Longevity may refer to especially long-lived members of a population, whereas life expectancy is defined statistically as the average number of years remaining at a given age. For example, a population's life expectancy at birth is the same as the average age at death for all people born in the same year (in the case of cohorts ).
113-550: Longevity studies may involve putative methods to extend life. Longevity has been a topic not only for the scientific community but also for writers of travel , science fiction , and utopian novels. The legendary fountain of youth appeared in the work of the Ancient Greek historian Herodotus . There are difficulties in authenticating the longest human life span , owing to inaccurate or incomplete birth statistics. Fiction, legend, and folklore have proposed or claimed life spans in
226-795: A peninsula or island, is located beyond what is now France, and stretches further north–south than east–west. Other descriptions put it in the general area of the Ural Mountains . Plutarch, writing in the 1st century AD, mentions Heraclides of Ponticus, who connected the Hyperboreans with the Gauls who had sacked Rome in the 4th century BC (see Battle of the Allia ). Aelian , Diodorus Siculus and Stephen of Byzantium all recorded important ancient Greek sources on Hyperborea, but added no new descriptions. The 2nd-century AD Stoic philosopher Hierocles equated
339-402: A 6-monthly periodical that provided brief summaries of the current state of evidence about important clinical questions for clinicians. By 2000, use of the term evidence-based had extended to other levels of the health care system. An example is evidence-based health services, which seek to increase the competence of health service decision makers and the practice of evidence-based medicine at
452-549: A Celtic tribe (perhaps the Helvetii ) who lived just beyond them. Aristotle placed the Riphean mountains on the borders of Scythia, and Hyperborea further north. Hecataeus of Abdera and others believed Hyperborea was Britain. Later Roman and Greek sources continued to change the location of the Riphean mountains, the home of Boreas, as well as Hyperborea, supposedly located beyond them. However, all these sources agreed these were all in
565-765: A dramatic impact on aging. For instance, Pacific Ocean rockfishes have widely varying lifespans. The species Sebastes minor lives a mere 11 years while its cousin Sebastes aleutianus can live for more than 2 centuries. Similarly, a chameleon , Furcifer labordi , is the current record holder for shortest lifespan among tetrapods , with only 4–5 months to live. By contrast, some of its relatives, such as Furcifer pardalis , have been found to live up to 6 years. There are studies about aging-related characteristics of and aging in long-lived animals like various turtles and plants like Ginkgo biloba trees. They have identified potentially causal protective traits and suggest many of
678-431: A generation of physicians to retire or die and be replaced by physicians who were trained with more recent evidence. Physicians may also reject evidence that conflicts with their anecdotal experience or because of cognitive biases – for example, a vivid memory of a rare but shocking outcome (the availability heuristic ), such as a patient dying after refusing treatment. They may overtreat to "do something" or to address
791-456: A grammarian in the 3rd century, wrote that the mythical Arimaspi were identical to the Hyperboreans in physical appearance ( De Prosodia Catholica , 1. 114) and Stephanus of Byzantium in the 6th century wrote the same ( Ethnica , 118. 16). The ancient poet Callimachus described the Arimaspi as having fair hair, but it is disputed whether the Arimaspi were Hyperboreans. According to Herodianus,
904-644: A major part of the evaluation of particular treatments. The Cochrane Collaboration is one of the best-known organisations that conducts systematic reviews. Like other producers of systematic reviews, it requires authors to provide a detailed study protocol as well as a reproducible plan of their literature search and evaluations of the evidence. After the best evidence is assessed, treatment is categorized as (1) likely to be beneficial, (2) likely to be harmful, or (3) without evidence to support either benefit or harm. A 2007 analysis of 1,016 systematic reviews from all 50 Cochrane Collaboration Review Groups found that 44% of
1017-435: A notable temple which is adorned with many votive offerings and is spherical in shape". Some scholars have identified this temple with Stonehenge . Diodorus, however, does not identify Hyperborea with Britain, and his description of Britain (5.21–23) makes no mention of the Hyperboreans or their spherical temple. Pseudo-Scymnus , around 90 BC, wrote that Boreas dwelled at the extremity of Gaulish territory, and that he had
1130-422: A number of limitations and criticisms of evidence-based medicine. Two widely cited categorization schemes for the various published critiques of EBM include the three-fold division of Straus and McAlister ("limitations universal to the practice of medicine, limitations unique to evidence-based medicine and misperceptions of evidence-based-medicine") and the five-point categorization of Cohen, Stavri and Hersh (EBM
1243-472: A patient's emotional needs. They may worry about malpractice charges based on a discrepancy between what the patient expects and what the evidence recommends. They may also overtreat or provide ineffective treatments because the treatment feels biologically plausible. It is the responsibility of those developing clinical guidelines to include an implementation plan to facilitate uptake. The implementation process will include an implementation plan, analysis of
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#17328840817091356-689: A perpetually sunny land beyond the north, since the Northern half of Scandinavia faces long days during high summer with no hour of darkness ('midnight sun'). This idea was especially strong during the 17th century in Sweden, where the later representatives of the ideology of Gothicism declared the Scandinavian peninsula both the lost Atlantis and the Hyperborean land. Northern regions and their inhabitants have been called "Hyperborean", without claims of descent from
1469-577: A pillar erected in his name on the edge of the sea ( Periegesis , 183). Some have claimed this is a geographical reference to northern France, and Hyperborea as the British Isles which lay just beyond the English Channel . Ptolemy ( Geographia , 2. 21) and Marcian of Heraclea ( Periplus , 2. 42) both placed Hyperborea in the North Sea which they called the "Hyperborean Ocean". In his 1726 work on
