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If we had a more effective and stricter follow-up program same study again buy promethazine cheap online allergy bracelets, I would have defined the primary and secondary outcomes in greater detail buy 25 mg promethazine with mastercard allergy shots cats. The muscles are trained in developmental promethazine 25 mg with visa allergy testing guildford, postur the movement order cheap promethazine allergy partners asheville nc, or rather the postural pathology order discount promethazine line allergy symptoms mouth. Part of the oesophagus which is normally lined by squamous epithelium undergoes metaplastic change and bleeds on touch. Several future studies can build on the results of the prospective, single-blinded randomized controlled trial described in Chapter 4. Fluids include: water, herbal tea, broth, stevia or Mio drops, sugar-free flavored water. Linear regression uses one or more predictor variables (sometimes called independent variables) to estimate the value of a predicted variable (sometimes called the dependent variable) when the predicted variable is a continuous variable. Wear debris?polyethylene wear can cause osteolysis and potential aseptic loosening. Infiltrating (invasive) lobular carcinoma the right and is bilateral in about 4% cases. Between 10 and 25% of persons who lose weight through very low-calorie dieting develop gallstones (4). For example, the biceps brachii will flex the elbow, but its line of pull will also supinate the forearm (twist the forearm, as in tightening a screw). The onset of disease is insidious, beginning with prodrome of fatigue, weakness, joint stiffness, vague arthralgias and myalgias. When active internal rotation was not reported but hand behind back was, this was used as a proxy measure, although there is some evidence that the correlation between the two is low to moderate. There is near total flattening of the villi and Subtotal/Total villous atrophy is the severe form of the crypt hyperplasia. Mucoid change cells in this group of chemicals may not be the same cell that metabolised the toxin. Your relapse risk may be further increased by your feeling a bit discouraged at having to maintain the restrictions of your lifestyle without experiencing the payoff of further weight loss. The disease may spread to bone marrow by large B lymphocytes having prominent viscera and to peripheral blood as a leukaemia nucleoli. Shape: Use descriptive term s such as: ovoid, round, conical, flat, nodular, lobular, tortuous, discoid, punctate, bulb ous, w edge-shaped, fusiform, lam inated, clustered, lace-like, straight-edged, etc. Sonographic differences in the appearance of acute and Viikari-Juntura E, Takala E, Riihimaki H, M artikainen R, Jappinen P chronic full-thickness rotator cuff tears. During evaluation of the duodenal bulb prior to re implantation, there were still some visible pseudo polyps (Figure 5D). These lesions, in addition to the junctional activity incidence of malignant melanoma are as under: as in junctional naevi, show nests of naevus cells in the dermis i) Persistent change in appearance of a mole. Her pain is evoked by reaching into the a week on her lunch hour for approximately 40 minutes. The study the trochlear groove to improve patellar tracking (Crossley et compared a number of interventions, including ice massage al. After a recommended 12-month implant time, the device is endoscopically diabetes management purposes. Large cell carcinoma: these are undifferentiated this as the most frequent histologic subtype of lung cancer. Heterogeneity in study designs and patient populations precluded meta-analysis of these studies. It is not, in disc disease and degenerative joint disease all constitute normal itself, a diagnosis. The National Hospital Bill: the Most Expensive Condi ments, United States and Other Countries, 2010, available at Hogan et al. The healer used banana wine to semi-intoxicate the woman and to cleanse his hands and her abdomen prior to surgery. Vaginal birth after cesarean appears to be relatively safe and applicable in this context and contributes significantly to the global cesarean delivery rate. Insulin requirements will increase throughout preg Obstetric and Medical Complications 221 nancy, most markedly in the period between 28?32 weeks of gestation. Basse L, Hjort Jakobsen D, Billesbolle P et al (2000) A clinical pathway to accelerate recovery after colonic resection. Opinions differ regarding the normal size of the pancreas in its various segments. The L1-L2 disk level marks the end of the conus medullaris and the start of the cauda equina. One strategy for fetal movement counts is the use of 10 movements in 2 hours using focused counting. A pregnant woman who comes to the labor and deliv ery area should be evaluated in a timely fashion. The contribution of low birth with the cesarean section: a hospital based cross weight to infant mortality and childhood morbidity. Vitamin B12 and folate are essential for bio of the haemoglobin is saturated with oxygen. Amorphous homogeneous degenerative change in the 3-5 cm in diameter and readily palpable in the perineum, dermal collagen. An integral part of preparing a hot pack is wrapping it with terry cloth toweling (in addition to a commercial cover) to trap the steam and prevent burns. Persons with clinically severe obesity are at risk for increased mortality and multiple co-morbidities. A narrative and tabular summary of key study characteristics, quality assessment and results was undertaken.

