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Over the past 20 years, a large body of research has documented a relationship between higher nurse-to-patient staffing ratios and better patient outcomes, including shorter hospital stays, lower rates of failure to prevent mortality after an in-hospital complication, inpatient mortality for multiple types of patients, hospital-acquired pneumonia, unplanned extubation, respiratory failure and cardiac arrest.1–5 In addition, patients report higher satisfaction when they are cared for in hospitals with higher staffing levels.6 7To date, most studies have not identified an ‘optimal’ nurse staffing ratio,8 which get lasix creates a challenge for determining appropriate staffing levels. If increasing nurse staffing always produces at least some improvement in the quality of care, how does one determine what staffing level is best?. This decision is ultimately an economic one, balancing the benefits get lasix of nurse staffing with the other options for which those resources could be used. It is in this context that hospitals develop staffing plans, generally based on historical patterns of patient acuity.Practical challenges of nurse staffingHospital staffing plans provide the structure necessary for determining hiring and scheduling, but fall short for a number of reasons.

First, there get lasix are multiple ways in which patient acuity can be measured, which can have measurable effects on the staffing levels resulting from acuity models.9 Second, patient volume and acuity can shift rapidly with changes in the volume of admissions, discharges and transfers between units. Third, staffing plans provide little guidance regarding the optimal mix of permanent staff, variable staff and externally contracted staff.The paper by Saville and colleagues10 in this issue of BMJ Quality &. Safety addresses the latter two issues by applying a simulation model to identify the optimal get lasix target for baseline nurse staffing in order to minimise periods of understaffing. Included in this model is consideration of the extent to which hospitals should leverage temporary personnel (typically obtained through an external agency) to fill gaps.

The model acknowledges the likelihood get lasix that a hospital cannot realistically prevent all shifts from having a shortfall of nurses at all times, as well as the reality that hospital managers lack information about the best balance between permanent and temporary staff. In addition, the analysis includes a calculation of the costs of each staffing approach, drawing from the records of 81 inpatient wards in four hospital organisations.The application of sophisticated simulation models and other advanced analyticl approaches to analysis of nurse staffing has been limited to date, and this paper is an exemplar of the value of such research. Recent studies have used machine learning methods to forecast hospital discharge volume,11 a discrete event simulation model to determine nursing staff get lasix needs in a neonatal intensive care unit,12 and a prediction model using machine learning and hierarchical linear regression to link variation in nurse staffing with patient outcomes.13 This new study applied a unique Monte Carlo simulation model to estimate demand for nursing care and test different strategies to meet demand.The results of the analysis are not surprising in that hospitals are much less likely to experience understaffed patient shifts if they aim to have higher baseline staffing. The data demonstrate a notable leftward skew, indicating that hospitals are more likely to have large unanticipated increases in patient volume and acuity than to have unanticipated decreases.

This results in hospitals being more likely get lasix to have shifts that are understaffed than shifts that are overstaffed, which inevitably places pressure on hospitals to staff at a higher level and/or have access to a larger pool of temporary nurses. It also is not surprising that hospitals will need to spend more money per patient day if they aim to reduce the percent of shifts that are understaffed. What is surprising about the results is that hospitals do not necessarily achieve cost savings by relying on temporary personnel versus setting regular staffing at a higher level.Trade-offs between permanent and temporary staffThe temporary nursing workforce enables healthcare facilities to maintain flexible yet full care teams based on patient care needs. Hospitals can use temporary nurses to address staffing gaps during leaves of absence, turnover or gaps between recruitment of permanent nurses, get lasix as well as during high-census periods.

Temporary personnel are typically more expensive on an hourly basis than permanent staff. In addition, over-reliance on temporary staff can have detrimental effects on get lasix permanent nurses’ morale and motivation. Orientations prior to shifts are often limited, which leads to a twofold concern as temporary nurses feel ill-prepared for shifts and permanent staff feel flustered when required to bring the temporary nurse up to speed while being expected to continue normal operations.14 Agency nurses may be assigned to patients and units that are incongruent with their experience and skills—either to unfamiliar units, which affects their ability to confidently deliver care, or to less complex patients where they feel as if their skills are not used adequately.14 15 These issues can create tension between temporary and permanent nursing staff, which can be compounded by the wage disparity. Permanent staff might feel demoralised and expendable when working alongside temporary staff who are not integrated into the social fabric of get lasix the staff.16Hospital managers also must be cognisant of the potential quality impact of relying heavily on temporary nursing staff.

Research on the impact of contingent nursing employment on costs and quality have often found negative effects on quality, including mortality, and higher costs.17 18 However, other studies have found that the association between temporary nursing staff and low quality result from general shortages of nursing staff, which make a hospital more likely to employ temporary staff, and not directly from the contingent staff.19–21 Thus, temporary nurses play an important role in alleviating staffing shortages that would otherwise lead to lower quality of care.22Charting a path forward in hospital management and healthcare researchThe maturation of electronic health records and expansion of computerised healthcare management systems provide opportunities both for improved decision making about workforce deployment and for advanced workforce research. In the area of workforce management, nursing and other leaders have a growing array of workforce planning tools available to them get lasix. Such tools are most effective when they display clear information about predicted patient needs and staff availability, but managers still must rely on their on-the-ground understanding of their staff and their context of patient care.23 Integration of human resources data with patient outcomes data has revealed that individual nurses and their characteristics have important discrete effects on the quality of care.24 25 Future development of workforce planning tools should translate this evidence to practice. In addition, new technology platforms are emerging to facilitate direct matching between temporary healthcare personnel and healthcare get lasix organisations.

One recent study tested a smartphone-based application that allowed for direct matching of locum tenens physicians with a hospital in the English National Health Service, finding that the platform generated benefits including greater transparency and lower cost.26 Similar technologies for registered nurses could facilitate better matching between hospital needs and temporary nurses’ preparedness to meet those needs.Analytical methods that fully leverage the large datasets compiled through electronic health records, human resources systems and other sources can be applied to advance research on the composition of nursing teams to improve quality of care. As noted above, prior research has applied machine learning and discrete event simulation to analyses of healthcare staffing get lasix. Other recent studies have leveraged natural language processing of nursing notes to identify fall risk factors27 and applied data mining of human resources records to understand the job titles held by nurses.28 Linking these rapidly advancing analytical approaches that assess the outcomes and costs of nurse staffing strategies, such as the work by Saville and colleagues published in this issue, to data on the impact of nurse staffing on the long-term costs of patient care will further advance the capacity of hospital leaders to design cost-effective policies for workforce deployment.Guidelines aim to align clinical care with best practice. However, simply publishing a guideline rarely triggers behavioural changes to match guideline recommendations.1–3 We thus transform guideline recommendations into actionable tasks by introducing interventions that promote behavioural changes meant to produce guideline-concordant care.

Unfortunately, not much has changed in the 25 years since Oxman and colleagues concluded that we have no ‘magic bullets’ when it comes to changing clinician behaviour.4 In fact, far from magic bullets, interventions aimed at increasing the degree to which patients receive care recommended in guidelines (eg, educational interventions, reminders, audit and feedback, financial incentives, computerised decision support) typically produce disappointingly small improvements in care.5–10Much improvement work aims to ‘make the right thing to do the easy thing to do.’ Yet, design solutions get lasix which hardwire the desired actions remain few and far between. Further, improvement interventions which ‘softwire’ such actions—not guaranteeing that they occur, but at least increasing the likelihood that clinicians will deliver the care recommended in guidelines—mostly produce small improvements.5–9 Until this situation changes, we need to acknowledge the persistent reality that guidelines themselves represent a main strategy for promoting care consistent with current evidence, which means their design should promote the desired actions.11 12In this respect, guidelines constitute a type of clinical decision support. And, like get lasix all decision support interventions, guidelines require. (1) user testing to assess if the content is understood as intended and (2) empirical testing to assess if the decision support provided by the guideline does in fact promote the desired behaviours.

