A case of pseudo-bulbar paralysis acne scar removal order eurax 20gm with mastercard, due to lesions in each internal capsule; degeneration of direct and crossed pyramidal tracts acne on back eurax 20 gm sale. Neuropsychiatric disturbnces associated with idiopathic calcification of the basal ganglia acne 5 dpo cheap 20gm eurax with mastercard. Peduncular hallucinosis and right hemiparkinsonism caused by left mesencephalic parkinsonism acne jensen eurax 20gm line. The incidence of the grasp reflex following hemispheric lesion skin care urdu tips eurax 20 gm otc, and its relation to frontal damage skin care anti aging buy eurax 20 gm with mastercard. Akinetic mutism in a bone marrow transplant recipient following total-body irradiation and amphotericin-B chemoprophylaxis. Usefulness of primitive reflexes in demented and non-demented cerebrovascular patients in daily clinical practice. Diagnosing narcolepsy through the simultaneous clinical and electrophysiologic analysis of cataplexy. Phantom pain, residual limb pain, and back pain in amputees: results of a national survey. Prevalence and neurobehavioral correlates of pathological laughing and crying in multiple sclerosis. Prevalence of KluverBucy syndrome as a positive prognostic feature for the remission of traumatic prolonged disturbances of consciousness. Peduncular hallucinosis: magnetic resonance imaging confirmation of mesencephalic infarction during life. Non-paralytic motor disturbance and speech disorders: the role of the supplementary motor area. Alien hand syndrome: interhemispheric motor disconnection due to a lesion in the midbody of the corpus callosum. Unilateral lenticular infarcts: radiological and clinical syndromes, etiology, and prognosis. Apraxia of the left limb in a case of callosal disconnection: the contribution of medial frontal lobe damage. Der makroskopische Hirnbefund in meinem Falle von linksseitiger motorischer Apraxie. The organism: a holistic approach to biology derived from pathological data in man. Nonhemorrhagic infarction of the thalamus: behavioral, anatomic, and physiologic correlates. Bereavement among elderly people: grief reactions, post-bereavement hallucinations and quality of life. Three-arms: a case study of supernumerary phantom limbs after right hemisphere stroke. Left alien hand sign and mirror writing after left anterior cerebral artery infarction. Contribution of the supplmentary motor area and anterior cingulate gyrus to pathological grasping phenomena. Acute pseudobulbar mutism due to discrete bilateral capsular infarction in the territory of the anterior choroidal artery. Frontal release signs and cognition in people with schizophrenia, their siblings and healthy controls. The diagnostic implication of formal thought disorder in mania and schizophrenia: a reassessment. Emotional facial paresis in temporal lobe epilepsy: its prevalence and lateralizing value. Failure of metacontrol: breakdown of behavioral unity after lesions of the corpus callosum and inferomedial frontal lobes. Oculogyric crises as compulsion phenomena in postencephalitis: their occurrence, phenomenology and meaning. Comparison of three primitive reflexes in neurological patients and in normal volunteers. Non-painful phantom limb phenomena in amputees: incidence, clinical characteristics and temporal course. Exploration of dimensions of psychopathology in neuroleptic-naive patients with recentonset schizophrenia/schizophreniform disorder. Comparative and interactive human psychopharmacologic effects of ketamine and amphetamine: implications for gluatamatergic and dopaminergic model psychoses and cognitive function. External and extreme capsular stroke: clinical, topographical and etiologic patterns. Kluver-Bucy syndrome in a patient with nasopharyngeal carcinoma: a late complication of radiation brain injury. Simple formed hallucinations confined to the area of a specific visual field defect. Charles Bonnet syndrome: successful treatment of visual hallucinations due to vision loss with selective serotonin reuptake inhibitors. Obsessive-compulsive and other behavioral changes with bilateral basal ganglia lesions. Occipital lobe epilepsy: clinical characteristics, surgical outcome, and role of diagnostic modalities. Spontaneous visual phenomena with visual loss: 104 patients with lesions of retinal and visual afferent pathways. Opticosensory ataxia and alien hand syndrome after posterior cerebral artery territory infarction. Echolalia-palilalia as the sole manifestation of nonconvulsive status epilepticus. Neuropsychological alterations in patients with computed tomography-detected basal ganglia calcification. Isolated myoclonic alien hand as the sole presentation of pathologically established CreutzfeldtJakob disease: a report of two patients. Charles Bonnet syndrome with visual hallucinations of childhood experience: successful treatment of 1 patient with risperidone. Obsessivecompulsive behavior, hyperactivity, and attention deficit disorder in Sydnham chorea. Risperidone for the core symptom domains of autism: results from the study by the autism network of the research units on pediatric psychopharmacology. Peduncular hallucinosis associated with isolated infarction of the substantia nigra pars reticulata. Neuropsychiatric features of frontotemporal dementia: evaluation of consensus criteria and review. Supernumerary phantom limbs associated with left hemispheric stroke: case report and review of the literature. On the dissociation of voluntary and emotional innervation in facial paresis of central origin. Symptoms of dissociation in humans experiencing acute uncontrollable stress: a prospective investigation. Leuprolide treatment of sexual aggression in a patient with dementia and the Kluver-Bucy syndrome. Randomized controlled trial of dextromethorphan/quinidine for pseudobulbar affect in multiple sclerosis. Pathological laughter and crying in patients with multiple system atrophy-cerebellar type. Bromocriptine-responsive akinetic mutism following endoscopy for ventricular neurocysticercosis. Behavioral and psychological symptoms in patients with dementia as a target for pharmacotherapy with risperidone. Outcomes and indications of corpus callosum section for intractable seizure control. Pathological laughing and crying following stroke; validation of a measurement scale and a double-blind treatment study. Akinetic mutism from hypothalamic damage: successful treatment with dopamine agonists. Images in clinical medicine: volitional and emotional supranuclear facial weakness. Schizophrenia-like illness in velo-cardio-facial syndrome: a genetic subsyndrome of schizophrenia? A case of depersonalizationderealization syndrome during treatment with quetiapine. Visual hallucinations and mental state: a study of 14 Charles Bonnet syndrome hallucinations. Symptomatological differences distinguish between frontotemporal dementia and vascular dementia with a dominant frontal lobe syndrome. Prevalence of obsessivecompulsive disorder in patients with systemic lupus erythematosus. Laterality in behavior and bilateral motor organization in man before and after section of the corpus callosum. Prolonged spontaneous complex visual hallucinations and illusions as ictal phenomena. Disconnection syndrome in a right-handed patient with right hemispheric speech dominance. Catastrophic reaction after cerebrovascular lesions: