Sinemet

By M. Ford. Albright College.

Linear rating scale A scale from zero to one on which patients can place a mark to determine their value for a particular outcome best sinemet 300mg. Markov models A method of decision analysis that considers all possible health states and their interactions at the same time buy 125 mg sinemet mastercard. Matching An attempt in an experiment to create equivalence between the control and treatment groups. Control subjects are matched with experimental subjects based upon one or more variables. Measurement The application of an instrument or method to collect data systematically. Meta-analysis A systematic review of a focused clinical question following rigorous methodological criteria and employing statistical techniques to combine data from multiple independently performed studies on that question. Non-inferiority trial A study that seeks to show that one of two treatments is not worse than the other. Normal (1) A normal distribution or Gaussian distribution of variables, the bell-shaped curve. Null hypothesis The assumption that there is no difference between groups or no association between predictor and outcome variables. Objective Information observed by the physician from the patient examination and diagnostic tests. Observational study Any study of therapy, prevention, or harm in which the exposure is not assigned to the individual subject by the investigator(s). A synonym is “non- experimental” and examples are case–control and cohort studies. Odds The number of times an event occurred divided by the number of times it didn’t. Odds ratio The ratio of the odds of an event in one group divided by the odds in another group. One-tailed statistical test Used when the alternative hypothesis is directional (i. P value The probability that the difference(s) observed between two or more groups in a study occurred by chance if there really was no difference between the groups. Pathognomonic The presence of signs or symptoms of disease which can lead to only one diagnosis (i. Patient satisfaction A rating scale which measures the degree to which patients are happy with the care they received or feel that the care was appropriate. Patient values A number, generally from 0 (usually death) to 1 (usually complete recovery), which denotes the degree to which a patient is desirous of a particular outcome. Pattern recognition Recognizing a disease diagnosis based on a pattern of signs and symptoms. Percentiles Cutoffs between positive and negative test result chosen within preset percentiles of the patients tested. Placebo An inert substance given to a study subject who has been assigned to the control group to make them think they are getting the treatment under study. Point On a decision tree, the outcome of possible decisions made by the patient and clinician. The confidence interval tells you the range within which the true value of the result is likely to lie with 95% confidence. Point of indifference The probability of an outcome of certain death at which a patient no longer can decide between that outcome and an uncertain outcome of partial disability. Population The group of people who meet the criteria for entry into a study (whether they actually participated in the study or not). Positive predictive value Probability of disease after the occurrence of a positive test result. Power The probability that an experimental study will correctly observe a statistically significant difference between the study groups when that difference actually exists. Measure of random variation or error, or a small standard deviation of the measurement across multiple measurements. Predictive values The probability that a patient with a particular outcome on a diagnostic test (positive or negative) has or does not have the disease. Predictor variable The variable that is going to predict the presence or absence of disease, or results of a test. Prevalence The proportion of people in a defined group who have a disease, condition, or injury. Prognosis The possible outcomes for a given disease and the length of time to those outcomes. Important in studies on therapy, prognosis, or harm, where retrospective studies make hidden biases more likely. Publication bias The possibility that studies with conflicting results (most often negative studies) are less likely to be published. Random selection or assignment Selection process of a sample of the population such that every subject in the population has an equal chance of being selected for each arm of the study.

