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Two or more applied studies: Programs that demonstrate the highest external and ecological validity are those that diferent settings have been implemented in two or more applied (“real-world”) settings that are distinct from both the original setting and each other in terms of their populations and physical/ geographical locations. Two or more applied studies: Some programs have been implemented in two or more applied (“real-world”) settings same settings that are similar to one another with similar populations. These prevention strategies demonstrate moderate external and ecological validity although not as much as those implemented in two or more settings that are diferent and that have diferent populations. Real-world–informed Programs that have not been implemented in applied settings may still demonstrate some external and ecological validity if they are made up of components that are consistent with an applied setting. Likewise, programs may demonstrate external and ecological validity if they are implemented in ways that mirror conditions of the “real-world. These prevention strategies demonstrate some external and ecological validity if some of their components and implementation approximate conditions in the “real world. Possible applied studies in Programs that demonstrate harm in any kind of a setting, applied or otherwise, are similar or diferent settings considered harmful. In other words, the program is considered harmful regardless of whether or not it has been conducted in an applied setting. Best Practices for Cardiovascular Disease Prevention Programs 69 Appendix D Appendix D. Glossary Best practice: A practice supported by a rigorous process of peer review and evaluation indicating efectiveness in improving health outcomes, generally demonstrated through systematic reviews. Best practices framework: A conceptual framework that includes important aspects of impact and quality to provide a common lexicon and criteria for assessing and strengthening public health practice. Community Guide (The Guide to Community Preventive Services): A resource with a collection of evidence-based fndings from the Community Preventive Services Task Force (Task Force). This resource was created to help states, communities, community organizations, business, health care organizations, and schools select interventions to improve health and prevent disease. Community programs linked to clinical services: A term to describe connecting community programs with health care systems to improve disease prevention, care, and management. Continuum of Evidence of Efectiveness: A tool to describe and assess various components in determining the strength of the best available research evidence on a program, practice, or policy’s efectiveness. It illuminates the strengths and weaknesses of the research evidence and ofers guidance on next steps for consideration. It consists of six dimensions, each of which addresses a specifc aspect of the best available research evidence. Efectiveness is important because it tells us whether a prevention strategy is having an impact on the outcomes of interest. The most efective strategies produce preventive efects in the short term, long term, or both. E-Prescribing: A prescriber’s ability to electronically send an accurate, error-free and understandable prescription directly to a pharmacy from the point-of-care. External validity refers to whether a program, practice, or policy can demonstrate preventive efects among a wide range of populations and contexts. Ecological validity refers to whether the program components and procedures approximate the “real-life” conditions specifc to a specifc setting. Health care system interventions: Efective delivery and use of quality care and preventive services in clinical settings. This includes any and all services and/or materials that aid in the implementation of a prevention strategy in a diferent setting, including but not limited to “training, coaching, technical assistance, support materials, organizational/systems change consultation, and manuals/guides. This helps determine whether or not a prevention program can be replicated and implemented with other participants, and produce the same efects. Independent replications are not used to determine whether a program can be successfully generalized to a broad variety of settings or populations. This refers to the extent to which the short-term and/or long-term outcomes of a program, practice, or policy can truly be attributed to it or if these outcomes could have been caused by something else. Medication therapy management services include medication therapy reviews, pharmacotherapy consults, anticoagulation management, immunizations, health and wellness programs and many other clinical services. Pharmacists provide medication therapy management to help patients get the best benefts from their medications by actively managing drug therapy and by identifying, preventing and resolving medication-related problems. The six-steps include the following: (1) topics suggested by end user(s); (2) scan fndings; (3) sort for relevance; (4) synthesize results; (5) translate for end user(s); and (6) end user expert review. The nature of the design of the research study determines whether and how to answer the research questions related to efectiveness. The more rigorous the research design, the higher its internal validity and the more likely outcomes can be attributed to the program, practice, or policy.

