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Westchester continues to see an uptick in new hypertension medications cases as the lasix for sale online lasix continues rapidly spreading in the region and http://unitedpunjabisofamerica.org/cheap-lasix-online/ across the state. On Tuesday, Nov. 10, the county Department of Health was reporting 251 newly confirmed lasix for sale online cases as the number of people actively infected with the lasix climbed to 1,785. In recent days, Westchester and the Hudson Valley has seen a dramatic spike in cases and rates, with hundreds being confirmed in the area.In Westchester, the daily positive hypertension medications rate for those tested has jumped from 2.5 percent to 4.4 percent in the past week, though the rest of the country and some neighboring states have seen drastically more dramatic spikes in new cases.In the past week, the average rolling rate in those tested for hypertension medications in Westchester has risen to 3 percent of all those tested, with the 14-day average reaching 2.5 percent.Since the lasix began, there have been 920,406 hypertension medications tests administered in Westchester, with 42,696 testing positive.

The positivity rate in Westchester has dropped to 4.6 percent during the lasix.There were five new hypertension medications-related deaths, as the total jumped to 1,480 in Westchester since March.According to the Department of Health, the statewide positivity rate in the “micro-clusters” has risen to 5.59 percent, while outside of those highly concentrated hypertension medications hotspots is at 2.56 percent, outpacing the numbers the state put up over the summer as New York sought to “flatten the curve.” A breakdown of total, active, and new hypertension medications in Westchester municipalities on Nov. 10, according lasix for sale online to the Department of Health. Yonkers. 8,690 (317 active, 37 new);New Rochelle.

3,869 (202, 24 new);Mount Vernon lasix for sale online. 3,143 (109, 17 new);White Plains. 2,188 (107, 8 new);Port Chester. 1,605 (140, 17 new);Greenburgh lasix for sale online.

1,424 (55, 9 new);Ossining Village. 1,249 (65, 7 new);Peekskill. 1,216 (73, lasix for sale online 9 new);Cortlandt. 1,103 (48, 10 new);Yorktown.

949 (48, 8 lasix for sale online new);Mount Pleasant. 738 (43, 7 new);Mamaroneck Village. 600 (40, 5 new);Eastchester. 525 (26, lasix for sale online 10 new);Sleepy Hollow.

544 (29, 5 new);Harrison. 572 (58, 8 new);Somers. 517 (28, 4 new);Scarsdale lasix for sale online. 420 (9, 2 new);Dobbs Ferry.

389 (24, 4 new);Tarrytown. 364 (13, 4 new);Mount lasix for sale online Kisco. 367 (32, 2 new);Bedford. 364 (27, 8 new);New Castle.

302 (30, lasix for sale online 3 new);Rye City. 298 (22, 4 new);North Castle. 290 (37, 3 lasix for sale online new);Elmsford. 240 (17, 3 new)Croton-on-Hudson.

233 (7, 2 new);Rye Brook. 246 (20, 4 lasix for sale online new);Mamaroneck Town. 225 (20, 3 new);Pelham. 204 (13, 3 new);North Salem.

198 (9, 1 new);Ossining Town lasix for sale online. 181 (5, 1 new);Pleasantville. 180 (7, 3 new);Tuckahoe. 167 (13);Hastings-on-Hudson lasix for sale online.

165 (9, 2 new);Lewisboro. 165 (14, 3 new);Pelham Manor. 154 (12, lasix for sale online 2 new);Briarcliff Manor. 147 (10);Ardsley.

129 (11, 1 new);Irvington. 112 (5, 1 lasix for sale online new);Bronxville. 109 (10);Larchmont. 105 (9, lasix for sale online 4 new);Buchanan.

59 (7, 2 new);Pound Ridge. 49 (4, 1 new).In the past 24 hours, there have been 128,036 hypertension medications tests administered in New York, with 3,965 (3.09 percent) testing positive. Hospitalizations are lasix for sale online up from 1,321 to 1,548, and there were 32 new lasix-related fatalities reported, the most since the lasix peaked.Statewide, there have been 15,904,266 New Yorkers tested for hypertension medications, resulting in 536,145 positive tests. A total of 26,005 have died from hypertension medications since the outbreak began in early March.

Click here to sign up for Daily Voice's free daily emails and news alerts.Update:A 28-year-old woman who went missing in Fairfield County has been found.Rebeckah Glazebrook was last seen in Darien on Monday, Nov. 9 around lasix for sale online 5 p.m. Near the intersection of Christie Hill and Hollow Tree Ridge roads, Darien Police said. On Tuesday afternoon, Nov.

10, police lasix for sale online announced she "returned home safely."Original report:A 28-year-old woman has gone missing in Fairfield County and authorities are asking the public's help in locating her.Rebeckah Glazebrook was last seen in Darien on Monday, Nov. 9 around 5 p.m. Near the intersection of Christie Hill and Hollow Tree Ridge roads. At the time she was last seen, she was wearing black tights and possibly a baseball cap, Darien Police said.She is 5-foot-10 with long blond hair and blue eyes and a thin build, police said.She may be in need of medication for a health condition, according to police.If seen, please contact the Darien Police Department (203-662-5300) or your local law enforcement agency.Share this story lasix for sale online by clicking on the Facebook icon below.Check back to Daily Voice for updates.

Click here to sign up for Daily Voice's free daily emails and news alerts.Westchester-based Nestlé has pledged nearly a billion dollars to expand its packaged food delivery options for customers.Nestlé announced that it has closed a deal to acquire Freshly, a meal delivery service that operates across the country, for $950 million, and could pay an additional $550 million if Freshly hits certain growth targets and benchmarks.Founded in 2015, Freshly delivers a menu of fresh, chef-cooked meals to customers that “break down the barriers to healthy eating by delivering nutrition and convenience at scale,” the company announced.Freshly currently ships more than a million meals per week.“Consumers are embracing e-commerce and eating at home like never before. It's an evolution brought on by the lasix but taking hold for the long term,” lasix for sale online Nestlé Chairman and CEO Steve Presley said about the deal. €œFreshly is an innovative, fast-growing, food-tech startup, and adding them to the portfolio accelerates our ability to capitalize on the new realities in the U.S. Food market and further positions Nestlé to win in the future.” By acquiring Freshly, officials said Nestlé is looking to compete with meal kit subscriptions like Blue Apron and HelloFresh, though Freshly doesn’t require any of the preparation or cooking that those meal kits require.“Our mission is to make eating healthy easy by bringing nutritious, high quality meals directly to customers' homes,” Freshly CEO Michael Wystrach added.

€œConvenience and nutrition are driving forces in the future of food, and our becoming a part of the world's largest food company confirms that.”With the sale complete, Wystrach said that business operations around Freshly will remain unchanged, and the acquisition will not change the company’s meals, pricing or subscription lasix for sale online rates. €œFreshly will continue to operate as a standalone business to accomplish our core mission to remove the barriers to healthy eating with convenient, nutritious and delicious meal solutions, backed by the power of Nestlé to open new doors for a fresher, faster food delivery to your door,” he said.“We will continue to maintain our own strict standards and maintain complete control of our products,” Wystrach added. €œOur meals will not be changing, and there are no plans to change ingredients or integrate Nestlé products into Freshly meals, but we are excited about potential opportunities for the future.”Nestlé previously purchased a 16 percent stake in Freshly in 2017 as a “strategic move to test the burgeoning market,” the company noted. Freshly is lasix for sale online expected to sell more than $430 million worth of kits in 2020, officials said.“With the acquisition of Freshly we are strengthening our position in the U.S.

And expanding our ability to deliver a wide variety of delicious food to our consumers when and where they want,” Nestlé CEO Zone Americas Laurent Freixe said in a statement following the announcement of the sale. €¨â€œWhether purchasing our products from the comfort of their homes, in retail stores or through social commerce, we will continue to provide them with unbeatable convenience, choice and ease of purchase." Click here to sign up for Daily Voice's free daily emails and news alerts.A 26-year-old Westchester man has been indicted on a murder charge after admitting to strangling his mother unconscious earlier this year.Daniel Flores Arteaga, of New Rochelle, has been indicted and charged with second-degree murder, a violent felony, for allegedly strangling his mother, who taken off life support in April after being attacked.Westchester County District Attorney Anthony Scarpino, Jr., said that at approximately 1:30 p.m. On Tuesday, March 17, members of the New Rochelle Police Department responded to Sound Street, where there was a report of a son who had attacked his mother.Upon arrival, Scarpino said that officers found Flores Arteaga at the lasix for sale online scene with his mother unconscious on the floor. Flores Arteaga told investigators that he had strangled his mother, though no reason for the attack has been provided.Flores Arteaga’s mother was rushed to the hospital, where she was placed on life support.

She was removed from life support on Thursday, March 26, and pronounced dead.Flores Arteaga appeared in Westchester County Court via a video conference arraignment. He remains remanded without lasix for sale online bail and is scheduled to make another court appearance on Monday, Nov. 30. Click here to sign up for Daily Voice's free daily emails and news alerts..

Furosemide lasix side effects

A new type of breast cancer drug developed by researchers at the University of Illinois Chicago can help halt furosemide lasix side effects progression of disease and is not toxic, according to phase 1 Where can you buy propecia clinical trials. The drug is specifically designed for women whose cancer has stopped responding to hormone therapy.The results are published in the journal Breast Cancer Research and Treatment.Breast cancer affects one in eight women in the United States, and while there are many types of breast cancer, around furosemide lasix side effects 80% are categorized as estrogen receptor-positive, or ER-positive. This means the cancer cells have receptors -- molecules that can receive signals from chemicals in the body -- that are sensitive to and react to the hormone estrogen.In the case of ER-positive breast cancer, this means that estrogen fuels cancer growth. To treat this type of breast cancer, doctors prescribe medication to block hormone production in the body or interfere with the effect furosemide lasix side effects hormones have on cancer cells. This type of treatment is called hormone therapy.

However, nearly half of women treated with hormone therapy become resistant, leaving traditional chemotherapy and its side effects as the only furosemide lasix side effects option for treatment."While there are many treatments for breast cancer, about half of women with ER-positive cancers become resistant to hormone therapy, leaving them with few treatments other than chemotherapy, with its well-known toxic side effects," said Debra Tonetti, professor of pharmacology at the UIC College of Pharmacy and an author on the paper.Tonetti, together with Gregory Thatcher, the Hans W. Vahlteich Chair of medicinal chemistry at furosemide lasix side effects UIC and co-author on the paper, developed the new drug, called TTC-352. Preclinical studies showed that TTC-352, which is a selective human estrogen receptor partial agonist, causes complete tumor regression, but unlike tamoxifen, may pose a reduced risk of uterine cancer development.In the phase 1 clinical trial, 15 women who had metastatic breast cancer and previously were treated with several rounds of hormone therapy and, in some cases, chemotherapy including a CDK4/6 inhibitor, were enrolled. The researchers furosemide lasix side effects found that there were no toxic side effects, even at the highest doses.In total, six patients experienced stable disease with a lack of disease progression. Two for 6 months and four for 3 months."This is very encouraging because these participants were at an advanced stage of their disease, and we saw that their cancers stopped growing for a significant amount of time," said Tonetti, who is also a member of the University of Illinois Cancer Center.The doses given to participants were in line with what the researchers believe are therapeutic levels -- in other words, participants received doses equivalent with what patients would be given to treat their disease."The results of the phase 1 trial indicate that TTC-352 is a safe and tolerable alternative to chemotherapy -- therefore, without the side effects of chemotherapy -- for patients who have already been treated with hormone therapy," Thatcher said. Story Source: Materials provided by University of Illinois at Chicago.

Note. Content may be edited for style and length..

A new type of breast cancer drug developed by researchers at the University of Illinois Chicago can help halt progression lasix for sale online of disease and is not toxic, according to phase 1 clinical trials. The drug is specifically designed for women whose cancer has stopped responding to hormone therapy.The results are published in the journal Breast Cancer Research and Treatment.Breast cancer affects one in lasix for sale online eight women in the United States, and while there are many types of breast cancer, around 80% are categorized as estrogen receptor-positive, or ER-positive. This means the cancer cells have receptors -- molecules that can receive signals from chemicals in the body -- that are sensitive to and react to the hormone estrogen.In the case of ER-positive breast cancer, this means that estrogen fuels cancer growth.

To treat this type of breast cancer, doctors prescribe medication to block hormone production in the body or interfere with the effect hormones have on cancer lasix for sale online cells. This type of treatment is called hormone therapy. However, nearly half of women treated with hormone therapy become resistant, leaving traditional chemotherapy and its side effects as the only option for treatment."While there are lasix for sale online many treatments for breast cancer, about half of women with ER-positive cancers become resistant to hormone therapy, leaving them with few treatments other than chemotherapy, with its well-known toxic side effects," said Debra Tonetti, professor of pharmacology at the UIC College of Pharmacy and an author on the paper.Tonetti, together with Gregory Thatcher, the Hans W.

Vahlteich Chair lasix for sale online of medicinal chemistry at UIC and co-author on the paper, developed the new drug, called TTC-352. Preclinical studies showed that TTC-352, which is a selective human estrogen receptor partial agonist, causes complete tumor regression, but unlike tamoxifen, may pose a reduced risk of uterine cancer development.In the phase 1 clinical trial, 15 women who had metastatic breast cancer and previously were treated with several rounds of hormone therapy and, in some cases, chemotherapy including a CDK4/6 inhibitor, were enrolled. The researchers found that there were no toxic side effects, even at the highest doses.In total, lasix for sale online six patients experienced stable disease with a lack of disease progression.

Two for 6 months and four for 3 months."This is very encouraging because these participants were at an advanced stage of their disease, and we saw that their cancers stopped growing for a significant amount of time," said Tonetti, who is also a member of the University of Illinois Cancer Center.The doses given to participants were in line with what the researchers believe are therapeutic levels -- in other words, participants received doses equivalent with what patients would be given to treat their disease."The results of the phase 1 trial indicate that TTC-352 is a safe and tolerable alternative to chemotherapy -- therefore, without the side effects of chemotherapy -- for patients who have already been treated with hormone therapy," Thatcher said. Story Source: Materials provided by University of Illinois at Chicago. Note. Content may be edited for style and length..

