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Potential targets and strategies for mesothelioma therapy that have been proposed based on recent studies blood pressure vitamin d buy 2 mg aceon otc. In summary blood pressure chart age 40 generic aceon 2 mg without a prescription, molecular therapies have not affected the average survival of mesothelioma patients blood pressure of 14090 buy aceon 4 mg, although in several trials 5% to 10% of the patients responded and experienced prolonged survival. Investigators in clinical trials normally look at averages, and therefore no significant benefit can be detected for any therapy when the benefit occurs in only a small fraction of patients. Thus, the challenge ahead of us is to identify the subset of patients who will respond to a given type of therapy. Targeting asbestos-induced inflammation to prevent or treat mesothelioma Chronic inflammation has been associated with an increased risk of developing numerous types of cancer. In this regard, daily treatment with aspirin for 5 years was shown to reduce tumor burden in several common malignancies (55), and results from animal experiments support a beneficial role for anti-inflammatory therapies in mesothelioma (56). Thus, we hypothesize that prolonged aspirin treatment may help reduce the incidence of mesothelioma and other asbestos-related malignancies among high-risk cohorts with either a lengthy history of exposure and/or genetic predisposition. Food and Drug Administration­approved reagents that inhibit these molecules are available. Glyburide, the most widely used sulfonylurea drug for type 2 diabetes in the United States, inhibits the Nalp3 inflammasome (60). Early detection of mesothelioma is associated with improved clinical outcomes (1). Conclusions Because the latency period from initial asbestos or erionite exposure to disease progression is often decades long (1), novel therapies that prevent or delay carcinogenesis in exposed individuals could lead to a substantial decrease in mesothelioma mortality. In light of our recent increased understanding that asbestos carcinogenesis is linked to chronic inflammation, we can design multiple strategies to target inflammation in asbestos- and erionite-exposed individuals. Clinical and translational research focusing on such strategies has the potential to reduce the impact of the carcinogenic effect of asbestos and erionite exposure. Strategies that seek to prevent carcinogenesis in asbestos/erionite-exposed, high-risk individuals would have the most wide-reaching impact on the incidence of this deadly cancer. Disclosure of Potential Conflicts of Interest No potential conflicts of interest were disclosed. Received September 15, 2011; revised October 18, 2011; accepted October 20, 2011; published OnlineFirst November 7, 2011. A mesothelioma epidemic in Cappadocia: scientific developments and unexpected social outcomes. Relative mesothelioma induction in rats by mineral fibers: comparison with residual pulmonary mineral fiber number and epidemiology. Unusually high incidence of malignant pleural mesothelioma in a town of eastern Sicily: an epidemiological and environmental study. Pleural mesothelioma in New Caledonia: associations with environmental risk factors. Residential proximity to naturally occurring asbestos and mesothelioma risk in California. Specificity of asbestos-induced chromosomal aberrations in short-term cultured human mesothelial cells. Asbestos fibers and interleukin-1 upregulate the formation of reactive nitrogen species in rat pleural mesothelial cells. Asbestos, lung cancers, and mesotheliomas: from molecular approaches to targeting tumor survival pathways. Jongsma J, van Montfort E, Vooijs M, Zevenhoven J, Krimpenfort P, van der Valk M, et al. Interleukin-1beta and tumour necrosis factor-alpha promote the transformation of human immortalised mesothelial cells by erionite. The inflammasome: a caspase-1-activation platform that regulates immune responses and disease pathogenesis. Programmed necrosis induced by asbestos in human mesothelial cells causes high-mobility group box 1 protein release and resultant inflammation. Innate immune activation through Nalp3 inflammasome sensing of asbestos and silica. Targeting the Wnt signaling pathway with dishevelled and cisplatin synergistically suppresses mesothelioma cell growth. Vascular endothelial growth factor is an autocrine growth factor in human malignant mesothelioma.

