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Aqueous beclomethasone dipropionate nasal spray: regular versus as required use in the treatment of seasonal allergic rhinitis buy clarithromycin toronto gastritis diet . Aqueous beclomethasone dipropionate in the treatment of ragweed pollen-induced rhinitis: further exploration of as needed use cheap 250 mg clarithromycin fast delivery gastritis definition symptoms. The effect of disodium- cromoglycate and beclomethasone diproprionate on the immediate response of the nasal mucosa to allergic challenge buy clarithromycin 500mg otc gastritis skin symptoms. The effect of sodium cromoglycate on the antigen-induced nasal reaction in allergic rhinitis as measured by rhinomanometry and symptomatology. Responses of the nonallergic rhinitis with eosinophilia syndrome to 4% cromolyn sodium nasal solution. A comparative trial of intranasal beclomethasone diproprionate and sodium cromoglycate in patients with chronic perennial rhinitis. Double-blind cross-over trial comparing beclomethasone diproprionate and sodium cromoglycate in perennial allergic rhinitis. A comparative trial of flunisolide and sodium cromoglycate nasal sprays in the treatment of seasonal allergic rhinitis. The effect of disodium cromoglycate and beclomethasone diproprionate on the immediate response of the nasal mucosa to allergen challenge. Pharmacologic intervention is discussed in the chapters relating to specific allergic diseases and in the chapters devoted to specific pharmacologic drug classes. The immunologic interventions avoidance of allergens and immunotherapy are the subjects of this chapter. In drier climates such as Sweden (7) and New Mexico (8), sensitization to cat and dog dander has been associated with increased risk for asthma. Children in the inner city who become sensitized to cockroach allergens are at increased risk for asthma (9). All of these studies suggest that avoidance of sensitization might reduce the predisposition to asthma. If exposure to the antigen or allergen can be avoided, no antigen antibody interaction takes place, and thus there are no allergic disease manifestations. Consequently, the first tenet of allergic management is to remove the allergen if possible. For instance, an individual who is sensitive to cat or dog dander or other animal protein should not have the animal in the home if complete control of symptoms is the goal of management. Another example would be an individual who is sensitive to certain foods or drugs. House Dust Mite In the case of house dust mite allergy, complete avoidance is not possible in most climates, but the degree of exposure to this allergen can be diminished. Control measures to reduce house dust mite exposure The effectiveness of controlling mite allergens in beds by using encasings is well established ( 12,13). Washing linens in hot water (>130 F) or tumble-drying at a temperature of more than 130 F for 10 minutes will essentially kill all mites ( 14,15). It is well recognized that carpet is a reservoir for mites; polished floors are preferable, especially in the bedroom ( 14). Several studies have reported the association between indoor humidity and dust mite allergen levels ( 16,17). Although steam cleaning of carpets or use of acaricides can kill mites, the reduction tends to be incomplete and short lived. Vacuum cleaning does help to reduce the overall allergen burden but is not likely to result in control of allergen from reservoirs like carpet and stuffed furniture (14). Mold Spores Exposure to mold spores may also be reduced by environmental precautions (18). The patient should avoid entering barns, mowing grass, and raking leaves because high concentrations of mold spores may be found there. Bathrooms, kitchens, and basements require adequate ventilation and frequent cleaning. Water-damaged furnishings or structural elements should be completely replaced to avoid mold growth. Cockroach Allergens Control of cockroach allergen exposure may be very difficult, especially in the inner city. The National Co-operative Inner-City Asthma Study Group reported that intervention using abamectin applied by professional exterminators resulted in decreased Bla g 1 levels in the kitchen, only for a short time. Moreover, even the reduced levels were above those considered clinically significant ( 19). However, at the end of the 8-month study, levels of Bla g 1 were still above the clinically significant level of 20 units per gram of house dust ( 20). In a study of cockroach extermination with hydramethylnon, there was persistence of elevated Bla g 1 and Bla g 2 6 months after treatment (21). Taken together, the results of these studies indicate that pesticides applied by professional pest control technicians are effective. Animal Dander Compared with house dust mite and cockroach allergen, animal aeroallergens are associated with smaller particles that remain airborne for hours; thus, there is a rationale for using air filtration. Air-conditioning and air-filtration systems reduce but do not eliminate exposure to these pollens. These terms are not strictly correct in that they imply a mechanism that has not been proved. Desensitization applies to clinical situations in which antigens are administered in a few hours in sufficient quantity to neutralize available immunoglobulin E (IgE) antibody rapidly ( 27). This type of true desensitization may be necessary in treating patients with allergy to an antibiotic. Immunotherapy, a term introduced by Norman and co-workers (28), does not imply a mechanism. It consists of injections of increasing amounts of allergen to which the patient has type I immediate hypersensitivity. As a result of these injections, the patient is able to tolerate exposure to the allergen with fewer symptoms. The mechanism by which this improvement occurs has not been definitely established. However, over the years, several mechanisms have been postulated to account for the improvement. Immunotherapy was first used by Noon and Freeman, who observed that pollen was the etiologic agent of seasonal rhinitis and that immunization was effective in the treatment of various infectious diseases, including tetanus and diphtheria. Cooke ( 29) observed that cutaneous reactivity was not obliterated by allergy injections. Cooke also discovered a serum factor, which he called blocking antibody, in the serum of patients receiving immunotherapy ( 30). This serum factor could inhibit the passive transfer of allergic antibody described by Prausnitz and Kstner.

