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Still, the little we do know about TDI claimants and their outcomes, and lessons learned from other social insurance programs, seems important as we consider new options for medical leave policies. In this paper I (1) provide background information on the five state TDI programs, (2) discuss what studies of other social insurance programs suggest for how TDI affects labor force participation, (3) summarize recent research findings based on analyses of TDI data in California and Rhode Island, (4) consider future research options to address important unanswered questions, and (5) discuss policy implications..

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The core criteria for PhD success—ubiquitous to all disciplines and universities—are that the student;Has made an original and significant contribution to knowledge of the topic under investigation;Draws on a well-argued and cohesive conceptual/theoretical framework;Demonstrates the ability to critically evaluate and cipro tendonitis justify the research methodology and methods adopted;Can convey information (written and verbally) succinctly;Produces a thesis is of sufficient rigour that the work is evaluated as publishable in relevant discipline-specific journal(s).Table 1 highlights some of the key ingredients of PhD success, in terms of the study, thesis and viva.View this table:Table 1 Key principles to PhD study successJustifying methodsThe justification of methodological choices is usually presented in a distinct chapter that typically has two components. First, a ‘big picture’ description of the theoretical perspective and methodological justification (sometimes called the research approach), followed by an account of procedure (methods) of how the research was undertaken.Critical writingAn essential criterion expected from examiners is that students demonstrate criticality in the way they present and defend information. This can be a cipro tendonitis challenge, and many PhD students perceive that there is little guidance about how to develop effective arguments and few opportunities to develop critical writing skills.2 3 Similar to developing knowledge and understanding of research methods, students need the knowledge and skills for effective oral communication of ideas and writing.3The student must be able to write succinctly and critically to produce a robust and coherent thesis.2 4 A thesis should open with a clear outline of the problem, informing the reader what the thesis about and why the topic is important. It should detail what cipro tendonitis contexts and perspectives are relevant and offer an outline to the layout of the thesis. In all chapters, students should consider the following:Use of ‘signposts’ to tell the reader where they are going to go, summarising afterwards and providing appropriate links throughout.Meaningful headings.

The content of chapters and sections need to reflect the heading.Avoidance of vague terms or superfluous words, keeping sentences clear and focussed.Paragraphs that are distinct enough to cipro tendonitis explore and evaluate a clear issue but linked well enough to enhance the flow of the thesis. A general rule of thumb is that a paragraph should be about half a page. Any less and cipro tendonitis there is limited criticality, any longer and there is a tendency to ramble, lose focus and cause the reader to become disengaged.A PhD is not about how much the student can write. It is about how well they articulate and critically analyse information.Critical writing at Doctoral level is essential to establish the quality of the research and the credibility of the researcher. A good thesis creates a portrait of an authoritative and competent researcher, and critical writing is crucial for building the examiners’ confidence in the research undertaken.Publishable standard of the workPublishing in refereed cipro tendonitis journals and conferences is the traditional way in which the research community disseminates findings and builds knowledge, although there is increasing recognition of the role of social media platforms as a means of rapidly sharing knowledge.

Refereed journals use recognised standards (such as the CONSORT (Consolidated Standards of Reporting Trials) guidelines for trials)5 and rigorous review processes to assess the quality of a research paper, cipro tendonitis which must be met for successful publication. It is therefore unsurprising that many examiners view a thesis more favourably if a student provides evidence of having published elements of their work.6Summary of key considerationsUnlike undergraduate assessment, there is a paucity of research exploring the assessment of PhDs. However, a study that explored the process and judgements of experienced examiners,6 provided a valuable summary of the characteristics of a poor and excellent thesis (table 2).View this table:Table 2 Characteristics of a poor and excellent thesis6ConclusionThis article has cipro tendonitis outlined some of the steps that a PhD student should consider in order to produce a high-quality thesis and ensure a successful viva. We have considered how it is important that decision-making is transparent in the thesis, and defendable in the oral defence/viva. A PhD thesis cipro tendonitis should show evidence of originality and theoretical/conceptual cohesiveness, communicated via the student’s critical writing ability.

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In addition, the student must undertake an oral defence of their work through a discussion (the ‘viva’) with examiners, who are deemed to be experts in the field of study or with related methodological expertise.2A thesis is a self-contained monograph written by the student which:Sets out the problem and context of the research, including theoretical perspectives.Outlines existing approaches that have addressed the problem or related issues before, typically by undertaking a thorough critical analysis of literature and identifying a gap in the evidence.Justifies and critically evaluates the research methodologies and methods chosen to address the problem.Presents the finding of the research and how they add to existing knowledge.Makes recommendations as to how the findings can advance the discipline and improve practice, and/or suggest further research directions.What criteria are used to assess a PhD thesis?. The core criteria for PhD success—ubiquitous to all disciplines and universities—are that the student;Has made an original and significant contribution to knowledge of the topic under investigation;Draws on a well-argued and cohesive conceptual/theoretical framework;Demonstrates the ability to critically evaluate and justify the research methodology and methods adopted;Can convey information (written and verbally) succinctly;Produces a thesis is of sufficient rigour that the work is evaluated as publishable in relevant discipline-specific journal(s).Table 1 highlights some of how to order cipro online the key ingredients of PhD success, in terms of the study, thesis and viva.View this table:Table 1 Key principles to PhD study successJustifying methodsThe justification of methodological choices is usually presented in a distinct chapter that typically has two components. First, a ‘big picture’ description of the theoretical perspective and methodological justification (sometimes called the research approach), followed by an account of procedure (methods) of how the research was undertaken.Critical writingAn essential criterion expected from examiners is that students demonstrate criticality in the way they present and defend information. This can be a challenge, and many how to order cipro online PhD students perceive that there is little guidance about how to develop effective arguments and few opportunities to develop critical writing skills.2 3 Similar to developing knowledge and understanding of research methods, students need the knowledge and skills for effective oral communication of ideas and writing.3The student must be able to write succinctly and critically to produce a robust and coherent thesis.2 4 A thesis should open with a clear outline of the problem, informing the reader what the thesis about and why the topic is important.