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This panel tells us that the majority Of respondents had sex with 2 or more Other men in the past twelve months arteria hepatica propria generic 4 mg aceon with amex. Unprotected anal sex amongst those in regular relationships was high (2 blood pressure chart seniors buy 4 mg aceon amex,455 of 3 arrhythmia vs heart attack order 4 mg aceon with visa,556 in a current relationship did not use condoms consistently) ­ a cause for concern when either or both partners were also having unprotected anal sex with casual partners (816 of 3,556). Many who have never been tested, or tested recently continued to have unprotected anal sex with casual partners (684 of 7,993). Sessions that will be delivered during Module Five Key learning outcomes of Module Five. Try to bring out the experience of the people in the room who are currently managing programmes. There are more detailed resources available for participants who want to further explore this area. It involves: scanning the political and cultural environment; anticipating problems before they emerge; finding opportunities for leaders to speak out in support of the programme: writing speeches and briefing materials; and providing oral or written briefings by your team or key informants on key issues. Ensure that implementing partners have: ­ ­ ­ ­ Establish clear and current contracts Published standards of care and programme implementation Regular monitoring and capacity development; and Effective information management systems. Religious and community leaders: Religious leaders of many different religions will speak out against the programme. Hold seminars and briefings to find ways to work with religious leaders to increase the range of messages that are being promoted. Police and public security: Sex between men is illegal with severe penalties in many countries. Programme managers need to negotiate with police at senior and local levels to reduce police resistance to their work. To last the distance, programme managers will need stamina, good health and well-being, and ways to protect themselves from burnout and stress. Back up essential program data and protect it with passwords or encryption if possible. Look after you physical health ­ get regular exercise, eat well, get proper sleep, minimize alcohol and drug use. Establish routines that support health ­ think ahead ­ be in control of how you spend your time. Lead by example ­ do what your programmes say in relation to safer sex, drug and alcohol use, manage people with respect. Take them through some of the competencies (meaning the skill or capacity that you need to have to do your job well). People need to be aware of this so that they can see where their strengths and weaknesses are. Divide the participants into four groups ­ mix them up so that they meet and work with new people. Tasks: (have these printed out so that each group has a copy of what it is expected to do). Meet with the panel the day before to brief them and ask them to prepare a 5­10 minute informal presentation. Facilitate the panel discussion like a talk show ­ ask questions, challenge them and try to make it light and humorous. Then facilitate the panel discussion like a talk show ­ ask questions, challenge them, and try to make it light and humorous, as well as serious. Follow the panel with general discussion ­ try to draw out the main points ­ have someone record them on the whiteboard. You can choose and highlight issues that have been raised by the panel, or mention issues that did not come up. Get organized Have a good filing system Document meetings/agreements Back up essential program data Take breaks Look after your physical health Establish routines that support health Lead by example Get regular support and supervision. Guest presenters from among participants 14 "The Time Has Come" 309 "The Time Has Come" Notes: 310 "The Time Has Come" Module 5 Programme management Annexes "The Time Has Come" 311 Annexes Annex 1: Hippocratic oath I do solemnly vow, to that which I value and hold most dear: That I will honor the Profession of Medicine, be just and generous to its members, and help sustain them in their service to humanity; That just as I have learned from those who preceded me, so will I instruct those who follow me in the science and the art of medicine; That I will recognize the limits of my knowledge and pursue lifelong learning to better care for the sick and to prevent illness; That I will seek the counsel of others when they are more expert so as to fulfill my obligation to those who are entrusted to my care; That I will not withdraw from my patients in their time of need; That I will lead my life and practice my art with integrity and honor, using my power wisely; That whatsoever I shall see or hear of the lives of my patients that is not fitting to be spoken, I will keep in confidence; That into whatever house I shall enter, it shall be for the good of the sick; That I will maintain this sacred trust, holding myself far aloof from wrong, from corrupting, from the tempting of others to vice; That above all else I will serve the highest interests of my patients through the practice of my science and my art; That I will be an advocate for patients in need and strive for justice in the care of the sick. I now turn to my calling, promising to preserve its finest traditions, with the reward of a long experience in the joy of healing. It provides a brief summary of each of the materials and their key elements as well as guidance on the likely usefulness to participants in relevant training courses.