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The main determinants may be differences in payment of health services and available hospital beds and surgeons cheap clarithromycin 500mg with mastercard gastritis diet . Lewis generic clarithromycin 500mg without a prescription dr weil gastritis diet, "Variations in the Incidence of Surgery cheap clarithromycin 250mg mastercard gastritis elimination diet," New England Journal of Medicine 281 (1969): 880-4, finds three- to fourfold variations in regional rates for six common surgical procedures in the U. The number of surgeons available was found to be the significant predictor in the incidence of surgery. Doyle, "Unnecessary Hysterectomies: Study of 6,248 Operations in Thirty-five Hospitals During 1948," Journal of the American Medical Association 151 (1953): 360-5. Doyle, "Unnecessary Ovariectomies: Study Based on the Removal of 704 Normal Ovaries from 546 Patients," Journal of the American Medical Association 148 (1952): 1105-11. Weller, "Pediatric Perceptions: The Pediatrician and latric Infectious Disease," Pediatrics 51 (April 1973): 595-602. For the physician accustomed to dealing only with pathologic entities, terms such as "nondisease entity" or "nondisease" are foreign and difficult to comprehend. This paper presents, with tongue in cheek, a classification of nondisease and the important therapeutic principles based on this concept. Iatrogenic disease probably arises as often from treatment of nondisease as from treatment of disease. Stamm, "The Morbidity of Cardiac Nondisease in School Children," New England Journal of Medicine 276 (1967): 1008-13. Gives one particular example from the "limbo where people either perceive themselves or are perceived by others to have a nonexistent disease. The ill effects accompanying some nondiseases are as extreme as those accompanying their counterpart diseases. Andriola, "A Note on Possible Iatrogenesis of Suicide," Psychiatry 36 (1973): 213-18. Doctors learn at our risk, they experiment and kill with sovereign impunity, in fact the doctor is the only one who may kill. They go further and make the patient responsible: they blame him who has succumbed. Citizens were not covered by these statutes, but could avenge malpractice on their own initiative. The Roman laws ordained that physicians should be punished for neglect or lack of skill (the Cornelian laws, De Sicariis, inst. If the physician was a person of any fortune or rank, he was only condemned to deportation, but if he was of low condition he was put to death. The Roman laws were not made under the same circumstances as ours: in Rome every ignorant pretender meddled with physic, but our physicians are obliged to go through a regular course of study and to take degrees, for which reason they are supposed to understand their profession. In this passage the 17th-century philosopher demonstrates an entirely modern optimism about medical education. Tamplin, "Epidemiological Studies of Carcinogenesis by Ionizing Radiation," in Proceedings of the Sixth Berkeley Symposium on Mathematical Statistics and Probability, Univ. The presumption is all too common that where uncertainty exists about the magnitude of carcinogenic effects, it is appropriate to continue the exposure of humans to the risk. The authors show that it is neither appropriate nor good public- health practice to demand human epidemiological evidence before stopping exposure. The argument against ionizing radiation from nuclear generation of electrical energy can be applied to all medical treatment in which there is uncertainty about genetic impact. The competence of physicians to establish levels of tolerance for entire populations must be questioned on theoretical grounds. House of Representatives, Committee on Interstate and Foreign Commerce, An Overview of Medical Malpractice, 94th Cong. One of the largest pockets of unrecognized malnutrition in America and Canada exists, not in rural slums or urban ghettos, but in the private rooms and wards of big-city hospitals. Mayer, "Iatrogenic Malnutrition," New England Journal of Medicine 284 (1971): 1218. Lowrey, "The Problem of Hospital Accidents to Children," Pediatrics 32 (December 1963): 1064-8. Huntley, "The Hazards of Hospitalization," Southern Medical Journal 60 (May 1967): 469-72. According to their etiology, they fall into several categories: those resulting from diagnosis and treatment, those relating to social and psychological attitudes and situations, and those resulting from man-made programs for the control and eradication of disease. Besides iatrogenic clinical entities, he recognizes other maladies that have a medical etiology. Internationaler Fortbildungskurs fur praktische und wissenschaftliche Pharmazie der Bundesapothekerkammer in Meran (Frankfurt am Main: Werbe- und