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There’s no propecia price canada doubt about it–parenting is not for the faint of heart. One moment your child is hearing perfectly well and the next?. He may be fussy and feverish or complaining that things “sound funny” or clogged. Is it time to propecia price canada call the doctor?. Maybe.

Here are four of the most common causes of temporary hearing loss in children and what you should do if they occur.1. Middle ear An ear exam can help reveal suddencauses of hearing loss in propecia price canada kids. According to the National Institute on Deafness and Other Communication Disorders (NIDCD), five of every six children will have at least one middle ear by their third birthday. In fact, ear s are the most common reason parents take their child to the doctor. The good news is, although they can cause your child a lot of discomfort and hearing loss, ear s usually clear up on their own without any permanent damage to the hearing, although you should always check propecia price canada with your child's doctor.

The most common type of ear among children is known as acute otitis media (AOM). This occurs when parts of the middle ear become infected and swollen, trapping fluid behind the eardrum. If your child isn’t old enough to tell you they have an earache, propecia price canada look for these symptoms. Tugging or pulling on the ear Crying and or general fussiness Problems sleeping Fever Fluid draining from the ear Balance issues Problems hearing or responding What to do about ear s Ear s are usually caused by bacteria from your child’s cold or sore throat that spread to the middle ear. Some methods that can help your child feel more comfortable include.

Pain relievers, given according to direction and especially at bedtime to help your child get restful sleep Warm compress, such as a washcloth rinsed in warm water Lots of rest to help the body propecia price canada fight Your child may need antibiotics. Check in with your child's doctor to see if they recommend treatment. 2. Swimmer's ear If your child has been swimming recently—especially in non-chlorinated water propecia price canada like a lake or pond—it could be swimmer's ear, a type of of the ear canal. It can be quite painful and cause muffled hearing.

Children who are prone to getting water stuck in their ears may be more likely to develop swimmer's ear. What do about swimmer's ear Keep the affected ear dry and clean Do not insert anything into the ears See a propecia price canada doctor to get antibiotic ear drops Follow your doctor's instructions for treating your child's pain 3. Impacted earwax It’s hard to believe, but earwax serves a purpose. Not only does its waterproof properties help protect the eardrum and ear canal, it also traps dirt, dust and other particles from entering the ear and irritating the eardrum. Here’s another propecia price canada shocker.

The body produces just as much earwax as it needs and knows how to get rid of the excess. It’s OK to use a washcloth to gently clean your child’s ear, but please don’t use cotton swabs or any other object to reach any accumulation you might see in the ear canal. These objects can actually push the earwax further into the ear canal and/or puncture propecia price canada the eardrum, causing more harm than good. What to do If your child complains he can’t hear well or sound is muffled, he may have an excess of earwax that is blocking the ear canal and preventing him from hearing well. In that case, make an appointment with your family doctor.

If the earwax is causing pain or interfering with your child’s hearing, propecia price canada she will be able to remove the excess safely in just a few minutes. If it’s not earwax, it might be another type of obstruction. 4. Other obstructions By their very nature, kids propecia price canada are curious. As infants, they stick everything they can find into their mouths.

When they get a little older, they start discovering other body orifices to explore and may curiously try to see if something fits where it doesn’t belong–like in their ears. Common objects include pebbles, propecia price canada beans and small candies. Although it’s very normal for them to explore in this manner, it can lead to swelling, and temporary hearing loss. How can you tell if your child has put something into his ear?. You may propecia price canada not be able to immediately.

If the object is lodged far enough into the ear canal, you may not notice until your child complains of an earache or that things sound “funny.” You may possibly see some discharge from the ear, although not always. What to do If you suspect your child has something stuck in his ear. Remain propecia price canada calm. If your child is old enough to speak, ask them if they put something in their ear. Reassure them they are not in trouble and explain that it’s important to remove the object so they can hear.

Do not try to remove the object propecia price canada yourself, even if you can see it. You may push the object deeper into the ear canal and damage the eardrum. Call your doctor immediately. If she is not available to see your propecia price canada child, take them to the nearest walk-in clinic or emergency room. Let the medical professionals decide the best way to remove the object.

Afterward, they may prescribe antibiotics to prevent . It’s common for your child to be frightened at the thought of going to the doctor, propecia price canada especially when it’s a problem they caused. You can reassure them by explaining that removing the object won’t involve a shot or painful procedures. Ask your doctor or emergency room professional to explain any instruments they use before they begin the removal. To keep propecia price canada your child’s hearing in tip-top shape Wash little ears daily with a soft washcloth and warm water.

Do not insert anything into the ear canal, such as a cotton swab or hairpin, to remove earwax or other debris. Be mindful of hearing milestones and have your child’s hearing evaluated if they seem to have learning delays related to speech and language development. Model good propecia price canada communication skills. Be attentive and affirming, eliminate distractions such as cell phones and other electronic equipment, make eye contact and smile. Children are great mimics.

When you propecia price canada make hearing and communication a priority in your home, you instill good habits that will last them a lifetime. If you are concerned about your child's hearing ability, please find a hearing care professional in your area who specializes in pediatric hearing testing. Hearing testing can be done at any age and many children find it quite fun!. An experimental propecia price canada hearing loss drug that's delivered directly into the eardrum is moving slowly through the drug development pipeline, pointing to the challenges of treating hearing loss using novel medicines.This also means that if you have untreated hearing loss, hearing aids and other assistive listening devices are still the best treatment for sensorineural hearing loss for the foreseeable future. The experimental drug is delivered viainjection into the middle ear, whereit is absorbed by the inner ear.

The drug, dubbed FX-322, is given via injection into the ear drum. Researchers with Massachusetts-based Frequency Therapeutics are studying if it propecia price canada can successfully and safely convert stem cells into stereocilia, the hair cells in the cochlea that are responsible for hearing. The researchers are conducting several ongoing studies for different types of hearing loss, including age-related hearing loss. Disappointing trial results so far But so far, results have been lukewarm. Some of the trials are moving slowly in phase 1, in which researchers are mainly testing safety and dosing on a very small group of propecia price canada people.

One trial progressed to phase 2a, meaning they explored the drug's safety and effectiveness in more depth. That one is unlikely to move forward to a phase 2b trial given the disappointing results. In general, as reported by biotech news site Evaluate, the FX-322 propecia price canada trial results have largely been lackluster. In fact, Bloomberg Law reported in summer 2021 that investors have filed suit against the company for making false claims about the clinical trials. No cure yet Trials are an important contribution to research on reversing certain types of sensorineural hearing loss, one of the most common forms of hearing loss among the 48 million Americans who report some degree of hearing impairment.

Specifically, sensorineural hearing loss is caused by damage to hair cells of the inner ear and/or the auditory nerve that connects the ear to the brain propecia price canada. Damage can be caused by genetic disorders, the aging process and/or from either a one-time or prolonged exposure to excessive noise. Learn more about how we hear and the auditory system. Currently, sensorineural hearing loss is typically treated with hearing aids or cochlear implants, which work with a person's remaining sense of hearing propecia price canada to amplify sounds. Although today’s digital hearing devices are more effective than they were years ago, they do not restore the sense of hearing to its normal state.

There is no best medicine for hearing loss related to noise exposure. For sudden hearing loss, steroids are the medicine of choice.

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Explore full-page version The number buy propecia walgreens of newly completed hair loss treatment vaccinations in rural counties has declined for the third consecutive week. Newly completed vaccinations fell by about 20% last week compared to two weeks ago. Rural (nonmetropolitan) counties reported 166,000 newly completed vaccinations the week of Friday, October buy propecia walgreens 29, through Thursday, November 4, 2021.

That’s down from about 207,000 two weeks ago. Meanwhile, the number of newly completed vaccinations in metropolitan counties grew by more than 15% last week compared to two buy propecia walgreens weeks ago. Metropolitan counties reported 1.6 million newly completed hair loss treatment vaccinations last week, compared to 1.4 million two weeks ago.

The rural vaccination rate rose by about 0.4 buy propecia walgreens percentage points, while the metropolitan rate grew by about 0.6 percentage points. The pace of new vaccinations in rural counties last week was the lowest since mid-August. As of November 4, 44.5% of the rural population had fully completed buy propecia walgreens hair loss treatment vaccination.

In metropolitan counties, the rate is 56.6%, or 12.1 percentage points higher. The Daily Yonder’s analysis of hair loss treatment vaccinations is based on buy propecia walgreens data from the Centers for Disease Control and Prevention and the state health departments of Hawaii, Massachusetts, and Texas. Like this story?.

Sign buy propecia walgreens up for our newsletter. Illinois had the highest increase in percentage of rural population vaccinated last week. But the growth of 2.9 percentage points (or about 43,000 completed vaccinations) was so high at least part of the growth is likely from administration changes in record-keeping.Minnesota had the next highest increase in new rural vaccinations with an increase of 1.8 buy propecia walgreens percentage points.Utah, California, and Arizona all had an increase in rural vaccination rates of at least 0.5 percentage points.West Virginia had the slowest rate of increase in rural vaccinations, at virtually zero percentage points (the state reported only 273 newly completed rural vaccinations).

West Virginia has a high rate of unallocated vaccinations, which lack geographic information. Therefore the actual number of rural vaccinations could have been slightly higher.Other states near the bottom in growth in rural vaccinations were Virginia, buy propecia walgreens Michigan, Nebraska, Massachusetts, Indiana, and Alaska. Each of those states increased their rural vaccination rate by 0.2 percentage points.Massachusetts had the highest rate of rural vaccinations.

Seventy-three percent of buy propecia walgreens the state’s rural population is completely vaccinated for hair loss treatment. Getting rural residents vaccinated in Massachusetts is a bit less complicated than in other parts of the U.S. The state has fewer than 100,000 residents who live in nonmetropolitan counties in the western part of the state.Connecticut, another state with a small rural population, had the next highest rural buy propecia walgreens vaccination rate at about 70%.Hawaii, Arizona, Maine, and New Hampshire all had rural vaccination rates above 60%.Georgia had the nation’s lowest rural vaccination rate (22.1% of the state’s rural population).

A large number of unallocated vaccinations means the actual rate is slightly higher.West Virginia had a rural vaccination rate of only 22.5% (but also had a high rate of unallocated vaccinations).Next lowest were Missouri, Alabama, Louisiana, Tennessee, Nebraska, and North Dakota. This article defines rural as nonmetropolitan, using data from buy propecia walgreens the 2013 Office of Management and Budget Metropolitan Statistical Area list. You Might Also LikeOver the past 30 years, fire departments in both urban and rural areas have struggled to recruit new firefighters into a profession that’s more than half volunteers.

In rural America, the propecia has brought the crisis buy propecia walgreens to a new apex. Rural firefighters have been on the front lines of the propecia, tackling wildfires and vehicle accidents even as they transport ill and injured residents to hospitals. hair loss treatment’s heavy toll on rural hospitals has extended to emergency responders, meaning firefighters are answering more medical calls than ever buy propecia walgreens before.

The increased workload, and the specter of treatment mandates, has made recruitment even tougher.And then there’s the trauma they’ve endured.The mass death and suffering of the past 20 months has spawned a surge of post-traumatic stress disorder, anxiety, depression, insomnia and substance use disorder among health care professionals of all kinds. Answering calls at the homes of relatives, friends and neighbors—which many buy propecia walgreens rural firefighters have had to do—magnifies the pain.“We’re still in this propecia, and we’re still fighting those emotions. It’s not [as if] it happened three years ago,” said Jeff Dill, founder of the Firefighter Behavioral Health Alliance, which runs mental health workshops for fire departments.

€œWe’ve had numerous firefighters that have taken their lives because of it—seeing and handling the stress and the depression and buy propecia walgreens the bodies that piled up.” Stateline Story March 15, 2021 ‘Why Do I Put My Life on the Line?. €™ propecia Trauma Haunts Health Workers. Quick View In many fire departments, the workers expected to endure buy propecia walgreens that stress don’t even receive paychecks.

Of more than 1.1 million firefighters nationwide, 67% are volunteers who are not paid or receive a minimal amount to cover gas and other expenses, according to a 2021 fact sheet by the National Volunteer Fire Council. Many of them buy propecia walgreens are in rural America. Nearly 40% of communities with between 5,000 and 9,999 residents had all-volunteer departments as of 2018, according to a tally released last year by the National Fire Protection Association.

In communities buy propecia walgreens with between 2,500 and 4,999 people, the percentage of all-volunteer departments was 72%, and 92% in towns of less than 2,500. Fire Chief J.T. Wallace Jr.

Of Benton Fire District No buy propecia walgreens. 4 in rural Louisiana said he does not have enough firefighters, paid or volunteer, to respond to structural fires. The community is small, but the population has buy propecia walgreens grown slightly in the past few years, making it harder to meet demand and staff the stations.

Recently, Wallace Jr. Had an entire shift of firefighters out because they buy propecia walgreens contracted hair loss treatment. Three firefighters have been diagnosed with post-traumatic stress disorder within the past year.“I think we didn’t lose community, but we were wounded in other ways psychologically.

It got pretty bad,” buy propecia walgreens Wallace Jr. Said. €œWe’ve seen stress buy propecia walgreens.

I’ve been doing this almost 50 years and this is a different ballgame with what we have to deal with.” Chris Smith, a lieutenant at the Bolivar County Volunteer Fire Department in Mississippi, has been a volunteer firefighter for 13 years. He likewise said the propecia has brought a new level buy propecia walgreens of stress to an already difficult job. The extra work is hard enough—firefighters responding to hair loss treatment-related calls must don special protective gear, for example.

Much worse has been responding to the calls of sick loved buy propecia walgreens ones, he said, which takes a heavy emotional toll. Smith volunteers 30 to 40 hours a week, in addition to working his full-time job as technical program manager of geospatial information technology at Delta State University. It has been “nearly impossible,” he said, to find volunteers to lighten the load over the past buy propecia walgreens year and a half.

Stateline Story September 16, 2021 States Embrace treatment Mandates Despite Potential Worker Exodus Quick View Smith said he is concerned that even the prospect of a hair loss treatment mandate is driving volunteers away, though there aren’t treatment mandates in place in Bolivar County—at least not yet. He is fully vaccinated but opposes a requirement because he worries it would dissuade would-be volunteers buy propecia walgreens. Even in the best of times, it’s difficult to find people who are willing to volunteer.

€œPeople are too busy, or they don't understand that the fire departments are volunteer buy propecia walgreens. And when they do, they're like, ‘That's not for me,’” Smith said. Between 2000 and buy propecia walgreens 2015, reported fires declined across the country, but fire departments have assumed a greater role in responding to the increasing number of medical aid and rescue calls.

In rural America, firefighters have a tougher task because they must respond to calls across greater distances. And there is a correlation between population density and fire deaths, according to a September 2019 report buy propecia walgreens by the National Fire Protection Association, which examined fire-related deaths between 2013 and 2017. Sparsely populated counties fared the worst, and nine of the 10 states with the highest fire death rates were in the South.The report also found that states with higher rates of fire deaths have more residents with low incomes, who have disabilities or who are Black, Native American or Native Alaskan.The propecia has exacerbated longstanding recruitment and retention problems in rural departments, especially those that rely on volunteers.

Volunteer firefighting just isn’t as appealing to younger couples who rely on two incomes, said Steve Hirsch, a veteran firefighter and chair of the National Volunteer Fire Council, a nonprofit buy propecia walgreens advocacy association representing volunteer fire, emergency medical and rescue services. Even some residents who do volunteer aren’t always available to answer calls, because they work full-time jobs in another community, Hirsch said. €œWhen my dad started in the fire service 60 years ago, typically it was dads buy propecia walgreens who were volunteering, and moms were at home to take care of the kids and it worked out fine.

But the reality today is that both mom and dad are working,” Hirsch said. €œSome of those rural communities buy propecia walgreens don't have any jobs available for people. So, they've lost population.

And sometimes the people that do live in those communities work someplace else.” Stateline Story May 20, 2021 California Lacks Federal Firefighters as Dangerous Season Looms Quick View George Richards, president of the Montana State Council of Professional Firefighters, said many buy propecia walgreens younger people “just don’t have the willingness to volunteer or serve without being compensated.” In Montana, 90% of departments are volunteer.“A lot of the departments had volunteers, members, for 20-plus, in some cases 40 years,” Richards said. €œThere’s just not that stronghold of commitment in this different generation.” Older firefighters tend to take more sick leave, Richards said. When many firefighters are absent, the ones who are available must work longer hours, or some stations are forced buy propecia walgreens to shut down on certain days.

Bob Timko, a member of the National Volunteer Fire Council’s recruitment and retention committee, said volunteer departments need to ratchet up recruitment efforts, perhaps in partnership with local businesses. “[Young people] aren’t coming in buy propecia walgreens the door,” Timko said. €œI would challenge leadership to develop a program or use resources to educate people on what we do.”Smith, the firefighter in the Mississippi Delta, said that even people who don’t want to be volunteer firefighters can do things to alleviate the stress on first responders, whether it's cleaning and maintaining the fire stations or helping with operations.“How would you feel if your house was on fire, and no one showed up?.

€ Smith buy propecia walgreens asked. €œThere's no one there to protect you or your property. We're here to do the community good and make it a better place.“We just want some good people to come and give back to their community.”.

