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Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www purchase estradiol 1mg on-line pregnancy 0-0-1-0. See Viral hepatitis services applications of data from estradiol 1mg overnight delivery womens health rights, 41, 42, 43-46 Sexual exposure to hepatitis, 1, 23, 44, 72, at-risk populations, 2, 4, 6, 7, 32, 61-62, 84, 113, 119-120 67, 68, 71-72 Copyright © National Academy of Sciences. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. Request reprint permission for this book Copyright © National Academy of Sciences. The members of the Committee responsible for the report were chosen for their special competences and with regard for appropriate balance. N01-0D-4-2139 between the National Academy of Sciences and the National Institutes of Health. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for the project. Toward Precision Medicine: Building a Knowledge Network for Biomedical Research and a New Taxonomy of Disease The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards of objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We thank the following individuals for their review of this report: x Leslie Biesecker, National Institutes of Health x Martin J. Blaser, New York University Langone Medical Center x Wylie Burke, University of Washington x Christopher G. Chute, University of Minnesota and Mayo Clinic x Sean Eddy, Howard Hughes Medical Institute Janelia Farm Research x Elaine Jaffe, National Cancer Institute x Brian J. Schwartz, University of Washington Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations, nor did they see the final draft of the report before its release. The review of the report was overseen by Dennis Ausiello, Harvard Medical School, Massachusetts General Hospital and Partners Healthcare and Queta Bond, Burroughs Welcome Fund. Appointed by the National Research Council, they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of the report rests entirely with the authoring committee and the institution. We are grateful to those who attended and participated in the workshop “Toward a New st nd Taxonomy of Disease,” held March 1 and 2 , 2011 (Appendix D) and those who discussed data sharing with the Committee during the course of this study. Kelly, Head of Informatics and Strategic Alignment, Aetna x Debra Lappin, President, Council for American Medical Innovation x Jason Lieb, Professor, Department of Biology, University of North Carolina at Chapel Hill x Klaus Lindpaintner, Vice President of R&D, Strategic Diagnostics Inc. Toward Precision Medicine: Building a Knowledge Network for Biomedical Research and a New Taxonomy of Disease Summary The Committee’s charge was to explore the feasibility and need for “a New Taxonomy of human disease based on molecular biology” and to develop a potential framework for creating one.

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Cases also N Phlebovirus terrestrial mammals estradiol 2 mg menstruation in the 1800s; predominantly sheep cheap estradiol 1mg without a prescription womens health yuma az, reported in Saudi Arabia and Yemen. Schistosomes Most commonly found in Asia, Africa Affects many species of wild animals and Schistosomiasis (trematode and South America in areas where the wildfowl, however, humans and livestock are ― worms) water contains freshwater snails. West Nile virus West Nile East, west and central Asia, Oceania Affects numerous bird species and some N disease Flavivirus and most recently, North America. Moderate impact No impact Fish A group of taxa, including hagfish, lampreys, sharks and rays, ray-finned fish, bony fish, coelacanths and lungfish. Amphibians and reptiles (together known as herpetafauna) Animals from the classes Amphibia (such as frogs, salamanders and caecilians) and Reptilia (such as crocodiles, lizards and turtles). Williams Epidemics of infectious diseases have been documented throughout history. In ancient Greece and Egypt accounts describe epidemics of smallpox, leprosy, tuberculosis, meningococcal infections, and diphtheria. These theories have evolved as our understanding of the natural world has advanced, sometimes slowly, sometimes, when there are profound break- throughs, with incredible speed. Remarkably, advances in knowledge and changes in theory have not always proceeded in synchrony. Although wrong theories or knowledge have hindered advances in understanding, there are also examples of great creativity when scientists have successfully pursued R1 their theories beyond the knowledge of the time. However, before advances in the underlying science of health, medicine lacked effective tools, and religious explanations for disease dominated. As early communi- ties consolidated people more closely, severe epidemics of plague, smallpox, and syphilis occurred. The bubonic plague and its coinfections, measles and smallpox, were the most devastating of the epidemic diseases. Starting in the lower Volga it spread to Italy and Egypt in 1347 on merchant ships carrying rats and feas infected with the plague bacillus, Yesinia pestis. The disease apparently was unknown in the New World prior to the appearance of the Spanish and Portuguese conquistadors. Cortez was routed in battle in 1520 but was ultimately victorious as smallpox killed more than 25% of the Aztecs over the next year. He reported that 1000 persons per day died in Tlaxcala, with ultimately 150,000 total dead. At the least, it was appreciated that the skin lesions and scabs could transmit the disease. It was known that survivors of the infection were immune to reinfection after further exposure. The practice