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We live in unprecedented lasix price times. But what makes them without parallel is not the current lasix crisis nor the continued problems facing minorities in our institutions. Rather, it’s that for lasix price the first time, the problems of accessibility, rights and freedoms are now invading privileged spaces. There can be no ‘getting back to normal’, because ‘normal’ only ever benefited the white, Western, patriarchal, abled and cis ideals. For many, the world is not suddenly on fire lasix price.

It has long been burning.The present lasix lays bare systemic prejudice against the most vulnerable among us. We at Medical Humanities, with our focus on global health and social justice, welcome discussion about how the crisis has disproportionately affected racial and fiscal minorities, those from the disabled community, those who are LGBTQA+ and other vulnerable groups. What we focus on here, now, can lead to greater accessibility and equity lasix price in the future.In this expanded issue, we offer some of the incredible work being done across the field of medical humanities prior to the hypertension medications crisis, and we are already reviewing articles on the role of health humanities during the lasix. The process of academic publishing tends not to lend itself to immediacy, however, and the challenges of lasix means greater pressure on everyone, from the authors to the reviewers and readers.To remedy this, we at Medical Humanities have been increasing the work on our blog platform, a place where content can be quickly updated, and where conversations can occur among readers and writers. We openly invite submissions lasix price concerning the lasix, as well as topics relevant to our wider CFP (call for posts/papers) this year on social justice and health, to both blog and journal.

We will do our best to expedite. Finally, we have also been addressing social justice and access in our podcast, where we interviewed disability activist Alice Wong and most recently Dr Oni Blackstock, primary care physician and HIV specialist in New York. We hope to have many more on these critical lasix price subjects.We wish all of you good health and safety and know that many of you are yet on the front lines. Thank you for being part of the community of Medical Humanities.IntroductionMinecraft is a computer game with no specific goals to accomplish. The gameworld consists of three-dimensional (3D) cubes and objects which the player (Steve) can lasix price mine and build into infinitely complex (and logically impossible) structures.

Steve sometimes encounters other characters (‘mobs’), such as animals and hostile creatures. He can ‘spawn’ and destroy them. While it looks like a harmless game of logical construction, lasix price it conveys some worryingly delusive ideas about the real world. The difference between real and imagined structures is at the heart of the age-old debate around categorising mental disorders.Classification in mental health has had various forms throughout history. Mack and colleagues set out a history of psychiatric classification beginning in 2600 BC lasix price with Egyptian references to melancholia and hysteria.

Through the Ancient Greeks with Hippocrates’ phrenitis, mania, melancholia, epilepsy, hysteria and Scythian disease. Through the Renaissance period. Through to 19th-century psychiatry featuring Pinel (known as the first psychiatrist), Kraepelin (known for observational classification) and Freud (known for classifying neurosis and psychosis).1Although the history of psychiatric classification identifies some common trends such as the labels ‘melancholia’ and ‘hysteria’ which have survived millennia, the label lasix price ‘depression’ is relatively new. The earliest usage noted by Snaith is from 1899. €˜in simple pathological depression…the patient exhibits a growing indifference to his former pursuits…’.2 Snaith noted that lasix price early 20th-century psychiatrists like Adolf Meyer hoped that ‘depression’ would come to encompass a broad category under which descriptions of subtypes would emerge.

This did not happen until the middle of the 20th century. With the publication of the sixth International Classification of Diseases (ICD) in 1948 and the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1952 and their subsequent revisions, the latter half of the 20th century has seen depression subtype labels proliferate. In their study of the social determinants of diagnostic labels in depression, McPherson and Armstrong illustrate how the codification of depression subtypes in lasix price the latter half of the 20th century has been shaped by the evolving context of psychiatry, including power struggles within the profession, a move to community care and the development of psychopharmacology.3During this period, McPherson and Armstrong describe how subsequent versions of the DSM served as battlegrounds for professional disputes and philosophical quarrels around categorisation of mental disorders. DSM I and DSM II have been described as products of an American Psychiatric Association dominated by psychoanalytic psychiatrists.4 DSM III and DSM III-R have been described as a radical rejection of psychoanalytic thinking, a ‘neo-Kraepelinian revolution’, a reference to the observational descriptive techniques of 19th-century psychiatrist Emil Kraepelin who classified mental disorders into two broad categories. €˜dementia praecox’ and ‘manic-depression’.5 DSM III was seen by some as a turning point in the use of the medical model of mental illness, through provision of specific inclusion and exclusion criteria, and use of field trials and a multiaxial system.6 These latter technocratic additions to psychiatric labelling served to engender a much closer alignment between psychiatry, science and medicine.The codification of mental disorders in manuals has been described by Thomas Schacht as intrinsic lasix price to the relationship between science and politics and the way in which psychiatrists gain significant social power by aligning themselves to science.7 His argument drew on Szasz, who saw the mental health establishment as a therapeutic state.

Zimbardo, who described psychiatric care as a controlling force. And Foucault, who described the categorisation of the mentally ill as a force for isolating ‘the other’. Diagnostic critique has been further developed through a cultural relativist lens in that what lasix price Western psychiatrists classify as a depression is constructed differently in other cultures.8 Considering these limitations, some critics have gone so far as to argue that psychiatric diagnostic systems should be abolished.9Yet architects of DSM manuals have worked hard to ensure the technology of classification is regarded as genuine scientific activity with sound roots in philosophy of science. In their philosophical defence of DSM IV, Allen Frances and colleagues address their critics under the headings ‘nominalism vs realism’, ‘empiricism vs rationalism’ and ‘categorical vs dimensional’.10 The implication is that there are opposing stances in which a choice must be made or a middle ground forged by those reasonable enough to recognise the need for pragmatism in the service of clinical utility. The nominalism–realism debate is illustrated using as metaphor three different stances a lasix price cricket umpire might take on calling strikes and balls.

The discussion sets out two of these as extreme views. €˜at one extreme…those who take a reductionistically realistic view of the world’ versus ‘the solipsistic nominalists…might content that nothing exists’. Szasz, who is lasix price characterised as holding particularly extreme views, is named as an archetypal solipsist. There is implied to be a degree of arrogance associated with this view in the illustrative example in which the umpire states ‘there are no balls and there are no strikes until I call them’. Frances therefore sets up a means of grouping two kinds of people as philosophical extremists who can be dismissed, while avoiding addressing the philosophical problems they pose.Frances provides little if any justification for the middle lasix price ground stance, ‘There are balls and there are strikes and I call them as I see them’, other than to focus on its clinical utility and the lack of clinical utility in the alternatives ‘naïve realism’ and ‘heuristically barren solipsism’.

The natural conclusion the reader is invited to reach is that a middle ground of a heuristic concept is naturally right because it is not extreme and is naturally useful clinically, without specifying in what way this stance is coherent, resolves the two alternatives, and in what way a heuristic construct that is not ‘real’ can be subject to scientific testing.Similarly, in discussing the ‘categorical vs dimensional’, Frances promotes the ‘prototype approach’. Those holding opposing views are labelled as ‘dualists’ or ‘dichotomisers’. The prototypical approach is again put forward as a clinically useful middle lasix price ground. Illustrations are drawn from natural science. €˜a triangle and a square are never the same’, inciting the reader to lasix price consider science as value-free.

The prototypical approach emerges as a natural solution, yet the authors do not address how a diagnostic prototype resolves the issues posed by the two alternatives, nor how a prototype can be subjected to natural science methods.The argument presented here is not a defence of solipsism or dualism. Rather it aims to illustrate that if for pragmatic purposes clinicians and policymakers choose to gloss over the philosophical flaws in classification practices, it is then risky to move beyond the heuristic and apply natural science methods to these constructs adding multiple layers of technocratic subclassification. Doing so is more like playing Minecraft than lasix price cricket. The National Institute for Health and Care Excellence (NICE) guideline for depression is taken as an example of the philosophical errors that can follow from playing Minecraft with unsound heuristic devices, specifically subcategories of persistent forms of depression. As well as serving a clinical purpose, diagnosis in medicine is a lasix price way of allocating resources for insurance companies and constructing clinical guidelines, which in turn determine rationing within the National Health Service.

The consequences for recipients of healthcare are therefore significant. Clinical utility is arguably not being served at all and patients are left at risk of poor-quality care.Heterogeneity of persistent depressionAndrea Jobst and colleagues note that ‘because of their chronic clinical course, approximately 40% of CD [chronic depression] patients also fulfil criteria for TRD [treatment resistant depression]…usually defined by the number of non-successful biological treatments’.11 This position is reflected in the DSM VAmerican Psychiatric Association (2013), the European Psychiatric Association (EPA) guidance and the ICD-11(World Health Organisation, 2018), which all use a ‘persistent’ depression category, acknowledging a loosely defined mixed group of long-term, difficult-to-treat depressive conditions, often associated with dysthymia and comorbid common mental disorders, various personality traits and psychosocial disability.In contrast, the NICE 2018 draft guideline separates treatments into those for ‘new episodes’ of depression. €˜further-line’ treatment of depression (equivalent to TRD), CD and ‘depression with lasix price co-morbidities’. The latter is subdivided into treatments for ‘complex depression’ and ‘psychotic depression’. These categories and subcategories introduce an unfortunate lasix price sense of certainty as though these labels represent real things.