While the processes for developing guidelines have received substantial get lasix attention over the years,13–18 surprisingly little attention has been paid to empirically answering basic questions about the finished product. Do users understand guidelines as intended?. And, what version of a given get lasix guideline engenders the desired behaviours by clinicians?. In this issue of BMJ Quality and Safety, Jones et al19 address this gap by using simulation to compare the frequency of medication errors when clinicians administer an intravenous medication using an existing guideline in the UK’s National Health Service (NHS) versus a revised and user-tested version of the guideline that more clearly promotes the desired actions.

Their findings demonstrate get lasix that changes to guideline design (through addition of actionable decision supports) based on user feedback does in fact trigger changes in behaviour that can improve safety. This is an exciting use of simulation, which we believe should encourage further studies in this vein.Ensuring end users understand and use guidelines as intendedJones and colleagues’ approach affords an opportunity to reflect on the benefits of user testing and simulation of guidelines. The design and evaluation of their revised guidelines provides an excellent example of a get lasix careful stepwise progression in the development and evaluation of a guideline as a type of decision support for clinicians. First, in a prior study,20 they user tested the original NHS guidelines to improve retrieval and comprehension of information.

The authors produced a revised guideline, which included reformatted sections as well as increased support for key calculations, such as for infusion rates. The authors again user tested the revised guideline, successfully showing higher rates of comprehension get lasix. Note that user testing refers to a specific approach focused on comprehension rather than behaviour21 and is distinct from usability testing. Second, in the current get lasix study, Jones et al evaluated whether nurse and midwife end users exhibited the desired behavioural changes when given the revised guidelines (with addition of actionable decision supports), compared with a control group working with the current version of the guidelines used in practice.

As a result, Jones and colleagues verify that end users (1) understand the content in the guideline and (2) actually change their behaviour in response to using it.Simulation can play a particularly useful role in this context, as it can help identify problems with users’ comprehension of the guideline and also empirically assess what behavioural changes occur in response to design changes in the guidelines. The level of methodological control and qualitative detail that simulation provides is difficult to feasibly replicate with real-world pilot studies, and therefore simulation fills a critical gap.Jones et al report successful changes in behaviour due to the revised guidelines in which they added actionable get lasix decision supports. For example, their earlier user testing found that participants using the initial guidelines did not account for displacement volume when reconstituting the powdered drug, leading to dosing errors. A second error with the initial guidelines involved participants using the shortest infusion rate provided (eg, guidelines state ‘1 to 3 hours’), without realising that the shortest rate is not appropriate for certain doses (eg, 1 hour is appropriate for smaller doses, but larger doses should not be infused over get lasix 1 hour because the drug would then be administered faster than the maximum allowable infusion rate of 3 mg/kg/hour).

These two issues were addressed in the revised guidelines by providing key determinants for ‘action’ such as calculation formulas that account for displacement volume and infusion duration, thereby more carefully guiding end users to avoid these dose and rate errors. These changes to the guideline triggered specific behaviours (eg, calculations that account for all variables) that did not occur with the initial get lasix guidelines. Therefore, the simulation testing demonstrated the value of providing determinants for action, such as specific calculation formulas to support end users, by showing a clear reduction in dose and rate errors when using the revised guidelines compared with the initial guidelines.The authors also report that other types of medication-specific errors remained unaffected by the revised guidelines (eg, incorrect technique and flush errors)—the changes made did not facilitate the desired actions. The initial guidelines indicate get lasix ‘DO NOT SHAKE’ in capital letters, and there is a section specific to ‘Flushing’.

In contrast, the revised guidelines do not capitalise the warning about shaking the vial, but embed the warning with a numbered sequence in the medication preparation section, aiming to increase the likelihood of reading it at the appropriate time. The revised guidelines do not have a section specific to flushing, but embed the flushing instructions as an unnumbered step in the administration section. Thus, the value of embedding technique and flushing information within the context of use was not validated in the simulation testing (ie, no significant differences in the rates of these errors), highlighting precisely the pivotal role that simulation can play get lasix in assessing whether attempts to improve usability result in actual behavioural changes.Finally, simulation can identify potential unintended consequences of a guideline. For instance, Jones and colleagues observed an increase in errors (although not statistically significant) that were not medication specific (eg, non-aseptic technique such as hand washing, swabbing vials with an alcohol wipe).

Given that the revised guidelines were specific to the medication tested, it is unusual that we see a tendency toward a worsening effect on generic get lasix medication preparation skills. Again, this finding was not significant, but we highlight this to remind ourselves of the very real possibility that some interventions might introduce new and unexpected errors in response to changing workflow and practice6. Simulations offer get lasix an opportunity to spot these risks in advance.Now that Jones et al have seen how the revised guidelines change behaviour, they are optimally positioned to move forward. On one hand, they have the option of revising the guidelines further in attempts to address these resistant errors, and on the other, they can consider designing other interventions to be implemented in parallel with their user-tested guidance.

At first glance, get lasix the errors that were resistant to change appear to be mechanical tasks that end users might think of as applying uniformly to multiple medications (eg, flush errors, non-aseptic technique). Therefore, a second intervention that has a more general scope (rather than drug specific) might be pursued. Regardless of what they decide to pursue, we applaud their measured approach and highlight that the key takeaway is that their next steps are supported with clearer evidence of what to expect when the guidelines get lasix are released—certainly a helpful piece of information to guide decisions as to whether broad implementation of guidelines is justified.Caveats and conclusionSimulation is not a panacea—it is not able to assess longitudinal adherence, and there are limitations to how realistically clinicians behave when observed for a few sample procedures when under the scrutiny of observers. Further, studies where interventions are implemented to assess whether they move the needle on the outcomes we care about (eg, adverse events, length of stay, patient mortality) are needed and should continue.

However, having end users physically perform clinical tasks with the intervention in representative environments represents an important strategy to get lasix assess the degree to which guidelines and other decision support interventions in fact promote the desired behaviours and to spot problems in advance of implementation. Such simulation testing is not currently a routine step in intervention design. We hope it becomes a more common phenomenon, with more improvement work following the example of the approach so effectively demonstrated by Jones and colleagues..

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Much of how long does lasix last in your system modern ethics is built around the idea that we http://markgrigsby.info/who-can-buy-amoxil/ should respect one another’s autonomy. Here, “we” are typically imagined to be adult how long does lasix last in your system human beings of sound mind, where the soundness of our mind is measured against what we take to be the typical mental capacities of a neurodevelopmentally “normal” person—perhaps in their mid-thirties or forties. When deciding about what constitutes ethical sex, for example, our dominant models hold that ethical sex is whatever is consented to, while a lack of consent makes sex wrong.1 Consent, in turn, is analysed in terms of autonomous decision-making. A “yes” or “no” that reflects the free and informed will of our idealised, sound-minded adult.Whether such models provide adequate normative guidance for ethical, much less good, sex between neurotypical human adults is an open question.2 3 When it comes to the ethics of sexual activity between humans and non-humans—robots, say—or between humans who don’t fit the rational stereotype (such as older people with dementia or younger adolescents), we hardly know where to begin.4–7 It is therefore heartening to see a number of papers in this issue tackling the difficult question how to respectfully facilitate or respond to the needs, desires, and decisions of people with different kinds or degrees of autonomy.8For how long does lasix last in your system example, Sumytra Menon and colleagues9 explicitly discuss the notion of “borderline capacity” and argue, in the medical domain, for shared and supportive decision-making practices to “foster the autonomy of patients with compromised mental capacity while being mindful of the need to safeguard their well-being.” (Could similar practices be applied to sexual decision-making?.