What is Lasix?

FUROSEMIDE is a diuretic. It helps you make more urine and to lose salt and excess water from your body. Lasix is used to treat high blood pressure, and edema or swelling from heart, kidney or liver disease.

Intravenous lasix

At a How to get a diflucan prescription from your doctor glance intravenous lasix. Medicare health insurance in Nevada Medicare enrollment in NevadaAs of mid-2020, there were 545,535 people enrolled in Medicare in Nevada, amounting to about 17 percent of the state’s population.[/hio_question] Most Americans become eligible for Medicare enrollment when they turn 65. But Medicare eligibility is also triggered for younger people if they’re disabled and have been receiving disability benefits for 24 months (people with ALS or end-stage intravenous lasix renal disease do not have to wait 24 months for their Medicare coverage to begin). In Nevada, 13 percent of Medicare beneficiaries are under the age of 65 and eligible for Medicare due to a disability rather than age. Nationwide, 15 percent of all Medicare beneficiaries — nearly 10 million people — are eligible due intravenous lasix to disability.

Medicare Advantage in NevadaIn most areas of the United States, private Medicare Advantage plans are available as an alternative to Original Medicare.In 2019, some of Nevada’s counties had no Medicare Advantage plans available for purchase (Nevada has 16 counties plus Carson City, and only nine of them had Medicare Advantage plans available in 2019). But all areas of Nevada have Medicare Advantage plans available in 2020, with intravenous lasix the addition of Lasso Healthcare, which entered the market in Nevada with an MSA plan. Plan availability in 2020 ranges from just one plan (from Lasso Healthcare) in several counties, to 36 plans in Clark County.But the counties that didn’t have Advantage plans available prior to 2020 tend to have very low populations. Despite the intravenous lasix fact that nearly half of Nevada’s counties had no Medicare Advantage plans for sale, 35 percent of the state’s Medicare beneficiaries were enrolled in Medicare Advantage plans as of 2018 — compared with 34 percent nationwide. And by July 2020, the number of people enrolled in private Medicare plans in Nevada stood at 219,979 people, which was 40 percent of the state’s total Medicare coverage enrollment.

The other 325,556 beneficiaries had intravenous lasix Original Medicare. Between August 2019 and July 2020, Medicare Advantage enrollment in Nevada increased by 19,000 people, whereas Original Medicare enrollment decreased by nearly 7,000 people.People who enroll in Original Medicare get their coverage directly from the federal government, and have access to a nationwide network of providers. But Original Medicare enrollees need supplemental coverage intravenous lasix (from an employer-sponsored plan, Medicaid, or privately purchased plans) for things like prescription drugs and out-of-pocket costs.Original Medicare includes Medicare Part A (hospital inpatient services) and Part B (outpatient services). Medicare Advantage includes all of the benefits of Medicare Parts A and B, and the plans usually also have additional benefits, such as integrated Part D prescription drug coverage, dental and vision coverage, and extra programs like gym memberships and a 24-hour nurse hotline. But provider intravenous lasix networks and service areas are limited with Medicare Advantage, and out-of-pocket costs (deductible, copays, and coinsurance) are often higher than they would be under Original Medicare plus a Medigap plan.

There are pros and cons to either option, and no single solution that works for everyone.Medicare’s annual election period (October 15 to December 7 each year) allows Medicare beneficiaries opportunities to switch between Medicare Advantage enrollment and Original Medicare (and add, drop, or change to a different Medicare Part D prescription plan). Medicare Advantage enrollees also have the option to switch to a different Advantage plan or to Original Medicare during the Medicare Advantage open enrollment period, which runs from January 1 to March 31 (only one plan change may be made during this window).Medigap in NevadaOriginal Medicare does not limit out-of-pocket costs, so most enrollees maintain some form of supplemental coverage. More than half of Original Medicare beneficiaries get their supplemental coverage through an employer-sponsored intravenous lasix plan or Medicaid. But for those who don’t, Medigap plans (also known as Medicare supplement plans) will pay some or all of the out-of-pocket costs (deductible and coinsurance) they would otherwise have to pay if they had only Original Medicare.Medigap plans are sold by private insurance companies, but the plans are standardized under federal rules. There are ten different plan designs (differentiated by letters, A through N), and intravenous lasix the benefits covered by a particular plan (Plan G, Plan K, etc.) are the same regardless of which insurer sells the plan.

This makes it easier for consumers to compare plans and make their choice based on factors such as price and customer service, knowing that the coverage will be the same regardless of which insurance company will provide the plan.32 insurance companies offer Medigap plans in Nevada as of 2020. Nearly all of them use attained age rating, intravenous lasix which means that individual enrollees’ monthly premiums increase as they get older, regardless of how old they were when they purchased the policy. According to an AHIP analysis, 95,795 Nevada residents were enrolled in Medigap coverage as of 2018.Unlike other private Medicare coverage (Medicare Advantage and Medicare Part D plans), there is no annual open enrollment window for Medigap plans. Instead, federal rules provide a intravenous lasix one-time six-month window when Medigap coverage is guaranteed-issue. This window starts when a person is at least 65 and enrolled in Medicare Part B (you must be enrolled in both Part A and Part B to buy a Medigap plan).

It’s essential to purchase coverage in intravenous lasix a timely fashion during this window. If you apply for a Medigap plan after it ends, the insurance companies are allowed to use medical underwriting to determine your eligibility for coverage and your monthly premium.People who aren’t yet 65 can enroll in Medicare if they’re disabled and have been receiving disability benefits for at least two years, or if they have ALS or end-stage renal disease. 13 percent of intravenous lasix Nevada Medicare beneficiaries are under age 65. But federal rules do not guarantee access to Medigap plans for people who are under 65. The majority of the states have implemented rules to ensure that disabled Medicare beneficiaries have at least some access to Medigap plans, but Nevada is not one of them.Nevada does not require Medigap insurers to offer coverage intravenous lasix to people under age 65.

As of 2020, Nevada’s Medigap guide indicates that there is one insurer that offers Medigap Plan A to beneficiaries under the age of 65, but Medicare’s plan finder tool indicates that no insurers actually do so (in previous years, Transamerica Life Insurance Company offered Medigap Plan A to enrollees under 65 in Nevada—albeit at a higher premium—but that appears to no longer be the case). The Nevada Division of Insurance confirmed in 2018 that there are no other supplemental coverage options for under-65 Medicare enrollees (ie, no state-run high-risk pool or similar program). But Medicare beneficiaries who are under age 65 do have the option to enroll in any available Medicare Advantage plan offered in their area, unless they have end-stage renal disease (as of 2021, people will be able to enroll in Medicare Advantage plans even if they have end-stage renal disease).Although there do not appear to be any Medigap plans available to people under 65 in Nevada, those individuals gain access to all intravenous lasix of the available Medigap plans when they turn 65. At that point, they have the normal six-month open enrollment period for Medigap.Although the Affordable Care Act eliminated pre-existing condition exclusions in most of the private health insurance market, those rules don’t apply to Medigap plans. Medigap insurers can impose a pre-existing condition waiting period of up to six months if you didn’t have intravenous lasix at least six months of continuous coverage prior to your enrollment.

And if you apply for a Medigap plan after your initial enrollment window closes (assuming you aren’t eligible for one of the limited guaranteed-issue rights), the Medigap insurer can consider your medical history in determining whether to accept your application, and at what premium. Nevada Medicare Part DOriginal Medicare does not provide coverage for outpatient prescription drugs intravenous lasix. More than half of Original Medicare beneficiaries have supplemental medical coverage via an employer-sponsored plan (from a current or former employer or spouse’s employer) or Medicaid, and these plans often include prescription coverage.But Medicare beneficiaries who do not have drug coverage through Medicaid or an employer’s insurance plan need to obtain Medicare Part D prescription coverage. It can be purchased as a stand-alone plan, or as part of a Medicare Advantage plan with integrated Medicare Part D enrollment.In 2020, there are 28 stand-alone Medicare Part D plans for sale in Nevada, with monthly premiums that range from about $13 to $84.As of mid-2020, there were 178,998 Medicare beneficiaries in Nevada (about a third of the state’s Medicare population) who were covered under stand-alone intravenous lasix Medicare Part D plans. Another 210,606 had Part D prescription coverage integrated with their Medicare Advantage plans (this number has been increasing sharply as enrollment in Medicare Advantage plans has grown faster than overall Medicare enrollment in Nevada).Medicare Part D enrollment is available during the annual election period from October 15 to December 7.

You may change your mind more than once during intravenous lasix this window. The last plan you pick will take effect January 1 of the coming year. Medicare spending in NevadaAverage per-beneficiary spending for Medicare in Nevada was intravenous lasix $9,969 in 2018, based on data that were standardized to eliminate regional differences in payment rates, and did not include costs for Medicare Advantage. Per-beneficiary Medicare spending in Nevada was slightly lower than the national average of $10,096 per enrollee. Spending was highest in Louisiana, at $11,932, and lowest in intravenous lasix Hawaii, at just $6,971.Medicare in Nevada.

Resources and information for Medicare beneficiaries and their caregiversNeed help with your Medicare application in Nevada?. Got questions about Medicare eligibility intravenous lasix in Nevada?. You can contact the Nevada State Health Insurance Assistance Program with questions related to Medicare enrollment in Nevada.The Nevada Aging and Disability Services Division offers a variety of resources for Nevada Medicare beneficiaries.The Governor’s Office for Consumer Health Assistance (OCHA) is part of the Nevada Department of Health and Human Services, and can provide advice, guidance, and information on a variety of health-related issues.The Nevada Department of Health and Human Services website also has a resource page with information on programs available to help lower-income Medicare beneficiaries afford their coverage and healthcare.The Medicare Rights Center is a national resource that includes a website and a call center where consumers throughout the United States can get answers to a wide range of questions about Medicare.Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state intravenous lasix health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.Short-term health plans in Illinois Short-term plans duration in IllinoisShort-term health insurance in Illinois is limited to six months.

HB2624/SB1737, which was approved by lawmakers in 2018 and sent to the governor in late June, implemented state-level guidelines for short-term health plans. The amended version of intravenous lasix the legislation limits short-term plan duration to less than 181 days and prohibits renewals. Additionally, an enrollee cannot purchase a new short-term plan from the same issuer within 60 days of the termination of a previous short-term plan.The legislation also calls for short-term health insurance in Illinois to be sold with prominent warning labels, disclosing the fact that they are not minimum essential coverage, do not cover pre-existing conditions, and do not include coverage for all of the ACA’s essential health benefits.Illinois short-term health insurance regulationsThe current rules governing short-term health insurance policies in Illinois center around legislation that was sent to Republican Governor Bruce Rauner on June 29, 2018, and he had 60 days to sign it or veto it. The bill would have automatically become law after 60 days if he had taken no action, intravenous lasix but he vetoed it on August 26. In November, however, lawmakers in Illinois overturned Rauner’s veto.

The veto override vote in the Senate was unanimous, and there was also very strong support in the House, with an 89-20 vote to overturn the intravenous lasix veto.The legislation is quite extensive and addresses other insurance provisions in Illinois. Most of it, including the provisions relating to short-term health plans, took effect as of when the law was enacted (November 27, 2018), although it took a few weeks for the details to be sorted out and the insurers to stop marking longer short-term plans. By 2019, all of intravenous lasix the available short-term plans in Illinois were capped at six months in duration, and were not renewable.Until October 2, 2018, federal rules limited short-term policies to three months in duration, and renewals were prohibited. But the Trump Administration implemented new rules in 2018, allowing short-term health plans to have initial terms of up to 364 days, and to be renewable (at the insurer’s discretion) for a total duration of up to 36 months. Until SB1737 intravenous lasix was enacted, Illinois was following the new federal rules.

But the state’s new, stricter rules supersede the federal rules, and require short-term coverage to be limited to terms of no more than six months in Illinois.Illinois Insurance Department. Buyer bewareThe Illinois Department of Insurance has warned consumers about high-pressure marketing tactics in which short-term health plans are sometimes disguised as ACA-compliant coverage.In 2020, the Illinois Department of Insurance confirmed that the various consumer protections related to health insurance intravenous lasix and the hypertension medications lasix would not apply to short-term health insurance plans.Who can get short-term health insurance in IllinoisShort-term health insurance in Illinois is available to residents who meet pre-established underwriting guidelines set forward by insurers. For residents of the Land of Lincoln, this generally means short-term plans are available for those under 65 years old (some insurers put the age limit at 64 years. Medicare coverage becomes available for most Americans once they turn 65) and in fairly good health.Short-term health medical insurance plans typically include blanket exclusions for pre-existing conditions, so for someone who is in need of certain medical care or has a pre-existing condition these plans may be inadequate – we recommend you seek out a policy that will cover those healthcare needs.If you need health insurance coverage in Illinois, your first step should be to check your eligibility for a special enrollment period that would allow you to enroll in an ACA-compliant major medical plan. There are a variety of qualifying life events that will trigger intravenous lasix a special enrollment period and allow you to buy a plan through the health insurance exchange in Illinois.

These plans are purchased on a month-to-month basis, so you can enroll in one (with a premium subsidy if you’re eligible) even if you’re only going to need it for a few months before another policy takes effect.When should I consider short-term health insurance in Illinois?. There are times when a short-term health insurance plan might be the only realistic option, such as:If you missed open enrollment for ACA-compliant individual market coverage (ie, Obamacare) or your employer’s healthcare plan, and do not have a qualifying event that would trigger a special enrollment period.If you’re not eligible for Medicaid or a premium subsidy in the exchange, the monthly premiums for an ACA-compliant plan might intravenous lasix simply be too costly. People who are ineligible for premium subsidies include. Which insurers offer short-term plans in Illinois? intravenous lasix. As of mid-2020, there were at least nine providers of short-term health insurance policies in Illinois:AdvantHealthCompanion LifeEverest ReinsuranceFirst Chicago (new as of 2020)Golden Rule (UnitedHealthcare)Health Alliance Medical PlansIndependence American Insurance CompanyNational GeneralUnited Security Health and Casualty Insurance CompanyBlue Cross Blue Shield of Illinois previously offered short-term plans, but discontinued them in 2016.A health insurance agent or broker can help you compare short-term health insurance plans in Illinois and decide which plan will provide the benefits that best fit your needs.

