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When referencing the gods buy cheap ciloxan 5 ml line, the reasons for their divine interference can be categorized into actions based on predetermined fates of an individual 5 ml ciloxan visa, actions taken arbitrarily against an individual due to quality 5 ml ciloxan other circumstances discount 5 ml ciloxan free shipping, or a directed attack against an individual. The concept of a predetermined fate is alluded to in passages protecting the owner of the decree from the book of �That which is in the year� (L2, recto 77 78). The closest reference to divine punishment 24 the provenance of these texts is largely unknown, except for C. While the gods had a variety of reasons to harm an individual, their exact means of infecting them are not well documented in the Oracular Amuletic Decrees. The medical texts, however, mention several ways in which the gods can cause illness in an individual. A god could send their own disease demons to cause illness indirectly, such as is most commonly mentioned with Sekhmet. Alternatively, a god could harm an individual through their influence (or even �stroke,� s. The aAa and other disease substances could cause illness in any part of the body by travelling through the mtw�a series of interconnected vessels of the body which could transport both air and blood and likely represented some combination of the cardiovascular system with other aspects of human anatomy from the urinary and nervous system (Nunn 1996, 44�49). These substances could 26 In these texts, as apotropaic amulets for children, it may not be suitable to mention specific ill behaviors on the part of the owner of the text. Ebers 296), an image which simultaneously evokes the malignancy of Apophis and the tangible association between parasitic worms and illness (Lang 2013, 110). The will of the gods was thus a primary concern during the New Kingdom in Egypt, and medical treatments in many cases would have had to influence divine will in order to be effective. Though deities did not appear to enter an individual directly, they could use their divine semen or demons to introduce a contamination into a sick person�s body. This categorical link between demons, the gods, and disease can be seen in the placement of demons in the texts; in some cases, demons are mentioned among a broader list of gods (T. By associating the demons with disease itself, the Egyptian ideology blurs the boundary between symptoms, disease, and agent. The two 35 In this case, this form denotes indirect speech in Late Egyptian (Peust 1996). The following phrase (�remove this illness�) would thus be said by the recipients of the letter. These two sets of demons act under the will of the divine, specifically Sekhmet and Bastet (Lucarelli 2010, 3), and are sometimes mentioned in conjunction with similar sets of disease demons such as the wpw. Edwin Smith and in the Calendar of Good and Bad Days, these demons were seen as particularly virulent during epagomenal days� the five days at the end of the year (Leitz 1994, 44�55). This period was viewed as particularly dangerous owing to its liminal position at the boundary of the old and new year. The use of the falcon standard and dead man/evil39 determinatives in their orthography suggests that they were both divine and malignant, and though the names are sometimes written in the singular, they are often referred to as plural entities (Edwards 1960a, 5, note 36). Through this imagery, I suggest that disease demons were personified by pests, an idea corroborated by the placement of an incantation for cleansing a man who has swallowed a fly just after incantations against the disease demons in P. This also explains the nature of these disease demons themselves as insects would have been more active after the inundation during the transition into the New 37 these demons are mentioned in both P. The hieratic interchange/conflation of ns and nDs is documented by Moller (1909, sign 161). Lucarelli suggests that, �The generally aggressive nature of the guardian demons is motivated by the need to protect their abode and is therefore sensible in some measure, as such, they are fundamentally different from disease demons, who invade the human body and other places they do not belong to� (2010, 4). Yet, this assessment may draw too fine a differentiation between the modes of attack and functions of the two. Instead, I suggest that in both cases, the disease demons would have been perceived as attacking an individual based 40 the wr. The disease demons were able to infect their victims through vicious attacks on the body. Leiden 346 I 1 3, the disease demons are described as those �who bring slaughtering about, who create uproar, who hurry through the land, who shoot their arrows from their mouths� (Borghouts 1978, 12). After attacking, they could then enter the body, as described in the following passage about a nsj. These demons were thus the infection themselves, not only bearing disease but manifesting it inside the body through the whim of the deity. They are often mentioned just before or after demons, and are usually listed specifically by region. It is used in other contexts to denote stretching out the arm in hostility and therefore striking or attacking the victim. Medical care would thus ideally treat the sick by removing the magic, and protecting an individual from repeated attacks by the malevolent foreigner. It is interesting to note that these texts do not specify other dangerous ways animals could cause traumatic injuries through clawing or ramming the body. Instead, the focus is on these poisonous bites and stings, which are mentioned in 13 of the texts. The need to protect against snakes and scorpions specifically thus demonstrates that the fear is not only of trauma, but of bites or stings that introduce poison into the body. His objective to prove his power and precedence over Horus would have also been perceived as a bodily attack and perhaps even an attempt to infect Horus with illness. They are mentioned nine times in the decrees and usually differentiated between male and female. The medical texts often mention the spirits of the dead in conjunction with the gods as both used the same indirect methods to disease an individual, namely their influence, shadow, and semen.

