By V. Sugut. Arcadia University.
Part : The Latin Manuscripts cheap apcalis sx 20mg without a prescription,’’ Scriptorium (): – generic apcalis sx 20mg visa, and ‘‘Part : The Vernacular Translations and Latin Re-Writings,’’ Scriptorium (): –; and the appendix to Women’s Healthcare in the Medieval West: Texts and Contexts (Aldershot: Ashgate, ). Georg Kraut, published in a collection entitled Experimen- tarius medicinae (Strasbourg: Joannes Schottus, ). All twelve subsequent editions (the last in ) reprint Kraut’s edition with only minor changes. The most famous medieval reference to the author ‘‘Trotula’’ is that of Geof- frey Chaucer, who includes her among the authorities in the clerk Jankyn’s notorious antifeminist collection, the ‘‘book of wikked wyves’’; Canterbury Tales, Wife of Bath’s Prologue, (D), –, in The Riverside Chaucer, ed. In a number of manuscripts, scribes still distinguished between the ﬁrst text, now dubbed the Trotula major (‘‘The Greater Trotula’’ = ¶¶–), and the latter two, which were often seen as a unit called the Trotula minor (‘‘The Lesser Trotula’’ = ¶¶– ). In his reprint of Kraut’s edition, Hans Kaspar Wolf claimed that the text was the work of a male physician named Eros, a freed slave of the Roman em- press Julia (ﬁrst century C. Benton, ‘‘Trotula,Women’s Problems, and the Professionalization of Medicine in the Middle Ages,’’ Bulletin of the History of Medicine (): –; and Monica H. Green, ‘‘In Search of an ‘Authentic’ Women’s Medicine: The Strange Fates of Trota of Salerno and Hildegard of Bingen,’’ Dy- namis: Acta Hispanica ad Medicinae Scientiarumque Historiam Illustrandam (): –. This is not to say that medieval editors and scribes never realized how protean the texts were; on the contrary, scribes frequently compared diﬀerent versions of the texts in order to correct the errors of faulty exemplars. In two ﬁfteenth-century cases, they even attempted to ‘‘reconstruct’’ the ensemble from original versions of the three independent texts. I have diﬀerentiated four versions of Conditions of Women,twoofTreatments for Women, three of Women’s Cosmetics, and six of the ensemble. The total numberof extant Latin manuscripts currently known is , comprising copies of the texts. Green, ‘‘The Development of the Trotula,’’ Revue d’Histoire des Textes (): –, reprinted in Green, Women’s Healthcare, essay ; ‘‘Handlist’’; and the appendix to Women’s Healthcare, s. Adaptations and manipulations of the texts were made long after the mid-thir- teenth century, but aside from the vernacular translations (which have a tremendous importance in their own right), most of these later adaptations were isolated revisions that are never found in more than one or two manuscripts. I have also, in both the edition and the translation, marked with an asterisk (*) those paragraphs that do not derive from the three original texts. The actual overlap Notes to Pages xv– is signiﬁcantly lower, however, since in only some of these cases are the herbs currently recommended for approximately the same conditions as cited in the Trotula. My arguments about authorial gender will be laid out fully in Women and Lit- erate Medicine in Medieval Europe: Trota and the ‘‘Trotula’’ (forthcoming). Green, ‘‘The Transmission of Ancient Theories of Female Physi- ologyand Disease Through the Early Middle Ages’’ (Ph. What would have diﬀered are the rates at which these diseases manifested them- selves in medieval populations. For excellent examples of the new data and interpre- tations from scientiﬁc paleopathological researches, see Joël Blondiaux, ‘‘La femme et son corps au haut moyen-âge vus par l’anthropologue et le paleopathologiste,’’ in La Femme au moyen âge, ed. Michel Rouche and Jean Heuclin (Maubeuge: Publication de laVille de Maubeuge, Diﬀusion Jean Touzot, ), pp. Jiménez Bro- beil, ‘‘A Contribution to Medieval Pathological Gynaecology,’’ Journal of Paleopathology (): –; and Anne L. Grauer, ‘‘Life Patterns of Women from Medieval York,’’ in The Archaeology of Gender: Proceedings of the Twenty-Second Annual Conference of the Archaeological Association of the University of Calgary, ed. Writers of ‘‘Arabic medicine’’ were in some cases non-Arabs; Christians,or Jews, as well as Mus- lims. In some manuscripts, the rubric Trotula minor encompassed both the Treat- ments for Women and Women’s Cosmetics. Treatments for Women cites the Salernitan masters Copho,Trota, Mattheus Fer- rarius, and either Johannes Furias or Johannes Ferrarius. Copho is likely to have been active in the second quarter of the twelfth century, while Mattheus Ferrarius ﬂourished in the