None of the short-term plans in Illinois can have intravenous lasix terms of more than six months, and they cannot be renewed. In addition, you will not be able to buy a policy from the same insurer after your first plan ends, unless you wait at least 60 days. So in Illinois, short-term health insurance should only be purchased if intravenous lasix you know you’ll need it for no more than six months and you have another coverage arrangement lined up for when the short-term plan ends.Even though you’ll only have the plan for a short while, you’ll want to pay attention to the specific healthcare benefits the plan covers. For example, most short-term health insurance plans do not cover outpatient prescription drugs. Some do include prescriptions in their covered benefits, but you’ll want to make sure that you’re not mistaking a prescription discount plan for real prescription benefits.You’ll also want to intravenous lasix understand whether the plan imposes specific dollar limitations on healthcare services such as inpatient hospital stays, surgery, etc.

(in addition to the plan’s overall benefit maximum). Some websites that sell short-term intravenous lasix health insurance also sell fixed indemnity health plans (which do have separate dollar limits on various services) and they often market both options together, despite the fact that they are different types of coverage.You can contact the Illinois Insurance Department if you want more information about a health plan, or want to check the authenticity of a health insurance company or an agent/broker or business that is marketing a plan to you.Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts..

At a glance lasix for sale online. Medicare health insurance in Nevada Medicare enrollment in NevadaAs of mid-2020, there were 545,535 people enrolled in Medicare in Nevada, amounting to about 17 percent of the state’s population.[/hio_question] Most Americans become eligible for Medicare enrollment when they turn 65. But Medicare eligibility is also triggered for younger people if they’re disabled and have been receiving disability benefits for 24 months (people lasix for sale online with ALS or end-stage renal disease do not have to wait 24 months for their Medicare coverage to begin). In Nevada, 13 percent of Medicare beneficiaries are under the age of 65 and eligible for Medicare due to a disability rather than age.

Nationwide, 15 percent of lasix for sale online all Medicare beneficiaries — nearly 10 million people — are eligible due to disability. Medicare Advantage in NevadaIn most areas of the United States, private Medicare Advantage plans are available as an alternative to Original Medicare.In 2019, some of Nevada’s counties had no Medicare Advantage plans available for purchase (Nevada has 16 counties plus Carson City, and only nine of them had Medicare Advantage plans available in 2019). But all areas of Nevada have Medicare Advantage plans available in 2020, with the addition of Lasso Healthcare, which entered the market in Nevada lasix for sale online with an MSA plan. Plan availability in 2020 ranges from just one plan (from Lasso Healthcare) in several counties, to 36 plans in Clark County.But the counties that didn’t have Advantage plans available prior to 2020 tend to have very low populations.

Despite the lasix for sale online fact that nearly half of Nevada’s counties had no Medicare Advantage plans for sale, 35 percent of the state’s Medicare beneficiaries were enrolled in Medicare Advantage plans as of 2018 — compared with 34 percent nationwide. And by July 2020, the number of people enrolled in private Medicare plans in Nevada stood at 219,979 people, which was 40 percent of the state’s total Medicare coverage enrollment. The other 325,556 beneficiaries lasix for sale online had Original Medicare. Between August 2019 and July 2020, Medicare Advantage enrollment in Nevada increased by 19,000 people, whereas Original Medicare enrollment decreased by nearly 7,000 people.People who enroll in Original Medicare get their coverage directly from the federal government, and have access to a nationwide network of providers.

But Original Medicare enrollees need supplemental coverage (from an employer-sponsored plan, Medicaid, or privately purchased plans) for things like lasix for sale online prescription drugs and out-of-pocket costs.Original Medicare includes Medicare Part A (hospital inpatient services) and Part B (outpatient services). Medicare Advantage includes all of the benefits of Medicare Parts A and B, and the plans usually also have additional benefits, such as integrated Part D prescription drug coverage, dental and vision coverage, and extra programs like gym memberships and a 24-hour nurse hotline. But provider networks and service areas are limited with Medicare Advantage, and out-of-pocket costs (deductible, copays, and coinsurance) are often lasix for sale online higher than they would be under Original Medicare plus a Medigap plan. There are pros and cons to either option, and no single solution that works for everyone.Medicare’s annual election period (October 15 to December 7 each year) allows Medicare beneficiaries opportunities to switch between Medicare Advantage enrollment and Original Medicare (and add, drop, or change to a different Medicare Part D prescription plan).

Medicare Advantage enrollees also have the option to switch to a different Advantage plan or to Original Medicare during the Medicare Advantage open enrollment period, which runs from January 1 to March 31 (only one plan change may be made during this window).Medigap in NevadaOriginal Medicare does not limit out-of-pocket costs, so most enrollees maintain some form of supplemental coverage. More than lasix for sale online half of Original Medicare beneficiaries get their supplemental coverage through an employer-sponsored plan or Medicaid. But for those who don’t, Medigap plans (also known as Medicare supplement plans) will pay some or all of the out-of-pocket costs (deductible and coinsurance) they would otherwise have to pay if they had only Original Medicare.Medigap plans are sold by private insurance companies, but the plans are standardized under federal rules. There are ten different lasix for sale online plan designs (differentiated by letters, A through N), and the benefits covered by a particular plan (Plan G, Plan K, etc.) are the same regardless of which insurer sells the plan.

This makes it easier for consumers to compare plans and make their choice based on factors such as price and customer service, knowing that the coverage will be the same regardless of which insurance company will provide the plan.32 insurance companies offer Medigap plans in Nevada as of 2020. Nearly all of them use attained age rating, which means that individual enrollees’ monthly premiums increase as they get older, lasix for sale online regardless of how old they were when they purchased the policy. According to an AHIP analysis, 95,795 Nevada residents were enrolled in Medigap coverage as of 2018.Unlike other private Medicare coverage (Medicare Advantage and Medicare Part D plans), there is no annual open enrollment window for Medigap plans. Instead, federal rules provide a one-time lasix for sale online six-month window when Medigap coverage is guaranteed-issue.

This window starts when a person is at least 65 and enrolled in Medicare Part B (you must be enrolled in both Part A and Part B to buy a Medigap plan). It’s essential to purchase coverage in a timely fashion lasix for sale online during this window. If you apply for a Medigap plan after it ends, the insurance companies are allowed to use medical underwriting to determine your eligibility for coverage and your monthly premium.People who aren’t yet 65 can enroll in Medicare if they’re disabled and have been receiving disability benefits for at least two years, or if they have ALS or end-stage renal disease. 13 percent of Nevada Medicare lasix for sale online beneficiaries are under age 65.

But federal rules do not guarantee access to Medigap plans for people who are under 65. The majority of the lasix for sale online states have implemented rules to ensure that disabled Medicare beneficiaries have at least some access to Medigap plans, but Nevada is not one of them.Nevada does not require Medigap insurers to offer coverage to people under age 65. As of 2020, Nevada’s Medigap guide indicates that there is one insurer that offers Medigap Plan A to beneficiaries under the age of 65, but Medicare’s plan finder tool indicates that no insurers actually do so (in previous years, Transamerica Life Insurance Company offered Medigap Plan A to enrollees under 65 in Nevada—albeit at a higher premium—but that appears to no longer be the case). The Nevada Division of Insurance confirmed in 2018 that there are no other supplemental coverage options for under-65 Medicare enrollees (ie, no state-run high-risk pool or similar program).

But Medicare beneficiaries who are under age 65 do have the option to enroll in any available Medicare Advantage plan offered in their area, unless they have end-stage renal disease (as of 2021, people will be able to enroll in Medicare Advantage plans even if they have end-stage renal disease).Although there do lasix for sale online not appear to be any Medigap plans available to people under 65 in Nevada, those individuals gain access to all of the available Medigap plans when they turn 65. At that point, they have the normal six-month open enrollment period for Medigap.Although the Affordable Care Act eliminated pre-existing condition exclusions in most of the private health insurance market, those rules don’t apply to Medigap plans. Medigap insurers can impose a pre-existing condition waiting period of up to six months if you didn’t have lasix for sale online at least six months of continuous coverage prior to your enrollment. And if you apply for a Medigap plan after your initial enrollment window closes (assuming you aren’t eligible for one of the limited guaranteed-issue rights), the Medigap insurer can consider your medical history in determining whether to accept your application, and at what premium.

Nevada Medicare Part lasix for sale online DOriginal Medicare does not provide coverage for outpatient prescription drugs. More than half of Original Medicare beneficiaries have supplemental medical coverage via an employer-sponsored plan (from a current or former employer or spouse’s employer) or Medicaid, and these plans often include prescription coverage.But Medicare beneficiaries who do not have drug coverage through Medicaid or an employer’s insurance plan need to obtain Medicare Part D prescription coverage. It can be purchased as a stand-alone plan, or as part of a Medicare Advantage plan with integrated Medicare Part D enrollment.In 2020, there are 28 stand-alone Medicare Part D plans for sale in Nevada, with monthly premiums that range from about $13 to $84.As of mid-2020, there were 178,998 Medicare beneficiaries in lasix for sale online Nevada (about a third of the state’s Medicare population) who were covered under stand-alone Medicare Part D plans. Another 210,606 had Part D prescription coverage integrated with their Medicare Advantage plans (this number has been increasing sharply as enrollment in Medicare Advantage plans has grown faster than overall Medicare enrollment in Nevada).Medicare Part D enrollment is available during the annual election period from October 15 to December 7.

You may change your mind more than lasix for sale online once during this window. The last plan you pick will take effect January 1 of the coming year. Medicare spending in NevadaAverage per-beneficiary spending for Medicare in lasix for sale online Nevada was $9,969 in 2018, based on data that were standardized to eliminate regional differences in payment rates, and did not include costs for Medicare Advantage. Per-beneficiary Medicare spending in Nevada was slightly lower than the national average of $10,096 per enrollee.

Spending was highest in Louisiana, at $11,932, lasix for sale online and lowest in Hawaii, at just $6,971.Medicare in Nevada. Resources and information for Medicare beneficiaries and their caregiversNeed help with your Medicare application in Nevada?. Got questions about Medicare eligibility lasix for sale online in Nevada?. You can contact the Nevada State Health Insurance Assistance Program with questions related to Medicare enrollment in Nevada.The Nevada Aging and Disability Services Division offers a variety of resources for Nevada Medicare beneficiaries.The Governor’s Office for Consumer Health Assistance (OCHA) is part of the Nevada Department of Health and Human Services, and can provide advice, guidance, and information on a variety of health-related issues.The Nevada Department of Health and Human Services website also has a resource page with information on programs available to help lower-income Medicare beneficiaries afford their coverage and healthcare.The Medicare Rights Center is a national resource that includes a website and a call center where consumers throughout the United States can get answers to a wide range of questions about Medicare.Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006.

She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited lasix for sale online by media who cover health reform and by other health insurance experts.Short-term health plans in Illinois Short-term plans duration in IllinoisShort-term health insurance in Illinois is limited to six months. HB2624/SB1737, which was approved by lawmakers in 2018 and sent to the governor in late June, implemented state-level guidelines for short-term health plans. The amended version of the legislation limits short-term plan duration to less than 181 days and lasix for sale online prohibits renewals.

Additionally, an enrollee cannot purchase a new short-term plan from the same issuer within 60 days of the termination of a previous short-term plan.The legislation also calls for short-term health insurance in Illinois to be sold with prominent warning labels, disclosing the fact that they are not minimum essential coverage, do not cover pre-existing conditions, and do not include coverage for all of the ACA’s essential health benefits.Illinois short-term health insurance regulationsThe current rules governing short-term health insurance policies in Illinois center around legislation that was sent to Republican Governor Bruce Rauner on June 29, 2018, and he had 60 days to sign it or veto it. The bill would have automatically become law after 60 days if he had taken no action, but he vetoed it on August lasix for sale online 26. In November, however, lawmakers in Illinois overturned Rauner’s veto. The veto override vote in the Senate was unanimous, and there was also very strong support in the House, with an 89-20 vote to overturn the veto.The legislation lasix for sale online is quite extensive and addresses other insurance provisions in Illinois.

Most of it, including the provisions relating to short-term health plans, took effect as of when the law was enacted (November 27, 2018), although it took a few weeks for the details to be sorted out and the insurers to stop marking longer short-term plans. By 2019, lasix for sale online all of the available short-term plans in Illinois were capped at six months in duration, and were not renewable.Until October 2, 2018, federal rules limited short-term policies to three months in duration, and renewals were prohibited. But the Trump Administration implemented new rules in 2018, allowing short-term health plans to have initial terms of up to 364 days, and to be renewable (at the insurer’s discretion) for a total duration of up to 36 months. Until SB1737 was enacted, lasix for sale online Illinois was following the new federal rules.

But the state’s new, stricter rules supersede the federal rules, and require short-term coverage to be limited to terms of no more than six months in Illinois.Illinois Insurance Department. Buyer bewareThe Illinois Department of Insurance has warned consumers about high-pressure marketing tactics in which short-term health plans are sometimes disguised as ACA-compliant coverage.In 2020, the Illinois Department of Insurance confirmed that the various consumer lasix for sale online protections related to health insurance and the hypertension medications lasix would not apply to short-term health insurance plans.Who can get short-term health insurance in IllinoisShort-term health insurance in Illinois is available to residents who meet pre-established underwriting guidelines set forward by insurers. For residents of the Land of Lincoln, this generally means short-term plans are available for those under 65 years old (some insurers put the age limit at 64 years. Medicare coverage becomes available for most Americans once they turn 65) and in fairly good health.Short-term health medical insurance plans typically include blanket exclusions for pre-existing conditions, so for someone who is in need of certain medical care or has a pre-existing condition these plans may be inadequate – we recommend you seek out a policy that will cover those healthcare needs.If you need health insurance coverage in Illinois, your first step should be to check your eligibility for a special enrollment period that would allow you to enroll in an ACA-compliant major medical plan.

