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Ketoacidosis and fluidsThe debate around fluid resuscitation and maintenance in DKA has been smouldering for years, the recent, large PECARN FLUID trial providing some guidance, but, not drawing a line under all the issuesIn the light of the kamagra for sale study, revisiting http://evsellshomes.com/buy-kamagra-fast-delivery/ the arguments is useful and a group of three papers re-open the discussion. The catalyst on this occasion has been the publication of new British Society of Paediatric Endocrinology (BSPED) guidance, recommendations which leave ultimate decision making to the individual clinician but in broad terms suggest an initial resuscitation bolus (of 10âÂÂmL/kg) to all children. Our first correspondent, John Lillie on behalf of the South Thames Retrieval Service whose policy has been restrictive since 2008 after three deaths from DKA associated cerebral oedema argues that degree of dehydration (an agreed moot point by all parties) is all too easily overestimated particularly when kamagra for sale capillary refill time (prolonged by hypocapnoea inherent to ketosis) is used to make the assessment. Neil Wright on behalf of BPSED argues that once initial resuscitation is completed there is little difference philosophically between the two approachesThe physiology, science and moot points are weighed up in Robert TaskerâÂÂs editorial in which one bystander in recent debate, the rate of insulin infusion is also revisited, a lower exposure causing less rapid shifts in osmotic pressure and (theoretically) less risk of cerebral oedema.
Here we come full circle in that the number of children developing this complication is so low that even a trial as large as FLUID is potentially underpowered. See pages 1019, 1020 and 917Perinatal encephalopathyThe dangers of over-diagnosis of a vague entity are kamagra for sale highlighted in MustayevâÂÂs systematic review. The term perinatal encephalopathy (PE) (sometimes also called the âÂÂsyndrome of intracranial hypertensionâÂÂ) was coined by a Russian paediatrician Iurii Iakunin in the 1970s referring to a range of signs and symptoms thought to be attributable to a perinatal insult, mediated by a rise in intracranial pressure. The notion was admirable, but the group kamagra for sale of disorders inevitably heterogenous.
As the term became more widely used in Eastern European countries, it was sometimes applied to infants and children with transient signs and no discernable pathology. The nomenclature was (paradoxically) reinforced by the lack of a unifying diagnostic test. The label being at the discretion of the paediatrician or paediatric neuropathologist, kamagra for sale to which many of these infants were referred. Diagnoses result in treatments and wide range of agents had been used on occasions.
Anticonvulsants, mineral and metabolic supplements, diuretics, cattle-derived neuropeptides, vasoactive agents, psychostimulants, and physical therapies. The issue of the Perinatal Encephalopathy Syndrome has long been on the radar of the WHO, and was the subject of a kamagra for sale meeting in St Petersburg in 2007, at which many positive signs of reform were seen. This review shows further change, but some areas of continuing concern related to the diagnosis which still appears to be applied in some areas. These potential harms are both direct and kamagra for sale indirect and include the failure to diagnose other disorders.
Unnecessary follow-up appointments and diagnostic procedures. The development of the vulnerable child syndrome. And even deferral of kamagra for sale vaccinations. See page 921After sudden infant deathSUDI is a rare event and a second death in a subsequent child extremely unusual, but to date there has been little data to quantify the recurrence risk and counsel parents.
GarstangâÂÂs analysis of the Care of the Next Infant database from 2000 to 2015 provides some answers. Over this period, 6608 live-born infants kamagra for sale were registered. 171 were first-born infants to mothers whose male partners had previously had an unexplained infant death. 29 unexpected infant deaths following the index death occurred in 26 families, 23 kamagra for sale with 2 deaths and 3 with three deaths.
The second SUDI rate was estimated as 3.93 per 1000 live births and the third as 115 per 1000 live births. The findings should not, though, engender complacency as there have in the past been convictions for homicide. The risk of repeat SUDI in a family is still 10 times kamagra for sale that of the general population, a reflection of inherent genetic risks as well as environmental factors such as maternal smoking and unsafe sleeping. CONI cannot address intrinsic risk factors, but these are very vulnerable families who need comprehensive care and support packages to help them understand safe sleeping, address mental health problems and enhance their parenting capacity.
See page 945Emergency steroids and asthma prophylaxisIn a neat and salutary reminder of the reason some children reach the stage of requiring rescue oral kamagra for sale corticosteroids (OCS) at routine clinic appointments, Willson reviews experience from a quarternary respiratory department with respect to adherence prescribed prophylaxis. In the series 25 children received 32 courses of OCS. For those episodes with full data, uptake of prescriptions for inhaled corticosteroid prophylaxis, the median uptake over the previous 6 months was only 33% and in only 29% episodes was uptake âÂÂ¥75% of that prescribed So, rather than just prescribe the emergency course and ascribe it to bad luck or bad asthma⦠maybe check on adherence. This and related themes are explored in Ian SinhaâÂÂs Viewpoint kamagra for sale exploration of the national respiratory audit database.
See pages 993 and 910Monitoring inflammatory bowel diseaseEqually pragmatic is the issue with calprotectin stability described by Haisma. Stool calprotectin is pivotal in the diagnosis, monitoring of and to treatment modifications in IBD. Often a sample will be taken in the home and dropped off at the lab or sent by post having spent time at room kamagra for sale temperature in the interim rather than the recommended 4 C. The fall in levels is so great (35% and 46% in extraction buffer) that disease activity will inevitably be underestimated and treatment not increased appropriately.
So, before reducing immune modulating treatment immediately, check how the sample travelled before analysis and, if in any doubt, kamagra for sale recheck making any changes. See page 996Two letters in the journal focus on the volume of intravenous fluid to be used during resuscitation and early management of paediatric patients presenting with diabetic ketoacidosis (DKA).1 2 The correspondence encapsulates an important debate about intravenous fluids and risk of morbidities, such as cerebral oedema, and provides us with the range in contemporary opinions in the UK.Lillie et al1 use their insights from the South Thames Retrieval service (STRS) and its 20 referring district general hospitals to highlight a concern about the new British Society for Paediatric Endocrinology and Diabetes (BSPED) guideline3 and integrated care pathway4 for the management of DKA. The authors have a network of emergency practice, and they imply that the new emphasis by the BSPED on permissive rather than restrictive (ie, reduced volume rules) intravenous fluids will be disruptive to the measures that they have taken since dealing with three cerebral oedema deaths in their region. Wright and Thomas2 have kamagra for sale responded on behalf of the BSPED DKA interest group.
They emphasise the importance of adequate intravenous fluid resuscitation in limiting morbidity. They also provide an instructive table2 showing fluid resuscitation and rehydration volumes used in a number of protocols, including that of STRS and the new BSPED approach. The main differences come down to the estimate of fluid deficit, the use of an intravenous fluid bolus at presentation and the calculation of maintenance fluid requirements.The STRS approach assumes a 10% fluid deficit in all patients with DKA at presentation, versus the new BSPED kamagra for sale guidelineâÂÂs use of three levels in estimated fluid deficit based on severity of acidosis (ie, pH >7.2, 5%. PH 7.1 to 7.2, 7%.
And pH <7.1, 10%) kamagra for sale. In the STRS approach, an intravenous fluid bolus of 10âÂÂmL/kg normal saline (NS) is reserved for patients in shock. In contrast, the new BSPED guideline recommends that all patients with DKA receive an intravenous bolus of 10âÂÂmL/kg NS, with an extra 10âÂÂmL/kg NS (20âÂÂmL/kg in total) for those in shock. Last, in the STRS protocol, the 10% fluid deficit is repaired over 48âÂÂhours by adding the volume to restrictive or so-called reduced volume rules for maintenance intravenous requirements and for body weight (ie, up to 10âÂÂkg, 2âÂÂmL/kg/hour kamagra for sale.
10âÂÂ14âÂÂkg, 1âÂÂmL/kg/hour and >40âÂÂkg, fixed volume 40âÂÂmL/hr). The new BSPED guideline also recommends replacing the presumed fluid deficit over 48âÂÂhours, but this hourly volume is added to standard (and higher than reduced volume rules) maintenance intravenous fluids.4 kamagra for sale 5Now, add to this mixture of opinions, the UK National Institute for Health and Care Excellence (NICE) latest updated pathway for DKA in children and young people.6 Like the new BSPED guideline, NICE also estimates fluid deficit based on severity of acidosis. However, severity of fluid deficit is dichotomised to 5% or 10% based on whether pH is above or below 7.1, respectively. Like the STRS approach, there is no routine use of an intravenous NS fluid bolus in severe DKA.
Last, like the STRS approach the estimated fluid deficit is repaired over 48âÂÂhours by adding the hourly volume to maintenance requirement calculated using reduced volume rules.How can there kamagra for sale be such variance in opinion and recommendations and what should we do?. To be fair, the new BSPED guideline3 was only ever âÂÂ⦠an interim recommendation pending the publication of the future NICE review.â But, more importantly, the BSPED website acknowledges that the onus for decision-making remains with the clinician. A similar stance on responsibility of guideline users is also taken by NICE.The new information that seems to have influenced the BSPED and the NICE updates on DKA is the Pediatric Emergency Care Applied Research Network (PECARN) clinical trial of fluid infusion rates for paediatric DKA (FLUID trial).7 It is worth re-reading the paper and its protocol and supplementary appendix, in particular have a look at Figure S1 on compliance to assigned fluid rate. The bottom line of the FLUID trial is that neither the rate of administration (fast vs slow kamagra for sale repair) nor the sodium chloride content (NS vs 0.45% saline) of intravenous fluids significantly influenced neurological outcomes.
Wright and Thomas2 show in their table that the difference between fast and slow repair in the trial was complex and not only included a difference in timing of fluid-deficit repair (ie, fast with 50% repair in first 12âÂÂhours followed by 50% repair in next 24âÂÂhours vs slow repair evenly distributed over 48âÂÂhours). It also kamagra for sale involved differences in presumed fluid deficit (10% vs 5%) and use of intravenous NS boluses (20âÂÂmL/kg vs 10âÂÂmL/kg). Close review of the compliance to assigned fluid rate in the FLUID trial (see Supplemental Figure S17) shows that actual fluid received by patients in the fast and slow repair groups are similar to those suggested by the BSPED and STRS/NICE, respectively. If there is no difference in neurological outcome, does the difference in fluid strategy really matter, as each of our correspondents argue?.
To attempt to answer this question we have to look at two key details of the FLUID kamagra for sale trial. The first is that of the 1389 patients undergoing randomisation, 1263 (91%) had Glasgow Coma Scale (GCS) score 15, 99 (7%) had GCS score 14 and 28 (2%) had GCS score <14. In essence, the test of fast versus slow fluid strategy is strongly influenced by patients with DKA who are fully awake at presentation. Both of kamagra for sale our correspondents1 2 acknowledge that patients with altered mental state raise concern, although their approaches differâÂÂon this matter we have no answer from the FLUID trial.
The other detail to consider is that the uniformly used standard insulin infusion rate (0.1âÂÂU/kg/hour) differs from the dosing range (0.05 to 0.1âÂÂU/kg/hour) used in UK practice.3 4 6 One theoretical aim of low-dose insulin (0.05âÂÂU/kg/hour)8 9 is to avoid too rapid decrease in serum glucose concentration (ie, >5.5âÂÂmmol/L/hour), with consequent too rapid change in serum osmolarity, which may increase the risk of cerebral oedema.10 11 Does this idea mean that the low-dose insulin strategy enables better tolerance of fast-fluid repair rate, with low risk of morbidity?. Impossible to kamagra for sale answer. As we see from the FLUID trial, such a propositionâÂÂwith an outcome of brain injury in less than 1% of DKA episodesâÂÂis likely untestable in a future sufficiently powered clinical trial.Taking all the above together, there is clearly a need to realign the variance in DKA fluid management reflected in the STRS,1 BSPED2âÂÂ4 and NICE6 approaches. Even though we have gold standard clinical information from the PECARN DKA FLUID trial,7 the relevance of that information to all paediatric patients presenting with DKA needs careful consideration.