) Touching on a similar theme, Zahra Ladan10 asks how we should conceive of liberty in the case of persons with certain inborn physical or mental limitations. Might it sometimes be necessary to constrain or interfere with how long does lasix last in your system a person’s actions as a means of promoting their liberty—or can that only be an oxymoron?. Finally, the problem of sexual consent in the context of diminished autonomy is addressed most directly in the piece by Andria Bianchi.11 Bianchi argues that people with certain cognitive impairments, such as dementia, should ideally be allowed to engage in sexual activity in accordance with their desires. But if consent, as that concept is traditionally understood, is required for sex to be ethical or legal, then people with dementia may be “prevented from having their sexual needs how long does lasix last in your system met even if we recognise these needs as important.”Which brings us to robots.

According to Bianchi, sex robots, whether now or in the future, might “allow people with dementia to fulfil their needs regardless of whether they can provide or understand consent.” A similar proposal is raised by Nancy Jecker12 in her feature article, on which Bianchi’s piece is a commentary. Additional commentaries are by Robert Sparrow,13 Tom Sorell,14 and Alexander Boni-Saenz.15Jecker’s article is entitled “Nothing to Be how long does lasix last in your system Ashamed of. Sex Robots for Older Adults with Disabilities.”1 The commenters on the article are united in their praise of Jecker for dispelling ageist stereotypes according to which older people either are, or should be, non-sexual beings. And they welcome Jecker’s attempt to stimulate creative thinking about how the sexual needs and desires of older people might best how long does lasix last in your system be accommodated.

At the same time, they felt that Jecker’s arguments in favour of sex robots toward this end fell short in some respects.Jecker begins by noting that older adults typically undergo certain physical and mental changes that can negatively affect sexual enjoyment. Jecker describes these changes in terms of functional impairments or lost abilities, where the functions in question seem mostly related to the ability to engage in penile-vaginal intercourse how long does lasix last in your system unassisted. For example, Jecker highlights “shortening and narrowing of the vagina, thinning of the vaginal walls and reduced lubrication” for older women, and various erectile difficulties for older men.But diminished sexual capacity, Jecker stresses, encompasses much more than a lessened ability to “accomplish the act of sexual intercourse itself.” Rather, for most human beings, sex with others “serves as a vehicle for expressing who they are as persons.” Sex is also integral, Jecker argues, to several basic capabilities (in the spirit of Nussbaum and Sen), including the ability to have a life-narrative, to be healthy, to feel and express a wide range of emotion, and to affiliate deeply with others. Jecker suggests that providing sex robots to older people could help them how long does lasix last in your system to maintain these capabilities at some minimum level.

So, we should try to see that such robots are provided.2Jecker anticipates some likely objections to her view. One is how long does lasix last in your system that, far from promoting the capability of being healthy for instance, repeatedly engaging in sexual activity with a humanoid robot3 (that is, an entity that presumably cannot provide ethically valid consent to such activity)4 would in fact harm the user. In particular, it would do so by damaging how long does lasix last in your system the user’s character. In effect, the user would be satisfying their sexual urges by repeatedly simulating rape.15–18 To diffuse this objection, Jecker emphasises that sex robots are not sentient beings with thoughts, feelings, or wishes, but are rather mere instruments or “toys.” But this may cause problems for the rest of Jecker’s argument, which turns on the ability of sex robots to stimulate real human emotions and play a meaningful relational role in older people’s lives.It might not be possible to have it both ways.

As Sorell argues, the sort of “affiliation” one might have how long does lasix last in your system with a sex robot is likely to be “too denuded” to serve as a substitute for the affiliation ideally achieved through sex with another human. After all, a human being who “automatically simulates arousal on demand for their sexual partner, who is receptive to sex no questions asked, no matter when or where, has handed over their sexual will.” Thus, in the case of human-robot sex, a single person would be deciding how it goes. Affiliation, by how long does lasix last in your system contrast, “requires two.”5 Or as Sparrow puts it. Sex with a robot is simply high-tech masturbation.Likewise, Boni-Saenz doubts that many people would find sex robots “adequate for sexual relationships.” But he remains open to the possibility that at least some people could find sex robots to be “a suitable replacement for human intimacy in periods of old age” even if they may not otherwise “represent their preferred mode of sexual interaction.” Here, we suggest it may be worthwhile to undertake empirical research into older people’s actual attitudes and preferences toward (the prospect of) sex with robots,6 in order to shape our normative inquiry going forward.7Suppose it turns out that older adults, or some reasonably large proportion of them, find that they are able to form (or imagine forming) a meaningful intimate relationship with a sex robot—one that is sufficient to support the “affiliation” capability at least to some extent.

It seems how long does lasix last in your system to us this creates a real dilemma. The more humanlike the (felt) affiliation, the less effective Jecker’s “just a toy” response becomes to the objection about simulated rape. And the less humanlike the affiliation, the less effective Jecker’s argument that sex robots could support such a capability.19In fact, it isn’t clear to us how sex robots would be altogether helpful even for physical or functional issues, how long does lasix last in your system like those raised by Jecker. How would a sex robot help with “shortening or narrowing of the vagina,” “reduced lubrication,” or erectile difficulties for those with penises?.

A sex robot could, perhaps, apply a synthetic lubricant as needed—but so could a how long does lasix last in your system human partner. In any event, the focus on sexual “function” (in this physical sense) may obscure other possibilities for erotic fulfilment in older people.As Jecker acknowledges, age-related physiological changes need not necessarily lead to a deterioration in the quality of our sex lives. Indeed, such changes may even contribute to a broader repertoire of sexual activities and bring partners closer together.20 Departing from the so-called coital imperative, for example, can – and often does – lead to the exploration of non-penetrative forms of sexual activity, which in turn how long does lasix last in your system may translate into greater sexual satisfaction, especially for women. The idea then might be to focus more on the building of erotic tension rather than on “performance,” and on becoming more sensitive to our partners’ emotional states rather than fixating on the mechanical possibilities of the body.21Jecker is right to call out sexual ageism.

Older people often do have sexual needs, and how long does lasix last in your system this should not be stigmatised or ignored. But we worry that a focus on sex robots may inadvertently strengthen the very ageism that Jecker decries. For such a focus could be how long does lasix last in your system seen as carrying an implicit message. Namely, that something crucial is lost if an older person does not maintain their youthful sexual stamina with the use of increasingly sophisticated tools..

Much of modern ethics is built around get lasix the idea that we should respect one another’s autonomy. Here, “we” are typically imagined to be adult human beings of sound mind, where the soundness of our get lasix mind is measured against what we take to be the typical mental capacities of a neurodevelopmentally “normal” person—perhaps in their mid-thirties or forties. When deciding about what constitutes ethical sex, for example, our dominant models hold that ethical sex is whatever is consented to, while a lack of consent makes sex wrong.1 Consent, in turn, is analysed in terms of autonomous decision-making.

A “yes” or “no” that reflects the free and informed will of our idealised, sound-minded adult.Whether such models provide adequate normative guidance for ethical, much less good, sex between neurotypical human adults is an open question.2 3 When it comes to the ethics of sexual activity between humans and non-humans—robots, say—or between humans who don’t fit the rational stereotype (such as older people with dementia or younger adolescents), we hardly know where to begin.4–7 It is therefore heartening to see a number of papers in this get lasix issue tackling the difficult question how to respectfully facilitate or respond to the needs, desires, and decisions of people with different kinds or degrees of autonomy.8For example, Sumytra Menon and colleagues9 explicitly discuss the notion of “borderline capacity” and argue, in the medical domain, for shared and supportive decision-making practices to “foster the autonomy of patients with compromised mental capacity while being mindful of the need to safeguard their well-being.” (Could similar practices be applied to sexual decision-making?. ) Touching on a similar theme, Zahra Ladan10 asks how we should conceive of liberty in the case of persons with certain inborn physical or mental limitations. Might it sometimes be necessary to constrain or interfere with a person’s get lasix actions as a means of promoting their liberty—or can that only be an oxymoron?.