1582-647: A promising candidate for further research within the field. Their study suggests that high levels of iron in the blood likely reduce, and genes involved in metabolising iron likely increase healthy years of life in humans. Longevity is a highly plastic trait, and traits that influence its components respond to physical (static) environments and to wide-ranging life-style changes: physical exercise, dietary habits, living conditions, and pharmaceutical as well as nutritional interventions. A 2012 study found that even modest amounts of leisure time physical exercise can extend life expectancy by as much as 4.5 years. As of 2021, there
1695-499: A small fraction of the heritability. Lymphoblastoid cell lines established from blood samples of centenarians have significantly higher activity of the DNA repair protein PARP ( Poly ADP ribose polymerase ) than cell lines from younger (20 to 70 year old) individuals. The lymphocytic cells of centenarians have characteristics typical of cells from young people, both in their capability of priming
1808-492: A systematic review, to consider the impact of different factors on their confidence in the results. Authors of GRADE tables assign one of four levels to evaluate the quality of evidence, on the basis of their confidence that the observed effect (a numeric value) is close to the true effect. The confidence value is based on judgments assigned in five different domains in a structured manner. The GRADE working group defines 'quality of evidence' and 'strength of recommendations' based on
1921-464: A treatment is either not safe or not effective, it may take many years for other treatments to be adopted. There are many factors that contribute to lack of uptake or implementation of evidence-based recommendations. These include lack of awareness at the individual clinician or patient (micro) level, lack of institutional support at the organisation level (meso) level or higher at the policy (macro) level. In other cases, significant change can require
2034-497: A tribute to the goddess Ilithyia for ease of child-bearing, accompanied by the gods themselves. The maidens received honours in Delos, where the women collected gifts from them and sang hymns to them. A particular Hyperborean legendary healer was known as "Abaris" or "Abaris the Healer" whom Herodotus first described in his works. Plato ( Charmides , 158C) regarded Abaris as a physician from
2147-526: A wide range of biases and constraints, from trials only being able to study a small set of questions amenable to randomisation and generally only being able to assess the average treatment effect of a sample, to limitations in extrapolating results to another context, among many others outlined in the study. Despite the emphasis on evidence-based medicine, unsafe or ineffective medical practices continue to be applied, because of patient demand for tests or treatments, because of failure to access information about
2260-469: Is "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. ... [It] means integrating individual clinical expertise with the best available external clinical evidence from systematic research." The aim of EBM is to integrate the experience of the clinician, the values of the patient , and the best available scientific information to guide decision-making about clinical management. The term
2373-420: Is a list of life expectancies in different types of countries: Population longevities are increasing as life expectancies around the world grow: The Gerontology Research Group validates current longevity records by modern standards, and maintains a list of supercentenarians ; many other unvalidated longevity claims exist. Record-holding individuals include: Evidence-based studies indicate that longevity
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#17328840817092486-419: Is a poor philosophic basis for medicine, defines evidence too narrowly, is not evidence-based, is limited in usefulness when applied to individual patients, or reduces the autonomy of the doctor/patient relationship). In no particular order, some published objections include: A 2018 study, "Why all randomised controlled trials produce biased results", assessed the 10 most cited RCTs and argued that trials face
2599-444: Is an expert (however, some critics have argued that expert opinion "does not belong in the rankings of the quality of empirical evidence because it does not represent a form of empirical evidence" and continue that "expert opinion would seem to be a separate, complex type of knowledge that would not fit into hierarchies otherwise limited to empirical evidence alone."). Several organizations have developed grading systems for assessing
2712-535: Is applied to populations versus individuals. When designing guidelines applied to large groups of people in settings with relatively little opportunity for modification by individual physicians, evidence-based policymaking emphasizes that good evidence should exist to document a test's or treatment's effectiveness. In the setting of individual decision-making, practitioners can be given greater latitude in how they interpret research and combine it with their clinical judgment. In 2005, Eddy offered an umbrella definition for
2825-434: Is based on two major factors: genetics and lifestyle . Twin studies have estimated that approximately 20-30% of the variation in human lifespan can be related to genetics , with the rest due to individual behaviors and environmental factors which can be modified. Although over 200 gene variants have been associated with longevity according to a US-Belgian-UK research database of human genetic variants these explain only
2938-427: Is likely due to an imbalance of pro- and anti-oxidants during flight-associated oxidative stress . Flight induced oxidative DNA damage appears to hasten senescence and reduce longevity in A. mellifera . Gene editing via CRISPR - Cas9 and other methods have significantly altered lifespans in animals. [REDACTED] Media related to Longevity at Wikimedia Commons Hyperborei In Greek mythology ,
3051-522: Is no clinical evidence that any dietary practice contributes to human longevity. Four well-studied biological pathways that are known to regulate aging, and whose modulation has been shown to influence longevity are Insulin/IGF-1 , mechanistic target of rapamycin ( mTOR ), AMP-activating protein kinase ( AMPK ), and Sirtuin pathways. Autophagy plays a pivotal role in healthspan and lifespan extension . In preindustrial times, deaths at young and middle age were more common than they are today. This
