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The problem created by the lack of a formal quantity for a radiation weighted dose for high doses is not limited to medicine but is also a real challenge in accidents involving radiation viagra capsules 100mg cheap, and remains unsolved order 100mg viagra capsules otc. In situations after accidental high dose exposures generic viagra capsules 100 mg without a prescription, health consequences have to be assessed and, potentially, decisions have to be made on treatments. The fundamental quantities to be used for quantifying exposure in such situations are organ and tissue absorbed doses (given in grays). Radiation dose to patients from radiopharmaceuticals Another dosimetric issue of concern is the radiation dose to patients from internal emitters, mainly radiopharmaceuticals. Initially, biokinetic models and best estimates of biokinetic data for some 120 individual radiopharmaceuticals were presented, giving estimated absorbed doses, including the range of variation to be expected in pathological states, for adults, children and the foetus. Absorbed dose estimates are needed in clinical diagnostic work for judging the risk associated with the use of specific radiopharmaceuticals, both for comparison with the possible benefit of the investigation and to help in giving adequate information to the patient. These estimates provide guidance to ethics committees having to decide upon research projects involving the use of radioactive substances in volunteers who receive no individual benefit from the study. It also provides realistic maximum 11 18 models for C and F substances, for which no specific models are available. Managing patient dose in digital radiology Digital techniques have the potential to improve the practice of radiology but they also risk the overuse of radiation. It is very easy to obtain (and delete) images with digital fluoroscopy systems, and there may be a tendency to obtain more images than necessary. In digital radiology, higher patient dose usually means improved image quality, so a tendency to use higher patient doses than necessary could occur. Different medical imaging tasks require different levels of image quality, and doses that have no additional benefit for the clinical purpose should be avoided. Image quality can be compromised by inappropriate levels of data compression and/or post-processing techniques. All of these new challenges should be part of the optimization process and should be included in clinical and technical protocols. Local diagnostic reference levels should be re-evaluated for digital imaging, and patient dose parameters should be displayed at the operator console. Training in the management of image quality and patient dose in digital radiology is necessary. Digital radiology will involve new regulations and invoke new challenges for practitioners. As digital images are easier to obtain and transmit, the justification criteria should be reinforced. Commissioning of digital systems should involve clinical specialists, medical physicists and radiographers to ensure that imaging capability and radiation dose management are integrated. The doses can often approach or exceed levels known with certainty to increase the probability of cancer. Proper justification of examinations, use of the appropriate technical parameters during examinations, proper quality control and application of diagnostic reference levels of dose, as appropriate, would all contribute to this end. All of these issues should be addressed for providing assistance in the successful management of patient dose. If the image quality is appropriately specified by the user, and suited to the clinical task, there will be a reduction in patient dose for most patients. Pregnancy and medical radiation Thousands of pregnant patients are exposed to radiation each year as a result of obstetrics procedures. Lack of knowledge is responsible for great anxiety and probably unnecessary termination of many pregnancies. Dealing with these problems continues to be a challenge primarily for physicians, but also for medical and health physicists, nurses, technologists and administrators. Medical professionals using radiation should be familiar with the effects of radiation on the embryo and foetus, including the risk of childhood cancer, at most diagnostic levels. Doses in excess of 100 ± 200 mGy risk nervous system abnormalities, malformations, growth retardation and fetal death. Justification of medical exposure of pregnant women poses a different benefit/risk situation to most other medical exposures, because in in utero medical exposures there are two different entities (the mother and the foetus) that must be considered. Prior to radiation exposure, female patients of childbearing age should be evaluated and an attempt made to determine who is or could be pregnant. For pregnant patients, the medical procedures should be tailored to reduce fetal dose. After medical procedures involving high doses of radiation have been performed on pregnant patients, fetal dose and potential fetal risk should be estimated. Pregnant medical radiation workers may work in a radiation environment as long as there is reasonable assurance that the fetal dose can be kept below 1 mGy during the course of pregnancy. Termination of pregnancy at fetal doses of less than 100 mGy is deemed to be unjustifiable, but at higher fetal doses, informed decisions should be made based upon individual circumstances. Radiological protection in paediatric diagnostic and interventional radiology Diagnostic radiological examinations carry a higher risk per unit of radiation dose for