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Resilient, committed and get kamagra prescription remarkable kamagra tablets uk next day delivery. Alvin Leonardo, the physician assistant class-elected speaker, celebrates with his family during the virtual event.These are the qualities attributed to and embodied by the new graduates of the Betty Irene Moore School of Nursing at UC Davis.To mark the milestone at the end of their academic journeys, school leaders hosted a virtual graduation celebration June 10. A videotaped message from David Lubarsky, CEO of UC Davis Health, kicked get kamagra prescription off the event. Faculty participated in the Zoom event in Betty Irene Moore Hall, while the 161 graduates joined remotely from their homes and communities.

Friends and family viewed via a Facebook Live stream.Despite the distance, the graduates of the school’s five degree programs commemorated the shared experience of completing their graduate degrees during a kamagra and persevering against unprecedented challenges.“For the past year, we’ve celebrated our 10th anniversary. We’ve learned a lot in our get kamagra prescription decade of discovery. Today, I want to share with you three things we have discovered about ourselves that very much parallel what you, graduates, have learned about yourselves,” said Dean Stephen J. Cavanagh.

€œA strong foundation can weather any storm. Adaptability is critical for success. And a legacy outlasts any experience. Go out into the world and go beyond in your contributions to make this world a better, healthier and more equitable place.”Among the Classes of 2021 is the final cohort of Master of Science — Leadership students.

In fall 2010, the first class of 25 leadership students entered what, at the time, was a new nursing school. The program, which ends after this year, has offered registered nurses the opportunity to elevate how they view nursing and see the systems that affect health. For a decade, it has produced graduates who lead nursing staff, teach future nurses in college, work as clinical instructors for the School of Nursing, serve on community boards and impact policy-making bodies.“To quote founding Dean Heather Young from our very first welcoming ceremony in 2010, ‘When I think of heaven, I think of a very still pond in the high Sierra. Betty Moore took a pebble and threw it into that pond.

Her pebble was her commitment and her vision,’” said Jessica Draughon Moret, an assistant professor who teaches in the program. €œJust as water molecules disperse to continue those ripples, you, as alumni, now make waves of change in health care.”Class-elected speaker Aron King echoed that sentiment.“We are so lucky to be here semi-together celebrating what has been a very challenging journey. Most of us entered this program as strangers. Over the last five quarters, we have grown to become family.

As our lives and careers continue in this album called life, know that we will always be connected by this single song,” he said.Nursing faculty recognized five students with awards of excellence, highlighting theStaff and faculty from the School of Nursing provided support for the virtual event from Betty Irene Moore Hall.school’s five core attributes:Excellence in Innovative Solutions. Jonathan TraskExcellence in Community Connection. Nicole VanceExcellence in Leadership. Hannah DavisExcellence in Collaboration.

Erika GonzalezExcellence in Diversity and Inclusion. Mohamed JawaraSchool of Nursing students and faculty also submitted nominations for the Dean’s Excellence Awards to honor staff and faculty in three areas. Teaching, Research, and Diversity and Inclusion. Those recognized include:Excellence in Teaching.

Kathryn SexsonExcellence in Research. Deb BakerjianExcellence in Diversity, Equity and Inclusion. Brent LuuFollowing the School of Nursing event, the graduates from the Nursing Science and Health-Care Leadership Degree Programs joined faculty for an informal mixer on the grounds outside in the Betty Irene Moore Hall courtyard on the Sacramento campus.The Nursing Science and Health-Care Leadership Graduate Degree Programs, which includes master’s degrees in leadership, family nurse practitioner, physician assistant studies and entry-level nursing, as well as a doctoral program, are led by an interprofessional team of more than 55 faculty from across UC Davis. You can view a recording of the event here.

Click here to view a program from the celebration. Learn more at nursing.ucdavis.edu.A new study from the University of California, Davis, and the Icahn School of Medicine at Mount Sinai confirms that surgical masks effectively reduce outgoing airborne particles from talking or coughing, even after allowing for leakage around the edges of the mask. The results were published June 8 in Scientific Reports. The study confirmed that surgical masks are effective at reducing outgoing particles from talking or coughing.Wearing masks and other face coverings can reduce the flow of airborne particles that are produced during breathing, talking, coughing or sneezing, protecting others from kamagraes carried by those particles such as SARS-CoV2 and influenza, said Christopher Cappa, professor of civil and environmental engineering at UC Davis and corresponding author on the paper.High-efficiency masks such as N95 respirators are designed to have a tight seal to the face, while surgical and most cloth face masks leave small gaps around the sides, which can be reduced when they are worn correctly.The researchers looked at particles flowing from these gaps by sitting volunteers in front of an instrument that counts airborne particles down to a size of half a micron.

The 12 volunteers read aloud or coughed, with and without a surgical mask of the type widely used by the public, either with their mouth directly in front of the funnel of the particle counter, turned to the side or with their head lowered or raised to count particles passing directly through the mask or leaking around the sides. The researchers found that wearing a mask while talking reduced particles directly through the mask by an average of 93%, from the bottom by 91%, the sides by 85% and the top by 47%, although with substantial variability between individuals. They got similar results for coughing.Models to measure leakageThe team used simulations to model the overall reduction in particles due to wearing a mask, allowing for leakage around the edges. They calculated that the overall efficiency of masks was about 70% for talking and 90% for coughing.“While air escape does limit the overall efficiency of surgical masks at reducing expiratory particle emissions, such masks nonetheless provide substantial reduction,” Cappa said.

€œOur results confirm that mask wearing provides a significant reduction in the probability of disease transmission via expiratory particles, especially when both infected and susceptible individuals wear masks.”Masks also redirect the flow of air from a high-velocity plume from the talker or cougher toward anybody in front of them, Cappa said. Additional authors on the study are. Sima Asadi, Santiago Barreda, Anthony Wexler and William Ristenpart at UC Davis. And Nicole Bouvier, Icahn School of Medicine at Mount Sinai, New York.

(Sima Asadi is now at the Massachusetts Institute of Technology.) The work was funded by a grant from the National Institute for Allergy and Infectious Diseases..

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Credit...Alana Paterson for The New York TimesSkip to contentSkip to site kamagra oral jelly review uk indexHow to Master the Pull-UpThe trick is to break the movement into pieces and train with patience and deliberateness.Credit...Alana Paterson for The New York TimesSupported byContinue reading the main story62March 8, 2022I’ve always loved pull-ups, partly out of spite. There is a common fitness refrain that women can’t do them, and I kamagra oral jelly review uk don’t like to be told I can’t do something — especially if the reason is my gender. As a teenager, I pushed lawn-mowers and hauled rocks just to show that being a girl didn’t mean I was weak.I love how pull-ups make me feel — powerful, strong. There’s nothing kamagra oral jelly review uk like the feeling of lifting yourself up.

Pull-ups are also beautiful for their simplicity. They require nothing more than a bar, and engage at least a dozen muscles, from the lats all kamagra oral jelly review uk the way to the glutes. Experts say they improve upper body strength, shoulder mobility and core stability, while helping to hone coordination too.Doing a pull-up is “an amazing feeling,” said Chilasa King, a powerlifter and coach at LiftedMBK in New York. The exercise boosts confidence and turns heads at the gym, she said kamagra oral jelly review uk.

€œIt’s a simple exercise that’s really hard to do.”Therein lies the pull-up paradox. Pull-ups are simple, but hard, and many people who think they can’t do one really could, if they put in the effort and time.Everybody has a good chance of achieving a pull-up if they train for it, said Meghan Callaway, a strength coach based in Vancouver, Canada, and creator of The Ultimate Pull-Up Program kamagra oral jelly review uk. Most people who fail to master the pull-up struggle not because they are physically incapable, but because they are not training in the right way, she said. The trick is to focus on proper technique and approach your kamagra oral jelly review uk training with patience and deliberateness.“It’s a simple exercise that’s really hard to do,” said Chilasa King, a New York powerlifter and coach.

But doing them is “an amazing feeling.” Credit...Ben Rayner for The New York TimesFocus on form.The first thing to understand is that pull-ups are a full body exercise. €œA lot kamagra oral jelly review uk of people think of a pull-up purely as an upper body exercise and they neglect what is going on from the chest down,” Ms. Callaway said. Your body should be rigid, not kamagra oral jelly review uk slack.

What would be easier to move, Ms. Callaway asked, a stiff kamagra oral jelly review uk board, or an equally weighted floppy sandbag?. If your torso, hips and lower body are rigid, it makes it a lot easier to lift them than if they’re dead weight. (Kipping pull-ups, done by swinging your legs for momentum, are a different exercise altogether, she said.)Grab the bar slightly greater than shoulder width with your kamagra oral jelly review uk palms facing away from you.

(Holding your palms toward you would be a chin-up, a different — and most people say easier — exercise.) Your body should be aligned in a relatively straight line with your feet just slightly ahead of your body so you’re in a very slight arc. It’s better for the bar to be just within reach on your tip toes, but if you’re doing them in a doorway, it’s OK to bend your knees with your feet out behind you, kamagra oral jelly review uk Ms. Callaway said.To initiate the pull-up, move your shoulder blades toward your spine (think of it as the opposite of shrugging) while simultaneously driving your elbows down toward your ribs. Keep your kamagra oral jelly review uk abs and glutes tight to maintain a rigid body position.

As you pull up, don’t reach up with your chin, Ms. Callaway said, but instead keep your chin tucked, your neck in a neutral position and your eyes looking straight ahead.Meghan Callaway, a strength coach based in Vancouver, demonstrates a version of inverted kamagra oral jelly review uk rows. If you don’t have access to a weight bar, you can use rings or even nylon straps.Credit...Alana Paterson for The New York TimesMs. Callaway demonstrates kamagra oral jelly review uk scapula pulls.

By lifting and holding with your shoulders, keeping your arms straight, you can begin to train the muscles needed for a pull-up.Credit...Alana Paterson for The New York TimesPractice the components.Not everyone can do a pull-up the first time. Even before you can do a complete pull-up, you can break the movement down into its component parts and train for each of them kamagra oral jelly review uk. Use these four exercises to help get stronger and more skilled at the essential parts of the pull-up motion.Bar HangsThe first step is to learn how to hang in a rigid position, rather than flaccidly. Ms.

King has beginners practice hanging by grabbing the bar, engaging their abs and glutes to make their body stiff like a board, and then holding for 30 to 45 seconds.Scapula Pull-UpsThese are a way to practice the initial pull-up movement. Start by hanging on a bar and then engage the muscles in your mid and upper back to move your shoulder blades in toward your spine. As you do this, you’ll feel yourself elevating just a tiny amount. Hold for a moment in this elevated position, then slowly lower yourself to the starting position.

Don’t bend your elbows. Your arms should be straight for the entire motion.Eccentric Pull-upsBegin at the top position of a pull-up with your head above the bar (stand on a chair to get up there if you need to) and then slowly lower yourself to a hanging position using a controlled, fluid motion.Inverted RowsThis exercise strengthens the back and improves shoulder mobility. Position yourself underneath a weight bar as if about to do a bench press. But instead of lying on a bench, hang from the bar, your heels on the floor.

Hold your body in a straight, rigid line and pull yourself up, initiating the movement using your back muscles, rather than your arms. Return to the starting position in a slow, controlled motion. Imagine moving your shoulder blades away from your spine and around your rib cage.Ms. King said it may take time to get your first pull-up.

While often seen as a strictly upper body exercise, pull-ups actually work parts of the core and even the glutes when done correctly. Credit...Ben Rayner for The New York TimesTake your time.“Be patient,” Ms. King said. Getting your first pull-up “takes time and a lot of consistency.

It doesn’t happen overnight.” Consistency is crucial, she said. €œThere is no way around this. You have to work at it, week after week and month after month.”For Casey Johnston, a health and science writer, and author of the weight lifting guide “Liftoff. Couch to Barbell,” pull-ups were just one part of a larger quest to get stronger.