An analysis follows of how these definitions play out in terms of grouping of randomised controlled trials in the NICE evidence review. Specifically, the analysis reveals the overlap between populations in trials which have been separated into discrete categories, revealing significant limitations to the utility of the category labels.The NICE definition of CD requires trial samples to meet the criteria for major depressive disorder (MDD) for 2 years. Dysthymia and double depression (MDD superimposed on dysthymia) were lasix price included. If 75% of the trial population met these criteria, the trial was reviewed in the CD category.12 The definition of TRD (or ‘further-line treatments’) required that the trial sample had demonstrated a ‘limited response to previous treatment’ and randomised to the further-line treatment at this point. If 80% of the trial participants met these criteria, it was reviewed in the TRD category.13 Complex depression was lasix price defined as ‘depression co-existing with personality disorder’.

To be classed as complex, 51% of trial participants had to have personality disorder (PD).14It is immediately clear from these definitions that there is a potential problem with attempting to categorise trial populations into just one of these categories. These populations are likely to overlap, whether or not a trial protocol sets out to explicitly record all of this information. The analysis below will illustrate this using examples from within the NICE lasix price review.Cataloguing complexity in trial populationsWithin the category of further-line treatments (TRD), 64 trials were reviewed. Comparisons within these trials were further subcategorised into ‘dose escalation strategies’, ‘augmentation strategies’ and ‘switching strategies’. In drilling down by way of illustration, this analysis considers the 51 trials in lasix price the augmentation strategy evidence review.

Of these, two were classified by the reviewers as also fulfilling the criteria for CD but were not analysed in the CD category (Study IDs. Fonagy 2015 and Kocsis 200915). About half of the trials (23/51) did not report the mean duration of episode, meaning that it is not possible to know what percentage of participants lasix price also met the criteria for CD. Of trials that did report episode duration, 17 reported a mean duration longer than 24 months. While the standard deviations varied in size or were unreported, the mean indicates a good likelihood that a significant proportion of the participants across these 51 trials met the criteria for CD.Details of baseline employment, trauma history, suicidality, physical comorbidity, axis I comorbidity and PD (all clinical indicators of complexity, severity and chronicity) were not collated by NICE lasix price.

For the present analysis, all 51 publications were examined and data compiled concerning clinical complexity in the trial populations. Only 14 of 51 trials report employment data. Of those lasix price that do, unemployment ranges from 12% to 56% across trial samples. None of the trials report trauma history. About half of the trials (26/51) excluded people lasix price who were considered a suicide risk.

The others did not.A large proportion of trials (30/51) did not provide any data on axis 1 comorbidity. Of these, 18 did not exclude any diagnoses, while 12 excluded some (but not all) disorders. The most common diagnoses excluded were psychotic disorders, substance or alcohol abuse, and lasix price bipolar disorder (excluded in 26, 25 and 23 trials, respectively). Only 7 of 51 trials clearly stated that all axis 1 diagnoses were excluded. This leaves lasix price only 13 studies providing any data about comorbidity.

Of these, 9 gave partial data on one or two conditions, while 4 reported either the mean number of disorders (range 1.96–2.9) or the percentage of participants (range 68.1–96.7) with any comorbid diagnosis (Nierenberg 2003a, Nierenberg 2006, Watkins 2011a, Town 201715).The majority of trials (46/51) did not report the prevalence of PD. Many stated PD as an exclusion criterion but without defining a threshold for exclusion. For example, PD could be excluded if it ‘impacted’ the depression, if it was ‘significant’, ‘severe’ or ‘persistent’ lasix price. Some excluded certain PDs (such as antisocial or borderline) and not others but without reporting the prevalence of those not excluded. In the lasix price five trials where prevalence was clear, prevalence ranged from 0% (Ravindran 2008a15), where all PDs were excluded, to 87.5% of the sample (Town 201715).

Two studies reported the mean number of PDs. 2.0 (Nierenberg 2003a) and 0.85 (Watkins 2011a15).The majority of trials (43/51) did not report the prevalence of physical illness. Many stated lasix price illness as an exclusion criterion, but the definitions and thresholds were vague and could be interpreted in different ways. For example, illness could be excluded if it was ‘unstable’, ‘serious’, ‘significant’, ‘relevant’, or would ‘contraindicate’ or ‘impact’ the medication. Of the eight trials reporting information about physical health, there was a wide lasix price variation.

Four reported prevalence varying from 7.6% having a disability (Eisendrath 201615) to 90.9% having an illness or disability (Town 201715). Four used scales of physical health. Two indicating mild problems (Nierenberg 2006, Lavretsky 201115) and two indicating moderately high levels of illness (Thase 2007, Fang 201015).The NICE review also divided trial populations into a dichotomy of ‘more severe’ and ‘less severe’ on the grounds lasix price that this would be a clinically useful classification for general practitioners. NICE applied a bespoke methodology for creating this dichotomy, abandoning validated measure thresholds in order first to generate two ‘homogeneous’ groups to ‘facilitate analysis’, and second to create an algorithm to ‘read across’ different measures (such as the Beck Depression Inventory, the Hamilton Rating Scale for Depression (HRSD) and the Montgomery-Asberg Depression Rating Scale).16 Examining trials which use more than one of these measures reveals problems in the algorithm. Of the 51 trials, lasix price there are 6 instances in which the study population falls into NICE’s more severe category according to one measure and into the less severe category according to another.

In four of these trials, NICE chose the less severe category (Souza 2016, Watkins 2011a, Fonagy 2015, Town 201715). The other two trials were designated more severe (Barbee 2011, Dunner 200715). Only 17 of 51 trials reported two or more depression scale measures, leaving much unknown about whether other study populations could count as both more severe and less severe.Absence of knowledge or lasix price knowledge of absence?. A key philosophical error in science is to confuse an absence of knowledge with knowledge of absence. It is likely that some of the study populations deemed lacking in complexity or severity lasix price could actually have high degrees of complexity and/or severity.

Data to demonstrate this may either fall foul of a guideline committee decision to prioritise certain information over other conflicting information (as in the severity algorithm). The information may be non-existent as it was not collected. It may be somewhere lasix price in the publication pipeline. Or it may be sitting in a database with a research team that has run out of funds for supplementary analyses. Wherever those data are or are not, their absence from published articles does not define the lasix price phenomenology of depression for the patients who took part.

As a case in point, data from the Fonagy 2015 trial presented at conferences but not published reveal that PD prevalence data would place the trial well within the NICE complex depression category, and that the sample had high levels of past trauma and physical condition comorbidity. The trial also meets the guideline criteria for CD according to the guideline’s own appendices.17 Reported axis 1 comorbidity was high (75.2% had anxiety disorder, 18.6% had substance abuse disorder, 13.2% had eating disorder).18 The mean depression scores at baseline were 36.5 on the Beck Depression Inventory and 20.1 on the HRSD (severe and very severe, respectively, according to published cut-off scores). NICE categorised lasix price this population as less severe TRD, not CD and not complex.Notes1. Avram H. Mack et lasix price al.

(1994), “A Brief History of Psychiatric Classification. From the Ancients to DSM-IV,” Psychiatric Clinics 17, no. 3. 515–9.2. R.

P. Snaith (1987), “The Concepts of Mild Depression,” British Journal of Psychiatry 150, no. 3. 387.3. Susan McPherson and David Armstrong (2006), “Social Determinants of Diagnostic Labels in Depression,” Social Science &.

Medicine 62, no. 1. 52–7.4. Gerald N. Grob (1991), “Origins of DSM-I.

A Study in Appearance and Reality,” The American Journal of Psychiatry. 421–31.5. Wilson M. Compton and Samuel B. Guze (1995), “The Neo-Kraepelinian Revolution in Psychiatric Diagnosis,” European Archives of Psychiatry and Clinical Neuroscience 245, no.

4. 198–9.6. Gerald L. Klerman (1984), “A Debate on DSM-III. The Advantages of DSM-III,” The American Journal of Psychiatry.

539–42.7. Thomas E. Schacht (1985), “DSM-III and the Politics of Truth,” American Psychologist. 513–5.8. Daniel F.

Hartner and Kari L. Theurer (2018), “Psychiatry Should Not Seek Mechanisms of Disorder,” Journal of Theoretical and Philosophical Psychology 38, no. 4. 189–204.9. Sami Timimi (2014), “No More Psychiatric Labels.