frequency, correlates, and validation of a scale. An unusual case of the grasp reflex, with some observations on the volitional and reflex components. Isolated corpus callosal infarction secondary to pericallosal artery disease presenting as alien hand syndrome. A case of foreign accent syndrome without aphasia caused by a lesion of the left precentral gyrus. Diagnostic dyspraxia: clinical characteristics, responsible lesions and possible underlying mechanism. Schneiderian first rank symptoms: reconfirmation of high specificity for schizophrenia. Clinical, genetic, and neuropathologic characteristics of posterior cortical atrophy. Syndrome of Kluver and Bucy: reproduced in man by bilateral removal of the temporal lobes. Clinical evaluation of 14 patients with the Charles Bonnet syndrome (isolated visual hallucinations). Progressive late delayed postirradiation encephalopathy with Kluver-Bucy syndrome. Pseudobulbar palsy clinically and pathologically considered with the clinical report of five cases. Schneiderian first-rank symptoms associated with fluvoxamine treatment: a case report. Pathologic crying as a prominent behavioral manifestation of central pontine myelinolysis. Surgical division of commisural pathways in the corpus callosum: relation to spread of an epileptic attack. Positive spontaneous visual phenomena limited to the hemianopic field in lesions of central visual pathways. Four legs: illusory reduplication of the lower limbs after bilateral parietal lobe damage. A placebo-controlled randomized crossover trial of the N-methyl-D-aspartate acid receptor antagonist, memantine, in patients with chronic phantom limb pain. Accurate diagnosis is critical not only for prognostic purposes, but also because a not insignificant number of the diseases capable of causing dementia are treatable. Clinical features Dementia is a syndrome of multiple different etiologies characterized by a global decrement in cognitive functioning occurring in a clear sensorium, without significant confusion (Cummings 1987). When the condition is fully developed, patients display deficits in memory, abstracting abilities, calculations, and judgment. Memory impairment is manifest most prominently with short-term memory loss, as manifest during examination by an inability to recall all out of three words after 5 minutes; this memory loss may be apparent as one obtains a history and finds that patients have forgotten where they put their keys or wallets, or tend to forget what family members have told them earlier. Long-term memory also suffers, although not as severely as does the short-term type: patients may be unable to recall public facts, such as the names of the last four presidents, or biographical facts, such as where they last worked, or where they went to school. Whenever memory impairment is present, one also typically finds partial or complete disorientation to time and, albeit less commonly, to place. For example, an accountant may find it no longer possible to understand complex accounting formulae or a chess player may find it impossible to think out moves. Difficulties with calculations may be evident in dayto-day life as patients have trouble making change or balancing a checkbook. Patients may make ruinous financial agreements or allow themselves to be misled in a variety of ways. This may be of a specific type, such as the frontal lobe syndrome, but is more often non-specific. In some cases, previously maladaptive traits may become accentuated, as when an overly thrifty person becomes miserly. In other cases, new traits may appear: a previously shy person may become overly familiar or a well-mannered person may become sloppy and crude. Other deficits, such as aphasia, apraxia, or agnosia, may or may not be present, depending on the underlying cause of the dementia.
Further information can be found in the review of Leishmania by Oldfield and colleagues (1991) acne under the skin eurax 20 gm sale. The time of year when most troops were deployed during the Gulf War favored the low rate of Leishmania infection and the absence of sandfly fever acne 6 weeks postpartum order eurax 20 gm with mastercard. Cross and colleagues (1996) used weather station and satellite data to model Persian Gulf weather conditions and predict the seasonal distribution of the sandfly skin care in winter order eurax 20 gm visa. Laboratory studies among Gulf War veterans have failed to demonstrate any evidence of exposure to acne medication reviews cheap 20gm eurax with amex, or infection by acne 6 months after giving birth generic 20 gm eurax mastercard, the sandfly fever virus (Richards et al acne x lanvin cheap eurax 20 gm without prescription. Summary Sandfly fever was a significant source of morbidity in previous military engagements. Protective measures, including mosquito nets and insecticides along 66 Infectious Diseases with the timing of the operation, may have contributed to the lack of incident cases. Increased antibody titers have not been observed in individuals who served in the Gulf War. These combined findings suggest that sandfly fever is not a cause of the symptoms experienced by some individuals with Gulf War illnesses. This virus is a member of the family Totiviridae, a group of viruses that infect protozoa and fungi (Saiz et al. Viruses that infect protozoan parasites were first recognized in the 1960s; however, Leishmania-infecting viruses were discovered in 1988 (Chung et al. Although the molecular characteristics of this group of viruses have recently been elucidated, its relationship to clinical disease is essentially unknown. What Infected Patients Experience Much more evaluation needs to be completed to understand whether infection of Leishmania with Leishmaniavirus alters the pathogenesis of the protozoa in humans. What clinical manifestations, if any, result from this infection would be speculative. Diagnosis the diagnosis of infection with Leishmaniavirus in patients who harbor a Leishmania infection is made through the use of molecular diagnostic tech- Viral Diseases 67 niques (Saiz et al. However, this diagnostic technique is currently performed only in specialized research laboratories. Treatment and Prevention Because this virus is present only in patients infected by Leishmania, the treatment and prevention are the same as those described in the discussion on Leishmania. Correlation with Gulf War Illnesses Because so little is known about this infection, correlation with unexplained Gulf War illnesses cannot be made at this time. However, because of the low rate of Leishmania among those who served in the Gulf War, it is unlikely that many, if any, veterans harbor this virus. Further research is needed to sufficiently understand the role of this virus in the pathogenesis of human disease. There is some speculation that the virus might modify the protozoan infection and influence the manifestations of disease in patients infected with Leishmania. At present, however, there is no evidence that a sufficient number of patients are infected with Leishmania that Leishmaniavirus could be present in more than, at most, a few individuals who served in the Gulf War. There are continuously evolving policies and guidelines on a global, national, state, institutional, and departmental level; thus, these guiding principles are intended to provide a framework to think about how to