She’d been weight lifting for about a year before she could finally do one, but it was worth it for the sense of accomplishment in mastering this quintessential show of strength. €œNo one is required to do pull-ups,” she said. €œI have long arms and I’m relatively big, which are both challenges.”It’s true that pull-ups are easier for some people than for others. €œIn general, as mass goes up, strength to weight ratios go down,” said Greg Nuckols, founder of StrongerByScience.com and a powerlifter who’s held three world records.

A tall person is likely to have more mass to pull up than a shorter person, even if they are similarly built. Some may never be able to manage a pull-up, no matter how long they try, and others might decide it’s not worth it.I will never set any pull-up records with my long arms and legs and taller-than-average height. But I do have a few advantages. Good upper body strength from years of cross-country skiing and not too much middle-aged pudge.

I still have to work at pull-ups, but the payoff is deeply satisfying.“Pulling yourself up onto something — a bar, over a fence, up a wall — makes you feel like a superhero,” Ms. Callaway said. Not only that, she added, it also makes the monkey bars at the nearby playground a little more fun.Christie Aschwanden is a writer based in western Colorado and the author of “Good to Go. What the Athlete in All of Us Can Learn from the Strange Science of Recovery.”AdvertisementContinue reading the main storyAdvertisementContinue reading the main storySupported byContinue reading the main storyJealousy Doesn’t Have to Ruin a FriendshipEveryone feels left out sometimes.

It’s how you handle it that matters.108Credit...Ohni LisleJuli Fraga and March 4, 2022When Bob Bergeson’s friend invited him to a Denver Nuggets basketball game with some new pals, he was excited to join in. Sure, the evening would cost him nearly $400, an amount he wouldn’t normally spend. But Mr. Bergeson’s splurge didn’t reflect a slavish devotion to basketball.

He opened his wallet because he felt insecure about his languishing relationship with his friend, who he perceived to be getting closer to a new group of people.“He started hanging out with the dads on his daughter’s soccer team and talking about them fondly and I thought, ‘Oh, man he’s kind of got some new friends,’” Mr. Bergeson, 42, a business consultant in Denver, said. €œI needed to insert myself to make sure I still mattered to him.”Just like you can lose a romantic partner to another person, “friends can also lose their slot in the best friend hierarchy,” said Jaimie Krems, a friendship researcher and assistant professor of psychology at Oklahoma State University. This fear of being replaced is often borne out of jealousy, Dr.

Krems said. And one way to cope with it, she added, is by doing something social scientists refer to as friend guarding — actions like excessively praising a friend or cutting down a new rival, for example — to maintain a threatened relationship.“Like all behaviors, there are good and bad aspects of friend guarding,” Dr. Krems said. Telling your friend how much they mean to you might bolster your friendship, she said, but badmouthing a newbie might anger your friend and cause them to pull away.Miriam Kirmayer, a friendship expert and clinical psychologist in Ottawa, said feelings of jealousy and envy in friendships are quite common with her adult clients, but many feel ashamed of those feelings because they mistake them “as a sign of immaturity.” On the contrary, Dr.

Kirmayer said. When handled correctly, jealousy can lead to a deeper understanding of yourself, and as a result, more fulfilling friendships. Here’s how.Jealousy can strengthen a relationship.Feelings of fear, anger and jealousy often make people uncomfortable, but like all emotions, they evolved to protect well-being, said Mark Leary, a professor of psychology and neuroscience at Duke University. €œNegative emotions alert us to potential danger and motivate us to take pre-emptive action.”In truly perilous scenarios — like a kamagra, for instance — you might cope with your anxiety by wearing a mask and steering clear of crowds.

In less dire situations, like when you think you’re on the brink of losing a friend, you might attempt to hold their interest by becoming a better listener or trying to be more positive and upbeat.When feelings of jealousy bubble to the surface, start by questioning how good of a friend you’ve really been. You might ask yourself, ‘What kind of friend do I want to be?. €™ And perhaps, the answer will help steer you toward traits that foster acceptance by your social circle, like more compassion and generosity.Identifying the origins of your feelings can also help you pinpoint potential triggers that may make jealousy worse. If you’re already second-guessing yourself at work, for instance, you might assume a turned down dinner invitation is a sign of a friend pulling away.

In other instances, unhealed wounds from childhood — growing up with inconsistent caregivers, for example — can make you more sensitive to rejection as an adult.To identify these potential triggers, ask yourself questions like. €œWhat past experiences might this feeling be linked to?. € and “Is my jealousy triggered by circumstances in my own life?. € Dr.

Kirmayer suggested.Once you understand your emotions, decide how you want to proceed. Instead of letting jealousy elicit knee-jerk negative responses like leveling accusations, you might see the emotion as a signal to talk with your friend, or to work through some issues on your own.When Joli Hamilton’s close friend planned a party without her, she was overcome with jealousy. €œI found out through mutual friends and the rejection really stung,” said Ms. Hamilton, 45, a relationship coach in Westfield, Mass.Ms.

Hamilton admitted that her hurt feelings unleashed catastrophic thoughts like, “I don’t know why I ever thought we were friends!. € and “After everything I’ve done for her, she doesn’t get to leave me out!. € But instead of telling her friend off, Ms. Hamilton decided to have an honest conversation about her concerns.As a result, both parties better understood the insecurities and desires that fueled their behavior.

€œI always wanted to be included in all of her plans, but she needed space to spend time with other people,” Ms. Hamilton said. And shortly after, the friends reached a compromise. €œWe ended up spending less time together, but that time was one-on-one with activities we both enjoyed.”Unlike with romantic relationships, we rarely ask ourselves, “What should I expect out of a really good friendship?.

€ Dr. Leary said. But stating your needs and developing boundaries can solidify trust, which helps build more mature friendships.Jealousy isn’t always personal.When jealousy swells, it can be easy to assume there’s something wrong with you. But in most cases, this is far from the truth.

€œEven though our feelings are real, our brains aren’t always objective truth tellers,” said Joel Minden, a clinical psychologist and lecturer at California State University, Chico, and the author of “Show Your Anxiety Who’s Boss.”To manage self-critical thoughts, he said, take a step back and see if there’s another way to understand the situation. If your best friend cancels your weekly phone date to have dinner with their new pal, you might assume it’s because you’re a downer or a bad friend. But ask yourself if there’s any evidence for or against that belief, or if there’s “another explanation for your friend’s behavior that’s more realistic,” Dr. Minden advised.Replacing negative thoughts with more useful explanations can ease the emotional weight that hurtful assumptions can bring, Dr.

Minden added. For example, “my friend needs different kinds of friends” is an easier pill to swallow than “my friend is replacing me.”Reframing jealous thoughts into empathetic ones can help.Another way to thwart the negative feelings of jealousy is to find small ways to be happy for your friend, said Sara Konrath, an empathy researcher at Indiana University. Instead of ruminating on how a buddy’s new friendship with someone else affects you, think, ‘I’m really happy that she has somebody else she feels connected to,’” Dr. Konrath suggested.

When we prioritize empathy in friendships, reminders of how much our friends mean to us and how much we mean to them can temper jealous feelings.As for Mr. Bergeson, he had a great time at the game. And fortunately for him, those feelings of jealousy ended up being short-lived. €œMy friend made sure I was enjoying myself and this relieved my worries about possibly losing him to a new crowd.”Juli Fraga is a psychologist and writer in San Francisco.Connie Chang is a writer and mother of three in Silicon Valley.AdvertisementContinue reading the main story.

Credit...Alana Paterson for The New York TimesSkip to contentSkip to site indexHow to Master the Pull-UpThe trick is to break the movement into pieces and train with patience and deliberateness.Credit...Alana Paterson for The New go to this web-site York TimesSupported byContinue reading the get kamagra prescription main story62March 8, 2022I’ve always loved pull-ups, partly out of spite. There is a common fitness refrain that women can’t do them, and I don’t like to be told I can’t do something — especially if the reason get kamagra prescription is my gender. As a teenager, I pushed lawn-mowers and hauled rocks just to show that being a girl didn’t mean I was weak.I love how pull-ups make me feel — powerful, strong. There’s nothing like the get kamagra prescription feeling of lifting yourself up.

Pull-ups are also beautiful for their simplicity. They require nothing more than a bar, and engage at get kamagra prescription least a dozen muscles, from the lats all the way to the glutes. Experts say they improve upper body strength, shoulder mobility and core stability, while helping to hone coordination too.Doing a pull-up is “an amazing feeling,” said Chilasa King, a powerlifter and coach at LiftedMBK in New York. The exercise boosts confidence and turns heads at the gym, she said get kamagra prescription.

€œIt’s a simple exercise that’s really hard to do.”Therein lies the pull-up paradox. Pull-ups are get kamagra prescription simple, but hard, and many people who think they can’t do one really could, if they put in the effort and time.Everybody has a good chance of achieving a pull-up if they train for it, said Meghan Callaway, a strength coach based in Vancouver, Canada, and creator of The Ultimate Pull-Up Program. Most people who fail to master the pull-up struggle not because they are physically incapable, but because they are not training in the right way, she said. The trick is to focus on proper technique and approach your training with get kamagra prescription patience and deliberateness.“It’s a simple exercise that’s really hard to do,” said Chilasa King, a New York powerlifter and coach.

But doing them is “an amazing feeling.” Credit...Ben Rayner for The New York TimesFocus on form.The first thing to understand is that pull-ups are a full body exercise. €œA lot of people get kamagra prescription think of a pull-up purely as an upper body exercise and they neglect what is going on from the chest down,” Ms. Callaway said. Your body get kamagra prescription should be rigid, not slack.

What would be easier to move, Ms. Callaway asked, a stiff board, or an equally weighted get kamagra prescription floppy sandbag?. If your torso, hips and lower body are rigid, it makes it a lot easier to lift them than if they’re dead weight. (Kipping pull-ups, done by swinging your legs for momentum, are a different exercise altogether, she said.)Grab the bar slightly greater than shoulder width with your palms get kamagra prescription facing away from you.

(Holding your palms toward you would be a chin-up, a different — and most people say easier — exercise.) Your body should be aligned in a relatively straight line with your feet just slightly ahead of your body so you’re in a very slight arc. It’s better for the bar to be just within reach on your tip toes, but if you’re doing them in get kamagra prescription a doorway, it’s OK to bend your knees with your feet out behind you, Ms. Callaway said.To initiate the pull-up, move your shoulder blades toward your spine (think of it as the opposite of shrugging) while simultaneously driving your elbows down toward your ribs. Keep your abs get kamagra prescription and glutes tight to maintain a rigid body position.

As you pull up, don’t reach up with your chin, Ms. Callaway said, but instead keep your chin tucked, your neck in a neutral position get kamagra prescription and your eyes looking straight ahead.Meghan Callaway, a strength coach based in Vancouver, demonstrates a version of inverted rows. If you don’t have access to a weight bar, you can use rings or even nylon straps.Credit...Alana Paterson for The New York TimesMs. Callaway demonstrates get kamagra prescription scapula pulls.

By lifting and holding with your shoulders, keeping your arms straight, you can begin to train the muscles needed for a pull-up.Credit...Alana Paterson for The New York TimesPractice the components.Not everyone can do a pull-up the first time. Even before you can do a complete pull-up, you can break the movement down into its component parts and train for get kamagra prescription each of them. Use these four exercises to help get stronger and more skilled at the essential parts of the pull-up motion.Bar HangsThe first step is to learn how to hang in a rigid position, rather than flaccidly. Ms.

King has beginners practice hanging by grabbing the bar, engaging their abs and glutes to make their body stiff like a board, and then holding for 30 to 45 seconds.Scapula Pull-UpsThese are a way to practice the initial pull-up movement. Start by hanging on a bar and then engage the muscles in your mid and upper back to move your shoulder blades in toward your spine. As you do this, you’ll feel yourself elevating just a tiny amount. Hold for a moment in this elevated position, then slowly lower yourself to the starting position.

