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By H. Myxir. Alderson-Broaddus College.

Because they are similar to t-tests order trecator sc australia, significance tests of the Pearson and Spearman correlation coefficients are also included generic 250 mg trecator sc visa, with a new introduction of the population correlation coefficient moved from Chapter 7 order trecator sc with visa. Preface to the Instructor xxv Chapter 12 covers the independent- and the dependent-samples t-tests and versions of the confidence interval used with each. The chapter ends with revised discussions of how to interpret two-sample experiments and using the point-biserial correlation to measure effect size. The discussion of the general logic of nonparametric procedures was revised and is followed by the Mann– Whitney, rank sums, Wilcoxon, Kruskal–Wallis, and Friedman tests (with appropriate post hoc tests and measures of effect size). The text is designed to also serve as a reference book for later course work and proj- ects, especially the material in Chapters 14 and 15 and the appendices. Also, the less common procedures tend to occur at the end of a chapter and are presented so that instructors may easily skip them without disrupting the discussion of the major proce- dures. Likewise, as much as possible, chapters are designed to stand alone so that instruc- tors may reorder or skip topics. The questions are separated into “Review Questions,” which require students to define terms and outline procedures, and “Application Questions,” which require students to perform procedures and interpret results. Then the “Integration Questions,” require students to combine information from the previous different chapters. Odd- numbered questions have final and intermediate answers provided in Appendix D. Tables on the inside front cover provide guidelines for selecting descriptive and inferential procedures based on the type of data or research design employed. Each chapter contains a review of objectives, terms, and formulas; a programmed review; conceptual and computational problems (with answers); and a set of multiple-choice questions similar to those in the Instructor’s Resource Manual with Test Bank. A final chapter, called “Getting Ready for the Final Exam,” facilitates student integration of the entire course. Walls, contains approximately 750 test items and problems as well as suggestions for classroom activities, discussion, and use of statistical software. It also includes answers to the even-numbered end-of-chapter questions from the book. In particular my thanks go to Rebecca Rosenberg, Assistant Editor, Psychology, and to Jane Potter, Senior Sponsoring Editor, Psychology, for their hard work and support. Students in the behavioral sciences throughout the world take a course like the one you are about to take, and they get through it. They are challenging, there is an elegance to their logic, and you can do nifty things with them. So, keep an open mind, be prepared to do a little work, and you’ll be amazed by what happens. You’ll find that statistics are interesting and educational, they help you to think logically, and they make behavioral research much easier to understand. In this chapter we first deal with some common misconceptions that students have about statistics. These are formulas and calculations developed by statisticians that psy- chologists and other behavioral researchers employ when “analyzing” the results of their research. Statistics are an integral part of psychology and other behavioral sciences, so statistics and statistical concepts are used every day. Therefore, to understand your chosen field of study, you must understand statistics. You’ve already experienced this if you’ve ever read a published research article—you probably skipped the section titled “Results. The word empirical means that knowledge is obtained through observation and measure- ment, and behavioral research measures behaviors. Thus, any study typically produces a very large batch of scores that must be made manageable and meaningful. At this point, statistics are applied because they help us to make sense out of the data. First, some procedures organize the scores so that we can more clearly see any patterns in the data. We don’t need to examine each of the hundreds of scores that may be obtained in a study. Instead, a summary—such as the average score—allows us to quickly and easily understand the general characteristics of the data. Researchers have created techniques and rules for this and, because everyone uses the same rules, it is much easier for us to communicate with each other, especially in published research reports. All behavioral research is designed to answer a question about a behavior and, ultimately, we must decide what the data tell us about that behavior. Even if you are not interested in becoming a researcher, statistics are necessary for comprehending other people’s research. You hear of a new therapy that says the way to “cure” people of some psychological problem is to scare the living daylights out of them. This sounds crazy but what is important is the research that does or does not support this therapy. As a responsible professional, you would evaluate the research supporting this therapy before you would use it. This book is written for students who have not yet studied how to conduct research. When we discuss each statistic, we also discuss simple studies that employ the procedure, and this will be enough. Later, when you study research methods, you will know the appropriate statistical procedures to use. We will discuss some research tools that happen to involve mathematical operations. But it is simple math: adding, subtracting, multiplying, dividing, finding square roots, and drawing simple graphs. Best of all, statisticians have already developed the statistics we’ll discuss, so we won’t be deriving formulas, performing proofs, or doing other “mystery” math. We will simply learn when to use the procedure that statisticians say is appropriate for a given situation, then compute the answer and then determine what it tells us about the data. First, there are not all that many procedures to learn, and these fancy sounding “procedures” include such simple things as computing an average or drawing a graph. A mechanic does not need to be an expert wrencher who loves to wrench, and you do not need be an expert statistician Why is It Important to Learn Statistics (and How Do You Do That? Rather, in the same way that a mechanic must understand how to correctly use a wrench, your goal is to be able to correctly use statistics. But these are simply the shorthand “code” for communicating statistical results and for simplifying statistical formulas. Think of it this way: To understand research you must speak the language, and you are about to learn the language of statistics. Once you speak this language, much of the mystery surrounding statistics evaporates. What makes some formulas appear difficult is that they are written in a code that communicates a sequence of operations: You first might square the scores, then add them together, then divide by some other number, and so on.