manage prostate cancer patients. The benefit of routine localized prostate cancer care should not be overestimated. Telehealth (phone or video) visits should be used, with rare exceptions, in place of inperson visits. If necessary given reallocation of staff/providers, telehealth visits can usually be safely deferred for patients with localized disease. Avoid, defer, and shorten/reduce routine care, staging, and treatment when possible: a. Encourage patients to have an adequate supply of oral cancer medications and supportive care medications on hand (and/or have delivered by mail). Educate patients receiving chronic steroids (eg, prednisone, methylprednisolone) and their caregivers that if they become sick, they may need stress-dose steroids. Consider non-myelosuppressive regimens when alternatives exist to minimize risk of immunosuppression and infectious complications. When cytotoxics are used consider growth factor support with administration of same-day growth factor injections or pegfilgrastim to minimize visits. Duration of androgen suppression before radiotherapy for localized prostate cancer: radiation therapy oncology group randomized clinical trial 9910. Evaluating the impact of length of time from diagnosis to surgery in patients with unfavourable intermediate-risk to very-high-risk clinically localised prostate cancer. Newborn Screening is a system coordinated by the Nebraska of Health and Human Services Newborn Screening Program collaborating with hospitals, laboratory, health care professionals and families and involving many elements including: Education of health care professionals and parents and efforts to increase public awareness. Appropriate and timely transport of specimens to the Newborn Screening laboratory. Appropriate referral of family to specialists for diagnosis, treatment and counseling. Each of these components of the system requires ongoing monitoring to ensure quality. The program, administered by the Department of Health and Human Services, also partnered with pediatric specialists in genetics, metabolism, endocrinology, hematology, pulmonology, and immunology to connect primary health care providers for babies who had positive screens with the appropriate subspecialist for diagnosis and treatment. An advisory committee with experts from these subspecialties, laboratory, hospitals, pediatrics, neonatology, family practice, as well as family representatives advised the program on technical and policy issues, monitoring quality, and professional and parent education through their quarterly meetings. The follow-up staff ensured that the health care provider for every newborn who requires additional testing, received the necessary information to act accordingly. The program completed ongoing evaluation and quality assurance activities throughout the year. The program sent educational updates to all birthing facilities as well as pediatricians and family physicians in Nebraska. The new reports monitoring the time from birth to specimen collection, collection to receipt at the lab, in-lab processing time and birth to results time, now measure the percent of specimens from each % meeting benchmark hospital meeting various benchmarks. Previously the reports only measured the Average performance on each measure average turnaround times on each of those measures. A new procedure for reporting hospital violations of newborn screening regulations to the Acute Facility Licensing Unit in the Department of Health and Human Services was developed, and implemented. This gives quicker feedback to hospitals and allows a more rapid response to systematically correct any problems. The University Of Nebraska College Of Nursing Accelerated Nursing Program subsequently partnered with the program on a project in the Fall/Winter of 2014. Further analysis will be conducted in 2015 to inform strategies for reaching out and providing more nurses with the knowledge and ability to be able to educate the patients and families with whom they work, about newborn screening. The nursing students were able to incorporate the project into their curriculum and report on the experience and what they learned to the rest of their class. They follow up until either a satisfactory screen has been completed, an inconclusive result has had a repeat screen, or a positive result has received confirmatory testing and a diagnosis is either made or ruled out. Follow-up can be complicated and a single baby may need it for multiple reasons, for example: an initial unsatisfactory specimen followed by a repeat specimen collected to0 close to the time of the last transfusion, followed by a result of multiple amino acid elevations consistent with hyperalimentation, or an inconclusive result for cystic fibrosis. This means ensuring the right test at the right time occurs for every baby who needs it, and appropriate consultation and referrals are made. The committee monitors national recommendations, trends, and reports, advising the program on recommended next steps, methods, or strategies. Members committed at least a half day every three months to advise the state program (collectively over 250 hours). Several members provide extensive review and consultation beyond the committee meetings to help the program meet the recommendations of the larger committee. The Title V Block Grant also funds the administrative aspects of the program (education, follow up, program management and quality assurance). Assurance of Treatment And Management For Inborn Errors In Metabolism To fulfill the statutorily-required public health assurance role, the Program contracted with the metabolic clinic through the University of Nebraska Medical Center to provide nutritional counseling and monitoring, and distribution of the metabolic formula. The program coordinated the day-to-day pharmaceutically manufactured metabolic foods program by helping families understand the program and stay connected, monitoring vendors with which the department contracted and processing payments for family orders. Families received a tracking log for their use in monitoring their orders and expenses and they received an annual spending report. During the last few months to ensure families could get the specialized foods that were otherwise unavailable, the program placed orders for families with another vendor that was carrying items not available from the contracted vendor. Working to optimize shipping times with the commercial overnight shipping company, and maximizing the efficiencies at the testing laboratory are also key to reporting out results on babies who need follow-up. Several factors can conspire to create delays in treatment, so speed and persistence in follow-up are essential. All parts of the system must work to reap the best benefits of early identification, treatment and intervention. Average age (days) Range in ages (days) Condition & number of babies diagnosed at intervention/tx. E Beta Thalassemia Disease E Beta Thal: 18 2 Sickle Beta Thalassemia S Beta Thal: 30-66 1 Beta Thalassemia Beta Thal: 27 1 Hgb. This data supports the need for continued funding for metabolic formula and foods required by patients identified with metabolic conditions via newborn screening. Introduction Approximately one to three in every 1,000 babies are born with permanent hearing loss, making hearing loss one of the most common birth defects