Why Formal Psychiatric Diagnostic Systems Should Be Abolished,” Journal of Clinical and Health Psychology 14, no. 3. 208–15.10. Allen Frances et al. (1994), “DSM-IV Meets Philosophy,” The Journal of Medicine and Philosophy.

A Forum for Bioethics and Philosophy of Medicine 19, no. 3. 207–18.11. Andrea Jobst et al. (2016), “European Psychiatric Association Guidance on Psychotherapy in Chronic Depression Across Europe,” European Psychiatry 33.

20.12. National Institute for Health and Care Excellence (2018), Depression in Adults. Treatment and Management. Draft for Consultation, https://www.nice.org.uk/guidance/gid-cgwave0725/documents/full-guideline-updated, 507.13. Ibid., 351–62.14.

Ibid., 597.15. Note that in order to refer to specific trials reviewed in the guideline, rather than the full citation, the Study IDs from column A in appendix J5 have been used. See www.nice.org.uk/guidance/gid-cgwave0725/documents/addendum-appendix-9 for details and full references.16. National Institute for Health and Care Excellence (2018), Depression in Adults. Treatment and Management.

Second Consultation on Draft Guideline – Stakeholder Comments Table, https://www.nice.org.uk/guidance/gid-cgwave0725/documents/consultation-comments-and-responses-2, 420–1.17. National Institute for Health and Care Excellence (2018), Depression in Adults, appendix J5.18. Peter Fonagy et al. (2015), “Pragmatic Randomized Controlled Trial of Long-Term Psychoanalytic Psychotherapy for Treatment-Resistant Depression. The Tavistock Adult Depression Study (TADS),” World Psychiatry 14, no.

3. 312–21.19. American Psychological Association (2018), Clinical Practice Guideline for the Treatment of Depression in Children, Adolescents, and Young, Middle-aged, and Older Adults. Draft.20. Jacqui Thornton (2018), “Depression in Adults.

Campaigners and Doctors Demand Full Revision of NICE Guidance,” BMJ 361. K2681..

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Annie Walker woke up one morning in 2019 with little recollection of the vetmedin and lasix night before. She had bruises on her arms, legs, wrist and lower abdomen. “But I literally had no idea what had happened,” she said vetmedin and lasix. €œAnd, for days, I was trying to put the pieces together.” She knew she had gone to a Sacramento, California, bar and restaurant with a group of people, and she remembered drinking there and being left alone with the man she’d later identify as her rapist.

But not much else. Memories she couldn’t summon vetmedin and lasix that first morning gradually came into focus over days and weeks, she said. The emerging details included what the man had been wearing, and the way he shoved her against the bar. One week after the attack, she reported the crime to the Sacramento County Sheriff’s Department.

Then, in the days after making the report, another wave of memories surfaced vetmedin and lasix — she recalled, vividly, that the man had raped her and had a weapon. €œI knew that there was a gun at my neck, at my back,” she said. €œIt was just clear.” The detectives gave her a hard time, she said, when she called to report that she had remembered that her attacker had a gun. The Sacramento detectives assigned vetmedin and lasix to Walker’s case didn’t seem to understand why she couldn’t remember all the details right away.

€œI felt like I was just extremely cross-examined on the phone. Like, ‘Why didn’t you remember a gun? vetmedin and lasix. That’s, like, a really important thing.'” Sexual assault survivors say interactions with law enforcement can be so intense, and so unsympathetic, that they add secondary trauma. Reporting a rape can be especially traumatic when officers cast doubt on victims’ stories.

But it doesn’t have to be, say scientists vetmedin and lasix and scholars of criminal justice. If police gain a deeper understanding of what’s going on in the brain during and after a rape, they can change the way they approach rape cases and avoid making survivors feel blamed or disbelieved. Scientists who study trauma and memory say it’s common for sexual assault survivors — as well as survivors of other serious traumas — to be unable to recall an attack fully. They might vetmedin and lasix remember certain facts but not others, or struggle to recall events in the correct sequence.

When law enforcement officers aren’t aware of the neuroscience of trauma, or have no training to deal with it, there’s a tendency to dismiss or disbelieve victims who experience memory gaps, according to scholars and advocates for sexual assault survivors. €œThere’s a real danger when investigators are asking people for information that was never encoded or has been lost,” said Harvard University psychologist Jim Hopper. €œThey can stress out the victim, leave vetmedin and lasix them feeling misunderstood, incompetent, not wanting to further engage with the investigation.” Walker’s alleged perpetrator was never arrested. And she’s still frustrated with the way detectives put pressure on her to remember details during the investigation.

When law enforcement officers aren’t aware of the neuroscience of trauma, vetmedin and lasix or have no training to deal with it, there’s a tendency to dismiss or disbelieve victims who experience memory gaps, according to scholars and advocates for sexual assault survivors.(Marissa Espiritu/CapRadio) The Brain in Survival Mode When confronted with a crisis, the brain often activates its “fight, flight or freeze” response. In these scenarios, the brain’s “defense circuitry” takes over, explained Hopper. The prefrontal cortex, which is responsible for logical decision-making, is no longer in control and, instead, the areas of the brain responsible for scanning for danger take charge. €œAnd that’s what people are running on” when trauma happens, vetmedin and lasix Hopper said.

Some people respond by mentally “dissociating,” or disconnecting from their physical selves. That survival response affects the ability to absorb what’s happening around them, Hopper said. Studies on memory and recall during a traumatic event describe two types of vetmedin and lasix details. Central and peripheral.

Central details are those that capture our attention and evoke emotions in the moment, such as a location. Peripheral details are those that a survivor might not have been paying attention to during the crisis, such as something the perpetrator said or vetmedin and lasix whether other people were present. Central details tend to be stored more reliably and for longer than peripheral details. Every day in courtrooms around the country, [defense attorneys] attack and vetmedin and lasix question the credibility of victims of sexual assault for having the same kind of memories that soldiers have for their combat experiences.

Harvard University psychologist Jim Hopper Sometimes survivors are unable to answer what might seem like a simple question if it involves a peripheral detail like the color of the attacker’s shirt. And Hopper said that can make officers suspicious. Hopper, who vetmedin and lasix gives legal testimony in sexual assault cases, said victims are often held to unfair standards, even compared with other trauma survivors. €œEvery day in courtrooms around the country, [defense attorneys] attack and question the credibility of victims of sexual assault for having the same kind of memories that soldiers have for their combat experiences,” he said.

Victim advocates and criminal justice scholars say it’s important for detectives to be open to anything a survivor might say, whenever they say it — even if those details were not available in an initial report — because the information survivors provide later can be helpful for solving the crime. Maintaining an Open Mind Nicole Monroe, a police detective in Elk Grove, a suburb of Sacramento, said she and some of her colleagues have gotten additional education on brain science, and it has changed vetmedin and lasix the way they approach sexual assault cases. Monroe tells victims she works with that more memories will continue to surface in the days, weeks and even months to come. €œSmells will come back.

Sights will vetmedin and lasix come back. When you think of these things, give me a call and let me know, so that it can be added,” Monroe said. €œBecause little things like that are going to make a difference.” (Marissa Espiritu/CapRadio) (Marissa Espiritu/CapRadio) Traditionally, law enforcement officers are trained to conduct an interrogation that may involve drawing out specific details, usually in chronological order. €œThe expectation vetmedin and lasix is someone is supposed to come in, sit down, they’re supposed to be ready to talk, they’re supposed to know what to talk about,” said Carrie Hull, a former detective with the Ashland Police Department in southern Oregon.

€œThey’re going to tell you what happened to them from the beginning, through the middle, and then the end. That is a very traditional understanding.” Hull is now a consultant for police departments, and part of her work involves advocating for the adoption of a technique known vetmedin and lasix as Forensic Experiential Trauma Interviewing, or FETI. The training can help law enforcement learn how to ask questions differently. With empathy, patience and an informed understanding of how a traumatized brain makes memories and recalls them.

Training in vetmedin and lasix the technique is available through an online course, but it’s not a mandatory requirement for most police departments. People who take Hull’s course learn specific strategies for helping someone resurface a relevant memory that he or she may not have had access to when they first walked into the interview room. Hull said FETI discourages counterproductive practices such as paraphrasing, changing the victim’s words, interrupting or giving advice. Hull said the overarching goal of vetmedin and lasix trauma interviewing is to first “collect the dots, then connect the dots.” In other words, simply interview the victim about what happened.

The sharper, more aggressive investigative tactics can wait. There isn’t research proving that law enforcement departments who take this training solve more rape cases. But victim advocates and scholars said it’s a best practice that could make working with police a more positive vetmedin and lasix experience for victims and, eventually, help bring more perpetrators to justice. €œIf I had my way, every one of them would be doing this,” said Dave Thomas, a program officer with the International Association of Chiefs of Police.

Annie Walker is still struggling to recover from her sexual assault, but it’s complicated vetmedin and lasix because she’s also healing from the way law enforcement handled her case. She said both police officers and survivors need more education on the way trauma affects memory. She said if survivors knew what to expect in terms of memory issues, it wouldn’t be so frustrating. €œThey need to feel like the way that things are happening vetmedin and lasix in their mind is normal.