Don’t bend your elbows. Your arms should be straight for the entire motion.Eccentric Pull-upsBegin at the top position of a pull-up with your head above the bar (stand on a chair to get up there if you need to) and then slowly lower yourself to a hanging position using a controlled, fluid motion.Inverted RowsThis exercise strengthens the back and improves shoulder mobility. Position yourself underneath a weight bar as if about to do a bench press. But instead of lying on a bench, hang from the bar, your heels on the floor.

Hold your body in a straight, rigid line and pull yourself up, initiating the movement using your back muscles, rather than your arms. Return to the starting position in a slow, controlled motion. Imagine moving your shoulder blades away from your spine and around your rib cage.Ms. King said it may take time to get your first pull-up.

While often seen as a strictly upper body exercise, pull-ups actually work parts of the core and even the glutes when done correctly. Credit...Ben Rayner for The New York TimesTake your time.“Be patient,” Ms. King said. Getting your first pull-up “takes time and a lot of consistency.

It doesn’t happen overnight.” Consistency is crucial, she said. €œThere is no way around this. You have to work at it, week after week and month after month.”For Casey Johnston, a health and science writer, and author of the weight lifting guide “Liftoff. Couch to Barbell,” pull-ups were just one part of a larger quest to get stronger.

She’d been weight lifting for about a year before she could finally do one, but it was worth it for the sense of accomplishment in mastering this quintessential show of strength. €œNo one is required to do pull-ups,” she said. €œI have long arms and I’m relatively big, which are both challenges.”It’s true that pull-ups are easier for some people than for others. €œIn general, as mass goes up, strength to weight ratios go down,” said Greg Nuckols, founder of StrongerByScience.com and a powerlifter who’s held three world records.

A tall person is likely to have more mass to pull up than a shorter person, even if they are similarly built. Some may never be able to manage a pull-up, no matter how long they try, and others might decide it’s not worth it.I will never set any pull-up records with my long arms and legs and taller-than-average height. But I do have a few advantages. Good upper body strength from years of cross-country skiing and not too much middle-aged pudge.

I still have to work at pull-ups, but the payoff is deeply satisfying.“Pulling yourself up onto something — a bar, over a fence, up a wall — makes you feel like a superhero,” Ms. Callaway said. Not only that, she added, it also makes the monkey bars at the nearby playground a little more fun.Christie Aschwanden is a writer based in western Colorado and the author of “Good to Go. What the Athlete in All of Us Can Learn from the Strange Science of Recovery.”AdvertisementContinue reading the main storyAdvertisementContinue reading the main storySupported byContinue reading the main storyJealousy Doesn’t Have to Ruin a FriendshipEveryone feels left out sometimes.

It’s how you handle it that matters.108Credit...Ohni LisleJuli Fraga and March 4, 2022When Bob Bergeson’s friend invited him to a Denver Nuggets basketball game with some new pals, he was excited to join in. Sure, the evening would cost him nearly $400, an amount he wouldn’t normally spend. But Mr. Bergeson’s splurge didn’t reflect a slavish devotion to basketball.

He opened his wallet because he felt insecure about his languishing relationship with his friend, who he perceived to be getting closer to a new group of people.“He started hanging out with the dads on his daughter’s soccer team and talking about them fondly and I thought, ‘Oh, man he’s kind of got some new friends,’” Mr. Bergeson, 42, a business consultant in Denver, said. €œI needed to insert myself to make sure I still mattered to him.”Just like you can lose a romantic partner to another person, “friends can also lose their slot in the best friend hierarchy,” said Jaimie Krems, a friendship researcher and assistant professor of psychology at Oklahoma State University. This fear of being replaced is often borne out of jealousy, Dr.

Krems said. And one way to cope with it, she added, is by doing something social scientists refer to as friend guarding — actions like excessively praising a friend or cutting down a new rival, for example — to maintain a threatened relationship.“Like all behaviors, there are good and bad aspects of friend guarding,” Dr. Krems said. Telling your friend how much they mean to you might bolster your friendship, she said, but badmouthing a newbie might anger your friend and cause them to pull away.Miriam Kirmayer, a friendship expert and clinical psychologist in Ottawa, said feelings of jealousy and envy in friendships are quite common with her adult clients, but many feel ashamed of those feelings because they mistake them “as a sign of immaturity.” On the contrary, Dr.

Kirmayer said. When handled correctly, jealousy can lead to a deeper understanding of yourself, and as a result, more fulfilling friendships. Here’s how.Jealousy can strengthen a relationship.Feelings of fear, anger and jealousy often make people uncomfortable, but like all emotions, they evolved to protect well-being, said Mark Leary, a professor of psychology and neuroscience at Duke University. €œNegative emotions alert us to potential danger and motivate us to take pre-emptive action.”In truly perilous scenarios — like a kamagra, for instance — you might cope with your anxiety by wearing a mask and steering clear of crowds.

In less dire situations, like when you think you’re on the brink of losing a friend, you might attempt to hold their interest by becoming a better listener or trying to be more positive and upbeat.When feelings of jealousy bubble to the surface, start by questioning how good of a friend you’ve really been. You might ask yourself, ‘What kind of friend do I want to be?. €™ And perhaps, the answer will help steer you toward traits that foster acceptance by your social circle, like more compassion and generosity.Identifying the origins of your feelings can also help you pinpoint potential triggers that may make jealousy worse. If you’re already second-guessing yourself at work, for instance, you might assume a turned down dinner invitation is a sign of a friend pulling away.

In other instances, unhealed wounds from childhood — growing up with inconsistent caregivers, for example — can make you more sensitive to rejection as an adult.To identify these potential triggers, ask yourself questions like. €œWhat past experiences might this feeling be linked to?. € and “Is my jealousy triggered by circumstances in my own life?. € Dr.

Kirmayer suggested.Once you understand your emotions, decide how you want to proceed. Instead of letting jealousy elicit knee-jerk negative responses like leveling accusations, you might see the emotion as a signal to talk with your friend, or to work through some issues on your own.When Joli Hamilton’s close friend planned a party without her, she was overcome with jealousy. €œI found out through mutual friends and the rejection really stung,” said Ms. Hamilton, 45, a relationship coach in Westfield, Mass.Ms.

Hamilton admitted that her hurt feelings unleashed catastrophic thoughts like, “I don’t know why I ever thought we were friends!. € and “After everything I’ve done for her, she doesn’t get to leave me out!. € But instead of telling her friend off, Ms. Hamilton decided to have an honest conversation about her concerns.As a result, both parties better understood the insecurities and desires that fueled their behavior.

€œI always wanted to be included in all of her plans, but she needed space to spend time with other people,” Ms. Hamilton said. And shortly after, the friends reached a compromise. €œWe ended up spending less time together, but that time was one-on-one with activities we both enjoyed.”Unlike with romantic relationships, we rarely ask ourselves, “What should I expect out of a really good friendship?.

€ Dr. Leary said. But stating your needs and developing boundaries can solidify trust, which helps build more mature friendships.Jealousy isn’t always personal.When jealousy swells, it can be easy to assume there’s something wrong with you. But in most cases, this is far from the truth.

€œEven though our feelings are real, our brains aren’t always objective truth tellers,” said Joel Minden, a clinical psychologist and lecturer at California State University, Chico, and the author of “Show Your Anxiety Who’s Boss.”To manage self-critical thoughts, he said, take a step back and see if there’s another way to understand the situation. If your best friend cancels your weekly phone date to have dinner with their new pal, you might assume it’s because you’re a downer or a bad friend. But ask yourself if there’s any evidence for or against that belief, or if there’s “another explanation for your friend’s behavior that’s more realistic,” Dr. Minden advised.Replacing negative thoughts with more useful explanations can ease the emotional weight that hurtful assumptions can bring, Dr.

Minden added. For example, “my friend needs different kinds of friends” is an easier pill to swallow than “my friend is replacing me.”Reframing jealous thoughts into empathetic ones can help.Another way to thwart the negative feelings of jealousy is to find small ways to be happy for your friend, said Sara Konrath, an empathy researcher at Indiana University. Instead of ruminating on how a buddy’s new friendship with someone else affects you, think, ‘I’m really happy that she has somebody else she feels connected to,’” Dr. Konrath suggested.

When we prioritize empathy in friendships, reminders of how much our friends mean to us and how much we mean to them can temper jealous feelings.As for Mr. Bergeson, he had a great time at the game. And fortunately for him, those feelings of jealousy ended up being short-lived. €œMy friend made sure I was enjoying myself and this relieved my worries about possibly losing him to a new crowd.”Juli Fraga is a psychologist and writer in San Francisco.Connie Chang is a writer and mother of three in Silicon Valley.AdvertisementContinue reading the main story.

What should I watch for while taking Kamagra?

If you notice any changes in your vision while taking this drug, call your doctor or health care professional as soon as possible. Call your health care provider right away if you have any change in vision. Contact you doctor or health care professional right away if the erection lasts longer than 4 hours or if it becomes painful. This may be a sign of a serious problem and must be treated right away to prevent permanent damage. If you experience symptoms of nausea, dizziness, chest pain or arm pain upon initiation of sexual activity after taking Kamagra, you should refrain from further activity and call your doctor or health care professional as soon as possible. Using Kamagra does not protect you or your partner against HIV (the kamagra that causes AIDS) or other sexually transmitted diseases.

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Wealthy nations must do much more, much faster.The United Nations http://www.ec-jean-racine-ostwald.ac-strasbourg.fr/?page_id=14980 General Assembly in September 2021 will bring countries together at a critical kamagra effervescent tablets uk time for marshalling collective action to tackle the global environmental crisis. They will meet again at the biodiversity summit in Kunming, China, and the climate conference (Conference of the Parties kamagra effervescent tablets uk (COP)26) in Glasgow, UK. Ahead of these pivotal meetings, we—the editors of health journals worldwide—call for urgent action to keep average global temperature increases below 1.5°C, halt the destruction of nature and protect health.Health is already being harmed by global temperature increases and the destruction of the natural world, a state of affairs health professionals have been bringing attention to for decades.1 The science is unequivocal. A global increase of 1.5°C above the preindustrial average and the continued loss of biodiversity risk catastrophic harm to health that will be impossible to reverse.2 3 Despite the world’s necessary preoccupation with erectile dysfunction treatment, we kamagra effervescent tablets uk cannot wait for the kamagra to pass to rapidly reduce emissions.Reflecting the severity of the moment, this editorial appears in health journals across the world. We are united in recognising that only fundamental and equitable changes to societies will reverse our current trajectory.The risks to health of increases above 1.5°C are now well established.2 Indeed, no temperature rise kamagra effervescent tablets uk is ‘safe’.

In the past 20 years, heat-related mortality among people aged over 65 has increased by more than 50%.4 Higher temperatures have brought increased dehydration and renal function loss, dermatological malignancies, tropical s, adverse mental health outcomes, pregnancy complications, allergies, and cardiovascular and pulmonary morbidity and mortality.5 6 Harms disproportionately affect the most vulnerable, including children, older populations, ethnic minorities, poorer communities and those with underlying health problems.2 4Global heating is also contributing to the decline in global yield potential for major crops, falling by 1.8%–5.6% since 1981. This, together with the effects of extreme weather and soil depletion, is hampering efforts to reduce undernutrition.4 Thriving ecosystems are kamagra effervescent tablets uk essential to human health, and the widespread destruction of nature, including habitats and species, is eroding water and food security and increasing the chance of kamagras.3 7 8The consequences of the environmental crisis fall disproportionately on those countries and communities that have contributed least to the problem and are least able to mitigate the harms. Yet no country, no matter how wealthy, can shield itself from these impacts. Allowing the consequences to fall disproportionately on the kamagra effervescent tablets uk most vulnerable will breed more conflict, food insecurity, forced displacement and zoonotic disease, with severe implications for all countries and communities. As with the erectile dysfunction treatment kamagra, we are globally as strong as our weakest member.Rises above 1.5°C increase the chance kamagra effervescent tablets uk of reaching tipping points in natural systems that could lock the world into an acutely unstable state.

