By Z. Dimitar. Saint Petersburg College. 2018.

The task of editor would clearly be for- in orthopedic surgery to the Royal Air Force early midable; equally clearly the man to undertake it discount 45mg midamor, in the 1939–1945 war discount midamor 45mg with visa. His literary talent had his usual enthusiasm discount 45mg midamor fast delivery, energy and power of per- been established by his splendid book: his admin- suasion had convinced the new and very progres- istrative skill had been amply displayed in both sive Director-General of Medical Services 45mg midamor with mastercard, Air peace and war cheap midamor 45mg online. Fortunately he agreed and we reap Vice-Marshal (later Air Marshal Sir Harold) the harvest of his labors—given freely for a Whittingham what was required to produce a quarter of a century. Ten orthopedic units of 100–150 beds ingly tireless energy and a superb intellect. His each were established in strategically placed methods were always his own, and they revealed Royal Air Force hospitals, each unit consisting of his rich personality. Like his patron saint Robert a team of three surgeons, nurses, secretaries, clin- Jones, he had a warm regard for his fellow men ical photographers and rehabilitation orderlies. Thus he These units were backed up by residential reha- found collaborators whom he imbued with his bilitation centers working in the closest harmony own enthusiasm and loyalty. Later, the achievement was the close link forged with similar units were established overseas. Every the Americans’ long-established Journal of Bone single member of these teams, both in the hospi- and Joint Surgery, already the official organ of tals and in the rehabilitation centers, had to make both the American and the British associations. These were of course the beginnings there has emerged an international characteristics so typical of R. On a morning early in January 1941, Watson- He had an outstanding affection for the English Jones telephoned me, urging that I should join language, of which he himself was so fine a him and followed with a letter asking me to think master. His own writings had not only the essen- and think quickly and ending with a sentence so tial virtues of clarity, simplicity, precision and typical of him: “I know that you will think this brevity, but displayed also a splendid style of his offer over carefully! I hope you will not turn it own, always recognizable, exciting, stimulating down lightly, not only because of the importance and persuasive. His speaking was much akin to of the appointment, but also because of the oppor- his writing, but he recognized the necessary dis- tunity it will afford of doing something for ‘those tinction between literature and oratory. It remarkable wartime experience, which even was always a joy to attend laborious editorial now I look back on as the finest orthopedic– meetings enlivened by his sparkling personality rehabilitation accident service I have ever worked and penetrating assessments. By mutual agreement we decided that I should papers, as of men, he was prompt to perceive go into uniform and conform to the pattern of 350 Who’s Who in Orthopedics service life and make the bullets, which, as a civil- envied him his ability to put affairs of the past ian, he could fire without being held up by “the behind him. A new task demanded his dedicated Thurso), and this was certainly a great advantage attention. Just before the war, it had been rumored that the Air Council had considered that any pilot or Sir Reginald and Oswestry other member of air-crew injured in battle could not engage in combat again. What a tragedy this My first contact with Reginald Watson-Jones, like would have been, especially in the year after the that of many other Liverpool undergraduates, was fall of France when we were “going it alone. For this magnificent dynamic enthusiasm infected his residents, and achievement he was knighted in 1945. Before the my recollections of this impressionable period war ended, he had persuaded friendly financiers were of putting on spinal jackets for fractured to buy Headley Court for the Royal Air Force, and spines at three o’clock in the morning, of a theater it remains to this day one of the finest rehabilita- sister gladly giving up her evening off to take a tion units in the world. In the the Postgraduate Hospital at Hammersmith two winter of 1940, during the Liverpool “blitz,” courses every year of lectures of 1 week each, R. Nutthall to covering the whole of fractures, for medical offi- exchange his week on night call. These we gave struck three times one night, and I remember together—lectures in the mornings and practical vividly a tall, striding figure in his element organ- classes in the afternoons, in which everyone had izing, directing and operating in the emergency to apply plaster-of-Paris casts, Tobruk splints and basement theater. At the end of the service of the Royal Air Force, what still stands week, R. Each paper tal to organize an orthopedic and accident depart- had to be word perfect, we were to speak to the ment and become its director. To this he brought back row, adhere strictly to the time allocated, and the same qualities of drive, enthusiasm and com- have illustrations of the highest standard. When I left the Royal Air Force in 1946, attention to detail characterized so much of what he insisted on my applying for a consultant post he did. Alexander Law, a superb Memorial Hospital, and it was typical that his department was built up much along the RAF acceptance was conditional on the allocation of lines, in which the four of us worked in great hap- one of the local practitioners exclusively to the piness and rapport until he and I retired from the management of fractures. In the same year he National Health Service within a year or two of joined the consultant staff of the Shropshire each other. Orthopedic Hospital at Oswestry, where he He was a wonderful colleague, inspiring and became the chief of the North Wales firm.

