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Johns Hopkins researchers say that a drug approved to treat lung cancer substantially slowed the growth of tumors, in mice, caused low price kamagra by a rare form of bone cancer. Reporting in the journal PLOS ONE, the researchers say the finding offers hope to chordoma patients, who have no treatment options once surgery and radiation have been exhausted. There are no low price kamagra U.S. Food and Drug Administration-approved medications for the disease and, because its incidence is only one in 1 million, there is little financial incentive for pharmaceutical companies to develop or test drugs to treat them. €œThe encouraging news is that low price kamagra this drug is already used in humans to treat lung cancer,” says study leader Gary L.

Gallia, M.D., Ph.D., an assistant professor of neurosurgery and oncology at the Johns Hopkins University School of Medicine. Chordoma occurs at the base of the skull and in the bones of the spine. This cancer low price kamagra is thought to arise from remnants of the cartilage-like structure that serves as a scaffold for the formation of the spinal column. These so-called notochord cells normally persist after birth and are lodged inside the spine and skull. In rare cases, they become low price kamagra malignant tumors.

The tumors are generally slow-growing but tend to recur, and their proximity to critical structures such as the spinal cord, cranial nerves and brain stem make them difficult to treat. Median survival time is seven years after diagnosis. Since chordoma is so rare, low price kamagra few models have existed to even study it outside cells in a petri dish, says Gallia, who together with colleagues last year developed a mouse model of the disorder. The model was created by implanting human tumor tissue into a mouse. The researchers began their drug studies low price kamagra by first examining the makeup of the tumor cells in their mouse model to determine what might be causing the cells to grow and divide uncontrolled.

They saw that the epidermal growth factor receptor (EGFR) pathway was active and suspected that it played a critical role in the malignancy. Gallia and his colleagues tested two FDA-approved drugs known to inhibit EGFR and found that erlotinib was able to better slow the growth of chordoma than gefitinib. They then tested low price kamagra erlotinib in mice transplanted with human chordoma tumors. After 37 days of treatment, the average tumor volume in the control group was more than three times larger than in those animals that were treated with erlotinib. Further research indicated that EGFR activation was low price kamagra significantly reduced.

€œWe hit our target,” Gallia says. €œIt drastically reduced the growth of the tumors.” Gallia says he hopes his findings will lead to testing in chordoma patients. Although a controlled clinical trial would be ideal, he says it may be difficult to low price kamagra get funding to test treatments for such a rare disease. Alternatively, he says he hopes erlotinib might be used in selected patients whose tumors are shown to have active EGFRs and who have run out of other treatment options. This research was supported by the Chordoma Foundation as well low price kamagra as Dr.

And Mrs. Irving J. Sherman. Other Johns Hopkins researchers involved in the study include I-Mei Siu, Ph.D.. Jacob Ruzevick.

Qi Zhao, Ph.D.. Nick Connis. Yuchen Jiao, Ph.D.. Chetan Bettegowda, M.D., Ph.D.. Xuewei Xia, M.D..

Peter C. Burger, M.D.. And Christine L. Hann, M.D., Ph.D. For more information about Gallia, click here, and click here for more information about chordoma care at Johns Hopkins.Using cervical fluid obtained during routine Pap tests, scientists at the Johns Hopkins Kimmel Cancer Center have developed a test to detect ovarian and endometrial cancers.

In a pilot study, the “PapGene” test, which relies on genomic sequencing of cancer-specific mutations, accurately detected all 24 (100 percent) endometrial cancers and nine of 22 (41 percent) ovarian cancers. Results of the experiments are published in the Jan. 9 issue of the journal Science Translational Medicine. The investigators note that larger-scale studies are needed before clinical implementation can begin, but they believe the test has the potential to pioneer genomic-based cancer screening tests. The Papanicolaou (Pap) test, during which cells collected from the cervix are examined for microscopic signs of cancer, is widely and successfully used to screen for cervical cancers.

However, no routine screening method is available for ovarian or endometrial cancers. Since the Pap test occasionally contains cells shed from the ovaries or endometrium, cancer cells arising from these organs could be present in the fluid as well, says Luis Diaz, M.D., associate professor of oncology at Johns Hopkins, as well as director of translational medicine at the Ludwig Center for Cancer Genetics and Therapeutics and director of the Swim Across America Laboratory, also at Johns Hopkins. The laboratory is sponsored by a volunteer organization that raises funds for cancer research through swim events. €œOur genomic sequencing approach may offer the potential to detect these cancer cells in a scalable and cost-effective way,” adds Diaz. Hear Diaz discuss the research in this podcast, courtesy of the American Association for the Advancement of Science, and watch an animation describing the PapGene test.

Cervical fluid of patients with gynecologic cancer carries normal cellular DNA mixed together with DNA from cancer cells, according to the investigators. The investigators’ task was to use genomic sequencing to distinguish cancerous from normal DNA. The scientists had to determine the most common genetic changes in ovarian and endometrial cancers in order to prioritize which genomic regions to include in their test. They searched publicly available genome-wide studies of ovarian cancer, including those done by other Johns Hopkins investigators, to find mutations specific to ovarian cancer. Such genome-wide studies were not available for the most common type of endometrial cancer, so they conducted genome-wide sequencing studies on 22 of these endometrial cancers.

From the ovarian and endometrial cancer genome data, the Johns Hopkins-led team identified 12 of the most frequently mutated genes in both cancers and developed the PapGene test with this insight in mind. The investigators then applied PapGene on Pap test samples from ovarian and endometrial cancer patients at The Johns Hopkins Hospital, Memorial Sloan-Kettering Cancer Center, the University of São Paulo in Brazil and ILSbio, a tissue bank. The new test detected both early- and late-stage disease in the endometrial and ovarian cancers tested. No healthy women in the control group were misclassified as having cancer. The investigators’ next steps include applying PapGene on more samples and working to increase the test’s sensitivity in detecting ovarian cancer.

€œPerforming the test at different times during the menstrual cycle, inserting the cervical brush deeper into the cervical canal, and assessing more regions of the genome may boost the sensitivity,” says Chetan Bettegowda, M.D., Ph.D., assistant professor of neurosurgery at Johns Hopkins and a member of the Ludwig Center as well. Together, ovarian and endometrial cancers are diagnosed in nearly 70,000 women in the United States each year, and about one-third of them will die from it. €œGenomic-based tests could help detect ovarian and endometrial cancers early enough to cure more of them,” says graduate student Yuxuan Wang, who notes that the cost of the test could be similar to current cervical fluid HPV testing, which is less than $100. PapGene is a high-sensitivity approach for the detection of cancer-specific DNA mutations, according to the investigators. However, false mutations can be erroneously created during the many steps — including amplification, sequencing and analysis — required to prepare the DNA collected from a Pap test specimen for sequencing.

This required the investigators to build a safeguard into PapGene’s sequencing method, designed to weed out artifacts that could lead to misleading test results. €œIf unaccounted for, artifacts could lead to a false positive test result and incorrectly indicate that a healthy person has cancer,” says graduate student Isaac Kinde. Kinde added a unique genetic barcode — a random set of 14 DNA base pairs — to each DNA fragment at an initial stage of the sample preparation process. Although each DNA fragment is copied many times before eventually being sequenced, all of the newly copied DNA can be traced back to one original DNA molecule through their genetic barcodes. If the copies originating from the same DNA molecule do not all contain the same mutation, then an artifact is suspected and the mutation is disregarded.

However, bonafide mutations, which exist in the sample before the initial barcoding step, will be present in all of the copies originating from the original DNA molecule. Funding for the research was provided by Swim Across America, the Commonwealth Fund, the Hilton-Ludwig Cancer Prevention Initiative, the Virginia &. D.K. Ludwig Fund for Cancer Research, the Experimental Therapeutics Center of the Memorial Sloan-Kettering Cancer Center, the Chia Family Foundation, The Honorable Tina Brozman Foundation, the United Negro College Fund/Merck Graduate Science Research Dissertation Fellowship, the Burroughs Wellcome Career Award for Medical Scientists, the National Colorectal Cancer Research Alliance and the National Institutes of Health’s National Cancer Institute (N01-CN-43309, CA129825, CA43460). In addition to Kinde, Bettegowda, Wang and Diaz, investigators participating in the research include Jian Wu, Nishant Agrawal, Ie-Ming Shih, Robert Kurman, Robert Giuntoli, Richard Roden and James R.

Eshleman from Johns Hopkins. Nickolas Papadopoulos, Kenneth Kinzler and Bert Vogelstein from the Ludwig Center at Johns Hopkins. Fanny Dao and Douglas A. Levine from Memorial Sloan-Kettering Cancer Center. And Jesus Paula Carvalho and Suely Kazue Nagahashi Marie from the University of São Paulo.

Papadopoulos, Kinzler, Vogelstein and Diaz are co-founders of Inostics and Personal Genome Diagnostics. They own stocks in the companies and are members of their Scientific Advisory Boards. Inostics and Personal Genome Diagnostics have licensed several patent applications from Johns Hopkins. These relationships are subject to certain restrictions under The Johns Hopkins University policy, and the terms of these arrangements are managed by the university in accordance with its conflict-of-interest policies..

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Lauren Gambill, MDPediatrician, AustinMember, Texas Medical Association (TMA) Committee on Child and Adolescent HealthExecutive Board Member, Texas Pediatric cheap kamagra jelly SocietyDoctors are community leaders. This role has become even more important during the COVID-19 pandemic. As patients navigate our new reality, they are looking to us to determine what is safe, how to protect their families, cheap kamagra jelly and the future of their health care. As more Texans lose their jobs, their health insurance, or even their homes, it is crucial that Texas receives the resources it needs to uphold our social safety net. The U.S.

Census helps determine funding for those resources, and that is why it is of the upmost importance cheap kamagra jelly that each and every Texan, no matter address, immigration status, or age, respond to the 2020 U.S. Census. The deadline has been cut short one month and now closes Sept cheap kamagra jelly. 30.COVID-19 has only increased the importance of completing the census to help our local communities and economies recover. The novel coronavirus has inflicted unprecedented strain on patients and exacerbated inequality as more people are out of work and are many in need of help with food, health care, housing, and more.

Schools also have been stretched thin, with teachers scrambling to teach students online cheap kamagra jelly. Yet, the amount of federal funding Texas has available today to help weather this emergency was driven in part by the census responses made a decade ago. Getting an accurate count in 2020 will help Texans prepare for the decade to follow, the first few years of which most certainly will be spent rebuilding from the pandemic’s fallout. Therefore, it is vital that all Texans be counted.The cheap kamagra jelly federal dollars Texas receives generally depends on our population. A George Washington University study recently found that even a 1% undercount can lead to a $300 million loss in funding.Take Medicaid, for example.

Federal funds pay for 60% of the state’s program, cheap kamagra jelly which provides health coverage for two out of five Texas children, one in three individuals with disabilities, and 53% of all births. The complicated formula used to calculate the federal portion of this funding depends on accurate census data. If Texas’ population is undercounted, Texans may appear better off financially than they really are, resulting in Texas getting fewer federal Medicaid dollars. If that happens, lawmakers will have to make up the difference, with cuts in services, program eligibility, or physician and provider payments, any of which are potentially detrimental.The census data also is key to funding other aspects of a community’s social safety net:Health careThe Children’s Health Insurance Program (CHIP) cheap kamagra jelly provides low-cost health insurance to children whose parents make too much to qualify for Medicaid, but not enough to afford quality coverage. Like Medicaid, how much money the federal government reimburses the state for the program depends in part on the census.Maternal and child health programs that promote public health and help ensure children are vaccinated relies on data from the census.

Texas also uses this federal funding to study cheap kamagra jelly and respond to maternal mortality and perinatal depression.Food and housing As unemployment rises and families struggle financially, many live with uncertainty as to where they will find their next meal. Already, one in seven Texans experiences food insecurity, and 20% of Texas children experience hunger. Food insecurity is rising in Texas as the pandemic continues. The Central Texas Food Bank saw a 206% rise in clients in March cheap kamagra jelly. Funding for the Supplemental Nutrition Assistance Program and school lunch programs are both determined by the census.

