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Now difference between proair hfa and ventolin hfa Joe has a bill that he can’t pay ventolin tablet online. Read below to find out -- SHORT ANSWER. QMB or Medicaid will pay the Medicare coinsurance only in limited situations.

First, the ventolin tablet online provider must be a Medicaid provider. Second, even if the provider accepts Medicaid, under recent legislation in New York enacted in 2015 and 2016, QMB or Medicaid may pay only part of the coinsurance, or none at all. This depends in part on whether the beneficiary has Original Medicare or is in a Medicare Advantage plan, and in part on the type of service.

However, the bottom line is that the provider is barred from "balance billing" a QMB ventolin tablet online beneficiary for the Medicare coinsurance. Unfortunately, this creates tension between an individual and her doctors, pharmacies dispensing Part B medications, and other providers. Providers may not know they are not allowed to bill a QMB beneficiary for Medicare coinsurance, since they bill other Medicare beneficiaries.

Even those who know may pressure their patients to ventolin tablet online pay, or simply decline to serve them. These rights and the ramifications of these QMB rules are explained in this article. CMS is doing more education about QMB Rights.

The Medicare Handbook, ventolin tablet online since 2017, gives information about QMB Protections. Download the 2020 Medicare Handbook here. See pp.

53, 86 ventolin tablet online. 1. To Which Providers will QMB or Medicaid Pay the Medicare Co-Insurance?.

"Providers must enroll as Medicaid providers in order to bill Medicaid for the Medicare coinsurance." CMS Informational Bulletin issued January 6, 2012, titled "Billing for Services Provided to ventolin tablet online Qualified Medicare Beneficiaries (QMBs). The CMS bulletin states, "If the provider wants Medicaid to pay the coinsurance, then the provider must register as a Medicaid provider under the state rules." If the provider chooses not to enroll as a Medicaid provider, they still may not "balance bill" the QMB recipient for the coinsurance. 2.

How Does a Provider that ventolin tablet online DOES accept Medicaid Bill for a QMB Beneficiary?. If beneficiary has Original Medicare -- The provider bills Medicaid - even if the QMB Beneficiary does not also have Medicaid. Medicaid is required to pay the provider for all Medicare Part A and B cost-sharing charges for a QMB beneficiary, even if the service is normally not covered by Medicaid (ie, chiropractic, podiatry and clinical social work care).

Whatever ventolin tablet online reimbursement Medicaid pays the provider constitutes by law payment in full, and the provider cannot bill the beneficiary for any difference remaining. 42 U.S.C. § 1396a(n)(3)(A), NYS DOH 2000-ADM-7 If the QMB beneficiary is in a Medicare Advantage plan - The provider bills the Medicare Advantage plan, then bills Medicaid for the balance using a “16” code to get paid.

The provider must include the ventolin tablet online amount it received from Medicare Advantage plan. 3. For a Provider who accepts Medicaid, How Much of the Medicare Coinsurance will be Paid for a QMB or Medicaid Beneficiary in NYS?.

The answer to this question has ventolin tablet online changed by laws enacted in 2015 and 2016. In the proposed 2019 State Budget, Gov. Cuomo has proposed to reduce how much Medicaid pays for the Medicare costs even further.

The amount Medicaid pays is different depending on whether the individual has Original Medicare or is a Medicare Advantage plan, with better payment ventolin tablet online for those in Medicare Advantage plans. The answer also differs based on the type of service. Part A Deductibles and Coinsurance - Medicaid pays the full Part A hospital deductible ($1,408 in 2020) and Skilled Nursing Facility coinsurance ($176/day) for days 20 - 100 of a rehab stay.

Full payment is made for QMB beneficiaries and Medicaid recipients ventolin tablet online who have no spend-down. Payments are reduced if the beneficiary has a Medicaid spend-down. For in-patient hospital deductible, Medicaid will pay only if six times the monthly spend-down has been met.

For example, if Mary has a $200/month spend down which has not been met otherwise, Medicaid will pay only $164 ventolin tablet online of the hospital deductible (the amount exceeding 6 x $200). See more on spend-down here. Medicare Part B - Deductible - Currently, Medicaid pays the full Medicare approved charges until the beneficiary has met the annual deductible, which is $198 in 2020.

For ventolin tablet online example, Dr. John charges $500 for a visit, for which the Medicare approved charge is $198. Medicaid pays the entire $198, meeting the deductible.

If the beneficiary has a spend-down, then the Medicaid payment would be subject to ventolin tablet online the spend-down. In the 2019 proposed state budget, Gov. Cuomo proposed to reduce the amount Medicaid pays toward the deductible to the same amount paid for coinsurance during the year, described below.

This proposal was REJECTED by the ventolin tablet online state legislature. Co-Insurance - The amount medicaid pays in NYS is different for Original Medicare and Medicare Advantage. If individual has Original Medicare, QMB/Medicaid will pay the 20% Part B coinsurance only to the extent the total combined payment the provider receives from Medicare and Medicaid is the lesser of the Medicaid or Medicare rate for the service.

For example, if the Medicare rate for a service is $100, the coinsurance is ventolin tablet online $20. If the Medicaid rate for the same service is only $80 or less, Medicaid would pay nothing, as it would consider the doctor fully paid = the provider has received the full Medicaid rate, which is lesser than the Medicare rate. Exceptions - Medicaid/QMB wil pay the full coinsurance for the following services, regardless of the Medicaid rate.

ambulance and ventolin tablet online psychologists - The Gov's 2019 proposal to eliminate these exceptions was rejected. hospital outpatient clinic, certain facilities operating under certificates issued under the Mental Hygiene Law for people with developmental disabilities, psychiatric disability, and chemical dependence (Mental Hygiene Law Articles 16, 31 or 32). SSL 367-a, subd.

1(d)(iii)-(v) , as amended 2015 If individual is in a Medicare Advantage plan, ventolin tablet online 85% of the copayment will be paid to the provider (must be a Medicaid provider), regardless of how low the Medicaid rate is. This limit was enacted in the 2016 State Budget, and is better than what the Governor proposed - which was the same rule used in Original Medicare -- NONE of the copayment or coinsurance would be paid if the Medicaid rate was lower than the Medicare rate for the service, which is usually the case. This would have deterred doctors and other providers from being willing to treat them.

SSL ventolin tablet online 367-a, subd. 1(d)(iv), added 2016. EXCEPTIONS.

The Medicare Advantage plan must pay the full coinsurance for the ventolin tablet online following services, regardless of the Medicaid rate. ambulance ) psychologist ) The Gov's proposal in the 2019 budget to eliminate these exceptions was rejected by the legislature Example to illustrate the current rules. The Medicare rate for Mary's specialist visit is $185.

The Medicaid rate for the same ventolin tablet online service is $120. Current rules (since 2016). Medicare Advantage -- Medicare Advantage plan pays $135 and Mary is charged a copayment of $50 (amount varies by plan).

Medicaid pays the ventolin tablet online specialist 85% of the $50 copayment, which is $42.50. The doctor is prohibited by federal law from "balance billing" QMB beneficiaries for the balance of that copayment. Since provider is getting $177.50 of the $185 approved rate, provider will hopefully not be deterred from serving Mary or other QMBs/Medicaid recipients.

Original Medicare ventolin tablet online - The 20% coinsurance is $37. Medicaid pays none of the coinsurance because the Medicaid rate ($120) is lower than the amount the provider already received from Medicare ($148). For both Medicare Advantage and Original Medicare, if the bill was for a ambulance or psychologist, Medicaid would pay the full 20% coinsurance regardless of the Medicaid rate.

The proposal to eliminate this exception was rejected by the legislature in 2019 budget ventolin tablet online. . 4.

May the Provider 'Balance Bill" a QMB Benficiary for the Coinsurance if Provider ventolin tablet online Does Not Accept Medicaid, or if Neither the Patient or Medicaid/QMB pays any coinsurance?. No. Balance billing is banned by the Balanced Budget Act of 1997.

42 ventolin tablet online U.S.C. § 1396a(n)(3)(A). In an Informational Bulletin issued January 6, 2012, titled "Billing for Services Provided to Qualified Medicare Beneficiaries (QMBs)," the federal Medicare agency - CMS - clarified that providers MAY NOT BILL QMB recipients for the Medicare coinsurance.

This is true whether or not the provider is ventolin tablet online registered as a Medicaid provider. If the provider wants Medicaid to pay the coinsurance, then the provider must register as a Medicaid provider under the state rules. This is a change in policy in implementing Section 1902(n)(3)(B) of the Social Security Act (the Act), as modified by section 4714 of the Balanced Budget Act of 1997, which prohibits Medicare providers from balance-billing QMBs for Medicare cost-sharing.

The CMS letter states, "All Medicare physicians, providers, and suppliers who offer services and supplies to QMBs are prohibited from billing QMBs for Medicare ventolin tablet online cost-sharing, including deductible, coinsurance, and copayments. This section of the Act is available at. CMCS Informational Bulletin http://www.ssa.gov/OP_Home/ssact/title19/1902.htm.

QMBs have no legal obligation to ventolin tablet online make further payment to a provider or Medicare managed care plan for Part A or Part B cost sharing. Providers who inappropriately bill QMBs for Medicare cost-sharing are subject to sanctions. Please note that the statute referenced above supersedes CMS State Medicaid Manual, Chapter 3, Eligibility, 3490.14 (b), which is no longer in effect, but may be causing confusion about QMB billing." The same information was sent to providers in this Medicare Learning Network bulletin, last revised in June 26, 2018.

CMS reminded Medicare Advantage plans of ventolin tablet online the rule against Balance Billing in the 2017 Call Letter for plan renewals. See this excerpt of the 2017 call letter by Justice in Aging - Prohibition on Billing Medicare-Medicaid Enrollees for Medicare Cost Sharing 5. How do QMB Beneficiaries Show a Provider that they have QMB and cannot be Billed for the Coinsurance?.

It can be difficult to show a provider that one is ventolin tablet online a QMB. It is especially difficult for providers who are not Medicaid providers to identify QMB's, since they do not have access to online Medicaid eligibility systems Consumers can now call 1-800-MEDICARE to verify their QMB Status and report a billing issue. If a consumer reports a balance billng problem to this number, the Customer Service Rep can escalate the complaint to the Medicare Administrative Contractor (MAC), which will send a compliance letter to the provider with a copy to the consumer.

See CMS Medicare Learning Network Bulletin ventolin tablet online effective Dec. 16, 2016. Medicare Summary Notices (MSNs) that Medicare beneficiaries receive every three months state that QMBs have no financial liability for co-insurance for each Medicare-covered service listed on the MSN.

The Remittance Advice (RA) that Medicare sends to providers shows the same information ventolin tablet online. By spelling out billing protections on a service-by-service basis, the MSNs provide clarity for both the QMB beneficiary and the provider. Justice in Aging has posted samples of what the new MSNs look like here.

They have also updated Justice in Aging’s Improper Billing Toolkit to incorporate references to ventolin tablet online the MSNs in its model letters that you can use to advocate for clients who have been improperly billed for Medicare-covered services. CMS is implementing systems changes that will notify providers when they process a Medicare claim that the patient is QMB and has no cost-sharing liability. The Medicare Summary Notice sent to the beneficiary will also state that the beneficiary has QMB and no liability.

These changes were scheduled to go into effect in October 2017, but have been delayed ventolin tablet online. Read more about them in this Justice in Aging Issue Brief on New Strategies in Fighting Improper Billing for QMBs (Feb. 2017).

QMBs are issued ventolin tablet online a Medicaid benefit card (by mail), even if they do not also receive Medicaid. The card is the mechanism for health care providers to bill the QMB program for the Medicare deductibles and co-pays. Unfortunately, the Medicaid card does not indicate QMB eligibility.

Not all people who have Medicaid ventolin tablet online also have QMB (they may have higher incomes and "spend down" to the Medicaid limits. Advocates have asked for a special QMB card, or a notation on the Medicaid card to show that the individual has QMB. See this Report - a National Survey on QMB Identification Practices published by Justice in Aging, authored by Peter Travitsky, NYLAG EFLRP staff attorney.

The Report, published in March 2017, documents how QMB beneficiaries could be better identified in order to ensure providers ventolin tablet online do not bill them improperly. What Codes the Provider Sees in eMedNY &. EPACES Medicaid eligibility system - see GIS 16 MA/005 - Changes to eMedNY for Certain Medicaid Recipient Coverage Codes (PDF) ​​​​​​​Recipient Coverage Code "09" is defined as "Medicare Savings Program only" (MSP) and is used along with an eMedNY Buy-in span and MSP code of "P" to define a Qualified Medicare Beneficiary (QMB).

Providers will receive the following eligibility messages when verifying coverage on EMEVS ventolin tablet online and ePaces. "Medicare coinsurance and deductible only" for individuals with Coverage Code 06 and an MSP code of P. *Code 06 is "provisional Medicaid coverage" for Medicaid recipients found provisionally eligible for Medicaid, subject to meeting the spend-down.

See more about provisional ventolin tablet online coverage here. "Family Planning Benefit and Medicare Coinsurance and Ded" for individuals with Coverage Code 18 and an MSP code of P. "Code 18" is for Medicare beneficiaries who are enrolled in the Family Planning Benefit Program (FPBP), who are also income eligible for QMB.

6 ventolin tablet online. If you are Billed -​ Strategies Consumers can now call 1-800-MEDICARE to report a billing issue. If a consumer reports a balance billng problem to this number, the Customer Service Rep can escalate the complaint to the Medicare Administrative Contractor (MAC), which will send a compliance letter to the provider with a copy to the consumer.

See CMS ventolin tablet online Medicare Learning Network Bulletin effective Dec. 16, 2016. Send a letter to the provider, using the Justice In Aging Model model letters to providers to explain QMB rights.​​​ both for Original Medicare (Letters 1-2) and Medicare Advantage (Letters 3-5) - see Overview of model letters.

Include a link to the CMS Medicare Learning Network Notice ventolin tablet online. Prohibition on Balance Billing Dually Eligible Individuals Enrolled in the Qualified Medicare Beneficiary (QMB) Program (revised June 26. 2018) In January 2017, the Consumer Finance Protection Bureau issued this guide to QMB billing.

A consumer who has a problem with ventolin tablet online debt collection, may also submit a complaint online or call the CFPB at 1-855-411-2372. TTY/TDD users can call 1-855-729-2372. Medicare Advantage members should complain to their Medicare Advantage plan.

In its 2017 Call Letter, CMS stressed to Medicare Advantage ventolin tablet online contractors that federal regulations at 42 C.F.R. § 422.504 (g)(1)(iii), require that provider contracts must prohibit collection of deductibles and co-payments from dual eligibles and QMBs. Toolkit to Help Protect QMB Rights ​​In July 2015, CMS issued a report, "Access to Care Issues Among Qualified Medicare Beneficiaries (QMB's)" documenting how pervasive illegal attempts to bill QMBs for the Medicare coinsurance, including those who are members of managed care plans.

Justice in Aging, a national advocacy organization, ventolin tablet online has a project to educate beneficiaries about balance billing and to advocate for stronger protections for QMBs. Links to their webinars and other resources is at this link. Their information includes.

September 4, 2009, updated 6/20/20 by Valerie Bogart, NYLAG ventolin tablet online Author. Cathy Roberts. Author.

Geoffrey Hale This article was authored by the Empire ventolin tablet online Justice Center.Some "dual eligible" beneficiaries (people who have Medicare and Medicaid) are entitled to receive reimbursement of their Medicare Part B premiums from New York State through the Medicare Insurance Premium Payment Program (MIPP). The Part B premium is $148.50 in 2021. MIPP is for some groups who are either not eligible for -- or who are not yet enrolled in-- the Medicare Savings Program (MSP), which is the main program that pays the Medicare Part B premium for low-income people.

Some people are not eligible for an MSP even though ventolin tablet online they have full Medicaid with no spend down. This is because they are in a special Medicaid eligibility category -- discussed below -- with Medicaid income limits that are actually HIGHER than the MSP income limits. MIPP reimburses them for their Part B premium because they have “full Medicaid” (no spend down) but are ineligible for MSP because their income is above the MSP SLIMB level (120% of the Federal Poverty Level (FPL).

Even if their income is ventolin tablet online under the QI-1 MSP level (135% FPL), someone cannot have both QI-1 and Medicaid). Instead, these consumers can have their Part B premium reimbursed through the MIPP program. In this article.

The MIPP program was established because the State determined that those who have full Medicaid and Medicare ventolin tablet online Part B should be reimbursed for their Part B premium, even if they do not qualify for MSP, because Medicare is considered cost effective third party health insurance, and because consumers must enroll in Medicare as a condition of eligibility for Medicaid (See 89 ADM 7). There are generally four groups of dual-eligible consumers that are eligible for MIPP. Therefore, many MBI WPD consumers have incomes higher than what MSP normally allows, but still have full Medicaid with no spend down.

Those consumers can qualify for MIPP and ventolin tablet online have their Part B premiums reimbursed. Here is an example. Sam is age 50 and has Medicare and MBI-WPD.

She gets $1500/mo gross from Social Security Disability and also makes $400/month ventolin tablet online through work activity. $ 167.50 -- EARNED INCOME - Because she is disabled, the DAB earned income disregard applies. $400 - $65 = $335.

Her countable earned income is 1/2 of $335 = $167.50 + $1500.00 -- UNEARNED INCOME from Social Security Disability ventolin tablet online = $1,667.50 --TOTAL income. This is above the SLIMB limit of $1,288 (2021) but she can still qualify for MIPP. 2.

Parent/Caretaker ventolin tablet online Relatives with MAGI-like Budgeting - Including Medicare Beneficiaries. Consumers who fall into the DAB category (Age 65+/Disabled/Blind) and would otherwise be budgeted with non-MAGI rules can opt to use Affordable Care Act MAGI rules if they are the parent/caretaker of a child under age 18 or under age 19 and in school full time. This is referred to as “MAGI-like budgeting.” Under MAGI rules income can be up to 138% of the FPL—again, higher than the limit for DAB budgeting, which is equivalent to only 83% FPL.

MAGI-like consumers can be enrolled in either MSP or MIPP, depending ventolin tablet online on if their income is higher or lower than 120% of the FPL. If their income is under 120% FPL, they are eligible for MSP as a SLIMB. If income is above 120% FPL, then they can enroll in MIPP.

(See GIS 18 MA/001 - 2018 Medicaid Managed Care Transition for Enrollees Gaining Medicare, #4) 3 ventolin tablet online. New Medicare Enrollees who are Not Yet in a Medicare Savings Program When a consumer has Medicaid through the New York State of Health (NYSoH) Marketplace and then enrolls in Medicare when she turns age 65 or because she received Social Security Disability for 24 months, her Medicaid case is normally** transferred to the local department of social services (LDSS)(HRA in NYC) to be rebudgeted under non-MAGI budgeting. During the transition process, she should be reimbursed for the Part B premiums via MIPP.

However, the transition time ventolin tablet online can vary based on age. AGE 65+ For those who enroll in Medicare at age 65+, the Medicaid case takes about four months to be rebudgeted and approved by the LDSS. The consumer is entitled to MIPP payments for at least three months during the transition.

