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For example discount 4 mg periactin visa, the journal Diabetes Care 17 Scientific Writing publishes papers about the diagnosis and treatment of diabetic patients, whereas the journal Diabetes also publishes articles that report the results of bench-top research. You also need to decide whether you want to publish in a relatively new journal or in a well-established journal, and in a journal that comes out weekly, monthly, or quarterly. Finally, you need to have a good idea about whether your results will be more relevant to an international or local audience. Your choice of journal will be influenced by your subject matter and will, in turn, also influence the audience that your work reaches. The journal that you choose will have important implications for the time that it takes for your paper to be published, the impact that it will have, and the prestige that it will bring back to you. New journals may be more likely to accept papers but often have low impact factors (see Chapter 6), may have limited circulation, and may not reach a wide audience. On the other hand, highly ranked established journals are harder to get into and may have long wait times between article acceptance and publication. Established journals with a high profile are much more likely to be read by people who are experts in your field, and they carry inestimable prestige. If you submit your paper to an established journal, it may be rejected, but you may reap unexpected gains in that you will receive pertinent reviews that enable you to improve your reporting. Established journals that are committed to short publication times may accept only a small percentage of submitted papers. The BMJ publishes only 14–17% of over 4000 papers submitted each year9 and JAMA published only 11% of the 4366 manuscripts submitted in 2000. With rejection rates running high, having an important message to report and reporting it well is essential for increasing your chance of being published. There is a delicate balance between aiming high, trying to maximise the possibility of acceptance, and trying to reduce the time to publication. Some useful considerations when 18 Getting started deciding where to publish are shown in Box 2. In deciding which journal to select, seek advice widely from your coauthors and peers, but be aware that their advice will be subjective and that their agenda may be very different from your own. It is a good idea to choose three or four journals in which you are most interested and rank them in order of prestige and competitiveness.

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CARDIAC CONDITIONS The CPSC operates a statistically valid injury and review system known as the national electronic injury Most young athletes who die suddenly have HCM 4mg periactin with visa. The These athletes typically have prodromal symptoms NEISS estimates are calculated using data from a such as presyncope or syncope with or without exer- sample of hospitals that are representative of emergency cise prior to the fatal event. A systolic murmur is often CHAPTER 6 CATASTROPHIC SPORTS INJURIES 25 appreciated only in the standing position or with a may result in a variety of life-threatening problems, Valsalva maneuver. Hydration should include both oral intake and intravenous (IV) EPIDEMIOLOGY fluids. Rehydration with sports drinks containing Heat illness is the third most common cause of death electrolyes is preferred over water. Emergency medical serv- respiratory or gastrointestinal (GI) viral illness, sickle ices (EMS) should be contacted for athletes with heat cell trait, stimulants, supplements such as ephedrine, exhaustion and heat stroke. PREVENTION Heat illness usually occurs during unseasonable hot The incidence of heat illness can be significantly conditions at times of extreme exertion. A typical sce- reduced by frequent hydration, acclimatization, iden- nario is an obese football lineman wearing a football tifying at-risk athletes, and monitoring daily weights, uniform and playing two a day practices during late medication use, and status of recent illnesses. CLINICAL FEATURES DIRECT INJURIES Heat cramps is a misnomer and should be termed exercise cramps. Muscle cramping is triggered by FOOTBALL fatigue and can occur at any temperature. The condi- and neck injuries per year for all high school and col- tion often occurs toward the completion of exercise lege sports (Mueller and Cantu, 2000). Heat syncope usually occurs during the first few MECHANISMS days of heat exposure before the body has been Spearing or tackling a player with the top of the head allowed to acclimatize. When the neck is flexed 30° the to exercise in the heat since the cardiovascular (CV) cervical spine becomes straight and the forces are system fails to respond to workload. Symptoms of heat exhaustion can include vical injuries dramatically dropped (Torg et al, 2002; muscle cramping, mild confusion, headache, dizzi- Torg and Gennarelli, 1994). Heatstroke and mental status paralysis in the arms, legs, or both (Torg et al, 2002). The Complete recovery usually occurs within 10 to 15 min athlete may or may not be sweating.

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The Eighteenth Century—the Beginning of Prevention By the eighteenth century periactin 4 mg with visa, much was known about the workings of the human body. This century was primarily a time of systemati- Physicians: A Historical Perspective 7 zation and classification. Carl von Linné (or Linnaeus), the Swedish botanist and physician, established the practice of classification both in botany and in medicine. He was the originator of binomial nomenclature in science, classifying each natural object by a fam- ily name and a specific name, like Homo sapiens for humans. The eighteenth century witnessed great strides in the develop- ment of preventive medicine. For years, smallpox epidemics had wreaked havoc with the population, killing many. When the smallpox vaccine was given to 12,000 people in London, the yearly rate of the disease dropped from 2,018 to 622. Other important medical advances were made by Caspar Friedrich Wolff and John Hunter. Wolff, a German, is noted for his major contribution to modern embryology. Wolff noted that the embryo was not preformed and encased in the ovary, as previously believed, but rather that organs are formed “in leaf-like layers. The Nineteenth Century—the Rise of Modern Medicine Modern medicine as we know it began during the nineteenth cen- tury. The causes of many diseases were beginning to be identified, and effective treatments were being developed. The nineteenth cen- tury also brought advances in medical research and the birth of modern surgery. One key discovery occurred when a French physician, Jean Corvisart des Marets, found that certain parts of the body have dif- 8 Opportunities in Physician Careers ferent sounds when thumped. Another French physician, René-Théophile Hyacinthe Laënnec, invented the stethoscope in 1819.