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But if [the patient] is not able to take it diluted discount levitra oral jelly 20 mg on line, make from it nine or eleven pills made with the juice of opium poppy buy levitra oral jelly 20 mg fast delivery. But if it has been made without the juice of opium poppy and you wish to make a laxative cheap levitra oral jelly 20 mg with amex, give two drams with two scruples of Levant scam- mony made into pills levitra oral jelly 20mg cheap. It purges the head and stomach of phlegm and foulness, and it takes away heaviness of the eyes. The fourth part is one pound because in each dose they put a pound and half of skimmed honey. Take eleven drams and ﬁfteen grains of aloe; four and a half drams each of saﬀron, costmary, mark- ing nut, agaric, coral, myrrh, ammoniacum, turpentine, galbanum, serapinum gum, opoponax, confected cleavers, calamite storax, and Florentine iris; two drams and ﬁfteen grains each of juice of opium poppy, frankincense, mastic Appendix gum, bdellium, and cozumbrum; one dram and a half each of balsam and cloves; [and] two drams of balm. Take the gums—galbanum, serapinum gum, ammoniacum, and opoponax—and grind them a little bit, and let them be placed in white and moderately sweet-smelling wine for one night. Afterward, add four ounces of skimmed honey and let them continue to boil until they begin to thicken. Then, having ground thoroughly the cala- mite storax, confected cleavers, and cozumbrum with a hot pestle, let them be placed in a cauldron, stirring constantly with a spatula until they liquefy. And if you wish to test whether it is cooked, place a little bit on some marble, and if it immediately congeals into the consistency of honey, [then it is cooked]. A little later, the cauldron having been placed on the ground, let the myrrh, together with the bdellium, be added. Then the costmary, marking nut, agaric, coral, Florentine iris, juice of opium poppy, cloves, and balm. Having ground all these together and pulverized them, let them be placed in the cauldron. Then spread this whole mixture onto a slab of marble that has ﬁrst been covered with oil of laurel. And let this be softened with the powder of aloe, while the saﬀron is ground with the spices. Populeon (¶): Unguentum populeon is so called because it is made from poplar buds [oculus populi]. It is good against the heat of an acute fever and for those who are unable to sleep if it is anointed on the temples and the pulse points and the palms of the hands and soles of the feet. This same unguent, when mixed with oil of roses or violets and anointed above the kidney, takes the heat away marvelously; when anointed on the abdomen, it provokes sweat- ing. Take one and a half pounds of poplar buds; three ounces each of red poppy, leaves of mandrake, the tips of the most delicate leaves of bramble, henbane, black nightshade, common stonecrop, lettuce, houseleek, burdock, violet, and scantuncelus (i. On the third day, gatherall the above- mentioned herbs and let them be ground well by themselves. Afterward, let the lozenges be put piece by piece in a cauldron with one pound of excellent,odoriferous wine. Afterward, Compound Medicines in the Trotula Ensemble having squeezed it all out in a sack, drain [the mixture] well. Potio Sancti Pauli (¶): Potio Sancti Pauli is called potio from potando [drink- ing], sancti Pauli because Saint Paul created it. This is the same potion which the Romans called potio maior, because Paul the Great modiﬁed it. Properly it is given to epileptics, cataleptics, analeptics, and those suﬀering in the stom- ach; it is given with wine in which incense or mixed peony has been cooked. This potion is given with Esdra11 in the wintertime and in the springtime to those suﬀering from quartan fever. It cures when given before the hour of crisis with wine in which felwort or golden gorse and castoreum have been cooked. It likewise heals those suﬀering from diseases of the windpipe and paralytics when given with wine in which sage or castoreum has been cooked. Take three drams and one scruple of natron; one dram and one scruple each of castoreum, antimony, houseleek, cloves, laurel berry, willow, wild celery, parsley, fennel, wild carrot, and stavesacre; three scruples each of sweet ﬂag, myrobalans, licorice, vitriol, peony, and pellitory; one scruple and eighteen grains of costmary, colocynth, agaric, mastic, both long and round aristolochia, roses, juice of wild cabbage, hazelwort, wood sage, cuckoopint, dittany, basil, bear’s breech, horsemint, oregano, penny- royal, wall germander or hyssop, savory, white pepper and black pepper and long