It should detail what contexts and perspectives are relevant and offer an outline to the layout of the how to order cipro online thesis. In all chapters, students should consider the following:Use of ‘signposts’ to tell the reader where they are going to go, summarising afterwards and providing appropriate links throughout.Meaningful headings. The content of chapters and sections need to reflect how to order cipro online the heading.Avoidance of vague terms or superfluous words, keeping sentences clear and focussed.Paragraphs that are distinct enough to explore and evaluate a clear issue but linked well enough to enhance the flow of the thesis. A general rule of thumb is that a paragraph should be about half a page.

Any less and there is limited criticality, any longer and there is a how to order cipro online tendency to ramble, lose focus and cause the reader to become disengaged.A PhD is not about how much the student can write. It is about how well they articulate and critically analyse information.Critical writing at Doctoral level is essential to establish the quality of the research and the credibility of the researcher. A good thesis creates a portrait of an authoritative and competent researcher, and critical writing is crucial for building the examiners’ confidence in the research undertaken.Publishable standard of the workPublishing in refereed journals and conferences is the traditional way in which the research community disseminates findings and builds knowledge, although there is increasing recognition how to order cipro online of the role of social media platforms as a means of rapidly sharing knowledge. Refereed journals use recognised standards (such as the CONSORT (Consolidated Standards of Reporting Trials) guidelines for trials)5 and rigorous review processes to assess the quality of a how to order cipro online research paper, which must be met for successful publication.

It is therefore unsurprising that many examiners view a thesis more favourably if a student provides evidence of having published elements of their work.6Summary of key considerationsUnlike undergraduate assessment, there is a paucity of research exploring the assessment of PhDs. However, a study that explored the process and judgements of experienced examiners,6 provided a valuable summary of the characteristics of a poor and excellent thesis (table 2).View this table:Table how to order cipro online 2 Characteristics of a poor and excellent thesis6ConclusionThis article has outlined some of the steps that a PhD student should consider in order to produce a high-quality thesis and ensure a successful viva. We have considered how it is important that decision-making is transparent in the thesis, and defendable in the oral defence/viva. A PhD thesis should show evidence of originality and theoretical/conceptual cohesiveness, communicated via how to order cipro online the student’s critical writing ability.

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€œAt the very least, we need the same uniform standards that every state is using, and every location that administers treatment is using, so that we can have some comparisons and design better strategies to reach the populations we’re cipro online without prescription trying to reach,” Bibbins-Domingo said. Now that federal, state and local governments are easing mask requirements and ending other measures to prevent the spread of the cipro, efforts to boost vaccination rates in underserved communities are even more urgent. At St cipro online without prescription. James United Methodist Church, a cornerstone for many in the Black community in Kansas City, Missouri, in-person services recently resumed after being online for more than a year. St.

James has also been hosting cipro online without prescription vaccination events designed to reach people in the neighborhood. €œPeople are really grieving not only the loss of their loved ones, but the loss of a whole year, a loss of being lonely, a loss being at home, not being able to come to church. Not being able to go out into the community,” said Yvette Richards, St. James’ director of community cipro online without prescription connection. Missouri’s population is 11% African American, but buy antibiotics cases among African Americans accounted for 25% of the total cases for the state, according to an analysis by KFF.

Richards said cipro online without prescription St. James has lost many congregants to the antibiotics, and the empty pews where they once sat on Sundays serve as stark reminders of all this community has been through during the cipro. A quartet of singers takes the place of a choir at a physically distanced service at St. James United Methodist Church in Kansas City, Missouri.(Carlos Moreno / KCUR) Missouri’s public buy antibiotics data appears to show robust data on vaccination rates broken down by cipro online without prescription race and ethnicity. But several groups are seen lagging far behind on vaccinations, including African Americans, who appear to have a vaccination rate of just 17.6%, nearly half of the 33% rate for the state as a whole.

To Dr. Rex Archer, director of the Kansas City health department, one number is a giveaway that this data isn’t cipro online without prescription right. It shows a completed vaccination rate of 64% for “multiracial” Missourians. Such an cipro online without prescription exceptionally high rate for one group beggars belief, according to Archer. €œSo, there’s some huge problem with the way the state is collecting race and ethnicity under buy antibiotics vaccination,” Archer said.

Missouri state officials have acknowledged since February that this data is wrong, but they haven’t managed to fix it or explain exactly what’s causing it. Archer suggested the inflated cipro online without prescription multiracial rate is probably due to different racial data being reported when individuals receive first and second shots. Other problems have been detected, including missing racial and ethnic data for many people who have been vaccinated, and the use of multiple categories such as “other” and “unknown.” The state also noted it used national racial percentages in the state’s vaccination data rather than actual percentages based on the state’s population. For example, earlier in the vaccination effort, the state used national racial data, which shows nearly 6% cipro online without prescription of the population is Asian, even though Missouri’s population is 2.2% Asian. Health officials are working to target vaccination campaigns in communities where rates are low, but Archer said the state’s data provides little help.

€œI mean, we have to look at it, but it’s got too many variables to be something we can count on,” Archer said. Though racial and ethnic categories are clearly cipro online without prescription defined in national U.S. Census data, the same data is not collected uniformly by states. For example, South Carolina’s vaccination data lumps together Asians, Native Americans and Pacific Islanders in one category. In Utah, residents can pick more cipro online without prescription than one race.

Wyoming doesn’t report racial or ethnic data for vaccinations at all. Bibbins-Domingo said the missing or inconsistent data doesn’t necessarily cipro online without prescription mean tracking equity is a lost cause. Vaccination rates for census tracts where racial and ethnic data is known can be used as a proxy to estimate treatment allocations. However, Bibbins-Domingo argued that the cipro has shined a light on racial data problems that have persisted far too long in U.S. Public health cipro online without prescription.

