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This author has http://www.1eren.dk/buy-kamagra-london/ published on various medical topics and is obviously on several lists as a potential reviewer how can i buy kamagra for papers on subjects of which he has only slight detailed knowledge. There appears to be no definition of, or qualifications for, a peer reviewer other than that he or she is, rightly or wrongly, perceived to be an expert in a particular field.About a million research papers are published each year and researchers are pressurised to publish because grants, enhanced reputations and rewards may follow (perhaps including a Nobel prize). Peer review is one way for how can i buy kamagra reputable journals to promote good science. But there are numerous problems as outlined by Richard Smith, a previous editor of the British Medical Journal.1Peer reviewers are usually busy people and often provide their opinions without charge. Journal editors, unless they reject submission independently, must choose and trust that reviewers are up to date especially concerning potentially important recent developments.For the purposes of this account, a differentiation is made between research studies and research trials.

Studies are solely observational and replications are unusual because surrounding circumstances often change with the passage of how can i buy kamagra time. In contrast, trials are interventional. Trials should how can i buy kamagra address predefined specific questions and the methods used should contain sufficient information to allow exact replication. Replication of trials is problematic because of the expenses involved and details of the exact methods used in the original trial may not be comprehensive. Double-blind randomised placebo-controlled research trials are said to be gold standard, but comparative trials are more important.

The former how can i buy kamagra only suggests that treatments given were more effective than placebo. Reviewers need to know is whether treatments are better than a known effective treatment.Traditionally studies and trials comprise titles, abstracts, introduction, methods, results, discussion, conclusions and references.Reviewers should ensure that …AbstractAt the beginning of 2020, the outbreak of erectile dysfunction treatment in China has brought great impact on the society, economy and life. This article introduces current status of Chinese postgraduate medical students under this epidemic situation in combination with the author's own how can i buy kamagra experience from four aspects. Professional spirit, professional knowledge, learning status and protective measures.IntroductionA novel erectile dysfunction has been discovered and confirmed since the first case of unidentified pneumonia was confirmed in Wuhan, China, in December 2019.1 2 The disease caused by this novel kamagra was officially named erectile dysfunction treatment by the WHO on 12 January 2020. Since the outbreak in China, the numbers of confirmed cases and deaths have rapidly increased.

erectile dysfunction treatment has been clarified as a grade B infectious disease, others of which include severe acute respiratory syndrome and highly pathogenic avian influenza, and is treated according to the protocol for grade A infectious how can i buy kamagra diseases. erectile dysfunction treatment is the seventh known erectile dysfunction-induced disease that involves of the respiratory system in human beings. The other how can i buy kamagra two potentially life-threatening erectile dysfunction-induced diseases are severe acute respiratory syndrome and Middle East respiratory syndrome.3 4 This novel erectile dysfunction-induced pneumonia is transmitted from person to person and is highly infectious, with high susceptibility among the general population. The erectile dysfunction responsible for erectile dysfunction treatment has a long incubation period and diverse clinical features, seriously impacting normal work and life throughout the country. As of 13 April 2020, erectile dysfunction treatment had been recognised in over 200 countries, with a total of 1 784 364 laboratory-confirmed cases and 111 832 deaths, and these numbers have since continued to rise.On 23 January 2020, the Chinese government immediately blocked the city of Wuhan and cut off all outside contact to stop the spread of erectile dysfunction treatment.

Other cities successively announced closure of public places and restricted the flow how can i buy kamagra of people. At the time of this writing, the Chinese Ministry of Education had stated that no student was allowed to return to school until further notification. Some postgraduate medical students residing at school how can i buy kamagra were isolated in safe places. Some others who had returned home for holiday were restricted to their local residence and prohibited to return to the hospital or medical school for studies or clinical work. We herein describe the status and situation of postgraduate medical students in China under the influence of erectile dysfunction treatment.Encouragement and promotion of the professional spirit of postgraduate medical studentsAt the frontline of the fight against erectile dysfunction treatment, many medical staff members around the country have devoted their full power without hesitation while ignoring their own personal safety.

Their teachers, colleagues and friends how can i buy kamagra have also participated in this battle. Such behaviour demonstrates the humanitarian nature of medicine, which involves healing the wounded and rescuing the dying. This vivid lesson helps medical students to internalise medical ethical how can i buy kamagra principles through emotional penetration and thus deepens their understanding and strengthens their beliefs. It benefits society to cultivate a spirit of benevolence among medical students and to train postgraduate medical students to engage in positive behaviour. In recent years, the position of the medical humanities in medical education has gradually improved.

The combination of medical humanities and medical knowledge is regarded as a successful medical education, which manifests how can i buy kamagra scientific and human brilliance. Such education could help medical students to realise the transformation from medical ethical cognition to medical ethical behaviour in their future career.Use of professional knowledge to assist othersMedical students can help their relatives and friends to recognise the symptoms of pneumonia early according to their professional knowledge. The diagnosis how can i buy kamagra of erectile dysfunction treatment is based on a combination of epidemiological information, clinical symptoms, CT imaging findings and laboratory tests according to the standards of either the WHO or the National Health Commission of China. Although medical students were not in the hospital and had no access to CT or test kits, they generally have a higher level of professional judgement than people in the general population with respect to medical knowledge and patients’ symptoms. For example, if a person within a medical student’s neighbourhood develops a fever and cough and has a travel history from Wuhan, the student can advise him or her to go to the hospital in a timely manner.

Postgraduate medical students can also educate the people around them, which helps the public how can i buy kamagra to realise the importance of prevention and comply with regulations formulated by the country. Medical students can also serve as volunteers within the community and use their professional knowledge to make more contributions to community residents.Non-stop learning despite suspension of classesThe sudden outbreak of this novel erectile dysfunction disrupted normal teaching and studying in the field of medical education. Non-stop learning via online teaching despite suspension how can i buy kamagra of classes was put forward by the ministry of education. During the disease outbreak, online lectures and learning tutorials were adopted to avoid unnecessary aggregation of people and the associated risk of .5 Basic medical courses such as physiology, pathology and biology are relatively easy to study by video or electronic books. However, clinical medicine courses such as surgery are not suitable for online study.

Because medicine is a practical science, it cannot break away from clinics and patients, and even how can i buy kamagra simulation training cannot achieve a real-world effect. Many universities lack the ability to use the computers or software required to conduct online teaching courses, record teaching videos and prepare teaching documents such as text, picture, audio and animation. Students living in rural areas with underdeveloped networks and poor hardware facilities may find it difficult to meet the requirements of online learning. During this special period in China, self-study has become an important skill for medical how can i buy kamagra students. Students of different majors have different learning styles.

Dermatology students can review photographs of lesions to improve their skills how can i buy kamagra in differential diagnosis. Internal medicine students can analyse complex cases to exercise their logical ability. Surgery students can learn more about internal medicine to become more comprehensive surgeons. Additionally, online learning allows students to how can i buy kamagra restart long-forgotten projects, modify research papers and complete unfinished work. They can also review the literature in a field of interest, create an outline of future research and contemplate their career plan.

All doctors in China are willing to apply for assistance from the National Natural Science Foundation of China, a famous and widely used research fund how can i buy kamagra. Online application usually starts in March every year, but in 2020, it was postponed until April because of the epidemic. This gave medical students more time to carefully prepare for their application under the guidance of a mentor.Effective measures to ensure the health of medical studentsAlthough the medical resources of the whole country are devoted to treatment of all patients infected with the novel erectile dysfunction, the schools and government still make special efforts to protect the health of students. Peking Union Medical College has developed an online system called SARISenor, which is used by medical students to report how can i buy kamagra the body temperature and physical condition every day. This system also has a locating function based on the global positioning system, which is convenient for localised management.

Our medical school also developed a course to increase knowledge of erectile dysfunction treatment, and all students are required to study this course online how can i buy kamagra. A test is administered after completion of the course, and students must complete the test to obtain a certificate and show the certificate to the school. This compulsory measure improves students’ awareness of the novel erectile dysfunction and strengthens their ability to prevent erectile dysfunction treatment. With respect to psychological health, medical students are easily affected by disease-associated fear and pressure, and schools should be prepared to provide psychological services to how can i buy kamagra those who need them.6 Students can also consult psychologists from university-affiliated hospitals who are online 24 hours a day. The Chinese government provides students with a wide coverage of kamagra protection education that has shown good results to date.

The government also provides corresponding psychological how can i buy kamagra counselling services. Specifically, China has1 stopped centralised classroom teaching,2 carried out antiepidemic knowledge training,3 encouraged the wearing of masks and4 paid attention to hand hygiene. These measures are worthy of implementation in foreign countries as well. Conversely, European countries have encouraged medical students to graduate early so that they may work to help fight erectile dysfunction treatment, which is worthy of implementation in China.We cannot neglect the adverse effects of erectile dysfunction treatment on how can i buy kamagra Chinese scientific research. Fundamental experiments, scientific conferences, funding applications and other activities have been postponed or suspended because of the kamagra situation, which has caused a huge loss in scientific research in China.

Specifically, pharmaceutical companies are lacking essential drugs because how can i buy kamagra of shutdowns. Scientific researchers are out of work because of the closures of laboratories. And students are unable to attain their academic degrees because of the suspension of research. However, the damage to science is insignificant compared with the level of human how can i buy kamagra suffering. Notably, 5G wireless communication technology, artificial intelligence and cloud computing have played effective roles in prevention and monitoring during this epidemic emergency.

Additionally, because of the lack of specific drugs how can i buy kamagra and treatments, traditional Chinese medicine has been adopted as a part of clinical therapy.Thanks to the leadership of the government and the efforts of many medical workers, the effect of erectile dysfunction treatment control in China has been remarkable. The Chinese Ministry of Education recently announced that senior medical students can return to universities in advance if circumstances permit. Doctors and postgraduate medical students are also glad to return to their clinical work and make their own contributions to the health of the people. With increased knowledge of the viral features, epidemiological characteristics, clinical symptoms and antikamagra theory, efficient strategies have been taken to prevent, control and stop the spread of how can i buy kamagra erectile dysfunction treatment. During the current erectile dysfunction treatment kamagra, which is a worldwide war, everyone is a fighter.

Under the close unity of all countries worldwide and with active participation of the world population, we believe that the prevention and control of erectile dysfunction treatment will be finally achieved.AcknowledgmentsWe thank the leaders and teachers from PUMC&CAMS for their help in processing this article..

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Latest Asthma how can i buy kamagra News WEDNESDAY, http://ssbsoftware.com/cialis-20mg-price-in-usa/ Sept. 23, 2020 (HealthDay News) -- Perrigo inhalers have been recalled because they could clog and not provide patients with any or enough medication, the U.S. Food and Drug Administration says.The retail recall how can i buy kamagra is for all unexpired albuterol sulfate inhalation aerosol made by Catalent Pharma Solutions for Perrigo Pharmaceutical Company. The inhalers are used to treat asthma and other airway/lung conditions, such as chronic obstructive pulmonary disease.Patients should continue to use the Perrigo inhaler they have, as needed and as directed by a doctor, the FDA said.Some of the recalled inhalers stop working after several uses. If their rescue albuterol inhaler malfunctions and doesn't relieve symptoms in an emergency situation, patients how can i buy kamagra should immediately seek emergency care if needed, the FDA advised.It recommended that patients have extra inhalers or an alternative treatment available in case of inhaler malfunction.For more information, patients should talk with their health care provider or pharmacist, the FDA said.Copyright © 2019 HealthDay.

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This didn’t kamagra polo chewable tablets really make sense to me, and then I read this. In the developing countries, they used antipsychotic drugs acutely, but not chronically. Only 16 percent of patients in the developing countries were regularly maintained on antipsychotics, whereas in the developed countries this was the standard of care. That didn’t fit with my understanding that these drugs were an essential treatment kamagra polo chewable tablets for schizophrenia patients.

Second, a study by Harvard researchers found that schizophrenia outcomes had declined in the previous 20 years, and were now no better than they had been in the first third of the 20th century. That didn’t fit with my understanding that psychiatry had made great progress in treating people so diagnosed. Those studies led to my questioning the story that our society told about kamagra polo chewable tablets those we call “mad,” and I got a book contract to dig into that question. That project turned into Mad in America, which told of the history of our society’s treatment of the seriously mentally ill, from colonial times until today—a history marked by bad science and societal mistreatment of those so diagnosed.

Horgan. Do you still see yourself as a journalist, or are you primarily an kamagra polo chewable tablets activist?. Whitaker. I don’t see myself as an “activist” at all.

In my kamagra polo chewable tablets own writings, and in the webzine I direct, Mad in America, I think you’ll see journalistic practices at work, albeit in the service of an “activist” mission. Here is our mission statement. €œMad in America’s mission is to serve as a catalyst for rethinking psychiatric care in the United States (and abroad). We believe that the current drug-based paradigm of care has failed our society, kamagra polo chewable tablets and that scientific research, as well as the lived experience of those who have been diagnosed with a psychiatric disorder, calls for profound change.” Thus, our starting point is that “change” is needed, and while that does have an activist element, I think journalism—serving as an informational source—is fundamental to that effort.

As an organization, we are not asserting that we have the answers for what that change should be, which would be the case if we were striving to be activists. Instead, we strive to be a forum for promoting an informed societal discussion about this subject. Here’s what kamagra polo chewable tablets we do. We publish daily summaries of scientific research with findings that are rarely covered in the mainstream media.

You’ll find, in the archives of our research reports, a steady parade of findings that counter the conventional narrative. For instance, there are reports of how kamagra polo chewable tablets the effort to find genes for mental disorders has proven rather fruitless, or of how social inequalities trigger mental distress, or of poor long-term outcomes with our current paradigm of care. And so forth—we simply want these scientific findings to become known.
We regularly feature interviews with researchers and activists, and podcasts that explore these issues. We launched MIA Reports as a showcase for our print journalism.

We have published in-depth articles on promising kamagra polo chewable tablets new initiatives in Europe. Investigative pieces on such topics as compulsory outpatient treatment. Coverage of “news” related to mental health policy in the United States. And occasional reports on how the mainstream media is kamagra polo chewable tablets covering mental health issues.

€¨We also publish blogs by professionals, academics, people with lived experience, and others with a particular interest in this subject. These blogs and personal stories are meant to help inform society’s “rethinking” of psychiatric care. All of these efforts, I think, fit within the framework of “journalism.” However, I do understand that I am going beyond the boundaries of usual “science journalism” when I publish critiques of the “evidence base” related kamagra polo chewable tablets to psychiatric drugs. I did this in my books Mad in America and Anatomy of an Epidemic, as well as a book I co-wrote, Psychiatry Under the Influence.

I have continued to do this with MIA Reports. The usual practice in “science journalism” is to look to the “experts” in kamagra polo chewable tablets the field and report on what they tell about their findings and practices. However, while reporting and writing Mad in America, I came to understand that when “experts” in psychiatry spoke to journalists they regularly hewed to a story that they were expected to tell, which was a story of how their field was making great progress in understanding the biology of disorders and of drug treatments that—as I was told over and over when I co-wrote the series for the Boston Globe—fixed chemical imbalances in the brain. But their own science, I discovered, regularly belied the story they were telling to the media.

That’s why I turned to focusing on the story that could be dug kamagra polo chewable tablets out from a critical look at their own scientific literature. So what I do in these critiques—such as suicide in the Prozac era and the impact of antipsychotics on mortality—is review the relevant research and put those findings together into a coherent report. I also look at research cited in support of mainstream beliefs and see if the data, in those articles, actually supports the conclusions presented in the abstract. None of this is really that difficult, kamagra polo chewable tablets and yet I know it is unusual for a journalist to challenge conventional “medical wisdom” in this way.

Horgan. Anatomy of an Epidemic argues that medications for mental illness, although they give many people short-term reliefs, cause net harm. Is that a fair summary? kamagra polo chewable tablets. Whitaker.

Yes, although my thinking has evolved somewhat since I wrote that book. I am more convinced than ever that kamagra polo chewable tablets psychiatric medications, over the long term, cause net harm. I wish that weren’t the case, but the evidence just keeps mounting that these drugs, on the whole, worsen long-term outcomes. However, my thinking has evolved in this way.

I am not so kamagra polo chewable tablets sure any more that the medications provide a short-term benefit for patient populations as a whole. When you look at the short-term studies of antidepressants and antipsychotics, the evidence of efficacy in reducing symptoms compared to placebo is really pretty marginal, and fails to rise to the level of a “clinically meaningful” benefit. Furthermore, the problem with all of this research is that there is no real placebo group in the studies. The placebo group is composed kamagra polo chewable tablets of patients who have been withdrawn from their psychiatric medications and then randomized to placebo.

Thus, the placebo group is a drug-withdrawal group, and we know that withdrawal from psychiatric drugs can stir myriad negative effects. A medication-naïve placebo group would likely have much better outcomes, and if that were so, how would that placebo response compare to the drug response?. In short, research on the short-term effects of psychiatric kamagra polo chewable tablets drugs is a scientific mess. In fact, a 2017 paper that was designed to defend the long-term use of antipsychotics nevertheless acknowledged, in an off-hand way, that “no placebo-controlled trials have been reported in first-episode psychosis patients.” Antipsychotics were introduced 65 years ago, and we still don’t have good evidence that they work over the short term in first episode patients.

Which is rather startling, when you think of it. Horgan. Have any of your critics—E. Fuller Torrey, for example—made you rethink your thesis?.

Whitaker. When the first edition of Anatomy of an Epidemic was published (2010), I knew there would be critics, and I thought, this will be great. This is just what is needed, a societal discussion about the long-term effects of psychiatric medications. I have to confess that I have been disappointed in the criticism.

