By P. Potros. The Baptist College of Florida. 2018.

Acute esotropia has been described following contralateral thalamic infarction purchase dutas 0.5mg fast delivery. Cross References Amblyopia; Cover tests; Diplopia; Exotropia; Heterotropia; Nystagmus Ewart Phenomenon This is the elevation of ptotic eyelid on swallowing generic 0.5mg dutas amex, a synkinetic move- ment. The mechanism is said to be aberrant regeneration of fibers from the facial (VII) nerve to the oculomotor (III) nerve innervating the levator palpebrae superioris muscle. Cross References Ptosis; Synkinesia, Synkinesis Exophoria Exophoria is a variety of heterophoria in which there is a tendency for the visual axes to deviate outward (latent divergent strabismus). Clinically this may be observed in the cover-uncover test as an inward movement as the covered eye is uncovered. Exophoria may occur in individuals with myopia, and may be physiological in many subjects because of the alignment of the orbits. Cross References Cover tests; Esophoria; Heterophoria Exophthalmos Exophthalmos is forward displacement of the eyeball. Cross References Lid retraction; Proptosis Exotropia Exotropia is a variety of heterotropia in which there is manifest out- ward turning of the visual axis of an eye; the term is synonymous with divergent strabismus. It may be demonstrated using the cover test as an inward movement of the eye which is forced to assume fixation by occlusion of the other eye. When the medial rectus muscle is paralyzed, the eyes are exotropic (wall-eyed) on attempted lateral gaze toward the paralyzed side, and the images are crossed. Cross References Cover tests; Esotropia; Heterotropia Extensor Posturing - see DECEREBRATE RIGIDITY External Malleolar Sign - see CHADDOCK’S SIGN - 113 - E External Ophthalmoplegia External Ophthalmoplegia - see OPHTHALMOPARESIS, OPHTHALMOPLEGIA Extinction Extinction is the failure to respond to a novel or meaningful sensory stimulus on one side when a homologous stimulus is given simultane- ously to the contralateral side (i. It is important to show that the patient responds appropriately to each hand being touched individually, but then neglects one side when both are touched simultaneously. More subtle defects may be tested using simultaneous bilateral heterologous (asymmetrical) stimuli, although it has been shown that some normal individuals may show extinction in this situation. A motor form of extinction has been postulated, manifesting as increased limb akinesia when the contralateral limb is used simultane- ously. The presence of extinction is one of the behavioral manifestations of neglect, and most usually follows nondominant (right) hemisphere lesions. There is evidence for physiological interhemispheric rivalry or competition in detecting stimuli from both hemifields, which may account for the emergence of extinction following brain injury.

The inward sign was the effortless way in which he immediately established affectionate relationships with most children cheap dutas 0.5mg free shipping, and working relationships with even the intractable discount 0.5 mg dutas visa. To be with him in a children’s ward was always an education in the art of surgery. Before such patients were George Patrick MITCHELL segregated, he would give me his advice upon orthopedic problems most generously: and—like 1917–1993 the man—it was always simple advice, and emi- nently practicable. George Patrick Mitchell, past president of the Mitchell’s broad education, wide interests and British Orthopedic Association, came from a long experience made him a wise counsellor. His medical background, his father having been a opinions were always definite and expressed in general practitioner in Aberdeenshire. If the matter were private, was educated at Trinity College, Glenalmond, one had to be prepared, on occasion, for unpalat- where he captained the shooting team that won able advice; often enough further reflection the Ashburton Shield at Bisley, and at Aberdeen showed him to be right. Soon after graduating in 1940, he complete disinterestedness made his opinions became Regimental Medical Officer to the 23rd and advice most influential; and I believe that it Hussars and had a distinguished military career, played a substantial part in the rapid and friction- which ended in 1944 when he was wounded in less establishment of the orthopedic service in the Normandy in an action for which he received the north-east. Throughout his life his military knew it: and he was careful that others knew his experience was evident in his bearing and in his mind. But no thought of himself was allowed to disciplined approach to work and recreation. Only two things disturbed his gener- after the war and continued at the Nuffield ally benevolent outlook: sins of omission, and Orthopedic Centre in Oxford. James, who came to He was good enough to serve two terms as Edinburgh as professor in 1957, recognized the an examiner in surgery in the University of value of specialization within orthopedics (a Edinburgh, and an excellent examiner he was— rather innovative concept at that time) and simple, direct and eminently fair. The whole staff encouraged George to develop his interests in 235 Who’s Who in Orthopedics pediatric orthopedics, which had been kindled by Joseph Trueta and Edgar Somerville in Oxford. He established in Edinburgh one of the most suc- cessful neonatal screening programs for congeni- tal dislocation of the hip and acquired an international reputation in the treatment of this disorder. Perhaps as a result of his experience as one of the early ABC Traveling Fellows in 1954, he rec- ognized the importance of international contacts and exchange of ideas.

