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Thin tissue grafts and flexible electronics where to buy viagra have a women viagra cvs host of applications for wound healing, regenerative medicine and biosensing. A new device inspired by an octopus's sucker rapidly transfers delicate tissue or electronic sheets to the patient, overcoming a key barrier to clinical application, where to buy viagra according to researchers at the University of Illinois at Urbana-Champaign and collaborators."For the last few decades, cell or tissue sheets have been increasingly used to treat injured or diseased tissues. A crucial aspect of tissue transplantation surgery, such as corneal tissue transplantation surgery, is surgical gripping and safe transplantation of soft tissues. However, handling these living substances remains a grand challenge because they are fragile and easily crumple when picking them up from the culture media," said study leader Hyunjoon Kong, a where to buy viagra professor of chemical and biomolecular engineering at Illinois.Kong's group, along with collaborators at Purdue University, the University of Illinois at Chicago, Chung-Ang University in South Korea, and the Korea Advanced Institute for Science and Technology, published their work in the journal Science Advances.Current methods of transferring the sheets involve growing them on a temperature-sensitive soft polymer that, once transferred, shrinks and releases the thin film.

However, this process takes 30-60 minutes to transfer where to buy viagra a single sheet, requires skilled technicians and runs the risk of tearing or wrinkling, Kong said."During surgery, surgeons must minimize the risk of damage to soft tissues and transplant quickly, without contamination. Also, transfer of ultrathin materials without wrinkle or damage is another crucial aspect," Kong said.Seeking a way to quickly pick up and release the thin, delicate sheets of cells or electronics without damaging them, the researchers turned to the animal kingdom for inspiration. Seeing the way an octopus or squid can pick up both wet and dry objects of all shapes where to buy viagra with small pressure changes in their muscle-powered suction cups, rather than a sticky chemical adhesive, gave the researchers an idea.They designed a manipulator made of a temperature-responsive layer of soft hydrogel attached to an electric heater. To pick up a thin sheet, the researchers gently heat the hydrogel to shrink it, then press it to the sheet and turn off the heat.

The hydrogel expands where to buy viagra slightly, creating suction with the soft tissue or flexible electronic film so it can be lifted and transferred. Then they gently place the thin film on the target and turn the heater back on, shrinking the hydrogel and releasing the sheet.The entire process takes about 10 seconds.Next, the researchers hope to integrate sensors into the manipulator, to further take advantage of their soft, bio-inspired design."For where to buy viagra example, by integrating pressure sensors with the manipulator, it would be possible to monitor the deformation of target objects during contact and, in turn, adjust the suction force to a level at which materials retain their structural integrity and functionality," Kong said. "By doing so, we can improve the safety and accuracy of handling these materials. In addition, we aim to examine therapeutic efficacy of cells and tissues transferred by the soft manipulator."The National Science Foundation, the National Institutes of Health, the Department of where to buy viagra Defense Vision Research Program and the Jump Applied Research in Community Health through Engineering and Simulation endowment supported this work.American and Polish scientists, reporting Oct.

16 in the journal Science Advances, laid out a novel rationale for erectile dysfunction treatment drug design -- blocking a molecular "scissor" that the viagra uses for viagra production and to disable human proteins crucial to the immune response.The researchers are from The University of Texas Health Science Center at San Antonio (UT Health San Antonio) and the where to buy viagra Wroclaw University of Science and Technology. Information gleaned by the American team helped Polish chemists to develop two molecules that inhibit the cutter, an enzyme called erectile dysfunction-PLpro.erectile dysfunction-PLpro promotes by sensing and processing both viral and human proteins, said senior author Shaun K. Olsen, PhD, associate professor of biochemistry and structural biology in the Joe R where to buy viagra. And Teresa Lozano Long School of Medicine at UT Health San Antonio."This enzyme executes a double-whammy," Dr.