Which means that clinicians still need kamagra for sale to exercise judgement in individual situations. Finally, the letter by Lillie et al1 also reminds us of the value of systems of care. Their hub-and-spoke network for emergency DKA care is not just about adopting latest recommendations but is also tasked with bringing about any necessary knowledge-to-action change (see the table and figure 2 as responses to three cerebral oedema DKA deaths),1 a process called implementation science.12.
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SOURCES http://www.ec-westhoffen.ac-strasbourg.fr/?page_id=7 buy kamagra oral jelly wholesale. National Multiple Sclerosis Society. ÃÂÂDefinition of buy kamagra oral jelly wholesale MS,â âÂÂDisease Modifying Therapies for MS,â âÂÂMS the Disease,â âÂÂTypes of MS.â Neurology. ÃÂÂEffect of comorbidity on mortality in multiple sclerosis.â Bianca Weinstock-Guttman, MD, professor of neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo. Director, Jacobs buy kamagra oral jelly wholesale MS Center for Treatment and Research, Buffalo, NY.
Julie Fiol, registered nurse, director of MS information, National Multiple Sclerosis Society, New York City. Barry Hendin, MD, chief medical officer, Multiple Sclerosis Association of America. Board-certified neurologist, Center for Neurology and buy kamagra oral jelly wholesale Spine Center, Phoenix, AZ. BMJ Open. ÃÂÂCause of death in MS buy kamagra oral jelly wholesale.
Long-term follow-up of a randomised cohort, 21â years after the start of the pivotal IFNò-1b study.By Robert PreidtHealthDay Reporter FRIDAY, Jan. 15, 2021 (HealthDay News) -- The erectile dysfunction treatment kamagra significantly shortened life expectancy buy kamagra oral jelly wholesale in the United States, especially among Black people and Hispanics, a new study says. With more than 336,000 erectile dysfunction treatment deaths nationwide last year, researchers decided to examine the kamagra's impact on life expectancy. The projection. Due to kamagra deaths, life expectancy at birth for Americans will shrink by buy kamagra oral jelly wholesale 1.13 years, to 77.48 years.
That's the largest single-year decline in at least 40 years, resulting in the lowest estimated life expectancy since 2003, according to the authors. Their findings revealed significant buy kamagra oral jelly wholesale racial differences that underscore the kamagra's heavy toll on racial and ethnic minority groups. The study projects a 0.68-year decline in life expectancy for white Americans to 77.84 years, compared to a 2.1-year decline for Black people, to 72.78 years, and a 3.05-year drop among Hispanics to 78.77 years. "The erectile dysfunction treatment kamagra's disproportionate effect on the life expectancy of Black and Latino Americans likely has to do with their greater exposure through their workplace or extended family contacts, in addition to receiving poorer health care, leading to more s and worse outcomes," study author Theresa Andrasfay said in a news release from the University of Southern California. She is a postdoctoral fellow in gerontology buy kamagra oral jelly wholesale at the university.
The researchers project the gap between Black Americans and white Americans to widen from 3.6 years to more than 5 years. That's more proof that minorities are especially hard hit by the kamagra, according to the buy kamagra oral jelly wholesale findings, published Jan. 14 in the journal Proceedings of the National Academy of Sciences. "The bigger reductions in life expectancy for the Black and Latino populations result in part from a disproportionate number of deaths at younger ages for these groups," buy kamagra oral jelly wholesale said study co-author Noreen Goldman, a professor of demography and public affairs at Princeton University. "These findings underscore the need for protective behaviors and programs to reduce potential viral exposure among younger individuals who may not perceive themselves to be at high risk," Goldman added in the release.
Continued Life expectancy is an important indicator of a population's health and helps assess the impact of erectile dysfunction treatment on survival, according to the researchers. The 1918 influenza kamagra buy kamagra oral jelly wholesale shortened life expectancy by 7 to 12 years, they noted. "While the arrival of effective treatments is hopeful, the U.S. Is currently experiencing more daily erectile dysfunction treatment deaths than at any buy kamagra oral jelly wholesale other point in the kamagra," Andrasfay said. "Because of that, and because we expect there will be long-term health and economic effects that may result in worse mortality for many years to come, we expect there will be lingering effects on life expectancy in 2021." More information The U.S.
Centers for Disease Control and Prevention has more on erectile dysfunction treatment. SOURCE. University of Southern California, news release, Jan. 14, 2021 WebMD News from HealthDay Copyright é 2013-2020 HealthDay. All rights reserved.SOURCES.
Barbara Giesser, MD, neurologist, MS specialist, Pacific Neuroscience Institute at Providence Saint JohnâÂÂs Health Center, Santa Monica, CA. Gabriel Pardo, MD, director, Oklahoma Medical Research FoundationâÂÂs Multiple Sclerosis Center of Excellence, Oklahoma City. National Multiple Sclerosis Society. ÃÂÂAdherence.â Multiple Sclerosis Trust (U.K.). ÃÂÂWhen Can You Safely Stop Taking Disease Modifying Drugs?.
àJournal of Neurology, Neurosurgery, and Psychiatry. ÃÂÂDiscontinuing disease-modifying therapy in MS after a prolonged relapse-free period. A propensity score-matched study.â International Journal of MS Care. ÃÂÂStopping Disease-Modifying Therapy in Nonrelapsing Multiple Sclerosis. Patient-Centered Outcomes Research Institute.
ÃÂÂCan Some MS Patients Safely Stop Taking Medicines?. ÃÂÂThe demand for erectile dysfunction treatments continues to outpace supply, forcing public health officials to decide who should be first in line for a shot, even among those in the same pool of eligible treatment recipients.To assist these efforts, researchers at the University of Wisconsin School of Medicine and Public Health and UW Health have developed a tool (https://www.hipxchange.org/erectile dysfunction treatmenttreatment) that incorporates a person's age and socioeconomic status to prioritize treatment distribution among people who otherwise share similar risks due to their jobs. The tool helps identify those who are at greater risk of severe complications or death from erectile dysfunction treatment.UW Health has implemented the prioritization algorithm to equitably provide limited doses to frontline health care workers. Other organizations can also access the freely available tool to guide their own treatment distribution plans.While the UW-Madison tool was designed with the first phase of eligible recipients in mind, it could be used as treatment distribution expands to larger populations. As the eligible population increases, the gap between initial supply and demand could grow, making such prioritization tools even more helpful."Knowing we're going to have limited treatment for some time, we wanted to develop an algorithm to equitably distribute vaccinations within these risk groups," says Grace Flood, the director of clinical analytics and reporting in the Office of Population Health at UW Health, who helped lead development of the tool along with the Health Innovation Program within SMPH.In addition to age, the algorithm uses the Social Vulnerability Index to measure a person's susceptibility to severe erectile dysfunction treatment based on where they live.
The Centers for Disease Control and Prevention developed the SVI metric to help emergency responders identify which neighborhoods and towns will require the most support following natural disasters or public health emergencies.The SVI incorporates 15 measures in four categories. Socioeconomic status, housing composition and disability, minority status and language, and housing and transportation. Race and ethnicity have been closely correlated with higher erectile dysfunction treatment-related hospitalizations and mortality.Flood and her team incorporated the SVI in accordance with a report by the National Academies of Sciences, Engineering and Medicine that recommended using the index to fairly distribute treatments. Because Wisconsin publishes data about erectile dysfunction treatment deaths at the census-tract level, "we were able to determine the relationship for risk of mortality between age and SVI," says Flood. This relationship allowed the researchers to verify that age and SVI combined provide an accurate estimate of an individual's risk.Since age and SVI are readily available pieces of information about an individual and each contributes to erectile dysfunction treatment risk, an algorithm that incorporates both elements may serve as one of the best ways to distribute treatments until supply catches up to demand, says Flood.The researchers have published their algorithm (https://deepblue.lib.umich.edu/handle/2027.42/163774) in the Annals of Family Medicine erectile dysfunction treatment collection and made it available for download on the project's website.
Story Source. Materials provided by University of Wisconsin-Madison. Original written by Eric Hamilton. Note. Content may be edited for style and length.Scientists studying the body's natural defenses against bacterial have identified a nutrient -- taurine -- that helps the gut recall prior s and kill invading bacteria, such as Klebsiella pneumoniae (Kpn).
The finding, published in the journal Cell by scientists from five institutes of the National Institutes of Health, could aid efforts seeking alternatives to antibiotics.Scientists know that microbiota -- the trillions of beneficial microbes living harmoniously inside our gut -- can protect people from bacterial s, but little is known about how they provide protection. Scientists are studying the microbiota with an eye to finding or enhancing natural treatments to replace antibiotics, which harm microbiota and become less effective as bacteria develop drug resistance.The scientists observed that microbiota that had experienced prior and transferred to germ-free mice helped prevent with Kpn. They identified a class of bacteria -- Deltaproteobacteria -- involved in fighting these s, and further analysis led them to identify taurine as the trigger for Deltaproteobacteria activity.Taurine helps the body digest fats and oils and is found naturally in bile acids in the gut. The poisonous gas hydrogen sulfide is a byproduct of taurine. The scientists believe that low levels of taurine allow pathogens to colonize the gut, but high levels produce enough hydrogen sulfide to prevent colonization.
During the study, the researchers realized that a single mild is sufficient to prepare the microbiota to resist subsequent , and that the liver and gallbladder -- which synthesize and store bile acids containing taurine -- can develop long-term protection.The study found that taurine given to mice as a supplement in drinking water also prepared the microbiota to prevent . However, when mice drank water containing bismuth subsalicylate -- a common over-the-counter drug used to treat diarrhea and upset stomach -- protection waned because bismuth inhibits hydrogen sulfide production.Scientists from NIH's National Institute of Allergy and Infectious Diseases led the project in collaboration with researchers from the National Institute of General Medical Sciences. The National Cancer Institute. The National Institute of Diabetes and Digestive and Kidney Diseases. And the National Human Genome Research Institute.
Story Source. Materials provided by NIH/National Institute of Allergy and Infectious Diseases. Note. Content may be edited for style and length.A new Northwestern University-led study is unfolding the mystery of how RNA molecules fold themselves to fit inside cells and perform specific functions. The findings could potentially break down a barrier to understanding and developing treatments for RNA-related diseases, including spinal muscular atrophy and perhaps even the novel erectile dysfunction."RNA folding is a dynamic process that is fundamental for life," said Northwestern's Julius B.
Lucks, who led the study. "RNA is a really important piece of diagnostic and therapeutic design. The more we know about RNA folding and complexities, the better we can design treatments."Using data from RNA-folding experiments, the researchers generated the first-ever data-driven movies of how RNA folds as it is made by cellular machinery. By watching their videos of this folding occur, the researchers discovered that RNA often folds in surprising, perhaps unintuitive ways, such as tying itself into knots -- and then immediately untying itself to reach its final structure."Folding takes place in your body more than 10 quadrillion times a second," Lucks said. "It happens every single time a gene is expressed in a cell, yet we know so little about it.
