&

Buy cheap viagra online

20/20 visionThere’s no doubt that trust buy cheap viagra online is ‘won’ immediately in some circumstances and in young children is the default position. Usually, though, it has to be earned. And even buy cheap viagra online when deserved it isn’t always granted. I wonder whether this ‘process’ (clumsy word, but possibly the best under the circumstances) has become slower, more attritional and more grudgingly acknowledged, a symbol perhaps of societal changes we might have to accept.

Taking this a step further, one spoke in the paediatric (or any medical) pathway is mutual visibility surely buy cheap viagra online a predictor of the point at which a family unmanacles themselves of reservations. How long does it take for a mother to disclose (even anonymously) to researchers that every time she enters her home, she risks adding to her bruise count. How many online consultations does it take before a family feel sufficiently at ease to disinter the spectres in their history lurking stage left behind the velvet curtains?. I rest my case… or maybe, teasingly, am only just hinting at it.Neglected global diseasesNo one is oblivious to the pernicious effects of intimate partner violence (IPV), but little is known about effect buy cheap viagra online sizes either on the mother or children.

Previous cohort studies that have had the ‘guts’ to examine this pervasive holoendemic disease might have underestimated the prevalence and effects by. Using only buy cheap viagra online physical violence (emotional control is more common). Using unidimensional measure (conflict tactics scale, for example) or by missing the opportunity for long term follow-up. Deidre Gartland and colleagues examined buy cheap viagra online close to 700 maternal-child dyads in Melbourne, Australia from the Maternal Health Study in children born between 2003 and 2005, recruitment beginning during pregnancy and repeat assessments at 3, 6 and 12 months then at 4 and 10 years.

IPV was assessed with the composite abuse scale and child outcomes by the Strengths and Difficulties Questionnaire (SDQ), Developmental and Well Being Assessment (DAWBA), Spence Children’s anxiety scale, Wechsler intelligence scale NIH picture vocabulary test and the Children’s Communications Shortlist. In short, 13% of mothers of children at 1 year and 16% at 10 years reported some form of IPV. Adjusted ORs for likely psychiatric diagnosis and emotional buy cheap viagra online difficulties (DAWBA and SDQ) with respect to IPV at 2.0 and 1.9 respectively were significant. Given the likely under-reporting in such studies the real effect is probably larger, a reflection of the dysfunctional parent -child relationships this sort of abuse inevitably fosters.

So, what do we, and paediatricians, do buy cheap viagra online about it?. We ask. We ask buy cheap viagra online in the same way that obstetricians do. The line ‘if there’s anything you haven’t already mentioned at home that you’d like to tell me…’ opens doors-literally and metaphorically.

See page 1066The future. Part 1 – distance consultationThe viagra reinforced the need to revisit the traditional default of all follow-upvisits needing to be in person both from medical and buy cheap viagra online family need angles. Three papers examine aspects of the evolution of and drawback to this seismic (and I don’t think is an exaggeration) shift towards tele-medicine. Ronny Cheung’s Viewpoint looks at buy cheap viagra online practicalities.

What does an outpatient visit entail for a family?. To buy cheap viagra online name but a few. Time off work and lost income. Days out of school.

Lost social contact lessons and sports buy cheap viagra online. A tedious gridlocked drive through the drizzle with the inherent carbon footprint. The search for the elusive car parking spot which is pounced on buy cheap viagra online by another vehicle. Of course, contact is important, but the value of physical proximity surely needs to be weighed up, the default surely being ‘is there a reason for the next visit not to be online—what does the childthink?.

€™The notion that ‘mobile phones buy cheap viagra online are wonderful because they enable parents to instantly send images to their children’s paediatricians’ is to some extent justified and predates even that hazy, carefree era before December 2019. It is, though, riddled with potholes. Potholes that are navigable, but potholes, nonetheless. These relate not buy cheap viagra online only to security but also on the tacit transfer of responsibility to act on the picture (particularly if unsolicited).

Mahmoud Motawea and colleagues thoughts on their use and implications (even in the face of highly secure NHS mechanisms) lends some context (but not cold water) to the wave of enthusiasm.The issues don’t stop there as, as Robert Wheeler’s Clinical Law series piece articulately demonstrates. The reality is that a video call whether as part of a legal assessment or otherwise simply buy cheap viagra online can’t (or can’t at present) replicate the sixth sense one gets (subtleties of movement, parental eye contact, signs of neglect) that being in the same room can. This isn’t always necessary, but the court precedents show there are times that it is. See pages 1041, buy cheap viagra online 1044, 1056The future.

Part 2 – robotsMaybe it uncovers the nascent techno-luddite in me, but the mention of robots as the future has generally tended to make me shudder and the notion of robot as anxiolytic a dismissive ‘what’s wrong with a hug/slug of midazolam/nitrous oxide?. €™ I think, though, I’m changing my mind, at least a bit, in no small part the result of Brenda Littler and colleagues’ narrative systematic review on the use of (social) robots in distress alleviation, some, ironically, ‘real’ teddy bears themselves. See page 1095Ethics statementsPatient consent for publicationNot applicable.Wealthy buy cheap viagra online nations must do much more, much faster.The United Nations General Assembly in September 2021 will bring countries together at a critical time for marshalling collective action to tackle the global environmental crisis. They will meet again at the biodiversity summit in Kunming, China, and the climate conference (Conference of the Parties (COP)26) in Glasgow, UK.

Ahead of these pivotal meetings, we—the editors of health journals worldwide—call for urgent action to keep average global temperature increases below 1.5°C, halt the destruction of nature and protect health.Health is already being harmed by global temperature increases and the destruction of the natural world, a state of affairs health professionals have been bringing attention to for decades.1 The science is unequivocal buy cheap viagra online. A global increase of 1.5°C above the preindustrial average and the continued loss of biodiversity risk catastrophic harm to health that will be impossible to reverse.2 3 Despite the world’s necessary preoccupation with erectile dysfunction treatment, we cannot wait for the viagra to pass to rapidly reduce emissions.Reflecting the severity of the moment, this editorial appears in health journals across the world. We are united in recognising that only fundamental and equitable changes to societies will reverse our current trajectory.The risks to health of increases above 1.5°C are now well established.2 buy cheap viagra online Indeed, no temperature rise is ‘safe’. In the past 20 years, heat-related mortality among people aged over 65 has increased by more than 50%.4 Higher temperatures have brought increased dehydration and renal function loss, dermatological malignancies, tropical s, adverse mental health outcomes, pregnancy complications, allergies, and cardiovascular and pulmonary morbidity and mortality.5 6 Harms disproportionately affect the most vulnerable, including children, older populations, ethnic minorities, poorer communities and those with underlying health problems.2 4Global heating is also contributing to the decline in global yield potential for major crops, falling by 1.8%–5.6% since 1981.

This, together with the effects of extreme weather and soil depletion, is hampering efforts to reduce undernutrition.4 Thriving ecosystems are essential to human health, and the widespread destruction of nature, including habitats and species, is eroding water and food security and increasing the chance of viagras.3 7 8The consequences of the environmental crisis fall disproportionately on those countries and communities that have contributed least to the problem and are least able to mitigate the harms. Yet no buy cheap viagra online country, no matter how wealthy, can shield itself from these impacts. Allowing the consequences to fall disproportionately on the most vulnerable will breed more conflict, food insecurity, forced displacement and zoonotic disease, with severe implications for all countries and communities. As with the erectile dysfunction treatment viagra, we are globally as strong as our weakest member.Rises above 1.5°C increase the chance of reaching tipping points in natural systems that could lock the world into an acutely unstable state buy cheap viagra online.

This would critically impair our ability to mitigate harms and to prevent catastrophic, runaway environmental change.9 10Global targets are not enoughEncouragingly, many governments, financial institutions and businesses are setting targets to reach net-zero emissions, including targets for 2030. The cost of buy cheap viagra online renewable energy is dropping rapidly. Many countries are aiming to protect at least 30% of the world’s land and oceans by 2030.11These promises are not enough. Targets are easy to set and hard to achieve.

They are yet to be matched with credible short-term and buy cheap viagra online longer-term plans to accelerate cleaner technologies and transform societies. Emissions reduction plans do not adequately incorporate health considerations.12 Concern is growing that temperature rises above 1.5°C are beginning to be seen as inevitable, or even acceptable, to powerful members of the global community.13 Relatedly, current strategies for reducing emissions to net zero by the middle of the century implausibly assume that the world will acquire great capabilities to remove greenhouse gases from the atmosphere.14 15This insufficient action means that temperature increases are likely to be well in excess of 2°C,16 a catastrophic outcome for health and environmental stability. Critically, the destruction of nature does not have parity of esteem with the climate element of buy cheap viagra online the crisis, and every single global target to restore biodiversity loss by 2020 was missed.17 This is an overall environmental crisis.18Health professionals are united with environmental scientists, businesses and many others in rejecting that this outcome is inevitable. More can and must be done now—in Glasgow and Kunming—and in the immediate years that follow.

We join health professionals worldwide who have already buy cheap viagra online supported calls for rapid action.1 19Equity must be at the centre of the global response. Contributing a fair share to the global effort means that reduction commitments must account for the cumulative, historical contribution each country has made to emissions, as well as its current emissions and capacity to respond. Wealthier countries will have to cut emissions more quickly, making reductions by 2030 beyond those currently proposed20 21 and reaching net-zero emissions before 2050. Similar targets and emergency action are needed for biodiversity loss and the wider destruction of the natural world.To achieve these targets, governments must make fundamental changes buy cheap viagra online to how our societies and economies are organised and how we live.

The current strategy of encouraging markets to swap dirty for cleaner technologies is not enough. Governments must intervene to buy cheap viagra online support the redesign of transport systems, cities, production and distribution of food, markets for financial investments, health systems, and much more. Global coordination is needed to ensure that the rush for cleaner technologies does not come at the cost of more environmental destruction and human exploitation.Many governments met the threat of the erectile dysfunction treatment viagra with unprecedented funding. The environmental crisis demands a similar emergency response buy cheap viagra online.

Huge investment will be needed, beyond what is being considered or delivered anywhere in the world. But such investments will produce huge positive health and economic outcomes. These include high-quality jobs, reduced air pollution, increased buy cheap viagra online physical activity, and improved housing and diet. Better air quality alone would realise health benefits that easily offset the global costs of emissions reductions.22These measures will also improve the social and economic determinants of health, the poor state of which may have made populations more vulnerable to the erectile dysfunction treatment viagra.23 But the changes cannot be achieved through a return to damaging austerity policies or the continuation of the large inequalities of wealth and power within and between countries.Cooperation hinges on wealthy nations doing moreIn particular, countries that have disproportionately created the environmental crisis must do more to support low-income and middle-income countries to build cleaner, healthier and more resilient societies.

High-income countries must meet and go beyond their outstanding buy cheap viagra online commitment to provide $100 billion a year, making up for any shortfall in 2020 and increasing contributions to and beyond 2025. Funding must be equally split between mitigation and adaptation, including improving the resilience of health systems.Financing should be through grants rather than loans, building local capabilities and truly empowering communities, and should come alongside forgiving large debts, which constrain the agency of so many low-income countries. Additional funding must be marshalled to compensate for inevitable loss and damage caused by the consequences of buy cheap viagra online the environmental crisis.As health professionals, we must do all we can to aid the transition to a sustainable, fairer, resilient and healthier world. Alongside acting to reduce the harm from the environmental crisis, we should proactively contribute to global prevention of further damage and action on the root causes of the crisis.

We must hold global leaders to account and continue to educate others about the health risks of the crisis. We must join in the work to achieve environmentally sustainable health systems before 2040, recognising buy cheap viagra online that this will mean changing clinical practice. Health institutions have already divested more than $42 billion of assets from fossil fuels. Others should join them.4The greatest threat to global public health is the buy cheap viagra online continued failure of world leaders to keep the global temperature rise below 1.5°C and to restore nature.

Urgent, society-wide changes must be made and will lead to a fairer and healthier world. We, as editors of health journals, call for governments and other leaders to act, marking 2021 as the year that the world finally changes course.Ethics statementsPatient consent for publicationNot required..

Afib and viagra

	Viagra	Viagra black
For womens	At cvs	Pharmacy
Where can you buy	200mg 20 tablet $89.95	200mg 10 tablet $54.95
Buy with debit card	200mg 180 tablet $449.95	200mg 120 tablet $324.95
Pack price	Online	No
How fast does work	No	200mg

A key consideration in timing of aortic valve replacement (AVR) for patients with aortic stenosis (AS) is whether there is an increased risk of sudden afib and viagra cardiac death (SCD) that might be reduced by relief of outflow obstruction. Minners and colleagues1 addressed this issue in a afib and viagra retrospective analysis of outcomes in 1840 patients with mild to moderate AS (aortic maximum velocity 2.5–4.0 m/s) in the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study. Overall the annualised rate of SCD was 0.39% per year with 27 events in asymptomatic patients. The most recent echocardiogram prior to SCD showed mild–moderate AS in most (80%) of these patients with no difference in SCD event rates in those who progressed afib and viagra to severe AS compared to those who did not develop severe valve obstruction.

On Cox regression analysis, the only independent risk factors for SCD were age (HR 1.06, 95% CI 1.01 to 1.11 per year, p=0.02), increased left ventricular mass index (HR 1.20, 95% CI 1.10 to 1.32 per 10 g/m2, p<0.001) and lower body mass index (HR 0.87, 95% CI 0.79 to 0.97 per kg/m2, p=0.01) but not the severity of valve obstruction (figure 1).Univariate (top) and multivariate (bottom) Cox regression analyses for SCD during 46.1±14.6 months of follow-up in afib and viagra the Simvastatin and Ezetimibe in Aortic Stenosis study. The number of events for each variable is reflected by the dark, horizontal bars with separation at the median for continuous variables. A forest afib and viagra plot visualisation of HRs for SCD is provided on the right. LVED, left ventricular enddiastolic diameter.

LVES, left afib and viagra ventricular endsystolic diameter. LVM, left afib and viagra ventricular mass. SCD, sudden cardiac death." data-icon-position data-hide-link-title="0">Figure 1 Univariate (top) and multivariate (bottom) Cox regression analyses for SCD during 46.1±14.6 months of follow-up in the Simvastatin and Ezetimibe in Aortic Stenosis study. The number of afib and viagra events for each variable is reflected by the dark, horizontal bars with separation at the median for continuous variables.

A forest plot visualisation of HRs for SCD is provided on the right. LVED, left afib and viagra ventricular enddiastolic diameter. LVES, left afib and viagra ventricular endsystolic diameter. LVM, left ventricular mass.

SCD, sudden cardiac death.The lack of association between AS severity and the risk of SCD in the SEAS study is thought-provoking and challenges the conventional wisdom that early AVR would prevent SCD in asymptomatic patients with AS.2 In the past, syncope and SCD in patients with AS were thought to be due to mechanisms such as afib and viagra left ventricle (LV) baroreceptor malfunction, hypotension secondary to peripheral vasodilation in the face of fixed valve obstruction, or a shortened diastolic filling interval at high heart rates leading to a reduced stroke volume. However, it is doubtful that any of these mechanisms would account for afib and viagra SCD when AS is only mild to moderate in severity. €˜It is increasingly recognised that that AS is not simply a mechanical problem of the valve leaflets not opening fully. Instead, AS compromises a complex interplay between the valve, ventricle and vasculature with abnormal function of all three components of the disease afib and viagra process.’ As I conclude in an editorial, ‘It is unlikely that early AVR will reduce the risk of sudden death when severe valve obstruction is not present.

Perhaps it is time to turn our attention to mitigating the non-valvular disease processes in adults with calcific valve disease.’In another interesting paper in this issue of Heart, Williams and Brown3 hypothesised that the apparent benefit of fractional flow reserve (FFR) guidance of percutaneous coronary intervention (PCI) in patients with chronic coronary syndromes (CCS) might simply be due to utilisation of fewer stents rather than to knowledge about the physiological severity of the coronary lesions. In a Monte Carlo simulation using data from the PCI strata of the Bypass Angioplasty Revascularization Investigation 2 Diabetes study, random deferral of PCI progressively reduced the risk of death and myocardial infarction at 1 year, suggesting that FFR-guided deferral of PCI improves outcomes simply because fewer stents are placed.In an editorial, Weintraub and Boden4 put this data into the context of 30 years of clinical trials comparing PCI with optimal medical therapy from CCS afib and viagra and conclude ‘In contrast to patients with acute coronary syndrome, there remains no convincing evidence that PCI will prevent events in patients with stable angina and chronic ischaemic heart disease. We know that, if needed, PCI will ameliorate severe angina, but we also afib and viagra know that this may not be a durable effect. By contrast, for the great majority of patients who are not disabled by angina, PCI can be safely deferred in both diabetic and non-diabetic patients, with revascularisation reserved only for those with unacceptable angina or who develop an acute coronary syndrome during follow-up.

The role of FFR remains uncertain at best and need not be performed routinely in all patients with CCS, though it may be useful where the visual estimation of angiographical severity is uncertain.’Cardiac involvement in patients with sepsis contributes to adverse outcomes with most previous studies focusing on left ventricular dysfunction afib and viagra. In order to assess the impact of right ventricular involvement on outcomes in sepsis Kim and colleagues5 performed a retrospective cohort study of 778 patients with septic shock with echocardiographic imaging. Sepsis-induced cardiac dysfunction was present in 34.7% of afib and viagra the entire cohort, affecting the LV in 67.3% and the right ventricle (RV) in 40.7% of these patients. Any type of sepsis-induced cardiac dysfunction was associated with a afib and viagra significantly higher 28-day mortality (35.9 vs 26.8%.

P<0.01), longer intensive care unit length of stay and longer duration of mechanical ventilator, compared with those without cardiac dysfunction. Isolated RV afib and viagra dysfunction was rare (24/270, 8.9%) but was associated with a higher risk of 28-day mortality (adjusted OR 2.77, 95% CI 1.20 to 6.40, p=0.02) (figure 2).Comparisons of survival curves between each type of dysfunction. LV, left ventricle. RV, right afib and viagra ventricle." data-icon-position data-hide-link-title="0">Figure 2 Comparisons of survival curves between each type of dysfunction.

LV, left afib and viagra ventricle. RV, right ventricle.The mechanisms of cardiac dysfunction in patients with sepsis are summarised in an editorial by Dugar and Vallabhajosyula6 (figure 3). They also point out the challenges in afib and viagra understanding cardiac involvement in patients with sepsis including the effect of timing of imaging on detection, difficulties in measuring RV systolic performance, and differing definitions of RV dysfunction. They conclude afib and viagra.

€˜there is a crucial need to understand the how to identify RV dysfunction in sepsis and the causative mechanisms associated with higher mortality in this population, which will significantly influence how we prevent and manage this disease process.’Mechanism of RV dysfunction associated organ failure and mortality in sepsis. RV, right ventricular." data-icon-position data-hide-link-title="0">Figure 3 Mechanism of RV dysfunction afib and viagra associated organ failure and mortality in sepsis. RV, right ventricular.The Education-in-Heart article in this issue by Steiner and Kirkpatrick7 focuses on palliative care in management of pateints with cardiovascular disease. Palliative care now encompasses much more than end-of-life comfort measures afib and viagra.

Instead, ‘Palliative care is a specialised type of medical care that focuses on improving communication about goals of care, maximising quality of life and reducing symptoms’ and thus applies to afib and viagra many of our patients at many time points in their disease course. Each of you will want to read the entire article yourself which includes several useful tools, such as the one shown in figure 4, to improve conversations with patients about treatment options, goals of care and planning for adverse outcomes.Ask-Tell-Ask tool to guide difficult conversations." data-icon-position data-hide-link-title="0">Figure 4 Ask-Tell-Ask tool to guide difficult conversations.Be sure to try the two Image Challenge questions in this issue.8 9 Over 150 board-review format multiple choice questions based on all types of cardiac images can be found in our online archive on the Heart homepage (https://heart.bmj.com/pages/collections/image_challenges/).In symptomatic patients with severe aortic stenosis (AS), there is no question that aortic valve replacement (AVR) relieves symptoms and prolongs life. In asymptomatic patients, clinical decision making is afib and viagra less clear because of the need to balance the risks of intervention and a prosthetic valve against the risks of continued watchful waiting. On the other hand, symptom onset is inevitable in patients with severe AS—the decision is not whether but rather when to replace the valve.The primary rationale for deferring AVR until a later date is the lack of evidence that AVR before symptom onset would improve longevity.

In addition, the risks, discomfort and disability associated with a surgical or transcatheter afib and viagra procedure are postponed until a later date. Furthermore, if afib and viagra a mechanical AVR is chosen, delaying intervention reduces the length of time the patient is exposed to the risks and inconvenience of warfarin anticoagulation. If a bioprosthetic AVR is chosen, implantation later in life increases the likelihood that the valve will not deteriorate to the point of reintervention during the patient’s lifetime. Unfortunately, patients with AS do not have the option of a normal afib and viagra aortic valve.

Instead the diseased native valve is replaced with an imperfect prosthetic valve.On the other hand, accumulating evidence from advanced imaging studies shows that aortic valve obstruction is associated with adverse changes in left ventricular (LV) structure and function, even in the absence of symptoms, which may not resolve after AVR.1 In addition, observational studies suggest that there may be an increased risk of sudden cardiac death in apparently asymptomatic patients with severe AS, although the magnitude and predictors of risk remain unclear.In order to provide clarity about the risk of sudden death in asymptomatic adults with AS, Minners and colleagues examined the data from the Simvastatin and Ezetimibe in Aortic ….

A key consideration in timing of aortic valve replacement (AVR) for patients with Order amoxilbuy amoxil no prescription aortic buy cheap viagra online stenosis (AS) is whether there is an increased risk of sudden cardiac death (SCD) that might be reduced by relief of outflow obstruction. Minners and colleagues1 addressed this buy cheap viagra online issue in a retrospective analysis of outcomes in 1840 patients with mild to moderate AS (aortic maximum velocity 2.5–4.0 m/s) in the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study. Overall the annualised rate of SCD was 0.39% per year with 27 events in asymptomatic patients. The most recent echocardiogram prior to SCD showed mild–moderate AS in most (80%) of buy cheap viagra online these patients with no difference in SCD event rates in those who progressed to severe AS compared to those who did not develop severe valve obstruction. On Cox regression analysis, the only independent risk factors for SCD were age (HR 1.06, 95% CI 1.01 to 1.11 per year, p=0.02), increased left ventricular mass index (HR 1.20, 95% CI 1.10 to 1.32 per 10 g/m2, p<0.001) and lower body mass index (HR 0.87, 95% CI 0.79 to 0.97 per kg/m2, p=0.01) but not the severity of valve obstruction (figure 1).Univariate (top) and multivariate (bottom) Cox regression analyses for SCD during 46.1±14.6 months of follow-up in the Simvastatin and Ezetimibe in Aortic Stenosis study buy cheap viagra online.

