Buy viagra or cialis online

Sport is predicated on the idea of victors emerging from a level playing field buy viagra or cialis online. All ethically informed evaluate practices are like this. They require an equality of respect, buy viagra or cialis online consideration, and opportunity, 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 students and not others, buy viagra or cialis online 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 buy viagra or cialis online meant to 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 buy viagra or cialis online 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 buy viagra or cialis online 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 buy viagra or cialis online similar ambitions should be given similar opportunities and 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 buy viagra or cialis online ‘relevant’ and therefore permit a 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 buy viagra or cialis online XX chromosones), with testosterone levels above five nanomoles per litre blood (nmol/L), and who experience a ‘material androgenizing effect’’ 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 buy viagra or cialis online 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 buy viagra or cialis online be 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 to permit them to have an impact buy viagra or cialis online. 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 so men’s competitions are unfair’ buy viagra or cialis online (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 buy viagra or cialis online interested in the exceptional among 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 would follow, whether it be the 100 m sprint, buy viagra or cialis online 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 buy viagra or cialis online 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 its aims, purpose or buy viagra or cialis online 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 erectile dysfunction treatment viagra, many medical systems have needed to divert routine services in order to support the large number of patients with acute erectile dysfunction treatment disease. For example, in the National Health Service (NHS) almost all elective surgery buy viagra or cialis online has been postponed1 and outpatient clinics 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-erectile dysfunction treatment-related illness. Even urgent treatments have needed to be modified. Patients with acute surgical emergencies such as appendicitis still present for care, cancers continue to be discovered in buy viagra or cialis online 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-viagra 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 erectile dysfunction 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 buy viagra or cialis online (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 that are available are buy viagra or cialis online 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 viagra 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 who presents to hospital at the peak of the erectile dysfunction treatment viagra buy viagra or cialis online with acute appendicitis. Her surgeon, Miss Schmidt, approaches Jenny to obtain consent for an open appendectomy.

Miss Schmidt explains the buy viagra or cialis online 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 buy viagra or cialis online and discovers that a laparoscopic procedure would ordinarily have been performed and would have 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 viagra lockdown in the UK June had an episode of severe chest pain and investigations revealed that she buy viagra or cialis online 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 becomes angry and demands that June is listed for surgery.In favour of non-disclosureIt might buy viagra or cialis online 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 obliged to buy viagra or cialis online 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 cost-effective to be offered by buy viagra or cialis online 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 buy viagra or cialis online 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, buy viagra or cialis online many previously standard treatments are no longer appropriate given the restrictions outlined. In other circumstances they are appropriate.

During a viagra 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 buy viagra or cialis online the absence 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 buy viagra or cialis online informed decision because it does not give them information that is relevant to consenting or to refusal of treatment 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 choices were open appendectomy or no buy viagra or cialis online 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 not available now? buy viagra or cialis online. There is provision in the Montgomery Ruling, in rare circumstances, for therapeutic exception. That is, if information is significantly detrimental to the health of buy viagra or cialis online a patient it might 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, buy viagra or cialis online requiring patients 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 viagra-specific guidance8 on consent and decision-making, but this guidance is focused on managing consent in erectile dysfunction treatment-related interventions. While the GMC takes the view that its buy viagra or cialis online consent guidelines continue to apply as 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 buy viagra or cialis online setting, it 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 is aware that she is not being offered standard treatment she buy viagra or cialis online 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 buy viagra or cialis online 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 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 erectile dysfunction treatment and June is in an age group and has comorbidities that put her at risk of severe erectile dysfunction treatment disease. Waiting for surgery leaves June at risk of sudden death. For an 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 buy viagra or cialis online 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 will take different buy viagra or cialis online 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 erectile dysfunction treatment viagra of 2020 is being characterised by limitations buy viagra or cialis online. 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 erectile dysfunction treatment might mean that another patient is denied access buy viagra or cialis online 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 surgery must proceed buy viagra or cialis online. 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 erectile dysfunction treatment.

Even if all that physical space is not currently occupied if may not be feasible or practical to buy viagra or cialis online try to simultaneously accommodate some non-erectile dysfunction treatment patients. (There would be a risk that June would contract erectile dysfunction 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 is so that Jenny understands the reasoning behind the decision buy viagra or cialis online. 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 viagra and the inevitable need for compromise. It may have avoided awkward discussions later after Jenny developed her complication.Transparent disclosure should not mean that patients can buy viagra or cialis online 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 buy viagra or cialis online appeal would only be possible if the 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 Jenny and the risk buy viagra or cialis online of death without treatment for June. But other risks are unknown, such as the risk of acquiring nosocomial with erectile dysfunction 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 viagra, 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 buy viagra or cialis online or contrary to the patient best interests. It is ethical. Indeed it is vital within a public healthcare system, to consider distributive justice buy viagra or cialis online in 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 buy viagra or cialis online 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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Demographic Characteristics of Where to buy cheap cipro the Participants in the Main Safety Population generic viagra no prescription. Between July 27, 2020, and November 14, 2020, a total of 44,820 persons were screened, and 43,548 persons 16 years of age or older underwent randomization at 152 sites worldwide (United States, 130 sites. Argentina, 1. Brazil, 2 generic viagra no prescription.

South Africa, 4. Germany, 6. And Turkey, 9) in the phase 2/3 portion of the generic viagra no prescription trial. A total of 43,448 participants received injections.

21,720 received BNT162b2 and 21,728 received placebo (Figure 1). At the data cut-off date of October 9, a total of 37,706 participants had a median of at least 2 months of safety data available after the second dose and contributed to the main safety generic viagra no prescription data set. Among these 37,706 participants, 49% were female, 83% were White, 9% were Black or African American, 28% were Hispanic or Latinx, 35% were obese (body mass index [the weight in kilograms divided by the square of the height in meters] of at least 30.0), and 21% had at least one coexisting condition. The median age was 52 years, and 42% of participants were older than 55 years of age (Table 1 and Table S2).

Safety Local Reactogenicity Figure 2 generic viagra no prescription. Figure 2. Local and Systemic Reactions Reported within 7 Days after Injection of BNT162b2 or Placebo, According to Age Group. Data on local and systemic generic viagra no prescription reactions and use of medication were collected with electronic diaries from participants in the reactogenicity subset (8,183 participants) for 7 days after each vaccination.

Solicited injection-site (local) reactions are shown in Panel A. Pain at the injection site was assessed according to the following scale. Mild, does not generic viagra no prescription interfere with activity. Moderate, interferes with activity.

Severe, prevents daily activity. And grade 4, emergency department generic viagra no prescription visit or hospitalization. Redness and swelling were measured according to the following scale. Mild, 2.0 to 5.0 cm in diameter.

Moderate, >5.0 to 10.0 cm generic viagra no prescription in diameter. Severe, >10.0 cm in diameter. And grade 4, necrosis or exfoliative dermatitis (for redness) and necrosis (for swelling). Systemic events and medication use are shown in Panel generic viagra no prescription B.

Fever categories are designated in the key. Medication use was not graded. Additional scales were as generic viagra no prescription follows. Fatigue, headache, chills, new or worsened muscle pain, new or worsened joint pain (mild.

Does not interfere with activity. Moderate. Some interference with activity. Or severe.

Prevents daily activity), vomiting (mild. 1 to 2 times in 24 hours. Moderate. >2 times in 24 hours.

Or severe. Requires intravenous hydration), and diarrhea (mild. 2 to 3 loose stools in 24 hours. Moderate.

4 to 5 loose stools in 24 hours. Or severe. 6 or more loose stools in 24 hours). Grade 4 for all events indicated an emergency department visit or hospitalization.

Н™¸ bars represent 95% confidence intervals, and numbers above the 𝙸 bars are the percentage of participants who reported the specified reaction.The reactogenicity subset included 8183 participants. Overall, BNT162b2 recipients reported more local reactions than placebo recipients. Among BNT162b2 recipients, mild-to-moderate pain at the injection site within 7 days after an injection was the most commonly reported local reaction, with less than 1% of participants across all age groups reporting severe pain (Figure 2). Pain was reported less frequently among participants older than 55 years of age (71% reported pain after the first dose.

66% after the second dose) than among younger participants (83% after the first dose. 78% after the second dose). A noticeably lower percentage of participants reported injection-site redness or swelling. The proportion of participants reporting local reactions did not increase after the second dose (Figure 2A), and no participant reported a grade 4 local reaction.

In general, local reactions were mostly mild-to-moderate in severity and resolved within 1 to 2 days. Systemic Reactogenicity Systemic events were reported more often by younger treatment recipients (16 to 55 years of age) than by older treatment recipients (more than 55 years of age) in the reactogenicity subset and more often after dose 2 than dose 1 (Figure 2B). The most commonly reported systemic events were fatigue and headache (59% and 52%, respectively, after the second dose, among younger treatment recipients. 51% and 39% among older recipients), although fatigue and headache were also reported by many placebo recipients (23% and 24%, respectively, after the second dose, among younger treatment recipients.

17% and 14% among older recipients). The frequency of any severe systemic event after the first dose was 0.9% or less. Severe systemic events were reported in less than 2% of treatment recipients after either dose, except for fatigue (in 3.8%) and headache (in 2.0%) after the second dose. Fever (temperature, ≥38°C) was reported after the second dose by 16% of younger treatment recipients and by 11% of older recipients.

Only 0.2% of treatment recipients and 0.1% of placebo recipients reported fever (temperature, 38.9 to 40°C) after the first dose, as compared with 0.8% and 0.1%, respectively, after the second dose. Two participants each in the treatment and placebo groups reported temperatures above 40.0°C. Younger treatment recipients were more likely to use antipyretic or pain medication (28% after dose 1. 45% after dose 2) than older treatment recipients (20% after dose 1.

38% after dose 2), and placebo recipients were less likely (10 to 14%) than treatment recipients to use the medications, regardless of age or dose. Systemic events including fever and chills were observed within the first 1 to 2 days after vaccination and resolved shortly thereafter. Daily use of the electronic diary ranged from 90 to 93% for each day after the first dose and from 75 to 83% for each day after the second dose. No difference was noted between the BNT162b2 group and the placebo group.

Adverse Events Adverse event analyses are provided for all enrolled 43,252 participants, with variable follow-up time after dose 1 (Table S3). More BNT162b2 recipients than placebo recipients reported any adverse event (27% and 12%, respectively) or a related adverse event (21% and 5%). This distribution largely reflects the inclusion of transient reactogenicity events, which were reported as adverse events more commonly by treatment recipients than by placebo recipients. Sixty-four treatment recipients (0.3%) and 6 placebo recipients (<0.1%) reported lymphadenopathy.

Few participants in either group had severe adverse events, serious adverse events, or adverse events leading to withdrawal from the trial. Four related serious adverse events were reported among BNT162b2 recipients (shoulder injury related to treatment administration, right axillary lymphadenopathy, paroxysmal ventricular arrhythmia, and right leg paresthesia). Two BNT162b2 recipients died (one from arteriosclerosis, one from cardiac arrest), as did four placebo recipients (two from unknown causes, one from hemorrhagic stroke, and one from myocardial infarction). No deaths were considered by the investigators to be related to the treatment or placebo.

No erectile dysfunction treatment–associated deaths were observed. No stopping rules were met during the reporting period. Safety monitoring will continue for 2 years after administration of the second dose of treatment. Efficacy Table 2.

Table 2. treatment Efficacy against erectile dysfunction treatment at Least 7 days after the Second Dose. Table 3. Table 3.

treatment Efficacy Overall and by Subgroup in Participants without Evidence of before 7 Days after Dose 2. Figure 3. Figure 3. Efficacy of BNT162b2 against erectile dysfunction treatment after the First Dose.

Shown is the cumulative incidence of erectile dysfunction treatment after the first dose (modified intention-to-treat population). Each symbol represents erectile dysfunction treatment cases starting on a given day. Filled symbols represent severe erectile dysfunction treatment cases. Some symbols represent more than one case, owing to overlapping dates.

The inset shows the same data on an enlarged y axis, through 21 days. Surveillance time is the total time in 1000 person-years for the given end point across all participants within each group at risk for the end point. The time period for erectile dysfunction treatment case accrual is from the first dose to the end of the surveillance period. The confidence interval (CI) for treatment efficacy (VE) is derived according to the Clopper–Pearson method.Among 36,523 participants who had no evidence of existing or prior erectile dysfunction , 8 cases of erectile dysfunction treatment with onset at least 7 days after the second dose were observed among treatment recipients and 162 among placebo recipients.

This case split corresponds to 95.0% treatment efficacy (95% confidence interval [CI], 90.3 to 97.6. Table 2). Among participants with and those without evidence of prior SARS CoV-2 , 9 cases of erectile dysfunction treatment at least 7 days after the second dose were observed among treatment recipients and 169 among placebo recipients, corresponding to 94.6% treatment efficacy (95% CI, 89.9 to 97.3). Supplemental analyses indicated that treatment efficacy among subgroups defined by age, sex, race, ethnicity, obesity, and presence of a coexisting condition was generally consistent with that observed in the overall population (Table 3 and Table S4).

treatment efficacy among participants with hypertension was analyzed separately but was consistent with the other subgroup analyses (treatment efficacy, 94.6%. 95% CI, 68.7 to 99.9.

Participants Figure Where to buy cheap cipro 1 buy viagra or cialis online. Figure 1. Enrollment and Randomization. The diagram represents all enrolled participants through buy viagra or cialis online November 14, 2020.

The safety subset (those with a median of 2 months of follow-up, in accordance with application requirements for Emergency Use Authorization) is based on an October 9, 2020, data cut-off date. The further procedures that one participant in the placebo group declined after dose 2 (lower right corner of the diagram) were those involving collection of blood and nasal swab samples.Table 1. Table 1 buy viagra or cialis online. Demographic Characteristics of the Participants in the Main Safety Population.

Between July 27, 2020, and November 14, 2020, a total of 44,820 persons were screened, and 43,548 persons 16 years of age or older underwent randomization at 152 sites worldwide (United States, 130 sites. Argentina, 1 buy viagra or cialis online. Brazil, 2. South Africa, 4.

Germany, 6 buy viagra or cialis online. And Turkey, 9) in the phase 2/3 portion of the trial. A total of 43,448 participants received injections. 21,720 received BNT162b2 and 21,728 buy viagra or cialis online received placebo (Figure 1).