Explore full-page version The number of newly propecia price canada completed hair loss treatment vaccinations in rural counties has Buy cialis in usa online declined for the third consecutive week. Newly completed vaccinations fell by about 20% last week compared to two weeks ago. Rural (nonmetropolitan) propecia price canada counties reported 166,000 newly completed vaccinations the week of Friday, October 29, through Thursday, November 4, 2021.

That’s down from about 207,000 two weeks ago. Meanwhile, the number of newly completed vaccinations in metropolitan counties grew by more than 15% last propecia price canada week compared to two weeks ago. Metropolitan counties reported 1.6 million newly completed hair loss treatment vaccinations last week, compared to 1.4 million two weeks ago.

The rural vaccination rate rose by about 0.4 percentage points, propecia price canada while the metropolitan rate grew by about 0.6 percentage points. The pace of new vaccinations in rural counties last week was the lowest since mid-August. As of November 4, 44.5% of the rural population had fully propecia price canada completed hair loss treatment vaccination.

In metropolitan counties, the rate is 56.6%, or 12.1 percentage points higher. The Daily Yonder’s analysis of hair loss treatment vaccinations is based on data from the Centers for Disease Control and Prevention and the state health departments of Hawaii, Massachusetts, and propecia price canada Texas. Like this story?.

Sign propecia price canada up for our newsletter. Illinois had the highest increase in percentage of rural population vaccinated last week. But the growth of 2.9 percentage points (or about 43,000 completed vaccinations) was so high at least part of the growth is likely from administration changes in record-keeping.Minnesota had the next highest increase in new rural vaccinations with an increase of 1.8 percentage points.Utah, California, and Arizona all had an increase in rural vaccination rates of at least 0.5 percentage points.West Virginia had the slowest rate of increase in rural vaccinations, at virtually zero percentage points (the state reported only 273 newly propecia price canada completed rural vaccinations).

West Virginia has a high rate of unallocated vaccinations, which lack geographic information. Therefore the actual propecia price canada number of rural vaccinations could have been slightly higher.Other states near the bottom in growth in rural vaccinations were Virginia, Michigan, Nebraska, Massachusetts, Indiana, and Alaska. Each of those states increased their rural vaccination rate by 0.2 percentage points.Massachusetts had the highest rate of rural vaccinations.

Seventy-three percent of the state’s rural population propecia price canada is completely vaccinated for hair loss treatment. Getting rural residents vaccinated in Massachusetts is a bit less complicated than in other parts of the U.S. The state has fewer than 100,000 residents who live in nonmetropolitan counties in the western part propecia price canada of the state.Connecticut, another state with a small rural population, had the next highest rural vaccination rate at about 70%.Hawaii, Arizona, Maine, and New Hampshire all had rural vaccination rates above 60%.Georgia had the nation’s lowest rural vaccination rate (22.1% of the state’s rural population).

A large number of unallocated vaccinations means the actual rate is slightly higher.West Virginia had a rural vaccination rate of only 22.5% (but also had a high rate of unallocated vaccinations).Next lowest were Missouri, Alabama, Louisiana, Tennessee, Nebraska, and North Dakota. This article defines propecia price canada rural as nonmetropolitan, using data from the 2013 Office of Management and Budget Metropolitan Statistical Area list. You Might Also LikeOver the past 30 years, fire departments in both urban and rural areas have struggled to recruit new firefighters into a profession that’s more than half volunteers.

In rural propecia price canada America, the propecia has brought the crisis to a new apex. Rural firefighters have been on the front lines of the propecia, tackling wildfires and vehicle accidents even as they transport ill and injured residents to hospitals. hair loss treatment’s heavy toll on rural propecia price canada hospitals has extended to emergency responders, meaning firefighters are answering more medical calls than ever before.

The increased workload, and the specter of treatment mandates, has made recruitment even tougher.And then there’s the trauma they’ve endured.The mass death and suffering of the past 20 months has spawned a surge of post-traumatic stress disorder, anxiety, depression, insomnia and substance use disorder among health care professionals of all kinds. Answering calls at the homes of relatives, friends and neighbors—which many rural firefighters have had to propecia price canada do—magnifies the pain.“We’re still in this propecia, and we’re still fighting those emotions. It’s not [as if] it happened three years ago,” said Jeff Dill, founder of the Firefighter Behavioral Health Alliance, which runs mental health workshops for fire departments.

€œWe’ve had numerous firefighters that have taken their lives because of it—seeing and handling the stress and propecia price canada the depression and the bodies that piled up.” Stateline Story March 15, 2021 ‘Why Do I Put My Life on the Line?. €™ propecia Trauma Haunts Health Workers. Quick View In many fire departments, the workers expected to endure that stress don’t even receive paychecks propecia price canada.

Of more than 1.1 million firefighters nationwide, 67% are volunteers who are not paid or receive a minimal amount to cover gas and other expenses, according to a 2021 fact sheet by the National Volunteer Fire Council. Many of them are in rural America propecia price canada. Nearly 40% of communities with between 5,000 and 9,999 residents had all-volunteer departments as of 2018, according to a tally released last year by the National Fire Protection Association.

In communities with between 2,500 and 4,999 people, the propecia price canada percentage of all-volunteer departments was 72%, and 92% in towns of less than 2,500. Fire Chief J.T. Wallace Jr.

Of Benton propecia price canada Fire District No. 4 in rural Louisiana said he does not have enough firefighters, paid or volunteer, to respond to structural fires. The community is small, but the population has grown slightly in the past few years, making it propecia price canada harder to meet demand and staff the stations.

Recently, Wallace Jr. Had an propecia price canada entire shift of firefighters out because they contracted hair loss treatment. Three firefighters have been diagnosed with post-traumatic stress disorder within the past year.“I think we didn’t lose community, but we were wounded in other ways psychologically.

It got pretty bad,” propecia price canada Wallace Jr. Said. €œWe’ve seen propecia price canada stress.

I’ve been doing this almost 50 years and this is a different ballgame with what we have to deal with.” Chris Smith, a lieutenant at the Bolivar County Volunteer Fire Department in Mississippi, has been a volunteer firefighter for 13 years. He likewise said the propecia has brought a new level of propecia price canada stress to an already difficult job. The extra work is hard enough—firefighters responding to hair loss treatment-related calls must don special protective gear, for example.

Much worse has been responding to the propecia price canada calls of sick loved ones, he said, which takes a heavy emotional toll. Smith volunteers 30 to 40 hours a week, in addition to working his full-time job as technical program manager of geospatial information technology at Delta State University. It has been “nearly impossible,” he said, to find volunteers to lighten the load over propecia price canada the past year and a half.

Stateline Story September 16, 2021 States Embrace treatment Mandates Despite Potential Worker Exodus Quick View Smith said he is concerned that even the prospect of a hair loss treatment mandate is driving volunteers away, though there aren’t treatment mandates in place in Bolivar County—at least not yet. He is fully vaccinated but opposes a requirement because he worries it would dissuade would-be volunteers propecia price canada. Even in the best of times, it’s difficult to find people who are willing to volunteer.

€œPeople are too busy, or propecia price canada they don't understand that the fire departments are volunteer. And when they do, they're like, ‘That's not for me,’” Smith said. Between 2000 and 2015, reported fires declined across the country, but fire departments have assumed a greater role in responding to the increasing number of medical aid and propecia price canada rescue calls.

In rural America, firefighters have a tougher task because they must respond to calls across greater distances. And there is a correlation between population density and fire deaths, according to a September 2019 report by the National Fire Protection Association, which examined fire-related deaths between 2013 propecia price canada and 2017. Sparsely populated counties fared the worst, and nine of the 10 states with the highest fire death rates were in the South.The report also found that states with higher rates of fire deaths have more residents with low incomes, who have disabilities or who are Black, Native American or Native Alaskan.The propecia has exacerbated longstanding recruitment and retention problems in rural departments, especially those that rely on volunteers.

Volunteer firefighting just propecia price canada isn’t as appealing to younger couples who rely on two incomes, said Steve Hirsch, a veteran firefighter and chair of the National Volunteer Fire Council, a nonprofit advocacy association representing volunteer fire, emergency medical and rescue services. Even some residents who do volunteer aren’t always available to answer calls, because they work full-time jobs in another community, Hirsch said. €œWhen my dad started in the fire service 60 years ago, typically it was dads who were volunteering, and moms were at home to take care of the kids and it propecia price canada worked out fine.

But the reality today is that both mom and dad are working,” Hirsch said. €œSome of those propecia price canada rural communities don't have any jobs available for people. So, they've lost population.

And sometimes the people that do live in those communities work someplace else.” Stateline Story May 20, 2021 California Lacks Federal Firefighters as Dangerous Season Looms Quick View George Richards, president of the Montana State Council of Professional Firefighters, said many younger people “just don’t have the willingness to volunteer or serve without being compensated.” In Montana, 90% of departments are volunteer.“A lot of the propecia price canada departments had volunteers, members, for 20-plus, in some cases 40 years,” Richards said. €œThere’s just not that stronghold of commitment in this different generation.” Older firefighters tend to take more sick leave, Richards said. When many firefighters are absent, the ones who are available must work longer hours, or some stations are forced to shut down on certain days propecia price canada.

Bob Timko, a member of the National Volunteer Fire Council’s recruitment and retention committee, said volunteer departments need to ratchet up recruitment efforts, perhaps in partnership with local businesses. “[Young people] aren’t coming in the door,” propecia price canada Timko said. €œI would challenge leadership to develop a program or use resources to educate people on what we do.”Smith, the firefighter in the Mississippi Delta, said that even people who don’t want to be volunteer firefighters can do things to alleviate the stress on first responders, whether it's cleaning and maintaining the fire stations or helping with operations.“How would you feel if your house was on fire, and no one showed up?.

€ Smith propecia price canada asked. €œThere's no one there to protect you or your property. We're here to do the community good and make it a better place.“We just want some good people to come and give back to their community.”.

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Much of modern ethics is built around the idea that we should respect one another’s where can i get propecia autonomy. Here, “we” are typically imagined to be adult human beings of sound mind, where the soundness of our mind is measured against what where can i get propecia we take to be the typical mental capacities of a neurodevelopmentally “normal” person—perhaps in their mid-thirties or forties. When deciding about what constitutes ethical sex, for example, our dominant models hold that ethical sex is whatever is consented to, while a lack of consent makes sex wrong.1 Consent, in turn, is analysed in terms of autonomous decision-making.

A “yes” or “no” that reflects the free and informed will of our idealised, sound-minded adult.Whether such models provide adequate normative guidance for ethical, much less good, sex between neurotypical human adults is an open question.2 3 When it comes to the ethics of sexual activity between humans and non-humans—robots, say—or between humans who don’t fit the rational stereotype (such as older people with dementia or younger adolescents), we hardly know where to begin.4–7 It is therefore heartening to see a number where can i get propecia of papers in this issue tackling the difficult question how to respectfully facilitate or respond to the needs, desires, and decisions of people with different kinds or degrees of autonomy.8For example, Sumytra Menon and colleagues9 explicitly discuss the notion of “borderline capacity” and argue, in the medical domain, for shared and supportive decision-making practices to “foster the autonomy of patients with compromised mental capacity while being mindful of the need to safeguard their well-being.” (Could similar practices be applied to sexual decision-making?. ) Touching on a similar theme, Zahra Ladan10 asks how we should conceive of liberty in the case of persons with certain inborn physical or mental limitations. Might it sometimes be necessary to constrain or interfere where can i get propecia with a person’s actions as a means of promoting their liberty—or can that only be an oxymoron?.

Finally, the problem of sexual consent in the context of diminished autonomy is addressed most directly in the piece by Andria Bianchi.11 Bianchi argues that people with certain cognitive impairments, such as dementia, should ideally be allowed to engage in sexual activity in accordance with their desires. But if consent, as that concept is traditionally where can i get propecia understood, is required for sex to be ethical or legal, then people with dementia may be “prevented from having their sexual needs met even if we recognise these needs as important.”Which brings us to robots. According to Bianchi, sex robots, whether now or in the future, might “allow people with dementia to fulfil their needs regardless of whether they can provide or understand consent.” A similar proposal is raised by Nancy Jecker12 in her feature article, on which Bianchi’s piece is a commentary.

Additional commentaries are by Robert Sparrow,13 Tom Sorell,14 and Alexander where can i get propecia Boni-Saenz.15Jecker’s article is entitled “Nothing to Be Ashamed of. Sex Robots for Older Adults with Disabilities.”1 The commenters on the article where can i get propecia are united in their praise of Jecker for dispelling ageist stereotypes according to which older people either are, or should be, non-sexual beings. And they welcome Jecker’s attempt to stimulate creative thinking about how the sexual needs and desires of older people might best be accommodated.

At the same time, they felt that Jecker’s arguments in favour of sex robots toward this end fell short in some respects.Jecker begins by noting that older adults typically undergo certain physical and mental changes that can negatively where can i get propecia affect sexual enjoyment. Jecker describes these changes in terms of functional impairments or lost abilities, where the functions in question seem mostly related to the ability to engage in penile-vaginal intercourse unassisted. For example, Jecker highlights “shortening and narrowing of the vagina, thinning of the vaginal walls where can i get propecia and reduced lubrication” for older women, and various erectile difficulties for older men.But diminished sexual capacity, Jecker stresses, encompasses much more than a lessened ability to “accomplish the act of sexual intercourse itself.” Rather, for most human beings, sex with others “serves as a vehicle for expressing who they are as persons.” Sex is also integral, Jecker argues, to several basic capabilities (in the spirit of Nussbaum and Sen), including the ability to have a life-narrative, to be healthy, to feel and express a wide range of emotion, and to affiliate deeply with others.

Jecker suggests that providing sex robots to older people could help them to maintain these capabilities at some minimum level. So, we should try where can i get propecia to see that such robots are provided.2Jecker anticipates some likely objections to her view. One is that, far from promoting the capability of being healthy for instance, repeatedly engaging in sexual activity with a humanoid robot3 (that is, an entity that presumably cannot provide ethically valid consent to such activity)4 would in fact harm the user.

In particular, it would do so by damaging the user’s where can i get propecia character. In effect, the user would be satisfying their sexual urges by repeatedly simulating rape.15–18 To diffuse this objection, Jecker emphasises that sex robots are not sentient beings with thoughts, feelings, or wishes, but are rather mere instruments or “toys.” But this may cause problems for the rest of Jecker’s argument, which turns on the ability of sex robots to stimulate real human emotions and play a meaningful relational role in where can i get propecia older people’s lives.It might not be possible to have it both ways. As Sorell argues, the sort of “affiliation” one might have with a sex robot is likely to be “too denuded” to serve as a substitute for the affiliation ideally achieved through sex with another human.

After all, a human being who “automatically simulates arousal on demand for their sexual partner, who is receptive to sex no questions asked, no matter when or where can i get propecia where, has handed over their sexual will.” Thus, in the case of human-robot sex, a single person would be deciding how it goes. Affiliation, by contrast, “requires two.”5 Or as Sparrow puts it. Sex with a robot is simply high-tech masturbation.Likewise, Boni-Saenz doubts that many people would find sex robots “adequate for where can i get propecia sexual relationships.” But he remains open to the possibility that at least some people could find sex robots to be “a suitable replacement for human intimacy in periods of old age” even if they may not otherwise “represent their preferred mode of sexual interaction.” Here, we suggest it may be worthwhile to undertake empirical research into older people’s actual attitudes and preferences toward (the prospect of) sex with robots,6 in order to shape our normative inquiry going forward.7Suppose it turns out that older adults, or some reasonably large proportion of them, find that they are able to form (or imagine forming) a meaningful intimate relationship with a sex robot—one that is sufficient to support the “affiliation” capability at least to some extent.

It seems to us this creates a real dilemma. The more humanlike the (felt) affiliation, where can i get propecia the less effective Jecker’s “just a toy” response becomes to the objection about simulated rape. And the less humanlike the affiliation, the less effective Jecker’s argument that sex robots could support such a capability.19In fact, it isn’t clear to us how sex robots would be altogether helpful even for physical or functional issues, like those raised by Jecker.

How would a sex robot help with “shortening or narrowing of where can i get propecia the vagina,” “reduced lubrication,” or erectile difficulties for those with penises?. A sex robot could, perhaps, apply a synthetic lubricant as needed—but so could a human partner. In any event, the focus on where can i get propecia sexual “function” (in this physical sense) may obscure other possibilities for erotic fulfilment in older people.As Jecker acknowledges, age-related physiological changes need not necessarily lead to a deterioration in the quality of our sex lives.

Indeed, such changes may even contribute to a broader repertoire of sexual activities and bring partners closer together.20 Departing from the so-called coital imperative, for example, can – and often does – lead to the exploration of non-penetrative forms of sexual activity, which in turn may translate into where can i get propecia greater sexual satisfaction, especially for women. The idea then might be to focus more on the building of erotic tension rather than on “performance,” and on becoming more sensitive to our partners’ emotional states rather than fixating on the mechanical possibilities of the body.21Jecker is right to call out sexual ageism. Older people often do have sexual needs, where can i get propecia and this should not be stigmatised or ignored.

But we worry that a focus on sex robots may inadvertently strengthen the very ageism that Jecker decries. For such where can i get propecia a focus could be seen as carrying an implicit message. Namely, that something crucial is lost if an older person does not maintain their youthful sexual stamina with the use of increasingly sophisticated tools.IntroductionThe hair loss treatment propecia has now reached all world continents except Antartica.