3164-562: Is not due to genetics, but because of environmental factors such as disease, accidents, and malnutrition, especially since the former were not generally treatable with pre-20th-century medicine. Deaths from childbirth were common for women, and many children did not live past infancy. In addition, most people who did attain old age were likely to die quickly from the above-mentioned untreatable health problems. Despite this, there are several examples of pre-20th-century individuals attaining lifespans of 85 years or greater, including John Adams , Cato
3277-437: Is provided by systematic review of randomized , well-blinded, placebo-controlled trials with allocation concealment and complete follow-up involving a homogeneous patient population and medical condition. In contrast, patient testimonials, case reports , and even expert opinion have little value as proof because of the placebo effect, the biases inherent in observation and reporting of cases, and difficulties in ascertaining who
3390-402: Is so rare is that certain categories of gene expression that are beneficial in youth become deleterious at an older age. Longevity myths are traditions about long-lived people (generally supercentenarians ), either as individuals or groups of people, and practices that have been believed to confer longevity, but for which scientific evidence does not support the ages claimed or the reasons for
3503-430: Is sometimes positively correlated to its structural complexity. It suggests that while biological complexity increases individual lifespan, it is counteracted in nature since the survivability of the overall species may be hindered when it results in a prolonged development process , which is an evolutionarily vulnerable state. According to the antagonistic pleiotropy hypothesis , one of the reasons biological immortality
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3616-647: The Hyperboreans ( Ancient Greek : ὑπερβόρε(ι)οι , romanized : hyperbóre(i)oi , pronounced [hyperbóre(ː)oi̯] ; Latin : Hyperborei ) were a mythical people who lived in the far northern part of the known world . Their name appears to derive from the Greek ὑπέρ Βορέᾱ , "beyond Boreas " (the God of the north wind ). Some scholars prefer a derivation from ὑπερφέρω ( hyperpherō , "to carry over"). Despite their location in an otherwise frigid part of
3729-509: The Inuit . Hyperborean has also been used in a metaphorical sense, to describe a sense of distance from the ordinary. In this way, Friedrich Nietzsche referred to his sympathetic readers as Hyperboreans in The Antichrist (written 1888, published 1895): "Let us look each other in the face. We are Hyperboreans – we know well enough how remote our place is." He quoted Pindar and added "Beyond
3842-598: The Issedones on the south-western slopes of the Altay Mountains , Carl P. Ruck places Hyperborea beyond the Dzungarian Gate into northern Xinjiang , noting that the Hyperboreans were probably Chinese. In 1974 Robert Charroux first related the Hyperboreans to an ancient astronaut race. Miguel Serrano was influenced by Charroux's writings on the Hyperboreans. Aleksandr Dugin has "touted ancient legends about
3955-475: The Pacific Northwest , described how: While the fiery and magnificent Spaniard, inflamed with the mania for gold, has extended his discoveries and conquests over those brilliant countries scorched by the ardent sun of the tropics, the adroit and buoyant Frenchman , and the cool and calculating Briton , have pursued the less splendid, but no less lucrative, traffic in furs amidst the hyperborean regions of
4068-616: The druids , John Toland specifically identified Diodorus' Hyperborea with the Isle of Lewis , and the spherical temple with the Callanish Stones . Along with Thule , Hyperborea was one of several terrae incognitae to the Greeks and Romans , where Pliny , Pindar and Herodotus , as well as Virgil and Cicero , reported that people lived to the age of one thousand and enjoyed lives of complete happiness. Hecataeus of Abdera collated all
4181-877: The 1901 and 1911 British censuses. Time magazine considered that, by the Soviet Union, longevity had been elevated to a state-supported "Methuselah cult". Robert Ripley regularly reported supercentenarian claims in Ripley's Believe It or Not! , usually citing his own reputation as a fact-checker to claim reliability. Longevity in other animals can shed light on the determinants of life expectancy in humans, especially when found in related mammals . However, important contributions to longevity research have been made by research in other species, ranging from yeast to flies to worms . In fact, some closely related species of vertebrates can have dramatically different life expectancies, demonstrating that relatively small genetic changes can have
4294-793: The AMA, and the American Association of Health Plans (now America's Health Insurance Plans). In 1999, the National Institute for Clinical Excellence (NICE) was created in the UK. In the area of medical education, medical schools in Canada, the US, the UK, Australia, and other countries now offer programs that teach evidence-based medicine. A 2009 study of UK programs found that more than half of UK medical schools offered some training in evidence-based medicine, although
4407-632: The American Cancer Society in 1980. The U.S. Preventive Services Task Force (USPSTF) began issuing guidelines for preventive interventions based on evidence-based principles in 1984. In 1985, the Blue Cross Blue Shield Association applied strict evidence-based criteria for covering new technologies. Beginning in 1987, specialty societies such as the American College of Physicians, and voluntary health organizations such as
4520-647: The American Heart Association, wrote many evidence-based guidelines. In 1991, Kaiser Permanente , a managed care organization in the US, began an evidence-based guidelines program. In 1991, Richard Smith wrote an editorial in the British Medical Journal and introduced the ideas of evidence-based policies in the UK. In 1993, the Cochrane Collaboration created a network of 13 countries to produce systematic reviews and guidelines. In 1997,
4633-400: The Arimaspi were close in appearance to the Hyperboreans, making the inference that the Hyperboreans had fair hair being potentially valid. Six classical Greek authors also came to identify the Hyperboreans with their Celtic neighbours in the north: Antimachus of Colophon , Protarchus , Heraclides Ponticus , Hecataeus of Abdera , Apollonius of Rhodes and Posidonius of Apamea . The way
