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By Z. Ilja. Bridgewater College. 2018.

Long sentences may occasionally be needed but they should be the exception rather than the rule doxycycline 100 mg cheap. One rule of thumb is that sentences that stretch to more than two printed lines and/or more than 30 words are too long doxycycline 200 mg cheap. Sentences longer than this suddenly become tedious and difficult to read whereas sentences with less than 20 words are usually very readable cheap 100 mg doxycycline otc. Simply by chopping up the snakes safe doxycycline 100mg, you make your paragraphs more digestible. Cut long sentences into little ones, shorten verbs, delete unnecessary clauses, or put points in a list. Although we have no evidence, it is possible that indigenous children who have bronchitis in early life are more likely to be diagnosed with asthma. The long snaky sentence of 63 words can easily be cut into two sentences, one of 32 words and one of 25 words (total 57 words). Parallel structures To be easy to read, your text has to be clear and say what you mean in a simple and straightforward way. JS Lilleyman11 By using the same sequences of word clusters both within and between sentences, you create “parallel sentence structures”. Parallel structures improve readability by creating a smooth, organised flow of thought. By establishing repetitive patterns, you introduce good structure to your writing because you present your ideas in a consistent way. Sentences that have an inconsistent, or non-parallel, structure inhibit thought patterns. By giving too many ideas that are presented in different word orders from one another, non-parallel sentences can become brain-teasers. In the first example, different forms of the two verbs (to study and to investigate) are used. In the second example, 208 Writing style the list needs to be standardised. You can write a list in which each item has a verb or you can write a list in which no items have a verb, but the list must be consistent. The first example is difficult to understand because the two different methods of describing the data from men and women are inconsistent. By simply making overweight the object of the sentence rather than an adjective in the first clause and by standardising the way in which results from the two studies are described, the message becomes much easier to comprehend. The first two and the final item are each reported in a consistent “subject–verb–object way. This confuses readers who expect to be able to process the words in the same order in each clause. The sentence becomes clearer when the third item becomes parallel by moving the verb to the centre and when two items with the same subject (follow up assessments) are merged. The sentence is reduced by only four words but the parallelism and therefore the flow and the readability are improved significantly. Similarly, in the third example, the sentence becomes clearer when the percentage is placed before the verb in both clauses rather than at the beginning of one clause and end of the next. If you are comparing two groups, always make one group the comparison group as shown in the fourth example. In the corrected sentence, indigenous children are the group of interest, and non-indigenous children, in the context of the study, are the control group. This avoids confusion in trying to understand which illnesses were more or less prevalent in which group. Parallelism can also be achieved between sentences by making them match one another in construction. If you are comparing data from two groups, then always cite the groups in the same order.

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Accordingly doxycycline 200mg low cost, disorders the aim is to facilitate the heel-to-toe roll as much as pos- Apert syndrome (Acrocephalosyndactyly) sible discount 200 mg doxycycline overnight delivery. If the great toe shows pronounced medial deviation or the metatarsal head shows plantar protrusion order doxycycline 200 mg on-line, it may be > Definition necessary to prevent any additional handicap by means of Simultaneous occurrence of synostoses on both hands an osteotomy (⊡ Fig order 100mg doxycycline with amex. In view of the lack of compensation options, tosomal dominant hereditary disorder (for a detailed surgery is indicated relatively often. Clinical features, diagnosis The foot deformity in Apert syndrome is very characteris- Foot abnormalities in various syndromes tic, and its development can be predicted. The great toe becomes increasingly shorter Thus macrodactyly, syndactyly and polydactyly all oc- and deviates in a medial direction. A langeal joint gradually deteriorates during the course of metatarsus varus and clinodactyly are also frequently ob- growth. The ring constriction syndrome (amniotic band show bony connections between the individual bones. Note the lack of segmentation between the toes, the medial tarsals, bottom after removal by chiseling of the exostosis on the 1st deviation of the great toes and the plantar projection of the 2nd metatarsal and osteotomy of the 2nd and 3rd metatarsals metatarsal on the right. AP and lateral x-rays of the right foot in a 10-month old girl with amni- otic band syndrome. Note the constriction at metatarsal level and the rudimentarily formed and incompletely segmented toes The Prader-Willi syndrome ( Chapter 4. Czeizel AE, Vitez M, Kodaj I, Lenz (1993) An epidemiological study brodysplasia ossificans progressiva ( Chapter 4. J Med Genet 30 anomalies of the great toes are invariably present, although (7): 593–6 in widely varying forms. Foulkes GD, Reinker K (1994) Congenital constriction band syn- observed in pterygium syndrome ( Chapter 4. J Pediatr Orthop 14: 242–8 abnormalities also commonly occur in diastrophic dwarf- 16. Gonzales P, Kumar, SJ (1990) Calcaneonavicular coalition treated by resection and interposition of the extensor digitorum brevis ism ( Chapter 4. J Bone Joint Surg (Am) 72: 71–85 ductus is present, in 37% an equinovarus adductus and, 17. Grogan DP, Holt GR, Ogden JA (1994) Talocalcaneal coalition in in 8%, an equinus deformity. There is increasing patients who have fibular hemimelia or proximal femoral focal evidence to suggest that amniocentesis can cause foot ab- deficiency. A comparison of the radiographic and pathological normalities, particularly if it is performed before the 13th findings. Guidera KJ, Brinker MR, Kousseff BG, Helal AA, Pugh LI, Ganey TM, Ogden JA (1993) Overgrowth management of Klippel-Tre- naunay-Weber and Proteus syndromes. Hadley N, Rahm M, Cain TE (1994) Dennyson-Fulford subtalar Apert’s syndrome. Harris RI (1965) Retrospect: Peroneal spastic flat foot (rigid valgus Paris 23: 1210–8 foot). Hefti F, Dick W, Fasel J (1985) Akzessorische Muskeln in der Retro- teus syndrome. J Hand Surg (Am) 17: 32–4 malleolarregion als Ursache von Weichteilschwellungen. Bennett GL, Weiner DS, Leighley B (1990) Surgical treatment of Praxis 21: 729–33 symptomatic accessory tarsal navicular. Bettin D, Karbowski A, Schwering L (1996) Congenital ball-and- ankle joint: anatomical and kinematic analysis of the hindfoot. Johnon JD, Buratti RA, Balfour GW (1993) Accessory peroneus hands and feet. Arch Orthop Trauma Surg 107: 334–44 brevis muscle [see comments] J Foot Ankle Surg 32: 132–3 7. Joseph B, Jacob T, Chacko V (1984) Hallux varus–a study of thirty dungen. Kawashima T, Uhthoff HK (1990) Prenatal development around cation based on roentgenographic morphology.