Our movies allow us to finally watch folding happen for the first time."The research will be published Jan. 15 in the journal Molecular Cell.Lucks is an associate professor of chemical and biological engineering at Northwestern's McCormick School of Engineering and a member of Northwestern's Center for Synthetic Biology. He co-led the work with Alan Chen, an associate professor of chemistry at the University of Albany.Although videos of RNA folding do exist, the computer models that generate them are full of approximations and assumptions. Lucks' team has developed a technology platform that captures data about RNA folding as the RNA is being made. His group then uses computational tools to mine and organize the data, revealing points where the RNA folds and what happens after it folds.
Angela Yu, a former student of Lucks, inputted this data into computer models to generate accurate videos of the folding process."The information that we give the algorithms helps the computer models correct themselves," Lucks said. "The model makes accurate simulations that are consistent with the data."Lucks and his collaborators used this strategy to model the folding of an RNA called SRP, an ancient RNA found in all kingdoms of life. The molecule is well-known for its signature hairpin shape. When watching the videos, the researchers discovered that the molecule ties itself into a knot and unties itself very quickly. Then it suddenly flips into the correct hairpin-like structure using an elegant folding pathway called toehold mediated strand displacement."To the best of our knowledge, this has never been seen in nature," Lucks said.
"We think the RNA has evolved to untie itself from knots because if knots persist, it can render the RNA nonfunctional. The structure is so essential to life that it had to evolve to find a way to get out of a knot."The study, "Computationally reconstructing cotranscriptional RNA folding pathways from experimental data reveals rearrangement of non-native folding intermediates," was supported by the National Institutes of Health (award numbers T32GM083937, 1DP2GM110838 and GM120582), the National Science Foundation (award numbers MCB1651877 and 1914567) and the Searle Funds at The Chicago Community Trust.Video. Https://www.youtube.com/watch?. V=2XTi9LG9NnU&feature=emb_logo Story Source. Materials provided by Northwestern University.
Original written by Amanda Morris. Note. Content may be edited for style and length..
SOURCES kamagra pill cost kamagra for sale. National Multiple Sclerosis Society. ÃÂÂDefinition of MS,â âÂÂDisease Modifying kamagra for sale Therapies for MS,â âÂÂMS the Disease,â âÂÂTypes of MS.â Neurology. ÃÂÂEffect of comorbidity on mortality in multiple sclerosis.â Bianca Weinstock-Guttman, MD, professor of neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo.
Director, Jacobs MS Center for Treatment and kamagra for sale Research, Buffalo, NY. Julie Fiol, registered nurse, director of MS information, National Multiple Sclerosis Society, New York City. Barry Hendin, MD, chief medical officer, Multiple Sclerosis Association of America. Board-certified neurologist, Center for Neurology and Spine Center, Phoenix, AZ kamagra for sale.
BMJ Open. ÃÂÂCause of death in kamagra for sale MS. Long-term follow-up of a randomised cohort, 21â years after the start of the pivotal IFNò-1b study.By Robert PreidtHealthDay Reporter FRIDAY, Jan. 15, 2021 (HealthDay News) -- The erectile dysfunction treatment kamagra significantly shortened life expectancy in the United States, especially among Black people and Hispanics, a kamagra for sale new study says.
With more than 336,000 erectile dysfunction treatment deaths nationwide last year, researchers decided to examine the kamagra's impact on life expectancy. The projection. Due to kamagra deaths, life expectancy at birth for Americans will shrink by 1.13 years, kamagra for sale to 77.48 years. That's the largest single-year decline in at least 40 years, resulting in the lowest estimated life expectancy since 2003, according to the authors.
Their findings revealed significant racial differences that kamagra for sale underscore the kamagra's heavy toll on racial and ethnic minority groups. The study projects a 0.68-year decline in life expectancy for white Americans to 77.84 years, compared to a 2.1-year decline for Black people, to 72.78 years, and a 3.05-year drop among Hispanics to 78.77 years. "The erectile dysfunction treatment kamagra's disproportionate effect on the life expectancy of Black and Latino Americans likely has to do with their greater exposure through their workplace or extended family contacts, in addition to receiving poorer health care, leading to more s and worse outcomes," study author Theresa Andrasfay said in a news release from the University of Southern California. She is a postdoctoral fellow in gerontology at the university kamagra for sale.
The researchers project the gap between Black Americans and white Americans to widen from 3.6 years to more than 5 years. That's more proof that minorities are especially hard hit by the kamagra, according to the findings, published kamagra for sale Jan. 14 in the journal Proceedings of the National Academy of Sciences. "The bigger kamagra for sale reductions in life expectancy for the Black and Latino populations result in part from a disproportionate number of deaths at younger ages for these groups," said study co-author Noreen Goldman, a professor of demography and public affairs at Princeton University.
"These findings underscore the need for protective behaviors and programs to reduce potential viral exposure among younger individuals who may not perceive themselves to be at high risk," Goldman added in the release. Continued Life expectancy is an important indicator of a population's health and helps assess the impact of erectile dysfunction treatment on survival, according to the researchers. The 1918 influenza kamagra shortened life expectancy by 7 to 12 kamagra for sale years, they noted. "While the arrival of effective treatments is hopeful, the U.S.
Is currently experiencing more daily erectile dysfunction treatment deaths than at any kamagra for sale other point in the kamagra," Andrasfay said. "Because of that, and because we expect there will be long-term health and economic effects that may result in worse mortality for many years to come, we expect there will be lingering effects on life expectancy in 2021." More information The U.S. Centers for Disease Control and Prevention has more on erectile dysfunction treatment. SOURCE.
University of Southern California, news release, Jan. 14, 2021 WebMD News from HealthDay Copyright é 2013-2020 HealthDay. All rights reserved.SOURCES. Barbara Giesser, MD, neurologist, MS specialist, Pacific Neuroscience Institute at Providence Saint JohnâÂÂs Health Center, Santa Monica, CA.
Gabriel Pardo, MD, director, Oklahoma Medical Research FoundationâÂÂs Multiple Sclerosis Center of Excellence, Oklahoma City. National Multiple Sclerosis Society. ÃÂÂAdherence.â Multiple Sclerosis Trust (U.K.). ÃÂÂWhen Can You Safely Stop Taking Disease Modifying Drugs?.
àJournal of Neurology, Neurosurgery, and Psychiatry. ÃÂÂDiscontinuing disease-modifying therapy in MS after a prolonged relapse-free period. A propensity score-matched study.â International Journal of MS Care. ÃÂÂStopping Disease-Modifying Therapy in Nonrelapsing Multiple Sclerosis.
Patient-Centered Outcomes Research Institute. ÃÂÂCan Some MS Patients Safely Stop Taking Medicines?. ÃÂÂThe demand for erectile dysfunction treatments continues to outpace supply, forcing public health officials to decide who should be first in line for a shot, even among those in the same pool of eligible treatment recipients.To assist these efforts, researchers at the University of Wisconsin School of Medicine and Public Health and UW Health have developed a tool (https://www.hipxchange.org/erectile dysfunction treatmenttreatment) that incorporates a person's age and socioeconomic status to prioritize treatment distribution among people who otherwise share similar risks due to their jobs. The tool helps identify those who are at greater risk of severe complications or death from erectile dysfunction treatment.UW Health has implemented the prioritization algorithm to equitably provide limited doses to frontline health care workers.
Other organizations can also access the freely available tool to guide their own treatment distribution plans.While the UW-Madison tool was designed with the first phase of eligible recipients in mind, it could be used as treatment distribution expands to larger populations. As the eligible population increases, the gap between initial supply and demand could grow, making such prioritization tools even more helpful."Knowing we're going to have buy kamagra online with paypal limited treatment for some time, we wanted to develop an algorithm to equitably distribute vaccinations within these risk groups," says Grace Flood, the director of clinical analytics and reporting in the Office of Population Health at UW Health, who helped lead development of the tool along with the Health Innovation Program within SMPH.In addition to age, the algorithm uses the Social Vulnerability Index to measure a person's susceptibility to severe erectile dysfunction treatment based on where they live. The Centers for Disease Control and Prevention developed the SVI metric to help emergency responders identify which neighborhoods and towns will require the most support following natural disasters or public health emergencies.The SVI incorporates 15 measures in four categories. Socioeconomic status, housing composition and disability, minority status and language, and housing and transportation.
Race and ethnicity have been closely correlated with higher erectile dysfunction treatment-related hospitalizations and mortality.Flood and her team incorporated the SVI in accordance with a report by the National Academies of Sciences, Engineering and Medicine that recommended using the index to fairly distribute treatments. Because Wisconsin publishes data about erectile dysfunction treatment deaths at the census-tract level, "we were able to determine the relationship for risk of mortality between age and SVI," says Flood. This relationship allowed the researchers to verify that age and SVI combined provide an accurate estimate of an individual's risk.Since age and SVI are readily available pieces of information about an individual and each contributes to erectile dysfunction treatment risk, an algorithm that incorporates both elements may serve as one of the best ways to distribute treatments until supply catches up to demand, says Flood.The researchers have published their algorithm (https://deepblue.lib.umich.edu/handle/2027.42/163774) in the Annals of Family Medicine erectile dysfunction treatment collection and made it available for download on the project's website. Story Source.
Materials provided by University of Wisconsin-Madison. Original written by Eric Hamilton. Note. Content may be edited for style and length.Scientists studying the body's natural defenses against bacterial have identified a nutrient -- taurine -- that helps the gut recall prior s and kill invading bacteria, such as Klebsiella pneumoniae (Kpn).
The finding, published in the journal Cell by scientists from five institutes of the National Institutes of Health, could aid efforts seeking alternatives to antibiotics.Scientists know that microbiota -- the trillions of beneficial microbes living harmoniously inside our gut -- can protect people from bacterial s, but little is known about how they provide protection. Scientists are studying the microbiota with an eye to finding or enhancing natural treatments to replace antibiotics, which harm microbiota and become less effective as bacteria develop drug resistance.The scientists observed that microbiota that had experienced prior and transferred to germ-free mice helped prevent with Kpn. They identified a class of bacteria -- Deltaproteobacteria -- involved in fighting these s, and further analysis led them to identify taurine as the trigger for Deltaproteobacteria activity.Taurine helps the body digest fats and oils and is found naturally in bile acids in the gut. The poisonous gas hydrogen sulfide is a byproduct of taurine.
The scientists believe that low levels of taurine allow pathogens to colonize the gut, but high levels produce enough hydrogen sulfide to prevent colonization. During the study, the researchers realized that a single mild is sufficient to prepare the microbiota to resist subsequent , and that the liver and gallbladder -- which synthesize and store bile acids containing taurine -- can develop long-term protection.The study found that taurine given to mice as a supplement in drinking water also prepared the microbiota to prevent . However, when mice drank water containing bismuth subsalicylate -- a common over-the-counter drug used to treat diarrhea and upset stomach -- protection waned because bismuth inhibits hydrogen sulfide production.Scientists from NIH's National Institute of Allergy and Infectious Diseases led the project in collaboration with researchers from the National Institute of General Medical Sciences. The National Cancer Institute.
The National Institute of Diabetes and Digestive and Kidney Diseases. And the National Human Genome Research Institute. Story Source. Materials provided by NIH/National Institute of Allergy and Infectious Diseases.
Note. Content may be edited for style and length.A new Northwestern University-led study is unfolding the mystery of how RNA molecules fold themselves to fit inside cells and perform specific functions. The findings could potentially break down a barrier to understanding and developing treatments for RNA-related diseases, including spinal muscular atrophy and perhaps even the novel erectile dysfunction."RNA folding is a dynamic process that is fundamental for life," said Northwestern's Julius B. Lucks, who led the study.
