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Welcome to can i buy levitra at walgreens levitra and alcohol the first issue of 2022!. We have several exciting changes to announce in the new year. To begin with, we have been increasing our number of published submissions per issue, including some of our content exclusively online (the most common way that our readers access can i buy levitra at walgreens the journal). In addition, we have put out additional calls for submissions and look forward to receiving new work.We have spent the last 4 years working towards social justice, accessibility, global …IntroductionThe subject of care is gaining importance within the medical humanities, but it also remains elusive. Hence, this paper aims to unpack theoretical notions of care in a way that integrates the elusiveness rather than trying to avoid it.

It also responds to a recent article by can i buy levitra at walgreens Julia Kristeva et al, in which they claim that care holds humanity (Kristeva et al. 2018).When in need of theoretical elaboration or re-development, medical humanities scholars have sometimes evoked Greek or Roman myths, such as those of Narcissus, Hephaestus or Leto (Cilione, Marinozzi, and Gazzaniga 2019. Pannese 2011. Schott 2017) can i buy levitra at walgreens. Similarly, this article evokes the Roman myth of Cura to unpack theoretical understandings of care.

In this myth, known from the writings of the first century mythographer Hyginus, humanity is created from clay by a personification of care. It has proven useful to thinkers as diverse as Martin Heidegger, Arthur Kleinman (Kleinman and van der Geest 2009) can i buy levitra at walgreens and Julia Kristeva (Kristeva (2012), Kristeva et al. 2018). While utilisation by Heidegger 1927, 196–200 ‘challenges the myth of self-sufficiency and individual atomization that that has shaped much of modern Western philosophy’ (Froese 2005, 16), both Kleinman and Kristeva explore the can i buy levitra at walgreens tension between universalised knowledge and the singularity of individual patients and intimate care (Engebretsen, Fraas Henrichsen, and Ødemark 2020).While none of these scholars engage with Hyginus’ Fabulae directly, I use the text as an ‘engine’ in a four-step endeavour. This endeavour follows Brandy Schillace’s description of the medical humanities as ‘a field that at its core considers the human story behind and within medicine, its history, its cultural valence and its influence on practice’ Schillace (2017, 139).First, a ‘human story’ entails agency, the things that humans do in their lives.

While the ‘appeal’ from Kristeva et al uses a case from intercultural psychoanalysis, the authors have previously researched a variety of professional healthcare practices (Engebretsen 2016. Engebretsen, Sandset, and Ødemark can i buy levitra at walgreens 2017. Hetrick et al. 2017). However, it is crucial to note that Cura (in Hyginus’ text) will ‘hold’ humanity quamdiu vixerit (for as long as he shall live) can i buy levitra at walgreens.

Such a life-long temporality does not dovetail with the temporary, regulated and systematised relations of healthcare organisations. Hyginus’ text has, I argue, a much stronger affinity to the temporality of parental care. Hence, I begin the endeavour by acknowledging that I am a scholar, and the father of a boy with little linguistic function.1 Although my parental care for my son entails a multitude of meanings and instances, I begin with two can i buy levitra at walgreens tales from my parental care in 2020:Sometimes, if he does not understand what is going on, or if his actions feel unintelligible to others who are present, I take him in my arms. In that way, we are at least together in a situation when both of us otherwise would have been on our own. Suddenly, it feels as if I am not only holding or embracing him away from an abyss can i buy levitra at walgreens.

I am also holding him—or, perhaps, shielding him—in the face of many, many abysses to come.In rough-and-tumble play, I often lift him up with my arms straight—holding him while he straightens his body, and ‘is an airplane’. Although this play is exhausting, particularly since I live with cerebral palsy, this is nevertheless an activity where we can be close to one another. When I hold him up like this, or suddenly ‘crash’ him safely down next to me on the bed, we are skin to skin, but not exactly like I used to be with his older siblings, and I suddenly have the impression that it also differs from how most fathers do this with their can i buy levitra at walgreens children. I cannot know if our way is exclusively ours, but while I hold him, that is how it feels.Second, a human story ‘behind and within medicine’—or, for that matter, behind and within any social field—consists of underlying notions and involved cultural categories. Hence, this article aims to unpack theoretical notions of care with reference to the thinkers mentioned above.

Throughout, I try to unpack how different aspects can i buy levitra at walgreens of care ‘follow’ each other in an analytical ‘path’ or trajectory, as if in a story (Kristeva et al. 2018).Third, the investigation of the human story of care must become an investigation of ‘history’ and ‘cultural valence’. In order to think historically, the analytical ‘engine’ includes Hyginus’ text, and 18th and 19th century uses of Cura and related motifs.Fourth, I follow Schillace’s advice to examine ‘influence on practice’. In addition to the practice of parental care, the exploration ends with a discussion of medical can i buy levitra at walgreens humanities as practice. When medical humanities scholars ’consider’ the human story of care, they bring together different perspectives and forms of knowledge.

In this case, however both the intertextual analyses and the can i buy levitra at walgreens autotheoretical work indicate that those complexities might overpower our theoretical perspectives. Hence, I conclude with a call for epistemological and analytical modesty.MethodAlthough the abovementioned scholars have used the myth of Cura for clearly theoretical purposes, several of them explore this also as carers in a personal sense. Julia Kristeva writes her work on care as the mother of a man with severe disabilities Kristeva (2013, 219–221), Arthur Kleinman and Geest (2009, 159–163) begin their rethinking with a rich narrative of his caring for his wife who lives with Alzheimer’s disease. In line with their work, this article combines textual interpretation with autotheoretical work.Often used in can i buy levitra at walgreens connection with genre-bending memoir The Argonauts by Maggie Nelson (2015), the term ‘autotheory’ designates a literary form involving ‘the combination of autobiography and critical theory’ (Pearl 2018, 200). In this article, however, I rely on the work of the Canadian artist, curator, writer and interdisciplinary researcher Fournier (2019), who has unpacked autotheory with particular reference to illness and embodiment.

Fournier describes autotheory as a specific form of academic practice:In autotheory as a conceptual and performative feminist practice, artists, writers, and critics use the first person, or related practices of self-imaging (Jones, Self/Image 134), to process, perform, enact, iterate, and wrestle with the hegemonic discourses of ‘theory’ and philosophy, extending the feminist practice of theorizing from one’s subject positioning as a way of engendering insights into questions related to aesthetics, politics, ethics, and social and cultural theory. In autotheory, one’s embodied experiences become the material through which can i buy levitra at walgreens one theorizes, and, in a similar way, theory becomes the discourse through which one’s lived experience is refracted (658).In Fournier’s definition, theory functions as ‘hegemonic discourses’, and as discourses through which one’s lived experience is refracted. Contrary to this emphasis on language—as well as their emphasis on language elsewhere (Heidegger 1927Heidegger 1937. Kleinman 1995. Kristeva 2019)—neither can i buy levitra at walgreens Kristeva nor Kleinman or Heidegger focus on Hyginus’ text.

In contrast to this body of research, this article emphasizes the interpretative potential of the original text. In addition to grammatical analysis, I utilize the can i buy levitra at walgreens well-known concept of intertextuality, as introduced by Kristeva (1980). However, I use it in a less structuralist sense than in her early formulations in Desire in Language. Instead, I approach Hyginus’ text in line with her approach in ‘Nos Deux’ or a short (hi)story of intertextuality (Kristeva 2002).For me, intertextuality is mostly a way of making history go down in us. We, two can i buy levitra at walgreens texts, two destinies, two psyches.

It is a way if introducing history to structuralism and its orphan, lonely texts and readings. […] the etymological meaning of ‘semeion’ is a distinctive mark, a trace, an engraved or written sign, that makes us think of the Freudian ‘psychical’ marks, called drives, rhythmical articulations of embodied impulses and psychical movements. In this sense, the can i buy levitra at walgreens meaning of the socio-historical aspect of intertextuality, as already developed by Bakhtin and Barthes, acquires a new significance. Within each sociolect or ideology, (both well-established sign-systems) there will always be a breach of subjectivity carrying out a hidden matrix of pre-symbolic forces able to make history move on through all its short and singular stories. (2002.

8-9)First, this means that I study Hyginus’ text not as a ‘lonely text’, but as part of a historical trajectory can i buy levitra at walgreens. The ‘singular stories’ are used to disturb the orderly (structural) notions of both textual and philosophical analysis.Second, I interpret Hyginus’ text—as well as other utilisations of the myth—with focus on traces. Or, more specifically, to find can i buy levitra at walgreens ‘distinctive marks’ relevant to the same material as in authotheretical work. €˜embodied impulses and psychical movements’. This, however, does not mean that the texts are reduced to a canvas for an engraved sign.

In methodological term, the aim is to allow the two destinies—the textual trajectory of can i buy levitra at walgreens the Cura motif, and the personal trajectory that becomes so intimate when I hold my son in my arms—to shed light on one another.Third, the interaction between these two methodological approaches will hopefully allow history—what Schillace calls the ‘human story’—to move in two diachronic ways. I aim to emphasise the differences between the different utilisations of the myth. Finally, I also aim to locate breaches in the ‘well-established sign systems’ we call theories of care, to get a glimpse of something yet hidden.Humanity as creation, care as fundamental conditionIn a narrative sense, Hyginus tells three stories. A story of the creation of humanity followed by a story can i buy levitra at walgreens of a quarrel between deities and finally, a verdict on the ontological role of care in human life. The first story in Hyginus’ fable begins thus:Cura cum quendam fluvium transiret, vidit cretosum lutum.

Sustulit cogitabunda et coepit fingere hominem.When Cura was crossing a certain river, she saw some clayey mud. She took it up thoughtfully and began to fashion a man.Before interpreting this first story, we must first acknowledge that the fable is an alteration or addition in a philological sense can i buy levitra at walgreens. While Fabulae is almost exclusively filled with Greek myths, the Cura fable’s position at the end of the collection suggests, ‘that this particularly Roman tale was simply added to the end of the existing narrative portion’ (Smith and Trzaskoma 2007, xlix). Moreover, philological research consistently argues that fable CCXX ‘hinges on Latin can i buy levitra at walgreens wordplay’ (Smith and Trzaskoma 2007, xlviii).More specifically, Hyginus, in the Cura fable, alters a prevailing myth in late antiquity, one that he has even told earlier in the pages of Fabulae. That of how the titan Prometheus fashioned man from clay.

In fable CXLII (‘Pandora’), Hyginus states explicitly that Prometheus lapeti filius primus homines ex luto finxit (Prometheus, son of Iapetus, first fashioned men from clay).Most Greek and Roman sources place the Prometheus plasticator motif within a three-stage narrative. First, Prometheus shapes the human from clay, and then Athena can i buy levitra at walgreens gives the creature inner life. Finally, sometimes after Prometheus has given humankind fire against the orders of Jove, Jove intervenes and sentences Prometheus to eternal punishment in the Caucasus.To understand the human story—to which both this motif and Hyginus’ text belong—comparison is needed. First, we must note that the neutral or slightly idyllic depictions in Hyginus and Ovid (respectively) differ from earlier and less optimistic renderings in Republican times. The poet Propertius, can i buy levitra at walgreens for instance, in his Libri Elegiarum from the first-century BC, laments and elaborates on how Prometheus was careless in his creating.

Here, the adverbial clause ille parum caute casts Prometheus as a figure of titanic heedlessness:ille parum caute pectoris egit opus.corpora disponens mentem non vidit in arto:The making of man’s reason he performed with too little care.Arranging our bodies, he overlooked the mind in his handiwork (Goold 1990, 232).Carelessness, the counterpart to the notion of care, is involved in the Prometheus plasticator motif throughout antiquity. The adverbial clause ille parum caute does not derive from the same verb as Cura, but rather from the verb caveo (to take precautions, to be aware of something). Nevertheless, Prometheus’ lack can i buy levitra at walgreens of care underlines how Hyginus’ text is an inversion these earlier texts. Instead of being created in a careless way, humanity is created by care.To be fair, a singular text never exhausts the potential of the history to which it belongs. Specific understandings—in this case can i buy levitra at walgreens.

Theoretical notions of care—are only a part of a wide array of potentials. The Prometheus Plasticator motif foreshadows 20th and 21st century theories of care, and 18th and 19th century depictions of Prometheus as a figure of romantic transgression. In Goethe’s poem Promethevs (written 1774, published 1789), Prometheus becomes a figure of independence and defiance—as expressed, for instance, in the final stanza:Hier sitz' ich, forme Menschen / Nach meinem Bilde, / Ein Geschlecht, das mir gleich sei, / Zu leiden, zu weinen, / can i buy levitra at walgreens Zu genießen und zu freuen sich, / Und dein nicht zu achten, / Wie ich!. (Goethe 1998, 44–46)Here sit I, forming mortals /In my image. / A race resembling me, / To suffer, to weep, / To enjoy, to be glad, / And thee to scorn, /As I!.

(Bowring 2015, 182)Typical of Goethe’s Sturm und Drang period, his Prometheus Plasticator is a figure can i buy levitra at walgreens of creativity, and embodies ‘ideals of freedom and rebellion’ (Raggio 1958, 44). Goethe’s poem emphasised the ‘autonomous existence’ of mankind (Dougherty 2006, 95), thereby constituting an ‘emancipatory gesture’ (Edgar 2002, 161). Hyginus’ text inverts both classical and romantic evokings of the myth by inserting dependency rather than autonomy and expansion. To shed further light on this inversion, we must first unpack the name of the personification that Hyginus instals in the can i buy levitra at walgreens Prometheus Plasticator motif. Cura.The name Cura is derived from the verb curo.

The Oxford Latin Dictionary defines the verb thus:To watch over, look after, care for.To tend to, to do what is necessary to.To administer remedies, to treat (a sick person, wound, disease, etc).To have charge of. (absol.) to be in command.To devote oneself to, to cultivate (a person).To undertake, to see to (a task or a responsibility).To regard with anxiety or interest, worry or care about, heed.As we can see, the first three can i buy levitra at walgreens senses of this verb invert the Prometheus motif we found in Propertius. To instal the personification of curo in the motif is to instal carefulness, attentiveness and responsibility in a motif usually filled with lack of care. The third sense also injects an can i buy levitra at walgreens aspect that is totally absent in classical anthropogenies. That of human frailty.

