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These female worms occur only for this limited period of time are 8-13mm long and very thin having the and thus only the one retreatment is usually appearance of small white pieces of thread purchase cialis sublingual 20 mg online erectile dysfunction condom. In patients with abdominal an infected patient is 1 to 2 months prior to pain or other gastrointestinal symptoms cheap 20mg cialis sublingual otc erectile dysfunction korean red ginseng, a appearance of adult female worms capable fecal examination may be necessary to rule of producing infective eggs generic cialis sublingual 20mg with mastercard erectile dysfunction operations. Prevention and Control Treatment In the young child a cycle of infection and reinfection is frequent, because of the Pyrantel pamoate in a single dose [11 ready transmissibility of the pinworm. Compounding the problem is improved effcacy approaching 100 percent if the fact that the eggs can survive for several a second dose is given two weeks after the days under conditions of high humidity and 24-27 frst. There are moate is an inexpensive and effective over no predilections on the basis of sex, race, or the counter option while treatment with socioeconomic class. None of these drugs or caring for school age children should help kills the eggs or developing larvae, therefore, 3 Trimming of fnger- to reduce transmission. Enterobius vermicularis 207 Comparative effcacy of thienpydin, pyrantel pamoate, mebendazole and albendazole in treating ascariasis and enterobiasis. Working with Henry Shortt, and a host of other colleagues, the group discovered the hypnozoite, the stage responsible for relapses of infection with Plasmodium vivax. Garnham also produced a wealth of publications on non-primate and non-human primate malarias, in addition to those infecting humans. His book, Malaria Parasites and Other Haemosporidia, remains a classic in the feld of malariology. The preva- lence of trichuriasis is approximately 477 million worldwide, with the largest numbers of infections in Asia, Sub-Saharan Africa, 5 and the tropical regions of the Americas. Worm burdens due to trichuris are usually higher in children The adult female (Fig. Historical Information In 1740, Giovanni Morgagni accurately described the location of T. Roederers report was accompanied by scientifc render- ings that are still deemed highly accurate. Carl Linnaeus classifed this parasite, then called 10 teretes, as a nematode in 1771. Trichuris trichiura 211 Cellular and Molecular Pathogenesis In trichuris-endemic areas, pediatric pop- ulations, typically harbor the largest whip- worm burdens, with highest burdens in chil- dren between age 5-15 years. Some studies indicate that susceptibility to heavy trichuris infections may depend on an inability to mount a strong 16 T helper cell type 2 response. In order to invade the Adult Trichuris trichiura live in the transverse colonic mucosa, adult trichuris release a and descending colon (Fig 17. The ante- novel pore-forming and channel-forming rior, narrow, elongate esophagus is embedded 19 protein. In vitro, these secreted proteins within a syncytium of host cells created by induce ion-conducting pores in lipid bilayers. This syncytium probably results Pore formation in epithelial cell membranes from exposure of the host to worm secretions may facilitate invasion and enable the para- emanating from its stichosome. The posterior site to maintain its syncytial environment in abdomen protrudes into the lumen, allow- the cecal epithelium. Fertilized eggs are deposited in soil with feces, and must embryonate in the soil before becoming infectious. Under optimal conditions, embryonic development 15 takes place over an 18-22 day period. With heavy infec- patients can resemble characteristics of better- tions, the population of whipworms may known forms of infammatory bowel disease, extend from the proximal to the terminal end such as Crohns disease and ulcerative coli- of the ileum and cause ileitis. Children suffering from heavy trichuriasis from a combination of capillary damage and develop chronic malnutrition, short stature, 18 erosion leading to blood loss and anemia anemia, and fnger clubbing. Following 21 Generally, the specifc chemotherapy, many of these condi- of chronic infammation. Increasing evidence suggests that in addi- In contrast to situations where there is a tion to the physical symptoms of trichuriasis, low-grade infammation, immunomodula- chronic infection can also produce long-term tory effects of adult trichuris can predomi- defcits in child cognitive and intellectual 7 The mechanism by which this nate. In cases 22, 23 The precise mechanism of of light infection, the concentration of feces the patient. Trichuris trichiura 213 for pathogenic protozoa, such as Entamoeba nausea and dizziness have been reported. Adult trichuris worms can also observation has not been confrmed in other 28 be identifed by direct visualization on colo- studies. Failure to control diar- fndings, the World Health Organization rec- rhea after trichuris is eradicated mandates ommends use of these drugs in pregnancy a more thorough evaluation of other causes only after the frst trimester and when the of diarrhea. Stool cultures should be used to benefts of de-worming to the health of the determine the possible presence of enteric mother and unborn fetus outweigh the risks. Treatment concluded that the incidence of side effects are likely to be the same in this population A benzimidazole