Persius/hicric huggingface dataset:
United states preventive services task force recommendations scheme

# USPSTF Grade Definitions 

### Grade: A
- The USPSTF recommends the service.
- There is high certainty that the net benefit is substantial.

### Grade: B
- The USPSTF recommends the service.
- There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.

### Grade: C
- The USPSTF recommends against routinely providing the service.
- There may be considerations that support providing the service in an individual patient.
- There is moderate or high certainty that the net benefit is small.

### Grade: D
- The USPSTF recommends against the service.
- There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.

### Grade: I Statement
- The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service.
- Evidence is lacking, of poor quality or conflicting, and the balance of benefits and harms cannot be determined.

# USPSTF Levels of Certainty Regarding Net Benefit 

### Level of Certainty: High
The available evidence usually includes consistent results from well-designed, well-conducted studies in representative primary care populations. These studies assess the effects of the preventive service on health outcomes. This conclusion is therefore unlikely to be strongly affected by the results of future studies.

### Level of Certainty: Moderate
- The available evidence is sufficient to determine the effects of the preventive service on health outcomes, but confidence in the estimate is constrained by factors such as:
- The number, size, or quality of individual studies
- Inconsistency of findings across individual studies
- Limited generalizability of findings to routine primary care practice
- Lack of coherence in the chain of evidence
- As more information becomes available, the magnitude or direction of the observed effect could change, and this change may be large enough to alter the conclusion.

### Level of Certainty: Low
- The available evidence is insufficient to assess effects on health outcomes.
- Evidence is insufficient because of:
- The limited number or size of studies
- Important flaws in study design or methods
- Inconsistency of findings across individual studies
- Gaps in the chain of evidence
- Findings not generalizable to routine primary care practice
- A lack of information on important health outcomes
- More information may allow an estimation of effects on health outcomes.

# U.S. Preventive Services Task Force Recommendation Grid 

# Resources
USPSTF Clinical Practice Guidelines
ACC AHA guideline on the primary prevention of hypercholestrolemia

# 2018 AHA ACC Guideline on the Management of Blood Cholesterol. Primary Prevention

## Primary Prevention Adults 40 to 75 Years of Age With LDL-C Levels 70 to 189 mg/dL (1.7 to 4.8 mmol/L)

## Monitoring in Response to LDL-CLowering Therapy

## Primary Prevention in older adults

## Primary Prevention in Children and Adolescents

## Other Population at risk:

## Ethnicity

## Issues and Recommendations Concerning Women

## Adults with CKD

## Adults With Chronic Inflammatory Disorders and HIV

# 2013 ACC AHA guideline on the treatment of blood cholesterol primary prevention

## Primary Prevention in Adult 21 Years With LDLC 190 mg/dL
- Cholesterol and triglycerides rise progressively throughout pregnancy (81); treatment with statins, niacin, and ezetimibe are contraindicated during pregnancy and lactation.

## Primary Prevention in Individuals With Diabetes

## Primary Prevention in Individuals Without Diabetes and With LDLC 70 to 189 mg/dL

# Initiating and Management of Statin Therapy in Individuals Without Clinical ASCVD
Clinical ASCVD is defined as acute coronary syndromes or history of MI, stable or unstable angina, coronary revascularization, stroke, or TIA presumed to be of atherosclerotic origin, and peripheral arterial disease or revascularization.

## Risk Assessment in Primary Prevention
Differentiating COVID-associated heart failure from other Diseases

# Overview
COVID-associated heart failure must be differentiated from other causes of dyspnea and/or hypoxia, including pneumonia, acute respiratory distress syndrome, myocarditis, and pulmonary embolism.

# Differential Diagnosis
COVID-associated heart failure must be differentiated from pneumonia, acute respiratory distress syndrome, myocarditis, and pulmonary embolism.
- COVID-associated heart failure from other Diseases should be differentiated from other diseases presenting with shortness of breath and tachypnea. The differentials include the following:
International Society on Thrombosis and Haemostasis bleeding scale

# Overview
The International Society on Thrombosis and Haemostasis (ISTH)/Scientific and Standardization Committee (SSC) definitions and bleeding assessment tool are useful for standardizing the reporting of bleeding symptoms.

# ISTH Definitions of Bleeding
Major bleeding has been used as a primary endpoint for the evaluation of safety in clinical trials. The ISTH definitions of major bleeding in non-surgical and surgical patients are as follows:

### Major Bleeding in Non-Surgical Patients

### Major Bleeding in Surgical Patients

### Minor Bleeding
All non-major bleeds will be considered minor bleeds. Minor bleeds will be further divided into those that are clinically relevant and those that are not.