It also relates to aspects of human lives that are particularly relevant to understanding care, illness, disease and disability.The fifth and sixth senses of the word similarly invert the romantic depictions of Prometheus motif. The anthropogenic act is no longer about rebellion can i buy levitra at walgreens and expansion, but devotion and responsibility. The seventh sense finally reverses the political impulse of the Sturm und Drang—the desire for increased individual freedom and self-expansion in every imaginable way—into worrying and heeding.In addition to these intertextual relations, it is also fruitful to note the verbs that connect humanity to the three deities. While Cura’s creating is described with the verb fingo (in Hyginus. €˜fingere’), Jove’s and can i buy levitra at walgreens Tellus’ acts of giving are described by do (in Hyginus.

€˜dedisti’). While the former verb is a very tactile verb, a matter of touch and contact, do signifies separation—to deliver or give something, to separate it from something in order to unite it with something else. An initial understanding of care can i buy levitra at walgreens emerges from these textual relations. Care is fundamental (by belonging to the anthropogony), antithetical (by being the antithesis of carelessness and neglect) and intimate (by establishing relation through touch).Care imaginationsWhen modern scholars use Hyginus’ text, one word of the first sentence is often overlooked. Cogitabunda (thoughtful) can i buy levitra at walgreens.

Although an adjective in the purely grammatical sense, this is the only word with an adverbial function in Hyginus’ text. Hence, it is the lone term specifying how actions and interactions take place. While Greco-Roman deities often act from rage (as in can i buy levitra at walgreens the conflict between the titans and Olympian deities) or desire (as in the story of Zeus and Leda), Cura acts thoughtfully or with thought.As we can see, the adverb cogitabunda is attached to the picking up of the clay, not primarily to the act of creation. Sustulit cogitabunda et coepit fingere hominem. Moreover, the temporal clause ‘and begun to’ (et coepit) also locates this thought as prior to the creation of humanity.

To understand care as thoughtful, then, is about understanding thoughts and imaginaries ‘involved’ in care, and it includes thoughts and imaginaries that ‘pre-exist’, ‘frame’ or can i buy levitra at walgreens ‘underpin’ care and care work.It is useful to explore how the meaning of cogitabunda is preserved and unveiled in the work of the German philosopher, poet and literary critic Johann Gottfried Herder (1744–1803). In his poem ‘Das Kind der Sorge’ (1787), Herder follows Hyginus very closely (Bernays 1869, 158-163). This poem was widely read, and it provided the basis for Goethe’s use of the Cura motif in Faust II (1832). Finally, Heidegger also comments on the poem and cites it in extenso when he develops his notion of Sorge as the fundamental human condition (Dye 2009, 207–218)., Kristeva (2001), too, refers several times to Herder, and can i buy levitra at walgreens even refers directly to this poem (25–26). The first stanza describes the moment of creation thus:Einst saß am murmelnden StromeDie Sorge nieder und sann:Da bildet im Traum der GedankenIhr Finger ein leimernes Bild (von Herder 1889, 75).Once by a murmuring riverSorrow sat down, and there,In a vision, thought to form with the touchA wavering figure (Groth 2016, 31).von Herder positions the moment of creation as a radically imaginative act in at least three ways.

First, the gaze is far more manifest in von Herder’s text than in Hyginus’ can i buy levitra at walgreens. While Hyginus’ Cura shapes a human (hominen) directly, von Herder’s ‘Sorge’ shapes an image (Bild). This dovetails well with important insights from care research. In relations of care, the cared-for becomes visible to the carer(s), can i buy levitra at walgreens thereby also becoming a valued imago. Conversely, the carer(s) become visible in the imagination of the cared-for—even in a Western culture that often obscures or silences interpersonal interdependence.Second, cogitabunda in Hyginus is also intertextually connected von Herder’s adverbial clause im Traum der Gedanken.

This phrase, roughly translatable as ‘in the dream of thoughts’, roots humanity in a singular image (or dream) that consist of or belong to several different thoughts or ways of thinking. This tension between individuality and multitude can i buy levitra at walgreens dovetails with research on the knowledge complexities involved in care.Third, the word ‘Traum’ (dream) in Traum der Gedanken does not denote unreality, fantasy or illusion. For von Herder, dreams are not the opposite of reality, but thoughts beyond or above manifest reality (Wirklichkeit überhöhenden Gedankens). A dream of thoughts, then, is an experience or interpretation wherein the understanding of a phenomenon moves beyond how the phenomenon presently is, to what it should or could be. Just as Hyginus’ cogitabunda can, if we can i buy levitra at walgreens interpret in intertextual connection with von Herder’s Traum der Gedanken, also refract my experiences of holding my son in my arms.

This is true of the experiences of performing actions that seem strange or unintelligible to those around us, but particularly true of the feeling of doing this in a way that is uniquely ours. The combination of these feelings—where the socially estranged ways of caring is fundamentally ours and can i buy levitra at walgreens integral to my parenting—engenders or entails a striving ‘upwards’. This striving is not limited to the idealisation that so often takes place in parenting, but is also a utopian, imaginative glimpse of a world wherein the both of us truly belong.In other words, the Cura motif foreshadows the ‘horizontal’ complexities involved in care (multiple cultural imaginaries, multiple forms of knowledge). It also foreshadows ‘vertical’ complexities, through which care imaginations include both underlying categories and überhöhende dimensions. These overarching or utopical dimensions, that both stem from and go beyond the localised, singular imaginations of care, is known by many names in and beyond the can i buy levitra at walgreens medical humanities.

Examples include ’underlying values’, ‘ethical content of particular practices’, ‘transformative learning’ and many others (Ayala 2019, 269. Pettersen 2008, 188. Winthrop 2003).Cogitabunda, can mean to be thoughtful and to can i buy levitra at walgreens be ‘full of thoughts’. The adverbial clause im Traum der Gedanken by von Herder (1888, 533), similarly, also signifies something unclear or disorganised. In his poetotological treatise Über Bild, Dictung und Fabel (1888, 533), von Herder juxtaposes this state with being in Leidenschaft (in passion), in Verrückung (in madness) or nicht auf seiner Hut (off guard).

There is complexity and openness—perhaps even fantasy or at can i buy levitra at walgreens least exploration—in this. When I hold my son in my arms connecting different realms of thought. As in ruff-and-tumble-play, these realms are also at can i buy levitra at walgreens play as I think.The quarrel of the deities. Culture, nature and careAfter the first narrative, the second deals with a quarrel between the deities Cura, Jove and Tellus. Once humanity has been given inner life, the focus in Hyginus’ texts shifts from creating to name-giving:Cum vellet Cura nomen suum imponere, Iovis prohibuit suumque nomen ei dandum esse dixit.

Dum de nomine Cura et lovis disceptarent, surrexit et Tellus suumque nomen ei imponi debere dicebat, quandoquidem corpus suum praebuisset.When Cura wanted can i buy levitra at walgreens to give it her name, Jove forbade, and said that his name should be given it. But while they were disputing about the name, Tellus arose and said that it should have her name, since she had given her own body.To name something after something else (and, perhaps particularly, after someone else) places the object within a certain taxonomy. Major deities such as Jove and Tellus are both rulers and personifications of different ontological realms or ‘elements’. Hyginus’ Cura is not known from other Roman sources can i buy levitra at walgreens. Instead, Cura is a ‘deification of abstract ideas’, a common feature of Roman culture (Axtell 1907).

Hence, it becomes clear that the quarrel deals with ontological ideas, more specifically with the ontology of humanity. Each deity proposes a ‘location’ can i buy levitra at walgreens in classical ontology.The philosopher John T. Hamilton has used the myth of Cura to explore how any understanding of security presupposes both care and carefulness. He underlines how this ‘locating’ somehow names humanity after something that is neither identical can i buy levitra at walgreens nor particularly resembling humanity:The controversy over the creature’s name strives to resolve the issue of the figure’s proper being, without the aid of physical resemblance, without the talent for self-reflection. In my view, the debate over the name revolves on whether humanity is essentially atemporal (Telluric matter or Iovian spirit) or instead fundamentally temporal and constituted by time and history (Hamilton 2013, 71).It is worth noting that the deities are not offering or suggesting certain framings of human life.

Hyginus’ text—in particular, the fact that Jove forbade any name other than his own—indicates conflicts between perspectives and disciplines. The imaginative richness involved in care, indicated by Hyginus can i buy levitra at walgreens cogitabunda or by the plural in von Herder’s Traum der Gedanken, is a plurality where incommensurabilities remain. In my view, the myth of Cura points towards three possible but incommensurable ways of studying, describing and interpreting care (corresponding to Jove, Tellus and Cura, respectively):As a cultural or semantic phenomenon, elucidated in terms of meaning or more or less idealised notions.As a biological phenomenon, elucidated in medical, psychological or other health-related terms.As a relational phenomenon, elucidated in terms of care work (professional or not).Although it is necessary to understand care in all these ways, it is nevertheless impossible to fully merge them or produce those understandings simultaneously. Hence, it is necessary to add a more epistemologically oriented aspect of care. Care is fundamentally imaginative and context-dependent, can i buy levitra at walgreens and stands in-between otherwise incommensurable interpretative domains.Saturn’s verdict.

The continuous presence of careIn the third narrative in Hyginus, the quarrel is somehow resolved when the deities choose Saturn as their judge. Sadly, this part of the text is fragmented. There is agreement, however, that Saturn’s verdict clarifies that Jove will receive human souls, while Tellus will receive the body can i buy levitra at walgreens post mortem:Tu Iovis quoniam spiritum dedisti, <…>. Corpus recipito. Cura quoniam prima eum finxit, quamdiu vixerit, cura eum can i buy levitra at walgreens possideat.

Sed quoniam de nomine eius controversia est, homo vocetur quoniam ex humo videtur esse factusJove, since you gave him spirit, let [Tellus] receive his body. Since Cura fashioned him from the start, let Cura possess him for as long as he lives. But since there is controversy about his name, let him be called homo, since he seems to be made from humus.Let us begin by pointing out that can i buy levitra at walgreens Saturn’s verdict exposes yet another way in which Hyginus’ text alters the Prometheus plasticator motif. In most classical renderings, Prometheus is a trickster, and a transgressor from whom humanity is eventually separated. After discovering his transgressions, the Olympian deities chain Prometheus to a mountain in the Caucasus, and humanity lives on without him.

The relation between humanity and its can i buy levitra at walgreens creator is therefore temporary. Hyginus, in contrast, makes it clear that humanity will remain under the guardianship of Cura quamdiu vixerit ‘for as long as he shall live’.The significance of this difference becomes clearer if we compare Hyginus’ text to Ovid’s use of the Prometheus plasticator motif in Metamorphoses. After describing the original moment when Prometheus created Humanity, Ovid goes on to describe the human condition:quam satus Iapeto mixtam pluvialibus undis / finxit in effigiem moderantum cuncta deorum, / pronaque cum spectent animalia cetera terram, / os homini sublime dedit caelumque videre(Ovid 1997, 47)so that his new creation, upright man, / was made in image of commanding gods?. / can i buy levitra at walgreens On earth the brute creation bends its gaze, / but man was given a lofty countenance / and was commanded to behold the skies. / and with an upright face may view the stars (Melville and Kenney 2009, 76).As we can see, Ovid’s Prometheus creates a strong and vital human being.

Humanity seems not dependent on care or assistance, but ‘made in image of commanding gods’. In Ovid, human can i buy levitra at walgreens life is essentially an independent life which resembles the lives of gods (in effigiem moderantum cuncta deorum). It is common—and tempting—to imagine care relations as exceptions in human lives. In care research, for instance, one often reserves care needs for vulnerable groups, thereby contrasting them with can i buy levitra at walgreens some kind of original, non-vulnerable state. In life-course research, similarly, care leaves life as people move into adolescence and adulthood, only to re-enter it in the special cases of disability, serious illness or old age.

Hyginus’ text, in contrast, opens up for a rethinking of care as a fundamental, continuous part of human lives.This is essentially an ontological argument. Although we often reserve the term for human beings who have unusual needs—for instance, children or people with disabilities—care is, in fact, much more pervasive.Noting the etymology of the verb curo—denoting what we call caring and worrying—Hyginus’ text also points towards an understanding of care can i buy levitra at walgreens as protection. The notion of care becomes meaningful in and of itself, and in relation to its counterparts, such as conflict, violence and neglect. If the so-called ‘normal’ human life—in Ovid’s words. Lives lived ‘in the image of commanding gods’—is met by a radical lack of care, it would have little freedom and in fact be over in a matter of days.Hyginus’ text points towards an understanding can i buy levitra at walgreens wherein care reigns, organises or facilitates human lives.

Cura somehow ‘holds’ humanity in this life, indicating that Jove’s and Tellus’ receiving somehow lies outside that life (after death). For the medical humanities, this understanding of care suggests ways to think about both medical and cultural knowledge as forms of afterlife. Biological knowledge, for instance, is a form of knowledge that has been aggregated outside and beyond can i buy levitra at walgreens individual lives. Through clinical generalisations, anatomical knowledge, systematic literature reviews and more. Cultural knowledge, conversely, is can i buy levitra at walgreens deeply historical and contextual—thereby inevitably also a testament to how both historical and contextual relations stretch far beyond individual lives.These ambiguities lead to a further understanding of care.

Care is not only a fundamental precondition—whose impact depends on context and interpretation—care is indeed a fundamental and omnipresent condition, that continuously engenders and relies on interpretative processes.Care as holding-togetherWhen I hold my son I ruff-and-tumble play, I am also holding together forms of knowledge. I connect many different forms of knowledge—my intimate experiences with him, my research experience from disability studies, the bits of knowledge I have received from medical and educational professionals and many others—with one another. Moreover, the knowledge I produce—from the actual holding, from being skin to skin and from sensing if he cannot understand others—is used in knowledge translation can i buy levitra at walgreens. I use it to stretch the understandings of medical professionals beyond uncertain prognoses. I also use it to connect the knowledge of the preschool teachers—a knowledge which mainly deals with so-called ordinary children—with the lives of extraordinary children such as my son.In Hyginus’ text, too, Cura holds together what otherwise would have been separate.