the development of cancer in infants and children compared to adults. The higher risk is due to the longer life expectancy of children, in which radiation effects could manifest, and the fact that developing organs and tissues are more sensitive to radiation. Risk is particularly high in infants and young children compared to older children. Justification of every examination involving ionizing radiation, followed by optimization of radiological protection is particularly important in every paediatric patient, in view of the higher risk of adverse effects per unit of radiation dose compared to adults. According to the justification principle, if a diagnostic imaging examination is indicated and justified, this implies that the risk to the patient of not performing the examination is greater than the risk of potential radiation induced harm to the patient. The implementation of quality criteria and regular audits should be instituted as part of the radiological protection culture in the institution. Imaging techniques that do not employ the use of ionizing radiation should always be considered as a possible alternative. For the purpose of minimizing radiation exposure, the criteria for the image quality necessary to achieve the diagnostic task in paediatric radiology may differ from adults, and noisier images, if sufficient for radiological diagnosis, should be accepted. The advice of medical physicists should be sought, if possible, to assist with installation, setting imaging protocols and optimization. Exposure parameters that control radiation dose should be carefully tailored for children and every examination should be optimized with regard to radiological protection. Apart from image quality, attention should also be paid to optimizing study quality. Acceptable quality also depends on the structure and organ being examined and the clinical indication for the study. Additional training in radiation protection is recommended for paediatric interventional procedures, which should be performed by experienced paediatric interventional staff due to the potential for high patient radiation dose exposure. Public protection: Release of patients after therapy with unsealed radionuclides A major concern for public protection related to medicine is the release of patients after therapy with unsealed radionuclides. After some therapeutic nuclear medicine procedures with unsealed radionuclides, precautions may be needed to limit doses to other people. Iodine-131 results in the largest dose to medical staff, the public, caregivers and relatives. Young children and infants, as well as visitors not engaged in direct care or comforting, should be treated as members of the public (i. The modes of exposure to other people are external exposure, internal exposure due to contamination, and environmental pathways.

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Measles buy viagra capsules online now, Mumps and Rubella - vaccine use and strategies for elimination of measles buy viagra capsules online, rubella generic 100mg viagra capsules fast delivery, and congenital rubella syndrome and control of mumps. Control and prevention of rubella: Evaluation and management of suspected outbreaks, rubella in pregnant women, and surveillance of congenital rubella syndrome. Compendium of measures to prevent disease associated with animals in public settings. Guidance for the Registration of Pesticide Products Containing Sodium and Calcium Hypochlorite Salts as the Active Ingredient. Because of international travel and migration, cities are becoming important Division of International and hubs for the transmission of infectious diseases, as shown by recent pandemics. Physicians in urban environments Humanitarian Medicine, Department of Community in developing and developed countries need to be aware of the changes in infectious diseases associated with Medicine and Primary Care, urbanisation. Furthermore, health should be a major consideration in town planning to ensure urbanisation works to Geneva University Hospitals, reduce the burden of infectious diseases in the future. Many national and municipal governments (E Alirol, L Getaz, F Chappuis, living in cities. The urban sector’s share of the poor is Geneva, Geneva, Switzerland their urban agglomerations (figure 1). In Sudan and Central African Correspondence to: Niamey, Niger, for example, increased from Republic, more than 94% of urban residents live in Prof Louis Loutan, Service de 250 000 people in the 1980s to almost 1 million today. In 2001, 924 million5 Médecine Internationale et humanitaire, Hôpitaux 2050, the world’s urban population is expected to reach urban residents lived in slums and informal settlements. Almost all of this growth will be in low- This number is expected to double to almost 2 billion by Rue Gabrielle Perret-Gentil 4, income regions: in Africa the urban population is likely 2030. Chronic illnesses have been increasing in sub-Saharan Africa remains mainly rural and is not importance, but infectious diseases remain a leading expected to pass the urban tipping point before 2030. This worldwide increase in urban population environments and others have emerged or re-emerged results from a combination of factors including natural in urban areas. The heterogeneity in health of urban population growth, migration, government policies, dwellers, increased rates of contact, and mobility of infrastructure development, and other major political people, results in a high risk of disease transmission in and economical forces, including globalisation. Cities become incubators There is no universally accepted definition of what where all the