€œWhat my hope is, is that our lessons from buy antibiotics really cause all of us to think about the infrastructure we need within our state and nationally to make sure we are prepared next time,” Bibbins-Domingo said. €œData is our friend.” The Rev. Emmanuel Cleaver cipro online without prescription III welcomes congregants to St. James United Methodist Church in Kansas City, Missouri, where in-person services were paused for more than a year because of the buy antibiotics cipro.(Carlos Moreno / KCUR) Local leaders and health officials in Missouri are scrambling to boost vaccination rates, especially among vulnerable communities, after Republican Gov. Mike Parson cipro online without prescription recently announced steps to urge residents back to working in person.

Parson ordered state workers back to the office in May and said he would end additional federal cipro-related benefits for unemployed workers in June, despite vaccination rates across the state being well below what Missouri health experts had hoped to achieve. Jackson County, Missouri, which includes most of Kansas City, authorized $5 million in federal CARES funding last month to increase vaccinations in six ZIP codes with large Black populations and low vaccination rates. The project cipro online without prescription will address problems of both access and hesitancy and focus on reaching out to individuals and neighborhoods. Although many of the state’s vaccination efforts have involved large mass events, St. James Pastor Jackie McCall said she’s been talking with many in her church and community who need encouragement to have faith in the cipro online without prescription treatments.

€œSo let’s go ahead and let’s trust,” McCall told congregants. €œLet’s trust the process. Let’s trust cipro online without prescription God. Let’s trust the science.” This story is part of a reporting partnership that includes KCUR, NPR and KHN. Alex Smith, KCUR.

@AlexSmithKCUR Related Topics Contact Us Submit a cipro online without prescription Story TipThe Food and Drug Administration’s decision next week whether to approve the first treatment for Alzheimer’s disease highlights a deep division over the drug’s benefits as well as criticism about the integrity of the FDA approval process. The agency said it will decide by June 7 the fate of Biogen’s drug aducanumab, despite a near-unanimous rejection of the product by an FDA advisory committee of outside experts in November. Doubts were raised when, in 2019, Biogen halted two large clinical trials of the drug after determining it wouldn’t reach its targets for efficacy cipro online without prescription. But the drugmaker later revised that assessment, stating that one trial showed the drug reduced the decline in patients’ cognitive and functional ability by 22%. Some FDA scientists in November joined with the company to present a document praising the intravenous drug.

But other FDA officials and many outside experts say the evidence for the drug is shaky at best and that another large clinical trial is cipro online without prescription needed. A consumer advocacy group has called for a federal investigation into the FDA’s handling of the approval process for the product. A lot is riding on the drug for Biogen. It is projected to carry a $50,000-a-year price tag and would cipro online without prescription be worth billions of dollars in revenue to the Cambridge, Massachusetts, company. The FDA is under pressure because an estimated 6 million Americans are diagnosed with Alzheimer’s, a debilitating and ultimately fatal form of dementia, and there are no drugs on the market to treat the underlying disease.

Although some drugs slightly mitigate symptoms, patients and their families are desperate cipro online without prescription for a medication that even modestly slows its progression. Aducanumab helps the body produce antibodies that remove amyloid plaques from the brain, which has been associated with Alzheimer’s. It’s designed for patients with mild-to-moderate cognitive decline from Alzheimer’s, of which there are an estimated 2 million Americans. But it’s not clear whether eliminating the plaque cipro online without prescription improves brain function in Alzheimer’s patients. So far, nearly two dozen drugs based on the so-called amyloid hypothesis have failed in clinical trials.

Besides questions cipro online without prescription about whether the drug works, there also are safety issues. More than one-third of patients in one of the trials experienced brain swelling and nearly 20% had brain bleeding, though those symptoms generally were mild and controllable. Because of those risks, patients receiving aducanumab have to undergo regular brain monitoring through expensive PET scans and MRI tests. Some physicians who treat Alzheimer’s patients cipro online without prescription say they won’t prescribe the drug even if it’s approved. €œThere’s a lot of hope among my patients that this is going to be a game changer,” said Dr.

Matthew Schrag, an assistant professor of neurology at Vanderbilt University. €œBut the cipro online without prescription cognitive benefits of this drug are quite small, we don’t know the long-term safety risks, and there will be a lot of practical issues in deploying this therapy. We have to wait until we’re certain we’re doing the right thing for patients.” Many aspects of aducanumab’s journey through the FDA approval process have been unusual. It’s “vanishingly rare” for a drug to continue on toward approval after its clinical trial was halted cipro online without prescription because unfavorable results showed that further testing was futile, said Dr. Peter Lurie, president of the Center for Science in the Public Interest and a former FDA associate commissioner.

And it’s “mind-boggling,” he added, for the FDA to collaborate with a drugmaker in presenting a joint briefing document to an FDA advisory committee. €œA joint briefing document strikes me as completely inappropriate and an abdication of the FDA’s claim to being the best regulatory agency in the world,” cipro online without prescription Lurie said. Three FDA advisory committee members who voted in November against approving the drug wrote in a recent JAMA commentary that the FDA’s “unusual degree of collaboration” with Biogen led to criticism that it “potentially compromised the FDA’s objectivity.” They cast doubt on both the drug’s safety and the revised efficacy data. The FDA and Biogen declined to comment for this article. Despite the uncertainties, the Alzheimer’s Association, the nation’s largest Alzheimer’s patient advocacy group, has pushed hard for FDA approval of aducanumab, mounting a major print and online ad campaign last month cipro online without prescription.

