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Ribavirin and interferon were the most widely used combination in observational studies menstrual 10 days cheap alendronate 35 mg fast delivery, and may warrant further investigation (Momattin menstrual girls buy 70mg alendronate with visa, H womens health first best alendronate 35mg. The optimum dose was determined to pregnancy verification form buy 70 mg alendronate with amex be 1-3 mg/kg (or 160-240 mg/day) for a total accumulated dose of 1000-2000 mg. Based on this experience, routine use of corticosteroids is not recommended in patients with 2019-nCoV (Huang, C. Broad-Spectrum Antiviral Agents Ribavirin is a ribonucleoside analogue that is active against some coronaviruses, as well as respiratory syncytial virus and metapneumoviruses. Adverse events, including dose-dependent anemia, arrhythmia, chest pain and dizziness, are a significant concern with ribavirin (Cleri, D. With the possible exception of ribavirin, there is a lack of broad-spectrum antiviral agents. Unlike other infections agents (bacteria, fungi and parasites), viruses share extremely few common features that could be targeted by broad-spectrum agents. The development of broad-range agents requires a better understanding of pivotal virus-host interactions and the identification of targetable host cell proteins involved. Viral Enzyme Inhibitors the process of coronavirus replication is well understood. Several unique steps have been identified as potential targets for antiviral drugs. Nucleoside inhibitors might specifically inhibit viral replication without causing damage to the host cell. Targeted inhibitors of the serine proteases, which are required to activate the viral infectivity of some coronaviruses, may block the later stages of the viral life cycle (Kilianski, A. Following successful preclinical evaluation of lopinavir/ritonavir plus interferon-beta1b, in which significant reductions in mortality were obtained in a marmoset model, clinical evaluation of the combination was recommended (Chan, J. Since the combination of lopinavir and ritonavir was already available in the Wuhan, China hospital where early 2019-nCoV-infected patients were treated, a randomized controlled trial was quickly initiated to assess the efficacy and safety of the combination to treat this emerging coronavirus infection (Huang, C. Elements of the viral replication process have also been identified as potential therapeutic targets, including viral helicase, features of which are highly conserved among different coronaviruses (Adedeji, A. Other potential antiviral drug targets include virus assembly and exocytosis, which enables the release of virus from host cells. Despite a good understanding of viral targets and the identification of potential antiviral agents in vitro and in animal models, however, these findings have not translated into efficacy in humans (Zumla, A. Nine patients were given the combination therapy, while 13 patients were treated with corticosteroids alone. However, the incidence of transfers to the intensive care unit and need for intubation and mechanical ventilation were lower in the interferon/corticosteroid combination group (33. Most significantly, the incidence of mortality in the corticosteroid therapy group was 7. Furthermore, chest x-rays were normal within four days of initiating combination therapy, versus nine days in the corticosteroid monotherapy group (Loutfy, M. Because ribavirin decreases the release of proinflammatory cytokines in mice infected with the mouse hepatitis coronaviruses, it may also act as an immunomodulator (Peiris, J. Therefore some of its benefits may be due to its immunomodulatory activity (Mazzulli, T. A systematic review and meta-analysis of healthcare databases and so-called grey literature describing the use of convalescent plasma, serum or hyperimmune immunoglobulin derived from convalescent plasma to treat severe acute respiratory infections of viral origin has concluded that this approach is safe and may decrease the risk of mortality 22 (Mair-Jenkins, J. However, Saudi Arabian scientists reported that clinical trials evaluating this therapy would be challenging due to the limited availability of suitable donors, i. The antibody was tested in animal models, in which it protected against acute lung injury. Neutralization of Middle East respiratory syndrome coronavirus has also been achieved using monoclonal antibodies. Tables may also include drugs not covered in the preceding sections because their mechanism of action is unknown or not well characterized. For an overview of validated therapeutic targets for this indication, consult the targetscape below. The targetscape shows an overall cellular and molecular landscape or comprehensive network of connections among the current therapeutic targets for the treatment of the condition and their biological actions. Purple and pink text boxes indicate extracellular and intracellular effects, respectively. For in-depth information on a specific target or mechanism of action, see the corresponding section in this report. Eligible participants were enrolled sequentially using a dose-escalation protocol to receive 0. Enrollment into the higher dose groups occurred after a safety monitoring committee reviewed the data following vaccination of the first 5 participants at the previous lower dose in each group. At the time of data cutoff, 25 subjects were enrolled in each of the 3 dose cohorts. The most commonly reported local solicited symptoms were administration site pain and tenderness, with most of these solicited symptoms being reported as mild and were self-limiting. Unsolicited symptoms were reported for 56 of the 75 participants (75%) and were deemed treatment-related for 26 participants (35%). There were no laboratory abnormalities of grade 3 or higher that were related to study treatment. Laboratory abnormalities were generally uncommon, except for 15 increases in creatine phosphokinase, reported in 14 participants. T-cell responses were