middle decades of the century. The Roman poet Ovid wrote a facetious poem on cosmetics in the ﬁrst cen- tury; see P. Ovidi Nasonis, Amores, Medicamina faciei femineae, Ars amatoris, Remedia Notes to Pages – amoris, ed. A ﬁrst-century Greek text, On Cosmetics, is attributed to Cleopatra; all that remains is a fragment on weights and measures. There is no evidence that the full text of this pseudo-Cleopatran Cosmetics was ever available in Latin, though a ref- erence to it may be behind the attribution of the strictly gynecological (and equally pseudonymous) Gynecology of Cleopatra (Gynaecia Cleopatrae) and Pessaries of Cleopatra (De pessis Cleopatrae). Patricia Skinner, Health and Medicine in Early Medieval Southern Italy, The Medieval Mediterranean, (Leiden: Brill, ), follows Morpurgo in expressing skepticism about Salerno’s uniqueness. My work with the Trotula texts, even though it shows (in the case of the Treatments for Women) English inﬂuence, oﬀers nothing to suggest a Parisian connection. And there is more than ample evidence—codicological, documentary, and textual—to conﬁrm the vibrant local intellectual activity in southern Italy (and Salerno in particular) in the early twelfth century. Salernitan physicians ﬁgure in tales by, for example, Marie de France, Chrétien de Troyes, and Hartman von Aue. Goitein, A Mediterranean Society: The Jewish Communities of the ArabWorld as Portrayed in the Documents of the Cairo Geniza, vols. Moshe Gil, ‘‘Sicily, –, in Light of the Geniza Documents and Parallel Sources,’’ in Italia Judaica: Gli ebrei in Sicilia sino all’espulsione del . Atti del V convegno internazionale Palermo, – giugno , Pubblicazioni degli Archivi di Stato, Saggi (Palermo: Ministero per i Beni Culturali e Ambientali, ), pp.
This may also be important to avoid the adverse welfare and financial implications of over-dosing individuals order apcalis sx 20 mg with amex. Vaccination storage and application Vaccines should be stored at the correct refrigeration temperatures at all times and must be used before expiry dates buy 20 mg apcalis sx otc. Selecting a vaccination programme When selecting a vaccination programme, the following should be considered: The programme should have a clear purpose and objective Once the target animal population and area have been defined, vaccination should be carried out as comprehensively as possible Separate vaccination personnel should be used for herds and flocks thought to have infection to minimise the spread of the disease between them Individual herds and flocks should be gathered separately to minimise the spread of disease Vaccinated animals should be permanently marked for future identification Vaccination programmes should be accompanied by other measures such as disease surveillance, livestock movement controls and quarantine (where possible and appropriate) Vaccination programmes should be accompanied by public awareness campaigns Examples of vaccination programmes: 1. Blanket vaccination is the comprehensive vaccination of ‘all’ susceptible animals over a large area. This may be favoured when the disease has become well established, when there are many sources of infection, or when other disease control measures are impractical and/or ineffective. Areas with known and suspected infection and areas thought to be at high risk of disease should be covered. Ring vaccination is the rapid creation of a belt of vaccinated animals around an infected area. This can be implemented to contain a fast spreading disease outbreak, in situations where the effectiveness of other methods is unlikely to succeed, or in areas which are too inaccessible for blanket vaccination or other disease control measures. Epidemiological factors and resource availability should be assessed to determine the width of the vaccination zone. Specific considerations for vaccination of wildlife Vaccination of domestic livestock has been widely used and may often present a practical disease control option where an effective vaccine exists. Vaccination of wildlife is more challenging owing to many technological and logistical barriers including difficulties in delivering it to a sufficiently large proportion of the target population. Also, only few vaccines have been tested sufficiently to demonstrate their safety and efficacy and achieve a licence for their use in wild hosts. Even domestic animal vaccines against the same pathogen, may need to undergo significant testing to determine their safety and efficacy in wild hosts. The aim of any wildlife vaccination programme needs to be clear from the outset, for example, does