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Interpretive (or Interpretative) research It explains how human beings interpret and make sense of reality generic atorlip-20 20mg otc, from the philosophy and human sciences purchase atorlip-20 20 mg visa, particularly history and anthropology. Qualitative Research–Concepts and Methods 91 Researcher approaches the participants not as individual who exist in a vacuum, but within the whole context of their lives. The Feminist standpoint, action research and phenomenology are influenced to some extent by critical theory. Trustworthiness consists of four components Credibility, transferability, dependability, and conformity [Denzin & Lincoln (1998)]. Data takes the form of field notes on the patterns of interaction as well as the rules and rituals they observe. Case study approach: It is the study of a single unit that has clear boundaries, e. Observation and documented research are the most common form of strategy used in case study research. It differs from other qualitative research methods because of its emphasis on Culture. Ethnography is undertaken by observations, interviews and examination of documents. The main features of ethnography are: Collection of data from interviews, thick description and the naturalistic stance. In addition, work is undertaken with key informants and the emic/etic dimension considered. In ethnography researchers observe their collaborators without prejudice or prior assumptions. Cognitive Ethnography: It has been proposed for the study of software tool development. This has been proposed because one of the criticisms of classical ethnography is that it fails to provide feedback into practice. Emic/Etic perspective: These terms were coined by Pike 1954 and widely used in ethnography.

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Note any swelling generic atorlip-20 20 mg without a prescription, deformities purchase atorlip-20 20mg overnight delivery, or rashes: • Lower leg deformities to note: tibia varum (or bow legs) in an older adult may be due to Paget’s disease of the tibia. Muscle wasting might suggest disuse atrophy, old polio, or spinal stenosis (bilateral and subtle usually in older adults). Although it may cause discomfort, oedema from cardiac failure, venous congestion, hypoproteinaemia, or lymphoedema is not painful unless there are ulcers or thrombophlebitis. Common patterns of foot deformity are: flat feet (pes planus), high-arched feet (pes cavus) with high medial arch, hallux valgus and rigidus, over-riding toes, hammer toes, or claw toes. Other skin lesions which may be relevant include purpura, panniculitis—which is often subtle and over the shins—and pyoderma gangrenosum. Ask the patient to walk in bare feet Gait patterns should be noted: • An antalgic (‘limp/wince’) gait is a non-specific indicator of pain. In the former, as weight is taken on the affected side, gluteus medius may be weak in controlling the small 2–3 cm lateral displacement in the weight-bearing hip that normally occurs. This can be compensated for if the body centre of gravity is brought over the hip by lurching the upper body over the affected side. With gluteus maximus lesions (S1) extension of the hip, which helps mediate motion through the stance phase prior to toeing-off, may be weak. Thrusting the thorax forward with an arched back (forward lurch) compensates for the weakness and helps to maintain hip extension. Examine the lower leg With the patient supine on the couch, examine the lower leg: • After a ruptured popliteal (Baker’s) cyst, calf tissues are often diffusely tender and swollen. Examine the ankle and hindfoot At the ankle and hindfoot, examine for joint and tendon synovitis, palpate specific structures and test passive hindfoot joint mobility: • Synovitis of hindfoot joints is not always easily detected. With ankle joint synovitis, thickened tissue may be felt anteriorly in the ankle crease (where there may be a ‘springy fullness’) or laterally around the malleoli. A negative test does not rule out pathology, as often the history is more sensitive. Examine for midfoot lesions Identifying specific midfoot lesions is difficult, though bony landmarks and discrete tender areas can be noted: • Twisting the midfoot may elicit pain but locating the source in the midfoot may be difficult. Examine the forefoot Check for bony or other swelling, digit separation, and examine the sole of the foot. The differential diagnosis (in adolescents) may be osteochondritis of the second and third metatarsal head.