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ETHNOCULTURAL VARIATIONS IN PAIN 173 and that societies that openly express pain also seem to openly express joy or happiness discount 100mg doxycycline amex. We have not clarified the definitions of race and ethnicity quality 200 mg doxycycline, often using them interchangeably 200 mg doxycycline for sale. Many scholars challenge the concept of “race-as- biology buy discount doxycycline 100 mg line,” arguing that it is, in fact, a social construct (Goodman, 2000). No genetic signature identifies individuals as members of a particular race, and even the term ethnicity leads to confusions (Dimsdale, 2000; Morris, 2001). A twin study of laboratory pain sensitivity (MacGregor, Griffiths, Baker, & Spector, 1997) found equally high correlations between both monozygotic and dizygotic twins, leading to the conclusion that “there is no significant genetic contribution to the strong correlation in pressure pain threshold that is observed in twin pairs. These findings reinforce the view that learned patterns of behavior within families are an important determinant of perceived sensitivity to pain” (p. A recent investigation by Raber and Devor (2002) showed that in rats the characteristics of a cagemate can largely override genetic predispositions to pain behavior, possibly through the influence of stress. They concluded: Can the presence of social partners affect pain behavior without actually al- tering felt pain? In animals, we have no direct access to information of pain ex- perience except as reflected in behavior. Could genotype or social convention (including the presence of specific others) change outward pain behavior without actually affecting the “raw feel” of the pain? In humans, the answer is clearly yes, although intuitively one imagines that rodents are less bound by social context (innate or learned), and that pain behavior should therefore more faithfully reflect actual pain sensation. Black, and White, and Asian groups within a single society such as the United States may have enormous differences in child-rearing practices, modeling, and behavioral reinforcement, in addition to whatever genetic factors might distinguish them. One cannot legitimately lump together individuals from China, Japan, Thailand, the Philippines, Singapore, Korea, Indonesia, and so on and pre- tend that they share a single cultural identity that can be labeled “Asian. This is not to say that there are no differences between racial or ethnic groups. Rather, it is to encourage extreme caution in statements based on 174 ROLLMAN small numbers in a single community. African Americans living in a major metropolitan area or a university town are not representative of all African Americans and are certainly not representative of all Blacks. We cannot have it both ways with regard to White participants: to proclaim the sup- posed differences between Irish, Italians, Poles, and Scandinavians, and then to randomly lump a cluster of them together as “Whites” or “Cauca- sians” when we need a group to contrast with Blacks or Asians. It is misleading and potentially detrimental to generalize to all members of one group based on a handful of subjects, often obtained nonrandomly, and who differ from other members of their group in myriad respects. The NIH Guidelines for Inclusion of Women and Minorities as Subjects in Clinical Research (http://grants1. To the extent that such research shows that there are ethnocultural dif- ferences in pain or the effects of analgesics or the degree of negative affect or the effects of psychosocial interventions, we have a responsibility to identify the evidence and take appropriate action to modify clinical prac- tice guidelines. At the moment, it seems we are best able to say that all pa- tients should be carefully evaluated and treated with respect. Irrespective of their ethnocultural status, their pain reports must be accepted and all ef- forts must be undertaken to reduce their pain and distress. ACKNOWLEDGMENTS Partial support for the preparation of this chapter came from a research grant from the Natural Sciences and Engineering Research Council of Can- ada. I wish to thank Heather Whitehead for her assistance in obtaining cop- ies of the many papers on the topic of this review. Musculoskeletal pain is more generalised among people from ethnic minorities than among white people in Greater Manchester. The pain locus of control orientation in a healthy sample of the Italian population: Sociodemographic modulating factors. Methods used by urban, low- income minorities to care for their arthritis. Race, ethnicity, and pain treatment: Striving to understand the causes and solutions to the disparities in pain treatment. American and Japanese chronic low back pain patients: Cross-cultural similarities and differences. Review of literature on culture and pain of adults with fo- cus on Mexican-Americans.