The number of events for each variable is reflected by the dark, horizontal bars with separation at the median for continuous variables. A forest plot visualisation of HRs for SCD buy cheap viagra online is provided on the right. LVED, left ventricular enddiastolic diameter. LVES, left buy cheap viagra online ventricular endsystolic diameter. LVM, left buy cheap viagra online ventricular mass.

SCD, sudden cardiac death." data-icon-position data-hide-link-title="0">Figure 1 Univariate (top) and multivariate (bottom) Cox regression analyses for SCD during 46.1±14.6 months of follow-up in the Simvastatin and Ezetimibe in Aortic Stenosis study. The number of events for each variable is reflected by the dark, horizontal buy cheap viagra online bars with separation at the median for continuous variables. A forest plot visualisation of HRs for SCD is provided on the right. LVED, left buy cheap viagra online ventricular enddiastolic diameter. LVES, left buy cheap viagra online ventricular endsystolic diameter.

LVM, left ventricular mass. SCD, sudden cardiac death.The lack of buy cheap viagra online association between AS severity and the risk of SCD in the SEAS study is thought-provoking and challenges the conventional wisdom that early AVR would prevent SCD in asymptomatic patients with AS.2 In the past, syncope and SCD in patients with AS were thought to be due to mechanisms such as left ventricle (LV) baroreceptor malfunction, hypotension secondary to peripheral vasodilation in the face of fixed valve obstruction, or a shortened diastolic filling interval at high heart rates leading to a reduced stroke volume. However, it is buy cheap viagra online doubtful that any of these mechanisms would account for SCD when AS is only mild to moderate in severity. €˜It is increasingly recognised that that AS is not simply a mechanical problem of the valve leaflets not opening fully. Instead, AS compromises a complex interplay between the valve, ventricle and vasculature with abnormal function of all three components of the disease process.’ As I conclude in an editorial, ‘It is unlikely that early AVR will reduce the risk buy cheap viagra online of sudden death when severe valve obstruction is not present.

Perhaps it is time to turn our attention to mitigating the non-valvular disease processes in adults with calcific valve disease.’In another interesting paper in this issue of Heart, Williams and Brown3 hypothesised that the apparent benefit of fractional flow reserve (FFR) guidance of percutaneous coronary intervention (PCI) in patients with chronic coronary syndromes (CCS) might simply be due to utilisation of fewer stents rather than to knowledge about the physiological severity of the coronary lesions. In a Monte Carlo simulation using data from the PCI strata of the Bypass Angioplasty Revascularization Investigation 2 Diabetes study, random deferral of PCI progressively reduced buy cheap viagra online the risk of death and myocardial infarction at 1 year, suggesting that FFR-guided deferral of PCI improves outcomes simply because fewer stents are placed.In an editorial, Weintraub and Boden4 put this data into the context of 30 years of clinical trials comparing PCI with optimal medical therapy from CCS and conclude ‘In contrast to patients with acute coronary syndrome, there remains no convincing evidence that PCI will prevent events in patients with stable angina and chronic ischaemic heart disease. We know that, if needed, PCI will ameliorate severe angina, buy cheap viagra online but we also know that this may not be a durable effect. By contrast, for the great majority of patients who are not disabled by angina, PCI can be safely deferred in both diabetic and non-diabetic patients, with revascularisation reserved only for those with unacceptable angina or who develop an acute coronary syndrome during follow-up. The role of FFR remains uncertain at best and buy cheap viagra online need not be performed routinely in all patients with CCS, though it may be useful where the visual estimation of angiographical severity is uncertain.’Cardiac involvement in patients with sepsis contributes to adverse outcomes with most previous studies focusing on left ventricular dysfunction.

In order to assess the impact of right ventricular involvement on outcomes in sepsis Kim and colleagues5 performed a retrospective cohort study of 778 patients with septic shock with echocardiographic imaging. Sepsis-induced cardiac dysfunction was present in 34.7% of the buy cheap viagra online entire cohort, affecting the LV in 67.3% and the right ventricle (RV) in 40.7% of these patients. Any type of sepsis-induced cardiac buy cheap viagra online dysfunction was associated with a significantly higher 28-day mortality (35.9 vs 26.8%. P<0.01), longer intensive care unit length of stay and longer duration of mechanical ventilator, compared with those without cardiac dysfunction. Isolated RV dysfunction was rare (24/270, 8.9%) but was associated with buy cheap viagra online a higher risk of 28-day mortality (adjusted OR 2.77, 95% CI 1.20 to 6.40, p=0.02) (figure 2).Comparisons of survival curves between each type of dysfunction.

LV, left ventricle. RV, right ventricle." data-icon-position data-hide-link-title="0">Figure 2 Comparisons of survival curves buy cheap viagra online between each type of dysfunction. LV, left ventricle buy cheap viagra online. RV, right ventricle.The mechanisms of cardiac dysfunction in patients with sepsis are summarised in an editorial by Dugar and Vallabhajosyula6 (figure 3). They also point out the challenges in understanding cardiac involvement in patients with sepsis buy cheap viagra online including the effect of timing of imaging on detection, difficulties in measuring RV systolic performance, and differing definitions of RV dysfunction.

They conclude buy cheap viagra online. €˜there is a crucial need to understand the how to identify RV dysfunction in sepsis and the causative mechanisms associated with higher mortality in this population, which will significantly influence how we prevent and manage this disease process.’Mechanism of RV dysfunction associated organ failure and mortality in sepsis. RV, right ventricular." data-icon-position data-hide-link-title="0">Figure buy cheap viagra online 3 Mechanism of RV dysfunction associated organ failure and mortality in sepsis. RV, right ventricular.The Education-in-Heart article in this issue by Steiner and Kirkpatrick7 focuses on palliative care in management of pateints with cardiovascular disease. Palliative care now encompasses much more than end-of-life comfort buy cheap viagra online measures.

Instead, ‘Palliative care is a specialised type of medical care that focuses on improving communication about goals of care, maximising quality of life and buy cheap viagra online reducing symptoms’ and thus applies to many of our patients at many time points in their disease course. Each of you will want to read the entire article yourself which includes several useful tools, such as the one shown in figure 4, to improve conversations with patients about treatment options, goals of care and planning for adverse outcomes.Ask-Tell-Ask tool to guide difficult conversations." data-icon-position data-hide-link-title="0">Figure 4 Ask-Tell-Ask tool to guide difficult conversations.Be sure to try the two Image Challenge questions in this issue.8 9 Over 150 board-review format multiple choice questions based on all types of cardiac images can be found in our online archive on the Heart homepage (https://heart.bmj.com/pages/collections/image_challenges/).In symptomatic patients with severe aortic stenosis (AS), there is no question that aortic valve replacement (AVR) relieves symptoms and prolongs life. In asymptomatic patients, clinical decision making is less clear because of the need to balance the risks of buy cheap viagra online intervention and a prosthetic valve against the risks of continued watchful waiting. On the other hand, symptom onset is inevitable in patients with severe AS—the decision is not whether but rather when to replace the valve.The primary rationale for deferring AVR until a later date is the lack of evidence that AVR before symptom onset would improve longevity. In addition, the risks, discomfort and disability associated with a surgical or transcatheter procedure are postponed until a later date buy cheap viagra online.

Furthermore, if buy cheap viagra online a mechanical AVR is chosen, delaying intervention reduces the length of time the patient is exposed to the risks and inconvenience of warfarin anticoagulation. If a bioprosthetic AVR is chosen, implantation later in life increases the likelihood that the valve will not deteriorate to the point of reintervention during the patient’s lifetime. Unfortunately, patients with AS do not have the option of buy cheap viagra online a normal aortic valve. Instead the diseased native valve is replaced with an imperfect prosthetic valve.On the other hand, accumulating evidence from advanced imaging studies shows that aortic valve obstruction is associated with adverse changes in left ventricular (LV) structure and function, even in the absence of symptoms, which may not resolve after AVR.1 In addition, observational studies suggest that there may be an increased risk of sudden cardiac death in apparently asymptomatic patients with severe AS, although the magnitude and predictors of risk remain unclear.In order to provide clarity about the risk of sudden death in asymptomatic adults with AS, Minners and colleagues examined the data from the Simvastatin and Ezetimibe in Aortic ….

Where can I keep Viagra?

Keep out of reach of children. Store at room temperature between 15 and 30 degrees C (59 and 86 degrees F). Throw away any unused medicine after the expiration date.

Do pornstars take viagra

Is i magenThe Swedish expression ‘att ha lite is i magen’ (literally do pornstars take viagra to have some additional resources ice in the stomach) like many idiomatic aphorisms, is hard to translate directly. The advantage, of course, is the flexibility that being unbound to a set definition affords and it has come to mean both ‘have something in reserve’ and to ‘keep cool’.Whichever definition is used (and they aren’t mutually exclusive) each of the featured papers imbues us with extra ‘is’, affirms we’re on roughly the right track or that our suspicions of a wrong turn have been corroborated.Preventable child mortality. European figuresUsing WHO global database coding and an incidence rate ratio approach, Ward examines UK standing relative to 17 other European countries in preventable child and adolescent do pornstars take viagra mortality. The numbers (both in progress and current grade in the class) make for uncomfortable reading. UK mortality do pornstars take viagra in 2015 was significantly higher than the EU15 +for common s.

Chronic respiratory conditions and digestive, neurological and diabetes/urological/blood/endocrine conditions in teenaged girls. The UK had the worst do pornstars take viagra to third worst mortality rank for common s in both sexes and all age groups, and in five out of eight non-communicable disease (NCD). Worryingly, despite relatively better placings on injury-related deaths, total mortality has increased year on year since 2013 among adolescent girls and in an estimated two thirds of UK deaths due to asthma and a quarter of deaths in children with epilepsy there were avoidable factors. See page 1055So, where do pornstars take viagra next?. Availability of paediatric expertise early in the illness course (debate point—is this a collateral (positive) effect of erectile dysfunction treatment?.

) to improve recognition of severity has promise but cannot alone do pornstars take viagra compensate for the disparities with which the UK has wrestled for so long.Adolescent healthFemale genital mutilationAli’s examination of referral and outcome data in girls seen at London FGM specialist clinic over 5 years (2014–2019) find that the number and proportions to be substantially lower than expected based on UK prevalence estimates. Median age at assessment was 13 years, most children had undergone FGM prior to UK entry and in most cases were initially disclosed by the child or family themselves. With the usual provisos of case ascertainment, these results suggest that, though there are still do pornstars take viagra pockets of practice, it is largely being abandoned by communities after migration. See page 1075Racism. Psychological effectsIn the speak out against racism (SOAR) study, Priest evaluates associations do pornstars take viagra between self-reported direct and vicarious racism on psychological well-being in Australian adolescents.

Outcomes were quantified by the Strengths and Difficulties Questionnaire and sleep duration and sadly but unsurprisingly, direct and vicarious experiences of racial discrimination were associated with difficulty in socioemotional adjustment and poorer sleep duration. See page 1079Protracted bacterial bronchitisThough the term protracted bacterial bronchitis (PBB) has existed for years, the label had a spell in the wilderness do pornstars take viagra not so long ago, the result of scepticism as to whether the diagnosis (requiring a persistent wet cough and response to antibiotic treatment) was, in fact, a separate entity. I suspect that the use of the term ‘bronchitis’ was thought by many to be too nebulous, but, with the wider use of broncho-alveolar lavage and hard evidence of intrabronchial inflammation, the phenotype is now firmly accepted. There is a recognised association with relapse and later bronchiectasis and although standard treatment consists of a ‘long course’ of antibiotics, the best of which has been amoxycillin-clavulanate, the problem is no-one knows what duration that should mean. Gross-Hodge’s evaluation of the North Midlands University Hospitals’ database strongly do pornstars take viagra suggests that a 6 rather than 2 week course should be chosen with an OR (95% CI) for recurrence of 0.12 (0.03 to 0.51).

Biologically, this seems plausible, longer duration courses possible can break down bronchial bacterial biofilms more successfully. These data are observational, but any allocation bias would be likely to be in favour of the 2 week course do pornstars take viagra based on the sicker-appearing children being given longer courses and an RCT now feels overdue. See page 1111E cigarettes. HypersensitivityAfter a Warholian 15 min of fame, basking in their ‘healthy (or do pornstars take viagra less harmful) alternative’ label, reality (and infamy) is catching up with low tar cigarettes. Literature in this area is accumulating, but, little as directly implicating as Bhatt’s report showing clinical, immunological and histological evidence of a pulmonary hypersensitivity reaction in a ‘casual vaper’, triggers likely being propylene glycol, vegetable glycerides or the flavourings inherent to the experience.

See page 1114TraditionsIn a delightful Voices from History, Emma do pornstars take viagra Sharland chronicles the origins of oral penicillin V dosing. This appears to have become established in children after use by a GP in 1955 based on a child receiving half an adult’s dose and an infant half of that which a child receives. The scientific basis do pornstars take viagra for this and subsequent BNF recommended dosing?. Almost none, but the tradition was set and, despite pharmacokinetic and body composition science has never been seriously challenged. See page 1118EnvironmentAfter some lockdown-related delays, Archives is now being mailed in a polymer derived from the waste products of sugar cane processing, polyair do pornstars take viagra.

This is still a single-use plastic wrapping, but it is made up of 75% biological material, is recyclable in plastic recycling collections, and has been certified as carbon neutral by the Carbon Trust. Progress on recyclable paper wrapping has been slow because of erectile dysfunction treatment and do pornstars take viagra lockdown but is still very much the aim. Armed with this ‘is’, you should be feeling ‘varmare i kläderna’—but that’s a tangent for another day…IntroductionIn the midst of lockdown, just as patient acuity and bed pressures eased, a number of teenagers were transferred to the paediatric intensive care unit (PICU) at Evelina London Children’s Hospital for inotropic support in the absence of respiratory involvement or any features of acute Severe acute respiratory syndrome related erectile dysfunction 2 (SARS CoV-2) .1 All patients had features of toxic shock syndrome (TSS) but no pathogens were identified despite extensive microbiological investigation. Several new do pornstars take viagra patients presented over the next few days. Febrile with high inflammatory markers and multisystem involvement.

The unusually high number of cases raised concerns, which were discussed with Public Health England regarding a possible infectious disease cluster with pathogen unknown.Following several discussions with National Health Service England (NHSE) and pan-London tertiary paediatric services who had also seen cases, a consensus was reached that a new clinical phenomenon was being seen across London. It was sufficiently concerning to send out an NHSE alert at do pornstars take viagra the end of April which triggered international discussion.2 Numerous teleconferences later, the emerging condition had a name. Paediatric inflammatory multisystem syndrome temporally associated with erectile dysfunction (PIMS-TS).3 Since the alert other countries have reported similar cases (figure 1).4 ,5 ,6Timeline of paediatric inflammatory multisystem syndrome temporally associated with erectile dysfunction (PIMS-TS) development.1–4 6–9 NHSE, National Health Service England." data-icon-position data-hide-link-title="0">Figure 1 Timeline of paediatric inflammatory multisystem syndrome temporally associated with erectile dysfunction (PIMS-TS) development.1–4 6–9 NHSE, National Health Service England.PresentationOver 6 weeks more than 70 patients were admitted to Evelina London Children’s Hospital who fulfilled criteria for a diagnosis of PIMS-TS.3 The majority of patients were between 9 years and 16 years of age with the youngest presenting at only 3 months. A higher proportion of patients was male, from black, Asian and minority ethnic groups, and had a parent classed as a key worker.All of do pornstars take viagra the patients presented with a history of fever and most presented with gastrointestinal symptoms including abdominal pain, diarrhoea or vomiting. A number of patients were transferred following surgery for symptoms and signs classical of acute appendicitis but intraoperatively found to have a normal appendix.

Other presenting features included conjunctivitis, rashes and lethargy.Key laboratory findings on presentation included a very high C reactive protein (CRP), high ferritin, raised neutrophils, low lymphocytes, raised D-dimer, raised troponin I, raised N-terminal pro B-type natriuretic do pornstars take viagra peptide and low vitamin D levels.The most common cardiac manifestation was myocarditis with impaired function. Other cardiac abnormalities included arrhythmias, ischaemia and pericardial effusions. Patients were monitored closely for coronary artery dilatation which in some patients continued to progress despite improvement in clinical symptoms and laboratory markers.Acute kidney injury was the most common do pornstars take viagra renal complication which improved with conservative management. Some patients developed thrombus formation and pulmonary emboli due to their prothrombotic state. Neurological involvement was also observed with one patient developing autoimmune encephalitis.PathogenesisMost patients with PIMS-TS reported no preceding illness or do pornstars take viagra mild symptoms consistent with erectile dysfunction treatment, 4–6 weeks prior to presentation.

Others had a household member with previous symptoms consistent with erectile dysfunction treatment . Most patients with PIMS-TS were erectile dysfunction PCR-negative but positive do pornstars take viagra for IgG antibodies against erectile dysfunction indicating previous . It has been postulated that a host immune response to erectile dysfunction triggers an inflammatory response.Although cases of PIMS-TS have similarities to Kawasaki disease (KD) and TSS, there are clear differences.7 Patients with PIMS-TS are older and present with higher inflammatory markers including CRP and ferritin plus higher troponin I suggestive of myocardial ischaemia. Like TSS a proportion of patients do pornstars take viagra with PIMS-TS present in shock with poor cardiac function but none had confirmed staphylococcus or streptococcus on microbiology.ManagementAssessment, stabilisation and early involvement of specialist centresThe majority of the patients needed intensive care for cardiovascular instability requiring single or multiple inotropic agents. Early discussion with specialist centres and transfer to a centre with PICU and cardiology on site is a necessity.Management for each patient was decided within a multidisciplinary team (MDT) setting including General Paediatrics, Cardiology, Paediatric Infectious Diseases and Immunology (PIID), Rheumatology, PICU, Haematology, Renal and Pharmacy, with re-evaluation on a twice daily basis as a minimum.

A General Paediatric overview was vital in coordinating the MDT and providing holistic care.TreatmentIn our cohort, as we gained experience, prompting earlier diagnosis and treatment initiation, fewer cardiac do pornstars take viagra complications and reduced PICU stay were observed. Treatments included intravenous immunoglobulin, methylprednisolone and biologics including tocilizumab, infliximab and anakinra. Currently there is no evidence for this area and recruiting children to research studies such as Recovery (https://www.recoverytrial.net/) and the ‘Best available treatment study (BATS) for inflammatory conditions associated with erectile dysfunction treatment’ (https://doi.org/10.1186/ISRCTN69546370) will hopefully provide evidence on which to base our treatment decisions. All patients receiving treatment were routinely prescribed aspirin, prophylactic dalteparin, high dose cholecalciferol and omeprazole.Psychology and supportPlay therapy do pornstars take viagra involvement and psychological support for this cohort was quickly escalated. Families were understandably extremely worried by the sudden clinical deterioration of their previously well child and need for intensive care.

Multiple interventions including scans, do pornstars take viagra cannulas and blood tests by staff masked in personal protective equipment added to the stress. Psychology support is now a routine part of the care offered.Overcoming challengesTo cope with the large number of unpredictable and high acuity patients with PIMS-TS, additional staffing was required on our paediatric wards. Within days, the number of high dependency unit (HDU) beds was rapidly do pornstars take viagra increased to accommodate the intense level of monitoring and treatment required. Ward rounds, handovers, MDT meetings and pathways were rapidly revised and implemented. We sought the return of our experienced paediatric nurses and doctors who had been redeployed do pornstars take viagra to adult services.

Additional pharmacists, psychologists and play therapists also joined a newly created and dedicated PIMS-TS team with representation from General Paediatrics, PIID, Cardiology and Rheumatology to manage the daily care of the patients. This ensured individualised, holistic do pornstars take viagra management plans could be made to provide the highest quality of care. The responsiveness by everyone involved was phenomenal.As patients are discharged the next challenge is ensuring follow-up plans are appropriately tailored, responsive and clinically robust. In the current lockdown era, this do pornstars take viagra is no small task given the numbers involved, the follow-up investigations needed, plus national pressures to reduce face-to-face appointments.Managing a new condition with no published consensus on treatment was a huge challenge, especially given the large numbers and high acuity of the patients who were admitted. Seeking out opinions, information and advice from other centres, nationally and internationally, as well as shared learning with other paediatric specialities has been key in helping manage these children.

Collaborative learning and reflection has enabled us do pornstars take viagra to develop a treatment pathway and shared management pathway for our patients. We have witnessed the MDT working at its best within the hospital, united with the sole aim of combating this rare condition.Next stepsLong-term follow-up is essential to enable us to understand the long-term implications and prognosis for these patients. Planning and vigilance is required to manage a possible influx of patients with PIMS-TS if there is another surge of erectile dysfunction.An ongoing coordinated effort is required to undertake do pornstars take viagra paediatric research to understand PIMS-TS and establish the most effective treatment. The British Paediatric Surveillance Unit team is collecting data about all reported cases in the UK and Ireland.8 We eagerly await the publication of evidence which may support, or disprove an association with erectile dysfunction. Certainly, the clinical histories taken from this cohort offer fascinating glimpses into the possibilities of an association..

Is i magenThe buy viagra with free samples Swedish expression ‘att ha lite is i magen’ (literally to have some ice in the stomach) like buy cheap viagra online many idiomatic aphorisms, is hard to translate directly. The advantage, of course, is the flexibility that being unbound to a set definition affords and it has come to mean both ‘have something in reserve’ and to ‘keep cool’.Whichever definition is used (and they aren’t mutually exclusive) each of the featured papers imbues us with extra ‘is’, affirms we’re on roughly the right track or that our suspicions of a wrong turn have been corroborated.Preventable child mortality. European figuresUsing WHO global database buy cheap viagra online coding and an incidence rate ratio approach, Ward examines UK standing relative to 17 other European countries in preventable child and adolescent mortality. The numbers (both in progress and current grade in the class) make for uncomfortable reading. UK mortality in 2015 was buy cheap viagra online significantly higher than the EU15 +for common s.

Chronic respiratory conditions and digestive, neurological and diabetes/urological/blood/endocrine conditions in teenaged girls. The UK had the worst to third worst mortality rank for common s in both sexes and all age buy cheap viagra online groups, and in five out of eight non-communicable disease (NCD). Worryingly, despite relatively better placings on injury-related deaths, total mortality has increased year on year since 2013 among adolescent girls and in an estimated two thirds of UK deaths due to asthma and a quarter of deaths in children with epilepsy there were avoidable factors. See page buy cheap viagra online 1055So, where next?. Availability of paediatric expertise early in the illness course (debate point—is this a collateral (positive) effect of erectile dysfunction treatment?.