At the data cut-off date of October 9, a total of 37,706 participants had a median of at least 2 months of safety data available after the second dose and contributed to the main safety data set. Among these 37,706 participants, 49% were female, 83% were White, 9% were Black or African American, 28% were Hispanic or Latinx, 35% were obese (body mass index [the weight in kilograms divided by the square of the height in meters] of at least 30.0), and 21% had at least one coexisting condition. The median buy viagra or cialis online age was 52 years, and 42% of participants were older than 55 years of age (Table 1 and Table S2). Safety Local Reactogenicity Figure 2.

Figure 2. Local and buy viagra or cialis online Systemic Reactions Reported within 7 Days after Injection of BNT162b2 or Placebo, According to Age Group. Data on local and systemic reactions and use of medication were collected with electronic diaries from participants in the reactogenicity subset (8,183 participants) for 7 days after each vaccination. Solicited injection-site (local) reactions are shown in Panel A.

Pain at the injection site was buy viagra or cialis online assessed according to the following scale. Mild, does not interfere with activity. Moderate, interferes with activity. Severe, prevents buy viagra or cialis online daily activity.

And grade 4, emergency department visit or hospitalization. Redness and swelling were measured according to the following scale. Mild, 2.0 to buy viagra or cialis online 5.0 cm in diameter. Moderate, >5.0 to 10.0 cm in diameter.

Severe, >10.0 cm in diameter. And grade 4, necrosis or exfoliative dermatitis (for redness) and necrosis (for buy viagra or cialis online swelling). Systemic events and medication use are shown in Panel B. Fever categories are designated in the key.

Medication use was not graded buy viagra or cialis online. Additional scales were as follows. Fatigue, headache, chills, new or worsened muscle pain, new or worsened joint pain (mild. Does not buy viagra or cialis online interfere with activity.

Moderate. Some interference with activity. Or severe buy viagra or cialis online. Prevents daily activity), vomiting (mild.

1 to 2 times in 24 hours. Moderate. >2 times in 24 hours. Or severe.

Requires intravenous hydration), and diarrhea (mild. 2 to 3 loose stools in 24 hours. Moderate. 4 to 5 loose stools in 24 hours.

Or severe. 6 or more loose stools in 24 hours). Grade 4 for all events indicated an emergency department visit or hospitalization. Н™¸ bars represent 95% confidence intervals, and numbers above the 𝙸 bars are the percentage of participants who reported the specified reaction.The reactogenicity subset included 8183 participants.

Overall, BNT162b2 recipients reported more local reactions than placebo recipients. Among BNT162b2 recipients, mild-to-moderate pain at the injection site within 7 days after an injection was the most commonly reported local reaction, with less than 1% of participants across all age groups reporting severe pain (Figure 2). Pain was reported less frequently among participants older than 55 years of age (71% reported pain after the first dose. 66% after the second dose) than among younger participants (83% after the first dose.

78% after the second dose). A noticeably lower percentage of participants reported injection-site redness or swelling. The proportion of participants reporting local reactions did not increase after the second dose (Figure 2A), and no participant reported a grade 4 local reaction. In general, local reactions were mostly mild-to-moderate in severity and resolved within 1 to 2 days.

Systemic Reactogenicity Systemic events were reported more often by younger treatment recipients (16 to 55 years of age) than by older treatment recipients (more than 55 years of age) in the reactogenicity subset and more often after dose 2 than dose 1 (Figure 2B). The most commonly reported systemic events were fatigue and headache (59% and 52%, respectively, after the second dose, among younger treatment recipients. 51% and 39% among older recipients), although fatigue and headache were also reported by many placebo recipients (23% and 24%, respectively, after the second dose, among younger treatment recipients. 17% and 14% among older recipients).

The frequency of any severe systemic event after the first dose was 0.9% or less. Severe systemic events were reported in less than 2% of treatment recipients after either dose, except for fatigue (in 3.8%) and headache (in 2.0%) after the second dose. Fever (temperature, ≥38°C) was reported after the second dose by 16% of younger treatment recipients and by 11% of older recipients. Only 0.2% of treatment recipients and 0.1% of placebo recipients reported fever (temperature, 38.9 to 40°C) after the first dose, as compared with 0.8% and 0.1%, respectively, after the second dose.

Two participants each in the treatment and placebo groups reported temperatures above 40.0°C. Younger treatment recipients were more likely to use antipyretic or pain medication (28% after dose 1. 45% after dose 2) than older treatment recipients (20% after dose 1. 38% after dose 2), and placebo recipients were less likely (10 to 14%) than treatment recipients to use the medications, regardless of age or dose.

Systemic events including fever and chills were observed within the first 1 to 2 days after vaccination and resolved shortly thereafter. Daily use of the electronic diary ranged from 90 to 93% for each day after the first dose and from 75 to 83% for each day after the second dose. No difference was noted between the BNT162b2 group and the placebo group. Adverse Events Adverse event analyses are provided for all enrolled 43,252 participants, with variable follow-up time after dose 1 (Table S3).

More BNT162b2 recipients than placebo recipients reported any adverse event (27% and 12%, respectively) or a related adverse event (21% and 5%). This distribution largely reflects the inclusion of transient reactogenicity events, which were reported as adverse events more commonly by treatment recipients than by placebo recipients. Sixty-four treatment recipients (0.3%) and 6 placebo recipients (<0.1%) reported lymphadenopathy. Few participants in either group had severe adverse events, serious adverse events, or adverse events leading to withdrawal from the trial.

Four related serious adverse events were reported among BNT162b2 recipients (shoulder injury related to treatment administration, right axillary lymphadenopathy, paroxysmal ventricular arrhythmia, and right leg paresthesia). Two BNT162b2 recipients died (one from arteriosclerosis, one from cardiac arrest), as did four placebo recipients (two from unknown causes, one from hemorrhagic stroke, and one from myocardial infarction). No deaths were considered by the investigators to be related to the treatment or placebo. No erectile dysfunction treatment–associated deaths were observed.

No stopping rules were met during the reporting period. Safety monitoring will continue for 2 years after administration of the second dose of treatment. Efficacy Table 2. Table 2.

treatment Efficacy against erectile dysfunction treatment at Least 7 days after the Second Dose. Table 3. Table 3. treatment Efficacy Overall and by Subgroup in Participants without Evidence of before 7 Days after Dose 2.

Figure 3. Figure 3. Efficacy of BNT162b2 against erectile dysfunction treatment after the First Dose. Shown is the cumulative incidence of erectile dysfunction treatment after the first dose (modified intention-to-treat population).

Each symbol represents erectile dysfunction treatment cases starting on a given day. Filled symbols represent severe erectile dysfunction treatment cases. Some symbols represent more than one case, owing to overlapping dates. The inset shows the same data on an enlarged y axis, through 21 days.

Surveillance time is the total time in 1000 person-years for the given end point across all participants within each group at risk for the end point. The time period for erectile dysfunction treatment case accrual is from the first dose to the end of the surveillance period.

What may interact with Viagra?

Do not take Viagra with any of the following:

  • cisapride
  • methscopolamine nitrate
  • nitrates like amyl nitrite, isosorbide dinitrate, isosorbide mononitrate, nitroglycerin
  • nitroprusside
  • other sildenafil products (Revatio)

Viagra may also interact with the following:

  • certain drugs for high blood pressure
  • certain drugs for the treatment of HIV or AIDS
  • certain drugs used for fungal or yeast s, like fluconazole, itraconazole, ketoconazole, and voriconazole
  • cimetidine
  • erythromycin
  • rifampin

This list may not describe all possible interactions. Give your health care providers a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

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We struggle to envision the viagra free trial fate of plastic waste that will outlast us by centuries. We fail to imagine our descendants inhabiting an exhausted Earth worn out from resource extraction and devoid of biodiversity. We lack frames of reference in our everyday lives for thinking about nuclear waste’s multimillennial timescales of radioactive hazard. I am an anthropologist who studies how societies hash out relationships between living communities viagra free trial of the present and unborn communities imagined to inhabit the future. Studying how a community relates to the passage of time, I’ve learned, can offer a window into its values, worldviews, and lifeways.

From 2012 to 2014, I conducted 32 months of anthropological fieldwork exploring how Finland’s nuclear energy waste experts grappled with Earth’s radically long-term future. These experts routinely dealt with long-lived radionuclides such as uranium-235, which has a half-life of over 700 million years viagra free trial. They worked with the nuclear waste management company Posiva to help build a final disposal facility approximately 450 meters below the islet of Olkiluoto in the Gulf of Bothnia in the Baltic Sea. If all goes according to plan, this facility will, in the mid-2020s, become the world’s first operating deep geologic repository for spent nuclear fuel. To assess the Olkiluoto repository’s long-term viagra free trial durability, these experts developed a “safety case” forecasting geological, hydrological, and ecological events that could potentially occur in Western Finland over the coming tens of thousands—or even hundreds of thousands—of years.

From their efforts emerged visions of distant future glaciations, climate changes, earthquakes, floods, human and animal population changes, and more. These forecasts became the starting point for a series of “mental time travel” exercises that I incorporated into my book, Deep Time Reckoning. Stretching the mind across time—even in the viagra free trial most speculative ways—can help us become more responsible planetary stewards. It can help endow us with the time literacy necessary for tackling long-term challenges such as biodiversity loss, microplastics accumulation, climate change, antibiotic resistance, asteroid impacts, sustainable urban planning, and more. This can not only make us feel more at home in pondering our planet’s pasts and futures.

It can viagra free trial also draw us to imagine the world from the perspective of future human and non-human communities—fostering empathy across generations. The year 5710 CE. A tired man lounges on a sofa. He lives viagra free trial in a small wooden house in a region once called Eurajoki, Finland. He works at a local medical center.

Today is his day off. He’s had a long day in the viagra free trial forest. He hunted moose and deer and picked lingonberries, mushrooms, and bilberries. He now sips water, drawn from a village well, from a wooden cup. His husband brings him viagra free trial a dinner plate.

On it are fried potatoes, cereal, boiled peas, and beef. All the food came from local farms. The cattle were watered viagra free trial at a nearby river. The crops were watered by irrigation channels flowing from three local lakes. The man has no idea that, more than 3,700 years ago, safety case biosphere modelers used 21st-century computer technologies to reckon everyday situations like his.

He does not know that they once named the lakes viagra free trial around him—which formed long after their own deaths—“Liiklanjärvi,” “Tankarienjärvi,” and “Mäntykarinjärvi.” He is unaware of Posiva’s ancient determination that technological innovation and cultural habits are nearly impossible to predict even decades in advance. He is unaware that Posiva, in response, instructed its modelers to pragmatically assume that Western Finland’s populations’ lifestyles, demographic patterns, and nutritional needs will not change much over the next 10,000 years. He does not know the safety case experts inserted, into their models’ own parameters, the assumption that he and his neighbors would eat only local food. Yet the hunter’s viagra free trial life is still entangled with the safety case experts’ work. If they had been successful, then the vegetables, meat, fruit, and water before him should have just a tiny chance of containing only tiny traces of radionuclides from 20th-century nuclear power plants.

12020 CE. A solitary farmer looks out over viagra free trial her pasture, surrounded by a green forest of heath trees. She lives in a sparse land once called Finland, on a fertile island plot once called Olkiluoto. The area is an island no longer. What was once a coastal bay is now dotted with viagra free trial small lakes, peat bogs, and mires with white sphagnum mosses and grassy sedge plants.

The Eurajoki and Lapijoki Rivers drain out into the sea. When the farmer goes fishing at the lake nearby, she catches pike. She watches a viagra free trial beaver swim about. Sometimes she feels somber. She recalls the freshwater ringed seals that once shared her country before their extinction.

The woman has no idea that, deep beneath her feet, lies an ancestral deposit of copper, iron, viagra free trial clay, and radioactive debris. This is a highly classified secret—leaked to the public several times over the millennia, but now forgotten. Yet even the government’s knowledge of the burial site is poor. Most records were destroyed viagra free trial in a global war in the year 3112. It was then that ancient forecasts of the site, found in the 2012 safety case report “Complementary Considerations,” were lost to history.

But the farmer does know the mythical stories of Lohikäärme. A dangerous, flying, salmon-colored venomous snake that kills anyone who dares dig viagra free trial too close to his underground cave. She and the other farmers in the area grow crops of peas, sugar beet, and wheat. They balk at the superstitious fools who tell them the monster living beneath their feet is real. 35,012 CE viagra free trial.

A tiny microbe floats in a large, northern lake. It does not know that the clay, silt, and mud floor below it is gaining elevation, little by little, year after year. It is unaware that, viagra free trial 30 millennia ago, the lake was a vast sea. Dotted with sailboats, cruise and cargo ships, it was known by humans as the Baltic. Watery straits, which connected the Baltic Sea to the North Sea, had risen above the water thousands of years ago.

Denmark and Sweden fused into a single viagra free trial landmass. The seafloor was decompressing from the Weichselian glaciation—an enormous sheet of ice that pressed down on the land during a previous ice age. After the last human died, the landmass kept on rising. Its uplift was indifferent to human extinction viagra free trial. It was indifferent to how, in 2013 CE, an anthropologist and a safety case expert sat chatting in white chairs in Ravintola Rytmi.

A café in Helsinki. There, the safety case expert relayed viagra free trial his projection that, by 52,000 CE, there would no longer be water separating Turku, Finland, and Stockholm, Sweden. At that point, one could walk from one city to the other on foot. The expert reckoned that, to the north—between Vaasa, Finland, and Umeå, Sweden—one would someday find a waterfall with the planet’s largest deluge of flowing water. The waterfall could viagra free trial be found at the site of a once-submerged sea shelf.

The microbe, though, does not know or care about Vaasa, Umeå, Denmark, long-lost boats, safety case reports, or Helsinki’s past dining options. It has no concept of them. Their significances died with the humans viagra free trial. Nor does the microbe grasp the suffering they faced when succumbing to Anthropocene collapse. Humans’ past technological feats, grand civilizations, passion projects, intellectual triumphs, wartime sacrifices, and personal struggles are now moot.

And yet, the radiological safety of the microbe’s viagra free trial lake’s waters still hinges on the work of a handful of human safety case experts who lived millennia ago. Thinking so far ahead, these experts never lived to see whether their deep time forecasts were accurate. We do not, of course, live in these imagined worlds. In this sense, they are unreal—merely fictions viagra free trial. However, our capacities to envision potential futures, and to feel empathy for those who may inhabit them, are very real.