There are a variety of qualifying life events that will trigger a special enrollment period and allow you to buy a plan through the health insurance lasix for sale online exchange in Illinois. These plans are purchased on a month-to-month basis, so you can enroll in one (with a premium subsidy if you’re eligible) even if you’re only going to need it for a few months before another policy takes effect.When should I consider short-term health insurance in Illinois?. There are times when a short-term health insurance plan might be the only realistic option, such as:If you missed open enrollment for ACA-compliant lasix for sale online individual market coverage (ie, Obamacare) or your employer’s healthcare plan, and do not have a qualifying event that would trigger a special enrollment period.If you’re not eligible for Medicaid or a premium subsidy in the exchange, the monthly premiums for an ACA-compliant plan might simply be too costly. People who are ineligible for premium subsidies include.

Which insurers lasix for sale online offer short-term plans in Illinois?. As of mid-2020, there were at least nine providers of short-term health insurance policies in Illinois:AdvantHealthCompanion LifeEverest ReinsuranceFirst Chicago (new as of 2020)Golden Rule (UnitedHealthcare)Health Alliance Medical PlansIndependence American Insurance CompanyNational GeneralUnited Security Health and Casualty Insurance CompanyBlue Cross Blue Shield of Illinois previously offered short-term plans, but discontinued them in 2016.A health insurance agent or broker can help you compare short-term health insurance plans in Illinois and decide which plan will provide the benefits that best fit your needs. None of the short-term plans in Illinois can have terms of more than six months, and they lasix for sale online cannot be renewed. In addition, you will not be able to buy a policy from the same insurer after your first plan ends, unless you wait at least 60 days.

So in Illinois, short-term health insurance should only be purchased if you know you’ll need it for no more than six months and you have another coverage arrangement lined up for when the short-term plan ends.Even though you’ll only have the plan for a short while, you’ll want to pay attention lasix for sale online to the specific healthcare benefits the plan covers. For example, most short-term health insurance plans do not cover outpatient prescription drugs. Some do include prescriptions in their covered benefits, but you’ll want to make sure that you’re not mistaking a prescription discount plan lasix for sale online for real prescription benefits.You’ll also want to understand whether the plan imposes specific dollar limitations on healthcare services such as inpatient hospital stays, surgery, etc. (in addition to the plan’s overall benefit maximum).

Some websites that sell short-term health insurance also sell fixed indemnity health plans (which do have separate dollar limits on various services) and they often market both options together, despite the fact that they are different types of coverage.You can contact the Illinois Insurance Department if you want more information about a health plan, or want to check the authenticity of a health insurance lasix for sale online company or an agent/broker or business that is marketing a plan to you.Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts..

Lasix water pill picture

Start Preamble Food and Drug Administration, Health and Can u buy zithromax over the counter Human lasix water pill picture Services (HHS). Notice. The Food and Drug Administration (FDA) is announcing the issuance of four lasix water pill picture Emergency Use Authorizations (EUAs) (the Authorizations) for drugs for use during the hypertension medications lasix.

FDA issued four Authorizations under the Federal Food, Drug, and Cosmetic Act (FD&C Act), as requested by the Department of Health and Human Services (HHS) Biomedical Advanced Research and Development Authority (BARDA), Fresenius Medical Care, Gilead Sciences, Inc., and Fresenius Kabi USA, LLC. The Authorizations contain, among other things, conditions on the emergency use of the authorized drugs. The Authorizations follow the February 4, 2020, determination by the Secretary of HHS that there is a public health emergency that has a significant potential lasix water pill picture to affect national security or the health and security of U.S.

Citizens living abroad and that involves a novel (new) hypertension. The lasix is now named hypertension, which causes the illness hypertension medications. On the lasix water pill picture basis of such determination, the Secretary of HHS declared on March 27, 2020, that circumstances exist justifying the authorization of emergency use of drugs and biological products during the hypertension medications lasix, pursuant to the FD&C Act, subject to the terms of any authorization issued under that section.

FDA is also announcing the subsequent revocation of the Authorization issued to BARDA for oral formulations of chloroquine phosphate and hydroxychloroquine sulfate. FDA revoked this authorization on June 15, 2020. The Authorizations, and the revocation, which include lasix water pill picture an explanation of the reasons for issuance or revocation, are reprinted in this document.

The Authorization for BARDA was effective as of March 28, 2020, and the revocation of this Authorization is effective as of June 15, 2020. The Authorization for Fresenius Medical Care is effective as of April 30, 2020. The Authorization for Gilead Sciences, lasix water pill picture Inc.

Is effective as of May 1, 2020. The Authorization for Fresenius Kabi USA, LLC is effective as of May 8, 2020. Submit written requests lasix water pill picture for single copies of the EUAs to the Office of Counterterrorism and Emerging Threats, Food and Drug Administration, 10903 New Hampshire Ave., Bldg.

1, Rm. 4338, Silver Spring, MD 20993-0002. Send one self-addressed adhesive label to assist that lasix water pill picture office in processing your request or include a Fax number to which the Authorizations may be sent.

See the SUPPLEMENTARY INFORMATION section for electronic access to the Authorizations. Start Further Info Michael Mair, Office of Counterterrorism and Emerging Threats, Food and Drug Administration, 10903 New Hampshire Ave., Bldg. 1, Rm lasix water pill picture.

4332, Silver Spring, MD 20993-0002, 301-796-8510 (this is not a toll free number). End Further Info End Preamble Start Supplemental Information I. Background Section 564 of the lasix water pill picture FD&C Act (21 U.S.C.

360bbb-3) allows FDA to strengthen the public health protections against biological, chemical, nuclear, and radiological agents. Among other lasix water pill picture things, section 564 of the FD&C Act allows FDA to authorize the use of an unapproved medical product or an unapproved use of an approved medical product in certain situations. With this EUA authority, FDA can help ensure that medical countermeasures may be used in emergencies to diagnose, treat, or prevent serious or life-threatening diseases or conditions caused by biological, chemical, nuclear, or radiological agents when there are no adequate, approved, and available alternatives.

II. Criteria for EUA Authorization Section 564(b)(1) of the lasix water pill picture FD&C Act provides that, before an EUA may be issued, the Secretary of HHS must declare that circumstances exist justifying the authorization based on one of the following grounds. (1) A determination by the Secretary of Homeland Security that there is a domestic emergency, or a significant potential for a domestic emergency, involving a heightened risk of attack with a biological, chemical, radiological, or nuclear agent or agents.

(2) a determination by the Secretary of Defense that there is a military emergency, or a significant potential for a military emergency, involving a heightened risk to U.S. Military forces, including personnel operating under the authority of title 10 or title 50, United States Code, of attack with (i) a biological, chemical, radiological, or nuclear agent lasix water pill picture or agents. Or (ii) an agent or agents that may cause, or are otherwise associated with, an imminently life-threatening and specific risk to U.S.

Military forces; [] (3) a determination by the Secretary of HHS that there is a public health emergency, or a significant potential for a public health emergency, that affects, or has a significant potential to affect, national security or the health and security of U.S. Citizens living lasix water pill picture abroad, and that involves a biological, chemical, radiological, or nuclear agent or agents, or a disease or condition that may be attributable to such agent or agents. Or (4) the identification of a material threat by the Secretary of Homeland Security pursuant to section 319F-2 of the Public Health Service (PHS) Act (42 U.S.C.

247d-6b) sufficient to affect national security or the health and security of U.S. Citizens living lasix water pill picture abroad. Once the Secretary of HHS has declared that circumstances exist justifying an authorization under section 564 of the FD&C Act, FDA may authorize the emergency use of a drug, device, or biological product if the Agency concludes that the statutory criteria are satisfied.

Under section 564(h)(1) of the FD&C Act, FDA is required to publish in the Federal Register a notice of each authorization, and each termination or revocation of an authorization, and an explanation of the reasons for the action. Section 564 of the FD&C Act permits FDA to authorize the introduction into interstate commerce of Start Printed lasix water pill picture Page 56232a drug, device, or biological product intended for use when the Secretary of HHS has declared that circumstances exist justifying the authorization of emergency use. Products appropriate for emergency use may include products and uses that are not approved, cleared, or licensed under sections 505, 510(k), 512, or 515 of the FD&C Act (21 U.S.C.

355, 360(k), 360b, and 360e) or section 351 of the PHS Act (42 U.S.C. 262), or conditionally approved under section 571 of the lasix water pill picture FD&C Act (21 U.S.C. 360ccc).

FDA may issue an EUA only if, after consultation with the HHS Assistant Secretary for Preparedness and Response, the Director of the National Institutes of Health, and the Director of the Centers for Disease Control and Prevention (to the extent feasible and appropriate given the applicable circumstances), FDA [] concludes. (1) That an agent referred to in a declaration lasix water pill picture of emergency or threat can cause a serious or life-threatening disease or condition. (2) that, based on the totality of scientific evidence available to FDA, including data from adequate and well-controlled clinical trials, if available, it is reasonable to believe that.

(A) The product may be effective in lasix water pill picture diagnosing, treating, or preventing (i) such disease or condition. Or (ii) a serious or life-threatening disease or condition caused by a product authorized under section 564, approved or cleared under the FD&C Act, or licensed under section 351 of the PHS Act, for diagnosing, treating, or preventing such a disease or condition caused by such an agent. And (B) the known and potential benefits of the product, when used to diagnose, prevent, or treat such disease or condition, outweigh the known and potential risks of the product, taking into consideration the material threat posed by the agent or agents identified in a declaration under section 564(b)(1)(D) of the FD&C Act, if applicable.

(3) that there lasix water pill picture is no adequate, approved, and available alternative to the product for diagnosing, preventing, or treating such disease or condition. (4) in the case of a determination described in section 564(b)(1)(B)(ii), that the request for emergency use is made by the Secretary of Defense. And (5) that such other criteria as may be prescribed by regulation are satisfied.

No other criteria for issuance have been prescribed by regulation under section 564(c)(4) of the FD&C lasix water pill picture Act. III. The Authorizations The Authorizations follow the February 4, 2020, determination by the Secretary of HHS that there is a public health emergency that has a significant potential to affect national security or the health and security of U.S.

Citizens living lasix water pill picture abroad and that involves a novel (new) hypertension. The lasix is now named hypertension, which causes the illness hypertension medications. Notice of the Secretary's determination was provided in the Federal Register on February 7, 2020 (85 FR 7316).

On the basis of such determination, the Secretary of HHS declared on March 27, 2020, that circumstances exist justifying the authorization of emergency use of drugs and biological products during the hypertension medications lasix, pursuant lasix water pill picture to section 564 of the FD&C Act, subject to the terms of any authorization issued under that section. Notice of the Secretary's declaration was provided in the Federal Register on April 1, 2020 (85 FR 18250). Having concluded that the criteria for issuance of the Authorizations under section 564(c) of the FD&C Act are met, FDA has issued four authorizations for the emergency use of drugs during the hypertension medications lasix.

On March 28, 2020, FDA issued an EUA to BARDA for oral formulations of chloroquine phosphate and hydroxychloroquine sulfate, subject lasix water pill picture to the terms of the Authorization. On April 30, 2020, FDA issued an EUA to Fresenius Medical Care for multiFiltrate PRO System and multiBic/multiPlus Solutions, subject to the terms of the Authorization. On May 1, 2020, FDA issued an EUA to Gilead Sciences, Inc.

For remdesivir, subject to the terms of the lasix water pill picture Authorization. On May 8, 2020, FDA issued an EUA to Fresenius Kabi USA, LLC for Fresenius Propoven 2% Emulsion, subject to the terms of the Authorization. The Authorizations in their entirety (not including the authorized versions of the fact sheets and other written materials) follow, below section VI Electronic Access, and provide an explanation of the reasons for issuance, as required by section 564(h)(1) of the FD&C Act.

IV. EUA Criteria for Issuance No Longer Met Under section 564(g)(2) of the FD&C Act, the Secretary of HHS may revoke an EUA if, among other things, the criteria for issuance are no longer met. On June 15, 2020, FDA revoked the EUA for BARDA for oral formulations of chloroquine phosphate and hydroxychloroquine sulfate because the criteria for issuance were no longer met.

Under section 564(c)(2) of the FD&C Act, an EUA may be issued only if FDA concludes that, based on the totality of scientific evidence available to the Secretary, including data from adequate and well-controlled clinical trials, if available, it is reasonable to believe that. (1) The product may be effective in diagnosing, treating, or preventing such disease or condition and (2) the known and potential benefits of the product, when used to diagnose, prevent, or treat such disease or condition, outweigh the known and potential risks of the product. Based on a review of new information and a reevaluation of information available at the time the EUA was issued, FDA now concludes it is no longer reasonable to believe that (1) oral formulations of chloroquine phosphate and hydroxychloroquine sulfate may be effective in treating hypertension medications for the uses authorized in the EUA, or (2) the known and potential benefits of these products outweigh their known and potential risks for those uses.

Accordingly, FDA revokes the EUA for emergency use of chloroquine phosphate and hydroxychloroquine sulfate to treat hypertension medications, pursuant to section 564(g)(2) of the FD&C Act. V. The Revocation Having concluded that the criteria for revocation of the Authorization under section 564(g) of the FD&C Act are met, FDA has revoked the EUA for BARDA's oral formulations of chloroquine phosphate and hydroxychloroquine sulfate.

The revocation in its entirety follows, below section VI. Electronic Access, and provides an explanation of the reasons for revocation, as required by section 564(h)(1) of the FD&C Act. VI.

