By M. Hassan. Kent State University.

Please submit the amended manuscript and three copies in addition to a copy of the original marked with the changes you have made within 3 months buy 20 mg tadalis sx impotence 25 years old. 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 tadalis sx 20 mg low cost erectile dysfunction after vasectomy. 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. Basically, you must take a positive attitude and put a lot of thought into your responses. A good way to respond is to use a table in which you list each of the reviewers’ comments, your responses, and the amended text as shown in Table 5. You don’t have to fully accept all suggestions but, if you don’t, you need to give reasons that will convince the editor that your opinion is reasonable. In doing this, it is best to be pragmatic and not to be dismissive of the reviewers’ work. Tabulating the responses makes it very clear what changes you have made and where you have made them. For comment 1, the reviewer’s suggestion has been met half way by shortening the section considerably but still leaving some information in the paper. For comments 2, 5, 6, 8, and 9, 127 Scientific Writing the reviewer’s suggestions have been accommodated entirely. For comment 3, the response is to politely point out that the explanation of the sampling processes was unclear in the original paper and has been amended. In response to the reviewer’s comment 4, it would be tempting to point out that Bland and Altman do not describe a “coefficient of repeatability” and that the reviewer might like to get his facts right! It is better to be certain that you have used the correct statistic and to just note what you have done, as in our reply. For comment 7, the decision has been left to the editor because the authors considered the figure to be essential to the message of the paper. Occasionally, you find that the reviewer has made disparaging or less than polite comments. Remember that two wrongs do not make a right and that responding with disparaging or impolite comments will not impress the editor. Occasionally reviewers may suggest that you include more work, seemingly forgetting that they are reviewing this paper and not the next one. This will take a prudent response, perhaps on advice from more senior researchers.

Cancer in its vari- ous forms is a genetic disease characterized by deviations of the normal genetic mechanisms that regulate cell growth discount tadalis sx 20mg fast delivery erectile dysfunction treatment covered by medicare. Caplan’s syndrome: A condition associated with pneumoconiosis (see pneumoconiosis) and charac- terized by the presence of rheumatoid nodules in the periphery of the lung tadalis sx 20 mg overnight delivery erectile dysfunction disorder. It results in a painful node that is covered by tight, reddened skin and contains pus. It may affect almost any organ or part of the body and spread by direct extension or through lymphatics or the blood stream. It is characterized by pain, tingling, numbness, and paresthesia, progressing to muscu- lar weakness in the distribution of the median nerve. The disease is defined by an inability to digest gluten, one of the proteins found in wheat, barley, rye, and oats. Characteristically, there is more severe neurologic involvement in the upper extremities than in the lower extremities. Function is typically retained in the thoracic, lumbar, and sacral regions, including the bowel, bladder, and genitals as peripherally located fibers are not affected. Manifestations of cerebellar lesions are ataxia hypotonia and truncal weakness causing postural and movement disorders. Dysarthria of cerebellar origin (scanning speech, producing a prolonged, monotone sound) is common. Diseases, Pathologies, and Syndromes Defined 389 cerebral palsy (CP): A nonhereditary and nonprogres- sive lesion of the cerebral cortex resulting in a group of neuromuscular disorders of posture and voluntary movement, including lack of voluntary control; spasticity; impaired speech, vision, hear- ing, and perceptual functions; seizure disorder; hydrocephalus; microcephaly; or mental retarda- tion. Damage to the motor area of the brain occurs during fetal life, birth, or infancy. Charcot-Marie-Tooth disease: This is a peroneal mus- cular atrophy that is an inherited autosomal domi- nant disorder affecting motor and sensory nerves. Initially, the disorder involves the peroneal nerve and affects muscles in the foot and lower leg. Loss of previously acquired skills in at least two of the following areas: expres- sive or receptive language, social skills or adaptive behavior, bowel or bladder control, play, or motor skills. It is associated with severe and prolonged fatigue, low-grade fever, sore throat, painful lymph nodes, muscle weakness, discomfort or myalgia, sleep distur- bances, headaches, migratory arthralgias without joint swelling or redness, photophobia, forgetful- ness, irritability, confusion, depression, transient visual scotomata, difficulty in thinking, and inabil- ity to concentrate. The primary distinction between chron- ic obstructive bronchitis and chronic obstructive pulmonary disease is the chronic cough. Diseases, Pathologies, and Syndromes Defined 391 chronic obstructive pulmonary disease (COPD): Also called chronic obstructive lung disease, this con- dition refers to a number of disorders that affect movement of air in and out of the lungs, particu- larly within the small airways. There is blockage of air and abnormalities of the lungs, causing an effect on expiratory flow. The most important of these disorders are obstructive bronchitis, emphysema, and asthma. Chronic pain is often associat- ed with depressive disorders, whereas acute pain appears to be associated with anxiety disorders. This ultimately leads to failure of the kidneys and affects all other body sys- tems. The episodic cluster headache is defined as the period of susceptibility to headache, called cluster periods, alternating with periods of remission. Chronic clus- ter headache is a term used when remissions have not occurred for at least 12 months. There are 2 cate- gories: cyanotic defects resulting from obstruction of blood flow to the lungs or mixing of desaturated blue venous blood with fully saturated red arterial blood within the chambers of the heart; and acyan- otic defects primarily involving left-to-right shunt- ing of blood through an abnormal opening. Congestive heart dis- ease represents a group of clinical manifestations caused by inadequate pump performance from either the cardiac valves or the myocardium. Diseases, Pathologies, and Syndromes Defined 393 There is excessive or abnormal accumulation of blood (congestion) in the heart. It causes mechani- cal or functional inadequacy to fully empty the blood from the heart, due to hypertrophic cardiac muscle changes. Conn’s syndrome: Conn’s syndrome, or primary aldosteronism, is a metabolic disorder that occurs when an adrenal lesion results in hypersecretion of aldosterone, the most powerful of the mineralocor- ticoids (aldosterone’s primary role is to conserve sodium, and it also promotes potassium excretion). There is an excess of sodium in the blood (ie, hyper- natremia), indicating water loss exceeding sodium loss, and fluid volume excess (ie, hypervolemia), leading to an increase in the volume of circulating fluid or plasma in the body; low blood levels of potassium (ie, hypokalemia), and metabolic alkalo- sis.

