How much does zithromax cost without insurance

IntroductionQuality-adjusted life years (QALYs) have how much does zithromax cost without insurance been increasingly used in general medicine and in psychiatry to evaluate the impact of a disease define zithromax on both the quantity and quality of life.1 One QALY is equal to 1 year in perfect health, can range down to zero (death) or may take negative values (worse than death). QALYs can be used to compare the burdens of various diseases, to appreciate the impact of their interventions, to help set priorities how much does zithromax cost without insurance in resource allocations across different diseases and interventions and to inform personal decisions.The representative method to evaluate QALYs is the generic, preference-based measure of health including the Euro-Qol five dimensions (EQ-5D)2 3 and the SF-6D based on Short Form Survey-36 (SF-36).4 5 Of these, the EQ-5D is the most frequently used and is the preferred instrument by the National Institute of Health and Care Excellence in the UK. While the responsiveness of such generic measures to various mental conditions, especially severe mental illnesses, has been questioned,6 its validity and responsiveness to common mental disorders including depression how much does zithromax cost without insurance and anxiety have been generally established.7 8However, the traditional focus of measurements in mental health has centred mainly on symptoms.

Many trials have, therefore, not administered the generic health-related quality of life measures. This has hindered comparison of impacts of mental disorders vis-à-vis other medical conditions on the one hand and also evaluation of values of their interventions on the other.9 10We have been collecting individual participant-level data from randomised controlled trials of internet cognitive-behavioural therapies (iCBT) for depression,11 several of which administered both symptomatologic scales and generic how much does zithromax cost without insurance health status scales simultaneously. This study, therefore, attempts to link the depression-specific measure onto the generic measure of health in order to enable estimation of QALYs for depressive states and their changes how much does zithromax cost without insurance.

Such cross-walking should facilitate assessment of burden of depression at how much does zithromax cost without insurance its various severity and of the impacts of its various treatments.MethodsDatabaseWe have been accumulating a data set of individual participant data of randomised controlled trials of iCBT among adults with depressive symptoms, as established by specified cut-offs on self-report scales or by diagnostic interviews.11 For this study, we have selected studies that have administered the EQ-5D and depression severity scales at baseline and at end of treatment. We excluded patients if they had missing data in either of the two scales at baseline or at endpoint. We excluded studies that focused on patients with general medical disorders (eg, diabetes, glioma) and depressive symptoms.MeasuresEQ-5D-3LThe EQ-5D-3L how much does zithromax cost without insurance comprises five dimensions of mobility, self-care, usual activities, pain/discomfort and anxiety/depression, each rated on three levels corresponding with 1=no problems, 2=some/moderate problems or 3=extreme problems/unable to do.

This produces 3ˆ5=243 different health states, ranging from no problem at all in any dimension (11111) to severe problems on all dimensions how much does zithromax cost without insurance (33333). Each of these 243 states is provided with a preference-based score, as determined through the how much does zithromax cost without insurance time trade-off (TTO) technique in a sample of the general population. In TTO, respondents are asked to give the relative length of time in full health that they would be willing to sacrifice for the poor health states as represented by each of the 243 combinations above.

The EQ-5D scores range between 1=full health and 0=death to minus values=worse than how much does zithromax cost without insurance death bounded by −1. The scoring algorithm how much does zithromax cost without insurance for the UK is based on TTO responses of a random sample (n=2997) of noninstitutionalised adults. Over the years, value sets for EQ-5D-3L have been produced for many countries/regions.2 3 7Depression severity scalesWe included any validated depression severity measures.

The scale scores were converted into the most frequently used scale, namely, the how much does zithromax cost without insurance Patient Health Questionnaire-9 (PHQ-9),12 using the established conversion algorithms13 14 for the Beck Depression Inventory, second edition (BDI-II)15 or the Centre for Epidemiologic Studies Depression Scale (CES-D).16The PHQ-9 consists of the nine diagnostic criteria items of major depression from the DSM-IV, each rated on a scale between 0 and 3, making the total score range 0–27. The instrument has demonstrated excellent reliability, validity and responsiveness how much does zithromax cost without insurance. The cut-offs have been proposed as 0–4, 5–9, 10–14, 15–19 and 20- for no, mild, moderate, moderately severe and severe depression, respectively.12Statistical analysesWe first calculated Spearman correlation coefficients between PHQ-9 and EQ-5D total scores at baseline, at end how much does zithromax cost without insurance of treatment and their changes, to establish if the linking is justified.

Correlations were considered weak if scores were <0.3, moderate if scores were ≥0.3 and<0.7 and strong if scores were ≥0.7.17 Correlations ≥0.3 have been recommended to establish linking.18 We then applied the equipercentile linking procedure,19 which identified scores on PHQ-9 and EQ-5D or their changes with the same percentile ranks and allows for a nominal translation from PHQ-9 to EQ-5D by using their percentile values. This approach has been used successfully for scales in depression, schizophrenia or Alzheimer’s disease.14 20–22 We analysed all trials collectively rather than by trial to how much does zithromax cost without insurance maximise the sample size, ensure variability in the included populations and attain robust estimates.We conducted a sensitivity analysis by excluding studies that require the conversion of various depression severity scores into PHQ-9.All the analyses were conducted in R V.4.0.2, with the package equate V.2.0.7.23Ethics statementThe authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008. Ethical approval was not required for this study as it used only deidentified patient data.FindingsIncluded studiesWe identified seven RCTs of iCBT (total n=2457), which administered validated depression scales and EQ-5D both at baseline how much does zithromax cost without insurance and at endpoint (online supplemental eTable 1).

Three studies included only patients with major depressive disorder (MDD), one only patients with subthreshold depression how much does zithromax cost without insurance and the remaining three included both. All the studies administered EQ-5D-3L. PHQ-9 scores were converted from the BDI-II in three studies24–26 and from the CES-D in one study.27 The mean age of the participants was how much does zithromax cost without insurance 41.8 (SD=12.3) years, 66.0% (1622/2457) were women and they scored 14.0 (5.4) on PHQ-9 and 0.74 (0.20) on EQ-5D at baseline and 9.1 (6.0) and 0.79 (0.21), respectively, at endpoint.

When using the standard cut-offs of the PHQ-9,12 2.4% (60/2449) suffered from no depression (PHQ-9 scores <5), 20.2% (492/2449) from subthreshold depression (5≤PHQ-9 scores <10), 33.5% (820/2449) from mild depression (10≤PHQ-9 scores <15), 26.5% (649/2449) from moderate depression (15≤PHQ-9 scores <20) and 17.3% (424/2449) from severe depression (20≤PHQ-9 scores) at baseline.Supplemental materialEquipercentile linkingSpearman’s how much does zithromax cost without insurance correlation coefficient between the PHQ-9 and the EQ-5D scores was r=−0.29 at baseline, increased to r=−0.50 after intervention and was r=−0.38 for change scores.Figure 1 shows the equipercentile linking between PHQ-9 and EQ-5D total scores at baseline and at endpoint. Figure 2 shows how much does zithromax cost without insurance the same between their change scores. Table 1 summarises the correspondences between the two scales.PHQ-9 and EQ-5D total scores at baseline and endpoint.

EQ-5D,Euro-Qol Five how much does zithromax cost without insurance Dimensions. PHQ-9, PatientHealth Questionnaire-9." data-icon-position data-hide-link-title="0">Figure 1 PHQ-9 and EQ-5D total scores at baseline and how much does zithromax cost without insurance endpoint. EQ-5D,Euro-Qol Five Dimensions.

