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May 19, 2021 (TORONTO) — Canada Health Infoway (Infoway) and Intrahealth Canada Limited (Intrahealth) are pleased to announce that prescribers in New lasix 40mg tablet pricelasix order Brunswick will now have access to e-prescribing through Intrahealth’s electronic medical record solution, Profile EMR. Profile EMR lasix 40mg tablet pricelasix order is now conformed with PrescribeIT®, Infoway’s national e-prescribing service that enables prescribers and pharmacists to electronically create, receive, renew and cancel prescriptions, while improving overall patient care through secure clinician messaging. Intrahealth is now beginning deployments to all interested prescribers in New Brunswick.Intrahealth, which is based in Vancouver, serves primary care markets in New Brunswick and British Columbia, as well as community health clinics in Ontario. In New Brunswick, 232 lasix 40mg tablet pricelasix order clinics and 420 prescribers use Intrahealth’s Profile EMR.“We are very excited to begin this rollout of PrescribeIT® to users of our Profile EMR in New Brunswick,” said Silvio Labriola, General Manager, Intrahealth.

€œInitial deployments in the province have been very successful, including the first French language clinic, Clinique Medicale Centre-Ville in Bathurst, and we look forward to making it widely available in June.”“I encourage prescribers who use the Profile EMR to take advantage of this opportunity to enable the PrescribeIT® service,” said Dr. Daniel Fletcher, family physician in lasix 40mg tablet pricelasix order Harvey Station, NB. €œIt’s easy to use, has improved the efficiency of lasix 40mg tablet pricelasix order my workflows and has reduced the amount of paper generated with faxed prescriptions. It’s also a great fit for prescribers who are offering virtual care to their patients.”“PrescribeIT® integrated seamlessly into our pharmacy management system, and it has improved medication safety and includes enhanced communication with prescribers through its secure messaging feature,” said Alison Smith, pharmacy manager at Sobeys Pharmacy in Bathurst, NB.“It’s great news that Intrahealth is beginning the rollout of PrescribeIT® to its Profile EMR users across New Brunswick,” said Jamie Bruce, Executive Vice President, Infoway.

€œWe congratulate Intrahealth on this terrific progress and we look forward to lasix 40mg tablet pricelasix order a long and rewarding partnership that will benefit so many Canadians, prescribers and pharmacists.”In addition to New Brunswick, PrescribeIT® is also available in Alberta, Ontario, Saskatchewan and Newfoundland and Labrador, and Infoway has signed agreements with all other provinces and territories. As of March 31, 2021, more than 6,000 prescribers and close to 5,000 pharmacies had enrolled in the service, and 17 EMR and eight PMS vendors had signed on to offer PrescribeIT®, giving millions of Canadians access to e-prescribing.About Intrahealth Canada LimitedIncorporated in 2005, Intrahealth Canada provides medical software solutions to general practitioner clinics and public health authorities. Privately owned and founded by two New Zealand medical doctors, the company offers lasix 40mg tablet pricelasix order robust, secure and scalable solutions via innovative technology that keeps pace with today’s mobile lifestyles. The platform functions across multiple community-based practice types — primary care, specialist physician, lasix 40mg tablet pricelasix order community care, home care, residential care, and more.

Our solutions meet the needs of front-line professionals by delivering core information to coordinating hubs, implementing programs more rapidly, and reducing the compliance burden on physicians and other clinicians. We help our customers capture lasix 40mg tablet pricelasix order structured data that holds context, meaning, and can be analyzed and processed automatically. Intrahealth is a wholly owned subsidiary lasix 40mg tablet pricelasix order of WELL Health Technologies Corp. (TSX.

WELL). Visit http://www.intrahealth.comAbout Canada Health InfowayInfoway helps to improve the health of Canadians by working with partners to accelerate the development, adoption and effective use of digital health across Canada. Through our investments, we help deliver better quality and access to care and more efficient delivery of health services for patients and clinicians. Infoway is an independent, not-for-profit organization funded by the federal government.

Visit www.infoway-inforoute.ca.About PrescribeIT®Canada Health Infoway is working with Health Canada, the provinces and territories, and industry stakeholders to develop, operate and maintain the national e-prescribing service known as PrescribeIT®. PrescribeIT® will serve all Canadians, pharmacies and prescribers and provide safer and more effective medication management by enabling prescribers to transmit a prescription electronically between a prescriber’s electronic medical record (EMR) and the pharmacy management system (PMS) of a patient’s pharmacy of choice. PrescribeIT® will protect Canadians’ personal health information from being sold or used for commercial activities. Visit www.PrescribeIT.ca.-30-Media InquiriesInquiries about PrescribeIT® Tania EnsorSenior Director, Marketing, Stakeholder Relations and Reputation Management, PrescribeIT®Canada Health Infoway416.707.6285Email UsFollow @PrescribeIT_CAInquiries about IntrahealthSilvio LabriolaGeneral Manager, Intrahealth Canada Limited604.980.5577 ext.

112This email address is being protected from spambots. You need JavaScript enabled to view it.April 8, 2021 (TORONTO, ON and VICTORIA, BC) — The British Columbia Ministry of Health (the BC Ministry of Health) and Canada Health Infoway (Infoway) are pleased to announce that they have entered into an agreement to work together to explore a solution that could allow Electronic Medical Records (EMRs) and Pharmacy Management Systems the option of supporting Provincial Prescription Management (e-Prescribing) in the province by connecting to PharmaNet through PrescribeIT®. Under this Agreement, the BC Ministry of Health and Infoway will work to identify a possible solution that meets BC Ministry of Health conformance requirements and aligns with the provincial enterprise architecture, health sector standards, legislation and information management requirements. This model would provide BC prescribers and pharmacists with an alternative option to direct integration with the PharmaNet system for electronic prescribing.“We are extremely pleased to be working with BC on this initiative,” said Michael Green, President and CEO of Infoway.

€œWe now have agreements in place with all 13 provinces and territories and we will continue to work closely with our provincial and territorial government partners to advance our shared priorities.”About Canada Health InfowayInfoway helps to improve the health of Canadians by working with partners to accelerate the development, adoption and effective use of digital health across Canada. Through our investments, we help deliver better quality and access to care and more efficient delivery of health services for patients and clinicians. Infoway is an independent, not-for-profit organization funded by the federal government. Visit www.infoway-inforoute.ca/en/.About PrescribeIT®Canada Health Infoway is working with Health Canada, the provinces and territories, and industry stakeholders to develop, operate and maintain the national e-prescribing service known as PrescribeIT®.

PrescribeIT® will serve all Canadians, pharmacies and prescribers and provide safer and more effective medication management by enabling prescribers to transmit a prescription electronically between a prescriber’s electronic medical record (EMR) and the pharmacy management system (PMS) of a patient’s pharmacy of choice. PrescribeIT® will protect Canadians’ personal health information from being sold or used for commercial activities. Visit www.prescribeit.ca/.-30-Media InquiriesInquiries about PrescribeIT® Tania EnsorSenior Director, Marketing, Stakeholder Relations and Reputation Management, PrescribeIT®Canada Health Infoway416.707.6285Email UsFollow @PrescribeIT_CA.

Lasix overdose

Since the modern era of research on autism began in the 1980s, questions about social cognition and social brain development lasix overdose have been of central interest to researchers. This year marks the 20th anniversary of the first annual meeting of the International Society for Autism Research (INSAR), and it is evident in this year’s meeting that the growth of social cognitive neuroscience over the past two decades has significantly enriched autism science. For those lasix overdose unfamiliar with the term, social cognitive neuroscience is the study of the brain systems that are involved in the causes and effects of social behaviors and social interaction. Some of these involve brain systems involved in thinking about other people’s thoughts or intentions, empathizing, social motivation and the impact of social attention on an individual’s thinking and emotions.

At the same time, research with and for autistic people has also enriched social cognitive neuroscience and the understanding of how our social minds develop. Autism spectrum disorder (ASD) is a complex and heterogeneous part of the human condition, or neurodiversity lasix overdose. It is associated with a wide range of life outcomes, from “disorder” or the profound challenges that encumber about 30 percent of affected individuals with minimal language and intellectual disability, to “differences” among people who have well-above-average abilities and accomplishments. Regardless of their outcomes, though, people on the autism spectrum travel a different path of social-cognitive neurodevelopment that appears to begin in infancy.

For example, many experience some level of difficulty with social cognitive mentalizing, also known as “theory of mind”—the mental representation of other people’s thoughts, perspectives, beliefs, intentions or emotions, which enables us to understand or predict their lasix overdose behaviors. Social cognitive neuroscience tells us that brain systems of the medial frontal cortex, temporal cortex and parietal cortex, as well as reward centers of the brain, enable mentalizing. Accordingly, differences in the development and/or transmissions of information across this distributed social cognitive brain network lasix overdose may contribute to differences in mentalizing among autistic people. These differences can lead to a range of outcomes, from problems in the capacity to mentalize to alterations in the spontaneous use of mentalizing, or the motivation and effort involved in mentalizing during social interactions.

These observations are informative, but do not address fundamental questions about how social-cognitive brain systems develop or why their development might be different for autistic people. These questions are essential in autism science because understanding lasix overdose the early course of social cognitive neurodevelopment may afford the best opportunity to mitigate the profoundly negative effects that social cognitive differences can have on some autistic people. Serendipitously, this motivation to understand the very early development of our social brain can inform the broader understanding of social-cognitive neuroscience and human nature. As it turns out, one key to understanding the development of our social brains may come from observations of social attention in infancy.

As early as six to 12 months of age, some infants who lasix overdose go on to receive an autism diagnosis already display differences in the development of social attention. They look less frequently at the face and eyes of people than other infants and are less likely to coordinate their attention with another person to adopt a common point of view or reference, or “joint attention.” Infants with neurotypical development follow the gaze direction or gesture of other people or lead the gaze of other people to establish joint attention and share information through a common perceptual perspective. Developing the ability to coordinate attention socially is important in and of itself. For example, every teacher’s admonition to students to lasix overdose “pay attention!.

€ is really a request to “pay attention to what I [the teacher] am attending to.” Joint attention is vital to social competence at all ages. Adolescents and adults who cannot follow, initiate or join with the rapid-fire changes of shared attention in social interactions may be impaired in their capacity for relatedness lasix overdose and relationships. Equally important, joint attention is also an early building block of social cognitive mentalizing. Every time infants coordinate attention socially with other people, they practice perceptual perspective-taking.

They do this hundreds if not thousands of times in lasix overdose early development. It tunes aspects of social-brain development that subsequently support the capacity for mental perspective-taking. Mental perspective-taking is synonymous with mentalizing and our ability to understand the thoughts, beliefs, and intentions of other people. Indeed, several lasix overdose studies provide evidence of a significant overlap in brain systems involved in joint attention and social-cognitive mentalizing.

Accordingly, differences in early social attention are thought to contribute to differences in the neurodevelopment of social cognitive mentalizing in some to many people with autism. Research also suggests that differences in systems that regulate the motivation for social attention might play a role in this aspect of the development of autism, though the nature of this motivation is not understood. One possibility is that decreased motivation to attend to faces may lead to critical early difference in social lasix overdose attention. Alternatively, differences in the “eye-contact effect” may impact social attention development.

The eye-contact effect is a phenomenon in which awareness of being the object of others’ attention triggers an arousal response that enhances stimulus salience and information processing during social attention coordination lasix overdose. When we are aware of other people looking at us, changes occur in our mental processes that can benefit social learning. Several studies now suggest that people with autism may be less responsive to, or less aware of, being the object of attention of others. Hence, autism science raises the hypothesis that the first step toward human social neurocognitive development may lasix overdose involve months of practice with social attention coordination with caregivers during infancy.

Moreover, our response to eye contact of other people may provide an early motivational stance that prioritizes infant social attention development and the development of our social brains. Notably, recent studies indicate that imitating the behavior of young children with autism, which likely affects a child’s awareness that another person is looking at them, can improve joint attention and language development. Of course, the most fundamental lesson we can draw from all these observations about the development of our social mind is that we are all more similar than different, regardless of our paths of neurodevelopment, and that autistic people have much to teach us about the nature lasix overdose of human nature. This is an opinion and analysis article.

Further reading. Baron-Cohen, S lasix overdose. (2019). The concept of neurodiversity is dividing lasix overdose the autism community.

Scientific American. Chevallier, C., Kohls, G., Troiani, V., Brodkin, E. S., & lasix overdose. Schultz, R.

T. (2012). The social motivation theory of autism. Trends in cognitive sciences, 16(4), 231-239.

Gulsrud, A. C., Hellemann, G., Shire, S., &. Kasari, C. (2016).

Isolating active ingredients in a parent‐mediated social communication intervention for toddlers with autism spectrum disorder. Journal of Child Psychology and Psychiatry, 57(5), 606-613. Grynszpan, O., Bouteiller, J., Grynszpan, S., Le Barillier, F., Martin, J. C., &.

Nadel, J. (2019). Altered sense of gaze leading in autism. Research in Autism Spectrum Disorders, 67, 101441.

Mundy, P. (2018). A review of joint attention and social‐cognitive brain systems in typical development and autism spectrum disorder. European Journal of Neuroscience, 47(6), 497-514.

Reddy, V. (2003). On being the object of attention. Implications for self–other consciousness.

Trends in cognitive sciences, 7(9), 397-402. Senju, A., &. Johnson, M. H.

(2009). The eye contact effect. Mechanisms and development. Trends in cognitive sciences, 13(3), 127-134.

Stephenson, L., Edwards, S. G., &. Bayliss, A. (2020).

From gaze perception to social cognition. A neurocognitive model of joint and shared attention. Perspectives on Psychological Science. Https://journals.sagepub.com/doi/10.1177/1745691620953773Exxon Mobil Corp.

Has used language to systematically shift blame for climate change from fossil fuel companies onto consumers, according to a new paper by Harvard University researchers. The paper, published yesterday in the journal One Earth, could bolster efforts to hold the oil giant accountable in court for its alleged deception about global warming. "This is the first computational assessment of how Exxon Mobil has used language in subtle yet systematic ways to shape the way the public talks about and thinks about climate change," Geoffrey Supran, a research fellow at Harvard and co-author of the paper, said in an interview with E&E News. "One of our overall findings is that Exxon Mobil has used rhetoric mimicking the tobacco industry to downplay the reality and seriousness of climate change and to shift responsibility for climate change away from itself and onto consumers," he added.