Had it not been for Cura’s can i buy levitra at walgreens holding, and Saturn’s verdict, humanity would have belonged to either Jove or Tellus. A recent ‘appeal to the medical humanities’ uses the potential of this narrative. In it, Kristeva et al. (2018) use the myth of Cura to explore how humanity ‘belongs to different ontological domains’ held together by care:Saturn, the God of time, settles the matter through an act of naming and by dividing and temporalising the possession of the various parts that can i buy levitra at walgreens comprise man. Jove is offered man’s soul and Tellus his body, after man’s death, while Cura will possess the creation in its lifetime since she made it.

[…] Thus, human life as a composite assembly of spiritual (Jove) and material elements (Tellus) is held together can i buy levitra at walgreens by Cura’s temporal care (55).In their unpacking, Cura’s holding of humanity becomes a holding-together of two forms of knowledge. Biomedical knowledge of bios and sociocultural knowledge of zoe. Faced with situations of care—situations that neither biomedical science nor cultural studies of health can understand sufficiently—the understanding of care becomes a point of intersection between otherwise separate landscapes.This holding-together is visible in a variety of care practices. In the case of evidence-based care, for instance, temporal doing at a certain point can i buy levitra at walgreens in time and history (professional work) holds together atemporal knowledge of effects (evidence) and atemporal norms (professional ethics). The temporal care work may seem like a mere ‘application’ of these atemporal knowledges.

However, recent studies argue that both evidence and norms exist as such if and only if they are interwoven with embodied practices. While ‘evidence in clinical decision making is relentlessly situated and contextual’ (Wieringa et can i buy levitra at walgreens al. 2017, 964), so can the normative aspects only be sufficiently understood as ‘embodied process’, located at ‘the action level’ (Doane and Varcoe 2008).Jove, Tellus and Cura personify ontological orders (ways of being), and epistemological orders (ways of knowing). If we then revisit the epistemological aspect of care, a further understanding emerges. Care is a relational matter—in the lived lives can i buy levitra at walgreens of care receivers, as well as in the work of care professionals—and it is crucial in holding together different social agents and different knowledge domains.Care as withholdingWhen I ‘play airplane’ with my son—or hold him close to me in situations where others do not understand him or vice versa—one might say that I know what I am doing.

On the other hand, this holding challenges several parts of my knowledge of this world. It challenges my images of what it is to be a father, since the play can i buy levitra at walgreens differs from how most fathers do this with their children. More importantly, perhaps, the knowledge produced when I hold my son in my arms in the face of many, many abysses to come differs from much of my academic and medical knowledge, including that which is inherent in his diagnoses and prognoses.This withholding might seem, contrary to the straightforward clarity of Hyginus’ text. However, a more detailed examination can refract these interpretations. It is particularly worth can i buy levitra at walgreens noting that the relation between Cura and the human being—that is, the fundamental ontological condition in this life—is described with a specific verbal clause with the verb possideo.

Cura eum possideat (Cura shall hold him).The Oxford Latin Dictionary defines possideo thusly:To have (land) in one’s control, occupy (as a tenant, etc). (absol.) to hold land.(in general) to hold as property, b. To take (property) into one’s keeping, appropriate.(of a sovereign, army, etc) to have control of (a country, position, etc) […] to assume or exercise control over (persons).To take or have in its power, dominate, overwhelm, possess.To fill can i buy levitra at walgreens or take up (a space) with one’s bulk.To take up wholly (a person’s time). To absorb the thoughts and energies of someone.Possideo denotes not a general sense of holding, or a more general sense of contact or connection, but an exclusive holding—similar to the English verb to possess. Cura, then, is not only holding a humanity that belongs to both Jove and Tellus, but she is also withholding this humanity from them.

This becomes even clearer if we emphasise can i buy levitra at walgreens that possideo is a transitive verb. At least to some extent, the clauses quamdiu vixerit, Cura eum possideat entail a micro-narrative. Although ‘created from,’ or consisting of biological matter, and being characterised by the presence of ‘soul’ or some measure of cognition, humanity is fundamentally can i buy levitra at walgreens ‘controlled’ by care in this life. The separating into meaning (spirit) and biology (bodily remains) takes place outside this life. Cura’s holding, then, allows us to understand the holding-together of medicine and culture, and a withholding from both these domains.The ‘hermeneutic story’ (Kristeva 2002, 10) of Hyginus’ possideat—wherein care holds humanity at the expense of both culture and biomedicine—contradicts epistemological optimism.

Hyginus text allows us to glimpse intimate care knowledge that connects can i buy levitra at walgreens cultural and biomedical knowledge, and that holds human life away from generalised knowledge. When Cura withholds humanity from generalised cultural knowledge (Jove) and generalised biochemical knowledge (Tellus) and care produces knowing—often described as insight, sharing and holding-together—and un-knowing.These difficulties indicate the need for an additional understanding of care. Care must be understood as a practice that holds together multiple parties and multiple forms of knowledge. However, it must also be understood as a practice—or if you will can i buy levitra at walgreens. A form of human relation—that withholds something from knowledge.I shall hold him for as long as I shall liveThe ‘human story’ of care relations (eum possideat) will necessarily entail a human story of singular actions that to some extent can only be described in first-person singular.

Eum possideam (I shall hold him). To explore this individual eum possideam, I can i buy levitra at walgreens try to ‘theorise from my subject position’ (Fournier 2019, 658). When activating my own intimate experiences, it became clear that interpretations of my eum possideam quamdiu vixerit can refract—or even fracture—theoretical notions of care.To connect intimate experiences of holding—be it in bodily care, in adverse social situations or in rough-and-tumble play—with cultural and political theory is clearly a daunting task. Although this still seems unclear to me, can i buy levitra at walgreens I can at least outline four aspects of the refraction. First, I do hold together cultural and biomedical knowledge.

When my son is in my arms, multiple cultural imaginaries are involved. My understanding of his life (and of mine) is dependent can i buy levitra at walgreens on my language and my cultural frames, and I am consistently aware of a clinical gaze. My son’s life—and, thereby, also my own life and my care work—are viewed or observed by medical professionals, psychologists, special needs educators and preschool teachers.Second, the holding is troublesome. In a narrower sense, I note that his needs lead me to hold and even carry him in ways that most parents only do with substantially younger children. Combined with my own embodied condition, there emerges a bodily trouble, an element of can i buy levitra at walgreens exhaustion, uncertain walking and muscular pain.

Regarding my cultural knowledge, it becomes clear that my own imaginaries entail expectations and understandings that somehow seem incompatible with his life. In this social context—parenting in Norway, located in middle-class families—childhood is simultaneously about ‘findings one’s own voice’ (autonomy) and about ‘following the path’ (social reproduction). To claim that autonomy outside language is possible, or that a person in his situation may reproduce his parents, seems equally futile.Regarding biomedical knowledge, I take care of my 4-year-old (as can i buy levitra at walgreens I do all three of my children) within a biomedical framework. Most Norwegian children are screened regularly for somatic problems, and to measure linguistic, cognitive and psychosocial development. While this knowledge has thus far granted me a certain comfort in parenting my two oldest children—confirming, as it were, that all is well—that has, obviously, can i buy levitra at walgreens not been the case with my youngest son.

Hence, his life is also framed by medical knowledge in a more direct way. He receives a range of health-related services, a provision that also positions my parental care within the same frame.Third, there is an uncertain future involved in this. This is of course always true of any can i buy levitra at walgreens intersubjective relation in general and of care relations in particular. The future is open, and it can entail painful events. However, his situation exposes uncertainty in a more radical way.

Culturally, it exposes how I see my other children—as having quite stable chances can i buy levitra at walgreens for social reproduction—partly thanks to how I see him. Through a fatherly lens of rather unclear hopes and worries. Medically, the tests of my youngest son continuously yield inconclusive results. This has replaced my former sense can i buy levitra at walgreens of parental comfort with gnawing anxiety over his future. Moreover, the complexities of his living leaves me, as a caregiver, with the unpredictability of his diagnostic results, rather than with stable prognoses.Fourth, these intimate situations entail a particular life-course temporality, which differs from the temporality of professional care, as well from the temporality in Hyginus’ text.

In the case of professional careers, their work is regulated to certain hours (of paid work), and to certain phases of life. Most professional carers will retire, and many will pursue other forms of work at some point in can i buy levitra at walgreens time. In Cura’s case, her care work is also time limited. The temporality of the deity’s existence is sufficient to can i buy levitra at walgreens encompass the temporality of humanity. In both cases, the life course temporality of the carer is sufficient for the imagined care work.In my parental care work, however, the temporality is insufficient rather than sufficient.

In all likelihood, I will somehow care for my son for as long as I am alive. Moreover, this lifelong work will likely be insufficient in at can i buy levitra at walgreens least two ways related to the temporality of my life. My own ageing will likely reduce my ability to perform the care work, and I will likely die before my son, leaving him without parental care. Hence, the temporality of my care cannot be formulated as eum possideam quamdiu vixerit (I shall hold him for as long as he shall live), but as eum possideam quamdiu vixero (I shall hold him for as long as I shall live).This rudimentary autotheoretical investigation brings to light three forms of withholding. First, the nature of the holding (eum possideam) withholds care from the epistemological domains can i buy levitra at walgreens that the medical humanities traditionally investigate.

Second, the temporality involved in parental care (quamdiu vixero) withholds something from the temporality of professional care. Third, something is also withheld from the ‘parental temporality.’. The need care depends on his life (quamidiu can i buy levitra at walgreens vixerit), not on mine. Several forms of knowledge, and several forms of embodied holding, are involved without being fully commensurable. Since I cannot resolve these enigmatic forms of withholding, the can i buy levitra at walgreens theoretical understandings remain breached, implicitly pointing towards not-yet-explicable or not-yet-nameable understandings.Withholding and ambiguityMy holding of my son in my arms come with several temptations.

One of them—in particular, as I am holding him, or, perhaps, shielding him—is to think that I hold some kind of vast, privileged knowledge. While this is of course true to some extent, there are more powerful movements at play. On the one hand, the complexities in the situation forces me out of the can i buy levitra at walgreens internal comfort that characterises the centre of any ontological or epistemological ‘domain’. On the other hand, I am also forced to admit another thing. That I can hold him, but it remains unclear—to some extent—if I can know him.

I cannot know if our way is exclusively ours.Similarly, intertextual analysis locates breaches in specific ‘sign-systems’, and in larger can i buy levitra at walgreens ‘social and historical material’ (Kristeva 2002, 9–10). Hence, the specific inquiries presented in this article relate to more general ways of inquiry. When we use those notions, we connect different academic investigations, and different academic disciplines, theoretical traditions and research methodologies. In Julia Kristeva’s words, these relations are ‘temporal connections’ and ‘points can i buy levitra at walgreens of contact‘ (2002:8) and points of ‘distortion, ambiguity and contradiction’ (2002:11).The understanding of care as holding-together connects very well with the rise in interdisciplinarity within the medical humanities. The three deities Jove, Tellus and Cura are brought together in dispute, and Saturn’s verdict foreshadows how different ontological domains are held together in human life.Studying an interaction between form of knowledge—in their case.

The interaction between medical imagining and patient creativity—Stahl and Stahl use the insufficiencies of medical knowledge in an argument for multiple perspectives:Although in contemporary Western society, many tend to believe the hard science provide the truest or most accurate interpretation of the natural can i buy levitra at walgreens world, it cannot exhaust the meaning of the body. If we believe we are more than the sum of our parts, then we ought to allow for multiple and even varied interpretations of our bodies (Stahl and Stahl 2016, 159).Interpreting care as connectedness and holding-together, medical humanities scholars aim to hold together medical and cultural knowledge in new, explorative and enriching ways, and they often succeed.Such interpretations also speak to an even more radical ambition, that of academic convergence, sometimes referred to as transdisciplinary research. Such appeals are often embedded in a considerable epistemological ambition. Pointing out the insufficiencies of ‘illustrative’ or ‘additive’ work in the can i buy levitra at walgreens medical humanities, Kristeva et al. (2018) express a particularly radical version of this ambition:[W]e do not consider the humanities as a critical and potentially liberating perspective that can be applied to medicine as an object in need of repairment.

Medical humanities should not be construed as a humanistic perspective on medicine. They should rather be seen as a cross-disciplinary and cross-cultural space for a bidirectional critical interrogation of both biomedicine (simplistic reductions of life to biology) and the humanities can i buy levitra at walgreens (simplistic reductions of suffering and health injustice to cultural relativism). On the one hand, this implies breaking with the culture–nature dichotomy and considering both the humanities and medicine as biocultural practices. On the other hand, it also implies understanding that boundary work requires boundaries, and that incommensurability between various partial disciplinary perspectives can—and will—emerge (56).The ambition at stake here listens to the holding-together outlined above. Whereas more ‘additive’ ways of connecting knowledge are can i buy levitra at walgreens valuable—for instance, when humanities-based research ‘fill the gaps’ of ‘pure’ medical research in order to facilitate evidence-based care—this is not what Hyginus’ text indicates.

Just as the relation between Jove and Tellus is symmetric and mutual (they are equally necessary for the creation of humanity and will ‘hold’ remain with equal sovereignty after this life), so is the relation between Cura and the two other deities. Jove and Tellus are separated from humanity in this life, and can i buy levitra at walgreens Cura is equally separated from humanity after this life. This fable cannot be intertextually connected with asymmetrical or additive relations between knowledge fields, but it is connected with a ‘space for bidirectional critical interrogation’.It is perhaps less clear how care as un-knowing speaks to larger trends in the medical humanities. It is therefore necessary to ask. How can understandings of care that emphasise withholding and un-knowing, including autotheoretical investigations that increase uncertainty, ambiguity and painful affects, can i buy levitra at walgreens inform knowledge production?.

