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You have to go to extreme lengths buy propecia from canada to find places on Earth that don’t reveal that they’re part visit our website of a water-rich planet. Even the highest and driest deserts, like the Atacama Plateau in South America, still get a minimum of a couple of millimeters of annual precipitation on average (although there are places where we don’t yet know what the average is because it’s simply not rained for years). And if you whip out your handy mass spectrometer on a desert buy propecia from canada walkabout the chances are that you’ll be able to detect at least a few atmospheric water molecules. Go elsewhere, and it’s hard to imagine anything but a water-logged world.

More than 70 percent of Earth’s surface is covered in oceans and roughly 97 percent of the surface water is in those oceans, leaving a scant 1 percent as freshwater. Water is also seldom static, whether it’s flowing in ocean currents or being evaporated and buy propecia from canada precipitated. Averaged out over the planet there is about 100 centimeters of rainfall a year, but that’s across a total surface area of around 5.1x1018 square centimeters. In other words, doing the back-of-the-envelope calculation, some 510 trillion metric tons of water gets evaporated and then re-precipitated every year on Earth.

But the catch is that we don’t really know buy propecia from canada where all of this water came from in the first place. For a long while our picture of the formation of a rocky planet like the Earth has involved a violent, hot assembly some 4.5 billion years ago out of comparatively dry material in the inner solar system. Water would have come along later, with proposals for possible delivery by comets from the chill, frozen outer solar system, or by rocky but still volatile-rich meteoritic infall. But these options have proven tricky to justify completely for a variety of reasons buy propecia from canada.

Comets, for instance, often (but not always) have a deuterium concentration that doesn’t match what we see in Earth’s water—limiting their likely contribution. Similarly, water-rich rocky meteoritic material—so-called carbonaceous chondrites—have isotopic differences that could also limit buy propecia from canada how much they contributed to a young planet. At the same time, the representative type of material for building the entirety of a rocky Earth (and matching the planet’s overall isotopic composition in elements like oxygen and calcium) seems to closely resemble what’s called enstatite chondrite. Chunks of enstatite chondrite are still around in the solar system, and occasionally fall as meteorites.

But they’ve been thought to be too dry to be involved buy propecia from canada in Earth’s water supply. Now, in a work reported by Piani, et al. In the journal Science, an analysis of the composition of 13 enstatite chondrite meteorite samples reveals a much higher than expected hydrogen content. Extrapolating from buy propecia from canada these numbers the researchers claim that if this is the type of protoplanetary material that built Earth, it could have resulted in a total, initial water content of at least three times the present mass of water in our oceans.

The same material could have also provided a starter mix of atmospheric nitrogen to the young planet. This possibility is enormously appealing for its relative simplicity. Our wet world was simply made this way from the very beginning, with little need buy propecia from canada to invoke any more complex evolution except for a small drizzling from comets and other outer solar system material. Whether or not this idea holds up to further scientific scrutiny, it’s a beautiful reminder that even the simplest things in our lives, like a glass of water or a shower in the morning, are actually windows into the deepest origins of everything we know.Scientists just completed one of the most comprehensive investigations of Earth’s climate history—and the findings aren’t favorable.

They found that the planet could eventually warm to levels it hasn’t reached in at least 34 million years. The researchers, led by Thomas Westerhold of buy propecia from canada the University of Bremen in Germany, constructed datasets using chemical analyses of ancient sediments, drilled from the bottom of the ocean. These sediments, some of which are 66 million years old, are filled with the preserved shells of tiny organisms that can tell scientists about the temperature and chemical composition of the ocean when they were formed. The sediments, buy propecia from canada collected from around the world over the course of many years, allowed the researchers to reconstruct Earth’s climate history going back to the mass extinction that killed three-quarters of the planet’s species, including dinosaurs.

They found that the planet has passed through four distinct climate phases. Warmhouse, hothouse, coolhouse and icehouse states. Transitions from one buy propecia from canada state to another have generally depended on changing greenhouse gas levels, often driven by volcanic eruptions and other natural processes, and shifts in the Earth’s orbit that affected the amount of solar energy reaching the planet. In the hottest phases, more than 50 million years ago, temperatures on Earth were more than 10 degrees Celsius hotter than they are today.

But it’s important to note that it took the planet thousands or even millions of years to reach these levels—and that was long before humans ever walked the Earth. That’s in stark contrast to buy propecia from canada the kind of climate change that human activity is driving today. For several million years now, the world has been in an icehouse state. But that’s quickly changing.

If human societies do nothing to curb their greenhouse gas emissions, in just a buy propecia from canada few centuries the Earth could once again reach a temperature threshold not seen for at least 34 million years. Before the industrial era, such a magnitude of warming would have taken thousands of years to occur, at least. €œIf you look at the worst-case scenario [by 2300], the change in mean global temperature is larger than most of the natural variability going back over the last 66 million years related to changes in the Earth’s orbit,” said Jim Zachos, a paleoclimatologist at the University of California, Santa Cruz, and a co-author buy propecia from canada of the new study, which was published Thursday in the journal Science. It’s not an inevitable future.

With immediate and stringent action to reduce climate change, the world can keep global temperatures from rising more than a few degrees above their preindustrial levels. But the study does warn that without these efforts, Earth is on track for some of the strongest, fastest buy propecia from canada climate change the planet has ever experienced. The study may also provide some important insights into how climate change could unfold in the coming decades and centuries. Earth’s climate doesn’t always shift in linear, predictable ways.

There are all kinds of feedback buy propecia from canada processes that can speed things up or slow things down—such as the speed at which glaciers and sea ice melt or the way that clouds change in response to future warming. In the ancient past, for instance, the study suggests that the world’s ice sheets played an important role in regulating the pace and predictability of the Earth’s climate response to natural changes in greenhouse gases or orbital shifts. Today, scientists believe that the world’s melting ice may also have a big impact on future climate change. These kinds of feedback buy propecia from canada processes can make it challenging to predict future change, especially over relatively short periods of time.

Reconstructing the Earth’s long-term climate history can help scientists test the models they use to predict its future. If a model can accurately simulate the past, scientists may have more confidence in its ability to simulate present-day climate processes. €œThat’s the beauty buy propecia from canada of this record,” Zachos said. €œIt’s something we’ve always wanted to have because of the applicability to testing climate theory.” Reprinted from Climatewire with permission from E&E News.

E&E provides daily buy propecia from canada coverage of essential energy and environmental news at www.eenews.net.Woo-hoo, d’oh, or meh?. Which of these Simpsonian reactions is appropriate to the fact, revealed by a 2019 survey conducted by researchers at Penn State University and the National Center for Science Education (NCSE), that about two in three—67 percent—of public high school biology teachers are presenting evolution forthrightly, emphasizing the broad scientific consensus on evolution while not giving any credence to creationism?. Only in the context of the long and contentious history of evolution education in the United States is it clear what the most plausible answer is. American teachers have not buy propecia from canada always been afforded the luxury of teaching evolution forthrightly.

John Thomas Scopes, for example, was famously prosecuted for violating Tennessee’s ban on teaching evolution in 1925. Although his conviction was subsequently overturned, a national survey of high school biology teachers conducted in 1939–1940 revealed that only about half were teaching evolution as a central principle of biology. And bans on teaching buy propecia from canada evolution remained in place in Arkansas, Mississippi and Tennessee until 1970. New obstacles then emerged, particularly requirements to teach various forms of creationism as alternatives to evolution.

As recently as 15 years ago, in Dover, Pennsylvania, the local school board attempted to require its high school biology teachers to read a statement to their ninth-grade students describing “Darwin’s theory of evolution” as “not a fact,” and commending “intelligent design”—then a trendy slogan for creationism—to their attention as a scientifically credible alternative. The teachers, buy propecia from canada to their credit, unanimously refused to comply. But their refusal, together with the controversy surrounding the related trial over the constitutionality of the board’s actions, Kitzmiller v. Dover, intrigued two parents a hundred miles to the northwest, in buy propecia from canada State College, Pa.

Michael Berkman and Eric Plutzer were not just any concerned parents, though. They were political scientists at Penn State with a particular interest in education policy. What—they wondered—are high school biology teachers teaching about evolution, and what factors buy propecia from canada influence their teaching practices?. To satisfy their curiosity, Berkman and Plutzer conducted the first modern national survey of high school biology teachers in 2007.

The results were dire. Only a slight majority, 51 percent, reported that they emphasized the broad scientific consensus on evolution while not giving any credence to creationism, buy propecia from canada as if to suggest no progress in the 67 years since the less rigorous survey of 1939–1940. That’s why the results of the 2019 survey—a collaboration between Plutzer and the NCSE—are so encouraging. Between 2007 and 2019, there definitely was progress.

From 51 percent of high school biology teachers reporting emphasizing evolution and not creationism in 2007 to 67 percent in 2019 buy propecia from canada. It was matched by a drop from 23 to 12 percent of teachers who offer mixed messages by endorsing both evolution and creationism as a valid scientific alternative to evolution, from 18 to 15 percent of teachers who endorse neither evolution nor creationism, and from 8.6 to 5.6 percent of teachers who endorse creationism while not endorsing evolution. Credit. National Center buy propecia from canada for Science Education What accounts for the improvement?.

Did intelligent design’s crushing defeat in the Kitzmiller trial make the difference?. Probably not buy propecia from canada. Science teachers are guided not by case law but by state science standards, which specify what students in the state’s public schools are expected to learn. Standards thus influence the content of textbooks, statewide testing, and coursework for pre-service and in-service teachers.

Importantly, they buy propecia from canada also provide a shield for teachers facing misguided community pressure over socially contentious topics like evolution. The results of the 2019 survey suggest that a concerted effort to improve state science standards helped to improve evolution education. The Next Generation Science Standards (NGSS), which debuted in 2013, include “Biological Evolution. Unity and Diversity” as buy propecia from canada a disciplinary core idea of the life sciences at the middle and high school levels.

By now, 20 states (plus the District of Columbia) have adopted the NGSS, and a further 24 states have adopted standards based on the same evolution-friendly framework on which the NGSS are based. Were states that adopted the NGSS especially hospitable to the teaching of evolution?. Not buy propecia from canada really. In 2007, their teachers were less likely to endorse evolution and not creationism than the national average.

By 2019, they were more likely. While a variety of explanations are possible, teachers in NGSS states reported having taken more pre-service and in-service coursework in evolution than their colleagues elsewhere, suggesting that the increased expectations impelled both novice and veteran teachers to upgrade their content knowledge of buy propecia from canada evolution. Despite the encouraging trend over a mere dozen years, there is still reason for concern. After all, more than buy propecia from canada one in six high school biology teachers, 17.6 percent, are still presenting creationism as a scientifically credible alternative to evolution.

And almost as many high school biology teachers, 15 percent, are still failing to emphasize the broad scientific consensus on evolution, despite its general prevalence in state science standards and despite encouragement from professional organizations. D’oh!. With 13,500-odd local school districts having primary responsibility for curriculum buy propecia from canada and instruction, changes to science education are inevitably going to be slow, scattered and incremental. Still, with the aid of uncounted scientists, educators, policymakers, administrators and concerned citizens in general (and perhaps even a certain episode of The Simpsons), clear and convincing improvements for evolution education were demonstrably attained in just a dozen years.

It is a victory worth not only celebrating—woo-hoo!. €”but also enlarging upon.ARGENTINA The earliest dinosaurs laid soft-shelled buy propecia from canada eggs, paleontologists say. A new chemical analysis of a more than 200-million-year-old fossilized egg from Patagonia—and a clutch of more recent eggs from Mongolia, found in the Gobi Desert—revealed a thin film matching the characteristics of modern soft-shelled eggs. ENGLAND Archaeologists found that 20 deep shafts, previously thought to be natural sinkholes and ponds, were dug by Neolithic humans.

The shafts form a circle two kilometers in diameter, with the Durrington Walls monument at buy propecia from canada its center, just three kilometers from Stonehenge. BRAZIL In a new paper, researchers documented the largest lightning bolt ever recorded. The “mega-flash,” which buy propecia from canada extended for more than 700 kilometers in southern Brazil in 2018, was detected by a new advanced weather satellite in geostationary orbit. ISRAEL Researchers sequenced DNA samples from the Dead Sea Scrolls, identifying fragments made from sheep skin and others made from cow hide.

The technique could help match fragments together and unravel the artifacts' geographic origins. INDONESIA Scientists buy propecia from canada identified an elusive nose-horned dragon lizard in the forests of North Sumatra. Despite appearing in the mythology of the indigenous Bataks, the visually striking species had been spotted by scientists only once before—almost 130 years ago. AUSTRALIA Submarine drones uncovered an extensive system of underwater “rivers” of dense, salty water along Australia's continental shelf.

These flows carry organic matter from the coast into the deep ocean, and their volume varies seasonally, peaking in winter.The items below are buy propecia from canada highlights from the free newsletter, “Smart, useful, science stuff about COVID-19.” To receive newsletter issues daily in your inbox, sign-up here.. Please consider a monthly contribution to support this newsletter. At Nature, Nicky Phillips, David Cyranoski and Smriti Mallapaty covered the announcement that a collaboration between researchers at AstraZeneca and the University of Oxford is pausing Phase 3 vaccine-candidate experiments due to a “suspected adverse event” in a study participant in the UK (9/9/20). The collaboration’s Phase 3 studies are buy propecia from canada being paused in the U.S., Brazil, South Africa and the UK, Nature reports.

€œThe news highlights the importance of waiting for the results of large, properly designed trials [experiments] to assess safety before approving a vaccine for widespread use,” the story states. Investigators will start by trying to find out if the participant received the vaccine candidate or a placebo, the story states. And then if it was the buy propecia from canada vaccine, they will assess whether the participant’s reaction is related or unrelated to receiving it. €œI have every confidence that this group [of investigators] will very quickly assess this adverse event and make the results of that investigation known,” said a McGill University bioethicist quoted in the story.

Presumably in response to reports of political pushing for approvals this fall, the chief executive officers (CEOs) of 9 pharmaceutical companies released a pledge (dated 9/8/20) to “uphold the integrity of the scientific process as they work towards potential global regulatory filings and approvals of the first COVID-19 vaccines.” The CEOs — including those for AstraZeneca, BioNTech, GlaxoSmithKline, Johnson & buy propecia from canada. Johnson, Merck, Moderna, and Pfizer — assert they will “only submit for approval or emergency use authorization after demonstrating safety and efficacy through a Phase 3 clinical study that is designed and conducted to meet requirements of expert regulatory authorities such as [the U.S. Food and Drug Administration].” In other words, they don’t plan to cut any corners in their research nor to yield to political pressure. For more contextualized commentary on what Ed Silverman buy propecia from canada describes as a “highly unusual turn of events," see his column at STAT (9/7/20).

Meanwhile, the U.S. Food and Drug Administration (FDA) has quickly taken measures to block any political influence over ongoing research to develop vaccines to protect us from SARS-CoV-2, report Anna Edney, Drew Armstrong, and Robert Langreth for Bloomberg (9/8/20). One measure reportedly includes the FDA “sticking by" June guidance that the agency will only consider buy propecia from canada for approval vaccine candidates that are at least 50% effective. Lower down in the story, the reporters write, “There is no guarantee the vaccines furthest along in development will be the most effective, or be safe.” And it could take “months more” for Phase 3 findings to be conclusive, the story suggests.

Still, the story ends with estimates by drug makers for how soon they might complete their Phase 3 studies (efficacy and safety experiments in thousands of study subjects) of SARS-CoV-2 vaccine candidates. Moderna reportedly says buy propecia from canada as soon as Thanksgiving, and Pfizer reportedly has been saying next month. I remain reasonably skeptical. On Twitter, I came buy propecia from canada across a searchable web site called “Dear Pandemic,” which bills itself as an “interdisciplinary all-female team of researchers and clinicians with expertise including nursing, mental health, demography, health policy/economics, and epidemiology.” Posts date back to July but the site appears to have officially launched 9/10/20.