Olsen said where to buy viagra. "It stimulates the release of where to buy viagra proteins that are essential for the viagra to replicate, and it also inhibits molecules called cytokines and chemokines that signal the immune system to attack the ," Dr. Olsen said.erectile dysfunction-PLpro cuts human proteins ubiquitin and ISG15, which help maintain protein integrity. "The enzyme acts like where to buy viagra a molecular scissor," Dr.

Olsen said. "It cleaves ubiquitin and ISG15 away from other where to buy viagra proteins, which reverses their normal effects."Dr. Olsen's team, which recently moved to the Long School of Medicine at UT Health San Antonio from the Medical University of where to buy viagra South Carolina, solved the three-dimensional structures of erectile dysfunction-PLpro and the two inhibitor molecules, which are called VIR250 and VIR251. X-ray crystallography was performed at the Argonne National Laboratory near Chicago."Our collaborator, Dr.

Marcin Drag, and his team developed the where to buy viagra inhibitors, which are very efficient at blocking the activity of erectile dysfunction-PLpro, yet do not recognize other similar enzymes in human cells," Dr. Olsen said where to buy viagra. "This is a critical point. The inhibitor is specific for this one viral enzyme and doesn't cross-react with human enzymes with a similar function."Specificity will be a key determinant of therapeutic value down the road, he said.The American team also compared erectile dysfunction-PLpro against similar enzymes from erectile dysfunctiones where to buy viagra of recent decades, SARS-CoV-1 and MERS.

They learned that erectile dysfunction-PLpro processes ubiquitin and ISG15 much differently than its SARS-1 counterpart."One of the key questions is whether that accounts for some of the differences we see in how those viagraes affect humans, if at all," Dr. Olsen said.By understanding similarities and differences of these enzymes in where to buy viagra various erectile dysfunctiones, it may be possible to develop inhibitors that are effective against multiple viagraes, and these inhibitors potentially could be modified when other erectile dysfunction variants emerge in the future, he said.A new study by UBC researchers is set to change international treatment recommendations for people who are newly diagnosed with HIV -- an update that could affect nearly two million people per year worldwide.The study, published today by The Lancet in the journal EClinicalMedicine, was commissioned by the World Health Organization (WHO) as part of a planned update to its guidelines for HIV antiretroviral treatment (ART). The study found that dolutegravir is the optimal medication for first-line treatment for people newly diagnosed with HIV, a choice that has not been clear over the past several years."Research supporting the 2016 WHO guidelines suggested that dolutegravir was effective and well tolerated, but its efficacy and safety among where to buy viagra key populations, such as pregnant women and people living with both HIV and tuberculosis (TB), remained unclear," said the study's lead author, Dr. Steve Kanters, who completed the research as a PhD candidate in UBC's School of Population and Public Health (SPPH).

"In 2018, new research warned of a potentially serious increase in risk of neural tube defects in the children of women who became pregnant while taking this treatment."The risk of adverse reaction meant that, although dolutegravir was found to be favourable compared to other where to buy viagra options, it was only recommended as an alternative, with an antiretroviral called efavirenz recommended as the primary treatment.The study team, which included Dr. Nick Bansback, associate where to buy viagra professor at SPPH, Dr. Aslam Anis, professor at SPPH and director of the Centre for Health Evaluation and Outcome Sciences (CHÃOS), and Dr. Ehsan Karim, assistant professor at SPPH, completed a network meta-analysis of research stemming from 68 available antiretroviral therapy (ART) clinical trials.They found where to buy viagra dolutegravir was superior to efavirenz in most outcomes, including viral suppression, tolerability, and safety.