National approaches and initiatives have been developed to address accident prevention order 125mg sinemet visa, reporting and follow-up buy 110mg sinemet otc. Examples include quality management systems [11, 12]; regulations defining professional responsibility within management frameworks [13–15] or requiring, for example, prior risk assessment, internal reporting, feedback committees and training of personnel [16]; professional initiatives providing consistent terminology and classification of events [17]; notification systems [18, 19]; incident rating for public communication [20]; and regulatory initiatives [21, 22]. The following points have to be taken into account and/or may represent specific challenges: systems to record and follow-up accidents have to be commensurate with the risk from the practice; dissemination of information about accidents is crucial to avoid repetition; trust between operators and regulators and a no-blame culture stimulating reporting shall be developed; defining a ‘significant event’ in radiotherapy may be challenging; for instance, numerical criteria seem insufficient to address cases of delivery to wrong volumes; developments in individual sensitivity have to be followed and factored into classification of events in radiotherapy. This will have an influence on medical practices with regard to occupational and patient exposures. The new requirement to monitor the dose to the lens of the eye for all staff liable to exceed the public limit (15 mSv) poses practical difficulties. The new dose limit of 20 mSv may be challenging for some busy cardiologists and there is a need to reinforce protective measures. A standardized set of dose quantities and units has to be developed and implemented on all equipment to allow recording and reporting of patient dose. The same applies to patient specific data needed for radiation protection purposes, e. A qualitative approach is needed for communicating risk and benefit to patients rather than reporting individual doses or risk. Clear assignment of responsibility has to be made on the national level, and this may be procedure dependent. There is still uncertainty among professionals about what are the most appropriate dose quantities in diagnostic radiology. Effective dose is needed for comparison between different procedures but is not appropriate for optimization. European guidelines [27] provide uniform methodology for converting machine displayed or directly measurable dose quantities into effective dose. Euratom has a limited role in this area and would place additional legal requirements on equipment in use only when considered of crucial importance for radiation protection. Other issues mentioned during the panel discussion and worth mentioning but not fully discussed include ongoing chest X ray screening for tuberculosis, which is not subject to the scrutiny applied, for instance, to mammography screening in some countries, second hand equipment where action may be needed to better control or limit use, and hand-held equipment where safety issues have recently been encountered. The Euratom legislation in this area has provided for considerable progress in ensuring a high level of radiation safety of patients in Europe. Nevertheless, technological and societal developments in the past decade or so have shown that there is a need to update European medical exposure legislation. This update has been done in the framework of the recently undertaken overhaul of the overall Euratom radiation protection legislation, which brings the additional advantage of providing for a consistent and consolidated legal framework covering all categories of exposure and exposure situations. This has to be followed by focused efforts to implement the new requirements into everyday practice. Such efforts should be collaborative by nature, and have to be based on dialogue and partnership between national regulators, professional groups and industry. Collaboration across Europe is needed to fully benefit from the advances in the common European legal basis for radiation protection; it is even more important and, indeed, unavoidable in today’s conditions of highly integrated European markets. Regular surveys have been conducted on the frequencies of medical radiological procedures and levels of exposure, equipment and staffing to monitor evolving trends. Two thirds of diagnostic radiological procedures and over 90% of all nuclear medicine procedures are performed in industrialized countries. The global average annual per caput effective dose from diagnostic radiological procedures nearly doubled between 1988 and 2007, from 0. A major challenge relating to the interpretation, analysis and use of radiation exposure data of a population is the uncertainty when attributing cancer risk to ionizing radiation exposure. The uncertainty of cancer risk after exposure to ionizing radiation is often underestimated. For solid cancer risk after an exposure of 100 mSv, upper and lower boundaries of the 95% confidence interval differ by a factor of 5. It is important to distinguish between a manifest ‘health effect’ and ‘health risk’, when describing such health implications for an individual or a population. A manifest health effect in an individual (such as skin burns) can be unequivocally attributed to radiation exposure only if other possible causes for an observable tissue reaction are excluded. Cancer cannot be unequivocally attributed to radiation exposure because radiation is not the only possible cause and there are, at present, no known biomarkers that are specific to radiation exposure. However, it is recognized that there is a need for such estimations by health authorities to allocate resources or to compare health risks. This is valid if applied consistently and the uncertainties in the estimations are fully taken into account, and the projected health effects are notional. It has also regularly evaluated the evidence for radiation induced health effects from studies of Japanese atomic bombing survivors and other exposed groups, and has reviewed advances in the mechanisms of radiation induced health effects. An important source of evidence is population based surveys of radiation use and exposure in medicine, as such surveys identify the levels and trends of exposure, and highlight the procedures requiring intervention by virtue of doses or frequency of procedures. Gaps in treatment capabilities and possible unwarranted dose variations for the same procedure are also identified. This imbalance in health care provision is also reflected in the availability of radiological equipment and of practitioners. In epidemiological surveys of populations exposed to radiation, there are statistical fluctuations and uncertainties due to selection and information bias, exposure and dose assessment, and model assumptions used when evaluating data.

