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Type I error A term used when a statistically signiﬁcant difference between two study groups is found although the null hypothesis is true order indocin 75mg amex rheumatoid arthritis doterra. Univariate tests Descriptive tests in which the distribution or summary statistics for only one variable are reported order generic indocin canada arthritis in dogs tablets. Unstandardized coefﬁcients These are the regression coefﬁcients in the equation y = a + bx buy 25 mg indocin with visa arthritis diet dogs,where‘a’ is the constant and ‘b’ is the coefﬁcient for explanatory variable. Variance A measure of spread that is calculated from the sum of the deviations from the mean, which have been squared to remove negative values. Wilcoxon signed rank (or matched pairs) test A non-parametric equivalent of the paired t-test that tests whether the median of the differences between pairs of observations is equal to zero. Values can be converted to z scores for variables with a normal or non-normal distribution; however, conversion to z scores does not transform the shape of the distribution. Also has detailed information on different effect sizes measures and how they are calculated. Epidemiologic statistics, tables, graphs, maps and sample size calculations conﬁdence intervals around a proportion can be produced. The site also has links to education notes, calcula- tion spreadsheets and statistical software. There is a section on the site that shows how to Useful websites 383 compute 95% conﬁdence intervals around a median values. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, or under terms agreed with the appropriate reprographics rights organization. International, Padstow Dedication To my late father George McDonald (1918–1983) whose love of words both ancient and modern was as ﬁne a legacy as any son could ask for. This page intentionally left blank Preface The Oxford Dictionary of Medical Quotations is intended to be a rich source of quotations covering a variety of medically related topics. Those selected have been deliberately kept short in an effort to highlight the pithiest phrase or the sharpest insight. They have been selected on the basis of their use- fulness to modern medical authors, journalists, politicians, nurses, physios, lecturers, and even health managers, who will always have need to season their works with the clever or witty phrases of former colleagues whose intuitions still say as much today as when they were ﬁrst published. Many reﬂect the compiler’s tastes and prejudices but there will be something for everyone within these pages. Browsing through many texts to ﬁnd the most appropriate quotations to include in the Oxford Dictionary of Medical Quotations has afforded an insight into both medical history as well as the nature of the doctors and others who have chiselled these phrases. A glance for the casual reader not looking for a speciﬁc quote will be rewarding in itself. Quotations are listed under author, with an index of keywords that permits the reader to access a number of quotes with the same keyword. Wherever possible, biographical information about the author and whence the quote originated are included, although it is acknowledged that there are several omissions in this regard. When the original source is not clear, the secondary source has been substituted if it was thought useful for further study for the reader. If the quotation was deened to merit a place in the Dictionary even without full reference being available, it was included. Indeed, it is not necessary for an author to be particularly well known to be in the dictionary if he or she had given birth to a bon mot or a succinct phrase. The majority of the quotations come from the English-speaking medical worlds of Great Britain, Ireland, and North America but several quotes from other rich medical cultures have been included in translation. Whether readers are looking for a suitable quotation on surgery, science, kidneys, or kindness, they should ﬁnd much here to satisfy. Medicine is both the narrowest and broad- est of subjects, and I have included examples of both the speciﬁc and the general. If I have failed to ﬁnd that favourite concise quote, please send it fully referenced and it will be included in the next edition. Any corrections of birth dates and deaths will be most wel- come and acknowledged in subsequent editions. This page intentionally left blank Contents Quotations Bibliography Index How to Use the Dictionary The sequence of entries is by alphabetical order of author, usually by surname but with occasional exceptions such as imperial or royal titles, authors known by a pseudonym (‘Zeta’) or a nickname (Caligula). In general authors’ names are given in the form by which they are best known, so we have Mark Twain (not Samuel L. Collections such as Anonymous, the Bible, the Book of Common Prayer, and so forth, are included in the alphabetical sequence.