conditions are met for outbreaks to occur. Some countries use a basic administrative Although poor urban areas are typically affected first, definition (eg, living in the capital city); others use population measures (eg, size or density), or functional 6000 More developed regions, urban population characteristics (eg, economic activities). Data are More developed regions, rural population Less developed regions, urban population therefore difficult to extrapolate from one country to 5000 Less developed regions, rural population another. Moreover, there are few high-quality studies assessing urban health in tropical regions and most 4000 studies are cross-sectional. Most studies address differences between urban and rural settings and data 3000 are rarely disaggregated according to disparities within urban settings, which are therefore masked. Finally, 2000 urban growth might be driven by different forces in different cities, and the epidemiology of individual diseases might differ according to specific urban 1000 dynamics and contexts. However, in many low-income countries, economic Figure 1: Evolution of urban and rural populations between 1950 and 20502 www. Additionally, in an interconnected Economic migration and forced displacement can world, cities become gateways for the worldwide spread contribute to population movements. These issues have substantial public- at least 500000 of the 2 million inhabitants have moved health implications, reshaping the epidemiology of to the city seeking refuge from conflict or disaster. For3 both chronic and infectious diseases, with consequences urban growth, migration is generally more important in worldwide. They also change the practice of physicians nations with low rates of natural increase. In China for working in cities of tropical regions, and of travel example, the floating population of rural migrants doctors in developed nations. Large summarise how urbanisation influences the population movements are also occurring between cities, epidemiology of infectious diseases. In São income countries where most rapid urbanisation is Paulo, Brazil, a third of all urban growth can be attributed taking place with important consequences because of to migration from other cities. First, cities might provide favourable conditions for the A web of interconnected determinants spread of germs that are imported by migrants. Specificities of urban populations Schistosomiasis has established itself in urban areas The close proximity of people is a prominent urban most probably through infected migrants. The world’s densest cities are in Asia, and with intermediate host of Schistosoma spp is present in urban almost 30 000 inhabitants per km², Mumbai, India leads water bodies, and endemic foci occur in large cities such the way. Population density affects diseases, particularly as in Bamako, Mali, Dar el Salam, Tanzania, and Kampala, those transmitted via respiratory and faecal–oral routes. In Kinshasa, Democratic Republic of influenza, measles, and Mycobacterium tuberculosis. Congo, the massive inflow of internally displaced persons Urban centres usually have higher rates of tuberculosis from provinces where African trypanosomiasis is infection than do rural areas. Many newcomers do not have the specific populated cities also provide favourable grounds for the immunity for these diseases and are more susceptible to spread of emerging diseases, as shown by the severe infections and more likely to develop severe forms than acute respiratory syndrome or the recent H1N1 influenza are residents. Careful urban planning is crucial to restrict spread of latent forms of the disease. In Kabul, household overcrowding, and the provision of parks and Afghanistan, where cutaneous leishmaniasis is endemic, open spaces relieves congestion. However, migration of movements have substantially increased the risk of transmission among newcomers, and the spread of this disease has reached epidemic proportions. In Nigeria for example, only 3% of residents from Ibadan have access to piped water, and in Greater Lagos, only 9% of its 10 million residents have access. The overall Dwellers of slums live in dire, overcrowded environments, with no access to water or sanitation. In the slum of Kibera, Kenya the number of inhabitants is prevalence of diarrhoea can be very high in cities as almost 1 million. Several surveys23–27 large-scale efforts to upgrade shantytowns and other show a high prevalence of intestinal parasites among impoverished areas. A government programme in Mexico children—for example, 52·8% in Karachi, Pakistan. If continued political and status, place of residence, race, ethnicity, gender, and financial commitment is made, these interventions education. Cities provide opportunities for many rural were established to address long-term sustainability of migrants who are attracted by greater job prospects and urban water cycles. Improved population between 1995 and 2003 has resulted in water socioeconomic status results in improved health and scarcity and serious environmental degradation. This El Salvador, Brazil, the risk of acquiring severe pollution might increase the prevalence of diarrhoeal and leptospirosis is four times higher for residents of favelas intestinal parasitic infections. Knowledge and skills attained through leishmaniasis is six times higher for people living in education make people more receptive to health houses with no regular rubbish collection than for people education. In many low-income countries, contraceptive use, and antenatal care were poorer in however, poor residents of slums generally build their slums than in other urban districts.