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4746-637: The Canadas, until they have advanced even within the Arctic Circle. The term "Hyperborean" still sees some jocular contemporary use in reference to groups of people who live in a cold climate. Under the Library of Congress Classification System , the letter subclass PM includes "Hyperborean Languages", a catch-all category that refers to all the linguistically unrelated languages of peoples living in Arctic regions , such as
4859-550: The Celts living in and beyond the Alps, or at least the Hyperborean lands with the lands inhabited by the Celts. A reputation for feasting and a love of gold may have reinforced the connection. Northern Europeans (Scandinavians), when confronted with the classical Greco-Roman culture of the Mediterranean, identified themselves with the Hyperboreans. This aligns with the traditional aspect of
4972-463: The Elder , Thomas Hobbes , Christopher Polhem , and Michelangelo . This was also true for poorer people like peasants or laborers . Genealogists will almost certainly find ancestors living to their 70s, 80s and even 90s several hundred years ago. For example, an 1871 census in the UK (the first of its kind, but personal data from other censuses dates back to 1841 and numerical data back to 1801) found
5085-785: The Far North, succumbing to the 'demonic' energies of the South Pole, the greatest point of materialization. Since Herodotus places the Hyperboreans beyond the Massagetae and Issedones , both Central Asian peoples, it appears that his Hyperboreans may have lived in Siberia . Heracles sought the golden-antlered hind of Artemis in Hyperborea. As the reindeer is the only deer species of which females bear antlers, this would suggest an arctic or subarctic region. Following J. D. P. Bolton's location of
5198-462: The Greeks understood their relationship with non-Greek peoples was significantly moulded by the way myths of the Golden Age were transplanted into the contemporary scene, especially in the context of Greek colonisation and trade. As the Riphean mountains of the mythical past were identified with the Alps of northern Italy, there was at least a geographic rationale for identifying the Hyperboreans with
5311-560: The Hospitals, out of the Camps, or from elsewhere, 200, or 500 poor People, that have fevers or Pleuritis. Let us divide them in Halfes, let us cast lots, that one halfe of them may fall to my share, and the others to yours; I will cure them without blood-letting and sensible evacuation; but you do, as ye know ... we shall see how many Funerals both of us shall have... The first published report describing
5424-399: The Hyperborean could not be superior to modern man. According to these esotericists , the Hyperborean people represented the Golden Age polar center of civilization and spirituality, with mankind, instead of evolving from a common ape ancestor, progressively devolving into an apelike state as a result of straying, both physically and spiritually, from its mystical otherworldly homeland in
5537-666: The Hyperboreans in their works. The Hyperboreans were believed to live beyond the snowy Riphean Mountains , with Pausanias describing the location as "The land of the Hyperboreans, men living beyond the home of Boreas." Homer placed Boreas in Thrace , and therefore Hyperborea was in his opinion north of Thrace, in Dacia . Sophocles ( Antigone , 980–987), Aeschylus ( Agamemnon , 193; 651), Simonides of Ceos (Schol. on Apollonius Rhodius, 1. 121) and Callimachus ( Delian , [IV] 65) also placed Boreas in Thrace . Other ancient writers believed
5650-565: The Hyperboreans with the Scythians, and the Riphean Mountains with the Ural Mountains . Clement of Alexandria and other early Christian writers also made this same Scythian equation. Hyperborea was identified with Britain first by Hecataeus of Abdera in the 4th century BC, as in a preserved fragment by Diodorus Siculus : In the regions beyond the land of the Celts there lies in the ocean an island no smaller than Sicily . This island,
5763-637: The North, beyond the ice, beyond death – our life, our happiness." John G. Bennett wrote a research paper entitled "The Hyperborean Origin of the Indo-European Culture" ( Journal Systematics , Vol. 1, No. 3, December 1963) in which he claimed the Indo-European homeland was in the far north, which he considered the Hyperborea of classical antiquity. This idea was earlier proposed by Bal Gangadhar Tilak (whom Bennett credits) in his The Arctic Home in
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#17328840817095876-510: The US Agency for Healthcare Research and Quality (AHRQ, then known as the Agency for Health Care Policy and Research, or AHCPR) established Evidence-based Practice Centers (EPCs) to produce evidence reports and technology assessments to support the development of guidelines. In the same year, a National Guideline Clearinghouse that followed the principles of evidence-based policies was created by AHRQ,
5989-690: The Vedas (1903) as well as the Austro-Hungarian ethnologist Karl Penka ( Origins of the Aryans , 1883). Soviet Indologist Natalia R. Guseva and Soviet ethnographer S. V. Zharnikova, influenced by Tilak's The Arctic Home in the Vedas , argued for a northern Urals Arctic homeland of the Indo-Aryan and Slavic people. Their ideas were popularized by Russian nationalists. According to Jason Jeffrey, H. P. Blavatsky , René Guénon and Julius Evola all shared
6102-411: The account continues, is situated in the north and is inhabited by the Hyperboreans, who are called by that name because their home is beyond the point whence the north wind (Boreas) blows; and the island is both fertile and productive of every crop, and has an unusually temperate climate. Hecateaus of Abdera also wrote that the Hyperboreans had on their island "a magnificent sacred precinct of Apollo and
6215-496: The autumn of 1990, Gordon Guyatt used it in an unpublished description of a program at McMaster University for prospective or new medical students. Guyatt and others first published the term two years later (1992) to describe a new approach to teaching the practice of medicine. In 1996, David Sackett and colleagues clarified the definition of this tributary of evidence-based medicine as "the conscientious, explicit and judicious use of current best evidence in making decisions about
6328-499: The average male life expectancy as being 44, but if infant mortality is subtracted, males who lived to adulthood averaged 75 years. The present life expectancy in the UK is 77 years for males and 81 for females, while the United States averages 74 for males and 80 for females. Studies have shown that black American males have the shortest lifespans of any group of people in the US, averaging only 69 years (Asian-American females average
