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By G. Tizgar. Grantham University.

The mother always knows how the child feels and what it is sensing even if the child is unable to speak order floxin 200mg overnight delivery. The fact that a child cannot give adequate responses should not stop you from talking to the child discount floxin 200 mg overnight delivery. Even a mentally handicapped child will notice the attention floxin 200 mg for sale, register the friendliness in your voice and will react order 200mg floxin overnight delivery, possibly strongly purchase 400mg floxin with amex, to physical contact, which you should not shy away from. Psychological factors play a significant role in this (Jean-Jacques Rousseau) growth disorder, and the influence of an extremely domi- nating parent is very frequently apparent. The parents From the doctor’s standpoint there are easy and difficult naturally expect to be supported in their constant ad- parents. However, since such Easy parents want the best for their children, are huge- admonitions are counterproductive, it is preferable to ly relieved when it emerges that nothing serious is present encourage the young patients, who often tend to be very but, if their child does have a serious illness, are prepared passive, to take up some pleasurable sporting activity. A to travel considerable distances in order to obtain the particular feature of adolescents is also their great need appropriate treatment, accept fairly long waiting times not to appear different from their peers: They have to without complaining, are understanding in the event of wear the same brand of shoes, the same cut of jeans and difficulties during treatment, reassure the child in the face the same type of sweater as their friends. Strict standards of procedures that will necessarily prove painful and leave also apply to hairstyles within a student’s class, and the the child in the care of the nursing staff confident that the earring is likewise a badge of identification. Most parents act in this way and dominant tendency of wanting to be the same as others it is always a joy to work with them. Adolescents, in particular, find it very dif- between parents during a medical consultation. Even ficult to accept treatments that change their external parents who are divorced will sometimes jointly at- appearance, e. They generally prove tend a consultation arranged to review a medical to be the sole individual wearing a brace in their class, or problem affecting their child and initially act as if possibly in the whole school. Only when something fails to that change the outward appearance in equally unflat- proceed according to plan do conflicts come to the tering terms, but which are employed much more com- surface, with corresponding accusations being made monly, are readily accepted: dental braces, for example, against the medical and nursing staff. Such conflicts are prescribed so frequently nowadays that dentists even are always very distressing for the child and can also complain that young people without any dental problems frequently influence the subsequent course of the ill- are coming to their offices and asking to be fitted with ness. While orthopaedic conditions tend to be very braces just because all the other students in their class typical somatic disorders, predominantly with well have them. The treating doctor often finds it difficult to under- ▬ Conflicts with the child: Parents occasionally have stand the real reasons for the protracted course of the serious conflicts with their child, particularly during illness. In many cases the cause of the problems can ing an operation the conflict is exacerbated, because be traced back to the parents themselves. Perhaps you will then be partly to blame for the fact that the the child does not fulfill the parents’ expectations, cabinet at home remains empty, instead of being filled whether in terms of intellectual performance or exter- with silver and gold trophies. The intoeing gait or the curved back One subtype of this parent category will send their does not correspond to the set standard and must (small) children to early childhood development pro- therefore be corrected by all means. The child must be able to play the violin by the shortcomings are usually better accepted than intel- age of 3, perform artistic tumbles on the trampoline lectual failure, physical attributes are not infrequently by the age of 4 and have internalized Pythagoras‘ interpreted as a sign of intellectual weakness (e. While it is doubtless true scenario is particularly bad for children with deformi- that the learning ability (including for complex move- ties when their parents believe that this is a »punish- ment sequences) is much greater in childhood than ment from God«, and that everyone can see how badly in later life, we should not forget that the appropriate they have sinned. The deformity must therefore be learning model for children is based on playing and corrected primarily because this provocative parading not training. Sometimes this Overstressed parents: In many cases these are single attitude will result in the surgical correction of defor- mothers who are in employment. Children notice the mities that are of no particular importance either from the functional or esthetic standpoint (e. But even parents who behave quite appropriately when it comes to the indications for surgery will often have the idea of »original sin« at the back of their mind. For this reason I avoid taking an excessively detailed history in cases of deformities occurring as a result of toxic damage during pregnancy. After all, the type of harmful substance is of almost no relevance to the nature of the damage (this is only determined by the particular moment during the pregnancy), and exces- sively detailed probing can unnecessarily make an already bad conscience even worse. This occurs more frequently with girls than with boys since girls are less likely to demon- strate any great ambition. Such children, or adolescents, arrive at the doctor‘s of- fice with symptoms that fail to respond to treatment. The parents become Many children (particularly girls) are pressurized by their parents to increasingly annoyed by the inability of the doctor to achieve sporting results that the children don’t actually want them- cure their offspring as the next competition, the one selves (achievement by proxy). Such children often respond to the that will bring (inter)national acclaim, approaches. If pressure with chronic disease symptoms whose true causes will need you then ask the child whether the need for a medal is to be explored... Money is often short and every minute is days an illness is no longer »endured«.