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The ages found here replicate exactly those found in the Conditions of Women’s source order viagra capsules with a mastercard, the Viaticum cheap viagra capsules 100 mg fast delivery, and can be traced back through the Arabic writers to late antique Byzantine texts buy 100 mg viagra capsules with visa. These, in turn, derive from ancient Greek sources, which probably reflect ancient numerological beliefs rather than empirical observation. See Helen King, ‘‘Medical Texts as a Source for Women’s History,’’ in The Greek World, ed. Nevertheless, the numbers varied slightly in dif- ferent versions of Conditions of Women and the ensemble (see note to ¶ in the edition) and in a few of the vernacular translations. A fifteenth-century Dutch translation, for example, says, ‘‘And it comes to some at their th year and to some at their th year; and if it comes sooner, that is very early, and if it comes after, then it is very late, and if it does not come, that is a too great defect of nature. And some women lose it at their th yearand that is by nature, but the bad humordepletes her. And otherwise she loses it at her th year, that is by nature, and some at their th year or th. And some have it until they are  years old or ’’ (Anna Delva, Vrouwengeneeskunde in Vlaan- deren tijdens de late middeleeuwen [Brugge: Vlaamse Historische Studies, ], p. See the concordance in table  of Green, ‘‘Development,’’ for a breakdown of sources. The Viaticumhad drawn an analogy between the menses and the resin that often exudes from trees: Viaticum :  (as printed in Opera omnia Ysaac, Lyons, , pars , fol. The author of the Conditions of Women replaced all the references to flos with menses, but the flower analogy remained intact in ¶. Other terms used in vernacular translations of the Trotula are the Dutch stonden (periods), German dy suberunge (i. Paul Kaiser (Leipzig: Teubner, ; reprint Basel: Basler Hildegard-Gesellschaft, ), p. Hildegard extends this metaphor even further to discuss the various stages of sexual maturity in adolescent women. The concept of greenness (viriditas) is found throughout Hildegard’s writ- ings; see, for example, Constant Mews, ‘‘Religious Thinker: ‘A Frail Human Being’ on Fiery Life,’’ in Voice of the Living Light: Hildegard of Bingen and Her World, ed. As cited in Alma Gottlieb, ‘‘Menstrual Cosmology Among the Beng of Ivory Coast,’’inBloodMagic:TheAnthropologyof Menstruation,ed. ThomasBuckleyandAlma Gottlieb (Berkeley: University of California Press, ), pp. See also the popular account of Janice Delaney, Mary Jane Lupton and Emily Toth, The Curse: A Cultural History of Menstruation, rev. Note that the ‘‘biblical’’ uses of the term ‘‘flowers’’ that they cite derive from the King James (i. Wood, ‘‘The Doctor’s Dilemma: Sin, Salvation, and the Menstrual Cycle in Medieval Thought,’’ Speculum  (): –; Helen Lemay, trans. Green, ‘‘ ‘Traittié tout de mençonges’: The Secrésdesdames,‘Trotula,’andAttitudesTowardsWomen’sMedicineinFourteenth-and Early Fifteenth-Century France,’’ in Christine de Pizan and the Categories of Difference, ed. One of the few instances where the Plinian tradition encroached upon the Tro- tula’s more positive view of menstruation is a Middle English translation entitled The boke called Trotela. Green, ‘‘A Handlist of Latin and Vernacular Manu- scripts of the So-Called Trotula Texts. Part : The Vernacular Translations and Latin Re-Writings,’’ Scriptorium  (): –, at pp. For an incisive critique of modern assumptions about the Hippocratic ‘‘dis- covery’’ of the disease ‘‘hysteria’’ (advocated particularly by Ilza Veith in Hysteria: The History of a Disease [Chicago: University of Chicago Press, ]), see Helen