They mostly have been ad hominem attacks—I cherry-picked the data, or I misunderstood findings, or I am just biased, but the critics don’t then say what data I missed, or point to findings that tell of medications that improve long-term outcomes. I honestly think I could do a much better job of critiquing my own work. You mention E. Fuller Torrey’s criticism, in which he states that I both misrepresented and misunderstood some of the research I cited.

I took this seriously, and answered it at great length. Now if your own “thesis” is indeed flawed, then a critic should be able to point out its flaws while accurately detailing what you wrote. If that is the case, then you have good reason to rethink your beliefs. But if a critique doesn’t meet that standard, but rather relies on misrepresenting what you wrote, then you have reason to conclude that the critic lacks the evidence to make an honest case.

And that is how I see Torrey’s critique. For example, Torrey said that I misunderstood Martin Harrow’s research on long-term outcomes for schizophrenia patients. Harrow reported that the recovery rate was eight times higher for those who got off antipsychotic medication compared to those who stayed on the drugs. However, in his 2007 paper, Harrow stated that the better outcomes for those who got off medication was because they had a better prognosis and not because of negative drug effects.

If you read Anatomy of an Epidemic, you’ll see that I present his explanation. Yet, in my interview with Harrow, I noted that his own data showed that those who were diagnosed with milder psychotic disorders who stayed on antipsychotics fared worse over the long term than schizophrenia patients who stopped taking the medication. This was a comparison that showed the less ill maintained on antipsychotics doing worse than the more severely ill who got off these medications. And I presented that comparison in Anatomy of an Epidemic.

By doing that, I was going out on a limb. I was saying that maybe Harrow’s data led to a different conclusion than he had drawn, which was that the antipsychotic medication, over the long-term, had a negative effect. After Anatomy was published, Harrow and his colleague Thomas Jobe went back to their data and investigated this very possibility. They have subsequently written several papers exploring this theme, citing me in one or two instances for raising the issue, and they found reason to conclude that it might be so.

They wrote. €œHow unique among medical treatments is it that the apparent efficacy of antipsychotics could diminish over time or become harmful?. There are many examples for other medications of similar long-term effects, with this often occurring as the body readjusts, biologically, to the medications.” Thus, in this instance, I did the following. I accurately reported the results of Harrow’s study and his interpretation of his results, and I accurately presented data from his research that told of a possible different interpretation.

The authors then revisited their own data to take up this inquiry. And yet Torrey’s critique is that I misrepresented Harrow’s research. This same criticism, by the way, is still being flung at me. Here is a recent article in Vice which, once again, quotes people saying I misrepresent and misunderstand research, with Harrow cited as an example.

I do want to emphasize that critiques of “my thesis” regarding the long-term effects of psychiatric drugs are important and to be welcomed. See two papers in particular that take this on (here and here), and my response in general to such criticisms, and to the second one. Horgan. When I criticize psychiatric drugs, people sometimes tell me that meds saved their lives.

You must get this reaction a lot. How do you respond?. Whitaker. I do hear that, and when I do, I reply, “Great!.

I am so glad to know that the medications have worked for you!. € But of course I also hear from many people who say that the drugs ruined their lives. I do think that the individual’s experience of psychiatric medication, whether good or bad, should be honored as worthy and “valid.” They are witnesses to their own lives, and we should incorporate those voices into our societal thinking about the merits of psychiatric drugs. However, for the longest time, we’ve heard mostly about the “good” outcomes in the mainstream media, while those with “bad” outcomes were resigned to telling their stories on internet forums.

What Mad in America has sought to do, in its efforts to serve as a forum for rethinking psychiatry, is provide an outlet for this latter group, so their voices can be heard too. The personal accounts, of course, do not change the bottom-line “evidence” that shows up in outcome studies of larger groups of patients. Unfortunately, that tells of medications that, on the whole, do more harm than good. As a case in point, in regard to this “saving lives” theme, this benefit does not show up in public health data.

The “standard mortality rate” for those with serious mental disorders, compared to the general public, has notably increased in the last 40 years. Horgan. Do you see any promising trends in psychiatry?. Whitaker.

Yes, definitely. You have the spread of Hearing Voices networks, which are composed of people who hear voices and offer support for learning to live with voices as opposed to squashing them, which is what the drugs are supposed to do. These networks are up and running in the U.S., and in many countries worldwide. You have Open Dialogue approaches, which were pioneered in northern Finland and proved successful there, being adopted in the United States and many European countries (and beyond.) This practice puts much less emphasis on treatment with antipsychotics, and much greater emphasis on helping people re-integrate into family and community.

You have many alternative programs springing up, even at the governmental level. Norway, for instance, ordered its hospital districts to offer “medication free” treatment for those who want it, and there is now a private hospital in Norway that is devoted to helping chronic patients taper down from their psychiatric medications. In Israel, you have Soteria houses that have sprung up (sometimes they are called stabilizing houses), where use of antipsychotics is optional, and the environment—a supportive residential environment—is seen as the principal “therapy.” You have the U.N. Special Rapporteur for Health, Dainius Pūras, calling for a “revolution” in mental health, one that would supplant today’s biological paradigm of care with a paradigm that paid more attention to social justice factors—poverty, inequality, etc.—as a source of mental distress.

All of those initiatives tell of an effort to find a new way. But perhaps most important, in terms of “positive trends,” the narrative that was told to us starting in the 1980s has collapsed, which is what presents the opportunity for a new paradigm to take hold. More and more research tells of how the conventional narrative, in all its particulars, has failed to pan out. The diagnoses in the Diagnostic and Statistical Manual (DSM) have not been validated as discrete illnesses.

The genetics of mental disorders remain in doubt. MRI scans have not proven to be useful. Long-term outcomes are poor. And the notion that psychiatric drugs fix chemical imbalances has been abandoned.

Ronald Pies, the former editor in chief of Psychiatric Times, has even sought to distance psychiatry, as an institution, from ever having made such a claim. Horgan. Do brain implants or other electrostimulation devices show any therapeutic potential?. Whitaker.

I don’t have a ready answer for this. We have published two articles about the spinning of results from a trial of deep-brain stimulation, and the suffering of some patients so treated over the long-term. Those articles tell of why it may be difficult to answer that question. There are financial influences that push for published results that tell of a therapeutic success, even if the data doesn’t support that finding, and we have a research environment that fails to study long-term outcomes.

The history of somatic treatments for mental disorders also provides a reason for caution. It’s a history of one somatic treatment after another being initially hailed as curative, or extremely helpful, and then failing the test of time. The inventor of frontal lobotomy, Egas Moniz, was awarded a Nobel Prize for inventing that surgery, which today we understand as a mutilation. It’s important to remain open to the possibility that somatic treatments may be helpful, at least for some patients.

But there is plenty of reason to be wary of initial claims of success. Horgan. Should psychedelic drugs be taken seriously as treatments?. Whitaker.

I think caution applies here too. Surely there are many risks with psychedelic drugs, and if you were to do a study of first-episode psychosis today, you would find a high percentage of the patients had been using mind-altering drugs before their psychotic break—antidepressants, marijuana, LSD and so forth. At the same time, we’ve published reviews of papers that have reported positive results with use of psychedelics. What are the benefits versus the risks?.

Can possible benefits be realized while risks are minimized?. It is a question worth exploring, but carefully so. Horgan. What about meditation?.

Whitaker. I know that many people find meditation helpful. I also know other people find it difficult—and even threatening—to sit with the silence of their minds. Mad in America has published reviews of research about meditation, we have had a few bloggers write about it, and in our resource section on “non-drug therapies,” we have summarized research findings regarding its use for depression.

We concluded that the research on this is not as robust as one would like. However, I think your question leads to this broader thought. People struggling with their minds and emotions may come up with many different approaches they find helpful. Exercise, diet, meditation, yoga and so forth all represent efforts to change one’s environment, and ultimately, I think that can be very helpful.

But the individual has to find his or her way to whatever environmental change that works best for them. Horgan. Do you see any progress toward understanding the causes of mental illness?. Whitaker.

Yes, and that progress might be summed up in this way. Researchers are returning to investigations of how we are impacted by what has “happened to us.” The Adverse Childhood Experiences study provides compelling evidence of how traumas in childhood—divorce, poverty, abuse, bullying and so forth—exact a long-term toll on physical and mental health. Interview any group of women diagnosed with a serious mental disorder, and you’ll regularly find accounts of sexual abuse. Racism exacts a toll.

So too poverty, oppressive working conditions, and so forth. You can go on and on, but all of this is a reminder that we humans are designed to respond to our environment, and it is quite clear that mental distress, in large part, arises from difficult environments and threatening experiences, past and present. And with a focus on life experiences as a source of “mental illness,” a related question is now being asked. What do we all need to be mentally well?.

Shelter, good food, meaning in life, someone to love and so forth—if you look at it from this perspective, you can see why, when those supporting elements begin to disappear, psychiatric difficulties appear. I am not discounting that there may be biological factors that cause “mental illness.” While biological markers that tell of a particular disorder have not been discovered, we are biological creatures, and we do know, for instance, that there are physical illnesses and toxins that can produce psychotic episodes. However, the progress that is being made at the moment is a moving away from the robotic “it’s all about brain chemistry” toward a rediscovery of the importance of our social lives and our experiences. Horgan.

Do we still have anything to learn from Sigmund Freud?. Whitaker. I certainly think so. Freud is a reminder that so much of our mind is hidden from us and that what spills into our consciousness comes from a blend of the many parts of our mind, our emotional centers and our more primal instincts.

You can still see merit in Freud’s descriptions of the id, ego and superego as a conceptualization of different parts of the brain. I read Freud when I was in college, and it was a formative experience for me. Horgan. I fear that American-style capitalism doesn’t produce good health care, including mental-health care.

What do you think?. Whitaker. It’s clear that it doesn’t. First, we have for-profit health-care that is set up to treat “disease.” With mental-health care, that means there is a profit to be made from seeing people as “diseased” and treating them for that “illness.” Take a pill!.

In other words, American-style capitalism, which works to create markets for products, provides an incentive to create mental patients, and it has done this to great success over the past 35 years. Second, without a profit to be made, you don’t have as much investment in psychosocial care that can help a person remake his or her life. There is a societal expense, but little corporate profit, in psychosocial care, and American-style capitalism doesn’t lend itself to that equation. Third, with our American-style capitalism (think neoliberalism), it is the individual that is seen as “ill” and needs to be fixed.

Society gets a free pass. This too is a barrier to good “mental health” care, for it prevents us from thinking about what changes we might make to our society that would be more nurturing for us all. With our American-style capitalism, we now have a grossly unequal society, with more and more wealth going to the select few, and more and more people struggling to pay their bills. That is a prescription for psychiatric distress.

Good “mental health care” starts with creating a society that is more equal and just. Horgan. How might the erectile dysfunction treatment kamagra affect care of the mentally ill?. Whitaker.

That is something Mad in America has reported on. The kamagra, of course, can be particularly threatening to people in mental hospitals, or in group homes. The threat is more than just the exposure to the kamagra that may come in such settings. People who are struggling in this way often feel terribly isolated, alone, and fearful of being with others.

erectile dysfunction treatment measures, with calls for social distancing, can exacerbate that. I think this puts hospital staff and those who run residential homes into an extraordinarily difficult position—how can they help ease the isolation of patients even as they are being expected to enforce a type of social distancing?. Horgan. If the next president named you mental health czar, what would be at the top of your To Do list?.

Whitaker. Well, I am pretty sure that’s not going to happen, and if it did, I would quickly confess to my being utterly unqualified for the job. But from my perch at Mad in America, here is what I would like to see happen in our society. As you can see from my answers above, I think the fundamental problem is that our society has organized itself around a false narrative, which was sold to us as a narrative of science.

In the early 1980s, we began to hear that psychiatric disorders were discrete brain illnesses, which were caused by chemical imbalances in the brain, and that a new generation of psychiatric drugs fixed those imbalances, like insulin for diabetes. That is a story of an amazing medical breakthrough. Researchers had discovered the very chemicals in our brain that cause madness, depression, anxiety or ADHD, and they had developed drugs that could put brain chemistry back into a normal state. Given the complexity of the human brain, if this were true, it would arguably be the greatest achievement in medical history.

And we understood it to be true. We came to believe that there was a sharp line between the “normal” brain and the “abnormal” brain, and that it was medically helpful to screen for these illnesses, and that psychiatric drugs were very safe and effective, and often needed to be taken for life. But what can be seen clearly today is that this narrative was a marketing story, not a scientific one. It was a story that psychiatry, as an institution, promoted for guild purposes, and it was a story that pharmaceutical companies promoted for commercial reasons.

Science actually tells a very different story. The biology of psychiatric disorders remains unknown. The disorders in the DSM have not been validated as discrete illnesses. The drugs do not fix chemical imbalances but rather perturb normal neurotransmitter functions.

And even their short term efficacy is marginal at best. As could be expected, organizing our thinking around a false narrative has been a societal disaster. A sharp rise in the burden of mental illness in our society. Poor long-term functional outcomes for those who are continuously medicated.

The pathologizing of childhood. And so on. What we need now is a new narrative to organize ourselves around, one steeped in history, literature, philosophy, and good science. I think step one is ditching the DSM.

That book presents the most impoverished “philosophy of being” imaginable. Anyone who is too emotional, or struggles with his or her mind, or just doesn’t like being in a boring environment (think ADHD) is a candidate for a diagnosis. We need a narrative that, if truth be told, can be found in literature. Novels, Shakespeare, the Bible—they all tell of how we humans struggle with our minds, our emotions and our behaviors.

That is the norm. It is the human condition. And yet the characters we see in literature, if they were viewed through the DSM lens, would regularly qualify for a diagnosis. At the same time, literature tells of how humans can be so resilient, and that we change as we age and move through different environments.

We need that to be part of a new narrative too. Our current disease-model narrative tells of how people are likely going to be chronically ill. Their brains are defective, and so the therapeutic goal is to manage the symptoms of the “disease.” We need a narrative that replaces that pessimism with hope. If we embraced that literary understanding of what it is to be human, then a “mental health” policy could be forged that would begin with this question.

How do we create environments that are more nurturing for us all?. How do we create schools that build on a child’s curiosity?. How do we bring nature back into our lives?. How do we create a society that helps provide people with meaning, a sense of community, and a sense of civic duty?.

How do we create a society that promotes good physical health, and provides access to shelter and medical care?. Furthermore, with this conception in mind, individual therapy would help people change their environments. You could encourage walks in nature. Recommend volunteer work.

Provide settings where people could go and recuperate, and so forth. Most important, in contrast to a “disease-based” paradigm of care, a “wellness-based” paradigm would help people feel hopeful, and help them find a way to create a different future for themselves. This is an approach, by the way, that can be helpful to people who have suffered a psychotic episode. Soteria homes and Open Dialogue are “therapies” that strive to help psychotic patients in this manner.

Within this “wellness” paradigm of care, there would still be a place for use of medications that help people feel differently, at least for a time. Sedatives, tranquilizers, and so forth. And you would still want to fund science that seeks to better understand the many pathways to debilitating mood states and to “psychosis”—trauma, poor physical health, physical disease, lack of sleep, setbacks in life, isolation, loneliness, and yes, whatever biological vulnerabilities that may be present. At the same time, you would want to fund science that seeks to better understand the pillars of “wellness.” Horgan.

What’s your utopia?. Whitaker. My “utopia” would be a world like the one I just described, based on a new narrative about mental illness, rooted in an understanding of how emotional we humans are, of how we struggle with our minds, and of how we are built to be responsive to our environments. And that really is the mission of Mad in America.

We want it to be a forum for creating a new societal narrative for “mental health.” Further Reading. Can Psychiatry Heal Itself?. Are Psychiatric Medications Making Us Sicker?. Meta-Post.

Posts on Mental Illness Meta-Post. Posts on Brain Implants Meta-Post. Posts on Psychedelics Meta-Post. Posts on Buddhism and Meditation See also “The Meaning of Madness,” a chapter in my free online book Mind-Body Problems.1970 Sweet Suburbia “Massive movement from central cities to their suburbs, a population boom in the West and Southwest, and a lower rate of population growth in the 1960's than in the 1950's are the findings that stand out in the preliminary results of the 1970 Census as issued by the U.S.

Bureau of the Census. The movement to the suburbs was pervasive. Its extent is indicated by the fact that 13 of the 25 largest cities lost population, whereas 24 of the 25 largest metropolitan areas gained. Washington, D.C., was characteristic.

The population of the city changed little between 1960 and 1970, but the metropolitan area grew by 800,000, or more than 38 percent.” 1920 Air Cargo “The proposed machine, known as the ‘Pelican Four-Ton Lorry,' is a colossal cantilever monoplane designed for two 460-horse-power Napier engines. Its cruising speed is 72 miles per hour. Its total weight is to be 24,100 pounds. The useful load is four tons, with sufficient fuel for the London-Paris journey.

Most interesting of all, however, is the novel system of quick loading and unloading which has been planned. This permits handling of shipments with the utmost speed, and is based on a similar practice in the motor truck field. Idle airplanes mean a large idle capital, hence the designers plan to keep the airplane in the air for the greater part of the time.” Don't Try This Anywhere “Dr. Charles Baskerville points out that while the data thus far obtained on chlorine and influenza do not warrant drawing conclusions, such facts as have been established would indicate to the medical man the advisability of trying experimentally dilute chlorinated air as a prophylactic in such epidemics as so-called influenza.