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Burst Pressure Pressure at which a pressure containment device would fail structurally discount 5 ml ciloxan. Certified Diver A diver who holds a recognized valid certification from an organizational member or internationally recognized certifying agency generic ciloxan 5ml amex. Controlled Ascent Any one of several kinds of ascents including normal ciloxan 5ml low price, swimming order ciloxan 5ml without a prescription, and air sharing ascents where the diver(s) maintain control so a pause or stop can be made during the ascent. Decompression Sickness A condition with a variety of symptoms, which may result from gas, and bubbles in the tissues of divers after pressure reduction. Dive A descent into the water, an underwater diving activity utilizing compressed gas, an ascent, and return to the surface. Dive Computer A microprocessor based device which computes a diver�s theoretical decompression status, in real time, by using pressure (depth) and time as input to a decompression model, or set of decompression tables, programmed into the device. Dive Table A profile or set of profiles of depth time relationships for ascent rates and breathing mixtures to be followed after a specific depth time exposure or exposures. Diver An individual in the water who uses apparatus, including snorkel, which supplies breathing gas at ambient pressure. Diver In Training An individual gaining experience and training in additional diving activities under the supervision of a dive team member experienced in those activities. Diver Carried Reserve Breathing Gas A diver carried independent supply of air or mixed gas (as appropriate) sufficient under standard operating conditions to allow the diver to reach the surface, or another source of breathing gas, or to be reached by another diver. Diving Mode A type of diving required specific equipment, procedures, and techniques, for example, snorkel, scuba, surface supplied air, or mixed gas. Emergency Ascent An ascent made under emergency conditions where the diver exceeds the normal ascent rate. This number, expressed in units of feet seawater or saltwater, will always be less than the actual depth for any enriched air mixture. Hookah While similar to Surface Supplied in that the breathing gas is supplied from the surface by means of a pressurized hose, the supply hose does not require a strength member, pneumofathometer hose, or communication line. The diver is responsible for the monitoring his/her own depth, time, and diving profile. Hyperbaric Conditions Pressure conditions in excess of normal atmospheric pressure at the dive location. Lead Diver Certified scientific diver with experience and training to conduct the diving operation. Maximum Working Pressure Maximum pressure to which a pressure vessel may be exposed under standard operating conditions. Nitrox Any gas mixture comprised predominately of nitrogen and oxygen, most frequently containing between 21% and 40% oxygen. No Decompression limits Depth time limits of the �no decompression limits and repetitive dive group designations table for no decompression air dives� of the U. Normal Ascent An ascent made with an adequate air supply at a rate of 60 feet per minute or less. Oxygen Compatible A gas delivery system that has components (o rings, valve seats, diaphragms, etc. Oxygen Service A gas delivery system that is both oxygen clean and oxygen compatible. Pressure Related Injury An injury resulting from pressure disequilibrium within the body as the result of hyperbaric exposure. Examples include: decompression sickness, pneumothorax, mediastinal emphysema, air embolism, subcutaneous emphysema, or ruptured eardrum. Scuba Diving A diving mode independent of surface supply in which the diver uses open circuit self contained underwater breathing apparatus. Standby Diver A diver at the dive location capable of rendering assistance to a diver in the water. Surface Supplied Diving Surface Supplied: Dives where the breathing gas is supplied from the surface by means of a pressurized umbilical hose. The umbilical generally consists of a gas supply hose, strength member, pneumofathometer hose, and communication line. Swimming Ascent An ascent, which can be done under normal or emergency conditions accomplished by simply swimming to the surface. Umbilical Composite hose bundle between a dive location and a diver or bell, or between a diver and a bell, which supplies a diver or bell with breathing gas, communications, power, or heat, as appropriate to the diving mode or conditions, and includes a safety line between the diver and the dive location. It is essential that emergency procedures are pre planned and that medical treatment is initiated as soon as possible. General Procedures Depending on and according to the nature of the diving accident: 1. Administer 100% oxygen, if appropriate (in cases of Decompression Illness, or Near Drowning). Explain the circumstances of the dive incident to the evacuation teams, medics and physicians. Do not assume that they understand why 100% oxygen may be required for the diving accident victim or that recompression treatment may be necessary. Call appropriate Diving Accident Coordinator for contact with diving physician and decompression chamber. List of Emergency Contact Numbers Appropriate For Dive Location Available Procedures � Emergency care � Recompression � Evacuation Emergency Plan Content � Name, telephone number, and relationship of person to be contacted for each diver in the event of an emergency. Only those makes and models of dive computers specifically approved by the Diving Control Board may be used.