### Clinically Relevant Minor Bleed
A clinically relevant minor bleed is an acute or subacute clinically overt bleed that does not meet the criteria for a major bleed but prompts a clinical response, in that it leads to at least one of the following:
- A hospital admission for bleeding, or
- A physician guided medical or surgical treatment for bleeding, or
- A change in antithrombotic therapy (including interruption or discontinuation of study drug).

# ISTH/SSC Bleeding Score
The ISTH/SSC proposed a bleeding assessment tool to standardize the reporting of bleeding symptoms in both pediatric and adult populations. It facilitates the diagnosis of less symptomatic mild bleeding disorder and the grading of severity in patients with known inherited bleeding disorders. For each specific bleeding symptom, a score of 1 or more is classified as significant. Scores and descriptions of bleeding symptoms are as follows:
Osteochondrodysplatic dwarfism -- deafness -- retinitis pigmentosa

# Overview
Osteochondrodysplatic dwarfism -- deafness -- retinitis pigmentosa is an autosomal dominant disease characterized by dwarfism and musculoskeletal problems along with deafness and eye problems.

# Pathophysiology
The disease seems to have a dominant autosomal pattern of inheritance with a variable degree of penetrance.
There is no associated metabolic abnormality

# Epidemiology and Demographics
Osteochondrodysplatic dwarfism -- deafness -- retinitis pigmentosa has a prevalence of <10/100000.

# Diagnosis

## Symptoms
- Sensorineural deafness
- Restricted joint mobility
- Spine problems
- Vision problems - night blindness

## Physical examination

### Appearance of the patient
The patient is short statured with a curved back.

### Ear
- Sensorineural deafness

### Eye
- Vision problems - due to retinitis pigmentosa

### Back
- Abnormal curvature of the spine

### Neurologic
- Mental retardation - decreased intellectual capacity

## Imaging

### X-ray
Radiographs showed:
- Diffuse osteoporosis
- Severe retardation of bone-age
- Dysplasia of the femoral head
Palliative treatment in dextro-transposition of the great arteries

# Overview

# Palliative treatment
Critically ill newborns benefit from the infusion of Prostaglanding E1, which is used to prevent closure of the PDA (additional shunt) through which the systemic circulation is provided with a higher level of oxygen.
Balloon atrial septostomy, enlargement of the interatrial communication using a balloon, allowing better atrial-level mixing between the two parallel circulations. The catheter is introduced via femoral venous or umbilical venous approach, and passed into the right atrium, across the oval foramen and into the left atrium (LA) under echocardiographic or angiographic guidance. Once the ballon is in the LA, is inflated and drawned back across the oval foramen, producing a tear of the interatrial septum.
Antibiotics are often used because the patient is invaded with arterial and vein lines, nasogastric tube, urethral catheter, etc, that makes the patient very susceptible to infections.
Diuretics aid in flushing excess fluid from the body, thereby easing strain on the heart.
Cardiac glycosides, used to maintain proper heart rhythm while increasing the strength of each contraction.
Sedatives may be used palliatively to prevent a young child from pulling out any of their lines.
University College of Medicine and Dentistry, University of Lahore
University College of Medicine and Dentistry, University of Lahore is one of the most prestigious medical schools in Pakistan. It is often abbreviated as UCM, UOL.

# History

# Campus and departments
The university has following departments:
Basic science departments:
Anatomy
Biochemistry
Community Medicine
Forensic Medicine
Pathology
Pharmacology
Physiology.
Medicine and allied departments:
Cardiology
Chest Medicine
Dermatology Unit I & II
Neurology
Pediatrics
Medicine Unit I,II, III & IV
Psychiatry and Behavioural Sciences
Radiotherapy
Social and Preventive Medicine
Urology.
Surgery and allied departments:
Anesthesiology unit I & II
Cardiac Surgery
Neurosurgery
Obstetrics and Gynaecology Unit I, II, III & IV
Ophthalmology unit I, II & III
Oral and Maxillofacial Surgery
Orthopedics Unit I & II
Otorhinolaryngology Unit I & II
Pediatric Surgery
Plastic Surgery
Radiology
Surgery Unit I, II, III & IV
Thoracic Surgery.