How- ever generic midamor 45 mg without a prescription, the physician must be prepared to intervene when there is optic neuropathy order midamor 45mg otc, very high pressure buy midamor 45 mg without a prescription, or documented progression of optic nerve damage buy midamor 45 mg amex. Unfortu- nately midamor 45mg otc, there is insufficient published evidence to clearly recommend one over the other procedure. Repeat eye examinations are required to monitor the outcome of either surgical drainage procedure. Lumboperitoneal Shunt Lumboperitoneal shunting involves the placement of a silicone tube from the lumbar subarachnoid space to the peritoneal cavity. These have long been used by neurosur- geons for PPTC, though not always successfully. This approach leads to a rapid resolution of the PPTC, but the tubes can obstruct, become infected, and are 242 Repka associated with the development of a Chiari malformation. Failure to drain is com- mon and blockage leads to a rapid increase in pressure, which can cause catastrophic damage to the optic nerve. Ongoing ophthalmologic observation is recommended especially when there is a recurrence of symptoms. Optic Nerve Sheath Fenestration This treatment has been reported in many adults for the relief of pseudotumor cere- bri, but has only been performed in a small number of children. An incision in the dural sheath of optic nerve is made from an orbital approach under general anesthe- sia. Fenestration has been shown to relieve papilledema of the operated nerve and sometimes even the contralateral nerve. If the contralateral eye does not show evidence of improvement, a second procedure will be needed for this eye. PROGNOSIS Most children with PPTC have a self-limited course, resolving once the causative problem has been corrected. However, the clinician should be vigilant for older chil- dren and teens, who may have more chronic elevation of intracranial pressure or lack an obvious association. Permanent damage to the optic nerves is found in about one- fourth of affected pediatric patients. There does not seem to be any age difference in the occurrence of this unfavorable outcome. SUMMARY Pediatric pseudotumor cerebri is an uncommon neurologic disease of childhood. Obesity is less common in the childhood form of the disease and there is often an asso- ciated condition. Management requires collaboration of neurology, ophthalmology, and pediatrics in evaluating and monitoring the patients. The sooner the increased pressure is reduced, the less likely there will be permanent visual impairment. Idiopathic intracranial hypertension (pseudotumor cerebri) in pediatric patients. Lumboperitoneal shunting: a retrospective study in the pediatric population. Idiopathic intracranial hypertension in prepu- bertal pediatric patients: characteristics, treatment, and outcome. Lee and Myson Yaster Departments of Anesthesiology, Critical Care Medicine, and Pediatrics, The Johns Hopkins Hospital, Baltimore, Maryland, U. INTRODUCTION The International Association for the Study of Pain defines pain as ‘‘an unpleasant sensory and emotional experience connected with actual or potential tissue damage, or described in terms of such damage. This has led many to conclude incorrectly that children do not experience pain in the same way as adults do. Unfortunately, even when their pain is obvious, children frequently receive no treatment or inadequate treatment for pain and for painful procedures. There is a lack of knowledge of pain assessment, pain syn- dromes, and the use of powerful analgesics, particularly the opioids, in the treatment of pain by many health-care professionals. There is in an unwarranted fear of produ- cing opioid-induced respiratory depression and of inducing opioid addiction. Health-care providers are often focused on the treatment of underlying disease pathology and not on symptom management. Finally, there is an under appreciation by physicians and nurses of the consequences of the failure to treat pain adequately. The structures necessary for nociception are present and functional between the first and second trimesters.