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The effects of the drugs over heart and drug drug interactions must taken into account of medical treatment 5ml ciloxan mastercard. During the treatment clinicians must be sensitive about their patient�s psychiatric symptoms and disorders effective ciloxan 5ml. Acknowledgment We offer thanks to buy generic ciloxan 5 ml on-line our team for suggesting that we write a book about ciloxan 5ml with visa. Acute myocardial infarction and posttraumatic stres disorder: the consequences of cumulative adversity. Association Between Anxiety and C Reactive Protein Levels in Stable Coronary Heart Disease Patients. Association between C reactive protein and generalized anxiety disorder in stable coronary heart disease patients. Sociodemographic characteristics and cardiovascular risk factors in patients with severe mental disorders compared with the general population. Evaluation of preoperative anxiety and depression in patients undergoing invasive cardiac procedures. Increased Risk of Acute Myocardial Infarction for Patients With Panic Disorder: A Nationwide Population Based Study. The 2009 Carl Ludwig Lecture: pathophysiology of the human sympathetic nervous system in cardiovascular diseases: the transition from mechanisms to medical management. Coronary risk appraisal for primary prevention of coronary heart disease in a community. Dilemma in predicting the infarct related artery in acute inferior myocardial infarction: A case report and review of the literature. Emotion, Psychiatric Disorders, and the Heart, In: Textbook of Cardiovascular Medicine, Braunwald E (ed), 3rd ed. Clinical utility of different lipid measures for prediction of coronary heart disease in men and women. Early Onset Depression, Anxiety, and Risk of Subsequent Coronary Heart Disease 37 Year Follow Up of 49,321 Young Swedish Men. Assessing risk factors of coronary heart disease and its risk prediction among Korean adults: the 2001 Korea National Health and Nutrition Examination Survey. Pentagastrin induced hemoconcentration in healthy volunteers and patients with panic disorder: effect of pretreatment with ethinyl estradiol. Relationship between psychological profile and cardiological variables in chronic heart failure. Heart Rate and Blood Pressure Changes During Autonomic Nervous System Challenge in Panic Disorder Patients. Takotsubo cardiomyopathy: an acute and reversible cardiomyopathy mimicking acute myocardial infarction. Is anxiety early after myocardial infarction associated with subsequent ischemic and arrhythmic events. Distinguishing a Heart Attack From the "Broken Heart Syndrome" (Takotsubo Cardiomyopathy). Selective serotonin re uptake inhibitors for the treatment of depression in coronary artery disease and chronic heart failure: evidence for pleiotropic effects. Sertraline for the treatment of depression in coronary artery disease and heart failure. Takotsubo cardiomyopathy: report of the first case series in Serbia and review of the literature. Role of depression in heart failure choosing the right antidepressive treatment. Takotsubo cardiomyopathy presenting as multivessel coronary spasm syndrome: case report and review of the literature. Acute Lead Exposure Increases Arterial Pressure: Role of the Renin Angiotensin System. Affective disorders in acute myocardial infarction and possibilities of their correction with tianeptin. Proarrhythmic risk with antipsychotic and antidepressant drugs: implications in the elderly. Association of anxiety with reduced baroreflex cardiac control in patients after acute myocardial infarction. World Health Organization, "The World Health Report 2006 � working together for health". Anxiety is a better predictor of platelet reactivity in coronary artery disease patients than depression. Introduction Lives can be severely disrupted after a momentous negative experience. Particularly potent are unexpected negative events, or �traumas,� such as a near death experience, a severe injury, or being exposed to intense interpersonal violence or a natural disaster. Although most people recover from these traumatic events, many do not, and experience persistent fear, anxiety and/or depression following the event. In the past, these maladaptations after trauma were considered to be a reflection of personal weaknesses and were stigmatized. Now, after 30 years of research, the physiological responses to severe stress and trauma are being increasingly understood, as are the risk factors for a pathological response to trauma. These reactions are characterized by a period of emotional numbness, depersonalization or derealization in the days after the trauma, followed by a longer period of anxiety, insomnia, nightmares, painful memories and phobic avoidance. However, these symptoms were considered to be time limited responses to combat or other sudden, unexpected trauma, much as grief was a time limited reaction to personal loss (McHugh & Treisman, 2007).