Once the case is with ventolin tablet online the LDSS she should automatically be re-evaluated for MSP. Consumers UNDER 65 who receive Medicare due to disability status are entitled to keep MAGI Medicaid through NYSoH for up to 12 months (also known as continuous coverage, See NY Social Services Law 366, subd. 4(c).

These consumers should receive MIPP payments for as long as their cases remain with NYSoH and throughout the ventolin tablet online transition to the LDSS. NOTE during asthma treatment emergency their case may remain with NYSoH for more than 12 months. See here.

See GIS 18 MA/001 - 2018 Medicaid ventolin tablet online Managed Care Transition for Enrollees Gaining Medicare, #4 for an explanation of this process. Note. During the asthma treatment emergency, those who have Medicaid through the NYSOH marketplace and enroll in Medicare should NOT have their cases transitioned to the LDSS.

They should keep the same MAGI budgeting and automatically receive ventolin tablet online MIPP payments. See GIS 20 MA/04 or this article on asthma treatment eligibility changes 4. Those with Special Budgeting after Losing SSI (DAC, Pickle, 1619b) Disabled Adult Child (DAC).

Special budgeting is available to those who are 18+ and lose SSI because they begin receiving Disabled Adult Child (DAC) benefits (or receive an ventolin tablet online increase in the amount of their benefit). Consumer must have become disabled or blind before age 22 to receive the benefit. If the new DAC benefit amount was disregarded and the consumer would otherwise be eligible for SSI, they can keep Medicaid eligibility with NO SPEND DOWN.

See this ventolin tablet online article. Consumers may have income higher than MSP limits, but keep full Medicaid with no spend down. Therefore, they are eligible for payment of their Part B premiums.

See page ventolin tablet online 96 of the Medicaid Reference Guide (Categorical Factors). If their income is lower than the MSP SLIMB threshold, they can be added to MSP. If higher than the threshold, they can be reimbursed via MIPP.

See ventolin tablet online also 95-ADM-11. Medical Assistance Eligibility for Disabled Adult Children, Section C (pg 8). Pickle &.

1619B. 5. When the Part B Premium Reduces Countable Income to Below the Medicaid Limit Since the Part B premium can be used as a deduction from gross income, it may reduce someone's countable income to below the Medicaid limit.

The consumer should be paid the difference to bring her up to the Medicaid level ($904/month in 2021). They will only be reimbursed for the difference between their countable income and $904, not necessarily the full amount of the premium. See GIS 02-MA-019.

Reimbursement of Health Insurance Premiums MIPP and MSP are similar in that they both pay for the Medicare Part B premium, but there are some key differences. MIPP structures the payments as reimbursement -- beneficiaries must continue to pay their premium (via a monthly deduction from their Social Security check or quarterly billing, if they do not receive Social Security) and then are reimbursed via check. In contrast, MSP enrollees are not charged for their premium.

Their Social Security check usually increases because the Part B premium is no longer withheld from their check. MIPP only provides reimbursement for Part B. It does not have any of the other benefits MSPs can provide, such as.

A consumer cannot have MIPP without also having Medicaid, whereas MSP enrollees can have MSP only. Of the above benefits, Medicaid also provides Part D Extra Help automatic eligibility. There is no application process for MIPP because consumers should be screened and enrolled automatically (00 OMM/ADM-7).

Either the state or the LDSS is responsible for screening &. Distributing MIPP payments, depending on where the Medicaid case is held and administered (14 /2014 LCM-02 Section V). If a consumer is eligible for MIPP and is not receiving it, they should contact whichever agency holds their case and request enrollment.

Unfortunately, since there is no formal process for applying, it may require some advocacy. If Medicaid case is at New York State of Health they should call 1-855-355-5777. Consumers will likely have to ask for a supervisor in order to find someone familiar with MIPP.

If Medicaid case is with HRA in New York City, they should email mipp@hra.nyc.gov. If Medicaid case is with other local districts in NYS, call your local county DSS. Once enrolled, it make take a few months for payments to begin.

Payments will be made in the form of checks from the Computer Sciences Corporation (CSC), the fiscal agent for the New York State Medicaid program. The check itself comes attached to a remittance notice from Medicaid Management Information Systems (MMIS). Unfortunately, the notice is not consumer-friendly and may be confusing.

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AbstractGGC repeat expansion in the 5′ untranslated region of NOTCH2NLC is the most ventolin tablet online common causative factor in neuronal intranuclear inclusion disease (NIID) in have a peek at this site Asians. Such expanded GGC repeats have been identified in patients with leukoencephalopathy, essential tremor (ET), multiple system atrophy, Parkinson’s disease (PD), amyotrophic lateral sclerosis and oculopharyngodistal myopathy (OPDM). Herein, we review the recently reported NOTCH2NLC-related disorders and potential disease-causing mechanisms. We found ventolin tablet online that visual abnormalities may be NOTCH2NLC-specific and should be investigated in other patients with NOTCH2NLC mutations.

NOTCH2NLC GGC repeat expansion was rarely identified in patients of European ancestry, whereas the actual prevalence of the expansion in European patients may be potentially higher than reported, and the CGG repeats in LRP12/GIPC1 are suggested to be screened in European patients with NIID. The repeat size and interruptions in NOTCH2NLC GGC expansion confer pleiotropic effects on clinical phenotype, a pure and stable ET phenotype may be an early symptom of NIID, and GGC repeats in NOTCH2NLC possibly give rise to ET. An association may also exist between intermediate-length NOTCH2NLC GGC ventolin tablet online repeat expansion and patients affected by PD and ET. NOTCH2NLC-OPDM highly resembles NOTCH2NLC-NIID, the two disorders may be the variations of a single neurodegenerative disease, and there may be a disease-causing upper limit in size of GGC repeats in NOTCH2NLC, repeats over which may be non-pathogenic.

The haploinsufficiency of NOTCH2NLC may not be primarily involved in NOTCH2NLC-related disorders and a toxic gain-of-function mechanism possibly drives the pathogenesis of neurodegeneration in patients with NOTCH2NLC-associated disorders.geneticsgenotypephenotypeDNA repeat expansion.

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Clinical questions can be asked and answered by querying and analyzing the data of 1.8 million active rheumatic apo salvent vs ventolin disease patients.Critically, this data is from the real world, not from clinical trials. This is important, since the phenotypes, or presenting clinical features, of patients in clinical trials apo salvent vs ventolin that are designed to get medications approved, versus those of patients in the real world, are quite different."For example, in a recent study more than 90% of patients with rheumatoid arthritis (RA) in real-world registries would not have been eligible to enter the clinical trials that led to the approval of each of the major medications used to treat the disease," Hamburger noted. "Patients in clinical trials tend to have much more florid disease."Therefore, even after a medication is approved, we lack information as to how real-world patients will respond to new medicines in terms of treatment effects, side effects and the patient experience of medication use," he continued.

"Data from UR-NICE is critically important to help fill in these gaps in understanding how real-word patients, rather apo salvent vs ventolin than their clinical trial counterparts, respond to treatment."One recent project allowed assessment of the three-month, real-world effectiveness of a medication for RA. Prior to this analysis, understanding of the medication response at that critical time-point for treatment-to-target decision-making had been unclear."These capabilities are important to each of the stakeholders in the rheumatology care apo salvent vs ventolin ecosystem," he explained. "Pharmaceutical manufacturers partner with United Rheumatology to ask nuanced, 'retrospective' clinical questions that benefit patients such as, 'Among rheumatoid arthritis patients with specific phenotypes, such as certain positive serologies (antibody blood tests), what is the response to drug X versus drug Y.'"Health plans can match disease activity data with medical and pharmacy claims information to answer questions such as, "Is it more expensive for patients to be in moderate or high disease activity versus remission or low disease activity?.

" or "What clinical apo salvent vs ventolin factors or data elements predict high healthcare resource utilization among patients with disease X?. "MEETING THE CHALLENGEWith the ability to ask retrospective questions from UR-NICE about the past responses to treatment approaches or specific medications, new questions and hypotheses are developed about how patients' results might be improved by approaching care differently on a prospective basis."Accordingly, United Rheumatology has created an enterprise software platform, Capricorn, as a companion to UR-NICE to support apo salvent vs ventolin direct patient engagement via text or email to facilitate capture of patient-reported outcome measures and/or patient reported experience metrics," Hamburger said. "This information can be brought to the attention of treating clinicians to inform shared decision-making, for instance, about the need for treatment changes."In doing so, the system can granularly capture the patient experience of the 90 days between office visits," he continued.

"The Capricorn platform is completely configured, supporting bespoke data capture requirements that can be leveraged to address prospective questions, including establishing the impact of value-based care programs on clinical outcomes."These programs have brought together health plans, pharmaceutical companies and United Rheumatology members to demonstrate new approaches to improve patients' conditions and lower healthcare costs."One example is programs that encourage dose optimization of targeted immune modulators among patients with RA or psoriatic arthritis who have sustained excellent apo salvent vs ventolin control of disease to provide only the precise amount of medication required to maintain disease control and eliminate unnecessary medication," Hamburger noted."The UR-NICE database supports numerous EHR vendors to extract data and translate it to a canonical data model," he continued. "The technology has been adapted to interface with multiple EHRs allowing practices to continue to use their desired EHR vendor, rather than requiring the use of a specific EHR solution to participate in UR programs."Capricorn has likewise been designed to "meet practices where they are," offering a range of integration options, including HL7 FHIR, custom file and online portal access. These options allow practices to participate with data collection via high-tech or low-tech solutions, based on their capability.RESULTSUnited Rheumatology has established a medical policy committee of members from apo salvent vs ventolin across the country who have written clinical pathways to reflect the approach to the care provided in the organization's clinics.

These pathways include a standardized set of disease-specific outcome measures and a "standard data model" to homogenize collection apo salvent vs ventolin at the practice level.Additionally, a dashboard has been generated to reflect the performance of clinicians from member practices in capturing disease-specific outcome measures. The dashboard results create accountability in adherence to the clinical pathways to ensure robust data capture and have improved the completeness of UR-NICE data collection of measures such as the Clinical Disease Activity Index (CDAI) for RA.It also helps move practices along a continuum of readiness that United Rheumatology has identified to help practices prepare for the implementation and adoption of value-based care programs."In a disease like systemic lupus erythematosus – lupus or SLE – the complexity of disease manifestations make standardized data collection challenging," Hamburger explained. "A first step in meeting the recognized need for the application of treat-to-target principles in SLE is operationalizing and routinizing the capture of a disease activity measure."By working with national experts, UR has developed such a measure and incorporated its capture into the Capricorn platform to simplify its capture," he added.ADVICE FOR apo salvent vs ventolin OTHERS"It is absolutely critical for the advancement of care quality that individual-level data capture be standardized and its collection routinized as an everyday function of real-world clinical medicine," Hamburger stated.

"If outcomes are apo salvent vs ventolin not measured, they cannot be compared or improved. Yet practices vary in their readiness to adopt the innovative strategies required to collect such data."A detailed implementation plan is necessary that takes into account the sociotechnical interface including the needs of patients and clinic personnel as well as the culture of the workplace to smooth the transition to a data- and technology-focused practice model," he continued. "Developing a apo salvent vs ventolin road map for the transition from the standard work of the present state versus the standard work required can aid this transition."A real-world database requires significant curation to optimize the interpretability of results, he added.

Simple challenges, such as practices using different units of measure for body weight (pounds versus kilograms), must be recognized and addressed to yield actionable data, he said."Additionally, including providers in programmatic planning stages and visiting the clinic environment, as the ventolin allows, can apo salvent vs ventolin help identify the impact of adaptations of programmatic methodology that define the positive or negative impact of the difference between 'work as planned' and 'work as done,'" he concluded.Twitter. @SiwickiHealthITEmail the writer. Bsiwicki@himss.orgHealthcare IT News is a HIMSS Media publication.Apollo Hospitals demonstrates use of Medtronic's RAS system in surgeryApollo Hospitals, one of the biggest hospital apo salvent vs ventolin chains in India, and Irish medical device maker Medtronic has partnered to demonstrate the first use case of the latter's robotics-assisted surgery system in Asia-Pacific.Medtronic's Hugo RAS system is a modular, multi-quadrant platform for soft-tissue procedures.

It features wristed instruments, 3D visualisation and a cloud-based surgical apo salvent vs ventolin video capture and management solution called Touch Surgery Enterprise, combined with dedicated support teams specialising in robotics programme optimisation, service and training.RAS, a form of minimally invasive surgery, can potentially contribute to reducing patient's hospital stay, minimising surgery complications and scars. Dr N Ragavan, who recently conducted a robotic prostatectomy using the Medtronic device, noted that nearly 70% of surgeries in India are performed as open procedures. "We feel confident that the Hugo RAS system will enable us to change that statistic and bring the benefits of minimally invasive surgery to more patients than ever before," the consultant urologist, uro-oncologist and robotic surgeon at Apollo Hospitals added."The addition of the Hugo RAS system to our robotic surgery program — and apo salvent vs ventolin our place in history as the first hospital in Asia-Pacific to use this new technology — reinforces that dedication and the pride we at Apollo Hospitals have as a premier destination for minimally invasive surgery.

This technology will complement the excellent clinical expertise garnered by our physicians over the years and is designed to help us enhance patient care," said Dr Prathap C. Reddy, founder and apo salvent vs ventolin chairman of Apollo Hospitals Group. The Hugo RAS system, first used in urologic and gynecologic procedures in Latin America early in the year, has apo salvent vs ventolin pending CE mark approval in Europe.

It has been designated in the US as a not-for-sale investigational device.Fujitsu announces new healthcare industry appointments in Australia and New ZealandJapanese ICT service provider Fujitsu has made new appointments in its healthcare business in Australia and New Zealand.According to a press statement, the company has appointed Ian Manovel as head of Health Industry and Anthony Wang as director of Digital Transformation in Health."These strategic appointments demonstrate Fujitsu’s commitment to driving positive transformative change in a sector that is under unprecedented pressure," said Graeme Beardsell, CEO of Fujitsu Australia and New Zealand. Manovel will lead Fujitsu's expansion in the region's health sector by handling strategy, apo salvent vs ventolin transformation agenda, sales growth and customer service management. He has three decades of experience in the sector, including 12 years as a apo salvent vs ventolin pharmacist in Australia and the UK.

Most recently, he worked as a government and healthcare consulting partner for DXC Technology. He had also been employed by Accenture, NPS MedicineWise and Bupa.Commenting on his new role, Manovel apo salvent vs ventolin said. "I am focused on finding new ways to drive healthcare innovation using digital technologies apo salvent vs ventolin to achieve the best possible health outcomes.

I look forward to working with Fujitsu’s customers on purposeful innovation and transformation that will help to shape the future of healthcare delivery across Australia and New Zealand."Meanwhile, Wang is bringing over two decades of experience in enterprise IT strategy development and delivery. Previously, he was chief technology officer at Ramsay Health Care where he led large-scale digital initiatives, including the first doctor-based mobile application to access the government's My Health Record and the first apo salvent vs ventolin digital patient flow program in Australian private hospitals. He had held roles at AMP Financial Services, Optus and Accenture.Together with Fujitsu, Wang intends to address the perceived challenges of transforming the health sector into a patient-centric, technology-enabled space.

"I am looking forward to harvesting the power of AI, machine learning, quantum computing, analytics, and internet-of-medical-things to solve those challenges currently in the too-hard basket," he said.More pathology labs connect to My Health RecordPathology labs in Queensland, northern New apo salvent vs ventolin South Wales and Tasmania have started uploading patient reports to the government's My Health Record system.The Australian Digital Health Agency said QML Pathology, IQ Pathology and TML Pathology are now sharing reports with consumers and healthcare providers in the digital health record platform.More than 500 QML collection centres in Queensland and northern NSW and 22 TML collection centres in Tasmania are sending reports to My Health Record, according to QML Pathology General Manager Kerri McPhie. These connections follow the recent delivery of reports from Laverty Pathology, a subsidiary of Healius Pathology, to the government platform.As of late, pathology labs across Australia are remitting over 1.6 million reports each week to My Health Record.More than half (56%) of hospital and health system leaders say they are planning to increase their investment in telemedicine during the next two years, according to a new survey from telehealth vendor Amwell and HIMSS Analytics.This apo salvent vs ventolin shows that the huge surge in and mainstreaming of telehealth during the ongoing ventolin has caused the C-suite and other healthcare leaders to embrace the technology that has for so long existed on the periphery of medicine.To dig into the results of this new survey, Healthcare IT News interviewed Kelly Lewis, vice president of commercial strategy and enablement at Amwell. Here she talks about growth and investment in virtual care, priorities and objectives with technology, platform consolidation and more.Q.

What does your survey show in the area of expected growth and investment in apo salvent vs ventolin telehealth?. A. It's no secret – the asthma treatment ventolin caused telehealth adoption to skyrocket.

However, because much of this adoption was driven out of an abundance of necessity, there was little time for organizations to think strategically about their technology investments.With urgency at a high, payers, provider organizations and clinicians all turned to the quickest options available so patients could continue to get care. The result, however, was what we are calling platform "sprawl" – the use of a number of disparate solutions that are leading to a confusing and frustrating care delivery system and experience.Now, as telehealth enters a new phase, healthcare leaders are reconsidering the role that it will and should play in care delivery and their organizational strategy over the long term. To better understand how key stakeholders – payers, provider organizations and clinicians – are thinking about digital care delivery moving forward, Amwell teamed with HIMSS Analytics.The clear message is that telehealth is here to stay and will continue to expand.

Over half of clinicians say the ventolin has positively impacted their long-term desire to use telehealth going forward, and 56% of hospital and health system leaders say they are planning to increase their investment in virtual care over the next two years, especially in the areas of staff training and support, specialty care, and hospital-at-home programs.The majority of payers without virtual care offerings also reported planning to add them in the next 24 months.Q. What are survey respondent's priorities and objectives regarding telehealth?. A.

While there is no clear shared vision among respondents for what the ideal or future state looks like, stakeholders broadly agree on the core elements that need to be in place. A streamlined experience for patients and providers, interoperability (of platforms as well as data), and a nimble and sustainable infrastructure that can support future growth.In terms of the specific priorities driving these elements for each group, the most cited benefit to using virtual care among clinicians is its ability to increase access for patients, followed by increased efficiency and an improved patient experience.The vast majority of hospital and health system leaders say they measure the effectiveness of their technology by patient satisfaction scores and provider satisfaction/adoption, making these key priorities for these stakeholders driving their digital care investments. Meanwhile, health plans reported visit volumes, member satisfaction scores, improved outcomes and improved access to care as their top priorities for virtual care.Q.

According to your survey, what are telehealth's technology needs and investment drivers?. A. Now that the dust has begun to settle around the mad dash to start using telehealth during the ventolin, healthcare decision-makers are taking stock of the systems and solutions they rushed to put in place during the first wave of asthma treatment.

