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O. Navaras. Elms College.

We summarize an experiment usually by computing the mean and standard devia- tion in each condition cheap cialis jelly 20 mg without prescription. When the standard deviations are relatively small purchase 20 mg cialis jelly otc, the scores in the conditions are similar purchase cialis jelly 20 mg amex, and so a more consistent—stronger—relation- ship is present discount cialis jelly 20mg on line. When we predict that participants obtained the mean score cheap cialis jelly 20mg amex, our error in predic- tions is determined by the variability in the scores. In this context the variance and standard deviation measure the differences between the participants’ actual scores 1X2 and the score we predict for them 1X2, so we are computing an answer that is somewhat like the “average” error in our predictions. The amount that a relationship with X helps us to predict the different Y scores in the data is the extent that X accounts for the variance in scores. What do measures of variability communicate about (a) the size of differences among the scores in a distribution? Why are your estimates of the population variance and standard deviation always larger than the corresponding values that describe a sample from that population? In a condition of an experiment, a researcher obtains the following creativity scores: 3 In terms of creativity, interpret the variability of these data using the following: (a) the range, (b) the variance, and (c) the standard deviation. If you could test the entire population in question 11, what would you expect each of the following to be? As part of studying the relationship between mental and physical health, you obtain the following heart rates: 73 72 67 74 78 84 79 71 76 76 79 81 75 80 78 76 78 In terms of differences in heart rates, interpret these data using the following: (a) the range, (b) the variance, and (c) the standard deviation. If you could test the population in question 14, what would you expect each of the following to be? Indicate whether by knowing someone’s score on the first variable, the relationship accounts for a large or small amount of the variance in the second variable. Consider the results of this experiment: Condition A Condition B Condition C 12 33 47 11 33 48 11 34 49 10 31 48 (a) What “measures” should you compute to summarize the experiment? Compute the appropriate descriptive statistics and summarize the relationship in the sample data. Consider these ratio scores from an experiment: Condition 1 Condition 2 Condition 3 18 8 3 13 11 9 9 6 5 (a) What should you do to summarize the experiment? Comparing the results in questions 19 and 22, which experiment produced the stronger relationship? What are the three major pieces of information we need in order to summarize the scores in any data? What is the difference between what a measure of central tendency tells us and what a measure of variability tells us? For each of the following, identify the conditions of the independent variable, the dependent variable, their scales of measurement, which measure of central tendency and variability to compute and which scores you would use in the com- putations. For each experiment in question 28, indicate the type of graph you would create, and how you would label the X and Y axes. The computational formula for estimating the population variance is Range highest score lowest score 1©X22 ©X2 2 2. The computational formula for the sample N s2 5 variance is X N 2 1 1©X22 ©X2 2 5. Your goals in this chapter are to learn ■ What a z-score is and what it tells you about a raw score’s relative standing. The techniques discussed in the preceding chapters for graphing, measuring central tendency, and measuring variability comprise the descriptive procedures used in most behavioral research. In this chapter, we’ll combine these procedures to answer another question about data: How does any one particular score compare to the other scores in a sample or population? In the following sections, we discuss (1) the logic of z-scores and their simple com- putation, (2) how z-scores are used to describe individual scores, and (3) how z-scores are used to describe sample means. The size of a number, regardless of its sign, is the absolute value of the number. When we do not ignore the sign, you’ll encounter the symbol ;, which means “plus or minus. Saying “the scores between ;1,” means all possible scores from 21, through 0, up to and including 11.

