3% of patients.
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The principle of conservation of angular mo- mentum relates the changes in rate of rotation to the resultant moment acting on an object gastritis healthy diet cheap bentyl 20mg with visa. Provide an estimate of the mass moment of inertia of your forearm about the three principal axes that pass through its center of mass gastritis diet jokes purchase bentyl 20mg line. The moment of inertia of an athlete with respect to his cen- ter of mass along an axis from posterior to anterior was experimentally determined to be equal to Ic 5 13 gastritis diet żšīņčźą discount bentyl 20 mg without prescription. Represent the athlete as a slender rigid rod and determine an approximate value (I*) for his moment of inertia. What would be the effective length h* of the rod that would correctly predict the moment of inertia of the athlete? The parameter H is the height of the adolescent, measured in meters, and W is his mass, measured in kilograms. To check whether this formula could also be applicable to adult men, a group of Air Force researchers measured the mass moment inertia of a select group of Air Force men. Following are the data obtained for three men in the group: Age Height (m) Mass (kg) I33 (kg-m2) I11 (kg-m2) 29 1. How far off would be the predictions of these mass moment of inertia compo- nents if one represented each individual with a slender rod whose length and mass are equal to that of the individual? Determine if there are phenome- nological equations already developed for these subpopulations. If not, how would you go about coming up with your own set of empirical equations? Provide an estimate of the spatial location of the center of mass C of the dancer leaping in air as shown in Fig. Specify in detail any addi- tional assumptions you had to make to arrive at your results. Note that you need to establish a reference frame to compute and specify the lo- cation of the center of mass. In this exercise, the man is represented as a rod with uniform distribution of mass (b). Determine the vertical ground forces acting on a man at the feet (FF e2) and hands (FH e2) while performing push-ups as shown in Fig. At the in- stant considered (t 5 0), the angle his body makes with the horizontal plane (u) is 20Ā°. The body is aligned straight and rotates around the fixed point O as shown in the figure. The fact that FF is negative implies that somebody must have been pressing at the ankles of the man do- ing the push-ups. They are hinged together and in the resting position are aligned on a straight line. The rod B1 slides on the smooth, frictionless surface of the floor and the center of mass of the system moves parallel to the floor. Determine the reaction force F2 and the angular accelerations of B1 and B2 right after the release. Note that this two-rod system might capture some of the essential features of sideway falls. Among the elderly population, a sideway fall is a most frequent cause of hip fracture. The answer to this problem may pro- vide information about the nature of shape change during such a fall 116 4.
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