Finally, the problem of sexual consent in the context of diminished autonomy is addressed most directly in the piece by Andria Bianchi.11 Bianchi argues that people with certain cognitive impairments, such as dementia, should ideally be allowed to engage in sexual activity in accordance with their desires. But if consent, as that concept is traditionally understood, is required for sex to be ethical or legal, then people with dementia may be “prevented from having their sexual needs met even if we recognise these needs as important.”Which brings get lasix us to robots. According to Bianchi, sex robots, whether now or in the future, might “allow people with dementia to fulfil their needs regardless of whether they can provide or understand consent.” A similar proposal is raised by Nancy Jecker12 in her feature article, on which Bianchi’s piece is a commentary.

Additional commentaries are by get lasix Robert Sparrow,13 Tom Sorell,14 and Alexander Boni-Saenz.15Jecker’s article is entitled “Nothing to Be Ashamed of. Sex Robots for Older Adults with Disabilities.”1 The commenters on the article are united in their praise of Jecker for dispelling ageist stereotypes according to which older people either are, or should be, non-sexual beings. And they welcome Jecker’s attempt to stimulate creative thinking about how the get lasix sexual needs and desires of older people might best be accommodated.

At the same time, they felt that Jecker’s arguments in favour of sex robots toward this end fell short in some respects.Jecker begins by noting that older adults typically undergo certain physical and mental changes that can negatively affect sexual enjoyment. Jecker describes these changes in terms of functional impairments get lasix or lost abilities, where the functions in question seem mostly related to the ability to engage in penile-vaginal intercourse unassisted. For example, Jecker highlights “shortening and narrowing of the vagina, thinning of the vaginal walls and reduced lubrication” for older women, and various erectile difficulties for older men.But diminished sexual capacity, Jecker stresses, encompasses much more than a lessened ability to “accomplish the act of sexual intercourse itself.” Rather, for most human beings, sex with others “serves as a vehicle for expressing who they are as persons.” Sex is also integral, Jecker argues, to several basic capabilities (in the spirit of Nussbaum and Sen), including the ability to have a life-narrative, to be healthy, to feel and express a wide range of emotion, and to affiliate deeply with others.

Jecker suggests that get lasix providing sex robots to older people could help them to maintain these capabilities at some minimum level. So, we should try to see that such robots are provided.2Jecker anticipates some likely objections to her view. One is get lasix that, far from promoting the capability of being healthy for instance, repeatedly engaging in sexual activity with a humanoid robot3 (that is, an entity that presumably cannot provide ethically valid consent to such activity)4 would in fact harm the user.

In particular, it would do so by damaging get lasix the user’s character. In effect, the user would be satisfying their sexual urges by repeatedly simulating rape.15–18 To diffuse this objection, Jecker emphasises that sex robots are not sentient beings with thoughts, feelings, or wishes, but are rather mere instruments or “toys.” But this may cause problems for the rest of Jecker’s argument, which turns on the ability of sex robots to stimulate real human emotions and play a meaningful relational role in older people’s lives.It might not be possible to have it both ways. As Sorell argues, the sort of “affiliation” one might have with a sex robot is likely to be “too denuded” to serve as a substitute for the affiliation ideally achieved through sex with another get lasix human.

After all, a human being who “automatically simulates arousal on demand for their sexual partner, who is receptive to sex no questions asked, no matter when or where, has handed over their sexual will.” Thus, in the case of human-robot sex, a single person would be deciding how it goes. Affiliation, by contrast, get lasix “requires two.”5 Or as Sparrow puts it. Sex with a robot is simply high-tech masturbation.Likewise, Boni-Saenz doubts that many people would find sex robots “adequate for sexual relationships.” But he remains open to the possibility that at least some people could find sex robots to be “a suitable replacement for human intimacy in periods of old age” even if they may not otherwise “represent their preferred mode of sexual interaction.” Here, we suggest it may be worthwhile to undertake empirical research into older people’s actual attitudes and preferences toward (the prospect of) sex with robots,6 in order to shape our normative inquiry going forward.7Suppose it turns out that older adults, or some reasonably large proportion of them, find that they are able to form (or imagine forming) a meaningful intimate relationship with a sex robot—one that is sufficient to support the “affiliation” capability at least to some extent.

It seems to us this creates a real get lasix dilemma. The more humanlike the (felt) affiliation, the less effective Jecker’s “just a toy” response becomes to the objection about simulated rape. And the less humanlike the affiliation, the less effective Jecker’s argument that sex robots could support such a capability.19In fact, it isn’t clear to us how sex robots would be altogether helpful even for physical or functional issues, like those raised get lasix by Jecker.

How would a sex robot help with “shortening or narrowing of the vagina,” “reduced lubrication,” or erectile difficulties for those with penises?. A sex get lasix robot could, perhaps, apply a synthetic lubricant as needed—but so could a human partner. In any event, the focus on sexual “function” (in this physical sense) may obscure other possibilities for erotic fulfilment in older people.As Jecker acknowledges, age-related physiological changes need not necessarily lead to a deterioration in the quality of our sex lives.

Indeed, such changes may even contribute to a get lasix broader repertoire of sexual activities and bring partners closer together.20 Departing from the so-called coital imperative, for example, can – and often does – lead to the exploration of non-penetrative forms of sexual activity, which in turn may translate into greater sexual satisfaction, especially for women. The idea then might be to focus more on the building of erotic tension rather than on “performance,” and on becoming more sensitive to our partners’ emotional states rather than fixating on the mechanical possibilities of the body.21Jecker is right to call out sexual ageism. Older people often do have get lasix sexual needs, and this should not be stigmatised or ignored.

But we worry that a focus on sex robots may inadvertently strengthen the very ageism that Jecker decries. For such a focus could be seen as carrying get lasix an implicit message. Namely, that something crucial is lost if an older person does not maintain their youthful sexual stamina with the use of increasingly sophisticated tools..

How should I use Lasix?

Take Lasix by mouth with a glass of water. You may take Lasix with or without food. If it upsets your stomach, take it with food or milk. Do not take your medicine more often than directed. Remember that you will need to pass more urine after taking Lasix. Do not take your medicine at a time of day that will cause you problems. Do not take at bedtime.

Talk to your pediatrician regarding the use of Lasix in children. While this drug may be prescribed for selected conditions, precautions do apply.

Overdosage: If you think you have taken too much of Lasix contact a poison control center or emergency room at once.

NOTE: Lasix is only for you. Do not share Lasix with others.

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Today is lasix best buy Juneteenth, lasix 40mg price in usa or Emancipation Day, the holiday created by Black Americans to celebrate and commemorate the end of slavery in the United States. Historians affirm what celebrants of Juneteenth have long known. That slavery’s overthrow was the culmination of countless acts of resilience, resistance, organizing, and uprising by enslaved and formerly enslaved people.

Similarly, the Black community created and preserved Juneteenth traditions over many years lasix 40mg price in usa while continuing to be victimized by systematic oppression. In light of current debates, Juneteenth is a good day to take a stand for looking honestly at the full reality of our nation’s history. If the rich and varied history of Juneteenth is new to you, the Smithsonian National Museum of African American History and Culture has created a wonderful site where you can learn more.

Let us follow the example of the Black community in celebrating a lasix 40mg price in usa momentous step forward while never losing sight of how far we have to go to secure full freedom and equality for all. At the Department of Labor, we are mindful that slavery was a system of labor exploitation, the legacies of which are yet to be fully eradicated. So as we celebrate, we also rededicate ourselves to the work of eliminating racism and achieving equity across all economic and social systems in our nation and around the world.

