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Ovidi Nasonis buy 50mg female viagra with visa, Amores purchase 50 mg female viagra mastercard, 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. On the total integration of Sicily into the much larger world of Muslim and Jewish Notes to Pages –  Mediterranean culture, see also Abraham Udovitch, ‘‘New Materials for the History of Islamic Sicily,’’ in Giornata di Studio: Del Nuovo sulla Sicilia musulmana (Roma,  maggio ) (Rome: Accademia Nazionale dei Lincei, ), pp. Giorgio (–) (Salerno: Archivio di Stato, ); the document regarding the infirmary dates from  (pp. Amarotta, Salerno romana e medievale: Dinamica di un insedia- mento, Società Salernitana di Storia Patria, Collana di Studi Storici Salernitani,  (Sa- lerno: Pietro Laveglia, ). Among those granted permis- sion to use the baths at Santa Sofia were the nuns of the neighboring house of S. The monastery of Santa Sofia became a female house in the thirteenth century; see Galante, Nuove pergamene,p. Citarella, ‘‘Amalfi and Salerno in the Ninth Century,’’ in Istituzioni civili e organizzazione ecclesiastica nello Stato medievale amalfitano: Atti del Congresso inter- nazionale di studi Amalfitani, Amalfi, – luglio  (Amalfi: Centro di Cultura e Storia Amalfitana, ), pp. For the twelfth century, see Donald Matthew, The Norman Kingdom of Sicily (Cambridge: Cambridge University Press, ). Drell, ‘‘Family Struc- ture in the Principality of Salerno During the Norman Period, –,’’ Anglo- Norman Studies: Proceedings of the Battle Conference  (): –; and ‘‘Marriage, Kinship, and Power: Family Structure in the Principality of Salerno under Norman Rule, –’’ (Ph. For their part, however, men could not alienate their female relatives’ property without the woman’s permission. Katherine Fischer Drew (Philadelphia: University of Pennsylvania Press, ), esp. Evidence concerning the general legal and social history of women in southern Italy in the central Middle Ages has only recently begun to be collected. See in particular the essays of Patricia Skinner, ‘‘Women, Wills and Wealth in Medieval Southern Italy,’’ Early Medieval Europe  (): –; ‘‘The Pos- sessions of Lombard Women in Italy,’’ Medieval Life  (spring ): –; ‘‘Disputes and Disparity: Women at Court in Medieval Southern Italy,’’ Reading Medieval Studies  (): –; ‘‘Women, Literacy and Invisibility in Southern Italy, –,’’ in Women, the Book and the Godly: Selected Proceedings of the St Hilda’s Conference, , ed. Drell notes some shifts in the role of mundoalds (men who held a woman’s mundium) over the course of the twelfth century (pp. Copho, for example, distinguishes special remedies for noble people at least six times. See Copho, Practica, in Rudolf Creutz, ‘‘Der Magister Copho und seine Stellung im Hochsalerno: Aus M. The essays collected by Judith Bennett and Amy Froide in Singlewomen in the European Past, – (Philadelphia: Universityof Pennsylvania Press, ) have laid out many new avenues for research. Muhammad ibn Ahmad ibn Jubayr, The Travels of Ibn Jubayr, being the chronicle of a mediaeval Spanish Moor concerning his journey to the Egypt of Saladin, [etc. It is not clear whether the reference to noble- women in ¶, which was added later in the development of the Trotula ensemble, comes out of a Salernitan context. David Nirenberg, Communities of Violence: Persecution of Minorities in the Middle Ages (Princeton: Princeton University Press, ), pp. For example, the polymath Adelard of Bath and several English or Anglo- Norman physicians are known to have studied in Salerno; some Salernitan physicians also emigrated to England. Moreover, some of the earliest extant manuscripts of Con- stantinian and Salernitan writings come from England. Burnett, The Introduction of Arabic Learning into England, Panizzi Lectures,  (London: British Library, ), pp. On the specific significance of this English connection to Treatments of Women, see below. The definitive studyof the institutional historyof the school remains Paul Oskar Kristeller, ‘‘The School of Salerno: Its Development and Its Contribution to the His- tory of Learning,’’ Bulletin of the History of Medicine  (): –; reprinted in Ital- ian translation with further revisions as Studi sulla Scuola medica Salernitana (Naples: Istituto Italiano per gli Studi Filosofici, ). See also Vivian Nutton, ‘‘Velia and the School of Salerno,’’ Medical History  (): –; and ‘‘Continuity or Rediscovery: The City Physician in Classical Antiquity and Mediaeval Italy,’’ in The Town and State Physician in Europe from the Middle Ages to the Enlightenment, ed. My thanks to Francis Newton for informing me of his findings on the early date of Alfanus’s translation of Nemesius (personal communication, June ). His reli- gion of birth is of less import for this story than his native language. On Constantine and his oeuvre, see Bloch, Monte Cassino, : –, –, and : –; and most recently the essays in Constantine the African and ‘Alī ibn al- ‘Abbās al-Magˇūsī: The ‘‘Pantegni’’ and Related Texts, ed. On the intellectual culture of Monte Cassino, see Newton, Scriptorium and Library.