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Cross References Hypergraphia; Utilization behaviour Automatism Automatisms are complex motor movements occurring in complex motor seizures buy ciloxan 5ml without prescription, which resemble natural movements but occur in an inappropriate set ting generic ciloxan 5 ml visa. These may occur during a state of impaired consciousness during or shortly after an epileptic seizure purchase 5 ml ciloxan. Automatisms occur in about one third of patients with complex partial seizures discount 5ml ciloxan, most commonly those of temporal or frontal lobe origin. Although 52 Autoscopy A there are qualitative differences between the automatisms seen in seizures arising from these sites, they are not of sufcient specicity to be of reliable diagnostic value; bizarre automatisms are more likely to be frontal. Automatisms may take various forms: � Oro facial movements: for example, lip smacking, chewing and swallowing movements, saliva tion (especially temporal lobe origin). Cross References Absence; Aura; Pelvic thrusting; Poriomania; Seizure Autophony the perception of the reverberation of ones own voice, which occurs with external or middle, but not inner, ear disease. Autoscopy Autoscopy (literally �seeing oneself�) is a visual hallucination of ones own face, sometimes with upper body or entire body, likened to seeing oneself in a mirror (hence mirror hallucination). Unlike heautoscopy, there is a coincidence of egocentric and body centred perspectives. Autoscopy may be associated with parieto occipital space occupying lesions, epilepsy, and migraine. Cross References Hallucination; Heautoscopy Autotopagnosia Autotopagnosia, or somatotopagnosia, is a rare disorder of body schema charac terized by inability to identify parts of the body, either to verbal command or by imitation; this is sometimes localized but at worst involves all parts of the body. This may be a form of category specic anomia with maximum difculty for naming body parts or one feature of anosognosia. Finger agnosia and right�left disorientation are partial forms of autotopagnosia, all of which are most often seen following cerebrovascular events involving the left parietal area. Autotopagnosia: occurrence in a patient without nominal aphasia and with an intact ability to point to parts of animals and objects. Cross References Agnosia; Anosognosia; Finger agnosia; Gerstmann syndrome; Right�left disori entation; Somatoparaphrenia 54 B Babinski�s Sign (1) Babinski�s sign is a polysynaptic cutaneous reex consisting of an extensor movement (dorsiexion) of the big toe on eliciting the plantar response, due to contraction of extensor hallucis longus. There may be in addition fanning (abduction) of the other toes (fan sign; signe de l�eventail) but this is neither necessary nor sufcient for Babinski�s sign to be judged present. There may be simultaneous contraction of other limb exor muscles, consistent with the notion that Babinski�s sign forms part of a exion synergy (withdrawal) of the leg. The use of the term �negative Babinski sign� to indicate the normal nding of a down going (exor; plantar exion) big toe is incorrect, �exor plantar response� being the appropriate description. The plantar response is most commonly performed by stroking the sole of the foot, although many other variants are described. Babinski�s sign is a normal nding in infants with immature (unmyelinated) corticospinal tracts; persistence beyond 3 years of age, or re emergence in adult life, is pathological. In