Their mission is to “educate and empower individuals to successfully navigate the COVID-19 information overwhelm.” About two-thirds of the way down the home page, there’s a “submit a question” link. And below that, previous posts are indexed by topic and dates. The risk of catching SARS-CoV-2 on an airplane is “relatively low” if travelers are screened for sickness, wear masks, buy propecia from canada and are spaced out among seats, according to experts interviewed by Noah Y. Kim for Kaiser Health News (9/10/20).

The air exchange rate and use of HEPA (high-efficiency particulate air) filters on planes also significantly reduce the risk of catching the virus from travelers who are several rows away, according to the story. There is still a risk from an buy propecia from canada infected person seated nearby, the story states. And air filtration alone is insufficient to prevent transmission even when travelers are distanced in the plane, Kim writes. Delta, Hawaiian, Southwest and JetBlue currently keep middle seats open, the story states.

Security checks and buy propecia from canada waiting at gates also pose some transmission risk. The U.S. Centers for Disease Control has not confirmed any SARS-CoV-2 transmission aboard a U.S. Flight, an airline industry source says in the story, but that might reflect the buy propecia from canada difficulty of determining where people in the U.S.

Contract the virus, Kim writes. €œEven though flying is a relatively low-risk buy propecia from canada activity,” the story states, “traveling should still be avoided unless absolutely necessary.” An undated, recently published ESPN interactive, bylined by Kyle Bonagura, illustrates its analysis and mapping of anonymized cellphone tracking data for three 2019 U.S. College football games. The maps provide a sense of where fans travel to and disperse to after games and thus the regional concentration of potential SARS-CoV-2 (and other infectious disease) spread resulting from the mixing of people before, during and after big match-ups.

The piece includes updates on some of the football conferences’ plans and protocols for the 2020 season. The Big Ten and Pac-12 have postponed their seasons, whereas the SEC (Southeastern Conference) seems to be allowing each school to set its own attendance guidelines. I can’t pretend to follow NCAA (National Collegiate Athletic Association) football designations but some or all of the NCAA teams drew “more than 47.5 million" attendees last season, the piece states. €œEven with fewer teams in action and limited-capacity crowds, the prospect that college football could play a role in spreading the coronavirus is too obvious to ignore,” the story states.

Thanks to a reader for alerting me to this piece. Check out “To build emotional strength, expand your brain,” by Kerry Hannon at The New York Times (9/2/20). It basically asserts that learning new material, such as a language or craft, that expands your horizons helps you deal with change and crisis, such as the coronavirus pandemic. Near the end, the piece lists some free or low-cost online class sites and some programs that allow nontraditional students to audit classes or work on projects with enrolled graduate and undergraduate students.

You might enjoy “Looks like I wasn’t muted during our Zoom meeting,” by Susie Aquilina, for McSweeney’s (9/10/20)..

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Exercise makes it easier to bounce back from too much stress, according to a fascinating new study with mice is propecia dangerous. It finds that regular exercise increases the levels of a chemical in the animals’ brains that helps them remain psychologically resilient and plucky, even when their lives seem suddenly strange, intimidating and filled with threats.The study involved mice, but it is likely to have implications for our species, too, as we face the stress and discombobulation of the ongoing pandemic and today’s political and social disruptions.Stress can, of course, be our ally. Emergencies and perils require immediate responses, and stress results in a fast, helpful flood of hormones and other chemicals that prime our bodies to act.“If a tiger jumps out is propecia dangerous at you, you should run,” says David Weinshenker, a professor of human genetics at Emory University School of Medicine in Atlanta and the senior author of the new study. The stress response, in that situation, is appropriate and valuable.But if, afterward, we “jump at every little noise” and shrink from shadows, we are overreacting to the original stress, Dr.

Weinshenker continues is propecia dangerous. Our response has become maladaptive, because we no longer react with appropriate dread to dreadful things but with twitchy anxiety to the quotidian. We lack stress resilience.In interesting past research, is propecia dangerous scientists have shown that exercise seems to build and amplify stress resilience. Rats that run on wheels for several weeks, for instance, and then experience stress through light shocks to their paws, respond later to unfamiliar — but safe — terrain with less trepidation than sedentary rats that also experience shocks.But the physiological underpinnings of the animals’ relative buoyancy after exercise remain somewhat mysterious.

And, rats is propecia dangerous are just one species. Finding similar relationships between physical activity and resilience in other animals would bolster the possibility that a similar link exists in people.So, for the new study, which was published in August in the Journal of Neuroscience, Dr. Weinshenker and his colleagues decided to work with frazzled mice and to focus on the possible effects of galanin, a peptide that is produced throughout the body in many animals, including humans.Galanin is known to be associated is propecia dangerous with mental health. People born with genetically low levels of galanin face an uncommonly high risk of depression and anxiety disorders.Multiple studies show that exercise increases production of the substance.

In the rat experiments, some of which were conducted at Dr is propecia dangerous. Weinshenker’s lab, researchers found that exercise led to a surge in galanin production in the animals’ brains, particularly in a portion of the brain that is known to be involved in physiological stress reactions. Perhaps most interesting, they also found that the more galanin there, the greater the rats’ subsequent stress resilience.For the new research, they is propecia dangerous gathered healthy adult male and female mice and gave some of them access to running wheels in their cages. Others remained inactive.

Mice generally seem to enjoy running, and those with wheels skittered through is propecia dangerous multiple miles each day. After three weeks, the scientists checked for genetic markers of galanin in the mouse brains and found them to be much higher in the runners, with greater mileage correlating with more galanin.Then the scientists stressed out all of the animals by lightly shocking their paws while the mice were restrained and could not dash away. This method does not physically harm the mice but does spook them, which the is propecia dangerous scientists confirmed by checking for stress hormones in the mice. They had soared.The next day, the scientists placed runners and inactive animals in new situations designed to worry them again, including cages with both light, open sections and dark, enclosed areas.

Mice are prey animals and their natural reaction is to run for the darkness and then, as they feel safe, explore the open spaces. The runners responded now like normal, is propecia dangerous healthy mice, cautiously moving toward the light. But the sedentary animals tended to cower in the shadows, still too overwhelmed by stress to explore. They lacked resilience.Finally, the researchers confirmed that galanin played a pivotal role in the animals’ stress resilience by is propecia dangerous breeding mice with unusually high levels of the substance.

Those rodents reacted like the runners to the stress of foot shocks, with full-body floods of stress hormones. But the next day, like the runners, they warily braved the well-lit portions of is propecia dangerous the light-and-dark cage, not recklessly but with suitable prudence.The upshot of these experiments is that abundant galanin seems to be crucial for resilience, at least in rodents, says Rachel P. Tillage, a Ph.D. Candidate in is propecia dangerous Dr.

Weinshenker’s lab who led the new study. And exercise increases galanin, amplifying the animals’ ability to remain stalwart in the face of whatever obstacles life — and science — places before them.Of course, this was a mouse study and mice are not people, so it is impossible to know from this research if exercise and galanin function precisely the same way in us, or, if they do, what amounts and types of exercise might best help us to cope with stress.But regular exercise is so good for us, anyway, that deploying it now to potentially help us deal with is propecia dangerous today’s uncertainties and worries “just makes good sense,” Dr. Weinshenker says.The medical mistakes that befell the 87-year-old mother of a North Carolina pharmacist should not happen to anyone, and my hope is that this column will keep you and your loved ones from experiencing similar, all-too-common mishaps.As the pharmacist, Kim H. DeRhodes of Charlotte, N.C., recalled, it all began when her mother went to the emergency is propecia dangerous room two weeks after a fall because she had lingering pain in her back and buttocks.

Told she had sciatica, the elderly woman was prescribed prednisone and a muscle relaxant. Three days later, she became delirious, returned to the E.R., was admitted to the hospital, and was discharged two days later when her drug-induced delirium resolved.A few weeks later, stomach pain is propecia dangerous prompted a third trip to the E.R. And a prescription for an antibiotic and proton-pump inhibitor. Within a month, is propecia dangerous she developed severe diarrhea lasting several days.

Back to the E.R., and this time she was given a prescription for dicyclomine to relieve intestinal spasms, which triggered another bout of delirium and three more days in the hospital. She was discharged after lab tests and imaging studies revealed nothing abnormal.“Review of my is propecia dangerous mother’s case highlights separate but associated problems. Likely misdiagnosis and inappropriate prescribing of medications,” Ms. DeRhodes wrote in JAMA Internal Medicine.

€œDiagnostic errors led to the use of prescription drugs that were not indicated and caused my mother further is propecia dangerous harm. The muscle relaxer and prednisone led to her first incidence of delirium. Prednisone likely led to the gastrointestinal issues, and the antibiotic likely led to the diarrhea, which led to the prescribing of dicyclomine, which led to the second incidence of delirium.”The doctors who wrote the woman’s prescriptions apparently never consulted the Beers Criteria, a list created by the American Geriatrics Society of drugs often unsafe for the elderly.In short, Ms is propecia dangerous. DeRhodes’s mother was a victim of two medical problems that are too often overlooked by examining doctors and unrecognized by families.

The first is giving is propecia dangerous an 87-year-old medications known to be unsafe for the elderly. The second is a costly and often frightening medically induced condition called “a prescribing cascade” that starts with drug-induced side effects which are then viewed as a new ailment and treated with yet another drug or drugs that can cause still other side effects.I’d like to think that none of this would have happened if instead of going to the E.R. The older woman had seen her primary care is propecia dangerous doctor. But experts told me that no matter where patients are treated, they are not immune to getting caught in a prescribing cascade.

The problem also can happen to people who self-treat with over-the-counter or herbal remedies is propecia dangerous. Nor is it limited to the elderly. Young people is propecia dangerous can also become victims of a prescribing cascade, Ms. DeRhodes said.“Doctors are often taught to think of everything as a new problem,” Dr.

Timothy Anderson, internist at Beth Israel Deaconess Medical Center in is propecia dangerous Boston, said. €œThey have to start thinking about whether the patient is on medication and whether the medication is the problem.”“Doctors are very good at prescribing but not so good at deprescribing,” Ms. DeRhodes said is propecia dangerous. €œAnd a lot of times patients are given a prescription without first trying something else.”A popular treatment for high blood pressure, which afflicts a huge proportion of older people, is a common precipitant of the prescribing cascade, Dr.

Anderson said.He cited a is propecia dangerous Canadian study of 41,000 older adults with hypertension who were prescribed drugs called calcium channel blockers. Within a year after treatment began, nearly one person in 10 was given a diuretic to treat leg swelling caused by the first drug. Many were inappropriately prescribed is propecia dangerous a so-called loop diuretic that Dr. Anderson said can result in dehydration, kidney problems, lightheadedness and falls.Type 2 diabetes is another common condition in which medications are often improperly prescribed to treat drug-induced side effects, said Lisa M.

McCarthy, doctor of pharmacy at the University of Toronto who directed the Canadian study. Recognizing a side effect is propecia dangerous for what it is can be hampered when the effect doesn’t happen for weeks or even months after a drug is started. While patients taking opioids for pain may readily recognize constipation as a consequence, Dr. McCarthy said that over time, patients taking metformin for diabetes can develop diarrhea and is propecia dangerous may self-treat with loperamide, which in turn can cause dizziness and confusion.Dr.

Paula Rochon, geriatrician at Women’s College Hospital in Ontario, said patients taking a drug called a cholinesterase inhibitor to treat early dementia can develop urinary incontinence, which is then treated with another drug that can worsen the patient’s confusion.Complicating matters is the large number of drugs some people take. €œOlder adults frequently take many medications, with two-fifths taking is propecia dangerous five or more,” Dr. Anderson wrote in JAMA Internal Medicine. In cases of polypharmacy, as this is called, it can be hard to determine which, if any, of the drugs a person is propecia dangerous is taking is the cause of the current symptom.Dr.

Rochon emphasized that a prescribing cascade can happen to anybody. She said, “Everyone needs to consider the possibility every time a drug is prescribed.”Before accepting a prescription, she recommended that patients or their caregivers should ask the doctor a series of questions, starting with “Am I experiencing a symptom that could be a side effect of a is propecia dangerous drug I’m taking?. € Follow-up questions should include:Is this new drug being used to treat a side effect?. Is there a safer drug available than the is propecia dangerous one I’m taking?.

Could I take a lower dose of the prescribed drug?. Most important, is propecia dangerous Dr. Rochon said, patients should ask “Do I need to take this drug at all?. €Patients and doctors alike often overlook or resist alternatives to medication that may be is propecia dangerous more challenging to adopt than swallowing a pill.

For example, among well-established nondrug remedies for hypertension are weight loss, increasing physical activity, consuming less salt and other sources of sodium, and eating more potassium-rich foods like bananas and cantaloupe.For some patients, frequent use of a nonsteroidal anti-inflammatory drug sold over-the-counter, like ibuprofen or naproxen, is responsible for their elevated blood pressure.The risk of getting caught in a prescribing cascade is increased when patients are prescribed medications by more than one provider. It’s up to patients to be sure every doctor they consult is given an up-to-date list of every drug they take, whether prescription or over-the-counter, as well as nondrug remedies and dietary is propecia dangerous supplements. Dr. Rochon recommended that patients maintain an up-to-date list of when and why they started every new drug, along with its dose and frequency, and show that list to the doctor as well..

Exercise makes buy propecia from canada it http://cz.keimfarben.de/best-place-to-buy-propecia/ easier to bounce back from too much stress, according to a fascinating new study with mice. It finds that regular exercise increases the levels of a chemical in the animals’ brains that helps them remain psychologically resilient and plucky, even when their lives seem suddenly strange, intimidating and filled with threats.The study involved mice, but it is likely to have implications for our species, too, as we face the stress and discombobulation of the ongoing pandemic and today’s political and social disruptions.Stress can, of course, be our ally. Emergencies and perils require immediate responses, and stress results in a fast, helpful flood of hormones buy propecia from canada and other chemicals that prime our bodies to act.“If a tiger jumps out at you, you should run,” says David Weinshenker, a professor of human genetics at Emory University School of Medicine in Atlanta and the senior author of the new study. The stress response, in that situation, is appropriate and valuable.But if, afterward, we “jump at every little noise” and shrink from shadows, we are overreacting to the original stress, Dr. Weinshenker continues buy propecia from canada.

Our response has become maladaptive, because we no longer react with appropriate dread to dreadful things but with twitchy anxiety to the quotidian. We lack stress resilience.In interesting past research, scientists have shown that exercise seems to build and buy propecia from canada amplify stress resilience. Rats that run on wheels for several weeks, for instance, and then experience stress through light shocks to their paws, respond later to unfamiliar — but safe — terrain with less trepidation than sedentary rats that also experience shocks.But the physiological underpinnings of the animals’ relative buoyancy after exercise remain somewhat mysterious. And, rats are buy propecia from canada just one species. Finding similar relationships between physical activity and resilience in other animals would bolster the possibility that a similar link exists in people.So, for the new study, which was published in August in the Journal of Neuroscience, Dr.

Weinshenker and his colleagues decided to work with frazzled mice and to focus on the possible buy propecia from canada effects of galanin, a peptide that is produced throughout the body in many animals, including humans.Galanin is known to be associated with mental health. People born with genetically low levels of galanin face an uncommonly high risk of depression and anxiety disorders.Multiple studies show that exercise increases production of the substance. In the rat experiments, buy propecia from canada some of which were conducted at Dr. Weinshenker’s lab, researchers found that exercise led to a surge in galanin production in the animals’ brains, particularly in a portion of the brain that is known to be involved in physiological stress reactions. Perhaps most interesting, they also found that the more galanin there, the greater the rats’ subsequent stress resilience.For the new research, they gathered healthy adult buy propecia from canada male and female mice and gave some of them access to running wheels in their cages.

Others remained inactive. Mice generally seem to enjoy running, and those with buy propecia from canada wheels skittered through multiple miles each day. After three weeks, the scientists checked for genetic markers of galanin in the mouse brains and found them to be much higher in the runners, with greater mileage correlating with more galanin.Then the scientists stressed out all of the animals by lightly shocking their paws while the mice were restrained and could not dash away. This method does not physically harm the mice but does buy propecia from canada spook them, which the scientists confirmed by checking for stress hormones in the mice. They had soared.The next day, the scientists placed runners and inactive animals in new situations designed to worry them again, including cages with both light, open sections and dark, enclosed areas.

