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She thinks about running a series of semi-structured in- terviews with a small sample of primary school tea- chers cheap himcolin 30 gm with amex. However purchase himcolin 30 gm overnight delivery, the researcher is concerned that some of the teachers may not have seen the programme and might be unable to comment buy cheap himcolin 30gm on-line, or might comment purely on ‘hearsay’ purchase 30gm himcolin mastercard. So she decides to gather together a group of teachers and show them one episode of The Teletub- bies. Then she discusses the programme with the tea- chers in a focus group setting. This method works well and the researcher decides to hold five more focus groups with other primary school teachers. Revised Statement 2: The aim of this research is to find out how many relatives of Alzheimer’s patients use the Maple Day Centre, and to ascertain whether the ser- vice is meeting their needs. This researcher decides to produce a questionnaire with a combination of closed and open-ended ques- tions. The first part of the questionnaire is designed to generate statistics and the second part asks people for a more in-depth opinion. He has approached mem- bers of staff at the Maple Day Centre who are happy to 36 / PRACTICAL RESEARCH METHODS distribute his questionnaire over a period of one month. Revised Statement 3: This research aims to find out how many people from our estate are interested in, and would use, a children’s play scheme in the school summer holi- day. Members of the tenants’ association approach the local school and ask the head teacher if a questionnaire could be distributed through the school. The head tea- cher feels that it is not appropriate so the tenants’ asso- ciation have to revise their plans. They’re worried that if they distribute a questionnaire through the post they won’t receive back many responses. Eventually, they de- cide to knock on each door on the estate and ask some simple, standard questions. They’re able to conduct this type of door-to-door, structured interview as they are a large group and are able to divide the work amongst everybody on the committee. If, at this stage, you are still unsure of the most appropri- ate methods for your research, read the following chapters as these explain in more detail how to go about using each method. This will give you more of an insight into what would be required of you if you were to choose that meth- od. As I stressed earlier, you need to think about your own personality, your strengths and weaknesses, your likes and dislikes. If you’re a nervous person who finds it difficult to talk to strangers, face-to-face interviewing might not be the best method for you. If you love working with groups, you might like to find out more about focus group re- search. 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, 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.

However purchase 30 gm himcolin free shipping, working in tandem with the genetic code is a diversity of mechanisms which cannot be mapped to any gene generic 30 gm himcolin overnight delivery, but which contribute much to the production of structure cheap himcolin 30 gm with mastercard, architecture and pattern cheap 30gm himcolin with visa. As explained by Cohen, the imaginary changeling-like introduction of fly DNA into the egg of a chicken would produce neither fly nor chicken since fly information and chicken constructional mechanisms would be largely incompatible. A fly needs fly construction mechanisms while the constructional apparatus in a chicken’s egg cannot use fly information to make a chicken. There is a design in the form of a blueprint, the workforce to manipulate the components, and the components themselves whose physical properties also play a role in determining the ultimate form. One cannot build a car engine from rubber or Wellington boots from steel. Microscopic algae may use silica, calcium carbonate, or organic polymers to produce such shells. Such patterns are common among spores and pollen, but how do they arise? It is spore walls such as these that have led botanists to consider colloids as fundamental in the production of complex wall patterns. The secret of Nature’s microscopic patterns 97 embodies these principles and has provided structures which were func- tional and have stood the test of time. Furthermore, the Greeks were aware of some fundamental patterns in nature. Their architects recognised the intrinsic aesthetic value of the ‘golden ratio’ (1:1. The same mathematical series governs many space-filling operations in nature, seen most obvi- ously in the arrangement of scales in a pine cone or of seeds on a sunflower head. The DNA (our blueprint) gives rise to proteins (commonly our compo- nents) by converting the genetic code into a sequence of linked amino acid units. The proteins roll up in a specific (self-assembling) way governed by the interactions of the side chains. Some, by a long history of chance and evolutionary selection, behave as efficient catalysts (enzymes) to bring about the formation of other types of molecule from the same simple com- ponents. Others break apart molecules releasing energy to power these pro- cesses. The self-assembly of biological molecules and synthetic analogues has received some attention from biochemists, but exactly how does an organism progress from such a molecular cocktail to something with a spinal column, a stem or a complex silica shell? What is the workforce that operates to achieve construction from our genetic blueprint? Today his work is perhaps seen as being overly directed to the description of nature by ‘natural’ mathematical rules, very much in the Greek tradition. However, the nub of his argument still has great merit; rules do apply in development and, as expounded by Kauffman, they are those of biophysics and chemistry acting at the inter- faces of components derived from the molecular soup within cells. Further, it is the interaction between cells so constructed and constrained that gives rise to the varied shapes of multicellular organisms, including ourselves. Nonetheless, it is at the scale of single-celled organisms that the mecha- nisms of self-assembly are most apparent and close observation of the often spectacular architecture displayed at this level, should give clues to the nature of these mechanisms. Given this connection, it is surprising that there are few studies attempting to correlate architecture and colloid chemistry. Proteins are not the only structures within cells to adopt a particular form dependent upon the intrinsic characteristics of their components. Self-assembly has been demonstrated in microtubules; cell components built from proteins that act like tug boats and guide large components to the interaction sites. Their various conformations are a result of concen- tration specific self-assembly processes. Similarly, the form taken by mem- branes is governed by the concentration of the components, the nature of the surrounding fluids, and physical parameters such as temperature. The formation of periodic minimal surfaces and other bicontinuous structures may be an inherent consequence, as seen in the prolamellar bodies of chloroplasts in plants. In both cases, the genetic code need not define all possible conformations, merely the required concentration of the compo- nents in order to initiate the ‘desired’ structure. It is perhaps noteworthy that the formation of complex membrane systems, and indeed the posi- tioning of the structural units, is often aided by microtubules presenting clear evidence of a hierarchy of developmental self-organisation and assembly.