detected in 47 of 66 participants (71%) after two vaccinations and in 44 of 58 participants (76%) after three vaccinations. At week 60, vaccine-induced humoral and cellular responses were detected in 51 of 66 participants (77%) and 42 of 66 participants (64%), respectively. Additionally, there were no statistically significant dose-dependent differences in antibody response rates (91%, 95%, and 95% at doses of 0. The study will assess the safety of the vaccine and immune responses to the vaccinations. Themis has established a versatile technology platform for the discovery, development and production of vaccines as well as other immune system activation approaches. The 16 month study will enroll approximately 48 evaluable subjects, with 8 subjects in each one of six sequential ascending intravenous dose cohorts. The highest tolerated dose in the study, 50 mg/kg, was recommended for initial use in human efficacy trials (Beigel, J. The primary and secondary goals of the trial are to obtain safety and immunogenicity data. Inovio and 29 GeneOne are also working on a preclinical vaccine for the emerging Zika virus (see Thomson Reuters Drug News, January 26, 2016). Anemia A condition characterized by too few circulating red blood cells resulting in insufficient oxygen to tissues and organs. Anemia, Iron Deficiency Iron deficiency anemia is one of the most common nutritional disorders and is due to excessive loss, deficient intake or poor absorption of iron. Iron is required for hemoglobin synthesis, which is responsible for the transport of oxygen in red blood cells. Red cells appear abnormal and are small (microcytic) and pale (hypochromic) in iron deficiency anemia. Angiotensin I A biologically inactive decapeptide hormone that is formed in the circulation from the cleavage of angiotensinogen by renin. It has other effects including stimulation of aldosterone release and renal absorption of sodium. It is released from the liver and cleaved in the circulation by renin to form the biologically inactive decapeptide angiotensin I. See also Renin-Angiotensin System Anorexia A condition charaterized by an abnormal loss of appetite or an aversion to food. Anorexia Nervosa See Anorexia Antibody A protein synthesized by B lymphocytes in response to an antigen that has the ability to specifically bind with said antigen. Igs are produced in many different forms, each with different amino acid sequences and antigen binding sites. Through recruiting the complement system and various white blood cells, they protect the body by inactivating viruses and bacterial toxins and by killing invading microorganisms and larger parasites. Antigen Any molecule specifically recognized by B and/or T cells that can induce the formation of a specific antibody.
A mother with tooth decay breast cancer embroidery designs order alendronate no prescription, or recent tooth decay menstrual reg purchase 70mg alendronate, can still transmit the caries causing bacteria to womens health boutique longview buy alendronate 70 mg with amex the child women's health center allentown pa cheap 35 mg alendronate. Antibacterial therapy as well as fuoride treatment for the mother is essential to control caries and reduce the severity of bacterial transmission to the infant. It is now well-established that mutans streptococci can be acquired and readily transferred through vertical transmission—from mother to child or caregiver to child136,137,138—or through horizontal transmission—from child to child, including unrelated children such as in preschool,139,140,141 or adult to adult as between spouses. Delaying or preventing primary infection by mutans streptococci reduces the risk for future dental caries. Evidence on effective interventions to reduce mother-to-child transmission of cariogenic bacteria supports recommendations for the appropriate use of fuorides, antibacterials and dietary control to reduce maternal salivary reservoirs of cariogenic bacteria, particularly for women who have experienced high rates of dental caries. Maternal use of xylitol chewing gum or lozenges (four to fve times a day) has been shown to be effective in reducing S. Poor oral hygiene and health practices such as lack of a consistent and early oral hygiene regimen, supplementation or replacement of breast milk feedings with sugary liquids or solids,152 and falling asleep with the breast nipple in the mouth153 are the underlying causes of caries among breastfed infants. Pediatricians should work collaboratively with the dental community to ensure that women are encouraged to breastfeed and use good oral hygiene practices. An important strategy in caries prevention includes measures to avoid infection and colonization of the oral cavity with primary cariogenic mutans streptococci, especially S. This objective is achieved at home by the woman with adequate plaque control (brushing, fossing, toothpastes, and use of antimicrobial agents such as xylitol and chlorhexidine rinses) and with professional prophylaxis including coronal scaling, root planing and polishing. In 2008 the American Dental Association released evidence based sealant guidelines including a recommendation for sealant placement on both adult teeth and primary teeth at risk for caries. Evidence suggests that pregnant women similarly would beneft from pit-and-fssure sealants on teeth at risk of caries. The dental patient must be provided with full information concerning risks, benefts and alternative procedures available to respond to her oral health condition. Specifc consent should be obtained for any invasive/surgical procedures in compliance with the prevailing standard of care. Dental Treatment During Pregnancy Dental treatment for a pregnant woman who has oral pain, an emergency oral condition or infection should not be delayed as the consequences of not treating an active infection during pregnancy outweigh the possible risks presented. The American Academy of Periodontology has urged oral health professionals to provide treatment for acute Part 2 the Evidence-Based