Funding for local housing programs also is calculated via the census. An accurate count will help cheap kamagra jelly ensure that people who lose their homes during this economic crisis have better hope of finding shelter while our communities recover. Homelessness is closely connected with declines in overall physical and mental health.Childcare and educationAs we navigate the new reality brought on by coronavirus, more parents are taking on roles as breadwinner, parent, teacher, and caretaker. This stress highlights the desperate need for affordable childcare cheap kamagra jelly. The census determines funding for programs like Head Start that provide comprehensive early childhood education to low-income families.

The good news is you still have time to complete the census. Visit 2020census.gov cheap kamagra jelly to take it. It takes less than five minutes to complete. Then talk to your family, cheap kamagra jelly neighbors, and colleagues about doing the same. If you are wondering who counts, the answer is everyone, whether it’s a newborn baby, child in foster care, undocumented immigrant, or an individual experiencing homelessness.Completing the census is one of the best things that you can do for the health of your community, especially during the pandemic.

Thank you for helping Texas heal and for supporting these essential safety net programs.(L to R). UTHSA medical students Swetha Maddipudi, Brittany Hansen, Charles Wang, Carson Cortino, faculty advisor Kaparaboyna Kumar, MD, Ryan Wealther, Sidney Akabogu, Irma Ruiz, cheap kamagra jelly and Frank Jung pose with the TMA Be Wise Immunize banner. Photo courtesy by Ryan WealtherRyan WealtherMedical Student, UT Health San Antonio Long School of MedicineStudent Member, Texas Medical AssociationEditor’s Note. August is National Immunization Awareness Month. This article cheap kamagra jelly is part of a Me&My Doctor series highlighting and promoting the use of vaccinations.“Can the flu shot give you the flu?.

€â€œIs it dangerous for pregnant women to get a flu shot?. €â€œCan vaccines cause cheap kamagra jelly autism?. €These were questions women at Alpha Home, a residential substance abuse rehabilitation center in San Antonio, asked my fellow medical students and me during a flu vaccine discussion. It is easy to see why these questions were asked, as vaccine misinformation is common today.UTHSA medical student Frank Jing (left) gets a vaccine fromKaparaboyna Kumar, MD, (right).Photo courtesy of Ryan Wealther“No” is the answer to all the questions. These were exactly the types of myths we set out to dispel at our vaccination drive.UT Health San Antonio Long School of Medicine medical students (under the supervision of Kaparaboyna Ashok Kumar, MD, faculty advisor for the Texas Medical Association Medical Student Section at UT Health San Antonio) hosted the vaccine drive at Alpha Home with the support of TMA’s cheap kamagra jelly Be Wise – Immunize℠ program, a public health initiative that aims to increase vaccinations and vaccine awareness through shot clinics and education.

Our program consisted of a vaccination drive and an interactive, educational presentation that addressed influenza, common flu shot questions, and general vaccine myths. The Alpha cheap kamagra jelly Home residents could ask us questions during the program.We were interested to see if our educational program could answer Alpha Home residents’ questions about vaccinations and allay their hesitations about getting a flu vaccination. To gauge this, we created a brief survey.(Before I discuss the results of the survey, I should define vaccine hesitancy. Vaccine hesitancy is a concept defined by the World Health Organization. It relates to when patients do not cheap kamagra jelly vaccinate despite having access to vaccines.

Vaccine hesitancy is a problem because it prevents individuals from receiving their vaccinations. That makes them more susceptible to getting sick from vaccine-preventable diseases.)We surveyed the residents’ opinions about vaccinations before and after our educational program. While opinions about shots improved with each survey question, we saw the most significant attitude change reflected cheap kamagra jelly in answers to the questions “I am concerned that vaccinations might not be safe,” and “How likely are you to receive a flu shot today?. € We had informed the residents and improved their understanding and acceptance of immunizations.Post-survey results show more residents at the Alpha Home shifted to more positive attitudes about vaccines, after learning more about their effectiveness by trusted members of the medical community. Graph by cheap kamagra jelly Ryan WealtherWhy is this important?.

First, our findings confirm what we already knew. Education by a trusted member of the medical community can effect change. In fact, it is widely known that cheap kamagra jelly physician recommendation of vaccination is one of the most critical factors affecting whether patients receive an influenza vaccination. Perhaps some added proof to this is that a few of the Alpha Home residents were calling me “Dr. Truth” by the cheap kamagra jelly end of the evening.Second, our findings add to our understanding of adult vaccine hesitancy.

This is significant because most of what we know about vaccine hesitancy is limited to parental attitudes toward their children’s vaccinations. Some parents question shots for their children, and many of the most deadly diseases we vaccinate against are given in childhood, including polio, tetanus, measles, and whooping cough shots. However, adults need some vaccinations as well, like the cheap kamagra jelly yearly influenza vaccine. After taking part in the UTHSA educational program, more residents at the Alpha Home shared more willingness to receive the flu vaccine. Graph by Ryan WealtherAnother reason improving attitudes is important is that receiving a flu shot is even more timely during the COVID-19 pandemic because it decreases illnesses and conserves health care resources.

Thousands of people each year are hospitalized cheap kamagra jelly from the flu, and with hospitals filling up with coronavirus patients, we could avoid adding dangerously ill flu patients to the mix. Lastly, these findings are important because once a COVID-19 vaccination becomes available, more people might be willing to receive it if their overall attitude toward immunizations is positive. Though the COVID-19 vaccine is still in development, it is not immune to vaccine cheap kamagra jelly hesitancy. Recent polls have indicated up to one-third of Americans would not receive a COVID-19 vaccine even if it were accessible and affordable. Work is already being done to try to raise awareness and acceptance.

In addition, misinformation cheap kamagra jelly about the COVID vaccine is circulating widely. (Someone recently asked me if the COVID vaccine will implant a microchip in people, and I have seen the same myth circulating on social media. It will not.) This myth, however, illustrates the need for health care professionals to answer patients’ questions and to assuage their concerns.Vaccines work best when many people in a community receive them, and vaccine hesitancy cheap kamagra jelly can diminish vaccination rates, leaving people who can't get certain vaccines susceptible to these vaccine-preventable diseases. For example, babies under 6 months of age should not receive a flu shot, so high community vaccination rates protect these babies from getting sick with the flu. Our educational program at Alpha Home is just one example of how health care professionals can increase awareness and acceptance of shots.

As the COVID-19 pandemic progresses, we need to cheap kamagra jelly ensure children and adults receive their vaccinations as recommended by their physician and the Centers for Disease Control and Prevention. I encourage readers who have questions about the vaccinations they or their child may need to talk with their physician. As health care professionals, we’re more than happy to answer your questions..

Lauren Gambill, MDPediatrician, AustinMember, Texas Medical Association (TMA) low price kamagra Committee on Child and Adolescent HealthExecutive Board Member, Texas Pediatric SocietyDoctors are community leaders. This role has become even more important during the COVID-19 pandemic. As patients navigate our new reality, they are looking to us to determine what is safe, how to protect their families, low price kamagra and the future of their health care. As more Texans lose their jobs, their health insurance, or even their homes, it is crucial that Texas receives the resources it needs to uphold our social safety net.

The U.S. Census helps determine funding for those resources, and that is why it is of the upmost importance that each and every Texan, no matter address, immigration status, low price kamagra or age, respond to the 2020 U.S. Census. The deadline has been cut short one month low price kamagra and now closes Sept.

30.COVID-19 has only increased the importance of completing the census to help our local communities and economies recover. The novel coronavirus has inflicted unprecedented strain on patients and exacerbated inequality as more people are out of work and are many in need of help with food, health care, housing, and more. Schools also low price kamagra have been stretched thin, with teachers scrambling to teach students online. Yet, the amount of federal funding Texas has available today to help weather this emergency was driven in part by the census responses made a decade ago.

Getting an accurate count in 2020 will help Texans prepare for the decade to follow, the first few years of which most certainly will be spent rebuilding from the pandemic’s fallout. Therefore, it is vital that all Texans be low price kamagra counted.The federal dollars Texas receives generally depends on our population. A George Washington University study recently found that even a 1% undercount can lead to a $300 million loss in funding.Take Medicaid, for example. Federal funds pay for 60% of the state’s program, which provides low price kamagra health coverage for two out of five Texas children, one in three individuals with disabilities, and 53% of all births.

The complicated formula used to calculate the federal portion of this funding depends on accurate census data. If Texas’ population is undercounted, Texans may appear better off financially than they really are, resulting in Texas getting fewer federal Medicaid dollars. If that happens, lawmakers will have to make up the difference, with cuts in services, program eligibility, or low price kamagra physician and provider payments, any of which are potentially detrimental.The census data also is key to funding other aspects of a community’s social safety net:Health careThe Children’s Health Insurance Program (CHIP) provides low-cost health insurance to children whose parents make too much to qualify for Medicaid, but not enough to afford quality coverage. Like Medicaid, how much money the federal government reimburses the state for the program depends in part on the census.Maternal and child health programs that promote public health and help ensure children are vaccinated relies on data from the census.

Texas also uses this federal funding to study and respond to maternal mortality and perinatal depression.Food and housing As unemployment rises low price kamagra and families struggle financially, many live with uncertainty as to where they will find their next meal. Already, one in seven Texans experiences food insecurity, and 20% of Texas children experience hunger. Food insecurity is rising in Texas as the pandemic continues. The Central Texas Food Bank saw a 206% rise low price kamagra in clients in March.

Funding for the Supplemental Nutrition Assistance Program and school lunch programs are both determined by the census. Funding for local housing programs also is calculated via the census. An accurate count will help ensure that people who lose their homes low price kamagra during this economic crisis have better hope of finding shelter while our communities recover. Homelessness is closely connected with declines in overall physical and mental health.Childcare and educationAs we navigate the new reality brought on by coronavirus, more parents are taking on roles as breadwinner, parent, teacher, and caretaker.

This stress low price kamagra highlights the desperate need for affordable childcare. The census determines funding for programs like Head Start that provide comprehensive early childhood education to low-income families. The good news is you still have time to complete the census. Visit 2020census.gov to low price kamagra take it.

It takes less than five minutes to complete. Then talk to your family, neighbors, and colleagues about doing the same low price kamagra. If you are wondering who counts, the answer is everyone, whether it’s a newborn baby, child in foster care, undocumented immigrant, or an individual experiencing homelessness.Completing the census is one of the best things that you can do for the health of your community, especially during the pandemic. Thank you for helping Texas heal and for supporting these essential safety net programs.(L to R).

UTHSA medical students Swetha Maddipudi, Brittany Hansen, Charles Wang, Carson Cortino, faculty advisor Kaparaboyna Kumar, MD, Ryan Wealther, Sidney low price kamagra Akabogu, Irma Ruiz, and Frank Jung pose with the TMA Be Wise Immunize banner. Photo courtesy by Ryan WealtherRyan WealtherMedical Student, UT Health San Antonio Long School of MedicineStudent Member, Texas Medical AssociationEditor’s Note. August is National Immunization Awareness Month. This article is part of a Me&My Doctor series highlighting and promoting the use of vaccinations.“Can the flu shot give low price kamagra you the flu?.

€â€œIs it dangerous for pregnant women to get a flu shot?. €â€œCan vaccines cause low price kamagra autism?. €These were questions women at Alpha Home, a residential substance abuse rehabilitation center in San Antonio, asked my fellow medical students and me during a flu vaccine discussion. It is easy to see why these questions were asked, as vaccine misinformation is common today.UTHSA medical student Frank Jing (left) gets a vaccine fromKaparaboyna Kumar, MD, (right).Photo courtesy of Ryan Wealther“No” is the answer to all the questions.

These were exactly the types of myths we set out to dispel at our vaccination drive.UT Health San Antonio Long School of Medicine medical students (under the supervision of Kaparaboyna Ashok Kumar, MD, faculty advisor for the Texas Medical Association Medical Student Section at UT Health San Antonio) hosted the vaccine drive at Alpha Home with the support of TMA’s Be Wise – Immunize℠ program, a public health initiative that aims to increase vaccinations and vaccine awareness through low price kamagra shot clinics and education. Our program consisted of a vaccination drive and an interactive, educational presentation that addressed influenza, common flu shot questions, and general vaccine myths. The Alpha Home residents could ask us questions during the program.We were interested to see if our educational program could low price kamagra answer Alpha Home residents’ questions about vaccinations and allay their hesitations about getting a flu vaccination. To gauge this, we created a brief survey.(Before I discuss the results of the survey, I should define vaccine hesitancy.