The oocyte is produced in the ovary by an untary control of ventilation that operates during ancestral cell called an oogonium and gives rise to waking hours is generally intact quality trecator sc 250 mg, but the involuntary the ovum (the egg) buy trecator sc cheap online, which can be fertilized generic 250 mg trecator sc. Open-angle glau- ophthalmoplegic migraine See migraine, coma is the most common form of glaucoma. They examine the eye that consists of a concave mirror range from A to Z, from the Abbe operation (on the and a battery-powered light. The ophthalmoscope is equipped with a rotating operation, Blalock-Taussig See Blalock- disc of lenses to permit the eye to be examined at Taussig operation. The ophthalmo- scope operator can better see into the eye by using operation, Macewen See Macewen operation. Opiate drugs are narcotic sedatives that depress activity of the ophthalmic Pertaining to the eye. For example, central nervous system, reduce pain, and induce an ophthalmic ointment is designed for the eye. Long-term use of opiates can ophthalmic artery The artery that supplies produce addiction, and overuse can cause overdose blood to the eye and adjacent structures of the face. It arises from the internal carotid artery, which courses up from deep within the front of the neck. The surface proteins to which opiates and opiods bind superior ophthalmic vein arises at the inner angle of in order to cause their effects. The inferior ophthalmic vein arises the back fully arched and the heels and head bent from a venous network at the forepart of orbit and back. Opisthotonos occurs in meningitis, especially divides into two branches, one of which also ends in in infants, due to irritation of the membranes sur- the cavernous sinus. Europe and the European colonies in the 18th cen- tury and became a main ingredient in patent medi- optic glioma See glioma, optic. Using an ophthalmo- scope, one can easily see the head of the optic opportunistic condition A condition that occurs nerve. Within the optic chiasma, typically seen in healthy people, but occurs because a some of the nerve fibers cross. Opportunistic nasal (inside) half of each retina cross over, but infections are a particular danger for people with those from the temporal (outside) half do not. Opportunistic microorganisms are often called the optic radiations, which lead to the visual ones that can lie dormant in body tissues for many (sight) cortex of the occipital (back) lobes of the years, such as the human herpesviruses, or that are brain. When the immune system cannot raise an optic neuroma A rare benign tumor of the optic adequate response, these microorganisms are acti- nerve. See also opportunistic optician A specialist in fitting eyeglasses and condition; opportunistic infection. An optometrist performs eye examinations and writes oppositional defiant disorder A behavior dis- prescriptions for corrective lenses; an optician fills order of children and teens characterized by an that prescription. An optometrist is a doctor of optometry orchiopathy Any and all diseases of the testes. When an optometrist detects eye disease, the patient may be referred instead to an orchiopexy Surgery to bring an undescended ophthalmologist, a physician who specializes in eval- testicle down into the scrotum. Oral can- cer is associated with smoking cigarettes and cigars organic 1 A chemical compound that contains as well as chewing tobacco. Orgasm normally accompa- nies male ejaculation as a result of sexual stimula- oral surgeon A dentist who has special training tion, and it also occurs in females as a result of in surgery to correct problems of the mouth and jaw. The jaw may be pulled open or orbit In medicine, the bony cavity in which the shut, and speech and swallowing can be difficult. Local injections of botulism toxin (Brand name: Botox) have been used as a treatment. Other orthotics include neck braces, lumbosacral ortho- Prefix meaning straight or erect, as in supports, knee braces, and wrist supports. The female sacrum is wider and less curved than the male sacrum, to per- orthodontics The dental specialty that is con- mit easier childbearing. Osgood-Schlatter disease is caused by that, according to biochemist Linus Pauling, is con- repetitive stress or tension on a part of the growth cerned with “the preservation of good health and the area of the upper tibia (the apophysis). The disease treatment of disease by varying the concentration in may also be associated with an avulsion injury, in the human body of substances that are normally pres- which