pepper, and rue seed; one scruple and four grains each of watercress and frankincense; one scruple each of balsam, spikenard, saﬀron, camel grass, Chi- nese cinnamon, myrrh, opoponax, sulfur, mandrake, felwort, malt, spurge, poppy, and cormorant blood; one scruple minus four grains each of cinnamon, cloves, ginger, marking nut, bark of the balsam tree, rhubarb, hog’s fennel, fruit of the balsam tree, calamite storax, serapinum gum, hazelwort, dragon’s blood, hare’s rennet, sheep’s and goat’s and veal rennet, bear’s gall, goose blood, and petroleum; seven drams and four grains of cowslip; and honey as needed. This is given in the evening, in the amount of a hazelnut, or with the above- mentioned decoctions, to those suﬀering from diseases of the head. It is called rosata from roses; novella [new] in contrast to the old rosata, which had tibar, that is, mercury. Take one ounce and one dram and two and a half scruples each of rose, sugar, and licorice; two drams, two scruples, and two grains of cinnamon; one scruple and eight grains each of cloves, spike- Appendix nard, ginger, galangal, nutmeg, zedoary, storax, watercress, and wild celery; and honey as needed. But if you wish to use it as a purgative, you should employ two scruples of Levant scammony and it will work more forcefully. Take three drams, three grains, plus a third of one grain of aloe; three drams each of cinnamon, wall germander, and sweet ﬂag; two drams and sixteen grains each of saﬀron, cassia tree bark, and rhubarb; two and a half drams of agaric; one and half drams of spikenard, costmary, mastic, hazelwort, silphium,12 squill, asafetida, ammoniacum, bdel- lium, Indian electuary, St. It is made against the most serious diseases of the whole human body: for epileptic conditions, cataleptic, apoplectic, cephalargic, stomach-related, and migrainous. It is best for respiratory, asthmatic, blood-spitting,13 jaundiced, dropsical, perip- neumonic, and intestinal conditions, and for those having wounds in the in- testines. It improves leprous lesions and variolas and periodic chills and other diseases of long standing. It is especially good against all kinds of poisons and the bites of serpents and reptiles. But the quan- tity and quality of the doses for each disease are diﬀerent, and they are written at the end. Take two drams and two scruples of tro- ches made from squill; two drams of long pepper; one dram and one scruple each of troches of Tyre and diacorallum;15 one scruple and seven grains of bal- Compound Medicines in the Trotula Ensemble sam wood; one scruple and fourteen grains each of juice of opium poppy, agaric, Florentine iris, rose, crow garlic, wild turnip seed, cinnamon, and juice of the balsam tree; one scruple and seven grains each of rhubarb, wax, spike- nard, costmary, camel grass, ginger, cassia tree bark, calamite storax, myrrh, turpentine, frankincense, calamint, dittany, French lavender, wall germander, roots of creeping cinquefoil, parsley, and white pepper; one scruple each of cloves, gum arabic, sweet ﬂag, burnt vitriol, serapinum gum, sealed earth or Armenian bole, juice of dodder, Celtic nard, germander, felwort, hog’s fen- nel, balsam fruit, poppy, wild celery, fennel, wild caraway, sermountain, gar- den cress, garden cress seed, anise, and St. Grind those things that need to be ground, and having melted the gums in wine, mix with the powder and with suﬃcient honey or grind with the spices. It is given in the amount of a hazelnut with lukewarm water to those suﬀering from apoplexy, scotomia, cephalargia, migraines, hoarseness of the voice, and chest pains; for these, it should be given with honey or gum tragacanth so that it can be toler- ated by the mouth. For those with blood-spitting conditions of the chest and disease of the lung, give it in a ptisan. For those with peripneumonia, give it with the juice or a decoction of white hore- hound. For nephritics, those suﬀering from stones, and cholerics, give it with a decoction of gromwell, and wild or domestic celery. For those suﬀering from conditions of the windpipe, give it with the juice or a decoction of meadow rue. For poisons and for bringing on the menses or the fetus, give it with warm wine, or with mulsa made with water in which mint or sweet basil has been cooked. And for those suﬀering from a periodic chill and all other diseases, give it with lukewarm water. It is given for pain of the stomach in men and women with water in which fennel seeds, anise, and mastic have been cooked. It is [also] given for disorder of the womb caused by frigidity if it is drunk mixed with wine in which mugwort has been cooked. It also provokes the menses if