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Your team will need to: ° establish the aims or objectives of the leaflet ° identify the target audience ° decide on the content order himcolin 30 gm with visa, format and presentation of the material ° choose the manner of production and distribution 93 94 WRITING SKILLS IN PRACTICE ° determine how and when the material will be evaluated ° cost the development effective 30 gm himcolin, production buy 30gm himcolin fast delivery, distribution and evaluation generic 30gm himcolin with visa. Planning the content of your leaflet Your choice of content will be determined by your objectives, your target audience and your evidence base. The purpose of written ma­ terial is usually one of the following: ° to increase awareness ° to motivate ° to change attitudes ° to change behaviour ° to teach a new behaviour ° to teach a new skill ° to offer support and advice ° to give information. Your aims will affect the type of information you choose and the way in which you present it. You need to define your target audience so that you can make the informa­ tion in your leaflet relevant and useful to them. They may share an illness or other condition, or they may be linked in some other way, for example attending the same GP practice. Find out about age, gender, ethnic group, and any special needs like low literacy skills or a sensory impairment. Once you are clear about your audience, you can start to identify their information needs. For example, at what point in the care process or stage of their illness would that type of information be useful? It would also be invalu­ able to have their views on other written material they have used. There are various ways of canvassing the views of clients (along with family and carers). These include using: INFORMATION LEAFLETS FOR CLIENTS 95 ° questionnaires ° interviews 1 ° focus groups ° representatives from voluntary organisations or self-help groups ° representatives of local ethnic minorities. Establish your evidence base Look for evidence on: ° need ° best practice ° current theory. Research other publications Find out about written leaflets that have already been produced for your client group. You may find that there is perfectly adequate information al­ ready published but not accessible to your clients. For instance, a lot of very good work is produced at a local level or by other associated agencies like social services. It may be more cost-effective to buy in this material than trying to re-invent the wheel yourself. Alternatively you may want to adapt ideas from other leaflets for the needs of your specific client group. For example, an interactive diary for­ mat used by one client group might be modified for another. Even reading leaflets where you feel the information is inadequate, incorrect or poorly presented is of use to you in your planning. Consult the users Users are not just the clients but also the clinicians and administrative staff who would be using the material. A facilitator using a set agenda of topics and questions runs groups of up to ten people. Clinical audits might also yield some information about complaints or plaudits regarding the giving of information. Consult with co-agencies Talk with associated agencies about the materials they produce and their perspective on the topic you wish to write about. Look at guidelines on best practice Check clinical guidelines, quality standards and care pathways. Review the research Search databases and liaise with medical schools or universities for infor­ mation on current research findings. Seek an expert opinion Find out from the experts about what should be in your leaflet. This involves a panel of experts who are asked to make suggestions about the ideal content. However, rather than discussing it as a group, the experts are asked to comment anonymously. The information is compiled into a list by a person external to the panel, who marks any items that have not received unanimous support. The list is returned to the ex­ perts who are asked to comment (again anonymously) on the items not agreed.