"RNA is a really important piece of diagnostic and therapeutic design. The more we know about RNA folding and complexities, the better we can design treatments."Using data from RNA-folding experiments, the researchers generated the first-ever data-driven movies of how RNA folds as it is made by cellular machinery. By watching their videos of this folding occur, the researchers discovered that RNA often folds in surprising, perhaps unintuitive ways, such as tying itself into knots -- and then immediately untying itself to reach its final structure."Folding takes place in your body more than 10 quadrillion times a second," Lucks said. "It happens every single time a gene is expressed in a cell, yet we know so little about it.
Our movies allow us to finally watch folding happen for the first time."The research will be published Jan. 15 in the journal Molecular Cell.Lucks is an associate professor of chemical and biological engineering at Northwestern's McCormick School of Engineering and a member of Northwestern's Center for Synthetic Biology. He co-led the work with Alan Chen, an associate professor of chemistry at the University of Albany.Although videos of RNA folding do exist, the computer models that generate them are full of approximations and assumptions. Lucks' team has developed a technology platform that captures data about RNA folding as the RNA is being made.
His group then uses computational tools to mine and organize the data, revealing points where the RNA folds and what happens after it folds. Angela Yu, a former student of Lucks, inputted this data into computer models to generate accurate videos of the folding process."The information that we give the algorithms helps the computer models correct themselves," Lucks said. "The model makes accurate simulations that are consistent with the data."Lucks and his collaborators used this strategy to model the folding of an RNA called SRP, an ancient RNA found in all kingdoms of life. The molecule is well-known for its signature hairpin shape.
When watching the videos, the researchers discovered that the molecule ties itself into a knot and unties itself very quickly. Then it suddenly flips into the correct hairpin-like structure using an elegant folding pathway called toehold mediated strand displacement."To the best of our knowledge, this has never been seen in nature," Lucks said. "We think the RNA has evolved to untie itself from knots because if knots persist, it can render the RNA nonfunctional. The structure is so essential to life that it had to evolve to find a way to get out of a knot."The study, "Computationally reconstructing cotranscriptional RNA folding pathways from experimental data reveals rearrangement of non-native folding intermediates," was supported by the National Institutes of Health (award numbers T32GM083937, 1DP2GM110838 and GM120582), the National Science Foundation (award numbers MCB1651877 and 1914567) and the Searle Funds at The Chicago Community Trust.Video.
Https://www.youtube.com/watch?. V=2XTi9LG9NnU&feature=emb_logo Story Source. Materials provided by Northwestern University. Original written by Amanda Morris.
Note. Content may be edited for style and length..
Take Kamagra by mouth with a glass of water. The dose is usually taken 1 hour before sexual activity. You should not take the dose more than once per day. Do not take your medicine more often than directed. Overdosage: If you think you have taken too much of Kamagra contact a poison control center or emergency room at once. NOTE: Kamagra is only for you. Do not share Kamagra with others.
Therapeutic creep in provision of hypothermia for hypoxic ischaemic encephalopathyThree articles relate to buy cheap kamagra jelly the changing practices of UK clinicians in can you buy kamagra online the provision of therapeutic hypothermia for hypoxic ischaemic encephalopathy (HIE). Lori Hage and colleagues report the clinical characteristics of term born infants treated with therapeutic hypothermia for a diagnosis of HIE in the UK between 2010 and 2017. The data came from the National Neonatal Research Database and include infants who were treated for 3âÂÂdays or who died during this buy cheap kamagra jelly period. There were 5201 infants who met this definition.
The number of infants treated increased year on year until 2015 and then levelled out. Markers of condition at birth suggested inclusion over time of greater numbers of buy cheap kamagra jelly infants with less severe disease. The number of infants treated with a diagnosis of mild encephalopathy increased four-fold from 31 infants per year to 133 infants per year over the study period. There was no important change in the number of infants treated with severe encephalopathy over buy cheap kamagra jelly the same time period.
Lara Shipley and colleagues report temporal changes in the incidence of hypoxic-ischaemic encephalopathy in the UK between the time periods 2011âÂÂ13 and 2014âÂÂ16. The incidence of mild and of moderate or severe HIE remained stable between epochs suggesting that there has not been diagnostic creep driving the therapeutic creep. The proportion of infants with mild HIE who were treated with therapeutic hypothermia significantly increased over time buy cheap kamagra jelly between 2011âÂÂ2013 (24.9%) and 2014âÂÂ2016 (35.8%). The number of late preterm infants diagnosed with HIE also remained stable over time but again the proportion treated with hypothermia increased from 34% to 47%.
This therapeutic creep, where larger numbers of infants are cooled who do not fulfil the criteria used to select infants for enrolment in the randomised controlled trials has been observed in other health systems. On the buy cheap kamagra jelly one hand it represents invasive treatment that is not well supported by the evidence base. Further trials are called for to determine whether hypothermia is beneficial in milder cases. The authors also point out that there is some is some subjectivity in the assessment of encephalopathy buy cheap kamagra jelly meaning that some clinicians don't cool borderline infants where others would classify them with more severe encephalopathy.
Unrelated to these articles but on the same theme we received a viewpoint from Mohamed Ali Tagin and Alastair Gunn. They argue that the criteria used to select infants for the trials were deliberately biased towards selecting infants at highest risk (and by inference not likely to have selected all infants that stand to benefit). The individual components of the buy cheap kamagra jelly inclusion criteria perform poorly and are subjective. They encourage clinicians in doubt about whether an infant should be cooled to choose cooling because there is still an appreciable risk of adverse outcome and the treatment can be delivered safely, so that the potential benefits outweigh the potential harms.
They argue that the limitations of the evidence should buy cheap kamagra jelly be discussed with the families involved. Perhaps therapeutic creep will push the trials out of reach. When new treatments are shown to be effective it is understandable that clinicians are keen to use them and this makes research more difficult before we know everything we want to know. This again is a situation that would become less likely if we continue to work towards inclusive research models normalising routine involvement buy cheap kamagra jelly in enhancing the knowledge base.
See pages F529, F501 and F458Methods for surfactant administrationA network meta-analysis by Ioannis Bellos and colleagues of 16 RCTs and 20 observational studies including data from more than 13âÂÂ000 infants, suggests that thin catheter administration of surfactant is associated with lower rates of mortality, PVL, BPD and mechanical ventilation. See page F474The cost of neonatal abstinence syndromePhilippa Rees and colleagues estimated the direct NHS costs of neonatal unit in-patient care for Neonatal Abstinence Syndrome in England between 2012 and 2017 using the National Neonatal Research Database. There were 6411 admissions with this diagnosis during the study period (1.6 buy cheap kamagra jelly per 1000 births) and the incidence increased over time. The direct annual cost of care was ã10 440 444, with a median cost of ã7715 per infant.
The median time to discharge was 10.2âÂÂdays and this was higher in the 49% of infants receiving buy cheap kamagra jelly pharmacotherapy. The emerging literature suggests that changes in the model of care away from neonatal unit admission could improve patient outcomes and greatly reduce costs. See page F494Measurement of the effect of chest compressionsResuscitation council guidance advises on the depth of chest compressions during cardiopulmonary resuscitation in the newborn. Although it makes sense that compression depth buy cheap kamagra jelly is important this is based on indirect information and extrapolation.
Marlies Bruckner and colleagues developed an automated device that could deliver controlled compression depth and investigated its effect on piglets with experimental asphyxia to asystole. Compression depth made an important difference to carotid blood flow and buy cheap kamagra jelly systolic blood pressure. See page F553Face mask versus nasal prong or nasopharyngeal tube for neonatal resuscitation in the delivery roomAvneet Magnat and colleagues performed a systematic review of evidence relating to the best interface for providing respiratory support in the delivery room. They identified five randomised controlled trials involving 873 infants.
There was no difference in buy cheap kamagra jelly mortality between devices. Confidence intervals for most outcomes were wide indicating the need for more data. Difference in rates of intubation in the delivery room and need for chest compressions during initial stabilisation suggest that more data may uncover clinically important differences. It will be interesting to buy cheap kamagra jelly see how this meta-analysis changes after inclusion of data from the recently completed CORSAD trial.
See page F561Ethics statementsPatient consent for publicationNot required.Clinical scenarioâÂÂSarah is a baby girl born by an emergency caesarean section following a period of observation for non-reassuring cardiotocographic recordings. She was initially âÂÂflatâ and received buy cheap kamagra jelly positive pressure ventilation for 3âÂÂmin before establishing spontaneous breathing. Her Apgar scores were 1, 6 and 8 at 1, 5 and 10âÂÂmin, respectively. Cord pH was 7.08 and standard base excess (sBE) was âÂÂ12.1.
Sarah stayed with her mother as she was breathing normally and buy cheap kamagra jelly centrally pink despite being mildly hypotonic with minimal activity. At 10 hours of age, she started to develop recurrent seizures. Cerebral MRI showed extensive diffusion restriction patterns compatible with acute hypoxicâÂÂischaemic insult.âÂÂSarah is a composite case, developed to include real events that we and others buy cheap kamagra jelly have observed. Unfortunately, many neonatal units receive similar cases every year and they often end up not offering therapeutic hypothermia, the only available treatment with proven safety and efficacy to this condition.1 The current guidelines are not inclusive and do not consider borderline cases.2 3The simple question clinicians should ask themselves, is it unreasonable to treat a newborn with perinatal asphyxia and moderate encephalopathy?.
Babies, in a situation like Sarah, may lose the opportunity to be treated with therapeutic hypothermia because they miss a single criterion from the current cooling guidelines. The selection criteria in the initial randomised controlled trials of hypothermia were developed to identify the highest risk newborns who buy cheap kamagra jelly had been exposed to hypoxiaâÂÂischaemia. Newborns who had lower levels of risk were pragmatically excluded. Now that the evidence for benefit is well established,1 4 we propose that those entry points â¦.
Therapeutic creep in provision of hypothermia for hypoxic ischaemic encephalopathyThree articles relate kamagra for sale to the changing practices of UK clinicians in the provision of therapeutic hypothermia for hypoxic ischaemic encephalopathy (HIE). Lori Hage and colleagues report the clinical characteristics of term born infants treated with therapeutic hypothermia for a diagnosis of HIE in the UK between 2010 and 2017. The data came from the National Neonatal Research Database and include infants who were treated for 3âÂÂdays or who died during this kamagra for sale period.
There were 5201 infants who met this definition. The number of infants treated increased year on year until 2015 and then levelled out. Markers of condition at birth kamagra for sale suggested inclusion over time of greater numbers of infants with less severe disease.
The number of infants treated with a diagnosis of mild encephalopathy increased four-fold from 31 infants per year to 133 infants per year over the study period. There was no important change in the number of infants treated kamagra for sale with severe encephalopathy over the same time period. Lara Shipley and colleagues report temporal changes in the incidence of hypoxic-ischaemic encephalopathy in the UK between the time periods 2011âÂÂ13 and 2014âÂÂ16.
The incidence of mild and of moderate or severe HIE remained stable between epochs suggesting that there has not been diagnostic creep driving the therapeutic creep. The proportion of infants with mild HIE who were treated with therapeutic hypothermia significantly increased over time between kamagra for sale 2011âÂÂ2013 (24.9%) and 2014âÂÂ2016 (35.8%). The number of late preterm infants diagnosed with HIE also remained stable over time but again the proportion treated with hypothermia increased from 34% to 47%.