6441-399: The basis for governmentality in health care, and consequently play a central role in the governance of contemporary health care systems. The steps for designing explicit, evidence-based guidelines were described in the late 1980s: formulate the question (population, intervention, comparison intervention, outcomes, time horizon, setting); search the literature to identify studies that inform
6554-441: The basis for medical decisions." In 2010, Greenhalgh used a definition that emphasized quantitative methods: "the use of mathematical estimates of the risk of benefit and harm, derived from high-quality research on population samples, to inform clinical decision-making in the diagnosis, investigation or management of individual patients." The two original definitions highlight important differences in how evidence-based medicine
6667-476: The belief in the Hyperborean, polar origins of mankind and a subsequent solidification and devolution . Blavatsky describes the Hyperboreans as the origin of the second " root race " and as non-intelligent ethereal creatures that reproduced by budding . However, Jeffrey's account may contradict some theosophical tenets, as according to other authors like Santucci, theosophy sees the passage from one root race to another as always evolution, never devolution, thus
6780-418: The care of individual patients. ... [It] means integrating individual clinical expertise with the best available external clinical evidence from systematic research." This branch of evidence-based medicine aims to make individual decision making more structured and objective by better reflecting the evidence from research. Population-based data are applied to the care of an individual patient, while respecting
6893-636: The claims. A comparison and contrast of "longevity in antiquity" (such as the Sumerian King List , the genealogies of Genesis , and the Persian Shahnameh ) with "longevity in historical times" (common-era cases through twentieth-century news reports) is elaborated in detail in Lucian Boia 's 2004 book Forever Young: A Cultural History of Longevity from Antiquity to the Present and other sources. After
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#17328840817097006-541: The conduct and results of a controlled clinical trial was by James Lind , a Scottish naval surgeon who conducted research on scurvy during his time aboard HMS Salisbury in the Channel Fleet , while patrolling the Bay of Biscay . Lind divided the sailors participating in his experiment into six groups, so that the effects of various treatments could be fairly compared. Lind found improvement in symptoms and signs of scurvy among
7119-611: The context, identifying barriers and facilitators and designing the strategies to address them. Training in evidence based medicine is offered across the continuum of medical education. Educational competencies have been created for the education of health care professionals. The Berlin questionnaire and the Fresno Test are validated instruments for assessing the effectiveness of education in evidence-based medicine. These questionnaires have been used in diverse settings. A Campbell systematic review that included 24 trials examined
7232-677: The death of Juan Ponce de León , Gonzalo Fernández de Oviedo y Valdés wrote in Historia General y Natural de las Indias (1535) that Ponce de León was looking for the waters of Bimini to cure his aging. Traditions that have been believed to confer greater human longevity also include alchemy , such as that attributed to Nicolas Flamel . In the modern era, the Okinawa diet has some reputation of linkage to exceptionally high ages. Longevity claims may be subcategorized into four groups: "In late life, very old people often tend to advance their ages at
7345-708: The dissatisfaction of his Alexandrian editors . Apollonius wrote that the Argonauts sighted Hyperborea, when they sailed through Eridanos . Alone among the Twelve Olympians , the Greeks venerated Apollo among the Hyperboreans, and the god was thought to spend his winters there amongst them. According to Herodotus , offerings from the Hyperboreans came to Scythia packed with straw , and they were passed from tribe to tribe until they arrived at Dodona and from them to other Greek peoples until they to came to Apollo's temple on Delos . He said they used this method because
7458-404: The earth" stories, the cult of Apollo , and exaggerated reports of phenomena in northern Europe (e.g. the Arctic " midnight sun "). The earliest extant source that mentions Hyperborea in detail, Herodotus ' Histories (Book IV, Chapters 32–36), dates from c. 450 BC . Herodotus recorded three earlier sources that supposedly mentioned the Hyperboreans, including Hesiod and Homer ,
7571-403: The effectiveness of e-learning in improving evidence-based health care knowledge and practice. It was found that e-learning, compared to no learning, improves evidence-based health care knowledge and skills but not attitudes and behaviour. No difference in outcomes is present when comparing e-learning with face-to-face learning. Combining e-learning and face-to-face learning (blended learning) has
7684-416: The evidence, or because of the rapid pace of change in the scientific evidence. For example, between 2003 and 2017, the evidence shifted on hundreds of medical practices, including whether hormone replacement therapy was safe, whether babies should be given certain vitamins, and whether antidepressant drugs are effective in people with Alzheimer's disease . Even when the evidence unequivocally shows that
7797-462: The evidence. A rationale must be written." He discussed evidence-based policies in several other papers published in JAMA in the spring of 1990. Those papers were part of a series of 28 published in JAMA between 1990 and 1997 on formal methods for designing population-level guidelines and policies. The term 'evidence-based medicine' was introduced slightly later, in the context of medical education. In
7910-435: The existence and location of the Hyperboreans, with some regarding them as purely mythological, and others connecting them to real-world peoples and places in northern Eurasia (e.g. Britain , Scandinavia , or Siberia ). In medieval and Renaissance literature , the Hyperboreans came to signify remoteness and exoticism. Modern scholars consider the Hyperborean myth to be an amalgam of ideas from ancient utopianism , "edge of