Dr. Baskerville determined to what extent workers in plants where small amounts of chlorine were to be found in the atmosphere were affected seriously by influenza. Many of those from whom information was requested expressed the opinion that chlorine workers are noticeably free from colds and other pneumatic diseases.” 1870 The Rise of Telegraphy “The rapid progress of the telegraph during the last twenty-five years has changed the whole social and commercial systems of the world. Its advantages and capabilities were so evident that immediately on its introduction, and demonstration of its true character, the most active efforts were made to secure them for every community which desired to keep pace with the advances of modern times.

The Morse or signal system seemed for a time to be the perfection of achievement, until Professor Royal E. House astonished the world with his letter printing telegraph. Now, almost every considerable expanse of water is traversed, or soon will be, by the slender cords which bind continents and islands together and practically bring the human race into one great family.” The Transport of Goods 1887. Cargo ship launched as Golconda had room for 6,000 tons of cargo, loaded and unloaded by crane and cargo nets, and 108 passengers.

Credit. Scientific American Supplement, Vol. XXIII, No. 574.

January 1, 1887 Oxcarts, railroad cars and freight ships can be loaded and unloaded one item at a time, but it is more efficient to handle cargo packed into “intermodal shipping containers” that are a standardized size and shape. Our October 1968 issue noted that a “break-bulk” freighter took three days to unload, a container ship less than one (including loading new cargo). Air transport became a link in this complex system, but the concept in the 1920 illustration shown is a little ahead of its time. These days air cargo (and luggage) makes abundant use of “unit load devices,” cargo bins shaped to fit the fuselage of specific aircraft models.The items below are highlights from the free newsletter, “Smart, useful, science stuff about erectile dysfunction treatment.” To receive newsletter issues daily in your inbox, sign-up here.

Are you in need of a “dose of optimism” about the kamagra, at least in the U.S.?. Check out this 10/12/20 story at The New York Times by by Donald McNeil Jr., who has covered infectious diseases and epidemics for many years. McNeil notes the 215,000 people in the U.S. Dead so far from the novel erectile dysfunction, as well as the estimates that the figure could go as high as 400,000 before this era draws to a close.

But here is some of the good news that he tallies. 1) mask-wearing by the public is “widely accepted”. 2) the development of treatments to protect against erectile dysfunction and of treatments for erectile dysfunction treatment are proceeding at record speed. 3) “experts are saying, with genuine confidence, that the kamagra in the United States will be over far sooner than they expected, possibly by the middle of next year”.

And 4) fewer infected people die today than did earlier this year, even at nursing homes. About 10 percent of people in the U.S. Have been infected with the kamagra so far, according to the U.S. Centers for Disease Control, the story states.

€œkamagras don’t end abruptly. They decelerate gradually,” McNeil writes. A 10/14/20 story by Carl Zimmer for The New York Times puts into context three late-stage (Phase 3 safety and effectiveness) erectile dysfunction treatment experiments that have been paused in recent weeks due to illness among some study participants. Pauses in treatment studies — in this case Johnson &.

Johnson’s treatment candidate and AstraZeneca’s treatment candidate — are “not unusual,” the story states, partly because the safety threshold is extremely high for a product that, if approved, could be given to millions or billions of people. But pauses are rare in treatment studies — in this case Eli Lilly’s monoclonal antibody cocktail drug. Once a drug or treatment experiment (trial) is paused, a safety board determines whether the ill participant was given the new product or a placebo. If it was the placebo, the study can resume.

If not, the board looks deeper into the case to determine whether or not the illness is related to the drug or treatment. If a clear connection is discovered, “the trial may have to stop,” Zimmer writes. Dr. Eric Topol at Scripps Research is quoted in the piece as saying he is “still fairly optimistic” about monoclonal antibody treatments for erectile dysfunction treatment.

The safety-related pauses of all three experiments are “an example of how things are supposed to work,” says Dr. Anna Durbin of Johns Hopkins Bloomberg School of Public Health in the story. The top of a story at The Washington Post features an instructive interactive that sketches “Scienceville,” a fictional place where “politicians and public health officials use every tool at their disposal to contain the erectile dysfunction.” It basically shows how genetic analysis and tracing of viral strains found in a frequently and widely tested population could help officials control outbreaks of erectile dysfunction. Then the 10/13/20 text story below, by Brady Dennis, Chris Mooney, Sarah Kaplan, and Harry Stevens, focuses on the details of such a “genomic epidemiology” approach and describes some real-life efforts under way, primarily in the UK, to implement the approach.

The U.S. Has not been able to effectively use the approach, in part because genetic sequencing of viral strains “has largely been left up to states and individual researchers, rather than being part of a coordinated and well-funded national program,” the story states. The rise in erectile dysfunction s in the U.S. Is now driven by “small gatherings in people’s homes,” according to officials with the U.S.

Centers for Disease Control, reports Carolyn Crist for WebMD (10/14/20). People should continue to wear face masks and to practice social distancing “since most people have still not been exposed to the erectile dysfunction worldwide," the researchers suggest, Crist writes. A newly developed test can detect erectile dysfunction in 5 minutes, reports Robert F. Service at Science (10/8/20).

The test relies on CRISPR gene-editing technology, for which Jennifer Doudna of the University of California, Berkeley, and Emmanuelle Charpentier of the Max Planck Unit for the Science of Pathogens won the Nobel Prize in Chemistry earlier this month. Doudna heads up the work that led to this new 5-minute CRISPR test for the erectile dysfunction. By comparison, it can take a day or more to get back standard erectile dysfunction test results, the story states. Donald G.

McNeil Jr. At The New York Times has written a guide to distinguishing common cold, flu, and erectile dysfunction treatment symptoms (10/3/20). A major difference between having a cold and having the flu is that "Flu makes you feel as if you were hit by a truck,” McNeil quotes experts as saying. The symptom that best distinguishes erectile dysfunction treatment from flu is loss of your sense of smell — strong smells don’t register, he writes.

But many flu and erectile dysfunction treatment symptoms overlap, the story states. The most common symptoms for erectile dysfunction treatment are a high fever, chills, dry cough and fatigue. For flu, it’s a fever, headaches, body aches, sore throat, runny nose, stuffed sinuses, coughing and sneezing, the story states. Dr.

Anthony Fauci’s three daughters do not plan to visit him for Thanksgiving to avoid potentially transmitting the new erectile dysfunction to their parents, reports Ralph Ellis at WebMD. The story includes holiday traveling and visiting tips from a pulmonary critical care doctor at the University of Washington Medical Center who “believes traveling for the holidays is risky.” The tips include ensuring you have no erectile dysfunction treatment-like symptoms two weeks before traveling, getting tested before traveling, quarantining in a hotel for at least 48 hours before visiting with loved ones, traveling by car, and cutting down on “close contact and talking without a mask” (10/9/20). Adele Chapin has written a guide for reducing kids’ risk of catching and spreading erectile dysfunction at the playground. The 10/8/20 piece in The Washington Post makes the usual recommendations for mask-wearing, hand-washing, hand-sanitizer, disinfecting wipes, and distancing.

It quotes a Children’s National Hospital pediatrician advises against gloves, because “people wearing them often touch their faces, which defeats the purpose.” The piece also recommends visiting playgrounds at less busy times and choosing playgrounds with more than one play structure, which makes it easier for kids to distance from one another. A story by Carl Zimmer for The New York Times beautifully describes and illustrates some of the amazing imaging work that scientists have done to study the structure of erectile dysfunction and how it infects our cells and multiplies (10/9/20). For starters, check out a mesmerizing video about a quarter of the way down-page that simulates spike proteins (complex molecules) doing a “molecular dance” on the kamagra membrane. The video (just one of several in this stunning piece) is part of research by a computational biophysicist at the Max Planck Institute of Biophysics and colleagues.

The spikes appear to shimmy, which “increases the odds of encountering the protein on the surface of our cells it uses to attach,” the researchers suspect, Zimmer writes. You might enjoy, “A letter of recommendation in the age of Zoom,” by Matt Cheung, for McSweeney’s (10/14/20).Editor’s Note (10/16/20). This story is being republished in light of the interim results of a large international clinical trial of remdesivir by the World Health Organization. The trial found that the drug, which is widely used to treat erectile dysfunction treatment patients, failed to prevent deaths.

An experimental drug—and one of the world’s best hopes against erectile dysfunction treatment—could shorten the time to recovery from erectile dysfunction , according to the largest and most rigorous clinical trial of the compound. The experimental drug, called remdesivir, interferes with replication of some kamagraes, including the erectile dysfunction kamagra responsible for the current kamagra. On 29 April, Anthony Fauci, director of the US National Institute of Allergy and Infectious Disease (NIAID), announced that a clinical trial of more than a thousand people showed that people taking remdesivir recovered in 11 days on average, compared to 15 days for those on a placebo. €œAlthough a 31% improvement doesn’t seem like a knockout 100%, it is a very important proof of concept,” Fauci said.

€œWhat it has proven is that a drug can block this kamagra.” Deaths were also lower in trial participants who received the drug, he said, but that trend was not statistically significant. The shortened recovery time, however, was significant, and was enough of a benefit that investigators decided to stop the trial early for ethical reasons, he said, to ensure that those participants who were receiving placebo could now access the drug. Fauci added that remdesivir would become a standard treatment for erectile dysfunction treatment. The news comes after weeks of data leaks and on a day of mixed results from clinical trials of the drug.

In a trial run by the drug’s maker, Gilead Sciences of Foster City, California, more than half of 400 participants with severe erectile dysfunction treatment recovered from their illness within two weeks of receiving treatment. But the study lacked a placebo controlled arm, making the results difficult to interpret. Another smaller trial run in China found no benefits from remdesivir when compared with a placebo. But the trial was stopped early due to the difficulty in enroling participants as the outbreak subsided in China.

Nevertheless, onlookers are hopeful that the large NIAID trial provides the first glimmer of hope in a race to find a drug that works against the erectile dysfunction, which has infected more than 3 million people worldwide. €œThere is a lot of focus on remdesivir because it’s potentially the best shot we have,” says virologist Stephen Griffin at the University of Leeds in the UK. Small trials The fast-flowing, conflicting information on remdesivir has left people reeling over the past weeks. In the rush to find therapies to combat erectile dysfunction treatment, small, clinical trials without control groups have been common.

€œI’m just very annoyed by all of these non-controlled studies,” says Geoffrey Porges, an analyst for the investment bank SVB Leerink in New York City. €œIt’s reassuring that 50–60% of patients are discharged from the hospital, but this is a disease that mostly gets better anyway.” With so much uncertainty, the remdesivir-watchers were waiting anxiously for final results from the NIAID trial, which were not expected until the end of May. In lieu of a treatment, which could still be more than a year away, effective therapies are critical to reducing deaths and limiting economic damage from the kamagra. Yet, despite the flood of small clinical trials, no therapy has been convincingly shown to boost survival in people with erectile dysfunction treatment.

The NIAID results put a new sheen on remdesivir. €œIt may not be the wonder drug that everyone’s looking for, but if you can stop some patients from becoming critically ill, that’s good enough,” says Griffin. Fauci said the finding reminded him of the discovery in the 1980s that the drug AZT helped to combat HIV . The first randomized, controlled clinical only showed a modest improvement, he said, but researchers continued to build on that success, eventually developing highly effective therapies.

For now, he said, remdesivir would become a standard treatment for erectile dysfunction treatment. Remdesivir works by gumming up an enzyme that some kamagraes, including erectile dysfunction, use to replicate. In February, researchers showed that the drug reduces viral in human cells grown in a laboratory. Gilead began to ramp up production of remdesivir well before the NIAID results.

By the end of March, the company had produced enough to treat 30,000 patients. By streamlining its manufacturing process and finding new sources of raw materials, Gilead announced that it hoped to produce enough remdesivir to treat more than a million people by the end of the year. That calculation was based on the assumption that people would take the drug for 10 days, but the results announced from Gilead’s trial today suggest that a 5-day course of treatment could work just as well. If so, that would effectively double the number of people who could be treated, says Porges.

Many drugs needed In the long term, clinicians will likely want a bevy of anti-viral drugs—with different ways of disabling the kamagra—in their arsenal, says Timothy Sheahan, a virologist at the University of North Carolina in Chapel Hill, who has teamed up with Gilead researchers to study remdesivir. €œThere is always the potential for antiviral resistance,” he says. €œAnd to hedge against that potential, it’s good to have not only a first-line, but also a second-, third-, fourth-, fifth-line antiviral.” Researchers are furiously testing a wide range of therapies, but early results, while not yet definitive, have not been encouraging. The malaria drugs chloroquine and hydroxychloroquine, both of which also have anti-inflammatory effects, drew so much attention from physicians and the public that some countries have depleted their supplies of the drugs.

Yet studies in humans have failed to show a consistent benefit, and some have highlighted the risks posed by side effects of the drugs on the heart. Early interest in a mix of two HIV drugs called lopinavir and ritonavir flagged when a clinical trial in nearly 200 people did not find any benefit of the mix for those with severe erectile dysfunction treatment. Another promising therapeutic hypothesis—that inhibiting the action of an immune system regulator called IL-6 could reduce the severe inflammation seen in some people with severe erectile dysfunction treatment—has met with mixed results thus far. Still, a host of other therapies are being tested in people, and many researchers are hunting for new drugs at the bench.

Sheahan and his colleagues have found a compound that is active against erectile dysfunction and other erectile dysfunctiones, including a remdesivir-resistant variant of a erectile dysfunction, when tested in laboratory-grown human cells. But much more testing would need to be done before the compound could be tried in people. €œWhat we’re doing now will hopefully have an impact on the current kamagra,” he says. €œBut maybe more importantly, it could position us to better respond more quickly in the future.” This article is reproduced with permission and was first published on April 29 2020.

Read more about the erectile dysfunction outbreak here.During a press conference in early September, President Donald Trump was asked when he thought a treatment for erectile dysfunction treatment might become available. His prediction was upbeat. €œWe’re going to have a treatment very soon,” Trump said. €œMaybe even before a very special day—you know what day I’m talking about.” Trump was referring, of course, to the presidential election on November 3.

But the odds of a treatment materializing for public use before then appear slim. New drugs and treatments ordinarily go through a lengthy review process prior to regulatory approval. treatments for erectile dysfunction treatment, however, are widely expected to be released under emergency use authorization (EUA) protocols, which allow for the sale of unapproved medical products during national health crises. On October 6 the White House agreed to new EUA guidelines that call on erectile dysfunction treatment developers to monitor their phase III clinical trial subjects for at least two months for side effects and severe disease.

The U.S. Food and Drug Administration, which administers EUAs, will host a widely anticipated meeting on October 22 to address standards for efficacy, safety and manufacturing of erectile dysfunction treatments. But the FDA’s recommended two-month observation period puts a preelection treatment approval out of reach. EUAs could, however, make the first successful erectile dysfunction treatments available to frontline workers by the start of 2021, although distribution in the general U.S.

Population will take longer, starting with elderly and other high-risk groups and then younger, healthier people who may not have access to them until late in the year, according to Paul Offit, a pediatrician and director of the treatment Education Center at Children’s Hospital of Philadelphia. The FDA has already granted hundreds of erectile dysfunction treatment-related EUAs for products such as diagnostic tests, medical devices and therapies—including for convalescent plasma and hydroxychloroquine (the latter was later revoked). €œAll the erectile dysfunction treatment developers are going for an EUA first,” says Eric Topol, a cardiologist and head of the Scripps Research Translational Institute in La Jolla, Calif., who has directed numerous multinational clinical trials (although none for treatments). €œIt makes no sense to wait for formal licensure.” Defining Success Obtaining an EUA hinges on how independent reviewers judge a treatment’s performance during periodic readouts of phase III clinical trial data.

The trials are each enrolling tens of thousands of people and are also double-blinded—meaning that neither the subjects nor the experimenters know which participants got a treatment versus a placebo. They were designed to continue until the number of symptomatic s reaches 150 in the vaccinated and control groups combined. If a treatment halves the risk of symptomatic s among the vaccinated group, it will meet the FDA’s minimum bar for approval. Reviewers examining the interim data readouts will be looking for better protection than that.

Pfizer, which began a phase III trial for its treatment on July 27, plans to conduct its first readout when the number of symptomatic cases reaches 32. The company expects that could happen this month, making it first in line for a potential EUA. Statistical thresholds are set such that if erectile dysfunction treatment case numbers in the vaccinated group are, at that point, at least five times lower than they are among vaccinated subjects, then reviewers can declare overwhelming efficacy. In that event, the company will “consult with regulatory authorities about next steps,” which could include an EUA, says a Pfizer spokesperson.

Whitaker how can i buy kamagra http://seniorji-upokojenci.si/where-to-buy-levitra-in-singapore/. I don’t see myself as an “activist” at all. In my own writings, and in the webzine I direct, Mad in America, I think you’ll see journalistic practices at work, albeit in the service of an “activist” mission. Here is how can i buy kamagra our mission statement.

€œMad in America’s mission is to serve as a catalyst for rethinking psychiatric care in the United States (and abroad). We believe that the current drug-based paradigm of care has failed our society, and that scientific research, as well as the lived experience of those who have been diagnosed with a psychiatric disorder, calls for profound change.” Thus, our starting point is that “change” is needed, and while that does have an activist element, I think journalism—serving as an informational source—is fundamental to that effort. As an organization, we are not asserting that we have the answers for what that change should be, how can i buy kamagra which would be the case if we were striving to be activists. Instead, we strive to be a forum for promoting an informed societal discussion about this subject.

Here’s what we do. We publish daily summaries of scientific research with findings how can i buy kamagra that are rarely covered in the mainstream media. You’ll find, in the archives of our research reports, a steady parade of findings that counter the conventional narrative. For instance, there are reports of how the effort to find genes for mental disorders has proven rather fruitless, or of how social inequalities trigger mental distress, or of poor long-term outcomes with our current paradigm of care.

