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Maeda Y, Nakamura M, Ninomiya H, et buy renova cream uk al. Trends in intensive neonatal care during the skin care products outbreak in Japan. Arch Dis buy renova cream uk Child Fetal Neonatal Ed 2021;106:327–29.

Doi. 10.1136/archdischild-2020-320521The authors have noticed an error in table 1 of their short report recently published. They mistakenly buy renova cream uk showed values for weeks 10–17 of 2019 instead of those for weeks 2–9 of 2020.

The values for ‘Births before 33 6/7 weeks’ and ‘Births between 34 0/7 and 36 6/7 weeks’ of Table 1 should be amended as follows:Births before 33 6/7 weeksWeeks 2-9, 2020. 83, instead of 99Difference (% change). 17 (20.5), instead of 33 (33.3)Births between 34 0/7 and 36 buy renova cream uk 6/7 weeksWeeks 2-9, 2020.

207, instead of 211Difference (% change). 17 (8.2), instead of 21 (10.0)Accordingly, the second sentence of the subsection ‘Preterm births’ should also be corrected to “The number of preterm births showed a statistically significant reduction in weeks 2–9 vs weeks 10–17 of 2020. Births before 33 6/7 gestational weeks from 83 to buy renova cream uk 66 (aIRR, 0.71.

95% CI, 0.50 to 1.00. P=0.05) and births between 34 0/7 and 36 6/7 gestational weeks from 207 to 190 (aIRR, 0.85. 95% CI, 0.74 to buy renova cream uk 0.98.

P=0.02) (figure 1 and table 1).Reviewing recordings of neonatal resuscitation with parentsFew of us relish the thought of our performance in a challenging situation being recorded and reviewed by others, but many have accepted it for research purposes in the context of newborn resuscitation. At Leiden University Medical Centre Neonatal Unit they have been recording videos of all newborn resuscitations since 2014 in order to study and improve buy renova cream uk care during transition. The recordings are kept as a part of the medical record and, in contrast with other published practice to date, parents are offered an opportunity to review the recording with a professional and to have still images from it or a copy of the video.

In this qualitative study Maria C den Boer and colleagues interviewed parents of preterm babies who had viewed their baby’s recording to provide insight into their experience. The study included 25 parents of 31 preterm babies with buy renova cream uk median gestational age 27+5 weeks. Four of the babies had gone on to die in the neonatal unit.

Most parents offered the opportunity to see the recording wished to do so and around two thirds asked for images or a copy. The parental experiences of viewing buy renova cream uk the videos were very positive. The experience improved their understanding of what had happened, enhanced their family relationships, and increased their appreciation of the care team.Colm O’Donnell discusses his own experience with researching video recordings of resuscitation, beginning with a visit to Neil Finer and Wade Rich at University of California, San Diego in 2003.

Colm also has positive experiences of sharing the recordings with families. The team in buy renova cream uk Leiden recommend this practice. Both articles are an interesting read that will challenge your assumptions and stimulate reflection.

See page F346 and F344Physiological responses to facemask application in newborns immediately after birthVincent Gaertner and colleagues reviewed video recordings of initial stabilisation at birth of term and late-preterm infants who were enrolled in a randomised trial of different face-masks. 128 face-mask applications were buy renova cream uk evaluated. In eleven percent of face-mask applications the infant stopped breathing.

When apnoea occurred after mask application there was a median fall in heart rate of 38 beats per minute. These episodes are considered to represent the trigeminocardiac buy renova cream uk reflex and recovered within 30 s. Apnoea was also observed after face-mask reapplications, although less frequently.

There were a median of 4 buy renova cream uk face-mask applications per infant, suggesting a lot of additional potential for avoidable interruption of support. This observation of apneoa after face-mask application is less frequent than in previous reports in more preterm infants but is still quite common. See page F381Outcomes of a uniformly active approach to infants born at 22–24 weeks of gestationThis single centre report by Fanny Söderström and colleagues from Uppsala in Sweden describes the outcomes of infants born at 22 to 24 weeks gestation between 2006 and 2015.

In this buy renova cream uk institution, all mother-infant dyads at risk for extremely preterm delivery are provided proactive treatment. This includes intrauterine referral when approaching 22 weeks of gestation, provision of tocolytics, antenatal steroids and family counselling. There were 222 liveborn infants born at the hospital or admitted soon after birth.

There had been buy renova cream uk four fetal deaths during in utero transport to the centre and there were 14 stillbirths of fetuses that were alive at admission. Two infants died in the delivery room after birth. Survival of the liveborn babies was 52% at 22 weeks, 64% at 23 weeks and 70% at 25 weeks.

Follow-up information was available for 93% of buy renova cream uk infants. There were 10 infants with cerebral palsy and no infants who were blind or deaf. Around a third had diagnosis of developmental delay.

The study provides a measure of what can be achieved when decisions to initiate treatment are not selective according buy renova cream uk to the views of the parents and physicians. See page F413Bronchopulmonary dysplasia and growthTheodore Dassios and colleagues analysed data from the UK National Neonatal Research Database for the years 2014 to 2018. They looked at postnatal growth in all liveborn infants born before 28 weeks gestation and admitted to neonatal units buy renova cream uk.

There were 11 806 infants. Bronchopulmonary dysplsia was defined as any requirement for respiratory support at 36 weeks and affected 57%. As measured by change in weight and head circumference z-scores from birth to discharge, the infants who developed BPD grew slightly better than those who did buy renova cream uk not.

See page F386Disorders of vision in neonatal hypoxic-ischaemic encephalopathyEva Nagy and colleagues undertook a systematic review of reports of outcome after hypoxic ischaemic encephalopathy to evaluate the evidence relating to visual impairment. Although this is a recognised complication of hypoxic ischaemic encephalopathy, it has not been well described. They identified six studies that enrolled 283 term buy renova cream uk born infants that met their inclusion criteria.

Some form of visual impairment was reported in 35% but there was huge variation in the techniques used for assessment. It remains difficult to advise families about the risks and nature of visual impairments that might be encountered. There are lots of barriers to obtaining good information in this area buy renova cream uk because of the need for prolonged follow-up and difficulty in testing individuals with other difficulties.

See page F357Management of systemic hypotension in term infants with persistent pulmonary hypertension of the newbornHeather Siefkes and Satyan Lakshminrusimha present a beautifully illustrated review of the multiple factors contributing to haemodynamic disturbance in infants with PPHN, and the mechanisms of action of the various candidate therapeutic agents. This supports a reasoned approach to treatment. The challenge remains to supplement this with high buy renova cream uk quality evidence.

The HIP trial report illustrates the enormous challenge of studying treatments for haemodynamic disturbance in the immediate newborn period and the hurdles that need to be overcome to enable progress. See page F446 and F398Ethics statementsPatient consent for publicationNot required..

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No
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2h
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Shutterstock Between renova environmental services 2010 and 2017, the rates of pregnant women diagnosed Best price for symbicort with opioid use disorder spiked 131 percent, and babies born with neonatal abstinence syndrome (NAS) grew 82 percent, according to a U.S. Department of Health and Human Services (HHS) study.Although some states had rates as high as one in 20 deliveries affected by opioids, the increases were seen nationwide. Twenty-five states doubled their rates between 2010 and 2017 while rates plateaued in New England.“We found that rural, white, and Medicaid populations continue to have the highest rates of maternal opioid-related diagnoses and neonatal renova environmental services abstinence syndrome,” Dr. Jean Ko, Maternal Health and Chronic Disease Team lead in the Centers for Disease Control and Prevention’s (CDC) Division of Reproductive Health said.

€œHowever, large variation by state highlight the importance of state-level strategies and initiatives to renova environmental services address the opioid crisis for pregnant and postpartum women and their infants.”HHS’ Health Resources and Services Administration, the CDC, Vanderbilt University Medical Center, and the Agency for Healthcare Research and Quality conducted the study.Researchers examined 11.8 million hospital records for trends in maternal opioid diagnoses and NAS. The records were from community, non-rehabilitation hospitals in 47 states and the District of Columbia.Shutterstock A team of scientists, led by Duke University, have developed a bio-compatible surgical patch that releases nonopioid painkillers directly to the site of a wound.The polymer patch, made of poly(ester urea) homopolymers and co-polymers, lasts for several days and then dissolves. It uses a controlled release of a drug that blocks renova environmental services the enzyme COX-2. The polymer’s surface area and thicknesses control the release of the painkiller.Traditional polymers swell and the medicine is released at once.“If you can get four or five days of pain control out of the patch and not have to take those other pain drugs, not only do you avoid some of the side effects and risks of addiction, you’re concentrating therapy where you need it,” Matthew Becker, Duke’s Pratt School of Engineering professor of mechanical engineering and materials science, said.Becker received a $2 million grant from the state of Ohio at his previous institution to investigate nonopioid pain management as a means of controlling the opioid epidemic.

Becker began renova environmental services working at Duke in 2019, and he and his research team partnered with Dr. Ru-Rong Ji, a pain control expert, and his team.Researchers originally planned to devise hernia meshes and antimicrobial films.Sutterstock U.S. Reps. David McKinley (R-WV) and Lisa Blunt Rochester (D-DE) announced Tuesday that they had introduced legislation that would help those suffering from addiction or mental illness access treatment via the states’ prescription drug monitoring programs.

The PDMP Help Patients Act would utilize states’ Prescription Drug Monitoring Programs (PDMP) to link patients to treatment, the legislators said. PDMPs are databases that track and record controlled substance prescriptions and allow health care providers to check and make sure a patient doesn’t already have an opioid or controlled substance prescription if they need to prescribe one. The PDMP Help Patients Act would create a pilot program that would integrate substance use disorder and behavioral health treatment locator tools into the PDMP. Health care providers could use the tool to provide their patients with resources if the PDMP indicates a possibility the patient is misusing their prescriptions, ensuring that those receiving opioid prescriptions have access to mental health and substance abuse treatment if needed.

€œThe skin care products -19 renova has only further fueled our nation’s opioid epidemic,” McKinley said. €œNow more than ever, we should be equipping providers and patients with every resource possible to provide those with substance abuse and mental health disorders the help they need. I am pleased to continue this critical work with Rep. Blunt Rochester to help combat the opioid epidemic.”McKinley and Blunt Rochester also introduced the legislation in the previous Congressional session.

€œDelaware’s overdose epidemic may have taken more lives in 2020 than any year before. Prescription drug monitoring programs are a critical tool in combatting the on-going overdose epidemic, and I’m proud to join my colleague, Congressman McKinley, in helping states enhance their effectiveness, so patients in need are immediately connected to treatment,” Blunt Rochester said.Shutterstock Washington, D. C. Councilmember Mary Cheh reintroduced the “Flavored Electronic Smoking Device Prohibition Amendment Act” to the DC Council Tuesday, hoping to end the sale of all flavored e-cigarette products inside the District of Columbia.

€œIt is past time to stop big tobacco from hooking our kids–and adults– with flavored tobacco. During this period of increased social isolation and heightened stress among young people, we especially cannot allow this predatory industry to gain any further foothold in the youth market,” Cheh said. €œI urge my colleagues to enact this bill as swiftly as possible.”The legislation is supported by public health officials, community leaders, and more than 70 local and national organizations. Councilmembers said they are being called on to strengthen the legislation to include menthol cigarettes and other flavored tobacco products and pass the bill immediately.

Previously referred to the Judiciary Committee of the Council, committee members heard five hours of testimony in January 2020, calling for the legislation to include the ban on all flavored tobacco. €œI’m proud to support this legislation. We’re going to act fast to put in place commonsense laws that protect the next generation from getting hooked by big tobacco,” said Councilmember Charles Allen. €œDoing so will have enormous benefits for public health.”Tobacco kills more than 800 DC residents a year, the Council said in a press release.