This therapeutic creep, where larger numbers of infants are cooled who do not fulfil the criteria used to select infants for enrolment in the randomised controlled trials has been observed in other health systems. On the one hand it represents invasive treatment that is not well kamagra for sale supported by the evidence base. Further trials are called for to determine whether hypothermia is beneficial in milder cases.
The authors also point out that there is some is kamagra for sale some subjectivity in the assessment of encephalopathy meaning that some clinicians don't cool borderline infants where others would classify them with more severe encephalopathy. Unrelated to these articles but on the same theme we received a viewpoint from Mohamed Ali Tagin and Alastair Gunn. They argue that the criteria used to select infants for the trials were deliberately biased towards selecting infants at highest risk (and by inference not likely to have selected all infants that stand to benefit).
The individual components of the inclusion criteria perform poorly and are kamagra for sale subjective. They encourage clinicians in doubt about whether an infant should be cooled to choose cooling because there is still an appreciable risk of adverse outcome and the treatment can be delivered safely, so that the potential benefits outweigh the potential harms. They argue that the limitations of the evidence should be discussed kamagra for sale with the families involved.
Perhaps therapeutic creep will push the trials out of reach. When new treatments are shown to be effective it is understandable that clinicians are keen to use them and this makes research more difficult before we know everything we want to know. This again is a situation that would kamagra for sale become less likely if we continue to work towards inclusive research models normalising routine involvement in enhancing the knowledge base.
See pages F529, F501 and F458Methods for surfactant administrationA network meta-analysis by Ioannis Bellos and colleagues of 16 RCTs and 20 observational studies including data from more than 13âÂÂ000 infants, suggests that thin catheter administration of surfactant is associated with lower rates of mortality, PVL, BPD and mechanical ventilation. See page F474The cost of neonatal abstinence syndromePhilippa Rees and colleagues estimated the direct NHS costs of neonatal unit in-patient care for Neonatal Abstinence Syndrome in England between 2012 and 2017 using the National Neonatal Research Database. There were 6411 admissions with this diagnosis kamagra for sale during the study period (1.6 per 1000 births) and the incidence increased over time.
The direct annual cost of care was ã10 440 444, with a median cost of ã7715 per infant. The median time to discharge was 10.2âÂÂdays and kamagra for sale this was higher in the 49% of infants receiving pharmacotherapy. The emerging literature suggests that changes in the model of care away from neonatal unit admission could improve patient outcomes and greatly reduce costs.
See page F494Measurement of the effect of chest compressionsResuscitation council guidance advises on the depth of chest compressions during cardiopulmonary resuscitation in the newborn. Although it makes sense that compression depth is important kamagra for sale this is based on indirect information and extrapolation. Marlies Bruckner and colleagues developed an automated device that could deliver controlled compression depth and investigated its effect on piglets with experimental asphyxia to asystole.
Compression depth made an kamagra for sale important difference to carotid blood flow and systolic blood pressure. See page F553Face mask versus nasal prong or nasopharyngeal tube for neonatal resuscitation in the delivery roomAvneet Magnat and colleagues performed a systematic review of evidence relating to the best interface for providing respiratory support in the delivery room. They identified five randomised controlled trials involving 873 infants.
There was no difference kamagra for sale in mortality between devices. Confidence intervals for most outcomes were wide indicating the need for more data. Difference in rates of intubation in the delivery room and need for chest compressions during initial stabilisation suggest that more data may uncover clinically important differences.
It will be interesting to see how this kamagra for sale meta-analysis changes after inclusion of data from the recently completed CORSAD trial. See page F561Ethics statementsPatient consent for publicationNot required.Clinical scenarioâÂÂSarah is a baby girl born by an emergency caesarean section following a period of observation for non-reassuring cardiotocographic recordings. She was initially âÂÂflatâ and received positive pressure ventilation for 3âÂÂmin before establishing spontaneous breathing kamagra for sale.
Her Apgar scores were 1, 6 and 8 at 1, 5 and 10âÂÂmin, respectively. Cord pH was 7.08 and standard base excess (sBE) was âÂÂ12.1. Sarah stayed kamagra for sale with her mother as she was breathing normally and centrally pink despite being mildly hypotonic with minimal activity.
At 10 hours of age, she started to develop recurrent seizures. Cerebral MRI showed extensive diffusion restriction kamagra for sale patterns compatible with acute hypoxicâÂÂischaemic insult.âÂÂSarah is a composite case, developed to include real events that we and others have observed. Unfortunately, many neonatal units receive similar cases every year and they often end up not offering therapeutic hypothermia, the only available treatment with proven safety and efficacy to this condition.1 The current guidelines are not inclusive and do not consider borderline cases.2 3The simple question clinicians should ask themselves, is it unreasonable to treat a newborn with perinatal asphyxia and moderate encephalopathy?.
Babies, in a situation like Sarah, may lose the opportunity to be treated with therapeutic hypothermia because they miss a single criterion from the current cooling guidelines. The selection criteria kamagra for sale in the initial randomised controlled trials of hypothermia were developed to identify the highest risk newborns who had been exposed to hypoxiaâÂÂischaemia. Newborns who had lower levels of risk were pragmatically excluded.
Now that the evidence for benefit is well established,1 4 we propose that those entry points â¦.
In addition, scientific expertise can be leveraged, leading to more fruitful kamagra fast uk and robust decision making, and enhancing the capacity of regulators. Consequently, reliance can also allow efficient allocation of resources by NRAs and improve access to medicines. The erectile dysfunction treatment kamagra has emphasized the importance of regulatory cooperation and information sharing which are important elements of reliance.
ICMRA emphasizes the relevance of reliance in streamlining responses and facilitating efforts to multiple regulatory activities during kamagra fast uk public health emergencies. For example, ICMRA published reports, described agreements on common approaches from workshops, and discussed regulatory considerations related to the development of erectile dysfunction treatment candidates and treatments among its members. ICMRA recognises that each NRA will decide the levels and approaches of reliance suitable for their context, and that the adoption of regulatory reliance must follow overarching principles.
These principles include sovereignty of decisions, kamagra fast uk transparency of processes and standards, consistency of products and practices, legality of procedures and mandates at national levels, competency of all stakeholders involved, and universality as reliance applies to all NRAs irrespective of their levels of maturity and resources. While there is a relevant role for reliance mechanisms, they should not replace the importance of continuously developing expertise within NRAs. Call on Stakeholders ICMRA expresses its support for reliance as a regulatory strategy and commits to work with medicines regulatory authorities towards the adoption of best practices when using reliance approaches, in order to make best use of available resources while ensuring that medicines have a favourable benefit-risk profile and are quality assured.
ICMRA invites stakeholders kamagra fast uk to cooperate and to engage in the efficient use of reliance. ICMRA calls on NRAs to continually assess regulatory capacities. To establish clear and transparent decision-making processes.
To participate in kamagra fast uk international harmonization and regulatory convergence. To engage with the development of international regulatory collaboration and cooperation. To share information on their practices to strengthen regulatory capacities with other NRAs.
And to seek the adoption of reliance mechanisms kamagra fast uk. These initiatives work to build robust and efficient regulatory systems and, consequently, to further develop trust. ICMRA calls on the WHO to provide technical support to NRAs.
To gather information from NRAs worldwide and kamagra fast uk explore areas of reliance. To support global distribution of medicines. To provide guidance documents, benchmarking, as well as regulatory tools to facilitate the implementation of reliance practices.
And to establish and maintain a kamagra fast uk framework to evaluate NRAs and assess their regulatory performance. ICMRA calls on the pharmaceutical industry to comply with legal and technical requirements. And to ensure the consistency and quality of the products and the completeness of the documentation submitted to different NRAs.
Companies can also benefit from reliance kamagra fast uk and the efficiency of regulatory processes through transparent collaboration. We all have a role to play in building a strong reliance system that can benefit health regulation worldwide. ICMRA[iv] therefore encourages continued cooperation among NRAs and highlights the benefits that regulatory reliance can bring in expediting access to medicines that have a favourable benefit-risk profile and are of high quality.
[i] WHO, kamagra fast uk 2020. Draft Good Reliance Practices in regulatory decision-making for medical products. High-level principles and considerations.
Working document kamagra fast uk QAS/20.851/Rev.1. Https://www.who.int/medicines/areas/quality_safety/quality_assurance/QAS20_851_Rev_1_Good_Reliance_Practices.pdf[ii] PAHO/WHO, 2019. Regulatory Reliance Principles.
Concept Note kamagra fast uk and Recommendations. Http://iris.paho.org/xmlui/bitstream/handle/123456789/51549/PAHOHSS19003_eng.pdf?. Sequence=1&isAllowed=y[iii] WHO, 2020.
Draft Good kamagra fast uk regulatory practices for regulatory oversight of medical products. Working document QAS/16.686/Rev.3 https://www.who.int/medicines/areas/quality_safety/quality_assurance/QAS16_686_rev_3_good_regulatory_practices_medical_products.pdf[iv] ICMRA is an international executive-level coalition of key regulators from every region in the world. It provides a global strategic focus for medicines regulators and gives strategic leadership on shared regulatory issues and challenges.
Priorities include kamagra fast uk coordinated response to crisis situations. Members of the ICMRA include. Therapeutic Goods Administration (TGA), Australia.
National Health Surveillance (ANVISA), Brazil kamagra fast uk. Health Products and Food Branch, Health Canada (HPFB-HC), Canada. China National Medical Products Administration (NMPA), China.
European Medicines Agency (EMA) and European Commission - Directorate General for Health and kamagra fast uk Food Safety (DG - SANTE), European Union. French National Agency for Medicines and Health Products Safety (ANSM), France. Paul-Ehrlich-Institute (PEI), Germany.
Health Product Regulatory Authority (HPRA), Ireland kamagra fast uk. Italian Medicines Agency (AIFA), Italy. Ministry of Health, Labour and Welfare (MHLW) and Pharmaceuticals and Medical Devices Agency (PMDA), Japan.
Ministry of Food and Drug Safety (MFDS), kamagra fast uk Korea. Federal Commission for the Protection against Sanitary Risks (COFEPRIS), Mexico. Medicines Evaluation Board (MEB), Netherlands.
Medsafe, Clinical kamagra fast uk Leadership, Protection &. Regulation, Ministry of Health, New Zealand. National Agency for Food Drug Administration and Control (NAFDAC), Nigeria.
Health Sciences kamagra fast uk Authority (HSA), Singapore. Medicines Control Council (MCC), South Africa. Medical Products Agency, Sweden.
Swissmedic, Switzerland kamagra fast uk. Medicines and Healthcare Products Regulatory Agency (MHRA), United Kingdom. Food and Drug Administration (FDA), United States and the World Health Organization as an observer.
Associate members include Austrian Medicines and Medical Devices Agency (AGES), Danish Medicines Agency, Israel Office of Medical Technology, Health Information and Research (MTHIR), Poland Office of Registration of Medicinal Products and Biocidal Products (URPLWMiPB), Russia Roszdravnadzor and Spain Agencia kamagra fast uk Española de Medicametos y Productos Sanitarios (AEMPS).abemaciclib 215268 Verzenio Eli Lilly Canada Inc. N/A 2019-04-08 2025-04-08 N/A 2027-04-08 acalabrutinib 214504 Calquence AstraZeneca Canada Inc. N/A 2019-08-23 2025-08-23 N/A 2027-08-23 aclidinium bromide 157598 Tudorza Genuair AstraZeneca Canada Inc.