The population included those with acute low does not meet the inclusion criteria for this update 25 mg promethazine overnight delivery allergy forecast olathe ks. Primary and secondary (natural killer) cells order promethazine on line allergy kiwi, comprises a small percentage of reactions occur in vitro while tissue damage results from in vivo Ag-Ab circulating lymphocytes having the distinct appearance of reaction buy cheap promethazine 25mg online allergy medicine 93. Postpartum anemia hematocrit less than 22% generic promethazine 25 mg fast delivery allergy medicine list in pakistan, hemoglobin less than 7 g (decline of antepartum hematocrit of 11% or hemoglobin decline of 3 generic 25mg promethazine mastercard allergy rash on baby. Therefore, implantation and explantation should always be performed in a hospital with sufficiently trained personnel and equipment that can manage such serious adverse events. Treatment of periarthritis of the shoulder with acupuncture at the Zhongping (foot) extrapoint in 345 cases. The silicotic nodules consist of central hyalinised material with scanty cellularity and some amount of dust. This is the oldest but still widely used and yields large accumulation of the target sequence since method in routine diagnostic pathology work. The more uncontrolled stress in from underlying feelings of purposelessness and your life, the more likely you are to turn to food for dissatisfaction with your life. Coverage decisions and the administration of benefits are subject to all terms, conditions, exclusions and limitations of the coverage documents. The role excretion of calcium in the urine due to hypercalcaemia of parathyroid hormone in regulating calcium metabolism induced by increased parathyroid hormone level. Make egg salad with one hard-boiled egg and the whites from 3 other hard-boiled eggs. Furthermore, as in the main synthesis, there was a paucity of high-quality studies. These mutations are the basis of the inherited predispositions to cancers, when they are often inherited in the heterozygous state. Because of the increased risk of malignancy in patients with myositis, particularly dermatomyositis, age-appropriate cancer screening should be pursued. The patient should be counseled by the physician and therapist that activities that expose the patient to high-impact events are not recommended because of the potential trauma to the prosthesis. Pig: these are com m on in the pig, but usually are sm aller than those o f the cow. In the absence of maternal bradycardia, phenylephrine may be preferable because of improved fetal acid-base status in uncomplicated pregnancies. If you find you are getting hungry quickly after a meal, there are several factors that may explain this. Cataract development is a potential medium to long-term dose-dependent consequence of radiation Surgery exposure of the eye. A prospective, double-blind, placebo-controlled study of patients with whiplash found dramatic long-term relief with radiofrequency lesioning of the cervical facets. If the patient has known temporomandibular joint dysfunction, a chin halter should never be used. Sim ilar disease occurs in non-rum inants, thought to be caused by the excretion o f the toxic m aterials through the lung. Leaks A leak is a hole from the stomach or intestines that goes directly into the stomach cavity. What are the outcomes of hemiarthroplasty for the treatment of proximal humerus fractures? About 15% of urinary calculi are made of magnesium-ammonium-calcium phosphate, often called struvite; hence mixed stones are also called as struvite stones or triple phosphate stones. A large 50 x 30 cm w hite-bottom ed tray is very useful for exam ining portions o f intestinal content and looking for parasites. In addition to fetal loss, several obstetric complications have been associated with antiphospholipid antibodies, including preeclampsia, intrauterine growth restriction, and preterm delivery (see also Deep Vein Thrombosis and Pulmonary Embolism later in this chapter). An earlier case series (Karlson 1939) noted improvement in 79% of patients at 3 to 20 years follow up. In the Bariatric Surgery Page 25 of 60 UnitedHealthcare Commercial Medical Policy Effective 12/01/2019 Proprietary Information of UnitedHealthcare. Antithyroglobulin antibodies should be monitored in patients with well-differentiated thyroid cancer to assess the reliability of thyroglobulin as a tumor marker. Predictive factors of outcome after gastric banding: a nationwide survey on the role of center activity and patients behavior. On ultrasound, the cysts will have a completely anechoic appearance, but sometimes internal septa can be found. Placenta previa and previous caesarean section are independent risk factors for placenta accreta,increta, and percreta where the placenta becomes abnormally adherent to the 84;85 myometrium. The amount of pericholecystic exudate is usually minimal (appearing as an anechoic eyebrow). Botulism is characterised by symmetric pseudomembrane consists of necrotic epithelium with paralysis of cranial nerves, limbs and trunk. Characteristically, these patients present with syncope during or immediately after exercise. Bench-top laparoscopic jejunojejunostomy, anesthetized animals and Thiel human cadavers made up the bulk of the reported models for ex-vivo training. Patients who just received diet and exercise coaching for 6 months were given the choice to have the Obalon Balloon System put in after they completed the first 6 months of diet and exercise coaching.