A spokesperson for Exxon Mobil disputed the paper, calling it part of a coordinated legal campaign against the company. Supran and co-author Naomi Oreskes, a professor of the history of science at Harvard (and Scientific American columnist), conducted a computational analysis of 180 Exxon Mobil documents from 1972 to 2019, including peer-reviewed publications, advertorials in The New York Times and internal memos. Using a series of algorithms, the Harvard researchers found that Exxon Mobil had privately relied on some terms while publicly avoiding them altogether. For example, Exxon Mobil's internal documents frequently described climate change as a problem caused by "fossil fuel combustion." But in public-facing documents, the company referred to global warming as a problem caused by the "energy demand" of "consumers." The public communications sought to deflect responsibility for climate change away from the oil giant and onto individual consumers who heat their homes and fill their cars with gas, the researchers wrote.

Following their merger in 1999, Exxon and Mobil also increasingly presented climate change as a "risk," rather than a reality, the analysis found. This language sought to minimize the dangers of global warming while not denying their existence outright, the paper says. Court battles The researchers drew a direct comparison between Exxon Mobil and major tobacco companies, which they said used similar tactics to shape public discourse about smoking cigarettes. "These patterns mimic the tobacco industry's documented strategy of shifting responsibility away from corporations — which knowingly sold a deadly product while denying its harms — and onto consumers," they wrote.

In the 1990s, attorneys general from all 50 states sued the largest U.S. Tobacco companies over their alleged deception about the harmful health effects of smoking cigarettes and the addictive nature of nicotine. The suits culminated in a $206 billion master settlement agreement (Climatewire, March 10). Since 2017, five states and more than a dozen municipalities have filed similar suits alleging that the biggest U.S.

Oil and gas companies misled the public about the climate risks of burning fossil fuels. The complaints ask the oil industry to help cover the costs of addressing floods, wildfires and other disasters fueled by rising global temperatures. Supran said that although he didn't conduct the study with the climate liability litigation in mind, the findings can nonetheless inform the legal fights. "Obviously, we did this completely independently.

I've never spoken to any of the lawyers involved," Supran said. "But certainly with hindsight, our insights may be relevant, especially to these more nascent cases alleging deceptive marketing." Last month, New York City filed a lawsuit asserting that Exxon Mobil, BP PLC and Royal Dutch Shell PLC violated the city's consumer protection law by engaging in "green washing," or the practice of making their fossil fuel products seem more environmentally friendly than they really are. Exxon pushback Asked for comment on the paper, Exxon spokesperson Casey Norton said in an email to E&E News. "This research is clearly part of a litigation strategy against Exxon Mobil and other energy companies." Norton noted that Oreskes is on retainer with Sher Edling LLP, a San Francisco-based law firm that represents a slew of the challengers in the climate liability suits.

"Oreskes did not disclose this blatant conflict of interest," he said. Norton also pointed to the paper's partial funding from the Rockefeller family, which Exxon has accused of supporting a climate conspiracy against the company (Climatewire, May 4). "The research was paid for by the Rockefeller Family Fund, which is helping finance climate change litigation against energy companies," he said. "This follows a previous study attacking Exxon Mobil that used a similar discredited methodology." Norton was referring to a 2017 paper by Supran and Oreskes in the journal Environmental Research Letters that found Exxon's communications from 1977 to 2014 misled the public about climate science.

Vijay Swarup, Exxon's vice president of research and development, previously blasted the 2017 paper as "fundamentally flawed" in a comment in Environmental Research Letters last year. Norton concluded by stressing that Exxon supports climate action, noting that the oil giant recently proposed a massive carbon capture project in Houston (Energywire, April 20). "Exxon Mobil supports the Paris climate agreement, and is working to reduce company emissions and helping customers reduce their emissions while working on new lower-emission technologies and advocating for effective policies," he said. In a joint statement to E&E News, Supran and Oreskes pushed back on Norton's allegations.

"Sher Edling played no role in the paper we published today, nor in any other academic work we have done. They have not funded any of our studies. They have not reviewed our data or interpretations prior to its peer-reviewed publication. And we have never discussed any of our work concerning ExxonMobil with them.

Therefore, there is no conflict of interest and nothing to disclose," the researchers said. "For context, we note that over the past four years, ExxonMobil have attacked us and our work," they added. "It has become a familiar pattern. We publish science, ExxonMobil offers spin and character assassination.

ExxonMobil is now misleading the public about its history of misleading the public." Reprinted from E&E News with permission from POLITICO, LLC. Copyright 2021. E&E News provides essential news for energy and environment professionals.And then there were two. Today China says it safely landed a spacecraft on Mars—for the first time in its history and in its first attempt, becoming the only other nation besides the U.S.

To achieve such a feat. Its Zhurong rover, named after a god of fire from Chinese folklore, successfully touched down in Utopia Planitia around 7:11 P.M. EST as part of the Tianwen-1 mission, according to the China National Space Administration. Soon the rover should drive down the ramp of its landing platform, ready to explore its unearthly surroundings.

If there was any doubt about China’s spacefaring prowess, it has been dispelled now that the nation has added interplanetary landings as a coveted notch on its belt “Mars is hard,” says Roger Launius, NASA’s former chief historian. €œThis is a really big deal.” Tianwen-1 was launched in July 2020 as part of a summer Martian armada that also included launches of NASA’s Perseverance rover and the United Arab Emirates’ Hope orbiter. All three missions arrived at Mars in February. But while Perseverance descended straight to the surface, Tianwen-1 instead entered an elliptical orbit around the planet to give its scientists a god’s-eye view for scouting out their planned landing site in Utopia Planitia, an immense impact basin on Mars.

€œChina does not have its own detailed Mars maps,” says Brian Harvey, a writer who covers the country’s space program. At least, that was the case until today, when Tianwen-1’s controllers decided they had seen enough to confidently initiate the spacecraft’s daring descent. Packed inside a cone-shaped protective shell, Zhurong and its rocket-powered landing platform detached from the orbiter, descended toward Mars and began the fiery plunge through the planet’s upper atmosphere. After jettisoning its protective shell lower in the atmosphere, the spacecraft unfurled parachutes to slow its descent before riding thrusters down to a gentle landing on the surface.

This was “very similar” to the powered landings China has used in its Chang’e missions to Earth’s moon, says Andrew Jones, a space journalist who follows the Chinese space program. The latest of those missions returned samples to Earth in 2020. Other nations have tried and failed to land on Mars, but China’s success highlights how it is rapidly catching up to, if not exceeding, many of its counterparts. The Soviet Union notably attempted multiple landings in the 1970s, coming closest with Mars 3, which touched down on the planet but stopped working moments later.

The U.K. Reached the surface with its Beagle 2 lander in 2003. The craft’s communications antenna failed to deploy, however, dooming the mission. The European Space Agency (ESA) and Russia also came close with their Schiaparelli lander—until it crashed on Mars in 2016.

ESA will try again with its Rosalind Franklin rover in 2022. Until today, only the U.S. Had successfully operated any spacecraft on Mars for a significant period of time, starting with the Viking landers of 1976 and extending to the country’s multiple landers and rovers that are exploring the surface today. China now joins this most elite and exclusive of clubs.

€œIt’s a big day for China,” says Mark McCaughrean, senior scientific adviser for science and exploration at ESA. €œWe know better than anyone how hard it can be to get safely down to the surface.” China will now wait an undisclosed amount of time, as little as a day or up to perhaps a week, before driving the Zhurong rover down a ramp from the lander and onto the surface. The six-wheeled solar-powered vehicle has a planned lifetime of 90 Martian days and is thought to have a top speed of 200 meters per hour, Jones says, although it will likely explore much more slowly. China will upload commands to the rover via its Tianwen-1 orbiter, with ESA’s Mars Express orbiter acting as a backup.

The rover will then perform its tasks autonomously on the surface, similar to the operational protocols NASA uses for its own fleet of robotic Martian explorers. Utopia Planitia was also the site for NASA’s Viking 2 in 1976. It is a rather bland expanse of rock-strewn sand—decent for spacecraft landings but decidedly subpar for addressing cutting-edge research questions, such as whether Mars harbors past or present life. €œ[China is] not looking for biosignatures,” says Agnes Cousin, a planetary scientist at the Institute for Research in Astrophysics and Planetology in France, who has advised Tianwen-1 scientists.

Yet Zhurong is still expected to perform important science on the surface of the Red Planet. €œWe always have surprises when we arrive on the surface,” Cousin says. €œFor the overall geological implications for Mars, it’s very nice to have a new location to compare.” The rover is equipped with a suite of six instruments and cameras to study the surface. They include a ground-penetrating radar that could look for water and ice up to 100 meters below the surface (NASA’s Perseverance boasts a similar instrument).

Zhurong also has a magnetometer, the first ever sent to Mars on a rover. Alongside a similar instrument on the Tianwen-1 orbiter, which will continue studying the planet from afar, the rover’s magnetometer could reveal the details of how Mars lost its magnetic field—and consequently its atmosphere and water—billions of years ago. €œConceivably this instrument could help address that question,” says David Flannery, an astrobiologist at the Queensland University of Technology in Australia, who is familiar with China’s space activities. €œTogether the instruments will tell us more about how the Martian magnetic field operates today.” Another instrument of note is the Mars Surface Composition Detector (MarSCoDe), a device similar to ChemCam on NASA’s Curiosity rover and SuperCam on Perseverance, which will use a laser to vaporize rock specimens on the surface, revealing their composition.

Cousin is part of both the ChemCam and SuperCam teams, and she was among a group of European collaborators that helped China develop their instrument. She traveled to Shanghai in 2019 to exchange information with Tianwen-1 scientists on topics such as data-processing techniques and calibration targets to include on the rover to test the instrument on Mars. €œThey wanted big calibration targets” for MarSCoDe, Cousin says. €œSo we gave them one”.

A two-centimeter-wide square of an igneous rock called norite that is one of 12 such targets on the rover. While the science goals of the rover may be somewhat modest, it is also expected to be a technology demonstration for a much more ambitious future project. By 2028 or 2030, China hopes to send a sample-return mission to Mars to bring pristine Martian rocks back to Earth. That timing is similar to, or perhaps even in advance of, when NASA and ESA plan to do the same with their own interplanetary grab-and-go effort.

€œWill it be China bringing the first Mars material back to Earth, or will it be NASA and ESA?. € says Jacqueline Myrrhe, a journalist affiliated with the Chinese space Web site Go Taikonauts!. “This could be a very good question.” Landing on Mars is the latest pinnacle achievement from China’s planned portfolio of ambitious space activities. But already the nation has more than proved its mettle.

It has conducted numerous sorties to the moon and has begun the construction of a space station in Earth orbit. The nation may send a pair of spacecraft to the edge of the solar system in just a few years and launch a mission to Jupiter by the end of the decade. Now that Tianwen-1 has shown that China is an adept interplanetary explorer, even more audacious projects may be on the horizon. €œIt’s the first step for much more,” Myrrhe says.Some of the oldest art in human history is disintegrating, scientists say.

And climate change may be hastening its demise. New research reports that ancient rock art in Indonesian caves is degrading over time, as bits of rock slowly flake away from the walls. It's a tremendous loss for human history — some of these paintings, which depict everything from animals to human figures to abstract symbols, date back about 40,000 years. Salt crystals building up on the walls are a key part of the problem, the study suggests.

These salt deposits seep into the cave walls, then proceed to expand and contract as temperatures rise and fall. This process causes the rock to slowly disintegrate. Changes in the weather may be helping the process along, scientists say. Salt crystals may expand more readily when they're exposed to repeated shifts between wet, humid conditions and periods of prolonged drought.

Indonesia is already a dynamic region to begin with, split between the rainy monsoon season and the annual dry season. But these kinds of shifts are expected to become more dramatic as the climate continues to warm. In particular, the researchers say, climate change may spur more intense El Niño events in the future. These events can amplify the kinds of conditions that help the damaging salt crystals form.

Scientists are still debating the exact influence of climate change on El Niño, a natural climate cycle that drives shifting patterns of warming and cooling in the Pacific Ocean. But some studies do suggest that El Niño events may be more severe going forward. The new study, led by Jillian Huntley at Australia's Griffith University, examined 11 ancient cave art sites in South Sulawesi, Indonesia. The researchers found evidence of salt formation at all 11 sites.

At three of the sites, they found the types of crystals that most notoriously cause rocks to break apart. It's a small sample. There are more than 300 known cave art sites scattered around the region. But the research suggests that salt crystals may indeed be part of the problem.

In recent years, archaeologists have reported that the art appears to be rapidly deteriorating — at some sites, experts have reported as much as an inch of art vanishing every couple of months. Scientists have proposed multiple theories about what might be causing it. Along with climate change, they've suggested that pollution and other disturbances from nearby limestone mining operations might be degrading the fragile paintings. It's probably all of the above, Huntley and her colleagues suggest.

But they add that climate change is a growing threat, one that deserves more attention. In fact, they argue, salt-related degradation is "the most pressing threat to rock art preservation in this region" aside from mining. Reprinted from E&E News with permission from POLITICO, LLC. Copyright 2021.

E&E News provides essential news for energy and environment professionals..

Since the modern era of research on autism Can you buy over the counter viagra began in the 1980s, questions about social cognition and social brain development have been of central interest lasix 40mg tablet pricelasix order to researchers. This year marks the 20th anniversary of the first annual meeting of the International Society for Autism Research (INSAR), and it is evident in this year’s meeting that the growth of social cognitive neuroscience over the past two decades has significantly enriched autism science. For those lasix 40mg tablet pricelasix order unfamiliar with the term, social cognitive neuroscience is the study of the brain systems that are involved in the causes and effects of social behaviors and social interaction. Some of these involve brain systems involved in thinking about other people’s thoughts or intentions, empathizing, social motivation and the impact of social attention on an individual’s thinking and emotions. At the same time, research with and for autistic people has also enriched social cognitive neuroscience and the understanding of how our social minds develop.

Autism spectrum disorder (ASD) lasix 40mg tablet pricelasix order is a complex and heterogeneous part of the human condition, or neurodiversity. It is associated with a wide range of life outcomes, from “disorder” or the profound challenges that encumber about 30 percent of affected individuals with minimal language and intellectual disability, to “differences” among people who have well-above-average abilities and accomplishments. Regardless of their outcomes, though, people on the autism spectrum travel a different path of social-cognitive neurodevelopment that appears to begin in infancy. For example, many lasix 40mg tablet pricelasix order experience some level of difficulty with social cognitive mentalizing, also known as “theory of mind”—the mental representation of other people’s thoughts, perspectives, beliefs, intentions or emotions, which enables us to understand or predict their behaviors. Social cognitive neuroscience tells us that brain systems of the medial frontal cortex, temporal cortex and parietal cortex, as well as reward centers of the brain, enable mentalizing.

