By D. Frillock. University of Pittsburgh at Bradford. 2017.

Such studies have the potential to lead to harmful practices in patient care 35 mg actonel overnight delivery. It is early days for electronic publishing and many changes in the acceptability, format, and scope of e-journals and netprints can be expected in the next few years. Although some journals will not consider accepting later versions of netprints for publication in their journal, many others will. Before you consider posting your work on the web, it is prudent to investigate the copyright restrictions of the journal in which you would ultimately like to publish. Citation index The concept behind citation indexing is fundamentally simple. By recognising that the value of information is determined by those who use it, what better way to measure the quality of the work than by measuring the impact it makes on the community at large. Dr Eugene Garfield (Founder and Chairman Emeritus of ISI) When a journal article is cited in another journal article it earns a scientific merit point. These merit points are formally recorded in what is known as the Science Citation Index (SCI). The Science Citation Index is a commercial database that contains information of citations from the reference lists of many published medical papers. This database is produced by the Institute for Scientific Information (ISI) in Philadelphia (www8), which also produces the weekly publication Current Contents that lists all journal articles published in 1375 scientific journals. Records in the Science Citation Index show how many times each publication has been cited within a certain period and by whom. Thus, the citation rate of a paper can be easily calculated by counting up the number of citations it receives in the years following publication. The average citation rate per year is often regarded as a marker of the scientific merit of the article especially if the annual citation rate becomes higher than the impact factor (see p 158) of the journal. Approximately 6000 major journals are indexed in the electronic Science Citation Index and over 2100 journals are indexed in the printed copy. The electronic database is constantly updated with approximately 17 750 new records added each week. Impact factors It is dangerous to use any kind of statistical data out of context.

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Pelsser V discount 35 mg actonel, Cardinal E, Hobden R, et al (2001) Extraarticular and ligament disorders in children. Farley FA, Kuhns L, Jacobson JA, et al (2001) Ultrasound examination of ankle injuries in children. J Pediatr Orthop 21:604–607 Inflammatory Disorders 53 4 Inflammatory Disorders David Wilson CONTENTS problem. The fractious and unwell child may resist this examination and it can prove very difficult to 4. However, the hip is a common site and serves to illustrate the range of possible diagnoses and the potential assis- 4. The same principles Introduction apply to all the other joints of the body. Inflammatory conditions of joints normally present with pain, swelling and dysfunction. However, the diagnosis is not so easy in infants for whom the presentation may be that the parents 4. Careful Irritable hip is the clinical syndrome that most com- physical examination may be required to locate the monly affects children between the age of four and ten years. It is most often due to transient syno- vitis which is a self-limiting condition for which no cause has been found. Wilson, FRCP, FRCR other potential causes some of which require urgent Department of Radiology, Nuffield Orthopaedic Centre, NHS medical attention if serious consequences are to be Trust, Windmill Road, Headington, Oxford, OX3 7LD, UK 54 D. The list of possible causes of an irritable although it is likely that clinical examination is just hip includes: as sensitive. In the elbow, provided that the image is ¼ Transient synovitis a true lateral, displacement of fat pads is an excel- ¼ Muscle or tendon injury lent and reliable means of detecting or excluding an ¼ Septic arthritis effusion. In 1966 Kemp and ¼ Crystal synovitis Boldero described lateral displacement of the femoral ¼ Haemorrhagic diatheses head associated with effusion in the hip of children with early Perthes’ disease. The authors attributed There may be clues in the history that assist—for the displacement to cartilage oedema and thickening, example, previous episodes, family predisposition or but others who misread and misinterpreted the paper a tendency to bleed easily. Recent overlap it is unwise to rely on the clinical presenta- ultrasound (US) evidence and correlation confirms tion to exclude the more serious causes of joint pain.

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American pating in repeated sprints buy 35mg actonel with amex, muscle glycogen is Academy of Family Physicians, Leawood, KS, 2002. Neither the power nor the speed pathways can pro- physical fitness and selected chronic diseases, in Roitman J, vide sufficient energy for the muscles to contract at a Haver E, Herridge M, (eds. The endurance pathway is used for events lasting Wygand J: Exercise programming, in Roitman J, Bibi K, longer than 2 min. Examples of events that use the endurance portion of energy comes from the oxidation of free pathway include a 1500-m run, marathon, half- fatty acids (Erp-Baart et al, 1989; Coyle et al, 1997; marathon, and all-day cycling or swimming events. As oxygen becomes more available to the working Training does not alter the total amount of energy muscle, the body begins to switch from anaerobic expended (during activity of the same intensity and systems to more aerobic ones. Only the aerobic duration) but rather changes the proportion of energy endurance pathway can produce large amounts of expended from carbohydrates and fat. As a result of ATP over extended periods of time via the Krebs training, the energy derived from fat increases and the cycle and the electron transport system. The changeover from anaerobic to aerobic pathways vidual uses a higher percentage of fat than an untrained is not abrupt, nor is there ever a time when one path- person at the same workload (Hurley et al, 1986). The intensity, duration, fre- Long-chain fatty acids derived from stored muscle quency, type of activity, and fitness level of the triglycerides are the preferred fuel for aerobic exercise participant determines when the crossover from pri- for individuals involved in mild- to moderate-intensity marily anaerobic to aerobic pathways occurs. GENERAL DIETARY NEEDS The more energy used in activity, the more calories OF ACTIVE INDIVIDUALS need to be consumed in the diet. CALORIES Individuals training for an athletic event will require more kilocalories than a sedentary individual. The ref- The dietary guidelines are predicated on consumption erence sedentary man weighs 154 lb and expends of adequate calories to sustain daily energy expendi- 2700 to 3500 kcals a day (average 3025) between the ture and should be provided on an individual basis ages of 20 and 29 years. Energy needs for strength trainers and body- The cost of the iron man triathlon (consisting of a 2. PROTEINS CONVERSION OF ENERGY SOURCES OVER TIME Approximately 50–60% of energy during 1 to 4 h of Protein requirements for both endurance and strength continuous exercise at 70% of maximal oxygen athletes should be individualized to determine adequacy capacity is derived from carbohydrates and the remain- of intake. The majority of athletes are consuming ade- ing energy is derived from fat (Coyle et al, 1986). TABLE 14-1 Estimated Energy Expenditure at Various Levels of Physical Activity LEVEL OF ENERGY EXPENDITURE INTENSITY TYPE OF ACTIVITY (KCAL/KG/DAY) Moderate Walking 3.