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Geographic distribution Endemic in tropical regions of eastern and southern Africa, with occasional outbreaks in other parts of Africa. Major epidemics occur at irregular intervals of 5-35 years: in Africa, outbreaks typically occur in savannah grasslands every 5-15 years, and in semi-arid regions every 25-35 years. Epidemics are associated with the hatching of mosquitoes during years of heavy rainfall and flooding. Aedes, Anopheles, Culex, Eretmapodites and Mansonia species) and other biting insects. In mammalian species the virus can also be transmitted to the foetus of an infected female. How does the disease The main amplifying hosts are sheep and cattle and once livestock are spread between groups of infected, many species of mosquitoes (e. Eretmapodites and Mansonia species) and biting insects can then spread the disease to other animals and humans. Transmission can also occur through direct contact, which may become relatively more important as an outbreak progresses. The disease may be spread by ingesting the unpasteurised or uncooked milk of infected animals. There is a higher risk of an outbreak in irrigated areas or if there is surface flooding in savannah or semi-arid areas followed by prolonged rains, if the mosquito populations are high, and if there is concurrent illness. Humans may suffer from influenza-like symptoms which can include fever, headache, muscular pain, weakness, nausea, sensitivity to light, loss of appetite and vomiting. Complications can lead to ocular disease (with loss of vision), meningoencephalitis, hepatitis, haemorrhagic fever and occasionally death. Recommended action if Contact and seek assistance from animal and human health professionals suspected immediately if there is any illness in livestock and/or people. For dead animals, whole blood, liver, lymph nodes and spleen are preferable tissues for detecting the virus. Construct artificial homes or manage for mosquito predators such as bird, bat and fish species. Reduce mosquito breeding habitat: Reduce the number of isolated, stagnant, shallow (2-3 inches deep) areas. Install fences to keep livestock from entering the wetland to reduce nutrient loading and sedimentation problems. In ornamental/more managed ponds: Add a waterfall, or install an aerating pump, to keep water moving and reduce mosquito larvae. Keep the surface of the water clear of free-floating vegetation and debris during times of peak mosquito activity. Vector control (chemical) It may be necessary to use alternative mosquito control measures if the above measures are not possible or ineffective: Use larvicides in standing water sources to target mosquitoes during their aquatic stage. This method is deemed least damaging to non- target wildlife and should be used before adulticides. However, during periods of flooding, the number and extent of breeding sites is usually too high for larvicidal measures to be feasible. The environmental impact of vector control measures should be evaluated and appropriate approvals should be granted before it is undertaken. Biosecurity Protocols for handling sick or dead wild animals and contaminated equipment can help prevent further spread of disease: Avoid contact with livestock where possible. Wear gloves whilst handling animals and wash hands with disinfectant or soap immediately after contact with each animal. Wear different clothing and footwear at each site and disinfect clothing/footwear between sites. Monitoring and surveillance Regular inspection of sentinel herds (small ruminant herds located in geographically representative areas) in high risk areas such as locations where mosquito activity is likely to be greatest (e. As a general guide, sentinel herds should be sampled twice to four times annually, with an emphasis during and immediately after rainy seasons. In livestock, clinical surveillance for abortion with laboratory confirmation and serology, and disease in humans in areas known to have had outbreaks. Restrict or ban the movement of livestock to slow the expansion of the virus from infected to uninfected areas: - Livestock should not be moved into/out of the high-risk epizootic areas during periods of greatest virus activity, unless they can be moved to an area where no potential vector species exist (such as at high altitudes). Bury animals rather than butchering them as freshly dead animals are a potential source of infection. For control of disease in captive collections of wild ruminant species, guidelines above for livestock, habitat and vector management may be applicable. Humans In the epidemic regions, thoroughly cook all animal products (blood, meat and milk) before eating them. Reduce the chance of being bitten by mosquitoes: Wear light coloured clothing which covers arms and legs.

