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Within Christianity some worship the Virgin Mary pain treatment toothache purchase 250 mg aleve, who is celebrated both as the mother of the church (Mater Ecclesia) and the mother of God (Madonna) pain medication for dogs at petsmart purchase 500 mg aleve mastercard. She fills a deep-seated need human need for a Mother Goddess in a culture where the established religions are dominated by male Gods pain treatment with heat discount aleve 250mg overnight delivery. In Mexico pain treatment for lumbar arthritis cheap 500 mg aleve with visa, for example, she is Our Lady of Guadeloupe; in Poland, the Virgin of Czestochowa. Apparitions of her have been seen at her Shrine in a grotto at Massabielle near Lourdes; at Santa Anatasia, near Naples, she is worshiped by the Cult of the Madonna of the Arch. From a more secular standpoint, instead of Venus figurines and bas-relief carvings of the Great Goddess that adorned rooms in Neolithic times, a calendar photograph of a reclining, naked Marilyn Monroe may be displayed. Since she died in 1962 more than forty biographies have been written already about this "ultimate sex goddess," including one by feminist Gloria Steinem. I do not think it is too farfetched to say that Marilyn Monroe has taken on, to some degree, at least, the role of a modern-day Venus of Laussel. One of her biographers characterized her as, "pouting, suggestive, submissive, subversive, erotic, available, forbidden, sometimes naked, sometimes overdressed, and always blond. Those who knew her well described Searching for God 107 Marilyn as an alert, intelligent, warm, compassionate person. In Goddess fashion she wrote this poem: I stood beneath your limbs and you flowered and finally clung to me and when the wind struck with. According to the Womanspirit Sourcebook, women in western Connecticut, for example, have been gathering in a secluded meadow every month on the full moon since 1980 to perform the Sweat Lodge ceremony, a Native American religious ceremony where the participant affirms the guiding power of the Earth Mother. In Pittsburgh, a group of women have formed an organization named Motherhearth, whose stated purpose is to revive Goddess mysteries, rituals, and healing. In Madison, Wisconsin, the Re-formed Congregation of the Goddess has been established "to provide the benefits and recognition of organized religion to its members. It impels us to worship a Supreme Being, one that has both paternal and maternal attributes. Nevertheless, even though humankind possess the idea of God, it does not necessarily mean that there really is a God or Goddess that watches over us and who can grant us everlasting life. Motivated by a desire to help people, I thought that going into the ministry would be a fulfilling thing to do. The Chaplain at the Newport Naval Hospital at the time that I assisted was inspiring and served as a good role model. I stood there for ten hours looking over the ether screen watching the procedure, and despite sore feet and a full bladder I was hooked. The importance of religion in the lives of many of my patients and their families, however, has continued to interest me. But the question remains, what evidence can we point to which indicates that God really does exist? Having seen how our species has developed a sense of the sacred and the concept of a female and then male deity from a cultural historical perspective, we now come to a crossroads in a search for God. We can travel in a number of different directions to try and determine if God really does exist. Woody Allen, in his unique and insightful way, provides us with some helpful signposts along several of these routes. I refer especially to his films Love and Death and Hannah and her Sisters; his one act play God; and "Mr. Big," a short story that appeared in Getting Even, his first published collection of short stories and comedic essays. In this story, a woman who claims to be a philosophy student hires a detective named Kaiser Lupowitz to find God. Searching for God 109 the detective then looks up a street-smart "forger, bank robber, strong-arm man, and avowed atheist" named Chicago Phil, who says: the guy never existed, Kaiser. The detective next wants to question the Pope, and a meeting is arranged with His Holiness at an Italian restaurant in New Jersey. But he learns that his Bryn Mawr client has a jazz musician boyfriend who does study philosophy.