the tendon is stretched so much that it tears ent in the body. Osgood-Schlatter disease most commonly iodine are examples of orthomolecular medicine. Osler node A small, tender, transient nodule that orthopedics The branch of surgery that is develops in the pads of fingers and toes and on the broadly concerned with the skeletal system. Treatment usually involves casting, although if tively expressed in osmoles of solute per liter of the fragment has detached completely, arthroscopic solution. Osteochondromas are usually discov- changes in hydration status during dehydration and ered in persons 15 to 25 years of age and are the rehydration. An osteochon- droma is typically detected when the area around it osseous Having to do with bone, consisting of is injured or when it becomes large. In a ossification 1 The normal process of bone small proportion of cases, an osteochondroma may growth. Treatment is directed toward the underlying parathyroid condition and osteoclasis The surgical destruction of bone tis- relieving any bone pain. Osteoclasis is performed to reconstruct a bone that is malformed, often a broken bone that healed osteo- Prefix meaning bone, as in osteogenesis improperly. The bone is broken and then reshaped (the production of bone) and osteosarcoma (can- with the aid of metal pins, casting, and bracing. From osteo-, bone + -arthro-, joint, + pathy, osteoclastoma A tumor of bone characterized by disease. It does so by is the knee — the far end of the femur and the near producing a matrix that then becomes mineralized. The tumor is often coated by new Bone mass is maintained by a balance between the bony growth and may grow aggressively. It may activity of osteoblasts that form bone and other cells cause pain and restricts movement. Osteoblastomas are small and are seen most frequently in children and young adults. Osteo- Treatment includes surgery, sometimes followed by dystrophy is most commonly caused by chronic kid- chemotherapy. Osteodystrophy osteochondritis dissecans A condition in which can require treatment with vitamin D. See also a fragment of bone in a joint is deprived of blood and osteodystrophy, renal. Osteo- teens or 20s and is found most frequently in the dystrophy can require treatment with vitamin D.

Fosphenytoin is available for parenteral administration as a replacement for phenytoin order trecator sc discount. Common: Nystagmus (occurs early) generic 250 mg trecator sc with amex, diplopia and ataxia (most common) generic 250 mg trecator sc otc, slurred speech, blurred vision, mental confusion, hirsutism (an issue particularly for females), gingival hyperplasia (can be minimized with good dental hygiene) b. Rare: With long-term use, coarsening of facial features, with mild peripheral neuropathy, and osteomalacia; idiosyncratic reactions requiring drug discontinuance (e. Fetal malformation (‘‘fetal hydantoin syndrome’’) includes growth retardation, microence- phaly, and craniofacial abnormalities (e. The plasma concentration of phenytoin is increased by drugs that inhibit its hepatic metab- olism (e. The plasma concentration of phenytoin is decreased by drugs that stimulate hepatic metab- olism (e. Carbamazepine has good oral absorption although there is significant interpatient variabil- ity in its rate of absorption. Nonlinear accumulation and variable serum levels of phenytoin dosage among different patients. Carbamazepine induces microsomal enzymes and increases its own hepatic clearance (autometabolism), thus reducing its half-life from more than 30 hours to less than 20 hours. Carbamazepine is the drug of choice to treat trigeminal neuralgia and other pain syndromes (phenytoin is occasionally used); it is also used to treat bipolar affective disorder. Oxcarbazepine is a prodrug whose actions are similar to those of carbamazepine; it has a short half-life of 1–2 hours. It may have a better adverse effect profile and be a less potent inducer of hepatic microsomal enzymes than carbamazepine. Carbamazepine induces microsomal enzymes and increases the hepatic clearance of numerous drugs including phenytoin and valproic acid. Plasma concentration of carbamazepine is increased by numerous drugs that inhibit he- patic metabolism. Valproic acid is also used to treat bipolar affective disorder and is used for migraine prophylaxis. Valproic acid inhibits the metabolism of other drugs including phenytoin and carbamazepine. Divalproex sodium (Depakote) is a 1:1 enteric formulation of valproic acid and valproate so- dium that is absorbed more slowly than valproic acid and is often preferred