Depictions of tomorrow can have powerful, concrete effects on the world today. This is why deep time thought experiments are not playful games, but serious acts of intellectual problem-solving viagra free trial. It is why the safety case experts’ models of far future nuclear waste risks are uniquely valuable, even if they are, at the end of the day, mere approximations. Yet pondering distant future Earths can also help us take a step back from our everyday lives—enriching our imaginations by transporting our minds to different places and times. Corporate coaches have viagra free trial recommended taking breaks from our familiar thinking patterns to experience the world in new ways and overcome mental blocks.

Cognitive scientists have shown how creativity can be sparked by perceiving "something one has not seen before (but that was probably always there).” Putting aside a few minutes each day for long-termist, planetary imagination can enrich us with greater mental dexterity in navigating between multiple, interacting timescales. This can cultivate more longsighted empathy for landscapes, people, and other organisms across decades, centuries, and millennia. As the global viagra free trial ecological crisis takes hold, embracing planetary empathy will prove essential to our collective survival. This is an opinion and analysis article. The views expressed by the author or authors are not necessarily those of Scientific American.

This essay first viagra free trial appeared in the MIT Reader on August 10, 2021.Beginning in May and appearing to slow down by the end of July, juvenile songbirds from the mid-Atlantic to the Midwest fell ill with odd symptoms and died. Scientists were baffled by the mass mortality event. Months later they still do not know what killed the birds. Suspects include pathogens that the victims could have contracted by consuming Brood X cicadas and environmental toxins to viagra free trial which the young birds were particularly vulnerable. Brian Evans, an ornithologist at the Smithsonian National Zoo and Conservation Biology Institute in Washington, D.C., is part of a collaborative effort that draws on community science to find out more about the scope of the event and narrow down the possible causes.* Scientific American spoke with Evans about the efforts to solve this ongoing mystery, the impact of community scientists and what the public can do to help.

[An edited transcript of the interview follows.] When did you first learn about these songbirds dying?. It first came to my attention viagra free trial in early to mid-May. Early on, I didn’t believe it. I know that fledgling mortality rates are phenomenally high in general. So to hear word of a bunch of people viagra free trial observing a lot of dead and dying fledglings, as an ornithologist, frankly, didn’t come as much surprise.

I had about five birds at that point in my backyard that had basically fallen out of the sky, and I blamed crows because I have an incredible crow population in my neighborhood [in Takoma Park, Md.]. It wasn’t until late May that my perspective on the event had started to change. One of my neighbors observed a bird on the street, out in front of the yard, that was still alive—all the viagra free trial birds that I had encountered at that point were dead—and described it as having really swollen eyes and this inability to respond to her and just [seeming] generally confused. Its head was making tremors. That seemed to me to be an odd set of symptoms to share.

We see a lot of swollen eyes in birds, especially house finches and house sparrows, that are infected with a bacterial viagra free trial called Mycoplasma gallisepticum. But these symptoms that she was describing didn’t sound like [those] caused by mycoplasma. I went from, at that very moment, being really skeptical to starting to doubt myself. Literally a half an hour later, I received a text message from a field technician at the [Smithsonian] Migratory Bird Center with a picture of an affected viagra free trial bird, and a neighbor called me to tell me that he had a bird that was up the road that was sick. He and I together went to City Wildlife, which is the rehab agency that has been crucial in getting the word out about the event and connecting various parties.

They let me know when I went there that, from their perspective, this is a serious event and that they are overwhelmed with the number of mortalities that are coming in. What are the symptoms of this condition, and what birds are affected? viagra free trial. The ophthalmic symptoms can be surprisingly swollen eyes, eyes that jut out of the head a little bit. They can be crusty eyes. They can viagra free trial be blindness.

The neurological symptoms can be things such as a shaking head, an inability to stand, involuntary muscle spasms in general. [They] can be depression or lethargy. When you observe one of these birds with this neurological set of symptoms, it’s fairly obvious, because they’re simply viagra free trial unresponsive. There’s one video that was submitted [via a form that the Smithsonian National Zoo and Conservation Biology Institute set up] of this bird that just had this slow shake to its head and could barely stand and was keeled to the side. It’s those strange behaviors that I think are most remarkable in this event.

To the viagra free trial best of our knowledge, [of those] affected, maybe 90 percent [are] juveniles. It can be tricky to tell a juvenile from an adult, but early on, they look really distinct, especially in regard to plumage, and they have a meaty gape around the corners of their mouth when they’re young in June. What did you do once you realized that these were not run-of-the-mill deaths you would expect among juveniles?. The first thing that we did was start to viagra free trial coordinate with City Wildlife, the rehab group. We’re sending e-mails back and forth and trying to see.

What do we know?. Is this just viagra free trial in [Washington], D.C., or is it in other states?. How many birds are affected?. Are we the worst?. We took in specimens that have the neurological/ophthalmic symptoms that are associated with the event, and we’re viagra free trial testing them internally through our Center for Conservation Genomics for everything from viral to bacterial to fungal s.

The other role I’m playing is reaching out to every rehab agency that I can that has specimens of birds that died from other reasons—so they died because they hit a window or because a cat killed them. Finally, we’re testing truly healthy specimens. We’re going out into the viagra free trial environment, and we’re banding birds and swabbing their eyelids and cloacae. They’ll act as controls for the conservation genomics group. It’s all about how ...

These specimens that are [symptomatic] differ from other specimens viagra free trial in the environment in terms of their microbial community. Why has the agent of disease been so elusive, despite months of this kind of testing?. It’s not just a question of what’s making a given bird sick.... It’s much harder to diagnose a problem viagra free trial that’s shared across a wide geography and a wide timescale and a wide number of species. What do all of these specimens have in common that are different from healthy birds?.

For example, we know a lot tested positive for mycoplasma [bacteria], but we know that a lot of healthy birds test positive for mycoplasma. And not all the birds that we think are viagra free trial associated with this event tested positive for mycoplasma. Something could be affecting the birds neurologically that’s also depressing their immune system, that’s allowing a secondary to come in. What do you think about the hypothesis that the Brood X cicada emergence had something to do with this?. There viagra free trial are a number of hypotheses for what’s potentially driving the event.

Some tests have come back negative. West Nile viagra, avian flu, salmonella have come back negative. The cicada hypothesis viagra free trial is actually a set of hypotheses that developed because of really strong overlap between the mortality event and the cicada Brood X distribution. Areas that had a lot of cicadas seemed to have a lot of mortalities. Areas with fewer cicadas seemed to have a lower number of mortalities....

We were always careful to say that correlation isn’t causation in this case—we also know that there are a lot more fledglings in the environment in June, at the peak of viagra free trial cicadas, than there would be in July and August. It’s still a hypothesis that’s on the table, but it’s much less likely now because we’ve found areas that have been impacted with mortalities that did not have Brood X emerge. It seemed like many of the early reports were from amateur birders and community members, and it took ornithologists a bit of time to take these reports seriously. Does that say anything about professional scientists’ relationship to community science? viagra free trial. I’m sure it does.

A lot of my research is associated with community science data, but even I share that skepticism toward community science. I think that this was a lesson to me that we’ve got to do a better job as scientists to listen to what the community is saying viagra free trial. It’s too easy to herald their importance when we agree with what they’re saying or when community scientists are doing as we would wish them to do. When it’s something like this, when community scientists have observed things prior to us making observations, that’s something else entirely. That’s when viagra free trial the old crotchety scientists in us come in.

What have you learned from this experience?. I’m frankly a little ashamed that I was such a cocky bastard at the get-go. It was viagra free trial a real lesson in humility for me. We did this with erectile dysfunction treatment. We too often pretend that something we don’t see isn’t happening.

What are the biggest questions about the event that still remain, and do you think we’ll get answers to viagra free trial them?. I think it’ll be solved. To me, the biggest thing to solve first is whether it’s caused by an infectious disease or whether it’s caused by a toxin. Everybody’s champing at the viagra free trial bit to put their bird feeders back up. I’ve heard so much language and so much pressure—“When can I start feeding birds again?.

€ And my answer is always “Let’s wait and see what [the U.S. Geological Survey’s National Wildlife Health Center] says.” If it’s an infectious disease, and we care about birds, we shouldn’t be putting our feeders back viagra free trial. It would also be really important to know if it’s an environmental toxin. Why did we see it in 2021—in such large numbers?. “Will we see it again in the next breeding viagra free trial season?.

€ is another important question that lingers. You mentioned guidance from USGS that people in some mid-Atlantic, southeastern and Midwest states should take down their birdfeeders. What else can viagra free trial people do?. The most important thing that folks can do is just submit their observations. I’ve gotten reports from people, both through the bird mortality reporting form and from colleagues, in different states that are outside what’s expected to be the affected area.

We need viagra free trial to address whether or not our area of impact is, in fact, accurate. So, for example, if this is occurring in Texas, and Texas does not have Brood X cicadas, that’s a real problem with the cicada hypothesis. Bird enthusiasts should submit their observations and take a lot of pictures and videos of birds. *Editor’s Note (8/13/21) viagra free trial. This sentence was revised after posting to correct the description of Evans’s role in the collaborative effort.In Science Book Talk, a new four-part podcast miniseries, host Deboki Chakravarti acts as literary guide to two science books that share a beautiful and sometimes deeply resonant entanglement.In this week’s show.

Entangled Life, by Merlin Sheldrake, and Gathering Moss, by Robin Wall Kimmerer.In ordinary times, there would be no question about whether a drug with opioidlike effects should be proven safe and effective and approved by the Food and Drug Administration (FDA) before it is widely marketed. But these viagra free trial aren’t ordinary times and the herbal supplement kratom is not a typical drug. In fact, the issue of whether or not to ban kratom is an excellent litmus test of whether the Biden administration will actually use the philosophy of harm reduction to guide drug policy—or just spout the trendy catchphrase as window dressing to hide ongoing engagement in the war on drugs. An estimated 10–16 million Americans currently use kratom as an alternative to opioids, most commonly to treat pain or as a substitute for street drugs. The herb, formally known as Mitrogyna speciosa, has a centuries-long history of use in herbal medicine in viagra free trial Southeast Asia—notably as a substitute for opium.

It is typically sold as a bitter-tasting powder, which can be made into a tea or swallowed in capsules. Since kratom never drew enough international attention to spur an American or global prohibition, our lax regulation of “health supplements” made from plants allows it to be sold legally here. Sales have risen sharply in recent years, viagra free trial as both pain patients and people with addiction have increasingly lost access to medical opioids during the overdose crisis. Kratom does appear to be far safer than all illegal and most prescription opioids. A CDC study of some 27,000 overdoses that occurred between 2016 and 2017 found that it was implicated in less than 1 percent of deaths.

Given the large number of people who regularly use it and the low number of fatalities, researchers viagra free trial estimate that it is more than 1,000 times less likely to kill than typical prescription opioids. Moreover, in nearly all overdose deaths associated with kratom, it was accompanied by stronger drugs that kill more often, so it is not clear that it actually played a major role or even any at all. For example, around two thirds of the 152 deaths the CDC studied also involved illicit fentanyl and its analogues, which are thousands of times more potent. In only seven cases was kratom the only substance identified—and even viagra free trial here, researchers cannot rule out the possibility of undetected drugs. Regardless of the specific facts about particular drugs, however, for more than 100 years, the main strategy America has used to deal with drug problems is prohibition.

With the exception of alcohol, caffeine and tobacco, nearly every substance that has publicly been associated with recreational use has either been banned entirely or strictly confined to medical use. Prohibition policy—such as the war on drugs—assumes that restricting drug sales and possession will solve viagra free trial the problem, period. In contrast, when policy makers are guided by harm reduction, they have to assess whether banning a specific drug or allowing continued sales will do more damage—in the current context of other drugs for which it may substitute and other factors like harms associated with arrest and incarceration. For example, in a country where no one was misusing stronger opioids and no one was already using kratom, introducing it without controls could well be harmful. However, in the context of an America with the highest number of overdose deaths viagra free trial ever—driven largely by street fentanyl—removing a safer substitute almost certainly will increase mortality.

Unfortunately, kratom prohibition may be coming. The FDA is now asking for public comment about whether the U.S. Should support an international ban on the drug, which the United Nations, viagra free trial through the World Health Organization, is considering. The agency’s own position is clear. It opposes over-the-counter sales of kratom as a health supplement and wants its sales to be illegal unless it is proven medically effective.

An international ban would automatically require viagra free trial the U.S. To prohibit the drug domestically, under its treaty obligations. In concert with the Drug Enforcement Administration, the FDA previously has sought to ban kratom. In 2016, the DEA announced that it planned to place kratom into Schedule I of the Controlled Substances Act—the viagra free trial category intended for drugs that have potential for misuse and have no medical use. Along with drugs like cocaine, this is where marijuana, MDMA (ecstasy) and LSD currently languish.

The classification itself makes research to determine medical usefulness extremely difficult, creating somewhat of a catch-22. But for what viagra free trial is apparently the first time since the Harrison Act of 1914 legally enshrined drug prohibition, consumers successfully fought back. The DEA had no problem getting the media and Congress terrified of LSD and MDMA when those drugs became popular in the 1960s and 1980s respectively. By 2016, though, both journalists and elected officials were far more skeptical of the usefulness of prohibitions—and, probably not incidentally, kratom sales had by then become a billion-dollar industry. The proposal was dropped viagra free trial.

The FDA, however, still seems to want it off the market. In its call for public input about whether the drug should be globally banned, it described the herb this way. €œKratom is viagra free trial abused for its ability to produce opioid-like effects…Kratom is an increasingly popular drug of abuse and readily available on the recreational drug market in the United States. Evidence suggests that kratom is abused individually and with other psychoactive substances... In the United States, kratom is misused to self-treat chronic pain and opioid withdrawal symptoms.” Kratom supporters and the industry see this as the agency’s attempt to bypass its previous failure to win direct support for a domestic ban.