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Studies on blood donors were included arrhythmia jantung purchase aceon 2mg with amex, but studies on healthcare workers were excluded blood pressure khan academy buy 8mg aceon with amex. Secondarily heart attack in spanish purchase 4mg aceon with amex, results from national studies were also examined from preliminary press releases and reports whenever a country had no other data presented in full papers of preprints. Results 36 studies (43 estimates) were identified with usable data to enter into calculations and another 7 preliminary national estimates were also considered for a total of 50 estimates. Estimates of infection fatality rates inferred from seroprevalence studies tend to be much lower than original speculations made in the early days of the pandemic. Other mathematical models suggested that 40-70%,4 or even5 81% of the global population would be infected. The most influential of these models, constructed by Imperial College estimated 2. Since late March 2020, many studies have tried to estimate the extend of spread of the virus in various locations by evaluating the seroprevalence, i. These studies can be useful because they may 240 medRxiv preprint doi: doi. At the same time, seroprevalence studies may have several caveats in their design, conduct, and analysis that may affect their results and their interpretation. Only studies with at least 500 assessed samples were considered, since smaller datasets would entail extremely large uncertainty for any calculations to be based on them. When studies focused on making seroprevalence assessments at different time interval, they were eligible if at least one time interval assessment had a sample size of at least 500 participants; among different eligible time points, the one with the highest seroprevalence was selected, since seroprevalence may decrease over time as antibody titers wane. Studies with data collected over more than a month, and that could not be broken into at least one eligible time interval that did not exceed one month in duration were excluded, since it would not be possible to estimate a point seroprevalence with any reliability. Studies were eligible regardless of the exact age range of included participants, but studies including only children were excluded. Studies where results were only released through press releases were not considered here, since it is very difficult to tell much about their design and analysis, and this is fundamental in making any inferences based on their results. Nevertheless, secondarily, results from national studies were also examined from preliminary press releases and reports whenever a country had no other data presented in full papers of preprints as of July 11, 2020. This allowed these countries to be represented in the collected data, but extra caution is required given the preliminary nature of this information. Preprints should also be seen with caution since they have not been yet fully peer-reviewed (although some of them have already been revised based on very extensive comments from the scientific community). However, in contrast to press releases, preprints typically offer at least a fairly complete paper with information about design and analysis. Studies were eligible regardless of whether they aimed to evaluate seroprevalence in large or small regions, provided that the population of reference in the region was at least 5000 people. Communication with colleagues who are field experts sought to ascertain if any major studies might have been missed. Information was extracted from each study on location, recruitment and sampling strategy, dates of sample collection, sample size, types of antibody used (IgG, IgM, IgA), estimated crude 242 medRxiv preprint doi: doi. Whenever it was missing, it was derived based on recent census data trying to approximate as much as possible the relevant catchment area. For consistency, the entire population, as well as, separately, only the population with age <70 years were used for estimating the number of infected people. It was assumed that the seroprevalence would be similar in different age groups, but significant differences in seroprevalence according to age strata that had been noted by the original authors were also recorded to examine the validity of this assumption. The number of infected people was calculated multiplying the relevant population with the adjusted estimate of seroprevalence. Whenever an adjusted seroprevalence estimate had not been obtained, the unadjusted seroprevalence was used instead. When seroprevalence estimates with different adjustments were available, the analysis with maximal adjustment was selected. If the choice of date had not been done by the authors, the number of deaths accumulated until after 1 week of the mid-point of the study period was chosen. This accounts for the differential delay in developing antibodies versus dying from the infection.