Can vary for different If manufacturer’s or published reference ranges are patient populations (age order cialis jelly 20 mg overnight delivery, gender generic 20 mg cialis jelly mastercard, race) purchase cialis jelly 20 mg without a prescription. Established used cheap 20mg cialis jelly, lab must test specimens from normal subjects to by testing minimum of 120 healthy subjects & de- verify ranges order 20 mg cialis jelly free shipping. Analytical specificity Ability of method to measure only analyte it’s sup- Determined by manufacturer. Requires a minimum of 40 patient samples representing wide range of concen- trations. Reference values (existing method) are plotted onxaxis, values from new method onyaxis. Preventive maintenance Schedule of maintenance to keep equipment in peak operating condition. Maintenance must be documented & must follow manufacturer’s specifications & frequencies. Function checks Procedures specified by manufacturer to evaluate critical operating characteristics of test system, e. Must be within manufacturer’s established limits before patient testing is conducted. When limit is exceeded, must determine if due to medical change in patient or lab error. Critical values Test results that indicate a potentially life-threatening situation. Person receiving critical values must record & read back patient’s name & critical values. Pertinent literature references collection, labeling, storage, preservation, transporta- 13. System for entering results in patient record & report- tion, processing, referral & criteria for specimen ac- ing (including protocol for critical values) ceptability & rejection 14. Procedures for microscopic examinations, including detection of inadequately prepared slides 3. Step-by-step performance of the procedure, including test calculations & interpretation of results 4. Preparation of slides, solutions, calibrators, controls, reagents, stains, & other materials used in testing 5. Corrective action when calibration or control results fail to meet lab’s criteria for acceptability 9. Limitations in methodology, including interfering substances Manufacturer’s instructions may be used for #1–12. Copies of procedures must be retained for 2 yr after discontinuance & must include dates of initial use & discontinuance. Restriction of access to information to those who have authorization and a need to know. Unauthorized disclosure of medical information could lead to charges of breach of confidentiality or invasion of privacy. Informed consent Consent for a medical procedure given by patient after procedure & possible risks have been explained. Drawing blood against a patient’s wishes could lead to charges of assault & battery. Each person handling specimen must sign chain-of-custody form that accompanies specimen & docu- ments custody of specimen at all times. Fluorometry Atoms absorb light of specific Light source (mercury or xenon arc Detector at 90ºto light source wavelength & emit light of lamp), primary monochromator, so that only light emitted by longer wavelength (lower sample holder (quartz cuvettes), sample is measured. Reagent probes, sample & reagent Doesn’t require excitation radia- Usually involves oxidation of cuvette, photomultiplier tube, tion or monochromators like luminol, acridinium readout device fluorometry. Nephelometry Similar to turbidity, but light is Light source, collimator, mono- Used to measure ag-ab rxn. Anions move to positively charged medium, buffer, stain, trophoresis, hemoglobin pole (anode); cations to negatively charged densitometer electrophoresis pole (cathode). Some analyzers have short sample & clot detection Reagent delivery Usually by syringes, pumps, or pressurized reagent bottles. Microalbumin 50–200 mg/24 hr ↑in diabetics at risk of Detects albumin in urine earlier than dipstick (on urine) predictive of diabetic nephropathy protein. Strict control of glucose & blood nephropathy pressure can prevent progression to end-stage renal disease.

