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SALT LAKE CITY, May cheap generic lasix 28, 2021 (GLOBE NEWSWIRE) -- Health Catalyst, Inc. ("Health Catalyst", Nasdaq. HCAT), a leading provider of data and analytics technology and services to healthcare organizations, today announced that Dan Burton, CEO, and Adam Brown, SVP of Investor Relations and FP&A, will participate in the 41st Annual William Blair Growth Stock Conference cheap generic lasix including a fireside chat on Wednesday, June 2, 2021 at 5:40 p.m.

ET. A webcast link will be available at https://ir.healthcatalyst.com/investor-relations. About Health Catalyst Health Catalyst is a leading provider of data and analytics technology and services to cheap generic lasix healthcare organizations committed to being the catalyst for massive, measurable, data-informed healthcare improvement.

Its customers leverage the cloud-based data platform—powered by data from more than 100 million patient records and encompassing trillions of facts—as well as its analytics software and professional services expertise to make data-informed decisions and realize measurable clinical, financial, and operational improvements. Health Catalyst envisions a future in which all healthcare decisions are data cheap generic lasix informed. Health Catalyst Investor Relations Contact.

Adam BrownSenior Vice President, Investor Relations and FP&A+1 (855)-309-6800ir@healthcatalyst.com Health Catalyst Media Contact. Amanda Hundtamanda.hundt@healthcatalyst.com+1 cheap generic lasix (575) 491-0974SALT LAKE CITY, May 06, 2021 (GLOBE NEWSWIRE) -- Health Catalyst, Inc. ("Health Catalyst," Nasdaq.

HCAT), a leading provider of data and analytics technology and services to healthcare organizations, today reported financial results for the quarter ended March 31, 2021 cheap generic lasix. €œIn the first quarter of 2021, I am pleased to share that we achieved strong performance across our business, including exceeding the mid-point of our quarterly guidance for both revenue and Adjusted EBITDA,” said Dan Burton, CEO of Health Catalyst. €œI am also happy to report that in the most recent team member engagement and satisfaction survey, independently administered by the Gallup organization, team member satisfaction scores at Health Catalyst measured in the 96th percentile.

This latest engagement level continues a pattern that has been in place for many years, of industry-leading engagement, consistently ranked between the 95th and 99th percentile in overall cheap generic lasix team member satisfaction scores. This latest result is of particular significance given that it comes during a period where we were required to adapt to global lasix necessitating a remote-only work environment, as well as having welcomed nearly two hundred new teammates who came to us primarily through multiple recent acquisitions.” Financial Highlights for the Three Months Ended March 31, 2021 Key Financial Metrics Three Months Ended March 31, Year over Year Change 2021 2020 GAAP Financial Data:(in thousands, except percentages, unaudited)Technology revenue$33,839 $24,699 37%Professional services revenue$22,007 $20,417 8%Total revenue$55,846 $45,116 24%Loss from operations$(24,317) $(18,105) (34)%Net loss$(28,370) $(17,490) (62)%Other Non-GAAP Financial Data:(1) Adjusted Technology Gross Profit$23,388 $16,969 38%Adjusted Technology Gross Margin69% 69% Adjusted Professional Services Gross Profit$6,929 $5,071 37%Adjusted Professional Services Gross Margin31% 25% Total Adjusted Gross Profit$30,317 $22,040 38%Total Adjusted Gross Margin54% 49% Adjusted EBITDA$(837) $(5,971) 86%________________________(1) These measures are not calculated in accordance with generally accepted accounting principles in the United States (GAAP). See the accompanying "Non-GAAP Financial Measures" section below cheap generic lasix for more information about these financial measures, including the limitations of such measures, and for a reconciliation of each measure to the most directly comparable measure calculated in accordance with GAAP.

Financial Outlook Health Catalyst provides forward-looking guidance on total revenue, a GAAP measure, and Adjusted EBITDA, a non-GAAP measure. For the second quarter of 2021, we expect. Total revenue between $55.1 million and $58.1 million, andAdjusted EBITDA between $(4.8) million and $(2.8) millionFor the full year cheap generic lasix of 2021, we expect.

Total revenue between $228.1 million and $231.1 million, andAdjusted EBITDA between $(15.0) million and $(13.0) millionWe have not reconciled guidance for Adjusted EBITDA to net loss, the most directly comparable GAAP measure, and have not provided forward-looking guidance for net loss, because there are items that may impact net loss, including stock-based compensation, that are not within our control or cannot be reasonably predicted. Chair of the Board cheap generic lasix Transition On April 29, 2021, our board of directors (the board) accepted Dr. Tim Ferris's resignation from the board and all board committees, effective May 1, 2021.

Dr. Ferris's resignation is not the result of any disagreement with Health Catalyst, but rather as a result of his new role as the National Director of Transformation for England's National Health cheap generic lasix Service (NHS). NHS required Dr.

Ferris to resign from our board in connection with cheap generic lasix his NHS appointment. €œDr. Ferris provided a unique perspective that will continue to impact our company for years to come.

We are grateful for the opportunity to have benefited from his wisdom and experience, and we congratulate him on his new role cheap generic lasix as National Director of Transformation at NHS,” said Dan Burton, CEO. Health Catalyst is thrilled to announce that John A. (Jack) Kane has accepted the invitation to serve as chair of the board effective May 1, 2021.

Mr. Kane has been a director of the Company and has been the chair of the audit committee of the board since February 2016. Mr.

Kane has more than 30 years’ experience in healthcare technology, including as a director and chairperson of the audit committee of Merchants Bancshares, Inc. (MBVT) from 2005 until 2014 and athenahealth, Inc. From 2007 until February 2019.

He previously occupied the position of CFO, Treasurer &. Senior VP-Administration at IDX Systems Corp. €œJack has served on our board for many years.

His valuable guidance and feedback often challenges us to think deeply about our solutions. I am grateful for Jack’s dedication to our mission and his depth of financial leadership experience in healthcare and technology, which make him uniquely qualified to serve as our chair,” said Burton. Quarterly Conference Call Details The company will host a conference call to review the results today, Thursday, May 6, 2021, at 5:00 p.m.

E.T. The conference call can be accessed by dialing 1-877-295-1104 for U.S. Participants, or 1-470-495-9486 for international participants, and referencing participant code 9183315.

A live audio webcast will be available online at https://ir.healthcatalyst.com/. A replay of the call will be available via webcast for on-demand listening shortly after the completion of the call, at the same web link, and will remain available for approximately 90 days. About Health Catalyst Health Catalyst is a leading provider of data and analytics technology and services to healthcare organizations committed to being the catalyst for massive, measurable, data-informed healthcare improvement.

Its customers leverage the cloud-based data platform—powered by data from more than 100 million patient records and encompassing trillions of facts—as well as its analytics software and professional services expertise to make data-informed decisions and realize measurable clinical, financial, and operational improvements. Health Catalyst envisions a future in which all healthcare decisions are data informed. Available Information Health Catalyst intends to use its Investor Relations website as a means of disclosing material non-public information and for complying with its disclosure obligations under Regulation FD.

Forward-Looking Statements This release contains forward-looking statements within the meaning of Section 27A of the Securities Act of 1933, as amended, and Section 21E of the Securities Exchange Act of 1934, as amended, and the Private Securities Litigation Reform Act of 1995, as amended. These forward-looking statements include statements regarding our future growth and our financial outlook for Q2 and fiscal year 2021. Forward-looking statements are subject to risks and uncertainties and are based on potentially inaccurate assumptions that could cause actual results to differ materially from those expected or implied by the forward-looking statements.

Actual results may differ materially from the results predicted, and reported results should not be considered as an indication of future performance. Important risks and uncertainties that could cause our actual results and financial condition to differ materially from those indicated in the forward-looking statements include, among others, the following. (i) changes in laws and regulations applicable to our business model.

(ii) changes in market or industry conditions, regulatory environment and receptivity to our technology and services. (iii) results of litigation or a security incident. (iv) the loss of one or more key customers or partners.

(v) the impact of hypertension medications on our business and results of operations. And (vi) changes to our abilities to recruit and retain qualified team members. For a detailed discussion of the risk factors that could affect our actual results, please refer to the risk factors identified in our SEC reports, including, but not limited to the Annual Report on Form 10-K for the year ended December 31, 2020 filed with the SEC on or about February 25, 2021 and the Quarterly Report on Form 10-Q for the fiscal quarter ended March 31, 2021 expected to be filed with the SEC on or about May 7, 2021.

All information provided in this release and in the attachments is as of the date hereof, and we undertake no duty to update or revise this information unless required by law. Condensed Consolidated Balance Sheets(in thousands, except share and per share data, unaudited) As ofMarch 31, As ofDecember 31, 2021 2020Assets Current assets. Cash and cash equivalents$132,627 $91,954 Short-term investments133,807 178,917 Accounts receivable, net45,905 48,296 Prepaid expenses and other assets12,404 10,632 Total current assets324,743 329,799 Property and equipment, net18,653 12,863 Intangible assets, net91,840 98,921 Operating lease right-of-use assets24,093 24,729 Goodwill107,822 107,822 Other assets4,068 3,606 Total assets$571,219 $577,740 Liabilities and stockholders’ equity Current liabilities.

Accounts payable$4,626 $5,332 Accrued liabilities12,946 16,510 Acquisition-related consideration payable— 2,000 Deferred revenue51,634 47,145 Operating lease liabilities2,454 2,622 Contingent consideration liabilities15,902 14,427 Convertible senior notes, net171,864 — Total current liabilities259,426 88,036 Convertible senior notes, net of current portion— 168,994 Deferred revenue, net of current portion1,135 1,878 Operating lease liabilities, net of current portion23,083 23,669 Contingent consideration liabilities, net of current portion16,509 16837 Other liabilities2,230 2227 Total liabilities302,383 301,641 Commitments and contingencies Stockholders’ equity. Common stock, $0.001 par value. 44,340,036 and 43,376,848 shares issued and outstanding as of March 31, 2021 and December 31, 2020, respectively44 43 Additional paid-in capital1,022,781 1,001,645 Accumulated deficit(754,020) (725,650)Accumulated other comprehensive income31 61 Total stockholders' equity268,836 276,099 Total liabilities and stockholders’ equity$571,219 $577,740 Condensed Consolidated Statements of Operations(in thousands, except per share data, unaudited) Three Months EndedMarch 31, 2021 2020Revenue.

Technology$33,839 $24,699 Professional services22,007 20,417 Total revenue55,846 45,116 Cost of revenue, excluding depreciation and amortization. Technology(1)10,825 7,906 Professional services(1)16,513 16,162 Total cost of revenue, excluding depreciation and amortization27,338 24,068 Operating expenses. Sales and marketing(1)15,651 13,487 Research and development(1)14,345 13,088 General and administrative(1)(2)(3)15,015 9,701 Depreciation and amortization7,814 2,877 Total operating expenses52,825 39,153 Loss from operations(24,317) (18,105)Interest and other expense, net(3,952) (621)Loss before income taxes(28,269) (18,726)Income tax provision (benefit)101 (1,236)Net loss$(28,370) $(17,490)Net loss per share, basic and diluted$(0.65) $(0.47)Weighted-average shares outstanding used in calculating net loss per share, basic and diluted43,870 37,109 Adjusted net loss(4)$(2,753) $(6,083)Adjusted net loss per share, basic and diluted(4)$(0.06) $(0.16) _______________(1) Includes stock-based compensation expense as follows.

Three Months EndedMarch 31, 2021 2020 Stock-Based Compensation Expense:(in thousands)Cost of revenue, excluding depreciation and amortization. Technology$374 $176 Professional services1,435 816 Sales and marketing4,818 3,182 Research and development2,257 1,882 General and administrative4,626 2,685 Total$13,510 $8,741 (2) Includes acquisition transaction costs as follows. Three Months EndedMarch 31, 2021 2020 Acquisition transaction costs:(in thousands)General and administrative$— $875 (3) Includes the change in fair value of contingent consideration liabilities, as follows.

Three Months EndedMarch 31, 2021 2020 Change in fair value of contingent consideration liabilities:(in thousands)General and administrative$2,156 $(359)(4) Includes non-GAAP adjustments to net loss. Refer to the "Non-GAAP Financial Measures—Adjusted Net Loss Per Share" section below for further details. Condensed Consolidated Statements of Cash Flows(in thousands, unaudited) Three Months Ended March 31,Cash flows from operating activities2021 2020Net loss$(28,370) $(17,490)Adjustments to reconcile net loss to net cash used in operating activities.