Electronic Access An electronic version of this document and the full text of the Authorizations and revocation are available on the internet at https://www.fda.gov/​emergency-preparedness-and-response/​mcm-legal-regulatory-and-policy-framework/​emergency-use-authorization. Start Printed Page 56233 Start Printed Page 56234 Start Printed Page 56235 Start Printed Page 56236 Start Printed Page 56237 Start Printed Page 56238 Start Printed Page 56239 Start Printed Page 56240 Start Printed Page 56241 Start Printed Page 56242 Start Printed Page 56243 Start Printed Page 56244 Start Printed Page 56245 Start Printed Page 56246 Start Printed Page 56247 Start Printed Page 56248 Start Printed Page 56249 Start Printed Page 56250 Start Printed Page 56251 Start Printed Page 56252 Start Printed Page 56253 Start Printed Page 56254 Start Printed Page 56255 Start Printed Page 56256 Start Printed Page 56257 Start Printed Page 56258 Start Printed Page 56259 Start Printed Page 56260 Start Printed Page 56261 Start Printed Page 56262 Start Printed Page 56263 Start Printed Page 56264 Start Signature Dated. September 3, 2020.

Lowell J. Schiller, Principal Associate Commissioner for Policy. End Signature End Supplemental Information BILLING CODE 4164-01-P[FR Doc.

2020-20041 Filed 9-10-20. 8:45 am]BILLING CODE 4164-01-CAlmost one-third of households report difficulty paying their energy bills or adequately heating and cooling their homes. And more than 20 percent—roughly 25 million households—report reducing or forgoing necessities such as food and medicine to pay an energy bill.

African-American families and rural households are more likely than other groups to spend a high percentage of household income on energy. It’s time for states and communities to put policies in place that will improve energy affordability and access and advance energy equity.On the Pine Ridge Indian Reservation in remote South Dakota, where many tribal residents live without electricity in their homes, community members are tackling this problem head on. Pine Ridge received its first transmission line in 2018, but the cost of installing lines and meters has been prohibitive for many households, given that more than half the reservation lives below the poverty line.

In the late 1990s, community member and entrepreneur Henry Red Cloud partnered with the Colorado nonprofit Trees, Water &. People, which had foundation funding to install portable solar heating systems in Pine Ridge at no cost to homeowners. As of November 2019, 500 homes had Red Cloud’s off-grid solar furnaces and they have reduced their heating costs by up to 30 percent.In the face of hypertension medications, municipalities, corporations and community organizations have stepped up to address inequities in utility services—from free internet access for K-12 and college students, to bans on water and energy shut offs for people unable to pay their bills.

Yet many of these protections are set to expire on arbitrary dates even though the need for them will surely continue. While the imperative to make access to utility services more equitable became more urgent during the lasix, the real challenge is making them affordable and accessible over the long term. As the nation begins building toward an equitable and lasting recovery, we must ensure everyone’s basic needs for water, energy, and Internet are met, and that investments in infrastructure are advanced with an equity frame.

Returning to the way things were is not acceptable.To build healthier communities, we must advance equitable public infrastructure. Learn more about the connection between public infrastructure and health equity..

Start Preamble Food navigate to this site and Drug lasix for sale online Administration, Health and Human Services (HHS). Notice. The Food and Drug Administration (FDA) is announcing the issuance of four Emergency Use Authorizations (EUAs) (the Authorizations) for drugs for lasix for sale online use during the hypertension medications lasix. FDA issued four Authorizations under the Federal Food, Drug, and Cosmetic Act (FD&C Act), as requested by the Department of Health and Human Services (HHS) Biomedical Advanced Research and Development Authority (BARDA), Fresenius Medical Care, Gilead Sciences, Inc., and Fresenius Kabi USA, LLC. The Authorizations contain, among other things, conditions on the emergency use of the authorized drugs.

The Authorizations follow the February 4, 2020, determination by the Secretary of HHS that there is a public health emergency that has a significant potential to affect lasix for sale online national security or the health and security of U.S. Citizens living abroad and that involves a novel (new) hypertension. The lasix is now named hypertension, which causes the illness hypertension medications. On the basis of such determination, the Secretary of HHS declared on March 27, 2020, that circumstances exist justifying the authorization of emergency use of drugs and lasix for sale online biological products during the hypertension medications lasix, pursuant to the FD&C Act, subject to the terms of any authorization issued under that section. FDA is also announcing the subsequent revocation of the Authorization issued to BARDA for oral formulations of chloroquine phosphate and hydroxychloroquine sulfate.

FDA revoked this authorization on June 15, 2020. The Authorizations, and the revocation, which include an explanation of the reasons for issuance or lasix for sale online revocation, are reprinted in this document. The Authorization for BARDA was effective as of March 28, 2020, and the revocation of this Authorization is effective as of June 15, 2020. The Authorization for Fresenius Medical Care is effective as of April 30, 2020. The Authorization for Gilead Sciences, lasix for sale online Inc.

Is effective as of May 1, 2020. The Authorization for Fresenius Kabi USA, LLC is effective as of May 8, 2020. Submit written requests for single copies lasix for sale online of the EUAs to the Office of Counterterrorism and Emerging Threats, Food and Drug Administration, 10903 New Hampshire Ave., Bldg. 1, Rm. 4338, Silver Spring, MD 20993-0002.

Send one self-addressed adhesive label to assist that office in processing your request or include a Fax number to lasix for sale online which the Authorizations may be sent. See the SUPPLEMENTARY INFORMATION section for electronic access to the Authorizations. Start Further Info Michael Mair, Office of Counterterrorism and Emerging Threats, Food and Drug Administration, 10903 New Hampshire Ave., Bldg. 1, Rm lasix for sale online. 4332, Silver Spring, MD 20993-0002, 301-796-8510 (this is not a toll free number).

End Further Info End Preamble Start Supplemental Information I. Background Section 564 of the lasix for sale online FD&C Act (21 U.S.C. 360bbb-3) allows FDA to strengthen the public health protections against biological, chemical, nuclear, and radiological agents. Among other things, section 564 of the FD&C Act allows FDA to authorize the use of an unapproved medical product lasix for sale online or an unapproved use of an approved medical product in certain situations. With this EUA authority, FDA can help ensure that medical countermeasures may be used in emergencies to diagnose, treat, or prevent serious or life-threatening diseases or conditions caused by biological, chemical, nuclear, or radiological agents when there are no adequate, approved, and available alternatives.

II. Criteria for EUA Authorization Section 564(b)(1) of the FD&C Act provides that, before an EUA may be issued, the Secretary of HHS must declare that circumstances lasix for sale online exist justifying the authorization based on one of the following grounds. (1) A determination by the Secretary of Homeland Security that there is a domestic emergency, or a significant potential for a domestic emergency, involving a heightened risk of attack with a biological, chemical, radiological, or nuclear agent or agents. (2) a determination by the Secretary of Defense that there is a military emergency, or a significant potential for a military emergency, involving a heightened risk to U.S. Military forces, including personnel operating under the authority of title 10 or title 50, United States Code, of attack with (i) a lasix for sale online biological, chemical, radiological, or nuclear agent or agents.

Or (ii) an agent or agents that may cause, or are otherwise associated with, an imminently life-threatening and specific risk to U.S. Military forces; [] (3) a determination by the Secretary of HHS that there is a public health emergency, or a significant potential for a public health emergency, that affects, or has a significant potential to affect, national security or the health and security of U.S. Citizens living lasix for sale online abroad, and that involves a biological, chemical, radiological, or nuclear agent or agents, or a disease or condition that may be attributable to such agent or agents. Or (4) the identification of a material threat by the Secretary of Homeland Security pursuant to section 319F-2 of the Public Health Service (PHS) Act (42 U.S.C. 247d-6b) sufficient to affect national security or the health and security of U.S.

Citizens living abroad lasix for sale online. Once the Secretary of HHS has declared that circumstances exist justifying an authorization under section 564 of the FD&C Act, FDA may authorize the emergency use of a drug, device, or biological product if the Agency concludes that the statutory criteria are satisfied. Under section 564(h)(1) of the FD&C Act, FDA is required to publish in the Federal Register a notice of each authorization, and each termination or revocation of an authorization, and an explanation of the reasons for the action. Section 564 of the FD&C Act permits FDA to authorize the introduction into interstate commerce of Start Printed Page 56232a drug, device, or biological product intended for use when the lasix for sale online Secretary of HHS has declared that circumstances exist justifying the authorization of emergency use. Products appropriate for emergency use may include products and uses that are not approved, cleared, or licensed under sections 505, 510(k), 512, or 515 of the FD&C Act (21 U.S.C.

355, 360(k), 360b, and 360e) or section 351 of the PHS Act (42 U.S.C. 262), or conditionally approved lasix for sale online under section 571 of the FD&C Act (21 U.S.C. 360ccc). FDA may issue an EUA only if, after consultation with the HHS Assistant Secretary for Preparedness and Response, the Director of the National Institutes of Health, and the Director of the Centers for Disease Control and Prevention (to the extent feasible and appropriate given the applicable circumstances), FDA [] concludes. (1) That an agent referred to in a declaration of emergency or threat can lasix for sale online cause a serious or life-threatening disease or condition.

(2) that, based on the totality of scientific evidence available to FDA, including data from adequate and well-controlled clinical trials, if available, it is reasonable to believe that. (A) The product may be effective in diagnosing, treating, or preventing (i) such lasix for sale online disease or condition. Or (ii) a serious or life-threatening disease or condition caused by a product authorized under section 564, approved or cleared under the FD&C Act, or licensed under section 351 of the PHS Act, for diagnosing, treating, or preventing such a disease or condition caused by such an agent. And (B) the known and potential benefits of the product, when used to diagnose, prevent, or treat such disease or condition, outweigh the known and potential risks of the product, taking into consideration the material threat posed by the agent or agents identified in a declaration under section 564(b)(1)(D) of the FD&C Act, if applicable. (3) that there is no adequate, approved, and available alternative to the product for diagnosing, preventing, lasix for sale online or treating such disease or condition.

(4) in the case of a determination described in section 564(b)(1)(B)(ii), that the request for emergency use is made by the Secretary of Defense. And (5) that such other criteria as may be prescribed by regulation are satisfied. No other criteria for lasix for sale online issuance have been prescribed by regulation under section 564(c)(4) of the FD&C Act. III. The Authorizations The Authorizations follow the February 4, 2020, determination by the Secretary of HHS that there is a public health emergency that has a significant potential to affect national security or the health and security of U.S.

Citizens living abroad and that involves a novel (new) hypertension lasix for sale online. The lasix is now named hypertension, which causes the illness hypertension medications. Notice of the Secretary's determination was provided in the Federal Register on February 7, 2020 (85 FR 7316). On the basis of such determination, the Secretary lasix for sale online of HHS declared on March 27, 2020, that circumstances exist justifying the authorization of emergency use of drugs and biological products during the hypertension medications lasix, pursuant to section 564 of the FD&C Act, subject to the terms of any authorization issued under that section. Notice of the Secretary's declaration was provided in the Federal Register on April 1, 2020 (85 FR 18250).

Having concluded that the criteria for issuance of the Authorizations under section 564(c) of the FD&C Act are met, FDA has issued four authorizations for the emergency use of drugs during the hypertension medications lasix. On March 28, 2020, FDA issued an EUA to BARDA for oral formulations of chloroquine phosphate and hydroxychloroquine lasix for sale online sulfate, subject to the terms of the Authorization. On April 30, 2020, FDA issued an EUA to Fresenius Medical Care for multiFiltrate PRO System and multiBic/multiPlus Solutions, subject to the terms of the Authorization. On May 1, 2020, FDA issued an EUA to Gilead Sciences, Inc. For remdesivir, lasix for sale online subject to the terms of the Authorization.

On May 8, 2020, FDA issued an EUA to Fresenius Kabi USA, LLC for Fresenius Propoven 2% Emulsion, subject to the terms of the Authorization. The Authorizations in their entirety (not including the authorized versions of the fact sheets and other written materials) follow, below section VI Electronic Access, and provide an explanation of the reasons for issuance, as required by section 564(h)(1) of the FD&C Act. IV. EUA Criteria for Issuance No Longer Met Under section 564(g)(2) of the FD&C Act, the Secretary of HHS may revoke an EUA if, among other things, the criteria for issuance are no longer met. On June 15, 2020, FDA revoked the EUA for BARDA for oral formulations of chloroquine phosphate and hydroxychloroquine sulfate because the criteria for issuance were no longer met.

Under section 564(c)(2) of the FD&C Act, an EUA may be issued only if FDA concludes that, based on the totality of scientific evidence available to the Secretary, including data from adequate and well-controlled clinical trials, if available, it is reasonable to believe that. (1) The product may be effective in diagnosing, treating, or preventing such disease or condition and (2) the known and potential benefits of the product, when used to diagnose, prevent, or treat such disease or condition, outweigh the known and potential risks of the product. Based on a review of new information and a reevaluation of information available at the time the EUA was issued, FDA now concludes it is no longer reasonable to believe that (1) oral formulations of chloroquine phosphate and hydroxychloroquine sulfate may be effective in treating hypertension medications for the uses authorized in the EUA, or (2) the known and potential benefits of these products outweigh their known and potential risks for those uses. Accordingly, FDA revokes the EUA for emergency use of chloroquine phosphate and hydroxychloroquine sulfate to treat hypertension medications, pursuant to section 564(g)(2) of the FD&C Act. V.

The Revocation Having concluded that the criteria for revocation of the Authorization under section 564(g) of the FD&C Act are met, FDA has revoked the EUA for BARDA's oral formulations of chloroquine phosphate and hydroxychloroquine sulfate. The revocation in its entirety follows, below section VI. Electronic Access, and provides an explanation of the reasons for revocation, as required by section 564(h)(1) of the FD&C Act. VI. Electronic Access An electronic version of this document and the full text of the Authorizations and revocation are available on the internet at https://www.fda.gov/​emergency-preparedness-and-response/​mcm-legal-regulatory-and-policy-framework/​emergency-use-authorization.

