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Shutterstock cheap renova online A new report by Kaufman, Hall &. Associates, LLC has found that the skin care products renova will continue to affect the financial health of hospitals and health systems through 2021. The report released by the American Hospital Association (AHA) Wednesday forecasts total hospital cheap renova online revenue in 2021 could be down by between $53 billion and $122 billion compared to pre-renova levels.

The financial pressure, the report said, could jeopardize hospital’s ability to care for their communities during the renova, resulting in a slowdown in treatment distribution and administration, continued pressure on front-line caregivers, and diminished access to care. €œWhen we talk about cheap renova online the historic financial challenges hospitals face, it’s about more than dollars and cents, it’s really about making sure hospitals and health systems have the resources needed to provide essential services for their patients and communities,” AHA President and CEO Rick Pollack said. €œDuring the renova, people have put off needed care, in some cases to the detriment of their health.

In addition, the costs of labor and supplies have increased, adding to financial stress. treatments give us hope that the end is in sight, but hospitals need additional support to continue to provide access to care and to help get as many treatment shots into arms quickly.”If cheap renova online hospitals experience a consistent and complete recovery of patient volumes, and treatment distribution and administration go smoothly, and the country continues to see a drop in skin care products cases, hospitals and health systems would face $53 billion in total revenue losses this year. However, if patient volumes recover slowly, treatment rollouts continue to face logistical challenges and delays, and the country sees more skin care products surges, hospitals could face a total of $122 billion in lost revenue.In 2020, an AHA report found that hospitals and health systems lost at least $323.1 billion due to patient volume decreases and skin care products.

At least four dozen hospitals entered bankruptcy or cheap renova online closed in 2020, according to Bloomberg.Shutterstock U.S. Reps. David Kustoff (R-TN) and Abigail Spanberger (D-VA) re-introduced the Criminalizing Abused Substance Templates (CAST) Act Wednesday.

The legislation would modify the Controlled Substances Act to define the criminal penalty for making counterfeit cheap renova online drugs using a pill press. Currently, the law bans the practice but doesn’t define the penalty for doing so. The CAST Act would make possessing a pill press with the intent to make counterfeit schedule I or II substances a crime and establish cheap renova online a sentence of up to 20 years for possession alone.

€œThe opioid epidemic has ravaged our communities in West Tennessee and across our nation. Unfortunately, as we continue to battle skin care products, the cheap renova online opioid crisis has only grown worse. We owe it to our loved ones to take stronger action to fight back against this public health emergency.

The CAST Act is the much-needed, bold step forward in this fight,” Kustoff said. €œIt will increase penalties against possession of harmful drugs and pill press molds, helping to cheap renova online combat the illegal drug market and the dangers it presents to our citizens and our brave law enforcement officers across the nation.”The Congressmembers said the law would prevent overdoses and reduce fentanyl-related deaths. €œFamilies, businesses, and entire communities in Virginia continue to face immense challenges due to opioid abuse.

As this public health crisis significantly worsens as a result of the skin care products renova, we also face the threat of extremely dangerous substances — such as fentanyl — being pressed into illicit pills and cheap renova online sold on our streets,” said Spanberger. €œThis bill would help crackdown on the production of counterfeit drugs via illicit pill press molds. By deterring drug traffickers and those who produce illicit drugs, we would take another step in the fight against fentanyl-related deaths.”.

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Shutterstock A Cialis price walmart new report by renova under eyes Kaufman, Hall &. Associates, LLC has found that the skin care products renova will continue to affect the financial health renova under eyes of hospitals and health systems through 2021. The report released by the American Hospital Association (AHA) Wednesday forecasts total hospital revenue in 2021 could be down by between $53 billion and $122 billion compared to pre-renova levels. The financial pressure, the report said, could jeopardize hospital’s ability to care for their renova under eyes communities during the renova, resulting in a slowdown in treatment distribution and administration, continued pressure on front-line caregivers, and diminished access to care. €œWhen we talk about the historic financial challenges hospitals face, it’s about more than dollars and cents, it’s really about making sure hospitals and health systems have the resources needed to provide essential services for their patients and communities,” AHA President and CEO Rick Pollack said.

€œDuring the renova, people have put off needed care, renova under eyes in some cases to the detriment of their health. In addition, the costs of labor and supplies have increased, adding to financial stress. treatments give us hope that the end is in sight, but hospitals need additional support to continue to provide access to care and to help get as many renova under eyes treatment shots into arms quickly.”If hospitals experience a consistent and complete recovery of patient volumes, and treatment distribution and administration go smoothly, and the country continues to see a drop in skin care products cases, hospitals and health systems would face $53 billion in total revenue losses this year. However, if patient volumes recover slowly, treatment rollouts continue to face logistical challenges and delays, and the country sees more skin care products surges, hospitals could face a total of $122 billion in lost revenue.In 2020, an AHA report found that hospitals and health systems lost at least $323.1 billion due to patient volume decreases and skin care products. At least four dozen hospitals entered bankruptcy or renova under eyes closed in 2020, according to Bloomberg.Shutterstock U.S.

Reps. David Kustoff (R-TN) and Abigail Spanberger (D-VA) re-introduced the Criminalizing Abused renova under eyes Substance Templates (CAST) Act Wednesday. The legislation would modify the Controlled Substances Act to define the criminal penalty for making counterfeit drugs using a pill press. Currently, the law bans the renova under eyes practice but doesn’t define the penalty for doing so. The CAST Act would make possessing a pill press with the intent to make counterfeit schedule I or II substances a crime and establish a sentence of up to 20 years for possession alone.

€œThe opioid epidemic has ravaged our communities renova under eyes in West Tennessee and across our nation. Unfortunately, as we continue to battle skin care products, the opioid crisis has only grown worse. We owe it to our loved ones to take stronger action to fight back against this public health emergency renova under eyes. The CAST Act is the much-needed, bold step forward in this fight,” Kustoff said. €œIt will increase penalties against possession of harmful drugs and pill press molds, helping renova under eyes to combat the illegal drug market and the dangers it presents to our citizens and our brave law enforcement officers across the nation.”The Congressmembers said the law would prevent overdoses and reduce fentanyl-related deaths.

€œFamilies, businesses, and entire communities in Virginia continue to face immense challenges due to opioid abuse. As this public health crisis significantly worsens as a result of the skin care products renova, we also face the threat of extremely dangerous substances — such as fentanyl — being pressed into illicit pills and sold on renova under eyes our streets,” said Spanberger. €œThis bill would help crackdown on the production of counterfeit drugs via illicit pill press molds. By deterring drug traffickers and those who produce illicit drugs, we would take another step renova under eyes in the fight against fentanyl-related deaths.”Shutterstock U.S. Sen.

Dick Durbin (D-IL), Senate Democratic whip and Senate Judiciary Committee chairman, recently spoke about the dramatic increase in renova under eyes suicides and opioid overdose deaths associated with the skin care products renova.“While the human suffering of skin care products has captured our attention, as it should, two other deadly epidemics in America still rage on. Opioids and the mental health crises,” Durbin said. €œEven before the renova took its toll, we had been in the midst of renova under eyes the worst drug overdose crisis in our nation’s history, and we’re witnessing skyrocketing rates of suicide, but skin care products has deepened these epidemics, which sadly feed on isolation and despair. With the convergence of skin care emergencies, we are failing those most vulnerable to addiction and mental health challenges.” Durbin spoke about a Lake County, Ill., resident who struggled with substance use disorder and committed suicide after being unable to access treatment and about the increase in suicides among African-American residents in Cook County, Ill.In 2020, 437 Cook County residents committed suicide, and more than 700 died from opioid overdoses between January and June 2020. The opioid death rate is renova under eyes double 2019’s rate.

Durbin also urged support for President Joe Biden’s American Rescue Plan, which includes nearly $4 billion in addiction and mental health treatment grants.Shutterstock The Delaware Department of Health and Social Services plans to offer a training program on treating opioid use disorder (OUD) among Medicaid recipients. The program is open to medical providers and practice managers in renova under eyes psychiatry, primary care, infectious diseases, and women’s health.The Office-Based Opioid Treatment (OBOT) Fellowship Program will offer webinars, self-paced modules, and weekly discussion groups from March 23 through Sept. 23. Participants will learn about the available Medicaid financing mechanisms for OBOT, receive technical assistance to offer OBOT, exchange ideas, and access a curated online library of tools and evidence-based practices.The program will be renova under eyes taught by addiction-medicine experts and will be offered in two phases.OBOT involves prescribing safe, effective, Food and Drug Administration-approved medications to treat OUD “Opioid addiction is an ongoing and often deadly presence for many Delawareans and their families, and we need every tool at our disposal to help them confront it,” Gov. John Carney said.

€œEquipping our medical providers renova under eyes to manage the treatment of these patients is an important part of this effort.”The U.S. Department of Health and Human Services’ Centers for Medicare and Medicaid Services supports the program through a $3.58 million grant awarded to the state.Shutterstock Pennsylvania’s Senate Labor and Industry Committee recently advanced legislation that aims to reduce opioid dependency.Senate Bill 147 would amend the Workers’ Compensation Act of 1915 to require employers who have a certified safety committee to provide employees with information about the consequences of addiction, including opioid painkillers.Under Pennsylvania’s Workers’ Compensation Law, employers receive a 5 percent discount on their workers’ compensation insurance premium if they establish a certified safety committee. The bill renova under eyes would require employers to incorporate addiction risks to receive certification and the discount. The Department of Labor and Industry would develop and make available the information.State Sen. Wayne Langerholc (R-Bedford renova under eyes and Cambria counties) introduced the bill.