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N/A 2014-08-22 kamagra fast uk 2020-08-22 Yes 2023-02-22 antihemophilic factor (recombinant), pegylated 189709 Adynovate Shire Pharma Canada ULC N/A 2016-11-17 2022-11-17 Yes 2025-05-17 antihemophilic factor (recombinant, B-domain deleted, pegylated) (also known as damoctocog alfa pegol) 210935 Jivi Bayer Inc. N/A 2018-10-18 2024-10-18 Yes 2027-04-18 antihemophilic factor (recombinant, B-domain deleted) (also known as simoctocog alfa) 169551 Nuwiq Octapharma Pharmazeutika Produktionsges.m.b.H N/A 2014-10-23 2020-10-23 Yes 2023-04-23 antihemophilic factor VIII (recombinant), singlechain (also known as lonoctocog alfa) 190891 Afstyla CSL Behring Canada Inc. N/A 2016-12-12 2022-12-12 Yes 2025-06-12 anthrax antigen filtrate 212387 Biothrax Emergent Biodefense Operations Lansing LLC N/A 2018-12-13 2024-12-13 N/A 2026-12-13 antihemophilic factor VIII (recombinant, B-domain truncated), PEGylated (turoctocog alfa pegol) 218531 Esperoct Novo Nordisk Canada Inc.
N/A 2019-07-04 kamagra fast uk 2025-07-04 Yes 2028-01-04 apalutamide 211942 Erleada Janssen Inc. N/A 2018-07-03 2024-07-03 N/A 2026-07-03 apremilast 169862 Otezla Amgen Canada Inc. N/A 2014-11-12 2020-11-12 N/A 2022-11-12 asfotase alfa 179340 Strensiq Alexion Pharma International SÃÂ rl N/A 2015-08-14 2021-08-14 Yes 2024-02-14 asunaprevir 172617 Sunvepra Bristol-Myers Squibb Canada N/A 2016-03-09 2022-03-09 N/A 2024-03-09 atezolizumab 196843 Tecentriq Hoffmann-La Roche Limited N/A 2017-04-12 2023-04-12 N/A 2025-04-12 avelumab 204052 Bavencio EMD Serono, a Division of EMD Inc., Canada N/A 2017-12-18 2023-12-18 N/A 2025-12-18 axicabtagene ciloleucel 218389 Yescarta Gilead Sciences Canada Inc N/A 2019-02-13 2025-02-13 N/A 2027-02-13 axitinib 144404 Inlyta Pfizer Canada Inc.
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N/A 2015-07-16 2021-07-16 N/A 2023-07-16 ravulizumab 217955 Ultomiris Alexion Pharma GmbH N/A 2019-08-28 2025-08-28 N/A 2027-08-28 recombinant kamagra fast uk human papillomakamagra types 31, 33, 45, 52 and 58 170006 Gardasil 9 Merck Canada Inc. N/A 2015-02-05 2021-02-05 Yes 2023-08-05 recombinant neisseria meningitidis group B NHBA fusion protein, recombinant neisseria meningitidis group B NadA fusion protein, recombinant neisseria meningitidis group B FHBP fusion protein, outer membrane vesicle (neisseria meningitidis group B NZ98/254 strain) 147275 Bexsero GlaxoSmithKline Inc. N/A 2013-12-06 2019-12-06 Yes 2022-06-06 recombinant porcine factor VIII (antihemophilic factor (recombinant), porcine sequence) 177290 Obizur Takeda Canada Inc.
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Rybelsus 2018-01-04 2024-01-04 N/A kamagra fast uk 2026-01-04 siltuximab 174291 Sylvant Janssen Inc. N/A 2014-12-03 2020-12-03 N/A 2022-12-03 simeprevir 164021 Galexos Janssen Inc. N/A 2013-11-18 2019-11-18 N/A 2021-11-18 siponimod 223225 Mayzent Novartis Pharmaceuticals Canada Inc.
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Reliance can involve direct collaboration between kamagra oral jelly 100mg price authorities or institutions in order to share regulatory kamagra for sale information such as assessment or inspection reports or scientific opinions. Formal tools can be used to support reliance, such as confidentiality commitments/agreements or memoranda of understanding. Global relevance and key principles Regulatory processes can be optimized and duplication of efforts can be minimized through reliance. In addition, scientific expertise can be kamagra for sale leveraged, leading to more fruitful and robust decision making, and enhancing the capacity of regulators.
Consequently, reliance can also allow efficient allocation of resources by NRAs and improve access to medicines. The erectile dysfunction treatment kamagra has emphasized the importance of regulatory cooperation and information sharing which are important elements of reliance. ICMRA emphasizes the relevance of reliance in streamlining responses and facilitating efforts to multiple regulatory kamagra for sale activities during public health emergencies. For example, ICMRA published reports, described agreements on common approaches from workshops, and discussed regulatory considerations related to the development of erectile dysfunction treatment candidates and treatments among its members.
ICMRA recognises that each NRA will decide the levels and approaches of reliance suitable for their context, and that the adoption of regulatory reliance must follow overarching principles. These principles include sovereignty of decisions, transparency kamagra for sale of processes and standards, consistency of products and practices, legality of procedures and mandates at national levels, competency of all stakeholders involved, and universality as reliance applies to all NRAs irrespective of their levels of maturity and resources. While there is a relevant role for reliance mechanisms, they should not replace the importance of continuously developing expertise within NRAs. Call on Stakeholders ICMRA expresses its support for reliance as a regulatory strategy and commits to work with medicines regulatory authorities towards the adoption of best practices when using reliance approaches, in order to make best use of available resources while ensuring that medicines have a favourable benefit-risk profile and are quality assured.
ICMRA invites kamagra for sale stakeholders to cooperate and to engage in the efficient use of reliance. ICMRA calls on NRAs to continually assess regulatory capacities. To establish clear and transparent decision-making processes. To participate in international kamagra for sale harmonization and regulatory convergence.
To engage with the development of international regulatory collaboration and cooperation. To share information on their practices to strengthen regulatory capacities with other NRAs. And to seek the adoption of reliance mechanisms kamagra for sale. These initiatives work to build robust and efficient regulatory systems and, consequently, to further develop trust.
ICMRA calls on the WHO to provide technical support to NRAs. To gather information from NRAs kamagra for sale worldwide and explore areas of reliance. To support global distribution of medicines. To provide guidance documents, benchmarking, as well as regulatory tools to facilitate the implementation of reliance practices.
And to kamagra for sale establish and maintain a framework to evaluate NRAs and assess their regulatory performance. ICMRA calls on the pharmaceutical industry to comply with legal and technical requirements. And to ensure the consistency and quality of the products and the completeness of the documentation submitted to different NRAs. Companies can also benefit kamagra for sale from reliance and the efficiency of regulatory processes through transparent collaboration.
We all have a role to play in building a strong reliance system that can benefit health regulation worldwide. ICMRA[iv] therefore encourages continued cooperation among NRAs and highlights the benefits that regulatory reliance can bring in expediting access to medicines that have a favourable benefit-risk profile and are of high quality. [i] WHO, kamagra for sale 2020. Draft Good Reliance Practices in regulatory decision-making for medical products.
High-level principles and considerations. Working document QAS/20.851/Rev.1 kamagra for sale. Https://www.who.int/medicines/areas/quality_safety/quality_assurance/QAS20_851_Rev_1_Good_Reliance_Practices.pdf[ii] PAHO/WHO, 2019. Regulatory Reliance Principles.
Concept Note kamagra for sale and Recommendations. Http://iris.paho.org/xmlui/bitstream/handle/123456789/51549/PAHOHSS19003_eng.pdf?. Sequence=1&isAllowed=y[iii] WHO, 2020. Draft Good regulatory practices for regulatory oversight of medical kamagra for sale products.
Working document QAS/16.686/Rev.3 https://www.who.int/medicines/areas/quality_safety/quality_assurance/QAS16_686_rev_3_good_regulatory_practices_medical_products.pdf[iv] ICMRA is an international executive-level coalition of key regulators from every region in the world. It provides a global strategic focus for medicines regulators and gives strategic leadership on shared regulatory issues and challenges. Priorities include kamagra for sale coordinated response to crisis situations. Members of the ICMRA include.
Therapeutic Goods Administration (TGA), Australia. National Health Surveillance (ANVISA), Brazil kamagra for sale. Health Products and Food Branch, Health Canada (HPFB-HC), Canada. China National Medical Products Administration (NMPA), China.
European Medicines Agency (EMA) and European Commission - Directorate General for Health and Food Safety (DG - SANTE), European Union kamagra for sale. French National Agency for Medicines and Health Products Safety (ANSM), France. Paul-Ehrlich-Institute (PEI), Germany. Health Product Regulatory Authority (HPRA), kamagra for sale Ireland.
Italian Medicines Agency (AIFA), Italy. Ministry of Health, Labour and Welfare (MHLW) and Pharmaceuticals and Medical Devices Agency (PMDA), Japan. Ministry of Food and kamagra for sale Drug Safety (MFDS), Korea. Federal Commission for the Protection against Sanitary Risks (COFEPRIS), Mexico.
Medicines Evaluation Board (MEB), Netherlands. Medsafe, Clinical Leadership, kamagra for sale Protection &. Regulation, Ministry of Health, New Zealand. National Agency for Food Drug Administration and Control (NAFDAC), Nigeria.
Health Sciences Authority kamagra for sale (HSA), Singapore. Medicines Control Council (MCC), South Africa. Medical Products Agency, Sweden. Swissmedic, Switzerland kamagra for sale.
Medicines and Healthcare Products Regulatory Agency (MHRA), United Kingdom. Food and Drug Administration (FDA), United States and the World Health Organization as an observer. Associate members include Austrian Medicines and Medical Devices Agency (AGES), Danish Medicines Agency, Israel Office of Medical Technology, Health Information and Research (MTHIR), Poland Office of Registration of Medicinal Products and Biocidal Products (URPLWMiPB), Russia Roszdravnadzor and Spain Agencia Española de Medicametos y Productos Sanitarios (AEMPS).abemaciclib 215268 Verzenio Eli Lilly Canada kamagra for sale Inc. N/A 2019-04-08 2025-04-08 N/A 2027-04-08 acalabrutinib 214504 Calquence AstraZeneca Canada Inc.
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Five of goedkoopste kamagra the nationâÂÂs top ice scientists found themselves in a http://wvlpac.com/2017/08/gdmedical/ conundrum. TheyâÂÂd been tasked with a formidable job. Reviewing candidates for the American goedkoopste kamagra Geophysical UnionâÂÂs fellows program, the most prestigious award given by the worldâÂÂs largest earth and space science society. But when the group looked at its list of candidates, all nominated by peers, it spotted a problem.
Every nominee on the list was a white man. ÃÂÂThat was kind of a bit of a showstopper for me,â goedkoopste kamagra said Helen Fricker, a glaciologist at Scripps Institution of Oceanography and one of the five committee members. The AGU fellows program, established nearly 60 years ago, recognizes members who have made exceptional contributions to their fields through scientific innovation, breakthroughs and discoveries. ItâÂÂs a high honor.
Fellows often serve as âÂÂexternal experts, capable of advising government agencies and other organizations outside the sciences upon request,â goedkoopste kamagra according to AGU. The selection process this past spring was an arduous, careful operation from beginning to end. Candidates, typically middle- or senior-level scientists, are first nominated by peers. The nominees are divided into groups with 20 or 30 names, and then organized goedkoopste kamagra by scientific disciplines within AGU â atmospheric sciences, ocean sciences, planetary sciences and so on.
Committees representing each section review the pool of nominees, select a few final candidates and send them on to an upper-tier committee. This last group, the âÂÂunion committee,â makes the final selections goedkoopste kamagra. The process proceeds the same way each year and concludes, ostensibly, with the same outcome. A new batch of AGUâÂÂs best and brightest scientists.