Science Pregnancy and Dental Care Perinatal Oral Health Practice Guidelines periodontal infection or sources of sepsis irrespective of the stage of pregnancy. If the woman does not receive treatment by the time of delivery, her infant could increase its own chance of early acquisition of cariogenic bacteria by transfer in saliva from the mother. There are practical considerations as well: After the baby is born, the mother may be too busy to attend to dental appointments or may lose pregnancy-related health insurance coverage. While treatment of periodontal disease during pregnancy has not been shown to prevent preterm birth, fetal growth restriction or preeclampsia, the treatment itself is not hazardous to the woman or pregnancy;161,162 and the benefts from treatment and risks from lack of treatment must be considered. The treatment approach tested so far consists of nonsurgical periodontal therapy in the second trimester. Evidence supporting the potential benefts of periodontal treatment on pregnancy outcomes shows that essential dental treatment, including the use of topical and local anesthetics, is safe and is not associated with an increased risk of experiencing serious medical adverse events or adverse pregnancy outcomes. Higher anxiety levels associated with pregnancy may intensify the stress of a dental appointment. Dental care during pregnancy should accommodate these changes with short appointments, judicious use of drugs and radiographs, and avoidance of fat supine positioning. Diagnostic radiographs are an important tool in the diagnosis and treatment of dental problems and are considered safe during pregnancy. The number and type of radiographs will depend upon the clinical conditions and the patient’s health history. As standard practice, the oral health professional should provide protection from radiation exposure for the pregnant woman’s abdomen and neck using an abdominal and neck shield. One new dental technology involving dental radiographs, which is also safe during pregnancy, is digital radiographs. They offer the advantage of a reduction in radiation, no need for flm or processing chemicals, and production of a nearly instantaneous image. The main disadvantage is the cost, limiting their use in many dental practice settings. Positioning the Pregnant Patient When the pregnant woman lies fat on her back, the uterus in the third trimester can press on the inferior vena cava and impede venous return to the heart, which can lead to the supine hypotensive syndrome. This syndrome (which only occurs in 15-20% of pregnant women) can be avoided during dental treatment by placing the patient in a semi-reclining position, encouraging frequent position changes, and/or by placing a wedge underneath one of her hips to displace the uterus. A small pillow or folded blanket under either hip moves the uterus off the vena cava to prevent postural hypotensive syndrome. Additionally, gastric emptying may be delayed by narcotics, onset of labor, pain and trauma. Maintaining a semi-seated position and 39 avoiding excessive sedation are required to prevent aspiration. Its widespread use in obstetrical analgesia is related to its ease of administration, minimal toxicity, minimal cardiovascular depression, lack of effect on uterine contractions, and the fact that it has not been implicated as one of the agents capable of causing malignant hyperthermia,169 a severe biochemical reaction triggered by exposure to certain general anesthetics. In obstetrics, nitrous oxide has been used alone or in combination with other methods of pain control. In dentistry, nitrous oxide/oxygen is the most commonly used inhalation anesthetic. Because pregnancy is associated with decreased anesthetic requirements, lower concentrations of nitrous oxide may be adequate for sedation and patient comfort. Prolonged dental treatments and nitrous oxide exposure should be avoided if possible. Adequate precautions and monitoring must be taken to prevent hypoxia, hypotension and aspiration. Continuous monitoring of vital signs and adequate scavenging of exhaled gases are recommended. Proper use of scavenging devices while nitrous oxide is provided to patients in the dental setting eliminates any signifcant risk. Short exposure during general anesthesia with such anesthetic agents as nitrous oxide and thiopental has not been shown to have deleterious effects or to be teratogenic. During pregnancy, oxygen consumption increases and functional lung capacity decreases. Consequently, oxygen reserve decreases and pregnant women may develop hypoxia and hypercapnia more easily with decreased ventilation. Airway management can be diffcult in pregnant women due to weight gain, increased chest wall diameter, breast enlargement, and laryngeal edema. This explains why from mid-gestation Part 2 the Evidence-Based Science Pregnancy and Dental Care Perinatal Oral Health Practice Guidelines onward women in the supine position are at risk for compression of the great vessels by the uterus, which may result in signifcant hypotension, a common complication that can be easily avoided during dental treatment by proper positioning of the patient as described previously. When used alone for mild to moderate sedation, nitrous oxide does not depress ventilation. However, when it is combined with sedatives or opioids that depress ventilation, a more pronounced and clinically important depression may result. Prior to planned use of nitrous oxide/oxygen during dental treatment, consultation with an obstetrician or maternal-fetal medicine subspecialist is recommended to check for any pulmonary concerns, in addition to standard nitrous oxide protocols in dentistry. Restorative Materials Safety considerations for treating dental caries arise in relation to the presence, placement, and removal of dental restorative materials, including amalgam, composite resin and the associated adhesive materials. Best practices in using dental restorative materials are based on perinatal and child outcomes from studies on