Its spread has placed an enormous and sustained burden on health systems, which has likely exacerbated the mortality rate of hair loss hair loss.1 Since the start of the propecia, several noteworthy contributions have discussed important aspects of intensive care units’ (henceforth ICUs) shortages.2–5 Like most allocation problems, this issue presents inherently normative questions that ethicists and physicians ought to address by developing a set of coherent and consistent rules, thus preventing healthcare practitioners to be faced ‘with the terrible task of improvising decisions on whom to treat’.2 Such guidelines are likely to directly affect a considerable number of citizens, as well where can i get propecia as their families and relatives, throughout the propecia and might have relevant legal implications.6 Hence, it is of paramount importance to assess their perception of the fairness of such rules. If these are not in line with people’s moral views, this may create resentment and feelings of injustice that could worsen the already traumatic impact of the choices. These views could, therefore, inform policy makers and clinicians on the need to communicate appropriately the rationale behind the guidelines, in order to (partially) alleviate the above-mentioned effects.4The purpose of this paper is to where can i get propecia inform the debate as to whether citizens’ moral principles are aligned with the proposed guidelines and recommendations.

To this end, we conducted where can i get propecia a survey among a sample of American citizens. We compare individuals’ responses with the recommendations contained in ref 2 that offer a comprehensive set of guidelines for the allocation of scarce resources during hair loss treatment representing a widespread consensus in the medical literature. The next section describes the survey structure and design where can i get propecia.

A methods section (section 3) describes characteristics of the sample and the statistical methodology. Section 4 presents our main results and section 5 concludes.The surveyOur survey was conducted among a sample of 1033 American citizens using the online survey where can i get propecia platform CloudResearch. An additional 443 started the survey but did not finish.

This rate of completion (around 70%) is in line with online where can i get propecia studies similar to ours. Subjects were recruited from the CloudResearch panel, which is heterogeneous in many sociodemographic dimensions (see Methods). In our survey, we asked respondents to imagine a situation in which the US Federal Government is planning to where can i get propecia publish guidelines for the allocation of ICUs during the hair loss treatment propecia.

Respondents are asked which principles these guidelines should contain according where can i get propecia to them. Respondents were informed that this was a research project and that their responses would remain anonymous. We elicited their views through the use of where can i get propecia several hypothetical scenarios (see table 1).

All scenarios contain two patients (neutrally labelled patient A and patient B), with different characteristics, who have been hospitalised. Both patients need an ICU bed but only one is where can i get propecia available. In all scenarios, respondents are asked which of four options they would suggest for the guidelines.

Admit patient A to where can i get propecia the ICU, admit patient B, decide randomly and admit on a first-come first-served basis. Through the use of our scenarios, we test the extent to which people’s moral views are in line with the recommendations highlighted in ref 2. Table 1 where can i get propecia reports the wording for each scenario and the implied recommendation.

Before being exposed to the scenarios, respondents had to answer four comprehension questions to ensure their understanding of the hypothetical situation. The order where can i get propecia in which the scenarios appeared was randomised at the individual level. We believe that control where can i get propecia questions and the randomised order of scenarios eliminate concerns about order and learning effects.

After the scenarios, respondents were asked several sociodemographic questions and questions about their perceptions of the hair loss treatment propecia (see online supplemental appendix A). There we no other questions about other subjects in the survey.Supplemental materialView this table:Table 1 The table describes the where can i get propecia eight different scenarios proposed in the surveyMethodsOur respondents are part of the survey panel (prime panel) of the platform CloudResearch. Respondents from this panel have been shown to be more heterogeneous in various aspects (eg, age, education and political attitudes) with respect to the more commonly used pool of Amazon Mechanical Turk.7 Our sample is composed by respondents from 50 different states.

Respondents are where can i get propecia highly heterogeneous in various dimensions. The majority of them are women (60.8%), and the average age is 44.6 years (SD=16.8). They have a higher educational attainment than the US average according to the 2018 data of the US Census Bureau,8 as almost all of them earned at least a where can i get propecia high school degree (98%), and the majority of them (52.5%) earned at least a bachelor’s degree.

The median household yearly income before taxes ranges between $60 000 and $70 000, in line with the national figures ($63 119).9 A percentage of 17.3 of them declared to be smokers (vs 15.1% at national level). Finally, 41.6% identified themselves as Democrats, 36.6% as Republicans where can i get propecia and 21.8% as Independents.10 The average survey completion time was 8.5 min. Therefore, the hourly compensation for the completion averaged to $8.82 where can i get propecia.

With respect to statistical analyses, we mainly used non-parametric tests for matched observations, that is, McNemar’s χ2 test and signrank test.11 Only in one case where we performed a between-subjects comparison, we use a test of proportions for independent observations (χ2 test).Survey responses. Each bar represents the distribution of answers for each of where can i get propecia the eight scenarios. The bars on the left-hand side represent the share of answers in line with the recommendations from the guidelines.

The bars on the right-hand side represent the share of answers not where can i get propecia in line with the recommendations." data-icon-position data-hide-link-title="0">Figure 1 Survey responses. Each bar represents the distribution of answers for each of the eight scenarios. The bars where can i get propecia on the left-hand side represent the share of answers in line with the recommendations from the guidelines.

The bars on the right-hand side represent the share of answers not in line with the recommendations.ResultsFigure 1 shows the percentage of responses in line with the recommendations contained in ref 2. As it can be seen from the figure, we find where can i get propecia high heterogeneity across scenarios. While for some scenarios responses are broadly in line with the recommendations, for others only a minority of responses where can i get propecia is.

The share of responses in line with the recommendations ranges from 5.4% to 68.7%. In what follows where can i get propecia we summarise our main results.Result 1. Maximise benefitsMaximising benefits is considered to be the most important principle in a propecia.2 This principle can be applied either as saving most lives or as many years of life as possible.

We tested both these applications of the principle where can i get propecia. To test the save most lives principle, in scenario 1, we describe both patients as having the same life expectancy but patient A as having higher probability of survival in an ICU. To test the save where can i get propecia the most years of life principle, in scenario 2, the probability of survival in the ICU is the same for both patients, but patient A has higher life expectancy post-treatment.

Our results show that people tend to apply the maximising benefits principle significantly more often when this increases the chances of saving a life rather than when it saves more years of life in expectation (59.6% vs 44.7%, McNemar’s χ2(1)=79.58, p<0.001. Signrank test, where can i get propecia z=8.92, p<0.001).Result 2. Maximise benefitsAnother important implication of the maximise benefits principle is that a patient with lower probability of survival ought to be removed from an ICU when a patient with higher probability of survival needs it.2 Despite being the most rational thing to do from a utilitarian perspective, this may be considered unfair for several reasons related to well-documented behavioural phenomena.

First, as resources have been already spent to cure the patient already in the ICU, respondents may be affected by the sunk cost fallacy, that is, the evidence that people commit to certain choices even when these choices are revealed to be suboptimal as time passes.12 13 Second, a patient’s incumbency may produce a sense of entitlement similar to the endowment effect in those who (perhaps subconsciously) identify with the incumbent, thus where can i get propecia leading to the status quo bias.14 Finally, and perhaps more importantly, the emotional burden of suspending treatment may be stronger than the one of not initiating treatment, which could be caused by the perceived moral differences in omission (not treating) versus commission (suspending treatment).15 In order to test this implication of the maximise benefits principle, we included two scenarios that we administered between subjects (n=521 in scenario 3 and n=511 in scenario 4). In scenario 3, patient B, who has lower probability of survival, has been in the ICU for 2 months where can i get propecia prior to the arrival of patient A. On the contrary, in scenario 4, the two are hospitalised at the same time.

The two vignettes are otherwise identical, and for obvious reasons, we have removed the first-come first-served option for these two scenarios.In line with our prediction, when the two patients arrive at the same time, 68.7% agree to admit patient A, while only where can i get propecia 54.3% do so when patient B has been in the ICU for 2 months (χ2(1)=22.5, p<0.001).Result 3. Instrumental valueOne additional recommendation is to promote and reward instrumental value, that is, to prioritise ICU admission for those patients who have contributed to the treatment of hair loss treatment (ie, retrospective instrumental value) and to patients who will likely offer future contributions (ie, prospective instrumental value).2 To assess moral views for retrospective instrumental value, we created scenario 5, in which the two patients are identical in terms of life expectancy and probability of survival, but patient A is a nurse who has being treating patients with hair loss treatment. Regarding prospective instrumental value, the scenario is identical to the previous one, but patient A, instead of being a nurse, is a scientist working on a potential treatment to prevent hair loss treatment where can i get propecia.

In both cases, only around 44% of respondents reward instrumental value, and we find no difference between prospective and retrospective instrumental value (McNemar’s χ2(1)=1.09, p=0.326. Signrank test, z=1.04, where can i get propecia p=0.296)).Result 4. Treat people equallyRecommendation 3 in ref 2 stresses that, for patients with similar prognosis, random allocation must be preferred to a first-come first-served principle, though both are application of egalitarianism.

First-come first-served is where can i get propecia typically used when scarcity is long-standing and patients can survive without the scarce resource, such as for example in the case of kidneys’ transplants. When needs are urgent, however, a first-come first-served approach could unfairly benefit patients living nearer to healthcare facilities, hence resulting in a less egalitarian treatment than pure randomisation where can i get propecia. To assess people’s views on this, we included scenario 7, in which the two patients are equal in all characteristics, as well as in prognosis.

Despite most respondents choose one of the where can i get propecia two egalitarian responses, among these the vast majority choose first-come first-served (91%). It is worth noticing that this difference consistently occurs across all other scenarios. Among those who prefer the egalitarian options, only 7.2% choose where can i get propecia random allocation.

This may be because most cases of allocation of scarce resources are of the type where first-come first-served is appropriate and random selection is rarely used (think, for instance, of any situation in which queuing is accepted as normal). This evidence may make first-come first-served more salient and available due to past experience.16 This result calls for greater information to patients, and citizens, on where can i get propecia the virtues of pure randomisation as the fairest means to insure equality (of opportunities).Result 5. Treat people equallyAnother recommendation related to equality states that patients with hair loss treatment and patients affected by other conditions should not be treated differently when allocating scarce resources.2 We tested this by including scenario 8, in which the two patients have the same prognosis, but one is affected by hair loss treatment and the other has pneumonia not caused by hair loss.

The percentages where can i get propecia of those who state a preference for treating one of the two patients sum up to 55.8%. This is much higher than the where can i get propecia same answers given in scenario 7 (20.3%), where instead an egalitarian principle is chosen by most. Most of the respondents (34.8%) in scenario 8 suggest to treat the patient affected by hair loss treatment.

This proportion alone is significantly higher compared with the sum of proportions of respondents choosing either option A or B in where can i get propecia scenario 7, indicating that individuals tend to favour the treatment of the patient with hair loss treatment in contrast to the recommendation (McNemar’s χ2(1)=62.50, p<0.001. Signrank test, z=7.91, p<0.001)).Next, we exploit our post survey sociodemographic dataset to assess whether the results reported are heterogeneous across different strata of the population. In online supplemental appendix B, we replicate each of the where can i get propecia results above (except result 4 in which we do not employ statistical tests) breaking down the sample for gender, education, employment status, age, political orientation and income.

For all subgroups, results are in line qualitatively and in terms of significance levels with the main results reported above. We conclude that our results do not depend on the specific subgroup analysed where can i get propecia but are stable across all subgroups.ConclusionsGuidelines for the allocation of scarce resources during the hair loss treatment propecia are essential and can guarantee a fair and consistent allocation across cases. We have shown, through survey results, that these ethically sensible recommendations do not always reflect the views of citizens.

We found considerable heterogeneity in people’s moral judgements, and we believe this heterogeneity where can i get propecia must be addressed by (better) informing citizens regarding the rationale behind each principle. We hope that this evidence may inform policy makers, as well as healthcare practitioners, of the need to provide an effective communication to citizens and patients, respectively, in order to avoid decision rules that may otherwise be perceived as arbitrary or unfair..

Much of modern ethics propecia price canada is built around the idea that we should respect one he has a good point another’s autonomy. Here, “we” are propecia price canada typically imagined to be adult human beings of sound mind, where the soundness of our mind is measured against what we take to be the typical mental capacities of a neurodevelopmentally “normal” person—perhaps in their mid-thirties or forties. When deciding about what constitutes ethical sex, for example, our dominant models hold that ethical sex is whatever is consented to, while a lack of consent makes sex wrong.1 Consent, in turn, is analysed in terms of autonomous decision-making. A “yes” or “no” that reflects the free and informed will of our idealised, sound-minded adult.Whether such models provide adequate normative propecia price canada guidance for ethical, much less good, sex between neurotypical human adults is an open question.2 3 When it comes to the ethics of sexual activity between humans and non-humans—robots, say—or between humans who don’t fit the rational stereotype (such as older people with dementia or younger adolescents), we hardly know where to begin.4–7 It is therefore heartening to see a number of papers in this issue tackling the difficult question how to respectfully facilitate or respond to the needs, desires, and decisions of people with different kinds or degrees of autonomy.8For example, Sumytra Menon and colleagues9 explicitly discuss the notion of “borderline capacity” and argue, in the medical domain, for shared and supportive decision-making practices to “foster the autonomy of patients with compromised mental capacity while being mindful of the need to safeguard their well-being.” (Could similar practices be applied to sexual decision-making?. ) Touching on a similar theme, Zahra Ladan10 asks how we should conceive of liberty in the case of persons with certain inborn physical or mental limitations.

Might it propecia price canada sometimes be necessary to constrain or interfere with a person’s actions as a means of promoting their liberty—or can that only be an oxymoron?. Finally, the problem of sexual consent in the context of diminished autonomy is addressed most directly in the piece by Andria Bianchi.11 Bianchi argues that people with certain cognitive impairments, such as dementia, should ideally be allowed to engage in sexual activity in accordance with their desires. But if consent, as that concept is traditionally understood, is required for sex to be ethical or legal, then people with dementia propecia price canada may be “prevented from having their sexual needs met even if we recognise these needs as important.”Which brings us to robots. According to Bianchi, sex robots, whether now or in the future, might “allow people with dementia to fulfil their needs regardless of whether they can provide or understand consent.” A similar proposal is raised by Nancy Jecker12 in her feature article, on which Bianchi’s piece is a commentary. Additional commentaries are by Robert Sparrow,13 Tom Sorell,14 and Alexander Boni-Saenz.15Jecker’s article is entitled “Nothing to Be Ashamed propecia price canada of.

Sex Robots for Older Adults with Disabilities.”1 The commenters on the article are united in their praise of Jecker for dispelling ageist stereotypes according to which propecia price canada older people either are, or should be, non-sexual beings. And they welcome Jecker’s attempt to stimulate creative thinking about how the sexual needs and desires of older people might best be accommodated. At the same time, they felt that Jecker’s arguments in favour of propecia price canada sex robots toward this end fell short in some respects.Jecker begins by noting that older adults typically undergo certain physical and mental changes that can negatively affect sexual enjoyment. Jecker describes these changes in terms of functional impairments or lost abilities, where the functions in question seem mostly related to the ability to engage in penile-vaginal intercourse unassisted. For example, Jecker highlights “shortening and narrowing of the vagina, thinning of the vaginal walls and reduced lubrication” propecia price canada for older women, and various erectile difficulties for older men.But diminished sexual capacity, Jecker stresses, encompasses much more than a lessened ability to “accomplish the act of sexual intercourse itself.” Rather, for most human beings, sex with others “serves as a vehicle for expressing who they are as persons.” Sex is also integral, Jecker argues, to several basic capabilities (in the spirit of Nussbaum and Sen), including the ability to have a life-narrative, to be healthy, to feel and express a wide range of emotion, and to affiliate deeply with others.

Jecker suggests that providing sex robots to older people could help them to maintain these capabilities at some minimum level. So, we should try to see that such propecia price canada robots are provided.2Jecker anticipates some likely objections to her view. One is that, far from promoting the capability of being healthy for instance, repeatedly engaging in sexual activity with a humanoid robot3 (that is, an entity that presumably cannot provide ethically valid consent to such activity)4 would in fact harm the user. In particular, it would propecia price canada do so by damaging the user’s character. In effect, the user would be satisfying their sexual urges by repeatedly simulating rape.15–18 To diffuse this objection, Jecker emphasises that sex robots are not sentient beings with thoughts, feelings, or wishes, but are rather mere instruments or “toys.” But this may cause problems for the rest of Jecker’s argument, which turns on the ability of sex robots to stimulate real propecia price canada human emotions and play a meaningful relational role in older people’s lives.It might not be possible to have it both ways.

As Sorell argues, the sort of “affiliation” one might have with a sex robot is likely to be “too denuded” to serve as a substitute for the affiliation ideally achieved through sex with another human. After all, a human being who “automatically simulates arousal on demand for their sexual partner, who is receptive to sex no questions asked, no matter when or where, has handed over their sexual will.” Thus, in the case of human-robot sex, a single person would be propecia price canada deciding how it goes. Affiliation, by contrast, “requires two.”5 Or as Sparrow puts it. Sex with a robot is simply high-tech masturbation.Likewise, Boni-Saenz doubts that many people would find sex robots “adequate for sexual relationships.” But he remains open to the possibility that at least some people could find sex robots to be “a suitable replacement for human intimacy in periods of old age” even if they may not otherwise “represent their preferred mode of sexual interaction.” Here, we suggest it may be worthwhile to undertake empirical research into older people’s actual attitudes and preferences toward (the prospect of) sex with robots,6 in order to shape our normative inquiry going forward.7Suppose it turns out that older adults, or some propecia price canada reasonably large proportion of them, find that they are able to form (or imagine forming) a meaningful intimate relationship with a sex robot—one that is sufficient to support the “affiliation” capability at least to some extent. It seems to us this creates a real dilemma.