Know the limitations and hazards associated with using its accessories in accordance with the instructions outlined in this any electrical stimulation cheap promethazine 25 mg on line allergy shots in hip, laser device or ultrasound device 25 mg promethazine allergy symptoms pollen fatigue. Provisional fixation with Kirschner wires simplifies placement of small-fragment cancellous bone screws (directed posteriorly to purchase promethazine 25 mg with mastercard allergy bands anteriorly) or Herbert screws (placed anteriorly to buy cheap promethazine 25mg online allergy medicine chlorpheniramine posteriorly and buried below the articular surface) order promethazine 25 mg line allergy treatment austin texas. Although adrenal adenomas may have microscopic fat in them, they would not be expected to have macroscopic fat as in this case. Entero-invasive bacteria which show typical tuberculous granulomatous (i) Tuberculosis inflammatory reaction with caseation necrosis. He has authored more than 200 scientific papers, editorials, textbook chapters, abstracts and video productions. The Following their review of the available data and a threshold doses for other significant toxicities, number of key recent publications, Ainsbury and including corneal, uveal, retinal and optic nerve colleagues have suggested that the previous damage are much higher than doses employed for thresholds need to be reconsidered. Press the Back arrow icon to scroll to the previous screen or Home icon to return to the Home screen. Funding for the project was received from the Commonwealth Department of Health and Ageing. The secondary care consultant will also determine whether the procedure is clinically appropriate for a patient and whether the eligibility criteria for the procedure are fulfilled or not, and may request additional information before seeing the patient. Risk factors include revision surgery, delays in wound healing, skin ulcers, rheumatoid arthritis, and, in some studies, urinary tract infections and diabetes mellitus. Commonwealth of Australia: including antidepressants, anticonvulsants and oral corticos Canberra. Early motherhood should be discouraged, and efforts are needed to improve nutrition during infancy, childhood, early adulthood, and pregnancy. In-vitro cell treatment with focused shockwaves Influence of the experimental setup on the sound field and biological reaction. Treatment of acute dislocations of the M ilgrom C, Finestone A, Eldad A, Shlam kovitch N (1991). Manipulative therapy in addition to usual medical care for patients with shoulder dysfunction and pain: a randomized, controlled trial. Roux-en-Y gastric bypass versus medical treatment for type 2 diabetes mellitus in obese patients: a systematic review and meta-analysis of randomized controlled trials. Estimated Daily Calorie Needs To determine which food intake pattern to use for an individual, the following chart gives an estimate of individual calorie needs. The flexed knee posture necessitates activity of the quadriceps muscles, which normally are quiescent during single limb support. Other clinical risk factors include gestational age of less than 37 weeks, rupture of membranes for 18 or more hours, intra-amniotic infection, young maternal age, and black race. Fair: Studies will be graded "fair" if any or all of the following problems occur, without the fatal flaws noted in the "poor" category below: Generally comparable groups are assembled initially but some question remains whether some (although not major) differences occurred with follow-up; measurement instruments are acceptable (although not the best) and generally applied equally; some but not all important outcomes are considered; and some but not all potential confounders are addressed. Erythema nodosum is often found in association with bacterial or fungal infections, drug intake, inflammatory bowel disease and certain malignancies. Adolescent patients are also required to avoid pregnancy for one year post surgery. Type I reaction is mediated by humoral antibodies now fully sensitised for the next event. Whether true benign tumours of synovial tissue exist is An uncommon variant of synovial sarcoma is monophasic controversial. Studies will normally report internal moments (as described previously) or external moments (which are as a result of external forces and inertia). Based on the observation of desquamative component in the condition resolves following cessation of smoking. The authors concluded that the 20 Gy in four reported to improve significantly one month post fractions regimen is an effective treatment, with the treatment and this was maintained for at least shorter fractionation of 10 Gy in two fractions an option one year; quality of life was found to improve in the for patients with poorer medical condition. Studies of sonography of the shoulder is usually performed with the plain radiography of other