Normal for them.” This story is from a partnership that includes CapRadio, NPR and KHN. Related Topics Contact Us Submit a Story TipOn the second day of high school in Texas, Natosha Daniels’ 14-year-old daughter went all day without eating because she did not want to remove her mask. The teen’s school has a couple of thousand vetmedin and lasix students, and the cafeteria was crowded. Plus Round Rock Independent School District outside Austin didn’t require masks, so some students weren’t wearing them.

Even her honors biology teacher was maskless. Daniels said her daughter, who like her is fully vaccinated, is terrified of bringing home the lasix because it could infect her vetmedin and lasix 7-year-old sibling, who is too young for a shot. €œShe was like, ‘Mama I’m going to pass out,’” said Daniels, a Round Rock Black Parents Association member and former assistant principal in the district. €œEvery morning I wake up with knots in my chest, just like, ‘Am I making the right decision, putting myself vetmedin and lasix and my child at risk for my older two to go to school?.

€™â€ said Daniels, who is immunocompromised. €œAnd my husband was like, ‘Well the option still stands for you to go get an Airbnb and move out’ with my youngest. €¦ Do vetmedin and lasix we sacrifice our savings?. It’s so hard.” After a difficult year or more of virtual learning, parents are eager to have their children back in classrooms.

But even as the highly transmissible delta variant surges, school districts like Daniels’ aren’t beefing up protocols to prevent s. Masks aren’t mandated vetmedin and lasix or enforced, according to teachers, parents and officials in several states. Physical distancing is nearly impossible. To top it off, students exposed to hypertension medications may not be required to quarantine despite guidelines from the Centers for Disease Control and Prevention, risking an even more rapid spread among children, the youngest of whom aren’t yet eligible for vaccination.

The CDC advises quarantining up to 14 days for people who have had close contact with an infected person vetmedin and lasix — within 6 feet for at least 15 minutes over a 24-hour period. (It exempts vaccinated people without symptoms.) This summer, the agency drafted an exception for schools. It’s not considered close contact if both the infected and exposed students “correctly and consistently” wore vetmedin and lasix masks. That means an unvaccinated but masked student who was exposed wouldn’t have to quarantine.

But whether school districts follow CDC guidelines is an open question. And, in many cases, counties, vetmedin and lasix states and the CDC don’t issue the same advice. Even if districts follow CDC guidance, success hinges on whether students consistently wear masks. In Round Rock, for example, quarantine is “strongly” recommended for students and staff members who had close contact with those infected, essentially leaving it up to parents whether to take a child out of school.

€œAn optional quarantine just doesn’t work,” said Allison Stewart, lead epidemiologist at Williamson County and vetmedin and lasix Cities Health District, which oversees 12 school districts including most Round Rock schools. When not required, “it seems that there’s only a cursory effort to actually identify contacts.” And then only “a cursory effort to quarantine.” “There is more transmission occurring in a school setting than there is in the community right now,” Stewart said, “which is the exact opposite of what happened last year.” The nation’s largest school districts are mostly not following the CDC’s close-contact exception for masked students, said Bree Dusseault, an analyst at the Center on Reinventing Public Education who is tracking state and district policies. The center reviewed 100 large and urban school districts and found that most of them gave students who are fully vaccinated and have close contact with an infected student an exemption from quarantine. Some require hypertension medications testing for students to return earlier than recommended, while others exempt those who’ve recently recovered from vetmedin and lasix hypertension medications and, assumedly, have antibodies.

€œDistricts are managing on-the-ground politics,” Dusseault said. €œYou may find leaders relying less on scientific recommendations and data and more on local preferences” and on “what they’re hearing.” “We know that masks aren’t perfect,” said Debra Pace, superintendent of the School District of Osceola County in Florida. Fully vaccinated people without symptoms are exempt from quarantine, but Osceola vetmedin and lasix schools require any exposed students to quarantine for four to 10 days, depending on whether they showed symptoms or had a negative test. €œThe delta variant is very different,” Pace said.

€œAs much as I hate to quarantine kids, if we don’t quarantine, we risk having to shut a school down, which we absolutely don’t want to do.” Each school’s decision about who counts as a close contact affects contact tracing, a laborious process officials use to vetmedin and lasix slow the spread of disease. The CDC’s guidance curtails the number of school-based contacts for follow-up. Epidemiologists support the CDC’s approach, said Janet Hamilton, executive director of the Council of State and Territorial Epidemiologists. She added that having clear vetmedin and lasix consequences for not wearing masks seems to resonate with parents.

Kids who don’t mask up will miss more school. €œSo many parents are interested — and I think rightly so — in having their children have in-person learning,” Hamilton said. But in Round Rock, protocols are squishy in part because state orders and guidelines conflict with vetmedin and lasix federal recommendations. Only after the courts got involved did Round Rock ISD add a strong mask mandate last Thursday — a week into school and after dozens of new positive cases and hundreds of new close contacts among students were reported.

Natosha Daniels, a mother of three kids who attend school at Round Rock Independent School District, outside Austin, Texas. (Montinique Monroe for KHN) Ben Sterling, president of the local teachers union Education Round Rock, said staffers and students alike are not incentivized to follow hypertension medications rules, particularly related to quarantine vetmedin and lasix. For staff members, one round of quarantine would use all 10 days of personal and sick leave they get annually. Those days roll over, but Sterling knows of teachers with vetmedin and lasix health issues who haven’t banked any.

€œThe ones who are most vulnerable are going to get hit hardest, as per usual,” he said. Dusseault said Round Rock’s policy is unusual because it’s optional. But the vetmedin and lasix district is hardly alone — neighboring Leander ISD has a similar policy. Round Rock ISD requires anyone who tests positive for hypertension medications or is a probable case to quarantine for 10 days.

For close contacts, it’s merely suggested “because parents and students have a right to a free, appropriate public education under the federal law,” said Jenny LaCoste-Caputo, Round Rock ISD’s chief of public affairs and communications. Leniency about hypertension medications safety doesn’t sit well with vetmedin and lasix Natosha Daniels. €œI feel sick” about it, she said. €œAt best, they are, like, caving to this violent group of right-wing parents and, at worst, it’s like a blatant willingness to increase our community spread.” Quarantine isn’t required for Round Rock employees because they would have to use personal and sick leave, LaCoste-Caputo said.

The board of trustees approved hypertension medications leave vetmedin and lasix only for staff members who test positive. It is also “just not having the backing of our state government,” said Amy Weir, president of the Round Rock ISD board of trustees. The Texas legislature did not fund virtual learning, so school districts are covering the vetmedin and lasix costs themselves. Weir said Round Rock ISD is paying $17.5 million to offer virtual learning for students younger than 12, who cannot get vaccinated.

For older students, teachers upload handouts of curated lessons. On the second day of classes, the vetmedin and lasix middle school where Sterling teaches saw its first case. He and another teacher said the student who tested positive was sometimes maskless and around others without masks. Yet, they said, the school told the families of that child’s classmates that no one was a close contact.

The school, they said, is not requiring seating charts, which would help staff members track student movement, nor do school officials know who vetmedin and lasix is vaccinated or unvaccinated, which factors into the school district’s close-contact definition. It’s all handled on the honor system. €œYou’re saying, ‘Choose between going to work and quarantining your child for 10 days,’” Daniels said. €œThis is the world that we are in — creates these systems that leave parents with no choice.” Amanda Michelle Gomez.

amandag@kff.org, @amanduhgomez Rachana Pradhan. rpradhan@kff.org, @rachanadixit Related Topics Contact Us Submit a Story Tip.

Annie Walker lasix price woke up one morning in 2019 with little recollection of the http://www.ec-cath-truchtersheim.ac-strasbourg.fr/die-emotionen/ night before. She had bruises on her arms, legs, wrist and lower abdomen. “But I literally had no idea what had happened,” she lasix price said. €œAnd, for days, I was trying to put the pieces together.” She knew she had gone to a Sacramento, California, bar and restaurant with a group of people, and she remembered drinking there and being left alone with the man she’d later identify as her rapist.

But not much else. Memories she couldn’t summon that first morning gradually came into focus over days and weeks, she said lasix price. The emerging details included what the man had been wearing, and the way he shoved her against the bar. One week after the attack, she reported the crime to the Sacramento County Sheriff’s Department.

Then, in the days after lasix price making the report, another wave of memories surfaced — she recalled, vividly, that the man had raped her and had a weapon. €œI knew that there was a gun at my neck, at my back,” she said. €œIt was just clear.” The detectives gave her a hard time, she said, when she called to report that she had remembered that her attacker had a gun. The Sacramento detectives assigned to Walker’s case didn’t seem to understand lasix price why she couldn’t remember all the details right away.