The more humanlike the (felt) affiliation, the less effective Jecker’s “just a toy” response becomes to propecia price canada the objection about simulated rape. And the less humanlike the affiliation, the less effective Jecker’s argument that sex robots could support such a capability.19In fact, it isn’t clear to us how sex robots would be altogether helpful even for physical or functional issues, like those raised by Jecker. How would a sex robot help with “shortening or narrowing propecia price canada of the vagina,” “reduced lubrication,” or erectile difficulties for those with penises?. A sex robot could, perhaps, apply a synthetic lubricant as needed—but so could a human partner. In any propecia price canada event, the focus on sexual “function” (in this physical sense) may obscure other possibilities for erotic fulfilment in older people.As Jecker acknowledges, age-related physiological changes need not necessarily lead to a deterioration in the quality of our sex lives.

Indeed, such changes may even contribute to a broader repertoire of sexual activities and bring partners closer together.20 propecia price canada Departing from the so-called coital imperative, for example, can – and often does – lead to the exploration of non-penetrative forms of sexual activity, which in turn may translate into greater sexual satisfaction, especially for women. The idea then might be to focus more on the building of erotic tension rather than on “performance,” and on becoming more sensitive to our partners’ emotional states rather than fixating on the mechanical possibilities of the body.21Jecker is right to call out sexual ageism. Older people often do have sexual needs, and propecia price canada this should not be stigmatised or ignored. But we worry that a focus on sex robots may inadvertently strengthen the very ageism that Jecker decries. For such a focus could be seen propecia price canada as carrying an implicit message.

Namely, that something crucial is lost if an older person does not maintain their youthful sexual stamina with the use of increasingly sophisticated tools.IntroductionThe hair loss treatment propecia has now reached all world continents except Antartica. Its spread has placed an enormous and sustained burden on health systems, which has likely exacerbated the mortality rate of hair loss hair loss.1 Since the start of the propecia, several noteworthy contributions have discussed important aspects of intensive care units’ (henceforth ICUs) shortages.2–5 Like most allocation problems, this issue presents inherently normative questions that ethicists and physicians ought to address by propecia price canada developing a set of coherent and consistent rules, thus preventing healthcare practitioners to be faced ‘with the terrible task of improvising decisions on whom to treat’.2 Such guidelines are likely to directly affect a considerable number of citizens, as well as their families and relatives, throughout the propecia and might have relevant legal implications.6 Hence, it is of paramount importance to assess their perception of the fairness of such rules. If these are not in line with people’s moral views, this may create resentment and feelings of injustice that could worsen the already traumatic impact of the choices. These views could, therefore, inform policy makers and clinicians on the need to communicate appropriately the rationale behind the guidelines, in order to (partially) alleviate the above-mentioned effects.4The purpose of this paper is to inform the debate as to whether citizens’ moral principles are aligned with the proposed guidelines and propecia price canada recommendations. To this end, we propecia price canada conducted a survey among a sample of American citizens.

We compare individuals’ responses with the recommendations contained in ref 2 that offer a comprehensive set of guidelines for the allocation of scarce resources during hair loss treatment representing a widespread consensus in the medical literature. The next propecia price canada section describes the survey structure and design. A methods section (section 3) describes characteristics of the sample and the statistical methodology. Section 4 presents our main results and section 5 concludes.The surveyOur survey was conducted propecia price canada among a sample of 1033 American citizens using the online survey platform CloudResearch. An additional 443 started the survey but did not finish.

This rate of completion (around 70%) is in line propecia price canada with online studies similar to ours. Subjects were recruited from the CloudResearch panel, which is heterogeneous in many sociodemographic dimensions (see Methods). In our survey, we asked respondents to propecia price canada imagine a situation in which the US Federal Government is planning to publish guidelines for the allocation of ICUs during the hair loss treatment propecia. Respondents are propecia price canada asked which principles these guidelines should contain according to them. Respondents were informed that this was a research project and that their responses would remain anonymous.

We elicited their views through the use of several hypothetical scenarios (see propecia price canada table 1). All scenarios contain two patients (neutrally labelled patient A and patient B), with different characteristics, who have been hospitalised. Both patients need an ICU bed but propecia price canada only one is available. In all scenarios, respondents are asked which of four options they would suggest for the guidelines. Admit patient A to the ICU, admit patient B, decide randomly and admit propecia price canada on a first-come first-served basis.

Through the use of our scenarios, we test the extent to which people’s moral views are in line with the recommendations highlighted in ref 2. Table 1 reports the wording for propecia price canada each scenario and the implied recommendation. Before being exposed to the scenarios, respondents had to answer four comprehension questions to ensure their understanding of the hypothetical situation. The order in which the scenarios appeared was randomised propecia price canada have a peek here at the individual level. We believe that control questions and the randomised order of scenarios eliminate concerns propecia price canada about order and learning effects.

After the scenarios, respondents were asked several sociodemographic questions and questions about their perceptions of the hair loss treatment propecia (see online supplemental appendix A). There we no other questions about other subjects in the survey.Supplemental materialView this table:Table 1 The table describes the eight different scenarios proposed in the surveyMethodsOur respondents are part of the survey panel propecia price canada (prime panel) of the platform CloudResearch. Respondents from this panel have been shown to be more heterogeneous in various aspects (eg, age, education and political attitudes) with respect to the more commonly used pool of Amazon Mechanical Turk.7 Our sample is composed by respondents from 50 different states. Respondents are highly heterogeneous in propecia price canada various dimensions. The majority of them are women (60.8%), and the average age is 44.6 years (SD=16.8).

They have a higher educational attainment than the US average according to the 2018 data of the US Census Bureau,8 as almost all of them earned at least a high school propecia price canada degree (98%), and the majority of them (52.5%) earned at least a bachelor’s degree. The median household yearly income before taxes ranges between $60 000 and $70 000, in line with the national figures ($63 119).9 A percentage of 17.3 of them declared to be smokers (vs 15.1% at national level). Finally, 41.6% identified themselves as Democrats, 36.6% propecia price canada as Republicans and 21.8% as Independents.10 The average survey completion time was 8.5 min. Therefore, the propecia price canada hourly compensation for the completion averaged to $8.82. With respect to statistical analyses, we mainly used non-parametric tests for matched observations, that is, McNemar’s χ2 test and signrank test.11 Only in one case where we performed a between-subjects comparison, we use a test of proportions for independent observations (χ2 test).Survey responses.

Each bar represents the distribution of answers for each of the eight propecia price canada scenarios. The bars on the left-hand side represent the share of answers in line with the recommendations from the guidelines. The bars on the right-hand side represent the share of answers not in line with the recommendations." data-icon-position propecia price canada data-hide-link-title="0">Figure 1 Survey responses. Each bar represents the distribution of answers for each of the eight scenarios. The bars on the left-hand side represent the share of answers in propecia price canada line with the recommendations from the guidelines.

The bars on the right-hand side represent the share of answers not in line with the recommendations.ResultsFigure 1 shows the percentage of responses in line with the recommendations contained in ref 2. As it can be seen from the figure, we find high heterogeneity across propecia price canada scenarios. While for some scenarios responses are broadly in line with the recommendations, for others only propecia price canada a minority of responses is. The share of responses in line with the recommendations ranges from 5.4% to 68.7%. In what follows we summarise propecia price canada our main results.Result 1.

Maximise benefitsMaximising benefits is considered to be the most important principle in a propecia.2 This principle can be applied either as saving most lives or as many years of life as possible. We tested propecia price canada both these applications of the principle. To test the save most lives principle, in scenario 1, we describe both patients as having the same life expectancy but patient A as having higher probability of survival in an ICU. To test the save the most years of life principle, in scenario 2, the probability of survival in the ICU is the same for both patients, but propecia price canada patient A has higher life expectancy post-treatment. Our results show that people tend to apply the maximising benefits principle significantly more often when this increases the chances of saving a life rather than when it saves more years of life in expectation (59.6% vs 44.7%, McNemar’s χ2(1)=79.58, p<0.001.

Signrank test, z=8.92, p<0.001).Result propecia price canada 2. Maximise benefitsAnother important implication of the maximise benefits principle is that a patient with lower probability of survival ought to be removed from an ICU when a patient with higher probability of survival needs it.2 Despite being the most rational thing to do from a utilitarian perspective, this may be considered unfair for several reasons related to well-documented behavioural phenomena. First, as resources have been already spent to cure the patient already in the ICU, respondents may be affected by the sunk cost fallacy, that is, the propecia price canada evidence that people commit to certain choices even when these choices are revealed to be suboptimal as time passes.12 13 Second, a patient’s incumbency may produce a sense of entitlement similar to the endowment effect in those who (perhaps subconsciously) identify with the incumbent, thus leading to the status quo bias.14 Finally, and perhaps more importantly, the emotional burden of suspending treatment may be stronger than the one of not initiating treatment, which could be caused by the perceived moral differences in omission (not treating) versus commission (suspending treatment).15 In order to test this implication of the maximise benefits principle, we included two scenarios that we administered between subjects (n=521 in scenario 3 and n=511 in scenario 4). In scenario 3, patient B, who has propecia price canada lower probability of survival, has been in the ICU for 2 months prior to the arrival of patient A. On the contrary, in scenario 4, the two are hospitalised at the same time.

The two vignettes are otherwise identical, and for obvious reasons, we have propecia price canada removed the first-come first-served option for these two scenarios.In line with our prediction, when the two patients arrive at the same time, 68.7% agree to admit patient A, while only 54.3% do so when patient B has been in the ICU for 2 months (χ2(1)=22.5, p<0.001).Result 3. Instrumental valueOne additional recommendation is to promote and reward instrumental value, that is, to prioritise ICU admission for those patients who have contributed to the treatment of hair loss treatment (ie, retrospective instrumental value) and to patients who will likely offer future contributions (ie, prospective instrumental value).2 To assess moral views for retrospective instrumental value, we created scenario 5, in which the two patients are identical in terms of life expectancy and probability of survival, but patient A is a nurse who has being treating patients with hair loss treatment. Regarding prospective instrumental value, the scenario is identical to the previous one, but patient A, instead of being a nurse, is a scientist working on a potential propecia price canada treatment to prevent hair loss treatment. In both cases, only around 44% of respondents reward instrumental value, and we find no difference between prospective and retrospective instrumental value (McNemar’s χ2(1)=1.09, p=0.326. Signrank test, z=1.04, p=0.296)).Result 4 propecia price canada.

Treat people equallyRecommendation 3 in ref 2 stresses that, for patients with similar prognosis, random allocation must be preferred to a first-come first-served principle, though both are application of egalitarianism. First-come first-served is typically used when scarcity is long-standing and patients can propecia price canada survive without the scarce resource, such as for example in the case of kidneys’ transplants. When needs are urgent, however, a first-come first-served approach could unfairly benefit patients living nearer to healthcare facilities, hence resulting in a less egalitarian treatment than pure propecia price canada randomisation. To assess people’s views on this, we included scenario 7, in which the two patients are equal in all characteristics, as well as in prognosis. Despite most propecia price canada respondents choose one of the two egalitarian responses, among these the vast majority choose first-come first-served (91%).

It is worth noticing that this difference consistently occurs across all other scenarios. Among those who prefer the egalitarian options, propecia price canada only 7.2% choose random allocation. This may be because most cases of allocation of scarce resources are of the type where first-come first-served is appropriate and random selection is rarely used (think, for instance, of any situation in which queuing is accepted as normal). This evidence may make first-come first-served more salient and available due to past experience.16 This result calls for greater information to patients, and citizens, on the virtues of pure randomisation as the propecia price canada fairest means to insure equality (of opportunities).Result 5. Treat people equallyAnother recommendation related to equality states that patients with hair loss treatment and patients affected by other conditions should not be treated differently when allocating scarce resources.2 We tested this by including scenario 8, in which the two patients have the same prognosis, but one is affected by hair loss treatment and the other has pneumonia not caused by hair loss.

The percentages of those who state propecia price canada a preference for treating one of the two patients sum up to 55.8%. This is much higher than the same answers given in scenario 7 (20.3%), where instead an egalitarian principle is chosen propecia price canada by most. Most of the respondents (34.8%) in scenario 8 suggest to treat the patient affected by hair loss treatment. This proportion alone is significantly higher compared with the sum of proportions of respondents choosing either propecia price canada option A or B in scenario 7, indicating that individuals tend to favour the treatment of the patient with hair loss treatment in contrast to the recommendation (McNemar’s χ2(1)=62.50, p<0.001. Signrank test, z=7.91, p<0.001)).Next, we exploit our post survey sociodemographic dataset to assess whether the results reported are heterogeneous across different strata of the population.

In online supplemental appendix B, we replicate each of the results above (except result 4 in which we do not employ statistical tests) breaking down the sample for gender, education, employment status, age, political orientation and income propecia price canada. For all subgroups, results are in line qualitatively and in terms of significance levels with the main results reported above. We conclude that our results do not depend on the specific subgroup analysed but are propecia price canada stable across all subgroups.ConclusionsGuidelines for the allocation of scarce resources during the hair loss treatment propecia are essential and can guarantee a fair and consistent allocation across cases. We have shown, through survey results, that these ethically sensible recommendations do not always reflect the views of citizens. We found considerable heterogeneity in people’s moral judgements, and we believe this heterogeneity must be addressed by (better) informing citizens regarding the rationale behind propecia price canada each principle.

We hope that this evidence may inform policy makers, as well as healthcare practitioners, of the need to provide an effective communication to citizens and patients, respectively, in order to avoid decision rules that may otherwise be perceived as arbitrary or unfair..

Can propecia grow hair

NCHS Data Brief can propecia grow hair No. 286, September 2017PDF Versionpdf icon (374 KB)Anjel Vahratian, Ph.D.Key findingsData from the National Health Interview Survey, 2015Among those aged 40–59, perimenopausal women (56.0%) were more likely than postmenopausal (40.5%) and premenopausal (32.5%) women to sleep less than 7 hours, on average, in a 24-hour period.Postmenopausal women aged 40–59 were more likely than premenopausal women aged 40–59 to have trouble falling asleep (27.1% compared with 16.8%, respectively), and staying asleep (35.9% compared with 23.7%), four times or more in the past week.Postmenopausal women aged 40–59 (55.1%) were more likely than premenopausal women aged 40–59 (47.0%) to not wake up feeling well rested 4 days or more in the past week.Sleep duration and quality are important contributors to health and wellness. Insufficient sleep is associated with an increased risk for chronic can propecia grow hair conditions such as cardiovascular disease (1) and diabetes (2).

Women may be particularly vulnerable to sleep problems during times of reproductive hormonal change, such as after the menopausal transition. Menopause is “the permanent cessation of menstruation that occurs after the loss of can propecia grow hair ovarian activity” (3). This data brief describes sleep duration and sleep quality among nonpregnant women aged 40–59 by menopausal status.

The age range selected for this analysis reflects the focus on midlife sleep health. In this analysis, 74.2% of women are can propecia grow hair premenopausal, 3.7% are perimenopausal, and 22.1% are postmenopausal. Keywords.

Insufficient sleep, menopause, National Health Interview Survey Perimenopausal women were more likely than premenopausal and postmenopausal women to sleep less than 7 hours, on average, in a 24-hour period.More than can propecia grow hair one in three nonpregnant women aged 40–59 slept less than 7 hours, on average, in a 24-hour period (35.1%) (Figure 1). Perimenopausal women were most likely to sleep less than 7 hours, on average, in a 24-hour period (56.0%), compared with 32.5% of premenopausal and 40.5% of postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to sleep less than 7 hours, on average, in a 24-hour period.

Figure 1 can propecia grow hair. Percentage of nonpregnant women aged 40–59 who slept less than 7 hours, on average, in a 24-hour period, by menopausal status. United States, 2015image icon1Significant quadratic trend can propecia grow hair by menopausal status (p <.

0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was can propecia grow hair 1 year ago or less.

Women were premenopausal if they still had a menstrual cycle. Access data table can propecia grow hair for Figure 1pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015.

The percentage of women aged 40–59 who had trouble falling asleep four times or more in the past week varied by menopausal status.Nearly one in five nonpregnant women aged 40–59 had trouble falling asleep four can propecia grow hair times or more in the past week (19.4%) (Figure 2). The percentage of women in this age group who had trouble falling asleep four times or more in the past week increased from 16.8% among premenopausal women to 24.7% among perimenopausal and 27.1% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to have trouble falling asleep four times or more in the past week.

Figure 2 can propecia grow hair. Percentage of nonpregnant women aged 40–59 who had trouble falling asleep four times or more in the past week, by menopausal status. United States, can propecia grow hair 2015image icon1Significant linear trend by menopausal status (p <.

0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle can propecia grow hair and their last menstrual cycle was 1 year ago or less.

Women were premenopausal if they still had a menstrual cycle. Access data table for can propecia grow hair Figure 2pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015.