To outline a provisional response to this question, it is useful to return to Hyginus’ text once again. The description of Cura’s relation to humanity—Cura quoniam prima eum finxit, quamdiu vixerit, cura eum possideat (Since Cura fashioned him from the start, let Cura hold him for as long as he shall live)—should also be read with attention to grammar. While the conjunction quoniam (since) introduces a causal clause in the indicative mood (finxit), followed by an adverbial clause in the indicative (vixerit), the resulting clause can i buy levitra at walgreens is in the subjunctive (possideat). Interestingly, this subjunctive inflection is the only use of the subjunctive mood in Hyginus’ text.This use of the subjunctive mood—sometimes called ‘independent’ usage—can have a variety of purposes. Although the usage in fable CCXX is iussive—in the sense that makes a permanent judgement—it is worth noting that the subjunctive mood is often associated with potentiality in classical Latin.

Other common areas of usage include ‘questions in which the speaker or writer expresses doubt or disbelief by “thinking aloud” (deliberative), wishes that cannot or may not be fulfilled can i buy levitra at walgreens (optative), and the potentiality that something may happen or might have happened (potential)’ (Palma 2012, 377). Moreover, it is worth noting that possideat is in present tense. Since the subjunctive mood lacks a future tense in Latin, the can i buy levitra at walgreens active present tense can also denote future actions. Hyginus’ text, then, points towards knowing and un-knowing, and towards openness to potentiality and some degree of uncertainty.When held together, withholding and uncertainty give a clear implication for the medical humanities as a form of academic practice. The epistemological ambitiousness in medical humanities should be supplemented with what one might call epistemological modesty.

Such modesty is rooted in the can i buy levitra at walgreens specifics of care, and in the relation between complexity and synthesis. What is at stake in care research—if we take the abovementioned complexities into account—is a ‘bidirectional space’, and an ever-expanding and exponentially multidimensional space. When medical humanities emerged, it was only a question of time before the field began to involve other humanities and social sciences disciplines than those involved in the initial phase. Similarly, the growth of critical medical humanities steadily increases the engagements with can i buy levitra at walgreens all kinds of critical research frontiers, in the social sciences as well as in the humanities. At least in an area such as studies of care—where the intimacy is so acutely palpable—it will become increasingly clear that the medical humanities will remain ‘outnumbered’ or ‘overpowered’ by the analytical complexities the field itself brings forth.Some scholars in the critical humanities have argued that scholars should ‘embrace’ this kind of overpowering (Viney, Callard, and Woods 2015, 2–7).

However, Hyginus’ text complicates the relation between care practices (Cura), culture (Jove) and biomedicine (Tellus) regardless of such embraces. Although care can i buy levitra at walgreens holds humanity at the expense of the other forms of knowing, his holding neither implies any disregard for humanities-based nor medical knowledge. Rather, the unpacking presented in this article demonstrates how care brings forth an epistemological modesty. Only an epistemologically modest way of can i buy levitra at walgreens doing medical humanities can address the intimate and enigmatic qualities of care.Discussion. Scholarly and analytical contributionWhile the textual and autotheoretical analyses presented in this paper followed the suggestion from Kristeva et al—to we question ‘the cultural distinction between the objectivity of (medical) science and the subjectivity of culture’ (2018:55)—it nevertheless ended in an emphasis on intimate withholding.

This withholding—be it epistemological, theoretical or inherent in the intimate experience of holding or embracing my son away from an abyss—is relevant to the medical humanities in general. However, it is also a contribution to four more specific tendencies in the available literature.First, the unpacking contributes can i buy levitra at walgreens to feminist care research. Beginning with the canonical work on ‘a different voice’ by Gilligan (1982), feminist care research has increasingly emphasised the knowledge multitude involved in care. More recent research also shows a multitude of empirical delineations. While some scholars reserve the term for face-to-face can i buy levitra at walgreens interaction, or for situations characterised by asymmetrical dependency, others do not.

The investigation in this article brings forth additional multitude by combining academic disciplines that rarely interact—care research, linguistic analysis of Latin texts, romanticism studies and autotheoretical analysis work—and implies many possibilities for further research.Second, the autotheoretical interpretations can contribute to the research field sometimes known as ethics of care. Following such works as the book Learning from my Daughter by Kittay Kittay (2019, xx), where she proposes that the relation of parental care provides ‘the only universal and morally significant property that all humans possess’, I aim to shed light on how care work engenders ethical thinking. My holding of my son in my arms—as well as the withholding that both this holding and Hyginus’ text entail—is as political and ethical as it is personal and can i buy levitra at walgreens embodied.Third, this paper also relates to a more critical strain of ethics of care. Pettersen (2008) work, for instance, demonstrates how the ethics of care ’subverts the public/private dimension altogether’, thereby allowing for a broader range of criticism (45). Moreover, Fletcher and Piemonte (2017) shed light on how can i buy levitra at walgreens healthcare practices constitute a ’quiet subversion’ of neoliberal cultural structures.

Arguably, both intimate withholding and epistemological overwhelming shows the power involved in such subversions.Fourth, I hope to contribute to the strand of research—in care research as well as in disability studies—that relate to the work of Julia Kristeva. On the one hand, the rethinking presented in this paper dovetails with her perspectives on how intimate aspects of care destabilise the larger frameworks, cultural structures that are nevertheless sustained by those actions of care. The autotheoretical exploration towards the emblematic formulation eum can i buy levitra at walgreens possideam quamdiu vixero (I shall hold him for as long as I shall live) might also respond fruitfully to Kristeva’s account of how her “living with […] the neurological difficulties of my son David” (2013, 220) lead her to explore maternity as I want that you be (2013, 229). On the other hand, I also try to challenge what I see as an epistemological and political optimism in Kristeva’s work.Data availability statementNo data are available. Since this is an autoethnographic investigation, primary data will not be available.Ethics statementsPatient consent for publicationNot required.Ethics approvalThe ethical aspects have been reviewed by the research management at the Work Research Institute.

See also footnote 1.AcknowledgmentsI would like to thank Eivind Engebretsen can i buy levitra at walgreens and John Ødemark for their encouragements, and the anonymous reviewers for their helpful suggestions.Notes1. Patient and public involvement statement. Although there is no public involvement in the writing of this paper, the autotheoretical approach does of course involve my son. This approach hinders full anonymisation, just like his way of living in this world hinders informed consent in can i buy levitra at walgreens the traditional sense. The approach also excludes the potential for full anonymisation.

The consent is therefore, in consultation with his mother, given by me as his legal guardian..

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Also, they levitra other uses aren't wireless, which severely limits mobility. Patients can't go about their normal daily routines if they're tethered to bulky external devices.The biosymbiotic device that Gutruf's team has introduced uses no adhesive, and it receives its power from a wireless system with a range of several meters. The device also includes a small energy storage unit, so that it will function even if the wearer goes out of the system's range, including out of the house."These devices are designed to require no interaction with the wearer," Gutruf said.

"It's as levitra other uses simple as putting the device on. Then you forget about it, and it does its job."This research was funded by the Flinn Foundation Translational Bioscience Seed Grants Pilot Program. The team has also been working with Tech Launch Arizona, levitra other uses the commercialization arm of the university, to protect the intellectual property and launch a startup to bring the technology to market.Video of new wearable sensor.

Https://www.youtube.com/watch?. V=MhSeWGbuVTUAs the popularity of fitness trackers levitra other uses has increased, so have the opportunities to use such devices to not only track fitness goals but also increase the motivation to meet those goals. Researchers in the College of Engineering and the College of Health and Human Development at Penn State have teamed up to use control systems engineering tools to tailor motivational messages sent to individual device users.The results of their study were published today (Oct.

7) in Health Psychology."One of the really exciting advances of the last 15 years has been the advent of wearable and portable consumer technology that can be used to help promote physical activity," said David Conroy, professor of kinesiology and human development and family studies, and co-principal investigator on the paper levitra other uses. "You can get real-time feedback from these devices and monitor your goals, and you can even push people messages, depending on what their goals are and what their behavior is. We know that those messages work well for improving behavior on average.

But nobody is average, and we don't know how to make sure each individual consistently gets the greatest benefit from a limited number of messages."Conroy said levitra other uses that researchers have tried several strategies, including messages that are specific to certain population segments. Messages based on recent behavior -- for example, sending one of two different messages depending on if a user did or did not meet their goals the previous day. And customizing the messages levitra other uses by putting in a person's name or something they might like.

So far, none of these approaches has proven to be consistently effective in improving the messages' effects.The new messaging approach developed by Conroy and Constantino Lagoa, co-principal investigator and professor of electrical engineering, applies tools used regularly in controlled systems engineering to behavior science."Essentially, we're using the same mathematical tools that people in control engineering usually use to model behaviors as differential equations," Lagoa said. "We're using those models to design feedback controllers that take into account the current state of the person and together with the model decide what is the best time to send the messages."Conroy emphasized that establishing the correct dosing -- meaning the type of message and its timing, frequency and context -- is a critical part to this approach. advertisement "We're really prioritizing understanding the dosing so that we only send the right message at the right time and in the right context so people get the benefits that they're looking for," he levitra other uses said.

"We don't want to disrupt them without them getting the payoff that they're looking for."The researchers refer to this individualized approach as precision behavioral medicine."This is one of the first studies that was able to leverage data collected from each individual and zoom in on his or her personal response," Lagoa said.One of the main examples of how the researchers personalized the messages was by considering the weather in the area of the user, noting that certain messages were more effective for certain individuals on rainy days, hot days and so on.The researchers acknowledged the potential concern people may have about trading privacy for personalization but said that the automation means that the data can be used and then discarded, as opposed to stored, and the location settings only need to be approximate to know the weather and customize the messaging appropriately. They also said, if their approach is commercialized, users would be able to adjust their settings to select how much information to share, and they plan on conducting more research before applying their approach to levitra other uses a larger population."We've established here is there's a new tool to use with an established problem," Conroy said. "Our next project will focus on establishing efficacy.

Does this work better than sending messages at random or levitra other uses not sending messages at all?. But once we establish efficacy, I would imagine that it'd be very attractive to device manufacturers to consider this kind of approach."Other authors of the paper include Sarah Hojjatinia, a former electrical engineering graduate student and currently at Advanced Safety &. User Experience.

Sahar Hojjatinia, an electrical engineering levitra other uses graduate student. And Deborah Brunke-Reese, research project manager for the Motivation Lab in the College of Health and Human Development.This research was funded by the National Institutes of Health (Grant R01 HL142732) and the National Science Foundation. Story Source levitra other uses.

Materials provided by Penn State. Original written by levitra other uses Sarah Small. Note.

Content may be edited for style and length.Our DNA is very similar to that of the chimpanzee, which in evolutionary terms is our closest living relative. Stem cell researchers at Lund University in Sweden have now found a previously overlooked part of our DNA, so-called non-coded DNA, that appears to contribute to a difference which, despite all our similarities, may levitra other uses explain why our brains work differently. The study is published in the journal Cell Stem Cell.The chimpanzee is our closest living relative in evolutionary terms and research suggests our kinship derives from a common ancestor.

About five to six million years ago, our evolutionary paths separated, leading to the chimpanzee of levitra other uses today, and Homo Sapiens, humankind in the 21st century.In a new study, stem cell researchers at Lund examined what it is in our DNA that makes human and chimpanzee brains different -- and they have found answers."Instead of studying living humans and chimpanzees, we used stem cells grown in a lab. The stem cells were reprogrammed from skin cells by our partners in Germany, the USA and Japan. Then we examined the stem cells that we levitra other uses had developed into brain cells," explains Johan Jakobsson, professor of neuroscience at Lund University, who led the study.Using the stem cells, the researchers specifically grew brain cells from humans and chimpanzees and compared the two cell types.

The researchers then found that humans and chimpanzees use a part of their DNA in different ways, which appears to play a considerable role in the development of our brains."The part of our DNA identified as different was unexpected. It was a so-called structural variant of DNA that were previously called "junk DNA," a long repetitive DNA string which has long been deemed to have no function. Previously, researchers have looked for answers in the part of the DNA where the protein-producing genes are -- which only makes up about two per cent of our entire DNA -- and examined the proteins themselves to find examples of differences."The new findings thus indicate that the differences appear to lie outside the protein-coding genes in levitra other uses what has been labelled as "junk DNA," which was thought to have no function and which constitutes the majority of our DNA.

advertisement "This suggests that the basis for the human brain's evolution are genetic mechanisms that are probably a lot more complex than previously thought, as it was supposed that the answer was in those two per cent of the genetic DNA. Our results indicate that what has been significant for the brain's development is instead levitra other uses perhaps hidden in the overlooked 98 per cent, which appears to be important. This is a surprising finding."The stem cell technique used by the researchers in Lund is revolutionary and has enabled this type of research.

The technique was recognised levitra other uses by the 2012 Nobel Prize in Physiology or Medicine. It was the Japanese researcher Shinya Yamanaka who discovered that specialised cells can be reprogrammed and developed into all types of body tissue. And in the Lund researchers' case, into brain cells.

Without this technique, it would not have been possible to study the differences between humans and chimpanzees using ethically defensible methods.Why did the researchers want to investigate the difference between levitra other uses humans and chimpanzees?. "I believe that the brain is the key to understanding what it is that makes humans human. How did it come about that levitra other uses humans can use their brain in such a way that they can build societies, educate their children and develop advanced technology?.

It is fascinating!. "Johan Jakobsson believes that in the future the new findings may also contribute to genetically-based answers to questions about psychiatric disorders, such as schizophrenia, a disorder that appears to be unique to humans."But there is a long way to go before we reach that point, as instead of levitra other uses carrying out further research on the two per cent of coded DNA, we may now be forced to delve deeper into all 100 per cent -- a considerably more complicated task for research," he concludes. Story Source.

Materials provided by Lund University. Note. Content may be edited for style and length.Adolescents who had received a mental health disorder diagnosis were often excluded from the labour market and education as young adults.

This particularly applied to adolescents who had been diagnosed with an autism spectrum disorder or psychosis. The results were found out in a birth cohort study of people born in Finland in 1987. The study was published on 6 October in British Journal of Psychiatry.Almost eleven percent of adolescents who had received a psychiatric diagnosis were excluded from education and labour market for at least five years in their early adulthood.