Start Printed Page 56233 Start Printed Page 56234 Start Printed Page 56235 Start Printed Page 56236 Start Printed Page 56237 Start Printed Page 56238 Start Printed Page 56239 Start Printed Page 56240 Start Printed Page 56241 Start Printed Page 56242 Start Printed Page 56243 Start Printed Page 56244 Start Printed Page 56245 Start Printed Page 56246 Start Printed Page 56247 Start Printed Page 56248 Start Printed Page 56249 Start Printed Page 56250 Start Printed Page 56251 Start Printed Page 56252 Start Printed Page 56253 Start Printed Page 56254 Start Printed Page 56255 Start Printed Page 56256 Start Printed Page 56257 Start Printed Page 56258 Start Printed Page 56259 Start Printed Page 56260 Start Printed Page 56261 Start Printed Page 56262 Start Printed Page 56263 Start Printed Page 56264 Start Signature Dated. September 3, 2020. Lowell J. Schiller, Principal Associate Commissioner for Policy. End Signature End Supplemental Information BILLING CODE 4164-01-P[FR Doc.

2020-20041 Filed 9-10-20. 8:45 am]BILLING CODE 4164-01-CAlmost one-third of households report difficulty paying their energy bills or adequately heating and cooling their homes. And more than 20 percent—roughly 25 million households—report reducing or forgoing necessities such as food and medicine to pay an energy bill. African-American families and rural households are more likely than other groups to spend a high percentage of household income on energy. It’s time for states and communities to put policies in place that will improve energy affordability and access and advance energy equity.On the Pine Ridge Indian Reservation in remote South Dakota, where many tribal residents live without electricity in their homes, community members are tackling this problem head on.

Pine Ridge received its first transmission line in 2018, but the cost of installing lines and meters has been prohibitive for many households, given that more than half the reservation lives below the poverty line. In the late 1990s, community member and entrepreneur Henry Red Cloud partnered with the Colorado nonprofit Trees, Water &. People, which had foundation funding to install portable solar heating systems in Pine Ridge at no cost to homeowners. As of November 2019, 500 homes had Red Cloud’s off-grid solar furnaces and they have reduced their heating costs by up to 30 percent.In the face of hypertension medications, municipalities, corporations and community organizations have stepped up to address inequities in utility services—from free internet access for K-12 and college students, to bans on water and energy shut offs for people unable to pay their bills. Yet many of these protections are set to expire on arbitrary dates even though the need for them will surely continue.

While the imperative to make access to utility services more equitable became more urgent during the lasix, the real challenge is making them affordable and accessible over the long term. As the nation begins building toward an equitable and lasting recovery, we must ensure everyone’s basic needs for water, energy, and Internet are met, and that investments in infrastructure are advanced with an equity frame. Returning to the way things were is not acceptable.To build healthier communities, we must advance equitable public infrastructure. Learn more about the connection between public infrastructure and health equity..

Lasix tablet sizes

We live http://franklysouthern.com/manchester-arms-english-pub/ in lasix tablet sizes unprecedented times. But what makes them without parallel is not the current lasix crisis nor the continued problems facing minorities in our institutions. Rather, it’s that for the first time, lasix tablet sizes the problems of accessibility, rights and freedoms are now invading privileged spaces. There can be no ‘getting back to normal’, because ‘normal’ only ever benefited the white, Western, patriarchal, abled and cis ideals.

For many, the world lasix tablet sizes is not suddenly on fire. It has long been burning.The present lasix lays bare systemic prejudice against the most vulnerable among us. We at Medical Humanities, with our focus on global health and social justice, welcome discussion about how the crisis has disproportionately affected racial and fiscal minorities, those from the disabled community, those who are LGBTQA+ and other vulnerable groups. What we focus on here, now, can lead to greater accessibility and equity in the future.In this expanded issue, we offer some of the incredible work being done across the field of medical humanities prior to the hypertension medications crisis, and we are already reviewing articles lasix tablet sizes on the role of health humanities during the lasix.

The process of academic publishing tends not to lend itself to immediacy, however, and the challenges of lasix means greater pressure on everyone, from the authors to the reviewers and readers.To remedy this, we at Medical Humanities have been increasing the work on our blog platform, a place where content can be quickly updated, and where conversations can occur among readers and writers. We openly invite submissions concerning the lasix, as well as topics lasix tablet sizes relevant to our wider CFP (call for posts/papers) this year on social justice and health, to both blog and journal. We will do our best to expedite. Finally, we have also been addressing social justice and access in our podcast, where we interviewed disability activist Alice Wong and most recently Dr Oni Blackstock, primary care physician and HIV specialist in New York.

We hope to have many more on these critical subjects.We lasix tablet sizes wish all of you good health and safety and know that many of you are yet on the front lines. Thank you for being part of the community of Medical Humanities.IntroductionMinecraft is a computer game with no specific goals to accomplish. The gameworld consists of three-dimensional (3D) cubes and objects which the player (Steve) can mine and build into infinitely complex lasix tablet sizes (and logically impossible) structures. Steve sometimes encounters other characters (‘mobs’), such as animals and hostile creatures.

He can ‘spawn’ and destroy them. While it looks lasix tablet sizes like a harmless game of logical construction, it conveys some worryingly delusive ideas about the real world. The difference between real and imagined structures is at the heart of the age-old debate around categorising mental disorders.Classification in mental health has had various forms throughout history. Mack and colleagues set out a history of psychiatric classification beginning lasix tablet sizes in 2600 BC with Egyptian references to melancholia and hysteria.

Through the Ancient Greeks with Hippocrates’ phrenitis, mania, melancholia, epilepsy, hysteria and Scythian disease. Through the Renaissance period. Through to 19th-century psychiatry featuring Pinel (known as the first psychiatrist), Kraepelin (known for observational classification) and Freud (known for classifying neurosis and psychosis).1Although the history of psychiatric classification identifies some common trends such as the labels ‘melancholia’ and ‘hysteria’ lasix tablet sizes which have survived millennia, the label ‘depression’ is relatively new. The earliest usage noted by Snaith is from 1899.

€˜in simple lasix tablet sizes pathological depression…the patient exhibits a growing indifference to his former pursuits…’.2 Snaith noted that early 20th-century psychiatrists like Adolf Meyer hoped that ‘depression’ would come to encompass a broad category under which descriptions of subtypes would emerge. This did not happen until the middle of the 20th century. With the publication of the sixth International Classification of Diseases (ICD) in 1948 and the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1952 and their subsequent revisions, the latter half of the 20th century has seen depression subtype labels proliferate. In their study of the social determinants of diagnostic labels in depression, McPherson and Armstrong illustrate how the codification of depression subtypes in the latter half of the 20th century has been lasix tablet sizes shaped by the evolving context of psychiatry, including power struggles within the profession, a move to community care and the development of psychopharmacology.3During this period, McPherson and Armstrong describe how subsequent versions of the DSM served as battlegrounds for professional disputes and philosophical quarrels around categorisation of mental disorders.

DSM I and DSM II have been described as products of an American Psychiatric Association dominated by psychoanalytic psychiatrists.4 DSM III and DSM III-R have been described as a radical rejection of psychoanalytic thinking, a ‘neo-Kraepelinian revolution’, a reference to the observational descriptive techniques of 19th-century psychiatrist Emil Kraepelin who classified mental disorders into two broad categories. €˜dementia praecox’ and ‘manic-depression’.5 DSM III was seen by some as a turning point in the use of the medical model of mental illness, through provision of specific inclusion and exclusion criteria, and use of field trials and lasix tablet sizes a multiaxial system.6 These latter technocratic additions to psychiatric labelling served to engender a much closer alignment between psychiatry, science and medicine.The codification of mental disorders in manuals has been described by Thomas Schacht as intrinsic to the relationship between science and politics and the way in which psychiatrists gain significant social power by aligning themselves to science.7 His argument drew on Szasz, who saw the mental health establishment as a therapeutic state. Zimbardo, who described psychiatric care as a controlling force. And Foucault, who described the categorisation of the mentally ill as a force for isolating ‘the other’.

Diagnostic critique has been further developed through a cultural relativist lens in that what Western psychiatrists classify as a depression is constructed differently in other cultures.8 Considering these limitations, some critics have gone so far as to argue that psychiatric diagnostic systems should be abolished.9Yet architects of DSM manuals have worked hard to ensure the technology of classification is regarded as genuine lasix tablet sizes scientific activity with sound roots in philosophy of science. In their philosophical defence of DSM IV, Allen Frances and colleagues address their critics under the headings ‘nominalism vs realism’, ‘empiricism vs rationalism’ and ‘categorical vs dimensional’.10 The implication is that there are opposing stances in which a choice must be made or a middle ground forged by those reasonable enough to recognise the need for pragmatism in the service of clinical utility. The nominalism–realism debate is illustrated using as metaphor three lasix tablet sizes different stances a cricket umpire might take on calling strikes and balls. The discussion sets out two of these as extreme views.

€˜at one extreme…those who take a reductionistically realistic view of the world’ versus ‘the solipsistic nominalists…might content that nothing exists’. Szasz, who is characterised as holding particularly extreme views, is named as lasix tablet sizes an archetypal solipsist. There is implied to be a degree of arrogance associated with this view in the illustrative example in which the umpire states ‘there are no balls and there are no strikes until I call them’. Frances therefore sets up a means of grouping two kinds of people as philosophical extremists who can be dismissed, while avoiding addressing the philosophical problems they pose.Frances provides little if any justification for the middle ground stance, ‘There are balls and there are strikes and I call them as I see them’, other than to focus lasix tablet sizes on its clinical utility and the lack of clinical utility in the alternatives ‘naïve realism’ and ‘heuristically barren solipsism’.

The natural conclusion the reader is invited to reach is that a middle ground of a heuristic concept is naturally right because it is not extreme and is naturally useful clinically, without specifying in what way this stance is coherent, resolves the two alternatives, and in what way a heuristic construct that is not ‘real’ can be subject to scientific testing.Similarly, in discussing the ‘categorical vs dimensional’, Frances promotes the ‘prototype approach’. Those holding opposing views are labelled as ‘dualists’ or ‘dichotomisers’. The prototypical approach is again put forward as lasix tablet sizes a clinically useful middle ground. Illustrations are drawn from natural science.

€˜a triangle and a square are never the same’, inciting lasix tablet sizes the reader to consider science as value-free. The prototypical approach emerges as a natural solution, yet the authors do not address how a diagnostic prototype resolves the issues posed by the two alternatives, nor how a prototype can be subjected to natural science methods.The argument presented here is not a defence of solipsism or dualism. Rather it aims to illustrate that if for pragmatic purposes clinicians and policymakers choose to gloss over the philosophical flaws in classification practices, it is then risky to move beyond the heuristic and apply natural science methods to these constructs adding multiple layers of technocratic subclassification. Doing so lasix tablet sizes is more like playing Minecraft than cricket.

The National Institute for Health and Care Excellence (NICE) guideline for depression is taken as an example of the philosophical errors that can follow from playing Minecraft with unsound heuristic devices, specifically subcategories of persistent forms of depression. As well as serving a clinical purpose, diagnosis in medicine lasix tablet sizes is a way of allocating resources for insurance companies and constructing clinical guidelines, which in turn determine rationing within the National Health Service. The consequences for recipients of healthcare are therefore significant. Clinical utility is arguably not being served at all and patients are left at risk of poor-quality care.Heterogeneity of persistent depressionAndrea Jobst and colleagues note that ‘because of their chronic clinical course, approximately 40% of CD [chronic depression] patients also fulfil criteria for TRD [treatment resistant depression]…usually defined by the number of non-successful biological treatments’.11 This position is reflected in the DSM VAmerican Psychiatric Association (2013), the European Psychiatric Association (EPA) guidance and the ICD-11(World Health Organisation, 2018), which all use a ‘persistent’ depression category, acknowledging a loosely defined mixed group of long-term, difficult-to-treat depressive conditions, often associated with dysthymia and comorbid common mental disorders, various personality traits and psychosocial disability.In contrast, the NICE 2018 draft guideline separates treatments into those for ‘new episodes’ of depression.

€˜further-line’ treatment of depression (equivalent to TRD), CD and ‘depression lasix tablet sizes with co-morbidities’. The latter is subdivided into treatments for ‘complex depression’ and ‘psychotic depression’. These categories and subcategories introduce an unfortunate lasix tablet sizes sense of certainty as though these labels represent real things. An analysis follows of how these definitions play out in terms of grouping of randomised controlled trials in the NICE evidence review.

Specifically, the analysis reveals the overlap between populations in trials which have been separated into discrete categories, revealing significant limitations to the utility of the category labels.The NICE definition of CD requires trial samples to meet the criteria for major depressive disorder (MDD) for 2 years. Dysthymia and lasix tablet sizes double depression (MDD superimposed on dysthymia) were included. If 75% of the trial population met these criteria, the trial was reviewed in the CD category.12 The definition of TRD (or ‘further-line treatments’) required that the trial sample had demonstrated a ‘limited response to previous treatment’ and randomised to the further-line treatment at this point. If 80% of the trial participants met these criteria, it was reviewed in the TRD category.13 Complex depression was defined as lasix tablet sizes ‘depression co-existing with personality disorder’.

To be classed as complex, 51% of trial participants had to have personality disorder (PD).14It is immediately clear from these definitions that there is a potential problem with attempting to categorise trial populations into just one of these categories. These populations are likely to overlap, whether or not a trial protocol sets out to explicitly record all of this information. The analysis below will illustrate this lasix tablet sizes using examples from within the NICE review.Cataloguing complexity in trial populationsWithin the category of further-line treatments (TRD), 64 trials were reviewed. Comparisons within these trials were further subcategorised into ‘dose escalation strategies’, ‘augmentation strategies’ and ‘switching strategies’.

In drilling down by way of lasix tablet sizes illustration, this analysis considers the 51 trials in the augmentation strategy evidence review. Of these, two were classified by the reviewers as also fulfilling the criteria for CD but were not analysed in the CD category (Study IDs. Fonagy 2015 and Kocsis 200915). About half of the trials (23/51) did not report the mean duration lasix tablet sizes of episode, meaning that it is not possible to know what percentage of participants also met the criteria for CD.

