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According to this policy “research mis- conduct is defined as fabrication medicine to increase appetite discount chloromycetin online, falsification medicine to reduce swelling generic chloromycetin 500mg free shipping, or plagiarism in proposing treatment centers for drug addiction chloromycetin 500mg without prescription, per- forming, or reviewing research, or in reporting research results. These three types of misconduct are defined as follows: Fabrication is making up data and recording or reporting them. Falsification is manipulating research materials, equipment, or processes, or changing or omitting data such that the research is not accurately repre- sented in the research record. Plagiarism is the appropriation of another person’s ideas, processes, results, or words without giving appropriate credit. It is likely that the vast majority of scientists, and people in general, know that it is wrong to lie, cheat, or steal. There are clearly numerous motivations that lead people to engage in such practices. These may include, but are not limited to , acting on personal or political biases, having personal financial incentives, personal and professional ambition, and fear of failure. In our system of research, the need for financial support and desire for academic advancement as measures of financial and pro- fessional success are dependent upon the productivity of a research program. Until there are some fundamental changes in the way research is funded, these questionable incentives are likely to remain in place. Many people believe that a substantial amount of research misconduct goes unreported because of concerns that there will be consequences to the whistle- blower. All institutions in the United States that engage in federally supported research must now have in place formal policies to prevent retaliation against whistle-blowers. Unfortunately, it is unlikely that someone will be able to recog- nize scientific misconduct simply by reading a research study unless the miscon- duct is plagiarism of work they did or is very familiar to them. Usually such mis- conduct, if found at all, is discovered locally or during the review process prior to publication and may never be disclosed to the general scientific community. Conflict of interest Conflicts of interest may provide the motivation for researchers to act outside of the boundaries of responsible conduct of research. Webster’s dictionary defines conflict of interest as “A conflict between the private interests and professional responsibilities of a person in a position of trust. Thompson who stated that “a conflict of interest is a set of conditions in which professional judgement concerning a primary interest (such as patient welfare or the validity Scientific integrity and the responsible conduct of research 183 Fig. Other interest interest Judgment Bias Alternative Decision decision of research) tends to be unduly influenced by secondary interest (such as finan- cial gain). It is very impor- tant to recognize that conflicts of interest per se are common among people with complex professional careers. Simply having conflict of interest is not necessar- ily wrong and is often unavoidable. What is wrong is when one is inappropri- ately making decisions founded on these conflicts or when one accepts a new responsibility over a previous professional interest. An example of this would be a physician becoming a part owner of a lab, to which he or she sends patients for bloodwork, at the cost of the physician’s previous priority of patient care. Deci- sions that are made based upon the bias produced by these interests are espe- cially insidious when they result in the compromise of patient care or in research misconduct. Many of the rules regarding conflict of interest focus on financial gain, not because it is the worst consequence, but because it is more objective and reg- ulable. There is substantial reason for concern that financially based conflicts of interest have affected research outcomes. Recent studies of calcium channel blockers,2 non-steroidal anti-inflammatory drugs,3 and health effects of second- hand smoke4 each found that physicians with financial ties to manufacturers were significantly less likely to criticize safety or efficacy. A study of clinical-trial publications5 determined a significant association between positive results and pharmaceutical company funding.
Paul M medicine doctor purchase 500mg chloromycetin visa, Silbiger I symptoms dengue fever order chloromycetin australia, Grozinsky S medicine pouch discount 500 mg chloromycetin with amex, et al: Beta lactam antibiotic mono- resistant bacteria in intensive care: A randomised controlled trial. Garnacho-Montero J, Sa-Borges M, Sole-Violan J, et al: Optimal 2009; 360:20–31 management therapy for Pseudomonas aeruginosa ventilator-asso- ciated pneumonia: An observational, multicenter study comparing 118. N Engl J Med 2009; 361:1935–1944 antibiotic resistance in patients in intensive-care units: An open- 98. Lancet Infect of Pandemic (H1N1) 2009 Infuenza; Bautista E, Chotpitayasu- Dis 2011; 11:372–380 nondh T, Gao Z, et al: Clinical aspects of pandemic 2009 infuenza 120. N Engl J Med 2010; 362:1708–1719 tive decontamination on resistant gram-negative bacterial coloniza- 99. Yamazaki T, Shimada Y, Taenaka N, et al: Circulatory responses to 367:124–134 afterloading with phenylephrine in hyperdynamic sepsis. Perel P, Roberts I: Colloids versus crystalloids for fuid resuscita- tion in critically ill patients. Lancet 2007; 370:676–684 starch and gelatin on renal function in severe sepsis: A multicentre 148. Regnier B, Rapin M, Gory G, et al: Haemodynamic effects of dopa- randomised study. Ruokonen E, Takala J, Kari A, et al: Regional blood fow and oxygen Trials Group: Fluid resuscitation in the management of early sep- transport in septic shock. N Engl J Med 2008; 358:125–139 versus norepinephrine in the management of septic shock. N Engl J Med 2004; 350:2247–2256 Comparison of dopamine and norepinephrine in the treatment of 130. N Engl J Med 2010; 362:779–789 citation fuid for patients with sepsis: A systematic review and meta- analysis. De Backer D, Aldecoa C, Njimi H, et al: Dopamine versus norepi- nephrine in the treatment of septic shock: A meta-analysis*. Crit tors: A comparison of epinephrine and norepinephrine in critically ill Care Med 2004; 32:1928–1948 patients. Morelli A, Ertmer C, Rehberg S, et al: Phenylephrine versus nor- sure on tissue perfusion in septic shock. Crit Care Med 2000; epinephrine for initial hemodynamic support of patients with septic 28:2729–2732 shock: A randomized, controlled trial. Crit Care Med 2000; 28:2758–2765 term vasopressin infusion during severe septic shock. De Backer D, Creteur J, Silva E, et al: Effects of dopamine, nor- ogy 2002; 96:576–582 epinephrine, and epinephrine on the splanchnic circulation in septic 159. Crit Care Med 2003; 31:1659–1667 advanced vasodilatory shock: A prospective, randomized, controlled 138. Circulation 2003; 107:2313–2319 adrenaline infusions on acid-base balance and systemic haemody- 160. Lancet 2002; 359:1209–1210 nephrine and dobutamine to epinephrine for hemodynamics, lac- 165. Sharshar T, Blanchard A, Paillard M, et al: Circulating vasopressin tate metabolism, and gastric tonometric variables in septic shock: levels in septic shock. Confalonieri M, Urbino R, Potena A, et al: Hydrocortisone infusion 31:1394–1398 for severe community-acquired pneumonia: A preliminary random- 168. Am J Respir Crit Care Med 2005; 171:242–248 in hyperdynamic septic shock: A prospective, randomized study.
Skew should be discussed when presenting and evaluating data and the range of the data given in addition to the standard measures of central tendency and dispersion symptoms lactose intolerance purchase chloromycetin us. One clue to the presence of skewed data is if twice the standard deviation is larger than the mean treatment xerostomia order chloromycetin 500 mg fast delivery. The mathematical measures used to describe data are different for skewed distributions than for symmetrical ones medicine 2 times a day buy chloromycetin now. Abraham de Moivre, a French mathematician, discovered it about 50 years before Gauss published his thesis. It is a special case of a symmetrical distribution, and it describes the frequency of occurrence of many naturally occurring phenomena. For the purposes of most statistical tests, we assume normality in the distribution of a variable. It is better defined by giving its properties: (1) The mean, median, and mode are equal so that we can say that the curve is symmetric around the mean and not skewed or has a skew = 0. There are specific numerical equivalents to the standard deviations of the nor- mal distribution, as shown in Table 9. The normal distribution is the basis of most statistical tests and concepts we will use in critical interpretation of the statistics used in the medical literature. Percentages Percentages are commonly used in reporting results in the medical literature. Percentage improvement or percentage of patients who achieve one of two dichotomous endpoints are the preferred method of reporting the results. A percentage is a ratio or fraction, the numer- ator divided by the denominator, multiplied by 100 to create a whole number. Obviously, inaccuracies in either the numerator or denominator will result in inaccuracy of the percentage. Percentofapercent will usually show a very large result, even when there is only a small absolute change in the variables. The second misleading technique is called the percentages of small num- bers, and can be misleading in a more subtle way. Twenty percent of ten subjects seems like a large number, yet represents only two subjects. For example, the fact that those two subjects had an adverse reaction to a drug could have occurred simply by chance and the percentage could be much lower (< 1%) or higher (> 50%) when the same intervention is studied in a larger sample of the population. To display these results properly when there are only a small number of subjects in a study, the percentage may be given as long as the overall numbers are also given with equal prominence. The best way to deal with this is through the use of confidence intervals, which will be discussed in the next chapter. Probability Probability tells you the likelihood that a certain event will or will not occur rel- ative to all possible related events of interest. Mathematically it is expressed as the number of times the event of interest occurs divided by the number of times all possible related events occur. This can be written as P(x) = nx/N where P(x)is the probability of an event x occurring in a total of N possible outcome events. This is calculated as P(head) = 1/2, or the outcome of interest (one head)/the total number of possible outcomes of the coin toss (one head plus one tail). Two events are said to be independent, not to be confused with the indepen- dent variable of an experiment, when the occurrence of one of the events does not depend on the occurrence of the other event. Since the probability of a head on one toss is 1/2, if the same coin is tossed again, the probability of flipping a head does not change. The probability will continue to be 1/2 no matter how many heads or tails are thrown, unless of course, the coin is rigged.