As they plan out their future digital care investments, different stakeholders report different priorities.For clinicians, patient preference/experience, quality video connections and the ability to integrate with existing workflows, systems, etc., are the most often cited needs for them to be able to use telehealth effectively. Clinicians also emphasize the importance of integrating telehealth in other systems.Meanwhile, hospital and health system leaders cite cost reduction, ease of use and compatibility as their top purchasing drivers. More than 80% of the respondents said the ability to integrate with existing workflows, fast video connections and reducing admin burden were "very" or "extremely" important factors in their telehealth technology investments.Q.

What do survey respondents see in the area of platform consolidation?. A. Several platforms/systems for digital care – as well as for patient engagement, remote patient monitoring, etc.

€“ are now in place, but they often live in silos and have not been part of a systematic, centralized plan. Hospital and health system leaders in particular are now seeing that as their digital care platforms scale and sprawl, they are straining the infrastructure of their organizations and creating challenges for senior executives and frontline clinicians alike.This was supported by our survey data, with the vast majority of hospitals and health systems surveyed reporting they want to move toward a single integrated platform. Among the-decision makers and influencers currently using two or more platforms, 77% said moving toward a single, secure telehealth platform that is fully integrated with other systems (such as the EHR and compliance systems) is "very" or "extremely" important for their organization.Clinicians agree that moving toward a fully integrated telehealth platform would be beneficial.

More than 80% believe investing in a fully integrated virtual or hybrid care system would have a positive impact on clinical outcomes and patient experiences.Roughly 75% of all payers said that access to virtual care member data and insights through a single digital platform would streamline the member experience (a top challenge today), improve patient outcomes and support the development of innovative models of care coordination and delivery.As we move into the next phase of care delivery, it has become clear that, in order to realize the potential of digital care delivery in the wake of the asthma treatment experience, healthcare organizations need to develop a cohesive, holistic strategy and plan their investments and next steps accordingly.Twitter. @SiwickiHealthITEmail the writer. Bsiwicki@himss.orgHealthcare IT News is a HIMSS Media publication.The rapid spread of the novel asthma disrupted many standard processes and protocols in hospitals across the country.

Likewise, the ventolin disrupted clinical and operational workflows for pharmacies, forcing pharmacists to discover new ways of performing common tasks to protect care team members and the community.THE PROBLEMWatching the impact of asthma treatment across the country, leaders at Murray, Utah-based Intermountain Medical Center quickly created a remote pharmacy services plan prior to a rapid rise of asthma cases in Utah. The plan was designed to limit the risk of exposure to the ventolin and mitigate potential staffing shortages due to illness or quarantine.The goals were to protect the general public, patients, clinical pharmacists and other caregivers while maintaining high standards of pharmacy clinical services."Proactive measures helped ensure pharmacy personnel had appropriate remote access and were equipped with the right technology and resources that enabled them to participate remotely in daily patient care rounds and consults and in verifying medication orders and delivering medication education to patients," said Gabe Fontaine, PharmD, clinical pharmacy coordinator, critical care medicine, at Intermountain Medical Center, and an associate professor at Intermountain Healthcare.PROPOSALIntermountain Medical Center is a level I trauma center, which includes a comprehensive stroke center. It serves four surrounding states and is the largest of Intermountain Healthcare's 25 hospitals.

It has 504 inpatient beds and 80 emergency department beds with approximately 90,000 annual ED visits.When the remote pharmacy services plan was implemented, there were 157 pharmacy staff, including 73 pharmacists and 7 residents."The plan, designed by a multidisciplinary team, was a hybrid of remote and on-site pharmacy services," Fontaine explained. "It was created to prevent exposure and subsequent illness, proactively address potential staffing shortages, and ensure uninterrupted clinical pharmacy services."As more was learned about the spread of the ventolin, the hospital developed a rotating schedule to keep workgroups together on-site and then alternate through remote assignments," he continued. "There were also contingency plans at the ready if a certain number of pharmacists became ill or required quarantine.""The technology was critical for clinicians to connect with the right team member, especially if the contingency staffing plan was in place."Gabe Fontaine, PharmD, Intermountain HealthcareThe plan outlined the strategies that Intermountain Medical Center would implement to consolidate personnel according to the number of healthy pharmacists, and also based on competencies of those available pharmacists."Clinical and IT team members implementing the remote pharmacy services plan knew that its success depended squarely on seamless and effective communication between the pharmacists working remotely and on-site hospital caregivers and patients," he said.MEETING THE CHALLENGETo enable fast and efficient collaboration between remote pharmacists and their clinical colleagues inside the hospital, Intermountain Medical Center relied on the Vocera Badge, a hands-free, voice-controlled communication device that care team members have been using to connect and collaborate.Additionally, staff leveraged their telehealth audio-visual equipment, an integral part of Intermountain's telehealth platform, known as Connect Care Pro, that includes microphones and high-definition video cameras."The wearable Vocera device allows caregivers to call and connect with each other in real time simply by saying a name, role or group," Fontaine explained.

"There is no need to remember phone numbers or know who is on call. The device also enables users to set reminders, leave messages and forward calls to other mobile devices and landline phones."Incoming calls to remote pharmacists' hands-free devices were rerouted to their cell phones or soft-phone lines connected to their laptops," he continued. "Remote clinical pharmacists leveraged the technology to contact physicians and other on-site caregivers to collaborate on patient rounds, consults, clinical recommendations, virtual huddles and patient education."Virtual huddles became essential to identify and address gaps in coverage.

Pharmacists working remotely checked in with nursing managers and caregivers, who wore the badges, to proactively address questions and concerns at the point of care. Pharmacists didn't need to know names or numbers of nurse managers in every unit. They could simply call by role."The technology was critical for clinicians to connect with the right team member, especially if the contingency-staffing plan was in place," he said.

"Under the contingency-staffing plan, pharmacists and caregivers also used instant messaging software to communicate emergent needs throughout the day."Nurses could instantly connect to their floor or unit-based pharmacist via Vocera to discuss new medication orders, ask questions and relay information from the frontline care teams," he added.RESULTSThe remote pharmacy services model led to an increase in interdisciplinary collaboration on clinical and operational initiatives, largely stemming from improved connectivity between care team members, regardless of location. Given the success of the remote pharmacy services, Intermountain Medical Center plans to extend various features of the program when the ventolin recedes.To continue protecting the public, patients and caregivers, Intermountain Medical Center has established an intermittent work-from-home program for pharmacists who are undergoing asthma treatment testing or exhibiting symptoms."The remote services plan also revealed new uses for its patient-monitoring technology, prompting leadership to enhance those capabilities to improve care for critically ill patients," Fontaine noted. "Additionally, the use of existing audio and visual resources led to increased attendance for clinical team meetings and presentations."ADVICE FOR OTHERS"When time is of the essence, it is important to look at the resources and technologies already in place and reimagine new ways to use them," Fontaine advised.

"Listen to frontline healthcare workers at every level of the organization. They often use technology in ways beyond the original intent."By leveraging existing technology resources, Intermountain Medical Center has been able to redesign pharmacy services during a ventolin while protecting patients, pharmacists and other caregivers, and preserving excellent clinical pharmacy coverage to support optimal patient care," he added.Other health systems considering process changes to improve their safety protocols could achieve similar outcomes by adopting a comparable approach, but it is important to be proactive, he said. Have the right technologies, resources and contingency plans in place before the next crisis, he concluded.Twitter.

@SiwickiHealthITEmail the writer. Bsiwicki@himss.orgHealthcare IT News is a HIMSS Media publication..

Not too long ago, Hauppauge, New York-based United Rheumatology had limited opportunities to directly capture the experience of patients across the country to answer important clinical questions.THE PROBLEMAlthough a given practice might capture data in its own electronic health record, even the largest of practices did not have enough patients to understand the real-world response to medicine or to capture the data from practices across the country as part of a value-based care initiative.Other databases either did not capture information directly from the EHR, leading to risk of bias in which patients were captured, or ventolin tablet online had restrictive policies for data access.PROPOSAL"United Rheumatology Normalized Integrated Community Evidence allows for access to real-world evidence EHR data that can be analyzed Buy amoxil online with free samples to address specific research questions in the real-world community rheumatology setting," explained Dr. Max Hamburger, founder, executive chairman and chief medical officer of United Rheumatology."Currently, the best clinical paradigm for treating patients with rheumatic disease is the use of a treat-to-target strategy wherein the activity of a patient's disease is measured at each visit and trends can be identified to guide shared decision making about changing treatment," he continued."Although the EHR could capture that information for an individual patient, encouraging clinicians to routinely capture the data required for such an approach has been challenging."UR-NICE addresses this challenge through the ability to gather data across clinicians, practices and locations across the country to evaluate clinicians' performance, gain insights as to the best clinical approaches, and yield insights on how to evolve care toward better value, he added."Thus, the data housed in UR-NICE provides direct insight into the outcomes of patients across that country that serves as the data ventolin tablet online source, or the life-blood, of value-based care initiatives designed to improve individual-level patient outcomes and reduce the cost of care," he said."United Rheumatology has created an enterprise software platform, Capricorn, as a companion to UR-NICE to support direct patient engagement via text or email to facilitate capture of patient-reported outcome measures and/or patient-reported experience metrics."Dr. Max Hamburger, United RheumatologyUR-NICE allows direct capture of a wide variety of clinical data from patients across the country and houses it in a single repository. Clinical questions can be asked and answered by querying and analyzing the data ventolin tablet online of 1.8 million active rheumatic disease patients.Critically, this data is from the real world, not from clinical trials. This is important, since the phenotypes, ventolin tablet online or presenting clinical features, of patients in clinical trials that are designed to get medications approved, versus those of patients in the real world, are quite different."For example, in a recent study more than 90% of patients with rheumatoid arthritis (RA) in real-world registries would not have been eligible to enter the clinical trials that led to the approval of each of the major medications used to treat the disease," Hamburger noted.

"Patients in clinical trials tend to have much more florid disease."Therefore, even after a medication is approved, we lack information as to how real-world patients will respond to new medicines in terms of treatment effects, side effects and the patient experience of medication use," he continued. "Data from UR-NICE is critically important to help fill in these gaps in understanding how real-word patients, rather than their clinical trial counterparts, respond to treatment."One recent project allowed assessment of the three-month, real-world effectiveness of ventolin tablet online a medication for RA. Prior to this analysis, understanding of the medication response at that critical time-point for treatment-to-target decision-making ventolin tablet online had been unclear."These capabilities are important to each of the stakeholders in the rheumatology care ecosystem," he explained. "Pharmaceutical manufacturers partner with United Rheumatology to ask nuanced, 'retrospective' clinical questions that benefit patients such as, 'Among rheumatoid arthritis patients with specific phenotypes, such as certain positive serologies (antibody blood tests), what is the response to drug X versus drug Y.'"Health plans can match disease activity data with medical and pharmacy claims information to answer questions such as, "Is it more expensive for patients to be in moderate or high disease activity versus remission or low disease activity?. " or "What clinical factors or data elements predict high ventolin tablet online healthcare resource utilization among patients with disease X?.

"MEETING THE CHALLENGEWith the ability to ask retrospective questions from UR-NICE about the past responses to treatment approaches or specific medications, new questions and hypotheses are developed about how patients' results might be improved by approaching care differently on a prospective basis."Accordingly, United ventolin tablet online Rheumatology has created an enterprise software platform, Capricorn, as a companion to UR-NICE to support direct patient engagement via text or email to facilitate capture of patient-reported outcome measures and/or patient reported experience metrics," Hamburger said. "This information can be brought to the attention of treating clinicians to inform shared decision-making, for instance, about the need for treatment changes."In doing so, the system can granularly capture the patient experience of the 90 days between office visits," he continued. "The Capricorn platform is completely configured, supporting bespoke data capture requirements that can be leveraged to address prospective questions, including establishing the impact of value-based care programs on clinical outcomes."These programs have brought together health plans, pharmaceutical companies and United Rheumatology members to demonstrate new approaches to improve patients' conditions and lower ventolin tablet online healthcare costs."One example is programs that encourage dose optimization of targeted immune modulators among patients with RA or psoriatic arthritis who have sustained excellent control of disease to provide only the precise amount of medication required to maintain disease control and eliminate unnecessary medication," Hamburger noted."The UR-NICE database supports numerous EHR vendors to extract data and translate it to a canonical data model," he continued. "The technology has been adapted to interface with multiple EHRs allowing practices to continue to use their desired EHR vendor, rather than requiring the use of a specific EHR solution to participate in UR programs."Capricorn has likewise been designed to "meet practices where they are," offering a range of integration options, including HL7 FHIR, custom file and online portal access. These options allow practices to participate with data collection via high-tech or low-tech solutions, based on ventolin tablet online their capability.RESULTSUnited Rheumatology has established a medical policy committee of members from across the country who have written clinical pathways to reflect the approach to the care provided in the organization's clinics.

These pathways include a standardized set of disease-specific ventolin tablet online outcome measures and a "standard data model" to homogenize collection at the practice level.Additionally, a dashboard has been generated to reflect the performance of clinicians from member practices in capturing disease-specific outcome measures. The dashboard results create accountability in adherence to the clinical pathways to ensure robust data capture and have improved the completeness of UR-NICE data collection of measures such as the Clinical Disease Activity Index (CDAI) for RA.It also helps move practices along a continuum of readiness that United Rheumatology has identified to help practices prepare for the implementation and adoption of value-based care programs."In a disease like systemic lupus erythematosus – lupus or SLE – the complexity of disease manifestations make standardized data collection challenging," Hamburger explained. "A first step in meeting the recognized need for the application of treat-to-target principles in SLE is operationalizing and routinizing the capture of a disease activity measure."By working with national experts, UR has ventolin tablet online developed such a measure and incorporated its capture into the Capricorn platform to simplify its capture," he added.ADVICE FOR OTHERS"It is absolutely critical for the advancement of care quality that individual-level data capture be standardized and its collection routinized as an everyday function of real-world clinical medicine," Hamburger stated. "If outcomes are not measured, they ventolin tablet online cannot be compared or improved. Yet practices vary in their readiness to adopt the innovative strategies required to collect such data."A detailed implementation plan is necessary that takes into account the sociotechnical interface including the needs of patients and clinic personnel as well as the culture of the workplace to smooth the transition to a data- and technology-focused practice model," he continued.

"Developing a road map for the transition ventolin tablet online from the standard work of the present state versus the standard work required can aid this transition."A real-world database requires significant curation to optimize the interpretability of results, he added. Simple challenges, such as practices using different units of measure for body weight (pounds versus kilograms), must be recognized and addressed to yield actionable data, he said."Additionally, including providers in programmatic planning stages and visiting the clinic environment, as the ventolin allows, can help identify the impact of adaptations of programmatic methodology that define the positive or negative impact of the difference between 'work as planned' and ventolin tablet online 'work as done,'" he concluded.Twitter. @SiwickiHealthITEmail the writer. Bsiwicki@himss.orgHealthcare IT News is a HIMSS Media publication.Apollo Hospitals demonstrates use of Medtronic's RAS system in surgeryApollo Hospitals, one of the biggest hospital chains in India, and Irish medical device maker Medtronic has partnered to demonstrate the ventolin tablet online first use case of the latter's robotics-assisted surgery system in Asia-Pacific.Medtronic's Hugo RAS system is a modular, multi-quadrant platform for soft-tissue procedures. It features wristed instruments, 3D visualisation and a cloud-based surgical video capture and management solution called Touch Surgery ventolin tablet online Enterprise, combined with dedicated support teams specialising in robotics programme optimisation, service and training.RAS, a form of minimally invasive surgery, can potentially contribute to reducing patient's hospital stay, minimising surgery complications and scars.

Dr N Ragavan, who recently conducted a robotic prostatectomy using the Medtronic device, noted that nearly 70% of surgeries in India are performed as open procedures. "We feel confident that the Hugo RAS system will enable us to change that statistic and bring the benefits of minimally invasive surgery to more patients than ever before," the consultant urologist, uro-oncologist and robotic surgeon at Apollo Hospitals added."The addition of the Hugo RAS system to our robotic surgery program — and our place in history ventolin tablet online as the first hospital in Asia-Pacific to use this new technology — reinforces that dedication and the pride we at Apollo Hospitals have as a premier destination for minimally invasive surgery. This technology will complement the excellent clinical expertise garnered by our physicians over the years and is designed to help us enhance patient care," said Dr Prathap C. Reddy, founder and ventolin tablet online chairman of Apollo Hospitals Group. The Hugo RAS system, first used in ventolin tablet online urologic and gynecologic procedures in Latin America early in the year, has pending CE mark approval in Europe.

It has been designated in the US as a not-for-sale investigational device.Fujitsu announces new healthcare industry appointments in Australia and New ZealandJapanese ICT service provider Fujitsu has made new appointments in its healthcare business in Australia and New Zealand.According to a press statement, the company has appointed Ian Manovel as head of Health Industry and Anthony Wang as director of Digital Transformation in Health."These strategic appointments demonstrate Fujitsu’s commitment to driving positive transformative change in a sector that is under unprecedented pressure," said Graeme Beardsell, CEO of Fujitsu Australia and New Zealand. Manovel will lead Fujitsu's expansion in the region's ventolin tablet online health sector by handling strategy, transformation agenda, sales growth and customer service management. He has three decades of experience in the sector, including 12 years as a pharmacist ventolin tablet online in Australia and the UK. Most recently, he worked as a government and healthcare consulting partner for DXC Technology. He had also been employed by Accenture, NPS MedicineWise and Bupa.Commenting on his new ventolin tablet online role, Manovel said.

"I am focused on finding new ways to drive healthcare innovation using digital technologies ventolin tablet online to achieve the best possible health outcomes. I look forward to working with Fujitsu’s customers on purposeful innovation and transformation that will help to shape the future of healthcare delivery across Australia and New Zealand."Meanwhile, Wang is bringing over two decades of experience in enterprise IT strategy development and delivery. Previously, he was chief technology officer at Ramsay Health Care where he led large-scale digital initiatives, including the first doctor-based mobile application to access the government's My Health Record and the first digital ventolin tablet online patient flow program in Australian private hospitals. He had held roles at AMP Financial Services, Optus and Accenture.Together with Fujitsu, Wang intends to address the perceived challenges of transforming the health sector into a patient-centric, technology-enabled space. "I am looking forward to harvesting the power of AI, machine learning, quantum computing, analytics, and internet-of-medical-things to solve those challenges currently in the too-hard basket," he said.More pathology labs connect to My Health RecordPathology labs in Queensland, northern New South Wales and Tasmania have started uploading patient reports to the government's My Health Record system.The Australian Digital Health Agency said QML Pathology, IQ Pathology and TML Pathology are now sharing reports with consumers and healthcare providers ventolin tablet online in the digital health record platform.More than 500 QML collection centres in Queensland and northern NSW and 22 TML collection centres in Tasmania are sending reports to My Health Record, according to QML Pathology General Manager Kerri McPhie.