It was one of five bills approved by the committee addressing workplace issues.“Pennsylvanians face a much greater risk of mental health challenges during the skin care products renova, so combatting the addiction crisis has never been more important than right now,” state Sen. Camera Bartolotta (R-Carroll), committee chairwoman, said. €œThese bills accomplish the key goals of providing a pathway for individuals in recovery to find quality jobs to rebuild their lives, while also making sure more Pennsylvanians do not fall victim to addiction.”The bill was originally introduced in May 2020..

Shutterstock http://cz.keimfarben.de/cialis-price-walmart A new cheap renova online report by Kaufman, Hall &. Associates, LLC has found that the skin care products renova cheap renova online will continue to affect the financial health of hospitals and health systems through 2021. The report released by the American Hospital Association (AHA) Wednesday forecasts total hospital revenue in 2021 could be down by between $53 billion and $122 billion compared to pre-renova levels.

The financial pressure, the report said, could jeopardize hospital’s ability to cheap renova online care for their communities during the renova, resulting in a slowdown in treatment distribution and administration, continued pressure on front-line caregivers, and diminished access to care. €œWhen we talk about the historic financial challenges hospitals face, it’s about more than dollars and cents, it’s really about making sure hospitals and health systems have the resources needed to provide essential services for their patients and communities,” AHA President and CEO Rick Pollack said. €œDuring the renova, people have put off needed care, in some cheap renova online cases to the detriment of their health.

In addition, the costs of labor and supplies have increased, adding to financial stress. treatments give us hope that the end is in sight, but hospitals need additional support to continue to provide access to care and to help get as many treatment shots into arms quickly.”If hospitals experience a consistent and complete cheap renova online recovery of patient volumes, and treatment distribution and administration go smoothly, and the country continues to see a drop in skin care products cases, hospitals and health systems would face $53 billion in total revenue losses this year. However, if patient volumes recover slowly, treatment rollouts continue to face logistical challenges and delays, and the country sees more skin care products surges, hospitals could face a total of $122 billion in lost revenue.In 2020, an AHA report found that hospitals and health systems lost at least $323.1 billion due to patient volume decreases and skin care products.

At least cheap renova online four dozen hospitals entered bankruptcy or closed in 2020, according to Bloomberg.Shutterstock U.S. Reps. David Kustoff (R-TN) and Abigail cheap renova online Spanberger (D-VA) re-introduced the Criminalizing Abused Substance Templates (CAST) Act Wednesday.

The legislation would modify the Controlled Substances Act to define the criminal penalty for making counterfeit drugs using a pill press. Currently, the law cheap renova online bans the practice but doesn’t define the penalty for doing so. The CAST Act would make possessing a pill press with the intent to make counterfeit schedule I or II substances a crime and establish a sentence of up to 20 years for possession alone.

€œThe opioid epidemic has ravaged our communities in West Tennessee and across our cheap renova online nation. Unfortunately, as we continue to battle skin care products, the opioid crisis has only grown worse. We owe it to our loved ones to take stronger action to fight back against this public cheap renova online health emergency.

The CAST Act is the much-needed, bold step forward in this fight,” Kustoff said. €œIt will increase penalties against possession of harmful drugs and pill press molds, helping to combat the illegal drug market and the dangers it presents to our cheap renova online citizens and our brave law enforcement officers across the nation.”The Congressmembers said the law would prevent overdoses and reduce fentanyl-related deaths. €œFamilies, businesses, and entire communities in Virginia continue to face immense challenges due to opioid abuse.

As this public health crisis significantly worsens as a result of cheap renova online the skin care products renova, we also face the threat of extremely dangerous substances — such as fentanyl — being pressed into illicit pills and sold on our streets,” said Spanberger. €œThis bill would help crackdown on the production of counterfeit drugs via illicit pill press molds. By deterring drug traffickers and those who produce illicit drugs, we would take another step cheap renova online in the fight against fentanyl-related deaths.”Shutterstock U.S.

Sen. Dick Durbin (D-IL), Senate Democratic whip and Senate Judiciary Committee chairman, recently spoke about the dramatic increase in suicides and opioid overdose deaths associated with the skin care products renova.“While the human suffering of skin care products has captured our attention, cheap renova online as it should, two other deadly epidemics in America still rage on. Opioids and the mental health crises,” Durbin said.

€œEven before the renova took its toll, we had been in the midst of the worst drug overdose crisis in our nation’s history, and we’re witnessing skyrocketing rates of suicide, but skin care products has deepened these epidemics, which sadly cheap renova online feed on isolation and despair. With the convergence of skin care emergencies, we are failing those most vulnerable to addiction and mental health challenges.” Durbin spoke about a Lake County, Ill., resident who struggled with substance use disorder and committed suicide after being unable to access treatment and about the increase in suicides among African-American residents in Cook County, Ill.In 2020, 437 Cook County residents committed suicide, and more than 700 died from opioid overdoses between January and June 2020. The opioid cheap renova online death rate is double 2019’s rate.

Durbin also urged support for President Joe Biden’s American Rescue Plan, which includes nearly $4 billion in addiction and mental health treatment grants.Shutterstock The Delaware Department of Health and Social Services plans to offer a training program on treating opioid use disorder (OUD) among Medicaid recipients. The program is open to medical providers and practice managers in psychiatry, primary care, infectious diseases, and women’s health.The Office-Based Opioid Treatment (OBOT) Fellowship Program will offer webinars, self-paced modules, and weekly discussion groups cheap renova online from March 23 through Sept. 23.

Participants will learn about the available Medicaid financing mechanisms for OBOT, receive technical assistance to offer OBOT, exchange ideas, and access a curated online library of tools and evidence-based practices.The program will be taught by cheap renova online addiction-medicine experts and will be offered in two phases.OBOT involves prescribing safe, effective, Food and Drug Administration-approved medications to treat OUD “Opioid addiction is an ongoing and often deadly presence for many Delawareans and their families, and we need every tool at our disposal to help them confront it,” Gov. John Carney said. €œEquipping our medical providers to manage the treatment of these patients cheap renova online is an important part of this effort.”The U.S.

Department of Health and Human Services’ Centers for Medicare and Medicaid Services supports the program through a $3.58 million grant awarded to the state.Shutterstock Pennsylvania’s Senate Labor and Industry Committee recently advanced legislation that aims to reduce opioid dependency.Senate Bill 147 would amend the Workers’ Compensation Act of 1915 to require employers who have a certified safety committee to provide employees with information about the consequences of addiction, including opioid painkillers.Under Pennsylvania’s Workers’ Compensation Law, employers receive a 5 percent discount on their workers’ compensation insurance premium if they establish a certified safety committee. The bill cheap renova online would require employers to incorporate addiction risks to receive certification and the discount. The Department of Labor and Industry would develop and make available the information.State Sen.

Wayne Langerholc (R-Bedford and Cambria counties) introduced cheap renova online the bill. It was one of five bills approved by the committee addressing workplace issues.“Pennsylvanians face a much greater risk of mental health challenges during the skin care products renova, so combatting the addiction crisis has never been more important than right now,” state Sen. Camera Bartolotta (R-Carroll), committee chairwoman, cheap renova online said.

€œThese bills accomplish the key goals of providing a pathway for individuals in recovery to find quality jobs to rebuild their lives, while also making sure more Pennsylvanians do not fall victim to addiction.”The bill was originally introduced in May 2020..

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Bobby Monacella was tired of sending her two kids to school on buses renova forum filled with diesel fumes. Pollution levels inside those iconic yellow buses can be up to 10 times higher than outside. €œThey're sitting on the bus for over an renova forum hour a day, and when you learn that the emissions are concentrated inside the bus, it’s scary,” said Monacella, who volunteers with the climate advocacy group Mothers out Front. So she teamed up with other moms in Fairfax County, Va., to do something about it.

The school district, which is the second largest in the country, agreed to replace its 1,650 diesel buses with electric ones by 2035. But other families face renova forum longer waits. The infrastructure package proposed by the Senate and the White House on Wednesday offers significantly less funding for electric school buses than what President Biden was seeking. And without a federal infusion of cash and incentives, advocates fear zero-emissions school buses—which can cost three times more than those with internal-combustion engines—could be distributed unevenly, potentially leaving behind low-income families and students of color renova forum who already bear the brunt of environmental pollution.

"Those schools that can afford to make the transition and cover the costs of not just the school bus, but the charging infrastructure that's needed, are in the predominantly wealthier communities," said Trisha DelloIacono, the legislative manager for Moms Clean Air Force. "So federal investment is so needed." Electric school buses would receive $2.5 billion in funding under the package, enough for approximately 11,000 zero-emissions buses. Another $2.5 billion would go toward what lawmakers and the White House are calling renova forum low-emissions buses. The lump sum is substantially less than the $174 billion Biden initially proposed last March to boost the overall EV market, including cars, trucks and buses.

That plan aimed to electrify 96,000 school buses, or about 20% of the U.S. Fleet. €œWe need the full funding,” said Sybil Azur, a mom and community organizer who has been working to expand the use of electric school buses in Los Angeles. €œWhat’s at stake is my children’s future, my children’s health and their ability to live productive, healthy lives.” She and other advocates are concerned that the allocation for “low-emissions” school buses in the infrastructure package could prioritize other fuel types over electric technology.