Accordingly, differences in the development and/or transmissions of information across this distributed social cognitive brain network may contribute to differences in lasix 40mg tablet pricelasix order mentalizing among autistic people. These differences can lead to a range of outcomes, from problems in the capacity to mentalize to alterations in the spontaneous use of mentalizing, or the motivation and effort involved in mentalizing during social interactions. These observations are informative, but do not address fundamental questions about how social-cognitive brain systems develop or why their development might be different for autistic people. These questions are essential in autism science because understanding the early course of social cognitive neurodevelopment may afford the best opportunity to mitigate the profoundly negative effects that social cognitive lasix 40mg tablet pricelasix order differences can have on some autistic people. Serendipitously, this motivation to understand the very early development of our social brain can inform the broader understanding of social-cognitive neuroscience and human nature.

As it turns out, one key to understanding the development of our social brains may come from observations of social attention in infancy. As early lasix 40mg tablet pricelasix order as six to 12 months of age, some infants who go on to receive an autism diagnosis already display differences in the development of social attention. They look less frequently at the face and eyes of people than other infants and are less likely to coordinate their attention with another person to adopt a common point of view or reference, or “joint attention.” Infants with neurotypical development follow the gaze direction or gesture of other people or lead the gaze of other people to establish joint attention and share information through a common perceptual perspective. Developing the ability to coordinate attention socially is important in and of itself. For example, lasix 40mg tablet pricelasix order every teacher’s admonition to students to “pay attention!.

€ is really a request to “pay attention to what I [the teacher] am attending to.” Joint attention is vital to social competence at all ages. Adolescents and adults who cannot follow, initiate or join with the rapid-fire changes of shared attention in social interactions may lasix 40mg tablet pricelasix order be impaired in their capacity for relatedness and relationships. Equally important, joint attention is also an early building block of social cognitive mentalizing. Every time infants coordinate attention socially with other people, they practice perceptual perspective-taking. They do lasix 40mg tablet pricelasix order this hundreds if not thousands of times in early development.

It tunes aspects of social-brain development that subsequently support the capacity for mental perspective-taking. Mental perspective-taking is synonymous with mentalizing and our ability to understand the thoughts, beliefs, and intentions of other people. Indeed, several studies provide evidence lasix 40mg tablet pricelasix order of a significant overlap in brain systems involved in joint attention and social-cognitive mentalizing. Accordingly, differences in early social attention are thought to contribute to differences in the neurodevelopment of social cognitive mentalizing in some to many people with autism. Research also suggests that differences in systems that regulate the motivation for social attention might play a role in this aspect of the development of autism, though the nature of this motivation is not understood.

One possibility is lasix 40mg tablet pricelasix order that decreased motivation to attend to faces may lead to critical early difference in social attention. Alternatively, differences in the “eye-contact effect” may impact social attention development. The eye-contact effect is a phenomenon in which awareness of being the object of others’ attention triggers an arousal lasix 40mg tablet pricelasix order response that enhances stimulus salience and information processing during social attention coordination. When we are aware of other people looking at us, changes occur in our mental processes that can benefit social learning. Several studies now suggest that people with autism may be less responsive to, or less aware of, being the object of attention of others.

Hence, autism science raises the hypothesis that the first step toward human social neurocognitive development lasix 40mg tablet pricelasix order may involve months of practice with social attention coordination with caregivers during infancy. Moreover, our response to eye contact of other people may provide an early motivational stance that prioritizes infant social attention development and the development of our social brains. Notably, recent studies indicate that imitating the behavior of young children with autism, which likely affects a child’s awareness that another person is looking at them, can improve joint attention and language development. Of course, the most fundamental lesson we can draw from all these observations about lasix 40mg tablet pricelasix order the development of our social mind is that we are all more similar than different, regardless of our paths of neurodevelopment, and that autistic people have much to teach us about the nature of human nature. This is an opinion and analysis article.

Further reading. Baron-Cohen, S lasix 40mg tablet pricelasix order. (2019). The concept of neurodiversity is dividing the autism community lasix 40mg tablet pricelasix order. Scientific American.

Chevallier, C., Kohls, G., Troiani, V., Brodkin, E. S., & lasix 40mg tablet pricelasix order. Schultz, R. T. (2012).

The social motivation theory of autism. Trends in cognitive sciences, 16(4), 231-239. Gulsrud, A. C., Hellemann, G., Shire, S., &. Kasari, C.

(2016). Isolating active ingredients in a parent‐mediated social communication intervention for toddlers with autism spectrum disorder. Journal of Child Psychology and Psychiatry, 57(5), 606-613. Grynszpan, O., Bouteiller, J., Grynszpan, S., Le Barillier, F., Martin, J. C., &.

Nadel, J. (2019). Altered sense of gaze leading in autism. Research in Autism Spectrum Disorders, 67, 101441. Mundy, P.

(2018). A review of joint attention and social‐cognitive brain systems in typical development and autism spectrum disorder. European Journal of Neuroscience, 47(6), 497-514. Reddy, V. (2003).

On being the object of attention. Implications for self–other consciousness. Trends in cognitive sciences, 7(9), 397-402. Senju, A., &. Johnson, M.

H. (2009). The eye contact effect. Mechanisms and development. Trends in cognitive sciences, 13(3), 127-134.

Stephenson, L., Edwards, S. G., &. Bayliss, A. (2020). From gaze perception to social cognition.

A neurocognitive model of joint and shared attention. Perspectives on Psychological Science. Https://journals.sagepub.com/doi/10.1177/1745691620953773Exxon Mobil Corp. Has used language to systematically shift blame for climate change from fossil fuel companies onto consumers, according to a new paper by Harvard University researchers. The paper, published yesterday in the journal One Earth, could bolster efforts to hold the oil giant accountable in court for its alleged deception about global warming.

"This is the first computational assessment of how Exxon Mobil has used language in subtle yet systematic ways to shape the way the public talks about and thinks about climate change," Geoffrey Supran, a research fellow at Harvard and co-author of the paper, said in an interview with E&E News. "One of our overall findings is that Exxon Mobil has used rhetoric mimicking the tobacco industry to downplay the reality and seriousness of climate change and to shift responsibility for climate change away from itself and onto consumers," he added. A spokesperson for Exxon Mobil disputed the paper, calling it part of a coordinated legal campaign against the company. Supran and co-author Naomi Oreskes, a professor of the history of science at Harvard (and Scientific American columnist), conducted a computational analysis of 180 Exxon Mobil documents from 1972 to 2019, including peer-reviewed publications, advertorials in The New York Times and internal memos. Using a series of algorithms, the Harvard researchers found that Exxon Mobil had privately relied on some terms while publicly avoiding them altogether.

For example, Exxon Mobil's internal documents frequently described climate change as a problem caused by "fossil fuel combustion." But in public-facing documents, the company referred to global warming as a problem caused by the "energy demand" of "consumers." The public communications sought to deflect responsibility for climate change away from the oil giant and onto individual consumers who heat their homes and fill their cars with gas, the researchers wrote. Following their merger in 1999, Exxon and Mobil also increasingly presented climate change as a "risk," rather than a reality, the analysis found. This language sought to minimize the dangers of global warming while not denying their existence outright, the paper says. Court battles The researchers drew a direct comparison between Exxon Mobil and major tobacco companies, which they said used similar tactics to shape public discourse about smoking cigarettes. "These patterns mimic the tobacco industry's documented strategy of shifting responsibility away from corporations — which knowingly sold a deadly product while denying its harms — and onto consumers," they wrote.

In the 1990s, attorneys general from all 50 states sued the largest U.S. Tobacco companies over their alleged deception about the harmful health effects of smoking cigarettes and the addictive nature of nicotine. The suits culminated in a $206 billion master settlement agreement (Climatewire, March 10). Since 2017, five states and more than a dozen municipalities have filed similar suits alleging that the biggest U.S. Oil and gas companies misled the public about the climate risks of burning fossil fuels.

The complaints ask the oil industry to help cover the costs of addressing floods, wildfires and other disasters fueled by rising global temperatures. Supran said that although he didn't conduct the study with the climate liability litigation in mind, the findings can nonetheless inform the legal fights. "Obviously, we did this completely independently. I've never spoken to any of the lawyers involved," Supran said. "But certainly with hindsight, our insights may be relevant, especially to these more nascent cases alleging deceptive marketing." Last month, New York City filed a lawsuit asserting that Exxon Mobil, BP PLC and Royal Dutch Shell PLC violated the city's consumer protection law by engaging in "green washing," or the practice of making their fossil fuel products seem more environmentally friendly than they really are.

Exxon pushback Asked for comment on the paper, Exxon spokesperson Casey Norton said in an email to E&E News. "This research is clearly part of a litigation strategy against Exxon Mobil and other energy companies." Norton noted that Oreskes is on retainer with Sher Edling LLP, a San Francisco-based law firm that represents a slew of the challengers in the climate liability suits. "Oreskes did not disclose this blatant conflict of interest," he said. Norton also pointed to the paper's partial funding from the Rockefeller family, which Exxon has accused of supporting a climate conspiracy against the company (Climatewire, May 4). "The research was paid for by the Rockefeller Family Fund, which is helping finance climate change litigation against energy companies," he said.

"This follows a previous study attacking Exxon Mobil that used a similar discredited methodology." Norton was referring to a 2017 paper by Supran and Oreskes in the journal Environmental Research Letters that found Exxon's communications from 1977 to 2014 misled the public about climate science. Vijay Swarup, Exxon's vice president of research and development, previously blasted the 2017 paper as "fundamentally flawed" in a comment in Environmental Research Letters last year. Norton concluded by stressing that Exxon supports climate action, noting that the oil giant recently proposed a massive carbon capture project in Houston (Energywire, April 20). "Exxon Mobil supports the Paris climate agreement, and is working to reduce company emissions and helping customers reduce their emissions while working on new lower-emission technologies and advocating for effective policies," he said. In a joint statement to E&E News, Supran and Oreskes pushed back on Norton's allegations.

"Sher Edling played no role in the paper we published today, nor in any other academic work we have done. They have not funded any of our studies. They have not reviewed our data or interpretations prior to its peer-reviewed publication. And we have never discussed any of our work concerning ExxonMobil with them. Therefore, there is no conflict of interest and nothing to disclose," the researchers said.

"For context, we note that over the past four years, ExxonMobil have attacked us and our work," they added. "It has become a familiar pattern. We publish science, ExxonMobil offers spin and character assassination. ExxonMobil is now misleading the public about its history of misleading the public." Reprinted from E&E News with permission from POLITICO, LLC. Copyright 2021.

E&E News provides essential news for energy and environment professionals.And then there were two. Today China says it safely landed a spacecraft on Mars—for the first time in its history and in its first attempt, becoming the only other nation besides the U.S. To achieve such a feat. Its Zhurong rover, named after a god of fire from Chinese folklore, successfully touched down in Utopia Planitia around 7:11 P.M. EST as part of the Tianwen-1 mission, according to the China National Space Administration.

Soon the rover should drive down the ramp of its landing platform, ready to explore its unearthly surroundings. If there was any doubt about China’s spacefaring prowess, it has been dispelled now that the nation has added interplanetary landings as a coveted notch on its belt “Mars is hard,” says Roger Launius, NASA’s former chief historian. €œThis is a really big deal.” Tianwen-1 was launched in July 2020 as part of a summer Martian armada that also included launches of NASA’s Perseverance rover and the United Arab Emirates’ Hope orbiter. All three missions arrived at Mars in February. But while Perseverance descended straight to the surface, Tianwen-1 instead entered an elliptical orbit around the planet to give its scientists a god’s-eye view for scouting out their planned landing site in Utopia Planitia, an immense impact basin on Mars.

€œChina does not have its own detailed Mars maps,” says Brian Harvey, a writer who covers the country’s space program. At least, that was the case until today, when Tianwen-1’s controllers decided they had seen enough to confidently initiate the spacecraft’s daring descent. Packed inside a cone-shaped protective shell, Zhurong and its rocket-powered landing platform detached from the orbiter, descended toward Mars and began the fiery plunge through the planet’s upper atmosphere. After jettisoning its protective shell lower in the atmosphere, the spacecraft unfurled parachutes to slow its descent before riding thrusters down to a gentle landing on the surface. This was “very similar” to the powered landings China has used in its Chang’e missions to Earth’s moon, says Andrew Jones, a space journalist who follows the Chinese space program.

The latest of those missions returned samples to Earth in 2020. Other nations have tried and failed to land on Mars, but China’s success highlights how it is rapidly catching up to, if not exceeding, many of its counterparts. The Soviet Union notably attempted multiple landings in the 1970s, coming closest with Mars 3, which touched down on the planet but stopped working moments later. The U.K. Reached the surface with its Beagle 2 lander in 2003.

The craft’s communications antenna failed to deploy, however, dooming the mission. The European Space Agency (ESA) and Russia also came close with their Schiaparelli lander—until it crashed on Mars in 2016. ESA will try again with its Rosalind Franklin rover in 2022. Until today, only the U.S. Had successfully operated any spacecraft on Mars for a significant period of time, starting with the Viking landers of 1976 and extending to the country’s multiple landers and rovers that are exploring the surface today.

China now joins this most elite and exclusive of clubs. €œIt’s a big day for China,” says Mark McCaughrean, senior scientific adviser for science and exploration at ESA. €œWe know better than anyone how hard it can be to get safely down to the surface.” China will now wait an undisclosed amount of time, as little as a day or up to perhaps a week, before driving the Zhurong rover down a ramp from the lander and onto the surface. The six-wheeled solar-powered vehicle has a planned lifetime of 90 Martian days and is thought to have a top speed of 200 meters per hour, Jones says, although it will likely explore much more slowly. China will upload commands to the rover via its Tianwen-1 orbiter, with ESA’s Mars Express orbiter acting as a backup.

The rover will then perform its tasks autonomously on the surface, similar to the operational protocols NASA uses for its own fleet of robotic Martian explorers. Utopia Planitia was also the site for NASA’s Viking 2 in 1976. It is a rather bland expanse of rock-strewn sand—decent for spacecraft landings but decidedly subpar for addressing cutting-edge research questions, such as whether Mars harbors past or present life. €œ[China is] not looking for biosignatures,” says Agnes Cousin, a planetary scientist at the Institute for Research in Astrophysics and Planetology in France, who has advised Tianwen-1 scientists. Yet Zhurong is still expected to perform important science on the surface of the Red Planet.

€œWe always have surprises when we arrive on the surface,” Cousin says. €œFor the overall geological implications for Mars, it’s very nice to have a new location to compare.” The rover is equipped with a suite of six instruments and cameras to study the surface. They include a ground-penetrating radar that could look for water and ice up to 100 meters below the surface (NASA’s Perseverance boasts a similar instrument). Zhurong also has a magnetometer, the first ever sent to Mars on a rover. Alongside a similar instrument on the Tianwen-1 orbiter, which will continue studying the planet from afar, the rover’s magnetometer could reveal the details of how Mars lost its magnetic field—and consequently its atmosphere and water—billions of years ago.