These connections follow the recent delivery of reports ventolin tablet online from Laverty Pathology, a subsidiary of Healius Pathology, to the government platform.As of late, pathology labs across Australia are remitting over 1.6 million reports each week to My Health Record.More than half (56%) of hospital and health system leaders say they are planning to increase their investment in telemedicine during the next two years, according to a new survey from telehealth vendor Amwell and HIMSS Analytics.This shows that the huge surge in and mainstreaming of telehealth during the ongoing ventolin has caused the C-suite and other healthcare leaders to embrace the technology that has for so long existed on the periphery of medicine.To dig into the results of this new survey, Healthcare IT News interviewed Kelly Lewis, vice president of commercial strategy and enablement at Amwell. Here she talks about growth and investment in virtual care, priorities and objectives with technology, platform consolidation and more.Q. What does your survey show in the area of expected growth ventolin tablet online and investment in telehealth?. A. It's no secret – the asthma treatment ventolin caused telehealth adoption to skyrocket.

However, because much of this adoption was driven out of an abundance of necessity, there was little time for organizations to think strategically about their technology investments.With urgency at a high, payers, provider organizations and clinicians all turned to the quickest options available so patients could continue to get care. The result, however, was what we are calling platform "sprawl" – the use of a number of disparate solutions that are leading to a confusing and frustrating care delivery system and experience.Now, as telehealth enters a new phase, healthcare leaders are reconsidering the role that it will and should play in care delivery and their organizational strategy over the long term. To better understand how key stakeholders – payers, provider organizations and clinicians – are thinking about digital care delivery moving forward, Amwell teamed with HIMSS Analytics.The clear message is that telehealth is here to stay and will continue to expand. Over half of clinicians say the ventolin has positively impacted their long-term desire to use telehealth going forward, and 56% of hospital and health system leaders say they are planning to increase their investment in virtual care over the next two years, especially in the areas of staff training and support, specialty care, and hospital-at-home programs.The majority of payers without virtual care offerings also reported planning to add them in the next 24 months.Q. What are survey respondent's priorities and objectives regarding telehealth?.

A. While there is no clear shared vision among respondents for what the ideal or future state looks like, stakeholders broadly agree on the core elements that need to be in place. A streamlined experience for patients and providers, interoperability (of platforms as well as data), and a nimble and sustainable infrastructure that can support future growth.In terms of the specific priorities driving these elements for each group, the most cited benefit to using virtual care among clinicians is its ability to increase access for patients, followed by increased efficiency and an improved patient experience.The vast majority of hospital and health system leaders say they measure the effectiveness of their technology by patient satisfaction scores and provider satisfaction/adoption, making these key priorities for these stakeholders driving their digital care investments. Meanwhile, health plans reported visit volumes, member satisfaction scores, improved outcomes and improved access to care as their top priorities for virtual care.Q. According to your survey, what are telehealth's technology needs and investment drivers?.

A. Now that the dust has begun to settle around the mad dash to start using telehealth during the ventolin, healthcare decision-makers are taking stock of the systems and solutions they rushed to put in place during the first wave of asthma treatment. As they plan out their future digital care investments, different stakeholders report different priorities.For clinicians, patient preference/experience, quality video connections and the ability to integrate with existing workflows, systems, etc., are the most often cited needs for them to be able to use telehealth effectively. Clinicians also emphasize the importance of integrating telehealth in other systems.Meanwhile, hospital and health system leaders cite cost reduction, ease of use and compatibility as their top purchasing drivers. More than 80% of the respondents said the ability to integrate with existing workflows, fast video connections and reducing admin burden were "very" or "extremely" important factors in their telehealth technology investments.Q.

What do survey respondents see in the area of platform consolidation?. A. Several platforms/systems for digital care – as well as for patient engagement, remote patient monitoring, etc. €“ are now in place, but they often live in silos and have not been part of a systematic, centralized plan. Hospital and health system leaders in particular are now seeing that as their digital care platforms scale and sprawl, they are straining the infrastructure of their organizations and creating challenges for senior executives and frontline clinicians alike.This was supported by our survey data, with the vast majority of hospitals and health systems surveyed reporting they want to move toward a single integrated platform.

Among the-decision makers and influencers currently using two or more platforms, 77% said moving toward a single, secure telehealth platform that is fully integrated with other systems (such as the EHR and compliance systems) is "very" or "extremely" important for their organization.Clinicians agree that moving toward a fully integrated telehealth platform would be beneficial. More than 80% believe investing in a fully integrated virtual or hybrid care system would have a positive impact on clinical outcomes and patient experiences.Roughly 75% of all payers said that access to virtual care member data and insights through a single digital platform would streamline the member experience (a top challenge today), improve patient outcomes and support the development of innovative models of care coordination and delivery.As we move into the next phase of care delivery, it has become clear that, in order to realize the potential of digital care delivery in the wake of the asthma treatment experience, healthcare organizations need to develop a cohesive, holistic strategy and plan their investments and next steps accordingly.Twitter. @SiwickiHealthITEmail the writer. Bsiwicki@himss.orgHealthcare IT News is a HIMSS Media publication.The rapid spread of the novel asthma disrupted many standard processes and protocols in hospitals across the country. Likewise, the ventolin disrupted clinical and operational workflows for pharmacies, forcing pharmacists to discover new ways of performing common tasks to protect care team members and the community.THE PROBLEMWatching the impact of asthma treatment across the country, leaders at Murray, Utah-based Intermountain Medical Center quickly created a remote pharmacy services plan prior to a rapid rise of asthma cases in Utah.

The plan was designed to limit the risk of exposure to the ventolin and mitigate potential staffing shortages due to illness or quarantine.The goals were to protect the general public, patients, clinical pharmacists and other caregivers while maintaining high standards of pharmacy clinical services."Proactive measures helped ensure pharmacy personnel had appropriate remote access and were equipped with the right technology and resources that enabled them to participate remotely in daily patient care rounds and consults and in verifying medication orders and delivering medication education to patients," said Gabe Fontaine, PharmD, clinical pharmacy coordinator, critical care medicine, at Intermountain Medical Center, and an associate professor at Intermountain Healthcare.PROPOSALIntermountain Medical Center is a level I trauma center, which includes a comprehensive stroke center. It serves four surrounding states and is the largest of Intermountain Healthcare's 25 hospitals. It has 504 inpatient beds and 80 emergency department beds with approximately 90,000 annual ED visits.When the remote pharmacy services plan was implemented, there were 157 pharmacy staff, including 73 pharmacists and 7 residents."The plan, designed by a multidisciplinary team, was a hybrid of remote and on-site pharmacy services," Fontaine explained. "It was created to prevent exposure and subsequent illness, proactively address potential staffing shortages, and ensure uninterrupted clinical pharmacy services."As more was learned about the spread of the ventolin, the hospital developed a rotating schedule to keep workgroups together on-site and then alternate through remote assignments," he continued. "There were also contingency plans at the ready if a certain number of pharmacists became ill or required quarantine.""The technology was critical for clinicians to connect with the right team member, especially if the contingency staffing plan was in place."Gabe Fontaine, PharmD, Intermountain HealthcareThe plan outlined the strategies that Intermountain Medical Center would implement to consolidate personnel according to the number of healthy pharmacists, and also based on competencies of those available pharmacists."Clinical and IT team members implementing the remote pharmacy services plan knew that its success depended squarely on seamless and effective communication between the pharmacists working remotely and on-site hospital caregivers and patients," he said.MEETING THE CHALLENGETo enable fast and efficient collaboration between remote pharmacists and their clinical colleagues inside the hospital, Intermountain Medical Center relied on the Vocera Badge, a hands-free, voice-controlled communication device that care team members have been using to connect and collaborate.Additionally, staff leveraged their telehealth audio-visual equipment, an integral part of Intermountain's telehealth platform, known as Connect Care Pro, that includes microphones and high-definition video cameras."The wearable Vocera device allows caregivers to call and connect with each other in real time simply by saying a name, role or group," Fontaine explained.

"There is no need to remember phone numbers or know who is on call. The device also enables users to set reminders, leave messages and forward calls to other mobile devices and landline phones."Incoming calls to remote pharmacists' hands-free devices were rerouted to their cell phones or soft-phone lines connected to their laptops," he continued. "Remote clinical pharmacists leveraged the technology to contact physicians and other on-site caregivers to collaborate on patient rounds, consults, clinical recommendations, virtual huddles and patient education."Virtual huddles became essential to identify and address gaps in coverage. Pharmacists working remotely checked in with nursing managers and caregivers, who wore the badges, to proactively address questions and concerns at the point of care. Pharmacists didn't need to know names or numbers of nurse managers in every unit.

They could simply call by role."The technology was critical for clinicians to connect with the right team member, especially if the contingency-staffing plan was in place," he said. "Under the contingency-staffing plan, pharmacists and caregivers also used instant messaging software to communicate emergent needs throughout the day."Nurses could instantly connect to their floor or unit-based pharmacist via Vocera to discuss new medication orders, ask questions and relay information from the frontline care teams," he added.RESULTSThe remote pharmacy services model led to an increase in interdisciplinary collaboration on clinical and operational initiatives, largely stemming from improved connectivity between care team members, regardless of location. Given the success of the remote pharmacy services, Intermountain Medical Center plans to extend various features of the program when the ventolin recedes.To continue protecting the public, patients and caregivers, Intermountain Medical Center has established an intermittent work-from-home program for pharmacists who are undergoing asthma treatment testing or exhibiting symptoms."The remote services plan also revealed new uses for its patient-monitoring technology, prompting leadership to enhance those capabilities to improve care for critically ill patients," Fontaine noted. "Additionally, the use of existing audio and visual resources led to increased attendance for clinical team meetings and presentations."ADVICE FOR OTHERS"When time is of the essence, it is important to look at the resources and technologies already in place and reimagine new ways to use them," Fontaine advised. "Listen to frontline healthcare workers at every level of the organization.

They often use technology in ways beyond the original intent."By leveraging existing technology resources, Intermountain Medical Center has been able to redesign pharmacy services during a ventolin while protecting patients, pharmacists and other caregivers, and preserving excellent clinical pharmacy coverage to support optimal patient care," he added.Other health systems considering process changes to improve their safety protocols could achieve similar outcomes by adopting a comparable approach, but it is important to be proactive, he said. Have the right technologies, resources and contingency plans in place before the next crisis, he concluded.Twitter. @SiwickiHealthITEmail the writer. Bsiwicki@himss.orgHealthcare IT News is a HIMSS Media publication..

Ventolin rotacaps side effects

First-of-its-kind study, based on a mouse model, finds living in a https://www.video-advertising.agency/can-i-buy-diflucan-in-usa/ polluted environment could be comparable to eating a high-fat diet, leading to a pre-diabetic state CLEVELAND—Air pollution is the world’s leading environmental risk factor, and ventolin rotacaps side effects causes more than nine million deaths per year. New research published in the Journal of Clinical Investigation shows air pollution may play a role in the development of cardiometabolic diseases, such as diabetes. Importantly, the effects were ventolin rotacaps side effects reversible with cessation of exposure. Researchers found that air pollution was a “risk factor for a risk factor” that contributed to the common soil of other fatal problems like heart attack and stroke. Similar to how an unhealthy diet and lack of exercise can lead to disease, exposure to air pollution could be added to this risk factor list as well.

“In this study, we ventolin rotacaps side effects created an environment that mimicked a polluted day in New Delhi or Beijing,” said Sanjay Rajagopalan, MD, first author on the study, Chief of Cardiovascular Medicine at University Hospitals Harrington Heart and Vascular Institute, and Director of the Case Western Reserve University Cardiovascular Research Institute. €œWe concentrated fine particles of air pollution, called PM2.5 (particulate matter component <. 2.5 microns) ventolin rotacaps side effects. Concentrated particles like this develop from human impact on the environment, such as automobile exhaust, power generation and other fossil fuels.” These particles have been strongly connected to risk factors for disease. For example, cardiovascular effects of air pollution can lead to heart attack and stroke.

The research team has shown exposure to air pollution can increase the likelihood of the same ventolin rotacaps side effects risk factors that lead to heart disease, such as insulin resistance and type 2 diabetes. In the mouse model study, three groups were observed. A control group receiving clean filtered air, a group exposed to polluted air for 24 weeks, and a group fed a high-fat diet. Interestingly, the researchers found that being exposed to air pollution was comparable ventolin rotacaps side effects to eating a high-fat diet. Both the air pollution and high-fat diet groups showed insulin resistance and abnormal metabolism – just like one would see in a pre-diabetic state.

These changes were associated with changes in the epigenome, a layer of control that can masterfully turn on and turn off thousands of genes, representing ventolin rotacaps side effects a critical buffer in response to environmental factors. This study is the first-of-its-kind to compare genome-wide epigenetic changes in response to air pollution, compare and contrast these changes with that of eating an unhealthy diet, and examine the impact of air pollution cessation on these changes.“The good news is that these effects were reversible, at least in our experiments” added Dr. Rajagopalan. €œOnce the air pollution was removed from the environment, the mice appeared healthier and the pre-diabetic state seemed to reverse.” Dr ventolin rotacaps side effects. Rajagopalan explains that if you live in a densely polluted environment, taking actions such as wearing an N95 mask, using portable indoor air cleaners, utilizing air conditioning, closing car windows while commuting, and changing car air filters frequently could all be helpful in staying healthy and limiting air pollution exposure.Next steps in this research involve meeting with a panel of experts, as well as the National Institutes of Health, to discuss conducting clinical trials that compare heart health and the level of air pollution in the environment.

For example, if someone has a heart attack, should they be wearing an N95 mask or using a portable air filter at home during recovery?. Dr ventolin rotacaps side effects. Rajagopalan and his team believe that it is important to address the environment as a population health risk factor and continue to diligently research these issues. The authors ventolin rotacaps side effects also note that these findings should encourage policymakers to enact measures aimed at reducing air pollution.Shyam Biswal, PhD, Professor in the Department of Environmental Health and Engineering at Johns Hopkins University School of Public Health, is the joint senior author on the study. Drs.

Rajagopalan and Biswal are co-PIs on the NIH grant that supported this work.###Rajagopalan, S., Biswal, S., et al. €œMetabolic effects of air ventolin rotacaps side effects pollution exposure and reversibility.” Journal of Clinical Investigation. DOI. 10.1172/JCI137315. This work was supported by the National Institute of Environmental Health Sciences TaRGET II Consortium grant U01ES026721, as well as grants R01ES015146 and R01ES019616.About one in five women experience some form of depression during pregnancy, with poorly understood effects on the fetus.

Prenatal depression is linked to behavioural and developmental issues in children as well as an increased risk for depression as young adults. But how prenatal depression leads to these changes remains unclear. UCalgary researcher Dr. Catherine Lebel, PhD, is helping understand what may be happening in the developing brains of these children. The research team has shown that young children whose mothers experienced more numerous symptoms of depression in pregnancy have weakened connectivity in brain pathways involved in emotion.

These structural changes can be related to increased hyperactivity and aggression in boys. The research is based on diffusion magnetic resonance imaging, an imaging technique that probes the strength of structural connections between brain regions. The findings are published in The Journal of Neuroscience. Catherine Lebel, senior author and investigator. Riley Brandt, University of Calgary “The results help us understand how depression can have multigenerational impacts, and speaks to the importance of helping mothers who may be experiencing depression during pregnancy,” says Lebel, an associate professor at the Cumming School of Medicine, and researcher in the Alberta Children’s Hospital Research Institute.

She holds the Canada Research Chair in Paediatric Neuroimaging. Lebel and her team studied 54 Calgary mothers and their children. They were enrolled from the ongoing, prospective study called the Alberta Pregnancy Outcomes and Nutrition study. Mothers answered a survey about their depression symptoms at several points during their pregnancy. Their children were followed after birth and undertook an MRI scan at the Alberta Children’s Hospital at around age four.

As well, the children’s behaviour was assessed within six months of their MRI scan. The team found a significant reduction in structural brain connectivity between the amygdala, a structure essential for emotional processing, and the frontal cortex. Weakened connectivity between the amygdala and frontal cortex is associated with disruptive behaviours and vulnerability to depression. The first author on the study, Dr. Rebecca Hay, MD, stresses the importance of recognition of depression and intervention in prenatal health.

€œThese results suggest complex associations between the prenatal environment and children’s brain development, and may help us to understand why children of depressed mothers are more vulnerable to depression themselves,” says Hay, a resident physician in paediatrics and recent Cumming School of Medicine graduate. The main clinical takeaway from this is to emphasize the importance of recognizing, treating prenatal depression and supporting mothers, both for better maternal outcomes and to help future child development. Rebecca Hay, the study's first author. Courtesy Rebecca Hay Current study looks at stress during ventolin Lebel and her research team are currently trying to understand how stress and mental health are affecting pregnant women during the asthma treatment ventolin. She is examining how factors such as social supports might mitigate stress, and how this may influence pregnancy and birth outcomes.

If you are interested, you can get involved here in the Pregnancy During the asthma treatment ventolin study at the University of Calgary. So far, approximately 7,500 women from across Canada are enrolled and supplying information through questionnaires. €œIt is critical to appropriately recognize and treat prenatal maternal mental health problems, both for the mothers and to improve child outcomes,” says Lebel. €œNow more than ever, with increased stress, anxiety and depression during the asthma treatment ventolin, we should do more to support mothers to positively impact the health of their children.” Lebel is an associate professor in the Department of Radiology at the Cumming School of Medicine, adjunct associate professor in the Werklund School of Education and a member of The Mathison Centre for Mental Health Research &. Education, Owerko Centre at ACHRI, Hotchkiss Brain Institute and Alberta Children's Hospital Research Institute.

The study was funded by the Canadian Institute of Health Research, Alberta Innovates - Health Solutions, the Alberta Children's Hospital Foundation, the National Institute of Environmental Health Sciences, the Mach-Gaensslen Foundation, and an Eyes High University of Calgary Postdoctoral Scholar. Led by the Hotchkiss Brain Institute, Brain and Mental Health is one of six research strategies guiding the University of Calgary toward its Eyes High goals. The strategy provides a unifying direction for brain and mental health research at the university..

First-of-its-kind study, based on a mouse model, finds living in a polluted environment could be comparable ventolin tablet online to eating a high-fat diet, leading to a pre-diabetic state CLEVELAND—Air pollution is the world’s leading environmental risk factor, and causes more than nine million deaths per year. New research published in the Journal of Clinical Investigation shows air pollution may play a role in the development of cardiometabolic diseases, such as diabetes. Importantly, the effects ventolin tablet online were reversible with cessation of exposure.

Researchers found that air pollution was a “risk factor for a risk factor” that contributed to the common soil of other fatal problems like heart attack and stroke. Similar to how an unhealthy diet and lack of exercise can lead to disease, exposure to air pollution could be added to this risk factor list as well. “In this study, we created an environment that mimicked a polluted day in New Delhi or Beijing,” said Sanjay Rajagopalan, MD, first author on the study, Chief of Cardiovascular Medicine at University Hospitals Harrington Heart and Vascular Institute, and Director of the ventolin tablet online Case Western Reserve University Cardiovascular Research Institute.

€œWe concentrated fine particles of air pollution, called PM2.5 (particulate matter component <. 2.5 microns) ventolin tablet online. Concentrated particles like this develop from human impact on the environment, such as automobile exhaust, power generation and other fossil fuels.” These particles have been strongly connected to risk factors for disease.

For example, cardiovascular effects of air pollution can lead to heart attack and stroke. The research team has shown exposure to air pollution can increase the likelihood of the same risk ventolin tablet online factors that lead to heart disease, such as insulin resistance and type 2 diabetes. In the mouse model study, three groups were observed.