Fricker and her colleagues goedkoopste kamagra â Jeff Dozier, Sinead Farrell, Bob Hawley, Don Perovich and Michele Koppes â represented the AGUâÂÂs cryosphere section, comprising scientists focused on the EarthâÂÂs snow and ice. The group was just one of about two dozen different committees, all reviewing their own lists of candidates. The homogeneous pool of nominees didnâÂÂt sit right. Fricker had been named goedkoopste kamagra a fellow herself in 2017, when relatively few women were recognized.
ÃÂÂOne of the reasons I was put on the committee was because IâÂÂd been quite vocal about the year that IâÂÂd been a fellow, I was very much in the minority, and we needed to do better and get more women,â she said in an interview. So the committee members made an uncomfortable decision. They declined goedkoopste kamagra to recommend any nominees at all. The decision has triggered a spirited dialogue among AGU members and other earth scientists about the persistent lack of diversity in science awards â and how to address it.
Within the AGU fellows program, itâÂÂs a pervasive goedkoopste kamagra issue. AGU selected a total of 59 fellows this year, and 45 of them are men. Additionally, 46 of the fellows are from the U.S., while only 13 are from other countries. The trend has been similar in goedkoopste kamagra recent years.
In 2020, 46 out of 62 fellows were men, and 43 fellows were from the U.S. In 2019, 47 out of 62 fellows were men, and 36 were from the U.S. AGU doesnâÂÂt publish data on the race or ethnicity of its fellows goedkoopste kamagra. But AGU scientists and committee members have pointed out that people of color tend to be underrepresented.
ÃÂÂWe are disappointed that there were fewer women and fewer individuals from international countries nominated and awarded in 2021,â AGU said in a statement last month, shortly after announcing the new class of fellows. ÃÂÂFor the first time ever, one Section chose not to advance any of goedkoopste kamagra their Sectionsâ nominees to the Union Fellows Committee for consideration. The Section felt that this was their only course of action due to a lack of diversity in the nomination pool.â The cryosphere committee further explained its decision in a letter to its section members, which it also shared publicly on Twitter. ÃÂÂWhile it is tempting to blame the kamagra and see this year as anomalous, the Cryosphere Fellows committee now realize that the slate of nominations received this year is part of an alarming trend in Fellows nominations that warrants review,â the letter stated.
The number of female cryosphere nominees has steadily dwindled over the past five years, goedkoopste kamagra the committee pointed out. It reached a low point in 2021. ÃÂÂWe realize that our decision means that excellent scientists who have goedkoopste kamagra done nothing wrong and who were strong candidates for recommendation by the Cryosphere section were denied the support of the Cryosphere Fellows committee at the AGU Union Fellows level this year,â the committee added. ÃÂÂWhat we hope is that this moment will serve as both a time to reflect on community engagement and a call to action.â Declining to recommend otherwise strong candidates was âÂÂthe hardest part,â Fricker added.
ÃÂÂIt was a very sad, sort of tough thing to have to do, because thereâÂÂs people on that list who were truly, amazingly deserving,â Fricker said. "But the honest truth is that they will get nominated again goedkoopste kamagra and they will become fellows. ThereâÂÂs no question there. It will just be a fairer process.â âÂÂNothing would changeâ The cryo committeeâÂÂs decision has triggered a flurry of responses from AGU members and other earth scientists.
Reactions have been mixed goedkoopste kamagra. Raymond Bradley, director of the climate system research center at the University of Massachusetts, Amherst, was among the first to publish a statement to AGUâÂÂs online member forum, AGU Connect. He called for the committee members to resign. ÃÂÂWhat the committee should have done goedkoopste kamagra is what they were tasked to do, which is to select from the nominations they received the best people and put them forward,â Bradley said in an interview.
ÃÂÂAt the same time they could recognize that there arenâÂÂt enough nominations being received from women and underrepresented groups, and they could shake up their members and say, âÂÂHey, come on, letâÂÂs nominate more people.âÂÂâ AGU data from the past few years suggests that there are significantly fewer female fellow nominees than male nominees. Of those nominees, a slightly greater percentage of women than men go on to be selected as fellows, Bradley pointed goedkoopste kamagra out. ÃÂÂThis hardly supports the idea that there is some sort of implicit bias in the selection process,â he said in a follow-up email. ÃÂÂThe problem lies in the low number of nominations, and that depends on the effort people make to submit candidates for Fellow.â But others have disagreed.
Simply drumming up more nominations isnâÂÂt as simple goedkoopste kamagra a solution as it might sound, said Twila Moon, a scientist with the National Snow &. Ice Data Center. ÃÂÂThere have been some really well-thought-out responses in AGU Connect pointing out that often the work of nominating more diverse groups of people falls to people who are within those diverse groups,â she said in an interview. ÃÂÂAnd that those are maybe people who are goedkoopste kamagra especially hard hit in having time available.â ThatâÂÂs especially true now, as the kamagra has disproportionately affected women, people of color and other underrepresented groups, she added.
Writing nominations requires time and effort. Others have voiced their support for the committeeâÂÂs decision. ÃÂÂI think that the committeeâÂÂs response was bold, but it definitely got the conversation started, and for that reason alone I goedkoopste kamagra think that it was a great reaction to the nomination pool,â said Melisa Diaz, a postdoctoral scholar and geochemist at Woods Hole Oceanographic Institution. ÃÂÂWhen you have a nomination pool that consists of one very specific demographic, how can you actually tell that that demographic is truly the best in our field?.
àNicole Gasparini, goedkoopste kamagra a geoscientist at Tulane University, agreed that the committeeâÂÂs gesture kick-started important conversations within the organization. While there have been both positive and negative responses on AGU Connect, reactions across social media, including Twitter, have been overwhelmingly supportive, she added. ÃÂÂI think their decision is absolutely bringing attention to the fact that there is a lack of diversity in AGU awardees,â she said. According to Fricker, raising awareness was a major goal when the goedkoopste kamagra committee made its decision.
ÃÂÂEverybody's given us all this great advice on what we could have done. But honestly, I donâÂÂt think anything would have had the impact of what we ended up doing,â she told E&E News. ÃÂÂIf you just go forward and put names forward and then say, âÂÂOK, weâÂÂve put these names forward, but honestly guys this is a terrible pool and you need to do better next year,â nothing would change.â âÂÂReal changeâ AGU is hardly the only organization to reckon goedkoopste kamagra with issues of diversity in awards. Studies have indicated that women and other underrepresented groups are often less likely to receive science prizes.
One recent study, just published last month in Quantitative Science Studies, found that women are less likely to receive prestigious science awards than men. Examining 141 of the worldâÂÂs most distinguished international research awards, the study found that the prizes were given to 2,011 men between 2001 and 2020, compared goedkoopste kamagra with just 262 women. The Nobel Prizes, widely considered the worldâÂÂs most prestigious science awards, have been subject to particular scrutiny in recent years. Only about 3 percent of Nobel science prizes have gone to women since the awards goedkoopste kamagra were established more than 100 years ago.
Not a single one has been awarded to a Black scientist. The AGU fellows announcement was followed by this yearâÂÂs Nobel science prizes, all of which went to men. Despite persistent goedkoopste kamagra problems with diversity in science awards around the world, researchers say there are plenty of ways to tackle the problem. Implicit bias plays a major role in who receives science awards, according to Mary Anne Holmes, a geologist and professor emeritus at the University of Nebraska, Lincoln.
ItâÂÂs an unconscious bias or prejudice that can lead people to identify more strongly with people from their own social groups. If awards goedkoopste kamagra nominators or selection committees are composed primarily of homogeneous groups â for instance, white people or men â that can lead to an unintentional skew in the people who are nominated or selected for awards. Holmes served on AGUâÂÂs Union Honors and Recognition Committee, which oversees all of its honors and awards programs, between 2013 and 2019. She also previously worked with the Association for Women in Science on a National Science Foundation-funded project aimed at studying and addressing gender disparities in science awards.
She and colleagues LaToya Myles and Blair Schneider, who also served on AGUâÂÂs honors committee, published some of goedkoopste kamagra their insights last year in the journal Advances in Geoscience. ÃÂÂWeâÂÂre all committing acts of implicit bias every day, all the time, without meaning to be biased,â Holmes said in an interview. Implicit bias training for awards selection committees âÂÂis huge,â she added. Experts say canvassing committees, designed to goedkoopste kamagra scout for worthy nominees and encourage people to nominate them, can also make a difference.
These committees can also help answer questions about the nomination process, which is often long and time-consuming. Gasparini, the goedkoopste kamagra Tulane scientist, is a member of AGUâÂÂs earth and planetary sciences section. A few years ago, she and several other members began canvassing after noticing a gap in the number of women in their section receiving awards. ÃÂÂWe went out and we found all the letter writers and did all this work, and it worked.
Women started winning,â goedkoopste kamagra she said. These committees can also help tackle the issue of implicit bias, she added. ÃÂÂItâÂÂs not that men donâÂÂt see women doing good work or white people donâÂÂt see people of color doing good work,â she said. ÃÂÂBut people need to goedkoopste kamagra be pushed to do it, and when they do it they might think only of the superstar whoâÂÂs already won seven awards and published 10 Nature papers.
And the truth is there's a lot of people making a lot of impact who arenâÂÂt those people.â Other scientists have pointed out that there may be broader structural issues in science awards. Prizes arenâÂÂt always designed to recognize all the people contributing to scientific breakthroughs, they say. ÃÂÂScience is so collaborative now,â said Diaz, the Woods Hole Oceanographic Institution scientist goedkoopste kamagra. ÃÂÂSo does it really make sense to give awards to a single person?.
TheyâÂÂre not doing the goedkoopste kamagra work by themselves. There are students and postdocs and collaborators and friends. So I think we really need to think about who we want these awards to go to and what we want them to represent.â Other scientists share the sentiment. ÃÂÂI actually think that there are some broken elements to the larger awards system,â goedkoopste kamagra said Moon, the NSIDC scientist.
ÃÂÂI think that thereâÂÂs really interest, particularly in the early and middle-career generations of scientists, who are for a system that recognizes a wider range of what it means to be a scientist and what it means to contribute to the scientific endeavor in its success.â Fricker hopes this yearâÂÂs events will spark a bigger conversation within AGU, perhaps culminating in new recommendations from the organization about how to diversify future pools of award nominees. ÃÂÂIâÂÂm looking forward to some real change,â she said. Holmes, the former honors committee member, said sheâÂÂs optimistic that the conversations around goedkoopste kamagra science awards are evolving. ÃÂÂI think people who normally wouldnâÂÂt have paid any attention to this are paying attention,â she said.
ÃÂÂAt least I hear people talking about it as if, yes, this is an issue now. ThatâÂÂs a big leap forward from 20 years ago.â Reprinted from goedkoopste kamagra E&E News with permission from POLITICO, LLC. Copyright 2021. E&E News provides essential news for energy and environment professionals..
Five of the nationâÂÂs http://robertflannagan.com/?p=33 top ice scientists found themselves in a conundrum kamagra for sale. TheyâÂÂd been tasked with a formidable job. Reviewing candidates for the American Geophysical UnionâÂÂs fellows program, the most prestigious award given by the worldâÂÂs largest earth and kamagra for sale space science society. But when the group looked at its list of candidates, all nominated by peers, it spotted a problem. Every nominee on the list was a white man.