it is made with well-ground mugwort Appendix and mixed with musk oil. A pessary made from cotton, if it has been anointed with [the trifera] and inserted into the vagina of the woman, provokes the menses in a woman who is not conceiving. If it is given with wine in which mandrake or dwarf elder has been cooked, it works in a wonderful way for chil- dren who are not able to sleep. And in the night when they chatter excessively, it works when an amount the size of a chickpea is mixed with woman’s milk and drunk. Take two drams of juice of opium poppy; one dram each of cinnamon, cloves, galangal, spikenard, zedoary, ginger, cost- mary, calamite storax, sweet ﬂag, galingale, Florentine iris, hog’s fennel, yel- low ﬂag, mandrake, Celtic nard, dog rose, pepper, anise, wild celery, parsley, alexanders, wild carrot, henbane, fennel, sweet basil, and cumin; and honey as needed. Trifera saracenica (¶¶, ): Trifera saracenica (otherwise known as ‘‘juve- nile’’) renders a person young again. It is given particularly for those suﬀer- ing from jaundice and liver problems, and to those suﬀering from head pain on account of a fumosity of red bile. And it restores sight lost from [excessive] heat, and it brings back lost color to its original state. Take three ounces of sugar; one ounce and a half each of the bark of citrine myrobalans, and the ﬂeshy innards of cassia tree bark and tamarinds; six drams, two scruples, and ﬁve grains each of cleaned chebulic myrobalans and manna; one-half ounce each of Indian [myrobalan] and fresh violets if they can be found; two drams and ﬁfteen grains each of anise and fennel; one dram and seven and a half grains each of mastic and mace; one-half ounce and four grains each of belleric and emblic. Prepare thus: in two pounds of water let there be placed three ounces of fresh violets if they can be found. Take part of the strained water, and let the cassia tree bark and the tamarinds be washed through a colander, and let them be strained through it as well. In another [container of] water, there should be put one pound and eight ounces of sugar, and let them be placed on the ﬁre and boil until it be- comes thick: and when it begins to thicken, let the strained water of cassia tree bark and tamarinds be added, and then the manna.
Fourth Decennial International Conference on Nosocomial and Healthcare-Associated Infections generic 20mg levitra oral jelly. Malnutrition and dehydration in nursing homes: key issues in prevention and treatment cheap levitra oral jelly 20mg otc. Nationwide poll on patient safety: 100 million Americans see medical mistakes directly touching them [press release] discount levitra oral jelly 20mg without a prescription. Characteristics of medical school faculty members serving on institutional review boards: results of a national survey purchase 20 mg levitra oral jelly with amex. Peer reporting of coworker wrongdoing: A qualitative analysis of observer attitudes in the decision to report versus not report unethical behavior. The incident reporting system does not detect adverse drug events: a problem for quality improvement. Clinical pharmacy services, hospital pharmacy staffing, and medication errors in United States hospitals. The incidence and severity of adverse events affecting patients after discharge from the hospital. Antibiotic prescribing by primary care physicians for children with upper respiratory tract infections. Prescriptions of systemic antibiotics for children in Germany aged between 0 and 6 years. Antibiotic treatment of adults with sore throat by community primary care physicians: a national survey, 1989- 1999. Impact of antibiotics on conjugational resistance gene transfer in Staphylococcus aureus in sewage. Combined in situ and in vitro assessment of the estrogenic activity of sewage and surface water samples. Ozonation: a tool for removal of pharmaceuticals, contrast media and musk fragrances from wastewater? Determination of neutral pharmaceuticals in wastewater and rivers by liquid chromatography-electrospray tandem mass spectrometry. Trace determination of fluoroquinolone antibacterial agents in urban wastewater by solid-phase extraction and liquid chromatography with fluorescence detection. Determination of antibiotics in different water compartments via liquid chromatography-electrospray tandem mass spectrometry. Prescription of non-steroidal anti-inflammatory agents and risk of iatrogenic adverse effects: a survey of 1072 French general practitioners. Economic analysis of conventional-dose chemotherapy compared with high-dose chemotherapy plus autologous hematopoietic stem-cell transplantation for metastatic breast