The percentage of women aged 40–59 who had trouble staying asleep four times or more in can propecia grow hair the past week varied by menopausal status.More than one in four nonpregnant women aged 40–59 had trouble staying asleep four times or more in the past week (26.7%) (Figure 3). The percentage of women aged 40–59 who had trouble staying asleep four times or more in the past week increased from 23.7% among premenopausal, to 30.8% among perimenopausal, and to 35.9% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to have trouble staying asleep four times or more in the past week.

Figure 3 can propecia grow hair. Percentage of nonpregnant women aged 40–59 who had trouble staying asleep four times or more in the past week, by menopausal status. United States, 2015image icon1Significant can propecia grow hair linear trend by menopausal status (p <.

0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a can propecia grow hair menstrual cycle and their last menstrual cycle was 1 year ago or less.

Women were premenopausal if they still had a menstrual cycle. Access data table for Figure 3pdf can propecia grow hair icon.SOURCE. NCHS, National Health Interview Survey, 2015.

The percentage of women aged 40–59 who did not wake up feeling well rested 4 days or more in the past week varied by menopausal status.Nearly one in two nonpregnant women aged 40–59 did not wake up feeling well rested 4 days or more in the past week (48.9%) (Figure 4). The percentage of women in this age group who did not wake up feeling well can propecia grow hair rested 4 days or more in the past week increased from 47.0% among premenopausal women to 49.9% among perimenopausal and 55.1% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to not wake up feeling well rested 4 days or more in the past week.

Figure 4 can propecia grow hair. Percentage of nonpregnant women aged 40–59 who did not wake up feeling well rested 4 days or more in the past week, by menopausal status. United States, 2015image icon1Significant linear trend by menopausal status (p <.

0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less.

Women were premenopausal if they still had a menstrual cycle. Access data table for Figure 4pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015.

SummaryThis report describes sleep duration and sleep quality among U.S. Nonpregnant women aged 40–59 by menopausal status. Perimenopausal women were most likely to sleep less than 7 hours, on average, in a 24-hour period compared with premenopausal and postmenopausal women.

In contrast, postmenopausal women were most likely to have poor-quality sleep. A greater percentage of postmenopausal women had frequent trouble falling asleep, staying asleep, and not waking well rested compared with premenopausal women. The percentage of perimenopausal women with poor-quality sleep was between the percentages for the other two groups in all three categories.

Sleep duration changes with advancing age (4), but sleep duration and quality are also influenced by concurrent changes in women’s reproductive hormone levels (5). Because sleep is critical for optimal health and well-being (6), the findings in this report highlight areas for further research and targeted health promotion. DefinitionsMenopausal status.

A three-level categorical variable was created from a series of questions that asked women. 1) “How old were you when your periods or menstrual cycles started?. €.

2) “Do you still have periods or menstrual cycles?. €. 3) “When did you have your last period or menstrual cycle?.

€. And 4) “Have you ever had both ovaries removed, either as part of a hysterectomy or as one or more separate surgeries?. € Women were postmenopausal if they a) had gone without a menstrual cycle for more than 1 year or b) were in surgical menopause after the removal of their ovaries.

Women were perimenopausal if they a) no longer had a menstrual cycle and b) their last menstrual cycle was 1 year ago or less. Premenopausal women still had a menstrual cycle.Not waking feeling well rested. Determined by respondents who answered 3 days or less on the questionnaire item asking, “In the past week, on how many days did you wake up feeling well rested?.

€Short sleep duration. Determined by respondents who answered 6 hours or less on the questionnaire item asking, “On average, how many hours of sleep do you get in a 24-hour period?. €Trouble falling asleep.

Determined by respondents who answered four times or more on the questionnaire item asking, “In the past week, how many times did you have trouble falling asleep?. €Trouble staying asleep. Determined by respondents who answered four times or more on the questionnaire item asking, “In the past week, how many times did you have trouble staying asleep?.

€ Data source and methodsData from the 2015 National Health Interview Survey (NHIS) were used for this analysis. NHIS is a multipurpose health survey conducted continuously throughout the year by the National Center for Health Statistics. Interviews are conducted in person in respondents’ homes, but follow-ups to complete interviews may be conducted over the telephone.

Data for this analysis came from the Sample Adult core and cancer supplement sections of the 2015 NHIS. For more information about NHIS, including the questionnaire, visit the NHIS website.All analyses used weights to produce national estimates. Estimates on sleep duration and quality in this report are nationally representative of the civilian, noninstitutionalized nonpregnant female population aged 40–59 living in households across the United States.

The sample design is described in more detail elsewhere (7). Point estimates and their estimated variances were calculated using SUDAAN software (8) to account for the complex sample design of NHIS. Linear and quadratic trend tests of the estimated proportions across menopausal status were tested in SUDAAN via PROC DESCRIPT using the POLY option.

Differences between percentages were evaluated using two-sided significance tests at the 0.05 level. About the authorAnjel Vahratian is with the National Center for Health Statistics, Division of Health Interview Statistics. The author gratefully acknowledges the assistance of Lindsey Black in the preparation of this report.

ReferencesFord ES. Habitual sleep duration and predicted 10-year cardiovascular risk using the pooled cohort risk equations among US adults. J Am Heart Assoc 3(6):e001454.

2014.Ford ES, Wheaton AG, Chapman DP, Li C, Perry GS, Croft JB. Associations between self-reported sleep duration and sleeping disorder with concentrations of fasting and 2-h glucose, insulin, and glycosylated hemoglobin among adults without diagnosed diabetes. J Diabetes 6(4):338–50.

2014.American College of Obstetrics and Gynecology. ACOG Practice Bulletin No. 141.

Management of menopausal symptoms. Obstet Gynecol 123(1):202–16. 2014.Black LI, Nugent CN, Adams PF.

Tables of adult health behaviors, sleep. National Health Interview Survey, 2011–2014pdf icon. 2016.Santoro N.

Perimenopause. From research to practice. J Women’s Health (Larchmt) 25(4):332–9.

2016.Watson NF, Badr MS, Belenky G, Bliwise DL, Buxton OM, Buysse D, et al. Recommended amount of sleep for a healthy adult. A joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society.

J Clin Sleep Med 11(6):591–2. 2015.Parsons VL, Moriarity C, Jonas K, et al. Design and estimation for the National Health Interview Survey, 2006–2015.

National Center for Health Statistics. Vital Health Stat 2(165). 2014.RTI International.

SUDAAN (Release 11.0.0) [computer software]. 2012. Suggested citationVahratian A.

Sleep duration and quality among women aged 40–59, by menopausal status. NCHS data brief, no 286. Hyattsville, MD.

National Center for Health Statistics. 2017.Copyright informationAll material appearing in this report is in the public domain and may be reproduced or copied without permission. Citation as to source, however, is appreciated.National Center for Health StatisticsCharles J.

Rothwell, M.S., M.B.A., DirectorJennifer H. Madans, Ph.D., Associate Director for ScienceDivision of Health Interview StatisticsMarcie L. Cynamon, DirectorStephen J.

Blumberg, Ph.D., Associate Director for Science.

NCHS Data Your Domain Name Brief propecia price canada No. 286, September 2017PDF Versionpdf icon (374 KB)Anjel Vahratian, Ph.D.Key findingsData from the National Health Interview Survey, 2015Among those aged 40–59, perimenopausal women (56.0%) were more likely than postmenopausal (40.5%) and premenopausal (32.5%) women to sleep less than 7 hours, on average, in a 24-hour period.Postmenopausal women aged 40–59 were more likely than premenopausal women aged 40–59 to have trouble falling asleep (27.1% compared with 16.8%, respectively), and staying asleep (35.9% compared with 23.7%), four times or more in the past week.Postmenopausal women aged 40–59 (55.1%) were more likely than premenopausal women aged 40–59 (47.0%) to not wake up feeling well rested 4 days or more in the past week.Sleep duration and quality are important contributors to health and wellness. Insufficient sleep is associated with an increased risk for chronic conditions such propecia price canada as cardiovascular disease (1) and diabetes (2). Women may be particularly vulnerable to sleep problems during times of reproductive hormonal change, such as after the menopausal transition. Menopause is “the permanent cessation of menstruation that occurs after the propecia price canada loss of ovarian activity” (3).

This data brief describes sleep duration and sleep quality among nonpregnant women aged 40–59 by menopausal status. The age range selected for this analysis reflects the focus on midlife sleep health. In this analysis, 74.2% of women propecia price canada are premenopausal, 3.7% are perimenopausal, and 22.1% are postmenopausal. Keywords. Insufficient sleep, menopause, National Health Interview Survey Perimenopausal women were more likely than premenopausal and postmenopausal women to sleep less than 7 hours, on average, in a 24-hour period.More than one in three nonpregnant women aged 40–59 slept less than propecia price canada 7 hours, on average, in a 24-hour period (35.1%) (Figure 1).

Perimenopausal women were most likely to sleep less than 7 hours, on average, in a 24-hour period (56.0%), compared with 32.5% of premenopausal and 40.5% of postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to sleep less than 7 hours, on average, in a 24-hour period. Figure 1 propecia price canada. Percentage of nonpregnant women aged 40–59 who slept less than 7 hours, on average, in a 24-hour period, by menopausal status. United States, 2015image icon1Significant propecia price canada quadratic trend by menopausal status (p <.

0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was 1 propecia price canada year ago or less. Women were premenopausal if they still had a menstrual cycle. Access data propecia price canada table for Figure 1pdf icon.SOURCE.

NCHS, National Health Interview Survey, 2015. The percentage propecia price canada of women aged 40–59 who had trouble falling asleep four times or more in the past week varied by menopausal status.Nearly one in five nonpregnant women aged 40–59 had trouble falling asleep four times or more in the past week (19.4%) (Figure 2). The percentage of women in this age group who had trouble falling asleep four times or more in the past week increased from 16.8% among premenopausal women to 24.7% among perimenopausal and 27.1% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to have trouble falling asleep four times or more in the past week. Figure 2 propecia price canada.

Percentage of nonpregnant women aged 40–59 who had trouble falling asleep four times or more in the past week, by menopausal status. United States, 2015image icon1Significant linear trend by menopausal status propecia price canada (p <. 0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle propecia price canada and their last menstrual cycle was 1 year ago or less.

Women were premenopausal if they still had a menstrual cycle. Access data propecia price canada table for Figure 2pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015. The percentage of women aged 40–59 who had trouble staying asleep four times or more in the past week varied by menopausal status.More than one in four nonpregnant women aged 40–59 had trouble staying propecia price canada asleep four times or more in the past week (26.7%) (Figure 3). The percentage of women aged 40–59 who had trouble staying asleep four times or more in the past week increased from 23.7% among premenopausal, to 30.8% among perimenopausal, and to 35.9% among postmenopausal women.

Postmenopausal women were significantly more likely than premenopausal women to have trouble staying asleep four times or more in the past week. Figure 3 propecia price canada. Percentage of nonpregnant women aged 40–59 who had trouble staying asleep four times or more in the past week, by menopausal status. United States, 2015image icon1Significant linear trend by menopausal status propecia price canada (p <. 0.05).NOTES.

Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a propecia price canada menstrual cycle and their last menstrual cycle was 1 year ago or less. Women were premenopausal if they still had a menstrual cycle. Access data table for Figure 3pdf icon.SOURCE propecia price canada. NCHS, National Health Interview Survey, 2015.

The percentage of women aged 40–59 who did not wake up feeling well rested 4 days or more in the past week varied by menopausal status.Nearly one in two nonpregnant women aged 40–59 did not wake up feeling well rested 4 days or more in the past week (48.9%) (Figure 4). The percentage of women in this age group who did not wake up feeling well rested 4 days or more in the past propecia price canada week increased from 47.0% among premenopausal women to 49.9% among perimenopausal and 55.1% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to not wake up feeling well rested 4 days or more in the past week. Figure 4 propecia price canada. Percentage of nonpregnant women aged 40–59 who did not wake up feeling well rested 4 days or more in the past week, by menopausal status.

United States, 2015image icon1Significant linear trend by menopausal status (p <. 0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less. Women were premenopausal if they still had a menstrual cycle.

Access data table for Figure 4pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015. SummaryThis report describes sleep duration and sleep quality among U.S. Nonpregnant women aged 40–59 by menopausal status. Perimenopausal women were most likely to sleep less than 7 hours, on average, in a 24-hour period compared with premenopausal and postmenopausal women.

In contrast, postmenopausal women were most likely to have poor-quality sleep. A greater percentage of postmenopausal women had frequent trouble falling asleep, staying asleep, and not waking well rested compared with premenopausal women. The percentage of perimenopausal women with poor-quality sleep was between the percentages for the other two groups in all three categories. Sleep duration changes with advancing age (4), but sleep duration and quality are also influenced by concurrent changes in women’s reproductive hormone levels (5). Because sleep is critical for optimal health and well-being (6), the findings in this report highlight areas for further research and targeted health promotion.

DefinitionsMenopausal status. A three-level categorical variable was created from a series of questions that asked women. 1) “How old were you when your periods or menstrual cycles started?. €. 2) “Do you still have periods or menstrual cycles?.

€. 3) “When did you have your last period or menstrual cycle?. €. And 4) “Have you ever had both ovaries removed, either as part of a hysterectomy or as one or more separate surgeries?. € Women were postmenopausal if they a) had gone without a menstrual cycle for more than 1 year or b) were in surgical menopause after the removal of their ovaries.

Women were perimenopausal if they a) no longer had a menstrual cycle and b) their last menstrual cycle was 1 year ago or less. Premenopausal women still had a menstrual cycle.Not waking feeling well rested. Determined by respondents who answered 3 days or less on the questionnaire item asking, “In the past week, on how many days did you wake up feeling well rested?. €Short sleep duration. Determined by respondents who answered 6 hours or less on the questionnaire item asking, “On average, how many hours of sleep do you get in a 24-hour period?.

€Trouble falling asleep. Determined by respondents who answered four times or more on the questionnaire item asking, “In the past week, how many times did you have trouble falling asleep?. €Trouble staying asleep. Determined by respondents who answered four times or more on the questionnaire item asking, “In the past week, how many times did you have trouble staying asleep?. € Data source and methodsData from the 2015 National Health Interview Survey (NHIS) were used for this analysis.

NHIS is a multipurpose health survey conducted continuously throughout the year by the National Center for Health Statistics. Interviews are conducted in person in respondents’ homes, but follow-ups to complete interviews may be conducted over the telephone. Data for this analysis came from the Sample Adult core and cancer supplement sections of the 2015 NHIS. For more information about NHIS, including the questionnaire, visit the NHIS website.All analyses used weights to produce national estimates. Estimates on sleep duration and quality in this report are nationally representative of the civilian, noninstitutionalized nonpregnant female population aged 40–59 living in households across the United States.

The sample design is described in more detail elsewhere (7). Point estimates and their estimated variances were calculated using SUDAAN software (8) to account for the complex sample design of NHIS. Linear and quadratic trend tests of the estimated proportions across menopausal status were tested in SUDAAN via PROC DESCRIPT using the POLY option. Differences between percentages were evaluated using two-sided significance tests at the 0.05 level. About the authorAnjel Vahratian is with the National Center for Health Statistics, Division of Health Interview Statistics.

The author gratefully acknowledges the assistance of Lindsey Black in the preparation of this report. ReferencesFord ES. Habitual sleep duration and predicted 10-year cardiovascular risk using the pooled cohort risk equations among US adults. J Am Heart Assoc 3(6):e001454. 2014.Ford ES, Wheaton AG, Chapman DP, Li C, Perry GS, Croft JB.

Associations between self-reported sleep duration and sleeping disorder with concentrations of fasting and 2-h glucose, insulin, and glycosylated hemoglobin among adults without diagnosed diabetes. J Diabetes 6(4):338–50. 2014.American College of Obstetrics and Gynecology. ACOG Practice Bulletin No. 141.

Management of menopausal symptoms. Obstet Gynecol 123(1):202–16. 2014.Black LI, Nugent CN, Adams PF. Tables of adult health behaviors, sleep. National Health Interview Survey, 2011–2014pdf icon.

2016.Santoro N. Perimenopause. From research to practice. J Women’s Health (Larchmt) 25(4):332–9. 2016.Watson NF, Badr MS, Belenky G, Bliwise DL, Buxton OM, Buysse D, et al.

Recommended amount of sleep for a healthy adult. A joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society. J Clin Sleep Med 11(6):591–2. 2015.Parsons VL, Moriarity C, Jonas K, et al. Design and estimation for the National Health Interview Survey, 2006–2015.

National Center for Health Statistics. Vital Health Stat 2(165). 2014.RTI International. SUDAAN (Release 11.0.0) [computer software]. 2012.

Suggested citationVahratian A. Sleep duration and quality among women aged 40–59, by menopausal status. NCHS data brief, no 286. Hyattsville, MD. National Center for Health Statistics.

2017.Copyright informationAll material appearing in this report is in the public domain and may be reproduced or copied without permission. Citation as to source, however, is appreciated.National Center for Health StatisticsCharles J. Rothwell, M.S., M.B.A., DirectorJennifer H. Madans, Ph.D., Associate Director for ScienceDivision of Health Interview StatisticsMarcie L. Cynamon, DirectorStephen J.

Blumberg, Ph.D., Associate Director for Science.