Resistant starch is naturally occurring medications zithromax buy cheap chloromycetin line, but can also be produced by the modification of starch during the processing of foods medications in pregnancy buy chloromycetin 250mg amex. Resistant starch is estimated to be approximately 10 percent (2 to 20 percent) of the amount of starch consumed in the Western diet (Stephen et al medicine 877 generic chloromycetin 250mg free shipping. Along the gastrointestinal tract, properties of fiber result in differ- ent physiological effects. Effect on Gastric Emptying and Satiety Consumption of viscous fibers delays gastric emptying (Low, 1990; Roberfroid, 1993) and expands the effective unstirred layer, thus slowing the process of absorption once in the small intestine (Blackburn et al. A slower emptying rate means delayed digestion and absorp- tion of nutrients (Jenkins et al. For example, Stevens and coworkers (1987) showed an 11 percent reduction in energy intake with psyllium gum intake. Postprandial glucose concentration in the blood is thus lower after the consumption of viscous fiber than after consumption of digestible carbohydrate alone (Benini et al. The extended presence of nutrients in the upper small intestine may promote satiety (Sepple and Read, 1989). Fermentation Fibers may be fermented by the colonic microflora to carbon dioxide, methane, hydrogen, and short-chain fatty acids (primarily acetate, propi- onate, and butyrate). Foods rich in hemicelluloses and pectins, such as fruits and vegetables, contain Dietary Fiber that is more completely ferment- able than foods rich in celluloses, such as cereals (Cummings, 1984; Cummings and Englyst, 1987; McBurney and Thompson, 1990). There appears to be no relationship between the level of Dietary Fiber intake and fermentability up to very high levels (Livesey, 1990). Butyrate, a four-carbon, short-chain fatty acid, is the preferred energy source for colon cells (Roediger, 1982), and lack of butyrate production, absorption, or metabo- lism is thought by some to contribute to ulcerative colitis (Roediger, 1980; Roediger et al. Others have suggested that butyrate may be protec- tive against colon cancer (see “Dietary Fiber and the Prevention of Colon Cancer”). However, the relationship between butyrate and colon cancer is controversial and the subject of ongoing investigation (Lupton, 1995). Once absorbed into the colon cells, butyrate can be used as an energy source by colonocytes (Roediger, 1982); acetate and propionate travel through the portal vein to the liver, where propionate is then utilized by the liver. A small proportion of energy from fermented fiber is used for bacterial growth and mainte- nance, and bacteria are excreted in feces, which also contain short-chain fatty acids (Cummings and Branch, 1986). Differences in food composi- tion, patterns of food consumption, the administered dose of fiber, the metabolic status of the individual (e. Because the process of fermentation is anaerobic, less energy is recovered from fiber than the 4 kcal/g that is recovered from carbohy- drate. While it is still unclear as to the energy yield of fibers in humans, current data indicate that the yield is in the range of 1. Physiological Effects of Isolated and Synthetic Fibers This section summarizes the fibers for which there is a sufficient data- base that documents their beneficial physiological human effects, which is the rationale for categorizing them as Functional Fibers. It is important to note that discussions on the potential benefits of what might eventually be classified as Functional Fibers should not be construed as endorsements of those fibers. While plant-based foods are a good source of Dietary Fiber, isolated or synthetic fibers have been developed for their use as food ingredients and because of their beneficial role in human health. In 1988 Health Canada published guidelines for what they considered to be “novel fiber sources” and food products containing them that could be labeled as a source of fiber in addition to those included in their 1985 definition (Health Canada, 1988). The rationale for these guidelines was that there were safety issues unique to novel sources of fiber, and if a product was represented as containing fiber, it should have the beneficial physiological effects associated with dietary fiber that the public expects. The guidelines indicated that both safety and efficacy of the fiber source had to be estab- lished in order for the product to be identified as a source of dietary fiber in Canada, and this had to be done through experiments using humans. Detailed guidelines were later produced for the clinical studies required to assess laxation effects, as this was the physiological function most often used by industry when seeking approval for a novel fiber source (Health Canada, 1997). For each of the fiber sources discussed below, studies will be summarized that relate to one of the three measures of efficacy identified by Health Canada, as these are the three most commonly accepted beneficial effects of fibers.
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