The “More Time” campaign featured personal stories from patients and family members. In one cipro online without prescription ad, actor Samuel L. Jackson posted on Twitter, “If a drug could slow Alzheimer’s, giving me more time with my mom, I would have read to her more.” But the association has drawn criticism for having its representatives testify before the FDA in support of the drug without disclosing that it received $525,000 in contributions last year from Biogen and its partner company, Eisai, and hundreds of thousands of dollars more in previous years. Other people who testified stated upfront whether or not they had financial conflicts. Dr.

Leslie Norins, founder of a group called Alzheimer’s Germ Quest that supports research, said the lack of disclosure hurts the Alzheimer’s Association’s credibility. €œWhen the association asks the FDA to approve a drug, shouldn’t it have to reveal that it received millions of dollars from the drug company?. € he asked. But Joanne Pike, the Alzheimer’s Association’s chief strategy officer, who testified before the FDA advisory committee about aducanumab without disclosing the contributions, denied that the association was hiding anything or that it supported the drug’s approval because of the drugmakers’ money. Anyone can search the association’s website to find all corporate contributions, she said in an interview.

Pike said her association backs the drug’s approval because its potential to slow patients’ cognitive and functional decline offers substantial benefits to patients and their caregivers, its side effects are “manageable,” and it will spur the development of other, more effective Alzheimer’s treatments. €œHistory has shown that approvals of first drugs in a category benefit people because they invigorate the pipeline,” she said. €œThe first drug is a start, and the second and third and fourth treatment could do even better.” Lurie disputed that. He said lowering the FDA’s standards and approving an ineffective or marginally effective drug merely encourages other manufacturers to develop similar, “me too” drugs that also don’t work well. Anne Saint says she wouldn’t have risked putting her husband, Mike Saint, on the new Alzheimer’s drug aducanumab because of safety issues.

Mike died in September at age 71. (Molly Saint) The Public Citizen Health Research Group, which opposes approval of aducanumab, has called for an investigation of the FDA’s “unprecedented and inappropriate close collaboration” with Biogen. It asked the inspector general of the Department of Health and Human Services to probe the approval process, which that office said it would consider. The group also urged the acting FDA commissioner, Dr. Janet Woodcock, to remove Dr.

Billy Dunn, an aducanumab advocate who testified about it to the advisory committee, from his position as director of the FDA’s Office of Neuroscience and hand over review of the drug to staffers who weren’t involved in the Biogen collaboration. Woodcock refused, saying in a letter that FDA “interactions” with drugmakers make drug development “more efficient and more effective” and “do not interfere with the FDA’s independent perspective.” Although it would be unusual for the FDA to approve a drug after rejection by an FDA advisory committee, it’s not unprecedented, Lurie said. Alternatively, the agency could approve it on a restricted basis, limiting it to a segment of the Alzheimer’s patient population and/or requiring Biogen to monitor patients. €œThat will be tempting but shouldn’t be the way the problem is solved,” he said. €œIf the product doesn’t work, it doesn’t work.

Once it’s on the market, it’s very difficult to get it off.” If the drug is approved, Alzheimer’s patients and their families will have to make a difficult calculation, balancing the limited potential benefits with proven safety issues. Anne Saint, whose husband, Mike, had Alzheimer’s for a decade and died in September at age 71, said that based on what she’s read about aducanumab, she wouldn’t have put him on the drug. €œMike was having brain bleeds anyway, and I wouldn’t have risked him having any more side effects, with no sure positive outcome,” said Saint, who lives in Franklin, Tennessee. €œIt sounds like maybe that drug’s not going to work, for a lot of money.” Their adult daughter, Sarah Riley Saint, feels differently. €œIf this is the only hope, why not try it and see if it helps?.

€ she said. Mike Saint walks daughter Molly down the aisle at her October 2019 wedding in Nashville, Tennessee. (Wandering Woo Photography) Harris Meyer. @Meyer_HM Related Topics Contact Us Submit a Story TipPresident Joe Biden has ordered U.S. Intelligence agencies to determine whether the buy antibiotics cipro, or a near ancestor, emerged from a cave, a live-animal market, a farm — or a secretive Chinese laboratory.

But it’s doubtful this probe will yield definitive insights, and it could even backfire. Some experts hypothesize that global pressure could prompt a Chinese scientific whistleblower to come forward with evidence of a lab leak. After all, it is unlikely such an accident could have occurred without dozens of people finding out about the leak, or an ensuing cover-up. But the growing political pressure to discover Chinese malfeasance or a lab accident at the root of the cipro could make a definitive answer less, rather than more, likely, according to virologists and experts on U.S.-China scientific exchanges. €œWe have to reduce the political tension and let the scientists do the work, not the politicians,” said Dr.

Jennifer Huang Bouey, a Chinese-born Rand Corp. Researcher. Yet that seems like a pipe dream. In the United States, the lab leak theory is part of the conservative arsenal of attacks on those in science and the media who criticized President Donald Trump’s handling of the cipro. For the ruling Chinese Communist Party, the political implications of acknowledging a lab leak and subsequent cover-up are a non-starter.

It would leave China essentially responsible for starting a global cipro that has killed 6 million and ground economies to a halt. As Biden last week announced a 90-day review of evidence on the cipro’s origin — which could involve a review of documents from U.S. Agencies that helped fund Chinese viral research— Chinese officials at a World Health Organization meeting dismissed the review and withdrew a promise to cooperate with scientists examining the full slate of origin possibilities. During its visit to China in February, a WHO investigative team received agreement from Chinese blood banks to preserve samples of donations that could indicate when and where the cipro might have been circulating before it swept over the city of Wuhan in December 2019. The team wants to go back to China, extending its investigation to markets and farms where animals like civet cats, raccoon dogs and bamboo rats — potential carriers of the cipro as it leaped from bats to humans — were raised as part of a $70 billion “wildlife farming” industry.