"Essentially, this is a tiny drop in the bucket of what is needed to protect our children from harmful diesel pollution," said DelloIacono. "To make matters worse, it won't help our kids at all if it's used for polluting fossil fuel buses under the guise of improving our nation's infrastructure." There are 480,000 school buses across the country, 95% of which run on high-polluting diesel fuel. And more than half the nation’s public school students, about 25 million children, ride the bus to school and back each day. Research conducted by Environment &.

Human Health Inc. Has shown that pollution levels on those school buses often exceed surrounding areas by five to 10 times, endangering students' health and contributing to greenhouse gas emissions. The transportation sector is the single largest source of carbon pollution in the country. While scientists have long known that diesel pollution can cause a host of health problems, among them asthma and bronchitis, developmental disabilities, and cancer, recent research suggests the health impacts could be worse than previously thought.

A meta-analysis of hundreds of studies, published in 2018 in the American Journal of Public Health, found strong links between pollution exposure and cardiorespiratory diseases. Another study, issued by the National Bureau of Economic Research in 2018, found that air pollution significantly exacerbates dementia. Even a slight increase in air pollution from a single car can send more kids to the hospital and lead to premature births, according to a 2019 working paper from the Federal Reserve Bank of Chicago. Environmental pollution is worse for children, whose brains are still developing, than for adults.

And Black children are hospitalized from asthma twice as often as white children and are four times as likely to die from the disease. Latino children are also at higher risk. That’s why Cinthia Moore, a mother and advocate living in a predominately Latino neighborhood in East Las Vegas, won’t let her son, Liam, ride the school bus. €œHe has breathing issues,” she explained.

€œWhenever we have a bad air quality day, like today, if he spends any time outside, he comes back already with a runny nose and sneezing, and he also has rashes around his body because of the extreme heat.” Monacella of Mothers out Front said the details around funding, and where charging infrastructure is placed, can determine whether electric school buses are distributed equitably. She pointed to a Virginia pilot program in which Dominion Energy has deployed 50 electric school buses as part of broader vehicle-to-grid plan. Monacella said she worries that the utility may not prioritize low-income school districts. €œDominion will help pay for some buses.

Maybe our state grant fund will help pay for some buses. And, you know, the more, the better,” she said. €œBut the way the Dominion program was set up, they wanted to own the batteries and the charging infrastructure, and they wanted to say where it could be sited. So it didn't matter where the highest asthma rates were.

It didn't matter the lowest air quality. It just mattered what worked for them.” A Dominion spokesperson said the utility has deployed its 50 electric school buses in geographically and economically diverse districts and intends to weigh equity concerns when expanding its vehicle-to-grid program. €œEvery student in the commonwealth deserves access to a safe, emissions-free school transportation, and our goal is to help school districts make that transition,” spokesperson Samantha Moore wrote in an email. As health impacts related to climate-fueled events like extreme heat or wildfires become more common among children, parents are increasingly calling on their elected officials to take action.

€œIf your child is struggling to breathe because of wildfire smoke due to climate change, to have the opportunity to put a child on an electric school bus and not be exposed to that additional pollution is critical for these families,” said DelloIacono of Moms Clean Air Force. €œAnd so they have really been at the forefront of advocating for this transition to electric school buses.” Curbing emissions from school buses would eliminate as much as 5.3 million tons of greenhouse gas emissions each year. And while electric buses are currently more expensive to purchase than their diesel counterparts, schools could save hundreds of thousands of dollars on fuel and maintenance costs, according to a recent report led by the U.S. PIRG Education Fund.

€œSo a new infusion of federal funds is so important because it can really help with financing the upfront costs,” said John Stout, a transportation advocate with U.S. PIRG. Despite funding hurdles, momentum for electric school buses is growing as the infrastructure debate intensifies on Capitol Hill. Last year, a school district in Sacramento, Calif., became the owner of the largest electric school bus fleet in the country, with 40 zero-emissions buses.

A county in Tennessee secured the state's first all-electric school bus last month. In Maryland, Montgomery County Public Schools announced a contract earlier this year to replace all of its diesel buses with electric ones, starting with 326 buses over four years. The list goes on. A recent poll from the American Lung Association found that 68 percent of American voters, across all major demographic groups, support Congress' investing in zero-emission school buses nationwide.

This month, over 100 local school board officials across the country signed a letter to Biden and Congress calling for a $30 billion federal investment over 10 years to replace half the nation’s school bus fleet with electric buses. Several lawmakers have introduced similar legislation. A recent measure from Reps. Tony Cárdenas (D-Calif.) and Jahana Hayes (D-Conn.) and from Sens.

Alex Padilla (D-Calif.) and Raphael Warnock (D-Ga.) would authorize $25 billion to transition the nation’s school bus fleet over 10 years, giving priority to low-income and front-line communities. Sen. Patty Murray (D-Wash.) also floated a bill earlier this year, which was originally introduced by former Sen. Kamala Harris in 2019, that would enable school districts to replace diesel buses with electric ones.

While many uncertainties remain—like how best to install charging infrastructure—Monacella said electrifying the nation’s school bus fleet is a crucial step not only to protect children’s health, but also to reduce carbon emissions. There are four times more school buses on the road than public transit buses. €œClimate change is happening all around us. It’s beyond crisis time,” she said.

Electrifying school buses “is just one piece of the puzzle, but I think it can have a big impact, and it’s something I can do to try to make a difference.” Reprinted from E&E News with permission from POLITICO, LLC. Copyright 2021. E&E News provides essential news for energy and environment professionals.Before they were postponed to this year, the Tokyo 2020 Olympic Games were billed by some as the “Hydrogen Olympics” because of plans to power much of the event’s infrastructure with the clean-burning gas. The Olympic Village, home to the athletes during the Games, was slated to run on it.

One hundred hydrogen-fuel-cell-powered buses and 500 hydrogen-powered cars were supposed to transport competitors and staff between venues. Even the iconic Olympic torch and cauldrons were set to be lit with hydrogen-powered flame. The Olympics, organizers and stakeholders said, would be a focal point for Japan’s serious aims to boost hydrogen use and become carbon-neutral by 2050. But reports indicate these initial goals were scaled back for reasons that are currently unclear.

(Tokyo 2020 and the International Olympic Committee have not yet responded to requests for comment.) The hydrogen bus plan was scrapped. Only one building in the Olympic Village is actually hydrogen-powered, and propane was used for part of the torch relay. Although the Summer Olympic Games’ use of hydrogen might not be as widespread as planned, Japan still is serious about its plans to shift to a system based on the gas, says Keith Wipke, a hydrogen and fuel cell researcher at the U.S.’s National Renewable Energy Laboratory. €œI certainly have seen no indications that Japan or any other country has backed off on their quite ambitious aspirations for hydrogen,” he says.

€œIf anything, I think they have doubled down on it because they realize, just looking at what’s going on around in the environment, climate change is happening. And we’re not acting quick enough.” Scientific American spoke with Wipke about hydrogen power at the Olympics and beyond. [An edited transcript of the interview follows.] The Tokyo Olympics had to roll back its original hydrogen plans. Is that likely a result of the skin care products renova?.

skin care products changed everything. Based on what I’ve seen within our laboratory and with the companies we work with, it’s also not just the disease itself—it’s the supply chain disruption. You’ve probably heard in the news about used car prices going up because people can’t get new cars—because there’s such a supply disruption caused by skin care products. The ripple effect of it is continuing to have a major impact on all kinds of industries in unexpected ways that nobody would have really been able to prepare for.

I think it’s really amazing what they’ve done [at the Tokyo Olympic Games] in spite of skin care products. I’m happy to see that, hey, they did follow through with some hydrogen activities and features as part of the Olympics. What are the benefits of using hydrogen as fuel?. Hydrogen is one of many ways to get serious about [climate change] without stopping commerce, without stopping moving vehicles, without stopping our factories or agriculture.

We can shift these things over relatively quickly to hydrogen if we can get the cost down. Hydrogen offers a lot of the benefits of diesel fuel, such as fast refueling and long driving range, without the carbon emissions—or any emissions, for that matter, as long as you make the hydrogen from a clean source. The way it works is through electrolysis. A technology that can take any electricity source—whether it’s wind, solar, geothermal, hydro or nuclear—[and use it to split] water into hydrogen and oxygen.

Japan’s clean-energy goals go beyond this push for a “Hydrogen Olympics,” correct?. With Japan, they have been planning for a hydrogen economy—and hydrogen to be part of their energy system—for a long time. And then, I think, they just put a stake in the ground, saying, “We’re going to host the Olympics—let’s use that to get visibility and attention for what we’re already planning.” But they weren’t doing this because of the Olympics. They were doing this because they don’t have a lot of natural resources, and they import a lot of energy.

Most of that energy is imported as fossil fuels that create a lot of carbon. Hydrogen really allows them an opportunity to import zero-emission carbon fuels, for example, from solar power in Australia, wind power in Norway or anywhere around the world. If you can get it to hydrogen and potentially [store and transport it in] a hydrogen energy carrier, you can still be importing your energy and doing it in a carbon-neutral way. Are other countries also investing in hydrogen?.

This is really a worldwide activity right now. If you look at the plans coming out of Europe, South Korea, China, the U.S., Canada, most countries have pretty well developed, or at least clearly stated, aspirations to hydrogen becoming a part of their energy system. I think Japan was one of the earlier ones to get out in front with it, going back 10 or 15 years ago. They laid out, in a timeline format, what they were going to do, beginning with their fuel-cell-vehicle demonstration activity, which was going on in parallel with the U.S.

There have been a lot of activities in Europe and other places that have maybe gotten more attention recently—with larger-scale demonstrations and [the conversion of] refineries to use hydrogen from electrolysis and renewable power rather than natural gas. What uses of hydrogen will we see in the coming years?. We are just at the tip of the iceberg with hydrogen. And what’s been visible—that top part of the iceberg—has been light-duty fuel-cell cars.