mebendazole or as in older children, and that both agents albendazole is the treatment of choice for could be used to treat children as young as 12 1 The primary mechanism of these months using reduced dosages. Although most global anthelminthic de-worming programs rely on Trichuris trichiura infection is common using a single dose of either drug, several in tropical areas, where prevalence as high as doses are usually required for cure of trichu- 80% has been documented. Warm, moist soils can sometimes be improved by adding either in tropical and subtropical regions favor the 31 ivermectin or oxantel. In Africa it is cur- maintenance of eggs, which can remain alive rently common to combine albendazole with for months under these optimum conditions. Eggs are Both albendazole and mebendazole have relatively resistant to chemical disinfectants, an excellent safety profle in children. In and can survive for protracted periods of time the doses used to treat soil-transmitted hel- in raw or treated sewage. Because school-aged Because school-aged children typically children contribute the most to trichuris and harbor the heaviest trichuris (and ascaris) ascaris transmission in the community, there infections, and specifc anthelmintic chemo- is also some optimism that widespread treat- therapy with either albendazole or meben- ment could theoretically interrupt transmis- dazole can result in catch-up growth and sion. High rates of post-treatment soil-trans- improved cognition for heavily-infected mitted helminth re-infection require that individuals, these agents have been used in children must be treated at least on an annual school-based programs throughout the devel- basis. While there are clear health and educa- 6, 34, 35 In 2001, the World Health oping world. Gottingische Anzeigen von gelebrten Sachen Unter der Aufsicht der Konigliche Gesellschaft der Wissenschaften Part 1761, 25, 243-245. Transactions of the Royal Society of Tropical Medicine and Hygiene 1983, 77 (4), 432-8. Ascaris lumbricoides (Linnaeus, 1758) Introduction Ascaris lumbricoides is one of the larg- est nematodes to infect humans. The adult lives in the small intestine where it can grow to a length of more than 30 cm. This worm infection is found almost wherever poverty occurs in developing countries. The most severe consequences of ascaris infection occur in children who are predisposed to suffer from heavier worm bur- dens than adults living under similar condi- tions. Ascaris eggs thrive in warm, moist soil, and are highly resistant to a variety of envi- ronmental conditions. The abil- It is controversial as to whether pigs can ity of ascaris eggs to survive in these harsh serve as an animal reservoir for A. It has been suggested that human infection arose in association with pig domestication, pos- 8 sibly in China. The available evidence sug- gests that ascaris in humans and pigs com- prise reproductively isolated populations, suggesting that zoonotic transmission is not 8 common.

Other symptoms or exposures not on the list will in special cases qualify for recognition after submission to the Occupational Diseases Committee buy generic cialis sublingual online impotence over 70. The following mental diseases may generic cialis sublingual 20mg without a prescription impotence in men over 60, after a concrete assessment buy discount cialis sublingual 20mg online drugs for erectile dysfunction list, be deemed to have been caused by external stresses and may be recognised after submission of the claim to the Committee: Stress response (including acute stress response, other stress disorders and unspecified forms of stress response (F43)) Depression (including depressive single episode F32). Most depressions are passing, and usually it is not possible to distinguish these from the more persistent types of depression, other than by following the course of the disorder. Enduring psychoses are not, however, deemed generally to have external stress factors as dominant causes Enduring personality change after catastrophic experience F62 (when the disease is not covered by the diagnosis of posttraumatic stress disorder) Whether these mental diseases will be deemed to have been caused by a work-related exposure will depend on a concrete assessment including symptom onset, the course of the disease and the nature and extent of mental exposures. Mental illness with the diagnosis of adjustment reaction will not normally qualify for recognition as an occupational disease. This diagnosis covers very moderate, unspecified and passing mental complaints which are not usually regarded as actual occupational diseases within the meaning of the Act and may besides develop after even very moderate exposures. Examples of decisions based on the list Posting (military stationing and relief work) Example 1: Recognition after stationing to the peace-keeping forces An officer who was stationed more than once, to regions at war, in the peace-keeping forces saw how a local soldier was executed by being shot through the mouth. He was furthermore exposed to a number of violent incidents, both direct war action and assaults on civilians. As part of the service in the peace-keeping forces, the officer had been exposed to a number of stressful situations. The medical examinations established a mental disease in the form of posttraumatic stress disorder, and there was good correlation between the work-related exposures of an exceptionally threatening and stressful nature and the disease. Example 2: Recognition after