In comments made to Marijuana Moment, a policy newsletter, Mac Haddow of the American Kratom Association (AKA) argued that the agency’s intent to support a worldwide prohibition was an “abuse” of its authority, adding, “More overdose deaths will occur if kratom viagra free trial is banned, and that is exactly what the FDA is trying to do.” Ideally, we would have a responsive regulatory system that allowed for the approval of the safest medical and recreational drugs—one that based its decisions on relative harms, rather than on moral panics that are more associated with fears about race, class and ethnicity than actual drug effects. But in our current system, it’s certainly understandable that the FDA would seek to ban kratom. The only alternative for a substance that has risks and can cause a high is prohibition or regulation as a medicine, which cannot be done without clinical trials for safety and efficacy first. If we are genuinely to enact harm reduction policy, we have to change this.

From 2012 to 2014, I conducted 32 months of anthropological fieldwork buy viagra or cialis online exploring how Finland’s nuclear energy waste experts grappled with Earth’s radically you can find out more long-term future. These experts routinely dealt with long-lived radionuclides such as uranium-235, which has a half-life of over 700 million years. They worked with the nuclear waste management company Posiva to help build a final disposal facility approximately 450 meters below the islet of Olkiluoto in the Gulf of Bothnia in the Baltic Sea.

If all goes according to plan, this facility will, in the mid-2020s, become the world’s first operating deep geologic repository for spent nuclear fuel buy viagra or cialis online. To assess the Olkiluoto repository’s long-term durability, these experts developed a “safety case” forecasting geological, hydrological, and ecological events that could potentially occur in Western Finland over the coming tens of thousands—or even hundreds of thousands—of years. From their efforts emerged visions of distant future glaciations, climate changes, earthquakes, floods, human and animal population changes, and more.

These forecasts became the starting point for a series of “mental time travel” exercises that I incorporated into my buy viagra or cialis online book, Deep Time Reckoning. Stretching the mind across time—even in the most speculative ways—can help us become more responsible planetary stewards. It can help endow us with the time literacy necessary for tackling long-term challenges such as biodiversity loss, microplastics accumulation, climate change, antibiotic resistance, asteroid impacts, sustainable urban planning, and more.

This can not only make us feel more at buy viagra or cialis online home in pondering our planet’s pasts and futures. It can also draw us to imagine the world from the perspective of future human and non-human communities—fostering empathy across generations. The year 5710 CE.

A tired buy viagra or cialis online man lounges on a sofa. He lives in a small wooden house in a region once called Eurajoki, Finland. He works at a local medical center.

Today is buy viagra or cialis online his day off. He’s had a long day in the forest. He hunted moose and deer and picked lingonberries, mushrooms, and bilberries.

He now sips water, drawn from a village buy viagra or cialis online well, from a wooden cup. His husband brings him a dinner plate. On it are fried potatoes, cereal, boiled peas, and beef.

All the food came buy viagra or cialis online from local farms. The cattle were watered at a nearby river. The crops were watered by irrigation channels flowing from three local lakes.

The man has no idea that, more than 3,700 years ago, safety case biosphere modelers used 21st-century computer technologies to reckon everyday situations like his buy viagra or cialis online. He does not know that they once named the lakes around him—which formed long after their own deaths—“Liiklanjärvi,” “Tankarienjärvi,” and “Mäntykarinjärvi.” He is unaware of Posiva’s ancient determination that technological innovation and cultural habits are nearly impossible to predict even decades in advance. He is unaware that Posiva, in response, instructed its modelers to pragmatically assume that Western Finland’s populations’ lifestyles, demographic patterns, and nutritional needs will not change much over the next 10,000 years.

He does not know the safety case experts inserted, into their models’ own parameters, the assumption that he and his neighbors would eat only local buy viagra or cialis online food. Yet the hunter’s life is still entangled with the safety case experts’ work. If they had been successful, then the vegetables, meat, fruit, and water before him should have just a tiny chance of containing only tiny traces of radionuclides from 20th-century nuclear power plants.

12020 CE buy viagra or cialis online. A solitary farmer looks out over her pasture, surrounded by a green forest of heath trees. She lives in a sparse land once called Finland, on a fertile island plot once called Olkiluoto.

The area is an island no longer buy viagra or cialis online. What was once a coastal bay is now dotted with small lakes, peat bogs, and mires with white sphagnum mosses and grassy sedge plants. The Eurajoki and Lapijoki Rivers drain out into the sea.

When the farmer goes buy viagra or cialis online fishing at the lake nearby, she catches pike. She watches a beaver swim about. Sometimes she feels somber.

She recalls the freshwater ringed seals that once shared her country before buy viagra or cialis online their extinction. The woman has no idea that, deep beneath her feet, lies an ancestral deposit of copper, iron, clay, and radioactive debris. This is a highly classified secret—leaked to the public several times over the millennia, but now forgotten.

Yet even the government’s knowledge of the buy viagra or cialis online burial site is poor. Most records were destroyed in a global war in the year 3112. It was then that ancient forecasts of the site, found in the 2012 safety case report “Complementary Considerations,” were lost to history.

But the buy viagra or cialis online farmer does know the mythical stories of Lohikäärme. A dangerous, flying, salmon-colored venomous snake that kills anyone who dares dig too close to his underground cave. She and the other farmers in the area grow crops of peas, sugar beet, and wheat.

They balk at the superstitious fools who tell them the monster living buy viagra or cialis online beneath their feet is real. 35,012 CE. A tiny microbe floats in a large, northern lake.

It does not buy viagra or cialis online know that the clay, silt, and mud floor below it is gaining elevation, little by little, year after year. It is unaware that, 30 millennia ago, the lake was a vast sea. Dotted with sailboats, cruise and cargo ships, it was known by humans as the Baltic.

Watery straits, buy viagra or cialis online which connected the Baltic Sea to the North Sea, had risen above the water thousands of years ago. Denmark and Sweden fused into a single landmass. The seafloor was decompressing from the Weichselian glaciation—an enormous sheet of ice that pressed down on the land during a previous ice age.

After the last human died, the landmass kept on buy viagra or cialis online rising. Its uplift was indifferent to human extinction. It was indifferent to how, in 2013 CE, an anthropologist and a safety case expert sat chatting in white chairs in Ravintola Rytmi.

A café in Helsinki buy viagra or cialis online. There, the safety case expert relayed his projection that, by 52,000 CE, there would no longer be water separating Turku, Finland, and Stockholm, Sweden. At that point, one could walk from one city to the other on foot.

The expert reckoned that, to the north—between Vaasa, Finland, and Umeå, Sweden—one would someday find a waterfall with the planet’s buy viagra or cialis online largest deluge of flowing water. The waterfall could be found at the site of a once-submerged sea shelf. The microbe, though, does not know or care about Vaasa, Umeå, Denmark, long-lost boats, safety case reports, or Helsinki’s past dining options.

It has buy viagra or cialis online no concept of them. Their significances died with the humans. Nor does the microbe grasp the suffering they faced when succumbing to Anthropocene collapse.

Humans’ past technological feats, grand civilizations, passion projects, intellectual triumphs, wartime buy viagra or cialis online sacrifices, and personal struggles are now moot. And yet, the radiological safety of the microbe’s lake’s waters still hinges on the work of a handful of human safety case experts who lived millennia ago. Thinking so far ahead, these experts never lived to see whether their deep time forecasts were accurate.

We do not, buy viagra or cialis online of course, live in these imagined worlds. In this sense, they are unreal—merely fictions. However, our capacities to envision potential futures, and to feel empathy for those who may inhabit them, are very real.

Depictions of tomorrow can have buy viagra or cialis online powerful, concrete effects on the world today. This is why deep time thought experiments are not playful games, but serious acts of intellectual problem-solving. It is why the safety case experts’ models of far future nuclear waste risks are uniquely valuable, even if they are, at the end of the day, mere approximations.

Yet pondering distant future Earths can also help us take a step back from our everyday lives—enriching our imaginations by transporting our minds buy viagra or cialis online to different places and times. Corporate coaches have recommended taking breaks from our familiar thinking patterns to experience the world in new ways and overcome mental blocks. Cognitive scientists have shown how creativity can be sparked by perceiving "something one has not seen before (but that was probably always there).” Putting aside a few minutes each day for long-termist, planetary imagination can enrich us with greater mental dexterity in navigating between multiple, interacting timescales.

This can cultivate more longsighted buy viagra or cialis online empathy for landscapes, people, and other organisms across decades, centuries, and millennia. As the global ecological crisis takes hold, embracing planetary empathy will prove essential to our collective survival. This is an opinion and analysis article.

The views expressed by the buy viagra or cialis online author or authors are not necessarily those of Scientific American. This essay first appeared in the MIT Reader on August 10, 2021.Beginning in May and appearing to slow down by the end of July, juvenile songbirds from the mid-Atlantic to the Midwest fell ill with odd symptoms and died. Scientists were baffled by the mass mortality event.

Months later buy viagra or cialis online they still do not know what killed the birds. Suspects include pathogens that the victims could have contracted by consuming Brood X cicadas and environmental toxins to which the young birds were particularly vulnerable. Brian Evans, an ornithologist at the Smithsonian National Zoo and Conservation Biology Institute in Washington, D.C., is part of a collaborative effort that draws on community science to find out more about the scope of the event and narrow down the possible causes.* Scientific American spoke with Evans about the efforts to solve this ongoing mystery, the impact of community scientists and what the public can do to help.

[An edited buy viagra or cialis online transcript of the interview follows.] When did you first learn about these songbirds dying?. It first came to my attention in early to mid-May. Early on, I didn’t believe it.

I know that fledgling mortality rates are phenomenally high buy viagra or cialis online in general. So to hear word of a bunch of people observing a lot of dead and dying fledglings, as an ornithologist, frankly, didn’t come as much surprise. I had about five birds at that point in my backyard that had basically fallen out of the sky, and I blamed crows because I have an incredible crow population in my neighborhood [in Takoma Park, Md.].

It wasn’t buy viagra or cialis online until late May that my perspective on the event had started to change. One of my neighbors observed a bird on the street, out in front of the yard, that was still alive—all the birds that I had encountered at that point were dead—and described it as having really swollen eyes and this inability to respond to her and just [seeming] generally confused. Its head was making tremors.

That seemed to me to buy viagra or cialis online be an odd set of symptoms to share. We see a lot of swollen eyes in birds, especially house finches and house sparrows, that are infected with a bacterial called Mycoplasma gallisepticum. But these symptoms that she was describing didn’t sound like [those] caused by mycoplasma.

I went from, at that very moment, being really skeptical to starting to doubt myself buy viagra or cialis online. Literally a half an hour later, I received a text message from a field technician at the [Smithsonian] Migratory Bird Center with a picture of an affected bird, and a neighbor called me to tell me that he had a bird that was up the road that was sick. He and I together went to City Wildlife, which is the rehab agency that has been crucial in getting the word out about the event and connecting various parties.

They let me know when I went there that, from buy viagra or cialis online their perspective, this is a serious event and that they are overwhelmed with the number of mortalities that are coming in. What are the symptoms of this condition, and what birds are affected?. The ophthalmic symptoms can be surprisingly swollen eyes, eyes that jut out of the head a little bit.

They can buy viagra or cialis online be crusty eyes. They can be blindness. The neurological symptoms can be things such as a shaking head, an inability to stand, involuntary muscle spasms in general.

[They] can be depression buy viagra or cialis online or lethargy. When you observe one of these birds with this neurological set of symptoms, it’s fairly obvious, because they’re simply unresponsive. There’s one video that was submitted [via a form that the Smithsonian National Zoo and Conservation Biology Institute set up] of this bird that just had this slow shake to its head and could barely stand and was keeled to the side.

It’s those buy viagra or cialis online strange behaviors that I think buy female viagra are most remarkable in this event. To the best of our knowledge, [of those] affected, maybe 90 percent [are] juveniles. It can be tricky to tell a juvenile from an adult, but early on, they look really distinct, especially in regard to plumage, and they have a meaty gape around the corners of their mouth when they’re young in June.

What did you do once you realized that these were not run-of-the-mill deaths buy viagra or cialis online you would expect among juveniles?. The first thing that we did was start to coordinate with City Wildlife, the rehab group. We’re sending e-mails back and forth and trying to see.

What do we know? buy viagra or cialis online. Is this just in [Washington], D.C., or is it in other states?. How many birds are affected?.

Are we the buy viagra or cialis online worst?. We took in specimens that have the neurological/ophthalmic symptoms that are associated with the event, and we’re testing them internally through our Center for Conservation Genomics for everything from viral to bacterial to fungal s. The other role I’m playing is reaching out to every rehab agency that I can that has specimens of birds that died from other reasons—so they died because they hit a window or because a cat killed them.

Finally, we’re testing truly healthy specimens buy viagra or cialis online. We’re going out into the environment, and we’re banding birds and swabbing their eyelids and cloacae. They’ll act as controls for the conservation genomics group.

It’s all about how buy viagra or cialis online ... These specimens that are [symptomatic] differ from other specimens in the environment in terms of their microbial community. Why has the agent of disease been so elusive, despite months of this kind of testing?.

It’s buy viagra or cialis online not just a question of what’s making a given bird sick.... It’s much harder to diagnose a problem that’s shared across a wide geography and a wide timescale and a wide number of species. What do all of these specimens have in common that are different from healthy birds?.

For example, we know a lot tested positive for mycoplasma [bacteria], but we buy viagra or cialis online know that a lot of healthy birds test positive for mycoplasma. And not all the birds that we think are associated with this event tested positive for mycoplasma. Something could be affecting the birds neurologically that’s also depressing their immune system, that’s allowing a secondary to come in.

What do you think about the hypothesis that the Brood X cicada emergence had something to buy viagra or cialis online do with this?. There are a number of hypotheses for what’s potentially driving the event. Some tests have come back negative.

West Nile buy viagra or cialis online viagra, avian flu, salmonella have come back negative. The cicada hypothesis is actually a set of hypotheses that developed because of really strong overlap between the mortality event and the cicada Brood X distribution. Areas that had a lot of cicadas seemed to have a lot of mortalities.

Areas with fewer cicadas seemed to buy viagra or cialis online have a lower number of mortalities.... We were always careful to say that correlation isn’t causation in this case—we also know that there are a lot more fledglings in the environment in June, at the peak of cicadas, than there would be in July and August. It’s still a hypothesis that’s on the table, but it’s much less likely now because we’ve found areas that have been impacted with mortalities that did not have Brood X emerge.

It seemed like many of the early reports were from amateur birders and buy viagra or cialis online community members, and it took ornithologists a bit of time to take these reports seriously. Does that say anything about professional scientists’ relationship to community science?. I’m sure it does.