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Consultation with a specialist is recommended for patients who do not attain their blood pressure goals after optimal dosages and a trial of additional drugs treatment for acute shingles pain discount aleve 500mg. People with diabetes are considered a cardiac risk equivalent and placed in the same category as if they have already had a heart attack pain tailbone treatment cheap aleve 250mg with amex. Add to back pain treatment kolkata purchase aleve 250 mg line that anyone with a family history of cardiac disease fibromyalgia treatment guidelines american pain society safe aleve 500mg, and they are at "high risk. What percentage of patients with diabetes achieve the combined goals of A1C <7%, blood pressure <130/80 mm Hg, and total cholesterol <200 mg/dL? Despite the proven benefits of aggressive comprehensive risk-factor management on diabetes outcomes, <10% of patients with diabetes achieve the combined goals of A1C <7%, blood pressure <130/80 mm Hg, and total cholesterol <200 mg/dL. Among the primary causes of end stage renal disease, diabetes accounts for the largest proportion of new cases at 36%. During this stage, tiny blood vessel deterioration due to atherosclerosis destroys some of the many nephrons within the kidney. Remaining nephrons increase in size and work capacity as they attempt to compensate. During Stage 2, thickened and inflamed capillaries reduce blood flow to the glomerulus. This results in glomerular basement membrane thickening, mesangial expansion (expansion of phagocytic cells of the mesangium), and diffuse intercapillary glomerulosclerosis (a degenerative process resulting in scarring of the renal glomeruli). During Stage 3, also referred to as incipient diabetic nephropathy, microscopic amounts of albumin (microalbuminuria) inadvertently slip through sclerosed glomerular membranes, signifying a progressive deterioration in kidney filtration. Metabolic waste begins to accumulate in the blood because unaffected nephrons can no longer compensate, and responsiveness to diuretic therapy decreases. Stage 4, also referred to as overt or clinical diabetic nephropathy, is characterized by detection of significantly large amounts of protein in the urine (albuminuria or proteinuria). Significant amounts of metabolic waste begin to accumulate, particularly urea and creatinine. Patients generally do not become symptomatic until stage 4 when oliguria, edema, and hypertension can develop. Without, and sometimes in spite of, aggressive treatment, deteriorating vasculature or end stage renal disease results in Stage 5. Screening for diabetic nephropathy should include evaluation of blood pressure at every office visit with a blood pressure goal of <130/80 mm Hg. Nephropathy screening also includes evaluating for microalbuminuria (usually with a spot urine albumin-to-serum creatinine ratio) annually beginning at diagnosis for people with type 2 diabetes and annually beginning at 5 years of diagnosis for people with type 1 diabetes, and during pregnancy for women. Glycemic and blood pressure control, as recommended by national guidelines, form the basis for the prevention and treatment of diabetic nephropathy. Antihypertensives recommended for patients with diabetic nephropathy include angiotensin-converting enzyme inhibitors and/or angiotensin receptor blockers. This level of protein intake essentially reflects the national recommendation of daily protein intake, which may in practice be a restricted amount. For patients who progress to end stage renal disease, treatment may include hemodialysis, peritoneal dialysis, or kidney transplant. Wastes, excess water, and salt are removed from the bloodstream using a dialysis machine. Hemodialysis is generally performed 3 times a week and can be done at a medical facility or at home. In peritoneal dialysis, waste products and extra fluid pass from the blood into the dialysis solution via the peritoneum, which lines the wall of the abdominal cavity. Other forms of peritoneal dialysis require a machine called a cycler to fill and drain the abdomen. Kidney transplantation can be performed with a kidney from a nonliving or living donor. Factors that must be taken into consideration to determine a kidney/recipient match include blood type, human leukocyte antigens, and cross-matching antigens. There has been dramatic progress over the past decade in the ease of matching donors and the success of kidney transplants. Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Here is another question to check our progress. At what stage of diabetic nephropathy do symptoms generally become clinically apparent?

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D C# D C" D C" D D 663 < " C" D // / < // / < "" // /" /# < // / < // / < # # // / < // 8 < // / 8 < // / #/ < // /" / < " // /" / < // " < // /! D 6 8 G // /" G // /" / G // /" / G // G // / # # G " // / # 8 G " // 8 / # 8 G " // / 8 G // / G // / G " // / G> // G> // G> // /" # G> // C D G> C D // / G> // G> // G> // /# G // / "/ N // 8 G // # # G " // # /! D // " / " C D // /#/ // # // / # // " 8 // " / " /// // # // / C" D E/ /# /# #8 #8 C 3 D C F D 6 G@ G@ # G C G G G G G G G G G G G G G G! D 63< 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 // // " // // // # " // /# // // # // # // # " C D // /// 8 /! C D // 3 // 8 3 C D // 3 // 3 / C D // / 3 // / 8 3 C D // / " / 3 // / 3 // / 3 C D // #/ 8 3 // 3 // " # 3 // 8 / C$ D 8 / 3 //! C# D // // /# / # " // # // / 8 / # // " /// / C D // // 8 / # // # / " // C D // 8 // # / # // /" /! B C D // # B // # / 8 B // B C @ D // # # B // 8 C/D C D B " // / B " // / P/ @ // P // 8 / P // P // / P " // 8 / P // P // P // 8 P // / P // / P // " / P " // / P " //! F Y// Z// Q//]// b // c // // a// [// `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he systems consist of an instrument shingles pain treatment natural aleve 250 mg line, personal computer phoenix pain treatment center order aleve 500mg otc, and preloaded software for running tests on collected samples and viewing the results southern california pain treatment center cheap aleve 500 mg otc. Because the cartridges are selfcontained dental pain treatment guidelines generic 500mg aleve with mastercard, cross-contamination between cartridges during the testing process is minimized. For a full description of the systems, refer to the appropriate GeneXpert Instrument System Operator Manual. The assay may be used to test the following specimens