And so forth—we simply want these scientific how can i buy kamagra findings to become known.
We regularly feature interviews with researchers and activists, and podcasts that explore these issues. We launched MIA Reports as a showcase for our print journalism. We have published in-depth articles on promising new initiatives in Europe. Investigative pieces on such topics as compulsory outpatient treatment how can i buy kamagra.

Coverage of “news” related to mental health policy in the United States. And occasional reports on how the mainstream media is covering mental health issues. €¨We also publish blogs by professionals, academics, people with lived experience, and others with a how can i buy kamagra particular interest in this subject. These blogs and personal stories are meant to help inform society’s “rethinking” of psychiatric care.

All of these efforts, I think, fit within the framework of “journalism.” However, I do understand that I am going beyond the boundaries of usual “science journalism” when I publish critiques of the “evidence base” related to psychiatric drugs. I did this in my how can i buy kamagra books Mad in America and Anatomy of an Epidemic, as well as a book I co-wrote, Psychiatry Under the Influence. I have continued to do this with MIA Reports. The usual practice in “science journalism” is to look to the “experts” in the field and report on what they tell about their findings and practices.

However, while reporting and writing Mad in America, I came to understand that when “experts” in psychiatry spoke to journalists they regularly hewed to a story that they were expected to tell, which was a story of how their field was making great progress in understanding the biology of disorders and of drug treatments that—as I was told over and how can i buy kamagra over when I co-wrote the series for the Boston Globe—fixed chemical imbalances in the brain. But their own science, I discovered, regularly belied the story they were telling to the media. That’s why I turned to focusing on the story that could be dug out from a critical look at their own scientific literature. So what I do in these critiques—such as suicide in the Prozac era and the impact of antipsychotics on mortality—is review the relevant research and put those findings together into a how can i buy kamagra coherent report.

I also look at research cited in support of mainstream beliefs and see if the data, in those articles, actually supports the conclusions presented in the abstract. None of this is really that difficult, and yet I know it is unusual for a journalist to challenge conventional “medical wisdom” in this way. Horgan. Anatomy of an Epidemic argues that medications for mental illness, although they give many people short-term reliefs, cause net harm.

Is that a fair summary?. Whitaker. Yes, although my thinking has evolved somewhat since I wrote that book. I am more convinced than ever that psychiatric medications, over the long term, cause net harm.

I wish that weren’t the case, but the evidence just keeps mounting that these drugs, on the whole, worsen long-term outcomes. However, my thinking has evolved in this way. I am not so sure any more that the medications provide a short-term benefit for patient populations as a whole. When you look at the short-term studies of antidepressants and antipsychotics, the evidence of efficacy in reducing symptoms compared to placebo is really pretty marginal, and fails to rise to the level of a “clinically meaningful” benefit.

Furthermore, the problem with all of this research is that there is no real placebo group in the studies. The placebo group is composed of patients who have been withdrawn from their psychiatric medications and then randomized to placebo. Thus, the placebo group is a drug-withdrawal group, and we know that withdrawal from psychiatric drugs can stir myriad negative effects. A medication-naïve placebo group would likely have much better outcomes, and if that were so, how would that placebo response compare to the drug response?.

In short, research on the short-term effects of psychiatric drugs is a scientific mess. In fact, a 2017 paper that was designed to defend the long-term use of antipsychotics nevertheless acknowledged, in an off-hand way, that “no placebo-controlled trials have been reported in first-episode psychosis patients.” Antipsychotics were introduced 65 years ago, and we still don’t have good evidence that they work over the short term in first episode patients. Which is rather startling, when you think of it. Horgan.

Have any of your critics—E. Fuller Torrey, for example—made you rethink your thesis?. Whitaker. When the first edition of Anatomy of an Epidemic was published (2010), I knew there would be critics, and I thought, this will be great.

This is just what is needed, a societal discussion about the long-term effects of psychiatric medications. I have to confess that I have been disappointed in the criticism. They mostly have been ad hominem attacks—I cherry-picked the data, or I misunderstood findings, or I am just biased, but the critics don’t then say what data I missed, or point to findings that tell of medications that improve long-term outcomes. I honestly think I could do a much better job of critiquing my own work.

You mention E. Fuller Torrey’s criticism, in which he states that I both misrepresented and misunderstood some of the research I cited. I took this seriously, and answered it at great length. Now if your own “thesis” is indeed flawed, then a critic should be able to point out its flaws while accurately detailing what you wrote.

If that is the case, then you have good reason to rethink your beliefs. But if a critique doesn’t meet that standard, but rather relies on misrepresenting what you wrote, then you have reason to conclude that the critic lacks the evidence to make an honest case. And that is how I see Torrey’s critique. For example, Torrey said that I misunderstood Martin Harrow’s research on long-term outcomes for schizophrenia patients.

Harrow reported that the recovery rate was eight times higher for those who got off antipsychotic medication compared to those who stayed on the drugs. However, in his 2007 paper, Harrow stated that the better outcomes for those who got off medication was because they had a better prognosis and not because of negative drug effects. If you read Anatomy of an Epidemic, you’ll see that I present his explanation. Yet, in my interview with Harrow, I noted that his own data showed that those who were diagnosed with milder psychotic disorders who stayed on antipsychotics fared worse over the long term than schizophrenia patients who stopped taking the medication.

This was a comparison that showed the less ill maintained on antipsychotics doing worse than the more severely ill who got off these medications. And I presented that comparison in Anatomy of an Epidemic. By doing that, I was going out on a limb. I was saying that maybe Harrow’s data led to a different conclusion than he had drawn, which was that the antipsychotic medication, over the long-term, had a negative effect.

After Anatomy was published, Harrow and his colleague Thomas Jobe went back to their data and investigated this very possibility. They have subsequently written several papers exploring this theme, citing me in one or two instances for raising the issue, and they found reason to conclude that it might be so. They wrote. €œHow unique among medical treatments is it that the apparent efficacy of antipsychotics could diminish over time or become harmful?.

There are many examples for other medications of similar long-term effects, with this often occurring as the body readjusts, biologically, to the medications.” Thus, in this instance, I did the following. I accurately reported the results of Harrow’s study and his interpretation of his results, and I accurately presented data from his research that told of a possible different interpretation. The authors then revisited their own data to take up this inquiry. And yet Torrey’s critique is that I misrepresented Harrow’s research.

This same criticism, by the way, is still being flung at me. Here is a recent article in Vice which, once again, quotes people saying I misrepresent and misunderstand research, with Harrow cited as an example. I do want to emphasize that critiques of “my thesis” regarding the long-term effects of psychiatric drugs are important and to be welcomed. See two papers in particular that take this on (here and here), and my response in general to such criticisms, and to the second one.

Horgan. When I criticize psychiatric drugs, people sometimes tell me that meds saved their lives. You must get this reaction a lot. How do you respond?.

Whitaker. I do hear that, and when I do, I reply, “Great!. I am so glad to know that the medications have worked for you!. € But of course I also hear from many people who say that the drugs ruined their lives.

I do think that the individual’s experience of psychiatric medication, whether good or bad, should be honored as worthy and “valid.” They are witnesses to their own lives, and we should incorporate those voices into our societal thinking about the merits of psychiatric drugs. However, for the longest time, we’ve heard mostly about the “good” outcomes in the mainstream media, while those with “bad” outcomes were resigned to telling their stories on internet forums. What Mad in America has sought to do, in its efforts to serve as a forum for rethinking psychiatry, is provide an outlet for this latter group, so their voices can be heard too. The personal accounts, of course, do not change the bottom-line “evidence” that shows up in outcome studies of larger groups of patients.

Unfortunately, that tells of medications that, on the whole, do more harm than good. As a case in point, in regard to this “saving lives” theme, this benefit does not show up in public health data. The “standard mortality rate” for those with serious mental disorders, compared to the general public, has notably increased in the last 40 years. Horgan.

Do you see any promising trends in psychiatry?. Whitaker. Yes, definitely. You have the spread of Hearing Voices networks, which are composed of people who hear voices and offer support for learning to live with voices as opposed to squashing them, which is what the drugs are supposed to do.

These networks are up and running in the U.S., and in many countries worldwide. You have Open Dialogue approaches, which were pioneered in northern Finland and proved successful there, being adopted in the United States and many European countries (and beyond.) This practice puts much less emphasis on treatment with antipsychotics, and much greater emphasis on helping people re-integrate into family and community. You have many alternative programs springing up, even at the governmental level. Norway, for instance, ordered its hospital districts to offer “medication free” treatment for those who want it, and there is now a private hospital in Norway that is devoted to helping chronic patients taper down from their psychiatric medications.

In Israel, you have Soteria houses that have sprung up (sometimes they are called stabilizing houses), where use of antipsychotics is optional, and the environment—a supportive residential environment—is seen as the principal “therapy.” You have the U.N. Special Rapporteur for Health, Dainius Pūras, calling for a “revolution” in mental health, one that would supplant today’s biological paradigm of care with a paradigm that paid more attention to social justice factors—poverty, inequality, etc.—as a source of mental distress. All of those initiatives tell of an effort to find a new way. But perhaps most important, in terms of “positive trends,” the narrative that was told to us starting in the 1980s has collapsed, which is what presents the opportunity for a new paradigm to take hold.

More and more research tells of how the conventional narrative, in all its particulars, has failed to pan out. The diagnoses in the Diagnostic and Statistical Manual (DSM) have not been validated as discrete illnesses. The genetics of mental disorders remain in doubt. MRI scans have not proven to be useful.

Long-term outcomes are poor. And the notion that psychiatric drugs fix chemical imbalances has been abandoned. Ronald Pies, the former editor in chief of Psychiatric Times, has even sought to distance psychiatry, as an institution, from ever having made such a claim. Horgan.

Do brain implants or other electrostimulation devices show any therapeutic potential?. Whitaker. I don’t have a ready answer for this. We have published two articles about the spinning of results from a trial of deep-brain stimulation, and the suffering of some patients so treated over the long-term.

Those articles tell of why it may be difficult to answer that question. There are financial influences that push for published results that tell of a therapeutic success, even if the data doesn’t support that finding, and we have a research environment that fails to study long-term outcomes. The history of somatic treatments for mental disorders also provides a reason for caution. It’s a history of one somatic treatment after another being initially hailed as curative, or extremely helpful, and then failing the test of time.

The inventor of frontal lobotomy, Egas Moniz, was awarded a Nobel Prize for inventing that surgery, which today we understand as a mutilation. It’s important to remain open to the possibility that somatic treatments may be helpful, at least for some patients. But there is plenty of reason to be wary of initial claims of success. Horgan.

Should psychedelic drugs be taken seriously as treatments?. Whitaker. I think caution applies here too. Surely there are many risks with psychedelic drugs, and if you were to do a study of first-episode psychosis today, you would find a high percentage of the patients had been using mind-altering drugs before their psychotic break—antidepressants, marijuana, LSD and so forth.

At the same time, we’ve published reviews of papers that have reported positive results with use of psychedelics. What are the benefits versus the risks?. Can possible benefits be realized while risks are minimized?. It is a question worth exploring, but carefully so.

Horgan. What about meditation?. Whitaker. I know that many people find meditation helpful.

I also know other people find it difficult—and even threatening—to sit with the silence of their minds. Mad in America has published reviews of research about meditation, we have had a few bloggers write about it, and in our resource section on “non-drug therapies,” we have summarized research findings regarding its use for depression. We concluded that the research on this is not as robust as one would like. However, I think your question leads to this broader thought.

People struggling with their minds and emotions may come up with many different approaches they find helpful. Exercise, diet, meditation, yoga and so forth all represent efforts to change one’s environment, and ultimately, I think that can be very helpful. But the individual has to find his or her way to whatever environmental change that works best for them. Horgan.

Do you see any progress toward understanding the causes of mental illness?. Whitaker. Yes, and that progress might be summed up in this way. Researchers are returning to investigations of how we are impacted by what has “happened to us.” The Adverse Childhood Experiences study provides compelling evidence of how traumas in childhood—divorce, poverty, abuse, bullying and so forth—exact a long-term toll on physical and mental health.

Interview any group of women diagnosed with a serious mental disorder, and you’ll regularly find accounts of sexual abuse. Racism exacts a toll. So too poverty, oppressive working conditions, and so forth. You can go on and on, but all of this is a reminder that we humans are designed to respond to our environment, and it is quite clear that mental distress, in large part, arises from difficult environments and threatening experiences, past and present.

And with a focus on life experiences as a source of “mental illness,” a related question is now being asked. What do we all need to be mentally well?. Shelter, good food, meaning in life, someone to love and so forth—if you look at it from this perspective, you can see why, when those supporting elements begin to disappear, psychiatric difficulties appear. I am not discounting that there may be biological factors that cause “mental illness.” While biological markers that tell of a particular disorder have not been discovered, we are biological creatures, and we do know, for instance, that there are physical illnesses and toxins that can produce psychotic episodes.

However, the progress that is being made at the moment is a moving away from the robotic “it’s all about brain chemistry” toward a rediscovery of the importance of our social lives and our experiences. Horgan. Do we still have anything to learn from Sigmund Freud?. Whitaker.

I certainly think so. Freud is a reminder that so much of our mind is hidden from us and that what spills into our consciousness comes from a blend of the many parts of our mind, our emotional centers and our more primal instincts. You can still see merit in Freud’s descriptions of the id, ego and superego as a conceptualization of different parts of the brain. I read Freud when I was in college, and it was a formative experience for me.

Horgan. I fear that American-style capitalism doesn’t produce good health care, including mental-health care. What do you think?. Whitaker.

It’s clear that it doesn’t. First, we have for-profit health-care that is set up to treat “disease.” With mental-health care, that means there is a profit to be made from seeing people as “diseased” and treating them for that “illness.” Take a pill!. In other words, American-style capitalism, which works to create markets for products, provides an incentive to create mental patients, and it has done this to great success over the past 35 years. Second, without a profit to be made, you don’t have as much investment in psychosocial care that can help a person remake his or her life.

There is a societal expense, but little corporate profit, in psychosocial care, and American-style capitalism doesn’t lend itself to that equation. Third, with our American-style capitalism (think neoliberalism), it is the individual that is seen as “ill” and needs to be fixed. Society gets a free pass. This too is a barrier to good “mental health” care, for it prevents us from thinking about what changes we might make to our society that would be more nurturing for us all.

With our American-style capitalism, we now have a grossly unequal society, with more and more wealth going to the select few, and more and more people struggling to pay their bills. That is a prescription for psychiatric distress. Good “mental health care” starts with creating a society that is more equal and just. Horgan.

How might the erectile dysfunction treatment kamagra affect care of the mentally ill?. Whitaker. That is something Mad in America has reported on. The kamagra, of course, can be particularly threatening to people in mental hospitals, or in group homes.

The threat is more than just the exposure to the kamagra that may come in such settings. People who are struggling in this way often feel terribly isolated, alone, and fearful of being with others. erectile dysfunction treatment measures, with calls for social distancing, can exacerbate that. I think this puts hospital staff and those who run residential homes into an extraordinarily difficult position—how can they help ease the isolation of patients even as they are being expected to enforce a type of social distancing?.

Horgan. If the next president named you mental health czar, what would be at the top of your To Do list?. Whitaker. Well, I am pretty sure that’s not going to happen, and if it did, I would quickly confess to my being utterly unqualified for the job.

But from my perch at Mad in America, here is what I would like to see happen in our society. As you can see from my answers above, I think the fundamental problem is that our society has organized itself around a false narrative, which was sold to us as a narrative of science. In the early 1980s, we began to hear that psychiatric disorders were discrete brain illnesses, which were caused by chemical imbalances in the brain, and that a new generation of psychiatric drugs fixed those imbalances, like insulin for diabetes. That is a story of an amazing medical breakthrough.

Researchers had discovered the very chemicals in our brain that cause madness, depression, anxiety or ADHD, and they had developed drugs that could put brain chemistry back into a normal state. Given the complexity of the human brain, if this were true, it would arguably be the greatest achievement in medical history. And we understood it to be true. We came to believe that there was a sharp line between the “normal” brain and the “abnormal” brain, and that it was medically helpful to screen for these illnesses, and that psychiatric drugs were very safe and effective, and often needed to be taken for life.

But what can be seen clearly today is that this narrative was a marketing story, not a scientific one. It was a story that psychiatry, as an institution, promoted for guild purposes, and it was a story that pharmaceutical companies promoted for commercial reasons. Science actually tells a very different story. The biology of psychiatric disorders remains unknown.

The disorders in the DSM have not been validated as discrete illnesses. The drugs do not fix chemical imbalances but rather perturb normal neurotransmitter functions. And even their short term efficacy is marginal at best. As could be expected, organizing our thinking around a false narrative has been a societal disaster.

A sharp rise in the burden of mental illness in our society. Poor long-term functional outcomes for those who are continuously medicated. The pathologizing of childhood. And so on.

What we need now is a new narrative to organize ourselves around, one steeped in history, literature, philosophy, and good science. I think step one is ditching the DSM. That book presents the most impoverished “philosophy of being” imaginable. Anyone who is too emotional, or struggles with his or her mind, or just doesn’t like being in a boring environment (think ADHD) is a candidate for a diagnosis.

We need a narrative that, if truth be told, can be found in literature. Novels, Shakespeare, the Bible—they all tell of how we humans struggle with our minds, our emotions and our behaviors. That is the norm. It is the human condition.

And yet the characters we see in literature, if they were viewed through the DSM lens, would regularly qualify for a diagnosis. At the same time, literature tells of how humans can be so resilient, and that we change as we age and move through different environments. We need that to be part of a new narrative too. Our current disease-model narrative tells of how people are likely going to be chronically ill.

