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Any theorizing is the respon- with no direct examination of the processes med- sibility of the experimenter and not of the subject iating these connections treatment tinnitus order 100 ml liv 52, whereas others involve (Ericsson & Simon 1984 medications list template effective 60 ml liv 52, Newell & Simon 1972) medications dictionary cheap liv 52 100 ml. The methods described in the clinical interview, the physical examination this section vary widely in terms of their origins results and the laboratory results (e. The subject is asked to read the informa- discourse analysis and ethnographic methods. Once the protocol has been collected, it is sub- A common theme in all these methods is that jected to an analysis aimed at uncovering the cog- they deal with real-life or close to real-life situa- nitive processes and the information that were tions. The analysis of the protocol is then com- become accepted as methods of scientific study pared to a reference or domain model of the task by scientists, often to complement other methods. This model is frequently taken either A third common feature is that they are applied from an expert collaborator in the study or from to unique situations. By this we mean that each printed information about the topic, such as text- case, consisting, for example, of a physician solv- books or scholarly expositions. For instance, Kui- ing a case or a pair of nurses discussing a patient pers & Kassirer (1984), in their study of causal problem, is taken as a unit. In contrast to the quan- reasoning, used a model of the Starling equilib- titative methods discussed above, qualitative rium mechanism which was compared to the pro- researchers attempt to describe single episodes in tocols from subjects at different levels of expertise: detail rather than obtaining gross average mea- medical students, residents, and expert physicians. In the same vein, Patel and her colleagues (Joseph Methods in the study of clinical reasoning 197 & Patel 1990, Patel & Groen 1986) used a reference differences in medical reasoning. The explanation protocol is based ditions pertain to the type of task that should be on a number of assumptions (Arocha et al 2005). That is, the information Ericsson & Simon (1984) developed an extensive generated from a clinical problem passes through description of these conditions, and there is also working memory first, and then linked later to independent research that has shown the validity information in long-term memory, which provides of the methods (White 1988). Third, although the clinical problem may be the same, Retrospective protocols the reasoning strategies and the final response (e. In most from the very specific symptom level to the general situations they are collected and analysed in the diagnostic level. Research shows that the critical same manner as think-aloud protocols, but with factor in determining generality is the expertise of different goals in mind. Finally, both reasoning strategies think-aloud protocols subjects are asked to report and inferences used during clinical reasoning are whatever comes to mind without making any eval- a function of domain-specific prior knowledge of uation of their thinking. In retrospective asking research subjects to explain the pathophys- protocols, verbalizations do not refer to the con- iology of a case. The explanation is then repre- tents in short-term memory alone but are probably sented in the form of a propositional structure a mixing of short- and long-term memory informa- (see Table 17. Therefore, whereas (1) segment the subject protocol (the explanation think-aloud protocols can be reliably used to char- of the case) into clauses according to the clause acterize clinical reasoning, retrospective protocols analysis method of Winograd (1972); (2) deter- can be used to characterize processes that are not mine the propositions in each clause, by taking dependent on the concurrent presentation of the each idea unit separately as a proposition; (3) relate stimulus materials. They may be used as a comple- the propositions in a semantic network in which ment to think-aloud protocols or to investigate the relations between propositions are labelled fol- other cognitive aspects associated with reasoning lowing the propositional grammar developed by such as comprehension, metacognitive activities Frederiksen (1975). The rela- tions in the semantic networks contain mostly Explanation protocols conditional and causal links. Thus a semantic net- Explanation protocols are a form of retrospective work is a connected graph in which the connec- protocol. Patel & Groen (1986) used such protocols tions among concepts as well as the direction of with the aim of investigating expert/novice reasoning are represented. Sentence: Painless recurrent haematuria suggests a possible tumour of the urinary tract Propositional analysis Proposition number Predicate Arguments 1. The types of nodes corre- are comprehensible only in the context where they spond either to data given in the problem or to occur. Interpre- Reasoning is characterized in the following tive research has had a long history in educational form. When the direction of the relations is from research (Glaser & Strauss 1967, Lincoln & Guba the given data in the problem to the hypothesized 1985).

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The musculus uvulae is attached to the posterior edge of the hard palate near the middle line symptoms 9dpo cheap liv 52 express. Its fbres run backwards (on either side of the middle line) through the palatine aponeurosis (45 medicine 852 order liv 52 120 ml with visa. The palatopharyngeus arises from the palatine aponeurosis and descends to the wall of the pharynx medications held before dialysis order liv 52 pills in toronto. All muscles of the palate, except the tensor palati, are supplied by the cranial part of the accessory nerve through the pharyngeal branch of the vagus. The palatine muscles are responsible for movements of the palate associated with deglutition and with speech. The levator palati helps to close the pharyngeal isthmus (communication between nasopharynx and orophar- ynx) by elevating the palate and bringing it into contact with the posterior wall of the pharynx. In this action it is helped by the palatopharyngeal sphincter that produces a ridge on the pharyngeal wall that comes in contact with the palate. The tensor palati helps in deglutition by pressing the bolus between the palate and the tongue. The palatopharyngeus helps in deglutition by pulling the pharynx up thus shortening its length. The palate is supplied by the greater palatine branch of the maxillary artery, the ascending palatine branch of the facial artery, and by the palatine branch of the ascending pharyngeal artery. The nerves supplying the palate are the greater and lesser palatine nerves and the nasopalatine nerves. Embryologically, both the upper lip and the palate are derived from three elements. On each side the frontonasal process fuses with the corresponding maxillary process. Abnormalities in fusion of these processes lead to clefts in the upper lip (called hare lip because the hare normally has an upper lip with a cleft). When defect in fusion is minimal only a small indentation may be seen in the margin of the lip. When non-union is complete the defect extends into the nostril, and is continuous with a defect in the palate as described below. As stated above the palate is derived from the frontonasal process and the right and left maxillary processes. The frontonasal process forms the part of the palate that bears the incisor teeth. The rest of the palate is formed by shelf-like projections of the right and left maxillary process. Anteriorly, each maxillary process fuses with the corresponding edge of the premaxilla. Behind the level of the premaxilla the two maxillary processes fuse with each other. From the manner of fusion it will be clear that the line of union of the three elements forming the palate is Y-shaped. Defects in the process of union lead to the formation of different varieties of cleft palate as follows. Remember that fusion of components of the palate starts anteriorly and proceeds posteriorly. The premaxilla may fuse with the maxillary process on one side, but not on the other side. Both the maxillary processes fuse with the premaxilla but their fusion to each other is defcient. The cleft may involve both the hard palate and the soft pal- ate, may be confned to the soft palate, or may be represented only by a cleft in the uvula. It has been said above that fusion of the elements forming the palate begins anteriorly and progresses back- wards. That the teeth in young children gradually fall off and are replaced by new ones that can last throughout life.

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