In 2003, China banned the sale of such exotic wildlife at “wet markets” — which mainly sell fish and game like live chickens — after they were implicated as the origin of the SARS epidemic, though such animals have returned to markets over the years. Further study is impossible without Chinese cooperation, which is mired in politics, the WHO investigators say. €œWe’re not following all these obvious leads now,” Dr. Marion Koopmans, a leading Dutch virologist who was part of the WHO team, said last week. €œEverything is stalled.” Her team has been criticized for caving to Chinese pressure by failing to seek a strict audit of the Wuhan Institute of Virology, the center of allegations about a lab leak.

But to forcefully demand such an audit would require evidence of a leak, rather than speculation based on classified intelligence reports and theoretical gaps in data, Koopmans said. Besides, the Chinese government won’t open its books. It has closed access to the data, claiming there had been thousands of hacking attempts against the Wuhan Institute. That awkward standoff could harm U.S.-Chinese scientific cooperation, which has gradually expanded over the past 40 years and remained strong despite Trump administration attacks. Whether a lab leak happened or not, it’s hard to see how a weakening of scientific exchanges would be a good thing for either country.

Full-tuition-paying Chinese students made up the majority of the international enrollees at U.S. Colleges and universities in 2019, though Chinese interest in U.S. Schools seems to be ebbing. U.S. Laboratories depend on Chinese scholars, many of whom end up remaining in the United States.

Scholars from the two countries co-publish scientific papers more often than any other national “dyad,” according to research by Caroline Wagner of the Ohio State University. But those partnerships have had their hiccups, sometimes for political reasons. With AIDS and SARS, the Chinese were either reluctant to allow their scientists to release data or released counts that many Western experts doubted were accurate. Trump curtailed scientific exchanges as early as 2017, issuing fewer visas and raising FBI vigilance of academics with ties to China. Some interagency agreements were allowed to lapse and, in 2018, a 45-member Centers for Disease Control and Prevention contingent in China was cut to 10.

Trump saw this as a punishment of the Chinese, but it effectively blinded the U.S. To the goings-on in Chinese epidemiology. Otherwise, “maybe we’d have had a quicker leg up on the outbreak,” said Ben Corb, spokesperson for the American Society for Biochemistry and Molecular Biology. Despite his anti-China stance, Trump in 2018 renewed a landmark 1979 agreement authorizing scientific and technological cooperation among the Chinese and U.S. Governments.

However, that renewal document is secret — presumably, Trump was not happy to have to take the advice of his scientific advisers — and it’s impossible to come by a copy, according to Duke University business professor Denis Simon, an expert on the US-China scientific relationship. The Biden administration is said to favor improving scientific cooperation — for example, by easing limits on visas for Chinese scholars. And while Trump clearly viewed the lab leak hypothesis as an opportunity to blame China for the administration’s misfortunate buy antibiotics response — an association that tarnished the theory’s plausibility during the Trump years — Biden seems to want an answer to the question, at least in part to prevent future cipros. Since the turn of the century and especially since SARS, China has sent many biologists to train in the United States, and they are now leery of being seen as unreliable partners in disease investigations. The Chinese government has copied many aspects of the U.S.

Scientific and public health system, Bouey noted. Close collaborations and friendships have resulted. Toward the beginning of the cipro, Dr. Anthony Fauci, the National Institutes of Health’s top infectious disease specialist, was in regular contact by email with George Gao, the Oxford- and Harvard-trained scientist who runs China’s equivalent of the CDC. Even with Chinese government cooperation, we might never know how buy antibiotics began.

But if the intelligence review suggests or manages to determine that a lab leak did cause the cipro, and China continues to stonewall, it’s hard to predict what might happen. €œI think there will be hell to pay,” said Simon. €œWe haven’t figured out the consequences to the answer. I’m very concerned about our ability to manage the emotions loosed if that hypothesis were to be accepted.” This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. Arthur Allen.

ArthurA@kff.org, @ArthurAllen202 Related Topics Contact Us Submit a Story Tip.

Throughout the buy antibiotics vaccination effort, public health officials and politicians have insisted that providing shots equitably across racial and ethnic groups is a top priority how to order cipro online. But it’s been left up to states to decide how to do that and to collect racial and ethnic data on vaccinated individuals so states can track how well they’re doing reaching all groups. The gaps and inconsistencies in the data have made it difficult to understand who’s actually getting shots how to order cipro online. Just as an uneven approach to containing the antibiotics led to a greater toll for Black and Latino communities, the inconsistent data guiding vaccination efforts may be leaving the same groups out on treatments, said Dr.

Kirsten Bibbins-Domingo, an epidemiologist at the University of California-San Francisco. €œAt the very least, we need the how to order cipro online same uniform standards that every state is using, and every location that administers treatment is using, so that we can have some comparisons and design better strategies to reach the populations we’re trying to reach,” Bibbins-Domingo said. Now that federal, state and local governments are easing mask requirements and ending other measures to prevent the spread of the cipro, efforts to boost vaccination rates in underserved communities are even more urgent. At St how to order cipro online.

James United Methodist Church, a cornerstone for many in the Black community in Kansas City, Missouri, in-person services recently resumed after being online for more than a year. St. James has also been hosting vaccination events designed to how to order cipro online reach people in the neighborhood. €œPeople are really grieving not only the loss of their loved ones, but the loss of a whole year, a loss of being lonely, a loss being at home, not being able to come to church.

Not being able to go out into the community,” said Yvette Richards, St. James’ director how to order cipro online of community connection. Missouri’s population is 11% African American, but buy antibiotics cases among African Americans accounted for 25% of the total cases for the state, according to an analysis by KFF. Richards said how to order cipro online St.

James has lost many congregants to the antibiotics, and the empty pews where they once sat on Sundays serve as stark reminders of all this community has been through during the cipro. A quartet of singers takes the place of a choir at a physically distanced service at St. James United Methodist Church in how to order cipro online Kansas City, Missouri.(Carlos Moreno / KCUR) Missouri’s public buy antibiotics data appears to show robust data on vaccination rates broken down by race and ethnicity. But several groups are seen lagging far behind on vaccinations, including African Americans, who appear to have a vaccination rate of just 17.6%, nearly half of the 33% rate for the state as a whole.