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This also applies to heart attack vol 1 pt 15 buy aceon 4 mg fast delivery any unwanted sexual behavior pulse pressure 53 2mg aceon fast delivery, verbal or otherwise hypertension nursing interventions order aceon 8mg mastercard, that results in the termination of employment. Revealing a privileged communication from or relating to a former or current patient, except when otherwise required or permitted by law. Knowingly engaging or assisting any person to engage in, or otherwise participating in, abusive or fraudulent billing practices, including violations of federal Medicare and Medicaid laws or state medical assistance laws. Improper management of patient records, including failure to maintain adequate patient records or to furnish a patient record or report required by law; or making, causing, or permitting anyone to make false, deceptive, or misleading entry in any patient record. Violating a rule adopted by any state board with competent jurisdiction, an order of such board, or state or federal law relating to the practice of radiologic technology, or any other medical or allied health professions, or a state or federal narcotics or controlledsubstance law. Knowingly providing false or misleading information that is directly related to the care of a former or current patient. Failing to immediately report to his or her supervisor information concerning an error made in connection with imaging, treating, or caring for a patient. For purposes of this rule, errors include any departure from the standard of care that reasonably may be considered to be potentially harmful, unethical, or improper (commission). The duty to report under this rule exists whether or not the patient suffered any injury. Situations can occur that make us wonder what is the "right" thing to do-situations that require us to make ethical decisions. The Standards of Ethics provides guidelines for making these very important decisions; the decision we make can impact our entire professional career. Radiographers, like all health care providers, must have the moral character required to practice in the health care professions. If their actions demonstrate that moral character is lacking, that individual can be sanctioned. The sanction can be in the form of a reprimand, a suspension of registration, revocation of registration, ineligibility for certification, or other sanctions deemed appropriate by the Ethics Committee. For example, if you become aware that one of your coworkers is in violation of one of the Rules of Ethics, what must you do? The Ethics Committee will conduct a peer review of the case and make a determination regarding possible sanction. One important consideration will be if the actions were job related and could present a risk to the welfare of the patient. Most health care facilities require that examination requests include pertinent diagnostic information and any infection control or isolation information. Negligence litigation in radiology most frequently involves injuries from falls, positioning injuries, pregnancy, errors or delays in diagnosis. Describe an Advance Health Care Directive and possible elements that it might address; what is its purpose (p. Identify the kinds of clarification that may be required prior to starting the examination (p. The threat to do harm is referred to as: (A) assault (B) battery (C) slander (D) libel 5. A radiographer who discloses confidential information to unauthorized individuals may be found liable for: (A) assault (B) battery (C) intimidation (D) defamation 6. What organization has the authority to impose professional sanction on a radiographer? Last Will and Testament (A) 1 only (B) 1 and 2 only (C) 2 and 3 only (D) 1, 2, and 3 9. If the patient lacks decision-making capacity, their rights can be exercised on their behalf by: 1. The Standards provide a legal role definition and identify Clinical, Quality, and Professional Standards of practice-each Standard has its own rationale and identifies general and specific criteria related to that Standard. A patient may feel sufficiently intimidated to claim assault by a radiographer who threatens to repeat a difficult examination if the patient does not try to cooperate better. A radiographer who discloses confidential information to unauthorized individuals may be found liable for invasion of privacy or defamation. A radiographer whose disclosure of confidential information is in some way detrimental to the patient may be accused of defamation. The 10-part Code of Ethics is aspirational; the 22 Rules of Ethics are enforceable and violation can result in professional sanction. Many people believe that potential legal and ethical issues can be avoided by creating an Advance Health Care Directive or Living Will.