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His confined to the skin and has a benign course in the topathologic examination of oral lesions is also vast majority of patients. The oral mucosa is involved in 15 to 25% of the cases, usually in association with skin lesions. The typical oral lesions are characterized by a well-defined central atrophic red area surrounded by a sharp elevated border of irradiating whitish striae (Fig. Ulcers, erosions, or white plaques may also be present and progress to atrophic scarring (Fig. The buccal mucosa is the most frequently af fected site, followed by the lower lip, palate, gingiva, and tongue. Systemic lupus erythematosus, multiple erosions surrounded by a whitish or reddish zone. The oral mucosa is localized scleroderma (morphea) and progressive involved in 30 to 45% of the cases. The localized form has a favor there are extensive painful erosions, or ulcers able prognosis and involves the skin alone, surrounded by a reddish or whitish zone (Fig. Frequent findings include petechiae, edema, terized by multisystem involvement, including the hemorrhages, and xerostomia. The oral mucosa is pale and thin with a lous pemphigoid, erythema multiforme, and der smooth dorsal surface of the tongue due to papil matomyositis. Histopathologic and immuno smoothing out of the palatal folds, and short and fluorescent studies of biopsy specimens are essen hard tongue frenulum, which results in dysarthria. Telangiectasia can occur antimalarials, immunosuppressants, and plasma on the lips and oral mucosa (Fig. Progressive systemic sclerosis, pale and atrophic epithelium of the dorsum of the tongue. Myalgia and malaise accompanied includes oral submucous fibrosis, cicatricial pem by fever are prominent early features. Histopathologic examination of erythema at the nail margins are the initial man ifestations. During its course, the disease is man biopsy specimens is indispensable for diagnosis. Radiographs show characteristic widening of the ifested by an erythematous, scaly papulomacular rash, skin discoloration, hyperpigmentation, and periodontal space in about 20% of the cases of systemic sclerosis. Topical and systemic steroids, anti malarials, potassium p-aminobenzoate (Potaba), neurotic edema, and stomatitis medicamentosa. D-penicillamine, azathioprine and other im Laboratory tests helpful in the diagnosis are serum munosuppressives, nifedipine, and other agents enzyme determination (creatine phosphokinase, have been tried. Cyto Dermatomyositis toxic drugs should be used when the disease is Dermatomyositis is an uncommon inflammatory severe. Progressive symmetrical muscle weak ness is usually the first and most important clinical manifestation in the majority of patients with der 21. Autoimmune Diseases Mixed Connective Tissue Disease include a recurrent enlargement of the parotid, submandibular (Fig. Females are more com include dysphagia, candidosis, cheilitis, and dental monly affected, with a mean of 35 years. Artificial saliva and sialagogues may teristically high titers of antibody to nuclear alleviate dryness of the mouth. Most frequently, it affects women in the fourth and fifth decades and is characterized by xerostomia and keratoconjunc tivitis sicca. Recent clinical, serologic, and genetic criteria have been used to distinguish two forms of the disease: primary and secondary. Autoimmune Diseases Benign Lymphoepithelial Lesion Lupoid Hepatitis the term "benign lymphoepithelial lesion" is used Lupoid hepatitis is a form of chronic active to define a localized lymphocytic infiltration of the hepatitis of autoimmune origin, which most fre salivary and lacrimal glands. It affects most frequently lung, and bowel manifestations, hemolytic middle-aged women.

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Historical Stress testing is important in measuring and managing and forecasted economic performance and trends are credit risk in the Firm’s credit portfolio. The process incorporated into the modeling of estimated consumer assesses the potential impact of alternative economic and credit losses and are part of the monitoring of the credit business scenarios on estimated credit losses for the Firm. Economic scenarios and the underlying parameters are Wholesale credit risk is monitored regularly at an aggregate defined centrally, articulated in terms of macroeconomic portfolio, industry, and individual client and counterparty factors and applied across the businesses. The stress test level with established concentration limits that are reviewed results may indicate credit migration, changes in and revised as deemed appropriate by management, delinquency trends and potential losses in the credit typically on an annual basis. In addition to the periodic stress testing limits, as measured in terms of exposure and economic risk processes, management also considers additional stresses appetite, are subject to stress-based loss constraints. In outside these scenarios, including industry and country addition, wrong-way risk — the risk that exposure to a specific stress scenarios, as necessary. Total credit portfolio Credit exposure Nonperforming(d)(e) December 31, In the following tables, reported loans include loans (in millions) 2018 2017 2018 2017 retained. The following Loans held-for-sale 11,988 3,351 — — tables do not include loans which the Firm accounts for at Loans at fair value 3,151 2,508 220 — Total loans – reported 984,554 930,697 4,831 5,943 fair value and classifies as trading assets. For further Derivative receivables 54,213 56,523 60 130 information regarding these loans, refer to Notes 2 and 3. Receivables from For additional information on the Firm’s loans, lending customers and other(a) 30,217 26,272 — — related commitments and derivative receivables, including Total credit-related assets 1,068,984 1,013,492 4,891 6,073 the Firm’s accounting policies, refer to Notes 12, 27, and 5, Assets acquired in loan respectively. For a further discussion of the wholesale credit environment and wholesale loans, refer to Year ended December 31, (in millions, except ratios) 2018 2017 Wholesale Credit Portfolio on pages 112–119 and Note 12. The Firm’s focus is on serving primarily the prime segment of the consumer credit market. Originated mortgage loans are retained in the mortgage portfolio, securitized or sold to U. The credit performance of the consumer portfolio continues to benefit from discipline in credit underwriting as well as improvement in the economy driven by low unemployment and increasing home prices. The total amount of residential real estate loans delinquent 30+ days, excluding government guaranteed and purchased credit-impaired loans, decreased from December 31, 2017 due to improved credit performance and the impact of loans that were delinquent in 2017 due to hurricanes. The Credit Card 30+ day delinquency rate and the