relief work A driver drove relief supplies to regions at war. He saw how whole towns were wiped out and he had to drive in regions with direct war action. The convoy was stopped every day by armed soldiers or civilians who threatened him with arms to get money etc. The driver developed posttraumatic stress syndrome after having been exposed to a number of violent incidents as a driver delivering relief supplies in regions with direct war action and threats in connection with robberies and similar incidents. There is furthermore good correlation between the work-related exposures and the disease. Example 3: Recognition after work for relief organisation in Kosovo A male employee in a Danish relief organisation worked for nearly 6 months as a warehouse manager in a major city in a region at war, where he was exposed to violence and murder threats. According to the medical specialists report the diagnosis was posttraumatic stress disorder. The warehouse manager was exposed to threats of violence and murder and had reason to take the threats seriously. Example 4: Recognition after being sent to war zones A driver had been sent to a war zone for 6 months. He worked as a driver and several times a week took part in transportation of military equipment from one camp to another. Typically there were several vehicles driving in line through unmarked mined areas. During transportation the vehicles occasionally came under fire by local militias, in particular when the transport occurred in the evening and during the night. The transports became very stressful for the driver, being in high alert because of the concrete dangers involved in the transports. The soldier was exposed to exceptionally threatening situations in connection with transports through mined areas and had furthermore been involved in war action, having been shot at. Example 5: Claim turned down sent out to military camp A soldier had been sent out to work as a cook in a military camp in a war zone. He was part of the permanent staff in the camp and had no errands outside the camp area. In the area, in particular during the night, there were a number of shooting incidents, but they were not directed at the camp. The soldier heard about shootings at other soldiers when they were out on patrol, but he was only in the camp. Even though he stayed in a military camp in a war zone, he did not experience dangerous situations, neither having had any errands outside the camp nor having been shot at in the camp or in any other way having been exposed to danger. Furthermore there is no possibility that the Occupational Diseases Committee will recommend recognition of the claim. This is because the solider has not experienced any exposures that solely or mainly caused his mental illness. The prison service and the police Example 6: Recognition after work as a prison officer A prison officer was for several years employed in a prison where the work became more and more stressful, i. It appeared from the medical specialists certificate that the diagnosis was posttraumatic stress disorder. The prison officer was for quite some time exposed to severe threats and other violent, mentally stressful incidents in his work as a prison officer, being in contact with psychologically very stressful prisoners. Furthermore he had developed symptoms consistent with posttraumatic stress disorder. Example 7: Recognition after work as a prison officer The injured person had for many years worked as a prison officer, i. Subsequently he was employed in a prison where he was exposed to violence, hand grenade attacks and shooting with automatic weapons. The injured person was exposed to threats of violence and actual violence as well as exceptionally severe mental stresses. He subsequently developed symptoms consistent with posttraumatic stress disorder, and there is good correlation between the mental disease and the exposures in the workplace. The police officer, as part of his work in the police force, was called out to a number of incidents involving violent deaths as well as a fatal shooting incident. Example 9: Claim turned down work as a prison officer A 50-year-old man had worked for 20 years as a prison officer. In this employment he was exposed to daily conflicts with the inmates, was threatened with broken glass and knives, and was kicked in the face in connection with an arrest. Well over 4 years after leaving the job he had symptoms of a mental disease with nightmares and emotional complaints. The medical specialist established symptoms of a moderate traumatic stress condition. The claim does not qualify for recognition on the basis of the list, and there are no grounds for submission of the claim to the Committee. The prison officer had psychologically very stressful experiences from his work, but only developed mental symptoms 4 years after cessation of work. Therefore there is no good time correlation between the exposure and the development of the disease. Healthcare work Example 10: Recognition after work as a home help A home help had for some years worked with a female patient who was paralysed on one side. The patients spouse behaved very aggressively and threateningly in the home helps presence, hit and kicked at objects and knocked a fist into the wall, right above the head of the home help. The medical specialists certificate stated the diagnosis of posttraumatic stress disorder. In her work, the home help experienced instances of a very threatening and aggressive behaviour on the part of a clients husband.