In its late (tertiary) stage generic 75mg indocin amex arthritis qld facebook, yaws can destroy and deform areas of the skin purchase 50mg indocin amex arthritis in neck and tinnitus, bones buy indocin 75 mg on-line magnets for arthritis relief, and joints. Diagnosis is confirmed via blood tests and via dark-field examination of the spirochete under a Yy microscope. Y In chemistry, the symbol for the element yttrium, an extremely rare metal that has been used yeast A group of single-celled fungi that repro- in certain nuclear medicine scans. The Y chromosome contains the teria, although this balance can be upset by illness, unique male-determining gene and the male fitness immune system problems, or antibiotic use. For example, the common on the Y chromosome have counterparts on the X yeast Candida albicans (once called Monilia) chromosome, are active in many body tissues, and causes thrush and rashes, fingernail infections, vagi- play crucial “housekeeping” roles with the cell. See also Candida region on the Y chromosome that decides the sex of albicans; candidiasis; thrush; yeast infection; the individual. It encodes the testis-determin- yeast diaper rash Infection in the diaper area of ing factor. The infected breasts), do not menstruate, and have scarred skin is usually fiery red with areas that may have a (fibrous) gonads without eggs. Yeast infections occur most frequently yawn Involuntary opening of the mouth, accom- in moist areas of the body. Although Candida albi- panied by slowly breathing inward and then out- cans and other Candida yeasts are the most frequent ward. Repeated yawning can be a sign of offenders, other yeast groups are known to cause drowsiness, boredom, or depression. Treatment involves use of topical or oral anti- yaws A chronic infectious disease that occurs fungal medications. See also Candida albicans; commonly in the warm, humid regions of the trop- candidiasis; thrush; yeast vaginitis; yeast rash. Yaws is characterized by bumps on the skin of the face, hands, feet, and genital area. Almost all yeast rash A slightly raised pink-to-red rash that cases of yaws are in children under 15 years of age. Yeast rash is most common chete bacteria, Treponema pertenue, which enters in infants, but it can also occur on the skin of older the skin at a scraped or cut spot after contact with children and adults. A painless bump (the mother affected area clean and dry and applying topical yaw) arises and grows at this spot. In selected cases, allergy injection burning, soreness, pain during intercourse and uri- therapy is highly effective for prevention. Yeast vaginitis occurs when new yeast are introduced into the vagina or Yersinia A family of bacteria that includes when the quantity of yeast in the vagina increases Yersinia pestis, which causes the bubonic, pneu- relative to the quantity of bacteria. Common symptoms include itching, burning, sore- Y-linked A gene on the Y chromosome that is ness, pain during intercourse and urination, and passed from father to son. Yellow fever efits for increasing physical flexibility and reducing occurs in sub-Saharan Africa and tropical South internal feelings of stress. Diagnosis is made via observation and, if mended as an alternative or complementary health- necessary, culturing or examining blood samples. Nonaspirin pain relievers, rest, and rehydration with yogurt Milk that is fermented with a culture fluids decrease discomfort. Yellow fever disease can of Lactobacillus (the milk bacillus) and often with be prevented with a vaccination. Yellow fever vaccination is recommended for people travel- yolk sac The membrane outside the human ing to or living in the tropical areas in the Americas embryo. Because yel- yolk stalk or omphalomesenteric duct, through the low fever vaccination is a live vaccine, it should not umbilical opening to the embryo’s midgut. The yolk be given to infants or people with immune-system sac serves as an early site for the formation of blood, and in time it is incorporated into the prim- problems. Avoidance and prompt treatment of allergic reac- youth The time between childhood and maturity.
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This handbook should be available for anyone in the team to refer to at any time to facilitate considered data collection and data analysis practices discount indocin online master card arthritis relief herbal. Suggested contents of data analysis log sheets that could be kept in the study handbook are shown in Box 1 25 mg indocin otc arthritis labs. In this buy indocin 25 mg lowest price rheumatoid arthritis diet remission, it is important that data are treated carefully and analysed by people who are familiar with their content, their meaning and the interrelationship between variables. Before beginning any statistical analyses, a data analysis plan should be agreed upon in consultation with the study team. The plan can include the research questions or hypotheses that will be tested, the outcome and explanatory variables that will be used, the journal where the results will be published and/or the scientiﬁc meeting where the ﬁndings will be presented. A good way to handle data analyses is to create a log sheet for each proposed paper, abstract or report. The log sheets should be formal documents that are agreed to by all stakeholders and that are formally archived in the study handbook. When a research team is managed efﬁciently, a study handbook is maintained that has up-to-date docu- mentation of all details of the study protocol and the study processes. This is especially important when the data set will be accessed in the future by researchers who are not familiar with all aspects of data collection or the coding and recoding of the variables. Data management and documentation are relatively mundane processes compared to the excitement of statistical analyses but are essential. Laboratory researchers document every detail of their work as a matter of course by maintaining accurate laboratory books. All researchers undertaking clinical and epidemiological studies should be equally dili- gent and document all of the steps taken to reach their conclusions. Documentation can be easily achieved by maintaining a data management book with a log sheet for each data analysis. In this, all steps in the data management processes are recorded together with the information of names and contents of ﬁles, the coding and names of variables and the results of the statistical analyses. Many funding bodies and ethics committees require that all steps in data analyses are documented and that in addition to archiving the data, the data sheets, the output ﬁles and the participant records are kept for 5 years or up to 15 years after the results are published. Although it may be tempt- ing to jump straight into the analyses that will answer the study questions rather than spend time obtaining descriptive statistics, a working knowledge of the descriptive statis- tics often saves time by avoiding analyses having to be repeated for example because outliers, missing values or duplicates have not been addressed or groups with small numbers are not identiﬁed. When entering data, it is important to crosscheck the data ﬁle with the original records to ensure that data has been entered correctly. It is important to have a high standard of 14 Chapter 1 data quality in research databases at all times because good data management practice is a hallmark of scientiﬁc integrity. Describing the charac- teristics of the sample also allows other researchers to judge the generalizability of the results. This is preferable to using an implausible value such as 9 or 999 which was commonly used in the past. If these values are not accurately deﬁned as discrete missing values in Missing column displayed in Variable View, they are easily incorporated into the analyses, thus producing erroneous results. Although these values can be predeﬁned as system missing, this coding scheme is discouraged because it is inefﬁcient, requires data analysts to be familiar with the coding scheme and has the potential for error. In the spreadsheet, the variable for ‘place of birth’ is coded as a string variable. If the variable had been deﬁned as numeric, the missing values would have been omitted. When collecting data in any study, it is essential to have methods in place to pre- vent missing values in, say, at least 95% of the data set. Methods such as restructuring questionnaires in which participants decline to provide sensitive information or train- ing research staff to check that all ﬁelds are complete at the point of data collection are invaluable in this process. In large epidemiological and longitudinal data sets, some missing data may be unavoidable. However, in clinical trials, it may be unethical to col- lect insufﬁcient information about some participants so that they have to be excluded from the ﬁnal analyses. If the number of missing values is small and the missing values occur randomly throughout the data set, the cases with missing values can be omitted from the anal- yses.