Vertriebsgesellschaft Deutscher Apotheker, 1971). Quinn, "Next Big Industry: Environmental Improvement," Harvard Business Review 49 (September-October 1971): 120-30. Implicitly the same argument is being made for the health-care field by the proponents of no-fault malpractice insurance. See reproduction of his drawing "Nemesis medicale" in Werner Block, Der Artzt und der Tod in Bildem aus seeks Jahrhunderten (Stuttgart: Enke, 1966). Swazey and Rene Fox, "The Clinical Moratorium: A Case Study of Mitral Valve Surgery," in Paul A. Model for a study of medicine by a newspaper reporter who knows how to combine studies in medicine with information that is significant but has been overlooked, repressed, or veiled in medical literature. Moore, "The Therapeutic Innovation: Ethical Boundaries in the Initial Clinical Trials of New Drugs and Surgical Procedures," in Freund, ed. The first wave was aimed mostly (2/3) at female state hospital patients, and claimed 50,000 persons in the U. New methods are available to destroy parts of the brain by ultrasonic waves, electric coagulation, and implantation of radium seeds. The technique is promoted for the sedation of the elderly, to render their institutionalization less expensive; for the control of hyperactive children; and to reduce erotic fantasies and the tendency to gamble. Both the extent of conditions classified as disease and the number and kinds of diseases listed change with history. In our society nosology is almost totally medicalized; ill-health that is not labeled by the physician is written off either as malingering or as illusion. As long as iatrogenic disease is treated as one small category within the established nosology, its contribution to the total volume of recognized diseases will not be appreciated. The Farmacopea Mexicana does not list any oral penicillin G even in trademark preparations. On the process by which the medical profession developed its self-image of benevolent caretaker, see L. This article shows how social iatrogenesis is fundamentally the result of the alibi function played by the professional monopoly of the sick-role. To exclude these things is a necessary condition for safeguarding man from total abasement by technical control. Brunetti, "Health in Ecological Perspective," Acta Psychiatrica Scandinavica 49, fasc.

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Similar changes in skin test responses have been reported after successful desensitization to aminoglycosides and vancomycin ( 233 buy cheap clarithromycin 500 mg on line gastritis diet recipes food,234) cheap clarithromycin online master card gastritis symptoms images. This is temporary; within 48 hours of discontinuing the drug purchase clarithromycin line gastritis diet , the skin tests are again positive. Although desensitization, as described, is limited to IgE-mediated reactions, the term has also been used in its broadest sense to describe a state of unresponsiveness to a drug that is accomplished by repeated and increasing exposure to that agent. This also is applied to patients who have had undeniable reactions to these drugs in the past. However, this does not involve elimination of available IgE antibodies through controlled anaphylaxis and may best be described as cautious readministration of the offending agent. Unlike desensitization to IgE-mediated reactions, these protocols are often more cumbersome and may require days or even weeks to complete. It should be emphasized that desensitization is a potentially hazardous procedure best left to physicians experienced in managing hypersensitivity reactions. Test Dosing In situations in which a drug is needed and the history of a previous reaction to that agent is vague, the possibility of true allergy is low, or the drug itself is an unlikely cause of such a reaction, test dosing or graded challenge is a method used to clarify the situation and safely determine whether it may be administered. A common example is a patient who has been advised to avoid all caines, and now requires the use of a local anesthetic agent. Test dosing provides reassurance to the patient, physician, or dentist that this agent can be given safely. The principle of test dosing is to select a dose of the drug below that which would potentially cause a serious reaction, and then proceed with relatively large incremental increases to full therapeutic doses. Using this technique, one can determine whether a reaction occurs before proceeding to the next dose. The starting dose, incremental increase, and interval between challenges depend on the drug and the urgency of reaching therapeutic doses. If the suspected reaction was immediate, a 30-minute interval between doses is appropriate, and the procedure is usually completed in 3 to 5 hours or less. For late-onset reactions, such