of inoculation, or variolation, whereby people were intentionally exposed to smallpox was practiced in China, Africa, and India centuries before the R1 practice would be adopted in Europe and the Americas. Syphilis became epidemic in the 1490s as a highly contagious vene- real disease in Spain, Italy, and France. One theory proposes that it began as a tropical disease transmitted by direct (nonsexual) contact. After the frst accounts of syphilis, it was reported to spread rapidly through Europe and then North America. In keeping with the hypothesis that syphilis was a recently emerged disease, mortality from syphilis was high in these early epidemics. In his treatise Airs, Water and Places, Hippocrates dismissed supernatural explanations of disease and instead attributed illness to characteristics of the climate, soil, water, mode of life, and nutrition surrounding the patient. Galen combined his practical experience caring for gladiators with experiments, including vivisections of animals, to study the anatomy and physiology of man. It was over a thousand years before Andreas Vesalius (1514–1564), who based his work on dissections of humans, was able to correct Galen’s errors in anatomy. Plague was rec- ognized to be contagious; however, the control measures focused primarily on quarantine and disposal of the bodies and the possessions (presumably contaminated) of the victims. Although it was observed that large numbers of rats appeared during an epidemic of plague, the role of rats and their feas was not appreciated.

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It is the job of the reader to find any sources of bias and assess the importance and potential effects of bias on the results of the study estradiol 2mg low cost women's health center medford oregon. Virtually no study is 100% bias-free and not all bias will result in an invalid study and in fact discount 1 mg estradiol amex australian women's health big book of 15 minute workouts, some bias may actually increase the validity of a study. After identifying a source of bias, you must determine the likely effect of that bias on the results of the study. If this effect is likely to be great and potentially decrease the results found by the research, internal validity and the conclusions of the study are threatened. If it could completely reverse the results of the study, it is called a “fatal” flaw. The results of a study with a fatal flaw should generally not be applied to your current patients. If the bias could have only small potential effects, then the results of these studies can be accepted and used with caution. Bias can be broken down into three areas according to its source: the population being studied, the measurement of the outcome, and miscellaneous sources. Bias in the population being studied Selection bias Selection bias or sampling bias occurs when patients are selected in a man- ner that will systematically influence the outcome of the study. Subjects who are volunteers or paid to be in the study may have different characteristics than the “average person” with the disease in question. Another form of selection bias occurs when patients are chosen to be in a study based upon certain physical or social characteristics. Commonly, selection bias exists in studies of therapy when patients chosen to be one arm of the study are ‘selected’ by some characteristics determined by the physicians enrolling them in the study. An investigator offered free psychiatric counseling to women who had just had an abortion if they took a free psychological test. He found the incidence of depression was higher in these women than in the general population. It is very likely that women who had an abortion and were depressed, therefore needing counseling, would 82 Essential Evidence-Based Medicine preferentially sign up to be in the study. Women who had an abortion and were not depressed would be less likely to sign up for the study and take the free psy- chological test. This is a potentially fatal flaw of this study, and therefore, the conclusion is very likely to be biased. This is a fatal flaw and would seriously skew the results, so the results of this study should not change a physician’s approach to these patients. Studies performed in tertiary care or referral centers often use only patients referred for specialty care as subjects. This eliminates cases that are milder and more easily treated or those diagnosed at an earlier stage and who are more likely to be seen in a primary care provider’s office. Overall, the subjects in the study are not like those patients with similar complaints seen in the primary care office, who will be much less likely to have unusual causes for their symptoms. This limits the external validity of the study and the results should not be generalized to all patients with the same complaint. The study patients reflected only those who were referred to the neurologist, who therefore had persistent problems from their head injury. The results, even if significant in this selected population, would not apply to the general population of all head-injured patients. Spectrum bias Spectrum bias occurs when only patients with classical or severe symptoms are selected for a study. This makes the expected outcomes more or less likely than for the population as a whole. Selecting only those patients with severe symptoms will bias the study and make the results inapplicable to those with less severe symptoms. Detection bias Detection bias is a form of selection bias that preferentially includes patients in a study if they have been exposed to a particular risk factor.