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Uniform requirements The Uniform Requirements are instructions to authors on how to prepare manuscripts 400 mg floxin with visa, not to editors on publication style best 200mg floxin. International Committee of Medical Journal editors (www3) All draft papers should be prepared in a format that is consistent with the “Uniform requirements for manuscripts submitted to biomedical journals” discount 400 mg floxin overnight delivery. The group naturally became known as the Vancouver group and the standard format is still referred to as Vancouver format buy floxin 400 mg with mastercard. The first uniform requirements for manuscripts and recommendations for formatting references were published in 1979 order floxin 200mg line, and an updated version can now be accessed via the world wide web (www3). The Vancouver group eventually evolved into the International Council of Medical Journal Editors (ICMJE) who publish the uniform requirements on their website. The ICMJE uniform requirements have been revised at intervals 21 Scientific Writing since their inception and are now widely adopted by the majority of medical journals. If you are writing a scientific paper, you need to be conversant with these standardised requirements for formatting both your paper and your reference list. Although some journals still have significantly different format requirements for references, the advent of reference database software (www4) means that lists can be more easily changed to different formats. Over 500 journals now use the ICMJE uniform requirements and either cite the document or make reference to it in their instructions to authors. The uniform requirements are clear and concise instructions to authors on how to prepare a manuscript for submission to a journal and which style to adopt. In the event of the acceptance of your paper for publication, the copy editor may ultimately change your style. However, regardless of publication style, many journals still require papers to be submitted according to the standard uniform requirements. Too few authors do this, but there is little point in writing a 400 word introduction when the journal has a limit for the whole article of 600 words. Richard Smith20 Although many journals require papers to be submitted according to the uniform requirements, each journal also has its own instructions to authors that are published on the journal website or in the printed copy of the journal. Sometimes the instructions are only published once or twice a year, for example, JAMA publishes its instructions to authors in January and July. The instructions to authors for many journals can be accessed via a central Medical College of Ohio website (www5). As soon as you have decided where to submit your paper, you should obtain the instructions to authors, read them carefully, make note of all of the relevant points, and then read them carefully again. In addition to requiring papers to conform to the uniform requirements, each journal often lists its own specific submission requirements. These may include the number of copies of the paper to submit, use of abbreviations, the standard dictionary to be used for spelling, the maximum length of the paper, the style for references, and so on. Any time you spend on formatting before you submit your paper to a journal is time well spent. If your paper conforms exactly to a journal’s guidelines, it is much more likely to be received favourably by the editor. This will help to ensure that your paper is processed expeditiously and that unnecessary delays are avoided. If you do not follow the guidelines, your manuscript may be returned to you before it is sent out for external peer review, thus causing unnecessary delay and wasting precious time. Some journals have a policy of returning papers that exceed the established length limits and ask authors to shorten them before they are sent out for review. Even when papers that exceed page limits are sent out for peer review, they may ultimately be rejected solely on the basis of their length and despite the scientific merit of the content. Shortening a paper so that it conforms to the limits set by a journal should not be 23 Scientific Writing too onerous. If you are having problems with word-trimming, consider whether each table needs all the information it shows, whether you have duplicated any of the information in the text and whether all of the tables and figures are absolutely essential for conveying your main results. If you have presented the same results as both categorical and continuous data analyses, one of the two approaches could probably be omitted. It is also worth considering whether all of the information in the introduction and discussion is essential for putting your work in the context of the literature.