8023-521: The extent to which it is feasible to incorporate individual-level information in decisions. Thus, evidence-based guidelines and policies may not readily "hybridise" with experience-based practices orientated towards ethical clinical judgement, and can lead to contradictions, contest, and unintended crises. The most effective "knowledge leaders" (managers and clinical leaders) use a broad range of management knowledge in their decision making, rather than just formal evidence. Evidence-based guidelines may provide
8136-734: The fact that practitioners have clinical expertise reflected in effective and efficient diagnosis and thoughtful identification and compassionate use of individual patients' predicaments, rights, and preferences. Between 1993 and 2000, the Evidence-Based Medicine Working Group at McMaster University published the methods to a broad physician audience in a series of 25 "Users' Guides to the Medical Literature" in JAMA . In 1995 Rosenberg and Donald defined individual-level, evidence-based medicine as "the process of finding, appraising, and using contemporaneous research findings as
8249-460: The far north of Greece or southern Europe. The ancient grammarian Simmias of Rhodes in the 3rd century BC connected the Hyperboreans to the Massagetae and Posidonius in the 1st century BC to the Western Celts, but Pomponius Mela placed them even further north in the vicinity of the Arctic. In maps based on reference points and descriptions given by Strabo , Hyperborea, shown variously as
8362-627: The far north, while Strabo reported Abaris was Scythian like the early philosopher Anacharsis ( Geographica , 7. 3. 8). Greek legend asserts that the Boreades, who were the descendants of Boreas and the snow-nymph Chione (or Khione), founded the first theocratic monarchy on Hyperborea. This legend is found preserved in the writings of Aelian : This god [Apollon] has as priests the sons of Boreas [North Wind] and Chione [Snow], three in number, brothers by birth, and six cubits in height [about 2.7 metres]. Diodorus Siculus added to this account: And
8475-424: The first time the gifts were brought by two maidens, Hyperoche and Laodice, with an escort of five men, but none of them returned. To prevent this, the Hyperboreans began to bring the gifts to their borders and ask their neighbours to deliver them to the next country and so on until they arrived to Delos. Herodotus also details that two other virgin maidens, Arge and Opis, had come from Hyperborea to Delos before, as
8588-497: The following system: GRADE guideline panelists may make strong or weak recommendations on the basis of further criteria. Some of the important criteria are the balance between desirable and undesirable effects (not considering cost), the quality of the evidence, values and preferences and costs (resource utilization). Despite the differences between systems, the purposes are the same: to guide users of clinical research information on which studies are likely to be most valid. However,
8701-477: The gold-guarding griffins , and beyond these the Hyperboreans. Herodotus assumed that Hyperborea lay somewhere in Northeast Asia . Pindar , lyric poet from Thebes and a contemporary of Herodotus in the tenth Pythian Ode described the Hyperboreans and tells of Perseus ' journey to them. Other 5th-century BC Greek authors, like Simonides of Ceos and Hellanicus of Lesbos , described or referenced
8814-544: The group of men treated with lemons or oranges. He published a treatise describing the results of this experiment in 1753. An early critique of statistical methods in medicine was published in 1835, in Comtes Rendus de l’Académie des Sciences, Paris, by a man referred to as "Mr Civiale". The term 'evidence-based medicine' was introduced in 1990 by Gordon Guyatt of McMaster University . Alvan Feinstein 's publication of Clinical Judgment in 1967 focused attention on
8927-563: The home of Boreas or the Riphean Mountains were in a different location. For example, Hecataeus of Miletus believed that the Riphean Mountains were adjacent to the Black Sea. Alternatively, Pindar placed the home of Boreas, the Riphean Mountains and Hyperborea all near the Danube . Heraclides Ponticus and Antimachus in contrast identified the Riphean Mountains with the Alps , and the Hyperboreans as
9040-411: The immune system, and women tend to mount a stronger immune response to pathogens than men. However, the idea that men have weaker immune systems due to the supposed immuno-suppressive actions of testosterone is unfounded. There is debate as to whether the pursuit of longevity is a worthwhile health care goal. Bioethicist Ezekiel Emanuel , who is also one of the architects of ObamaCare , has argued that
9153-431: The individual studies still require careful critical appraisal. Evidence-based medicine attempts to express clinical benefits of tests and treatments using mathematical methods. Tools used by practitioners of evidence-based medicine include: Evidence-based medicine attempts to objectively evaluate the quality of clinical research by critically assessing techniques reported by researchers in their publications. There are
9266-434: The kings of this (Hyperborean) city and the supervisors of the sacred precinct are called Boreadae, since they are descendants of Boreas, and the succession to these positions is always kept in their family. The Boreades were thus believed to be giant kings, around 10 feet (3.0 m) tall, who ruled Hyperborea. No other physical descriptions of the Hyperboreans are provided in classical sources. However, Aelius Herodianus ,
9379-469: The latter purportedly having written of Hyperborea in his lost work Epigoni . Homer's provenance to the epic is suspect by Herodotus. Herodotus wrote that the 7th-century BC poet Aristeas wrote of the Hyperboreans in a poem (now lost) called Arimaspea about a journey to the Issedones , who are estimated to have lived in the Kazakh Steppe . Beyond these lived the one-eyed Arimaspians , further on
9492-513: The longest). This reflects overall poorer health and greater prevalence of heart disease, obesity, diabetes, and cancer among black American men. Women normally outlive men. Theories for this include smaller bodies that place lesser strain on the heart (women have lower rates of cardiovascular disease ) and a reduced tendency to engage in physically dangerous activities. Conversely, women are more likely to participate in health-promoting activities. The X chromosome also contains more genes related to