Vaccine hesitancy is a concept defined by the World Health Organization. It relates to when patients do not vaccinate despite low price kamagra having access to vaccines. Vaccine hesitancy is a problem because it prevents individuals from receiving their vaccinations. That makes them more susceptible to getting sick from vaccine-preventable diseases.)We surveyed the residents’ opinions about vaccinations before and after our educational program.

While opinions about shots improved with each survey question, we saw the most significant attitude change reflected in answers to the questions “I am concerned that vaccinations might not be safe,” and “How likely are you to receive a flu shot today? low price kamagra. € We had informed the residents and improved their understanding and acceptance of immunizations.Post-survey results show more residents at the Alpha Home shifted to more positive attitudes about vaccines, after learning more about their effectiveness by trusted members of the medical community. Graph by Ryan low price kamagra WealtherWhy is this important?. First, our findings confirm what we already knew.

Education by a trusted member of the medical community can effect change. In fact, it is widely known that physician recommendation low price kamagra of vaccination is one of the most critical factors affecting whether patients receive an influenza vaccination. Perhaps some added proof to this is that a few of the Alpha Home residents were calling me “Dr. Truth” by the end of the evening.Second, our findings add to our understanding low price kamagra of adult vaccine hesitancy.

This is significant because most of what we know about vaccine hesitancy is limited to parental attitudes toward their children’s vaccinations. Some parents question shots for their children, and many of the most deadly diseases we vaccinate against are given in childhood, including polio, tetanus, measles, and whooping cough shots. However, adults low price kamagra need some vaccinations as well, like the yearly influenza vaccine. After taking part in the UTHSA educational program, more residents at the Alpha Home shared more willingness to receive the flu vaccine.

Graph by Ryan WealtherAnother reason improving attitudes is important is that receiving a flu shot is even more timely during the COVID-19 pandemic because it decreases illnesses and conserves health care resources. Thousands of people each year are hospitalized from the flu, and with hospitals filling low price kamagra up with coronavirus patients, we could avoid adding dangerously ill flu patients to the mix. Lastly, these findings are important because once a COVID-19 vaccination becomes available, more people might be willing to receive it if their overall attitude toward immunizations is positive. Though the COVID-19 vaccine is still in development, it is not immune to vaccine low price kamagra hesitancy.

Recent polls have indicated up to one-third of Americans would not receive a COVID-19 vaccine even if it were accessible and affordable. Work is already being done to try to raise awareness and acceptance. In addition, misinformation about the COVID vaccine is circulating widely low price kamagra. (Someone recently asked me if the COVID vaccine will implant a microchip in people, and I have seen the same myth circulating on social media.

It will not.) This myth, however, illustrates the need for health care professionals to answer patients’ questions and to assuage their concerns.Vaccines work best when many people in a community receive them, and vaccine hesitancy can diminish vaccination rates, leaving people who can't get certain vaccines susceptible low price kamagra to these vaccine-preventable diseases. For example, babies under 6 months of age should not receive a flu shot, so high community vaccination rates protect these babies from getting sick with the flu. Our educational program at Alpha Home is just one example of how health care professionals can increase awareness and acceptance of shots. As the COVID-19 pandemic progresses, we need low price kamagra to ensure children and adults receive their vaccinations as recommended by their physician and the Centers for Disease Control and Prevention.

I encourage readers who have questions about the vaccinations they or their child may need to talk with their physician. As health care professionals, we’re more than happy to answer your questions..

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The International Journal of can you buy kamagra over the counter usa Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on lung health world-wide. To share scientific research of immediate concern as rapidly as possible, The Union is fast-tracking the publication of certain articles from the IJTLD and publishing them on The Union website, prior to their publication in the Journal.

Read fast-track articles.Certain IJTLD articles are also selected for translation into French, Spanish, Chinese or can you buy kamagra over the counter usa Russian. These are available on the Union website.Editorial BoardInformation for AuthorsSubscribe to this TitleInternational Journal of Tuberculosis and Lung DiseasePublic Health ActionIngenta Connect is not responsible for the content or availability of external websitesNo AbstractNo Reference information available - sign in for access. No Supplementary Data.No Article MediaNo MetricsDocument Type.

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[email protected]Publication date:01 July 2020More about this publication?. The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of can you buy kamagra over the counter usa lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on lung health world-wide.

To share scientific research of immediate concern as rapidly as possible, The Union is fast-tracking the publication of certain articles from the IJTLD and publishing them on The Union website, prior to their publication in the Journal. Read fast-track articles.Certain IJTLD articles are also selected for translation into French, Spanish, Chinese or Russian.

UCSF Pulmonary Rehabilitation and low price kamagra Sleep Disorders Center 4. Division of Pulmonary and Critical Care Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, San Francisco, CA, USA, , Email. [email protected]Publication date:01 July 2020More about this publication?. The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung low price kamagra health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on lung health world-wide.

To share scientific research of immediate concern as rapidly as possible, The Union is fast-tracking the publication of certain articles from the IJTLD and publishing them on The Union website, prior to their publication in the Journal. Read fast-track articles.Certain IJTLD articles are also selected for translation into French, low price kamagra Spanish, Chinese or Russian. These are available on the Union website.Editorial BoardInformation for AuthorsSubscribe to this TitleInternational Journal of Tuberculosis and Lung DiseasePublic Health ActionIngenta Connect is not responsible for the content or availability of external websitesNo AbstractNo Reference information available - sign in for access. No Supplementary Data.No Article MediaNo MetricsDocument Type. Research ArticleAffiliations:1.

Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil low price kamagra 2. Center for Infectious Disease Epidemiology and Surveillance, National Institute of Public Health and the Environment, Bilthoven, The Netherlands, , Email. [email protected]Publication date:01 July 2020More about this publication?. The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, low price kamagra epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on lung health world-wide.

To share scientific research of immediate concern as rapidly as possible, The Union is fast-tracking the publication of certain articles from the IJTLD and publishing them on The Union website, prior to their publication in the Journal. Read fast-track articles.Certain IJTLD articles are also selected for translation into French, Spanish, Chinese or Russian.

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October 9, 2020Our file ajanta kamagra number. 20-113699-873 As a standing regulatory member of the International Council for Harmonisation (ICH), Health Canada is committed to the adoption and implementation of all ICH guidance. By way of this Notice, ajanta kamagra Health Canada is advising of its intent to implement ICH Q12.

Technical and Regulatory Considerations for Pharmaceutical Product Lifecycle Management and the ICH Q12 associated annexes. This guidance has been developed by the appropriate ICH Expert Working Group ajanta kamagra and has been subject to consultation by the regulatory parties, in accordance with the ICH Process. The ICH Assembly has endorsed the final draft and recommended its implementation by membership of ICH.

The target timeframe for Health Canada implementation of ICH Q12 has been set to the third quarter of 2021 in order to allow sufficient time for the preparation of regulators and stakeholders. Health Canada will be launching a stakeholder consultation in early 2021 to gather feedback on the final elements of ajanta kamagra the implementation of the Q12 guidance in Canada.This new Guideline is proposed to provide a framework to facilitate the management of post-approval Chemistry, Manufacturing and Controls (CMC) changes in a more predictable and efficient manner across the product lifecycle. Implementation of this new ICH Guideline will promote innovation and continual improvement in the biopharmaceutical sector and strengthen quality assurance and reliable supply of product, including proactive planning of supply chain adjustments.

It will allow regulators (assessors and ajanta kamagra inspectors) to better understand the firms' Pharmaceutical Quality Systems (PQSs) for management of post-approval CMC changes.ICH Q12 should be read in conjunction with this accompanying notice and with the relevant sections of other applicable Health Canada guidances. This and other ICH Guidance documents are available on the ICH Website. Please note that the ICH website is only available in ajanta kamagra English.

If you would like to request a copy of the French version of the document, please contact the HPFB ICH inbox.Contact InformationFor any comments or inquiries related to this notice, please contact:Health Canada – ICH CoordinatorE-mail. Hc.ich.sc@canada.ca Please include "Implementation of ICH Q12" in the subject line.The Register of Innovative Drugs is maintained pursuant to C.08.004.1 of the Food and Drug Regulations. The register ajanta kamagra indicates the drugs that are eligible for data protection.

Under C.08.004.1 (3) a subsequent manufacturer that seeks a notice of compliance on the basis of a direct or indirect comparison between the new drug and an innovative drug may not file a submission before the end of a period of six years after the day on which the first notice of compliance was issued for the innovative new drug. In addition, the notice of compliance cannot be issued before the end of a period of ajanta kamagra eight years after the day on which the first notice of compliance was issued to the innovator. The format of the Register of Innovative Drugs is an electronic table, which is updated weekly.

The register lists, in alphabetical order, ajanta kamagra the medicinal ingredients in the innovative drugs which were not previously approved in a drug by the Minister and that are not variations of a previously approved medicinal ingredient. Please note that there may be other medicinal ingredients included in the drugs. The register was re-formatted in summer 2016 to increase the clarity of the information provided regarding the medicinal ingredient, brand name and manufacturer of each innovative drug.

For information related to treatment options, choices of medications and ajanta kamagra their uses, illnesses, side effects or drug interactions, please contact your health care professional (for example, doctor, pharmacist, etc.). We do not provide medical advice regarding the use of the products identified in this database. For comments or questions, please contact by hc.opml-bmbl.sc@canada.ca or by ajanta kamagra telephone at 613-941-7281.Date published.

October 7, 2020On this page OverviewAs the global COVID-19 pandemic emerged in December 2019, the need for coherent, pan-Canadian guidance on provincial and territorial testing was quickly recognized. Led by ajanta kamagra the National Microbiology Laboratory, initial interim guidance on laboratory testing was developed in consultation with the Canadian Public Health Lab Network and was finalized and approved by the Special Advisory Committee on April 16, 2020. This guidance was based on scientific evidence and testing resources available at that time.

The recommended testing guidance focused on the molecular polymerase chain reaction (PCR) as the sole laboratory technique to accurately identify SARS-CoV-2 in a patient sample.In May 2020, based on new evidence, the National Laboratory Testing Indication Guidance for COVID-19 was updated to reflect developments in four areas. Expanded laboratory resources viral transmission from asymptomatic individuals or individuals in the pre-symptomatic phase outbreaks in congregate living and work settings new testing modalities (molecular Point of Care and ajanta kamagra serological tests)The COVID-19 landscape has further evolved and it is now necessary to update key aspects of this document to reflect recent scientific and public health data. One key consideration relates to limiting asymptomatic diagnostic PCR testing where public health action could have significant benefits.

Several pilot programs were conducted in Canada, confirming very low levels of COVID-19 in the general population and supporting an evidence-based approach to the relaunch of ajanta kamagra economic activity. In addition, it enabled jurisdictions to stress-test testing capacity and prepare jurisdictions for higher testing volumes. Asymptomatic testing was also found to displace diagnostic capacity for symptomatic individuals, close contacts, high-risk settings and outbreak management.

The National Laboratory Testing Indication Guidancefor COVID-19 has been updated to reflect these learnings and advances in science.Recognizing that testing regimes are within provincial and territorial jurisdiction, this document reflects the collaboration among jurisdictions, leveraging learnings from one another through the ajanta kamagra different adopted approaches.Emerging testing and screening technologiesThe Pan-Canadian COVID-19 Testing and Screening Guidance is designed to reflect changing risk management approaches as the pandemic conditions change. Recognizing that one size does not fit all, the Guidance is also designed to respond to a significant increase in the need to access testing and screening technologies. Scaling to meet increased and sustained testing and screening demand will require a paradigm shift, broadening ajanta kamagra the technologies that are used in a manner that is tailored to the purpose and application of technologies in a variety of settings.

Although PCR remains the gold standard in diagnostic testing, numerous technologies and testing modalities are emerging that could serve to supplement diagnostic testing. These recent testing and sampling options could create opportunities to expand the approach to testing by including broad-based approaches to screening through less sensitive and potentially more cost-effective technologies, thereby ajanta kamagra alleviating strain on the overall public health system.While they can be less sensitive, these technologies could have multiple benefits including ease and reduced cost of production, improved efficiency and reduced reliance on PCR testing supplies. They also have the potential to be less invasive depending on the technology.