pregnant women as well as from relevant research conducted on dental professionals who may, during their pregnancies, receive higher exposures to these same materials through their workplace activities. Amalgam, an alloy of silver, copper, tin and mercury,184 is the most commonly used 41 dental restorative material for repairing posterior teeth. The elemental mercury found in 42 dental amalgam is inorganic, in contrast to organic forms such as methyl mercury, found largely in fsh and seafood, and thimerosal, an ethyl mercury-based preservative found in pharmaceuticals. Current-day exposures to mercury are predominantly to methyl mercury from food intake, with inorganic mercury present at much lower concentrations. Oral habits such as bruxism and gum chewing can lead to higher concentrations of inorganic mercury in blood. Placement and removal of amalgam restorations results in transiently higher blood mercury concentrations. It is advisable to delay removal until after pregnancy or weaning if a rubber dam and high-speed suction cannot be used. However, even during placement and removal, studies do not show any adverse reproductive effects if safe amalgam practices are used.
The appropriate code from category O30 pregnancy jokes cartoons buy alendronate 35 mg without prescription, Multiple gestation menopause signs and symptoms alendronate 70 mg without a prescription, must also be assigned when assigning code O33 womens health network purchase genuine alendronate on line. The appropriate code from category O30 menopause groups purchase alendronate without prescription, Multiple gestation, must also be assigned when assigning a code from category O40 that has a 7th character of 1 through 9. This code is for use as a single diagnosis code and is not to be used with any other code from chapter 15. P00 Newborn (suspected to be) affected by maternal conditions that may be unrelated to present pregnancy Code first any current condition in newborn Excludes2:newborn (suspected to be) affected by maternal complications of pregnancy (P01. In general, categories in this chapter include the less well-defined conditions and symptoms that, without the necessary study of the case to establish a final diagnosis, point perhaps equally to two or more diseases or to two or more systems of the body. Injury of unspecified body region (T14) T14 Injury of unspecified body region Excludes1:multiple unspecified injuries (T07) T14. It should be used as a supplementary code with categories T20-T25 when the site is specified. A11 Poisoning by pertussis vaccine, including combinations with a pertussis component, accidental (unintentional) T50. A12 Poisoning by pertussis vaccine, including combinations with a pertussis component, intentional self-harm T50. A15 Adverse effect of pertussis vaccine, including combinations with a pertussis component T50. A2 Poisoning by, adverse effect of and underdosing of mixed bacterial vaccines without a pertussis component T50. A21 Poisoning by mixed bacterial vaccines without a pertussis component, accidental (unintentional) T50. A9 Poisoning by, adverse effect of and underdosing of other bacterial vaccines T50. Z Poisoning by, adverse effect of and underdosing of other vaccines and biological substances T50. Z9 Poisoning by, adverse effect of and underdosing of other vaccines and biological substances T50. A1 Traumatic compartment syndrome of upper extremity Traumatic compartment syndrome of shoulder, arm, forearm, wrist, hand, and fingers T79. Where a code from this section is applicable, it is intended that it shall be used secondary to a code from another chapter of the Classification indicating the nature of the condition. Most often, the condition will be classifiable to Chapter 19, Injury, poisoning and certain other consequences of external causes (S00-T98). For these conditions, codes from Chapter 20 should be used to provide additional information as to the cause of the condition. A roadway is that part of the public highway designed, improved and customarily used for vehicular traffic. A pedestrian is any person involved in an accident who was not at the time of the accident riding in or on a motor vehicle, railway train, streetcar or animal-drawn or other vehicle, or on a pedal cycle or animal. A driver is an occupant of a transport vehicle who is operating or intending to operate it. A passenger is any occupant of a transport vehicle other than the driver, except a person traveling on the outside of the vehicle. A person on the outside of a vehicle is any person being transported by a vehicle but not occupying the space normally reserved for the driver or passengers, or the space intended for the transport of property. A pedal cycle is any land transport vehicle operated solely by nonmotorized pedals including a bicycle or tricycle. A streetcar, is a device designed and used primarily for transporting passengers within a municipality, running on rails, usually subject to normal traffic control signals, and operated principally on a right-of-way that forms part of the roadway. A special vehicle mainly used on industrial premises is a motor vehicle designed primarily for use within the buildings and premises of industrial or commercial establishments. A special vehicle mainly used in agriculture is a motor vehicle designed specifically for use in farming and agriculture (horticulture), to work the land, tend and harvest crops and transport materials on the farm. A special construction vehicle is a motor vehicle designed specifically for use on construction and demolition sites. Pedestrian injured in transport accident (V00-V09) Includes: person changing tire on transport vehicle person examining engine of vehicle broken down in (on side of) road Excludes1:fall due to non-transport collision with other person (W03) pedestrian on foot falling (slipping) on ice and snow (W00. See categories T15-T19 W45 Foreign body or object entering through skin Excludes2:contact with hand tools (nonpowered) (powered) (W27-W29) contact with knife, sword or