Depreciation and amortization7,814 2,877 Amortization of debt discount and issuance costs2,870 285 Non-cash operating lease expense965 741 Investment discount and premium amortization417 (6)Provision for expected credit losses300 51 Stock-based compensation expense13,510 8,741 Deferred tax (benefit) provision2 (1,280)Change in fair value of contingent consideration liabilities2,156 (359)Other(34) (4)Change in operating assets and liabilities. Accounts receivable, net2,090 (7,335)Deferred costs— 444 Prepaid expenses and other assets(2,173) (2,244)Accounts payable, accrued liabilities, and other liabilities(5,352) (4,283)Deferred revenue3,745 3,936 Operating lease liabilities(1,083) (843)Net cash used in operating activities(3,143) (16,769) Cash flows from investing activities Purchase of short-term investments(8,621) — Proceeds from the sale and maturity of short-term investments53,240 66,653 Acquisition of businesses, net of cash acquired— (15,249)Purchase of property and equipment(5,882) (428)Capitalization of internal use software(887) (78)Purchase of intangible assets(480) (758)Proceeds from sale of property and equipment6 6 Net cash provided by investing activities37,376 50,146 Cash flows from financing activities Proceeds from exercise of stock options6,488 9,046 Proceeds from employee stock purchase plan1,349 1,289 Payments of acquisition-related consideration(1,391) (748)Net cash provided by financing activities6,446 9,587 Effect of exchange rate on cash and cash equivalents(6) (31)Net increase in cash and cash equivalents40,673 42,933 Cash and cash equivalents at beginning of period91,954 18,032 Cash and cash equivalents at end of period$132,627 $60,965 Non-GAAP Financial Measures To supplement our financial information presented in accordance with GAAP, we believe certain non-GAAP measures, including Adjusted Gross Profit, Adjusted Gross Margin, Adjusted EBITDA, Adjusted Net Loss, and Adjusted Net Loss per share, basic and diluted, are useful in evaluating our operating performance. For example, we exclude stock-based compensation expense because it is non-cash in nature and excluding this expense provides meaningful supplemental information regarding our operational performance and allows investors the ability to make more meaningful comparisons between our operating results and those of other companies.

We use this non-GAAP financial information to evaluate our ongoing operations, as a component in determining employee bonus compensation, and for internal planning and forecasting purposes. We believe that non-GAAP financial information, when taken collectively, may be helpful to investors because it provides consistency and comparability with past financial performance. However, non-GAAP financial information is presented for supplemental informational purposes only, has limitations as an analytical tool and should not be considered in isolation or as a substitute for financial information presented in accordance with GAAP.

In addition, other companies, including companies in our industry, may calculate similarly-titled non-GAAP measures differently or may use other measures to evaluate their performance. A reconciliation is provided below for each non-GAAP financial measure to the most directly comparable financial measure stated in accordance with GAAP. Investors are encouraged to review the related GAAP financial measures and the reconciliation of these non-GAAP financial measures to their most directly comparable GAAP financial measures, and not to rely on any single financial measure to evaluate our business.

Adjusted Gross Profit and Adjusted Gross Margin Adjusted Gross Profit is a non-GAAP financial measure that we define as revenue less cost of revenue, excluding depreciation and amortization and excluding stock-based compensation. We define Adjusted Gross Margin as our Adjusted Gross Profit divided by our revenue. We believe Adjusted Gross Profit and Adjusted Gross Margin are useful to investors as they eliminate the impact of certain non-cash expenses and allow a direct comparison of these measures between periods without the impact of non-cash expenses and certain other non-recurring operating expenses.

The following is a reconciliation of revenue, the most directly comparable GAAP financial measure, to Adjusted Gross Profit, for the three months ended March 31, 2021 and 2020. Three Months Ended March 31, 2021 (in thousands, except percentages) Technology Professional Services TotalRevenue$33,839 $22,007 $55,846 Cost of revenue, excluding depreciation and amortization(10,825) (16,513) (27,338)Gross profit, excluding depreciation and amortization23,014 5,494 28,508 Add. Stock-based compensation374 1,435 1,809 Adjusted Gross Profit$23,388 $6,929 $30,317 Gross margin, excluding depreciation and amortization68% 25% 51%Adjusted Gross Margin69% 31% 54% Three Months Ended March 31, 2020 (in thousands, except percentages) Technology Professional Services TotalRevenue$24,699 $20,417 $45,116 Cost of revenue, excluding depreciation and amortization(7,906) (16,162) (24,068)Gross profit, excluding depreciation and amortization16,793 4,255 21,048 Add.

Stock-based compensation176 816 992 Adjusted Gross Profit$16,969 $5,071 $22,040 Gross margin, excluding depreciation and amortization68% 21% 47%Adjusted Gross Margin69% 25% 49% Adjusted EBITDA Adjusted EBITDA is a non-GAAP financial measure that we define as net loss adjusted for (i) interest and other expense, net, (ii) income tax (benefit) provision, (iii) depreciation and amortization, (iv) stock-based compensation, (v) acquisition transaction costs, and (vi) change in fair value of contingent consideration liabilities when they are incurred. We view acquisition-related expenses when applicable, such as transaction costs and changes in the fair value of contingent consideration liabilities that are directly related to business combinations as events that are not necessarily reflective of operational performance during a period. We believe Adjusted EBITDA provides investors with useful information on period-to-period performance as evaluated by management and comparison with our past financial performance and is useful in evaluating our operating performance compared to that of other companies in our industry, as this metric generally eliminates the effects of certain items that may vary from company to company for reasons unrelated to overall operating performance.

The following is a reconciliation of our net loss, the most directly comparable GAAP financial measure, to Adjusted EBITDA, for the three months ended March 31, 2021 and 2020. Three Months EndedMarch 31, 2021 2020 (in thousands)Net loss$(28,370) $(17,490)Add. Interest and other expense, net3,952 621 Income tax (benefit) provision101 (1,236)Depreciation and amortization7,814 2,877 Stock-based compensation13,510 8,741 Acquisition transaction costs— 875 Change in fair value of contingent consideration liabilities2,156 (359)Adjusted EBITDA$(837) $(5,971) Adjusted Net Loss Per Share Adjusted Net Loss is a non-GAAP financial measure that we define as net loss attributable to common stockholders adjusted for (i) stock-based compensation, (ii) amortization of acquired intangibles, (iii) acquisition transaction costs, (iv) change in fair value of contingent consideration liabilities, and (v) non-cash interest expense related to our convertible senior notes.

We believe Adjusted Net Loss provides investors with useful information on period-to-period performance as evaluated by management and comparison with our past financial performance and is useful in evaluating our operating performance compared to that of other companies in our industry, as this metric generally eliminates the effects of certain items that may vary from company to company for reasons unrelated to overall operating performance. Three Months Ended March 31, 2021 2020 Numerator:(in thousands, except share and per share amounts)Net loss attributable to common stockholders$(28,370) $(17,490)Add. Stock-based compensation13,510 8,741 Amortization of acquired intangibles7,081 2,150 Acquisition transaction costs— 875 Change in fair value of contingent consideration liabilities2,156 (359)Non-cash interest expense related to convertible senior notes2,870 — Adjusted Net Loss$(2,753) $(6,083)Denominator.

Weighted-average number of shares used in calculating net loss, basic and diluted43,870,288 37,108,998 Adjusted net loss per share, basic and diluted$(0.06) $(0.16) Health Catalyst Investor Relations Contact:Adam BrownSenior Vice President, Investor Relations and FP&A+1 (855)-309-6800ir@healthcatalyst.com Health Catalyst Media Contact:Amanda HundtVice President, Corporate Communicationsamanda.hundt@healthcatalyst.com+1 (575) 491-0974AdvertisementContinue reading the main storySupported byContinue reading the main storyThe NYT Parenting NewsletterRaising Kids to Love ExerciseBody positive ways to encourage the joy of movement.Credit...Nan LeeJune 23, 2021As someone who came of age during the late 1990s, when the cultural messages around the female body were demented, and Britney Spears’s bronzed abdomen was considered an attainable and appropriate goal, playing sports was one of the few things that allowed me to feel good about myself. Sports made me feel capable and strong, rather than ornamental. I might not have looked the way I wanted to in those stupidly low-slung jeans, but I could run my heart out on the field hockey pitch and lose myself in the camaraderie of my teammates on the long bus rides back from away games.My field hockey team was not good!.

But our losing record did not detract from my overall enjoyment of the activity. In fact, the low stakes might have increased my enjoyment — in the past 20 to 30 years, youth sports have become more competitive and more time consuming. Experts are concerned that children are risking injury from overtraining and specializing in a single sport at ever younger ages, according to reporting by Roni Caryn Rabin in The Times.

Research has shown that there are additional risks to specializing and intense training, which include psychological stress and quitting sports entirely.I have two daughters, and despite my best attempts to run a body positive home, I can already tell that my older daughter, who is in third grade, is getting messages from the outside world about how she is supposed to look. My hope is that exercise can provide a counter message about what her body can do. There is ample evidence that playing sports is correlated with a host of psychological benefits for children of all genders, including higher self-worth and body image for girls.But I’m not naïve.

I know that my girls may also be told that exercise is important because it’s an avenue for weight loss, not because it’s an opportunity for joy, strength or friendship. So how do I encourage my children to be active, without making it an area of stress, or a chore?. I asked two experts on kids and health for their tips.Don’t force it.

If you push your kid into a sport they really don’t want to do, it’s not going to stick. People (children included) feel motivated to do something when they have control, when they can feel like they’re a part of something, and when they can feel successful, said Matthew Myrvik, a clinical sports psychologist and an associate professor at The Medical College of Wisconsin. €œWhere you start is you give them control,” he said — which is to say, give them several different kinds of activities to choose from.For a child who isn’t excited about team sports like soccer or basketball, you can offer skateboarding or yoga, which are physical activities that they can master on their own.

€œIf you have a kid who is more cerebral or into science, taking a nature walk and identifying different plants or birds, or taking a bike ride through a beautiful setting,” can keep activity joyful, said Christy Harrison, a registered dietitian and host of the podcast “Food Psych.”If you try to force particular activities on your kids, it may backfire, Ms. Harrison said. €œA lot of adults who are healing from disordered relationships with their bodies were pushed into adult type activities that made them hate exercise.

It made them feel like they were being punished,” she said.Praise effort, not outcome. As children reach adolescence, they tend to drop out of sports entirely if they are not highly competitive, according to a 2019 policy statement from the American Academy of Pediatrics. Teach your kids that especially in team sports, they cannot control the outcome of the game, Dr.

Myrvik said. What they can control is how hard they try. After a game, whether your kid wins or loses, praise the process, saying something like.

€œI love how many shots you took today,” or “It’s great to see you out there having fun with your friends.”Make it a family activity. Kids are smart, and they will notice the mirthless way that some adults view exercise — going out for a jog that feels like checking off a box or doing some mandatory drudgery, Ms. Harrison said.So try to find activities you can do as a family together that are joyful, and that get your bodies moving.

Dr. Myrvik said his children look forward to their family dance parties (and also use them as a tactic to delay bedtime). During the lasix, we started taking family hikes and doing Cosmic Kids yoga together, both of which we are continuing even as group sports open up again.As soon as I heard about a local rec soccer league that was enrolling for the spring, I encouraged my older daughter to join.

I said we could practice together, since I played soccer from kindergarten through high school. She scoffed, and said she wasn’t interested. Then, a week after the rec league began, her best friend was telling her about how much fun she was having at soccer, and my daughter begged me to get her in the league.

She ended up loving the experience, and wants to do it again in the fall.AdvertisementContinue reading the main storyCredit...Tony Luong for The New York TimesSkip to contentSkip to site index‘Death Doulas’ Provide Aid at the End of LifeEnd-of-life doulas support people emotionally, physically, spiritually and practically. Sitting vigil, giving hand massages, making snacks.Credit...Tony Luong for The New York TimesSupported byContinue reading the main storyJune 24, 2021, 5:00 a.m. ETAs parents of a child with a progressive and potentially fatal illness, Maryanne and Nick O’Hara lived on hope.

Hope that their daughter, Caitlin, who was diagnosed with cystic fibrosis at age 2, would prove the statistics wrong and live longer than the 46 years expected. Hope that she would receive the lung transplant she spent two and a half years waiting for in her early 30s. Hope that her body wouldn’t reject it.That hope faded on Dec.

20, 2016, when Caitlin O’Hara died of a brain bleed at the University of Pittsburgh Medical Center, two days post-transplant. She was 33.Shattered, her mother decided to try to give meaning to her grief. And so she signed up for a certificate program at the University of Vermont’s Larner College of Medicine to become an end-of-life doula, or “death doula,” working with individuals and families as they moved from this life into whatever is next.

(The terms “end-of-life doula” and “death doula” are used interchangeably, though some find the latter a little too blunt.)“In our culture, we go overboard preparing for birth, but ‘hope for the best’ at the end of life,” said Ms. O’Hara, 62, who lives in Boston and Ashland, Mass., and is the author of “Little Matches. A Memoir of Grief and Light,” published in April.

€œThe training was really a way of going even deeper into my own grief and realizing how I could take my own experience and help other people have a better end of life.“I saw for myself how horrifying it is during a medical crisis and then after a death, to realize that life keeps going and needs attending to,” she continued. €œAs soon as Caitlin passed, suddenly it’s over and the person is gone and you have to deal with the business of living. A good doula will support you with that.”The word “doula” comes from the Greek word meaning “woman who serves,” though most people associate it with someone who helps during birth to usher in life.