To Dr. Rex Archer, director of the Kansas City health department, one number is a giveaway how to order cipro online that this data isn’t right. It shows a completed vaccination rate of 64% for “multiracial” Missourians. Such an exceptionally high rate for one group beggars belief, according to Archer how to order cipro online.

€œSo, there’s some huge problem with the way the state is collecting race and ethnicity under buy antibiotics vaccination,” Archer said. Missouri state officials have acknowledged since February that this data is wrong, but they haven’t managed to fix it or explain exactly what’s causing it. Archer suggested the inflated how to order cipro online multiracial rate is probably due to different racial data being reported when individuals receive first and second shots. Other problems have been detected, including missing racial and ethnic data for many people who have been vaccinated, and the use of multiple categories such as “other” and “unknown.” The state also noted it used national racial percentages in the state’s vaccination data rather than actual percentages based on the state’s population.

For example, earlier in the vaccination effort, the state used national racial how to order cipro online data, which shows nearly 6% of the population is Asian, even though Missouri’s population is 2.2% Asian. Health officials are working to target vaccination campaigns in communities where rates are low, but Archer said the state’s data provides little help. €œI mean, we have to look at it, but it’s got too many variables to be something we can count on,” Archer said. Though racial and ethnic categories are how to order cipro online clearly defined in national U.S.

Census data, the same data is not collected uniformly by states. For example, South Carolina’s vaccination data lumps together Asians, Native Americans and Pacific Islanders in one category. In Utah, residents can pick how to order cipro online more than one race. Wyoming doesn’t report racial or ethnic data for vaccinations at all.

Bibbins-Domingo said the missing or inconsistent data doesn’t how to order cipro online necessarily mean tracking equity is a lost cause. Vaccination rates for census tracts where racial and ethnic data is known can be used as a proxy to estimate treatment allocations. However, Bibbins-Domingo argued that the cipro has shined a light on racial data problems that have persisted far too long in U.S. Public health how to order cipro online.

€œWhat my hope is, is that our lessons from buy antibiotics really cause all of us to think about the infrastructure we need within our state and nationally to make sure we are prepared next time,” Bibbins-Domingo said. €œData is our friend.” The Rev. Emmanuel Cleaver III welcomes congregants to St how to order cipro online. James United Methodist Church in Kansas City, Missouri, where in-person services were paused for more than a year because of the buy antibiotics cipro.(Carlos Moreno / KCUR) Local leaders and health officials in Missouri are scrambling to boost vaccination rates, especially among vulnerable communities, after Republican Gov.

Mike Parson recently announced steps to urge residents back to working in how to order cipro online person. Parson ordered state workers back to the office in May and said he would end additional federal cipro-related benefits for unemployed workers in June, despite vaccination rates across the state being well below what Missouri health experts had hoped to achieve. Jackson County, Missouri, which includes most of Kansas City, authorized $5 million in federal CARES funding last month to increase vaccinations in six ZIP codes with large Black populations and low vaccination rates. The project will address problems of both access and hesitancy how to order cipro online and focus on reaching out to individuals and neighborhoods.

Although many of the state’s vaccination efforts have involved large mass events, St. James Pastor Jackie McCall said she’s been talking with many in her church and community who need encouragement to have faith in the how to order cipro online treatments. €œSo let’s go ahead and let’s trust,” McCall told congregants. €œLet’s trust the process.

Let’s trust God how to order cipro online. Let’s trust the science.” This story is part of a reporting partnership that includes KCUR, NPR and KHN. Alex Smith, KCUR. @AlexSmithKCUR Related Topics Contact Us Submit a Story TipThe Food and Drug Administration’s decision next week whether to approve the first treatment for how to order cipro online Alzheimer’s disease highlights a deep division over the drug’s benefits as well as criticism about the integrity of the FDA approval process.

The agency said it will decide by June 7 the fate of Biogen’s drug aducanumab, despite a near-unanimous rejection of the product by an FDA advisory committee of outside experts in November. Doubts were raised when, in 2019, Biogen halted two large clinical trials of the drug after determining it wouldn’t how to order cipro online reach its targets for efficacy. But the drugmaker later revised that assessment, stating that one trial showed the drug reduced the decline in patients’ cognitive and functional ability by 22%. Some FDA scientists in November joined with the company to present a document praising the intravenous drug.

But other FDA officials and many outside experts say the evidence for the drug is shaky at best and that how to order cipro online another large clinical trial is needed. A consumer advocacy group has called for a federal investigation into the FDA’s handling of the approval process for the product. A lot is riding on the drug for Biogen. It is projected to carry a $50,000-a-year price tag and would be worth billions of dollars in how to order cipro online revenue to the Cambridge, Massachusetts, company.

The FDA is under pressure because an estimated 6 million Americans are diagnosed with Alzheimer’s, a debilitating and ultimately fatal form of dementia, and there are no drugs on the market to treat the underlying disease. Although some drugs slightly mitigate symptoms, patients and how to order cipro online their families are desperate for a medication that even modestly slows its progression. Aducanumab helps the body produce antibodies that remove amyloid plaques from the brain, which has been associated with Alzheimer’s. It’s designed for patients with mild-to-moderate cognitive decline from Alzheimer’s, of which there are an estimated 2 million Americans.

But it’s not clear whether eliminating the plaque improves how to order cipro online brain function in Alzheimer’s patients. So far, nearly two dozen drugs based on the so-called amyloid hypothesis have failed in clinical trials. Besides questions about whether the drug how to order cipro online works, there also are safety issues. More than one-third of patients in one of the trials experienced brain swelling and nearly 20% had brain bleeding, though those symptoms generally were mild and controllable.