Mice are prey animals and their natural reaction is to run for the darkness and then, as they feel safe, explore the open spaces. The runners responded now like normal, healthy buy propecia from canada mice, cautiously moving toward the light. But the sedentary animals tended to cower in the shadows, still too overwhelmed by stress to explore. They lacked resilience.Finally, the researchers confirmed that galanin played a pivotal role in the animals’ buy propecia from canada stress resilience by breeding mice with unusually high levels of the substance. Those rodents reacted like the runners to the stress of foot shocks, with full-body floods of stress hormones.

But the next day, like the runners, they warily braved the well-lit portions of the light-and-dark cage, not recklessly but with suitable prudence.The upshot of these experiments is that abundant galanin seems to be crucial buy propecia from canada for resilience, at least in rodents, says Rachel P. Tillage, a Ph.D. Candidate in buy propecia from canada Dr. Weinshenker’s lab who led the new study. And exercise increases galanin, amplifying the animals’ ability to remain stalwart in the face of whatever obstacles life — and science — places before them.Of course, this was a mouse study and mice are not people, so it is impossible to know from this research if exercise and buy propecia from canada galanin function precisely the same way in us, or, if they do, what amounts and types of exercise might best help us to cope with stress.But regular exercise is so good for us, anyway, that deploying it now to potentially help us deal with today’s uncertainties and worries “just makes good sense,” Dr.

Weinshenker says.The medical mistakes that befell the 87-year-old mother of a North Carolina pharmacist should not happen to anyone, and my hope is that this column will keep you and your loved ones from experiencing similar, all-too-common mishaps.As the pharmacist, Kim H. DeRhodes of Charlotte, N.C., recalled, it all began when her mother went to the emergency room two weeks after a fall because she buy propecia from canada had lingering pain in her back and buttocks. Told she had sciatica, the elderly woman was prescribed prednisone and a muscle relaxant. Three days later, she became delirious, returned to the E.R., was admitted to the hospital, and was buy propecia from canada discharged two days later when her drug-induced delirium resolved.A few weeks later, stomach pain prompted a third trip to the E.R. And a prescription for an antibiotic and proton-pump inhibitor.

Within a month, she developed buy propecia from canada severe diarrhea lasting several days. Back to the E.R., and this time she was given a prescription for dicyclomine to relieve intestinal spasms, which triggered another bout of delirium and three more days in the hospital. She was discharged after lab tests and imaging studies revealed nothing abnormal.“Review of my mother’s case buy propecia from canada highlights separate but associated problems. Likely misdiagnosis and inappropriate prescribing of medications,” Ms. DeRhodes wrote in JAMA Internal Medicine.

€œDiagnostic errors led to buy propecia from canada the use of prescription drugs that were not indicated and caused my mother further harm. The muscle relaxer and prednisone led to her first incidence of delirium. Prednisone likely led to the gastrointestinal issues, and the antibiotic likely led to the diarrhea, which led to buy propecia from canada the prescribing of dicyclomine, which led to the second incidence of delirium.”The doctors who wrote the woman’s prescriptions apparently never consulted the Beers Criteria, a list created by the American Geriatrics Society of drugs often unsafe for the elderly.In short, Ms. DeRhodes’s mother was a victim of two medical problems that are too often overlooked by examining doctors and unrecognized by families. The first is buy propecia from canada giving an 87-year-old medications known to be unsafe for the elderly.

The second is a costly and often frightening medically induced condition called “a prescribing cascade” that starts with drug-induced side effects which are then viewed as a new ailment and treated with yet another drug or drugs that can cause still other side effects.I’d like to think that none of this would have happened if instead of going to the E.R. The older buy propecia from canada woman had seen her primary care doctor. But experts told me that no matter where patients are treated, they are not immune to getting caught in a prescribing cascade. The problem also can happen to people who self-treat with buy propecia from canada over-the-counter or herbal remedies. Nor is it limited to the elderly.

Young people can also become victims of buy propecia from canada a prescribing cascade, Ms. DeRhodes said.“Doctors are often taught to think of everything as a new problem,” Dr. Timothy Anderson, internist buy propecia from canada at Beth Israel Deaconess Medical Center in Boston, said. €œThey have to start thinking about whether the patient is on medication and whether the medication is the problem.”“Doctors are very good at prescribing but not so good at deprescribing,” Ms. DeRhodes said buy propecia from canada.

€œAnd a lot of times patients are given a prescription without first trying something else.”A popular treatment for high blood pressure, which afflicts a huge proportion of older people, is a common precipitant of the prescribing cascade, Dr. Anderson said.He cited a Canadian study of 41,000 older adults with hypertension who were prescribed drugs called calcium buy propecia from canada channel blockers. Within a year after treatment began, nearly one person in 10 was given a diuretic to treat leg swelling caused by the first drug. Many were inappropriately prescribed a so-called loop diuretic that buy propecia from canada Dr. Anderson said can result in dehydration, kidney problems, lightheadedness and falls.Type 2 diabetes is another common condition in which medications are often improperly prescribed to treat drug-induced side effects, said Lisa M.

McCarthy, doctor of pharmacy at the University of Toronto who directed the Canadian study. Recognizing a side effect buy propecia from canada for what it is can be hampered when the effect doesn’t happen for weeks or even months after a drug is started. While patients taking opioids for pain may readily recognize constipation as a consequence, Dr. McCarthy said that over time, patients taking metformin for diabetes can develop diarrhea and may self-treat with loperamide, which in turn can buy propecia from canada cause dizziness and confusion.Dr. Paula Rochon, geriatrician at Women’s College Hospital in Ontario, said patients taking a drug called a cholinesterase inhibitor to treat early dementia can develop urinary incontinence, which is then treated with another drug that can worsen the patient’s confusion.Complicating matters is the large number of drugs some people take.

€œOlder adults frequently take many buy propecia from canada medications, with two-fifths taking five or more,” Dr. Anderson wrote in JAMA Internal Medicine. In cases of polypharmacy, as this is called, it can be hard to determine which, if buy propecia from canada any, of the drugs a person is taking is the cause of the current symptom.Dr. Rochon emphasized that a prescribing cascade can happen to anybody. She said, “Everyone needs to buy propecia from canada consider the possibility every time a drug is prescribed.”Before accepting a prescription, she recommended that patients or their caregivers should ask the doctor a series of questions, starting with “Am I experiencing a symptom that could be a side effect of a drug I’m taking?.

€ Follow-up questions should include:Is this new drug being used to treat a side effect?. Is there a safer drug available than the buy propecia from canada one I’m taking?. Could I take a lower dose of the prescribed drug?. Most important, Dr buy propecia from canada. Rochon said, patients should ask “Do I need to take this drug at all?.

€Patients and doctors alike often buy propecia from canada overlook or resist alternatives to medication that may be more challenging to adopt than swallowing a pill. For example, among well-established nondrug remedies for hypertension are weight loss, increasing physical activity, consuming less salt and other sources of sodium, and eating more potassium-rich foods like bananas and cantaloupe.For some patients, frequent use of a nonsteroidal anti-inflammatory drug sold over-the-counter, like ibuprofen or naproxen, is responsible for their elevated blood pressure.The risk of getting caught in a prescribing cascade is increased when patients are prescribed medications by more than one provider. It’s up to patients to be sure every buy propecia from canada doctor they consult is given an up-to-date list of every drug they take, whether prescription or over-the-counter, as well as nondrug remedies and dietary supplements. Dr. Rochon recommended that patients maintain an up-to-date list of when and why they started every new drug, along with its dose and frequency, and show that list to the doctor as well..

What if I miss a dose?

If you miss a dose, take it as soon as you can. If you do not remember until the next day, take only that day's dose. Do not take double or extra doses.

Propecia causes cancer

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In 2003, severe acute respiratory syndrome (SARS) propecia causes cancer spread through 26 countries, infecting at least 8098 and causing at least 774 deaths (a case fatality rate of 9.6%). Middle East respiratory syndrome (MERS) by January 2020 caused 2519 cases and 866 deaths (a case fatality rate of 34%). SARS and MERS are coronaviruses and both are not as easily transmitted as COVID-19 because they require propecia causes cancer close contact with those infected (or also with camels in the case of MERS), and infected humans tend not to transmit before they have symptoms.

Transmission of both mostly occurred within healthcare settings and could be controlled by improving infection control in hospitals.In 2015, Bill Gates in a TED lecture warned that we were more at risk of a global pandemic (he thought it would be influenza) than we were from nuclear war.COVID-19 probably first entered the human population in China in November 2019 in Wuhan and was first identified as such in December 2019. It spreads easily with a R0 (basic reproduction number) that represents the average number of people the average infected person would infect being between 1.5 and 3.5, depending on the surrounding circumstances. While a propecia causes cancer large proportion of infections are asymptomatic, there is a significant mortality rate (about 3.4% worldwide).

Survival rates are worse in the elderly, in men and in those with comorbidities. There are no suitable mammal models to study.Because there is a significant proportion of asymptomatic infectious people, monitoring of epidemics necessitates screening to determine (1) the proportion of the population that is actively infected and or (2) the total number of those who have been infected. Both require screening propecia causes cancer.

To gain significant data, then whole populations or representative samples have to be tested. In many circumstances, only those with high probability are tested.DNA polymerase techniques on throat swabs (notably real-time reverse transcription PCR) can identify the actively infected, but such tests will need to be repeated, especially in healthcare staff who are both at increased risk of infection and could provide an increased risk of infection to their contacts.Antibody tests in theory can reveal who has been infected. However, such tests may not provide 100% reliable results, including the fact that their sensitivity will propecia causes cancer vary according to how common the infection is.

If an infection is common, then a very sensitive test will identify all those infected and also a small number of false positives, but when the infection becomes less common, then the proportion of false positives will rise and a positive test could become less useful. Moreover, for how long would the antibody-person be propecia causes cancer immune?. Counting the number of hospital deaths attributed to COVID-19 may be a guide to an epidemic, but deaths may be difficult to count in the community.

In any case, changes in death numbers usually lag a few weeks behind the time of infection.Would a lower infecting dose cause the following illness to be less severe?. Does the virus need several extra doubling times to exert its effects such that in this gained time host responses will be in a better position to combat the infection in high-risk groups or in groups where propecia causes cancer medical care is minimal?. Could low-dose vaccination with COVID-19 itself be useful?.

Shakespeare’s Hamlet (not an epidemiologist) suggested, ‘Diseases desperate grown, By desperate appliance are relieved, Or not at all’.All the aforementioned are key questions, the answers to many of which are not known at the time of writing and, even if they were, the answers might change with the passage of time.Various countries have made various policy choicesAt the time of writing (April 2020), COVID-19 has probably been in the human population for only about 6 months. In most countries, there are concerns propecia causes cancer about how the epidemic was initially handled, and it is possible to predict some damming retrospective judgements. However, we should concentrate on where we are, not where we might have been.

Recriminations should wait.Many important decisions have to be made based on incomplete information. Most COVID-19 decisions have to be made on speculations (guesswork and wishful thinking), on hypotheses (propositions made as a propecia causes cancer basis for reasoning, without an assumption of its truth) or on theories (suppositions or systems of ideas explaining something based on general principles). All COVID-19 decisions have to be made at the time ‘We have to start from where we are’ guided by the experiences of other countries that are ahead of us in the epidemic.Pandemics usually reveal inequalities and the poor, or those in unstable employment or in crowded accommodation, or with underlying health issues, or where healthcare is less affordable, or are in the less well educated will suffer the most.

They will also comply less with restrictions propecia causes cancer. Ideologies, power blocks, leaders, social cohesion beliefs, the relevance of centralised or regional decision making, the abilities of popularism (political doctrines chosen to appeal to a majority of the electorate), welfare states (usually capitalist nations that recognise that food, shelter, education and medicine are basic rights to be ensured by government actions) and authoritarianism are all being stress tested by COVID-19. In the future, it will be interesting to judge how these societal systems played out when confronting the conflicting requirement to reconcile conflicting priorities of health and economic factors that involve conflicts between responding and planning for deaths (‘How should we cope with these’) and actually planning deaths.

€˜We will have to accept propecia causes cancer that we will cause deaths whatever policy we adopt’.There is only one initial response to COVID-19 that reduces infection rates and death rates. Dramatic quarantine ‘total lockdown’ measures. Some countries, including China, South Korea, Hong Kong, Taiwan and Singapore, hit the epidemic hard and early with lockdown quarantine to reduce the epidemic.

Such countries perhaps tend towards acceptance of authoritarianism and their citizens less rebellious than propecia causes cancer in other countries. New Zealand did similarly. I could not possibly comment on the US responses.

However, on what criteria propecia causes cancer and at what speed should liberalisation of quarantine measure occur to avoid re-emergences?. There are in theory three final paths out of the COVID-19 crisis:First, a vaccine. Even a propecia causes cancer perfect vaccine would be difficult to evaluate with changing risks in the community.

How protective would a vaccine be and for how long would it be effective?. Second, the identification of a treatment, either preventative or curative, so that the disease becomes a considerably less worrisome prospect even for those with comorbidities.Third, herd immunity, when enough of the population has acquired and survived COVID-19 and thus developed immunity with the infection persisting at a low level. Currently the only, not entirely definitive, way of estimating this is by measuring propecia causes cancer antibodies such that there would not be enough opportunities for disease transmission for the virus to continue circulating through populations with an Ro of less than 1, but the risk would not disappear entirely.

Moreover, how should immunity be monitored if antibody testing may not reflect herd immunity?. Allowing herd immunity to develop initially would result in a huge spike in hospitalisations and deaths that could overwhelm most healthcare services, and that is why flattening such spikes by quarantine was indicated. With flattening, there would still be illness and deaths but at a controlled slower rate and hopefully also smaller numbers, such that healthcare services could cope.There is a lot of opinion and numerous contributions by official and unofficial organisations and individuals who think their “single issue advice” should be followed propecia causes cancer.

No one individual has the expertise required for management of all the complexities. Committees are required, including microbiologists, infectious diseases doctors, public health doctors, epidemiologists, hospital and general practice representatives, epidemic mathematical modellers and economic advisers. Politicians have the propecia causes cancer responsibility to deliver decisions when, especially when, information is imperfect.

How many people would be infected if we did nothing?. What would the epidemic curve look propecia causes cancer like in various situations?. What proportion of those infected would infect others in various situations?.

How many of which population groups would require what extra healthcare services in various situations?. What would propecia causes cancer be the effect of various measures at various times?. What economic impacts might there be when these in themselves affect mortality rates?.

I predict that COVID-19 will cause two significant changes in political thought. First, it has to be realised that globalisation propecia causes cancer of such epidemics, and there will be more to come, will demand an integrated globalised response. Second, in 1987, Margaret Thatcher, the UK Prime Minister, said that ‘There is no such thing as society… the quality of our lives will depend on how much each of us is prepared to take responsibility for ourselves and each of us prepared to turn round and help by our own efforts those who are unfortunate’.

The current UK Prime Minister in March 2020 presented a new synthesis, ‘There really is such a thing as society’.Finally, it is important to realise that everyone, no matter where they are, for better or worse, has to rely on their existing rulers or governments..

In 2003, severe acute respiratory syndrome (SARS) spread through 26 buy propecia from canada countries, infecting at least 8098 and causing at least 774 deaths (a case fatality rate of 9.6%). Middle East respiratory syndrome (MERS) by January 2020 caused 2519 cases and 866 deaths (a case fatality rate of 34%). SARS and MERS are coronaviruses and both are buy propecia from canada not as easily transmitted as COVID-19 because they require close contact with those infected (or also with camels in the case of MERS), and infected humans tend not to transmit before they have symptoms. Transmission of both mostly occurred within healthcare settings and could be controlled by improving infection control in hospitals.In 2015, Bill Gates in a TED lecture warned that we were more at risk of a global pandemic (he thought it would be influenza) than we were from nuclear war.COVID-19 probably first entered the human population in China in November 2019 in Wuhan and was first identified as such in December 2019. It spreads easily with a R0 (basic reproduction number) that represents the average number of people the average infected person would infect being between 1.5 and 3.5, depending on the surrounding circumstances.