According to Kanters, the increased odds of viral suppression with dolutegravir could have a significant impact on achieving international goals for HIV treatment. advertisement "We found about a five per cent increase in the probability of viral suppression, which means that more people who start treatment will be able to successfully control their HIV," he said.Another key attribute of dolutegravir is that it is effective in people who are resistant where to buy viagra to NNRTI-class antiretrovirals, like efavirenz, a problem that is becoming increasingly common.The analysis also showed that dolutegravir and efavirenz had similar rates of adverse events for pregnant women -- the increased risk of neural tube defects for dolutegravir was estimated to be less than 0.3 per cent."The new evidence on neural tube defects show that the risk with dolutegravir is much more tolerable than previously thought and should quell the initial worry about this drug," said Kanters."Dolutegravir appears to be here to stay as the preferred treatment for people newly diagnosed with HIV," he said. "However, it is important to recognize the good that efavirenz has done over the past two decades, as it helped lead the ART scale-up around the world."Despite the many benefits of dolutegravir, dolutegravir use was associated with increased weight gain, a side effect that could increase the risk of aging-associated comorbidities, like heart attack or stroke."In many places, well-treated HIV has become where to buy viagra a chronic condition and we are now seeing people living long lives with HIV," said Kanters. "The research community will continue to monitor the effects dolutegravir may have on the healthy aging process."While this study is specifically focused on the optimal treatment for people newly diagnosed with HIV, an upcoming publication will review the evidence in support of switching to dolutegravir for people whose first treatment choice has been unsuccessful in controlling their .

This recommendation could mean improved treatment for the many people living with HIV around the world who are unable to achieve viral where to buy viagra suppression despite being on treatment.People with multiple sclerosis (MS) gradually develop increasing functional impairment. Researchers at Karolinska Institutet have now found a possible explanation for the progressive course of the disease in mice and how it can be reversed. The study, which is published in Science Immunology, can prove valuable to future treatments.MS is a chronic inflammatory where to buy viagra disease of the central nervous system (CNS) and one of the main causes of neurological functional impairment.The disease is generally diagnosed between 20 and 30 years of age. It can cause severe neurological symptoms, where to buy viagra such as loss of sensation and trembling, difficulties walking and maintaining balance, memory failure and visual impairment.MS is a life-long disease with symptoms that most often gradually worsen over time.In the majority of cases the disease comes in bouts with a certain amount of subsequent recovery.

A gradual loss of function with time is, however, inevitable. Research has made great progress in treatments that reduce the frequency and damaging effects of these bouts."Despite these important breakthroughs, the disease generally worsens when the patient has had it for 10 to 20 years," says Maja Jagodic, docent of experimental medicine at the Department of Clinical Neuroscience where to buy viagra and the Centre for Molecular Medicine, Karolinska Institutet. "There is currently only one, where to buy viagra recently approved, treatment for what is called the secondary progressive phase. The mechanisms behind this progressive phase require more research."Researchers at Karolinska Institutet have now shown that recovery from MS-like symptoms in mice depends on the ability of the CNS's own immune cells -- microglia -- to break down the remains of damaged cells, such as myelin.The processes was interrupted when the researchers removed a so-called autophagy gene, Atg7.

Autophagy is a process where cells normally break down and recycle where to buy viagra their own proteins and other structural components.Without Atg7 the ability of the microglia to clean away tissue residues created by the inflammation was reduced. These residues accumulated over time, which is a possible explanation for the progressiveness of the disease.The study also shows how microglia from aged mice resemble the cells from young mice that lacked Atg7 in terms of deficiencies in this process, which had a negative effect on the course of the disease.This is a significant result since increasing age is an important risk factor in the progressive phase of MS. The researchers also show how this process where to buy viagra can be reversed."The plant and fungi-derived sugar Trehalose restores the functional breakdown of myelin residues, stops the progression and leads to recovery from MS-like disease." says doctoral student Rasmus Berglund. "By enhancing this process we hope one day to where to buy viagra be able to treat and prevent age-related aspects of neuroinflammatory conditions." Story Source.

Materials provided by Karolinska Institutet. Note. Content may be edited for style and length..

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Marcela Maria does viagra raise blood pressure Estrada is an assistant professor of pediatric ophthalmology and adult strabismus at the UC Davis Health Eye Center. In the following Q&A, she answers questions about how vision problems can affect schoolwork, the impact of screen time on kidsâ eyes, and tips for healthy eyesight no matter what your age!. Pediatric ophthalmologist Marcela Maria Estrada brings lots of toys into the exam room.Do kids know they need glasses?. No, kids generally donât know they does viagra raise blood pressure have bad vision. They adapt to whatever eyesight they have.

