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Since segmental Luque wires pull on the verte- temporary continuous growth stimulation at the concave bral arches on the concave side purchase pristiq 100 mg without prescription treatment wasp stings, they produce a derotating side cheap pristiq 50mg amex kerafill keratin treatment. With such a method preservation of mobility should effect, though this is only slight. Much has been writ- ten about the derotating effect of the Cotrel-Dubousset Supplementary remarks system. During the operation the rod is turned through The sagittal plane and the extent of the rotation must be approx. In children under 12 or for very severe scolioses (over The most efficient method in terms of derotation is 60°), we always perform an anterior (thoracoscopic) disk ventral derotation spondylodesis (Zielke procedure). We sup- the anterior longitudinal ligament and the intervertebral plement the (lumbar) ventral derotation spondylodesis disks are removed during this procedure, the strongest (because of the risk of additional kyphosing) with poste- forces of resistance to the derotation are eliminated. As we ourselves have discovered, aver- > In almost all idiopathic thoracic scolioses we routinely age derotations of 20° to 30° are perfectly possible. Long-term results Genuine long-term results are available, particularly after Results of surgical scoliosis treatment Harrington procedures: Several studies have reported on Frontal plane (correction of the Cobb angle) follow-up periods of over 20 years [17, 18, 42, 75, 94]. A Corrections of between 28% and 55% have been correction loss of 5–10° occurs over time [17, 42]. How- achieved with the Harrington instrumentation, while cor- ever, the functional result is generally very good and the rections of 55% have been calculated for the use of the frequency of back pain is no greater than in a healthy Harrington-Luque technique. Scoliosis surgery does not reported for the Cotrel-Dubousset instrumentation are be- adversely affect partnerships or pregnancy. On average, the result is patients with a badly distorted sagittal profile experience comparable with that for the Harrington-Luque method. Figures as high as 87% are reported for the anterior Zielke procedure [108]. Average corrections of over 70% are also Complications of scoliosis surgery possible with the modern anterior double-rod systems [36, The following possible complications are associated with 37]. As a rule, anterior techniques with disk removal pro- scoliosis surgery: duce better correction results than posterior operations. Early complications Sagittal plane (kyphosing/lordosing) Neurological lesion: Although the risk is relatively low While Harrington rods exacerbate the pre-existing patho- in idiopathic scoliosis, it is highly relevant as the oc- logical lordosis of the thoracic spine observed in most currence of such a lesion can be devastating for the cases, the combination of Harrington rods with segmental patient and his family. Good preoperative briefing wiring according to Luque and the Cotrel-Dubousset proce- is important in this respect. Another these operations are predominantly sited) and the kyphos- larger-scale study reported four cases of partial lesions ing can be avoided, or at least reduced, by the insertion of in 1090 operated patients (0. Three of the four substantial allogeneic bone chips or synthetic implants. The combined anterior and posterior procedure and severe kyphoses were Horizontal plane (derotation) found to be risk factors. Much higher percentages, Not much information is available in the literature on the however, were cited in another study (17 lesions in effect of Harrington rods on the rotation of the vertebral 667 operated patients = 2. Surgeons must also be careful to ensure the atypical scolioses, to rule out any other cause by MRI (e. Intraoperative monitoring is also impor- though nowadays this occurs much less frequently tant. Recording somatosensory and motor potentials during with modern instrumentations than when the Har- the operation is the most reliable way of detecting lesions rington operation prevailed. The correction loss al- at an early stage and eliminating the triggering mechani- ways occurs during the first three years, after which cal factor. The chances of a recovery are much better time the patient’s condition stabilizes. It is particu- with an immediate reaction than one produced several larly pronounced if a pseudarthrosis establishes itself, hours later. Motor potentials are considerably influenced which can frequently lead to rod fracture. If the metal by anesthetic drugs and their reliable recording is only has to be removed for any reason, correction loss can possible in close consultation with the anesthetists.