the vaccination programme aim to reduce mortality, reduce suffering, reduce the risk of spread to livestock or humans, or to ensure the viability of the population? There may be risks associated with the vaccine itself, either in target or non-target populations. Live vaccines have the greatest potential for problems following release into the environment. Also, the ecological consequences of vaccination should be considered, including the possibility of altering demographic processes (e. Delivery of the vaccine to the target population may be logistically difficult or prohibitively expensive. Methods of vaccine delivery include the injection of captured animals and the deployment of palatable baits containing vaccine. Capture and injection options are likely to be relatively expensive and could have adverse welfare implications. Deployment of edible baits is often a more attractive option, but the development of a suitable bait which is compatible with the vaccine and sufficiently stable in the environment can be technically challenging. Some well-resourced wildlife vaccination programmes such as rabies vaccination for red foxes Vulpes vulpes in Europe have proved successful. Other successful projects have involved vaccination of endangered wild populations against domestic animal diseases for which vaccines already exist, where populations were relatively restricted in range and well studied, and the aims of the project have been clear. Vaccination of wildlife can be successful and may seem like an appealing option, however, other management techniques, particularly where naturally acquired immunity is developed, may be just as effective and in many ways preferable. Buffalo treatment campaign in Iraq Breeding marsh buffalo Bubalus bubalis is important in different parts of Iraq, particularly in its southern regions and wetlands such as the Central marsh due to the abundance of appropriate food, water and pasture land. Unfortunately, many by-products of modern technology and poor water management policies have damaged the natural environment of these areas. This in turn necessitates the existence of veterinary centres to provide the proper treatment and vaccines needed for healthy buffalo populations. Due to an apparent lack of training and proper supplies, there is the potential for these centres to spread and worsen some diseases that afflict buffalo and cattle, such as septic blood haemorrhages and other diseases. These diseases lead to substantial losses in livestock, so consequently the authorities have instituted serious measures with the close support of Nature Iraq, an Iraqi environmental organisation, to contain these diseases through a campaign for fast and effective treatment of haemorrhagic blood septicaemia and other diseases. Main diseases that afflict buffalo: Haemorrhagic septicaemia Symptomatic anthrax The focus of this report is the prevention of haemorrhagic septicaemia. The following are the vaccines used in the prevention of this disease: Haemorrhagic Septicaemia Vaccine (H. Haemorrhagic septicaemia This is among the most common diseases infecting buffaloes throughout Iraq as well as in other African and Asian countries. After 13 years of two epidemiological studies in India, this disease was determined to be the more deadly than diseases such as cow plague, foot and mouth disease and symptomatic anthrax. It is caused by the bacterium Pasteurella multocida and it is pathogenic in cows and deadly for buffaloes. Infection Cows and buffaloes which carry the disease are considered the main source of the disease, which can exist inside the mouth of other nearby animals that can infect them directly or indirectly. The high rate of infection is closely tied to the animals’ wetland habitat and the close quarters the herds experience at night inside their enclosures. Clinical signs The infected buffaloes can be recognised by sluggishness, lack of movement, salivation, increased temperature, difficulty breathing, breathing through their mouth, nose excretions, and throat or neck lesions sometimes extending to the chest, as well as fluid in the throat and lungs. The vaccination should also vary according to local conditions in various countries but it is essential that the vaccination must begin early, as soon as the disease is detected. There are methods to help buffaloes survive the disease by making a slot in the trachea of the animals to give more time for the vaccine to work. It is possible to inject the animals intravenously whilst executing this minor surgical procedure at the same time by using anaesthetic.