In recent years, however, more people have come to recognize the need for as much assistance at the end of life as the start, part of the so-called death positivity movement that is gaining momentum in the United States and other countries. The movement, popularized by the mortician and writer Caitlin Doughty, encourages open discussion on death and dying and people’s feelings on mortality.“The beginning of life and the end are so similar,” said Francesca Arnoldy, the lead instructor at UVM’s End-of-Life Doula program. €œThe intensity of it, the mystery, all of the unknowns.

You have to relinquish your sense of control and agenda and ride it out, and be super attentive in the moment.”Unlike hospice workers, doulas don’t get involved in medical issues. Rather, they support clients emotionally, physically, spiritually and practically, stepping in whenever needed. That could be a few days before someone dies, sitting vigil with them in their last hours, giving hand massages, making snacks.

Or it could be months or even years earlier, after someone receives a terminal diagnosis, keeping them company, listening to their life stories or helping them craft autobiographies, planning funerals. Prices range from $25 an hour on up, although many, like Ms. O’Hara, do it voluntarily.

And like Ms. O’Hara, many have signed on to help give new meaning to their own grief while helping others in the process.More than 1,400 people have graduated from the UVM program since its inception in 2017. Coursework, which costs $800 for eight weeks, includes writing farewell letters to loved ones, crafting their own obituaries, completing legacy work or a “Life Story Project” with a trained volunteer, and starting or updating their own advance care planning files.

The program also recently started a “StoryListening” research project in which mourners across the country are invited to share their stories of loss during the lasix with a trained doula. At the end of the hourlong session, participants are given a recording of their own conversation.Maryanne O’Hara, who became an end-of-life doula following the death of her daughter in 2016, in her home in Ashland, Mass.Credit...Tony Luong for The New York TimesSince its founding in 2018, the National End-of-Life Doula Alliance, a professional organization of end-of-life practitioners and trainers, has grown to nearly 800 members. Membership nearly doubled in the last year, said its president, Angela Shook.

Interest has increased in training programs with the International End-of-Life Doula Association, Doulagivers, and the Doula Program to Accompany and Comfort, a nonprofit run by a hospice social worker, Amy L. Levine.Much of the growing interest in these programs has come from artists, actors, young people and restaurant workers who found themselves unemployed during the lasix and recognized that they could still be of service.“People were reaching out from a variety of different ages, younger than we would normally see, because they realized that people were dying in their age category, which doesn’t usually happen,” said Diane Button, 62, of San Francisco, a doula facilitator at UVM and a member of the Bay Area End-of-Life Doula Alliance, a collective of death workers. €œIt made them more aware of their own mortality and really made them want to plan and get their documents and advance directives in order.”Rebecca Ryskalczyk, 32, a singer in Vergennes, Vt., had always felt “kind of comfortable” with death.

She lost two cousins in a plane crash when she was 12 and a friend to suicide four years later. When hypertension medications put her performing schedule on pause, she enrolled at UVM. Her goal is to let people know that they don’t have to be afraid of death.

Nor do they have to do it alone. €œBeing able to help advocate for someone and to spend the last moments of their life with them and help them stick to their plan when they may not be able to express that is an honor,” she said.Before the lasix, Kate Primeau, 35, also worked in the music industry. Last June, after her grandfather died of hypertension medications, she began researching how to host a Zoom memorial and came across the concept of a death doula.

€œI felt a huge gap between the amount of grief everyone was feeling and the resources available,” she said. She got certified as an end-of-life doula through Alua Arthur’s company, Going with Grace, and also volunteers in a hospice program. €œI can’t believe how much I’m geeking out over all this death education.”During the lasix, of course, doulas had to shift the way they worked.

That was one of the main challenges. They couldn’t interact in person. So like the rest of the world, they resorted to Zoom calls and FaceTime.

Families often reached out for their own healing.“A lot are coming to me for ritual and ceremony when they can’t be with their loved one physically and they’re alone in the hospital room,” said Ash Canty, 34, of Eugene, Ore., who refers to himself as a “death walker.” “There’s a curiosity that wasn’t there prior to hypertension medications. They’re wanting to know, ‘How do I make sense of this spiritually?. How do I be with this?.

Because I’m really struggling.’”As for Ms. O’Hara, who is also a novelist, she is primarily helping people write their life stories. Her training at UVM was “humbling.” “I went into it thinking ‘I’ve been a volunteer with people who are dying, I’ve lost my daughter, I’m an expert in grief,’” she said.

But the longer she studied, the more she realized that she was only an expert in her grief.“You really can’t tell anyone else how to grieve,” she said. €œYou can offer advice, but there’s no timeline for grief. As soon as people get a diagnosis, they’re grieving.

Their way of life is over. Everyone has suffered some kind of grief with the lasix, even if they haven’t lost a person.”She believes that grief and joy can coexist. €œMy grief is never going to go away,” she said.

€œI wouldn’t want it to. Grief and joy and love — it’s all part of the same spectrum. I’m grieving because I loved someone so much.”AdvertisementContinue reading the main story.

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By Dennis lasix 40mg for dogs ThompsonHealthDay Reporter MONDAY, Jan. 11, 2021 (HealthDay News) -- A special calorie-burning type of body fat appears to help protect against an array of chronic ailments, including heart disease, type 2 diabetes and high blood pressure, a new study suggests. Brown fat generates heat by drawing glucose from the bloodstream, as opposed to energy-storing white fat, explained lasix 40mg for dogs senior researcher Dr.

Paul Cohen. He's an assistant professor and senior attending physician at the Rockefeller University Hospital in New York City. That sort of a tissue sounds like a godsend lasix 40mg for dogs.

However, brown fat has been long thought to have little impact on human health because your stores of brown fat diminish as you age. But research now shows that adults who have active brown fat tissues in their bodies are far less likely than their peers to suffer from a range of chronic illnesses. What's more, lasix 40mg for dogs this protective effect holds even if the person carries excess weight, researchers reported recently in the journal Nature Medicine.

"When we grouped our subjects based on their body mass index, we saw that even obese people with brown fat show protection from these conditions," Cohen said. "For example, it's well known that type 2 diabetes is more common in overweight and obese individuals, but what we saw was that even obese individuals who have brown fat have a significantly lower likelihood of type 2 diabetes than obese individuals without brown fat," he continued. Brown fat lasix 40mg for dogs is thought to be an evolutionary response to cold weather, helping generate heat to maintain the body's core temperature, experts say.

"Babies cannot shiver, and so when they are cold they would activate the brown fat and stay warm that way," said Ruth Loos, director of the Genetics of Obesity and Related Metabolic Traits Program at the Charles R. Bronfman Institute of Personalized Medicine with the Icahn School of Medicine at Mount Sinai, in New York City. "For a long time it was believed it's present in babies, and as we age, it was believed that it would disappear," Loos lasix 40mg for dogs said.

"Now with better ways to measure, we now know that it does not totally disappear in adults. Some people do have a measurable amount of brown fat, which we did not know before." Continued Cohen said that studies performed about a decade ago "generated a lot lasix 40mg for dogs of enthusiasm because they showed that adult humans have brown fat that can be stimulated by cold exposure and that it's functional, meaning it takes up glucose from the bloodstream." Brown fat is found in a layer of fat under the skin, typically in a region extending from the base of the head and along the shoulders, and then down the spine, said Dr. Aaron Cypess, acting chief of the translational physiology section of the diabetes, endocrinology and obesity branch of the U.S.

National Institute of Diabetes and Digestive and Kidney Diseases. Researchers can detect active brown fat stores using PET scans that are normally used to diagnose and lasix 40mg for dogs track cancer by looking for tissues burning heavy levels of glucose. Cohen and his team reached out to Memorial Sloan Kettering Cancer Center, obtaining more than 130,000 PET scans from more than 52,000 patients.

They then reviewed those scans to search for brown fat deposits. Nearly 10% lasix 40mg for dogs of the patients carried active brown fat, Cohen said. He added that this is likely an underestimate because patients undergoing the scans had been asked to avoid cold exposure, exercise and caffeine, all of which increase brown fat activity.

The researchers verified earlier findings about brown fat -- that women are more likely to carry it than men, that the amount of brown fat decreases as you age and gain weight, and that active brown fat is more likely to be found in scans done in cold versus warm weather. But when the research team compared brown fat levels to the patients' medical histories, they found new associations lasix 40mg for dogs between brown fat tissue and better overall health in people, regardless of weight. For example, people with active brown fat have improved levels of cholesterol and blood sugars.

They also were less likely to have high cholesterol, coronary artery disease, congestive heart failure, high blood pressure and type 2 diabetes. "Some of lasix 40mg for dogs those associations have never been documented before," Cohen said, though the study did not definitively prove that brown fat causes disease risk to drop. Continued It's not yet clear why this link might exist, Cypess said.

"Is it through the simple process of burning up glucose and fat to keep you warm, or is brown fat acting also as an endocrine organ that releases hormones into the blood and leads to these benefits?. " Cypess lasix 40mg for dogs said. It doesn't take extreme cold to activate brown fat, Cohen noted -- even a couple of hours in a 60-degree Fahrenheit room is sufficient.

That temperature "is cool lasix 40mg for dogs but certainly not frigid," Cohen said. "I think it's intriguing from a public health perspective that simply lowering our thermostats by a few degrees may result in health benefits." Researchers and pharmaceutical companies also are looking into drugs that might activate brown fat and promote these benefits, Cohen said. However, the experts all agreed that too little is known about brown fat for anyone to try to either lose weight or gain health benefits by gallivanting about in cool rooms or the frigid outdoors.

"If you lasix 40mg for dogs ate less at a meal, you might be better off dropping some weight than trying to increase your brown fat," Cypess said. "I'm still going to tell you the two things you have to do is eat a healthy meal plan and exercise, and we're hoping we can bring brown fat activity into that plan." More information The U.S. National Institutes of Health has more about brown fat.

SOURCES. Paul Cohen, MD, PhD, assistant professor and senior attending physician, Rockefeller University Hospital, New York City. Ruth Loos, PhD, director, Genetics of Obesity and Related Metabolic Traits Program, Charles R.

Bronfman Institute of Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York City. Aaron Cypess, MD, PhD, acting chief, translational physiology section, diabetes, endocrinology and obesity branch, U.S. National Institute of Diabetes and Digestive and Kidney Diseases.

Nature Medicine, Jan. 4, 2021, online WebMD News from HealthDay Copyright © 2013-2020 HealthDay. All rights reserved..

By Dennis check out here ThompsonHealthDay cheap generic lasix Reporter MONDAY, Jan. 11, 2021 (HealthDay News) -- A special calorie-burning type of body fat appears to help protect against an array of chronic ailments, including heart disease, type 2 diabetes and high blood pressure, a new study suggests. Brown fat generates heat by drawing glucose from the bloodstream, as opposed to energy-storing white fat, explained senior researcher Dr cheap generic lasix.

Paul Cohen. He's an assistant professor and senior attending physician at the Rockefeller University Hospital in New York City. That sort of a tissue sounds like a godsend cheap generic lasix.

However, brown fat has been long thought to have little impact on human health because your stores of brown fat diminish as you age. But research now shows that adults who have active brown fat tissues in their bodies are far less likely than their peers to suffer from a range of chronic illnesses. What's more, cheap generic lasix this protective effect holds even if the person carries excess weight, researchers reported recently in the journal Nature Medicine.

"When we grouped our subjects based on their body mass index, we saw that even obese people with brown fat show protection from these conditions," Cohen said. "For example, it's well known that type 2 diabetes is more common in overweight and obese individuals, but what we saw was that even obese individuals who have brown fat have a significantly lower likelihood of type 2 diabetes than obese individuals without brown fat," he continued. Brown fat is thought to be an evolutionary response to cold weather, helping generate heat to maintain the body's core temperature, cheap generic lasix experts say.

"Babies cannot shiver, and so when they are cold they would activate the brown fat and stay warm that way," said Ruth Loos, director of the Genetics of Obesity and Related Metabolic Traits Program at the Charles R. Bronfman Institute of Personalized Medicine with the Icahn School of Medicine at Mount Sinai, in New York City. "For a long time it was believed cheap generic lasix it's present in babies, and as we age, it was believed that it would disappear," Loos said.

"Now with better ways to measure, we now know that it does not totally disappear in adults. Some people do have a measurable amount of brown fat, which we did not know before." Continued Cohen said that studies performed about a decade ago "generated a lot of enthusiasm because they showed that adult humans have brown fat that can be stimulated by cold exposure and that it's functional, meaning it takes up glucose from the bloodstream." Brown fat is found in a layer of fat under the skin, typically in a region extending from the base of the head and along the shoulders, and then down cheap generic lasix the spine, said Dr. Aaron Cypess, acting chief of the translational physiology section of the diabetes, endocrinology and obesity branch of the U.S.