Antigen and extraction-free nucleic acid testing are examples of such technologies that, in addition to being more cost-effective and easier to produce, are also easily adaptable to mobile, rapid applications. However, due to their ajanta kamagra lower sensitivity than current PCR technology, these emerging technologies may be better used as a part of screening, in conjunction with repeated testing in some settings. Recognizing that these novel technologies have lower sensitivity and specificity than current PCR technology, their use should be targeted to scenarios where both positive and negative are interpreted and acted upon appropriately.Complementing the deployment of these emerging technologies, techniques such as pooled testing are being used to contribute to the preservation of testing resources.

Governments are also tapping non-traditional ajanta kamagra data sources to complement case data. For example, data for wastewater testing could complement COVID-19 surveillance systems by providing readily accessible pooled community samples and data for communities where testing is not available or underutilized.As of September 29, Health Canada has authorized 36 COVID-19 testing devices (PCR and serological). Health Canada is fast-tracking the review of submissions related to antigen and nucleic acid tests ajanta kamagra.

Submissions that are reviewed include various sample types, including saliva. Consult the list of authorized medical devices for uses related to COVID-19.In anticipation of regulatory approval for antigen tests, an Interim Guidance on Antigen Testing has been developed to outline potential scenarios such as routine outbreak monitoring, monitoring in different situations including high-risk settings (for example, long-term care facilities) and possible adaptation into mobile, rapid testing in rural and remote communities.Pan-Canadian COVID-19 Testing and Screening GuidanceLike the Laboratory Testing Guidance, the Pan-Canadian COVID-19 Testing and Screening Guidance (“Guidance”) is based on new public health evidence and emerging technologies, while adopting a broadened approach that leverages and tailors technologies to appropriate uses. The Guidance is designed to protect and expand the resilience of federal, provincial and territorial testing and screening capacity.The Guidance is based on a portfolio approach that uses different types of testing technologies for various purposes (diagnostic, ajanta kamagra screening, surveillance).

The intent of the Guidance is to better use testing resources to target the most relevant test in particular situations or use cases to address specific problems or purposes. Figure 1 ajanta kamagra. Technology streams of Pan-Canadian COVID-19 Testing and Screening Guidance Figure 1.

Technology streams of Pan-Canadian COVID-19 ajanta kamagra Testing and Screening Guidance - Text equivalent Testing. Definitive diagnosis of COVID-19 with high sensitivity PCR-based tests, with potential refinements to specimen collecting modalities (for example, saliva) Less amenable to high frequency conduct due to greater resource utilization Screening. Indicative of COVID-19 status, with lower sensitivity Typically newer, rapid technology approaches Amenable to higher frequency repetition and more easily scalable Surveillance.

Use of traditional and non-traditional data sources to complement case data Wastewater ajanta kamagra surveillance complements conventional COVID-19 surveillance systems by providing. efficient pooled community sample data for communities where timely clinical testing is underutilized or unavailable data at the local level Five key foundational, interrelated pillars support the advancement of the Guidance. Scientific integrity regulatory excellence proactive procurement robust data and capacity strategic communication and partnershipsUpdates to ajanta kamagra laboratory testing and antigen testing guidance founded on rigorous scientific integrity enable and inform decision-making on testing allocations within Canada, and support jurisdictions in the timely use of emerging technologies once regulatory approval is received.

Regulatory excellence is equally important as a foundational pillar to implementing the Guidance in a manner that allows for rapid approvals while still preserving the scientific integrity of the process.In addition, undertaking a proactive procurement approach ensures steady access to equipment and supplies for testing and screening. Governments continue to take a proactive procurement approach, purchasing whenever possible, contingent on regulatory approvals.Timely and comprehensive data is critical, underpinning decision-making ajanta kamagra by governments. Governments have established a new data set for COVID-19 cases that provides more targeted information, improving the ability to understand whether infections are acquired via domestic or international travel, or if they are linked to a known outbreak.

Race and ethnicity indicators have been added as well as greater information on health care workers, allowing a better understanding of the COVID-19 experience among different population groups. In addition to the case data, key data on turnaround times for testing and contact tracing, for example, can also help identify issues related to capacity and timeliness of interventions.Finally, in addition to strong federal, provincial and territorial partnerships, relationships are being further enhanced with key partners in industry ajanta kamagra and the scientific community. While ensuring rapid and effective progress is critical, it is also important to communicate what we know, what we are doing and what we are going to do.

This collaboration and ajanta kamagra transparency supports critical decisions, including what additional capacity may be required as part of the Guidance, for instance, federal surge capacity to supplement provincial and territorial leadership. Strategic communications and partnerships are critical to maintaining and strengthening the confidence of Canadians in Governments' actions to address COVID-19. Implementation plan of the Pan-Canadian COVID-19 Testing and Screening Guidance.

Updated Guidance Scientific integrity Regulatory excellence Proactive procurement Robust data and capacity Strategic communications and partnerships Regularly updated public health advice as science evolves Updated national lab testing indication guidance Interim antigen testing guidance Guidance on sample types Prioritized, timely review of emerging and promising technologies Responsive to testing, screening and surveillance developments Founded in and driven by scientific excellence Linking regulatory pipeline with production capacity Prioritizing made in ajanta kamagra Canada solutions Advance purchasing of promising technologies Surge capacity through full value chain and timely, comprehensive data Improving national performance data (turnaround times) Surge capacity for sample collection, lab testing contact tracing Working closely with key partners FPT. Enables agile responses to emerging issues Industry. Linking public health and workforce requirements Tapping emerging tech Public education/understanding ajanta kamagra Looking forwardThe Guidance is expected to evolve as the state of knowledge and risk management strategies continue to develop.

Guidance on sample types is expected to be finalized during the fall and the balance of testing and screening technologies will be adjusted to respond to the needs of various populations. Researchers and companies continue to innovate ajanta kamagra and develop new technologies and solutions. Guidance will need to keep pace with, and take advantage of, these innovations.

The continuous updating of this Guidance will rely on strong federal, provincial and territorial partnerships and collaboration leveraging key governance bodies, including the Special Advisory Committee. The Guidance will also capitalize on opportunities to leverage input and the capacity to mobilize knowledge in Canada and from around the world.Related linksOn this page Purpose and backgroundThe purpose of this notice is to communicate minimum values of sensitivity for COVID-19 antigen testing devices.Health Canada refers to guidance ajanta kamagra published by the U.S. Food and Drug Administration (FDA) on antigen detecting tests.

This guidance outlines the requirements that these ajanta kamagra products must meet. This document addresses only sensitivity for antigen tests. It complements the published FDA guidance.Sensitivity is technically a measure of the accuracy ajanta kamagra of a test against a reference standard.

No such standard exists at this time, therefore the accuracy of the positive results from a test is currently expressed as the positive percent agreement (PPA). The term sensitivity is used throughout this document in place of PPA for ease of reading. Sensitivity is the proportion of subjects with the target condition ajanta kamagra in whom the test is positiveIt is an important measure to determine whether test information is useful and reliable.Minimum value for sensitivity Health Canada does not usually set minimum standards for sensitivity.

Normally we review the submitted data to determine whether a test performs to the standard claimed by the manufacturer. We then ajanta kamagra compare that to the standard claimed by similar tests. However, the COVID-19 pandemic is a unique public health crisis.

For this reason, we are taking a different approach.We have set minimum standards for sensitivity that a ajanta kamagra COVID-19 antigen test must meet in order for us to consider it for authorization. Tests with sensitivity below this minimum do not meet the criteria of 5(c) and (d) of the interim order on the importation and sale of medical devices for use in relation to COVID-19. For this reason, they will not be authorized.Health Canada considers the following to be unacceptable for authorization.

Sensitivity below 80% Sensitivity ajanta kamagra values below this level will produce too many false negative results. These tests will not be authorized, regardless of other factors.Future considerationsHealth Canada’s target value aligns with the FDA target. However, as more research results become available, we may revise this value accordingly.Health Canada welcomes applications ajanta kamagra for technologies that meet or exceed the minimum limit value.

We will continue to monitor emerging science and international experience to determine whether we need to amend this value.Contact usPlease email your questions or comments about this notice to. Hc.meddevices-instrumentsmed.sc@canada.ca.Related Links.

October 9, 2020Our file number low price kamagra. 20-113699-873 As a standing regulatory member of the International Council for Harmonisation (ICH), Health Canada is committed to the adoption and implementation of all ICH guidance. By way of this low price kamagra Notice, Health Canada is advising of its intent to implement ICH Q12. Technical and Regulatory Considerations for Pharmaceutical Product Lifecycle Management and the ICH Q12 associated annexes.

This guidance has been developed by the appropriate ICH Expert Working Group and has been low price kamagra subject to consultation by the regulatory parties, in accordance with the ICH Process. The ICH Assembly has endorsed the final draft and recommended its implementation by membership of ICH. The target timeframe for Health Canada implementation of ICH Q12 has been set to the third quarter of 2021 in order to allow sufficient time for the preparation of regulators and stakeholders. Health Canada will be launching a stakeholder consultation in early 2021 to gather feedback on the final elements of the implementation of the Q12 guidance in Canada.This new Guideline is proposed to provide a framework low price kamagra to facilitate the management of post-approval Chemistry, Manufacturing and Controls (CMC) changes in a more predictable and efficient manner across the product lifecycle.

Implementation of this new ICH Guideline will promote innovation and continual improvement in the biopharmaceutical sector and strengthen quality assurance and reliable supply of product, including proactive planning of supply chain adjustments. It will allow regulators (assessors low price kamagra and inspectors) to better understand the firms' Pharmaceutical Quality Systems (PQSs) for management of post-approval CMC changes.ICH Q12 should be read in conjunction with this accompanying notice and with the relevant sections of other applicable Health Canada guidances. This and other ICH Guidance documents are available on the ICH Website. Please note that the low price kamagra ICH website is only available in English.

If you would like to request a copy of the French version of the document, please contact the HPFB ICH inbox.Contact InformationFor any comments or inquiries related to this notice, please contact:Health Canada – ICH CoordinatorE-mail. Hc.ich.sc@canada.ca Please include "Implementation of ICH Q12" in the subject line.The Register of Innovative Drugs is maintained pursuant to C.08.004.1 of the Food and Drug Regulations. The register indicates the drugs that are low price kamagra eligible for data protection. Under C.08.004.1 (3) a subsequent manufacturer that seeks a notice of compliance on the basis of a direct or indirect comparison between the new drug and an innovative drug may not file a submission before the end of a period of six years after the day on which the first notice of compliance was issued for the innovative new drug.

In addition, the notice of compliance cannot be issued before the end of a period of eight years after the day on which the first notice of compliance was issued to the innovator low price kamagra. The format of the Register of Innovative Drugs is an electronic table, which is updated weekly. The register lists, in alphabetical order, the medicinal ingredients in low price kamagra the innovative drugs which were not previously approved in a drug by the Minister and that are not variations of a previously approved medicinal ingredient. Please note that there may be other medicinal ingredients included in the drugs.

The register was re-formatted in summer 2016 to increase the clarity of the information provided regarding the medicinal ingredient, brand name and manufacturer of each innovative drug. For information related to treatment options, choices of medications and their uses, illnesses, side effects or drug interactions, please contact your health care professional low price kamagra (for example, doctor, pharmacist, etc.). We do not provide medical advice regarding the use of the products identified in this database. For comments or questions, please contact by hc.opml-bmbl.sc@canada.ca or low price kamagra by telephone at 613-941-7281.Date published.

October 7, 2020On this page OverviewAs the global COVID-19 pandemic emerged in December 2019, the need for coherent, pan-Canadian guidance on provincial and territorial testing was quickly recognized. Led by the National Microbiology Laboratory, initial interim guidance on laboratory testing was developed in consultation with the Canadian Public Health Lab Network and was finalized and approved by the Special Advisory Committee on April 16, 2020 low price kamagra. This guidance was based on scientific evidence and testing resources available at that time. The recommended testing guidance focused on the molecular polymerase chain reaction (PCR) as the sole laboratory technique to accurately identify SARS-CoV-2 in a patient sample.In May 2020, based on new evidence, the National Laboratory Testing Indication Guidance for COVID-19 was updated to reflect developments in four areas.