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He was elected 28 midamor 45mg on-line, 1940 he flew to South Carolina and generic 45 mg midamor otc, with to Phi Beta Kappa buy 45 mg midamor otc. Bosworth interned at Mary Fletcher Hospi- ment of the proximal 12 inches of the upper end tal in Burlington discount midamor 45mg without a prescription, Vermont 45mg midamor with visa, and returned to New of the femur of a 53-year-old man that had been York City in 1921 and 1922 for a residency at the destroyed by a recurrent giant cell tumor. After this he returned to years later, when the patient died of a heart attack, Vermont, where for 3 years he was instructor of the implant, including the entire proximal femur anatomy at the medical school. While there he and hemipelvis, was examined in detail at autopsy met Dr. Mather Cleveland, who had been instruc- and microscopically to determine why the patient tor of anatomy at Columbia. This meeting led to had walked so well without a support, using only a firm, lasting association between the two men a cane for long distances. Bosworth’s later move of recurrence of the giant cell tumor, and the back to New York City and orthopedic surgery. He became energy was inexhaustible, and his collaboration a lecturer in anatomy at Columbia University in with Moore is an important landmark in the 1925 and finally discovered his calling in 1926, history of American orthopedic surgery. Bosworth made the New York area his home and orthope- dics his life’s work, to the benefit of both. Bosworth joined the American Medical Association in 1921 and was chairman of its orthopedic section in 1949. A Fellow of the New York Academy of Medicine, he served as chair- man of the orthopedic section in 1938. He was elected to head the orthopedic section of the Medical Society of the State of New York in 1943, and was a life member of the American College of Surgeons. In 1935 he became a member of the American Academy of Orthopedic Surgeons, and he actively participated in meetings and instruc- tional courses. He was elected to membership of the American Orthopedic Association in 1939 and served as president of that organization in 1957. He was also active in the International Society of Orthopedic Surgery and Traumatology. Other honors conferred on him included membership David Marsh BOSWORTH of the Japanese Orthopedic Association, the 1897–1979 Howmet Hall of Fame Award, a Citation of Merit from St. Luke’s Hospital, and election to the Born in New York City on January 23, 1897, the Alpha Omega Alpha fraternity. Bosworth was son of a minister, David Bosworth attended City the only foreign recipient of the Japanese award, College of New York and graduated from the the Second Order of the Sacred Treasure, which 31 Who’s Who in Orthopedics was awarded to him in April 1968 for his contri- Perhaps best known for his work in the surgi- butions to orthopedic surgery. Because of his many publications, it was only With his wife, Dorothy, Dr. Bosworth be appointed to the edi- made his home a welcome place for his many res- torial board of The Journal of Bone and Joint idents away from home. He held annual New Surgery, and he served for a time as assistant to Year’s Eve parties attended by his residents and the editor. He was also appointed to the Board of many a Sunday night was spent in his basement, Trustees of the Journal and served as treasurer for in a cloud of cigar smoke, with his staff, ironing his entire term as trustee. Many of his residents in Orthopedics at New York Polyclinic Medical can recall him quoting from memory during School, at Flower Fifth Avenue Medical School, long operations in the late afternoon—lengthy and as a lecturer in orthopedic surgery at passages from Hamlet or “Elegy in a Country Bellevue Medical College and the University Churchyard. Bosworth left New York His staff appointments included: Assistant City to return to his birthplace, Vermont, where Surgeon, Attending Surgeon, and Director of he was in active practice almost until his 82nd Orthopedic Surgery at St. David Marsh Bosworth died in Vermont on Seaview Hospital, the House of St. His 94 original Cripple, and Richmond Borough Hospital, all of orthopedic publications alone (from 1930 to New York City. He was also consultant to 22 1967) could fill a volume or two, and indicate the hospitals in New York and surrounding areas. Bosworth’s many community service efforts David Marsh Bosworth was affectionately included working as consultant surgeon of the known as “Uncle David” by all his ex-residents, New York City Police Department, beginning in although he was seldom called anything but Dr. His great surgical State Supreme Court, Department of Labor, and wisdom and experience have passed from him to the United States Department of Labor. When, as it must served as an examiner for the American Board of sometime happen to all of us, we encounter a dif- Orthopedic Surgery from 1940 to 1966. Bosworth, in order to cover more the most natural thing in the world to ask, “What ground faster, he early obtained his own airplane would Uncle David do here?

