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Their implied argument was that if the methods were equivalent the slope of the regression line would be 1 skin care lines order discount acnotin on line. However acne quick treatment generic acnotin 20 mg line, this ignores the fact that both dependent and independent variables are measured with error acne 6 year old daughter acnotin 30mg with mastercard. In our previous notation the expected slope is 2 2 2 = T /(A + T ) and is therefore less than l. How much less than 1 depends on the amount of measurement error of the method chosen as independent. Similarly, the expected value of the intercept will be greater than zero (by an amount that is the product of the mean of the true values and the bias in the slope) so that the conclusion of Ross et al. We do not reject regression totally as a suitable method of analysis, and will discuss it further below. Asking the right question None of the previously discussed approaches tells us whether the methods can be considered equivalent. We think that this is because the authors have not thought about what question they are trying to answer. The questions to be asked in method comparison studies fall into two categories: (a) Properties of each method: How repeatable are the measurements? This may include both errors due to repeatability and errors due to patient/method interactions. Most studies standardize these, but do not consider their effects, although when they are considered, confusion may result. Altmans (1979) criticism of the design of the study by Serfontein and Jaroszewicz (1978) provoked the response that: For the actual study it was felt that the fact assessments were made by two different observers (one doing only the Robinson technique and the other only the Dubowitz method) would result in greater objectivity (Serfontein and Jaroszewicz, 1979). What we need is a design and analysis which provide estimates of both error and bias. We feel that a relatively simple pragmatic approach is preferable to more complex analyses, especially when the results must be explained to non-statisticians. It is difficult to produce a method that will be appropriate for all circumstances. What follows is a brief description of the basic strategy that we favour; clearly the various possible complexities which could arise might require a modified approach, involving additional or even alternative analyses. Properties of each method: repeatability The assessment of repeatability is an important aspect of studying alternative methods of measurement. Replicated measurements are, of course, essential for an assessment of repeatability, but to judge from the medical literature the collection of replicated data is rare. Repeatability is assessed for each measurement method separately from replicated measurements on a sample of subjects. We obtain a measure of repeatability from the within- subject standard deviation of the replicates. The British Standards Institution (1979) define a coefficient of repeatability as the value below which the difference between two single test results. Provided that the differences can be assumed to follow a Normal distribution this coefficient is 2. For the purposes of the present analysis the standard deviation alone can be used as the measure of repeatability. It is important to ensure that the within-subject repeatability is not associated with the size of the measurements, in which case the results of subsequent analyses might be misleading.
List the etiologies & animal reservoirs of the different types of leishmaniasis 4 acne killer purchase generic acnotin on line. Refer suspected cases of leishmaniasis to hospitals for investigation & treatment 12 acne medication reviews buy acnotin american express. Design appropriate methods of prevention andcontrol of leishmaniasis Definition: is an infectious disease caused by the protozoa called Leishmania Classification of leishmaniasis There are three major clinical forms of leishmaniasis: Visceral leishmaniasis Cutaneous leishmaniasis Mucocutaneous leishmaniasis Etiologic Agents The different clinical forms of leishmaniasis (listed above) are caused by different species of leishmanial parasites which are listed under each of these diseases skin care 4d motion cleanser buy discount acnotin. The parasites are seen in two forms Leishmanial form:- ( amastogote ) this is non flagellate form seen in man and extra human vertebrate reservoir Leptomonad forms (also called promastigotes) are flagellated forms The parasite is transmitted by the bite of vectors of the species phlebotomus, Sand flies 56 Internal Medicine Life Cycle of Leshimaniasis Transmitted by the bite of an infected female phlebotomine Sand fly, the leishmaniases are globally widespread diseases. Sand flies are primarily infected by animal reservoir hosts, but humans are also a reservoir for some forms. Animal Reservoirs: include Rodents - Commonly in East Africa, Ethiopia, the Sudan and Kenya and Canines - Mediterranean and Asia. As the sandfly feeds, promastigote forms of the leishmanial parasite enter the human host via the proboscis. Within the human host, the promastigote forms of the parasite are ingested by macrophage where they metamorphose into amastigote forms and reproduce by binary fission. They increase in number until the cell eventually bursts, then infect other phagocyctic cells and continue the cycle. The parasites are transformed inside the fly and delivered to a new host, and the life-cycle continues Fig 3. It is characterized by chronic irregular fever, profound wasting, debility and hepatosplenomegally. Epidemiology Visceral leishmaniasis affects many countries in Africa, mainly Ethiopia and the Sudan the Middle East, Southern soviet union, India and S. Transmission The commonest way of transmission is by inoculation of promastigotes into humans by the bite of sand flies which breed in termite hills and forests. The source of the aflagellate forms may be either humans or extra human vertebrate reservoirs, and the disease may have life cycles that involve humans and sand flies only, or humans, sand flies and extra human vertebrate reservoirs together. Pathogenesis The common site of entrance is the skin where primary cutaneous lesion appears at the sites of sand fly bite. Here a cellular reaction by lymphocytes and plasma cells develop around the amasitigote-filled histiocytes in the dermis. As immune response develops epitheloid and giant cells appear, to be followed in some by healing. In others usually 4-6 months later amastigotes escape to the blood in macrophages, hematogeneous spread occurs and colonize the cells of reticuloendothelial system, where they multiply further and released after rupture of the cells and transported to new cells. The cells affected include that of spleen, liver, bone marrow and lymphatic glands, where the parasite multiplies and cause overcrowding of cells and as a result these organs are enlarged. The liver with its Kuppfer cells packed with amastigotes is enlarged & progress to cirrhosis. Clinical Features Incubation period usually varies from weeks to months but can be as long as years. Diagnosis Definitive diagnosis is based on demonstration of the Parasite - Giemsa stained smear of peripheral blood (in Indian form) and tissue touch preparation of organ aspirates and examined by light microscopy. Following the bite of sand flies, leishmania multiply in the macrophages of the skin.
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