Because of those risks, patients receiving aducanumab have to undergo regular brain monitoring through expensive PET scans and MRI tests. Some physicians who treat Alzheimer’s patients say they won’t prescribe the drug even how to order cipro online if it’s approved. €œThere’s a lot of hope among my patients that this is going to be a game changer,” said Dr. Matthew Schrag, an assistant professor of neurology at Vanderbilt University.

€œBut the how to order cipro online cognitive benefits of this drug are quite small, we don’t know the long-term safety risks, and there will be a lot of practical issues in deploying this therapy. We have to wait until we’re certain we’re doing the right thing for patients.” Many aspects of aducanumab’s journey through the FDA approval process have been unusual. It’s “vanishingly rare” for a drug to continue on toward approval how to order cipro online after its clinical trial was halted because unfavorable results showed that further testing was futile, said Dr. Peter Lurie, president of the Center for Science in the Public Interest and a former FDA associate commissioner.

And it’s “mind-boggling,” he added, for the FDA to collaborate with a drugmaker in presenting a joint briefing document to an FDA advisory committee. €œA joint briefing document strikes me as completely inappropriate and an abdication of the FDA’s claim to being the best regulatory agency in the world,” how to order cipro online Lurie said. Three FDA advisory committee members who voted in November against approving the drug wrote in a recent JAMA commentary that the FDA’s “unusual degree of collaboration” with Biogen led to criticism that it “potentially compromised the FDA’s objectivity.” They cast doubt on both the drug’s safety and the revised efficacy data. The FDA and Biogen declined to comment for this article.

Despite the uncertainties, the Alzheimer’s Association, the nation’s largest Alzheimer’s patient advocacy group, has pushed hard how to order cipro online for FDA approval of aducanumab, mounting a major print and online ad campaign last month. The “More Time” campaign featured personal stories from patients and family members. In one ad, actor Samuel how to order cipro online L. Jackson posted on Twitter, “If a drug could slow Alzheimer’s, giving me more time with my mom, I would have read to her more.” But the association has drawn criticism for having its representatives testify before the FDA in support of the drug without disclosing that it received $525,000 in contributions last year from Biogen and its partner company, Eisai, and hundreds of thousands of dollars more in previous years.

Other people who testified stated upfront whether or not they had financial conflicts. Dr. Leslie Norins, founder of a group called Alzheimer’s Germ Quest that supports research, said the lack of disclosure hurts the Alzheimer’s Association’s credibility. €œWhen the association asks the FDA to approve a drug, shouldn’t it have to reveal that it received millions of dollars from the drug company?.

€ he asked. But Joanne Pike, the Alzheimer’s Association’s chief strategy officer, who testified before the FDA advisory committee about aducanumab without disclosing the contributions, denied that the association was hiding anything or that it supported the drug’s approval because of the drugmakers’ money. Anyone can search the association’s website to find all corporate contributions, she said in an interview. Pike said her association backs the drug’s approval because its potential to slow patients’ cognitive and functional decline offers substantial benefits to patients and their caregivers, its side effects are “manageable,” and it will spur the development of other, more effective Alzheimer’s treatments.

€œHistory has shown that approvals of first drugs in a category benefit people because they invigorate the pipeline,” she said. €œThe first drug is a start, and the second and third and fourth treatment could do even better.” Lurie disputed that. He said lowering the FDA’s standards and approving an ineffective or marginally effective drug merely encourages other manufacturers to develop similar, “me too” drugs that also don’t work well. Anne Saint says she wouldn’t have risked putting her husband, Mike Saint, on the new Alzheimer’s drug aducanumab because of safety issues.

Mike died in September at age 71. (Molly Saint) The Public Citizen Health Research Group, which opposes approval of aducanumab, has called for an investigation of the FDA’s “unprecedented and inappropriate close collaboration” with Biogen. It asked the inspector general of the Department of Health and Human Services to probe the approval process, which that office said it would consider. The group also urged the acting FDA commissioner, Dr.

Janet Woodcock, to remove Dr. Billy Dunn, an aducanumab advocate who testified about it to the advisory committee, from his position as director of the FDA’s Office of Neuroscience and hand over review of the drug to staffers who weren’t involved in the Biogen collaboration. Woodcock refused, saying in a letter that FDA “interactions” with drugmakers make drug development “more efficient and more effective” and “do not interfere with the FDA’s independent perspective.” Although it would be unusual for the FDA to approve a drug after rejection by an FDA advisory committee, it’s not unprecedented, Lurie said. Alternatively, the agency could approve it on a restricted basis, limiting it to a segment of the Alzheimer’s patient population and/or requiring Biogen to monitor patients.

€œThat will be tempting but shouldn’t be the way the problem is solved,” he said. €œIf the product doesn’t work, it doesn’t work. Once it’s on the market, it’s very difficult to get it off.” If the drug is approved, Alzheimer’s patients and their families will have to make a difficult calculation, balancing the limited potential benefits with proven safety issues. Anne Saint, whose husband, Mike, had Alzheimer’s for a decade and died in September at age 71, said that based on what she’s read about aducanumab, she wouldn’t have put him on the drug.

€œMike was having brain bleeds anyway, and I wouldn’t have risked him having any more side effects, with no sure positive outcome,” said Saint, who lives in Franklin, Tennessee. €œIt sounds like maybe that drug’s not going to work, for a lot of money.” Their adult daughter, Sarah Riley Saint, feels differently. €œIf this is the only hope, why not try it and see if it helps?. € she said.

Mike Saint walks daughter Molly down the aisle at her October 2019 wedding in Nashville, Tennessee. (Wandering Woo Photography) Harris Meyer. @Meyer_HM Related Topics Contact Us Submit a Story TipPresident Joe Biden has ordered U.S. Intelligence agencies to determine whether the buy antibiotics cipro, or a near ancestor, emerged from a cave, a live-animal market, a farm — or a secretive Chinese laboratory.