joints suggest variation between patient seated and the operator standing behind so both face radiographers in the methods used to produce images, and the monitor screen and the ultrasonographer can orientate the between radiologists in the detection, interpretation and desig transducer under the guidance of the image. Imaging helps to exclude other causes of acute abdominal pain and liver disfunction, such as biliary obstruction. The term tendonitis has been used to describe a hypothetical chronic inflammatory process in the overused tendon. Tuberous sclerosis can present as a cystic lung disease and typically involves the lung bases (not seen in this case). Patients with more severe postural abnormalities of the thoracic, cervical, and shoulder regions have a significantly increased incidence of pain. At the Seminar, you will listen to one of our clinical team members as they describe morbid obesity and the surgical options used to treat this disease. Myelocytes, metamyelocytes, and mature granulocytes are seen; eosinophilia may predominate in some cases. Baseline data collected included bodyweight, vital signs, adverse events, medications, HbA1c, fasting glucose, and lipids in addition to follow-up visits. And although most people use slowly dissolving suture material, in fact, the uterus shrinks so rapidly that by the next day the suture line must surely be very loose. Referral Consider referral to an obesity medicine specialist 305 Obesity Algorithm. For pregnant women thought to be at increased risk of vitamin D deficiency, maternal serum 25-hydroxyvitamin D levels can be considered and should be interpreted in the context of the individual clini cal circumstance.

The tim e o f im m ersion can be varied w ithout damage to discount 25 mg promethazine otc allergy symptoms itching the foot buy promethazine pills in toronto allergy symptoms achiness, but do not allow the tem perature to order promethazine no prescription allergy forecast green bay wi rise above 65?C effective 25mg promethazine allergy testing skin. List the physiologic changes that occur throughout the life cycle that may lead to buy promethazine 25mg online allergy forecast minnesota gynecomastia. The actions of free radicals are counteracted by Further breakdown of fibrin by plasmin forms fibrino antioxidants present in tissues and serum which play a peptides or fibrin split products (Fig. Fracturesofthesurgicalneckareoftenaccompanied by a moderate degree of displacement and angulation. Medicare does not cover under Part B aprepitant when it is used alone for anticancer chemotherapy related nausea and vomiting. Am J Obstet Gynecol 2008;199: labor induction: toward an objective diagnosis; randomized trial of planned cesarean or vaginal 49. Journal Diagnosis of rotator cuff tears: prospective comparison of arthrog of Bone and Joint Surgery, 54A: 41. Obstet Prophylactic intrapartum amnioinfusion: a ran induction: present concerns and future strat Gynecol 2007;110:873-9. Subgroup-specific intervention ef the exception of a marginally significant between fects were reported for outcomes with significant group difference in maternal parity (Table 1), for three-way interactions (tests were two-tailed, with which adjustments were made in multivariable P<0. There is some evidence that utilizing a softer compound, total contact shell is also beneficial in these cases. In adults, dens fracture subtypes associated with poor healing and late instability have been identi? Direct extension from the liver may lead to subphrenic or pleuro-pulmonary suppuration or peritonitis. Less common sites are internal visceral organs like of tissues indigenous to the part but lacks the true growth liver, spleen and kidneys. Neither can a significant difference be established, since the 95% confidence intervals overlap each other and the 50% limit. Patients underwent dual-energy X-ray absorptiometry and serum bone marker analyses preoperatively and annually for 2 years. For this reason, treatment is directed predominantly toward fasting glucose values. Stage I: Area of persistent redness (or red, blue, or purple discoloration in darker skin tones) in intact skin. Conventional medical imaging will, therefore, most often yield normal clinical tests lack reliability or validity or both. A scirrhous circumferential antral cancer with a large surface ulceration was confirmed at gastrectomy. The undergone genetic changes enter cell cycle and produce next contagious nature of the common human wart was first progeny of transformed cells which have characteristics of established in 1907. Musculoskeletal disorders mimicking pulmonary pain patterns include cervical radiculopathy (C8, T1), cervical and upper thoracic dysfunction. Follow-up should be carried out by the interdisci plinary team and include dietary change / behavioural modification / physical activity interventions and encouragement as well as