) to improve recognition buy cheap viagra online of severity has promise but cannot alone compensate for the disparities with which the UK has wrestled for so long.Adolescent healthFemale genital mutilationAli’s examination of referral and outcome data in girls seen at London FGM specialist clinic over 5 years (2014–2019) find that the number and proportions to be substantially lower than expected based on UK prevalence estimates. Median age at assessment was 13 years, most children had undergone FGM prior to UK entry and in most cases were initially disclosed by the child or family themselves. With the usual provisos of case ascertainment, buy cheap viagra online these results suggest that, though there are still pockets of practice, it is largely being abandoned by communities after migration. See page 1075Racism. Psychological effectsIn the buy cheap viagra online speak out against racism (SOAR) study, Priest evaluates associations between self-reported direct and vicarious racism on psychological well-being in Australian adolescents.

Outcomes were quantified by the Strengths and Difficulties Questionnaire and sleep duration and sadly but unsurprisingly, direct and vicarious experiences of racial discrimination were associated with difficulty in socioemotional adjustment and poorer sleep duration. See page 1079Protracted bacterial bronchitisThough the term protracted bacterial bronchitis (PBB) has existed for years, buy cheap viagra online the label had a spell in the wilderness not so long ago, the result of scepticism as to whether the diagnosis (requiring a persistent wet cough and response to antibiotic treatment) was, in fact, a separate entity. I suspect that the use of the term ‘bronchitis’ was thought by many to be too nebulous, but, with the wider use of broncho-alveolar lavage and hard evidence of intrabronchial inflammation, the phenotype is now firmly accepted. There is a recognised association with relapse and later bronchiectasis and although standard treatment consists of a ‘long course’ of antibiotics, the best of which has been amoxycillin-clavulanate, the problem is no-one knows what duration that should mean. Gross-Hodge’s evaluation of the North Midlands University Hospitals’ database strongly suggests that buy cheap viagra online a 6 rather than 2 week course should be chosen with an OR (95% CI) for recurrence of 0.12 (0.03 to 0.51).

Biologically, this seems plausible, longer duration courses possible can break down bronchial bacterial biofilms more successfully. These data are observational, but any allocation bias would be likely to be in favour of the 2 week course based on the sicker-appearing children being given longer courses and buy cheap viagra online an RCT now feels overdue. See page 1111E cigarettes. HypersensitivityAfter a Warholian 15 min of fame, basking in their buy cheap viagra online ‘healthy (or less harmful) alternative’ label, reality (and infamy) is catching up with low tar cigarettes. Literature in this area is accumulating, but, little as directly implicating as Bhatt’s report showing clinical, immunological and histological evidence of a pulmonary hypersensitivity reaction in a ‘casual vaper’, triggers likely being propylene glycol, vegetable glycerides or the flavourings inherent to the experience.

See page 1114TraditionsIn a delightful Voices from History, Emma Sharland chronicles buy cheap viagra online the origins of oral penicillin V dosing. This appears to have become established in children after use by a GP in 1955 based on a child receiving half an adult’s dose and an infant half of that which a child receives. The scientific basis buy cheap viagra online for this and subsequent BNF recommended dosing?. Almost none, but the tradition was set and, despite pharmacokinetic and body composition science has never been seriously challenged. See page 1118EnvironmentAfter some lockdown-related delays, buy cheap viagra online Archives is now being mailed in a polymer derived from the waste products of sugar cane processing, polyair.

This is still a single-use plastic wrapping, but it is made up of 75% biological material, is recyclable in plastic recycling collections, and has been certified as carbon neutral by the Carbon Trust. Progress on recyclable paper wrapping has been slow because of buy cheap viagra online erectile dysfunction treatment and lockdown but is still very much the aim. Armed with this ‘is’, you should be feeling ‘varmare i kläderna’—but that’s a tangent for another day…IntroductionIn the midst of lockdown, just as patient acuity and bed pressures eased, a number of teenagers were transferred to the paediatric intensive care unit (PICU) at Evelina London Children’s Hospital for inotropic support in the absence of respiratory involvement or any features of acute Severe acute respiratory syndrome related erectile dysfunction 2 (SARS CoV-2) .1 All patients had features of toxic shock syndrome (TSS) but no pathogens were identified despite extensive microbiological investigation. Several new patients presented buy cheap viagra online over the next few days. Febrile with high inflammatory markers and multisystem involvement.

The unusually high number of cases raised concerns, which were discussed with Public Health England regarding a possible infectious disease cluster with pathogen unknown.Following several discussions with National Health Service England (NHSE) viagra online canadian pharmacy and pan-London tertiary paediatric services who had also seen cases, a consensus was reached that a new clinical phenomenon was being seen across London. It was sufficiently concerning to send out an NHSE alert at the end of April which triggered international discussion.2 Numerous teleconferences later, the emerging condition had a name buy cheap viagra online. Paediatric inflammatory multisystem syndrome temporally associated with erectile dysfunction (PIMS-TS).3 Since the alert other countries have reported similar cases (figure 1).4 ,5 ,6Timeline of paediatric inflammatory multisystem syndrome temporally associated with erectile dysfunction (PIMS-TS) development.1–4 6–9 NHSE, National Health Service England." data-icon-position data-hide-link-title="0">Figure 1 Timeline of paediatric inflammatory multisystem syndrome temporally associated with erectile dysfunction (PIMS-TS) development.1–4 6–9 NHSE, National Health Service England.PresentationOver 6 weeks more than 70 patients were admitted to Evelina London Children’s Hospital who fulfilled criteria for a diagnosis of PIMS-TS.3 The majority of patients were between 9 years and 16 years of age with the youngest presenting at only 3 months. A higher proportion of patients was male, from black, Asian and minority ethnic groups, and had a parent classed as a key worker.All of buy cheap viagra online the patients presented with a history of fever and most presented with gastrointestinal symptoms including abdominal pain, diarrhoea or vomiting. A number of patients were transferred following surgery for symptoms and signs classical of acute appendicitis but intraoperatively found to have a normal appendix.

Other presenting features included conjunctivitis, rashes and lethargy.Key laboratory findings on presentation included a very high C reactive protein (CRP), high ferritin, raised neutrophils, low lymphocytes, raised D-dimer, raised troponin I, raised N-terminal pro B-type natriuretic peptide and low vitamin buy cheap viagra online D levels.The most common cardiac manifestation was myocarditis with impaired function. Other cardiac abnormalities included arrhythmias, ischaemia and pericardial effusions. Patients were monitored closely for coronary artery dilatation which in some patients continued to progress despite improvement in clinical symptoms and laboratory markers.Acute kidney injury was the most common renal complication buy cheap viagra online which improved with conservative management. Some patients developed thrombus formation and pulmonary emboli due to their prothrombotic state. Neurological involvement was also observed with one patient developing autoimmune encephalitis.PathogenesisMost patients with PIMS-TS reported buy cheap viagra online no preceding illness or mild symptoms consistent with erectile dysfunction treatment, 4–6 weeks prior to presentation.

Others had a household member with previous symptoms consistent with erectile dysfunction treatment . Most patients with PIMS-TS were erectile dysfunction PCR-negative buy cheap viagra online but positive for IgG antibodies against erectile dysfunction indicating previous . It has been postulated that a host immune response to erectile dysfunction triggers an inflammatory response.Although cases of PIMS-TS have similarities to Kawasaki disease (KD) and TSS, there are clear differences.7 Patients with PIMS-TS are older and present with higher inflammatory markers including CRP and ferritin plus higher troponin I suggestive of myocardial ischaemia. Like TSS a proportion of patients with PIMS-TS present in shock buy cheap viagra online with poor cardiac function but none had confirmed staphylococcus or streptococcus on microbiology.ManagementAssessment, stabilisation and early involvement of specialist centresThe majority of the patients needed intensive care for cardiovascular instability requiring single or multiple inotropic agents. Early discussion with specialist centres and transfer to a centre with PICU and cardiology on site is a necessity.Management for each patient was decided within a multidisciplinary team (MDT) setting including General Paediatrics, Cardiology, Paediatric Infectious Diseases and Immunology (PIID), Rheumatology, PICU, Haematology, Renal and Pharmacy, with re-evaluation on a twice daily basis as a minimum.

A General Paediatric overview was vital buy cheap viagra online in coordinating the MDT and providing holistic care.TreatmentIn our cohort, as we gained experience, prompting earlier diagnosis and treatment initiation, fewer cardiac complications and reduced PICU stay were observed. Treatments included intravenous immunoglobulin, methylprednisolone and biologics including tocilizumab, infliximab and anakinra. Currently there is no evidence for this area and recruiting children to research studies such as Recovery (https://www.recoverytrial.net/) and the ‘Best available treatment study (BATS) for inflammatory conditions associated with erectile dysfunction treatment’ (https://doi.org/10.1186/ISRCTN69546370) will hopefully provide evidence on which to base our treatment decisions. All patients receiving treatment were routinely prescribed aspirin, prophylactic dalteparin, high dose cholecalciferol buy cheap viagra online and omeprazole.Psychology and supportPlay therapy involvement and psychological support for this cohort was quickly escalated. Families were understandably extremely worried by the sudden clinical deterioration of their previously well child and need for intensive care.

Multiple interventions including scans, cannulas and buy cheap viagra online blood tests by staff masked in personal protective equipment added to the stress. Psychology support is now a routine part of the care offered.Overcoming challengesTo cope with the large number of unpredictable and high acuity patients with PIMS-TS, additional staffing was required on our paediatric wards. Within days, the buy cheap viagra online number of high dependency unit (HDU) beds was rapidly increased to accommodate the intense level of monitoring and treatment required. Ward rounds, handovers, MDT meetings and pathways were rapidly revised and implemented. We sought the return of our experienced paediatric nurses and doctors buy cheap viagra online who had been redeployed to adult services.

Additional pharmacists, psychologists and play therapists also joined a newly created and dedicated PIMS-TS team with representation from General Paediatrics, PIID, Cardiology and Rheumatology to manage the daily care of the patients. This ensured individualised, holistic management plans could be made buy cheap viagra online to provide the highest quality of care. The responsiveness by everyone involved was phenomenal.As patients are discharged the next challenge is ensuring follow-up plans are appropriately tailored, responsive and clinically robust. In the current lockdown era, this is no small buy cheap viagra online task given the numbers involved, the follow-up investigations needed, plus national pressures to reduce face-to-face appointments.Managing a new condition with no published consensus on treatment was a huge challenge, especially given the large numbers and high acuity of the patients who were admitted. Seeking out opinions, information and advice from other centres, nationally and internationally, as well as shared learning with other paediatric specialities has been key in helping manage these children.

Collaborative learning and reflection has enabled us to buy cheap viagra online develop a treatment pathway and shared management pathway for our patients. We have witnessed the MDT working at its best within the hospital, united with the sole aim of combating this rare condition.Next stepsLong-term follow-up is essential to enable us to understand the long-term implications and prognosis for these patients. Planning and vigilance is required to manage a possible influx of patients with PIMS-TS if there is another surge of erectile dysfunction.An ongoing coordinated effort is buy cheap viagra online required to undertake paediatric research to understand PIMS-TS and establish the most effective treatment. The British Paediatric Surveillance Unit team is collecting data about all reported cases in the UK and Ireland.8 We eagerly await the publication of evidence which may support, or disprove an association with erectile dysfunction. Certainly, the clinical histories taken from this cohort offer fascinating glimpses into the possibilities of an association..

Blue chew viagra

As flu season creeps up on Web Site the blue chew viagra Northern Hemisphere, cold and flu relief medications will inevitably fly off store shelves. A natural remedy that shoppers might reach for is elderberry, a small, blackish-purple fruit that companies turn into syrups, lozenges and gummies. Though therapeutic uses of the berry date back centuries, Michael Macknin, a pediatrician at the Cleveland Clinic, hadn’t heard of using elderberry to treat the flu until a patient’s mother blue chew viagra asked him about it. Some industry-sponsored research claims that the herbal remedy could cut the length of the symptoms by up to four days.

For a comparison, Tamiflu, an FDA-approved treatment, only blue chew viagra reduces flu duration by about a single day. €œI said, 'Gee, if that’s really true [about elderberry], it would be a huge benefit,'” Macknin says. But the effectiveness and safety of elderberry is still fairly unclear. Unlike the over-the-counter blue chew viagra medicines at your local pharmacy, elderberry hasn't been through rigorous FDA testing and approval.

However, Macknin and his team recently published a study in the Journal of General Internal Medicine, which found that elderberry treatments did nothing for flu patients. This prompts a need for further studies into the remedy — work that unfortunately stands a low chance of happening in the blue chew viagra future, Macknin says. Looking For ProofElderberries are full of chemicals that could be good for your health. Like similar fruits, the berries contain high levels of antioxidants, compounds that shut down reactions blue chew viagra in our bodies that damage cells.

But whether or not elderberry's properties also help immune systems fend off a viagra is murky. There are only a handful of studies that have examined if elderberries reduced the severity or duration of the flu. And though some of the work prior to Macknin’s was well-designed and supported this herbal remedy as a helpful flu aid, at least some — and potentially all — of those studies were funded by elderberry treatment manufacturers.Macknin says an elderberry supplement company provided his team with their products and a placebo version for blue chew viagra free, but that the company wasn’t involved in the research beyond that. Macknin's study is the largest one conducted on elderberry to date, with 87 influenza patients completing the entire treatment course.

Participants in the study were also welcome to take Tamiflu, for ethical reasons, as the team didn’t want blue chew viagra to exclude anyone from taking a proven flu therapy. Additionally, each participant took home either a bottle of elderberry syrup or the placebo with instructions on when and how to take it. The research team called participants every day for a symptom check and to remind them to take blue chew viagra their medication.By chance, it turned out that a higher percentage of the patients given elderberry syrup had gotten their flu shot and also chose to take Tamiflu. Since the vaccination can reduce the severity of in recipients who still come down with the flu, the study coincidentally operated in favor of those who took the herbal remedy, Macknin says.

Those patients could have dealt with a shorter, less-intense illness because of the Tamiflu and vaccination. €œEverything was stacked to have blue chew viagra it turn out better [for the elderberry group],” Macknin says, “and it turned out the same.” The researchers found no difference in illness duration or severity between the elderberry and placebo groups. While analyzing the data, the team also found that those on the herbal treatment might have actually fared worse than those on the placebo. The potential blue chew viagra for this intervention to actually harm instead of help influenza patients explains why Macknin thinks the therapy needs further research.But, don't expect that work to happen any time soon.

Researchers are faced with a number of challenges when it comes to studying the efficacy of herbal remedies. For starters, there's little financial incentive to investigate if they actually work blue chew viagra. Plant products are challenging to patent, making them less lucrative prospects for pharmaceutical companies or research organizations to investigate. Additionally, investigations that try and prove a proposed therapy as an effective drug — like the one Macknin and his team accomplished — are expensive, Macknin says.

Those projects need FDA oversight and additional paperwork, blue chew viagra components that drive up study costs. €œIt’s extraordinarily expensive and there’s no money in it for anybody,” Macknin says.Talk To Your DoctorUltimately, research on elderberry therapies for flu patients is a mixed bag, and deserves more attention from scientists. However, if you blue chew viagra still want to discuss elderberry treatments for the flu with your doctor, that’s a conversation you should feel comfortable having, says Erica McIntyre, an expert focused on health and environmental psychology in the School of Public Health at the University of Technology Sydney. Navigating what research says about a particular herbal medicine is challenging for patients and health practitioners alike.

The process is made more complex by the range of similar-sounding products on the blue chew viagra market that lack standardized ingredients, McIntyre says. But when doctors judge or shame patients for asking about non-conventional healthcare interventions, the response can distance people and push them closer to potentially unproven treatments. Even worse, those individuals might start to keep their herbal remedies a secret. €œIt is that fear about being judged for use of that medication,” McIntyre says, that drives up to 50 percent blue chew viagra of people taking herbal treatments to withhold that information from healthcare practitioners.

That’s a dangerous choice, as some herbal and traditional medications can interact and cause health problems.If a physician shames someone for asking about alternative medicines, it’s likely time to find a new doctor, McIntyre says. Look for someone who will listen to your concerns — whether it's that you feel traditional treatments haven’t worked for you, or that you didn’t like the side effects, the two common reasons people pursue blue chew viagra herbal treatments in the first place. €œYou’re not necessarily looking for a doctor that will let you do whatever you want,” McIntyre says, “but that they actually consider you as a patient, your treatment choices and your treatment priorities, and communicate in a way that’s supportive.” And if a doctor suggests that you avoid a treatment you’re interested in, ask why. They generally have a good reason, McIntyre says.For now, know that even if your doctor doesn’t support you taking elderberry, there are other proven preventative measures that are worth your while — like the flu shot.

Anyone six months or older should get it, Macknin says, and stick to the protocols we’re blue chew viagra used to following to prevent erectile dysfunction treatment s, like social distancing, mask-wearing and hand-washing. Those measures also help prevent flu transmission, too — something, so far, no elderberry supplement package can claim.The yearly influenza season threatens to make the erectile dysfunction treatment viagra doubly deadly, but I believe that this isn’t inevitable.There are two commonly given treatments – the pneumococcal treatment and the Hib treatment – that protect against bacterial pneumonias. These bacteria complicate both influenza and erectile dysfunction treatment, blue chew viagra often leading to death. My examination of disease trends and vaccination rates leads me to believe that broader use of the pneumococcal and Hib treatments could guard against the worst effects of a erectile dysfunction treatment illness.I am an immunologist and physiologist interested in the effects of combined s on immunity.

I have reached my insight by juxtaposing two blue chew viagra seemingly unrelated puzzles. Infants and children get erectile dysfunction, the viagra that causes erectile dysfunction treatment, but very rarely become hospitalized or die. And case numbers and death rates from erectile dysfunction treatment began varying greatly from nation to nation and city to city even before lockdowns began. I wondered why.One night I woke blue chew viagra up with a possible answer.

Vaccination rates. Most children, beginning at age two blue chew viagra months, are vaccinated against numerous diseases. Adults less so. And, both infant and adult vaccination blue chew viagra rates vary widely across the world.

Could differences in the rates of vaccination against one or more diseases account for differences in erectile dysfunction treatment risks?. As someone who had previously investigated other viagras such as the Great Flu viagra of 1918-19 and AIDS, and who has worked with treatments, I had a strong background for tracking down the relevant data to test my hypothesis.Pneumococcal Vaccination Rates Correlate With Lower erectile dysfunction treatment Cases and DeathsI gathered national and some local data on vaccination rates against influenza, polio, measles-mumps-rubella (MMR), diphtheria-tetanus-pertussis (DTP), tuberculosis (BCG), pneumococci and Haemophilus influenzae type B (Hib). I correlated blue chew viagra them with erectile dysfunction treatment case rates and death rates for 24 nations that had experienced their erectile dysfunction treatment outbreaks at about the same time. I controlled for factors such as percentage of the population who were obese, diabetic or elderly.I found that only pneumococcal treatments afforded statistically significant protection against erectile dysfunction treatment.

Nations such as Spain, Italy, blue chew viagra Belgium, Brazil, Peru and Chile that have the highest erectile dysfunction treatment rates per million have the poorest pneumococcal vaccination rates among both infants and adults. Nations with the lowest rates of erectile dysfunction treatment – Japan, Korea, Denmark, Australia and New Zealand – have the highest rates of pneumococcal vaccination among both infants and adults.A recent preprint study (not yet peer-reviewed) from researchers at the Mayo Clinic has also reported very strong associations between pneumococcal vaccination and protection against erectile dysfunction treatment. This is especially true blue chew viagra among minority patients who are bearing the brunt of the erectile dysfunction viagra. The report also suggests that other treatments, or combinations of treatments, such as Hib and MMR may also provide protection.These results are important because in the U.S., childhood vaccination against pneumococci – which protects against Streptococcus pneumoniae bacteria – varies by state from 74% to 92%.

Although the CDC recommends that all adults 18-64 in high risk groups for erectile dysfunction treatment and all adults over the age of 65 get a pneumococcal vaccination, only 23% of high-risk adults and 64% of those over the age of 65 do so.Similarly, although the CDC recommends at all infants and some high-risk adults be vaccinated against Haemophilus influenzae type B (Hib), only 80.7% of children in the U.S. And a blue chew viagra handful of immunologically compromised adults have been. Pneumococcal and Hib vaccination rates are significantly lower in minority populations in the U.S. And in countries that have been hit harder by erectile dysfunction treatment than the U.S.Based on these data, I advocate universal pneumococcal and Hib vaccination among children, at-risk adults and blue chew viagra all adults over 65 to prevent serious erectile dysfunction treatment disease.Left.

Combined rates of childhood and adult (over 65) pneumococcal vaccination (out of a possible 200). Right. Cases (per million) population of erectile dysfunction treatment at about 90 days into the viagra for 24 nations. Nations with high pneumococcal vaccination rates have low erectile dysfunction treatment case rates.

(Credit. CC BY-SA)How Pneumococcal Vaccination Protects Against erectile dysfunction treatmentProtection against serious erectile dysfunction treatment disease by pneumococcal and Hib treatments makes sense for several reasons. First, recent studies reveal that the majority of hospitalized erectile dysfunction treatment patients, and in some studies nearly all, are infected with streptococci, which causes pneumococcal pneumonias, Hib or other pneumonia-causing bacteria. Pneumococcal and Hib vaccinations should protect erectile dysfunction patients from these s and thus significantly cut the risk of serious pneumonia.I also found that pneumococcal, Hib and possibly rubella treatments may confer specific protection against the erectile dysfunction viagra that causes erectile dysfunction treatment by means of “molecular mimicry.”Molecular mimicry occurs when the immune system thinks one microbe looks like another.

In this case, proteins found in pneumococcal treatments and, to a lesser degree, ones found in Hib and rubella treatments as well look like several proteins produced by the erectile dysfunction viagra.Two of these proteins found in pneumococcal treatments mimic the spike and membrane proteins that permit the viagra to infect cells. This suggests pneumococcal vaccination may prevent erectile dysfunction . Two other mimics are the nucleoprotein and replicase that control viagra replication. These proteins are made after viral , in which case pneumococcal vaccination may control, but not prevent, erectile dysfunction replication.Either way, these treatments may provide proxy protection against erectile dysfunction that we can implement right now, even before we have a specific viagra treatment.

Such protection may not be complete. People might still suffer a weakened version of erectile dysfunction treatment but, like most infants and children, be protected against the worst effects of the .Fighting Influenza-related Pneumonias During the erectile dysfunction treatment viagraWhile the specific protection these other treatments confer against erectile dysfunction treatment has not yet been tested in a clinical trial, I advocate broader implementation of pneumococcal and Hib vaccination for one additional, well-validated reason.Pneumococcal and Hib pneumonias – both caused by bacteria – are the major causes of death following viral influenza. The influenza viagra rarely causes death directly. Most often, the viagra makes the lungs more susceptible to bacterial pneumonias, which are deadly.