as dermatitis, the dosing interval may be as long as 24 to 48 hours, with the procedure requiring 1 to 2 weeks or longer to complete. Although there is always the possibility of a severe reaction, the risk of test dosing appears to be very low ( 217). Similar changes in skin test responses have been reported following successful desensitization to aminoglycosides and vancomycin ( 1,2). As noted earlier, the term desensitization also has been used in its broadest sense to describe a state of unresponsiveness to a drug that is accomplished by repeated and increasing exposure to that agent ( 3). Similar to acute desensitization for IgE-mediated reactions, these patients have had undeniable reactions to these drugs in the past. Finally, one should be reminded that desensitization is a potentially hazardous procedure best left to physicians experienced in managing hypersensitivity reactions. Test dosing provides reassurance to the patient, physician, or dentist that this agent can be safely given. Using this technique, one can determine whether a reaction has occurred before proceeding to the next dose. When the suspected reaction was immediate, a 20 to 30-minute interval between doses is appropriate, and the procedure is usually completed in 3 to 5 hours or less. For late-onset reactions, such as a dermatitis, the dosing interval may be as long as 24 to 48 hours, with the same protocols requiring 1 to 2 weeks or longer. Although there is always the possibility of a severe reaction, the risk of test dosing appears to be very low ( 8). Additional information about those drugs may be found in the last edition of this text ( 9) and elsewhere (6,10,11 and 12). Examples of useful evaluation techniques and management strategies for selected drugs and agents Penicillins and Other b-Lactam Antibiotics Background b-Lactam antibiotic hypersensitivity deserves special consideration because of its medical importance. Penicillin has been studied extensively and has become a prototype for the study of allergic drug reactions. In a study of 1,893 consecutive adult patients who had an order written for an antimicrobial agent while hospitalized, 470 (25%) patients reported an allergy to at least one drug ( 13). A manual review of the charts revealed that just 32% of records specified the details of the allergic reaction. Some patients have been labeled falsely as penicillin allergic and are denied this useful, remarkably nontoxic agent. The reasons for this discrepancy are either a previously incorrect diagnosis or the frequently evanescent nature of penicillin allergy. Following an acute allergic reaction, there is a time-dependent decline in the rate of positive skin tests to penicillin. In the first year, 90% to 100% retain sensitivity after a convincing allergic reaction, but that percentage drops to about 30% at 10 years (14). Some patients, however, maintain penicillin-specific IgE antibody for 30 to 40 years. It is therefore highly desirable to predict which patients are at risk for a penicillin reaction. Alternatively, a literature review reported that 347 of 1,063 (33%) patients who tested positive on penicillin skin test had vague histories of penicillin allergy (15). The overall prevalence of b-lactam allergy is estimated to be about 2% per course of treatment ( 16). The most frequent manifestations are cutaneous, notably morbilliform, and urticarial eruptions; the most serious is anaphylaxis. In an older, often quoted study, penicillin-induced anaphylaxis occurred in about 0. Anaphylaxis occurring in patients with asthma may result in acute severe respiratory failure. Also, atopic patients with Penicillium species mold allergy can receive penicillin unless specifically allergic to penicillin. Patients with a history of prior penicillin reaction have a fourfold to sixfold increased risk for subsequent reactions to b-lactam antibiotics, including imipenem and meropenem. Among penicillin-allergic individuals, the unmodified administration of these drugs causes acute reactions in about two thirds of patients. Although this discussion focuses primarily on the evaluation of and strategies to deal with IgE-mediated reactions, this group of agents has also been associated with other adverse, IgE-independent immunologic events that are briefly noted here and have been extensively reviewed elsewhere ( 16). Immediate reactions occur within the first hour following administration of the b-lactam drug, are IgE mediated, and may present an immediate threat to life. Accelerated reactions develop 1 to 72 hours after drug administration, are usually IgE mediated, usually present as urticaria and angioedema, and are rarely life endangering. Delayed or late reactions occur after 3 days, are IgE independent, and usually present as benign morbilliform skin eruptions.