For other adolescents, this number was slightly under three percent. The results highlight the importance of the treatment and rehabilitation of people with mental health disorders in the prevention of adolescents' social exclusion. ""To help prevent the social exclusion of adolescents, their treatment and rehabilitation require more resources than are currently being used as well as development of evidence-based treatment and rehabilitation," says Adolescent Psychiatrist and Doctoral Candidate Ida Ringbom from the Research Centre for Child Psychiatry at the University of Turku.The results are concerning because they highlight the link between mental health disorders and long-term exclusion from education and labour market.

In the study, long-term exclusion was defined as a period spent outside education or paid employment lasting a minimum of five years. The link was particularly strong with those teenagers who had not completed their upper secondary education and who had been diagnosed with a mental health disorder. Almost half of these teenagers who had experienced psychosis and almost three quarters of teenagers who had been diagnosed with an autism spectrum disorder experienced long-term exclusion from education and labour market in their early adulthood."Vocational rehabilitation and tight collaboration between psychiatry and social services are important for enabling adolescents suffering from mental health problems to access the labour market," says Assistant Professor David Gyllenberg who led the study."Adolescents who have not completed their upper secondary education require more targeted support because their risk of becoming socially excluded is particularly high."The research was conducted at the Research Centre for Child Psychiatry as a part of the INVEST flagship programme for the study of inequality, interventions, and the welfare state.

A joint project of the University of Turku and Finnish Institute for Health and Welfare and funded by the Academy of Finland, INVEST focuses on reducing social inequality and reforming the welfare state. Finnish Institute for Health and Welfare is responsible for the national birth cohort of 1987. The research group included researchers from e.g.

The University of Turku, Finnish Institute for Health and Welfare, Helsinki University Hospital, and Itla Children's Foundation. Story Source. Materials provided by University of Turku.

Note. Content may be edited for style and length.Neuroscientists at Technische Universität Dresden discovered a novel, non-invasive imaging-based method to investigate the visual sensory thalamus, an important structure of the human brain and point of origin of visual difficulties in diseases such as dyslexia and glaucoma. The new method could provide an in-depth understanding of visual sensory processing in both health and disease in the near future.The visual sensory thalamus is a key region that connects the eyes with the cerebral cortex.

It contains two major compartments. Symptoms of many diseases are associated with alterations in this region. So far, it has been very difficult to assess these two compartments in living humans, because they are tiny and located very deep inside the brain.This difficulty of investigating the visual sensory thalamus in detail has hampered the understanding of the function of visual sensory processing tremendously in the past.

By coincidence, Christa Müller-Axt, Ph.D. Student in the lab of neuroscientist Prof. Katharina von Kriegstein at TU Dresden, discovered structures that she thought might resemble the two visual sensory thalamus compartments in neuroimaging data.

The neuroimaging data was unique because it had an unprecedented high spatial resolution obtained on a specialised magnetic resonance imaging (MRI) machine at the MPI-CBS in Leipzig, where the group was researching developmental dyslexia. She followed up this discovery in a series of novel experiments involving analysis of high spatial resolution in-vivo and post-mortem MRI data as well as post-mortem histology and was soon sure to have discovered the two major compartments of the visual sensory thalamus.The results showed that the two major compartments of the visual sensory thalamus are characterised by different amounts of brain white matter (myelin). This information can be detected in novel MRI data and thus, can be used to investigate the two compartments of the visual sensory thalamus in living humans."The finding that we can display visual sensory thalamus compartments in living humans is fantastic, as it will be a great tool for understanding visual sensory processing both in health and disease in the near future," claims first author Christa Müller-Axt and explains, "Post-mortem studies in developmental dyslexia have shown that there are alterations specifically in one of the two compartments of the visual sensory thalamus.

However, there are very few of these post-mortem studies, so it is difficult to say whether all dyslexics are characterised by these kind of visual sensory thalamus alterations. Also, post-mortem data cannot reveal anything about the functional impact of these alterations and their specific contribution to developmental dyslexia symptoms. Therefore, we expect that our novel in-vivo approach will be a great asset in facilitating research on the role of the visual sensory thalamus in developmental dyslexia." Story Source.

Materials provided by Technische Universität Dresden. Note. Content may be edited for style and length..

Wearable sensors to monitor can i buy levitra at walgreens everything from step count to heart rate are levitra best price nearly ubiquitous. But for scenarios such as measuring the onset of frailty in older adults, promptly diagnosing deadly diseases, testing the efficacy of new drugs or tracking the performance of professional athletes, medical-grade devices are needed.University of Arizona engineers have developed a type of wearable they call a "biosymbiotic device," which has several unprecedented benefits. Not only are the devices custom 3D-printed and based on body scans of wearers, but they can operate continuously using a combination of wireless can i buy levitra at walgreens power transfer and compact energy storage.

The team, led by Philipp Gutruf, assistant professor of biomedical engineering and Craig M. Berge Faculty can i buy levitra at walgreens Fellow in the College of Engineering, published its findings today in the journal Science Advances."There's nothing like this out there," said Gutruf, a member of the university's BIO5 Institute. "We introduce a completely new concept of tailoring a device directly to a person and using wireless power casting to allow the device to operate 24/7 without ever needing to recharge."Custom Fit Enables Precise MonitoringCurrent wearable sensors face various limitations.

Smartwatches, for example, need to be charged, and they can only gather limited amounts of data due to their placement on the wrist. By using 3D scans of a wearer's body, which can be gathered via methods including MRIs, CT scans and even carefully combined smartphone images, Gutruf and his team can i buy levitra at walgreens can 3D-print custom-fitted devices that wrap around various body parts. Think a virtually unnoticeable, lightweight, breathable, mesh cuff designed specifically for your bicep, calf or torso.

The ability to specialize sensor placement allows researchers to measure physiological parameters they otherwise couldn't."If you want something close to core body temperature can i buy levitra at walgreens continuously, for example, you'd want to place the sensor in the armpit. Or, if you want to measure the way your bicep deforms during exercise, we can place a sensor in the devices that can accomplish that," said Tucker Stuart, a doctoral student in biomedical engineering and first author on the paper. "Because of the way we fabricate the device and attach it to the body, we're able to use it to gather data a traditional, wrist-mounted wearable device wouldn't be able to collect."Because these biosymbiotic can i buy levitra at walgreens devices are custom fitted to the wearer, they're also highly sensitive.

Gutruf's team tested the device's ability to monitor parameters including temperature and strain while a person jumped, walked on a treadmill and used a rowing machine. In the rowing machine test, subjects wore multiple devices, tracking exercise intensity and the way muscles deformed with fine detail. The devices were accurate enough to detect body temperature changes induced by walking can i buy levitra at walgreens up a single flight of stairs.

advertisement Continuous, Wireless and EffortlessGutruf and his team aren't the first to adapt wearables to track health and body function. However, current wearables do not have the ability to track metrics continuously, or with enough precision to make medically meaningful conclusions.Some wearables used by researchers are patches that stick to the skin, but they come off when can i buy levitra at walgreens skin goes through its normal shedding process, or sometimes when a subject sweats. Even highly sophisticated wearables used in clinical settings, such as ECG monitors, face these issues.

Also, they aren't wireless, which can i buy levitra at walgreens severely limits mobility. Patients can't go about their normal daily routines if they're tethered to bulky external devices.The biosymbiotic device that Gutruf's team has introduced uses no adhesive, and it receives its power from a wireless system with a range of several meters. The device also includes a small energy storage unit, so that it will function even if the wearer goes out of the system's range, including out of the house."These devices are designed to require no interaction with the wearer," Gutruf said.

"It's as simple as putting the device on can i buy levitra at walgreens. Then you forget about it, and it does its job."This research was funded by the Flinn Foundation Translational Bioscience Seed Grants Pilot Program. The team has also been working with Tech Launch Arizona, the commercialization arm of the university, to protect can i buy levitra at walgreens the intellectual property and launch a startup to bring the technology to market.Video of new wearable sensor.

Https://www.youtube.com/watch?. V=MhSeWGbuVTUAs the popularity of fitness trackers has increased, so have the opportunities to use such devices to can i buy levitra at walgreens not only track fitness goals but also increase the motivation to meet those goals. Researchers in the College of Engineering and the College of Health and Human Development at Penn State have teamed up to use control systems engineering tools to tailor motivational messages sent to individual device users.The results of their study were published today (Oct.

7) in Health Psychology."One of the really exciting advances of the last can i buy levitra at walgreens 15 years has been the advent of wearable and portable consumer technology that can be used to help promote physical activity," said David Conroy, professor of kinesiology and human development and family studies, and co-principal investigator on the paper. "You can get real-time feedback from these devices and monitor your goals, and you can even push people messages, depending on what their goals are and what their behavior is. We know that those messages work well for improving behavior on average.

But nobody is average, can i buy levitra at walgreens and we don't know how to make sure each individual consistently gets the greatest benefit from a limited number of messages."Conroy said that researchers have tried several strategies, including messages that are specific to certain population segments. Messages based on recent behavior -- for example, sending one of two different messages depending on if a user did or did not meet their goals the previous day. And customizing the messages by putting in can i buy levitra at walgreens a person's name or something they might like.

So far, none of these approaches has proven to be consistently effective in improving the messages' effects.The new messaging approach developed by Conroy and Constantino Lagoa, co-principal investigator and professor of electrical engineering, applies tools used regularly in controlled systems engineering to behavior science."Essentially, we're using the same mathematical tools that people in control engineering usually use to model behaviors as differential equations," Lagoa said. "We're using those models to design feedback controllers that take into account the current state of the person and together with the model decide what is the best time to send the messages."Conroy emphasized that establishing the correct dosing -- meaning the type of message and its timing, frequency and context -- is a critical part to this approach. advertisement "We're really prioritizing understanding can i buy levitra at walgreens the dosing so that we only send the right message at the right time and in the right context so people get the benefits that they're looking for," he said.

"We don't want to disrupt them without them getting the payoff that they're looking for."The researchers refer to this individualized approach as precision behavioral medicine."This is one of the first studies that was able to leverage data collected from each individual and zoom in on his or her personal response," Lagoa said.One of the main examples of how the researchers personalized the messages was by considering the weather in the area of the user, noting that certain messages were more effective for certain individuals on rainy days, hot days and so on.The researchers acknowledged the potential concern people may have about trading privacy for personalization but said that the automation means that the data can be used and then discarded, as opposed to stored, and the location settings only need to be approximate to know the weather and customize the messaging appropriately. They also said, if their approach is commercialized, users would be able to adjust their settings to select how much information to share, and they plan can i buy levitra at walgreens on conducting more research before applying their approach to a larger population."We've established here is there's a new tool to use with an established problem," Conroy said. "Our next project will focus on establishing efficacy.

Does this work can i buy levitra at walgreens better than sending messages at random or not sending messages at all?. But once we establish efficacy, I would imagine that it'd be very attractive to device manufacturers to consider this kind of approach."Other authors of the paper include Sarah Hojjatinia, a former electrical engineering graduate student and currently at Advanced Safety &. User Experience.

Sahar Hojjatinia, an can i buy levitra at walgreens electrical engineering graduate student. And Deborah Brunke-Reese, research project manager for the Motivation Lab in the College of Health and Human Development.This research was funded by the National Institutes of Health (Grant R01 HL142732) and the National Science Foundation. Story Source can i buy levitra at walgreens.

Materials provided by Penn State. Original written can i buy levitra at walgreens by Sarah Small. Note.

Content may be edited for style and length.Our DNA is very similar to that of the chimpanzee, which in evolutionary terms is our closest living relative. Stem cell researchers at Lund University in Sweden have now found a previously overlooked part of our DNA, so-called non-coded DNA, that appears to contribute to a difference which, despite all can i buy levitra at walgreens our similarities, may explain why our brains work differently. The study is published in the journal Cell Stem Cell.The chimpanzee is our closest living relative in evolutionary terms and research suggests our kinship derives from a common ancestor.

About five to six million years ago, our evolutionary paths separated, leading to the chimpanzee of today, and Homo Sapiens, humankind in the 21st century.In a new study, stem cell researchers at Lund examined what it is in our DNA that makes human and chimpanzee brains different -- and they have found answers."Instead of studying can i buy levitra at walgreens living humans and chimpanzees, we used stem cells grown in a lab. The stem cells were reprogrammed from skin cells by our partners in Germany, how to buy levitra in usa the USA and Japan. Then we can i buy levitra at walgreens examined the stem cells that we had developed into brain cells," explains Johan Jakobsson, professor of neuroscience at Lund University, who led the study.Using the stem cells, the researchers specifically grew brain cells from humans and chimpanzees and compared the two cell types.

The researchers then found that humans and chimpanzees use a part of their DNA in different ways, which appears to play a considerable role in the development of our brains."The part of our DNA identified as different was unexpected. It was a so-called structural variant of DNA that were previously called "junk DNA," a long repetitive DNA string which has long been deemed to have no function. Previously, researchers have looked for answers in the part of the DNA where the protein-producing genes are -- which only makes up about two per cent of our entire DNA -- and examined the proteins themselves to find examples of differences."The new findings thus indicate that the differences appear to lie outside the protein-coding genes in what has been labelled as "junk DNA," which was thought to have no function and which constitutes can i buy levitra at walgreens the majority of our DNA.

advertisement "This suggests that the basis for the human brain's evolution are genetic mechanisms that are probably a lot more complex than previously thought, as it was supposed that the answer was in those two per cent of the genetic DNA. Our results indicate that what has been significant can i buy levitra at walgreens for the brain's development is instead perhaps hidden in the overlooked 98 per cent, which appears to be important. This is a surprising finding."The stem cell technique used by the researchers in Lund is revolutionary and has enabled this type of research.

The technique was recognised by the 2012 Nobel Prize in can i buy levitra at walgreens Physiology or Medicine. It was the Japanese researcher Shinya Yamanaka who discovered that specialised cells can be reprogrammed and developed into all types of body tissue. And in the Lund researchers' case, into brain cells.