this context, Babinski�s sign is considered a reliable (�hard�) sign of corticospinal (pyramidal) tract dysfunction (upper motor neurone pathol ogy) and may coexist with other signs of upper motor neurone dysfunction. However, if weakness of extensor hallucis longus is one of the features of upper motor neurone dysfunction, or from any other cause, Babinski�s sign may be unexpectedly absent although anticipated on clinical grounds. Other causes of Babinski�s sign include hepatic coma, postepileptic seizure, deep sleep following prolonged induced wakefulness, and cataplectic attack, hence it is not necessarily a consequence of a permanent and irreversible lesion of the pyramidal tracts. In the presence of extrapyramidal signs, it is important to distinguish Babinski�s sign, a �pyramidal sign�, from a striatal toe (spontaneous up going plantar). This observation indicated to Babinski the periph eral (facial nerve) origin of hemifacial spasm. It may assist in differentiating hemifacial spasm from other craniofacial movement disorders. Cross Reference Hemifacial spasm Babinski�s Trunk�Thigh Test Babinski�s trunk�thigh test, also known as the �rising sign�, is suggested to be of use in distinguishing organic from functional paraplegia and hemiplegia (the abductor sign may also be of use in the former case, Hoover�s sign in the latter). The recumbent patient is asked to sit up with the arms folded on the front of the chest. In organic hemiplegia there is involuntary exion of the paretic leg, which may automatically rise higher than the normal leg; in paraplegia both legs are involuntarily raised. In functional paraplegic weakness neither leg is raised, and in functional hemiplegia only the normal leg is raised. This pattern of facial sensory impairment may also be known as onion peel or onion skin. Cross Reference Onion peel, Onion skin Balint�s Syndrome Balint�s syndrome, rst described by a Hungarian neurologist in 1909, consists of: � Simultanagnosia (q. Not all elements may be present; there may also be coexisting visual eld defects, hemispatial neglect, visual agnosia, or prosopagnosia. Balint�s syndrome results from bilateral lesions of the parieto occipital junc tion causing a functional disconnection between higher order visual cortical regions and the frontal eye elds, with sparing of the primary visual cortex. Balint syndrome has also been reported as a migrainous phenomenon, following traumatic brain injury and in association with Alzheimer�s disease, brain tumour (buttery glioma), radiation necrosis, progressive multifocal leucoencephalopa thy, Marchiafava�Bignami disease with pathology affecting the corpus callosum, and X linked adrenoleucodystrophy. Cross References Apraxia; Blinking; Ocular apraxia; Optic ataxia; Simultanagnosia Ballism, Ballismus Ballism or ballismus is a hyperkinetic involuntary movement disorder char acterized by wild, inging, throwing movements of a limb. These movements most usually involve one half of the body (hemiballismus), although they may sometimes involve a single extremity (monoballismus) or both halves of the body (paraballismus). Clinical and pathophysiological studies suggest that ballism is a severe form of chorea. It is most commonly associated with lesions of the contralateral subthalamic nucleus. Beevor�s Sign Beevor�s sign is an upward movement of the umbilicus in a supine patient attempting either to ex the head onto the chest against resistance. It indicates a lesion causing rectus abdominis muscle weakness below the umbilicus.