in America. Before newborn hearing screening, children who were deaf or hard of hearing sometimes were not identified until 2Ѕ to 3 years of age. If detected soon after birth, the impacts can be reduced and even eliminated through early intervention. The Infant Hearing Act became a state law in Nebraska in 2000 and required the hearing screening of newborns in birthing facilities in Nebraska as a standard of care. Also in 2000, the Nebraska Department of Health and Human Services started the Nebraska Newborn Hearing Screening Program. This program strives to fulfill the following four main purposes of the Infant Hearing Act (Neb. To enable these children and their families and other caregivers to obtain needed multidisciplinary evaluation, treatment, and intervention services at the earliest opportunity. To prevent or mitigate the developmental delays and academic failures associated with late detection of hearing loss. To provide the state with the information necessary to effectively plan, establish, and evaluate a comprehensive system for the identification of newborns and infants who have a hearing loss. The Act also requires birthing facilities to educate parents about newborn hearing screening and any necessary follow-up care. The education includes information about the hearing screening test, the likelihood of the newborn having a hearing loss, follow-up procedures, and community resources, including referral for early intervention and a description of the normal - 13 - auditory, speech, and language developmental process in children. The Act also requires that regulations be promulgated to mandate newborn hearing screening if less than 95% of newborns in the state receive a hearing screening. Newborn Hearing Screening Data Reported for 2014 Birthing Facility Screening Programs Since 2003, 100% of the birthing facilities in Nebraska have been conducting hearing screenings, consistent with the Neb. Hearing Screening at Birthing Facilities and Birthing Centers In 2014, inpatient hearing screens were reported on 26,858 newborns, or 99. The percentage of newborns screened during birth admission has increased dramatically since reporting began in 2000, when only slightly more than one-third of newborns received a hearing screen during birth admission. An outpatient screening or audiology evaluation is recommended for infants who do not pass the inpatient screening or who do not receive the inpatient screening. Parent Education Recommending a hearing screening test has been operationally defined as educating parents about newborn hearing screening, hearing loss, and normal communication development as required by Neb. Birthing facilities reported educating over 99% of parents about newborn hearing screening, hearing loss, and normal speech and language development in 2014. This is accomplished through letters and printed materials sent to the parents, along with phone calls. The reasons for the 15% of infants not enrolling include: parents declining services, - 15 - unable to contact the family, family moved out of state, and no indication of developmental delay (diagnosed with slight or mild hearing loss). Reviewed the quarterly newborn screening statistics and made recommendations for program improvements. In 2014 there were 64 hearing aids provided to 37 children (age range of two months 18 years) by HearU Nebraska. Roots and Wings Parent Weekend the Roots and Wings parent weekend was held September 26-28, 2014 in Nebraska City at the Lied Lodge. The goal of this workshop was to provide: 1) families basic information on hearing loss, 2) an overview of current hearing technology, 3) knowledge on the various ways to communicate with deaf or hard of hearing individuals, 4) emotional support during the period after a family receives the diagnosis, and 5) an opportunity to network with other families. The purpose of the workshops was to help parents build skills for effective parental advocacy for their child. Website the Nebraska Early Hearing Detection and Intervention Program website was created and can be found at dhhs. One began focusing on how hearing screening results are presented to parents, by birthing facility staff, when the baby does not does not pass the inpatient newborn hearing screening. Hospital Site Visits During 2014, the program manager traveled Nebraska to visit 16 birthing facilities. Summary · All of the 56 birthing hospitals in Nebraska were conducting newborn hearing screening in 2014, all but one conducted the hearing screenings prior to discharge from the hospital or birthing center. In 2014, birthing hospitals reported screening the hearing of over 99% of newborns prior to discharge from the hospital. The overall "refer" rate (those who do not pass) during 2014 for hearing screening during birth admission was 2. Seven percent were still in the process of completing the outpatient screening/diagnostic protocol in 2015. In 2014, confirmatory audiologic evaluations were completed within three months of age for almost 70% of newborns who did not pass the inpatient/outpatient screening or did not receive an inpatient screening. There were 137 infants born in 2014 whose hearing status remains unknown due to: 1) parents refusing to follow the recommended hearing screening/testing protocol, 2) unreported results, 3) medical conditions causing postponed final hearing testing, and 4) families moving out of Nebraska. Eighty-five percent of the infants identified as deaf/hard of hearing and residing in Nebraska were verified for the Early Development Network and received special education services within six months of birth.
It occurs skin care 50th and france order eurax 20 gm with amex, by chance acne vs rosacea purchase 20 gm eurax with amex, about twice out of every 10 skin care gift packs discount eurax 20gm online,000 repetitions of the experiment acne scar removal eurax 20 gm low price. This outcome will occur about 19 times out of every 100 repetitions of the coin-tossing experiment acne guidelines generic 20 gm eurax with amex. If the event in question or an event more unusual would have occurred less than 5% of the time acne 40 years purchase 20 gm eurax free shipping, most psychological researchers are willing to make the judgment that the outcome is rare and ascribe it to nonchance factors. This cutoff point for inferring the operation of nonchance factors is referred to as the 0. When the observed event or one that is more deviant would occur by chance less than 1% of the time, we assert that the results are due to nonchance factors. It is conventional to refer to the results of the experiment as statistically significant at the 0. The level of significance set by the investigator for rejecting Ho is known as the alpha level. Let us look at a few examples of this statistical decision-making process: · Jeanette conducted a study in which she used = 0. Upon completing her statistical analysis, she found that the probability of obtaining such an outcome simply by chance was 0. She rejects Ho and asserts that the experimental variable had an effect on the dependent measure. Note that he cannot claim to have proved the null hypothesis, nor should he claim "there is a trend toward significance. Rather, they present critical values that define the region of rejection at various levels of. The region of rejection is that portion of the area under a