A control group receiving clean filtered air, a group exposed to polluted air for 24 weeks, and a group fed a high-fat diet. Interestingly, the researchers found that being exposed to air pollution was comparable to eating a high-fat diet ventolin tablet online. Both the air pollution and high-fat diet groups showed insulin resistance and abnormal metabolism – just like one would see in a pre-diabetic state.

These changes were associated with changes in the epigenome, a layer of control that can masterfully turn on and turn off thousands of genes, ventolin tablet online representing a critical buffer in response to environmental factors. This study is the first-of-its-kind to compare genome-wide epigenetic changes in response to air pollution, compare and contrast these changes with that of eating an unhealthy diet, and examine the impact of air pollution cessation on these changes.“The good news is that these effects were reversible, at least in our experiments” added Dr. Rajagopalan.

€œOnce the air pollution was removed from the environment, the mice appeared ventolin tablet online healthier and the pre-diabetic state seemed to reverse.” Dr. Rajagopalan explains that if you live in a densely polluted environment, taking actions such as wearing an N95 mask, using portable indoor air cleaners, utilizing air conditioning, closing car windows while commuting, and changing car air filters frequently could all be helpful in staying healthy and limiting air pollution exposure.Next steps in this research involve meeting with a panel of experts, as well as the National Institutes of Health, to discuss conducting clinical trials that compare heart health and the level of air pollution in the environment. For example, if someone has a heart attack, should they be wearing an N95 mask or using a portable air filter at home during recovery?.

Dr ventolin tablet online. Rajagopalan and his team believe that it is important to address the environment as a population health risk factor and continue to diligently research these issues. The authors also note that these findings should encourage policymakers to enact measures aimed at reducing air pollution.Shyam Biswal, PhD, Professor in the Department of Environmental Health and Engineering at Johns Hopkins University ventolin tablet online School of Public Health, is the joint senior author on the study.

Drs. Rajagopalan and Biswal are co-PIs on the NIH grant that supported this work.###Rajagopalan, S., Biswal, S., et al. €œMetabolic effects of air pollution exposure ventolin tablet online and reversibility.” Journal of Clinical Investigation.

DOI. 10.1172/JCI137315. This work was supported by the National Institute of Environmental Health Sciences TaRGET II Consortium grant U01ES026721, as well as grants R01ES015146 and R01ES019616.About one in five women experience some form of depression during pregnancy, with poorly understood effects on the fetus.

Prenatal depression is linked to behavioural and developmental issues in children as well as an increased risk for depression as young adults. But how prenatal depression leads to these changes remains unclear. UCalgary researcher Dr.

Catherine Lebel, PhD, is helping understand what may be happening in the developing brains of these children. The research team has shown that young children whose mothers experienced more numerous symptoms of depression in pregnancy have weakened connectivity in brain pathways involved in emotion. These structural changes can be related to increased hyperactivity and aggression in boys.

The research is based on diffusion magnetic resonance imaging, an imaging technique that probes the strength of structural connections between brain regions. The findings are published in The Journal of Neuroscience. Catherine Lebel, senior author and investigator.

Riley Brandt, University of Calgary “The results help us understand how depression can have multigenerational impacts, and speaks to the importance of helping mothers who may be experiencing depression during pregnancy,” says Lebel, an associate professor at the Cumming School of Medicine, and researcher in the Alberta Children’s Hospital Research Institute. She holds the Canada Research Chair in Paediatric Neuroimaging. Lebel and her team studied 54 Calgary mothers and their children.

They were enrolled from the ongoing, prospective study called the Alberta Pregnancy Outcomes and Nutrition study. Mothers answered a survey about their depression symptoms at several points during their pregnancy. Their children were followed after birth and undertook an MRI scan at the Alberta Children’s Hospital at around age four.

As well, the children’s behaviour was assessed within six months of their MRI scan. The team found a significant reduction in structural brain connectivity between the amygdala, a structure essential for emotional processing, and the frontal cortex. Weakened connectivity between the amygdala and frontal cortex is associated with disruptive behaviours and vulnerability to depression.

The first author on the study, Dr. Rebecca Hay, MD, stresses the importance of recognition of depression and intervention in prenatal health. €œThese results suggest complex associations between the prenatal environment and children’s brain development, and may help us to understand why children of depressed mothers are more vulnerable to depression themselves,” says Hay, a resident physician in paediatrics and recent Cumming School of Medicine graduate.

The main clinical takeaway from this is to emphasize the importance of recognizing, treating prenatal depression and supporting mothers, both for better maternal outcomes and to help future child development. Rebecca Hay, the study's first author. Courtesy Rebecca Hay Current study looks at stress during ventolin Lebel and her research team are currently trying to understand how stress and mental health are affecting pregnant women during the asthma treatment ventolin.

She is examining how factors such as social supports might mitigate stress, and how this may influence pregnancy and birth outcomes. If you are interested, you can get involved here in the Pregnancy During the asthma treatment ventolin study at the University of Calgary. So far, approximately 7,500 women from across Canada are enrolled and supplying information through questionnaires.

€œIt is critical to appropriately recognize and treat prenatal maternal mental health problems, both for the mothers and to improve child outcomes,” says Lebel. €œNow more than ever, with increased stress, anxiety and depression during the asthma treatment ventolin, we should do more to support mothers to positively impact the health of their children.” Lebel is an associate professor in the Department of Radiology at the Cumming School of Medicine, adjunct associate professor in the Werklund School of Education and a member of The Mathison Centre for Mental Health Research &. Education, Owerko Centre at ACHRI, Hotchkiss Brain Institute and Alberta Children's Hospital Research Institute.

The study was funded by the Canadian Institute of Health Research, Alberta Innovates - Health Solutions, the Alberta Children's Hospital Foundation, the National Institute of Environmental Health Sciences, the Mach-Gaensslen Foundation, and an Eyes High University of Calgary Postdoctoral Scholar. Led by the Hotchkiss Brain Institute, Brain and Mental Health is one of six research strategies guiding the University of Calgary toward its Eyes High goals. The strategy provides a unifying direction for brain and mental health research at the university..

Can ventolin cause anxiety

IntroductionLa Peste can ventolin cause anxiety (Camus 1947) has served as a basis for several critical works, http://www.em-kleber-schiltigheim.ac-strasbourg.fr/?p=89 including some in the field of medical humanities (Bozzaro 2018. Deudon 1988. Tuffuor and Payne 2017) can ventolin cause anxiety. Frequently interpreted as an allegory of Nazism (with the plague as a symbol of the German occupation of France) (Finel-Honigman 1978.

Haroutunian 1964), it has also received philosophical readings beyond the sociopolitical context in which it was written (Lengers 1994). Other scholars, on the other hand, have centred their analyses on its literary aspects (Steel 2016).The asthma treatment ventolin has increased general interest about can ventolin cause anxiety historical and fictional epidemics. La Peste, as one of the most famous literary works about this topic, has been revisited by many readers during recent months, leading to an unexpected growth in sales in certain countries (Wilsher 2020. Zaretsky 2020).

Apart from that, can ventolin cause anxiety commentaries about the novel, especially among health sciences scholars, have emerged with a renewed interest (Banerjee et al. 2020. Bate 2020. Vandekerckhove 2020 can ventolin cause anxiety.

Wigand, Becker, and Steger 2020). This sudden curiosity is easy to understand if we consider both La Peste’s literary value, and people’s desire to discover real or fictional situations similar to theirs. Indeed, Oran inhabitants’ experiences are not quite far from our own, even if geographical, chronological and, can ventolin cause anxiety specially, scientific factors (two different diseases occurring at two different stages in the history of medical development) prevent us from establishing too close resemblances between both situations.Furthermore, it will not be strange if asthma treatment serves as a frame for fictional works in the near future. Other narrative plays were based on historical epidemics, such as Daniel Defoe’s A Journal of the Plague Year or Giovanni Boccaccio’s Decameron (Wigand, Becker, and Steger 2020.

Withington 2020). The biggest ventolin in the last century, the so-called ‘Spanish Influenza’, has been described as not very can ventolin cause anxiety fruitful in this sense, even if it produced famous novels such as Katherine A Porter’s Pale Horse, Pale Rider or John O’Hara’s The Doctor Son (Honigsbaum 2018. Hovanec 2011). The overlapping with another disaster like World War I has been argued as one of the reasons explaining this scarce production of fictional works (Honigsbaum 2018).

By contrast, we may think that asthma treatment is having a global impact hardly overshadowed by other events, and that it will leave a significant mark on the collective memory.Drawing on the reading of La Peste, we point out in this essay different aspects of living under an epidemic that can be identified both in Camus’s work and can ventolin cause anxiety in our current situation. We propose a trip throughout the novel, from its early beginning in Part I, when the Oranians are not aware of the threat to come, to its end in Part V, when they are relieved of the epidemic after several months of ravaging disasters.We think this journey along La Peste may be interesting both to health professionals and to the lay person, since all of them will be able to see themselves reflected in the characters from the novel. We do not skip critique of some aspects related to the authorities’ management of asthma treatment, as Camus does concerning Oran’s rulers. However, what we want to foreground is La Peste’s intrinsic value, its suitability to be read now and after asthma treatment has passed, when Camus’s novel endures as a solid art work and asthma treatment remains only can ventolin cause anxiety as a defeated plight.MethodsWe confronted our own experiences about asthma treatment with a conventional reading of La Peste.

A first reading of the novel was used to establish associations between those aspects which more saliently reminded us of asthma treatment. In a second reading, we searched for some examples to illustrate those aspects and tried to detect new associations. Subsequent readings of can ventolin cause anxiety certain parts were done to integrate the information collected. Neither specific methods of literary analysis, nor systematic searches in the novel were applied.

Selected paragraphs and ideas from Part I to Part V were prepared in a draft copy, and this manuscript was written afterwards.Part ISome phrases in the novel could be transposed word by word to our situation. This one pertaining to its start, for instance, may make us remember the first months of 2020:By now, it will be easy to accept that nothing could lead the people of our town can ventolin cause anxiety to expect the events that took place in the spring of that year and which, as we later understood, were like the forerunners of the series of grave happenings that this history intends to describe. (Camus 2002, Part I)By referring from the beginning to ‘the people of our town’, Camus is already suggesting an idea which is repeated all along the novel, and which may be well understood by us as asthma treatment’s witnesses. Epidemics affect the community as a whole, they are present in everybody’s mind and their joys and sorrows are not individual, but collective.

For example (and we are anticipating Part II), the narrator says:But, once the gates were closed, they all noticed that they were in the same boat, can ventolin cause anxiety including the narrator himself, and that they had to adjust to the fact. (Camus 2002, Part II)Later, he will insist in this opposition between the concepts of ‘individual’, which used to prevail before the epidemic, and ‘collective’:One might say that the first effect of this sudden and brutal attack of the disease was to force the citizens of our town to act as though they had no individual feelings. (Camus 2002, Part II)There were no longer any individual destinies, but a collective history that was the plague, and feelings shared by all. (Camus 2002, Part III)This distinction is not trivial, since the story will display a strong confrontation between those can ventolin cause anxiety who get involved and help their neighbours and those who remain behaving selfishly.

Related to this, Claudia Bozzaro has pointed out that the main topic in La Peste is solidarity and auistic love (Bozzaro 2018). We may add that the disease is so attached to people’s lives that the epidemic becomes the new everyday life:In the morning, they would return to the pestilence, that is to say, to routine. (Camus 2002, Part III)Being collective issues does not mean that epidemics always enhance can ventolin cause anxiety auism and solidarity. As said by Wigand et al, they frequently produce ambivalent reactions, and one of them is the opposition between auism and maximised profit (Wigand, Becker, and Steger 2020).

Therefore, the dichotomy between individualism and collectivism, a central point in the characterisation of national cultures (Hofstede 2015), could play a role in epidemics. In fact, concerning asthma treatment, some authors have described a greater impact of the ventolin in those countries can ventolin cause anxiety with higher levels of individualism (Maaravi et al. 2021. Ozkan et al.

2021). However, this finding should be complemented with other national cultures’ aspects before concluding that collectivism itself exerts a protective role against epidemics. Concerning this, it has been shown how ‘power distance’ frequently intersects with collectivism, being only a few countries in which the last one coexists with a small distance to power, namely with a capacity to disobey the power authority (Gupta, Shoja, and Mikalef 2021). Moreover, those countries classically classified as ‘collectivist’ (China, Japan, South Korea, India, Vietnam, etc.) are also characterised by high levels of power distance, and their citizens have been quite often forced to adhere to asthma treatment restrictions and punished if not (Gupta, Shoja, and Mikalef 2021).

Thus, it is important to consider that individualism is not always opposed to ‘look after each other’ (Ozkan et al. 2021, 9). For instance, the European region, seen as a whole as highly ‘individualistic’, holds some of the most advanced welfare protection systems worldwide. It is worth considering too that collectivism may hide sometimes a hard institutional authority or a lack in civil freedoms.Coming back to La Peste, we may think that Camus’s Oranians are not particularly ‘collectivist’.

Their initial description highlights that they are mainly interested in their own businesses and affairs:Our fellow-citizens work a good deal, but always in order to make money. They are especially interested in trade and first of all, as they say, they are engaged in doing business. (Camus 2002, Part I)And later, we see some of them trying selfishly to leave the city by illegal methods. By contrast, we observe in the novel some examples of more ‘collectivistic’ attitudes, such as the discipline of those quarantined at the football pitch, and, over all, the main characters’ behaviour, which is generally driven by auism and common goals.Turning to another topic, the plague in Oran and asthma treatment are similar regarding their animal origin.

This is not rare since many infectious diseases pass to humans through contact with animal vectors, being rodents, especially rats (through rat fleas), the most common carriers of plague bacteria (CDC. N.d.a, ECDC. N.d, Pollitzer 1954). Concerning asthma, even if further research about its origin is needed, the most recent investigations conducted in China by the WHO establish a zoonotic transmission as the most probable pathway (Joint WHO-China Study Team 2021).

In Camus’s novel, the animal’s link to the epidemic seemed very clear since the beginning:Things got to the point where Infodoc (the agency for information and documentation, ‘ all you need to know on any subject’) announced in its free radio news programme that 6,231 rats had been collected and burned in a single day, the 25th. This figure, which gave a clear meaning to the daily spectacle that everyone in town had in front of their eyes, disconcerted them even more. (Camus 2002, Part I)This accuracy in figures is familiar to us. People nowadays have become very used to the statistical aspects of the ventolin, due to the continuous updates in epidemiological parameters launched by the media and the authorities.

Camus was aware about the relevance of figures in epidemics, which always entail:…required registration and statistical tasks. (Camus 2002, Part II)Because of this, the novel is scattered with numbers, most of them concerning the daily death toll, but others mentioning the number of rats picked up, as we have seen, or combining the number of deaths with the time passed since the start of the epidemic:“ Will there be an autumn of plague?. Professor B answers. €˜ No’ ”, “ One hundred and twenty-four dead.

The total for the ninety-fourth day of the plague.” (Camus 2002, Part II)We permit ourselves to introduce here a list of recurring topics in La Peste, since the salience of statistical information is one of them. These topics, some of which will be treated later, appear several times in the novel, in various contexts and stages in the evolution of the epidemic. We synthesise them in Table 1, coupled with a asthma treatment parallel example extracted from online press. This ease to find a current example for each topic suggests that they are not exclusive of plague or of Camus’s mindset, but shared by most epidemics.View this table:Table 1 Recurring topics in La Peste.

Each topic is accompanied by two examples from the novel and one concerning asthma treatment, extracted from online press.Talking about journalism and the media (one of the topics above), we might say that asthma treatment’s coverage is frequently too optimistic when managing good news and too alarming when approaching the bad. Media’s ‘exaggerated’ approach to health issues is not new. It was already a concern for medical journals’ editors a century ago (Reiling 2013) and it continues to be it for these professionals in recent times (Barbour et al. 2008).

It is well known that media tries to attract spectators’ attention by making the news more appealing. However, they deal with the risk of expanding unreliable information, which may be pernicious for the public opinion. Related to the intention of ‘garnishing’ the news, Aslam et al. (2020) have described that 82% of more than 100 000 pieces of information about asthma treatment appearing in media from different countries carried an emotional, either negative (52%) or positive (30%) component, with only 18% of them considered as ‘neutral’ (Aslam et al.

2020). Some evidence about this tendency to make news more emotional was described in former epidemics. For instance, a study conducted in Singapore in 2009 during the H1N1 crisis showed how press releases by the Ministry of Health were substantially transformed when passed to the media, by increasing their emotional appeal and by changing their dominant frame or their tone (Lee and Basnyat 2013). In La Peste, this superficial way of managing information by the media is also observed:The newspapers followed the order that they had been given, to be optimistic at any cost.

(Camus 2002, Part IV)At the first stages of the epidemic in Oran, journalists proclaim the end of the dead rats’ invasion as something to be celebrated. Dr Rieux, the character through which Camus symbolises caution (and comparable nowadays to trustful scientists, well-informed journalists or sensible authorities), exposes then his own angle, quite far from suggesting optimism:The vendors of the evening papers were shouting that the invasion of rats had ended. But Rieux found his patient lying half out of bed, one hand on his belly and the other around his neck, convulsively vomiting reddish bile into a rubbish bin. (Camus 2002, Part I)Camus, who worked as a journalist for many years, insists afterwards on this cursory interest that some media devote to the epidemic, more eager to grab the noise than the relevant issues beneath it:The press, which had had so much to say about the business of the rats, fell silent.

This is because rats die in the street and people in their bedrooms. And newspapers are only concerned with the street. (Camus 2002, Part I)By then, Oranians continue rejecting the epidemic as an actual threat, completely immersed in that phase that dominates the beginning of all epidemics and is characterised by ‘denial and disbelief’ (Wigand, Becker, and Steger 2020, 443):A pestilence does not have human dimensions, so people tell themselves that it is unreal, that it is a bad dream which will end. […] The people of our town were no more guilty than anyone else, they merely forgot to be modest and thought that everything was still possible for them, which implied that pestilence was impossible.

They continued with business, with making arrangements for travel and holding opinions. Why should they have thought about the plague, which negates the future, negates journeys and debate?. They considered themselves free and no one will ever be free as long as there is plague, pestilence and famine. (Camus 2002, Part I)Probably to avoid citizens' disapproval, among other reasons, the Oranian Prefecture (health authority in Camus' novel) does not want to go too far when judging the relevance of the epidemic.

While not directly exposed, we can guess in this fragment the tone of the Prefect’s message, his intention to convey confidence despite his own doubts:These cases were not specific enough to be really disturbing and there was no doubt that the population would remain calm. None the less, for reasons of caution which everyone could understand, the Prefect was taking some preventive measures. If they were interpreted and applied in the proper way, these measures were such that they would put a definite stop to any threat of epidemic. As a result, the Prefect did not for a moment doubt that the citizens under his charge would co-operate in the most zealous manner with what he was doing.