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A review of the effectiveness of weight-loss diets in adults with raised blood pressure (systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg) found modest weight losses sinemet 110 mg for sale, of 3–9% of body weight (227) cheap 125mg sinemet otc. The diets were associated with modest decreases in systolic and diastolic blood pressure of about 3 mmHg, and may lead to reduced dosage requirements for patients taking blood-pressure-lowering medications. In most trials, the provider/instructor was a dietician; however, the nature and duration of interventions varied significantly, with intervention periods ranging from 2 weeks to 3 years. In the two trials that reported post-intervention follow-up, it was found that participants tended to regain some, though not all, of the weight lost. Evidence Many studies have shown a U- or J-shaped association between mortality and alcohol consump- tion, in which people who drink light or moderate amounts have a lower death rate than non- drinkers, while those who drink large amounts have a higher death rate (232–240). People who drink heavily have a high mortality from all causes and cardiovascular disease, including sudden death and haemorrhagic stroke. In addition, they may suffer from psychological, social and other medical problems related to high alcohol consumption (237–240). Smaller protective associations and more harmful effects were found in women, in men living in countries outside the Mediterra- nean area, and in studies where fatal events were used as the outcome (238). The amount of alcohol associated with the lowest mortality rates was between 10 and 30 g (1–3 units) per day for men and half these quantities for women (1 unit is equivalent to 150 ml of wine, 250 ml of beer or 30–50 ml of spirits) (239). The benefits of alcohol in light to moderate drinkers may be overestimated in meta-analyses of observational studies, as a result of confounding and reverse causality. The meta-analysis was dominated by a few very large studies, which did not carefully assess the reasons for not drink- ing, and did not measure multiple potential confounders. It is primarily the non-drinking group that causes the U-shaped relationship, and this may contain both life-long abstainers and people who stopped drinking because of ill-health; this could result in a spurious association suggesting that there is a safe level of alcohol intake. A recent meta-analysis of 54 published studies con- cluded that lack of precision in the classification of abstainers may invalidate the results of studies showing the benefits of moderate drinking (243). If the authors’ claim is correct, it implies that there is no level of alcohol consumption that is beneficial with respect to coronary heart disease; rather, risk increases with increasing consumption in a linear fashion. However, subsequent randomized controlled trials have found either no benefit or a harmful association; the earlier results are likely to be due to uncontrolled confounding. It is possible that the protective association between light-to-moderate alcohol consumption and coronary heart disease is also an artefact caused by confounding. It is also important to note that alcohol consumption is associated with a wide range of medical and social problems, including road traffic injuries. Other risks associated with moderate drinking include fetal alcohol syndrome, haemorrhagic stroke, large bowel cancer, and female breast cancer (237, 245). Con- sequently, from both the public health and clinical viewpoints, there is no merit in promoting alcohol consumption as a preventive strategy. Psychosocial factors Issue Are there specific psychosocial interventions that can reduce cardiovascular risk? Evidence Observational studies have indicated that some psychosocial factors, such as depression and anxiety, lack of social support, social isolation, and stressful conditions at work, independently 38 Prevention of cardiovascular disease influence the occurrence of major risk factors and the course of coronary heart disease, even after adjusting for confounding factors (246–248). Other psychosocial factors, such as hostility and type A behaviour patterns, and anxiety or panic disorders, show an inconsistent association (249, 250). Rugulies (246), in a meta-analysis of studies of depression as a predictor for coronary heart disease, reported an overall relative risk for the development of coronary heart disease in depressed subjects of 1. This finding was consistent across regions, in different ethnic groups, and in men and women (247). In a large randomized trial of psychological intervention after myocardial infarction, no impact on recurrence or mortality was found (253). Another large trial that provided social support and treatment for depression also found no impact (254). Depression has a negative impact on quality of life (255, 256), and antidepressant therapy has been shown to significantly improve quality of life and functioning in patients with recurrent depression who are hospitalized with acute coronary syndromes (257, 258). The association has been demonstrated in subjects in different countries, and in various age groups (250, 259–262). While these findings provide some support for a causal interpretation of the associations, it is quite possible that they represent confounding or a form of reporting bias, as illustrated in a large Scottish cohort (263). Well planned trials of interventions to reduce work stress and social isolation are required to elucidate whether there is a true cause–effect relationship and, more importantly, whether inter- vention reduces cardiovascular risk. In the meantime, physicians and health care providers should consider the whole patient. Early detection, treatment and referral of patients with depression and other emotional and behavioural problems are, in any case, important for reducing suffering and improving the quality of life, independent of any effect on cardiovascular disease. Mobilizing social support to avoid or solve social and work concerns is also a legitimate response to a patient’s difficulties (258).