While a large proportion of buy propecia from canada infections are asymptomatic, there is a significant mortality rate (about 3.4% worldwide). Survival rates are worse in the elderly, in men and in those with comorbidities. There are no suitable mammal models to study.Because there is a significant proportion of asymptomatic infectious people, monitoring of epidemics necessitates screening to determine (1) the proportion of the population that is actively infected and or (2) the total number of those who have been infected. Both require buy propecia from canada screening. To gain significant data, then whole populations or representative samples have to be tested.

In many circumstances, only those with high probability are tested.DNA polymerase techniques on throat swabs (notably real-time reverse transcription PCR) can identify the actively infected, but such tests will need to be repeated, especially in healthcare staff who are both at increased risk of infection and could provide an increased risk of infection to their contacts.Antibody tests in theory can reveal who has been infected. However, such tests may not provide 100% reliable results, buy propecia from canada including the fact that their sensitivity will vary according to how common the infection is. If an infection is common, then a very sensitive test will identify all those infected and also a small number of false positives, but when the infection becomes less common, then the proportion of false positives will rise and a positive test could become less useful. Moreover, for how buy propecia from canada long would the antibody-person be immune?. Counting the number of hospital deaths attributed to COVID-19 may be a guide to an epidemic, but deaths may be difficult to count in the community.

In any case, changes in death numbers usually lag a few weeks behind the time of infection.Would a lower infecting dose cause the following illness to be less severe?. Does the virus need several extra doubling times to exert its effects such that in this gained time host responses will be in a better position to combat the infection in high-risk groups or in groups buy propecia from canada where medical care is minimal?. Could low-dose vaccination with COVID-19 itself be useful?. Shakespeare’s Hamlet (not an epidemiologist) suggested, ‘Diseases desperate grown, By desperate appliance are relieved, Or not at all’.All the aforementioned are key questions, the answers to many of which are not known at the time of writing and, even if they were, the answers might change with the passage of time.Various countries have made various policy choicesAt the time of writing (April 2020), COVID-19 has probably been in the human population for only about 6 months. In most countries, there are concerns about how the epidemic was initially handled, and buy propecia from canada it is possible to predict some damming retrospective judgements.

However, we should concentrate on where we are, not where we might have been. Recriminations should wait.Many important decisions have to be made based on incomplete information. Most COVID-19 decisions have to be made on speculations (guesswork and wishful thinking), buy propecia from canada on hypotheses (propositions made as a basis for reasoning, without an assumption of its truth) or on theories (suppositions or systems of ideas explaining something based on general principles). All COVID-19 decisions have to be made at the time ‘We have to start from where we are’ guided by the experiences of other countries that are ahead of us in the epidemic.Pandemics usually reveal inequalities and the poor, or those in unstable employment or in crowded accommodation, or with underlying health issues, or where healthcare is less affordable, or are in the less well educated will suffer the most. They will buy propecia from canada also comply less with restrictions.

Ideologies, power blocks, leaders, social cohesion beliefs, the relevance of centralised or regional decision making, the abilities of popularism (political doctrines chosen to appeal to a majority of the electorate), welfare states (usually capitalist nations that recognise that food, shelter, education and medicine are basic rights to be ensured by government actions) and authoritarianism are all being stress tested by COVID-19. In the future, it will be interesting to judge how these societal systems played out when confronting the conflicting requirement to reconcile conflicting priorities of health and economic factors that involve conflicts between responding and planning for deaths (‘How should we cope with these’) and actually planning deaths. €˜We will have to accept that we will cause deaths whatever policy we adopt’.There is only one initial response to COVID-19 that reduces buy propecia from canada infection rates and death rates. Dramatic quarantine ‘total lockdown’ measures. Some countries, including China, South Korea, Hong Kong, Taiwan and Singapore, hit the epidemic hard and early with lockdown quarantine to reduce the epidemic.

Such countries perhaps tend towards acceptance of authoritarianism and buy propecia from canada their citizens less rebellious than in other countries. New Zealand did similarly. I could not possibly comment on the US responses. However, on what criteria and at what speed should liberalisation of quarantine measure occur buy propecia from canada to avoid re-emergences?. There are in theory three final paths out of the COVID-19 crisis:First, a vaccine.

Even a perfect vaccine buy propecia from canada would be difficult to evaluate with changing risks in the community. How protective would a vaccine be and for how long would it be effective?. Second, the identification of a treatment, either preventative or curative, so that the disease becomes a considerably less worrisome prospect even for those with comorbidities.Third, herd immunity, when enough of the population has acquired and survived COVID-19 and thus developed immunity with the infection persisting at a low level. Currently the buy propecia from canada only, not entirely definitive, way of estimating this is by measuring antibodies such that there would not be enough opportunities for disease transmission for the virus to continue circulating through populations with an Ro of less than 1, but the risk would not disappear entirely. Moreover, how should immunity be monitored if antibody testing may not reflect herd immunity?.

Allowing herd immunity to develop initially would result in a huge spike in hospitalisations and deaths that could overwhelm most healthcare services, and that is why flattening such spikes by quarantine was indicated. With flattening, there would still be illness and deaths but at a controlled slower rate and hopefully also smaller numbers, such that healthcare services could cope.There is a lot of opinion and numerous buy propecia from canada contributions by official and unofficial organisations and individuals who think their “single issue advice” should be followed. No one individual has the expertise required for management of all the complexities. Committees are required, including microbiologists, infectious diseases doctors, public health doctors, epidemiologists, hospital and general practice representatives, epidemic mathematical modellers and economic advisers. Politicians have the responsibility to deliver decisions buy propecia from canada when, especially when, information is imperfect.

How many people would be infected if we did nothing?. What would the epidemic curve look like in various situations? buy propecia from canada. What proportion of those infected would infect others in various situations?. How many of which population groups would require what extra healthcare services in various situations?. What would buy propecia from canada be the effect of various measures at various times?.

What economic impacts might there be when these in themselves affect mortality rates?. I predict that COVID-19 will cause two significant changes in political thought. First, it has to be realised that globalisation of such epidemics, and there will be more to come, will demand buy propecia from canada an integrated globalised response. Second, in 1987, Margaret Thatcher, the UK Prime Minister, said that ‘There is no such thing as society… the quality of our lives will depend on how much each of us is prepared to take responsibility for ourselves and each of us prepared to turn round and help by our own efforts those who are unfortunate’. The current UK Prime Minister in March 2020 presented a new synthesis, ‘There really is such a thing as society’.Finally, it is important to realise that everyone, no matter where they are, for better or worse, has to rely on their existing rulers or governments..

Propecia coupon online

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A free pilot program to help new and expectant fathers navigate the physical, mental and emotional challenges of becoming a dad propecia coupon online will be rolled out in four regions in NSW from today.Health Minister Brad Hazzard said the ‘Focus on New Fathers’ program will be trialled with men in Northern NSW, Northern and Western Sydney and the Murrumbidgee area. €œAsk any father and they will tell you, becoming a parent is an equally joyous and terrifying experience because your entire routine is turned on its head,” Mr Hazzard said. €œIt is a considerable adjustment which can put tremendous stress on you propecia coupon online and on your relationship, so it’s important to know you are not alone and help is at hand – literally.

€œThis pilot will see texts sent to dads, offering valuable health advice and links into pathways to ensure support options are available, particularly in these uncertain COVID times.” Research has shown men are often reluctant to engage with the health system to get support, despite around one in 10 dads experiencing depression and anxiety in the postnatal period. The pilot, which is being delivered by the University of Newcastle in partnership with NSW Health, will run over the next year with results helping to improve the program. Men living in the trial site areas will be eligible for the program if they propecia coupon online are over the age of 18, their partner is at least 16 weeks pregnant or their baby is up to 24 weeks of age.

They must have a mobile phone capable of receiving and sending text messages. Associate Professor Elisabeth Murphy, Senior Clinical Advisor, Child and Family Health, said self-care for new fathers is extremely important as the mental and physical wellbeing of both parents has a direct effect on their children. €œReceiving help with health issues early on ensures dads are in the best possible position to care for their new baby and partner,” Associate Professor Murphy said propecia coupon online.

€œWe also understand expecting and new parents may experience more worries about their health and wellbeing in relation to COVID-19. We encourage expectant and new parents, particularly at this time, to reach out for support to their healthcare provider or GP.” ​​​​​​Regional and rural patients now have access to 24-hour critical care under a $21.7 million telestroke service being rolled out across NSW.Patients at Port Macquarie and Coffs Harbour hospitals are the first to benefit from the NSW Telestroke Service, based at Sydney’s Prince of Wales Hospital. Health Minister Brad Hazzard said the revolutionary propecia coupon online service will expand to up to 23 sites over the next three years.

€œThe NSW Telestroke Service will remove geographical barriers and improve outcomes for thousands of regional and rural stroke patients every year, giving them a much greater chance of surviving and leading a normal life,” Mr Hazzard said. €œPeople in regional and rural areas have a far greater risk of hospitalisation from stroke and this vital service will provide them with immediate, life-saving diagnosis and treatment from the propecia coupon online state’s leading clinicians.” In 2018-19, 13,651 people were hospitalised for a stroke in NSW. Of those, 32 per cent were from regional, rural or remote areas.

A successful pilot project in the Hunter New England, Central Coast and Mid North Coast local health districts since 2017 has already helped 1200 patients. The Stroke Foundation’s Chief Executive Officer Sharon McGowan propecia coupon online welcomed the launch of the statewide service, jointly funded by the State and Federal governments. €œWhen a stroke strikes, it kills up to 1.9 million brain cells per minute.

This service will have an enormous impact by providing time-critical, best-practice treatment that saves lives and reduces lifelong disability,” Ms McGowan said. Prince of Wales propecia coupon online Hospital’s Director of Clinical Neuroscience Professor Ken Butcher said. €œThe service links expert stroke clinicians with local emergency physicians to quickly determine the best possible treatment plan for a patient.” ​Date published.

August 26, 2020On this page BackgroundCOVID-19 is an infectious disease caused by the SARS-CoV-2 coronavirus. The World Health Organization declared a global pandemic in March 2020, and the Minister of Health signed the Interim Order Respecting the Importation and Sale of Medical Devices for Use in Relation to COVID-19 propecia coupon online on March 18, 2020. The Interim Order (IO) allows us to quickly address large-scale public health emergencies.This IO allows for faster authorization of Class I-IV medical devices for COVID-19.This document presents the criteria for safety and effectiveness that apply to test swabs used for COVID-19 sampling.

It also provides guidance on propecia coupon online how to meet these criteria in an application under the IO pathway. Diagnostic testing is a key element in both. identifying cases of infection preventing the spread of the coronavirus A test swab may be used to collect a sample for either Polymerase Chain Reaction (PCR) laboratory testing or point-of-care testing.

Point-of-care testing can be done directly in propecia coupon online a hospital or doctor’s office. Once the sample has been taken, the swab is either placed in a preserving liquid and sent to a laboratory for testing, or placed directly in a testing device (point-of-care).Swabs may be packaged in a variety of virus transport media (VTM). Specifications for individual VTMs are beyond the scope of this document.

Swabs play propecia coupon online a role in the accuracy of COVID-19 diagnostic testing. For example, false negatives can occur in PCR tests if. the swab material inhibits the test reaction or the swab design doesn’t provide enough surface area to obtain a sufficient sample Test swabs that are not safe and effective may cause or lead to harm.

For example propecia coupon online. A swab that breaks during sample collection can cause physical injury a non-sterile swab that produces an incorrect test result can lead to harmHealth Canada has published a guidance document to support the preparation of applications submitted under the IO. It should propecia coupon online be read in conjunction with this document.

We are processing applications as quickly as possible. To avoid delays, please ensure you have completed your application properly.Medical Devices Regulations (MDR) classification In the Canadian regulatory framework, Class I devices present the lowest potential risk and Class IV the highest. Swabs are propecia coupon online classified according to their labelling and intended use.

For example, if a swab is labelled for nasopharyngeal (NP) or oropharyngeal (OP) use only, it will be classified as a Class I medical device according to Classification Rule 2(2) of the MDR. If a swab is not exclusively for use in oral or nasal cavities, or its use is not explicitly stated, it will be classified as a Class II device by Rule 2(1). These swabs belong propecia coupon online to a higher risk class because their use in other body orifices for the collection of tissue samples (for example, to test for chlamydia or ureaplasma) is associated with greater risk.

Rule 2 Subject to subrules (2) to (4), all invasive devices that penetrate the body through a body orifice or that come into contact with the surface of the eye are classified as Class II. A device described in subrule (1) that is intended to be placed in the oral or nasal cavities as far as the pharynx or in the ear canal up to the ear drum is classified as Class I.Regulatory pathways for COVID-19 devicesManufacturers of Class I swabs may seek authorization to import and sell their products under either. A Medical Device Establishment Licence (MDEL) MDEL is an establishment oversight framework that is not product-specific and not designed to assess safety and effectiveness an IO authorization information on safety and effectiveness are required as part of the application Health Canada is encouraging a sub-group of swab manufacturers to use the IO authorization pathway for Class propecia coupon online I swabs, especially if they are.

New to the manufacturing of swabs and manufacturing in Canada (such as a company that has re-tooled to manufacture), or using a new manufacturing process or design for swabs (such as 3D printing or honeycomb design)IO applications for swabs should include the following information.Device description The device description should include. A picture and/or engineering drawing identification of all materials propecia coupon online used in the production of the swab the intended use(s) (for example, NP swabs)Quality manufacturingManufacturers must either. demonstrate compliance with Quality Manufacturing Systems (for example, ISO 13485 certificate) applicable to the swab, or provide a clear description of the planned quality manufacturing systems that are consistent with similar existing manufacturing systemsDesign verificationProvide swab design verification (bench testing) data in a summary report.

It should show that the essential minimum design characteristics are met. These data should be based on test samples propecia coupon online representative of finished swabs that have undergone sterilization prior to bench testing.Dimensions Swabs should have minimum length specifications and minimum and maximum head diameter specifications in order to be safe and effective. Minimum length specification for example, adult NP swabs require ≥14 cm to reach the posterior nasopharynx minimum and maximum head diameter specification for example, adult NP swabs require 1–4 mm to pass into the mid-inferior portion of the inferior turbinate and maneuver well FlexibilitySwab flexibility is assessed through.

Durability for example, tolerate 20 rough repeated insertions into a 4 mm inner diameter clear plastic tube curved back on itself with a curve radius of 3 cm bendability for example, bend tip and neck 90º without breaking ability to maintain initial form for example, restore to initial form following 45º bending Manufacturers may describe the test performed, the number of samples, and a summary of the results.Strength/Breakpoint (failure) To limit the potential for patient harm, the minimum breakpoint distance should be approximately 8 to 9 cm from the nasopharynx. However, no breaks propecia coupon online or fractures should occur following reasonable manipulation. Applicants should submit a rationale for the design of the breakpoint distance from the swab tip.

It should demonstrate that the breakpoint length can be accommodated by commercially available swab/media tubes.Surface propertiesThe swab surface should be free of. processing aids (such as disinfectants) foreign materials degreasers mold release agents For injection molded swabs, no burrs, flashing, or propecia coupon online sharp edges should be present. Design validationProvide swab validation (performance) data in a summary report that demonstrates that the swab.

can acquire propecia coupon online samples comparable to a commercially available swab control, and will not inhibit the PCR reactionThese data should be based on test samples representative of finished swabs that have undergone sterilization prior to testing.Comparable sample acquisition to a control, and PCR compatibilityThe manufacturer should demonstrate test swab cycle threshold (Ct) recovery values (RT-PCR) that are statistically comparable to those obtained from a commercially available swab control using SARS-CoV-2 (or a scientifically justified surrogate).Pass/Fail criteria. Values ≥ 2Cts indicate significantly less efficient ribonucleic acid collection and/or elution.Clinical feasibility/suitability simulationManufacturers should submit either. A clinical test report or previous clinical data Clinical test reportThe clinical test report should describe the use of the proposed finished swab (sterilized) in a sufficient number of individuals by trained healthcare professionals in a minimum of 30 patients that have tested positive for SARS-CoV-2, or a scientifically justified surrogate virus.