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So it made economic sense for hospitals to employ a time-sharing order female viagra 100mg without a prescription, remote computing model purchase 50 mg female viagra overnight delivery. The fact that tomorrow’s computer systems will employ a network model recapitulates the first 15 years of hospital computing history. Hospitals 49 In theory, all these professionals work together both in patient care and in supporting administrative activities. In practical reality, in many hospitals, collaboration between professional departments is grudging at best. Through the clinical and support departments they control, professions in the hospital compete for resources and control over patients. Furthermore, physicians, who control where patients are cared for, are increasingly directing patients with less complex illnesses to settings they control, like surgi-centers and freestanding heart hospitals. The boundaries separating the hospital from other caregivers are constantly shifting, due in major part to economic incentives and other nonclinical factors. Internal competition among hospital departments and the need to compete with freestanding facilities (like surgi-centers and heart hospitals, many of which have physician investors) results in an unseemly clamor for capital spending. Physicians who are em- ployees (and one-third are employed by someone, according to Amer- ican Medical Association data) tend to be employed by physician- dominated entities (group practices, academic faculty practice plans), which are organizationally distinct from the hospital. Because 83 percent of physicians’ records are in paper form, building interfaces from the hospital or other physicians’ offices to reach them is technically impossible. The hospital-physician clinical information boundary is like the blood- brain barrier in the body—a virtually impermeable boundary that traps information on either side that is needed to render safe health- care. For all these reasons, short of running a large urban school sys- tem, running a hospital may be one of the most demanding and frustrating jobs in the entire economy. In the political wheeling and dealing, often the vision of a future information architecture that works for pa- tients and physicians gets lost in the struggle to accommodate the historical culture of the hospital and to meet the short-term needs of its departments. Fragmentation Affects Patients Departmental records were not organized primarily to support or coordinate patient care, which inevitably involves multiple depart- ments. Rather, departmental record-keeping systems were created to support billing for the department’s services. Each department had its own registration and scheduling function; each departmental system assigned the patient a different identification number. This is why, until very recently, a multidepartment hospital visit required a patient to re-register at each stop. In each location, clerks handed patients clipboards with forms that asked questions such as their social security number, mother’s maiden name, and health history. Each time they visited, patients were asked for the same information yet again, as if they were strangers. In many cases, the information was inaccessible in a physician’s office and needed to be Hospitals 51 duplicated in the hospital. In this fragmented information world, crucial information (like what drugs patients are allergic to, what happened the last time they were hospitalized, or what their blood type is) often was very difficult to obtain at the moment in time in which patients were in the office to influence and guide their care. Moreover, if the hospital wants the dozen or more separate pa- tient records for each patient to actually come together, it must hire a consulting firm to provide “systems integration. Each time the hospital adds a new computer system, someone must write custom software code to get the new system to talk to the other, older systems. In enterprisewide computing, the hospital has a single (digital) clinical record, a single patient identifier that every department and professional uses, a common repository for clinical and financial information, and an ability to retrieve that information quickly anywhere in the organization that it is needed. The problem is that replacing all the information systems in a hospital is costly and painful. Kleinke wrote in an oft- quoted 1998 analysis, enterprise software in hospitals has been a costly disappointment for most institutions. Certainly this has been a real (and continuing) problem—vendors promising complex applica- tions that are not completed. However, I believe the problem is larger than the reality of how hard it is to build complex tools that work. The fact that it has been so difficult to automate what hospitals do reflects the almost crippling complexity of what hospitals do and, indeed, what they are. Healthcare is the most complex thing our economy produces; there is more variability and uncertainty at the point of care in an emergency room, intensive care unit, or hospital operating suite than in just about any other part of our economy. However, the fundamental reason why enterprise computing has been so difficult to implement in hospitals is that many of them are not really enterprises. They look like enterprises, with buildings, budgets, and or- ganizational charts, but they function more like loose collections of professions uncomfortably housed in the same physical structures. A coral reef is such a structure, much more a colorful Darwinian ecology than a sentient being. The nervous sys- tem for a jellyfish is going to look and function differently than the nervous system for a higher, thinking organism. Hospitals are like large amoeboid organisms with poorly developed central nervous systems. One can design a nervous system for a collaborative enterprise, but one should not be surprised if it does not work very well if the actors in the enterprise really do not effectively collaborate. Hospitals 53 In addition to the physiology of the organism, there is a work- force problem. Until very recently, health executive and professional education ignored information technology. Vendors as well as providers struggle to find qualified workers at every skill level.