# Attached hospitals:

# Institutes, schools and centres:

# Auxiliary services:

# Attached Hostel facilities:
Boys Hostel
Girls Hostel

# Academic degrees at UCMD, UOL
For Undergraduates:
Bachelor of Medicine and Bachelor of Surgery (MBBS)
Bachelor of Science (BSc).

# For Postgraduates:
Diploma (D)
Master of Science (MSc)
Doctor of Medicine (MD)
Master of Surgery (MS)
Master of Dental Surgery (MDS).
Master of Philosophy (MPhil)
Degree of Doctor of Philosophy (PhD).

# Organization

# Students', unions and sports
Students' Patient Welfare Society (SPWS)
Literary Society
Debating Society
Sports Department
Photographic Club
Dramatic Society
The members of these societies compete at both the national and international level, and have won numerous competitions.

# Research
Research is conducted by every department of UCM. Pakistan lags behind in research. Mainly because of lack of funding, facilities and to some extent due to the present culture which discourages independent and critical thinking. Despite the situation, the most notable departments which regularly conduct research inlcude Anesthesiology, Obstetrics and Gynaecology, Medicine, Opthalmology, Otorhinolaryngology, Pediatrics, Physiology, Plastic surgery, Radiotherapy, Surgey and almost all the departments.

# Notable alumni
Ebstein's anomaly of the tricuspid valve associated abnormalities

# Associated Abnormalities
While Ebstein's anomaly is defined as the congenital displacement of the tricuspid valve towards the apex of the right ventricle, it is often associated with other abnormalities.

## Anatomy
Typically, there are anatomic abnormalities of the tricuspid valve, with enlargement of the anterosuperior leaflet of the valve which is often adherent to the right ventricular free wall.
About 50% of individuals with Ebstein's anomaly have an associated shunt between the right and left atriums, either an atrial septal defect ASD  or a patent foramen ovale PFO.
- The tricuspid valve leaflets are displaced toward the RV apex.
- The RV cavity is dilated and the free wall is thin.
- May be associated with LV dysfunction and mitral valve prolapse (MVP).
- It has also been associated with pulmonic stenosis  (PS), VSD, pulmonary hypertension, bicuspid aortic valve and right sided aortic arch.
-It is commonly associated with congenitally corrected transposition of the great vessels and occasionally with tetralogy of Fallot.
- Is often associated with one or more accessory conduction pathways in 25%, and WPW in 13%. Usually this is a right sided accessory pathway.
- The presence of an ASD permits right-to-left shunting and cyanosis. The degree of cyanosis is related to the degree of tricuspid regurgitation (TR), tricuspid stenosis (TS) and the compliance of the RV.
- Graphical represntation of Ebstein's Anomaly from the Mayo Clinic website (note there is also an ASD on this diagram)
- Ebstein Anomaly
Solitary pulmonary nodule evaluation of solitary pulmonary nodule

# Overview
A hallmark feature in the evaluation of pulmonary nodule is the malignancy risk assessment. The evaluation approach for pulmonary nodule will mainly depend in the initial morphological evaluation of the nodule (size, margins, contours, and growth). Other characteristics, such as location, clinical features, and distribution may be helpful in the risk assessment, management, surveillance, and follow-up of pulmonary nodule. Pulmonary nodule can be divided into 3 risk categories: low risk, intermediate/moderate, and high risk. Based upon these risk categories, complementary diagnostic studies and management include: PET/CT scan, CT scan, non-surgical biopsy, and surgical resection.