PHQ-9, PatientHealth Questionnaire-9.PHQ-9 change scores and EQ-5D change scores how much does zithromax cost without insurance. EQ-5D, Euro-Qol how much does zithromax cost without insurance Five Dimensions. PHQ-9, Patient Health Questionnaire-9." data-icon-position data-hide-link-title="0">Figure 2 PHQ-9 change how much does zithromax cost without insurance scores and EQ-5D change scores.

EQ-5D,Euro-Qol Five Dimensions. PHQ-9, PatientHealth Questionnaire-9.View this table:Table 1 Conversion table from PHQ-9 to EQ-5D total and change scoresSensitivity analysisWhen we limited the samples to the three studies28–30 that administered PHQ-9 (total n=1375), the linking results were replicated (online supplemental eFigure 1).DiscussionThis is the first study to link a depression severity measure with the EQ-5D-3L both for total and change how much does zithromax cost without insurance scores. To summarise, subthreshold depression corresponded with EQ-5D-3L how much does zithromax cost without insurance index values of 0.9–0.8, mild major depression with 0.8–0.7, moderate depression with 0.7–0.5 and severe depression with 0.6–0.0.

A five-point improvement in PHQ-9 corresponded approximately how much does zithromax cost without insurance with an increase in EQ-5D-3L index values by 0.03, and a ten-point improvement can lead to an increase by approximately 0.25.A systematic review of utility values for depression31 found that the pooled mean (SD) utilities based on studies using the standard gamble as a direct valuation method were 0.69 (0.14) for mild, 0.52 (0.28) for moderate and 0.27 (0.26) for severe major depression. The estimates based on studies using EQ-5D as an indirect valuation method were 0.56 (0.16) for mild, 0.52 (0.28) for moderate and 0.25 (0.15) for severe depression. One recent study regressed PHQ-9 on SF-6D scores among 394 patients in theimproving Access to Psychological Therapies (IAPT) cohort7 32 and estimated none/mild depression on PHQ-9 to be worth how much does zithromax cost without insurance 0.73 SF-6D scores, moderate depression 0.65 and severe depression 0.56.

Our results are how much does zithromax cost without insurance largely in line with these aforementioned studies.There was a consistent difference of about 0.07 EQ-5D scores for the same PHQ-9 score if it represented the baseline or endpoint measurements (figure 1). This is understandable because a patient would rate their health status less satisfactory if they stayed equally symptomatic as before after the treatment and also because it means that they continued to suffer from depression for longer. It is, therefore, reasonable how much does zithromax cost without insurance to use the conversion table at baseline for relatively new cases of depression and that at end of treatment for more chronic cases (table 1).An effect size to be typically expected after 2 months of antidepressant pharmacotherapy33 or psychotherapy27 34 over the pill placebo condition is 0.3.

Given that the average SD of PHQ-9 in the studies was about 6, an effect size of 0.3 corresponds to a difference by two points on PHQ-9 how much does zithromax cost without insurance. The differences in EQ-5D scores corresponding with the end-of-treatment PHQ-9 scores of x versus x+2, where x is between 5 and 15 (table 1), ranges between 0.08 how much does zithromax cost without insurance and 0.13, producing an approximate average of 0.1 EQ-5D scores. If we assume that the same difference would continue for the ensuing 10 months, the gain in QALY per year would be equal to 0.09 QALY.

If we assume that the difference would eventually wear out over the how much does zithromax cost without insurance course of the year due to naturalistic improvements to be expected in the control group, the gain in QALY per year would be equal to 0.05 QALY. (See figure 3 for a schematic drawing to help understand the calculation of QALYs based how much does zithromax cost without insurance on changing EQ-5D scores. In reality, the changes will be more smoothly curvilinear but the calculation will be similar.) Since one QALY is typically valuated at US$50 000 or 3000 Stirling pounds,35 such therapies would be cost-effective if they cost US$2500 to US$4500 (150 how much does zithromax cost without insurance to 270 pounds) or less.

If a 1 day fill of generic selective serotonergic reuptake inhibitor antidepressants costs 1–3 dollars and a 1-year prescription costs US$400–1200 dollars, or if 8–16 sessions of psychotherapy cost US$1600–3200 dollars, both therapies would be deemed largely cost-effective. An individual’s decision, by contrast, how much does zithromax cost without insurance will and should be more variable and no one can categorically reject nor require such treatments for all patients.A schematic graph showing gains in QALY due to typical pharmacotherapies or psychotherapies. A patient may start with PHQ-9 of 20, how much does zithromax cost without insurance corresponding with EQ-5D index value of 0.5.

Then they may improve after 2 months of antidepressant therapy to how much does zithromax cost without insurance EQ-5D score of 0.9 (solid line), while they may improve to EQ-5D score of 0.8 even if on placebo (dashed line). If we assume that the same difference would continue for the ensuing 10 months while showing slow gradual improvement in both cases, the gain in QALY per year would be equal to 0.09 QALY. If we assume that the difference would eventually wear out over the course of the year due to naturalistic improvements to be how much does zithromax cost without insurance expected in the control group, the gain in QALY per year would be equal to 0.05 QALY.

Please note that how much does zithromax cost without insurance this is a schematic drawing for illustrative purposes. In reality, the changes will be more smoothly curvilinear but the calculation will be similar. EQ-5D, Euro-Qol Five Dimensions how much does zithromax cost without insurance.

PHQ-9, Patient Health Questionnaire-9 how much does zithromax cost without insurance. QALY, quality-adjusted life years." data-icon-position data-hide-link-title="0">Figure 3 A schematic graph showing gains in QALY due to typical how much does zithromax cost without insurance pharmacotherapies or psychotherapies. A patient may start with PHQ-9 of 20, corresponding with EQ-5D index value of 0.5.

Then they may improve after 2 months of antidepressant therapy to EQ-5D score of 0.9 (solid line), while they may improve to EQ-5D score of 0.8 even how much does zithromax cost without insurance if on placebo (dashed line). If we assume that the same difference would how much does zithromax cost without insurance continue for the ensuing 10 months while showing slow gradual improvement in both cases, the gain in QALY per year would be equal to 0.09 QALY. If we assume that the difference would eventually wear how much does zithromax cost without insurance out over the course of the year due to naturalistic improvements to be expected in the control group, the gain in QALY per year would be equal to 0.05 QALY.

Please note that this is a schematic drawing for illustrative purposes. In reality, the changes will be more smoothly curvilinear but the calculation how much does zithromax cost without insurance will be similar. EQ-5D,Euro-Qol Five how much does zithromax cost without insurance Dimensions.

PHQ-9, PatientHealth how much does zithromax cost without insurance Questionnaire-9. QALY, quality-adjustedlife years.Several caveats should be considered when interpreting the results. First, our sample was limited to participants of trials of how much does zithromax cost without insurance iCBT.

It may be argued that the results, therefore, would not apply to patients with depression undergoing other therapies how much does zithromax cost without insurance or in other settings. Second, the correlations between PHQ-9 and EQ-5D were strong enough for total scores at endpoint and for change scores to justify linking but were somewhat weaker at baseline, probably due to limited variability in PHQ-9 scores at baseline because some studies required minimum depression scores. However, the overall correspondence between how much does zithromax cost without insurance PHQ-9 scores and EQ-5D had the same shape between baseline and endpoint, which will increase credibility of the linking at baseline as well.