Include comparisons of the proposed swab against a flocked swab commercially propecia coupon online available in Canada with respect to. flexibility fit ability to navigate to the nasopharynx (or other areas specified in the indications) ability to collect a specimen/respiratory epithelial cells for example, using the RNase P housekeeping gene test results agreement for example, ≥ 90% positive % agreement using a composite control (positive % agreement calculation that includes all positive findings from control and test swabs) Clinical testing considerations A scientifically justified surrogate virus may be used if COVID-positive patients are not available. Positive % agreement should not be determined using high Ct samples.

One-half (1/2) to propecia coupon online two-thirds (2/3) of COVID-positive samples should have a high viral loads (Cts <. 30). Report agreement between control and test swabs in terms of quantitative (Ct) and qualitative (+/- test) values with appropriate descriptive statistics.

Include patient symptomatology propecia coupon online for samples. For example, days from symptom onset, known vs. Suspected COVID status propecia coupon online.

Use of different VTM/universal transport media (V/UTM) across COVID-positive samples may contribute to Ct variability. Ensure consistency by using the same media/tubes for each specimen within a clinical evaluation. Validate the propecia coupon online chosen V/UTM media/tubes to show they will not interfere with the PCR test results.

For example, allowing 7 days of swab positive specimen incubation with the chosen media/vial is considered a worst-case transportation scenario to evaluate maximal leaching/interaction potential). Use a single PCR test platform throughout each clinical evaluation. The platform should have been previously authorized by HC or propecia coupon online another jurisdiction.

Location (for example, left vs right nostril) and order of sampling (for example, control vs. Test swab) can affect specimen quality and results variability. Location and swab sampling order should be randomized.For additional information propecia coupon online on collecting, handling, and testing COVID-19 specimens, please refer to the Centers for Disease Control and Prevention (CDC) Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens for COVID-19.Previous clinical dataPreviously obtained clinical data may be submitted in lieu of clinical testing.

Those data should demonstrate the safe and effective use of a swab of identical design and materials in human subjects. The proposed swab should be compared against a flocked swab commercially available in Canada with respect to. flexibility fit ability to navigate to the nasopharynx (or other areas specified in the indications) ability to collect a specimen/respiratory epithelial cells for example, using the RNase P housekeeping gene test results agreement for example, ≥ 90% positive % agreement) using propecia coupon online a composite control (positive % agreement calculation that includes all positive findings from control and test swabs) Sterility Provide sterilization validation data in a summary report.

It should demonstrate that the chosen sterilization method will achieve a minimum Sterility Assurance Level (SAL) of 10-6 for the proposed swab, using an appropriate biological indicator (BI) organism (see below). If the swab will be sterilized using an ethylene oxide (EtO) method, you should demonstrate that propecia coupon online EtO and ethylene chlorohydrin (ECH) residuals meet the tolerable contact limits (TCL) specified in ISO 10993-7. Commonly used swab materials, compatible sterilization methods, and appropriate biological indicators are described below.

Sterilization Method Swab Materials EtO(for example, ISO 11135) Gamma Irradiation(ISO 11137) Polystyrene handle, polyester bicomponent fiber tipFootnote * X(for example, Puritan 25-3316-H/U) Not applicable Polystyrene handle, nylon flocked fiber tipFootnote * X(for example, Copan 503CS01) X(for example, BD 220252) Footnote * The CDC provides guidance on the types of swabs that should be used for optimal specimen collection for PCR testing. They include swabs that are made of polyester propecia coupon online (for example, Dacron), rayon, or nylon-flocked. Cotton-tipped or calcium alginate swabs are not acceptable because residues present in those materials inhibit the PCR reaction.

Return to footnote * referrer Appropriate BIIf ionizing radiation will be used to sterilize the swab. Bacillus pumilus spores are recommended for doses of 25 kGy Bacillus cereus or propecia coupon online Bacillus sphaericus spores are recommended for doses of >. 25 kGy (World Health Organization, The International Pharmacopoeia, 9th Ed., 2019) Sterilization Process Spore (Indicator Organism) Steam Geobacillus stearothermophilus(formerly Bacillus stearothermophilus) Dry Heat Bacillus atrophaeus (formerly Bacillus subtilis var.

Niger) Ethlylene Oxide Bacillus atrophaeus (formerly Bacillus subtilis var. Niger) Hydrogen Peroxide Geobacillus stearothermophilus(formerly propecia coupon online Bacillus stearothermophilus) Source. US Food and Drug Administration, "Biological Indicator (BI) Premarket Notification [510(k)] Submissions," October 2007.

[Online].Packaging validation Provide packaging validation data in a propecia coupon online summary report. It should demonstrate that the swab packaging system will maintain a sterile environment across the labelled shelf life (for example, ASTM F1980). without leakage (for example, ASTM D3078-02) with adequate seal strength (for example, ASTM F88/EN 868-5)Test packaging samples should be representative of finished swab packages that have undergone sterilization prior to testing.Biocompatibility Provide biocompatibility data in a summary report.

It should demonstrate compliance with biocompatibility tests recommended for devices in limited contact (≤24 hrs) with mucosal propecia coupon online membranes, as per ISO 10993-1. These include. cytotoxicity sensitization irritation/intracutaneous reactivityThese data should be based on test samples representative of finished swabs that have undergone sterilization prior to testing.LabellingSwabs should be individually packaged and labelled.

The application must include the propecia coupon online swab label, which must include. The name and model number of the device the term ‘sterile’, along with the sterilization method (EtO = ethylene oxide. R = gamma irradiation), if the swab is intended to be sold in a sterile condition the name and address of the manufacturer manufacturing and expiry datesIf swabs are not sterile but must be sterilized at the user facility, then the sterilization parameters and method should be clearly described in accompanying instructions for use documentation.Post-market requirementsAs stated in Section 12 of the IO, within 10 days of becoming aware of an incident in Canada, all IO authorization holders must.

report the incident specify the nature of the incident specify the circumstances surrounding the incidentOn this page About face shields propecia coupon online Personal protective equipment (PPE) can help prevent potential exposure to infectious disease. They are considered medical devices in Canada and therefore must follow the requirements outlined in the Medical Devices Regulations. Medical devices propecia coupon online are classified into 4 groups (Class I, II, III and IV) based on their risk to health and safety.

Class I devices, such as gauze bandages, pose the lowest potential risk, while Class IV devices, such as pacemakers, pose the greatest potential risk. In Canada, face shields are Class I medical devices. A face shield has a transparent window propecia coupon online or visor that shields the face and associated mucous membranes (eyes, nose and mouth).

It protects the wearer against exposure from splashes and sprays of body fluids. Face shields are made of shatterproof plastic, fit over the face and are held in place by head straps or caps. They may be propecia coupon online made of polycarbonate, propionate, acetate, polyvinyl chloride, or polyethylene terephthalate.

They are usually worn with other PPE, such as a medical mask, respirator or eyewear. Health Canada strongly advises against the use of plastic bags as an alternative to face shields. Standards and requirements for face shields Organizations that are manufacturing face shields are advised to propecia coupon online consult some or all of the following standards throughout the design and testing stages.

ANSI/ISEA Z.87.1 (2015), American National Standard for Occupational and Educational Personal Eye and Face Protection Devices CSA Z94.3 (2020), Eye and Face Protectors CSA Z94.3.1 (2016), Guideline for Selection, Use, and Care of Eye and Face Protectors BS EN 166 (2002), Personal Eye Protection. Specifications. Minimum specifications must be incorporated into the design and verification stages to ensure safe and effective face shields.

Provide adequate coverage (CSA Z94.3 Sections 0.2.1/10.2.2/10.3/10.4). The size of the face shield is important because it must protect the face and front part of the head. This includes the eyes, forehead, cheeks, nose, mouth, and chin.

Protection may also need to extend to the front of the neck in situations with flying particles and sprays of hazardous liquids. Fit snugly to afford a good seal to the forehead area and to prevent slippage of the device Footnote 1. Be made of optically clear, distortion-free, lightweight materials (CSA Z94.3.1-16 and Footnote 1).

Be free of visible defects or flaws that would impede vision (ANSI Z87.1 Section 9.4). Be comfortable and easy to assemble, use and remove by health care professionals. Provide adequate space between the wearer’s face and the inner surface of the visor to allow for the use of ancillary equipment (for example, medical mask, respirator, eyewear) Footnote 1.

The characteristics and performance requirements of face shields must not be altered when attaching shields to other protective equipment, such as hats or caps. Display anti-fog characteristics on inside and outside of shield (CSA Z94.3.1-16). For face shields that are not fog resistant, anti-fog spray must be provided.

Provide user-contacting materials that have adequate material biocompatibility (skin sensitivity and cytotoxic testing) (ISO 10993-5, 10). Other items to take note of include. Face shields used for protection in hospital settings do not have to be impact- or flame- resistant.

If the device is specifically designed to withstand impact from sharp or fast projectiles, it must comply with set-out standards (ANSI Z87.1, sections 9.2 and 9.3, CSA Z94.3, section 10.1). For reuse, manufacturers must provide validated cleaning instructions. Sterilization procedures must not compromise the shield in any way, such as deformation or cracking.

Regulatory authorization Most PPE, including face shields, are Class I medical devices if they are manufactured, sold or represented for use for reducing the risk of or preventing the user from infection. This includes COVID-19. Face shields may be authorized for sale or import into Canada through the following regulatory pathways.

Pathway 1. Interim order authorization to import and sell medical devices related to COVID-19. Pathway 2.

Expedited review and issuance of Medical Device Establishment Licences (MDEL) related to COVID-19. MDEL holders that import and sell face shields should take measures to ensure they are safe and effective. Pathway 3.

Exceptional importation and sale of certain non-compliant medical devices related to COVID-19. Note that a sale generally requires the transfer of ownership of a device from one party to another and does not necessitate any transfer of money. Applicants should carefully review the pathways and select the most appropriate authorization route for their product.

For more information, see Personal protective equipment (COVID-19). How to get authorization. If you intend to manufacture 3D print face shields in response to the COVID-19 crisis, see.

3D printing and other manufacturing of personal protective equipment in response to COVID-19 Feedback If you have any questions or comments about this notice, contact the Medical Devices Directorate at hc.meddevices-instrumentsmed.sc@canada.ca R. J. Roberge, "Face shields for infection control.

A review," Journal of Occupational and Environmental Hygiene, pp. 235-242, 2016. Related links FootnotesFootnote 1 R.

J. Roberge, "Face shields for infection control. A review," Journal of Occupational and Environmental Hygiene, pp.

235-242, 2016.Return to footnote 1 referrer.

A free pilot program to help new and expectant fathers navigate the physical, mental and emotional challenges of becoming a dad will be rolled buy propecia from canada out in four blog regions in NSW from today.Health Minister Brad Hazzard said the ‘Focus on New Fathers’ program will be trialled with men in Northern NSW, Northern and Western Sydney and the Murrumbidgee area. €œAsk any father and they will tell you, becoming a parent is an equally joyous and terrifying experience because your entire routine is turned on its head,” Mr Hazzard said. €œIt is a considerable adjustment which can put tremendous stress on you and on your relationship, so it’s important to know you are not alone buy propecia from canada and help is at hand – literally.

€œThis pilot will see texts sent to dads, offering valuable health advice and links into pathways to ensure support options are available, particularly in these uncertain COVID times.” Research has shown men are often reluctant to engage with the health system to get support, despite around one in 10 dads experiencing depression and anxiety in the postnatal period. The pilot, which is being delivered by the University of Newcastle in partnership with NSW Health, will run over the next year with results helping to improve the program. Men living in the trial site areas will be eligible for the program if they buy propecia from canada are over the age of 18, their partner is at least 16 weeks pregnant or their baby is up to 24 weeks of age.

They must have a mobile phone capable of receiving and sending text messages. Associate Professor Elisabeth Murphy, Senior Clinical Advisor, Child and Family Health, said self-care for new fathers is extremely important as the mental and physical wellbeing of both parents has a direct effect on their children. €œReceiving help with health issues early on ensures dads are in the best possible position to care for their new baby and partner,” Associate buy propecia from canada Professor Murphy said.

€œWe also understand expecting and new parents may experience more worries about their health and wellbeing in relation to COVID-19. We encourage expectant and new parents, particularly at this time, to reach out for support to their healthcare provider or GP.” ​​​​​​Regional and rural patients now have access to 24-hour critical care under a $21.7 million telestroke service being rolled out across NSW.Patients at Port Macquarie and Coffs Harbour hospitals are the first to benefit from the NSW Telestroke Service, based at Sydney’s Prince of Wales Hospital. Health Minister Brad Hazzard said the buy propecia from canada revolutionary service will expand to up to 23 sites over the next three years.

€œThe NSW Telestroke Service will remove geographical barriers and improve outcomes for thousands of regional and rural stroke patients every year, giving them a much greater chance of surviving and leading a normal life,” Mr Hazzard said. €œPeople in regional and rural areas have a far greater risk of hospitalisation from stroke and this vital service buy propecia from canada will provide them with immediate, life-saving diagnosis and treatment from the state’s leading clinicians.” In 2018-19, 13,651 people were hospitalised for a stroke in NSW. Of those, 32 per cent were from regional, rural or remote areas.

A successful pilot project in the Hunter New England, Central Coast and Mid North Coast local health districts since 2017 has already helped 1200 patients. The Stroke buy propecia from canada Foundation’s Chief Executive Officer Sharon McGowan welcomed the launch of the statewide service, jointly funded by the State and Federal governments. €œWhen a stroke strikes, it kills up to 1.9 million brain cells per minute.

This service will have an enormous impact by providing time-critical, best-practice treatment that saves lives and reduces lifelong disability,” Ms McGowan said. Prince of Wales Hospital’s Director of Clinical Neuroscience buy propecia from canada Professor Ken Butcher said. €œThe service links expert stroke clinicians with local emergency physicians to quickly determine the best possible treatment plan for a patient.” ​Date published.

August 26, 2020On this page BackgroundCOVID-19 is an infectious disease caused by the SARS-CoV-2 coronavirus. The World Health Organization declared a global pandemic in March 2020, and the Minister of Health signed buy propecia from canada the Interim Order Respecting the Importation and Sale of Medical Devices for Use in Relation to COVID-19 on March 18, 2020. The Interim Order (IO) allows us to quickly address large-scale public health emergencies.This IO allows for faster authorization of Class I-IV medical devices for COVID-19.This document presents the criteria for safety and effectiveness that apply to test swabs used for COVID-19 sampling.

It also provides guidance on how to meet these criteria in an application buy propecia from canada under the IO pathway. Diagnostic testing is a key element in both. identifying cases of infection preventing the spread of the coronavirus A test swab may be used to collect a sample for either Polymerase Chain Reaction (PCR) laboratory testing or point-of-care testing.

Point-of-care testing can buy propecia from canada be done directly in a hospital or doctor’s office. Once the sample has been taken, the swab is either placed in a preserving liquid and sent to a laboratory for testing, or placed directly in a testing device (point-of-care).Swabs may be packaged in a variety of virus transport media (VTM). Specifications for individual VTMs are beyond the scope of this document.

Swabs play a role in the accuracy buy propecia from canada of COVID-19 diagnostic testing. For example, false negatives can occur in PCR tests if. the swab material inhibits the test reaction or the swab design doesn’t provide enough surface area to obtain a sufficient sample Test swabs that are not safe and effective may cause or lead to harm.

For example buy propecia from canada. A swab that breaks during sample collection can cause physical injury a non-sterile swab that produces an incorrect test result can lead to harmHealth Canada has published a guidance document to support the preparation of applications submitted under the IO. It should buy propecia from canada be read in conjunction with this document.