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A number of commenters proposed modifications related to heart attack american buy generic aceon 4 mg on line training that commenters believed would improve implementation of this provision and promote objectivity and competence blood pressure 60 year old cheap aceon 8 mg line, such as training about applying rules of evidence blood pressure 10070 discount aceon 2mg without prescription, how to collect and evaluate evidence, and how to determine if evidence is credible, relevant, or reliable. Many commenters suggested types of evidence that should be considered, specific investigative processes, or other evidentiary requirements. Commenters proposed, for example, that the final regulations should require consideration of letters, videos, photos, e-mails, texts, phone calls, social media, mental health history, drug, alcohol, and medication use, and rape kits. Commenters also proposed requiring a variety of investigative techniques, including asking the Department to require recipients to take immediate action to collect and test all evidence, including permitting recipients to interview community members and other witnesses. Some commenters asked whether the proposed rules would allow respondents to introduce lie detector test results and impact statements. Some commenters wanted the final regulations to require investigators to identify any data gaps in investigative report noting unavailable information. Other commenters asserted that the final regulations should require all evidence to be shared with the parties to ensure fairness, and that an investigator should not get to decide what is relevant. Commenters requested that the Department clarify how to evaluate whether evidence is relevant. Commenters asked how recipients should make credibility determinations, and whether it would be permissible to admit character and reputation evidence, including past sexual history or testimony based on hearsay. Some commenters suggested specific modifications to the wording of the proposed provision. One commenter asserted that underweighting relevant testimony simply because someone is a friend to a party in a case will make it materially harder to prove an assault and will not promote equitable treatment for all parties; this commenter mistakenly believed that the proposed rules used the phrase "arbiters should underweight character feedback from biased witnesses" and wanted that language changed. The Department understands that in some situations, there may be little or no evidence other than the statements of the parties themselves, and this provision applies to those situations. This provision does not require "objective" evidence (as in, corroborating evidence); this provision requires that the 808 recipient objectively evaluate the relevant evidence that is available in a particular case. The Department disagrees that this provision could permit endlessly delayed proceedings while parties or the recipient search for "all" relevant evidence; § 106. A process that permitted credibility inferences or conclusions to be based on party status would inevitably prejudge the facts at issue rather than determine facts based on the objective evaluation of evidence, and this would decrease the likelihood that the outcome reached would be accurate. Treating the respondent as not responsible until the conclusion of the grievance process does not mean considering the respondent truthful or credible; rather, that presumption buttresses the requirement that investigators and decisionmakers serve impartially without prejudging the facts at issue. Both the presumption of non-responsibility and this provision are designed to promote a fair process by which an impartial fact-finder determines whether the respondent is responsible for perpetrating sexual harassment. Every determination regarding responsibility must be based on evidence, not assumptions about respondents or complainants. The Department disagrees that disregarding party status poses problems for investigators or adjudicators or directs them to ignore central factors in reaching credibility determinations. For example, a recipient may not adopt a rule excluding relevant evidence because such relevant evidence may be unduly prejudicial, concern prior bad acts, or constitute character evidence. A recipient may adopt rules of order or decorum to forbid badgering a witness, and may fairly deem repetition of the same question to be irrelevant. Similarly, the Department is not persuaded that the final regulations permit inappropriate subjectivity as to defining bias or constitute overreach into campus administrative proceedings. The Department notes that the universe of evidence given to the parties for inspection and review under § 106. This does not preclude, for instance, a recipient adopting a rule or providing training to a decision-maker regarding how to assign weight to a given type of relevant evidence, so long as such a rule applies equally to both parties. To the extent that the commenter was arguing that prohibiting bias is itself an overreach into campus administrative decisions, the Department does not agree. Biased decision making increases the risk of erroneous outcomes because bias, rather than evidence, dictates the conclusion. Sex-based bias is a specific risk in the context of sexual harassment allegations, where the underlying conduct at issue inherently raises issues related to sex, making these proceedings susceptible to improper sex-based bias that prevents reliable outcomes. Whether or not the determination regarding responsibility is made by a single decision-maker or by multiple decision-makers serving as a hearing board, § 106. Prior to the time that a determination regarding responsibility will be reached, § 106. The Department disagrees that an investigator should not get to decide what is relevant, and the final regulations give the parties ample opportunity to challenge relevancy determinations. The parties may then inspect and review the 814 evidence directly related to the allegations.