Third, we were able to compare how much does zithromax cost without insurance PHQ-9 to EQ-5D-3L only. The EQ-5D-5L, which measures health in five levels instead of three, has been developed to be more sensitive to change and to milder conditions.36 When data become available, we will need how much does zithromax cost without insurance to link PHQ-9 and EQ-5D-5L to examine if we can obtain similar conversion values.Our study also has several important strengths. First, our sample included patients with subthreshold depression and major depression and from the community or workplace and the primary care.

Furthermore, they encompassed mild through how much does zithromax cost without insurance severe major depression in approximately equal proportions. Second, all the patients in our sample received how much does zithromax cost without insurance iCBT or control interventions including care as usual. Potential side effects of different antidepressants, repetitive brain stimulation, electroconvulsive therapy and other more aggressive therapies must of course be taken into consideration when evaluating their impacts, but our estimates, arguably independent of major side effects, how much does zithromax cost without insurance can better inform such considerations.

Finaly, unlike any prior studies, we were able to link specific PHQ-9 scores and their changes scores to EQ-5D-3L index values.Conclusion and clinical implicationsIn conclusion, we constructed a conversion table linking the EQ-5D, the representative generic preference-based measure of health status, and the PHQ-9, one of the most popular depression severity rating scale, for both its total scores and change scores. The table will enable fine-grained assessment of burden of depression at its various levels of severity and of impacts of how much does zithromax cost without insurance its various treatments which may bring various degrees of improvement at the expense of some potential side effects.Data availability statementData are available upon reasonable request. The overall database used for how much does zithromax cost without insurance this IPD is restricted due to data sharing agreements with the research institutes where the studies were conducted.

IPD from individual studies are available from the individual study authors.Ethics statementsPatient consent for publicationNot required..

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Unlock this article by subscribing to STAT+ zithromax allergy symptoms and a fantastic read enjoy your first 30 days free!. GET STARTED Log In | Learn More What is it?. STAT+ is STAT's premium subscription service for in-depth biotech, pharma, policy, and life science coverage and analysis zithromax allergy symptoms. Our award-winning team covers news on Wall Street, policy developments in Washington, early science breakthroughs and clinical trial results, and health care disruption in Silicon Valley and beyond.

What's included? zithromax allergy symptoms. Daily reporting and analysis The most comprehensive industry coverage from a powerhouse team of reporters Subscriber-only newsletters Daily newsletters to brief you on the most important industry news of the day STAT+ Conversations Weekly opportunities to engage with our reporters and leading industry experts in live video conversations Exclusive industry events Premium access to subscriber-only networking events around the country The best reporters in the industry The most trusted and well-connected newsroom in the health care industry And much more Exclusive interviews with industry leaders, profiles, and premium tools, like our CRISPR Trackr.WASHINGTON — Gus Perna, the four-star Army general responsible for coordinating the U.S. antibiotics treatment response, is set to retire this summer, according to four current and former Health and Human Services officials.A number of Perna’s top deputies have also left the initiative in recent weeks, including Doug Meyer, the operation’s former chief of operations, Marion Whicker, the former deputy chief of supply, production and distribution, and Eric Shirley, the operation’s former chief of staff, according to STAT’s review of the officials’ LinkedIn profiles.Other officials appear to be looking for new jobs. The initiative’s general counsel, Gregory Gillette, wrote on his LinkedIn profile that he is “looking to transition this fall.”advertisement Operation Warp zithromax allergy symptoms Speed is technically ongoing.

The Biden administration has renewed the agreement that allows the military and health departments to work together on the initiative, but it also quietly changed the name. Now, Warp Speed is known as the zithromax allergy symptoms Countermeasures Acceleration Group, according to two sources.The Biden administration has downplayed the contributions of the Warp Speed operation to the U.S. Vaccination effort. In addition to the name change, the administration has largely centralized the treatment distribution effort within the White House, rather than relying on HHS and the Department of Defense, as President Trump did.advertisement However, Biden’s pick to co-lead the vaccination effort alongside Perna, former FDA Commissioner David Kessler, vociferously praised Perna zithromax allergy symptoms and his contributions to the vaccination effort.“There is no finer public servant,” Kessler said.

€œHe was instrumental in getting this country vaccinated so quickly.” Perna was chosen to serve as chief operating officer of Operation Warp Speed in May 2020. The 39-year Army veteran, who most recently led the Army’s logistics arm, frequently served as the chief spokesperson for the Trump administration’s rocky treatment rollout.It’s not entirely clear why Warp Speed is facing such staff turnover, though three sources told STAT changes in Department of Defense staff were normal, planned staff rotations. Perna had previously pledged not to zithromax allergy symptoms leave the initiative “until my part of the mission is done or I’m told otherwise.” The White House and Department of Defense did not respond to requests for comment. Perna also did not respond to requests for comment.Shirley is now commanding another branch of the military’s Defense Logistics Agency, according to his LinkedIn profile.

Whicker appears to be back serving in her old position in the Army, zithromax allergy symptoms according to her LinkedIn profile. Neither could be reached for comment.Meyer told STAT that he left the initiative in May for training obligations.The pharmaceutical industry has developed a “hidden web of policy influence” over members of the U.K. Parliament through payments that run the risk of creating of “institutional corruption,” according to a new analysis.Specifically, researchers focused on All-Party Parliamentary Groups, which are informal clusters zithromax allergy symptoms of lawmakers that focus on particular issues and seek to influence government through meetings and reports. However, APPGs do not receive government funding, so the findings raise questions about the extent to which these groups act independently.

Unlock this article by subscribing to STAT+ and enjoy your first 30 days free!. GET STARTED Log In | Learn More zithromax allergy symptoms What is it?. STAT+ is STAT's premium subscription service for in-depth biotech, pharma, policy, and life science coverage and analysis. Our award-winning team covers news on Wall Street, policy developments in Washington, early science breakthroughs and clinical trial results, and health care zithromax allergy symptoms disruption in Silicon Valley and beyond.

What's included?. Daily reporting and analysis The most comprehensive industry coverage from a powerhouse team of reporters Subscriber-only newsletters Daily newsletters to brief you on the most important industry news of the day STAT+ Conversations Weekly opportunities to engage with our reporters and leading industry experts in live video conversations Exclusive industry events zithromax allergy symptoms Premium access to subscriber-only networking events around the country The best reporters in the industry The most trusted and well-connected newsroom in the health care industry And much more Exclusive interviews with industry leaders, profiles, and premium tools, like our CRISPR Trackr.Over the past few months, thousands of people in India who survived buy antibiotics returned to hospitals with a rare and life-threatening called mucormycosis, or black fungus. But the medicine used to treat the is in short supply and priced out of reach for many people, according to dozens of advocacy groups that are urging the manufacturer to quickly widen access.At issue is amphotericin B, which is marketed by Gilead Sciences (GILD) to combat cryptococcal meningitis in patients with HIV or visceral leishmaniasis, a parasitic disease. But the sudden emergence of black fungus has opened the company zithromax allergy symptoms to criticism that it failed to ensure a predictable and affordable supply of the intravenous drug.