€œI’m joining with my colleagues to support legislation that will end the sale of all flavored tobacco products, including menthol cigarettes,” said Councilmember Vince Gray. €œThis is not just a public health issue. It is a social justice issue. Big Tobacco has preyed upon people of color in DC for far too long.”Shutterstock A new study suggests that collaboration between physicians and pharmacists may increase the adherence to and participant satisfaction of treatments for opioid use disorder.

Researchers at Duke University, in Durham, N.C., looked at 71 participants in buprenorphine maintenance therapy for opioid use disorder to study the transfer of care from waivered physicians treating them to trained community pharmacists providing their prescriptions. Because buprenorphine prescribing requires a federal waiver, fewer than 10 percent of primary care providers are authorized to prescribe the drug. As a result, more than 20 million people in the United States live in a county without a buprenorphine-waivered physician. The Duke study involved the 71 participants as well as six physicians and six community pharmacists.

As part of the study, from March to December 2018, the physician initially prescribed the buprenorphine until a satisfactory dose was reached. Then, participants in the study attended monthly maintenance visits with trained pharmacists who dispensed the medication, assessed how well the medication was working, and provided counseling and referrals to specialists, as needed. Pharmacists then gave feedback to the physicians to adjust the buprenorphine as necessary. The researchers found that nearly 89 percent of the participants remained in the study, and 95.3 percent adhered to the daily medication regimen.

During the 6-month trial, no opioid-related emergencies or hospitalizations were required. Additionally, the proportion of opioid-positive urine drug screens was less than 5 percent. Researchers concluded that the study offers support for the idea of advancing physician-pharmacists team-based approaches to make use of community pharmacies as a way to expand access to opioid use disorder treatment with buprenorphine..

Shutterstock Between 2010 and 2017, the rates of pregnant women diagnosed with opioid use disorder spiked 131 percent, and babies born with neonatal abstinence syndrome (NAS) grew 82 percent, according to a buy renova cream uk U.S. Department of Health and Human Services (HHS) study.Although some states had rates as high as one in 20 deliveries affected by opioids, the increases were seen nationwide. Twenty-five states doubled their rates between 2010 and 2017 while rates plateaued in New England.“We found that rural, white, and Medicaid populations continue to have the highest rates of maternal opioid-related diagnoses and neonatal abstinence syndrome,” Dr buy renova cream uk. Jean Ko, Maternal Health and Chronic Disease Team lead in the Centers for Disease Control and Prevention’s (CDC) Division of Reproductive Health said. €œHowever, large variation by state highlight the importance of state-level strategies and initiatives to address the opioid crisis for pregnant and postpartum women and their infants.”HHS’ Health Resources and Services Administration, the CDC, Vanderbilt University Medical Center, and the Agency for Healthcare Research and Quality conducted the study.Researchers examined 11.8 million hospital records for trends in maternal opioid diagnoses buy renova cream uk and NAS.

The records were from community, non-rehabilitation hospitals in 47 states and the District of Columbia.Shutterstock A team of scientists, led by Duke University, have developed a bio-compatible surgical patch that releases nonopioid painkillers directly to the site of a wound.The polymer patch, made of poly(ester urea) homopolymers and co-polymers, lasts for several days and then dissolves. It uses a controlled release of a buy renova cream uk drug that blocks the enzyme COX-2. The polymer’s surface area and thicknesses control the release of the painkiller.Traditional polymers swell and the medicine is released at once.“If you can get four or five days of pain control out of the patch and not have to take those other pain drugs, not only do you avoid some of the side effects and risks of addiction, you’re concentrating therapy where you need it,” Matthew Becker, Duke’s Pratt School of Engineering professor of mechanical engineering and materials science, said.Becker received a $2 million grant from the state of Ohio at his previous institution to investigate nonopioid pain management as a means of controlling the opioid epidemic. Becker began working at Duke in 2019, and he buy renova cream uk and his research team partnered with Dr. Ru-Rong Ji, a pain control expert, and his team.Researchers originally planned to devise hernia meshes and antimicrobial films.Sutterstock U.S.

Reps. David McKinley (R-WV) and Lisa Blunt Rochester (D-DE) announced Tuesday that they had introduced legislation that would help those suffering from addiction or mental illness access treatment via the states’ prescription drug monitoring programs. The PDMP Help Patients Act would utilize states’ Prescription Drug Monitoring Programs (PDMP) to link patients to treatment, the legislators said. PDMPs are databases that track and record controlled substance prescriptions and allow health care providers to check and make sure a patient doesn’t already have an opioid or controlled substance prescription if they need to prescribe one. The PDMP Help Patients Act would create a pilot program that would integrate substance use disorder and behavioral health treatment locator tools into the PDMP.

Health care providers could use the tool to provide their patients with resources if the PDMP indicates a possibility the patient is misusing their prescriptions, ensuring that those receiving opioid prescriptions have access to mental health and substance abuse treatment if needed. €œThe skin care products -19 renova has only further fueled our nation’s opioid epidemic,” McKinley said. €œNow more than ever, we should be equipping providers and patients with every resource possible to provide those with substance abuse and mental health disorders the help they need. I am pleased to continue this critical work with Rep. Blunt Rochester to help combat the opioid epidemic.”McKinley and Blunt Rochester also introduced the legislation in the previous Congressional session.

€œDelaware’s overdose epidemic may have taken more lives in 2020 than any year before. Prescription drug monitoring programs are a critical tool in combatting the on-going overdose epidemic, and I’m proud to join my colleague, Congressman McKinley, in helping states enhance their effectiveness, so patients in need are immediately connected to treatment,” Blunt Rochester said.Shutterstock Washington, D. C. Councilmember Mary Cheh reintroduced the “Flavored Electronic Smoking Device Prohibition Amendment Act” to the DC Council Tuesday, hoping to end the sale of all flavored e-cigarette products inside the District of Columbia. €œIt is past time to stop big tobacco from hooking our kids–and adults– with flavored tobacco.

During this period of increased social isolation and heightened stress among young people, we especially cannot allow this predatory industry to gain any further foothold in the youth market,” Cheh said. €œI urge my colleagues to enact this bill as swiftly as possible.”The legislation is supported by public health officials, community leaders, and more than 70 local and national organizations. Councilmembers said they are being called on to strengthen the legislation to include menthol cigarettes and other flavored tobacco products and pass the bill immediately. Previously referred to the Judiciary Committee of the Council, committee members heard five hours of testimony in January 2020, calling for the legislation to include the ban on all flavored tobacco. €œI’m proud to support this legislation.

We’re going to act fast to put in place commonsense laws that protect the next generation from getting hooked by big tobacco,” said Councilmember Charles Allen. €œDoing so will have enormous benefits for public health.”Tobacco kills more than 800 DC residents a year, the Council said in a press release. €œI’m joining with my colleagues to support legislation that will end the sale of all flavored tobacco products, including menthol cigarettes,” said Councilmember Vince Gray. €œThis is not just a public health issue. It is a social justice issue.

Big Tobacco has preyed upon people of color in DC for far too long.”Shutterstock A new study suggests that collaboration between physicians and pharmacists may increase the adherence to and participant satisfaction of treatments for opioid use disorder. Researchers at Duke University, in Durham, N.C., looked at 71 participants in buprenorphine maintenance therapy for opioid use disorder to study the transfer of care from waivered physicians treating them to trained community pharmacists providing their prescriptions. Because buprenorphine prescribing requires a federal waiver, fewer than 10 percent of primary care providers are authorized to prescribe the drug. As a result, more than 20 million people in the United States live in a county without a buprenorphine-waivered physician. The Duke study involved the 71 participants as well as six physicians and six community pharmacists.

As part of the study, from March to December 2018, the physician initially prescribed the buprenorphine until a satisfactory dose was reached. Then, participants in the study attended monthly maintenance visits with trained pharmacists who dispensed the medication, assessed how well the medication was working, and provided counseling and referrals to specialists, as needed. Pharmacists then gave feedback to the physicians to adjust the buprenorphine as necessary. The researchers found that nearly 89 percent of the participants remained in the study, and 95.3 percent adhered to the daily medication regimen. During the 6-month trial, no opioid-related emergencies or hospitalizations were required.

Additionally, the proportion of opioid-positive urine drug screens was less than 5 percent. Researchers concluded that the study offers support for the idea of advancing physician-pharmacists team-based approaches to make use of community pharmacies as a way to expand access to opioid use disorder treatment with buprenorphine..

What should my health care professional know before I take Renova?

They need to know if you have any of these conditions:

  • eczema
  • excessive sensitivity to the sun
  • sunburn
  • an unusual or allergic reaction to tretinoin, vitamin A, other medicines, foods, dyes, or preservatives
  • pregnant or trying to get pregnant
  • breast-feeding

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The Henry renova shampoo suero J blog. Kaiser Family renova shampoo suero Foundation Headquarters. 185 Berry St., Suite 2000, San Francisco, CA 94107 | Phone 650-854-9400 Washington Offices and Barbara Jordan Conference Center.

1330 G renova shampoo suero Street, NW, Washington, DC 20005 | Phone 202-347-5270 www.kff.org | Email Alerts. Kff.org/email | facebook.com/KaiserFamilyFoundation | twitter.com/kff Filling the renova shampoo suero need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in San Francisco, California.About This TrackerThis tracker provides current data on the share of the population having received at least one skin care products treatment dose by country, income-level, region, and globally. Additionally, this tool estimates future treatment coverage levels if the current rate of first dose administration is maintained going forward and compares these coverage levels to global vaccination targets.

These targets include 40% by the end of 2021 (set by the World Health Organization), 70% by mid-2022 (set by the WHO), and 70% by the United Nations renova shampoo suero General Assembly in 2022 (set by the U.S.). This tracker will be updated regularly as new data are available.Related Content:.

The Henry Cheap cipro canada J buy renova cream uk. Kaiser Family buy renova cream uk Foundation Headquarters. 185 Berry St., Suite 2000, San Francisco, CA 94107 | Phone 650-854-9400 Washington Offices and Barbara Jordan Conference Center. 1330 G Street, NW, Washington, DC 20005 | Phone 202-347-5270 www.kff.org buy renova cream uk | Email Alerts. Kff.org/email | facebook.com/KaiserFamilyFoundation | twitter.com/kff Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in San Francisco, California.About This TrackerThis tracker provides current buy renova cream uk data on the share of the population having received at least one skin care products treatment dose by country, income-level, region, and globally.

Additionally, this tool estimates future treatment coverage levels if the current rate of first dose administration is maintained going forward and compares these coverage levels to global vaccination targets. These targets include 40% by the end of 2021 (set by the World Health Organization), 70% by mid-2022 (set by the WHO), and 70% by the United buy renova cream uk Nations General Assembly in 2022 (set by the U.S.). This tracker will be updated regularly as new data are available.Related Content:.