But it’s doubtful this probe will yield definitive insights, and it could even backfire. Some experts hypothesize that global pressure could prompt a Chinese scientific whistleblower to come forward with evidence of a lab leak. After all, it is unlikely such an accident could have occurred without dozens of people finding out about the leak, or an ensuing cover-up. But the growing political pressure to discover Chinese malfeasance or a lab accident at the root of the cipro could make a definitive answer less, rather than more, likely, according to virologists and experts on U.S.-China scientific exchanges.

€œWe have to reduce the political tension and let the scientists do the work, not the politicians,” said Dr. Jennifer Huang Bouey, a Chinese-born Rand Corp. Researcher. Yet that seems like a pipe dream.

In the United States, the lab leak theory is part of the conservative arsenal of attacks on those in science and the media who criticized President Donald Trump’s handling of the cipro. For the ruling Chinese Communist Party, the political implications of acknowledging a lab leak and subsequent cover-up are a non-starter. It would leave China essentially responsible for starting a global cipro that has killed 6 million and ground economies to a halt. As Biden last week announced a 90-day review of evidence on the cipro’s origin — which could involve a review of documents from U.S.

Agencies that helped fund Chinese viral research— Chinese officials at a World Health Organization meeting dismissed the review and withdrew a promise to cooperate with scientists examining the full slate of origin possibilities. During its visit to China in February, a WHO investigative team received agreement from Chinese blood banks to preserve samples of donations that could indicate when and where the cipro might have been circulating before it swept over the city of Wuhan in December 2019. The team wants to go back to China, extending its investigation to markets and farms where animals like civet cats, raccoon dogs and bamboo rats — potential carriers of the cipro as it leaped from bats to humans — were raised as part of a $70 billion “wildlife farming” industry. In 2003, China banned the sale of such exotic wildlife at “wet markets” — which mainly sell fish and game like live chickens — after they were implicated as the origin of the SARS epidemic, though such animals have returned to markets over the years.

Further study is impossible without Chinese cooperation, which is mired in politics, the WHO investigators say. €œWe’re not following all these obvious leads now,” Dr. Marion Koopmans, a leading Dutch virologist who was part of the WHO team, said last week. €œEverything is stalled.” Her team has been criticized for caving to Chinese pressure by failing to seek a strict audit of the Wuhan Institute of Virology, the center of allegations about a lab leak.

But to forcefully demand such an audit would require evidence of a leak, rather than speculation based on classified intelligence reports and theoretical gaps in data, Koopmans said. Besides, the Chinese government won’t open its books. It has closed access to the data, claiming there had been thousands of hacking attempts against the Wuhan Institute. That awkward standoff could harm U.S.-Chinese scientific cooperation, which has gradually expanded over the past 40 years and remained strong despite Trump administration attacks.

Whether a lab leak happened or not, it’s hard to see how a weakening of scientific exchanges would be a good thing for either country. Full-tuition-paying Chinese students made up the majority of the international enrollees at U.S. Colleges and universities in 2019, though Chinese interest in U.S. Schools seems to be ebbing.

U.S. Laboratories depend on Chinese scholars, many of whom end up remaining in the United States. Scholars from the two countries co-publish scientific papers more often than any other national “dyad,” according to research by Caroline Wagner of the Ohio State University. But those partnerships have had their hiccups, sometimes for political reasons.

With AIDS and SARS, the Chinese were either reluctant to allow their scientists to release data or released counts that many Western experts doubted were accurate. Trump curtailed scientific exchanges as early as 2017, issuing fewer visas and raising FBI vigilance of academics with ties to China. Some interagency agreements were allowed to lapse and, in 2018, a 45-member Centers for Disease Control and Prevention contingent in China was cut to 10. Trump saw this as a punishment of the Chinese, but it effectively blinded the U.S.

To the goings-on in Chinese epidemiology. Otherwise, “maybe we’d have had a quicker leg up on the outbreak,” said Ben Corb, spokesperson for the American Society for Biochemistry and Molecular Biology. Despite his anti-China stance, Trump in 2018 renewed a landmark 1979 agreement authorizing scientific and technological cooperation among the Chinese and U.S. Governments.

However, that renewal document is secret — presumably, Trump was not happy to have to take the advice of his scientific advisers — and it’s impossible to come by a copy, according to Duke University business professor Denis Simon, an expert on the US-China scientific relationship. The Biden administration is said to favor improving scientific cooperation — for example, by easing limits on visas for Chinese scholars. And while Trump clearly viewed the lab leak hypothesis as an opportunity to blame China for the administration’s misfortunate buy antibiotics response — an association that tarnished the theory’s plausibility during the Trump years — Biden seems to want an answer to the question, at least in part to prevent future cipros. Since the turn of the century and especially since SARS, China has sent many biologists to train in the United States, and they are now leery of being seen as unreliable partners in disease investigations.

The Chinese government has copied many aspects of the U.S. Scientific and public health system, Bouey noted. Close collaborations and friendships have resulted. Toward the beginning of the cipro, Dr.

Anthony Fauci, the National Institutes of Health’s top infectious disease specialist, was in regular contact by email with George Gao, the Oxford- and Harvard-trained scientist who runs China’s equivalent of the CDC. Even with Chinese government cooperation, we might never know how buy antibiotics began. But if the intelligence review suggests or manages to determine that a lab leak did cause the cipro, and China continues to stonewall, it’s hard to predict what might happen. €œI think there will be hell to pay,” said Simon.

€œWe haven’t figured out the consequences to the answer. I’m very concerned about our ability to manage the emotions loosed if that hypothesis were to be accepted.” This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. Arthur Allen. ArthurA@kff.org, @ArthurAllen202 Related Topics Contact Us Submit a Story Tip.

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