curve that includes those values of a test statistic that lead to rejection of the null hypothesis. You may have noticed that in the above discussion we assumed a two-tailed test of significance. That is, the probability associated with the alpha level was split into the left and right tails of the sampling distribution to determine the critical values for the significance test. Most researchers use two-tailed tests, and most statistical software programs conduct two-tailed tests as the default. The two-tailed test is slightly more conservative, and it lets us reject the null hypothesis if the treatment increases or decreases scores on the dependent variable. However, if you are confident that your independent variable will only affect scores on the dependent variable in a particular direction, you may decide to use a one-tailed test of significance. In that case, you would place all of the probability associated with your alpha level into one tail of the sampling distribution. This results in a slightly more powerful analysis but risks the chance that the effect may go in the direction that is opposite of your prediction. If we reject Ho (conclude that Ho is false) when in fact Ho is true, we have made the error of falsely rejecting the null hypothesis. If we fail to reject Ho (we do not assert the alternative hypothesis) when in fact Ho is false, we have made the error of falsely accepting Ho. You should know that a Type I error can be made only when Ho is true because this type of error is defined as the mistaken rejection of a true hypothesis. It is beyond the scope of this book to delve into the calculation of probabilities. The concept of this error is important because, among other things, it relates to the economics of research. It would make little sense to expend large amounts of funds, tie up laboratory space and equipment, and devote hours of human effort to the conceptualization, conduct, and statistical analysis of research if, for example, the probability were as high as 90 percent. This would mean that the probability of making a correct decision-rejecting the false null hypothesis- would be only 10 percent. This probability-the probability of correctly rejecting the null hypothesis when it is false-is known as the power of the test. A failure to find a significant difference may cause a researcher to prematurely abandon a promising line of experimentation. As a consequence, potentially important discoveries may never be made because the researcher relegated a seminal idea to the junk heap. Clearly, one of the goals of the careful researcher must be to reduce the probability of error and, thereby, increase the power of the test. Among them are sample size, alpha level, and precision in estimating experimental error. Other things being equal, as you increase the sample size, you increase the power of your statistical test. In research in which the cost per participant is low, increasing the sample size may be an attractive way to boost power. However, the relationship between sample size and power is one of diminishing returns. Beyond a certain point, further increases in sample size lead to negligible increases in power. Balanced against this is the fact that increasing the level also increases the probability of falsely rejecting a true null hypothesis. If the consequences of making a Type I error are serious (claiming that a chemical compound cures a serious disease when it does not), it is desirable to set a low level. Thus, a chemical compound "proved safe after exhaustive testing" could lead to the introduction of a lethal compound into the marketplace. The third factor, control over the precision in estimating experimental error, is the one that should receive the most attention from a careful researcher. Any steps that lead to increased precision of our measurement of experimental error will also increase the power of the test. We can increase our precision in measuring experimental error in numerous ways, including improving the reliability of our criterion measure, standardizing the experimental technique, and using correlated measures. In a correlated samples design, for example, the power of the test will increase as the correlation between paired measures increases. We had more to say about this important topic in earlier chapters, where we noted that a feature of various research designs was the degree of precision in estimating both the effects of experimental treatments and the error variance. Thus, it is critical for the researcher to consider all of the factors discussed in the previous paragraphs to increase confidence that an erroneous conclusion will not be made. As noted above, we can increase the power of our experiment by increasing the sample size. At some point, we can use such large samples and have such high power that we begin to detect statistically significant differences that are, in fact, practically meaningless (the differences between the treatment group and control group are small and trivial). Measuring effect size is a helpful technique for separating statistical significance and practical significance. For r2 and 2, the value indicates the proportion of variance in the criterion variable that can be explained by the predictor variable. The larger the proportion of variance that can be explained, the larger is the effect size. Meta-analysis Whereas measures of effect size provide important information for a particular study, meta-analysis is a statistical technique that provides an indication of the size of an effect across the results of many studies. As different researchers continue to explore a particular research question, published studies begin to accumulate. After some period of time, it is common for someone to publish a review article to summarize the different studies that have been done and their findings. These review articles often reveal mixed findings; that is, some studies report effects, and some do not. Essentially, a measure of effect size is calculated for each study and then weighted according to the sample size and quality of the study. These measures are then averaged across studies to produce an overall effect size. Do you believe that prevention programs targeted to children in school can reduce the incidence of child sexual abuse? Two researchers conducted a meta-analysis of 27 such studies (Davis & Gidycz, 2000). Based on their analysis, they also concluded that long-term programs that required active involvement from the children were more effective. Such analyses effectively summarize a body of literature and direct further research. Parametric Versus Nonparametric Analyses Many data are collected in the behavioral sciences that either do not lend themselves to analysis in terms of the normal probability curve or fail to meet the basic assumptions for its use. For example, researchers explore many populations that consist of two categories-for example, yes/no, male/female, heads/tails, right/wrong. Other populations consist of more than two categories-for example, political affiliation or year in college. When comparing the attributes of objects, events, or people, we are often unable to specify precise quantitative differences. However, we are frequently able to state ordered relationships-for example, Event A ranks the highest with respect to the attribute in question, Event B the second