Homogene- Diagram of Hypnosis ity of variance means that the variances of the populations being represented are Study using an equal generic indocin 50mg line arthritis in knee stages. That is 50 mg indocin fast delivery arthritis medication starting with s, we assume that if we computed σ2 for each population 25mg indocin with amex castiva arthritis pain relief lotion, we would X Independent-Samples have the same answer each time. It is not required that each condition have the same n, but the ns should not be mas- is amount of hypnosis, sively unequal—a difference in the neighborhood of 10 to 20 is best. You’ll know if you meet these assumptions by seeing how the vari- ables are treated in previously published research related to your study. No Hypnosis Hypnosis Recall X X Scores X X Statistical Hypotheses for the ➝ X X Independent-Samples t-Test X X X X As usual, we may have a one- or a two-tailed test. For now, say that we don’t predict whether hypnosis will increase or decrease recall X X scores so we have a two-tailed test. The Independent-Samples t-Test 263 First, the alternative hypothesis: A relationship exists if one population mean 1 12 is larger or smaller than the other 1 22, producing two distributions, similar to that back in Figure 12. Perhaps there is no rela- tionship, so if we tested everyone under the two conditions, we would find the same population and. Thus, our two-tailed null hypothesis is H0: 1 2 2 5 0 H0 implies that both samples represent the same population of scores, having the same , so a relationship is not present. If our sample means differ, it’s because of sampling error in representing that one. Therefore, these are the two-tailed hypotheses for any independent-samples t-test, when you are testing an H0 that says there is zero difference between the populations. The Sampling Distribution for the Independent-Samples t-Test To understand the sampling distribution here, say that we find a mean recall score of 20 in the no-hypnosis condition and a mean of 23 in the hypnosis condition. We can sum- marize these results by looking at the difference between the means: Changing from no hypnosis to hypnosis results in a difference in mean recall of 3 points. We always test H0 by finding the probability of obtaining our results when there is not a relationship, so here we will determine the probability of obtaining a difference of 3 between two Xs when they both actually represent the same. Using the same ns as in our study, we select two random samples from one raw score population. We do this an infinite number of times and plot a frequency distribution of these differences, producing the sampling distribution of differences between means. This is the distri- bution of all possible differences between two means when they are drawn from one raw score population. On the X axis, each score is the difference between two randomly selected sample means. The mean of the sampling distribution is zero because, most often, both sample means will equal the of the population of raw scores, so their difference will be zero. However, sometimes X1 or X2 is larger, so the difference will be a positive or negative amount. Small negative or positive differences will occur relatively frequently, but larger differences occur less frequently. The larger the difference between the means, the farther into the tail of the distribution it lies. To test H0, we determine where our difference between means lies on this sampling dis- tribution. To do so, we compute a new version of tobt but it provides information similar to previous t-tests: A difference of zero between X1 and X2, located at the of the distribu- tion, produces a tobt of zero. A positive difference produces a positive tobt and a negative difference produces a negative tobt. Larger differences between the means are further into a tail of the distribution and have a larger tobt. Therefore, if the difference between our sam- ple means produces a tobt close to the center of the distribution, then our difference occurs frequently when H0 is true: In our example, our two samples are likely to represent the same population of recall scores. But, if tobt places our difference beyond tcrit, far into a tail of the sampling distribution, then this difference is unlikely when H0 is true: Our two samples are unlikely to represent the same population of recall scores. Computing the Independent-Samples t-Test In the previous chapter, you computed tobt by computing X and then performing three steps: (1) estimating the variance of the raw score population, (2) computing the esti- mated standard error of the sampling distribution, and (3) computing tobt. For the two- sample t-test, after computing X1 and X2, you perform three similar steps. Estimating the Population Variance First, calculate s2 for each condition, using X the formula 1©X22 ©X2 2 2 n sX 5 n 2 1 Each time, use the Xs from only one condition, and n is the number of scores in that condition.