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For a considerable period of time the auto spray painter suffered substantial exposure to isocyanates in connection with spray painting of cars purchase cialis sublingual on line amex male erectile dysfunction icd 9. There is a good time and causal relationship between the exposures in the workplace purchase cialis sublingual 20 mg line erectile dysfunction caused by surgery, where he was in contact with isocyanates in connection with painting of cars order cialis sublingual 20mg on-line erectile dysfunction drugs dosage, and the asthma symptoms, which likewise receded after he began to use better respiratory protection. He was inside the pig stables for most of the work day and was in close contact with the animals in connection with mucking out, piglet births, etc. Furthermore there was a constant reek of pigs in the stable, and the exhaust equipment was inadequate. It appeared from the medical information that he had been suffering from asthma since childhood and that he had experienced continuous and periodic, very severe attacks of asthma, right up to the beginning of his work in the pig stable. There was no record of any change in the attack patterns, and he had just as frequent and just as severe attacks during weekends and holidays as in connection with work. He furthermore suffered relevant exposure to pigs while working in a pig stable for 6 months. However, before starting in this job he had asthma attacks for a significant number of years and previously tested allergic to many different sources, including pigs and dogs. He is in contact with pigs in his free time and also has a dog himself, even though he is allergic to such animals. Furthermore there is no evidence of any substantial aggravation in his condition in clear connection with his work. Overall it is likely beyond reasonable doubt that his asthma was primarily caused by his previous asthma and the continued private exposure, including in particular the daily contact with pigs and his dog. Item on the list Lung disease with restricted lung function of the obstructive type is included on the list of occupational diseases (Group E, item 9): Disease Exposure Lung disease with restricted lung function of Isocyanates the obstructive type 4. Exposure requirements In order for a lung disease with restricted lung function of the obstructive type to be covered by the item on the list, there must have been one or more relevant exposures for many years, as described in detail below. Exposure to isocyanates Isocyanates are a generic term for a group of chemical substances which are much used in industry today, for instance in the production of lacquers. It is used for instance in: The building and construction industry The plastics industry The iron and metal industry The wood industry The car industry The electrics and electronics industry Isocyanates belong to the group of components that make various materials harden. This is the case, for instance, with lacquered car parts which are repaired/welded in garages or electronic parts that are repaired. Time correlation In principle there need to have been 4-5 years of daily or almost daily exposure to isocyanates. In the event of particularly massive exposure the time requirement may be reduced after a concrete assessment. Working conditions In the assessment of whether the exposure in the workplace is sufficient for recognition of the disease, it is relevant to look at the conditions under which the work was performed. The exposure will be 244 greatest in small rooms without proper ventilation, whereas the exposure will be smallest when the work was performed out of doors. If the work was performed indoors, it is essential to look at whether there has been ventilation and whether respiratory protection equipment has been used. If the protection measures have been efficient, it requires a longer-lasting exposure in order to recognise an occupational disease than if exhaustion and other protection measures were deficient. Examples of pre-existing and competitive diseases/factors Examples of possible competitive factors that may affect the development or course of the disease: Tobacco smoking Alpha-1 antitrypsin deficiency, which is a hereditary gene disorder Smoking is a substantial cause of lung disease with restricted lung function of the obstructive type. Therefore, in some cases, smoking may lead to a reduction in the compensation amount. Managing claims without applying the list Only lung disease with restricted lung function of the obstructive type is covered by Group E, item 9 of the list. There must furthermore have been exposures meeting the recognition requirements, as stated on the list. A lung disease with restricted lung function of the obstructive type which is not covered by the list of occupational diseases may in special cases be recognised after submission of the claim to the Occupational Diseases Committee. Examples of decisions based on the list Example 1: Recognition of lung disease with restricted lung function of the obstructive type (E. He had never smoked, but towards the end of the 6-year- period he developed coughing and sputum and had shortness of breath in connection with physical exertion. For 6 years the auto mechanic was significantly exposed to isocyanates, which are released in connection with welding and grinding when the car