9605-704: The mechanism of repair after H 2 O 2 sublethal oxidative DNA damage and in their PARP gene expression. These findings suggest that elevated PARP gene expression contributes to the longevity of centenarians, consistent with the DNA damage theory of aging . In July 2020 , scientists used public biological data on 1.75 m people with known lifespans overall and identified 10 genomic loci which appear to intrinsically influence healthspan , lifespan, and longevity – of which half have not been reported previously at genome-wide significance and most being associated with cardiovascular disease – and identified haem metabolism as
9718-417: The medical policy documents of major US private payers were informed by Cochrane systematic reviews, there was still scope to encourage the further use. Evidence-based medicine categorizes different types of clinical evidence and rates or grades them according to the strength of their freedom from the various biases that beset medical research. For example, the strongest evidence for therapeutic interventions
9831-424: The methods and content varied considerably, and EBM teaching was restricted by lack of curriculum time, trained tutors and teaching materials. Many programs have been developed to help individual physicians gain better access to evidence. For example, UpToDate was created in the early 1990s. The Cochrane Collaboration began publishing evidence reviews in 1993. In 1995, BMJ Publishing Group launched Clinical Evidence,
9944-456: The mid-1980s, Alvin Feinstein, David Sackett and others published textbooks on clinical epidemiology , which translated epidemiological methods to physician decision-making. Toward the end of the 1980s, a group at RAND showed that large proportions of procedures performed by physicians were considered inappropriate even by the standards of their own experts. David M. Eddy first began to use
10057-507: The mythological Hyperboreans. In this vein, the self-described "Hyperborean-Roman Company" ( Hyperboreisch-römische Gesellschaft ) were a group of northern European scholars who studied classical ruins in Rome, founded in 1824 by Theodor Panofka , Otto Magnus von Stackelberg , August Kestner and Eduard Gerhard . In this sense, Washington Irving , in elaborating on the Astor Expedition in
10170-682: The organizational or institutional level. The multiple tributaries of evidence-based medicine share an emphasis on the importance of incorporating evidence from formal research in medical policies and decisions. However, because they differ on the extent to which they require good evidence of effectiveness before promoting a guideline or payment policy, a distinction is sometimes made between evidence-based medicine and science-based medicine, which also takes into account factors such as prior plausibility and compatibility with established science (as when medical organizations promote controversial treatments such as acupuncture ). Differences also exist regarding
10283-477: The past or future vastly longer than those verified by modern standards, and longevity narratives and unverified longevity claims frequently speak of their existence in the present. A life annuity is a form of longevity insurance . Various factors contribute to an individual's longevity. Significant factors in life expectancy include gender , genetics , access to health care , hygiene , diet and nutrition , exercise , lifestyle , and crime rates . Below
10396-419: The postponement of senescence as well as happiness and wisdom in old age. Most biological organisms have a naturally limited longevity due to aging , unlike a rare few that are considered biologically immortal . Given that different species of animals and plants have different potentials for longevity, the disrepair accumulation theory of aging tries to explain how the potential for longevity of an organism
10509-411: The prevention, diagnosis, and treatment of human disease. In the 11th century AD, Avicenna , a Persian physician and philosopher, developed an approach to EBM that was mostly similar to current ideas and practises. The concept of a controlled clinical trial was first described in 1662 by Jan Baptist van Helmont in reference to the practice of bloodletting . Wrote Van Helmont: Let us take out of
10622-467: The previous steps; implement the guideline. For the purposes of medical education and individual-level decision making, five steps of EBM in practice were described in 1992 and the experience of delegates attending the 2003 Conference of Evidence-Based Health Care Teachers and Developers was summarized into five steps and published in 2005. This five-step process can broadly be categorized as follows: Systematic reviews of published research studies are
10735-403: The principles of evidence-based guidelines and population-level policies, which Eddy described as "explicitly describing the available evidence that pertains to a policy and tying the policy to evidence instead of standard-of-care practices or the beliefs of experts. The pertinent evidence must be identified, described, and analyzed. The policymakers must determine whether the policy is justified by
10848-546: The process of finding evidence feasible and its results explicit. In 2011, an international team redesigned the Oxford CEBM Levels to make them more understandable and to take into account recent developments in evidence ranking schemes. The Oxford CEBM Levels of Evidence have been used by patients and clinicians, as well as by experts to develop clinical guidelines, such as recommendations for the optimal use of phototherapy and topical therapy in psoriasis and guidelines for
10961-499: The pursuit of longevity via the compression of morbidity explanation is a "fantasy" and that longevity past age 75 should not be considered an end in itself. This has been challenged by neurosurgeon Miguel Faria , who states that life can be worthwhile in healthy old age, that the compression of morbidity is a real phenomenon, and that longevity should be pursued in association with quality of life. Faria has discussed how longevity in association with leading healthy lifestyles can lead to
11074-403: The quality as two different concepts that are commonly confused with each other. Systematic reviews may include randomized controlled trials that have low risk of bias, or observational studies that have high risk of bias. In the case of randomized controlled trials, the quality of evidence is high but can be downgraded in five different domains. In the case of observational studies per GRADE,