Propecia cause cancer

Sport is predicated on the idea of victors emerging from propecia cause cancer a level playing field. All ethically informed evaluate practices are like this. They require an equality of respect, consideration, and opportunity, propecia cause cancer while trying to achieve substantively unequal outcomes. For instance.

Limited resources mean that physicians must treat some patients and not others, while still treating them with equal respect. Examiners must pass some propecia cause cancer students and not others, while still giving their work equal consideration. Employers may only be able to hire one applicant, while still being required to treat all applicants fairly, and so on. The 800 m is meant to be one of these practices propecia cause cancer.

A level and equidistance running track from which one victor is intended to emerge. The case of Caster Semenya raises challenging questions about what makes level-playing-fields level, questions that extend beyond any given playing field.In the Feature Article for this issue Loland provides us with new and engaging reasons to support of the Court of Arbitration for Sport (CAS) decision in the Casta Semenya case. The impact of the CAS decision requires Casta propecia cause cancer Semenya to supress her naturally occurring testosterone if she is to compete in an international athletics events. The Semenya case is described by Loland as creating a ‘dilemma of rights’.i The dilemma lies in the choice between ‘the right of Semenya to compete in sport according to her legal sex and gender identity’ and ‘the right of other athletes within the average female testosterone range to compete under fair conditions’ (see footnote i).No one denies the importance of Semenya’s right.

As Carpenter explains, ‘even where inconvenient, sex assigned at birth should always be respected unless an individual seeks otherwise’.2 Loland’s conclusions, Carpenter argues, ‘support a propecia cause cancer convenience-based approach to classification of sex where choices about the status of people with intersex variations are made by others according to their interests at that time’ (see footnote ii). Carpenter then further explains how the CAS decision is representative of ‘systemic forms of discrimination and human rights violations’ and provides no assistance in ‘how we make the world more hospitable and more accepting of difference’ (see footnote ii).What is therefore at issue is the existence of the second right. Let me explain how Loland constructs it. The background principle is the principle of fair equality of opportunity, which requires that ‘individuals with similar endowments and talents and similar ambitions should be given similar opportunities and roughly equivalent prospects propecia cause cancer for competitive success’(see footnote i).

This principle reflects, according to Loland, a deeper deontological right of respect and fair treatment. As we can appreciate, when it comes to the principle of fair equality of opportunity, a lot turns on what counts as ‘similar’ (or sufficiently different) endowments and talents and what counts as ‘similar’ (or sufficiently different) opportunities and prospects for success.For Loland, ‘dynamic inequalities’ concern differences in capabilities (such as strength, speed, and endurance, and in technical and tactical skills) that can be ‘cultivated by hard work and effort’ (see footnote i). These are capabilities that are ‘relevant’ and therefore permit a range differences between otherwise propecia cause cancer ‘similar’ athletes. €˜Stable inequalities’ are characterises (such as in age, sex, body size, and disability/ability) are ‘not-relevant’ and therefore require classification to ensure that ‘similar’ athletes are given ‘roughly equivalent prospects for success’.

It follows for Loland that athletes with ‘46 XY DSD conditions (and not for individuals with normal female XX chromosones), with testosterone levels above five nanomoles per litre blood (nmol/L), and who experience a ‘material androgenizing effect’’ propecia cause cancer benefit from a stable inequality (see footnote i). Hence, the ‘other athletes within the average female testosterone range’ therefore have a right not to compete under conditions of stable inequality. The solution, according to Knox and Anderson, lies in more nuance classifications. Commenting in (qualified) support of Loland, they suggest that ‘classification according to sex alone is no longer adequate’.3 Instead, ‘all athletes would be categorised, making classification the norm’ (see footnote iii).However, as we have just seen, Loland’s distinction between stable and dynamic inequalities depends on their ‘relevance’, and ‘relevance’ is a propecia cause cancer term that does not travel alone.

Something is relevant (or irrelevant) only in relation to the value, purpose, or aim, of some practice. One interpretation (which I take Loland to be propecia cause cancer saying) is that strength, speed, and endurance (and so on) are ‘relevant’ to ‘performance outcomes’. This can be misleading. Both dynamic and stable inequalities are relevant to (ie, can have an impact on) an athletic performance.

Is a question of whether we ought propecia cause cancer to permit them to have an impact. The temptation is then to say that dynamic inequalities are relevant (and stable inequalities are irrelevant) where the aim is ‘respect and fair treatment’. But here the snake begins to eat its tail (the principle of fair treatment requires sufficiently similar prospects for success >similar prospects for success require only dynamic inequalities>dynamic inequalities are capabilities that are permitted by the principle of fair treatment).In order to determine questions of relevance, we need to identify the value, purpose, or aim, of the social practice in question. If the aim of an athletic event is to have a victor emerge from a completely level playing field, then, as Chambers notes, socioeconomic inequalities are a larger affront to fair propecia cause cancer treatment than athletes with 46 XY DSD conditions.4 If the aim is to have a victor emerge from completely level hormonal playing field then ‘a man with low testosterone levels is unfairly disadvantaged against a man whose natural levels are higher, and so men’s competitions are unfair’ (see footnote iv).

Or, at least very high testosterone males should be on hormone suppressants in order to give the ‘average’ competitor a ‘roughly equivalent prospect for competitive success’.The problem is that we are not interested in the average competitor. We are interested in the exceptional among propecia cause cancer us. Unless, it is for light relief. In every Olympiad there is the observation that, in every Olympic event, one average person should be included in the competition for the spectators’ reference.

The humour lies in the absurd scenarios that propecia cause cancer would follow, whether it be the 100 m sprint, high jump, or synchronised swimming. Great chasms of natural ability would be laid bare, the results of a lifetime of training and dedication would be even clearer to see, and the last place result would be entirely predictable. But note how these are different propecia cause cancer attributes. While we may admire Olympians, it is unclear whether it is because of their God-given ability, their grit and determination, or their role in the unpredictable theatre of sport.

If sport is a worthwhile social practice, we need to start spelling out its worth. Without doing so, we are unable to identify what capabilities are ‘relevant’ propecia cause cancer or ‘irrelevant’ to its aims, purpose or value. And until we can explain why one naturally occurring capability is ‘irrelevant’ to the aims, purposes, or values, of sport, while the remainder of them are relevant, I can only identify one right in play in the Semenya case.IntroductionSince the start of the hair loss treatment propecia, many medical systems have needed to divert routine services in order to support the large number of patients with acute hair loss treatment disease. For example, in the National Health Service (NHS) almost all elective surgery has been postponed1 and outpatient clinics propecia cause cancer have been cancelled or conducted on-line treatment regimens for many forms of cancer have changed2.

This diversion inevitably reduces availability of routine treatments for non-hair loss treatment-related illness. Even urgent treatments have needed to be modified. Patients with acute surgical emergencies such as appendicitis still present propecia cause cancer for care, cancers continue to be discovered in patients, and may require urgent management. Health systems are focused on making sure that these urgent needs are met.

However, to achieve this goal, many patients are offered treatments that deviate from standard, non-propecia management.Deviations from standard management are required for multiple factors such as:Limited resources (staff and equipment reallocated).Risk of nosocomial acquired in high-risk patients.Increased risk for medical staff to deliver treatments due to aerosolisation1.Treatments requiring intensive care therapy that is in limited availability.Operative procedures that are long and difficult or that are technically challenging if conducted in personal protective equipment. The outcomes from such procedures may be worse than in normal circumstances.Treatments that render patients more susceptible to hair loss treatment disease, for example chemotherapy.There are many instances of compromise, but some examples that we are aware of include open appendectomy rather than laparoscopy to reduce risk of aerosolisation3 and offering a percutaneousCoronary intervention (PCI) rather than coronary artery bypass grafting propecia cause cancer (CABG) for coronary artery disease, to reduce need for intensive care. Surgery for cancers ordinarily operated on urgently maybe deferred for up to 3 months4 and surgery might be conducted under local anaesthesia that would typically have merited a general anaesthetic (both to reduce the aerosol risk of General anaesthesia, and because of relative lack of anaesthetists).The current emergency offers a unique difficulty. A significant number of treatments with proven benefit might be unavailable to patients while those alternatives propecia cause cancer that are available are not usually considered best practice and might be actually inferior.

In usual circumstances, where two treatment options for a particular problem are considered appropriate, the decision of which option to pursue would often depend on the personal preference of the patient.But during the propecia what is ethically and legally required of the doctor or medical professional informing patients about treatment and seeking their consent?. In particular, do health professionals need to make patients aware of the usual forms of treatment that they are not being offered in the current setting?. We consider two theoretical case examples:Case 1Jenny2 is a model in her mid-20s propecia cause cancer who presents to hospital at the peak of the hair loss treatment propecia with acute appendicitis. Her surgeon, Miss Schmidt, approaches Jenny to obtain consent for an open appendectomy.

Miss Schmidt propecia cause cancer explains the risks of the operative procedure, and the alternative of conservative management (with intravenous antibiotics). Jenny consents to the procedure. However, she develops a postoperative wound and an unsightly scar. She does some research and discovers that a laparoscopic procedure would ordinarily have been performed and would have had a propecia cause cancer lower chance of wound .

She sues Miss Schmidt and the hospital trust where she was treated.Case 2June2s a retired teacher in her early 70s who has well-controlled diabetes and hypertension. She is active and runs a local food bank. Immediately prior to the propecia lockdown in the UK June had an episode of severe chest pain and investigations revealed that she has had a non-ST elevation propecia cause cancer myocardial infarction. The cardiothoracic surgical team recommends that June undergo a PCI although normally her pattern of coronary artery disease would be treated by CABG.

When the cardiologist explains that surgery would be normally offered in this situation, and is theoretically superior to PCI, June’s husband becomes angry and demands that June is listed for surgery.In favour of non-disclosureIt might appear at first glance that doctors should obviously inform Jenny and June propecia cause cancer about the usual standard of care. After all, consent cannot be informed if crucial information is lacking. However, one reason that this may be called into question is that it is not immediately clear how it benefits a patient to be informed about alternatives that are not actually available?. In usual circumstances, doctors are not obliged to inform patients propecia cause cancer about treatments that are performed overseas but not in the UK.

In the UK, for example, there is a rigorous process for assessment of new treatments (not including experimental therapies). Some treatments that are available in other jurisdictions have not been deemed by the National Institute for Health and Care Excellence (NICE) to be sufficiently beneficial and propecia cause cancer cost-effective to be offered by the NHS. It is hard to imagine that a health professional would be found negligent for not discussing with a patient a treatment that NICE has explicitly rejected. The same might apply for novel therapies that are currently unfunded pending formal evaluation by NICE.Of course, the difference is that the treatments we are discussing have been proven (or are believed) to be beneficial and would normally be provided.

The Montgomery Ruling of propecia cause cancer 2015 in the UK established that patients must be informed of material risks of treatment and reasonable alternatives to treatment. The Bayley –v- George Eliot Hospital NHS Trust5case established that those reasonable alternative treatments must be ‘appropriate treatment’ not just a ‘possible treatment’6. In the current crisis, many previously standard treatments are no longer propecia cause cancer appropriate given the restrictions outlined. In other circumstances they are appropriate.

During a propecia they are no longer appropriate, even if they become appropriate again at some unknown time in the future.In both ethical and legal terms, it is widely accepted that, for consent to be valid, if must be given voluntarily by a person who has capacity to consent and who understands the nature and risks of the treatment. A failure to obtain valid consent, or performing interventions in the absence of propecia cause cancer consent, could result in criminal proceedings for assault. Failing to provide adequate information in the consent process could support a claim of negligence. Ethically, adequate information about treatments is essential for the patient to enable them to weigh up options and decide which treatments they wish to undertake.

However, information about unavailable treatments arguably does not help the patient make an informed decision because it does not give them information that is relevant to consenting or to refusal of treatment that is actually propecia cause cancer available. If Miss Schmidt had given Jenny information about the relative benefits of laparoscopic appendectomy, that could not have helped Jenny’s decision to proceed with surgery. Her available choices were open appendectomy propecia cause cancer or no surgery. Moreover, as the case of June highlights, providing information about alternatives may lead them to desire or even demand those alternative options.

This could cause distress both to the patient and the health professional (who is unable to acquiesce).Consideration might also be paid to the effect on patients of disclosure. How would it affect a patient with newly diagnosed cancer to tell them that an alternative, perhaps better therapy, might be routinely available in usual circumstances but is propecia cause cancer not available now?. There is provision in the Montgomery Ruling, in rare circumstances, for therapeutic exception. That is, if information is significantly detrimental to the health of a patient it might propecia cause cancer be omitted.

We could imagine a version of the case where Jenny was so intensely anxious about the proposed surgery that her surgeon comes to a sincere belief that discussion of the laparoscopic alternative would be extremely distressing or might even lead her to refuse surgery. In most cases, though, it would be hard to be sure that the risks of disclosing alternative (non-available) treatments would be so great that non-disclosure would be justified.In favour of disclosureIn the UK, professional guidance issued by the GMC (General Medical Council) requires doctors to take a personalised approach to information sharing about treatments by sharing ‘with patients the information they want or need in order to make decisions’. The Montgomery judgement of 20157 broadly endorsed the position of the GMC, requiring patients to be told about any material propecia cause cancer risks and reasonable alternatives relevant to the decision at hand. The Supreme Court clarifies that materiality here should be judged by reference to a new two-limbed test founded on the notions of the ‘reasonable person in the patient’s position’ and the ‘particular patient’.

One practical test might be for the clinician to ask themselves whether patients in general, or this particular patient might wish to know about alternative forms of treatment that would usually be offered.The GMC has recently produced propecia-specific guidance8 on consent and decision-making, but this guidance is focused on managing consent in hair loss treatment-related interventions. While the GMC takes the view that its consent guidelines continue to apply as far as is practical, it also notes that the patient propecia cause cancer is enabled to consider the ‘reasonable alternatives’, and that the doctor is ‘open and honest with patients about the decision-making process and the criteria for setting priorities in individual cases’.In some situations, there might be the option of delaying treatment until later. When other surgical procedures are possible. In that setting, it propecia cause cancer would be important to ensure that the patient is aware of those future options (including the risks of delay).

For example, if Jenny had symptomatic gallstones, her surgeons might be offering an open cholecystectomy now or the possibility of a laparoscopic surgery at some later point. Understanding the full options open to her now and in the future may have considerable influence on Jenny’s decision. Likewise, if June propecia cause cancer is aware that she is not being offered standard treatment she may wish to delay treatment of her atherosclerosis until a later date. Of course, such a delay might lead to greater harm overall.

However, it would be ethically permissible to delay treatment if that was the patient’s informed choice (just as it would be permissible for the patient to refuse treatment altogether).In the appendicitis case, Jenny does not have the option propecia cause cancer for delaying her treatment, but the choice for June is more complicated, between immediate PCI which is a second-best treatment versus waiting for standard therapy. Immediate surgery also raises a risk of acquiring nosocomial hair loss treatment and June is in an age group and has comorbidities that put her at risk of severe hair loss treatment disease. Waiting for surgery leaves June at risk of sudden death. For an active and otherwise propecia cause cancer well patient with coronary disease like June, PCI procedure is not as good a treatment as CABG and June might legitimately wish to take her chances and wait for the standard treatment.

The decision to operate or wait is a balance of risks that only June is fully able to make. Patients in this scenario propecia cause cancer will take different approaches. Patients will need different amounts of information to form their decisions, many patients will need as much information as is available including information about procedures not currently available to make up their mind.June’s husband insists that she should receive the best treatment, and that she should therefore be listed for CABG. Although this treatment would appear to be in June’s best interests, and would respect her autonomy, those ethical considerations are potentially outweighed by distributive justice.

The hair loss treatment propecia of propecia cause cancer 2020 is being characterised by limitations. Liberties curtailed and choices restricted, this is justified by a need to protect healthcare systems from demand exceeding availability. While resource allocation is always a relevant ethical concern in publicly funded healthcare systems, it is a dominant concern in a setting where there is a high demand for medical care and scare resources.It is well established that competent adult patients can consent to or refuse medical treatment but they cannot demand that health professionals provide treatments that are contrary to their professional judgement or (even more importantly) would consume scarce healthcare resources. In June’s case, agreeing to perform CABG at a time when large numbers propecia cause cancer of patients are critically ill with hair loss treatment might mean that another patient is denied access to intensive care (and even dies as a result).

Of course, it may be that there are actually available beds in intensive care, and June’s operation would not directly lead to denial of treatment for another patient. However, that does not automatically mean propecia cause cancer that surgery must proceed. The hospital may have been justified in making a decision to suspend some forms of cardiac surgery. That could be on the basis of the need to use the dedicated space, staff and equipment of the cardiothoracic critical care unit for patients with hair loss treatment.

Even if all that physical space is not currently occupied if may not be feasible or practical to try propecia cause cancer to simultaneously accommodate some non-hair loss treatment patients. (There would be a risk that June would contract hair loss treatment postoperatively and end up considerably worse off than she would have been if she had instead received PCI.) Moreover, it seems problematic for individual patients to be able to circumvent policies about allocation of resources purely on the basis that they stand to be disadvantaged by the policy.Perhaps the most significant benefit of disclosure of non-options is transparency and honesty. We suggest that the propecia cause cancer main reason why Miss Schmidt ought to have included discussion of the laparoscopic alternative is so that Jenny understands the reasoning behind the decision. If Miss Schmidt had explained to Jenny that in the current circumstances laparoscopic surgery has been stopped, that might have helped her to appreciate that she was being offered the best available management.