Dozens of studies around the world have demonstrated that increasing rates of pneumococcal and Hib vaccination dramatically lowers influenza-related pneumonias.Similar studies demonstrate that the price of using these treatments is balanced by savings due to lower rates of influenza-related hospitalizations, intensive care unit admissions and deaths. In the context of erectile dysfunction treatment, lowering rates of influenza-related hospitalizations and ICU admissions would free up resources to fight the erectile dysfunction, independent of any effect these treatments might have on erectile dysfunction itself. In my opinion, that is a winning scenario.In short, we need not wait for a erectile dysfunction treatment to slow down erectile dysfunction treatment.I believe that we can and should act now by fighting the erectile dysfunction with all the tools at our disposal, including influenza, Hib, pneumococcal and perhaps rubella vaccinations.Preventing pneumococcal and Hib complications of influenza and erectile dysfunction treatment, and perhaps proxy-vaccinating against erectile dysfunction itself, helps everyone. Administering these already available and well-tested pneumococcal and Hib treatments to people will save money by freeing up hospital beds and ICUs.

It will also improve public health by reducing the spread of multiple s and boost the economy by nurturing a healthier population.Robert Root-Bernstein is a Professor of Physiology at Michigan State University. This article was originally published on The Conversation under a Creative Commons liscense Read the original here.This story appeared in the November 2020 issue as "Bacteria and the Brain." Subscribe to Discover magazine for more stories like this.It’s not always easy to convince people that the human gut is a sublime and wondrous place worthy of special attention. Sarkis Mazmanian discovered that soon after arriving at Caltech for his first faculty job 14 years ago, when he explained to a local artist what he had in mind for the walls outside his new office.The resulting mural greets visitors to the Mazmanian Lab today. A vaguely psychedelic, 40-foot-long, tube-shaped colon that’s pink, purple and red snakes down the hallway.

In a panel next to it, fluorescent yellow and green bacteria explode out of a deeply inflamed section of the intestinal tract, like radioactive lava from outer space.The mural is modest compared with what the scientist has been working on since. Over the last decade or so, Mazmanian has been a leading proponent of the idea that the flora of the human digestive tract has a far more powerful effect on the human body and mind than we thought — a scientific effort that earned him a $500,000 MacArthur Fellowship “Genius Grant” in 2012. Since then, Mazmanian and a small but growing cadre of fellow microbiologists have amassed a tantalizing body of evidence on the microbiome’s role in all kinds of brain disorders, including schizophrenia, Alzheimer’s disease, Parkinson’s disease and depression.But the results they’ve seen in autism could, in the end, prove the most transformative. Autism affects about 1 in 59 children in the U.S., and involves profound social withdrawal, communication problems, and sometimes anxiety and aggression.

The causes of the brain disorder have remained speculative. Now, Mazmanian and other researchers are finding that autism may be inextricably linked to — or even caused by — irregularities in the gut microbiome.A Biology StoryAt 47, Mazmanian — with his shaved head, flannel shirt and skinny jeans — resembles a young, urban hipster on his way to write at the local café. Originally, literary life was his plan. Born in Lebanon to two Armenian refugees, neither of whom had more than a first-grade education, Mazmanian landed in the class of an energetic high school English teacher in California’s San Fernando Valley, where his family first settled.

The teacher recognized his gift for language and encouraged him to pursue a career in literature. Mazmanian enrolled at UCLA in 1990, planning to major in English.Everything changed when he took his first biology class. Hunched over his new, thick textbook in the library, reading about basic biological concepts like photosynthesis, Mazmanian felt a vast new world opening up to him.Sarkis Mazmanian, shown in front of a mural that celebrates the human gut, is part of a group of microbiologists researching the effects of the digestive tract on a range of disorders. (Credit.

Caltech)“For the first time in my life, I wanted to turn the page and see where the story was going to go,” he says. €œI think I decided that minute to become a scientist.”Mazmanian was most fascinated by the idea that tiny organisms, invisible to the naked eye, could function as powerful, self-contained machines — powerful enough to take over and destroy the human body. After graduating with a degree in microbiology, Mazmanian joined a UCLA infectious diseases lab and began studying bacteria that cause staph s.As his dissertation defense approached, Mazmanian read a one-page commentary penned by a prominent microbiologist, highlighting the fact that our intestines are teeming with hundreds, if not thousands, of different species of bacteria. But it was still largely unknown what they are and how they affect the human body.When Mazmanian dug further, he found that no one had yet answered what seemed to him to be the most obvious question.

Why would the human immune system, designed to attack and destroy foreign invaders, allow hundreds of species of bacteria to live and thrive in our guts unmolested?. To him, the bacteria’s survival implied that we had evolved to coexist with them. And if that were so, he reasoned, there must be some benefit to both the microbes and the human body — a symbiotic relationship. But what was it?.

Gut InvadersMazmanian set out to study the link between gut microbes and the immune system. As a postdoctoral researcher, he joined the lab of Harvard University infectious disease specialist Dennis Kasper.To start, Mazmanian examined how the immune systems of germ-free mice — lab mice completely protected, starting at birth, from all microbes — differed from those of mice with either few or normal levels of microbes. He expected this initial census would be just a first step in a long and arduous quest for scientific pay dirt. But when he went to examine a printout of his results in the lab, he realized immediately he might already be onto something big.

The germ-free mice had a 30 to 40 percent reduction in a specific type of immune cell known as helper T-cells.This colorized close-up of a mouse’s gut reveals the tight relationship between the gut microbe Bacteroides fragilis (red) and the epithelial surface of the colon (blue). (Credit. Caltech)Since helper T-cells play a key role in coordinating attacks against invading pathogens, the finding suggested that the immune systems of the germ-free mice were far less robust than those found in peers with normal levels of microbes.“That was exciting, right?. € Mazmanian recalls.

€œObviously I repeated it and tested it in a number of different ways. Then I asked the next question. €˜Can I restore the [immune] function in an adult animal?. €™â€‰â€Mazmanian colonized the guts of the immunocompromised, germ-free mice with microbes from standard lab mice.

After receiving the fecal transplant, their T-cell counts shot up. Within a month, their numbers were identical to mice raised outside the germ-free bubble.Resolving to identify the microorganisms causing this transformation, Mazmanian resorted to trial and error. One by one, he added strains of bacteria found in the guts of mice to the guts of germ-free mice.He got nowhere with the first five or six species he examined. Then, simply because it was convenient, he decided to test one more that was readily available in his lab.

Mazmanian’s adviser, Kasper, had been studying a gut microbe called Bacteroides fragilis. When Mazmanian implanted one of Kasper’s specimens into the gut of his germ-free mice, the results were dramatic. The T-cell numbers spiked to normal. Eventually, Mazmanian demonstrated he could reproduce this effect simply by adding a single molecule that these bacteria produce, called polysaccharide A, to their guts.“There was no logic in the choice whatsoever,” Mazmanian recalls.

€œ[B. Fragilis] was available, it came from the gut.” In other words, he got lucky.Mazmanian dug deeper and discovered that the biggest impact B. Fragilis had was on the population of a subtype of helper T-cells called regulatory, or suppressor, T-cells. These cells play a key role in preventing the immune system from attacking its host body, protecting against autoimmune or inflammatory diseases.

It was the first time any scientist had demonstrated that a single compound from a single microbe could reverse a specific problem with the immune system.To Mazmanian, the finding, published in 2005 in the journal Cell, alluded to new approaches to treating a wide array of autoimmune, inflammatory and allergic disorders. What if it were possible to help a faulty immune system by tweaking a patient’s microbiome?. It was with this exploration in mind that he arrived in Pasadena in 2006 to set up his lab at Caltech.A Convenient CollaborationA few years later, Mazmanian was having lunch on campus with neuroscientist and colleague Paul Patterson. Patterson had been preoccupied with a mystery that had, for years, confounded those studying autism in humans.

When pregnant mothers have a severe in the second trimester, their babies are much more likely to develop autism.As Mazmanian tells it, Patterson was a man of few words, and at lunch Mazmanian was “going on and on” about his own work.“You know,” Patterson interjected thoughtfully, “I think kids with autism have GI issues.”Patterson recalled reading that something like 60 percent of children with autism had some form of clinical GI problem, such as bloating, constipation, flatulence or diarrhea. Was it possible, he wondered, that there was a microbiome connection?. As they talked, Mazmanian’s excitement grew.A few years earlier, Patterson had discovered that when he exposed pregnant mice to pathogens like the influenza viagra, they gave birth to pups that grew up more likely to be startled by loud noises, to shy away from social contact and to groom themselves repetitively — symptoms that resemble those of autism. Patterson was in the process of comparing the brains of these autism-mimicking mice with their neurotypical cousins to see if he could detect any differences that might explain how the maternal immune system was somehow interfering with the pups’ brain development.Mazmanian had a suggestion.

The next time Patterson sacrificed one of his autistic mice to study their brains, what if he set the intestines aside for his colleague down the hall?. When the guts arrived in Mazmanian’s lab, he found that the intestines of the neurotypical mice looked normal. But the guts of the autism-mimicking offspring were almost uniformly inflamed. Could it be that the microbiome was the cause of this inflammation?.

And could that, in turn, be somehow connected to the behavioral symptoms?. Throughout the winter and spring of 2012, Mazmanian and Patterson continued their conversation. Mazmanian found distinct differences in the microbiomes of the mice. And, they noticed, the mice with the features of autism had leaky gut syndrome, an increased permeability of the gut lining that can allow pathogens and allergens to leach out.

This condition had also been reported in children with autism.So Mazmanian and Patterson turned their attention outside the gut. They took blood samples to see if any gut microbes, or the compounds they produce, were circulating in the rest of the body. They homed in on one molecule in particular, called 4-ethylphenyl sulfate, which was roughly 45 times as abundant in the mice that had symptoms of autism. And it looked familiar.

Structurally, it was almost identical to a molecule recently found to be significantly elevated in human children with autism.It was enough to take the next step. Every day for three weeks, Mazmanian injected the molecule, harvested from the mice with autism-like symptoms, directly into the bloodstream of 5-week-old normal lab mice (the age at which the autistic mice normally developed leaky gut). Then Mazmanian and his team gave them a series of behavioral tests. The mice were far more easily startled and were less comfortable in large empty spaces than their untreated peers, indications of an increase in anxiety-related behaviors commonly seen in the mice with autism-like symptoms.

The researchers published their results in Cell in 2013.Though surprising, the data made sense in some ways. Many drug companies rely on small-molecule drugs that can be taken orally, but still manage to cross the blood-brain barrier and affect behavior. It seemed entirely possible that small molecules, created by bacteria in the gut, could enter the bloodstream and reach the brain. And they don’t even have to leak out of the gut to do so.Of Mice and MenPatterson died in 2014, at age 70, just six months after the publication of the duo’s groundbreaking Cell paper.

Around the same time, a series of parallel experiments in a clinic hundreds of miles away was already paving the way forward. While Patterson and Mazmanian had been working in mice, Rosa Krajmalnik-Brown, a microbiologist at Arizona State University, had teamed up with Jim Adams, who directs the university’s autism and Asperger’s research program, to study humans.The researchers were conducting a detailed analysis of the microbiome of human autism patients and found that the bacteria were far less diverse in the children with autism. Notably, several important species involved in the digestion of carbohydrates were severely depleted.Krajmalnik-Brown and Adams launched a preliminary trial to test the effects of fecal transplants on 18 children between the ages of 7 and 16 with severe autism, who also had severe GI issues. The researchers administered powerful antibiotics to kill off the microbiomes of the children and followed them with a bowel cleanse.

They then replaced the microbes with transplanted flora taken from the guts of healthy neurotypical adult volunteers.The results were better than anyone could have expected. The procedure resulted in a large reduction in GI symptoms and increased the diversity of bacteria in the children’s guts. But more significantly, their neurological symptoms were reduced. At the onset of the study in 2017, an independent evaluator found 83 percent of participants had severe autism.

Two years after the initial trial, only 17 percent were rated as severely autistic. And 44 percent were no longer on the autism scale.“[My child] did a complete 180,” says Dana Woods, whose then-7-year-old son Ethan enrolled in the initial study five years ago. €œHis ability to communicate is so much different now. He’s just so much more present.

He’s so much more aware. He’s no longer in occupational therapy. He’s no longer in speech therapy. After the study, he tested two points away from a neurotypical child.”In their first report on the trial in 2017, the team highlighted a number of distinct changes in the microbiome after the transplants, in particular a surge in the populations of three types of bacteria.

Among them was a four-fold increase in Bifidobacterium, a probiotic organism that seems to play a key role in the maintenance of a healthy gut.But figuring out what was happening on a cellular level — to really look inside some guts — would require another vehicle. The ASU team needed Mazmanian’s mice.“At the end of the day, what we care about is healing people and how the microbiome affects people,” explains Krajmalnik-Brown. €œThat’s why we work with people. But with mice you can do things that are more mechanistic.”The Great Mouse Detective(Credit.

Caltech)Together, Krajmalnik-Brown, Mazmanian and their collaborators would uncover some tantalizing new insights that go a long way to solving the mystery. In May 2019, the team published another high-profile paper in Cell, after they transplanted stool samples from Krajmalnik-Brown’s severely autistic patients into the guts of Mazmanian’s germ-free mice. The offspring of these mice showed the autism-like symptoms, such as repetitive and compulsive behavior.This time, the team dug even deeper into the biochemical processes playing out in the brain, looking not just at behavior but at the chemicals involved in creating it. The mice that developed autism-like behaviors had measurably lower levels of two substances called taurine and 5-aminovaleric acid (5AV).

When they dug into the literature, the team learned that these two substances are known to mimic activity of a key signaling agent in the brain called gamma-aminobutyric acid (GABA) — a neurotransmitter that other studies have found is deficient in the brains of children with autism.What’s more, some have speculated that the tendency of children with autism to experience sensory overstimulation may stem from the inability to tamp down overexcited neurons. A lack of GABA could lead to just that.The scientists next orally administered high levels of taurine and 5AV to pregnant mice with the autistic children’s microbiomes. When their pups were born, the researchers continued to feed the young the substances until they reached adulthood. Compared with untreated animals, the second-generation mice had significantly fewer behavioral symptoms.

Taurine reduced repetitive behavior, as measured by marble burying, increased the level of social interaction, and relieved anxiety. Mice administered 5AV were more active and social.“We healed humans with behavioral problems,” says Krajmalnik-Brown. €œ[And we] transferred some of those deficits and behaviors to mice — basically the opposite. It’s huge.”Mazmanian hopes to take the next step in the months ahead.“I can flip a switch, turn on a light, I know that switch turns on that light.

I don’t know the circuit, I don’t know where the wire is,” Mazmanian says. €œExactly how that’s happening … we just don’t understand that.”This most recent study, by itself, hardly proves that dysregulated microbiomes cause the brain disorder — a point that plenty of other scientists skeptical of Mazmanian’s work are happy to make.“The paper made a big splash, but trying to model psychiatric-related human conditions in mice, in my view, is a little bit of a stretch,” says Sangram Sisodia, a neurobiologist at the University of Chicago who studies the microbiome. €œA mouse with autism?. €Nor was that the only criticism.

Several researchers have suggested that the group didn’t give proper attention to one of their tests ­— one whose results conflicted with their thesis ­— while others found flaws in the statistical methods they used to assess their results. Mazmanian downplays these criticisms, but agrees the work is not yet conclusive.Meanwhile, the ASU trial has also engendered skepticism, mainly due to its tiny sample size, the lack of a control group and the methods by which the children were assessed for autism severity. Krajmalnik-Brown and Adams say they stand by their results, but agree more research is needed. In recent months, they have launched two new studies that will address these issues.Adams insists the work is already changing lives.

€œWe followed up with every one of our 18 participants,” he says, referring to the children who received fecal transplants. €œSure enough, we found that most of the GI benefits had remained. And family after family said their child just slowly, steadily continued making more improvement.” They published the update in Scientific Reports in spring 2019.“I’m not ready to say the case is closed,” says Mazmanian. €œHealthy skepticism is a good thing.

I believe the preclinical data, I believe the mouse data. But there’s a lot of studies that still need to be done.” A Healthy Gut, A New OutlookEthan Woods had GI issues and symptoms of autism until researchers introduced new microbes to his gut. His mother says the treatment changed everything. (Credit.

Dana Woods)Prior to his fecal transplant at age 7, Ethan Woods suffered from chronic and severe diarrhea, constipation and cramping, symptoms so extreme that to his mother, Dana, he sounded like “a bit like a woman in labor when he was trying to have a bowel movement.” “It was just awful watching your child go through this,” she says, explaining that when she enrolled her autistic son in the Arizona State study, her “only goal was to fix his gut.”Remarkably, Ethan’s agony began to disappear just a few weeks into the trial. But that was not the most dramatic difference. Before the transplant, Ethan’s speech was drawn out and slow, his language skills rudimentary. He seemed to live in his own bubble.

He had frequent outbursts. For as long as Dana could remember, her mornings with Ethan had been marked by arguing, fighting, pushing and anger. But then one morning, something shocking happened.“He woke me up one morning with his face right in my face with this big smile and he said, ‘Morning, Mom!. €™â€‰â€ she recalls.

€œAnd he was just excited and happy and ready to go about his day with this big smile. It choked me up to the point where I teared up because I had never experienced a happy kid in the morning.”Later, Ethan carried over an iPad and opened an app with a talking cat that repeats back the words children speak aloud. He played back a video recording of himself from just a few weeks earlier.“[He] looks me in the eye and says, ‘Mom, why did I talk like that?. What is wrong with me?.

€™ And as soon as he did that, I caught my breath. I had to compose myself and say, ‘I don’t know. But do you feel better?. Do you feel different?.

Why do you think?. €™â€‰â€Ethan’s communication skills had already begun to improve. Within a year of the study, his speech therapist graduated him from speech therapy because he had met all his goals.“He went from one end of the rainbow all the way to the other end of the rainbow,” she says. €œPrior to the study, I was very afraid.

My biggest fear was ‘how is he going to navigate the world when I’m not here?. €™ And I think I have a lot of hope now that he is going to be OK now on his own.”There’s something strange about the female orgasm, something that scientists have been unable to explain. Biological functions are normally discussed in terms of evolutionary pressure, or reproductive advantage. If a biological trait improves your chances of having more offspring, then it’s more likely to stick around in your species.

The male orgasm makes perfect sense — ejaculate contains the genetic material that’s necessary for making babies. But the female orgasm has been harder to nail down. Fertilization doesn’t depend on it, and “fun” isn’t exactly in the pantheon of evolutionary explanations.Researchers that study how the female orgasm relates to reproductive success have two main options — either ask people invasive questions about their most personal moments, or to find a way to stick probes in or on them during said moments. Neither of these approaches have resulted in the kind of “wet lab” research that’s the gold standard for biological understanding.What we do know, despite widespread cultural discomfort with talking openly about sex and pleasure, is that there appears to be significant sexual dysfunction in American society.

Back in 2014, researchers from the Kinsey Institute, the preeminent U.S. Academy for the study of sex and relationships, said as much. In a survey of nearly 3,000 people, they found that men, straight or gay, orgasmed 85 percent of the time during consensual sexual encounters. Lesbian women orgasmed less often, 75 percent of the time, while straight women fared worst with just a 60 percent chance of orgasm.

Other studies have shown that something like 10-15 percent of women experience lifelong anorgasmia, meaning they’ve never experienced orgasm. A further 40 percent of women report some kind of inability to reach orgasm in the past year.The orgasm gap is hard to explain. Some think that it comes down to straight men’s finesse, or lack thereof, citing the difference between straight and lesbian satisfaction. Indeed, it makes sense that knowing your way around the territory would help.

But for many couples this isn’t a helpful revelation, since the emotional maturity necessary to teach sexual dexterity is often out of reach. Shortcut to SatisfactionLuckily, we live in an era of Silicon Valley disruption, which has even started lapping at the shores of sex research. Technologist Liz Klinger is at the forefront of this transition. She and her team have built a platform that lets people become citizen scientists of sex —without ever having to get out from between the sheets.About a decade ago, Klinger’s company, Lioness, released what they billed as the first “smart vibrator,” a sex toy that could actually learn about you.

The final product was a far cry from the first prototype, which was much more laboratory object than sex toy.The “test device was this whole mess of wires, with a hard connection. We had to physically send it to our beta testers, who used it and sent it back,” recalls Klinger. The researchers would download the data collected by the toy’s four sensors — temperature, motion, acceleration and pressure — and compile it into a chart that represented arousal and orgasm, as told through the story of pelvic-floor muscle contractions.It was an immediate success for sex partners who needed ways to talk about pleasure in a more objective way. Klinger recalled that when she got the first beta-test couple on the phone, “the wife was like ‘holy crap, we finally were able to talk about these things that I’ve had a lot of trouble talking about.’ It turned out that she wanted more foreplay, and he didn’t know quite that that meant.

He’d spend more time, but it just didn’t match up, you know?. € With the company’s signature offering in hand — a chart of sexual arousal over time — Klinger found that couples could have a conversation “without the subtext of ‘oh, you’re not good enough, or I don’t like you enough,’ on the husband’s part and ‘I’m so tired of talking about this’ on the wife’s part,” she says. The chart “can change people’s perceptions of their own experiences, and how they talk about them with others.”Doing the Deed — For ScienceThis spring, the company has launched a research platform dubbed Lioness 2.0 — a new optional service that, unsurprisingly, their data-obsessed users have greeted with open arms. Now, instead of simply using the toy to understand themselves better, Lioness owners can opt in to the kinds of hands-on studies that are necessary for a deeper understanding of sex and pleasure.

So far, the company is working with Nigeria’s Society for Family Health to study how pleasure changes with menopause across age, race and orientation, as well as with the U.S.’s Center for Genital Health and Education to explore the role of pelvic floor muscles in orgasm.Pani Farvid, a professor of applied psychology at The New School in New York City, has some reservations about the platform. €œI really like what they’re trying to do, but there could be more added to make it a bit more comprehensive. My concern is that there's a misconception that sex is just about the orgasm, that it’s just physiological and that pleasure just has to do with the genitals.” From where she’s sitting, “that’s a very mechanical view of sexuality.” If the Lioness is helping to equalize the orgasm gap, or helping people understand their bodies better, “I think that's great,” says Farvid. €œBut as a critical sexologist, I'm interested in delving deeper into what these practices mean.” If sex is hyper-focused on orgasm, to exclusion of everything else, she cautions that these norms “have real-life negative impacts on people's sex lives and their sense of themselves.”At this point, knee-deep in an era of data collection that was once the sole purview of white-coat-wearing scientists, it’s old news that we need to be careful with what our technology is doing to us.

No tool can serve as a cure-all, even if it comes loaded with a neat app and some space-age sensors. What it can offer, though, is the opportunity to start a conversation, and the chance to take a long, honest look at something about yourself — whether it’s the number of steps you take every day, or the way you want to be touched.Wondering how to keep your glasses from fogging up when your mask is on?. Look no further. If we've learned one thing throughout the erectile dysfunction treatment viagra, it's the importance of wearing a mask.