€œConceivably this instrument could help address that question,” says David Flannery, an astrobiologist at the Queensland University of Technology in Australia, who is familiar with China’s space activities. €œTogether the instruments will tell us more about how the Martian magnetic field operates today.” Another instrument of note is the Mars Surface Composition Detector (MarSCoDe), a device similar to ChemCam on NASA’s Curiosity rover and SuperCam on Perseverance, which will use a laser to vaporize rock specimens on the surface, revealing their composition. Cousin is part of both the ChemCam and SuperCam teams, and she was among a group of European collaborators that helped China develop their instrument. She traveled to Shanghai in 2019 to exchange information with Tianwen-1 scientists on topics such as data-processing techniques and calibration targets to include on the rover to test the instrument on Mars. €œThey wanted big calibration targets” for MarSCoDe, Cousin says.

€œSo we gave them one”. A two-centimeter-wide square of an igneous rock called norite that is one of 12 such targets on the rover. While the science goals of the rover may be somewhat modest, it is also expected to be a technology demonstration for a much more ambitious future project. By 2028 or 2030, China hopes to send a sample-return mission to Mars to bring pristine Martian rocks back to Earth. That timing is similar to, or perhaps even in advance of, when NASA and ESA plan to do the same with their own interplanetary grab-and-go effort.

€œWill it be China bringing the first Mars material back to Earth, or will it be NASA and ESA?. € says Jacqueline Myrrhe, a journalist affiliated with the Chinese space Web site Go Taikonauts!. “This could be a very good question.” Landing on Mars is the latest pinnacle achievement from China’s planned portfolio of ambitious space activities. But already the nation has more than proved its mettle. It has conducted numerous sorties to the moon and has begun the construction of a space station in Earth orbit.

The nation may send a pair of spacecraft to the edge of the solar system in just a few years and launch a mission to Jupiter by the end of the decade. Now that Tianwen-1 has shown that China is an adept interplanetary explorer, even more audacious projects may be on the horizon. €œIt’s the first step for much more,” Myrrhe says.Some of the oldest art in human history is disintegrating, scientists say. And climate change may be hastening its demise. New research reports that ancient rock art in Indonesian caves is degrading over time, as bits of rock slowly flake away from the walls.

It's a tremendous loss for human history — some of these paintings, which depict everything from animals to human figures to abstract symbols, date back about 40,000 years. Salt crystals building up on the walls are a key part of the problem, the study suggests. These salt deposits seep into the cave walls, then proceed to expand and contract as temperatures rise and fall. This process causes the rock to slowly disintegrate. Changes in the weather may be helping the process along, scientists say.

Salt crystals may expand more readily when they're exposed to repeated shifts between wet, humid conditions and periods of prolonged drought. Indonesia is already a dynamic region to begin with, split between the rainy monsoon season and the annual dry season. But these kinds of shifts are expected to become more dramatic as the climate continues to warm. In particular, the researchers say, climate change may spur more intense El Niño events in the future. These events can amplify the kinds of conditions that help the damaging salt crystals form.

Scientists are still debating the exact influence of climate change on El Niño, a natural climate cycle that drives shifting patterns of warming and cooling in the Pacific Ocean. But some studies do suggest that El Niño events may be more severe going forward. The new study, led by Jillian Huntley at Australia's Griffith University, examined 11 ancient cave art sites in South Sulawesi, Indonesia. The researchers found evidence of salt formation at all 11 sites. At three of the sites, they found the types of crystals that most notoriously cause rocks to break apart.

It's a small sample. There are more than 300 known cave art sites scattered around the region. But the research suggests that salt crystals may indeed be part of the problem. In recent years, archaeologists have reported that the art appears to be rapidly deteriorating — at some sites, experts have reported as much as an inch of art vanishing every couple of months. Scientists have proposed multiple theories about what might be causing it.

Along with climate change, they've suggested that pollution and other disturbances from nearby limestone mining operations might be degrading the fragile paintings. It's probably all of the above, Huntley and her colleagues suggest. But they add that climate change is a growing threat, one that deserves more attention. In fact, they argue, salt-related degradation is "the most pressing threat to rock art preservation in this region" aside from mining. Reprinted from E&E News with permission from POLITICO, LLC.

Copyright 2021. E&E News provides essential news for energy and environment professionals..

What may interact with Lasix?

• certain antibiotics given by injection
• diuretics
• heart medicines like digoxin, dofetilide, or nitroglycerin
• lithium
• medicines for diabetes
• medicines for high blood pressure
• medicines for high cholesterol like cholestyramine, clofibrate, or colestipol
• medicines that relax muscles for surgery
• NSAIDs, medicines for pain and inflammation like ibuprofen, naproxen, or indomethacin
• phenytoin
• steroid medicines like prednisone or cortisone
• sucralfate

This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

How does lasix increase blood sugar

INTRODUCTIONSevere acute respiratory syndrome hypertension 2 (hypertension), causative agent of http://moneysavvyteen.com/ventolin-nebules-for-salehow-to-get-a-ventolin-prescription-from-your-doctor/ hypertension disease (hypertension medications), emerged how does lasix increase blood sugar in Wuhan, China, in late 2019. On 11 March 2020, the World Health Organization (WHO) declared hypertension medications a lasix, with over how does lasix increase blood sugar 10 million confirmed cases as of the beginning of July 2020.1 2 The first patient in the Netherlands was confirmed on 27 February 2020.3 Cases primarily clustered in the southeastern part of the country, but were reported in other regions quickly hereafter. Multi-pronged interventions to suppress the spread of the lasix, including social distancing, school and bar/restaurant closure, and stringent advice to home quarantine when feeling ill and work from home, were implemented on 16 March 2020—and were relaxed gradually since 1 June 2020.

By 1 July 2020, 50 273 cases, 11 877 hospitalisations, and 6113 related deaths were reported in the Netherlands.3Supplemental materialReported hypertension medications cases worldwide are an underestimation of the true magnitude how does lasix increase blood sugar of the lasix. The scope of undetected cases remains largely unknown due to difference in restrictive testing policy and registration across countries, and occurrence of asymptomatic s.4 5 Large-scale nationwide serosurveillance studies measuring hypertension-specific serum antibodies could help to better assess the number of s, how does lasix increase blood sugar viral spread, and groups at risk of in the general population by incorporating extensive questionnaire data, for example, on lifestyle, behaviour and profession. This might yield different factors than those identified for (severely-ill) clinical cases investigated more frequently up until now.6 7 Unfortunately, such nationwide studies (eg, in Spain8 and Iceland,9) also referred to as Unity Studies by the WHO,10 are scarce and mainly set up through convenience sampling.Therefore, a nationwide serosurveillance study (PIENTER-Corona, PICO) was initiated quickly after the lockdown was in effect.

This cohort how does lasix increase blood sugar is unique as it comprises data available from a previous serosurvey established in 2016/17 (PIENTER-3) of a randomised nationwide sample of Dutch citizens, across all ages and a separate sample enriched for Orthodox-Reformed Protestants, whom might have been exposed to hypertension more frequently due to their socio-geographical-clustered lifestyle.11 12 The presented serological framework and findings of our first round of inclusion can support public health policy in the Netherlands as well as internationally.METHODSStudy designIn 2016/17, the National Institute for Public Health and the Environment of the Netherlands (RIVM) initiated a large-scale nationwide serosurveillance study (PIENTER-3) (n=7600. Age-range 0–89 years). The primary aim was to how does lasix increase blood sugar obtain insights into the protection against treatment-preventable diseases offered by the National Immunisation Programme in the Netherlands.

A comprehensive description of PIENTER-3 has been published previously.13 Briefly, participants were selected via a two-stage cluster design, comprising 40 municipalities in five regions nationwide (henceforth ‘national sample’, NS), and nine municipalities in the low vaccination coverage how does lasix increase blood sugar municipalities (LVC), inhabited by a relative large proportion of Orthodox-Reformed Protestants (figure 1). Among other materials, sera and questionnaire data had been collected from all participants. Hence, the PIENTER-3 study acted as baseline sample of the Dutch population for the present cross-sectional PICO-study since 6102 participants (80%) consented to be how does lasix increase blood sugar approached for follow-up (after updating addresses and screening of possible deaths).

The study was powered to estimate an overall seroprevalence with a precision of at least 2.5%.13 The PICO-study protocol was approved by the Medical Ethics Committee MEC-U, the Netherlands (Clinical Trial Registration NTR8473), and conformed to the principles embodied in the Declaration of Helsinki.Geographical representation of number of participants in the PICO-study, the Netherlands, first round of inclusion, per municipality. The size of how does lasix increase blood sugar the dots reflect the absolute number of participants. Thicker grey and smaller light grey boundaries represent provinces and municipalities, respectively, and orange and blue boundaries characterise municipalities from the national and low vaccination coverage sample, respectively." data-icon-position data-hide-link-title="0">Figure 1 Geographical representation of number of participants in the PICO-study, how does lasix increase blood sugar the Netherlands, first round of inclusion, per municipality.

The size of the dots reflect the absolute number of participants. Thicker grey and smaller light grey boundaries represent provinces and municipalities, respectively, and orange and blue boundaries characterise municipalities from the national and low vaccination how does lasix increase blood sugar coverage sample, respectively.Study population and materialsOn 25 March 2020, an invitation letter was sent. Invitees (age-range 2–92 years) willing to how does lasix increase blood sugar participate registered online.

After enrolment, participants received an instruction letter on how to self-collect a fingerstick blood sample in a microtainer (maximum of 0.3 mL). Blood samples were returned to the RIVM-laboratory in safety envelopes how does lasix increase blood sugar. Serum samples were stored at −20°C awaiting analyses.

Materials were how does lasix increase blood sugar collected between March 31 and May 11, with the majority (80%) in the first week of April 2020 (median collection date April 3). Simultaneous with the blood collection, participants were asked to how does lasix increase blood sugar complete an (online) questionnaire, including questions regarding sociodemographic characteristics, hypertension medications-related symptoms, and potential other determinants for hypertension seropositivity, such as comorbidities, medication use and behavioural factors. All participants provided written informed consent.Laboratory methodsSerum samples (diluted 1:200) were tested for the presence of hypertension spike S1-specific IgG antibodies using a validated fluorescent bead-based multiplex-immunoassay as described.14 A cut-off concentration for seropositivity (2.37 AU/mL.

With specificity of 99% and sensitivity of 84.4%) was how does lasix increase blood sugar determined by ROC-analysis of 400 pre-lasix control samples (including a nationwide random cross-sectional sample (n=108)) as well as patients with confirmed influenza-like illnesses caused by hypertensiones and other lasixes, and a selection of sera from 115 PCR-confirmed hypertension medications cases with mild, or severe disease symptoms. Seropositive PICO-samples and those with a concentration 25% below the cut-off were retested (n=138), and the geometric mean concentration (GMC) was calculated. Paired pre-lasix PIENTER-3-samples of these retested PICO-samples (available from 129/138) were tested correspondingly as described above to correct for false-positive results (online supplemental figure S1A).Statistical analysesStudy population, hypertension medications-related symptoms and antibody responsesData management and analyses were conducted in SAS v.9.4 (SAS Institute Inc., USA) and how does lasix increase blood sugar R v.3.6.

P values <0.05 were considered statistically significant how does lasix increase blood sugar. Sociodemographic characteristics and hypertension medications-related symptoms (general, respiratory, and gastrointestinal) developed since the start of the epidemic were stratified by sample (NS vs LVC), or sex, respectively, and described for seropositive and seronegative participants. Differences were how does lasix increase blood sugar tested via Pearson’s χ², or Fisher’s exact test if appropriate.

Differences in GMC between reported symptoms in seropositive participants were determined by calculating the difference in log-transformed concentrations of those who developed symptoms at least 4 weeks prior to the sampling—ensuring a plateaued response—and tested by means of a Mann-Whitney U-test.Seroprevalence estimatesSeroprevalence estimates (with 95% Wilson CIs (CI)) for hypertension-specific antibodies were calculated taking into account the survey design (ie, controlling for region and municipality) and weighted by sex, age, ethnic how does lasix increase blood sugar background and degree of urbanisation to match the distribution of the general Dutch population in both the NS and LVC sample. Estimates were corrected for test performance via the Rogan &. Gladen bias correction (with sensitivity how does lasix increase blood sugar of 84.4% and assuming a specificity of 100% after cross-validation with pre-sera).15 Smooth age-specific seroprevalence estimates were obtained with a logistic regression in a Generalised Additive Model using penalised splines.16Risk factors for hypertension seropositivityA random-effects logistic regression model was used to identify risk factors for hypertension seropositivity, applying a full case analysis (n=3100.

Values were missing for <5% of the participants). Potential risk factors included sociodemographic characteristics (sex, age group, region, ethnic background, Orthodox-Reformed Protestants, educational level, household size, (parent with a) contact profession, healthcare worker), and hypertension medications-related factors (contact with a hypertension medications confirmed case, number of persons contacted yesterday, working from home how does lasix increase blood sugar (normally and in the last week), comorbidities (combining diabetes, history of malignancy, immunodeficiency, cardio-vascular, kidney and chronic lung disease (note. As a sensitivity analysis, comorbidities were also included separately)), and use of blood pressure medication, immunosuppressants, statins and antivirals/antibiotics in how does lasix increase blood sugar the last month).

Models included a random intercept, potential clustering by municipality and region was accounted for, and odds ratios (OR) in univariable analyses were a priori adjusted for sex and age. Variables with p<0.10 were entered in the multivariable analysis, and backward how does lasix increase blood sugar selection was performed—manually dropping variables one-by-one based on p≥0.05—to identify significant risk factors. Adjusted ORs and corresponding 95% CIs were provided.RESULTSStudy populationOf 6102 invitees, 3207 (53%) donated a serum sample and filled-out the questionnaire, of which 2637 persons from the NS and 570 from the LVC.

Participants from across the country participated (figure 1), with age ranging from 2 to 90 years how does lasix increase blood sugar (table 1). In the NS, slightly more women (55%) participated, most (88%) were of how does lasix increase blood sugar Dutch descent, nearly half had a high educational level, and 45% was religious. 20 percent of persons between age 25–66 years were healthcare workers and 56% of the (parents of) participants reported to have had daily contact with patients, clients and/or children in their profession/volunteer work normally.