ÃÂÂThat was kind of a bit of kamagra for sale a showstopper for me,â said Helen Fricker, a glaciologist at Scripps Institution of Oceanography and one of the five committee members. The AGU fellows program, established nearly 60 years ago, recognizes members who have made exceptional contributions to their fields through scientific innovation, breakthroughs and discoveries. ItâÂÂs a high honor. Fellows often kamagra for sale serve as âÂÂexternal experts, capable of advising government agencies and other organizations outside the sciences upon request,â according to AGU. The selection process this past spring was an arduous, careful operation from beginning to end.
Candidates, typically middle- or senior-level scientists, are first nominated by peers. The nominees are divided into groups with 20 or 30 names, and then organized by scientific disciplines within AGU kamagra for sale â atmospheric sciences, ocean sciences, planetary sciences and so on. Committees representing each section review the pool of nominees, select a few final candidates and send them on to an upper-tier committee. This last group, the âÂÂunion committee,â makes kamagra for sale the final selections. The process proceeds the same way each year and concludes, ostensibly, with the same outcome.
A new batch of AGUâÂÂs best and brightest scientists. Fricker and her colleagues â Jeff Dozier, Sinead Farrell, Bob Hawley, Don Perovich and Michele Koppes â represented the AGUâÂÂs cryosphere section, comprising kamagra for sale scientists focused on the EarthâÂÂs snow and ice. The group was just one of about two dozen different committees, all reviewing their own lists of candidates. The homogeneous pool of nominees didnâÂÂt sit right. Fricker had been named a fellow herself in 2017, when relatively kamagra for sale few women were recognized.
ÃÂÂOne of the reasons I was put on the committee was because IâÂÂd been quite vocal about the year that IâÂÂd been a fellow, I was very much in the minority, and we needed to do better and get more women,â she said in an interview. So the committee members made an uncomfortable decision. They declined to recommend any nominees at kamagra for sale all. The decision has triggered a spirited dialogue among AGU members and other earth scientists about the persistent lack of diversity in science awards â and how to address it. Within the AGU fellows kamagra for sale program, itâÂÂs a pervasive issue.
AGU selected a total of 59 fellows this year, and 45 of them are men. Additionally, 46 of the fellows are from the U.S., while only 13 are from other countries. The trend has been similar in kamagra for sale recent years. In 2020, 46 out of 62 fellows were men, and 43 fellows were from the U.S. In 2019, 47 out of 62 fellows were men, and 36 were from the U.S.
AGU doesnâÂÂt publish data on kamagra for sale the race or ethnicity of its fellows. But AGU scientists and committee members have pointed out that people of color tend to be underrepresented. ÃÂÂWe are disappointed that there were fewer women and fewer individuals from international countries nominated and awarded in 2021,â AGU said in a statement last month, shortly after announcing the new class of fellows. ÃÂÂFor the first kamagra for sale time ever, one Section chose not to advance any of their Sectionsâ nominees to the Union Fellows Committee for consideration. The Section felt that this was their only course of action due to a lack of diversity in the nomination pool.â The cryosphere committee further explained its decision in a letter to its section members, which it also shared publicly on Twitter.
ÃÂÂWhile it is tempting to blame the kamagra and see this year as anomalous, the Cryosphere Fellows committee now realize that the slate of nominations received this year is part of an alarming trend in Fellows nominations that warrants review,â the letter stated. The number of female cryosphere nominees has kamagra for sale steadily dwindled over the past five years, the committee pointed out. It reached a low point in 2021. ÃÂÂWe realize that our decision means that excellent scientists who have done nothing wrong and who were strong candidates for recommendation by the Cryosphere section were denied the support of the Cryosphere Fellows committee at the AGU Union Fellows level kamagra for sale this year,â the committee added. ÃÂÂWhat we hope is that this moment will serve as both a time to reflect on community engagement and a call to action.â Declining to recommend otherwise strong candidates was âÂÂthe hardest part,â Fricker added.
ÃÂÂIt was a very sad, sort of tough thing to have to do, because thereâÂÂs people on that list who were truly, amazingly deserving,â Fricker said. "But the honest truth kamagra for sale is that they will get nominated again and they will become fellows. ThereâÂÂs no question there. It will just be a fairer process.â âÂÂNothing would changeâ The cryo committeeâÂÂs decision has triggered a flurry of responses from AGU members and other earth scientists. Reactions have kamagra for sale been mixed.
Raymond Bradley, director of the climate system research center at the University of Massachusetts, Amherst, was among the first to publish a statement to AGUâÂÂs online member forum, AGU Connect. He called for the committee members to resign. ÃÂÂWhat the committee should have done is what they were tasked to do, which is to select kamagra for sale from the nominations they received the best people and put them forward,â Bradley said in an interview. ÃÂÂAt the same time they could recognize that there arenâÂÂt enough nominations being received from women and underrepresented groups, and they could shake up their members and say, âÂÂHey, come on, letâÂÂs nominate more people.âÂÂâ AGU data from the past few years suggests that there are significantly fewer female fellow nominees than male nominees. Of those nominees, a slightly greater percentage of women than men go on to be selected kamagra for sale as fellows, Bradley pointed out.
ÃÂÂThis hardly supports the idea that there is some sort of implicit bias in the selection process,â he said in a follow-up email. ÃÂÂThe problem lies in the low number of nominations, and that depends on the effort people make to submit candidates for Fellow.â But others have disagreed. Simply drumming up more nominations isnâÂÂt as simple a solution as kamagra for sale it might sound, said Twila Moon, a scientist with the National Snow &. Ice Data Center. ÃÂÂThere have been some really well-thought-out responses in AGU Connect pointing out that often the work of nominating more diverse groups of people falls to people who are within those diverse groups,â she said in an interview.
ÃÂÂAnd that those are maybe people who are especially hard hit in having time available.â ThatâÂÂs especially true now, kamagra for sale as the kamagra has disproportionately affected women, people of color and other underrepresented groups, she added. Writing nominations requires time and effort. Others have voiced their support for the committeeâÂÂs decision. ÃÂÂI think that the committeeâÂÂs response was bold, but it definitely got the conversation started, and for that reason alone I think that it was kamagra for sale a great reaction to the nomination pool,â said Melisa Diaz, a postdoctoral scholar and geochemist at Woods Hole Oceanographic Institution. ÃÂÂWhen you have a nomination pool that consists of one very specific demographic, how can you actually tell that that demographic is truly the best in our field?.
àNicole Gasparini, a geoscientist at Tulane University, agreed that the kamagra for sale committeeâÂÂs gesture kick-started important conversations within the organization. While there have been both positive and negative responses on AGU Connect, reactions across social media, including Twitter, have been overwhelmingly supportive, she added. ÃÂÂI think their decision is absolutely bringing attention to the fact that there is a lack of diversity in AGU awardees,â she said. According to Fricker, kamagra for sale raising awareness was a major goal when the committee made its decision. ÃÂÂEverybody's given us all this great advice on what we could have done.
But honestly, I donâÂÂt think anything would have had the impact of what we ended up doing,â she told E&E News. ÃÂÂIf you just go forward and put names forward and then say, âÂÂOK, weâÂÂve put these names forward, but honestly guys this is a terrible pool and you need to do better next year,â nothing would change.â âÂÂReal changeâ kamagra for sale AGU is hardly the only organization to reckon with issues of diversity in awards. Studies have indicated that women and other underrepresented groups are often less likely to receive science prizes. One recent study, just published last month in Quantitative Science Studies, found that women are less likely to receive prestigious science awards than men. Examining 141 of the worldâÂÂs most distinguished international kamagra for sale research awards, the study found that the prizes were given to 2,011 men between 2001 and 2020, compared with just 262 women.
The Nobel Prizes, widely considered the worldâÂÂs most prestigious science awards, have been subject to particular scrutiny in recent years. Only about 3 percent of Nobel science prizes have gone to women since the awards were established more kamagra for sale than 100 years ago. Not a single one has been awarded to a Black scientist. The AGU fellows announcement was followed by this yearâÂÂs Nobel science prizes, all of which went to men. Despite persistent problems with diversity in science awards around the world, kamagra for sale researchers say there are plenty of ways to tackle the problem.
Implicit bias plays a major role in who receives science awards, according to Mary Anne Holmes, a geologist and professor emeritus at the University of Nebraska, Lincoln. ItâÂÂs an unconscious bias or prejudice that can lead people to identify more strongly with people from their own social groups. If awards nominators or selection committees are composed primarily of homogeneous groups â for instance, white people or men â that can lead to an unintentional skew kamagra for sale in the people who are nominated or selected for awards. Holmes served on AGUâÂÂs Union Honors and Recognition Committee, which oversees all of its honors and awards programs, between 2013 and 2019. She also previously worked with the Association for Women in Science on a National Science Foundation-funded project aimed at studying and addressing gender disparities in science awards.
She and colleagues LaToya Myles and Blair Schneider, who also served on AGUâÂÂs honors committee, published some of their insights last year in kamagra for sale the journal Advances in Geoscience. ÃÂÂWeâÂÂre all committing acts of implicit bias every day, all the time, without meaning to be biased,â Holmes said in an interview. Implicit bias training for awards selection committees âÂÂis huge,â she added. Experts say canvassing committees, kamagra for sale designed to scout for worthy nominees and encourage people to nominate them, can also make a difference. These committees can also help answer questions about the nomination process, which is often long and time-consuming.
Gasparini, the Tulane scientist, is a member of kamagra for sale AGUâÂÂs earth and planetary sciences section. A few years ago, she and several other members began canvassing after noticing a gap in the number of women in their section receiving awards. ÃÂÂWe went out and we found all the letter writers and did all this work, and it worked. Women started winning,â kamagra for sale she said. These committees can also help tackle the issue of implicit bias, she added.
ÃÂÂItâÂÂs not that men donâÂÂt see women doing good work or white people donâÂÂt see people of color doing good work,â she said. ÃÂÂBut people need to be pushed to do it, and when they do kamagra for sale it they might think only of the superstar whoâÂÂs already won seven awards and published 10 Nature papers. And the truth is there's a lot of people making a lot of impact who arenâÂÂt those people.â Other scientists have pointed out that there may be broader structural issues in science awards. Prizes arenâÂÂt always designed to recognize all the people contributing to scientific breakthroughs, they say. ÃÂÂScience is so collaborative now,â said Diaz, the Woods Hole Oceanographic Institution kamagra for sale scientist.
ÃÂÂSo does it really make sense to give awards to a single person?. TheyâÂÂre not doing the work kamagra for sale by themselves. There are students and postdocs and collaborators and friends. So I think we really need to think about who we want these awards to go to and what we want them to represent.â Other scientists share the sentiment. ÃÂÂI actually think that there are some broken kamagra for sale elements to the larger awards system,â said Moon, the NSIDC scientist.
ÃÂÂI think that thereâÂÂs really interest, particularly in the early and middle-career generations of scientists, who are for a system that recognizes a wider range of what it means to be a scientist and what it means to contribute to the scientific endeavor in its success.â Fricker hopes this yearâÂÂs events will spark a bigger conversation within AGU, perhaps culminating in new recommendations from the organization about how to diversify future pools of award nominees. ÃÂÂIâÂÂm looking forward to some real change,â she said. Holmes, the former honors committee member, said sheâÂÂs optimistic that kamagra for sale the conversations around science awards are evolving. ÃÂÂI think people who normally wouldnâÂÂt have paid any attention to this are paying attention,â she said. ÃÂÂAt least I hear people talking about it as if, yes, this is an issue now.
ThatâÂÂs a big leap forward from 20 years ago.â Reprinted from E&E News with permission from POLITICO, LLC kamagra for sale. Copyright 2021. E&E News provides essential news for energy and environment professionals..