Countless studies have shown over the past eight months that wearing a protective barrier over your nose and mouth — whether it's a standard-issue surgical mask or an N95 respirator — can significantly decrease the odds of catching and transmitting disease. What's more, some research shows that masking up can reduce the severity of an if a masked person does contract erectile dysfunction treatment. But while masks are potentially lifesaving, they can be uncomfortable, often changing your breathing patterns and fogging up your glasses when breath escapes through the top of the mask. Among people who choose not to wear a mask to prevent the spread of erectile dysfunction treatment, many cite discomfort as a key reason why.Wesley Wilson, a tumor immunologist in Pennsylvania, knows how annoying it can be when your glasses are fogging up.

He says fogging is “definitely a problem” among his hospital colleagues, who need to wear protective goggles and surgical masks while on the job. Fortunately, they've also picked up a few helpful hacks for keeping their vision clear while wearing a mask with glasses.#1. Use Tape“If you have to keep your mask on for hours, tape works like a charm,” Wilson says. This especially applies to healthcare professionals in his practice who are required to keep their masks on at all times, except during lunch.

€œIf you're putting on your mask and taking it off a lot, tape probably isn't practical — but two small pieces of tape on the cheeks keep the mask fitted closer to your face, and the hot air out of your glasses,” he says.#2. Fit the Mask to Your FaceWhile some air leakage is to be expected, wearing a mask that fits securely to your face will prevent glass fogging and filter the viagra more effectively since less air is coming in or out. Find surgical masks or N95s that come with a nose bridge, a small, flexible piece of metal or plastic that allows the mask to more closely fit the contours of your face. Nose bridges can be sewn inside masks or affixed to the front.Read More.

Why It Feels Like You Can't Breathe Inside Your Face Mask#3. Adjust Your MaskAccording to the American Academy of Ophthalmology, a minor adjustment in how you wear your mask could be enough to prevent fog as well. Simply pull the mask over your nose and rest your glasses on top of your face mask. As long as the mask is fitted close to your face, this should prevent hot air from slipping out.#4.

Spray Your GlassesA former ice hockey player, Wilson says the protective visor under his helmet would often fog with hot air while he was on the ice during games. Like an ocean diver, he would use de-misting solution or a defogging spray (such as this one) to keep his visor free of fog. The same concept applies to eyeglass fog caused by masking, he says. €œYou can either buy a spray or you can make your own with either shaving cream or soap and water,” says Wilson.

€œWiping some shaving cream on your glasses and then wiping it off will coat them with a similar surface-tension altering compound that prevents fog.”.

As flu season creeps up on the Northern Hemisphere, buy cheap viagra online cold and http://www.em-passerelle-dingsheim.site.ac-strasbourg.fr/erectile dysfunction treatment-informations/ flu relief medications will inevitably fly off store shelves. A natural remedy that shoppers might reach for is elderberry, a small, blackish-purple fruit that companies turn into syrups, lozenges and gummies. Though therapeutic uses of the berry date buy cheap viagra online back centuries, Michael Macknin, a pediatrician at the Cleveland Clinic, hadn’t heard of using elderberry to treat the flu until a patient’s mother asked him about it. Some industry-sponsored research claims that the herbal remedy could cut the length of the symptoms by up to four days. For a comparison, Tamiflu, an FDA-approved treatment, only reduces flu duration by about buy cheap viagra online a single day.

€œI said, 'Gee, if that’s really true [about elderberry], it would be a huge benefit,'” Macknin says. But the effectiveness and safety of elderberry is still fairly unclear. Unlike the over-the-counter medicines at your local pharmacy, elderberry hasn't been through rigorous FDA testing and buy cheap viagra online approval. However, Macknin and his team recently published a study in the Journal of General Internal Medicine, which found that elderberry treatments did nothing for flu patients. This prompts a need for further studies into the remedy — work that unfortunately stands a low chance buy cheap viagra online of happening in the future, Macknin says.

Looking For ProofElderberries are full of chemicals that could be good for your health. Like similar fruits, the berries contain high buy cheap viagra online levels of antioxidants, compounds that shut down reactions in our bodies that damage cells. But whether or not elderberry's properties also help immune systems fend off a viagra is murky. There are only a handful of studies that have examined if elderberries reduced the severity or duration of the flu. And though some of the work prior to Macknin’s was well-designed and supported this herbal remedy as buy cheap viagra online a helpful flu aid, at least some — and potentially all — of those studies were funded by elderberry treatment manufacturers.Macknin says an elderberry supplement company provided his team with their products and a placebo version for free, but that the company wasn’t involved in the research beyond that.

Macknin's study is the largest one conducted on elderberry to date, with 87 influenza patients completing the entire treatment course. Participants in the study were also welcome to buy cheap viagra online take Tamiflu, for ethical reasons, as the team didn’t want to exclude anyone from taking a proven flu therapy. Additionally, each participant took home either a bottle of elderberry syrup or the placebo with instructions on when and how to take it. The research team called participants every day for a symptom check and to remind them to buy cheap viagra online take their medication.By chance, it turned out that a higher percentage of the patients given elderberry syrup had gotten their flu shot and also chose to take Tamiflu. Since the vaccination can reduce the severity of in recipients who still come down with the flu, the study coincidentally operated in favor of those who took the herbal remedy, Macknin says.

Those patients could have dealt with a shorter, less-intense illness because of the Tamiflu and vaccination. €œEverything was stacked to have it turn out better [for the buy cheap viagra online elderberry group],” Macknin says, “and it turned out the same.” The researchers found no difference in illness duration or severity between the elderberry and placebo groups. While analyzing the data, the team also found that those on the herbal treatment might have actually fared worse than those on the placebo. The potential for this intervention to actually harm instead of help influenza patients explains why Macknin thinks the therapy needs further research.But, don't expect that work buy cheap viagra online to happen any time soon. Researchers are faced with a number of challenges when it comes to studying the efficacy of herbal remedies.

For starters, there's little financial incentive to buy cheap viagra online investigate if they actually work. Plant products are challenging to patent, making them less lucrative prospects for pharmaceutical companies or research organizations to investigate. Additionally, investigations that try and prove a proposed therapy as an effective drug — like the one Macknin and his team accomplished — are expensive, Macknin says. Those projects need FDA oversight and additional paperwork, components that drive buy cheap viagra online up study costs. €œIt’s extraordinarily expensive and there’s no money in it for anybody,” Macknin says.Talk To Your DoctorUltimately, research on elderberry therapies for flu patients is a mixed bag, and deserves more attention from scientists.

However, if you still want to discuss elderberry treatments for the flu with your doctor, that’s a conversation you should feel comfortable having, says Erica McIntyre, an expert focused on health and environmental psychology in buy cheap viagra online the School of Public Health at the University of Technology Sydney. Navigating what research says about a particular herbal medicine is challenging for patients and health practitioners alike. The process is made more complex by the range of similar-sounding products on the market that lack standardized ingredients, McIntyre buy cheap viagra online says. But when doctors judge or shame patients for asking about non-conventional healthcare interventions, the response can distance people and push them closer to potentially unproven treatments. Even worse, those individuals might start to keep their herbal remedies a secret.

€œIt is that fear about being judged for buy cheap viagra online use of that medication,” McIntyre says, that drives up to 50 percent of people taking herbal treatments to withhold that information from healthcare practitioners. That’s a dangerous choice, as some herbal and traditional medications can interact and cause health problems.If a physician shames someone for asking about alternative medicines, it’s likely time to find a new doctor, McIntyre says. Look for someone who will buy cheap viagra online listen to your concerns — whether it's that you feel traditional treatments haven’t worked for you, or that you didn’t like the side effects, the two common reasons people pursue herbal treatments in the first place. €œYou’re not necessarily looking for a doctor that will let you do whatever you want,” McIntyre says, “but that they actually consider you as a patient, your treatment choices and your treatment priorities, and communicate in a way that’s supportive.” And if a doctor suggests that you avoid a treatment you’re interested in, ask why. They generally have a good reason, McIntyre says.For now, know that even if your doctor doesn’t support you taking elderberry, there are other proven preventative measures that are worth your while — like the flu shot.

Anyone six months or older should get it, Macknin says, and stick to the protocols we’re used to following to prevent erectile dysfunction treatment s, like buy cheap viagra online social distancing, mask-wearing and hand-washing. Those measures also help prevent flu transmission, too — something, so far, no elderberry supplement package can claim.The yearly influenza season threatens to make the erectile dysfunction treatment viagra doubly deadly, but I believe that this isn’t inevitable.There are two commonly given treatments – the pneumococcal treatment and the Hib treatment – that protect against bacterial pneumonias. These bacteria buy cheap viagra online complicate both influenza and erectile dysfunction treatment, often leading to death. My examination of disease trends and vaccination rates leads me to believe that broader use of the pneumococcal and Hib treatments could guard against the worst effects of a erectile dysfunction treatment illness.I am an immunologist and physiologist interested in the effects of combined s on immunity. I have buy cheap viagra online reached my insight by juxtaposing two seemingly unrelated puzzles.

Infants and children get erectile dysfunction, the viagra that causes erectile dysfunction treatment, but very rarely become hospitalized or die. And case numbers and death rates from erectile dysfunction treatment began varying greatly from nation to nation and city to city even before lockdowns began. I wondered why.One night I woke up with a buy cheap viagra online possible answer. Vaccination rates. Most children, beginning at age two months, are vaccinated against numerous buy cheap viagra online diseases.

Adults less so. And, both buy cheap viagra online infant and adult vaccination rates vary widely across the world. Could differences in the rates of vaccination against one or more diseases account for differences in erectile dysfunction treatment risks?. As someone who had previously investigated other viagras such as the Great Flu viagra of 1918-19 and AIDS, and who has worked with treatments, I had a strong background for tracking down the relevant data to test my hypothesis.Pneumococcal Vaccination Rates Correlate With Lower erectile dysfunction treatment Cases and DeathsI gathered national and some local data on vaccination rates against influenza, polio, measles-mumps-rubella (MMR), diphtheria-tetanus-pertussis (DTP), tuberculosis (BCG), pneumococci and Haemophilus influenzae type B (Hib). I correlated them with erectile dysfunction treatment case rates and death rates for 24 nations that had experienced buy cheap viagra online their erectile dysfunction treatment outbreaks at about the same time.

I controlled for factors such as percentage of the population who were obese, diabetic or elderly.I found that only pneumococcal treatments afforded statistically significant protection against erectile dysfunction treatment. Nations such as Spain, Italy, Belgium, Brazil, Peru and Chile that have the highest erectile dysfunction treatment rates per buy cheap viagra online million have the poorest pneumococcal vaccination rates among both infants and adults. Nations with the lowest rates of erectile dysfunction treatment – Japan, Korea, Denmark, Australia and New Zealand – have the highest rates of pneumococcal vaccination among both infants and adults.A recent preprint study (not yet peer-reviewed) from researchers at the Mayo Clinic has also reported very strong associations between pneumococcal vaccination and protection against erectile dysfunction treatment. This is especially true among buy cheap viagra online minority patients who are bearing the brunt of the erectile dysfunction viagra. The report also suggests that other treatments, or combinations of treatments, such as Hib and MMR may also provide protection.These results are important because in the U.S., childhood vaccination against pneumococci – which protects against Streptococcus pneumoniae bacteria – varies by state from 74% to 92%.

Although the CDC recommends that all adults 18-64 in high risk groups for erectile dysfunction treatment and all adults over the age of 65 get a pneumococcal vaccination, only 23% of high-risk adults and 64% of those over the age of 65 do so.Similarly, although the CDC recommends at all infants and some high-risk adults be vaccinated against Haemophilus influenzae type B (Hib), only 80.7% of children in the U.S. And a handful buy cheap viagra online of immunologically compromised adults have been. Pneumococcal and Hib vaccination rates are significantly lower in minority populations in the U.S. And in countries that have been hit harder by erectile dysfunction treatment than the U.S.Based on these data, I advocate universal pneumococcal and Hib vaccination among children, at-risk adults and all buy cheap viagra online adults over 65 to prevent serious erectile dysfunction treatment disease.Left. Combined rates of childhood and adult (over 65) pneumococcal vaccination (out of a possible 200).

Right. Cases (per million) population of erectile dysfunction treatment at about 90 days into the viagra for 24 nations. Nations with high pneumococcal vaccination rates have low erectile dysfunction treatment case rates. (Credit. CC BY-SA)How Pneumococcal Vaccination Protects Against erectile dysfunction treatmentProtection against serious erectile dysfunction treatment disease by pneumococcal and Hib treatments makes sense for several reasons.

First, recent studies reveal that the majority of hospitalized erectile dysfunction treatment patients, and in some studies nearly all, are infected with streptococci, which causes pneumococcal pneumonias, Hib or other pneumonia-causing bacteria. Pneumococcal and Hib vaccinations should protect erectile dysfunction patients from these s and thus significantly cut the risk of serious pneumonia.I also found that pneumococcal, Hib and possibly rubella treatments may confer specific protection against the erectile dysfunction viagra that causes erectile dysfunction treatment by means of “molecular mimicry.”Molecular mimicry occurs when the immune system thinks one microbe looks like another. In this case, proteins found in pneumococcal treatments and, to a lesser degree, ones found in Hib and rubella treatments as well look like several proteins produced by the erectile dysfunction viagra.Two of these proteins found in pneumococcal treatments mimic the spike and membrane proteins that permit the viagra to infect cells. This suggests pneumococcal vaccination may prevent erectile dysfunction . Two other mimics are the nucleoprotein and replicase that control viagra replication.

These proteins are made after viral , in which case pneumococcal vaccination may control, but not prevent, erectile dysfunction replication.Either way, these treatments may provide proxy protection against erectile dysfunction that we can implement right now, even before we have a specific viagra treatment. Such protection may not be complete. People might still suffer a weakened version of erectile dysfunction treatment but, like most infants and children, be protected against the worst effects of the .Fighting Influenza-related Pneumonias During the erectile dysfunction treatment viagraWhile the specific protection these other treatments confer against erectile dysfunction treatment has not yet been tested in a clinical trial, I advocate broader implementation of pneumococcal and Hib vaccination for one additional, well-validated reason.Pneumococcal and Hib pneumonias – both caused by bacteria – are the major causes of death following viral influenza. The influenza viagra rarely causes death directly. Most often, the viagra makes the lungs more susceptible to bacterial pneumonias, which are deadly.

Dozens of studies around the world have demonstrated that increasing rates of pneumococcal and Hib vaccination dramatically lowers influenza-related pneumonias.Similar studies demonstrate that the price of using these treatments is balanced by savings due to lower rates of influenza-related hospitalizations, intensive care unit admissions and deaths. In the context of erectile dysfunction treatment, lowering rates of influenza-related hospitalizations and ICU admissions would free up resources to fight the erectile dysfunction, independent of any effect these treatments might have on erectile dysfunction itself. In my opinion, that is a winning scenario.In short, we need not wait for a erectile dysfunction treatment to slow down erectile dysfunction treatment.I believe that we can and should act now by fighting the erectile dysfunction with all the tools at our disposal, including influenza, Hib, pneumococcal and perhaps rubella vaccinations.Preventing pneumococcal and Hib complications of influenza and erectile dysfunction treatment, and perhaps proxy-vaccinating against erectile dysfunction itself, helps everyone. Administering these already available and well-tested pneumococcal and Hib treatments to people will save money by freeing up hospital beds and ICUs. It will also improve public health by reducing the spread of multiple s and boost the economy by nurturing a healthier population.Robert Root-Bernstein is a Professor of Physiology at Michigan State University.

This article was originally published on The Conversation under a Creative Commons liscense Read the original here.This story appeared in the November 2020 issue as "Bacteria and the Brain." Subscribe to Discover magazine for more stories like this.It’s not always easy to convince people that the human gut is a sublime and wondrous place worthy of special attention. Sarkis Mazmanian discovered that soon after arriving at Caltech for his first faculty job 14 years ago, when he explained to a local artist what he had in mind for the walls outside his new office.The resulting mural greets visitors to the Mazmanian Lab today. A vaguely psychedelic, 40-foot-long, tube-shaped colon that’s pink, purple and red snakes down the hallway. In a panel next to it, fluorescent yellow and green bacteria explode out of a deeply inflamed section of the intestinal tract, like radioactive lava from outer space.The mural is modest compared with what the scientist has been working on since. Over the last decade or so, Mazmanian has been a leading proponent of the idea that the flora of the human digestive tract has a far more powerful effect on the human body and mind than we thought — a scientific effort that earned him a $500,000 MacArthur Fellowship “Genius Grant” in 2012.

Since then, Mazmanian and a small but growing cadre of fellow microbiologists have amassed a tantalizing body of evidence on the microbiome’s role in all kinds of brain disorders, including schizophrenia, Alzheimer’s disease, Parkinson’s disease and depression.But the results they’ve seen in autism could, in the end, prove the most transformative. Autism affects about 1 in 59 children in the U.S., and involves profound social withdrawal, communication problems, and sometimes anxiety and aggression. The causes of the brain disorder have remained speculative. Now, Mazmanian and other researchers are finding that autism may be inextricably linked to — or even caused by — irregularities in the gut microbiome.A Biology StoryAt 47, Mazmanian — with his shaved head, flannel shirt and skinny jeans — resembles a young, urban hipster on his way to write at the local café. Originally, literary life was his plan.

Born in Lebanon to two Armenian refugees, neither of whom had more than a first-grade education, Mazmanian landed in the class of an energetic high school English teacher in California’s San Fernando Valley, where his family first settled. The teacher recognized his gift for language and encouraged him to pursue a career in literature. Mazmanian enrolled at UCLA in 1990, planning to major in English.Everything changed when he took his first biology class. Hunched over his new, thick textbook in the library, reading about basic biological concepts like photosynthesis, Mazmanian felt a vast new world opening up to him.Sarkis Mazmanian, shown in front of a mural that celebrates the human gut, is part of a group of microbiologists researching the effects of the digestive tract on a range of disorders. (Credit.

Caltech)“For the first time in my life, I wanted to turn the page and see where the story was going to go,” he says. €œI think I decided that minute to become a scientist.”Mazmanian was most fascinated by the idea that tiny organisms, invisible to the naked eye, could function as powerful, self-contained machines — powerful enough to take over and destroy the human body. After graduating with a degree in microbiology, Mazmanian joined a UCLA infectious diseases lab and began studying bacteria that cause staph s.As his dissertation defense approached, Mazmanian read a one-page commentary penned by a prominent microbiologist, highlighting the fact that our intestines are teeming with hundreds, if not thousands, of different species of bacteria. But it was still largely unknown what they are and how they affect the human body.When Mazmanian dug further, he found that no one had yet answered what seemed to him to be the most obvious question. Why would the human immune system, designed to attack and destroy foreign invaders, allow hundreds of species of bacteria to live and thrive in our guts unmolested?.

To him, the bacteria’s survival implied that we had evolved to coexist with them. And if that were so, he reasoned, there must be some benefit to both the microbes and the human body — a symbiotic relationship. But what was it?. Gut InvadersMazmanian set out to study the link between gut microbes and the immune system. As a postdoctoral researcher, he joined the lab of Harvard University infectious disease specialist Dennis Kasper.To start, Mazmanian examined how the immune systems of germ-free mice — lab mice completely protected, starting at birth, from all microbes — differed from those of mice with either few or normal levels of microbes.

He expected this initial census would be just a first step in a long and arduous quest for scientific pay dirt. But when he went to examine a printout of his results in the lab, he realized immediately he might already be onto something big. The germ-free mice had a 30 to 40 percent reduction in a specific type of immune cell known as helper T-cells.This colorized close-up of a mouse’s gut reveals the tight relationship between the gut microbe Bacteroides fragilis (red) and the epithelial surface of the colon (blue). (Credit. Caltech)Since helper T-cells play a key role in coordinating attacks against invading pathogens, the finding suggested that the immune systems of the germ-free mice were far less robust than those found in peers with normal levels of microbes.“That was exciting, right?.

€ Mazmanian recalls. €œObviously I repeated it and tested it in a number of different ways. Then I asked the next question. €˜Can I restore the [immune] function in an adult animal?. €™â€‰â€Mazmanian colonized the guts of the immunocompromised, germ-free mice with microbes from standard lab mice.

After receiving the fecal transplant, their T-cell counts shot up. Within a month, their numbers were identical to mice raised outside the germ-free bubble.Resolving to identify the microorganisms causing this transformation, Mazmanian resorted to trial and error. One by one, he added strains of bacteria found in the guts of mice to the guts of germ-free mice.He got nowhere with the first five or six species he examined. Then, simply because it was convenient, he decided to test one more that was readily available in his lab. Mazmanian’s adviser, Kasper, had been studying a gut microbe called Bacteroides fragilis.

When Mazmanian implanted one of Kasper’s specimens into the gut of his germ-free mice, the results were dramatic. The T-cell numbers spiked to normal. Eventually, Mazmanian demonstrated he could reproduce this effect simply by adding a single molecule that these bacteria produce, called polysaccharide A, to their guts.“There was no logic in the choice whatsoever,” Mazmanian recalls. €œ[B. Fragilis] was available, it came from the gut.” In other words, he got lucky.Mazmanian dug deeper and discovered that the biggest impact B.

Fragilis had was on the population of a subtype of helper T-cells called regulatory, or suppressor, T-cells. These cells play a key role in preventing the immune system from attacking its host body, protecting against autoimmune or inflammatory diseases. It was the first time any scientist had demonstrated that a single compound from a single microbe could reverse a specific problem with the immune system.To Mazmanian, the finding, published in 2005 in the journal Cell, alluded to new approaches to treating a wide array of autoimmune, inflammatory and allergic disorders. What if it were possible to help a faulty immune system by tweaking a patient’s microbiome?. It was with this exploration in mind that he arrived in Pasadena in 2006 to set up his lab at Caltech.A Convenient CollaborationA few years later, Mazmanian was having lunch on campus with neuroscientist and colleague Paul Patterson.

Patterson had been preoccupied with a mystery that had, for years, confounded those studying autism in humans. When pregnant mothers have a severe in the second trimester, their babies are much more likely to develop autism.As Mazmanian tells it, Patterson was a man of few words, and at lunch Mazmanian was “going on and on” about his own work.“You know,” Patterson interjected thoughtfully, “I think kids with autism have GI issues.”Patterson recalled reading that something like 60 percent of children with autism had some form of clinical GI problem, such as bloating, constipation, flatulence or diarrhea. Was it possible, he wondered, that there was a microbiome connection?. As they talked, Mazmanian’s excitement grew.A few years earlier, Patterson had discovered that when he exposed pregnant mice to pathogens like the influenza viagra, they gave birth to pups that grew up more likely to be startled by loud noises, to shy away from social contact and to groom themselves repetitively — symptoms that resemble those of autism. Patterson was in the process of comparing the brains of these autism-mimicking mice with their neurotypical cousins to see if he could detect any differences that might explain how the maternal immune system was somehow interfering with the pups’ brain development.Mazmanian had a suggestion.

The next time Patterson sacrificed one of his autistic mice to study their brains, what if he set the intestines aside for his colleague down the hall?. When the guts arrived in Mazmanian’s lab, he found that the intestines of the neurotypical mice looked normal. But the guts of the autism-mimicking offspring were almost uniformly inflamed. Could it be that the microbiome was the cause of this inflammation?. And could that, in turn, be somehow connected to the behavioral symptoms?.