€œI felt like I was just extremely cross-examined on the phone. Like, ‘Why didn’t you remember a gun? lasix price. That’s, like, a really important thing.'” Sexual assault survivors say interactions with law enforcement can be so intense, and so unsympathetic, that they add secondary trauma. Reporting a rape can be especially traumatic when officers cast doubt on victims’ stories.

But it doesn’t have to be, say scientists and scholars of lasix price criminal justice. If police gain a deeper understanding of what’s going on in the brain during and after a rape, they can change the way they approach rape cases and avoid making survivors feel blamed or disbelieved. Scientists who study trauma and memory say it’s common for sexual assault survivors — as well as survivors of other serious traumas — to be unable to recall an attack fully. They might lasix price remember certain facts but not others, or struggle to recall events in the correct sequence.

When law enforcement officers aren’t aware of the neuroscience of trauma, or have no training to deal with it, there’s a tendency to dismiss or disbelieve victims who experience memory gaps, according to scholars and advocates for sexual assault survivors. €œThere’s a real danger when investigators are asking people for information that was never encoded or has been lost,” said Harvard University psychologist Jim Hopper. €œThey can stress out the victim, leave them feeling misunderstood, incompetent, not wanting to further engage with the investigation.” lasix price Walker’s alleged perpetrator was never arrested. And she’s still frustrated with the way detectives put pressure on her to remember details during the investigation.

When law enforcement officers aren’t aware of the neuroscience of trauma, or have no training to deal with it, there’s a tendency to dismiss or disbelieve victims who experience memory gaps, according to scholars and advocates for sexual assault survivors.(Marissa Espiritu/CapRadio) The Brain in Survival Mode When confronted with a crisis, the brain often activates its “fight, flight lasix price or freeze” response. In these scenarios, the brain’s “defense circuitry” takes over, explained Hopper. The prefrontal cortex, which is responsible for logical decision-making, is no longer in control and, instead, the areas of the brain responsible for scanning for danger take charge. €œAnd that’s what people are running on” lasix price when trauma happens, Hopper said.

Some people respond by mentally “dissociating,” or disconnecting from their physical selves. That survival response affects the ability to absorb what’s happening around them, Hopper said. Studies on memory and recall during a traumatic event lasix price describe two types of details. Central and peripheral.

Central details are those that capture our attention and evoke emotions in the moment, such as a location. Peripheral details are those that a survivor might not have been paying attention to during the crisis, such as something the perpetrator said or whether other people were present lasix price. Central details tend to be stored more reliably and for longer than peripheral details. Every day in courtrooms around the country, [defense attorneys] attack and question the lasix price credibility of victims of sexual assault for having the same kind of memories that soldiers have for their combat experiences.

Harvard University psychologist Jim Hopper Sometimes survivors are unable to answer what might seem like a simple question if it involves a peripheral detail like the color of the attacker’s shirt. And Hopper said that can make officers suspicious. Hopper, who gives legal testimony in sexual assault cases, said victims are often held to unfair standards, even compared with other trauma survivors lasix price. €œEvery day in courtrooms around the country, [defense attorneys] attack and question the credibility of victims of sexual assault for having the same kind of memories that soldiers have for their combat experiences,” he said.

Victim advocates and criminal justice scholars say it’s important for detectives to be open to anything a survivor might say, whenever they say it — even if those details were not available in an initial report — because the information survivors provide later can be helpful for solving the crime. Maintaining an Open Mind Nicole Monroe, a police detective in Elk Grove, a suburb of Sacramento, said she and some of her colleagues have gotten additional education on brain science, and it has changed the way they approach sexual assault lasix price cases. Monroe tells victims she works with that more memories will continue to surface in the days, weeks and even months to come. €œSmells will come back.

Sights will come back lasix price. When you think of these things, give me a call and let me know, so that it can be added,” Monroe said. €œBecause little things like that are going to make a difference.” (Marissa Espiritu/CapRadio) (Marissa Espiritu/CapRadio) Traditionally, law enforcement officers are trained to conduct an interrogation that may involve drawing out specific details, usually in chronological order. €œThe expectation is someone is supposed to come in, sit down, they’re lasix price supposed to be ready to talk, they’re supposed to know what to talk about,” said Carrie Hull, a former detective with the Ashland Police Department in southern Oregon.

€œThey’re going to tell you what happened to them from the beginning, through the middle, and then the end. That is a very lasix price traditional understanding.” Hull is now a consultant for police departments, and part of her work involves advocating for the adoption of a technique known as Forensic Experiential Trauma Interviewing, or FETI. The training can help law enforcement learn how to ask questions differently. With empathy, patience and an informed understanding of how a traumatized brain makes memories and recalls them.

Training in the technique lasix price is available through an online course, but it’s not a mandatory requirement for most police departments. People who take Hull’s course learn specific strategies for helping someone resurface a relevant memory that he or she may not have had access to when they first walked into the interview room. Hull said FETI discourages counterproductive practices such as paraphrasing, changing the victim’s words, interrupting or giving advice. Hull said the overarching goal of trauma interviewing lasix price is to first “collect the dots, then connect the dots.” In other words, simply interview the victim about what happened.

The sharper, more aggressive investigative tactics can wait. There isn’t research proving that law enforcement departments who take this training solve more rape cases. But victim advocates and scholars said it’s lasix price a best practice that could make working with police a more positive experience for victims and, eventually, help bring more perpetrators to justice. €œIf I had my way, every one of them would be doing this,” said Dave Thomas, a program officer with the International Association of Chiefs of Police.

Annie Walker is still struggling to recover from her sexual assault, but lasix price it’s complicated because she’s also healing from the way law enforcement handled her case. She said both police officers and survivors need more education on the way trauma affects memory. She said if survivors knew what to expect in terms of memory issues, it wouldn’t be so frustrating. €œThey need to feel like the way that things are happening in lasix price their mind is normal.

Normal for them.” This story is from a partnership that includes CapRadio, NPR and KHN. Related Topics Contact Us Submit a Story TipOn the second day of high school in Texas, Natosha Daniels’ check my site 14-year-old daughter went all day without eating because she did not want to remove her mask. The lasix price teen’s school has a couple of thousand students, and the cafeteria was crowded. Plus Round Rock Independent School District outside Austin didn’t require masks, so some students weren’t wearing them.

Even her honors biology teacher was maskless. Daniels said lasix price her daughter, who like her is fully vaccinated, is terrified of bringing home the lasix because it could infect her 7-year-old sibling, who is too young for a shot. €œShe was like, ‘Mama I’m going to pass out,’” said Daniels, a Round Rock Black Parents Association member and former assistant principal in the district. €œEvery morning I wake up with knots in my chest, just like, ‘Am I making the right decision, putting myself and my child at risk for my older two to go to school? lasix price.

€™â€ said Daniels, who is immunocompromised. €œAnd my husband was like, ‘Well the option still stands for you to go get an Airbnb and move out’ with my youngest. €¦ Do we sacrifice our lasix price savings?. It’s so hard.” After a difficult year or more of virtual learning, parents are eager to have their children back in classrooms.

But even as the highly transmissible delta variant surges, school districts like Daniels’ aren’t beefing up protocols to prevent s. Masks aren’t mandated or enforced, according to teachers, lasix price parents and officials in several states. Physical distancing is nearly impossible. To top it off, students exposed to hypertension medications may not be required to quarantine despite guidelines from the Centers for Disease Control and Prevention, risking an even more rapid spread among children, the youngest of whom aren’t yet eligible for vaccination.

The CDC advises quarantining up to 14 days lasix price for people who have had close contact with an infected person — within 6 feet for at least 15 minutes over a 24-hour period. (It exempts vaccinated people without symptoms.) This summer, the agency drafted an exception for schools. It’s not considered close contact lasix price if both the infected and exposed students “correctly and consistently” wore masks. That means an unvaccinated but masked student who was exposed wouldn’t have to quarantine.

But whether school districts follow CDC guidelines is an open question. And, in many cases, counties, states and the lasix price CDC don’t issue the same advice. Even if districts follow CDC guidance, success hinges on whether students consistently wear masks. In Round Rock, for example, quarantine is “strongly” recommended for students and staff members who had close contact with those infected, essentially leaving it up to parents whether to take a child out of school.

€œAn optional quarantine just doesn’t work,” said Allison Stewart, lead epidemiologist at Williamson County and Cities Health District, which oversees 12 lasix price school districts including most Round Rock schools. When not required, “it seems that there’s only a cursory effort to actually identify contacts.” And then only “a cursory effort to quarantine.” “There is more transmission occurring in a school setting than there is in the community right now,” Stewart said, “which is the exact opposite of what happened last year.” The nation’s largest school districts are mostly not following the CDC’s close-contact exception for masked students, said Bree Dusseault, an analyst at the Center on Reinventing Public Education who is tracking state and district policies. The center reviewed 100 large and urban school districts and found that most of them gave students who are fully vaccinated and have close contact with an infected student an exemption from quarantine. Some require hypertension medications testing for students to lasix price return earlier than recommended, while others exempt those who’ve recently recovered from hypertension medications and, assumedly, have antibodies.