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The NSW Government’s economic renova container roadmap has mental health as a top priority with a record $130 million to provide immediate access to help for anyone whose mental health has been impacted by the skin care products renova.The funding boost will provide more appointments for psychology and psychiatry services, address the sharp rise in eating disorders and self-harm presentations, free up more mental health beds and launch the biggest suicide prevention training program ever undertaken.Premier Dominic Perrottet said the lockdown combined with working from home and home schooling has seen a record number of people reach out to crisis lines.“This funding means that parents, children and the most vulnerable in our community can get the help they need now,” Mr Perrottet said.“As we navigate the economic recovery from this renova we must also support people’s mental wellbeing along the way.”Minister for Mental Health Bronnie Taylor said the new funding will provide public access to private psychiatrists, psychologists and mental health beds as well as training 275,000 people in the community to become mental health first aiders.“We want NSW to be a whole state of mental health champions, which is why we’re launching a statewide community training blitz to make sure help is always close at hand, from the schoolyard to the sports club and beyond.” Mrs Taylor said.“This is all about fast-tracking access to boosted services to support people doing it tough right now as well as preventing the emergence of mental health issues in the future.“Our focus over the next two years will be on supporting our young people and families, building system capacity to meet demand and supporting our communities to lead the recovery,” Mrs Taylor said.Treasurer Matt Kean said the funding builds on the $2.6 billion 2021-2022 NSW Mental Health Budget – the largest mental health investment in the state’s history. €œWe’re leading the nation with our skin care products mental health support for our communities, making sure the help is there for particularly vulnerable groups, from new parents to older adults, children and young people,” Mr Kean said.“Mental health issues often present after the crisis, so as we emerge from lockdown and life returns to normal, this funding will mean parents and children will have free access to help, where they need renova container it and when they need it.”Key highlights of the mental health recovery package include:$35 million over two years to boost the surge capacity of the mental health clinical workforce. In partnership with Primary Health renova container Networks, NSW Health will be able to access privately practising psychologists and psychiatrists and other mental health professionals for NSW residents. It’s estimated this will create an extra 60,000 psychiatry renova container consultations and 85,000 consults with other mental health professionals, including psychologists$20 million over 18 months to provide up to 55,000 additional services to young people through their local headspace centre.

This funding renova container will boost GP and clinical psychiatrist sessions at headspace centres across NSW. It will also enable masters and doctorate psychology students (clinical and general registration) and social work and occupational therapy students (pre-registration/masters) to undertake placements at headspace renova container centres. Overseen by clinical educators, students will conduct comprehensive mental health assessments renova container and deliver clinical sessions for young people.$14 million over two years to train 275,000 people across NSW in suicide prevention training. The training will target high school renova container teachers and support staff.

Parents. Youth influencers (e.g. Sports coaches, club managers). Community groups, and peer leaders.$21 million over four years to employ 18 FTE Aboriginal Care Navigators and 18 FTE Aboriginal Peer Workers across NSW.

These roles will link Aboriginal Australians to a range of culturally-appropriate mental health and suicide prevention services.$16.5 million over four years to address the increase in eating disorder presentations. This funding will increase frontline workforce capacity to recognise and respond to eating disorder presentations. It will also fund the Butterfly Foundation to admit NSW residents into its national eating disorders centre at Wandi Nerida in Queensland.$6 million over two years to build the capacity of caseworkers and casework managers to provide timely support to child protection practitioners at high risk of trauma.$5 million over two years to fund a grants program for local community wellbeing events.$3 million over one year to assist NSW sporting bodies to deliver mental health and wellbeing initiatives.$3 million over one year to provide access to private beds for 12-24-year-olds experiencing complex trauma and eating disorders. This will be trialled in South Western Sydney Local Health District.$2.6 million over two years to expand Gidget Foundation’s services and provide an extra 280 psychological sessions every month.$3.2 million over four years to establish a Multicultural Mental Health Line – a NSW first.People experiencing emotional distress will now be able to access support in two novel ways, thanks to a $46 million investment in new suicide prevention initiatives across NSW.Minister for Mental Health Bronnie Taylor said that 20 calming non-clinical hubs called Safe Havens and 20 Suicide Prevention Outreach Teams (SPOTs) will add to the web of support the NSW Government has already embedded in communities across NSW.“We know suicide prevention support needs to engage distressed people where they live their lives – if we can be there to provide support before someone needs to be hospitalised, we can help reduce the likelihood of further suicidal behaviours,” Mrs Taylor said.“Instead of struggling alone or heading to a bustling emergency department, anyone who is experiencing mental health distress can now head to one of these purpose-designed Safe Havens.“There are no appointments or referrals needed, so whether you need some peace and quiet, a chat with someone who understands what you’re going through, or some calming activities to reduce the intensity of your negative thoughts and feelings, you can walk right in.”South Western Sydney Local Health District Mental Health Director Dr Claire Jones said the free and confidential service is a place where people can informally chat to trained staff, have a cup of tea or coffee, play board games or puzzles, join an activity or chill out in a quiet spot.“Our Safe Haven provides a different type of support for people who are experiencing suicidal thoughts.

The Peer Support Team have had their own personal lived experience of suicidal distress and they can help people by linking them to the services and support programs that can assist them.’’District Chief Executive Amanda Larkin said Campbelltown Safe Haven features a quiet room and sensory items, including a massage chair and weighted blankets to help people relax.“The Safe Haven is a friendly and compassionate place where everyone is welcome,’’Ms Larkin said.“All of the staff members understand first-hand how hard it can be to experience suicidal thoughts. They come from all ages, cultures and backgrounds including people who identify as LGBTIQA+.”In addition to the new Safe Havens, 20 new mobile SPOT teams will provide rapid outreach to people in suicidal distress in the community, with 14 teams already up and running.“The new teams combine clinical expertise and lived experience of suicide, and care for people at or near their homes – ensuring they stay connected with their family, friends and other valuable support networks,” Mrs Taylor said.“We know thoughts of suicide can be triggered by a painful experience - such as a divorce, unemployment, retirement or death of a loved one - and these mobile teams will support individuals in the places where they live their day to day lives.”The NSW Government has invested $25.1 million in the Safe Haven initiative and $21.35 million in the Suicide Prevention Outreach Teams, which both contribute to the Towards Zero Suicides - a Premier’s Priority.If you, or someone you know, is thinking about suicide or experiencing a personal crisis or distress, please seek help immediately by calling 000 or one of these services:Lifeline 13 11 14Suicide Call Back Service 1300 659 467NSW Mental Health Line 1800 011 511.

The NSW Government’s economic roadmap has mental health as a top priority with a record $130 million to provide immediate access to help for anyone whose mental health has been impacted by the skin care products renova.The funding boost will provide more appointments for psychology and psychiatry services, address the sharp rise in eating disorders and self-harm presentations, free up more mental health beds and launch the biggest suicide prevention training program ever undertaken.Premier Dominic Perrottet said the lockdown combined with working from home and home schooling has seen a record number of people reach out to crisis lines.“This funding means that parents, children and the most vulnerable in our community can get the help they need now,” Mr Perrottet said.“As we navigate the economic recovery from this renova we must also support people’s mental wellbeing along the way.”Minister for Mental Health Bronnie Taylor said the new funding will provide public access to private psychiatrists, psychologists and mental health beds as well as training 275,000 people in the community to become mental health first aiders.“We want NSW to be a whole state of mental health champions, which is why we’re launching a statewide community training blitz to make sure help is always close at hand, from the buy renova cream uk schoolyard to the sports club and beyond.” Mrs Taylor said.“This is all about fast-tracking access to boosted services to support people doing it tough right now as well as preventing the emergence of mental health issues in the future.“Our focus over the next two years will be on supporting our young people and families, building system capacity to meet demand and supporting our communities to lead the recovery,” Mrs Taylor said.Treasurer Matt Kean said the funding builds on the $2.6 billion 2021-2022 NSW Mental Health Budget – the largest mental health investment in the state’s history. €œWe’re leading the nation with our skin care products mental health support for our communities, making sure the help is there for particularly vulnerable groups, from new parents to older adults, children and young people,” Mr Kean said.“Mental health issues often present after the crisis, so as we emerge from lockdown and life returns to normal, this funding will mean parents and children will have free access to help, where they need it and when they need it.”Key highlights of the mental health recovery package include:$35 million over two years to boost the surge capacity of the mental health clinical workforce buy renova cream uk. In partnership with Primary Health Networks, NSW Health will be able to access buy renova cream uk privately practising psychologists and psychiatrists and other mental health professionals for NSW residents. It’s estimated this will create an extra 60,000 psychiatry consultations buy renova cream uk and 85,000 consults with other mental health professionals, including psychologists$20 million over 18 months to provide up to 55,000 additional services to young people through their local headspace centre. This funding will boost GP and clinical psychiatrist buy renova cream uk sessions at headspace centres across NSW.

It will also enable masters and doctorate buy renova cream uk psychology students (clinical and general registration) and social work and occupational therapy students (pre-registration/masters) to undertake placements at headspace centres. Overseen by buy renova cream uk clinical educators, students will conduct comprehensive mental health assessments and deliver clinical sessions for young people.$14 million over two years to train 275,000 people across NSW in suicide prevention training. The training will target high school teachers and buy renova cream uk support staff. Parents. Youth influencers (e.g.

Sports coaches, club managers). Community groups, and peer leaders.$21 million over four years to employ 18 FTE Aboriginal Care Navigators and 18 FTE Aboriginal Peer Workers across NSW. These roles will link Aboriginal Australians to a range of culturally-appropriate mental health and suicide prevention services.$16.5 million over four years to address the increase in eating disorder presentations. This funding will increase frontline workforce capacity to recognise and respond to eating disorder presentations. It will also fund the Butterfly Foundation to admit NSW residents into its national eating disorders centre at Wandi Nerida in Queensland.$6 million over two years to build the capacity of caseworkers and casework managers to provide timely support to child protection practitioners at high risk of trauma.$5 million over two years to fund a grants program for local community wellbeing events.$3 million over one year to assist NSW sporting bodies to deliver mental health and wellbeing initiatives.$3 million over one year to provide access to private beds for 12-24-year-olds experiencing complex trauma and eating disorders.

This will be trialled in South Western Sydney Local Health District.$2.6 million over two years to expand Gidget Foundation’s services and provide an extra 280 psychological sessions every month.$3.2 million over four years to establish a Multicultural Mental Health Line – a NSW first.People experiencing emotional distress will now be able to access support in two novel ways, thanks to a $46 million investment in new suicide prevention initiatives across NSW.Minister for Mental Health Bronnie Taylor said that 20 calming non-clinical hubs called Safe Havens and 20 Suicide Prevention Outreach Teams (SPOTs) will add to the web of support the NSW Government has already embedded in communities across NSW.“We know suicide prevention support needs to engage distressed people where they live their lives – if we can be there to provide support before someone needs to be hospitalised, we can help reduce the likelihood of further suicidal behaviours,” Mrs Taylor said.“Instead of struggling alone or heading to a bustling emergency department, anyone who is experiencing mental health distress can now head to one of these purpose-designed Safe Havens.“There are no appointments or referrals needed, so whether you need some peace and quiet, a chat with someone who understands what you’re going through, or some calming activities to reduce the intensity of your negative thoughts and feelings, you can walk right in.”South Western Sydney Local Health District Mental Health Director Dr Claire Jones said the free and confidential service is a place where people can informally chat to trained staff, have a cup of tea or coffee, play board games or puzzles, join an activity or chill out in a quiet spot.“Our Safe Haven provides a different type of support for people who are experiencing suicidal thoughts. The Peer Support Team have had their own personal lived experience of suicidal distress and they can help people by linking them to the services and support programs that can assist them.’’District Chief Executive Amanda Larkin said Campbelltown Safe Haven features a quiet room and sensory items, including a massage chair and weighted blankets to help people relax.“The Safe Haven is a friendly and compassionate place where everyone is welcome,’’Ms Larkin said.“All of the staff members understand first-hand how hard it can be to experience suicidal thoughts. They come from all ages, cultures and backgrounds including people who identify as LGBTIQA+.”In addition to the new Safe Havens, 20 new mobile SPOT teams will provide rapid outreach to people in suicidal distress in the community, with 14 teams already up and running.“The new teams combine clinical expertise and lived experience of suicide, and care for people at or near their homes – ensuring they stay connected with their family, friends and other valuable support networks,” Mrs Taylor said.“We know thoughts of suicide can be triggered by a painful experience - such as a divorce, unemployment, retirement or death of a loved one - and these mobile teams will support individuals in the places where they live their day to day lives.”The NSW Government has invested $25.1 million in the Safe Haven initiative and $21.35 million in the Suicide Prevention Outreach Teams, which both contribute to the Towards Zero Suicides - a Premier’s Priority.If you, or someone you know, is thinking about suicide or experiencing a personal crisis or distress, please seek help immediately by calling 000 or one of these services:Lifeline 13 11 14Suicide Call Back Service 1300 659 467NSW Mental Health Line 1800 011 511.