National Institute of Diabetes and Digestive and Kidney Diseases. Researchers can detect active brown fat stores using PET scans that are normally used to diagnose and track cheap generic lasix cancer by looking for tissues burning heavy levels of glucose. Cohen and his team reached out to Memorial Sloan Kettering Cancer Center, obtaining more than 130,000 PET scans from more than 52,000 patients.

They then reviewed those scans to search for brown fat deposits. Nearly 10% of the cheap generic lasix patients carried active brown fat, Cohen said. He added that this is likely an underestimate because patients undergoing the scans had been asked to avoid cold exposure, exercise and caffeine, all of which increase brown fat activity.

The researchers verified earlier findings about brown fat -- that women are more likely to carry it than men, that the amount of brown fat decreases as you age and gain weight, and that active brown fat is more likely to be found in scans done in cold versus warm weather. But when the research team compared brown fat levels to the patients' medical histories, they found new cheap generic lasix associations between brown fat tissue and better overall health in people, regardless of weight. For example, people with active brown fat have improved levels of cholesterol and blood sugars.

They also were less likely to have high cholesterol, coronary artery disease, congestive heart failure, high blood pressure and type 2 diabetes. "Some of those associations have never been documented before," Cohen cheap generic lasix said, though the study did not definitively prove that brown fat causes disease risk to drop. Continued It's not yet clear why this link might exist, Cypess said.

"Is it through the simple process of burning up glucose and fat to keep you warm, or is brown fat acting also as an endocrine organ that releases hormones into the blood and leads to these benefits?. " Cypess said cheap generic lasix. It doesn't take extreme cold to activate brown fat, Cohen noted -- even a couple of hours in a 60-degree Fahrenheit room is sufficient.

That temperature "is cool but certainly not frigid," cheap generic lasix Cohen said. "I think it's intriguing from a public health perspective that simply lowering our thermostats by a few degrees may result in health benefits." Researchers and pharmaceutical companies also are looking into drugs that might activate brown fat and promote these benefits, Cohen said. However, the experts all agreed that too little is known about brown fat for anyone to try to either lose weight or gain health benefits by gallivanting about in cool rooms or the frigid outdoors.

"If you ate less at a meal, you might be cheap generic lasix better off dropping some weight than trying to increase your brown fat," Cypess said. "I'm still going to tell you the two things you have to do is eat a healthy meal plan and exercise, and we're hoping we can bring brown fat activity into that plan." More information The U.S. National Institutes of Health has more about brown fat.

SOURCES. Paul Cohen, MD, PhD, assistant professor and senior attending physician, Rockefeller University Hospital, New York City. Ruth Loos, PhD, director, Genetics of Obesity and Related Metabolic Traits Program, Charles R.

Bronfman Institute of Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York City. Aaron Cypess, MD, PhD, acting chief, translational physiology section, diabetes, endocrinology and obesity branch, U.S. National Institute of Diabetes and Digestive and Kidney Diseases.

Nature Medicine, Jan. 4, 2021, online WebMD News from HealthDay Copyright © 2013-2020 HealthDay. All rights reserved..

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If you miss a dose, take it as soon as you can. If it is almost time for your next dose, take only that dose. Do not take double or extra doses.

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The superintendent of a Westchester County lasix cost per pill school is furosemide the same as lasix district has resigned after 14 months in the role.On Saturday, Oct. 2, the Lakeland Central School District announced that Dr. Brendan Lyons’ is furosemide the same as lasix resignation was accepted by the school board.The district said Lyons' departure is amicable.In a letter to families, Lyons said he stepped down from the role, effective Thursday, Sept. 30, "to tend to family matters and pursue other opportunities.""Whatever the future may hold, please remain unified in service to the children of Lakeland," he added. "I wish you all is furosemide the same as lasix the best."Dr.

Karen Gagliardi is serving as acting superintendent of schools until an interim superintendent is chosen, the district said.Lakeland Schools said the district expects an interim superintendent to be chosen as soon as the next Board of Education meeting, which is set for Thursday, Oct. 7.Check back to Daily Voice for is furosemide the same as lasix updates. Click here to sign up for Daily Voice's free daily emails and news alerts.I recently tried to order white blood cell growth factor (pegfilgrastim) biosimilar for one of my patients. This is a drug that helps prevent fever and associated with low white blood cell counts.For years, prescribing it is furosemide the same as lasix has been simple, since the only option was the brand-name drug, Neulasta brand pegfilgrastim. But the patent on Neulasta expired in October 2015, and there are now several FDA-approved biosimilars on the market.

Fulphila (pegfilgrastim-jmdb), Nyvepria (pegfilgrastim-apgf), Udenyca (pegfilgrastim-cbqv) and Ziextenzo (pegfilgrastim-bmez).Each is pegfilgrastim but, as required by FDA guidance, each of the biosimilars and the originator itself is is furosemide the same as lasix further identified by a random four-letter suffix. Even though the intention of Congress was to make biosimilar usage equivalent to that of generic drugs, health care providers are now required to order a specific version, including the suffix. Further complicating the process, prescribers have no idea which version will be covered by a patient’s insurer.advertisement How did we get into this complicated and confusing is furosemide the same as lasix situation?. As part of the Affordable Care Act, Congress passed the Biologics Price and Competition Innovations Act of 2009. This created a new pathway for approval of biosimilar is furosemide the same as lasix molecules, which are functionally equivalent to their brand name “originator” biologics.

These are biologically active macromolecules such as antibodies, receptors, and ligands that are not synthesized chemically but are created in culture by mammalian or microbial cells. Because they are not exact molecular copies, as are generic drugs, biosimilars do not qualify as generic under the Hatch-Waxman Act of 1984. That may be true under the letter of the law, but I must point out that all biologics undergo minor chemical changes over time — the Neulasta of today is not identical to the Neulasta made a few years ago.advertisement The Biologics Price and Competition Innovations Act created an accelerated approval process for biosimilar molecules that required submission is furosemide the same as lasix of extensive chemical and manufacturing data plus one clinical trial result for approval of a biomolecule which would be biosimilar in structure and activity to an approved drug that was now off patent protection. Once approved, the biosimilar receives approval for the full range of uses of the originator molecule as stipulated in the “package insert,” and not just the one used in the clinical trial. The goal of this legislation and the subsequent is furosemide the same as lasix FDA regulations is to substantially cut down on the cost of development of the biosimilar drugs.Unfortunately, the process has gone off the rails due to concerns about interchangeability (switching between originator and biosimilars) and pharmacovigilance (toxicity monitoring).

While state laws or hospital policies may allow a generic to be substituted for a brand-name drug without specific approval from the prescriber, the FDA demanded extra and complex trials to show that the biosimilar and originator molecules could be switched back and forth without loss of clinical efficacy.Interchangeability may easy to demonstrate for a biologic drug like insulin, for which glucose levels can be monitored hourly, but it would be virtually impossible for cancer or rheumatologic drugs, where the outcome is a clinical benefit demonstrated over months, or even years.Nevertheless, the FDA now requires all biologics to bear a four-letter suffix in addition to the generic name which would identify it to regulators. There are no data comparing one biosimilar to another, so physicians and pharmacists must assume it works as well as the is furosemide the same as lasix others. And since each has its own identifier, physicians cannot just order “pegfilgrastim,” but must ask instead for a specific one and know which one will be covered by the patient’s insurance at that moment (which is subject to change at any time without notice). The suffix also means that each biosimilar is now an individually identifiable drug and the pharmaceutical companies have adopted a is furosemide the same as lasix strategy of branded biosimilars. This is leading to the proliferation of confusing brand names in addition to suffixes.A colleague of mine, physician Michael Kane, who directs the oncology pharmacy for RWJBarnabas Health, has told me that this biosimilar system costs our medium-sized health care system about $2 million a year in extra personnel costs, denials of reimbursement, and the need to stock multiple versions of each biosimilar drug to comply with the arbitrary requirements of third-party payers.Is this really necessary?.

Is is furosemide the same as lasix concern over switching from one biosimilar to another in the middle of treatment reasonable?. No one knows since none of the companies making oncologic biosimilars have done the interchangeability experiment.Instead of resulting in a simpler system for prescribing biosimilars, the regulation requiring the use of an identifying suffix has resulted in a plethora of brand names and suffixes for each biosimilar for a biologic coming off patent, creating more work, greater confusion, and less market competition. Instead of all biosimilars competing as one drug is furosemide the same as lasix pool, there are now five “brands” brands of pegfilgrastim and each competes as a unique agent in the marketplace. Is it any wonder the advent of biosimilars has not resulted in the anticipated savings to the health care system?. This week is furosemide the same as lasix I was able to finally get pegfilgrastim-cbqv (Udenyca) approved for my patient and covered by the patient’s insurance, but only after multiple phone calls with the insurer.

Now I can only hope it will be delivered in time.Howard S. Hochster is an oncologist, director of oncology research at RWJBarnabas Health in New Jersey, associate director of the Rutgers Cancer Institute, and distinguished professor of medicine at the Rutgers Robert Wood Johnson School of Medicine..

The superintendent of a cheap generic lasix Westchester County school district has resigned after 14 months in the role.On Saturday, Oct. 2, the Lakeland Central School District announced that Dr. Brendan Lyons’ resignation was accepted by the school board.The district cheap generic lasix said Lyons' departure is amicable.In a letter to families, Lyons said he stepped down from the role, effective Thursday, Sept. 30, "to tend to family matters and pursue other opportunities.""Whatever the future may hold, please remain unified in service to the children of Lakeland," he added. "I wish you cheap generic lasix all the best."Dr.

Karen Gagliardi is serving as acting superintendent of schools until an interim superintendent is chosen, the district said.Lakeland Schools said the district expects an interim superintendent to be chosen as soon as the next Board of Education meeting, which is set for Thursday, Oct. 7.Check back cheap generic lasix to Daily Voice for updates. Click here to sign up for Daily Voice's free daily emails and news alerts.I recently tried to order white blood cell growth factor (pegfilgrastim) biosimilar for one of my patients. This is a drug that helps prevent fever and associated with low white blood cell counts.For years, prescribing it has been simple, since the cheap generic lasix only option was the brand-name drug, Neulasta brand pegfilgrastim. But the patent on Neulasta expired in October 2015, and there are now several FDA-approved biosimilars on the market.

Fulphila (pegfilgrastim-jmdb), Nyvepria (pegfilgrastim-apgf), Udenyca (pegfilgrastim-cbqv) and Ziextenzo (pegfilgrastim-bmez).Each is pegfilgrastim but, as required by FDA guidance, each of cheap generic lasix the biosimilars and the originator itself is further identified by a random four-letter suffix. Even though the intention of Congress was to make biosimilar usage equivalent to that of generic drugs, health care providers are now required to order a specific version, including the suffix. Further complicating the process, prescribers have no idea which version will be covered by a patient’s insurer.advertisement How did we get into this complicated and cheap generic lasix confusing situation?. As part of the Affordable Care Act, Congress passed the Biologics Price and Competition Innovations Act of 2009. This created a new pathway for approval of biosimilar cheap generic lasix molecules, which are functionally equivalent to their brand name “originator” biologics.

These are biologically active macromolecules such as antibodies, receptors, and ligands that are not synthesized chemically but are created in culture by mammalian or microbial cells. Because they are not exact molecular copies, as are generic drugs, biosimilars do not qualify as generic under the Hatch-Waxman Act of 1984. That may be true under the letter of the cheap generic lasix law, but I must point out that all biologics undergo minor chemical changes over time — the Neulasta of today is not identical to the Neulasta made a few years ago.advertisement The Biologics Price and Competition Innovations Act created an accelerated approval process for biosimilar molecules that required submission of extensive chemical and manufacturing data plus one clinical trial result for approval of a biomolecule which would be biosimilar in structure and activity to an approved drug that was now off patent protection. Once approved, the biosimilar receives approval for the full range of uses of the originator molecule as stipulated in the “package insert,” and not just the one used in the clinical trial. The goal of this legislation and the subsequent FDA regulations is cheap generic lasix to substantially cut down on the cost of development of the biosimilar drugs.Unfortunately, the process has gone off the rails due to concerns about interchangeability (switching between originator and biosimilars) and pharmacovigilance (toxicity monitoring).