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Our award-winning team covers news on Wall Street, policy developments in Washington, early science breakthroughs and clinical trial results, and health care disruption in Silicon Valley and beyond. What's included?. Daily reporting and analysis The most comprehensive industry coverage from a powerhouse team of reporters Subscriber-only newsletters Daily newsletters to brief you on the most important industry news of the day STAT+ Conversations Weekly opportunities to engage with our reporters and leading industry experts in live video conversations Exclusive industry events Premium access to subscriber-only networking events around the country The best reporters in the industry The most trusted and well-connected newsroom in the health care industry And much more Exclusive interviews with industry leaders, profiles, and premium tools, like our CRISPR Trackr..

Unlock this article by subscribing to STAT+ and enjoy Cialis price increase 2020 your first 30 days how much does zithromax cost without insurance free!. GET STARTED Log In | Learn More What is it?. STAT+ is STAT's premium subscription service for how much does zithromax cost without insurance in-depth biotech, pharma, policy, and life science coverage and analysis. Our award-winning team covers news on Wall Street, policy developments in Washington, early science breakthroughs and clinical trial results, and health care disruption in Silicon Valley and beyond. What's how much does zithromax cost without insurance included?.

Daily reporting and analysis The most comprehensive industry coverage from a powerhouse team of reporters Subscriber-only newsletters Daily newsletters to brief you on the most important industry news of the day STAT+ Conversations Weekly opportunities to engage with our reporters and leading industry experts in live video conversations Exclusive industry events Premium access to subscriber-only networking events around the country The best reporters in the industry The most trusted and well-connected newsroom in the health care industry And much more Exclusive interviews with industry leaders, profiles, and premium tools, like our CRISPR Trackr.WASHINGTON — Gus Perna, the four-star Army general responsible for coordinating the U.S. antibiotics treatment response, is set to retire this summer, according to four current and former Health and Human Services officials.A number of Perna’s top deputies have also left the initiative in recent weeks, including Doug Meyer, the operation’s former chief of operations, Marion Whicker, the former deputy chief of supply, production and distribution, and Eric Shirley, the operation’s former chief of staff, according to STAT’s review of the officials’ LinkedIn profiles.Other officials appear to be looking for new jobs. The initiative’s general counsel, Gregory Gillette, wrote on his LinkedIn profile that he is “looking to transition this fall.”advertisement how much does zithromax cost without insurance Operation Warp Speed is technically ongoing. The Biden administration has renewed the agreement that allows the military and health departments to work together on the initiative, but it also quietly changed the name. Now, Warp Speed is known as how much does zithromax cost without insurance the Countermeasures Acceleration Group, according to two sources.The Biden administration has downplayed the contributions of the Warp Speed operation to the U.S.

Vaccination effort. In addition to the name change, the administration has largely centralized the treatment distribution effort within the White House, rather than relying on HHS and the Department of Defense, as President Trump did.advertisement However, Biden’s pick to co-lead the vaccination effort alongside how much does zithromax cost without insurance Perna, former FDA Commissioner David Kessler, vociferously praised Perna and his contributions to the vaccination effort.“There is no finer public servant,” Kessler said. €œHe was instrumental in getting this country vaccinated so quickly.” Perna was chosen to serve as chief operating officer of Operation Warp Speed in May 2020. The 39-year Army veteran, who most recently led the Army’s logistics arm, frequently served as the chief spokesperson for the Trump administration’s rocky treatment rollout.It’s not entirely clear why Warp Speed is facing such staff turnover, though three sources told STAT changes in Department of Defense staff were normal, planned staff rotations. Perna had previously pledged not to leave the initiative “until my part of the mission is done or I’m told how much does zithromax cost without insurance otherwise.” The White House and Department of Defense did not respond to requests for comment.

Perna also did not respond to requests for comment.Shirley is now commanding another branch of the military’s Defense Logistics Agency, according to his LinkedIn profile. Whicker appears to be back serving in her old position in the Army, according how much does zithromax cost without insurance to her LinkedIn profile. Neither could be reached for comment.Meyer told STAT that he left the initiative in May for training obligations.The pharmaceutical industry has developed a “hidden web of policy influence” over members of the U.K. Parliament through payments that run the risk of creating of “institutional corruption,” according how much does zithromax cost without insurance to a new analysis.Specifically, researchers focused on All-Party Parliamentary Groups, which are informal clusters of lawmakers that focus on particular issues and seek to influence government through meetings and reports. However, APPGs do not receive government funding, so the findings raise questions about the extent to which these groups act independently.

Unlock this article by subscribing to STAT+ and enjoy your first 30 days free!. GET STARTED Log In how much does zithromax cost without insurance | Learn More What is it?. STAT+ is STAT's premium subscription service for in-depth biotech, pharma, policy, and life science coverage and analysis. Our award-winning team covers news on Wall Street, policy developments in Washington, early science breakthroughs and clinical trial how much does zithromax cost without insurance results, and health care disruption in Silicon Valley and beyond. What's included?.

Daily reporting and analysis The most comprehensive industry coverage from a powerhouse team of reporters Subscriber-only newsletters Daily newsletters to brief you on the most important industry news of the day STAT+ Conversations how much does zithromax cost without insurance Weekly opportunities to engage with our reporters and leading industry experts in live video conversations Exclusive industry events Premium access to subscriber-only networking events around the country The best reporters in the industry The most trusted and well-connected newsroom in the health care industry And much more Exclusive interviews with industry leaders, profiles, and premium tools, like our CRISPR Trackr.Over the past few months, thousands of people in India who survived buy antibiotics returned to hospitals with a rare and life-threatening called mucormycosis, or black fungus. But the medicine used to treat the is in short supply and priced out of reach for many people, according to dozens of advocacy groups that are urging the manufacturer to quickly widen access.At issue is amphotericin B, which is marketed by Gilead Sciences (GILD) to combat cryptococcal meningitis in patients with HIV or visceral leishmaniasis, a parasitic disease. But the sudden emergence of black fungus has opened the company to criticism that it failed to ensure a predictable and affordable supply of the how much does zithromax cost without insurance intravenous drug. The , which has an overall mortality rate of 50%, may be being triggered by the use of steroids, a life-saving treatment for severe and critically ill buy antibiotics patients. Unlock this article by subscribing to STAT+ and enjoy your first 30 days free!.

GET STARTED Log In | Learn More What how much does zithromax cost without insurance is it?. STAT+ is STAT's premium subscription service for in-depth biotech, pharma, policy, and life science coverage and analysis. Our award-winning team covers news on Wall Street, policy developments in Washington, early science breakthroughs and clinical trial results, and health care disruption in Silicon Valley and beyond. What's included?. Daily reporting and analysis The most comprehensive industry coverage from a powerhouse team of reporters Subscriber-only newsletters Daily newsletters to brief you on the most important industry news of the day STAT+ Conversations Weekly opportunities to engage with our reporters and leading industry experts in live video conversations Exclusive industry events Premium access to subscriber-only networking events around the country The best reporters in the industry The most trusted and well-connected newsroom in the health care industry And much more Exclusive interviews with industry leaders, profiles, and premium tools, like our CRISPR Trackr..

What side effects may I notice from Zithromax?

Side effects that you should report to your prescriber or health care professional as soon as possible:

• dark yellow or brown urine;
• difficulty breathing; severe or watery diarrhea;
• skin rash, itching;
• irregular heartbeat, palpitations, or chest pain;
• vomiting;
• yellowing of the eyes or skin

Side effects that usually do not require medical attention (report to your prescriber or health care professional if they continue or are bothersome):

• diarrhea;
• dizziness, drowsiness;
• hearing loss;
• headache;
• increased sensitivity to the sun;
• nausea;
• stomach pain or cramps;
• tiredness;
• vaginal irritation, itching or discharge

This list may not describe all possible side effects.