Earlier this week, I sent my colleagues at DOL an update on our goals for implementing Executive Order 13985, Advancing Racial Equity and Support for Underserved Communities Through the Federal Government. In that work, as well as in our day-to-day duties – be it the enforcement of wage laws in occupations dominated by members of underserved communities, training young people in Job Corps centers for good careers, empowering women workers of color with education about their labor rights, and so much more – we can help complete the unfinished work we celebrate on Juneteenth. On Thursday, President Biden signed the bill making Juneteenth the 11th federal holiday, following the example of Texas, which was the first state to make Juneteenth an official holiday in 1980.

The unanimous passage of the bill in the Senate and the overwhelming support in the House of Representatives testify to Juneteenth’s undeniable significance across the political spectrum. Please join me in observing this essential day of national commemoration, and have a joyful Juneteenth. Marty Walsh is the secretary of labor.

Follow him on Twitter and Instagram at @SecMartyWalsh..

Today is Juneteenth, or Emancipation Day, the holiday created by Black Americans to celebrate what is the cost of lasix and commemorate the end of slavery in get lasix the United States. Historians affirm what celebrants of Juneteenth have long known. That slavery’s overthrow was the culmination of countless acts of resilience, resistance, organizing, and uprising by enslaved and formerly enslaved people.

Similarly, the Black community created and preserved Juneteenth traditions over many years while continuing to be victimized by get lasix systematic oppression. In light of current debates, Juneteenth is a good day to take a stand for looking honestly at the full reality of our nation’s history. If the rich and varied history of Juneteenth is new to you, the Smithsonian National Museum of African American History and Culture has created a wonderful site where you can learn more.

Let us follow the example of the Black community in celebrating a momentous step forward while never losing sight of how far get lasix we have to go to secure full freedom and equality for all. At the Department of Labor, we are mindful that slavery was a system of labor exploitation, the legacies of which are yet to be fully eradicated. So as we celebrate, we also rededicate ourselves to the work of lasix 40mg price in usa eliminating racism and achieving equity across all economic and social systems in our nation and around the world.

Earlier this week, I sent my colleagues get lasix at DOL an update on our goals for implementing Executive Order 13985, Advancing Racial Equity and Support for Underserved Communities Through the Federal Government. In that work, as well as in our day-to-day duties – be it the enforcement of wage laws in occupations dominated by members of underserved communities, training young people in Job Corps centers for good careers, empowering women workers of color with education about their labor rights, and so much more – we can help complete the unfinished work we celebrate on Juneteenth. On Thursday, President Biden signed the bill making Juneteenth the 11th federal holiday, following the example of Texas, which was the first state to make Juneteenth an official holiday in 1980.

The unanimous passage of get lasix the bill in the Senate and the overwhelming support in the House of Representatives testify to Juneteenth’s undeniable significance across the political spectrum. Please join me in observing this essential day of national commemoration, and have a joyful Juneteenth. Marty Walsh is the secretary of labor.

Follow him on Twitter and Instagram at @SecMartyWalsh..

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€˜None of what is lasix used for us will be safe until everyone is http://nickfarnell.ca/ventolin-online-no-prescription/ safe. Global access to hypertension treatments, tests and treatments for everyone who needs them, anywhere, is the only way out’ what is lasix used for. This statement by Dr Tedros Adhanom Ghebreyesus, Director-General of the WHO and Ursula von der Leyen, President of the European Commission1 has become the rallying call for hypertension medications vaccination. The success of a safe and efficacious hypertension medications treatment depends just what is lasix used for not only on production and availability but also crucially on uptake.In countries such as the UK where hypertension medications treatment prioritisation and rollout are proceeding quickly, attitudes to vaccination have rapidly become a priority.2 treatment hesitancy (‘behavioural delay in acceptance or refusal of treatments despite availability of treatment services’)3 is not a single entity. Reasons vary and there is a continuum from complete acceptance to refusal of all treatments, with treatment hesitancy lying between the what is lasix used for two poles.

Factors involved include confidence (trusting or not the treatment or provider), complacency (seeing the need or value of a treatment) and convenience (easy, convenient access to the treatment).3 4 Importantly, attitudes to vaccination can change and people who are initially hesitant can still come to see a treatment’s safety, efficacy and necessity.5Developing strategies to address hesitancy is key.6 The expedited development and relative novelty of the hypertension medications treatments have led to public uncertainty.4 In addition, efforts to explain the mode of action of these treatments involve a degree of complexity (eg, immune response and genetic mechanisms), which is difficult to communicate quickly and simply. There are genuine knowledge voids (eg, long-term safety data), which in some cases have been filled with misinformation.7 Recent studies what is lasix used for have assessed potential acceptance rates specifically for the hypertension medications treatment. A UK study of more than 5000 adults using a validated scale found 71.7% were willing to be vaccinated, 16.6% were very unsure and 11.7% were strongly hesitant, with hesitancy relatively evenly spread across the population.8 Willingness to take a treatment was closely bound to recognition of the collective importance of this decision as well what is lasix used for as beliefs about the likelihood of hypertension medications , the efficacy, speed of development and side effects of the treatment. This implies that public information emphasising social benefits may be especially effective, at least in a majority of a population, and information that encourages mistrust or undermines social cohesion will lower treatment uptake.We also need to consider more focused strategies about treatment hesitancy for particular groups, including those groups who are most at risk of hesitancy and severe course of illness. As mental health clinicians, we assessed the impact of mental health conditions on hypertension medications treatment hesitancy what is lasix used for and searched for current guidance in this area using a validated approach.9 We found that there is currently no specific guidance in addressing treatment hesitancy in those with mental health difficulties,10 although it is recognised that this is a high-risk group who should be monitored.

People with what is lasix used for mental health issues, particularly with severe mental illness (SMI), are at particular risk both for with hypertension medications and for more severe complications and higher mortality.11 Historically, the uptake of similar treatments such as the influenza treatment in those with SMI can be as low as 25%,12 and so, similar to other low uptake groups, focused efforts are needed to increase this. Suggestions for change include offering specific discussions from mental health professionals and peer workers, treatment education and awareness focused for those with SMI, vaccination programmes within mental health services (with coexistent organisational change to facilitate this), alignment with other preventative health strategies (such as influenza vaccination, smoking cessation, metabolic monitoring), focused outreach and monitoring uptake.13Monitoring of vulnerable groups treatment uptake itself presents problems. In the example of the UK, monitoring of treatment coverage of most what is lasix used for routine immunisation programmes relies on data extracted from primary care systems. To monitor vulnerable groups, what is lasix used for the data need to be specifically recorded. For example, Public Health England’s national immunisation equity audit in 2019 identified inequalities in uptake by a number of important variables (such as age, geography, ethnicity) but could not assess others including mental illness due to a lack of systematically collected data.14 Inequalities that were assessed by the audit were not only in overall coverage but also in timing of treatments and completion of treatment schedules.

In addition, the what is lasix used for extent of a particular inequality varies when it intersects with one or more other factors. In the case of mental illness, multiple long-term conditions across mental and physical health domains as well as socio-economic factors what is lasix used for means that both vulnerability and inequality are likely to be additive.11 However, treatment impact may be greater among the most vulnerable despite lower treatment uptake because the baseline absolute risk is so high.15 Therefore, in the context of a hypertension medications treatment programme, even if treatment uptake falls short in some high-risk groups, even small increases in treatment uptake will still have significant health benefits.14Uptake of vaccination is crucial both for the individual and protection of others. It is in everyone’s interests to ensure that groups where a low uptake is predicted have extra care and input. At the moment there is little formal guidance on how to support those with mental health issues to access clear and reliable what is lasix used for information, and practical and easy access to vaccination for those who are willing. If we are to ensure that ‘everyone is safe’, we need a concerted and global effort16 to guide and focus strategies to support and inform those who are both potentially most hesitant and most vulnerable, including and prioritising those with mental health difficulties..