Their brains are defective, and so the therapeutic goal is to manage the symptoms of the “disease.” We need a narrative that replaces that pessimism with hope. If we embraced that literary understanding of what it is to be human, then a “mental health” policy could be forged that would begin with this question. How do we create environments that are more nurturing for us all?. How do we create schools that build on a child’s curiosity?.

How do we bring nature back into our lives?. How do we create a society that helps provide people with meaning, a sense of community, and a sense of civic duty?. How do we create a society that promotes good physical health, and provides access to shelter and medical care?. Furthermore, with this conception in mind, individual therapy would help people change their environments.

You could encourage walks in nature. Recommend volunteer work. Provide settings where people could go and recuperate, and so forth. Most important, in contrast to a “disease-based” paradigm of care, a “wellness-based” paradigm would help people feel hopeful, and help them find a way to create a different future for themselves.

This is an approach, by the way, that can be helpful to people who have suffered a psychotic episode. Soteria homes and Open Dialogue are “therapies” that strive to help psychotic patients in this manner. Within this “wellness” paradigm of care, there would still be a place for use of medications that help people feel differently, at least for a time. Sedatives, tranquilizers, and so forth.

And you would still want to fund science that seeks to better understand the many pathways to debilitating mood states and to “psychosis”—trauma, poor physical health, physical disease, lack of sleep, setbacks in life, isolation, loneliness, and yes, whatever biological vulnerabilities that may be present. At the same time, you would want to fund science that seeks to better understand the pillars of “wellness.” Horgan. What’s your utopia?. Whitaker.

My “utopia” would be a world like the one I just described, based on a new narrative about mental illness, rooted in an understanding of how emotional we humans are, of how we struggle with our minds, and of how we are built to be responsive to our environments. And that really is the mission of Mad in America. We want it to be a forum for creating a new societal narrative for “mental health.” Further Reading. Can Psychiatry Heal Itself?.

Are Psychiatric Medications Making Us Sicker?. Meta-Post. Posts on Mental Illness Meta-Post. Posts on Brain Implants Meta-Post.

Posts on Psychedelics Meta-Post. Posts on Buddhism and Meditation See also “The Meaning of Madness,” a chapter in my free online book Mind-Body Problems.1970 Sweet Suburbia “Massive movement from central cities to their suburbs, a population boom in the West and Southwest, and a lower rate of population growth in the 1960's than in the 1950's are the findings that stand out in the preliminary results of the 1970 Census as issued by the U.S. Bureau of the Census. The movement to the suburbs was pervasive.

Its extent is indicated by the fact that 13 of the 25 largest cities lost population, whereas 24 of the 25 largest metropolitan areas gained. Washington, D.C., was characteristic. The population of the city changed little between 1960 and 1970, but the metropolitan area grew by 800,000, or more than 38 percent.” 1920 Air Cargo “The proposed machine, known as the ‘Pelican Four-Ton Lorry,' is a colossal cantilever monoplane designed for two 460-horse-power Napier engines. Its cruising speed is 72 miles per hour.

Its total weight is to be 24,100 pounds. The useful load is four tons, with sufficient fuel for the London-Paris journey. Most interesting of all, however, is the novel system of quick loading and unloading which has been planned. This permits handling of shipments with the utmost speed, and is based on a similar practice in the motor truck field.

Idle airplanes mean a large idle capital, hence the designers plan to keep the airplane in the air for the greater part of the time.” Don't Try This Anywhere “Dr. Charles Baskerville points out that while the data thus far obtained on chlorine and influenza do not warrant drawing conclusions, such facts as have been established would indicate to the medical man the advisability of trying experimentally dilute chlorinated air as a prophylactic in such epidemics as so-called influenza. Dr. Baskerville determined to what extent workers in plants where small amounts of chlorine were to be found in the atmosphere were affected seriously by influenza.

Many of those from whom information was requested expressed the opinion that chlorine workers are noticeably free from colds and other pneumatic diseases.” 1870 The Rise of Telegraphy “The rapid progress of the telegraph during the last twenty-five years has changed the whole social and commercial systems of the world. Its advantages and capabilities were so evident that immediately on its introduction, and demonstration of its true character, the most active efforts were made to secure them for every community which desired to keep pace with the advances of modern times. The Morse or signal system seemed for a time to be the perfection of achievement, until Professor Royal E. House astonished the world with his letter printing telegraph.

Now, almost every considerable expanse of water is traversed, or soon will be, by the slender cords which bind continents and islands together and practically bring the human race into one great family.” The Transport of Goods 1887. Cargo ship launched as Golconda had room for 6,000 tons of cargo, loaded and unloaded by crane and cargo nets, and 108 passengers. Credit. Scientific American Supplement, Vol.

XXIII, No. 574. January 1, 1887 Oxcarts, railroad cars and freight ships can be loaded and unloaded one item at a time, but it is more efficient to handle cargo packed into “intermodal shipping containers” that are a standardized size and shape. Our October 1968 issue noted that a “break-bulk” freighter took three days to unload, a container ship less than one (including loading new cargo).

Air transport became a link in this complex system, but the concept in the 1920 illustration shown is a little ahead of its time. These days air cargo (and luggage) makes abundant use of “unit load devices,” cargo bins shaped to fit the fuselage of specific aircraft models.The items below are highlights from the free newsletter, “Smart, useful, science stuff about erectile dysfunction treatment.” To receive newsletter issues daily in your inbox, sign-up here. Are you in need of a “dose of optimism” about the kamagra, at least in the U.S.?. Check out this 10/12/20 story at The New York Times by by Donald McNeil Jr., who has covered infectious diseases and epidemics for many years.

McNeil notes the 215,000 people in the U.S. Dead so far from the novel erectile dysfunction, as well as the estimates that the figure could go as high as 400,000 before this era draws to a close. But here is some of the good news that he tallies. 1) mask-wearing by the public is “widely accepted”.

2) the development of treatments to protect against erectile dysfunction and of treatments for erectile dysfunction treatment are proceeding at record speed. 3) “experts are saying, with genuine confidence, that the kamagra in the United States will be over far sooner than they expected, possibly by the middle of next year”. And 4) fewer infected people die today than did earlier this year, even at nursing homes. About 10 percent of people in the U.S.

Have been infected with the kamagra so far, according to the U.S. Centers for Disease Control, the story states. €œkamagras don’t end abruptly. They decelerate gradually,” McNeil writes.

A 10/14/20 story by Carl Zimmer for The New York Times puts into context three late-stage (Phase 3 safety and effectiveness) erectile dysfunction treatment experiments that have been paused in recent weeks due to illness among some study participants. Pauses in treatment studies — in this case Johnson &. Johnson’s treatment candidate and AstraZeneca’s treatment candidate — are “not unusual,” the story states, partly because the safety threshold is extremely high for a product that, if approved, could be given to millions or billions of people. But pauses are rare in treatment studies — in this case Eli Lilly’s monoclonal antibody cocktail drug.

Once a drug or treatment experiment (trial) is paused, a safety board determines whether the ill participant was given the new product or a placebo. If it was the placebo, the study can resume. If not, the board looks deeper into the case to determine whether or not the illness is related to the drug or treatment. If a clear connection is discovered, “the trial may have to stop,” Zimmer writes.

Dr. Eric Topol at Scripps Research is quoted in the piece as saying he is “still fairly optimistic” about monoclonal antibody treatments for erectile dysfunction treatment. The safety-related pauses of all three experiments are “an example of how things are supposed to work,” says Dr. Anna Durbin of Johns Hopkins Bloomberg School of Public Health in the story.

The top of a story at The Washington Post features an instructive interactive that sketches “Scienceville,” a fictional place where “politicians and public health officials use every tool at their disposal to contain the erectile dysfunction.” It basically shows how genetic analysis and tracing of viral strains found in a frequently and widely tested population could help officials control outbreaks of erectile dysfunction. Then the 10/13/20 text story below, by Brady Dennis, Chris Mooney, Sarah Kaplan, and Harry Stevens, focuses on the details of such a “genomic epidemiology” approach and describes some real-life efforts under way, primarily in the UK, to implement the approach. The U.S. Has not been able to effectively use the approach, in part because genetic sequencing of viral strains “has largely been left up to states and individual researchers, rather than being part of a coordinated and well-funded national program,” the story states.

The rise in erectile dysfunction s in the U.S. Is now driven by “small gatherings in people’s homes,” according to officials with the U.S. Centers for Disease Control, reports Carolyn Crist for WebMD (10/14/20). People should continue to wear face masks and to practice social distancing “since most people have still not been exposed to the erectile dysfunction worldwide," the researchers suggest, Crist writes.

A newly developed test can detect erectile dysfunction in 5 minutes, reports Robert F. Service at Science (10/8/20). The test relies on CRISPR gene-editing technology, for which Jennifer Doudna of the University of California, Berkeley, and Emmanuelle Charpentier of the Max Planck Unit for the Science of Pathogens won the Nobel Prize in Chemistry earlier this month. Doudna heads up the work that led to this new 5-minute CRISPR test for the erectile dysfunction.

By comparison, it can take a day or more to get back standard erectile dysfunction test results, the story states. Donald G. McNeil Jr. At The New York Times has written a guide to distinguishing common cold, flu, and erectile dysfunction treatment symptoms (10/3/20).

A major difference between having a cold and having the flu is that "Flu makes you feel as if you were hit by a truck,” McNeil quotes experts as saying. The symptom that best distinguishes erectile dysfunction treatment from flu is loss of your sense of smell — strong smells don’t register, he writes. But many flu and erectile dysfunction treatment symptoms overlap, the story states. The most common symptoms for erectile dysfunction treatment are a high fever, chills, dry cough and fatigue.

For flu, it’s a fever, headaches, body aches, sore throat, runny nose, stuffed sinuses, coughing and sneezing, the story states. Dr. Anthony Fauci’s three daughters do not plan to visit him for Thanksgiving to avoid potentially transmitting the new erectile dysfunction to their parents, reports Ralph Ellis at WebMD. The story includes holiday traveling and visiting tips from a pulmonary critical care doctor at the University of Washington Medical Center who “believes traveling for the holidays is risky.” The tips include ensuring you have no erectile dysfunction treatment-like symptoms two weeks before traveling, getting tested before traveling, quarantining in a hotel for at least 48 hours before visiting with loved ones, traveling by car, and cutting down on “close contact and talking without a mask” (10/9/20).

Adele Chapin has written a guide for reducing kids’ risk of catching and spreading erectile dysfunction at the playground. The 10/8/20 piece in The Washington Post makes the usual recommendations for mask-wearing, hand-washing, hand-sanitizer, disinfecting wipes, and distancing. It quotes a Children’s National Hospital pediatrician advises against gloves, because “people wearing them often touch their faces, which defeats the purpose.” The piece also recommends visiting playgrounds at less busy times and choosing playgrounds with more than one play structure, which makes it easier for kids to distance from one another. A story by Carl Zimmer for The New York Times beautifully describes and illustrates some of the amazing imaging work that scientists have done to study the structure of erectile dysfunction and how it infects our cells and multiplies (10/9/20).

For starters, check out a mesmerizing video about a quarter of the way down-page that simulates spike proteins (complex molecules) doing a “molecular dance” on the kamagra membrane. The video (just one of several in this stunning piece) is part of research by a computational biophysicist at the Max Planck Institute of Biophysics and colleagues. The spikes appear to shimmy, which “increases the odds of encountering the protein on the surface of our cells it uses to attach,” the researchers suspect, Zimmer writes. You might enjoy, “A letter of recommendation in the age of Zoom,” by Matt Cheung, for McSweeney’s (10/14/20).Editor’s Note (10/16/20).

This story is being republished in light of the interim results of a large international clinical trial of remdesivir by the World Health Organization. The trial found that the drug, which is widely used to treat erectile dysfunction treatment patients, failed to prevent deaths. An experimental drug—and one of the world’s best hopes against erectile dysfunction treatment—could shorten the time to recovery from erectile dysfunction , according to the largest and most rigorous clinical trial of the compound. The experimental drug, called remdesivir, interferes with replication of some kamagraes, including the erectile dysfunction kamagra responsible for the current kamagra.

On 29 April, Anthony Fauci, director of the US National Institute of Allergy and Infectious Disease (NIAID), announced that a clinical trial of more than a thousand people showed that people taking remdesivir recovered in 11 days on average, compared to 15 days for those on a placebo. €œAlthough a 31% improvement doesn’t seem like a knockout 100%, it is a very important proof of concept,” Fauci said. €œWhat it has proven is that a drug can block this kamagra.” Deaths were also lower in trial participants who received the drug, he said, but that trend was not statistically significant. The shortened recovery time, however, was significant, and was enough of a benefit that investigators decided to stop the trial early for ethical reasons, he said, to ensure that those participants who were receiving placebo could now access the drug.

Fauci added that remdesivir would become a standard treatment for erectile dysfunction treatment. The news comes after weeks of data leaks and on a day of mixed results from clinical trials of the drug. In a trial run by the drug’s maker, Gilead Sciences of Foster City, California, more than half of 400 participants with severe erectile dysfunction treatment recovered from their illness within two weeks of receiving treatment. But the study lacked a placebo controlled arm, making the results difficult to interpret.

Another smaller trial run in China found no benefits from remdesivir when compared with a placebo. But the trial was stopped early due to the difficulty in enroling participants as the outbreak subsided in China. Nevertheless, onlookers are hopeful that the large NIAID trial provides the first glimmer of hope in a race to find a drug that works against the erectile dysfunction, which has infected more than 3 million people worldwide. €œThere is a lot of focus on remdesivir because it’s potentially the best shot we have,” says virologist Stephen Griffin at the University of Leeds in the UK.

Small trials The fast-flowing, conflicting information on remdesivir has left people reeling over the past weeks. In the rush to find therapies to combat erectile dysfunction treatment, small, clinical trials without control groups have been common. €œI’m just very annoyed by all of these non-controlled studies,” says Geoffrey Porges, an analyst for the investment bank SVB Leerink in New York City. €œIt’s reassuring that 50–60% of patients are discharged from the hospital, but this is a disease that mostly gets better anyway.” With so much uncertainty, the remdesivir-watchers were waiting anxiously for final results from the NIAID trial, which were not expected until the end of May.

In lieu of a treatment, which could still be more than a year away, effective therapies are critical to reducing deaths and limiting economic damage from the kamagra. Yet, despite the flood of small clinical trials, no therapy has been convincingly shown to boost survival in people with erectile dysfunction treatment. The NIAID results put a new sheen on remdesivir. €œIt may not be the wonder drug that everyone’s looking for, but if you can stop some patients from becoming critically ill, that’s good enough,” says Griffin.

Fauci said the finding reminded him of the discovery in the 1980s that the drug AZT helped to combat HIV . The first randomized, controlled clinical only showed a modest improvement, he said, but researchers continued to build on that success, eventually developing highly effective therapies. For now, he said, remdesivir would become a standard treatment for erectile dysfunction treatment. Remdesivir works by gumming up an enzyme that some kamagraes, including erectile dysfunction, use to replicate.

In February, researchers showed that the drug reduces viral in human cells grown in a laboratory. Gilead began to ramp up production of remdesivir well before the NIAID results. By the end of March, the company had produced enough to treat 30,000 patients. By streamlining its manufacturing process and finding new sources of raw materials, Gilead announced that it hoped to produce enough remdesivir to treat more than a million people by the end of the year.

That calculation was based on the assumption that people would take the drug for 10 days, but the results announced from Gilead’s trial today suggest that a 5-day course of treatment could work just as well. If so, that would effectively double the number of people who could be treated, says Porges. Many drugs needed In the long term, clinicians will likely want a bevy of anti-viral drugs—with different ways of disabling the kamagra—in their arsenal, says Timothy Sheahan, a virologist at the University of North Carolina in Chapel Hill, who has teamed up with Gilead researchers to study remdesivir. €œThere is always the potential for antiviral resistance,” he says.

€œAnd to hedge against that potential, it’s good to have not only a first-line, but also a second-, third-, fourth-, fifth-line antiviral.” Researchers are furiously testing a wide range of therapies, but early results, while not yet definitive, have not been encouraging. The malaria drugs chloroquine and hydroxychloroquine, both of which also have anti-inflammatory effects, drew so much attention from physicians and the public that some countries have depleted their supplies of the drugs. Yet studies in humans have failed to show a consistent benefit, and some have highlighted the risks posed by side effects of the drugs on the heart. Early interest in a mix of two HIV drugs called lopinavir and ritonavir flagged when a clinical trial in nearly 200 people did not find any benefit of the mix for those with severe erectile dysfunction treatment.

Another promising therapeutic hypothesis—that inhibiting the action of an immune system regulator called IL-6 could reduce the severe inflammation seen in some people with severe erectile dysfunction treatment—has met with mixed results thus far. Still, a host of other therapies are being tested in people, and many researchers are hunting for new drugs at the bench. Sheahan and his colleagues have found a compound that is active against erectile dysfunction and other erectile dysfunctiones, including a remdesivir-resistant variant of a erectile dysfunction, when tested in laboratory-grown human cells. But much more testing would need to be done before the compound could be tried in people.

€œWhat we’re doing now will hopefully have an impact on the current kamagra,” he says. €œBut maybe more importantly, it could position us to better respond more quickly in the future.” This article is reproduced with permission and was first published on April 29 2020. Read more about the erectile dysfunction outbreak here.During a press conference in early September, President Donald Trump was asked when he thought a treatment for erectile dysfunction treatment might become available. His prediction was upbeat.