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He also serves on the Board of Directors of the Association for the Accreditation of Human Research Protection Programs clarithromycin 250mg with visa gastritis diet 7 up cake. He has pioneered the field of genome cell biology by developing live-cell microscopy approaches to study the nuclear organization of the genome and gene expression in intact cells buy generic clarithromycin 250 mg line gastritis diet , and his laboratory aims to apply this knowledge to the development of novel diagnostic and therapeutic strategies for cancer and aging purchase genuine clarithromycin on-line gastritis symptoms australia. Dr Misteli has received numerous awards for his work, and currently serves as Editor-in-Chief of The Journal of Cell Biology and of Current Opinion in Cell Biology. Toward Precision Medicine: Building a Knowledge Network for Biomedical Research and a New Taxonomy of Disease 88 Sean J. Morrison, PhD, is the Director of the Children s Research Institute and the Mary McDermott Cook Chair in Pediatric Genetics at the University of Texas Southwestern Medical Center as well as an Investigator of the Howard Hughes Medical Institute. The Morrison laboratory is investigating the mechanisms that regulate stem cell function in the nervous and hematopoietic systems and the ways in which these mechanisms are hijacked by cancer cells to enable neoplastic proliferation and metastasis. The Morrison laboratory is particularly interested in the mechanisms that regulate stem cell self-renewal, stem cell aging, and the role these mechanisms play in cancer. Parallel studies of these mechanisms in two tissues reveals the extent to which different types of stem cells and cancer cells depend upon similar mechanisms to regulate their function. The Morrison laboratory has discovered a number of critical mechanisms that distinguish stem cell self-renewal from the proliferation of restricted progenitors. They have shown that stem cell self-renewal is regulated by networks of proto-oncogenes and tumor suppressors and that the balance between proto-oncogenic and tumor suppressor signals changes with age. This likely explains why the mutation spectrum changes with age in cancer patients, as different mechanisms become competent to hyper-activate self-renewal pathways in patients at different ages. The Morrison laboratory has further shown that in some cancers many tumor cells are capable of driving disease growth and progression while other cancers are driven by minority subpopulations of cancer cells that adopt stem cell characteristics. These insights into the cellular and molecular mechanisms of self-renewal have suggested new approaches for promoting normal tissue regeneration and cancer treatment. Morrison was at the University of Michigan where he Directed their Center for Stem Cell Biology. Morrison moved to the University of Texas Southwestern Medical Center where he is the founding Director of the new Children s Research Institute. Morrison has also been active in public policy issues surrounding stem cell research. For example, he has twice testified before Congress and was a leader in the successful Proposal 2 campaign to protect stem cell research in Michigan s state constitution. Nichols is a professor of anesthesiology/critical care medicine and pediatrics and the Mary Wallace Stanton Professor of Education. Since joining the School of Medicine faculty in 1984, he has held numerous leadership posts in both the Department of Anesthesiology and Critical Care Medicine and school-wide. Toward Precision Medicine: Building a Knowledge Network for Biomedical Research and a New Taxonomy of Disease guidelines; restructure graduate medical education; oversee the design of a new $50 million medical education building; and enhance diversity throughout Johns Hopkins Medicine. Nichols was associate director of the residency education program in the Department of Anesthesiology and Critical Care Medicine. Nichols became a full professor of anesthesiology/critical care medicine and pediatrics in 1998 and became the recipient of the Mary Wallace Stanton Professorship for Education in 2005. He has written more than 80 professional journal articles and abstracts, held 17 guest professorships, headed more than 20 symposia and delivered more than 115 guest lectures. He also has been editor in chief of the leading textbooks in pediatric critical care medicine and edited Rogers Textbook of Pediatric Intensive Care and Critical Heart Disease in Infants and Children. Maynard Olson is Professor Emeritus of Medicine and Genome Sciences, at the University of Washington. His research interests focus on studies of natural genetic variation in both bacteria and humans. Olson was involved in shaping scientific policy toward the Human Genome Project, serving on the National Research Council Committee on Mapping and Sequencing the Human Genome, the Program Advisory Committee of the National Center for Human Genome Research Institute. Charmaine Royal is an Associate Research Professor in the Institute for Genome Sciences & Policy and the Department of African and African American Studies at Duke University. She subsequently completed her postdoctoral training in the Bioethics and Special Populations Research Program at the National Human Genome Research Institute