But below that is all this other activity. This is going to be much more commercially driven—not based on somebody’s emotions but more about the business sense. For example, heavy-duty hydrogen-fuel-cell trucks are going to be driven by the need for transporting goods across long distances in both an economical way and an environmental way. On local shorter routes, battery-electric 18-wheel trucks can do just fine, and they’ll be able to come back and charge slowly.

But if you go out to I-70 from Denver, going west up into the mountains, you are climbing literally 5,000 to 6,000 feet at a 6 percent grade. If you’re pulling 80,000 pounds of cargo, you don’t want 10,000 of that to be batteries. When you get over the Continental Divide, you might want to refuel in five to 10 minutes and keep going because you’re on your way to Utah before you spend the night—or before you switch drivers and keep going all the way to California. That’s where hydrogen really shines.

The higher-power, long-duration activities that are challenging—not impossible but challenging—to do with battery electrics only. What’s next for hydrogen in the U.S.?. We’re not done yet. All that other stuff [including producing hydrogen via solar power or biomasses such as crop residues] is below the iceberg and still needs work to develop it further.

The secretary of energy [Jennifer Granholm] announced the hydrogen energy “Earthshot” to reduce the cost of hydrogen production to $1 per kilogram [$0.45 per pound] in one decade. That’s challenging—like an 80 percent reduction in costs. That is reinforcing and spurring a lot of our research in the industry to try and get to that goal. If you can get to that low-cost green hydrogen, it opens up all kinds of commercial opportunities [such as converting hydrogen to electrical power or building heat] that don’t exist when you’re at, say, $5 a kilogram [$2.27 per pound].

You can be refining oil into diesel and gasoline using hydrogen from solar and wind power rather than hydrogen from natural gas. That, right there, makes a big dent and cleans up from a carbon perspective..

Bobby Monacella was tired of sending her two kids to school on cheap renova online buses filled with pop over here diesel fumes. Pollution levels inside those iconic yellow buses can be up to 10 times higher than outside. €œThey're sitting on the bus for over an hour a day, and when you learn that the emissions are concentrated inside the bus, it’s scary,” said Monacella, who volunteers with the climate advocacy group Mothers cheap renova online out Front. So she teamed up with other moms in Fairfax County, Va., to do something about it.

The school district, which is the second largest in the country, agreed to replace its 1,650 diesel buses with electric ones by 2035. But other families cheap renova online face longer waits. The infrastructure package proposed by the Senate and the White House on Wednesday offers significantly less funding for electric school buses than what President Biden was seeking. And without a federal infusion of cash and incentives, advocates fear zero-emissions school buses—which can cost three times more than those with internal-combustion engines—could be distributed unevenly, potentially leaving behind low-income families and students of color cheap renova online who already bear the brunt of environmental pollution.

"Those schools that can afford to make the transition and cover the costs of not just the school bus, but the charging infrastructure that's needed, are in the predominantly wealthier communities," said Trisha DelloIacono, the legislative manager for Moms Clean Air Force. "So federal investment is so needed." Electric school buses would receive $2.5 billion in funding under the package, enough for approximately 11,000 zero-emissions buses. Another $2.5 cheap renova online billion would go toward what lawmakers and the White House are calling low-emissions buses. The lump sum is substantially less than the $174 billion Biden initially proposed last March to boost the overall EV market, including cars, trucks and buses.

That plan aimed to electrify 96,000 school buses, or about 20% of the U.S. Fleet. €œWe need the full funding,” said Sybil Azur, a mom and community organizer who has been working to expand the use of electric school buses in Los Angeles. €œWhat’s at stake is my children’s future, my children’s health and their ability to live productive, healthy lives.” She and other advocates are concerned that the allocation for “low-emissions” school buses in the infrastructure package could prioritize other fuel types over electric technology.

"Essentially, this is a tiny drop in the bucket of what is needed to protect our children from harmful diesel pollution," said DelloIacono. "To make matters worse, it won't help our kids at all if it's used for polluting fossil fuel buses under the guise of improving our nation's infrastructure." There are 480,000 school buses across the country, 95% of which run on high-polluting diesel fuel. And more than half the nation’s public school students, about 25 million children, ride the bus to school and back each day. Research conducted by Environment &.

Human Health Inc. Has shown that pollution levels on those school buses often exceed surrounding areas by five to 10 times, endangering students' health and contributing to greenhouse gas emissions. The transportation sector is the single largest source of carbon pollution in the country. While scientists have long known that diesel pollution can cause a host of health problems, among them asthma and bronchitis, developmental disabilities, and cancer, recent research suggests the health impacts could be worse than previously thought.

A meta-analysis of hundreds of studies, published in 2018 in the American Journal of Public Health, found strong links between pollution exposure and cardiorespiratory diseases. Another study, issued by the National Bureau of Economic Research in 2018, found that air pollution significantly exacerbates dementia. Even a slight increase in air pollution from a single car can send more kids to the hospital and lead to premature births, according to a 2019 working paper from the Federal Reserve Bank of Chicago. Environmental pollution is worse for children, whose brains are still developing, than for adults.

And Black children are hospitalized from asthma twice as often as white children and are four times as likely to die from the disease. Latino children are also at higher risk. That’s why Cinthia Moore, a mother and advocate living in a predominately Latino neighborhood in East Las Vegas, won’t let her son, Liam, ride the school bus. €œHe has breathing issues,” she explained.

€œWhenever we have a bad air quality day, like today, if he spends any time outside, he comes back already with a runny nose and sneezing, and he also has rashes around his body because of the extreme heat.” Monacella of Mothers out Front said the details around funding, and where charging infrastructure is placed, can determine whether electric school buses are distributed equitably. She pointed to a Virginia pilot program in which Dominion Energy has deployed 50 electric school buses as part of broader vehicle-to-grid plan. Monacella said she worries that the utility may not prioritize low-income school districts. €œDominion will help pay for some buses.

Maybe our state grant fund will help pay for some buses. And, you know, the more, the better,” she said. €œBut the way the Dominion program was set up, they wanted to own the batteries and the charging infrastructure, and they wanted to say where it could be sited. So it didn't matter where the highest asthma rates were.

It didn't matter the lowest air quality. It just mattered what worked for them.” A Dominion spokesperson said the utility has deployed its 50 electric school buses in geographically and economically diverse districts and intends to weigh equity concerns when expanding its vehicle-to-grid program. €œEvery student in the commonwealth deserves access to a safe, emissions-free school transportation, and our goal is to help school districts make that transition,” spokesperson Samantha Moore wrote in an email. As health impacts related to climate-fueled events like extreme heat or wildfires become more common among children, parents are increasingly calling on their elected officials to take action.

€œIf your child is struggling to breathe because of wildfire smoke due to climate change, to have the opportunity to put a child on an electric school bus and not be exposed to that additional pollution is critical for these families,” said DelloIacono of Moms Clean Air Force. €œAnd so they have really been at the forefront of advocating for this transition to electric school buses.” Curbing emissions from school buses would eliminate as much as 5.3 million tons of greenhouse gas emissions each year. And while electric buses are currently more expensive to purchase than their diesel counterparts, schools could save hundreds of thousands of dollars on fuel and maintenance costs, according to a recent report led by the U.S. PIRG Education Fund.

€œSo a new infusion of federal funds is so important because it can really help with financing the upfront costs,” said John Stout, a transportation advocate with U.S. PIRG. Despite funding hurdles, momentum for electric school buses is growing as the infrastructure debate intensifies on Capitol Hill. Last year, a school district in Sacramento, Calif., became the owner of the largest electric school bus fleet in the country, with 40 zero-emissions buses.

A county in Tennessee secured the state's first all-electric school bus last month. In Maryland, Montgomery County Public Schools announced a contract earlier this year to replace all of its diesel buses with electric ones, starting with 326 buses over four years. The list goes on. A recent poll from the American Lung Association found that 68 percent of American voters, across all major demographic groups, support Congress' investing in zero-emission school buses nationwide.

This month, over 100 local school board officials across the country signed a letter to Biden and Congress calling for a $30 billion federal investment over 10 years to replace half the nation’s school bus fleet with electric buses. Several lawmakers have introduced similar legislation. A recent measure from Reps. Tony Cárdenas (D-Calif.) and Jahana Hayes (D-Conn.) and from Sens.

Alex Padilla (D-Calif.) and Raphael Warnock (D-Ga.) would authorize $25 billion to transition the nation’s school bus fleet over 10 years, giving priority to low-income and front-line communities. Sen. Patty Murray (D-Wash.) also floated a bill earlier this year, which was originally introduced by former Sen. Kamala Harris in 2019, that would enable school districts to replace diesel buses with electric ones.

While many uncertainties remain—like how best to install charging infrastructure—Monacella said electrifying the nation’s school bus fleet is a crucial step not only to protect children’s health, but also to reduce carbon emissions. There are four times more school buses on the road than public transit buses. €œClimate change is happening all around us. It’s beyond crisis time,” she said.

Electrifying school buses “is just one piece of the puzzle, but I think it can have a big impact, and it’s something I can do to try to make a difference.” Reprinted from E&E News with permission from POLITICO, LLC. Copyright 2021. E&E News provides essential news for energy and environment professionals.Before they were postponed to this year, the Tokyo 2020 Olympic Games were billed by some as the “Hydrogen Olympics” because of plans to power much of the event’s infrastructure with the clean-burning gas. The Olympic Village, home to the athletes during the Games, was slated to run on it.