Over half of the participants lived in a ≥2-person household, and 78% reported to have had physical contact with <5 people outside their own household yesterday (during lockdown), how does lasix increase blood sugar of which more than half with nobody. Comorbidities most frequently reported included chronic lung and cardiovascular how does lasix increase blood sugar disease (both 13%), and a history of malignancy (5%). In line with the population distribution, the LVC sample was characterised by a relative high proportion of Orthodox-Reformed Protestants from Dutch descent (table 1).

Sociodemographic characteristics between responders how does lasix increase blood sugar and non-responders are provided in online supplemental table S1.View this table:Table 1 Sociodemographic characteristics of participants in the PICO-study and weighted seroprevalence in the general population of the Netherlands, first round of inclusion, by national sample and low vaccination coverage sampleSupplemental materialhypertension medications-related symptoms and antibody responsesIn total, 63% of participants reported to have had ≥1 hypertension medications-related symptom(s) since the start of the epidemic, with runny nose (37%), headache (33%), and cough (30%) being most common (table 2). All reported symptoms were significantly higher in seropositive compared to seronegative persons, except for stomach ache. The majority of those seropositive (93%) reported to have had symptoms (90% of men vs 95% of women), of whom three already in how does lasix increase blood sugar mid-February, 2 weeks prior to the official first notification.

Median duration of illness in the how does lasix increase blood sugar seropositive participants was 8.5 days (IQR. 4.0–12.5), 16% (n=12) visited ageneral practitioner and one was admitted to the hospital. Among seropositive persons, most reported to have had ≥1 respiratory symptom(s) (86%), with runny nose and cough (both 61%) most regularly, and ≥1 how does lasix increase blood sugar general (84%) symptom(s), of which anosmia/ageusia (53%) was most discriminative as compared to the seronegative participants (4%, p<0.0001) (table 2).

Symptoms were more common in women, except for anosmia/ageusia, cough and irritable/confusion. Almost 75% of the seropositive participants met the hypertension medications case definition of fever and/or cough and/or dyspnoea, which improved to 80% when how does lasix increase blood sugar anosmia/ageusia was included—while remaining 36% in those seronegative. GMC was significantly higher among seropositive persons with fever vs without (48.2 vs 11.6 AU/mL, p=0.01), and with dyspnoea vs without (78.6 vs 13.5 how does lasix increase blood sugar AU/mL, p=0.04).View this table:Table 2 hypertension medications-related symptoms since the start of the epidemic among all participants in the PICO-study reporting symptoms (n=3147), first round of inclusionSeroprevalence estimatesOverall weighted seroprevalence in the NS was 2.8% (95% CI 2.1 to 3.7), did not differ between sexes or ethnic backgrounds (table 1), and was not higher among healthcare workers (2.7% vs non-healthcare workers 2.5%).

Seroprevalence was lowest in the northern region (1.3%) and highest in the mid-west (4.0%). Estimates were lowest in children—gradually increasing from below 1% at age 2 years to 3% at 17 years—was highest in age group 18–39 years (4.9%) and ranged between how does lasix increase blood sugar 2 and 4% up to 90 years of age (figure 2). In both samples, seroprevalence was highest in Orthodox-Reformed Protestants (>7%) (table 1) how does lasix increase blood sugar.

Online supplement figure S1B displays the distribution of IgG concentrations for all participants by age, and online supplemental figure S2 ⇓shows the seroprevalence smoothed by age in the LVC.Smooth age-specific hypertension seroprevalence in the general population of the Netherlands, beginning of April 2020." data-icon-position data-hide-link-title="0">Figure 2 Smooth age-specific hypertension seroprevalence in the general population of the Netherlands, beginning of April 2020.Risk factors for hypertension seropositivityVariables that were associated with hypertension seropositivity in univariable analyses included age group, Orthodox-Reformed Protestant, had been in contact with a hypertension medications case, use of immunosuppressants, and antibiotic/antiviral medication in the last month (table 3). In multivariable analysis, substantial higher odds were observed for those who took immunosuppressants the last month, were Orthodox-Reformed Protestant, had been in contact with a hypertension medications confirmed case, and from age groups how does lasix increase blood sugar 18–24 and 25–39 years (compared to 2–12 years).View this table:Table 3 Risk factor analysis for hypertension seropositivity among all participants (n=3100. Full case analysis) in the PICO-study, first round of inclusionDISCUSSIONHere, we have estimated the seroprevalence of hypertension-specific antibodies and identified risk factors for seropositivity in the general population of the Netherlands during the first epidemic wave in April 2020.

Although overall how does lasix increase blood sugar seroprevalence was still low at this phase, important risk factors for seropositivity could be identified, including adults aged 18–39 years, persons using immunosuppressants, and Orthodox-Reformed Protestants. These data can guide future interventions, including strategies for vaccination, how does lasix increase blood sugar believed to be a realistic solution to overcome this lasix.This PICO-study revealed that 2.8% (95% CI 2.1 to 3.7) of the Dutch population had detectable hypertension-specific serum IgG antibodies, suggesting that almost half a million inhabitants (of in total 17 423 98117) were infected (487 871 (95% CI 365 904 to 644 687)) in mid-March, 2020 (taking into account the median time to seroconvert18). Several seropositive participants reported to have had hypertension medications-related symptoms back in mid-February, suggesting the lasix circulated in our country at the beginning of February already.

Our overall estimate is in line with preliminary results from another study conducted in the Netherlands in the beginning of April which found 2.7% how does lasix increase blood sugar to be seropositive, although this study was performed in healthy blood donors aged 18–79 years.19 Worldwide, various seroprevalence studies are ongoing. A large nationwide study in Spain showed that around 5% (ranging between 3.7% and 6.2%) was seropositive, indicating that only a small proportion of the population had been infected in one of the hardest hit countries in Europe. Current studies in literature mostly cover hypertension medications hotspots how does lasix increase blood sugar or specific regions—with possibly bias in selection of participants and/or smaller age-ranges—with rates ranging between 1–7% in April (eg, in Los Angeles County (CA, USA)20 or ten other sites in the USA,21 Geneva (Switzerland),22 and Luxembourg23).

Estimates also very how does lasix increase blood sugar much depend on test performances. Particularly, when seroprevalence is relatively low, specificity of the assay should approach near 100% to diminish false-positive results and minimise overestimation. Although we cannot rule-out false-positive samples completely, our assay was validated how does lasix increase blood sugar using a broad range of positive and negative hypertension samples.

PICO-samples were how does lasix increase blood sugar cross-linked to pre-lasix concentration. And bias correction for test performance was applied to represent most accurate estimates. In addition, future studies should establish whether epidemiologically dominant genetic changes in the spike protein of hypertension influence binding to spike S1 used in our and other assays.Seroprevalence was highest in adults aged 18–39 years, which is in line with the serosurvey among blood donors in the Netherlands, but contrary to the low incidence rate as reported in Dutch surveillance, caused by restrictive testing of risk groups and healthcare workers at the beginning of the epidemic, primarily identifying severe cases.3 19 The elevation in these younger adults may be explained by increased how does lasix increase blood sugar social contacts typical for this age group, in addition to specific social activities in February, such as skiing holidays in the Alps (from where the lasix disseminated quickly across Europe), or carnival festivities in the Netherlands (ie, multiple superspreading events primarily in the mid and Southern part, explaining local elevation in seroprevalence).

In correspondence with other nationwide studies8 9 and reports from the Dutch government,3 24 seroprevalence was lowest in children. Although some rare events of paediatric inflammatory multisystem syndrome have been reported, this group seems to be at decreased risk for developing (severe) hypertension medications in general, which may be explained by less severe possibly how does lasix increase blood sugar resulting in a limited humoral response.25 26 Further, significantly higher odds for seropositivity were seen in Orthodox-Reformed Protestants. This community lives socio-geographically clustered in the Netherlands, that is, work, school, leisure and church are intertwined heavily how does lasix increase blood sugar.

As observed in other countries, particularly frequent attendance of church with close distance to others, including singing activities, might have fuelled the spread of hypertension within this community in the beginning of the epidemic.11 12 Whereas the comorbidities with possible increased risk of severe hypertension medications were not associated with seropositivity in this study, immunosuppressants use did display higher odds (note. We did not have information of how does lasix increase blood sugar specific drugs). Recent data indicate that immunosuppressive treatment is not associated with worse hypertension medications outcomes,27 28 yet continued surveillance is warranted as these patients might be more prone to (future) , for instance due to a possible attenuated humoral immune response.29The majority of seropositive participants exhibited ≥1 symptom(s), mostly general and respiratory.

A recent meta-analysis found a pooled asymptomatic proportion of 16%,5 hence the observed overall fraction in the present study (7%) might be a conservative estimate as the self-reported symptoms how does lasix increase blood sugar could have been due to other reasons or circulating pathogens along the recalled period (ie, 62% of the seronegative participants reported symptoms too). The asymptomatic proportion might be different across ages5 and should be explored further along with elucidating the overall contribution of how does lasix increase blood sugar asymptomatic transmission via well-designed contact-tracing studies. Interestingly, clinical studies have observed anosmia/ageusia to be associated with hypertension , and this notion is supported here at a population-based level.30 In the lasix context, sudden onset of anosmia/ageusia seems to be a useful surveillance tool, which can contribute to early disease recognition and minimise transmission by rapid self-isolation.This study has some limitations.

First, although half of the total municipalities in the how does lasix increase blood sugar Netherlands were included, some hypertension medications hotspots might be missed due to the study design. Second, our study population consisted of more Dutch (88%) than how does lasix increase blood sugar non-Dutch persons and relative more healthcare workers (20%) when compared to the general population (76% and 14%, respectively).17 Healthcare workers in the Netherlands do not seem to have had a higher likelihood of , and transmission seems to have taken place mostly in household settings.3 31 Although selectivity in response was minimised by weighting our study sample on a set of sociodemographic characters to match the Dutch population, seroprevalence might still be slightly influenced. Third, some potential determinants for seropositivity could have been missed as we might have been underpowered to detect small differences given the low prevalence in this phase, or because these questions had not been included in the questionnaire (as it was designed in the very beginning of the epidemic).

Finally, at this stage the proportion of infected individuals that fail to show detectable seroconversion is unknown, potentially leading to underestimation of the percentage of infected persons.To conclude, we estimated that 2.8% of the Dutch inhabitants, that is, nearly half a million, were infected with how does lasix increase blood sugar hypertension amidst the first epidemic wave in the beginning of April 2020. This is in striking contrast with the 30-fold lower number of reported cases (of approximately 15 000)3, and underlines the importance of seroepidemiological studies to estimate the true lasix size. The proportion of persons still susceptible to hypertension is high and IFR is substantial.4 Globally, nationwide seroepidemiological studies are urgently needed for better understanding of related risk factors, viral spread, and measures applied to mitigate dissemination.7 The prospective nature of our study will enable us to gain key insights on the duration and quality of antibody responses in infected persons, and hence possible protection how does lasix increase blood sugar of disease by antibodies.6 Serosurveys will thus play a major role in guiding future interventions, such as strategies for vaccination (of risk groups), since even when treatments become available, initial treatment availability will be limited.What is already known on this topicReported hypertension medications cases worldwide are an underestimation of the true magnitude of the lasix as the scope of undetected cases remains largely unknown.Various symptoms and risk factors have been identified in patients seeking medical advice, however, these may not be representative for s in the general population.Seroepidemiological studies in outbreak settings have been performed, however, studies on a nationwide level covering all ages remain limited.What this study addsThis nationwide seroepidemiological study covering all ages reveals that 2.8% of the Dutch population had been infected with hypertension at the beginning of April 2020, that is, 30 times higher than the official cases reported, leaving a large proportion of the population still susceptible for .The highest seroprevalence was observed in young adults from 18 to 39 years of age and lowest in children aged 2 to 17 years, indicating marginal hypertension s among children in general.Persons taking immunosuppressants as well as those from the Orthodox-Reformed Protestant community had over four times higher odds of being seropositive compared to others.The extend of the spread of hypertension and the risk groups identified here, can inform monitoring strategies and guide future interventions internationally.AcknowledgmentsFirst of all, we gratefully acknowledge the participants of the PICO-study.

Secondly, this study would not have been possible without the instrumental contribution of colleagues from the National Institute of Public Health and Environment (RIVM), Bilthoven, the Netherlands, more specially the department of Immunology of Infectious Diseases and treatments, regarding logistics and/or laboratory analyses (Marjan Bogaard-van Maurik, Annemarie Buisman, Pieter van Gageldonk, Hinke ten Hulscher-van Overbeek, Petra Jochemsen, Deborah Kleijne, Jessica Loch, Marjan Kuijer, Milou Ohm, Hella Pasmans, Lia de Rond, Debbie van Rooijen, Liza Tymchenko, Esther van Woudenbergh, and Mary-lene de Zeeuw-Brouwer), the Epidemiology and Surveillance department concerning logistics (Francoise van Heiningen, Alies van Lier, how does lasix increase blood sugar Jeanet Kemmeren, Joske Hoes, Maarten Immink, Marit Middeldorp, Christiaan Oostdijk, Ilse Schinkel-Gordijn, Yolanda van Weert, and Anneke Westerhof), methodological insights (Hendriek Boshuizen, Susan Hahné, Scott McDonald, Rianne van Gageldonk-Lafeber, Jan van de Kassteele, and Maarten Schipper) and manuscript reviewing (Susan van den Hof, and Don Klinkenberg), department of IT and Communication for help with the invitations (Luppo de Vries, Daphne Gijselaar, and Maaike Mathu), student interns for additional support (Stijn Andeweg for creating online supplemental figures 1A and 1B. Janine Wolf, Natasha Kaagman, and Demi Wagenaar for logistics. And Lisette van Cooten for data entry of paper questionnaires), and Sidekick-IT, Breda, the how does lasix increase blood sugar Netherlands, regarding data flow (Tim de Hoog).

This study was funded by the ministry of Health, Welfare and Sports (VWS), the Netherlands..

INTRODUCTIONSevere acute respiratory syndrome hypertension 2 hop over to this website (hypertension), causative agent of lasix 40mg tablet pricelasix order hypertension disease (hypertension medications), emerged in Wuhan, China, in late 2019. On 11 March 2020, the World Health Organization (WHO) declared hypertension medications a lasix, with over 10 million confirmed cases as of the beginning of July 2020.1 2 The first patient in the Netherlands was confirmed on 27 February 2020.3 Cases primarily clustered in the southeastern part of the country, but lasix 40mg tablet pricelasix order were reported in other regions quickly hereafter. Multi-pronged interventions to suppress the spread of the lasix, including social distancing, school and bar/restaurant closure, and stringent advice to home quarantine when feeling ill and work from home, were implemented on 16 March 2020—and were relaxed gradually since 1 June 2020.