cancer. Does inappropriate use explain geographic variations in the use of health care services? Excess length of stay, charges, and mortality attributable to medical injuries during hospitalization. Injuries in hospitals pose a significant threat to patients and a substantial increase in health care charges [press release]. Radiation from Medical Procedures in the Pathogenesis of Cancer and Ischemic Heart Disease: Dose-Response Studies with Physicians per 100,000 Population. Preventing Breast Cancer: The Story of a Major, Proven, Preventable Cause of This Disease. Patient, provider and hospital characteristics associated with inappropriate hospitalization. The cost of inappropriate admissions: a study of health benefits and resource utilization in a department of internal medicine. Continuous electronic heart rate monitoring for fetal assessment during labor (Cochrane Review). Assessing benefits and harms of hormone replacement therapy: clinical applications. A retrospective study of intra-operative and postoperative maternal complications of cesarean section during a 10-year period. Smoking and cancer: the cigarette papers: how the industry is trying to smoke us all. Consumer group criticizes Thompson letter dismissing report on dangerous staffing levels in nursing homes [news release]. Multi-site study of incidence of pressure ulcers and the relationship between risk level, demographic characteristics, diagnoses and prescription of preventive interventions. Accuracy of death certificates for coding coronary heart disease as the cause of death. The relationship between physical restraint removal and falls and injuries among nursing home residents. California reaches $100 million multi-state settlement with drug giant Mylan over alleged price-fixing scheme [press release]. After talking to his doctor, he decides J to see a therapist and go on medication. Joe’s doctor gives him two weeks’ worth of samples for a brand name drug called SteadyMood and asks him to come back to see him in two weeks. When he returns, Joe’s feeling a little better and agrees to keep taking SteadyMood for another month. When he gets to the pharmacy, Joe learns that his insurance plan’s co-pay for a month’s supply of SteadyMood is $40. His pharmacist tells him that he’s fortunate to have insurance coverage; without it, the brand name would cost $100. His insurance co-pay would be $10 for a month’s supply of the generic, but his doctor would have to approve it. The pharmacist calls Joe’s doctor and gets approval to fill his prescription with the generic. He’s confused and believes there must be some kind of mistake since the SteadyMood samples his doctor gave him were pink ovals. Joe calls his phar- macist who tells him that the round, white pills are the generic form for SteadyMood and they should work just fine. He returns to the drugstore with another prescription from his doctor, and this time, it allows for generic substitution. The next morning, he opens the bottle to find a completely different-looking medi- cine—now, the pills are yellow and square. Should he simply stay with the brand name version that his doctor originally gave him? Many of us have found ourselves in situations like Joe’s and can understand his frustration. You’ll you want your prescription filled with learn that the decision to choose a the brand name medicine or the generic brand name or a generic is one that medicine. This brochure will “The decision to choose a brand name or a generic is one that involves you and your health care team. Generics only that’s dis- become available after the patent expires covered, on a brand name drug. Once brand name drug may also a new drug is discovered, the company produce the generic files for a patent to protect against other version. It’s important to remember that there are percent of all prescriptions are filled with brand name and generic versions of medi- generic drugs. For example, some people ■ It must have the same route of admin- have reactions to certain dyes used in istration (the way the medication is some drugs. Generics can cost amount of the drug into the blood- between 20 and 80 percent less, but stream within a similar time period keep in mind that cost is only one as the brand name drug). Both private and gov- ernment insurance companies promote using generic drugs when possible. Some insurance plans might require you to pay the entire cost of the brand name drug if you don’t accept the available generic. It takes several years, costly scientific “pioneer drugs”) usually take on the development and many clinical studies research and development costs for new to get a drug approved.