This would critically impair our ability to mitigate harms and to prevent catastrophic, runaway environmental change.9 10Global targets are not enoughEncouragingly, many governments, financial institutions and businesses are setting targets to reach net-zero emissions, including targets for 2030. The cost of kamagra effervescent tablets uk renewable energy is dropping rapidly. Many countries kamagra effervescent tablets uk are aiming to protect at least 30% of the world’s land and oceans by 2030.11These promises are not enough. Targets are easy to set and hard to achieve. They are yet to be matched with kamagra effervescent tablets uk credible short-term and longer-term plans to accelerate cleaner technologies and transform societies.

Emissions reduction plans do not adequately incorporate health considerations.12 Concern is growing that temperature rises above 1.5°C are beginning to be seen as inevitable, or even acceptable, to powerful members of the global community.13 Relatedly, current strategies for reducing emissions to net zero by the middle of the century implausibly assume that the world will acquire great capabilities to remove greenhouse gases from the atmosphere.14 15This insufficient action means that temperature increases are likely to be well in excess of 2°C,16 a catastrophic outcome for health and environmental stability. Critically, the destruction of nature does not have parity of esteem with the climate element of the crisis, and every single global target to restore biodiversity loss by 2020 was missed.17 This is an overall environmental crisis.18Health professionals are united with environmental scientists, businesses and kamagra effervescent tablets uk many others in rejecting that this outcome is inevitable. More can and must be done now—in Glasgow and Kunming—and in the kamagra effervescent tablets uk immediate years that follow. We join health professionals worldwide who have already supported calls for rapid action.1 19Equity must be at the centre of the global response. Contributing a fair share to the kamagra effervescent tablets uk global effort means that reduction commitments must account for the cumulative, historical contribution each country has made to emissions, as well as its current emissions and capacity to respond.

Wealthier countries will have to cut emissions more quickly, making reductions by 2030 beyond those currently proposed20 21 and reaching net-zero emissions before 2050. Similar targets and emergency action are needed for biodiversity loss and the kamagra effervescent tablets uk wider destruction of the natural world.To achieve these targets, governments must make fundamental changes to how our societies and economies are organised and how we live. The current strategy of encouraging markets to kamagra effervescent tablets uk swap dirty for cleaner technologies is not enough. Governments must intervene to support the redesign of transport systems, cities, production and distribution of food, kamagra canada wholesale markets for financial investments, health systems, and much more. Global coordination is needed to ensure that kamagra effervescent tablets uk the rush for cleaner technologies does not come at the cost of more environmental destruction and human exploitation.Many governments met the threat of the erectile dysfunction treatment kamagra with unprecedented funding.

The environmental crisis demands a similar kamagra effervescent tablets uk emergency response. Huge investment will be needed, beyond what is being considered or delivered anywhere in the world. But such investments will produce huge positive health kamagra effervescent tablets uk and economic outcomes. These include high-quality jobs, reduced air pollution, increased physical activity, and improved housing and diet. Better air quality alone would realise health benefits that easily offset the global costs of emissions reductions.22These measures will also improve the social and economic determinants of health, the poor state of which may have made populations more vulnerable to the erectile dysfunction treatment kamagra.23 But the changes cannot be achieved through a return to damaging austerity policies or the continuation of the large inequalities of wealth and power within and between countries.Cooperation hinges on wealthy nations doing moreIn particular, countries that have disproportionately kamagra effervescent tablets uk created the environmental crisis must do more to support low-income and middle-income countries to build cleaner, healthier and more resilient societies.

High-income countries must meet and go beyond their outstanding commitment to provide $100 billion a year, making kamagra effervescent tablets uk up for any shortfall in 2020 and increasing contributions to and beyond 2025. Funding must be equally split between mitigation and adaptation, including improving the resilience of health systems.Financing should be through grants rather than loans, building local capabilities and truly empowering communities, and should come alongside forgiving large debts, which constrain the agency of so many low-income countries. Additional funding must be marshalled to compensate for inevitable loss and damage caused by the consequences of the environmental crisis.As health professionals, we must do all we can to aid the transition to a kamagra effervescent tablets uk sustainable, fairer, resilient and healthier world. Alongside acting to reduce the harm from the environmental crisis, we should proactively contribute to global prevention of further damage and action on the root causes of the crisis. We must hold global leaders to account and continue to educate others about the health risks of kamagra effervescent tablets uk the crisis.

We must join in the work to achieve environmentally sustainable health systems before 2040, recognising that this will kamagra effervescent tablets uk mean changing clinical practice. Health institutions have already divested more than $42 billion of assets from fossil fuels. Others should join them.4The greatest threat to global public health is kamagra effervescent tablets uk the continued failure of world leaders to keep the global temperature rise below 1.5°C and to restore nature. Urgent, society-wide kamagra effervescent tablets uk changes must be made and will lead to a fairer and healthier world. We, as editors of health journals, call for governments and other leaders to act, marking 2021 as the year that the world finally changes course.Ethics statementsPatient consent for publicationNot required.AbstractPhenome-wide association study (PheWAS) has been increasingly used to identify novel genetic associations across a wide spectrum of phenotypes.

This systematic review aims to summarise the PheWAS methodology, discuss the advantages kamagra effervescent tablets uk and challenges of PheWAS, and provide potential implications for future PheWAS studies. Medical Literature Analysis and Retrieval System Online (MEDLINE) and Excerpta Medica Database (EMBASE) databases were searched to identify all published PheWAS studies up until 24 April 2021. The PheWAS methodology incorporating how to perform PheWAS analysis and kamagra effervescent tablets uk which software/tool could be used, were summarised based on the extracted information. A total of 1035 studies were identified and 195 eligible articles were finally included kamagra effervescent tablets uk. Among them, 137 (77.0%) contained 10 000 or more study participants, 164 (92.1%) defined the phenome based on electronic medical records data, 140 (78.7%) used genetic variants as predictors, and 73 (41.0%) conducted replication analysis to validate PheWAS findings and almost all of them (94.5%) received consistent results.

The methodology applied in these PheWAS studies was dissected into several critical steps, kamagra effervescent tablets uk including quality control of the phenome, selecting predictors, phenotyping, statistical analysis, interpretation and visualisation of PheWAS results, and the workflow for performing a PheWAS was established with detailed instructions on each step. This study provides a comprehensive overview of PheWAS methodology to help practitioners achieve a better understanding of the PheWAS design, to detect understudied or overstudied outcomes, and to direct their research by applying the most appropriate software and online tools for their study data structure.genetic association studiesmolecular epidemiologypublic health.

Wealthy nations must do much more, much faster.The United cheap kamagra supplier Nations General Assembly in September 2021 will bring countries together at a critical time for get kamagra prescription marshalling collective action to tackle the global environmental crisis. They will meet again at the biodiversity summit in get kamagra prescription Kunming, China, and the climate conference (Conference of the Parties (COP)26) in Glasgow, UK. Ahead of these pivotal meetings, we—the editors of health journals worldwide—call for urgent action to keep average global temperature increases below 1.5°C, halt the destruction of nature and protect health.Health is already being harmed by global temperature increases and the destruction of the natural world, a state of affairs health professionals have been bringing attention to for decades.1 The science is unequivocal. A global increase get kamagra prescription of 1.5°C above the preindustrial average and the continued loss of biodiversity risk catastrophic harm to health that will be impossible to reverse.2 3 Despite the world’s necessary preoccupation with erectile dysfunction treatment, we cannot wait for the kamagra to pass to rapidly reduce emissions.Reflecting the severity of the moment, this editorial appears in health journals across the world.

We are united in recognising that only fundamental and equitable changes to societies will reverse our current trajectory.The risks to health of increases above 1.5°C are now get kamagra prescription well established.2 Indeed, no temperature rise is ‘safe’. In the past 20 years, heat-related mortality among people aged over 65 has increased by more than 50%.4 Higher temperatures have brought increased dehydration and renal function loss, dermatological malignancies, tropical s, adverse mental health outcomes, pregnancy complications, allergies, and cardiovascular and pulmonary morbidity and mortality.5 6 Harms disproportionately affect the most vulnerable, including children, older populations, ethnic minorities, poorer communities and those with underlying health problems.2 4Global heating is also contributing to the decline in global yield potential for major crops, falling by 1.8%–5.6% since 1981. This, together with the effects of extreme weather and soil depletion, is hampering efforts to reduce undernutrition.4 Thriving ecosystems are essential to get kamagra prescription human health, and the widespread destruction of nature, including habitats and species, is eroding water and food security and increasing the chance of kamagras.3 7 8The consequences of the environmental crisis fall disproportionately on those countries and communities that have contributed least to the problem and are least able to mitigate the harms. Yet no country, no matter how wealthy, can shield itself from these impacts.

Allowing the consequences to fall disproportionately on the most vulnerable will breed more conflict, food insecurity, forced displacement and zoonotic disease, with severe implications for all countries get kamagra prescription and communities. As with the erectile dysfunction treatment kamagra, we are globally as strong as our weakest member.Rises above 1.5°C increase get kamagra prescription the chance of reaching tipping points in natural systems that could lock the world into an acutely unstable state. This would critically impair our ability to mitigate harms and to prevent catastrophic, runaway environmental change.9 10Global targets are not enoughEncouragingly, many governments, financial institutions and businesses are setting targets to reach net-zero emissions, including targets for 2030. The cost get kamagra prescription of renewable energy is dropping rapidly.

Many countries are aiming to protect at least 30% of the world’s land get kamagra prescription and oceans by 2030.11These promises are not enough. Targets are easy to set and hard to achieve. They are yet to be matched with credible short-term and longer-term plans to accelerate cleaner technologies and get kamagra prescription transform societies. Emissions reduction plans do not adequately incorporate health considerations.12 Concern is growing that temperature rises above 1.5°C are beginning to be seen as inevitable, or even acceptable, to powerful members of the global community.13 Relatedly, current strategies for reducing emissions to net zero by the middle of the century implausibly assume that the world will acquire great capabilities to remove greenhouse gases from the atmosphere.14 15This insufficient action means that temperature increases are likely to be well in excess of 2°C,16 a catastrophic outcome for health and environmental stability.

Critically, the destruction of nature does not have parity of esteem with the climate element of the crisis, and every single global target to restore biodiversity loss by 2020 was missed.17 This is an overall environmental crisis.18Health professionals are get kamagra prescription united with environmental scientists, businesses and many others in rejecting that this outcome is inevitable. More can and must be done now—in Glasgow and Kunming—and in the immediate years get kamagra prescription that follow. We join health professionals worldwide who have already supported calls for rapid action.1 19Equity must be at the centre of the global response. Contributing a fair share to the global effort means that reduction commitments must account for the cumulative, historical contribution each country has made to emissions, as well get kamagra prescription as its current emissions and capacity to respond.

Wealthier countries will have to cut emissions more quickly, making reductions by 2030 beyond those currently proposed20 21 and reaching net-zero emissions before 2050. Similar targets and emergency action are needed for biodiversity get kamagra prescription loss and the wider destruction of the natural world.To achieve these targets, governments must make fundamental changes to how our societies and economies are organised and how we live. The current strategy of encouraging markets to get kamagra prescription swap dirty for cleaner technologies is not enough. Governments must intervene to support the redesign of transport systems, cities, production and distribution of food, markets for financial investments, health systems, and http://thieroutdoors.com/great-washington-hikes/ much more.

Global coordination is needed to ensure that the rush for cleaner technologies does not come at the cost of more environmental destruction and human exploitation.Many governments met get kamagra prescription the threat of the erectile dysfunction treatment kamagra with unprecedented funding. The environmental crisis demands a similar emergency response get kamagra prescription. Huge investment will be needed, beyond what is being considered or delivered anywhere in the world. But such get kamagra prescription investments will produce huge positive health and economic outcomes.