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There is evidence that adolescents are unaware of hepatitis B and hepatitis C risks and how to prevent becoming infected (Moore-Caldwell et al buy female viagra 100mg on line. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www order 50 mg female viagra free shipping. Some 30% of the programs were supported by local government funding, 27% by state fund- ing, and 10% by federal funding. Other sources include pharmaceutical and insurance companies, research and service grants, community hospitals, and other private funding sources (Rein et al. Education and prevention programs should be expanded to provide services in underserved regions of the United States given that the highest rates of acute hepatitis B incidence are in the south (Daniels et al. The major risk factors for viral hepatitis in people in correctional facilities are injection-drug use, tattooing, and sexual activity (see Chapters 4 and 5 for additional information about incarcerated populations). Increased knowledge and awareness about the dis- eases will lead to a greater understanding among inmates about how to prevent them, the advantages of hepatitis B vaccination, why they should be tested for chronic hepatitis B and hepatitis C, and what to do about a positive test result for either infection. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. The addition of hepatitis education to existing peer-based inmate educational programs is feasible and will prob- ably incur minimal additional cost. Women and young people who inject drugs are less likely than others to attend needle-exchange and drug-treatment programs (Bluthenthal et al. Novel programs are needed that will access the hidden injectors, and outreach and peer-education programs are potentially effective ways to achieve this goal. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. The women should be given culturally and linguistically ap- propriate educational information about the importance of administration of the birth dose of the hepatitis B vaccine and hepatitis B immunoglobulin within 12 hours of birth if needed, completion of the hepatitis B vaccine series by the age of 6 months, and postvaccination testing. There is a need to develop a novel program to educate pregnant women in perinatal-care facilities about hepatitis B to prevent perinatal transmission, to refer women who are chronically infected for medical care, and to refer family and household contacts for testing, vaccination, and care if needed. Hepatocellular carcinoma inci-Hepatocellular carcinoma inci- dence, mortality, and survival trends in the United States from 1975 to 2005. Screening and counseling practices reported by obstetrician-gynecologists for patients with hepatitis C virus infec- tion. The ef- fect of syringe exchange use on high-risk injection drug users: A cohort study. Hepatitis B virus: A comprehensive strategy for eliminating transmission in the United States through universal childhood vaccination: recommendations of the Immunization Practices Advisory Committee. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. Hepatitis C virus transmission from an antibody-negative organ and tissue donor—United States, 2000-2002. Transmission of hepatitis B and C viruses in outpatient settings—New York, Oklahoma, and Nebraska, 2000-2002. Transmission of hepatitis B virus among persons undergoing blood glucose moni- toring in long-term-care facilities—Mississippi, North Carolina, and Los Angeles county, California, 2003-2004. Screening for chronic hepatitis B among Asian/Pacifc Islander populations— New York City, 2005. Acute hepatitis C virus infections attributed to unsafe injection practices at an endoscopy clinic—Nevada, 2007. Hepatitis C virus transmission at an outpatient hemodialysis unit—New York, 2001-2008. Building partnerships with traditional Chinese medicine practitioners to increase hepatitis B awareness and prevention. The Jade Rib- bon Campaign: A model program for community outreach and education to prevent liver cancer in Asian Americans. Low hepatitis B knowledge among peri- natal healthcare providers serving county with nation’s highest rate of births to mothers chronically infected with hepatitis B. Hepatitis B and liver cancer beliefs among Korean immigrants in western Washington. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. Hepatitis B virus screening practices of Asian-American primary care physicians who treat Asian adults living in the United States. Organizational climate, staffng, and safety equipment as predictors of needlestick injuries and near-misses in hospital nurses. Living with chronic hepatitis C means “you just haven’t got a normal life any more. The next plague: Stigmatization and discrimination re- lated to Hepatitis C virus infection in Australia. Are primary care clinicians knowl- edgeable about screening for chronic hepatitis B infection? The impact of iatrogenically acquired Hepatitis C infec- tion on the well-being and relationships of a group of Irish women. Impact of four urban perinatal hepatitis B prevention programs on screening and vaccination of infants and household members. Hepatitis B surface antigen prevalence among pregnant women in urban areas: Implications for testing, reporting, and preventing perinatal transmission. Family physi- cians’ knowledge and screening of chronic hepatitis and liver cancer.

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