While state laws or hospital policies may allow a generic to be substituted for a brand-name drug without specific approval from the prescriber, the FDA demanded extra and complex trials to show that the biosimilar and originator molecules could be switched back and forth without loss of clinical efficacy.Interchangeability may easy to demonstrate for a biologic drug like insulin, for which glucose levels can be monitored hourly, but it would be virtually impossible for cancer or rheumatologic drugs, where the outcome is a clinical benefit demonstrated over months, or even years.Nevertheless, the FDA now requires all biologics to bear a four-letter suffix in addition to the generic name which would identify it to regulators. There are no data comparing one biosimilar cheap generic lasix to another, so physicians and pharmacists must assume it works as well as the others. And since each has its own identifier, physicians cannot just order “pegfilgrastim,” but must ask instead for a specific one and know which one will be covered by the patient’s insurance at that moment (which is subject to change at any time without notice). The suffix also means that each biosimilar is now an individually identifiable drug and the pharmaceutical companies have adopted cheap generic lasix a strategy of branded biosimilars. This is leading to the proliferation of confusing brand names in addition to suffixes.A colleague of mine, physician Michael Kane, who directs the oncology pharmacy for RWJBarnabas Health, has told me that this biosimilar system costs our medium-sized health care system about $2 million a year in extra personnel costs, denials of reimbursement, and the need to stock multiple versions of each biosimilar drug to comply with the arbitrary requirements of third-party payers.Is this really necessary?.

Is cheap generic lasix concern over switching from one biosimilar to another in the middle of treatment reasonable?. No one knows since none of the companies making oncologic biosimilars have done the interchangeability experiment.Instead of resulting in a simpler system for prescribing biosimilars, the regulation requiring the use of an identifying suffix has resulted in a plethora of brand names and suffixes for each biosimilar for a biologic coming off patent, creating more work, greater confusion, and less market competition. Instead of cheap generic lasix all biosimilars competing as one drug pool, there are now five “brands” brands of pegfilgrastim and each competes as a unique agent in the marketplace. Is it any wonder the advent of biosimilars has not resulted in the anticipated savings to the health care system?. This week I was able to finally get pegfilgrastim-cbqv (Udenyca) approved for my patient and covered by the patient’s insurance, but only after multiple phone calls with the insurer.

Now I can only hope it will be delivered in time.Howard S. Hochster is an oncologist, director of oncology research at RWJBarnabas Health in New Jersey, associate director of the Rutgers Cancer Institute, and distinguished professor of medicine at the Rutgers Robert Wood Johnson School of Medicine..

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New Jersey Democratic you can try here Gov who can buy lasix. Phil Murphy said Thursday on CNBC he hopes to avoid broad economic lockdowns to deal with rising hypertension cases in the state and the nation."I think we're less likely, and please God that this is the case, we're less likely to use blunt instruments we used in March and April when we shut the garage doors down on everything, and much more likely to use a scalpel and go into a particular community," Murphy who can buy lasix told "Squawk Box."The governor acknowledged that new hypertension medications cases in New Jersey have been moving higher between 700 and under 1,000 per day recently. "We've come a long way but our numbers are up, there's no question about it, over the past several weeks," he said.

"For instance, higher education has been a challenge," adding he's putting more resources behind contact tracing and testing at state colleges and universities.Murphy who can buy lasix described the escalation of hypertension cases in the state as "hot spots" and not everywhere. "But there's a fair amount of community who can buy lasix spread," he said, explaining people are mostly following lasix mitigation measures, such as wearing masks and practicing social distancing, when they are out in public. However, people are letting their guards down at homes and in "frat houses," he stressed.Murphy urged people feeling ill to "take yourself off the field" and self-quarantine.

He said government officials need to continue to stay on the "bullhorn" to encourage people to stay vigilant.The governor also said that while hypertension testing has been a challenge and there's been a lack a national strategy in responding to the lasix, it's not too late to get a federal mandate on mask-wearing and other measures that scientists recommend for helping protect who can buy lasix against transmission.There is emerging concern that spikes in hypertension medications cases in Europe may be indicative of what the U.S. May see in the coming weeks as colder weather brings Americans indoors where risks of transmission who can buy lasix of the disease are greater. New cases in Europe have recently been running at about 100,000 per day — about double the U.S.The British government on Thursday announced tougher hypertension restrictions for London in an attempt to curb the rapid spread of the lasix.

The U.K.'s capital city will who can buy lasix move to a "high" alert level starting midnight Friday, up from the current "medium" alert level. European nations generally saw their peaks a few weeks who can buy lasix ahead the U.S. Earlier this year.Dr.

Anthony Fauci (R), director who can buy lasix of the National Institute of Allergy and Infectious Diseases, and U.S. President Donald Trump participate in the daily hypertension task force briefing at the White who can buy lasix House on April 22, 2020 in Washington, DC.Drew Angerer | Getty ImagesWhite House hypertension advisor Dr. Anthony Fauci reiterated Thursday that his comments used in one of President Donald Trump's campaign ads were taken out of context.The 30-second ad from Trump's reelection campaign praises the president's response to the hypertension lasix and includes a clip of Fauci saying, "I can't imagine that anybody could be doing more.""The way that ad went, where they quoted me at the end, it was certainly in the context that looked very much like a political endorsement, and I've assiduously avoided that for so many years, like decades," Fauci, director of the National Institute of Allergy and Infectious Diseases, said during an interview with Yahoo News.Fauci said he was referring to the White House hypertension Task Force in the early days of the lasix when the group was working 24 hours a day and "things were really on fire." Fauci, a member of the task force, said the ad "made it look very much like a political endorsement." He previously said his comments were taken out of context."I have never ever indirectly or directly endorsed a political candidate," said Fauci, who was appointed director of NIAID in 1984.

"I have been in the public health arena and advising six administrations for the last five decades."Fauci said he wants to be "completely apolitical" and stay as a "scientist, a physician and a public health person."Fauci and Trump have been at odds at times over hypertension response efforts, with the president often who can buy lasix critical of Fauci. Just two days who can buy lasix ago, Trump mocked Fauci in a tweet, writing that the infectious disease expert's "pitching arm is far more accurate than his prognostications.""'No problem, no masks'. WHO no longer likes Lockdowns - just came out against.

Trump was right who can buy lasix. We saved 2,000,000 who can buy lasix USA lives!. !.

!. " Trump tweeted.Trump could be referring to Fauci's previous criticism about the U.S. Not completely locking down early in the outbreak.

Fauci said in July that the U.S. Had so many hypertension cases because it "did not shut down entirely."The World Health Organization now says full-scale lockdowns should only be used as a last resort if other restrictive measures don't work..

New Jersey Democratic http://rollinwithmama.com/cialis-online-canada/ Gov cheap generic lasix. Phil Murphy said Thursday on CNBC he hopes to avoid broad economic cheap generic lasix lockdowns to deal with rising hypertension cases in the state and the nation."I think we're less likely, and please God that this is the case, we're less likely to use blunt instruments we used in March and April when we shut the garage doors down on everything, and much more likely to use a scalpel and go into a particular community," Murphy told "Squawk Box."The governor acknowledged that new hypertension medications cases in New Jersey have been moving higher between 700 and under 1,000 per day recently. "We've come a long way but our numbers are up, there's no question about it, over the past several weeks," he said.

"For instance, higher education has been a challenge," adding he's putting more resources behind contact tracing and testing at state colleges and universities.Murphy described the escalation cheap generic lasix of hypertension cases in the state as "hot spots" and not everywhere. "But there's a fair amount of community spread," he said, explaining people are mostly following lasix mitigation measures, such as wearing masks and practicing social distancing, cheap generic lasix when they are out in public. However, people are letting their guards down at homes and in "frat houses," he stressed.Murphy urged people feeling ill to "take yourself off the field" and self-quarantine.

He said government officials need to continue to stay on the "bullhorn" to encourage people to stay vigilant.The governor also said that cheap generic lasix while hypertension testing has been a challenge and there's been a lack a national strategy in responding to the lasix, it's not too late to get a federal mandate on mask-wearing and other measures that scientists recommend for helping protect against transmission.There is emerging concern that spikes in hypertension medications cases in Europe may be indicative of what the U.S. May see in the coming weeks as colder weather brings Americans indoors where risks of transmission of the cheap generic lasix disease are greater. New cases in Europe have recently been running at about 100,000 per day — about double the U.S.The British government on Thursday announced tougher hypertension restrictions for London in an attempt to curb the rapid spread of the lasix.

The U.K.'s capital city will move to a "high" alert level starting midnight cheap generic lasix Friday, up from the current "medium" alert level. European nations generally saw their peaks a few cheap generic lasix weeks ahead the U.S. Earlier this year.Dr.

Anthony Fauci (R), director of the National Institute of Allergy and Infectious Diseases, and U.S cheap generic lasix. President Donald Trump participate in the daily hypertension task force briefing at the White House on April 22, 2020 in Washington, DC.Drew Angerer | Getty ImagesWhite cheap generic lasix House hypertension advisor Dr. Anthony Fauci reiterated Thursday that his comments used in one of President Donald Trump's campaign ads were taken out of context.The 30-second ad from Trump's reelection campaign praises the president's response to the hypertension lasix and includes a clip of Fauci saying, "I can't imagine that anybody could be doing more.""The way that ad went, where they quoted me at the end, it was certainly in the context that looked very much like a political endorsement, and I've assiduously avoided that for so many years, like decades," Fauci, director of the National Institute of Allergy and Infectious Diseases, said during an interview with Yahoo News.Fauci said he was referring to the White House hypertension Task Force in the early days of the lasix when the group was working 24 hours a day and "things were really on fire." Fauci, a member of the task force, said the ad "made it look very much like a political endorsement." He previously said his comments were taken out of context."I have never ever indirectly or directly endorsed a political candidate," said Fauci, who was appointed director of NIAID in 1984.

"I have been in the public health arena and advising cheap generic lasix six administrations for the last five decades."Fauci said he wants to be "completely apolitical" and stay as a "scientist, a physician and a public health person."Fauci and Trump have been at odds at times over hypertension response efforts, with the president often critical of Fauci. Just two days ago, Trump mocked Fauci in a tweet, writing that the infectious disease expert's "pitching arm is far more cheap generic lasix accurate than his prognostications.""'No problem, no masks'. WHO no longer likes Lockdowns - just came out against.

Trump was cheap generic lasix right. We saved 2,000,000 cheap generic lasix USA lives!. !.

!. " Trump tweeted.Trump could be referring to Fauci's previous criticism about the U.S. Not completely locking down early in the outbreak.

Fauci said in July that the U.S. Had so many hypertension cases because it "did not shut down entirely."The World Health Organization now says full-scale lockdowns should only be used as a last resort if other restrictive measures don't work..

Lasix side effects in humans

In this issue of the Journal of Medical Ethics arguments online pharmacy lasix are cogently made that sustainability and solidarity should be considered as core medical ethical principles, and that more explicit attention should be given to the complex context in which a decision is made.Munthe et al propose that sustainability should become an established principle for justifying healthcare resource allocation, and should lasix side effects in humans be an explicit factor in procuring drugs and other resources.1 They argue that the current operational norms which guide decision making (need, prognosis, equal treatment and cost-effectiveness) can lead to what they call ‘negative dynamics’. The gradual depletion of resource available for healthcare.They illustrate this first by examining some well recognised examples of ‘positive dynamics’ which are considered in health policy. Immunisation programmes are funded because lead to reduction lasix side effects in humans or absence of disease in the population, thus freeing up resource for other uses.

Public health measures are offset by future cost reductions or income increases for healthcare via reduction of sick leave.‘Negative dynamics’ however, are not routinely considered in operational decisions and they persuasively argue that they should be. Resource depletion (not only fiscal resource, but environmental and human resource) lasix side effects in humans has a negative effect on future cycles of healthcare. As an illustrative example, they discuss the emission of resistance-driving residue in the production of antibiotics.

The accepted principles, particularly of cost effectiveness, lasix side effects in humans drive producers to make antibiotics cheaply, without consideration of gradual contribution to antibiotic resistance. If a principle of sustainability was included when considering procurement, subsidy and prioritisation, this would provide an incentive to change production practices. This argument can be lasix side effects in humans extended to many aspects of the healthcare.

System including how we recruit, train and treat our staff. How we invest in infrastructure and how lasix side effects in humans we plan for lasixs. Munthe et al go on to provide a robust definition of their sustainability principle, and to address possible objections.

It is an excellent example of reasoned ethical argument which has the potential to change clinical practice.With the roll out of vaccinations for hypertension medications across the globe, Julian Savulescu proposes an algorithm for when mandatory vaccination might be ethically justified.2 Drawing and expanding upon the 2007 Nuffield Council of Bioethics lasix side effects in humans report he suggests that four criteria are required. 1. There is a lasix side effects in humans grave threat to public health 2.

The treatment is safe and effective 3. Mandatory vaccination has lasix side effects in humans a superior cost/benefit profile compared with other alternatives 4. The level of coercion is proportionate.

Discussing the value judgement associated with each criterion, he concludes that, at lasix side effects in humans least initially (where uncertainty around safety is greater), mandatory vaccination for hypertension medications would be ethically problematic.He goes on to explore alternative approaches, including non-financial (eg, immunisation passports) and financial incentives. He argues that individuals could essentially be paid for the risk they are undertaking (by being early adopters of a treatment) for societal benefit, but to do this government would need to be ‘transparent, explicit and comprehensive in disclosure of data’, a standard which unfortunately has not always (or even often?. ) been lasix side effects in humans kept.