Without this technique, it would not have been possible to study the differences between humans and chimpanzees using ethically defensible methods.Why did can i buy levitra at walgreens the researchers want to investigate the difference between humans and chimpanzees?. "I believe that the brain is the key to understanding what it is that makes humans human. How did can i buy levitra at walgreens it come about that humans can use their brain in such a way that they can build societies, educate their children and develop advanced technology?.

It is fascinating!. "Johan Jakobsson believes that in the future the new findings may also contribute to genetically-based answers to questions about psychiatric disorders, such as schizophrenia, a disorder that appears to be unique to humans."But there can i buy levitra at walgreens is a long way to go before we reach that point, as instead of carrying out further research on the two per cent of coded DNA, we may now be forced to delve deeper into all 100 per cent -- a considerably more complicated task for research," he concludes. Story Source.

Materials provided by Lund University. Note. Content may be edited for style and length.Adolescents who had received a mental health disorder diagnosis were often excluded from the labour market and education as young adults.

This particularly applied to adolescents who had been diagnosed with an autism spectrum disorder or psychosis. The results were found out in a birth cohort study of people born in Finland in 1987. The study was published on 6 October in British Journal of Psychiatry.Almost eleven percent of adolescents who had received a psychiatric diagnosis were excluded from education and labour market for at least five years in their early adulthood.

For other adolescents, this number was slightly under three percent. The results highlight the importance of the treatment and rehabilitation of people with mental health disorders in the prevention of adolescents' social exclusion. ""To help prevent the social exclusion of adolescents, their treatment and rehabilitation require more resources than are currently being used as well as development of evidence-based treatment and rehabilitation," says Adolescent Psychiatrist and Doctoral Candidate Ida Ringbom from the Research Centre for Child Psychiatry at the University of Turku.The results are concerning because they highlight the link between mental health disorders and long-term exclusion from education and labour market.

In the study, long-term exclusion was defined as a period spent outside education or paid employment lasting a minimum of five years. The link was particularly strong with those teenagers who had not completed their upper secondary education and who had been diagnosed with a mental health disorder. Almost half of these teenagers who had experienced psychosis and almost three quarters of teenagers who had been diagnosed with an autism spectrum disorder experienced long-term exclusion from education and labour market in their early adulthood."Vocational rehabilitation and tight collaboration between psychiatry and social services are important for enabling adolescents suffering from mental health problems to access the labour market," says Assistant Professor David Gyllenberg who led the study."Adolescents who have not completed their upper secondary education require more targeted support because their risk of becoming socially excluded is particularly high."The research was conducted at the Research Centre for Child Psychiatry as a part of the INVEST flagship programme for the study of inequality, interventions, and the welfare state.

A joint project of the University of Turku and Finnish Institute for Health and Welfare and funded by the Academy of Finland, INVEST focuses on reducing social inequality and reforming the welfare state. Finnish Institute for Health and Welfare is responsible for the national birth cohort of 1987. The research group included researchers from e.g.

The University of Turku, Finnish Institute for Health and Welfare, Helsinki University Hospital, and Itla Children's Foundation. Story Source. Materials provided by University of Turku.

Note. Content may be edited for style and length.Neuroscientists at Technische Universität Dresden discovered a novel, non-invasive imaging-based method to investigate the visual sensory thalamus, an important structure of the human brain and point of origin of visual difficulties in diseases such as dyslexia and glaucoma. The new method could provide an in-depth understanding of visual sensory processing in both health and disease in the near future.The visual sensory thalamus is a key region that connects the eyes with the cerebral cortex.

It contains two major compartments. Symptoms of many diseases are associated with alterations in this region. So far, it has been very difficult to assess these two compartments in living humans, because they are tiny and located very deep inside the brain.This difficulty of investigating the visual sensory thalamus in detail has hampered the understanding of the function of visual sensory processing tremendously in the past.

By coincidence, Christa Müller-Axt, Ph.D. Student in the lab of neuroscientist Prof. Katharina von Kriegstein at TU Dresden, discovered structures that she thought might resemble the two visual sensory thalamus compartments in neuroimaging data.

The neuroimaging data was unique because it had an unprecedented high spatial resolution obtained on a specialised magnetic resonance imaging (MRI) machine at the MPI-CBS in Leipzig, where the group was researching developmental dyslexia. She followed up this discovery in a series of novel experiments involving analysis of high spatial resolution in-vivo and post-mortem MRI data as well as post-mortem histology and was soon sure to have discovered the two major compartments of the visual sensory thalamus.The results showed that the two major compartments of the visual sensory thalamus are characterised by different amounts of brain white matter (myelin). This information can be detected in novel MRI data and thus, can be used to investigate the two compartments of the visual sensory thalamus in living humans."The finding that we can display visual sensory thalamus compartments in living humans is fantastic, as it will be a great tool for understanding visual sensory processing both in health and disease in the near future," claims first author Christa Müller-Axt and explains, "Post-mortem studies in developmental dyslexia have shown that there are alterations specifically in one of the two compartments of the visual sensory thalamus.

However, there are very few of these post-mortem studies, so it is difficult to say whether all dyslexics are characterised by these kind of visual sensory thalamus alterations. Also, post-mortem data cannot reveal anything about the functional impact of these alterations and their specific contribution to developmental dyslexia symptoms. Therefore, we expect that our novel in-vivo approach will be a great asset in facilitating research on the role of the visual sensory thalamus in developmental dyslexia." Story Source.

Materials provided by Technische Universität Dresden. Note. Content may be edited for style and length..

Vardenafil levitra staxyn

NCHS Data Brief vardenafil levitra staxyn No Where to purchase zithromax. 286, September 2017PDF Versionpdf icon (374 KB)Anjel Vahratian, Ph.D.Key findingsData from the National Health Interview Survey, 2015Among those aged 40–59, perimenopausal women (56.0%) were more likely than postmenopausal (40.5%) and premenopausal (32.5%) women to sleep less than 7 hours, on average, in a 24-hour period.Postmenopausal women aged 40–59 were more likely than premenopausal women aged 40–59 to have trouble falling asleep (27.1% compared with 16.8%, respectively), and staying asleep (35.9% compared with 23.7%), four times or more in the past week.Postmenopausal women aged 40–59 (55.1%) were more likely than premenopausal women aged 40–59 (47.0%) to not wake up feeling well rested 4 days or more in the past week.Sleep duration and quality are important contributors to health and wellness. Insufficient sleep is associated with an increased vardenafil levitra staxyn risk for chronic conditions such as cardiovascular disease (1) and diabetes (2).

Women may be particularly vulnerable to sleep problems during times of reproductive hormonal change, such as after the menopausal transition. Menopause is “the permanent cessation of menstruation vardenafil levitra staxyn that occurs after the loss of ovarian activity” (3). This data brief describes sleep duration and sleep quality among nonpregnant women aged 40–59 by menopausal status.

The age range selected for this analysis reflects the focus on midlife sleep health. In this analysis, 74.2% of women are premenopausal, 3.7% are perimenopausal, and 22.1% are postmenopausal vardenafil levitra staxyn. Keywords.

Insufficient sleep, menopause, National Health Interview Survey Perimenopausal women were more likely than premenopausal and postmenopausal women to vardenafil levitra staxyn sleep less than 7 hours, on average, in a 24-hour period.More than one in three nonpregnant women aged 40–59 slept less than 7 hours, on average, in a 24-hour period (35.1%) (Figure 1). Perimenopausal women were most likely to sleep less than 7 hours, on average, in a 24-hour period (56.0%), compared with 32.5% of premenopausal and 40.5% of postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to sleep less than 7 hours, on average, in a 24-hour period.

Figure 1 vardenafil levitra staxyn. Percentage of nonpregnant women aged 40–59 who slept less than 7 hours, on average, in a 24-hour period, by menopausal status. United States, 2015image icon1Significant quadratic trend by menopausal status (p < vardenafil levitra staxyn.

0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were vardenafil levitra staxyn perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less.

Women were premenopausal if they still had a menstrual cycle. Access data table for vardenafil levitra staxyn Figure 1pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015.

The percentage of women aged 40–59 who had trouble falling asleep four times vardenafil levitra staxyn or more in the past week varied by menopausal status.Nearly one in five nonpregnant women aged 40–59 had trouble falling asleep four times or more in the past week (19.4%) (Figure 2). The percentage of women in this age group who had trouble falling asleep four times or more in the past week increased from 16.8% among premenopausal women to 24.7% among perimenopausal and 27.1% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to have trouble falling asleep four times or more in the past week.

Figure 2 vardenafil levitra staxyn. Percentage of nonpregnant women aged 40–59 who had trouble falling asleep four times or more in the past week, by menopausal status. United States, 2015image icon1Significant linear trend by menopausal vardenafil levitra staxyn status (p <.

0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a vardenafil levitra staxyn menstrual cycle and their last menstrual cycle was 1 year ago or less.

Women were premenopausal if they still had a menstrual cycle. Access data table vardenafil levitra staxyn for Figure 2pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015.

The percentage of women aged 40–59 who had trouble staying asleep four times or more in the past week varied by vardenafil levitra staxyn menopausal status.More than one in four nonpregnant women aged 40–59 had trouble staying asleep four times or more in the past week (26.7%) (Figure 3). The percentage of women aged 40–59 who had trouble staying asleep four times or more in the past week increased from 23.7% among premenopausal, to 30.8% among perimenopausal, and to 35.9% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to have trouble staying asleep four times or more in the past week.

Figure 3 vardenafil levitra staxyn. Percentage of nonpregnant women aged 40–59 who had trouble staying asleep four times or more in the past week, by menopausal status. United States, 2015image icon1Significant linear trend by menopausal status vardenafil levitra staxyn (p <.

0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if vardenafil levitra staxyn they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less.

Women were premenopausal if they still had a menstrual cycle. Access data vardenafil levitra staxyn table for Figure 3pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015.

The percentage of women aged 40–59 who did not wake up feeling well rested 4 days or more in the past week varied by menopausal status.Nearly one in two nonpregnant women aged 40–59 did not wake up feeling well rested 4 days or more in the past week (48.9%) (Figure 4). The percentage of women in this age group who did not wake up feeling well rested 4 days or more in the past week increased from 47.0% among premenopausal women to 49.9% among vardenafil levitra staxyn perimenopausal and 55.1% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to not wake up feeling well rested 4 days or more in the past week.

Figure 4 vardenafil levitra staxyn. Percentage of nonpregnant women aged 40–59 who did not wake up feeling well rested 4 days or more in the past week, by menopausal status. United States, 2015image icon1Significant linear trend by menopausal status (p <.

0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less.

Women were premenopausal if they still had a menstrual cycle. Access data table for Figure 4pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015.

SummaryThis report describes sleep duration and sleep quality among U.S. Nonpregnant women aged 40–59 by menopausal status. Perimenopausal women were most likely to sleep less than 7 hours, on average, in a 24-hour period compared with premenopausal and postmenopausal women.

In contrast, postmenopausal women were most likely to have poor-quality sleep. A greater percentage of postmenopausal women had frequent trouble falling asleep, staying asleep, and not waking well rested compared with premenopausal women. The percentage of perimenopausal women with poor-quality sleep was between the percentages for the other two groups in all three categories.

Sleep duration changes with advancing age (4), but sleep duration and quality are also influenced by concurrent changes in women’s reproductive hormone levels (5). Because sleep is critical for optimal health and well-being (6), the findings in this report highlight areas for further research and targeted health promotion. DefinitionsMenopausal status.

A three-level categorical variable was created from a series of questions that asked women. 1) “How old were you when your periods or menstrual cycles started?. €.

2) “Do you still have periods or menstrual cycles?. €. 3) “When did you have your last period or menstrual cycle?.

€. And 4) “Have you ever had both ovaries removed, either as part of a hysterectomy or as one or more separate surgeries?. € Women were postmenopausal if they a) had gone without a menstrual cycle for more than 1 year or b) were in surgical menopause after the removal of their ovaries.

Women were perimenopausal if they a) no longer had a menstrual cycle and b) their last menstrual cycle was 1 year ago or less. Premenopausal women still had a menstrual cycle.Not waking feeling well rested. Determined by respondents who answered 3 days or less on the questionnaire item asking, “In the past week, on how many days did you wake up feeling well rested?.

€Short sleep duration. Determined by respondents who answered 6 hours or less on the questionnaire item asking, “On average, how many hours of sleep do you get in a 24-hour period?. €Trouble falling asleep.

Determined by respondents who answered four times or more on the questionnaire item asking, “In the past week, how many times did you have trouble falling asleep?. €Trouble staying asleep. Determined by respondents who answered four times or more on the questionnaire item asking, “In the past week, how many times did you have trouble staying asleep?.

€ Data source and methodsData from the 2015 National Health Interview Survey (NHIS) were used for this analysis. NHIS is a multipurpose health survey conducted continuously throughout the year by the National Center for Health Statistics. Interviews are conducted in person in respondents’ homes, but follow-ups to complete interviews may be conducted over the telephone.

Data for this analysis came from the Sample Adult core and cancer supplement sections of the 2015 NHIS. For more information about NHIS, including the questionnaire, visit the NHIS website.All analyses used weights to produce national estimates. Estimates on sleep duration and quality in this report are nationally representative of the civilian, noninstitutionalized nonpregnant female population aged 40–59 living in households across the United States.

The sample design is described in more detail elsewhere (7). Point estimates and their estimated variances were calculated using SUDAAN software (8) to account for the complex sample design of NHIS. Linear and quadratic trend tests of the estimated proportions across menopausal status were tested in SUDAAN via PROC DESCRIPT using the POLY option.

Differences between percentages were evaluated using two-sided significance tests at the 0.05 level. About the authorAnjel Vahratian is with the National Center for Health Statistics, Division of Health Interview Statistics. The author gratefully acknowledges the assistance of Lindsey Black in the preparation of this report.

ReferencesFord ES. Habitual sleep duration and predicted 10-year cardiovascular risk using the pooled cohort risk equations among US adults. J Am Heart Assoc 3(6):e001454.