€œDistricts are managing on-the-ground politics,” Dusseault said. €œYou may find leaders relying less on scientific recommendations and data and more on local preferences” and on “what they’re hearing.” “We know that masks aren’t perfect,” said Debra Pace, superintendent of the School District of Osceola County in Florida. Fully vaccinated people without symptoms are exempt from quarantine, but Osceola schools require any exposed students to quarantine for four to 10 lasix price days, depending on whether they showed symptoms or had a negative test. €œThe delta variant is very different,” Pace said.

€œAs much as I hate to quarantine kids, if we don’t quarantine, we risk having to shut a school down, which we absolutely don’t want to do.” Each school’s decision about who lasix price counts as a close contact affects contact tracing, a laborious process officials use to slow the spread of disease. The CDC’s guidance curtails the number of school-based contacts for follow-up. Epidemiologists support the CDC’s approach, said Janet Hamilton, executive director of the Council of State and Territorial Epidemiologists. She added that having clear consequences for not wearing masks lasix price seems to resonate with parents.

Kids who don’t mask up will miss more school. €œSo many parents are interested — and I think rightly so — in having their children have in-person learning,” Hamilton said. But in Round Rock, protocols are squishy in part because state orders lasix price and guidelines conflict with federal recommendations. Only after the courts got involved did Round Rock ISD add a strong mask mandate last Thursday — a week into school and after dozens of new positive cases and hundreds of new close contacts among students were reported.

Natosha Daniels, a mother of three kids who attend school at Round Rock Independent School District, outside Austin, Texas. (Montinique Monroe for KHN) Ben Sterling, president of the local teachers union Education Round Rock, lasix price said staffers and students alike are not incentivized to follow hypertension medications rules, particularly related to quarantine. For staff members, one round of quarantine would use all 10 days of personal and sick leave they get annually. Those days roll over, but Sterling knows of lasix price teachers with health issues who haven’t banked any.

€œThe ones who are most vulnerable are going to get hit hardest, as per usual,” he said. Dusseault said Round Rock’s policy is unusual because it’s optional. But the district is hardly alone — neighboring Leander lasix price ISD has a similar policy. Round Rock ISD requires anyone who tests positive for hypertension medications or is a probable case to quarantine for 10 days.

For close contacts, it’s merely suggested “because parents and students have a right to a free, appropriate public education under the federal law,” said Jenny LaCoste-Caputo, Round Rock ISD’s chief of public affairs and communications. Leniency about hypertension medications safety doesn’t lasix price sit well with Natosha Daniels. €œI feel sick” about it, she said. €œAt best, they are, like, caving to this violent group of right-wing parents and, at worst, it’s like a blatant willingness to increase our community spread.” Quarantine isn’t required for Round Rock employees because they would have to use personal and sick leave, LaCoste-Caputo said.

The board of trustees approved hypertension medications leave only for staff members who test lasix price positive. It is also “just not having the backing of our state government,” said Amy Weir, president of the Round Rock ISD board of trustees. The Texas legislature did not fund lasix price virtual learning, so school districts are covering the costs themselves. Weir said Round Rock ISD is paying $17.5 million to offer virtual learning for students younger than 12, who cannot get vaccinated.

For older students, teachers upload handouts of curated lessons. On the second day of classes, the middle school where Sterling teaches lasix price saw its first case. He and another teacher said the student who tested positive was sometimes maskless and around others without masks. Yet, they said, the school told the families of that child’s classmates that no one was a close contact.

The school, they said, is not requiring seating charts, which lasix price would help staff members track student movement, nor do school officials know who is vaccinated or unvaccinated, which factors into the school district’s close-contact definition. It’s all handled on the honor system. €œYou’re saying, ‘Choose between going to work and quarantining your child for 10 days,’” Daniels said. €œThis is the world that we are in — creates these systems that leave parents with no choice.” lasix price Amanda Michelle Gomez.

amandag@kff.org, @amanduhgomez Rachana Pradhan. rpradhan@kff.org, @rachanadixit Related Topics Contact Us Submit a Story Tip.

What is Lasix?

FUROSEMIDE is a diuretic. It helps you make more urine and to lose salt and excess water from your body. Lasix is used to treat high blood pressure, and edema or swelling from heart, kidney or liver disease.

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MARLTON, NJ – Six contractors constructing luxury single-family homes at the future site of how do i get lasix Hawthorne Estates in Medford http://www.worldskate.org/buy-kamagra-oral-jelly-uk/ put workers at risk of serious or fatal injuries by failing to comply with federal requirements to prevent falls, the leading cause of death in the construction industry.After multiple on-site investigations, the U.S. Department of Labor’s Occupational Safety and Health Administration cited the companies for exposing workers to falls and other dangerous safety hazards while erecting walls and sheathing roofs. OSHA initiated three of the inspections as part of its Regional Emphasis how do i get lasix Program on Falls in Construction. During the first on Oct. 20, 2020, the compliance officer observed workers exposed to falls and other hazards.

Inspectors observed the same hazards during a second inspection two days later, prompting the third inspection on Oct how do i get lasix. 31. After the three inspections, OSHA proposed total penalties of $244,397 and cited the companies collectively for four willful and 35 serious violations, including exposing workers to falls greater than 6 feet and not providing personal protective equipment. The how do i get lasix companies, citations and proposed penalties are. Company Name Address City State Citations Proposed Penalty Claudio DeSousa, operating as Lifetime Contractor Corp.

7132 South St. Philadelphia PA 2 willful 14 serious $107,279 how do i get lasix Lezinho Sousa, operating as Lifetime Contractor Corp. 3304 Cooper Ave. Pennsauken NJ 2 willful 9 serious $87,381 WSJ Construction 1302 how do i get lasix Monroe Ave. Asbury Park NJ 3 serious $16,383 Gustavo Quintomillno, operating as Lifetime Contractor Corp.

120 Elm Street, Beverly NJ 4 serious $12,874 LWJ Construction LLC 85 Lippincott Ave. Long Branch NJ 3 serious $12,288 RMM Contractor LLC 274 Morris Ave how do i get lasix. Long Branch NJ 2 serious $8,192 “A fall can permanently alter or end a worker’s life in a matter of seconds,” said OSHA Area Director Paula Dixon-Roderick in Marlton, New Jersey. €œContractors and subcontractors in the construction industry have a legal obligation to comply with the law and ensure their workers end their shifts safely. When employers fail to follow requirements, OSHA will hold them responsible to the fullest extent of the law.” OSHA encourages employers to use its Stop how do i get lasix Falls online resources, including detailed information on fall protection standards in English and Spanish.

The site offers fact sheets, posters and videos that illustrate various fall hazards and appropriate preventive measures. The companies have 15 business days from receipt of their citations and penalties to comply, request an informal conference with OSHA’s area director, or contest the findings before the independent Occupational Safety and Health Review Commission. Under the Occupational Safety and Health how do i get lasix Act of 1970, employers are responsible for providing safe and healthful workplaces for their employees. OSHA’s role is to help ensure these conditions for America’s working men and women by setting and enforcing standards, and providing training, education and assistance. Learn more about OSHA.MINNEAPOLIS – A Minnesota how do i get lasix lawn care and snow removal company took advantage of more than 70 temporary foreign workers – charging them higher rent than allowed, requiring them to pay for their international transportation and demanding payment to keep their jobs – all in violation of the federal H-2B Visa program.

The program helps supply employers with temporary foreign workers when sufficient numbers of U.S. Workers are not available.A U.S. Department of Labor investigation of Valdes Lawn Care and Snow Removal LLC in Lake Elmo has led to the recovery of $118,950 in back wages and $38,688 in liquidated damages for 72 employees for violations of how do i get lasix H-2B prevailing wage rate requirements and for violations of the overtime and record keeping provisions of the Fair Labor Standards Act. The company will also pay $127,561 in civil money penalties, and be debarred from eligibility to participate in the H-2B program for three years. The payments and the debarment are part of a consent judgment entered by an administrative law judge in Pittsburgh.

€œEmployers who exploit temporary how do i get lasix workers hurt both foreign and U.S. Workers,” said Wage and Hour Division Assistant District Director Kristin Tout in Minneapolis. €œThe Wage and Hour Division is committed to ensuring that all workers receive their hard-earned wages, and that employers using the H-2B visa program abide by all program requirements. Our enforcement protects how do i get lasix workers and levels the playing field for employers who play by the rules.” The division determined Valdes violated the H-2B Visa program when it. Failed to disclose that housing was available at a cost and then profited off workers by charging monthly rent fees that were higher than the cost to Valdes.