€˜None of us get lasix will be safe Ventolin online no prescription until everyone is safe. Global access to hypertension treatments, tests and treatments for everyone who needs them, anywhere, is get lasix the only way out’. This statement by Dr Tedros Adhanom Ghebreyesus, Director-General of the WHO and Ursula von der Leyen, President of the European Commission1 has become the rallying call for hypertension medications vaccination. The success of a safe and efficacious hypertension medications treatment depends just not only on production and availability but also crucially on uptake.In countries such as the UK where hypertension medications treatment prioritisation and rollout are proceeding quickly, attitudes to vaccination have rapidly become a priority.2 treatment hesitancy (‘behavioural delay in acceptance or refusal of treatments despite get lasix availability of treatment services’)3 is not a single entity. Reasons vary and there is a continuum from complete acceptance to refusal of all treatments, with treatment hesitancy lying get lasix between the two poles.

Factors involved include confidence (trusting or not the treatment or provider), complacency (seeing the need or value of a treatment) and convenience (easy, convenient access to the treatment).3 4 Importantly, attitudes to vaccination can change and people who are initially hesitant can still come to see a treatment’s safety, efficacy and necessity.5Developing strategies to address hesitancy is key.6 The expedited development and relative novelty of the hypertension medications treatments have led to public uncertainty.4 In addition, efforts to explain the mode of action of these treatments involve a degree of complexity (eg, immune response and genetic mechanisms), which is difficult to communicate quickly and simply. There are genuine knowledge voids get lasix (eg, long-term safety data), which in some cases have been filled with misinformation.7 Recent studies have assessed potential acceptance rates specifically for the hypertension medications treatment. A UK get lasix study of more than 5000 adults using a validated scale found 71.7% were willing to be vaccinated, 16.6% were very unsure and 11.7% were strongly hesitant, with hesitancy relatively evenly spread across the population.8 Willingness to take a treatment was closely bound to recognition of the collective importance of this decision as well as beliefs about the likelihood of hypertension medications , the efficacy, speed of development and side effects of the treatment. This implies that public information emphasising social benefits may be especially effective, at least in a majority of a population, and information that encourages mistrust or undermines social cohesion will lower treatment uptake.We also need to consider more focused strategies about treatment hesitancy for particular groups, including those groups who are most at risk of hesitancy and severe course of illness. As mental health clinicians, we assessed the impact of mental health conditions on hypertension medications treatment hesitancy and searched for current guidance in this area using a validated approach.9 We found that there is currently no specific guidance in addressing treatment hesitancy in get lasix those with mental health difficulties,10 although it is recognised that this is a high-risk group who should be monitored.

People with mental health issues, particularly with severe mental illness (SMI), are at particular risk both for with hypertension medications and for more severe complications and higher mortality.11 Historically, the uptake of similar treatments such as the influenza treatment in those with SMI can be as low as 25%,12 and so, similar to other low uptake groups, focused efforts are get lasix needed to increase this. Suggestions for change include offering specific discussions from mental health professionals and peer workers, treatment education and awareness focused for those with SMI, vaccination programmes within mental health services (with coexistent organisational change to facilitate this), alignment with other preventative health strategies (such as influenza vaccination, smoking cessation, metabolic monitoring), focused outreach and monitoring uptake.13Monitoring of vulnerable groups treatment uptake itself presents problems. In the example of the UK, get lasix monitoring of treatment coverage of most routine immunisation programmes relies on data extracted from primary care systems. To monitor vulnerable groups, the data need to be specifically recorded get lasix. For example, Public Health England’s national immunisation equity audit in 2019 identified inequalities in uptake by a number of important variables (such as age, geography, ethnicity) but could not assess others including mental illness due to a lack of systematically collected data.14 Inequalities that were assessed by the audit were not only in overall coverage but also in timing of treatments and completion of treatment schedules.

In addition, the extent of a particular inequality get lasix varies when it intersects with one or more other factors. In the case of mental illness, multiple long-term conditions across mental and physical health domains as well as socio-economic factors means that both vulnerability and inequality are likely to be additive.11 However, treatment impact may be greater among the most vulnerable despite lower treatment uptake because the baseline get lasix absolute risk is so high.15 Therefore, in the context of a hypertension medications treatment programme, even if treatment uptake falls short in some high-risk groups, even small increases in treatment uptake will still have significant health benefits.14Uptake of vaccination is crucial both for the individual and protection of others. It is in everyone’s interests to ensure that groups where a low uptake is predicted have extra care and input. At the moment there is little formal guidance on how to support those with mental health issues get lasix to access clear and reliable information, and practical and easy access to vaccination for those who are willing. If we are to ensure that ‘everyone is safe’, we need a concerted and global effort16 to guide and focus strategies to support and inform those who are both potentially most hesitant and most vulnerable, including and prioritising those with mental health difficulties..

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Lauren Gambill, MDPediatrician, AustinMember, Texas Medical Association (TMA) how to buy lasix online Committee on Child and Adolescent HealthExecutive Board Member, Texas Pediatric SocietyDoctors are read this community leaders. This role has become even more important during the hypertension medications lasix. As patients navigate our new how to buy lasix online reality, they are looking to us to determine what is safe, how to protect their families, and the future of their health care.

As more Texans lose their jobs, their health insurance, or even their homes, it is crucial that Texas receives the resources it needs to uphold our social safety net. The U.S. Census helps determine funding for those resources, and how to buy lasix online that is why it is of the upmost importance that each and every Texan, no matter address, immigration status, or age, respond to the 2020 U.S.

Census. The deadline how to buy lasix online has been cut short one month and now closes Sept. 30.hypertension medications has only increased the importance of completing the census to help our local communities and economies recover.

The novel hypertension has inflicted unprecedented strain on patients and exacerbated inequality as more people are out of work and are many in need of help with food, health care, housing, and more. Schools also have been stretched thin, with teachers how to buy lasix online scrambling to teach students online. Yet, the amount of federal funding Texas has available today to help weather this emergency was driven in part by the census responses made a decade ago.

Getting an accurate count in 2020 will help Texans prepare for the decade to follow, the first few years of which most certainly will be spent rebuilding from the lasix’s fallout. Therefore, it is vital that all Texans be counted.The federal dollars Texas receives generally depends on our population how to buy lasix online. A George Washington University study recently found that even a 1% undercount can lead to a $300 million loss in funding.Take Medicaid, for example.

Federal funds pay for 60% of the state’s program, which provides health coverage how to buy lasix online for two out of five Texas children, one in three individuals with disabilities, and 53% of all births. The complicated formula used to calculate the federal portion of this funding depends on accurate census data. If Texas’ population is undercounted, Texans may appear better off financially than they really are, resulting in Texas getting fewer federal Medicaid dollars.

If that happens, lawmakers will have to make up the difference, with cuts in services, program eligibility, or physician and provider payments, any of how to buy lasix online which are potentially detrimental.The census data also is key to funding other aspects of a community’s social safety net:Health careThe Children’s Health Insurance Program (CHIP) provides low-cost health insurance to children whose parents make too much to qualify for Medicaid, but not enough to afford quality coverage. Like Medicaid, how much money the federal government reimburses the state for the program depends in part on the census.Maternal and child health programs that promote public health and help ensure children are vaccinated relies on data from the census. Texas also uses this federal funding to study and respond to maternal mortality and how to buy lasix online perinatal depression.Food and housing As unemployment rises and families struggle financially, many live with uncertainty as to where they will find their next meal.

Already, one in seven Texans experiences food insecurity, and 20% of Texas children experience hunger. Food insecurity is rising in Texas as the lasix continues. The Central Texas how to buy lasix online Food Bank saw a 206% rise in clients in March.

Funding for the Supplemental Nutrition Assistance Program and school lunch programs are both determined by the census. Funding for local housing programs also is calculated via the census. An accurate count will help ensure that how to buy lasix online people who lose their homes during this economic crisis have better hope of finding shelter while our communities recover.

