Defining Plagiarism: Keynotes from “Council of Writing Program Administrators”
Note: This is a key notes taken from article "Defining and Avoiding Plagiarism: The WPA Statement on Best Practices", Council of Writing Program Administrators, January 2003.
Definition: In an instructional setting, plagiarism occurs when a writer deliberately uses someone else’s language, ideas, or other original (not common-knowledge) material without acknowledging its source. It also applies to texts published in print or on-line, to manuscripts, and to the work of other student writers.
There is a need to differentiate between plagiarism VS misuse of sources
What is not considered as plagiarism
“A student who attempts (even if clumsily) to identify and credit his or her source, but who misuses a specific citation format or incorrectly uses quotation marks or other forms of identifying material taken from other sources, has not plagiarized. Instead, such a student should be considered to have failed to cite and document sources appropriately.”
From the experimental study using rat by M. Gaab et al,
The diuretic effect is insufficient to establish an osmotic gradient, and its general dehydrating effect does not acutely influence the ICP. The absence of effect on the experimental tissue edema would not appear to commend furosemide as basic therapy for cases of traumatic cerebral edema. [M. Gaab, O. E. Knoblich, J. Schupp et al]
Summary from “Medical management of cerebral edema by Ahmed Raslan and Anish Bhardwaj, Neurosurg Focus 22 (5):E12, 2007
1)The role is controversial especially when used alone
2)Combining it with mannitol will produce profound diuresis but the efficacy and optimum duration of this treatment remain unknown
3)Risk of serious volume depletion is substantial hence need rigorous attention to systemic hydration status.
4)May compromised the cerebral perfusion
5)Acetazolamide, a carbonic anhydrase inhibitor that acts as a weak diuretic and modulates CSF production, does not have a role in cerebral edema that results from acute brain injuries
From the experimental rat study by By Kokila Thenuwara et al, "Effect of Mannitol and Furosemide on Plasma Osmolality and Brain Water", Anesthesiology 2002; 96:416–21
1)One mechanism by which these changes might occur is via a reduction in brain water content
2)Furosemide alone did not affect plasma osmolality or brain water at any dose.
3)Furosemide produced marked loss of body water or body weight without alteration of brain water, indicating that reduction of peripheral water content alone may not affect brain water
4)Furosemide enhanced the effect of mannitol on plasma osmolality, resulting in a greater reduction of brain water content
5)The mechanism by which furosemide affects mannitol induced change in plasma osmolality is not clear
My conclusion is
1)Using of furosemide alone is not beneficial and has no effect in reducing brain edema
2)Furosemide may be add to the mannitol therapy but require intensive monitoring of systemic body fluid.
3)Using of alternative like hypertonic saline are more beneficial than furosemide.
Cervical Spine Clearance; Canadian C Spine Rule vs. Nexus I Study
C Spine clearance provide standard early protection for trauma patient as 2–6% of admitted trauma patient suffered from blunt trauma to the cervical spine. 5-10% of pt shows deterioration of neurological function during ED admission d/t delay in diagnosis@ inadequate spinal admission
Two commonly use criteria to establish which patient needs cervical clearance are Nexus I study and Canadian C- Spine Rule.
High risk patient require radiological clearance according to Nexus can be remembered by mnemonics “NSAID”
N- Neurological deficit
S- Spine (cervical) tenderness
A- Altered mental status
I- Intoxication
D- Distracting pain
Meanwhile, according to Canadian C Spine Rule, we can divide patient into high risk criteria requiring imaging and low risk patient which can be allowed to undergone assesment of active range of motion.
High risk patient requiring imaging
1)Age more than 65 years
2)Dangerous mechanism of injury (fall from 1m @ 5 stairs); axial load to the head (eg; diving); MVA at high speed (more than 100 km/hr), rollover, ejection; motorized recreational vehicles; bicycle collision
3)Paraesthesia in extremities
Low risk patient to undergone assessment of active range of motion.
1)Simple rear end motor vehicle collision (excluding of being pushed into oncoming traffic, being hit by bus or large truck, rollover, hit by high speed vehicle)
2)Sitting position in the emergency department
3)Ambulatory at any time
4)Delayed onset of neck pain
5)Absence of midline C-spine tenderness
Method of cervical clearance
1)Cervical X ray 3 view series (lateral view skull base up to C7/T1 junction, AP view, Open mouth odontoid)
2)CT scan is more superior to 3 view series X-ray in high risk patient
3)As a general rule, CT scan cervical clearance is indicated in unconscious patient.
4)MRI is the best modality for soft tissue injury.
Red flag means emergency and require further evaluation including CT Scan.
1)Acute onset of first most severe headache ever in life.
2)Headache that is increase in frequency or intensity
3)New onset of headache after age of 50 years old
4)Present of mental state changes
5)Associated with fever, neck stiffness and vomiting
6)Presence of neurological deficit
7)Headache with evidence of increase ICP
Extra notes
1)Most of the headache are primary headache
2)Patient with Subarachnoid hemorrhage may explain the headache as acute onset, most severe headache in their life, thunder clap around occipital area.
3)Primary headache can be safely manage with NSAIDs
4)Brain cell do not have pain receptor. Headache usually cause by stretching of pain receptor in blood vessel either due to direct insult or increase ICP.
5)Although first line of treatment for migraine is 5HT3 antagonist or triptans group, patient can be managed with IV NSAIDs + IV Maxalon.
6)Hypertension rarely cause headache unless the diastolic blood pressure more than 120 mmHg.