by patients. Rare: Idiosyncratic hepatotoxicity; may be fatal in infants and in patients using multiple anticonvulsants. Fetal malformations: Spina bifida; orofacial and cardiovascular anomalies have been reported. Although it is effective in fewer patients with absence seizures than valproic acid, ethosuxi- mide is often the drug of choice because of its greater safety. Phenobarbital at less than hypnotic doses is used most often as a first-line drug for neonatal seizures and for maintenance control of status epilepticus. Benzodiazepines: Diazepam, lorazepam, clonazepam, and clorazepate (see also I B) 1. Diazepam and lorazepam are highly effective in short-term treatment of status epilepticus. Other anticonvulsant agents (for partial and generalized tonic-clonic seizures) 1. Adverse effects include headache, ataxia, dizziness, and (rarely) a rash that may be life- threatening, particularly in children. It suppresses weight loss and has been used to treat patients with eating disorders. Its use is limited by development of aplastic anemia (1:3,000) and severe hepatitis with liver failure (1:10,000). Zonisamide acts at the sodium channel and possibly the voltage-dependent calcium channel. It binds to voltage- gated calcium channels and reduces release of excitatory neurotransmitters. It is also approved for use in treating postherpetic neuralgia and diabetic peripheral neuropathy. Its major adverse effects are dizziness, dry mouth, blurred vision, and weight gain. It is a schedule V controlled substance because of reports that it causes euphoria. General anesthesia is characterized by a loss of consciousness, analgesia, amnesia, skeletal muscle relaxation, and inhibition of autonomic and sensory reflexes. Balanced anesthesia refers to a combination of drugs used to take advantage of individual drug properties while attempting to minimize their adverse actions. The stages and planes of anesthesia identify the progression of physical signs that indicate the depth of anesthesia. Newer, more potent agents progress through these stages rapidly, and therefore, the stages are often obscured. Mechanical ventila- tion and the use of adjunct drugs also obscure the signs indicating the depth of anesthesia. Nitrous oxide, isoflurane, desflurane, and sevoflurane are the most commonly used inhala- tion anesthetics. They decrease cerebral vascular resist- ance with increased perfusion of the brain. These anesthetics are all respiratory depressants; consequently, assisted or controlled venti- lation is usually necessary during surgical anesthesia. Also, they are generally administered with nitrous oxide, which decreases the extent of cardiovascular and respiratory depression at equivalent anesthetic depths. Inhalation and intravenous anesthetic agent interaction with discrete protein binding sites in nerve endings to activate ligand-gated ion channels best explains their mechanism of action. Ligand-gated potassium (K ) channels, where these anesthetic agents increase potassium conductance to hyperpolarize and inhibit neuronal membrane activity 3. The relative solubility of an inhalation anesthetic in blood relative to air is defined by its blood–gas partition coefficient, lambda (k), which is directly related to the pharmacoki- netics of an anesthetic (see Table 5-9): λ =[anesthetic] in blood/[anesthetic] in gas Relatively few molecules of an anesthetic with low solubility in blood are necessary to increase its partial pressure in blood. Increased pulmonary flow from, for example, increased cardiac output decreases the rate of rise in partial pressure by presenting a larger volume of blood into which the anesthetic can dissolve. Conversely, decreased pulmonary flow, such as occurs during shock, increases the rate of induction of anesthesia. For soluble anesthetics, the longer the exposure, the lon- ger the time to recovery, because of accumulation of anesthetic in various tissues. Other factors that affect recovery include pulmonary ventilation and pulmonary blood flow. Nitrous oxide (N2O) (1) Advantages (a) Nitrous oxide is an anesthetic gas that has good analgesic and sedative properties but no skeletal muscle relaxant properties. When given in large volumes, it increases the volume of uptake of a second blood-soluble gas such as halothane (second-gas effect), which then speeds the induction of anesthesia. Isoflurane (1) Advantages (a) Isoflurane produces more rapid induction and emergence than halothane. However, paradoxically, isoflur- ane may precipitate cardiac ischemia in patients with underlying coronary heart disease.