(Camus 2002, Part I)The relevant role acquired by health authorities during epidemics is another topic listed in our table. Language use, on the other hand, is an issue linkable both with the media topic and with this one. As in La Peste, during asthma treatment we have seen some public figures using words not always truthfully, carrying out a careful selection of words that serves to the goal of conveying certain interests in each moment. Dr Rieux refers in Part I to this language manipulation by the authorities:The measures that had been taken were insufficient, that was quite clear.

As for the ‘ specially equipped wards’, he knew what they were. Two outbuildings hastily cleared of other patients, their windows sealed up and the whole surrounded by a cordon sanitaire. (Camus 2002, Part I)He illustrates the need of frankness, the preference for clarity in language, which is often the clarity in thinking:No. I phoned Richard to say we needed comprehensive measures, not fine words, and that either we must set up a real barrier to the epidemic, or nothing at all.

(Camus 2002, Part I)At the end of this part, his fears about the inadequacy of not taking strict measures are confirmed. Oranian hospitals become overwhelmed, as they are now in many places worldwide due to asthma treatment.Part IILeft behind the phases of ‘denial and disbelief’ and of ‘fear and panic’, it appears among the Oranians the ‘acceptance paired with resignation’ (Wigand, Becker, and Steger 2020, 443):Then we knew that our separation was going to last, and that we ought to try to come to terms with time. […] In particular, all of the people in our town very soon gave up, even in public, whatever habit they may have acquired of estimating the length of their separation. (Camus 2002, Part II)In asthma treatment as well, even if border closure has not been so immovable as in Oran, many people have seen themselves separated from their loved ones and some of them have not yet had the possibility of reunion.

This is why, in the actual ventolin, the idea of temporal horizons has emerged like it appeared in Camus’s epidemic. In Spain, the general lockdown in March and April 2020 made people establish the summer as their temporal horizon, a time in which they could resume their former habits and see their relatives again. This became partially true, and people were allowed in summer to travel inside the country and to some other countries nearby. However, there existed some reluctance to visit ill or aged relatives, due to the fear of infecting them, and some families living in distant countries were not able to get together.

Moreover, autumn brought an increase in the number of cases (‘the second wave’) and countries returned to limit their internal and external movements.Bringing all this together, many people nowadays have opted to discard temporal horizons. As Oranians, they have noted that the epidemic follows its own rhythm and it is useless to fight against it. Nonetheless, it is in human nature not to resign, so abandoning temporal horizons does not mean to give up longing for the recovery of normal life. This vision, neither maintaining vain hopes nor resigning, is in line with Camus’s philosophy, an author who wrote that ‘hope, contrary to what it is usually thought, is the same to resignation.’ (Camus 1939, 83.

Cited by Haroutunian 1964, 312 (translation is ours)), and that ‘there is not love to human life but with despair about human life.’ (Camus 1958, 112–5. Cited by Haroutunian 1964, 312–3 (translation is ours)).People nowadays deal with resignation relying on daily life pleasures (being not allowed to make further plans or trips) and in company from the nearest ones (as they cannot gather with relatives living far away). Second, they observe the beginning of vaccination campaigns as a first step of the final stage, and summer 2021, reflecting what happened with summer 2020, has been fixed as a temporal horizon. This preference for summers has an unavoidable metaphorical nuance, and their linking to joy, long trips and life in the streets may be the reason for which we choose them to be opposed to the lockdown and restrictions of the ventolin.We alluded previously to the manipulation of language, and figures, as relevant as they are, they are not free from manipulation either.

Tarrou, a close friend to Dr Rieux, points out in this part of the novel how this occurred:Once more, Tarrou was the person who gave the most accurate picture of our life as it was then. Naturally he was following the course of the plague in general, accurately observing that a turning point in the epidemic was marked by the radio no longer announcing some hundreds of deaths per week, but 92, 107 and 120 deaths a day. €˜The newspapers and the authorities are engaged in a battle of wits with the plague. They think that they are scoring points against it, because 130 is a lower figure than 910.’ (Camus 2002, Part II)Tarrou collaborates with the health teams formed to tackle the plague.

Regarding these volunteers and workers, Camus refuses to consider them as heroes, as many essential workers during asthma treatment have rejected to be named as that. The writer thinks their actions are the natural behaviour of good people, not heroism but ‘a logical consequence’:The whole question was to prevent the largest possible number of people from dying and suffering a definitive separation. There was only one way to do this, which was to fight the plague. There was nothing admirable about this truth, it simply followed as a logical consequence.

(Camus 2002, Part II)We consider suitable to talk here about two issues which represent, nowadays, a great part of asthma treatment fears and hopes, respectively. New genetic variants and treatments. Medical achievements are another recurrent issue included in table 1, and we write about them here because it is in Part II where Camus writes for the first time about treatments, and where it insists on an idea aforementioned in Part I. That the plague bacillus affecting Oran is different from previous variants:…the microbe differed very slightly from the bacillus of plague as traditionally defined.

(Camus 2002, Part II)Related to asthma treatment new variants, they represent a challenge because of two main reasons. Their higher transmissibility and/or severity and their higher propensity to skip the effect of natural or treatment-induced immunity. Public health professionals are determining which is the actual threat of all the new variants discovered, such as those first characterised in the UK (Public Health England 2020), South Africa (Tegally et al. 2021) or Brazil (Fujino et al.

2021). In La Peste, Dr Rieux is always suspecting that the current bacteria they are dealing with is different from the one in previous epidemics of plague. Since several genetic variations for the bacillus Yersinia pestis have been characterised (Cui et al. 2012), it could be possible that the epidemic in Oran originated from a new one.

However, we should not forget that we are analysing a literary work, and that scientific accuracy is not a necessary goal in it. In fact, Rieux’s reluctances have to do more with clinical aspects than with microbiological ones. He doubts since the beginning, relying exclusively on the symptoms observed, and continues doing it after the laboratory analysis:I was able to have an analysis made in which the laboratory thinks it can detect the plague bacillus. However, to be precise, we must say that certain specific modifications of the microbe do not coincide with the classic description of plague.

(Camus 2002, Part II)Camus is consistent with this http://bobmackin.ca/?p=970 idea and many times he mentions the bacillus to highlight its oddity. Insisting on the literary condition of the work, and among other possible explanations, he is maybe declaring that that in the novel is not a common (biological, natural) bacteria, but the Nazism bacteria.Turning to treatments, they constitute the principal resource that the global community has to defeat the asthma treatment ventolin. Vaccination campaigns have started all over the world, and three types of asthma treatments are being applied in the European Union, after their respective statements of efficacy and security (Baden et al. 2021.

Polack et al. 2020. Voysey et al. 2021), while a fourth treatment has just recently been approved (EMA 2021a).

Although some concerns regarding the safety of two of these treatments have been raised recently (EMA 2021b. EMA 2021c), vaccination plans are going ahead, being adapted according to the state of knowledge at each moment. Some of these treatments are mRNA-based (Baden et al. 2021.

Polack et al. 2020), while others use a viral vector (Bos et al. 2020. Voysey et al.

2021). They are mainly two-shot treatments, with one exception (Bos et al. 2020), and complete immunity is thought to be acquired 2 weeks after the last shot (CDC. N.d.b, Voysey et al.

2021). Other countries such as China or Russia, on the other hand, were extremely early in starting their vaccination campaigns, and are distributing among their citizens different treatments than the aforementioned (Logunov et al. 2021. Zhang et al.

2021).Even if at least three types of plague treatments had been created by the time the novel takes place (Sun 2016), treatments do not play an important role in La Peste, in which therapeutic measures (the serum) are more important than prophylactic ones. Few times in the novel the narrator refers to prophylactic inoculations:There was still no possibility of vaccinating with preventive serum except in families already affected by the disease. (Camus 2002, Part II)Deudon has pointed out that Camus mixes up therapeutic serum and treatment (Deudon 1988), and in fact there exists a certain amount of confusion. All along the novel, the narrator focuses on the prophylactic goals of the serum, which is applied to people already infected (Othon’s son, Tarrou, Grand…).

However, both in the example above (which can be understood as vaccinating household contacts or already affected individuals) and in others, the differences between treating and vaccinating are not clear:After the morning admissions which he was in charge of himself, the patients were vaccinated and the swellings lanced. (Camus 2002, Part II)In any case, this is another situation in which Camus stands aside from scientific matters, which are to him less relevant in his novel than philosophical or literary ones. The distance existing between the relevance of treatments in asthma treatment and the superficial manner with which Camus treats the topic in La Peste exemplifies this.Part IIIIn part III, the plague’s ravages become tougher. The narrator turns his focus to burials and their disturbance, a frequent topic in epidemics’ narrative (table 1).

Camus knew how acutely increasing demands and hygienic requirements affect funeral habits during epidemics:Everything really happened with the greatest speed and the minimum of risk. (Camus 2002, Part III)Like many other processes during epidemics, the burial process becomes a protocol. When protocolised, everything seems to work well and rapidly. But this perfect mechanism is the Prefecture’s goal, not Rieux’s.

He reveals in this moment an aspect in his character barely shown before. Irony.The whole thing was well organized and the Prefect expressed his satisfaction. He even told Rieux that, when all was said and done, this was preferable to hearses driven by black slaves which one read about in the chronicles of earlier plagues. €˜ Yes,’ Rieux said.

€˜ The burial is the same, but we keep a card index. No one can deny that we have made progress.’ (Camus 2002, Part III)Even if this characteristic may seem new in Dr Rieux, we must bear in mind that he is the story narrator, and the narration is ironic from time to time. For instance, speaking precisely about the burials:The relatives were invited to sign a register –which just showed the difference that there may be between men and, for example, dogs. You can keep check of human beings-.

(Camus 2002, Part III)In Camus’s philosophy, the absurd is a core issue. According to Lengers, Rieux is ironic because he is a kind of Sisyphus who has understood the absurdity of plague (Lengers 1994). The response to the absurd is to rebel (Camus 2013), and Rieux does it by helping his fellow humans without questioning anything. He does not pursue any other goal than doing his duty, thus humour (as a response to dire situations) stands out from him when he observes others celebrating irrelevant achievements, such as the Prefect with his burial protocol.

In the field of medical ethics, Lengers has highlighted the importance of Camus’s perspective when considering ‘the immediacy of life rather than abstract values’ (Lengers 1994, 250). Rieux himself is quite sure that his solid commitment is not ‘abstract’, and, even if he falls into abstraction, the importance relies on protecting human lives and not in the name given to that task:Was it truly an abstraction, spending his days in the hospital where the plague was working overtime, bringing the number of victims up to five hundred on average per week?. Yes, there was an element of abstraction and unreality in misfortune. But when an abstraction starts to kill you, you have to get to work on it.

(Camus 2002, Part II)Farewells during asthma treatment may have not been particularly pleasant for some families. Neither those dying at nursing homes nor in hospitals could be accompanied by their families as previously, due to corpses management protocols, restrictions of external visitors and hygienic measures in general. However, as weeks passed by, certain efforts were made to ease this issue, allowing people to visit their dying beloved sticking to strict preventive measures. On the other hand, the number of people attending funeral masses and cemeteries was also limited, which affected the conventional development of ceremonies as well.

Hospitals had to deal with daily tolls of deaths never seen before, and the overcrowding of mortuaries made us see rows of coffins placed in unusual spaces, such as ice rinks (transformation of facilities is another topic in table 1).We turn now to two other points which asthma treatment has not evaded. s among essential workers and epidemics’ economic consequences. The author links burials with s among essential workers because gravediggers constitute one of the most affected professions, and connects this fact with the economic recession because unemployment is behind the large availability of workers to replace the dead gravediggers:Many of the male nurses and the gravediggers, who were at first official, then casual, died of the plague. […] The most surprising thing was that there was never a shortage of men to do the job, for as long as the epidemic lasted.

[…] When the plague really took hold of the town, its very immoderation had one quite convenient outcome, because it disrupted the whole of economic life and so created quite a large number of unemployed. […] Poverty always triumphed over fear, to the extent that work was always paid according to the risk involved. (Camus 2002, Part III)The effects of the plague over the economic system are one of our recurrent topics (table 1). The plague in Oran, as it forces to close the city, impacts all trading exchanges.

In addition, it forbids travellers from arriving to the city, with the economic influence that that entails:This plague was the ruination of tourism. (Camus 2002, Part II)Oranians, who, as we saw, were very worried about making money, are especially affected by an event which jeopardises it. In asthma treatment, for one reason or for another, most of the countries are suffering economic consequences, since the impact on normal life from the epidemic (another recurrent topic) means also an impact on the normal development of trading activities.Part IVIn Part IV we witness the first signals of a stabilisation of the epidemic:It seemed that the plague had settled comfortably into its peak and was carrying out its daily murders with the precision and regularity of a good civil servant. In theory, in the opinion of experts, this was a good sign.

The graph of the progress of the plague, starting with its constant rise, followed by this long plateau, seemed quite reassuring. (Camus 2002, Part IV)At this time, we consider interesting to expand the topic about the transformation of facilities. We mentioned the case of ice rinks during asthma treatment, and we bring up now the use of a football pitch as a quarantine camp in Camus’s novel, a scene which has reminded some scholars of the metaphor of Nazism and concentration camps (Finel-Honigman 1978). In Spain, among other measures, a fairground was enabled as a field hospital during the first wave, and it is plausible that many devices created with other purposes were used in tasks attached to healthcare provision during those weeks, as occurred in Oran’s pitch with the loudspeakers:Then the loudspeakers, which in better times had served to introduce the teams or to declare the results of games, announced in a tinny voice that the internees should go back to their tents so that the evening meal could be distributed.

(Camus 2002, Part IV)Related to this episode, we can also highlight the opposition between science and humanism that Camus does. The author alerts us about the dangers of a dehumanised science, of choosing procedures perfectly efficient regardless of their lack in human dignity:The men held out their hands, two ladles were plunged into two of the pots and emerged to unload their contents onto two tin plates. The car drove on and the process was repeated at the next tent.‘ It’s scientific,’ Tarrou told the administrator.‘ Yes,’ he replied with satisfaction, as they shook hands. €˜ It’s scientific.’ (Camus 2002, Part IV)Several cases with favourable outcomes mark Part IV final moments and prepare the reader for the end of the epidemic.

To describe these signs of recovering, the narrator turns back to two elements with a main role in the novel. Rats and figures. In this moment, the first ones reappear and the second ones seem to be declining:He had seen two live rats come into his house through the street door. Neighbours had informed him that the creatures were also reappearing in their houses.

Behind the walls of other houses there was a hustle and bustle that had not been heard for months. Rieux waited for the general statistics to be published, as they were at the start of each week. They showed a decline in the disease. (Camus 2002, Part IV)Part VGiven that we continue facing asthma treatment, and that forecasts about its end are not easy, we cannot compare ourselves with the Oranians once they have reached the end of the epidemic, what occurs in this part.

However, we can analyse our current situation, characterised by a widespread, though cautious, confidence motivated by the beginning of vaccination campaigns, referring it to the events narrated in Part V.Even more than the Oranians, since we feel further than them from the end of the problem, we are cautious about not to anticipate celebrations. From time to time, however, we lend ourselves to dream relying on what the narrator calls ‘a great, unadmitted hope’. asthma treatment took us by surprise and everyone wants to ‘reorganise’ their life, as Oranians do, but patience is an indispensable component to succeed, as fictional and historical epidemics show us.Although this sudden decline in the disease was unexpected, the towns-people were in no hurry to celebrate. The preceding months, though they had increased the desire for liberation, had also taught them prudence and accustomed them to count less and less on a rapid end to the epidemic.

However, this new development was the subject of every conversation and, in the depths of people’s hearts, there was a great, unadmitted hope. […] One of the signs that a return to a time of good health was secretly expected (though no one admitted the fact) was that from this moment on people readily spoke, with apparent indifference, about how life would be reorganized after the plague. (Camus 2002, Part V)We put our hope on vaccination. Social distancing and other hygienic measures have proved to be effective, but treatments would bring us a more durable solution without compromising so hardly many economic activities and social habits.

As we said, a more important role of scientific aspects is observed in asthma treatment if compared with La Peste (an expected fact if considered that Camus’s story is an artistic work, that he skips sometimes the most complex scientific issues of the plague and that health sciences have evolved substantially during last decades). Oranians, in fact, achieve the end of the epidemic not through clearly identified scientific responses but with certain randomness:All one could do was to observe that the sickness seemed to be going as it had arrived. The strategy being used against it had not changed. It had been ineffective yesterday, and now it was apparently successful.

One merely had the feeling that the disease had exhausted itself, or perhaps that it was retiring after achieving all its objectives. In a sense, its role was completed. (Camus 2002, Part V)They receive the announcement made by the Prefecture of reopening the town’s gates in 2 weeks time with enthusiasm. Dealing with concrete dates gives them certainty, helps them fix the temporal horizons we wrote about.

This is also the case when they are told that preventive measures would be lifted in 1 month. Camus shows us then how the main characters are touched as well by this positive atmosphere:That evening Tarrou and Rieux, Rambert and the rest, walked in the midst of the crowd, and they too felt they were treading on air. Long after leaving the boulevards Tarrou and Rieux could still hear the sounds of happiness following them… (Camus 2002, Part V)Then, Tarrou points out a sign of recovery coming from the animal world. In a direct zoological chain, infected fleas have vanished from rats, which have been able again to multiply across the city, making the cats abandon their hiding places and to go hunting after them again.

At the final step of this chain, Tarrou sees the human being. He remembers the old man who used to spit to the cats beneath his window:At a time when the noise grew louder and more joyful, Tarrou stopped. A shape was running lightly across the dark street. It was a cat, the first that had been seen since the spring.

It stopped for a moment in the middle of the road, hesitated, licked its paw, quickly passed it across its right ear, then carried on its silent way and vanished into the night. Tarrou smiled. The little old man, too, would be happy. (Camus 2002, Part V)Unpleasant things as a town with rats running across its streets, or a man spending his time spitting on a group of cats, constitute normality as much as the reopening of gates or the reboot of commerce.

However, when Camus speaks directly about normality, he highlights more appealing habits. He proposes common leisure activities (restaurants, theatres) as symbols of human life, since he opposes them to Cottard’s life, which has become that of a ‘wild animal’:At least in appearance he [ Cottard ] retired from the world and from one day to the next started to live like a wild animal. He no longer appeared in restaurants, at the theatre or in his favourite cafés. (Camus 2002, Part V)We do not disclose why Cottard’s reaction to the end of the epidemic is different from most of the Oranians’.

In any case, the narrator insists later on the assimilation between common pleasures and normality:‘ Perhaps,’ Cottard said, ‘ Perhaps so. But what do you call a return to normal life?. €™ ‘ New films in the cinema,’ said Tarrou with a smile. (Camus 2002, Part V)Cinema, as well as theatre, live music and many other cultural events have been cancelled or obliged to modify their activities due to asthma treatment.

Several bars and restaurants have closed, and spending time in those who remain open has become an activity which many people tend to avoid, fearing contagion. Thus, normality in our understanding is linked as well to these simple and pleasant habits, and the complete achievement of them will probably signify for us the desired defeat of the ventolin.In La Peste, love is also seen as a simple good to be fully recovered after the plague. While Rieux goes through the ‘reborn’ Oran, it is lovers’ gatherings what he highlights. Unlike them, everyone who, during the epidemic, sought for goals different from love (such as faith or money, for instance) remain lost when the epidemic has ended:For all the people who, on the contrary, had looked beyond man to something that they could not even imagine, there had been no reply.