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If you’re a nervous person who finds it difficult to talk to strangers discount midamor 45mg, face-to-face interviewing might not be the best method for you order midamor 45 mg free shipping. If you love working with groups buy midamor 45mg lowest price, you might like to find out more about focus group re- search order midamor 45mg visa. If a particular culture has fascinated you for years and you know you could immerse yourself within that cul- HOW TO CHOOSE YOUR RESEARCH METHODS / 37 ture cheap 45 mg midamor amex, perhaps participant observation would interest you. If you love number crunching or using statistical software, a closed-ended questionnaire may be the best method for you. Remember to think about choosing a method or meth- od(s) with which you are happy as this is important to keep your motivation levels high. X Three types of interview are used in social research: – Unstructured or life history interviews. X Focus groups are held with a number of people to ob- tain a group opinion. X Focus groups are run by a moderator who asks ques- tions and makes sure the discussion does not digress. X Questionnaires can be closed-ended, open-ended or a combination of both. X Participant observation is used when a researcher wants to immerse herself in a specific culture to gain a deeper understanding. X The chosen research methodology should help to indi- cate the most appropriate research tools. X The purpose of the research will provide an indicator to the most appropriate methods. X You should think about your personality, strengths and weakness, likes and dislikes when choosing re- search methods. This will help you to become more familiar with your topic and intro- duce you to any other research which will be of benefit to you when you begin your own project. PRIMARY RESEARCH AND SECONDARY RESEARCH There are two types of background research – primary re- search and secondary research (see Table 2). Primary re- search involves the study of a subject through firsthand observation and investigation. This is what you will be doing with your main project, but you may also need to conduct primary research for your background work, especially if you’re unable to find any previously pub- lished material about your topic. Primary research may come from your own observations or experience, or from the information you gather personally from other people, as the following example illustrates. I had noticed how some children didn’t fit the classic description of a truant and I wanted to find out more as I thought it might help me to deal with some of the problems children were experiencing. So I guess you’d say my own experience provided me with some initial data. Then I decided to go and have a dis- cussion with some of my colleagues and see if they’d noticed anything like me. It was really useful to do this because they helped me to think about other things I hadn’t even thought of. One of them told me about a new report which had just come out and it was useful formetogoandhavealookatitasitraisedsome of the issues I was already thinking about. Actually this made me change the focus of my work a little because I soon found out that there had been a lot of work on one area of what I was doing, but not so much on another area. It was really useful to have done this before I rushed into my research as I think I might have wasted quite a bit of time. In the above example, Jenny mentions a recently pub- lished report which she has read. This is secondary re- search and it involves the collection of information from studies that other researchers have made of a subject. The two easiest and most accessible places to find this informa- tion are libraries and the internet. However, you must re- 42 / PRACTICAL RESEARCH METHODS member that anybody can publish information over the internet and you should be aware that some of this infor- mation can be misleading or incorrect.

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