Expanded laboratory resources viral transmission from asymptomatic individuals or individuals in the pre-symptomatic phase outbreaks in congregate living and work settings low price kamagra new testing modalities (molecular Point of Care and serological tests)The COVID-19 landscape has further evolved and it is now necessary to update key aspects of this document to reflect recent scientific and public health data. One key consideration relates to limiting asymptomatic diagnostic PCR testing where public health action could have significant benefits. Several pilot programs were conducted in Canada, confirming very low levels of COVID-19 in the general population and supporting an evidence-based approach to the low price kamagra relaunch of economic activity. In addition, it enabled jurisdictions to stress-test testing capacity and prepare jurisdictions for higher testing volumes.

Asymptomatic testing was also found to displace diagnostic capacity for symptomatic individuals, close contacts, high-risk settings and outbreak management. The National Laboratory Testing Indication Guidancefor COVID-19 has been updated to reflect these learnings and advances in science.Recognizing that testing regimes are within provincial and territorial jurisdiction, this document reflects the collaboration among jurisdictions, leveraging learnings from one another through the different adopted approaches.Emerging testing and screening technologiesThe Pan-Canadian COVID-19 low price kamagra Testing and Screening Guidance is designed to reflect changing risk management approaches as the pandemic conditions change. Recognizing that one size does not fit all, the Guidance is also designed to respond to a significant increase in the need to access testing and screening technologies. Scaling to meet increased and sustained testing and screening demand will require a paradigm shift, broadening the low price kamagra technologies that are used in a manner that is tailored to the purpose and application of technologies in a variety of settings.

Although PCR remains the gold standard in diagnostic testing, numerous technologies and testing modalities are emerging that could serve to supplement diagnostic testing. These recent low price kamagra testing and sampling options could create opportunities to expand the approach to testing by including broad-based approaches to screening through less sensitive and potentially more cost-effective technologies, thereby alleviating strain on the overall public health system.While they can be less sensitive, these technologies could have multiple benefits including ease and reduced cost of production, improved efficiency and reduced reliance on PCR testing supplies. They also have the potential to be less invasive depending on the technology. Antigen and extraction-free nucleic acid testing are examples of such technologies that, in addition to being more cost-effective and easier to produce, are also easily adaptable to mobile, rapid applications.

However, due to low price kamagra their lower sensitivity than current PCR technology, these emerging technologies may be better used as a part of screening, in conjunction with repeated testing in some settings. Recognizing that these novel technologies have lower sensitivity and specificity than current PCR technology, their use should be targeted to scenarios where both positive and negative are interpreted and acted upon appropriately.Complementing the deployment of these emerging technologies, techniques such as pooled testing are being used to contribute to the preservation of testing resources. Governments are also tapping non-traditional data sources to complement case data low price kamagra. For example, data for wastewater testing could complement COVID-19 surveillance systems by providing readily accessible pooled community samples and data for communities where testing is not available or underutilized.As of September 29, Health Canada has authorized 36 COVID-19 testing devices (PCR and serological).

Health Canada is fast-tracking the review of submissions related to low price kamagra antigen and nucleic acid tests. Submissions that are reviewed include various sample types, including saliva. Consult the list of authorized medical devices for uses related to COVID-19.In anticipation of regulatory approval for antigen tests, an Interim Guidance on Antigen Testing has been developed to outline potential scenarios such as routine outbreak monitoring, monitoring in different situations including high-risk settings (for example, long-term care facilities) and possible adaptation into mobile, rapid testing in rural and remote communities.Pan-Canadian COVID-19 Testing and Screening GuidanceLike the Laboratory Testing Guidance, the Pan-Canadian COVID-19 Testing and Screening Guidance (“Guidance”) is based on new public health evidence and emerging technologies, while adopting a broadened approach that leverages and tailors technologies to appropriate uses. The Guidance is designed to protect and expand the resilience of federal, provincial and territorial testing and screening capacity.The Guidance is low price kamagra based on a portfolio approach that uses different types of testing technologies for various purposes (diagnostic, screening, surveillance).

The intent of the Guidance is to better use testing resources to target the most relevant test in particular situations or use cases to address specific problems or purposes. Figure 1 low price kamagra. Technology streams of Pan-Canadian COVID-19 Testing and Screening Guidance Figure 1. Technology streams of low price kamagra Pan-Canadian COVID-19 Testing and Screening Guidance - Text equivalent Testing.

Definitive diagnosis of COVID-19 with high sensitivity PCR-based tests, with potential refinements to specimen collecting modalities (for example, saliva) Less amenable to high frequency conduct due to greater resource utilization Screening. Indicative of COVID-19 status, with lower sensitivity Typically newer, rapid technology approaches Amenable to higher frequency repetition and more easily scalable Surveillance. Use of traditional and non-traditional data sources to complement case data Wastewater surveillance complements conventional COVID-19 surveillance systems by low price kamagra providing. efficient pooled community sample data for communities where timely clinical testing is underutilized or unavailable data at the local level Five key foundational, interrelated pillars support the advancement of the Guidance.

Scientific integrity regulatory low price kamagra excellence proactive procurement robust data and capacity strategic communication and partnershipsUpdates to laboratory testing and antigen testing guidance founded on rigorous scientific integrity enable and inform decision-making on testing allocations within Canada, and support jurisdictions in the timely use of emerging technologies once regulatory approval is received. Regulatory excellence is equally important as a foundational pillar to implementing the Guidance in a manner that allows for rapid approvals while still preserving the scientific integrity of the process.In addition, undertaking a proactive procurement approach ensures steady access to equipment and supplies for testing and screening. Governments continue low price kamagra to take a proactive procurement approach, purchasing whenever possible, contingent on regulatory approvals.Timely and comprehensive data is critical, underpinning decision-making by governments. Governments have established a new data set for COVID-19 cases that provides more targeted information, improving the ability to understand whether infections are acquired via domestic or international travel, or if they are linked to a known outbreak.

Race and ethnicity indicators have been added as well as greater information on health care workers, allowing a better understanding of the COVID-19 experience among different population groups. In addition to the case data, key data on turnaround times for testing and contact tracing, for example, can also help identify issues related to capacity and timeliness of interventions.Finally, in addition to strong federal, provincial and territorial partnerships, relationships are being further enhanced with key partners in industry low price kamagra and the scientific community. While ensuring rapid and effective progress is critical, it is also important to communicate what we know, what we are doing and what we are going to do. This collaboration and transparency supports critical decisions, including what additional capacity may be required as part of low price kamagra the Guidance, for instance, federal surge capacity to supplement provincial and territorial leadership.

Strategic communications and partnerships are critical to maintaining and strengthening the confidence of Canadians in Governments' actions to address COVID-19. Implementation plan of the Pan-Canadian COVID-19 Testing and Screening Guidance. Updated Guidance Scientific integrity Regulatory excellence Proactive procurement Robust data and capacity Strategic communications and partnerships Regularly updated public health advice as science evolves Updated national lab testing indication guidance Interim antigen testing guidance Guidance on sample types Prioritized, timely review of emerging and promising technologies Responsive to testing, screening and surveillance developments Founded in and driven by scientific excellence Linking regulatory pipeline with production capacity Prioritizing made in Canada solutions Advance purchasing of promising technologies Surge capacity through full value chain and timely, comprehensive data Improving national performance low price kamagra data (turnaround times) Surge capacity for sample collection, lab testing contact tracing Working closely with key partners FPT. Enables agile responses to emerging issues Industry.

Linking public health and workforce requirements Tapping emerging tech Public education/understanding Looking forwardThe Guidance is expected to evolve as the state of knowledge and risk low price kamagra management strategies continue to develop. Guidance on sample types is expected to be finalized during the fall and the balance of testing and screening technologies will be adjusted to respond to the needs of various populations. Researchers and low price kamagra companies continue to innovate and develop new technologies and solutions. Guidance will need to keep pace with, and take advantage of, these innovations.

The continuous updating of this Guidance will rely on strong federal, provincial and territorial partnerships and collaboration leveraging key governance bodies, including the Special Advisory Committee. The Guidance will also capitalize on opportunities to leverage input and the capacity low price kamagra to mobilize knowledge in Canada and from around the world.Related linksOn this page Purpose and backgroundThe purpose of this notice is to communicate minimum values of sensitivity for COVID-19 antigen testing devices.Health Canada refers to guidance published by the U.S. Food and Drug Administration (FDA) on antigen detecting tests. This guidance low price kamagra outlines the requirements that these products must meet.

This document addresses only sensitivity for antigen tests. It complements the published FDA guidance.Sensitivity low price kamagra is technically a measure of the accuracy of a test against a reference standard. No such standard exists at this time, therefore the accuracy of the positive results from a test is currently expressed as the positive percent agreement (PPA). The term sensitivity is used throughout this document in place of PPA for ease of reading.

Sensitivity is the proportion of subjects with the target condition in whom the test is positiveIt is an important measure to determine whether test information low price kamagra is useful and reliable.Minimum value for sensitivity Health Canada does not usually set minimum standards for sensitivity. Normally we review the submitted data to determine whether a test performs to the standard claimed by the manufacturer. We then compare that to the standard claimed by similar tests low price kamagra. However, the COVID-19 pandemic is a unique public health crisis.

For this reason, we are taking a different approach.We have set minimum standards for sensitivity that a COVID-19 antigen test must meet in order for us to consider it for authorization low price kamagra. Tests with sensitivity below this minimum do not meet the criteria of 5(c) and (d) of the interim order on the importation and sale of medical devices for use in relation to COVID-19. For this reason, they will not be authorized.Health Canada considers the following to be unacceptable for authorization. Sensitivity below 80% low price kamagra Sensitivity values below this level will produce too many false negative results.

These tests will not be authorized, regardless of other factors.Future considerationsHealth Canada’s target value aligns with the FDA target. However, as more research results become available, we may revise this value accordingly.Health Canada welcomes applications for technologies that meet or exceed the minimum low price kamagra limit value. We will continue to monitor emerging science and international experience to determine whether we need to amend this value.Contact usPlease email your questions or comments about this notice to. Hc.meddevices-instrumentsmed.sc@canada.ca.Related Links.

What i should buy with kamagra

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COVID-19 has evolved rapidly into a pandemic with global what i should buy with kamagra impacts. However, as the pandemic has what i should buy with kamagra developed, it has become increasingly evident that the risks of COVID-19, both in terms of infection rates and particularly of severe complications, are not equal across all members of society. While general risk factors for hospital admission with COVID-19 infection include age, male sex and specific comorbidities (eg, cardiovascular disease, hypertension and diabetes), there is increasing evidence that people identifying with Black, Asian and Minority Ethnic (BAME) groupsi have disproportionately higher risks of being adversely affected by COVID-19 in the UK and the USA. The ethnic disparities include overall numbers of cases, as well as the relative numbers of critical what i should buy with kamagra care admissions and deaths.1In the area of mental health, for people from BAME groups, even before the current pandemic there were already significant mental health inequalities.2 These inequalities have been increased by the pandemic in several ways.

The constraints of quarantine have made access to traditional face-to-face support from mental health services more difficult in general. This difficulty will increase pre-existing inequalities where there are what i should buy with kamagra challenges to engaging people in care and in providing early access to services. The restrictions may also reduce the flexibility of care offers, given the need for social isolation, limiting non-essential travel and closure of routine clinics. The service impacts are compounded by constraints on the use of non-traditional or alternative routes to care and support.In addition, there is growing evidence of specific mental health consequences from significant COVID-19 infection, with increased rates of not only post-traumatic stress disorder, anxiety and depression, but also specific neuropsychiatric what i should buy with kamagra symptoms.3 Given the higher risks of mental illnesses and complex care needs among ethnic minorities and also in deprived inner city areas, COVID-19 seems to deliver a double blow.