The danger that payment might signal a lack of confidence in safety is real. Clearly payment should only be offered for a treatment which lasix side effects in humans was considered safe enough to be used in any circumstances. Payment for a treatment which was not considered safe without payment would not be morally acceptable.

Payment may also lasix side effects in humans erode the sense of solidarity that people feel when contributing to societal well-being. To ensure that this was maintained he suggests the option of ‘donating back’ the fee to the NHS could be made available. People could be rewarded for taking the treatment with an increasing sense of civic duty as they not only protect themselves and the vulnerable, but contribute to the (fiscal) sustainability of the health service which treats them.While Savulescu acknowledges the worth of solidarity, Avery Kolers proposes that solidarity plays not just an auxillary part in the interests of acknowledged bioethical values (justice, beneficence etc) but has a lasix side effects in humans freestanding role, which should be independently assessed.3 He acknowledges that solidarity per se is not valuable.

There is solidarity, he notes, among a firing squad and within a terrorist cell. He develops Prainsack and Buyx metaphor of solidarity as the putty of justice4 and suggests five individually necessary and sufficient conditions of morally lasix side effects in humans valuable solidarity. It must be (1) norm grounded (2) acknowledged (3) political (4) action and (5) on others’ behalf.

He suggests lasix side effects in humans that solidarity (with X) is morally required ‘when it constitutes equitable treatment of X such as to countermand or resist inequitable treatment of X’. He notes that moral dilemmas may arise where solidarity with X may lead to inequitable treatment of Y and emphasises that solidarity with the most vulnerable in society will help address inequities in healthcare and in healthcare institutions.The complexities and competing moral demands of healthcare institutions, and primary care in particular, are explored by Spicer et al, who question the use of normative moral theories to determine the ‘best’ actions.5 They argue that the context in which ethical decisions are made is not sufficiently acknowledged. If complex contextual factors are not considered, then predictions about outcomes will be flawed, as will the resulting ethical analyses.Examples of contextual factors which lasix side effects in humans might influence decision-making include power relations within the staff and external regulators (including achieving externally determined quality markers and ‘standard’ practice) and the need to maintain both group and individual professional identities.It is often helpful to peel back the layers of complexity in order to reveal a specific ethical question.

Before coming to a conclusion, however, we must remember to reapply the layers and reconsider the question in the context of its complex environment. Integrating this proposal with others in the journal, this might include considerations of sustainability and solidarity.IntroductionWhile the role and importance of solidarity has been the focus of long-running and extensive debate surrounding public health ethics and practice,1 the hypertension medications lasix has cast this debate into even starker relief.2 In lasix side effects in humans doing so, it has emphasised the particular importance of solidarity for the delivery of effective public health programmes by highlighting the potentially disastrous consequences of its absence. In this paper I examine these consequence with reference to the response of the current British government to hypertension medications which failed to deliver an effective public health response to the crisis.

I argue that this response represents mismanagement of a public health crisis, and a rejection of important democratic norms and values.Defining solidaritySolidarity has a wide range of definitions in academic discourse, with its precise features being the subject of heated debate.3 4 Historically, solidarity has been seen as emerging most readily, and most often between persons sharing relatively stable, deeply ingrained qualities, such as shared membership of a state or religious group,5 or commitment to shared political ideals and objectives.6 7 More recently, it has been suggested that more transient, or less deeply ingrained features of persons may serve as the basis for acts of solidarity, and at least short-term solidarity lasix side effects in humans relationships.4 On a larger scale, it has also been suggested that recognition of shared vulnerability in the face of global threats to health, such as climate change and antimicrobial resistance, may serve as a catalyst for solidarity between nations and peoples.8 As I explain below, this perspective is particularly relevant to the current lasix context.2In this paper I rely mainly on the definition of solidarity offered by Prainsack and Buyx, who define solidarity as ‘enacted commitments to accept costs to assist others with whom a person or persons recognise similarity in a relevant respect’.4 Therefore, solidarity describes what it is that we do when we assist, benefit or support other people because we recognise some form of relevant similarity or connection with/to them. Thus solidarity is active, in that it is something we do, not merely a feeling or attitude. It is also egalitarian, with motivation for action being grounded in recognition of what is shared between parties, not in what distinguishes them.3 Finally, acting in solidarity also involves incurring of costs of some kind, though these may be lasix side effects in humans extremely minimal, or be counterbalanced by the benefits of a given solidarity action.Prainsack and Buyx argue that there are three main ‘tiers’ of solidaristic action.

Interpersonal, group and institutional solidarity.4 The first of these tiers describes what happens between individual persons. For example, Prainsack and Buyx suggest that giving up one’s seat on a crowded bus for a pregnant fellow passenger is an act of solidarity when based on recognition of shared experience of discomfort while standing during pregnancy.4 The second tier ‘comprises manifestations of a shared commitment to lasix side effects in humans carry costs to assist others with whom people consider themselves bound together through at least one similarity in a relevant respect’. These group solidarities occur when many individuals share a similar specific context, and engage in actions to benefit others with whom the context is shared.

Such solidarity is informal, though it may also be heavily normalised within lasix side effects in humans a given community, such that it forms an expectation of behaviour.Tier 3 solidarity comprises formalised, or legally mandated expectations of behaviour. Here, solidarity is fully institutionalised, ‘in the form of legally enforceable norms’,4 such as progressive tax systems and welfare state arrangements. For example, the British National Health lasix side effects in humans Service (NHS) exemplifies institutionalised solidarity, because it is funded through taxation and provides healthcare to citizens and legal residents of the UK, regardless of their ability to pay.

According to Prainsack and Buyx, these three tiers of solidarity are closely connected, with tier 3 solidarity typically emerging from solidarity at tiers 1 and 2. Correlatively, Sangiovanni discusses the participation in collaborative institutions as solidaristic practice when he argues that solidarity is grounded in ‘our joint action as authors of political and social lasix side effects in humans helpful resources institutions’.7 Thus, for Sangiovanni solidarity is something which emerges from shared participation in the construction and enactment of civic society. Solidarity can therefore be interpreted in a range of ways—as the act of carrying costs for relevantly similar others, ‘standing up for’, ‘standing up with’ and ‘standing up as’’ those persons with whom solidarity is identified,3 or the act of working together for a shared goal.7 Regardless of the precise definition adopted, at least basic solidarity, as active engagements in interpersonal and/or institutional egalitarian relationality, by all or most members of a group is fundamentally necessary for the existence and functioning of any community—as I explain below, it is particularly important in democracies.Solidarity and public healthIn normal circumstances, private individuals can engage in interpersonal and group solidarity in the context of public health provision, by avoiding social interaction when sick and helping others to do the same, by purchasing groceries for an ill neighbour, for example.

Individuals can lasix side effects in humans engage in tier 3 solidarity by participating in institutions which promote and protect public and individual health. For example, participation in fair taxation schemes can help fund health and welfare programmes, such as the British NHS, ensuring the accessibility of these services to all members of a given community, thereby contributing to public health and individual well-being.Correlatively, while elected and appointed governmental officials, such as cabinet ministers, can also engage in solidarity in the same way as their constituents, they also have additional responsibilities in virtue of their public role and status as elected representatives of their communities. These responsibilities include things like enacting legislation which lasix side effects in humans establishes and maintains institutions and programmes which promote and protect health.

Such actions protect the health of their constituents, and they enable those constituents to more effectively engage in solidarity with their peers, by providing the systems necessary to do so most effectively, and guidance as to the reasons for so doing. It is therefore particularly important that elected officials engage in solidarity with their constituents in this manner because individual citizens lack the capacity to establish and govern public health institutions, and more importantly, have deferred authority to do these things to those in government through the democratic process.The delivery and maintenance of effective public health programmes relies on most members of lasix side effects in humans a community engaging in solidarity in a range of ways. To illustrate, vaccination programmes cannot deliver herd immunity without mass participation from community members, but individuals cannot contribute to herd immunity if treatments are prohibitively expensive, or only available at an inaccessible venue.

They are also unlikely lasix side effects in humans to contribute if they have been misled into believing that treatments are dangerous or unnecessary. Here, engagement in solidarity is required from both private individuals, who must participate in the programme, and elected officials, who must ensure it is accessible to all members of a community, and provide an epistemic context in which the importance and safety of the programme is widely understood, in order for it to be effective.Solidarity and hypertension medicationsIn his opening remarks to a press briefing on 18 March 2020, Tedros Adhanom Ghebreyesus, Director-General of WHO stated that “(the) spirit of solidarity must be at the centre of our efforts to defeat hypertension medications”.2 Similar statements have also been made by a number of other agencies, each of which have emphasised solidarity’s role as an essential part of an effective public health response.9 Correlatively, many governments have instituted lockdowns, and are enforcing social distancing measures (to greater or lesser extent) in order to limit the spread of . We have all thereby been asked, even instructed, to avoid public gatherings, minimise lasix side effects in humans our contact with others and help to protect our neighbours.

In so doing, we engage in solidarity with our compatriots.For private individuals, engaging in solidarity with their peers in response to hypertension medications is thus very similar to such engagement for public health under normal circumstances—participation in public health programmes, social distancing, community cooperation, and contributing through taxation to the cost of public health efforts and medical research. Elected officials lasix side effects in humans can do these things as individuals, but can also respond in their role as public officials in at least two additional ways. First, by collaborating with other governments to share information, and coordinate regional and global public health responses.10 Second, by ensuring that NHS exist and are adequately funded, staffed and equipped to be able to respond to the lasix, and by providing clear information and support to citizens so that they may engage in solidarity with one another.There has been great variation in the extent to which different regions have achieved engagement in solidarity across these vectors.

New Zealand and South Korea both implemented thorough testing and tracing programmes which allowed them to counteract the spread of (and in South Korea, also reduced influenza s), while New Zealand also imposed strict lockdown lasix side effects in humans protocols, going as far as closing its borders.11 12 Equally importantly, officials in both locations acted quickly, and communicated clearly with their communities, ensuring that residents knew how to minimise the risk of transmission, and why doing so was important. Individual members of these communities were thus able to engage in interpersonal solidarity, by following lockdown rules, maintaining social distancing, and participating in track and trace programmes, because their governments had proactively established the material and epistemological conditions where such engagement was enabled, empowered and encouraged. By doing so, the New Zealand and South Korean governments lasix side effects in humans thus engaged in solidarity with their constituents.In contrast, the current British government’s response to hypertension medications lacked the transparency, clarity and urgency which characterised the actions of these more successful nations.

First, while the UK and New Zealand each initiated lockdowns in the same week in late March, New Zealand at that stage had only 102 cases of hypertension medications, with no deaths, compared with the UK’s total of 5687 cases and 281 deaths.12 13 Correlatively, while South Korea did not enforce a strict lockdown, it had enacted social distancing policies even earlier, at the end of February.11 The risk of ongoing transmission was therefore significantly higher in the UK than in either nation at this time.Second, communication from the current British government was often unclear, and the prime minister and other officials frequently downplayed the severity of the lasix—at one point the prime minister (who was later hospitalised with hypertension medications) stated that he would not refrain from shaking hands, and that he had recently shaken hands with everyone in a hypertension medications ward.14 In this way, the risks of hypertension medications were initially minimised in official communications, creating uncertainty about how to act, and which guidance to follow. Exacerbating this issue, where advice was given, it lasix side effects in humans was initially often discretionary, and little material support was made available to enable people to follow it. For example, on 16 March 2020, people were advised to work from home if possible and avoid social venues, such as pubs and theatres.15 However, this was not mandatory, and social venues were not required to close until 20 March, so some employees were required to work onsite, despite known risks.16Correlatively, no support was initially made available to those who could not work remotely, meaning that choices had to be made between employment and ‘fighting the lasix’.

Financial support was later made available, in the form of the government’s job retention scheme, which allowed employers to furlough non-essential workers, the wages of whom would lasix side effects in humans be subsidised by government.17 However, this only covered 80% of employee wages, meaning that many of those furloughed would have to live on a reduced income. Likewise, while support has been offered to home owners in the form of mortgage holidays, at the time of writing, renters have not received similar assistance.18Third, the government also initially moved to adopt a strategy that deviated from the recommendations of the WHO, which focused on minimising rates through conventional public health measures, such as active testing, social distancing and increased emphasis on personal hygiene (hand washing, etc).19 In contrast, the government initially endorsed a ‘herd immunity’ strategy, which appeared to focus on allowing approximately 60% of the British population to become infected with the lasix, which would have led to an even higher level of excess mortality.20 Despite the eventual rejection of this strategy in favour of closer adherence to WHO guidelines, at the time of writing the UK has the world’s second highest hypertension medications mortality rate.21 Further, the consequences of these policy choices were compounded because of the historical policy context in which they occur. In the last decade the NHS has seen a significant reduction in funding as a result of austerity policies.22 Consequently, many NHS trusts have found it extremely difficult to respond safely and effectively to the crisis, because of lack of resources (in terms of people, money and equipment)—the absence of sufficient personal protective equipment for those lasix side effects in humans treating patients with hypertension medications being particularly notable.23The current British government’s response to hypertension medications therefore deviated significantly from those of nations with more successful responses, and from WHO guidance.