Zithromax for impetigo

9 November 2020 Registration is now open for zithromax for impetigo our 4-day virtual event The Biomedical Scientist Live. The Biomedical Scientist Live is a new virtual event brought to you by the IBMS.Delivered from 16th-19th zithromax for impetigo November 2020, The Biomedical Scientist Live will feature a packed line up of knowledge sharing sessions, including seminars, presentations, discussions and demonstrations.buy antibiotics has brought our profession even more into the spotlight as biomedical scientists have been required to meet the challenges presented by the zithromax. The Biomedical Scientist Live will present learnings from the zithromax, share the latest research across a range of specialisms, and showcase cutting-edge technologies.Registration InformationThe Biomedical Scientist Live is free to access for IBMS members, who can register here.If you are a non-member the fee to access the event is £150 + VAT.

Non-members can zithromax for impetigo register here. If you would like to become an IBMS member, visit our joining page.If you have any questions about this event or the registration process please call 0207 324 2771ProgrammeThe programme of events and presenter information can be viewed online..

9 November http://jurain.com/portfolio/blocage-n1 2020 Registration is now open for our 4-day virtual how much does zithromax cost without insurance event The Biomedical Scientist Live. The Biomedical Scientist Live is a new virtual event brought to you by the IBMS.Delivered from 16th-19th November 2020, The Biomedical Scientist Live will feature a how much does zithromax cost without insurance packed line up of knowledge sharing sessions, including seminars, presentations, discussions and demonstrations.buy antibiotics has brought our profession even more into the spotlight as biomedical scientists have been required to meet the challenges presented by the zithromax. The Biomedical Scientist Live will present learnings from the zithromax, share the latest research across a range of specialisms, and showcase cutting-edge technologies.Registration InformationThe Biomedical Scientist Live is free to access for IBMS https://www.mein2tes-leben.at/ members, who can register here.If you are a non-member the fee to access the event is £150 + VAT.

Non-members can how much does zithromax cost without insurance register here. If you would like to become an IBMS member, visit our joining page.If you have any questions about this event or the registration process please call 0207 324 2771ProgrammeThe programme of events and presenter information can be viewed online..

Zithromax alcohol consumption

Biology, music and neuroscience zithromax alcohol consumption. Our paper, published in early May in Frontiers in Psychology, argues that the mockingbird, one of the American birds with the most complex of songs, uses musical techniques familiar to composers from many kinds of human music. Our thesis is that mockingbirds use four compositional strategies to create their melodious song.

Timbre change, pitch change, zithromax alcohol consumption stretch and squeeze. This allows the birds to transition from one sound to the next in ways that tickle the ears of both songbirds and people. We called this overall activity morphing, a phrase more familiar in imagery but that works for audio just the same.

I’m a philosopher and musician, a person who does not usually work on scientific papers zithromax alcohol consumption. But I have written about scientific method many times, in popular books like Why Birds Sing, Bug Music and Survival of the Beautiful. All of these works put science in the context of culture, and most deal with the music of the animal world in one way or another.

Long fascinated with the compositional methods of the mockingbird, I finally decided to dig deep into his sense of form zithromax alcohol consumption and structure. For that I needed the help of the greatest expert on listening to these birds, Dave Gammon, professor of biology at Elon University, who has studied the large population of mockers on his campus for many years now. He knows about 20 individual singing males by name, and can identify by ear most of the species each one imitates and which sounds are not imitations at all.

€¦â€œWhen you listen to a mockingbird,” he says, “they repeat an individual phrase three or four times, and then they're doing something new, and then doing something new again.” “And after you've listened to them for just a minute,” Dave adds, “you've heard 20 to 25 different song phrases and they're still zithromax alcohol consumption pulling out new ones. If you listened to them for 10 minutes, you might be hard pressed to recognize anything that was repeated. The diversity is huge, and it's so loud, so conspicuous.

I always felt they were composing with these diverse sounds, and that the organization of their song phrases might be perceived by humans.” [embedded zithromax alcohol consumption content] Dave also insisted that we compare these songs to human music. As someone who’s studied a lot of ethnomusicology, I was a bit afraid to do that. Immediately opens a can of worms!.

Which zithromax alcohol consumption human music?. But I was impressed by his examples. Beethoven’s Fifth symphony for pitch change.

The Tuvan throat-singing zithromax alcohol consumption ensemble Huun-Huur-Tu for timbre change. And Idina Menzel from Disney's Frozen II for stretch. All we needed is an example for squeeze, so I immediately thought we needed something from hip-hop, and I was sure Kendrick Lamar’s album Damn would have something.

It really had everything, and the last piece on the album, “Duckworth,” sounded more mockingbirdesque zithromax alcohol consumption than anything we found. It didn’t win the Pulitzer Prize in composition for nothing. Okay, we had all these cool examples.

Look, mockingbirds play with sounds just like zithromax alcohol consumption humans do. We call what humans do music, so why can’t the birds be making music?. “It’s all fine to propose the bird is doing something,” says lead author Tina Roeske of the Max Planck Institute for Empirical Aesthetics in Frankfurt.

€œBut for science, we must analyze the data to show that our assertions fit the data.” She designed the zithromax alcohol consumption algorithms that tested the paper’s hypotheses. The statistics support our hypotheses, and that is what it takes for something to become science." She explains her methods. €œI'm the kind of scientist who just loves the really not so sexy stuff.

I really just sit in front of zithromax alcohol consumption the computer and listen to stuff and try to recognize structure.” She continues. €œI mean, I love when I can show that a pattern that I perceive and perhaps find beautiful is truly there. It's like finding a proof that this is real.

It's not zithromax alcohol consumption a random thing. It's really there. Start thinking about why is it that we also have this strong, subjective response to the mockingbird’s song.

And that's really interesting zithromax alcohol consumption. And I don't think the analysis takes away from the beauty of the song itself.” In my books, I have long argued that for humans to best understand any phenomenon, we have to combine all the different forms of knowledge at our disposal. Poetry says one thing about mockingbirds, as in Walt Whitman’s “Out of the Cradle Endlessly Rocking.” Music says another.

€œListen to the Mockingbird.” zithromax alcohol consumption Ornithology says. Here are all the species the mockingbird copies. Neuroscience says.

Look at these numbers zithromax alcohol consumption that prove our intuitions about pitch, timbre, stretch and squeeze are correct. Each form of human knowledge has different criteria for truth. None reduces to the others or cancels each other out.

But all zithromax alcohol consumption can be impressed by beauty in a bird’s song, albeit in different ways. Charles Darwin knew this full well, observing in The Descent of Man that birds have a natural aesthetic sense. €œThat’s why they evolved such beautiful songs,” I told a reporter at Elon University.

€œIt takes zithromax alcohol consumption the full range of human forms of knowledge to figure out what they are up to. Not one of us could have done this research alone." The paper, and all its data, are free to view in the open-access journal Frontiers in Psychology. And this video version demonstrates how this bird makes such special music out of the songs of so many other birds in his habitat.

If we take its music more seriously, our own sense of music expands to care just a little more about the world of nature that surrounds us and made us possible in the first place.During zithromax alcohol consumption a congressional hearing last week, Republican Representative Louie Gohmert of Texas asked a U.S. Forest Service official if her organization or the Bureau of Land Management could change the orbit of the moon or Earth to reverse the effects of human-caused climate change. That seems like a perfectly reasonable idea, doesn’t it?.