One hundred hydrogen-fuel-cell-powered buses and 500 hydrogen-powered cars were supposed to transport competitors and staff between venues. Even the iconic Olympic torch and cauldrons were set to be lit with hydrogen-powered flame. The Olympics, organizers and stakeholders said, would be a focal point for Japan’s serious aims to boost hydrogen use and become carbon-neutral by 2050. But reports indicate these initial goals were scaled back for reasons that are currently unclear.

(Tokyo 2020 and the International Olympic Committee have not yet responded to requests for comment.) The hydrogen bus plan was scrapped. Only one building in the Olympic Village is actually hydrogen-powered, and propane was used for part of the torch relay. Although the Summer Olympic Games’ use of hydrogen might not be as widespread as planned, Japan still is serious about its plans to shift to a system based on the gas, says Keith Wipke, a hydrogen and fuel cell researcher at the U.S.’s National Renewable Energy Laboratory. €œI certainly have seen no indications that Japan or any other country has backed off on their quite ambitious aspirations for hydrogen,” he says.

€œIf anything, I think they have doubled down on it because they realize, just looking at what’s going on around in the environment, climate change is happening. And we’re not acting quick enough.” Scientific American spoke with Wipke about hydrogen power at the Olympics and beyond. [An edited transcript of the interview follows.] The Tokyo Olympics had to roll back its original hydrogen plans. Is that likely a result of the skin care products renova?.

skin care products changed everything. Based on what I’ve seen within our laboratory and with the companies we work with, it’s also not just the disease itself—it’s the supply chain disruption. You’ve probably heard in the news about used car prices going up because people can’t get new cars—because there’s such a supply disruption caused by skin care products. The ripple effect of it is continuing to have a major impact on all kinds of industries in unexpected ways that nobody would have really been able to prepare for.

I think it’s really amazing what they’ve done [at the Tokyo Olympic Games] in spite of skin care products. I’m happy to see that, hey, they did follow through with some hydrogen activities and features as part of the Olympics. What are the benefits of using hydrogen as fuel?. Hydrogen is one of many ways to get serious about [climate change] without stopping commerce, without stopping moving vehicles, without stopping our factories or agriculture.

We can shift these things over relatively quickly to hydrogen if we can get the cost down. Hydrogen offers a lot of the benefits of diesel fuel, such as fast refueling and long driving range, without the carbon emissions—or any emissions, for that matter, as long as you make the hydrogen from a clean source. The way it works is through electrolysis. A technology that can take any electricity source—whether it’s wind, solar, geothermal, hydro or nuclear—[and use it to split] water into hydrogen and oxygen.

Japan’s clean-energy goals go beyond this push for a “Hydrogen Olympics,” correct?. With Japan, they have been planning for a hydrogen economy—and hydrogen to be part of their energy system—for a long time. And then, I think, they just put a stake in the ground, saying, “We’re going to host the Olympics—let’s use that to get visibility and attention for what we’re already planning.” But they weren’t doing this because of the Olympics. They were doing this because they don’t have a lot of natural resources, and they import a lot of energy.

Most of that energy is imported as fossil fuels that create a lot of carbon. Hydrogen really allows them an opportunity to import zero-emission carbon fuels, for example, from solar power in Australia, wind power in Norway or anywhere around the world. If you can get it to hydrogen and potentially [store and transport it in] a hydrogen energy carrier, you can still be importing your energy and doing it in a carbon-neutral way. Are other countries also investing in hydrogen?.

This is really a worldwide activity right now. If you look at the plans coming out of Europe, South Korea, China, the U.S., Canada, most countries have pretty well developed, or at least clearly stated, aspirations to hydrogen becoming a part of their energy system. I think Japan was one of the earlier ones to get out in front with it, going back 10 or 15 years ago. They laid out, in a timeline format, what they were going to do, beginning with their fuel-cell-vehicle demonstration activity, which was going on in parallel with the U.S.

There have been a lot of activities in Europe and other places that have maybe gotten more attention recently—with larger-scale demonstrations and [the conversion of] refineries to use hydrogen from electrolysis and renewable power rather than natural gas. What uses of hydrogen will we see in the coming years?. We are just at the tip of the iceberg with hydrogen. And what’s been visible—that top part of the iceberg—has been light-duty fuel-cell cars.

But below that is all this other activity. This is going to be much more commercially driven—not based on somebody’s emotions but more about the business sense. For example, heavy-duty hydrogen-fuel-cell trucks are going to be driven by the need for transporting goods across long distances in both an economical way and an environmental way. On local shorter routes, battery-electric 18-wheel trucks can do just fine, and they’ll be able to come back and charge slowly.

But if you go out to I-70 from Denver, going west up into the mountains, you are climbing literally 5,000 to 6,000 feet at a 6 percent grade. If you’re pulling 80,000 pounds of cargo, you don’t want 10,000 of that to be batteries. When you get over the Continental Divide, you might want to refuel in five to 10 minutes and keep going because you’re on your way to Utah before you spend the night—or before you switch drivers and keep going all the way to California. That’s where hydrogen really shines.

The higher-power, long-duration activities that are challenging—not impossible but challenging—to do with battery electrics only. What’s next for hydrogen in the U.S.?. We’re not done yet. All that other stuff [including producing hydrogen via solar power or biomasses such as crop residues] is below the iceberg and still needs work to develop it further.

The secretary of energy [Jennifer Granholm] announced the hydrogen energy “Earthshot” to reduce the cost of hydrogen production to $1 per kilogram [$0.45 per pound] in one decade. That’s challenging—like an 80 percent reduction in costs. That is reinforcing and spurring a lot of our research in the industry to try and get to that goal. If you can get to that low-cost green hydrogen, it opens up all kinds of commercial opportunities [such as converting hydrogen to electrical power or building heat] that don’t exist when you’re at, say, $5 a kilogram [$2.27 per pound].

You can be refining oil into diesel and gasoline using hydrogen from solar and wind power rather than hydrogen from natural gas. That, right there, makes a big dent and cleans up from a carbon perspective..

Renova colored toilet paper

We live in renova colored toilet paper unprecedented times. But what makes them without parallel is not the current renova crisis nor the continued problems facing minorities in our institutions. Rather, it’s that for the first time, the problems of accessibility, rights and freedoms renova colored toilet paper are now invading privileged spaces.

There can be no ‘getting back to normal’, because ‘normal’ only ever benefited the white, Western, patriarchal, abled and cis ideals. For many, renova colored toilet paper the world is not suddenly on fire. It has long been burning.The present renova lays bare systemic prejudice against the most vulnerable among us.

We at Medical Humanities, with our focus on global health and social justice, welcome discussion about how the crisis has disproportionately affected racial and fiscal minorities, those from the disabled community, those who are LGBTQA+ and other vulnerable groups. What we focus on here, now, can lead to renova colored toilet paper greater accessibility and equity in the future.In this expanded issue, we offer some of the incredible work being done across the field of medical humanities prior to the skin care products crisis, and we are already reviewing articles on the role of health humanities during the renova. The process of academic publishing tends not to lend itself to immediacy, however, and the challenges of renova means greater pressure on everyone, from the authors to the reviewers and readers.To remedy this, we at Medical Humanities have been increasing the work on our blog platform, a place where content can be quickly updated, and where conversations can occur among readers and writers.

We openly invite submissions concerning the renova, as well as topics relevant to our wider CFP (call for posts/papers) this year on social justice and health, to both renova colored toilet paper blog and journal. We will do our best to expedite. Finally, we have also been addressing social justice and access in our podcast, where we interviewed disability activist Alice Wong and most recently Dr Oni Blackstock, primary care physician and HIV specialist in New York.

We hope to have many more on these critical subjects.We wish all of you good health and safety and know renova colored toilet paper that many of you are yet on the front lines. Thank you for being part of the community of Medical Humanities.IntroductionMinecraft is a computer game with no specific goals to accomplish. The gameworld consists of three-dimensional (3D) cubes and objects which the player (Steve) can mine and build into infinitely complex (and renova colored toilet paper logically impossible) structures.

Steve sometimes encounters other characters (‘mobs’), such as animals and hostile creatures. He can ‘spawn’ and destroy them. While it looks like a harmless game of logical construction, it conveys some worryingly renova colored toilet paper delusive ideas about the real world.

The difference between real and imagined structures is at the heart of the age-old debate around categorising mental disorders.Classification in mental health has had various forms throughout history. Mack and colleagues set out a history of psychiatric classification renova colored toilet paper beginning in 2600 BC with Egyptian references to melancholia and hysteria. Through the Ancient Greeks with Hippocrates’ phrenitis, mania, melancholia, epilepsy, hysteria and Scythian disease.

Through the Renaissance period. Through to 19th-century psychiatry featuring Pinel (known as the first psychiatrist), Kraepelin (known for observational classification) and Freud (known for classifying neurosis and psychosis).1Although the history of psychiatric classification identifies some common trends such as the labels ‘melancholia’ and ‘hysteria’ which have survived millennia, renova colored toilet paper the label ‘depression’ is relatively new. The earliest usage noted by Snaith is from 1899.

€˜in simple pathological depression…the renova colored toilet paper patient exhibits a growing indifference to his former pursuits…’.2 Snaith noted that early 20th-century psychiatrists like Adolf Meyer hoped that ‘depression’ would come to encompass a broad category under which descriptions of subtypes would emerge. This did not happen until the middle of the 20th century. With the publication of the sixth International Classification of Diseases (ICD) in 1948 and the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1952 and their subsequent revisions, the latter half of the 20th century has seen depression subtype labels proliferate.