If a patient presents greater than two weeks after visiting an endemic area buy trecator sc with paypal, dengue is much less likely (61) discount generic trecator sc canada. Laboratory abnormalities include neutropenia followed by lymphocytosis cheap trecator sc 250 mg fast delivery, hemoconcentration, thrombocytopenia, and an elevated aspartate aminotransferase in the serum (62). Lyme disease is caused by the spirochete Borrelia burgdorferi, a microbe that is transmitted by the tick Ixodes. Lyme disease is endemic in the northeastern, mid-Atlantic, north, central, and far western regions of the United States. The disease has a bimodal age distribution, with peaks in patients younger than 15 and older than 29 years of age (67). Lyme disease has three stages: early localized, early disseminated, and late disease. Erythema migrans occurs in 60% to 80% of the cases and begins as a small red papule at the site of the bite. Other symptoms associated with early localized disease include fatigue, myalgias, arthralgias, headache, fever, and chills. Patients at this stage can present with lymphocytic meningitis, cranial nerve palsies, mild pericarditis, atrial-ventricular block, arthritis, generalized or regional adenopathy, conjunctivitis, iritis, hepatitis, and painful radiculoneuritis 30 Engel et al. Figure 5 Characteristic rash, erythema migrans, on the arm of a patient with Lyme disease. Late disease is characterized by chronic asymmetric oligoarticular arthritis that involves the large joints (most often the knee). The central nervous system may also be affected, manifesting as subacute encephalopathy, axonal polyneuropathy, or leukoencephalopathy. Serology is confirmatory but takes four to six weeks after the onset of symptoms to become positive. Drug Reactions Drugs cause adverse skin reactions in 2% to 3% of hospitalized patients (70). Diagnosis of a drug reaction is based on a patient’s previous reaction to the drug, ruling out alternate etiological causes of the rash, timing of events, drug levels, evidence of overdose, patient reaction to drug discontinuation, and patient reaction to rechallenge. The rash usually appears within the first two weeks after the offending drug is started and resolves within days after the drug is stopped. Low-grade fever and peripheral blood eosinophilia may also occur in association with drug exanthems. Erythema Multiforme Erythema multiforme is an acute, self-limited, peripheral eruptive maculopapular rash that is characterized by a target lesion. Erythema multiforme most often affects persons between 20 and 30 years of age and has a predilection for men. The rash begins as a dull-red macular eruption that evolves into papules and the characteristic target lesion. Erythema multiforme may present with varying degrees of severity (previously classified as erythema multiforme minor and major) (8). The rash rarely affects the mucous membranes and is usually limited to the extensor surfaces of the extremities. This mild form of erythema multiforme is often associated with herpes simplex virus infection. Conversely, drug reactions are usually associated with more severe manifestations of erythema multiforme. Fever, cheilosis, stomatitis, balanitis, vulvitis, and conjunctivitis can also occur (70). Stevens–Johnson Syndrome Stevens–Johnson syndrome is a blistering disorder that is usually more severe than erythema multiforme (73,74). The causes of Stevens–Johnson syndrome are similar to the etiologies of erythema multiforme (Table 7). Patients with Stevens–Johnson syndrome often present with pharyngitis, malaise, and fever. The syndrome evolves over a few days with the evolution of mucous membrane erosions. It is usually caused by the same drugs that cause erythema multiforme (Table 7), and its onset is acute. Because extensive skin detachment results in massive transepidermal fluid losses, patients with these maladies are managed similarly to patients who have had extensive burn injuries. It is classified into primary, secondary, early latent, late latent, and tertiary stages. The lesion of primary syphilis, the chancre, usually develops about 21 days after infection and resolves in one to two months. Patients with secondary syphilis can present with rash, mucosal lesions, lymphadenopathy, and fever. The rash of secondary syphilis may be maculo-papular, papulosquamous, or pustular and is characteristically found on the palms and the soles (Fig. The specific treponemal tests are used to rule in the diagnosis of syphilis because false-positive nontreponemal tests can occur. Darkfield examination of skin or mucous membrane lesions can be done to diagnose syphilis definitively during the early stages as well. Figure 6 Papulosquamous rash on wrist and hands of patient with secondary syphilis. West Nile fever is characterized by acute onset of fever, headache, fatigue, malaise, muscle pain, difficulty concentrating, and neck pain (85,86). Approximately 57% of patients with West Nile fever will have a transient macular rash on the trunk of the body (85). Risk increases tenfold for persons 50 to 59 years of age and 43 times for persons greater than 80 years of age (77,81). Neuroinvasive disease can present as meningitis, encephalitis, or paralysis (84,86,88,89). Patients who have been recently vaccinated for yellow fever or Japanese encephalitis or persons recently infected with the St. Initially, cases associated with menstruation accounted for as many as 91% of the total cases (95). Patients may also present with headache, vomiting, diarrhea, myalgias, pharyngitis, conjunc- tivitis, vaginitis, arthralgias, abdominal pain, or encephalopathy (102–105). Nonmenstrual cases are caused by abscesses, cellulitis, bursitis, postpartum infections, vaginal infections, sinusitis, burn wounds, insect bites, and surgical procedures (104,109). Other laboratory abnormalities may include hypocalcemia, elevated liver enzymes, elevated creatinine, thrombocytopenia, pyuria, and proteinuria (106). Skin and soft-tissue infections are often the source of invasive group A and B streptococci (92,94).

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