Let’s do zithromax alcohol consumption it. First, we must take stock of what we have—the givens in what will be our equation for moving Earth. Our planet orbits the sun at an average distance of 149.6 million kilometers, and it soaks up enough sunlight to have an average temperature of about 15 degrees Celsius.

The latter figure is, however, an zithromax alcohol consumption increase of slightly more than one degree C from Earth’s typical temperature across the past century. In short, this world is running a low-grade fever. According to current consensus estimates, that fever is likely to get much worse if left unchecked, raising Earth’s average temperature by another one degree C by the 2060s.

Such an increase would render some presently people-packed parts of the planet effectively uninhabitable and threaten the sustainability of global civilization as we know it zithromax alcohol consumption. Radiative equilibrium, the balance between incoming energy from the sun’s rays and energy emitted from Earth, is key to our understanding of our planet’s changing temperature, says Britt Scharringhausen, a planetary astronomer at Beloit College. It is described in the following equation, as scribbled out by Scharringhausen.

Page from planetary astronomer Britt Scharringhausen’s lab notebook shows a handwritten equation for determining a planet’s zithromax alcohol consumption radiative equilibrium (highlighted in green), which sets its effective temperature. Credit. Britt Scharringhausen Here, Teq is Earth’s temperature, T☉ is the sun’s temperature, R☉ is the sun’s radius, X is the distance to the sun, and A is Earth’s albedo, or reflectivity.* Albedo measures how well our planet reflects solar energy, where 0 would be perfect absorption and 1 would be perfect reflection.

There is a connection between climate zithromax alcohol consumption change and albedo. Snow and ice, for instance, have a high albedo, reflecting up to 90 percent of the sunlight that hits them back to outer space. Anthropogenic warming causes snow and ice caps to melt, which can make Earth’s albedo decrease.

That, in turn, eventually zithromax alcohol consumption leads to a higher average planetary temperature. Some variables in this equation are changing naturally. Our star is very slowly swelling and brightening, becoming slightly larger and more luminous as it ages.

Ethan Siegel, a theoretical astrophysicist and science writer, says that while it will take the sun on the order of 100 million years to increase in luminosity by 1 percent, our greenhouse-gas-emitting global civilization is projected to zithromax alcohol consumption increase the solar energy retained by Earth by 1 percent over the next few hundred to 1,000 years. To make Earth cooler, we need to decrease a variable on the right side of the equation. We can’t easily lower the sun’s temperature or radius—and clearly meaningful reductions to our heat-trapping, albedo-shifting greenhouse gas emissions are out of the question.

So let’s zithromax alcohol consumption take Representative Gohmert’s advice and simply increase X, the distance to the sun. All we have to do is find a way to move all 5.972 septillion kilograms of Earth’s mass farther away from our star. Easy, right?.

By Scharringhausen’s calculations, zithromax alcohol consumption a three-degree-C decrease in temperature to counteract current and near-future anthropogenic warming would require us to move our planet an additional three million kilometers from the sun. Using another back-of-the-envelope calculation, Scharringhausen finds that 5 x 1031 joules could push all 5,972,000,000,000,000,000,000,000 kilograms of Earth’s mass three million kilometers out from its present orbit. These numbers present challenges for Representative Gohmert’s plan because annual global electricity production is around 1019 joules, or 0.0000000000002 percent of what we’d need to move the globe.

That’s also assuming we can apply all that energy to Earth zithromax alcohol consumption at 100 percent efficiency, which, thanks to the laws of thermodynamics, is physically impossible. Setting aside such particulars, we haven’t addressed what form this applied energy would take. There is the literal nuclear option.

One method that scientists have proposed to move an asteroid is to detonate a zithromax alcohol consumption nuclear bomb near it, Scharringhausen says. €œIt will basically vaporize part of the asteroid, and that escaping rock vapor acts like rocket exhaust and will push the asteroid along,” she explains. Scaled up, such a mechanism could, in principle, provide enough oomph to shift a planet’s orbit.

Still, it would take a billion times more nuclear explosions than we have ever set off to move Earth the required distance, or the equivalent of dropping an atomic bomb every second for 500 years, according zithromax alcohol consumption to Geza Gyuk, director of astronomy at the Adler Planetarium in Chicago. The strategy of constantly detonating nuclear bombs near Earth’s surface with the goal of vaporizing parts of it to act as rocket exhaust also has several drawbacks. For our purposes, the most notable deleterious effect is that the blasts themselves would heat up the planet, counteracting the stated goal of reversing global warming.

A gentler option would zithromax alcohol consumption be to siphon off the energy of other celestial objects, such as passing asteroids or comets, by engineering close planetary flybys. This technique is regularly used in reverse, with great success, by spacecraft that boost their speed by passing close to a planet to steal a portion of its orbital energy. For moving our planet, the issue with the method is scale, Siegel says.

The total mass of the asteroid belt is only 4 to 5 percent of that of the moon, zithromax alcohol consumption or 0.05 to 0.06 percent of that of Earth. Using the mass of the entire asteroid belt in flybys would migrate Earth away from the sun by less than 748,000 kilometers, or a quarter of the distance we’d need, he says. And a single off-course collision with our planet would spark destruction approaching that caused by the asteroid impact that eradicated the dinosaurs in a global mass extinction.

Fortunately, we have a much more massive space rock sitting zithromax alcohol consumption in our backyard. The moon itself. Could we “cut” the gravitational string connecting the moon to the Earth, thereby slingshotting our planet into a wider orbit?.

Not in any way that we’re capable of zithromax alcohol consumption doing today, Siegel says, and the consequences would be disastrous. Besides having greatly reduced tides, a moonless Earth would have much darker nights, shorter days and extreme, unpredictable seasons because of a destabilized axis of rotation. What if instead of getting rid of our natural satellite altogether, we only change its orbit around Earth?.

Increasing the radius of the moon’s orbit by 10 percent would affect Earth’s own trajectory around the sun in the long term, says Matteo Ceriotti, a rocket scientist at the University of Glasgow’s James zithromax alcohol consumption Watt School of Engineering. We could extract and accelerate material off the moon, Ceriotti says. Using a 100-gigawatt laser, or one with about the power capacity of every single wind turbine in the U.S., it would take 300 trillion years to lift sufficient amounts of material from the lunar surface.

There is always the aforementioned nuclear option, too, which could be zithromax alcohol consumption used to move the moon rather than Earth. Another, less messy choice would be to manually extract lunar material with conventional rockets. €œIf we were able to build a spaceport on the moon and build a rocket equivalent to SpaceX’s Falcon Heavy to lift off moon material into deep space, we would need 7 x 1016 launches,” Ceriotti says.

That’s 70,000 trillion zithromax alcohol consumption rocket launches. For comparison, during the entirety of the space age, humankind has only managed to achieve 70,780 launches, and more than half of them did not leave Earth’s atmosphere. Humans could add a twist to the use of asteroids in the flyby idea and instead put them on a collision course with the moon, Gyuk says.

We would need kilometer-sized comets to crash into the moon every second for a couple of zithromax alcohol consumption hundred years to make a substantial difference. Again, though, an off-course projectile could cause a planetary mass extinction event. Because of the magnitude of the change necessary to increase the Earth’s orbit, any intervention would probably need to last for many millions of years at minimum, which raises an unexpected sociological issue, Gyuk says.