Homelessness is closely connected with declines in overall physical and mental health.Childcare and educationAs we navigate the new reality brought on by hypertension, more parents are taking on roles as breadwinner, parent, teacher, and caretaker. This stress how to buy lasix online highlights the desperate need for affordable childcare. The census determines funding for programs like Head Start that provide comprehensive early childhood education to low-income families.

The good news is you still have time to complete the census. Visit 2020census.gov how to buy lasix online to take it. It takes less than five minutes to complete.

Then talk to your family, neighbors, and colleagues about doing the same how to buy lasix online. If you are wondering who counts, the answer is everyone, whether it’s a newborn baby, child in foster care, undocumented immigrant, or an individual experiencing homelessness.Completing the census is one of the best things that you can do for the health of your community, especially during the lasix. Thank you for helping Texas heal and for supporting these essential safety net programs.(L to R).

UTHSA medical students Swetha Maddipudi, Brittany Hansen, Charles Wang, Carson Cortino, faculty advisor Kaparaboyna Kumar, MD, Ryan how to buy lasix online Wealther, Sidney Akabogu, Irma Ruiz, and Frank Jung pose with the TMA Be Wise Immunize banner. Photo courtesy by Ryan WealtherRyan WealtherMedical Student, UT Health San Antonio Long School of MedicineStudent Member, Texas Medical AssociationEditor’s Note. August is National Immunization Awareness Month.

This article is part of a Me&My Doctor series highlighting and promoting the use of how to buy lasix online vaccinations.“Can the flu shot give you the flu?. €â€œIs it dangerous for pregnant women to get a flu shot?. €â€œCan treatments how to buy lasix online cause autism?.

€These were questions women at Alpha Home, a residential substance abuse rehabilitation center in San Antonio, asked my fellow medical students and me during a flu treatment discussion. It is easy to see why these questions were asked, as treatment misinformation is common today.UTHSA medical student Frank Jing (left) gets a treatment fromKaparaboyna Kumar, MD, (right).Photo courtesy of Ryan Wealther“No” is the answer to all the questions. These were exactly the types of myths we set out to dispel at our how to buy lasix online vaccination drive.UT Health San Antonio Long School of Medicine medical students (under the supervision of Kaparaboyna Ashok Kumar, MD, faculty advisor for the Texas Medical Association Medical Student Section at UT Health San Antonio) hosted the treatment drive at Alpha Home with the support of TMA’s Be Wise – Immunize℠ program, a public health initiative that aims to increase vaccinations and treatment awareness through shot clinics and education.

Our program consisted of a vaccination drive and an interactive, educational presentation that addressed influenza, common flu shot questions, and general treatment myths. The Alpha Home residents could ask us questions during the program.We were interested to see if our educational program could answer Alpha Home residents’ questions about vaccinations and allay how to buy lasix online their hesitations about getting a flu vaccination. To gauge this, we created a brief survey.(Before I discuss the results of the survey, I should define treatment hesitancy.

treatment hesitancy is a concept defined by the World Health Organization. It relates to when patients do not how to buy lasix online vaccinate despite having access to treatments. treatment hesitancy is a problem because it prevents individuals from receiving their vaccinations.

That makes them more susceptible to getting sick from treatment-preventable diseases.)We surveyed the residents’ opinions about vaccinations before and after our educational program. While opinions about shots improved with each survey question, we saw the most significant attitude change reflected in answers to the questions “I am concerned that vaccinations might not be safe,” and “How likely are you to how to buy lasix online receive a flu shot today?. € We had informed the residents and improved their understanding and acceptance of immunizations.Post-survey results show more residents at the Alpha Home shifted to more positive attitudes about treatments, after learning more about their effectiveness by trusted members of the medical community.

Graph by how to buy lasix online Ryan WealtherWhy is this important?. First, our findings confirm what we already knew. Education by a trusted member of the medical community can effect change.

In fact, it is widely known that physician recommendation of vaccination is one of the most how to buy lasix online critical factors affecting whether patients receive an influenza vaccination. Perhaps some added proof to this is that a few of the Alpha Home residents were calling me “Dr. Truth” by the end of the evening.Second, our findings add to our understanding of adult how to buy lasix online treatment hesitancy.

This is significant because most of what we know about treatment hesitancy is limited to parental attitudes toward their children’s vaccinations. Some parents question shots for their children, and many of the most deadly diseases we vaccinate against are given in childhood, including polio, tetanus, measles, and whooping cough shots. However, adults need some vaccinations as well, like the yearly how to buy lasix online influenza treatment.

After taking part in the UTHSA educational program, more residents at the Alpha Home shared more willingness to receive the flu treatment. Graph by Ryan WealtherAnother reason improving attitudes is important is that receiving a flu shot is even more timely during the hypertension medications lasix because it decreases illnesses and conserves health care resources. Thousands of people each year are hospitalized how to buy lasix online from the flu, and with hospitals filling up with hypertension patients, we could avoid adding dangerously ill flu patients to the mix.

Lastly, these findings are important because once a hypertension medications vaccination becomes available, more people might be willing to receive it if their overall attitude toward immunizations is positive. Though the hypertension medications treatment is still in development, how to buy lasix online it is not immune to treatment hesitancy. Recent polls have indicated up to one-third of Americans would not receive a hypertension medications treatment even if it were accessible and affordable.

Work is already being done to try to raise awareness and acceptance. In addition, how to buy lasix online misinformation about the hypertension medications treatment is circulating widely. (Someone recently asked me if the hypertension medications treatment will implant a microchip in people, and I have seen the same myth circulating on social media.

It will not.) This myth, however, illustrates the need how to buy lasix online for health care professionals to answer patients’ questions and to assuage their concerns.treatments work best when many people in a community receive them, and treatment hesitancy can diminish vaccination rates, leaving people who can't get certain treatments susceptible to these treatment-preventable diseases. For example, babies under 6 months of age should not receive a flu shot, so high community vaccination rates protect these babies from getting sick with the flu. Our educational program at Alpha Home is just one example of how health care professionals can increase awareness and acceptance of shots.

As the hypertension medications lasix progresses, we need to how to buy lasix online ensure children and adults receive their vaccinations as recommended by their physician and the Centers for Disease Control and Prevention. I encourage readers who have questions about the vaccinations they or their child may need to talk with their physician. As health care professionals, we’re more than happy to answer your questions..

Lauren Gambill, MDPediatrician, AustinMember, Texas Medical Association (TMA) Committee on Child and Adolescent HealthExecutive Board Member, Texas Azithromycin zithromax 500mg price Pediatric SocietyDoctors get lasix are community leaders. This role has become even more important during the hypertension medications lasix. As patients navigate our new reality, they are looking get lasix to us to determine what is safe, how to protect their families, and the future of their health care. As more Texans lose their jobs, their health insurance, or even their homes, it is crucial that Texas receives the resources it needs to uphold our social safety net.

The U.S. Census helps determine funding for those resources, and that is why it is of the upmost importance that each and every Texan, no matter address, immigration status, or age, respond to get lasix the 2020 U.S. Census. The deadline has been cut short one month and get lasix now closes Sept.

30.hypertension medications has only increased the importance of completing the census to help our local communities and economies recover. The novel hypertension has inflicted unprecedented strain on patients and exacerbated inequality as more people are out of work and are many in need of help with food, health care, housing, and more. Schools also have been stretched thin, with teachers scrambling get lasix to teach students online. Yet, the amount of federal funding Texas has available today to help weather this emergency was driven in part by the census responses made a decade ago.