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Emphasis will be given both to current issues in Malaysian politics and the historical and economic developments and trends of the country generic sinemet 125mg mastercard. An analysis of the formation and workings of the major institutions of government – parliament buy discount sinemet 300 mg line, judiciary, bureaucracy, and the electoral and party systems will follow this. The scope and extent of Malaysian democracy will be considered, especially in the light of current changes and developments in Malaysian politics. The second part of the course focuses on specific issues: ethnic relations, national unity and the national ideology; development and political change; federal-state relations; the role of religion in Malaysian politics; politics and business; Malaysia in the modern world system; civil society; law, justice and order; and directions for the future. It is compulsory for students from the School of Education to choose a uniformed body co-curriculum package from the list below (excluding Seni Silat Cekak). Students who do not enrol for any co-curriculum courses or who enrol for only a portion of the 3 units need to replace these units with skill/option courses. Students are not allowed to register for more than one foreign language course per semester. They must complete at least two levels of a foreign language course before they are allowed to register for another foreign language course. However, students are not required to complete all four levels of one particular foreign language course. However, in certain cases (for example, the student is repeating his academic year and needs only several units to graduate), the Dean can recommend that the student register for units below the minimum number required. Students need to accumulate only a specific number of the outstanding units for graduation purposes. However if the School wishes to accredit only one course at the diploma level for unit exemption for one course at the degree level, the said course at the diploma level must be equivalent to that at the degree level and carry the same number of units or more. If the student has completed Industrial Training while pursuing the programme of study at the diploma level, he/she must have at least one year’s work experience. In addition, the student should also submit a report on their work performance and the type of work performed. Dean’s List Guidelines (i) Students who achieve academic excellence at the end of a semester will be placed in the Dean’s List. University Courses University courses are offered to students as part of the requirement for graduation. Compulsory (10 units) a) Malay Language 108 b) English Language c) Islamic and Asian Civilisations d) Ethnic Relations 2. Note: To obtain credit units for Bahasa Malaysia courses, a minimum grade of a ’C’ is required. English Language Courses (as compulsory English Language units) The English Language courses offered as University Courses are as follows:- Course Academic School No. English Language Courses (as compulsory English Language/ Option/Skills units) The following courses may be taken as university courses to fulfil the compulsory English Language requirements or as skills/option courses: Course Code/ Academic School No. Students are not allowed to register for more than one foreign language course per semester. They must complete at least two levels of a foreign language course before they are allowed to register for another foreign language course. However, students are not required to complete all four levels of one particular foreign language course. Students who sign up for this package will obtain one (1) extra unit upon graduation. Students taking the minor package have to begin with level 100 and then proceed to the subsequent levels. The wisdom to comfort and counsell all our patients towards well being, peace and harmony regardless of their social status, race and religion. The ability to understand that our profession is sacred, dealing with your most precious gifts of life and intellect. We promise to devote our lives in serving Mankind, poor or rich, literate or illiterate, irrespective of race and religion with patience and tolerance, with virtue and reverence, with knowledge and vigilance, and with Your love in our hearts. If there is any other information that you think should be included in the guidebook, please suggest in the space below. The Statistician 32 (1983) 307-317 © 1983 Institute of Statisticians Measurement in Medicine: the Analysis of Method Comparison Studies† D. The use of correlation, regression and the difference between means is criticized. A simple parametric approach is proposed based on analysis of variance and simple graphical methods. Frequently, however, we cannot regard either method as giving the true value of the quantity being measured. In this case we want to know whether the methods give answers which are, in some sense, comparable. For example, we may wish to see whether a new, cheap and quick method produces answers that agree with those from an established method sufficiently well for clinical purposes.