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Hadjistavropoulos best doxycycline 200mg, Ross 200 mg doxycycline free shipping, and von Baeyer (1990) found that physicians were inclined to attribute lower levels of pain trusted 200mg doxycycline, distress buy cheap doxycycline 200 mg line, and need for help and higher ratings of health when people in pain were attrac- tive rather than unattractive. Hadjistavropoulos, McMurtry, and Craig (1996) similarly found that the physically attractive and male patients were perceived as experiencing less pain intensity and disability than less attrac- tive and female patients. Physically attractive patients were also perceived as being less likely to catastrophize and less likely to receive compensation than were unattractive patients. Finally, attractive patients were judged as being more likely to use cognitive and behavioral coping strategies than less attractive patients. These impressions were unrelated to actual patient functioning (as assessed using psychometrically valid instruments). The finding that men were viewed as having less pain and disability than women is especially interesting given that, in at least one study (Cleeland et al. In another study, Hadjistavropoulos, LaChapelle, Hale, and MacLeod (2000) investigated observers’ perceptions of patients who dif- fered with respect to age and who were undergoing a painful medical pro- cedure (after controlling for actual levels of patient pain expressiveness). Results showed that older and less physically attractive patients were perceived as experiencing more pain and having lower overall functioning. SOCIAL INFLUENCES AND COMMUNICATION OF PAIN 103 The coping style of the patient may also interfere with the ability to make accurate judgments about pain and disability. For example, does the individual who reacts with stoicism to pain receive as much attention as an- other who reacts in a melodramatic fashion? MacLeod, LaChapelle, Hadji- stavropoulos, and Pfeifer (2001) asked undergraduate students to make judgments about pain patients who claimed disability compensation. The patients were described in short fictitious vignettes that highlighted differ- ent approaches of coping with pain. Despite keeping the patients’ self- reported level of pain constant across all vignettes, claimants who were de- scribed as catastrophizing or coping with pain largely by hoping for divine intervention were more likely than other claimants to be perceived as dis- abled and as deserving compensation. A further study (von Baeyer, John- son, & Macmillan, 1984) was consistent with the proposition that vigorous complaints led to more sympathetic reactions. High nonverbal expressive- ness yielded significantly higher ratings of patients’ pain and distress, and observer concern. However, in another vignette study, Chibnall and Tait (1999) did not find any evidence that ethnicity (Caucasian vs. African Ameri- can) affected symptom evaluations by employees of a university health cen- ter. Nonetheless, involvement of social psychological factors in judgments of pain make the task more complex than it might appear on the surface. Actions to Assist Persons Who Are in Pain Pain interventions stem directly from the observer’s understanding of the patient’s experience of pain. Family members and health care practitioners typically attempt to provide relief, although exceptions are inevitable. Family members might believe that the pain suffered by kin is desirable—for example, when neces- sary medical procedures are used, or when cultural or religious rituals are followed. The following examples illustrate special contexts in which pain communication assumes particular importance. The onset of painful conditions, whether as a result of physical injury or disease, ordinarily pro- vokes sympathy and support from family members. Usually, these condi- tions are self-limiting or responsive to treatment. Therefore, the length of time the sick role elicits responsive behavior from family members is lim- ited. However, many people suffer from chronic pain, either recurrent or unremitting. In this case, special demands are made of family members who are unexpectedly committed to intense relationships with patients whose lives are often transformed by chronic pain. The relationship between the 104 HADJISTAVROPOULOS, CRAIG, FUCHS-LACELLE person in pain and the other family member has the potential to have an impact on both pain and pain-related disability. The operant model of chronic pain emphasizes the potential of social re- inforcement to perpetuate pain and disability (Block, Kremer, & Gaylor, 1980a; Fordyce, 1976). This model has been supported by studies that dem- onstrated a relationship between pain-relevant interactions, particularly so- licitous attention from the spouse, and pain reports, pain behaviors fre- quency, and disability ratings (Kerns, Haythornthwaite, Southwick, & Giller, 1990; Kerns, Haythornthwaite, Rosenburg, Southwick, Giller, & Jacob, 1991; Flor, Kerns, & Turk, 1987; Flor, Turk, & Rudy, 1989; Romano et al.

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