A lot buy viagra or cialis online of my research is associated with community science data, but even I share that skepticism toward community science. I think that this was a lesson to me that we’ve got to do a better job as scientists to listen to what the community is saying. It’s too easy to herald their importance when we agree with what they’re saying or when community scientists are doing as we would wish them to do.

When it’s something like this, when community scientists have buy viagra or cialis online observed things prior to us making observations, that’s something else entirely. That’s when the old crotchety scientists in us come in. What have you learned from this experience?.

I’m frankly a buy viagra or cialis online little ashamed that I was such a cocky bastard at the get-go. It was a real lesson in humility for me. We did this with erectile dysfunction treatment.

We too buy viagra or cialis online often pretend that something we don’t see isn’t happening. What are the biggest questions about the event that still remain, and do you think we’ll get answers to them?. I think it’ll be solved.

To me, buy viagra or cialis online the biggest thing to solve first is whether it’s caused by an infectious disease or whether it’s caused by a toxin. Everybody’s champing at the bit to put their bird feeders back up. I’ve heard so much language and so much pressure—“When can I start feeding birds again?.

€ And my answer is always buy viagra or cialis online “Let’s wait and see what [the U.S. Geological Survey’s National Wildlife Health Center] says.” If it’s an infectious disease, and we care about birds, we shouldn’t be putting our feeders back. It would also be really important to know if it’s an environmental toxin.

Why did we see it in buy viagra or cialis online 2021—in such large numbers?. “Will we see it again in the next breeding season?. € is another important question that lingers.

You mentioned guidance from USGS that people in some mid-Atlantic, southeastern and Midwest states should take buy viagra or cialis online down their birdfeeders. What else can people do?. The most important thing that folks can do is just submit their observations.

I’ve gotten reports from people, both through the bird mortality reporting form and from colleagues, in different states that are buy viagra or cialis online outside what’s expected to be the affected area. We need to address whether or not our area of impact is, in fact, accurate. So, for example, if this is occurring in Texas, and Texas does not have Brood X cicadas, that’s a real problem with the cicada hypothesis.

Bird enthusiasts should submit their observations and take a lot of pictures and buy viagra or cialis online videos of birds. *Editor’s Note (8/13/21). This sentence was revised after posting to correct the description of Evans’s role in the collaborative effort.In Science Book Talk, a new four-part podcast miniseries, host Deboki Chakravarti acts as literary guide to two science books that share a beautiful and sometimes deeply resonant entanglement.In this week’s show.

Entangled Life, by Merlin Sheldrake, and Gathering Moss, by Robin Wall Kimmerer.In ordinary times, there would be no question about whether a drug with opioidlike effects should be proven safe and effective and approved by the Food and Drug Administration (FDA) before it is buy viagra or cialis online widely marketed. But these aren’t ordinary times and the herbal supplement kratom is not a typical drug. In fact, the issue of whether or not to ban kratom is an excellent litmus test of whether the Biden administration will actually use the philosophy of harm reduction to guide drug policy—or just spout the trendy catchphrase as window dressing to hide ongoing engagement in the war on drugs.

An estimated 10–16 million Americans currently use kratom as an alternative to opioids, most commonly to treat pain or as a buy viagra or cialis online substitute for street drugs. The herb, formally known as Mitrogyna speciosa, has a centuries-long history of use in herbal medicine in Southeast Asia—notably as a substitute for opium. It is typically sold as a bitter-tasting powder, which can be made into a tea or swallowed in capsules.

Since kratom never drew enough international attention to spur an American or global prohibition, our lax regulation buy viagra or cialis online of “health supplements” made from plants allows it to be sold legally here. Sales have risen sharply in recent years, as both pain patients and people with addiction have increasingly lost access to medical opioids during the overdose crisis. Kratom does appear to be far safer than all illegal and most prescription opioids.

A CDC study of some 27,000 overdoses that occurred between 2016 and 2017 found that it was implicated in less than 1 percent of deaths buy viagra or cialis online. Given the large number of people who regularly use it and the low number of fatalities, researchers estimate that it is more than 1,000 times less likely to kill than typical prescription opioids. Moreover, in nearly all overdose deaths associated with kratom, it was accompanied by stronger drugs that kill more often, so it is not clear that it actually played a major role or even any at all.

For example, around two buy viagra or cialis online thirds of the 152 deaths the CDC studied also involved illicit fentanyl and its analogues, which are thousands of times more potent. In only seven cases was kratom the only substance identified—and even here, researchers cannot rule out the possibility of undetected drugs. Regardless of the specific facts about particular drugs, however, for more than 100 years, the main strategy America has used to deal with drug problems is prohibition.

With the exception of alcohol, caffeine and tobacco, nearly every substance that has publicly been buy viagra or cialis online associated with recreational use has either been banned entirely or strictly confined to medical use. Prohibition policy—such as the war on drugs—assumes that restricting drug sales and possession will solve the problem, period. In contrast, when policy makers are guided by harm reduction, they have to assess whether banning a specific drug or allowing continued sales will do more damage—in the current context of other drugs for which it may substitute and other factors like harms associated with arrest and incarceration.

For example, in a country where no one buy viagra or cialis online was misusing stronger opioids and no one was already using kratom, introducing it without controls could well be harmful. However, in the context of an America with the highest number of overdose deaths ever—driven largely by street fentanyl—removing a safer substitute almost certainly will increase mortality. Unfortunately, kratom prohibition may be coming.

The FDA is now buy viagra or cialis online asking for public comment about whether the U.S. Should support an international ban on the drug, which the United Nations, through the World Health Organization, is considering. The agency’s own position is clear.

It opposes buy viagra or cialis online over-the-counter sales of kratom as a health supplement and wants its sales to be illegal unless it is proven medically effective. An international ban would automatically require the U.S. To prohibit the drug domestically, under its treaty obligations.

In concert with the Drug buy viagra or cialis online Enforcement Administration, the FDA previously has sought to ban kratom. In 2016, the DEA announced that it planned to place kratom into Schedule I of the Controlled Substances Act—the category intended for drugs that have potential for misuse and have no medical use. Along with drugs like cocaine, this is where marijuana, MDMA (ecstasy) and LSD currently languish.

The classification itself makes research to determine medical usefulness extremely difficult, creating somewhat of a catch-22 buy viagra or cialis online. But for what is apparently the first time since the Harrison Act of 1914 legally enshrined drug prohibition, consumers successfully fought back. The DEA had no problem getting the media and Congress terrified of LSD and MDMA when those drugs became popular in the 1960s and 1980s respectively.

By 2016, buy viagra or cialis online though, both journalists and elected officials were far more skeptical of the usefulness of prohibitions—and, probably not incidentally, kratom sales had by then become a billion-dollar industry. The proposal was dropped. The FDA, however, still seems to want it off the market.

In its call for public input about whether the drug should be globally banned, it described the herb this way buy viagra or cialis online. €œKratom is abused for its ability to produce opioid-like effects…Kratom is an increasingly popular drug of abuse and readily available on the recreational drug market in the United States. Evidence suggests that kratom is abused individually and with other psychoactive substances...

In the United States, kratom is misused to self-treat chronic pain and opioid withdrawal symptoms.” Kratom supporters and the industry see this as the agency’s attempt to bypass its previous failure to win direct support buy viagra or cialis online for a domestic ban. In comments made to Marijuana Moment, a policy newsletter, Mac Haddow of the American Kratom Association (AKA) argued that the agency’s intent to support a worldwide prohibition was an “abuse” of its authority, adding, “More overdose deaths will occur if kratom is banned, and that is exactly what the FDA is trying to do.” Ideally, we would have a responsive regulatory system that allowed for the approval of the safest medical and recreational drugs—one that based its decisions on relative harms, rather than on moral panics that are more associated with fears about race, class and ethnicity than actual drug effects. But in our current system, it’s certainly understandable that the FDA would seek to ban kratom.

The only alternative for a substance that has risks and can cause a high is prohibition or regulation as a medicine, which cannot buy viagra or cialis online be done without clinical trials for safety and efficacy first. If we are genuinely to enact harm reduction policy, we have to change this. Banning a substance that does less harm than other widely available substitutes will make things worse.

President Biden’s buy viagra or cialis online policy needs to be more flexible. Otherwise, it will increase harm rather than reducing it. This is an opinion and analysis article.

The views expressed by the author or authors are not necessarily those of Scientific American..

Is virmax like viagra

AdvertisementContinue reading the main is virmax like viagra storySupported byContinue reading the main storyWhy Is Perimenopause Still Get flagyl prescription Such a Mystery?. Over 1 billion women around the world will have experienced perimenopause by 2025. But a culture is virmax like viagra that has spent years dismissing the process might explain why we don’t know more about it.Credit...Monica GarwoodPublished April 29, 2021Updated April 30, 2021Angie McKaig calls it “peri brain” out loud, in meetings. That’s when the 49-year-old has moments of perimenopause-related brain fog so intense that she will forget the point she is trying to make in the middle of a sentence. Sometimes it will happen when she’s presenting to her colleagues in digital marketing is virmax like viagra at Canada’s largest bank in Toronto.

But it can happen anywhere — she has forgotten her own address. Twice.Ms. McKaig’s symptoms were a rude surprise when she first started experiencing them in 2018, right around when her mother died. She had an irregular period, hot flashes, insomnia and massive hair loss along with memory issues she describes as “like somebody had taken my brain and done the Etch A Sketch thing,” which is to say, shaken it until it was blank.She thought she might have early-onset Alzheimer’s, or that these changes were a physical response to her grief, until her therapist told her that her symptoms were typical signs of perimenopause, which is defined as the final years of a woman’s reproductive life leading up to the cessation of her period, or menopause. It usually begins in a woman’s 40s, and is marked by fluctuating hormones and a raft of mental and physical symptoms that are “sufficiently bothersome” to send almost 90 percent of women to their doctors for advice about how to cope.Ms.

McKaig is aggressively transparent about her “peri brain” at work, because she “realized how few people actually talk about this, and how little information we are given. So I have tried to normalize it,” she said.An oft-cited statistic from the North American Menopause Society is that by 2025, more than 1 billion women around the world will be post-menopausal. The scientific study of perimenopause has been going on for decades, and the cultural discussion of this mind and body shift has reached something of a new fever pitch, with several books on the subject coming out this spring and a gaggle of “femtech” companies vowing to disrupt perimenopause.If the experience of perimenopause is this universal, why did almost every single layperson interviewed for this article say something along the lines of. No one told me it would be like this?. €œYou’re hearing what I’m hearing, ‘Nobody ever told me this, my mother never told me this,’ and I had the same experiences many years ago with my mother,” said Dr.

Lila Nachtigall, a professor of obstetrics and gynecology at N.Y.U. Grossman School of Medicine who has been treating perimenopausal women for 50 years, and is an adviser to Elektra Health, a telemedicine start-up.Dr. Nachtigall said her mother had the worst hot flashes, and even though they were living in the same house when her mother was experiencing perimenopausal symptoms, they never discussed it. €œThat was part of the taboo. You were supposed to suffer in silence.”The shroud of secrecy around women’s intimate bodily functions is among the many reasons experts cite for the lack of public knowledge about women’s health in midlife.

But looking at the medical and cultural understanding of perimenopause through history reveals how this rite of passage, sometimes compared to a second puberty, has been overlooked and under discussed.From ‘Women’s Hell’ to ‘Age of Renewal’Though the ancient Greeks and Romans knew a woman’s fertility ended in midlife, there are few references to menopause in their texts, according to Susan Mattern, a professor of history at the University of Georgia, in her book “The Slow Moon Climbs. The Science, History, and Meaning of Menopause.”The term “menopause” wasn’t used until around 1820, when it was coined by Charles de Gardanne, a French physician. Before then, it was colloquially referred to as “women’s hell,” “green old age” and “death of sex,” Dr. Mattern notes. Dr.

De Gardanne cited 50 menopause-related conditions that sound somewhat absurd to modern ears, including “epilepsy, nymphomania, gout, hysterical fits and cancer.”Physicians in the 19th century believed that receiving bad news could cause early menopause, and that women who worked in “unwomanly” occupations, like fishwives, were most at risk, according to “The Curse. A Cultural History of Menstruation,” by Emily Toth, Janice Delaney and Mary Lupton. These Victorian doctors also believed that menopausal women grew scales on their breasts and experienced a “loss of feminine grace.”Things did not get much better for women in perimenopause during the latter half of the 19th century. €œA woman consulting the American gynecologist Andrew Currier in the 1890s would have been told that leeches were still an effective remedy for congested genitals,” more commonly known as pelvic pain, according to “The Curse.” Other physicians of the era thought that perimenopausal women were more susceptible to mental illnesses, “among them ‘morbid irrationality,’ ‘minor forms of hysteria’, melancholia and the impulses to drink spirits, to steal, and perchance, to murder.”In the first half of the 20th century, the hormone estrogen was discovered and its role in menopause was clarified somewhat — after a woman’s period ceases, her estrogen levels are lower than they were during her fertile years. Even though doctors no longer thought menopausal women were murderous lizard people, cultural ideas about them did not improve.It wasn’t until the 1980s that longitudinal studies — which followed the same cohort of women for years — deepened public knowledge about the role of hormones during menopause.

Before that, doctors thought perimenopause was a slow draining of estrogen levels until you hit the end of your period. €œBut what we’ve learned is it is more of a turbulent process — hormones are bouncing around,” said Dr. Stephanie Faubion, the medical director of the North American Menopause Society.Even now, perimenopause is described in medical research as an “ill-defined time period” primarily marked when the ovarian reserve is depleted and by irregular periods (but if one has a history of irregular periods, as 14 percent to 25 percent of women do, it may be tougher to tell when the transition has begun). This time period is still often referred to as menopause in common parlance, but the medical definition of menopause is just one day — the last day of your final period — though it is only diagnosed when a whole year has gone by without menstruation.Because hormones fluctuate wildly during perimenopause, it can be difficult to test for. The average age of the beginning of perimenopause is 47, and the average age of menopause is 51, but again, the length of the transitional period may be much longer, and the onset of symptoms can happen earlier or later.There are four symptoms of perimenopause that are most common.