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Cross References Diplopia; Hypertropia; Skew deviation Bitemporal Hemianopia - see HEMIANOPIA; VISUAL FIELD DEFECTS Blepharoptosis - see PTOSIS Blepharospasm Blepharospasm is a focal dystonia of the orbicularis oculi resulting in repeated involuntary forced eyelid closure cheap himcolin 30 gm online, with failure of voluntary opening buy 30gm himcolin otc. The condition typically begins in the sixth decade of life buy cheap himcolin 30 gm line, and is com- moner in women than men purchase himcolin 30gm without a prescription. Blepharospasm may occur in isolation or in combination with other involuntary movements which may be dys- tonic (orobuccolingual dystonia or Meige syndrome; limb dystonia) or dyspraxic (eyelid apraxia). Blepharospasm is usually idiopathic but may be associated with lesions (usually infarction) of the rostral brainstem, diencephalon, and striatum; it has been occasionally reported with thalamic lesions. The - 55 - B Blind Spot pathophysiological mechanisms underlying blepharospasm are not understood, but may reflect dopaminergic pathway disruption causing disinhibition of brainstem reflexes. Local injections of botulinum toxin into orbicularis oculi are the treatment of choice, the majority of patients deriving benefit and requesting further injection. Failure to respond to botulinum toxin may be due to concurrent eyelid apraxia or dopaminergic therapy with levodopa. Journal of Neurology, Neurosurgery and Psychiatry 1988; 51: 767-772 Hallett M, Daroff RB. Neurology 1996; 46: 1213-1218 Cross References Blinking; Dystonia; Eyelid apraxia; Gaping; Yawning Blind Spot The blind spot is defined anatomically as the point on the retina at which axons from the retinal ganglion cells enter the optic nerve; since this area is devoid of photoreceptors there is a physiological blind spot. This area may be mapped clinically by confrontation with the examiner’s blind spot, or mechanically. Enlargement of the blind spot (peripapillary scotoma) is observed with raised intracranial pressure causing papilledema: this may be helpful in differentiating papilledema from other causes of disc swelling, such as optic neuritis, in which a central scotoma is the most common field defect. Enlargement of the blind spot may also be a feature of peripapillary retinal disorders including big blind spot syndrome. Cross References Disc swelling; Papilledema; Scotoma Blinking Involuntary blinking rate is decreased in idiopathic Parkinson’s disease (and may be improved by dopaminergic therapy) and progressive supranuclear palsy (Steele-Richardson-Olszewski syndrome). In contrast, blink rate is normal in multiple system atrophy and dopa-responsive dys- tonia, and increased in schizophrenia and postencephalitic parkinsonism. These disparate observations are not easily reconciled with the suggestion that blinking might be a marker of central dopaminergic activity. In patients with impaired consciousness, the presence of invol- untary blinking implies an intact pontine reticular formation; absence suggests structural or metabolic dysfunction of the reticular forma- tion. Cross References Balint’s syndrome; Blink reflex; Coma; Corneal reflex; Parkinsonism; Sighing; Yawning - 56 - Body Part as Object B Blink Reflex The blink reflex consists of bilateral reflex contraction of the orbicu- laris oculi muscles. This may be induced by: ● Mechanical stimulus: Examples include percussion over the supraorbital ridge (glabellar tap reflex, Myerson’s sign, nasopalpebral reflex): this quickly habituates with repetitive stimulation in normal individuals; touching the cornea (corneal reflex); stroking the eyelashes in unconscious patients with closed eyes (“eyelash reflex”). Care should be taken to avoid generating air currents with the hand movement as this may stimulate the corneal reflex which may simulate the visuopalpebral reflex. It is probable that this reflex requires cortical processing: it is lost in persistent vegetative states. Loss of this reflex may occur in Balint’s syndrome, ascribed to inability to recognize the nearness of the threatening object. The final common (efferent) pathway for these responses is the facial nerve nucleus and facial (VII) nerve, the afferent limbs being the trigeminal (V), optic (II), and auditory (VIII) nerves respectively. Electrophysiological study of the blink reflex may demonstrate peripheral or central lesions of the trigeminal (V) nerve or facial (VII) nerve (afferent and efferent pathways, respectively). It has been reported that in the evaluation of sensory neuronopathy the finding of an abnormal blink reflex favors a nonparaneoplastic etiology, since the blink reflex is normal in paraneoplastic sensory neuronopathies. Journal of Clinical Neuro-ophthalmology 1992; 12: 47-56 Cross References Balint’s syndrome; Blinking; Corneal reflex; Glabellar tap reflex Body Part as Object In this phenomenon, apraxic patients use a body part when asked to pan- tomime certain actions, such as using the palm when asked to demon- strate the use of a hair brush or comb, or fingers when asked to demonstrate use of scissors or a toothbrush. Ideomotor apraxia in patients with Alzheimer’s disease: why do they use their body parts as objects? Neuro- psychiatry Neuropsychology and Behavioral Neurology 2001; 14: 45-52 Cross References Apraxia “Bon-Bon Sign” Involuntary pushing of the tongue against the inside of the cheek, the “bon-bon sign,” is said to be typical of the stereotypic orolingual move- ments of tardive dyskinesia, along with chewing and smacking of the mouth and lips, and rolling of the tongue in the mouth. These signs may help to distinguish tardive dyskinesia from chorea, although periodic pro- trusion of the tongue (flycatcher, trombone tongue) is common to both. Cross References Chorea, Choreoathetosis; Trombone tongue Bouche de Tapir Patients with facioscapulohumeral (FSH) dystrophy have a peculiar and characteristic facies, with puckering of the lips when attempting to whistle. The pouting quality of the mouth, unlike that seen with other types of bilateral (neurogenic) facial weakness, has been likened to the face of the tapir (Tapirus sp. Cross References Facial paresis Bovine Cough A bovine cough lacks the explosive character of a normal voluntary cough.

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