The rapid implementation of disease control activities will ultimately reduce thedisease outbreak buy generic apcalis sx 20mg. The rapid implementation of disease control activities will ultimately reduce the overall cost of the disease control campaign 20mg apcalis sx with mastercard. Criteria should be agreed for the release of funds, for example, when an outbreak has been identified or the presence of disease is strongly suspected, when effective control and/or elimination of the disease is possible and when there are approved plans to implement such measures. If the funding and resources of a disease management strategy is limited in a country or area, potential international donor sources should be identified (e. It may be wise to include procedures for applying for funding from various ‘back-up’ sources in the financial plan. If possible, funds for compensation of wetland stakeholders who have incurred financial losses as a result of disease control activities should also be included where this is national policy. Resource plans It is important to make an inventory which lists all the resources that will be needed during a disease outbreak, including capacity of personnel (their qualifications, expertise and experience) and equipment (quantities, specifications and locations). This should be compared with an inventory list of existing resources and any deficiencies should be rectified. All staff should be thoroughly trained in their roles, duties and responsibilities, and a contingency plan should allow for ‘back-up’ staff [►Section 3. Legislation A contingency plan should include information on legislation and regulations that may or may not give permissions to conduct various disease prevention and control activities, in the event of an outbreak at or around your site. This should include information about the compulsory notification of certain animal diseases and may also include authorisations for the declaration of infected areas and disease control zones, movements of animals and people, the destruction and safe disposal of infected or potentially infected animals and objects, compensation for those financially affected by disease control activities and authorisation for any other relevant activities. Simulation exercises It is important to ensure that your contingency plan is practically achievable and for this, simulation exercises should be carried out in advance of their implementation. Lessons learnt from such exercises should be used to further refine and improve your contingency plan. These exercises are essential for building effective teams, ensuring that there are adequate resources and for training staff [►Section 3. Disease outbreak scenarios should be realistic and real data should be used if possible. Each stage of an outbreak response may need to be tested before a full-scale disease scenario is attempted. Changing circumstances may require that a contingency plan be updated to retain its effectiveness in preventing and controlling disease. The effectiveness of a contingency plan in preventing and/or controlling a disease in a wetland should be thoroughly evaluated after a disease outbreak response has ended, and recommendations for improvement should be incorporated where necessary. Risk analysis as a component of animal disease emergency preparedness planning, Chapter 3. Exotic animal disease contingency framework plan: covering exotic notifiable animal diseases of livestock. Chapter 4, Field manual of wildlife diseases: general field procedures and diseases of birds. The specific actions required to reduce risks associated with these diseases should be identified within risk assessments [►Section 3. More generally, ‘healthy habitat management’ and reducing stressors at a site will benefit disease prevention and/or control [►Section 3. Additionally, following standardised protocols for releasing and moving animals into, within and out of wetlands will help to mitigate disease risks [►Section 3. It is important that wetland managers identify stressor risks within their site and the broader catchment/landscape, and understand that these may change over time. Once these factors are identified, they can be managed and/or their impact mitigated, as appropriate. Disease zoning (although challenging in wildlife and/or aquatic systems) can help control some infectious diseases through the delineation of infected and uninfected zones defined by sub-populations with different disease status. Buffer zones separating infected and uninfected zones may consist of physical barriers, an absence of hosts, an absence of disease vectors or only immune hosts e. Appropriate levels of surveillance are required to accurately define zones and for prevention of disease spread to occur, the movements of animals between zones needs to be restricted. The movement of infected animals to new areas and populations represents the most obvious potential route for introduction of new/novel infections. The risk of transmission and spread of disease can be minimised by conducting risk assessments and following certain standardised national and international guidelines and regulations for moving, relocating and/or releasing animals. A disease risk analysis should be conducted for any translocations for conservation purposes. Biosecurity in wetlands refers to the precautions taken to minimise the risk of introducing infection (or invasive alien species) to a previously uninfected site and, therefore, preventing further spread. Infectious animal diseases are spread not only through movement of infected hosts but also their products e. Constructed treatment wetlands can assist greatly in reducing risks from contaminated wastewaters. Where possible, biosecurity measures should be implemented routinely as standard practice whether or not an outbreak has been detected. A regional/supra-national approach to biosecurity is important for trans-boundary diseases, particularly those where domestic and international trade are considered as important pathways for disease spread, e. If wetland stakeholders understand the principles and value of biosecurity and what measures to take, this will encourage the development of an everyday ‘culture’ of biosecurity which can help disease prevention and control. Implementing biosecurity measures in the natural environment can be extremely challenging, particularly in aquatic systems, and although eliminating risk will be impossible, a substantial reduction in risk may be achievable, particularly where several complementary measures are employed. Stressors may not in themselves cause disease but their effects can be subtle and can influence disease dynamics and the likelihood of a disease outbreak. Stressors can be additive or synergistic, working together to shift the balance between health and disease within individual hosts or populations. Consequently, stressors at wetland sites should be identified and managed to reduce disease susceptibility.
