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Demand for treatment thus depends upon the severity of the malocclusion as perceived by patients and parents rather than by dentists buy aricept 10mg otc. Demand for orthodontic treatment tends to increase as appliances become more common and accepted among a population buy 10mg aricept with mastercard, but it is also greatly affected by the availability of treatment (geographic accessibility 10 mg aricept fast delivery, waiting lists, etc. Reproduced with kind permission of the Editor of the European Journal of Orthodontics. Timing of referral The right time for orthodontic intervention will vary according to the condition, but if specialist advice is needed it is better to refer too early rather than too late. The majority of orthodontic treatments are carried out in the late mixed and early permanent dentition, but some conditions may be treated earlier (see Section 14. Patient and family attitudes In many cases the dentist will have known the family for some time, and will know their level of dental awareness, their degree of concern about the malocclusion, and their attendance record. This information can be difficult for the orthodontist to pick up during one or two short consultations, but is vital when assessing the likely compliance with orthodontic treatment. Oral hygiene Appliance therapy is inappropriate for patients whose oral hygiene is poor and in general this should be improved before referring for orthodontic treatment. However, this should not be at the expense of excessive delay in referring those patients with more severe malocclusions who may gain some benefit from simple interceptive measures. Prognosis of teeth The family dentist is in a much better position than the orthodontist to estimate the prognosis of restored or traumatized teeth. Radiographs Any relevant radiographs should be forwarded with the referral to avoid unnecessary repetition. Key Points Screening • All children should be screened for malocclusion from 8 years of age. The extraction of teeth in the mixed dentition for purely orthodontic reasons, usually crowding, can sometimes be helpful, but managing the enforced extraction of carious or poor quality teeth is a matter of trying to minimize disruption of the developing dentition. Usually, it is the teeth distal to the extraction that migrate forwards as a result of mesial drift. This drifting is generally unhelpful where the extraction is enforced, but in some situations it can be harnessed to help with the management of dental crowding. As there is a significant increase in the size of the arches during the mixed dentition stage, decisions about the treatment of crowding should be deferred until the permanent incisors have erupted for at least a year, usually at about 8 1/2 - 9 years of age. Where there is severe crowding, the extraction of primary teeth may be considered at this point as part of a programme of serial extractions, but where the crowding is mild the decision should be delayed until the permanent canines and premolars are erupting. Primary canines⎯extracted as the permanent lateral incisors erupt to allow them space to align. First primary molars⎯about 1 year later, or when the roots of the first primary molars are half resorbed or more, to encourage eruption of the first premolars.
Postscript Discussions of this fragment that came out after the original publication of this paper can be found in Hankinson (1998a) generic aricept 10 mg with visa, (1999) and (2002) aricept 10 mg otc, in van der Eijk (2001a) 321–34 order aricept 5 mg free shipping, and in Frede (forthcoming). But a re-examination of the Arabic would seem to make this interpretation less plausible. A literal translation of the Arabic would read as follows: ‘It is not possible to ascertain in the case of food and drink where their last things (akhiriyatuha? The idea is then that although a Dogmatist might speculate theoretically about the power (dÅnamiv)ofa particular foodstuff, e. Thus the position attributed to Diocles here corresponds closely with that attributed to him by Galen in fr. This would suggest that Galen is referring to how foods and drinks are ultimately disposed of; but this would seem to be quite inappropriate to the context. Principles and practices of therapeutics in the Hippocratic Corpus and in the work of Diocles of Carystus 1 introduction In a well-known passage from the Hippocratic Epidemics, the doctor’s duties are succinctly characterised as follows: [The doctor should] declare what has happened before, understand what is present, and foretell what will happen in the future. As to diseases, he should strive to achieve two things: to help, or to do no harm. The (medical) art consists of three components: the disease, the patient, and the doctor. It is succinctly summarised here in the words ‘to help, or to do no harm’ (Ýfele±n £ m blptein), a formula