In their study of the social determinants of diagnostic labels in depression, McPherson and Armstrong illustrate how the codification of depression subtypes in the latter half of the 20th century has been shaped by the evolving context of psychiatry, including power struggles within the profession, a move to community care and the development of psychopharmacology.3During this period, McPherson and Armstrong describe how subsequent versions of the DSM served as battlegrounds for professional disputes and philosophical renova colored toilet paper quarrels around categorisation of mental disorders. DSM I and DSM II have been described as products of an American Psychiatric Association dominated by psychoanalytic psychiatrists.4 DSM III and DSM III-R have been described as a radical rejection of psychoanalytic thinking, a ‘neo-Kraepelinian revolution’, a reference to the observational descriptive techniques of 19th-century psychiatrist Emil Kraepelin who classified mental disorders into two broad categories. €˜dementia praecox’ and ‘manic-depression’.5 DSM III was seen by some as a turning point in the use of the medical model of mental illness, through provision of specific inclusion and exclusion criteria, and use of field trials and a multiaxial renova colored toilet paper system.6 These latter technocratic additions to psychiatric labelling served to engender a much closer alignment between psychiatry, science and medicine.The codification of mental disorders in manuals has been described by Thomas Schacht as intrinsic to the relationship between science and politics and the way in which psychiatrists gain significant social power by aligning themselves to science.7 His argument drew on Szasz, who saw the mental health establishment as a therapeutic state.

Zimbardo, who described psychiatric care as a controlling force. And Foucault, who described the categorisation of the mentally ill as a force for isolating ‘the other’. Diagnostic critique has been further developed through a cultural relativist lens in that what Western psychiatrists classify as a depression is constructed differently in other cultures.8 Considering these limitations, some critics have gone so far as to argue that psychiatric diagnostic systems should be abolished.9Yet architects of DSM manuals have worked hard to ensure the technology of classification is regarded as genuine scientific activity with sound roots in philosophy of renova colored toilet paper science.

In their philosophical defence of DSM IV, Allen Frances and colleagues address their critics under the headings ‘nominalism vs realism’, ‘empiricism vs rationalism’ and ‘categorical vs dimensional’.10 The implication is that there are opposing stances in which a choice must be made or a middle ground forged by those reasonable enough to recognise the need for pragmatism in the service of clinical utility. The nominalism–realism debate is illustrated using as metaphor renova colored toilet paper three different stances a cricket umpire might take on calling strikes and balls. The discussion sets out two of these as extreme views.

€˜at one extreme…those who take a reductionistically realistic view of the world’ versus ‘the solipsistic nominalists…might content that nothing exists’. Szasz, who is renova colored toilet paper characterised as holding particularly extreme views, is named as an archetypal solipsist. There is implied to be a degree of arrogance associated with this view in the illustrative example in which the umpire states ‘there are no balls and there are no strikes until I call them’.

Frances therefore sets up a means of grouping two kinds of people as philosophical extremists who can be dismissed, while avoiding addressing the philosophical problems they pose.Frances provides little if any justification for the middle ground stance, ‘There are balls and there are strikes and I call them as I see them’, other than to focus on its clinical utility and the lack of clinical utility in the alternatives ‘naïve realism’ and ‘heuristically barren solipsism’ renova colored toilet paper. The natural conclusion the reader is invited to reach is that a middle ground of a heuristic concept is naturally right because it is not extreme and is naturally useful clinically, without specifying in what way this stance is coherent, resolves the two alternatives, and in what way a heuristic construct that is not ‘real’ can be subject to scientific testing.Similarly, in discussing the ‘categorical vs dimensional’, Frances promotes the ‘prototype approach’. Those holding opposing views are labelled as ‘dualists’ or ‘dichotomisers’.

The prototypical renova colored toilet paper approach is again put forward as a clinically useful middle ground. Illustrations are drawn from natural science. €˜a triangle and a square renova colored toilet paper are never the same’, inciting the reader to consider science as value-free.

The prototypical approach emerges as a natural solution, yet the authors do not address how a diagnostic prototype resolves the issues posed by the two alternatives, nor how a prototype can be subjected to natural science methods.The argument presented here is not a defence of solipsism or dualism. Rather it aims to illustrate that if for pragmatic purposes clinicians and policymakers choose to gloss over the philosophical flaws in classification practices, it is then risky to move beyond the heuristic and apply natural science methods to these constructs adding multiple layers of technocratic subclassification. Doing so renova colored toilet paper is more like playing Minecraft than cricket.

The National Institute for Health and Care Excellence (NICE) guideline for depression is taken as an example of the philosophical errors that can follow from playing Minecraft with unsound heuristic devices, specifically subcategories of persistent forms of depression. As well as serving a clinical purpose, diagnosis in medicine is a way of allocating renova colored toilet paper resources for insurance companies and constructing clinical guidelines, which in turn determine rationing within the National Health Service. The consequences for recipients of healthcare are therefore significant.

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

These categories and subcategories introduce an unfortunate sense of certainty as though these labels represent renova colored toilet paper real things. An analysis follows of how these definitions play out in terms of grouping of randomised controlled trials in the NICE evidence review. Specifically, the analysis reveals the overlap between populations in trials which have been separated into discrete categories, revealing significant limitations to the utility of the category labels.The NICE definition of CD requires trial samples to meet the criteria for major depressive disorder (MDD) for 2 years.

Dysthymia and double renova colored toilet paper depression (MDD superimposed on dysthymia) were included. If 75% of the trial population met these criteria, the trial was reviewed in the CD category.12 The definition of TRD (or ‘further-line treatments’) required that the trial sample had demonstrated a ‘limited response to previous treatment’ and randomised to the further-line treatment at this point. If 80% of the trial participants met these criteria, it was renova colored toilet paper reviewed in the TRD category.13 Complex depression was defined as ‘depression co-existing with personality disorder’.

To be classed as complex, 51% of trial participants had to have personality disorder (PD).14It is immediately clear from these definitions that there is a potential problem with attempting to categorise trial populations into just one of these categories. These populations are likely to overlap, whether or not a trial protocol sets out to explicitly record all of this information. The analysis below will illustrate this using examples from within the NICE review.Cataloguing complexity in trial populationsWithin the category of further-line treatments (TRD), 64 renova colored toilet paper trials were reviewed.

Comparisons within these trials were further subcategorised into ‘dose escalation strategies’, ‘augmentation strategies’ and ‘switching strategies’. In drilling down by way of illustration, this analysis considers the 51 trials in the augmentation strategy evidence review renova colored toilet paper. Of these, two were classified by the reviewers as also fulfilling the criteria for CD but were not analysed in the CD category (Study IDs.

Fonagy 2015 and Kocsis 200915). About half of the trials (23/51) did not report the mean duration of episode, meaning that it is not possible to know what percentage of participants also met renova colored toilet paper the criteria for CD. Of trials that did report episode duration, 17 reported a mean duration longer than 24 months.

While the standard deviations varied in size or were unreported, the mean indicates a good likelihood that a significant proportion of the participants across these 51 trials met the criteria for CD.Details of baseline employment, trauma history, suicidality, physical comorbidity, axis I comorbidity and PD (all clinical indicators of complexity, severity and chronicity) were not renova colored toilet paper collated by NICE. For the present analysis, all 51 publications were examined and data compiled concerning clinical complexity in the trial populations. Only 14 of 51 trials report employment data.

Of those that do, renova colored toilet paper unemployment ranges from 12% to 56% across trial samples. None of the trials report trauma history. About half of the trials (26/51) excluded people who were considered renova colored toilet paper a suicide risk.

The others did not.A large proportion of trials (30/51) did not provide any data on axis 1 comorbidity. Of these, 18 did not exclude any diagnoses, while 12 excluded some (but not all) disorders. The most renova colored toilet paper common diagnoses excluded were psychotic disorders, substance or alcohol abuse, and bipolar disorder (excluded in 26, 25 and 23 trials, respectively).

Only 7 of 51 trials clearly stated that all axis 1 diagnoses were excluded. This leaves only 13 studies providing any data about comorbidity renova colored toilet paper. Of these, 9 gave partial data on one or two conditions, while 4 reported either the mean number of disorders (range 1.96–2.9) or the percentage of participants (range 68.1–96.7) with any comorbid diagnosis (Nierenberg 2003a, Nierenberg 2006, Watkins 2011a, Town 201715).The majority of trials (46/51) did not report the prevalence of PD.

Many stated PD as an exclusion criterion but without defining a threshold for exclusion. For example, PD could be excluded if it ‘impacted’ the depression, if it was ‘significant’, ‘severe’ or ‘persistent’ renova colored toilet paper. Some excluded certain PDs (such as antisocial or borderline) and not others but without reporting the prevalence of those not excluded.

In the five trials where prevalence was clear, prevalence ranged from 0% (Ravindran 2008a15), where all PDs were excluded, to 87.5% of the sample (Town renova colored toilet paper 201715). Two studies reported the mean number of PDs. 2.0 (Nierenberg 2003a) and 0.85 (Watkins 2011a15).The majority of trials (43/51) did not report the prevalence of physical illness.

Many stated illness as an exclusion criterion, but the definitions and thresholds were vague and could be interpreted renova colored toilet paper in different ways. For example, illness could be excluded if it was ‘unstable’, ‘serious’, ‘significant’, ‘relevant’, or would ‘contraindicate’ or ‘impact’ the medication. Of the eight renova colored toilet paper trials reporting information about physical health, there was a wide variation.