dagger (W26. W67 Accidental drowning and submersion while in swimming pool Excludes1:accidental drowning and submersion due to fall into swimming pool (W16. W73 Other specified cause of accidental non-transport drowning and submersion Includes: accidental drowning and submersion while in quenching tank accidental drowning and submersion while in reservoir Excludes1:accidental drowning and submersion due to fall into other water (W16. See category W86 W88 Exposure to ionizing radiation Excludes1:exposure to sunlight (X32) the appropriate 7th character is to be added to each code from category W88 A initial encounter D subsequent encounter S sequela W88. See category X08 Contact with heat and hot substances (X10-X19) Excludes1: exposure to excessive natural heat (X30) exposure to fire and flames (X00-X09) X10 Contact with hot drinks, food, fats and cooking oils the appropriate 7th character is to be added to each code from category X10 A initial encounter D subsequent encounter S sequela X10. See category T71 X71 Intentional self-harm by drowning and submersion the appropriate 7th character is to be added to each code from category X71 A initial encounter D subsequent encounter S sequela X71. See category T71 X92 Assault by drowning and submersion the appropriate 7th character is to be added to each code from category X92 A initial encounter D subsequent encounter S sequela X92. If no such documentation is present, code to accidental (unintentional) Categories Y10-Y19 deactivated. See category T71 Y21 Drowning and submersion, undetermined intent the appropriate 7th character is to be added to each code from category Y21 A initial encounter D subsequent encounter S sequela Y21. Replaced with 7th character S for categories V00-Y38 Supplementary factors related to causes of morbidity classified elsewhere (Y90-Y99) Note: these categories may be used to provide supplementary information concerning causes of morbidity. Y90 Evidence of alcohol involvement determined by blood alcohol level Code first any associated alcohol related disorders (F10) Y90. They are also appropriate for use with external cause codes for cause and intent if identifying the activity provides additional information on the event. A corresponding procedure code must accompany a Z code if a procedure is performed. A separate procedure code is required to identify any examinations or procedures performed Excludes1:encounter for examination for administrative purposes (Z02. They may be used for patients who have already been treated for a disease or injury, but who are receiving aftercare or prophylactic care, or care to consolidate the treatment, or to deal with a residual state Excludes2:follow-up examination for medical surveillance after treatment (Z08-Z09) Z40 Encounter for prophylactic surgery Excludes1:organ donations (Z52. Excludes1:target of adverse discrimination such as for racial or religious reasons (Z60. It works shoulder-to-shoulder with like-minded groups and individuals who share a common purpose to clean up the feld of mental health. It shall continue to do so until psychiatry’s abusive and coercive practices cease and human rights and dignity are returned to all. Tel: (323) 467-4242 or (800) 869-2247 Fax: (323) 467-3720 E-mail: humanrights@cchr. For further information consult the Physicians’ Desk Reference which can be found at. It could be dangerous to immediately cease taking psychiatric drugs because of potential signifcant withdrawal side effects. No one should stop taking any psychiatric drug without the advice and assistance of a competent, medical doctor. Some of the brand names of drugs included relate to countries outside of the United States. An amphetamine’s chemical structure resembles natural stimulants in the body, like adrenaline. However, as a drug, it alters the natural system and can reduce appetite and fatigue and “speed” you up. A stimulant (psychostimulant) refers to any mind-altering chemical or substance that affects the central nervous system by speeding up the body’s functions, including the heart and breathing rates. In children, however, stimulants appear to act as suppressants, but psychiatrists and doctors have no idea why. A 1999 study published in Science Journal, determined: “The mechanism by which psychostimulants act as calming agentsis currently unknown. The frst panel recommended stronger warnings against stimulants, emphasizing these should appear on special handouts called “Med Guides” (Medication Guides) that doctors must give to patients with each prescription. Cylert posed a threat of serious liver complications, including liver failure resulting in death or liver transplantation.
First breast cancer 3 day cheap 35mg alendronate amex, support for this project was provided by two offces within the United States Department of Education women's health magazine subscription buy cheap alendronate 35 mg online, the Offce of Special Education Programs (Project No womens health doctors purchase alendronate line. The fndings and conclusions of this report are those of the authors and do not necessarily refect the policies of either of these funding sources women's health center camp hill pa purchase alendronate 70 mg overnight delivery. The authors wish to acknowledge the support of the following individuals who provided assistance, feedback, and guidance during the process of the project: Grace Baranek, Angela Bardeen, Brian Boyd, Laura Hall, Rob Horner, Julia Shaw-Kokot, and Paul Yoder. The What Works Clearinghouse/Mathematica staff (Josh Furgeson, Jean Knab, and Stephen Lipscomb) provided training for a number of the members of our team, which assisted us in designing our meth odological review criteria. Also, the following individuals at the Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill provided technical support for the production of the manual: Jay Hargrove, Gina Harrison, Marie Huff, Katie Hume, Stephanie Ridley, Dave Shaw, John Sideris, and Cici Sidor. The many reviewers of the 1000+ articles evaluated in this project