which is often quoted or echoed both in the Hippocratic Corpus and in later Greek and Roman medical literature. The Hippocratic Oath, which explicitly mentions the well-being of the patient as the doctor’s This chapter was ﬁrst published in slightly different form in I. Thus, according to the Oath, the doctor is not allowed to give a woman an abortive, nor to administer a lethal poison, not even when being asked to do so; and the doctor is instructed to refrain from every kind of abuse of the relation of trust that exists between him and the patient. Yet it is also possible – as the word ‘or’ suggests – to take the formula in the sense of unintended harm: ‘To help, or at least to cause no harm’, that is to say, the doctor should be careful when treating the patient not to aggravate the patient’s condition, for example in cases that are so hopeless that treatment will only make matters worse, or in cases which are so difﬁcult that the doctor may fail in the execution of his art; and as we shall see, there is evidence that Greek doctors considered this possibility too. In this chapter I will examine how this principle ‘to help, or to do no harm’ is interpreted in Greek medical practice and applied in cases where it is not immediately obvious what ‘helping’ or ‘causing harm’ consists in. I will study this question by considering the therapeutic sections of a number of Hippocratic writings (most of which date from the period 425–350 bce) and in the fragments of the fourth-century bce medical writer Diocles of Carystus. This passage has received ample attention in scholarship, and it is not my in- tention to give a detailed interpretation or an assessment of its historical reliability. By this I mean the position and relative importance of therapeutics within the ﬁeld of medicine as a whole, which gives rise to 3 ‘I will use dietetic measures to the beneﬁt of the patients... I will keep them from harm and injustice’ (diaitmas© te crsomai pì Ýfele©h tän kamn»ntwn... For more general assessments of Celsus as a source for the history of medicine see Smith (1979) 226–30 and (1989) 74–80; von Staden (1994b) 77–101 and (1999b); Stok (1994) 63–75; Temkin (1935) 249–64.
A study’s design is the way the study is laid out: how many samples there are cheap 10 mg aricept with amex, how the partici- pants are tested discount aricept 5 mg without a prescription, and the other specifics of how a researcher goes about demonstrating a relationship order 5mg aricept with visa. Therefore, part of learning when to use different statistical procedures is to learn with what type of de- sign a procedure is applied. To begin, research can be broken into two major types of designs because, essentially, there are two ways of demonstrating a relationship: exper- iments and correlational studies. Experiments In an experiment the researcher actively changes or manipulates one variable and then measures participants’ scores on another variable to see if a relationship is produced. For example, say that we examine the amount of study time and test errors in an exper- iment. We decide to compare 1, 2, 3, and 4 hours of study time, so we randomly select four samples of students. We ask one sample to study for 1 hour, administer the test, and count the number of errors that each participant makes. We have another sample study for 2 hours, administer the test, and count their errors, and so on. Then we look to see if we have produced the relationship where, as we increase study time, error scores tend to decrease. To select the statistical procedures you’ll use in a particular experiment, you must understand the components of an experiment. The Independent Variable An independent variable is the variable that is changed or manipulated by the experimenter. Implicitly, it is the variable that we think causes a change in the other variable. In our studying experiment, we manipulate study time because we think that longer studying causes fewer errors. Or, in an experiment to determine whether eating more chocolate causes people to blink more, the experimenter would manipulate the Understanding Experiments and Correlational Studies 23 independent variable of the amount of chocolate a person eats. You can remember the independent variable as the variable that occurs independently of the participants’ wishes (we’ll have some participants study for 4 hours whether they want to or not). Technically, a true independent variable is manipulated by doing something to par- ticipants. However, there are many variables that an experimenter cannot manipulate in this way. For example, we might hypothesize that growing older causes a change in some behavior. Instead, we would manipulate the variable by selecting one sample of 20-year-olds and one sample of 40-year-olds. Similarly, if we want to examine whether gender is related to some behavior, we would select a sample of females and a sample of males.