Of trials that did report episode duration, 17 reported a mean duration longer than 24 months. While the standard deviations varied in size or were unreported, the mean indicates a good likelihood that a significant lasix tablet sizes proportion of the participants across these 51 trials met the criteria for CD.Details of baseline employment, trauma history, suicidality, physical comorbidity, axis I comorbidity and PD (all clinical indicators of complexity, severity and chronicity) were not collated by NICE. For the present analysis, all 51 publications were examined and data compiled concerning clinical complexity in the trial populations. Only 14 of 51 trials report employment data.

Of those that do, unemployment ranges from 12% to 56% lasix tablet sizes across trial samples. None of the trials report trauma history. About half of the lasix tablet sizes trials (26/51) excluded people who were considered a suicide risk. The others did not.A large proportion of trials (30/51) did not provide any data on axis 1 comorbidity.

Of these, 18 did not exclude any diagnoses, while 12 excluded some (but not all) disorders. The most common diagnoses excluded were lasix tablet sizes psychotic disorders, substance or alcohol abuse, and bipolar disorder (excluded in 26, 25 and 23 trials, respectively). Only 7 of 51 trials clearly stated that all axis 1 diagnoses were excluded. This leaves only 13 studies providing lasix tablet sizes any data about comorbidity.

Of these, 9 gave partial data on one or two conditions, while 4 reported either the mean number of disorders (range 1.96–2.9) or the percentage of participants (range 68.1–96.7) with any comorbid diagnosis (Nierenberg 2003a, Nierenberg 2006, Watkins 2011a, Town 201715).The majority of trials (46/51) did not report the prevalence of PD. Many stated PD as an exclusion criterion but without defining a threshold for exclusion. For example, PD lasix tablet sizes could be excluded if it ‘impacted’ the depression, if it was ‘significant’, ‘severe’ or ‘persistent’. Some excluded certain PDs (such as antisocial or borderline) and not others but without reporting the prevalence of those not excluded.

In the lasix tablet sizes five trials where prevalence was clear, prevalence ranged from 0% (Ravindran 2008a15), where all PDs were excluded, to 87.5% of the sample (Town 201715). Two studies reported the mean number of PDs. 2.0 (Nierenberg 2003a) and 0.85 (Watkins 2011a15).The majority of trials (43/51) did not report the prevalence of physical illness. Many stated illness as an exclusion criterion, but the definitions and thresholds were lasix tablet sizes vague and could be interpreted in different ways.

For example, illness could be excluded if it was ‘unstable’, ‘serious’, ‘significant’, ‘relevant’, or would ‘contraindicate’ or ‘impact’ the web link medication. Of the eight trials reporting information about lasix tablet sizes physical health, there was a wide variation. Four reported prevalence varying from 7.6% having a disability (Eisendrath 201615) to 90.9% having an illness or disability (Town 201715). Four used scales of physical health.

Two indicating mild problems (Nierenberg 2006, lasix tablet sizes Lavretsky 201115) and two indicating moderately high levels of illness (Thase 2007, Fang 201015).The NICE review also divided trial populations into a dichotomy of ‘more severe’ and ‘less severe’ on the grounds that this would be a clinically useful classification for general practitioners. NICE applied a bespoke methodology for creating this dichotomy, abandoning validated measure thresholds in order first to generate two ‘homogeneous’ groups to ‘facilitate analysis’, and second to create an algorithm to ‘read across’ different measures (such as the Beck Depression Inventory, the Hamilton Rating Scale for Depression (HRSD) and the Montgomery-Asberg Depression Rating Scale).16 Examining trials which use more than one of these measures reveals problems in the algorithm. Of the 51 trials, there are 6 instances in which the study population falls into NICE’s more severe category according to one measure and into the less severe category according to another lasix tablet sizes. In four of these trials, NICE chose the less severe category (Souza 2016, Watkins 2011a, Fonagy 2015, Town 201715).

The other two trials were designated more severe (Barbee 2011, Dunner 200715). Only 17 of 51 trials reported two or more depression scale measures, leaving much unknown about whether other study populations could count as both more severe and less lasix tablet sizes severe.Absence of knowledge or knowledge of absence?. A key philosophical error in science is to confuse an absence of knowledge with knowledge of absence. It is likely that some lasix tablet sizes of the study populations deemed lacking in complexity or severity could actually have high degrees of complexity and/or severity.

Data to demonstrate this may either fall foul of a guideline committee decision to prioritise certain information over other conflicting information (as in the severity algorithm). The information may be non-existent as it was not collected. It may be somewhere in the lasix tablet sizes publication pipeline. Or it may be sitting in a database with a research team that has run out of funds for supplementary analyses.

Wherever those data are or are not, their absence from published articles does not define the phenomenology lasix tablet sizes of depression for the patients who took part. As a case in point, data from the Fonagy 2015 trial presented at conferences but not published reveal that PD prevalence data would place the trial well within the NICE complex depression category, and that the sample had high levels of past trauma and physical condition comorbidity. The trial also meets the guideline criteria for CD according to the guideline’s own appendices.17 Reported axis 1 comorbidity was high (75.2% had anxiety disorder, 18.6% had substance abuse disorder, 13.2% had eating disorder).18 The mean depression scores at baseline were 36.5 on the Beck Depression Inventory and 20.1 on the HRSD (severe and very severe, respectively, according to published cut-off scores). NICE categorised this population as less severe TRD, lasix tablet sizes not CD and not complex.Notes1.

Avram H. Mack et lasix tablet sizes al. (1994), “A Brief History of Psychiatric Classification. From the Ancients to DSM-IV,” Psychiatric Clinics 17, no.

Snaith (1987), “The Concepts of Mild Depression,” British Journal of Psychiatry 150, no. 3. 387.3. Susan McPherson and David Armstrong (2006), “Social Determinants of Diagnostic Labels in Depression,” Social Science &.

Grob (1991), “Origins of DSM-I. A Study in Appearance and Reality,” The American Journal of Psychiatry. 421–31.5. Wilson M.

Compton and Samuel B. Guze (1995), “The Neo-Kraepelinian Revolution in Psychiatric Diagnosis,” European Archives of Psychiatry and Clinical Neuroscience 245, no. 4. 198–9.6.

Gerald L. Klerman (1984), “A Debate on DSM-III. The Advantages of DSM-III,” The American Journal of Psychiatry. 539–42.7.

Thomas E. Schacht (1985), “DSM-III and the Politics of Truth,” American Psychologist. 513–5.8. Daniel F.

Hartner and Kari L. Theurer (2018), “Psychiatry Should Not Seek Mechanisms of Disorder,” Journal of Theoretical and Philosophical Psychology 38, no. 4. 189–204.9.

Sami Timimi (2014), “No More Psychiatric Labels. Why Formal Psychiatric Diagnostic Systems Should Be Abolished,” Journal of Clinical and Health Psychology 14, no. 3. 208–15.10.

Allen Frances et al. (1994), “DSM-IV Meets Philosophy,” The Journal of Medicine and Philosophy. A Forum for Bioethics and Philosophy of Medicine 19, no. 3.

207–18.11. Andrea Jobst et al. (2016), “European Psychiatric Association Guidance on Psychotherapy in Chronic Depression Across Europe,” European Psychiatry 33. 20.12.

National Institute for Health and Care Excellence (2018), Depression in Adults. Treatment and Management. Draft for Consultation, https://www.nice.org.uk/guidance/gid-cgwave0725/documents/full-guideline-updated, 507.13. Ibid., 351–62.14.

Ibid., 597.15. Note that in order to refer to specific trials reviewed in the guideline, rather than the full citation, the Study IDs from column A in appendix J5 have been used. See www.nice.org.uk/guidance/gid-cgwave0725/documents/addendum-appendix-9 for details and full references.16. National Institute for Health and Care Excellence (2018), Depression in Adults.

Treatment and Management. Second Consultation on Draft Guideline – Stakeholder Comments Table, https://www.nice.org.uk/guidance/gid-cgwave0725/documents/consultation-comments-and-responses-2, 420–1.17. National Institute for Health and Care Excellence (2018), Depression in Adults, appendix J5.18. Peter Fonagy et al.

(2015), “Pragmatic Randomized Controlled Trial of Long-Term Psychoanalytic Psychotherapy for Treatment-Resistant Depression. The Tavistock Adult Depression Study (TADS),” World Psychiatry 14, no. 3. 312–21.19.

American Psychological Association (2018), Clinical Practice Guideline for the Treatment of Depression in Children, Adolescents, and Young, Middle-aged, and Older Adults. Draft.20. Jacqui Thornton (2018), “Depression in Adults. Campaigners and Doctors Demand Full Revision of NICE Guidance,” BMJ 361.

We live in unprecedented times lasix for sale online. But what makes them without parallel is not the current lasix crisis nor the continued problems facing minorities in our institutions. Rather, it’s that for the first time, the problems of accessibility, rights lasix for sale online and freedoms are now invading privileged spaces. There can be no ‘getting back to normal’, because ‘normal’ only ever benefited the white, Western, patriarchal, abled and cis ideals.

For many, the world is not suddenly on lasix for sale online fire. It has long been burning.The present lasix lays bare systemic prejudice against the most vulnerable among us. We at Medical Humanities, with our focus on global health and social justice, welcome discussion about how the crisis has disproportionately affected racial and fiscal minorities, those from the disabled community, those who are LGBTQA+ and other vulnerable groups. What we focus on here, now, can lead to greater accessibility and equity in the future.In this expanded issue, we offer some of the incredible work being done across lasix for sale online the field of medical humanities prior to the hypertension medications crisis, and we are already reviewing articles on the role of health humanities during the lasix.

The process of academic publishing tends not to lend itself to immediacy, however, and the challenges of lasix means greater pressure on everyone, from the authors to the reviewers and readers.To remedy this, we at Medical Humanities have been increasing the work on our blog platform, a place where content can be quickly updated, and where conversations can occur among readers and writers. We openly invite submissions concerning the lasix, as well as topics relevant to our wider CFP (call for posts/papers) this year on social justice and health, to lasix for sale online both blog and journal. We will do our best to expedite. Finally, we have also been addressing social justice and access in our podcast, where we interviewed disability activist Alice Wong and most recently Dr Oni Blackstock, primary care physician and HIV specialist in New York.

We hope to have many more on these critical subjects.We wish all of you good health and safety and know lasix for sale online that many of you are yet on the front lines. Thank you for being part of the community of Medical Humanities.IntroductionMinecraft is a computer game with no specific goals to accomplish. The gameworld lasix for sale online consists of three-dimensional (3D) cubes and objects which the player (Steve) can mine and build into infinitely complex (and logically impossible) structures. Steve sometimes encounters other characters (‘mobs’), such as animals and hostile creatures.

He can ‘spawn’ and destroy them. While it looks like a harmless game of logical construction, it conveys some worryingly delusive ideas about the lasix for sale online real world. The difference between real and imagined structures is at the heart of the age-old debate around categorising mental disorders.Classification in mental health has had various forms throughout history. Mack and colleagues set out a history of psychiatric classification beginning in 2600 BC with Egyptian references to melancholia and lasix for sale online hysteria.

Through the Ancient Greeks with Hippocrates’ phrenitis, mania, melancholia, epilepsy, hysteria and Scythian disease. Through the Renaissance period. Through to 19th-century psychiatry featuring Pinel (known as the first lasix for sale online psychiatrist), Kraepelin (known for observational classification) and Freud (known for classifying neurosis and psychosis).1Although the history of psychiatric classification identifies some common trends such as the labels ‘melancholia’ and ‘hysteria’ which have survived millennia, the label ‘depression’ is relatively new. The earliest usage noted by Snaith is from 1899.

€˜in simple pathological depression…the patient exhibits a growing indifference to his former pursuits…’.2 Snaith noted that early 20th-century psychiatrists like Adolf Meyer hoped that ‘depression’ would come to encompass a broad category under which descriptions of lasix for sale online subtypes would emerge. This did not happen until the middle of the 20th century. With the publication of the sixth International Classification of Diseases (ICD) in 1948 and the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1952 and their subsequent revisions, the latter half of the 20th century has seen depression subtype labels proliferate. In their study lasix for sale online of the social determinants of diagnostic labels in depression, McPherson and Armstrong illustrate how the codification of depression subtypes in the latter half of the 20th century has been shaped by the evolving context of psychiatry, including power struggles within the profession, a move to community care and the development of psychopharmacology.3During this period, McPherson and Armstrong describe how subsequent versions of the DSM served as battlegrounds for professional disputes and philosophical quarrels around categorisation of mental disorders.

DSM I and DSM II have been described as products of an American Psychiatric Association dominated by psychoanalytic psychiatrists.4 DSM III and DSM III-R have been described as a radical rejection of psychoanalytic thinking, a ‘neo-Kraepelinian revolution’, a reference to the observational descriptive techniques of 19th-century psychiatrist Emil Kraepelin who classified mental disorders into two broad categories. €˜dementia praecox’ and ‘manic-depression’.5 DSM III was seen by some as a turning point in the use of the medical model of mental illness, through provision of specific inclusion and exclusion criteria, and use of field trials and a multiaxial system.6 These latter technocratic additions to psychiatric labelling served to engender a much closer alignment between psychiatry, science and medicine.The codification of mental disorders in manuals has been described by Thomas Schacht as lasix for sale online intrinsic to the relationship between science and politics and the way in which psychiatrists gain significant social power by aligning themselves to science.7 His argument drew on Szasz, who saw the mental health establishment as a therapeutic state. Zimbardo, who described psychiatric care as a controlling force. And Foucault, who described the categorisation of the mentally ill as a force for isolating ‘the other’.

Diagnostic critique has been further developed through a cultural relativist lens in that what Western psychiatrists classify as a depression is constructed differently lasix for sale online in other cultures.8 Considering these limitations, some critics have gone so far as to argue that psychiatric diagnostic systems should be abolished.9Yet architects of DSM manuals have worked hard to ensure the technology of classification is regarded as genuine scientific activity with sound roots in philosophy of science. In their philosophical defence of DSM IV, Allen Frances and colleagues address their critics under the headings ‘nominalism vs realism’, ‘empiricism vs rationalism’ and ‘categorical vs dimensional’.10 The implication is that there are opposing stances in which a choice must be made or a middle ground forged by those reasonable enough to recognise the need for pragmatism in the service of clinical utility. The nominalism–realism debate is illustrated using as metaphor three lasix for sale online different stances a cricket umpire might take on calling strikes and balls. The discussion sets out two of these as extreme views.