This distribution of pain buy tadalis sx 20mg free shipping erectile dysfunction quran, fatigue generic tadalis sx 20 mg without prescription impotence ring, 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. Additional attempts to reduce morbidity associated with chronic postwar symptoms and disability (e. Intensive specialty care programs for postwar symptoms and disability are then used for those who are Can We Prevent a Second ‘Gulf War Syndrome’? Schematic of population-based healthcare for chronic idiopathic postwar pain, fatigue, and associated disability. Figure 1 and table 2 offer a schematic and summary description, respectively, of each level of care in our model. The next section of the paper presents these levels of care in greater detail. Levels of Care for Chronic Postwar Pain and Fatigue Preclinical Prevention Upon return from war, efforts to mitigate chronic symptoms and related disability can focus on risk groups based on the level of psychosocial, medical, and geographic proximity to traumatic events or environmental exposures (see table 3). For example, the military medical system response to the September 11 Pentagon attack used several measures of proximity to estimate risk. Decreasing levels of geographic proximity included the attacked ‘wedge’ of the Pentagon, the rest of the Pentagon, and the National Capital Region. Exposures of concern included the physically injured, those attending to the injured or killed, those otherwise physically exposed (e. Levels of emotional proximity included family, friends, colleagues, and subordinates of those injured or killed, of those in the damaged wedge, and of those working elsewhere in the Pentagon. Several commonly used postwar preventive psychosocial interventions are in need of systematic evaluation. Chaos, loss of control, multiple health fears, Engel/Jaffer/Adkins/Riddle/Gibson 108 Table 2. Overview of a stepped approach to population-based healthcare for postwar idiopathic pain and fatigue Step Emphasis Setting Goal General Information approach systems 1 Postwar symptom Preclinical Incidence and General prevention Identify prevention prevalence efforts based on precipitating reduction exposures and events proximity 2 Routine primary Primary care Identification Primary care provider Identify care symptom and prevalence delivers diagnostic symptoms and mitigation reduction services, low intensity concerns treatments, and psychosocial support 3 Collaborative Primary care Prevalence Interdisciplinary Identify persistent primary care reduction practice team symptoms or symptom reduction intensifies care in concerns and disability coordination with prevention primary care provider 4 Intensive Specialty care Morbidity Specialized Identify persistent rehabilitative reduction multidisciplinary symptoms or reduction of symptom and multifaceted concerns duration and disability rehabilitative combined severity programs with disability Table 3. Preclinical modalities used to prevent chronic idiopathic postwar pain and Workplace screening fatigue Workplace education and support networks Informal (‘lay’) debriefings Family education and support networks and chronic pain, fatigue and other idiopathic symptoms are common after catastrophic events including war. Workplace educational approaches teach workers about health risks and psychosocial responses to war. Community and workplace leaders often facilitate an early return to usual work routines and other roles in an effort to maximize postattack productivity. Town hall-style meetings in which leaders address community concerns provide forums for information dissemination and feedback to leaders from members of the community. Telephone ‘hot lines’ also afford personalized contact to people with health-related questions or concerns or who desire clinical care. However, randomized controlled trials of psychological debriefings have shown no efficacy and even potential for harm. Perhaps this is not surprising given that the majority of individuals do well after a traumatic experience and can therefore only experience potential adverse effects (e. In addition wide-scale preclinical debriefings are seldom feasible to perform with appro- priate quality control procedures. Workplace liability concerns and over- whelming community desires to help victims often fuel preclinical debriefings, but scarce community resources may be better directed toward targeted clinical efforts to recognize and intervene early for adverse trauma-related outcomes including chronic pain, fatigue and other idiopathic symptoms. Population-based preclinical screening is another commonly considered postwar strategy. Screening involves identification of individuals in need of clinical management (individual-level intervention delivered in a healthcare setting). Surveillance, by comparison, is the use of active and passive health measurement strategies to characterize the health of a community and its subgroups. It is often assumed that screening is harmless, but population- based preclinical screening has the potential to unnecessarily medicalize psychosocial concerns, and there are often significant problems with false- negative and false-positive findings.