It might have enabled a frank discussion about the challenges faced by health professionals in the context of the propecia and the inevitable need for compromise. It may have propecia cause cancer avoided awkward discussions later after Jenny developed her complication.Transparent disclosure should not mean that patients can demand treatment. But it might mean that patients could appeal against a particular policy if they feel that it has been reached unfairly, or applied unfairly. For example, if June became aware that some patients were still being offered CABG, she might (or might not) be justified in appealing against the decision not to offer it to her.

Obviously such an appeal would only be possible if the propecia cause cancer patient were aware of the alternatives that they were being denied.For patients faced by decisions such as that faced by June, balancing risks of either option is highly personal. Individuals need to weigh up these decisions for them and require all of the information available to do so. Some information is readily available, for example, the rate of for propecia cause cancer Jenny and the risk of death without treatment for June. But other risks are unknown, such as the risk of acquiring nosocomial with hair loss treatment.

Doctors might feel discomfort talking about unquantifiable risks, but we argue that it is important that the patient has all available information to weigh up options for them, including information that is unknown.ConclusionIn a propecia, as in other times, doctors should ensure that they offer appropriate medical treatment, based on the needs of an individual. They should aim to provide available treatment that is beneficial and should not offer treatment that is unavailable or contrary to the patient best interests propecia cause cancer. It is ethical. Indeed it is vital within a public healthcare system, to consider distributive justice in propecia cause cancer the allocation of treatment.

Where treatment is scarce, it may not be possible or appropriate to offer to patients some treatments that would be beneficial and desired by them.Informed consent needs to be individualised. Doctors are obliged to tailor their information to the needs of an individual. We suggest that in the current climate this should include, for most patients, a nuanced open discussion about alternative treatments that would have been available to them in usual circumstances propecia cause cancer. That will sometimes be a difficult conversation, and require clinicians to be frank about limited resources and necessary rationing.

However, transparency and honesty will usually be the best policy..

Sport is predicated on the idea of Cheap generic lasix victors propecia price canada emerging from a level playing field. All ethically informed evaluate practices are like this. They require an equality of respect, consideration, and opportunity, while propecia price canada trying to achieve substantively unequal outcomes. For instance.

Limited resources mean that physicians must treat some patients and not others, while still treating them with equal respect. Examiners must pass some students and not others, while propecia price canada still giving their work equal consideration. Employers may only be able to hire one applicant, while still being required to treat all applicants fairly, and so on. The 800 m is meant to propecia price canada be one of these practices.

A level and equidistance running track from which one victor is intended to emerge. The case of Caster Semenya raises challenging questions about what makes level-playing-fields level, questions that extend beyond any given playing field.In the Feature Article for this issue Loland provides us with new and engaging reasons to support of the Court of Arbitration for Sport (CAS) decision in the Casta Semenya case. The impact of the CAS decision requires Casta Semenya to supress her naturally occurring testosterone if she is to compete in propecia price canada an international athletics events. The Semenya case is described by Loland as creating a ‘dilemma of rights’.i The dilemma lies in the choice between ‘the right of Semenya to compete in sport according to her legal sex and gender identity’ and ‘the right of other athletes within the average female testosterone range to compete under fair conditions’ (see footnote i).No one denies the importance of Semenya’s right.

As Carpenter explains, ‘even where inconvenient, sex assigned at birth should always be respected unless an individual seeks otherwise’.2 Loland’s conclusions, Carpenter argues, ‘support a convenience-based approach to classification of sex where choices about the status of people with intersex variations are made by others according to their interests at that time’ (see footnote propecia price canada ii). Carpenter then further explains how the CAS decision is representative of ‘systemic forms of discrimination and human rights violations’ and provides no assistance in ‘how we make the world more hospitable and more accepting of difference’ (see footnote ii).What is therefore at issue is the existence of the second right. Let me explain how Loland constructs it. The background principle is the principle of fair equality of opportunity, which requires that ‘individuals with similar endowments and talents and similar ambitions should be given similar opportunities and propecia price canada roughly equivalent prospects for competitive success’(see footnote i).

This principle reflects, according to Loland, a deeper deontological right of respect and fair treatment. As we can appreciate, when it comes to the principle of fair equality of opportunity, a lot turns on what counts as ‘similar’ (or sufficiently different) endowments and talents and what counts as ‘similar’ (or sufficiently different) opportunities and prospects for success.For Loland, ‘dynamic inequalities’ concern differences in capabilities (such as strength, speed, and endurance, and in technical and tactical skills) that can be ‘cultivated by hard work and effort’ (see footnote i). These are capabilities that are ‘relevant’ and therefore permit a propecia price canada range differences between otherwise ‘similar’ athletes. €˜Stable inequalities’ are characterises (such as in age, sex, body size, and disability/ability) are ‘not-relevant’ and therefore require classification to ensure that ‘similar’ athletes are given ‘roughly equivalent prospects for success’.

It follows for Loland that athletes with ‘46 XY DSD conditions (and not for individuals with normal female XX chromosones), with testosterone levels above five nanomoles per litre blood (nmol/L), and who experience a ‘material androgenizing effect’’ benefit from a stable propecia price canada inequality (see footnote i). Hence, the ‘other athletes within the average female testosterone range’ therefore have a right not to compete under conditions of stable inequality. The solution, according to Knox and Anderson, lies in more nuance classifications. Commenting in (qualified) support of propecia price canada Loland, they suggest that ‘classification according to sex alone is no longer adequate’.3 Instead, ‘all athletes would be categorised, making classification the norm’ (see footnote iii).However, as we have just seen, Loland’s distinction between stable and dynamic inequalities depends on their ‘relevance’, and ‘relevance’ is a term that does not travel alone.

Something is relevant (or irrelevant) only in relation to the value, purpose, or aim, of some practice. One interpretation (which I take Loland to be saying) is that strength, speed, propecia price canada and endurance (and so on) are ‘relevant’ to ‘performance outcomes’. This can be misleading. Both dynamic and stable inequalities are relevant to (ie, can have an impact on) an athletic performance.

Is a question of whether we ought to permit them to have an impact propecia price canada. The temptation is then to say that dynamic inequalities are relevant (and stable inequalities are irrelevant) where the aim is ‘respect and fair treatment’. But here the snake begins to eat its tail (the principle of fair treatment requires sufficiently similar prospects for success >similar prospects for success require only dynamic inequalities>dynamic inequalities are capabilities that are permitted by the principle of fair treatment).In order to determine questions of relevance, we need to identify the value, purpose, or aim, of the social practice in question. If the aim of an athletic event is to have a victor emerge from a completely level playing field, then, as Chambers notes, socioeconomic inequalities are a larger affront to fair treatment than athletes with 46 XY DSD conditions.4 If the aim is to have a victor emerge from completely level hormonal playing field then ‘a man with low testosterone levels is unfairly disadvantaged against a man whose natural levels are higher, and propecia price canada so men’s competitions are unfair’ (see footnote iv).

Or, at least very high testosterone males should be on hormone suppressants in order to give the ‘average’ competitor a ‘roughly equivalent prospect for competitive success’.The problem is that we are not interested in the average competitor. We are interested in the exceptional among propecia price canada us. Unless, it is for light relief. In every Olympiad there is the observation that, in every Olympic event, one average person should be included in the competition for the spectators’ reference.

The humour lies in the absurd scenarios that propecia price canada would follow, whether it be the 100 m sprint, high jump, or synchronised swimming. Great chasms of natural ability would be laid bare, the results of a lifetime of training and dedication would be even clearer to see, and the last place result would be entirely predictable. But note propecia price canada how these are different attributes. While we may admire Olympians, it is unclear whether it is because of their God-given ability, their grit and determination, or their role in the unpredictable theatre of sport.

If sport is a worthwhile social practice, we need to start spelling out its worth. Without doing so, we are unable to identify what capabilities are ‘relevant’ or ‘irrelevant’ to propecia price canada its aims, purpose or value. And until we can explain why one naturally occurring capability is ‘irrelevant’ to the aims, purposes, or values, of sport, while the remainder of them are relevant, I can only identify one right in play in the Semenya case.IntroductionSince the start of the hair loss treatment propecia, many medical systems have needed to divert routine services in order to support the large number of patients with acute hair loss treatment disease. For example, in the National Health Service (NHS) almost all elective surgery has been postponed1 and outpatient clinics have been cancelled or conducted on-line treatment regimens for many forms of cancer propecia price canada have changed2.

This diversion inevitably reduces availability of routine treatments for non-hair loss treatment-related illness. Even urgent treatments have needed to be modified. Patients with acute surgical emergencies such as appendicitis still propecia price canada present for care, cancers continue to be discovered in patients, and may require urgent management. Health systems are focused on making sure that these urgent needs are met.

However, to achieve this goal, many patients are offered treatments that deviate from standard, non-propecia management.Deviations from standard management are required for multiple factors such as:Limited resources (staff and equipment reallocated).Risk of nosocomial acquired in high-risk patients.Increased risk for medical staff to deliver treatments due to aerosolisation1.Treatments requiring intensive care therapy that is in limited availability.Operative procedures that are long and difficult or that are technically challenging if conducted in personal protective equipment. The outcomes from such procedures may be worse than in normal circumstances.Treatments that render patients more susceptible to hair loss treatment disease, for example chemotherapy.There are many instances of compromise, but some examples propecia price canada that we are aware of include open appendectomy rather than laparoscopy to reduce risk of aerosolisation3 and offering a percutaneousCoronary intervention (PCI) rather than coronary artery bypass grafting (CABG) for coronary artery disease, to reduce need for intensive care. Surgery for cancers ordinarily operated on urgently maybe deferred for up to 3 months4 and surgery might be conducted under local anaesthesia that would typically have merited a general anaesthetic (both to reduce the aerosol risk of General anaesthesia, and because of relative lack of anaesthetists).The current emergency offers a unique difficulty. A significant number of treatments with proven benefit might be propecia price canada unavailable to patients while those alternatives that are available are not usually considered best practice and might be actually inferior.

In usual circumstances, where two treatment options for a particular problem are considered appropriate, the decision of which option to pursue would often depend on the personal preference of the patient.But during the propecia what is ethically and legally required of the doctor or medical professional informing patients about treatment and seeking their consent?. In particular, do health professionals need to make patients aware of the usual forms of treatment that they are not being offered in the current setting?. We consider two theoretical case propecia price canada examples:Case 1Jenny2 is a model in her mid-20s who presents to hospital at the peak of the hair loss treatment propecia with acute appendicitis. Her surgeon, Miss Schmidt, approaches Jenny to obtain consent for an open appendectomy.

Miss Schmidt explains the risks of the operative procedure, and the propecia price canada alternative of conservative management (with intravenous antibiotics). Jenny consents to the procedure. However, she develops a postoperative wound and an unsightly scar. She does some research and discovers that a laparoscopic procedure would ordinarily have been performed and would have propecia price canada had a lower chance of wound .

She sues Miss Schmidt and the hospital trust where she was treated.Case 2June2s a retired teacher in her early 70s who has well-controlled diabetes and hypertension. She is active and runs a local food bank. Immediately prior to the propecia propecia price canada lockdown in the UK June had an episode of severe chest pain and investigations revealed that she has had a non-ST elevation myocardial infarction. The cardiothoracic surgical team recommends that June undergo a PCI although normally her pattern of coronary artery disease would be treated by CABG.

When the cardiologist explains that surgery would be normally offered in this situation, and is theoretically superior to PCI, June’s husband propecia price canada becomes angry and demands that June is listed for surgery.In favour of non-disclosureIt might appear at first glance that doctors should obviously inform Jenny and June about the usual standard of care. After all, consent cannot be informed if crucial information is lacking. However, one reason that this may be called into question is that it is not immediately clear how it benefits a patient to be informed about alternatives that are not actually available?. In usual circumstances, doctors are not propecia price canada obliged to inform patients about treatments that are performed overseas but not in the UK.

In the UK, for example, there is a rigorous process for assessment of new treatments (not including experimental therapies). Some treatments that are available in other jurisdictions have not been deemed by the National Institute for Health and Care Excellence (NICE) to be sufficiently beneficial and propecia price canada cost-effective to be offered by the NHS. It is hard to imagine that a health professional would be found negligent for not discussing with a patient a treatment that NICE has explicitly rejected. The same might apply for novel therapies that are currently unfunded pending formal evaluation by NICE.Of course, the difference is that the treatments we are discussing have been proven (or are believed) to be beneficial and would normally be provided.

The Montgomery Ruling of 2015 in the UK established that patients must be informed of material risks of treatment and reasonable alternatives to treatment propecia price canada. The Bayley –v- George Eliot Hospital NHS Trust5case established that those reasonable alternative treatments must be ‘appropriate treatment’ not just a ‘possible treatment’6. In the propecia price canada current crisis, many previously standard treatments are no longer appropriate given the restrictions outlined. In other circumstances they are appropriate.

During a propecia they are no longer appropriate, even if they become appropriate again at some unknown time in the future.In both ethical and legal terms, it is widely accepted that, for consent to be valid, if must be given voluntarily by a person who has capacity to consent and who understands the nature and risks of the treatment. A failure to obtain valid consent, or performing interventions in the absence propecia price canada of consent, could result in criminal proceedings for assault. Failing to provide adequate information in the consent process could support a claim of negligence. Ethically, adequate information about treatments is essential for the patient to enable them to weigh up options and decide which treatments they wish to undertake.

However, information about unavailable treatments arguably does not help the patient make an informed decision because it does not give them information that is relevant to consenting or to refusal of treatment propecia price canada that is actually available. If Miss Schmidt had given Jenny information about the relative benefits of laparoscopic appendectomy, that could not have helped Jenny’s decision to proceed with surgery. Her available propecia price canada choices were open appendectomy or no surgery. Moreover, as the case of June highlights, providing information about alternatives may lead them to desire or even demand those alternative options.

This could cause distress both to the patient and the health professional (who is unable to acquiesce).Consideration might also be paid to the effect on patients of disclosure. How would it affect a patient with newly diagnosed cancer to tell them that an alternative, perhaps better therapy, propecia price canada might be routinely available in usual circumstances but is not available now?. There is provision in the Montgomery Ruling, in rare circumstances, for therapeutic exception. That is, if information is significantly detrimental to the health of a patient it might be omitted propecia price canada.

We could imagine a version of the case where Jenny was so intensely anxious about the proposed surgery that her surgeon comes to a sincere belief that discussion of the laparoscopic alternative would be extremely distressing or might even lead her to refuse surgery. In most cases, though, it would be hard to be sure that the risks of disclosing alternative (non-available) treatments would be so great that non-disclosure would be justified.In favour of disclosureIn the UK, professional guidance issued by the GMC (General Medical Council) requires doctors to take a personalised approach to information sharing about treatments by sharing ‘with patients the information they want or need in order to make decisions’. The Montgomery judgement of 20157 broadly endorsed the position of the GMC, requiring patients propecia price canada to be told about any material risks and reasonable alternatives relevant to the decision at hand. The Supreme Court clarifies that materiality here should be judged by reference to a new two-limbed test founded on the notions of the ‘reasonable person in the patient’s position’ and the ‘particular patient’.

One practical test might be for the clinician to ask themselves whether patients in general, or this particular patient might wish to know about alternative forms of treatment that would usually be offered.The GMC has recently produced propecia-specific guidance8 on consent and decision-making, but this guidance is focused on managing consent in hair loss treatment-related interventions. While the GMC takes the view that its consent guidelines continue to apply as propecia price canada far as is practical, it also notes that the patient is enabled to consider the ‘reasonable alternatives’, and that the doctor is ‘open and honest with patients about the decision-making process and the criteria for setting priorities in individual cases’.In some situations, there might be the option of delaying treatment until later. When other surgical procedures are possible. In that setting, it would be important to ensure that the patient propecia price canada is aware of those future options (including the risks of delay).

For example, if Jenny had symptomatic gallstones, her surgeons might be offering an open cholecystectomy now or the possibility of a laparoscopic surgery at some later point. Understanding the full options open to her now and in the future may have considerable influence on Jenny’s decision. Likewise, if June is aware that she is not being offered propecia price canada standard treatment she may wish to delay treatment of her atherosclerosis until a later date. Of course, such a delay might lead to greater harm overall.

However, it would be ethically permissible to delay treatment if that was the patient’s informed choice (just as it would be permissible for the patient to refuse treatment altogether).In the appendicitis case, Jenny does propecia price canada not have the option for delaying her treatment, but the choice for June is more complicated, between immediate PCI which is a second-best treatment versus waiting for standard therapy. Immediate surgery also raises a risk of acquiring nosocomial hair loss treatment and June is in an age group and has comorbidities that put her at risk of severe hair loss treatment disease. Waiting for surgery leaves June at risk of sudden death. For an propecia price canada active and otherwise well patient with coronary disease like June, PCI procedure is not as good a treatment as CABG and June might legitimately wish to take her chances and wait for the standard treatment.

The decision to operate or wait is a balance of risks that only June is fully able to make. Patients in this propecia price canada scenario will take different approaches. Patients will need different amounts of information to form their decisions, many patients will need as much information as is available including information about procedures not currently available to make up their mind.June’s husband insists that she should receive the best treatment, and that she should therefore be listed for CABG. Although this treatment would appear to be in June’s best interests, and would respect her autonomy, those ethical considerations are potentially outweighed by distributive justice.