Physical and mental health vulnerabilities are inextricably linked, especially as a significant proportion of healthcare workers (including in mental health services) in the UK are from BAME groups.Focusing on mental health, there is very little COVID-19-specific guidance on the needs of patients in the BAME group. The risk to staff in general healthcare (including mental healthcare) is a particular concern, and in response, the Royal College of Psychiatrists and NHS England have produced a report on the impact of COVID-19 on BAME staff in mental healthcare settings, with guidance on assessment and management of risk what i should buy with kamagra using an associated risk assessment tool for staff.4 5However, there is little formal guidance for the busy clinician in balancing different risks for individual mental health patients and treating appropriately. Thus, for example, an inpatient clinician may want to know whether a patient who is older, has additional comorbidities and is from an ethnic background, should be started on one antipsychotic medication or another, or whether treatments such as vitamin D prophylaxis or treatment and venous thromboembolism prevention should be started earlier in the context of the COVID-19 pandemic. While syntheses of the existing guidelines are available about COVID-19 and mental health,6 7 there is nothing specific about the healthcare needs of patients from ethnic minorities during the pandemic.To fill this gap, we propose three core actions that may help:Ensure good information and psychoeducation packages are made available to those with English as a second language, and ensure health beliefs and knowledge are based on the what i should buy with kamagra best evidence available.

Address culturally grounded explanatory models and illness perceptions to allay fears and worry, and ensure timely access to testing and care if needed.Maintain what i should buy with kamagra levels of service, flexibility in care packages, and personal relationships with patients and carers from ethnic minority backgrounds in order to continue existing care and to identify changes needed to respond to worsening of mental health.Consider modifications to existing interventions such as psychological therapies and pharmacotherapy. Have a high index of suspicion to take into account emerging physical health problems and the greater risk of serious consequences of COVID-19 in ethnic minority people with pre-existing chronic conditions and vulnerability factors.These actions are based on clinical common sense, but guidance in this area should be provided on the basis of good evidence. There has already been a call for urgent research in what i should buy with kamagra the area of COVID-19 and mental health8 and also a clear need for specific research focusing on the post-COVID-19 mental health needs of people from the BAME group. Research also needs to recognise the diverse range of different people, with different needs and vulnerabilities, who are grouped under the multidimensional term BAME, including people from different generations, first-time migrants, people from Africa, India, the Caribbean and, more recently, migrants from Eastern Europe.

Application of a race equality impact assessment to all research questions and methodology has recently been proposed as a first step in this process.2 At this early stage, the guidance for assessing risks of what i should buy with kamagra COVID-19 for health professionals is also useful for patients, until more refined decision support and prediction tools are developed. A recent Public Health England report on ethnic minorities and COVID-199 recommends better recording of ethnicity data in health and social care, and goes further to suggest this should also apply to death certificates. Furthermore, the report recommends more participatory and experience-based research to understand causes and consequences of pre-existing multimorbidity and COVID-19 infection, integrated care systems that work well for susceptible and marginalised groups, culturally competent what i should buy with kamagra health promotion, prevention and occupational risk assessments, and recovery strategies to mitigate the risks of widening inequalities as we come out of restrictions.Primary data collection will need to cover not only hospital admissions but also data from primary care, linking information on mental health, COVID-19 and ethnicity. We already have research and specific guidance emerging on other risk factors, such as age and gender.

Now we also need to what i should buy with kamagra focus on an equally important aspect of vulnerability. As clinicians, we need to balance the relative risks for each of our patients, so that we can act promptly and proactively in response to their individual needs.10 For this, we need evidence-based guidance to ensure we are balancing every risk appropriately and without bias.Footnotei While we have used the term ‘people identifying with BAME groups’, we recognise that this is a multidimensional group and includes vast differences in culture, identity, heritage and histories contained within this abbreviated term..

COVID-19 has evolved rapidly into a pandemic with global impacts low price kamagra. However, as the pandemic low price kamagra has developed, it has become increasingly evident that the risks of COVID-19, both in terms of infection rates and particularly of severe complications, are not equal across all members of society. While general risk factors for hospital admission with COVID-19 infection include age, male sex and specific comorbidities (eg, cardiovascular disease, hypertension and diabetes), there is increasing evidence that people identifying with Black, Asian and Minority Ethnic (BAME) groupsi have disproportionately higher risks of being adversely affected by COVID-19 in the UK and the USA. The ethnic disparities include overall numbers of cases, as well as the relative numbers of critical care admissions and deaths.1In the area of mental health, for people from BAME groups, even before the current pandemic there were already significant mental health inequalities.2 These low price kamagra inequalities have been increased by the pandemic in several ways. The constraints of quarantine have made access to traditional face-to-face support from mental health services more difficult in general.

This difficulty will increase pre-existing inequalities where there are challenges to engaging people in care and low price kamagra in providing early access to services. The restrictions may also reduce the flexibility of care offers, given the need for social isolation, limiting non-essential travel and closure of routine clinics. The service impacts are compounded low price kamagra by constraints on the use of non-traditional or alternative routes to care and support.In addition, there is growing evidence of specific mental health consequences from significant COVID-19 infection, with increased rates of not only post-traumatic stress disorder, anxiety and depression, but also specific neuropsychiatric symptoms.3 Given the higher risks of mental illnesses and complex care needs among ethnic minorities and also in deprived inner city areas, COVID-19 seems to deliver a double blow. Physical and mental health vulnerabilities are inextricably linked, especially as a significant proportion of healthcare workers (including in mental health services) in the UK are from BAME groups.Focusing on mental health, there is very little COVID-19-specific guidance on the needs of patients in the BAME group. The risk to staff in general healthcare (including mental healthcare) is a particular concern, and in response, the Royal College of Psychiatrists and NHS England have produced a report on the impact of COVID-19 on BAME staff in mental healthcare settings, with guidance on assessment and management of risk using low price kamagra an associated risk assessment tool for staff.4 5However, there is little formal guidance for the busy clinician in balancing different risks for individual mental health patients and treating appropriately.

Thus, for example, an inpatient clinician may want to know whether a patient who is older, has additional comorbidities and is from an ethnic background, should be started on one antipsychotic medication or another, or whether treatments such as vitamin D prophylaxis or treatment and venous thromboembolism prevention should be started earlier in the context of the COVID-19 pandemic. While syntheses of the existing guidelines are available about COVID-19 and mental health,6 7 there is nothing specific about the healthcare needs of patients from ethnic minorities during the pandemic.To fill this gap, we propose low price kamagra three core actions that may help:Ensure good information and psychoeducation packages are made available to those with English as a second language, and ensure health beliefs and knowledge are based on the best evidence available. Address culturally low price kamagra grounded explanatory models and illness perceptions to allay fears and worry, and ensure timely access to testing and care if needed.Maintain levels of service, flexibility in care packages, and personal relationships with patients and carers from ethnic minority backgrounds in order to continue existing care and to identify changes needed to respond to worsening of mental health.Consider modifications to existing interventions such as psychological therapies and pharmacotherapy. Have a high index of suspicion to take into account emerging physical health problems and the greater risk of serious consequences of COVID-19 in ethnic minority people with pre-existing chronic conditions and vulnerability factors.These actions are based on clinical common sense, but guidance in this area should be provided on the basis of good evidence. There has already been a call for urgent research in the area of COVID-19 and mental health8 and also a clear need for specific research focusing on the post-COVID-19 mental health needs of people from the BAME low price kamagra group.

Research also needs to recognise the diverse range of different people, with different needs and vulnerabilities, who are grouped under the multidimensional term BAME, including people from different generations, first-time migrants, people from Africa, India, the Caribbean and, more recently, migrants from Eastern Europe. Application of a race equality impact assessment to all research questions and methodology has recently been proposed as a first step in this process.2 At this early stage, the guidance for assessing risks of COVID-19 for health professionals is low price kamagra also useful for patients, until more refined decision support and prediction tools are developed. A recent Public Health England report on ethnic minorities and COVID-199 recommends better recording of ethnicity data in health and social care, and goes further to suggest this should also apply to death certificates. Furthermore, the report recommends more participatory and experience-based research to understand causes and consequences of pre-existing multimorbidity and COVID-19 infection, integrated care systems that work well for susceptible and marginalised groups, culturally competent health promotion, prevention and occupational risk assessments, and recovery strategies to mitigate the risks of widening inequalities as we low price kamagra come out of restrictions.Primary data collection will need to cover not only hospital admissions but also data from primary care, linking information on mental health, COVID-19 and ethnicity. We already have research and specific guidance emerging on other risk factors, such as age and gender.

Now we also need to low price kamagra focus on an equally important aspect of vulnerability. As clinicians, we need to balance the relative risks for each of our patients, so that we can act promptly and proactively in response to their individual needs.10 For this, we need evidence-based guidance to ensure we are balancing every risk appropriately and without bias.Footnotei While we have used the term ‘people identifying with BAME groups’, we recognise that this is a multidimensional group and includes vast differences in culture, identity, heritage and histories contained within this abbreviated term..

Kamagra effervescent 100mg

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The past week has kamagra effervescent 100mg seen an explosion of media commentary about whether children in the UK should go back to school. Since ‘lockdown’ (23 kamagra effervescent 100mg March 2020) began schools have been open to vulnerable children and young people, and to the children of ‘key workers’. Right from the start there have been differing opinions about the necessity or wisdom of closing schools. Viner et al1 produced a rapid systematic review that concludes that school closures have less impact on infection kamagra effervescent 100mg rate and mortality than other social distancing measures. Many countries have closed their schools for less time than the UK and have already started to reopen with several protective measures in place.2Concerns about the long-term economic, social and mental impact of lockdown led to the generation of plans to ‘get back to business’.

This was conveyed to the population of the UK kamagra effervescent 100mg on 10 May by the UK prime minister, Boris Johnson. He announced a range of measures to gradually reduce the level of lockdown. This is in keeping with modelling undertaken by various groups, including a preprint (not peer-reviewed) modelling exercise by Zhang et al.3Mr Johnson announced that there would be a phased return kamagra effervescent 100mg (in England) of some children to school from 1 June. There are no national guidelines as it is recognised that school have differences that require a flexible approach, but there are a broad set of principles relating to social distancing and hygiene.Government ministers and teachers’ unions have opposing views on the safety of reopening schools. In a joint statement nine unions representing teachers stated that they thought 1 June was too early to be safe.4 They recognise that the opening of kamagra effervescent 100mg schools is a vital part of restarting the UK economy, but they have concerns about the safety and welfare of children and others.Meanwhile, the education secretary, Gavin Williamson, spoke at a press conference on 16 May stating that scientific evidence backed their decision.

Interestingly, much of his statement was not about the scientific evidence but setting out an emotive argument that school was essential for safe and happy children.There is a consequence to this, the longer that schools are closed the more that children miss out. Teachers know kamagra effervescent 100mg that there are children out there that have not spoken or played with another child their own age for the last two months. They know there are children from difficult or very unhappy homes for whom school is the happiest moment in their week, and it’s also the safest place for them to be. The poorest children will be the ones who fall further behind kamagra effervescent 100mg if we keep school gates closed. This phased return is in line with what other European countries are doing.There ensued kamagra effervescent 100mg an at times ill-tempered debate and a flurry of tweets and news articles identifying problems in enacting the government plan and the illogical nature of Williamson’s statement.

The Institute for Fiscal Studies has produced a briefing note on children’s experiences of learning during lockdown.5 This is being widely cited as a rationale for reopening schools because children from vulnerable backgrounds are disproportionately affected by not being able to attend school. This has caused concern about the attainment gap, but as Quinn6 points out fewer children from disadvantaged backgrounds are likely to return to school kamagra effervescent 100mg than those from more affluent backgrounds.Government ministers and spokespeople reiterated that scientific evidence and observation of other European countries where schools had reopened demonstrated their decision was the correct one. However, there were no links provided to the scientific evidence and unions were quick to seize on this (eg, NASUWT7).The chief scientific advisor to the Department for Education, Osama Rahman, made a statement in a parliamentary science and technology committee meeting on 13 May that:There is a low degree of confidence in evidence that [children] might transmit it less.Carol Monaghan, the Scottish National Party education spokesperson, replied:We’re putting together hundreds of potential vectors that can then go on and transmit. Is that kamagra effervescent 100mg correct?. Osama Rahman responded:Possibly, depending on school sizes.His final statement contains layers of complexity but can be interpreted simply as ‘we don’t know’.