€œWe’re going to have a treatment very soon,” Trump said. €œMaybe even before a very special day—you know what day I’m talking about.” Trump was referring, of course, to the presidential election on November 3. But the odds of a treatment materializing for public use before then appear slim. New drugs and treatments ordinarily go through a lengthy review process prior to regulatory approval.

treatments for erectile dysfunction treatment, however, are widely expected to be released under emergency use authorization (EUA) protocols, which allow for the sale of unapproved medical products during national health crises. On October 6 the White House agreed to new EUA guidelines that call on erectile dysfunction treatment developers to monitor their phase III clinical trial subjects for at least two months for side effects and severe disease. The U.S. Food and Drug Administration, which administers EUAs, will host a widely anticipated meeting on October 22 to address standards for efficacy, safety and manufacturing of erectile dysfunction treatments.

But the FDA’s recommended two-month observation period puts a preelection treatment approval out of reach. EUAs could, however, make the first successful erectile dysfunction treatments available to frontline workers by the start of 2021, although distribution in the general U.S. Population will take longer, starting with elderly and other high-risk groups and then younger, healthier people who may not have access to them until late in the year, according to Paul Offit, a pediatrician and director of the treatment Education Center at Children’s Hospital of Philadelphia. The FDA has already granted hundreds of erectile dysfunction treatment-related EUAs for products such as diagnostic tests, medical devices and therapies—including for convalescent plasma and hydroxychloroquine (the latter was later revoked).

€œAll the erectile dysfunction treatment developers are going for an EUA first,” says Eric Topol, a cardiologist and head of the Scripps Research Translational Institute in La Jolla, Calif., who has directed numerous multinational clinical trials (although none for treatments). €œIt makes no sense to wait for formal licensure.” Defining Success Obtaining an EUA hinges on how independent reviewers judge a treatment’s performance during periodic readouts of phase III clinical trial data. The trials are each enrolling tens of thousands of people and are also double-blinded—meaning that neither the subjects nor the experimenters know which participants got a treatment versus a placebo. They were designed to continue until the number of symptomatic s reaches 150 in the vaccinated and control groups combined.

If a treatment halves the risk of symptomatic s among the vaccinated group, it will meet the FDA’s minimum bar for approval. Reviewers examining the interim data readouts will be looking for better protection than that. Pfizer, which began a phase III trial for its treatment on July 27, plans to conduct its first readout when the number of symptomatic cases reaches 32. The company expects that could happen this month, making it first in line for a potential EUA.

Statistical thresholds are set such that if erectile dysfunction treatment case numbers in the vaccinated group are, at that point, at least five times lower than they are among vaccinated subjects, then reviewers can declare overwhelming efficacy. In that event, the company will “consult with regulatory authorities about next steps,” which could include an EUA, says a Pfizer spokesperson. In an October 16 open letter, Pfizer chairman and CEO Albert Bourla wrote that if the efficacy data are positive, the company will apply for an EUA in the U.S. €œsoon after the safety milestone is achieved in the third week of November.” The company’s study protocol also includes data readouts at 62, 92 and 120 cases, respectively, although the amount of protection the treatment has to achieve at each step declines progressively until it reaches the FDA’s minimum target of 50 percent.

Other companies racing to develop erectile dysfunction treatments are taking a less aggressive approach. Cambridge, Mass.–based Moderna, for instance, plans for a first data readout when it reaches 53 cases among its study subjects and another at 106 cases. The company anticipates filing for an EUA in late November. Meanwhile Johnson &.

Johnson recently paused its clinical trials after a participant got sick. This delay follows a similar pause by AstraZeneca, which has since resumed its trials outside of the U.S. What Happens Postapproval A significant issue is how treatment developers will continue to assess safety and efficacy after an EUA. The FDA has said they should include strategies for monitoring a treatment’s long-term performance in their EUA applications and generate the data needed to support future licensing.

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Consultant Psychiatrist, AMRI hop over to here Hospitals, Kolkata, West Bengal, IndiaClick here for correspondence address and email Date of Submission11-Jun-2021Date of Decision11-Jun-2021Date of Acceptance11-Jun-2021Date of Web viagra kamagra uk Publication17-Jun-2021 How to cite this article:Singh OP. Grief management in erectile dysfunction treatment. Indian context. Indian J Psychiatry 2021;63:211Grief is a normal response to loss and bereavement viagra kamagra uk.

Human beings are aware of the concept of death and permanence of loss leading to grief and bereavement. It may be seen in some other species also. While there has been a neurobiological mechanism explaining grief, it primarily remains a sociocultural phenomenon affecting the brain viagra kamagra uk and the body. The perception of death followed by the gradual “sinking in” of its consequences leads to psychobiological reaction.

Grief which is unmanaged can lead to serious health reactions like increased cardiovascular mortality (broken heart) and psychiatric disorders like depression and suicide.erectile dysfunction treatment as an epidemic has brought grief and bereavement to the doorstep of each and every person. Constantly hearing, seeing about death, and losing friends and family has viagra kamagra uk brought enormous strain to people's lives. Death rituals have a therapeutic function wherein they allow a family and a group to mourn in a ritualistic way. This allows people to share grief and keep the deceased as focus of attention for a fixed time and then to move on with life.

Sometimes, this process is hampered by what Kenneth Doka called “disenfranchised grief” in 1989 and defined it “as a process in which loss is felt as not being openly acknowledged, socially validated or publicly mourned.”[1] Externally imposed disenfranchised grief leads to grief remaining unresolved and unaddressed, and the person feels that his right to grieve has been denied.erectile dysfunction treatment has unexpectedly disturbed the process of death rituals as it leads to:Unexpected or viagra kamagra uk sudden lossDepletion of emotional and coping resourcesLimitation in visiting and end of care supportNot able to perform last ritualsLack of social support due to erectile dysfunction treatment restrictions.[2]The mechanical and impersonal process has led to severe psychological trauma in the survivors, particularly in the early phase of the disease when the knowledge was less and health-care workers were burdened and under cover of personal protective equipment, communication was difficult. Realizing this, the Indian Council of Medical Research has come out with guidelines for health-care workers to deal with death and guide family members. However, persistence of grief reaction remains a problem, and due to lack of social support due to erectile dysfunction treatment, people are increasingly relying on professionals to take care of their grief reactions.In India, the sharing of grief is very important. People try to reach the viagra kamagra uk grieving family.

So, what should be the model of care for these people?. We should try to increase the sharing of grief and the handling of the person should be allowed to take placeThe physical support and the economical support have to be arranged, particularly where both parents have diedThere are some common modes like “condolence meetings” or “smaran sabha” which should be attended by both family members and colleagues.erectile dysfunction treatment has brought an unprecedented amount of grief, and it is our duty to manage grief with innovative solutions to prevent the emergence of prolonged grief reaction, depression, and suicide. References 1.Doka viagra kamagra uk KJ, editor. Disenfranchised Grief.

New Directions, Challenges, and Strategies for Practice. Champaign, IL viagra kamagra uk. Research Press. 2002.

2.Albuquerque S, Teixeira viagra kamagra uk AM, Rocha JC. erectile dysfunction treatment and Disenfranchised Grief. Front Psychiatry 2021;12:638874. Correspondence Address:Om Prakash SinghDepartment of Psychiatry, WBMES, Kolkata, viagra kamagra uk West Bengal.

AMRI Hospitals, Kolkata, West Bengal IndiaSource of Support. None, Conflict of Interest. NoneDOI. 10.4103/indianjpsychiatry.indianjpsychiatry_489_21How to cite this article:Parthasarathy R, Channaveerachari NK, Manjunatha N, Sadh K, Kalaivanan RC, Gowda GS, Basvaraju V, Harihara SN, Rao GN, Math SB, Thirthalli J.

Mental health care in Karnataka. Moving beyond the Bellary model of District Mental Health Program. Indian J Psychiatry 2021;63:212-4How to cite this URL:Parthasarathy R, Channaveerachari NK, Manjunatha N, Sadh K, Kalaivanan RC, Gowda GS, Basvaraju V, Harihara SN, Rao GN, Math SB, Thirthalli J. Mental health care in Karnataka.

Moving beyond the Bellary model of District Mental Health Program. Indian J Psychiatry [serial online] 2021 [cited 2021 Jul 15];63:212-4. Available from. Https://www.indianjpsychiatry.org/text.asp?.

2021/63/3/212/318719Karnataka state has taken many strides forward with regard to the District Mental Health Program (DMHP) and is one of the few states to have dedicated DMHP psychiatrists as team leaders in all the districts. Moreover, some of the recent developments have moved beyond the Bellary model and augur well for the nation. This article attempts to provide a summary of such developments in the state and discusses the future directions. Core Services DMHP in Karnataka offers (a) clinical services, including the outreach services (on a rotation basis), covering the primary health centers (PHCs), community health centers, and taluk hospitals.

(b) training of all the medical officers and other health professionals such as nurses and pharmacists of the district. (c) information, education, and communication (IEC) activities – posters, wall paintings in PHCs, IEC activities for schools, colleges, police personnel, judicial departments, elected representatives, faith healers, bus branding, radio talks, etc., In addition, sensitization of Anganwadi workers, accredited social health activists, auxiliary nurse midwives, police/prison staff, agriculture department/horticulture department/primary land development bank staff, village rehabilitation workers, staff of noncommunicable disease/revised National Tuberculosis Control Program, etc.. And (d) targeted interventions are being focused on life skills education and counseling in schools, college counseling services, workplace stress management, and suicide prevention services. These initiatives have led to a phenomenal increase in patient footfalls to clinics [Figure 1] and >100,000 stakeholders are trained in various aspects of mental health (in the past 3 years).Figure 1.

Chart showing the phenomenal increase in the number of footfalls covered over the past 3 yearsClick here to view Seamless Medication Availability The procurement has been streamlined. The state-level purchase is done by the Karnataka Drugs and Logistics Society, based on the indents collated from each of the districts, and then, sent to their respective district warehouses. Individual indenters (taluk hospitals, community health centers, and primary health centers) then need to procure them from the district warehouses. The amount spent for the purpose has gone up drastically to INR 3 crores (30 million rupees) in the past financial year (2017–2018).

However, further streamlining is possible in the sense that the delays can be further curtailed. The Collaboration with the Karnataka State Wakf Board The WAKF board of Karnataka runs a “Darga” in south interior Karnataka. Thousands of persons with mental illnesses do come over here for religious cure. On a day of every week, the attendance crosses 10,000 footfalls.

Recently, the authorities have agreed to come up with an allopathic PHC inside the campus of the Darga. The idea is to have integrated and comprehensive care for patients without hurting their religious sentiments. Although such collaborative initiatives are spread across the country, this one is occurring at a larger scale with involvement of governmental agencies [Table 1].Table 1. Details of the key developments and innovations in mental health care in IndiaClick here to view Research Initiatives Although excellent evidence-based studies have come out in community settings, actual involvement of government machinery in these kinds of initiatives is few and far.

Their involvement is imperative for the evidence to become pragmatic and generalizable. Of course, by doing so, the methodological rigor compromises a bit. NIMHANS and Government of Karnataka have been collaborating for such service-driven research initiatives for over a decade and a half. Community-based interventions are going on in three taluks – Thirthahalli, Turuvekere, and Jagaluru, wherein cohorts of severe mental disorders are being cared for.

In addition, several research questions (of public health significance) are being answered.[6],[7] Exciting new initiatives are also underway. Examining the magnitude of reduction of treatment gap by these community interventions, impact of care at doorsteps (CAD) services from the DMHP machinery, impact of technology-based mentoring program for DMHP staff, evaluation of the impact of tele-OCT, etc. Discussion and Future Directions All the above-mentioned activities in Karnataka take it beyond the Bellary model of DMHP. For example, the Memorandum of understanding (MOU) between NIMHANS and the state gives the flexibility and easy maneuverability for active collaboration.

Odisha is another state which has taken this path of MOU. This collaborative activity can be expanded pan India as there are several Centers of Excellence spread throughout India. Another aspect of the Karnataka story is collaborative research activity. As described above, many activities going on across the state have the potential to inform public health policies.

Karnataka has also been able to counter long-standing and well-known criticisms of DMHP/NMHP. For example, issues related to human resources, availability of medications, funding, mentoring and monitoring, and sustenance, etc., at least to an extent. Of course, the state needs to do much more for mental health care. For example, compliance with Mental Health Care Act-2017.

Handling unequal distribution of mental health human resources. Rigorous involvement of local administration to tackle micro-level issues. Refining DMHP to suit special populations such as geriatric, children, and adolescents. And perinatal and upscaling urban DMHP, in areas such as Bengaluru Metropolitan City.

Another area for improvement is that the DMHP evaluation strategies should move beyond head counting and consider meaningful patient-related outcomes, including cost-effective analysis. Digital technology should further be exploited. The upcoming Karnataka Mental Healthcare Management System is a step in the right direction.[8] Finally, the DMHP should involve health and wellness centers to cater to the mental health needs, particularly for follow-up services, case detection, providing basic counseling, stress management, advocating lifestyle changes, relapse prevention strategies, and other preventive and promotive strategies. References 1.Manjunatha N, Kumar CN, Chander KR, Sadh K, Gowda GS, Vinay B, et al.

Taluk Mental Health Program. The new kid on the block?. Indian J Psychiatry 2019;61:635-9. [PUBMED] [Full text] 2.Manjunatha N, Kumar CN, Math SB, Thirthalli J.

Designing and implementing an innovative digitally driven primary care psychiatry program in India. Indian J Psychiatry 2018;60:236-44. [PUBMED] [Full text] 3.Pahuja E, Santhosh KT, Fareeduzzafar, Manjunatha N, Kumar CK, Gupta R, et al. An impact of digitally-driven Primary Care Psychiatry Pr.

Indian J Psychiatry 2020;62 Suppl 1:S17. 4.Manjunatha N, Singh G. Manochaitanya. Integrating mental health into primary health care.

Lancet 2016;387:647-8. 5.Manjunatha N, Singh G, Chaturvedi SK. Manochaitanya programme for better utilization of primary health centres. Indian J Med Res 2017;145:163-5.

[PUBMED] [Full text] 6.Agarwal PP, Manjunatha N, Parthasarathy R, Kumar CN, Kelkar R, Math SB, et al. A performance audit of first 30 months of Manochaitanya programme at secondary care level of Karnataka, India. Indian J Community Med 2019;44:222-4. [PUBMED] [Full text] 7.Kumar CN, Thirthalli J, Suresha KK, Arunachala U, Gangadhar BN.

Alcohol use disorders in patients with schizophrenia. Comparative study with general population controls. Addict Behav 2015;45:22-5. 8.

Correspondence Address:Naveen Kumar ChannaveerachariDepartment of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka IndiaSource of Support. None, Conflict of Interest.

Om Prakash Cipro tablet online SinghProfessor of how can i buy kamagra Psychiatry, WBMES. Consultant Psychiatrist, AMRI Hospitals, Kolkata, West Bengal, IndiaClick here for correspondence address and email Date of Submission11-Jun-2021Date of Decision11-Jun-2021Date of Acceptance11-Jun-2021Date of Web Publication17-Jun-2021 How to cite this article:Singh OP. Grief management in erectile dysfunction treatment.

Indian context how can i buy kamagra. Indian J Psychiatry 2021;63:211Grief is a normal response to loss and bereavement. Human beings are aware of the concept of death and permanence of loss leading to grief and bereavement.

It may be seen in how can i buy kamagra some other species also. While there has been a neurobiological mechanism explaining grief, it primarily remains a sociocultural phenomenon affecting the brain and the body. The perception of death followed by the gradual “sinking in” of its consequences leads to psychobiological reaction.

Grief which is unmanaged can lead to serious health reactions like increased cardiovascular mortality (broken heart) and psychiatric disorders like depression and suicide.erectile dysfunction treatment as an epidemic how can i buy kamagra has brought grief and bereavement to the doorstep of each and every person. Constantly hearing, seeing about death, and losing friends and family has brought enormous strain to people's lives. Death rituals have a therapeutic function wherein they allow a family and a group to mourn in a ritualistic way.

This allows people to share grief and keep the deceased as focus of attention for a fixed time and then to move on how can i buy kamagra with life. Sometimes, this process is hampered by what Kenneth Doka called “disenfranchised grief” in 1989 and defined it “as a process in which loss is felt as not being openly acknowledged, socially validated or publicly mourned.”[1] Externally imposed disenfranchised grief leads to grief remaining unresolved and unaddressed, and the person feels that his right to grieve has been denied.erectile dysfunction treatment has unexpectedly disturbed the process of death rituals as it leads to:Unexpected or sudden lossDepletion of emotional and coping resourcesLimitation in visiting and end of care supportNot able to perform last ritualsLack of social support due to erectile dysfunction treatment restrictions.[2]The mechanical and impersonal process has led to severe psychological trauma in the survivors, particularly in the early phase of the disease when the knowledge was less and health-care workers were burdened and under cover of personal protective equipment, communication was difficult. Realizing this, the Indian Council of Medical Research has come out with guidelines for health-care workers to deal with death and guide family members.

However, persistence of grief reaction remains a problem, and due to lack of social support due to erectile dysfunction treatment, people are increasingly relying on professionals to take care of their how can i buy kamagra grief reactions.In India, the sharing of grief is very important. People try to reach the grieving family. So, what should be the model of care for these people?.

We should try to increase the sharing of grief and the handling of the person should be allowed to take placeThe physical support and the economical support have to be arranged, particularly how can i buy kamagra where both parents have diedThere are some common modes like “condolence meetings” or “smaran sabha” which should be attended by both family members and colleagues.erectile dysfunction treatment has brought an unprecedented amount of grief, and it is our duty to manage grief with innovative solutions to prevent the emergence of prolonged grief reaction, depression, and suicide. References 1.Doka KJ, editor. Disenfranchised Grief.