from asymptomatic and symptomatic individuals: female and male urine, patient-collected vaginal swabs (collected in a clinical setting), clinician-collected endocervical swabs, and female and male pharyngeal and rectal swabs. No ruminant protein or other animal protein was fed to the animals; the animals passed ante- and post- Fo +2 rI 7 +28 nf mortem testing. During processing, there was no mixing of the material with other animal materials. Summary and detailed test results are obtained in approximately 90 minutes and are displayed in tabular and graphic formats. Biological specimens, transfer devices, and used cartridges should be considered capable of transmitting infectious agents requiring standard precautions. These materials may exhibit characteristics of chemical hazardous waste requiring specific national or regional disposal procedures. K August 2019 rI nf · · · · · or For collection of endocervical swab specimens, patient-collected vaginal swab specimens, pharyngeal swab specimens and rectal swab specimens, use the Xpert Swab Specimen Collection Kit. Under or over dispensing of urine into Urine Transport Reagent tubes may affect assay performance. Endocervical and patient-collected vaginal swab specimens must be collected and tested before the expiration date of the Swab Transport Reagent tube. Urine specimens must be tested before the expiration date of the Urine Transport Reagent tube. For rectal swab collection, highly soiled fecal swabs should not be used as they may result in errors. Maintain proper storage conditions during specimen transport to ensure the integrity of the specimen. Specimen stability under shipping conditions other than those recommended has not been evaluated. Treat all biological specimens, including used cartridges, as if capable of transmitting infectious agents. Because it is often impossible to know which might be infectious, all biological specimens should be treated with standard precautions.

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These questions are components of a complete sexual history which would include relationship types pain management for dogs with osteosarcoma discount 250mg aleve fast delivery, frequency of sexual activity prescription pain medication for uti cheap aleve 250 mg with visa, age of sexual debut nerve pain treatment back discount aleve 250mg visa, use of drugs or alcohol during sex knee pain treatment home remedy purchase 250 mg aleve fast delivery, sex work history, history of sexual abuse, and sexual function. Self-collected vaginal and rectal swabs as well as urine specimens have equivalent sensitivity and specificity to provider-collected samples for nucleic acid amplification testing for gonorrhea, chlamydia, and trichomonas. Some surgical approaches include the use of urethral tissue, which could result in mucosal infectious such as chlamydia or gonorrhea. The risk of infection of intact, inverted penile skin with these organisms is unknown, though lesions such as a syphilitic chancre, herpes or chancroid are possible. When clinically indicated due to symptoms, a physical examination and appropriate testing should be performed. The anatomy of a neovagina created in a transgender woman differs from a natal vagina in that it is a blind cuff, lacks a cervix or surrounding fornices, and may have a more posterior orientation. As such using an anoscope may be a more anatomically appropriate approach for a visual examination. There is no evidence to guide a decision to perform routine pelvic exams on transgender women in order to screen for such conditions as [formerly penile skin] warts or lesions. Transgender women who have undergone vaginoplasty retain prostate tissue, therefore infectious prostatitis should be included in the differential diagnoses for sexually active trans women with suggestive symptoms. There is no evidence to guide routine screening for Chlamydia in asymptomatic transgender women who have undergone vaginoplasty, though it is reasonable to consider urinary screening in women with risk factors. The role of vaginal gonorrhea and Chlamydia specimens, as opposed to urine testing only, is unknown in women June 17, 2016 91 Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People who have undergone penile inversion. Providers may consider vaginal testing however urine testing should be considered essential. Pelvic inflammatory disease should be in the differential for transgender men with a uterus and fallopian tubes who have vaginal intercourse. Testosterone use is associated with vaginal atrophy; therefore, use of lubricant and a small speculum may be appropriate for pelvic and speculum exams among transgender men with vaginas. Some transgender men retain patent vaginas after metoidoplasty and may require vaginal screening based on sexual history. Trauma informed care in medicine: current knowledge and future research directions. June 17, 2016 92 Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People 17. A common cause of scrotal contents pain in transgender women is "tucking," which allows a female-appearing genital contour in tight fitting clothing. Tucking involves manually displacing the testes upward into the inguinal canal, and then positioning the penis and scrotal skin between the legs and rearward toward the anus. Tight underwear, tape or a special garment known as a gaff is then used to maintain this positioning. Many transgender women find this practice to be gender-affirming, and may maintain this positioning even at night when asleep. Prolonged tucking may also result in urinary reflux and symptoms of prostatism or even infection such as epididymoorchitis, prostatitis, or cystitis. Prolonged positioning of a compressed urethral meatus in close approximation to the anus may also serve as a portal of infection. Pain related to the onset of hormone therapy is a common complaint however the etiology of this symptom is unknown. Acute scrotal contents pain requires a workup to rule out conditions requiring emergency treatment. A physical exam to rule out tumors, hernia, hydrocele or other causes of pain is appropriate. Ready access to transgender surgeries when medically necessary, including orchiectomy and vaginoplasty for the treatment of gender dysphoria, may also minimize this condition. Chronic orchialgia algorithms for non-transgender men often suggest an empirical course of antibiotics (after attempting diagnosing an etiology) and discourage orchiectomy as a last resort measure.