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The most easily recognised infinitives are verbs that begin with to as in to write pristiq 50 mg without a prescription medicine for pink eye. There are also other types of infinitives that are recognisable as the last word in a verb cluster cheap 100mg pristiq overnight delivery 4 medications walgreens. For example, in the sentence I must write the word must is an auxiliary verb and write is the infinitive, which, because it does not appear with another word, is called a bare infinitive. In the examples that show split infinitives, the words more than splits into the centre of the infinitive to double. In the following example, the word carefully is placed between the auxiliary verb and its infinitive, so this is similarly split. Reference books on English grammar restrict split infinitives to word(s) used between to and the verb because “infinitive” refers to the to—form. Type Example “To” infinitives I would like to write this paper Bare infinitives I must write this paper Split infinitives I want to more than double the length of the review that I am writing I want you to carefully consider my amendments to your paper Infinitives that are not split I happily began to write the journal article that I am writing more than double its present length. Of course, not everyone agrees that infinitives should not be split and many great writers have knowingly and successfully split their infinitives. Verbs add drama to a random grouping of other words, producing an event, a happening, an exciting moment. It is important that these verbs are not used to attribute an action to a non-human subject that cannot actually perform that action. In writing about your study or your results or any other non-human nouns associated with your research, you cannot use any of the verbs in the left-hand side of the table. However, the verbs in the right-hand side of the table are freely available for your use. When you choose a verb, it is important not to suggest that your study can do the research all by itself. For example, in a sentence such as A study that collects information from the time of diagnosis is needed, the verb collects cannot be used with the noun study. The sentence is more correctly written as A study is needed in which data can be collected from the time of diagnosis. Human subject only Human or non-human subject Observe Show Record Demonstrate Compare Indicate Identify Suggest Describe Support See Confirm Speculate Imply Conclude Need Believe Know Collect Aim Table 9. In this way, the study is treated as a tool that we use to test a hypothesis and is not ascribed the powers of a researcher. Similar errors are apparent in phrases such as This study seeks to …, This study will determine …, This research aims to … and even This study has looked at …. This erroneous assignment of power is not limited to the world of science. In a recent TV documentary, the commentator waxed lyrical with As winter releases its icy grip …. Such licence may be acceptable for poetry and the media but must not be used in scientific writing, which should be limited to describing facts. For example, in the sentence Participants with allergy who have seasonal symptoms is better written as Participants who have allergy with seasonal symptoms so that the verb is placed correctly in the sentence. An example of the correct use of both is in the sentence When you affect something, you have an effect on it. Students often ask whether it is correct to use may or might in scientific text to express whether something is possible, for example as in Babies who are allergic may develop severe skin rash. Sometimes, might is construed as describing a possibility that is more remote than may. However, as far as we can tell, there is no difference in meaning between may and might 228 Grammar when they are used in the sense of possibility. Of course, may can sometimes indicate permission and the two words can be used interchangeably. For example, a researcher may write that Lung function tests were performed in 21 infants. To be correct, it is more straightforward to write that Twenty-one infants had lung function tests or Twenty-one infants underwent lung function testing. One final note on the use of verbs is that sentences ending with a verb tend to be ugly. For example, the sentences We found that atopy to cat dander was not associated with asthma but that atopy to house dust mites was and Children who live in rural areas have a lower prevalence of allergy than those who do not do not make pleasant reading.

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This can then be followed by papers in which results directly related to the study aims are reported generic pristiq 100 mg with mastercard doctor of medicine, perhaps in sequential stages buy discount pristiq 100 mg on line medications vertigo. Further papers may follow that fulfil aims that were not planned when the study began but for which the data are appropriate. Although practices such as testing for all relationships between all variables (so called “data-dredging”) are unscientific, it is acceptable to make economical use of data that have been expensive to collect and that are appropriate for answering new questions. The first paper reported the development of a new questionnaire to measure the prevalence of chronic, persistent cough in epidemiological studies of children. The second and third papers report data from studies in which the questionnaire was used. The second paper was used to report evidence that children with symptoms of persistent cough do not have the same clinical features as children with clinically recognised asthma. Finally, in the third paper, the prevalence and risk factors for asthma and allergic illness in the two different countries was compared. Each paper has a clear, individual message and avoids the duplicate publication of data in the other papers. This process makes sense because the results reported in the three papers answer discrete questions and could not have been compressed into the constraints of a single paper. Because it was unlikely that one journal would have taken all three papers, each journal was chosen because the paper fell within its scope. Measuring persistent cough in epidemiological studies: development of a questionnaire and assessment of prevalence in two countries. Prevalence of atopy, asthma symptoms and diagnosis, and the management of asthma: comparison of an affluent and a non-affluent country. Policies for data sharing Premature release of research data before careful analysis of results, and without the independent scientific peer review that is part of the normal process of publication of scientific research, would also increase the risk of public disclosure of erroneous or misleading conclusions and confuse the public. In many large research studies from which more than one paper will be published, strict policies are needed for data sharing to avoid duplicate publication and to specify each researcher’s rights and responsibilities. It is the duty of the stakeholders in these studies to make collective deci- sions, in advance, about many aspects of publication. The stakeholders will include the principal investigators and other researchers, such as the divisional or departmental head, the project coordinator, the data manager, the research assistants, research fellows, postdoctoral students, and/or a statisti- cian, etc. The decisions will include which questions will be answered, which dependent and independent variables will be used, which journals to select for publication, which national or international meetings the data will be presented at, and who will write the paper and present the data. One good way to handle data sharing is to create a log sheet for each proposed paper. The log sheets should be formal documents that are agreed to by all stakeholders and that are formally archived in the study handbook. Once the questions to be answered in the paper are finalised and the log sheet has been approved by the stakeholders, data sharing becomes plain sailing. In a perfect world, data sharing log sheets would be used routinely in all research studies. Conferences where data will be presented and by whom 151 Scientific Writing This level of organisation often makes the difference between an everyday research team and a highly successful research team. As discussed in Chapter 2, the first author must take full responsibility for preparing the paper. This author will be responsible for supervising or conducting the data analyses, documenting the results, and preparing the drafts of the paper, abstracts, posters, etc. The first author should also have the first option of presenting the results at scientific meetings. However, all stakeholders should have access to results for use in reviews, talks, research reports, etc. When data are used by other stakeholders in this way, the first author should be acknowledged accordingly. Data sharing has the potential to cause many emotional and professional conflicts.

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