We are processing applications as quickly as possible. To avoid delays, please ensure you have completed your application properly.Medical Devices Regulations (MDR) classification In the Canadian regulatory framework, Class I devices present the lowest potential risk and Class IV the highest. Swabs are buy propecia from canada classified according to their labelling and intended use.

For example, if a swab is labelled for nasopharyngeal (NP) or oropharyngeal (OP) use only, it will be classified as a Class I medical device according to Classification Rule 2(2) of the MDR. If a swab is not exclusively for use in oral or nasal cavities, or its use is not explicitly stated, it will be classified as a Class II device by Rule 2(1). These swabs belong to a higher buy propecia from canada risk class because their use in other body orifices for the collection of tissue samples (for example, to test for chlamydia or ureaplasma) is associated with greater risk.

Rule 2 Subject to subrules (2) to (4), all invasive devices that penetrate the body through a body orifice or that come into contact with the surface of the eye are classified as Class II. A device described in subrule (1) that is intended to be placed in the oral or nasal cavities as far as the pharynx or in the ear canal up to the ear drum is classified as Class I.Regulatory pathways for COVID-19 devicesManufacturers of Class I swabs may seek authorization to import and sell their products under either. A Medical Device Establishment Licence (MDEL) MDEL is an establishment oversight framework that is not product-specific and not designed to assess safety and effectiveness an IO authorization information on safety and effectiveness are required as part of the application Health Canada is encouraging a sub-group of swab manufacturers to use the IO authorization pathway buy propecia from canada for Class I swabs, especially if they are.

New to the manufacturing of swabs and manufacturing in Canada (such as a company that has re-tooled to manufacture), or using a new manufacturing process or design for swabs (such as 3D printing or honeycomb design)IO applications for swabs should include the following information.Device description The device description should include. A picture and/or engineering drawing identification of all materials used in buy propecia from canada the production of the swab the intended use(s) (for example, NP swabs)Quality manufacturingManufacturers must either. demonstrate compliance with Quality Manufacturing Systems (for example, ISO 13485 certificate) applicable to the swab, or provide a clear description of the planned quality manufacturing systems that are consistent with similar existing manufacturing systemsDesign verificationProvide swab design verification (bench testing) data in a summary report.

It should show that the essential minimum design characteristics are met. These data should be based on test samples representative of finished swabs that have undergone sterilization prior to bench testing.Dimensions Swabs should have minimum length specifications and minimum and maximum head diameter specifications in order to be safe buy propecia from canada and effective. Minimum length specification for example, adult NP swabs require ≥14 cm to reach the posterior nasopharynx minimum and maximum head diameter specification for example, adult NP swabs require 1–4 mm to pass into the mid-inferior portion of the inferior turbinate and maneuver well FlexibilitySwab flexibility is assessed through.

Durability for example, tolerate 20 rough repeated insertions into a 4 mm inner diameter clear plastic tube curved back on itself with a curve radius of 3 cm bendability for example, bend tip and neck 90º without breaking ability to maintain initial form for example, restore to initial form following 45º bending Manufacturers may describe the test performed, the number of samples, and a summary of the results.Strength/Breakpoint (failure) To limit the potential for patient harm, the minimum breakpoint distance should be approximately 8 to 9 cm from the nasopharynx. However, no breaks or fractures should occur buy propecia from canada following reasonable manipulation. Applicants should submit a rationale for the design of the breakpoint distance from the swab tip.

It should demonstrate that the breakpoint length can be accommodated by commercially available swab/media tubes.Surface propertiesThe swab surface should be free of. processing aids (such as disinfectants) foreign materials degreasers mold release agents buy propecia from canada For injection molded swabs, no burrs, flashing, or sharp edges should be present. Design validationProvide swab validation (performance) data in a summary report that demonstrates that the swab.

can acquire samples comparable to a commercially available swab control, and will not inhibit the PCR reactionThese data should be based on test buy propecia from canada samples representative of finished swabs that have undergone sterilization prior to testing.Comparable sample acquisition to a control, and PCR compatibilityThe manufacturer should demonstrate test swab cycle threshold (Ct) recovery values (RT-PCR) that are statistically comparable to those obtained from a commercially available swab control using SARS-CoV-2 (or a scientifically justified surrogate).Pass/Fail criteria. Values ≥ 2Cts indicate significantly less efficient ribonucleic acid collection and/or elution.Clinical feasibility/suitability simulationManufacturers should submit either. A clinical test report or previous clinical data Clinical test reportThe clinical test report should describe the use of the proposed finished swab (sterilized) in a sufficient number of individuals by trained healthcare professionals in a minimum of 30 patients that have tested positive for SARS-CoV-2, or a scientifically justified surrogate virus.

Include comparisons of the proposed swab against a flocked swab commercially available in Canada with respect to buy propecia from canada. flexibility fit ability to navigate to the nasopharynx (or other areas specified in the indications) ability to collect a specimen/respiratory epithelial cells for example, using the RNase P housekeeping gene test results agreement for example, ≥ 90% positive % agreement using a composite control (positive % agreement calculation that includes all positive findings from control and test swabs) Clinical testing considerations A scientifically justified surrogate virus may be used if COVID-positive patients are not available. Positive % agreement should not be determined using high Ct samples.

One-half (1/2) to two-thirds (2/3) of COVID-positive samples should have a high viral loads (Cts buy propecia from canada <. 30). Report agreement between control and test swabs in terms of quantitative (Ct) and qualitative (+/- test) values with appropriate descriptive statistics.

Include patient buy propecia from canada symptomatology for samples. For example, days from symptom onset, known vs. Suspected COVID buy propecia from canada status.

Use of different VTM/universal transport media (V/UTM) across COVID-positive samples may contribute to Ct variability. Ensure consistency by using the same media/tubes for each specimen within a clinical evaluation. Validate the buy propecia from canada chosen V/UTM media/tubes to show they will not interfere with the PCR test results.

For example, allowing 7 days of swab positive specimen incubation with the chosen media/vial is considered a worst-case transportation scenario to evaluate maximal leaching/interaction potential). Use a single PCR test platform throughout each clinical evaluation. The platform should have been previously authorized by HC or buy propecia from canada another jurisdiction.

Location (for example, left vs right nostril) and order of sampling (for example, control vs. Test swab) can affect specimen quality and results variability. Location and swab sampling order should be randomized.For additional information on collecting, handling, and testing COVID-19 specimens, please refer to the Centers for Disease Control and Prevention (CDC) Interim Guidelines for Collecting, Handling, and Testing Clinical buy propecia from canada Specimens for COVID-19.Previous clinical dataPreviously obtained clinical data may be submitted in lieu of clinical testing.

Those data should demonstrate the safe and effective use of a swab of identical design and materials in human subjects. The proposed swab should be compared against a flocked swab commercially available in Canada with respect to. flexibility fit ability to navigate to the nasopharynx buy propecia from canada (or other areas specified in the indications) ability to collect a specimen/respiratory epithelial cells for example, using the RNase P housekeeping gene test results long term propecia use agreement for example, ≥ 90% positive % agreement) using a composite control (positive % agreement calculation that includes all positive findings from control and test swabs) Sterility Provide sterilization validation data in a summary report.

It should demonstrate that the chosen sterilization method will achieve a minimum Sterility Assurance Level (SAL) of 10-6 for the proposed swab, using an appropriate biological indicator (BI) organism (see below). If the swab will buy propecia from canada be sterilized using an ethylene oxide (EtO) method, you should demonstrate that EtO and ethylene chlorohydrin (ECH) residuals meet the tolerable contact limits (TCL) specified in ISO 10993-7. Commonly used swab materials, compatible sterilization methods, and appropriate biological indicators are described below.

Sterilization Method Swab Materials EtO(for example, ISO 11135) Gamma Irradiation(ISO 11137) Polystyrene handle, polyester bicomponent fiber tipFootnote * X(for example, Puritan 25-3316-H/U) Not applicable Polystyrene handle, nylon flocked fiber tipFootnote * X(for example, Copan 503CS01) X(for example, BD 220252) Footnote * The CDC provides guidance on the types of swabs that should be used for optimal specimen collection for PCR testing. They include swabs that are made of polyester buy propecia from canada (for example, Dacron), rayon, or nylon-flocked. Cotton-tipped or calcium alginate swabs are not acceptable because residues present in those materials inhibit the PCR reaction.

Return to footnote * referrer Appropriate BIIf ionizing radiation will be used to sterilize the swab. Bacillus pumilus spores are recommended for doses of 25 kGy Bacillus cereus or Bacillus sphaericus spores are buy propecia from canada recommended for doses of >. 25 kGy (World Health Organization, The International Pharmacopoeia, 9th Ed., 2019) Sterilization Process Spore (Indicator Organism) Steam Geobacillus stearothermophilus(formerly Bacillus stearothermophilus) Dry Heat Bacillus atrophaeus (formerly Bacillus subtilis var.

Niger) Ethlylene Oxide Bacillus atrophaeus (formerly Bacillus subtilis var. Niger) Hydrogen Peroxide Geobacillus buy propecia from canada stearothermophilus(formerly Bacillus stearothermophilus) Source. US Food and Drug Administration, "Biological Indicator (BI) Premarket Notification [510(k)] Submissions," October 2007.

[Online].Packaging validation Provide packaging buy propecia from canada validation data in a summary report. It should demonstrate that the swab packaging system will maintain a sterile environment across the labelled shelf life (for example, ASTM F1980). without leakage (for example, ASTM D3078-02) with adequate seal strength (for example, ASTM F88/EN 868-5)Test packaging samples should be representative of finished swab packages that have undergone sterilization prior to testing.Biocompatibility Provide biocompatibility data in a summary report.

It should demonstrate compliance with biocompatibility tests recommended for devices in limited contact (≤24 hrs) with mucosal membranes, as per buy propecia from canada ISO 10993-1. These include. cytotoxicity sensitization irritation/intracutaneous reactivityThese data should be based on test samples representative of finished swabs that have undergone sterilization prior to testing.LabellingSwabs should be individually packaged and labelled.

The application must buy propecia from canada include the swab label, which must include. The name and model number of the device the term ‘sterile’, along with the sterilization method (EtO = ethylene oxide. R = gamma irradiation), if the swab is intended to be sold in a sterile condition the name and address of the manufacturer manufacturing and expiry datesIf swabs are not sterile but must be sterilized at the user facility, then the sterilization parameters and method should be clearly described in accompanying instructions for use documentation.Post-market requirementsAs stated in Section 12 of the IO, within 10 days of becoming aware of an incident in Canada, all IO authorization holders must.

report the incident specify the nature of the incident specify the circumstances surrounding the incidentOn this page buy propecia from canada About face shields Personal protective equipment (PPE) can help prevent potential exposure to infectious disease. They are considered medical devices in Canada and therefore must follow the requirements outlined in the Medical Devices Regulations. Medical devices are classified into 4 groups (Class I, II, III buy propecia from canada and IV) based on their risk to health and safety.

Class I devices, such as gauze bandages, pose the lowest potential risk, while Class IV devices, such as pacemakers, pose the greatest potential risk. In Canada, face shields are Class I medical devices. A face shield has a transparent window or visor that shields the buy propecia from canada face and associated mucous membranes (eyes, nose and mouth).

It protects the wearer against exposure from splashes and sprays of body fluids. Face shields are made of shatterproof plastic, fit over the face and are held in place by head straps or caps. They may buy propecia from canada be made of polycarbonate, propionate, acetate, polyvinyl chloride, or polyethylene terephthalate.

They are usually worn with other PPE, such as a medical mask, respirator or eyewear. Health Canada strongly advises against the use of plastic bags as an alternative to face shields. Standards and requirements for face shields Organizations that buy propecia from canada are manufacturing face shields are advised to consult some or all of the following standards throughout the design and testing stages.

ANSI/ISEA Z.87.1 (2015), American National Standard for Occupational and Educational Personal Eye and Face Protection Devices CSA Z94.3 (2020), Eye and Face Protectors CSA Z94.3.1 (2016), Guideline for Selection, Use, and Care of Eye and Face Protectors BS EN 166 (2002), Personal Eye Protection. Specifications. Minimum specifications must be incorporated into the design and verification stages to ensure safe and effective face shields.

Provide adequate coverage (CSA Z94.3 Sections 0.2.1/10.2.2/10.3/10.4). The size of the face shield is important because it must protect the face and front part of the head. This includes the eyes, forehead, cheeks, nose, mouth, and chin.

Protection may also need to extend to the front of the neck in situations with flying particles and sprays of hazardous liquids. Fit snugly to afford a good seal to the forehead area and to prevent slippage of the device Footnote 1. Be made of optically clear, distortion-free, lightweight materials (CSA Z94.3.1-16 and Footnote 1).

Be free of visible defects or flaws that would impede vision (ANSI Z87.1 Section 9.4). Be comfortable and easy to assemble, use and remove by health care professionals. Provide adequate space between the wearer’s face and the inner surface of the visor to allow for the use of ancillary equipment (for example, medical mask, respirator, eyewear) Footnote 1.

The characteristics and performance requirements of face shields must not be altered when attaching shields to other protective equipment, such as hats or caps. Display anti-fog characteristics on inside and outside of shield (CSA Z94.3.1-16). For face shields that are not fog resistant, anti-fog spray must be provided.

Provide user-contacting materials that have adequate material biocompatibility (skin sensitivity and cytotoxic testing) (ISO 10993-5, 10). Other items to take note of include. Face shields used for protection in hospital settings do not have to be impact- or flame- resistant.

If the device is specifically designed to withstand impact from sharp or fast projectiles, it must comply with set-out standards (ANSI Z87.1, sections 9.2 and 9.3, CSA Z94.3, section 10.1). For reuse, manufacturers must provide validated cleaning instructions. Sterilization procedures must not compromise the shield in any way, such as deformation or cracking.

Regulatory authorization Most PPE, including face shields, are Class I medical devices if they are manufactured, sold or represented for use for reducing the risk of or preventing the user from infection. This includes COVID-19. Face shields may be authorized for sale or import into Canada through the following regulatory pathways.

Pathway 1. Interim order authorization to import and sell medical devices related to COVID-19. Pathway 2.

Expedited review and issuance of Medical Device Establishment Licences (MDEL) related to COVID-19. MDEL holders that import and sell face shields should take measures to ensure they are safe and effective. Pathway 3.

Exceptional importation and sale of certain non-compliant medical devices related to COVID-19. Note that a sale generally requires the transfer of ownership of a device from one party to another and does not necessitate any transfer of money. Applicants should carefully review the pathways and select the most appropriate authorization route for their product.

For more information, see Personal protective equipment (COVID-19). How to get authorization. If you intend to manufacture 3D print face shields in response to the COVID-19 crisis, see.

3D printing and other manufacturing of personal protective equipment in response to COVID-19 Feedback If you have any questions or comments about this notice, contact the Medical Devices Directorate at hc.meddevices-instrumentsmed.sc@canada.ca R. J. Roberge, "Face shields for infection control.

A review," Journal of Occupational and Environmental Hygiene, pp. 235-242, 2016. Related links FootnotesFootnote 1 R.

J. Roberge, "Face shields for infection control. A review," Journal of Occupational and Environmental Hygiene, pp.

235-242, 2016.Return to footnote 1 referrer.

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A fourth wave of the opioid epidemic is coming, a national expert on drug use and policy said during a propecia cost per pill virtual panel discussion this week hosted by the Berkshire County, Massachusetts, District Attorney’s Office and visit the site the Berkshire Opioid Addiction Prevention Collaborative.Dr. Daniel Ciccarone, a professor of family and community medicine at the University of California, San Francisco (UCSF) School of Medicine, said the next wave in the country’s opioid health emergency will focus on stimulants like methamphetamine and cocaine, and drug combinations where stimulants are used in conjunction with opioids.“The use of methamphetamines is back and it’s back big time,” said Ciccarone, whose most recent research has focused on heroin use.Previously, officials had said there were three waves of the opioid epidemic – the first being prescription pills, the second being heroin, and the third being synthetic drugs, like fentanyl.Now, Ciccarone said, what federal law enforcement and medical experts are seeing propecia cost per pill is an increase in the use of stimulants, especially methamphetamines.The increase in deaths due to stimulants may be attributed to a number of causes. The increase in supply, both imported and domestically produced, as well as the increase of the drugs’ potency.“Meth’s purity and potency has gone up to historical levels,” he said. €œAs of 2018, we’ve propecia cost per pill reached unseen heights of 97 percent potency and 97 percent purity.