New Directions, how can i buy kamagra Challenges, and Strategies for Practice. Champaign, IL. Research Press.

2002. 2.Albuquerque S, Teixeira AM, Rocha JC. erectile dysfunction treatment and Disenfranchised Grief.

Front Psychiatry 2021;12:638874. Correspondence Address:Om Prakash SinghDepartment of Psychiatry, WBMES, Kolkata, West Bengal. AMRI Hospitals, Kolkata, West Bengal IndiaSource of Support.

None, Conflict of Interest. NoneDOI. 10.4103/indianjpsychiatry.indianjpsychiatry_489_21How to cite this article:Parthasarathy R, Channaveerachari NK, Manjunatha N, Sadh K, Kalaivanan RC, Gowda GS, Basvaraju V, Harihara SN, Rao GN, Math SB, Thirthalli J.

Mental health care in Karnataka. Moving beyond the Bellary model of District Mental Health Program. Indian J Psychiatry 2021;63:212-4How to cite this URL:Parthasarathy R, Channaveerachari NK, Manjunatha N, Sadh K, Kalaivanan RC, Gowda GS, Basvaraju V, Harihara SN, Rao GN, Math SB, Thirthalli J.

Mental health care in Karnataka. Moving beyond the Bellary model of District Mental Health Program. Indian J Psychiatry [serial online] 2021 [cited 2021 Jul 15];63:212-4.

Available from. Https://www.indianjpsychiatry.org/text.asp?. 2021/63/3/212/318719Karnataka state has taken many strides forward with regard to the District Mental Health Program (DMHP) and is one of the few states to have dedicated DMHP psychiatrists as team leaders in all the districts.

Moreover, some of the recent developments have moved beyond the Bellary model and augur well for the nation. This article attempts to provide a summary of such developments in the state and discusses the future directions. Core Services DMHP in Karnataka offers (a) clinical services, including the outreach services (on a rotation basis), covering the primary health centers (PHCs), community health centers, and taluk hospitals.

(b) training of all the medical officers and other health professionals such as nurses and pharmacists of the district. (c) information, education, and communication (IEC) activities – posters, wall paintings in PHCs, IEC activities for schools, colleges, police personnel, judicial departments, elected representatives, faith healers, bus branding, radio talks, etc., In addition, sensitization of Anganwadi workers, accredited social health activists, auxiliary nurse midwives, police/prison staff, agriculture department/horticulture department/primary land development bank staff, village rehabilitation workers, staff of noncommunicable disease/revised National Tuberculosis Control Program, etc.. And (d) targeted interventions are being focused on life skills education and counseling in schools, college counseling services, workplace stress management, and suicide prevention services.

These initiatives have led to a phenomenal increase in patient footfalls to clinics [Figure 1] and >100,000 stakeholders are trained in various aspects of mental health (in the past 3 years).Figure 1. Chart showing the phenomenal increase in the number of footfalls covered over the past 3 yearsClick here to view Seamless Medication Availability The procurement has been streamlined. The state-level purchase is done by the Karnataka Drugs and Logistics Society, based on the indents collated from each of the districts, and then, sent to their respective district warehouses.

Individual indenters (taluk hospitals, community health centers, and primary health centers) then need to procure them from the district warehouses. The amount spent for the purpose has gone up drastically to INR 3 crores (30 million rupees) in the past financial year (2017–2018). However, further streamlining is possible in the sense that the delays can be further curtailed.

The Collaboration with the Karnataka State Wakf Board The WAKF board of Karnataka runs a “Darga” in south interior Karnataka. Thousands of persons with mental illnesses do come over here for religious cure. On a day of every week, the attendance crosses 10,000 footfalls.

Recently, the authorities have agreed to come up with an allopathic PHC inside the campus of the Darga. The idea is to have integrated and comprehensive care for patients without hurting their religious sentiments. Although such collaborative initiatives are spread across the country, this one is occurring at a larger scale with involvement of governmental agencies [Table 1].Table 1.

Details of the key developments and innovations in mental health care in IndiaClick here to view Research Initiatives Although excellent evidence-based studies have come out in community settings, actual involvement of government machinery in these kinds of initiatives is few and far. Their involvement is imperative for the evidence to become pragmatic and generalizable. Of course, by doing so, the methodological rigor compromises a bit.

NIMHANS and Government of Karnataka have been collaborating for such service-driven research initiatives for over a decade and a half. Community-based interventions are going on in three taluks – Thirthahalli, Turuvekere, and Jagaluru, wherein cohorts of severe mental disorders are being cared for. In addition, several research questions (of public health significance) are being answered.[6],[7] Exciting new initiatives are also underway.

Examining the magnitude of reduction of treatment gap by these community interventions, impact of care at doorsteps (CAD) services from the DMHP machinery, impact of technology-based mentoring program for DMHP staff, evaluation of the impact of tele-OCT, etc. Discussion and Future Directions All the above-mentioned activities in Karnataka take it beyond the Bellary model of DMHP. For example, the Memorandum of understanding (MOU) between NIMHANS and the state gives the flexibility and easy maneuverability for active collaboration.

Odisha is another state which has taken this path of MOU. This collaborative activity can be expanded pan India as there are several Centers of Excellence spread throughout India. Another aspect of the Karnataka story is collaborative research activity.

As described above, many activities going on across the state have the potential to inform public health policies. Karnataka has also been able to counter long-standing and well-known criticisms of DMHP/NMHP. For example, issues related to human resources, availability of medications, funding, mentoring and monitoring, and sustenance, etc., at least to an extent.

Of course, the state needs to do much more for mental health care. For example, compliance with Mental Health Care Act-2017. Handling unequal distribution of mental health human resources.

Rigorous involvement of local administration to tackle micro-level issues. Refining DMHP to suit special populations such as geriatric, children, and adolescents. And perinatal and upscaling urban DMHP, in areas such as Bengaluru Metropolitan City.

Another area for improvement is that the DMHP evaluation strategies should move beyond head counting and consider meaningful patient-related outcomes, including cost-effective analysis. Digital technology should further be exploited. The upcoming Karnataka Mental Healthcare Management System is a step in the right direction.[8] Finally, the DMHP should involve health and wellness centers to cater to the mental health needs, particularly for follow-up services, case detection, providing basic counseling, stress management, advocating lifestyle changes, relapse prevention strategies, and other preventive and promotive strategies.

References 1.Manjunatha N, Kumar CN, Chander KR, Sadh K, Gowda GS, Vinay B, et al. Taluk Mental Health Program. The new kid on the block?.

Indian J Psychiatry 2019;61:635-9. [PUBMED] [Full text] 2.Manjunatha N, Kumar CN, Math SB, Thirthalli J. Designing and implementing an innovative digitally driven primary care psychiatry program in India.

Indian J Psychiatry 2018;60:236-44. [PUBMED] [Full text] 3.Pahuja E, Santhosh KT, Fareeduzzafar, Manjunatha N, Kumar CK, Gupta R, et al. An impact of digitally-driven Primary Care Psychiatry Pr.

Indian J Psychiatry 2020;62 Suppl 1:S17. 4.Manjunatha N, Singh G. Manochaitanya.

Integrating mental health into primary health care. Lancet 2016;387:647-8. 5.Manjunatha N, Singh G, Chaturvedi SK.

Manochaitanya programme for better utilization of primary health centres. Indian J Med Res 2017;145:163-5. [PUBMED] [Full text] 6.Agarwal PP, Manjunatha N, Parthasarathy R, Kumar CN, Kelkar R, Math SB, et al.

A performance audit of first 30 months of Manochaitanya programme at secondary care level of Karnataka, India. Indian J Community Med 2019;44:222-4. [PUBMED] [Full text] 7.Kumar CN, Thirthalli J, Suresha KK, Arunachala U, Gangadhar BN.

Alcohol use disorders in patients with schizophrenia. Comparative study with general population controls. Addict Behav 2015;45:22-5.

8. Correspondence Address:Naveen Kumar ChannaveerachariDepartment of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka IndiaSource of Support.

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When Helene http://electronickitssite.com/how-to-avoid-monumental-stuff-ups/ Langevin was practicing medicine, many of her patients came to her for kamagra price comparison pain relief, and she had little to offer them. Curiosity led kamagra price comparison her to a nearby school for training in acupuncture.A few years later, Langevin transitioned to full-time research and began to study how acupuncture needles react to connective tissue.“I could feel with my hands that something was happening. I felt a resistance to the needle manipulation, and there was no explanation,” says Langevin, who’s now director of the National Center for Complementary and Integrative Health (NCCIH) at the National Institutes of Health.Acupuncture has been around for 3,000 years and comes from traditional Chinese medicine, which aims to prevent and treat health issues with mind and body practices.

The technique kamagra price comparison took hold in the U.S. When then-President Richard Nixon opened up relations with China, kamagra price comparison says Kimberly Henneman, a veterinarian who specializes in performance animals and uses the technique in her practice.Although not every person (or animal) responds to the technique, you’d be hard-pressed to find a condition that hasn’t been studied in connection with acupuncture, including low back pain, neck pain, knee pain from osteoarthritis, carpal tunnel, infertility, migraines, bedwetting, ADHD, nausea and vomiting.The body responds to acupuncture depending on where the needle is placed and how the area is stimulated, says Chi-Tsai Tang, a rehabilitation physician in the department of orthopedics at Washington University School of Medicine in St. Louis, MO.There are also different types of acupuncture.

Some techniques relax the muscle and surrounding fascia, a kind kamagra price comparison of connective tissue. Electroacupuncture, which is commonly used for pain relief, stimulates your body to release its own pain inhibitors, as well as an immune chemical that's normally released during exercise. Acupuncture also causes the release of local anti-inflammatory chemicals, and kamagra price comparison some research suggests it might even rewire the brain to produce long-term relief from conditions like carpal tunnel syndrome.All Creatures Great and SmallMany people might be surprised to learn that acupuncture is also sometimes used on animals.

As with people, not all kamagra price comparison animals respond to the treatment. Likewise, many animals dislike needles so much that it's not an option. But for some kamagra price comparison cooperative animals, it works well, saya Henneman.

€œYou will see profound relaxation at the time of treatment, or some will have a little check-out moment, and then kamagra price comparison all of a sudden, they are very energetic."Electroacupuncture in a middle-aged bomb detection dog who was starting to develop back pain and disk degeneration. This was done out on the sidewalk of the handler's agency while they were both on duty (with the dog unrestrained). It was summer and kamagra price comparison the dog was most comfortable outside.

(Credit. Kimberly Henneman)When she first started using acupuncture, Henneman kamagra price comparison says she got a lot of grief from local horse vets. Now, it’s common for veterinary schools to have an acupuncture specialist on staff.As with the technique in kamagra price comparison humans, there’s much discussion over where to place the needles, and whether location really matters.

If you’re familiar with the charts from traditional Chinese medicine showing an outline of the human body with needles jutting out along anatomical markers, veterinary acupuncture uses similar ancient charts.The technique has its skeptics in both human and animal practices. Needle placement is only one of the kamagra price comparison contentious issues. Researchers still haven’t kamagra price comparison connected the dots between mechanical stimulation of the needle and response to treatment.Veterinarian Kimberly Henneman performs acupuncture on a Clydesdale named Duffy in 2002.

(Credit. Tracy Turner)Under the MicroscopePrevious clinical trials on acupuncture (in humans) often didn’t include enough people and didn’t last long kamagra price comparison enough, according to Langevin. Acupuncture is also tricky to study in blinded, randomized controlled trials because designing a sham treatment to use on the control groups hasn’t been easy.

The feel of the needle going into the skin is distinctive, and both patients and practitioners would know the difference if they were kamagra price comparison being duped. This makes it kamagra price comparison easy for both parties to figure out whether they’re in the experimental or the sham group, which could influence results. Complicating matters even more, study participants receiving fake treatments also commonly report pain relief.

But whether that’s due to a placebo effect or something else has yet to be sorted out.“Some of the well-done studies don’t show that true acupuncture is better kamagra price comparison than sham [treatments] and that’s where a lot of issues come in,” says Tang.A 2012 review of many studies did show that people who got acupuncture over a control treatment experienced improvements to pain, but the effect was small. The researchers updated their work in a 2017 analysis based on data for more than 20,000 kamagra price comparison people and found a statistically significant difference between the acupuncture, sham and usual-care groups."Ten or 15 years ago, I was one of the people who would have said there’s no difference between real and sham acupuncture,” says Langevin. €œSince then, I think what it needed was a lot of data, because the response to acupuncture is variable, and we need big studies to see the effects.”Sticking PointsWhile the practice has won over a few skeptics, acupuncture is still a controversial treatment in the medical community.

Critics say that there aren’t enough solid kamagra price comparison studies to make the technique scientifically credible and often point to a 2017 review that picked apart a slew of acupuncture trials for a wide variety of conditions. After the review was published, Edzard Ernst — a former professor of complementary medicine at the University of Exeter and critic of the procedure — posted a commentary on his website, writing that “It would be hard to dispute the conclusion that there is no convincing evidence that acupuncture is an effective therapy, I believe.” The website Science-Based Medicine has several posts criticizing the insufficient evidence for the technique, as does Coyne of the Realm.But if acupuncture does work for pain, the benefits likely come from a combination of things — including the specific needling technique used, the amount of pressure applied on the body and the natural analgesic effects produced, along with other factors. There is also a placebo effect, says Tang.As to whether it matters where needles are placed on the body, Tang says this aspect is "less important than kamagra price comparison what people think it is.” Langevin agrees and says this dogma of acupuncture bugs her.

€œI have been one of the critics of the notion that there are specific points you are supposed to put the needle.” To help resolve the debate, Langevin is advocating for a reliable database kamagra price comparison that describes the exact anatomical location of the points, and the anatomical features that needles are interacting with. Such information could help researchers sort out whether there’s really something specific about applying needles to a particular location.“This thing about the points is dragging the field down,” says Langevin. €œIt’s been heavily criticized, and if that can get cleaned up it would go kamagra price comparison a long way to rehabilitate the image of acupuncture as something that’s scientific and rational, as opposed to pre-scientific.”BCAA supplements are considered one of the most essential products for improving muscle growth, recovery, and exercise capacity.

These types of supplements have such kamagra price comparison a positive impact, you'll find them in every serious athlete's supplement stash. They simply do wonders when it comes to helping you improve performance.But as you've probably already noticed, there are loads of supplements containing branched-chain amino acids (BCAAs) on the market. Due to the massive amount of products, finding the best and most effective product for you can be challenging.Our team of experts kamagra price comparison at M.D.

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But if you want our advice, choose a product from our list as you can't go wrong with them. Our top-rated product can be bought from HugeSupplements.An article reporting an increased risk of death when surgery is carried out on the surgeon's birthday has caused a Christmas controversy at the BMJ.The paper, "Patient mortality after surgery on the surgeon’s birthday. Observational study," was published December 10 in the BMJ's Christmas issue.Based on an analysis of nearly 1 million emergency surgical procedures carried out by 47,489 surgeons in the U.S., authors Hirotaka Kato et al.

Found that birthday surgeries had a mortality rate of 6.9 percent, compared to 5.6 percent for non-birthday procedures (p=0.03).The authors conclude. "These findings suggest that surgeons might be distracted by life events that are not directly related to work."But the BMJ has come in for criticism for publishing this study — or more specifically, for publishing it when they did. Physician Richard D.

Jenkins wrote a response to the paper, asking why it was published in the BMJ's traditionally light-hearted Christmas special edition."Slipping it out among papers talking about children mixing potions and previous editions that included losing teaspoons and recognising chocolate types diminishes the importance of data that could be used to improve patient care..."Jenkins is also unimpressed by the decision to illustrate the Kato et al. Paper with birthday cake images, saying this looks "more like cheap 'click bait' than reasoned discussion of patient mortality."In my view, the birthday mortality paper certainly does seem out of place in the Christmas special, where it appears between articles on whether monkeys can read x-rays and an interactive graphic based on a children's book.Getting the tone right for a light-hearted issue of a medical journal must be no easy task, but I agree with Jenkins that this paper was an error of judgement.This isn't the first time that sparks have flown over a BMJ holiday issue. Six year ago, I wrote about another BMJ Christmas upset, caused by an article which reported that praying for patients could improve their health retrospectively (i.e.

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Some of the erectile dysfunction treatments take advantage of mRNA technology, which essentially programs our cells to develop immune responses against erectile dysfunction.Others use kamagraes as delivery mechanisms for erectile dysfunction proteins to which your body develops an immune response. Both types have thus far been shown to be effective, but long-term safety will remain controversial when treatments are developed on such an expedited timeline.Lessons LearnedThis disease, which began in Wuhan, Hubei Province, China, and was first diagnosed in either November or December of 2019, is the perfect illustration of just how rapidly kamagraes spread in a connected world. We got previews of what could happen from the recent outbreaks of Ebola and Zika kamagra, but the spread of erectile dysfunction has been on a different level.

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When Helene Langevin was practicing medicine, many of her patients came how can i buy kamagra to her for pain relief, and she had little to offer them. Curiosity led her to a nearby school for training in acupuncture.A few years later, Langevin transitioned to full-time research and began to study how acupuncture needles react to connective how can i buy kamagra tissue.“I could feel with my hands that something was happening. I felt a resistance to the needle manipulation, and there was no explanation,” says Langevin, who’s now director of the National Center for Complementary and Integrative Health (NCCIH) at the National Institutes of Health.Acupuncture has been around for 3,000 years and comes from traditional Chinese medicine, which aims to prevent and treat health issues with mind and body practices. The technique took hold in the how can i buy kamagra U.S.