This provoked a great deal kamagra effervescent 100mg of disquiet. Rahman had already stated that the Scientific Advisory Group for Emergencies (SAGE) was collecting and considering evidence that was new and emerging, and that confidence was low in the evidence relating to transmission because there was very little evidence.8 However, this normal scientific caution in the evidence base was not discussed, and therefore it was assumed that low or moderate confidence in the evidence means a high-risk strategy is being mooted.There appear to be two major concerns about lifting the lockdown for children. First is kamagra effervescent 100mg the risk to children of developing coronavirus disease. The second is the risk to others of children transmitting coronavirus disease, either while being symptomatic or asymptomatic. Here are some of the available evidence.Morbidity and mortality in children from coronavirus diseaseChildren appear to be less likely to acquire coronavirus disease in various nations.9–11 Barton et kamagra effervescent 100mg al12 found that children account for 1.9% of confirmed cases (data collected from government websites and publications).

Of these 8113 paediatric cases, 14% required hospital admission. The admission rate to critical care was 2.2% of confirmed cases (7.2% of admitted kamagra effervescent 100mg children). Death was reported in 15 cases (0.18%) kamagra effervescent 100mg. This adds to other evidence suggesting that children are at a relatively low risk from the virus, with other estimates coming in at around 0.01%.13 14 This is likely to be because they appear to have a stronger immune response to the virus.15There are concerns that children who have been infected with the virus can develop a postviral inflammatory reaction (Kawasaki disease) and this can be severe,16 but the research evidence for this is not well developed yet.Transmission by childrenChildren can be asymptomatic and test positive for COVID-19, and in the absence of effective community testing it will be impossible to know if they are carrying the virus. Children also can have normal or abnormal signs (eg, chest imaging) when they have tested positive.17 In kamagra effervescent 100mg short, it is difficult to determine without much more extensive testing if a child can transmit the infection.Arav et al18 found that the contact route was much more important than the airborne route, which they concluded had a negligible contribution.

They suggest protective measures would therefore be good hand hygiene, careful cleaning and avoiding physical contact.Given that there are quite low numbers of symptomatic cases and an unknown quantity of asymptomatic cases, it is very difficult to determine whether children are a significant vector for the disease. Studies cited by the Royal College of Paediatrics and Child Health that explored family clusters of infection suggest that the child was unlikely to be the index case.The riskThis evidence suggests that there is a case for reopening schools to limited numbers kamagra effervescent 100mg of pupils—the risk to pupils and the adults they come into contact with seems to be small, and the potential gains for children may outweigh them. There is a big proviso with this however, and that is that the overall incidence of COVID-19 has fallen below specified threshold. This is quite a contentious issue and depends on us meeting the five key tests for easing lockdown.Making sure the National Health Service can cope.A sustained and consistent fall in the daily death rate.Rate of infection decreasing to manageable kamagra effervescent 100mg levels.Ensuring that personal protective equipment supply can meet demand.Being confident that any adjustments would not risk a second peak.These conditions are open to interpretation, and there appears to be a lack of trust by the public and by professionals from education and health in the information that the government and their scientific advisors are sharing. An example of this is a group of scientists who have come together to challenge the government about their decision-making.19 The concern about whether the evidence and advice that we are given are biased in any way has also been increased by concerns that a government advisor (Dominic Cummings) has attended what were supposed to be politically independent meetings of the SAGE.Scientific evidence continues to emerge, but weighing up the risks and benefits is not easy.

Decisions about whether to reopen schools are taken on a kamagra effervescent 100mg national level with a distance from personal concerns and fears. Individuals who are making decisions often rely on media translations of the evidence, and there is a level of mistrust in politicians and the media.20 Individuals are often irrational in their risk perception and management (eg, continuing to smoke or drink alcohol despite strong scientific evidence about the risk).21 22Overall, we are information-poor and opinion-rich. It is a kamagra effervescent 100mg difficult path to navigate. The debate about whether the benefits outweigh the risks of returning to school reminds me of the post-Wakefield Measles Mumps and Rubella vaccination situation. Parents were being asked to believe that MMR was a safe vaccine in the face of a massive and kamagra effervescent 100mg emotive campaign that promoted the ‘risk’ of having the vaccine above all else.

This situation is even more complex than that as we have increased access to opinion and kamagra effervescent 100mg difficulty in understanding if or how much that information is biased. It is no wonder that decision-making is difficult. It is likely that evidence will continue to emerge and gradually the choice kamagra effervescent 100mg will become easier to make. For now, however, we can understand the difficulties that parents, teachers and councils face.IntroductionWhenever developing training competencies, tools to support clinical practice or a response to a professional issue, seeking the opinion of experts is a common approach. By working to identify a consensus position, researchers can report findings on a specific question (or set of questions) that are based on the knowledge and experience of experts kamagra effervescent 100mg in their field.However, there are challenges to this approach.

For example, what should be done when consensus cannot be reached?. How can experts be engaged kamagra effervescent 100mg in a way that allows them to consider objectively the views of others and—where appropriate—change their own opinions in response?. One approach that attempts to provide a clear method for gathering expert opinion is the Delphi technique.The Delphi technique was first developed in the 1950s by Norman Dalkey and Olaf Helmer in an attempt to gain reliable expert consensus. Specifically, they developed an approach—named after the Ancient Greek Oracle of Delphi, who could predict the future—which promoted anonymity kamagra effervescent 100mg and avoided direct confrontation between experts, so that the methods employed “…appear to be more conducive to independent thought on the part of the experts and to aid them in the gradual formation of a considered opinion”.1 Though the original Delphi study was linked to the defence industry, the technique has spread to other research areas, including nursing.2Characteristics of Delphi studiesAs with all research methods, the Delphi technique has evolved since it was first reported on in the 1960s. However, many of the fundamental characteristics of the approach still remain from Dalkey and Helmer’s original outline.

First, the overarching approach is based on a series of ‘rounds’, where a set of experts are asked their opinions on kamagra effervescent 100mg a particular issue. The questions for each round are based in part of the findings of the previous one, allowing the study to evolve over time in response to earlier findings.Second, participants are able to see the results of previous rounds—including their own responses—allowing them to reflect on the views of others and reposition their own opinions accordingly.2 This also gives them the opportunity to consider and feedback on what they perceive to be the strengths and weaknesses of other’s responses. Finally, the kamagra effervescent 100mg findings of each round are always shared with the broader group anonymously. This avoids any bias that might result from participants being concerned about their own views being viewed negatively or from their own opinions being biased by personal kamagra effervescent 100mg factors. This framework of expert opinion rounds, with each round built on previous findings and each allowing for responses to be reconsidered by participants, is designed to allow the development of a consensus view that answers the research question.Within this broad approach, there can be variation in areas such as how many rounds there are, how the questions are delivered and responses collected, and how ‘consensus’ is judged.

For example, a study kamagra effervescent 100mg of human factors that contributed to nursing errors used only two rounds. The first took the form of an online survey asking 25 experts to list all the ‘human’ causes of nursing errors that they could. Analysis of responses resulted in a list of 28 potential reasons—this list was sent back to the same group of experts for the kamagra effervescent 100mg second round, asking them to score each one for importance. Analysis of this scoring then allowed for consensus conclusions on the top 10 human factors that contributed to nursing errors (with fatigue, heavy workload and communication problems the top three).3In another example, nurse practitioners (NPs) were recruited to participate in a Delphi study to achieve consensus related to NP advance care planning competencies. In round 1, draft competencies were developed from the findings of a survey of NP beliefs, kamagra effervescent 100mg knowledge and level of implementation of advance care planning.

Round 2 included engagement with 29 NPs who evaluated the draft competencies and their components. Revisions were made based on the original feedback, kamagra effervescent 100mg and a third round was conducted where 15 of the original NP participants confirmed their consensus with the final document. The final document includes four competencies, each with several elements. Clinical Practice, Consultation and Communication, Advocacy and Therapeutic Management.4Strengths kamagra effervescent 100mg and weaknesses of Delphi studiesThe Delphi technique offers a flexible approach to gathering the views of experts on an area of interest. The ability for participants to reconsider their views in light of the contribution of others allows for an element of reflection that is missing from studies based on single interviews or focus groups.

The anonymity among the expert groups that underpins Delphi studies promotes honesty among participants and reduces the risk of the ‘halo kamagra effervescent 100mg effect’ where views from dominant or high-profile members of the group are given extra credence.5However, Delphi studies can—by their very nature—be complex and time consuming. The need for participants to complete multiple rounds can lead to high drop-out rates which impacts on validity of kamagra effervescent 100mg the study. The ability of participants to amend or alter their views at each round is also something of a double-edged sword. It provides those taking part with the opportunity to reflect and reconsider their position in response to additional information, which is an kamagra effervescent 100mg important part of nursing practice. Conversely though, there is a danger that this flexibility introduces bias, with participants altering their response to comply with what they view to be the majority view (sometime called the ‘bandwagon effect’).5Delphi studies can be criticised due to a lack of clarity on what is meant by ‘consensus’.

Even with the level of flexibility and reflexivity present in Delphi kamagra effervescent 100mg studies, it is still unlikely that a group of experts will demonstrate 100% agreement on issues. However, because consensus is a requirement of a Delphi study, there does need to be a judgement on when this point is reached. This is where there is inconsistency across studies and kamagra effervescent 100mg authors, with the suggested level of consensus ranging from 51% to 100%.2 In addition, it has been identified that in some areas, consensus is not predefined as part of the study method. For example, a review of Delphi studies in nurse education found that fewer than half of the papers appraised included a predefined level at which consensus was judged to have been achieved.6 In addition, the identification of an objective level consensus is only possible when gathering quantifiable data—the judgement on consensus being reached in some qualitative Delphi studies will always be rather more subjective on the part of the researcher, and therefore potentially open to bias.By their nature, Delphi studies often rely purely on expert opinion to generate findings. A further limitation is therefore related to the quality of kamagra effervescent 100mg evidence, with expert opinion viewed as providing a poor basis for making judgements on healthcare interventions.7 This does not mean that the findings of Delphi studies are intrinsically unreliable or invalid.

It does mean that researchers should consider whether their research question is one that can be answered through expert consensus or whether other approaches (such as a systematic review of research evidence) are more appropriate.ConclusionThe Delphi technique is a well-established approach to answering a research question through the identification of a consensus view across subject experts. It allows for reflection among participants, who are able to nuance and reconsider their opinion based on the kamagra effervescent 100mg anonymised opinions of others. However, researchers must take steps to enhance robustness of the studies. It is important to try and prevent participants from simply resorting to agreeing with kamagra effervescent 100mg the majority view. Studies must also predefine what is meant by ‘consensus’ and how it will be established.With careful and clear design though, Delphi studies can make a valuable contribution to the nursing evidence base by tapping into the profession’s most precious resource—the knowledge and expertise of its practitioners..

The past low price kamagra week has seen an explosion of media commentary about whether children in the UK should go back to school. Since ‘lockdown’ (23 March 2020) began schools have been open to vulnerable children and young people, and to the children of ‘key low price kamagra workers’. Right from the start there have been differing opinions about the necessity or wisdom of closing schools. Viner et al1 produced a low price kamagra rapid systematic review that concludes that school closures have less impact on infection rate and mortality than other social distancing measures.

Many countries have closed their schools for less time than the UK and have already started to reopen with several protective measures in place.2Concerns about the long-term economic, social and mental impact of lockdown led to the generation of plans to ‘get back to business’. This was conveyed to the population of the UK on 10 May by the UK low price kamagra prime minister, Boris Johnson. He announced a range of measures to gradually reduce the level of lockdown. This is low price kamagra in keeping with modelling undertaken by various groups, including a preprint (not peer-reviewed) modelling exercise by Zhang et al.3Mr Johnson announced that there would be a phased return (in England) of some children to school from 1 June.

There are no national guidelines as it is recognised that school have differences that require a flexible approach, but there are a broad set of principles relating to social distancing and hygiene.Government ministers and teachers’ unions have opposing views on the safety of reopening schools. In a joint statement nine unions representing teachers stated that they thought 1 June was too early to be safe.4 They recognise that the opening of schools is a vital part of restarting the UK economy, but they low price kamagra have concerns about the safety and welfare of children and others.Meanwhile, the education secretary, Gavin Williamson, spoke at a press conference on 16 May stating that scientific evidence backed their decision. Interestingly, much of his statement was not about the scientific evidence but setting out an emotive argument that school was essential for safe and happy children.There is a consequence to this, the longer that schools are closed the more that children miss out. Teachers know that there are children out there that have not spoken or played with another child their own age for the last low price kamagra two months.