These include high-quality jobs, reduced air pollution, increased physical activity, and improved housing and diet. Better air quality alone would realise health benefits that easily offset the global costs of emissions reductions.22These measures will also improve the social and economic determinants of health, the poor state get kamagra prescription of which may have made populations more vulnerable to the erectile dysfunction treatment kamagra.23 But the changes cannot be achieved through a return to damaging austerity policies or the continuation of the large inequalities of wealth and power within and between countries.Cooperation hinges on wealthy nations doing moreIn particular, countries that have disproportionately created the environmental crisis must do more to support low-income and middle-income countries to build cleaner, healthier and more resilient societies. High-income countries must meet and go beyond their outstanding commitment to provide get kamagra prescription $100 billion a year, making up for any shortfall in 2020 and increasing contributions to and beyond 2025. Funding must be equally split between mitigation and adaptation, including improving the resilience of health systems.Financing should be through grants rather than loans, building local capabilities and truly empowering communities, and should come alongside forgiving large debts, which constrain the agency of so many low-income countries.

Additional funding must be marshalled to compensate for inevitable loss and damage caused by the consequences of the environmental crisis.As health professionals, we must do all we get kamagra prescription can to aid the transition to a sustainable, fairer, resilient and healthier world. Alongside acting to reduce the harm from the environmental crisis, we should proactively contribute to global prevention of further damage and action on the root causes of the crisis. We must get kamagra prescription hold global leaders to account and continue to educate others about the health risks of the crisis. We must join in the work to achieve environmentally sustainable health systems before 2040, recognising that this get kamagra prescription will mean changing clinical practice.

Health institutions have already divested more than $42 billion of assets from fossil fuels. Others should join them.4The greatest threat to global public health is the continued failure of world leaders to get kamagra prescription keep the global temperature rise below 1.5°C and to restore nature. Urgent, society-wide changes must get kamagra prescription be made and will lead to a fairer and healthier world. We, as editors of health journals, call for governments and other leaders to act, marking 2021 as the year that the world finally changes course.Ethics statementsPatient consent for publicationNot required.AbstractPhenome-wide association study (PheWAS) has been increasingly used to identify novel genetic associations across a wide spectrum of phenotypes.

This systematic review aims to summarise the PheWAS methodology, discuss the advantages and challenges of PheWAS, and provide potential implications get kamagra prescription for future PheWAS studies. Medical Literature Analysis and Retrieval System Online (MEDLINE) and Excerpta Medica Database (EMBASE) databases were searched to identify all published PheWAS studies up until 24 April 2021. The PheWAS methodology incorporating how to perform PheWAS analysis and which get kamagra prescription software/tool could be used, were summarised based on the extracted information. A total of 1035 studies were identified and 195 get kamagra prescription eligible articles were finally included.

Among them, 137 (77.0%) contained 10 000 or more study participants, 164 (92.1%) defined the phenome based on electronic medical records data, 140 (78.7%) used genetic variants as predictors, and 73 (41.0%) conducted replication analysis to validate PheWAS findings and almost all of them (94.5%) received consistent results. The methodology applied in these PheWAS studies was dissected into several critical steps, including quality control of the phenome, selecting predictors, phenotyping, statistical analysis, interpretation and get kamagra prescription visualisation of PheWAS results, and the workflow for performing a PheWAS was established with detailed instructions on each step. This study provides a comprehensive overview of PheWAS methodology to help practitioners achieve a better understanding of the PheWAS design, to detect understudied or overstudied outcomes, and to direct their research by applying the most appropriate software and online tools for their study data structure.genetic association studiesmolecular epidemiologypublic health.

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How shall see here now we decide for others who cannot (currently) decide what is kamagra 100mg oral jelly used for for themselves?. And who—or what, in the case of artificial intelligence—should make the decision?. The present issue of the journal tackles several interrelated topics, many of them having to do with surrogate decision making. For example, the feature article by Jardas et al1 explores the potential use what is kamagra 100mg oral jelly used for of artificial intelligence (AI) to predict incapacitated patients’ likely treatment preferences based on their sociodemographic characteristics, raising questions about the means by which we come to decide for others. And a clinical ethics round table led by Wilkinson and Pillay2 examines the case of a premature baby on life support whose primary surrogate is herself incapacitated.

Together, these examples force us to think more deeply about the meaning and significance of taken-for-granted concepts. Respect for what is kamagra 100mg oral jelly used for autonomy, substituted judgement, best interests. We’ll consider the baby first and then turn to AI.“Baby T” is a critically ill newborn delivered prematurely by emergency caesarean section. The mother had entered into a surrogacy arrangement with a same-sex male couple, the intended parents, who were to take over the baby’s care after birth—just as soon as a formal parental order could be obtained through the court. Until then, the birth mother, who had used her own eggs to conceive Baby T along with sperm from an unidentified donor, would have legal and ethical responsibility to decide about the baby’s care (also the right to what is kamagra 100mg oral jelly used for keep Baby T if she chose).

Unfortunately, she too was in critical condition, having fallen unconscious prior to delivery due to a sudden brain haemorrhage. She remained unconscious, and thus incapacitated, during a crucial period in which time-sensitive decisions about Baby T’s care needed to be made, including whether to continue life support.Given the mother’s incapacity, who should determine Baby T’s care?. According to the analyses of Pillay et al3 and what is kamagra 100mg oral jelly used for Jackson et al,4 the intended parents, although clearly both ethically and emotionally invested in these decisions, would not at that point have the legal authority to make them. Instead, the spouse or civil partner of the birth mother would be the legal second parent (unless they had not consented to the surrogacy arrangement) until parenthood could be officially transferred to the intended parents through a court order or adoption. No second parent is mentioned in this case, and there isn’t time to transfer parenting rights to the intended parents before key decisions need to be made.

Although the commentators agreed that the couple should not be marginalised, but rather substantially included in discussions about Baby T’s care,5 the legal position seems to be that, in such a scenario, it is Baby T’s doctors who would have the final say.There is an interesting question here about the what is kamagra 100mg oral jelly used for standard that should guide the doctors’ decision making. In his commentary, Dominic Wilkinson6 asks us to suppose that Baby T’s prognosis is neither so poor that that treatment must cease, nor so good that it must continue. The decision, then, might be said to fall within what is sometimes called the “zone of parental discretion”7 (for a critique, see8). According to this view, if the what is kamagra 100mg oral jelly used for mother had had the capacity to decide, the medical team would have been obligated to follow her instructions (assuming she was adequately informed, and so on) regardless of whether they themselves agreed that the decision was in Baby T’s best interests. Given that the mother did not have the capacity to decide, however, what should the doctors do?.

Let us add a few more stipulations. Suppose the mother is unlikely what is kamagra 100mg oral jelly used for to regain capacity any time soon, and the treatment required to keep Baby T alive is painful and invasive. Treating Baby T indefinitely while waiting for the mother to recover therefore isn’t the obvious answer. Even the intended parents are split on what to do. The doctors need to decide whether to continue a painful treatment despite an unclear prognosis or what is kamagra 100mg oral jelly used for withdraw treatment out of compassion for the baby’s suffering.

Should they (1) try to infer what the mother would have decided—based on her values, wishes, cultural commitments, or religious beliefs, for instance—and make a substituted judgment on her behalf, or (2) simply do, directly, whatever they believe is in Baby T’s best interests, whether or not they think it is what the mother herself would have decided?. The answer depends, in part, on how we conceive of the ethical basis for parental “proxy” decision making. There are two main schools of thought, one that what is kamagra 100mg oral jelly used for is arguably more child-centred and one that is arguably more parent-centred, but we can start with common ground. First, it widely acknowledged that most parents love their children, deeply, and truly want what is best for them (that is, they have a maximally strong motive of beneficence toward their children). Moreover, parents usually are better positioned to know what is best for their children than just about anyone else (that is, they have special epistemic access to what is, in fact, in their child’s best interest).

So, for any decision that needs to be made about a child’s treatment in a medical context, if the child is insufficiently autonomous to make what is kamagra 100mg oral jelly used for their own decision, the parents should—barring exceptional circumstances—decide on their behalf.There are two different ways of glossing this conclusion, however. The child-centred way suggests that, ultimately, the right thing to do is simply whatever is in the child’s best interests (the best interests standard),9 whereas, deferring to parental judgement just happens to be the most reliable general decision procedure for figuring out what that is (given motive of beneficence and special epistemic access). So, the parents should be deferred to.The parent-centred way adds a premise. Parents, on this what is kamagra 100mg oral jelly used for view, have a fundamental right to make decisions about their children’s upbringing, including their healthcare, in the context of wider family life and communal considerations. It is therefore wrong to interfere with, or override, their parenting decisions—even if those decisions are not necessarily in the child’s best interests—unless the child is put at a significant risk of serious harm (the so-called harm principle).10 However, this view continues, given motive of beneficence, most parents do not want to harm their children, so there is no compelling reason to challenge this basic picture on grounds of children’s welfare or rights.The first, “best interests of the child” gloss is basically consequentialist, although tethered to the welfare interests of a focal individual.

The child-patient. It says what is kamagra 100mg oral jelly used for. Whoever has the authority to decide about a child’s treatment should weigh up the child-relative goods and bads of each feasible option, and choose the option that is all things-considered best for the child (or at least among the “good enough” options), given the child’s particular welfare interests.In the case of Baby T, the child’s parent—the one who would usually have the authority to decide—is incapacitated. However, plausibly, she would not know any more about the child’s specific welfare interests (vis-à-vis treatment options) than would Baby T’s doctors, given that Baby T is a newborn who hasn’t yet developed unique personal needs. Since the “defer to the parent” decision procedure is not available in this case, and the parent plausibly would not have special epistemic access anyway, the doctors should, according to what is kamagra 100mg oral jelly used for this analysis, simply make their own informed judgement about what is best for Baby T.The second, “parental rights” approach, by contrast, is more about respecting autonomy—parental autonomy.

According to this perspective, parents’ decisions are to be respected as such, irrespective of the likely consequences for child, unless the child is put at a significant risk of serious harm. In the case of Baby T, it has been stipulated that the decision to continue, or not to continue, life support are both within the zone of parental discretion. So, the correct thing to do, on this analysis, is to try to infer what Baby T’s mother would have chosen—for example, based on her cultural values or religious beliefs—and make a substituted judgement on her behalf.1Suppose that the hospital where Baby T is being treated what is kamagra 100mg oral jelly used for has adopted a policy in line with the second approach. When a baby’s mother is incapacitated and there is no second parent to decide—leaving time-sensitive, life or death decisions to the clinicians—they should not simply do what they think is in the best interests of the baby. Rather, they should try to infer what the mother would decide (irrespective of the child’s interests, but within the zone of parental discretion) and act accordingly.However, suppose the clinicians don’t know much about what Baby T’s mother, in particular, would decide—they only have some general information about her demographic background.

They know her age, gender, racial or ethnic categorization, city what is kamagra 100mg oral jelly used for of residence, and perhaps the type of church she attends. There isn’t enough time to try to bring in friends or family for special interviews. They need to make a substituted judgement as quickly as they can.Perhaps they can fire up the Patient Preference Predictor (PPP)?. In their feature what is kamagra 100mg oral jelly used for article,1 E.J. Jardas, David Wasserman, and David Wendler describe a proposed computer-based algorithm that would use machine learning (a type of artificial intelligence) to predict an incapacitated patient’s treatment preferences based solely on their sociodemographic characteristics.

Applied to the Baby T case, the preferences to be predicted would be slightly different. Not those of an incapacitated patient regarding her own treatment, but rather, her preferences regarding what is kamagra 100mg oral jelly used for the treatment of her non-competent child (a kind of meta-surrogate decision making). But let’s simplify, going forward, and think about predicting only self-directed treatment preferences.By drawing on existing correlations between past patients’ treatment preferences and their sociodemographic characteristics, the PPP could, hypothetically, make predictions about current patients’ preferences that were more accurate than the guesses of their real-life human surrogates. In fact, existing data suggest that a preliminary PPP prototype is already about as accurate as human surrogates,12 so this is not an unreasonable hypothesis. Suppose it what is kamagra 100mg oral jelly used for comes to pass.