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Serum levels of lipoprotein-associated phospholipase A2 (Lp-PLA2) activity are associated with the presence renova0.02 topical cream of CAVS. However, it has been unclear whether this association is due to a cause–effect relationship. In this issue of Heart, Perrot and colleagues1 used genetic association studies from eight cohorts to show that CAVS was not associated with any of four single nucleotide polymorphisms that are associated with Lp-PLA2 activity or mass. These findings suggest that although Lp-PLA2 activity is a biomarker for CAVS unfortunately, it is unlikely to be a therapeutic target (figure 1).Higher Lp-PLA2 activity is significantly associated with the presence of CAVS in patients with heart disease, but variants influencing Lp-PLA2 mass or activity are not associated with renova0.02 topical cream CAVS in this large genetic association study.

CAVS, calcific aortic valve stenosis. Lp-PLA2, lipoprotein-associated phospholipase A2." data-icon-position data-hide-link-title="0">Figure 1 Higher Lp-PLA2 activity is significantly associated with the presence of CAVS in patients with heart disease, but variants influencing Lp-PLA2 mass or activity are not associated with CAVS in this large genetic association study. CAVS, calcific aortic renova0.02 topical cream valve stenosis. Lp-PLA2, lipoprotein-associated phospholipase A2.In an editorial, Zheng and Dweck2 discuss this article, summarise current ongoing trials of medical therapy for CAVS (table 1) and comment.

€˜Strong evidence points towards elevated Lp(a) levels and its associated oxidised phospholipids (OxPL) as causal risk factors for CAVS, suggesting that targeting this lipid-driven, inflammatory pathway has a real chance to translate into therapy capable of mitigating disease. The current study suggests that this association is not mediated by Lp-PLA2 and underlines the importance of scrutinising whether biological factors within pathophysiological pathways are merely biomarkers or actually represent a feasible and causal target.’View this table:Table 1 Ongoing randomised clinical trials of medical therapies in aortic stenosisRheumatic heart disease (RHD) remains the primary cause of valve disease worldwide and renova0.02 topical cream contributes significantly to maternal and fetal morbidity and mortality. In a study by Baghel and colleagues3 of 681 pregnant women with RHD, adverse cardiovascular evens occurred in about 15% of pregnancies. Multivariable predictors of adverse outcomes during pregnancy were prior adverse cardiovascular events, lack of appropriate medical therapy, severity of mitral stenosis, valve replacement and pulmonary hypertension.

Based on this analysis, the authors propose a risk score from pregnant women with RHD (table 2).View this table:Table 2 New prognostic score (DEVI’s score) to predict composite adverse cardiac outcome in pregnant women with renova0.02 topical cream rheumatic valvular heart diseaseCommenting on this paper, Elkayam and Shmueli4 point out that in about one-fourth of women, the diagnosis of RHD was not known prior to pregnancy and that a late diagnosis often was associated with adverse outcomes. Their editorial provides a concise summary of optimal management of pregnant women with RHD. They conclude ‘With proper evaluation and risk stratification prior to pregnancy, a close multidisciplinary follow-up during pregnancy, and close monitoring during labour and delivery as well as the early postpartum period most complications can be prevented.’The importance of psychosocial factors in cardiovascular disease (CVD) prevalence and outcomes is increasingly recognised. Using data from the English Longitudinal Study of Ageing, Bu and colleagues5 found that loneliness was associated with CVD, independent of possible confounders and renova0.02 topical cream other risk factors, with a 30% higher risk of a new CVD diagnosis in the most lonely people compared with the least lonely people.

As O’Keefe and colleagues6 point out, this data is especially important now in the context of social distancing and stay-at-home recommendations and they offer several approaches to mitigating loneliness during the skin care products renova.The Education in Heart article7 in this issue focuses on the clinical use and prognostic implications of echocardiographic speckle tracking measurements of global longitudinal strain to detect and quantify early systolic dysfunction of the left ventricle (figure 2).Left ventricular global longitudinal strain to differentiate between mutation-positive sarcomeric hypertrophic cardiomyopathy and cardiac amyloidosis. (A) Apical four-chamber view of a 66-year-old patient known with mutation-positive hypertrophic cardiomyopathy. The thickness of the septum was 28 mm and the left ventricular ejection fraction was renova0.02 topical cream 55%. (B) The polar map shows markedly impaired longitudinal strain in the septal mid and basal areas and the global longitudinal strain is impaired (−13.6%).

(C) Apical four-chamber view of a 75-year-old patient diagnosed with light chain amyloidosis. There is renova0.02 topical cream concentric hypertrophy of the left ventricle and the ejection fraction is 56%. Based on speckle tracking echocardiography analysis, the left ventricular global longitudinal strain is impaired (−12.2%), with typical sparing of the longitudinal strain values in the apical segments (D). ANT, anterior.

ANT SEPT, renova0.02 topical cream anteroseptal. GS, global strain. INF, inferior. LAT, lateral.

POST, posterior renova0.02 topical cream. SEPT, septal." data-icon-position data-hide-link-title="0">Figure 2 Left ventricular global longitudinal strain to differentiate between mutation-positive sarcomeric hypertrophic cardiomyopathy and cardiac amyloidosis. (A) Apical four-chamber view of a 66-year-old patient known with mutation-positive hypertrophic cardiomyopathy. The thickness of the septum was 28 mm and the renova0.02 topical cream left ventricular ejection fraction was 55%.

(B) The polar map shows markedly impaired longitudinal strain in the septal mid and basal areas and the global longitudinal strain is impaired (−13.6%). (C) Apical four-chamber view of a 75-year-old patient diagnosed with light chain amyloidosis. There is concentric renova0.02 topical cream hypertrophy of the left ventricle and the ejection fraction is 56%. Based on speckle tracking echocardiography analysis, the left ventricular global longitudinal strain is impaired (−12.2%), with typical sparing of the longitudinal strain values in the apical segments (D).

ANT, anterior. ANT SEPT, anteroseptal renova0.02 topical cream. GS, global strain. INF, inferior.

LAT, lateral renova0.02 topical cream. POST, posterior. SEPT, septal.Our Cardiology-in-Focus article by Hudson and Pettit8 provides a clear-eyed but brief discussion and outstanding graphic of the challenges in reconciling the varying definitions of the ‘normal’ values for left ventricular ejection fraction, as stated in different guidelines (figure 3).Categories of left ventricular ejection fraction. EF, ejection renova0.02 topical cream fraction.

HF, heart failure. LVEF, left ventricular ejection fraction." data-icon-position data-hide-link-title="0">Figure 3 Categories of left ventricular ejection fraction. EF, ejection fraction renova0.02 topical cream. HF, heart failure.

LVEF, left ventricular ejection fraction.Loneliness is an unpleasant emotional state induced by perceived isolation. Until about 200 years ago, the English word for being on one’s own was ‘oneliness’, a term that connoted solitude, and was generally considered an renova0.02 topical cream essential and positive experience in life. However, solitude and loneliness are not synonymous. Loneliness is also described as ‘social pain’ from an unwanted lack of connection and intimacy.

Artists have likened loneliness to hunger, not only because we can feel it physically, sometimes described as an ache, a hollowness or a sense of coldness, but also because these physical sensations might be the body’s way of telling us that we are missing something that is renova0.02 topical cream important to our survival and flourishing.In this issue of Heart, Bu and colleagues,1 in a prospective observational study that comprised approximately 5000 adults followed for about 10 years, found that individuals reporting high levels of loneliness had 30%–48% increased risks of developing cardiovascular disease (CVD) and CVD-related hospital admission, respectively, even after adjusting for the usual cardiovascular risk factors.1 This major study has three implications. (1) loneliness should be considered among the most dangerous CVD risk factors. (2) feeling lonely is a highly modifiable state that would seemingly respond to lifestyle adjustments as compared with the other foremost psychosocial CVD risk factors—depression and stress/anxiety—which typically require prescription medication or exercise2. And (3) social isolation without the anguish of loneliness does not appear to increase CVD risk.The current study confirms prior data showing that self-reported loneliness is significantly correlated with increased healthcare utilisation and heightened morbidity and mortality risks.3 4 Advanced age, poor health, fewer ….

Rather than treating the mechanical consequences of severe CAVS, identification of causal disease pathways at the tissue level might lead to medical therapies that could actually prevent or delay the pathological changes in the valve view it leaflets buy renova cream uk. Serum levels of lipoprotein-associated phospholipase A2 (Lp-PLA2) activity are associated with the presence of CAVS. However, it has been unclear whether this association is due to a cause–effect relationship. In this issue of Heart, Perrot and colleagues1 used genetic association studies from eight cohorts buy renova cream uk to show that CAVS was not associated with any of four single nucleotide polymorphisms that are associated with Lp-PLA2 activity or mass. These findings suggest that although Lp-PLA2 activity is a biomarker for CAVS unfortunately, it is unlikely to be a therapeutic target (figure 1).Higher Lp-PLA2 activity is significantly associated with the presence of CAVS in patients with heart disease, but variants influencing Lp-PLA2 mass or activity are not associated with CAVS in this large genetic association study.

CAVS, calcific aortic valve stenosis. Lp-PLA2, lipoprotein-associated phospholipase A2." data-icon-position data-hide-link-title="0">Figure 1 Higher Lp-PLA2 activity is significantly associated with the presence of CAVS in patients with heart disease, but variants influencing Lp-PLA2 mass or activity are buy renova cream uk not associated with CAVS in this large genetic association study. CAVS, calcific aortic valve stenosis. Lp-PLA2, lipoprotein-associated phospholipase A2.In an editorial, Zheng and Dweck2 discuss this article, summarise current ongoing trials of medical therapy for CAVS (table 1) and comment. €˜Strong evidence points towards elevated Lp(a) levels and its associated oxidised phospholipids (OxPL) as buy renova cream uk causal risk factors for CAVS, suggesting that targeting this lipid-driven, inflammatory pathway has a real chance to translate into therapy capable of mitigating disease.

The current study suggests that this association is not mediated by Lp-PLA2 and underlines the importance of scrutinising whether biological factors within pathophysiological pathways are merely biomarkers or actually represent a feasible and causal target.’View this table:Table 1 Ongoing randomised clinical trials of medical therapies in aortic stenosisRheumatic heart disease (RHD) remains the primary cause of valve disease worldwide and contributes significantly to maternal and fetal morbidity and mortality. In a study by Baghel and colleagues3 of 681 pregnant women with RHD, adverse cardiovascular evens occurred in about 15% of pregnancies. Multivariable predictors of buy renova cream uk adverse outcomes during pregnancy were prior adverse cardiovascular events, lack of appropriate medical therapy, severity of mitral stenosis, valve replacement and pulmonary hypertension. Based on this analysis, the authors propose a risk score from pregnant women with RHD (table 2).View this table:Table 2 New prognostic score (DEVI’s score) to predict composite adverse cardiac outcome in pregnant women with rheumatic valvular heart diseaseCommenting on this paper, Elkayam and Shmueli4 point out that in about one-fourth of women, the diagnosis of RHD was not known prior to pregnancy and that a late diagnosis often was associated with adverse outcomes. Their editorial provides a concise summary of optimal management of pregnant women with RHD.