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Basic airway manoeuvres Manoeuvres to open the airway differ from those used in the management of primary cardiac arrest discount 0.5mg dutas with mastercard. The standard head tilt and chin lift results in significant extension of the cervical spine and is inappropriate when cervical spine injury is suspected buy 0.5mg dutas with visa. These are: G Jaw thrust—the rescuer’s fingers are placed along the angle of the jaw with the thumbs placed on the maxilla. The jaw is then lifted, drawing it anteriorly, thus opening the airway G Chin lift—this achieves the same as a jaw thrust by lifting the tip of the jaw anteriorly. Airway adjuncts If basic airway manoeuvres fail to clear the airway, consider the use of adjuncts, such as an oropharyngeal (Guedel) or nasopharyngeal airway. The oropharyngeal airway is inserted into the mouth inverted and then rotated 180 before being inserted fully over the tongue. The nasopharyngeal airway is inserted backwards into the nostril as far as the proximal flange, using a safety pin to prevent it slipping into the nostril. It should be used with caution in patients with suspected basal skull fracture. Blood, saliva, and vomit frequently contribute to airway obstruction and must be removed promptly. Be prepared to roll the patient and tip them head down if they vomit, taking particular care of those who cannot protect their airway—for example, those who are unconscious or those on a spinal board. The oropharyngeal (Guedel) airway is inserted into the mouth inverted and then rotated 180 before being inserted fully over the tongue Definitive airways It is important to secure the airway early to allow effective ventilation. The gold standard is endotracheal intubation because a cuffed tracheal tube isolates the airway from ingress of debris. Unless patients are completely obtunded with a Glasgow Coma Score (GCS) of 3, intubation can only be performed safely with the use of anaesthetic drugs and neuromuscular blocking drugs, together with cricoid pressure to prevent aspiration of gastric contents. Distorted anatomy, blood, and secretions, and the presence of a hard cervical collar all impair visualisation of the vocal cords. Removal of the collar and use of manual inline stabilisation will improve the view at laryngoscopy.

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If a market re- searcher has stopped you on the streets dutas 0.5 mg sale, or you have filled in a questionnaire which has arrived through the post 0.5mg dutas amex, this falls under the umbrella of quantitative research. This type of research reaches many more people, but the con- tact with those people is much quicker than it is in quali- tative research. Qualitative versus quantitative inquiry Over the years there has been a large amount of complex discussion and argument surrounding the topic of re- search methodology and the theory of how inquiry should proceed. Much of this debate has centred on the issue of qualitative versus quantitative inquiry – which might be the best and which is more ‘scientific’. Different meth- odologies become popular at different social, political, historical and cultural times in our development, and, in my opinion, all methodologies have their specific strengths and weaknesses. At the end of this chap- ter references are given if you are interested in following up any of these issues. Certainly, if you were to do so, it 16 / PRACTICAL RESEARCH METHODS would help you to think about your research methodology in considerable depth. Deciding which methodology is right for you Don’t fall into the trap which many beginning (and ex- perienced) researchers do in thinking that quantitative re- search is ‘better’ than qualitative research. Neither is better than the other – they are just different and both have their strengths and weaknesses. What you will find, however, is that your instincts probably lean you towards one rather than the other. Listen to these instincts as you will find it more productive to conduct the type of re- search with which you will feel comfortable, especially if you’re to keep your motivation levels high. Also, be aware of the fact that your tutor or boss might prefer one type of research over the other. If this is the case, you might have a harder time justifying your chosen methodology, if it goes against their preferences. EXAMPLES OF QUALITATIVE RESEARCH METHODOLGIES Action research Some researchers believe that action research is a re- search method, but in my opinion it is better under- stood as a methodology. In action research, the researcher works in close collaboration with a group of people to improve a situation in a particular setting.

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