We don’t have precedent for planning across such vast zithromax alcohol consumption timescales. And in fact, no civilization in human history has endured more than a mere few thousand years. Finally, even if humans managed to alter our planet’s orbit using any of these methods, they wouldn’t be able to rest easy, Siegel says.

€œIf we even somehow could make this enormous change in Earth’s orbit,” he says, “it doesn’t absolve us from the responsibility that we’ll keep needing to make this change as long as we keep increasing the greenhouse gas concentration in our atmosphere.” To my ears, that zithromax alcohol consumption sounds like a stirring endorsement of our fossil-fuel-addicted status quo!. We should immediately prioritize pouring all our energy into changing Earth’s orbit, starting now and lasting forever. Sure, it’s a Sisyphean task in which humanity is Sisyphus and the boulder being eternally pushed uphill is Earth itself.

But at least zithromax alcohol consumption we’d get to keep driving our sweet SUVs!. I say we get to work. *Editor’s Note (7/18/21).

This sentence was revised after posting to better align with the symbols given in the image..

People must how much does zithromax cost without insurance have thought this behavior was vaguely insulting to other birds, else we wouldn’t have named this one the mockingbird. But now, listen more closely. You’ll hear that this virtuoso bird isn’t just copying other species’ tunes. He’s sampling them how much does zithromax cost without insurance like a DJ and transposing, bending, tweaking them into his own quite deliberate form. We can always tell it’s a mockingbird, not because of his copying, but because of his unique and specific way of composing music out of the material he hears in the world around him.

It turned out that no humans had specifically articulated what these birds were doing, so my colleagues and I decided to delve deep into the mockingbird’s process, using the analytical tools of three different disciplines at once. Biology, music and how much does zithromax cost without insurance neuroscience. Our paper, published in early May in Frontiers in Psychology, argues that the mockingbird, one of the American birds with the most complex of songs, uses musical techniques familiar to composers from many kinds of human music. Our thesis is that mockingbirds use four compositional strategies to create their melodious song. Timbre change, pitch change, stretch and how much does zithromax cost without insurance squeeze.

This allows the birds to transition from one sound to the next in ways that tickle the ears of both songbirds and people. We called this overall activity morphing, a phrase more familiar in imagery but that works for audio just the same. I’m a how much does zithromax cost without insurance philosopher and musician, a person who does not usually work on scientific papers. But I have written about scientific method many times, in popular books like Why Birds Sing, Bug Music and Survival of the Beautiful. All of these works put science in the context of culture, and most deal with the music of the animal world in one way or another.

Long fascinated with the compositional methods of the mockingbird, I finally decided to dig deep into his sense of form and structure how much does zithromax cost without insurance. For that I needed the help of the greatest expert on listening to these birds, Dave Gammon, professor of biology at Elon University, who has studied the large population of mockers on his campus for many years now. He knows about 20 individual singing males by name, and can identify by ear most of the species each one imitates and which sounds are not imitations at all. €¦â€œWhen you listen to a mockingbird,” he says, “they repeat an individual phrase three or four times, and then they're doing something new, and then doing something new again.” “And after you've listened to them for just a minute,” how much does zithromax cost without insurance Dave adds, “you've heard 20 to 25 different song phrases and they're still pulling out new ones. If you listened to them for 10 minutes, you might be hard pressed to recognize anything that was repeated.

The diversity is huge, and it's so loud, so conspicuous. I always felt they were composing with these diverse sounds, and that the organization of their song phrases might be perceived by humans.” [embedded content] Dave also insisted that we compare these songs to human music how much does zithromax cost without insurance. As someone who’s studied a lot of ethnomusicology, I was a bit afraid to do that. Immediately opens a can of worms!. Which human music? how much does zithromax cost without insurance.

But I was impressed by his examples. Beethoven’s Fifth symphony for pitch change. The Tuvan how much does zithromax cost without insurance throat-singing ensemble Huun-Huur-Tu for timbre change. And Idina Menzel from Disney's Frozen II for stretch. All we needed is an example for squeeze, so I immediately thought we needed something from hip-hop, and I was sure Kendrick Lamar’s album Damn would have something.

It really how much does zithromax cost without insurance had everything, and the last piece on the album, “Duckworth,” sounded more mockingbirdesque than anything we found. It didn’t win the Pulitzer Prize in composition for nothing. Okay, we had all these cool examples. Look, mockingbirds how much does zithromax cost without insurance play with sounds just like humans do. We call what humans do music, so why can’t the birds be making music?.

“It’s all fine to propose the bird is doing something,” says lead author Tina Roeske of the Max Planck Institute for Empirical Aesthetics in Frankfurt. €œBut for science, we must analyze the data to show that our assertions fit the data.” She how much does zithromax cost without insurance designed the algorithms that tested the paper’s hypotheses. The statistics support our hypotheses, and that is what it takes for something to become science." She explains her methods. €œI'm the kind of scientist who just loves the really not so sexy stuff. I really just sit in front of the how much does zithromax cost without insurance computer and listen to stuff and try to recognize structure.” She continues.

€œI mean, I love when I can show that a pattern that I perceive and perhaps find beautiful is truly there. It's like finding a proof that this is real. It's not how much does zithromax cost without insurance a random thing. It's really there. Start thinking about why is it that we also have this strong, subjective response to the mockingbird’s song.

And that's how much does zithromax cost without insurance really interesting. And I don't think the analysis takes away from the beauty of the song itself.” In my books, I have long argued that for humans to best understand any phenomenon, we have to combine all the different forms of knowledge at our disposal. Poetry says one thing about mockingbirds, as in Walt Whitman’s “Out of the Cradle Endlessly Rocking.” Music says another. €œListen to the Mockingbird.” Ornithology how much does zithromax cost without insurance says. Here are all the species the mockingbird copies.

Neuroscience says. Look at these numbers that prove our intuitions about how much does zithromax cost without insurance pitch, timbre, stretch and squeeze are correct. Each form of human knowledge has different criteria for truth. None reduces to the others or cancels each other out. But all can be how much does zithromax cost without insurance impressed by beauty in a bird’s song, albeit in different ways.

Charles Darwin knew this full well, observing in The Descent of Man that birds have a natural aesthetic sense. €œThat’s why they evolved such beautiful songs,” I told a reporter at Elon University. €œIt takes the full range of human forms of knowledge to figure out what they are how much does zithromax cost without insurance up to. Not one of us could have done this research alone." The paper, and all its data, are free to view in the open-access journal Frontiers in Psychology. And this video version demonstrates how this bird makes such special music out of the songs of so many other birds in his habitat.

If we take its music more seriously, our own sense of music expands to care just a little more about how much does zithromax cost without insurance the world of nature that surrounds us and made us possible in the first place.During a congressional hearing last week, Republican Representative Louie Gohmert of Texas asked a U.S. Forest Service official if her organization or the Bureau of Land Management could change the orbit of the moon or Earth to reverse the effects of human-caused climate change. That seems like a perfectly reasonable idea, doesn’t it?. Let’s do it how much does zithromax cost without insurance. First, we must take stock of what we have—the givens in what will be our equation for moving Earth.

Our planet orbits the sun at an average distance of 149.6 million kilometers, and it soaks up enough sunlight to have an average temperature of about 15 degrees Celsius. The latter figure is, however, an increase of slightly more than one degree C from Earth’s typical temperature across how much does zithromax cost without insurance the past century. In short, this world is running a low-grade fever. According to current consensus estimates, that fever is likely to get much worse if left unchecked, raising Earth’s average temperature by another one degree C by the 2060s. Such an how much does zithromax cost without insurance increase would render some presently people-packed parts of the planet effectively uninhabitable and threaten the sustainability of global civilization as we know it.