In doing so, it established an epistemological and financial context where it was difficult for individuals to afford to follow public health guidelines, or to even know exactly what those guidelines required. As I lasix side effects in humans argued above, the successful delivery and maintenance of public health programmes requires engagement in solidarity from both private individuals, and government officials. Engagement in solidarity by the latter entails legislating for the delivery and management of effective public health programmes, and providing clear guidance for their constituents to follow.Unlike their counterparts in New Zealand and South Korea, the current British government has failed to achieve either of these objectives, though it should be noted, that there have also been high profile instances of individual agents in the UK failing to engage in solidarity with their communities.24 However, these solidarity failures must be considered in context.

Arguably some lasix side effects in humans failures of individuals to engage in solidarity may at least in part be attributed to governmental failures to deliver an effective public health response to hypertension medications, or communicate its importance and requirements. It has been noted, for example, that panic buying and stockpiling can be sensible strategies in times of potential social chaos and market disruption—especially when told by the government that a total social lockdown may imminently limit access to necessities.25 In each of these cases, the individuals concerned do have duties of solidarity (as well as professional duties, in the case of healthcare workers) to their compatriots and communities, and failure to fulfil them may cause harm. However, the costs and challenges of fulfilling those duties have been amplified (and in the case of the professional duties of healthcare workers dangerously so) by the government’s failure to fulfil its own responsibilities of solidarity.ConclusionEffective public health programmes cannot rely solely on private individuals lasix side effects in humans always engaging in interpersonal solidarity in an optimal fashion.

Private citizens all operate under epistemological constraints—we may not know of the needs of others with whom we would engage in solidarity if we had more complete information, or we may be honestly mistaken about the best way to engage in solidarity with people we do know about. Alternatively, we may know of the needs of others, lasix side effects in humans but face material constraints which make providing significant assistance to them impossible. Governments must therefore engage in solidarity with their constituents by providing the epistemological, institutional, material and financial resources, which compensate for these constraints and thus make interpersonal solidarity possible.

By failing lasix side effects in humans to do so, the current British government has failed to adequately protect the residents of the UK in a time of crisis. It has thus failed to engage in solidarity with its constituents, and effectively devolved responsibility for action to agents with far less power to deliver an effective response to hypertension medications. Further and importantly, those thus tasked with responding to the lasix are disempowered in part because of the failures of the government.Had the government’s failures in response to hypertension medications occurred despite the early adoption of recommended strategies proven to work elsewhere, they would not count lasix side effects in humans as failures of solidarity, but of policy—as unfortunate consequences of mistakes made under challenging circumstances, despite a good faith effort to achieve the best possible outcome.

The government’s actions became failures of solidarity when it ignored compelling and accessible information about how best to respond to the crisis, and did not take actions that they could and should have taken. Further, by failing to provide either definitive rules, or sufficient material and financial lasix side effects in humans support, the government devolved responsibility for responding to the crisis to their constituents and expected them to each individually act in the correct manner to prevent the spread of —an unrealistic expectation. As discussed above, private individuals operate under significantly stricter financial, social and epistemological constraints than their elected representatives, constraints which in this instance were exacerbated by the actions of those in power.

Even under ideal conditions (that is, in the absence of material and epistemological constraints), reliance on mass lasix side effects in humans individual choices delivering an appropriate response to hypertension medications would not be an effective strategy. To rely on such a strategy where such constraints are present is mistaken, and arguably avoidably so. It is also a dereliction of the government’s responsibilities to its constituents.Importantly therefore, the government’s actions represent more than mere failure lasix side effects in humans to adequately protect its constituents.

By devolving responsibility for action to those without sufficient power to act, the government’s actions should be recognised both as a failure of solidarity, and as a dereliction of it. Indeed, where engagement in solidarity by the government has occurred, it has frequently been delayed, insufficient or reluctantly lasix side effects in humans provided, contributing to the significant excess mortality and morbidity experienced by the UK.21A government which fails to engage in solidarity with its constituents, makes an implicit statement about the nature of the relationship between itself and the rest of society. In doing so, and in abdicating their responsibilities to their constituents while simultaneously expecting them to collectively deliver an effective response to hypertension medications, they redefine that relationship, from being one of elected representatives and constituents, to one of rulers and ruled.There are two ways to interpret the phrase ‘solidarity is for other people’.

First, it can be read as a statement of closeness and relationality—an expression of the understanding that solidarity is something we lasix side effects in humans engage in to assist or benefit other people with whom we identify. Second, it can be understood as an assertion that the speaker holds themselves apart from other people—a claim that solidarity is something that other people should or may do, but that is not something with which the speaker is concerned. Sadly, recent events suggest that we must give serious consideration to the idea that it is this second interpretation which more accurately reflects the attitudes of the British government at this time.AcknowledgmentsThe author thanks Dr Agomoni Ganguli-Mitra for her very helpful comments on an earlier version of this paper..

In this issue of the Journal of Medical Ethics cheap generic lasix arguments are cogently made that sustainability and solidarity should be considered as core medical ethical principles, and http://scaeyc.net/alternative-communities-in-a-time-of-crisis-susan-bernheimer-ph-d/ that more explicit attention should be given to the complex context in which a decision is made.Munthe et al propose that sustainability should become an established principle for justifying healthcare resource allocation, and should be an explicit factor in procuring drugs and other resources.1 They argue that the current operational norms which guide decision making (need, prognosis, equal treatment and cost-effectiveness) can lead to what they call ‘negative dynamics’. The gradual depletion of resource available for healthcare.They illustrate this first by examining some well recognised examples of ‘positive dynamics’ which are considered in health policy. Immunisation programmes are funded because lead to reduction or absence of disease in the population, thus cheap generic lasix freeing up resource for other uses. Public health measures are offset by future cost reductions or income increases for healthcare via reduction of sick leave.‘Negative dynamics’ however, are not routinely considered in operational decisions and they persuasively argue that they should be.

Resource depletion (not only fiscal resource, but environmental and human resource) has a negative effect on future cheap generic lasix cycles of healthcare. As an illustrative example, they discuss the emission of resistance-driving residue in the production of antibiotics. The accepted principles, particularly cheap generic lasix of cost effectiveness, drive producers to make antibiotics cheaply, without consideration of gradual contribution to antibiotic resistance. If a principle of sustainability was included when considering procurement, subsidy and prioritisation, this would provide an incentive to change production practices.

This argument can be extended to many aspects of cheap generic lasix the healthcare. System including how we recruit, train and treat our staff. How we invest in infrastructure and how we cheap generic lasix plan for lasixs. Munthe et al go on to provide a robust definition of their sustainability principle, and to address possible objections.

It is an excellent example of reasoned ethical argument which has the potential to change clinical cheap generic lasix practice.With the roll out of vaccinations for hypertension medications across the globe, Julian Savulescu proposes an algorithm for when mandatory vaccination might be ethically justified.2 Drawing and expanding upon the 2007 Nuffield Council of Bioethics report he suggests that four criteria are required. 1. There is a cheap generic lasix grave threat to public health 2. The treatment is safe and effective 3.

Mandatory vaccination has a superior cost/benefit profile compared with other alternatives cheap generic lasix 4. The level of coercion is proportionate. Discussing the value judgement associated with each criterion, he concludes that, at least initially (where uncertainty around safety is greater), mandatory vaccination for hypertension medications would be ethically problematic.He goes on to explore alternative cheap generic lasix approaches, including non-financial (eg, immunisation passports) and financial incentives. He argues that individuals could essentially be paid for the risk they are undertaking (by being early adopters of a treatment) for societal benefit, but to do this government would need to be ‘transparent, explicit and comprehensive in disclosure of data’, a standard which unfortunately has not always (or even often?.

) been kept cheap generic lasix. The danger that payment might signal a lack of confidence in safety is real. Clearly payment cheap generic lasix should only be offered for a treatment which was considered safe enough to be used in any circumstances. Payment for a treatment which was not considered safe without payment would not be morally acceptable.

Payment may cheap generic lasix also erode the sense of solidarity that people feel when contributing to societal well-being. To ensure that this was maintained he suggests the option of ‘donating back’ the fee to the NHS could be made available. People could be rewarded for taking the treatment with an increasing sense of civic duty as they not only protect themselves and cheap generic lasix the vulnerable, but contribute to the (fiscal) sustainability of the health service which treats them.While Savulescu acknowledges the worth of solidarity, Avery Kolers proposes that solidarity plays not just an auxillary part in the interests of acknowledged bioethical values (justice, beneficence etc) but has a freestanding role, which should be independently assessed.3 He acknowledges that solidarity per se is not valuable. There is solidarity, he notes, among a firing squad and within a terrorist cell.

He develops Prainsack and Buyx metaphor of solidarity as the putty of justice4 and suggests five individually necessary and sufficient conditions of cheap generic lasix morally valuable solidarity. It must be (1) norm grounded (2) acknowledged (3) political (4) action and (5) on others’ behalf. He suggests that solidarity (with X) is morally required ‘when it constitutes equitable treatment of X such cheap generic lasix as to countermand or resist inequitable treatment of X’. He notes that moral dilemmas may arise where solidarity with X may lead to inequitable treatment of Y and emphasises that solidarity with the most vulnerable in society will help address inequities in healthcare and in healthcare institutions.The complexities and competing moral demands of healthcare institutions, and primary care in particular, are explored by Spicer et al, who question the use of normative moral theories to determine the ‘best’ actions.5 They argue that the context in which ethical decisions are made is not sufficiently acknowledged.

If complex contextual factors are not considered, then predictions about outcomes will be flawed, as will the resulting ethical analyses.Examples of contextual factors cheap generic lasix which might influence decision-making include power relations within the staff and external regulators (including achieving externally determined quality markers and ‘standard’ practice) and the need to maintain both group and individual professional identities.It is often helpful to peel back the layers of complexity in order to reveal a specific ethical question. Before coming to a conclusion, however, we must remember to reapply the layers and reconsider the question in the context of its complex environment. Integrating this proposal with others in the journal, this might include considerations of sustainability and solidarity.IntroductionWhile the role and cheap generic lasix importance of solidarity has been the focus of long-running and extensive debate surrounding public health ethics and practice,1 the hypertension medications lasix has cast this debate into even starker relief.2 In doing so, it has emphasised the particular importance of solidarity for the delivery of effective public health programmes by highlighting the potentially disastrous consequences of its absence. In this paper I examine these consequence with reference to the response of the current British government to hypertension medications which failed to deliver an effective public health response to the crisis.

I argue that this response represents mismanagement of a public health crisis, and a rejection of important democratic norms and values.Defining solidaritySolidarity has a wide range of definitions in academic discourse, with its precise features being the subject of heated debate.3 4 Historically, solidarity has been seen as emerging most readily, and most often between persons sharing relatively stable, deeply ingrained qualities, such as shared membership of a state or religious group,5 or commitment to shared political ideals and objectives.6 7 More recently, it has been suggested that more transient, or less deeply ingrained features of persons may serve as the basis for acts of solidarity, and at least short-term solidarity relationships.4 On a larger scale, it has also been suggested that recognition of shared vulnerability in the face of global threats to health, such as climate change and antimicrobial resistance, may serve as a catalyst for solidarity between nations and peoples.8 As I explain below, this perspective is particularly relevant to the current lasix context.2In this paper I rely mainly on the definition of solidarity offered by Prainsack and Buyx, who define solidarity as ‘enacted commitments to accept costs to assist others with whom a person or persons recognise similarity in a relevant respect’.4 Therefore, solidarity cheap generic lasix describes what it is that we do when we assist, benefit or support other people because we recognise some form of relevant similarity or connection with/to them. Thus solidarity is active, in that it is something we do, not merely a feeling or attitude. It is also egalitarian, with motivation for action being grounded in recognition of what is shared between parties, not in what distinguishes them.3 Finally, acting in solidarity also involves incurring of costs of some kind, though these may be extremely minimal, or be counterbalanced by the benefits of a given solidarity action.Prainsack and Buyx argue that there are three main ‘tiers’ of solidaristic cheap generic lasix action. Interpersonal, group and institutional solidarity.4 The first of these tiers describes what happens between individual persons.

For example, Prainsack and Buyx suggest that giving up one’s seat on a crowded bus for cheap generic lasix a pregnant fellow passenger is an act of solidarity when based on recognition of shared experience of discomfort while standing during pregnancy.4 The second tier ‘comprises manifestations of a shared commitment to carry costs to assist others with whom people consider themselves bound together through at least one similarity in a relevant respect’. These group solidarities occur when many individuals share a similar specific context, and engage in actions to benefit others with whom the context is shared. Such solidarity is informal, though it may also be cheap generic lasix heavily normalised within a given community, such that it forms an expectation of behaviour.Tier 3 solidarity comprises formalised, or legally mandated expectations of behaviour. Here, solidarity is fully institutionalised, ‘in the form of legally enforceable norms’,4 such as progressive tax systems and welfare state arrangements.