highest, and so on. In addition to equivalence and nonequivalence, then, the mathematical relationships germane to such data are "greater than" (>) and "less than" (<). The relationship a > b may mean that a is taller than b, of higher rank than b, more prestigious than b, prettier than b, and so on. Similarly, the relationship a < b may mean that a is less than b, of lower rank than b, less prestigious than b, and so on. These data are measured on a scale with equal intervals 10 - 28 between adjacent values-that is, an interval or ratio scale. For example, in a timed task, a difference of 1 second is the same throughout the time scale. That is, the distribution of scores conforms to a bell-shaped distribution rather some other shape of distribution (such as positively or negatively skewed, or multimodal). Homogeneity of variance is the assumption that the populations for the dependent variable have equal variances. That is, the degree to which the scores are spread out around the mean is the same in the populations represented by the groups in the study. As long as the assumptions are not seriously violated, the conclusions derived from parametric tests will be accurate. For data measured on a nominal scale, an ordinal scale, an interval scale with a nonnormal distribution, or a ratio scale with a nonnormal distribution, the investigator should use nonparametric statistics for the analysis. For data on a nominal scale, nonparametric analyses include the chi-square test for goodness of fit, the chi-square test for independence, the binomial test, and the median test. For data on an ordinal scale or for data on an interval/ratio scale that do not satisfy the assumption of normality, nonparametric analyses include the Wilcoxon test and the MannWhitney test. Using Statistical Software Computers have greatly increased the efficiency with which research data can be analyzed. The particular software that you use as a student researcher will depend on which software is available at your university and which software is familiar to your instructor. Although we do not want to recommend a particular program, we do suggest that you learn at least one of them. The statistical output that we present in the next several chapters is presented in generic form rather than the format of a particular software package. Whichever package you use, you should be able to locate the same information in the output. The ease with which inferential statistics can be calculated by the computer creates a temptation to simply enter the data and click on the button to perform the inferential analysis so that a conclusion statement can be written. Get a strong feel for your data by calculating measures of central tendency and measures of variability. Let your data talk to you through various graphs that not only depict summary statistics, but also depict the distribution of raw scores. These graphs can show outliers and patterns in the data that would be overlooked by the inferential statistic and may, in fact, create inferential analyses that are misleading. Case Analysis One recent area of research in the behavioral sciences involves the positive impact that natural environments have on mental, social, and physical health. This research on "restorative environments" has implications for the design of homes, office space, and hospital recovery rooms. You decide to study this phenomenon by comparing two recovery rooms at your local hospital. The rooms are identical except that the view from one looks out over a park with trees and grass, and the view from the other simply shows a brick wall of the building. Patients recovering from routine surgeries are randomly assigned to one of the recovery rooms, and you record the number of days of recovery prior to discharge from the hospital. Because you understand the concept of confounding variables, you make sure that the patients and nurses are unaware of the experiment. Which type of graph would you use to illustrate the average days to recovery as a function of the type of view? Which type of inferential analysis would you use to determine whether there was any effect of the type of view on recovery rate? General Summary Statistics provide a way to summarize and interpret behavioral observations. Descriptive statistics, such as measures of central tendency, measures of variability, and graphical representations of data, summarize observations. The mean, the most common measure, has the advantage of considering the specific value of every score in the distribution. The median is often appropriate when the distribution of scores is skewed or contains a few extreme scores. The mode can be used when the data are measured on a nominal scale of measurement. Variability is most often measured using standard deviation, which provides an indication of how far, on average, scores are from the mean. Inferential statistics, such the t test and analysis of variance, provide a way to interpret the data and arrive at conclusions.
Uses described in pharmacopoeias and well-established documents Internally: as a mild sudorific and diuretic for treatment of bladder and kidney problems acne medicine purchase eurax 20 gm mastercard, for conditions producing blood in the urine (haematuria) (36) skin care unlimited cheap eurax 20gm with amex, as an astringent acne regimen order 20gm eurax free shipping, and for treatment of diarrhoea and ulcerative colitis (15 skin care options ultrasonic generic eurax 20gm line, 28) acne scar laser treatment generic eurax 20 gm fast delivery. Uses described in traditional medicine As a diuretic acne 7 dpo order eurax 20 gm on-line, antidiarrhoeal, antiallergic, anti-inflammatory (37), anthelminthic, febrifuge, diaphoretic, for gallbladder and as a kidney tonic (38). Used for the treatment of alopecia (4), scrofulosis (39), gout, arthralgia (40), furunculosis, diathesis (a constitutional predisposition towards a particular state or condition and especially one that is abnormal or diseased), seborrhoeic dermatitis, acne vulgaris (17, 27, 4143), eczema (44), infantile rickets (45, 46), digestive tract ailments, flatulence, fevers, bladder and kidney stones, as a styptic haemostatic and for curing insect bites (47). Used externally as a bath for various diathesis conditions, especially in children (28). Pharmacology Experimental pharmacology Antimalarial activity A 90% ethanol extract of the dried whole plant was active against Plasmodium falciparum at a concentration of 20 µg/ml (48). Choleretic activity Oral administration of the total flavonoids isolated from the aerial parts of the plant to rats (500 mg/kg body weight (bw)) significantly induced choleretic activity. Subsequently, an increase of cholic acids and cholesterol in bile was observed (49). Antiulcer activity Separate intragastric administration of methanol and aqueous extracts of the aerial parts to rats, at a dose of 500 mg/kg bw, showed antiulcer activ42 Herba Bidentis ity in vivo against aspirin-induced ulcers, but the extracts were inactive against indomethacin-induced ulcers (50). The inhibition effect was more pronounced when the extract was added during irradiation (51). Toxicology An ethanol-aqueous extract (1:1) of the aerial parts administered intraperitoneally to mice had a median lethal dose of 750 mg/kg bw (52). Clinical pharmacology Aerial parts of the plant were used in