(Camus 2002, Part V)And this is because lovers, as the narrator says:If they had found that they wanted, it was because they had asked for the only thing that depended on them. (Camus 2002, Part V)We have spoken before about language manipulation, hypocrisy and public figures’ roles during epidemics. Camus, during Dr Rieux’s last visit to the old asthmatic man, makes this frank and humble character criticise, with a point of irony, the authorities’ attitude concerning tributes to the dead:‘ Tell me, doctor, is it true that they’re going to put up a monument to the victims of the plague?. €™â€˜ So the papers say.

A pillar or a plaque.’‘ I knew it!. And there’ll be speeches.’The old man gave a strangled laugh.‘ I can hear them already. €œ Our dead…” Then they’ll go and have dinner.’ (Camus 2002, Part V)The old man illustrates wisely the authorities’ propensity for making speeches. He knows that most of them usually prefer grandiloquence rather than common words, and seizes perfectly their tone when he imitates them (‘Our dead…’).

We have also got used, during asthma treatment, to these types of messages. We have also heard about ‘our old people’, ‘our youth’, ‘our essential workers’ and even ‘our dead’. Behind this tone, however, there could be an intention to hide errors, or to falsely convey carefulness. Honest rulers do not usually need nice words.

They just want them to be accurate.We have seen as well some tributes to the victims during asthma treatment, some of which we can doubt whether they serve to victims’ relief or to authorities’ promotion. We want rulers to be less aware of their own image and to stress truthfulness as a goal, even if this is a hard requirement not only for them, but for every single person. Language is essential in this issue, we think, since it is prone to be twisted and to become untrue. The old asthmatic man illustrates it with his ‘There’ll be speeches’ and his ‘Our dead…’, but this is not the only time in the novel in which Camus brings out the topic.

For instance, he does so when he equates silence (nothing can be thought as further from wordiness) with truth:It is at the moment of misfortune that one becomes accustomed to truth, that is to say to silence. (Camus 2002, Part II)or when he makes a solid statement against false words:…I understood that all the misfortunes of mankind came from not stating things in clear terms. (Camus 2002, Part IV)The old asthmatic, in fact, while praising the deceased Tarrou, remarks that he used to admire him because ‘he didn’t talk just for the sake of it.’ (Camus 2002, Part V).Related to this topic, what the old asthmatic says about political authorities may be transposed in our case to other public figures, such as scholars and researchers, media leaders, businessmen and women, health professionals… and, if we extend the scope, to every single citizen. Because hypocrisy, language manipulation and the fact of putting individual interests ahead of collective welfare fit badly with collective issues such as epidemics.

Hopefully, also examples to the contrary have been observed during asthma treatment.The story ends with the fireworks in Oran and the depiction of Dr Rieux’s last feelings. While he is satisfied because of his medical performance and his activity as a witness of the plague, he is concerned about future disasters to come. When asthma treatment will have passed, it will be time for us as well to review our life during these months. For now, we are just looking forward to achieving our particular ‘part V’..

IntroductionLa Peste ventolin tablet online (Camus 1947) has served as a basis for several critical works, including some ventolin price uk in the field of medical humanities (Bozzaro 2018. Deudon 1988. Tuffuor and ventolin tablet online Payne 2017). Frequently interpreted as an allegory of Nazism (with the plague as a symbol of the German occupation of France) (Finel-Honigman 1978. Haroutunian 1964), it has also received philosophical readings beyond the sociopolitical context in which it was written (Lengers 1994).

Other scholars, on the other hand, have centred their analyses on its literary aspects (Steel 2016).The asthma treatment ventolin has increased general interest about historical ventolin tablet online and fictional epidemics. La Peste, as one of the most famous literary works about this topic, has been revisited by many readers during recent months, leading to an unexpected growth in sales in certain countries (Wilsher 2020. Zaretsky 2020). Apart from that, commentaries about the novel, ventolin tablet online especially among health sciences scholars, have emerged with a renewed interest (Banerjee et al. 2020.

Bate 2020. Vandekerckhove 2020 ventolin tablet online. Wigand, Becker, and Steger 2020). This sudden curiosity is easy to understand if we consider both La Peste’s literary value, and people’s desire to discover real or fictional situations similar to theirs. Indeed, Oran inhabitants’ experiences are not quite far from our own, even if geographical, chronological and, specially, scientific factors (two different diseases occurring at two different stages in the history of medical development) prevent us from establishing too close resemblances between both situations.Furthermore, it will not be strange if asthma treatment serves as a frame ventolin tablet online for fictional works in the near future.

Other narrative plays were based on historical epidemics, such as Daniel Defoe’s A Journal of the Plague Year or Giovanni Boccaccio’s Decameron (Wigand, Becker, and Steger 2020. Withington 2020). The biggest ventolin in the last century, the so-called ‘Spanish Influenza’, has been described as not very fruitful in this sense, even if ventolin tablet online it produced famous novels such as Katherine A Porter’s Pale Horse, Pale Rider or John O’Hara’s The Doctor Son (Honigsbaum 2018. Hovanec 2011). The overlapping with another disaster like World War I has been argued as one of the reasons explaining this scarce production of fictional works (Honigsbaum 2018).

By contrast, we may think that asthma treatment is having a global impact hardly overshadowed by other events, and that it will leave a significant mark on the collective memory.Drawing on the reading of La Peste, we point out in this ventolin tablet online essay different aspects of living under an epidemic that can be identified both in Camus’s work and in our current situation. We propose a trip throughout the novel, from its early beginning in Part I, when the Oranians are not aware of the threat to come, to its end in Part V, when they are relieved of the epidemic after several months of ravaging disasters.We think this journey along La Peste may be interesting both to health professionals and to the lay person, since all of them will be able to see themselves reflected in the characters from the novel. We do not skip critique of some aspects related to the authorities’ management of asthma treatment, as Camus does concerning Oran’s rulers. However, what we want to foreground is La Peste’s intrinsic value, its suitability to be read now and after asthma treatment has passed, when Camus’s novel endures as a solid art work and asthma treatment remains only as a defeated plight.MethodsWe confronted our own experiences about asthma treatment with a conventional reading ventolin tablet online of La Peste. A first reading of the novel was used to establish associations between those aspects which more saliently reminded us of asthma treatment.

In a second reading, we searched for some examples to illustrate those aspects and tried to detect new associations. Subsequent readings of certain ventolin tablet online parts were done to integrate the information collected. Neither specific methods of literary analysis, nor systematic searches in the novel were applied. Selected paragraphs and ideas from Part I to Part V were prepared in a draft copy, and this manuscript was written afterwards.Part ISome phrases in the novel could be transposed word by word to our situation. This one pertaining to its start, for instance, may make us remember the first months of 2020:By now, it will be easy to accept that nothing could lead the people of our town to expect the events that took place in the spring of ventolin tablet online that year and which, as we later understood, were like the forerunners of the series of grave happenings that this history intends to describe.

(Camus 2002, Part I)By referring from the beginning to ‘the people of our town’, Camus is already suggesting an idea which is repeated all along the novel, and which may be well understood by us as asthma treatment’s witnesses. Epidemics affect the community as a whole, they are present in everybody’s mind and their joys and sorrows are not individual, but collective. For example (and we are anticipating Part II), the narrator says:But, once the gates were closed, they all noticed that they were in the same boat, including the narrator himself, and that they had ventolin tablet online to adjust to the fact. (Camus 2002, Part II)Later, he will insist in this opposition between the concepts of ‘individual’, which used to prevail before the epidemic, and ‘collective’:One might say that the first effect of this sudden and brutal attack of the disease was to force the citizens of our town to act as though they had no individual feelings. (Camus 2002, Part II)There were no longer any individual destinies, but a collective history that was the plague, and feelings shared by all.

(Camus 2002, Part III)This distinction is not trivial, since the story will display a strong confrontation between ventolin tablet online those who get involved and help their neighbours and those who remain behaving selfishly. Related to this, Claudia Bozzaro has pointed out that the main topic in La Peste is solidarity and auistic love (Bozzaro 2018). We may add that the disease is so attached to people’s lives that the epidemic becomes the new everyday life:In the morning, they would return to the pestilence, that is to say, to routine. (Camus 2002, Part III)Being collective issues does not mean that ventolin tablet online epidemics always enhance auism and solidarity. As said by Wigand et al, they frequently produce ambivalent reactions, and one of them is the opposition between auism and maximised profit (Wigand, Becker, and Steger 2020).

Therefore, the dichotomy between individualism and collectivism, a central point in the characterisation of national cultures (Hofstede 2015), could play a role in epidemics. In fact, concerning asthma treatment, some authors have described a greater impact of the ventolin in those countries with higher levels of individualism (Maaravi et ventolin tablet online al. 2021. Ozkan et al. 2021).

However, this finding should be complemented with other national cultures’ aspects before concluding that collectivism itself exerts a protective role against epidemics. Concerning this, it has been shown how ‘power distance’ frequently intersects with collectivism, being only a few countries in which the last one coexists with a small distance to power, namely with a capacity to disobey the power authority (Gupta, Shoja, and Mikalef 2021). Moreover, those countries classically classified as ‘collectivist’ (China, Japan, South Korea, India, Vietnam, etc.) are also characterised by high levels of power distance, and their citizens have been quite often forced to adhere to asthma treatment restrictions and punished if not (Gupta, Shoja, and Mikalef 2021). Thus, it is important to consider that individualism is not always opposed to ‘look after each other’ (Ozkan et al. 2021, 9).

For instance, the European region, seen as a whole as highly ‘individualistic’, holds some of the most advanced welfare protection systems worldwide. It is worth considering too that collectivism may hide sometimes a hard institutional authority or a lack in civil freedoms.Coming back to La Peste, we may think that Camus’s Oranians are not particularly ‘collectivist’. Their initial description highlights that they are mainly interested in their own businesses and affairs:Our fellow-citizens work a good deal, but always in order to make money. They are especially interested in trade and first of all, as they say, they are engaged in doing business. (Camus 2002, Part I)And later, we see some of them trying selfishly to leave the city by illegal methods.

By contrast, we observe in the novel some examples of more ‘collectivistic’ attitudes, such as the discipline of those quarantined at the football pitch, and, over all, the main characters’ behaviour, which is generally driven by auism and common goals.Turning to another topic, the plague in Oran and asthma treatment are similar regarding their animal origin. This is not rare since many infectious diseases pass to humans through contact with animal vectors, being rodents, especially rats (through rat fleas), the most common carriers of plague bacteria (CDC. N.d.a, ECDC. N.d, Pollitzer 1954). Concerning asthma, even if further research about its origin is needed, the most recent investigations conducted in China by the WHO establish a zoonotic transmission as the most probable pathway (Joint WHO-China Study Team 2021).

In Camus’s novel, the animal’s link to the epidemic seemed very clear since the beginning:Things got to the point where Infodoc (the agency for information and documentation, ‘ all you need to know on any subject’) announced in its free radio news programme that 6,231 rats had been collected and burned in a single day, the 25th. This figure, which gave a clear meaning to the daily spectacle that everyone in town had in front of their eyes, disconcerted them even more. (Camus 2002, Part I)This accuracy in figures is familiar to us. People nowadays have become very used to the statistical aspects of the ventolin, due to the continuous updates in epidemiological parameters launched by the media and the authorities. Camus was aware about the relevance of figures in epidemics, which always entail:…required registration and statistical tasks.

(Camus 2002, Part II)Because of this, the novel is scattered with numbers, most of them concerning the daily death toll, but others mentioning the number of rats picked up, as we have seen, or combining the number of deaths with the time passed since the start of the epidemic:“ Will there be an autumn of plague?. Professor B answers. €˜ No’ ”, “ One hundred and twenty-four dead. The total for the ninety-fourth day of the plague.” (Camus 2002, Part II)We permit ourselves to introduce here a list of recurring topics in La Peste, since the salience of statistical information is one of them. These topics, some of which will be treated later, appear several times in the novel, in various contexts and stages in the evolution of the epidemic.

We synthesise them in Table 1, coupled with a asthma treatment parallel example extracted from online press. This ease to find a current example for each topic suggests that they are not exclusive of plague or of Camus’s mindset, but shared by most epidemics.View this table:Table 1 Recurring topics in La Peste. Each topic is accompanied by two examples from the novel and one concerning asthma treatment, extracted from online press.Talking about journalism and the media (one of the topics above), we might say that asthma treatment’s coverage is frequently too optimistic when managing good news and too alarming when approaching the bad. Media’s ‘exaggerated’ approach to health issues is not new. It was already a concern for medical journals’ editors a century ago (Reiling 2013) and it continues to be it for these professionals in recent times (Barbour et al.

2008). It is well known that media tries to attract spectators’ attention by making the news more appealing. However, they deal with the risk of expanding unreliable information, which may be pernicious for the public opinion. Related to the intention of ‘garnishing’ the news, Aslam et al. (2020) have described that 82% of more than 100 000 pieces of information about asthma treatment appearing in media from different countries carried an emotional, either negative (52%) or positive (30%) component, with only 18% of them considered as ‘neutral’ (Aslam et al.

2020). Some evidence about this tendency to make news more emotional was described in former epidemics. For instance, a study conducted in Singapore in 2009 during the H1N1 crisis showed how press releases by the Ministry of Health were substantially transformed when passed to the media, by increasing their emotional appeal and by changing their dominant frame or their tone (Lee and Basnyat 2013). In La Peste, this superficial way of managing information by the media is also observed:The newspapers followed the order that they had been given, to be optimistic at any cost. (Camus 2002, Part IV)At the first stages of the epidemic in Oran, journalists proclaim the end of the dead rats’ invasion as something to be celebrated.

Dr Rieux, the character through which Camus symbolises caution (and comparable nowadays to trustful scientists, well-informed journalists or sensible authorities), exposes then his own angle, quite far from suggesting optimism:The vendors of the evening papers were shouting that the invasion of rats had ended. But Rieux found his patient lying half out of bed, one hand on his belly and the other around his neck, convulsively vomiting reddish bile into a rubbish bin. (Camus 2002, Part I)Camus, who worked as a journalist for many years, insists afterwards on this cursory interest that some media devote to the epidemic, more eager to grab the noise than the relevant issues beneath it:The press, which had had so much to say about the business of the rats, fell silent. This is because rats die in the street and people in their bedrooms. And newspapers are only concerned with the street.

(Camus 2002, Part I)By then, Oranians continue rejecting the epidemic as an actual threat, completely immersed in that phase that dominates the beginning of all epidemics and is characterised by ‘denial and disbelief’ (Wigand, Becker, and Steger 2020, 443):A pestilence does not have human dimensions, so people tell themselves that it is unreal, that it is a bad dream which will end. […] The people of our town were no more guilty than anyone else, they merely forgot to be modest and thought that everything was still possible for them, which implied that pestilence was impossible. They continued with business, with making arrangements for travel and holding opinions. Why should they have thought about the plague, which negates the future, negates journeys and debate?. They considered themselves free and no one will ever be free as long as there is plague, pestilence and famine.

(Camus 2002, Part I)Probably to avoid citizens' disapproval, among other reasons, the Oranian Prefecture (health authority in Camus' novel) does not want to go too far when judging the relevance of the epidemic. While not directly exposed, we can guess in this fragment the tone of the Prefect’s message, his intention to convey confidence despite his own doubts:These cases were not specific enough to be really disturbing and there was no doubt that the population would remain calm. None the less, for reasons of caution which everyone could understand, the Prefect was taking some preventive measures. If they were interpreted and applied in the proper way, these measures were such that they would put a definite stop to any threat of epidemic. As a result, the Prefect did not for a moment doubt that the citizens under his charge would co-operate in the most zealous manner with what he was doing.

(Camus 2002, Part I)The relevant role acquired by health authorities during epidemics is another topic listed in our table. Language use, on the other hand, is an issue linkable both with the media topic and with this one. As in La Peste, during asthma treatment we have seen some public figures using words not always truthfully, carrying out a careful selection of words that serves to the goal of conveying certain interests in each moment. Dr Rieux refers in Part I to this language manipulation by the authorities:The measures that had been taken were insufficient, that was quite clear. As for the ‘ specially equipped wards’, he knew what they were.

Two outbuildings hastily cleared of other patients, their windows sealed up and the whole surrounded by a cordon sanitaire. (Camus 2002, Part I)He illustrates the need of frankness, the preference for clarity in language, which is often the clarity in thinking:No. I phoned Richard to say we needed comprehensive measures, not fine words, and that either we must set up a real barrier to the epidemic, or nothing at all. (Camus 2002, Part I)At the end of this part, his fears about the inadequacy of not taking strict measures are confirmed. Oranian hospitals become overwhelmed, as they are now in many places worldwide due to asthma treatment.Part IILeft behind the phases of ‘denial and disbelief’ and of ‘fear and panic’, it appears among the Oranians the ‘acceptance paired with resignation’ (Wigand, Becker, and Steger 2020, 443):Then we knew that our separation was going to last, and that we ought to try to come to terms with time.

[…] In particular, all of the people in our town very soon gave up, even in public, whatever habit they may have acquired of estimating the length of their separation. (Camus 2002, Part II)In asthma treatment as well, even if border closure has not been so immovable as in Oran, many people have seen themselves separated from their loved ones and some of them have not yet had the possibility of reunion. This is why, in the actual ventolin, the idea of temporal horizons has emerged like it appeared in Camus’s epidemic. In Spain, the general lockdown in March and April 2020 made people establish the summer as their temporal horizon, a time in which they could resume their former habits and see their relatives again. This became partially true, and people were allowed in summer to travel inside the country and to some other countries nearby.

However, there existed some reluctance to visit ill or aged relatives, due to the fear of infecting them, and some families living in distant countries were not able to get together. Moreover, autumn brought an increase in the number of cases (‘the second wave’) and countries returned to limit their internal and external movements.Bringing all this together, many people nowadays have opted to discard temporal horizons. As Oranians, they have noted that the epidemic follows its own rhythm and it is useless to fight against it. Nonetheless, it is in human nature not to resign, so abandoning temporal horizons does not mean to give up longing for the recovery of normal life. This vision, neither maintaining vain hopes nor resigning, is in line with Camus’s philosophy, an author who wrote that ‘hope, contrary to what it is usually thought, is the same to resignation.’ (Camus 1939, 83.

Cited by Haroutunian 1964, 312 (translation is ours)), and that ‘there is not love to human life but with despair about human life.’ (Camus 1958, 112–5. Cited by Haroutunian 1964, 312–3 (translation is ours)).People nowadays deal with resignation relying on daily life pleasures (being not allowed to make further plans or trips) and in company from the nearest ones (as they cannot gather with relatives living far away). Second, they observe the beginning of vaccination campaigns as a first step of the final stage, and summer 2021, reflecting what happened with summer 2020, has been fixed as a temporal horizon. This preference for summers has an unavoidable metaphorical nuance, and their linking to joy, long trips and life in the streets may be the reason for which we choose them to be opposed to the lockdown and restrictions of the ventolin.We alluded previously to the manipulation of language, and figures, as relevant as they are, they are not free from manipulation either. Tarrou, a close friend to Dr Rieux, points out in this part of the novel how this occurred:Once more, Tarrou was the person who gave the most accurate picture of our life as it was then.