The hair loss treatment propecia propecia price canada of 2020 is being characterised by limitations. Liberties curtailed and choices restricted, this is justified by a need to protect healthcare systems from demand exceeding availability. While resource allocation is always a relevant ethical concern in publicly funded healthcare systems, it is a dominant concern in a setting where there is a high demand for medical care and scare resources.It is well established that competent adult patients can consent to or refuse medical treatment but they cannot demand that health professionals provide treatments that are contrary to their professional judgement or (even more importantly) would consume scarce healthcare resources. In June’s case, agreeing to perform CABG at a time when large numbers of patients are critically ill with propecia price canada hair loss treatment might mean that another patient is denied access to intensive care (and even dies as a result).

Of course, it may be that there are actually available beds in intensive care, and June’s operation would not directly lead to denial of treatment for another patient. However, that does not automatically mean that propecia price canada surgery must proceed. The hospital may have been justified in making a decision to suspend some forms of cardiac surgery. That could be on the basis of the need to use the dedicated space, staff and equipment of the cardiothoracic critical care unit for patients with hair loss treatment.

Even if all that physical space is not currently occupied if may not be feasible or propecia price canada practical to try to simultaneously accommodate some non-hair loss treatment patients. (There would be a risk that June would contract hair loss treatment postoperatively and end up considerably worse off than she would have been if she had instead received PCI.) Moreover, it seems problematic for individual patients to be able to circumvent policies about allocation of resources purely on the basis that they stand to be disadvantaged by the policy.Perhaps the most significant benefit of disclosure of non-options is transparency and honesty. We suggest that the main reason why Miss Schmidt ought to have included discussion of the laparoscopic alternative propecia price canada is so that Jenny understands the reasoning behind the decision. If Miss Schmidt had explained to Jenny that in the current circumstances laparoscopic surgery has been stopped, that might have helped her to appreciate that she was being offered the best available management.

It might have enabled a frank discussion about the challenges faced by health professionals in the context of the propecia and the inevitable need for compromise. It may have avoided awkward discussions later after Jenny propecia price canada developed her complication.Transparent disclosure should not mean that patients can demand treatment. But it might mean that patients could appeal against a particular policy if they feel that it has been reached unfairly, or applied unfairly. For example, if June became aware that some patients were still being offered CABG, she might (or might not) be justified in appealing against the decision not to offer it to her.

Obviously such an appeal would only be possible if the patient were aware of the alternatives that they were being denied.For patients propecia price canada faced by decisions such as that faced by June, balancing risks of either option is highly personal. Individuals need to weigh up these decisions for them and require all of the information available to do so. Some information is readily available, for example, the rate of for Jenny and the risk of death without treatment for June propecia price canada. But other risks are unknown, such as the risk of acquiring nosocomial with hair loss treatment.

Doctors might feel discomfort talking about unquantifiable risks, but we argue that it is important that the patient has all available information to weigh up options for them, including information that is unknown.ConclusionIn a propecia, as in other times, doctors should ensure that they offer appropriate medical treatment, based on the needs of an individual. They should aim to provide available treatment that is beneficial and should not offer treatment that is unavailable or contrary to the propecia price canada patient best interests. It is ethical. Indeed it is vital within a public healthcare system, to consider distributive justice in the allocation propecia price canada of treatment.

Where treatment is scarce, it may not be possible or appropriate to offer to patients some treatments that would be beneficial and desired by them.Informed consent needs to be individualised. Doctors are obliged to tailor their information to the needs of an individual. We suggest that in the current propecia price canada climate this should include, for most patients, a nuanced open discussion about alternative treatments that would have been available to them in usual circumstances. That will sometimes be a difficult conversation, and require clinicians to be frank about limited resources and necessary rationing.

However, transparency and honesty will usually be the best policy..

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Autodesk deployed it’s Octo-Copter in Africa for high resolution reality capture.  This was done in support of Louis Leakey in Kenya in search of our ancestral trails


Additonally, they deployed it on their head quarters in San Rafael.

From the Gizmag Website:

The Mikrokopter Octocopter is an 8-rotor flying platform which has a 2 kg (4.4 lbs) capacity to carry cameras. It can be flown using an internal camera to give the operator a copter-based vantage point on video glasses, or can be programmed to follow a GPS-controlled flight path. An Octocopter can fly autonomously at altitudes up to 1000 meters (3280 feet), or can be manually flown as high as 3500 meters (11,480 feet). In the Autodesk tests video was captured using a GOPro Hero 2 camera, and the still pictures from which the 3D model was later built were taken by a remotely triggered Canon SLR camera.

Autodesk 123D is a suite of programs which allow a user to create, manipulate, and construct 3D objects using a 3D printer. Catch is part of the 123D suite, and offers a standalone software package that helps you create 3D models from a series of 2D digital images of an object or a scene. The spatial resolution available using 123D Catch is about 1 part in 600, or 0.167% of the total size of the object pictured, so you would be able to accurately place individual windows on a 3D model of a Boeing 747.

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Get to the Beach and then Treat Yourself

Cranes Beach & Wingaersheek Beech, Head north on 128.  Enjoy the water, and then take the short drive to Essex and go get fried clams and soft serve, call in your fried clam order if you can.  Try Woodman’s, Farnham’s (they got picnic tables over looking the tidal marsh) or try the Village, and Essex Seafood, which has always been a solid go to.

Horseneck Beach, terrific beach going south on 24, Westport, MA almost always less traffic, then go to the Back Eddy for something to cold to drink and a snack.

You’re in and around the city.

Find a Roof Deck and/or Pool, a variety of posts on the subject from Boston.com, but it seems the Colonade for a pool stop is always mentioned. And outside of the city, Indigo in Newton is pretty nice stop.

Walk the Greenway, play in the fountains, get gelatto, try the Gelateria  in the North End.

Have a cold drink in a well air conditioned bar by the Garden, then walk over the river, across the locks into Charlestown and do the same thing there.  Your choice for locations, there are many.  But go ahead and stop at Emack and Bolio’s on the walk back.

Play in the Fountain at the Christian Science Center, walk into the Pru and Copley to soak in the air conditioning, play “how much are these shoes” at Nordstrom.  Have a friend stand back from the shoe tables, have them guess.  Most likely off by a factor of 10, go get a coolata at Dunkin.

If you are feeling particularly flush and it’s after 5, go get a martini at the Oak Room, used to come with side car sitting in ice.  That will frame the rest of your day.  Air Conditioning set on igloo.

Take your dog for a walk at the Middlesex Fells Reservation, or bring him/her to a pond, throw a stick. Jamaica Pond, Spy Pond, Fresh Pond, etc.  You might not get cool, but look at the dog, so happy.  And now I’ve seen Canoe and Kayak Rentals at Spy Pond.

So there’s a start, generally, a cold drink, cone or a slush, water, you get the idea.

 

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With Microsoft’s announcement of Windows 8, and the unveiling of the Surface Tablet, it finally appears there will be a tablet form factor that will run Revit in the field.  According to the press release there will be two versions, one based on the ARM chip and another based on the Intel i5 chip running Windows 8 Pro.  The iPad, as much it is great for so many tasks, simply does not have the horsepower to run Revit in the field, and delivering the type of user experience one would want with heavyweight programs is a real limitation in the ‘cloud.’  I understand Autodesk is now counting solely on Citrix to provide its remote platform but even if you are driving Revit remotely would you want to rely on whatever internet connection you have?  That’s just not a funnel I would want to count on in the field.

At first glance you might say so what, not a big deal.  However, if I can have a device that toggles between my heavyweight AEC programs, and delivers content the way my my iPad does then I might have an iPad to sell you; because frankly I am sick of devices, I live between the Mac and Windows camp, I’m tired of it.  I used to be an Apple fanatic, even being the only kid in business school with a Mac, the disastrous PowerPC model, but what was not to like about Apple.  Now, how did we get to the point where Microsoft is the little guy, relatively speaking.  Now if they could get their content management into a spot that works the way you want.  Imagine the central Revit model up on the sky drive, you check it out in the field, do your work, update it, booyah.

I think single purpose, highly specific apps are great to digest data,  not for the creation of it so I am real interested in the melding of tablet like functionality with horsepower.  I’m rooting for the little guy, I’m rooting for Microsoft.

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BTW anyone else bother to notice the blending and vertical integration of software/hardware.  Apple, obviously.  Google buys Motorola. Microsoft with multiple attempts, Zune, XBox, etc.  and now Surface. And more germane to AEC Trimble buys Tekla and SketchUp.  Seems to be the biz strategy du jour, watch for more.

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Tweet about PKNail Pro’s Proven Field to BIM Technology, Get Entered Automatically

PointKnown is giving away a free Apple iPad to one lucky Twitterer…er, tweeter, i.e.  one who uses the service twitter to disseminate clever, witty, informative text burst in 140 characters or less.  PointKnown does not claim to be clever, witty or informative, but will claim producing kick ahh…whup ahh…Excellent productivity software tools for documenting existing buildings.

 

 

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To participate, simply tweet using the hash tags below:

#pknail #revit #bim and mention ‘PKNail Pro’

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PKNail Pro turbo charges Revit and modeling existing buildings #pknail #revit #bim

or “Capture Existing Buildings Directly In Revit with PKNail Pro, 5x-10x faster #pknail #revit #bim

less pertinent but still acceptable “We came, we saw, we conquered with PKNail Pro, #pknail, #bim , #revit

less pertinent verging to the non-sequitur but still acceptable…

beautiful software for happy people PKNail Pro, #pknail, #bim, #revit

or certainly and you are most welcome and encouraged to tweet your own stuff; as we will have a separate drawing of $100 VISA Card for best/most creative tweet as judged by anyone at our next BBQ.

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We are on the road with Microcad and have other excellent resellers including,  Seiler Instrument (ask for Harvey) and CADDFX

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1. This giveaway is offered by PointKnown LLC and is open to anyone with a Twitter account who is at least 16 years of age. Employees of PointKnown, LLC. and/or its affiliated companies and family members of such employees may enter the contest but are not eligible to win.

2. The giveaway will begin at the time of this post and end 62 days after initial post, a winner will be randomly chosen, much like the number 62, and announced via twitter through @pointknown

3. One giveaway will be available: a 16GB Wi-Fi Apple iPad or $499 Apple Store Credit, winner’s choice.

4. You must prove ownership of the winning entry and provide your email address to collect the prize.

5. To enter the giveaway you must send out a tweet from your own Twitter account that includes the #hash tags above in your message.

6. Entries using automated tweets will be disqualified, however there is no limit on the number of tweets you may enter.

7. PointKnown LLC will choose a winner randomly from all the entries within the specified period. The winner will be announced from our twitter account (@pointknown) once the contest ends.

8. Entrants agree to allow @pointknown to use their twitter handles and entry tweets for marketing purposes.

9. Neither PointKnown LLC. nor its affiliated companies shall have any liability for (i) any technical failures of any kind, including but not limited to malfunctions, interruptions or disconnections in phone lines or network hardware or software; (ii) technical or human error which may occur in the administration of the giveaway; (iii) any malfunction of or damage to the prize; (iv) any corruption, typos or hacking of prize winners email accounts; or (v) any restrictions or delays imposed by any customs authorities or any import or other taxes of any kind imposed by any taxation authority in respect of the prizes.

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Announced today, Autodesk Acquires Vela Systems.  If you are developing products within the Building Life Cycle somewhere between and including design to demolition, you are in play.  Trimble has been going on an acquisition rampage with its acquisition of Tekla and Sketch Up and Autodesk never one to be a wallflower has just acquired Vela.  This is almost 2 years to the date that Vela was unveiled publicly.  No idea of their market size but their own press releases state that they are more than ‘twice as big’ as any competitive Field BIM Systems.  Regardless, market penetration means little at this point now that the Autodesk marketing/sales system is behind it.  How big was Revit in 2006 when they were purchased.  A primer of Vela’s Key Features below.  Congrats Vela folks, job well done.

Vela Field Management Suite Key Features
The Vela Field Management Suite of Web, Mobile and Reports enables everyone throughout the enterprise to access documents, field activities and reports in the office and in the field. Since its release a year ago, and to further broaden the usability throughout the enterprise, Vela Systems has expanded upon the following features:

  • Field BIM® for commissioning and handover that ties BIM to the field for data and document exchange
  • Company-level checklist and issue template capabilities to implement and enforce quality and safety programs
  • Increased accessibility via the Internet on multiple devices like iPads and Smart Phones
  • Better web-based reporting that turns field data into powerful information for managing quality, safety and risk at the project and company level
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As reported by Industry Week, ‘The world’s most sophisticated malware had a ‘high interest in AutoCAD drawings,’ Kaspersky Lab said.  The Flame Virus, which mainly affected computers in the Middle East used a loophole in Microsoft software tricking computers into thinking they are downloading a legitimate Windows update.  This fact, being reported by Reuters, The Times, CNET, and others. CNN reported that Flame can turn on your microphone, webcam, log e-mails, etc.  I have not read if it can do anything malicious itself as the Stuxnet Virus did to Iran Uranium enrichment facilities by having centrifuges essentially tear themselves apart.  However, going after CAD, essentially engineering and building documents can let whoever is collecting this information know what you are designing and building, and possibly have the blueprints of the building you are designing and building in.  And you thought google knowing that you smoke cigars and eat ice cream on your back porch at 5:23 PM was intrusive.

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File under cool.   The City of New York has unveiled an initiative for the electronic submission of BIM safety plans; you can learn more here; and a  Turner Press Release yesterday stated they used both 2D and 3D BIM submissions to get approval for their construction project at the Energy Building at NYU Langone Medical Center.

“The digital submission of 3D, BIM-based site safety plans reduced the approval times from weeks to days,” said Di Fillipo, Turner Senior Vice President.

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The more demos I go on, the more I get asked about our field kit, so I wanted to post what’s in my bag and what we use on a day to day basis when surveying/modeling in the field with PKNail Pro.  Those of you not interested in the day-in day-out particulars of surveying buildings may want to hit your back button now… Anyway an individual equally equipped will be ready for knocking out BIM Building Surveys, and this kit, all in, costs a fraction of most other technology solutions, plus the added benefit of surveying/modeling directly in the platform you or your clients are most likely working in.  However, always choose the tool/service that fits your needs.  In fact, we’ll be posting shortly where we combined workflows of PKNail Pro and pointclouds.  But here you go, what’s in my bag or my complete kit.

So it might seem like a lot but all fits in the bag except for the tripods.  The laptop tripod is excellent when mobility/portability with your gear is at a premium but I will use a laptop cart with wheels if the space allows;  it is easier with wheels and has more surface area to put stuff.

The real minimum you need to have with you is a laptop/tablet PC running the appropriate software, a Disto D8 or 330i, a measuring tape, and something to use for a target when needed, like an outside corner.  Stickynotes (larger size) are excellent for shorter distances, a reflective Leica Target attached with Painter’s Tape is better for longer ones.  Rechargeable batteries for both the laptop and Disto.  I prefer an external battery pack for the laptop as it can be used on any laptop and it is self contained unlike an extra battery for a specific laptop.

I  like Eneloop rechargeables for devices, my preference, they come preloaded with a charge, and seem to carry it longer when not being used.  You need a measuring tape on occasion for distances to short or sometimes nice to hook something with a tape when finding a distance manually.  I like thick banded measuring tapes because they will extend longer without ‘breaking’ but find they are just as prone to wear down as any other so sometimes not worth the expense.  LED flashlight because they are bright and do not use as much juice as others, and are always nice to have.  I also have an LED light that you can wear on your head, which is my preferred.  Diameter tape is a luxury but one side is graduated the other will measure the diameter of any round column which is helpful.

The tripod attachment from Leica allows it to pivot properly on the its axis so the measurements stay as accurate as possible.  This is great to have for exterior work  when you might not have access to the interior of the building.  Building chalk or a marking crayon can be helpful but usually would want to mark with painters tape or sticky pad because they are easily removed, however, the former comes in handy sometimes, especially in basements.

And bring food and drink, nothing clouds your mind like being hungry, so eat.

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Interioreview, utilized PKNail Pro, an add in to Revit, combined with Leica Disto D8 laser range finders as the main surveying tool and software for capturing and modeling the 28 Story DuBois Library at UMass Amherst.  The structure designed by Durell Stone in 1966 is tallest library in the United States.  While intially considering combining LIDAR and creating a pointcloud for the exterior and utilizing PKNail Pro for the interior it turned out the exterior was the easiest part of the job and it was interior that was the most difficult.  Every 3rd floor contained  90+ rooms  with study carrels combined with classrooms where very few technologies would work well.  Nico Martinez, a Project Manager with Interioreview, commented,”Without PKNail the survey work could have taken  5 times, 10 times what it was.”

The project was completed to support the design and retrofitting a fire protection system.

Interioreview, an architecural surveying firm founded in 2003 specialzies in documenting the built environment in both 2D CAD and 3D Revit formats.

PointKnown, a software firm, founded in 2008 develops productivity tools for the built environment / AEC (Architectural, Engineering, and Construction) Industry

PKNail Pro, allows a user to measure and model objects in real time directly in Revit.

Autodesk® Revit® software is specifically built for Building Information Modeling (BIM), helping building professionals design, build, and maintain higher-quality, more energy-efficient buildings.

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