an open clinical trial, without a control group, to treat 500 patients with dysentery, 65 with acute enteritis and 248 with chronic enteritis. Several different dosage forms of the herb were used: 200 g of fresh whole herb and 100 g of dried herb in decoctions (in three divided doses per day); granules containing 5 g of dried aqueous extract, three times daily; 0. The herbal preparations were administered for 310 days to patients who had already had diarrhoea for 715 days. Of the 500 patients with chronic dysentery, 387 were reported to have been cured; 13 had not responded within 3 days. All 313 patients with enteritis were reported to have been cured (12 of the patients with chronic enteritis relapsed later) (35). In an open clinical trial without a control group, a 70% ethanol extract of the aerial parts of the plant and an ointment containing 2. After oral administration of the extract (20 drops three times daily) and simultaneous application of the ointment to the affected areas of the skin once a day, the combination was found to have anti-inflammatory activity as well as an ability to stimulate adrenal functions. After one week of treatment, desquamation of the skin was decreased, and a decoloration of the psoriatic plaques was observed. A clinical recovery was recorded for 29 of the patients; an improvement in condition was recorded for 22 patients; and a failure of treatment for 2 patients (17). Contraindications No irrigation therapy is recommended in people with oedema due to impaired heart or kidney function. If signs of hypersensitivity reactions appear, Herba Bidentis must not be used again. Nursing mothers Preparations of Herba Bidentis should not be used by nursing mothers. Paediatric use Preparations of Herba Bidentis should not be used for the treatment of children under the age of 12 years. One glass of an infusion of 10 g of cut herb together with 100 g of cooking salt or sea salt per bath (54). Polnyi spravotchnik lekarstvennykh rasteni [The complete reference of medicinal plants]. Antimalarial activity of extracts and fractions from Bidens pilosa and other Bidens species (Asteraceae) correlated with the presence of acetylene and flavonoid compound. Cultivated commercially in North America, the Balkans, Eastern Europe and Germany (6, 8). Leaves sessile, light green, with semiamplexicaul base; entire, undulate or remotely denticulate; glandular hairs on both surfaces; lower leaves spatulate, obtuse, sometimes acute at the apex, 1020 cm long and 14 cm wide; higher leaves oblong and mucronate, 47 cm long. Achenes narrowly oblong, strongly curved, faintly ribbed, thinly pubescent or glabrous, 1012 mm long, outer achenes warty-ribbed outside, inner achenes prickly-warty, often with broad, thick margins (2, 7, 9). Plant material of interest: dried ligulate florets and composite flowers General appearance Ligulate florets consist of a yellow, orange or orange-yellow ligule, 35 mm wide and about 7 mm in the middle part, with 3-toothed apex and hairy, partly sickle-shaped, yellowish-brown to orange-brown tube with projecting style and 2-lobed stigma; occasionally with a partly bent yellowishbrown to orange-brown ovary. Tubular florets about 5 mm long, consist of yellow, orange-red or red-violet 5-lobed corolla and yellowish-brown or orange-brown tube, hairy in its lower part, mostly with a bent yellowishbrown to orange-brown ovary (1). Organoleptic properties Odour: faint, pleasantly aromatic (10, 11); taste: bitter (2). Microscopic characteristics Inner epidermal cells of ray floret elongated, rectangular and almost straight walled, cuticle faintly striated; stomata absent; outer epidermal cells similar, but with 3 or 4 anomocytic stomata; trichomes very numerous on the tube, biseriate; stigma epidermal cells straight-walled, polygonal. In disc floret, outer epidermal cells elongated, straight or slightly sinuous-walled, stomata absent; abundant trichomes on area below point of insertion of the stamens, mainly glandular, uniseriate or biseriate. Within the upper part of the anthers, a layer of isodiametric to elongated, moderately thick-walled, lignified and pitted cells; pollen grains spherical, up to 45 µm in diameter, with 3 germinal pores, exine finely granular with numerous short spines; apex of stigma covered by short, bulbous papillae (2). Powdered plant material Yellow-green; fragments of corollas containing light yellow oil droplets; some corollas with fairly large anomocytic stomata, others containing 50 Flos Calendulae prismatic and very small clusters of calcium oxalate crystals. Covering trichomes biseriate, multicellular and conical; glandular trichomes with a uniseriate or biseriate, multicellular stalk and a large, ovoid, biseriate, multicellular head. Spherical pollen grains up to 45 µm in diameter, exine finely granular with numerous short spines and with 3 germinal pores; occasional fragments of stigmas with short, bulbous papillae (1). General identity tests Macroscopic and microscopic examinations, and thin-layer chromatography for flavonoid content (1, 2). Foreign organic matter Not more than 5% bracts and not more than 2% other foreign matter (1, 2). Other purity tests Chemical, sulfated ash and alcohol-soluble extractive tests to be established in accordance with national requirements. Major chemical constituents the major constituents are triterpene saponins (210%) based on oleanolic acid. The structures of the characteristic triterpene saponins and flavonoids are presented below. Uses described in pharmacopoeias and in traditional systems of medicine External treatment of superficial cuts, minor inflammations of the skin and oral mucosa, wounds and ulcus cruris (2, 18, 19). Pharmacology Experimental pharmacology Phagocytosis Three polysaccharides isolated from an aqueous extract of Flos Calendulae enhanced phagocytosis in human granulocytes in vitro in the colloidal carbon clearance test (17). Intraperitoneal injection of a polysaccharide fraction isolated from an aqueous extract of the flowers to mice (10 mg/kg body weight) enhanced phagocytosis (20). Antimicrobial activity the essential oil of the flowers inhibited the growth in vitro of Bacillus subtilis, Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa and Candida albicans (22). A flavonoid fraction isolated from the flowers inhibited the growth in vitro of S. However, chloroform, ethanol, methanol or water extracts of the flowers did not inhibit bacterial growth in vitro (2426). Acetone, ethanol or water extracts inhibited the growth in vitro of the fungus Neurospora crassa (27). Extracts of the flowers inhibited the growth in vitro of Trichomonas vaginalis (28). A 5% hot aqueous extract of the 54 Flos Calendulae flowers (2 ml) inhibited the replication of encephalitis virus after intraperitoneal administration to mice (33). Anti-inflammatory activity Topical application of a 70% ethanol extract of the flowers to mice at a dose of 1. External application of a carbon dioxide extract of the flowers (300 µg/cm2) suppressed croton oil-induced ear oedema in mice (34). The triterpene fraction of an extract of the flowers had marked antiinflammatory activity in mice (1 µg/ear) against ear oedema induced by 12-O-tetradecanoylphorbol-13-acetate (35). Faradiol esters isolated from the flowers (240 µg/cm2) inhibited croton oil-induced ear oedema in mice (36). Intragastric administration