11187-422: The quality of evidence starts off lower and may be upgraded in three domains in addition to being subject to downgrading. Meaning of the levels of quality of evidence as per GRADE: In guidelines and other publications, recommendation for a clinical service is classified by the balance of risk versus benefit and the level of evidence on which this information is based. The U.S. Preventive Services Task Force uses
11300-671: The quality of evidence. For example, in 1989 the U.S. Preventive Services Task Force (USPSTF) put forth the following system: Another example are the Oxford CEBM Levels of Evidence published by the Centre for Evidence-Based Medicine . First released in September 2000, the Levels of Evidence provide a way to rank evidence for claims about prognosis, diagnosis, treatment benefits, treatment harms, and screening, which most grading schemes do not address. The original CEBM Levels were Evidence-Based On Call to make
11413-411: The question; interpret each study to determine precisely what it says about the question; if several studies address the question, synthesize their results ( meta-analysis ); summarize the evidence in evidence tables; compare the benefits, harms and costs in a balance sheet; draw a conclusion about the preferred practice; write the guideline; write the rationale for the guideline; have others review each of
11526-415: The rate of about 17 years per decade .... Several celebrated super-centenarians (over 110 years) are believed to have been double lives (father and son, relations with the same names or successive bearers of a title) .... A number of instances have been commercially sponsored, while a fourth category of recent claims are those made for political ends ...." The estimate of 17 years per decade was corroborated by
11639-399: The reviews concluded that the intervention was likely to be beneficial, 7% concluded that the intervention was likely to be harmful, and 49% concluded that evidence did not support either benefit or harm. 96% recommended further research. In 2017, a study assessed the role of systematic reviews produced by Cochrane Collaboration to inform US private payers' policymaking; it showed that although
11752-457: The role of clinical reasoning and identified biases that can affect it. In 1972, Archie Cochrane published Effectiveness and Efficiency , which described the lack of controlled trials supporting many practices that had previously been assumed to be effective. In 1973, John Wennberg began to document wide variations in how physicians practiced. Through the 1980s, David M. Eddy described errors in clinical reasoning and gaps in evidence. In
11865-656: The species have "slow or [times of] negligible senescence" (or aging). The jellyfish T. dohrnii is biologically immortal and has been studied by comparative genomics . Honey bees ( Apis mellifera ) are eusocial insects that display dramatic caste-specific differences in longevity. Queen bees live for an average of 1-2 years, compared to workers who live on average 15-38 days in summer and 150-200 days in winter. Worker honey bees with high amounts of flight experience exhibit increased DNA damage in flight muscle, as measured by elevated 8-Oxo-2'-deoxyguanosine , compared to bees with less flight experience. This increased DNA damage
11978-502: The stories about the Hyperboreans current in the 4th century BC and published a lengthy, now-lost treatise on them that was noted by Diodorus Siculus (ii.47.1–2). Legend told that the sun was supposed to rise and set only once a year in Hyperborea, which would place it above or upon the Arctic Circle , or, more generally, in the arctic polar regions . The ancient Greek writer Theopompus , in his work Philippica , claimed Hyperborea
12091-477: The sunken city of Atlantis and the mythical civilisation Hyperborea" in defense of his vision of a vast Russian Empire. "He believes Russia is the modern-day reincarnation of the ancient 'Hyperboreans', who need to stand at odds with the modern-day 'Atlanteans', the United States ". [REDACTED] Africa [REDACTED] Antarctica Evidence-based medicine Evidence-based medicine ( EBM )
12204-693: The term 'evidence-based' in 1987 in workshops and a manual commissioned by the Council of Medical Specialty Societies to teach formal methods for designing clinical practice guidelines. The manual was eventually published by the American College of Physicians . Eddy first published the term 'evidence-based' in March 1990, in an article in the Journal of the American Medical Association ( JAMA ) that laid out
12317-407: The two branches of EBM: "Evidence-based medicine is a set of principles and methods intended to ensure that to the greatest extent possible, medical decisions, guidelines, and other types of policies are based on and consistent with good evidence of effectiveness and benefit." In the area of evidence-based guidelines and policies, the explicit insistence on evidence of effectiveness was introduced by
12430-526: The use of the BCLC staging system for diagnosing and monitoring hepatocellular carcinoma in Canada. In 2000, a system was developed by the Grading of Recommendations Assessment, Development and Evaluation ( GRADE ) working group. The GRADE system takes into account more dimensions than just the quality of medical research. It requires users who are performing an assessment of the quality of evidence, usually as part of
12543-514: The world, the Hyperboreans were believed to inhabit a sunny, temperate, and divinely blessed land. In many versions of the story, they lived north of the Riphean Mountains , which shielded them from the effects of the cold north wind . The oldest myths portray them as the favorites of Apollo , and some ancient Greek writers regarded the Hyperboreans as the mythical founders of Apollo's shrines at Delos and Delphi . Later writers disagreed on
12656-541: Was once planned to be conquered by a large race of soldiers from another island; however, this plan was apparently abandoned, as the soldiers from Meropis realized the Hyperboreans were too strong, and too blessed, for them to be conquered. This unusual tale, which some believe was satire or comedy, was preserved by Aelian ( Varia Historia , 3. 18). Theseus visited the Hyperboreans and Pindar transferred Perseus ' encounter with Medusa there from its traditional site in Libya, to
12769-407: Was originally used to describe an approach to teaching the practice of medicine and improving decisions by individual physicians about individual patients. The EBM Pyramid is a tool that helps in visualizing the hierarchy of evidence in medicine, from least authoritative, like expert opinions, to most authoritative, like systematic reviews. Medicine has a long history of scientific inquiry about
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