For example, the British National Health Service (NHS) exemplifies institutionalised solidarity, because cheap generic lasix it is funded through taxation and provides healthcare to citizens and legal residents of the UK, regardless of their ability to pay. According to Prainsack and Buyx, these three tiers of solidarity are closely connected, with tier 3 solidarity typically emerging from solidarity at tiers 1 and 2. Correlatively, Sangiovanni discusses the participation in collaborative institutions as solidaristic practice when he argues that solidarity cheap generic lasix is grounded in ‘our joint action as authors of political and social institutions’.7 Thus, for Sangiovanni solidarity is something which emerges from shared online lasix prescription participation in the construction and enactment of civic society. Solidarity can therefore be interpreted in a range of ways—as the act of carrying costs for relevantly similar others, ‘standing up for’, ‘standing up with’ and ‘standing up as’’ those persons with whom solidarity is identified,3 or the act of working together for a shared goal.7 Regardless of the precise definition adopted, at least basic solidarity, as active engagements in interpersonal and/or institutional egalitarian relationality, by all or most members of a group is fundamentally necessary for the existence and functioning of any community—as I explain below, it is particularly important in democracies.Solidarity and public healthIn normal circumstances, private individuals can engage in interpersonal and group solidarity in the context of public health provision, by avoiding social interaction when sick and helping others to do the same, by purchasing groceries for an ill neighbour, for example.

Individuals can engage in tier 3 solidarity by participating in institutions which promote and protect public and individual health cheap generic lasix. For example, participation in fair taxation schemes can help fund health and welfare programmes, such as the British NHS, ensuring the accessibility of these services to all members of a given community, thereby contributing to public health and individual well-being.Correlatively, while elected and appointed governmental officials, such as cabinet ministers, can also engage in solidarity in the same way as their constituents, they also have additional responsibilities in virtue of their public role and status as elected representatives of their communities. These responsibilities include things like cheap generic lasix enacting legislation which establishes and maintains institutions and programmes which promote and protect health. Such actions protect the health of their constituents, and they enable those constituents to more effectively engage in solidarity with their peers, by providing the systems necessary to do so most effectively, and guidance as to the reasons for so doing.

It is therefore particularly important that elected officials engage in solidarity with their constituents in this manner because individual citizens lack the capacity to establish and govern public health institutions, and more importantly, have deferred authority to do these things to those in government through the democratic process.The delivery and maintenance of effective public health programmes relies on most members of a community engaging in solidarity cheap generic lasix in a range of ways. To illustrate, vaccination programmes cannot deliver herd immunity without mass participation from community members, but individuals cannot contribute to herd immunity if treatments are prohibitively expensive, or only available at an inaccessible venue. They are also unlikely to contribute if they have been misled into believing that treatments are cheap generic lasix dangerous or unnecessary. Here, engagement in solidarity is required from both private individuals, who must participate in the programme, and elected officials, who must ensure it is accessible to all members of a community, and provide an epistemic context in which the importance and safety of the programme is widely understood, in order for it to be effective.Solidarity and hypertension medicationsIn his opening remarks to a press briefing on 18 March 2020, Tedros Adhanom Ghebreyesus, Director-General of WHO stated that “(the) spirit of solidarity must be at the centre of our efforts to defeat hypertension medications”.2 Similar statements have also been made by a number of other agencies, each of which have emphasised solidarity’s role as an essential part of an effective public health response.9 Correlatively, many governments have instituted lockdowns, and are enforcing social distancing measures (to greater or lesser extent) in order to limit the spread of .

We have all cheap generic lasix thereby been asked, even instructed, to avoid public gatherings, minimise our contact with others and help to protect our neighbours. In so doing, we engage in solidarity with our compatriots.For private individuals, engaging in solidarity with their peers in response to hypertension medications is thus very similar to such engagement for public health under normal circumstances—participation in public health programmes, social distancing, community cooperation, and contributing through taxation to the cost of public health efforts and medical research. Elected officials can do these things as individuals, but can also respond in their role as cheap generic lasix public officials in at least two additional ways. First, by collaborating with other governments to share information, and coordinate regional and global public health responses.10 Second, by ensuring that NHS exist and are adequately funded, staffed and equipped to be able to respond to the lasix, and by providing clear information and support to citizens so that they may engage in solidarity with one another.There has been great variation in the extent to which different regions have achieved engagement in solidarity across these vectors.

New Zealand and South Korea both implemented thorough testing and tracing programmes which allowed them to counteract the spread of (and in South Korea, also reduced influenza s), while New Zealand also imposed strict lockdown protocols, going as far as closing its borders.11 12 Equally importantly, officials in both locations acted quickly, and communicated clearly with their communities, ensuring that residents knew how to minimise the risk of transmission, and why doing so cheap generic lasix was important. Individual members of these communities were thus able to engage in interpersonal solidarity, by following lockdown rules, maintaining social distancing, and participating in track and trace programmes, because their governments had proactively established the material and epistemological conditions where such engagement was enabled, empowered and encouraged. By doing so, the New Zealand and South Korean governments thus engaged in solidarity with their constituents.In contrast, the current British government’s response to hypertension medications lacked the transparency, clarity and urgency which characterised the actions of cheap generic lasix these more successful nations. First, while the UK and New Zealand each initiated lockdowns in the same week in late March, New Zealand at that stage had only 102 cases of hypertension medications, with no deaths, compared with the UK’s total of 5687 cases and 281 deaths.12 13 Correlatively, while South Korea did not enforce a strict lockdown, it had enacted social distancing policies even earlier, at the end of February.11 The risk of ongoing transmission was therefore significantly higher in the UK than in either nation at this time.Second, communication from the current British government was often unclear, and the prime minister and other officials frequently downplayed the severity of the lasix—at one point the prime minister (who was later hospitalised with hypertension medications) stated that he would not refrain from shaking hands, and that he had recently shaken hands with everyone in a hypertension medications ward.14 In this way, the risks of hypertension medications were initially minimised in official communications, creating uncertainty about how to act, and which guidance to follow.

Exacerbating this issue, where advice was cheap generic lasix given, it was initially often discretionary, and little material support was made available to enable people to follow it. For example, on 16 March 2020, people were advised to work from home if possible and avoid social venues, such as pubs and theatres.15 However, this was not mandatory, and social venues were not required to close until 20 March, so some employees were required to work onsite, despite known risks.16Correlatively, no support was initially made available to those who could not work remotely, meaning that choices had to be made between employment and ‘fighting the lasix’. Financial support was later made available, in the form of the government’s job retention scheme, which allowed employers to furlough non-essential workers, the wages of whom would be subsidised by government.17 However, this only covered 80% of employee wages, cheap generic lasix meaning that many of those furloughed would have to live on a reduced income. Likewise, while support has been offered to home owners in the form of mortgage holidays, at the time of writing, renters have not received similar assistance.18Third, the government also initially moved to adopt a strategy that deviated from the recommendations of the WHO, which focused on minimising rates through conventional public health measures, such as active testing, social distancing and increased emphasis on personal hygiene (hand washing, etc).19 In contrast, the government initially endorsed a ‘herd immunity’ strategy, which appeared to focus on allowing approximately 60% of the British population to become infected with the lasix, which would have led to an even higher level of excess mortality.20 Despite the eventual rejection of this strategy in favour of closer adherence to WHO guidelines, at the time of writing the UK has the world’s second highest hypertension medications mortality rate.21 Further, the consequences of these policy choices were compounded because of the historical policy context in which they occur.

In the last decade the NHS has seen a significant reduction in funding as a result of austerity policies.22 Consequently, many NHS trusts have found it extremely difficult to respond safely and effectively to the crisis, because of lack of resources (in terms of people, money and equipment)—the absence of sufficient personal protective equipment for those treating patients with hypertension medications being particularly cheap generic lasix notable.23The current British government’s response to hypertension medications therefore deviated significantly from those of nations with more successful responses, and from WHO guidance. In doing so, it established an epistemological and financial context where it was difficult for individuals to afford to follow public health guidelines, or to even know exactly what those guidelines required. As I argued above, the successful delivery and maintenance of public health cheap generic lasix programmes requires engagement in solidarity from both private individuals, and government officials. Engagement in solidarity by the latter entails legislating for the delivery and management of effective public health programmes, and providing clear guidance for their constituents to follow.Unlike their counterparts in New Zealand and South Korea, the current British government has failed to achieve either of these objectives, though it should be noted, that there have also been high profile instances of individual agents in the UK failing to engage in solidarity with their communities.24 However, these solidarity failures must be considered in context.

Arguably some failures of individuals to engage in solidarity may at least in part cheap generic lasix be attributed to governmental failures to deliver an effective public health response to hypertension medications, or communicate its importance and requirements. It has been noted, for example, that panic buying and stockpiling can be sensible strategies in times of potential social chaos and market disruption—especially when told by the government that a total social lockdown may imminently limit access to necessities.25 In each of these cases, the individuals concerned do have duties of solidarity (as well as professional duties, in the case of healthcare workers) to their compatriots and communities, and failure to fulfil them may cause harm. However, the cheap generic lasix costs and challenges of fulfilling those duties have been amplified (and in the case of the professional duties of healthcare workers dangerously so) by the government’s failure to fulfil its own responsibilities of solidarity.ConclusionEffective public health programmes cannot rely solely on private individuals always engaging in interpersonal solidarity in an optimal fashion. Private citizens all operate under epistemological constraints—we may not know of the needs of others with whom we would engage in solidarity if we had more complete information, or we may be honestly mistaken about the best way to engage in solidarity with people we do know about.

Alternatively, we may know of the needs of others, but face material constraints which make providing significant cheap generic lasix assistance to them impossible. Governments must therefore engage in solidarity with their constituents by providing the epistemological, institutional, material and financial resources, which compensate for these constraints and thus make interpersonal solidarity possible. By failing to do so, the current British cheap generic lasix government has failed to adequately protect the residents of the UK in a time of crisis. It has thus failed to engage in solidarity with its constituents, and effectively devolved responsibility for action to agents with far less power to deliver an effective response to hypertension medications.

Further and importantly, those thus tasked with responding to the lasix are disempowered in part because of the failures of the government.Had the government’s failures in response to hypertension medications occurred despite the early adoption of recommended strategies proven to work elsewhere, they would not count as failures of solidarity, but of policy—as unfortunate consequences of cheap generic lasix mistakes made under challenging circumstances, despite a good faith effort to achieve the best possible outcome. The government’s actions became failures of solidarity when it ignored compelling and accessible information about how best to respond to the crisis, and did not take actions that they could and should have taken. Further, by failing to provide either definitive rules, or sufficient material and financial support, the government devolved responsibility for responding to the crisis to their constituents and expected them to each individually act in the cheap generic lasix correct manner to prevent the spread of —an unrealistic expectation. As discussed above, private individuals operate under significantly stricter financial, social and epistemological constraints than their elected representatives, constraints which in this instance were exacerbated by the actions of those in power.

Even under ideal conditions (that is, in the absence of material cheap generic lasix and epistemological constraints), reliance on mass individual choices delivering an appropriate response to hypertension medications would not be an effective strategy. To rely on such a strategy where such constraints are present is mistaken, and arguably avoidably so. It is also a dereliction of the government’s responsibilities to its constituents.Importantly therefore, the government’s actions represent more than mere failure to adequately cheap generic lasix protect its constituents. By devolving responsibility for action to those without sufficient power to act, the government’s actions should be recognised both as a failure of solidarity, and as a dereliction of it.

Indeed, where engagement cheap generic lasix in solidarity by the government has occurred, it has frequently been delayed, insufficient or reluctantly provided, contributing to the significant excess mortality and morbidity experienced by the UK.21A government which fails to engage in solidarity with its constituents, makes an implicit statement about the nature of the relationship between itself and the rest of society. In doing so, and in abdicating their responsibilities to their constituents while simultaneously expecting them to collectively deliver an effective response to hypertension medications, they redefine that relationship, from being one of elected representatives and constituents, to one of rulers and ruled.There are two ways to interpret the phrase ‘solidarity is for other people’. First, it can be read as a cheap generic lasix statement of closeness and relationality—an expression of the understanding that solidarity is something we engage in to assist or benefit other people with whom we identify. Second, it can be understood as an assertion that the speaker holds themselves apart from other people—a claim that solidarity is something that other people should or may do, but that is not something with which the speaker is concerned.

Sadly, recent events suggest that we must give serious consideration to the idea that it is this second interpretation which more accurately reflects the attitudes of the British government at this time.AcknowledgmentsThe author thanks Dr Agomoni Ganguli-Mitra for her very helpful comments on an earlier version of this paper..

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