of an aqueous extract of the flowers (100 mg/kg body weight) inhibited carrageenan-induced footpad oedema in rats (37). However, an 80% ethanol extract of the flowers was weakly active (11% inhibition) at a concentration of 100 mg/kg body weight administered orally 1 hour prior to induction of oedema (38). Isorhamnetin glycosides isolated from the flowers inhibited rat lung lipoxygenase in vitro (39). Wound-healing activity External application of a hydroalcoholic extract accelerated the rate of contraction and epithelialization of excision wounds in rats (40). A 3% freeze-dried aqueous extract of the flowers induced vascularization in the chick chorioallantoic membrane assay. Histological sections of the treated chorioallantoic membranes also indicated the presence of hyaluronan, a tissue glycosaminoglycan associated with neovascularization (41). Clinical pharmacology Although no randomized, controlled clinical trials have been performed, two case reports in the early medical literature support the traditional use of Flos Calendulae. The reports describe the use of a strong tincture of the flowers applied on compresses to reduce inflammation and suppuration, and to accelerate the healing of wounds (42, 43). Contraindications Flos Calendulae is contraindicated in cases of known allergy to plants of the Asteraceae (Compositae) family (18). Extracts of the flowers were not carcinogenic after daily intragastric administration of 0. Mutagenicity testing of the fluidextract in the Salmonella/microsome assay (using S. The mouse bone marrow micronucleus test was also negative after daily administration of up to 1 g/kg body weight for 2 days (46). A fluidextract of the flowers (100 mg/ ml, 60% ethanol) was genotoxic in both mitotic crossing-over and chromosome segregation when assayed for mitotic segregation in the heterozygous diploid D-30 of Aspergillus nidulans (46). Other precautions No information available on general precautions or precautions concerning drug interactions; drug and laboratory test interactions; teratogenic and nonteratogenic effects in pregnancy; nursing mothers; or paediatric use. Therefore, Flos Calendulae should not be administered during pregnancy or lactation or to children without medical supervision. Dosage forms Infusion for topical use; aqueous and alcohol extracts, tinctures and ointment for external use (2, 18, 19). Posology (Unless otherwise indicated) Topical application: an infusion of 12 g/150 ml (18). For the treatment of wounds, the tincture is applied undiluted; for compresses, the tincture is usually diluted at least 1:3 with sterile water (18, 48, 49). Encyclopedia of common natural ingredients used in food, drugs, and cosmetics, 2nd ed. Structural analysis of a rhamnoarabinogalactan and arabinogalactans with immunostimulating activity from Calendula officinalis. Screening for antimicrobial activity of some essential oils by the agar overlay technique. In vitro antimicrobial activity of various plant extracts used by purepecha against some Enterobacteriaceae. Investigations on known or potential antitumoral plants by means of microbiological tests. The role of triterpenoids in the topical anti-inflammatory activity of Calendula officinalis flowers. Triterpene alcohols from the flowers of Compositae and their antiinflammatory effects. Anti-oedematous activities of the main triterpendiol esters of marigold (Calendula officinalis L. Induction of vascularisation by an aqueous extract of the flowers of Calendula officinalis L. Contact sensitization by alternative topical medicaments containing plant extracts. However, according to the International Rules of Botanical Nomenclature, Chamomilla recutita (L. Selected vernacular names Baboonig, babuna, babunah camomile, babunj, bunga kamil, camamilla, camomile, chamomile, camomilla, chamomille allemande, campomilla, chamomille commune, camomille sauvage, fleurs de petite camomille, flos chamomillae, german chamomile, hungarian chamomile, Kamille, Kamillen, kamitsure, kamiture, manzanilla, manzanilla chiquita, manzanilla comun, manzanilla dulce, matricaire, matricaria flowers, pin heads, sweet false chamomille, sweet feverfew, wild chamomile (3, 69). Description Herbaceous annual; 1030 cm in height, with erect, branching stems and alternate, tripinnately divided leaves below and bipinnately divided leaves above, both types having almost filiform lobes; the capitulum (to 1. Organoleptic properties Odour, pleasant, aromatic; taste, aromatic and slightly bitter (13). Microscopic characteristics Receptacle and bracteoles with schizogenous secretory ducts; vascular bundles with phloem fibres; spiral, annular and reticulate but pitted vessels; lignified cells at the bases of the ovaries absent; nearly all parts of florets bear composite-type glandular hairs with short, biseriate stalk and enlarged head, formed of several tiers, each of two cells; ovary with longitudinal bands of small mucilage cells; stigma with elongated papillae at the apex; pollen grains, spherical or triangular, with numerous short spines (3). Powdered plant material Powdered Flos Chamomillae is greenish yellow to yellowish brown; spiny pollen grains numerous, 1825 µm in diameter; fragments of yellow or white corolla, with polygonal, small epidermal cells having straight or slightly wavy walls, sometimes papillosed, and sometimes bearing glandular hairs of composite type; fragments of the fibrous layer of anther; fragments from ovary, with glandular hairs and rows of small mucilage cells; green fragments of parenchyma of involucre; stigma with papillae; cells of the achenes with scalariform perforations in walls; fragments of fibrovascular bundles with spiral, annular and reticulate vessels and sclerenchyma fibres; fragments of involucral bracts with epidermis having elliptical stomata up to 30 µm in length, also vessels and fibres; occasional fibre from the stems; minute cluster crystals of calcium oxalate, up to 10 µm in diameter; fragments of lignified parenchyma of the filaments and occasional fragments of vessels (3, 7, 10). Also found in western Asia, the Mediterranean region of northern Africa, and the United States of America. General identity tests the drug is identified by its macroscopic and microscopic characteristics, and by thin-layer chromatography (13). Preparations for external use: aerobic bacteria-not more than 102/g or ml; fungi-not more than 102/g or ml; enterobacteria and certain Gram-negative bacteria-not more than 101/g or ml. Foreign organic matter Not more than 10% stems and not more than 2% foreign organic matter (3). Normally, the maximum residue limit of aldrin and dieldrin for Flos Chamomillae is not more than 0. Other tests Chemical, dilute ethanol-soluble extractive, and water-soluble extractive tests to be established in accordance with national requirements. Thin-layer (1, 2) and gasliquid (17) chromatography for volatile oil constituents, and high-performance liquid chromatography for flavonoids (18, 19). Other major constituents include -bisabolol and related sesquiterpenes (up to 50% of the oil). Apigenin and related flavonoid glycosides constitute up to 8% (dry weight) of the drug (10, 18). Medicinal uses Uses supported by clinical data Internal use Symptomatic treatment of digestive ailments such as dyspepsia, epigastric bloating, impaired digestion, and flatulence (3, 7, 8, 10, 11, 20, 21).