# Evaluation of Solitary Pulmonary Nodule

## Initial Evaluation Algorithm

# Malignancy Risk Assessment
The malignancy risk assessment for pulmonary nodule considers the following factors:
- Age
- Smoking
- Current
- Never smoker
- Cancer
- Extrathoracic cancer more than 5 years prior
- Nodule diameter
- Spiculation
- Yes
- No
- Upper lobe
- Yes
- No
- The risk calculator is not validated for patients with history of cancer in the past 5 years.
The malignancy of pulmonary nodule can be categorized into 3 groups:
Low Probability
- Usually less than < 5 percent
- The nodule size is less than or equal to 4 mm
- The nodule size may also be between  4 - 6 mm, with no associated risk factors
- Observation is suggested
- Observation usually involves radiologic surveillance with serial CT scans
Intermediate Probability
- Between 5 to 65 percent
- The nodule size is between 6 - 8 mm
- The nodule size is more than > 8 mm with associated risk factors
- Diagnostic testing is indicated: Positron emission tomography (PET), CT-FNA, and bronchoscopy
High Probability
- More than > 65 percent
- The nodule size is more than > 8 mm with associated risk factors
- Diagnostic testing is indicated: Positron emission tomography (PET), CT-FNA, and bronchoscopy
- Surgical excision
The patient risk assessment of pulmonary nodule can be categorized into 2 groups:
- High Risk Patients
- Patient age is > 35
- Positive smoking history
- Male patients
- Positive for prior malignancy
- Other associated risk factors.
- Low Risk Patients
- Patient age < 35
- No smoking history
- Female patients
- Negative for prior malignancy
- No associated risk factors
World Health Organization Framework Convention on Tobacco Control
The World Health Organization Framework Convention on Tobacco Control (abbreviated WHO FCTC) is a treaty adopted unanimously by the 56th World Health Assembly on May 21, 2003. It became the first World Health Organization treaty adopted under article 19 of the WHO constitution. The treaty came into force on February 27, 2005. It had been signed by 168 countries and is legally binding in 154 ratifying countries representing over 3 billion people. Notable non-parties are Russia (which has not signed the treaty) and the United States (which have signed but not ratified the treaty).
The objective of the treaty is "to protect present and future generations from the devastating health, social, environmental and economic consequences of tobacco consumption and exposure to tobacco smoke." To this end, the treaty provides a framework of national, regional and international tobacco control measures, including the setting of broad limits on the production, sale, distribution, advertisement, taxation, and government policies towards tobacco.
The United States has sought to change certain provisions of this treaty, but with limited success. Among the provisions opposed successfully were a mandatory ban on the distribution of free tobacco samples (which is now optional), a narrow definition of the term "minor" regarding the sale of tobacco (which now refers to domestic or national law) and broad limitations concerning the tobacco advertising, promotion and sponsorship (which were seen as violating free speech, and are now subject to constitutional limitations). Among the provisions unsuccessfully opposed by the U.S. were the requirement for warning labels to be written in the language of the country where the tobacco products are being sold, and the ban on deceptive and misleading descriptions such as "low tar" or "ultra-light", which might infringe on trademark protections.

# Requirements
Significant provisions of the treaty require that parties implement the following measures:
Wild-type (senile) ATTR amyloidosis epidemiology and demographics

# Overview
The incidence of amyloidosis is approximately 1.2 per 100,000 individuals per year worldwide.  The mortality rate of systemic amyloidosis is approximately 100 per 100,000 deaths in developed countries. In amyloidosis, the mean age of presentation is 55 - 60 years. Men are more commonly affected by amyloidosis than women.

# Epidemiology and Demographics

## Incidence
- The incidence of amyloidosis is approximately 1.2 per 100,000 individuals per year worldwide.

## Mortality rate
- The mortality rate of systemic amyloidosis is approximately 100 per 100,000 deaths in developed countries.

## Age
- In familial amyloidosis, the mean age of presentation is:
Transthyretin (TTR): After 50 years of age
The age of onset in TTR Val30Met variant of the disease in northern Portugal is in the early 30s
Apolipoprotein AI: Third decade and older
Apolipoprotein AII: Early adulthood
Fibrinogen Aa: Fourth to fifth decade
Lysozyme: Third to fourth decade
Gelsolin: Late adulthood
Cystatin C: Third to fourth decade
- Transthyretin (TTR): After 50 years of age
The age of onset in TTR Val30Met variant of the disease in northern Portugal is in the early 30s
- The age of onset in TTR Val30Met variant of the disease in northern Portugal is in the early 30s
- Apolipoprotein AI: Third decade and older
- Apolipoprotein AII: Early adulthood
- Fibrinogen Aa: Fourth to fifth decade
- Lysozyme: Third to fourth decade
- Gelsolin: Late adulthood
- Cystatin C: Third to fourth decade

## Race
- Hereditary amyloidosis subtypes include a substitution of an amino acid that is detected in approximately 4% of the african american population.