lacquer is warmed up. There is good time correlation and causality between the exposure in the workplace and the disease. Item on the list The disease pneumonia is included on the list of occupational diseases (Group E, item 10): Disease Exposure Pneumonia Vanadium and vanadium compounds 5. Diagnosis requirements Main conditions A medical doctor needs to have diagnosed pneumonia (pneumonia/pleuropneumonia non specificata J. In order to make a diagnosis of lung disease with restricted function, the following requirements must be met: Relevant subjective complaints (symptoms) and Clinical, objective changes Symptoms Eye and nose irritation as well as coughing followed by the development of pneumonia with a fever in the course of a few days. Objective signs A fever higher than 38C and pneumonia diagnosed by way of stethoscopy of the lungs, or degeneration typical for pneumonia established by way of x-rays of the lungs. Exposure requirements In order for pneumonia to be covered by the item on the list, there must have been a relevant exposure, as described in detail below. Exposure to vanadium and vanadium compounds Vanadium is an element which is primarily used for the manufacture of hard steel. It is also found in connection with exposure to large quantities of tarry soot in chimney sweeps. It is only when using vanadium for the production and manufacture of steel and glass that exposure takes place. Time correlation A prerequisite for recognition is that the symptoms of the disease have developed in close time correlation with work-related exposure to vanadium. There is no requirement, however, that the exposure should be of a certain duration or intensity. This is because pneumonia in some cases develops after a short while and even after limited exposure. The exposure will be greatest in small rooms without proper ventilation, whereas the exposure will be smallest when the work was performed out of doors. Managing claims without applying the list Only pneumonia is covered by Group E, item 10 of the list. Pneumonia not covered by the list of occupational diseases may in special cases be recognised after submission of the claim to the Occupational Diseases Committee. In 2009 the factory received a large order for armour plates, which meant that for a long period of time he only worked with steel with added vanadium. Subsequently he developed irritation of eyes and nose, and a few days later he was diagnosed with pneumonia. The injured person was exposed to vanadium, which is released in connection with the production of steel/armour plates. There is good time correlation between the exposure in the workplace and the disease. Item on the list The following mental disease is included on the list of occupational diseases (Group F, item 1): Disease Exposure F. Posttraumatic stress Traumatic events or situations of short or longer duration that are of an disorder (where symptom exceptionally ominous or catastrophic nature onset of the disease is within six months and the disease is fully present within a few years) 1. A: Exposure to stressful events or situations (either short- or long-lasting) of an exceptionally threatening or catastrophic nature B: 1.

Variation in estimates may be due to against violence purchase 20 mg cialis sublingual overnight delivery erectile dysfunction doctors northern virginia, render women particularly vulnerable purchase 20mg cialis sublingual with visa erectile dysfunction solutions. Prevention of abuse largely focuses on identifica- Intimate partner violence is a repetitive phenome- tion and support for victims purchase cialis sublingual canada erectile dysfunction 31 years old, legal reform, and treatment non. Clinical screening of abuse had been victimized at least twice in the previous in Emergency Departments and clinics has helped iden- 6 months. Violence is also considered to be cyclical and tify victims and has increased referral to support 229 Douching systems. Many women try to Suggested Reading hide their abuse, in some cases because the abusive partner is with them during treatment. Health concerns across a womans lifespan: The Commonwealth Fund 1998 Survey of Womens story, especially when accompanied by old injuries, is Health. Victims may also present to clin- The National Center for Injury Prevention and Control. Physical violence in health care providers, although these laws are contro- American families: Risk factors and adaptations to violence in versial. Violence by intimates: Analysis of data on crimes by current or former spouses, centers offer such services as protected and anonymous boyfriends, and girlfriends. In victimless prosecution, the state can prose- cute the perpetrator in the absence of a formal victim complaint so that the victim does not need to be the Douching Douching is the irrigation or flushing of primary accuser. This approach was enacted because the vagina with plain water, vinegar and water, or other many women recanted their reports of abuse to police name brand prepared or medicated products. The fluid because of fear of retaliation or fear of losing financial is allowed to run into the vagina from a bag connected support for themselves and their children. Most police to tubing or is flushed into the vagina from a premixed jurisdictions have implemented training to better pre- squeeze bottle. Many women feel this is necessary for pare police officers to