They conclude ‘With proper evaluation and risk stratification prior to pregnancy, a close multidisciplinary follow-up during pregnancy, and close monitoring during labour and delivery as buy renova cream uk well as the early postpartum period most complications can be prevented.’The importance of psychosocial factors in cardiovascular disease (CVD) prevalence and outcomes is increasingly recognised. Using data from the English Longitudinal Study of Ageing, Bu and colleagues5 found that loneliness was associated with CVD, independent of possible confounders and other risk factors, with a 30% higher risk of a new CVD diagnosis in the most lonely people compared with the least lonely people. As O’Keefe and colleagues6 point out, this data is especially important now in the context of social distancing and stay-at-home recommendations and they offer several approaches to mitigating loneliness during the skin care products renova.The Education in Heart article7 in this issue focuses on the clinical use and prognostic implications of echocardiographic speckle tracking measurements of global longitudinal strain to detect and quantify early systolic dysfunction of the left ventricle (figure 2).Left ventricular global longitudinal strain to differentiate between mutation-positive sarcomeric hypertrophic cardiomyopathy and cardiac amyloidosis. (A) Apical four-chamber view of a 66-year-old buy renova cream uk patient known with mutation-positive hypertrophic cardiomyopathy. The thickness of the septum was 28 mm and the left ventricular ejection fraction was 55%.

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

ANT SEPT, anteroseptal. GS, global strain. INF, inferior. LAT, lateral buy renova cream uk. POST, posterior.

SEPT, septal." data-icon-position data-hide-link-title="0">Figure 2 Left ventricular global longitudinal strain to differentiate between mutation-positive sarcomeric hypertrophic cardiomyopathy and cardiac amyloidosis. (A) Apical four-chamber view of a 66-year-old patient known with mutation-positive hypertrophic buy renova cream uk cardiomyopathy. The thickness of the septum was 28 mm and the left ventricular ejection fraction was 55%. (B) The polar map shows markedly impaired longitudinal strain in the septal mid and basal areas and the global longitudinal strain is impaired (−13.6%). (C) Apical four-chamber view of a 75-year-old patient buy renova cream uk diagnosed with light chain amyloidosis.

There is concentric hypertrophy of the left ventricle and the ejection fraction is 56%. Based on speckle tracking echocardiography analysis, the left ventricular global longitudinal strain is impaired (−12.2%), with typical sparing of the longitudinal strain values in the apical segments (D). ANT, anterior buy renova cream uk. ANT SEPT, anteroseptal. GS, global strain.

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

HF, heart failure. LVEF, left buy renova cream uk ventricular ejection fraction." data-icon-position data-hide-link-title="0">Figure 3 Categories of left ventricular ejection fraction. EF, ejection fraction. HF, heart failure. LVEF, left ventricular ejection fraction.Loneliness is an unpleasant buy renova cream uk emotional state induced by perceived isolation.

Until about 200 years ago, the English word for being on one’s own was ‘oneliness’, a term that connoted solitude, and was generally considered an essential and positive experience in life. However, solitude and loneliness are not synonymous. Loneliness is also described as ‘social pain’ from an unwanted buy renova cream uk lack of connection and intimacy. Artists have likened loneliness to hunger, not only because we can feel it physically, sometimes described as an ache, a hollowness or a sense of coldness, but also because these physical sensations might be the body’s way of telling us that we are missing something that is important to our survival and flourishing.In this issue of Heart, Bu and colleagues,1 in a prospective observational study that comprised approximately 5000 adults followed for about 10 years, found that individuals reporting high levels of loneliness had 30%–48% increased risks of developing cardiovascular disease (CVD) and CVD-related hospital admission, respectively, even after adjusting for the usual cardiovascular risk factors.1 This major study has three implications. (1) loneliness should be considered among the most dangerous CVD risk factors.

(2) feeling lonely is a highly modifiable state that would seemingly respond to lifestyle adjustments as compared with the other foremost psychosocial CVD risk factors—depression and stress/anxiety—which typically require prescription medication or exercise2.

Renova zero starter kit

Chandramma is a member of the Deccan Development Society (DDS), a cooperative of nearly 5,000 Dalit (oppressed caste) and Adivasi (Indigenous) women whose remarkable integration renova zero starter kit of biodiversity conservation with agricultural livelihoods earned them the United http://jamessmithc21.com/?p=1 Nations' prestigious Equator Award in 2019. Emerging from a situation of extreme malnutrition and social and gender discrimination in the 1980s, these farmers now enjoy food sovereignty and economic security. Not only are they weathering the renova, in 2020 each family in DDS contributed around 10 kilograms of food grains to the region's relief effort for those without land and livelihoods. On the other side of the world, six Indigenous Quechua communities of the Peruvian Andes govern the Parque de la Papa (Potato Park) in Pisac, Cusco, a renova zero starter kit mountainous landscape that is one of the original homelands of the potato.

They protect the region as a “biocultural heritage” territory, a trove of biological and cultural riches inherited from ancestors, and conserve more than 1,300 varieties of potato. When I visited in 2008 with other researchers and activists, I was stunned into silence by the diversity. €œThis is the outcome of 20 years' renova zero starter kit consistent work in relocalizing our food system, from a time when we had become too dependent on outside agencies for our basic needs,” farmer Mariano Sutta Apocusi told Local Futures, an organization dedicated to strengthening communities worldwide, in August 2020. €œFocusing on the local has helped us improve access to and affordability of a great diversity of food products—especially native potatoes, quinoa, kiwicha, other Andean tubers and maize, which we cultivate using Indigenous agroecological methods.” The communities instituted strong health and safety measures when the renova hit, even as they harvested a bumper crop and distributed more than a ton of potatoes to migrants, the elderly and a shelter for abused teenage mothers in Cusco town.

In Europe, many “solidarity economy” initiatives, which promote a culture of caring and sharing, swung into action when skin care products-related lockdowns rendered massive numbers of people jobless. In Lisbon, Portugal, renova zero starter kit the social centers Disgraa and RDA69, which strive to re-create community life in an otherwise highly fragmented urban situation, reached out with free or cheap food to whoever needed it. They provided not only meals but also spaces where refugees, the homeless, unemployed young people and others who might otherwise have fallen through the cracks could interact with and develop relationships with better-off families, creating a social-security network of sorts. The organizers trusted those with adequate means to donate food or funds to the effort, strengthening the feeling of community in surrounding neighborhoods.

The renova has renova zero starter kit exposed the brittleness of a globalized economy that is advertised as benefiting everyone but in fact creates deep inequalities and insecurities. In India alone, 75 million people fell below the poverty line in 2020. Globally, hundreds of millions who depend for their survival and livelihoods on the long-distance trade and exchange of goods and services were badly hit. Similar, albeit less extreme, dislocations also appeared during the 2008 financial crisis, when commodity speculation, along with the diversion of food grains to biofuel production, precipitated a steep rise in global grain prices, leading to hunger and food riots in many countries that renova zero starter kit depended on imported food.

Threats to survival also emerge when war or other dislocations stop the movement of goods. In such crises, communities fare better if they have local markets and services and can provide their own food, energy and water while taking care of the less fortunate. Moligeri Chandramma manages the DDS seed bank (top) renova zero starter kit. It contains more than 70 species and varieties of crops.

People gathered (bottom) in 2005 to mark 20 years of sustained protests against dam construction on the Narmada River. Credit. Ashish Kothari The value of these alternative ways of living goes far beyond their resilience during relatively short-term upheavals like the renova, however. As a researcher and environmental activist based in a “developing” country, I have long advocated that the worldviews of peoples who live close to nature be incorporated into global strategies for wildlife protection, such as at the International Union for Conservation of Nature and the United Nations' Convention on Biological Diversity.

And in recent decades I have come to agree with critics of globalization such as social scientist and environmentalist Wolfgang Sachs that fending off calamities like biodiversity collapse will require not only environmental adaptations but also radical changes to the dominant economic, social and even political paradigms. In 2014 a few of us in India initiated a process to explore pathways to a world in which people are at peace with one another and with nature. Five years later (and fortuitously, just before the renova hit), the endeavor grew into an international online network we called the Global Tapestry of Alternatives. These conversations and other research indicate that viable options, no matter where they are, tend to be based on self-reliance and solidarity.

Such values are at odds with globalization, which delivers to denizens of the Global North (the better off, no matter where we live) many things that we have come to regard as essential. In contrast to the promise of ever increasing material wealth that underpins our civilization, peoples who live near or beyond its margins have a multitude of visions for living well, each tailored to the specifics of their ecosystems and cultures. To walk away from the cliff edge of irreversible destabilization of the biosphere, I believe we must enable alternative structures, such as those of the Dalit farmers, the Quechua conservers and the Lisbon volunteers, to flourish and link up into a tapestry that ultimately covers the globe. An Enlightening Journey Growing up in India, where lifestyles that are intimately entwined with the natural environment survive in large pockets, unquestionably influenced my ideas of what constitutes true sustainability.

In the 1970s, as a high school student who loved bird-watching in forests around Delhi, I joined classmates to demonstrate outside the Saudi Arabian embassy when some princes arrived in the country to hunt the (now critically endangered) Great Indian Bustard. Our protest, along with that of the Bishnoi community in Rajasthan, which traditionally protects these birds and other wildlife, embarrassed the Indian government into requesting that the hunters go home. Many of us went on to campaign for protection of the Delhi Ridge Forest, one of the world's biggest urban jungles. In 1979 we formed an environmental group to systematize our efforts.

We called it Kalpavriksh, after a mythical tree that makes wishes come true. The name symbolized our growing awareness that nature gives us everything. Our activism would teach us at least as much as we learned in school and college. While investigating the sources of Delhi's air pollution, for instance, we interviewed villagers who lived around a coal-fired power plant just outside the city.

They turned out to be far worse affected by its dust and pollution than we city dwellers were—although they got none of its electricity. The benefits of the project flowed mainly to those who were already better off, whereas the disempowered experienced most of the harms. In late 1980 we traveled to the western Himalayans to meet the protagonists of the iconic Chipko movement. Since 1973 village women had been protecting trees slated for logging by the forest department or by companies based in the Indian plains with their bodies.

The deodars being felled, as well as the oaks, rhododendrons, and other species, were sacred, the women told us, as well as being essential for their survival. They provided cattle fodder, fertilizer and wild foods and sustained their water sources. Even as an urban student, I could see the central role that rural women played in protecting the environment—as well as the injustice of distant bureaucrats making decisions with little concern for how they impacted those on the ground. Parque de la Papa (top) in Peru is one of the original homelands of the potato.

The Quechua Indigenous people (middle) govern the region as a “biocultural heritage” territory, conserving a remarkable diversity of potatoes (bottom). Credit. Ashish Kothari Soon after, my friends and I learned that 30 major dams were to be constructed on the Narmada River basin in central India. Millions worshipped the Narmada as a tempestuous but bountiful goddess—so pristine that the Ganga is believed to visit her every year to wash away her sins.

Trekking, boating and riding buses along its length of 1,300 kilometers, we were dazzled by waterfalls plunging into spectacular gorges, densely forested slopes teeming with wildlife, fields of diverse crops, thriving villages and ancient temples, all of which would be drowned. We began to question the concept of development itself. Surely the destruction would far outweigh any possible benefits?. Almost four decades later our fears have proved tragically true.

Hundreds of thousands of displaced people still await proper rehabilitation, and the river downstream of the dams has become a trickle—enabling seawater to reach 100 kilometers inland. Over the years I came to understand how powerful economic forces reach around the globe to intimately link social injustice with ecological destruction. The era of colonization and slavery vastly expanded the economic and military reach of some nation-states and their allied corporations, enabling the worldwide extraction of natural resources and exploitation of labor to feed the emerging industrial revolution in Europe and North America. Economic historians, anthropologists and others have demonstrated how this painful history laid the foundation of today's global economy.

Apart from driving irreversible ecological damage, this economic system robs many communities of access to the commons—to rivers, meadows and forests essential for their survival—while creating a dependence on external markets. The massive suffering during the renova has merely exposed these historical and contemporary fault lines. During my wanderings over the decades and especially while researching a book with economist Aseem Shrivastava, I became aware of a far more hopeful trend. Across the country and indeed around the world, hundreds of social movements are empowering the marginalized to wrest back control over their lives and livelihoods.