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In consideration for the rights granted to pain diagnostic treatment center sacramento cheap aleve 250 mg on line Dyax sacroiliac pain treatment options aleve 500 mg amex, we received an upfront fee of $3 back pain treatment nerve burning buy aleve 250 mg. In December 2016 back pain treatment ucla cheap 250mg aleve with mastercard, we sold our rights to receive further royalties under this agreement for a payment of $11. As part of that transaction, the parties, subject to the satisfaction of certain conditions, entered into an intellectual property license agreement (the "Nanotherapeutics License Agreement"), under which we agreed to license to Nanotherapeutics certain intellectual property rights related to the purchased assets. In February 2017, we executed an Amendment and Restatement to both the Nanotherapeutics Purchase Agreement and Nanotherapeutics License Agreement primarily to (i) remove the obligation to issue 23,008 shares of common stock of Nanotherapeutics under the Nanotherapeutics Purchase Agreement, and (ii) revise the payment schedule related to the timing of the $4. In addition to the cash consideration, we received shares of common stock of Agenus with an aggregate value of $0. The remaining common stock of Agenus will only be received upon our satisfaction of certain operational matters, which we are unlikely to satisfy. Financing Agreements Hercules Loan and Security Agreement In February 2015, we entered into a Loan and Security Agreement with Hercules Technology Growth Capital, Inc. We used a portion of the proceeds received under the Hercules Loan Agreement to repay the outstanding principal, final payment fee, prepayment fee, and accrued interest of $5. The interest rate under the Hercules Loan Agreement is calculated at a rate equal to the greater of either (i) 9. Payments under the Hercules Loan Agreement were interest only until June 1, 2016, after which we have paid equal monthly payments of principal and interest amortized over a 30-month schedule through the scheduled maturity date of September 1, 2018 (the "Hercules Loan Maturity Date"). The entire principal balance, including a balloon payment of principal, will be due and payable on the Hercules Loan Maturity Date. If we prepay the loan prior to the Hercules Loan Maturity Date, we may pay Hercules a prepayment charge equal to 1. Our obligations under the Hercules Loan Agreement are secured by a security interest in substantially all of our assets, other than our intellectual property. Up on the occurrence of an event of default, a default interest rate of an additional 5% may be applied to the outstanding loan balances, and Hercules may declare all outstanding obligations immediately due and payable and take such other actions as set forth in the Hercules Loan Agreement. After taking into account the January 2017 payment, t he principal balance of the Hercules Loan was $6. In connection with the Hercules Loan Agreement, we issued a warrant to Hercules that is exercisable for an aggregate of up to 9,063 shares of our common stock at an exercise price of $66. The number of shares for which the Hercules Warrant is exercisable and the associated exercise price are subject to certain proportional adjustments as set forth in the Hercules Warrant. Research and Development Our research and development expenses currently include costs of personnel, supplies, facilities and equipment, consultants, third-party costs and other expenses related to preclinical and clinical testing. Our research and development activities can be divided into those related to our internal projects and those related to collaborative and contract arrangements, which are reimbursed by our collaborators. In 2016, research and development expenses relating to internal projects were $42. In 2016, research and development expenses related to collaborative and contract arrangements were $1. In December 2016, we initiated a corporate reorganization to eliminate all activities not directly in support of X358 clinical development. Competition the biotechnology and pharmaceutical industries are subject to continuous and substantial technological change. Competition in antibody-based technologies is intense and is expected to increase as new technologies emerge and established biotechnology firms and large chemical and pharmaceutical companies continue to advance in the field. A number of these large pharmaceutical and chemical companies have enhanced their capabilities by entering into arrangements with or acquiring biotechnology companies or entering into business combinations with other large pharmaceutical companies. Many of these companies have significantly greater financial resources, larger research and development and marketing staffs, and larger production facilities than ours. Moreover, certain of these companies have extensive experience in undertaking preclinical testing and human clinical trials. These factors may enable other companies to develop products and processes competitive with or superior to ours.

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