But there are some clues for parents. For example, notice if your child is does viagra raise blood pressure squinting or standing really close to the television or other stimuli. Or if they hold books, phones or tablets really close to their face. If you notice your child doing any of these things, they may need glasses.Can poor eyesight impact kids during school?. Poor eyesight does viagra raise blood pressure absolutely can affect learning!.

If you have a child who does well with homework and reading materials but is inattentive in class and has behavioral issues, it may be a problem with the childâs vision. Kids donât know they should be able to see whatâs on the board.What has been the impact of the viagra on kidsâ eye health?. During this past year, weâve seen a lot of dry eyes â people, including kids, blink does viagra raise blood pressure less while staring at a screen. A normal blinking rate is 25-35 blinks per minute, but our blink rate decreases to five to seven times per minute when using electronic devices for a prolonged time.We have also seen a high spike in children with eyelid inflammation known as blepharitis, and inflammatory bumps on the eyelid known commonly as âstyes.â We call styles chalazion or hordeolum. Kids are at home more, and they arenât bathing and washing their faces as much as they used to.

Many are also wearing poorly fitting masks does viagra raise blood pressure that might not be so clean, so they are blowing their mouth germs up into their eyes. Combined with decreased blinking from screen time, itâs a recipe for eye problems.How has distance learning impacted eye health?. Kids often donât know they have poor eyesight, which is why screening and exams are important.Screen time increased dramatically during the viagra. Developmentally, childrenâs eyes are does viagra raise blood pressure still growing, so most are slightly âfarsighted,â which means itâs easier for them to see objects in the distance. Now kids are doing more close-up work, straining their eyes to keep things in focus.

We call that âaccommodating.âBut itâs not just at school. Almost every child now has a tablet, does viagra raise blood pressure iPad or cellphone with videos, games and social media that kids absorb for hours. So, in addition to distance learning, they are also playing on screens more outside of school hours, which increases eye strain.Whatâs the recommended amount of screen time for kids?. The American Academy of Pediatrics (AAP) recommends:no screen time other than video chatting for children younger than 18 monthsvery minimal screen time for children between 18 and 24 monthsno more than one hour per day of high-quality programming for children 2 to 5 years oldChildren are far exceeding that now. AAP used to recommend two hours or less per day for children older than 5, but they does viagra raise blood pressure now recommend developing a Family Media Plan.Why is it important to limit screen time?.

Toys can help keep young patients focused during eye exams.Spending too much time doing close work can permanently change the development of a childâs eye, which changes their vision and leads to more nearsightedness, called myopia. This not only sets children up for a lifetime of glasses, but also puts them at risk for complications of nearsightedness, like retinal detachment, glaucoma, amblyopia (âlazy eyeâ), and even blindness.What are some strategies to improve screen time?. A television across the room is better than a tablet close to does viagra raise blood pressure the face. So instead of letting your child stare at a phone or tablet, try streaming the content so your child can watch it on a television or large monitor. If they are on a laptop for distance learning, consider getting a separate monitor and putting it more than 25 inches, or an armâs length away, from your child.

Farther is does viagra raise blood pressure better.Should children wear sunglasses?. What about blue light glasses?. There is currently not enough evidence or data to support blue light glasses and filters to reduce the effects of strain on the eye. But children do need does viagra raise blood pressure sun protection for their eyes as much as adults. Sunglasses are especially important during the summer months when they are out in the bright sunlight.

During summer, itâs also important that kids wear goggles in the pool to prevent eye irritation from chlorine and chemical cleaners. Sunglasses are also important during winter if you are in the snow and thereâs does viagra raise blood pressure a lot of glare.Are carrots actually good for eyesight?. Yes, carrots are good for eyesight!. They contain beta-carotene, which the body uses to produce vitamin A. Vitamin A helps the eye convert does viagra raise blood pressure light to a signal sent to your brain.