In 2014 Kalpavriksh initiated a series of gatherings called Vikalp Sangam, or Confluence of Alternatives, where the drivers of these spirited efforts could come together, share ideas and experiences, and collaborate, helping to build a critical mass for change. These interactions and eclectic reading gave me insights into a vital question I was investigating. What are the essential characteristics of desirable and viable alternatives?. Happily, I was far from alone in this quest.

At a degrowth conference in Leipzig in 2014, I was excited to hear Alberto Acosta, an economist and former politician from Ecuador, speaking on buen vivir, an Indigenous worldview founded on living well with one another and with the rest of nature. Although Acosta spoke no English and I spoke no Spanish, we tried excitedly to converse. Subsequently, degrowth expert Federico Demario joined us and helped to translate. We decided to work on a compilation of thriving alternatives from around the world—jotting down 20 possible ideas on the back of an envelope.

Later we roped in development critic Arturo Escobar and ecofeminist Ariel Salleh as co-editors of a volume we called Pluriverse. The number of entries expanded to more than 100. Commonalities Though dazzlingly diverse, the alternatives emerging worldwide share certain core principles. The most important is sustaining or reviving community governance of the commons—of land, ecosystems, seeds, water and knowledge.

In 12th-century England, powerful people began fencing off, or “enclosing,” fields, meadows, forests and streams that had hitherto been used by all. Enclosures by landlords and industrialists expanded to Europe and accelerated with the industrial revolution, forcing tens of millions of dispossessed people to either become factory workers or emigrate to the New World, devastating native populations. Imperial nations seized large portions of continents and reconfigured the economies of the colonies, extracting raw materials for factories, capturing markets for exports of manufactured goods and obtaining foods such as wheat, sugar and tea for the newly created working class. In this way, colonizers and their allies established a system of perpetual economic domination that generated the Global North and the Global South (the world of the marginalized, no matter where they live).

The wave of anticolonial movements in the first few decades of the 20th century, many of them successful, sparked fears that supplies of raw materials for industries and markets for finished goods of higher value would dry up. President Harry S. Truman responded by launching a program for alleviating poverty in what he described as “underdeveloped areas” with their “primitive and stagnant” economies. As detailed by ecologist Debal Deb, newly formed financial institutions controlled by the rich countries helped the ex-colonies “develop” along the path blazed by the West, providing the materials and energy sources for and creating markets for cars, refrigerators and other consumer goods.

An integral aspect of development, as thus conceived, propagated and usually enforced by stringent conditions attached to loans from the World Bank and the International Monetary Fund, has been privatization or state confiscation of the commons to extract metals, oil and water. Credit. Federica Fragapane. Source.

€œAlternatives Transformation Format. A Process for Self-Assessment and Facilitation towards Radical Change,” prepared by Kalpavriksh for ACKnowl-EJ (chart reference) As Elinor Ostrom, winner of the 2009 Nobel Memorial Prize in Economic Sciences, demonstrated, however, the commons are far more sustainably governed by the communities from which they are wrested than by the governments or corporations that claim them. This awareness has given rise to innumerable grassroots efforts to protect the surviving commons and reestablish control over others. What constitutes the commons has also expanded to include “physical and knowledge resources that we all share for everyone's benefit,” explains sociologist Ana Margarida Esteves, who helps with the European Commons Assembly, an umbrella organization for hundreds of such endeavors.

Many of the efforts resemble the DDS and the Parque de la Papa in using community governance of commonly held resources to enhance agroecology (smallholder farming that sustains soil, water and biodiversity) and food sovereignty (control over all means of food production, including land, soil, seeds and the knowledge of how to use them). The food-sovereignty movement La Via Campesina, which originated in Brazil in 1993, now includes about 200 million farmers in 81 countries. Such attempts at self-reliance and community governance extend also to other basic needs, such as for energy and water. In Costa Rica, Spain and Italy, rural cooperatives have been generating electricity locally and controlling its distribution since the 1990s.

And hundreds of villages in western India have moved toward “water democracy,” based on decentralized harvesting of water and community management of wetlands and groundwater. Mobilizing people to sustain, build or rebuild local systems of knowledge is essential to such ventures. Secure rights to govern the commons are also important. In the Ecuadorian Amazon, the Sapara Indigenous people fought hard to gain collective rights over their rain-forest home.

They are now defending it against oil and mining interests while developing a model of economic well-being that blends their traditional cosmovisions—ways of knowing, being and doing that are physically and spiritually linked to their environs—with new activities such as community-led ecotourism. Their income from tourism has dropped during the renova, but their forests and community ethic give them almost all the food, water, energy, housing, medicines, enjoyment, health and learning that they need. They are now offering online sessions on their cosmovisions, dream analysis and healing. I participated in such sessions in person in their Naku ecotourism camp in 2019.

The virtual version is not as immersive but nonetheless represents an innovative adaptation to the circumstances. Greening cities or making them more welcoming, as the Lisbon social centers do, also requires community-based governance and economies of caring and sharing. Across the Global South, development projects have driven hundreds of millions of people to cities, where they live in slums and work in hazardous conditions. Wealthy city dwellers could do their part by consuming less, which would reduce the extraction and waste dumping that displace people in faraway places.

A spectrum of avenues toward more equitable and sustainable cities has emerged. These include, for example, the Transition Movement, which is attempting to regenerate the commons and make European cities carbon-neutral, and the municipalism movement, which is creating a network of Fearless Cities, among them Barcelona, Valparaiso, Madrid and Athens, to provide secure environments for refugees and migrants. Urban agriculture in Havana supplies more than half of its fresh food requirements and has inspired many other city farming initiatives around the world. Five Petals These initiatives point to the need for fundamental transformations in five interconnected realms.

In the economic sphere, we need to get away from the development paradigm—including the notion that economic growth, as measured by gross domestic product (GDP), is the best means of achieving human goals. In its place, we need systems for respecting ecological limits, emphasizing well-being in all its dimensions and localizing exchanges to enable self-reliance—as well as good measures of these indicators. Bhutan has long experimented with gross national happiness as an index. The idea has spawned variants, such as New Zealand's recent focus on mental health and other such measures of progress.

We also need freedom from centralized monetary and financial control. Many experiments in alternative currencies and economies based on trust and local exchanges are underway. Perhaps the most innovative of these is “time banking,” a system for swapping services founded on the principle that all skills or occupations merit equal respect. One can, for example, give a one-hour-long yoga lesson for credit that can be redeemed for an hour's work on bicycle repair.

In many parts of the world, workers are seeking to control the means of production. Land, nature, knowledge and tools. A few years back I visited Vio.Me, a detergent factory in Thessaloniki, Greece, which workers had taken over and converted from chemical to olive-oil-based and eco-friendly production, and where they had established complete parity in pay, regardless of what job the worker was doing. The slogan on their wall proclaimed.

€œWe have no boss!. € Workers such as Dimitris Koumatsioulis (top) collectively run Vio.Me, an eco-friendly detergent factory in Thessaloniki, Greece. In Prague, Czech Republic, people buy and sell locally (bottom) at a farmers' and producers' market. Credit.

Ashish Kothari In fact, work itself is being redefined. Globalized modernity has created a chasm between work and leisure—which is why we wait desperately for the weekend!. Many movements seek to bridge this gap, enabling greater enjoyment, creativity and satisfaction. In industrial countries, people are bringing back manual ways of making clothes, footwear or processed foods under banners such as “The future is handmade!.

€ In western India, many young people are leaving soul-killing routines in factories to return to handloom weaving, which allows them to control their schedules while providing a creative outlet. In the political sphere, the centralization of power inherent in the nation-state, whether democratic or authoritarian, disempowers many peoples. The Sapara nation in Ecuador and the Adivasis of central India argue for a more direct democracy, where power resides primarily with the community. The state—insofar as it continues to exist—would then mainly help with larger-scale coordination while being strictly accountable to decision-making units on the ground.

The ancient Indian notion of swaraj, literally translated as “self-rule,” is particularly relevant here. It emphasizes individual and collective autonomy and freedom that are linked to responsibility for others' autonomy and freedom. A community that practices swaraj may not dam a stream, for example, if that threatens the water supply of downstream villages. Its well-being cannot compromise that of others.

Such a notion of democracy also challenges the boundaries of nation-states, many of which are products of colonial history and have ruptured ecologically and culturally contiguous areas. The Kurdish people, for instance, are split among Turkey, Iran, Iraq and Syria. For three decades they have struggled to achieve autonomy and direct democracy based on principles of ecological sustainability and women's liberation—and without borders dividing them. And Indigenous groups in Mexico collectively identifying as Zapatistas have for more than three decades asserted and sustained an autonomous region based on similar principles.

Moving toward such radical democracy would suggest a world with far fewer borders, weaving tens of thousands of relatively autonomous and self-reliant communities into a tapestry of alternatives. These societies would connect with one another through “horizontal” networks of equitable and respectful exchange, as well as through “vertical” but downwardly accountable institutions that manage processes and activities across the landscape. Several experiments in bioregionalism at large scales are underway, although most remain somewhat top-down in their governance. In Australia, the Great Eastern Ranges Initiative seeks to coordinate the conservation of ecosystems across 3,600 kilometers while sustaining livelihoods and community health.

And a project spanning six countries in the Andes aims to conserve as a World Heritage Site the Qhapaq an, a 30,000-kilometer network of roads built by the Inca Empire, along with its related cultural, historical and environmental heritage. Local self-governance may, of course, be oppressive or exclusionary. The intensely patriarchal and casteist traditional village councils in many parts of India and the xenophobic antirefugee approaches of the right wing in Europe illustrate this drawback. A third crucial sphere of transformation is therefore social justice, encompassing struggles against racism, casteism, patriarchy, and other traditional or modern forms of discrimination and exploitation.

Fortunately, success in defying the dominant economic system often goes hand in hand with victories against discrimination, such as Dalit women farmers' shaking off centuries of caste and patriarchal oppression to achieve food sovereignty. Political autonomy and economic self-reliance need not mean isolationism and xenophobia. Rather cultural and material exchanges that maintain local self-reliance and respect ecological sustainability would replace present-day globalization—which perversely allows goods and finances to flow freely but stops desperate humans at borders. This kind of localization would be open to people in need.

Refugees from climate change or war would be welcomed, as in the network of Fearless Cities in Europe. Both grounded practice and shifts in policy could help transit toward such a system. Necessary, of course, are attempts to rebuild societies in regions of strife so that people do not have to flee from them. Radical change also necessitates transformations in a fourth sphere.

That of culture and knowledge. Globalization devalues languages, cultures and knowledge systems that do not adapt to development. Several movements are confronting this homogenizing tendency. The Sapara nation is trying to resuscitate its almost extinct language and preserve its knowledge of the forest by bringing these into the curriculum of the local school, for instance.

Many communities are “decolonizing” maps, putting back their own place names and defying political borders. Even the colonial-era Mercator projection used to generate the familiar world map is being upended. (Only recently did I realize that Africa is large enough to contain Europe, China, the U.S. And India put together.) Increasingly, traditional and modern sciences are collaborating to help solve humankind's most vexing problems.

The Arctic Biodiversity Assessment, for example, involves cooperation among Indigenous peoples and university scientists to tackle climate change. One problem is that present-day educational institutions train graduates who are equipped to serve and perpetuate the dominant economic system. People are bringing community and nature back into spaces of learning, however. These efforts include Forest Schools in many parts of Europe that provide children with hands-on learning in the midst of nature, the Zapatista autonomous schools that teach about diverse cultures and struggles, and the Ecoversities Alliance of centers of higher learning around the world that enable scholars to seek knowledge across the boundaries that typically separate academic disciplines.