Hot flashes, sleep disruption, depression and vaginal dryness, known as “the core four” among menopause experts. But the full panoply of symptoms related to the perimenopause transition “is not yet known with any great degree of certainty,” said Dr. Nanette Santoro, the chair of obstetrics and gynecology at the University of Colorado School of Medicine. At this point, the perimenopausal period is associated with as many as 34 different maladies ranging from hair loss to “burning mouth syndrome,” which is a tingling or numb feeling in your lips, gums and tongue.There’s also what Dr. Faubion refers to as “the menopause management vacuum.” As she explained to Lisa Selin Davis, a Times contributor, no one medical specialty really “owns” treatment of perimenopausal and menopausal women, because the symptoms affect so many different systems and parts of the body.

Furthermore, less than 7 percent of medical residents surveyed said they felt “adequately prepared” to manage women going through menopause.Though images of midlife women have definitely improved — a popular meme compares Jennifer Lopez, who at 50 was pole dancing at the Super Bowl, to Rue McClanahan, who at 51 in 1985 was on “Golden Girls” drinking coffee on the lanai — there is still much progress to be made. It was only this year that an online Arabic dictionary changed the description of menopause from “age of despair” to “age of renewal.”With so much negative cultural baggage, so much still unknown around symptoms and timing, and so few doctors confident in the treatment of midlife women, “no wonder people are confused,” Dr. Nachtigall said. And it helps explain why so many companies and writers are jumping into the morass.Having a MomentWhat Angie McKaig is trying to do on a micro level by freely sharing her perimenopause travails with colleagues, health care start-ups, beauty companies and writers are trying to do on a macro level. Raising awareness about the experience of this period of a woman’s life (and sometimes selling them products and services along the way).“Femtech” companies such as the telemedicine providers Elektra Health and Gennev are moving into the perimenopause market.

Stacy London, the stylist and reality TV star, just started a skin care company called The State of Menopause. And celebrities like Michelle Obama and Gwyneth Paltrow have spoken honestly about their perimenopause symptoms (though Ms. Paltrow did it in the service of promoting a supplement called “Madame Ovary” that she sells on her website, Goop).Books on the topic from Heather Corinna, a sexual health expert, and Dr. Jen Gunter, a Times contributor and OB/GYN, will be published this spring. Newsletters and online communities like TueNight and The Black Girl’s Guide to Surviving Menopause are gaining traction with tens of thousands of readers.One community aimed at connecting women during their perimenopausal transition is called The Woolfer — named for the writer Virginia Woolf.

The website and social platform started as a Facebook group called What Would Virginia Woolf Do?. The name was meant to be a “dark joke,” said Nina Lorez Collins, 51, the founder and chief executive of The Woolfer — as in, “Should we just throw in the towel and wander into a river,” as Woolf did?. The answer, of course, is a resounding no. Ms. Collins said her group has helped women normalize the more shocking symptoms of the menopause transition.

(More than one woman interviewed for this piece used the phrase “crime scene periods.”) And they have also reframed the journey into menopause as one of triumph, not irrelevance.Shifting the Narrative and Getting HelpThough perimenopause presents as so many different symptoms, there are treatments available. However, there “is not one single solution,” Dr. Faubion said. The treatment is symptom dependent. If heavy or irregular bleeding is the issue, an intrauterine device, or a birth control pill could help.

A low-dose birth control pill may also relieve hot flashes. €œBirth control pills are made up of so many different permutations and combinations of hormones,” it’s important to discuss which one is right based on your medical history and individual needs, Dr. Nachtigall said. If mood issues are the biggest complaint, an antidepressant might be appropriate. (Hormone therapy may be an option for some women to help ease symptoms, but it is more frequently prescribed after menopause).Ongoing longitudinal studies are finding associations between women with intense perimenopause symptoms in midlife, and risks of heart disease and osteoporosis in later years.

Currently, there is not evidence to support the use of vitamins or supplements like black cohosh or magnesium, contrary to claims that these products help with hot flashes.Despite expanded and continuing research, finding a knowledgeable physician who won’t dismiss your symptoms or tell you there’s nothing they can do to help is a struggle for many women. Ms. McKaig said that though her therapist diagnosed her as perimenopausal, her family doctor keeps telling her that her symptoms can’t be perimenopause because she’s still having her period sometimes. She said she’s “given up trying to educate her.”For Black women, there is an added layer of difficulty in finding a sympathetic doctor, with ample research showing racial bias in physicians’ consideration of symptoms. As The Washington Post noted earlier this year, Black women “have a higher risk of experiencing hot flashes but are less likely to be offered effective hormone replacement therapy.” Jennifer White, 46, a journalist who recently relocated to the Washington, D.C., area, has been experiencing perimenopause-related insomnia and painful, irregular periods for a year.

€œFinding the right clinician to take seriously my concerns as a Black woman, and not tell me to walk it off, is top of mind,” she said.The North American Menopause Society’s website lists qualified physicians throughout the country and abroad, but if you live outside major metropolitan areas, the pickings may be slim (for example, there are only two NAMS-certified menopause practitioners listed for the entire state of Wyoming). Telemedicine is aiming to fill the void, but even in the erectile dysfunction treatment era, there are limitations and complications to practicing medicine across state lines.Though finding a qualified and sympathetic doctor may be a challenge, shifting the cultural narrative may be just as vital.“I actually think it’s extraordinarily important to change the conversation. Because so much of what you hear about perimenopause is spoken about in an anti-feminist and ageist way,” said Dr. Lucy Hutner, a reproductive psychiatrist in New York. Dr.

Hutner said that many of her patients who are navigating these midlife shifts find them deeply empowering. They feel more resilient, and are following their “inner compass.” While part of it is just the wisdom that comes with age, many women feel that once they are through the menopause transition, they don’t have to make themselves appealing to the world. As Dr. Hutner put it. €œI feel liberated because I’m not trying to take care of everyone else or correspond to anyone’s societal view.

I have been able to shake off the shackles.”AdvertisementContinue reading the main story.

AdvertisementContinue reading the main storySupported buy viagra or cialis online byContinue reading the main http://julieparticka.com/get-flagyl-prescription/ storyWhy Is Perimenopause Still Such a Mystery?. Over 1 billion women around the world will have experienced perimenopause by 2025. But a culture that has spent buy viagra or cialis online years dismissing the process might explain why we don’t know more about it.Credit...Monica GarwoodPublished April 29, 2021Updated April 30, 2021Angie McKaig calls it “peri brain” out loud, in meetings. That’s when the 49-year-old has moments of perimenopause-related brain fog so intense that she will forget the point she is trying to make in the middle of a sentence. Sometimes it will happen when she’s presenting to her colleagues in digital marketing at Canada’s buy viagra or cialis online largest bank in Toronto.

But it can happen anywhere — she has forgotten her own address. Twice.Ms. McKaig’s symptoms were a rude surprise when she first started experiencing them in 2018, right around when her mother died. She had an irregular period, hot flashes, insomnia and massive hair loss along with memory issues she describes as “like somebody had taken my brain and done the Etch A Sketch thing,” which is to say, shaken it until it was blank.She thought she might have early-onset Alzheimer’s, or that these changes were a physical response to her grief, until her therapist told her that her symptoms were typical signs of perimenopause, which is defined as the final years of a woman’s reproductive life leading up to the cessation of her period, or menopause. It usually begins in a woman’s 40s, and is marked by fluctuating hormones and a raft of mental and physical symptoms that are “sufficiently bothersome” to send almost 90 percent of women to their doctors for advice about how to cope.Ms.

McKaig is aggressively transparent about her “peri brain” at work, because she “realized how few people actually talk about this, and how little information we are given. So I have tried to normalize it,” she said.An oft-cited statistic from the North American Menopause Society is that by 2025, more than 1 billion women around the world will be post-menopausal. The scientific study of perimenopause has been going on for decades, and the cultural discussion of this mind and body shift has reached something of a new fever pitch, with several books on the subject coming out this spring and a gaggle of “femtech” companies vowing to disrupt perimenopause.If the experience of perimenopause is this universal, why did almost every single layperson interviewed for this article say something along the lines of. No one told me it would be like this?. €œYou’re hearing what I’m hearing, ‘Nobody ever told me this, my mother never told me this,’ and I had the same experiences many years ago with my mother,” said Dr.

Lila Nachtigall, a professor of obstetrics and gynecology at N.Y.U. Grossman School of Medicine who has been treating perimenopausal women for 50 years, and is an adviser to Elektra Health, a telemedicine start-up.Dr. Nachtigall said her mother had the worst hot flashes, and even though they were living in the same house when her mother was experiencing perimenopausal symptoms, they never discussed it. €œThat was part of the taboo. You were supposed to suffer in silence.”The shroud of secrecy around women’s intimate bodily functions is among the many reasons experts cite for the lack of public knowledge about women’s health in midlife.

But looking at the medical and cultural understanding of perimenopause through history reveals how this rite of passage, sometimes compared to a second puberty, has been overlooked and under discussed.From ‘Women’s Hell’ to ‘Age of Renewal’Though the ancient Greeks and Romans knew a woman’s fertility ended in midlife, there are few references to menopause in their texts, according to Susan Mattern, a professor of history at the University of Georgia, in her book “The Slow Moon Climbs. The Science, History, and Meaning of Menopause.”The term “menopause” wasn’t used until around 1820, when it was coined by Charles de Gardanne, a French physician. Before then, it was colloquially referred to as “women’s hell,” “green old age” and “death of sex,” Dr. Mattern notes. Dr.

De Gardanne cited 50 menopause-related conditions that sound somewhat absurd to modern ears, including “epilepsy, nymphomania, gout, hysterical fits and cancer.”Physicians in the 19th century believed that receiving bad news could cause early menopause, and that women who worked in “unwomanly” occupations, like fishwives, were most at risk, according to “The Curse. A Cultural History of Menstruation,” by Emily Toth, Janice Delaney and Mary Lupton. These Victorian doctors also believed that menopausal women grew scales on their breasts and experienced a “loss of feminine grace.”Things did not get much better for women in perimenopause during the latter half of the 19th century. €œA woman consulting the American gynecologist Andrew Currier in the 1890s would have been told that leeches were still an effective remedy for congested genitals,” more commonly known as pelvic pain, according to “The Curse.” Other physicians of the era thought that perimenopausal women were more susceptible to mental illnesses, “among them ‘morbid irrationality,’ ‘minor forms of hysteria’, melancholia and the impulses to drink spirits, to steal, and perchance, to murder.”In the first half of the 20th century, the hormone estrogen was discovered and its role in menopause was clarified somewhat — after a woman’s period ceases, her estrogen levels are lower than they were during her fertile years. Even though doctors no longer thought menopausal women were murderous lizard people, cultural ideas about them did not improve.It wasn’t until the 1980s that longitudinal studies — which followed the same cohort of women for years — deepened public knowledge about the role of hormones during menopause.

Before that, doctors thought perimenopause was a slow draining of estrogen levels until you hit the end of your period. €œBut what we’ve learned is it is more of a turbulent process — hormones are bouncing around,” said Dr. Stephanie Faubion, the medical director of the North American Menopause Society.Even now, perimenopause is described in medical research as an “ill-defined time period” primarily marked when the ovarian reserve is depleted and by irregular periods (but if one has a history of irregular periods, as 14 percent to 25 percent of women do, it may be tougher to tell when the transition has begun). This time period is still often referred to as menopause in common parlance, but the medical definition of menopause is just one day — the last day of your final period — though it is only diagnosed when a whole year has gone by without menstruation.Because hormones fluctuate wildly during perimenopause, it can be difficult to test for. The average age of the beginning of perimenopause is 47, and the average age of menopause is 51, but again, the length of the transitional period may be much longer, and the onset of symptoms can happen earlier or later.There are four symptoms of perimenopause that are most common.

Hot flashes, sleep disruption, depression and vaginal dryness, known as “the core four” among menopause experts. But the full panoply of symptoms related to the perimenopause transition “is not yet known with any great degree of certainty,” said Dr. Nanette Santoro, the chair of obstetrics and gynecology at the University of Colorado School of Medicine. At this point, the perimenopausal period is associated with as many as 34 different maladies ranging from hair loss to “burning mouth syndrome,” which is a tingling or numb feeling in your lips, gums and tongue.There’s also what Dr. Faubion refers to as “the menopause management vacuum.” As she explained to Lisa Selin Davis, a Times contributor, no one medical specialty really “owns” treatment of perimenopausal and menopausal women, because the symptoms affect so many different systems and parts of the body.

Furthermore, less than 7 percent of medical residents surveyed said they felt “adequately prepared” to manage women going through menopause.Though images of midlife women have definitely improved — a popular meme compares Jennifer Lopez, who at 50 was pole dancing at the Super Bowl, to Rue McClanahan, who at 51 in 1985 was on “Golden Girls” drinking coffee on the lanai — there is still much progress to be made. It was only this year that an online Arabic dictionary changed the description of menopause from “age of despair” to “age of renewal.”With so much negative cultural baggage, so much still unknown around symptoms and timing, and so few doctors confident in the treatment of midlife women, “no wonder people are confused,” Dr. Nachtigall said. And it helps explain why so many companies and writers are jumping into the morass.Having a MomentWhat Angie McKaig is trying to do on a micro level by freely sharing her perimenopause travails with colleagues, health care start-ups, beauty companies and writers are trying to do on a macro level. Raising awareness about the experience of this period of a woman’s life (and sometimes selling them products and services along the way).“Femtech” companies such as the telemedicine providers Elektra Health and Gennev are moving into the perimenopause market.

Stacy London, the stylist and reality TV star, just started a skin care company called The State of Menopause. And celebrities like Michelle Obama and Gwyneth Paltrow have spoken honestly about their perimenopause symptoms (though Ms. Paltrow did it in the service of promoting a supplement called “Madame Ovary” that she sells on her website, Goop).Books on the topic from Heather Corinna, a sexual health expert, and Dr. Jen Gunter, a Times contributor and OB/GYN, will be published this spring. Newsletters and online communities like TueNight and The Black Girl’s Guide to Surviving Menopause are gaining traction with tens of thousands of readers.One community aimed at connecting women during their perimenopausal transition is called The Woolfer — named for the writer Virginia Woolf.

The website and social platform started as a Facebook group called What Would Virginia Woolf Do?. The name was meant to be a “dark joke,” said Nina Lorez Collins, 51, the founder and chief executive of The Woolfer — as in, “Should we just throw in the towel and wander into a river,” as Woolf did?. The answer, of course, is a resounding no. Ms. Collins said her group has helped women normalize the more shocking symptoms of the menopause transition.