donated their time and intellectual energy, free of charge. They are: Khaled Alkherainej Miriam Allen Sheryl Alvies Kristie Asaro-Saddler Jeannine Bagnall Sara Baillie Erin E. Brann Nicolette Bainbridge Brigham Alicia Brophy Sheila Bulmer Carol Burmeister Betsy Caporale Christina Carnahan Amy M. Casey Jefrey Chan Lynette Chandler Ching-I Chen Jodi Cholewicki Shelley Clarke Eric A Common Marissa Congdon Peter Doehring Elizabeth Drame Sarah Dufek Richard Duggan Jessica Dykstra Farah El Zein David N. Flynn Leslie Fox ii Wong, Odom, Hume, Cox, Fettig, Kucharczyk, Brock, Plavnick, Fleury & Schultz Dawn W. Hampshire Caroline Harkins McCarty Josh Harrower Michelle Hartley-McAndrew Shane Herriott Michelle Hickman Rebecca Elder Hinshaw Camilla Hileman Jefrey F. Jobin Irene Jones Melissa Jones-Bromenshenkel Debra Kamps Eunjoo Kim Anita Kliewer-Mal’akhim Scott Kozlowski Lefki Kourea Delilah Krasch Catherine A. Loftin Jesse Logue Mari MacFarland Wendy Machalicek Sara Moore Mackiewicz Laura M. Reeve Debra Reinhartsen Stephanie Reszka Leila Ansari Ricci Sandra Hess Robbins Rachel E. Rowand Robinson Dawn Rowe Cheri Sandford Jessie Sandoval Alicia Saunders Crystalyn Schnorr Naomi A. Schoenfeld Ilene Schwartz Peggy Sepetys Maureen Short Jenzi Silverman Katie Snyder Candice Southall Scott Spaulding Laurie Sperry Amy D. Trivette Shu-Fei Tsai Linda Tuchman-Ginsberg Vanessa Tucker Karen Umstead Stanley Urban Potheini Vaiouli Kimberly Vannest Joel L. In Chapter 2, we describe in detail the methodology followed in searching the literature, evaluating research studies, and identifying practices. In Chapter 3, the practices are described along with the type of outcomes individual practices generate and the age of children for whom the outcomes were found. In Chapter 4, we summarize the fndings, discuss their relationship to other reviews, compare the current review process to the previous process, identify limitations of this review, and propose implications of study results for practice and future research. In the Appendix, each practice is described and specifc studies that provide empirical support for the practice are listed. Autism Spectrum Disorder: Diagnostic Criteria the defnition of autism has evolved over the years. Early on, Kanner (1943) noted that autism was characterized by failure to develop social relationships and a need for sameness. The characteristics, stated slightly differently, continue to defne the condition today. These diagnostic classifcations were grouped under a broader classifcation called Pervasive Devel opmental Disorders (American Psychiatric Association, 1994). Examples of diffculties in social communication include challenges in social reciprocity, nonver bal social behaviors, and establishment of social relationships. Restrictive and repetitive behav iors include stereotypic behavior or speech, excessive adherence to routines, and highly fxated interests. In addition, we have included studies in which participants may also have had co-occurring conditions such as intellectual disability, speech/language im pairment, seizure disorder, sensory impairment, and attention defcit hyperactivity disorder. Intervention Approaches Two broad classes of interventions appear in the research literature (Smith, 2013), and we have identifed them as comprehensive treatment models and focused intervention practices. Although the current review concentrated on the latter class of interventions, it is important to describe both in order to distinguish the two. Examples include discrete trial teaching, pivotal response training, prompting, and video modeling. The subsequent adoption of the evidence-based conceptual approach in the social sciences is exemplifed in the work of the Campbell Collaboration. In the 1990s, the American Psychological Association Division 12 established criteria for classify ing an intervention practice as effcacious or “probably effcacious,” which provided a precedent for quantifying the amount and type of evidence needed for establishing practices as evidence based (Chambless & Hollon, 1998; Chambless et al. Although these reviews were systematic and useful, they did not follow a stringent review process that incorporated clear criteria for including or excluding studies for the reviews or organizing the information into sets of practices. Their search, after excluding articles that did not meet their criteria, yielded a total of 775 studies. They identifed 11 practices as established treatments (see the top row of Table 1). In addition, they identifed 22 practices as emerging treatments, meaning that there was some evidence but it was not strong enough to meet the established criteria. Also, they found fve practices for which researchers demonstrated, experimentally, that there were no effects, and no practices they would characterize as ineffective/harmful. They content analyzed the intervention methodologies, created intervention categories, and sorted articles into those categories. For some practices that were developed in the 1980s, foundational articles from the earlier time period were included if they were routinely cited in the articles from the 10 year time period. A second purpose was to expand the timeframe previous to the initial review, extending the coverage to 1990 to be consistent with other research synthesis organizations in going back approximately 20 years. The third purpose was to create and utilize a broader and more rigorous review process than occurred in the previous review. As such, the review that we present in the following chapters includes a new and expanded database of articles, a new evaluation process, and new or modifed focused intervention categories. An initial descrip tion of inclusion/exclusion criteria for studies is followed by a summary of the search process and articles accessed for the review. Reviewer training, the review process, and the process for Idocumentary evidence-based practices conclude the chapter. Inclusion/Exclusion Criteria for Studies in the Review Articles included in this