In a prohibitionist world, we should not be seeing such high quality. This is almost pharmaceutical quality.”Additionally, law enforcement and public health experts like Ciccarone are seeing an propecia cost per pill increase in the co-use of stimulants with opioids, he said. Speedballs, cocaine mixed with heroin, and goofballs, methamphetamines used with heroin or fentanyl, are becoming more common from the Midwest into Appalachia and up through New England, he said.Federal law enforcement officials are recommending local communities prepare for the oncoming rise in illegal drugs coming into their communities.“Some people will use them both at the same time, but some may use them in some combination regularly,” he said. €œThey may use meth in the morning to go to work, and use heroin at night to come down.”The co-use, he said, was an organic response to the fentanyl overdose epidemic.“Some of the things that we heard … is that meth is popularly construed as helping propecia cost per pill to decrease heroin and fentanyl use.

Helping with heroin propecia cost per pill withdraw symptoms and helping with heroin overdoses,” he said. €œWe debated this for many years that people were using stimulants to reverse overdoses – we’re hearing it again.”“Supply is up, purity is up, price is down,” he said. €œWe know from economics that when drug patterns go in that direction, use is going up.”Ciccarone said that there should not be deaths because of stimulants, but that heroin/fentanyl is the deadly element in the equation.His recommendations to propecia cost per pill communities were not to panic, but to lower the stigma surrounding drug use in order to affect change. Additionally, he said, policies should focus on reduction.

supply reduction, demand reduction and harm reduction propecia cost per pill. But not focus on only one single drug.Additionally, he said that by addressing issues within communities and by healing communities socially, economically and spiritually, communities can begin to reduce demand.“We’ve got to fix the cracks in our society, because drugs fall into the cracks,” he said..

A fourth wave of the opioid epidemic is coming, a national expert on drug use and buy propecia from canada policy said during a virtual panel discussion this week hosted by the Berkshire County, does propecia really cause depression Massachusetts, District Attorney’s Office and the Berkshire Opioid Addiction Prevention Collaborative.Dr. Daniel Ciccarone, a professor of family and community medicine at the University of California, San Francisco (UCSF) School of Medicine, said the next wave in the country’s opioid health emergency will focus on stimulants like methamphetamine and cocaine, and drug combinations where stimulants are used in conjunction with opioids.“The use of methamphetamines is back and it’s back big time,” said Ciccarone, whose most recent research has focused on heroin use.Previously, officials had said there were three waves buy propecia from canada of the opioid epidemic – the first being prescription pills, the second being heroin, and the third being synthetic drugs, like fentanyl.Now, Ciccarone said, what federal law enforcement and medical experts are seeing is an increase in the use of stimulants, especially methamphetamines.The increase in deaths due to stimulants may be attributed to a number of causes. The increase in supply, both imported and domestically produced, as well as the increase of the drugs’ potency.“Meth’s purity and potency has gone up to historical levels,” he said. €œAs of 2018, we’ve reached unseen heights of 97 percent buy propecia from canada potency and 97 percent purity.

In a prohibitionist world, we should not be seeing such high quality. This is almost pharmaceutical quality.”Additionally, law enforcement buy propecia from canada and public health experts like Ciccarone are seeing an increase in the co-use of stimulants with opioids, he said. Speedballs, cocaine mixed with heroin, and goofballs, methamphetamines used with heroin or fentanyl, are becoming more common from the Midwest into Appalachia and up through New England, he said.Federal law enforcement officials are recommending local communities prepare for the oncoming rise in illegal drugs coming into their communities.“Some people will use them both at the same time, but some may use them in some combination regularly,” he said. €œThey may use meth in the morning to go to work, and use http://cz.keimfarben.de/best-place-to-buy-propecia/ heroin at night to come down.”The co-use, he said, was an organic response to the fentanyl overdose epidemic.“Some of the things that we heard … is that buy propecia from canada meth is popularly construed as helping to decrease heroin and fentanyl use.

Helping with heroin withdraw symptoms and helping with heroin overdoses,” buy propecia from canada he said. €œWe debated this for many years that people were using stimulants to reverse overdoses – we’re hearing it again.”“Supply is up, purity is up, price is down,” he said. €œWe know from economics that when drug patterns go in that direction, use is going up.”Ciccarone said that there should not be deaths because of stimulants, buy propecia from canada but that heroin/fentanyl is the deadly element in the equation.His recommendations to communities were not to panic, but to lower the stigma surrounding drug use in order to affect change. Additionally, he said, policies should focus on reduction.

supply reduction, demand reduction and harm buy propecia from canada reduction. But not focus on only one single drug.Additionally, he said that by addressing issues within communities and by healing communities socially, economically and spiritually, communities can begin to reduce demand.“We’ve got to fix the cracks in our society, because drugs fall into the cracks,” he said..

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Serum levels of lipoprotein-associated phospholipase A2 propecia lawsuit update (Lp-PLA2) activity are associated with the presence of CAVS. However, it has been unclear whether this association is due to a cause–effect relationship. In this issue of Heart, Perrot and colleagues1 used genetic association studies from eight cohorts to show that CAVS was not associated with any of four single nucleotide polymorphisms that are associated with Lp-PLA2 activity or mass. These findings suggest that although Lp-PLA2 activity is a biomarker for CAVS unfortunately, it is unlikely to be a therapeutic target (figure 1).Higher Lp-PLA2 activity is significantly associated with the presence of CAVS in patients with heart disease, but variants influencing Lp-PLA2 mass or activity are not associated propecia lawsuit update with CAVS in this large genetic association study.

CAVS, calcific aortic valve stenosis. Lp-PLA2, lipoprotein-associated phospholipase A2." data-icon-position data-hide-link-title="0">Figure 1 Higher Lp-PLA2 activity is significantly associated with the presence of CAVS in patients with heart disease, but variants influencing Lp-PLA2 mass or activity are not associated with CAVS in this large genetic association study. CAVS, calcific propecia lawsuit update aortic valve stenosis. Lp-PLA2, lipoprotein-associated phospholipase A2.In an editorial, Zheng and Dweck2 discuss this article, summarise current ongoing trials of medical therapy for CAVS (table 1) and comment.

€˜Strong evidence points towards elevated Lp(a) levels and its associated oxidised phospholipids (OxPL) as causal risk factors for CAVS, suggesting that targeting this lipid-driven, inflammatory pathway has a real chance to translate into therapy capable of mitigating disease. The current study suggests that this association is propecia lawsuit update not mediated by Lp-PLA2 and underlines the importance of scrutinising whether biological factors within pathophysiological pathways are merely biomarkers or actually represent a feasible and causal target.’View this table:Table 1 Ongoing randomised clinical trials of medical therapies in aortic stenosisRheumatic heart disease (RHD) remains the primary cause of valve disease worldwide and contributes significantly to maternal and fetal morbidity and mortality. In a study by Baghel and colleagues3 of 681 pregnant women with RHD, adverse cardiovascular evens occurred in about 15% of pregnancies. Multivariable predictors of adverse outcomes during pregnancy were prior adverse cardiovascular events, lack of appropriate medical therapy, severity of mitral stenosis, valve replacement and pulmonary hypertension.

Based on this analysis, the authors propose a risk score from pregnant women with RHD (table 2).View this table:Table 2 New prognostic score (DEVI’s score) to predict composite adverse propecia lawsuit update cardiac outcome in pregnant women with rheumatic valvular heart diseaseCommenting on this paper, Elkayam and Shmueli4 point out that in about one-fourth of women, the diagnosis of RHD was not known prior to pregnancy and that a late diagnosis often was associated with adverse outcomes. Their editorial provides a concise summary of optimal management of pregnant women with RHD. They conclude ‘With proper evaluation and risk stratification prior to pregnancy, a close multidisciplinary follow-up during pregnancy, and close monitoring during labour and delivery as well as the early postpartum period most complications can be prevented.’The importance of psychosocial factors in cardiovascular disease (CVD) prevalence and outcomes is increasingly recognised. Using data from the English Longitudinal Study of Ageing, Bu and colleagues5 found that loneliness was associated with CVD, independent of possible confounders and other risk factors, with a 30% propecia lawsuit update higher risk of a new CVD diagnosis in the most lonely people compared with the least lonely people.

As O’Keefe and colleagues6 point out, this data is especially important now in the context of social distancing and stay-at-home recommendations and they offer several approaches to mitigating loneliness during the COVID-19 pandemic.The Education in Heart article7 in this issue focuses on the clinical use and prognostic implications of echocardiographic speckle tracking measurements of global longitudinal strain to detect and quantify early systolic dysfunction of the left ventricle (figure 2).Left ventricular global longitudinal strain to differentiate between mutation-positive sarcomeric hypertrophic cardiomyopathy and cardiac amyloidosis. (A) Apical four-chamber view of a 66-year-old patient known with mutation-positive hypertrophic cardiomyopathy. The thickness of the septum was 28 mm and propecia lawsuit update the left ventricular ejection fraction was 55%. (B) The polar map shows markedly impaired longitudinal strain in the septal mid and basal areas and the global longitudinal strain is impaired (−13.6%).

(C) Apical four-chamber view of a 75-year-old patient diagnosed with light chain amyloidosis. There is concentric hypertrophy of the left ventricle and the ejection fraction is propecia lawsuit update 56%. Based on speckle tracking echocardiography analysis, the left ventricular global longitudinal strain is impaired (−12.2%), with typical sparing of the longitudinal strain values in the apical segments (D). ANT, anterior.

ANT SEPT, propecia lawsuit update anteroseptal. GS, global strain. INF, inferior. LAT, lateral.

POST, posterior propecia lawsuit update. SEPT, septal." data-icon-position data-hide-link-title="0">Figure 2 Left ventricular global longitudinal strain to differentiate between mutation-positive sarcomeric hypertrophic cardiomyopathy and cardiac amyloidosis. (A) Apical four-chamber view of a 66-year-old patient known with mutation-positive hypertrophic cardiomyopathy. The thickness of the septum was 28 mm and propecia lawsuit update the left ventricular ejection fraction was 55%.

(B) The polar map shows markedly impaired longitudinal strain in the septal mid and basal areas and the global longitudinal strain is impaired (−13.6%). (C) Apical four-chamber view of a 75-year-old patient diagnosed with light chain amyloidosis. There is concentric hypertrophy of the propecia lawsuit update left ventricle and the ejection fraction is 56%. Based on speckle tracking echocardiography analysis, the left ventricular global longitudinal strain is impaired (−12.2%), with typical sparing of the longitudinal strain values in the apical segments (D).

ANT, anterior. ANT SEPT, propecia lawsuit update anteroseptal. GS, global strain. INF, inferior.

LAT, lateral propecia lawsuit update. POST, posterior. SEPT, septal.Our Cardiology-in-Focus article by Hudson and Pettit8 provides a clear-eyed but brief discussion and outstanding graphic of the challenges in reconciling the varying definitions of the ‘normal’ values for left ventricular ejection fraction, as stated in different guidelines (figure 3).Categories of left ventricular ejection fraction. EF, ejection propecia lawsuit update fraction.

HF, heart failure. LVEF, left ventricular ejection fraction." data-icon-position data-hide-link-title="0">Figure 3 Categories of left ventricular ejection fraction. EF, ejection propecia lawsuit update fraction. HF, heart failure.

LVEF, left ventricular ejection fraction.Loneliness is an unpleasant emotional state induced by perceived isolation. Until about 200 years ago, the English word for being on one’s own was ‘oneliness’, a term that connoted solitude, and was generally considered an essential and propecia lawsuit update positive experience in life. However, solitude and loneliness are not synonymous. Loneliness is also described as ‘social pain’ from an unwanted lack of connection and intimacy.

Artists have likened loneliness to hunger, not only because we can feel it physically, sometimes described as an ache, a hollowness or a sense of coldness, but also because these physical sensations might be the body’s way of telling us that we are missing something that is important to our survival and flourishing.In this propecia lawsuit update issue of Heart, Bu and colleagues,1 in a prospective observational study that comprised approximately 5000 adults followed for about 10 years, found that individuals reporting high levels of loneliness had 30%–48% increased risks of developing cardiovascular disease (CVD) and CVD-related hospital admission, respectively, even after adjusting for the usual cardiovascular risk factors.1 This major study has three implications. (1) loneliness should be considered among the most dangerous CVD risk factors. (2) feeling lonely is a highly modifiable state that would seemingly respond to lifestyle adjustments as compared with the other foremost psychosocial CVD risk factors—depression and stress/anxiety—which typically require prescription medication or exercise2. And (3) social isolation without the anguish of loneliness does not appear to increase CVD risk.The current study confirms prior data showing that self-reported loneliness is significantly correlated with increased healthcare utilisation and heightened morbidity and mortality risks.3 4 Advanced age, poor health, fewer ….

Serum levels of lipoprotein-associated phospholipase A2 (Lp-PLA2) buy propecia from canada activity view website are associated with the presence of CAVS. However, it has been unclear whether this association is due to a cause–effect relationship. In this issue of Heart, Perrot and colleagues1 used genetic association studies from eight cohorts to show that CAVS was not associated with any of four single nucleotide polymorphisms that are associated with Lp-PLA2 activity or mass. These findings suggest that although Lp-PLA2 activity is a biomarker for CAVS unfortunately, it is unlikely to be a therapeutic target (figure 1).Higher Lp-PLA2 activity is significantly associated with the presence of CAVS in patients with heart disease, but variants buy propecia from canada influencing Lp-PLA2 mass or activity are not associated with CAVS in this large genetic association study. CAVS, calcific aortic valve stenosis.

Lp-PLA2, lipoprotein-associated phospholipase A2." data-icon-position data-hide-link-title="0">Figure 1 Higher Lp-PLA2 activity is significantly associated with the presence of CAVS in patients with heart disease, but variants influencing Lp-PLA2 mass or activity are not associated with CAVS in this large genetic association study. CAVS, calcific buy propecia from canada aortic valve stenosis. Lp-PLA2, lipoprotein-associated phospholipase A2.In an editorial, Zheng and Dweck2 discuss this article, summarise current ongoing trials of medical therapy for CAVS (table 1) and comment. €˜Strong evidence points towards elevated Lp(a) levels and its associated oxidised phospholipids (OxPL) as causal risk factors for CAVS, suggesting that targeting this lipid-driven, inflammatory pathway has a real chance to translate into therapy capable of mitigating disease. The current study suggests that this association is not mediated by Lp-PLA2 and underlines the importance of scrutinising whether biological factors within pathophysiological pathways are merely biomarkers or actually represent a feasible and causal target.’View this table:Table 1 Ongoing randomised clinical trials of medical therapies in aortic stenosisRheumatic heart disease (RHD) remains the primary cause of valve disease worldwide and contributes significantly to maternal and buy propecia from canada fetal morbidity and mortality.

In a study by Baghel and colleagues3 of 681 pregnant women with RHD, adverse cardiovascular evens occurred in about 15% of pregnancies. Multivariable predictors of adverse outcomes during pregnancy were prior adverse cardiovascular events, lack of appropriate medical therapy, severity of mitral stenosis, valve replacement and pulmonary hypertension. Based on this analysis, the authors propose a risk score from pregnant women with buy propecia from canada RHD (table 2).View this table:Table 2 New prognostic score (DEVI’s score) to predict composite adverse cardiac outcome in pregnant women with rheumatic valvular heart diseaseCommenting on this paper, Elkayam and Shmueli4 point out that in about one-fourth of women, the diagnosis of RHD was not known prior to pregnancy and that a late diagnosis often was associated with adverse outcomes. Their editorial provides a concise summary of optimal management of pregnant women with RHD. They conclude ‘With proper evaluation and risk stratification prior to pregnancy, a close multidisciplinary follow-up during pregnancy, and close monitoring during labour and delivery as well as the early postpartum period most complications can be prevented.’The importance of psychosocial factors in cardiovascular disease (CVD) prevalence and outcomes is increasingly recognised.