This may further reduce their ability to acquire and develop the adaptive coping strategies and social problem solving styles that are necessary for healthy adult functioning in society cheap 110 mg sinemet with mastercard. Adolescents who are slower to develop the complex social skills necessary to interact effectively with peers and the wider world are also more at risk of turning to drug or alcohol use purchase sinemet 300mg online. They may use alcohol or drugs to mask their anxiety in social situations or they may use these substances in an attempt to demonstrate their ‘maturity’ to peers. However, it would be wrong to assume 19 The Epidemiological Triangle of Drug Use that a ‘lack of confidence’ is a universal problem among teenagers who use drugs. Indeed, a personality profile that includes excessive confidence, sensation seeking and substantial risk taking is also associated with progression to drug misuse. Problematic drug or alcohol use therefore demonstrates a complex interaction with normal adolescent development. Conversely, drug and alcohol misuse can themselves cause a delay in, or a deviation from, normal adolescent development. As a drug or alcohol problem grows, the young person is likely to find himself or herself in a progressively more deviant environment, e. These environments promote a social inter- actional style that is likely to perpetuate a further delay in the acquisition of the skills appropriate to survival in ‘mainstream society’. These issues highlight the potentially massive damage which problematic drug use can inflict on a young person during this crucial stage of development. Young people’s attitudes and behaviours in relation to alcohol cannot be considered in isolation to how alcohol is used and m is-used in the adult world – the reality is that alcohol use and m isuse is part of the sam e continuum for both young and old. Our tolerance and am biguity towards alcohol is at variance with m any M editerranean countries where drunkenness is seen as a source of great sham e and em barrassm ent. However, in Ireland episodes of drunkenness, for adults and adolescents of both genders, are routinely recounted with pride. This is one particular facet of our alcohol culture which needs to be challenged through drugs education. Binge drinking and its consequences are not a necessary rite of passage which adolescents m ust go through to m ark their status as em erging adults, rather it is a feature of our social landscape. Changing this aspect of our drinking behaviour m eans challenging the attitudes in adults and young people as to its desirability. From a preventative perspective, the other issue to consider is both the ready availability of alcohol and the linked issue of the lack of social events and venues for adolescents where alcohol does not feature. W hilst it m ay be outside of the scope of schools to address these areas directly, they are issues the wider school com m unity (particularly parents) can engage in. The other issue to be considered from a context perspective is awareness of how adult alcohol use im pacts on children and young people. Am ong the approxim ate 600,000 people living in the South W estern Area Health Board region it is estim ated that: 20 The Epidemiological Triangle of Drug Use y 18,000 adults would identify themselves as having a problem with their alcohol use. Research shows that there is a com plex grid of m ultiple influences which relate to drug use and other problem behaviours, rather than sim plistic single ‘cause and effect’ m odels. Those influences which m ay increase the likelihood of drug use are referred to as risk factors and those which may reduce the likelihood of drug use are referred to as protective factors. It is important to note that models like this are not predictors of individual drug use. Just because a young person is surrounded by risk factors, it does not automatically follow that he or she will engage in any of the problem behaviours identified – rather it postulates that there is a higher risk of such behaviours. Web of Influence Domains Individual Risk and Protective Factors y Biological and Psychological Dispositions y Attitudes and Values y Knowledge and Skills y Problem Behaviours † Refers to the total complex of external social, cultural and economic conditions affecting a community or an individual. School/Work Risk and Protective Factors y Bonding y Climate y Policy y Performance 4. Community Risk and Protective Factors y Bonding y Norms y Resources y Awareness/Mobilisation 5. Society/Environment Related Risk and Protective Factors y External social, economic and cultural conditions y Norms y Policy/Sanctions For a more detailed discussion of risk and protective