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Individuals with polymorphisms in genes coding for well-characterized enzymes of the lipid metabolism have significantly different metabolic capacities with respect to the syn- thesis of some polyunsaturated fatty acids discount cialis jelly 20 mg without a prescription, the beta-oxidation of short- and medium- chain fatty acids 20 mg cialis jelly with visa, and the breakdown of triglycerides buy 20 mg cialis jelly amex. These metabotypes generic cialis jelly 20 mg amex, in interactions with envi- ronmental factors such as nutrition of lifestyle buy cialis jelly 20 mg mastercard, may influence the susceptibility of an individual for certain phenotypes. For example, there are potential links between Universal Free E-Book Store Metabolomics, Biomarkers and Personalized Medicine 171 long-chain fatty acid metabolism and attention deficit hyperactivity syndrome. Understanding these connections, in turn, may eventually lead to more targeted nutrition or therapies and more refined disease risk stratification. These could result in a step towards personalized health care and nutrition based on a combination of genotyping and metabolic characterization. In a multi-“omics” systems biology approach, the metabolome may be the clos- est biological representation of a clinical trait. Phenomics can be used to fully char- acterize clinical traits associated with drug therapy, and when combined with metabolomics, common biological pathways can be identified, providing insight into mechanisms of efficacy and safety (Monte et al. This approach has the potential to eliminate drug therapy that will either be ineffective or unsafe in spe- cific subsets of patients. Metabolomics, Biomarkers and Personalized Medicine Metabolomics has used to identify biomarkers for disease as well as to identify off- target side effects in marketed drugs and new chemical entities in development. Compared to ~19,000 genes and ~1 million proteins, there are only 2,500 metabo- lites (small molecules). Plasma samples obtained from patients can be analyzed for signatures of neurodegenerative disorders by measuring the spectrum of biochemi- cal changes and mapping these changes to metabolic pathways. This technology can be applied to discover biomarkers for diabetic nephropathy in type 1 diabetes. Within the last few years, metabolomics has developed into a technology that complements proteomics and transcriptomics. In combination with techniques for functional analysis of genes, it is hoped that a holistic picture of metabolism can be formed. In addition to the genome analysis and proteome analyses, the exhaustive analysis of metabolites is important for a comprehensive understanding of cellular functions because the dynamic behavior of metabolites cannot be predicted without information regarding metabolome. In view of the chemical and physical diversity of small biological molecules, the challenge remains of developing protocols to gather the whole ‘metabolome’. No single technique is suitable for the analysis of different types of molecules, which is why a mixture of techniques has to be used. In the field of metabolomics, the gen- eral estimations of the size and the dynamic range of a species-specific metabolome are at a preliminary stage. Metabolic fingerprinting and metabonomics with high sample throughput but decreased dynamic range and the deconvolution of individ- ual components achieve a global view of the in vivo dynamics of metabolic Universal Free E-Book Store 172 7 Role of Metabolomics in Personalized Medicine networks. However, it is important to note that each type of technology exhibits a bias towards certain compound classes, mostly due to ionization techniques, chromatog- raphy and detector capabilities. Ultracomplex samples contain hundreds of co-eluting compounds that vary in abun- dance by several orders of magnitude. Urinary Profiling by Capillary Electrophoresis Metabolomic approaches have become particularly important for discovery of bio- markers in urine. The analytical technology for urinary profiling must be efficient, sensitive and offer high resolution. These profiles have been visualized using novel advanced pattern recognition tools. The method has been applied in investigation of biomarkers characteristic of alcoholics or Down’s syndrome persons. Lipid Profiling Modern medicine has come to rely on a small suite of single biomarkers, such as plasma cholesterol or triglycerides, to assess the risk of certain diseases. However, such single-biomarker assessments overlook the inherent complexity of metabolic disorders involving hundreds of biochemical processes. Assessing the full breadth of lipid metabolism is what drives the field of lipomic profiling. However, unlike the other “-omics” technologies, in which only a small portion of the genes or proteins is known, lipid metabolic pathways are well characterized. Another limitation of “-omics” technologies is that they produce so many false positive results that it is difficult to be sure that findings are valid.