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These factors may be compounded order ciloxan 5ml visa, increasing the risk of co morbidities cheap ciloxan 5 ml amex, and the economic impact and socio economic disadvantage of families with certain genetic conditions can be compounded through successive generations cheap ciloxan 5 ml without prescription. Health economics is the study of the economics of health systems: the efficiency discount ciloxan 5 ml on-line, effectiveness, value and behaviour in the production and consumption of health and healthcare. In reality, the externalities involved in any change in such a complex system are likely to be hard to account for with any degree of confidence, particularly given that health is strongly linked with the economic productivity of workers. This may account for some of the notorious difficulty of health service management. A greater range of treatments is often available for cancers, including surgical, chemical, biological and radiation treatments. These therapies are known as somatic treatments because they notionally intervene in somatic cells (the cells of the body that are not involved in reproduction) as opposed to the reproductive cells that comprise the �germ line� (which, if altered, can lead to the alteration being passed on to offspring). Many interest groups sustained either by patients themselves or by pharmaceutical companies offer strong advocacy for the funding and development of new treatments for genetic diseases, including the extension of reproductive options. These play a role not only in how different genotypes are expressed for an embodied individual, but also in the way that people are able to respond to their situation. These conditions include the physical environment and social context (ramps for wheelchairs, supportive family and communities, public services, anti discrimination legislation), as well as their social and cultural context (genetic conditions may have culturally specific meanings that vary significantly between cultures). For example, the need for assistance, care and treatment may be hard for some people to accept while, for others, they reinforce valued interpersonal bonds. The genome editing systems, and the prospects and limitations of genome editing gene therapies were discussed in our report, Nuffield Council on Bioethics (2016) Genome editing: an ethical review, available at: nuffieldbioethics. This has led some countries to introduce genetic non discrimination legislation in attempts to redress what may be seen as actuarially reasonable but socially unjust penalties for those with pre existing genetic diagnoses. Routine use of information technologies and recent developments in data science, however, make such measures increasingly insecure. It is easy to see how having a genetic predisposition 54 See: Human Genetics Commission (2011) the concept of genetic discrimination, available at: webarchive. Under the Concordat and moratorium, insurers agree not to use the results of genetic tests in underwriting decisions except where approved by a committee convened by the Department of Health. Only one test (for Huntingdon�s disease for life insurance policies with a value of over 500,000) has been approved for this purpose. Arrangements were put in place by the Department of Health for the constitution of an ad hoc committee to review applications, should this prove necessary. Prospective parents may decide to conceive without assistance and not to have testing during pregnancy. They may welcome having a child whether or not the child is affected by the condition, or, though they might prefer to have an unaffected child, they might not consider any other options acceptable. The information it gives can help the pregnant woman prepare for the birth of a child with or without the condition. Information from the tests is used to decide which embryo (or embryos) should be transferred to the womb. The woman�s eggs are then mixed with her male partner�s sperm in the laboratory and the formation of the embryos is monitored. A very common 59 the usual case would be two parents, one male and one female, although there may be situations in which a woman or man (using the services of a female surrogate), whether alone or in a same sex relationship, may be at risk of passing on a genetic condition. A few cells are then removed from each resulting embryo, usually from the trophectoderm cell population (the group of cells that would go on to form the placenta in pregnancy) at approximately five to six days after fertilisation. The embryos are usually frozen while the test is carried out on the biopsied cells and the results obtained. A decision can then be made about which embryos, if any, to thaw and place in the woman�s womb in the hope of establishing a pregnancy. However, in the rare case that a couple carry two disorders, the chances of obtaining an unaffected embryo would diminish. In a very few cases, because of the nature of the genetic endowment of the parents and the mode of inheritance, a given couple may be unable to produce any embryos that do not have a genetic condition they wish to exclude in their offspring. Furthermore, the chances of having a child with selected characteristics are further reduced by the likelihood of any given embryo resulting in a live birth. There is no finer detail of the case mix, but it may be assumed that the majority are autosomal recessive conditions and chromosomal rearrangements. The limiting constraint in the first approach is the availability of mature eggs (sperm are sufficiently numerous and can usually be obtained without surgical intervention). In other words, we are interested in how we �frame� questions about genome editing in human reproduction. Interrogating the framing of social phenomena helps to reveal what people think they are talking about when they engage in discussion of a particular subject, and therefore how meanings are assigned, asserted and circumscribed and how misunderstandings arise. In our 2016 report, Genome editing: an ethical review, we said: �Genome editing is not straightforwardly therapeutic in the way that gene therapy is therapeutic, treating an existing patient who is affected by an unwelcome condition; 68 Finding a suitable embryo will still depend on chance and on segregation of the various alleles associated with disorders. In any case, the more characteristics being screened for, the less likely it is to find an embryo with none of them. Their findings suggest that presenting information about genetic modification as contrasting vignettes using one of five �framing� metaphors (genetic editing, engineering, hacking, modification or surgery) made little difference to public attitudes. On the other hand, it is therapeutic, in the sense that it potentially overcomes infertility (albeit that the infertility is voluntary, a hard choice among an undesirable set of options) and it is preventative in that, taking the decision to reproduce as given (or, at least, one that a couple is entitled to make and should not be prevented from making), it may prevent any child they have being born with a serious or life limiting disability. They are also often obscure, perhaps even to the people themselves, and furthermore, practically impossible for others to verify. This is no doubt all the more true in cases in which there is a known, non negligible prospect of having a child with a genetic condition.

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