## Gender
- Men are more commonly affected by amyloidosis than women.

## Region
- Transthyretin-related hereditary amyloidosis is endemic in Portuguese locations Povoa de Varzim and Vila do Conde (Caxinas), with more than 1000 affected people, coming from about 500 families, where 70% of the people develop the illness.
- In northern Sweden, more specifically Pitea, Skelleftea and Umea, 1.5% of the population has the mutated gene.
- There are many other populations in the world who exhibit the illness after having developed it independently.
- The majority of gelsolin related amyloidosis cases are reported in the United States, Japan, Portugal, England, Germany, Spain, France, Brazil, Sewden, Denmark, the Czech Republic, and Iran.
Differentiating systemic lupus erythematosus from other diseases

# Overview
Systemic lupus erythematosus (SLE) must be differentiated from other diseases that cause skin rash, arthritis, positive autoimmune serology, weight loss, fevers and chronic pain, such as rheumatoid arthritis (RA), mixed connective tissue disease (MCTD), systemic sclerosis (SSc), dermatomyositis (DM), polymyositis (PM), and other autoimmune diseases.

# Differentiating systemic lupus erythematosus from other diseases
Systemic lupus erythematosus (SLE) must be differentiated from other diseases that cause skin rash, arthritis, positive autoimmune serology, weight loss, fevers and chronic pain, such as rheumatoid arthritis (RA), mixed connective tissue disease (MCTD), systemic sclerosis (SSc), dermatomyositis (DM), polymyositis (PM), and other autoimmune diseases.
Abbreviations:
ANA: Antinuclear antibody, RF: Rheumatoid factor, Anti-CCp: Anti-cyclic citrullinated protein antibody, Anti U1RNP: Anti-U1 ribonucleoprotein antibodies, Anti Sm: Anti-Sm antibodies, Anti Ro: Anti Ro antibody also called anti-Sjogren's-syndrome-related antigen A antibody, Anti-dsDNA: Anti-double stranded DNA.
(Up arrows represent higher amounts and down arrows represent lower amounts)
Just heard say he would put black and silver on his pod moves 96
Difficulty:
Moderately Challenging
Instructions
1 Learn on gold and silver bullion. There are any large quantity of bullion products besides the commonly traded gold or silver U.S. American Eagles, Canadian Maple Departs, also the South African Krugerrands. There are coins and bars from many countries, in diverse weights; some are sold in bulk rather other than individually. Find out which coins plus bars are provided with certificates of authentication.
2 Evaluate bullion sources. Consider both "brick and mortar" stores from your vicinity and online dealers. See whether the source claims to be any member of a professional organization, such as the Industrial Council for Discernible Assets. Check to any complaints concerning the dealer with the Better Business Office in the metropolis where the source is. Unearth out, if you can, the way long the dealer has been within business. Learn whether the dealer will allow return regarding your buy within a given interval about time if you are not satisfied. If a buyback yous promised, be because absolutely as you may that the dealer will honor it. Gold Bullion Silver Coins.
3 Establish the conditions of sale if you are buying online. In addition to the quoted price, here might be additional charges to postage, insurance also probably a sales commission. While you location one buy for bullion, it is potential that you are agreeing to acquire and the dealer to sell on the price in impact at the time your payment is received. The fastest--plus recommended--way to pay is to post a bank wire. Sending a cashier's check, cash order or personal examine could hold off the transaction pair to three weeks, during which time the price could change.
4 Purchase the bullion you have decided to purchase away from the source you have picked.
Suggestions & Warnings
Some dealers might require a minimum pay for.
Perform not buy bullion coins at rare-coin prices.
References
Better Business Bureau: "FTC -- Investing in Uncommon Coins website: Metals Quotes internet site: Bullion
Means website: Metals Quotes website: Spot Prices internet site: Place Costs
Picture Credit 
coins picture by Maria Brzostowska from website ;
Read Following:
Major or mild neurocognitive disorder due to Alzheimer's disease

# Overview

# Major or Mild Neurocognitive Disorder Due to Alzheimer's Disease

## DSM-V Diagnostic Criteria for Major or Mild Neurocognitive Disorder Due to Alzheimers Disease 

# Epidemiology and Demographics

## Prevalence
By age group, the prevalence of major or mild neurocognitive disorders due to Alzheimer's disease is:
- 7,000 per 100,000 (7%) in ages 65-74 years
- 53,000 per 100,000 (53%) in ages 75-84 years
- 40,000 per 100,000 (40%) in ages 85 years and older

# Risk Factors
Risk factors for the development of neurocognitive disorders due to Alzheimer's disease include:
- Age
- Down's syndrome
- Genetic predisposition
- Multiple vascular risk factors
- Traumatic brain injury

# Differential Diagnosis
- Major depressive disorder
- Other neurocognitive disorders
- Frontotemporal lobar degeneration
- Lewy body disease
- Other concurrent, active neurological or systemic illness
- Thyroid disorders
- Vitamin B12 deficiency