Duck virus enteritis Ducks and geese In susceptible domestic waterfowl flocks 20 mg levitra oral jelly for sale, high percentage mortality and reduced egg production can occur cheap levitra oral jelly 20 mg with amex. Epizootic ulcerative Wide range of wild High losses to fish farmers through mortalities generic 20mg levitra oral jelly visa, reduced syndrome and farmed fish productivity and market rejection due to presence of lesions affecting consumer confidence discount levitra oral jelly 20 mg mastercard. Lead poisoning Mammals, poultry Lead is a common cause of morbidity and mortality in including livestock, particularly for sheep and cattle. Salmonellosis Most commonly in Many infected animals will not show clinical disease. In poultry and pigs mammals, clinical disease is most common in very young, pregnant or lactating animals, and often occurs after a stressful event. Outbreaks in young ruminants, pigs and poultry can result in a high morbidity rate. African animal Cattle, swine, Trypanosomiasis threatens 50 million cattle in Africa trypanosomiasis camels, goats and and can reduce livestock holdings by 10-50%. The mortality rate can reach 50- 100% within months of exposure, particularly if the animal is exposed to poor nutrition and other stresses. Bovine tuberculosis Cattle plus a wide Significant importance to the cattle industry through range of wild and loss of production, control measures and trade domestic restrictions. The majority (60%) of emerging infectious diseases in humans are caused by zoonotic pathogens. Livestock production systems provide opportunities for zoonotic disease transmission and increased human population density living with domestic livestock and pet animals is linked to a rise in the number of zoonotic infections in humans. Additionally, wildlife plays a key role by providing a ‘zoonotic pool’ from which new diseases may emerge. Human encroachment into wildlife habitats and wildlife utilising urban settings, as well as trade and use of wildlife (e. As well as the direct impact of animal diseases on humans, there are numerous indirect impacts mainly caused by the reduced production of livestock in terms of both food security and quality and reduced income linked to production losses and trade restrictions. An increasing range of interfaces between humans and animals allows zoonotic diseases to emerge. There are economic losses to livestock production as disease causes direct mortality and morbidity and reduces production efficiency, e. Production efficiency is also affected if a disease forces farmers to use resources sub-optimally, e. Disease also causes losses of revenue from restrictions on animal movement and trade, costs of control measures (including veterinary treatments) which can be prohibitive, negative impacts on agriculture and aquaculture markets, socio-economic influence on livelihoods, public health concerns especially in the instance of zoonotic disease, and even loss of income to tourism initiatives, e. However, the costs of disease control operations following an outbreak can be even more so: as a general principle, prevention costs provide a sound investment. Although complicated, the economics of disease management need to be seen in the broader context of ecosystem health [►Section 2. Viewing disease management from this perspective which includes ‘all’ the costs of loss of ecosystem function and benefits can help determine appropriate disease control strategies. Although disease may affect income in one sector there may be other compensations. As an example, losses and theoretical losses to livestock production in endemic African animal trypanosome areas allow areas to be left for wildlife from which other direct revenue can flow, e. A cost-benefit analysis, or decision tree, for example, may be useful when comparing the relative merits of different strategies. Diseases of organisms other than animals, such as plant diseases and diseases primarily of humans, such as malaria and dengue fever, are not included. The practicalities and resources available may vary but the principles of disease management remain the same. Written for wetland managers, this Manual aims to bring together what is currently known about animal diseases affecting wetlands and what options are available for managing them. Following an introduction to the issue of diseases in wetlands, we present the general principles of disease and its management in wetlands. We then provide descriptions of a selection of management practices for preventing and controlling disease outbreaks. Thereafter, factsheets present 2 descriptions of a selection of priority