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Set against this background purchase estradiol 2 mg visa breast cancer lumps, the phenomenon of Trota is all the more re- markable buy estradiol 2 mg with visa pregnancy blood test. Trota is the only Salernitan woman healer whose name is attached to any extant medical writings. First, there is the Practical Medicine According to Trota (Practica secun- dum Trotam). Now extant in only two manuscripts, this is a compendium of seventy-one different remedies for gynecological and obstetric conditions, cos- metic problems, hair lice, burns, cancer, frenzy, eye problems, sprained foot, excessive sweat, snakebite, toothache, scrofula, spleen problems, depilatories, hemorrhoids, and fevers. The extent of this larger text is hinted at by a second witness to Trota’s medical writings, a compen- dium called On the Treatment of Illnesses (De egritudinum curatione). Made in the second half of the twelfth century, this massive compilation draws together excerpts from seven leading Salernitan medical writers. Trota is among them, and the excerpts attributed to her here demonstrate her considerable exper- tise in the fields of gastrointestinal disorders and ophthalmology. A third piece of evidence for Trota’s medical practice is found within one of the Trotula texts themselves. About a third of the way into Treatments for Women (¶), we find a story of how Trota cured a young woman suffering from gas or flatulence in her uterus (ventositas matricis). Trota, however, was called in ‘‘as a master’’ and was astonished  Introduction by what she found. Doubting the initial diagnosis, she took the young woman home with her and there realized that she had ‘‘wind’’ (ventositas) in her uterus. She treated her with a combination of baths and external applications, and so effected a cure. The inclusion of this anecdote—which refers to Trota consistently in the third person—suggests, of course, that she is not the author of Treatments for Women. Yet in attributing Treatments for Women to Trota, early scribes were claiming not so much that Trota was the text’s sole author as that she was the authority who stood behind it. Trota’s Practical Medicine and Treatments for Women have fifteen remedies that overlap directly. There are, moreover, additional similarities in theoretical character, materia medica, and the practical therapies employed. The attribution of Treatments for Women to Trota thus reflects both Trota’s reputation and her ‘‘maternity’’ of the collected wisdom on women’s diseases and othercures assembled in this text. It may well be that Treatments forWomen reflects a transcript of Trota’s cures as she orally recounted them to a scribe, who then added further elements of his/her own choosing. Given its associations not simply with Trota but with the southern Italian city of Salerno, it is surprising that three times in the earliest versions of the text we find vernacular English synonyms for diseases or herbs. It may, indeed, be precisely the shock of an outsider at seeing the dramatic and violent mourning practices of the Saler- nitan women that caused this author to specify that it was Salernitan women (rather than, say, ‘‘our women’’ or simply ‘‘women’’) who rip up their faces in mourning. The close relations between the Practical Medicine According to Trota and Treatments for Women confirm that Trota is directly associated with Treatments for Women, whether or not she authored all the parts of the text as it now exists. Either way, it is in no way inappropriate to consider her the text’s principal source. The more we learn about the characteristics of Trota’s authentic work, however, the less plausible it seems that she could have been directly connected with Introduction  either Conditions of Women or Women’s Cosmetics. BothConditions of Women and Women’s Cosmetics circulated anonymously and seem not to have been as- sociated with Trota’s name until they were brought into juxtaposition with Treatments for Women. We still and may forever lack much of the information we should like to have about Trota: when, exactly, she lived, who her family was, how she was trained, whom she taught. More particularly, we should like to know how she came by her literacy in Latin and for whom she believed she was writing. There is nothing in Practical Medicine or Treatments for Women to suggest any direct connection with the Church. That Trota was not the author of the Trotula texts in their entirety does not detract from her achievement.

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