recognize and respond to domes- good hygiene, to feel fresh, or to treat a problem tic disputes. Women who douche increase their chances for their use have shown various levels of effectiveness. Group counseling is the most common protection against other, less healthy bacteria. When men voluntarily seek help and actively par- tion but is not sexually transmitted. Many women do ticipate in such programs they are thought to be not realize they have this infection. However, many men who attend these pro- pregnant do not require treatment if they are asymptom- grams do so based on a court order or by referral and atic. For these reasons, it is not recommended is not as altruistic as the definition above seems to as a healthy practice. In India, the groom and the grooms family, either directly or indi- Suggested Reading rectly, sets the amount of the dowry. Risk of preterm birth that is associated with vaginal and/or reception expenses, honeymoon expenses, travel douching. American Journal of Obstetrics and Gynecology, expenses, fees for education (virtually always for the 186(6), 13451350. However, if either the groom or his family is dissatisfied with the dowry or the brides family Suggested Resources is destitute, the dowry may be considered insufficient Warner, J. Douching linked to vaginal infections: Largest study with sometimes devastating results. In the past few and physical abuse, and will have to bear the insults decades there has been much research on the institu- slung at her parents. The dowry apparently originated in cient dowry due to financial problems, the impact the giving of a marriage gift by the family of the bride- becomes a national problem. Dowry is closely linked to groom to the bride and the bestowal of money upon the many crimes against women in India; to list a few: bride by her parents. It was most familiar in child, denial of educational and career opportunities to propertied cultures such as Ancient Greece and Rome, daughters. However, in civil-law countries the dowry is still Crime Bureau of the Government of India are evidence recognized as an important form of property. In Bangladesh, the Grameen Bank is a group fund and major small-scale credit program that provides produc- tion credit and other services to the poor. Founded in 1976 by Muhammed Yunus, the maker who has delegated away that authority. The Grameen Bank provides financing for nonagricultural principal can delegate as much (for instance, a general self-employment activities to 2 million borrowers, 94% of or complete delegation) or as little (such as a delega- whom are women. In order to participate in the micro- tion specifically delineating what types of choices the loan program, an eligible woman must memorize, chant, agent may and may not make) power as desired. Although the dowry seems like an cipal who created it dies or becomes mentally incom- offering, more and more it is a sale of a loved one into petent. Slavery is always an unwelcome and deceased or incompetent person no longer has the uninvited wedding guest. New York: In an effort to get around this practical problem, Columbia University Press. Merriam-Websters collegiate dictionary (Electronic ing citizens to create (or execute) a durable power of ed. The Journal of Political Economy, principals later incapacity as long as that continuing 106(5), 958996. Dysmenorrhea is more common in younger instruction directives; other states have separate women, declining after 30 years of age. The ondary to) reduction in blood flow (ischemia), which agent may, but need not be, a family member of the accompanies the uterine contractions in menstruation. The treatment of primary dysmenorrhea includes Proxy directives provide the advantage, for both prostaglandin inhibitors to reduce uterine contractions patients and their health care providers, of legally and intrauterine pressure. Other effective treatments include oral rent information and other considerations, most impor- contraceptives that inhibit ovulation and suppress tantly the agents interpretation of the patients prostaglandin production in the lining of the uterus previously expressed and implied wishes. A specialized procedure to cut specific irrelevant, however, for people who do not have avail- nerves causing the pain (laparoscopic uterosacral nerve able to name as a potential agent someone else whom ligation) has been used in patients who have not been they can trust to make future medical decisions for helped by standard medical therapy. Living wills Secondary dysmenorrhea is painful menstrual cramping due to pelvic pathology. This may occur at any age after menarche and before menopause and is usually seen in women over 20 years of age. A com- Suggested Reading plete history and physical examination along with diag- Bishop, S. Crossing the decisional abyss: An evaluation of sur- nostic tests such as laparoscopy, hysteroscopy, rogate decision-making statutes as a means of bridging the gap ultrasound, and hysterosalpingography (specialized between post-Quinlan red tape and the realization of an incom- imaging test to examine the uterus and tubes going out petent patients right to refuse life-sustaining medical treatment. The legal and functional status of the medical include cervical stenosis (cervical closure/narrowing), proxy: Suggestions for statutory reform.

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