Vitamin C and E, lutein and zeaxanthin are also important antioxidants for the eyes that are found in leafy greens, nuts, legumes, seeds, sweet potatoes and citrus fruits.Improve eyesight with the 20-20-20 Rule and âBLINKâ20-20-20 Rule. Every 20 minutes, look 20 feet away, for 20 seconds. BLINK B does viagra raise blood pressure. Blink more frequently!. L.

Lubricate your childâs eyes with artificial tears during the day or does viagra raise blood pressure artificial tear ointment at night. If your house is dry, use a humidifier.I. Inches away â Computers and screens should be viewed from at least 25 inches or an armâs length away.N. Near device breaks â Go outside for at least one hour per day to expose your eyes to natural light.K does viagra raise blood pressure. Know your sources â Follow evidence-based guidelines and strategies.

Good sources include your childâs pediatrician, pediatric ophthalmologist, the American Academy of Ophthalmology, and the American Association of Pediatric Ophthalmology and StrabismusIs there a special diet that helps eyesight?. A well-balanced, healthy diet, like the Mediterranean diet, is good does viagra raise blood pressure for eye health. We also know that a diet rich in Omega-3 fatty acids is good for eye health and can help treat dry eyes and eyelid inflammation. Omega-3s are a type of polyunsaturated fat. You can get them from fish like salmon, mackerel and albacore tuna, or does viagra raise blood pressure from fish oil.

If you are a vegetarian or vegan, you can get Omega-3s from plant sources like flaxseed or walnuts.You can also take multivitamins with Omega 3. They come in yummy liquid and gummy forms for children and picky eaters!. What should parents or caregivers do does viagra raise blood pressure if they think a child may be having vision problems?. A childâs vision can be screened by a pediatrician, family physician, optometrist, ophthalmologist or trained health care provider. Vision screens are also offered at schools, community health centers or community events.

In California, does viagra raise blood pressure kids get their vision screened at school in kindergarten, second, fifth and eighth grades.Vision can change quickly. We are seeing vision changes and progression in the strength of glasses sometimes in just six months. So even if your childâs vision has been normal, that may have changed. If you think your child might be having vision problems, make an appointment to have their vision screened.The UC Davis Eye CenterThe UC Davis Eye Center provides world-class eye care, pioneers collaborative vision research, and trains the next generation of specialists does viagra raise blood pressure and investigators to become leaders in the Sacramento region and beyond. The Eye Center team aims to transform vision care and develop cures for blinding eye diseases, from cornea to cortex.

The Eye Centerâs Pediatric Ophthalmology Service, an affiliate program of the UC Davis Children's Hospital, provides comprehensive evaluation, consultation and proven treatments for all aspects of routine and complex pediatric eye disease, as well as adult strabismus..

For many kids, itâs their website the month they are returning to the classroom where to buy viagra after more than a year of remote learning. Marcela Maria Estrada is an assistant professor of pediatric ophthalmology and adult strabismus at the UC Davis Health Eye Center. In the following Q&A, she answers questions about how vision problems can affect schoolwork, the impact of screen time on kidsâ eyes, and tips for healthy eyesight no matter what your age!. Pediatric ophthalmologist Marcela Maria Estrada brings lots of toys into the exam room.Do kids where to buy viagra know they need glasses?.

No, kids generally donât know they have bad vision. They adapt to whatever eyesight they have. But there are some clues for where to buy viagra parents. For example, notice if your child is squinting or standing really close to the television or other stimuli.

Or if they hold books, phones or tablets really close to their face. If you where to buy viagra notice your child doing any of these things, they may need glasses.Can poor eyesight impact kids during school?. Poor eyesight absolutely can affect learning!. If you have a child who does well with homework and reading materials but is inattentive in class and has behavioral issues, it may be a problem with the childâs vision.