Four reported prevalence varying from 7.6% having a disability (Eisendrath 201615) to 90.9% having an illness or disability (Town 201715). Four used scales of physical health. Two indicating mild problems (Nierenberg 2006, Lavretsky 201115) and two indicating moderately high levels of renova colored toilet paper illness (Thase 2007, Fang 201015).The NICE review also divided trial populations into a dichotomy of ‘more severe’ and ‘less severe’ on the grounds that this would be a clinically useful classification for general practitioners.

NICE applied a bespoke methodology for creating this dichotomy, abandoning validated measure thresholds in order first to generate two ‘homogeneous’ groups to ‘facilitate analysis’, and second to create an algorithm to ‘read across’ different measures (such as the Beck Depression Inventory, the Hamilton Rating Scale for Depression (HRSD) and the Montgomery-Asberg Depression Rating Scale).16 Examining trials which use more than one of these measures reveals problems in the algorithm. Of the 51 trials, there are 6 instances in which the study population falls into NICE’s more severe category according to one measure and into the less severe category according to renova colored toilet paper another. In four of these trials, NICE chose the less severe category (Souza 2016, Watkins 2011a, Fonagy 2015, Town 201715).

The other two trials were designated more severe (Barbee 2011, Dunner 200715). Only 17 of 51 trials reported two or more depression scale measures, leaving much unknown about whether other study populations could count as both more severe and less severe.Absence of knowledge or knowledge of absence? renova colored toilet paper. A key philosophical error in science is to confuse an absence of knowledge with knowledge of absence.

It is likely that some of the renova colored toilet paper study populations deemed lacking in complexity or severity could actually have high degrees of complexity and/or severity. Data to demonstrate this may either fall foul of a guideline committee decision to prioritise certain information over other conflicting information (as in the severity algorithm). The information may be non-existent as it was not collected.

It may be renova colored toilet paper somewhere in the publication pipeline. Or it may be sitting in a database with a research team that has run out of funds for supplementary analyses. Wherever those data are or are not, their renova colored toilet paper absence from published articles does not define the phenomenology of depression for the patients who took part.

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

Avram H. Mack et renova colored toilet paper al. (1994), “A Brief History of Psychiatric Classification.

From the Ancients to DSM-IV,” Psychiatric Clinics 17, no. 3. 515–9.2.

R. P. Snaith (1987), “The Concepts of Mild Depression,” British Journal of Psychiatry 150, no.

3. 387.3. Susan McPherson and David Armstrong (2006), “Social Determinants of Diagnostic Labels in Depression,” Social Science &.

Gerald N. Grob (1991), “Origins of DSM-I. A Study in Appearance and Reality,” The American Journal of Psychiatry.

421–31.5. Wilson M. Compton and Samuel B.

Guze (1995), “The Neo-Kraepelinian Revolution in Psychiatric Diagnosis,” European Archives of Psychiatry and Clinical Neuroscience 245, no. 4. 198–9.6.

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

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

Theurer (2018), “Psychiatry Should Not Seek Mechanisms of Disorder,” Journal of Theoretical and Philosophical Psychology 38, no. 4. 189–204.9.

Sami Timimi (2014), “No More Psychiatric Labels. Why Formal Psychiatric Diagnostic Systems Should Be Abolished,” Journal of Clinical and Health Psychology 14, no. 3.

208–15.10. Allen Frances et al. (1994), “DSM-IV Meets Philosophy,” The Journal of Medicine and Philosophy.

A Forum for Bioethics and Philosophy of Medicine 19, no. 3. 207–18.11.

Andrea Jobst et al. (2016), “European Psychiatric Association Guidance on Psychotherapy in Chronic Depression Across Europe,” European Psychiatry 33. 20.12.

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

Ibid., 351–62.14. Ibid., 597.15. Note that in order to refer to specific trials reviewed in the guideline, rather than the full citation, the Study IDs from column A in appendix J5 have been used.

See www.nice.org.uk/guidance/gid-cgwave0725/documents/addendum-appendix-9 for details and full references.16. National Institute for Health and Care Excellence (2018), Depression in Adults. Treatment and Management.

Second Consultation on Draft Guideline – Stakeholder Comments Table, https://www.nice.org.uk/guidance/gid-cgwave0725/documents/consultation-comments-and-responses-2, 420–1.17. National Institute for Health and Care Excellence (2018), Depression in Adults, appendix J5.18. Peter Fonagy et al.

(2015), “Pragmatic Randomized Controlled Trial of Long-Term Psychoanalytic Psychotherapy for Treatment-Resistant Depression. The Tavistock Adult Depression Study (TADS),” World Psychiatry 14, no. 3.

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

Jacqui Thornton (2018), “Depression in Adults. Campaigners and Doctors Demand Full Revision of NICE Guidance,” BMJ 361. K2681..

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

For many, the world is not suddenly on cheap renova online fire. It has long been burning.The present renova lays bare systemic prejudice against the most vulnerable among us. We at Medical Humanities, with our focus on global health and social justice, welcome discussion about how the crisis has disproportionately affected racial and fiscal minorities, those from the disabled community, those who are LGBTQA+ and other vulnerable groups. What we focus on here, now, can lead to greater accessibility and equity in the future.In this expanded issue, we offer some of the incredible work being done across the field of medical cheap renova online humanities prior to the skin care products crisis, and we are already reviewing articles on the role of health humanities during the renova.

The process of academic publishing tends not to lend itself to immediacy, however, and the challenges of renova means greater pressure on everyone, from the authors to the reviewers and readers.To remedy this, we at Medical Humanities have been increasing the work on our blog platform, a place where content can be quickly updated, and where conversations can occur among readers and writers. We openly invite submissions concerning the renova, as well as topics relevant to our wider CFP (call for posts/papers) this year on social justice and health, cheap renova online to both blog and journal. We will do our best to expedite. Finally, we have also been addressing social justice and access in our podcast, where we interviewed disability activist Alice Wong and most recently Dr Oni Blackstock, primary care physician and HIV specialist in New York.

We hope to cheap renova online have many more on these critical subjects.We wish all of you good health and safety and know that many of you are yet on the front lines. Thank you for being part of the community of Medical Humanities.IntroductionMinecraft is a computer game with no specific goals to accomplish. The gameworld consists of three-dimensional (3D) cubes and objects which cheap renova online the player (Steve) can mine and build into infinitely complex (and logically impossible) structures. Steve sometimes encounters other characters (‘mobs’), such as animals and hostile creatures.

He can ‘spawn’ and destroy them. While it looks cheap renova online like a harmless game of logical construction, it conveys some worryingly delusive ideas about the real world. The difference between real and imagined structures is at the heart of the age-old debate around categorising mental disorders.Classification in mental health has had various forms throughout history. Mack and colleagues set out a history of psychiatric classification beginning cheap renova online in 2600 BC with Egyptian references to melancholia and hysteria.

Through the Ancient Greeks with Hippocrates’ phrenitis, mania, melancholia, epilepsy, hysteria and Scythian disease. Through the Renaissance period. Through to 19th-century psychiatry featuring Pinel (known cheap renova online as the first psychiatrist), Kraepelin (known for observational classification) and Freud (known for classifying neurosis and psychosis).1Although the history of psychiatric classification identifies some common trends such as the labels ‘melancholia’ and ‘hysteria’ which have survived millennia, the label ‘depression’ is relatively new. The earliest usage noted by Snaith is from 1899.

€˜in simple pathological depression…the patient exhibits a growing cheap renova online indifference to his former pursuits…’.2 Snaith noted that early 20th-century psychiatrists like Adolf Meyer hoped that ‘depression’ would come to encompass a broad category under which descriptions of subtypes would emerge. This did not happen until the middle of the 20th century. With the publication of the sixth International Classification of Diseases (ICD) in 1948 and the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1952 and their subsequent revisions, the latter half of the 20th century has seen depression subtype labels proliferate. In their study of the social determinants of diagnostic labels in depression, McPherson and Armstrong illustrate how the codification of depression subtypes in the latter cheap renova online half of the 20th century has been shaped by the evolving context of psychiatry, including power struggles within the profession, a move to community care and the development of psychopharmacology.3During this period, McPherson and Armstrong describe how subsequent versions of the DSM served as battlegrounds for professional disputes and philosophical quarrels around categorisation of mental disorders.

DSM I and DSM II have been described as products of an American Psychiatric Association dominated by psychoanalytic psychiatrists.4 DSM III and DSM III-R have been described as a radical rejection of psychoanalytic thinking, a ‘neo-Kraepelinian revolution’, a reference to the observational descriptive techniques of 19th-century psychiatrist Emil Kraepelin who classified mental disorders into two broad categories. €˜dementia praecox’ and ‘manic-depression’.5 DSM III was seen by some as a turning point in the use of the medical model of mental illness, through provision of specific inclusion and exclusion criteria, and use of field trials and a multiaxial system.6 These latter technocratic additions to psychiatric labelling served to engender a much closer alignment between psychiatry, science and medicine.The codification of mental disorders in manuals has been described by Thomas Schacht as intrinsic to the relationship between science and politics and the way in which psychiatrists gain significant social power by aligning themselves to science.7 His argument drew on Szasz, who saw the mental health cheap renova online establishment as a therapeutic state. Zimbardo, who described psychiatric care as a controlling force. And Foucault, who described the categorisation of the mentally ill as a force for isolating ‘the other’.