review were published in peer-reviewed, English language journals be tween 1990 and 2011 and tested the effcacy of focused intervention practices. Population/Participants To qualify for the review, participants in a study had to be Table 2. These conditions could be intellectual disability, alternate intervention conditions genetic syndrome. Evidence-Based Practices for Children, Youth, and Young Adults with Autism Spectrum Disorder Interventions To be included in this review, the focused intervention practices examined in a study had to be behavioral, developmental, and/or educational in nature. Studies in which the independent variables were only medications, alternative/complementary medicine. In addition, only interventions that could be practically implemented in typical educational, home, or community settings were included. As such, intervention practices requiring highly specialized materials, equipment, or locations unlikely to be available in most educational, clinic, community, or home settings were also excluded. Comparison For inclusion in the review, the design of the study had to compare an experimental or treatment condition. All relevant features of the comparison condition had to be described to allow for a clear understanding of the differences between the conditions. If the control was “business as usual” instruction, the instructional or classroom environment had to be described. Outcomes Additionally, focused intervention practices had to generate behavioral, developmental, or academic outcomes. Studies reporting both behavioral and health/medical outcomes for children were included, but studies only reporting physical health outcomes were excluded from the review. Search Process Research articles were obtained through an electronic library search of published studies.
We sent with this a belt and a string of wampum in token of our appreciation of your precious gift breast cancer quilt alendronate 35mg without prescription. In Britain he received nan cial rewards of 10 womens health 50 plus order 35 mg alendronate visa,000 and 20 women's health center vidalia ga purchase alendronate online from canada,000 in 1802 and 1807 menstrual question buy alendronate with mastercard, respectively. One example is the case of Benjamin Waterhouse and James Smith in the United States (40,41). Benjamin Waterhouse was appointed Professor of Theory and Practice of Physics at the newly established Harvard Medical School in 1783 after returning to Boston from several years of study abroad. For eight years he had studied at the best medical schools of that time, the University of Edinburgh, Scotland, and the University of Smallpox 81 Leiden, Holland. After receiving his medical degree from the University of Leiden, he stayed at the university for an additional session and boarded with John Adams, the American minister. Thereafter, Waterhouse devoted his ener gies to advocating the use of cowpox to vaccinate against smallpox, rather than using variolation. Those vaccinated resisted infection when exposed to natural smallpox or when variolated with smallpox. A coalition of physi cians from Harvard and the Boston community petitioned the Boston Board of Health in 1802 to set up and conduct a public test of the new vaccine. Although it may not have been their intent, this investigation clearly proved the superiority of vaccination over variolation. Subsequently Waterhouse wrote to Thomas Jefferson and sent him his pamphlet on “A Prospect of Eliminating Smallpox. Through his efforts, vaccine material received from Waterhouse was distributed to Jefferson’s native Virginia, then to Pennsylvania and numerous areas within the South. Jefferson also sent Jenner’s vaccine with Meriwether Lewis and William Clark on their journey to explore the Louisiana Purchase and nd passage to the Pacic Ocean. He instructed Lewis on its use and requested it be brought to the frontier and Indians (44). Finally, James Madison, the fourth president of the United States, who was familiar with both Jefferson’s and Waterhouse’s activities, signed legislation, the rst of its kind, to encourage vaccination. James Smith of Maryland was appointed as the federal agent for the distribution of the vaccine. To avoid entanglement in the war he traveled to and lived in 82 Viruses, Plagues, and History Britain in the early part of 1775. Further, he was born in Rhode Island and was considered an outsider by many in the Boston community. Finally, his political sympathies were with Thomas Jefferson and his style of government, a Populist democracy. By contrast to Waterhouse, the Boston elite supported Federalism and considered Jefferson immoral. A coalition of physicians at Harvard and throughout Boston, in concert with church leaders, arranged the dismissal of Waterhouse from his chair at the Harvard Medical School in 1812. Accordingly, the changing polit ical climate in Washington in the 1820s led to repeal of the vaccine law followed by the dismissal of James Smith from his ofce in 1822. The result was that by 1840, epidemics of smallpox and deaths that followed once again increased in the United States. Jenner and Jefferson expressed the hope in the early nineteenth century that smallpox might someday be eliminated. However, it was over 150 years after Jenner proved the effectiveness of vaccination that the rst serious proposal to undertake smallpox eradication appeared. In 1950, the Pan-American Sanitary Organization made the commit ment to conquer smallpox throughout the Americas. A program of mass vaccinations eliminated smallpox by the 1970s from all countries in the Americas except for Argentina, Brazil, Colombia, and Ecuador; in the countries with vaccination programs, the number of cases decreased markedly. With governments around the world promoting vaccination, out breaks of smallpox came under control in many but not all countries. Representatives of virtually every industrialized country, including the United States, argued that such a program was too complicated, too vast. Unfortunately, this