King, ‘‘Once Upon a Text: Hysteria from Hippocrates,’’ in Hysteria Beyond Freud, ed. AsKingshows,thenoun‘‘hysteria’’wasneverusedbyancient medical writers, nor did any of them conceive of the disease entity of ‘‘uterine suffoca- tion’’ as having anything but a physical, organic cause. Ancient (and for the most part, medieval) concepts of uterine suffocation cannot be subsumed under modern psychi- atric understandings of ‘‘hysteria’’ (a term which, significantly, has now been removed from the psychiatric etiological canon) without violence to the historical notions them- selves. Ann Ellis Hanson, ‘‘Hippocrates: Diseases of Women ,’’ Signs  (): –, at p. Heinrich von Staden, Herophilus: The Art of Medicine in Early Alexandria (Cam- bridge: Cambridge University Press, ). He allowed use of fragrant substances applied to the nose for uterine prolapse on the belief that they had a relaxing effect; King, Hippocrates’ Woman,p. Aside from two encounters with already decomposed corpses (from which he was able to discern skeletal anatomy only), Galen never dissected humans. Latin text edited byWerner Bernfeld, ‘‘Eine Beschwörung der Gebärmutter aus dem frühen Mittelalter,’’ Kyklos  (): –. For ex- amples from German, see Britta-Juliane Kruse, Verborgene Heilkünste: Geschichte der Frauenmedizin im Spätmittelalter, Quellen und Forschungen zur Literatur- und Kul- turgeschichte,  (Berlin: Walter de Gruyter, ), pp. The existence of earlier, similar charms or exorcisms without the Christian elements confirms that these, too, have their source in pagan antiquity. Theseviews were rendered into Latin by Constantine the African with no significant variation; see Green, ‘‘Transmis- sion,’’ p. Jahrhundert, Abhandlungen zur Geschichte der Medizin und der Naturwissenschaften, Heft  (Berlin: Emil Ebering, ), p. On Johannes Platearius and his Practica brevis, see Tony Hunt, Anglo-Norman Medicine,  vols. Anothomia Mundini (Pavia, ), as reproduced in Ernest Wickersheimer, Anatomies de Mondino dei Luzzi et de Guido de Vigevano (Paris: E. Sed hoc contingit siue accidit quia ipsa non potens expellerit uapores per partes inferio- Notes to Pages –  res propter aliquam causam mouetur et constringitur in parte inferiori ut expellat ad superiora. Men needed it, too, though the pathological consequences of abstinence were less dire for them. One text, the De passionibus mulierum B, omitted all discussion of general physi- ology and anatomy. The second adaptation, Non omnes quidem, deliberately omitted reference to virginity when it compressed Muscio’s original discussion of sexuality. The salubriousness of virginity was also actively suppressed in two later renderings of the Gynecology, one a late-twelfth-century Hebrew translation and the other a late- thirteenth-century Latin abbreviation called De naturis mulierum. Erler,‘‘EnglishVowedWomenatthe End of the Middle Ages,’’ Mediaeval Studies  (): –. These remedies consist of medicated pessaries intended to cause the corrupted seed to issue forth. Charles Talbot was the first to rec- ognize these figures as referring to the disease of uterine suffocation; see C. Talbot, Medicine in Medieval England (NewYork: Science History Publications, London: Old- bourne, ), pp. My interpretation of these scenes differs from that proposed by Laurinda Dixon, Peril- ous Chastity: Women and Illness in Pre-Enlightenment Art and Medicine (Ithaca, N. Platearius, Practica: ‘‘nisi ex flosculo lane naribus apposito vel ex ampulla vitrea super pectus posita ut dicit Galenus. Luis García-Ballester, Roger French, Jon Arriz- abalaga, and Andrew Cunningham, pp. It empowers individuals with the knowledge and life skills to make effective behavior changes that address the underlying causes of disease.