Using data from the English Longitudinal Study of Ageing, Bu and colleagues5 found that loneliness was associated with CVD, independent of possible confounders and other risk factors, with a 30% higher risk of a new CVD diagnosis buy propecia from canada in the most lonely people compared with the least lonely people. As O’Keefe and colleagues6 point out, this data is especially important now in the context of social distancing and stay-at-home recommendations and they offer several approaches to mitigating loneliness during the COVID-19 pandemic.The Education in Heart article7 in this issue focuses on the clinical use and prognostic implications of echocardiographic speckle tracking measurements of global longitudinal strain to detect and quantify early systolic dysfunction of the left ventricle (figure 2).Left ventricular global longitudinal strain to differentiate between mutation-positive sarcomeric hypertrophic cardiomyopathy and cardiac amyloidosis. (A) Apical four-chamber view of a 66-year-old patient known with mutation-positive hypertrophic cardiomyopathy. The thickness buy propecia from canada of the septum was 28 mm and the left ventricular ejection fraction was 55%. (B) The polar map shows markedly impaired longitudinal strain in the septal mid and basal areas and the global longitudinal strain is impaired (−13.6%).

(C) Apical four-chamber view of a 75-year-old patient diagnosed with light chain amyloidosis. There is concentric hypertrophy of the left ventricle and the ejection fraction buy propecia from canada is 56%. Based on speckle tracking echocardiography analysis, the left ventricular global longitudinal strain is impaired (−12.2%), with typical sparing of the longitudinal strain values in the apical segments (D). ANT, anterior. ANT SEPT, anteroseptal buy propecia from canada.

GS, global strain. INF, inferior. LAT, lateral. POST, posterior buy propecia from canada http://cz.keimfarben.de/online-propecia-prescription/. SEPT, septal." data-icon-position data-hide-link-title="0">Figure 2 Left ventricular global longitudinal strain to differentiate between mutation-positive sarcomeric hypertrophic cardiomyopathy and cardiac amyloidosis.

(A) Apical four-chamber view of a 66-year-old patient known with mutation-positive hypertrophic cardiomyopathy. The thickness of the septum was 28 mm and buy propecia from canada the left ventricular ejection fraction was 55%. (B) The polar map shows markedly impaired longitudinal strain in the septal mid and basal areas and the global longitudinal strain is impaired (−13.6%). (C) Apical four-chamber view of a 75-year-old patient diagnosed with light chain amyloidosis. There is concentric hypertrophy buy propecia from canada of the left ventricle and the ejection fraction is 56%.

Based on speckle tracking echocardiography analysis, the left ventricular global longitudinal strain is impaired (−12.2%), with typical sparing of the longitudinal strain values in the apical segments (D). ANT, anterior. ANT SEPT, buy propecia from canada anteroseptal. GS, global strain. INF, inferior.

LAT, lateral buy propecia from canada. POST, posterior. SEPT, septal.Our Cardiology-in-Focus article by Hudson and Pettit8 provides a clear-eyed but brief discussion and outstanding graphic of the challenges in reconciling the varying definitions of the ‘normal’ values for left ventricular ejection fraction, as stated in different guidelines (figure 3).Categories of left ventricular ejection fraction. EF, ejection fraction buy propecia from canada. HF, heart failure.

LVEF, left ventricular ejection fraction." data-icon-position data-hide-link-title="0">Figure 3 Categories of left ventricular ejection fraction. EF, ejection fraction buy propecia from canada. HF, heart failure. LVEF, left ventricular ejection fraction.Loneliness is an unpleasant emotional state induced by perceived isolation. Until about 200 years ago, the English word for being on one’s own was ‘oneliness’, a term that connoted solitude, and was generally considered an essential buy propecia from canada and positive experience in life.

However, solitude and loneliness are not synonymous. Loneliness is also described as ‘social pain’ from an unwanted lack of connection and intimacy. Artists have likened loneliness to hunger, not only because we can feel it physically, buy propecia from canada sometimes described as an ache, a hollowness or a sense of coldness, but also because these physical sensations might be the body’s way of telling us that we are missing something that is important to our survival and flourishing.In this issue of Heart, Bu and colleagues,1 in a prospective observational study that comprised approximately 5000 adults followed for about 10 years, found that individuals reporting high levels of loneliness had 30%–48% increased risks of developing cardiovascular disease (CVD) and CVD-related hospital admission, respectively, even after adjusting for the usual cardiovascular risk factors.1 This major study has three implications. (1) loneliness should be considered among the most dangerous CVD risk factors. (2) feeling lonely is a highly modifiable state that would seemingly respond to lifestyle adjustments as compared with the other foremost psychosocial CVD risk factors—depression and stress/anxiety—which typically require prescription medication or exercise2.

And (3) social isolation without the anguish of loneliness does not appear to increase CVD risk.The current study confirms prior data showing that self-reported loneliness is significantly correlated with increased healthcare utilisation and heightened morbidity and mortality risks.3 4 Advanced age, poor health, fewer ….

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Imagine being infected with a deadly virus that where can i buy propecia in canada makes you you can find out more impervious to pain. By the time you realize you are infected, it’s already too late where can i buy propecia in canada. You have spread it far and wide.

Recent findings where can i buy propecia in canada in my lab suggest that this scenario may be one reason that people infected with SARS-CoV-2, the virus causing COVID-19, may be spreading the disease without knowing it.Most accounts to date have focused on how the virus invades cells via the ACE2 protein on the surface of many cells. But recent studies, which have not yet been peer-reviewed, suggest there is another route to infecting the cell that enables it to infect the nervous system. This led my research group where can i buy propecia in canada to uncover a link between a particular cellular protein and pain – an interaction that is disrupted by the coronavirus.

Our research has now been peer-reviewed and will be published in the journal PAIN.I am a scientist who studies how proteins on cells trigger pain signals that are transmitted through the body to the brain. When these where can i buy propecia in canada proteins are active, the nerve cells are talking to each other. This conversation occurs at deafening levels in chronic pain.

So by where can i buy propecia in canada studying what causes the excitability of nerve cells to change, we can begin to unravel how chronic pain becomes established. This also allows us to design ways to mute this conversation to blunt or stop chronic pain.My laboratory has a longstanding interest in designing nonopioid-based alternatives for pain management.Linking SARS-CoV-2 and painYou might be wondering how my lab began to probe the connection between SARS-CoV-2 and pain. We were inspired by two preliminary reports that appeared on the preprint server BioRxiv that showed that the infamous spike proteins on the surface of the SARS-CoV-2 virus bound to where can i buy propecia in canada a protein called neuropilin-1.

This means that the virus can also use this protein to invade nerve cells as well as through the ACE2 protein.For the past year, some six months before the pandemic took hold, my colleagues and I had been studying the role of neuropilin-1 in the context of pain perception. Because neuropilin-1, like the ACE2 receptor, allowed spike to enter the cells, we wondered if this alternate gateway could also be related to pain.Under normal circumstances, the neuropilin-1 protein controls the growth of blood vessels, and as well as the growth and survival of neurons.However, when neuropilin-1 binds to a naturally occurring protein called called Vascular endothelial growth factor A where can i buy propecia in canada (VEGF-A), this triggers pain signals. This signal is transmitted via the spinal cord into higher brain centers to cause the sensation we all know as pain.Staring at this jigsaw puzzle – neuropilin-1 and VEGF-A and neuropilin and spike – we wondered if there was a link between spike and pain.Previous research has shown a link between VEGF-A and pain.

For people with osteoarthritis, for instance, studies have shown that increased activity of the VEGF gene in fluids lubricating joints, like the knee, is associated with higher pain scores.Although activity of the neuropilin-1 gene is higher in biological samples from COVID-19 patients compared to healthy controls and activity of the neuropilin-1 gene is increased in pain-sensing neurons in an animal model of chronic pain, the role of neuropilin-1 in pain has never been explored until now.In in vitro studies done in my lab using nerve cells, we showed that when where can i buy propecia in canada spike binds to neuropilin-1 it decreases pain signaling, which suggests that in a living animal it would also have a pain-dulling effect.When the spike protein binds to the neuropilin-1 protein, it blocks the VEGF-A protein from binding and thus hijack’s a cell’s pain circuitry. This binding suppresses the excitability of pain neurons, leading to lower sensitivity to pain.Crystal structure of neuropilin-1 b1 domain (white surface with binding site in red) showing binding of VEGF-A (left), spike protein (middle), and the neuropilin-1 inhibitor EG00229 (right). (Credit.

Dr. Samantha Perez-Miller, CC BY-SA)From the COVID-19 fog a new pain target emergesIf our finding that the new coronavirus is attacking cells through a protein associated with pain and disabling the protein can be confirmed in humans, it may provide a new pathway for drug development to treat COVID-19.A small molecule, called EG00229, targeting neuropilin-1 had been reported in a 2018 study. This molecule binds to the same region of the neuropilin-1 protein as the viral spike protein and VEGF-A.

So I and my colleagues asked if this molecule was able to block pain. It did, during pain simulations in rats. Our data reaffirmed the notion of neuropilin-1 as a new player in pain signaling.There is precedence for targeting the neuropilin-1 protein for cancer treatment.

For example, a Phase 1a clinical trial of an antibody called MNRP1685A (known under the product name Vesencumab) that recognizes and binds to neuropilin-1 and blocks VEGF-binding. This was mostly well tolerated in cancer patients, but it caused pain rather than blocking it.Our studies identify a different approach because we targeted blocking the pain-triggering VEGF-A protein, which then resulted in pain relief. So our preclinical work described here provides a rationale for targeting the VEGF-A/NRP-1 pro-pain signaling system in future clinical trials.Analysis of the structure of the neuropilin-1 receptor protein may allow design of drugs targeting this critical site which also controls axon growth, cell survival – in addition to pain relief.For instance, these neuropilin-1 receptor targeted drugs could potentially block viral infection.

The testing of several candidate compounds, some of them on the FDA’s generally regarded as safe list, is currently underway by my group.Sneaky virus, fooling people into believing that they do not have COVID-19. But, ironically, it may be gifting us with the knowledge of a new protein, critical for pain. Two roads emerge in the forest ahead.

(1) block neuropilin-1 to limit SARS-CoV-2 entry, and (2) block neuropilin-1 to block pain.Rajesh Khanna is a Professor of Pharmacology, University of Arizona. This article originally appeared on The Conversation under a Creative Commons license. Read the original here..

Imagine being infected with a deadly virus that buy propecia from canada makes you where to buy cheap propecia impervious to pain. By the time you realize you are buy propecia from canada infected, it’s already too late. You have spread it far and wide. Recent findings in my lab suggest buy propecia from canada that this scenario may be one reason that people infected with SARS-CoV-2, the virus causing COVID-19, may be spreading the disease without knowing it.Most accounts to date have focused on how the virus invades cells via the ACE2 protein on the surface of many cells. But recent studies, which have not yet been peer-reviewed, suggest there is another route to infecting the cell that enables it to infect the nervous system.

This led my research group to uncover a link between a particular cellular protein and pain – an interaction buy propecia from canada that is disrupted by the coronavirus. Our research has now been peer-reviewed and will be published in the journal PAIN.I am a scientist who studies how proteins on cells trigger pain signals that are transmitted through the body to the brain. When these proteins are active, the nerve cells are talking buy propecia from canada to each other. This conversation occurs at deafening levels in chronic pain. So by studying what causes the excitability of nerve cells to change, we can begin to unravel how chronic pain becomes buy propecia from canada established.

This also allows us to design ways to mute this conversation to blunt or stop chronic pain.My laboratory has a longstanding interest in designing nonopioid-based alternatives for pain management.Linking SARS-CoV-2 and painYou might be wondering how my lab began to probe the connection between SARS-CoV-2 and pain. We were inspired by two preliminary reports that appeared on the preprint server BioRxiv that showed that the infamous spike proteins on the surface of the SARS-CoV-2 virus bound to a protein buy propecia from canada called neuropilin-1. This means that the virus can also use this protein to invade nerve cells as well as through the ACE2 protein.For the past year, some six months before the pandemic took hold, my colleagues and I had been studying the role of neuropilin-1 in the context of pain perception. Because neuropilin-1, like the ACE2 receptor, allowed spike to enter the buy propecia from canada cells, we wondered if this alternate gateway could also be related to pain.Under normal circumstances, the neuropilin-1 protein controls the growth of blood vessels, and as well as the growth and survival of neurons.However, when neuropilin-1 binds to a naturally occurring protein called called Vascular endothelial growth factor A (VEGF-A), this triggers pain signals. This signal is transmitted via the spinal cord into higher brain centers to cause the sensation we all know as pain.Staring at this jigsaw puzzle – neuropilin-1 and VEGF-A and neuropilin and spike – we wondered if there was a link between spike and pain.Previous research has shown a link between VEGF-A and pain.

For people with osteoarthritis, for instance, studies have shown that increased activity of the VEGF gene in fluids lubricating joints, like the knee, is associated with higher pain scores.Although activity of the neuropilin-1 gene is higher in biological samples from COVID-19 patients compared to healthy controls and activity of the neuropilin-1 gene is increased in pain-sensing neurons in an animal model of chronic pain, the role of neuropilin-1 in pain has never buy propecia from canada been explored until now.In in vitro studies done in my lab using nerve cells, we showed that when spike binds to neuropilin-1 it decreases pain signaling, which suggests that in a living animal it would also have a pain-dulling effect.When the spike protein binds to the neuropilin-1 protein, it blocks the VEGF-A protein from binding and thus hijack’s a cell’s pain circuitry. This binding suppresses the excitability of pain neurons, leading to lower sensitivity to pain.Crystal structure of neuropilin-1 b1 domain (white surface with binding site in red) showing binding of VEGF-A (left), spike protein (middle), and the neuropilin-1 inhibitor EG00229 (right). (Credit. Dr. Samantha Perez-Miller, CC BY-SA)From the COVID-19 fog a new pain target emergesIf our finding that the new coronavirus is attacking cells through a protein associated with pain and disabling the protein can be confirmed in humans, it may provide a new pathway for drug development to treat COVID-19.A small molecule, called EG00229, targeting neuropilin-1 had been reported in a 2018 study.

This molecule binds to the same region of the neuropilin-1 protein as the viral spike protein and VEGF-A. So I and my colleagues asked if this molecule was able to block pain. It did, during pain simulations in rats. Our data reaffirmed the notion of neuropilin-1 as a new player in pain signaling.There is precedence for targeting the neuropilin-1 protein for cancer treatment. For example, a Phase 1a clinical trial of an antibody called MNRP1685A (known under the product name Vesencumab) that recognizes and binds to neuropilin-1 and blocks VEGF-binding.

This was mostly well tolerated in cancer patients, but it caused pain rather than blocking it.Our studies identify a different approach because we targeted blocking the pain-triggering VEGF-A protein, which then resulted in pain relief. So our preclinical work described here provides a rationale for targeting the VEGF-A/NRP-1 pro-pain signaling system in future clinical trials.Analysis of the structure of the neuropilin-1 receptor protein may allow design of drugs targeting this critical site which also controls axon growth, cell survival – in addition to pain relief.For instance, these neuropilin-1 receptor targeted drugs could potentially block viral infection. The testing of several candidate compounds, some of them on the FDA’s generally regarded as safe list, is currently underway by my group.Sneaky virus, fooling people into believing that they do not have COVID-19. But, ironically, it may be gifting us with the knowledge of a new protein, critical for pain. Two roads emerge in the forest ahead.

(1) block neuropilin-1 to limit SARS-CoV-2 entry, and (2) block neuropilin-1 to block pain.Rajesh Khanna is a Professor of Pharmacology, University of Arizona. This article originally appeared on The Conversation under a Creative Commons license. Read the original here..