The most important sphere of transformation, however, is the ecological—recognizing that we are part of nature and that other species are worthy of respect in their own right. Across the Global South, communities are leading efforts to regenerate degraded ecosystems and wildlife populations and conserve biodiversity. Tens of thousands of “territories of life” are being governed by Indigenous or other local communities, for example. These include locally managed marine areas in the South Pacific, Indigenous territories in Latin America and Australia, community forests in South Asia, and the Ancestral Domain territories in the Philippines.

Also noteworthy is recent legislation or court judgments in several countries asserting that rivers, for example, enjoy the same protections as people. The United Nations' 2009 Declaration on Harmony with Nature is an important milestone toward such a goal. Values I am often asked how one scales up successful alternatives. It would be self-defeating, however, to try to either scale up or replicate a DDS or a Parque de la Papa.

The essence of this approach is diversity. The recognition that every situation is different. What people can do—and this, indeed, is how successful initiatives spread—is understand the underlying values and apply these in their own communities while networking with like ventures to spread the impact. The Vikalp Sangam process has identified the following values as crucial.

Solidarity, dignity, interconnectedness, rights and responsibilities, diversity, autonomy and freedom, self-reliance and self-determination, simplicity, nonviolence and respect for all life. Around the world both ancient and modern worldviews that are focused on life articulate similar principles. Indigenous peoples and other local communities have lived by worldviews such as buen vivir, swaraj, ubuntu (an African philosophy that sees the well-being of all living things as interconnected) and many other such ethical systems for centuries and are reasserting them. Simultaneously, approaches such as degrowth and ecofeminism have emerged from within industrial societies, seeding powerful countercultures.

At the heart of these worldviews lies a simple principle. That we are all holders of power. That in the exercise of this power, we not only assert our own autonomy and freedom but also are responsible for ensuring the autonomy of others. Such a swaraj merges with ecological sustainability to create an eco-swaraj, encompassing respect for all life.

Chandramma is a member of the Deccan Development Society (DDS), a cooperative of nearly 5,000 Dalit (oppressed caste) and Adivasi (Indigenous) women whose remarkable integration of biodiversity conservation http://whiterockboatclub.com/official-club-facebook-page/ with agricultural livelihoods earned them the United Nations' prestigious Equator buy renova cream uk Award in 2019. Emerging from a situation of extreme malnutrition and social and gender discrimination in the 1980s, these farmers now enjoy food sovereignty and economic security. Not only are they weathering the renova, in 2020 each family in DDS contributed around 10 kilograms of food grains to the region's relief effort for those without land and livelihoods.

On the other side of the world, six Indigenous Quechua communities of the Peruvian Andes govern the Parque de la Papa (Potato Park) in Pisac, Cusco, a mountainous landscape that is one of buy renova cream uk the original homelands of the potato. They protect the region as a “biocultural heritage” territory, a trove of biological and cultural riches inherited from ancestors, and conserve more than 1,300 varieties of potato. When I visited in 2008 with other researchers and activists, I was stunned into silence by the diversity.

€œThis is the outcome buy renova cream uk of 20 years' consistent work in relocalizing our food system, from a time when we had become too dependent on outside agencies for our basic needs,” farmer Mariano Sutta Apocusi told Local Futures, an organization dedicated to strengthening communities worldwide, in August 2020. €œFocusing on the local has helped us improve access to and affordability of a great diversity of food products—especially native potatoes, quinoa, kiwicha, other Andean tubers and maize, which we cultivate using Indigenous agroecological methods.” The communities instituted strong health and safety measures when the renova hit, even as they harvested a bumper crop and distributed more than a ton of potatoes to migrants, the elderly and a shelter for abused teenage mothers in Cusco town. In Europe, many “solidarity economy” initiatives, which promote a culture of caring and sharing, swung into action when skin care products-related lockdowns rendered massive numbers of people jobless.

In Lisbon, Portugal, the social centers Disgraa and RDA69, which strive to re-create community life in an buy renova cream uk otherwise highly fragmented urban situation, reached out with free or cheap food to whoever needed it. They provided not only meals but also spaces where refugees, the homeless, unemployed young people and others who might otherwise have fallen through the cracks could interact with and develop relationships with better-off families, creating a social-security network of sorts. The organizers trusted those with adequate means to donate food or funds to the effort, strengthening the feeling of community in surrounding neighborhoods.

The renova has exposed the buy renova cream uk brittleness of a globalized economy that is advertised as benefiting everyone but in fact creates deep inequalities and insecurities. In India alone, 75 million people fell below the poverty line in 2020. Globally, hundreds of millions who depend for their survival and livelihoods on the long-distance trade and exchange of goods and services were badly hit.

Similar, albeit less extreme, dislocations also appeared during the 2008 financial crisis, when commodity speculation, along with the diversion of food grains to biofuel production, buy renova cream uk precipitated a steep rise in global grain prices, leading to hunger and food riots in many countries that depended on imported food. Threats to survival also emerge when war or other dislocations stop the movement of goods. In such crises, communities fare better if they have local markets and services and can provide their own food, energy and water while taking care of the less fortunate.

Moligeri Chandramma manages the DDS buy renova cream uk seed bank (top). It contains more than 70 species and varieties of crops. People gathered (bottom) in 2005 to mark 20 years of sustained protests against dam construction on the Narmada River.

Credit. Ashish Kothari The value of these alternative ways of living goes far beyond their resilience during relatively short-term upheavals like the renova, however. As a researcher and environmental activist based in a “developing” country, I have long advocated that the worldviews of peoples who live close to nature be incorporated into global strategies for wildlife protection, such as at the International Union for Conservation of Nature and the United Nations' Convention on Biological Diversity.

And in recent decades I have come to agree with critics of globalization such as social scientist and environmentalist Wolfgang Sachs that fending off calamities like biodiversity collapse will require not only environmental adaptations but also radical changes to the dominant economic, social and even political paradigms. In 2014 a few of us in India initiated a process to explore pathways to a world in which people are at peace with one another and with nature. Five years later (and fortuitously, just before the renova hit), the endeavor grew into an international online network we called the Global Tapestry of Alternatives.

These conversations and other research indicate that viable options, no matter where they are, tend to be based on self-reliance and solidarity. Such values are at odds with globalization, which delivers to denizens of the Global North (the better off, no matter where we live) many things that we have come to regard as essential. In contrast to the promise of ever increasing material wealth that underpins our civilization, peoples who live near or beyond its margins have a multitude of visions for living well, each tailored to the specifics of their ecosystems and cultures.

To walk away from the cliff edge of irreversible destabilization of the biosphere, I believe we must enable alternative structures, such as those of the Dalit farmers, the Quechua conservers and the Lisbon volunteers, to flourish and link up into a tapestry that ultimately covers the globe. An Enlightening Journey Growing up in India, where lifestyles that are intimately entwined with the natural environment survive in large pockets, unquestionably influenced my ideas of what constitutes true sustainability. In the 1970s, as a high school student who loved bird-watching in forests around Delhi, I joined classmates to demonstrate outside the Saudi Arabian embassy when some princes arrived in the country to hunt the (now critically endangered) Great Indian Bustard.

Our protest, along with that of the Bishnoi community in Rajasthan, which traditionally protects these birds and other wildlife, embarrassed the Indian government into requesting that the hunters go home. Many of us went on to campaign for protection of the Delhi Ridge Forest, one of the world's biggest urban jungles. In 1979 we formed an environmental group to systematize our efforts.

We called it Kalpavriksh, after a mythical tree that makes wishes come true. The name symbolized our growing awareness that nature gives us everything. Our activism would teach us at least as much as we learned in school and college.

While investigating the sources of Delhi's air pollution, for instance, we interviewed villagers who lived around a coal-fired power plant just outside the city. They turned out to be far worse affected by its dust and pollution than we city dwellers were—although they got none of its electricity. The benefits of the project flowed mainly to those who were already better off, whereas the disempowered experienced most of the harms.

In late 1980 we traveled to the western Himalayans to meet the protagonists of the iconic Chipko movement. Since 1973 village women had been protecting trees slated for logging by the forest department or by companies based in the Indian plains with their bodies. The deodars being felled, as well as the oaks, rhododendrons, and other species, were sacred, the women told us, as well as being essential for their survival.

They provided cattle fodder, fertilizer and wild foods and sustained their water sources. Even as an urban student, I could see the central role that rural women played in protecting the environment—as well as the injustice of distant bureaucrats making decisions with little concern for how they impacted those on the ground. Parque de la Papa (top) in Peru is one of the original homelands of the potato.

The Quechua Indigenous people (middle) govern the region as a “biocultural heritage” territory, conserving a remarkable diversity of potatoes (bottom). Credit. Ashish Kothari Soon after, my friends and I learned that 30 major dams were to be constructed on the Narmada River basin in central India.

Millions worshipped the Narmada as a tempestuous but bountiful goddess—so pristine that the Ganga is believed to visit her every year to wash away her sins. Trekking, boating and riding buses along its length of 1,300 kilometers, we were dazzled by waterfalls plunging into spectacular gorges, densely forested slopes teeming with wildlife, fields of diverse crops, thriving villages and ancient temples, all of which would be drowned. We began to question the concept of development itself.

Surely the destruction would far outweigh any possible benefits?. Almost four decades later our fears have proved tragically true. Hundreds of thousands of displaced people still await proper rehabilitation, and the river downstream of the dams has become a trickle—enabling seawater to reach 100 kilometers inland.

Over the years I came to understand how powerful economic forces reach around the globe to intimately link social injustice with ecological destruction. The era of colonization and slavery vastly expanded the economic and military reach of some nation-states and their allied corporations, enabling the worldwide extraction of natural resources and exploitation of labor to feed the emerging industrial revolution in Europe and North America. Economic historians, anthropologists and others have demonstrated how this painful history laid the foundation of today's global economy.

Apart from driving irreversible ecological damage, this economic system robs many communities of access to the commons—to rivers, meadows and forests essential for their survival—while creating a dependence on external markets. The massive suffering during the renova has merely exposed these historical and contemporary fault lines. During my wanderings over the decades and especially while researching a book with economist Aseem Shrivastava, I became aware of a far more hopeful trend.

Across the country and indeed around the world, hundreds of social movements are empowering the marginalized to wrest back control over their lives and livelihoods. In 2014 Kalpavriksh initiated a series of gatherings called Vikalp Sangam, or Confluence of Alternatives, where the drivers of these spirited efforts could come together, share ideas and experiences, and collaborate, helping to build a critical mass for change. These interactions and eclectic reading gave me insights into a vital question I was investigating.

What are the essential characteristics of desirable and viable alternatives?. Happily, I was far from alone in this quest. At a degrowth conference in Leipzig in 2014, I was excited to hear Alberto Acosta, an economist and former politician from Ecuador, speaking on buen vivir, an Indigenous worldview founded on living well with one another and with the rest of nature.

Although Acosta spoke no English and I spoke no Spanish, we tried excitedly to converse. Subsequently, degrowth expert Federico Demario joined us and helped to translate. We decided to work on a compilation of thriving alternatives from around the world—jotting down 20 possible ideas on the back of an envelope.

Later we roped in development critic Arturo Escobar and ecofeminist Ariel Salleh as co-editors of a volume we called Pluriverse. The number of entries expanded to more than 100. Commonalities Though dazzlingly diverse, the alternatives emerging worldwide share certain core principles.

The most important is sustaining or reviving community governance of the commons—of land, ecosystems, seeds, water and knowledge. In 12th-century England, powerful people began fencing off, or “enclosing,” fields, meadows, forests and streams that had hitherto been used by all. Enclosures by landlords and industrialists expanded to Europe and accelerated with the industrial revolution, forcing tens of millions of dispossessed people to either become factory workers or emigrate to the New World, devastating native populations.

