By A. Bengerd. University of Southern Mississippi.

Remember that you can withdraw from a journal at any time but the withdrawal has to be formally accepted at editorial level before you can submit the paper to another journal cheap 100mg vermox with visa. Deciding to withdraw and then submit to another journal will bring another set of reviewers’ comments, albeit different ones, and will almost certainly delay the publication of your paper. If the paper is in a very specialised field, it may well find its way back to one of the original reviewers who will be less than impressed if you have not taken their original comments on board. BF Skinner When you receive the reviewers’ comments, the extent of them may leave you feeling devastated. This is a normal response when unknown peers widely criticise many aspects of your work. All you need to do is deconstruct each of the messages into individual items that you can respond to. In doing this, you will find that many comments are more easily responded to than at first thought. It is probably best to try and make the majority of the changes requested, and to try carefully to negotiate the more radical suggestions as needed. At the end of the line, editors take the review process very seriously so no comments from the reviewers should be lightly dismissed. Sending back a paper with minimal changes implies either disdain or arrogance for the review process and will not impress the journal editor. Your replies to the reviewers’ comments should make your responses very clear. This is the time to get the editorial panel on your side by simplifying the work they have to do in assessing your responses.

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On the other hand order vermox 100 mg mastercard, patients with a good sense of balance can maneuver their wheelchair themselves in almost any situation. The weight can be shifted from the front wheels to the back wheels by weight trans- fer. The wheelchair travels more easily, but is less stable to backward falls. Otherwise, the weight should not be trans- ferred too far back over the back wheels, or else brackets should be fitted at the back to prevent a fall. Depending on the use and the needs in each case, wheels with drum brakes or obliquely angled wheels can be fitted to improve stability and protect the fingers from getting trapped. Many patients with neuro-orthopaedic problems are partially or permanently reliant on wheelchairs, and optimal wheelchair adaptation can help the patient ⊡ Fig. If a wheelchair so that they are neither hampered by spasms, symmetrical position is attempted in a patient with asym- which can affect the whole body, nor obstructed in their metrical deformities, the pelvis will always be distorted in contacts with the outside world as a result of an inap- relation to the long lever arm of the legs. Wheelchair patients must be sion on the spine, potentially resulting in scoliosis. This includes balance it is not possible to actually fix the pelvis in the seat, the training, weight transfer, overcoming obstacles such as positioning of the legs must be adapted to the position of steps and standing the chair upright and getting back the pelvis. Where possible, a correspond- The simplest solution is to sit the patient on a stable ing training program should be arranged under the base and allow the legs to fall loosely. Slight distraction direction of suitably trained therapists or in a rehabilita- or a posture with spread legs is desirable as this enlarges tion center. Not all patients are strong enough to control the sitting area and improves stability.

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These levels of care are linked together through primary care using a public health approach involving passive and active health surveillance buy vermox 100mg with visa. Population-level care employs interventions that affect whole populations. Individual-level care, in contrast, uses interventions that target specific patient groups defined by a common illness or service need. Exposure of an entire community to an intervention as occurs in population-level care can lead to a large community benefit even though the average benefit per individual is small. However, a population-level intervention Engel/Jaffer/Adkins/Riddle/Gibson 106 must be exceedingly safe and relatively inexpensive, because everyone in the population is exposed to it, including many who would have remained healthy even without it. In contrast, individual-level intervention allows the use of higher risk and more costly interventions because the returns when used only in highly ill individuals may be great. A major drawback of individual-level inter- vention is that illnesses usually occur along a continuum of severity and risk. Many with relatively minor symptoms or needs necessarily go undiagnosed and untreated. Those symptoms and needs sum across a population, the result being that individual-level interventions address only a small proportion of the full magnitude of a health problem. Efforts to achieve and maintain an optimal mix of population- and individual-level interventions are the major features of population-based healthcare. For this to work efficiently, community subgroups with elevated risk or with current symptoms and disability must be identified, and a mechanism to track health outcomes and help match key subgroups to specific interventions must be devised. Within the population, only a small proportion of incident pain or fatigue become chronic, but individuals with these chronic symptoms are seen more frequently in healthcare settings than are individuals with transient symp- toms. This spectrum of chronicity, severity, and healthcare use results in a healthcare system gradient: individuals from general population samples report the fewest symptoms and least severe illness on average, those from specialty care samples report the most, and individuals from primary care samples report intermediate levels. This distribution of pain, fatigue, and other idiopathic symptoms across various levels of care has implications for when, where, and how to intervene (e. Incidence reduction (preventing first onset of postwar symptoms) generally relies on population-level interventions applied before postwar symptoms and disability occur (i. Efforts to reduce duration and prevent future episodes of postwar symp- toms and disability are best achieved in the primary care setting because this tends to be where care is first sought.

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