Frequently discount apcalis sx 20mg fast delivery, however order apcalis sx 20mg overnight delivery, 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. Yet few really answer the question “Do the two methods of measurement agree sufficiently closely? We will restrict our consideration to the comparison of two methods of measuring a continuous variable, although similar problems can arise with categorical variables. Comparison of means Cater (1979) compared two methods of estimating the gestational age of human babies. He divided the babies into three groups: normal birthweight babies, low birthweight pre-term (< 36 weeks gestation) babies, and low birthweight term babies. For each group he compared the mean by each method (using an unspecified test of significance), finding the mean gestational age to be significantly different for pre-term babies but not for the other groups. His criterion of agreement was that the two methods gave the same mean measurement; “the same” appears to stand for “not significantly different”. By his criterion, the greater the measurement error, and hence the less chance of a significant difference, the better. Correlation The favourite approach is to calculate the product-moment correlation coefficient, r, between the two methods of measurement. The correlation coefficient in this case depends on both the variation between individuals (i. In some applications the “true value” will be the subject’s average value over time, and short-term within-subject variation will be part of the measurement error. In others, where we wish to identify changes within subjects, the true value is not assumed constant. The correlation coefficient will therefore partly depend on the choice of subjects. For if the variation between individuals is high compared to the measurement error the correlation will be high, whereas if the variation between individuals is low the correlation will be low. This can be seen if we regard each measurement as the sum of the true value of the measured quantity and the error due to measurement. We have: 2 variance of true values = σT 2 variance of measurement error, method A = σA 2 variance of measurement error, method B = σB In the simplest model errors have expectation zero and are independent of one another and of the true value, so that 2 2 variance of method A = σA + σT 2 2 variance of method B = σB + σT 2 covariance = σT (see appendix) Hence the expected value of the sample correlation coefficient r is 2 σ T ρ = 2 2 2 2 (σ A + σT )(σ B + σT ) 2 2 2 2 2 Clearly ρ is less than one, and it depends only on the relative sizes of σT , σA and σB. If σA and σB 2 are not small compared to σT , the correlation will be small no matter how good the agreement between the two methods. In the extreme case, when we have several pairs of measurements on the same individual, 2 σT = 0 (assuming that there are no temporal changes), and so ρ = 0 no matter how close the agreement is. They concluded that the two methods did not agree because low correlations were found when the range of cardiac output was small, even though other studies covering a wide range of cardiac output had shown high correlations. In fact the result of their analysis may be 308 explained on the statistical grounds discussed above, the expected value of the correlation coefficient being zero. Their conclusion that the methods did not agree was thus wrong - their approach tells us nothing about dye-dilution and impedance cardiography. As already noted, another implication of the expected value of r is that the observed correlation will increase if the between subject variability increases. Diastolic blood pressure varies less between individuals than does systolic pressure, so that we would expect to observe a worse correlation for diastolic pressures when methods are compared in this way. It is not an indication that the methods agree less well for diastolic than for systolic measurements. This table provides another illustration of the effect on the correlation coefficient of variation between individuals. Correlation coefficients between methods of measurement of blood pressure for systolic and diastolic pressures Systolic pressure Diastolic pressure sA sB r sA sB r Laughlin et al. A further point of interest is that even what appears (visually) to be fairly poor agreement can produce fairly high values of the correlation coefficient. They concluded that because the correlation was high and significantly different from zero, agreement was good. However, from their data a baby with a gestational age of 35 weeks by the Robinson method could have been anything between 34 and 39. For two methods which purport to measure the same thing the agreement between them is not close, because what may be a high correlation in other contexts is not high when comparing things that should be highly related anyway. It is unlikely that we would consider totally unrelated quantities as candidates for a method comparison study. The correlation coefficient is not a measure of agreement; it is a measure of association. At the extreme, when measurement error is very small and correlations correspondingly high, it becomes difficult to interpret differences. It is difficult to imagine another context in which it were thought possible to improve materially on a correlation of 0. Regression Linear regression is another misused technique in method comparison studies. This is equivalent to testing the correlation coefficient against zero, and the above remarks apply. These authors gave not only correlation coefficients but the regression line of one method, Teichholz, on the other, angiography. They noted that the slope of the regression line differed significantly from the line of identity.
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