of the National Institutes of Health, and in the Division of Epidemiology and Behavioral Medicine at the Howard University Cancer Center. Royal was Assistant Professor of Pediatrics and Director of the GenEthics Unit in the National Human Genome Center at Howard University. She serves on the: Bioethics Advisory Committee of the March of Dimes Foundation; Social Issues Committee of the American Society of Human Genetics; Editorial Board of the American Journal of Bioethics; and various other professional Committees and boards. Toward Precision Medicine: Building a Knowledge Network for Biomedical Research and a New Taxonomy of Disease 90 ethnicity, and identity. She has taught, presented, published, and received funding in these and other related areas. A key objective of her research program is to advance a more holistic and ethical approach to understanding and improving human health and well-being through increased integration of genetic and genomic research with behavioral, social science, and humanities research. Yamamoto s research is focused on signaling and transcriptional regulation by intracellular receptors, which mediate the actions of several classes of essential hormones and cellular signals; he uses both mechanistic and systems approaches to pursue these problems in pure molecules, cells and whole organisms. Yamamoto was elected as a member of the American Academy of Arts and Sciences in 1988, the National Academy of Sciences in 1989, the Institute of Medicine in 2003, and as a fellow of the American Association for the Advancement of Sciences in 2002. Hook-Barnard is a program officer with the Board on Life Sciences of the National Research Council. She came to the National Academies from the National Institutes of Health where she was a Postdoctoral Research Fellow from 2003 to 2008. Her graduate research examined translational regulation and ribosome binding in Escherichia coli. Toward Precision Medicine: Building a Knowledge Network for Biomedical Research and a New Taxonomy of Disease she contributes to projects in a variety of topic areas. Much of her current work is related to issues of molecular biology, microbiology, biosecurity and genomics. She was study director for the 2010 report Sequence-Based Classification of Select Agents: A Brighter Line, and continues to direct the U. How would a New Taxonomy of human disease enable more cost effective and rapid development of new, effective and safe drugs in the pharma/biotech setting? How would a New Taxonomy of human disease promote integration of clinical and research cultures in the pharma/biotech industry? How would a New Taxonomy of human disease promote public/private partnerships between industry and academia? What are key factors that would limit the implementation of a New Taxonomy of human disease in the pharma/biotech setting? Such studies involve testing hundreds of thousands of genetic variants called single nucleotide polymorphisms throughout the genome in people with and without a condition of interest. In addition, the consortium includes a focus on social and ethical issues such as privacy, confidentiality, and interactions with the broader community. Data Sharing Guiding Principles: All data sharing will adhere to 1) the terms of consent agreed to by research participants; 2) applicable laws and regulations, and; 3) the principle that individual sites within the network have final authority regarding whether their site s data will be used or shared, on a per-project basis.

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And the many ethical considerations surrounding such a program would need to be addressed discount 250mg clarithromycin with amex gastritis symptoms chest pain. Toward Precision Medicine: Building a Knowledge Network for Biomedical Research and a New Taxonomy of Disease Each of these areas is technically complex safe clarithromycin 250 mg gastritis y dolor de espalda. Undertaking such a program would clearly require the participation and collaboration of many government and private entities over a considerable period of time buy clarithromycin toronto gastritis diet . To ensure that progress is being made, goals and milestones against which program success can be measured would need to be developed. The Committee would leverage the expertise of additional scientists, clinicians, and others by holding a large (approximately 100 participants) workshop to obtain ideas from the broader scientific and medical communities. Desmond-Hellmann previously served as president of product development at Genentech, a position she held from March 2004 through April 30, 2009. In this role, she was responsible for Genentech s pre-clinical and clinical development, process research and development, business development and product portfolio management. She also served as a member of Genentech s executive Committee, beginning in 1996. She joined Genentech in 1995 as a clinical scientist, and she was named chief medical officer in 1996. In 1999, she was named executive vice president of development and product operations. She holds a bachelor of science degree in pre-medicine and a medical degree from the University of Nevada, Reno, and a master s degree in public health from the University of California, Berkeley. Prior to joining Genentech, Desmond-Hellmann was associate director