(More than one woman interviewed for this piece used the phrase “crime scene periods.”) And they have also reframed the journey into menopause as one of triumph, not irrelevance.Shifting the Narrative and Getting HelpThough perimenopause presents as so many different symptoms, there are treatments available. However, there “is not one single solution,” Dr. Faubion said. The treatment is symptom dependent. If heavy or irregular bleeding is the issue, an intrauterine device, or a birth control pill could help.

A low-dose birth control pill may also relieve hot flashes. €œBirth control pills are made up of so many different permutations and combinations of hormones,” it’s important to discuss which one is right based on your medical history and individual needs, Dr. Nachtigall said. If mood issues are the biggest complaint, an antidepressant might be appropriate. (Hormone therapy may be an option for some women to help ease symptoms, but it is more frequently prescribed after menopause).Ongoing longitudinal studies are finding associations between women with intense perimenopause symptoms in midlife, and risks of heart disease and osteoporosis in later years.

Currently, there is not evidence to support the use of vitamins or supplements like black cohosh or magnesium, contrary to claims that these products help with hot flashes.Despite expanded and continuing research, finding a knowledgeable physician who won’t dismiss your symptoms or tell you there’s nothing they can do to help is a struggle for many women. Ms. McKaig said that though her therapist diagnosed her as perimenopausal, her family doctor keeps telling her that her symptoms can’t be perimenopause because she’s still having her period sometimes. She said she’s “given up trying to educate her.”For Black women, there is an added layer of difficulty in finding a sympathetic doctor, with ample research showing racial bias in physicians’ consideration of symptoms. As The Washington Post noted earlier this year, Black women “have a higher risk of experiencing hot flashes but are less likely to be offered effective hormone replacement therapy.” Jennifer White, 46, a journalist who recently relocated to the Washington, D.C., area, has been experiencing perimenopause-related insomnia and painful, irregular periods for a year.

€œFinding the right clinician to take seriously my concerns as a Black woman, and not tell me to walk it off, is top of mind,” she said.The North American Menopause Society’s website lists qualified physicians throughout the country and abroad, but if you live outside major metropolitan areas, the pickings may be slim (for example, there are only two NAMS-certified menopause practitioners listed for the entire state of Wyoming). Telemedicine is aiming to fill the void, but even in the erectile dysfunction treatment era, there are limitations and complications to practicing medicine across state lines.Though finding a qualified and sympathetic doctor may be a challenge, shifting the cultural narrative may be just as vital.“I actually think it’s extraordinarily important to change the conversation. Because so much of what you hear about perimenopause is spoken about in an anti-feminist and ageist way,” said Dr. Lucy Hutner, a reproductive psychiatrist in New York. Dr.

Hutner said that many of her patients who are navigating these midlife shifts find them deeply empowering. They feel more resilient, and are following their “inner compass.” While part of it is just the wisdom that comes with age, many women feel that once they are through the menopause transition, they don’t have to make themselves appealing to the world. As Dr. Hutner put it. €œI feel liberated because I’m not trying to take care of everyone else or correspond to anyone’s societal view.

I have been able to shake off the shackles.”AdvertisementContinue reading the main story.

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Oct Lasix price viagra connect amazon. 12, 2021 -- The effects of climate change span the globe and have reached an overwhelming majority of people on Earth in the form of coastal flooding, wildfires, and other climate-related events, new findings suggest.Using a special computer program to analyze the sizeable amount of data on climate change, researchers report that about 85% of people have felt its effects, according toresults published Monday in Nature Climate Change.To come to this conclusion, scientists fed published summaries of more than 100,000 studies on climate change into a computer trained to identify key information. The computer mapped that information onto a global grid of data on local temperature and precipitation changes that are linked to human viagra connect amazon activity.The maps show where these precipitation and temperature shifts -- both of which are measures of climate change -- were likely connected to climate-related outcomes such as drought, floods, fires, and even human health.The results suggest that 80% of the Earth’s land, not including Antarctica, is experiencing climate change because of human activity -- at least in part. Almost all the temperature shifts are toward warming, though precipitation changes are mixed, with increases in some areas and declines in others.Compared with low-income countries, high-income countries had about double the amount of solid evidence for the human factor in climate change, the researchers found.

That said, one possible explanation for why the roughly 20% of land mass where human-induced effects were seemingly viagra connect amazon weaker -- like in western Africa and some parts of Asia -- is that these areas have been less scrutinized by scientists, the study authors said.TUESDAY, Oct. 12, 2021 (HealthDay News) -- How do men and women respond to a crisis?. A look viagra connect amazon at their behavior during the first erectile dysfunction treatment lockdown in 2020 offers a clue. Women flocked to their phones for long conversations with a few trusted contacts.

Men, chafing at being cooped up, headed out and about viagra connect amazon as soon as they could, European researchers report. "The total shutdown of public life was like a population-wide live experiment," said researcher Tobias Reisch of Complexity Science Hub Vienna (CSH). "We were interested in the extent to which people supported viagra connect amazon the anti-Corona measures imposed by the government. When we analyzed the data by gender, we found surprisingly strong behavioral differences between men and women." For the study, CSH looked at mobile phone data from 1.2 million Austrians.

The records revealed that people made much longer phone calls after the lockdown was imposed. "Interestingly, they talked to fewer people than usual — but with these few, they spoke longer," viagra connect amazon Reisch said. After Austria locked down on March 16, 2020, women-to-women calls were up to 1.5 times longer than before, and calls from men to women were nearly twice as long as before. When women called men, they talked 80% longer, while the length of calls between men rose by 66%, viagra connect amazon the findings showed.

Researcher Georg Heiler said, "Of course, we don't know the content or purpose of these calls. Yet, literature from the social sciences provides evidence — mostly from small surveys, polls, or interviews -- that women tend to choose more viagra connect amazon active strategies to cope with stress, such as talking with others. Our study would confirm that." The researchers also found that differences in mobility between men and women before the lockdown were amplified during the lockdown, with women limiting trips outside their home more and for longer than men. Men flocked to a large recreational area viagra connect amazon in Vienna and a shopping mall during the lockdown, phone data showed.

And once restrictions were lifted, they returned to their usual pre-viagra habits. On the one hand, the authors said their study offers support for research in psychology and the social sciences — including a look at new questions from data evaluations.You can’t see, smell, or taste them, but they’re in hundreds of consumer products you use every day viagra connect amazon. They’re also in the food you eat. Phthalates (pronounced THAL-ates) are chemicals that make plastic soft and flexible.Phthalates are even in your body.

Nearly all Americans have phthalate byproducts in their urine, says Ami Zota, associate professor of environmental and occupational health at George viagra connect amazon Washington University.But are phthalates bad for you?. Here’s what we know about their links to health.What Products Are Phthalates Found In?. You can find them in things like:Cosmetics and personal care products such as perfume, nail polish, hair spray, soap, shampoo, and skin moisturizersMedical tubing viagra connect amazon and fluid bagsWood finishesDetergentsAdhesivesPlastic plumbing pipesLubricantsSolventsInsecticidesBuilding materialsVinyl flooringShower curtainsWhat Foods Are High in Phthalates?. Foods linked to higher phthalate levels include:Restaurant, cafeteria, and fast foodsHigh-fat dairyFatty meats and pouyCooking oilsHow Do Phthalates Get Into My Body?.

You get them by:Eating or drinking things served or packaged in plastic that has phthalatesEating or drinking dairy and meat viagra connect amazon products from animals that have been exposedUsing cosmetics, shampoo, skin moisturizers, and other personal care productsHaving contact with dust in rooms where the carpet, upholstery, wall coverings, or wood finishes have phthalatesYou might be more likely to get exposed if you:Work in painting, printing, or plastics processingHave a medical condition like kidney disease or hemophilia. Kidney dialysis and blood transfusions often use IV tubing and other supplies made with phthalates.What Does the Research Say?. We’re still learning about viagra connect amazon how phthalates affect us. At this point, more studies have been done on animals than on people.One study links high levels of phthalate exposure to early death in older people.The researchers looked at data on more than 5,000 adults in the U.S.

They found that those between 55 and 64 years viagra connect amazon old with the highest levels of phthalates in their urine were more likely to die of heart disease than those with lower levels. People in the high-exposure group were also likelier to die of any cause. But high concentrations of phthalates didn’t seem to raise the chances of dying from cancer. The researchers say their findings viagra connect amazon suggest that daily contact with phthalates may lead to the early deaths of about 100,000 older Americans a year, costing the country an estimated $40 billion to $47 billion in lost economic productivity each year.But the study only suggests a link between phthalates and dying early.

It doesn’t prove cause and effect. More research is needed to confirm the findings and shed more light viagra connect amazon on the link, including how exactly these chemicals might lead to premature death. Other research doesn’t always address the ways phthalates and other chemicals affect each other.It’s not just one phthalate that might cause a problem. The chemicals in products viagra connect amazon and food work together in combination.How Do Phthalates Affect Humans?.

New research areas are expanding our understanding. The link between phthalates and surging rates of chronic disease is one viagra connect amazon example. Other studies have focused on people who are more sensitive to chemicals than others.Phthalates affect different groups of people in different ways:Unborn babies and children are among the most affected. Phthalates can do more harm to males.Kids in puberty are also at viagra connect amazon risk.

Times when our bodies are changing seem to leave us more vulnerable, Zota says.Adult women have more side effects than men, possibly because they use more personal care products.Are Phthalates Safe?. There’s no simple viagra connect amazon answer. Phthalates aren’t a single chemical. They’re an entire family of them.

And like most families, they don’t all behave the same way.Three of them -- BBP, DBP, and DEHP -- are permanently banned from toys and products intended to help children under 3 sleep, eat, teethe, or viagra connect amazon suck.DBP and DEHP damage the reproductive systems of lab rats, especially males. Tests on people show DBP can irritate skin. We’re not sure if BBP causes cancer in people, but research shows it may have viagra connect amazon caused cancer in lab rats. DEHP is confirmed to cause cancer in animals, and expected, but not confirmed, in people.

It also causes developmental problems in animals, but it hasn’t been shown to affect people the same way.Three more viagra connect amazon -- DiDP, DINP, and DnOP -- are under an interim ban from toys that can go into a child’s mouth.DiDP can make your eyes and skin red or cause nausea, dizziness, and vomiting. DINP causes tumors and developmental problems in lab rats. In 2014, California added it to its list of chemicals known to viagra connect amazon cause cancer. But it hasn’t been proven to cause cancer in people.

DnOP was linked to endometriosis in women and caused problems in reproductive development in viagra connect amazon rats. It can irritate the skin in both people and animals. Phthalate levels in people are changing. Some are going viagra connect amazon up.

Others are on their way down.DBP, BBP, and DEHP have declined in recent years. They’re now below the amounts considered unsafe by federal health agencies. But exposure to replacement phthalates likes DINP, DnOP, and DIDP is higher.How Can I Protect Myself?. Our bodies have a natural detoxifying system.

Your best bet is to avoid phthalates as much as possible. Here’s how to start:Read product labels. Phthalates aren’t always included on labels, especially with personal care products and vinyl or plastic toys. When they are identified, it’s usually with an acronym like DHEP or DiBP.When you can, choose items labeled “phthalate-free.”Use only “microwave safe” and phthalate-free containers and plastic wrap -- especially with oily or fatty foods.Watch what you eat.

Studies show that diets high in dairy and meat bring high levels of phthalate exposure.Avoid fast food. Zota and other researchers have found that fast food containers can be a source of harmful exposure.Ask for phthalate-free medical devices if you are on kidney dialysis or receive a blood transfusion..

Oct http://thecassiechronicles.com/lasix-price/ buy viagra or cialis online. 12, 2021 -- The effects of climate change span the globe and have reached an overwhelming majority of people on Earth in the form of coastal flooding, wildfires, and other climate-related events, new findings suggest.Using a special computer program to analyze the sizeable amount of data on climate change, researchers report that about 85% of people have felt its effects, according toresults published Monday in Nature Climate Change.To come to this conclusion, scientists fed published summaries of more than 100,000 studies on climate change into a computer trained to identify key information. The computer mapped that information onto a global grid of data on local temperature and precipitation changes that are linked to human activity.The maps show where these precipitation and temperature shifts -- both of which are measures of buy viagra or cialis online climate change -- were likely connected to climate-related outcomes such as drought, floods, fires, and even human health.The results suggest that 80% of the Earth’s land, not including Antarctica, is experiencing climate change because of human activity -- at least in part.

Almost all the temperature shifts are toward warming, though precipitation changes are mixed, with increases in some areas and declines in others.Compared with low-income countries, high-income countries had about double the amount of solid evidence for the human factor in climate change, the researchers found. That said, one possible explanation for why the roughly 20% of land mass where human-induced effects were seemingly weaker -- like in buy viagra or cialis online western Africa and some parts of Asia -- is that these areas have been less scrutinized by scientists, the study authors said.TUESDAY, Oct. 12, 2021 (HealthDay News) -- How do men and women respond to a crisis?.

A look at their behavior during the first erectile dysfunction treatment lockdown buy viagra or cialis online in 2020 offers a clue. Women flocked to their phones for long conversations with a few trusted contacts. Men, chafing at being cooped up, buy viagra or cialis online headed out and about as soon as they could, European researchers report.

"The total shutdown of public life was like a population-wide live experiment," said researcher Tobias Reisch of Complexity Science Hub Vienna (CSH). "We were interested buy viagra or cialis online in the extent to which people supported the anti-Corona measures imposed by the government. When we analyzed the data by gender, we found surprisingly strong behavioral differences between men and women." For the study, CSH looked at mobile phone data from 1.2 million Austrians.

The records revealed that people made much longer phone calls after the lockdown was imposed. "Interestingly, they talked to fewer buy viagra or cialis online people than usual — but with these few, they spoke longer," Reisch said. After Austria locked down on March 16, 2020, women-to-women calls were up to 1.5 times longer than before, and calls from men to women were nearly twice as long as before.

When women called men, they buy viagra or cialis online talked 80% longer, while the length of calls between men rose by 66%, the findings showed. Researcher Georg Heiler said, "Of course, we don't know the content or purpose of these calls. Yet, literature from the social sciences provides evidence — mostly buy viagra or cialis online from small surveys, polls, or interviews -- that women tend to choose more active strategies to cope with stress, such as talking with others.