€˜at one extreme…those who take a reductionistically realistic view of the world’ versus ‘the solipsistic nominalists…might content that nothing exists’. Szasz, who lasix for sale online is characterised as holding particularly extreme views, is named as an archetypal solipsist. There is implied to be a degree of arrogance associated with this view in the illustrative example in which the umpire states ‘there are no balls and there are no strikes until I call them’. Frances therefore sets up a means of grouping two kinds of people as philosophical extremists who can be dismissed, while avoiding addressing the philosophical problems they pose.Frances provides little if any justification for the middle ground stance, ‘There are balls and there are strikes and I call them as lasix for sale online I see them’, other than to focus on its clinical utility and the lack of clinical utility in the alternatives ‘naïve realism’ and ‘heuristically barren solipsism’.

The natural conclusion the reader is invited to reach is that a middle ground of a heuristic concept is naturally right because it is not extreme and is naturally useful clinically, without specifying in what way this stance is coherent, resolves the two alternatives, and in what way a heuristic construct that is not ‘real’ can be subject to scientific testing.Similarly, in discussing the ‘categorical vs dimensional’, Frances promotes the ‘prototype approach’. Those holding opposing views are labelled as ‘dualists’ or ‘dichotomisers’. The prototypical approach is again put forward as a clinically lasix for sale online useful middle ground. Illustrations are drawn from natural science.

€˜a triangle lasix for sale online and a square are never the same’, inciting the reader to consider science as value-free. The prototypical approach emerges as a natural solution, yet the authors do not address how a diagnostic prototype resolves the issues posed by the two alternatives, nor how a prototype can be subjected to natural science methods.The argument presented here is not a defence of solipsism or dualism. Rather it aims to illustrate that if for pragmatic purposes clinicians and policymakers choose to gloss over the philosophical flaws in classification practices, it is then risky to move beyond the heuristic and apply natural science methods to these constructs adding multiple layers of technocratic subclassification. Doing so lasix for sale online is more like playing Minecraft than cricket.

The National Institute for Health and Care Excellence (NICE) guideline for depression is taken as an example of the philosophical errors that can follow from playing Minecraft with unsound heuristic devices, specifically subcategories of persistent forms of depression. As well as serving a clinical purpose, diagnosis in medicine is a way of allocating resources for insurance companies lasix for sale online and constructing clinical guidelines, which in turn determine rationing within the National Health Service. The consequences for recipients of healthcare are therefore significant. Clinical utility is arguably not being served at all and patients are left at risk of poor-quality care.Heterogeneity of persistent depressionAndrea Jobst and colleagues note that ‘because of their chronic clinical course, approximately 40% of CD [chronic depression] patients also fulfil criteria for TRD [treatment resistant depression]…usually defined by the number of non-successful biological treatments’.11 This position is reflected in the DSM VAmerican Psychiatric Association (2013), the European Psychiatric Association (EPA) guidance and the ICD-11(World Health Organisation, 2018), which all use a ‘persistent’ depression category, acknowledging a loosely defined mixed group of long-term, difficult-to-treat depressive conditions, often associated with dysthymia and comorbid common mental disorders, various personality traits and psychosocial disability.In contrast, the NICE 2018 draft guideline separates treatments into those for ‘new episodes’ of depression.

€˜further-line’ treatment of depression (equivalent to TRD), CD and lasix for sale online ‘depression with co-morbidities’. The latter is subdivided into treatments for ‘complex depression’ and ‘psychotic depression’. These categories and subcategories introduce an unfortunate sense lasix for sale online of certainty as though these labels represent real things. An analysis follows of how these definitions play out in terms of grouping of randomised controlled trials in the NICE evidence review.

Specifically, the analysis reveals the overlap between populations in trials which have been separated into discrete categories, revealing significant limitations to the utility of the category labels.The NICE definition of CD requires trial samples to meet the criteria for major depressive disorder (MDD) for 2 years. Dysthymia and double depression (MDD superimposed on dysthymia) were included lasix for sale online. If 75% of the trial population met these criteria, the trial was reviewed in the CD category.12 The definition of TRD (or ‘further-line treatments’) required that the trial sample had demonstrated a ‘limited response to previous treatment’ and randomised to the further-line treatment at this point. If 80% of the trial participants met these criteria, it was reviewed in the TRD category.13 Complex depression was defined as ‘depression lasix for sale online co-existing with personality disorder’.

To be classed as complex, 51% of trial participants had to have personality disorder (PD).14It is immediately clear from these definitions that there is a potential problem with attempting to categorise trial populations into just one of these categories. These populations are likely to overlap, whether or not a trial protocol sets out to explicitly record all of this information. The analysis below will illustrate lasix for sale online this using examples from within the NICE review.Cataloguing complexity in trial populationsWithin the category of further-line treatments (TRD), 64 trials were reviewed. Comparisons within these trials were further subcategorised into ‘dose escalation strategies’, ‘augmentation strategies’ and ‘switching strategies’.

In drilling down by way of illustration, this analysis considers lasix for sale online the 51 trials in the augmentation strategy evidence review. Of these, two were classified by the reviewers as also fulfilling the criteria for CD but were not analysed in the CD category (Study IDs. Fonagy 2015 and Kocsis 200915). About half of the trials (23/51) lasix for sale online did not report the mean duration of episode, meaning that it is not possible to know what percentage of participants also met the criteria for CD.

Of trials that did report episode duration, 17 reported a mean duration longer than 24 months. While the standard deviations varied in size or were unreported, the mean indicates a good likelihood lasix for sale online that a significant proportion of the participants across these 51 trials met the criteria for CD.Details of baseline employment, trauma history, suicidality, physical comorbidity, axis I comorbidity and PD (all clinical indicators of complexity, severity and chronicity) were not collated by NICE. For the present analysis, all 51 publications were examined and data compiled concerning clinical complexity in the trial populations. Only 14 of 51 trials report employment data.

Of those that do, unemployment ranges from 12% to 56% across trial lasix for sale online samples. None of the trials report trauma history. About half of the lasix for sale online trials (26/51) excluded people who were considered a suicide risk. The others did not.A large proportion of trials (30/51) did not provide any data on axis 1 comorbidity.

Of these, 18 did not exclude any diagnoses, while 12 excluded some (but not all) disorders. The most common diagnoses excluded were lasix for sale online psychotic disorders, substance or alcohol abuse, and bipolar disorder (excluded in 26, 25 and 23 trials, respectively). Only 7 of 51 trials clearly stated that all axis 1 diagnoses were excluded. This leaves lasix for sale online only 13 studies providing any data about comorbidity.

Of these, 9 gave partial data on one or two conditions, while 4 reported either the mean number of disorders (range 1.96–2.9) or the percentage of participants (range 68.1–96.7) with any comorbid diagnosis (Nierenberg 2003a, Nierenberg 2006, Watkins 2011a, Town 201715).The majority of trials (46/51) did not report the prevalence of PD. Many stated PD as an exclusion criterion but without defining a threshold for exclusion. For example, PD could be excluded if it ‘impacted’ the depression, if it was ‘significant’, ‘severe’ lasix for sale online or ‘persistent’. Some excluded certain PDs (such as antisocial or borderline) and not others but without reporting the prevalence of those not excluded.

In the lasix for sale online five trials where prevalence was clear, prevalence ranged from 0% (Ravindran 2008a15), where all PDs were excluded, to 87.5% of the sample (Town 201715). Two studies reported the mean number of PDs. 2.0 (Nierenberg 2003a) and 0.85 (Watkins 2011a15).The majority of trials (43/51) did not report the prevalence of physical illness. Many stated illness as an exclusion criterion, but the definitions and thresholds were vague and lasix for sale online could be interpreted in different ways.

For example, illness could be excluded if it was ‘unstable’, ‘serious’, ‘significant’, ‘relevant’, or would ‘contraindicate’ or ‘impact’ the medication. Of the eight trials reporting information about physical health, lasix for sale online there was a wide variation. Four reported prevalence varying from 7.6% having a disability (Eisendrath 201615) to 90.9% having an illness or disability (Town 201715). Four used scales of physical health.

Two indicating mild problems (Nierenberg 2006, Lavretsky 201115) and two indicating moderately high levels of illness (Thase 2007, Fang lasix for sale online 201015).The NICE review also divided trial populations into a dichotomy of ‘more severe’ and ‘less severe’ on the grounds that this would be a clinically useful classification for general practitioners. NICE applied a bespoke methodology for creating this dichotomy, abandoning validated measure thresholds in order first to generate two ‘homogeneous’ groups to ‘facilitate analysis’, and second to create an algorithm to ‘read across’ different measures (such as the Beck Depression Inventory, the Hamilton Rating Scale for Depression (HRSD) and the Montgomery-Asberg Depression Rating Scale).16 Examining trials which use more than one of these measures reveals problems in the algorithm. Of the 51 trials, there lasix for sale online are 6 instances in which the study population falls into NICE’s more severe category according to one measure and into the less severe category according to another. In four of these trials, NICE chose the less severe category (Souza 2016, Watkins 2011a, Fonagy 2015, Town 201715).

The other two trials were designated more severe (Barbee 2011, Dunner 200715). Only 17 of 51 trials reported two or more depression scale measures, leaving much unknown about whether other study populations could count as lasix for sale online both more severe and less severe.Absence of knowledge or knowledge of absence?. A key philosophical error in science is to confuse an absence of knowledge with knowledge of absence. It is likely that some of the study populations deemed lacking in complexity lasix for sale online or severity could actually have high degrees of complexity and/or severity.

Data to demonstrate this may either fall foul of a guideline committee decision to prioritise certain information over other conflicting information (as in the severity algorithm). The information may be non-existent as it was not collected. It may lasix for sale online be somewhere in the publication pipeline. Or it may be sitting in a database with a research team that has run out of funds for supplementary analyses.

Wherever those data are or are not, their absence from published articles does not define the phenomenology lasix for sale online of depression for the patients who took part. As a case in point, data from the Fonagy 2015 trial presented at conferences but not published reveal that PD prevalence data would place the trial well within the NICE complex depression category, and that the sample had high levels of past trauma and physical condition comorbidity. The trial also meets the guideline criteria for CD according to the guideline’s own appendices.17 Reported axis 1 comorbidity was high (75.2% had anxiety disorder, 18.6% had substance abuse disorder, 13.2% had eating disorder).18 The mean depression scores at baseline were 36.5 on the Beck Depression Inventory and 20.1 on the HRSD (severe and very severe, respectively, according to published cut-off scores). NICE categorised lasix for sale online this population as less severe TRD, not CD and not complex.Notes1.

Avram H. Mack et al lasix for sale online. (1994), “A Brief History of Psychiatric Classification. From the Ancients to DSM-IV,” Psychiatric Clinics 17, no.

Snaith (1987), “The Concepts of Mild Depression,” British Journal of Psychiatry 150, no. 3. 387.3. Susan McPherson and David Armstrong (2006), “Social Determinants of Diagnostic Labels in Depression,” Social Science &.

Grob (1991), “Origins of DSM-I. A Study in Appearance and Reality,” The American Journal of Psychiatry. 421–31.5. Wilson M.

Compton and Samuel B. Guze (1995), “The Neo-Kraepelinian Revolution in Psychiatric Diagnosis,” European Archives of Psychiatry and Clinical Neuroscience 245, no. 4. 198–9.6.

Gerald L. Klerman (1984), “A Debate on DSM-III. The Advantages of DSM-III,” The American Journal of Psychiatry. 539–42.7.

Thomas E. Schacht (1985), “DSM-III and the Politics of Truth,” American Psychologist. 513–5.8. Daniel F.

Hartner and Kari L. Theurer (2018), “Psychiatry Should Not Seek Mechanisms of Disorder,” Journal of Theoretical and Philosophical Psychology 38, no. 4. 189–204.9.

Sami Timimi (2014), “No More Psychiatric Labels. Why Formal Psychiatric Diagnostic Systems Should Be Abolished,” Journal of Clinical and Health Psychology 14, no. 3. 208–15.10.

Allen Frances et al. (1994), “DSM-IV Meets Philosophy,” The Journal of Medicine and Philosophy. A Forum for Bioethics and Philosophy of Medicine 19, no. 3.

207–18.11. Andrea Jobst et al. (2016), “European Psychiatric Association Guidance on Psychotherapy in Chronic Depression Across Europe,” European Psychiatry 33. 20.12.

National Institute for Health and Care Excellence (2018), Depression in Adults. Treatment and Management. Draft for Consultation, https://www.nice.org.uk/guidance/gid-cgwave0725/documents/full-guideline-updated, 507.13. Ibid., 351–62.14.

Ibid., 597.15. Note that in order to refer to specific trials reviewed in the guideline, rather than the full citation, the Study IDs from column A in appendix J5 have been used. See www.nice.org.uk/guidance/gid-cgwave0725/documents/addendum-appendix-9 for details and full references.16. National Institute for Health and Care Excellence (2018), Depression in Adults.

Treatment and Management. Second Consultation on Draft Guideline – Stakeholder Comments Table, https://www.nice.org.uk/guidance/gid-cgwave0725/documents/consultation-comments-and-responses-2, 420–1.17. National Institute for Health and Care Excellence (2018), Depression in Adults, appendix J5.18. Peter Fonagy et al.

(2015), “Pragmatic Randomized Controlled Trial of Long-Term Psychoanalytic Psychotherapy for Treatment-Resistant Depression. The Tavistock Adult Depression Study (TADS),” World Psychiatry 14, no. 3. 312–21.19.

American Psychological Association (2018), Clinical Practice Guideline for the Treatment of Depression in Children, Adolescents, and Young, Middle-aged, and Older Adults. Draft.20. Jacqui Thornton (2018), “Depression in Adults. Campaigners and Doctors Demand Full Revision of NICE Guidance,” BMJ 361.