Imperial nations seized large portions of continents and reconfigured the economies of the colonies, extracting raw materials for factories, capturing markets for exports of manufactured goods and obtaining foods such as wheat, sugar and tea for the newly created working class. In this way, colonizers and their allies established a system of perpetual economic domination that generated the Global North and the Global South (the world of the marginalized, no matter where they live). The wave of anticolonial movements in the first few decades of the 20th century, many of them successful, sparked fears that supplies of raw materials for industries and markets for finished goods of higher value would dry up.

President Harry S. Truman responded by launching a program for alleviating poverty in what he described as “underdeveloped areas” with their “primitive and stagnant” economies. As detailed by ecologist Debal Deb, newly formed financial institutions controlled by the rich countries helped the ex-colonies “develop” along the path blazed by the West, providing the materials and energy sources for and creating markets for cars, refrigerators and other consumer goods.

An integral aspect of development, as thus conceived, propagated and usually enforced by stringent conditions attached to loans from the World Bank and the International Monetary Fund, has been privatization or state confiscation of the commons to extract metals, oil and water. Credit. Federica Fragapane.

Source. €œAlternatives Transformation Format. A Process for Self-Assessment and Facilitation towards Radical Change,” prepared by Kalpavriksh for ACKnowl-EJ (chart reference) As Elinor Ostrom, winner of the 2009 Nobel Memorial Prize in Economic Sciences, demonstrated, however, the commons are far more sustainably governed by the communities from which they are wrested than by the governments or corporations that claim them.

This awareness has given rise to innumerable grassroots efforts to protect the surviving commons and reestablish control over others. What constitutes the commons has also expanded to include “physical and knowledge resources that we all share for everyone's benefit,” explains sociologist Ana Margarida Esteves, who helps with the European Commons Assembly, an umbrella organization for hundreds of such endeavors. Many of the efforts resemble the DDS and the Parque de la Papa in using community governance of commonly held resources to enhance agroecology (smallholder farming that sustains soil, water and biodiversity) and food sovereignty (control over all means of food production, including land, soil, seeds and the knowledge of how to use them).

The food-sovereignty movement La Via Campesina, which originated in Brazil in 1993, now includes about 200 million farmers in 81 countries. Such attempts at self-reliance and community governance extend also to other basic needs, such as for energy and water. In Costa Rica, Spain and Italy, rural cooperatives have been generating electricity locally and controlling its distribution since the 1990s.

And hundreds of villages in western India have moved toward “water democracy,” based on decentralized harvesting of water and community management of wetlands and groundwater. Mobilizing people to sustain, build or rebuild local systems of knowledge is essential to such ventures. Secure rights to govern the commons are also important.

In the Ecuadorian Amazon, the Sapara Indigenous people fought hard to gain collective rights over their rain-forest home. They are now defending it against oil and mining interests while developing a model of economic well-being that blends their traditional cosmovisions—ways of knowing, being and doing that are physically and spiritually linked to their environs—with new activities such as community-led ecotourism. Their income from tourism has dropped during the renova, but their forests and community ethic give them almost all the food, water, energy, housing, medicines, enjoyment, health and learning that they need.

They are now offering online sessions on their cosmovisions, dream analysis and healing. I participated in such sessions in person in their Naku ecotourism camp in 2019. The virtual version is not as immersive but nonetheless represents an innovative adaptation to the circumstances.

Greening cities or making them more welcoming, as the Lisbon social centers do, also requires community-based governance and economies of caring and sharing. Across the Global South, development projects have driven hundreds of millions of people to cities, where they live in slums and work in hazardous conditions. Wealthy city dwellers could do their part by consuming less, which would reduce the extraction and waste dumping that displace people in faraway places.

A spectrum of avenues toward more equitable and sustainable cities has emerged. These include, for example, the Transition Movement, which is attempting to regenerate the commons and make European cities carbon-neutral, and the municipalism movement, which is creating a network of Fearless Cities, among them Barcelona, Valparaiso, Madrid and Athens, to provide secure environments for refugees and migrants. Urban agriculture in Havana supplies more than half of its fresh food requirements and has inspired many other city farming initiatives around the world.

Five Petals These initiatives point to the need for fundamental transformations in five interconnected realms. In the economic sphere, we need to get away from the development paradigm—including the notion that economic growth, as measured by gross domestic product (GDP), is the best means of achieving human goals. In its place, we need systems for respecting ecological limits, emphasizing well-being in all its dimensions and localizing exchanges to enable self-reliance—as well as good measures of these indicators.

Bhutan has long experimented with gross national happiness as an index. The idea has spawned variants, such as New Zealand's recent focus on mental health and other such measures of progress. We also need freedom from centralized monetary and financial control.

Many experiments in alternative currencies and economies based on trust and local exchanges are underway. Perhaps the most innovative of these is “time banking,” a system for swapping services founded on the principle that all skills or occupations merit equal respect. One can, for example, give a one-hour-long yoga lesson for credit that can be redeemed for an hour's work on bicycle repair.

In many parts of the world, workers are seeking to control the means of production. Land, nature, knowledge and tools. A few years back I visited Vio.Me, a detergent factory in Thessaloniki, Greece, which workers had taken over and converted from chemical to olive-oil-based and eco-friendly production, and where they had established complete parity in pay, regardless of what job the worker was doing.

The slogan on their wall proclaimed. €œWe have no boss!. € Workers such as Dimitris Koumatsioulis (top) collectively run Vio.Me, an eco-friendly detergent factory in Thessaloniki, Greece.

In Prague, Czech Republic, people buy and sell locally (bottom) at a farmers' and producers' market. Credit. Ashish Kothari In fact, work itself is being redefined.

Globalized modernity has created a chasm between work and leisure—which is why we wait desperately for the weekend!. Many movements seek to bridge this gap, enabling greater enjoyment, creativity and satisfaction. In industrial countries, people are bringing back manual ways of making clothes, footwear or processed foods under banners such as “The future is handmade!.

€ In western India, many young people are leaving soul-killing routines in factories to return to handloom weaving, which allows them to control their schedules while providing a creative outlet. In the political sphere, the centralization of power inherent in the nation-state, whether democratic or authoritarian, disempowers many peoples. The Sapara nation in Ecuador and the Adivasis of central India argue for a more direct democracy, where power resides primarily with the community.

The state—insofar as it continues to exist—would then mainly help with larger-scale coordination while being strictly accountable to decision-making units on the ground. The ancient Indian notion of swaraj, literally translated as “self-rule,” is particularly relevant here. It emphasizes individual and collective autonomy and freedom that are linked to responsibility for others' autonomy and freedom.

A community that practices swaraj may not dam a stream, for example, if that threatens the water supply of downstream villages. Its well-being cannot compromise that of others. Such a notion of democracy also challenges the boundaries of nation-states, many of which are products of colonial history and have ruptured ecologically and culturally contiguous areas.

The Kurdish people, for instance, are split among Turkey, Iran, Iraq and Syria. For three decades they have struggled to achieve autonomy and direct democracy based on principles of ecological sustainability and women's liberation—and without borders dividing them. And Indigenous groups in Mexico collectively identifying as Zapatistas have for more than three decades asserted and sustained an autonomous region based on similar principles.

Moving toward such radical democracy would suggest a world with far fewer borders, weaving tens of thousands of relatively autonomous and self-reliant communities into a tapestry of alternatives. These societies would connect with one another through “horizontal” networks of equitable and respectful exchange, as well as through “vertical” but downwardly accountable institutions that manage processes and activities across the landscape. Several experiments in bioregionalism at large scales are underway, although most remain somewhat top-down in their governance.

In Australia, the Great Eastern Ranges Initiative seeks to coordinate the conservation of ecosystems across 3,600 kilometers while sustaining livelihoods and community health. And a project spanning six countries in the Andes aims to conserve as a World Heritage Site the Qhapaq an, a 30,000-kilometer network of roads built by the Inca Empire, along with its related cultural, historical and environmental heritage. Local self-governance may, of course, be oppressive or exclusionary.

The intensely patriarchal and casteist traditional village councils in many parts of India and the xenophobic antirefugee approaches of the right wing in Europe illustrate this drawback. A third crucial sphere of transformation is therefore social justice, encompassing struggles against racism, casteism, patriarchy, and other traditional or modern forms of discrimination and exploitation. Fortunately, success in defying the dominant economic system often goes hand in hand with victories against discrimination, such as Dalit women farmers' shaking off centuries of caste and patriarchal oppression to achieve food sovereignty.

Political autonomy and economic self-reliance need not mean isolationism and xenophobia. Rather cultural and material exchanges that maintain local self-reliance and respect ecological sustainability would replace present-day globalization—which perversely allows goods and finances to flow freely but stops desperate humans at borders. This kind of localization would be open to people in need.

Refugees from climate change or war would be welcomed, as in the network of Fearless Cities in Europe. Both grounded practice and shifts in policy could help transit toward such a system. Necessary, of course, are attempts to rebuild societies in regions of strife so that people do not have to flee from them.

Radical change also necessitates transformations in a fourth sphere. That of culture and knowledge. Globalization devalues languages, cultures and knowledge systems that do not adapt to development.

Several movements are confronting this homogenizing tendency. The Sapara nation is trying to resuscitate its almost extinct language and preserve its knowledge of the forest by bringing these into the curriculum of the local school, for instance. Many communities are “decolonizing” maps, putting back their own place names and defying political borders.

Even the colonial-era Mercator projection used to generate the familiar world map is being upended. (Only recently did I realize that Africa is large enough to contain Europe, China, the U.S. And India put together.) Increasingly, traditional and modern sciences are collaborating to help solve humankind's most vexing problems.

The Arctic Biodiversity Assessment, for example, involves cooperation among Indigenous peoples and university scientists to tackle climate change. One problem is that present-day educational institutions train graduates who are equipped to serve and perpetuate the dominant economic system. People are bringing community and nature back into spaces of learning, however.

These efforts include Forest Schools in many parts of Europe that provide children with hands-on learning in the midst of nature, the Zapatista autonomous schools that teach about diverse cultures and struggles, and the Ecoversities Alliance of centers of higher learning around the world that enable scholars to seek knowledge across the boundaries that typically separate academic disciplines. The most important sphere of transformation, however, is the ecological—recognizing that we are part of nature and that other species are worthy of respect in their own right. Across the Global South, communities are leading efforts to regenerate degraded ecosystems and wildlife populations and conserve biodiversity.

Tens of thousands of “territories of life” are being governed by Indigenous or other local communities, for example. These include locally managed marine areas in the South Pacific, Indigenous territories in Latin America and Australia, community forests in South Asia, and the Ancestral Domain territories in the Philippines. Also noteworthy is recent legislation or court judgments in several countries asserting that rivers, for example, enjoy the same protections as people.

The United Nations' 2009 Declaration on Harmony with Nature is an important milestone toward such a goal. Values I am often asked how one scales up successful alternatives. It would be self-defeating, however, to try to either scale up or replicate a DDS or a Parque de la Papa.

The essence of this approach is diversity. The recognition that every situation is different. What people can do—and this, indeed, is how successful initiatives spread—is understand the underlying values and apply these in their own communities while networking with like ventures to spread the impact.

The Vikalp Sangam process has identified the following values as crucial. Solidarity, dignity, interconnectedness, rights and responsibilities, diversity, autonomy and freedom, self-reliance and self-determination, simplicity, nonviolence and respect for all life. Around the world both ancient and modern worldviews that are focused on life articulate similar principles.

Indigenous peoples and other local communities have lived by worldviews such as buen vivir, swaraj, ubuntu (an African philosophy that sees the well-being of all living things as interconnected) and many other such ethical systems for centuries and are reasserting them. Simultaneously, approaches such as degrowth and ecofeminism have emerged from within industrial societies, seeding powerful countercultures. At the heart of these worldviews lies a simple principle.

That we are all holders of power. That in the exercise of this power, we not only assert our own autonomy and freedom but also are responsible for ensuring the autonomy of others. Such a swaraj merges with ecological sustainability to create an eco-swaraj, encompassing respect for all life.