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This disrespects the truth of their lives for the sake of a binary conception of sexual orientation xylitol hypertension buy cheap aceon 4mg. It also makes it more difficult for bisexuals just coming out to blood pressure is lowest in quality 8 mg aceon find role models hypertension benign essential cheap aceon 8mg with amex. In just one example, it was a bi woman, Brenda Howard, who organized the one-month anniversary rally in honor of the Stonewall uprising (which in turn was led by transsexuals and drag queens). Even when an organization is inclusive, the press and public officials often fall back on the "safety" of saying just "gay and lesbian. In a 2010 court case, three San Francisco softball players filed a lawsuit alleging they were disqualified from the 2008 Gay Softball World Series for being bisexual (see sidebar). Bisexual Invisibility: Impacts and Recommendations 5 San Francisco Human Rights Commission positive atmosphere at Hastings for lesbian, gay, bisexual, transgendered, intersex, asexual, two-spirit, and queer students and their allies. District Court for the western district of Washington on behalf of three bisexual softball players from San Francisco. Their team, D2, had been playing together in the San Francisco Gay Softball League for years. In 2008, they had practiced more than ever in the hopes of winning the World Series, and they made it all the way to the championship game. During the championship, D2 learned that another team challenged their eligibility to play based on a tournament rule that each team could have no more than two straight players. The players were forced to answer whether they were "predominantly attracted to men" or "predominantly attracted to women," without the option of answering that they were attracted to both. The committee also declared that the other two players, both white-one of whom had given precisely the same answers as Russ-were gay. The committee recommended disciplinary measures against Apilado, Charles, and Russ, their team, and the San Francisco Gay Softball League, including forcing their team, D2, to retroactively forfeit their second-place World Series win. This had me angry, had me in tears, contemplating whether I even want to be part of the league anymore after being in it since 1999. We believe that team sports can offer opportunities for personal enrichment, and a sense of community that is not available otherwise. It is not unlike other groups whom [sic] choose to organize around a commonality such as the Black American Softball Assoc. Our group recognizes that in the arena of team sports, homophobia is still all too common. Almost daily it seems, one hears or reads of another gay bashing, often resulting in fatal outcomes. These tragedies serve as a reminder of our mission to provide a safe place for Gay/Lesbian [sic] players to enjoy competition while not compromising their true identity. The bi community served as a kind of refuge for people who felt excluded from the established lesbian and gay communities. This was especially important when both groups lobbied gay and lesbian groups for more inclusion of their issues. By February 1994, the Commission had voted to change the name to the Lesbian Gay Bisexual Transgender Advisory Committee, and in May 1994, held a public hearing on discrimination against transgender people. The recommendations that came out of that hearing paved the way for the Board of Supervisors to pass groundbreaking legislation adding gender identity as a protected category in San Francisco. Other Forms of Biphobia15 Bisexual invisibility is one of many manifestations of biphobia. Others include: Assuming that everyone you meet is either heterosexual or homosexual. Supporting and understanding a bisexual identity for young people because you identified "that way" before you came to your "real" lesbian/gay/heterosexual identity. Automatically assuming romantic couplings of two women are lesbian, or two men are gay, or a man and a woman are heterosexual. Expecting a bisexual to identify as gay or lesbian when coupled with the "same" sex/gender. Expecting a bisexual to identify as heterosexual when coupled with the "opposite" sex/gender.