2014.Ford ES, Wheaton AG, Chapman DP, Li C, Perry GS, Croft JB. Associations between self-reported sleep duration and sleeping disorder with concentrations of fasting and 2-h glucose, insulin, and glycosylated hemoglobin among adults without diagnosed diabetes. J Diabetes 6(4):338–50.

2014.American College of Obstetrics and Gynecology. ACOG Practice Bulletin No. 141.

Management of menopausal symptoms. Obstet Gynecol 123(1):202–16. 2014.Black LI, Nugent CN, Adams PF.

Tables of adult health behaviors, sleep. National Health Interview Survey, 2011–2014pdf icon. 2016.Santoro N.

Perimenopause. From research to practice. J Women’s Health (Larchmt) 25(4):332–9.

2016.Watson NF, Badr MS, Belenky G, Bliwise DL, Buxton OM, Buysse D, et al. Recommended amount of sleep for a healthy adult. A joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society.

J Clin Sleep Med 11(6):591–2. 2015.Parsons VL, Moriarity C, Jonas K, et al. Design and estimation for the National Health Interview Survey, 2006–2015.

National Center for Health Statistics. Vital Health Stat 2(165). 2014.RTI International.

SUDAAN (Release 11.0.0) [computer software]. 2012. Suggested citationVahratian A.

Sleep duration and quality among women aged 40–59, by menopausal status. NCHS data brief, no 286. Hyattsville, MD.

National Center for Health Statistics. 2017.Copyright informationAll material appearing in this report is in the public domain and may be reproduced or copied without permission. Citation as to source, however, is appreciated.National Center for Health StatisticsCharles J.

Rothwell, M.S., M.B.A., DirectorJennifer H. Madans, Ph.D., Associate Director for ScienceDivision of Health Interview StatisticsMarcie L. Cynamon, DirectorStephen J.

Blumberg, Ph.D., Associate Director for Science.

NCHS Data can i buy levitra at walgreens Brief No. 286, September 2017PDF Versionpdf icon (374 KB)Anjel Vahratian, Ph.D.Key findingsData from the National Health Interview Survey, 2015Among those aged 40–59, perimenopausal women (56.0%) were more likely than postmenopausal (40.5%) and premenopausal (32.5%) women to sleep less than 7 hours, on average, in a 24-hour period.Postmenopausal women aged 40–59 were more likely than premenopausal women aged 40–59 to have trouble falling asleep (27.1% compared with 16.8%, respectively), and staying asleep (35.9% compared with 23.7%), four times or more in the past week.Postmenopausal women aged 40–59 (55.1%) were more likely than premenopausal women aged 40–59 (47.0%) to not wake up feeling well rested 4 days or more in the past week.Sleep duration and quality are important contributors to health and wellness. Insufficient sleep is can i buy levitra at walgreens associated with an increased risk for chronic conditions such as cardiovascular disease (1) and diabetes (2). Women may be particularly vulnerable to sleep problems during times of reproductive hormonal change, such as after the menopausal transition. Menopause is can i buy levitra at walgreens “the permanent cessation of menstruation that occurs after the loss of ovarian activity” (3).

This data brief describes sleep duration and sleep quality among nonpregnant women aged 40–59 by menopausal status. The age range selected for this analysis reflects the focus on midlife sleep health. In this can i buy levitra at walgreens analysis, 74.2% of women are premenopausal, 3.7% are perimenopausal, and 22.1% are postmenopausal. Keywords. Insufficient sleep, menopause, National Health Interview Survey Perimenopausal women were more likely than premenopausal and postmenopausal women to sleep less than 7 hours, on average, can i buy levitra at walgreens in a 24-hour period.More than one in three nonpregnant women aged 40–59 slept less than 7 hours, on average, in a 24-hour period (35.1%) (Figure 1).

Perimenopausal women were most likely to sleep less than 7 hours, on average, in a 24-hour period (56.0%), compared with 32.5% of premenopausal and 40.5% of postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to sleep less than 7 hours, on average, in a 24-hour period. Figure 1 can i buy levitra at walgreens. Percentage of nonpregnant women aged 40–59 who slept less than 7 hours, on average, in a 24-hour period, by menopausal status. United States, 2015image icon1Significant quadratic trend by menopausal status (p < can i buy levitra at walgreens.

0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was can i buy levitra at walgreens 1 year ago or less. Women were premenopausal if they still had a menstrual cycle. Access data table can i buy levitra at walgreens for Figure 1pdf icon.SOURCE.

NCHS, National Health Interview Survey, 2015. The percentage of women can i buy levitra at walgreens aged 40–59 who had trouble falling asleep four times or more in the past week varied by menopausal status.Nearly one in five nonpregnant women aged 40–59 had trouble falling asleep four times or more in the past week (19.4%) (Figure 2). The percentage of women in this age group who had trouble falling asleep four times or more in the past week increased from 16.8% among premenopausal women to 24.7% among perimenopausal and 27.1% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to have trouble falling asleep four times or more in the past week. Figure 2 can i buy levitra at walgreens.

Percentage of nonpregnant women aged 40–59 who had trouble falling asleep four times or more in the past week, by menopausal status. United States, 2015image icon1Significant linear can i buy levitra at walgreens trend by menopausal status (p <. 0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was 1 can i buy levitra at walgreens year ago or less.

Women were premenopausal if they still had a menstrual cycle. Access data table for can i buy levitra at walgreens Figure 2pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015. The percentage of can i buy levitra at walgreens women aged 40–59 who had trouble staying asleep four times or more in the past week varied by menopausal status.More than one in four nonpregnant women aged 40–59 had trouble staying asleep four times or more in the past week (26.7%) (Figure 3). The percentage of women aged 40–59 who had trouble staying asleep four times or more in the past week increased from 23.7% among premenopausal, to 30.8% among perimenopausal, and to 35.9% among postmenopausal women.

Postmenopausal women were significantly more likely than premenopausal women to have trouble staying asleep four times or more in the past week. Figure 3 can i buy levitra at walgreens. Percentage of nonpregnant women aged 40–59 who had trouble staying asleep four times or more in the past week, by menopausal status. United States, 2015image icon1Significant linear trend can i buy levitra at walgreens by menopausal status (p <. 0.05).NOTES.

Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a can i buy levitra at walgreens menstrual cycle and their last menstrual cycle was 1 year ago or less. Women were premenopausal if they still had a menstrual cycle. Access data can i buy levitra at walgreens table for Figure 3pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015.

The percentage of women aged 40–59 who did not wake up feeling well rested 4 days or more in the past week varied by menopausal status.Nearly one in two nonpregnant women aged 40–59 did not wake up feeling well rested 4 days or more in the past week (48.9%) (Figure 4). The percentage of women in this age group who did not wake up feeling well rested 4 days or more in the past week increased from 47.0% among premenopausal can i buy levitra at walgreens women to 49.9% among perimenopausal and 55.1% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to not wake up feeling well rested 4 days or more in the past week. Figure 4 can i buy levitra at walgreens. Percentage of nonpregnant women aged 40–59 who did not wake up feeling well rested 4 days or more in the past week, by menopausal status.

United States, 2015image icon1Significant linear trend by menopausal status (p <. 0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less. Women were premenopausal if they still had a menstrual cycle.

Access data table for Figure 4pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015. SummaryThis report describes sleep duration and sleep quality among U.S. Nonpregnant women aged 40–59 by menopausal status. Perimenopausal women were most likely to sleep less than 7 hours, on average, in a 24-hour period compared with premenopausal and postmenopausal women.

In contrast, postmenopausal women were most likely to have poor-quality sleep. A greater percentage of postmenopausal women had frequent trouble falling asleep, staying asleep, and not waking well rested compared with premenopausal women. The percentage of perimenopausal women with poor-quality sleep was between the percentages for the other two groups in all three categories. Sleep duration changes with advancing age (4), but sleep duration and quality are also influenced by concurrent changes in women’s reproductive hormone levels (5). Because sleep is critical for optimal health and well-being (6), the findings in this report highlight areas for further research and targeted health promotion.

DefinitionsMenopausal status. A three-level categorical variable was created from a series of questions that asked women. 1) “How old were you when your periods or menstrual cycles started?. €. 2) “Do you still have periods or menstrual cycles?.

€. 3) “When did you have your last period or menstrual cycle?. €. And 4) “Have you ever had both ovaries removed, either as part of a hysterectomy or as one or more separate surgeries?. € Women were postmenopausal if they a) had gone without a menstrual cycle for more than 1 year or b) were in surgical menopause after the removal of their ovaries.

Women were perimenopausal if they a) no longer had a menstrual cycle and b) their last menstrual cycle was 1 year ago or less. Premenopausal women still had a menstrual cycle.Not waking feeling well rested. Determined by respondents who answered 3 days or less on the questionnaire item asking, “In the past week, on how many days did you wake up feeling well rested?. €Short sleep duration. Determined by respondents who answered 6 hours or less on the questionnaire item asking, “On average, how many hours of sleep do you get in a 24-hour period?.

€Trouble falling asleep. Determined by respondents who answered four times or more on the questionnaire item asking, “In the past week, how many times did you have trouble falling asleep?. €Trouble staying asleep. Determined by respondents who answered four times or more on the questionnaire item asking, “In the past week, how many times did you have trouble staying asleep?. € Data source and methodsData from the 2015 National Health Interview Survey (NHIS) were used for this analysis.

NHIS is a multipurpose health survey conducted continuously throughout the year by the National Center for Health Statistics. Interviews are conducted in person in respondents’ homes, but follow-ups to complete interviews may be conducted over the telephone. Data for this analysis came from the Sample Adult core and cancer supplement sections of the 2015 NHIS. For more information about NHIS, including the questionnaire, visit the NHIS website.All analyses used weights to produce national estimates. Estimates on sleep duration and quality in this report are nationally representative of the civilian, noninstitutionalized nonpregnant female population aged 40–59 living in households across the United States.

The sample design is described in more detail elsewhere (7). Point estimates and their estimated variances were calculated using SUDAAN software (8) to account for the complex sample design of NHIS. Linear and quadratic trend tests of the estimated proportions across menopausal status were tested in SUDAAN via PROC DESCRIPT using the POLY option. Differences between percentages were evaluated using two-sided significance tests at the 0.05 level. About the authorAnjel Vahratian is with the National Center for Health Statistics, Division of Health Interview Statistics.

The author gratefully acknowledges the assistance of Lindsey Black in the preparation of this report. ReferencesFord ES. Habitual sleep duration and predicted 10-year cardiovascular risk using the pooled cohort risk equations among US adults. J Am Heart Assoc 3(6):e001454. 2014.Ford ES, Wheaton AG, Chapman DP, Li C, Perry GS, Croft JB.

Associations between self-reported sleep duration and sleeping disorder with concentrations of fasting and 2-h glucose, insulin, and glycosylated hemoglobin among adults without diagnosed diabetes. J Diabetes 6(4):338–50. 2014.American College of Obstetrics and Gynecology. ACOG Practice Bulletin No. 141.

Management of menopausal symptoms. Obstet Gynecol 123(1):202–16. 2014.Black LI, Nugent CN, Adams PF. Tables of adult health behaviors, sleep. National Health Interview Survey, 2011–2014pdf icon.

2016.Santoro N. Perimenopause. From research to practice. J Women’s Health (Larchmt) 25(4):332–9. 2016.Watson NF, Badr MS, Belenky G, Bliwise DL, Buxton OM, Buysse D, et al.

Recommended amount of sleep for a healthy adult. A joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society. J Clin Sleep Med 11(6):591–2. 2015.Parsons VL, Moriarity C, Jonas K, et al. Design and estimation for the National Health Interview Survey, 2006–2015.

National Center for Health Statistics. Vital Health Stat 2(165). 2014.RTI International. SUDAAN (Release 11.0.0) [computer software]. 2012.

Suggested citationVahratian A. Sleep duration and quality among women aged 40–59, by menopausal status. NCHS data brief, no 286. Hyattsville, MD. National Center for Health Statistics.

2017.Copyright informationAll material appearing in this report is in the public domain and may be reproduced or copied without permission. Citation as to source, however, is appreciated.National Center for Health StatisticsCharles J. Rothwell, M.S., M.B.A., DirectorJennifer H. Madans, Ph.D., Associate Director for ScienceDivision of Health Interview StatisticsMarcie L. Cynamon, DirectorStephen J.

Blumberg, Ph.D., Associate Director for Science.

Levitra 20mg price in online pharmacy

The 24-hour news cycle is just as important to https://www.anitapt.com/online-ventolin-prescription/ medicine as it is to politics, finance, or levitra 20mg price in online pharmacy sports. At MedPage Today, new information is posted daily, but keeping up can be a levitra 20mg price in online pharmacy challenge. As an aid for our readers and for a little amusement, here is a 10-question quiz based on the news of the week.

Topics include physicians spreading erectile dysfunction treatment misinformation, tapering opioid doses, and a lupus levitra 20mg price in online pharmacy treatment approval. After taking the quiz, scroll down in your browser window to find the correct answers and explanations, as well as links to the original articles.Despite the widespread belief that obstructive sleep apnea (OSA) causes cardiovascular events like strokes and heart attacks, there is actually no good evidence that treating OSA lowers the risk of such cardiovascular outcomes.Observational data showing that OSA is associated with cardiovascular outcomes like atrial fibrillation (Afib), stroke, cardiovascular death, and myocardial infarction (MI) have been utilized by the sleep apnea academic-industrial complex (in ways very similar to the omega-fatty acid academic-industrial complex) to market the need for sleep apnea diagnosis and treatment.However, as we saw in the omega-fatty acid world, causality can only be proven with a randomized trial of effective therapy of the disease (given that there is no way to randomize patients to having OSA or not having it.) The most widely prescribed and effective therapy for OSA is continuous positive airway pressure (CPAP).Healthy user bias is a major confounder of most CPAP and all observational studies as noted at Clinical Correlations:Observational studies have demonstrated that among patients with OSA, CPAP is associated with a lower incidence of fatal and nonfatal cardiovascular events. A recent meta-analysis of observational studies corroborated these findings, noting a hazard ratio (HR) of 0.37 (95% CI, 0.16 to 0.54) for cardiovascular mortality in CPAP treated levitra 20mg price in online pharmacy patients compared to untreated patients.