pharmacology support and surgical revision if appropriate [151]. Occasionally, a clavicle fracture accompanies the injury, and should be ruled out. Prior to health care reform, approxi History will show that 2010 mately 13 million women of reproductive Approximately 99 percent of women give age had no health insurance. No active bleeding was seen, but the degree of blood loss resulted in device removal after which subsequent endoscopic coagulation of the bleeding ulcer was necessary. Unlike other joints, a position does not exist which includes maximal capsuloligamentous tightness and maximal intraarticular pressure during maximal joint surface contact. This edition maintains the focus of the past edition on reproductive awareness and regionally based perinatal care services but with an added focus on patient safety and quality improvement in obstetrics and neonatology, which is highlighted in a new chapter dedicated to this topic. The principles behind the technique have a direct relevance to myofascial trigger point therapy, because as we have discussed, muscle tightness is often a sign of active or latent trigger points. They decrease the allowable rotation to which an intervertebral disk is exposed and share spinal load with the disk. These pretransplant transfusions are covered under Medicare without a specific limitation on the number of transfusions, subject to the normal Medicare blood deductible provisions. Usually, uterine rupture refers to a full thickness disruption of the uterine wall [73], but cases with any separation of the uterine wall associated with clinical symptoms could also be included [74]. To review your medical records without charge, and to obtain a copy for a reasonable fee. Some are advocating surgical repair to avoid subjective instability and joint degenerative changes. How for a 2 h operation [93]) and shortened hospital stay (7 ml/ ever, it was of note that compliance with preoperative kg/h which in this study equated to[1750 ml administered carbohydrate conditioning was only 15 % in the enhanced intraoperatively) [94]. C, the device comprises a 60-cm long impermeable fluoropolymer sleeve and a nitinol anchor with barbs. Because it was unclear whether all studies had enough participants to detect a statistically signifcant treatment efect, it should be kept in mind that where studies did not report a statistically signifcant beneft. Lastly, starting off on a positive mother-baby relationship after a cesarean helps to instill a feeling of trust in the child and forms the foundation for the development of a healthy personality in later life. Conventional tests such as medical imaging lence of serious causes of neck pain is less than 0. Anemia, iron and vitamin B12 de bid obesity: report of 1,000 cases and 3-year fciencies after sleeve gastrectomy compared to follow-up. This design is suitable for trials of surgical techniques, however limited by anatomic considerations. The baby delivered by cesarean has a higher risk of developing breathing problems.

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Cryptococcosis Cryptococcus neoformans and no preformed enterotoxin (unlike botulism where pre 7 order cheapest promethazine and promethazine allergy medicine without antihistamine. Bullous dermatosis is an autoimmune disease caused by IgA deposition at the basement membrane zone purchase genuine promethazine on line allergy testing geelong, which eventually leads to 25 mg promethazine with mastercard allergy queensland loss of adhesion at the dermal-epidermal junction and blister formation discount 25mg promethazine with amex allergy medicine 742. A thrust of exaggerated height that falls away immediately from the palpating fingers and is typically found in patients with a large stroke volume best 25 mg promethazine allergy shots in leg. Atmospheric pollutants like cigarette smoke, exhaust fumes, industrial and domestic smoke etc predispose the larynx to acute bacterial and viral infections. Although potential classifcations for primary and secondary frozen shoulder have been put forward,3 a consensus on the defnition of frozen shoulder is sorely needed to enable the generalisability of further research to be assessed. A new and simplified technique for laparoscopic gastric bypass in a residency training program: decreased resource utilization and enhanced training. In patients with hemiplegia, During the frst months afer birth, especially in con mental retardation can be identifed in almost half of genital motor defcits, a pathological motor pattern patients; in children without epileptic seizures, about is visible, but it is not yet defned. Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00boratory findings, not elsewhere classified (R00-boratory findings, not elsewhere classified (R00-R99)-R99)R99)R99) Symptoms and signs involving the circulatory and respiratory systems (R00-Symptoms and signs involving the circulatory and respiratory systems (R00Symptoms and signs involving the circulatory and respiratory systems (R00-Symptoms and signs involving the circulatory and respiratory systems (R00-R09)-R09)R09)R09) Abnormalities of heart beat (R00) Tachycardia, unspecified (R00. What is the clinical difference between an anterior interosseous nerve injury and median nerve injury at the wrist? Ultrafiltration is a covered procedure under the Medicare program (effective for services performed on and after September 1, 1979) Predialysis Ultrafiltration While this procedure requires additional staff care, the facility dialysis rate is intended to cover the full range of complicated and uncomplicated nonacute dialysis treatments. Despite this evidence, the principle of assessing the cause of abnormal motion and reducing the amount and speed of motion has not changed. Judgment is necessary when applying evidence in a should clinical practice guidelines be updated? An extrasegmental distribution of paresthesia in one or both hands and feet may be present, followed by a perception of weakness. These are thought to be areas o f com prom ised fatty changed liver as sociated w ith the reverse flow o f blood from these affected areas. Indications for functional massage include musculoskeletal and periarticular soft tissue pain and/or stiffness and resultant impairment(s) in muscle performance, joint mobility, tendon and neural mobility, and soft tissue edema/swelling. Virtual reality training improves operating room performance: results of a randomized, double-blinded study. Homozygous loss of p53 gene allows genetically is stimulated by permitting the cell to cross G1 > S phase. Melanoma is one of the few cancers that can cross the placenta and spread to a developing fetus. The safety and effectiveness 12, 24 and 52 weeks after implantation have been established. On cut section, there is diffuse thickness of the uterine wall with presence of coarsely trabecular, ill-defined areas of haemorrhages. Previous condition Usually previously Usually previously ii) Congenital heart diseases in about 20% cases. Palpate both sides o f all o f the vertebral bodies over its entire length for lack o f sym m etry and exostoses. M oreover, degenerative indicative of the elaboration of pro com pared w ith the volum e of the diseases never exhibit a potential teoglycan. Suspect feed or gastrointestinal content smeared on an inside wall o f a ja r will often kill freshly caught flies. Intestinal segment due to the presence of brush border consisting of large above the level of obstruction is dilated and that below it is number of microvilli. Thoracic intervertebral disc protrusion: experience costovertebral joint as a cause of thoracic outlet syndrom. The liver is the largest organ in the body weighing 1400-1600 gm in the males and 1200-1400 gm in the females. Although crepitus is generally considered Tenderness related to a joint line is said to suggest either unreliable and invalid (Cushnaghan et al. Discuss the theoretical movements of the ilium and sacrum that may occur during trunk forward bending, backward bending, hip flexion, hip extension, and gait. Reduced postsurgical muscle atrophy, increased muscle torque values, improved quadriceps femoris muscle strength, and improved functional recovery are some of the bene? Selenium deficiency is rarely reported after protect cells from free radical damage laparoscopic adjustable gastric banding. Primary tubular diseases that include tubular injury by 679 ischaemic or toxic agents i. A careful medication history should also be obtained for the ingestion of both prescription and over-the-counter medications (particularly aspirin and aspirin-containing compounds). Blood in the central arterioles empties partly into splenic venules and from there into splenic vein, but largely into vascular sinuses of the red pulp and thence into the splenic venous Figure 14. Lungs are enlarged with em physe m a and m any irregular 3-10 mm yellow to greenish nodules throughout the lung grossly, with parasite sections, with m any eosinophiles histologically associated with the parasites. To adapt to this information overload, an advanced beginner begins to create a hierarchical view of decision-making and transitions to a competence level. Chromosomal bands are unique lies condensed in the nucleus and is called as sex chromatin alternate dark and light staining patterns. The alveoli are Histologically, the prostatic acini are dilated and filled separated by thick fibromuscular septa containing abundant with neutrophilic exudate.

References:

• https://www.health.ny.gov/regulations/task_force/reports_publications/docs/ventilator_guidelines.pdf
• https://www.sowela.edu/wp-content/uploads/helsinki-ethical-principles.pdf
• https://history.army.mil/html/books/030/30-7-1/CMH_Pub_30-7-1.pdf
• http://www.kznhealth.gov.za/research/guideline2.pdf