Now, a patient is incapacitated, there is no advance directive, there isn’t time to reach out to family and friends. The doctors must decide about treatment.Ordinarily, if they knew nothing in particular about a patient’s preferences under such conditions, doctors would resort to a “best interests” standard and act accordingly. At first, this might seem quite different from the substituted judgement standard that is supposed to apply what is kamagra 100mg oral jelly used for to once-competent patients who are currently incapacitated. According to that standard, the way to show respect someone who was previously autonomous, but who is now unable to make a treatment decision on their own behalf, is not to ask, “What do I or anyone else think is best for them?. € but rather, “What would they decide for themselves in this situation?.

€However, if “they” are essentially a black box, the best interests standard and what is kamagra 100mg oral jelly used for the substituted judgement standard arguably amount to the same thing. It’s like asking, “What would someone with no idiosyncratic preferences or desires—a fully informed, abstract, rational, self-interested person with no individuating features—choose for themselves if they were in this situation?. € The answer is. €œWhatever is in their best interests.”But the prospect of a PPP what is kamagra 100mg oral jelly used for changes things. It invites us to fill in the “black box” and return to a more fully-fledged substituted judgement standard.

By plugging in whatever limited information we have about the patient—their age, race, gender, and so on—we can make an empirical prediction about what the patient would, if autonomous, have in fact decided for themselves, over and above a rational “best interests” abstraction. And the prediction would be based on previously established correlations between those very same demographic what is kamagra 100mg oral jelly used for variables and actual past patient preferences regarding treatment under similar conditions.We are supposing that there isn’t time to consult the patient’s family or friends to find out more particular information. The doctors can either resort to a bland “best interests” test, or they can plug the patient’s demographic information into PPP, which we are stipulating is known to be better, on average, at accurately predicting patient preferences than human surrogates. Should the doctors use the PPP?. Jardas et al consider a number of objections, according what is kamagra 100mg oral jelly used for to which the PPP should not be used.

One of them holds that, although there may be population-level statistical correlations between certain demographic features and associated treatment preferences, this is misleading at the individual level (that is, the level at which PPP-inspired treatment decision would actually be made). After all, one’s group-level demographic features are not themselves the cause of one’s individual-level preferences.13True enough, say Jardas et al. However, the PPP does not assume that group-level demographic factors cause what is kamagra 100mg oral jelly used for individual-level preferences. It simply harnesses those group-level factors to make an empirical prediction about one’s likely treatment preferences, above chance. Given that the alternative would be to make a nondescript “best interests” decision—one that is no more likely to be what you, in particular, would make than what any other random (rational, fully-informed, self-interested, etc.) person would make—isn’t the PPP more respectful of your autonomy?.

Another objection resists this move.14 It holds that respecting someone’s autonomy “is not simply a matter of treating them the ways they prefer to be what is kamagra 100mg oral jelly used for treated. It is also important to make decisions for the right reasons, reasons the patient would endorse”.1 In response, Jardas et al suggest that there may be a trade-off, in certain cases, between respecting someone’s autonomy in the sense of how they actually want their life to go (based, in turn, on on how they are treated) and honouring their assumed wishes for having surrogate decisions made for them according to a specific decision-making process (eg, only based on reasons they would endorse). However, if failing to honour their assumed wishes regarding a specific decision-making process nevertheless significantly improved one’s ability to respect their autonomy in the first sense, it may be that one has done more to respect their autonomy overall.The student essay and Editor's choice by Sara Kate Heide15 also explores surrogate decision-making for those with diminished autonomy, including older persons with dementia. It is a beautifully written personal what is kamagra 100mg oral jelly used for reflection and qualitative exploration of how seniors conceive of quality of life. In her experience working in care homes, she finds, it is often not so much about pursuing what is in their “medical best interests” that matters to seniors, but rather respecting their own sense of autonomy by helping them to maintain their lifelong sense of personal identity.

In another essay, Mike King and Hazem Zohny deal with use of non-human animals in research.16 These animals do not have decision-making autonomy in the sense that humans do, and might therefore be thought to require “paternalistic” treatment according to what is in their best interests. However, that what is kamagra 100mg oral jelly used for is not the standard that is applied to non-human animals. Rather, they are used instrumentally, as in lab research, and then euthanized. King and Zohny argue that, however bad this treatment is for the animals, it is also psychologically distressing to the human scientists who are charged with doing the experimentation and killing. They suggest what is kamagra 100mg oral jelly used for that animal ethics committees ought to take steps to help reduce this “psychological burden” in humans.Finally, a number of essays add to a welcome shift in focus for medical ethics, toward broader socio-structural and historical issues.

Christina Richie17 argues that pharmaceutical companies have an obligation to reduce their carbon footprint, for the sake of the environment. Pugh et al18 analyse trade-offs in the use of “inaccurate” erectile dysfunction treatment tests for effective public health policy at a national level. Milne et al19 map out a model for participatory governance in handling of massive amounts what is kamagra 100mg oral jelly used for of data in the context of large-scale biobanks. Pierre et al20 share the results of their study on physician attitudes and behaviours toward incarcerated patients. And Yeo-Teh and Tang21 address researchers’ obligations to the public in conducting studies on stem-cell based therapies for autism spectrum disorder, given the ways that even poor quality research in this area is likely to be taken up by parents and other laypeople hoping for a “cure.” It is heartening to see the Journal of Medical Ethics continue to publish essays ranging from the detailed analysis of a specific clinical case study (like Baby T) to philosophical discussions of key concepts, like autonomy, in the context of cutting-edge technological innovations (the PPP), to appraisals of systemic issues in society.22Ethics statementsPatient consent for publicationNot applicable.Ethics approvalNot applicable.AbstractCare of the critically ill newborn includes support for the birth mother/parents with regular updates around the clinical condition of the baby, and involvement in discussions around complex decision-making issues.

Discussions around continuation or discontinuation of life-sustaining are challenging even in the most straightforward of cases, but what happens when the birth mother is critically unwell?. Such cases can lead to uncertainty around who should assume the parental role for these difficult discussions. In this round table discussion, we explore the ethical, moral and legal uncertainties raised by coincident severe maternal and neonatal illness in the context of surrogacy.decision-makingclinical ethicsneonatologyreproductive medicineData availability statementThere are no data in this work..

How shall we decide for others get kamagra prescription who cannot http://cz.keimfarben.de/how-to-get-amoxil-without-prescription (currently) decide for themselves?. And who—or what, in the case of artificial intelligence—should make the decision?. The present issue of the journal tackles several interrelated topics, many of them having to do with surrogate decision making. For example, the feature article by get kamagra prescription Jardas et al1 explores the potential use of artificial intelligence (AI) to predict incapacitated patients’ likely treatment preferences based on their sociodemographic characteristics, raising questions about the means by which we come to decide for others.

And a clinical ethics round table led by Wilkinson and Pillay2 examines the case of a premature baby on life support whose primary surrogate is herself incapacitated. Together, these examples force us to think more deeply about the meaning and significance of taken-for-granted concepts. Respect for autonomy, substituted judgement, best get kamagra prescription interests. We’ll consider the baby first and then turn to AI.“Baby T” is a critically ill newborn delivered prematurely by emergency caesarean section.

The mother had entered into a surrogacy arrangement with a same-sex male couple, the intended parents, who were to take over the baby’s care after birth—just as soon as a formal parental order could be obtained through the court. Until then, get kamagra prescription the birth mother, who had used her own eggs to conceive Baby T along with sperm from an unidentified donor, would have legal and ethical responsibility to decide about the baby’s care (also the right to keep Baby T if she chose). Unfortunately, she too was in critical condition, having fallen unconscious prior to delivery due to a sudden brain haemorrhage. She remained unconscious, and thus incapacitated, during a crucial period in which time-sensitive decisions about Baby T’s care needed to be made, including whether to continue life support.Given the mother’s incapacity, who should determine Baby T’s care?.

According to the analyses of Pillay et al3 and Jackson et al,4 get kamagra prescription the intended parents, although clearly both ethically and emotionally invested in these decisions, would not at that point have the legal authority to make them. Instead, the spouse or civil partner of the birth mother would be the legal second parent (unless they had not consented to the surrogacy arrangement) until parenthood could be officially transferred to the intended parents through a court order or adoption. No second parent is mentioned in this case, and there isn’t time to transfer parenting rights to the intended parents before key decisions need to be made. Although the commentators get kamagra prescription agreed that the couple should not be marginalised, but rather substantially included in discussions about Baby T’s care,5 the legal position seems to be that, in such a scenario, it is Baby T’s doctors who would have the final say.There is an interesting question here about the standard that should guide the doctors’ decision making.

In his commentary, Dominic Wilkinson6 asks us to suppose that Baby T’s prognosis is neither so poor that that treatment must cease, nor so good that it must continue. The decision, then, might be said to fall within what is sometimes called the “zone of parental discretion”7 (for a critique, see8). According to get kamagra prescription this view, if the mother had had the capacity to decide, the medical team would have been obligated to follow her instructions (assuming she was adequately informed, and so on) regardless of whether they themselves agreed that the decision was in Baby T’s best interests. Given that the mother did not have the capacity to decide, however, what should the doctors do?.

Let us add a few more stipulations. Suppose the mother is unlikely to regain capacity any time soon, and the treatment required to keep get kamagra prescription Baby T alive is painful and invasive. Treating Baby T indefinitely while waiting for the mother to recover therefore isn’t the obvious answer. Even the intended parents are split on what to do.

The doctors need to decide whether to continue a painful treatment despite an unclear prognosis or withdraw treatment out of get kamagra prescription compassion for the baby’s suffering. Should they (1) try to infer what the mother would have decided—based on her values, wishes, cultural commitments, or religious beliefs, for instance—and make a substituted judgment on her behalf, or (2) simply do, directly, whatever they believe is in Baby T’s best interests, whether or not they think it is what the mother herself would have decided?. The answer depends, in part, on how we conceive of the ethical basis for parental “proxy” decision making. There are two main schools of thought, one get kamagra prescription that is arguably more child-centred and one that is arguably more parent-centred, but we can start with common ground.

First, it widely acknowledged that most parents love their children, deeply, and truly want what is best for them (that is, they have a maximally strong motive of beneficence toward their children). Moreover, parents usually are better positioned to know what is best for their children than just about anyone else (that is, they have special epistemic access to what is, in fact, in their child’s best interest). So, for any decision that needs to be made about a child’s treatment in a medical context, if the child is insufficiently autonomous to make their own decision, the parents should—barring exceptional circumstances—decide on their behalf.There are two different get kamagra prescription ways of glossing this conclusion, however. The child-centred way suggests that, ultimately, the right thing to do is simply whatever is in the child’s best interests (the best interests standard),9 whereas, deferring to parental judgement just happens to be the most reliable general decision procedure for figuring out what that is (given motive of beneficence and special epistemic access).

So, the parents should be deferred to.The parent-centred way adds a premise. Parents, on this view, have a fundamental right to make decisions about their children’s upbringing, including their healthcare, in the context get kamagra prescription of wider family life and communal considerations. It is therefore wrong to interfere with, or override, their parenting decisions—even if those decisions are not necessarily in the child’s best interests—unless the child is put at a significant risk of serious harm (the so-called harm principle).10 However, this view continues, given motive of beneficence, most parents do not want to harm their children, so there is no compelling reason to challenge this basic picture on grounds of children’s welfare or rights.The first, “best interests of the child” gloss is basically consequentialist, although tethered to the welfare interests of a focal individual. The child-patient.