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

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

The natural conclusion the reader is invited to reach is that a middle ground of a heuristic concept is naturally right because it is not extreme and is naturally useful clinically, without specifying in what way this stance is coherent, resolves the two alternatives, and in what way a heuristic construct that is not ‘real’ can be subject to scientific testing.Similarly, in discussing the ‘categorical vs dimensional’, Frances promotes the ‘prototype approach’. Those holding opposing views are labelled as ‘dualists’ or ‘dichotomisers’. The prototypical approach cheap renova online is again put forward as a clinically useful middle ground. Illustrations are drawn from natural science.

€˜a triangle and a square are cheap renova online never the same’, inciting the reader to consider science as value-free. The prototypical approach emerges as a natural solution, yet the authors do not address how a diagnostic prototype resolves the issues posed by the two alternatives, nor how a prototype can be subjected to natural science methods.The argument presented here is not a defence of solipsism or dualism. Rather it aims to illustrate that if for pragmatic purposes clinicians and policymakers choose to gloss over the philosophical flaws in classification practices, it is then risky to move beyond the heuristic and apply natural science methods to these constructs adding multiple layers of technocratic subclassification. Doing so is more cheap renova online like playing Minecraft than cricket.

The National Institute for Health and Care Excellence (NICE) guideline for depression is taken as an example of the philosophical errors that can follow from playing Minecraft with unsound heuristic devices, specifically subcategories of persistent forms of depression. As well as serving a clinical purpose, diagnosis in medicine is a way of allocating resources for insurance companies and constructing clinical guidelines, which in turn determine cheap renova online rationing within the National Health Service. The consequences for recipients of healthcare are therefore significant. Clinical utility is arguably not being served at all and patients are left at risk of poor-quality care.Heterogeneity of persistent depressionAndrea Jobst and colleagues note that ‘because of their chronic clinical course, approximately 40% of CD [chronic depression] patients also fulfil criteria for TRD [treatment resistant depression]…usually defined by the number of non-successful biological treatments’.11 This position is reflected in the DSM VAmerican Psychiatric Association (2013), the European Psychiatric Association (EPA) guidance and the ICD-11(World Health Organisation, 2018), which all use a ‘persistent’ depression category, acknowledging a loosely defined mixed group of long-term, difficult-to-treat depressive conditions, often associated with dysthymia and comorbid common mental disorders, various personality traits and psychosocial disability.In contrast, the NICE 2018 draft guideline separates treatments into those for ‘new episodes’ of depression.

€˜further-line’ treatment of depression (equivalent to TRD), CD and ‘depression with co-morbidities’ cheap renova online. The latter is subdivided into treatments for ‘complex depression’ and ‘psychotic depression’. These categories and subcategories introduce an unfortunate sense of certainty as cheap renova online though these labels represent real things. An analysis follows of how these definitions play out in terms of grouping of randomised controlled trials in the NICE evidence review.

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

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

In drilling down by way of illustration, this analysis considers the 51 trials in cheap renova online the augmentation strategy evidence review. Of these, two were classified by the reviewers as also fulfilling the criteria for CD but were not analysed in the CD category (Study IDs. Fonagy 2015 and Kocsis 200915). About half of the trials (23/51) did not report the mean duration of episode, meaning that it is not possible to know what cheap renova online percentage of participants also met the criteria for CD.

Of trials that did report episode duration, 17 reported a mean duration longer than 24 months. While the standard deviations varied in size or were unreported, the mean indicates a good likelihood that a significant proportion of the participants across these 51 trials met the criteria for CD.Details of baseline employment, trauma history, suicidality, physical comorbidity, axis I comorbidity and PD (all clinical indicators of complexity, severity and chronicity) were not collated by cheap renova online NICE. For the present analysis, all 51 publications were examined and data compiled concerning clinical complexity in the trial populations. Only 14 of 51 trials report employment data.

Of those that do, unemployment ranges from 12% to 56% across trial samples cheap renova online. None of the trials report trauma history. About half of the trials (26/51) excluded people who were considered a cheap renova online suicide risk. The others did not.A large proportion of trials (30/51) did not provide any data on axis 1 comorbidity.

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

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

In the five trials where prevalence was clear, prevalence ranged from 0% (Ravindran 2008a15), where all PDs cheap renova online were excluded, to 87.5% of the sample (Town 201715). Two studies reported the mean number of PDs. 2.0 (Nierenberg 2003a) and 0.85 (Watkins 2011a15).The majority of trials (43/51) did not report the prevalence of physical illness. Many stated illness as an exclusion criterion, but the definitions cheap renova online and thresholds were vague and could be interpreted in different ways.

For example, illness could be excluded if it was ‘unstable’, ‘serious’, ‘significant’, ‘relevant’, or would ‘contraindicate’ or ‘impact’ the medication. Of the eight trials reporting information about physical health, there was cheap renova online a wide variation. Four reported prevalence varying from 7.6% having a disability (Eisendrath 201615) to 90.9% having an illness or disability (Town 201715). Four used scales of physical health.

Two indicating mild problems (Nierenberg 2006, Lavretsky 201115) and two indicating moderately high levels of illness (Thase 2007, Fang 201015).The NICE review also divided trial populations into a dichotomy of ‘more severe’ and ‘less severe’ on the grounds that this would be a clinically useful classification cheap renova online for general practitioners. NICE applied a bespoke methodology for creating this dichotomy, abandoning validated measure thresholds in order first to generate two ‘homogeneous’ groups to ‘facilitate analysis’, and second to create an algorithm to ‘read across’ different measures (such as the Beck Depression Inventory, the Hamilton Rating Scale for Depression (HRSD) and the Montgomery-Asberg Depression Rating Scale).16 Examining trials which use more than one of these measures reveals problems in the algorithm. Of the 51 trials, there are 6 instances in which the study population falls into NICE’s more severe category according to one measure and into cheap renova online the less severe category according to another. In four of these trials, NICE chose the less severe category (Souza 2016, Watkins 2011a, Fonagy 2015, Town 201715).

The other two trials were designated more severe (Barbee 2011, Dunner 200715). Only 17 of 51 trials reported two or more depression scale measures, leaving much unknown about whether other study populations could count as both more severe and cheap renova online less severe.Absence of knowledge or knowledge of absence?. A key philosophical error in science is to confuse an absence of knowledge with knowledge of absence. It is likely that some of the study populations deemed lacking in complexity or severity could actually have high degrees of complexity and/or cheap renova online severity.

Data to demonstrate this may either fall foul of a guideline committee decision to prioritise certain information over other conflicting information (as in the severity algorithm). The information may be non-existent as it was not collected. It may be somewhere in the cheap renova online publication pipeline. Or it may be sitting in a database with a research team that has run out of funds for supplementary analyses.

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

Avram H. Mack et al cheap renova online. (1994), “A Brief History of Psychiatric Classification. From the Ancients to DSM-IV,” Psychiatric Clinics 17, no.

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

Grob (1991), “Origins of DSM-I. A Study in Appearance and Reality,” The American Journal of Psychiatry. 421–31.5. Wilson M.

Compton and Samuel B. Guze (1995), “The Neo-Kraepelinian Revolution in Psychiatric Diagnosis,” European Archives of Psychiatry and Clinical Neuroscience 245, no. 4. 198–9.6.

Gerald L. Klerman (1984), “A Debate on DSM-III. The Advantages of DSM-III,” The American Journal of Psychiatry. 539–42.7.

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

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

Sami Timimi (2014), “No More Psychiatric Labels. Why Formal Psychiatric Diagnostic Systems Should Be Abolished,” Journal of Clinical and Health Psychology 14, no. 3. 208–15.10.

Allen Frances et al. (1994), “DSM-IV Meets Philosophy,” The Journal of Medicine and Philosophy. A Forum for Bioethics and Philosophy of Medicine 19, no. 3.

207–18.11. Andrea Jobst et al. (2016), “European Psychiatric Association Guidance on Psychotherapy in Chronic Depression Across Europe,” European Psychiatry 33. 20.12.

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

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

Treatment and Management. Second Consultation on Draft Guideline – Stakeholder Comments Table, https://www.nice.org.uk/guidance/gid-cgwave0725/documents/consultation-comments-and-responses-2, 420–1.17. National Institute for Health and Care Excellence (2018), Depression in Adults, appendix J5.18. Peter Fonagy et al.

(2015), “Pragmatic Randomized Controlled Trial of Long-Term Psychoanalytic Psychotherapy for Treatment-Resistant Depression. The Tavistock Adult Depression Study (TADS),” World Psychiatry 14, no. 3. 312–21.19.

American Psychological Association (2018), Clinical Practice Guideline for the Treatment of Depression in Children, Adolescents, and Young, Middle-aged, and Older Adults. Draft.20. Jacqui Thornton (2018), “Depression in Adults. Campaigners and Doctors Demand Full Revision of NICE Guidance,” BMJ 361.

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Shutterstock Texas Health and Human Services recently launched a website to promote Texas Targeted Opioid Response (TTOR), the state’s public health campaign to combat opioid addiction and overdose.The website, TXopioidresponse.org, features resources, information, and Where can i buy lasix videos in English and Spanish on what opioid medications are, how they affect the body, safe opioid use, pain management, and the danger of misusing prescription opioids.Nearly 80 percent of heroin users report misusing prescription opioids before trying heroin.In the United States, 128 people die daily from prescription or illicit opioids, according to the Centers for cheap renova online Disease Control and Prevention. €œOne in five Texans has experienced an opioid overdose or cheap renova online know someone who has,” Kasey Strey, Texas Health and Human Services Commission TTOR director, said. €œWe are dedicated to preventing prescription cheap renova online opioid misuse, overdoses, and opioid use disorder.

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