They know there are children from difficult or very unhappy homes for whom school is the happiest moment in their week, and it’s also the safest place for them to be. The poorest children will be the ones who fall low price kamagra further behind if we keep school gates closed. This phased return is in line with what other European countries are low price kamagra doing.There ensued an at times ill-tempered debate and a flurry of tweets and news articles identifying problems in enacting the government plan and the illogical nature of Williamson’s statement. The Institute for Fiscal Studies has produced a briefing note on children’s experiences of learning during lockdown.5 This is being widely cited as a rationale for reopening schools because children from vulnerable backgrounds are disproportionately affected by not being able to attend school.

This has caused concern about the attainment gap, but as Quinn6 points out fewer children from disadvantaged backgrounds are likely to return to school than low price kamagra those from more affluent backgrounds.Government ministers and spokespeople reiterated that scientific evidence and observation of other European countries where schools had reopened demonstrated their decision was the correct one. However, there were no links provided to the scientific evidence and unions were quick to seize on this (eg, NASUWT7).The chief scientific advisor to the Department for Education, Osama Rahman, made a statement in a parliamentary science and technology committee meeting on 13 May that:There is a low degree of confidence in evidence that [children] might transmit it less.Carol Monaghan, the Scottish National Party education spokesperson, replied:We’re putting together hundreds of potential vectors that can then go on and transmit. Is that correct? low price kamagra. Osama Rahman responded:Possibly, depending on school sizes.His final statement contains layers of complexity but can be interpreted simply as ‘we don’t know’.

This provoked a great deal of low price kamagra disquiet. Rahman had already stated that the Scientific Advisory Group for Emergencies (SAGE) was collecting and considering evidence that was new and emerging, and that confidence was low in the evidence relating to transmission because there was very little evidence.8 However, this normal scientific caution in the evidence base was not discussed, and therefore it was assumed that low or moderate confidence in the evidence means a high-risk strategy is being mooted.There appear to be two major concerns about lifting the lockdown for children. First is the low price kamagra risk to children of developing coronavirus disease. The second is the risk to others of children transmitting coronavirus disease, either while being symptomatic or asymptomatic.

Here are some of the available evidence.Morbidity and mortality in children from coronavirus diseaseChildren appear to be less likely to acquire coronavirus disease in low price kamagra various nations.9–11 Barton et al12 found that children account for 1.9% of confirmed cases (data collected from government websites and publications). Of these 8113 paediatric cases, 14% required hospital admission. The admission rate to critical care was 2.2% of confirmed cases (7.2% of admitted children) low price kamagra. Death was reported in 15 cases (0.18%) low price kamagra.

This adds to other evidence suggesting that children are at a relatively low risk from the virus, with other estimates coming in at around 0.01%.13 14 This is likely to be because they appear to have a stronger immune response to the virus.15There are concerns that children who have been infected with the virus can develop a postviral inflammatory reaction (Kawasaki disease) and this can be severe,16 but the research evidence for this is not well developed yet.Transmission by childrenChildren can be asymptomatic and test positive for COVID-19, and in the absence of effective community testing it will be impossible to know if they are carrying the virus. Children also can have normal or abnormal signs (eg, chest imaging) when they have tested positive.17 In short, it is difficult to determine without much more extensive testing if a child can transmit the infection.Arav et al18 found that the contact route was much more important than low price kamagra the airborne route, which they concluded had a negligible contribution. They suggest protective measures would therefore be good hand hygiene, careful cleaning and avoiding physical contact.Given that there are quite low numbers of symptomatic cases and an unknown quantity of asymptomatic cases, it is very difficult to determine whether children are a significant vector for the disease. Studies cited by the Royal College of Paediatrics and Child Health that explored family clusters of infection suggest that the child was unlikely to be the index case.The riskThis evidence suggests that there is a case for reopening schools to limited numbers of pupils—the risk to pupils low price kamagra and the adults they come into contact with seems to be small, and the potential gains for children may outweigh them.

There is a big proviso with this however, and that is that the overall incidence of COVID-19 has fallen below specified threshold. This is quite a contentious issue and depends on us meeting the five key tests for easing lockdown.Making sure the National Health Service can cope.A sustained low price kamagra and consistent fall in the daily death rate.Rate of infection decreasing to manageable levels.Ensuring that personal protective equipment supply can meet demand.Being confident that any adjustments would not risk a second peak.These conditions are open to interpretation, and there appears to be a lack of trust by the public and by professionals from education and health in the information that the government and their scientific advisors are sharing. An example of this is a group of scientists who have come together to challenge the government about their decision-making.19 The concern about whether the evidence and advice that we are given are biased in any way has also been increased by concerns that a government advisor (Dominic Cummings) has attended what were supposed to be politically independent meetings of the SAGE.Scientific evidence continues to emerge, but weighing up the risks and benefits is not easy. Decisions about whether to reopen schools are taken on a national level with a distance from personal concerns low price kamagra and fears.

Individuals who are making decisions often rely on media translations of the evidence, and there is a level of mistrust in politicians and the media.20 Individuals are often irrational in their risk perception and management (eg, continuing to smoke or drink alcohol despite strong scientific evidence about the risk).21 22Overall, we are information-poor and opinion-rich. It is a difficult path low price kamagra to navigate. The debate about whether the benefits outweigh the risks of returning to school reminds me of the post-Wakefield Measles Mumps and Rubella vaccination situation. Parents were being asked to believe that MMR was a safe vaccine in the face of a massive and emotive campaign that promoted the ‘risk’ of having the low price kamagra vaccine above all else.

This situation is even more complex than that as we have increased access to opinion and difficulty in understanding if or how low price kamagra much that information is biased. It is no wonder that decision-making is difficult. It is likely that evidence will continue to emerge and gradually the choice low price kamagra will become easier to make. For now, however, we can understand the difficulties that parents, teachers and councils face.IntroductionWhenever developing training competencies, tools to support clinical practice or a response to a professional issue, seeking the opinion of experts is a common approach.

By working to identify a consensus position, researchers can report findings on a specific low price kamagra question (or set of questions) that are based on the knowledge and experience of experts in their field.However, there are challenges to this approach. For example, what should be done when consensus cannot be reached?. How can experts be engaged in a way that allows them to consider objectively the views of others and—where appropriate—change their own opinions in low price kamagra response?. One approach that attempts to provide a clear method for gathering expert opinion is the Delphi technique.The Delphi technique was first developed in the 1950s by Norman Dalkey and Olaf Helmer in an attempt to gain reliable expert consensus.

Specifically, they developed an approach—named after the Ancient Greek Oracle of Delphi, who could predict the future—which promoted anonymity and avoided direct confrontation between experts, so that the methods employed “…appear to be more conducive to independent thought on the part of the low price kamagra experts and to aid them in the gradual formation of a considered opinion”.1 Though the original Delphi study was linked to the defence industry, the technique has spread to other research areas, including nursing.2Characteristics of Delphi studiesAs with all research methods, the Delphi technique has evolved since it was first reported on in the 1960s. However, many of the fundamental characteristics of the approach still remain from Dalkey and Helmer’s original outline. First, the overarching approach is based on a series of ‘rounds’, low price kamagra where a set of experts are asked their opinions on a particular issue. The questions for each round are based in part of the findings of the previous one, allowing the study to evolve over time in response to earlier findings.Second, participants are able to see the results of previous rounds—including their own responses—allowing them to reflect on the views of others and reposition their own opinions accordingly.2 This also gives them the opportunity to consider and feedback on what they perceive to be the strengths and weaknesses of other’s responses.

Finally, the findings of each round low price kamagra are always shared with the broader group anonymously. This avoids any bias that might result from participants being concerned about their own low price kamagra views being viewed negatively or from their own opinions being biased by personal factors. This framework of expert opinion rounds, with each round built on previous findings and each allowing for responses to be reconsidered by participants, is designed to allow the development of a consensus view that answers the research question.Within this broad approach, there can be variation in areas such as how many rounds there are, how the questions are delivered and responses collected, and how ‘consensus’ is judged. For example, low price kamagra a study of human factors that contributed to nursing errors used only two rounds.

The first took the form of an online survey asking 25 experts to list all the ‘human’ causes of nursing errors that they could. Analysis of responses resulted in a list of 28 potential reasons—this list was sent back to the same group of experts for low price kamagra the second round, asking them to score each one for importance. Analysis of this scoring then allowed for consensus conclusions on the top 10 human factors that contributed to nursing errors (with fatigue, heavy workload and communication problems the top three).3In another example, nurse practitioners (NPs) were recruited to participate in a Delphi study to achieve consensus related to NP advance care planning competencies. In round 1, draft competencies were developed from the low price kamagra findings of a survey of NP beliefs, knowledge and level of implementation of advance care planning.

Round 2 included engagement with 29 NPs who evaluated the draft competencies and their components. Revisions were made based on the original feedback, and a third round was conducted where 15 of the original NP participants confirmed their consensus with the final low price kamagra document. The final document includes four competencies, each with several elements. Clinical Practice, Consultation and Communication, low price kamagra Advocacy and Therapeutic Management.4Strengths and weaknesses of Delphi studiesThe Delphi technique offers a flexible approach to gathering the views of experts on an area of interest.

The ability for participants to reconsider their views in light of the contribution of others allows for an element of reflection that is missing from studies based on single interviews or focus groups. The anonymity among the expert groups that underpins Delphi studies promotes honesty among participants and reduces the risk of low price kamagra the ‘halo effect’ where views from dominant or high-profile members of the group are given extra credence.5However, Delphi studies can—by their very nature—be complex and time consuming. The need for participants to complete multiple rounds can lead to high drop-out rates which low price kamagra impacts on validity of the study. The ability of participants to amend or alter their views at each round is also something of a double-edged sword.

It provides those taking part with the opportunity to reflect and reconsider low price kamagra their position in response to additional information, which is an important part of nursing practice. Conversely though, there is a danger that this flexibility introduces bias, with participants altering their response to comply with what they view to be the majority view (sometime called the ‘bandwagon effect’).5Delphi studies can be criticised due to a lack of clarity on what is meant by ‘consensus’. Even with the level of flexibility and reflexivity present in Delphi studies, it is still unlikely that a group of experts will demonstrate 100% low price kamagra agreement on issues. However, because consensus is a requirement of a Delphi study, there does need to be a judgement on when this point is reached.

This is where there is inconsistency across studies and authors, with the suggested level of consensus ranging from 51% to 100%.2 In addition, it has been identified that in some areas, consensus is not low price kamagra predefined as part of the study method. For example, a review of Delphi studies in nurse education found that fewer than half of the papers appraised included a predefined level at which consensus was judged to have been achieved.6 In addition, the identification of an objective level consensus is only possible when gathering quantifiable data—the judgement on consensus being reached in some qualitative Delphi studies will always be rather more subjective on the part of the researcher, and therefore potentially open to bias.By their nature, Delphi studies often rely purely on expert opinion to generate findings. A further limitation is therefore related to the quality of evidence, with expert opinion viewed low price kamagra as providing a poor basis for making judgements on healthcare interventions.7 This does not mean that the findings of Delphi studies are intrinsically unreliable or invalid. It does mean that researchers should consider whether their research question is one that can be answered through expert consensus or whether other approaches (such as a systematic review of research evidence) are more appropriate.ConclusionThe Delphi technique is a well-established approach to answering a research question through the identification of a consensus view across subject experts.

It allows for reflection among participants, who are able to nuance and reconsider their opinion low price kamagra based on the anonymised opinions of others. However, researchers must take steps to enhance robustness of the studies. It is important to try and prevent participants from simply resorting low price kamagra to agreeing with the majority view. Studies must also predefine what is meant by ‘consensus’ and how it will be established.With careful and clear design though, Delphi studies can make a valuable contribution to the nursing evidence base by tapping into the profession’s most precious resource—the knowledge and expertise of its practitioners..