factors recommended reading would be Dr. Mark Morgan’s ‘Drug Use Prevention – An Overview of Research’ published by the National Advisory Committee on Drugs in 2001. As with the previous section, it is important to note that the following information is aimed at an adult audience in order to build their capacity to engage with young people in drugs education and prevention work in the school setting and, as such, is not a resource to be given out to students in an unmediated fashion. Engaging young people in discussion around drug facts should always be done in a way which is (i) developmentally appropriate (ii) in accordance with the curriculum being used (iii) in accordance with the school’s substance policy The information is organised around the following headings: y Name y Physical Description(s) y Administration y Desired Effects y Duration of Effects y Signs and Symptoms of Use y Short Term Risks y Long Terms Risks y Legal Status 25 Drug Facts All drugs are viewed in terms of both their desired effects and their associated short and long-term risks. This emphasis on risk, as opposed to distinctions between so called ‘soft’ and ‘hard’ drugs is because the risks involved in drug use are not located purely within the drug itself but rather, how the drug is used, how much is used, who uses it and where – as discussed earlier in the section on the epidemiological triangle. Equally, the soft/hard distinction can also be used to build an argument as to which drugs (i. Drugs and the Law Drug laws in Ireland are complex and subject to change and schools are advised to be proactive in developing a good working relationship with local Gardaí as they will be able to clarify issues relating to drug laws.

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Kraut’s artificial text with his artificially unified and gendered author proved to be authoritative buy sinemet 125 mg line; all subsequent Renaissance editors reprinted this humanist fabrication rather than returning to the medieval manuscripts buy sinemet 125 mg on-line. Kraut’s edition thus occluded the medieval history of the texts from view, with the result that most of the modern controversy about the authoress ‘‘Trotula’’ has produced little more than idle speculation. The Trotula texts, whoever their authors may have been, were very real and very influential throughout Europe for nearly half a millennium. What- ever their relationship to Trota or the other women of Salerno, the Trotula were one of the pillars on which later medieval culture was built, being present in the libraries of physicians and surgeons, monks and philosophers, theolo- gians and princes from Italy to Ireland, from Spain to Poland. When Latin- ate physicians or surgeons (such as the anonymous surgeon who owned the Laon manuscript used in the edition here) wanted a handbook on women’s medicine, they used the Trotula. When medieval translators looked for gyne- cological material to render into the vernacular, it was to the Trotula texts that they most frequently turned. Of ten gynecological texts composed in Middle English between the fourteenth and fifteenth centuries, for example, five are renditions of the Trotula. The Latin texts probably only rarely made their way into women’s hands in the early years after their composition, perhaps not at all after the thirteenth century. The Laon manuscript just mentioned, for example, passed from that anonymous male surgeon into the holdings of the cathedral of Laon, where it was annotated and used by the canons of the cathedral for the rest of the Middle Ages. Every other manuscript whose provenance is known is similarly found passing exclusively through the hands of men. Its early provenance is not known, but it has the distinction among the Latin Trotula manuscripts in being the smallest codex, a handbook less than six by four inches in size. It also contains only one other text: a brief tract on useful and harmful foods, which could, conceivably, be used for self-medication by controlling diet. There are no contemporary annotations to confirm owner- ship by a woman, but its small size (similar to that of the books of hours owned by many upper-class women in this period) and the absence of any other, more technical medical literature may suggest use by a layperson and so, perhaps, by a woman. The author of the earliest English translation, writ- ing in the late fourteenth or early fifteenth century, went so far as to demand of any male reader who happened upon the text that ‘‘he read it not in spite nor [in order to] slander any woman nor for any reason but for healing and helping them. It seems, then, that relative to their widespread popularity among male practitioners and intellectuals, it