Throughout the winter and spring of 2012, Mazmanian and Patterson continued their conversation. Mazmanian found distinct differences in the microbiomes of the mice. And, they noticed, the mice with the features of autism had leaky gut syndrome, an increased permeability of the gut lining that can allow pathogens and allergens to leach out. This condition had also been reported in children with autism.So Mazmanian and Patterson turned their attention outside the gut. They took blood samples to see if any gut microbes, or the compounds they produce, were circulating in the rest of the body.

They homed in on one molecule in particular, called 4-ethylphenyl sulfate, which was roughly 45 times as abundant in the mice that had symptoms of autism. And it looked familiar. Structurally, it was almost identical to a molecule recently found to be significantly elevated in human children with autism.It was enough to take the next step. Every day for three weeks, Mazmanian injected the molecule, harvested from the mice with autism-like symptoms, directly into the bloodstream of 5-week-old normal lab mice (the age at which the autistic mice normally developed leaky gut). Then Mazmanian and his team gave them a series of behavioral tests.

The mice were far more easily startled and were less comfortable in large empty spaces than their untreated peers, indications of an increase in anxiety-related behaviors commonly seen in the mice with autism-like symptoms. The researchers published their results in Cell in 2013.Though surprising, the data made sense in some ways. Many drug companies rely on small-molecule drugs that can be taken orally, but still manage to cross the blood-brain barrier and affect behavior. It seemed entirely possible that small molecules, created by bacteria in the gut, could enter the bloodstream and reach the brain. And they don’t even have to leak out of the gut to do so.Of Mice and MenPatterson died in 2014, at age 70, just six months after the publication of the duo’s groundbreaking Cell paper.

Around the same time, a series of parallel experiments in a clinic hundreds of miles away was already paving the way forward. While Patterson and Mazmanian had been working in mice, Rosa Krajmalnik-Brown, a microbiologist at Arizona State University, had teamed up with Jim Adams, who directs the university’s autism and Asperger’s research program, to study humans.The researchers were conducting a detailed analysis of the microbiome of human autism patients and found that the bacteria were far less diverse in the children with autism. Notably, several important species involved in the digestion of carbohydrates were severely depleted.Krajmalnik-Brown and Adams launched a preliminary trial to test the effects of fecal transplants on 18 children between the ages of 7 and 16 with severe autism, who also had severe GI issues. The researchers administered powerful antibiotics to kill off the microbiomes of the children and followed them with a bowel cleanse. They then replaced the microbes with transplanted flora taken from the guts of healthy neurotypical adult volunteers.The results were better than anyone could have expected.

The procedure resulted in a large reduction in GI symptoms and increased the diversity of bacteria in the children’s guts. But more significantly, their neurological symptoms were reduced. At the onset of the study in 2017, an independent evaluator found 83 percent of participants had severe autism. Two years after the initial trial, only 17 percent were rated as severely autistic. And 44 percent were no longer on the autism scale.“[My child] did a complete 180,” says Dana Woods, whose then-7-year-old son Ethan enrolled in the initial study five years ago.

€œHis ability to communicate is so much different now. He’s just so much more present. He’s so much more aware. He’s no longer in occupational therapy. He’s no longer in speech therapy.

After the study, he tested two points away from a neurotypical child.”In their first report on the trial in 2017, the team highlighted a number of distinct changes in the microbiome after the transplants, in particular a surge in the populations of three types of bacteria. Among them was a four-fold increase in Bifidobacterium, a probiotic organism that seems to play a key role in the maintenance of a healthy gut.But figuring out what was happening on a cellular level — to really look inside some guts — would require another vehicle. The ASU team needed Mazmanian’s mice.“At the end of the day, what we care about is healing people and how the microbiome affects people,” explains Krajmalnik-Brown. €œThat’s why we work with people. But with mice you can do things that are more mechanistic.”The Great Mouse Detective(Credit.

Caltech)Together, Krajmalnik-Brown, Mazmanian and their collaborators would uncover some tantalizing new insights that go a long way to solving the mystery. In May 2019, the team published another high-profile paper in Cell, after they transplanted stool samples from Krajmalnik-Brown’s severely autistic patients into the guts of Mazmanian’s germ-free mice. The offspring of these mice showed the autism-like symptoms, such as repetitive and compulsive behavior.This time, the team dug even deeper into the biochemical processes playing out in the brain, looking not just at behavior but at the chemicals involved in creating it. The mice that developed autism-like behaviors had measurably lower levels of two substances called taurine and 5-aminovaleric acid (5AV). When they dug into the literature, the team learned that these two substances are known to mimic activity of a key signaling agent in the brain called gamma-aminobutyric acid (GABA) — a neurotransmitter that other studies have found is deficient in the brains of children with autism.What’s more, some have speculated that the tendency of children with autism to experience sensory overstimulation may stem from the inability to tamp down overexcited neurons.

A lack of GABA could lead to just that.The scientists next orally administered high levels of taurine and 5AV to pregnant mice with the autistic children’s microbiomes. When their pups were born, the researchers continued to feed the young the substances until they reached adulthood. Compared with untreated animals, the second-generation mice had significantly fewer behavioral symptoms. Taurine reduced repetitive behavior, as measured by marble burying, increased the level of social interaction, and relieved anxiety. Mice administered 5AV were more active and social.“We healed humans with behavioral problems,” says Krajmalnik-Brown.

€œ[And we] transferred some of those deficits and behaviors to mice — basically the opposite. It’s huge.”Mazmanian hopes to take the next step in the months ahead.“I can flip a switch, turn on a light, I know that switch turns on that light. I don’t know the circuit, I don’t know where the wire is,” Mazmanian says. €œExactly how that’s happening … we just don’t understand that.”This most recent study, by itself, hardly proves that dysregulated microbiomes cause the brain disorder — a point that plenty of other scientists skeptical of Mazmanian’s work are happy to make.“The paper made a big splash, but trying to model psychiatric-related human conditions in mice, in my view, is a little bit of a stretch,” says Sangram Sisodia, a neurobiologist at the University of Chicago who studies the microbiome. €œA mouse with autism?.

€Nor was that the only criticism. Several researchers have suggested that the group didn’t give proper attention to one of their tests ­— one whose results conflicted with their thesis ­— while others found flaws in the statistical methods they used to assess their results. Mazmanian downplays these criticisms, but agrees the work is not yet conclusive.Meanwhile, the ASU trial has also engendered skepticism, mainly due to its tiny sample size, the lack of a control group and the methods by which the children were assessed for autism severity. Krajmalnik-Brown and Adams say they stand by their results, but agree more research is needed. In recent months, they have launched two new studies that will address these issues.Adams insists the work is already changing lives.

€œWe followed up with every one of our 18 participants,” he says, referring to the children who received fecal transplants. €œSure enough, we found that most of the GI benefits had remained. And family after family said their child just slowly, steadily continued making more improvement.” They published the update in Scientific Reports in spring 2019.“I’m not ready to say the case is closed,” says Mazmanian. €œHealthy skepticism is a good thing. I believe the preclinical data, I believe the mouse data.

But there’s a lot of studies that still need to be done.” A Healthy Gut, A New OutlookEthan Woods had GI issues and symptoms of autism until researchers introduced new microbes to his gut. His mother says the treatment changed everything. (Credit. Dana Woods)Prior to his fecal transplant at age 7, Ethan Woods suffered from chronic and severe diarrhea, constipation and cramping, symptoms so extreme that to his mother, Dana, he sounded like “a bit like a woman in labor when he was trying to have a bowel movement.” “It was just awful watching your child go through this,” she says, explaining that when she enrolled her autistic son in the Arizona State study, her “only goal was to fix his gut.”Remarkably, Ethan’s agony began to disappear just a few weeks into the trial. But that was not the most dramatic difference.

Before the transplant, Ethan’s speech was drawn out and slow, his language skills rudimentary. He seemed to live in his own bubble. He had frequent outbursts. For as long as Dana could remember, her mornings with Ethan had been marked by arguing, fighting, pushing and anger. But then one morning, something shocking happened.“He woke me up one morning with his face right in my face with this big smile and he said, ‘Morning, Mom!.

€™â€‰â€ she recalls. €œAnd he was just excited and happy and ready to go about his day with this big smile. It choked me up to the point where I teared up because I had never experienced a happy kid in the morning.”Later, Ethan carried over an iPad and opened an app with a talking cat that repeats back the words children speak aloud. He played back a video recording of himself from just a few weeks earlier.“[He] looks me in the eye and says, ‘Mom, why did I talk like that?. What is wrong with me?.

€™ And as soon as he did that, I caught my breath. I had to compose myself and say, ‘I don’t know. But do you feel better?. Do you feel different?. Why do you think?.

€™â€‰â€Ethan’s communication skills had already begun to improve. Within a year of the study, his speech therapist graduated him from speech therapy because he had met all his goals.“He went from one end of the rainbow all the way to the other end of the rainbow,” she says. €œPrior to the study, I was very afraid. My biggest fear was ‘how is he going to navigate the world when I’m not here?. €™ And I think I have a lot of hope now that he is going to be OK now on his own.”There’s something strange about the female orgasm, something that scientists have been unable to explain.

Biological functions are normally discussed in terms of evolutionary pressure, or reproductive advantage. If a biological trait improves your chances of having more offspring, then it’s more likely to stick around in your species. The male orgasm makes perfect sense — ejaculate contains the genetic material that’s necessary for making babies. But the female orgasm has been harder to nail down. Fertilization doesn’t depend on it, and “fun” isn’t exactly in the pantheon of evolutionary explanations.Researchers that study how the female orgasm relates to reproductive success have two main options — either ask people invasive questions about their most personal moments, or to find a way to stick probes in or on them during said moments.

Neither of these approaches have resulted in the kind of “wet lab” research that’s the gold standard for biological understanding.What we do know, despite widespread cultural discomfort with talking openly about sex and pleasure, is that there appears to be significant sexual dysfunction in American society. Back in 2014, researchers from the Kinsey Institute, the preeminent U.S. Academy for the study of sex and relationships, said as much. In a survey of nearly 3,000 people, they found that men, straight or gay, orgasmed 85 percent of the time during consensual sexual encounters. Lesbian women orgasmed less often, 75 percent of the time, while straight women fared worst with just a 60 percent chance of orgasm.

Other studies have shown that something like 10-15 percent of women experience lifelong anorgasmia, meaning they’ve never experienced orgasm. A further 40 percent of women report some kind of inability to reach orgasm in the past year.The orgasm gap is hard to explain. Some think that it comes down to straight men’s finesse, or lack thereof, citing the difference between straight and lesbian satisfaction. Indeed, it makes sense that knowing your way around the territory would help. But for many couples this isn’t a helpful revelation, since the emotional maturity necessary to teach sexual dexterity is often out of reach.

Shortcut to SatisfactionLuckily, we live in an era of Silicon Valley disruption, which has even started lapping at the shores of sex research. Technologist Liz Klinger is at the forefront of this transition. She and her team have built a platform that lets people become citizen scientists of sex —without ever having to get out from between the sheets.About a decade ago, Klinger’s company, Lioness, released what they billed as the first “smart vibrator,” a sex toy that could actually learn about you. The final product was a far cry from the first prototype, which was much more laboratory object than sex toy.The “test device was this whole mess of wires, with a hard connection. We had to physically send it to our beta testers, who used it and sent it back,” recalls Klinger.

The researchers would download the data collected by the toy’s four sensors — temperature, motion, acceleration and pressure — and compile it into a chart that represented arousal and orgasm, as told through the story of pelvic-floor muscle contractions.It was an immediate success for sex partners who needed ways to talk about pleasure in a more objective way. Klinger recalled that when she got the first beta-test couple on the phone, “the wife was like ‘holy crap, we finally were able to talk about these things that I’ve had a lot of trouble talking about.’ It turned out that she wanted more foreplay, and he didn’t know quite that that meant. He’d spend more time, but it just didn’t match up, you know?. € With the company’s signature offering in hand — a chart of sexual arousal over time — Klinger found that couples could have a conversation “without the subtext of ‘oh, you’re not good enough, or I don’t like you enough,’ on the husband’s part and ‘I’m so tired of talking about this’ on the wife’s part,” she says. The chart “can change people’s perceptions of their own experiences, and how they talk about them with others.”Doing the Deed — For ScienceThis spring, the company has launched a research platform dubbed Lioness 2.0 — a new optional service that, unsurprisingly, their data-obsessed users have greeted with open arms.

Now, instead of simply using the toy to understand themselves better, Lioness owners can opt in to the kinds of hands-on studies that are necessary for a deeper understanding of sex and pleasure. So far, the company is working with Nigeria’s Society for Family Health to study how pleasure changes with menopause across age, race and orientation, as well as with the U.S.’s Center for Genital Health and Education to explore the role of pelvic floor muscles in orgasm.Pani Farvid, a professor of applied psychology at The New School in New York City, has some reservations about the platform. €œI really like what they’re trying to do, but there could be more added to make it a bit more comprehensive. My concern is that there's a misconception that sex is just about the orgasm, that it’s just physiological and that pleasure just has to do with the genitals.” From where she’s sitting, “that’s a very mechanical view of sexuality.” If the Lioness is helping to equalize the orgasm gap, or helping people understand their bodies better, “I think that's great,” says Farvid. €œBut as a critical sexologist, I'm interested in delving deeper into what these practices mean.” If sex is hyper-focused on orgasm, to exclusion of everything else, she cautions that these norms “have real-life negative impacts on people's sex lives and their sense of themselves.”At this point, knee-deep in an era of data collection that was once the sole purview of white-coat-wearing scientists, it’s old news that we need to be careful with what our technology is doing to us.

No tool can serve as a cure-all, even if it comes loaded with a neat app and some space-age sensors. What it can offer, though, is the opportunity to start a conversation, and the chance to take a long, honest look at something about yourself — whether it’s the number of steps you take every day, or the way you want to be touched.Wondering how to keep your glasses from fogging up when your mask is on?. Look no further. If we've learned one thing throughout the erectile dysfunction treatment viagra, it's the importance of wearing a mask. Countless studies have shown over the past eight months that wearing a protective barrier over your nose and mouth — whether it's a standard-issue surgical mask or an N95 respirator — can significantly decrease the odds of catching and transmitting disease.

What's more, some research shows that masking up can reduce the severity of an if a masked person does contract erectile dysfunction treatment. But while masks are potentially lifesaving, they can be uncomfortable, often changing your breathing patterns and fogging up your glasses when breath escapes through the top of the mask. Among people who choose not to wear a mask to prevent the spread of erectile dysfunction treatment, many cite discomfort as a key reason why.Wesley Wilson, a tumor immunologist in Pennsylvania, knows how annoying it can be when your glasses are fogging up. He says fogging is “definitely a problem” among his hospital colleagues, who need to wear protective goggles and surgical masks while on the job. Fortunately, they've also picked up a few helpful hacks for keeping their vision clear while wearing a mask with glasses.#1.

Use Tape“If you have to keep your mask on for hours, tape works like a charm,” Wilson says. This especially applies to healthcare professionals in his practice who are required to keep their masks on at all times, except during lunch. €œIf you're putting on your mask and taking it off a lot, tape probably isn't practical — but two small pieces of tape on the cheeks keep the mask fitted closer to your face, and the hot air out of your glasses,” he says.#2. Fit the Mask to Your FaceWhile some air leakage is to be expected, wearing a mask that fits securely to your face will prevent glass fogging and filter the viagra more effectively since less air is coming in or out. Find surgical masks or N95s that come with a nose bridge, a small, flexible piece of metal or plastic that allows the mask to more closely fit the contours of your face.

Nose bridges can be sewn inside masks or affixed to the front.Read More. Why It Feels Like You Can't Breathe Inside Your Face Mask#3. Adjust Your MaskAccording to the American Academy of Ophthalmology, a minor adjustment in how you wear your mask could be enough to prevent fog as well. Simply pull the mask over your nose and rest your glasses on top of your face mask. As long as the mask is fitted close to your face, this should prevent hot air from slipping out.#4.

Spray Your GlassesA former ice hockey player, Wilson says the protective visor under his helmet would often fog with hot air while he was on the ice during games. Like an ocean diver, he would use de-misting solution or a defogging spray (such as this one) to keep his visor free of fog. The same concept applies to eyeglass fog caused by masking, he says. €œYou can either buy a spray or you can make your own with either shaving cream or soap and water,” says Wilson. €œWiping some shaving cream on your glasses and then wiping it off will coat them with a similar surface-tension altering compound that prevents fog.”.

Bluechew vs viagra

Date published bluechew vs viagra. August 5th, 2021The erectile dysfunction treatment viagra has seen increased interest in the use of uaviolet (UV) light-emitting products for decontamination. Some products claim to bluechew vs viagra protect against erectile dysfunction treatment or prevent its transmission by using UV radiation to eliminate the erectile dysfunction viagra. These products are used to disinfect rooms, environmental surfaces and household items such as keys and wallets.This notice is intended to inform industry of the regulatory classification of UV light-emitting decontamination products making erectile dysfunction treatment claims. Health Canada also wishes to provide information on the applicable pathways for market authorization.On this page About UV lightUV light-emitting products are typically sold bluechew vs viagra as lamps, wands and small or large chambers.

They make various claims related to decontamination and are sold and represented using terms such as dis, sterilization, sanitization, decontamination and cleaning. In addition to bluechew vs viagra disinfecting hard surfaces, UV light has been used for many years to decontaminate water and purify indoor air quality.Uaviolet C (UVC) is a dangerous but useful form of UV radiation. The UVC rays have more energy than UVA and UVB rays, making it more effective at decontamination. However, products using UVC for decontamination may pose health and safety risks. Factors such as bluechew vs viagra the wavelength, dose and duration of exposure contribute to the severity of risk and injury, especially to the eyes and skin.

An improperly designed, used or installed product can increase these risks.erectile dysfunction treatment claimsHealth Canada regulates UV light-emitting decontamination products as either pest control products or medical devices based on their intended use and representation.Manufacturers of these products should not make claims related to erectile dysfunction treatment unless the claims can be supported by evidence. To date, these claims have not been substantiated in scientific literature or in applications received by Health Canada.Health Canada has not yet authorized any UV light-emitting products with claims that they protect against or prevent erectile dysfunction bluechew vs viagra and transmission. As of August 5th, 2021, Health Canada has only authorized 1 UV light-emitting decontamination product without erectile dysfunction treatment claims as a pest control product.Manufacturers, importers and distributors making unsubstantiated claims related to the erectile dysfunction viagra and erectile dysfunction treatment will be subject to compliance and enforcement actions. These include being referred to the Competition Bureau, which is monitoring the marketplace and taking bluechew vs viagra action to stop deceptive marketing practices related to erectile dysfunction treatment.The Competition Act prohibits false or misleading claims about any product. It also prohibits performance claims that are not supported with adequate and proper testing.

The Competition Bureau has issued warnings to a number of manufacturers and businesses, including those claiming their products filter out or inactivate erectile dysfunction.The Competition Bureau actively monitors the marketplace to stop deceptive claims.Regulatory requirements as a pest control productThe Pest Management Regulatory Agency (PMRA) is the authority within Health Canada that regulates pest control products under the Pest Control Product Act (PCPA), including certain UV light-emitting products.On June 7, 2021, the Minister of Health signed the Interim Order Respecting Uaviolet Radiation-emitting Devices and Ozone-generating Devices. This interim order brings the regulation of UV-emitting and ozone-generating products that control, reduce, destroy or inactivate bacteria, viagraes (including erectile dysfunction that causes erectile dysfunction treatment) or other human pathogens on environmental surfaces, water or air under the scope of bluechew vs viagra the PCPA.Applicants should consult the notice of intent and questions and answers pages for more information on the interim order. If you have any questions, please contact PMRA by email. Hc.pmra.subject.to.regulation-sujet.a.la.reglementation.arla.sc@canada.ca.Regulatory requirements bluechew vs viagra as a medical deviceThe Medical Devices Directorate (MDD) is the federal authority that regulates the sale and importation of medical devices under the Food and Drugs Act. Decontamination products using UVC that fall under MDD's scope include those intended for sterilization or high-level dis of reusable medical devices used for critical or semi-critical purposes (for example, invasive procedures and personal protective equipment) within a controlled space.

These sterilizers and high-level disinfectants bluechew vs viagra are Class II medical devices. They are used to mitigate or prevent infectious disease in humans and must not deteriorate the performance of the medical device. Therapeutic devices using UVA/UVB to treat skin conditions are also Class II medical devices.Manufacturers of UVC decontamination devices must demonstrate high-level dis or sterilization of bacterial spores with an organism that offers a maximum challenge for the chosen technology (for example, Bacillus subtilis spores) or a bluechew vs viagra scientifically justified surrogate organism (for example, Mycobacterium species). A high level of dis or sterilization is generally considered to be a minimum 6 log reduction (99.9999%).UV light-emitting decontamination products intended for use in rooms, on environmental surfaces or household products are not considered medical devices. They do not diagnose, treat, prevent or mitigate disease in an individual.

Rather, they bluechew vs viagra correct or adjust environmental conditions and are therefore under the scope of the PMRA.Other regulatory requirementsIn addition to the requirements mentioned, manufacturers should be aware of other considerations. The requirements of the Radiation Emitting Devices Act governing radiation safety apply to all products that emit UV radiation, no matter their classification as a pest control product, medical device or other type of product. There may be requirements at bluechew vs viagra the provincial/territorial and municipal levels.DefinitionsCleaning. Removal of microbiological and organic contamination from an item to the extent necessary for further processing or for the intended use. Removal is bluechew vs viagra done using water with detergents or enzymatic products.Decontamination.

Removal of microorganisms to leave an item safe for further handling. There are 3 levels of decontamination. Cleaning, dis and sterilization.Device bluechew vs viagra (Food and Drugs Act). An instrument, apparatus, contrivance or other similar article, or an in vitro reagent, including a component, part or accessory of any of them, that is manufactured, sold or represented for use in. Diagnosing, treating, mitigating or preventing a disease, disorder or abnormal physical state, or any of their symptoms, in human beings or animals restoring, modifying or correcting the body structure of human beings or animals or the functioning of any part of the bodies of human beings or animals diagnosing pregnancy in human beings or animals caring for human beings or animals during pregnancy or at or after the birth of the offspring, including caring for the offspring or preventing conception in human beings or animalsHowever, a device does bluechew vs viagra not include such an instrument, apparatus, contrivance or article, or a component, part or accessory of any of them, that does any of the actions referred to in paragraphs (a) to (e) solely by pharmacological, immunological or metabolic means or solely by chemical means in or on the body of a human being or animal.Dis.