However, these studies are marred by levitra 20mg price in online pharmacy their lack of randomization. Therefore, the patients compliant with CPAP may have enjoyed their cardiovascular benefit from any number of downstream effects of their general aptitude towards making healthy lifestyle choices (the healthy user bias) rather than from CPAP alone.A recent draft document on CPAP therapy for OSA, from the Agency for Healthcare Research and Quality (AHRQ) of the U.S. Department of Health and Human Services, outlines some of the major unresolved questions:Obstructive sleep apnea (OSA) is a disorder characterized by levitra 20mg price in online pharmacy periods of airflow cessation (apnea) or reduced airflow (hypopnea) during sleep.

The diagnosis and severity of OSA, and response to therapy, are typically assessed using the apnea-hypopnea index (AHI). However, no standard definition of this measure exists, and whether AHI (and associated measures) are valid surrogate measure of clinical outcomes levitra 20mg price in online pharmacy is unknown. OSA is commonly treated with the use of levitra 20mg price in online pharmacy continuous positive airway pressure (CPAP) devices during sleep.

The efficacy of CPAP, including for Food and Drug Administration (FDA) clearance/approval, has been based on changes in AHI, but the long-term effect of CPAP on clinical outcomes and the role of disease severity (as measured by AHI) or sleepiness symptoms on the putative effect of CPAP are unclear.After looking at 47 studies on this question, the AHRQ review concluded that there was no evidence to support the idea that CPAP treatment lowers "clinically important outcomes."And there isn't evidence that CPAP treatment of OSA influences individual aspects of cardiovascular disease, including Afib, which totally counters the mantra that sleep centers and Afib experts have been spouting for years.In fact, the two randomized controlled trials (RCTs) that report Afib came to opposite conclusions, with one showing it lowered risk and the other one showing that CPAP raised the risk of developing Afib!. Pretty much everything you thought would be helped by CPAP treatment has not been proven, says the AHRQ:Regarding other assessed outcomes, CPAP does not affect the levitra 20mg price in online pharmacy risk of driving accidents or the risk of incident diabetes (both low SoE [standard of evidence]). CPAP does not result in clinically significant changes in depression or anxiety scores, executive cognitive function measures, or levitra 20mg price in online pharmacy nonspecific quality of life measures (all low SoE).

There is insufficient evidence regarding the effect of CPAP on incident hypertension, functional status measures, male or female sexual function, or days of work missed.There is a clear and obvious way to prove that diagnosing OSA matters (beyond improving daytime sleep and snoring) and that OSA is a life-threatening disease. That is to randomize patients diagnosed with OSA to treatment with effective therapy (i.e., CPAP), and levitra 20mg price in online pharmacy several of these have been performed. Unfortunately for the OSA business, the results of these RCTs do not show a benefit of therapy, consequently sleep experts/centers and businesses that sell OSA diagnostic and therapeutic equipment tend to gloss over, dismiss, or ignore these data.Clinical Correlations does a good job of summarizing the methods and outcomes of the major randomized trials for those interested and they concluded:Recurrent patterns emerge from these data reviewed here.

Typical use of CPAP does not levitra 20mg price in online pharmacy ameliorate the risks of fatal and nonfatal cardiovascular events in patients with OSA, though it may reduce symptoms of daytime sleepiness and snoring. Subgroup analyses of patients wearing CPAP over 4 hours per night suggest that CPAP may lower cardiovascular events. However, these findings are subject to significant bias.Post-hoc subgroup analyses like the association of CPAP usage >4 hours with levitra 20mg price in online pharmacy lower events cannot be used to prove causality.

They should serve as hypothesis-generating levitra 20mg price in online pharmacy. However, if your business is diagnosing and treating sleep apnea you are highly biased to cherry-pick the available studies.Thus, although the non-biased writers of the main analysis section at Clinical Correlations came to the proper conclusion -- no benefit -- a pulmonary/sleep medicine MD "commentary" addition concluded the exact opposite:As multiple studies have shown, treatment of OSA with CPAP has numerous cardiovascular benefits, including arrhythmia control and prevention of recurrence, improved glycemic control, and reduction of the risk for stroke and MI.This pro-sleep apnea treatment commentary focused on the CPAP>4 hour subgroup analysis without admitting the severe bias this introduces and without discussing how common this is.Such cherry-picking of the data is common in marketing and surprisingly throughout peer-reviewed articles in major journals. Social and news media summaries of such articles invariably eliminate discussion of the weakness of the observational database supporting the Afib/OSA connection and ignore the lack of support from RCTs.Screening and Marketing of OSAScreening for OSA is often done by questionnaires such as STOP-BANG levitra 20mg price in online pharmacy or the Epworth Sleepiness Scale.STOP-BANG asks questions about snoring, sleepiness, observed apnea or choking and hypertension plus 4 clinical attributes (hypertension, obesity, age, neck size, and gender) and classifies patients as low, intermediate or high risk.

It has a high sensitivity of 90% but a very low specificity of 36%. This means that two-thirds of individuals who take this screening who don't have OSA when tested formally will be told they may have OSA.I just took the STOP-BANG questionnaire and scored 4 (age 50 years, hypertension, fatigued during levitra 20mg price in online pharmacy the day, and male). This was classified as "high risk" for OSA.A male over age 55 already has 2 points on the score and since 3 points is considered "high risk of OSA" and all wives tell me their husbands snore, every man over age 55 is going to be identified at high risk.To summarize and answer the question in my title:Despite numerous flawed observational studies suggesting an association between sleep apnea and cardiovascular outcomes including Afib, the gold standard, high-quality RCT data do not clearly show that treatment of sleep apnea with CPAP improves cardiovascular outcomes.Until good scientific evidence proves that treatment of OSA really does save lives, reduces heart failure, Afib, or other important cardiovascular outcomes, widespread screening and marketing levitra 20mg price in online pharmacy for the diagnosis and treatment of OSA other than reducing snoring and daytime sleepiness should cease.Anthony C.

Pearson, MD, is a noninvasive cardiologist and professor of medicine at St. Louis University levitra 20mg price in online pharmacy School of Medicine. He blogs on nutrition, cardiac testing, quackery, and other things worthy of skepticism at The Skeptical Cardiologist, where a version of this post first appeared..

The 24-hour news cycle is just as important to medicine as it is to can i buy levitra at walgreens politics, finance, or sports. At MedPage Today, new information is posted daily, but can i buy levitra at walgreens keeping up can be a challenge. As an aid for our readers and for a little amusement, here is a 10-question quiz based on the news of the week. Topics include physicians spreading erectile dysfunction treatment misinformation, tapering opioid can i buy levitra at walgreens doses, and a lupus treatment approval. After taking the quiz, scroll down in your browser window to find the correct answers and explanations, as well as links to the original articles.Despite the widespread belief that obstructive sleep apnea (OSA) causes cardiovascular events like strokes and heart attacks, there is actually no good evidence that treating OSA lowers the risk of such cardiovascular outcomes.Observational data showing that OSA is associated with cardiovascular outcomes like atrial fibrillation (Afib), stroke, cardiovascular death, and myocardial infarction (MI) have been utilized by the sleep apnea academic-industrial complex (in ways very similar to the omega-fatty acid academic-industrial complex) to market the need for sleep apnea diagnosis and treatment.However, as we saw in the omega-fatty acid world, causality can only be proven with a randomized trial of effective therapy of the disease (given that there is no way to randomize patients to having OSA or not having it.) The most widely prescribed and effective therapy for OSA is continuous positive airway pressure (CPAP).Healthy user bias is a major confounder of most CPAP and all observational studies as noted at Clinical Correlations:Observational studies have demonstrated that among patients with OSA, CPAP is associated with a lower incidence of fatal and nonfatal cardiovascular events.

A recent meta-analysis of observational studies can i buy levitra at walgreens corroborated these findings, noting a hazard ratio (HR) of 0.37 (95% CI, 0.16 to 0.54) for cardiovascular mortality in CPAP treated patients compared to untreated patients. However, these studies are can i buy levitra at walgreens marred by their lack of randomization. Therefore, the patients compliant with CPAP may have enjoyed their cardiovascular benefit from any number of downstream effects of their general aptitude towards making healthy lifestyle choices (the healthy user bias) rather than from CPAP alone.A recent draft document on CPAP therapy for OSA, from the Agency for Healthcare Research and Quality (AHRQ) of the U.S. Department of can i buy levitra at walgreens Health and Human Services, outlines some of the major unresolved questions:Obstructive sleep apnea (OSA) is a disorder characterized by periods of airflow cessation (apnea) or reduced airflow (hypopnea) during sleep. The diagnosis and severity of OSA, and response to therapy, are typically assessed using the apnea-hypopnea index (AHI).

However, no standard definition of this measure exists, and whether AHI (and associated measures) are valid can i buy levitra at walgreens surrogate measure of clinical outcomes is unknown. OSA is commonly can i buy levitra at walgreens treated with the use of continuous positive airway pressure (CPAP) devices during sleep. The efficacy of CPAP, including for Food and Drug Administration (FDA) clearance/approval, has been based on changes in AHI, but the long-term effect of CPAP on clinical outcomes and the role of disease severity (as measured by AHI) or sleepiness symptoms on the putative effect of CPAP are unclear.After looking at 47 studies on this question, the AHRQ review concluded that there was no evidence to support the idea that CPAP treatment lowers "clinically important outcomes."And there isn't evidence that CPAP treatment of OSA influences individual aspects of cardiovascular disease, including Afib, which totally counters the mantra that sleep centers and Afib experts have been spouting for years.In fact, the two randomized controlled trials (RCTs) that report Afib came to opposite conclusions, with one showing it lowered risk and the other one showing that CPAP raised the risk of developing Afib!. Pretty much can i buy levitra at walgreens everything you thought would be helped by CPAP treatment has not been proven, says the AHRQ:Regarding other assessed outcomes, CPAP does not affect the risk of driving accidents or the risk of incident diabetes (both low SoE [standard of evidence]). CPAP does not result in clinically significant changes in depression or anxiety scores, executive cognitive function can i buy levitra at walgreens measures, or nonspecific quality of life measures (all low SoE).

There is insufficient evidence regarding the effect of CPAP on incident hypertension, functional status measures, male or female sexual function, or days of work missed.There is a clear and obvious way to prove that diagnosing OSA matters (beyond improving daytime sleep and snoring) and that OSA is a life-threatening disease. That is to randomize patients diagnosed with OSA to treatment with effective therapy (i.e., CPAP), and several of these have been can i buy levitra at walgreens performed. Unfortunately for the OSA business, the results of these RCTs do not show a benefit of therapy, consequently sleep experts/centers and businesses that sell OSA diagnostic and therapeutic equipment tend to gloss over, dismiss, or ignore these data.Clinical Correlations does a good job of summarizing the methods and outcomes of the major randomized trials for those interested and they concluded:Recurrent patterns emerge from these data reviewed here. Typical use of CPAP does not ameliorate the risks of fatal and nonfatal cardiovascular events in patients with OSA, though it can i buy levitra at walgreens may reduce symptoms of daytime sleepiness and snoring. Subgroup analyses of patients wearing CPAP over 4 hours per night suggest that CPAP may lower cardiovascular events.

However, these can i buy levitra at walgreens findings are subject to significant bias.Post-hoc subgroup analyses like the association of CPAP usage >4 hours with lower events cannot be used to prove causality. They should serve can i buy levitra at walgreens as hypothesis-generating. However, if your business is diagnosing and treating sleep apnea you are highly biased to cherry-pick the available studies.Thus, although the non-biased writers of the main analysis section at Clinical Correlations came to the proper conclusion -- no benefit -- a pulmonary/sleep medicine MD "commentary" addition concluded the exact opposite:As multiple studies have shown, treatment of OSA with CPAP has numerous cardiovascular benefits, including arrhythmia control and prevention of recurrence, improved glycemic control, and reduction of the risk for stroke and MI.This pro-sleep apnea treatment commentary focused on the CPAP>4 hour subgroup analysis without admitting the severe bias this introduces and without discussing how common this is.Such cherry-picking of the data is common in marketing and surprisingly throughout peer-reviewed articles in major journals. Social and news media summaries of such articles invariably eliminate discussion of the weakness of the observational database supporting the Afib/OSA connection and ignore the lack of support from RCTs.Screening and Marketing of OSAScreening for OSA is often done by questionnaires such as STOP-BANG or the Epworth Sleepiness Scale.STOP-BANG asks questions about snoring, sleepiness, observed apnea or choking and hypertension plus 4 clinical attributes (hypertension, obesity, age, neck size, and gender) and can i buy levitra at walgreens classifies patients as low, intermediate or high risk. It has a high sensitivity of 90% but a very low specificity of 36%.

This means that can i buy levitra at walgreens two-thirds of individuals who take this screening who don't have OSA when tested formally will be told they may have OSA.I just took the STOP-BANG questionnaire and scored 4 (age 50 years, hypertension, fatigued during the day, and male). This was classified as "high risk" for OSA.A male over age 55 already has 2 points on the score and since 3 points is considered "high risk of OSA" and all wives tell me their husbands snore, every man over age 55 is going to be can i buy levitra at walgreens identified at high risk.To summarize and answer the question in my title:Despite numerous flawed observational studies suggesting an association between sleep apnea and cardiovascular outcomes including Afib, the gold standard, high-quality RCT data do not clearly show that treatment of sleep apnea with CPAP improves cardiovascular outcomes.Until good scientific evidence proves that treatment of OSA really does save lives, reduces heart failure, Afib, or other important cardiovascular outcomes, widespread screening and marketing for the diagnosis and treatment of OSA other than reducing snoring and daytime sleepiness should cease.Anthony C. Pearson, MD, is a noninvasive cardiologist and professor of medicine at St. Louis University School of Medicine can i buy levitra at walgreens. He blogs on nutrition, cardiac testing, quackery, and other things worthy of skepticism at The Skeptical Cardiologist, where a version of this post first appeared..

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