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Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www buy cheap viagra capsules 100 mg on line. See Liver cancer referral for medical management order viagra capsules 100mg overnight delivery, 148 and liver cirrhosis screening buy generic viagra capsules 100mg online, testing, and counseling, 14, High-risk populations. See At-risk 62, 83, 85, 86, 94, 148, 156-157, populations Hispanics, 2, 10, 27, 30, 93, 116, 121, 159, 158, 162, 163, 179 stigmatization and discrimination, 24, 168-169, 184-185 85 Copyright © National Academy of Sciences. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. See also Foreign-born Insurance coverage populations gaps and barriers, 11, 134-135, 170 Immunization. See also Educational surveillance, 62 programs vaccination, 121-124, 157, 185 age and, 93 viral health services, 6, 16, 149, 184-186 asymptomatic infected individuals, 1, 3, Incidence of hepatitis. See Prevalence and 24, 26, 27, 50, 51, 90 incidence of hepatitis at-risk populations, 3, 4, 8, 9, 13, 34, Infants. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. See Viral hepatitis services applications of data from, 41, 42, 43-46 Sexual exposure to hepatitis, 1, 23, 44, 72, at-risk populations, 2, 4, 6, 7, 32, 61-62, 84, 113, 119-120 67, 68, 71-72 Copyright © National Academy of Sciences. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. Request reprint permission for this book Copyright © National Academy of Sciences. The members of the Committee responsible for the report were chosen for their special competences and with regard for appropriate balance. N01-0D-4-2139 between the National Academy of Sciences and the National Institutes of Health. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for the project. Toward Precision Medicine: Building a Knowledge Network for Biomedical Research and a New Taxonomy of Disease The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards of objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We thank the following individuals for their review of this report: x Leslie Biesecker, National Institutes of Health x Martin J. Blaser, New York University Langone Medical Center x Wylie Burke, University of Washington x Christopher G. Chute, University of Minnesota and Mayo Clinic x Sean Eddy, Howard Hughes Medical Institute Janelia Farm Research x Elaine Jaffe, National Cancer Institute x Brian J. Schwartz, University of Washington Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations, nor did they see the final draft of the report before its release. The review of the report was overseen by Dennis Ausiello, Harvard Medical School, Massachusetts General Hospital and Partners Healthcare and Queta Bond, Burroughs Welcome Fund. Appointed by the National Research Council, they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of the report rests entirely with the authoring committee and the institution. We are grateful to those who attended and participated in the workshop “Toward a New st nd Taxonomy of Disease,” held March 1 and 2 , 2011 (Appendix D) and those who discussed data sharing with the Committee during the course of this study. Kelly, Head of Informatics and Strategic Alignment, Aetna x Debra Lappin, President, Council for American Medical Innovation x Jason Lieb, Professor, Department of Biology, University of North Carolina at Chapel Hill x Klaus Lindpaintner, Vice President of R&D, Strategic Diagnostics Inc. Toward Precision Medicine: Building a Knowledge Network for Biomedical Research and a New Taxonomy of Disease Summary The Committee’s charge was to explore the feasibility and need for “a New Taxonomy of human disease based on molecular biology” and to develop a potential framework for creating one. Clearly, the motivation for this study is the explosion of molecular data on humans, particularly those associated with individual patients, and the sense that there are large, as-yet- untapped opportunities to use these data to improve health outcomes. The Committee agreed with this perspective and, indeed, came to see the challenge of developing a New Taxonomy of Disease as just one element, albeit an important one, in a truly historic set of health-related challenges and opportunities associated with the rise of data-intensive biology and rapidly expanding knowledge of the mechanisms of fundamental biological processes. Hence, many of the implications of the Committee’s findings and recommendations ramify far beyond the science of disease classification and have substantial implications for nearly all stakeholders in the vast enterprise of biomedical research and patient care. Given the scope of the Committee’s deliberations, it is appropriate to start this report by tracing the logical thread that unifies the Committee’s major findings and recommendations and connects them to its statement of task. The Committee’s charge highlights the importance of taxonomy in medicine and the potential opportunities to use molecular data to improve disease taxonomy and, thereby, health outcomes. Taxonomy is the practice and science of classification, typically considered in the context of biology (e. The Committee envisions these data repositories as essential infrastructure, necessary both for creating the New Taxonomy and, more broadly, for integrating basic biological knowledge with medical histories and health outcomes of individual patients. The Committee believes that building this infrastructure—the Information Commons and Knowledge Network—is a grand challenge that, if met, would both modernize the ways in which biomedical research is conducted and, over time, lead to dramatically improved patient care (see Figure S-1). Toward Precision Medicine: Building a Knowledge Network for Biomedical Research and a New Taxonomy of Disease ʹ Figure S-1: Creation of a New Taxonomy first requires an “Information Commons” in which data on large populations of patients become broadly available for research use and a “Knowledge Network” that adds value to these data by highlighting their interconnectedness and integrating them with evolving knowledge of fundamental biological processes. Toward Precision Medicine: Building a Knowledge Network for Biomedical Research and a New Taxonomy of Disease ͵ The Committee envisions this ambitious program, which would play out on a time scale of decades rather than years, as proceeding through a blend of top-down and bottom-up activity.