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Efect of early interferon treatment on conversion to defnite multi- ple sclerosis: a randomized study buy atorlip-20 20 mg cheap. Patients presenting with clinically isolated syndrome Randomization Glatiramer acetate 20 mg daily lacebo Figure 13 discount atorlip-20 20mg online. Follow- Up: Site visits at screening; randomization (baseline); months 1, 3, and every 3 months aferward; and at early termination. Based on this fnding, the study was discontinued and all subjects were transitioned to glatiramer acetate. T e drug was tolerated by most participants, and efcacy was similar to that of the interferons. Patients who are at risk for developing multiple sclerosis should be placed on disease-modifying treatment as early as possible. She denies sensory changes, weakness in other extremity, bowel or bladder incontinence, or change in vision. T ey occur in both cerebral hemispheres, and 3 are perpendicular to the corpus callosum on sagital views. Glatiramer acetate 20 mg daily subcutaneous injection is one option that has been shown to efectively delay onset to a second clinical atack. Efects of early treatment with glati- ramer acetate in patients with clinically isolated syndrome. Intramuscular interferon beta-1a therapy initiated during a frst demyelinating event in multiple sclerosis. Efect of early interferon treatment on conver- sion to defnite multiple sclerosis: a randomised study. Additionally, patients needed to receive interferon beta-1a therapy for the 12 months preceding trial entry, during which time the patient needed to have had at least one exacerbation on therapy. Also, patients were excluded if they experienced an exacerbation within 50 days of random- ization or had received another type of disease-modifying therapy other than interferon beta- 1a. Study Intervention: Patients were randomized to receive either 300 mg of natalizumab or placebo intravenously every 4 weeks in addition to 30 µg of interferon beta-1a intramuscularly every week for up to 116 weeks. Natalizumab for Relapsing Multiple Sclerosis 101 Endpoints: Primary efcacy endpoints: the rate of new clinical relapses at 1 year and the cumulative probability of sustained disability progression at 2 years. New relapses were defned as new or recurrent neurological symptoms that (1) were not associated with an infection, (2) lasted greater than 24 hours, and (3) were associated with new and objective neurological fndings.

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Crown Proportions and Size of Primary permanent molars purchase atorlip-20 20 mg amex, maxillary primary molars tend to be Canines from the Incisal View wider buccolingually than mesiodistally cheap atorlip-20 20 mg with visa, whereas man- Primary maxillary canine crowns are broader faciolin- dibular molars tend to be wider mesiodistally than buc- gually than incisor crowns and are considerably wider colingually. Mandibular canine crowns are only slightly detail at this time, emphasizing the traits that further wider mesiodistally than faciolingually. Discussion begins with primary of these teeth compared to the permanent canines is second molars since they are so similar to the perma- quite noticeable. Maxillary primary to primary canines and just mesial to primary second second molars may even have a cusp of Carabelli molars. The crown of the maxillary second premolar develops in the space bounded by these roots. From this aspect, the primary maxillary second molar resembles a miniature 6-year first molar (even with a Carabelli cusp). Since these teeth are adjacent to one another during an important clue for tooth identification. If there are the time of mixed dentition, it is important to distin- no missing teeth, the primary second molar is the fifth guish between a primary second molar and the per- tooth from the midline, and the permanent first molar manent 6-year first molar that erupts just distal to it. In the maxillary arch, the fifth tooth from the midline on the left side of the photograph is a second premolar. On the right side, a retained primary canine is still present and the permanent canine has erupted quite labial to the arch, but if you consider that the third position from the midline is reserved for the permanent canine, then the fifth tooth on the right side is a primary second molar. Notice the similarity of the primary second molar with the larger 6-year molar just distal to it. Also notice the position of the secondary maxillary canine, which is normally the last succedaneous tooth to erupt (positioned just labial to the primary canine, which is still present). In the mandibular arch, the fifth tooth from the midline on both the right and left sides is a primary second molar. Notice the similarity in morphology with the larger 6-year molar just distal to it (sixth from the mid- line).