It says get kamagra prescription. Whoever has the authority to decide about a child’s treatment should weigh up the child-relative goods and bads of each feasible option, and choose the option that is all things-considered best for the child (or at least among the “good enough” options), given the child’s particular welfare interests.In the case of Baby T, the child’s parent—the one who would usually have the authority to decide—is incapacitated. However, plausibly, she would not know any more about the child’s specific welfare interests (vis-à-vis treatment options) than would Baby T’s doctors, given that Baby T is a newborn who hasn’t yet developed unique personal needs. Since the “defer to the parent” decision procedure is not available in this case, and the parent plausibly would not have special epistemic access anyway, the doctors should, according to this analysis, simply make their own get kamagra prescription informed judgement about what is best for Baby T.The second, “parental rights” approach, by contrast, is more about respecting autonomy—parental autonomy.

According to this perspective, parents’ decisions are to be respected as such, irrespective of the likely consequences for child, unless the child is put at a significant risk of serious harm. In the case of Baby T, it has been stipulated that the decision to continue, or not to continue, life support are both within the zone of parental discretion. So, the correct thing to do, on this analysis, is to try to infer what Baby T’s mother would get kamagra prescription have chosen—for example, based on her cultural values or religious beliefs—and make a substituted judgement on her behalf.1Suppose that the hospital where Baby T is being treated has adopted a policy in line with the second approach. When a baby’s mother is incapacitated and there is no second parent to decide—leaving time-sensitive, life or death decisions to the clinicians—they should not simply do what they think is in the best interests of the baby.

Rather, they should try to infer what the mother would decide (irrespective of the child’s interests, but within the zone of parental discretion) and act accordingly.However, suppose the clinicians don’t know much about what Baby T’s mother, in particular, would decide—they only have some general information about her demographic background. They know her age, get kamagra prescription gender, racial or ethnic categorization, city of residence, and perhaps the type of church she attends. There isn’t enough time to try to bring in friends or family for special interviews. They need to make a substituted judgement as quickly as they can.Perhaps they can fire up the Patient Preference Predictor (PPP)?.

In their feature article,1 E.J get kamagra prescription. Jardas, David Wasserman, and David Wendler describe a proposed computer-based algorithm that would use machine learning (a type of artificial intelligence) to predict an incapacitated patient’s treatment preferences based solely on their sociodemographic characteristics. Applied to the Baby T case, the preferences to be predicted would be slightly different. Not those of an incapacitated patient regarding her own treatment, but rather, her preferences regarding the treatment of her non-competent child (a kind of meta-surrogate decision making) get kamagra prescription.

But let’s simplify, going forward, and think about predicting only self-directed treatment preferences.By drawing on existing correlations between past patients’ treatment preferences and their sociodemographic characteristics, the PPP could, hypothetically, make predictions about current patients’ preferences that were more accurate than the guesses of their real-life human surrogates. In fact, existing data suggest that a preliminary PPP prototype is already about as accurate as human surrogates,12 so this is not an unreasonable hypothesis. Suppose it comes get kamagra prescription to pass. Now, a patient is incapacitated, there is no advance directive, there isn’t time to reach out to family and friends.

The doctors must decide about treatment.Ordinarily, if they knew nothing in particular about a patient’s preferences under such conditions, doctors would resort to a “best interests” standard and act accordingly. At first, this might seem quite different from the substituted judgement standard that is supposed to apply to get kamagra prescription once-competent patients who are currently incapacitated. According to that standard, the way to show respect someone who was previously autonomous, but who is now unable to make a treatment decision on their own behalf, is not to ask, “What do I or anyone else think is best for them?. € but rather, “What would they decide for themselves in this situation?.

€However, if “they” are get kamagra prescription essentially a black box, the best interests standard and the substituted judgement standard arguably amount to the same thing. It’s like asking, “What would someone with no idiosyncratic preferences or desires—a fully informed, abstract, rational, self-interested person with no individuating features—choose for themselves if they were in this situation?. € The answer is. €œWhatever is in their best interests.”But the prospect of a PPP changes get kamagra prescription things.

It invites us to fill in the “black box” and return to a more fully-fledged substituted judgement standard. By plugging in whatever limited information we have about the patient—their age, race, gender, and so on—we can make an empirical prediction about what the patient would, if autonomous, have in fact decided for themselves, over and above a rational “best interests” abstraction. And the prediction would be based on previously established correlations between those very same demographic variables and actual past patient preferences regarding treatment under similar conditions.We are supposing that there isn’t time to consult the patient’s family or friends get kamagra prescription to find out more particular information. The doctors can either resort to a bland “best interests” test, or they can plug the patient’s demographic information into PPP, which we are stipulating is known to be better, on average, at accurately predicting patient preferences than human surrogates.

Should the doctors use the PPP?. Jardas et al consider a number of objections, according to get kamagra prescription which the PPP should not be used. One of them holds that, although there may be population-level statistical correlations between certain demographic features and associated treatment preferences, this is misleading at the individual level (that is, the level at which PPP-inspired treatment decision would actually be made). After all, one’s group-level demographic features are not themselves the cause of one’s individual-level preferences.13True enough, say Jardas et al.

However, the get kamagra prescription PPP does not assume that group-level demographic factors cause individual-level preferences. It simply harnesses those group-level factors to make an empirical prediction about one’s likely treatment preferences, above chance. Given that the alternative would be to make a nondescript “best interests” decision—one that is no more likely to be what you, in particular, would make than what any other random (rational, fully-informed, self-interested, etc.) person would make—isn’t the PPP more respectful of your autonomy?. Another objection resists this move.14 It holds that respecting someone’s autonomy “is not simply a matter get kamagra prescription of treating them the ways they prefer to be treated.

It is also important to make decisions for the right reasons, reasons the patient would endorse”.1 In response, Jardas et al suggest that there may be a trade-off, in certain cases, between respecting someone’s autonomy in the sense of how they actually want their life to go (based, in turn, on on how they are treated) and honouring their assumed wishes for having surrogate decisions made for them according to a specific decision-making process (eg, only based on reasons they would endorse). However, if failing to honour their assumed wishes regarding a specific decision-making process nevertheless significantly improved one’s ability to respect their autonomy in the first sense, it may be that one has done more to respect their autonomy overall.The student essay and Editor's choice by Sara Kate Heide15 also explores surrogate decision-making for those with diminished autonomy, including older persons with dementia. It is get kamagra prescription a beautifully written personal reflection and qualitative exploration of how seniors conceive of quality of life. In her experience working in care homes, she finds, it is often not so much about pursuing what is in their “medical best interests” that matters to seniors, but rather respecting their own sense of autonomy by helping them to maintain their lifelong sense of personal identity.

In another essay, Mike King and Hazem Zohny deal with use of non-human animals in research.16 These animals do not have decision-making autonomy in the sense that humans do, and might therefore be thought to require “paternalistic” treatment according to what is in their best interests. However, that get kamagra prescription is not the standard that is applied to non-human animals. Rather, they are used instrumentally, as in lab research, and then euthanized. King and Zohny argue that, however bad this treatment is for the animals, it is also psychologically distressing to the human scientists who are charged with doing the experimentation and killing.

They suggest that animal ethics committees ought to take steps to help reduce this “psychological burden” in humans.Finally, a number of essays add to a get kamagra prescription welcome shift in focus for medical ethics, toward broader socio-structural and historical issues. Christina Richie17 argues that pharmaceutical companies have an obligation to reduce their carbon footprint, for the sake of the environment. Pugh et al18 analyse trade-offs in the use of “inaccurate” erectile dysfunction treatment tests for effective public health policy at a national level. Milne et al19 map out a model for participatory governance in handling of massive amounts of data in get kamagra prescription the context of large-scale biobanks.

Pierre et al20 share the results of their study on physician attitudes and behaviours toward incarcerated patients. And Yeo-Teh and Tang21 address researchers’ obligations to the public in conducting studies on stem-cell based therapies for autism spectrum disorder, given the ways that even poor quality research in this area is likely to be taken up by parents and other laypeople hoping for a “cure.” It is heartening to see the Journal of Medical Ethics continue to publish essays ranging from the detailed analysis of a specific clinical case study (like Baby T) to philosophical discussions of key concepts, like autonomy, in the context of cutting-edge technological innovations (the PPP), to appraisals of systemic issues in society.22Ethics statementsPatient consent for publicationNot applicable.Ethics approvalNot applicable.AbstractCare of the critically ill newborn includes support for the birth mother/parents with regular updates around the clinical condition of the baby, and involvement in discussions around complex decision-making issues. Discussions around continuation or discontinuation of life-sustaining are challenging get kamagra prescription even in the most straightforward of cases, but what happens when the birth mother is critically unwell?. Such cases can lead to uncertainty around who should assume the parental role for these difficult discussions.

In this round table discussion, we explore the ethical, moral and legal uncertainties raised by coincident severe maternal and neonatal illness in the context of surrogacy.decision-makingclinical ethicsneonatologyreproductive medicineData availability statementThere are no data in this work..

Kamagra 100 chewable tablet

Credit Read Full Article kamagra 100 chewable tablet. IStock Share Fast Facts New @HopkinsMedicine study finds African-American women with common form of hair loss at increased risk of uterine fibroids - Click to Tweet New study in @JAMADerm shows most common form of alopecia (hair loss) in African-American women associated with higher risks of uterine fibroids - Click to Tweet In a study of medical records gathered on hundreds of thousands of African-American women, Johns Hopkins researchers say they have evidence that women with a common form of hair loss have an increased chance of developing uterine leiomyomas, or fibroids.In a report on the research, published in the December 27 issue of JAMA Dermatology, the researchers call on physicians who treat women with central centrifugal cicatricial alopecia (CCCA) to make patients aware that they may be at increased risk for fibroids and should be screened for the condition, particularly if they have symptoms such as heavy bleeding and pain. CCCA predominantly affects black women and is the most common form of permanent alopecia in kamagra 100 chewable tablet this population. The excess scar tissue that forms as a result of this type of hair loss may also explain the higher risk for uterine fibroids, which are characterized by fibrous growths in the lining of the womb. Crystal Aguh, M.D., assistant professor of dermatology at the Johns Hopkins University School of Medicine, says the scarring associated with CCCA is similar to the scarring associated with excess fibrous tissue elsewhere in the body, a situation that may explain why women with this type of hair loss are at a higher risk for fibroids.People of African descent, she notes, are more prone to develop other disorders of abnormal scarring, termed fibroproliferative kamagra 100 chewable tablet disorders, such as keloids (a type of raised scar after trauma), scleroderma (an autoimmune disorder marked by thickening of the skin as well as internal organs), some types of lupus and clogged arteries.

During a four-year period from 2013-2017, the researchers analyzed patient data from the Johns Hopkins electronic medical record system (Epic) of 487,104 black women ages 18 and over. The prevalence kamagra 100 chewable tablet of those with fibroids was compared in patients with and without CCCA. Overall, the researchers found that 13.9 percent of women with CCCA also had a history of uterine fibroids compared to only 3.3 percent of black women without the condition. In absolute numbers, out of the 486,000 women who were reviewed, 16,212 had fibroids.Within that population, 447 had CCCA, of which 62 had fibroids. The findings kamagra 100 chewable tablet translate to a fivefold increased risk of uterine fibroids in women with CCCA, compared to age, sex and race matched controls.

Aguh cautions that their study does not suggest any cause and effect relationship, or prove a common cause for both conditions. €œThe cause of the link between the two conditions remains unclear,” she says kamagra 100 chewable tablet. However, the association was strong enough, she adds, to recommend that physicians and patients be made aware of it. Women with this kamagra 100 chewable tablet type of scarring alopecia should be screened not only for fibroids, but also for other disorders associated with excess fibrous tissue, Aguh says. An estimated 70 percent of white women and between 80 and 90 percent of African-American women will develop fibroids by age 50, according to the NIH, and while CCCA is likely underdiagnosed, some estimates report a prevalence of rates as high as 17 percent of black women having this condition.