A physical and/or chemical process that eliminates many or all pathogenic microorganisms, except bacterial spores, on inanimate objects. Note. Dis processes do not ensure the margin of safety associated with sterilization processes.High-level disinfectant. Destroys vegetative bacteria, mycobacteria, fungi and enveloped (lipid) and non-enveloped (non-lipid) viagraes, but not necessarily bacterial spores.Medical device (Medical Devices Regulations). A device within the meaning of the [Food and Drugs Act], but does not include any device that is intended for use in relation to animals.Microorganisms.

Entity of microscopic size encompassing bacteria, fungi, protozoa and viagraes (Association for the Advancement of Medical Instrumentation, AAMI).Pest control product (Pest Control Products Act). A product, an organism or a substance, including a product, an organism or a substance derived through biotechnology, that consists of its active ingredient, formulants and contaminants and that is manufactured, represented, distributed or used as a means for directly or indirectly controlling, destroying, attracting or repelling a pest or for mitigating or preventing its injurious, noxious or troublesome effects an active ingredient that is used to manufacture anything described in paragraph (a) or any other thing that is prescribed to be a pest control productRadiation emitting device (Radiation Emitting Devices Act). Any device that is capable of producing and emitting radiation and any component of or accessory to a device described in paragraph (a)Reprocessing. To make ready for reuse a device, instrument or piece of equipment by any or a combination of cleaning, decontamination or dis, repackaging and sterilization (AAMI).Sanitization. The reduction of microorganisms on environmental inanimate surfaces, objects or air by significant numbers.

Sanitizers do not destroy or eliminate all microorganisms.Sterilization. A physical and/or chemical process that destroys or eliminates all forms of microbial life (AAMI).Contact usYou may send your questions or comments about this notice to the Medical Devices Directorate at hc.meddevices-instrumentsmed.sc@canada.ca.Related linksAt the onset of the viagra, there was an urgent need for safe and effective health products and medical devices that would help limit the spread of the novel erectile dysfunction. Health Canada quickly reached out to our stakeholders and worked with our international partners. We put in place a regulatory approach that focused on flexibility, while maintaining safety and efficacy of regulated products for erectile dysfunction treatment. Communications Throughout the viagra, we engaged our stakeholders to better support access to health products for erectile dysfunction treatment.

Our discussions focused on potential health product solutions, and collaborating with other government departments to address challenges in getting erectile dysfunction treatment products to market. We worked quickly to support businesses that were eager to mobilize needed products. We provided guidance and advice on regulatory requirements, and enhanced the information on our websites. We also helped equip health care professionals and Canadians with information about the products we approved. This includes a new portal with information about the treatments and treatments for erectile dysfunction treatment.

Collaborations The viagra prompted an unprecedented level of collaboration among the regulatory community around the world. We worked with other regulators to align our regulatory response, coordinating our strategies and guidance. We also worked with key regulatory partners to share information and expertise on the review and monitoring of erectile dysfunction treatment health products. erectile dysfunction treatment health products In responding to the viagra, we focussed on allowing flexibility without compromising our standards for safety, efficacy and quality. We put in place measures to prioritize and help expedite the review of.

disinfectants and hand sanitizers, medical devices, such as ventilators, testing devices and personal protective equipment (PPE), and treatments and treatments. Central to this response were five Interim Orders. An interim order is one of the fastest regulatory tools available to help address large-scale public health emergencies. The Interim Orders helped to. facilitate the conduct of clinical trials and broaden access for trial participants, establish temporary approval pathways to expedite the review of medical devices and drugs, allow exceptional importation of drugs, medical devices or foods for a special dietary purpose, and provide additional tools to help prevent and alleviate shortages of drugs and medical devices that may have been caused or worsened by the erectile dysfunction treatment viagra.

Additional measures and guidance helped to support industry in meeting the incredible demand for health products. In 2020 we approved the following for use in erectile dysfunction treatment. over 4,400 hand sanitizer products, approximately 200 disinfectants, 545 medical devices, 81 clinical trials for drugs and 18 for medical devices, 2 drug treatments, and 2 treatments. We will continue to monitor the safety and effectiveness of these and any additional treatments, and all other erectile dysfunction treatment-related products. These remain extraordinary times.

Moving forward, we will leverage the insights learned from the viagra response to inform future approaches to regulation that promote agility, innovation and safety, while continuing to work with our partners to provide the health products and information that Canadians need..

Date published buy cheap viagra online http://unitedpunjabisofamerica.org/where-to-buy-generic-cialis/. August 5th, 2021The erectile dysfunction treatment viagra has seen increased interest in the use of uaviolet (UV) light-emitting products for decontamination. Some products claim to protect against erectile dysfunction treatment or prevent buy cheap viagra online its transmission by using UV radiation to eliminate the erectile dysfunction viagra. These products are used to disinfect rooms, environmental surfaces and household items such as keys and wallets.This notice is intended to inform industry of the regulatory classification of UV light-emitting decontamination products making erectile dysfunction treatment claims.

Health Canada also wishes to provide information on the applicable pathways for buy cheap viagra online market authorization.On this page About UV lightUV light-emitting products are typically sold as lamps, wands and small or large chambers. They make various claims related to decontamination and are sold and represented using terms such as dis, sterilization, sanitization, decontamination and cleaning. In addition to buy cheap viagra online disinfecting hard surfaces, UV light has been used for many years to decontaminate water and purify indoor air quality.Uaviolet C (UVC) is a dangerous but useful form of UV radiation. The UVC rays have more energy than UVA and UVB rays, making it more effective at decontamination.

However, products using UVC for decontamination may pose health and safety risks. Factors such as the wavelength, dose and duration of exposure contribute to the severity buy cheap viagra online of risk and injury, especially to the eyes and skin. An improperly designed, used or installed product can increase these risks.erectile dysfunction treatment claimsHealth Canada regulates UV light-emitting decontamination products as either pest control products or medical devices based on their intended use and representation.Manufacturers of these products should not make claims related to erectile dysfunction treatment unless the claims can be supported by evidence. To date, these claims have not been substantiated in scientific literature or in applications received by Health Canada.Health Canada has not yet authorized any UV buy cheap viagra online light-emitting products with claims that they protect against or prevent erectile dysfunction and transmission.

As of August 5th, 2021, Health Canada has only authorized 1 UV light-emitting decontamination product without erectile dysfunction treatment claims as a pest control product.Manufacturers, importers and distributors making unsubstantiated claims related to the erectile dysfunction viagra and erectile dysfunction treatment will be subject to compliance and enforcement actions. These include being referred buy cheap viagra online to the Competition Bureau, which is monitoring the marketplace and taking action to stop deceptive marketing practices related to erectile dysfunction treatment.The Competition Act prohibits false or misleading claims about any product. It also prohibits performance claims that are not supported with adequate and proper testing. The Competition Bureau has issued warnings to a number of manufacturers and businesses, including those claiming their products filter out or inactivate erectile dysfunction.The Competition Bureau actively monitors the marketplace to stop deceptive claims.Regulatory requirements as a pest control productThe Pest Management Regulatory Agency (PMRA) is the authority within Health Canada that regulates pest control products under the Pest Control Product Act (PCPA), including certain UV light-emitting products.On June 7, 2021, the Minister of Health signed the Interim Order Respecting Uaviolet Radiation-emitting Devices and Ozone-generating Devices.

This interim order brings the regulation of UV-emitting and ozone-generating products that control, reduce, destroy or inactivate bacteria, viagraes (including erectile dysfunction that causes buy cheap viagra online erectile dysfunction treatment) or other human pathogens on environmental surfaces, water or air under the scope of the PCPA.Applicants should consult the notice of intent and questions and answers pages for more information on the interim order. If you have any questions, please contact PMRA by email. Hc.pmra.subject.to.regulation-sujet.a.la.reglementation.arla.sc@canada.ca.Regulatory requirements as a medical deviceThe Medical Devices Directorate (MDD) is the federal authority that regulates the sale and importation of buy cheap viagra online medical devices under the Food and Drugs Act. Decontamination products using UVC that fall under MDD's scope include those intended for sterilization or high-level dis of reusable medical devices used for critical or semi-critical purposes (for example, invasive procedures and personal protective equipment) within a controlled space.

These sterilizers and high-level disinfectants are Class II buy cheap viagra online medical devices. They are used to mitigate or prevent infectious disease in humans and must not deteriorate the performance of the medical device. Therapeutic devices using UVA/UVB to treat skin conditions are also Class II medical devices.Manufacturers of UVC decontamination devices must demonstrate high-level dis or sterilization of bacterial spores with an organism that offers a maximum challenge for the chosen technology (for example, Bacillus subtilis spores) or a scientifically justified buy cheap viagra online surrogate organism (for example, Mycobacterium species). A high level of dis or sterilization is generally considered to be a minimum 6 log reduction (99.9999%).UV light-emitting decontamination products intended for use in rooms, on environmental surfaces or household products are not considered medical devices.

They do not diagnose, treat, prevent or mitigate disease in an individual. Rather, they correct or adjust environmental buy cheap viagra online conditions and are therefore under the scope of the PMRA.Other regulatory requirementsIn addition to the requirements mentioned, manufacturers should be aware of other considerations. The requirements of the Radiation Emitting Devices Act governing radiation safety apply to all products that emit UV radiation, no matter their classification as a pest control product, medical device or other type of product. There may buy cheap viagra online be requirements at the provincial/territorial and municipal levels.DefinitionsCleaning.

Removal of microbiological and organic contamination from an item to the extent necessary for further processing or for the intended use. Removal is done using water with detergents buy cheap viagra online or enzymatic products.Decontamination. Removal of microorganisms to leave an item safe for further handling. There are 3 levels of decontamination.

Cleaning, dis and buy cheap viagra online sterilization.Device (Food and Drugs Act). An instrument, apparatus, contrivance or other similar article, or an in vitro reagent, including a component, part or accessory of any of them, that is manufactured, sold or represented for use in. Diagnosing, treating, mitigating or preventing a disease, disorder or abnormal physical state, or any of their symptoms, in human beings or animals restoring, modifying or correcting the body structure of human beings or animals or the functioning of any part of the bodies of human beings or animals diagnosing pregnancy in human beings or animals caring for human beings or animals during pregnancy or at or after the birth of the offspring, including caring for the offspring or preventing conception buy cheap viagra online in human beings or animalsHowever, a device does not include such an instrument, apparatus, contrivance or article, or a component, part or accessory of any of them, that does any of the actions referred to in paragraphs (a) to (e) solely by pharmacological, immunological or metabolic means or solely by chemical means in or on the body of a human being or animal.Dis. A physical and/or chemical process that eliminates many or all pathogenic microorganisms, except bacterial spores, on inanimate objects.

Note. Dis processes do not ensure the margin of safety associated with sterilization processes.High-level disinfectant. Destroys vegetative bacteria, mycobacteria, fungi and enveloped (lipid) and non-enveloped (non-lipid) viagraes, but not necessarily bacterial spores.Medical device (Medical Devices Regulations). A device within the meaning of the [Food and Drugs Act], but does not include any device that is intended for use in relation to animals.Microorganisms.

Entity of microscopic size encompassing bacteria, fungi, protozoa and viagraes (Association for the Advancement of Medical Instrumentation, AAMI).Pest control product (Pest Control Products Act). A product, an organism or a substance, including a product, an organism or a substance derived through biotechnology, that consists of its active ingredient, formulants and contaminants and that is manufactured, represented, distributed or used as a means for directly or indirectly controlling, destroying, attracting or repelling a pest or for mitigating or preventing its injurious, noxious or troublesome effects an active ingredient that is used to manufacture anything described in paragraph (a) or any other thing that is prescribed to be a pest control productRadiation emitting device (Radiation Emitting Devices Act). Any device that is capable of producing and emitting radiation and any component of or accessory to a device described in paragraph (a)Reprocessing. To make ready for reuse a device, instrument or piece of equipment by any or a combination of cleaning, decontamination or dis, repackaging and sterilization (AAMI).Sanitization.

The reduction of microorganisms on environmental inanimate surfaces, objects or air by significant numbers. Sanitizers do not destroy or eliminate all microorganisms.Sterilization. A physical and/or chemical process that destroys or eliminates all forms of microbial life (AAMI).Contact usYou may send your questions or comments about this notice to the Medical Devices Directorate at hc.meddevices-instrumentsmed.sc@canada.ca.Related linksAt the onset of the viagra, there was an urgent need for safe and effective health products and medical devices that would help limit the spread of the novel erectile dysfunction. Health Canada quickly reached out to our stakeholders and worked with our international partners.

We put in place a regulatory approach that focused on flexibility, while maintaining safety and efficacy of regulated products for erectile dysfunction treatment. Communications Throughout the viagra, we engaged our stakeholders to better support access to health products for erectile dysfunction treatment. Our discussions focused on potential health product solutions, and collaborating with other government departments to address challenges in getting erectile dysfunction treatment products to market. We worked quickly to support businesses that were eager to mobilize needed products.

We provided guidance and advice on regulatory requirements, and enhanced the information on our websites. We also helped equip health care professionals and Canadians with information about the products we approved. This includes a new portal with information about the treatments and treatments for erectile dysfunction treatment. Collaborations The viagra prompted an unprecedented level of collaboration among the regulatory community around the world.

We worked with other regulators to align our regulatory response, coordinating our strategies and guidance. We also worked with key regulatory partners to share information and expertise on the review and monitoring of erectile dysfunction treatment health products. erectile dysfunction treatment health products In responding to the viagra, we focussed on allowing flexibility without compromising our standards for safety, efficacy and quality. We put in place measures to prioritize and help expedite the review of.

disinfectants and hand sanitizers, medical devices, such as ventilators, testing devices and personal protective equipment (PPE), and treatments and treatments. Central to this response were five Interim Orders. An interim order is one of the fastest regulatory tools available to help address large-scale public health emergencies. The Interim Orders helped to.

facilitate the conduct of clinical trials and broaden access for trial participants, establish temporary approval pathways to expedite the review of medical devices and drugs, allow exceptional importation of drugs, medical devices or foods for a special dietary purpose, and provide additional tools to help prevent and alleviate shortages of drugs and medical devices that may have been caused or worsened by the erectile dysfunction treatment viagra. Additional measures and guidance helped to support industry in meeting the incredible demand for health products. In 2020 we approved the following for use in erectile dysfunction treatment. over 4,400 hand sanitizer products, approximately 200 disinfectants, 545 medical devices, 81 clinical trials for drugs and 18 for medical devices, 2 drug treatments, and 2 treatments.

We will continue to monitor the safety and effectiveness of these and any additional treatments, and all other erectile dysfunction treatment-related products. These remain extraordinary times. Moving forward, we will leverage the insights learned from the viagra response to inform future approaches to regulation that promote agility, innovation and safety, while continuing to work with our partners to provide the health products and information that Canadians need..

Viagra name

Stephen Matthew viagra name Shumaker counted on in-home, in-person demonstrations to drive his water fiation business, which serves the Atlanta area. So when erectile dysfunction treatment hit and no one was inviting people indoors, he turned to the air-cleaning part of his operation. He sent cards viagra name in the mail advertising air purifiers using ActivePure technology to new homeowners.

€œKILL erectile dysfunction treatment, erectile dysfunction IN YOUR HOME!. !. € One viagra name card landed on the desk of a postal inspector, who called it false and misleading in a court record.

Shumaker then told an undercover agent on the phone on April 24, 2020, that the air purifier “kills the erectile dysfunction viagra on the spot,” according to a criminal complaint. Weeks later, as Shumaker was heading out the door to his daughter’s tennis tournament, eight law enforcement officers detained him. In August, viagra name he pleaded guilty to distributing “a pesticide device that was misbranded in that the product label was missing an EPA establishment number.” In other words, he failed to follow the letter of a little-known law.

Shumaker told KHN he was just a salesperson and the devices were being shipped straight from the manufacturer. €œSo I don’t know — what am I supposed to do?. € he viagra name asked.

€œHow do I know if there’s a sticker on there or not?. I don’t have a clue.” The company that makes the devices, viagra name ActivePure Technologies, said Shumaker was not an authorized or known salesperson of its products. The sting is a rare example of enforcement in an arena where money is gushing like a geyser but oversight is nearly nonexistent.

Electronic air cleaners, heavily marketed to gyms, doctors’ offices and hospitals, companies and schools awash in federal erectile dysfunction treatment relief funds, tend to use high-voltage charges to alter molecules in the air. The companies selling the devices say they can destroy pathogens and clean the viagra name air. But academic air quality experts say the technology can be ineffective or potentially create harmful byproducts.

Companies that make the devices are subject to virtually no standardized testing or evaluation of their marketing claims. A KHN investigation viagra name this spring found that over 2,000 schools across the country have bought such technology. €œThat’s one of the reasons these companies thrive, is that there’s nobody, nobody checking every aspect of what they do,” said Delphine Farmer, a Colorado State University associate professor who specializes in atmospheric and indoor chemistry.

EMAIL SIGN-Up Subscribe to California Healthline's free Daily Edition. Regulatory Patchwork An alphabet soup of federal agencies have truth-in-advertising or product medical device oversight powers but have done little about air cleaners or left broad loopholes. That has left a handful of states to take the viagra name most decisive action on the industry. The Centers for Disease Control and Prevention does not regulate the devices but, like academic air quality experts, recommends time-tested portable HEPA filters to clean the air in rooms.

In comparison, ionizing and dry hydrogen peroxide air purifiers have a “less-documented track record” in air cleaning, the CDC says. The CDC also urges consumers to research the viagra name technology and “request testing data.” Those reports, though, can be difficult to parse. They include arcane terms like “natural decay” and test conditions that only an expert could spot as different from those that prevail in real life.

The Food and Drug Administration regulates medical viagra name devices. But only air purifiers for a direct medical use or that make a medical claim, like relieving allergies, qualify. The FDA doesn’t consider ads saying a device can kill a microorganism a “medical claim,” spokesperson Shirley Simson said in an email.

Instead, the air purifiers fall under the Environmental Protection Agency’s authority as devices marketed to destroy “pests,” which include bacteria viagra name or viagraes. But “unlike chemical pesticides, the EPA does not register devices and, therefore, does not routinely review their safety or efficacy,” the agency said. Trying to fill the gaps, California bans the sale of air purifiers that emit more than a certain level of the toxic ozone gas.

The New York State Education viagra name Department is “not recommending” that schools buy air purifiers it describes as “ion generators” or “corona discharge technology.” Jeffrey Siegel, a University of Toronto civil engineering professor who studies indoor air quality, said more meaningful national regulation might clarify for consumers how the devices would work in an actual room. €œIf you get any serious government oversight, a big chunk of this industry will go away,” said Siegel. €˜I Was Alone’ While “pesticide” might evoke the idea of a roach killer, the EPA applies the term more broadly.

A pesticide viagra name is any substance that claims to kill or mitigate pests. Technologies that claim to do the same through physical means — including air purifiers that inactivate bacteria and viagraes — are considered pesticide devices. And while the agency requires proof that pesticides such as some types of Clorox wipes are safe viagra name and work in its premarket review, it has no such requirement for so-called pesticide devices — such as electronic air cleaners that deploy ions or “reactive oxygen” to purify the air.

Instead, manufacturers need to obtain what’s known as an establishment number indicating where the device is made, and then they and their sellers must label their products with it. That’s the step Shumaker pleaded guilty to skipping. €œThere is no review associated with that,” said James Votaw, a lawyer who specializes in chemical regulation law at Keller and viagra name Heckman in Washington, D.C.

€œThat is automatic. It’s like trying to get license plates for your car.” So Shumaker told KHN he was baffled as to why he was targeted instead of the corporate level, which in this case would be the company, Aerus, which is now ActivePure Technologies. Dr.

Deborah Birx, former adviser to President Donald Trump, joined ActivePure in March as chief medical and science adviser. €œI was alone,” Shumaker said in an interview about facing charges. €œNobody backed me up.” Joe Urso, CEO of ActivePure Technologies, told KHN that its studies showing its devices inactivate the viagra that causes erectile dysfunction treatment were not completed until the fall, long after the postcards were sent.

Urso said in a statement that his company’s devices do have establishment numbers, and that he supports the ruling against Shumaker. Federal Trade Commission officials have written warning letters to some air cleaner companies during the viagra. The commission requires claims about a product’s safety and efficacy to be supported with “competent and reliable scientific evidence.” One of the last high-profile actions the FTC took against an air purifier company was in 1997, when the Justice Department filed an action on its behalf against Alpine Industries, which made ozone-generating air purifiers.

In 2001, a judge fined Alpine $1.49 million for failing to stop making unsubstantiated claims about its devices, which it had said relieved allergies and removed indoor pollutants. Alpine is a related company to EcoQuest International, according to the FTC. And a majority of EcoQuest International assets were bought in 2009 by ActivePure Technologies, according to its 2021 press kit.

ActivePure makes the device Shumaker got into trouble for selling. Siegel, of the University of Toronto, consulted with U.S. Government agencies targeting the misleading marketing claims of some air-cleaner companies about 10 years ago.

He finds the company-by-company approach to be a game of “whack-a-mole.” “A company goes away because they have regulatory scrutiny and reinvent themselves a few months later,” he said. €œThe only solution I see to this problem is a government agency really takes ownership of this — the information dissemination to consumers and the claims by manufacturers. I see no other path forward.” ‘It’s Just Buyer Beware’ The Federal Insecticide, Fungicide, and Rodenticide Act, which regulates pesticide devices, was written decades ago and applied to things such as flypaper, long before anyone anticipated machines that would blast ions to clean the air.

€œWe’re just pushing EPA to try and get updated,” said Patrick Jones, president of the Association of American Pesticide Control Officials. €œIt’s just buyer beware.” Even before the erectile dysfunction treatment viagra, Jones’ group was ringing the alarm over the increasing public health claims around pesticide devices. The pesticide control association wrote in a 2019 public comment to the EPA of its concern about the growing use in health care facilities of “non-government evaluated pesticide devices that make unsubstantiated human health claims … with no scientific data being submitted to EPA to prove their effectiveness.” EPA spokesperson Tim Carroll said in an email that the agency is developing more outreach materials for schools on air purifiers.

But as few independent authorities assess the effectiveness of the devices, school officials have been snapping them up. Last summer, the private St. Thomas More School in Kansas City, Missouri, bought ionizing air purifiers to fight erectile dysfunction treatment.

Scott Dulle, the director of building and grounds, said he went with technology he saw health leaders buying. €œWe followed the doctors and the hospitals and the government,” he said. €œThey would not put their patients and staff in harm’s way.” AAPCO’s Jones said changes to federal oversight are needed to better deal with the flood of devices.

His solution. If a pesticide device makes a public health claim, it should be evaluated with the same rigor used for pesticides like ant spray. But to alter the law fundamentally would take congressional action, EPA’s Carroll said.

The EPA can prosecute pesticide device companies and sellers under existing laws if a product makes misleading or false claims — and fines can reach into the millions, according to Brandon Neuschafer, a lawyer who specializes in agricultural regulations at the St. Louis-based firm Bryan Cave Leighton Paisner. He noted companies are often turned in by their competitors.