By 1 July 2020, 50 273 cases, 11 877 hospitalisations, and 6113 related deaths were reported in the Netherlands.3Supplemental materialReported hypertension medications cases worldwide lasix 40mg tablet pricelasix order are an underestimation of the true magnitude of the lasix. The scope of undetected cases remains largely unknown due to difference in restrictive testing policy and registration across countries, and occurrence of asymptomatic s.4 5 Large-scale nationwide serosurveillance studies lasix 40mg tablet pricelasix order measuring hypertension-specific serum antibodies could help to better assess the number of s, viral spread, and groups at risk of in the general population by incorporating extensive questionnaire data, for example, on lifestyle, behaviour and profession. This might yield different factors than those identified for (severely-ill) clinical cases investigated more frequently up until now.6 7 Unfortunately, such nationwide studies (eg, in Spain8 and Iceland,9) also referred to as Unity Studies by the WHO,10 are scarce and mainly set up through convenience sampling.Therefore, a nationwide serosurveillance study (PIENTER-Corona, PICO) was initiated quickly after the lockdown was in effect.

This cohort is unique as it comprises data available from a previous serosurvey established in 2016/17 (PIENTER-3) of a randomised nationwide sample of Dutch citizens, across all ages and a separate sample enriched for Orthodox-Reformed Protestants, whom might have been exposed to hypertension more frequently due to their socio-geographical-clustered lifestyle.11 12 The presented serological framework and findings of our first round of inclusion can support public health policy in the Netherlands as well as internationally.METHODSStudy designIn 2016/17, the National Institute for Public Health and the Environment of the Netherlands (RIVM) initiated a large-scale nationwide serosurveillance study (PIENTER-3) lasix 40mg tablet pricelasix order (n=7600. Age-range 0–89 years). The primary aim was to obtain lasix 40mg tablet pricelasix order insights into the protection against treatment-preventable diseases offered by the National Immunisation Programme in the Netherlands.

A comprehensive description of PIENTER-3 has been published previously.13 Briefly, participants were selected via a two-stage cluster design, comprising 40 municipalities in five regions nationwide (henceforth ‘national lasix 40mg tablet pricelasix order sample’, NS), and nine municipalities in the low vaccination coverage municipalities (LVC), inhabited by a relative large proportion of Orthodox-Reformed Protestants (figure 1). Among other materials, sera and questionnaire data had been collected from all participants. Hence, the PIENTER-3 study acted as baseline sample of the Dutch population for the present lasix 40mg tablet pricelasix order cross-sectional PICO-study since 6102 participants (80%) consented to be approached for follow-up (after updating addresses and screening of possible deaths).

The study was powered to estimate an overall seroprevalence with a precision of at least 2.5%.13 The PICO-study protocol was approved by the Medical Ethics Committee MEC-U, the Netherlands (Clinical Trial Registration NTR8473), and conformed to the principles embodied in the Declaration of Helsinki.Geographical representation of number of participants in the PICO-study, the Netherlands, first round of inclusion, per municipality. The size of the dots reflect the absolute number of lasix 40mg tablet pricelasix order participants. Thicker grey and smaller light grey boundaries represent provinces and municipalities, respectively, and orange lasix 40mg tablet pricelasix order and blue boundaries characterise municipalities from the national and low vaccination coverage sample, respectively." data-icon-position data-hide-link-title="0">Figure 1 Geographical representation of number of participants in the PICO-study, the Netherlands, first round of inclusion, per municipality.

The size of the dots reflect the absolute number of participants. Thicker grey and smaller light grey boundaries represent provinces and lasix 40mg tablet pricelasix order municipalities, respectively, and orange and blue boundaries characterise municipalities from the national and low vaccination coverage sample, respectively.Study population and materialsOn 25 March 2020, an invitation letter was sent. Invitees (age-range 2–92 years) willing to participate registered lasix 40mg tablet pricelasix order online.

After enrolment, participants received an instruction letter on how to self-collect a fingerstick blood sample in a microtainer (maximum of 0.3 mL). Blood samples were returned to the RIVM-laboratory in safety lasix 40mg tablet pricelasix order envelopes. Serum samples were stored at −20°C awaiting analyses.

Materials were collected between March 31 and May 11, with the majority (80%) in the first lasix 40mg tablet pricelasix order week of April 2020 (median collection date April 3). Simultaneous with the blood lasix 40mg tablet pricelasix order collection, participants were asked to complete an (online) questionnaire, including questions regarding sociodemographic characteristics, hypertension medications-related symptoms, and potential other determinants for hypertension seropositivity, such as comorbidities, medication use and behavioural factors. All participants provided written informed consent.Laboratory methodsSerum samples (diluted 1:200) were tested for the presence of hypertension spike S1-specific IgG antibodies using a validated fluorescent bead-based multiplex-immunoassay as described.14 A cut-off concentration for seropositivity (2.37 AU/mL.

With specificity of 99% and sensitivity of 84.4%) was determined by ROC-analysis of 400 pre-lasix control samples (including a nationwide random cross-sectional sample (n=108)) as well as patients with confirmed influenza-like illnesses caused by hypertensiones and other lasixes, and a selection of sera from lasix 40mg tablet pricelasix order 115 PCR-confirmed hypertension medications cases with mild, or severe disease symptoms. Seropositive PICO-samples and those with a concentration 25% below the cut-off were retested (n=138), and the geometric mean concentration (GMC) was calculated. Paired pre-lasix PIENTER-3-samples of these retested PICO-samples (available from 129/138) were tested correspondingly as described above lasix 40mg tablet pricelasix order to correct for false-positive results (online supplemental figure S1A).Statistical analysesStudy population, hypertension medications-related symptoms and antibody responsesData management and analyses were conducted in SAS v.9.4 (SAS Institute Inc., USA) and R v.3.6.

P values <0.05 lasix 40mg tablet pricelasix order were considered statistically significant. Sociodemographic characteristics and hypertension medications-related symptoms (general, respiratory, and gastrointestinal) developed since the start of the epidemic were stratified by sample (NS vs LVC), or sex, respectively, and described for seropositive and seronegative participants. Differences were tested via Pearson’s χ², or lasix 40mg tablet pricelasix order Fisher’s exact test if appropriate.

Differences in GMC between reported symptoms in seropositive lasix 40mg tablet pricelasix order participants were determined by calculating the difference in log-transformed concentrations of those who developed symptoms at least 4 weeks prior to the sampling—ensuring a plateaued response—and tested by means of a Mann-Whitney U-test.Seroprevalence estimatesSeroprevalence estimates (with 95% Wilson CIs (CI)) for hypertension-specific antibodies were calculated taking into account the survey design (ie, controlling for region and municipality) and weighted by sex, age, ethnic background and degree of urbanisation to match the distribution of the general Dutch population in both the NS and LVC sample. Estimates were corrected for test performance via the Rogan &. Gladen bias correction (with sensitivity of 84.4% and assuming a specificity of 100% after cross-validation with pre-sera).15 Smooth age-specific seroprevalence estimates were obtained with a logistic regression in a Generalised lasix 40mg tablet pricelasix order Additive Model using penalised splines.16Risk factors for hypertension seropositivityA random-effects logistic regression model was used to identify risk factors for hypertension seropositivity, applying a full case analysis (n=3100.

Values were missing for <5% of the participants). Potential risk factors included sociodemographic characteristics (sex, age group, region, ethnic background, Orthodox-Reformed Protestants, educational level, household size, (parent with a) contact profession, healthcare worker), and hypertension medications-related factors (contact with a hypertension medications confirmed case, number of persons lasix 40mg tablet pricelasix order contacted yesterday, working from home (normally and in the last week), comorbidities (combining diabetes, history of malignancy, immunodeficiency, cardio-vascular, kidney and chronic lung disease (note. As a sensitivity analysis, comorbidities were also included separately)), and use of blood pressure medication, immunosuppressants, statins and antivirals/antibiotics in the lasix 40mg tablet pricelasix order last month).

Models included a random intercept, potential clustering by municipality and region was accounted for, and odds ratios (OR) in univariable analyses were a priori adjusted for sex and age. Variables with p<0.10 were entered in the multivariable analysis, and backward lasix 40mg tablet pricelasix order selection was performed—manually dropping variables one-by-one based on p≥0.05—to identify significant risk factors. Adjusted ORs and corresponding 95% CIs were provided.RESULTSStudy populationOf 6102 invitees, 3207 (53%) donated a serum sample and filled-out the questionnaire, of which 2637 persons from the NS and 570 from the LVC.

Participants from across the country participated lasix 40mg tablet pricelasix order (figure 1), with age ranging from 2 to 90 years (table 1). In the NS, slightly more women (55%) participated, most (88%) were of Dutch descent, nearly half had lasix 40mg tablet pricelasix order a high educational level, and 45% was religious. 20 percent of persons between age 25–66 years were healthcare workers and 56% of the (parents of) participants reported to have had daily contact with patients, clients and/or children in their profession/volunteer work normally.

Over half of the participants lived in a ≥2-person household, and 78% reported to have had physical contact with <5 people outside their own household yesterday (during lockdown), lasix 40mg tablet pricelasix order of which more than half with nobody. Comorbidities most lasix 40mg tablet pricelasix order frequently reported included chronic lung and cardiovascular disease (both 13%), and a history of malignancy (5%). In line with the population distribution, the LVC sample was characterised by a relative high proportion of Orthodox-Reformed Protestants from Dutch descent (table 1).

Sociodemographic characteristics between responders and non-responders are provided in online supplemental table S1.View this table:Table 1 Sociodemographic characteristics of participants in the PICO-study and weighted seroprevalence in the general population of the Netherlands, first round of inclusion, by national sample and low vaccination coverage sampleSupplemental materialhypertension medications-related symptoms and antibody responsesIn total, 63% of participants reported to have had ≥1 hypertension medications-related symptom(s) since the start of the epidemic, with runny nose (37%), headache lasix 40mg tablet pricelasix order (33%), and cough (30%) being most common (table 2). All reported symptoms were significantly higher in seropositive compared to seronegative persons, except for stomach ache. The majority of those seropositive (93%) reported to have had symptoms lasix 40mg tablet pricelasix order (90% of men vs 95% of women), of whom three already in mid-February, 2 weeks prior to the official first notification.

Median duration of illness in the seropositive participants was lasix 40mg tablet pricelasix order 8.5 days (IQR. 4.0–12.5), 16% (n=12) visited ageneral practitioner and one was admitted to the hospital. Among seropositive persons, most reported to have had ≥1 respiratory symptom(s) (86%), with runny nose and cough (both 61%) most regularly, and ≥1 general (84%) symptom(s), of which anosmia/ageusia (53%) was most discriminative as compared to the seronegative participants (4%, p<0.0001) (table 2) lasix 40mg tablet pricelasix order.

Symptoms were more common in women, except for anosmia/ageusia, cough and irritable/confusion. Almost 75% of the seropositive participants met the hypertension medications case definition of fever and/or cough lasix 40mg tablet pricelasix order and/or dyspnoea, which improved to 80% when anosmia/ageusia was included—while remaining 36% in those seronegative. GMC was significantly higher among seropositive persons with fever vs without (48.2 vs 11.6 AU/mL, p=0.01), and with dyspnoea vs without (78.6 vs 13.5 AU/mL, p=0.04).View this table:Table 2 hypertension medications-related symptoms since the start of the epidemic among all participants in the PICO-study reporting symptoms (n=3147), first round of inclusionSeroprevalence estimatesOverall weighted seroprevalence in the NS was 2.8% (95% CI 2.1 to 3.7), did not differ between sexes or ethnic backgrounds (table 1), and was lasix 40mg tablet pricelasix order not higher among healthcare workers (2.7% vs non-healthcare workers 2.5%).

Seroprevalence was lowest in the northern region (1.3%) and highest in the mid-west (4.0%). Estimates were lowest in children—gradually increasing from below 1% at age 2 years to 3% at 17 years—was highest in age group 18–39 years (4.9%) and ranged between 2 and 4% lasix 40mg tablet pricelasix order up to 90 years of age (figure 2). In both samples, seroprevalence was highest in Orthodox-Reformed Protestants (>7%) lasix 40mg tablet pricelasix order (table 1).

Online supplement figure S1B displays the distribution of IgG concentrations for all participants by age, and online supplemental figure S2 ⇓shows the seroprevalence smoothed by age in the LVC.Smooth age-specific hypertension seroprevalence in the general population of the Netherlands, beginning of April 2020." data-icon-position data-hide-link-title="0">Figure 2 Smooth age-specific hypertension seroprevalence in the general population of the Netherlands, beginning of April 2020.Risk factors for hypertension seropositivityVariables that were associated with hypertension seropositivity in univariable analyses included age group, Orthodox-Reformed Protestant, had been in contact with a hypertension medications case, use of immunosuppressants, and antibiotic/antiviral medication in the last month (table 3). In multivariable analysis, substantial higher odds were observed for those who took immunosuppressants the last month, were Orthodox-Reformed Protestant, had been in contact with a hypertension medications confirmed case, and from age groups 18–24 and 25–39 years (compared to 2–12 lasix 40mg tablet pricelasix order years).View this table:Table 3 Risk factor analysis for hypertension seropositivity among all participants (n=3100. Full case analysis) in the PICO-study, first round of inclusionDISCUSSIONHere, we have estimated the seroprevalence of hypertension-specific antibodies and identified risk factors for seropositivity in the general population of the Netherlands during the first epidemic wave in April 2020.

Although overall lasix 40mg tablet pricelasix order seroprevalence was still low at this phase, important risk factors for seropositivity could be identified, including adults aged 18–39 years, persons using immunosuppressants, and Orthodox-Reformed Protestants. These data can guide future interventions, including strategies for vaccination, believed to lasix 40mg tablet pricelasix order be a realistic solution to overcome this lasix.This PICO-study revealed that 2.8% (95% CI 2.1 to 3.7) of the Dutch population had detectable hypertension-specific serum IgG antibodies, suggesting that almost half a million inhabitants (of in total 17 423 98117) were infected (487 871 (95% CI 365 904 to 644 687)) in mid-March, 2020 (taking into account the median time to seroconvert18). Several seropositive participants reported to have had hypertension medications-related symptoms back in mid-February, suggesting the lasix circulated in our country at the beginning of February already.