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I take my role as one of the few physician-legislators in the State of Minnesota very seriously blood pressure 70 over 50 buy aceon 4 mg cheap, and I firmly believe that I have an obligation to arteria buccalis order 2 mg aceon with visa my patients prehypertension effects purchase 8mg aceon free shipping, constituents, and all Minnesotans to use my medical expertise and senate experience to further an understanding of the pandemic situation by "connecting the dots" for citizens and patients who choose to consider a perspective other than what mainstream legacy news sources might choose to provide. While serving as a legislator, I have been criticized and abused via social media, e-mail, voicemails and phone calls. I view the current allegations you are inquiring about as possible attempts by those who wish to discourage me from voicing alternative or contrarian points of view which may call into question certain governmental actions. In the last few months, I have made hundreds of statements and comments on the floor of the Minnesota Senate, in various committee meetings, and in local and regional meetings. To my dismay I have been chastised for not knowing in advance if a hosting media event was conservative or liberal regarding biases ­ I never thought it should matter. It has become more than clear to me that the American political scene has truly become "blood sport. In responding to the two allegations outlined in your letter dated June 22, 2020, my intention is to respond in my own words and also provide attachments to help reveal the rationale informing my perspectives. I do believe these allegations evolved from an emotional and changing intersection of healthcare, public policy, and partisan politics such that information shared two months ago may no longer represent current perspectives. I have found in my last four years of serving in the Minnesota Senate that when people disagree with me politically, there is almost no telling what type of action or retaliation may occur. Response: An allegation of "spreading misinformation" is nebulous and quite broad. But the fact of the matter is that on April 3, 2020 the Minnesota Department of Health emailed information to medical certifiers involved with cause of death certification responsibilities which did advise "physicians, physician assistants, and advanced practice registered nurses who certify deaths to. I believe this represented a significant and noteworthy change 3 172 regarding the recommended practice for death certification which could easily reduce the number of deaths related to heart disease, cancer, stroke, emphysema, etc. Any information, guidance, or publication which had the potential to skew, camouflage, or muddy the waters regarding an actual cause of death needed to be intensely scrutinized, in part because the recorded data in 2020 would shape future public policies which would have immense and lasting impact with potentially devastating unintended consequences. I have completed hundreds of death certificates over the last 40 years, and I vehemently disagree with this advice because it is absolutely contrary to past standard practice, created havoc and perverse incentives, and undermined quality data collection. The issue of laboratory confirmed cases not being segregated from presumed cases presents huge challenges which will require some level of uniformity in coding. The angst caused by such challenging considerations took root throughout the country, and Americans in every state have proven that they are worthy participants in this crucial conversation regarding the determination of death counts which will obviously impact on case fatality rates, comparisons with influenza epidemics, and state and federal funding decisions to help all Americans get through this crisis. At the very least there should have been a conversation about this approach, but this did not occur. I reached out to dozens of physicians experienced in the completion of death certificates, and found no disagreement with my concerns. I suspect many physicians lacking ongoing experience with death certificate completion might see my concerns as more esoteric than real. I have made numerous appearances on local, national, and international television and radio shows. I cannot possibly respond with precision to an allegation that I have provided "reckless advice over social media," as such an allegation is overly broad, and no specific instance of any such "reckless advice" is provided. Further, what someone who disagrees with a viewpoint I have expressed may deem "reckless advice," another may deem quite sensible. Anthony Fauci stated in a New England Journal of Medicine Editorial on March 26, 2020: 6 175 "This suggests that the overall clinical consequences of Covid-19 may ultimately be more akin to those of a severe seasonal influenza (which has a case fatality rate of approximately 0. Michael Osterholm told Beret Leone of Fox 47 Duluth News on March 14, 2020: "Deadly strains of Influenza or the flu have been around for centuries. It still exists today, but modern health experts are discussing what would happen if a new influenza virus showed up today, in world of 8-billion people. I have called into question certain reporting metrics which fail to take into account the context of a given perspective. I have tried to convey a message centering on scientifically established facts and teachings, personal responsibility, and hopefulness. I have recruited numerous persons to scan media and promptly report any concerns to me. As a Senator receiving thousands of inputs every week, I have diligently reached out to many detractors inviting conversation ­ some have accepted, most have not.