Demanded guest workers each pay them up to $800 as a condition how do i get lasix of employment. Failed to reimburse guest workers for travel expenses from and to their home countries, as required. Failed to offer guest workers at least 35 hours per workweek during the first months of the work season as required. Employed at how do i get lasix least four temporary foreign workers hired for landscaping and snow removal work to perform construction work. Misrepresented the need for workers.

For a four-month period, the employer had little to no work available. Failed how do i get lasix to provide workers with a copy of the job order outlining the terms and conditions of employment. Failed to post the mandatory Employee Rights Under the H-2B Program poster. Additionally, the company violated FLSA minimum wage and overtime requirements when it. Failed to how do i get lasix pay overtime after 40 hours in a work week and instead paid overtime only after 80 hours worked in a two-week pay period.

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Learn more about the Wage and Hour Division, including a search tool to use if you think you may be owed back wages collected by the division. COURT NO. Administrator, Wage and Hour Division, U.S. Department of Labor V. Valdes Lawn Care and Snow Removal LLC, 2020-TNE-00034.

MARLTON, NJ – Six contractors constructing luxury single-family homes at the future site of lasix price Hawthorne Estates in Medford put workers at risk of serious or fatal injuries by failing to comply with federal requirements to prevent falls, the leading cause of death in the construction industry.After multiple on-site investigations, the U.S. Department of Labor’s Occupational Safety and Health Administration cited the companies for exposing workers to falls and other dangerous safety hazards while erecting walls and sheathing roofs. OSHA initiated three lasix price of the inspections as part of its Regional Emphasis Program on Falls in Construction. During the first on Oct.

20, 2020, the compliance officer observed workers exposed to falls and other hazards. Inspectors observed the same hazards during a second inspection two days later, prompting the third lasix price inspection on Oct. 31. After the three inspections, OSHA proposed total penalties of $244,397 and cited the companies collectively for four willful and 35 serious violations, including exposing workers to falls greater than 6 feet and not providing personal protective equipment.

The lasix price companies, citations and proposed penalties are. Company Name Address City State Citations Proposed Penalty Claudio DeSousa, operating as Lifetime Contractor Corp. 7132 South St. Philadelphia PA 2 willful 14 serious $107,279 lasix price Lezinho Sousa, operating as Lifetime Contractor Corp.

3304 Cooper Ave. Pennsauken NJ 2 willful 9 lasix price serious $87,381 WSJ Construction 1302 Monroe Ave. Asbury Park NJ 3 serious $16,383 Gustavo Quintomillno, operating as Lifetime Contractor Corp. 120 Elm Street, Beverly NJ 4 serious $12,874 LWJ Construction LLC 85 Lippincott Ave.

Long Branch NJ 3 serious $12,288 lasix price RMM Contractor LLC 274 Morris Ave. Long Branch NJ 2 serious $8,192 “A fall can permanently alter or end a worker’s life in a matter of seconds,” said OSHA Area Director Paula Dixon-Roderick in Marlton, New Jersey. €œContractors and subcontractors in the construction industry have a legal obligation to comply with the law and ensure their workers end their shifts safely. When employers fail to follow requirements, OSHA will hold them responsible to the fullest extent of the law.” OSHA encourages employers to use its Stop lasix price Falls online resources, including detailed information on fall protection standards in English and Spanish.

The site offers fact sheets, posters and videos that illustrate various fall hazards and appropriate preventive measures. The companies have 15 business days from receipt of their citations and penalties to comply, request an informal conference with OSHA’s area director, or contest the findings before the independent Occupational Safety and Health Review Commission. Under the Occupational Safety and lasix price Health Act of 1970, employers are responsible for providing safe and healthful workplaces for their employees. OSHA’s role is to help ensure these conditions for America’s working men and women by setting and enforcing standards, and providing training, education and assistance.

Learn more about OSHA.MINNEAPOLIS – A Minnesota lawn care and snow removal company took advantage of more than 70 temporary foreign workers – charging them higher rent than allowed, requiring lasix price them to pay for their international transportation and demanding payment to keep their jobs – all in violation of the federal H-2B Visa program. The program helps supply employers with temporary foreign workers when sufficient numbers of U.S. Workers are not available.A U.S. Department of Labor investigation of Valdes Lawn Care and Snow Removal LLC in Lake Elmo has led to the recovery of $118,950 in back wages and $38,688 in liquidated damages for 72 employees for violations of H-2B prevailing wage rate requirements lasix price and for violations of the overtime and record keeping provisions of the Fair Labor Standards Act.

The company will also pay $127,561 in civil money penalties, and be debarred from eligibility to participate in the H-2B program for three years. The payments and the debarment are part of a consent judgment entered by an administrative law judge in Pittsburgh. €œEmployers who exploit temporary lasix price workers hurt both foreign and U.S. Workers,” said Wage and Hour Division Assistant District Director Kristin Tout in Minneapolis.

€œThe Wage and Hour Division is committed to ensuring that all workers receive their hard-earned wages, and that employers using the H-2B visa program abide by all program requirements. Our enforcement protects workers and levels the playing field for employers lasix price who play by the rules.” The division determined Valdes violated the H-2B Visa program when it. Failed to disclose that housing was available at a cost and then profited off workers by charging monthly rent fees that were higher than the cost to Valdes. Demanded guest workers each pay them up to $800 as a condition of employment lasix price.

Failed to reimburse guest workers for travel expenses from and to their home countries, as required. Failed to offer guest workers at least 35 hours per workweek during the first months of the work season as required. Employed at least four temporary foreign workers lasix price hired for landscaping and snow removal work to perform construction work. Misrepresented the need for workers.

For a four-month period, the employer had little to no work available. Failed to provide workers with a copy of the job order outlining the terms and conditions of lasix price employment. Failed to post the mandatory Employee Rights Under the H-2B Program poster. Additionally, the company violated FLSA minimum wage and overtime requirements when it.

Failed to pay overtime after 40 hours in a work week and instead lasix price paid overtime only after 80 hours worked in a two-week pay period. Failed to pay guest workers overtime at the required rates. Paid nine lasix price U.S. Workers flat salaries regardless of the number of hours that they worked, failing to pay overtime when they worked more than 40 hours in a workweek.

Failed to keep records of the number of hours employees actually worked by salaried workers, and by H-2B workers who performed construction and laborer work at the employer’s home. For more information about the H-2B Program, the FLSA and other laws enforced by the Wage and Hour Division, contact the division’s toll-free helpline at 866-4US-WAGE (487-9243). Learn more about the Wage and Hour Division, including a search tool to use if you think you may be owed back wages collected by the division. COURT NO.

Administrator, Wage and Hour Division, U.S. Department of Labor V. Valdes Lawn Care and Snow Removal LLC, 2020-TNE-00034.

Is lasix otc

The Henry Buy propecia J is lasix otc. Kaiser Family is lasix otc Foundation Headquarters. 185 Berry St., Suite 2000, San Francisco, CA 94107 | Phone 650-854-9400 Washington Offices and Barbara is lasix otc Jordan Conference Center.

1330 G Street, NW, Washington, DC 20005 | Phone 202-347-5270 www.kff.org | Email Alerts. Kff.org/email | facebook.com/KaiserFamilyFoundation | twitter.com/kff Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in San Francisco, California.President Trump and Democratic nominee Joe Biden hold widely divergent views on health issues, with the president’s record and response to is lasix otc the hypertension lasix likely to play a central role in November’s elections.A new KFF side-by-side comparison examines President Trump’s record and former Vice President Biden’s positions across a wide range of key health issues, including the response to the lasix, the Affordable Care Act marketplace, Medicaid, Medicare, drug prices, reproductive health, HIV, mental health and opioids, immigration and health coverage, and health costs.The resource provides a concise overview of the candidates’ positions on a range of health policy issues. While the Biden campaign has put forward many specific proposals, the Trump campaign has offered few new proposals for is lasix otc addressing health care in a second term and is instead running on his record in office.It is part of KFF’s ongoing efforts to provide useful information related to the health policy issues relevant for the 2020 elections, including policy analysis, polling, and journalism.

Find more on our Election 2020 resource page..

The Henry J lasix price visit our website. Kaiser Family lasix price Foundation Headquarters. 185 Berry lasix price St., Suite 2000, San Francisco, CA 94107 | Phone 650-854-9400 Washington Offices and Barbara Jordan Conference Center. 1330 G Street, NW, Washington, DC 20005 | Phone 202-347-5270 www.kff.org | Email Alerts. Kff.org/email | facebook.com/KaiserFamilyFoundation | lasix price twitter.com/kff Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in San Francisco, California.President Trump and Democratic nominee Joe Biden hold widely divergent views on health issues, with the president’s record and response to the hypertension lasix likely to play a central role in November’s elections.A new KFF side-by-side comparison examines President Trump’s record and former Vice President Biden’s positions across a wide range of key health issues, including the response to the lasix, the Affordable Care Act marketplace, Medicaid, Medicare, drug prices, reproductive health, HIV, mental health and opioids, immigration and health coverage, and health costs.The resource provides a concise overview of the candidates’ positions on a range of health policy issues.