Last fiscal year, Carroll said, the agency issued 19 import refusal notices and sent six advisory letters for erectile dysfunction treatment-related air-purifying products — a small fraction of its 2020 pesticide actions. Carroll said such investigations are ongoing and a high priority. But EPA’s resources were not the same as they were many years ago, Neuschafer said, as the agency is working with smaller staffing and budgets.

€˜Worse Indoor Air Quality’ Almost a decade before erectile dysfunction treatment emerged, New York’s education department asked state health officials to test an AtmosAir bipolar ionization unit to see if it would improve the air quality. During a test in an empty classroom, they found that levels of harmful ozone gas and “uafine particles” that can cause cardiovascular problems were elevated, indicating “worse indoor air quality when the AtmosAir Bipolar ionization unit is operating,” the 2013 state Bureau of Toxic Substance Assessment report said. New York State Department of Health officials released the study in response to a KHN public records request about the education department’s erectile dysfunction treatment-era guidance, which urges schools not to buy ionizers.

AtmosAir spokesperson Sarah Berman said the device studied in 2013 is discontinued and “all current products have no affiliation to” it. She also said in an email that tests by third-party labs found that “our bipolar ionization products do not contribute to unacceptable levels” of volatile organic compounds, which are potentially harmful substances. The California Department of Public Health advised in September against using “air cleaning devices that generate harmful pollutants (i.e., ionization devices or ozone generators)” on the third page of a single-spaced, 44-page document.

That guidance was widely overlooked. Districts from Berkeley to Fontana to Culver City bought ionization systems. But the state does have a one-of-a-kind law.

It bans air purifiers that emit anything above a certain level of ozone. New Jersey doesn’t have the same kind of regulation. A public school district there bought thousands of ozone-emitting Odorox devices on the California Air Resources Board’s list of “potentially hazardous” air purifiers.

Back in Georgia, Shumaker was fined more than $9,000 and is on two years’ probation. And the postcards that got him into trouble?. Those led to only a handful of sales.

€œSo it was just like setting money on fire,” he said. This story was produced by KHN (Kaiser Health News), a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation).

KFF is an endowed nonprofit organization providing information on health issues to the nation. Lauren Weber. lweber@kff.org, @LaurenWeberHP Christina Jewett.

cjewett@kff.org, @by_cjewett Related Topics Contact Us Submit a Story TipIt took five months for the Biden administration to make a substantive policy change to advance abortion rights. And even that change was buried in a 61-page regulation setting rules for 2022’s Affordable Care Act enrollment. The policy would reverse a Trump administration rule requiring insurers that cover abortion to send separate bills for that coverage.

Abortion opponents had hoped the extra paperwork would persuade insurers to stop offering the coverage. But the new administration’s effort also highlights the frustrations abortion-rights advocates have with the slow pace of change from a president they strongly supported — and who courted their votes. €œBiden will work to codify Roe v.

Wade, and his Justice Department will do everything in its power to stop the rash of state laws that so blatantly violate Roe v. Wade,” said his campaign platform. The late-June action was technically Biden’s second move on reproductive rights.

Following a recent custom in which presidents taking office from the opposite party have reversed each other’s abortion policies, Biden in January gave an initial nod to that campaign promise. He issued an executive order that overturned the so-called Mexico City policy that prohibited U.S. Funding of foreign organizations that perform abortions or even lobby for looser abortion laws.

It also instructed the Department of Health and Human Services to rewrite a Trump regulation that has effectively shut Planned Parenthood out of the federal family planning program, Title X. But those Title X changes haven’t happened yet, nor has the administration formally moved to undo rules that make it easier for employers to opt out of the ACA mandate to provide no-cost contraception. Also so far unchanged are Trump administration modifications to Medicaid guidance that allow states to ban Planned Parenthood from Medicaid.

And abortion rights supporters’ concerns are growing after the Supreme Court accepted a Mississippi case that could significantly weaken or even overturn Roe v. Wade, the 1973 ruling that legalized abortion nationwide. In fact, to the consternation of reproductive rights advocates, Biden has apparently not even uttered the word “abortion” as president.

A website is keeping track. None of that, however, has stopped abortion opponents from painting the president and his administration as pro-abortion crusaders. €œOnce a supporter of policies that protect the lives of the unborn and their mothers, President Biden today caters to the most extreme voices within his party,” said a statement from the Susan B.

Anthony List in May. The statement was in response to Biden’s keeping a campaign pledge to submit a budget calling for Congress to eliminate the Hyde Amendment, which for years has forbidden most federal abortion funding, particularly affecting low-income women in the Medicaid health program. It’s named after former Republican Rep.

Henry Hyde of Illinois. EMAIL SIGN-Up Subscribe to California Healthline's free Daily Edition. It’s true that Biden, a practicing Roman Catholic whose stance is criticized by many U.S. Bishops, used to be much less supportive of abortion than he is today.

But abortion moderates are a disappearing species in both political parties. As recently as the 1990s, Democrats and Republicans jointly led “pro-life” and “pro-choice” caucuses in Congress. In 1991 an estimated third of Democrats in the U.S.

House voted with anti-abortion advocates. A smaller but still significant minority of Republican House members voted with abortion-rights backers. The Senate was similarly divided.

The divisions through the ’90s helped explain why Democrats, even when they controlled both houses of Congress and the White House, were unable to eliminate the Hyde Amendment or codify abortion rights (they tried both). Since then, though, both parties have retreated more firmly to their respective corners on reproductive health. Despite some complaints, the 2020 Democratic platform calls for repealing the Hyde Amendment, and the 2016 GOP platform (there was no formal platform in 2020) asserts that “the unborn child has a fundamental right to life which cannot be infringed.” Anti-abortion Democrats in each chamber of Congress can be counted on one hand, as can Republican abortion-rights supporters.

The shift clearly has a lot to do with the replacement of Democratic conservatives in the South — many of whom opposed abortion — with Republicans. Along with that came redistricting, which has created more reliably red and blue districts. In a heavily Democratic or Republican district, politicians out of alignment with the majority of their party on issues such as abortion are more likely to draw primary opposition and less likely to raise money from activists.

But it’s not just Democrats who are retreating from the middle of the abortion debate. In 1992, the Senate approved a bill by an overwhelming margin that would specifically allow federal funding of research on fetal tissue left over from elective abortions. Among the Republicans who voted for that measure who are still in the Senate are current Minority Leader Mitch McConnell and Chuck Grassley (R-Iowa).

By the time the issue returned to the political agenda in 2015, McConnell and Grassley had changed their positions. Abortion will remain front and center for both parties as the Supreme Court prepares to review a Mississippi law that bans the procedure after 15 weeks and allows no exceptions for cases of rape or incest. But Democrats will be tested most immediately.

Progressives are determined to vote to eliminate the Hyde Amendment. Yet direct federal abortion funding makes even some abortion-rights backers squeamish, as Biden was until 2020 when, under some duress, he promised to sign the repeal if it came to his desk. As always, abortion remains a political high wire.

HealthBent, a regular feature of Kaiser Health News, offers insight and analysis of policies and politics from KHN’s chief Washington correspondent, Julie Rovner, who has covered health care for more than 30 years. This story was produced by KHN (Kaiser Health News), a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation).

KFF is an endowed nonprofit organization providing information on health issues to the nation. Julie Rovner. jrovner@kff.org, @jrovner Related Topics Contact Us Submit a Story Tip.

Stephen Matthew buy cheap viagra online Shumaker counted on in-home, in-person demonstrations to drive his water fiation business, which serves the Atlanta area. So when erectile dysfunction treatment hit and no one was inviting people indoors, he turned to the air-cleaning part of his operation. He sent buy cheap viagra online cards in the mail advertising air purifiers using ActivePure technology to new homeowners. €œKILL erectile dysfunction treatment, erectile dysfunction IN YOUR HOME!.

!. € One card landed on the desk of a postal inspector, buy cheap viagra online who called it false and misleading in a court record. Shumaker then told an undercover agent on the phone on April 24, 2020, that the air purifier “kills the erectile dysfunction viagra on the spot,” according to a criminal complaint. Weeks later, as Shumaker was heading out the door to his daughter’s tennis tournament, eight law enforcement officers detained him.

In August, he pleaded guilty to distributing “a pesticide device that was misbranded in that the product buy cheap viagra online label was missing an EPA establishment number.” In other words, he failed to follow the letter of a little-known law. Shumaker told KHN he was just a salesperson and the devices were being shipped straight from the manufacturer. €œSo I don’t know — what am I supposed to do?. € he buy cheap viagra online asked.

€œHow do I know if there’s a sticker on there or not?. I don’t have a clue.” The company that makes the devices, ActivePure Technologies, said Shumaker was not an authorized or known buy cheap viagra online salesperson of its products. The sting is a rare example of enforcement in an arena where money is gushing like a geyser but oversight is nearly nonexistent. Electronic air cleaners, heavily marketed to gyms, doctors’ offices and hospitals, companies and schools awash in federal erectile dysfunction treatment relief funds, tend to use high-voltage charges to alter molecules in the air.

The companies selling the devices say they can destroy pathogens and clean the air buy cheap viagra online. But academic air quality experts say the technology can be ineffective or potentially create harmful byproducts. Companies that make the devices are subject to virtually no standardized testing or evaluation of their marketing claims. A KHN investigation buy cheap viagra online this spring found that over 2,000 schools across the country have bought such technology.

€œThat’s one of the reasons these companies thrive, is that there’s nobody, nobody checking every aspect of what they do,” said Delphine Farmer, a Colorado State University associate professor who specializes in atmospheric and indoor chemistry. EMAIL SIGN-Up Subscribe to California Healthline's free Daily Edition. Regulatory Patchwork An alphabet soup of federal agencies have truth-in-advertising or product medical device oversight powers but have done little about air cleaners or left broad loopholes. That has left a handful of states to take the most decisive action on the industry buy cheap viagra online. The Centers for Disease Control and Prevention does not regulate the devices but, like academic air quality experts, recommends time-tested portable HEPA filters to clean the air in rooms.

In comparison, ionizing and dry hydrogen peroxide air purifiers have a “less-documented track record” in air cleaning, the CDC says. The CDC also urges consumers to research the technology and “request buy cheap viagra online testing data.” Those reports, though, can be difficult to parse. They include arcane terms like “natural decay” and test conditions that only an expert could spot as different from those that prevail in real life. The Food and Drug Administration regulates medical buy cheap viagra online devices.

But only air purifiers for a direct medical use or that make a medical claim, like relieving allergies, qualify. The FDA doesn’t consider ads saying a device can kill a microorganism a “medical claim,” spokesperson Shirley Simson said in an email. Instead, the air purifiers fall under the Environmental Protection Agency’s authority as devices marketed to destroy “pests,” which include bacteria or buy cheap viagra online viagraes. But “unlike chemical pesticides, the EPA does not register devices and, therefore, does not routinely review their safety or efficacy,” the agency said.

Trying to fill the gaps, California bans the sale of air purifiers that emit more than a certain level of the toxic ozone gas. The New York State Education Department is buy cheap viagra online “not recommending” that schools buy air purifiers it describes as “ion generators” or “corona discharge technology.” Jeffrey Siegel, a University of Toronto civil engineering professor who studies indoor air quality, said more meaningful national regulation might clarify for consumers how the devices would work in an actual room. €œIf you get any serious government oversight, a big chunk of this industry will go away,” said Siegel. €˜I Was Alone’ While “pesticide” might evoke the idea of a roach killer, the EPA applies the term more broadly.

A pesticide is any substance that claims to kill or mitigate buy cheap viagra online pests. Technologies that claim to do the same through physical means — including air purifiers that inactivate bacteria and viagraes — are considered pesticide devices. And while the agency requires proof that pesticides such as some types of Clorox wipes are safe and work in its premarket review, it has no such requirement buy cheap viagra online for so-called pesticide devices — such as electronic air cleaners that deploy ions or “reactive oxygen” to purify the air. Instead, manufacturers need to obtain what’s known as an establishment number indicating where the device is made, and then they and their sellers must label their products with it.

That’s the step Shumaker pleaded guilty to skipping. €œThere is no review associated with that,” said James Votaw, buy cheap viagra online a lawyer who specializes in chemical regulation law at Keller and Heckman in Washington, D.C. €œThat is automatic. It’s like trying to get license plates for your car.” So Shumaker told KHN he was baffled as to why he was targeted instead of the corporate level, which in this case would be the company, Aerus, which is now ActivePure Technologies.

Dr. Deborah Birx, former adviser to President Donald Trump, joined ActivePure in March as chief medical and science adviser. €œI was alone,” Shumaker said in an interview about facing charges. €œNobody backed me up.” Joe Urso, CEO of ActivePure Technologies, told KHN that its studies showing its devices inactivate the viagra that causes erectile dysfunction treatment were not completed until the fall, long after the postcards were sent.

Urso said in a statement that his company’s devices do have establishment numbers, and that he supports the ruling against Shumaker. Federal Trade Commission officials have written warning letters to some air cleaner companies during the viagra. The commission requires claims about a product’s safety and efficacy to be supported with “competent and reliable scientific evidence.” One of the last high-profile actions the FTC took against an air purifier company was in 1997, when the Justice Department filed an action on its behalf against Alpine Industries, which made ozone-generating air purifiers. In 2001, a judge fined Alpine $1.49 million for failing to stop making unsubstantiated claims about its devices, which it had said relieved allergies and removed indoor pollutants.

Alpine is a related company to EcoQuest International, according to the FTC. And a majority of EcoQuest International assets were bought in 2009 by ActivePure Technologies, according to its 2021 press kit. ActivePure makes the device Shumaker got into trouble for selling. Siegel, of the University of Toronto, consulted with U.S.

Government agencies targeting the misleading marketing claims of some air-cleaner companies about 10 years ago. He finds the company-by-company approach to be a game of “whack-a-mole.” “A company goes away because they have regulatory scrutiny and reinvent themselves a few months later,” he said. €œThe only solution I see to this problem is a government agency really takes ownership of this — the information dissemination to consumers and the claims by manufacturers. I see no other path forward.” ‘It’s Just Buyer Beware’ The Federal Insecticide, Fungicide, and Rodenticide Act, which regulates pesticide devices, was written decades ago and applied to things such as flypaper, long before anyone anticipated machines that would blast ions to clean the air.

€œWe’re just pushing EPA to try and get updated,” said Patrick Jones, president of the Association of American Pesticide Control Officials. €œIt’s just buyer beware.” Even before the erectile dysfunction treatment viagra, Jones’ group was ringing the alarm over the increasing public health claims around pesticide devices. The pesticide control association wrote in a 2019 public comment to the EPA of its concern about the growing use in health care facilities of “non-government evaluated pesticide devices that make unsubstantiated human health claims … with no scientific data being submitted to EPA to prove their effectiveness.” EPA spokesperson Tim Carroll said in an email that the agency is developing more outreach materials for schools on air purifiers. But as few independent authorities assess the effectiveness of the devices, school officials have been snapping them up.

Last summer, the private St. Thomas More School in Kansas City, Missouri, bought ionizing air purifiers to fight erectile dysfunction treatment. Scott Dulle, the director of building and grounds, said he went with technology he saw health leaders buying. €œWe followed the doctors and the hospitals and the government,” he said.

€œThey would not put their patients and staff in harm’s way.” AAPCO’s Jones said changes to federal oversight are needed to better deal with the flood of devices. His solution. If a pesticide device makes a public health claim, it should be evaluated with the same rigor used for pesticides like ant spray. But to alter the law fundamentally would take congressional action, EPA’s Carroll said.

The EPA can prosecute pesticide device companies and sellers under existing laws if a product makes misleading or false claims — and fines can reach into the millions, according to Brandon Neuschafer, a lawyer who specializes in agricultural regulations at the St. Louis-based firm Bryan Cave Leighton Paisner. He noted companies are often turned in by their competitors. Last fiscal year, Carroll said, the agency issued 19 import refusal notices and sent six advisory letters for erectile dysfunction treatment-related air-purifying products — a small fraction of its 2020 pesticide actions.

Carroll said such investigations are ongoing and a high priority. But EPA’s resources were not the same as they were many years ago, Neuschafer said, as the agency is working with smaller staffing and budgets. €˜Worse Indoor Air Quality’ Almost a decade before erectile dysfunction treatment emerged, New York’s education department asked state health officials to test an AtmosAir bipolar ionization unit to see if it would improve the air quality. During a test in an empty classroom, they found that levels of harmful ozone gas and “uafine particles” that can cause cardiovascular problems were elevated, indicating “worse indoor air quality when the AtmosAir Bipolar ionization unit is operating,” the 2013 state Bureau of Toxic Substance Assessment report said.

New York State Department of Health officials released the study in response to a KHN public records request about the education department’s erectile dysfunction treatment-era guidance, which urges schools not to buy ionizers. AtmosAir spokesperson Sarah Berman said the device studied in 2013 is discontinued and “all current products have no affiliation to” it. She also said in an email that tests by third-party labs found that “our bipolar ionization products do not contribute to unacceptable levels” of volatile organic compounds, which are potentially harmful substances. The California Department of Public Health advised in September against using “air cleaning devices that generate harmful pollutants (i.e., ionization devices or ozone generators)” on the third page of a single-spaced, 44-page document.

That guidance was widely overlooked. Districts from Berkeley to Fontana to Culver City bought ionization systems. But the state does have a one-of-a-kind law. It bans air purifiers that emit anything above a certain level of ozone.

New Jersey doesn’t have the same kind of regulation. A public school district there bought thousands of ozone-emitting Odorox devices on the California Air Resources Board’s list of “potentially hazardous” air purifiers. Back in Georgia, Shumaker was fined more than $9,000 and is on two years’ probation. And the postcards that got him into trouble?.

Those led to only a handful of sales. €œSo it was just like setting money on fire,” he said. This story was produced by KHN (Kaiser Health News), a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation).

KFF is an endowed nonprofit organization providing information on health issues to the nation. Lauren Weber. lweber@kff.org, @LaurenWeberHP Christina Jewett. cjewett@kff.org, @by_cjewett Related Topics Contact Us Submit a Story TipIt took five months for the Biden administration to make a substantive policy change to advance abortion rights.

And even that change was buried in a 61-page regulation setting rules for 2022’s Affordable Care Act enrollment. The policy would reverse a Trump administration rule requiring insurers that cover abortion to send separate bills for that coverage. Abortion opponents had hoped the extra paperwork would persuade insurers to stop offering the coverage. But the new administration’s effort also highlights the frustrations abortion-rights advocates have with the slow pace of change from a president they strongly supported — and who courted their votes.

€œBiden will work to codify Roe v. Wade, and his Justice Department will do everything in its power to stop the rash of state laws that so blatantly violate Roe v. Wade,” said his campaign platform. The late-June action was technically Biden’s second move on reproductive rights.

Following a recent custom in which presidents taking office from the opposite party have reversed each other’s abortion policies, Biden in January gave an initial nod to that campaign promise. He issued an executive order that overturned the so-called Mexico City policy that prohibited U.S. Funding of foreign organizations that perform abortions or even lobby for looser abortion laws. It also instructed the Department of Health and Human Services to rewrite a Trump regulation that has effectively shut Planned Parenthood out of the federal family planning program, Title X.

But those Title X changes haven’t happened yet, nor has the administration formally moved to undo rules that make it easier for employers to opt out of the ACA mandate to provide no-cost contraception. Also so far unchanged are Trump administration modifications to Medicaid guidance that allow states to ban Planned Parenthood from Medicaid. And abortion rights supporters’ concerns are growing after the Supreme Court accepted a Mississippi case that could significantly weaken or even overturn Roe v. Wade, the 1973 ruling that legalized abortion nationwide.

In fact, to the consternation of reproductive rights advocates, Biden has apparently not even uttered the word “abortion” as president. A website is keeping track. None of that, however, has stopped abortion opponents from painting the president and his administration as pro-abortion crusaders. €œOnce a supporter of policies that protect the lives of the unborn and their mothers, President Biden today caters to the most extreme voices within his party,” said a statement from the Susan B.

Anthony List in May. The statement was in response to Biden’s keeping a campaign pledge to submit a budget calling for Congress to eliminate the Hyde Amendment, which for years has forbidden most federal abortion funding, particularly affecting low-income women in the Medicaid health program. It’s named after former Republican Rep. Henry Hyde of Illinois.

EMAIL SIGN-Up Subscribe to California Healthline's free Daily Edition. It’s true that Biden, a practicing Roman Catholic whose stance is criticized by many U.S. Bishops, used to be much less supportive of abortion than he is today. But abortion moderates are a disappearing species in both political parties. As recently as the 1990s, Democrats and Republicans jointly led “pro-life” and “pro-choice” caucuses in Congress.

In 1991 an estimated third of Democrats in the U.S. House voted with anti-abortion advocates. A smaller but still significant minority of Republican House members voted with abortion-rights backers. The Senate was similarly divided.

The divisions through the ’90s helped explain why Democrats, even when they controlled both houses of Congress and the White House, were unable to eliminate the Hyde Amendment or codify abortion rights (they tried both). Since then, though, both parties have retreated more firmly to their respective corners on reproductive health. Despite some complaints, the 2020 Democratic platform calls for repealing the Hyde Amendment, and the 2016 GOP platform (there was no formal platform in 2020) asserts that “the unborn child has a fundamental right to life which cannot be infringed.” Anti-abortion Democrats in each chamber of Congress can be counted on one hand, as can Republican abortion-rights supporters. The shift clearly has a lot to do with the replacement of Democratic conservatives in the South — many of whom opposed abortion — with Republicans.

Along with that came redistricting, which has created more reliably red and blue districts. In a heavily Democratic or Republican district, politicians out of alignment with the majority of their party on issues such as abortion are more likely to draw primary opposition and less likely to raise money from activists. But it’s not just Democrats who are retreating from the middle of the abortion debate. In 1992, the Senate approved a bill by an overwhelming margin that would specifically allow federal funding of research on fetal tissue left over from elective abortions.

Among the Republicans who voted for that measure who are still in the Senate are current Minority Leader Mitch McConnell and Chuck Grassley (R-Iowa). By the time the issue returned to the political agenda in 2015, McConnell and Grassley had changed their positions. Abortion will remain front and center for both parties as the Supreme Court prepares to review a Mississippi law that bans the procedure after 15 weeks and allows no exceptions for cases of rape or incest. But Democrats will be tested most immediately.

Progressives are determined to vote to eliminate the Hyde Amendment. Yet direct federal abortion funding makes even some abortion-rights backers squeamish, as Biden was until 2020 when, under some duress, he promised to sign the repeal if it came to his desk. As always, abortion remains a political high wire. HealthBent, a regular feature of Kaiser Health News, offers insight and analysis of policies and politics from KHN’s chief Washington correspondent, Julie Rovner, who has covered health care for more than 30 years.

This story was produced by KHN (Kaiser Health News), a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation. Julie Rovner.

jrovner@kff.org, @jrovner Related Topics Contact Us Submit a Story Tip.

;