Getting an accurate count in 2020 will help Texans prepare for the decade to follow, the first few years of which most certainly will be spent rebuilding from the lasix’s fallout. Therefore, it is vital that all Texans be counted.The federal dollars Texas receives generally depends get lasix on our population. A George Washington University study recently found that even a 1% undercount can lead to a $300 million loss in funding.Take Medicaid, for example. Federal funds pay for 60% of the state’s program, which provides health coverage for two out of get lasix five Texas children, one in three individuals with disabilities, and 53% of all births.

The complicated formula used to calculate the federal portion of this funding depends on accurate census data. If Texas’ population is undercounted, Texans may appear better off financially than they really are, resulting in Texas getting fewer federal Medicaid dollars. If that happens, lawmakers will have to make up the difference, with cuts in services, program eligibility, or physician and provider payments, any of which are potentially detrimental.The census data also is key to funding other aspects get lasix of a community’s social safety net:Health careThe Children’s Health Insurance Program (CHIP) provides low-cost health insurance to children whose parents make too much to qualify for Medicaid, but not enough to afford quality coverage. Like Medicaid, how much money the federal government reimburses the state for the program depends in part on the census.Maternal and child health programs that promote public health and help ensure children are vaccinated relies on data from the census.

Texas also uses this federal funding to study and respond to get lasix maternal mortality and perinatal depression.Food and housing As unemployment rises and families struggle financially, many live with uncertainty as to where they will find their next meal. Already, one in seven Texans experiences food insecurity, and 20% of Texas children experience hunger. Food insecurity is rising in Texas as the lasix continues. The Central Texas Food Bank saw a 206% rise get lasix in clients in March.

Funding for the Supplemental Nutrition Assistance Program and school lunch programs are both determined by the census. Funding for local housing programs also is calculated via the census. An accurate count will help ensure that people who lose their homes during this economic crisis have better hope of finding shelter while our communities get lasix recover. Homelessness is closely connected with declines in overall physical and mental health.Childcare and educationAs we navigate the new reality brought on by hypertension, more parents are taking on roles as breadwinner, parent, teacher, and caretaker.

This stress highlights the desperate need for get lasix affordable childcare. The census determines funding for programs like Head Start that provide comprehensive early childhood education to low-income families. The good news is you still have time to complete the census. Visit 2020census.gov get lasix to take it.

It takes less than five minutes to complete. Then talk to your get lasix family, neighbors, and colleagues about doing the same. If you are wondering who counts, the answer is everyone, whether it’s a newborn baby, child in foster care, undocumented immigrant, or an individual experiencing homelessness.Completing the census is one of the best things that you can do for the health of your community, especially during the lasix. Thank you for helping Texas heal and for supporting these essential safety net programs.(L to R).

UTHSA medical students Swetha Maddipudi, Brittany Hansen, Charles Wang, Carson Cortino, faculty advisor Kaparaboyna Kumar, MD, Ryan Wealther, Sidney Akabogu, Irma Ruiz, and get lasix Frank Jung pose with the TMA Be Wise Immunize banner. Photo courtesy by Ryan WealtherRyan WealtherMedical Student, UT Health San Antonio Long School of MedicineStudent Member, Texas Medical AssociationEditor’s Note. August is National Immunization Awareness Month. This article is part of a Me&My Doctor series highlighting and promoting the use of get lasix vaccinations.“Can the flu shot give you the flu?.

€â€œIs it dangerous for pregnant women to get a flu shot?. €â€œCan treatments get lasix cause autism?. €These were questions women at Alpha Home, a residential substance abuse rehabilitation center in San Antonio, asked my fellow medical students and me during a flu treatment discussion. It is easy to see why these questions were asked, as treatment misinformation is common today.UTHSA medical student Frank Jing (left) gets a treatment fromKaparaboyna Kumar, MD, (right).Photo courtesy of Ryan Wealther“No” is the answer to all the questions.

These were exactly the types of myths we set out to dispel at our vaccination drive.UT Health San Antonio Long School of Medicine medical students (under the supervision of Kaparaboyna Ashok Kumar, MD, faculty advisor for the Texas Medical Association Medical Student Section at UT Health San Antonio) hosted the get lasix treatment drive at Alpha Home with the support of TMA’s Be Wise – Immunize℠ program, a public health initiative that aims to increase vaccinations and treatment awareness through shot clinics and education. Our program consisted of a vaccination drive and an interactive, educational presentation that addressed influenza, common flu shot questions, and general treatment myths. The Alpha Home residents could ask us questions during the program.We were interested to see if our educational get lasix program could answer Alpha Home residents’ questions about vaccinations and allay their hesitations about getting a flu vaccination. To gauge this, we created a brief survey.(Before I discuss the results of the survey, I should define treatment hesitancy.

treatment hesitancy is a concept defined by the World Health Organization. It relates to when patients do not vaccinate despite having access to get lasix treatments. treatment hesitancy is a problem because it prevents individuals from receiving their vaccinations. That makes them more susceptible to getting sick from treatment-preventable diseases.)We surveyed the residents’ opinions about vaccinations before and after our educational program.

While opinions about shots improved with each survey question, we saw the most significant attitude change reflected in answers to the questions “I am concerned that vaccinations might not be safe,” and “How likely are you to receive a flu shot today? get lasix. € We had informed the residents and improved their understanding and acceptance of immunizations.Post-survey results show more residents at the Alpha Home shifted to more positive attitudes about treatments, after learning more about their effectiveness by trusted members of the medical community. Graph by Ryan WealtherWhy get lasix is this important?. First, our findings confirm what we already knew.

Education by a trusted member of the medical community can effect change. In fact, it is widely get lasix known that physician recommendation of vaccination is one of the most critical factors affecting whether patients receive an influenza vaccination. Perhaps some added proof to this is that a few of the Alpha Home residents were calling me “Dr. Truth” by the end of the evening.Second, our findings add to our understanding of adult get lasix treatment hesitancy.

This is significant because most of what we know about treatment hesitancy is limited to parental attitudes toward their children’s vaccinations. Some parents question shots for their children, and many of the most deadly diseases we vaccinate against are given in childhood, including polio, tetanus, measles, and whooping cough shots. However, adults need some vaccinations as get lasix well, like the yearly influenza treatment. After taking part in the UTHSA educational program, more residents at the Alpha Home shared more willingness to receive the flu treatment.

Graph by Ryan WealtherAnother reason improving attitudes is important is that receiving a flu shot is even more timely during the hypertension medications lasix because it decreases illnesses and conserves health care resources. Thousands of people each year get lasix are hospitalized from the flu, and with hospitals filling up with hypertension patients, we could avoid adding dangerously ill flu patients to the mix. Lastly, these findings are important because once a hypertension medications vaccination becomes available, more people might be willing to receive it if their overall attitude toward immunizations is positive. Though the hypertension medications treatment is still in development, it get lasix is not immune to treatment hesitancy.

Recent polls have indicated up to one-third of Americans would not receive a hypertension medications treatment even if it were accessible and affordable. Work is already being done to try to raise awareness and acceptance. In addition, misinformation about the hypertension medications treatment is circulating get lasix widely. (Someone recently asked me if the hypertension medications treatment will implant a microchip in people, and I have seen the same myth circulating on social media.

It will not.) This myth, however, illustrates the need for health care professionals to answer patients’ questions and to assuage their concerns.treatments work best when many people in a community receive them, and treatment hesitancy can diminish vaccination rates, leaving people who can't get certain treatments susceptible to get lasix these treatment-preventable diseases. For example, babies under 6 months of age should not receive a flu shot, so high community vaccination rates protect these babies from getting sick with the flu. Our educational program at Alpha Home is just one example of how health care professionals can increase awareness and acceptance of shots. As the hypertension medications lasix progresses, we need get lasix to ensure children and adults receive their vaccinations as recommended by their physician and the Centers for Disease Control and Prevention.

I encourage readers who have questions about the vaccinations they or their child may need to talk with their physician. As health care professionals, we’re more than happy to answer your questions..