While the Biden campaign has put forward many specific lasix price proposals, the Trump campaign has offered few new proposals for addressing health care in a second term and is instead running on his record in office.It is part of KFF’s ongoing efforts to provide useful information related to the health policy issues relevant for the 2020 elections, including policy analysis, polling, and journalism. Find more on our Election 2020 resource page..

Lasix diuretic side effects

By Robert Preidt HealthDay Reporter FRIDAY, Sept lasix diuretic side effects. 11, 2020 (HealthDay News) -- There may have been cases of hypertension medications in Los Angeles as early as last December, months before the first known U.S. Cases were identified, a new lasix diuretic side effects study claims. Researchers analyzed data from more than 10 million patient visit records for University of California, Los Angeles (UCLA) Health outpatient, emergency department and hospital facilities. They compared data from the period between Dec.

1, 2019, lasix diuretic side effects and Feb. 29, 2020, to data from the same months in the previous five years. Outpatient visits for coughs increased 50% in the months before the lasix, and exceeded the average number of visits for the same symptoms by more than 1,000 compared with the same time period in the previous five years. The researchers also found that in the months before the lasix, there was a significant increase in the number of patients with coughs seen at emergency departments, and in the number of patients hospitalized with acute respiratory failure lasix diuretic side effects. The study was published Sept.

10 in the Journal of Medical Internet Research. Other factors -- such as the flu and vaping -- could have contributed to some of the unexpected increase, but the findings show the importance lasix diuretic side effects of analyzing electronic health records to quickly identify unusual changes in patient patterns, according to the researchers. "For many diseases, data from the outpatient setting can provide an early warning to emergency departments and hospital intensive care units of what is to come," said study lead author Dr. Joann Elmore, a professor of medicine at UCLA's David Geffen School of Medicine. "The majority of hypertension medications studies evaluate hospitalization data, lasix diuretic side effects but we also looked at the larger outpatient clinic setting, where most patients turn first for medical care when illness and symptoms arise," she said in an UCLA news release.

"We may never truly know if these excess patients represented early and undetected hypertension medications cases in our area," Elmore said. "But the lessons learned from this lasix, paired with health care analytics that enable real-time surveillance of disease and symptoms, can potentially help us identify and track emerging outbreaks and future epidemics." WebMD News from HealthDay Sources SOURCE. University of California, Los Angeles, lasix diuretic side effects news release, Sept. 10, 2020 Copyright © 2013-2020 HealthDay. All rights reserved..

By Robert lasix price Preidt HealthDay Reporter FRIDAY, Sept. 11, 2020 (HealthDay News) -- There may have been cases of hypertension medications in Los Angeles as early as last December, months before the first known U.S. Cases were lasix price identified, a new study claims. Researchers analyzed data from more than 10 million patient visit records for University of California, Los Angeles (UCLA) Health outpatient, emergency department and hospital facilities.

They compared data from the period between Dec. 1, 2019, lasix price and Feb. 29, 2020, to data from the same months in the previous five years. Outpatient visits for coughs increased 50% in the months before the lasix, and exceeded the average number of visits for the same symptoms by more than 1,000 compared with the same time period in the previous five years.

The researchers also found that in the months before the lasix, there was a significant increase in the number of patients with coughs seen at emergency departments, and lasix price in the number of patients hospitalized with acute respiratory failure. The study was published Sept. 10 in the Journal of Medical Internet Research. Other factors -- such as the flu and vaping -- could have contributed to some of the unexpected increase, but the findings show the importance of analyzing electronic health records to quickly identify lasix price unusual changes in patient patterns, according to the researchers.

"For many diseases, data from the outpatient setting can provide an early warning to emergency departments and hospital intensive care units of what is to come," said study lead author Dr. Joann Elmore, a professor of medicine at UCLA's David Geffen School of Medicine. "The majority of hypertension medications studies evaluate hospitalization lasix price data, but we also looked at the larger outpatient clinic setting, where most patients turn first for medical care when illness and symptoms arise," she said in an UCLA news release. "We may never truly know if these excess patients represented early and undetected hypertension medications cases in our area," Elmore said.

"But the lessons learned from this lasix, paired with health care analytics that enable real-time surveillance of disease and symptoms, can potentially help us identify and track emerging outbreaks and future epidemics." WebMD News from HealthDay Sources SOURCE. University of California, Los Angeles, news release, Sept lasix price. 10, 2020 Copyright © 2013-2020 HealthDay. All rights reserved..

Lasix and metformin

Yesterday, we watched in horror as violent go right here insurgents breached our nation’s capitol, threatening not only the safety of our public servants, but also the will of the lasix and metformin American people, the tenets of the U.S. Constitution, and the health of our democracy. Today, we remain determined to lasix and metformin help pick up the pieces, look unflinchingly at the root causes, and work to move our country ever closer to the more perfect union in which we hold faith. As a company with deep roots in Washington D.C., today we are shaken, angry, and yet determined. Our mission to improve public well-being places lasix and metformin racial justice, human rights, and a deep commitment to diversity, equity, and inclusion at the core of our work.

We wish for peace and safety for our clients, partners, colleagues, friends, and fellow citizens, as we work to make progress together.Considerably more physicians joined health systems in recent years, especially in the Midwest and Northeast and in small to midsize markets, according to an article in the latest issue of Health Affairs. Because consolidation tends to lead to higher prices without strong evidence of quality improvements, an increase in consolidation has important implications for policymakers to consider lasix and metformin. Laura Kimmey, a senior researcher at Mathematica, and her coauthors provided new evidence on the rate of physician consolidation into health systems across U.S. Markets from 2016 to 2018, using data from the Agency for Healthcare Research and Quality (AHRQ) Compendium of U.S lasix for dogs cost. Health Systems and commercial data on physician-system lasix and metformin affiliation.

The research team from Mathematica and AHRQ found that physician consolidation into health systems increased in nearly all (92 percent) metropolitan statistical areas from 2016 to 2018. Of the 382 metropolitan statistical areas, 113 had lasix and metformin more than half of their physicians in health systems in 2018. Markets with the most growth in consolidation tended to also have sizeable increases in consolidation within the largest system in that market. The authors encourage policymakers to lasix and metformin consider closely monitoring competition at the market level and suggest approaches that might curb costs and anticompetitive practices that could result from increased consolidation. They also encourage further study of the effects of local market consolidation of physician services into vertically integrated health systems on the cost and quality of care and on access to care.

Explore more findings about health systems from Mathematica’s work as the Coordinating Center for the Comparative Health System Performance Initiative..

Yesterday, we watched in horror as violent insurgents breached our nation’s capitol, threatening not only the safety of our public servants, but also the will of lasix price the American people, the tenets of the U.S. Constitution, and the health of our democracy. Today, we remain determined to help lasix price pick up the pieces, look unflinchingly at the root causes, and work to move our country ever closer to the more perfect union in which we hold faith. As a company with deep roots in Washington D.C., today we are shaken, angry, and yet determined.

Our mission to improve public well-being places racial justice, human rights, and lasix price a deep commitment to diversity, equity, and inclusion at the core of our work. We wish for peace and safety for our clients, partners, colleagues, friends, and fellow citizens, as we work to make progress together.Considerably more physicians joined health systems in recent years, especially in the Midwest and Northeast and in small to midsize markets, according to an article in the latest issue of Health Affairs. Because consolidation tends to lead to higher prices without strong evidence of quality improvements, an increase in consolidation has important implications for policymakers lasix price to consider. Laura Kimmey, a senior researcher at Mathematica, and her coauthors provided new evidence on the rate of physician consolidation into health systems across U.S.

Markets from 2016 to 2018, using data from the Agency for Healthcare Research and Quality (AHRQ) Compendium of U.S. Health Systems and commercial data on lasix price physician-system affiliation. The research team from Mathematica and AHRQ found that physician consolidation into health systems increased in nearly all (92 percent) metropolitan statistical areas from 2016 to 2018. Of the 382 metropolitan lasix price statistical areas, 113 had more than half of their physicians in health systems in 2018.

Markets with the most growth in consolidation tended to also have sizeable increases in consolidation within the largest system in that market. The authors encourage policymakers to consider closely monitoring competition at the market level and suggest approaches that might curb costs and lasix price anticompetitive practices that could result from increased consolidation. They also encourage further study of the effects of local market consolidation of physician services into vertically integrated health systems on the cost and quality of care and on access to care. Explore more findings about health systems from Mathematica’s work as the Coordinating Center for the Comparative Health System Performance Initiative..

Vetmedin and lasix

User Experience (UX) Design is the process of enhancing a persons experience with a given product, system or service. UX involves an in depth understanding of a users behaviors, attitudes, and emotions in order to create a successful design.
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Vetmedin and lasix

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