diseases affecting wetlands and information to assist in their management. Throughout the Manual key messages for wetland managers and policy makers are highlighted. As seen in Table 1-2, the drivers for disease emergence in wetlands are closely associated with human activity and disease prevention in these habitats lies primarily with land users and managers, together with decision makers. Use of this Manual should provide managers with enhanced understanding that will help assist better informed decision making with respect to preventing and controlling disease in wetlands. This will assist with the task of maintaining the ecological character of wetlands – an essential element of Ramsar’s wise use agenda. It should also materially benefit human communities dependent on wetlands by reducing disease risk either directly, or indirectly, to their livelihoods by impacts on livestock and other agricultural interests. The drivers for disease emergence in wetlands are closely associated with human activity and thus disease prevention in these habitats lies primarily with wetland managers and users. In summary… Aim of this Manual: Well-informed decisions by wetland managers and policy makers with regard to the prevention and control of animal diseases in wetlands so as to ensure wise use. Objectives of this Manual: To explain the principles of disease prevention and control; To provide guidance on practical measures for disease control in wetlands; To provide generic information on a selection of priority diseases; To provide advice on incorporating disease control measures into site management plans; and To provide links to further resources and information. There are many disease types, including: infectious, toxic, nutritional, traumatic, immunological, developmental, congenital/genetic and cancers. Disease is often viewed as a matter of survival or death when, in fact, effects are often far more subtle, instead affecting productivity, development, behaviour, ability to compete for resources or evade predation, or susceptibility to other diseases factors which can consequentially influence population status. Disease is an integral part of ecosystems serving an important role in population dynamics. However, there are anthropogenic threats affecting wetlands including climate change, substantial habitat modification, pollution, invasive alien species, pathogen pollution, wildlife and domestic animal trade, agricultural intensification and expansion, increasing industrial and human population pressures including the interface between humans and domestic and wild animals within wetlands, all of which may act as drivers for emergence or re-emergence of diseases. Wetlands are meeting places for people, livestock and wildlife and infectious diseases can be readily transmitted at these interfaces. Stress is often an integral aspect of disease capable of exacerbating existing disease conditions and increasing susceptibility to infection. There are a broad range of stressors including toxins, nutritional stress, disturbance from humans and/or predators, competition, con-current disease, weather and other environmental perturbations. Stressors can be additive, working together to alter the disease dynamics within an individual host or a population. Impacts of disease on public and livestock health, biodiversity, livelihoods and economies can be significant. The emergence and re-emergence of diseases has become a wildlife conservation issue both in terms of the impact of the diseases themselves and of the actions taken to control them. Some diseases may be significant sources of morbidity and mortality of wetland species and in some cases (e. Revue Scientifique et Technique – Office International des Épizooties, 28 (3): 1031-1035. Anthropogenic environmental change and the emergence of infectious diseases in wildlife. The impact of regional climate change on malaria risk due to greenhouse forcing and land-use changes in tropical Africa. Implications of wildlife trade on the movement of avian influenza and other infectious disease. Revue Scientifique et Technique – Office International des Épizooties, 23 (2): 443-451. An indicator of human impact: gastrointestinal parasites of mountain gorillas (Gorrilla gorilla berengei) from the Virunga volcanoes region, Central Africa. In: Proceedings of the American Association of Zoo Veterinarians and the American Association of Wildlife Veterinarians joint conference. Climate extremes promote fatal co-infections during canine distemper epidemics in African lions. Causal inference in disease ecology: investigating ecological drivers of disease emergence.