program turned out to be disap pointing, even as smallpox was successfully eliminated from several more countries, including China. Five years later the Vice Minister of Health of the Soviet Union, Victor Zhadnov, proposed a ten-year program for the eradication of smallpox. At this time even the inuential and prominent microbiologist Rene Dubos, like Lord Byron 150 years earlier, referred to smallpox eradication as a passing fancy: “Make it probably useless to discuss the theoretical aws and technical difculties of eradi cation programs, because more earthly factors will certainly bring them soon to a gentle and silent death. Eradication programs will even tually become a curiosity item on library shelves, just as have all social utopias. Incredibly, almost every industrialized country again protested the size of the budget, and most expressed doubts about the wisdom of the program. Thus, the pivotal discovery by Jenner that would lead to one of the major accomplishments of mankind became implemented by a margin of only two votes. He received his medical training at the University of Rochester and public health training at Johns Hopkins. First, international vaccine testing centers were developed to ensure that all vaccines met the standards of safety and effectiveness. Second, reduc ing the number of smallpox cases to zero became the established goal rather than documenting the number of vaccine doses given. With this goal, effective surveillance teams were set up to both report and contain outbreaks of smallpox. In the early years of the program, it became clear that the number of smallpox cases was underreported and that only 10 percent of vaccines being produced or provided met the accepted international standards. Subsequently, with more accurate 84 Viruses, Plagues, and History surveillance and reporting, with the use of only those vaccines approved by the international vaccine testing centers, and with a program for vigorous vaccination of peoples in Africa and Asia, by 1970 smallpox was eliminated from twenty countries of western and central Africa. In 1971, smallpox was eliminated from Brazil, in 1972 from Indone sia, in 1975 from the entire Asian continent, in 1976 from Ethiopia, and in 1977 the last case was reported in Somalia. Thus by 1980, 184 years after Edward Jenner inoculated James Phipps and 182 years after he published An Inquiry into the Causes and Effects of the Variolae Vaccinae, the World Health Assembly announced worldwide eradication of smallpox. This singular event is one of the greatest accomplishments undertaken and performed for the benet of mankind anywhere or at any time. The microbe hunters who accomplished this deed are many but can be placed into two groups. First and unquestionably the most innovative was Edward Jenner for his work, perseverance, and inuence. Second is the large group of dedicated health-care workers who traveled to the distant corners of the earth to track cases of smallpox and to vaccinate all peoples on the globe. Henderson reects the best qualities of many in the long line of public health ofcers in the United States and throughout the world who have devoted their energies both scientically and politically toward the control and elimination of infectious diseases. The success of the Smallpox Eradication Program indicates clearly that other viruses with characteristics similar to smallpox—that is, whose natural host is man, that have no animal intermediate, and that do not cause persistent infection—such as measles and poliomyelitis, can and should be controlled. Scientic research has provided the tools; all that remains is the political and economic willpower and desire to apply them effectively. Thus smallpox, one of the viruses most intently studied by newly emerging practitioners of medicine, and a killer of millions of people, was to become no more than a curiosity, likely to be removed from the teaching curriculum of medical schools. Prior to September 11, plans were made to eliminate all stocks of smallpox within the next sev eral years, thus making the virus the rst species purposely eliminated from this planet. Smallpox 85 Despite the eradication of smallpox as a disease, could the virus return Since the virus does not linger in the form of a persistent infection, it is amenable to permanent eradication—that is to say, removal from the world. But because the virus no longer circulates in any community, the numbers of never-vaccinated or never-infected susceptible individ uals increases continually. Further, complete or efcient immunity of those previously vaccinated is believed to wane in ten to twenty years. In the last few years, some countries and individuals with hidden stores of smallpox viruses have actually chosen to develop more danger ous varieties by inserting materials alongside its genes. For example, the Soviet Biologic-Weapons Program near Novosibirsk in western Siberia continued such work engineering a component of Ebola virus into the smallpox virus, despite attempts from Gorbachev to curtail it. With the breakup of the Soviet Union, government-funded research decreased dramatically, and scientists working in biowarfare programs often found themselves without jobs. Several emigrated to the United States or Great Britain as consultants in the defense against such biological weapons, even as the Offensive Biological Weapons Program was discontinued in the United States during the Nixon presidency. One can only guess that they ended up in Iraq, Syria, Libya, Iran, or perhaps other areas with their stocks of smallpox and their technical knowledge to ini tiate and expand a bioweapons program. But because of that threat, several specialists who earlier led the ght to remove smallpox from our planet and destroy the virus as a species have recently advised that funds be earmarked to stockpile vaccines against smallpox and other pathogens and to store the deadly virus in American and Russian designated laboratories.
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