Our overall estimate is in line with preliminary results from another study conducted in the Netherlands in the beginning of April which found 2.7% to be lasix 40mg tablet pricelasix order seropositive, although this study was performed in healthy blood donors aged 18–79 years.19 Worldwide, various seroprevalence studies are ongoing. A large nationwide study in Spain showed that around 5% (ranging between 3.7% and 6.2%) was seropositive, indicating that only a small proportion of the population had been infected in one of the hardest hit countries in Europe. Current studies in literature mostly cover hypertension medications hotspots or specific regions—with possibly bias in selection of participants and/or smaller age-ranges—with rates ranging between 1–7% in April (eg, in Los Angeles County (CA, USA)20 or ten other sites lasix 40mg tablet pricelasix order in the USA,21 Geneva (Switzerland),22 and Luxembourg23).

Estimates also very much depend on lasix 40mg tablet pricelasix order test performances. Particularly, when seroprevalence is relatively low, specificity of the assay should approach near 100% to diminish false-positive results and minimise overestimation. Although we cannot rule-out false-positive samples completely, lasix 40mg tablet pricelasix order our assay was validated using a broad range of positive and negative hypertension samples.

PICO-samples were lasix 40mg tablet pricelasix order cross-linked to pre-lasix concentration. And bias correction for test performance was applied to represent most accurate estimates. In addition, future studies should establish whether epidemiologically dominant genetic changes in the spike protein of hypertension influence binding to spike S1 used in our and other assays.Seroprevalence was highest in adults aged 18–39 years, which is in line with the serosurvey among blood donors in the Netherlands, but contrary to the low incidence rate as reported in Dutch surveillance, caused by restrictive testing of risk groups and healthcare workers at the beginning of the epidemic, primarily identifying severe cases.3 19 The elevation in these younger adults may be explained by increased social contacts typical for this age group, in addition to specific social activities in February, such as skiing holidays in the Alps (from lasix 40mg tablet pricelasix order where the lasix disseminated quickly across Europe), or carnival festivities in the Netherlands (ie, multiple superspreading events primarily in the mid and Southern part, explaining local elevation in seroprevalence).

In correspondence with other nationwide studies8 9 and reports from the Dutch government,3 24 seroprevalence was lowest in children. Although some rare events of paediatric inflammatory multisystem syndrome have been reported, this group seems to be at decreased risk for developing (severe) hypertension medications in general, which may be explained by less lasix 40mg tablet pricelasix order severe possibly resulting in a limited humoral response.25 26 Further, significantly higher odds for seropositivity were seen in Orthodox-Reformed Protestants. This community lives socio-geographically clustered in the Netherlands, that lasix 40mg tablet pricelasix order is, work, school, leisure and church are intertwined heavily.

As observed in other countries, particularly frequent attendance of church with close distance to others, including singing activities, might have fuelled the spread of hypertension within this community in the beginning of the epidemic.11 12 Whereas the comorbidities with possible increased risk of severe hypertension medications were not associated with seropositivity in this study, immunosuppressants use did display higher odds (note. We did not lasix 40mg tablet pricelasix order have information of specific drugs). Recent data indicate that immunosuppressive treatment is not associated with worse hypertension medications outcomes,27 28 yet continued surveillance is warranted as these patients might be more prone to (future) , for instance due to a possible attenuated humoral immune response.29The majority of seropositive participants exhibited ≥1 symptom(s), mostly general and respiratory.

A recent meta-analysis found a pooled asymptomatic proportion of 16%,5 lasix 40mg tablet pricelasix order hence the observed overall fraction in the present study (7%) might be a conservative estimate as the self-reported symptoms could have been due to other reasons or circulating pathogens along the recalled period (ie, 62% of the seronegative participants reported symptoms too). The asymptomatic proportion might be different across ages5 and should be explored further along with elucidating the overall contribution of asymptomatic lasix 40mg tablet pricelasix order transmission via well-designed contact-tracing studies. Interestingly, clinical studies have observed anosmia/ageusia to be associated with hypertension , and this notion is supported here at a population-based level.30 In the lasix context, sudden onset of anosmia/ageusia seems to be a useful surveillance tool, which can contribute to early disease recognition and minimise transmission by rapid self-isolation.This study has some limitations.

First, although half of the total municipalities in the Netherlands were included, some hypertension medications hotspots might lasix 40mg tablet pricelasix order be missed due to the study design. Second, our study population consisted lasix 40mg tablet pricelasix order of more Dutch (88%) than non-Dutch persons and relative more healthcare workers (20%) when compared to the general population (76% and 14%, respectively).17 Healthcare workers in the Netherlands do not seem to have had a higher likelihood of , and transmission seems to have taken place mostly in household settings.3 31 Although selectivity in response was minimised by weighting our study sample on a set of sociodemographic characters to match the Dutch population, seroprevalence might still be slightly influenced. Third, some potential determinants for seropositivity could have been missed as we might have been underpowered to detect small differences given the low prevalence in this phase, or because these questions had not been included in the questionnaire (as it was designed in the very beginning of the epidemic).

Finally, at this stage the proportion of infected individuals that fail to show detectable lasix 40mg tablet pricelasix order seroconversion is unknown, potentially leading to underestimation of the percentage of infected persons.To conclude, we estimated that 2.8% of the Dutch inhabitants, that is, nearly half a million, were infected with hypertension amidst the first epidemic wave in the beginning of April 2020. This is in striking contrast with the 30-fold lower number of reported cases (of approximately 15 000)3, and underlines the importance of seroepidemiological studies to estimate the true lasix size. The proportion of persons still susceptible to hypertension is high and IFR is substantial.4 Globally, nationwide seroepidemiological studies are urgently needed for better understanding of related risk factors, viral spread, and measures applied to mitigate dissemination.7 The prospective nature of our study will enable us to gain key insights on the duration and quality of antibody responses in infected persons, and hence possible protection of disease by antibodies.6 Serosurveys will thus play a major role in guiding future interventions, such as strategies for vaccination (of risk groups), since even when treatments become available, initial treatment availability will be limited.What is already known on this topicReported hypertension medications cases worldwide are an underestimation of the true magnitude of the lasix as the scope of undetected cases remains largely unknown.Various symptoms and risk factors have been identified in patients seeking medical advice, however, these may not be representative for s in the general population.Seroepidemiological studies in outbreak settings have been performed, however, studies on a nationwide level covering all ages remain limited.What this study addsThis nationwide seroepidemiological study covering all ages reveals lasix 40mg tablet pricelasix order that 2.8% of the Dutch population had been infected with hypertension at the beginning of April 2020, that is, 30 times higher than the official cases reported, leaving a large proportion of the population still susceptible for .The highest seroprevalence was observed in young adults from 18 to 39 years of age and lowest in children aged 2 to 17 years, indicating marginal hypertension s among children in general.Persons taking immunosuppressants as well as those from the Orthodox-Reformed Protestant community had over four times higher odds of being seropositive compared to others.The extend of the spread of hypertension and the risk groups identified here, can inform monitoring strategies and guide future interventions internationally.AcknowledgmentsFirst of all, we gratefully acknowledge the participants of the PICO-study.

Secondly, this study would not have been possible without the instrumental contribution of colleagues from the National Institute of Public Health and Environment (RIVM), Bilthoven, the Netherlands, more specially lasix 40mg tablet pricelasix order the department of Immunology of Infectious Diseases and treatments, regarding logistics and/or laboratory analyses (Marjan Bogaard-van Maurik, Annemarie Buisman, Pieter van Gageldonk, Hinke ten Hulscher-van Overbeek, Petra Jochemsen, Deborah Kleijne, Jessica Loch, Marjan Kuijer, Milou Ohm, Hella Pasmans, Lia de Rond, Debbie van Rooijen, Liza Tymchenko, Esther van Woudenbergh, and Mary-lene de Zeeuw-Brouwer), the Epidemiology and Surveillance department concerning logistics (Francoise van Heiningen, Alies van Lier, Jeanet Kemmeren, Joske Hoes, Maarten Immink, Marit Middeldorp, Christiaan Oostdijk, Ilse Schinkel-Gordijn, Yolanda van Weert, and Anneke Westerhof), methodological insights (Hendriek Boshuizen, Susan Hahné, Scott McDonald, Rianne van Gageldonk-Lafeber, Jan van de Kassteele, and Maarten Schipper) and manuscript reviewing (Susan van den Hof, and Don Klinkenberg), department of IT and Communication for help with the invitations (Luppo de Vries, Daphne Gijselaar, and Maaike Mathu), student interns for additional support (Stijn Andeweg for creating online supplemental figures 1A and 1B. Janine Wolf, Natasha Kaagman, and Demi Wagenaar for logistics. And Lisette van Cooten for data entry of paper questionnaires), and lasix 40mg tablet pricelasix order Sidekick-IT, Breda, the Netherlands, regarding data flow (Tim de Hoog).

This study was funded by the ministry of Health, Welfare and Sports (VWS), the Netherlands..

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Former Editor-in-Chief of How to order cipro online the Postgraduate Medical Journal Dr Barry Ian Hoffbrand died suddenly on April 24, 2020 at the age of 86.A prominent member of a generation of very bright young doctors at University College Hospital (UCH) in London who went on to distinguished careers, he was much admired for his keen intellect, clinical perception and skills, taking lasix for weight loss gentle good humour and kindly nature, combined with a wonderfully sharp intelligence. Professor Dame Jane Dacre remembered him as ‘a kind, witty, clever man, and a great physician’.He was born in Bradford, West Yorkshire, to Philip Hoffbrand, a bespoke tailor, and Minnie (née Freedman), both from Jewish families from Eastern Europe. After Bradford Grammar School, he went up to read medicine from 1952 to 1956 at The Queen’s College, Oxford, where he was a keen member of the college taking lasix for weight loss cricket team—the Quondams. He was pleased to feature in the 1950s on the silver Quondams Cup. Clinical training on a Goldsmid scholarship followed from 1956 to 1958 at UCH Medical School, London, where he was awarded prizes in clinical pathology and haematology.

His postgraduate medical training was mainly at UCH, where he was house physician taking lasix for weight loss to Max (later Lord) Rosenheim, after an initial 6 months at St Luke’s Hospital, Bradford. He also spent a year as senior research fellow from 1967 to 1968 at the Cardiovascular Research Institute, at the University of California Medical Center in San Francisco. Barry’s research on cardiovascular physiology lead to a DM in 1971 from Oxford University.Barry was appointed in 1970 as a consultant physician at the Whittington Hospital and honorary senior clinical lecturer at UCH Medical School, with interests in general and …INTRODUCTIONAs cardiac arrest occurs in around 20% of the patients with severe hypertension medications, a large number of them will require immediate resuscitative efforts.1 Cardiopulmonary resuscitation (CPR) in hypertension medications lasix has become a source of speculation and debate worldwide. Healthcare professionals (HCPs) resuscitating this subset of patients are subject to fears and enormous mental stress pertaining to risk taking lasix for weight loss of transmission, breach in personal protective equipment (PPE), unsure effectiveness of PPE and nevertheless bleak positive outcomes in patients despite best resuscitative measures.2 CPR, which is conventionally deemed to be life-saving for patients, appears as an aerosol-generating procedure risking lives of HCPs caring for patients with hypertension medications. Protected code blue algorithm has been formulated to address both performer and patient safety.3POCUS-INTEGRATED CPR.

WHY THE taking lasix for weight loss NEED IN hypertension medications?. Danilo Buonsenso and colleagues have described hypertension medications era as demanding less stethoscope and more ultrasound usage in clinical practice.4 PPE is now an essential measure for HCP protection, and goggles used as a part of PPE are associated with fogging and poor visibility. This coupled with the inability to confirm endotracheal tube position with stethoscope due to poor accessibility in PPE, increases the risk of oesophageal intubation, re-intubation attempts, aerosol generation and thus HCP exposure. Bedside ultrasound could act as visual stethoscope in the taking lasix for weight loss described scenario. Sono-CPR in hypertension medications can help intervene quickly in treatable cases and reduce the time spent by HCP in futile resuscitative efforts.

Reduced time spent equates to reduced duration of aerosol exposure and thus reduced risk of transmission. Various algorithms are described for sono-cardiopulmonary resuscitation (sono-CPR) during cardiac arrest, but none are discussed to address patients with hypertension medications.5 It would hence be wise to integrate taking lasix for weight loss bedside point-of-care ultrasound (POCUS) in the code blue algorithm.HOW THE BEDSIDE TOOL HELPS?. Hypoxemia and respiratory failure attribute over 80% aetiology of cardiac arrest in patients with hypertension medications.1 Prioritising oxygenation and ventilation using definitive airway and use of high-efficiency particulate air filters reduces airborne transmission, thereby making early intubation the dictum of resuscitation.3 Considering poor visualisation due to fogging with the goggles and face shield, inability to use stethoscope and lack of availability of end-tidal CO2 (EtCO2) in resource constraint settings, ultrasound-guided real-time intubation by trained HCP or endotracheal tube (ETT) placement confirmation post intubation could prove beneficial. Confirming ETT placement and direct visualisation of oesophagal lumen can be done using a linear ultrasound probe.6 In cases of oesophageal intubation, tissue-air hyperechoic lines are visualised in both trachea and oesophagus, referred to as ‘double-track sign’.State of hypercoagulability and myocardial dysfunction exist in patients with hypertension medications, hence increasing taking lasix for weight loss the likelihood of myocardial infarction or pulmonary thromboembolism as aetiologies of cardiac arrest.7 Regional wall motion abnormality, dilated right atrium or right ventricle, plethoric inferior vena cava are easily identified by goal-directed echocardiography. Pneumothorax has been reported in patients with hypertension medications, and ultrasound can identify absence of lung sliding, helping in quick needle thoracocentesis in arrest and peri-arrest cases.

Few cases of cardiac tamponade owing to myopericarditis have also been reported and bedside ultrasound can help diagnose and perform pericardiocentesis in such patients.Literature suggests that the chances of Return Of Spontaneous Circulation (ROSC) and survival to hospital admission at 24 hours is better in patients with baseline cardiac activity rather than no baseline cardiac activity. In patients with no baseline cardiac activity on arrival, one can withhold CPR, thereby protecting the HCP in this resource-intensive, aerosol-generating futile resuscitative effort.8 Asystole could be the disguised entity of fine taking lasix for weight loss ventricular fibrillation, which can be confirmed by fibrillatory cardiac activity on transthoracic echocardiography and can be defibrillated, thereby increasing the chances of earlier ROSC.9POCUS-INTEGRATED CPR. THE PROPOSED ALGORITHMCPR is a chaotic scenario, and to prevent added chaos, there is a need for a well-trained ultrasound performer placed in an appropriate area (figure 1). Intubating room needs to consist of minimal necessary number of HCPs, and all of them should be equipped with full PPE. Ultrasound device could be a potential fomite facilitating cross-transmission and requires adequate protection of machine and taking lasix for weight loss its components with a transparent cover, sheet or bag.