was only very infrequently that the Trotula found their way into the hands of women. Despite the recognition by the author of Conditions of Women that women often did not want to turn to male physicians, the Trotula seem to have functioned as a prime tool by which male practitioners did, in fact, come to have significant control over the practice of gynecology and cosmetics. Note on This Edition and Translation T E The following edition of the Trotula ensemble represents the standardized text as it circulated in the latter half of the thirteenth century through the turn of the fourteenth century. The nine manuscripts collated here were chosen on the basis of their early date and the integrity of their text. The text, including orthography, reflects that of the Basel manuscript, including the hand of the original scribe (B), that scribe’s own corrections (B1), and the corrections of a second, slightly later hand (B2). I have deviated from B’s text only in those cases where the orthography seemed misleading, or where the unanimous agreement of the other manuscripts suggested a lacuna or an error in B. Where B’s reading is unique but not necessarily erroneous, however, I have retained it despite the unanimity of the other manuscripts. All variants are noted in the apparatus with the following two exceptions: varia- tions in word order and orthography, except in those cases where they seemed potentially meaningful, and the presence orabsence of et except, again, in those cases where it might be important to the sense. Corrections or expunctions in the hand of the original scribes have not been specially flagged; the text has simply been read as corrected. It is meant not only to indicate the obvi- ous grammatical and topical breaks (and in this I have respected the manu- scripts’ readings as much as possible) but also to reflect the original compo- nent parts of the texts. Thus, strings of recipes will often be separated except in those instances (such as ¶) where they all come uninterrupted from a single source. More detailed information on when, exactly, this material entered the ensemble and on internal transpositions of material within the texts can be found in my  essay on the subject. B’s orthography displays certain Italianate features, such as a characteristic doubling of consonants (e. The text has been carefully corrected by a contemporary hand (B2), who notes a few omissions in the margins or interlinearly. The original scribe entered the text of the rubrics at the bottom of the page; these were then written in by the same hand. Contents: Johannes de Sancto Paolo, De simpli- cium medicinarum virtutibus; treatise on preparation of colors; Petrus His- panus, Liber de egritudinibus oculorum; idem, Tractatus secundus, i. Zacharias, Tractatus de passionibus oculorum; Trotula, standardized ensemble; Magister Petrus Lumbardus, Cure. Owner: original owner(s) unknown; apparently owned in the late fif- teenth century by Henricus de Sutton, who added some additional reme- dies at the end of the book, including one that he claims to have employed for pain in the penis and breasts. Contents: Isaac Israeli, De dietis particularibus; list of prebends in Laon, held predominantly by Italian canons, between  and ; Trotula, standardized ensemble; Richardus Anglicus, Anathomia. Owners: an unidentified male surgeon (partially erased owner’s mark: Iste liber est. Contents: Bernard de Gordon, Lilium medi-  Introduction cine; table of contents of whole codex; Alphita; Nicholaus, Synonima; Quid pro quo; Tabule Salerni; Nicholaus, De dosibus; Walter, De dosibus; Johannes Stephanus, De medicinis purgantibus; Trotula, standardized en- semble; Thadeus, Experimenta; idem, Practica disputata (an. Contents: Antidotarium Nicolai; Additiones Anthidotarii; Walter, De dosibus; Johannes Stephanus, De dosibus; Walter, De febribus; De conferentibus et nocentibus; He ben Mesue, De simplicibus medicinis; De medicinis solutivis in speciali; He ben Mesue, Liber graduum, followed by list of Arabic words and their definitions; Johannes Damascenus Nafra- nus, filius Mesuhe Calbdei, Agregatio vel antidotarium electuorum con- fectionum; Avicenna, Flebotomia; Rhazes, Flebotomia; Constantinus Afri- canus, Flebotomia; Lectura Johannis de Sancto Amando supra Antidotarium Nicolai; Ricardus Anglicus, De signis pronosticis; Rogerina maior; Rogerina minor; Trotula, standardized ensemble; Practica puerorum (inc. Contents: Mattheus Platearius, Circa instans;WalterAgi- lon, Conferentibus et nocentibus; Gerard of Montpellier, Summa de modo medendi; Walter Agilon, De dosibus; Trotula, standardized ensemble; Rhazes, Passiones sive Practica puerorum;RogerBaron,Rogerina maior; idem, Rogerina minor; Johannes de S.