The other authors on this kamagra 100 chewable tablet paper were Ginette A. Okoye, M.D. Of Johns Hopkins and Yemisi Dina of Meharry Medical College.Credit. The New England Journal of Medicine Share Fast Facts This study clears up how big an effect the mutational burden has on outcomes to immune checkpoint inhibitors across kamagra 100 chewable tablet many different cancer types. - Click to Tweet The number of mutations in a tumor’s DNA is a good predictor of whether it will respond to a class of cancer immunotherapy drugs known as checkpoint inhibitors.

- Click to Tweet The “mutational burden,” or the number of mutations present in a tumor’s DNA, is a good predictor of whether that cancer type will respond to a class of cancer immunotherapy drugs known as checkpoint inhibitors, a new kamagra 100 chewable tablet study led by Johns Hopkins Kimmel Cancer Center researchers shows. The finding, published in the Dec. 21 New kamagra 100 chewable tablet England Journal of Medicine, could be used to guide future clinical trials for these drugs. Checkpoint inhibitors are a relatively new class of drug that helps the immune system recognize cancer by interfering with mechanisms cancer cells use to hide from immune cells. As a result, the drugs cause the immune system to fight cancer in the same way that it would fight an .

These medicines have had remarkable success in treating some types of cancers that historically have had poor kamagra 100 chewable tablet prognoses, such as advanced melanoma and lung cancer. However, these therapies have had little effect on other deadly cancer types, such as pancreatic cancer and glioblastoma. The mutational burden of certain tumor types has previously been proposed as an explanation for why certain cancers respond kamagra 100 chewable tablet better than others to immune checkpoint inhibitors says study leader Mark Yarchoan, M.D., chief medical oncology fellow. Work by Dung Le, M.D., associate professor of oncology, and other researchers at the Johns Hopkins Kimmel Cancer Center and its Bloomberg~Kimmel Cancer Institute for Cancer Immunotherapy showed that colon cancers that carry a high number of mutations are more likely to respond to checkpoint inhibitors than those that have fewer mutations. However, exactly how big an effect the mutational burden kamagra 100 chewable tablet has on outcomes to immune checkpoint inhibitors across many different cancer types was unclear.

To investigate this question, Yarchoan and colleagues Alexander Hopkins, Ph.D., research fellow, and Elizabeth Jaffee, M.D., co-director of the Skip Viragh Center for Pancreas Cancer Clinical Research and Patient Care and associate director of the Bloomberg~Kimmel Institute, combed the medical literature for the results of clinical trials using checkpoint inhibitors on various different types of cancer. They combined these findings with data on the mutational burden of thousands of kamagra 100 chewable tablet tumor samples from patients with different tumor types. Analyzing 27 different cancer types for which both pieces of information were available, the researchers found a strong correlation. The higher a cancer type’s mutational burden tends to be, the more likely it is to respond to checkpoint inhibitors. More than half of the differences in how well cancers responded to immune checkpoint inhibitors could be explained by the mutational burden of that cancer kamagra 100 chewable tablet.

€œThe idea that a tumor type with more mutations might be easier to treat than one with fewer sounds a little counterintuitive. It’s one of those things that doesn’t sound kamagra 100 chewable tablet right when you hear it,” says Hopkins. €œBut with immunotherapy, the more mutations you have, the more chances the immune system has to recognize the tumor.” Although this finding held true for the vast majority of cancer types they studied, there were some outliers in their analysis, says Yarchoan. For example, Merkel cell cancer, a rare and highly aggressive skin cancer, tends to have a moderate number kamagra 100 chewable tablet of mutations yet responds extremely well to checkpoint inhibitors. However, he explains, this cancer type is often caused by a kamagra, which seems to encourage a strong immune response despite the cancer’s lower mutational burden.

In contrast, the most common type of colorectal cancer has moderate mutational burden, yet responds poorly to checkpoint inhibitors for reasons that are still unclear. Yarchoan notes that these findings kamagra 100 chewable tablet could help guide clinical trials to test checkpoint inhibitors on cancer types for which these drugs haven’t yet been tried. Future studies might also focus on finding ways to prompt cancers with low mutational burdens to behave like those with higher mutational burdens so that they will respond better to these therapies. He and his colleagues plan to extend this line of research by investigating whether mutational burden might be a good predictor of whether cancers in individual patients might respond well to this class of immunotherapy drugs kamagra 100 chewable tablet. €œThe end goal is precision medicine—moving beyond what’s true for big groups of patients to see whether we can use this information to help any given patient,” he says.

Yarchoan receives funding kamagra 100 chewable tablet from the Norman &. Ruth Rales Foundation and the Conquer Cancer Foundation. Through a licensing agreement with Aduro Biotech, Jaffee has the potential to receive royalties in the future..

Credit http://nickfarnell.ca/how-to-buy-amoxil-in-usa/ get kamagra prescription. IStock Share Fast Facts New @HopkinsMedicine study finds African-American women with common form of hair loss at increased risk of uterine fibroids - Click to Tweet New study in @JAMADerm shows most common form of alopecia (hair loss) in African-American women associated with higher risks of uterine fibroids - Click to Tweet In a study of medical records gathered on hundreds of thousands of African-American women, Johns Hopkins researchers say they have evidence that women with a common form of hair loss have an increased chance of developing uterine leiomyomas, or fibroids.In a report on the research, published in the December 27 issue of JAMA Dermatology, the researchers call on physicians who treat women with central centrifugal cicatricial alopecia (CCCA) to make patients aware that they may be at increased risk for fibroids and should be screened for the condition, particularly if they have symptoms such as heavy bleeding and pain. CCCA predominantly get kamagra prescription affects black women and is the most common form of permanent alopecia in this population. The excess scar tissue that forms as a result of this type of hair loss may also explain the higher risk for uterine fibroids, which are characterized by fibrous growths in the lining of the womb. Crystal Aguh, M.D., assistant professor of dermatology at the Johns Hopkins University School of Medicine, says the scarring associated with CCCA is similar to the scarring associated with excess fibrous tissue elsewhere in the body, a situation that may explain why women with this type of hair loss are at a higher risk for fibroids.People of African descent, she notes, are more prone to develop other disorders of abnormal scarring, termed fibroproliferative disorders, such as keloids (a get kamagra prescription type of raised scar after trauma), scleroderma (an autoimmune disorder marked by thickening of the skin as well as internal organs), some types of lupus and clogged arteries.

During a four-year period from 2013-2017, the researchers analyzed patient data from the Johns Hopkins electronic medical record system (Epic) of 487,104 black women ages 18 and over. The prevalence of those with fibroids was compared in patients with and without CCCA get kamagra prescription. Overall, the researchers found that 13.9 percent of women with CCCA also had a history of uterine fibroids compared to only 3.3 percent of black women without the condition. In absolute numbers, out of the 486,000 women who were reviewed, 16,212 had fibroids.Within that population, 447 had CCCA, of which 62 had fibroids. The findings translate to a fivefold increased risk of uterine fibroids in women with CCCA, compared to age, sex and get kamagra prescription race matched controls.

Aguh cautions that their study does not suggest any cause and effect relationship, or prove a common cause for both conditions. €œThe cause of get kamagra prescription the link between the two conditions remains unclear,” she says. However, the association was strong enough, she adds, to recommend that physicians and patients be made aware of it. Women with this type of scarring alopecia should get kamagra prescription be screened not only for fibroids, but also for other disorders associated with excess fibrous tissue, Aguh says. An estimated 70 percent of white women and between 80 and 90 percent of African-American women will develop fibroids by age 50, according to the NIH, and while CCCA is likely underdiagnosed, some estimates report a prevalence of rates as high as 17 percent of black women having this condition.

The other authors get kamagra prescription on this paper were Ginette A. Okoye, M.D. Of Johns Hopkins and Yemisi Dina of Meharry Medical College.Credit. The New England Journal of Medicine Share Fast Facts This study clears get kamagra prescription up how big an effect the mutational burden has on outcomes to immune checkpoint inhibitors across many different cancer types. - Click to Tweet The number of mutations in a tumor’s DNA is a good predictor of whether it will respond to a class of cancer immunotherapy drugs known as checkpoint inhibitors.

- Click to Tweet The “mutational burden,” or the number of mutations present in a tumor’s DNA, is a good predictor of whether that cancer type will respond to a class of cancer immunotherapy drugs get kamagra prescription known as checkpoint inhibitors, a new study led by Johns Hopkins Kimmel Cancer Center researchers shows. The finding, published in the Dec. 21 New England Journal of Medicine, get kamagra prescription could be used to guide future clinical trials for these drugs. Checkpoint inhibitors are a relatively new class of drug that helps the immune system recognize cancer by interfering with mechanisms cancer cells use to hide from immune cells. As a result, the drugs cause the immune system to fight cancer in the same way that it would fight an .

These medicines have had remarkable success in treating some types of cancers that historically have had poor prognoses, such as advanced melanoma and lung cancer get kamagra prescription. However, these therapies have had little effect on other deadly cancer types, such as pancreatic cancer and glioblastoma. The mutational burden of certain tumor types has previously been proposed as an explanation for why certain cancers respond better than others to immune checkpoint get kamagra prescription inhibitors says study leader Mark Yarchoan, M.D., chief medical oncology fellow. Work by Dung Le, M.D., associate professor of oncology, and other researchers at the Johns Hopkins Kimmel Cancer Center and its Bloomberg~Kimmel Cancer Institute for Cancer Immunotherapy showed that colon cancers that carry a high number of mutations are more likely to respond to checkpoint inhibitors than those that have fewer mutations. However, exactly how big an effect the mutational burden has on outcomes to immune checkpoint inhibitors across many different get kamagra prescription cancer types was unclear.

To investigate this question, Yarchoan and colleagues Alexander Hopkins, Ph.D., research fellow, and Elizabeth Jaffee, M.D., co-director of the Skip Viragh Center for Pancreas Cancer Clinical Research and Patient Care and associate director of the Bloomberg~Kimmel Institute, combed the medical literature for the results of clinical trials using checkpoint inhibitors on various different types of cancer. They combined these findings with data on the mutational burden of thousands of tumor samples from patients with get kamagra prescription different tumor types. Analyzing 27 different cancer types for which both pieces of information were available, the researchers found a strong correlation. The higher a cancer type’s mutational burden tends to be, the more likely it is to respond to checkpoint inhibitors. More than half of the differences in how well cancers responded to immune checkpoint inhibitors could be get kamagra prescription explained by the mutational burden of that cancer.

€œThe idea that a tumor type with more mutations might be easier to treat than one with fewer sounds a little counterintuitive. It’s one of those things that doesn’t sound right get kamagra prescription when you hear it,” says Hopkins. €œBut with immunotherapy, the more mutations you have, the more chances the immune system has to recognize the tumor.” Although this finding held true for the vast majority of cancer types they studied, there were some outliers in their analysis, says Yarchoan. For example, Merkel cell cancer, a rare and highly aggressive skin cancer, tends to have a moderate number of mutations yet responds extremely get kamagra prescription well to checkpoint inhibitors. However, he explains, this cancer type is often caused by a kamagra, which seems to encourage a strong immune response despite the cancer’s lower mutational burden.

In contrast, the most common type of colorectal cancer has moderate mutational burden, yet responds poorly to checkpoint inhibitors for reasons that are still unclear. Yarchoan notes that these findings could help guide clinical trials get kamagra prescription to test checkpoint inhibitors on cancer types for which these drugs haven’t yet been tried. Future studies might also focus on finding ways to prompt cancers with low mutational burdens to behave like those with higher mutational burdens so that they will respond better to these therapies. He and his colleagues plan to extend this line of research by investigating whether mutational burden might be a good predictor of whether cancers in individual patients might respond well to this class of immunotherapy drugs get kamagra prescription. €œThe end goal is precision medicine—moving beyond what’s true for big groups of patients to see whether we can use this information to help any given patient,” he says.

Yarchoan receives funding from get kamagra prescription the Norman &. Ruth Rales Foundation and the Conquer Cancer Foundation. Through a licensing agreement with Aduro Biotech, Jaffee has the potential to receive royalties in the future..