Naturally he was following the course of the plague in general, accurately observing that a turning point in the epidemic was marked by the radio no longer announcing some hundreds of deaths per week, but 92, 107 and 120 deaths a day. €˜The newspapers and the authorities are engaged in a battle of wits with the plague. They think that they are scoring points against it, because 130 is a lower figure than 910.’ (Camus 2002, Part II)Tarrou collaborates with the health teams formed to tackle the plague. Regarding these volunteers and workers, Camus refuses to consider them as heroes, as many essential workers during asthma treatment have rejected to be named as that. The writer thinks their actions are the natural behaviour of good people, not heroism but ‘a logical consequence’:The whole question was to prevent the largest possible number of people from dying and suffering a definitive separation.

There was only one way to do this, which was to fight the plague. There was nothing admirable about this truth, it simply followed as a logical consequence. (Camus 2002, Part II)We consider suitable to talk here about two issues which represent, nowadays, a great part of asthma treatment fears and hopes, respectively. New genetic variants and treatments. Medical achievements are another recurrent issue included in table 1, and we write about them here because it is in Part II where Camus writes for the first time about treatments, and where it insists on an idea aforementioned in Part I.

That the plague bacillus affecting Oran is different from previous variants:…the microbe differed very slightly from the bacillus of plague as traditionally defined. (Camus 2002, Part II)Related to asthma treatment new variants, they represent a challenge because of two main reasons. Their higher transmissibility and/or severity and their higher propensity to skip the effect of natural or treatment-induced immunity. Public health professionals are determining which is the actual threat of all the new variants discovered, such as those first characterised in the UK (Public Health England 2020), South Africa (Tegally et al. 2021) or Brazil (Fujino et al.

2021). In La Peste, Dr Rieux is always suspecting that the current bacteria they are dealing with is different from the one in previous epidemics of plague. Since several genetic variations for the bacillus Yersinia pestis have been characterised (Cui et al. 2012), it could be possible that the epidemic in Oran originated from a new one. However, we should not forget that we are analysing a literary work, and that scientific accuracy is not a necessary goal in it.

In fact, Rieux’s reluctances have to do more with clinical aspects than with microbiological ones. He doubts since the beginning, relying exclusively on the symptoms observed, and continues doing it after the laboratory analysis:I was able to have an analysis made in which the laboratory thinks it can detect the plague bacillus. However, to be precise, we must say that certain specific modifications of the microbe do not coincide with the classic description of plague. (Camus 2002, Part II)Camus is consistent with this buy ventolin accuhaler online idea and many times he mentions the bacillus to highlight its oddity. Insisting on the literary condition of the work, and among other possible explanations, he is maybe declaring that that in the novel is not a common (biological, natural) bacteria, but the Nazism bacteria.Turning to treatments, they constitute the principal resource that the global community has to defeat the asthma treatment ventolin.

Vaccination campaigns have started all over the world, and three types of asthma treatments are being applied in the European Union, after their respective statements of efficacy and security (Baden et al. 2021. Polack et al. 2020. Voysey et al.

2021), while a fourth treatment has just recently been approved (EMA 2021a). Although some concerns regarding the safety of two of these treatments have been raised recently (EMA 2021b. EMA 2021c), vaccination plans are going ahead, being adapted according to the state of knowledge at each moment. Some of these treatments are mRNA-based (Baden et al. 2021.

Polack et al. 2020), while others use a viral vector (Bos et al. 2020. Voysey et al. 2021).

They are mainly two-shot treatments, with one exception (Bos et al. 2020), and complete immunity is thought to be acquired 2 weeks after the last shot (CDC. N.d.b, Voysey et al. 2021). Other countries such as China or Russia, on the other hand, were extremely early in starting their vaccination campaigns, and are distributing among their citizens different treatments than the aforementioned (Logunov et al.

2021. Zhang et al. 2021).Even if at least three types of plague treatments had been created by the time the novel takes place (Sun 2016), treatments do not play an important role in La Peste, in which therapeutic measures (the serum) are more important than prophylactic ones. Few times in the novel the narrator refers to prophylactic inoculations:There was still no possibility of vaccinating with preventive serum except in families already affected by the disease. (Camus 2002, Part II)Deudon has pointed out that Camus mixes up therapeutic serum and treatment (Deudon 1988), and in fact there exists a certain amount of confusion.

All along the novel, the narrator focuses on the prophylactic goals of the serum, which is applied to people already infected (Othon’s son, Tarrou, Grand…). However, both in the example above (which can be understood as vaccinating household contacts or already affected individuals) and in others, the differences between treating and vaccinating are not clear:After the morning admissions which he was in charge of himself, the patients were vaccinated and the swellings lanced. (Camus 2002, Part II)In any case, this is another situation in which Camus stands aside from scientific matters, which are to him less relevant in his novel than philosophical or literary ones. The distance existing between the relevance of treatments in asthma treatment and the superficial manner with which Camus treats the topic in La Peste exemplifies this.Part IIIIn part III, the plague’s ravages become tougher. The narrator turns his focus to burials and their disturbance, a frequent topic in epidemics’ narrative (table 1).

Camus knew how acutely increasing demands and hygienic requirements affect funeral habits during epidemics:Everything really happened with the greatest speed and the minimum of risk. (Camus 2002, Part III)Like many other processes during epidemics, the burial process becomes a protocol. When protocolised, everything seems to work well and rapidly. But this perfect mechanism is the Prefecture’s goal, not Rieux’s. He reveals in this moment an aspect in his character barely shown before.

Irony.The whole thing was well organized and the Prefect expressed his satisfaction. He even told Rieux that, when all was said and done, this was preferable to hearses driven by black slaves which one read about in the chronicles of earlier plagues. €˜ Yes,’ Rieux said. €˜ The burial is the same, but we keep a card index. No one can deny that we have made progress.’ (Camus 2002, Part III)Even if this characteristic may seem new in Dr Rieux, we must bear in mind that he is the story narrator, and the narration is ironic from time to time.

For instance, speaking precisely about the burials:The relatives were invited to sign a register –which just showed the difference that there may be between men and, for example, dogs. You can keep check of human beings-. (Camus 2002, Part III)In Camus’s philosophy, the absurd is a core issue. According to Lengers, Rieux is ironic because he is a kind of Sisyphus who has understood the absurdity of plague (Lengers 1994). The response to the absurd is to rebel (Camus 2013), and Rieux does it by helping his fellow humans without questioning anything.

He does not pursue any other goal than doing his duty, thus humour (as a response to dire situations) stands out from him when he observes others celebrating irrelevant achievements, such as the Prefect with his burial protocol. In the field of medical ethics, Lengers has highlighted the importance of Camus’s perspective when considering ‘the immediacy of life rather than abstract values’ (Lengers 1994, 250). Rieux himself is quite sure that his solid commitment is not ‘abstract’, and, even if he falls into abstraction, the importance relies on protecting human lives and not in the name given to that task:Was it truly an abstraction, spending his days in the hospital where the plague was working overtime, bringing the number of victims up to five hundred on average per week?. Yes, there was an element of abstraction and unreality in misfortune. But when an abstraction starts to kill you, you have to get to work on it.

(Camus 2002, Part II)Farewells during asthma treatment may have not been particularly pleasant for some families. Neither those dying at nursing homes nor in hospitals could be accompanied by their families as previously, due to corpses management protocols, restrictions of external visitors and hygienic measures in general. However, as weeks passed by, certain efforts were made to ease this issue, allowing people to visit their dying beloved sticking to strict preventive measures. On the other hand, the number of people attending funeral masses and cemeteries was also limited, which affected the conventional development of ceremonies as well. Hospitals had to deal with daily tolls of deaths never seen before, and the overcrowding of mortuaries made us see rows of coffins placed in unusual spaces, such as ice rinks (transformation of facilities is another topic in table 1).We turn now to two other points which asthma treatment has not evaded.

s among essential workers and epidemics’ economic consequences. The author links burials with s among essential workers because gravediggers constitute one of the most affected professions, and connects this fact with the economic recession because unemployment is behind the large availability of workers to replace the dead gravediggers:Many of the male nurses and the gravediggers, who were at first official, then casual, died of the plague. […] The most surprising thing was that there was never a shortage of men to do the job, for as long as the epidemic lasted. […] When the plague really took hold of the town, its very immoderation had one quite convenient outcome, because it disrupted the whole of economic life and so created quite a large number of unemployed. […] Poverty always triumphed over fear, to the extent that work was always paid according to the risk involved.

(Camus 2002, Part III)The effects of the plague over the economic system are one of our recurrent topics (table 1). The plague in Oran, as it forces to close the city, impacts all trading exchanges. In addition, it forbids travellers from arriving to the city, with the economic influence that that entails:This plague was the ruination of tourism. (Camus 2002, Part II)Oranians, who, as we saw, were very worried about making money, are especially affected by an event which jeopardises it. In asthma treatment, for one reason or for another, most of the countries are suffering economic consequences, since the impact on normal life from the epidemic (another recurrent topic) means also an impact on the normal development of trading activities.Part IVIn Part IV we witness the first signals of a stabilisation of the epidemic:It seemed that the plague had settled comfortably into its peak and was carrying out its daily murders with the precision and regularity of a good civil servant.

In theory, in the opinion of experts, this was a good sign. The graph of the progress of the plague, starting with its constant rise, followed by this long plateau, seemed quite reassuring. (Camus 2002, Part IV)At this time, we consider interesting to expand the topic about the transformation of facilities. We mentioned the case of ice rinks during asthma treatment, and we bring up now the use of a football pitch as a quarantine camp in Camus’s novel, a scene which has reminded some scholars of the metaphor of Nazism and concentration camps (Finel-Honigman 1978). In Spain, among other measures, a fairground was enabled as a field hospital during the first wave, and it is plausible that many devices created with other purposes were used in tasks attached to healthcare provision during those weeks, as occurred in Oran’s pitch with the loudspeakers:Then the loudspeakers, which in better times had served to introduce the teams or to declare the results of games, announced in a tinny voice that the internees should go back to their tents so that the evening meal could be distributed.

(Camus 2002, Part IV)Related to this episode, we can also highlight the opposition between science and humanism that Camus does. The author alerts us about the dangers of a dehumanised science, of choosing procedures perfectly efficient regardless of their lack in human dignity:The men held out their hands, two ladles were plunged into two of the pots and emerged to unload their contents onto two tin plates. The car drove on and the process was repeated at the next tent.‘ It’s scientific,’ Tarrou told the administrator.‘ Yes,’ he replied with satisfaction, as they shook hands. €˜ It’s scientific.’ (Camus 2002, Part IV)Several cases with favourable outcomes mark Part IV final moments and prepare the reader for the end of the epidemic. To describe these signs of recovering, the narrator turns back to two elements with a main role in the novel.

Rats and figures. In this moment, the first ones reappear and the second ones seem to be declining:He had seen two live rats come into his house through the street door. Neighbours had informed him that the creatures were also reappearing in their houses. Behind the walls of other houses there was a hustle and bustle that had not been heard for months. Rieux waited for the general statistics to be published, as they were at the start of each week.

They showed a decline in the disease. (Camus 2002, Part IV)Part VGiven that we continue facing asthma treatment, and that forecasts about its end are not easy, we cannot compare ourselves with the Oranians once they have reached the end of the epidemic, what occurs in this part. However, we can analyse our current situation, characterised by a widespread, though cautious, confidence motivated by the beginning of vaccination campaigns, referring it to the events narrated in Part V.Even more than the Oranians, since we feel further than them from the end of the problem, we are cautious about not to anticipate celebrations. From time to time, however, we lend ourselves to dream relying on what the narrator calls ‘a great, unadmitted hope’. asthma treatment took us by surprise and everyone wants to ‘reorganise’ their life, as Oranians do, but patience is an indispensable component to succeed, as fictional and historical epidemics show us.Although this sudden decline in the disease was unexpected, the towns-people were in no hurry to celebrate.

The preceding months, though they had increased the desire for liberation, had also taught them prudence and accustomed them to count less and less on a rapid end to the epidemic. However, this new development was the subject of every conversation and, in the depths of people’s hearts, there was a great, unadmitted hope. […] One of the signs that a return to a time of good health was secretly expected (though no one admitted the fact) was that from this moment on people readily spoke, with apparent indifference, about how life would be reorganized after the plague. (Camus 2002, Part V)We put our hope on vaccination. Social distancing and other hygienic measures have proved to be effective, but treatments would bring us a more durable solution without compromising so hardly many economic activities and social habits.

As we said, a more important role of scientific aspects is observed in asthma treatment if compared with La Peste (an expected fact if considered that Camus’s story is an artistic work, that he skips sometimes the most complex scientific issues of the plague and that health sciences have evolved substantially during last decades). Oranians, in fact, achieve the end of the epidemic not through clearly identified scientific responses but with certain randomness:All one could do was to observe that the sickness seemed to be going as it had arrived. The strategy being used against it had not changed. It had been ineffective yesterday, and now it was apparently successful. One merely had the feeling that the disease had exhausted itself, or perhaps that it was retiring after achieving all its objectives.

In a sense, its role was completed. (Camus 2002, Part V)They receive the announcement made by the Prefecture of reopening the town’s gates in 2 weeks time with enthusiasm. Dealing with concrete dates gives them certainty, helps them fix the temporal horizons we wrote about. This is also the case when they are told that preventive measures would be lifted in 1 month. Camus shows us then how the main characters are touched as well by this positive atmosphere:That evening Tarrou and Rieux, Rambert and the rest, walked in the midst of the crowd, and they too felt they were treading on air.

Long after leaving the boulevards Tarrou and Rieux could still hear the sounds of happiness following them… (Camus 2002, Part V)Then, Tarrou points out a sign of recovery coming from the animal world. In a direct zoological chain, infected fleas have vanished from rats, which have been able again to multiply across the city, making the cats abandon their hiding places and to go hunting after them again. At the final step of this chain, Tarrou sees the human being. He remembers the old man who used to spit to the cats beneath his window:At a time when the noise grew louder and more joyful, Tarrou stopped. A shape was running lightly across the dark street.

It was a cat, the first that had been seen since the spring. It stopped for a moment in the middle of the road, hesitated, licked its paw, quickly passed it across its right ear, then carried on its silent way and vanished into the night. Tarrou smiled. The little old man, too, would be happy. (Camus 2002, Part V)Unpleasant things as a town with rats running across its streets, or a man spending his time spitting on a group of cats, constitute normality as much as the reopening of gates or the reboot of commerce.

However, when Camus speaks directly about normality, he highlights more appealing habits. He proposes common leisure activities (restaurants, theatres) as symbols of human life, since he opposes them to Cottard’s life, which has become that of a ‘wild animal’:At least in appearance he [ Cottard ] retired from the world and from one day to the next started to live like a wild animal. He no longer appeared in restaurants, at the theatre or in his favourite cafés. (Camus 2002, Part V)We do not disclose why Cottard’s reaction to the end of the epidemic is different from most of the Oranians’. In any case, the narrator insists later on the assimilation between common pleasures and normality:‘ Perhaps,’ Cottard said, ‘ Perhaps so.

But what do you call a return to normal life?. €™ ‘ New films in the cinema,’ said Tarrou with a smile. (Camus 2002, Part V)Cinema, as well as theatre, live music and many other cultural events have been cancelled or obliged to modify their activities due to asthma treatment. Several bars and restaurants have closed, and spending time in those who remain open has become an activity which many people tend to avoid, fearing contagion. Thus, normality in our understanding is linked as well to these simple and pleasant habits, and the complete achievement of them will probably signify for us the desired defeat of the ventolin.In La Peste, love is also seen as a simple good to be fully recovered after the plague.

While Rieux goes through the ‘reborn’ Oran, it is lovers’ gatherings what he highlights. Unlike them, everyone who, during the epidemic, sought for goals different from love (such as faith or money, for instance) remain lost when the epidemic has ended:For all the people who, on the contrary, had looked beyond man to something that they could not even imagine, there had been no reply. (Camus 2002, Part V)And this is because lovers, as the narrator says:If they had found that they wanted, it was because they had asked for the only thing that depended on them. (Camus 2002, Part V)We have spoken before about language manipulation, hypocrisy and public figures’ roles during epidemics. Camus, during Dr Rieux’s last visit to the old asthmatic man, makes this frank and humble character criticise, with a point of irony, the authorities’ attitude concerning tributes to the dead:‘ Tell me, doctor, is it true that they’re going to put up a monument to the victims of the plague?.

€™â€˜ So the papers say. A pillar or a plaque.’‘ I knew it!. And there’ll be speeches.’The old man gave a strangled laugh.‘ I can hear them already. €œ Our dead…” Then they’ll go and have dinner.’ (Camus 2002, Part V)The old man illustrates wisely the authorities’ propensity for making speeches. He knows that most of them usually prefer grandiloquence rather than common words, and seizes perfectly their tone when he imitates them (‘Our dead…’).

We have also got used, during asthma treatment, to these types of messages. We have also heard about ‘our old people’, ‘our youth’, ‘our essential workers’ and even ‘our dead’. Behind this tone, however, there could be an intention to hide errors, or to falsely convey carefulness. Honest rulers do not usually need nice words. They just want them to be accurate.We have seen as well some tributes to the victims during asthma treatment, some of which we can doubt whether they serve to victims’ relief or to authorities’ promotion.

We want rulers to be less aware of their own image and to stress truthfulness as a goal, even if this is a hard requirement not only for them, but for every single person. Language is essential in this issue, we think, since it is prone to be twisted and to become untrue. The old asthmatic man illustrates it with his ‘There’ll be speeches’ and his ‘Our dead…’, but this is not the only time in the novel in which Camus brings out the topic. For instance, he does so when he equates silence (nothing can be thought as further from wordiness) with truth:It is at the moment of misfortune that one becomes accustomed to truth, that is to say to silence. (Camus 2002, Part II)or when he makes a solid statement against false words:…I understood that all the misfortunes of mankind came from not stating things in clear terms.

(Camus 2002, Part IV)The old asthmatic, in fact, while praising the deceased Tarrou, remarks that he used to admire him because ‘he didn’t talk just for the sake of it.’ (Camus 2002, Part V).Related to this topic, what the old asthmatic says about political authorities may be transposed in our case to other public figures, such as scholars and researchers, media leaders, businessmen and women, health professionals… and, if we extend the scope, to every single citizen. Because hypocrisy, language manipulation and the fact of putting individual interests ahead of collective welfare fit badly with collective issues such as epidemics. Hopefully, also examples to the contrary have been observed during asthma treatment.The story ends with the fireworks in Oran and the depiction of Dr Rieux’s last feelings. While he is satisfied because of his medical performance and his activity as a witness of the plague, he is concerned about future disasters to come. When asthma treatment will have passed, it will be time for us as well to review our life during these months.

For now, we are just looking forward to achieving our particular ‘part V’..