On the contrary order sinemet 300 mg line, the Government uses financial incentives (from the public purse) to entice general practitioners into participation safe sinemet 125mg, as agents of the state, in health screening schemes. Moreover, screening for disease has so far been largely exempted from ethical guidelines since most doctors believe that screening is a good thing and the public, believing their doctors, have not yet questioned this faith. Private clinics and laboratories are ready to catch any remain- ing hypochondriacs. Misguided politicians, besides liking to be seen as benefactors of mankind, actually believe that screen- ing will save money, which could be used in underfinanced 34 Healthism departments such as the civil service, the army or the police. To ask about the ethics of screening, generally aimed to make healthy people healthier, sounds, if not perverse, then definitely superfluous. The fact that screening is a swinging, lucrative business is an incidental phenomenon - a rare example of goodness being rewarded on this earth. It does not make much sense to screen only women, and only for some rare disease, such as cervical cancer. Why not screen also for hypertension, diabetes, glaucoma, toxoplasmosis, coronary heart disease risk factors, ovarian cancer, lung cancer, breast cancer, gastric cancer, prostatic cancer, mela- noma, testicular cancer. And surely the more often we screen, the better the chances of detecting something wrong. Is not the person invited for screening entitled to full dis- closure of the likelihood of any adverse effects besides the promise of benefit? The likelihood of having a false-positive result is a function of a number of the tests. The resulting anxiety, further diagnostic tests which are not necessarily harmless, and occasionally unnecessary surgery due to false- positive tests in large numbers of healthy people may well outweigh the potential benefit for the lucky few. If a doctor does not inform healthy clients about these complications he should expect to run the risk of being sued. However, to admit that some screening tests are not very accurate, that treatment for the screened condition is not very successful, and that he has not himself been screened, may be more than discouraging for potential screening candidates. If the doctor tells the truth that her husband does not know his cholesterol number, and that she does not test the stools of other members of the family for occult blood every six months, the patient may not be terribly keen to have it done himself. In the first case you practise ordinary medicine: you may not know what is wrong with the patient, and you may have no cure, but the poor lassie or chap is in trouble and has nowhere else to go (except perhaps down the road to an acupuncturist). You console the patient, give him hope and reassurance, you treat him (often with informed consent) and hope for the best. You are soliciting custom without a guarantee of benefit, and things can go wrong. The argument that they have been asking for it is not going to hold water for much longer, as the demand has been created by false promises emanating from the medical profession. Syl- vester Graham, a Bostonian health eccentric taught the importance of abstinence, bran and chastity. His followers, because of their gaunt, sickly looks, were locally known as the Bran and Sawdust Pathological Society. Nowadays the message is not preached from soap boxes, but transmitted through official governmental channels. That acute diagnos- tician of health follies, Lewis Thomas, noticed the change some twenty years ago. It would appear to be only a matter of time before a new medi- cal specialty is established - orthobiostylist consultants, who advise on correct lifestyle. Nearly all Americans (96 per cent) say they would like to change something about their bodies. Particularly vulnerable to this obsession are the middle and upper-middle classes. It is important for the image of the American President to be seen jogging, and for his wife to ban ashtrays from the White House. For example, the British Health Minister, Virginia Bottomley banned biscuits at coffee breaks (to be replaced with fruit) and made it publicly known that she would abstain from alcohol two days in a week. Keith Botsford, writing in The Independent described the American scene as follows: Americans are indeed in a constant state of alarm about the immortality to which they seem to think they are consti- tutionally entitled. This state of affairs is not orchestrated by some worldwide conspiracy, but is rather the result of a positive feedback between the masses stricken by fear of death and the health promotionists seeking enrichment and power. Simple minds, stupefied by the sterilised pap of television and the bland diet 38 Healthism of bowdlerised culture and semi-literacy, are a fertile ground for the gospel of the new lifestyle. The American sociologist Renee Fox has argued that the input by the medical profession into the increased preoccu- pation with health is only one variable in the equation. In the past medicine and magico- religious rituals were fused into one explanatory system that accounted for health, disease, strength, fecundity and invul- nerability, all of them being supernaturally conferred. In modern society, medicine has largely separated from religion, but health has retained its religious, or rather, pseudo- religious, metaphysical, mystical symbolism. For example, Rick Carlson writes in his book The End of Medicine: We have not understood what health is.