Our study would confirm that." The researchers also found that differences in mobility between men and women before the lockdown were amplified during the lockdown, with women limiting trips outside their home more and for longer than men. Men flocked to a large recreational area buy viagra or cialis online in Vienna and a shopping mall during the lockdown, phone data showed. And once restrictions were lifted, they returned to their usual pre-viagra habits.

On the one hand, the authors said their study offers support for research in psychology and the social sciences — including a look at new questions from data evaluations.You can’t see, smell, or taste them, but they’re in hundreds of consumer products you use every buy viagra or cialis online day. They’re also in the food you eat. Phthalates (pronounced THAL-ates) are chemicals that make plastic soft and flexible.Phthalates are even in your body.

Nearly all Americans buy viagra or cialis online have phthalate byproducts in their urine, says Ami Zota, associate professor of environmental and occupational health at George Washington University.But are phthalates bad for you?. Here’s what we know about their links to health.What Products Are Phthalates Found In?. You can find them in things like:Cosmetics buy viagra or cialis online and personal care products such as perfume, nail polish, hair spray, soap, shampoo, and skin moisturizersMedical tubing and fluid bagsWood finishesDetergentsAdhesivesPlastic plumbing pipesLubricantsSolventsInsecticidesBuilding materialsVinyl flooringShower curtainsWhat Foods Are High in Phthalates?.

Foods linked to higher phthalate levels include:Restaurant, cafeteria, and fast foodsHigh-fat dairyFatty meats and pouyCooking oilsHow Do Phthalates Get Into My Body?. You get them by:Eating or drinking things served or packaged in plastic that buy viagra or cialis online has phthalatesEating or drinking dairy and meat products from animals that have been exposedUsing cosmetics, shampoo, skin moisturizers, and other personal care productsHaving contact with dust in rooms where the carpet, upholstery, wall coverings, or wood finishes have phthalatesYou might be more likely to get exposed if you:Work in painting, printing, or plastics processingHave a medical condition like kidney disease or hemophilia. Kidney dialysis and blood transfusions often use IV tubing and other supplies made with phthalates.What Does the Research Say?.

We’re still learning buy viagra or cialis online about how phthalates affect us. At this point, more studies have been done on animals than on people.One study links high levels of phthalate exposure to early death in older people.The researchers looked at data on more than 5,000 adults in the U.S. They found buy viagra or cialis online that those between 55 and 64 years old with the highest levels of phthalates in their urine were more likely to die of heart disease than those with lower levels.

People in the high-exposure group were also likelier to die of any cause. But high concentrations of phthalates didn’t seem to raise the chances of dying from cancer. The researchers say their findings suggest that daily contact with phthalates may lead to the early deaths of about 100,000 older Americans a year, costing the country an buy viagra or cialis online estimated $40 billion to $47 billion in lost economic productivity each year.But the study only suggests a link between phthalates and dying early.

It doesn’t prove cause and effect. More research is needed to confirm the findings and shed more light on the link, including how buy viagra or cialis online exactly these chemicals might lead to premature death. Other research doesn’t always address the ways phthalates and other chemicals affect each other.It’s not just one phthalate that might cause a problem.

The chemicals in products and food buy viagra or cialis online work together in combination.How Do Phthalates Affect Humans?. New research areas are expanding our understanding. The link between phthalates and surging buy viagra or cialis online rates of chronic disease is one example.

Other studies have focused on people who are more sensitive to chemicals than others.Phthalates affect different groups of people in different ways:Unborn babies and children are among the most affected. Phthalates can do more harm to males.Kids in puberty are also at risk buy viagra or cialis online. Times when our bodies are changing seem to leave us more vulnerable, Zota says.Adult women have more side effects than men, possibly because they use more personal care products.Are Phthalates Safe?.

There’s no simple buy viagra or cialis online answer. Phthalates aren’t a single chemical. They’re an entire family of them.

And like most families, they don’t all behave the same way.Three of them -- buy viagra or cialis online BBP, DBP, and DEHP -- are permanently banned from toys and products intended to help children under 3 sleep, eat, teethe, or suck.DBP and DEHP damage the reproductive systems of lab rats, especially males. Tests on people show DBP can irritate skin. We’re not sure if BBP causes cancer buy viagra or cialis online in people, but research shows it may have caused cancer in lab rats.

DEHP is confirmed to cause cancer in animals, and expected, but not confirmed, in people. It also causes developmental problems in animals, but it hasn’t been shown to affect people the same way.Three more -- DiDP, DINP, and DnOP -- are under an interim ban from toys that can go into a child’s mouth.DiDP can make your buy viagra or cialis online eyes and skin red or cause nausea, dizziness, and vomiting. DINP causes tumors and developmental problems in lab rats.

In 2014, California added it to its list buy viagra or cialis online of chemicals known to cause cancer. But it hasn’t been proven to cause cancer in people. DnOP was linked to endometriosis in women and caused problems in reproductive buy viagra or cialis online development in rats.

It can irritate the skin in both people and animals. Phthalate levels in people are changing. Some are buy viagra or cialis online going up.

Others are on their way down.DBP, BBP, and DEHP have declined in recent years. They’re now below the amounts considered unsafe by federal health agencies buy viagra or cialis online. But exposure to replacement phthalates likes DINP, DnOP, and DIDP is higher.How Can I Protect Myself?.

Our bodies buy viagra or cialis online have a natural detoxifying system. Your best bet is to avoid phthalates as much as possible. Here’s how to start:Read product labels.

Phthalates aren’t always included on labels, especially with personal care products and vinyl or plastic toys. When they are identified, it’s usually with an acronym like DHEP or DiBP.When you can, choose items labeled “phthalate-free.”Use only “microwave safe” and phthalate-free containers and plastic wrap -- especially with oily or fatty foods.Watch what you eat. Studies show that diets high in dairy and meat bring high levels of phthalate exposure.Avoid fast food.

Zota and other researchers have found that fast food containers can be a source of harmful exposure.Ask for phthalate-free medical devices if you are on kidney dialysis or receive a blood transfusion..

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One in five Best site to buy propecia online Australian women have experienced male viagra sexual assault. Recent research has suggested the trauma may lead to cognitive decline.Sexual assault in Australia is all too common, with 20 percent of women reporting sexual assault or threat since they were 15, according to the Australian Bureau male viagra of Statistics. Given so many sexual assaults go unreported, this number is likely much larger.This experience can impact survivors in male viagra more ways than one. In addition to the immediate physical trauma that may occur, the psychological impact can cause sleeplessness, flashbacks, a feeling of being ‘unclean’, or an overwhelming sense of being unsafe, to name but a few.But a new study, from the male viagra University of Pittsburg, has suggested the damage goes even further, leading to the kind of brain damage that causes cognitive decline, dementia, and stroke.Like what you see?.

Sign up to our bodyandsoul.com.au newsletter for more stories like this.145 women with an average age of 59, with no history of cardiovascular disease, stroke, or dementia were recruited for the male viagra study. 68 percent of participants had experienced trauma and for 23 percent of the women, that trauma was either childhood or adult sexual abuse.Using magnetic resonance imaging (MRI) researchers found women with a history of sexual assault have greater white matter hyperintensities (WMH) in the brain, which indicates small vessel disease that has been linked to cognitive decline, stroke, dementia, and mortality.WMHs show up as small, white spots on MRIs and they’re markers of disruptions of blood flow that have left damage in the brain.“A trauma history, particularly sexual assault, was associated with greater WMH volume controlling for covariates, including depressive and post-traumatic symptoms,” the research paper, titled Sexual Assault and White Matter Hyperintensities Among Midlife Women, contended.“Sexual assault may place women at risk for poor brain health.”It follows on from male viagra previous research by the lead study author, Rebecca Thurston, a professor and director of the Women's Biobehavioral Health Laboratory at the University of Pittsburgh's Graduate School of Public Health.In 2018, Prof. Thurston found women who’ve reported prior sexual assault were three times more likely to experience depression and twice as likely to experience anxiety and insomnia more than male viagra women without a history of sexual trauma."It's almost like your body has a memory that may not be fully manifesting through psychological symptoms,” Prof. Thurston told CNN.“The male viagra sexual assault also leaves footprints of the trauma in our brains and our bodies."Any products featured in this article are selected by our editors, who don’t play favourites.

If you buy something, male viagra we may get a cut of the sale. Learn more.Case numbers may male viagra be dropping, but erectile dysfunction treatment remains a threat. As we move into pollen and allergy male viagra season, it can be difficult to differentiate between the two.You’re talking a walk outside (within your permitted radius, of course), when something tickles your nose. You sneeze and look around, a bit male viagra panicked.

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One in five Australian women have experienced sexual buy viagra or cialis online assault. Recent research has suggested the trauma may lead to cognitive decline.Sexual assault in Australia is buy viagra or cialis online all too common, with 20 percent of women reporting sexual assault or threat since they were 15, according to the Australian Bureau of Statistics. Given so many sexual assaults buy viagra or cialis online go unreported, this number is likely much larger.This experience can impact survivors in more ways than one. In addition to the immediate physical trauma that may occur, the psychological impact can cause sleeplessness, flashbacks, a buy viagra or cialis online feeling of being ‘unclean’, or an overwhelming sense of being unsafe, to name but a few.But a new study, from the University of Pittsburg, has suggested the damage goes even further, leading to the kind of brain damage that causes cognitive decline, dementia, and stroke.Like what you see?.

Sign up to our bodyandsoul.com.au newsletter for more stories like this.145 buy viagra or cialis online women with an average age of 59, with no history of cardiovascular disease, stroke, or dementia were recruited for the study. 68 percent of participants had experienced trauma and for 23 percent of the women, that trauma was either childhood or adult sexual abuse.Using magnetic resonance imaging (MRI) researchers found women with a history of sexual assault have greater white buy viagra or cialis online matter hyperintensities (WMH) in the brain, which indicates small vessel disease that has been linked to cognitive decline, stroke, dementia, and mortality.WMHs show up as small, white spots on MRIs and they’re markers of disruptions of blood flow that have left damage in the brain.“A trauma history, particularly sexual assault, was associated with greater WMH volume controlling for covariates, including depressive and post-traumatic symptoms,” the research paper, titled Sexual Assault and White Matter Hyperintensities Among Midlife Women, contended.“Sexual assault may place women at risk for poor brain health.”It follows on from previous research by the lead study author, Rebecca Thurston, a professor and director of the Women's Biobehavioral Health Laboratory at the University of Pittsburgh's Graduate School of Public Health.In 2018, Prof. Thurston found women who’ve reported prior sexual assault were three times more likely to experience depression and twice as likely to experience anxiety and insomnia more than women without a history of sexual trauma."It's almost like your body has a memory that may not be fully buy viagra or cialis online manifesting through psychological symptoms,” Prof. Thurston told buy viagra or cialis online CNN.“The sexual assault also leaves footprints of the trauma in our brains and our bodies."Any products featured in this article are selected by our editors, who don’t play favourites.

If you buy buy viagra or cialis online something, we may get a cut of the sale. Learn more.Case numbers may be dropping, but erectile dysfunction treatment buy viagra or cialis online remains a threat. As we move into pollen and allergy season, buy viagra or cialis online it can be difficult to differentiate between the two.You’re talking a walk outside (within your permitted radius, of course), when something tickles your nose. You sneeze and look buy viagra or cialis online around, a bit panicked.

You know erectile dysfunction treatment is still out there, and the delta variant is so much more contagious than the original strain of the viagra.But spring and pollen season are also upon us, so it can be difficult to know whether your sneeze, cough, or headaches are seasonal allergies or a potentially deadly viagra.“Most people with buy viagra or cialis online hayfever have a history of allergic reactions and are well versed in recognising those symptoms,” explains Dr. Andrew Thompson, a registered doctor at InstantScripts.Like buy viagra or cialis online what you see?. Sign up to our bodyandsoul.com.au newsletter for more stories like this.“However, these symptoms can mimic buy viagra or cialis online an upper respiratory and it is impossible for us to say for certain whether or not your symptoms are due to erectile dysfunction treatment or not.”Dr. Thompson is seeing a significant increase in patients reporting respiratory and erectile dysfunction-like symptoms—up 149 percent from 2020.Even though erectile dysfunction treatment is the talking point of the day, it’s still possible to contract other viral or bacterial s, as well as allergies that are commonly agitated at this time of year.“Not only is the Delta strain more infectious, but the symptoms are now more commonly aligned with common viral s and your run-of-the-mill cold,” he says.“With the highly infectious nature of Delta and its often-indistinguishable characteristics to common viral s, some Aussies may buy viagra or cialis online be going days without seeking a test and could naturally assume they are simply experiencing a cold or flu.”But anosmia, aka a loss of taste and/or smell, is unique to erectile dysfunction treatment.“My advice would be that if you are in an area with local cases of erectile dysfunction treatment and are experiencing symptoms that are not in keeping with your usual allergies, or are not responding to your usual therapies, then you should get a erectile dysfunction treatment test,” he says.“At worst, this will put your mind at ease.”Here are the commonly reported symptoms of erectile dysfunction treatment:FeverThis is one of the most common erectile dysfunction treatment symptoms and often the first sign of erectile dysfunction treatment – while the flu typically begins with a cough, the first symptom of erectile dysfunction treatment is often fever.

A temperature of 37.5C or higher may warrant a erectile dysfunction treatment test.Lingering coughPersistent coughing buy viagra or cialis online is another common erectile dysfunction treatment symptom that Aussies should look out for.Shortness of breathThis symptom isn’t typically associated with the common cold or flu. However, it is known buy viagra or cialis online to be a common erectile dysfunction treatment symptom.Runny noseWhile not as common in earlier strains of erectile dysfunction treatment, a runny nose is commonly associated with the Delta strain, which has been estimated to be 50 percent more infectious.Temporary loss of taste or smellAnother symptom unique to erectile dysfunction treatment, a study found that loss of taste or smell can sometimes appear before the emergence of other symptoms.Muscle, joint or chest painThese symptoms have been known to manifest after people experience a fever or cough.HeadachesA symptom commonly associated with several strains of erectile dysfunction treatment, including the Delta variant.Nausea, vomiting or diarrheaThese symptoms can sometimes arise after respiratory symptoms such as fever and cough and can point to a erectile dysfunction treatment .Any products featured in this article are selected by our editors, who don’t play favourites. If you buy something, we buy viagra or cialis online may get a cut of the sale. Learn more..

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