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Poor eating habits resulting in oral disease need to be tackled together with the paediatrician and dietician 20 mg cialis jelly, as well as the parents or caregivers order cialis jelly 20 mg overnight delivery. It is wise therefore to check the diet carefully before advocating the use of fluoride supplements for such children order 20 mg cialis jelly visa. Where dental caries is potentially a real problem and in the absence of any other form of systemic fluorides purchase 20mg cialis jelly overnight delivery, then the daily fluoride supplement regimen of 0 cialis jelly 20mg generic. Once the concentration of fluoride in the local water supply is known from the water company, fluoride supplements can be prescribed by the general dental practitioner if indicated, either as drops for the younger child or tablets for the preschool child. It is likely that some children with impairments will never cope with fluoride tablets and have to remain on drops. As long as the parent is given written instructions to overrule the prescribing schedule given for younger children on the label of the bottle, there is no reason why older children should not be prescribed fluoride drops. The dentist should also advise on the appropriate fluoride toothpaste to be used in conjunction with fluoride supplementation or water fluoridation. Each case should be considered individually taking into account the relative risks and benefits that may occur. Paramount is consideration of the risk of developing dental caries versus the potential for enamel opacities in the permanent dentition. As a guideline, if the risk of caries is minimal, and if the diet is reasonably well controlled and home oral care is generally good, then it is sensible to suggest the use of a pea-sized amount of toothpaste containing approximately 500-600 p. Older children, in the same situation should use a toothpaste containing between 1000 and 1500 p. In the child where the development of dental disease would pose a real hazard to their general health, and where home care in terms of oral hygiene and diet is poorly controlled, it is advisable to confer maximum protection by recommending the use of a toothpaste containing 1000-1500 p. Because of the inability of many disabled children to hold solutions in their mouths or to expectorate, fluoride mouthwashes are contraindicated; however, they can be used on a toothbrush (dipped) where toothpaste is not well tolerated, to mimic the amount of topical fluoride received from toothpaste. Key Points Fluoride advice: • supplements to give optimal caries protection; • fluoride mouthwash on a toothbrush instead of paste in cases of paste intolerance; • low caries risk: 500-600 p. Included in this general category of physical impairment are children with clefts of the lip and/or palate (Chapter 141148H ), where there may well be an associated syndrome in up to 19% of cases. This is a group of non-progressive neuromuscular disorders caused by brain damage, which can be pre-, peri-, or postnatal in origin, and is classified according to the type of motor defect: 1. There is the appearance of severe muscle stiffness and the planned movement of an affected limb results in a hypotonic tendon reflex, especially with rapid movements. Athetosis⎯uncontrolled, slow twisting, and writhing movements, which are frequent and involuntary and occur in over 16% of cases. For example, with the decrease in kernicterus (neonatal jaundice), there has been a fall in the athetoid form, but the spastic form, associated with prematurity, has increased. In addition, they may be disabled by other impairments such as convulsions, intellectual impairment, sensory disorders, emotional disorders, speech and communication defects, and a poorly developed swallowing and cough reflex. Although not confined to children with cerebral palsy, gastric reflux is relatively common (Fig. There may be an obvious aetiology, for example, a hiatus hernia, but quite often a cause for the erosion cannot be identified (Chapter 101152H ). Key Points Oral features in cerebral palsy: • gingival hyperplasia; • increased caries prevalence; • malocclusion; • dental trauma; • enamel hypoplasia; • heightened gag reflex; • dental erosion and abrasion (bruxism). Plentiful reassurance, efficient suction and skilled assistance are vital to success in these situations. Impaired ventilation may accompany scoliosis and becomes an even more important consideration if procedures involving a general anaesthetic are contemplated. Children who spend long periods in one position may be predisposed to pressure sores, therefore lengthy procedures in the dental chair without a break are best avoided. Patients can experience acute discomfort during tooth preparation or ultrasonic scaling (even when the affected teeth are distant from the operating site), merely from the cold produced by high volume aspiration. The use of a desensitizing agent like Duraphat fluoride varnish or fissure sealing the symptomatic surface can be helpful if a restoration is not indicated. Hypoplastic enamel does not have the same ordered prism structure as normal enamel and, despite acid etching, may not provide optimum retention for conventional resins. Some less severely disabled children will have little or no intellectual impairment but will have a degree of spasticity or rigidity. This may prevent them from co-operating fully with dental procedures, despite their willingness to do so, and they may be helped by nitrous oxide sedation (Chapter 41155H ). Most children require help with brushing until they are 7 years or older, but for the child with physical limitations this may be a permanent commitment on the part of carers.

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