When then-President Richard Nixon opened up relations with China, says Kimberly Henneman, a veterinarian who specializes how can i buy kamagra in performance animals and uses the technique in her practice.Although not every person (or animal) responds to the technique, you’d be hard-pressed to find a condition that hasn’t been studied in connection with acupuncture, including low back pain, neck pain, knee pain from osteoarthritis, carpal tunnel, infertility, migraines, bedwetting, ADHD, nausea and vomiting.The body responds to acupuncture depending on where the needle is placed and how the area is stimulated, says Chi-Tsai Tang, a rehabilitation physician in the department of orthopedics at Washington University School of Medicine in St. Louis, MO.There are also different types of acupuncture. Some techniques relax the muscle how can i buy kamagra and surrounding fascia, a kind of connective tissue. Electroacupuncture, which is commonly used for pain relief, stimulates your body to release its own pain inhibitors, as well as an immune chemical that's normally released during exercise.

Acupuncture also causes the release of local anti-inflammatory chemicals, and some research suggests it might even rewire the brain how can i buy kamagra to produce long-term relief from conditions like carpal tunnel syndrome.All Creatures Great and SmallMany people might be surprised to learn that acupuncture is also sometimes used on animals. As with people, not all animals respond to the treatment how can i buy kamagra. Likewise, many animals dislike needles so much that it's not an option. But for some cooperative animals, how can i buy kamagra it works well, saya Henneman.

€œYou will see profound relaxation at the time of treatment, or some will have a little check-out moment, and then all how can i buy kamagra of a sudden, they are very energetic."Electroacupuncture in a middle-aged bomb detection dog who was starting to develop back pain and disk degeneration. This was done out on the sidewalk of the handler's agency while they were both on duty (with the dog unrestrained). It was summer and the dog was how can i buy kamagra most comfortable outside. (Credit.

Kimberly Henneman)When she first started using acupuncture, Henneman says she got a lot of grief how can i buy kamagra from local horse vets. Now, it’s common for veterinary schools to have how can i buy kamagra an acupuncture specialist on staff.As with the technique in humans, there’s much discussion over where to place the needles, and whether location really matters. If you’re familiar with the charts from traditional Chinese medicine showing an outline of the human body with needles jutting out along anatomical markers, veterinary acupuncture uses similar ancient charts.The technique has its skeptics in both human and animal practices. Needle placement is only one of the how can i buy kamagra contentious issues.

Researchers still haven’t connected the dots between mechanical stimulation of the needle and response to treatment.Veterinarian Kimberly Henneman performs acupuncture on how can i buy kamagra a Clydesdale named Duffy in 2002. (Credit. Tracy Turner)Under the MicroscopePrevious clinical trials on acupuncture (in humans) often didn’t include enough people and didn’t last long enough, according to Langevin how can i buy kamagra. Acupuncture is also tricky to study in blinded, randomized controlled trials because designing a sham treatment to use on the control groups hasn’t been easy.

The feel of the needle going how can i buy kamagra into the skin is distinctive, and both patients and practitioners would know the difference if they were being duped. This makes how can i buy kamagra it easy for both parties to figure out whether they’re in the experimental or the sham group, which could influence results. Complicating matters even more, study participants receiving fake treatments also commonly report pain relief. But whether that’s due to a placebo effect or something else has yet to be sorted out.“Some of the well-done studies don’t show that true acupuncture is better than sham [treatments] and that’s where a lot of issues come in,” says Tang.A 2012 review of many studies did show that people who got acupuncture over a control treatment experienced improvements to pain, how can i buy kamagra but the effect was small.

The researchers updated their work in a 2017 analysis based on data for more than 20,000 people and found a statistically significant difference between the acupuncture, sham and usual-care groups."Ten or 15 years ago, I was one of the people who would have said there’s no difference between real and sham how can i buy kamagra acupuncture,” says Langevin. €œSince then, I think what it needed was a lot of data, because the response to acupuncture is variable, and we need big studies to see the effects.”Sticking PointsWhile the practice has won over a few skeptics, acupuncture is still a controversial treatment in the medical community. Critics say that there aren’t enough solid studies to make the technique scientifically credible and often point to a 2017 review that picked apart a slew of acupuncture trials for a wide variety how can i buy kamagra of conditions. After the review was published, Edzard Ernst — a former professor of complementary medicine at the University of Exeter and critic of the procedure — posted a commentary on his website, writing that “It would be hard to dispute the conclusion that there is no convincing evidence that acupuncture is an effective therapy, I believe.” The website Science-Based Medicine has several posts criticizing the insufficient evidence for the technique, as does Coyne of the Realm.But if acupuncture does work for pain, the benefits likely come from a combination of things — including the specific needling technique used, the amount of pressure applied on the body and the natural analgesic effects produced, along with other factors.

There is also a placebo effect, says Tang.As to whether it matters where needles are placed on the body, Tang says this aspect is "less important than what people think how can i buy kamagra it is.” Langevin agrees and says this dogma of acupuncture bugs her. €œI have been one of the critics of the notion that there are specific points you are supposed to put the needle.” To help resolve the debate, Langevin is advocating for a reliable database that how can i buy kamagra describes the exact anatomical location of the points, and the anatomical features that needles are interacting with. Such information could help researchers sort out whether there’s really something specific about applying needles to a particular location.“This thing about the points is dragging the field down,” says Langevin. €œIt’s been heavily criticized, how can i buy kamagra and if that can get cleaned up it would go a long way to rehabilitate the image of acupuncture as something that’s scientific and rational, as opposed to pre-scientific.”BCAA supplements are considered one of the most essential products for improving muscle growth, recovery, and exercise capacity.

These types of supplements have such a positive impact, you'll find them in every serious how can i buy kamagra athlete's supplement stash. They simply do wonders when it comes to helping you improve performance.But as you've probably already noticed, there are loads of supplements containing branched-chain amino acids (BCAAs) on the market. Due to the massive amount of products, finding the best and most effective product for you can be how can i buy kamagra challenging.Our team of experts at M.D. Marketing have extensively tested most options on the market and evaluated which products are the best BCAA supplements.

You won't have to waste any time, money, or how can i buy kamagra resources trying to evaluate dozens of products - we've done it for you. Top 5 Best BCAA Powder how can i buy kamagra Supplements RevealedIt's time to introduce you to our top 5 best BCAA powder supplements. These products are the most stacked, most effective, and best bang for your buck. Our top 5 is ranked by the grams per scoop to show you how much how can i buy kamagra active ingredients each contains.1. Huge BCAA – 19.4 grams per scoop.

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Alpha Amino how can i buy kamagra by CellucorThe second BCAA supplement we stand by is Cellucor's Alpha Amino. It's a well-known product that has been designed to help accelerate recovery how can i buy kamagra and muscle growth. Each scoop of Alpha Amino provides a total of 12.8 grams, of which 5 grams are branched-chain amino acids. Not as much as our top pick, but still a substantial amount.Why it's #2 on our list:● Produced by a well-known supplement company.● It contains several types of Electrolytes.● It doesn't have any calories or sugar.● Designed to help optimize your performance.● Provides 5000mg of branched-chain amino acids.● Available in different tasty flavors.With this option, you'll stay hydrated during your workouts, and the product will make how can i buy kamagra sure to maximize your recovery.

You can find Alpha Amino for sale on platforms how can i buy kamagra such as Amazon and other sports supplement retailers.#3. Xtend Sport by ScivationAnother excellent BCAA supplement that has landed the third spot on our list is Xtend Sport by Scivation. Chances are that you've come across this how can i buy kamagra product since it's well-known amongst athletes. It's often consumed during workouts by athletes to help them stay hydrated, pumped, and on top of their game.

Why it's #3 on our list:● It holds how can i buy kamagra 7 grams of BCAAs per serving.● Comes in several flavors.● Tested and trusted by third parties.● Calorie and sugar-free.● Focuses on improving muscle recovery.Xtend Sport contains a solid amount of amino acids that will positively impact your muscles' recovery process. Each tub of this how can i buy kamagra product holds 30 servings. Since Scivation's XTend is a relatively popular supplement, many online retailers carry it. #4.

BCAA5000 by Evlution NutritionThe next product we have lined up is BCAA500 by Evlution Nutrition. It's often used by athletes looking to improve muscle mass, endurance, and recovery naturally. Simply mix a scoop of this product with water and consume it before or during your workout, and you'll be reaping the benefits.Why it's #4 on our list:● Uses the science-backed 2:1:1 ratio of branched-chain amino acids.● It helps with preserving lean muscle mass.● This supplement contains 5 grams of premium BCAAs per scoop.● It helps fuel the muscles and prevents fatigue.● Free of gluten and tastes excellent. You've probably noticed that there are just 5 grams of amino acids in this product, which is less than the others mentioned on our list.

However, that doesn't mean it's not a good product as it will still help with improving recovery and other aspects of your training.Let's move onto the final product that is featured in our article.#5. Naked BCAAs by Naked NutritionWe're finishing this top 5 with Naked BCAAs by Naked Nutrition. If you're a vegan, this is the perfect option for you. Holding only pure, vegan branched-chain amino acids, this product doesn't contain any useless fillers whatsoever.

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Whether you are new to working out or an experienced athlete, this stuff is great. We are massive fans of these amino acids simply because they've got a lot of data to prove their effectiveness. It's one of the main reasons we've written this article, to show our audience that there are, in fact, natural supplements that can help.Our recommendation would be to go with Huge BCAA powder since it holds the most aminoacids. It also contains other ingredients that will help with recovery and muscle growth.The Final VerdictThere are many BCAA supplements on the market, but we've managed to bring it down to just a handful of products through extensive research and testing.

Our top 5 best BCAA powders consist of only the best quality products to help take your training and physique to a new level. Of course, there are other useful products out there besides the ones we have mentioned. It's essential to do your research on the ingredients in any supplement to be sure of their efficacy. But if you want our advice, choose a product from our list as you can't go wrong with them.

Our top-rated product can be bought from HugeSupplements.An article reporting an increased risk of death when surgery is carried out on the surgeon's birthday has caused a Christmas controversy at the BMJ.The paper, "Patient mortality after surgery on the surgeon’s birthday. Observational study," was published December 10 in the BMJ's Christmas issue.Based on an analysis of nearly 1 million emergency surgical procedures carried out by 47,489 surgeons in the U.S., authors Hirotaka Kato et al. Found that birthday surgeries had a mortality rate of 6.9 percent, compared to 5.6 percent for non-birthday procedures (p=0.03).The authors conclude. "These findings suggest that surgeons might be distracted by life events that are not directly related to work."But the BMJ has come in for criticism for publishing this study — or more specifically, for publishing it when they did.

Physician Richard D. Jenkins wrote a response to the paper, asking why it was published in the BMJ's traditionally light-hearted Christmas special edition."Slipping it out among papers talking about children mixing potions and previous editions that included losing teaspoons and recognising chocolate types diminishes the importance of data that could be used to improve patient care..."Jenkins is also unimpressed by the decision to illustrate the Kato et al. Paper with birthday cake images, saying this looks "more like cheap 'click bait' than reasoned discussion of patient mortality."In my view, the birthday mortality paper certainly does seem out of place in the Christmas special, where it appears between articles on whether monkeys can read x-rays and an interactive graphic based on a children's book.Getting the tone right for a light-hearted issue of a medical journal must be no easy task, but I agree with Jenkins that this paper was an error of judgement.This isn't the first time that sparks have flown over a BMJ holiday issue. Six year ago, I wrote about another BMJ Christmas upset, caused by an article which reported that praying for patients could improve their health retrospectively (i.e.

Prayer could change the past.)erectile dysfunction, the kamagra that causes the respiratory illness erectile dysfunction treatment, has killed approximately 2.2% of those worldwide who are known to have contracted it. But the situation could be a lot worse without modern medicine and science.The last such global scourge was the influenza kamagra of 1918, which is estimated to have killed 50 million people at a time when there was no internet or easy access to long-distance telephones to disseminate information. Science was limited, which made it difficult to identify the cause and initiate treatment development. The world is 100% more prepared for the current kamagra than it was 100 years ago.

However, it has still affected our lives profoundly.I am a physician scientist who specializes in the study of kamagraes and runs a microbiology laboratory that tests for erectile dysfunction s. I’ve seen firsthand patients with severe erectile dysfunction treatment illness and have dedicated myself to developing diagnostics for this disease. It’s a remarkable testament to science that a novel disease-causing kamagra has been discovered, the genetic material completely decoded, new therapies created to fight it and multiple safe and effective treatments developed all within the span of a year – an accomplishment that the journal Science has pegged the breakthrough of 2020.Most treatments take 10-15 years to develop. Until now the fastest treatment developed was against the mumps kamagra, which took four years.

Now, in the midst of the erectile dysfunction kamagra, one treatment is already authorized for use in the U.S., with a second close behind. Other treatments have already been rolled out in countries across the globe.Science Fast-TrackedThis kamagra put science front and center. One of the most significant scientific advances in the past 15 years has been the ability to read the genetic instructions – or genome – that encode kamagraes. The process of sequencing the genome of a kamagra is called next generation sequencing, and it has revolutionized science by allowing researchers to rapidly decode the genome of a kamagra or bacterium, quickly and cost-effectively.

This strategy was used to determine the sequence of erectile dysfunction early in January 2020 before epidemiologists even recognized that it had already spread around the world. Obtaining the sequence allowed for the rapid development of diagnostics for erectile dysfunction and to figure out who was infected and how the kamagra might spread.SARS-CoV erectile dysfunction was responsible for an outbreak that spanned 2002-2004, but was not particularly contagious and was limited mostly to Southeast Asia.erectile dysfunction has evolved two separate qualities that allow it to spread more easily. First, it has an enormous potential for triggering asymptomatic s, in which the kamagra infects carriers who don’t experience symptoms and may never know they are infected and transmitting the kamagra to others.Second, it can spread via aerosolized particles. Most of these kamagraes spread via large respiratory droplets, which are visible and fall out of the air within three to six feet.

But erectile dysfunction can also spread through airborne transmission via much smaller particles that remain in the air for several hours.While in 1918 people went on blind faith that masking reduced transmission, this time around, science provided us with concrete answers. There have been several studies demonstrating the efficacy of masking. These types of studies inform the public that mask-wearing, social distancing, hand-washing and limiting crowd sizes decrease circulating kamagra and thus reduce hospitalizations and death. While they don’t get much fanfare, these studies are among the most important discoveries in response to this kamagra.Science Aids DiagnosticsMany tests for the kamagra are performed using PCR, which is short for polymerase chain reaction.

This method uses specialized proteins and kamagra-matching DNA sequences called primers to create more copies of the kamagra. These additional copies allow PCR machines to detect the presence of the kamagra. Doctors can then tell you if you are infected. Because of the availability of the kamagra’s genome sequence, any researcher can design primers that match the kamagra to develop a diagnostic test.Early on, the World Health Organization developed a PCR test to detect the kamagra and disseminated instructions on how to use it to researchers and physicians around the globe.This was a remarkable achievement that allowed countries across the world to rapidly develop diagnostic tests using this template.

This distribution changed the course of the kamagra in many countries.Treatments Have Lowered Mortality RatesTreatments for infectious diseases often evolve over time. There is no treatment yet for hepatitis C, but over recent years treatments have evolved from those that make you very ill to those that are highly efficacious with few side effects.We are now seeing similar things in the erectile dysfunction kamagra, just on an accelerated timeline. With the aid of clinical studies, we now have treatments such as steroids, antiviral medications like Remdesivir and infusions of antibodies. Physicians also know how to alter a patient’s position in ways that increase the chance of survival.treatment Development Could End kamagraThis kamagra could end if the kamagra swept through the population killing millions but leaving the survivors with natural immunity.

More likely the kamagra will snuff itself out when most of the population has been vaccinated with a erectile dysfunction treatment. That is especially true in parts of the world where frequent testing and public health strategies are difficult to implement.It took many years to develop an influenza treatment, with the first available in 1942. Other successes with smallpox and polio, and more recent ones like HPV and Haemophilus influenzae Type b, have provided blueprints for treatment development.Governments across the world have partnered with private companies to expedite the development of erectile dysfunction treatments. This has led to multiple different companies developing their own different versions of treatments.

Normally, these take years to develop. However, by leveraging recent successes and accumulated knowledge, the timeline was accelerated significantly. Normally, new treatments go through phase 1 (safety), phase 2 (efficacy) and phase 3 (comparison) trials, but as demonstrated in the current trials, phases 2 and 3 can be combined for expediency. And large-scale manufacturing can begin when the treatment is still in trials, potentially cutting years off the timeline.Technology is at the forefront of the development of these treatments.

Some of the erectile dysfunction treatments take advantage of mRNA technology, which essentially programs our cells to develop immune responses against erectile dysfunction.Others use kamagraes as delivery mechanisms for erectile dysfunction proteins to which your body develops an immune response. Both types have thus far been shown to be effective, but long-term safety will remain controversial when treatments are developed on such an expedited timeline.Lessons LearnedThis disease, which began in Wuhan, Hubei Province, China, and was first diagnosed in either November or December of 2019, is the perfect illustration of just how rapidly kamagraes spread in a connected world. We got previews of what could happen from the recent outbreaks of Ebola and Zika kamagra, but the spread of erectile dysfunction has been on a different level. It has underscored that when we receive warnings about contagious kamagraes, rapid and decisive action must be taken in all parts of the world to reduce its spread.Where there is more strict compliance with public health policies, there have been profound reductions in kamagra transmission.While the research that has made all this possible might fly under the radar right now, history will record this time as one of the greatest periods for scientific advancements.David Pride is an Associate Director of Microbiology, University of California San Diego.

This article is republished from The Conversation under a Creative Commons license. Read the original article..

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