net charge-off rate increased from the prior year, in line with expectations. For further information about the Firm’s nonaccrual and charge-off accounting policies, refer to Note 12. These operating lease assets are included in other assets on the Firm’s Consolidated balance sheets. The risk of loss on these assets relates to the residual value of the leased vehicles, which is managed through projection of the lease residual value at lease origination, periodic review of residual values, and through arrangements with certain auto manufacturers that mitigates this risk. The Firm has not experienced, and does not anticipate, that all available lines of credit would be used at the same time. For credit card commitments, and if certain conditions are met, home equity commitments, the Firm can reduce or cancel these lines of credit by providing the borrower notice or, in some cases as permitted by law, without notice. These receivables are reported within accrued interest and accounts receivable on the Firm’s Consolidated balance sheets. These amounts have been excluded from nonaccrual loans based upon the government guarantee. For further information about the Firm’s consumer December 31, December 31, portfolio, including information about delinquencies, loan (in millions) 2018 2017 modifications and other credit quality indicators, refer to Current $ 2,884 $ 2,401 Note 12. The residential mortgage portfolio increased from the amount of 30+ day delinquencies decreased from December 31, 2017 driven by the retention of originated December 31, 2017. Nonaccrual loans decreased from high-quality prime mortgage loans, which exceeded December 31, 2017 due to lower delinquencies. Residential mortgage a net recovery for the year ended December 31, 2018 30+ day delinquencies decreased from December 31, 2017. December 31, 2018 improved when compared with the At December 31, 2018, approximately 90% of the Firm’s prior year, reflecting loan sales and continued improvement home equity portfolio consists of home equity lines of credit in home prices and delinquencies. The Firm continues amortizing payments or have been modified and $4 billion to monitor the risks associated with these loans. These loans are December 31, 2017 due to loan originations, considered “high-risk seconds” and are classified as predominantly offset by paydowns and charge-offs of nonaccrual as they are considered to pose a higher risk of delinquent loans. Nonaccrual loans decreased from payments, although such payments are not necessarily fully December 31, 2017.

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Choice b discusses a metaphor of life as a journey down a river, and choice d states that life is a comedy. This is supported by the Last scene of all in which Shakespeare suggests that old age is a second childhood that will lead to oblivion without control of the senses, like the infant in the first act. No fear of death is mentioned, nor is free will, so choices a and d are in correct. Choice c is incorrect because man is used as the subject of the entries, but never presented as a gender-specific measure. It softens the effect of both suggestions that we are only actors on the world’s stage, and that the seventh age of man results in oblivion. It ties his theme together by carrying us from the first stage to the last and then back again, and the words convey his tone of indifference, as discussed above. You don’t have to be an expert in either subject to answer the questions cor rectly. Look for the main idea, words in context, and the topic sentence to help you understand the basic information. Using all the available information in the passage will help you identify ideas not explicitly stated in the text. The fictional world of Nobel Prize winner Toni Morrison’s novel Sula—the African-American section of Medallion, Ohio, a commu nity called the Bottom—is a place where people and natural things are apt to go awry, to break from their prescribed boundaries, a place where bizarre and unnatural happenings and strange reversals of the ordinary are commonplace. The very naming of the setting of Sula is a turning upside-down of the expected; the Bottom is located high in the hills. A great part of the lives of the characters, there fore, is taken up with making sense of the world, setting boundaries, and devising methods to control what is essentially uncontrollable. One of the major devices used by the people of the Bottom is the seemingly universal one of creating a ; in this case, the title character Sula—upon which to project both the evil they perceive outside themselves and the evil in their own hearts. Which of the following words would best fit into the blank in the final sentence of the passage? Based on the description of the setting of the novel Sula, which of the following adjectives would most likely describe the behavior of many of its residents? The English language premiere of Samuel Beckett’s play Waiting for Godot took place in London in August 1955. The play has two acts; the second act repeats what little action occurs in the first with few changes: the tree, for instance, acquires one leaf. In a statement that was to become famous, the critic, Vivian Mercer, has described Godot as “a play in which nothing happens twice. However, Harold Hobson’s review in the Sunday Times managed to recognize the play for what history has proven it to be, a revolution ary moment in theater. Which sentence, if inserted in the blank space on the previous page, would make the best sense in the context of the passage? The director, Peter Hall, had to beg the theater management not to close the play immediately but to wait for the Sunday reviews. It looked as if Waiting for Godot was beginning a long run as the most controversial play of London’s 1955 season. Waiting for Godot was in danger of closing the first week of its run and of becoming nothing more than a footnote in the annals of the English stage. Judging from the information provided in the paragraph, which of the following statements is accurate? The sets and characters in Waiting for Godot were typical of London stage productions in the 1950s. Which of the following provides the best definition of the term avant-garde as the author intends it in the passage? Which of the following best describes the attitude of the author of the passage toward the play Waiting for Godot? The people inside the cave could not see the world outside the cave, they could only see shadows of people and animals as they passed by. Plato was suggesting that the shadows would seem very real and alive to the people inside the cave, because that was all they had ever seen of the outside world. But these shadows were not the real, living creatures of the outside world, they were merely reflections of them. Plato’s point was that this temporal world is a of some greater, eternal reality.