When unavailable, low-level disinfectant solution should be used between each patient.Proposed algorithm for integration of POCUS during CPR in patients with hypertension medications with team dynamics. The illustration is original work of the authors taking lasix for weight loss Dr Brunda RL and colleagues. CPR, cardiopulmonary resuscitation. HCP, healthcare professional. POCUS, point-of-care taking lasix for weight loss ultrasound.

PPE, personal protective equipment. RA, right atrium. RV, right taking lasix for weight loss ventricle. VF, ventricular fibrillation. USG, ultrasonography." data-icon-position data-hide-link-title="0">Figure 1 Proposed algorithm for integration of POCUS during CPR in patients with hypertension medications with team dynamics.

The illustration is original work of the authors Dr Brunda RL and taking lasix for weight loss colleagues. CPR, cardiopulmonary resuscitation. HCP, healthcare taking lasix for weight loss professional. POCUS, point-of-care ultrasound. PPE, personal protective equipment.

RA, right taking lasix for weight loss atrium. RV, right ventricle. VF, ventricular fibrillation. USG, ultrasonography.When a patient experiences cardiac arrest, there is taking lasix for weight loss a need for HCPs with full PPE to check pulse and begin CPR as per standard guidelines. After 2 min of CPR, if there is no ROSC, during the 10 second pause for rhythm assessment, a trained HCP can perform POCUS in a stepwise manner.

Each step needs to be performed individually during 10 second pause without prolonging taking lasix for weight loss delay between chest compressions and compromising the quality of CPR. Any treatable aetiology identified during the algorithm requires immediate intervention.Step 1. Assess cardiac activity—Sub-xiphoid view can be procured and cardiac activity assessed. If absent, consider termination of efforts, and if present, resuscitative efforts can be continued.After repeating 2 min cycle of CPR, if there has been no ROSC, consider hypoxic aetiology taking lasix for weight loss as the cause of arrest in patients with hypertension medications and intubate without delay. Withholding chest compressions during intubation is recommended.3Step 2.

Assess ETT placement—At the level of thyroid gland, above the suprasternal notch, place ultrasound probe transversely and visualise the oesophagus.10 If the posterior wall of oesophagus is obscured by a dark acoustic shadow or if there is ‘double-track’ sign, consider failed endotracheal intubation and perform immediate re-intubation.Step 3. Assess lung for pneumothorax—Assess lung taking lasix for weight loss sliding, and if absent look for ‘stratosphere sign’ in M-mode of ultrasound.10 If detected, perform immediate needle thoracocentesis.Step 4. Assess for Cardiac etiology of arrest—Obtain sub-xiphoid window preferably, and look for the presence of cardiac tamponade, chamber dilatation or collapse, regional wall motion abnormality and cardiac contractility.Availability of trained personnel and smaller portable ultrasound devices makes its use during cardiac arrest plausible.CPR with the help of POCUS could thus prove to improve chances of ROSC and also reduced transmission to HCP by early identification, treatment of reversible causes and avoidance of prolonged efforts. Sono-CPR appears to be more HCP-friendly than prolonged blind CPR and necessitates its utility in the era of hypertension medications addressing performer safety as well as patient safety..

Former Editor-in-Chief of the Postgraduate Medical Journal Dr Barry Ian Hoffbrand died suddenly on April 24, 2020 How to order cipro online at the age of 86.A prominent member of a generation of very bright young doctors at University College lasix 40mg tablet pricelasix order Hospital (UCH) in London who went on to distinguished careers, he was much admired for his keen intellect, clinical perception and skills, gentle good humour and kindly nature, combined with a wonderfully sharp intelligence. Professor Dame Jane Dacre remembered him as ‘a kind, witty, clever man, and a great physician’.He was born in Bradford, West Yorkshire, to Philip Hoffbrand, a bespoke tailor, and Minnie (née Freedman), both from Jewish families from Eastern Europe. After Bradford Grammar School, he went up to read medicine from 1952 to 1956 at The Queen’s College, Oxford, where lasix 40mg tablet pricelasix order he was a keen member of the college cricket team—the Quondams.

He was pleased to feature in the 1950s on the silver Quondams Cup. Clinical training on a Goldsmid scholarship followed from 1956 to 1958 at UCH Medical School, London, where he was awarded prizes in clinical pathology and haematology. His postgraduate lasix 40mg tablet pricelasix order medical training was mainly at UCH, where he was house physician to Max (later Lord) Rosenheim, after an initial 6 months at St Luke’s Hospital, Bradford.

He also spent a year as senior research fellow from 1967 to 1968 at the Cardiovascular Research Institute, at the University of California Medical Center in San Francisco. Barry’s research on cardiovascular physiology lead to a DM in 1971 from Oxford University.Barry was appointed in 1970 as a consultant physician at the Whittington Hospital and honorary senior clinical lecturer at UCH Medical School, with interests in general and …INTRODUCTIONAs cardiac arrest occurs in around 20% of the patients with severe hypertension medications, a large number of them will require immediate resuscitative efforts.1 Cardiopulmonary resuscitation (CPR) in hypertension medications lasix has become a source of speculation and debate worldwide. Healthcare professionals (HCPs) resuscitating this subset of patients are subject to fears and enormous mental stress pertaining to risk of transmission, breach in personal protective equipment (PPE), unsure effectiveness of PPE and nevertheless bleak positive outcomes in patients despite best resuscitative measures.2 CPR, which is conventionally deemed to be life-saving lasix 40mg tablet pricelasix order for patients, appears as an aerosol-generating procedure risking lives of HCPs caring for patients with hypertension medications.

Protected code blue algorithm has been formulated to address both performer and patient safety.3POCUS-INTEGRATED CPR. WHY THE NEED lasix 40mg tablet pricelasix order IN hypertension medications?. Danilo Buonsenso and colleagues have described hypertension medications era as demanding less stethoscope and more ultrasound usage in clinical practice.4 PPE is now an essential measure for HCP protection, and goggles used as a part of PPE are associated with fogging and poor visibility.

This coupled with the inability to confirm endotracheal tube position with stethoscope due to poor accessibility in PPE, increases the risk of oesophageal intubation, re-intubation attempts, aerosol generation and thus HCP exposure. Bedside ultrasound could act as visual stethoscope in the lasix 40mg tablet pricelasix order described scenario. Sono-CPR in hypertension medications can help intervene quickly in treatable cases and reduce the time spent by HCP in futile resuscitative efforts.

Reduced time spent equates to reduced duration of aerosol exposure and thus reduced risk of transmission. Various algorithms are described for sono-cardiopulmonary resuscitation (sono-CPR) during cardiac arrest, but none are discussed to address patients with lasix 40mg tablet pricelasix order hypertension medications.5 It would hence be wise to integrate bedside point-of-care ultrasound (POCUS) in the code blue algorithm.HOW THE BEDSIDE TOOL HELPS?. Hypoxemia and respiratory failure attribute over 80% aetiology of cardiac arrest in patients with hypertension medications.1 Prioritising oxygenation and ventilation using definitive airway and use of high-efficiency particulate air filters reduces airborne transmission, thereby making early intubation the dictum of resuscitation.3 Considering poor visualisation due to fogging with the goggles and face shield, inability to use stethoscope and lack of availability of end-tidal CO2 (EtCO2) in resource constraint settings, ultrasound-guided real-time intubation by trained HCP or endotracheal tube (ETT) placement confirmation post intubation could prove beneficial.

Confirming ETT placement and direct visualisation of oesophagal lumen can be done using a linear ultrasound probe.6 In cases of oesophageal intubation, tissue-air hyperechoic lines are visualised in both trachea and oesophagus, referred to as ‘double-track sign’.State of hypercoagulability and myocardial dysfunction exist in patients with hypertension medications, hence increasing the likelihood of myocardial infarction or pulmonary thromboembolism as aetiologies of cardiac arrest.7 Regional wall motion abnormality, dilated right atrium or right ventricle, plethoric inferior vena cava are easily identified by goal-directed echocardiography lasix 40mg tablet pricelasix order. Pneumothorax has been reported in patients with hypertension medications, and ultrasound can identify absence of lung sliding, helping in quick needle thoracocentesis in arrest and peri-arrest cases. Few cases of cardiac tamponade owing to myopericarditis have also been reported and bedside ultrasound can help diagnose and perform pericardiocentesis in such patients.Literature suggests that the chances of Return Of Spontaneous Circulation (ROSC) and survival to hospital admission at 24 hours is better in patients with baseline cardiac activity rather than no baseline cardiac activity.

In patients with no baseline cardiac activity on lasix 40mg tablet pricelasix order arrival, one can withhold CPR, thereby protecting the HCP in this resource-intensive, aerosol-generating futile resuscitative effort.8 Asystole could be the disguised entity of fine ventricular fibrillation, which can be confirmed by fibrillatory cardiac activity on transthoracic echocardiography and can be defibrillated, thereby increasing the chances of earlier ROSC.9POCUS-INTEGRATED CPR. THE PROPOSED ALGORITHMCPR is a chaotic scenario, and to prevent added chaos, there is a need for a well-trained ultrasound performer placed in an appropriate area (figure 1). Intubating room needs to consist of minimal necessary number of HCPs, and all of them should be equipped with full PPE.

Ultrasound device could be a potential fomite facilitating cross-transmission and requires adequate protection of machine and its components with a transparent lasix 40mg tablet pricelasix order cover, sheet or bag. When unavailable, low-level disinfectant solution should be used between each patient.Proposed algorithm for integration of POCUS during CPR in patients with hypertension medications with team dynamics. The illustration is original work of the authors Dr Brunda RL and lasix 40mg tablet pricelasix order colleagues.

CPR, cardiopulmonary resuscitation. HCP, healthcare professional. POCUS, point-of-care lasix 40mg tablet pricelasix order ultrasound.

PPE, personal protective equipment. RA, right atrium. RV, right lasix 40mg tablet pricelasix order ventricle.

VF, ventricular fibrillation. USG, ultrasonography." data-icon-position data-hide-link-title="0">Figure 1 Proposed algorithm for integration of POCUS during CPR in patients with hypertension medications with team dynamics. The illustration is original work of lasix 40mg tablet pricelasix order the authors Dr Brunda RL and colleagues.

CPR, cardiopulmonary resuscitation. HCP, healthcare lasix 40mg tablet pricelasix order professional. POCUS, point-of-care ultrasound.

PPE, personal protective equipment. RA, right lasix 40mg tablet pricelasix order atrium. RV, right ventricle.

VF, ventricular fibrillation. USG, ultrasonography.When a patient experiences cardiac arrest, there is a need for HCPs with full PPE to check pulse lasix 40mg tablet pricelasix order and begin CPR as per standard guidelines. After 2 min of CPR, if there is no ROSC, during the 10 second pause for rhythm assessment, a trained HCP can perform POCUS in a stepwise manner.

Each step needs to be performed individually during 10 lasix 40mg tablet pricelasix order second pause without prolonging delay between chest compressions and compromising the quality of CPR. Any treatable aetiology identified during the algorithm requires immediate intervention.Step 1. Assess cardiac activity—Sub-xiphoid view can be procured and cardiac activity assessed.

If absent, consider termination of efforts, and if present, resuscitative efforts can lasix 40mg tablet pricelasix order be continued.After repeating 2 min cycle of CPR, if there has been no ROSC, consider hypoxic aetiology as the cause of arrest in patients with hypertension medications and intubate without delay. Withholding chest compressions during intubation is recommended.3Step 2. Assess ETT placement—At the level of thyroid gland, above the suprasternal notch, place ultrasound probe transversely and visualise the oesophagus.10 If the posterior wall of oesophagus is obscured by a dark acoustic shadow or if there is ‘double-track’ sign, consider failed endotracheal intubation and perform immediate re-intubation.Step 3.

Assess lung for pneumothorax—Assess lung sliding, and if absent look for ‘stratosphere sign’ in M-mode of ultrasound.10 If detected, perform immediate needle lasix 40mg tablet pricelasix order thoracocentesis.Step 4. Assess for Cardiac etiology of arrest—Obtain sub-xiphoid window preferably, and look for the presence of cardiac tamponade, chamber dilatation or collapse, regional wall motion abnormality and cardiac contractility.Availability of trained personnel and smaller portable ultrasound devices makes its use during cardiac arrest plausible.CPR with the help of POCUS could thus prove to improve chances of ROSC and also reduced transmission to HCP by early identification, treatment of reversible causes and avoidance of prolonged efforts. Sono-CPR appears to be more HCP-friendly than prolonged blind CPR and necessitates its utility in the era of hypertension medications addressing performer safety as well as patient safety..

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The Ministry has revised the guidance to the Mental Health (Compulsory Assessment and Treatment) Act 1992 (the lasix 20mg tabletas precio Act), outlining the rights of compulsory mental health consumers and the obligations of mental health clinicians. This guidance is intended to promote the protection of compulsory mental health consumers’ rights by clarifying the responsibilities of mental health services and clinicians and offering guidance on how sections of the Act can be administered. A number of key changes and emerging issues have been signalled in the revision of these Guidelines. In particular lasix 20mg tabletas precio. the growing influence of rights-based approaches and how these can be better promoted within the parameters of the current Mental Health Act.

The need to give greater emphasis to our obligations under Te Tiriti o Waitangi the impact of He Ara Oranga and, in particular, the feedback from people with lived experience and families and whānau on how they experience the current administration of the Mental Health Act. Please also read the companion document to these guidelines, Human Rights and the Mental Health (Compulsory Assessment and Treatment) Act 1992, which offers guidance to thinking about and applying a human rights approach and supported decision-making when implementing the Act..

The Ministry has revised the guidance to lasix 40mg tablet pricelasix order the Mental buy lasix online without a prescription Health (Compulsory Assessment and Treatment) Act 1992 (the Act), outlining the rights of compulsory mental health consumers and the obligations of mental health clinicians. This guidance is intended to promote the protection of compulsory mental health consumers’ rights by clarifying the responsibilities of mental health services and clinicians and offering guidance on how sections of the Act can be administered. A number of key changes and emerging issues have been signalled in the revision of these Guidelines. In particular lasix 40mg tablet pricelasix order http://atspittsburghsecurity.com/contact-pittsburgh-security/.

the growing influence of rights-based approaches and how these can be better promoted within the parameters of the current Mental Health Act. The need to give greater emphasis to our obligations under Te Tiriti o Waitangi the impact of He Ara Oranga and, in particular, the feedback from people with lived experience and families and whānau on how they experience the current administration of the Mental Health Act. Please also read the companion document to these guidelines, Human Rights and the Mental Health (Compulsory Assessment and Treatment) Act 1992, which offers guidance to thinking about and applying a human rights approach and supported decision-making when implementing the Act..