Radiative equilibrium, the balance between incoming energy from the sun’s rays and energy emitted from Earth, is key to our understanding of our planet’s changing temperature, says Britt Scharringhausen, a planetary astronomer at Beloit College. It is described in the following equation, as scribbled out by Scharringhausen. Page from planetary astronomer Britt Scharringhausen’s lab notebook shows a handwritten equation for determining a planet’s radiative equilibrium (highlighted in green), which how much does zithromax cost without insurance sets its effective temperature. Credit. Britt Scharringhausen Here, Teq is Earth’s temperature, T☉ is the sun’s temperature, R☉ is the sun’s radius, X is the distance to the sun, and A is Earth’s albedo, or reflectivity.* Albedo measures how well our planet reflects solar energy, where 0 would be perfect absorption and 1 would be perfect reflection.

There is a connection between climate change and how much does zithromax cost without insurance albedo. Snow and ice, for instance, have a high albedo, reflecting up to 90 percent of the sunlight that hits them back to outer space. Anthropogenic warming causes snow and ice caps to melt, which can make Earth’s albedo decrease. That, in turn, eventually leads to a higher how much does zithromax cost without insurance average planetary temperature. Some variables in this equation are changing naturally.

Our star is very slowly swelling and brightening, becoming slightly larger and more luminous as it ages. Ethan Siegel, a theoretical astrophysicist and how much does zithromax cost without insurance science writer, says that while it will take the sun on the order of 100 million years to increase in luminosity by 1 percent, our greenhouse-gas-emitting global civilization is projected to increase the solar energy retained by Earth by 1 percent over the next few hundred to 1,000 years. To make Earth cooler, we need to decrease a variable on the right side of the equation. We can’t easily lower the sun’s temperature or radius—and clearly meaningful reductions to our heat-trapping, albedo-shifting greenhouse gas emissions are out of the question. So let’s take Representative Gohmert’s advice and simply increase X, the distance to the sun how much does zithromax cost without insurance.

All we have to do is find a way to move all 5.972 septillion kilograms of Earth’s mass farther away from our star. Easy, right?. By Scharringhausen’s calculations, a three-degree-C decrease in temperature to how much does zithromax cost without insurance counteract current and near-future anthropogenic warming would require us to move our planet an additional three million kilometers from the sun. Using another back-of-the-envelope calculation, Scharringhausen finds that 5 x 1031 joules could push all 5,972,000,000,000,000,000,000,000 kilograms of Earth’s mass three million kilometers out from its present orbit. These numbers present challenges for Representative Gohmert’s plan because annual global electricity production is around 1019 joules, or 0.0000000000002 percent of what we’d need to move the globe.

That’s also assuming we can apply all that energy to Earth at 100 percent efficiency, which, thanks to the laws how much does zithromax cost without insurance of thermodynamics, is physically impossible. Setting aside such particulars, we haven’t addressed what form this applied energy would take. There is the literal nuclear option. One method that scientists have proposed to move an asteroid is to detonate a nuclear bomb near it, Scharringhausen says how much does zithromax cost without insurance. €œIt will basically vaporize part of the asteroid, and that escaping rock vapor acts like rocket exhaust and will push the asteroid along,” she explains.

Scaled up, such a mechanism could, in principle, provide enough oomph to shift a planet’s orbit. Still, it would take a billion times more nuclear explosions than we have ever set off to move Earth the required distance, or the equivalent of dropping an atomic bomb every second how much does zithromax cost without insurance for 500 years, according to Geza Gyuk, director of astronomy at the Adler Planetarium in Chicago. The strategy of constantly detonating nuclear bombs near Earth’s surface with the goal of vaporizing parts of it to act as rocket exhaust also has several drawbacks. For our purposes, the most notable deleterious effect is that the blasts themselves would heat up the planet, counteracting the stated goal of reversing global warming. A gentler option would be to siphon off the energy of other celestial how much does zithromax cost without insurance objects, such as passing asteroids or comets, by engineering close planetary flybys.

This technique is regularly used in reverse, with great success, by spacecraft that boost their speed by passing close to a planet to steal a portion of its orbital energy. For moving our planet, the issue with the method is scale, Siegel says. The total mass how much does zithromax cost without insurance of the asteroid belt is only 4 to 5 percent of that of the moon, or 0.05 to 0.06 percent of that of Earth. Using the mass of the entire asteroid belt in flybys would migrate Earth away from the sun by less than 748,000 kilometers, or a quarter of the distance we’d need, he says. And a single off-course collision with our planet would spark destruction approaching that caused by the asteroid impact that eradicated the dinosaurs in a global mass extinction.

Fortunately, we have a much more massive space rock sitting how much does zithromax cost without insurance in our backyard. The moon itself. Could we “cut” the gravitational string connecting the moon to the Earth, thereby slingshotting our planet into a wider orbit?. Not in any way that we’re capable of doing today, Siegel says, and the consequences would how much does zithromax cost without insurance be disastrous. Besides having greatly reduced tides, a moonless Earth would have much darker nights, shorter days and extreme, unpredictable seasons because of a destabilized axis of rotation.

What if instead of getting rid of our natural satellite altogether, we only change its orbit around Earth?. Increasing the radius of the moon’s orbit by 10 percent would affect Earth’s own trajectory around the sun in the long term, says Matteo Ceriotti, a rocket scientist at the University of Glasgow’s James Watt School of Engineering how much does zithromax cost without insurance. We could extract and accelerate material off the moon, Ceriotti says. Using a 100-gigawatt laser, or one with about the power capacity of every single wind turbine in the U.S., it would take 300 trillion years to lift sufficient amounts of material from the lunar surface. There is always the aforementioned nuclear option, too, which could be used to move the how much does zithromax cost without insurance moon rather than Earth.

Another, less messy choice would be to manually extract lunar material with conventional rockets. €œIf we were able to build a spaceport on the moon and build a rocket equivalent to SpaceX’s Falcon Heavy to lift off moon material into deep space, we would need 7 x 1016 launches,” Ceriotti says. That’s 70,000 trillion how much does zithromax cost without insurance rocket launches. For comparison, during the entirety of the space age, humankind has only managed to achieve 70,780 launches, and more than half of them did not leave Earth’s atmosphere. Humans could add a twist to the use of asteroids in the flyby idea and instead put them on a collision course with the moon, Gyuk says.

We would need kilometer-sized comets to crash into the moon every second for a couple of hundred years to make a substantial difference. Again, though, an off-course projectile could cause a planetary mass extinction event. Because of the magnitude of the change necessary to increase the Earth’s orbit, any intervention would probably need to last for many millions of years at minimum, which raises an unexpected sociological issue, Gyuk says. We don’t have precedent for planning across such vast timescales. And in fact, no civilization in human history has endured more than a mere few thousand years.

Finally, even if humans managed to alter our planet’s orbit using any of these methods, they wouldn’t be able to rest easy, Siegel says. €œIf we even somehow could make this enormous change in Earth’s orbit,” he says, “it doesn’t absolve us from the responsibility that we’ll keep needing to make this change as long as we keep increasing the greenhouse gas concentration in our atmosphere.” To my ears, that sounds like a stirring endorsement of our fossil-fuel-addicted status quo!.