Kids donât know they where to buy viagra should be able to see whatâs on the board.What has been the impact of the viagra on kidsâ eye health?. During this past year, weâve seen a lot of dry eyes â people, including kids, blink less while staring at a screen. A normal blinking rate is 25-35 blinks per minute, but our blink rate decreases to five to seven times per minute when using electronic devices for a prolonged time.We have also seen a high spike in children with eyelid inflammation known as blepharitis, and inflammatory bumps on the eyelid known commonly as âstyes.â We call styles chalazion or hordeolum. Kids are where to buy viagra at home more, and they arenât bathing and washing their faces as much as they used to.

Many are also wearing poorly fitting masks that might not be so clean, so they are blowing their mouth germs up into their eyes. Combined with decreased blinking from screen time, itâs a recipe for eye problems.How has distance learning impacted eye health?. Kids often donât know they have poor eyesight, which is why screening and exams are where to buy viagra important.Screen time increased dramatically during the viagra. Developmentally, childrenâs eyes are still growing, so most are slightly âfarsighted,â which means itâs easier for them to see objects in the distance.

Now kids are doing more close-up work, straining their eyes to keep things in focus. We call that âaccommodating.âBut itâs not just at where to buy viagra school. Almost every child now has a tablet, iPad or cellphone with videos, games and social media that kids absorb for hours. So, in addition to distance learning, they are also playing on screens more outside of school hours, which increases eye strain.Whatâs the recommended amount of screen time for kids?.

The American Academy of Pediatrics (AAP) recommends:no screen time other than video chatting for children younger than 18 monthsvery minimal screen time for children between 18 and 24 monthsno more than one hour per day of high-quality programming for children where to buy viagra 2 to 5 years oldChildren are far exceeding that now. AAP used to recommend two hours or less per day for children older than 5, but they now recommend developing a Family Media Plan.Why is it important to limit screen time?. Toys can help keep young patients focused during eye exams.Spending too much time doing close work can permanently change the development of a childâs eye, which changes their vision and leads to more nearsightedness, called myopia. This not only sets children up for a lifetime of glasses, but also puts them at risk for complications of nearsightedness, like where to buy viagra retinal detachment, glaucoma, amblyopia (âlazy eyeâ), and even blindness.What are some strategies to improve screen time?.

A television across the room is better than a tablet close to the face. So instead of letting your child stare at a phone or tablet, try streaming the content so your child can watch it on a television or large monitor. If they are on a laptop for distance learning, consider getting a separate monitor and putting it more than 25 where to buy viagra inches, or an armâs length away, from your child. Farther is better.Should children wear sunglasses?.

What about blue light glasses?. There is currently not enough evidence or data to support blue light where to buy viagra glasses and filters to reduce the effects of strain on the eye. But children do need sun protection for their eyes as much as adults. Sunglasses are especially important during the summer months when they are out in the bright sunlight.

During summer, itâs where to buy viagra also important that kids wear goggles in the pool to prevent eye irritation from chlorine and chemical cleaners. Sunglasses are also important during winter if you are in the snow and thereâs a lot of glare.Are carrots actually good for eyesight?. Yes, carrots are good for eyesight!. They contain beta-carotene, which the body where to buy viagra uses to produce vitamin A.

Vitamin A helps the eye convert light to a signal sent to your brain. Vitamin C and E, lutein and zeaxanthin are also important antioxidants for the eyes that are found in leafy greens, nuts, legumes, seeds, sweet potatoes and citrus fruits.Improve eyesight with the 20-20-20 Rule and âBLINKâ20-20-20 Rule. Every 20 minutes, look 20 feet away, where to buy viagra for 20 seconds. BLINK B.

Blink more frequently!. L. Lubricate your childâs eyes with artificial tears during the day or artificial tear ointment at night. If your house is dry, use a humidifier.I.

Inches away â Computers and screens should be viewed from at least 25 inches or an armâs length away.N. Near device breaks â Go outside for at least one hour per day to expose your eyes to natural light.K. Know your sources â Follow evidence-based guidelines and strategies. Good sources include your childâs pediatrician, pediatric ophthalmologist, the American Academy of Ophthalmology, and the American Association of Pediatric Ophthalmology and StrabismusIs there a special diet that helps eyesight?.