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J Clin Pathol G floxin 400 mg cheap, Kabisch H cheap floxin 400 mg on line, Reichardt P floxin 400mg low cost, Jurgens H cheap 400 mg floxin with amex, Gadner H buy discount floxin 400mg on-line, Bielack S (2003) 56: 96–102 Primary metastatic osteosarcoma: presentation and outcome 6. Cecchetto G, Carli M, Alaggio R, Dall’Igna P, Bisogno G, Scarzello of patients treated on neoadjuvant Cooperative Osteosarcoma G, Zanetti I, Durante G, Inserra A, Siracusa F, Guglielmi M (2001) Study Group protocols. J Clin Oncol 21: 2011–8 Fibrosarcoma in pediatric patients: results of the Italian Coopera- 27. Kahn L (2003) Adamantinoma, osteofibrous dysplasia and differ- tive Group studies (1979–1995). Kunisada T, Ozaki T, Kawai A, Sugihara S, Taguchi K, Inoue H (1999) Craft A (2000) Prognostic factors in Ewing’s tumor of bone: analy- Imaging assessment of the responses of osteosarcoma patients sis of 975 patients from the European Intergroup Cooperative to preoperative chemotherapy: angiography compared with thal- Ewing’s Sarcoma Study Group. Lagrange J, Ramaioli A, Chateau M, Marchal C, Resbeut M, Richaud sarcoma. Am J Surg Pathol 17: 1–13 P, Lagarde P, Rambert P, Tortechaux J, Seng S, de la Fontan B, 9. Klinische Reme-Saumon M, Bof J, Ghnassia J, Coindre J (2000) Sarcoma after und therapeutische Aspekte. Orthopäde 32: 74–81 radiation therapy: retrospective multiinstitutional study of 80 his- 10. Dickey ID, Rose PS, Fuchs B, Wold LE, Okuno SH, Sim FH, Scully SP tologically confirmed cases. Radiation Therapist and Pathologist (2004) Dedifferentiated chondrosarcoma: the role of chemothera- Groups of the Fédération Nationale des Centres de Lutte Contre le py with updated outcomes. Machak G, Tkachev S, Solovyev Y, Sinyukov P, Ivanov S, Kochergi- clinical characteristics, prognostic factors, and outcome. Med na N, Ryjkov A, Tepliakov V, Bokhian B, Glebovskaya V (2003) Neo- Pediatr Oncol 37: 30–5 adjuvant chemotherapy and local radiotherapy for high-grade 51. Widhe B, Widhe T (2000) Initial symptoms and clinical features osteosarcoma of the extremities. Mervak TR, Unni KK, Pritchard DJ, McLeod RA (1991) Teleangiec- 667–74 tatic osteosarcoma. Nakajima H, Sim F, Bond J, Unni K (1997) Small cell osteosarcoma proved survival in primary nonmetastatic pediatric osteosarcoma of bone. Wunder JS, Gokgoz N, Parkes R, Bull SB, Eskandarian S, Davis AM, S (1994) Familial occurrence of teleangiectatic osteosarcoma: Beauchamp CP, Conrad EU, Grimer RJ, Healey JH, Malkin D, Mang- Cousin cases. J Pediatr Orthop 14: 119–22 ham DC, Rock MJ, Bell RS, Andrulis IL (2005) TP53 mutations and 4 34. Okada K, Frassica FJ, Sim FH, Beabout JW, Bond JR, Unni KK (1994) outcome in osteosarcoma: a prospective, multicenter study. Ozaki T, Lindner N, Hoffmann C, Hillmann A, Rodl R, Blasius S, Link T, Winkelmann W, Jürgens H (1995) Ewing’s sarcoma of the ribs. Paulussen M, Ahrens S, Braun-Munzinger G, Craft A, Dockhorn- Dworniczak B, Dorffel W, Dunst J, Fröhlich B, Gobel U, Haussler G. Hefti M, Klingebiel T, Koscielniak E, Mittler U, Rube C, Winkelmann W, Voute P, Zoubek A, Jürgens H (1999) EICESS 92 (European Inter- > This chapter focuses exclusively on those orthopaedically group Cooperative Ewing’s Sarcoma Study) – Erste Ergebnisse. Klin Padiatr 211: 276–83 relevant tumors and tumor-like lesions in soft tissues that 37. Qureshi A, Shott S, Mallin B, Gitelis S (2000) Current trends in the occur primarily in childhood and adolescence [12, 36]. An international The Enneking staging system can also be used for these study. Rödl R, Hoffmann C, Gosheger G, Leidinger B, Jürgens H, Winkel- mann W (2003) Ewing’s sarcoma of the pelvis: combined surgery and radiotherapy treatment. A long-term oncological, Fibrous hamartoma of infancy functional, and quality-of-life study. Rydholm A (1996) Chromosomal aberrations in musculoskeletal A fibrous hamartoma of infancy occurs almost exclu- tumours: Clinical importance. J Bone Joint Surg (Br) 78: 501–6 sively in the area of the shoulder and axilla, primarily in 41. Although the tumor is rare, it is one of the most Karger C, Scholz M, Kraft G, Wannenmacher M, Debus J (2003) common soft tissue lesions in early childhood and usu- Carbon ion radiotherapy for chordomas and low-grade chondro- ally manifests itself during the first three years of life. Strahlenther Onkol 179:598–605 Histologically the lesion consists of three different com- 42.

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