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Instead of more than 6 partners per month in 1982 heart attack 8 trailer order aceon 4mg, the average non-monogamous respondent in San Francisco reported having about 4 partners per month in 1984 blood pressure medication urination buy cheap aceon 4mg. Centers for Disease Control has reported an upswing in promiscuity prehypertension remedies generic aceon 4mg line, at least among young homosexual men in San Francisco. From 1994 to 1997, the percentage of homosexual men reporting multiple partners and unprotected anal sex rose from 23. Some advocates argue that the average would be lower if closeted homosexuals were included in the statistics. Men who were associated with the gay community were nearly four times as likely to have had more than 50 sex partners in the six months preceding the survey as men who were not associated with the gay community. Excessive sexual promiscuity results in serious medical consequences-indeed, it is a recipe for transmitting disease and generating an epidemic. According to the San Francisco Chronicle: "Experts believe syphilis is on the rise among gay and bisexual men because they are engaging in unprotected sex with multiple partners, many of whom they met in anonymous situations such as sex clubs, adult bookstores, meetings through the Internet and in bathhouses. The new data will show that in the 93 cases involving gay and bisexual men this year, the group reported having 1,225 sexual partners. Promiscuity among lesbians is less extreme, but it is still higher than among heterosexual women. Physical Health Unhealthy sexual behaviors occur among both heterosexuals and homosexuals. Yet the medical and social science evidence indicate that homosexual behavior is uniformly unhealthy. Although both male and female homosexual practices lead to increases in sexually transmitted diseases, the practices and diseases are sufficiently different that they merit separate discussion. Male Homosexual Behavior Men having sex with other men leads to greater health risks than men having sex with women19 not only because of promiscuity but also because of the nature of sex among men. Mouth-anal contact is the reason for the relatively high 2 A study done in Baltimore and reported in the Health Risks of Gay Sex incidence of diseases caused by bowel pathogens in male homosexuals. Trauma may encourage the entry of micro-organisms and thus lead to primary syphilitic lesions occurring in the anogenital area. In addition to sodomy, trauma may be caused by foreign bodies, including stimulators of various kinds, penile adornments, and prostheses. Rectal insemination of rabbits has shown that sperm impaired the immune defenses of the recipient. The list of diseases found with extraordinary frequency among male homosexual practitioners as a result of anal intercourse is alarming: Anal Cancer Chlamydia trachomatis Cryptosporidium Giardia lamblia Herpes simplex virus Human immunodeficiency virus Human papilloma virus Isospora belli Microsporidia Gonorrhea Viral hepatitis types B & C Syphilis25 Sexual transmission of some of these diseases is so rare in the exclusively heterosexual population as to be virtually unknown. Others, while found among heterosexual and homosexual practitioners, are clearly predominated by those involved in homosexual activity. But in 1999, King County, Washington (Seattle), reported that 85 percent of syphilis cases were among self-identified homosexual practitioners. The rectum is significantly different from the vagina with regard to suitability for penetration by a penis. It is composed of a mucus membrane with a multi-layer stratified squamous epithelium that allows it to endure friction without damage and to resist the immunological actions caused by semen and sperm. In comparison, the anus is a delicate mechanism of small muscles that comprise an "exit-only" passage. With repeated trauma, friction and stretching, the sphincter loses its tone and its ability to maintain a tight seal. Consequently, anal intercourse leads to leakage of fecal material that can easily become chronic. The potential for injury is exacerbated by the fact that the intestine has only a single layer of cells separating it from highly vascular tissue, that is, blood. Therefore, any organisms that are introduced into the rectum have a much easier time establishing a foothold for infection than they would in a vagina. The single layer tissue cannot withstand the friction associated with penile penetration, resulting in traumas that expose both participants to blood, organisms in feces, and a mixing of bodily fluids. In the course of ordi- Corporate Resource Council Anal intercourse also puts men at significant risk for anal cancer.


  • https://www.researchsquare.com/article/rs-3244/v1.pdf
  • https://www.npcnow.org/system/files/research/download/Pain-Current-Understanding-of-Assessment-Management-and-Treatments.pdf
  • http://eknygos.lsmuni.lt/springer/218/263-282.pdf