A well-balanced, healthy diet, like the Mediterranean diet, is good for eye health. We also know that a diet rich in Omega-3 fatty acids is good for eye health and can help treat dry eyes and eyelid inflammation. Omega-3s are a type of polyunsaturated fat. You can get them from fish like salmon, mackerel and albacore tuna, or from fish oil.

If you are a vegetarian or vegan, you can get Omega-3s from plant sources like flaxseed or walnuts.You can also take multivitamins with Omega 3. They come in yummy liquid and gummy forms for children and picky eaters!. What should parents or caregivers do if they think a child may be having vision problems?. A childâs vision can be screened by a pediatrician, family physician, optometrist, ophthalmologist or trained health care provider.

Vision screens are also offered at schools, community health centers or community events. In California, kids get their vision screened at school in kindergarten, second, fifth and eighth grades.Vision can change quickly. We are seeing vision changes and progression in the strength of glasses sometimes in just six months. So even if your childâs vision has been normal, that may have changed.

If you think your child might be having vision problems, make an appointment to have their vision screened.The UC Davis Eye CenterThe UC Davis Eye Center provides world-class eye care, pioneers collaborative vision research, and trains the next generation of specialists and investigators to become leaders in the Sacramento region and beyond. The Eye Center team aims to transform vision care and develop cures for blinding eye diseases, from cornea to cortex.

Where to get viagra

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

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

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

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

This has caused concern about the attainment gap, but as Quinn6 points out fewer children from disadvantaged backgrounds are likely to return to school than those from more affluent backgrounds.Government ministers and spokespeople reiterated that scientific evidence and observation of other European countries where schools had reopened demonstrated their decision where to get viagra was the correct one. However, there were no links provided to the scientific evidence and unions were quick to seize on this (eg, NASUWT7).The chief scientific advisor to the Department for Education, Osama Rahman, made a statement in a parliamentary science and technology committee meeting on 13 May that:There is a low degree of confidence in evidence that [children] might transmit it less.Carol Monaghan, the Scottish National Party education spokesperson, replied:Weâre putting together hundreds of potential vectors that can then go on and transmit. Is that where to get viagra correct?. Osama Rahman responded:Possibly, depending on school sizes.His final statement contains layers of complexity but can be interpreted simply as âwe donât knowâ.

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

Here are some of the available evidence.Morbidity and where to get viagra mortality in children from erectile dysfunction diseaseChildren appear to be less likely to acquire erectile dysfunction disease in various nations.9â11 Barton et al12 found that children account for 1.9% of confirmed cases (data collected from government websites and publications). Of these 8113 paediatric cases, 14% required hospital admission. The admission rate to critical care was 2.2% of confirmed cases (7.2% of admitted where to get viagra children). Death was reported in 15 where to get viagra cases (0.18%).

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

This provoked a where to buy viagra great deal of disquiet. Rahman had already stated that the Scientific Advisory Group for Emergencies (SAGE) was collecting and considering evidence that was new and emerging, and that confidence was low in the evidence relating to transmission because there was very little evidence.8 However, this normal scientific caution in the evidence base was not discussed, and therefore it was assumed that low or moderate confidence in the evidence means a high-risk strategy is being mooted.There appear to be two major concerns about lifting the lockdown for children. First is the where to buy viagra risk to children of developing erectile dysfunction disease. The second is the risk to others of children transmitting erectile dysfunction disease, either while being symptomatic or asymptomatic. Here are some of the available evidence.Morbidity and mortality in children from erectile dysfunction diseaseChildren appear to be less likely to acquire erectile dysfunction disease in various nations.9â11 Barton et al12 found that children account for 1.9% of confirmed cases (data where to buy viagra collected from government websites and publications).

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

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

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

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

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

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

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

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

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

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

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