of clinical cancer research at Bristol-Myers Squibb Pharmaceutical Research Institute. While at Bristol-Myers Squibb, she was the project team leader for the cancer-fighting drug Taxol. She also spent two years in private practice as a medical oncologist before returning to clinical research. In January 2009, Desmond-Hellmann joined the Federal Reserve Bank of San Francisco s Economic Advisory Council for a three-year term. In July 2008, she was appointed to the California Academy of Sciences board of trustees. Desmond-Hellmann was named to the Biotech Hall of Fame in 2007 and as the Healthcare Businesswomen s Association Woman of the Year for 2006. She was listed among Fortune magazine s top 50 most powerful women in business in 2001 and from 2003 to 2008. In 2005 and 2006, the Wall Street Journal listed Desmond-Hellmann as one of its women to watch. Toward Precision Medicine: Building a Knowledge Network for Biomedical Research and a New Taxonomy of Disease 84 served a three-year term as a member of the American Association for Cancer Research board of directors, and from 2001 to 2009, she served on the executive Committee of the board of directors of the Biotechnology Industry Organization. Sawyers laboratory is currently focused on characterizing signal transduction pathway abnormalities in prostate cancer, with an eye toward translational implications. Sawyers work in prostate cancer has defined critical signaling pathways for disease initiation and progression through studies in mouse models and humane tissues. Sawyers is past President of the American Society of Clinical Investigation and served on the National Cancer Institute s Board of Scientific Councilors. He has won numerous honors and awards, including: the Richard and Hinda Rosenthal Foundation Award; the Dorothy Landon Prize from the American Association of Cancer Research and the David A. Karnofsky Award from the American Society of Clinical Oncology; and the 2009 Lasker DeBakey Clinical Medical Research Award. He is a member of the Institute of Medicine and in 2010 was elected to the National Academy of Sciences. David is a co-founder of Perlegen, and was most recently Chief Scientific Officer of the company since its formation in 2000. David was Professor of Genetics and Pediatrics at the Stanford University School of Medicine as well as the co-director of the Stanford Genome Center. He completed a Pediatric Residency at the Yale-New Haven Hospital in New Haven, Connecticut and was a Fellow in both genetics and pediatrics at the University of California, San Francisco. David is certified by the American Board of Pediatrics and the American Board of Medical Genetics. Toward Precision Medicine: Building a Knowledge Network for Biomedical Research and a New Taxonomy of Disease of the Human Genome Project while carrying out research involving the molecular basis of human genetic disease. He has authored over 100 peer- reviewed scientific publications and has served on numerous editorial boards. Cox s honors include election to the Institute of Medicine of the National Academy of Sciences. Fraser-Liggett is Director of the Institute for Genome Sciences and a Professor of Medicine at the University Of Maryland School Of Medicine in Baltimore, Maryland. Previously she was the President and Director of The Institute for Genomic Research in Rockville, Maryland. She led the teams that sequenced the genomes of several microbial organisms, including important human and animal pathogens, and as a consequence helped to initiate the era of comparative genomics. She has served on a number of National Research Council Committees on counter-bioterrorism, domestic animal genomics, polar biology, and metagenomics. Fraser-Liggett has more than 220 scientific publications, and has served on Committees of the National Science Foundation, Department of Energy and National Institutes of Health. She received her PhD in pharmacology from State University of New York at Buffalo. He is also Co-Director of the Stanford Center for Genomics and Personalized Medicine. Galli s research focuses on the development and function of mast cells and basophils (key players in anaphylaxis, allergies, asthma and many other biological responses), and on developing new animal models to study the diverse roles of these cells in health and disease. Galli serves on the editorial boards of several medical journals and is a co-editor of The Annual Review of Pathology: Mechanisms of Disease. Toward Precision Medicine: Building a Knowledge Network for Biomedical Research and a New Taxonomy of Disease 86 of a three year elected term, Dr. Galli was the Chair of the Advisory Board to the President and Provost of Stanford University. Goldstein is currently Professor of Molecular Genetics & Microbiology and Director of the Center for Human Genome Variation at Duke University. Goldstein is the author of over 150 scholarly publications in the areas of population and medical genetics. His work focuses on the genetics of human disease and treatment response, with a concentration on neuropsychiatric disease and host determinants of response to infectious diseases. Most recently, he was appointed the co-chair and chair of the Gordon Research Conference meeting on human genetics and genomics for 2011 and 2013.

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